Archive for the ‘Being a doctor’ Category

At the end of another Arctic assignment

November 27, 2017

After the lessons not learned

And the good advice has been spurned

Sometimes slow, rarely quick,

People get sick,

I do my best though the bridges are burned.

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. I followed 3 years Community Health Center work with a return to traveling and adventures in temporary positions in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska. After 3 months in northern British Columbia, and a month of occasional shifts in northwest Iowa, I just finished a month in the Arctic.  Any identifiable patient information has been included with permission.

Aside from well child checks, perfect people do not come to see me. Most of my patients have made a lot of decisions they regret, and, whether they realize it or not, when the consequences add up they get ill.

In my years in Community Health I learned that schizophrenia, bipolar (formerly called manic-depression), and substance abuse overlap so much as to be indistinguishable.

Sometimes patients are difficult to talk to. Schizophrenia, for example, can rob the face of expression and make speech slow and monotonous; Parkinson’s disease can do the same thing.

Alcoholics, marijuana abusers, smokers, meth heads, and narcotics addicts get sick more often and more severely than those who lead orderly, substance-free lives. Leaving the start line with mental illness that hampers learning from experience gets compounded with substances that do the same thing.

I do my best to focus on my job: fixing what can be fixed and preventing what can be prevented. Bringing up a person’s past mistakes brings nothing good to a medical visit.

Every day I attend patients in desperate circumstances. I do my best to listen to what they say, and what they don’t say.

When I start to fall into the trap of judging people who have come to the inevitable consequences of reality avoidance, I remember the many mentally ill I’ve cared for who tried so hard to stop the voices in the heads. Because it’s easier not to judge if the person has a diagnosis.

I sit and talk to someone who has burned a lot of bridges, brain cells, and assets using recreational chemicals, and I do my best to tease out the story from a wandering narrative. I nod and look into the face of devastated youth and beauty.  I listen to speech patterns that some find annoying, and when the patient finishes talking I ask the right questions.

I do my best to get them to the correct medicine. Often the patient requests drugs that will make their problems worse, not better, and I explain the rationale for avoiding them.  Mostly they follow the logic, sometimes they don’t.

A lot of the people here have asked me if I’m staying. I don’t plan to, but I’d like to come back.

Inevitably, I don’t get along with some people.

But then, perfect people don’t come to see me.

 

 

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When is influenza Work Comp?

November 7, 2017

A recurring problem, I fear,

Is the flu I get every year

Am I a jerk

To say I got it at work?

I don’t want to be a pain in the rear.

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. I followed 3 years Community Health Center work with a return to traveling and adventures in temporary positions in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska. After 3 months in northern British Columbia, and a month of occasional shifts in northwest Iowa, I have returned to the Arctic.  Any identifiable patient information has been included with permission.

Friday I worked but not very hard. I saw more people off the schedule than on due to the number of no shows.  I attended as many people with respiratory problems as with bone-and-joint problems.  As the day wore on I felt, more and more, the aching from yesterday’s 3-hour walk on the ice-covered road leading out of town.  I resolved walk more.

After work Bethany met me in the hospital cafeteria for the weekly prime rib dinner. As Iowa beef snobs we rarely leave home to eat it.  We made an exception; it turned out to be very good, and my piece of meat came large enough to overwhelm.

But my cough, gradually improving over the last 8 weeks, came back stronger than ever on the short walk back to our apartment, and I realized that my tundra-seeing expedition couldn’t account for the ache in my upper back.

I started to shiver, my nose started to run, and my cough worsened. At 9:00 PM I called the Veteran’s Administration for permission to go to the local ER.

I spent 40 of my prepaid phone’s 200 minutes on hold.

My fever and aching worsened, I took Tylenol, I broke into a sweat and I felt better. Which I told the nurse when she answered.

The nurse had no concept of Alaska’s vastness.   She asked if I could get to the VA facility in Palmer, Wasilla, or Anchorage; I told her that I was a good deal closer to the Russian border than  to any of those places.

She knew more nursing than geography.

Eventually she advised fluids, rest, and Tylenol.

Every year I get the flu shot; it’s about 50% effective at preventing flu but it’s 90% effective at preventing death from the flu. And every year, I get the flu.

I got sicker on Saturday evening and went to the ER. I anticipated and got a flu test.

During the wait for results my chills cycled with sweats twice. I took my first oseltamivir (Tamiflu) pill before I left the ER.

But as I had signed in, the slip of paper wanted to know if the problem were work-related.

So many times in the last year I asked sufferers who sought my advice if they wanted the problem put onto Work Comp (or, in Canada, onto the WCB, Workman’s Compensation Board). The vast majority refused; some feared being fired in reprisal, some didn’t want to hassle Human Resources, and some felt their regular insurance would take care of things.

I have almost no social interaction outside the hospital, and I deal with the infected on a daily basis. Until now, I understood the perspective of the self-employed: fear the Work Comp insurance rates will go up.  This time, though, I stood in the shoes of the employed.  And I understood the hesitance.

I didn’t check YES or NO. I wrote, Let’s talk.

A Halloween parade seen from the ER

November 1, 2017

The children went trick-or-treat

While Anchorage was shut down with sleet

Thus diverting the flight

With the time growing tight

But the end was alright, it was sweet.

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. I followed 3 years Community Health Center work with a return to traveling and adventures in temporary positions in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska. After 3 months in northern British Columbia, and a month of occasional shifts in northwest Iowa, I have returned to the Arctic.  Any identifiable patient information has been included with permission.

I like to be flexible in my assignments. While I prefer to concentrate on outpatient work, I enjoy the intensity of inpatient.  And I’ll cover ER to keep things running smoothly.  So for the last two days I’ve worked the Emergency Room.

Of the three morning patients, one turned out a good deal sicker than anyone could have foreseen.

The nursing staff prepped for Halloween, scrounging odd props for impromptu costumes. We found a red rubber half ball manufactured with a valley down the flat side so that the proper pinch would keep it on the face as a clown nose; with the addition of a hood used for positive pressure in the event of severe respiratory contagion, it made for a really creepy visual.

The kids started showing up at 3:30PM in costume. The hospital distributed large sacks of candy to each department, and three distributors took their places at the end of a corridor, just outside the ER door, giving out miniature candy bars.

Inside the Emergency Room, while the costumed kids paraded past, severe illness worsened in front of our eyes and we dealt with the rippling waves of back stories of drama, irony, and dysfunction. I danced back and forth with increasing urgency as the notorious Alaska weather complicated the patient transfer, past distraction and into improvisation.

By 5:00 PM, when I went into the corridor to snag a bite of junk food, I found the nurse jauntily giving out the treats by the handful.

“I thought we were supposed to give out candy one at a time,” I said.

“I’m tired of this,” he said sotto voce, “I want to go back to work.” And he kept greeting the kids in costumes with laughter.

Just after 6:00 PM I hot-footed down to the cafeteria; the kids had finished trick-or-treating but the Halloween decorations remained on the doors and bits of black and orange crepe paper littered the floor. I got the last 4 pieces of fish and returned to the ER.

Missing food, sleep and human affection leads to burnout. Large paychecks cannot make up for the inability to eat a relaxed meal.  Bolting bites of fried cod between talking to patients did not give me a break but it kept me from impatience.

During one of my status checks I found the patient double thumbing her phone’s keyboard. “Have you put everything up on Facebook yet?” I asked.

“Oh. Yeah,” came the off-handed reply.

I finished at 8:30 PM, full of adrenaline. When I got back to the apartment, Bethany told me that the three foxes which live beneath the school hadn’t been relocated yet, thus the children missed recess. “I know,” I told her.  But I couldn’t tell her why.

 

 

A procedure I couldn’t talk the patient out of

October 29, 2017

I looked down at the big toe

To see how the nail did grow

It sure wasn’t right

And it hurt day and night

So I fixed it, but not for the dough.

 

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. I followed 3 years Community Health Center work with a return to traveling and adventures in temporary positions in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska. After 3 months in northern British Columbia, and a month of occasional shifts in northwest Iowa, I have returned to the Arctic.  Any identifiable patient information has been included with permission.

Medical school and residency merely start the process of lifelong learning required of my profession.

In residency, I saw one ingrown toenail removal before I did three under supervision. In the Indian Health Service, a podiatrist said, “This is the procedure that’s going to put your kids through college!” and gave me some tips on speed.  In the 90’s I did quite a few, but by the time the century turned, despite a large financial motivation to the contrary, I figured out how to get the patient taken care of without shedding blood.  A bit of cotton, an orange stick (a wood implement widely used to rearrange cuticles) and a bit of povidone dione (marketed most commonly as Betadine), with patience and about a week, can usually move the flesh away from the nail a millimeter a day.

Over the summer, researching the problem while in Canada, I came across the concept of a nail spreader, which can flatten out a curved nail over the course of several months.

But the patient yesterday (who gave permission to write more than I have) had already tried everything I had to offer, yet the problem persisted.  And I couldn’t talk  the patient out of the procedure.

Finding the right equipment takes up more than half the time of an office surgery when neither the physician nor the nurse knows where anything is.

I got trained to not only take out the nail plate, but scrape away germinal matrix (the tissue that makes the nail) down to the bone with an instrument called a curette, then apply a chemical, phenol, so destructive to human tissue that the nail would, hopefully, never grow back.

We had no curette, and no phenol, and I didn’t mind: less work for me and a good deal less blood loss.  At the end, I used a stick coated with silver nitrate to burn the heaped-up inflammatory tissue growing over the nail.

During the procedure we talked about high school sports (very important in small-town America) and music while outside, the gentle snow fell.

Contentment and birthday pizza

August 13, 2017

At the end of a beautiful day,

We caught the sun’s reddened ray

We snacked on raspberries,

Pizza and cherries

And then we went on our way.

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I went back to traveling and adventures in temporary positions. Assignments in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska have followed.  I finished my most recent assignment in Clarinda on May 18.  Right now I’m in northern British Columbia, getting a first-hand look at the Canadian system. Any identifiable patient information has been included with permission.

Different organizations have different ways of celebrating birthdays. During my New Mexico years, I got used to bringing food for the clinic when I marked a change in age.  I continued the habit into private practice and Community health.  Mostly, I had Bethany pick out a good selection from Panera.

One of my colleagues ticked just a little closer to 40 last week, and a selection of cupcakes appeared in the clinic. And, at the last-minute, he and his wife put together a pizza-based gathering after work.

Bethany and I drove out to his house at the outskirts of town. He has had black bear, grizzly bear, deer, moose, wolves, and caribou in his back yard.  But on this particular evening we contented ourselves with stories of close wildlife encounters.

The docs drove up, one by one. Before the noise disrupted conversation, I showed off my trick of sharpening knives on the back of a ceramic plate.  Till the pizza arrived, we snacked on chips, and sweet cherries freshly picked in southern British Columbia.

We ate the pizza at leisure. I’ve written in the past about how doctors tend to bolt their food because we never know when we’re going to get called away.  These physicians know how to work hard but more than that they know how not to overwork.  We enjoyed our food.  We chatted.  Topics included economics, politics, horticulture, wildlife, and medicine.  We recounted various places we’d been.  Perhaps because of my country of origin, we had some lively history discussions, fortunately none of them mentioned the Fenian raids, where renegade Americans tried to invade Canada shortly after the Civil War.

The day waned, and I relaxed. Forest fire smoke takes the clarity from the air but it makes spectacular sunsets.  In this case, the solar disc reddened well above the horizon, while cool evening breezes mixed in with the heat of the day.  I reclined after a good day at the clinic and in the late stages of a great summer.  I had worked but not too hard, I had eaten but not too much.  I had chatted knowledgeably but without pedantry.  I had sharpened the knives, but no one cut themselves.

I wallowed in contentment, thoroughly in the moment.

After a bit we toured the grounds. We picked raspberries and ate them immediately.  We saw the Saskatoon berry bush, trampled by the visiting bear.  I looked for the peach tree I had seen earlier.

And when the mosquitos came out, we said good night.

 

 

Patient Transfer and Push-back

August 12, 2017

The specialist just needed a chance

To vent his frustration and rants

Just as expected,

The referral’s accepted

Sorta what I thought in advance.

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I went back to traveling and adventures in temporary positions. Assignments in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska have followed.  I finished my most recent assignment in Clarinda on May 18.  Right now I’m in northern British Columbia, getting a first-hand look at the Canadian system. Any identifiable patient information has been included with permission.

I listen to the subspecialist’s voice on the phone, and I can hear the overwork through the bluster, asking me what I think he can do for the patient that I can’t.

The local term for what he is giving me is “push-back.”

I got a lot of it from Alaska Native Medical Center (ANMC) in Anchorage when I would try to transfer a patient. Even before I would pick up the phone, I knew I’d be attempting to enlist the cooperation of a physician close to burnout, with a service already bursting at the seams, analogous to pouring gallons into quarts.

In another century, in another country, I faced push-back from every rung of the hierarchic ladder at the academic hospital, when I had to ship out a patient with Reye’s syndrome. With vomiting, altered mental status and a swollen liver, I had made the diagnosis in less than a minute, and spent two hours proving it with lab, while late evening ticked into early morning. The medical student, intern, and resident all tried to block the transfer, but passed my call up the food chain.  The presentation to the chief resident, polished by the first three layers, included answers to the questions posed by the underlings in a coherent, rapid fire fashion.  In the silence of a 3 second pause I could hear something in him break, a resignation to the inevitable, and then he said, “Well, I supposed I’m going to have to accept the transfer.”

(I’ve not seen a case of Reye’s syndrome before or since; it disappeared when we stopped giving children aspirin. That particular patient recovered completely.)

I never ran into push-back in New Zealand. The physicians at the university hospital sounded fresh and cheerful every time I called.  But they have a different system; following the online flowchart weeded out the majority of unnecessary calls.

Today I catch the subspecialist in at the university hospital fresh, in the middle of the afternoon.  He fires off a list of questions, interspersed with complaints of thinly spread resources.  When he pauses, I confess I use a whiff of sarcasm when I say, “Would you like me to answer, or would you like to keep going?”

I figured out, early in my private practice years, that I spent more time and energy trying to avoid work than actually doing it, and I quit pushing back the ER docs when they called me to admit a doctorless patient. Because I built up good will, about every 7 years, when I really needed to, I could dodge an admission.

Between my sarcasm and the chance to rant uninterrupted, the subspecialist loses momentum, and in the silence over the phone, I can hear something break. Resignation replaces resentment when he accepts the admission.

I later learn he has a reputation as a good, caring, skillful physician in a badly understaffed situation.

I feel for him. I hope he doesn’t burn out.

A very long taxi ride back

July 26, 2017

The day sure started out slow

It went fine, but wouldn’t you know

To make the trip back

I caught a ride in a hack

And the driver made satisfactory dough.

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I went back to traveling and adventures in temporary positions. Assignments in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska have followed.  I finished my most recent assignment in Clarinda on May 18.  Right now I’m in northern British Columbia, getting a first-hand look at the Canadian system. Any identifiable patient information has been included with permission.

The day on call went smooth and slow to start, with fine, solid naps in the morning and afternoon, caring for 5 patients. On the brink of leaving for the day on time, I knew I had to stay when the ambulance radioed in news of two injuries from the highway.

I have to confess my ambivalence when it comes to airbags. Front airbags don’t add much safety to modern seatbelts, too often they activate when they shouldn’t.  Side airbags, on the other hand, provide another layer of protection that saves lives.

I have never before attended survivors of crashes where airbags deployed. I developed the term “bag rash” to denote an abrasion from the airbag, and the patient gave me permission to write about it (and more).

Right when most people would sit down to dinner, the ambulance brought in another patient with problems exceeding our hospital’s capacities; in fact, requiring trained escort for the trip to Prince George.

The responsibility fell to me because nursing staff could not be spared from the hospital.

The back of the ambulance amplifies a road’s imperfections. I did my best to meditate through my nausea as we sped down the highway.

We stopped at the EMS station at the halfway point. Not all stretchers (in EMS-speak, carts) can lock securely in all ambulances (EMS-speak, cars).  I can’t detail here the complications that demanded a change of ambulances and crews, but I got to stretch my legs and breathe in the cool pure air, and ride in a much more comfortable seat.

I turned the patient over to the ER doctor, we volleyed a bit of French, and then I had to confess to the staff I’m not really Canadian. I have been working on my accent, after all, and I don’t obviously sound like an American at this point.

Then I called a taxi: the ambulance that met us would only go back as far as the halfway point.

A very long time ago, my pre-med biology lab partner drove cab, I rode with her a couple of times. She clued me into the details of the business.  In the States, the cab company rents cars to drivers.  The drivers don’t start making money till they’ve made up the fee, and some shifts they don’t make any money at all.  Bidding on the best cabs goes by seniority, and the new drivers (at that time) drove uncomfortable, unsafe vehicles.

As we rode, I interviewed the driver, just like I interview patients. He speaks fluent Punjabi and Hindi and a bits of Tagalog and Mandarin, but has forgotten the French required of all students in Canadian schools.  His English carried a perfect northern British Columbia accent, but I found out he’d been born in India and at age 10 moved to the very town we were headed to.  As the daylight faded into twilight, and as the long northern twilight deepened to dark, I listened.  He worked in the pulp and paper business till age 55 and started driving cab a couple of years later.  He doesn’t rent the hack from the owner; he keeps 45% of his fares.  He makes good money in the winter, but not in the summers.

We came into town in the darkness, talking about aurora borealis. He pointed out places from his youth, but had to be directed to the new hospital.  He showed me where the movie theater used to be.  They changed the films three times a week, he said, and he went to all the movies, and that’s where he’d learned English.

When he dropped me off at the hospital, I looked at the fare on the meter, and I was glad that the trip had been worth his while.

I dropped the unused morphine and the crash bag at the nurse’s station and walked back to the hotel. I hoped for a glimpse of Northern Lights in the moonless sky, but the clouds hid the stars.

 

The diversion of patients because of forest fires

July 12, 2017

The forest, it seems, is on fire.

And the wait can sure make me tire

When our referral facility

Has maxed capability

And my patients have problems most dire.

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I went back to traveling and adventures in temporary positions. Assignments in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska have followed.  I finished my most recent assignment in Clarinda on May 18.  Right now I’m in northern British Columbia, getting a first-hand look at the Canadian system. Any identifiable patient information has been included with permission.

As I write this, 183 wildfires rampage through the wilds of British Columbia. The smell of wood smoke permeates the air and a haze hangs over the nearby mountains.

We have been lucky during this last week of fires, with 3 days of solid, soaking rain. But with complex topography comes complex weather patterns, and nearby valleys have had no precipitation at all.

Yesterday I had call. I took care of people with problems in their skins, bones, throats, lungs, hearts, eyes, abdomens, fingers, toes, brains, ears, and genitals.  Two came in close together, with problems exceeding our facility’s capability.  I ordered blood work; I like to sound prepared when I speak to a doc in a referral center.  Then I waited.

And waited. When I got results back, I called the hospital in Prince George to speak to a couple of consultants and to formulate a plan, then I had the central ambulance dispatching service called.

Theoretically, the dispatch centralization makes sense; practically, however, it means a terrible delay in getting patients into the ambulance.

I had hoped to send both patients in the same vehicle to Prince George, but in the course of making arrangements I found out that the number of injuries coming in out of the forest fire had overwhelmed the schedule for sophisticated diagnostic tools, and couldn’t I please send the second patient to Dawson Creek?

It meant a longer delay for the second patient, but I agreed, and called the ER there with a bizarre, creepy history perfect for the opening of a horror movie.

Of course, in the hours between the arrival of those two patients and their departure, other patients came in for treatment.

At six I walked to the hotel to eat supper with Bethany. I had been continuously occupied for the previous 10 hours.  I wolfed my food, napped briefly, and walked back to the ER.

I started in on documentation, typing directly into the Electronic Medical Record. I continued between the patients who kept trickling in.  I ran into a surprising number of patients with back pain who adamantly spoke against narcotics (and I agreed with them).

I finished at ten, and returned to the hotel. I had attended 21 patients.  The emotional fatigue of waiting to transport those two critical patients far exceeded the physical tiredness.

And then I had no calls for the rest of the night.

Dislocated thumbs and warmth in the ER

June 24, 2017

To the ER the injuries come,

So I just took hold of the thumb

Yes, dislocated

But a technique underrated

Includes no drugs to make the hand numb

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I went back to traveling and adventures in temporary positions. Assignments in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska have followed.  I finished my most recent assignment in Clarinda on May 18.  Right now I’m in northern British Columbia, getting a first-hand look at the Canadian system. Any identifiable patient information has been included with permission.

Over the years I’ve learned at least 8 different ways to put a dislocated shoulder back into place (medicalese: reduce the subluxation).   My favorite remains the one I learned in the parking lot of the hospital on my last day of residency.  I met one of the emergency docs coming in as I was going out for the last time.  He told me he’d learned the technique that involved no drugs, bandages, tape, buckets of sand, or force, and he showed it to me.  I use it to this day.

It failed only once, when in another clinic in another city a very muscular young man suffered a dislocated shoulder in the course of an electrical injury.

Last night, on call, for the first time in my career I faced a patient with a dislocated thumb (the patient gave permission to include a good deal more information than I have). I looked at the x-ray, I reviewed the anatomy, and put together a plan.  But I’d never done one before so I felt I should at least speak with someone with more experience before I tried it.  I put out a call to a consultant orthopedist and I waited.

And I waited.

One of my colleagues who had done several of the procedures, just back from an ambulance run came striding through. I told him the plan, and he gave me the nod.

I had the patient give me the thumbs up sign. I grasped the digit, and we started to chat.  As the patient relaxed, I took the weight of the hand, and, eventually, the arm.  After 5 minutes, supporting the forearm with my other hand, I let go.  Using patience and gravity, the thumb had slid back into place, with no drugs, no violence, and no clunk.

Just the way I like it.

_*_*_*

Injured people rarely come into the ER alone. Some of my patients have problems so difficult to look at that you wouldn’t see them in a horror movie.   The visual impact can jar friends and relatives into free displays of affection.  But during a recent night on call, I witnessed a kiss so astounding that the warmth flooded the ER and so memorable I had to comment on it.  I kept doing what I had to do, thinking all the while that so much love must make a difference in the healing process.

 

An ambulance ride to town and back

June 22, 2017

The patient gave us a scare
We did as much as we dare
A long ways we did ride
While it was raining outside
And I spotted a young dead black bear.

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I went back to traveling and adventures in temporary positions. Assignments in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska have followed. I finished my most recent assignment in Clarinda on May 18. Right now I’m in northern British Columbia, getting a first-hand look at the Canadian system. Any identifiable patient information has been included with permission.

I ride in the back of the ambulance with the patient, a nurse, and an EMT.
I can’t talk about the patient or the patient’s problem, except to say its seriousness demanded the presence of a doctor and a nurse on the ambulance.
Sending both of us put a significant crimp on the healthcare manpower of the town, as well as leaving the municipality without ambulance coverage.
I have ridden in ambulances before, but during the last century. Common IV pumps remained a dream then, and I adjusted the IV drip rate using my wrist watch. Ambulances ran a lower profile at the time, and I couldn’t stand up while we rode; nor did I have a seat belt.
I got little precious sleep in the wind-up to this transfer, and we left in the rain while the beginnings of daylight brought color to the world.
Between the bumps in the road, the need for speed, and my position sitting sideways, after 40 minutes I begin to fear meditation failure ending in vomit, and I request a basin. The nurse, a woman of immense and invaluable experience, knows exactly where to reach for it.
I see nothing of the beautiful landscape as we proceed. Mostly I keep my eyes closed and my breathing deep and slow while I imagine worst-case scenarios, and how I would proceed if they happened.
Three times the nurse asks for permission to medicate the patient, and I consent. We keep our eyes on the instrument that measures blood oxygenation, blood pressure, pulse, and breathing rate.
A few miles out of the city the road acquires more lanes and divides, and the traffic picks up. The change in siren pattern tells me when we blast through intersections.
Ten minutes from the University hospital I look at the patient and the word “deterioration” springs to mind. But when we wheel into the brightly-lit, well-staffed, fully-equipped Emergency Room I know that we’ve done our job.
Just before we depart, one of the EMTs gets a call to transport a patient from the city back to their outlying hospital. In the time it takes to ready the next patient, we decide to go to breakfast, and the choice is easy: Tim Horton’s.
“Timmy’s,” as the Canadians call it, with higher quality than McDonald’s, not quite as fancy as Perkins, has outlets across Canada. I’d think they’d want to invade the US.
We drive a few blocks in traffic denser than anything I’ve seen for weeks. We park in a position of dubious legality, knowing ambulances never get parking tickets. The four of us stand in line, a little too polite to walk up to order. But at the end we walk out with our food, past a rapidly growing line. I carry a cookie and a yogurt parfait, hoping the way back will go smoother.
We pick up the new patient, the transport does not justify lights and sirens. I get to ride in the front.
On the way back I learn about the pulp industry, how ambulance services get billed, how EMT shifts get arranged, and some of the history of the town. I comment that although I see signs cautioning wildlife corridor I don’t see dead animals on the side of the road.
The EMT explains that Animal Control removes the carcasses quickly, so that local predators don’t hang out on the pavement and cause more problems.
And, just like that, we pass a road-kill bear.