Tim Hortons "Double-Doubles" as Emergency Outpatient Department

Honestly, if I never eat another Timbit for the rest of my worldly existence, it will be too soon.

http://www.flickr.com/photos/megbee/4681323082/

It seems no matter where I work in Canada there is always a rock-hard raisin Tim Bit to be found somewhere in the emergency department. You see it when you come on shift and wonder, "How many days has that been there? Where did it come from? Has it fallen on the floor? Where are the raisin doughnuts which supposedly give rise to these revolting timbits? Is that a sugar coating or a MRSA coating?" yet by three am the only question is "Where the HELL is that raisin timbit??" Gnom, gnom, gnom.

I think it is safe to say that most Canadian emergency departments are fueled mostly by T-ho's and *Bucks. So it seems like a natural (and horrifying) transition that a West coast emergency department had to actually use the Tim Hortons as an overflow department last week. In reality the headline (of course) is not really as shocking as it sounds; the coffee shop is right next to the ED, not open to customers at that hour, and the patients were separated by screens.

I have had to treat patients in much less civilized environments which never made headlines because they were considered 'part of the department'. But really, gangrene-limb dressing changes in a packed ultrasound waiting room, bed pan toileting in the main hallways under the 'privacy' of a blanket, infusing blood into demented septic geriatrics stuck on gurneys for days near the constant swoosh of the ambulance bay doors...it is all completely inappropriate and dangerous. Yet just part of the day to day challenges of the emergency department.

What baffles me is the shock that this has happened. Um hello, if you fire facilitate retirement of senior nurses, decrease medical floor staffing, and close or cut feeder hospital services in the face of the oncoming silver tsunami then, guess what? A lot of flotsam and jetsam is going to back up in the emergency departments.

The only question I have about this whole ordeal is how plopping the fast-tracks into the T-Ho's wasn't a major health code violation for the restaurant. I guess now the MRSA will come free with your extra large double-double. 

It is actually good that this happened because I can guarantee that for at least a few days some magical discharges will happen, beds will suddenly appear, staffing levels will be startlingly appropriate, and at least a handful of people who've been rotting as inpatients in the ED will finally get access to a room with a shower and a toilet in it. Oh, and the ability to turn off the overhead lights. What luxuries.

Damn though, now they also might want a honey cruller with that...

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. 

A Timely Whooping Cough Outbreak

Ok I promise not to turn this blog SOLELY into a vaccination campaign...BUT...today the CBC reported a whooping cough outbreak in the west Kootenay region of BC, Canada. That area of BC's interior has the lowest vaccination rate by the way, not a coincidence.

I say it is timely as I just did a post a few days ago on Andrew Wakefield and his contribution to worldwide lows in immunization rates.

All 19 cases in BC were on un-immunized children.

I had an aunt that died at age 2 of whooping cough and a grandfather that was on the team of physicians who brought the first iron lung to Canada.

So I take vaccinations a little more personally that I ought to perhaps...

Country Doc Saves Boy With Home Drill

This gave me chills, especially listening to the doctor describing the procedure. Having faced a few scary situations in the arctic--though obviously never anything this harrowing--I can appreciate the statement the doc made when describing what prompted him to take action, "the actual procedure itself was not as terrifying as the possible outcome if I didn't do it.''

Here is the full article.

I recommend listening to the doctor describing the event if you go to the article.

Pretty amazing story! I can't help but think, what if we had to do this in the ED I am currently in. Note to self, on night shift tonight...suss out where drill and makeshift shunt might be...

Grandmother Gives Birth To Triplets?

I had to comment. There are just so many things WRONG with this "news" story.

1) She's 46 years old. Funny how the headline doesn't read "46 year old..." Maybe I am choked because the fact that "grandmother" was in the headline made me read the story. Damn it! I hate being tricked by sleazy journalists!

2) Apparently she's aware that she would be challenged by looking after the boys.

"I'll probably have to use different coloured nail polish on them to tell them apart," she said.

"I don't want to get them mixed up."

Ummm...I think it is safe to say that the smallest thing you'll be worrying about is "getting them mixed up"!

3) 'David Molloy from the Queensland Fertility group said the chance of having identical triplets at the age of 46 was "probably the same as winning Gold Lotto."

I'd rather win the lotto.