Posts Tagged ‘stranger anxiety’

Teaching 3 things I didn’t learn in med school

February 26, 2019

The student might have thought I was mad

When I lit up an alcohol pad

And then used that fire

To heat up a wire

But then I made happy the sad.

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, western Nebraska and Canada. After 3 weeks’ vacation in Texas and Denver, I have returned to northern British Columbia.

Some of the docs here have decided to split weekend call so as to avoid working 72 continuous hours, a step I regard as so healthy that I volunteered for Saturday call last weekend. I had the chance to teach a medical student, Dyon, who intends to do a Family Practice residency.

All patients mentioned gave permission to write about their cases.

The first patient came in with a subungual hematoma, or blood clot under the finger or toe nail. A very painful problem, but one easy to cure by putting a hole into the nail.

The nurses couldn’t find the usual tool, an electrocautery, which looks like a disposable electric soldering iron.

I taped an unfolded paper clip to a tongue depressor with 3cm of wired extending past the end. In the absence of a Bunsen burner, I turned an alcohol pad into an alcohol lamp by tearing a corner from the foil packet and lighting it with the patient’s cigarette lighter.  The student, in his capacity as fireman, held the flame close at hand.  I kept the paper clip tip in the hottest part of the flame till it glowed, and applied it to the nail.  It sizzled nicely but cooled too quickly to go all the way through.  The first “alcohol lamp” burnt out before resolving the problem.  Then the patient volunteered to keep his lighter burning.  On the 3rd try, the glowing metal melted the nail, and close to half a teaspoon of dark red blood spurted free.  The patient, like most in his situation, had such relief that he started to chuckle, probably from endorphin rebound.

In short order we faced an 11-month-old, and another chance to teach. When babies, about 10 months old, distinguish family from non-family, they fear strangers.  While humans can see from birth, it takes till age 9 to fully organize the information coming from our eyes.  Thus, if you don’t make eye contact with a 10-month-old patient, you can examine the ears without force or trauma; they think if they can’t see you, then you can’t see them.  The trick worked on the 11-month-old.

About an hour after, an adolescent arrived with a toothache. Standard treatment consists of pills for pain and infection; in addition I showed the student, the patient, and the parent how to find the acupuncture point that the Chinese call Ho-Ku and that Western anatomists call the branching point of the superficial radial nerve.

For all three patients I got to show off knowledge acquired outside of medical school.

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