Don't Mess with the Choos

Gentlemen, if you get into an argument with your girlfriend and things get out of hand, do NOT deface her Jimmy Choos with permanent marker. She will smash your laptop and then use a jagged piece of the wreckage to try to cut you. She will succeed, it will not pretty and you will not be happy.

The Five Stages of Grief

A wonderful teaching and learning tool. Enjoy!

Health Teaching Gems

In a recent shift, I met a young man who had a few questions about the transmission and pathology behind influenza. Since it was a quiet lull in my day, I relished the opportunity to flex my teaching muscles and started by asking him to describe what he knew so I could proceed from there. He knew that he should wash his hands and cover his mouth when sneezing or coughing but he did not know how that prevented flu’s spread. The conversation eventually led to me explaining how the virus essentially hijacks cellular machinery to assemble millions of copies that burst out of the cell thereby destroying it. He became slightly confused and in order to clarify the concept, I asked him to imagine an overcrowded place in which people are pushing to get out. Lost deep in thought, he stared at the wall behind me before his eyes lit up and he triumphantly announced, “the virus bursts out of the cell like hookers from a cake!” Flabbergasted at such a crude, yet visually effective analogy, I had no choice but to enthusiastically agree!

Diagnosis Wenckebach

Bad Idea

The economy is bad. We’re hearing doom and gloom reports all over the news. People are losing their jobs and youth employment is steadily decreasing. Nonetheless, if you’re a 20 year old man-boy, you should not let your friends pay you $10 per shot to let them shoot your leg with a BB gun. Even if you made $300 from this fine entrepreneurial endeavour, the resulting cellulitis, abscess drainages and time needed to adequately heal is worth far more than the cash acquired (which was quickly exchanged for beer and cigarettes). Also, if you want even a measure of feigned compassion from me, you cannot tell me to hurry my ‘sweet ass over with some food’. That makes me want to replace your morphine with bleach and your antibiotics with C. diff diarrhea samples.

Meow

Sometime during the last of Christmas holidays, I took care of a patient who was an elderly homeless man. He came in complaining of recurrent dizziness and frostbite to his toes. When I went to greet him, he seemed very worried and held onto his coat as tightly as he could. I tried to reassure him that his belongings would be safe in his room and that there is security throughout the ER keeping an eye on everything. And then his coat meowed. For a second I thought I had finally lost my damn mind but his coat meowed again. The man finally opened it and inside was a tiny little mangy black kitten that I wanted to cat-nap immediately. The man said that although he was feeling very sick (and he looked it), he didn’t want to leave Tiger out on the street in case he never finds him again. Apparently Tiger was separated from its mom and siblings and the poor thing looked like it was scared to death. The man said that prior to finding Tiger, he was contemplating suicide and if he couldn’t keep Tiger, then he’d leave. Now I had to tell him the man that animals are not allowed in the ER but we didn’t want to separate the two. Long story short, we found a box, lined it with a warm blanket, put some tuna and milk in denture cups and let Tiger be watched at the main security desk. The man got admitted and the staff pitched in to get Tiger seen by a vet and get neutered. Owner and cat left a few weeks later in good spirits. I write about this now because the man came back to the ER a few days ago and was completely unrecognizable. He wanted to thank us for taking care of Tiger and setting him up with the right community resources because he’s no longer homeless. Moral of the story – pets are wonderful for your health. Now to go feed my giant roving cotton ball of a cat.

Sick Days

For the past several days, the weather was gorgeous (low 20s), the skies were clear, gardens were blooming everywhere, people were out strolling about in the parks and me? I was stuck inside my room febrile and nauseated while countless trees were killed to contain the buckets of snot my nasal passages were perpetually seeping out. And whose fault is this? It’s the fault of the irresponsible, incompetent, rude and completely asinine family of my sweet lom who came to the ER with lots and lots of wheezing. One of them had a cold and kept spraying the room with his snotty secretions. He also refused to wear a mask because “I’m not fucking staying here”. Yet another delightful family member marched right up to the nursing station and demanded that I page the doctor right away – when her request was flat out denied, she coughed her smoker’s cough without covering her face or at least turning away almost in my face. She also got quite offended when I decided to don a N-95 in thier presence. I finally got fed up with all of them and told them to leave. As a parting gift, some of them left snotty tissues around the patient’s bed and the nursing station when there are PLENTY of garbage cans around. Three days later, I too am sick. If there’s any sort of karmic justice at work, I really hope that those pricks contracted C. diff and lose their driver’s license.

Creepy – with a Capital CREEP!

Two hours into my shift, I got a patient with chest pain and he got the standard initial workup – ECG, bloodwork, line, oxygen, monitor etc. Three hours after that, I got a lady with similar symptoms and she got the same treatment. She was placed in the room next to the guy. The rooms are divided by glass walls and are covered with curtains. The curtains were FULLY drawn between the two rooms because undrawn curtains are my pet peeves. Patients are already forced to expose themselves to the staff – they shouldn’t have to be exposed to other patients as well. While the woman went to the washroom, I figured, I’d quickly down some juice to prevent a hypoglycemic episode while assessing my patient. When she returned to her room, I started hooking the woman up to the monitor and what do I see out of the corner of my eye? The man peeking out from the uncovered part of the glass partition and staring openly at the woman. I quickly closed the curtain and finished hooking the woman up to the monitor. I then talked to the charge nurse about moving him to another room. He was moved and then he started peeking into other women’s rooms with a very visible erection (one woman was being catheterized)! A 30 something woman got so freaked out by him staring at her that she tried to throw a bag of NS at him. It (unfortunately) missed. Security was promptly called after that little incident and was made to stay in his room. What a f%$*ing CREEP!

How Much?

In economics, the term ‘free’ is used to describe something that is available in nearly unlimited quantities with zero opportunity cost to society. (For the non-economics folks here, opportunity costs measures the value foregone as the result of deciding to produce one good over the other). Free in this sense does not mean that an individual (or group of individuals) can consume a good in unlimited quantities without deflecting a part of the cost to society as a whole. However, that’s exactly how a lot of folks are treating ER. In Canada, health care is ‘free’. That means that if an individual goes to a clinic or (for the purposes of this blog) the ER, they should be able to get a superfluous treatment that they deem necessary for themselves right? After all, it’s free, so what does it matter to the referring physician? And let’s say that the individual’s request was fulfilled and they went home happy with their productive visit, they have an exciting anecdote to share with their family and friends, right? Because in Canada, the discharge papers don’t include a bill. But here’s the thing –I think sending people with an itemized list of the expenses that they accumulate while visiting an ER versus the cost of visiting a family doctor might make the average person think twice before coming into an ER to seek treatment for non-urgent problems.* Maybe I’m being overly naïve here, but a population wide reminder of how much ER abuse costs the system (and raises taxes) can influence a shift in health care consumer behavior to make more socially conscious choices. Of course, this means that Canada really should start making it a little easier for foreign trained health care professionals to enter the Canadian system instead of letting them drive cabs (and other upstream interventions) but that’s another blog post entirely.

*Some stellar examples include, a cold sore, a cold, a well healing bruised hand, having TWO beers and feeling ‘wrong’, calling 911 for an ambulance and then talking on your cell phone the entire time while in the department, stubbing one’s foot against a parked car, bunions that suddenly got worse after wearing a new pair of shoes two sizes too small for the past several hours and on and on…

Med Error?

Talking to a patient who was particularly hard of hearing today for almost 12 hours has not been good for my voice. However, it was all worth it just for this conversation:

Patient: What pill is this?
Me: This is your Losec.
Patient: Low sex? I’m already old and feeble! Why the hell would I need a pill for that?
Me:* LO-SEC! NOT Low sex! This is for your heartburn!
Patient: Good! I don’t need a pill for low sex!

Good times! I could never have a conversation like this in the corporate world.

*While trying desperately to suppress loud and boisterous laughter

My First Time

“I think I’m joy-gasming”

Overheard when the charge nurse for the day walks into a completely empty department. No one in triage, no one in trauma, no one in resuscitation and no one in fast track. I doubt this will ever happen again. I think the night crew should have gotten a raise just for that night. This has nothing to do with the fact that I was part of that night shift.