Letter From America

When you travel from Perth in Western Australia to San Francisco you are in for a long day…a forty hour day in fact, thanks to the arbitrary placement of the international dateline.

A naive hope that my permanently discombobulated circadian rhythm — one of the ever-present ‘perks’ of shift work — would effortlessly synch in with the California sun proved to be forlorn. Perhaps watching Inception on the plane didn’t help.

If I was any more dissociated from time and place I’d probably find myself in a Kurt Vonnegut, Jr. novel. Which, incidentally, reminds me of an ICU patient who unwisely chose to watch 12 Monkeys soon after extubation. Needless to say I now always check what videos the patient has been watching when I can’t find a cause of ICU psychosis…

Anyway, it’s 4 in the morning and as good a time as any to put the virtual pen to paper.

Why am I in San Francisco? Well, to meet emergency medicine edumactor extraordinaire Mel Herbert at the USC Essentials of Emergency Medicine extravaganza no less. Incidentally, there is also the small matter of the first meeting of the inaugural Fellows of the Utopian College of Emergency Medicine which you may also hear about in due course…

Tomorrow — I mean today — the preconference courses are being held where I will be wading through multimedia, blood and gore in the trauma review session.

That meant today (or perhaps yesterday?) was a day (or was it night?) of rest and relaxation. I elected to explore the city on foot. Starting from the palatial monolith of the Marriott Marquis I headed north past the materialist’s mecca of union square to china town (not coincidentally reminiscent of the classic film ‘big trouble in little china’). A short walk to North Beach and I found myself in the footsteps of Jack Kerouac and mingling with the ghosts of the beatniks.

A short detour east saw me reach the top of Telegraph Hill from where I caught first glimpses of Alcatraz and the imperial orange of the Golden Gate Bridge. Sadly though, none of the fabled parakeets of Telegraph Hill were to be seen.

telgraph-hill — On top of Telegraph Hill

Fighting off the incessant nagging of my sleep hungry pineal gland I followed the coast from Fort Mason through El Presidio Real de San Francisco. Five kilometers west and I was rejuvenated, with blue sky above and golden steel below.

The bridge is a phenomenon.

Striking to behold, it groans with the passage of hurtling traffic and the pacific winds. Yet it’s golden glow casts a dark shadow. Every two weeks, like malevolent clockwork, a lost soul plummets from these golden heights and breaks the icy water below at a speed of 125 km/h. Over a thousand people have died this way, and survivors of the great leap are sadly few. Such are the dark thoughts that fill ones mind while jack knifing through the chequerboard streets of San Francisco to the solitary comfort of a hotel room.

I wonder what today, that’s right today, will bring.

crisis-call — Crisis Call on the Golden Gate Bridge

Chris Nickson

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of three amazing children.

On Twitter, he is @precordialthump.

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