Wednesday, August 24, 2011

The Worm

I see a lot of disgusting things at work and it takes a lot to gross me out.

This morning, however, I made a particularly gruesome discovery.  I was out walking Libby and she was doing

I looked down and what did I see?


Libby has worms.

Tapeworms to be specific.

I will spare you sample images. If you're interested, feel free to google.

It was a total freak-out moment and I have literally been shuddering all day.  Thankfully, tapeworms are relatively benign and easily treated.  They occur after the dog swallows an infected flea so I guess it could happen to any dog.  I'm fairly confident that Libby doesn't have fleas but we did a flea bath just in case.

The vet listened to my description, basically threw the medication across the counter like this was totally routine, and I went on my merry way. 

We are now embarking on a mass genocideTapeworm execution. Worm murder.

Wish us luck. 


Wednesday, August 17, 2011

The Evolution of a 12 hour Emergency Visit

You've either experienced it yourself or you've heard about it from other people.  It's a common complaint and one that hospital administrators, medical workers, and government officials are always trying to solve.  I'm talking about the lengthy emergency department visits. 

I frequently hear friends or family complain about waiting seven, eight, nine, ten hours in the emergency department for their medical care.  Honestly, I feel for you. I really do.  I know it can be frustrating and boring and can seem completely unnecessary to have to sit on a stretcher in a hallway for hours upon hours.

I want to shed a little light on why this happens and hopefully change a few viewpoints out there.

First and foremost, the emergency department is primarily for emergencies.  The main focus is to resuscitate and stabilize people who are very sick and who may not survive without intervention.  That's not to say that back pain, sprained ankles, vomiting, urinary tract infections, sore throats, flu-like symptoms, or lacerations don't have a place in the emergency department.  Sometimes people don't have primary care physicians, cannot get an appointment with their doctor, or feel so lousy that they want some help in the middle of the night.  I understand.  Most emergency doctors and nurses are in the field because they like seeing "any patient, any time, with any problem." We don't mind treating more minor complaints.

There's just one very important caveat:  Sick people get seen first.  Always.

This means that you may watch 20 people come through the doors and get taken back from the waiting room while you continue to sit in your chair.  This is because someone qualified and trained in medical triage decided that all those people were more sick than you.  Every effort is made to see people in a quick and timely fashion, but in reality there are just too many patients.  Sometimes it can take 4 hours before there is no one who is sicker than you are and then it's finally your turn. 

This also means that once you are in a room or on a stretcher in the hallway, it may take some time before you are evaluated by a physician.  Emergency medicine is all about prioritizing so sometimes the doctor must let someone wait so that they can tend to a critical patient.  Your physician may be spending that hour resuscitating a child who has stopped breathing.  The hour you wait is an hour that someone else is fighting for their life.

Next comes tests.  Perhaps you get blood drawn, urine tests, xrays, or CT scans.  These all take time.  It takes time for the blood to get to the lab, for the lab technicians to prepare it to go through the machines, and for the computers to calculate the results.  The final step is that your doctor has to be able to get to the computer in between patients, see the results, and decide what to do with them.

There's a good chance that you will wait hours for your xray or CT scan.  There are usually only 1 or 2 CT scanners for the whole hospital and the same concept applies here: Sick people go first.  Just as you are about to go to the radiology department, another patient may bump you out of line because they were involved in a major trauma or there is concern that they are hemorrhaging internally.  This may happen over and over again.

Technology rules the world but computers don't create results for your imaging studies.  There is a radiologist sitting in a dark room looking at every image taken from every single patient in the department and meticulously interpreting it.  This takes time and they read them in an order that puts the urgent patients first. They go as quickly as they can but they also have to be extremely thorough so that they don't miss anything on the images.  Again, these results have to be entered into the computer and your physician has to find the time between patients to view them.

Next time you are in the emergency department (I hope you never are there), take a look around at the amount of patients that are in that small space.  Your physician is treating every single one of those people at the exact same time.  It's the ultimate juggling act.

Perhaps your doctor has your discharge paperwork and prescriptions in hand and suddenly a stroke patient comes through the double doors.  Unfortunately, your paperwork will be thrown back down on their desk and that's another hour you might wait.

We live in a fast food society.  There is an expectation that everything must be done promptly, that all information can be at our fingertips in seconds, and that a few minutes of waiting is a few minutes too long.  The emergency department is it's own universe.  There are no appointments and it isn't first come first serve.  Every patient is valued but some are more critical and important than others in terms of promptness of care.

Next time you're heading into the ED for something that is not life or limb threatening, remember that there are others there for whom seconds literally count.

Grab a book, bring your ipod, and enjoy the show.

Monday, August 8, 2011

Grasping to the Learning Curve

I'm here!

Really, I am.

I'm so sorry I have gone away & I promise to pay closer attention to this blog.  Writing here and getting your feedback is so important to me.  I'm going to catch up on reading your blogs too.  Believe it or not, I have 707 unread blog entries right now from all of you.  I'm sorry I've been so bad!

I've just been really really busy with this thing called INTERN YEAR.  Let me just tell you, it's a lot harder than I thought it would be.  They say the learning curve is steep when you transition from a 4th year medical student to a 1st year resident but I think the curve is not just steep. It's a totally vertical line.  You basically spend your time trying to climb directly straight up on the learning curve while at the same time grasping on with all you have to prevent yourself from falling off completely.  There isn't a day that goes by that I don't feel like a complete and utterly incompetent idiot.  There isn't a day that goes by that I don't make mistakes.  There isn't a day that goes by that I don't doubt my ability to do this and ultimately become a proficient doctor.  In short, my confidence is at an all time low.

I wonder when I will stop feeling this way and when I will get to the point when I've climbed over the vertical curve and I am cruising up at the top.  I wonder if I'll ever get there.  They say I will.  They say that everyone feels this way and that it will get better.  It's hard to believe right now but I just have to put some confidence in the system and just keep pushing myself to get better every day.

Emergency Medicine is what I love.  I know it's the right specialty for me and I'm sure I will be happy with my career.  I want to love residency but it's a strong word when you aren't confident in yourself.

I'm happy to have the support of my husband, family, and friends to help get me through this.  I also could not be doing it without this girl:

I get to come home to her wagging nub tail every single day and cuddle with her every night.  No matter how my day was and no matter what happened, she is always there with endless love.

Deployment combined with residency is hard.  Really hard.

It is is made so much better by my battle buddy.