911 Call of the Night

We got the call from the ambulance, just before 2 am informing us that they were bringing in a man who'd called 911 for scabies.

Yes, that was his chief complaint. Which may win the "are you kidding me that you called an ambulance for that?" award.

The two night nurses debated on who would be the one to put the scabies cream on his back. The matter was settled by the ER doc putting a paper clip in one hand and letting the more senior RN choose which hand. She chose poorly.

We all itched and scratched for the rest of the night.

Downside...it cost taxpayers approximately $1000. Upside...the guy had a place to sleep and a change of clothing in the morning.

*Shudder* Image from here.

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.

Hard Mattress

After a somewhat lengthy orthopedic surgery where I had been holding a foot / leg up off the table, Dr. Boots handed over the suture material and told me to get to work.

Me:

Umm...should I come around to the other side of the table?

Dr. Boots:

No, sweetheart just get to work, this man's got a bloody tourniquet on! We don't have time for dancing around. Put in some mattress sutures. 

(Some of you might scoff at the fact that I haven't mastered the mattress suture. As a potentially aspiring surgeon I maybe should be able to do them in my sleep, however, I spent most of my time in general surgery trying to perfect my sub-cue stitches and hand-tying. Bad medical student, BAD!)

And now I have.

And they were a thing of beauty. All two of them. Damn you arthroscopy and your tiny wounds!

Dr. Boots:

There, that wasn't so bad now. No need for all the shivering and shaking. You know my 17 year old daughter can do mattress sutures, no problem. She taught herself.

(Surgical Drape) Curtain Falls. 

[For the record...my hands were shaking because my forearm muscles were maxed out from assisting...I swear! I should also add, Dr. Boots is amazing and kind of like the slightly-unimpressed-but-fantastic-teacher orthopedic-surgeon-father I never had. Above example illustrates the way we communicate. Me, hopeless rube in ortho...him ortho king. Get it?]

First Ultrasound!

Bet that got your attention!

Yes, last night I had the opportunity to do my first ultrasound on a pregnant woman. Can I just state for the record that there are many concepts in medicine that fascinate and perplex me, not to mention the endless list of interesting presentations and procedures. But apparently there is one thing that turns me into a giddy, effusive fool: prenatal ultrasound.

I trundled down to the emergency department last night after my flatmate (and ER nurse) called me in to see some good cases. The doc who was working knows me well so he was happy to have me seeing and working up patients. Early on in the shift a pregnant woman presented with some minor bleeding so he wheeled in the ultrasound machine, flicked off the lights and handed me the transducer.

At first all I could see was fuzzy blobs and fluid and then lo! A vertebral column appears in the darkness! And then I saw the heart, its tiny chambers pumping away. I practically jumped up and down, Look! Look at the heart! Hey, there is a femur, wow! The baby is moving his, ah...or her hands! That is amazing!! 

So maybe I should have played it slightly more cool, but I couldn't help myself. It is quite something to look at a nearly flat and unremarkable belly and then suddenly be given a glimpse into a hidden world that houses a kicking, twirling, fist-pumping little being.

I spent the next portion of the evening smiling to myself as I stitched up wounds and listened to heart sounds.

The little beating heart and those dancing legs were a delightful reminder that there are also joys in medicine, even in the emergency department on a Friday night. 

Thank you, little one. I needed that.

A little bigger but you get the idea, image from here.

Apparently I Look Like a Drug Dealer

So, I am here in BC doing an orthopedics elective. But really, I am doing an everything elective. I've worked in this hospital before as a nurse and most of the doctors know me. I want to scrub for surgeries, stitch wounds in the ER, catch babies, intubate, whathaveyou. So I need a cell phone, otherwise no one can reach me when wounds / babies / femurs are presenting themselves.

I walked into the 7-eleven and looked for the cheapest phone. $39. Brilliant. I asked the attendant to please fetch me the $39 phone from behind the counter. He looked at me strangely and said, "Er....are you sure you don't want a nicer phone? These ones are only $100". I waffled for a moment but held strong. All I need this for is "baby coming" texts. Status symbol, status schmimbol. Give me the ridiculous one. 

I was quite proud of my new phone so during my next shift I whipped it out to show one of the murses. He burst out laughing, "Dude!! You've got a burner!!"


"Uh...what is a burner?"

"It's a phone that drug dealers use so that their calls can't be traced. They're disposable. Hilarious. You totally will look like a dealer every time you take that phone out."

Now I feel old, and crazy out of touch with slang.

The next day I get a text at the nurses station and I'm trying to thumb my way through a response when one of the other nurses starts pointing and laughing, "NICE BURNER!!!!"

Siiiiiiighhhhhh. Am I the only person that didn't know this term? Apparently if I watched The Wire or CSI I'd be well versed in these matters.

I sent a text to my orthopod to give him my number (since we were on call) saying "Here is my mobile number courtesy of 7-eleven" and the next day in theater he tells me that his wife saw the text and asked him who was sending him messages from a burner.

For the record, he's in his 50's.

It's no iphone 4, it's small, it is ridiculous. I look like a complete rube (and low-life, apparently) when I try to text from it. But you know what? It is almost so lame that it feels cool. In fact, I like that it is ghetto. It feels slightly rebellious and hip to not be showing off what apps I can get on it. I wear rubber boots to work and I own a burner. It is just how I roll these days.

On Bended Knee

I've really been loving the push, the post race endorphins, the crazy sense of "did I really just do that?"

Until recently, I would never have considered myself an athlete. My friends are athletes, my family members are athletes. But since November, when I did my first adventure race, I've come to think...maybe I am one too?

Three weeks ago I did my first trail race. It was a 1/2 marathon with a nice sprinkling of 3500ft elevation for good measure. It was much, much harder than I anticipated. Waaaaaaaaay more difficult than the 10 mile road race the weekend before, and hella more mentally challenging than the Sea2Summit (which was 2h longer). I got crazy calf-cramp-of-doom followed by inhumane-hamstring-tetany-of-death which stuck with me steady for the last 2 miles. Yeah, I was 'running' as if I had a wooden leg, whimpering, and generally feeling miserable and frustrated. But dammed if I wasn't going to finish it...and then chug a large glass of orange squash concentrate by mistake at the finish line (who has bottles of concentrate and no water at a finish line???)

So I've been kettlebell-ing and running a little and cycling, feeling pretty pleased with my fitness and shiny new upper-body strength.  Ok, maybe the odd twinge to my knee and feeling of fullness in the back of my leg. Then 3 days ago I squatted down in the emergency department and saw stars...um...why can I not squat? Oh, because my knee is blown up like a balloon. Awesome.

So ice, ibuprofen, ice, elevation...more ice...did I mention I bought this sweet gel sleeve that doesn't freeze solid and can cuff right around my knee?

No improvement. No acute injury...hell, I hadn't biked/run/kettled in a week.

Today I had a steroid / lidocaine injection into it just before heading into theater for the day. Ooooooooh maybe standing on it for 8h after wasn't super brilliant. And now I am here. Not allowed to run or squat, my knee hurts like a fecker and looks like it belongs to Rita McNeil.

So frustrating to finally feel like I'm getting into the shape I've always wanted to be in...with an adventure race coming up in 4 weeks, a 1/2 marathon in May, and a triathlon in June...GAHHHHH!

[Pouts]

[Reaches for bag of peanut butter cups.]

[Recalls how tight work pants already are, puts aforementioned cups down.]

[Steps away from cups.]

Signs off.

(Photo credit: pic of the race trail taken by my good friend Stephen Bennett.)

Surgical Pearl: Nutrition

Today the locum pediatric orthopod took me down to the x-ray department to look at some films, on our way out he stopped at their desk and poached some chocolate. He clearly saw my judging questioning gaze (I have firm beliefs that you ought to contribute to the trough you graze from).

"Look, when you're a surgical resident you learn to get calories from any source available. It's an old habit. You find every patient fridge that is stocked with ensure or crackers...this hospital is great because the recovery room fridge has cheese. Cheese will be where you get your fluids from."

Residency: when you begin to see cheese as hydrating nourishment.

Arrived

My eyes are sore from being open for so many of the past 96 hours. I am still in a jet lag / sleep deprived haze after being in transit since Saturday morning. But now, after a 'emergency' landing in Iceland, a botched ticket issued for my missed connecting flights, a surprise visit to my family, a trip to the Red Deer mall, and a final sprint to my northern flight connection...

I. Have. Arrived.

Despite having been up since 4 a.m I managed to stock up on some groceries (thanks Trish!), unpack, cram in a few hours of orthopedic clinic, and even see some patients in emerg. It is fantastic to be back in a hospital where I have spent so many hours as a nurse. Already the people here have given me a wonderful welcome and shown outstanding hospitality. It is now 2043h and I am going to finally allow myself to sleep...I will not let the jet lag best me! Also, I promise to get back in the posting groove. Promise.

But for now...Zzzzzzzzzzzzzz....

My Recent Mid-Term Evaluation

Above is photographic evidence of why Dr. Joe is one of my favorite people on the planet. Yesterday we went through my mid-term evaluation. On the back of the score sheet they are invited to make comments on specific strengths and weaknesses (theoretically so we can improve by the final eval).

I pretty much spent the rest of the day chuckling when he handed it over to me to submit to the school.