Page 38 - ANZCP Gazette-August-Booklet

Despite working in an ECMO centre in the UK, QCH had a much more extensive and active program. I was accustomed to the use of the Levitronix centrifugal system and Hilite MPPM oxygenators. Instead I had to become competent with the Rotaflow and Quadrox, and the use of a haemofilter in all circuits, rather than attaching CVVH if filtration was required. The ECMO service used a hybrid approach as I had been accustomed to in my home unit, with specialists undertaking the day to day bedside care. I was particularly impressed by the inclusive nature of the service, where surgeons, specialists, and perfusionists were invited to attend daily ward rounds to discuss treatment and offer their opinion without judgement. Back in Birmingham, aside from technical issues on the circuit, once safely established onto support, our involvement was very little, and our opinions or inclusion in the ongoing care rarely sought. Despite not being able to go on any transfers myself, I was able to observe on a couple of occasions the packaging up of a patient for transfer both to a different hospital within the Brisbane region and also for a flight to Melbourne. This was truly impressive with every last detail considered. In the UK it is pretty unlikely to have a transfer by plane as everywhere can be reached in a relatively short time by road....unlike the expanse of the Australian continent.
One of the main aspects of my new place of work I found to be the most refreshing was the surgical approach to a work life balance for all persons in the team. Back home I was accustomed to the daily grind of finishing several hours late every night without fail, even on days I wasn’t on call. It was fairly routine to undertake a 1st Stage Norwood on a Saturday, quite possibly to give the surgeon an excuse for not going to the supermarket to do the weekly family shop! Constant short staffing meant lots of on calls, and ignorance of the working time directive and recognised rest periods before duty when called in during the night. This is not to say the unit did not work hard, it certainly did, but whether it is down to NHS pressures or just a UK attitude, it was fair to say the work life balance was much easier to achieve and the welfare of the team given much more consideration.
I would love to say I returned home and was able to introduce some of the new methods and approaches I had learned, but unfortunately this was not to be. The surgeons I worked with were interested to hear of my experiences and I do believe it did influence their temperature of choice, suddenly undertaking more operations at 32°C rather than 28°C .......but alas not brave enough to attempt normothermia! From a perfusion perspective, little changed as the remaining team were uninterested in hearing of anything I had experienced, even if it would improve their practice. My frustrations at this became palpable as I knew there were strengths in our current practises but also weaknesses. If patient outcome can be improved then why would we not consider how we could change our approach rather than relying on 30 year old practises? Unfortunately this was not to be and ultimately I was compelled to seek authorisation from the surgeons to make small but very effective changes in my own practise alone.
Despite my homesickness, I thoroughly enjoyed my time in Brisbane and the opportunity it gave me to widen my experience, with the added bonus of partaking of a little travelling too! I will be forever grateful for the patience of those in the unit who supported me and taught me so much. My experience down under gave me the confidence to finally apply for a post elsewhere in the UK, as doubts about
my wider knowledge and experience had previously proved a psychological stumbling block. I returned to the UK and knew I still had the desire to widen my horizons, so I now find myself working in a combined adult and paediatric unit 160 miles away from Birmingham, which affords me the chance to live locally to my close family for the first time in over 20 years. That said, I’ve still not fulfilled my learning capacity and would never say no to the adventure of life again down under on a more permanent basis should the opportunity ever arise!!
My sincere thanks to Tony [Black], Mahesh [Naidu] and Nicole [Shrimpton] and Carla [Zazulak] for facilitating the opportunity!
Angela Horsburgh and Anthony Black
River side walking commute to work
35 SEPTEMBER 2020 | www.anzcp.org