How could I be mad?

When at the end of my 24 hour shift my patient’s epigastric pain changed to a STEMI? As I explained to him and his wife what was going on and how dire the situation was given his prostate cancer? As I told them the high risk of bleeding to death on our way to the city to see the cardiologist? As he kept sneaking his thumb over to touch my hand that was on his leg while I talked to him? Tough old coot was scared at the odds I gave him, worried about his wife, worried about his chest pain, worried. 

These are patients who are used to the doctor just telling them what to do. I won’t do that. I’ll present the options as I see them, and likely bias the discussion one way or the other, but I ask them to make the decision. Sometimes the decision is to let me decide, then I check if they are relieved or distressed with that decision and adjust accordingly. Not by the book med school ethics, but patient centred. Luckily my patient’s wife was able to decide for all of us. 

I’m worried too. I hate sending my patients to the city with another doc but I’m not safe to still be caring for him. Very happy I kept doing serial ECGs though and trust my gut when I think something is wrong. 

Sexism in Clerkship

I’m going to point out that frequently during your clerkship, you will experience sexism. Sometimes these moments will be not too bad, a patient thinking you’re a nurse (are you kidding? I wish I knew that much in clerkship!)

Most times, it will be subtle. It will be everyone ignoring the suggestions made by the female clerk. It will be judging her outfit or flirting with anyone. It will be interrupting her, presenting her ideas as their own. It happens. It becomes common. Everyone will act like this is just how it is. Your job, male or female, is to make sure this is no longer common. Your job is to make sure that clerk feels supported. This is your team, you all need to be strong.

Here’s how to do it without waving a flag and making everyone on the team afraid of you.

When she is interrupted or ignored, wait until the interrupter is finished speaking, then say “I think that Meredith was making a good point, did everyone get to hear it?” When derogatory comments are made, ignore them and change the topic to whichever patient was being discussed prior to the comment. If someone is presenting Meredith’s ideas as their own, be subtle, this one is tricky. Something along the lines of “It’s a great idea, I thought as much when Meredith said it this morning at rounds. Maybe you two should work on it together!”

Everyone on your clerkship team deserves to feel supported. Everyone deserves to be able to show what they know and learn. When your colleagues thrive they bring you with them.

Be the colleague you want to have.

Not gone. Dead.

I love when I’m working emerg and my next patient is someone I already know. It makes it so easy to get to the bottom of what’s happening and get them feeling better.

Unless they come in VSA. Then it just sucks.

Especially when they are young and their kids aren’t ready to be an orphan in high school.

Especially when they’re your own patient.

Especially when the family thinks, because of a diagnosis you magically pulled out of your ass that you walk on water.

Especially when no matter how many of the Hs you cross off the PEA list, he just doesn’t come back. His pulse never returns. He doesn’t have another joke, or jab, or hug. He’s just purple and bloaty and looking nothing like you’re guy anymore. His brain stem hasn’t caught up to his heart and doesn’t realize he is dead so keeps telling his lungs to breath horrific, agonal breathes and you have to explain to his children that he is dead.

Not gone. Not done. Dead. Without those words his kids can’t move on.

But they need answers. Why? How? What did I do wrong?? Who can I blame? Maybe I didn’t love him enough? I just want to hide and cry. Because I have the same questions and no answers.

It’s an honour to say that I fought valiantly to save his life. But would be a greater honour to say I had actually won.

My current patronus is Lewis Black

I am furious. So angry. Yelling at people angry. I never yell at people.

The group of middle aged men I work with has described my work as less than medicine. They are suggesting that as someone who practices patient centred medicine, I am not a real doctor.

I work my ass off all day every day, and their interpretation of my work is that a middle aged man could easy double the patients seen just by not being nice.

Protecting these men’s reputation is more important than caring for patients. Slagging patients is ok as long as I don’t question a man’s clinical judgement. As of Hallowe'en I am done here. Until then I will try to avoid hurting anyone. And destroying my reputation.