Wednesday, December 15, 2010

laughter makes everything so much easier


I keep finding that the docs I work with use humor to diffuse the stresses of our days. It's a relief since it's one of the mechanisms I use most frequently.

We tease couples who have been married for more than 60 years for not listening to each other.

We pretend that we are going to use the largest needle possible to perform a digital block.

We talk about patients who make us nuts in humorous, if dark, ways.

We find reasons to laugh with our terminal patients - their loss of hair, inability to control their farts, whatever joke the patient has made at their own (or our) expense.

Patients use humor defensively as well. It's one of the few ways they are able to speak the same language as their docs.

Posted by ShoZu

Saturday, December 11, 2010

Rural Medicine is where I belong



I had the absolute best day yesterday. It started off with me being late. Nothing out of the ordinary. And I went to the wrong room. Also not out of the ordinary.

In the wrong room, the nurses prodded me with questions about me and my partner; generally tried to make me feel welcome.

Made it the OB rounds where I was supposed to be which was mildly boring but incredibly educational. I love being able to learn.

Then to the emergency department. It was a busy day - 4 ambulances, lots of walk in patients. We also had 4 admissions. Wackiness.

We've had a patient with inoperable gut cancer that was an "orphan" patient my preceptor picked up. She has been bleeding constantly since admission and suffering from melena and diarrhea. In gynecology, when a fibroid bleeds too much and the woman requires as many transfusions as my cancer patient does, we consider embolizing the arteries feeding the fibroid to kill it. I didn't understand why this hadn't been done yet so I asked my preceptor who told me to ask the specialist who gave me multiple reasons including "because we don't do it". That's fine he's the specialist not me. Through the week I helped the patient with edema, anemia, increasing food intake, decreasing diarrhea and generally feeling like she and her husband were part of the health care plan.

Last night we transferred our patient to a higher care centre. The specialist was on the phone with my preceptor and told him that they planned to try to embolize the tumour, to which my preceptor responded "oh, isn't that what my medical student suggested last week?". I love this preceptor.

The patient's husband went over the plan with me one last time before the transfer. He'd had a horribly stressful week which he had the nasty habit of taking out on me and the staff. He cried and gave me a big hug before leaving and thanked me for helping them through their week.

In the afternoon all doctors were asked to report to the delivery room ASAP. We ran down the hall and entered to find a shoulder dystocia that wasn't going well. Since so many doctors made it to the room, after the baby was out, I stood back and watched the baby resuscitation (which went well). Dad was also quite far against the wall. Mom was freaking out because baby wasn't doing very well yet. I told him, in my very firm, no nonsense voice, that it was his job to hold mom's hand and keep her calm. Which he did. And that was good.