Why I'm not much of a drinker anymore

During my 2 week elective in geriatrics I had a few patients who were in the rough situation they are in because of their drinking habits/addictions.

One is thought to have Korsakoff encephalopathy from years of drinking. It took doctors a while to figure out what was going on with this man and really shows the importance of a good social/addictions history when taking people in. It also shows the importance of getting a collateral histroy from family. One or two drinks a day (that the patient said he was drinking) would not cost the thousand dollars his daughter said he was spending monthly. He has tremors and no short term memory. His family is dissapointed with how things have turned out, not surprisingly.

Another has chronic pancreatitis, after acute pancreatitis and years of abuse (Scorpion stings are my class's favourite cause of acute pancreatitis). Her digestive system is blooey (technical term). Bingeing on alcohol = a bad idea.

My usual glass or 2 of wine every night have turned into none - 1/2 a glass.

Here's an article on how to determine if your loved one has an alcohol problem. Or, I guess, you.

What is going on in Montreal??

Another father has delivered his baby at the Royal Vic because the staff weren't available. At least the last one delivered a live baby.

The latest couple was sent home from emerg the night before after being told that their fetus had died. What a long night they must have had after hearing this bad news, worrying about what would come next. They ended up back in emerg again the next day. Apparently, the department was busy and when the baby was delivered, no staff was around.

Losing a pregnancy, especially one this far along can be the worst day someone has. It bothers me that the people who work at the hospital, presumably the ones who went into health care because they wanted to help people, didn't seem to care that this couple was having a terrible day.

Simple goals aren't always that easy to reach

I've been working at our Geriatric Rehab Unit this week. It's been a great experience and I've been learning so much. Patients are complicated but motivated to get better. It's a treat.

Their goals are mostly attainable. They want to be able to walk again, with or without a gait aid. They want to be continent of bladder and bowel. They want to remember how to make dinner. It takes a lot for some of these folks to literally get back on their feet. They've been in hospital dealing with a fractured hip or MI and become 'deconditioned' and need to rebuild their atrophied muscles, deal with the increase in dementia from inactivity and retrain their bladders to do what they used to know before they were catheterized for week.

Their families are heavily invested in their loved one's health.

Our patients spend a few hours a day in PT and OT, working with social workers and volunteers. When I do their admission interviews they tell me that they are here to work and excited to do so.

Unreal.

Emerg!!

I think I'm in love with Emergency medicine. It's easy to jump back and forth between patients and see many different things. I got to spend the last 2 nights hanging out with my preceptor for clinical. She's wonderful and I'd consider her to be a mentor.

A list of the things I can now say I've done:

• sutured a finger and put in a nerve block (grab the other end higher HIGHER, little bit of lidocaine just under the skin before going deeper, watch for tenting on the other side)
• performed several neuro, msk, cranial nerve exams
• diagnosed cataracts
• helped reduce a displaced wrist fracture
• used a silver nitrate stick to stop bleeding (use water if not currently bleeding!)

Not as many things as I wish I could have done, but still a good couple of nights!

A series of updates

First things first, I passed my classes. Some by the skin of my teeth, others by the whole tooth.

Second, I've survived H1N1. Hopefully I'm now immune and won't get sick again this fallwith it when it morphs into the superflu everyone keeps warning me about.

Third, there are only 3 bugs that I actively kill; fruit flies, mosquitoes and earwigs.

Fourth, I spent last week in Edmonton doing a week of geriatrics. Edmonton is a fabulous city. I was shocked. It's well planned, very green, has a great night life and terrific restaurants and has an amazing amount of money in the health care system. We were given tours of the various facilities and were surprised by the quality and amount of resources available. The docs and staff were all incredibly passionate about the care of the elderly. It was inspiring, though to be honest, I don't see a future for myself in geriatrics.

In Alberta, it seems that the Care of the Elderly diploma (a 6 month fellowship following a Family Med degree) is highly valued. These docs are considered geriatricians and work with the elderly full time. I don't think that the same education in Ontario is as well respected, but I don't really know.

Given that we have a shortage of geriatricians in Ontario, it seems that the short cut in training would be popular but it doesn't seem to be. Part of the concern is that the first baby boomer turns 65 in 2011. They won't be needed the service of a geriatrician for several years following that but the cohort before them will need the specialized attention. Despite the supposed raucous that the boomers are able to raise, no one seems to be championing the need for geriatricians.

Few med students choose to enter geriatrics. As far as I can tell, it's not necessarily because they don't like the idea of working with the old folks, it's that something else is just much more interesting. It's hard to see what the point is in specializing in the care of the elderly when you're planning on doing your residency in internal medicine since the majority of your patients are geriatric. Also, it's hard to see geriatrics as anything but a dead end. Geriatricians across Canada are trying to figure out how to woo medical students to join their ranks.

I mentioned that I don't see myself going into geriatrics. This is for a couple of reasons. For starters, I don't really see myself dealing with just one population forever. It's why pediatrics and obstetrics are not that appealing to me. While it's true that geriatrics is not a dead end, you still spend a short amount of time with your patients, either doing their assessment and sending them back to their primary care provider or because their life expectancy at that point is nearing its due date.

Fifth, my cat is really sick again. We've taken to calling him the million dollar cat. This vet bill ran $800 with the possibility of surgery and more imaging still to come.

Ironically, he is a geriatric cat.