Crunch

I am looking after a 19 year old right now. Saturday night he was drinking with buddies and they got all fired up. "Somebody punch me in the face!" he said. "Do it!!" So they did.

He has a broken jaw now.

I met him in the early hours of Sunday morning. He was still pretty intoxicated, his mouth was dripping with blood and he smelled like vomit and Axe body spray. My heart melted.

I gently explained his upcoming operation and gave him drugs so he wouldn't get a hangover. I spoke to his parents on the phone, asking them to give him the benefit of the doubt and be kind to him. I patted his foot as he talked to them.

This kid is getting nothing but scorn from my fellow residents. He asked his friend to hit him and now he's taking up space in our grid-locked hospital, costing the system two thousand dollars a day. He's going to need surgery to correct the jaw, plus about 6 weeks of rehab, tube feeding, ongoing clinic visits and expensive painkillers.

But...I remember being 19. I remember the stupid shit we'd get up to. Throwing shopping carts around, packing 12 people into someone's Mom's volvo and speeding through the night, getting drunk on $4 vodka and vomiting on people's front lawns. The only difference between me and this kid is luck. I did so many stupid things (including drunk fight clubs) and it was only luck that stopped me from ending up in hospital (...ahem. More than I did).

Docs and nurses who are mean to these drunk kids, who refuse them painkillers and fluids, who lecture them when they're injured, surprise me. I suppose there are people who got through med school and university without getting into any trouble. I just didn't met them on my way through.

I like to think that my years of stupid, reckless behaviour give me an edge of compassion. Bring me your drunks, your bottle-lacerations, your huddled pukers. For I am Sam, Patron Saint of Drunk Teenagers. And I'll take care of you...

threshold

Maybe I am getting lazier.
Maybe I am getting weaker.
Maybe I am getting softer.

But:
I am not getting out of bed at 5:30 am to stand around a bed with a bunch of other residents, saying "Um, yeah, I think the wound looks better, but we'll come back at noon with the boss and check..."

Admittedly, I have never been great with early morning. Surgical rotations have always seemed hellish to me, but I could see the point of seeing surgical patients at 6 in the morning. If you have a huge belly wound, and were in pain all night, and we're going to be operating all day, we should see you before we go to theatre.

Plastic surgery, however, is not about big belly wounds.

Rounds on Tuesday were excruciating. We saw 6 patients. It took over an hour (avg # of gen surg patients seen in ward round = 17, in about 30 mins). Because there are only residents in the morning, seeing these patients is useless. We make no decisions, write no orders. We literally wake up these groggy patients to look at their wounds, then say, "We'll be back at noon with the consultant!"

I don't know if it's cos I only have 5 months left.
Maybe I'm drunk with the power of being a senior resident.
All I know is that I haven't been to rounds since Tuesday.
I may not go again this week.
And if they try to make me?
They can't. There is literally nothing they can do to make me.

Ok. I am drunk with power. Never had this realization before. May never go to work again.

PS: Last week I started work at 6am every day - it was ER shifts, so it was a pleasure to get up and go do useful, valuable work. Plastics can burn in hell.

babies for everyone!

I've been threatened with my first lawsuit!!

"J" is a young transgender woman who presented to the emergency department with abdominal pain. She said to me, "My mother wanted a boy, so she fed me hormones as a child. That is why I have an Adam's apple, some facial hair, and sound like a boy."

Ok.
"So, what hormones are you taking, J?"
"NO HORMONES! I'M REALLY A GIRL!"

Ok.
 "Well, tell me about this abdominal pain..."
"Fine. So, I'm pregnant and I want an ultrasound to check on the baby. See, I have this pregnancy test here."
(J is showing me a positive "Clearblue" home pregnancy test. The result has been drawn in with magic marker.)

Ok.
"When was your last period?"
Silence.
"I mean, how pregnant do you think you are?"
"Oh! I'm 17 weeks pregnant!"
I look at her slim build, flat stomach and overall male physique.

Ok.
 "Well, J, I'll just get you to pee in a cup for us here, we'll confirm that you're pregnant, and if that's positive, I'll grab the ultrasound machine!"

At this point J becomes visible angry. She yells.

She tells me I'm a bitch. That I should trust her home pregnancy test and that she refuses to do one in hospital. She tells me that she has a lawyer in Vancouver who will take away my license. She tells me she has a doctor in Toronto who has done a previous ultrasound that shows she's having twins. There is a lot of anger, threats and verbal abuse.

I re-iterate, "You give us a urine sample, if it's positive, I'll do your ultrasound!"

More abuse.

J eventually needs to be escorted from the premises by 4 security guards. She is a big girl. (Such broad shoulders!) As she leaves, she pauses at the physicians desk.

"I hope you don't like your job!! Cos you'll never be a doctor again when I'm done with you!"

I think about this on my way home. Lets say, worst case scenario, that my license was taken away, and that I could never practice medicine again. I have almost NO idea of what I would do for a living.

Seriously. I can't go back to Starbucks. I don't have any real computer or tech skills. I don't have the patience for customer service (when I deal with the public now, I'M always right. Ish.).

I am good at asking people personal questions within minutes of meeting them. And touching them intimately right after that.

I guess I could be a journalist?
Or a prostitute?
I'll keep thinking.