Daytrip to Noumea

One morning during the ward round, my boss showed me an email written in strange English about a patient in Noumea with severe ARDS. Asked what my thoughts were, I answered I think she needs ECMO! and was told that that was indeed the plan. I asked if I could tag along, not really expecting that it would really happen – after all I am supposed to be at work looking after patients! But the next thing I knew, the head honcho of cardiac anaesthesia had organised a seat for me on the retrieval plane.

So on this sunny afternoon, we stood outside RPA waiting for a taxi with our dark green ECMO bags (2 large duffles and 2 square bags, one of which contained the precious Maquet Cardiohelp machine). The whole setup was surprisingly compact and light, and as the surgeon would later remark, we can put someone on ECMO in the supermarket!

We went the backway through the taxi driver hangouts of Alexandria to the private part of Sydney airport, adjacent to the domestic terminal. Our terminal was a fancy building with hippy paintings, plush leather couches, fancy coffee machine and plentiful glossy magazines. Aesop handwash in the bathroom – what planet am I on? I thought. As we waited for everyone to arrive, domestic jets landed on the tarmac right in front of our noses. 

We boarded our Learjet 55, which was a vast improvement on the smaller Learjet 36 that we used to fly around NT in. The aircraft was relatively spacious and well set up with the removal of 2 seats to accommodate the stretcher. The cardiac anaesthetist, surgeon and I occupied the back pod of 4 seats along with our giant oxygen bottle. The temperature was regulated (no more teeth chattering at altitude) and the stability of the aircraft during takeoff and landing was excellent. There was even a little pulldown service area where one could have a hot drink and some snacks from the mini oven! It was pretty damn luxurious compared to my previous experiences with small planes in Darwin.

The others slept but I was too excited to sleep, and ended up chatting with the co-pilot and the Careflight nurse most of the way. We watched the sun set, gliding through the thick cloud layer, scattering orange rays everywhere. 

As the light faded, we descended through myriad layers of cloud moving in different directions, finally landing in Noumea to light sprinkling rain. 

The police met us on the tarmac and we filled out forms by the dim light of the ambulance that had come to fetch us. It was the first time I was stamped both in and out of the country at the same time! They obviously weren’t worried about us overstaying.

The ambulance was positively ancient, the back piled with equipment that did not fill us with confidence. The cervical collars looked like they’d been reused hundreds of times, dirty packets of gauze and grubby looking bottles of fluids lined the shelves. From where we sat on a ricketty bench we could hardly see outside as we drove the 40 minutes from the airport to Gaston Bourret hospital.

I saw a Bingo! Parlour sign as we pulled into the hospital street and wondered if that was a popular form of entertainment in New Caledonia. Then we were there, stumbling out onto the footpath at the front entrance. We loaded our bags onto a discarded hospital bed which didn’t have any functioning steering, brakes or sides. A petite woman managed to help us wheel this into ICU Service de Reanimation which I thought was such an apt name for ICU.

The ICU was brightly lit, sparkling clean and full of modern equipment – it would put many Australian hospitals to shame. The nurses and doctors were dressed in white scrubs and this did indeed make them stand out as the health care professionals – I really liked it!

We visited the patient along with the French intensivist on duty. We looked at the ventilator, infusions, blood tests and X-rays just as we would do at home, then a few phone calls were made and we decided to hold off putting the patient on ECMO for the time being. The pilots have specific rules about how long they can work before they need to have a mandatory rest, so by our calculations we could have two hours to observe the patient and make sure our decision was correct. 

What else to do but dinner? The French intensivist generously offered his car, which we promptly drove onto the wrong side of the road. Just as well there was hardly anyone out on a weeknight at 8pm, and everything seemed to be shut including the supermarket! We went to a waterfront restaurant, ate some super fresh fish, drank Perrier, and chatted about how this would be the most expensive dinner any of us would ever have (imagine, a private flight to New Caledonia just for dinner!)

Back at the hospital, we confirmed the patient was not deteriorating and packed our bags to leave. I was surprised that the intensivist was still on duty, and he told me they usually have no registrars! They have one at the moment, so one of the ten lucky intensivists get to be on-call with a registrar but she doesn’t do on-call by herself. Seems like a pretty tough life, but I guess it’s only 5 nights a month and the patients are getting the best standard of care. Just walking past the rooms, it seemed like the disease acuity in the 10-bed Service de Reanimation was pretty high – almost everyone was ventilated, and about half on dialysis. It’s apparently so busy that their 12-bed HDU mostly serves as a second ICU. 

On the way back to the airport, I sat in the front of the ambulance with the solid Melanesian ambo who looked like he could defeat anyone by sitting on them. The freeway was straight and featureless, I felt deplete of adrenaline and quite drowsy. I slept for some of the three hour flight back, waking up occasionally to see a perfect semi-lunar moon shining brightly above our heads like a street lamp. The field of stars was  simply incredible as we were flying above the cloud layer. We were so close to them that it was like we could reach out and touch them, yet they stretched so far beyond our fields of vision that they were infinite.

It was freezing in Sydney when we landed, and the customs officers looked as exhausted as we were. We lugged the gear back to the perfusion office, and I crawled into bed at 3am finally. And that was that, the end of our Noumean adventure. I had thought excitedly on the way to Noumea – in the years to come I will always remember this, my first retrieval mission. Even though we didn’t bring back the patient, I think I still will remember this day as when my love for retrieval was re-ignited. Now I’m certain I have to do some real retrievals!

Food: April & May

An impromptu lunch from a healthy eating stall at Eveleigh markets - roast vegetable tart, broccoli & feta quiche, and a yummy gluten-free banana bread. You know you are in Sydney when everything is delicious, tiny and pricey!

 

Salad Banh Mi from Marrickville Pork Roll. Not as good as a "real" pork roll, but pretty damn good. Especially love that pickled daikon, coriander and chilli.

An excellent breakfast at Element 6 in West Ryde. Baked eggs with chickpea and haloumi, topped by coriander relish and sprinkled with zaatar. The pillowy pita bread was just perfect to scoop up this spicy concoction, and I absolutely adored the double coriander flavour of roast coriander seeds used in the stew and the vibrant coriander relish on top.

Vegetarian eggs benedict from Thyme Square in Hornsby. This was pretty tasty - roast eggplant, zuccini and sweet potato atop good toast, a couple of well poached eggs and a solid hollandaise. Shame service was terrible though.

 Behold the new equivalent of the original cheeseburger that S and I used to eat all the time at Cafe Giulia. This is an amazing toasted bagel with avocado, tomato and haloumi. Really hits the spot along with one of their awesome juices.

Isn't this pretty as a picture? This is called "the most amazing vegan salad" at In the Annex which was pretty damn amazing. Chickpeas sit atop a bed of garlic hummus, topped by slivers of baby carrots and radish. The whole thing is bound together by a very mild chilli dressing and sprinkles of zaatar. Home made bread made the perfect scoop for this. If all food was this amazing, end.

Fleetwood Macchiato in Erskineville is one busy place, we waited over an hour for a table! These perfectly poached eggs were served with a softly-softly pickled eggplant, slivers of celery & fennel and topped with roasted almonds. Sounds like a strange combination, but the combined flavours were heavenly. The bread by the Bread & Butter project was also incredible, I could just eat that alone.

Now, it's hard for me to have a food post without some ramen. It's hard to eat ramen as a vegetarian - this beautiful one is from Gumshara but after picking out all the pork and dunking half a bowl of chilli pickled veg in it, I did feel like I was eating pickle ramen. 

Enter the solution. Rising Sun workshop in Newtown is a ramen popup bar which repairs motorcycles, and serves ramen too. They have three simple options - the Dark (pork), the Light (chicken? fish? can't remember) and the Monk (vegetarian). The vegetarian broth is amazing, and the first time I tried it I had to ask if it really was vegetarian. Apparently they have been throwing kilos of shiitake mushrooms in there, along with whole roasted bulbs of garlic and onion. The condiments are quite traditional - seaweed, bamboo, shallots. Each bowl is served with a slab of miso-roasted eggplant and half an egg (I was there with 2 non-egg eaters so I got all their eggs!).

 

This place is utterly amazing for vegetarians. 

A lake in Addis, and a plane crash

A beautiful lake in Addis 
(I looked on Google maps, and there is no such lake..)

In this dream, Papaya is working for a NGO in Ethiopia and has moved to Addis. She's renting a house with 3 other NGO workers who all seem young and funky, of the hippie idealistic type. We are all sitting around in the living room chatting and smoking, the dark space filled with the earthy smell of smoke. Her housemates suggest that we go to a lake near Addis, which they rave wonders about. They are amazed that neither of us have visited, and say that it is the most amazing sight in all of Ethiopia.

The next day we set out to bike to the lake. Perhaps true to the fact that I can't ride a bike in real life, I get stuck about halfway to the lake and my legs won't move anymore. We are on the side of a relatively empty highway, so we ditch my bike and I hitch a ride on the back of Papaya's bike.

When we arrive at the lake it is an utterly majestic sight. The water is a royal blue, so clear that one can see the bottom and all the little fish swimming in the lake. It stretches as far as the eye can see, resembling an inland sea. There is hardly any vegetation around the lake, and the water is so still the surface shimmers like a diamond. We dip our toes in and the water is cold - I realise that the weather is quite cold at this moment in time. We sit down on the rocks by the lakeshore and have a picnic. I am struck by how there are no other people at the lake, locals or tourists.

When we decide to go back to Addis, Papaya suggests that we take the "back way" which she says will be faster. First we ride through desert-like landscape, dry and arid, dotted with little shrubs. Then we get to a farming area where we plough through the narrow paths that farmers have made in between fields. Finally we encounter a really muddy stretch where the dust road has been flooded time and again. In this part, trucks suddenly appear out of nowhere and splatter us with mud as we ride past.

We get back to Addis and it's 4:30pm. Dirty and weary, we drag ourselves into Papaya's house and collapse on the couch. Neither of us can get up except to fetch some Diet Coke. As we sip it (so refreshing after a long tiring ride!), Papaya suddenly says, you know this is why there is so much cancer in the world.

What do you mean? I ask, puzzled by her random comment.
Diet coke is the reason for all the cancer in the world. She says, looking rather solemn. I'm so glad you've come to help me spread the message all around Ethiopia, we will start tomorrow.

Awww.. I think in my head. I thought I was here for a holiday!

Then I woke up.


A plane crash
In this dream I am living in an apartment on the 9th floor with my dad and grandma. Outside there are many other apartment buildings, and the landscape is unidentifiable. We are sitting in the living room which faces out of a very large glass window.

I am looking through the window when I suddenly notice that there is a plane approaching the area very rapidly. It is flying so low down that I can read Air France on its side. Lurching wildly, it appears to be dropping altitude quickly then cruising for a few seconds, then dropping again. I am gripped by a nauseous sense of fear in the pit of my stomach, and I stand up to get a closer look.

As I approach the window I see the plane come closer and closer to our building. Then it disappears from view and I realise it has just skimmed the top of our building. I turn around to see if I can see it from a different window, then I hear a huge explosion which is loud beyond description.

The world turns white. All noise disappears momentarily.

Then there is a high pitched buzzing sound in my ears, which I instinctively know is a leftover effect from the massive noise of the crash. The air seems to be vibrating and it's almost as if I can touch the soundwaves. I am crouched on the ground along with my family, and I have a little laugh at myself as if to say - how does crouching on the ground help if a plane crashes into our building?

The buzz subsides slowly and I help my grandma to her feet. Nothing is damaged in our apartment and we all sit down in our chairs again. I notice that there's an obs machine in the living room and I decide to do my own observations. When I put the Sats probe on, my heart rate reads 150 and there's no oxygen saturation. I put the blood pressure cuff on and I can't get it to read the first 3 times, even though it inflates so much my arm starts to go numb.

I must be really stressed from this. I think to myself. But that's funny, I don't feel stressed.

The BP finally reads 190/  and the diastolic remains empty. I stand up and look out the window again. There is a huge crater where the building opposite ours was, and I strain to see if there are any parts of the plane I can see.

Then I wake up