The VA - Monday August 9th

Monday August 9th

Not much happening in the main OHSU interventional labs today so I crossed the 660ft skybridge (the longest suspended pedestrian skybridge in North America no less) to spend the day at the neighboring veterans association hospital or "VA".

The VA is an organisation which provides a range of benefits and medical care for US military veterans and their families - clearly a huge benefit of military service in a nation with no civilian state health care. It is the second largest department of the US government (after the department of defence obviously) and employs nearly 300,000 staff.

Most VA hospitals operate entirely independently from civilian hospitals but the VA in Portland takes advantage of the local sub specialist expertise by sharing OHSU staff including IRs.

Everything on the other side of the skybridge is slightly different. The walls are covered in military promotional material with the VA "honouring our promise" slogan everywhere. There are signs too reminding patients not to bring firearms into clinical consultations. The patients themselves are a different breed - routinely refusing any sedation or analgesia during procedure and often refusing to remove the baseball cap with the logo of their army unit/ship. A slice of pure Americana.

Road Trip - Sunday August 8th

Favourite things that have been said to me:

1. "Yes"
When I asked Kate to marry me.

2. "It's a boy"
When George was born. Actually I'd have been just as happy if it had been a girl but you know what I mean.

3. "For an extra twenty dollars would you like to upgrade to a convertible mustang sir?"

I love you Hertz car hire man and I always will.

My hire car. Seriously.

So in my subtle, understated 3.7L V6 convertible I headed out into rural Oregon. Most visitors do "the loop" which is a 150 mile route along the Columbia river gorge and then around mount hood park before finishing with a hike in the foothills of mount Hood.

Far too beautiful to describe but I've stuck a few iPhone photos in below. Enjoy.

Columbia River Gorge viewed from Vista House

Multnomah Falls

Bridal Falls

Mount Hood viewed from the end of the Pacific Crest Trail

The Timberline Lodge - Famous for being the exterior location for one of my favourite films "The Shining"

Attempted self portrait at the end of the Pacific Crest Trail

Saturday Market - Saturday August 7th

I know that my heavily pregnant wife, currently single parenting whilst I galavant in the Pacific North West will not have much sympathy for this, but it's been a truly exhausting week here so I've been looking forward to some R&R. I've spent the week polling all the Docs and Techs for suggestions and have settled on spending today exploring Portland downtown and hiring a car to explore further afield tomorrow.

Saturday is market day in downtown Portland and the freaks (sorry, "counter-culturalists") are out in force. The area under the Burnside bridge is filled with hundreds of stalls with artists selling their own work. Good for a browse with a few gems amongst the tut. Of more interest to me, there are loads of food stalls - I broadened my gastronomical horizons with Philly Cheese Steak, Burrito salad and Cheesecake on a stick.

Arlene Schnitzer Concert Hall - 'The Schnitz'

After hanging around the market and listening to the bands that play there I wandered back to the hotel via the cultural district. Tomorrow - road trip!

Rob Barton and the Second Ammendment - Friday August 6th

Apologies for the gap in blog entries. A busy few days here.


One interesting aspect of the time I've spent here has been the opportunity to meet people from different parts of the USA. On my previous trips to the states I've visited huge multicultural cities like Chicago and New York but spent most of my time in the company of fellow Brits. Not so here. Whilst the majority of the rad techs and nurses are native Portlanders, the IR fellows and attending physicians (equivalent of UK consultants) have been recruited from throughout America and have their own regional accents and traits.

Keller and Kaufman are from Birmingham (Alabama not the midlands) and Boston respectively. My favourite though is Rob Barton, a stereotypical Texan:

Rob Barton

Time spent with Rob is particularly enjoyable because, as well as being a superb and vastly experienced interventionalist (probably the best practical interventional radiologist here as he tends to avoid academic roles in favour of hands on teaching) he also completely lacks any political correctness.

 As soon as he got wind of my (vaguely) left wing political tendencies he started to test my convictions with a few choice digs. He is a typical republican; pro Bush, anti-immigration, anti-health reform, anti-gun control etc etc. His particularly favoured political philosophy is the 'Tytler cycle' - an interesting and initially persuasive argument against democracy if you've never heard it before (which I hadn't).

A passionate defender of the second amendment  (the right to keep and bear arms) he is a fully card-carrying member of the NRA and has an extensive collection of handguns, hunting and assault rifles. He also has a license to carry a concealed handgun (which I think he brings to work with him) so I'm not tempted to push him too far in any of our heated political debates.

A nice guy - he's lent me a bunch of maps for hiking this weekend - but I'm quietly glad that he lives 4900 miles away.

Doing more with less - Thursday August 5th

What I'm starting to really like about the Dotter institute is the 'can do' attitude of the staff. My perception of medical healthcare in the states before my visit was that it was exceptionally well funded and that insured patients routinely received the gold standard of diagnostic tests and treatments.

The reality that I've seen is quite different. Medical insurance companies demand value for money and in the context of a rapidly evolving specialty like interventional radiology this often means that the latest equipment and technologies simply aren't funded. The Dotter institute is particularly good at adapting to these constraints. "We do more with less" is an unofficial motto here.

One of the interventional rooms at the Dotter. Note the vending machine style equipment lockers.

A nice example of this is the set up of the interventional labs themselves. Rather than shelves of equipment on the walls, all the wires, catheters and other kit are kept in computer controlled storage lockers, similar vending machines. Rather than just taking a different catheter of the shelf when it is needed, the rad techs have to request the kit via the computer to ensure that everything is billed to the insurance company.

In the UK if we are unable to access a vessel with a particular shaped catheter we will open a new catheter (at about £100 a go). Here, to avoid opening unneccesary kit and incurring additional expense, a large flask is kept boiling on the side and catheters are held in the steam until malleable and then reshaped.

A constantly boiling flask kept on a hot plate to reshape catheters.

Keep Portland Weird! - Wednesday August 4th

The working day at the Dotter finished a bit earlier yesterday, and my jetlag is beginning to wear off a little, so after work I got on the free street car and headed north into downtown Portland.

The Portland streetcar

Portland is fairly compact as American cities go and once you're downtown it's easy to get around on foot. I walked through the old town and Chinatown where I had Thai food "a-la-cart" at one of the numerous food carts which fill any empty parking lot. Then I walked into the  cultural district where I watched a bit of live jazz in the street outside the art museum.

Eating "a la cart" in Portland - a massive Thai meal for $5

Shopping in Portland is fairly quirky. I was looking for a big music and video shop to buy a couple of DVDs but instead I found off-the-wall art shops, second hand book shops and little independent coffee shops, restaurants and micro-brewery bars.

Portland also has it's fair share of random weirdness boasting several small museums including the hat and vacuum cleaner museums. I saw lots of cars with the "Keep Portland Weird" bumper sticker, and this pretty well sums ups this side of Portland life.

Add caption

Leather bindings and scary politics - Tuesday August 3rd

Attended my first American MDT meeting today, known in local parlance as "tumor board". For the uninitiated, an MDT or multi-diciplinary-team meeting is a forum for discussion of patients with cancer, which allows doctors from a range of specialties to discuss and (hopefully) agree on an appropriate treatment strategy. These days interventional radiologists play a fairly central role in both the diagnosis and treatment of many different tumours so I will spend a lot of my working life in these meetings.

The format for the meeting was very similar to the UK, although the coffee was much better, but what I was really struck by was the setting for the meeting - a vast wood paneled library shelved floor to ceiling in leather bound books and journals. The staff doctors all sat in huge leather chairs and quoted "the latest research" at one another.

There seems to be a real fondness here for old fashioned academia and all the associated paraphernalia. I've noticed that at European meetings you are simply awarded a distinction for your presentation/poster but in America you are awarded Magna Cum Laude or some similar tripe. Similarly, American students have endless formal graduations and join college fraternities and sororities with Latin names. It all seems to be an odd contradiction from a country that usually wants to distance itself from its European roots.

On the subject of which, I spent most of today watching cases from the control room because the interventionists were doing radio-embolisation and the hospital radiation control officer wouldn't let me in the room. As a result I got chatting to the "rad techs" (radiographers) who are all friendly guys but politically just a little bit right wing. They started with a bit of Obama-bashing, then a rant on illegal immigration but after their grievances on British Petroleum and Libyan (alleged) bombers we were soon on to the perceived state of the UK. "Is it true that Britain is being taken over by Muslims?"

Scary stuff.

I might cancel that canoeing trip this weekend.

"Is it true that Britain is being taken over by Muslims?"