ANZCA Bulletin - June 2009 - Australian and New Zealand College ...

large number of anaesthetic colleaguesbeing readily available within a smallspace, so making for a fertile learningenvironment. I am truly fortunate to havebeen able to interact in this way with DrColin McCartney, a humble Scotsmanwith inexhaustible patience who hasestablished himself as an authorityin the field of ultrasound guidedregional anaesthesia.Surgery at this location is almostexclusively performed under regionalanaesthesia with sedation. The full rangeof upper and lower limb blocks, bothsingle-shot and catheter techniques,are employed in achieving this. Needlesare successfully placed in many unlikelyplaces – and I thought my pain traininghad prepared me for most of the possibilities!A few years back in an effort to improveefficiency, the anaesthesia departmentmade a purposeful move to regionalanaesthesia away from a strict GA practice.This move achieved efficiency gains,partly by eliminating the delays due to GAinduction and emergence in the operatingtheatre. Regional anaesthesia also avoidedrecovery room backlogs through havingpatients practically ward-ready by the timethey left the OR. Efficiency gains throughearly discharge are aimed for by optimisingpostoperative analgesia, with an impressivearmamentarium of multimodal analgesics,and working this in with a comprehensiverehabilitation program.The reality, as with any job, is that itis not all tea and scones. There is alsothe real work to be done. This being theother lists that need covering up at themain Sunnybrook campus. For these listsI needed brawn (no theatre orderlies to helptransfer patients), brains to remember MACvalues (as there is no TCI in North America)and a production-line-like efficiency(no anaesthetic nurse to assist in set up).Overtime regularly exposed me to gunshotwounds from gang-related violence (notsomething I regularly see on Sydney’sNorth Shore) and far too much of thatNorth American coffee I derided earlier.The Canadian health care system isalmost wholly publicly funded. Inevitably,though surprisingly only recently, thishas led to the conflicts that occur whenescalating costs meet a limited budget. Bedshortages and rotating list cancellationsare a new experience for Canadian doctorswhile for a practitioner from NSW it is anall too familiar feeling.For a smooth transition into Canadianlife, an Australian needs to be aware ofimportant cultural differences, the mainone being that Canadians are incrediblypolite. The latest James Bond movie,Quantum of Solace, even made a subtlereference to this fact. In one of the finalscenes, Bond ambushes a Canadian doubleagent in her apartment, but after beingforgiven she is released from gunpoint.Leaving the room and knowing the deadlyfate of the partner she leaves behind, theagent turns to Bond and softly says in herCanadian accent “thank you”.After arriving in Toronto we stumbledupon a mini-boom of Australian and NewZealanders completing fellowships here.It seems that the closing down of theUnited Kingdom to Australian and NewZealand doctors by the European Unionemployment regulations has pushedmore of us towards Canada. It is easy tospot your countrymen here – they are theones despondently wandering around thesupermarket looking for Tim Tams.The benefits for those who do comeare wide ranging. Specifically for thoseinterested in ultrasound, coming to the citywhere a lot of it started offers the benefitsof quality real world training. Otherwiseback in your anaesthetic bay as youstand all alone and a million miles fromthe ultrasound courses with their buffedmodels, lays your reality; a patient who isaged, deconditioned and overweight – andan ultrasound machine that annoyinglykeeps disappearing.I encourage those interested andable to come to Toronto to enhance yourultrasound skills and take these new skillsback home to build upon the base alreadyestablished by a number of centres. Thoughfor this New South Welshman, the talentpool currently seems to be alarminglyskewed toward those south of the border!Anyone planning an overseas fellowshipshould carefully research the details andbear in mind that often the key informationcomes from those who have been before you.I would like to thank Dr Gil Faclierand all the members of SunnybrookAnaesthesia Department for their kindnessand support during my fellowship.Dr Gavin Pattullo completed medicalschool in Tasmania and then went on toundertake his training for FANZCA (2003)and FFPMANZCA (2004) at Royal NorthShore Hospital, Sydney. He has taken leavefrom his role as Staff Specialist and Directorof the Acute Pain Service at RNSH toundertake his fellowship in Toronto.The ANZCA Bulletin June 2009 35