rich mouse, poor mouse

What's the difference between ER in O-town and ER in Big Smoke?

The approach to the drug seeking patient.

O-town is a wealthy area of the province. Most of the patients are well dressed, ask for the wifi password while they wait (so they can play on their i-pads) and have access to insurance that covers extended benefits.

It was a delight - I was treating back pain with physiotherapy referrals (best option!), giving the appropriate medication for the condition (even if not on ODB!) and talking to patients who really, truly believed that their health was a priority.

Contrast this to my previous work at Big Smoke ER, in the inner city. There, patients would be wearing soiled, thin clothing, ask if they could have a sandwich while they waited and let me know that while their health is important to them, they were not able to give it their full attention at this time.

The number one difference became apparent when I met a man who was asking for a refill of his oxyneo prescription. He told me he had dropped his pills in the sink and so he needed enough to get him through the weekend. He told me he was taking 80mg four times a day. He told me he had been taking this amount for years.

If this patient had walked into Big Smoke ER, we would have laughed him out the door. Patients with addictions are offered help to quit and directed to supportive chronic care, but they are NOT given massive doses of opiates cos they dropped theirs "down the sink". Honestly, the addicts downtown will know this and at least give a more creative story. They fake a serious injury. They say they've never had this pain before. And they don't ask for a dose that would level a hippopotamus.

I carefully documented this conversation and went to chat to my boss. "I'm going to offer him the number of addictions services, a family physician number and tell him not to come back to ER", I said.

The boss said, "Enh. We get these guys so rarely. Just give him a few days worth and send him home."

I prescribed enough oxyneo to kill several people and sent this (surprised but excited) young man out the door. This does not sit well with me.

I think I am not well suited to the easy, cut and dried, clean and wealthy medicine of O-town. I think I am supposed to be surrounded by chaos and serious pathology and patients with bed bugs. I think I am meant to have my new job. I'm excited, and ready, to say no to drugs.

Back in the Saddle

Butt bleeds. Peritonism. Dialysis patients with infected lines. Dudes who can't pee.

A four year old who was afraid to be examined until I gave her a smile. She turned and whispered something to her Mum, who said, "She DOES look like Doc McStuffins!" and then she let me poke her in the eye.

Asking the back dude if he had had any erections since his injury. When he hesitated, I prompted, "Not even morning wood? Or...a more professional way of saying that?" He and his girlfriend laughed and then it was a little less awkward when I tickled his anus with a Q-tip.

I am so so so rusty. I didn't give pantoprazole to the guy with the upper GI bleed! (Mr G shrugged when I said this, but it's the equivalent of not giving morphine to someone with appendicitis...)

I forgot to give morphine to my lady with appendicitis.

The thing is, everyone was really nice, the nurses are great, my staff doc was SO fun to work with and I got to do some bone crunching in a little old lady wearing fabulous sunglasses.

I was very happy to go home and watch my baby sleep on the monitor. And it was nice to have today off. But

I still love my job. Yay!

Game On!

Things I am allowed to think about between now and September:
1. My family (baby + Mr G)
2. My job (emergency med residency - last 4 months!)
3. My upcoming exam (EM. All of it.)

Things I am not allowed to think about before September:
1. My butt. Yes, it's a little flatter post-baby, but I am not allowed to think about lunging, working my glutes or power squats until this is all over.

2. My social life. I have wonderful, supportive friends who bring light and joy into my life. I cannot see them until I have learned ALL the medicine.

3. My family (extended version). Yes, I will call them and send photos and whinge to them about my current life situation, but I cannot let my need to see them distract me.

4. Summer. (Does not apply, this year)

5. Nutritional balance - if I eat ONLY microwaved weight watchers meals, this will give me more time to study.

6. The Kardashians. Or the Gallaghers. Or Mindy Lahiri. Or the Lannisters. I am off all delightful forms of media until this is all over.

Starting tomorrow I am back to work. My first shift is from 2-10pm at a regional hospital and I am both calm (it's my happy place!) and terrified (what's a heart attack?).

I am so glad I get to go back to being a resident, as this means someone will be looking over my shoulder and hopefully stopping me BEFORE I kill someone.

I am worried that I will not be able to stay awake through the whole shift. I am worried that I will lactate during the shift. I am worried that I won't remember what blood tests I need to order, or that I will miss my Bub so much that I can't function. But...

I am not allowed to think about these things, starting tomorrow. As of tomorrow, it's game on.