Once again, my profession is stepping up to try and ruin Christmas. Manitoba Christmas, to be more precise.
I'm sitting in a toasty living room while snow falls softly outside. My hot chocolate is Irish, my niece & nephew are napping and I don't have to shovel the walk again for at least 6 hours. Bliss, yes?
Weeeeell...
This morning we went to the Polar Bear zoo. As we walked around the "Churchill South" enclosure I was reminded of a story my boss told me.
A family med resident had gone up north with her new husband to celebrate their graduation from medicine. They canoed for 4 days, then were attacked by a bear. The girl was mauled until her husband fought the bear off with a pen-knife. He then carried his wife back through the wilderness for 3 days, trying to get help. She died on the way.
I told my in-laws this tale as we watched Hudson the Bear tearing apart a tire.
When I watch Mr G play with the kids, my first thought is, "That's how you break an arm", "That's how head injuries happen", "That kid is gonna aspirate that pen-cap"... He's big, they're small, he doesn't know the meaning of the word "aspirate".
I was hoping to let go and not think of work while we were in Manitoba, but it is not to be. Instead, I'm leaning in; when the kids nap, I'll read about mechanical ventilation. While my in-laws curl, I'll look up head-injury guidelines. As my father-in-law pounds litres of coke, I'll think about managing SVT in older adults.
Not very festive, but very G.
Thursday, November 28, 2013
Monday, November 25, 2013
The Why & the How
I am on vacation this week, which means sleeping in, drinking expensive lattes and walking the dog as far as her paws can carry her. It also means a chance to catch up on my reading.
I started with "Pre-oxygenation in patients destined for Endotracheal Intubation".
It turns out that there are many things we do in the ER, that I do without thinking, that have a scientific basis I didn't know.
Why do we try and get a patient's oxygen saturation up to 100%?
Because when they drop below 90%, they lose the partial pressure of oxygen required to maintain saturation, de-saturate rapidly, develop cardiac arrythmias and die.
Why do we continue to oxygenate a patient after we have paralyzed them, effectively stopping their breathing?
Because oxygen behaves like a liquid, pooling in the back of the throat and diffusing into the lungs, even without the driving force of breath to guide it.
I know. These seem like things a kid could tell you.
Why do we breathe? Cos if you don't breathe, you die.
Still, it's nice to know that the things I do have science behind them. And I forgot how lovely academic reading can be. Coffee in hand, Pickle at my feet, knowledge washing over me in gentle waves. Almost distracts me from my imminent trip to Winnipeg. In November. Almost.
I started with "Pre-oxygenation in patients destined for Endotracheal Intubation".
It turns out that there are many things we do in the ER, that I do without thinking, that have a scientific basis I didn't know.
Why do we try and get a patient's oxygen saturation up to 100%?
Because when they drop below 90%, they lose the partial pressure of oxygen required to maintain saturation, de-saturate rapidly, develop cardiac arrythmias and die.
Why do we continue to oxygenate a patient after we have paralyzed them, effectively stopping their breathing?
Because oxygen behaves like a liquid, pooling in the back of the throat and diffusing into the lungs, even without the driving force of breath to guide it.
I know. These seem like things a kid could tell you.
Why do we breathe? Cos if you don't breathe, you die.
Still, it's nice to know that the things I do have science behind them. And I forgot how lovely academic reading can be. Coffee in hand, Pickle at my feet, knowledge washing over me in gentle waves. Almost distracts me from my imminent trip to Winnipeg. In November. Almost.
Sunday, November 10, 2013
shift.
I got home from work at 2:45 am this morning. My boss of the night was very disorganized and likes to touch every patient before letting them leave the hospital. "I like to lay eyes on them, so I know you're telling me the truth..." As a result, instead of finishing at 1, I left at 2:30.
At home, the dog had eaten some chocolate chips, so I got to hear the tale of how Mr G had attempted to make her vomit (hydrogen peroxide in yoghurt, fingers in dog-mouth) and was now wracked by guilt and fear. Settling them both back to sleep (in the guest room; chocolate makes dogs poop) and I was asleep by 3:30.
I woke at 11:30 today. Washed myself, ate some food, and now it's time to go back to work. Days like this are a write-off (unless you consider burning through Netflix an achievement) and then I go, buy more coffee and go back to work. I have worn my sweat suit for the last 3 days straight. No point in changing, I've got scrubs to put on in an hour.
I know this is my dream job and technically, I'm getting all the perks of random hours. I can go to yoga in the middle of the day! No lineups at the bank! Brunch on a Wednesday morning!
I just wish it didn't take me 12 years of post-secondary education to finally start living like a teenager.
At home, the dog had eaten some chocolate chips, so I got to hear the tale of how Mr G had attempted to make her vomit (hydrogen peroxide in yoghurt, fingers in dog-mouth) and was now wracked by guilt and fear. Settling them both back to sleep (in the guest room; chocolate makes dogs poop) and I was asleep by 3:30.
I woke at 11:30 today. Washed myself, ate some food, and now it's time to go back to work. Days like this are a write-off (unless you consider burning through Netflix an achievement) and then I go, buy more coffee and go back to work. I have worn my sweat suit for the last 3 days straight. No point in changing, I've got scrubs to put on in an hour.
I know this is my dream job and technically, I'm getting all the perks of random hours. I can go to yoga in the middle of the day! No lineups at the bank! Brunch on a Wednesday morning!
I just wish it didn't take me 12 years of post-secondary education to finally start living like a teenager.
Sunday, October 27, 2013
Unrelated
Technically, this is a blog about my experiences with medical training. The focus is intended to be purely professional (ha!) and limited to "things that happen at work".
However.
We got a dog. Sort of.
Pickle is a 6 year old beagle/mutt cross that we saw on the SPCA website. She was happy and smiley in her pictures, and was described as "a quiet, gentle lap dog" who just needed a place to nap in the sun. We like to nap in the sun. Mr Gargantuana works from home, so is available for walks, pats, feeding and other dog sundries. I was not actively afraid of this dog. It seemed like a perfect fit.
We applied.
"There are a few other applicants", the SPCA lady said. "We'll let you know..."
My competitive instinct blanketed out my common sense. The voices is my head were saying, "But you don't like dogs. Pets gross you out. You're really bad with messiness and uncontrollable situations." I ignored them. No one was going to beat me at dog ownership! I wrote an email to the SPCA explaining that we were the perfect parents for Pickle.
We got her.
It turns out I don't like dogs. I don't handle poopy messes well. I get angry when she barks, when she pees on the carpet, when she tries to get into bed. I don't like the fact that, as we were walking out the SPCA door with her, we were told that she was in heat and that she had lungworm.
Do you know what lungworms look like?
Do you know that heat = dog period?
Do you know how bad dog farts can be?
It's been a week and a half. Mr G and I have a deal; every day that she's here, we renegotiate. She can stay for another week as long as I don't have to scoop her poop. If I don't have to walk her. If she stays off the furniture. If she doesn't pee on the rug. If we move to BC.
She's still here.
Mr G is away for a day. Pickle is lying beside me on the sofa (she will NOT be allowed on furniture) and snoring like an 86 year old with emphysema. I will take her for a walk. I will clean her pee off the rug. I will feed her treats and try not to panic when she claws at our bedroom door in the middle of the night. We are still living in Ontario.
I am losing at dog ownership.
However.
We got a dog. Sort of.
Pickle is a 6 year old beagle/mutt cross that we saw on the SPCA website. She was happy and smiley in her pictures, and was described as "a quiet, gentle lap dog" who just needed a place to nap in the sun. We like to nap in the sun. Mr Gargantuana works from home, so is available for walks, pats, feeding and other dog sundries. I was not actively afraid of this dog. It seemed like a perfect fit.
We applied.
"There are a few other applicants", the SPCA lady said. "We'll let you know..."
My competitive instinct blanketed out my common sense. The voices is my head were saying, "But you don't like dogs. Pets gross you out. You're really bad with messiness and uncontrollable situations." I ignored them. No one was going to beat me at dog ownership! I wrote an email to the SPCA explaining that we were the perfect parents for Pickle.
We got her.
It turns out I don't like dogs. I don't handle poopy messes well. I get angry when she barks, when she pees on the carpet, when she tries to get into bed. I don't like the fact that, as we were walking out the SPCA door with her, we were told that she was in heat and that she had lungworm.
Do you know what lungworms look like?
Do you know that heat = dog period?
Do you know how bad dog farts can be?
It's been a week and a half. Mr G and I have a deal; every day that she's here, we renegotiate. She can stay for another week as long as I don't have to scoop her poop. If I don't have to walk her. If she stays off the furniture. If she doesn't pee on the rug. If we move to BC.
She's still here.
Mr G is away for a day. Pickle is lying beside me on the sofa (she will NOT be allowed on furniture) and snoring like an 86 year old with emphysema. I will take her for a walk. I will clean her pee off the rug. I will feed her treats and try not to panic when she claws at our bedroom door in the middle of the night. We are still living in Ontario.
I am losing at dog ownership.
Monday, October 14, 2013
Friday, October 11, 2013
Show, don't tell...
Last night, a kid came into ER. He had sand in his eye. His eye was irritated, red and leaking thick tears. He was not a happy chappy.
Part of our standard eye exam is to put drops into the eyes to make them numb. They also dye the eye yellow, so we can see any scratches in the surface of the eye. They (allegedly) sting a bit, but most people tolerate them fine.
This kid had already had his parents squirting water in his eye and the teachers at school trying to flush him out, so he was understandably nervous about the drops.
I decided to try and make him feel comfortable.
"Look!" I said. "I can put the drops in my eye to show you it doesn't hurt!"
I stood up, tilted my head back and opened my eyes wide. A single drop of yellow dye hit the surface of my cornea with a splash.
"FUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUU*K", I thought.
"Oh holy sh*t this burns with an unholy fire!", I thought.
"Owowowowowow", I thought.
I stood totally still. Rigid, even. I couldn't move a muscle or the kid would know how bad it hurt.
"See?" I said. My face with a rictus smile. "Not so bad!"
The kid looked at me with total suspicion, but submitted to his drops. He bounced up after they were placed. "That was fine!"
As for me, I had yellow snotty-looking dye leaking from my eye for the rest of the night. Every patient I saw leaned away from me during exams and one little girl burst into tears when I walked into the room.
Good with kids? You bet.
Part of our standard eye exam is to put drops into the eyes to make them numb. They also dye the eye yellow, so we can see any scratches in the surface of the eye. They (allegedly) sting a bit, but most people tolerate them fine.
This kid had already had his parents squirting water in his eye and the teachers at school trying to flush him out, so he was understandably nervous about the drops.
I decided to try and make him feel comfortable.
"Look!" I said. "I can put the drops in my eye to show you it doesn't hurt!"
I stood up, tilted my head back and opened my eyes wide. A single drop of yellow dye hit the surface of my cornea with a splash.
"FUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUUU*K", I thought.
"Oh holy sh*t this burns with an unholy fire!", I thought.
"Owowowowowow", I thought.
I stood totally still. Rigid, even. I couldn't move a muscle or the kid would know how bad it hurt.
"See?" I said. My face with a rictus smile. "Not so bad!"
The kid looked at me with total suspicion, but submitted to his drops. He bounced up after they were placed. "That was fine!"
As for me, I had yellow snotty-looking dye leaking from my eye for the rest of the night. Every patient I saw leaned away from me during exams and one little girl burst into tears when I walked into the room.
Good with kids? You bet.
Wednesday, October 9, 2013
Coasting
The Pitch:
Welcome to the Community! In this Emergency Department, you will see a wide variety of cases under the supervision of an experienced physician. You will have the opportunity to practice resource management, while providing excellent care for the people of your town. Friendly nursing staff and a safe, engaging place to build your skills!
Yay.
The Reality:
Welcome to the Community. In this ER, you will see little old ladies who have sprained their ankles (plus one who broke her foot and walked around on it until it turned black!), old farmers who have cow-bite-related infections and lots of lovely babies with coughs, colds and rashes. So far, so good.
The usual lacerations, back pain and UTI's will cycle through the department. The nursing staff will alternate between feeding you and making fun of you (this is ok). Your (one) staff doctor will let you see patients and manage them as you see best, while keeping an eye on sicker people to make sure you're doing the right thing.
Then, the ambulance phone will ring.
A VSA arrest is coming in. Vital Signs Absent. The ambos gave 3 shocks and some epinephrine, and this guy now has a heartbeat. Your boss, knowing you need this practice, will ask you to run the code. You will think over your training and stand at the door, gloves on, pits sweating. When you see the lights coming towards the driveway, you feel sick.
They roll in with the guy on the stretcher. His heart is beating, his pulse is strong, but his pupils are not reacting to light and he is totally limp. He doesn't fight when you put drips in, when you shift him onto the stretcher, when you pull his teeth out and stick a tube down his throat. You can't remember what order the drugs are supposed to go in; should you give the amiodarone now? Does he need the full dose, or can he have less cos he has a heartbeat? Do you need to paralyze him before putting the tube in? Or is his total non-resistance an indication that he's braindead and you're just temporizing? The one staff doc is watching you through this whole process and nodding, so you keep going, but then it's 5pm and shift change and she has to go home and pick up her kid so you're suddenly alone in the trauma bay, trying to remember what the next step is and...
Anyways. Community ER. It's like that whole "Air Traffic Controllers" joke; mind-numbing boredom 90% of the time, pant-wetting terror 10% of the time. This is my future.
I am trying to remember why I picked this job.
Anyone? ... Anyone?
Welcome to the Community! In this Emergency Department, you will see a wide variety of cases under the supervision of an experienced physician. You will have the opportunity to practice resource management, while providing excellent care for the people of your town. Friendly nursing staff and a safe, engaging place to build your skills!
Yay.
The Reality:
Welcome to the Community. In this ER, you will see little old ladies who have sprained their ankles (plus one who broke her foot and walked around on it until it turned black!), old farmers who have cow-bite-related infections and lots of lovely babies with coughs, colds and rashes. So far, so good.
The usual lacerations, back pain and UTI's will cycle through the department. The nursing staff will alternate between feeding you and making fun of you (this is ok). Your (one) staff doctor will let you see patients and manage them as you see best, while keeping an eye on sicker people to make sure you're doing the right thing.
Then, the ambulance phone will ring.
A VSA arrest is coming in. Vital Signs Absent. The ambos gave 3 shocks and some epinephrine, and this guy now has a heartbeat. Your boss, knowing you need this practice, will ask you to run the code. You will think over your training and stand at the door, gloves on, pits sweating. When you see the lights coming towards the driveway, you feel sick.
They roll in with the guy on the stretcher. His heart is beating, his pulse is strong, but his pupils are not reacting to light and he is totally limp. He doesn't fight when you put drips in, when you shift him onto the stretcher, when you pull his teeth out and stick a tube down his throat. You can't remember what order the drugs are supposed to go in; should you give the amiodarone now? Does he need the full dose, or can he have less cos he has a heartbeat? Do you need to paralyze him before putting the tube in? Or is his total non-resistance an indication that he's braindead and you're just temporizing? The one staff doc is watching you through this whole process and nodding, so you keep going, but then it's 5pm and shift change and she has to go home and pick up her kid so you're suddenly alone in the trauma bay, trying to remember what the next step is and...
Anyways. Community ER. It's like that whole "Air Traffic Controllers" joke; mind-numbing boredom 90% of the time, pant-wetting terror 10% of the time. This is my future.
I am trying to remember why I picked this job.
Anyone? ... Anyone?
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