Sunday, September 16, 2012

Whose patient is it anyway?

Spent another hour at our site's Medical Advisory Committee meeting on Friday which is essentially a circle jerk in which the doctors and the administration pretend that the doctors have anything to do with running the hospital.  At least breakfast was provided and wasn't too bad, although not quite up to the standards of some of our administrators.

Towards the end of the meeting an item came up where it seems that residents will only now be allowed to work 16 hours consecutively.  There was of course the usual concern about how we were going to run our hospital without all that cheep labour.  Then inevitably somebody  brought up the issue of if residents worked fewer hours, should not the length of their training be extended.

I had to respond to this.

"For the past 30 years," I said, "anaesthetic residents have not worked after being on call.  This means that the anaesthetic residency is about one year shorter than comparable residencies.  Yet if your life depended on being cared by:  a newly qualified surgeon, a newly qualified internist or a newly qualified anaesthesiologist, which specialty would you pick?"*

The answer is of course pretty obvious as most of the room acknowledged.  It is not quantity of training, it is quality of training.

What I should have asked, and might have asked if I hadn't had to leave to start working.

"How come hospitals with similar case loads to ours who have never had residents are able to deliver good patient care?"


"Don't you guys get paid to look after your patients?"

We of course don't get residents on a regular basis in anaesthesiology at our hospital.

* Obviously for this hypothetical question, different scenarios for each specialty are possible.

Saturday, September 8, 2012

How I spent my summer vacation

My wife who reads my blog pointed out that I haven't posted on my blog since July.

After going to Rwanda last year, I had planned a quiet summer with only a few weeks of vacation.  This was not to be and I had quite an eventful (in a good way) summer.

I went cycling in Quebec

My wife and I have now gone on a few cycling holidays with Freewheeling adventures an outfit based in Nova Scotia with tours all over the world.  I have been to the Czech republic and Mexico with them, my wife has done a few others.  We had a $500 gift certificate we had to use so decided to go to Quebec.  Originally my plan was to link this to the CAS meeting but we couldn't find a trip which coordinated with the CAS meeting, so no tax write-off.  We were able to use frequent flyer points for the flight and hey who says the Queen has to subsidize all your vacations.   On top of this my wife's sister and her husband from the US were able to come along.

We flew into  Montreal and stayed at our favourite hotel in Montreal, the Hotel Nelligan in Old Montreal, arriving in the evening and eating on their fabulous roof-top restaurant.  Sunday we had a little time to look around Old Montreal before getting a taxi to the train station and off to Quebec city by Via Rail.  Via Rail while nothing like the service in Europe I was to experience later in the summer is still pretty good.  We arrived in Quebec City had a short taxi ride to our hotel an pleasant "Auberge" in an old restored building, walked around Quebec City and had dinner.  My sister in law and her husband arrived around 2300, we took them out to the Old Town for a beer.  

I got to play tour guide the next day, showing them around Quebec City and boring them with my knowledge of Canadian history.  I only had to make up a few facts I wasn't sure of.  Around 1600 the van from Freewheeling came to pick us up and we got to meet our fellow cyclists, another American from Baltimore and an older (than us) couple from Waterloo, Ontario.

I could really bore you with what we did in detail the next five days; it was a fantastic trip, we stayed in some great hotels and ate like kings.  The weather was crappy but but instead of making everybody miserable, it brought the group together.  The trip was labelled green or easy; the longest we rode was 60 km and there were a few hills.  

On the last day we got dropped off at the train which we took back to Montreal, and our favourite hotel.  We rolled into Montreal and crossed the St. Lawrence River as the sun was going down and got to our hotel in time to hear the Canada day fireworks.  We flew back home the next evening.

We got the house re-renovated (still in progress)

I am beginning to learn that renovation is a two step process.  First you do the renovation and then a couple of years later, you redo of the stuff that the contractor didn't do (or wouldn't do) right the first time or that you didn't think you could afford when you did the renovation.  We renovated our house in 2008 at the crest of the biggest housing boom in history (followed by the biggest crash in history).  This of course meant that we considered ourselves lucky to even have a contractor (2 in our case) which meant paying a lot of money and generally sucking up to them.  About two years ago we noticed that the carpet upstairs was loosened and wrinkling.  This meant that we would have to move all our furniture out so someone could come and fix this.  Anyway I had this brilliant idea, why don't we get rid of the carpet and put in hardwood floors.  Then I had another brilliant idea, why not put in built in bookcases in my office.  This required dealing with a hardwood guy and a cabinet guy.  I had this vision of them actually working together so that on a given week of their choosing, we could get all the work done in close sequence preferably while we stayed down at the dacha.  Then again I still believe in the Easter Bunny.  Eventually we got a date for the cabinet installation with the hardwood installation booked safely in the future in case there were snags (which there weren't).

Now even in our oil-rich province, we are in a recession and it is safe to safe that there are not as many hardwood floors and built in cabinets being installed as there were in 2008.  Like maybe you have to be nice to the customer and act like you appreciate their business?.   For example I had to sign and initial a two page long contract by the hardwood company which mostly outlined what they would not do; we had to put down rather large deposits well in advance of the work being done and finally my wife had to wait around all day waiting for the hardwood to be delivered because they would only give us an 8 hour window and we were last on the list (apparently they have never heard of cell phones).  We do have the cabinets in and they look marvelous tomorrow the hardwood installers may just show up.  We had to hire movers to move our large heavy furniture into our garage and my wife and I are sleeping in the basement and coping quite well I must say.

I screwed up my shoulder

I had a week of vacation booked at the end of July/ beginning of August which I do to ensure that I will not be on call on my birthday which usually falls on the 3 day weekend.  I had  planned to spend the first weekend moving stuff from upstairs where the renovation was to take place but my parasite son who lives at my dacha needed his bike for a race so I had to leave Saturday with the bike.  My wife wanted to stay in town, presumably happy to have some time to herself.  I arrived in the early afternoon, my son took his bike then his brother and he took off for Golden for their race the next day.  They may actually have thanked me.

I tidied up the dacha, half-heartedly tried to deal with the weeds, took a nap, BBQed a steak watched some Olympics and went to bed, vowing to be more active the next day.

I arose to the beginnings of a sunny hot day and immediately I knew what I had to do.  I had to ride my mountain bike to Banff on an XC trail, eat lunch in Banff and ride home on the new paved trail along the highway.  There are two XC trails between Canmore and Banff.  The easier one, the Goat Creek Trail starts high above Canmore and while it is possible to ride from Canmore up the dusty dirt road, one usually gets dropped off.  As my children were away, this was not an option.  The more difficult one the Banff/Rundle/Riverside trail is easily accessable from Canmore but I remember it as a tree-root infested ordeal when I rode it many years ago.  Nonetheless, that was the route I decided to take.  I climbed up to the Canmore Nordic Centre, stopping for a coffee at the cafe there.  I made sure I texted my boys and my wife to tell her where I was going so that they would know where to look for the body.  You might think riding alone was pretty stupid and maybe it was but I figured it is a pretty busy trail, there is cell phone reception all the way and I was a much better rider than a few years ago.

I climbed up from the Nordic Centre along the wide trails arriving at the National Park Boundary in about 30 minutes.  Inside the park, the trail narrowed and headed downhill.  There were lots of tree-roots and rocks.  Occasionally I got off my bike to walk around some of the worse obstacles but gradually I gained more and more confidence.  From time to time my bike balked at tree root and stopped dead but I was always going slow so stayed on my bike.  As I said, I was gaining more confidence and probably going faster.  All of a sudden my bike hit a tree root, and stopped abruptly.  I didn't and sailed over the handlebars, landing on my outstretched right arm.  I felt my shoulder pop out and then pop in.  This was accompanied by significant pain which actually made me feel a little nauseous.  I sat down on a log, drank some water and paced around for a few minutes.  I was pretty sure my shoulder was back in, it was sore but I could move it thru a limited range of motion.  I decided to keep riding vowing to be more careful.  I didn't really have much choice, I was half way between trailheads and it was either ride or walk.

About 5 minutes later, I brushed a tree and fell over sideways.  As I pushed myself up with my right arm, I felt a searing pain and I could not move my shoulder at all.  SHZT.  It didn't look like it was going back in.  The circulation looked okay and there was no numbness or paresthesia.  Okay, I thought I am going to walk out to the trailhead, call a taxi and go the emergency in Banff.  Off I went pushing my bike with my left arm.  After about 5 minutes my shoulder decided to pop back in.  I walked and rode to the trailhead and then from there rode into Banff.  My shoulder was feeling pretty good all considered and I didn't relish spending time in the ER so I had and ice cream cone at COWS and rode back uneventfully along the paved trail 20 km back to Canmore where naproxen and beer awaited (I do not by the way advocate this analgesic combination although I remember it worked pretty well).

I took things pretty easy the next few days.  I flew to visit my parents for a couple of days, attended the Canmore Folk Festival and was back at work the next week.  It must of been my grimacing that got one of the Pain Clinic nurses to get an orthopod to see me and 10 days after the accident, I was in a sling.  Of course because I am right handed, I had to take it off to work.  It was and still is hard to get used to using my left arm.  I can only hope this is helping to develop my right brain.

I wore the sling on and off for the next week.  At the Edmonton Folk Festival I started noticing all the other people in slings, and felt a subtle solidarity with them.  (I was a little disappointed that by wearing a sling I didn't get to go to the head of any lines or sit in a special disabled viewing area)  Travelling around Europe hauling a saxophone and way too much clothing hasn't really helped.  I got back home and saw my orthopod in the coffee room.  We better get an MRI he said.  He even made me fill out the req.  I am still waiting for the MRI (this is Canada after all).

Did I learn anything?  I have learned that I will never ride single track again.  I have learned that at 55 you don't bounce back from injuries.  I no longer regard all the people I saw in the pain clinic with shoulder pain as wimps and complainers.

I went to Band Camp

Playing the saxophone was a dream of mine realized as an adult.  Fortunately or unfortunately the saxophone is irrevocably linked to jazz, a genre I have very little background or for that matter taste for.  This has not kept me from playing in two jazz bands and attending two jazz workshops.  Anyway a few years ago I figured that the only way to see if jazz and I were compatable was to get some intense experience.  Hence I googled "adult jazz band camps".   I came up with the Jazz Summer School an English outfit which runs a summer camp in a French chateau (along with a winter camp in Cuba).  I made the usual inquires and got put on their mailing list.

Time passed, I always had something else on.  I left my jazz band partly because of time and partly because I was frustrated at how badly I thought I was playing.

This summer I was going to attend the IASP meeting in Milan at the end of August.  Just after I registered, the mailout for Band Camp came along.  Hmmm, I thought this is just before my meeting.  I checked and there was a vacancy for a saxophonist, I was able to change my flights and I was heading off to band camp.  As the date approached I had the usual misgivings.... I suck at jazz, I suck at the saxophone, I won't know anybody there etc.  Injuring my shoulder and my impending renovation which my wife was going to have to deal with, played a part.

The camp is held at Chomerac.  Chomerac does not appear in any guidebooks nor does Privas the nearest large town.  The town is south and west of Lyon, a one hour taxi ride from the nearest train station at Valence.

I flew to Milan where the conference was to be, stayed a couple of days to get acclimatized and then caught the train for Lyon which left at 0607.  It was a pleasant trip through the Alps and in about 5 hours I was at the Lyon St. Exubery TGV station at the airport.  After a two hour stopover, from there it was a 30 minute ride on the TGV to Valence.  The course organizers had given me the names of two people who would be on the same train and and could share a taxi.  I looked at them on the platform but couldn't see anybody so I walked into the station where somebody seeing my saxophone case introduced themselves and soon 4 of us were heading in a taxi to Chomerac and the chateau.

For some stupid reason I had envisioned a castle but the chateau was a rather large 3 story building although one with turrets and arrow slits (probably ornamental I am thinking).  The course organizer, Clive was there to meet us and we sat at tables in the shade outside while he organized our rooms.  My room which I shared with one of the other campers was quite larger and one of the turrets had been made into a shower.  Gradually other people started to arrive.   Everybody seemed to know everybody, in fact there were only 3 of us who had never been. Some people were starting their second consecutive week.  Despite this, everybody was very friendly.

After getting organized, we had dinner at 1900 with carafes of wine on the table.  Although the "chef" was English, the food was excellent.  At 2100 we had a "play around".  It was a bit of a humbling experience as there were some excellent players with a good knowledge of jazz.  I did get up to play in a few blues jams and acquitted myself reasonably well.

As I said, I have been two weekend jazz workshops in North American.  These tend to be structured busy affairs where your face is sore at the end of the day.  This camp was much less structured with a lot of different teaching techniques.  We would have breakfast at 0800 and would start playing around 0900 either all together or in groups.   At 1300 there was lunch and you were theoretically free until 1630 when you got together with your small group which played the piece you had worked on for the whole group.   Between 1400 and 1630 as mentioned you were theoretically free however most people used that time to work on pieces they planned to play at the evening "cabaret".

After dinner at 1900, we had the evening cabaret where small group of 2-6 people played songs they had worked on in the afternoon.  Beer, and wine were available at cost during this session which went on until midnight.  The instructors would usually also play a set a some point.

All and all a very relaxing place out in the French countryside, overlooked by a large hill or small mountain.  There was a swimming pool to relax by.

On the Friday we played a concert for the villagers.  There must be very little to do in Chomerac because about 30 people showed up.

Overall it was a very positive experience and I may just come back next year.

I got to tour southern France and Northern Italy a bit

I was able to get business class on points which is really the only way to fly 8 hours.  With the help of the little blue pill I got about 3 hours of sleep and arrived reasonable refreshed.  When I leave North America to travel to Europe I usually take Melatonin at the time it is going to get dark where I am heading and I have found this makes a huge difference.

I took the airport shuttle to Milan which only cost 5 Euros and deposited me at the Central Train Station closed to where I thought my hotel would be.  The hotel didn't seem to be within walking distance so I got a taxi and paid 8 Euros for a 2 block ride.  After showering and changing, I took the metro to the Duomo area which is the massive Gothic cathedral and walked around the area.  It was a holiday in Milan and except for tourists the streets were deserted.  I ate supper at an outdoor cafe and took the metro back to my hotel.

The next morning I packed a small daypack with a change of clothes, checked my luggage and took the train to Como where I took a ferry ride to Bellagio and back and stayed overnight in Como returning to Milan the following afternoon to my original hotel.

I left for Valence and band camp the next day.

After band camp which ended on a Saturday, I had not made any arrangements until I was to return to Milan on Sunday, figuring I could spend Saturday looking around the area.  After talking to people, I decided to go the Avignon, so on Saturday I shared a taxi with the first group out.  On arriving in Valence, I found that there was a train to Avignon leaving in 10 minutes so I was able to get on it and was in Avignon by 1100.  I found the hotel I had booked on Expedia, dropped off my luggage and visited the Palais Des Papes and then the Avignon bridge.

I had to be at the Valence Ville train station by 1440, the next day in order to make my train to Milan.  In order to  do this it was necessary to take a bus to Avignon TGV station which is outside of Avignon and catch the TGV to the Valence TGV station and then catch a bus to the Valence Ville train station, where I could then catch the train I had booked a couple of months earlier.  Miraculously this complicated arrangement worked, depositing in at the Valence Ville station with enough to time eat lunch at an outdoor cafe across from the train station.  I then caught my train to Lyon airport and after a two hour stopover was on the train back to Milan arriving around 2200.  I took a taxi to my conference hotel.

The following day I had booked a cycle tour of Milan.  I find that the best way to see a city is on a bike.  You can cover way more ground than on foot and you miss a lot in a car or bus.  I had booked in advance with Bike and the City.  This is a really great tour which I would highly recommend.  The guide was very passionate about the history and architecture of the city.  Her English was pretty good despite adding a vowel to every word.

For the next 4 days I attended the IASP meeting which I found a little disappointing.  The IASP has recently gone to World Congresses every 2 rather than 3 years and 2 years doesn't seem to generate a lot of cutting edge material.  There was also the matter of it coming at the end of a pretty jam-packed trip.  I did have a couple of fantastic meals thanks to the pharmaceutical industry and one night a bunch of us participated in "appertivo".  Appertivo is a Milan tradition where buying a drink entitles you to eat at the buffet for the rest of the evening.

All good things had to come to an end.  I actually managed to last at the meeting until 1800 on Friday, after which I picked up my luggage and taxied out to the airport hotel, I had booked.  This, like many airport hotels was a bit of a disappointment.  The Russian dragon boat team was staying there so I anticipated a noisy time but they were pretty quiet.

I flew out of Milan at 0730.  I had the usual panicky  1 km run thru the Frankfurt airport to catch the flight I thought was boarding 10 minutes after we landed (it was an hour late).  After a 6 hour stopover in Toronto, I was home by 2100.

I managed to book the entire trip without the help of a travel agent.  I found the Rail Europe website incredibly helpful and two days after I booked my trains, the tickets were couriered to my home.  They did sell my two meal vouchers at 20 Euros which the train staff wouldn't honour but otherwise the service was great.  I booked all my non-conference hotels through Expedia.  There are lots of horror stories abounding about Expedia but I use them for most of my travel and have never had any trouble.  The Hotel Mini Tiziano where I stayed during the conference was booked thru the conference website.  In this respect I was lucky as the hotel was a 20 minute walk from the Congress Centre and close to a Metro station, bars and restaurants.  Many people found themselves having to take a 30 minute taxi ride every morning and evening.