Surgery is a Lifestyle

Or so says my elective preceptor, a general surgeon/surgical oncologist. Life is something you fit in around it. Things for me to ponder, to be sure, over the next two years or so. In the meantime, I'm loving my elective; in the new year I'll get some exposure to ENT/head and neck surgery.

At some point I need to write about non-medical topics, though. Before that point, I did notice something curious about some of the heart murmurs we've been learning about over the past few weeks. Last Tuesday I examined a patient with a very loud systolic murmur, indicating aortic valve stenosis. Every time this patient's left ventricle contracted, there would be a loud, transient whoosh as blood passed through his narrowed aortic valve. After listening for a bit, it suddenly dawned on me that the murmur sounded almost exactly like the alien signal from Contact.



Still a very cool movie - and now it provides a handy way of recognizing certain types of valvular disease.

Le mois d'Octobre

It's been a rather nice fall so far in Halifax. Nice, generally sunny weather (today's being a notable exception), and I've been enjoying Med 2 a lot so far. I've finally scrubbed into surgery and it's been great. Really great. I'll have to write more soon, but this appears to be the direction in which OR procedures are going:

Next time you go in for surgery, don't be surprised if the surgeon and staff introduce themselves before you go under the scalpel.

It's just one of the 26 tasks on a surgical safety checklist that hospitals across the province will be required to implement starting in January, because it has been proven to reduce patient complications and death.

[...]

The checklist includes common items such as requiring doctors and staff to check equipment, review patient information and resuscitation plans, and even identify themselves by name and role before they make their first cut.

The checklist will be mandatory for all surgeries in the province, and hospitals will be required to report twice a year on compliance.

The list is divided into three parts: tasks that must be completed before the anesthesia, before the first incision and before the patient leaves the operating room.

In case there's any concern that this sort of thing wasn't done previously, I can say that it's just a more systematic, formal way of approaching normal practice. But don't take my word for it:

"Everything on the checklist is a well-known standard of care," said Dr. Michael Baker, head of patient safety for the province, at a media briefing Thursday.

"There are no new ideas in the checklist," he said.

"The new idea is that the team needs to communicate and be obsessive-compulsive about the surgical process."

The video accompanying the article even has an example of a typical anesthesia monitor alarm. It helps remind me of the OR, and that I was taught (in Austria anyway) that the appropriate response to such alarms is to turn them off (I think it's an apnea alarm).

Bodyworlds Returns!

The Bodyworlds exhibit is coming back to the Science Centre:

Four years after BODY WORLDS 2 brought record crowds to the Science Centre, the new blockbuster exhibition, BODY WORLDS & The Story of the Heart, will open to the public on October 9, 2009 for a limited engagement.

See through the lenses of anatomy, cardiology, psychology and culture how the heart nourishes, regulates and sustains life. The exhibition will give you a profound insight into the human body, health and disease, and the intricate world of the cardiovascular system with over 200 human specimens including whole-body plastinates, organs and translucent body slices.

From the sound of it, tickets should be bought in advance. As usual, I expect to be in TO around Christmas time, and I think it would be fun to organize a group trip. It's not altogether cheap, but it's cool and it must not be forgotten that it featured prominently in Casino Royale. What more do you need?

Austrian Observations

Generally speaking, Austria is quite similar to what I'm used to in Canada, but, of course, different, and not just because all the signs are in German. A few brief notes:

• Smoking: Everywhere, that is. I don't know if there exists the concept of a "no smoking" section in Austria, but I have yet to discover it. Sure, you can't smoke on trains or on buses, but it's been only a year or so since smoking was banned in most areas of hospitals. It's possible that the Landeskrankenhaus Innsbruck is behind larger centres. Of course, since many on the surgical floor still smoke, the compromise was to put smoking lounges just off the OR hallway (I had forgotten just how awful smoke is in very confined spaces). It's not really airtight, though, so the scent of smoke tends to waft down the hallway.


• Shopping hours: Sunday shopping? Evening shopping? Like, after 7pm? Forget about it! Not possible, and even the local video store near me closes at 10pm weeknights. I'm sure some of the more touristy places in the Innsbruck Altstadt are open Sundays, but they sure aren't open in the evening. This would be a lot more inconvenient if my schedule was tighter, but fortunately I'm pretty much always done by mid-afternoon.


• Free lunches: Self-explanatory, and applies both on the OR floor and in the main hospital cafeteria. The food isn't great, but it gets the job done, so to speak.


• Coffee machines: Coffee vending machines, I should say. It tends to be expensive to buy coffee from bakeries, bars, restaurants, or coffee shops, as a small cup (about the same size as a Tim's small) will run you about 2 euros. Despair not, however, as you can get a cup of about the same size and quantity from a vending machine for 50 or 75 euro cents. Very reasonable, not to mention fast!


• Trains, trams, and buses: Fast, convenient, everywhere. Even Innsbruck, population just under 120,000, has an efficient bus and tram network (good for me since I take the bus at least once daily). I seldom wait more than about five minutes; the outside might be ten. There are night buses too, though I haven't taken any as of yet. Vienna similarly has an extensive public transit network: U-bahn, tram, bus. Innsbruck makes the buses in Halifax seem slow and inconvenient... which they are. Rail is the other issue here; you can take the train everywhere and it's reliable and comfortable. They'll even apologize if it's 15 minutes late (the norm for Via Rail!). While the train can be a bit on the pricey side, it makes day tripping very easy. (Concerning Italian trains, while they are not remotely pricey, let's just reiterate that one should never trust a bargain too much...)


• Language: In light of my less than stellar German skills, I've had an okay time managing here, primarily because most people seem to have some command of English. I'm working on improving, but it's slow-going, despite being surrounded by the language all the time. Arguably just as challenging is the local Tiroler accent, considered "quite strange" by some Viennese. I can probably get by simply by knowing "bitte schön", "genau", and "past".

I suppose that's all for now. Pictures to come later. Bis später!

Mwahaha

So, it seems that Tim Hortons has now come to New York City:

The Canadian doughnut invasion has begun.

Over the weekend, 12 Dunkin’ Donuts restaurants in Manhattan and Brooklyn underwent a transformation, emerging Monday morning as the first New York City locations of Tim Hortons, a Canadian chain that sells coffee and baked goods.

It's so nice that New Yorkers will now be part of an exclusive set of locations that includes the two locations in New Minas, NS (not to mention the 24 hour Wolfville outlet), Hamilton, Finch subway station, and the Sir Charles Tupper Medical Building, along with every mall, airport, suburb, and indeed many gas stations in Canada. At least one New Yorker is just as excited:

Mr. Weprin said the arrival of Tim Hortons "shows New York City is on the move, we’re a desirable market," adding that he was "so excited to have Tim Hortons here." (emphasis mine)

Evidently this Weprin character is a city councillor, but surely he is simply a creation of The Onion and this is not actually a legitimate article in the NY Times.

Of course, it is exactly that. I wonder how long it will take for the novelty to wear off.

(Disclaimer: I probably go to Tim's at least a hundred times a year, if not more. It's the price I pay of not wanting to go outside for food/coffee/whatever when it's really cold out.)

Change of Venue

I started this blog while in Waterloo ("wintering" there), and in September I returned to Nova Scotia where I may just stay forever. Except, of course, for my current travels, which have brought me to a hostel in Vienna. On Sunday I'll go to Innsbruck for a month-long clinical elective; this is pretty much the farthest and longest time that I've been away from home. Last year in Waterloo might sort of count as being "away", but being less than an hour's drive from friends and family doesn't quite count. The closest thing previously was way back in 2003 when I went for a 5 week French immersion program in Trois-Rivières. At that time, we were actually forced to speak French exclusively (or, well, as much as possible); now I *should* be speaking (some) German, but my vocabulary and grammar is pretty rudimentry not to mention very rusty.

Now, I'd planned to spend time studying and reviewing some German prior to departing, but... well, it was always hard to that during school, of course, and I was fairly busy and then travelling during the three weeks immediately after it was over. I do actually remember a surprising amount considering it's been *six* years since I've really practised it at all. Currently when I try to think of a German word for something, French inevitably comes up first as my "default" non-mother tongue. A bit frustrating. C'est la vie... (again with the français!)

Otherwise, I think travelling alone can be - unsurprisingly - a bit on the lonely side, but I'm grateful for some personal private space after 12 or so hours of planes and airports. It felt a lot longer than that, though, and how the Zurich airport can justify charging $10 for a coffee and donut is utterly beyond my comprehension. The Berliner was rather short on jelly at that.

Anyway, that's about all for now. Ideally I'll be posting more on this trip (especially to make up for not posting at all in June!).

Useless Products

Most commercials tend to make little impression on me, but one I saw just now convinced me that a confiscatory useless product tax at point of manufacture is in order:

Aqua Globes™ watering bulbs are an attractive solution for automatic houseplant watering. Fill the hand blown stained glass bulbs as the plant needs it. Aqua Globes™ watering bulbs are a great alternative to the daily chore of watering plants and an excellent choice for automatic watering while on vacation.

Now, I don't know about anyone else, but I haven't found watering plants to be much of a chore lately or ever. For only $14.99, though, I could purchase an Aqua Globe which would save this daily chore. Keeping in mind that you still need to fill the globe with water and stick it into the soil. And that I seldom actually need to water my plants *daily*.

How much time do you think one would save with an Aqua Globe? 30 seconds per plant? I'll grant that they look kinda... interesting - and they could serve as a conversation starter for guests:

Guest no. 1: Ohhh, what's that glass sphere in that pot?
You: It's an Aqua Globe (TM).
Guest no. 1: ...
You: It waters my plant for me.
Guest no. 2: You still have to put water in it, right?
You: Yup.
Guest no. 2: So what's the advantage?
You: Oh, it automatically releases water when the soil's dry, so it waters the plant better.
Guest no. 1: You know, your soil feels kinda dry...
You: Ohh!! My Aqua Globe (TM) is empty!

Anyway. This is a good example of a product designed to create a demand that, really, does not exist.