Posts Tagged ‘cell phone’

A drunk with a cut

May 19, 2011

The laceration was open then shut.

Quiet? It was anything but.

     To sew up a drunk

    Took a two-hour chunk

But it was really quite a large cut.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  On sabbatical to dance back from the brink of burnout, while my one-year non-compete clause ticks off, I’m having adventures and working in out-of-the-way experiences.  Right now I’m living in Amberley and working in Waikari, within an hour of Christchurch in New Zealand’s South Island.

I had call last night, taking the four bags of resuscitation equipment in the clinic car.

At bedtime, I checked the two beepers and the three cell phones. Then I told myself, lying, that I wasn’t on call. I slept marvelously for two hours.

The beeper went off about 12:30AM.

The first problem I faced was not knowing which beeper went off, the second was trying to figure the beeper out. Eventually, I got the info from the parasitic collection of semiconductors and realized that I didn’t know what to do with the terse codes and abbreviations, followed by an address in a municipality I didn’t recognize.

I hate waking doctors in the middle of the night, especially when they’re not on call, but I had to phone my back-up.
He received the call graciously, and told me whom to ring.

By this time Bethany was wide awake.

With the full moon light streaming in the bedroom window, I explained to the dispatcher that I didn’t understand the system. She asked for my phone number. I realized I didn’t know it.  I heard her clicking keys in the background, and then she agreed to call me back

Ten minutes later I talked to the ambulance crew.

The problem involved a drunk and a laceration, and a ten minute ambulance ride.

Back home, I’ve figured out a system to slip out of the house with minimal family disturbance when I get called out in the middle of the night; here I still stumble around with the lights on.

The ambulance beat me to the clinic.

Having the key to the clinic and the code to the alarm system doesn’t mean I know where to find the key pad or light switches or how to actually disarm the system. I triggered the alarm, a deafening experience.  My ears are still ringing.

The St John ambulance crew, marvels of professionalism, kept the intoxicated patient calm.  I eventually found everything I needed.  I anesthetized and scrubbed the 7 cm (3 inch) gash and stitched it back together. 

After the laceration, the EMT’s worked with the patient to figure out disposition (not an easy task) while I wrote a note to the receptionists about billing and filling out the ACC45 form. 

I enjoyed driving through the sleeping town in the full moonlight, alone with my thoughts.

I got back to the flat two hours after I left, to find Bethany sleeping soundly.

I did my best in the moonlight not to need to turn on the light.  I dropped one of the beepers in the dark, discovering that I couldn’t really handle five pieces of electronics without pockets. 

I arranged them on the bedside table.  I could lie to myself again about my on-call status only because I trusted the multiple layer redundancy of my communications equipment.

I slept deep till the alarm went off.

Two beepers, three phones: first night on call in Amberley

May 12, 2011

These days, the bag isn’t black,

Not one, they are four, each a pack.

      You can’t carry them far

     Unless you’ve a car

And for beepers there’s never a lack 

Synopsis: I’m a family practitioner from Sioux City, Iowa.  On sabbatical to dance from the brink of burnout, while my one-year non-compete clause ticks away I’m having adventures and working in out-of-the-way places.  Right now I’m on assignment in Waikari, a rural area in New Zealand’s North Island, an hour outside of Christchurch.

I took my first night on call. As I left the clinic in Waikari the nurse handed me four backpacks of medical equipment: one each with oxygen, resuscitation equipment, resuscitation medications, and immobilization devices like cervical collars.
My father, a physician, carried a black bag everywhere, even on vacation, and we, the children, couldn’t understand why he would do such a thing. I understand why now, and with greater understanding comes an adult’s disagreement.  A vacation needs to be a vacation, a time to rest and let go of vigilance.

An article 105 years ago in the Journal of the American Medical Association detailed what a doctor should carry so that lives could be saved outside of hospital.

The black bag has morphed into the 21st century in New Zealand.  The internal combustion engine assures the doctor that a hundred pounds of gear stays available. What would have passed for dead on the spot a hundred years ago has become salvageable.
In the US, doctors don’t get on-site trauma training. Few would go to the scene of an accident or tragedy.  Almost none make house calls, and the black bag remains a relic of the past.

Here, an on call doctor might respond to the site of a cardiac arrest or massive trauma car collision.

I made a house call in New Zealand for a post-op Maori patient.  Manicured grounds surrounded a well-maintained home down a long driveway.  (Most Kiwis take better care of their yards most Americans, and the homes, for the most part, are neater.)  I brought a stethoscope, but all I needed was good clinical judgement and compassion.

I arrived home today with two beepers clipped to my belt, one for each geographic district that I covered, and the clinic cell phone in addition to my NZ cell phone (still undependable) along with my American Droid. 

I haven’t carried a beeper for a year.  In Alaska the hospital provided a wonderfully reliable cell phone; in Keosauqua my cell phone coupled with my apartment land line served well.  With no call in Grand Island, I didn’t need any sort of after-hours communication. 

Yet I clipped the two hip-sucking parasites on my belt, and, as if they had never left, they felt right at home.  I shuddered.

With my five pieces of electronics and Bethany’s two, we went out to supper, and just as we walked up to the restaurant, my clinic cell phone rang.

I gave instruction about stopping bleeding from a cut that didn’t require stitches. 

I have discovered that the secret for sleeping well when on call consists of convincing yourself you’re not on call.  I looked at my quintuple-redundancy electronics and lied to myself, but I still had a faint niggle at the back of my mind.  Self-deception prevailed for six hours of sound sleep but not for all eight.  I received no calls.

I gave over the beepers in the morning, and as soon as I got to the clinic I gave up the extra cell phone.

A blizzard shuts down the hospital

February 23, 2011

Was ever a walker so bold

As to go out into the cold

     Only a wizard

     Could get through this blizzard

And the hospital got put onto hold.

 

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  Avoiding burnout, I’m taking a sabbatical while my one-year non-compete clause winds down, having adventures, visiting family and friends, and working in out-of-the-way places.  Currently I’m on assignment at the hospital in Barrow, Alaska, the northernmost point in the United States.

 

The author, outside in a whiteout

 

Winds howled around the hospital loud enough last night to interfere with slumber.  My Care Initiatives Hospice meeting took place behind schedule because I had overslept.  Skype failed to pick up the nuances of blizzard sounds while we talked.

Bethany walked to her job at the school, about two kilometers away. 

“You’re sure you want to do that?” I asked.

“I’ve got my phone,” she said.  “Worst comes to worst I’ll call a cab.”

Taxis are part of Barrow.  They are quick and cheap.

After she left I started trying to use my cell phone and found I had no service, and no way to call her.

At morning conference we talked about the weather and how it makes medicine in Barrow unique; we can’t do what we can’t do and we don’t have what we don’t have.  For a complex litany of reasons we’ll not be able to do transfusions outside of absolute life-and-death situations until a plane can land with certain vital supplies.

Planes won’t be able to land until the forty mph winds die down.

Bethany called.  She had gotten to school safely, arriving at 730.  Promptly at 735 the administration closed school.  Nonetheless, she said, she had work till 230.  When I rang off I recounted her morning’s exploits; she drew a round of applause.

Though we discuss matters of vast importance, though we may disagree about things, the mood of the meeting stays lighthearted. 

At the Clinic Formerly Known As Mine, we called snow “patient repellant.”  We never got mad at those who didn’t come in during bad weather, we looked forward to a more relaxed schedule.  With a blizzard raging, only one of my scheduled patients showed up.

I used the time to phone other patients about lab work.

Lunch passed leisurely; the snowstorm occupied the conversation.  I learned (in Spanish) that the current storm won’t break for three days.

After lunch, two patients showed despite KBRW’s announcement that the hospital had closed.  Most of us just stood around and chatted.

Bethany called; with school closed she’d gotten a ride to within three blocks.  Safe and warm inside an apartment house, she was considering walking home.  I told her to stay put or get a ride.

Two nurses came in, looking cold, wet, and frightened.  They left early, their truck stuck fast in a drift, and they’d had to call 911.  In the process of walking from the truck to the police they’d gotten wet.  One, on the verge of tears, started to shiver.   I put her on the phone to Bethany as a warning to not try to brave the elements. 

We cut the conversation short when we recognized hypothermia.  As we swarmed around her with towels and warmed blankets, the hospital PA system announced all those not living on hospital grounds needed to report immediately to Medical Staff Administration.  Those employees will form up into a caravan to make sure everyone arrives home safely, even if their vehicles don’t.

 I took these pictures from our apartment window:

Visibility going once...

 

Visibility going twice...

 

Gone!

And…Gone!

Friends and colleagues, it’s good to be back home

January 3, 2011

I’m home, getting ready to go,

Running into the folks that I know

     I ran into a doc,

     No slave to the clock,

And I talked to a cellular pro.

I received warm greetings and hugs when I stopped into St. Luke’s doctors’ lounge today. 

If more of my colleagues heeded my warnings about cutting back schedules, working reasonable hours, and avoiding early burnout and death, we clearly wouldn’t have enough doctors.   One doc I spoke with has visions of doing locum tenens work, and I told him to call me for concrete advice when he decides to actually make the move.  I have a lot of things to say about how to tell a good recruiter from a bad recruiter.

A doctor who has avoided overwork and I talked about our professional enthusiasm.

Nobody I spoke with can sleep restfully when on call, but all downplayed the price we pay for vigilance. 

Many of the doctors expressed surprised when I talked about looking forward to doing inpatient work.  Some questioned my sanity. 

But one, whose wisdom I value, reminded me that some of our finest moments as physicians have been between midnight and six in the morning, helping families and individuals through difficult transitions.  Those times bring deep professional fulfillment and little reimbursement.  He understands my position.

Many docs remembered I’d been in Alaska.  I answered a lot of questions about Barrow, the North Slope, Inuit culture, and cold weather.

I didn’t get a chance to talk about my new insulated Carhartt Arctic Extreme bib overalls.

I signed medical records dating back to before my job transition.  I had conscientiously tried to clear out all my hospital medical records back in May, but apparently some fell through the cracks.  Or got pushed.

In the parking lot I talked with a colleague who knows me well.  I gushed about my experiences, and told about the recruiter from South Australia who offered a huge sum for 36 weeks work.  The idea of doing two weeks at a time appealed to me, I said, and paused.  She said, “But you’d miss your garden.  And your cherry trees.”

“Boy, do you know me,” I said.

In the afternoon Bethany and I went to a cellular phone business; we count the owners as friends.  We’ve gotten great service there over the years.  I’ve decided I need a smart phone.

I adopt new technology slowly, and I tend to use an instrument until it wears out or otherwise loses its usefulness.  Decades ago I bought the Franklin Pocket PDR and replaced the platform once.  When the manufacturer rendered that digital book obsolete, I bought a Palm and loaded Epocrates, an updatable drug database.  That Palm rode on my hip for seven years, functioning reliably till it expired forever, sending me to scramble for an updated Palm TX, which now resets every time I try to open my most-used application. A smart phone can consolidate two instruments into one.

We also changed our phone plan, signing up for more liberal texting rates, but I fear I’ll start getting tons of frivolous messages that will interfere with patient care.

In the grocery store we saw friends in the produce section and patients in dairy. 

It feels good to be back.  I’m treasuring the weeks I have before I set out again.

Mennonites and CT scans

December 14, 2010

For the patient, here is the plan

Forget the equivocal scan

     I don’t need much urgin’

     To call up the surgeon

With the results of the tests that we ran

SYNOPSIS:  I’m a Family Physician from Sioux City, Iowa, making a career transition to avoid burnout.  While my one-year non-compete clause ticks off I’m traveling, doing locum tenens, and having adventures.  Right now I’m working at Van Buren County Hospital in southeast Iowa, where there are no stop lights or fast food.

I’m on call in Keosauqua, Iowa, where the mid-level providers (Physician’s Assistants and Nurse Practitioners) take first ER call, and the MD or DO provides back-up and more definitive care. 

The day till now has run on a low stress level.  As with any other day I care for patients, I came across a physical finding I’d never seen before, a soft lump where I should find hard bone.  The MRI machine comes in a trailer tomorrow and will give me an answer.

I hesitate more about ordering MRIs now than I did when I owned a part-share in a scanner, but I seem to order the same number.  I’m likely to fill out the paperwork and jump through the insurance company hoops when back pain goes down the leg and doesn’t get better, when mysterious physical findings can’t be denied, or when the patient worsens.  I find a lot of occult fractures, that is, broken bones that didn’t show on x-ray.

I remember patients I sent for MRI when I had profit motive to do so; scans showed problems malignant and benign, and surgeons prolonged or saved lives.

Keosauqua has growing Amish and Mennonite populations.  They call us English even if we aren’t English, we call them Pennsylvania Dutch even if they don’t live in Pennsylvania and they aren’t Dutch.  Their economic basis depends on subsistence farming; their agricultural methods qualify for the trendy buzzword sustainable.  I haven’t seen horse-drawn vehicles on the roads here but I have seen traditionally dressed people at the café and in the hospital waiting room.

A call comes from the ER for me to evaluate a Mennonite patient.  I find the family straightforward, respectful, and friendly.  I’ve seen the problem at hand hundreds of times.  The CT scan, ordered before I saw the patient, comes back equivocal, but my exam makes a firm diagnosis requiring a surgeon.

Our surgeon and I have come to similar places in our careers: we want to work but we want to slow down.  His solution to the full-time-means-eighty-hours problem led him to work two weeks out of four, while I intend to go to a forty-hour week when I get back to Sioux City. 

Thus, the patient arrives while our hospital’s surgeon is en route to Florida.

I admit my surprise when the matriarch pulls a cell phone from her skirt pocket.  You should have been there.  The family requests a surgeon across the state line in Missouri.

I make the call requesting a transfer, speaking to the surgeon herself.  My presentation of the patient comes off smooth and articulate.  

The family drives into the night, subsistence farmers with hard copies of lab results and a CD copy of the CT scan.

Contrast is the essence of meaning.