I’m working for the Lakes District Health Board at Taupo Hospital. My official title is Medical Officer Special Service, or something like that. I know the acronym is MOSS; I’m a little fuzzy on the details. I’m working as a specialist in emergency medicine. We have a 6 bed ED; two resuscitation rooms and four cubicles. One of the cubicles has some cartoon characters on the wall, so I think that makes it the peds department. We also have a waiting room that is fortunately pretty much empty for most of the day. We see about 9,000 patients per year, which works out to about 25 per day. Days can be pretty busy, especially in the late afternoon/evening hours. Overnights are pretty chill (so far).
The cases I see are essentially the same as what I saw in the States. Chest pain, belly pain, headache, old-lady-generally-weak. I seem to see a lot more accident/injury cases. Most are pretty minor. So far the most interesting would be:
- Shoulder dislocation while skydiving (ruined his birthday gift from girlfriend)
- Shoulder dislocation while kayaking (dislocated while upside down in kayak)
- Finger fracture while wrangling a sheep (didn’t want to be sheered, apparently)
- Radius/ulnar fracture by cow kick (didn’t want to be milked, obviously)
- Septic 700lb Maori chief with necrotizing fasciitis (too big to get out of ambulance rig, had no IV access) surrounded by many, many family members.
There are also a lot of things of which I don’t see much. I’ve only seen one migraine headache in three weeks; I’m used to seeing two or three a day. I was actually kind of excited to give my “narcotics make migraines worse” speech. Vaginal bleeding doesn’t seem to represent the emergency that it does in the States. Apparently the women here have come to expect it on a roughly monthly basis. Did someone forget to tell American women this in junior high health class?
I spend a lot less of my day trying to convince patients that there is nothing wrong with them. That conversation seemed to occupy a good portion of my workday back home.
There are some difficulties, for sure. My hospital doesn’t have a CT scanner. I have to call in a lab tech and an x-ray tech after 5pm. On weekends I have to round on the inpatients, which shouldn’t be too bad in a 10 bed hospital, but it’s been a long while since I did any inpatient medicine. If I want a CT scan, I call the medical or surgical resident at Rotorua hospital (my referral hospital about an hour away), tell them that they need to evaluate the patient and likely order the CT, and then transfer the patient by ambulance to the Rotorua ED. There is no ED-to-ED transfer. I essentially directly admit the patient from my ED to the Rotorua medical or surgical service; they still go through the ED for initial assessment, though.
The nurses here are actually very good. Most have upwards of 8-10 years of experience and work in most every part of the hospital from ED to operating theatre (that’s what they call it, not just me being pretentious) to the inpatient ward. They don’t have much patience for difficult IVs, so if they fail after a couple tries, they come to me. Fortunately I have an ultrasound, because without it I’m rubbish at peripheral IVs.
As you can see from the pictures, the view from my chair is pretty awesome. I can see the mountains in Tongariro national park from my window on clear days.
My favorite part of the ED is the sign at the front that reads “Emergency department use is for urgent illness and injury only. If you have a condition that can be evaluated by a general practioner, call and make an appointment.” If only we could hang that sort of sign up in the States instead of the EMTALA sign. It wouldn’t change anything, but I’d feel better.