googles, "how much is botox"...

When the patient's mother grabs me and says, "Are you the staff?" I am momentarily chuffed. 

I must look authoritative. Mature. Confident in my medical professionalism. 

"I'm not", I say. "But what can I help you with?"

"We want another doctor. Our doctor looks too young."

Sigh.

I am in that delightful stage where I look haggard enough to be staff, but am inexperienced enough to need someone supervising me. 

The fun part about working at the Children's Hospital is that I am not supposed to know how to manage kids, so people give me lots of help and training and double check my plans. 

(They also ask me for help with ER specific problems; last night I used ultrasound to place a hematoma block and reduce a Bennet's fracture, which is a bit of a rock star move. FYI.) 

The less fun part is that the junior residents look about 12 years old and I keep mixing them up with the patients.

Oh well. Wiggly butts, rashes, minions teeshirts and therapeutic popsicles. Pediatric ER is not all bad.

Routine

Elective time.

Drive a million miles, arrive at a musty-smelling home with sad motel furniture.

Claim a room, figure out which couch is comfiest.

How many channels do you get?

The wifi password is Isengard? How are you nerdy enough to have that password, but misspell Isengaard? How did I notice?

I think the hospital is walking distance to here, but where is the nearest LCBO?

Yelp "best delivery thai Ottawa".

Is this pad thai? The soup tastes like dirty bathwater.

Man, I wish this place had air conditioning, but at least it's clean.

Why can't I log into my schedule?

I think my first shift is tomorrow. Where are my scrubs? Did I forget to pack my scrubs?

I have done this every year, several times a year, for about 10 years. This is my last elective. Unusually, I have my family with me to help settle in, and also make things complicated (I know which couch is comfiest and I'm not currently on it.) Three weeks, then I'm done. Living in one place for more than a year at a time. Making a paycheque. Deciding what shifts I want to work and when...

Now all I need is a recommendation for good delivery food in Ottawa.

Killing it!

What happens if you take all the drugs, then all the pills, then decide to take a little sleep? ICU!

What happens when your stomach starts bleeding and we suction 2L of frank red blood out of your esophagus and end up needing a transfusion of 15 units? ICU.

What if your balls turn black and the skin starts flaking off them and you get a fever? ICU.

Emergency C-section for placental abruption due to cocaine use? ICU.

Morbid obesity preventing you from breathing? ICU.

Anorexia stopping your heart from beating? ICU.

Fall down go boom brain bleed? ICU.

It's been a good rotation so far. I'm tubing and lining and tapping everyone. The nurses have finally learned my name and let me sleep at least one hour per call shift (5-6am, holla!). I have supervised my juniors and taught them things and haven't bitch-slapped the one who suggested I'm dumb cos I have a baby (win!). They've offered me a job covering the weekends that will give me ludicrous amounts of money and lots of chances to learn.

Am I winning at ICU? I'm winning at ICU.
I want to call in sick for the next two weeks, stay home and play with my baby, but I'm winning to ICU.

24 hours

At three thirty on Tuesday afternoon, I sat in the library basement with my baby on my lap. We sang songs and passed toys around a circle of babies and carers. We clapped our hands, we stomped our feet, we shouted hurray! (We were happy and we knew it).

At three thirty Tuesday morning, I was doing chest compressions.

A young guy who worked at the hospital was chatting to his girlfriend on the phone. She said they were laughing and then suddenly he stopped.

She heard, "Oh my god, babe..." and then a horrible moaning sound. The phone dropped. The girlfriend also works at the hospital and called security to go find him. He was in an upper hallway, and by the time security got to him, he had been down for about 15 minutes. They called the code blue. We arrived and started doing all the things we do. Chest compressions. Intubation. Drilling into his bones so we could give IV fluids, drugs and electrolytes.

His girlfriend arrived and watched the whole process, sobbing and repeating, "He's ok. He's ok. He's fine..."

Blood started coming up the tube. We suctioned about a litre in the first 5 minutes. He still didn't have a pulse. More epinephrine. More bicarb. More compressions. Ten minutes passed. Twenty. Still no pulse. No shockable rhythms.

Finally, the code doc called it. After 30 minutes of no return of circulation, there's not going to be a heartbeat. We stopped working on him and started to pack up. Because it was a mysterious death, we weren't allowed to remove his tubes or wires. The coroner was called to assess the scene. The police were involved. The girlfriend lay across her partner's body and gently stroked his hair.

"We had such a nice conversation..." she said.

It was a bad night.

12 hours later, I held a chubby squirmy girl in my lap and nuzzled into the softness of her neck. I sang songs to her and tried not to think about having to do compressions on her. Or having to drill into her bones. Or having to put a tube in her throat.

99% of the time, my job is awesome. The other 1% gives me nightmares.

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.