Tuesday, April 28, 2009

Clearly I am Not the Only One Frustrated

Hadlington sent me this link and I enjoyed my morning coffee while reading it.

It's funny cuz it's true, as they say.

Monday, April 27, 2009

Conversations I am Tired of Having (Or Don't Have Time to Have) at Triage

Forgive me, this is more of an "I am triage, hear me vent" sort of a post and will likely not be very cogent because I am sleep deprived and trying to figure out how I am going to scrounge my first tuition payment due in August ($ 64 000 CDN--thanks for asking).

I have often felt that ER departments are the final resting place for all the crap that runs downhill in the health care system. Public health programs get less and less funding (and harm reduction programs just get canned altogether) so people aren't getting the education/programs/information there. They are sicker and know less about how to manage it. So they go to their local walk in clinic (because no one seems to actually have a GP anymore). Or better yet, they just wander down to the local ER on a Sunday evening.

My favorite quotes from last night:

"well I saw a doctor already and had an xray and was told it isn't broken, but it still hurts"
--did you take any tylenol or advil for pain?
"no, I don't like taking pills"

and

--how long has Junior had the earache for?
"oh about 2 h"
--did you give him anything for pain?
"no"
--are his 3rd year immunizations up to date?
"we don't immunize our children"

and

"I saw my doctor and he started me on this antibiotic...but it isn't working"
--how many doses have you had? (my inside voice finishing the sentence with--'for your virus')
"1 dose this morning"

The medical floors are understaffed so they can't take more of our inpatients, therefore these patients are stuck in the ED which means that we have fewer actual beds to see the incoming emerg patients. This pushes the backlog to the waiting rooms, which is where it gets ugly.

Voila. The crap comes to a halt, just at the final threshold of the hospital...the emergency waiting room door. Let me clarify, when I say 'crap' I mean the policy, the lack of funding, the shortage of staff, the health care CRISIS if you will, finally stops rolling and is allowed to show itself in all its glory.

The urgent and will-never-be-urgent are squeezed together in a tiny place, clamoring for their moment with the triage nurse.

One woman with diarrhea threatened to call 911 from the waiting room to get an ambulance so she could be triaged faster. I know this isn't a new tactic but last night it seemed particularly poignant as

a)the ambulance service is on strike right now and there have been code 3 calls that have had to be dispatched to cars over 100kms away because of the dirth of running cars right now

b) I was the triage nurse but was also looking after the inpatients and the IV therapy patients which meant that I didn't even have TIME to address this threat or give any direction to patients as to WHY they are waiting and what other strategies they could use to access health care or gain relief from their chief complaints.

I felt like imposing the triage method described to me by the South African doctor I was working with last night:

ask everyone in the waiting room to stand up

whoever stands up is told they are not sick enough to require ER services and is told to leave.

Ok so maybe a little Draconian, but...I was so incredibly frustrated at that point it almost seemed reasonable. If she had called 911 then an ambulance would have been dispatched, and could have possibly been sent from anywhere in a 100km radius...thus removing that car from it's region and putting REAL emergency patients at risk...you know those pesky time-sensitive things like heart attacks, traumas, strokes, allergic reactions, etc.

Am I done venting?

Almost.

We were simply lucky last night that we had no codes or REALLY sick folks in the department because things could have gone south very fast. Short 2 nurses in an ED is dangerous. There is no other word for it. And I know this is the case all over the country. It seems every emerg doc or nurse I know has similar 'flying by the seat of our pants' stories from their departments.

Here's to saving lives on a shoestring.

Saturday, April 18, 2009

Celebrate Good Times C'Mon!


So after 5 days of nail biting and fielding the q 3 hourly calls from my mother seeking "updates" I finally broke down and called the admissions office. I spoke with one of the directors whom I met when I was in Toronto for my interview. He said, "is there a drum roll in the background?"

"Let me see if you are on the regrets list...hmmm...no no I don't see you on the regrets list...Congratulations! They are offering you a seat!"

I was unconvinced, "Double check and make sure I am not on the list by my first instead of last name".

He laughed, "No no, I just opened the offers list and here I see your name in capital letters!"

And with that I realised my goal. It has been literally years and years in the making.

I never really believed that I would ever be capable of getting accepted. It took me 9 years to get up the courage to try those pre requisite courses again, after dropping out of chem and physics in my second year of university. I can still vividly remember being on the pay phone with my mother after my devastating physics midterm, crying and telling her I'd never be a doctor all because of physics--and feeling sooo frustrated and that the world was completely unjust as a result of that fact.

That memory makes me smile now.

So Jerry and I began drinking bubbly at about 1600h. We lounged around and went for dinner at this wonderful restaurant in town which uses as many local ingredients as possible--spectacular food. He told our server what we were celebrating and when the black forest cake (my absolute favorite dessert in the world because it was my birthday cake every year when I was a child) arrived there was the scrawled "Congratulations" on the plate. I had to take a photo, Jerry wouldn't let me use my camera so I did it a bit more stealthily with my phone (no flash). I couldn't resist!

It was pretty much a perfect day.

Wednesday, April 15, 2009

Refresh...Pace...Refresh...Pace

Admissions committee's are such teases. They are like the really hot single interesting person you met at that dinner party who said they'd call you 'early in the week'.

What does 'early in the week' mean exactly? Before Friday? Tomorrow is Thursday and I will be driving through the mountains all day with intermittent phone reception. ARGHGH I just want to KNOW already! It's been a couple of years now of being in limbo and these past few days have stretched to eternity-feeling status.

I have hit 'refresh' on my email inbox so many times today I've worn a callus on my pointer finger.

Monday, April 13, 2009

Tough Day At the Storage Locker

Of course it was drizzling a bit this morning and cold. I was making trips back and forth to the storage locker all day, moving my things into AMG and Ryan's basement to get the goods on display for the "binge and purge" party.

Going through all of my boxes with a ruthless "am I going to want this in 10 years?" attitude was what kept the "for sale" piles much much more plentiful than the "going into storage in my mom's basement" pile. But every box I opened flooded so many memories back to me, from my stemless wine glasses to my flour crusted cook books to my tattered pink feather boa. I remembered what road trip I bought those engraved glasses on, what gig I wore that skirt for, what used bookstore I bought that Timothy Findley book in. Every piece has a story, a little part of my history, a little part of my life.

It was a tough day. There were a few times when I couldn't help the tears that welled up in my eyes as I stared at a handmade mug or a handful of arctic cotton that I had carefully wrapped up from Baffin Island. I couldn't help but wonder what I was doing, getting rid of all these little treasures. But the truth is, I'll be gone for at least the next 4 years and likely a residency in the US (which tacks on another 3-5 after that). And I know, it's only stuff, but it has taken me years to acquire and attain these things, some of them from many different corners of the world.

Soon my friends were stopping by and putting their bids on my various belongings. The buzz of activity jerked me out of my 'how sorry for myself can I feel as I get ready to embark on the adventure I've been hoping for for so long' reverie.

It ended up being quite the evening. Verena just kept saying "This is so weird! You're getting rid of all of your things! This is sooo weird!"

Small bidding wars have started over things like my retro dressers and Ikea lamps. Tomorrow we'll finish up the not-so-silent auction and I'll take whatever doesn't go to the second hand store, the bookstore, and the dump. The nostalgic bits are heading back to the storage locker and then to mom's basement (again).

AMG's contractions are now 1 minute apart and they are off to the hospital.

New beginnings all around.

Saturday, April 11, 2009

Interview Post-Mortem

Just taking a few minutes to enjoy a hot beverage from my favorite world-dominating coffee distributor while I wait for my connecting flight...reflecting on the interview and the last couple of days.

I think, overall that the interview(s) went well. The group interview was, as suspected, somewhat frustrating and harrowing. We arrived first thing in the morning and were divided into groups of eight, assigned an evaluator (mine was the Dean of Medicine from the school) and sent off with a scenario. We were told to spend some time reviewing it and 'solving' the problem on our own and then we were to discuss our solution with the group and come up with a single, unified, answer.

I am not going to give away the problem on the blog as I don't really think the Uni would appreciate it, and I would hate to give someone else an unfair advantage (because I am sure that my readership includes at least dozens of pre-meds that will be interviewing for this school-ha!).

When the discussion began it was as I predicted a bit of a gong show--people interrupting others, cutting applicants off mid-sentence, talking loudly over others...there was no bloodshed but a few claws definitely were bared. I sat back and listened for a while, watching the fur fly. Then realised that if I didn't start doing the same the group part would be over and I would have appeared like a shy wall flower to the Dean. Not good. So I jumped in. It was pretty stressful. Tough to be under the gun, trying to make yourself look good without strutting, while under a major time limitation (about 20 mins).

Finally it was over. I had 3 hours until my classic interview. Scampered back up to my hotel room, had lunch, then went and rode the bike in the gym downstairs for half an hour to settle my nerves. Re-ironed my suit. I think that was the best thing I could have done--the biking I mean, not the ironing.

I was interviewed by the Dean and a gastroenterology prof from one of our Canadian schools. It was only about 25 mins long and the conversation was actually pretty fun! I had done TONS of completely unnecessary prep--I could tell you all kinds of facts about everything from the rugby team to the major industries in the city...how long the school's been around, how the curriculum is organized, how many hours a day we are in class...Both of my interviewers were very congenial and pleasant. We chatted about my work in the North, my criticisms of problem based learning, my music background, and why I was choosing to make the leap from nursing to medicine. I felt I represented myself well and if I am not offered admission I can be comfortable with the belief that it wasn't because I choked during the interview.

So now I wait and try to decide what to do if offered a seat in Ireland.

I hit 'refresh' on my email inbox every 7 minutes or so (the offer comes out this week).

And wait.

And in the meantime give away most of my earthly possessions. Anyone want a full set of Paderno pots?

Wednesday, April 8, 2009

Eek! Interview Friday!

Just taking a quick procrastination break to say that I am cramming (I know, you'd think I'd have learned by now) for my Irish med school interview which is in two days.

The morning is a group interview which is totally stressing me out as I have no frame of reference for such an endeavor and the afternoon is for classic interviews. How to come across as a well rounded, smart, interesting, compassionate professional instead of a ADD, arrogant, conceited, emotionally unstable, domineering Captain of the Universe?

It shall be a fine line.

There isn't much I can find about group interviews online which is kind of frustrating...so I am prepping as I would for a classic and hope I don't fall flat on my face and say something inane like "because I want to help people" when they ask why I want to be a doctor.

Eeek! I am stressing.

On the plus side, my suit pants look better now that I've dropped the too-much-dahl-in-India poundage.

Look out world, I am on my way in baggy trousers!