tag:blogger.com,1999:blog-297981852024-03-06T23:59:18.753-08:00vitum medicinus ::: a life of medicineA 22-year-old medical student (MS-I) reflects upon his journey through a life of medicineVitum Medicinushttp://www.blogger.com/profile/09994320714669547787noreply@blogger.comBlogger210125tag:blogger.com,1999:blog-29798185.post-86379846840481106272009-12-19T08:58:00.014-08:002009-12-19T23:28:58.063-08:00Vitum's Field Guide to Hospital Grunts - Patient Edition<p><span style=";font-family:georgia;font-size:85%;" ><strong><span style="font-size:130%;">1. HHUUUUUUUNNNNGGGGHHHH</span></strong></span></p><p><span style=";font-family:georgia;font-size:85%;" ><strong>ID</strong>: <em>Reproductus cornicopious</em>, the common multip (i.e. multiparous woman, who has delivered a few babies already)<br /><strong>HABITAT</strong>: Maternity Ward<br /><strong>ACTION REQUIRED:</strong> RUN AND DON GLOVES. She is about to pop.<br /><br /><strong>BACKGROUND</strong>: There is a saying on the maternity ward: “Never turn your back on a multip.” It is a known medical phenomenon these women, who have already had a few babies, have shorter and shorter labour for subsequent pregnancies, to the point where you better not ever be too far away or you’ll be picking baby up off the floor.<br /><br />I have actually been trained that these multips often make a loud, primal, guttural grown the moment before the serious pushing begins. If you’re not in the room, and you hear this, hustle.</span><br /><span class="fullpost"><br /><strong><span style="font-size:130%;"><span style="font-family:georgia;">2. GAHHHHHHHHHH GAHHHHHH GAH GAH GAH GAH GAHHHH</span></span></strong></p><p><span style="font-family:georgia;"><span style="font-size:85%;"><strong>ID</strong>: <em>Narcoticus demandilus</em>, the drug seeker<br /><strong>HABITAT</strong>: Emergency Department<br /><strong>ACTION REQUIRED: </strong>Holistic support up to and not including writing an opioid prescription<br /><br /><strong>BACKGROUND</strong>: The loudest patients demanding pain medication tend to be the ones for whom Tylenol just doesn’t work, they’re allergic to the stronger anti-inflammatories, and gosh darn it your only option is to prescribe the good stuff. The ones who are bad at it are the ones who only seem to be in pain when the doctor walks by, and are easily fooled (i.e. “Let me examine your back.” “Ow ow ow! Even the slightest touch on my back hurts!” “Funny, when I felt your back earlier and didn’t warn you that I was examining you, you didn’t seem to notice…”<br />A good rule of thumb is the more convincing the patient, the more you should look for signs they’re trying to fool you.<br /><br />Be careful, though. Every so often you’ll get someone who you are convinced just wants drugs, and then you are later corrected and find out with convincing evidence they are in legitimate pain. Looking back and realizing you denied a cancer patient some form of relief makes you feel really bad.<br /><br />The hard part is, there is a legitimate argument that drug seekers need treatment too, just not the drugs they’re looking for. This is something I wish modern medicine could treat way better than it does.</span><br /><br /><span style="font-size:130%;"><strong>3. MMGGGGNNNNNHHHHHHHHHHH</strong></span></span></p><p><span style="font-family:georgia;"><span style="font-size:85%;"><strong>ID</strong>: <em>Constipationaticus fecalis</em>, the bunged-up ones<br /><strong>HABITAT</strong>: Old folk’s wards<br /><strong>ACTION REQUIRED:</strong> Grab a diaper. Just in case.<br /><br /><strong>BACKGROUND</strong>: I was called one night to see an ornery elderly woman, and recognized her from seeing her in the emergency department, shouting at the nurse. “Closer, I’m deaf! Closer! Louder! I can’t hear you! Closer! WHY ARE YOU SHOUTING AT ME? *smacks the nurse*” I thought she was hysterical.<br /><br />I’m not even sure what the original call was about, probably needing a sleeping pill or something basic like that. All I do remember is walking in the room, and she was moaning, as above. “MMGGGGNNNNHHH!”<br /><br />“Why are you groaning?” I asked of the woman laying in the bed, gripping the siderail for dear life. “I’m POOPING!” she shouted at me. “I’m POOping in my DIAper!”<br /><br />I was only a third-year medical student at the time, so not an expert in things medical. But I did know a few things, and took haste to correct her.<br />“Ma’am, you’re not wearing a diaper.”<br /><br />The ruckus stopped. She looked down, and stopped to think for a minute.<br /><br />“MMGGGGNNNNHHH!” I went and got someone who knew where the diapers were.<br /></span><br /><strong><span style="font-size:130%;">4. HUUNFGH</span></strong></span></p><p><span style="font-family:georgia;"><span style="font-size:85%;"><strong>ID</strong>: <em>Cardiovascularis joltishockus</em>, or defibrillating a semi-sedated patient<br /><strong>HABITAT</strong>: Emergency department, cardiology ward<br /><strong>ACTION REQUIRED:</strong> Increase sedation!<br /><br /><strong>BACKGROUND</strong>: Some patients who have a heart arrhythmia need to be shocked with the defibrillator, or cardioverted, to get their hearts back in normal rhythm. They are given sedation, then, under strangely close supervision, the medical student is often allowed to push the button with the little lightning bolt on it. One or two, sometimes three, shocks, and their hearts are back to happy beat (Yes, that’s what we call it when the patients are sedated and can’t hear us).<br /><br />There was one patient who didn’t seem to have very much sedation. He had just barely fallen asleep, and the doctor turned to me and said, “Vitum, push the button!” “Uh, does he need some more propofol?” I asked. “No! Push the button!” So I pushed it, wincing a bit as I did, sending 100 joules of electricity through this young, muscular man’s heart.<br /><br />The machine clicked, the patient jolted just like on TV, uttering a HUUNFGH, and his eyes went COMPLETELY wide open. And he turned his head, and stared directly at me. And stared. And stared. His eyes were bugging out of his head, and he was clearly sending the first silent death threat I had ever received, probably trying to kill me with his mind.<br /><br />And then the doctor said the words I didn’t want to hear: “Hmm, he needs another one. Shock him again, Vitum.”<br /><br />I asked the patient later if he remembered. Fortunately, the doc was right – he’d had enough sedation, which made me breathe a huge sigh of relief. I swore he’d be waiting in the parking lot for me after work.</span></span></p><br /></span>Vitum Medicinushttp://www.blogger.com/profile/09994320714669547787noreply@blogger.com11tag:blogger.com,1999:blog-29798185.post-56416158506500248852009-09-23T22:45:00.004-08:002009-09-23T22:49:31.249-08:00Few things are worth more than sleep...<div><blockquote></blockquote><blockquote></blockquote>...and telling you about <a href="http://tallguywrites.livejournal.com/133179.html">this cartoon</a> is one of them.</div><div><br /></div><div><blockquote><i>"Sufferers of schizophrenia are no more dangerous than anyone else."</i></blockquote></div><div><br /></div><div>Medical school has taught me an immense amount about the reality of mental illness.... and this cartoon can teach you the most important things I learned about it, in only about a minute.</div><div><br /></div><div><blockquote><i>"If I'd had cancer, people would have rallied around, but because I had schizophrenia, few wanted to know."</i></blockquote></div><div><br /></div><div><a href="http://tallguywrites.livejournal.com/133179.html">Please, please, click this and even just read the first page of this cartoon...</a></div><div><br /></div><div><br /></div><blockquote></blockquote>Vitum Medicinushttp://www.blogger.com/profile/09994320714669547787noreply@blogger.com5tag:blogger.com,1999:blog-29798185.post-48302223791926631092009-08-19T20:52:00.004-08:002009-08-19T21:30:57.946-08:00The best part of spending two weeks with medevac? Not what you might think.<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiNUjKnTVl-BQnoj-7TGikhJD1ydbjqVfi9_wj_irJjQ_Gw3Zl8GWFdNoCQU2oyiGhQRqE1VhH2km1qhZjLjAwixhsquwUHP2HghL2dmAwBlBrTNehDHyOdMVFA_y1ePits9Mp_Bg/s1600-h/load.jpg"><img style="MARGIN: 0px 0px 10px 10px; WIDTH: 320px; FLOAT: right; HEIGHT: 210px; CURSOR: hand" id="BLOGGER_PHOTO_ID_5371914239451015586" border="0" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiNUjKnTVl-BQnoj-7TGikhJD1ydbjqVfi9_wj_irJjQ_Gw3Zl8GWFdNoCQU2oyiGhQRqE1VhH2km1qhZjLjAwixhsquwUHP2HghL2dmAwBlBrTNehDHyOdMVFA_y1ePits9Mp_Bg/s320/load.jpg" /></a> <span style="font-family:georgia;font-size:85%;">As my third year was winding down last month, I had the opportunity to do a two-week elective in anything I wanted. Supposedly it had to be medically-related, but given that some of my classmates were approved for two weeks of wakeboarding or a 3-hour first aid course*, spending two weeks in paramedicine made me look like an overachiever. </span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><span style="font-family:georgia;font-size:85%;">The elective was pretty incredible from a medical point of view. Among the dozens of calls we attended, we picked up a young lady whose ATV had gotten away from her, crushing her leg to the point where she might never walk again. We also treated a few patients who had fallen off ladders or nearly drowned, and a nailgun injury. As well, there was a variety of medical patients too complex for the rural hospitals who needed to be brought to the big city for super-specialized care. </span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><span style="font-family:georgia;font-size:85%;">There were things that I didn't anticipate. There were heart-wrenching moments, like talking to one of our patients, a young lady who had been poisioned by carbon monoxide...intentionally. Sadly, she was not the only suicide survivor that we saw during my two weeks. As well, we went to a few car accident scenes and I saw some things, tragic things, that I wish I hadn't. </span><br /><span style="font-family:georgia;font-size:85%;"></span><span class="fullpost"><br /><span style="font-family:georgia;font-size:85%;">One thing about the elective really surprised me. Those of you who have read this blog for a while might remember that I have </span><a href="http://blog.vitummedicinus.com/2007/03/thrill-of-flying-with-helicopter.html"><span style="font-family:georgia;font-size:85%;">shadowed flight paramedics in the past</span></a><span style="font-family:georgia;font-size:85%;">. Back then, it was fascinating for me to see what the paramedics did...treat and transport the sickest patients in the province. What surprised me is that this year, my time with the paramedics served as a stunning eye-opener, revealing to me how little I knew about not only paramedicine, but medicine in general back then. </span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><span style="font-family:georgia;font-size:85%;">In other words, until I had completed my third year of medical school, I had no comprehension of just how sick the patients were that we were transporting. Not only that, but I had no idea the elite level of training of the flight paramedics. Back then, I did not understand the skill demanded when handling ventilator settings for patients with severe lung disease, or the implications and specialization required in order to keep alive a patient with bacterial infection coursing through their entire body. I only now realized just how sick these patients were, having been involved in identifying and treating sick patients myself, and also that some of the drugs that the paramedics were trained to prescribe are typically only used by intensive care specialists. </span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><span style="font-family:georgia;font-size:85%;">It was exciting to be able to understand at a deeper level the diseases affecting our patients, and to be able to have a new level of conversation with the flight paramedics, actually discussing treatment options with them. To put it another way, before I had completed three years of medical school, I didn't even know what questions to ask.</span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><span style="font-family:georgia;font-size:85%;">Needless to say, my understanding of the complexity of the patients and the difficulty of their management gave me a new level of respect for the critical care flight paramedics. </span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><span style="font-family:georgia;font-size:85%;">Retrospect, for me, is a valuable, meaningful experience. In fact, one of the reasons I started this blog was so I could look back and see how far I've come; in a program that is years in length and where you rarely realize how much you have learned from day to day, sometimes looking back is the only time you'll realize how much you are learning. It was a huge privilege to be invited back to spend time with these highly-trained paramedics, and it was a great surprise to discover that without realizing it, I had signed up for two weeks of seeing how much I have learned. Glad the $45,000 I've spent so far on tuition seems to be paying for something!</span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><em><span style="font-family:georgia;font-size:78%;">*In defense of my classmates, they did have to write a 500-word essay relating their elective to medicine<br /></span></em><br /></span>Vitum Medicinushttp://www.blogger.com/profile/09994320714669547787noreply@blogger.com5tag:blogger.com,1999:blog-29798185.post-26925388062943360752009-08-15T07:25:00.002-08:002009-08-15T08:44:06.093-08:00Part 2: Vitum Loses 85 Pounds...and the mistakes that kept me from doing it earlier<span style="font-size:85%;"><em><span style="font-family:georgia;">Continued from </span><a href="http://blog.vitummedicinus.com/2009/08/never-trust-skinny-chef-fat-doctor.html"><span style="font-family:georgia;">Never Trust a Skinny Chef. A Fat Doctor, however...</span></a></em></span><span style="font-family:georgia;"><br /><em><span style="font-size:85%;"></span></em><br /><span style="font-size:85%;">For several years, I was eating healthy, knew about the dangers of obesity, and yet found myself at 280 pounds... so overweight that I was considered <em>class 2 </em>obese. So why wasn't I losing weight? </span><br /><span style="font-size:85%;"></span><br /><span style="font-size:85%;">There are three reasons - three mistakes I was making. Once I corrected these mistakes, and took on a lifestyle of a healthy, balanced diet and exercise,</span><span style="font-size:85%;"> the results were amazing:</span><br /></span><ul><li><span style="font-family:georgia;font-size:85%;">In September, I weighed 280 pounds. By January, I was down to 230 - I had lost 50 pounds. </span></li><li><span style="font-family:georgia;font-size:85%;">In April, I met my long-term goal of running a 10 kilometer race, something I thought was a big deal</span></li><li><span style="font-family:georgia;font-size:85%;">In May, I blew that goal away - and successfully completed a half marathon. That's right, I ran for 21.1 kilometers. Never thought I'd pull that off. Ever.</span></li><li><span style="font-family:georgia;font-size:85%;">My weight now is 195 pounds. That's 85 pounds lost so far (I say so far because that puts me - believe it or not - still at an <em>overweight</em> BMI. 10 pounds to go.)</span></li><li><span style="font-family:georgia;font-size:85%;">Finally, I don't feel like a chump telling patients they need to lose weight to be healthy... and in fact, if I want to show them it can be done, I just point to the photo of me on my ID badge from September. </span></li></ul><p><span style="font-family:georgia;"><span style="font-size:85%;">So, what were those mistakes that kept me from doing this earlier? </span><span style="font-size:85%;">Well, for three easy payments of $9.99 sent to.... just kidding! Here they are:</span></span></p><span class="fullpost"><span style="font-family:georgia;"><span style="font-size:85%;"><strong><span style="font-size:100%;">1. I thought QUALITY was more important than QUANTITY. </span></strong></span><br /><br /><span style="font-size:85%;"></span><br /><span style="font-size:85%;">Healthy eating is important for disease prevention - I ate multigrain bagels and chose sugar-free fruit juice for years, never buying pop, chips, donuts or cookies... and only gained weight. </span><br /><br /></span><span style="font-family:georgia;"><span style="font-size:85%;">Consider this: I would go to Tim Horton's for a snack between morning classes and proudly ate a healthy 12 grain bagel with cream cheese, instead of what I really wanted - a chocolate glazed donut. Despite my choice being overall more healthy, I was eating 471 calories of healthy goodness instead of the 260 calories in the donut - almost DOUBLE! If I ate one of those bagels every day, and didn't jog for half an hour to burn off those extra 471 calories, I would gain almost 50...that's right, FIFTY... extra pounds in a year.<br /></span><br /><span style="font-size:85%;">So, I changed my mindset to cut down on how much food I ate, instead of just choosing healthy foods. And wouldn't you know it, the pounds started coming off. That's why I like to tell people I started on the "put less stuff in me diet." </span><br /><br /></span><span style="font-family:georgia;"><span style="font-size:85%;"><strong><span style="font-size:100%;">2. I used to only think of my weight when I stepped on a scale.</span></strong><br /></span><br /><span style="font-size:85%;">In order to actually make a difference and lose weight, my goal to lose weight had to become something I thought of every minute of every day, not just for the moment when I stepped on a scale in the morning. </span><br /><span style="font-size:85%;"></span><br /><span style="font-size:85%;">I knew you had to eat less to lose weight, but I always found myself only thinking about this between meals, and forgetting about it when the food was in front of me.</span><br /><span style="font-size:85%;"></span><br /></span><span style="font-family:georgia;"><span style="font-size:85%;">So what had to change? Every decision I made, such as getting in the elevator, and every time I put something in my mouth, such as my morning coffee or cereal, had to be filtered through the perspective of "how could I change this to increase calories burned or decrease calories taken in?" The answers were easy - take the stairs instead, switch to milk in my coffee, only 1 bowl of cereal instead of 2 (okay, who am I kidding, 3). I just had to ask myself the question...dozens of times in a day, before I did anything.<br /></span><br /><span style="font-size:85%;">My weight loss goals had to be something that influenced everything I did and every thought I had. Sure, it might sound a bit obsessive, but after years of unsuccessfuly trying to "eat healthy," for me, that's what it took - a complete mindset change.</span><br /><br /><strong>3. I didn't use a simple strategy to overcome my hatred of exercise.</strong><br /><br /><span style="font-size:85%;">I hate exercising. I was able to run regularly for a while a few years ago, but that dropped off. I didn't really have anything to keep me going. </span><br /><br /><span style="font-size:85%;">But now I found three things to keep me getting out there and exercising. First, I combined exercise with diet modification - and started to see results. Seeing the weight come off, and having people comment on it, is a great way to keep you excited about getting out and running. </span><br /></span><span style="font-size:85%;"><br /><span style="font-family:georgia;">Secondly, I began to time myself, and try to break my records. I got </span><a href="http://www.runkeeper.com/"><span style="font-family:georgia;">RunKeeper</span></a><span style="font-family:georgia;">, a free app for my iPhone, and tracked how long it took me to run a certain time. The next time, I would try to run the same distance just a second or two faster.</span></span><span style="font-family:georgia;"><br /><br /><span style="font-size:85%;">Thirdly, I signed up for a 10k race. This gave me a goal to work towards, and an exciting event to participate in when the day finally came. </span><br /><br /><span style="font-size:85%;">Now I just have to come up with a way to overcome my even more intense hatred of lifting weights...</span></span><span style="font-family:georgia;font-size:85%;"><br /></span><span style="font-size:85%;"></span></span>Vitum Medicinushttp://www.blogger.com/profile/09994320714669547787noreply@blogger.com13tag:blogger.com,1999:blog-29798185.post-82073557892573496172009-08-10T08:15:00.017-08:002009-08-15T08:44:56.930-08:00Never trust a skinny chef. A fat doctor, however...<div align="center"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhNJswtKgt6SKzRRsewZD2sXpwPK9gue_98saEzHgTJKqp4AlymEJY34PsXC9zejfLpUjWwsZYimy4753dn_ZYGt8X8ymk-pLYHEDU5t-I1llHbhceOKvqKwPCBEndT-p1VNbtB_w/s1600-h/surgeon_general-0121.jpg"><span style="font-family:georgia;font-size:85%;"><img style="TEXT-ALIGN: center; MARGIN: 0px auto 10px; WIDTH: 200px; DISPLAY: block; HEIGHT: 134px; CURSOR: hand" id="BLOGGER_PHOTO_ID_5368384572038027298" border="0" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhNJswtKgt6SKzRRsewZD2sXpwPK9gue_98saEzHgTJKqp4AlymEJY34PsXC9zejfLpUjWwsZYimy4753dn_ZYGt8X8ymk-pLYHEDU5t-I1llHbhceOKvqKwPCBEndT-p1VNbtB_w/s200/surgeon_general-0121.jpg" /></span></a><em><span style="font-family:georgia;font-size:78%;">U.S. President Obama with Dr . Benjamin, Surgeon General nominee. Source: The White House</span></em></div><div align="center"><span style="font-family:georgia;"><span style="font-size:85%;"><em></em><br /></span></span></div><span style="font-family:georgia;font-size:85%;">Today's LA Times has an </span><a href="http://www.latimes.com/features/health/la-he-surgeon-general10-2009aug10,0,5052150.story"><span style="font-family:georgia;font-size:85%;">interesting piece about a new Surgeon General nominee</span></a><span style="font-size:85%;"><span style="font-family:georgia;"> in the USA, who herself is obese. Her nomination has generated discussion about whether or not doctors should be overweight.<br /><br />Let me explain why this article caught my eye.<br /></span><br /></span><span style="font-family:georgia;font-size:85%;">Last year, in a family practice rotation, I was in the room when my preceptor was counselling a patient on the<span id="SPELLING_ERROR_0" class="blsp-spelling-corrected">importance</span> of losing weight to cut down his risk of heart and stroke (and countless other diseases). The patient was obviously feeling a bit sheepish about the lecture, and awkwardly tried to draw the attention away from his waistline. He pointed at me, and said, "<em>Well, this guy will be needing to lose some weight too then, won't he?</em>"<br /><br />This was the first time somebody had said something about my weight since I was teased in high school, and afterwards, my preceptor apologized profusely for the behaviour of his patient. However, even though it was a bit more surprising and amusing to me than offensive, he did have a point.<br /></span><span class="fullpost"><br /><span style="font-family:georgia;font-size:85%;">At that point, I was 6' and weighed almost 280 lbs. That means my BMI was 38.0 - not just obese, but <em>class 2 obese</em>... and </span><a href="http://www.nhlbi.nih.gov/health/public/heart/obesity/lose_wt/bmi_dis.htm"><span style="font-family:georgia;font-size:85%;">my disease risk</span></a><span style="font-family:georgia;font-size:85%;"> for high blood pressure, heart disease, and type 2 diabetes was a few pounds short of <strong><em>extremely high</em>.</strong><br /><br />If you think this is starting to read like a diet book, it actually does. I had always "eaten healthy," and had even done some jogging in the past. My list of reasons to lose weight was long...pages long. But not long enough to get me to have a healthy weight.<br /><br />At the start of third year, my list of reasons to lose weight got longer. I began to spend over 8 hours a day seeing patients....most of whom were fat, and most of whom were dying or very sick... because they were fat.<br /><br />In fact, every ward I rotated on showed me new ways people were suffering from obesity. I expected to see fat people with heart attacks on the cardiology wards, but I began to see obesity-related diseases and complications in ALL of my other rotations, almost ENTIRELY due to the patients' obesity, in other words, PREVENTABLE - in orthopedics, ophthalmology, surgery, maternity, emergency, dermatology, anesthesia, and scarily enough, even in pediatrics.<br /><br />I knew that obesity caused disease, but that didn't really frighten me. Until I saw the complications of the diseases first-hand. They can lead to heart failure (which is a slow death with fluid in your lungs just like drowning), heart attack (pain and sudden death), stroke (paralysis and loss of ability to speak), dementia (to the nursing home we go, and hand in your driver's licence and memories of your family and friends on the way), permanent loss of sensation (can't tell if you stepped on a tack, so it could stay in your foot for WEEKS until you notice - yes I have seen this happen), osteoarthritis (waking up with pain in your knees every single morning increasing until you can't walk anymore), limb amputation (I have seen black toes and feet from the arteries getting so clogged with fat that they stop supplying blood to the feet) and blindness (a complication of diabetes). <em>All because of obesity...all almost entirely preventable</em>.<br /><br />Seeing all this helped me get my butt in gear. I took a close look at my lifestyle and eating habits, and was surprised to find some mistakes that I was making. That's right - I discovered that even as a reasonably bright, educated medical student, there were simple things staring me right in the face, easy things to change in order to lose weight, that I was oblivious to (I'll talk about these in another post shortly).<br /><br />And soon, I began to see results. Dramatic results. I've lost so much weight that people barely recognize me anymore.<br /><br /></span><div align="center"><span style="font-family:georgia;"><span style="font-size:85%;"><em>Continued at <a href="http://blog.vitummedicinus.com/2009/08/part-2-vitum-loses-85-poundsand.html">Part 2: Vitum Loses 85 Pounds...and the mistakes that kept me from doing it earlier</a></em><br /></span></span></div></span>Vitum Medicinushttp://www.blogger.com/profile/09994320714669547787noreply@blogger.com6tag:blogger.com,1999:blog-29798185.post-73047694160695921862009-06-26T12:27:00.000-08:002009-06-26T12:27:00.502-08:00"...and that's when I broke the child's arm in my bare hands."<span style="font-family:georgia;font-size:85%;">The surgery I was watching was getting into the tedious stages, fitting and re-fitting a bone chunk that cracked off when the elderly woman had slipped on a banana peel (yes, you read that right). They already had an assist, so I wasn't scrubbed in for this one. Just as I was looking for a new distraction the orthopedic surgeon's pager went off. </span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><br /><span style="font-family:georgia;font-size:85%;">A five-year-old boy had fallen out of a tree, and landed on his arm, which was broken. The emerg doc was going to re-set the bone, but wanted the orthopedic surgeon to have a quick look at the x-ray first. They called it up on the computer screens in the OR, and the surgeon gave his blessing that the emerg doc could set the bone himself.</span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><br /><span style="font-family:georgia;font-size:85%;">I asked the surgeon if I could go watch the reduction of the bone, and soon was on my way to the ER where I found the doctor. I knew him from working with him in the ER a few weeks prior.<br /></span><br /><span style="font-family:georgia;font-size:85%;">"I heard you're doing a closed reduction - can I watch?" I asked.<br /></span><br /><span style="font-family:georgia;font-size:85%;">"No," he replied.</span><br /><br /><span style="font-family:georgia;font-size:85%;">I was a little surprised, but didn't have time to react before he said, "You're going to do it."</span><br /><br /><span style="font-family:georgia;font-size:85%;">"Uh, I'll give it a shot, but just so you know, I haven't done one before," I admitted.</span><br /><br /><span style="font-family:georgia;font-size:85%;">"That's fine, I hurt my wrist. Come look at the x-ray."</span><br /><br /><span style="font-family:georgia;font-size:85%;">That's when things got exciting. </span><span class="fullpost"><br /><span style="font-family:georgia;font-size:85%;"></span><br /><span style="font-family:georgia;font-size:85%;">This wasn't just going to be a regular reduction.</span><br /><br /><span style="font-family:georgia;font-size:85%;">The doc showed me on the x-ray where the wrist had broken through the smaller of the two arm bones, the ulna - but not quite all the way through the radius. </span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><span style="font-family:georgia;font-size:85%;">Turns out that for a break like this to heal correctly, rather than just pulling the bone into place, like is done with most reductions, it was important to make sure that the break went all the way through the radius. </span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><span style="font-family:georgia;font-size:85%;">And how would that happen?<br /><br />You guessed it... breaking the radius would be my job. </span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><span style="font-family:georgia;font-size:85%;">Sure enough, after a quick briefing, under close supervision, and as soon as the child was COMPLETELY sedated (what, you thought we would do this with the poor kid awake?!), it was time to hold on to the arm just above the wrist, and see-saw it back and forth at 90 degrees until I heard a pop and crunch. And that moment was just as the doc had predicted: "That's when all the eyes of nurses and staff watching will bug out of their heads." Fortunately, the child's parents weren't there to see what was involved. </span><br /><br /><span style="font-family:georgia;font-size:85%;"></span><br /><p><span style="font-family:georgia;font-size:85%;">Once the bone was broken, we were able to tug it into position, and put a cast on while still applying traction with our hands, just long enough for the cast to harden. By then, the patient was just starting to wake up from the sedation.</span></p><p><span style="font-family:georgia;font-size:85%;">And while the patient didn't remember a thing - thank goodness - I definitely won't forget doing this for the first time.<br /></span></p></span>Vitum Medicinushttp://www.blogger.com/profile/09994320714669547787noreply@blogger.com8tag:blogger.com,1999:blog-29798185.post-24173278245775866662009-06-24T17:30:00.001-08:002009-06-24T22:39:08.015-08:00Maybe I'm not cut out for this... maybe I should think about quitting...<span style="font-family:georgia;font-size:85%;"><em>This post was actually written around March, about 6 months into my third year.</em></span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><span style="font-family:georgia;font-size:85%;">I'll admit it. For a while there, in the middle of third year, I wasn't sure if this medicine thing was right for me. Just look at this line from a post I wrote back in January:</span><br /><blockquote><em><span style="font-family:georgia;font-size:85%;">as hard as I am being worked right now, I'm doing what I love, and worked hard to be able to do.</span></em></blockquote><span style="font-family:georgia;font-size:85%;">Yeah, it sounds chipper and rosy, but in all honesty, I didn't actually <em>say</em> I enjoyed third year... I was really just trying to convince myself that I <em>should</em> enjoy what I'm doing. </span><br /><br /><span style="font-family:georgia;font-size:85%;">At that point, third year was really starting to wear on me, and I was almost ready to throw in the towel. I try really hard not to complain, but I was ready to write a post similar to one of the many I have found on other medical blogs, featuring such depressing tidbits as: <em>"Medicine has made me a shitty person"</em> and "<em>Times I muttered “kill me now” under my breath [during third year]: 84,239." </em>(In fact, I found so many tidbits like this back in the day that </span><a href="http://blog.vitummedicinus.com/2006/07/selected-highlights-from-mostly-recent_30.html"><span style="font-family:georgia;font-size:85%;">I made a list</span></a><span style="font-family:georgia;font-size:85%;">). </span><br /><span class="fullpost"><br /><span style="font-family:georgia;font-size:85%;">There were a bunch of reasons I was feeling this way. A few: The shifts are so long. It's really hard to have a life while you're in med school. The finals are demoralizing, and you leave almost every one thinking you failed. It's embarassing when you feel like the custodian knows more about treating patients than you do. You have barely enough time to do your hospital work and call shifts, let alone study outside of them. You are in a huge amount of debt. You're on call whenever you want to be doing something fun with your friends. You keep making mistakes. The list goes on...and on.</span><br /><br /><span style="font-family:georgia;font-size:85%;">But of all these, the biggest reason I wanted to quit:</span><br /></span><span class="fullpost"><p><em><span style="font-family:georgia;font-size:85%;">I was sick and tired of feeling like I don't know anything at all. </span></em></p><p><span style="font-family:georgia;font-size:85%;">Every day, I'd see patients and think I knew what was going on, and then realize I had no idea. Even if I knew what medical condition they had, I didn't know the basics on treatment - I mean the very basics - such as which IV fluid to run or if I should even start an IV, let alone how to treat the condition. Most of the doctors supervising me were nice about it, but I still felt like an idiot.</span></p><p><span style="font-family:georgia;font-size:85%;">This is especially tough to handle when you have done two years of medical school, and worked your butt off to pass those exams, and feel like you have accomplished something by passing two years of medical school, completing a four-year degree before med school, and by even just making it into med school. But no. You show up on the wards, and then realize how very, very little you know.</span></p><p><span style="font-family:georgia;font-size:85%;">Like I've said before, now I understand why some doctors are assholes.</span></p><p><span style="font-family:georgia;font-size:85%;">I know I said I don't like to complain much, and actually, the only reason I am willing to vent about this is because I don't feel this way anymore. In fact, over the last month or two, I've come to a realization - <strong><em>I am actually enjoying what I'm doing.</em></strong> </span></p><p><span style="font-family:georgia;font-size:85%;">Slowly but surely, the passion I had for all this - the same passion I felt back when I was a pre-med - is coming back.</span></p><p><span style="font-family:georgia;font-size:85%;">I'm not sure exactly when it happened. It might have been when I did a full history and physical on a patient and then realized that I had learned a lot about those and could do a pretty decent one now. It might have been when I was chatting with an inquisitive nursing student who knew about as much as I did when I started third year, and realized that I've actually learned something this year. Most likely, though, it was when I thought I knew what was going on with a patient... and actually did get it right... and actually had an idea about what type of treatment they needed. </span></p><p><span style="font-family:georgia;font-size:85%;">That's exactly it. After 4 years of high school, 4 years of undergrad, and 2.5 years of med school, I'm finally starting to be able to do what I've trained for for so long. </span></p><p><span style="font-family:georgia;font-size:85%;">I'm finally starting to play doctor.</span></p><span style="font-family:georgia;font-size:85%;"></span><br /><br /></span><em></em>Vitum Medicinushttp://www.blogger.com/profile/09994320714669547787noreply@blogger.com3tag:blogger.com,1999:blog-29798185.post-567145300211652532009-06-24T11:36:00.000-08:002009-06-24T22:32:44.375-08:00PDA Update: Why I RETURNED the PDA I chose!<div align="center"><span style="color:#3333ff;">UPDATED Again June 24 - <em>Now includes the phone I chose AND how I like it</em></span></div><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi-AjopI40a1OGj81SxzNXa4x5QTrpKJO4lKzavC11IDMkgTw7SiRAuNks2ZSDdUr2TEp7qmrVhAOugpWMs8rGzEBGVL1hcYNfFacH59vNftE72ctAkE6qzMRLlWIzgRcoGKm1E7w/s1600-h/samsung-blackjack2.jpg"><span style="font-family:georgia;"><img id="BLOGGER_PHOTO_ID_5329458383988021522" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 179px; CURSOR: hand; HEIGHT: 200px" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi-AjopI40a1OGj81SxzNXa4x5QTrpKJO4lKzavC11IDMkgTw7SiRAuNks2ZSDdUr2TEp7qmrVhAOugpWMs8rGzEBGVL1hcYNfFacH59vNftE72ctAkE6qzMRLlWIzgRcoGKm1E7w/s200/samsung-blackjack2.jpg" border="0" /></span></a><span style="font-family:georgia;font-size:85%;">In the summer I wrote </span><a href="http://blog.vitummedicinus.com/2008/07/vitum-goes-high-tech-which-pda-i-chose.html"><span style="font-family:georgia;font-size:85%;">a fairly comprehensive report on which PDA I chose for my clerkship</span></a><span style="font-family:georgia;"><span style="font-size:85%;">, taking into account the pros and cons of the ones on the market.</span><br /><br /><span style="font-size:85%;">In short, I ended up choosing the Samsung Jack (also known as the i616) from Rogers, known in the USA as the BlackJack II. </span><br /><span style="font-size:85%;"></span><br /><span style="font-size:85%;">I LOVED this phone. So much. It was exactly what I wanted, and </span><span style="font-size:85%;">so much more.</span><br /><span style="font-size:85%;">I sent it back to Rogers today.</span><br /><span style="font-size:85%;"></span><br /><span style="font-size:85%;">You see, Rogers came out with a new version of the Windows software - upgrading Windows Mobile 6.0 to 6.1. And that's when the problems began.</span><br /><br /><em><strong>Why I returned it:</strong></em><br /><strong><em><span style="font-size:85%;"></span></em></strong><br /><span style="font-size:85%;">The old phone was fantastic. Quick to respond, looked great, worked amazingly well, good call quality, outstanding battery life, and ran all the medical software I used on a regular basis (post on this to come soon).</span><br /><span style="font-size:85%;"></span><br /><span style="font-size:85%;">Then the new version of Windows Mobile came out, and it was horrible. </span><br /><span style="font-size:85%;"></span><br /><span style="font-size:85%;">There were glitches that were merely minor annoyances, ie. waiting 7 seconds between songs in a playlist.</span><br /><span style="font-size:85%;"></span><span class="fullpost"><br /><span style="font-size:85%;">There were more severe annoyances, such as the phone randomly changing time zones, screwing up all your reminder and appointment times, or the battery life being significantly shorter with the new version of Windows.</span><br /><span style="font-size:85%;"></span><br /><span style="font-size:85%;">There were major technological glitches, in that the phone would stop working - calls could connect incoming and outgoing, but would not have any audio. My internal medicine attending was not impressed when I missed his calls beacuse of that.</span><br /><span style="font-size:85%;"></span><br /><span style="font-size:85%;">And then, to just drive me entirely up the wall, there were glitches that made me wonder if the people that designed it had ever used a phone before (switching the phone to "silent" silenced ONLY the ringers - but alarms, e-mails and texts would all cause the phone to ring loudly!)</span><br /><span style="font-size:85%;"></span><br /><span style="font-size:85%;">Each one of these was a step backward - none of these problems occurred before I made the upgrade, which I downloaded from the cell service provider's website. And the improvements in the new version were minimal. So, I sent the phone back, and got a new one - which had the same new version of Windows - and ALL the same problems. And after a few months of not bening able to make calls, I finally threw in the towel and said "enough."</span><br /><span style="font-size:85%;"></span><br /><strong><em>Which mobile phones I considered:</em></strong><br /><strong><em><span style="font-size:85%;"></span></em></strong><br /><span style="font-size:85%;">I looked at 3 phones:</span><br /><br /></span></span><span style="font-family:georgia;"><span class="fullpost"><br /><br /><ul><li><span style="font-family:georgia;font-size:85%;">the HTC Touch Diamond, which my provider was willing to exchange for free</span></li><br /><li><span style="font-family:georgia;font-size:85%;">Blackberry, which I would have had to pay for</span></li><br /><li><span style="font-family:georgia;font-size:85%;">the iPhone, which I would have had to pay for</span></li></ul><p><span style="font-family:georgia;font-size:85%;">I had some qualms about the Blackberry and iPhone from the last time I went through this choosing a phone process, and the HTC Touch Diamond was new to me, but I reconsidered all of these.</p><br /><br /><p><strong><em><span style="font-family:georgia;">Which phone I exchanged it for:</span></em></strong></p><p><span style="font-family:georgia;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEihKZ94YdqTXizNa-AT2_lE8rvpPpiE-aH1LETGN-NWzdpUnKTo3AZhV-VHOeRkEX8lZx_XTyUA2scyjoaXL1aLQsr2Zb8UcexhDkrYFHAwvBuP67RUOgJS9WpX8fGNcFCLVAvhOA/s1600-h/htctouch.jpg"><img id="BLOGGER_PHOTO_ID_5345206589733320690" style="FLOAT: right; MARGIN: 0px 0px 10px 10px; WIDTH: 128px; CURSOR: hand; HEIGHT: 200px" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEihKZ94YdqTXizNa-AT2_lE8rvpPpiE-aH1LETGN-NWzdpUnKTo3AZhV-VHOeRkEX8lZx_XTyUA2scyjoaXL1aLQsr2Zb8UcexhDkrYFHAwvBuP67RUOgJS9WpX8fGNcFCLVAvhOA/s200/htctouch.jpg" border="0" /></a>I was really excited about the HTC Touch Diamond. It's a sleek phone, with a Windows operating system like my old phone, so I knew it would support all the exact same software I had used. </span><span style="font-family:georgia;">So, I went to a Rogers store and tried one of these slick things out.</span></p><p><span style="font-family:georgia;">After <strong>five</strong> minutes, the phone had just about finished booting up.</span></p><p><span style="font-family:georgia;">After <strong>ten</strong> minutes, the phone was about halfway through its mandatory First Startup configuration.</span></p><p><span style="font-family:georgia;">After <strong>fifteen</strong> minutes, I was trying to figure out how to do basic things, like start the Internet explorer, add a new contact, and use the keyboard.</span></p><p>After <strong>twenty</strong> minutes, I was STILL trying to figure out how to do those basic things, and was starting to get annoyed with the touch screen which was a tad unresponsive.</p><p>After <strong>twenty-five</strong> minutes, I was STILL doing the above, and just about ready to <em>throw the phone against the wall</em>. Learning to use a new phone should not be that difficult...especially for someone who is fairly tech-minded like myself.</p><p>After <strong>thirty</strong> minutes, I gave up. Scratch the HTC Touch Diamond off the list.<span style="font-family:georgia;"></p><p>My concerns about the Blackberry and the iPhone were that not a lot of medical applications were made for these platforms - most are made for Palm or Windows.</p><p>However the medical applications I found I used almost exclusively were:</p><ul><li><a href="http://www.epocrates.com/">Epocrates</a> - a <strong>free</strong> drug lookup<br /></li><li><a href="http://www.uptodate.com/">UpToDate</a> - subscription to the latest research on medical topics (wait until your med class does a group order for a massive discount, or better yet, arrange one yourself)</li><br /><li><a href="http://www.skyscape.com/EStore/ProductDetail.aspx?ProductID=227">Archimedes</a> - a <strong>free</strong> medical calculator</li><br /><li><a href="http://books.mcgraw-hill.com/medical/diagnosaurus/index.html">Diagnosaurus</a> - a <strong>free</strong> differential diagnosis generator</li></ul>Even though I paid for Merck Manual, I found that with UpToDate on my phone, I turned to UpToDate for most topics.<br /><br /><p>Turns out all of the above except UpToDate are available as iPhone applications, and UpToDate is available through the iPhone, you just have to use the Internet connection. As well, Rogers offered me a deal on the iPhone. </p><p>So, I decided to set my concerns about the touch screen keyboard aside, and went for the iPhone.</p><p><strong><em>The Verdict...How do I like the iPhone?</em></strong></p><p>Perhaps the best way to answer this is to ask, what do I miss about the BlackJack? </p><p>Frankly, almost nothing. While I thought I would miss the tactile keyboard, it turns out that I'm getting along on the iPhone just fine. My typing is slower, mind you, but not by much.</p><p>As well, until the iPhone 3G S came out, the iPhone didn't have video. But to be honest, I never used the video on my BlackJack.</p><p>The only thing the BlackJack had the upper hand on was battery life - the iPhone isn't that great (no word yet on how much better the 3G S will be). As well, loading UpToDate on the BlackJack was faster - I didn't have to type in a password, because it was downloaded to the device already, rather than accessed through the mobile web.</p><p>The iPhone is much better at browsing the internet, or surfing through a long page on UpToDate, for example. Rather than rolling a little scroll wheel over and over, you simply slide your finger - much easier.</p><p>And, the iPhone's GPS is much faster to lock a signal than the BlackJack (even though both are extremely accurate) - helpful for finding hospitals or doctors' offices on the first day of a new rotation, and for using <a href="http://www.runkeeper.com/">RunKeeper</a> - a FREE program MUCH better than Nike's run tracker - to track my exercise. </p><p>All in all, I don't miss the BlackJack. But to be honest, I was perfectly happy with my BlackJack...before the new version of Windows. I'll even go so far as to say that had the Microsoft update not been so full of glitches, and I stayed with my BlackJack, I would be just as happy as I am today, as far as a medical device is concerned.</p></span></span></span></span>Vitum Medicinushttp://www.blogger.com/profile/09994320714669547787noreply@blogger.com10tag:blogger.com,1999:blog-29798185.post-6746951072473559682009-05-12T20:24:00.004-08:002009-05-12T20:25:39.223-08:00Electives - any suggestions?<span style="font-family:georgia;font-size:85%;">I'm currently looking into doing a two-week Emergency Medicine elective in any American city... any suggestions?<br /><br />Most of the ones I've come across so far in my research are four-week electives, but we only get a two-week block during our third year at my school. </span>Vitum Medicinushttp://www.blogger.com/profile/09994320714669547787noreply@blogger.com4tag:blogger.com,1999:blog-29798185.post-6177925533630128632009-05-04T06:34:00.007-08:002009-05-04T06:44:01.844-08:00The tragic outcome of a homeopath treating his daughter's eczema<span style="font-family:georgia;"><span class="Apple-style-span" style="font-face: Georgia;font-size:small;" ><span style="font-size:85%;">It is devestating to hear stories of people deluded into believing that alternative medicine can cure ails.</span> </span></span><div><span class="Apple-style-span" style="font-size:small;"><br /></span></div><div><span class="Apple-style-span" style="font-family:georgia;font-size:85%;">It's even worse when the one who suffers never had a choice in the matter.</span></div><div><span class="Apple-style-span" style="font-size:small;"><br /></span><span style="font-family:georgia;font-size:85%;">In England, </span><a href="http://www.news.com.au/dailytelegraph/story/0,22049,25427280-5001021,00.html"><span class="Apple-style-span" style="font-family:georgia;font-size:85%;">a homeopath is on trial for gross criminal negligence after his daughter died of a skin infection</span></a><span class="Apple-style-span" style="font-family:georgia;font-size:85%;">. She could have easily been treated by a dermatologist, but instead, the father, a homeopath, provided only homeopathic treatment, the jury was told. </span></div><div><span class="Apple-style-span" style="font-size:small;"><br /></span><span style="font-size:85%;"><span style="font-family:georgia;"></span></span></div><div><span style="font-family:georgia;"><strong><span style="font-size:130%;"><blockquote><span style="font-family:georgia;"><strong><span style="font-size:130%;">"<span class="Apple-style-span" style="LINE-HEIGHT: 16px"><span class="Apple-style-span" style="font-size:small;">The court heard that by the time Gloria was six months old, the eczema had begun weeping and her clothing and nappies would stick to her skin and tear it whenever her parents changed her.</span></span></span></strong></span><br /></blockquote></span></strong></span><span class="Apple-style-span" style="LINE-HEIGHT: 16px"><br /></span></div><div><p style="PADDING-RIGHT: 0px; PADDING-LEFT: 0px; PADDING-BOTTOM: 0px; MARGIN: 0px 0px 1.6em; LINE-HEIGHT: 1.34; PADDING-TOP: 0px"><span class="Apple-style-span" style="font-family:georgia;font-size:85%;">"Crown prosecutor Mark Tedeschi QC said the baby girl's skin began to peel off, allowing infections to enter her bloodstream."</span></p><p style="PADDING-RIGHT: 0px; PADDING-LEFT: 0px; PADDING-BOTTOM: 0px; MARGIN: 0px 0px 1.6em; LINE-HEIGHT: 1.34; PADDING-TOP: 0px"><span class="Apple-style-span" style="font-family:georgia;font-size:85%;">Her body couldn't handle the repeated infections, and she died from septicemia in May 2002.</span></p><p style="PADDING-RIGHT: 0px; PADDING-LEFT: 0px; PADDING-BOTTOM: 0px; MARGIN: 0px 0px 1.6em; LINE-HEIGHT: 1.34; PADDING-TOP: 0px"><span class="Apple-style-span" style="LINE-HEIGHT: 17px;font-family:georgia;font-size:85%;" >Had homeopathy been explained to Gloria, I bet even she could have seen the folly of using mere diluted water to treat her raging skin condition and ensuing secondary infections...</span></p><span class="Apple-style-span" style="font-size:small;"><br /></span></div>Vitum Medicinushttp://www.blogger.com/profile/09994320714669547787noreply@blogger.com3tag:blogger.com,1999:blog-29798185.post-52566194680390944122009-04-24T16:45:00.004-08:002009-04-24T16:54:10.291-08:00I sterilized a man today.<span style="font-family:georgia;font-size:85%;">Sticks and stones may break my bones...</span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><span style="font-family:georgia;font-size:85%;">...but you better watch out, because I now know how to do a vasectomy.</span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><span style="font-family:georgia;font-size:85%;">Thanks to my nimble fingers, three men limped out of the urology office this morning, their virility forever compromised...at least we hope it is.</span>Vitum Medicinushttp://www.blogger.com/profile/09994320714669547787noreply@blogger.com3tag:blogger.com,1999:blog-29798185.post-14734899169190079592009-04-16T15:15:00.008-08:002009-04-16T15:20:44.446-08:00First do no harm...unless you haven't gone to medical school<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh_Zv5skCFmCAhbQW2si2ZRFGKLyScUtdnxiZVLRLfRjfzZkyxdvCZlwgc6lnznQJo7m4YzM-pehlUVmnT3eAGLBncTcILNwDfVZaNF_3HFmbHuS5S_U06meeXmzhSkSwh8rXArcA/s1600-h/natural.jpg"><img id="BLOGGER_PHOTO_ID_5325432255248968450" style="FLOAT: left; MARGIN: 0px 10px 10px 0px; WIDTH: 200px; CURSOR: hand; HEIGHT: 158px" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh_Zv5skCFmCAhbQW2si2ZRFGKLyScUtdnxiZVLRLfRjfzZkyxdvCZlwgc6lnznQJo7m4YzM-pehlUVmnT3eAGLBncTcILNwDfVZaNF_3HFmbHuS5S_U06meeXmzhSkSwh8rXArcA/s200/natural.jpg" border="0" /></a> <span style="font-family:georgia;font-size:85%;">Albert was on the phone with his sister on a sunny afternoon last week, telling her about the trip they had gone on over the weekend and his wife's bingo winnings at the local senior's centre that week, when suddenly she interrupted. "Albert, don't be silly."<br /><br />"What are you talking about?" he replied.<br /><br />"Albert, I can't understand you, what's going on?" He was confused - he was speaking perfectly fine, as far as he could tell.<br /><br />His wife walked into the room, and noticed that he was indeed slurring all his words, and rushed him to their naturopath. The naturopath saw his mouth drooping on one side, and told him he knew exactly what was going on. He promptly gave him a glass of water, into which she had mixed several spoonfuls of salt, and told him to drink up, and encouraged him to do this over the next several days. Why?<br /><br />Because, as the wife explained to me, "Well, when the left side of the mouth droops, he has a deficiency of sodium. And when the right side droops, he is low in potassium, you see. When both droop, then he needs more calcium."<br /><span class="fullpost"><br />Sure enough, in about half an hour, his droop had resolved, and his speech returned to normal. So the naturopath was right, right?<br /><br />Unfortunately, in this case, his naturopath was wrong. Because he'd had a heart attack in the past, and his heart muscle didn't contract the way it should anymore, giving salt to this patient was a bad decision. In fact, research shows that patients with heart failure have worsening of their symptoms when they have salt in their diet, and the most recent heart association guidelines recommend low-salt diets for these patients.<br /><br />And why did he get better? It had nothing to do with chugging brine. He'd had a TIA, or a transient ischemic attack, exactly like a stroke except it's just that - transient. The brain is starved of oxygen for a short time because of low flow or a small clot blocking an artery, but then the flow is restored before brain tissue dies. Had this lasted long enough to kill the brain tissue, it would have been called a stroke; in his case, the symptoms - temporary paralysis of his facial nerve innervating the orbicularis oris muscle, causing a mouth droop on one side - went away about half an hour after he drank the salt water. Though it looked like the natural treatment worked, it in fact had nothing to do with his symptoms resolving.<br /><br />But, because of this advice, his wife faithfully gave him several spoonfuls of salt every day, causing more and more water to build up in his blood vessels. And it wasn't long before his failing heart couldn't cope with this excess salt. He soon could walk shorter and shorter distances without having to stop for air, and would wake up gasping for breath in the middle of the night. His heart muscle's ability to pump blood, which had been measured right after his heart attack as still being still quite reasonable, couldn't cope with the extra water in his blood vessels and took a drastic turn for the worse.<br /><br />I saw him when he came into the hospital with his wife, unable to breathe, but it was too late. Despite receiving massive amounts of diuretics, vasodilators, and being placed on a breathing machine, it was too little too late. A few weeks later his heart gave out completely, he died with his lungs full of water instead of air, with a look of panic on his face, gasping for oxygen, because of the misinformation the wife had been told naturopath.<br /><br />It doesn't worry me that naturopaths provide a whole-person approach, and attempt to treat the cause of patients' ailments rather than the symptoms.<br /><br />It does worry me when they cause harm to patients, and make their health worse.<br /><br />Any doctor that prescribed salt to a patient with heart failure... not to mention miss the diagnosis of a stroke... could be sued, successfully, for malpractice.<br /><br />It also worries me that out on the western coast of this country, in British Columbia, <a href="http://www.cbc.ca/health/story/2009/04/10/bc-naturopaths.html"><span style="font-family:georgia;">naturopaths have been given the right to prescribe medications</span></a>,which not only seems to go against their entire profession's objective of treating things naturally, but is possibly dangerous given that they are quite simply not trained in this area.<br /><br />But going back to the story...you know what the worst part is? Had he seen a physician earlier, this could have been avoided... but the wife didn't see it that way. She left the hospital, without her husband, thinking that traditional medical treatment had failed to save her husband, when in fact the damage had been done long before he got to the hospital. Hopefully, her stronger belief in natural therapy doesn't kill her too.</span><br /></span></span>Vitum Medicinushttp://www.blogger.com/profile/09994320714669547787noreply@blogger.com6tag:blogger.com,1999:blog-29798185.post-33057050667414882922009-03-18T18:30:00.000-08:002009-03-18T18:30:57.588-08:00That poor, poor transcriptionist. I almost admitted it was my first dictation.<span style="font-family:georgia;font-size:85%;">I picked up the phone with a shaky hand, and slowly dialed the number for the hospital dictation system for the first time.</span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><span style="font-family:georgia;"><span style="font-size:85%;"><em>"Welcome to the Excelleris Express Dictation Service. Enter User ID , followed by the pound key,"</em> a cheerful voice said. </span></span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><span style="font-family:georgia;font-size:85%;">Good, I thought. She doesn't yet know that I have no clue what I'm doing.<br /><br />I keyed in the number for the doctor who was dumb enough to ask me to dictate for him. 6-2-1-0-9-#.</span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><span style="font-family:georgia;"><span style="font-size:85%;"><em>Enter hospital ID. </em>1-6-#.</span></span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><span style="font-family:georgia;"><span style="font-size:85%;"><em>Enter work type.</em> 1-0-#, specialist consultation of a patient.</span></span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><span style="font-family:georgia;"><span style="font-size:85%;"><em>Enter patient number.</em> 2-1-6-2-7-8-1-#. </span></span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><span style="font-family:georgia;"><span style="font-size:85%;"><em>Beep beep. . . . beep beep. . . bee- okay, are you going to make me wait all day? this is where you start talking, idiot. </em>Fortunately, it didn't actually say that to me. </span></span><span class="fullpost"><br /><span style="font-family:georgia;font-size:85%;"></span><br /><span style="font-family:georgia;font-size:85%;">I pressed 2 to begin, and slowly began to talk. </span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><span style="font-family:georgia;font-size:85%;">"This is Vitum Medicinus, M-e-d-i-c-i-n-u-s, medical student intern, dictating on behalf of Dr. Doe, a consultation note on patient James Smith, S-m-i-t-h, unit number 2162781, date of birth 02/20/1949. " </span><br /><em><span style="font-family:georgia;font-size:85%;"></span></em><br /><span style="font-family:georgia;font-size:85%;">This isn't so bad, I thought. I picked up speed.</span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><span style="font-family:georgia;font-size:85%;">"Copy to Dr. Doe, copy to Dr. Wilson. Date of consult March 6 2009, date of dictation March 6 2009. New heading, patient identification. Mr. Smith is a previously healthy 60-year-old Caucasian male who presented to the emergency department with his wife and daughter. Period. New heading. Chief complaint. Open quote, I passed out in the McDonald's parking lot, close quote."</span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><span style="font-family:georgia;font-size:85%;">I was doing it just like all the doctors I had seen dictate before! I was dictating! How exciting! I went on.</span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><span style="font-family:georgia;font-size:85%;">"New heading. History of presenting illness. This afternoon Mr Smith was getting out of his car at McDonalds when he began to feel presyncopal, period, before he could stop himself he fell to the ground, period, he described his presyncopal symptoms as open quote I was light headed comma I felt like I was going to pass out, close quote, but denied vertiginous symptoms, period. he lost consciousness for approximately ten seconds and in this time did not have any tonic clonic movements comma nor did he lose control of his bowel or bladder or bite his tongue period."</span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><span style="font-family:georgia;font-size:85%;">Okay, it didn't go that smoothly. My actual transcription went something like this... or at least what it would have looked like if I hadn't known how to pause, rewind, and re-record:</span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><span style="font-family:georgia;font-size:85%;">"Uh.... um.... uh... consult...dictation.... on ... patient .... copy to... Dr.... heading...new heading.... History of, uh, no wait....go back... Mr. Smith..." ... well, you get the idea. </span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><span style="font-family:georgia;font-size:85%;">Starting to dictate on behalf of the physicians has been really helpful. I've done a fair bit since that first one, and the process has made me realize that as far as taking the history and presenting the physical exam goes, I've started to really get the hang of it. It's when it comes time to dictate the assessment of what the patient has going on, and the plan of how to treat them, that I kindof fall apart and realize that I still have a lot to learn; with my first dictation, I had a fair bit of trouble with it even though I had discussed the case with the doctor already. Obviously, that's what I'm here to learn in third year, and throughout residency. </span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><span style="font-family:georgia;font-size:85%;">After I finished my first dictation, I sat the phone down, and began to gather my notes. I took a deep breath in and out. I noticed that one of the other emerg docs had sat down at the same desk about two-thirds of the way through my dication, and turned to him and asked, "Do you remember your first dictation?"</span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><span style="font-family:georgia;font-size:85%;">He smiled really big, and laughed, as he replied, "I try not to!"</span><br /></span>Vitum Medicinushttp://www.blogger.com/profile/09994320714669547787noreply@blogger.com5tag:blogger.com,1999:blog-29798185.post-56056982283773946612009-02-18T09:16:00.005-08:002009-02-18T11:06:27.361-08:00Planning for my 4th year<span style="font-family:georgia;font-size:85%;">"When are you going to be a doctor?" is a question I get asked by patients quite often. </span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><span style="font-family:georgia;font-size:85%;">I like to think they are asking because they are interested in my progress and eager to see me fulfilling my dreams.</span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><span style="font-family:georgia;font-size:85%;">More likely, however, the question is based on a thought process along the lines of:</span><br /><blockquote><p><span style="font-family:georgia;"><span style="font-size:85%;"><em>"Is THIS GUY going to be a doctor soon!? </em><em>He started out by asking me all these irrelevant questions - what's he thinking when he asks how many pillows I sleep with at night?* What's he going to ask next, what colour my blankets are?</em></span></span></p><p><em><span style="font-family:georgia;font-size:85%;">Then... he moved on to a fumbling, shoddy excuse for a 'physical exam,' making sure he touched me in every part of my body. Why on earth is he "feeling for the pulses in my groin?" Is he making this stuff up? And now he is using his stethoscope 'down there,'** is he crazy?!...ohhhh dear, when is the real doctor going to show up??</span></em></p><p><em><span style="font-family:georgia;font-size:85%;">Good heavens, how long until he is unleashed to practice his incompetence on me and my friends and family? I'd better ask so I can move out of town by then."</span></em></p></blockquote><p><span style="font-family:georgia;font-size:85%;">In my defense:</span></p><p><span style="font-family:georgia;font-size:85%;">* This is how I ask about orthopnea, or increased difficulty breathing when you are laying down flat, a symptom suggestive of impending heart failure. </span></p><p><span style="font-family:georgia;font-size:85%;">** I'm listening for bruits in the femoral artery, which could indicate arterial blockage or disease... and I always ask if its OK for me to proceed.</span></p><p><span style="font-family:georgia;font-size:85%;">The answer to the question is, just under 1.5 years, and trust me, I'm even more frightened by the thought than you are.</span></p><p><strong><span style="font-family:georgia;"><em>More on fourth year...</em></span></strong></p><p><span style="font-family:georgia;font-size:85%;">As I get closer to graduating, however, a few more decisions need to be made. My classmates and I are at the point in our education where we are choosing what we want to do for our fourth year. </span></p><p><span style="font-family:georgia;font-size:85%;">While our first two years were mostly lectures, and the third and fourth year are mostly clinical, the third and fourth years are quite different. </span></p><p><span class="fullpost"><span style="font-family:georgia;font-size:85%;">Our schedule is quite firmly set in third year - we rotate through a number of "core" specialties (internal medicine, pediatrics, surgery, obstetrics, etc), and the only thing we can have any input on is the order in which we do these (and even still, need to enter a lottery to decide which students get to pick first).</span></p><p><span style="font-family:georgia;font-size:85%;">However, in fourth year, we have a huge amount of flexibility in that we choose a number of electives. These can take place anywhere in Canada, the USA, or in some cases, elsewhere in the world, as long as I meet the requirements for the individual programs (some American schools, for example, want you to take the US Medical Licensing Exam after my 2nd year of medical school, which is not required in Canada).</span></p><p><strong><span style="font-family:georgia;"><em>The dirty details (for those who care...or can offer me some help!)</em></span></strong></p><p><span style="font-family:georgia;font-size:85%;">Based on how I understand it, what a medical student chooses for their senior electives is prompted by a number of factors, such as - </span></p><ul><li><span style="font-family:georgia;"><span style="font-size:85%;">the requirements of their school - <em>I have to do at least 1 elective in each of the following: medical, surgical, primary care</em></span></span></li></ul><p><em><span style="font-family:georgia;font-size:85%;"></span></em></p><ul><li><span style="font-family:georgia;"><span style="font-size:85%;">the career and residency programs they are interested in - <em>someone interested in Plastic Surgery will obviously want to do many electives in the same, and check out the cities and hospitals where they might do their training</em></span></span></li></ul><p><em><span style="font-family:georgia;font-size:85%;"></span></em></p><ul><li><span style="font-family:georgia;"><span style="font-size:85%;">geographic preference - <em>a specific city might be chosen for an elective because they have a good residency program the student wants to check out, or because the student can easily arrange accomodation there with family / friends (it helps to avoid paying double the rent for the months you're away!), or simply because the student wants to visit a city they've never been to (my friend did a 3rd year elective in Pittsburgh so he could go watch a Penguins NHL game)</em></span></span></li></ul><p><em><span style="font-family:georgia;font-size:85%;"></span></em></p><ul><li><span style="font-family:georgia;"><span style="font-size:85%;">interest - <em>a student applying to a generalist (i.e. Family Practice) or less competitive specialty will probably spend more of their electives experiencing a variety of specialties they find enjoyable and interesting, rather than ones they think they "need" in order for their application to be impressive</em></span></span></li></ul><p><span style="font-family:georgia;font-size:85%;">As well, I also need to consider some other things regarding when I do an elective, based on applying to residencies:</span></p><ul><li><span style="font-family:georgia;"><span style="font-size:85%;">whether or not the elective has a lot of call - <em>if so, it might be tough to work on an application for residency at the same time!</em></span></span></li></ul><p><em><span style="font-family:georgia;font-size:85%;"></span></em></p><ul><li><span style="font-family:georgia;"><span style="font-size:85%;">whether or not it's likely to yield a good reference letter for residency - <em>this only applies to the first few electives until the reference letter due date - you're more likely to earn a good reference letter from a specialty in which you work with 1 preceptor quite often, rather than something like emergency medicine, where you are supervised by someone else every shift.</em></span></span></li></ul><p><span style="font-family:georgia;font-size:85%;">Here's what I'm thinking so far, given that I am mostly interested in emergency medicine but may apply for a family medicine residency so that I can have a variety of options when I finish (ie. spend my time delivering babies, working as a hospitalist, or doing surgical assisting):</span></p><ul><li><span style="font-family:georgia;"><span style="font-size:85%;">Places - <em>I'm thinking of doing my electives mostly in Alberta, BC and Ontario, because that's where I'm thinking of doing my residency, they're most familiar to me, and I know more students who have done electives in these places and therefore can get the scoop on them</em></span></span></li></ul><p><em><span style="font-family:georgia;font-size:85%;"></span></em></p><ul><li><span style="font-family:georgia;"><span style="font-size:85%;">Basics - <em>I'm interested in spending time in ER and obstetrics, so I'll likely do at least 1 elective in each of those</em></span></span></li></ul><p><em><span style="font-family:georgia;font-size:85%;"></span></em></p><ul><li><span style="font-family:georgia;"><span style="font-size:85%;">Helpful add-ons - <em>For someone interested in ER, I would probably benefit from spending some time in pediatric emergency, trauma surgery, and/or anaesthesia</em></span></span></li></ul><p><em><span style="font-family:georgia;font-size:85%;"></span></em></p><ul><li><span style="font-family:georgia;"><span style="font-size:85%;">Just for fun / interest - <em>If I have time,</em> <em>I might as well do some shorter electives in things I don't know much about, that intimidate me, or that I have simply never seen - such as rheumatology, or neurology</em></span></span></li></ul><p><span style="font-family:georgia;font-size:85%;">There are a few deadlines for choosing coming up, so now, the question is to decide where I want to do each of these electives, and if there's anything I'm missing. If you can think of anything, by all means, let me know!</span></p><br /></span>Vitum Medicinushttp://www.blogger.com/profile/09994320714669547787noreply@blogger.com7tag:blogger.com,1999:blog-29798185.post-46437330422273378842009-02-05T20:20:00.006-08:002009-02-14T15:56:02.555-08:00Trauma Team vs. Delirium team?<span style="font-family:georgia;font-size:85%;">My Internal Medicine attending made an interesting point today, brought up at a lecture by Dr Rivers (famous for his work on treatment of shock/sepsis in the emergency department, </span><a href="http://www.ncbi.nlm.nih.gov/pubmed/11794169"><span style="font-family:georgia;font-size:85%;">published in the NEJM</span></a><span style="font-family:georgia;font-size:85%;">):<br /><br /></span><ul><br /><li><span style="font-family:georgia;font-size:85%;">Number of hospital staff who work on a trauma patient who just arrived at a large hospital: usually ~10-20</span></li><br /><li><span style="font-family:georgia;font-size:85%;">Your chance of dying from an auto accident if you make it to the hospital alive: ~10%</span></li></ul><br /><p><span style="font-family:georgia;font-size:85%;"></span></p><br /><ul><br /><li><span style="font-family:georgia;font-size:85%;">Number of hospital staff who work on a patient with delirium who just arrived at a large hospital: perhaps the medical student at first, then the doctor when s/he gets around to it</span></li><br /><li><span style="font-family:georgia;font-size:85%;">Your chance of dying from delirium: ~50%</span></li></ul><p><span style="font-family:georgia;font-size:85%;"></span></p><p><span style="font-family:georgia;font-size:85%;">A bit of a disconnect, perhaps?</span></p>Vitum Medicinushttp://www.blogger.com/profile/09994320714669547787noreply@blogger.com2tag:blogger.com,1999:blog-29798185.post-18938028814794557522009-02-05T20:10:00.007-08:002009-02-05T20:19:57.412-08:00Internal Medicine so far<span style="font-family:georgia;font-size:85%;">I'm well into my Internal Medicine rotation. Fortunately, I have been well-warned that internal medicine attendings are notorius for demanding perfection, immense detail, and will respond to any lack of the aforementioned with insults substantial in volume and quantity, so it wasn't too much of a surprise.</span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><span style="font-family:georgia;font-size:85%;">Here are a few choice events so far: </span><br /><ul><li><span style="font-family:georgia;font-size:85%;">doing CPR for the second time (second time for real, that is) in a code blue</span></li></ul><p><span style="font-family:georgia;font-size:85%;"></span></p><ul><li><span style="font-family:georgia;font-size:85%;">one time feeling like I had learned something about medicine</span></li></ul><p><span style="font-family:georgia;font-size:85%;"></span></p><ul><li><span style="font-family:georgia;font-size:85%;">most times feeling like I have not learned anything</span></li></ul><p><span style="font-family:georgia;font-size:85%;"></span></p><ul><li><span style="font-family:georgia;font-size:85%;">being schooled by nurses who know critical care medicine much better than I do</span></li></ul><p><span style="font-family:georgia;font-size:85%;"></span></p><ul><li><span style="font-family:georgia;font-size:85%;">being asked by my attending doctor, "I was wondering when your brain would turn on" (don't worry, he was joking...I think)</span></li></ul><p><span style="font-family:georgia;font-size:85%;"></span></p><ul><li><span style="font-family:georgia;font-size:85%;">developing near-delirium after losing my cell phone in a call room (the first time I have ever lost my phone in about 5 years)</span></li></ul><p><span style="font-family:georgia;font-size:85%;"></span></p></span><ul><li><span class="fullpost"><span style="font-family:georgia;font-size:85%;">smelling <em><a href="http://en.wikipedia.org/wiki/Fetor_hepaticus">fetor hepaticus</a></em> - the "sweet, feculent odour" on the breath of a patient with end-stage liver failure</span></li></ul><p><span style="font-family:georgia;font-size:85%;">I haven't cried yet, so I think that means I'm doing well.</span></p><br /></span>Vitum Medicinushttp://www.blogger.com/profile/09994320714669547787noreply@blogger.com6tag:blogger.com,1999:blog-29798185.post-8268553134632705692009-01-18T20:42:00.007-08:002009-01-18T20:54:49.046-08:00Drinking from the fire hydrant<span style="font-family:georgia;font-size:85%;">My facebook status this week:</span><br /><blockquote><span style="font-family:georgia;font-size:85%;">Vitum is entering one of those hell weeks that usually end with his friends asking, "Why don't we see you anymore?" Trust me, my bed feels the same way.</span></blockquote><br /><span style="font-family:georgia;font-size:85%;">I spent most of Christmas describing third year to my friends and family like this: it's like working full-time (a doctor's definition of full-time, which is often 50 or 60 hours a week), plus being on call for an overnight shift every fourth night, plus studying for a major exam every month. Wheeeee!</span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><span style="font-family:georgia;font-size:85%;">Like I've said many times before, though, I am careful not to whine too much. Not only were my first two years of med school two of the most fun-packed years of my life (as I was reminiscing with a classmate just this afternoon), but as hard as I am being worked right now I'm doing what I love, and worked hard to be able to do. </span><br /><span style="font-family:georgia;font-size:85%;"></span><span class="fullpost"><br /><span style="font-family:georgia;font-size:85%;">After all, it is indeed my signature at the bottom of the application to medical school from three years back.</span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><span style="font-family:georgia;font-size:85%;">Yet, sometimes I check just to make sure.</span><br /></span>Vitum Medicinushttp://www.blogger.com/profile/09994320714669547787noreply@blogger.com1tag:blogger.com,1999:blog-29798185.post-63004455543760649122009-01-07T07:27:00.005-08:002009-01-07T07:31:28.341-08:00The strangest thing said to me during a pelvic exam<span style="font-family:georgia;font-size:85%;">She had been fairly relaxed about the whole situation, considering, and after taking her history and doing the rest of the physical examination, I was standing at the foot of the bed. She had assumed the unpleasant position, and I was cautiously brandishing the well-lubricated speculum, when she said to me, </span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><div align="center"><em><span style="font-family:georgia;font-size:85%;">Don't lose your gum, Vitum!</span></em></div><em><span style="font-family:georgia;font-size:85%;"></span></em><span class="fullpost"><br /><span style="font-family:georgia;font-size:85%;">Hope I didn't look <em>that</em> eager...</span></span>Vitum Medicinushttp://www.blogger.com/profile/09994320714669547787noreply@blogger.com5tag:blogger.com,1999:blog-29798185.post-29332062719405367802008-12-26T10:44:00.005-08:002008-12-26T11:01:00.466-08:00My first NBME board exam<span style="font-family:georgia;font-size:85%;">It's Christmas break.</span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><span style="font-family:georgia;font-size:85%;">Thank God.</span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><span style="font-family:georgia;font-size:85%;">I just wrote my Surgery exams and they were well-timed to occur just before the break. I'm not sure I would have lasted if I had to go back to work the day after my first NBME (National Board of Medical Examiners) written & oral exam of the year. </span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><span style="font-family:georgia;font-size:85%;">Now only 4 more to go. We write 5 NBMEs in our third year - Psychiatry, Obs/Gyn, and the "Big Three" - Surgery, Internal Medicine, and Pediatrics. </span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><span style="font-family:georgia;font-size:85%;">Before I wrote my first NBME, I was given a heads up about what they're like. The way these exams were explained to me by those who had written it? </span><span class="fullpost"><br /><br /></span><span class="fullpost"><blockquote><p><span style="font-family:georgia;font-size:85%;">"You study your butt off for 8 weeks for one of the subjects, you live and breathe it, you learn everything there is to know, all the basics, all the obscure rare diseases you'll never see, and then you show up to the exam and feel like you get 0 of the 100 questions correct. Everyone thinks they failed. Everyone does just fine."</span></p></blockquote><br /><span style="font-family:georgia;font-size:85%;">Another piece of advice, which I'm not sure how it was supposed to help me prepare for the test (other than psychologically):</span><br /><br /><blockquote><span style="font-family:georgia;font-size:85%;">"People walked out of the exam room crying. I heard someone sobbing <em>during </em>the exam."</span></blockquote><br /><span style="font-family:georgia;font-size:85%;">On the test day, we had to sign and be read a few dozen disclaimers about the exam and not sharing questions, so the following isn't word-for word, but it suffices as a sample question:</span><br /><br /><blockquote><span style="font-family:georgia;font-size:85%;">A 42-year-old man presents with bilateral ear pain. Choose the correct diagnosis from the following list of options (a through f):</span></blockquote><br /><span style="font-family:georgia;font-size:85%;">Or, to compliment the questions with too little information, there are also long, detailed clinical scenarios of patients who present with a plethora of symptoms, have every known comorbidity, and their family history, social history, physical examination results, and lab data are all spelled out for you. So, you read through and underline the pertinent information, convert the lab data from American to International units, and then realize the question at the end of the scenario has nothing to do with the scenario and simply asks something like, </span><br /><br /><blockquote><span style="font-family:georgia;font-size:85%;">What is the most common cause of small bowel obstruction?</span></blockquote><br /><span style="font-family:georgia;font-size:85%;">I'm not sure the point of writing an exam that gets curved so vehemently that it doesn't really help you learn what you know and what you don't, or why we aren't given the opportunity to see where we went wrong and use the questions as a learning experience.</span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><span style="font-family:georgia;font-size:85%;">Just another hoop to jump through, I suppose. Just like the oral exam. </span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><span style="font-family:georgia;font-size:85%;">I'll rant about that one another time. </span><br /><br /><span style="font-family:georgia;font-size:85%;">For now, you'll find me on the couch by the TV, sipping egg nog.</span><br /><br /><div align="center">~~~</div><div align="center"> </div><div align="left"><span style="font-size:85%;">One more thing - thanks to </span><a href="http://medblog-groupie.blogspot.com/"><span style="font-size:85%;">Medblog Addict</span></a><span style="font-size:85%;"> for including me in the unique Christmas feature interviewing a different blogger for the 12 days of Christmas. You might enjoy the picture of myself that I submitted :)</span></div><div align="left"><span style="font-size:85%;"></span> </div><div align="left"><a href="http://medblog-groupie.blogspot.com/2008/12/nine-pipers-pipin-for-vitum-medicinus.html"><span style="font-size:85%;">Check out my (admittedly quite clever) responses to the interview questions!</span></a></div><div align="left"> </div></span>Vitum Medicinushttp://www.blogger.com/profile/09994320714669547787noreply@blogger.com3tag:blogger.com,1999:blog-29798185.post-1983394968352797322008-12-04T20:25:00.000-08:002008-12-04T21:27:33.918-08:00I don't think your arm is "bruised"<span style="font-family:georgia;font-size:85%;">He was coming into the family doctor's office I was placed for an entirely different reason, this pleasant, absent-minded, blissfully unaware old chap. "Hello, young fellow!" he said, when I came into the room. </span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><span style="font-family:georgia;font-size:85%;">I returned his happy greeting, and asked what brought him in. "Oh, nothing much, just here to get my prescriptions renewed, then I'm on my way! Sorry to trouble you!" He was such a cheery guy.</span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><span style="font-family:georgia;font-size:85%;">"Why are you wearing that long hankerchief around your neck?" I asked him, making small talk as I started copying out his drug list.</span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><span style="font-family:georgia;font-size:85%;">"Oh, just for a bruise on my arm, it's a little sore. I tripped over my shoelaces while I was getting my morning paper a couple weeks ago." He held up his arm. </span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><span style="font-family:georgia;font-size:85%;">My eyes bugged out when I saw it. </span><span class="fullpost"><br /><span style="font-family:georgia;font-size:85%;"></span><br /><span style="font-family:georgia;font-size:85%;">His bruise had gone away, but he had much more than that left over - about six inches up his arm from his wrist, he had what is called a "step deformity" - his arm bone was simply no longer straight. An obvious sign, visible from across the room, that his arm was broken, not bruised. </span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><span style="font-family:georgia;font-size:85%;">Not surprisingly, the doctor I was working with sent him to the emergency department to get his arm casted. </span></span><br /><span class="fullpost"><span style="font-size:85%;"></span><br /><span style="font-family:georgia;font-size:85%;">On my way back home from the office at the end of the day, I stopped at the hospital and called up his x-ray on the computer. Sure enough, he had a definite <a href="http://en.wikipedia.org/wiki/Smith">Smith's fracture</a> of his distal radius, typical of a fall onto a closed fist. </span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><span style="font-family:georgia;font-size:85%;">By chance, the emerg doc was walking by, saw I had dropped in to look at the x-ray, and said, "We're about to reduce that patient's fracture - do you want to do it?" Nice! </span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><span style="font-family:georgia;font-size:85%;">So, we put the jolly old fellow into an even more blissful state with some propofol ("milk of amnesia," as this white liquid is sometimes called), and yanked and pulled and tugged on his arm to get it back in the right place, then wrapped a cast around it. I love working in small hospitals - a pretty neat chance for followup on the patients, and no other resident or student there at the time so I could just jump in and do the procedure. </span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><span style="font-family:georgia;font-size:85%;"><em>Epilogue: </em>I didn't stick around to look at the post-reduction x-ray, but a few days later, I came back to the emergency department and called it up to see if the bones were set in the right place. Randomly enough, there was an orthopedic surgeon charting at the desk next to me, so I told him the story and asked him what he thought of the post-reduction x-ray. He was not impressed - turns out that if someone's arm has been broken for two weeks, it shouldn't be reduced in the ER because it's too far into the healing stages - surgery would have been more appropriate. Well, now I know. </span><br /><br /></span><span class="fullpost"></span>Vitum Medicinushttp://www.blogger.com/profile/09994320714669547787noreply@blogger.com7tag:blogger.com,1999:blog-29798185.post-33123547361870753582008-11-27T23:12:00.000-08:002008-11-28T13:50:28.662-08:00Med Student Syndrome: I have ADHD.<p><span style="font-family:georgia;"><span style="font-size:85%;"><em><strong>Med Student Syndrome:</strong> </em>A disorder, commonly seen among medical students, in which the student feels they suffer from every medical condition known to mankind. </span></span></p><p><span style="font-family:georgia;font-size:85%;">It's hard not to feel this way when you are learning about attention-deficit hyperactivity disorder, with which I have diagnosed myself (along with </span><a href="http://blog.vitummedicinus.com/2007/12/final-are-depressing-no-really-i-can.html"><span style="font-family:georgia;font-size:85%;">depression</span></a><span style="font-family:georgia;font-size:85%;"> and many other conditions). </span></p><p><span style="font-family:georgia;font-size:85%;">A selected portion of the diagnostic criteria. Let's see how many of them I fall under:</span></p><ul><li><span style="font-family:georgia;font-size:85%;">Often has difficulty sustaining attention. <em>Check</em>.<br /></span></li><li><span style="font-family:georgia;font-size:85%;">Often avoids tasks that require sustained attention. <em>Check</em>.<br /></span></li><li><span style="font-family:georgia;font-size:85%;">Often is forgetful. <em>Check.</em><br /></span></li><li><span style="font-family:georgia;font-size:85%;">Often loses things necessary for activities. <em>Check</em>.<br /></span></li><li><span style="font-family:georgia;font-size:85%;">Often fails to give close attention to details and make careless mistakes. <em>Chk</em>. </span></li><span class="fullpost"><br /><li><span style="font-family:georgia;font-size:85%;">Often does not seem to listen. <em>Pardon me</em>?<br /></span></li><li><span style="font-family:georgia;font-size:85%;">Often is forgetful. <em>Check. </em><br /></span></li><li><span style="font-family:georgia;font-size:85%;">Often does not seem to follow through.<br /></span></li><li><span style="font-family:georgia;"><span style="font-size:85%;"><strong><u>CHECK </u></strong>- organizing tasks: often has difficulty.<br /></span></span></li><li><span style="font-family:georgia;"><span style="font-size:85%;">Often is forgetful. <em>Check.</em></span></span></li><br /><li><span style="font-family:georgia;font-size:85%;">Often is easily distrac - hey, it's nice outside... </span></li></ul><p><span style="font-family:georgia;font-size:85%;"></span> </p><br /><br /><p><span style="font-family:georgia;font-size:85%;"></span></p></span>Vitum Medicinushttp://www.blogger.com/profile/09994320714669547787noreply@blogger.com6tag:blogger.com,1999:blog-29798185.post-86478375156695349652008-11-22T19:07:00.002-08:002008-11-22T20:24:00.252-08:00Make sure you know what you are getting into... [part two]<span style="font-family:georgia;font-size:85%;">When I give that advice to pre-med students, I say it knowing full well that they'll respond to that advice the same way I did - by spending a bit of time learning about medicine, being fascinated by the great parts, and pretty much completely whitewashing any challenges that come up without ever experiencing what they are like:</span><br /><br /><em><span style="font-family:georgia;font-size:85%;">"Being on call and getting to sleep at the hospital after a full office day sounds exciting!"</span></em><br /><br /><em><span style="font-family:georgia;font-size:85%;">"Having a patient stop breathing and everyone looking to me for a decision sounds like it would be a thrilling challenge!"</span></em><br /><br /><em><span style="font-family:georgia;font-size:85%;">"Not seeing my wife and family because I am spending 16 hours a day studying sounds like an honourable sacrifice!"</span></em><br /><br /><span style="font-family:georgia;"><span style="font-size:85%;">And some of them last well into med school:<em> "<a href="http://blog.vitummedicinus.com/2008/04/looking-forward-to-my-pager.html">I can't wait to have a pager!</a>"</em></span></span><span class="fullpost"><br /><br /><span style="font-family:georgia;font-size:85%;">It's not necessarily Mr. Eager McPremed's fault. A large part of it has to do with the fact that it is so hard (especially in North America) to get experience shadowing physicians one-on-one, let alone living the life of a physician day in and day out with full office days and on call nights. </span><span style="font-family:georgia;font-size:85%;"><br /><br /></span><span style="font-family:georgia;font-size:85%;"></span><span style="font-family:georgia;font-size:85%;">Another reason pre-meds tend to brush off the difficult parts is because the pull towards the pursuit of medicine is so strong, especially when the pre-med student has the capability to succeed in it. It is so hard to be honest with yourself and walk away from a career path that impresses everybody you tell about it. </span></span><br /><span class="fullpost"><span style="font-family:georgia;font-size:85%;"></span></span><br /><span class="fullpost"><span style="font-family:georgia;font-size:85%;">When you tell someone you're thinking of applying to medical school, the look on their faces, the eyebrows going up, the subtle gasp, and the inevitable story of their friend's nephew with an A+ average who now works for a drug company because he didn't get in after four times applying to med school gives you a feeling as addictive as some drugs. ..and coming to the point where one realizes that a life of medicine is not for them would mean having to give up the dream and everything that comes with it... including the look on peoples faces when you tell them.</span><br /><br /><br /><span style="font-family:georgia;"><span style="font-size:85%;"><strong>I had this in mind the other day when</strong> I read a Starbucks cup quote, only the second one to ever make an impact on me (the first one that ever impacted me I read the day of my med school interview, ask me about that one some other time):</span></span><br /><br /><span style="font-family:georgia;font-size:85%;">The Way I See It #26</span><br /><span style="font-family:georgia;font-size:85%;">"<em>Failure's hard, but success is far more dangerous. If you're successful at the wrong thing, the mix of praise and money and opportunity can lock you in forever</em>." - Po Bronson, Author of "What Should I Do With My Life" </span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><span style="font-family:georgia;font-size:85%;">That's why I have frequently recommended reading medical blogs, which have a great way of showing all sides of medicine if direct experience can't be obtained. I have also often recommended Ifinding's series of blog posts, the </span><a href="http://ifinding.blogspot.com/2007/08/dont-become-doctor.html"><span style="font-family:georgia;font-size:85%;">Don't Become a Doctor Series</span></a><span style="font-family:georgia;font-size:85%;">. </span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><span style="font-family:georgia;font-size:85%;">Hopefully reading those will encourage medical school hopefuls to realize that getting into medicine is an extremely serious decision that should be fully investigated before it is pursued.</span></span><br /><span class="fullpost"><span style="font-family:georgia;font-size:85%;"></span></span><br /><span class="fullpost"><span style="font-family:georgia;font-size:85%;">It might sound like I'm regretting going into this. I'm not - I've just come to a challenging part of the journey that makes me stop and be thankful for what is driving me and giving me the motivation it takes to get through this. It also makes me feel really, really sorry for those people who are going into medical school for superficial reasons, like the money, their parents' wishes, or that look on peoples faces... beacuse when they get to the rough patches, I really don't know how they'll keep putting one foot in front of the other if that's all that is driving them. If those are the driving reasons, and not something deeper, spare yourself... dragging yourself through this gauntlet just isn't worth it.</span></span>Vitum Medicinushttp://www.blogger.com/profile/09994320714669547787noreply@blogger.com3tag:blogger.com,1999:blog-29798185.post-28949144661583752092008-11-08T22:00:00.002-08:002008-11-08T22:07:00.998-08:00Make sure you know what you are getting into... [part one]<span style="font-family:georgia;font-size:85%;">One of the pieces of advice I was given as a pre-med, and that I frequently give to pre-med students (it's #7 on my </span><a href="http://blog.vitummedicinus.com/2007/07/top-10-list-pieces-of-advice-for-pre.html"><span style="font-family:georgia;font-size:85%;">Top 10 list of advice for pre-med students</span></a><span style="font-family:georgia;font-size:85%;">) is, </span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><div align="center"><strong><em><span style="font-family:georgia;font-size:85%;">"Make sure you know what medicine is like before you sign up for it."</span></em></strong></div><br /><span style="font-family:georgia;font-size:85%;">That was ringing quite loudly in my mind when I started my call shift the other night. I had had a busy week in surgery. There were some really long days of showing up on the ward at 7am then a full day of office then going straight to the hospital at 5pm and seeing emergency patients and eventually taking them to the operating room and getting home well into the wee hours of the morning... with a full day in the office after that. </span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><br /><span style="font-family:georgia;"><span style="font-size:85%;"><strong>Most of the surgeries were routine, but</strong> some came with the emotional stress of having to tell a patient and their family they had a 50% chance of dying on the operating table, and a 50% chance of us opening them up, finding that we could do nothing, and closing them up to face their death within the next few days. (One patient's response to that speech? "<em>Bloody hell</em>." Yeah, no kidding.) </span></span><br /><span class="fullpost"><br /><span style="font-family:georgia;font-size:85%;">I also had a long academic half-day full of lectures on things that I need to know but had no energy to learn, that also went late into what was going to be my evening relaxation time.</span><br /><br /><span style="font-family:georgia;font-size:85%;">I had to try and fit in studying for my two upcoming exams in between all that, and then on top of that I tried hard to make time to get some exercise and spend some quality time, either on the phone, online or in person, with the people in my life who mean a lot to me. And no, there was no time for going to my buddy's poker game, watching the Leafs get their butts kicked (I haven't watched one game this season!), an afternoon round of golf, or any of the other things I would have enjoyed doing that resemble this "<em>having a life</em>" thing I've heard so much about.</span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><br /><span style="font-family:georgia;"><span style="font-size:85%;"><strong>As soon as I finished work in the surgeon's office</strong> for the last day of this tough week, I headed to the hospital to get my pager and start call - and within five minutes of my call shift starting, my resident and I had five patients to see, all of whom were pretty sick. Just as we were trying to figure out who to see first, the pager went off two more times. We didn't get a break longer than ten minutes until 2am, when I got a bit of sleep before the pager started going off again (getting a bit of sleep means it was a lucky call night). </span></span><br /><br /><span style="font-family:georgia;font-size:85%;">I'll admit when all those pages were coming in right at the start of the shift, I was feeling the stress of the whole week on top of having a lot on my plate all at once, and I fell into a rut I find myself in once every year or so when all the negative thoughts come rushing to me. I find myself seriously asking if I am in the right place, if I made the right career decision, if I will ever be able to treat patients on my own, if I really knew that medicine was like this before I invested all that effort and money into pursuing it. </span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><br /><span style="font-family:georgia;"><span style="font-size:85%;"><strong>Fortunately, the five minutes the resident gave me</strong> before I had to meet up with him on the ward was just enough time to break down, almost re neg on my no-crying policy, and beg for some strength from heaven.</span></span><br /><br /><span style="font-family:georgia;font-size:85%;">Fortunately, God was listening and obliged. And all in all it ended up being a really good call shift. For me, that means a night with some varied, useful cases that are important for me to learn how to manage, and with some good opportunities for me to see patients on my own, evaluate their situations, and develop a plan and present it to the resident for their approval and questioning. We triaged those first cases well, and got through them and all the other calls throughout the night, and put off studying for just a few more hours in order to do those therapeutic things like write this post and sleep in late for the first time in a while.</span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><div align="center"><em><span style="font-family:georgia;font-size:85%;">::: part two to come... :::</span></em></div></span>Vitum Medicinushttp://www.blogger.com/profile/09994320714669547787noreply@blogger.com5tag:blogger.com,1999:blog-29798185.post-25761710572644927682008-11-03T10:35:00.001-08:002008-11-03T12:33:51.898-08:00Poking a screaming child? That'll put hair on your...<span style="font-family:georgia;font-size:85%;">"Bet you feel the testosterone surging through your veins now, eh?" the ER doc supervising me said. "That'll put hair on your chest." </span><br /><br /><span style="font-family:georgia;font-size:85%;">Then again, I'm sure everyone else in the ED (and all the other wards on that floor) also had a snappy comment for me, seeing as how each and every one of them could hear the screams of my patient. </span><br /><br /><span style="font-family:georgia;font-size:85%;">A young girl had gotten a huge gash in her arm after falling through a plate-glass window, and the emerg doc took one look at her chart and handed it to the resident, who handed it straight to me. At that point I was still unsuspecting, super keen to sew up yet another wound. Boy, was I naive.<br /></span><span class="fullpost"><br /><span style="font-family:georgia;font-size:85%;">After looking at the wound I flattered her quite nicely about being such a trooper, such a large gash and all and so little crying. </span><br /><br /><span style="font-family:georgia;font-size:85%;">Turns out that all my buttering up was for nothing, which I found out as soon as she asked if she would be needing a needle.</span><br /><br /><span style="font-family:georgia;font-size:85%;">That's where I went wrong.<br /></span><br /><span style="font-family:georgia;font-size:85%;">She sensed my instant of hesitation before my answer, and took that as her cue to start screaming at the top of her lungs. </span><br /><br /><span style="font-family:georgia;font-size:85%;">The screaming didn't stop. We tried everything from distraction, to warm blankets, to massaging her temples, to topical anesthetic and intranasal fentanyl, all of which seemed to only fuel the screaming, which lasted well into the procedure, despite the gallon or so of lidocaine I used to freeze the wound. </span><br /><br /><span style="font-family:georgia;font-size:85%;">Even though I have sewed many a wound with very little fanfare, this whole experience actually stressed me out a lot -- much more than I expected it to. </span><br /><br /><span style="font-family:georgia;font-size:85%;">You see, I still have enough compassion left that it makes me feel REALLY bad when I know I'm hurting a patient, especially a child, and I get uncomfortable when I see a pouty look, let alone screams of bloody murder and "PLEASE STOP! NO MORE NEEDLES! OH FOR THE LOVE OF...' Yeah, I didn't know 11-year-olds knew that many swear words. Kids these days. </span></span><br /><span class="fullpost"><span style="font-family:georgia;font-size:85%;"></span></span><br /><span class="fullpost"><span style="font-family:georgia;font-size:85%;">It was made even better with the parents shooting me the look of death the entire time for causing harm to their little angel. Fortunately, the father's claim that he wouldn't be bothered by the blood soon proved to be quite false, and the emerg doc saw him starting to reel and whisked him away, saying "OK, come with me, you are sitting down over here. Put your head between your legs."</span><br /><br /><span style="font-family:georgia;font-size:85%;">As well, with all the the flying fists and limbs I was pretty scared of buring the syringe or suture needle in my own hand. </span><br /><br /><span style="font-family:georgia;font-size:85%;">In fact, I was even more stressed that I'd be poking the care aide holding the child down. Keeping this saint happy had risen to a very high priority ever since she set aside one of the leftover hospital meals for me (which, despite being hospital food and looking like it had already been digested once, was still food). </span><br /><br /><span style="font-family:georgia;font-size:85%;">The procedure finally ended, and she finally went home, and a strange calm fell over the emerg. In fact, with the young girl gone I could only really hear monitors beeping, ambulance sirens, nurses shouting, and other patients yelling, which was so much more quiet than when that girl was there.<br /></span><br /><span style="font-family:georgia;font-size:85%;">Later on, one of the doctors told me that he used to feel bad poking children because they would cry so much. "Then," he said, "I had my own kids, and realized they cry <em>all the time...</em> even if you are not doing anything to hurt them."</span></span><br /><span class="fullpost"><span style="font-family:georgia;font-size:85%;"></span></span><br /><span class="fullpost"><span style="font-family:georgia;font-size:85%;">That did make me feel a bit better. But I was still so worked up when it was all over that I considered going to the homeless gentleman and ask if he was gonna finish that bottle of rubbing alcohol he was using to get drunk (tuition is due soon, so I am trying to get all the free hospital food and free alcohol - of any form - I can get). I figured if dealing with the screaming child didn't put my hair on my chest, perhaps some isopropyl alcohol will. </span></span><span class="fullpost"><br /><span style="font-family:georgia;font-size:85%;"></span><br /><span style="font-family:georgia;font-size:85%;">Either way, any more shifts like this and I think I'll start losing hair rather than growing any more. </span><br /><br /></span><span class="fullpost"></span>Vitum Medicinushttp://www.blogger.com/profile/09994320714669547787noreply@blogger.com4tag:blogger.com,1999:blog-29798185.post-25176495416621430882008-10-17T15:44:00.002-08:002008-10-17T16:21:02.147-08:00The call any med student in Emerg is waiting for: "There's been a massive accident."<span style="font-family:georgia;font-size:85%;">It was shaping up to be quite a boring shift. Only a couple hours to go, and nothing very interesting. There must have been a notice in the paper that the super keen medical student (myself) was going to be working a shift in Emerg, because there really could not have been any other explanation for the massive numbers of people showing up in droves with a chief complaint of "I have a runny nose."</span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><span style="font-family:georgia;font-size:85%;">Then suddenly the night got very interesting. Here's the play-by-play.</span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><span style="font-family:georgia;font-size:85%;">6:30 pm ::: </span><br /><span style="font-family:georgia;font-size:85%;">A call came in from ambulance dispatch, and the unit clerk quickly summoned the doctor and charge nurse to keep them informed: "There's been a <em><strong>massive car accident</strong></em> down in the valley. A minivan and a car carrying six people in total <strong><em>crashed into each other</em></strong> head-on, somehow got entangled to the point where they were attached, and then both went over the side of the bridge, <strong><em>careened down an embankment</em></strong>, ran into a few trees and then <strong><em>burst into flames</em></strong>. We're setting up for massive burns, tree trunk impalements, major trauma and who knows what else. The medevac helicopter will likely take out the most serious victims to the larger hospital in the next city over, so we'll likely get a few of the less severe tramas...but by the sounds of it, even those will be pretty serious. By the time they get them extracted and bring them in, they should be here in about 50 minutes."</span><span class="fullpost"><br /><span style="font-family:georgia;font-size:85%;"></span><br /><span style="font-family:georgia;font-size:85%;">6:40 pm :::</span><br /><span style="font-family:georgia;font-size:85%;">There is a buzz around the department. The night shift MD shows up to start what he had hoped would be another routine shift, and is instead informed about the upcoming chaos, with several curious other ER staff crowding around to hear the briefing. More reports have come in - the area is too heavily forested, meaning the helicopter can't land. <strong><em>All the traumas</em></strong> will be brought in by ambulance to our hospital!!</span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><span style="font-family:georgia;font-size:85%;">7:00 pm :::</span><br /><span style="font-family:georgia;font-size:85%;">The night resident has been paged to show up earlier, the afternoon shift MD (whose shift was just ending) made the decision to stay a bit later, and people are busy in the trauma bay setting up IV bags. The care aides and clerks are suddenly finding solutions to the longstanding province-wide 'no beds in the rest of the hospital' crisis, magically clearing up four beds in emerg in anticipation for the incoming carnage. I'm helping out a lot, too, I'm told, by going to see a patient who had a bookshelf fall on her head. And another runny nose.</span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><span style="font-family:georgia;font-size:85%;">7:10 pm :::</span><br /><span style="font-family:georgia;font-size:85%;">Another report comes in. The meat wagon won't be in with what's left of the survivors for yet another hour; it seems as though the army or search & rescue might have to be called in to access the area. There's even a suggestion that there might even be gunshot wounds if the drivers got into a road rage argument after the dust settled. In the meantime, my patient with the bookshelf falling on her head turned out to only end up having a textbook fall on her head, the rest of the shelf narrowly missing her body. Her friends were quite concerned, and brought her in. Oh, and she also wants me to assess her runny nose.</span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><span style="font-family:georgia;font-size:85%;">7:20 pm :::</span><br /><span style="font-family:georgia;font-size:85%;">The latest from the disaster zone is relayed to the physician: there is an indication that things may not be as serious as they were initially thought. Three of the people walked out of the accident unscathed, but the other three still seem to be pretty serious. No word on the accuracy of the gunshot rumour. For my patients, I continue to prescribe kleenex, one of the few things that I as a medical student can actually dole out, like it's nobody's business. </span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><span style="font-family:georgia;font-size:85%;">7:40 pm :::<br />Word arrives - the ambulances are on their way! One is coming Code 3 - lights and sirens - with the major trauma victim. The other two will follow, as they're coming routine, without lights and sirens, as their patients aren't too serious. The afternoon shift doctor figures that she may as well go home, since things aren't as bad as they first seemed.</span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><span style="font-family:georgia;font-size:85%;">8:00 pm :::</span><br /><span style="font-family:georgia;font-size:85%;">Things have somewhat died down, until the first ambulance is heard in the distance bringing in what must be the major trauma victim. A crowd of ER staff instantaneously gathers at the ambulance bay entrance to greet the incoming disaster. Notably absent from the crowd are the seasoned veterans among the emerg staff, and the doctors, who are going about their own jobs. </span><br /><span style="font-family:georgia;font-size:85%;"></span><br /><span style="font-family:georgia;font-size:85%;">8:05 pm :::</span><br /><span style="font-family:georgia;font-size:85%;">The ambulance has screeched to a halt, and the paramedics are throwing open the rear doors to reveal their mangled cargo. The crowd that gathered utters nearly an audible, collective groan of disappointment as the patient is wheeled out of the ambulance, sitting up on the stretcher, laughing and joking with the paramedic, without so much as a single indication of major burns, tree trunk impalements, or missing limbs or appendages. In fact, the patient has a makeshift splint on one of his legs, and other than that, appears to be completely well. The patient is deemed non-urgent, and the doctor sends me in to see him. He explains that the accident was pretty much a fender-bender that ended up with his car ramming the guardrail. And despite having what might have been a broken leg, he says that it doesn't hurt that much, and that actually the major thing bothering him right now is his runny nose. </span><br /></span>Vitum Medicinushttp://www.blogger.com/profile/09994320714669547787noreply@blogger.com8