Naturally we took her to the vet expecting the worst. And the answer, as expected, is that she has diabetes. Just to really stick the boot in she also has pancreatitis and inflammatory bowel disease. The combination is not good and her prognosis is an inevitable decline. A possibility is that she has pancreatic cancer, as apparently this is how it presents in cats, but the investigations to check are not straightforward and knowing wouldn’t really help her at all.

We were advised to start her on insulin, so with much angst she was admitted to the vet’s “hospital” for a couple of days to have glucose testing and be initiated on therapy. That time was not pleasant for us, the other cats noticed her absence, and she had a thoroughly miserable time being jabbed and poked every few hours. On her return home we were requested to continue the insulin and give her a special low-calorie diet. And this is where the road forked.

Many cats may have tolerated the injections, which aren’t that painful apparently, and the difference in diet. But not Milly. She’s always been a determined, independent animal for whom everything is on her terms. More importantly, she’s always been our pet and over the past decade we’ve developed a strong bond. After a couple of days of injections it reached a nadir where she wouldn’t eat the special food, wouldn’t let me touch her for fear of being hurt (and despite what the vet said, the injections were painful for her) and started avoiding us.

This became a no-win situation in which she started hating us for pestering her, and even worse she stopped eating which meant she was getting even thinner and I couldn’t give her the insulin that was supposed to be helping her. At this point pragmatism stepped in and we’ve stopped everything. She’s back on food she likes and we’re leaving her alone, even though this means her diabetes goes untreated.

I’m arguing it out like this. Firstly, if she won’t eat, she can’t have insulin so she’ll lose weight and her diabetes will go untreated anyway. Secondly, even if we treat the diabetes she still has two other unpleasant conditions that will still see her out. Most importantly, if she’s got a short life expectancy then I can’t justify making that limited time unpleasant for her. I can’t have her spend her last few months fearing us and feeling like a prisoner in her own home. And when she does die, we have to be able to live with what we’ve done to her.

So, the net result is she’s being pampered. I’m buying the best quality food I can find that is best for her but also tasty enough that she’ll eat. She’s not getting any pills or injections but plenty of TLC instead. The vet will continue to monitor her remotely and when she becomes too sick or develops a complication she’ll go for the green dream. In the meantime she’ll continue to live in dignity and be the typical pain-in-the-arse that she is. And when she goes, I will be able to live with myself for letting her decide on what happens to her. We give patients the right of autonomy, so why not cats. She’s told us loud and clear that she didn’t want treatment, so that’s what she’ll have.

Of course this means her life is now markedly shortened and she’s on borrowed time. But we’re friends again and our memories of her will be happy ones when the inevitable happens.

1. Competitive sheep. Some very strange psychology is at play here. Many drivers seem unwilling to occupy empty stretches of road on their own. Instead they feel the need to either drop speed until other cars catch them up or speed up until they catch drivers ahead. These people become very annoying as they are oblivious to the actual speed they are going and rather adjust their pace to those around them. Then they fall into one of two camps. Some attach themselves to my rear quarter and hang half a car length behind matching any change in my velocity with frightening precision. The others make sure the nose of their car is just ahead of mine and also adjust their speed minutely to make sure they are half a car length ahead at all times. It worries me that they have such little autonomy.
2. Lane Wanderers. Nothing to do with the soccer team from Wolverhampton but those who can’t stick to a lane. I get the impression that there is a breed of drivers who occasionally notice that there seem to be some white lines painted on the road. Surely the council must have put them there as decoration to make the road look more pretty. As a result they wander all over the road especially in corners and feign surprise when other drivers are inconvenienced and irritated by their disregard of lane discipline. When the perpetrator is a car this doesn’t become too much of a problem as there is usually sufficient room to allow some leeway, but when a bus suddenly starts coming into your lane (as one did to me the other day) there isn’t much margin for error. Be grateful that Brembo makes good brakes.
3. Hill Climbers. Again, for some reason that eludes me, a large number of drivers seem to have no difficulty maintaining the speed limit with reasonable consistency while the road is level. Yet as soon as they meet a gradient they apply pedal to metal and speed up markedly. Then on reaching the top of the incline and getting back onto the flat, their speed drops again. It’s not that hard to keep the same speed on varying grades. Vehicles are fitted with a device specially designed to assist called a speedometer. And since the majority here have cruise control I would have thought there should be no excuse really. But I see this behaviour every day leading me to question whether I’m missing something.
4. Cruise control stuck. As I’ve just mentioned, cruise control is a pretty standard feature here. A feature that must be malfunctioning on some cars so it can only meet one speed, namely 69km/h. Due to concerns about the exorbitant fees charged for speeding and the ever present hidden “safety” cameras, I tend to stick reasonably close to the limit. Which is 60km/h on much of the journey from home to work. So while I’m minding my own business in the 60 zone many cars rush past me. Along this commute the limits increase up to 70 and, in places, 80km/h. It’s frustrating to get stuck behind the same car that pounded past me in the 60 zone who still does 69km/h in the 70 zone. And even more frustrating when that same car does the same speed in the 80 zone. Yet as soon as we re-enter a 60 zone and I obligingly slow down to match the limit, that car disappears away from me clearly having not varied his speed at all for the whole time.

As much as possible and with chants of “deep blue ocean” I try to maintain zen and be a considerate motorist. But illogical, baffling and deeply frustrating behaviour by others tests this to the maximum day after day. Sometimes I wish the Subaru was fitted with Bond-esque machine guns and rockets. Immoral perhaps but undoubtedly satisfying. You never know, the threat of being blown off the road might be enough to discourage bad habits and raise the general standard of driving on display. Q … where are you?

So, with my parents over on holiday, there was no better excuse to see some of the other landscapes this state provides. Over two weeks we visited the Flinders Ranges to soak up views such as:

All of which is down dirt roads and took us many kilometres from the luxuries we were used to. A sobering thought was that a breakdown would have left us stranded, relying on passing traffic on a road that sees very little. Fortunately a reliable 4-wheel drive and a couple of slabs of water made this safe. While there is an element of hyperbole and overreaction in our preparations, people (usually tourists) have died out there.

Then onto Kangaroo Island to see, amongst other things, the Remarkable Rocks which were …. remarkable.

Well they would have been if examples of Australia’s native species homo boganis hadn’t been clambering all over them. Why are some people just unable to just enjoy an attractive natural feature without ruining the experience for everyone else.

Overall it was a great trip with some great photo opportunities … and a selection of those I captured can be found here. There were some unique and very special moments too with the stand-out being waking up in the middle of the night to witness kangaroos feeding right outside the (floor-to-ceiling) bedroom window of the holiday house. You can find them in any zoo but seeing the real deal that close in the wild is something else.

I acknowledge that this blog has been noticeably quiet over the past few months and that a strong element of negligence has developed. Some people may not have noticed, some may not have minded but to the literally one person who asked RickInOz will receive some attention again. There are a few items to relay but rather than deluging information, I’ll dribble them out over the next few weeks or so.

Firstly, let’s get the major agenda out of the way. Namely I am now a dual citizen. Well, to say “now” is a little inaccurate as the day in question was actually getting on for 3 months ago. So on Australia Day (26th January for those unfamiliar with the local public holiday scheduling) we presented ourselves to the town hall and I got to shake hands with the Lord Mayor of Adelaide. Welcome Brother Australian he said. Well obviously something more political came from him, but a representative from the Sudanese community spoke far more eloquently and did recognise us with that  appellation.

So now I have my name on two passports and it almost seems a shame to spoil the newer one by using it. More importantly it’s a recognition of stability here and that life has treated us well in this country. It also means they can’t chuck me out now.

Advance Australia Fair!

This year, I have:

• been granted (provisional) Australian citizenship
•  completed my first year as a specialist
• officially graduated from the ICU college
• continued to work on my Masters
• finished off the marathon Potassium study (publication still pending)
• started work on a project to introduce non-technical skills training for the hospital’s emergency response team
• racked up my 200th retrieval job
• became an Advanced Life Support instructor
• took on more ultrasound training
• been honoured as Jamie’s godfather
• got one foot on the property ladder
• rehabilitated my back with some intense and directed physical training
• given in to Magpie Syndrome and acquired more geeky gear
• finally got our lemon tree to bear fruit

This year Regan has:

• commenced a PhD
• done more consulting work
• donated time to numerous boards, committee and NGOs
• won a South Australian Tourism award
• cycled in the Tour Down Under free-for-all

This year, together we have:

• spent 2 weeks holidaying in New Zealand
• returned to the UK for our second prodigal trip since coming over here
• had our horizons broadened at the Sydney Mardi Gras
• caught up with friends in Canberra
• ran the Mother’s Day Classic charity race again
• done lots of (perhaps too much) wine tasting

There’s plenty more planned for 2012 though perhaps less travelling. As mentioned earlier, this blog will be updated only sporadically. Naturally the novelty and gloss has worn off but I’ll keep spamming everyone with the more salient events.

Have a happy new year and best wishes to all for a productive, and hopefully more peaceful, year ahead.

We have a comprehensive wireless network within the house. A total of 16 devices link into this network and many of them are accessible to others. The printer, for example, reports to any computer. The network drive stores all of our music, videos and work accessible from any device anywhere. This makes it very easy to work as documents can be retrieved, edited, saved and printed from different devices. The term cloud computing has only recently entered the zeitgeist but we’ve been running a domestic cloud for the best part of 10 years. In fact, at one point we even ran an externally accessible server here which meant we could obtain the same services from anywhere in the world.

Versatility is key to the interaction of our kit. And the geek can have endless possibilities. For example, the amplifier can read the media library from the media computer and the network storage and then play music or video without needing any direct input from the user to either of those devices. This laptop can wirelessly beam it’s AV output to the amplifier allowing it to also be used as a media centre. The amplifier responds to an application on my tablet so I can control music within the house without needing to be in the same room as the amp. Radio now streams seamlessly across the internet to a variety of devices allowing us to listen to Radio 4 for a reassuring dose of the Today program and to find out what’s going on back in Blighty. A VPN token for the Health intranet allowing me to effectively “sit” at my office desk while at home.

But there are plenty of future options I would like to explore. A dedicated home server so that we can be completely independent from webmail, web-hosts and other online services. White goods with a network interface. Wireless speakers in an acoustically perfect home cinema. A unified tablet interface for everything in the house. 3D video without special glasses. Having the media player in the car access the home network. Wireless IP cameras covering the exterior of the house.

Regan is, of course, utterly unimpressed by all of this. Which shows the different ways our minds work. Mine is obviously intrigued by the available options and hungry for more. The obsessive compulsive type A in me thinks nothing of spending hours fiddling around with equipment getting it to work … just so … even though the modification may be little different to the standard. Time well spent … indulging the inner geek.

Quite a delay since the last instalment.  Mostly due to laziness on my part and a distraction that seems to be occupying every minute of my spare time and most of my mental stamina. I’d like to report that it was a hobby, social life or other lifestyle activity, but unfortunately we’re well within the “work-related” category.

In the year since I started at the ‘Mac, various possibilities have passed in and out of my attention. Many have been relegated to the too-hard-basket, others have been de prioritised but one or two have remained fixed at the top of the agenda. The most pressing of which is “The IMPACT Project”. What started off as an interesting concept has, like many such ideas, snowballed into a barely controllable monster.

The original notion was to introduce some team-working training for the hospital’s service which attends medical emergencies. If a patients keels over, tries to expire or suffers some other catastrophe, treating staff can summon the cavalry and all will be well. Or maybe not so well. Unfortunately while medical staff, doctors in particular, are very good at sticking pointy things into people and giving powerful mind-altering drugs, they’re generally pretty crap at the basics like talking to one another coherently.

Aviation is a similarly pressurised working environment that seems to attract similarly obsessive type A personalities. The general public decided long ago that having planes fall out of the sky was “a bad thing”, so experts looked for reasons why it happened. Boeing, Airbus and others dusted off their lawyers, expecting the blame ball to be firmly chucked in their direction. However, it transpired that the weak link, the causal factor in most crashes was the squidgy thing sitting at the front. So, airlines started watching pilots intently and noticed that when things go wrong that they still remembered how to fly the planes. So it wasn’t that. Instead, when sufficient scrutiny was applied, it transpired that aspects such as communication, cross-checking, team-working and psychological flaws were responsible.

This all occurred 40 years ago when “human factors” dictated the need for “crew resource management” training. And ever since, air travel has been a darn sight safer. We’re statistically safer flying around the globe than driving to work. No matter what bad publicity Qantas might have garnered recently, you’re more likely to arrive alive travelling with them than any other form of transport.

So, bringing that back, how is it relevant to us? Well a couple of us got talking one day. The next day we started going along to attendances by our emergency teams. We noticed something striking yet worrying. For professionals who are supposed to capable of function and organisation at a high level, the tolerance of chaos was staggering. Perhaps such behaviour had become the “norm” and while embroiled ourselves, we’d not noticed. Interesting what a difference in perspective being the fly makes.

The solution seemed simple. Fly-boys have been training one another how to act and communicate as a team. Why shouldn’t we just borrow their tactics. The world will keep spinning and all will be peachy. Ah, if only it were that easy. Unfortunately medicine, more pertinently public sector medicine, demands proof. And so we’re now pushing through a multi-phase research  project involving the entire hospital. Naturally none of this comes cheap and some major scrounging is on the agenda for next year.

My computer keyboard has been glowing red-hot recently as it’s discharged 3 ethics submissions, 2 funding applications, multiple drafts of a protocol and numerous associated supporting documents. I think we’re almost there; in terms of preliminary work. The actual conduct of the project will be another 3 years of slog. But if this goes to plan we’ll save lives and maybe some of the hospital’s money too. Famine and war will still go on but there is the chance to do something truly ground-breaking here. This could be really big. Or it could flop. Sometimes researchers have to be brave.

It goes without saying that some of our colleagues work under very difficult circumstances and great pressure. None more so than those in the emergency department who have to deal with some of the worst of humanity and some who have been turned into the worst of humanity by deliberately ingested substances. For undertaking this thankless task they are offered … no thanks. At least not by their employers who clearly have never witnessed the barely controlled anarchy and chaos that prevails on an average Saturday night.

To add insult to this ambivalence, we now have the Minster for Health blithely dismissing the concerns of his employees. When told that the Code Black (*) rate is at an all time high, he denied that it was a problem and implied that the figures were inflated and exaggerated. In other words, he refused to back the people he is supposed to represent. I’m at a loss to explain why as, for once, this was not a problem that could be in any way blamed on him. Rather it is a sinister culture in which abusing and assaulting public service workers is considered acceptable by some. And that alcohol and drug abuse continue to ruin society. Neither are the fault of the Minister, so why didn’t he stand up for his staff, praise their efforts and put out a message to society that such behaviour is not acceptable.

I suspect that his capitulation and betrayal is symbolic of modern democracy in which elected officials are petrified of admitting that anything is wrong lest it be construed as an admission of the faintest shred of failure. As a result we wind up with an “ostrich” mentality and no action. During which time staff continue to be hurt and sick leave due to stress is commonplace.

Thanks a lot, boss.

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(*) Code Black is the emergency request for assistance made in a situation in which staff perceive that someone presents imminent risk of serious harm to themselves and/or others

For example, and the reason for this update, it’s now a year since I started my full-time job. No longer am I “the new guy”. The past year seems to have passed quickly in the sense that I can recall very vividly my first day. But over that year a great deal has happened and I have had some mixed experiences. Looking back, while the year has in one sense gone quickly, at the same time it seems like quite a while ago. A very strange mental conflict that is beyond the ability of my dyslexic English to describe.

Indeed, soon it will be 5 years since we came to Australia. Those years seem to have gone at quite a pace, yet now looking back it does seem like another age. Again the contradiction. This has been documented elsewhere, but usually the phenomenon is one of a correlation between the passage of time and how fun that time is. My perception is that time, while unfailingly linear, not only does not run at a constant speed … regardless of what the atomic clock might say … but also passes at those variables rates simultaneously.

On behalf of the Government and people of Australia, I am delighted to advise that your application for Australian citizenship has been approved

Technically speaking I’m not a citizen proper as I still need to swear allegiance to beer, cricket and Holden at a ceremony next Australia Day (26th of Jan incidentally … one of the many Bradmanisms necessary to pass “the test” ). Then I’ll be a true-blue Strayan.

The only conflict I can foresee is working out which country to support in various international sporting events. It shouldn’t be too hard though, as I’ve decided that it will always be England in the Ashes. When it comes to (soccer) football or rugby I’m not that fussed given I don’t follow either. Thereafter Australia and England don’t compete against one another in that many competitions. The Olympics will be an interesting dilemma next year. Perhaps I’ll be the worst fan of all … the fair weather supporter. So it’s St George for the sailing and cycling and then I’m behind the Aussie boys for the swimming. Who knows, Australand/Englasia might win rather a lot of medals that way. Well, as long as one of them beats the bloody Yanks.

So, regardless of the other negative things I might say about them, the incumbent government has at least made one good decision this year.