Permission to Take Blood

A sprightly 72 year old came into the office for a prescription refill and blood pressure check. His tie was tightly knotted, thick hair combed into place, and shoes well polished.

We asked him once more if we could take blood to screen him for the routine things; high cholesterol, diabetes, prostate antigen. Once more he said, no doctor, I don't want to know if something is a brewin'. Not interested. 

Joe pressed him a little, sure come on now, are you sure you wont let us?

To which his eyes shone a little brighter and he answered, listen Joe...if I walk out into the street and collapse in front of the surgery, tell ya what, I give you permission to take as much blood as you want.

Fair enough! 

Is There a Translator In the House??

We had a very sick patient who spoke very little English. He presented to the emergency department acutely short of breath with oxygen saturations in the 70's (a.k.a badness). He needed a chest tube but we couldn't get a proper consent since we couldn't explain to him what we were going to do. We also didn't know his resuscitation status. No next of kin. Fingertips blue, lips blue, respirations labored, shallow and >30 per min. Not good.

The hospital is small, as is the town. There is no translation service on site. I asked one of the nurses what I could to do help and was handed the phone book, "Start calling restaurants to see if anyone speaks his language". 

So I did. The waitress answered the phone, I explained the situation and asked if they had any staff that spoke Vietnamese. The receiver was placed down and I could hear muffled voices:

There is an emergency at the hospital....Vietnamese...they'll pay for a cab...yeah...but I'm working...no no go then...OK. 

Then a man's voice into the phone, "I am on my way".

Soon after our improvised translator approached the desk, within minutes the anesthetist was explaining to our patient what was going on, what needed to be done, and what the risks and benefits were. The chest tube was inserted, his fingertips became skin colored again and he stopped using his entire body to breathe. Today I walked by and saw him sitting up in bed tackling a plateful of peas.

Little hospital medicine: where we make pediatric armboards from tongue depressors and find medical translators in restaurant kitchens.

I (Heart) Rural Medicine

In the last 48h have included having the opportunity to:

-catch a baby
-cut a piece of glass out of someone's face (and then stitch them up afterward)
-surgically assist with fusing toes, replacing hips, replacing knees
-perform a D&C
-assist with a hysterectomy
-sew up knife wounds
-assess / treat / discharge about 75 emergency patients
-learn how to insert an IUD

Despite the exceedingly damp climate my hands are cracking from so much handwashing, I'm surviving solely on t.v. dinners and instant soups, clean underwear is becoming a scarce commodity, and I've spent every day (except one) in the hospital since my arrival. And I couldn't be happier.

My days are so full and varied, with such fantastic teaching from the docs here. It's hard to sleep at night, completely wired and excited by each day's events. I feel so fortunate to be here. I'm starting to believe that saying about how "there are teaching hospitals and then there are learning hospitals". Say what you will about rural medicine...but my experience is that people working in remote areas have half the egos and double the desire to teach.

I've been spending a lot of my retractor-holding and trying-to-sleep time thinking about the (soon arriving) residency application process. Today I truly felt like a few things have started to crystallize in my mind about what I want to pursue...

As always it is a work in progress, but I think that will have to be a post for another day.

In the meantime, check out my new O.R clogs while I try to get some well deserved sleep.

Yes, yes I did.

Racing: The Irish Way

 

A few weeks back I convinced my brotha-from-anotha-motha, Ryan, to run this 10 mile race. So he signed up. 

I balked. He trash-talked. I registered. I regretted.

It was actually pretty fun.

The drive there was an adventure, at one point the GPS (who I've named Dunce Cap or D.C for short) even got lost, telling us to turn left but mapping us to the right and then getting all hissy when I went left. I really want to throw that thing in the majestic river Shannon most days.  Though the road (pictured above) was scary and narrow, the directions were typically Irish ('after a long bend in the road take a left and follow that road') we somehow found the place. I had a moment of anxiety the night before when I realised that doing a race in the middle of February is actually a really bad idea. You see, it is too soon for there to be any resolutionists (as I like to call them). No one decides on Jan 1st to do a race 6 weeks later. Most would think it is not enough time to train for a medium distance run. And this race, in particular, is known as the 'most challenging 10 mile race in the country'. I'm not sure about this claim as it is possible that it is the only 10 mile race in the country. So, the folks running an ass-buster in Feb are likely going to be really in shape, doing it as a fun day out as they prepare for their next big race somewhere else. 

Oh I so called it. As we pulled up we could see a blur of lyrca stretching and light-jogging up the first hill.  Formidable specimens, they were. I could see the outline of their vastus mediali  from the parking lot (which, by the way, was a farmers driveway, complete with fowl and swingsets, pictured above).

This is what happens when you set a camera timer and try to look tough.

The weather was outstanding. It was indeed a challenging race with loads of hills. But both Ryan and I were happy with our times (Ryan had hoped to do it in 1:30 despite the elevation and he finished in 1:19)! I was hoping to finish under 2 hours since I haven't really been distance running since....oh....2008! But I managed to pull a 1:32 out which isn't exactly olympic qualifying time, but it got the job done. And I was pleased. And apparently haggard.

Hello, beauty.

After the race I drove home, grabbed some food, water, bathing suit, and towel, and headed to the icy Atlantic nearby. My car thermometer read 7 degrees yet somehow I managed to strip off my many layers and plunge in. I am a firm believer in the ice bath. It had to be done and I figured a sunset dip in the ocean would be better than the view from my bathtub.

Turns out, I was right. Shortly after my dip the clouds rolled into this amazing formation that nearly took my mind off the fact that every cell in my body was shivering. I sat in my car, cranked the heat on (sorry environment, it had to be done for a few minutes) and ate my picnic supper. I made a mental note regarding what a lovely date I'd taken myself on, and deciding that yes indeed I would go out with myself again. Once the beach was dark I drove to the gym and vegged out in the sauna and decided that life was pretty much all I ever hoped it'd be. Oh Ireland, I really (heart) you sometimes.

FIRST CUT!!

Dear Diary,

Today I had the chance to make my first scalpel to skin incision. M.C was very nonchalant about the whole thing. I had set up the tray as per usual (thanks to years of nursing and having to set up many a tray for minor ops) and then he just casually said to me, "okay, so work away there...get a blade for yourself..."

Yeah, I tried to play it cool but I am fairly sure that the eyes-popping-out-of-my-head-with-questioning-stare gave it all away.

He smirked and pretended to have something to do away from the patient while I went about (excitedly) excising my first skin tag.

This was followed by a sebaceous cyst excision and another skin tag removal (of a patient I had seen 1 month ago and booked for the procedure). She said she hadn't felt a thing, and that I was worth every penny that he was paying me. HA! I shall never let M.C live that one down.

I was pleased to learn that I have a steady hand and do indeed get a rather large kick out of cutting people (in the socially acceptable cutting to cure sort of way). I am sure that such a milestone is something you never forget. Course I am happy that this happened in one of my favorite little hospitals, on Valentine's day nonetheless.

Today was a good day.

Sincerely,

ABB

Surgical Field Trip

Headed for the hills today for a surgical assist field trip. M.C took me with him to the wild and wooly west coast for an operating theater day in one of the remote hospitals.

I have Monday's off (from GP) but was more than happy to spring out of bed at 0545h, knowing that I'd have the chance to be first assist and 'camera woman' for all the cases today.

And indeed, it was well worth it. Worked a lot on my sub-cue suturing skills and scope handling. Lots of neck craning and nervous sweat. So. Much. Fun.

I really cannot pretend to be aloof about this whole surgery thing. Pretty soon I'll stop sheepishly mumbling and toeing the floor when people ask me what I want to be when I grow up. Not today, but pretty soon.

The Apples Do Not Fall...

In a complete blog non-sequitar I'd like to present a post by one of my good friends, Ryan. It's like cute overload if you're into children and skiing.

It made me laugh at least.

Oh how I miss Revelstoke, and the great people there (and killer skiing)!

Luck Be A Placement

"I never come to work with a heavy heart, I am always whistling on my way in. Sometimes, at the end of the day I have a heavy heart, but never at the beginning". 

This was said to me today by my new preceptor, a man who has been a family physician since opening his clinic thirty five years ago. At that moment I said a silent prayer that I will someday be able to say the same thing about my career.

J. A is easy to laugh, and a very straight talker.  A shock of white hair rings his bald head yet he carries himself like a much younger man. I was fairly certain we'd get along well right from the beginning based on the fact that his expression seems to carry the right combination of mirth and sincerity. But he sealed the deal today on our way to a home visit when, as we walked out to his car dressed in our long winter coats, he suddenly turned to me and said, "Oh dear, I've just remembered...I've got a lot of game in the trunk of my car...er...I'm really sorry...I was hunting on the weekend and...well...the car smells quite bad!"

Yes, I think we're going to get along just fine. How could he have known he was dealing with an Alberta girl, raised in a family of hunters? One of my earliest memories is going to my Dad's shop, and opening the door to the horrifying sight of a moose head on the cement floor, then lifting my eyes to an even more gruesome view, the skinned body hanging from a large winch.  I just smiled and reassured him he didn't have to worry, the smell would not offend my delicate sensibilities.

To be paired with a physician who--still whistles on his way to work, is genuinely keen to learn about current best practices in medicine, and is quirky enough to have animal hides in his car makes me think I've probably hit the jackpot for the next 5 months. Woot!

Last to Know

So, why is it that no one ever told me about surgical critical care as a specialty? It basically combines all the things that I love: really sick patients, emergency medicine, critical care, and...surgery...!

What? Why was this option never presented to me at career day in high school?

Off the cuff one day M.C told me I should consider trauma surgery (yeah yeah, OMDG I hear you snorting) and I brushed the suggestion aside because I would like to start my career sometime before the age of 45. But I've started looking at some of these different fellowship programs and (Trauma! Surgery! and Critical Care! Oh my!) they sound ahhhh-mazing.  

How seriously bad assed would that be? I can only imagine people who have that training must land in the department completely dressed in black, crashing through ceiling windows, and worming their way under laser sensors to get to their patients, because that is how medical ninjas roll.

I just hope I am married by then because LORD knows no man will have me if that is the career I choose.

Anyway, just reading the program descriptions makes me slightly wide eyed.

The problem is, I could also see myself running a vegetarian aromatherapy clinic where we sit and knit our own yogurt after telemarking to work.

And thus continues the fight within me on choosing a medical specialty. My complete love for living the simple life in the mountains, attending bake sales for the hockey team, and making soup is at odds with the part of me that could live in a crazy wild big city cracking chests in the ED by day and going to the symphony at night.

The only thing that really comforts me is that M.C also said, "I think you'd be good at anything you do". Which is no small thing, coming from someone who you have a great professional respect for.

So I suppose time will tell.

The Blasket Blast

Last week I was whining to Paddy (our surgical SHO) about the fact that my bike needed a tune up, M.C overheard and kindly offered to get it road worthy for me. From this, the topic of the Blasket Blast road ride came up. It is an organized bike ride that goes around the Dingle Peninsula, along some of the most breath taking scenery that this country has to offer. So M.C asks Paddy and I if we want to enter the event with him as he's going to be participating. In true ABB form, I agree without asking any questions (you know, shoot first, ask questions later). I either didn't hear that it was 150 kms or figured that he was exaggerating.

I forgot all about the discussion until a few days later when M.C informed me that he'd paid my registration. Paddy was out because he was on call and couldn't get anyone to switch (how hard he tried is unknown!) Right, so at that point I started asking for details because the longest road ride I've  done is ~70 km in Prince Rupert TWO SUMMERS AGO. He tells me it is 150 km and 8 days away, that was when I started to get really, really worried. This was compounded the day my roommie met M.C and uttered immediately afterward: you are so screwed! He looks seriously fit. Great. Thanks.

Thus began my week of fretting and bike riding. I did ~80 kms last Sunday, then two 35 km rides during the week. I had no idea what was going to happen but I figured I better give it a lash. 

I did enjoy the carb loading part of the whole thing and took it to the next level...indulging for several days before the ride. You know--popcorn for dinner, hummus and crackers several times a day, granola by the handfuls...and chocolate mousse the night before (there are carbs in chocolate, right?)

A scene from the night before, all the food and water ready. And spare socks. Of course my riding shoes with clips were nowhere to be found so I busted out the sneaks. Awwww yeah.

First coffees, just after the summit of Connor Pass.

So there were two rides, one that was 110 kms and one that was 150 kms. We were doing the latter with about 40 other people, men in tights to be specific. Ok, there was one other woman doing the long ride...at least we think she was...a woman. If you note the biker in the background you'll get an idea of the one-piece spandex jumpsuits and waterproof clip booties that everyone else was wearing. All the long riders were SERIOUSLY decked out. We looked like we'd found our gear at a garage sale the night before, by comparison. Both M.C and I were also the only people wearing running shoes. We got some very disappointed and looks and clucks throughout the day due to our athletic faux pas of epic proportions!

And then there was the flat tire. The guy who stopped to radio the support car with a foot pump informed us that he hadn't gotten a flat in 4000 miles. We were undeterred though our place at the end of the line was definitely secured.

And then we got stuck behind some sheep. As you do, when you're riding the Tour De Irelande.

 

Some lovely scenes from the day. 

The Blasket Islands.

 

The above photo shows the Irish version of a 'highway', and how wide a bike rider can expect the shoulders to be. 

 

First lunches. And a latte from a road-side bus! This was my kind of race. 

 

 At the 95 km mark we decided it was time for ice-cream.

And a photo op of the old ABB and her bike.

Finally! Several hours, 150 kms, 2 pairs of socks, 2 lunches, 3 coffees, 1 ice cream, several rainstorms, and 3 pee breaks later we arrived back at the start. We had a really fun day, actually. I even managed to pull out my last bit of juice on the final summit and trash talked M.C all the way to the top.

And it was GREAT!!

I am so glad I did it. I love it when I surprise myself! Go Team Sneaks!!

I Want Babies!

Sometimes things come out of my mouth before I think of how it might sound to others. 'Others' as in the other people in the check out line at Safeway this afternoon.

A few days ago I was chatting with one of the docs who knows I am about to start medical school and I was lamenting the fact that I have never really had any ICU or maternity experience as a nurse, and how I wished I had before starting my medical degree.

He told me that while I am here he'll let me catch any babies that arrive when he is on call. SWEET! He's really nice and keen to teach so I have been quite excited about this prospect. Last night he was on call and we did our best to not call him in for things we could deal with on our own so he got to sleep most of the shift.

So today I was getting coffees and he spotted me, came up to me in line and said

"Thanks for last night, you were so GOOD to me! Really, it was what I needed...had a great sleep too."

"Oh yeah, no problem", I said..."we had fun, that is what it is all about right?"

"Cool, ok well I am on call this weekend so maybe we'll see if we can make something work" he says as he's walking away--referring to me getting some OB experience.

"Yeah, thanks! Just don't forget that I WANT BABIES!!" I said over the din as he disappeared down the aisle.

As I turn back to face the line of people the lady in front of me is staring at me with an odd expression--a raised eyebrow and pursed lip. I think--what did I just yell out? I replay the conversation in my head--IDIOT! I wanted to explain--no no no, I don't want HIS baby--he's got some of his own, and I don't even WANT to have babies, and no we were talking about work, and no I am not really interested or having an affair with one of the local pillars of this small community...er...ah....oh forget it.

Yeah. Smooth. Really smooth.

P.S BINY I know you are going to have a field day with this... :)