Nights

Darwin is such a crazy place to work - I already knew that before I started, but the reality is just starting to sink in now.

The hospital itself is sort of old, and perhaps I'm a bit biased since I've only worked at night, but the wards just seem semi run down. One night I felt like I walked into an orphanage, with a ring of what looked like steel cots in the dim light. I've also seen a few cockroaches around the place, and a lot of ants.. Run-down-ness aside, I went to an arrest in the middle of the night where the ward had no arrest trolley or ECG machine, and all that was available was oxygen and a cannula trolley. That was a rude shock to the system!

The wards are certainly not the flashiest, but the medicine is so much more interesting than in the Eastern states. The complexity of medicine here is not yet entirely revealed to me, but already I can see so many challenges. Language is a huge problem, and often patients will either speak little or no English, relying on gestures and interpreting from family members to get their story across. Never in my working life have I adapted my speech to such a basic functional level, but it just shows that sometimes complicated words are not actually essential.

The cultural differences are also quite evident - the Indigenous population have a very different attitude towards doctors, hospitals and medicine in general. Often the patients are guarded and reserved, not really wanting to talk much. Open questions get nowhere and closed questions bring answers that are not entirely convincing. Especially at night, patients don't respond well to being woken up and some refuse to be woken up altogether. I had one woman who refused to talk to me, and just pulled the sheet over her head. What do you do with that? I guess I just ended up walking away and coming back later.

And then there are the absconders, and those who leave against medical advice. I was lucky there were only 3 absconded re-admissions in my week, all of whom left the hospital to go drinking with their buddies and eventually got brought back from the gutter. When I re-admitted one of them, he punched a wardsman on his way up to the ward and ended up sleeping off the grog in ED the rest of the night.

All of that aside, medically I had an extremely interesting week, where I saw some amazing cases that I had never thought of. I'll write some down, so that one day I can look back upon this list of very first "firsts" (probably when I'm back in Sydney) and think ahhh, those were the days.

.. a woman with a loculated breast abscess (for which she had been partially treated multiple times but kept absconding from antibiotics), which made one breast four times the size of the other
.. a white cell count of 690
.. a woman with sick sinus syndrome who kept having asystolic periods in ED lasting up to 30 seconds
.. an entry in the notes by the ICU team treating a patient with K 1.4 - patient given 100mmol IV KCl and 8 bananas
.. patient ineligible for home oxygen until he stops long-grassing (no fixed address)
.. several whiteouts and one bilateral whiteout
.. the first cerebellar syndrome I ever diagnosed in a woman with a orange sized lung cancer
.. man with nephrotic syndrome
.. man, apparently allergic to cocaine
.. pemphigus vulgaris (only ever seen in books before)
.. rheumatic fever
.. patient who had to be retrieved from the pub because he couldn't wait for his Troponin to come back
.. 2 new PEs, one with a new R bundle branch block and one with S1Q3T3

Some nights were ok but most were really busy. Overall the patients were sicker, more complicated and had more chronic disease. It was shocking to see people in such poor states of health in their 20s and 30s, and it provoked much thought - end stage renal failure from diabetes in one's 30s? It seems insane, but that is the reality of life here.

After this week of nights, I am tired but excited about the future - the rest of the year is going to be really interesting, and so far, I'm pretty glad I moved up here. It's going to be an awesome year of medicine!