What Happens at Work...

Yesterday I had an afternoon off. Between 12 and 6pm, I wandered the sunny streets of Kincardine, napped, ate cookies and wrote thank you notes.

Between the hours of 12 and 6 pm, two people came in to the Emergency Department and died.

A woman had come in to hospital with shortness of breath. It had been going on for several days, but was now getting worse to the point that she and her husband were worried. They dropped the dog off at the groomers and brought her to ER. She walked in gasping, and wheezing. They put her on a stretched, she arrested and she died. It was completely unexpected.

Her husband was obviously terribly distressed. He went to pick up the dog before telling his family about the sudden tragedy that had struck them. He was in the parking lot outside the dog groomers when he collapsed. The ambulance was there in 5 minutes, but by the time he arrived in ER, he was dead too.

Husband and wife from healthy and well to stone cold in 5 hours.

I arrived at 6 to meet a shaken supervising Doctor. He had offered to cover the half-shift from 1-6 so his colleague could attend a meeting. He was not expecting a day like this.

My night, after 6pm, was uneventful with respect to the patients. I, on the other hand, blacked out while fighting with a drug addict. I woke up in the resuscitation room with my boss listening to my chest. "Did you know you have a heart murmur?" he asked. "Do you think you could be pregnant?".

The nurses brought me orange juice and petted me and called me sweetie for the rest of the night. I got up, saw patients until 1am, then went home to sleep. There was no reason for me to faint (eg: not prego). I was not expecting a night like that.

On again Friday. I don't know what to hope for, but whatever happens, it will be interesting.

I know this place

I am on day 3 of my rural rotation and I have a strong sense of deja vu. My intern year included 3 months in Warrnambool; a small town on the southern coast of Australia. Kincardine is a small town on Lake Huron, which might as well be the ocean. Wide streets, gorgeous blue skies and lots of leafy trees. The only difference is the accent.

The rural placement is a bizarre situation. Designed by medical schools to encourage rural practice, they are often incredibly luxurious. Right now I'm sitting in a 5 bedroom architectural gem, where sunlight streams from every window and Adirondack chairs overlook the hummingbird garden. I walk to work, have my scrubs provided, nurses prep and review each patient before I see them and I'm out on time every day. Luxury. Right?

Well. Tonight I'm running the ER overnight. Most of the time this means coughs, cuts and chest pain. Sometimes it means managing a stabbing from the local pub. Sometimes they have a 3 vehicle pileup on the freeway and send the mangled bits your way. The other Docs can be called in, but you're the first port of call.

Great luxury? Great responsibility. To paraphrase Alfred.


In the 'Bool, I coped by coming home every day and watching Friday Night Lights. Today, as I try to sleep under a blanket of anxiety, I attempted The Newsroom.

I'm gonna need another distraction.

Blip!

Anaesthetics has previously been described as 98% boredom, 2% disaster.
This is apt.

However, this is also a perfect description for weekend call on Internal Medicine. I spent my morning scrolling through bloodwork results, checking vital signs, writing succinct notes to demonstrate due diligence and thinking about afternoon tea. It was dry, mind-numbing work, but I powered through and got it done.

Finally, I got my chai latte & rice-krispie square (delightful!) and sat down for 15 minutes of well deserved rest.

My pager went off.

"Patient desaturated to 75%, not responsive, please come ASAP"

The next 2.5 hours are lost in a blur of suctioning, blood gases, sternal rubs, compressions and ultimately, begging the ICU doctor to take my patient to a safe place. That is, a place he can be intubated.

I stumbled back into the Doctor's lounge and was surprised to find my latte was cold. I was drenched in sweat. My hands are still shaking. I have 22 unanswered pages.

Internal Medicine: 90% paperwork, 10% shit hitting fan.

0% afternoon tea.

Joy!*

I have been dreading my family medicine clinic all week; I haven't seen my patients in a MONTH and I was expecting an afternoon of drear, gloom and complaints about life.

I got giggly babies, fetal heart rates, happy chat with my mentally challenged patient (she has a new boyfriend who is really really nice to her and takes her on bike rides) and a new installment of the "My Weird Penis" show. (This week's contestant had surgery to have small plastic lumps inserted under his penile skin "to give ladies pleasure". I don't know if he meant my irrepressible mirth, but it certainly worked.)

I have but 2.5 weeks of internal medicine to go. Yes, it's a hellish slog that sucks joy from my life and colour from my cheeks, but it has it's benefits. Specifically, it forces me to appreciate my career choice.

So, yes! Bring me your tired. Your back pain. Your poopy babies and your sore knees. Your weird rashes and your dribbly genitals. Bring it all, bring it on! I love my job!

*It should be noted that I consumed an entire jar of leftover frosting before composing this post. FYI.

Truth!

My dentist thinks I'm awesome. In fact, he thinks my life and my choices are so awesome that he would like me to sit down with his 13 year old daughter and give her life advice. If I hadn't had 17 steel pointy things embedded in my gums, I might have laughed at this.

I've been home (on vacation) for 3 days. I wake up reaching for my pager. Friends ask me how work is going and I tell them I'm dead inside. My "hilarious anecdotes" of time on the wards are met with silence. All I want is to sleep, but I am too anxious to relax. Would wish this life on a 13 year old?

I will admit, there are aspects of the job that I like. I like working with people. I like looking for clues about what's wrong, then testing my hypothesis with treatment. I like when I get it right. I like figuring out where I'm going wrong. I like the adrenaline of Code Blues. I like the warm fuzzies of family meetings. I like the camaraderie of Team Medicine. BUT I would like it to happen in manageable, 12 hour stretches, with ample rest and recuperation in between.

Anyways, my life advice for 13 year old girls (me) would be:
- If you can do it for 3 hours in a row without noticing time pass, it's a passion.
- If it makes you feel stronger, smarter and more engaged with the world around you, keep doing it.
- If it gets in the way of your hobbies and you feel stressed, stop doing it.
- Don't worry too much about finding boys/girls/romance.The bad ones are passive and hard work and will exhaust you. The good ones will find you and make your life more fun.
- Don't let your parents tell you what you like. Don't let your friends tell you what you like. You are the only one who has to live with your choices, and no matter what you choose, you'll end up annoying someone. Don't let it be you.

Presumably she (I) would roll her eyes at me. Then I would take her out for a blizzard, buy her clothes her parents won't like and tell her to call me anytime.

Ethics 200

I have this patient. She weighs 900lbs. Her fat is killing her.

She was admitted to hospital about 7 months ago with a leg infection. She only weighed 700lbs then, was able to get around with a scooter, and was very very unhealthy, but still living relatively independently.

Since she has come to hospital, she has gained 200lbs. How? By ordering pizza. By asking the nurses to bring her T-Ho's "Iced capps" or get frappucinos (extra whip) for her. By snacking.

She is no longer able to turn herself. She is so heavy that she cannot roll from side to side. She has developed bedsores. They are infected. This week, we had a discussion with her and her family about the fact that, should she have a cardiac arrest, we will not be able to resuscitate her.

Why don't we stop her from eating?

Because, in Canada, individual rights trump common sense (or medical experience). She is a human who wants to eat herself to death. We must respect her right to do this.

I have issues with this:

1. People who refuse food (anorexics) are considered mentally ill. We force feed them. This woman is literally eating herself to death. She is aware that her food choices are killing her, but she cannot stop eating. However, as food addiction is considered a life-choice (like alcoholism or smoking) we must allow her to continue.

2. Suicidal patients have their human rights temporarily violated until can be treated for their intention to self-harm. This woman's in-hospital weight gain is an act of self-harm. As such, we should be able to temporarily restrict her caloric intake until she has undergone psychiatric assessment and treatment.

3. She is not capable of getting this food by herself. She only gets these extra/unnecessary calories when hospital staff bring them to her. Just as smokers are allowed to leave the hospital to smoke, we could allow her to snack as long as she gets the snacks herself. We are enabling her by providing her with toxic food.

4. She is currently costing the Canadian health care system 10,000 dollars a day. Our socialist system does not have an unlimited budget. She is currently scheduled to stay in hospital until she dies, because there is no other facility that can hold or treat her. Even if we argue that her individual rights should allow her to kill herself, surely the collective rights of the Canadian people outweigh this. She should be restricted to a sensible diet until she is mobile can be managed in a less expensive facility where she is not taking a hospital bed from someone else.

Alas, I am not in charge. She will stay until her wounds become too infected, her heart gives up or she chokes on her own fatty tissues. This could be tomorrow, it could be next year. So it goes.

I miss the Australian medical system; I remember my boss saying, "I'm the doctor, I'm responsible, why should I let this bloody idiot kill himself under my care?"

Canadian medicine is too precious for my taste. I'll take common sense over individual rights any day.

Existential Crisis

Everything is heightened when you don't sleep. I've been on call for 72 hours in the last 5 days. Last night my pager went off at 5am and I woke to run to a Code Blue. 45 seconds from waking to pushing down on a man's rib-cage so hard that his ribs scrunched. He died anyways. It was truly horrifying, but I didn't have time to process it during the night. Today, I had nightmares.

Of course, this highly emotional state leads to big questions; what am I doing with my life? Am I making the right choices? Should I cut off all my hair?

I don't think I'll ever get convincing answers. And I don't know if it's better to roll the dice, despite your doubts, or to hold off and wait until you're sure. I've been alive for 31 years, and the only thing I was sure of, medicine, is making me question everything else.

Blah blah blah. Deep thoughts have no place in a post-call brain. Forgive the maudlin crap, I will be back and bright tomorrow. With proper medical tales to tickle your brain and poke your gag reflex.