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.
Monday, April 20, 2015
Wednesday, April 8, 2015
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!
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
Monday, April 6, 2015
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.
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.
Thursday, February 26, 2015
s'not that bad
Human orifices are lined with epithelial tissue. (In other words, there is wet stuff in your holes. )This "mucus membrane" acts as a barrier to infection. It has all kinds of defence mechanisms.
When you get sick, the mucus membrane kicks into action, producing "mucin", a polysaccharide complex that absorbs water. Snot, to y'all. This thick layer of snot prevents further viral particles from penetrating and sloughs existing particles away.
As a side note, polysaccharide is a fancy word for "complex sugar molecule", which is why snot tastes vaguely sweet. Ask any 3 year old.
Why discuss this rather intemperate subject?
Cos I have been vacuuming snot out of my lovely daughter's nostrils with a hose-pipe connected to my mouth.
We have walked on the moon, we hold the world's knowledge in a pocket-sized computer, but we still haven't figured out how to get boogers out of tiny nostrils. This is a problem.
Babies can only breathe through their nostrils (mouth-breathing is a sadly acquired trait) and when those nostrils are blocked, they stop eating and sleeping. You may not realise this, but eating and sleeping are the only things babies want to do, hence the snot-vacuum. It's a little bulb that inserts into her nose (she loves this about as much as you would) and connects to a flexible straw. The straw connects to my lips. To prevent liquid mucus from entering my mouth, a thin paper "filter" is poked between bulb and straw. It works about 40% of the time.
I shove the bulb in and start hyperventilating so I can generate as much suction as possible without passing out. A chunk materialises in the bulb, Bub's cries get clearer (and LOUDER) and then we calm her by poking a nipple in her mouth. Mine, for what it's worth.
The past few days, I've been repeating this procedure every 2 hours. Bub hates it, I hate it and Mr G gets queasy just watching. The glamour and reward of parenting.
Makes me nostalgic for work, where the suction is connected to the wall, and I rarely get bitten after making someone feel better.
PS: Yes, I'm spelling it mucus. Mucus is the substance. Mucous means "pertaining to, or related to mucus". Look it up.
When you get sick, the mucus membrane kicks into action, producing "mucin", a polysaccharide complex that absorbs water. Snot, to y'all. This thick layer of snot prevents further viral particles from penetrating and sloughs existing particles away.
As a side note, polysaccharide is a fancy word for "complex sugar molecule", which is why snot tastes vaguely sweet. Ask any 3 year old.
Why discuss this rather intemperate subject?
Cos I have been vacuuming snot out of my lovely daughter's nostrils with a hose-pipe connected to my mouth.
We have walked on the moon, we hold the world's knowledge in a pocket-sized computer, but we still haven't figured out how to get boogers out of tiny nostrils. This is a problem.
Babies can only breathe through their nostrils (mouth-breathing is a sadly acquired trait) and when those nostrils are blocked, they stop eating and sleeping. You may not realise this, but eating and sleeping are the only things babies want to do, hence the snot-vacuum. It's a little bulb that inserts into her nose (she loves this about as much as you would) and connects to a flexible straw. The straw connects to my lips. To prevent liquid mucus from entering my mouth, a thin paper "filter" is poked between bulb and straw. It works about 40% of the time.
I shove the bulb in and start hyperventilating so I can generate as much suction as possible without passing out. A chunk materialises in the bulb, Bub's cries get clearer (and LOUDER) and then we calm her by poking a nipple in her mouth. Mine, for what it's worth.
The past few days, I've been repeating this procedure every 2 hours. Bub hates it, I hate it and Mr G gets queasy just watching. The glamour and reward of parenting.
Makes me nostalgic for work, where the suction is connected to the wall, and I rarely get bitten after making someone feel better.
PS: Yes, I'm spelling it mucus. Mucus is the substance. Mucous means "pertaining to, or related to mucus". Look it up.
Thursday, January 22, 2015
itchy
Being diagnosed with post-partum depression is a lot like being told you have head lice.
Even though you know it's common and treatable, it's still pretty embarrassing, and you wouldn't be in this position if you didn't have a kid.
That said, it's also a relief.
It's nice to know that you're not just an incompetent mother. Or that your feelings of failure are pathologically disproportionate. It's nice to know that feeling out of sync with all the other mothers at Baby Time isn't just your personality.
Of course, much like head lice, acknowledging the problem is only the first step. Now we get out the medicated shampoo, the gloves and the teeny tiny comb, and start working the problem out. With time, you'll be able to show your face in public again, confident that you're going to be ok.
Bring on the permethrin.
Even though you know it's common and treatable, it's still pretty embarrassing, and you wouldn't be in this position if you didn't have a kid.
That said, it's also a relief.
It's nice to know that you're not just an incompetent mother. Or that your feelings of failure are pathologically disproportionate. It's nice to know that feeling out of sync with all the other mothers at Baby Time isn't just your personality.
Of course, much like head lice, acknowledging the problem is only the first step. Now we get out the medicated shampoo, the gloves and the teeny tiny comb, and start working the problem out. With time, you'll be able to show your face in public again, confident that you're going to be ok.
Bring on the permethrin.
Thursday, January 15, 2015
whoopsadaisy
My post-secondary education has been a meandering journey. It's taken 14 in 8 different cities across two continents. You would think that somewhere in that time, I would have had a real job interview. Nope.
The last time I sat in front of someone and answered questions about my "greatest weakness" and "communication skills", I ended up wearing a green apron and making extra-hot lattes for Gordon Campbell. It's been a while.
The medical interview should, theoretically, be a highly structured process. I envisioned walking into a room with a long table, 2-3 suit-clad members of the team facing me. They ask me about my experience with critically ill patients. They ask me how I feel about the latest BMJ on tranexamic acid in trauma. They ask if I've ever sexually harassed the nurses, or how I would handle interpersonal conflict.
In reality, my phone rings at 10am. I am still in bed, in pajamas, feeding Bub. She's latched on and I'm fumbling to answer the phone without dislodging her, which would result in screaming.
I answer the unidentified number and the friendly voice on the other end says, "I know you were going to call tomorrow, but I'm going on vacation and wanted to make sure we caught you - what do you want to know about our ER?"
The chief of this community hospital is excited and engaging, promising me solid billings and access to a CT scanner overnight (luxury!) plus a good relationship with nursing staff and "tons of support during the early days".
At the end of his spiel, I say, "It sounds great - I'd love to apply for the position..."
He says, "Oh, ok. Send me your references - if there are no surprises we'll get your paperwork started!"
Just like that?
Just like that.
Now I'm nervous. Was it too easy? Am I missing something?
The larger sister hospital to this one has also asked me to come in for a tour and "chat" where they would suss me out. Do I wear my interview suit? Can I bring the baby? Is this an assessment of my suitability or are they trying to sell me on the joint?
Despite all the education, all the planning and all possible signs pointing towards this day, I am still in shock.
I think I have a job.
The last time I sat in front of someone and answered questions about my "greatest weakness" and "communication skills", I ended up wearing a green apron and making extra-hot lattes for Gordon Campbell. It's been a while.
The medical interview should, theoretically, be a highly structured process. I envisioned walking into a room with a long table, 2-3 suit-clad members of the team facing me. They ask me about my experience with critically ill patients. They ask me how I feel about the latest BMJ on tranexamic acid in trauma. They ask if I've ever sexually harassed the nurses, or how I would handle interpersonal conflict.
In reality, my phone rings at 10am. I am still in bed, in pajamas, feeding Bub. She's latched on and I'm fumbling to answer the phone without dislodging her, which would result in screaming.
I answer the unidentified number and the friendly voice on the other end says, "I know you were going to call tomorrow, but I'm going on vacation and wanted to make sure we caught you - what do you want to know about our ER?"
The chief of this community hospital is excited and engaging, promising me solid billings and access to a CT scanner overnight (luxury!) plus a good relationship with nursing staff and "tons of support during the early days".
At the end of his spiel, I say, "It sounds great - I'd love to apply for the position..."
He says, "Oh, ok. Send me your references - if there are no surprises we'll get your paperwork started!"
Just like that?
Just like that.
Now I'm nervous. Was it too easy? Am I missing something?
The larger sister hospital to this one has also asked me to come in for a tour and "chat" where they would suss me out. Do I wear my interview suit? Can I bring the baby? Is this an assessment of my suitability or are they trying to sell me on the joint?
Despite all the education, all the planning and all possible signs pointing towards this day, I am still in shock.
I think I have a job.
Wednesday, December 10, 2014
tie my hands
After years of being a student, an intern, a resident and a fellow, I am poised to become a real, grownup doctor. This coming July, I will be unleashed on the population with my skills, knowledge and sanitized hands. The question is, "which population"?
I have, at this moment, 3 options.
1. Buy out the Return of Service obligation - this will cost around 360 thousand dollars, up front, in cash, 30 days from graduation.
Pros: Goodbye Ontario, flexibility to work in the GTA if I so choose, flexibility to take on short term contracts instead of committing to 5 years in a single under-serviced location.
Cons: Holy jebus the debt. My daughter will have to wear bread bags on her feet instead of shoes. I will have to do a side business doing illicit organ farming.
2. Sign a contract with a nearby hospital (peripheral to GTA) and start working.
Pros: I have offers from several locals, including one where several of my friends are on staff. They assure me that I am "tough enough" to handle the patients and the flow. They are also financially solvent after only 2 years of grownup work.
Cons: FIVE FRICKING YEARS?!? I know, I know, medicine is all about delayed gratification, but I have delayed and delayed and...I would like my kid to know what my home province looks like. I would like to take a few months to travel with my family before we're all stuck in school holiday scheduling. I would like to have a choice to try something else if my first job isn't what I want.
3. Run run away... I only have to deal with the ROS if I choose to practice medicine. What if I finish the program and then run away and become a goat farmer on Pender Island? Free free free!!! Never to be held accountable for deaths and disability! Never to be spat or bled or shat upon (well, by a human)! Never to have to smile while someone insults me!
Believe me, I'm leaning towards three.
I have, at this moment, 3 options.
1. Buy out the Return of Service obligation - this will cost around 360 thousand dollars, up front, in cash, 30 days from graduation.
Pros: Goodbye Ontario, flexibility to work in the GTA if I so choose, flexibility to take on short term contracts instead of committing to 5 years in a single under-serviced location.
Cons: Holy jebus the debt. My daughter will have to wear bread bags on her feet instead of shoes. I will have to do a side business doing illicit organ farming.
2. Sign a contract with a nearby hospital (peripheral to GTA) and start working.
Pros: I have offers from several locals, including one where several of my friends are on staff. They assure me that I am "tough enough" to handle the patients and the flow. They are also financially solvent after only 2 years of grownup work.
Cons: FIVE FRICKING YEARS?!? I know, I know, medicine is all about delayed gratification, but I have delayed and delayed and...I would like my kid to know what my home province looks like. I would like to take a few months to travel with my family before we're all stuck in school holiday scheduling. I would like to have a choice to try something else if my first job isn't what I want.
3. Run run away... I only have to deal with the ROS if I choose to practice medicine. What if I finish the program and then run away and become a goat farmer on Pender Island? Free free free!!! Never to be held accountable for deaths and disability! Never to be spat or bled or shat upon (well, by a human)! Never to have to smile while someone insults me!
Believe me, I'm leaning towards three.
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