Posts Tagged ‘hypothermia’

Team Building Experience, Past and Present

July 23, 2017

We played Two Truths and a Lie,

Then had sushi and beer bye and bye

From the end to the start

Team building’s an art

And none of our airplanes could fly.

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 began my second year of residency in Wyoming, the buzz words “Team Building Experience” had just started circulation. Who knows who decided tubing the North Platte would fill that function?  But nobody objected to the idea of leaving town for a day, driving an hour or two, renting truck inner tubes, and getting into a meandering river.

Whoever made the decision hadn’t looked realistically at the time involved. What should have lasted two hours at most turned into a six-hour struggle.  All of us, at one point or another, left the water carrying the tube, swearing never to get back in.  And all of us jumped back in the river.  We all had our reasons, but the most common one turned out to be the sound of rattlesnakes.

I can honestly say no one died, though most of us finished in the gentler stages of hypothermia.

The program wisely decided against further Team Building Exercises for the duration of my tenure. At various times different subgroups held bonding experiences involving large amounts of alcohol and no official sanction.

I don’t know when and if more Team Building Exercises happened.

The office here has Team Building Exercises twice yearly. The clinic closes and a locum takes over the ER.  This time vacations had a couple of the permanent docs absent, and, despite the temporary nature of my assignment, I got invited, too.

We started off with a couple of getting acquainted exercises; one of them called Two Truths and a Lie. We all wrote three sentences on a card, two true and one false.  The group had to figure out the author and to ferret out the lie.

I wrote, “My first college major was Music Theory and Composition. I was an Olympic hopeful in Archery.  I spent 4 nights in jail.”  More people believed I’d been a top athlete (false) than I’d been a composer (true).  But everyone found the idea I’d spent time behind bars plausible, and wanted to know why.  They couldn’t understand what Illegal Pedestrian meant.  I explained it was an archaic Kansas expression meaning Male with a Ponytail.

We went on to build airplanes using nothing other than 3 boxes of aluminum foil. We broke into pairs, sat back to back, and had one person describe a picture to the other person so as to reproduce it.

The last game involved trying to grab an unfolded red napkin from the back of the belt from as many others as possible. I decided to abstain more because of my back and ankles than my age.

After sushi and beer we sat around and chatted and relaxed, something we don’t get to do often.

At the end we thanked our office manager for putting together a great day.

It beat the heck out of inner tubes, rivers, and rattlesnakes.

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Mothering, fathering, and dead baby monkeys

May 30, 2013

When it comes to a pigtail macaque

With a maternal quality lack

Life expectancy’s brief

If you bring it to grief

And don’t let the mother come back.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  In May 2010, I left my position of 23 years, and honoring my non-compete clause, traveled for a year doing locum tenens work.  In June of 2011 I joined up with the Community Health Center, which provides care for the underserved.  I’m now working part-time, which, for a doctor, means 54 hours a week.

During my premedical years I held a lot of jobs, some of them pretty weird.  One had to do with death, grief, and infant pigtail macaque monkeys.

At that time, an investigational neuropsychiatrist worked with pigtail macaque monkeys at the University.  On an irregular basis, he needed unskilled but intelligent labor to work all night.

The project involved taking an infant monkey, implanting three EEG (brain wave) leads, three EKG (heart monitor) leads, leads to measure time, temperature and muscle activity in the eyes and the back of the neck.  Those leads would feed into a radio transmitter the size of a matchbook, implanted in the monkey’s abdomen.  The signal would be picked up by a receiver in the next room, and the information recorded as a polygraph (much like a lie detector)on a piece of paper a quarter-mile long; remember these events took place in the age before digital recording.

The nature of paper records makes them vulnerable to failure of pen and paper, thus the project would pay a grunt like me to monitor the equipment.  I found it a good time to study.

The experiment aimed to find out exactly how an infant dies of grief; one can induce grief in an infant monkey by taking it away from its mother.

I do not know what journal published the results; I know that personal involvement in the study brings information that doesn’t make it into the books.  And I don’t mean the time that the alpha male monkey broke through the one-way glass and set out to terrorize the building.

Not all the experimental subjects died: hypothermia in the middle of the night provided the mechanism of death for those baby macaques; if you look in psychiatric journals from the early 70’s you can find that result.  But you won’t find quality of mothering as a predictor of death, and it’s very counter-intuitive.

One would think that a bad mother’s baby would be happy the source of irritation went away and would bounce right back, but the experiments showed just the opposite.  The infants of the good mothers survived, those from bad mothers didn’t.  The investigator hypothesized that the bad mothers took up all the offspring’s energy trying to get attention, and loss of focal point made for more intense grief.

I think that good mothering gave babies better emotional resilience.

My father-in-law died two weeks ago, age 90.  The death came suddenly but not unexpectedly.  Easy to love wholeheartedly but difficult to get close to, he and my mother-in-law gave their three children a firm emotional foundation.

 

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!

Art and Architecture in rural Iowa: Bethany and I do American Gothic

December 19, 2010

There once was an artist, Grant Wood,

Who did that best that he could

    A house he did paint,

    With a couple so quaint

And the parodies all turn out good.

Bethany drove six hours from Sioux City this weekend, and yesterday I took her for a walk around town.  We heard a skittering cry from a large bird gliding above the Des Moines River.  We stood still to watch, it circled and wheeled and leisurely came to us, twenty feet up, a bald eagle, with snow-white head and tail.

Then we heard the helicopter. 

The sound of a helicopter in a small town usually bodes ill as the harbinger of significant injury or illness.  We strode up the hill to the hospital.

My colleague had the situation well under control.

We walked past the Manning Hotel, an historic structure dating to the era when goods moved by riverboat and horse. 

The Manning Hotel, Keosauqua, Iowa, on the banks of Des Moines River

The bridge over the Des Moines River here carries partitions for three types of traffic: the east lane for pedestrians, the center lanes for cars, and the west lane for horse-and-buggy (the Amish regularly cross the bridge).

This part of Iowa has wonderful architecture, with colonnaded porticoes and functional verandas on many houses.  Victorian-style gingerbread sits next to single- and double-wide trailers.  In Birmingham we found a trailer with a colonnaded portico.

Trailer with collonaded portico

On the way there we saw the sign proclaiming AMERICAN GOTHIC HOUSE 18 MILES.  Today, we made the drive.

Grant Wood’s painting, American Gothic, ranks second only to the Mona Lisa for number of parodies.  The house, I have been told, is the second most recognizable house in the country, after the White House.

That house still stands at the edge of Eldon, Iowa, less than a half hour from Keosauqua. 

The town itself looks like many other small towns but for the beautiful architecture.

The American Gothic House reminded us of the size of our first house in Casper, Wyoming, with less than nine hundred square feet.  The American Gothic House Center, on the other hand, stood large in the neighborhood, with a CLOSED sign in the front door.

Bethany at the American Gothic House Center. Eldon, Iowa. December 2010

Of course we had to make our own parody of Grant Wood’s famous painting, which rendered difficult the task of trying to look dour.  I had not a pitchfork nor a shovel to hold, Bethany observed, as she shivered and tried not to crack a smile. 

Steve and Bethany in front of the American Gothic house, Eldon, Iowa, December 19 2010

With the camera screwed onto the tripod, the self-timer did its job as hypothermia started to set in.

The famous house now shares the corner with a single-wide trailer; functioning agricultural buildings stand between it and the corn fields.  A trendy compact car nestles in back.

The American Gothic House and Mini-Cooper, Eldon, Iowa, Dec 19 2010

The recognizable icon stands but the times, as always, change.

On the road again, so soon: South Bend and Advanced Trauma Life Support

December 6, 2010

I drove all the way to South Bend

Through the snow and the dark I did wend

    I went out to learn

    About trauma and burn

And the latest emergency trend.

I took the Advanced Trauma Life Support (ATLS) course in South Bend, Indiana, this weekend.

The clinical staff of the hospital in Keosauqua, my latest locum tenens job, arranged for me to leave early Friday afternoon, and I kept ahead of the freezing rain, arriving in the dark and the snow.

I finished reading the 360 page book, as recommended, and I skimmed the information again once I got to the hotel.

Ten doctors and eight nurses attended the course.  One, a second-year surgical resident, had left call, driven four hours, and arrived in time to nap before the class started. 

I took the class in 1985, shortly after its inception, and I found a few changes in nuance.  Course doctrine demands keeping the patient from contracting hypothermia during the resuscitation.  Head trauma no longer requires steroid therapy.  Military Anti Shock Trousers (MAS pants), so important thirty years ago, later reviled, have made a small comeback, renamed Pneumatic Anti Shock Garment.  Diagnostic Peritoneal Lavage has almost disappeared, largely replaced by the Focused Abdominal Sonogram in Trauma (FAST).

Much has not changed.  Fluids for shock, needles for cardiac tamponade, chest tubes for blood or air outside the lungs; the first three priorities remain airway, breathing, and circulation.

Six hours of lectures the first day, followed by four hours of practicing skills on plastic dummies and reading x-rays.

The second day brought another six hours of lectures.  Then we worked with simulated patients, attractive young women with moulage wounds.

The author, foreground, with a person moulaged to simulate a patient involved in a bad car wreck.

One case scenario supposedly involved an eighteen-year-old meth addict sustaining three rifle shot wounds at close range after a bungled liquor store robbery.  I worried because I didn’t see exit wounds.  I handled the challenges OK, establishing a definitive airway first, moving onto a chest tube and arranging for transport to a trauma center.  At the end I saw the x-rays, derived from a real case.  Three retained bullets, to my practiced eye, obviously had exited the barrel of a handgun, not a rifle.  Realistically, few people with three rifle wounds will survive long enough to require medical care. 

I took the written test.  People don’t get into or out of medical school without being good test takers, but exam scores have little to do with real world ability to care for patients.

In the Indian Health Service, the ATLS course and the subsequent five-day “mini-residency” helped me save three people who encountered the undeniable physical realities consequent when flesh and bone try to occupy the same space as decelerating steel. 

I drove back to Keosauqua, in the southeast corner of Iowa, in the dark and the snow, hoping I would never have to use the skills I’d just learned.