family business

On Friday, I saw 12 patients. One patient for each half-hour appointment allocated to me in a day.

This is, roughly, about half the number of patients seen by a senior family medicine resident.
One third of the patients seen by a regular family doc.
Walk in clinic doc? 6 patients an hour.

I meet these people, hear their life stories, hear the secret dirty/horrifying/shocking parts of their life stories, then figure out what to do for them, document it all and kick them out the door.

As a random sample of Friday's patients I had a morning-after-pill, a post-female-circumcision PTSD patient, a psychotic young guy who asked me out for the weekend, a depressed patient who simply cried for half an hour, plus several adorable babies.

By Friday night, I was utterly spent.

I know it's wrong, but I couldn't muster the energy to interact with my friends. Going out, sitting down and asking them "How are you today?" seemed way too much like work.

For years, I thought my Dad was nuts; he prefers mindless physical tasks or chores to socializing. But now, having spent my Saturday night cleaning my kitchen, listening to music and not talking or listening to anyone, I get it. You run out of steam.

I'm not sure how I'll cope next year - 24 patients a day? For serious?

Incident Report

My patient this afternoon was a young woman. At 25, she had never had a pap smear, so I carefully explained the procedure, making sure to reassure her that a) it should not be too uncomfortable and b)it would be over quickly.

We got started. In soothing tones, I talked her through the steps;

"I'm just going to place my hand here. Take a deep breath, try to relax..."
"I'm inserting the speculum now. Deep breath, try to relax..."
"I'm just getting the first swab. Deep breath..."

There was a crack. I turned back. The plastic speculum had broken. Shattered, actually, against the pressure of her internal musculature. I maintained the soothing tones.

"Ok, so that noise you heard was the speculum breaking. That doesn't normally happen. Are you feeling alright?"
"Um, it's a bit uncomfortable."
(No shit! Holy jesus, your ladyness is full of sharp plastic shards! I'm surprised you're not screaming!)
"Alright, love, I'm just going to remove those bits and put a new one in. Deep breath, try to relax..."

We got through it, but I'm pretty sure she's traumatized.

Hell, I'm traumatized. I never want to see another crappy plastic speculum as long as I live. I told my boss and she baulked. Actually flinched. We exchanged glances and said, "At least she doesn't have to do it again until next year..."

The job may not be glamorous, but it's never boring.

more than family...

There is an incredibly annoying water bottle that my bosses carry. It's a PBA-free, all stainless steel, sustainable, caribeener-to-your-fixie-bike model. Conveniently sized to fit into a messenger bag. Just like every other hipster water bottle in Canada. However, this is not the source of my irritation.

This water bottle has a message on it:

"Family Medicine: more than family, more than medicine..."

I roll my eyes every time I see this.

But:

This week, I got sick. I woke up feverish, sore, sniffling and miserable. In Australia, this happened during my Rehab block. I was very, very, unwell but I did not miss a day of work. If I had, I would be looked upon as weak. Not pulling my weight. Letting down the mates. Etc. Etc.

On Monday morning, I sat in my teaching session, trying to snivel discreetly. After an hour, the head of Family Med stopped the lesson.

HFM: "Sam, are you sick?"
Me: "Urm. No. I'm just coughing up lung butter to demonstrate my understanding of URTI's"
HFM: "I think you should go home. You need to rest. Cancel your clinics."
Me: ....
HFM: "Off you go. You need to look after yourself."

I reeled for a moment.

Then I went home. I looked after myself.

Today, I am still sick. I went to my clinics, supported by a drug cocktail that (upon further research) is essentially crystal meth. And I got through the day.

Until 5pm, when we usually meet to discuss our patients. My preceptor, who is also sick, took one look at me and said, "Go home. You can't learn when you're sick. Call in sick tomorrow if you need to. You need to look after yourself."

More than medicine. More than family.
This job might just be good for me.