Light at the end of the tunnel

You know that you're getting sick of residency when you find humour in the quality of the waiting room books at your family medicine centre. I especially like the one entitled, "The Bastard". Great family oriented reading.

Annoyances

Parents, please prep your kids for going to the doctor's. All you have to do is show them that a stethoscope DOESN'T HURT. Needles on the other hand...well, just give them lots of hugs.

Also, do not listen to your mother in law about starting solids at 1 month of age.

Also, if you already have 5 kids, three of which were apprehended by children's aid services, do not get pregnant again.

Also, do not tell me that your smoking does not affect your kid's asthma.

Also, constipation is normal. Every kid gets constipation.

Also, I do not know what that rash is dammit.

Crazy stuff

Last night's ER shift was so brutal...people came in with the weirdest symptoms. Like, "my arm hurts"....and "no I didn't fall, no one hit me, it didn't hurt two days ago..and I could move it all around". But then he turned out to have a posteriorly dislocated shoulder that was definitely more than a few days old. Another woman came in who had no less than 5 complaints:

"I have decreased appetite, tingling in my arms and legs, a crawling sensation in my heart, sweats when I wake up in the morning, disorientation, dizziness, and I'm hearing voices."

"Oh really? hearing voices? Are they talking to you? Or can you just hear their conversation?"

"I just hear them...but I don't really want to talk about that now"

"Umm...okay."

Then it was someone coding in another pod, who was triaged as level 3, and while that was happening, someone else was giving birth in a third pod. She thought she was only 4 months pregnant, so she was actually refused by the delivery room. Well...the baby was coming out...and it was definitely more than 4 months...because it was very alive and crying....tiny little thing, but had to be at least 32 weeks. Poor mom though. No pain meds.

Anyways. That's life.

Have you ever...

Wondered whether or not you'll end up like your patients down the road? For example, do you think you'll ever become that 68 year old type II diabetic with hypertension, mild incontinence, and early dementia?? I'm sure they didn't think they would either.

Just when you thought things would get boring

Family Medicine call is supposed to be all about sore throats and coughs and stuff. Lately I've been doing stuff like:

-trying to remove a sliver that i can't even see
-packing a sebaceous cyst wound
-giving someone imovane who hasn't been able to sleep in 52 hours
-listening to an elderly woman's abdomen for bowel sounds cause the nurse couldn't find any
-trying to ask a demented person if she thinks she has a urinary tract infection
-being asked at 11 pm if i can give someone a prescription for ritalin because they were out of town and forgot theirs and needed it RIGHT NOW

Sometimes I wish for the routine things to come through the door so that my brain doesn't hurt at the end of the night, but you know, these little escapades are what makes medicine really interesting at times. Just wish patients could have all their problems during normal daylight hours.

Who said family medicine is easy?

I feel so drained. Every day...9-6....and I feel TOTALLY drained afterwards. When I get home, I eat dinner, and I just need to veg ALL night long. For example, tonight I watched TV for 4 hours straight. Feels so GOOD.

Why is family medicine so hard? Why does everyone have a billion problems that they want you to fix all in one appointment? Why are people so consciously unhealthy?? I don't care if stress makes you smoke. Try chewing gum or something.

I really do feel blessed to be healthy. All I have to do is to see a patient who just had his left leg amputated from diabetes and I thank my lucky stars. The other day I saw a woman who was so obese that her pannus probably weighed about 60 pounds. She could have pannus-butted me and knocked me unconscious.

Anywho...shouldn't be making fun of my patients...but sometimes, they do brighten my day.

It's the little things....

I truly do not like emerg work. Occasionally it's fun when you get to put on casts and other procedures, but when you're doing the mundane fever workup or weakness NYD, I count down the minutes until I get home. Tonight was a little more interesting....we had a possible conversion disorder, which the staff tried to decipher by sticking a sterile needle all the way down her legs to make sure she really was numb. She freaked out when she started bleeding in little dots all down her leg. Well I guess she wasn't exactly telling the truth, cause it hurt. I saw a kid who came in with abdo pain and went home with a diagnosis of croup. Apparently also this woman gave birth out in the hallway...ah, what am I talking about. I'm getting bored just writing about this stuff.

Waaaaaah!!! Waaaaaaahh!!

Man, doing pediatric emergency sucks sometime. Why do all the kiddies hate me so much? I can't even approach within 10 feet before they start crying. I can't even bribe with popsicles! And then of course by the time the staff physician sees them they've all tired themselves out and are perfectly calm and complacent.

I do not want to look in a single ear ever again. Or throat.

I am so glad I left when I did tonight. The department was full of "young adults" with various ingestions. A couple of them knew each other. Typical Saturday night. I wonder if they were all at the same party...

On a brighter note, I think I might try and ride along with the paramedics and see some "real" action.

Go Community Medicine!

I am doing a general surgery rotation right now in a small town, and it's great, because there is NO call, and NO rounding, you get to be first assist in the OR, and they send me home early if it's snowing outside, since it's a one hour commute.

Yesterday in clinic I saw a guy who was referred for right groin pain. He was kind of skeptical during our appointment and really made me feel uncomfortable. His doctor sent him to rule out an inguinal hernia, but according to his history, it really didn't sound like it. But nonetheless I had to examine him anyways. I asked him if he had shorts on underneath his pants, and he said to me sarcastically, "I've got some old white briefs". Well, he DID have old white briefs.

So...I'm trying to be all professional, all the while thinking to myself that he probably thinks I'm invading his personal space. I put on gloves, and didn't even ask him to expose himself. He starts looking at me funny, and I said, "What's the problem? I don't think it's a hernia." And I said, "Well, we have to check it out, and besides, this is how my staff would be examining you anyways" (= pushing on groin and asking to cough......I think that's pretty benign!). He said, "Well, I kind of feel stupid." Well thanks, you just made me feel REALLY uncomfortable. So I just ended the exam and said, well it's possible you just have a muscle strain, or something called a sports hernia.

So I got my staff into the room, and within 30 seconds, he had the patient's pants down, briefs down and I'm trying NOT to look at this guy's weenie. He examines him just the way I did, except WITHOUT gloves (EWWWW) and....comes to the same conclusion. And I don't recall him washing his hands either (DOUBLE EWWWW)

Lamest fake script ever

So my staff told me about a script that she wrote once at the urgent care centre, and was called a few hours later by the pharmacist. On the script were two legitimate prescriptions, labelled (1) and (2)...... and well ......the patient had put a (3) before the (1) line...(hence, out of order).... and wrote "oxycontite": 40 tabs. In a totally different handwriting.

That was it.

My staff said, "What's oxycontite??"

The pharmacist said, "Beats me..."

Hahaha

Another time she had written a script for 15 tablets and the person tried to make it look like 45. And they used a different colour pen.

What gives? At least put some effort into faking your scripts!!!