Trauma Team.

On my current surgical rotation, sometimes I carry the trauma pager. That means that if a trauma arrives at the hospital, I go down to Emergency and become part of the team who deals with whatever comes through the door.

My first trauma was a young guy (15) who had fallen off the back of his friend's motorcycle. He was wearing a helmet (thank GOD!) so his major injuries were a distinct loss of skin and multiple fractures in his hands. This was a good trauma.

Yesterday we had another young patient. At 2 in the afternoon, she was crossing the street in front of her house and was hit by a car going 40kph. She was thrown through a fence and knocked unconscious at the scene. I was cutting her clothes off (to expose any hidden injuries) as they assessed her pupils; both blown. The CT scan showed a massive intra-cranial bleed. We put in a chest tube, then sent her up with the neurosurgeons to have her brain drained. I don't know for sure, but the consensus was that she would not live. This is a bad trauma.

I am loving this job; long hours melt away when you feel that you are doing valuable work. And when you are involved in these high-tension situations, every nerve comes alive and you function at a higher level than you knew possible. However.

However.

I was lying on my bed last night, reading trashy comics, when I closed my eyes. The sight of trauma 2's broken body appeared in my head. I had to call the people I love to make sure that they hadn't been hit by cars. I dreamed about the push of forcep & tube into the chest wall.

There are some drawbacks to this career path.

2 weeks till babies. Perhaps that will be less traumatic.

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.

em-pathetic

There is a huge and fascinating article in today's Globe & Mail about empathy. It's loosely focused on the recent tragedy in Norway and explores the idea that "evil" in people can actually be attributed to a lack of empathy.

The researchers interviewed discuss situations where people (and animals) display a lack of empathy; chronically, such as in people with Autism, or acutely, in the case of torture or murder.

I have previously gone on record saying that my clinical medical skills improved when I learned to suppress my empathy.

As a medical student, I had trouble placing drips (IV's). I would wince as the patient winced. I would break into a sweat, fumbling, jostling the tip and carving up their delicate vessels. Then I'd have to find another vein, and repeat ad nauseum.

When I learned to shut my empathy down, I found I could treat the vein as an isolated problem. Yes, I can hear someone wailing and moaning and carrying on, but I just have to slide this needle into this tube and get some red stuff. Smooth as. No worries.

In the article, they talk about people who can spontaneously shut off their empathy in morally difficult situations. These people are sociopaths.

Luckily, in family medicine, I rarely do procedural stuff.

I do, however, hear about 20 sad stories a day. Some things are horrifying; surprise pregnancy with a side of surprise HIV, domestic violence, sudden death and disease. Some things are less extreme, but just as devastating for the people going through them. I ended up comforting a jilted lover for 40 minutes as they sobbed into my tissue box. (Your tax dollars at work.)

Here, at week four, I have run out of empathy.

Not at work - I have an endless supply of sympathetic nods, heartfelt sighs and respectful, supportive, asexual shoulder pats.

My lack is coming through at home. I don't give a shit.

Worried about your career trajectory? I could care less! Your haircut doesn't flatter you? Suck it up! You're just not sure if he likes you enough? Blow me! And that's just self-talk. My friends get it worse.

I read the article thoroughly, looking for people who get empathy-depleted. Not a sociopath, not yet Autistic. I wanted to know that burn-out doesn't necessarily lead to mass murder. Alas, I couldn't find anything to soothe.

In order to get my empathy back, I'm going to watch kitten DJ's all night. People can be harsh, but kittens never let you down...

Three Oh.

Officially old. But not, unfortunately, mature.

I am truly grateful that every year my life gets better and better. When I'm 95 (Happy Birthday Gran!) I will be having more fun than is physically possible. I can just feel it.

Time to dance!




En espagnol!

Love!

Monday is the worst day, right?
Not so! Not if you're living the dream that is family medicine.

On paper, it was a typically crappy medical day:
8 -12: "Evidence based medicine" (eg: reading journal articles aloud to each other) followed by "Behavioural medicine" (eg: social worker reading journal articles to us).

1-5: Clinic (eg: poking sick people & their icky parts)

5-9am: Call (eg: pager panic)

BUT in reality:

8-10: Immunization Trivial Pursuit
Seriously. Our program director (and head of U of T family med) actually made a Trivial Pursuit board game with questions about various vaccines. I believe the green was Diptheria, blue was Hepatitis and orange Varicella. I learned a tremendous amount, though I couldn't shake my craving for a G&T and some Pender sunshine.

10-12: Social work articles? Nope! Parenting lessons! And thanks to my father's professional tutelage, I had all the answers.

This relates to the time Dad asked brother & me to make a powerpoint on parenting for his students. As we turned his notes into slides, we exchanged worried glances. "Time outs? Neutral language? Psychological discipline? We've been parented!"

1-5: Clinic! Transgendered alcoholics begging for rehab! Tiny kids with sore ears! Swabs for lesbians with cheating lovers! Medical marijuana for HIV positive old dudes!

And as for call...

As of 10pm, I have taken some pages, answered some questions and done some reading. All from the comfort of my own home. With take-out tacos. In my undies. (34 degrees here).

I love my job.