I have entered the homestretch of my time here, with another ten days on the general medical service, then a bit of time for travel prior to heading back to the States. Due to the somewhat strange call cycle here, I was accepting all general medical patients for three out of four days last weekend, so my service ballooned from a manageable eighteen patients to a rather more unwieldy fifty. The typical day on a general medical service is basically the same here as in the US - it starts with a ward round, where my intern and I check in on each patient and plot out the day, prioritizing what needs to be done. For each patient on the ward round we chat with the patient, see how the night was, do a physical exam, review labs and medications, make a plan, write a note and orders for the day, answer questions from the patient and family, and communicate with the nursing staff. When I was a medical student, I remember budgeting forty-five minutes for each patient in the morning, which seems insane now. These days, when I am really cruising, it’s possible to accomplish all of this for a single patient in four or five minutes, at least if the patient as no complicated medical issues. But with fifty patients, of course some are inevitably complex, requiring active management and lots of time at the bedside, and it becomes very, very challenging to stay on top of the changing status and needs of two score and ten individuals (and this is further complicated in a place like Darwin, where alcoholism and tobacco abuse are especially rife, so on every call day I admit multiple medically similar patients – smokers with chest infections and alcoholics with complications of liver disease). And I’m not sure it’s an art, but it’s at least a life skill to maintain an appearance of unhurried calm with each individual patient, as well as with nursing and ancillary staff who all need my time. It’s tough at the end of the day to avoid feeling like I must have missed something, and probably no one was that satisfied with the quick care received.

Of course, all patients eventually leave the hospital (and no one left pulseless last week), so after a few days the service started to dwindle, and my intern Harish and I stopped looking at each other and saying, “Wait a second…. John Smith…. Who is he again?” Now we have a census back down in the twenties, and everything starts to seem easier. I have time to really read and think about whatever is wild and wonderful on the service this week - Legionnaire’s disease, erysipelothrix endocarditis, Machado-Joseph disease, and ascending aortic dissection are the new diagnoses of four of my current patients (well, except the man with the dissection, he’s on a med-evac flight to Adelaide for emergency surgery).

My social life has picked up a little bit, too, perhaps inevitable even for one as retiring as I. I received an urgent call on Saturday morning that it was almost time for a big cricket match between the Menzies School of Health Research and the Center for Disease Control, and would I like to come along? I understood this as an invitation to spectate some cricket; I did not grasp that I was being asked whether I was competent to fill in on the Menzies team. In fact, this crucial distinction was not clear to me until we actually arrived at the field – err, pitch – and I was instructed to proceed to silly point. As is often the case as a medical resident when faced with an unusual situation requiring an appearance of proficiency, I decided to just fake it until I could make it (or is that AA’s slogan?). I established myself confidently on the pitch – unfortunately nowhere near this purported “silly point”, and it just unraveled from there. Thankfully, the overall level of athleticism on the field what was you might expect if asked to envision a group of medical researchers, PhD students, and laboratory staff. And Nick, who had asked me to play in the first place, confided that he met his wife when she and he both joined a cricket team that was founded as a team for people who were so bad they would never be asked to play on anyone else’s team. So in the end I even managed to contribute to a winning effort, and I assure you that no one has ridiculed me for being struck out (no doubt the wrong term) by the seven-year old daughter of one of the senior faculty. She threw a googly, what was I supposed to do (run, apparently).

I’ve also been out for a few barbies with the other hospital staff. And I finally ventured out to the nude beach, after I learned that you don’t have to be nude yourself to go out on the beach. I reckoned I should check that scene out, how could I spend my entire time here several hundred meters from a nude beach and never look over the dune. What I saw may shock and amaze you. Or maybe not, if you already knew that: 1) grown men fly kites, and 2) grown men fly kites naked, and 3) when there is not a brisk breeze, sometimes grown men of dubious physical conditioning must jog to keep their kites aloft. I had a short stay on the nude beach.

Next weekend, I’m off to Sydney for some tourist action, then back to Darwin to greet my lovely bride as she arrives fresh from a few months of high-intensity parenting (and full-time wage earning, and moving into our new house). It’s even our sixth wedding anniversary the day after she arrives, so I’ll have to get her a new iron or something.

(waiting for the lightning bolt to strike)