RickInOz

It will come as little surprise to many of you that my favourite show on television is Top Gear. Of course we all watch it for the motoring eye candy, but there is so much more to the show than watching Jeremy driving around in clouds of tyre smoke while laughing manically. In an era of mass-produced monotonous mediocrity, Top Gear comes as a welcome relief. It is great to watch a show whose presenters seem to genuinely enjoy the work - and why not, I know many people would give their eye teeth for that job. However the biggest appeal for me is the utter contempt shown for the modern obsession with nanny-state and political correctness.

The great tragedy though is that the BBC have never capitalised on the show’s enormous international following. The only way to see the shows is catch them when broadcast, as the seasons have never been made available for sale. If you have the time and the means then recording each episode is one option, but you would only have to miss one screening to ruin your whole collection. Otherwise the British viewer is relegated to catching re-runs on the Clarkson channel (aka Dave).

Fortunately there is an answer now. I’d like to point fellow fans in the direction of the following website:

Click on the above image to be taken to the site. There you can download the complete back catalogue of Top Gear episodes. Old seasons can be downloaded in their entirety, or you can grab favourite episodes individually. So finally someone has gone to the trouble of recording and hosting the show for our benefit.

To download you will need a BitTorrent client, such as μTorrent. To watch the files you will need a media player with built-in codecs such as VLC. Both are free, install themselves, and are easy to use.

In case you are wondering whether downloading these will have the feds breaking down your door in the middle of the night - all is OK. The files are not strictly speaking legit as the BBC lawyers can’t condone redistribution for obvious reasons, however Top Gear’s producer, And Willman, has been known to post on the site forum in support of its continued existence.

So, go grab them before the copyright-Nazis spoil the fun!

An event triggered this posting today … but more about that later.

All of us who use computers, credit cards, or work in buildings with security systems sooner or later have to charge our memories with a huge number of codes and passwords. These consume our lives and demand ever increasing amounts of memory. As a quick tally I have 6 cards that require PINs, 8 email accounts, 4 computer logins, 5 different door codes at work and countless website username/passwords.

Remembering all of these is well beyond the limited capacity of my brain so, like many others, I cheat. How many of you have seen the following:

How tempting is it to simply click the “Yes” box and trust your confidential information to a computer. Not just a machine, but one that is vulnerable to hacking with the attendant risk of losing money. There are a number of electronic solutions that offer to encrypt this vital data, but none is completely safe and foolproof. Not least as you still have to remember a password to access the stored data!

So what alternative is there? I adopt the tried and tested method of using the same password or simple variants for most purposes. Obviously this makes life significantly easier for me, but carries the risk that knowing one password will lead to knowing, or least having a good guess, at the rest.

To get back to my original motive for this posting - the Royal Adelaide’s IT system. The administrators have set the computers to require a new password every month. This is great in theory as it minimises the risk of a hacker having prolonged access to your account. However I find it difficult to come up with a new password, and then remember it, every 30 days. Instead I tend to keep to the same basic password but vary it subtly in such a way that I could guess it easily if I forget. This clearly undoes the whole purpose of their security model, but I can’t think of a reasonable alternative, and I’m sure I’m not the only one.

I’d far rather all institutions adopt the model used by the University of Adelaide. As you remember I have taken on a part-time tutor position which affords access to the library and IT services. Of course I had to chose a password to get on the system. However rather than enforcing regular changes of weak passwords, they encourage the creation of a permanent, yet complicated password. It had to be at least 10 characters long, one of which had to be an integer, and at least one other had to be a punctuation mark. The chance of hacking this is extremely remote, and since I knew I would only have to chose once, I deliberately picked something completely complicated.

This seems far more inherently sensible, and suits my increasing senility!

Rather than bore you with yet more news about another Retrieval mission or witter on about some tedious facet of life I find interesting, I thought I’d show you some photos of Adelaide taken on a recent trip up to the helideck on the roof of the RAH. It provides some of the best views of the city and surrounding area.

The CBD looking down onto North Terrace:

The view of the east of the city out towards the Adelaide Hills and Mount Lofty

Looking down onto the CBD from the helicopter:

A birds-eye view of the airport from the RFDS plane:

And just one to show the beautiful clear skies here in Australia. This was taken at Broken Hill airport just as the sun set.

This is the second in a series of posts providing detailed information on what working for the Retrieval Service entails. Last time I wrote about the referral sources for our patients. This posting will cover what happens next - the arrangements and phone calls we have to make before we go out.

The most important phone call

Firstly we have to check in with the aeromedical consultant to report the referral and find out whether we should retrieve the patient, and if there are any special considerations. It also lets them know that one team will be busy so they can appropriately triage future referrals.

Finding a destination

Once the retrieval has been approved we have to find a receiving centre for the patient. In many cases this will have already been arranged by the referring hospital, but most of the time we have to ring round the ICUs in the city to find a bed. All spinal injuries, burns, major trauma and head injuries have to come back to the Royal Adelaide. Other patients can go to any other unit, which comes in useful as our unit is often full.

Sorting out some transport

Next we make a call to SAAS Communications to arrange transport. They route our call depending on the destination. Within the city and they will send an ambulance to meet us at the Casualty entrance. If further afield means going by helicopter or plane. We will have a conference call with Australian Helicopters (the company contracted to provide rotary-wing services to the Government of South Australia) or RFDS (who provide transport for our fixed-wing missions) so SAAS can find out where and when we are going.

If we go by helicopter they can usually be on the roof helideck within 15 minutes which doesn’t give us long to get everything else ready. As a result we tend to leave phoning for the helicopter until we are pretty much ready to go ourselves. We then phone the hospital security guards who will send up an officer to open the deck and make sure it is safe for us to approach the chopper.

If going by plane, we arrange a mutually convenient take-off time which allows us to sort out other arrangements including booking a taxi to the airport. If we can’d get a taxi on demand there is a hospital car we have access to that we can take instead.

Choosing what to take

We have a variety of equipment, medications and supplies that we can take out on jobs. The standard kit includes a portable monitor, portable ventilator, procedure pack (includes all of the equipment needed to place a variety of invasive lines, tubes and catheters in patients) and resuscitation pack (this carries all of the airway, breathing and circulation equipment and drugs we need to keep a patient alive and bring them back safely). The idea is for us to be utterly independent and capable of replicating an ICU even if the patient is in the middle of nowhere.

Then we are ready to go and fetch the patient. I’ll cover the getting there aspect of a mission in the next posting.

The weather in South Australia is supposed to be predictable, and provide many calm days. Unfortunately this is not the case at the moment and the spring winds, as the season changes, have persisted.

The upside to these winds is the pleasant ambient temperature over the past few weeks. Unfortunately the winds are creating havoc with the coastal waters. Firstly the average swell currently is between one and two metres. Doesn’t sound much, but imagine trying to climb into a boat as it changes position relative to you by more than your height and you will get the idea. Secondly these waves have stirred up the sea bed resulting in some lousy visibility. Thirdly the changeable temperatures are fueling strong currents in the gulf waters which also make underwater activities uncomfortable.

My Nitrox dive has been put on hold more times than I can remember and I’m getting a little frustrated, especially since my new cylinder has yet to be christened. Therefore I’m getting a little twitchy and desperate to get in the water regardless of conditions. Hopefully a dive boat will be going out in the near future as soon as the sea looks a little less like this:

I’m not generally a fan of ringtones. They seem to be incredibly popular, yet insanely annoying. The humorous ditty that seemed the pinnacle of wit when installed on a phone fast becomes irritating, especially if the user receives many calls. Some of my colleagues are guilty of this and vary their ringtone more often than a 12 year old with ADHD.

In an effort to beat them at their own game I recently decided to up the ante a little. The past few months have seen a few sporting disappointments for the Aussies and as such some feel their national pride has been dented. Seizing on this opportunity I decided to show off my patriotic roots too with a range of ring tones designed to appeal to every red-blooded Brit, recorded at The Last Night of the Proms.

So here for you all to share are a selection of true blue ringtones in mp3 format. You will obviously need a compatible mobile if you want to use them. I’ve included them as embedded audio files and downloadable links. Just a word of warning, the volume level is pretty high, so they will be audible on a mobile phone.

Land of Hope and Glory

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Jerusalem

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Rule Britannia

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Many people I’ve talked to think the world of medicine is a glamorous one. They see the hectic excitement in Casualty, the smug assurance of Diagnosis Murder, or the egotistical clashes of Holby City. These dramas often put the medical profession up on a pedestal, in portraying hero figures amongst the chaos. They also show the extremes of work and case load. Fortunately this couldn’t be further from the truth otherwise we would all be burnt out within days.

However if you want to see a far more realistic portrayal of what it is like to be a junior doctor in a busy hospital then I’d recommend watching “Scrubs“. For those who haven’t seen it, the series follow a doctor, and his friends, from graduation to achieving specialist status. Being a comedy, there is a lot of tongue-in-cheek flippancy, but the most accurate aspect is the lead character’s awkward rise through the ranks. He displays hesitancy, incompetence and crises of confidence. And in his discomfort I saw a lot of myself. Learning to trust oneself when lives are on the line, and discovering how to haul oneself out of the poo is a winding and often difficult route. If I didn’t know better I would assume that the writers based J.D on me. Do watch it and you will get the idea.

One other morsel of information may also surprise and somewhat unsettle you. Regan once asked me what reference material we use when needing to research an obscure medical condition or drug. I wanted to say we use one or other textbook, or sift through a prestigious peer-reviewed journal. Unfortunately this would have been a lie. Instead we use …. Wikipedia …. or …. Google. Sorry to shatter the illusion, but we don’t see the point in digging through impenetrable text when we can get the same information quicker. After all there is a principle that having the knowledge isn’t enough, you have to know how to use it. But next time you want to find out something medical, rather than worrying about bothering your doctor, why not use the same reference they do and go Google it!

Every week, on Wednesday, we have tutorials as part of the teaching component of work. It is designed to get us successfully through the Intensive Care Medicine fellowship exam. These tutorials take the format of what we call “hot cases”. In other words we are asked to assess one of the patients on the unit and present our findings and a synopsis of current problems and our suggested management plan. To make things harder the patient will be unknown to us prior to this test. This makes it a good facsimile of the actual exam setting.

Now on the face of it this may sound easy. After all we assess and present patients every day. Identifying problems and formulating a solution again should be bread and butter stuff. This should especially be so for those of us who are reasonably experienced in ICU.

However, even in this relatively friendly environment it is amazing how much you go to pieces. The cliche of rabbits caught in the headlights tends to be banded about, but it describes the feeling of scrutiny frighteningly well. It’s also amazing how a brain that normally makes graceful mental leaps and almost subconciously comes up with answers can utterly abandon you under pressure.

While feeling like a complete cretin this afternoon, after a tame grilling from two of our consultants I had to reassure myself that there are many months until the real thing to prepare. It also helped a little to know I wasn’t the only one feeling the pressure, as a couple of my registrar colleagues felt the heat too. Still, it didn’t make me feel any less stupid.

As Homer would say:

Credit to Green Day for this title.

In the past few days Regan and realised that we have, quite unintentionally, not been having any alcohol. We, like many people, tended to have some wine, beer and spirits around the house most of the time. I used to treat myself to at least one glass of wine, or shot of Scotch pretty much every evening. This was as a cathartic mechanism to signify to myself that the stress of the day was over and that it was time to relax. Of course the biochemical effects of alcohol complement the psychological benefit.

There are real gains and advantages to regular, moderate alcohol intake. Not least the reduced incidence of diabetes, coronary disease, osteoporosis, and overall mortality. These improvements in health are only seen if alcohol is taken in moderation and this may explain the good health despite high incidence of smoking in Mediterranean countries.

I did become concerned a few months ago whether I was becoming dependent on alcohol. I hasten to add that this was never remotely at risk of spilling over into addiction as the different is marked. However I did notice I was starting to crave that evening “settler” on at least a psychological, if not physical level. At one point my OCD/neuroses even lead me to take the CAGE questionnaire, but fortunately I didn’t score highly enough to flag concern.

The acid test never came and we have barely had more than a bottle of wine between us over the past 3 weeks. And it all happened unintentionally. We simply ran out of wine and were both too busy to make it to the off-licence. Now we’re on the wagon I’m not sure where to go from here. I can’t ignore the wealth of medical evidence showing a benefit from regular low intake, but the reduced risk of hypertension and the loss of empty calories from ethanol is also hard to discount. Perhaps we can find a happy balance - easier said than done since the risk:benefit line is hard to pin down.

No, I’m not talking about Homer’s despised “wuss rock” act. Instead this is a reference to my latest diving toy.

Like most scuba divers, to start with I hired most of the equipment I needed. This is fine up to a point as hire outlets tend to keep their stuff well maintained, but it does wear out quickly, and you have to share with other divers. There is a strong incentive for owning your own gear. Partly because it acts as an incentive to use it regularly, and also as you can set it up per your preference and keep it that way.

Until recently I had pretty much all of the necessary equipment barring an air cylinder. Today that changed and my magpie gene was satisfied again with a 15l steel Faber tank.

Now there is good reason for getting this shiny thing. I’m in the middle of obtaining my Nitrox qualification which will allow me to use gas mixtures with more oxygen than atmospheric air. This comes in useful when wanting to make prolonged and/or frequent dives with a reduced risk of the bends.

Unfortunately the weather is conspiring against me at the moment, and the practical part of my course is on hold. Time pressures and roster clashes have also prevented any recreational dives with any of my dive buddies. So at the moment I’m getting a touch of withdrawal symptoms from lack of underwater exposure. Hopefully the weather will improve as summer draws on and I’ll get to try out my complete kit.