Consultant Crushes and Medical Miracles

I'm not going to get too sentimental about all this. Just hear me out.

There are a lot of things we get wrong in medicine, a lot of things we can't treat, cure, or figure out. But today in clinic I had the opportunity to meet some children who are living (playing, giggling, bright eyed, rose-cheeked) proof that modern medicine can be amazing. Similar sort of feeling to a day I blogged about 2 years ago.

I met a child who had a catastrophic birth with many complications, but because of the swift and expert interventions provided (including total body cooling) has managed to develop with no deficits in any area (physically or cognitively). Today she is an adorable, intelligent, able bodied little bean who seriously rocks pink UGG boots.

Another child who was born with a fatal cardiac anomaly, had surgical treatment, and also is now a happy-go-lucky perfectly healthy little man. I couldn't help but send mental props to the cardiac surgeons like Lillehei* who trialed, and failed, and failed, and developed and perfected surgeries like the repair of Tetralogy of Fallot or the Norwood procedures. If those men hadn't risked their careers and their emotional fortitude 50 years ago, today these children would have died at birth or after short and difficult lives.

My awestruck gaze was only sharpened by the fact that I was working with a seriously butt-kicking-ridiculously-intelligent-biochemistry-genetics-pediatric-metabolic-disorder-expert-ball-of-awesomeness consultant who loves to teach! I hoped some of her brain power might waft over in my direction if I sat close enough to her in clinic (without being too creepy and really invading her personal space).

And so, I return to my reading and eventually the newest episode of "New Girl".  Oh and yes, I am working like mad on my CaRMS application and my new research project. I have a whole post on recent CaRMS trauma in the works...but for now...I'll just say that today was a good day. A perfectly timed reminder of why I am putting myself through all of this.

*Read "Walk on Water" by Ruhlman and "King of Hearts" by Cooley if you really want to know what I am talking about. Both fascinating and unreal stories of larger than life pediatric cardiac surgeons.

Ding! Ding! Round Two.

Today I bought:

-Toronto Notes, 2011. Yes. All 1400 pages. I think it's officially in the lead as most expensive (135 Euro) and heaviest textbook of my collection. Yet it is light compared to the weight of worry which is post graduate training....dun....dun....dunnnnnn. It is basically the study guide for our Canadian boards, known as the "EE"'s because there are too many letters ahead of that, so even the acronym gets shortened.

I've held off until now because I thought it was a bit much in every sense of the word.  But, I've realised that if I don't get 99% on the EE's I'll either be staying in Ireland to train or working as an RN in Canada, with M.D. after my name. And almost half a mil of debt. Sub-awesome. So the Toronto Notes are now becoming my new BFF.

It's true though. The fourth years in my program have just found out their Canadian interview offers and two (of 13 Canadians applying to get back) didn't even get an interview. Nada. The shopping spree continues...

I also bought the kindle version of First Aid Cases for Step 2. Mostly just as a way to structure some of my studying using cases instead of just reams of multiple choice questions. Which brings me to my next purchase...

Access to the Canadian MCCEE's Question bank for the next 9 months.

And then I accidentally bought USMLE Secrets For Step 1 for my ipad kindle. Yeah. I already have written step one. I meant to buy step 2. [Hits head on self-assembled desk.]

After reading dozens of reviews on step 2 study guides I opted for Step Up to Step 2.  It will also be arriving shortly via the postman.

Then I bought some pens. You know the ones. Because there is a lot of writing looming on the horizon, and that writing is going to be done nicely in blue-black 0.3mm point style, dammit. We have the technology, people.

It's only a short matter of time until I also cave on a USMLE q-bank but I just can't decide on USMLE-World or Kaplan. Kaplan is cheaper (wow, I can't believe I just typed that phrase!) but everyone seems to say U-World is tougher and prepares you better. In the same way getting hit repeatedly with a hammer makes getting hit with a hockey stick almost seem gentle.

I need to give my visa some time to stop shaking before I use it again. It was an expensive day. I am not even allowing myself a mental tally at this stage.

As always, any thoughts, experiences, frustrations, or treasured methods of study for the EE's or step 2 welcome.

And so, round two of studying for a life-and-career-path-altering exam begins!! Ding! Ding!

Palm Reading

I love looking at people’s hands.

My fascination with hands started when I learned how to I.V cannulate.  I found myself subconsciously evaluating the potential ease or difficulty an I.V start would be, even absentmindedly tapping along the length of a vein (usually creeping out the boyfriend or family member).

Now that I’ve been learning so much about how many clues the hands and nails can reveal regarding systemic pathology, I’m becoming borderline obsessive about looking at the hands of people around me…hoping to see some obscure clue to illness.

Last night I came across a quote in my favorite textbook, “Hamilton Bailey’s Demonstrations of Physical Signs in Clinical Surgery” which I thought encapsulated my rekindled curiosity,

“Regarding the hands, ‘one does not need the mysteries of palmistry to read in them something of the past, a great deal of the present, and even a little of the future. In them is written the record of age and sex; of occupation and habits; of skill or ineptitude; of hard work or indolence’ (Cutler)."

Engrossed

I don't know where to begin talking about "And the Band Played On" by Schiltz.

I've been wanting to read it since I had the unique opportunity to hear Dr. Paul Gallo speak 2 years ago at the University. Of course, I am only now beginning to grasp his role in the discovery of HIV and how he stood at the epicenter of an extraordinary time in medical science.

At the risk of sounding laughably naive, I never thought of how powerfully the politics of the time and society's value judgements facilitated the development of the AIDS epidemic. I hadn't considered the blatant discrimination displayed against gays by the lack of alarm and media coverage. How one of the first news stories to appear about the epidemic was only when a woman had contracted the disease...suddenly it was a story only when someone other than a homosexual man was sick. As I write this I shake my head at how stupid I sound. Of course politics and conservative beliefs played a huge role in the pathetic response by agencies like the CDC and the NIH. Of course. I just hadn't considered all these angles to the issue before.

But still, it boggles my mind. And it saddens me so deeply to learn how many lives could have been spared if only things had been handled more efficiently and more aggressively by people in power--from government agencies to gay leaders. I temper this statement only by saying that I know how easy it is to judge through the lens of the retrospectoscope.

And yet it is also enthralling to read about a time in medical science when clinicians and researchers were scrambling to put together this puzzle with seemingly random pieces. Some patients had toxoplasmosis, others had PCP, some thrush, many Kaposi's sarcoma...no wonder if took time for people to figure out this was one disease with so many faces. Even the concept of determining that it was an infectious disease...when many thought it came from a bad batch of 'poppers', inhaled nitrites.

I am just over half way through the book and already it has made me frustrated, angry, inspired, impressed and very, very sad. What would it have been like to be a nurse or doctor in San Fransisco in 1982 when we didn't know how the disease was transmitted? Let alone, what it would have been like to be a gay man in the same place at the same time? It is chilling to go there in one's mind.

I grew up knowing AIDS only as something famous people did fundraisers for, then as a rare disease I might encounter as a nurse, to a collection of the faces of AIDS patients I did care for. Then it was a complex subject I needed to memorize for the USMLE, and now to this...something I really know nothing about at all.

This book has certainly opened my eyes and heavied my heart.

Summer Reading

One of the readers of Asystole sent me a link to an article she wrote, "The 20 Essential Biographies for Medical Students".

I've only read two on the list, My Stroke of Insight and Hot Lights, Cold Steel, both of which were very good---especially My Stroke of Insight. Seeing the list made me wish I wasn't cramming for the USMLE* because it looks like a very interesting collection that I'd like to dig into, today!

So if you're looking for some medically related summer reading, check it out and let me know if / when you read any of them. Thanks for the link, Carol!

--

*Countdown is at 5 days and change and I am beginning to panic. Wait no, that's Panic with a capital "P".

How Pharmacologists Bitch Slap

Sometimes I wonder if the people who write textbooks get off on sneaking in random digs or inside jokes just to see if anyone ever actually reads full sentences anymore. Especially under dazzling headings like, "Classifying 5-HT₁ Receptors". 

Maybe I really need to get out more but when I came across this line from Rang and Dale's Pharmacology text, it made me chuckle:

"The cerebral vessels are unusual in that vasoconstriction is mediated by 5-HT₁ receptors; in most vessels, 5-HT₂ receptors are responsible. The hapless '5-HT_1C' receptor-actually the first to be cloned -has been officially declared non-existent, having been ignominiously reclassified as the 5-HT_2C receptor when it was found to be linked to inositol trisphosphate production rather than adenylate cyclase." [my bold]

The tone of that makes it sound like the genius idiot that CLONED a RECEPTOR and then mistakenly classified it is forced to remain in his apartment and order his groceries online because of his atrocious pharmacological blunder. I mean, everyone knows it wasn't linked to adenylate cyclase. How embarrassing. 

 Ok, I do need to get out more.

Currently Reading: Shadow of the Wind

Have any of you read this book?

I am about 150 pages in right now and trying to decide if I want to soldier on with it or not.

I don't want to stop reading because it is poorly written, on the contrary, Zafon's style is incredibly descriptive, in an almost poetic way yet not at all indulgent or tedious.

The reason I am wondering about how others may have found it is that it is really starting to develop a dark, creepy, suspense to it and I am just not sure if that is what I want in a novel right now.

It reminds me of when I saw the movie "Crash" for the first time. I had to stop it about half way in and ask my friend who'd seen it "tell me, does this turn out ok? Because if not I need to stop watching this right now" I found it so disturbing (no, not the Cronenberg "Crash", the Don Cheadle one).

Anyway, I am thinking about putting it down and reading "And the Band Played On" by Shilts, partly because our case this week has malaria and AIDS but also because I've been wanting to read it ever since Dr. Gallow spoke at our school last year*.

Thoughts? Stay with it? Or does it turn into some crazy-assed psychological thriller that is going to give me nightmares for a month?

--

*If you haven't read that post, I recommend it, it'll shed some light on why the Dalai Lama's visit here had people planted in the audience with pre-approved questions.

Currently Reading: Ice Bound

 

My mother bought me Ice Bound ages ago and somehow the book has traveled from my life in Kelowna, Revelstoke, Whistler, Mission, Prince Rupert (twice!), Ireland, back to Canada, and then back to Ireland without ever being lost or read--which to me seems like an 'untouched possession' record of some kind. I know that it has made all those journeys because I found, tucked inside the front cover, a handbill for the blood donor clinic in Kelowna from 2007. Maybe I just needed a break from reading about cold exotic places, or maybe I was irked by the thought of reading about a female doctor while I was still desperately trying to get into medical school. Either way it traveled with me for a long time before being cracked open. 

I started reading it a few nights ago and wow, am I ever glad it didn't end up sold at the "great auction of all my personal belongings" in the spring of 2009. 

As the cover states it is about a emergency physician from the US who travels to Antarctica to 'winter-over' as the medical staff at the American base. While she is there, she (somehow, haven't gotten that far yet) finds out she has breast cancer but has no way of leaving until winter is over, 8 months later, and planes can land at the base again. As a result she ends up having to diagnose and treat herself with the limited resources there on the base. The photos inside are intense, including one of her biopsying her own breast.

So far it is very well written and paced nicely. Of course a part of me can identify with the tingles of excitement that she gets with the prospect and then departure to such an extreme location. The packing and preparation scenes certainly rang true with my previous life of Northern adventures, and it made me smile at the reminiscence of having no bloody clue whatsoever of what I was getting myself into.

And like most books I've been reading lately, this one has me hooked which means my hours of sleep are infringed upon as the only place I can find a way to make the day longer. 

Worth it though. I highly recommend checking it out.  

Currently Reading: In Stitches

Some days I think I am probably doing myself (and my GPA) a disservice by keeping this blog going. I've watched 90% of my hobbies and pastimes fall away, so I figure the blog is probably next on the chopping block. But then something really cool happens and I think, "NEVER!! They will have to pull this blog from my cold, dead, permanent-student fingers!!!!!"

Allow me to explain.

It appears that putting near-daily efforts into maintaining a blog does indeed have some benefits.  This week I received a galley copy* of In Stitches by Anthony Youn and was told that I could do a contest for a book giveaway on Asystole. I started reading it 2 nights ago and am already halfway through it. This, to me, is a genuine sign that I am enjoying it. The only commodity I have right now is time and I give that away very selectively.

It is a book about a gawky Korean-American who grows up in a 99% white community in Michigan. On top of a wildly controlling father and constant nerd-herd constellation keeping him from ever being cool, he also develops a disorder in his jaw, resulting in a lot of headgear wearing and eventual plastic surgery. He is forced by his father decides to study medicine and eventually becomes a plastic surgeon (I am not that far in yet, he is still in first year med right now).

So far I've found the book to be an easy and enjoyable read. There are some absolutely hilarious parts in it as well, and some definite parallels to my life in medical school. It is hip and self-deprecating, and honest**. It is also an interesting perspective for me to see; he was a very intelligent, driven, hardworking kid who did everything right and got into medicine. I was a rambling, traveling, musician, wanderlust ER nurse, who did everything wrong and got into medicine.

Anyway, details of the contest will be up soon, but in the meantime you can check out excerpts from the book here. Or you can go to the website for the book, here.  Heck, you can even pre-order the book here. Now back to my regularly scheduled program of pulling out my hair and typing a paper on central line infection rates in Ireland. Hooray!

--

*I am pretty sure that just means an advance copy in cool-publisher-jargon-speak.

**No I am not getting paid to say this, reading is a serious matter to me and if I didn't truly enjoy it I wouldn't tarnish my good-hobbie's-name by promoting something I thought was shite.

And While I am on the Tiny Soapbox...

I suppose I could have also titled this post, "Voice of Reason, Part II".  Maybe this will turn into a series of posts dedicated to people in this wild world of 'healing' whom I consider to be voices of reason.  Allow me to add Ben Goldacre to that list of voices. 

Just so happened that today Life in the Fast Lane (one of the best EM blogs in the history of mankind) posted this video about placebos. Which I enjoyed and thought you might as well.



It is based on parts of Ben Goldacre's book, Bad Science. As far as I am concerned, that book ought to be required reading for all nursing, medical, journalism, and pharmacy students. Or people that want to procreate. Or people who just generally want to understand how the media, health food stores, nutritionists, medical establishments, and pharmaceutical companies can toy with your mind (and your wallet).

One of my favorite aspects of the book is how it highlights the use of certain magical / flawed thought processes to arrive at unrelated conclusions. Example: pharmaceutical companies are bad and are only trying to make a buck so therefore I am going to turn to homeopathy (or shady sellers of snake oil and macrobiotic diet products) and refuse to immunize my children. This is faulty reasoning and doesn't make sense.

What does make sense is questioning the medical establishment as well as the alternative health business.  And, for your own critical thinking skills, attempting to understand how statistics can be manipulated to financially benefit people across the entire spectrum of 'health' related services--from the ear candlers to the radiation oncologists. One should be skeptical of pharmaceutical claims as well as alternative health claims. 

--I suppose I should clarify that I am not lumping things like acupuncture into the same category as caramel high colonics. We all have our 'too wacky to even consider' cut-offs in terms of treatments and I am not about to say where yours ought to be (as long as it falls somewhere after immunizing your children). Yes. This is my blog/soapbox and I will bring that issue up as much as I want.--

For the record, I think the placebo effect is a wonderful thing and if taking a sugar pill from a homeopathy jar makes you feel better--then be my guest. I am not pretending that the people who sell healing crystals are the only ones who benefit from this phenomenon. I realized very quickly as a nurse the power of the placebo even in emergency medicine. Lets face it, a big part of the successes in evidence-based western medicine can probably be attributed to the placebo effect as well.  I just think that alternative practices (i.e. industries that are not governed by evidence-based research and professional standards) can exploit the power of the placebo a little more, at greater costs.

Bottom line: Goldacre's book* is a hilarious eye-opener of an exploration into wrong-doings and exploitations from all sides of the health-care field. It gave me a better understanding of statistics, a thousand more reasons to seethe when I hear the name 'Wakefield' and the ability to see that I was being seriously duped on high-end skin care products. Ok, I may have just made his book sound like the most disorganized jangle of chapters ever written but trust me when I say he ties it all together nicely (and amusingly, especially if you read it with an English-accent in your head).

Read it. 

*No I do not have any personal/professional ties to Goldacre and I do not stand to make any profit from this endorsement.

[Oh, and please continue to vote for my friend Richard's stamp design here. He's climbed into the top finalist position! You can vote once a day until the competition closes in March.]

Voice of Reason

Watch the full episode. See more Need To Know.

Every time I read or see a well thought out piece on end-of-life decisions, it makes me want to go into palliative care medicine. Yes, I am a trauma/critical care junkie--but I also love the holistic approach and paradigm shift that palliative care provides. They are my yin/yang areas of love and interest in medicine. The ability to reach out and pull someone back from the brink---or the skill and wisdom to let go and let be when that is what a patient wants.

I think that Atul Gawande is an excellent writer and though he is a surgeon (i.e. from the specialty that probably gets slammed the most in the media with regard to these issues) he has an amazing grasp of these dichotomies.

I have droned on about end-of-life issues on this blog before, I know, but his article on the matter is a work of art as far as I am concerned. If you haven't already read it, you should. And then you should make your friends read it. And your parents. And your siblings.

I will now step off my well worn tiny soapbox. 

Surprisingly Wonderful

Last night I finished "The Elegance of the Hedgehog". 

It was not an easy read and many times I got frustrated with it and wanted to throw it against the wall. Ok, not that violently frustrated (I did want to do that to Bryce Courtenay's Tandia when I got to the end). But I did feel rather exasperated by Elegance on more than one occasion. I wanted to lose myself in a book, something non-medical and gripping. This book made me think about philosophy and sociology and frankly, I wanted a romp. 

But as the chapters wore on, it grew on me and the characters really came to life. And then the last 50 pages enthralled. Ohhhhh...and the end. The END! I couldn't sleep. I just lay there, head-lamp on, reading the last few pages again and again, crying. 

No sleep. More crying. 

It was a good book, in the end. I think I'll have to tackle it again from the beginning, less standoffishly. 

The Fear

It's really starting to set in.

Since we get our curriculum delivered via case-studies (PBL) and our exams are cumulative for years 1 and 2 that means I have to memorize/learn/understand/regurgitate 48 cases from the last year and a half for my exams. Which start in 8 days.

Each case has an anatomy component (these weekly mini-case studies we have to know around all the differentials, embryology, etc--usually about 20 slides), a histology component (usually about 30 slides), pharmacology, physiology, pathology, stats, and of course all the psycho-social stuff (which has yet to ever show up on an exam).

So I thought I'd get through all the cardiac cases today (as a treat to myself, since I like cardiac).

Yeah, I got through 2 cases. TWO. And I have cranked out a solid 10-11h of focused study. This is not good. I think I will have to abandon all plans for actually going through cases properly and go into a take-no-prisoners mode. I don't know what that last statement means but...first, I will have to start flying through the anatomy sheets...basically ignoring most of the details and skimming though the cases.

I really never thought I'd have to
know so much about the larynx...
next slide! 

Then I'll throw my eyes over each diagnosis in Medicine at a Glance (the book that every patient hopes their doctor never used in medical school). Burn through about 1300 histology slides. (Thank goodness that pink stain never starts to blur into one image after a while...)

Next I'll somehow read through the learning objectives from all a handful of the cases and hope to hell it's those ones that show up on the long answer. Not like last year where 10% of the written marks came from if you knew what a P-value was or not. Really glad I spent all that time memorizing, oh, everything but stats.

Wow. There were a lot of numbers in the preceding paragraphs. Am I perseverating on irrelevant details? Trying to somehow strategize how I can cram all of those numbers into the number "7" which is how many days I have left to study?


In other, more interesting, non-medical-school-meltdown news, I think I'm going to abandon my attempt to read 100 Years of Solitude unless someone from the blogoland can convince me that it's worth sticking with it. I am about 100 pages in now, and it just hasn't grabbed me. I thought I'd give Gabriel García Márquez another shot after Love in the Time of Cholera became an anvil in my backpack two years ago on my Himalayan trip (one of the few books I brought with me so I felt I had to keep reading it). 


The other reason I am feeling tempted is Freedom by Johnathan Franzen is sitting on my bedside table waiting to be read. Well, it was supposed to be for my Christmas break (but then, so was Into the Wild which I accidentally started reading and finished last week). I remember loving The Corrections so I have been wanting to get into Freedom ever since I saw it at the bookstore.

I just like staring at the cover and thinking "December 15th, late afternoon...sigh" I'll get my own little taste of freedom for a few sweet weeks.

Breaks over! Back to it...

Finished. Repeat.

Just finished the book I was reading. S l o w l y.

It was amazing. Book report to follow.

Tomorrow I am going to start reading it again, from the beginning.

Yep, it was that good.

Currently Reading

It is seriously blowing my mind. 

And keeping me motivated to stay in medical school. More on this when I actually finish it. 

A New Chapter

I wish there were more hours in the day so that I could read. Well, non-medical texts, that is. Although it'd be nice for some extra time to crank through those as well.

I miss the mountains, I miss my nieces and nephews, and I miss reading.

My reading time is now after Tobie falls asleep, headlamp on, buried under the covers. It's a bit like summer-camp or secret reading after your parents told you to go to sleep. But it's the only time that I don't feel guilty doing it.

I just started "Anatomy of an Illness" by Norman Cousins, and I am so excited about it. Almost as excited as I am about getting to "William Osler, A Life in Medicine" by Bliss, which is also burning a hole on my nightstand.

The intro to the Cousins book contained the famous quote by Francis Peabody, "The secret of the care of the patient is in caring for the patient".

A simple, and very true fact.

I sense many late(r) nights ahead.

That's A Negative, Ghost Rider

A couple of months back I read the book "Outliers" by Malcolm Gladwell.

I have to say it didn't impress me as much as his book, "Blink", but there were a couple of interesting chapters. The one I found most fascinating was the one about Air Korea and their increasing number of deadly crashes. Forgive me if you've read it but I'll flesh it out a little for those who haven't...(and also forgive me/correct me if I recall some of this sloppily as I've already passed the book on to a friend and can't reference it now for complete accuracy).

In brief, Air Korea was having so many plane crashes that it was in danger of losing it's ability to fly in North American airspace and going under as an airline. Experts were brought in to look at why the crashes were happening. In reviewing the documented dialogue between pilots/flight engineers they found the language that was being used (both to air traffic controllers and colleagues) often did not convey the seriousness of problems early enough for them to be corrected. It was often vague or the seriousness of the situation was watered down.

Also compounding that, the deference that the 1st officer has toward the captain (as a cultural implication) does not really allow for him to a)take over the controls if the captain is screwing up or b) tell the captain that he is royally screwing up and get him to change his actions. Even in the face of imminent death these 1st mates could not or would not violate the cultural norms to do as they are instructed in emergency situations (i.e take over the controls if the captain is making a grave error). I have to say that reading the transcripts of the dialogue prior to the crashes was heart wrenching and fascinating.

So the company was re-vamped, retrained, and dissected to see how this behavior could be 'un-learned' when the pilots were at the controls. One of the changes that was implemented was that the crew were to address each other by first names, thus eliminating some of the power differential present in the language of titles. Once the 1st officers were trained to be assertive and see themselves on more equal footing with the captains, the company soared (literally and figuratively). The pilots were trained to communicate more effectively with all of the members of the team--the captains consulting with the flight engineers and first officers and vice versa.
Korean Air, as it is now called, is a top notch airline with a safety record better than most of the competition.

So this got me thinking about the dynamics that occur in health care. Pilot errors and physician errors (or health care related errors) are often compared. Pilots have very strict guidelines in terms of sleep and work related to job safety...most hospitals have nothing in place that is comparable for nurses and doctors. Look at the hours that residents pull!! Would a pilot ever have to be at the controls for an entire weekend on only a few hours of sleep here and there? Not on your life! (Ha!)

This thread then got me thinking about the 'safest' places I've ever worked. And by safest I mean...ER departments or outpost clinics that I felt their existed a harmony amongst the staff where one could ask questions, point out errors, admit to errors, ask for help, admit to being swamped, call attention to urgent needs...etc. versus places where none of the nurses would speak up if they didn't understand an order, or thought that maybe the physician was making a mistake, or noticed a patient deteriorating. Or where physicians would ask for input, feedback, collaboration from the rest of the staff (be it physios, R.T's, nurses, whatever).

Trust and mutual respect go an amazingly long way with regards to patient safety in my humble opinion. The more I reflected on examples of this the more glaringly obvious it was.

The parallels between the airline crew example and an ER department staff seemed pretty obvious. Right down to addressing one another by first names instead of titles.

I know these aren't new or groundbreaking thoughts on workplace dynamics in the ED but it got me thinking back to a post that Old MD Girl made on her blog* about being a doctor and being the "boss" of nurses.

Nurses (and other health professionals) certainly have a lot more respect in the workplace than they did 100 years ago when their duties included cleaning the doctors lounge and standing up whenever one walked in the room (I would have lasted about 5 mins as a nurse if I'd been born 120 years ago, BTW).

Today I see us as the 1st officers to a certain degree. I have had relationships with some docs where I have felt my opinion and input on a patient was seen as important information and I have worked with docs who made me feel like an annoying mosquito buzzing in their ear every time I opened my mouth.

I have had physician colleagues write "sedative analgesic" as an order and trust me enough to use my discretion with regards to what I am going to give a patient to make them relaxed and pain free. And I have worked with doctors who have angrily told me NOT to use the word "angina" when describing a patients symptoms to him because "angina" is a medical diagnosis and nurses do not make medical diagnoses. (Not even joking).

So what sort of utopian emergency department would it be if nurses and doctors could lose some of that power differential and see each other as colleagues instead of two very separate camps. I know that all work places are all about hierarchies and titles and posturing and inflated egos. But I have seen how these natural human tendencies can actually put patients lives in jeopardy and I think it is something worth reflecting (or ranting?) on a little.





*To my surprise I actually wasn't irked by this post. Overall I enjoy her blog and think that she has interesting and often funny anecdotes (which I can certainly relate to being 'old' myself).

Bliss

I had a very long, very hot drive from Whistler to this...my last nursing contract. Can you believe that one can drive for over 1400 kms and still be in the same province? Sigh. I love this country.

I kept myself entertained by "My Sister's Keeper" on audiobook, along with an emergency lecture podcast series with topics ranging from 'ASA toxicity' to 'bronchiolitis treatment' to 'syncope in the ED'. Both so good that I found myself actually wanting to get back on the road and into my listening booth on wheels.

Day one of the drive was 10h long as I had to make a small detour to pick up a few things I had left behind at my last contract...bike shoes, laptop speakers, mandolin, and mini blender.

Welcome to my life and my essentials.

During the first day of the drive I was in what I call 'dad mode' which is the get up super early and stop only when decreased LOC from hypoglycemia or bladder explosion are fighting to be your next presenting complaint in an ED.

Day two of the drive I realised I didn't need to be in a huge rush, I had gotten another early start following my truckstop breakfast and only (only! ha!) had 717 kms to go. So I meandered my way here, stopping for fruit then stopping again to eat the fruit at a picnic table with a view.


I took another detour and found myself alone at yet another picnic table beside a raging river. I rolled out my yoga mat and attempted to stretch my legs and spine back to the length they had had 1200 kms ago. At one point in a wide stance forward bend I opened my eyes as the wind picked up causing pine needles to rain down on me from the sky...it looked and sounded like some kind of weighty scented earthy snow. I lay down in the shade with my straw hat covering my face and enjoyed the beauty, the sounds, and the breeze that surrounded me. I was just so thankful to have that moment, the stillness.

I arrived later in the evening and was invited to a BBQ at one of the nurses houses...starving and without groceries I was grateful for the grub and the company.

So I am here, safe and sound. Worked one shift yesterday and had today off, which was great because I was able to finish my book, "Late Nights on Air" by Elizabeth Hay. Ummm...amazing book. It resonated with me since I have spent some time in Yellowknife (where the book is set) a few years ago falling in love with the North and a person in it. Ah well...at least my relationship with the North ended up being a little more long lasting.

More Amazing Brain Development Information

Ok. If you have a few hours to kill in a car (like I always seem to...) let me recommend listening to this radio show. It is from one of my favorite podcasts, "Ideas" on CBC.

This feature, The Brains of Babes, especially episode one, has some fascinating discussion about studies linking heart disease and diabetes to fetal/early childhood health as well as pre-pregnancy maternal health.

And while we are on the matter of fetal/early childhood development can I also mention that the two most recent books that left my jaw on the floor were, "The Brain that Changes Itself" by Doidge and "In the Realm of Hungry Ghosts" by Mate. Really, if these books don't fascinate you to the point where everyone around you rolls your eyes when you begin yet another sentence with "so I was reading today..." then send me your copy and I'll send you the money for it. :)

My apologies if I've mentioned these books before on Asystole, but listening to those features on Ideas just reminded me and I wanted to give them the props they deserve.

So there you have your summer light reading list.

Oh, and add "Book of Negroes" by Hill to that. Finished it today.

Wow. What a book.

(I know that is the weakest review of a book ever, but seriously...just read it.)