Being A Tourist

This city is just plain amazing. I love it, love it, love it. It's crazy hot, it's humid, but it's fantastic.

Today was my first proper "I'm going to be a tourist" day here. I had my recommendations (French Quarter, French Quarter, French Quarter), I had my map, and I was wearing sensible shoes. Oh, and being environmentally conscious, I had a handbag AND a shopping bag. Go me, saving the planet.

So I got onto the streetcar ($1.25 - EXACT change, please, thankyou ma'am), and spent a lovely hour travelling downtown in the already unbelievable heat. Incidentally, I've been getting it wrong - the US has been hitting the FORTIES for heat.

Arriving on Canal St, I grabbed some batteries for the camera (how prepared I was, right?), and started walking to the French Quarter when I saw... Basin St. The street. One of the main reasons for coming to NOLA, thanks to the song "Basin St Blues". Wow.

Anyway! Straight on to Cafe du Monde - the cafe in NOLA - for Cafe au lait and beignets (ben-yays) - squarish puffy donuts loaded with sugar. Yummy scrummy but overly filling. Then some shopping; there are a LOT of shops filled with, um, touristy stuff. T-shirts saying "I got Bourbon-ed on Smash St", "I drove my chevy to the levee but the levee was gone", and so on. And a lot of Creole/Cajun spices.

So I shopped... in the still insane heat. What hits you is that inside is all airconditioned, so you feel like you've been whacked over the head with a pan when you step outside. HOT.

I found the most amazing 2nd hand bookshop, ever. It was huge. Unbelievably so. And crammed full of books, with a great owner who was so helpful and friendly...and had visited Bath before, madness. So I bought a lot of books (and would have bought more, except for stupid luggage allowance on the plane, grr).

Then lunch. Now, I was stupidly hot, I really was. But I had been told about a restaurant that I had to try, so despite the lack of hunger and abundance of sweating, I set off to find "jonny's po-boys". Po-boys are huge sandwiches, stuffed with food, and unbelievably good. And the restaurant are happy to wrap what you can't eat for later. Yum yum yum. BBQ beef po'boy. Wow.

After lunch, my first sight of the mighty Mississippi (Spelt right!). It's huge. But a lot grubbier than you think. And it makes the surrounding area cooler. So I was more than happy there. It was fantastic. h

Back to Canal St, and finally I bought my camera! I had been looking for a long time, and was thinking of an SLR, but bought instead a Sony DSC-H50, which is beautiful and fantastic and wonderful. So very fitting for a camera from N'Orleans.

By 4, I was exhausted, and VERY hot and sweaty. So I headed back, collapsed for a bit, showered and played with the camera.

Tea was... interesting... my first ever crab. Now, I dislike fish. I am unsure about seafood, but the rule is "try everything once". So crab (fresh in it's shell) it was. Peggy helped me get into it, and I tried it. My final assessment was that it would be good in something like paella. But alone... I'm not entirely sold on it. But I ate crab. And we should all be impressed & proud.

Then, that evening, we went for a ferry ride across the Mississippi. It was stunning, the town lit up across the water, the cool(ish) breeze. Wonderful.

Oh, and last night, LSU WON!!!! A fantastic ballgame, very exciting stuff. And I had my first every "Snowball"... finely crushed ice with syrup on it, mmmmmmmmmmmm. Lemon-lime. Mmmmmmmmmm. I LOVE ice.

Tomorrow... more shopping... and packing...

Musings upon the subject of commercials.

I like to think of myself as a fairly open-minded, unshockable person. The line most doctors use is “I’ve heard it/seen it all before”. Even if this is not strictly true, there are many things we are told that may… surprise.

However, I found out today that there are limits to my tolerance, namely certain commercials. Note they are being called commercials because they are undoubtedly an American phenomenon which I have not come across elsewhere.

Whilst watching the news earlier – around 6pm local time – I was treated to a pair of happy, older people gallivanting across the screen. So far, so good. Unfortunately, this couple were all smiles as a result of Viagra. Yes. Viagra. The immortal line “if you experience an erection lasting more than 3 hours, consult a physician” will be haunting my dreams for a good long while.

Having seen this, I started paying attention to the other things being advertised. A myriad of commercials related to drugs in one form or another. Now, this just doesn’t happen in England, presumably because we only pay the £7.15 needed for prescriptions.

There is no point to this post, but I thought it was interesting. Something to think about while you eat your tea… slightly more appropriate than the “perky” (and I use that term after much thought) twosome I had to contemplate over my meal.

Up at 5.50, twice in a row?!?!

Yes. Yes I was. Need to be at the ER at 6.50, a ten minute drive, and need to be ready and smart beforehand. No promises, but I may never moan about going to Barrow again (that’s a lie, I will ALWAYS moan about going to Barrow!).

I love wearing scrubs though. It’s pretty challenging NOT to be bare-below-the-elbows (BBE) if you’re in scrubs, so I’m all for every doctor and student wearing them from now on. Bizarrely though, BBE doesn’t apply in America, I could have decked myself out in rings, bracelets, etc, had I so wished. I started off wearing a couple of rings, but it just felt so wrong, I had to take them off…

The other major positive for today… I appreciated the neurology rotation I’ve just finished oh-so-much. I saw a youngish patient with a history of seizures over the past few months, and was able to take a history, examine and diagnose the patient with confidence. I also discussed some of the epilepsy issues with the consultant, things I would never have known about otherwise.

I love it when what I’ve learnt has immediate relevance. It makes all the work worthwhile…

Some musings on language barriers.

One of the (admittedly multiple) reasons for choosing the USA for this elective, was, in all seriousness, because they are English-speaking, so I wouldn’t have to be trying to work and cope in another language at the same time. Oops.

While fellow students learnt Spanish medical words (l’estomacho! Phayngeo! Laryngeo! El guardo!), I merely smiled and contented myself with looking through a couple of A&E handbooks, and revising my emergency care knowledge.

Um, yes. So I turned up at the ER and my first three patients all spoke Spanish exclusively. It’s not taken long for me to 1) befriend the fantastic people who speak Spanish (a couple of the doctors and nurses) and 2) learn some important Spanish words. A typical consultation: “Hola! Mi llamo Olivia. Dolor? Si? Esta qui? Muchos? Por quito? Urinado? Sangrias?” (Hello! My name is Olivia. Pain? Yes? Where? Lots? Not a lot? Weeing? Blood?”). Which, when you think about it, is all you really need to know… ish.

But I do have an entertaining story about one of the patients who spoke Spanish with a tiny tiny bit of English. I went in with one of the other doctors, and a nurse who spoke Spanish. The patient was a teenager, and her mother was with her. We took a history, with the nurse translating, which was pretty challenging all in all… then went out to write our notes and think about what was going on. A little later, the resident I’d been following came over to us and started talking about this patient. She had a somewhat different history to us, and we asked her who’d translated for her. Hmm. Apparently, the same patient had spoken perfect English. (!!!).

The other main language difference I’ve noticed is, bizarrely, one small word. Ma’am. I have been called ma’am almost continuously. “How are you feeling today?” “not so good ma’am”. “does it hurt here?” “yes ma’am”. “Where is the bathroom, please?” “Right over there, ma’am”.

I’m all ma’am-ed out.

2 for the price of one… 2 for the price of one…

Yes indeed, you will be getting multiple entries today, mainly because the internet is having a funny old time of it, and doesn’t want to work, so I’ve been typing it up, just so I don’t forget it all, and ready to upload when I can!

So, it’s still insanely hot here, but all that is of no consequence, because I spent twelve hours in the ER, and didn’t leave the building once. I turned up (rather nervously) at 6.50, ready for handover (“rounds”), and met my lovely resident, who I intended to follow all day, not being all that familiar with what is expected from American doctors.

How wrong I was.

I was assigned to the back part of ER, or Gulf ward. This deals with medium emergencies, for example chest pain, diabetics with high blood sugar, and unfortunately a lot of genitourinary problems…

So today, I saw (in no particular order) epidydimitis, stomach pain, back pain, chest pain, hyperglycaemia, vaginal bleeding, threatened miscarriage, epiglottitis, dizziness, and the list goes on. That’s quite a lot of patients! There are 12 beds in the Gulf ward, and a lot of the time at least 75% of them are full. It’s busy, very busy.

I followed the resident or the junior doctor for the first two or three cases… and then off I went (horrifically nervous), and took my first “H&P” – history and physical exam – which needs to be quick but thorough, and the exam needs to check all the systems – heart, lungs, abdo, muscles, nerves, etc. Straight out, present to the resident, who then says “ok, so what do you think?” So I make some suggestions, and say what tests I think we could do. The exact response I got was… “ok, off you go then”. So I was ordering tests, getting consults from any and every speciality. Wow. That’s more responsibility in one day than I’ve had in three years back here!

It was fantastic though. I was actually a proper doctor all day!

What has really surprised me is the difference in tests. I’d say I sent about half my patients off for a CT scan, and they were normally gone for the test before I’d finished writing my notes. Crazy quick!

For routine tests – blood tests & urinalysis – I just had to order them and they’d be done by the (absolutely WONDERFUL) nurses. What intrigues me is that urinalysis (one of the quickest and easiest tests… just dip a test strip into some wee and check it against the chart provided) is always sent off to labs, and yet when I did a high vaginal swab, I had to go look at it under the microscope myself, which we really don’t do here.

A twelve hour day passed pretty quickly though, because you are always busy. The worst bits are when you’ve written everything up, done all your tests, and you’re just waiting results. There’s nothing you can do, and so you do end up sitting at the desk for a while, which is rubbish, and I imagine really annoying for the patients (actually, I know that it’s really annoying from being a patient in A&E!).
It got to 7pm, and we went for rounds again, handing over to the night staff. And then blessed freedom! I walked outside for my lift, and my goodness, the heat HIT me like a… thing that hits you. It was SO hot, and I had completely forgotten about it, being in the lovely, temperate ER all day.

Incidentally, LSU (Lousiana State Uni) , the university I am affiliated to for this placement, is in the finals of the college baseball championships. This doesn’t sound massively impressive, until I tell you that ESPN (the major sport channel) is covering it for about 3-4 hours a night. The final is “best of three”, and LSU are playing Texas (the reigning champs). Last night was the first game, and we were losing until the very end, when it went to extra time and we won! Tonight is the second game of three, so we either win and take the championship, or lose, and have to play tomorrow. We shall see…

First Day Blues...

Well, I say first day. I mean "orientation" although to be honest, that was plenty!

Just to get me off to a great start, I turned up at the ER... and there was a metal detector. You know, like the ones you go through at airports? Yes, them. To check for guns. Wow. You're not in the RLI any more.

So I manage to get over this, and meet the lovely resident who is to show me around, and she does - first letting me watch the trauma case that had just come in - someone hit by a pickup truck. There were more than TWENTYFIVE people in the room with him, and I can't even begin to list who exactly... but surgeons, anaesthetists, bloodbank, etc.

Not bad for 20 minutes spent in the ER.

Anyway! So I have my ID, my manual, my shift cards, and am ready to begin properly tomorrow. 7am - 7pm. Gulp.

But, because all this lasted approximately 90minutes, I was free to spend the rest of the day 1) riding on a streetcar 2) wandering around the French Quarter 3) getting lost in same 4) taking a few pictures of where I am staying... which have all been thrown onto Picasa... so check out:

http://picasaweb.google.com/originalliv

And now, I must go and read the orientation manual, and then watch the LSU (Louisiana State University) Baseball game. I feel so American!

All-American Hospitality

Well, it's official. New Orleans is going to make me FAT. But happy. So who cares?

I was so privileged today to be included in a my host's family gathering - celebrating Fathers Day (which is a WAY bigger deal here in the US than back in the UK, Barack Obama even did an interview about it!), and two of the "younger generation's" birthdays. It was lovely, a really happy family gathering, with Grandma, 3 kids plus husbands/wifes, and the some of the grandkids. And me, the anomalous Brit. But one who was accepted with open arms - partly due to my love of ice (because of this, I was referred to as the "respectable British person").

Anyway! So we went to a beautiful family home (all the houses here are huge and beautiful, spacious, with fantastic design and furnishings) for a meal. Since being here (i.e. an entire 24 hours), I have been eating the traditional American fare with a vengeance. My list:

-Fried chicken (LOVE it. Hot or cold)
-Italian salad (a meal in itself: ham, chicken, salami, shrimp, egg, asparagus, cheese x2, lettuce)
-Ranch dressing (mmmmmm!)
-Potato salad
-Doberge cake (a New Orleans speciality. Multiple thin layers of cake with eg custard/pudding between them, and chocolate icing. Google it. And be jealous)
-Brownies (made by yours truly and my lovely host, JD)
-Chocolate peanut butter brownies (oh my.)
-Reece's Pieces
-Milk Duds (chocolate covered caramal. Yummy!)

Like I say, FAT.

But it's wonderful. All of it. Absolutely wonderful. I love it here, I love the heat, and I am very excited about tomorrow - my orientation day at the hospital.

Fallen on my feet in amazing N'ORLEANS!

Yes, I am here! After... 17 (!!) hours of travelling, and about 1 hour of sleep in the past 40, I have arrived.

And what an arrival. The place is beautiful, the people I am staying with are wonderful, and my little home from home is incredible!

Can't believe I'm here, it is wonderful :o) AND boiling. Literally. Over 90 deg F - no idea what that is in real money, but I will just tell you: when I left London it was 12 deg C outside. When I was 1,000m above Chicago, it was... yes, you've guessed it... 12 deg C. I love air conditioning.

Pics to follow in due course. Right now, I need to shower. It's really not pretty (me, not N'Orleans).

Oh, and I also LOVE Reece's Pieces.

Leaving on a jet plane

Well, it is finally here! Exams are done, I'm packed (as much as I can remember, anyway, and despite several cruel and heartless "culls" of pretty things that Mike wouldn't let me take), and I've said goodbye to Alfie (the tortoise).

So I'm readyish to go I suppose. I got my rotation details yesterday, and am now officially terrified. I'm expected to suture, clerk and examine my own patients, help in resuscitation, you name it, I'll be up to my ears in it! I suddenly remember my complete and utter lack of experience in A&E...or ER, as I must call it.

And now, the M4 calls, ready to take me to Heathrow, and then Chicago, and then, finally, New Orleans! Watch out America... I'm on my way....

It beats revision...

And so it starts.

I am heading off to New Orleans in (countdown) FOUR days for a medical elective, and want a record of all the exciting times out there. Thus, a blog starts.

Also, I don't want to revise this afternoon and so playing around with the colours on this website is quite good fun, comparatively!

So here we go. A lot of these posts will be slightly odd ramblings, probably bought about by jetlag, and exhaustion, and such like, but there might be some good stuff in here every now and then. You never know...

Enjoy!