It's September 1 in Australia, and I'm longing
for the sun after a cold and rainy August. Although it's considered the first day of spring here (Australians do not adhere to the lunar calendar as Americans do), the sky is gray and it reminds me of my hometown of Seattle, Washington.
I'm one of the four original PAs involved in the South Australian Department of Health PA pilot. This month marks 22 months that I have been here working as a PA for the Department of Anaesthesia, Pain and Hyperbaric Medicine at the Royal Adelaide Hospital in Adelaide, South Australia. As part of the Perioperative Anaesthesia Care Team (PACT) developed specifically for the PA pilot, I see patients pre- and postoperatively who are at risk of perioperative events and complications. The following represents a typical day for me.
8:30 AM
Simply the time I arrive at work reminds me of how different practicing medicine is in Australia compared to in the United States. As a surgical PA in Seattle, my day usually started at 7:00 am. Here, the relaxed attitude toward almost everything allows a bit more rest in the morning, for which I admittedly am thankful. I grab a cup of coffee and check the emergency surgery schedule. Patients are triaged and placed on this list in order of urgency and then tracked by a running clock.
As the largest hospital in South Australia, the Royal Adelaide Hospital serves a rather large region. As usual, a number of elderly patients with hip fractures arrived overnight and will require a tune-up before heading to theatre (the operating room). After determining the priority patients with one of the emergency anaesthetists (anesthesiologists), I head out to Q3, one of the orthopedic wards.
My first patient is an 85-year-old female with a history of chronic atrial fibrillation (AF). I read in her charts that she fell while walking to the shops (mall). This term is reminiscent of the noticeable differences in the spoken and written language here, even though Australians and Americans both speak English. The patient appears to be quite confused despite no history of dementia and is currently in rapid AF. A day earlier, she had been given a single dose of digoxin to control her heart rate. However, the intern did not order her regular metoprolol dose, causing her heart rate to convert back into a rapid rate. With a current heart rate of 130 beats per minute, we need to rule out ischemia and control her rate before sending her to theatre. I organize how to handle this with the patient's home team and arrange for third party consent from her daughter.
After spending a significant amount of time with the patient and nurses and speaking to the daughter, I realize how long coordination of care does actually take. I make a mental note to place this patient on our list for postoperative follow-up. My colleague, who joined me a year after the pilot began, is doing the postoperative rounding this week. As part of PACT, we essentially function as anaesthetic outreach, providing the home team, nurses, and allied health staff with an additional resource for patient care outside of the theatre. With doctor shortages in Australia being such a hot topic, this added support is essential for maintaining quality patient care. However, it is not without its own controversy, as this extra care is currently being provided by PAs.
10:30 AM
My second patient of the day is a 57-year-old male scheduled for a relook laparotomy. After a terrible hospital course, he is being intubated in the intensive care unit (ICU) and will be undergoing his fourth abdominal operation today. The anaesthetists are familiar with him but need an update on his condition. When I arrive in the ICU, his sister, who has flown in from Sydney, is whispering in his ear and holding his hand. I receive an update from the nurse and review his chart, x-rays, and recent labs. Then I listen to his heart, lungs, and abdomen. His condition is grave, but surgery is necessary.
As I head to the theatre to update the anaesthetist on his condition, I reflect on being so far away from my family and friends. I have been in Australia for nearly 2 years, and even with advances in communication such as Skype, distance is still an issue. This experience has been invaluable to me, but my family, friends, and I have all paid an emotional price for me to be here.