Carrick to Calgary

It's nearly midnight again, at the end of a long and eventful week. How come I always end up blogging at the midnight hour? Anyway, we had a good evening tonight, with chips and dips on the deck in glorious summer sunshine, and later homemade blueberry crumble for pudding. And then Richard & Emma called round - they were watering the garden for our next-door neighbours while they're away for a bit, and they knocked on our door to see what we've done to the inside of their old house! We ended up sitting on the front step, shooting the breeze as the sun went down over the Rockies - very nice!

I've really started to settle into work at the hospital, and am getting more time to read the recent literature on some big surgical cancer topics and (more importantly) some time to think about what sort of surgery I want to do and what research projects I can get going while I'm here. I've already made some progress this week, making a few new connections in my brain and I've got several topics that I'm reading around and getting quite enthusiastic about. This time element is what's lacking in UK surgery - you're so busy keeping the service running that you don't have time to keep up to date with new developments.

I've done 3 weeks of Radiation Oncology and have one more to do before I do a month's Pathology. I've also started to 'tweak' my rotations a bit, deciding what I want to get out of my time in each specialist area and speaking to the appropriate people to arrange this rather than just 'going where I'm sent'. This approach seems to be paying off, and it's good to have this kind of flexibility and get to see the procedures I really want to see here.

My month in Pathology is slowly taking shape at the moment too, and it looks like I'll be spending 3 weeks at the Foothills and 1 at the Peter Lougheed Hospital. I'll also be involved in writing up a paper of some sort too, so more details on that when I know...

The 'salary issue' hopefully pretty much sorted out at the moment, although I imagine there'll be a few more bumps in the road next week before the money is actually in my hand. It's really a case of the hospital bureaucracy gone mad. It's too detailed (and tedious) to go into in any detail, but suffice it to say that the problem relates to my doing on call in the hospital to provide me with living expenses. I'm registered with the appropriate medical authorities in Canada, but the issue seems to be which 'code' I am registered on. One code allows me to be paid, and the other doesn't and here lies the crux of the matter. My code has been changed this week to allow payment, and I've got an email which confirms they will pay me, so I'll just keep working (and claiming payment) until I'm told otherwise. Even if it's an ongoing problem, I should be able to apply for full Canadian registration in Feb 2005, which will allow me to bill for doing operations, etc. and should provide a nice income boost. My colleague is an ENT surgeon from Zurich who is in the same boat as me, but although the hospital will pay him it seems that they don't want him to work in General Surgery as he is here on an ENT fellowship rather than General Surgical Oncology, as I am. He can't work on-call as an ENT doc, and they won't let him work as a General Surgeon, so at the moment it's a bit of a deadlock and he has no income at all. He's living on his own here in a 2-room basement flat at the moment, and his wife is back home and is pregnant too, so if the money issue isn't resolved soon, he says he'll have to go home again, which would be a shame. Hopefully I'll have some better news next week...

More info on my night on call: I was on-call as the junior resident (like an SHO back home), with a medical student (i.e. JHO) on below me and a senior resident (registrar) and staff surgeon (consultant) on above. The medical students are pretty good, but aren't able to make any decisions or prescribe any drugs, so I have to do all of that. The resident and the staff guy are there to decide who we operate on and to do the operation. Although, as I'm a Fellow, I'm actually senior to the senior resident, so I seem to end up taking the resident through the case while the staff guy observes. Go figure, as they say here...

0800-1100: 3 hour ward round. Bit difficult as I didn't know any of the patients, but I kept a list of 'what needs doing' for later on. Eyes and ears open, gub shut on the first day, I say.

1105 Started to enter 'patient orders' for the first time on the computer system, which is all new to me. These are basically instructions for the nurses on each patient. Do this blood test, give this drug, etc. Might be easier to just talk to the nurses, I say, but 'when in Rome'...

1107 Called away to the ER to see an elderly man with a very sore tummy who is going down the tubes fast. Decide we need to open his tummy up, so make arrangements for this. Also called to assess another patient while I'm in the ER.

1200-1300 Running around the wards, prescribing painkillers, correcting electrolyte results and placating nurses. Bleeped constantly. I can only survive because the nurses tell me what to do, as I'm unfamiliar with basic Canadian ward practice and don't know the trade names of common drugs.

1300-1500 In operating theatre ('the OR', or 'operating room')

1500-1530 called to ward to see patient with low blood pressure. Not too bad.

1530-1545 grab 'lunch' (coffee and a bun)

1545-1700 back to the OR

1700-1900 running around wards and ER again. Bleeped every 4-5 minutes or so.

1900-1920 get to sit down and have some soup and a sandwich for my tea

1920-2200 back to the ER again to assess another patient, plus running up and down to the wards

2200-0700 whole night in on-call room. Phoned about every 1/2 - 1 hour during the night, but nothing serious. Longer call at 0430, but don't have to get up.

So not too bad after all, especially if they end up paying me for the privilege! Apparently there are other nights when you're on-call as a Fellow alone, with no senior resident to help, and these nights can be a bit more intense, but hopefully I'll not be doing any of those for a while.

STOP PRESS.... STOP PRESS... Mum and Dad are coming to visit for 3 weeks - THE DAY AFTER TOMORROW! They always said they were coming to see us soon, but we didn't expect it to be this soon! It'll be great to see them again, and the house is all ready for their arrival - they even have a nice bed! It's going to be a fun 3 weeks, and I've asked to be off-call for the weekends while they're here so we can get out and about a bit while they're here. Maybe I can even talk Dad into posting his first blog from here...

Anyway, nighty night for now...

J

Too tired to write much tonight... I've now completed my very first night on call as a Canadian resident in general surgery. I'll write a bit more tomorrow, but suffice it to say that both I and my patients survived the night, I did a bit of operating and that North American surgery is rather like UK surgery after all.

It's the little differences that are going to take the most getting used to - the instruments having different names, having the scrub nurse 'gown and glove' you, having to take your wedding ring off to operate (really not happy about this one), etc. It turns out that I'm also responsible for providing ward care at the most basic level, prescribing painkillers, sleeping tablets, getting dopey calls all night long, etc. It's a bit like being a houseman all over again and I spent the day feeling a bit like I'd rewinded by 10 years. Then when I was operating, I was often showing the senior resident how to do the procedures, as I'm the Fellow during the day and I'm a good bit more experienced than him. It's all a bit confusing, but I suppose it's a good way to get used to the system 'from the bottom up'. I spent a lot of time in the ER too, assessing various patients, and I can assure you that it's not quite as exciting as it looks on ER on the TV!


Not me

Anyway, I got some sleep, but those 04:30 phone calls really take it out of you, so I'll sign off now and write more tomorrow.

Oh, one more news item - due to an administrative slip-up, at the moment the hospital says we're not going to get paid for doing our on-call, which more or less leaves the overseas fellows without any income!! I don't mind doing on-call, but not if it's a 'freebie'! Hopefully we'll have some good news on this over the next day or two, or else we'll not be doing any on call at all!! Good thing P's got an income, after all!

[Seriously, though, this should be sorted out in a day or two, so don't worry...]

Night all,

J

P here - its been a while since I've written, but even though I'm not working, I seem to be able to fill my days up with no bother at all. If you asked me what I did, it would sound extremely boring, but I have to say I'm sort of enjoying the mundane things in life, such as washing, ironing, cleaning, cutting the grass, deciding what to have for dinner etc. My mum reckons I'm only enjoying it because I know I'm getting back out to work again within the next couple of weeks, and she's probably right. Speaking of which, I finally have my work permit... but not without a little anxiety and worry that it wouldn't happen. I had had a little bit of trouble communicating with the Canadian High Commission in London, as they will only accept communications by letter or fax, and they will not communicate by email or phone. I wrote to them in early May to ask whether I should apply for a work permit before travelling to Canada as Mr White's 'accompanying dependent', or whether I should wait and apply from within the country. I heard nothing until the Saturday we were due to fly out, when I received a note saying that I MUST apply before I left the UK. This caused all sorts of panic, not least because they wanted CAD$150 to process the application, and they would only accept a bank draft - not the easiest thing to source on a Saturday morning!! The application form was duly completed (including my CV, two photographs of me and him, a letter outlining the job I had been offered, a copy of my passport identification page, but no bank draft). The draft was ordered by telephone banking with the Halifax, and it was due to arrive on Tuesday of the following week. Denise was (yet again) asked to come to the rescue, and was to post the application form and draft as soon as possible. Needless to say, this threw me into a complete panic as the application would not be received by the High Commission before I left the country...

Anyway, as you know, they let me into Canada as Mr White's cling-on, and we heard nothing more from the Commission until some time around the 4th July, when they EMAILED to say that they had received my application but they needed me to confirm BY FAX (not email) that I wasn't going to work in childcare or education. A couple of days later, we received half a fax that implied that my work permit had been approved, but no letter...so we faxed to say that it hadn't arrived...they faxed another page, but still not the all important letter,,,we faxed to say that it hadn't arrived, and then we got my fax back with a scribbled note to say that the letter was in the mail. The mail between UK and here is not the fastest (understatement of the year!), so we had to wait another 7-8 days for the letter to finally arrive. When it did come, there was another scribbled note with it that said "You must leave Canada via the nearest Port of Entry; present your work permit to a customs or immigration official, and re-enter Canada with your change of status, as a worker".......

With regard to officialdom like this, I tend to be a little bit of a sheep and think that I must do exactly as I am told. So, I dutifully hoked round the net to see where our nearest Port of Entry was (5 hours drive south to Montana, or a CAD$600 return flight to Seattle). Thankfully though, Mr White is somewhat less in awe of authority than I am, and he managed to phone Canadian Immigration at the airport and got to speak to an actual person (rather than a series of automated messages), who said that she would look into the circumstances surrounding the application for the work permit. She then phoned me, asked a few questions, and then (wonder of wonders) said that if I came to the airport the next day, she would be able to issue the work permit there and then and that I wouldn't have to leave the country after all! So after all the worry, I now have a work permit that allows me to work in any occupation (except for childcare, education or the medical profession) for any employer, right up until 30th June 2006 - thank you to Canadian Immigration. So, it looks like I'll be starting work at the Cancer Board on 3rd August....

Anyway, back to P and J's adventures on the roads of southern Alberta... we set off yesterday with the intention of going to Bragg Creek and (breaking one of our recently formulated rules of travel), deciding where we would go next when we got there. On the way (breaking yet another rule of travel), we stopped into Rona to buy a fan for the bedroom. Most unusually for Calgary, the weather is really hot and even slightly humid, which makes sleep a little difficult. The previous night, the temperature didn't drop below 20 degrees C, and even with all of the windows in the house left open, there wasn't a breath of air to be felt. (By the way, we can keep all of the windows open without any fear of insect attack because all of the windows are fitted with flyscreens.) I think that Rona did a great trade in floor fans yesterday, as even in the short time that we were there, I counted 4 other people buying them!! We then headed up highway 1A towards a small town called Cochrane, which used to be the cattle ranching centre of southern Alberta. The guidebooks are a bit insulting about the town now, and most of them tell you that it is nothing more than a dormitory town for Calgary. Given the amount of new houses being built on the outskirts, this may well have some truth to it, but we thought that the centre of the town was worth a visit. I don't know how authentic the buildings on the main street are, but they're done up to look old, and we thought it was pretty effective. They also have some lovely shops - antique shops, a great kitchen shop (where we had to buy a new garlic press - I broke my 'Good Grips' one on Friday), loads of small restaurants, craft shops, etc etc.

Here are a few pictures of the main street:





We bought several bottles of water, and Mr White's latest road atlas (all of Canada - which joins our atlases of Calgary, Calgary and surrounding areas, Southern Alberta and All of Alberta) and then headed further down the road towards Bragg Creek. When we got there, we weren't terribly impressed. Everyone told us that Bragg Creek was lovely, but we both thought that it was a little 'touristy', with most of the action seeming to be centred on a couple of shopping centres. In fact, in contrast to Cochrane, there didn't seem to be a lot of structure to the place, and it looked like it only existed to sell things to tourists, rather than being a town in its own right. Anyway, we got something to eat (one sandwich and one piece of cherry pie - which we shared - two sandwiches being enough to feed a family of four!!), and started to head out the road towards Kananaskis Country. At this stage, we had about a quarter tank of petrol, and remembering that Canada is a very big country(!), we decided that we should get some more before heading too much further. Needless to say, we had already passed all the normal gas stations and thought that we'd have to go back into Bragg Creek. However, we came around a corner and found a small shop with a very old 'gas pump' standing outside. We thought maybe that it was for decoration only, but rather than turning around, we stopped and asked whether it actually dispensed petrol. Strangely enough it did, and we were able to get about 5 or 6 gallons....



Its not a great picture, but I think you get the gist. Basically, the lady came out and hand pumped 5 or 6 gallons of petrol up from a storage tank in the ground, into a glass reservoir at the top. The glass reservoir was marked off in gallon gradations. Then, when the desired amount of petrol was pumped up, it was fed by gravity into the car's tank...

Having refuelled, we then felt confident enough to head off into the wilds of Kananaskis. Kananaskis is where Calgarians go at the weekends. I had never heard of it before we got here, and had assumed that Calgary headed to places like Banff and Lake Louise at the weekends. But no, they head to Kananaskis. The first place we stopped was Bragg Creek Provincial Park - forest, walking trails, picnic tables, and most importantly, the river. When you haven't got a seaside to go to, the rivers take on an important role... I think that a big proportion of Calgary was in that park - it looked like people had packed up their families, their picnics, their swimming costumes etc and had staked out a picnic table for the day. People were paddling in the river:






While others were jumping in to deep pools, others were floating in tractor inner tubes... (no, not us this time!!)




The weather being so hot, our feet dried off pretty quickly and we then headed on up to the end of the road. Well - I say the road ended.... but it didn't really....we just didn't feel that the poor old Civic would like us to go any further...




so we turned round, and came back the way we had come, this time stopping off at various viewpoints along the way:






and finally, by special request, a lovely view of the whole car (rather than the back half and the front half that appeared on earlier pages)





So...that's about it for the Saturday road trip. Its now Sunday, and Mr White is doing his first ever 24 hour stint on call at the hospital...we'll let you know how that goes...



On a completely different matter, I thought I'd update you on a few other differences between here and home:

We came across a sign yesterday that said 'Texas Gate':



I thought it was a place, until we rattled rather hard over a cattle grid in the middle of the road - so for future reference, a Texas Gate is a cattle grid...


You know how we think Americans like to do everything bigger than we do.... Canadians have a tendency towards the same sort of thing.

Here's a picture of some of the shopping (note the Denby coffee cup in the front of the picture to give you an idea of scale)



Finally, Kananaskis country isn't total wilderness - there are public toilets dotted about all over the place. Mr White wonders why I rarely use public toilets...




So - on that lovely note, I'll go...

More later...

Just a quick post tonight from a hot and sultry Calgary evening. The temperature's been touching 30 degrees (oC) today, and it hasn't really cooled off yet (it's after 11pm). All the windows are open and we can't get to sleep for the heat. After teatime the sun was shining on the front porch and the thermometer there was reading 38oC - WOW! Apparently it's now too hot for thunder and lightning, if that makes any sense. So anyway, it's HOT!

Yesterday was Dad's 60th birthday and P's 30-something-th birthday, and we had celebrations on both sides of the Atlantic. The new eMac arrived in perfect time (as carefully planned, thanks to TNT) and the webcam worked a treat - it was great to see everyone from home and to talk to mum and dad normally for a change instead of having to 'press the button to talk' on the useful-but-clunky iSPQ Videochat software. Everyone seemed have a good time at the birthday dinner, and we're really sorry we weren't there - here are some pictures which were beamed across to us yesterday:


Poppa Sam and the 3 degrees


The White Clan at the Cafe Milano (cameraman Simon)

P also had a wee party, and I arranged to go in to work late so we could have a birthday breakfast and official present-opening and then to come home early so we could spend the afternoon together. I had managed to convince her that she wasn't getting any 'stuff' for her birthday (we had agreed to go out for dinner and have a weekend at the hot springs in Banff instead, as we are now officially poor!), so she was pretty surprised when her presents appeared! She also got some lovely flowers from her mum & dad.



We ended up going out for dinner anyway, to an Ethiopian restaurant called 'Marathon' downtown - pretty good food but no knives and forks (you use small swatches of bread to pick up food from a big communal platter). We got soaked on the way back to the LRT (the "overground subway") by a passing thunderstorm, but it was worth it for the experience!


Dinner Ethiopian style (note the floppy dishcloth-like bread -and this is a plate for two, not just for P(!))


A wet walk home (I didn't bring a coat, of course)

And in other news:

Here's my new hat (it's actually an Australian-made hat, but it's quite the thing around town at the moment and it cost 60 dollars)



And here's me in my hat (I'm saving up for the rest of the cowboy gear - belt buckle next!)



Our sofas arrived like this:





and are now like this:



Hope Granny Brown in enjoying our old sofa chairs - P had been dying for a new one for YEARS!

We also got a new rug from mum & dad via IKEA - many thanks!





Oh, and lastly I had a little accident with the wooden chopping board and one of the electric rings this week, so now the board looks like it's been branded by some over-enthusiastic cowboy:


Whoops!

Weekend preview- Off to Bragg Creek in Kananaskis tomorrow and then on-call all day (& night) in the hospital on Sunday [I won't know what's hit me, probably!]

Now if we can just get to sleep in all this heat...

Love

J (&P)

Weatherman J here again, with images of last night's thunder and lightning show!

First, the hail covered the deck:



And then the storm warning came on the TV during the day's Calgary Stampede RoundUp Program (note the cowboy doing the steer-wrestling!):



It wasn't quite 9pm, but the sky got dark all of a sudden with dark clouds swirling around and those weird strands of cloud hanging down to the ground like teased-out bits of cotton wool:



One minute it was dark:



and then the lightning lit the place up like daylight a second later:



And then the real lightshow started (these images are lifted from a video clip):











So there you go!

Weather today a little less eventful - hot all day, clear blue skies and no electric fireworks (yet). It's about 10pm here and it's still warm. Oh, and P has her work permit in her wee hot hands right now, and all without having to go to the USA after all - it's a long and surprising story, but I'll let her fill you in (she's promised to blog tomorrow)

A few more images from me, taken with the phone cam:


Me in my white coat - seems to be required here, as everyone else wears one, but I'm trying to lose mine ASAP, as I haven't had to wear one at home for years [in the UK, only medical students ever wear them]


My office (well, actually my corner of an office, shared with 3 other surgical fellows) - P's will be much nicer (& bigger!) than this!


We have discovered our local wine shop - very important indeed!

Lastly, just to give you an idea of the size of Calgary, here's a composite photo taken from the Canada Olympic park, looking north over the Transcanada Highway (which goes right across the whole country and right through the heart of Calgary). We live in Tuscany, on the extreme left, and the downtown is on the right, about 30 minutes away on the highway.



If you want to see the big version, click here

Just to give you an idea where we are, here's a small map of the city:



We're the red dot up in the north-west, the green dot is the Olympic Park, the blue dot is work, the yellow dot is Nose Hill Park, the downtown is in the middle and IKEA is the orange dot near the airport!


That's all for now - tomorrow's gonna be a big day, July 15 - two big birthdays to celebrate in 2 different timezones... Hope the presents arrive in time...

Love J

It's late Tuesday night here and we've just been in the middle of the biggest thunder-and-lightning show you ever saw! It's been hot all day, up to 25oC, blue skies and sun all morning and then some light clouds which came and went in the afternoon. At 7pm, there was some hot, light rain that just appeared out of a clear sky. Then at 8pm the TV stations started broadcasting a Severe Weather Warning for thunderstorms... The storm came out of the west, from the Rockies and rattled around for 10 or 15 minutes a mile or two away, with the usual lightning and distant thunder we've come to expect. When the interval between the lightning and the thunder got small (1-2 seconds), the house started to shake with the noise and we unplugged the computer just to be on the safe side. After another few minutes, the storm seemed to pass and all was quiet - the blue sky returned and the evening sun came out again. A couple of minutes later, we heard a few thumps on the roof and jumped up in time to find that we were in the middle of an intense, heavy shower of hailstones, each about 2cm across bouncing off the deck and turning it white like snow! I tried to go out to see what it was like, but it was actually too heavy for me to get out the door without getting hit by the hail! The house was roaring and rattling with the noise of hail hitting it... and then 2 minutes later, it stopped as suddenly as it had started, the sun came out again the hail melted like it had never been.

A couple of hours later, just at sunset, the storm returned again with a sudden increase in the temperature and even more impressive lightning, lighting up the neighbourhood like it was daylight. And this time, the lightning was firing constantly from the clouds, striking the ground every few seconds and flickering horizontally around the clouds. It kept on like that for maybe 30 minutes, rattling around just above us before drifting off to the north. Assuming that it's maybe coming back again during the night, the computer is still unplugged, so I'm blogging wirelessly from the laptop and we haven't been able to upload any of our pictures of the hail. We also took a few short video clips of the lightning, so we'll take a
look at them tomorrow and see what we got. Apparently this sort of weather is normal for July in Calgary. Photos tomorrow, anyway.

And in other news...

P got her work permit approval today, so we won't have to starve on my pay after all. No doubt she'll tell you more about her adventures with Immigration Canada, but we've been told she may have to leave the country to get her work permit issued. She's going to see the immigration people tomorrow morning for more info, so watch this space...

Our sofas arrived, so our furniture is just about complete (although we still need a rug or two)! They're huge, and really comfy. More photos tomorrow...

Work proceeds apace, still in Rad Onc for another 3 weeks. Starting to get into the swing of things now... First night on call (Sunday) will still be an big learning experience, but it's all grist for the mill, and I have been doing this surgery thing for a long time now - how different can it be here? (famous last words)

Anyway, off to bed for now - got to be up at 05:15 tomorrow for a 07:00 round.

Oh, and then the day after tomorrow is the big Birthday day! Watch this space...

You know how you take things for granted - the way things are done at home is the way that things should be done...?

Well, when it rained here the other day,



I noticed that the drainpipes don't have any drains or gratings below them for the water to go away. In fact, they have a very strange arrangement where the drainpipe at the side of the house can be hooked up, or unfolded to let water run down the grass at the side of the house. At the risk of the neighbours thinking I am very very strange, I went out in the pouring rain to take a picture so that you can see what I mean:



Given the amount of rain that we've had last week (with the exception of the weekend), it has made for very soggy ground beside the house. Maybe this amount of rain is unusual - we'll see...


Not only does it make for soggy ground, but with the heat that is now staring to kick in, the grass keeps growing... therefore we have purchased a lawnmower. We thought we'd have to splash out on a petrol monster, but we found a very nice Black and Decker electric job (which we can plug into one of the 6 grounded power outlets on the outside of the house), and it does a good job:




I think this amount of grass growth is unusual - when we were at Dr T's house on Saturday, he said that his ride-on mower has a thing that counts the number of hours that it has been used. In all of last year, it was used for a total of 8 hours (can you believe that?!), but this year, it has been used for 20 hours already. We were promised that the grass would go brown and stop growing pretty shortly, buts it not showing any signs of stopping...


Yesterday, we got up to find several large hot-air balloons drifting past the house - I'm not sure that views of scenic Tuscany (our estate) are what the people paid up for but there you go...




Calgary is a very equitable city - you can busk for money, but only in designated places, and only for a certain length of time in each of those places. The city holds auditions each spring, and only those judged good enough will be given a busking licence, which enables them to busk at a busk-stop (seriously!!)




Some days we have mountain views:



and some days we don't...




but today we do, and I'm now going outside to the deck to read (bliss!!).

P