Monday, August 15, 2011

Randoms of the Day

Today at lunch in the cafeteria I was reviewing the different types of physical diagnoses that can be made based on 'inspection of the faeces' (complete with photographs). Didn't seem odd to me until the Senior House Officer (SHO) joined me for lunch. He peered over my shoulder and shuddered when he saw what I was reading while slurping back my soup-of-unknown-components. I actually find the lost art of physical diagnosis riveting. I do.


I saw an SHO in the emergency department today wearing a scrub top (fine) with loose athletic pants that were 2 inches too long, dragging on the ground, with bare feet and flip flops (the opposite of fine). I am not the Emily Post of medical uniforms by any means but that was horrendous on so many levels.

On the subject of ridiculously unsafe and disgusting footwear I also saw a phlebotomist wearing open toed sandals on the wards today. WHAT?

That would never fly in North America. The infection-control-worksafe-auditing-psychos would be snapping their clipboards in half if they saw such a thing. I remember being told by an old manager of mine that I wouldn't be covered by WCB if I had a work related injury because my clogs had too low of a heel. Oh Ireland, sometimes your "it'll be grand" attitude goes a little too far.


I am getting my vertigo et al issues finally checked out tomorrow. Freaked that I'll hit the ground while holding a retractor in theater so I figured it was time to actually see a doctor instead of reading UpToDate. Here's to hoping I'll be able to rule out acoustic neuroma or other space occupying lesions, soon.


There is the most adorable little old lady on our ward having an abdominal mass and bowel resection done this evening. Initially she didn't consent to surgery (she is in her late 80's, after all, and not in the greatest health to begin with). She had fears that she would not make it through. It must be a terrifying decision to make. My registrar went and discussed things with her on evening rounds. She stuck out her wrinkled chin and said, "That is FINE. Do whatever it is you need to do. If I make it through I make it through, if be it." But her voice did quaver a little. Her hair and skin were so thin but her eyes were bright and sharp. When the SHO poked his head around the curtain she saw him and pointed his direction, "Whatever that young man was trying to talk me into this afternoon, I'll do. Where do I have to sign?" It was funny and sad, and we all sort of chuckled awkwardly.

I don't know what it was but at that moment I wished I was her nurse who'd be there to talk to her once the doctors left,  rather than the mute medical student who didn't even know her name. And I decided, I didn't want to watch her surgery. Even though normally I'd be itching to scrub in on a new pathology and procedure.  I walked out to my car in the rain and was glad to shut the door to all of it.


Thanks to everyone who sent emails or wrote thoughtful and positive comments on the last post. I had the chance to make a great meal for friends on Saturday, then scamper in the mountains on Sunday. Both activities were much needed and much was gained in terms of perspective. As always, will keep everyone posted on how things are unfolding.


MDToBe said...

Just wanted to add my positive thoughts to all the others!

I'm sorry you didn't get the Step 1 score you were hoping for (and wholly deserved, in my opinion, based on how hard you were working! TBH, I couldn't even read your site for about a month after I took my own Step 1 because your work ethic was making me break out in a cold sweat of guilt :).). However, one thing I know from having read your blog for awhile, and having gone pretty far back in the archives: you're going to do great. You'll end up somewhere you're super-happy, and you'll learn amazing things (because you're so good at taking the most and the best out of everything you see and do) no matter where it is. And your patients are going to be among the best cared for patients in *any* country, whether that's Canada or elsewhere. I'll eat my scrub cap if I'm wrong about this.

Also, about wishing you could be the nurse instead of the mute med student: this has happened to me a dozen times since I started clinical training 2 months ago, and I never even trained as a nurse! I t's so hard to see doctors not take/have the time to give to their patients when there's a hard emotional hurdle to get over. I've been able to stay behind or wiggle my way in to catch the patients before they leave a few times, to have a few extra minutes with them, but I know I've been lucky in the past with that. I hope you'll have the chance to do that more in the future.

Good luck with everything, and never forget: you're going to make a *damn* fine doctor!

jberry said...

I don't know if you've ever heard of the TV shows scrubs, but there is a whole episode on poop and they sing and dance, if you have time check out for it, it will bring a smile to your face.

Liana said...

One of the consultants at the Hospital for Tropical Diseases in London told us that when he trained, his consultant used to insist that all the patients' feces from the past 24 h were kept in individual buckets in the cold room. And they would have to examine the feces everyday.

ertwro said...

That picture of you is pure Winning.