So... My flight took an eventful and unexpected turn... And I'm going
to put some things here for really one reason only. Please remember, it
is far more important that you are safe and healthy than on time this
holiday season.
I was flying trans-atlantic
on a 767 with a major airline. I was sitting in coach (near the back)
because long gone are the days that doctors can afford to fly 1st class
(if you think I'm kidding, I will explain a thing). Prior to take off, a
gentleman had (what seems like) a pre-syncopal episode. He was attended
by a doctor sitting across the aisle, and seemed ok for flight. 30
minutes into the air, he got worse. The doctor who had attended him previously asked for another set of hands. That's when I stood up to help.
Aside:
standing up on a flight to say that you can help is terrifying. I don't
like to do it. It's scary. You have very little to no equipment (none
of which you're particularly familiar with) or help. And, to put it bluntly, adults of any kind are not my specialty.
Now,
that gentleman was ok... He probably (and his family probably) should
have had the sense to not fly before we pushed back from the gate. But
if the person says they're ok, a doctor cannot really force them off the
flight. And, in defense of the first doctor (a chiropractor), I didn't
see him at the first event. I may have made the same decision. Now... he
was fairly easily managed. And I was comfortable not turning back to
Dublin. I treated him, and returned to my seat with the thought that I'd
check on him every hour (much to the dismay of my poor seat neighbor
who really wanted to sleep - I am so sorry! I should have suggested you
take the window...).
2.5 hours later...
Things changed. Another passenger had what looked to be a seizure and
collapse. Now, my college (God bless them) trained us well. I worked in
adult medicine as part of my qualifications and intern. To make a call
over the ocean with a manual sphig, a stethoscope, and your own clinical
judgement is not easy or a happy matter. But I have to say, I know a
clinical stroke when I see one. And that's when I had to make a
decision, as the only qualified doctor, on a 767, over the atlantic,
whether or not to divert the plane. And yes, I did.
The
2 hour delay plus repeat customs and passport control when we landed
was a horrible inconvenience for both the passengers and the airline.
For that, I am sorry. When they build isolation CT suites on all 767s
with interventional capabilities, I will never have to do that again.
For the passengers that missed connections, that had to reschedule
events, that had to stay in NYC overnight, I am sorry. No one wants to
start their holiday that way. It's crap. I've had it happen myself. And I
particularly apologise to those of you with small children. They were
so good! And you were so patient. To the flight attendants that took the
flack for the delay before we touched ground, I am sorry. You too are
front line staff. I know that pain. But you were all so calm and
composed, and for that, I am eternally grateful. I was also grateful for
the business class seat for the last 3 hours of the flight to NYC, not
for the leg room particularly (I'm kinda short), but it gave me a quiet
space to freak out in private. [Yes, freak out. As I mentioned before, I
don't treat adults... I'm a paediatrician... I haven't had an adult
patient in 4 years. But I did work in geriatrics for 3 months (I know
that sounds short, but I have working experience in a number of small
subspecialties) and my focus is emergency medicine.]
But
let me be clear. I am not sorry for diverting the plane. That passenger
needed hospital care on a time limited basis. I would do it again. And I
would do it for another passenger if necessary. And I'm sure the
airlines support this practice, because you cannot get repeat business
if your passengers die (That's blunt and tasteless and they care about
their passengers beyond revenue, but it's also kinda true). Furthermore,
I have one thing to say to the "super important business man" who
complained for the remainder of the flight and through customs and
through passport control and through rebooking your flight and who
suggested that "we" (I use the royal we to encompass all of the people
looking out for the well being of the passenger) made the wrong
decision--whatever it is that you do for your living... you are alive.
And I doubt your career calls on you to perform outside of your
expertise, in front of terrified and captive people, when you are
supposed to be on holiday! (Yes... that's right... when's the last time
you had a business emergency on a flight where they came over the PA and
asked for a CEO volunteer?) If it had been you... If you were
unconscious on the ground, seizing, vomiting... I would have diverted
that plane for you... And you'd (hopefully) still be alive as well.
Now...
I'm going to try to put this 25hrs of travel behind me... Sleep (since I
am now essentially post-call)... And spend some quality time with my
family.
Saturday, December 21, 2013
Monday, October 7, 2013
Regarding the NCHD Strike - October 8th...
Dear Friends,
As most of you know the NCHD doctors in Ireland will be going on strike tomorrow. As my contract this year is through RCSI, I am not an employee of the HSE. As such, legally I cannot join the picket lines. As a clinical tutor, in solidarity with my colleagues, I will not be bringing any of the students into the clinical areas tomorrow. It is with a heavy heart that I admit the necessity of this industrial action. 24 hour shifts are in violation of the decade old EWTD law. Numerous times the HSE has been found at fault in various legal proceedings. It is not the 24 hour shift against which we strike; 24 hours is a compromise on our part. Instead, we strike against 30, 36, 48, 72 hour shifts. We strike against the exhaustion that threatens our health and the safety of the patients for whom we are responsible.
We are not looking for more money, as the HSE would like to the public to believe. In fact, we will make less money with less hours worked. In response to Minister Reilly who suggested we are causing pain to patients, I would like to address our fallen colleagues, those whom the system failed, those who are no longer with us, because dedication to patients cost them their lives. To our colleagues in foreign countries, who have left this system for greener pastures, seeking a place they can practice and thrive as humans. Not one of us has inflicted pain on patients. Their safety is central to this strike. Their continued well-being and our ability to care for them is why we ask for a limit to shifts at 24 hours. Airplane pilots are not allowed to fly a plane for 24 hours straight, truck drivers are not allowed to drive that long; these rules implemented for safety, yours and mine.
I cannot do these hours anymore. I have slaved through 36 hours straight. I have battled fatigue and my conscience in order to complete menial tasks. I have cried in fear for my patients and myself. I have worked above my pay-grade and out of my depth, because we are spread too thin on the front lines. I have borrowed money from a senior colleague to take a taxi home after 32 hours on my feet without sleep, without food, without a bathroom break. I have worked 80 hour weeks and come home to study for required exams in my "free time." I have collected my partner from work when he has been on his feet, scrubbed in theatre for nearly 40 hours in a row. I have watched my friends leave. I have been asked what I'm thinking remaining here. These hours are putting lives at risk; patients and doctors alike.
I ask you to consider this. Consider what happens at 3am when you are frightened, sick, in pain, and need a doctor... We care. We are there for you. We want to be better doctors for you. We want to sleep so we can make better, faster, smarter decisions for your care, for your parents, for your children. We ask for your support with the industrial action. It is not convenient. But after a decade of our work, our energy, our study, our skill, our compassion and our trust being squandered by the HSE, we can no long stand by, keep our heads down and plow ahead, ignore the imminent collapse of the over-stretched system and have "faith" that the HSE will fix it. We take this action with health, healing, and care in mind. Enough is Enough. You deserve better.
As most of you know the NCHD doctors in Ireland will be going on strike tomorrow. As my contract this year is through RCSI, I am not an employee of the HSE. As such, legally I cannot join the picket lines. As a clinical tutor, in solidarity with my colleagues, I will not be bringing any of the students into the clinical areas tomorrow. It is with a heavy heart that I admit the necessity of this industrial action. 24 hour shifts are in violation of the decade old EWTD law. Numerous times the HSE has been found at fault in various legal proceedings. It is not the 24 hour shift against which we strike; 24 hours is a compromise on our part. Instead, we strike against 30, 36, 48, 72 hour shifts. We strike against the exhaustion that threatens our health and the safety of the patients for whom we are responsible.
We are not looking for more money, as the HSE would like to the public to believe. In fact, we will make less money with less hours worked. In response to Minister Reilly who suggested we are causing pain to patients, I would like to address our fallen colleagues, those whom the system failed, those who are no longer with us, because dedication to patients cost them their lives. To our colleagues in foreign countries, who have left this system for greener pastures, seeking a place they can practice and thrive as humans. Not one of us has inflicted pain on patients. Their safety is central to this strike. Their continued well-being and our ability to care for them is why we ask for a limit to shifts at 24 hours. Airplane pilots are not allowed to fly a plane for 24 hours straight, truck drivers are not allowed to drive that long; these rules implemented for safety, yours and mine.
I cannot do these hours anymore. I have slaved through 36 hours straight. I have battled fatigue and my conscience in order to complete menial tasks. I have cried in fear for my patients and myself. I have worked above my pay-grade and out of my depth, because we are spread too thin on the front lines. I have borrowed money from a senior colleague to take a taxi home after 32 hours on my feet without sleep, without food, without a bathroom break. I have worked 80 hour weeks and come home to study for required exams in my "free time." I have collected my partner from work when he has been on his feet, scrubbed in theatre for nearly 40 hours in a row. I have watched my friends leave. I have been asked what I'm thinking remaining here. These hours are putting lives at risk; patients and doctors alike.
I ask you to consider this. Consider what happens at 3am when you are frightened, sick, in pain, and need a doctor... We care. We are there for you. We want to be better doctors for you. We want to sleep so we can make better, faster, smarter decisions for your care, for your parents, for your children. We ask for your support with the industrial action. It is not convenient. But after a decade of our work, our energy, our study, our skill, our compassion and our trust being squandered by the HSE, we can no long stand by, keep our heads down and plow ahead, ignore the imminent collapse of the over-stretched system and have "faith" that the HSE will fix it. We take this action with health, healing, and care in mind. Enough is Enough. You deserve better.
Monday, July 8, 2013
9 ways to piss off your paediatrician: A disgruntled A&E Manifesto
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Most people think that paediatricians are all fluffy bunnies
and stickers. Well, we are… sort of… I find that as a group of doctors, we are
generally nice. We tolerate a lot of things that the other subspecialties don’t
see, at least, not en mass: Screaming patients, patients trying to kick us or
bite us, patients vomiting on us, patients peeing on us, patients who stick
things up their noses, patients that can’t/won’t talk to us, parents/families
controlling the care (I know Psych and Med El know some of these feels). That
being said, it is possible to upset your paediatrician. If that’s what you’re
looking to do, look no further; I’ve compiled a list of ways to make your
paediatrician cringe… Consider it something of a manifesto.
9 things that parents
say in the ED that are likely to piss off the Paediatrician… (or at least, they
really grind my gears) and the reasons why I stand my ground:
1.
I thought
we were going to see a doctor.
Not to eschew gender stereotypes, but in spite of my size (yeah, I’m less than 5 and a half feet tall), and my gender (I am female), and my apparent age (I’m actually older than I look), I am, in fact, a doctor. I’m a paediatrician; I’m not going to pull out my diplomas to prove it. Let’s get past the fact that I’ve introduced myself as a doctor. I have worked my butt off to get to this point in my career.
I have, more than once, been asked if a patient could be seen by, “that nice male doctor.” Short answer: no. Long answer: more than likely, there is no male doctor working this fine day in the A&E. Furthermore, if you want to shop around for a doctor, go to your GP (or find some new GPs for every time your child gets the sniffles). An emergency department doesn’t work like that.
While this is one of the things that makes my blood boil, let me just say something small here. I have been a customer of many different A&Es (I was a bit injury prone). I’ve found a lovely group of doctors in each one. And to the kind, albeit nervous, ED doc that did my LP when I was SO sick, I feel your pain now. And you were fantastic.
Not to eschew gender stereotypes, but in spite of my size (yeah, I’m less than 5 and a half feet tall), and my gender (I am female), and my apparent age (I’m actually older than I look), I am, in fact, a doctor. I’m a paediatrician; I’m not going to pull out my diplomas to prove it. Let’s get past the fact that I’ve introduced myself as a doctor. I have worked my butt off to get to this point in my career.
I have, more than once, been asked if a patient could be seen by, “that nice male doctor.” Short answer: no. Long answer: more than likely, there is no male doctor working this fine day in the A&E. Furthermore, if you want to shop around for a doctor, go to your GP (or find some new GPs for every time your child gets the sniffles). An emergency department doesn’t work like that.
While this is one of the things that makes my blood boil, let me just say something small here. I have been a customer of many different A&Es (I was a bit injury prone). I’ve found a lovely group of doctors in each one. And to the kind, albeit nervous, ED doc that did my LP when I was SO sick, I feel your pain now. And you were fantastic.
2.
What do you think is wrong with him?
Now, I do understand this question. I actually don’t mind it (if you’re going to listen to what I say). But please don’t plop your kid down on the examining table and sweep your hand in a fed up gesture and demand an answer. I am not a psychic. I need to ask you some questions. I generally start off a history with, “What’s the story? What’s going on with?” I don’t find it amusing or appropriate to respond with, “That.” Or, “See for yourself.”
Further, what I express as an answer to this question is my medical opinion. You can take it or leave it. But it is based upon my (or the other physician’s) clinical opinion as to how your child is medically managed. We studied hard and work harder (I’m not going to go into the hours and pay thing) to get to our place in this profession. We treat each patient individually. Yes, we occasionally make mistakes. But, not pulling rank here, we are the doctors. To the parents that respond with a roll of the eyes and, “That’s what my GP said too.” … I think there’s a special place in hell for you.
Now, I do understand this question. I actually don’t mind it (if you’re going to listen to what I say). But please don’t plop your kid down on the examining table and sweep your hand in a fed up gesture and demand an answer. I am not a psychic. I need to ask you some questions. I generally start off a history with, “What’s the story? What’s going on with
Further, what I express as an answer to this question is my medical opinion. You can take it or leave it. But it is based upon my (or the other physician’s) clinical opinion as to how your child is medically managed. We studied hard and work harder (I’m not going to go into the hours and pay thing) to get to our place in this profession. We treat each patient individually. Yes, we occasionally make mistakes. But, not pulling rank here, we are the doctors. To the parents that respond with a roll of the eyes and, “That’s what my GP said too.” … I think there’s a special place in hell for you.
3.
I want my
child scanned.
Generally, these are the first words out of the parent’s mouth. I find that they are often accompanied by a chronic (6 months or longer) complaint for which they are already seeing a general paediatrician. And frequently, it’s Saturday or Sunday at 8pm. Shockingly, most of the complaints are not ones that can or should be investigated by a scan. Also, I don’t care if your GP suggested you come in to us for a scan [Dear GPs, don’t do that, cheers.].
CT scans carry a very high burden of radiation. This is why every child in the door isn’t passed through one on the way to triage. There is research that demonstrates lifelong increased cancer risk and mortality is linked to childhood CTs, and leukaemia and brain tumours are similarly linked (triple the risk!!!). Down the road, I may have to stand up in court and explain why I requested (nay required) a CT scan knowing this risk. Saying the parents bullied me into it won’t stand in court, nor would it stand in my conscience.
X-rays carry a small burden of radiation; that is why the nurses and techs that hold your child for an x-ray wear protective lead shields. I realize that it is a quick test, but it is not without risk. I don’t x-ray children without indication. And x-rays are crap for diagnosing bowel problems…
MRIs are really pretty. I love them. They’re great for certain soft tissue windows. They make nice brain pictures. They’re time consuming. Your child needs to sit, unmoving, in a loud banging tube for thirty minutes to an hour… So, at times (such as in the A&E) I find them a little unpractical.
Generally, these are the first words out of the parent’s mouth. I find that they are often accompanied by a chronic (6 months or longer) complaint for which they are already seeing a general paediatrician. And frequently, it’s Saturday or Sunday at 8pm. Shockingly, most of the complaints are not ones that can or should be investigated by a scan. Also, I don’t care if your GP suggested you come in to us for a scan [Dear GPs, don’t do that, cheers.].
CT scans carry a very high burden of radiation. This is why every child in the door isn’t passed through one on the way to triage. There is research that demonstrates lifelong increased cancer risk and mortality is linked to childhood CTs, and leukaemia and brain tumours are similarly linked (triple the risk!!!). Down the road, I may have to stand up in court and explain why I requested (nay required) a CT scan knowing this risk. Saying the parents bullied me into it won’t stand in court, nor would it stand in my conscience.
X-rays carry a small burden of radiation; that is why the nurses and techs that hold your child for an x-ray wear protective lead shields. I realize that it is a quick test, but it is not without risk. I don’t x-ray children without indication. And x-rays are crap for diagnosing bowel problems…
MRIs are really pretty. I love them. They’re great for certain soft tissue windows. They make nice brain pictures. They’re time consuming. Your child needs to sit, unmoving, in a loud banging tube for thirty minutes to an hour… So, at times (such as in the A&E) I find them a little unpractical.
4.
I need an
antibiotic.
No, that’s not a typo. “I” need an antibiotic. My brain instantly responds with, well then why are you here, clearly you need an adult physician, you’re far too old to be treated by a paediatrician. And yes, I know what they mean… They mean that they think their child needs an antibiotic. These too are often the first words out of the parent’s mouth, prior to the history, prior to the exam, often accompanied by the phrase, “The D-doc said it was viral, but I know my child and they’ll only get better with an antibiotic.”
Small news flash: If your child has vomiting and/or diarrhea, there is an incredibly slim chance that an antibiotic is the right answer and an even slimmer chance that the antibiotic will do anything but make the vomiting and/or diarrhea worse.
We are no longer living in a time where it is acceptable to give an antibiotic without a source. If a child has a UTI, there needs to be a culture and sensitivities. If it’s a bacterial tonsillitis, a swab should be taken. If it’s OM… don’t get me started. People are all up in arms about super bugs and MRSA, yet won’t bat an eye to demand an unnecessary antibiotic from the GP or Paediatrician. Yes, my responsibility is to look out for children, so I’m doing my best not to breed super bugs. You tell me that every time your child gets a head cold, it becomes a bacterial pneumonia, fine. I’ll give you an antibiotic when there’s a pneumonia. It sounds harsh, but trust me, you’d rather the standard penicillin actually treat tonsillitis than just give your kid the trots.
That being said, I do, on occasion, prescribe antibiotics. Which brings us to the next point…
No, that’s not a typo. “I” need an antibiotic. My brain instantly responds with, well then why are you here, clearly you need an adult physician, you’re far too old to be treated by a paediatrician. And yes, I know what they mean… They mean that they think their child needs an antibiotic. These too are often the first words out of the parent’s mouth, prior to the history, prior to the exam, often accompanied by the phrase, “The D-doc said it was viral, but I know my child and they’ll only get better with an antibiotic.”
Small news flash: If your child has vomiting and/or diarrhea, there is an incredibly slim chance that an antibiotic is the right answer and an even slimmer chance that the antibiotic will do anything but make the vomiting and/or diarrhea worse.
We are no longer living in a time where it is acceptable to give an antibiotic without a source. If a child has a UTI, there needs to be a culture and sensitivities. If it’s a bacterial tonsillitis, a swab should be taken. If it’s OM… don’t get me started. People are all up in arms about super bugs and MRSA, yet won’t bat an eye to demand an unnecessary antibiotic from the GP or Paediatrician. Yes, my responsibility is to look out for children, so I’m doing my best not to breed super bugs. You tell me that every time your child gets a head cold, it becomes a bacterial pneumonia, fine. I’ll give you an antibiotic when there’s a pneumonia. It sounds harsh, but trust me, you’d rather the standard penicillin actually treat tonsillitis than just give your kid the trots.
That being said, I do, on occasion, prescribe antibiotics. Which brings us to the next point…
5.
My child
won’t take that medicine.
I assume you mean that you’re not willing to make your child take that medicine? Let me be frank for a moment. You have brought your child to an emergency department. They have been diagnosed with something that requires medicine. Now you’re telling me that they will be dying of overwhelming sepsis, because you don’t know how to give them medicine?! Ok, that was a bit over the top. But think about it. What wouldn’t you do for your child? Apparently force them to take medicine…
I’m not trying to be glib. I know it isn’t easy to be a parent. I know it isn’t easy to do things that your child disagrees with. But you HAVE to do them every day. If it’s not medicine, it’s brushing their teeth, eating their vegetables, going to bed at night, NOT PLAYING IN TRAFFIC! As a parent, you are going to have to do things your child does not like. And no… I don’t think it’s appropriate for me to stab your child, break the skin and introduce a foreign body into their vascular system, and give them IV antibiotics so that you can be the good guy… That does not make you the good guy… Nor does that make you a parent. Stop trying to be their friend, be an adult.
On occasion, the objection to a medication is one of allergy… That I do understand. But just going back to my previous point, vomiting and/or diarrhea is not an allergy, that’s a normal side effect of antibiotics. Swelling up so you can’t breathe or breaking out in a rash and having your skin peel off… Now that’s an allergy.
I assume you mean that you’re not willing to make your child take that medicine? Let me be frank for a moment. You have brought your child to an emergency department. They have been diagnosed with something that requires medicine. Now you’re telling me that they will be dying of overwhelming sepsis, because you don’t know how to give them medicine?! Ok, that was a bit over the top. But think about it. What wouldn’t you do for your child? Apparently force them to take medicine…
I’m not trying to be glib. I know it isn’t easy to be a parent. I know it isn’t easy to do things that your child disagrees with. But you HAVE to do them every day. If it’s not medicine, it’s brushing their teeth, eating their vegetables, going to bed at night, NOT PLAYING IN TRAFFIC! As a parent, you are going to have to do things your child does not like. And no… I don’t think it’s appropriate for me to stab your child, break the skin and introduce a foreign body into their vascular system, and give them IV antibiotics so that you can be the good guy… That does not make you the good guy… Nor does that make you a parent. Stop trying to be their friend, be an adult.
On occasion, the objection to a medication is one of allergy… That I do understand. But just going back to my previous point, vomiting and/or diarrhea is not an allergy, that’s a normal side effect of antibiotics. Swelling up so you can’t breathe or breaking out in a rash and having your skin peel off… Now that’s an allergy.
6.
But…
We’re going on holiday tomorrow…
Look, I know how much we treasure our holidays. I’m happy that you are one of the few families that can afford flights and sun based holidays. I know how expensive they are. Do you know how expensive life long impairment is? I’m sorry that you wanted to swim with the dolphins. But your child has a) a serious infection requiring hospitalization or b) broken their arm/leg/head and require treatment.
I am not unsympathetic to the need to change holiday plans. However, looking at me with puppy-dog eyes will not make this problem go away, nor will it change the way the system works. For example, we do not put full fiberglass casts on in the A&E, because there is a good chance that a fresh fracture will continue to swell. You end up with one of two outcomes; either the cast is too tight and it cuts off circulation to the extremity, or the swelling recedes and the cast is too loose and the fracture is not stabilized. There is a reason we do things this way.
More aggravating to me, is the idea that some amount of negotiating is going to make me laugh and say, “Just kidding, there’s nothing wrong. Your child was screaming for no reason and that massive deformity in their forearm is just a joke.”
Look, I know how much we treasure our holidays. I’m happy that you are one of the few families that can afford flights and sun based holidays. I know how expensive they are. Do you know how expensive life long impairment is? I’m sorry that you wanted to swim with the dolphins. But your child has a) a serious infection requiring hospitalization or b) broken their arm/leg/head and require treatment.
I am not unsympathetic to the need to change holiday plans. However, looking at me with puppy-dog eyes will not make this problem go away, nor will it change the way the system works. For example, we do not put full fiberglass casts on in the A&E, because there is a good chance that a fresh fracture will continue to swell. You end up with one of two outcomes; either the cast is too tight and it cuts off circulation to the extremity, or the swelling recedes and the cast is too loose and the fracture is not stabilized. There is a reason we do things this way.
More aggravating to me, is the idea that some amount of negotiating is going to make me laugh and say, “Just kidding, there’s nothing wrong. Your child was screaming for no reason and that massive deformity in their forearm is just a joke.”
7.
This wait
is too long. I’m leaving.
Sometimes, there are no words. Sometimes, there is only an expression of exasperation. Let me be clear on this: the reason there is a wait time in the emergency department is because there are a lot of sick children; and if you’re waiting, it’s because the other children are sicker than yours. I don’t like the days when the wait times brush 4 hours. I think it’s terrible. But frankly, if your child is sick, and you’ve been concerned enough to come to the A&E, you should be concerned enough to wait. Leaving before being seen by a doctor is normally a sign that you didn’t need to be there in the first place.
One of the reasons the A&Es are overrun is that we don’t have the space, the equipment, the staffing numbers that are needed. Another reason is that people just don’t go to the GP… Most of the kids (and shamefully, I’m going to estimate about 50% of them) don’t need to be in the A&E… There is neither an accident nor an emergency in some of the attendances. And yes, it’s summer, kids are out doing silly things, there are a lot of injuries. This means that certain things get pushed back on the timeline. Wounds that need suturing in the ED, sometimes we have to leave them until we can sit down and give them the appropriate attention. This isn’t because we don’t care; this is because we have to work as efficiently and effectively as possible. And not all lacerations need sutures, and not all lacerations that need sutures need to be seen by a plastic surgeon.
Sometimes, there are no words. Sometimes, there is only an expression of exasperation. Let me be clear on this: the reason there is a wait time in the emergency department is because there are a lot of sick children; and if you’re waiting, it’s because the other children are sicker than yours. I don’t like the days when the wait times brush 4 hours. I think it’s terrible. But frankly, if your child is sick, and you’ve been concerned enough to come to the A&E, you should be concerned enough to wait. Leaving before being seen by a doctor is normally a sign that you didn’t need to be there in the first place.
One of the reasons the A&Es are overrun is that we don’t have the space, the equipment, the staffing numbers that are needed. Another reason is that people just don’t go to the GP… Most of the kids (and shamefully, I’m going to estimate about 50% of them) don’t need to be in the A&E… There is neither an accident nor an emergency in some of the attendances. And yes, it’s summer, kids are out doing silly things, there are a lot of injuries. This means that certain things get pushed back on the timeline. Wounds that need suturing in the ED, sometimes we have to leave them until we can sit down and give them the appropriate attention. This isn’t because we don’t care; this is because we have to work as efficiently and effectively as possible. And not all lacerations need sutures, and not all lacerations that need sutures need to be seen by a plastic surgeon.
8.
We have a
safety net on the trampoline; it just wasn’t closed…
I file statements like this under the same category as, “My child doesn’t like wearing helmets,” “I always let them swim by themselves,” and “My child’s friends drink, but they don’t.” … And I know, there are some kids who can have that peer group that drinks when they themselves don’t partake (I was one of them). There are some things you cannot prevent. Kids will fall down (or off of things). Kids will push boundaries and challenge you. Kids will strive for independence. But there should be a safety net where possible. Don’t buy a safety device that you don’t plan to use. Don’t let your kids swim in a pool/ocean/river/pond without supervision. Don’t leave your kids to fend for themselves without preparing them for the pressures they will face.
Also, trampolines and bouncy castles should be banned… Or you should be required to sign a waiver before letting a kid on it, accepting all consequences, including broken bones.
I file statements like this under the same category as, “My child doesn’t like wearing helmets,” “I always let them swim by themselves,” and “My child’s friends drink, but they don’t.” … And I know, there are some kids who can have that peer group that drinks when they themselves don’t partake (I was one of them). There are some things you cannot prevent. Kids will fall down (or off of things). Kids will push boundaries and challenge you. Kids will strive for independence. But there should be a safety net where possible. Don’t buy a safety device that you don’t plan to use. Don’t let your kids swim in a pool/ocean/river/pond without supervision. Don’t leave your kids to fend for themselves without preparing them for the pressures they will face.
Also, trampolines and bouncy castles should be banned… Or you should be required to sign a waiver before letting a kid on it, accepting all consequences, including broken bones.
9.
I don’t
believe in vaccination.
To me, that’s like saying, “I don’t believe in gravity,” or “I don’t believe in the moon.” It not only makes you sound foolish, it makes you sound dangerous. I’ve talked to many parents that don’t wish to vaccinate their children. I’ve also listened to them plead for a solution when their child is ill with measles.
We see some pretty horrible things in paediatrics. One of the worst is something preventable. I don’t like watching children suffer. Measles is horrible. But worse than measles is slowly dying of encephalitis years later. I have, thankfully, only seen one such case. I’ve seen epiglottitis, where a child struggles to breathe as the airway swells. I’ve seen little babies cough so hard they cannot catch a breath due to pertussis. I’ve seen a child need multiple infusions to prevent infection following a dog bite. And that horrible discomfort you see with chickenpox… Yeah, that too is preventable (though not on the national immunization scheme). There was an 8 month measles outbreak in Wales that was just declared over which saw more than 1200 notifications, 88 hospitalizations, and one death (you can read more about it here).
My largest concern is that opting not to vaccinate your child puts other children (even the ones that are vaccinated) at risk. I’m going to be super controversial here and say that not vaccinating is like drunk driving: you put more than yourself at risk (single story here). There are buckets of research in favour of vaccination. There’s only anecdotal stories to the contrary. A couple in New Zealand went through a horrible experience as their son nearly died of tetanus; they’ve been telling their story (here) in hopes of keeping others from suffering the same. Maybe only 4 out of 5 dentists recommend a certain tooth paste, but 95% of paediatricians are all for vaccines (and of the remaining 5%, there are some objections to the schedule, not the vaccinations). In the US, paediatricians now have the right to “fire” patients whose parents are vaccine refusers. Still have doubts, this is one of best responses to arguments against vaccination I’ve read (here).
To me, that’s like saying, “I don’t believe in gravity,” or “I don’t believe in the moon.” It not only makes you sound foolish, it makes you sound dangerous. I’ve talked to many parents that don’t wish to vaccinate their children. I’ve also listened to them plead for a solution when their child is ill with measles.
We see some pretty horrible things in paediatrics. One of the worst is something preventable. I don’t like watching children suffer. Measles is horrible. But worse than measles is slowly dying of encephalitis years later. I have, thankfully, only seen one such case. I’ve seen epiglottitis, where a child struggles to breathe as the airway swells. I’ve seen little babies cough so hard they cannot catch a breath due to pertussis. I’ve seen a child need multiple infusions to prevent infection following a dog bite. And that horrible discomfort you see with chickenpox… Yeah, that too is preventable (though not on the national immunization scheme). There was an 8 month measles outbreak in Wales that was just declared over which saw more than 1200 notifications, 88 hospitalizations, and one death (you can read more about it here).
My largest concern is that opting not to vaccinate your child puts other children (even the ones that are vaccinated) at risk. I’m going to be super controversial here and say that not vaccinating is like drunk driving: you put more than yourself at risk (single story here). There are buckets of research in favour of vaccination. There’s only anecdotal stories to the contrary. A couple in New Zealand went through a horrible experience as their son nearly died of tetanus; they’ve been telling their story (here) in hopes of keeping others from suffering the same. Maybe only 4 out of 5 dentists recommend a certain tooth paste, but 95% of paediatricians are all for vaccines (and of the remaining 5%, there are some objections to the schedule, not the vaccinations). In the US, paediatricians now have the right to “fire” patients whose parents are vaccine refusers. Still have doubts, this is one of best responses to arguments against vaccination I’ve read (here).
Thursday, June 20, 2013
On Morality and Blackmail...
I have made a decision. Rather, I should say that I made a
decision about 4 months ago. But it’s something I’m ready to talk about;
something that needs to be talked about. This is my power move.
“In a perfect meritocracy, tiaras would be doled out to the
deserving, but I have yet to see one floating around an office. Hard work and
results should be recognized by
others, but when they aren’t, advocating for oneself becomes necessary… The
most common way people give up their power is by thinking they don’t have any.
Do not wait for power to be offered. Like that tiara, it might never
materialize.”
Lean in, Sheryl Sandberg
Back in November… Way back when… I made the decision not to
apply to the SPR scheme. This was a personal decision that was in no way based
on the 24hour turn around on applications following notification on the
Membership exams. And while I could list the reasons why I chose not to go on
scheme, they really don’t matter to anyone else… Frankly, it’s no one’s business.
But I immediately received a large amount of feedback as to why I made the
wrong decision. Here is a sample of why I’d thrown my life away:
·
The SPR is the only way to get to consultant
·
You’re too good to waste time as a registrar
·
Only people who don’t know what they want stay
off the SPR
·
You’ve already done research, so just get on
with it
·
You have your exams, this is the next step
·
You’ll get your year of neonates out of the way
sooner
·
You can always turn it down
Again, while I appreciate feedback, none of these took into
account my rationale for not applying to the SPR, a rationale I had shared with
my seniors at the time. In fact, I felt that my opinion, my plan, my career
choices were dismissed as immature and I was fed guidance that I had no desire
for.
More recently, I made another decision. I have decided that
from the July hand-over, I will be acting as a locum rather than taking a 6
month job. I have many many good reasons for this, the least of which is that I
will actually be taking time off of work (completely) to study. Unfortunately,
the current system does not allow enough study time for my goals, and I’m sick
of it. Having made my decision, and slowly informing my seniors, I am, again,
receiving more feedback than I appreciate. Another small sample:
·
The HSE can’t afford locums anymore
·
No one respects the locums
·
There won’t be enough work
·
You won’t work enough hours to keep busy
·
It’s a terrible job
But far worse than the verbalized reasons as to why I’ve
made the wrong life decision, there is a current of subtext in many of the
conversations I’ve held that conveys the impression that my decision is a
betrayal. How can someone trained in Ireland, a product of the BST, not fill a
regular reg job? Don’t you feel a duty? A responsibility to pay back the system
that trained you? They don’t have enough regs to fill the posts, what are you
thinking not taking a normal job?! In other words… How dare you…
Let me fill you all in on a little secret. A dirty little
secret. I have never been treated as Irish trained doctor. Never.
Now, I will, hand on my heart, say that I’ve never been
treated with the same blatant racism that I see some of my colleagues subjected
to (It is noticed… And it is shameful). I have an Irish name, I’m white,
English is my first language, and I’ve even developed a brogue in the time I’ve
lived here. But while I would identify myself as Irish-American, I am not
treated as an Irish doctor. A few weeks before my graduation (and shortly after
the rank lists were due in the US), my class was informed that they’d be using
a central match for interns… We would be the test bunnies for that system, and
if you were non-EU, you’d have to wait until all the EU students had jobs
first. So that jackass next to you, the one that barely scraped by with a 50,
would have pick of jobs before you… Because you’re not from the EU… (and I’m
not going to address the tuition fees and education loans prior to that). And
for those of us from North America that wanted to stay here, we were told that
we’d been warned this was coming and we’d have to just wait and see. Told after
our only option to get back to the States had passed. Told callously. And boy
did my confidence going into my exams suffer. When I applied to the BST scheme
of my choice, I received a 1st round offer. Not my 1st
choice, but an offer. And you know what, I was one of the only North Americans
to be offered something 1st round. It was suggested later that it
was because people were afraid that we’d just leave before our training was
complete. I wonder where they got that idea?
Every 3 to 6 months, I change jobs, change hospitals, change
supervisors and colleagues, and every 3 to 6 months I face the same question:
What are you still doing here? As if I am in some way defective for remaining
in Ireland. As if I do not belong here. Well… Do I belong here? Now I actually
want to know. Because from the moment I decided to locum, I’ve been getting a
wave of, “now your true colours show…” That’s right, my true colours… I am
putting my career path in front of the desperate needs of the HSE.
When I tell people that I’m leaving Ireland (and it is
something I did not take lightly, I’ve lived here for a third of my life), I
get mixed reactions. My compatriots – Good for you. My seniors – Get out while
you can. My supervisors – You’re going to abandon your training? I want to give
my response here. And this is keeping in mind the reflection I previously
posted, the one on remembering…
1)
Any and all training I have received while here
is something I have fought for. You can easily advance in the Irish system (to
a certain extent) by keeping your head down and not killing anyone. Actually
training is something NCHDs have to want and seek out. Now I’m going to take
some time to train myself. Some of the most important exams are not Irish…
Let’s all accept that fact.
2)
I have a partner here in Ireland (who is also
American) and our families are in the US. This is going home. This is returning
to the system that for 20 years prepared me to work as a doctor. I don’t need a
lecture on loyalty. I miss my family. I feel guilty for not being close enough
to watch my nephew grow up, for not being with him often enough that he knows
me. I wish I had the money and time to see my friends get married on the
weekends. I hate that I don’t talk to my parents as much as I should.
3)
I have made a career defining decision, much
like the one I made to attend med-school in Ireland. And whether or not it fits
into the convenient box of HSE plans is not my problem. There is no career ladder
here. There is a pot of muck that you slop around in for ten years and
hopefully manage to find your way out of… and shower before becoming a
consultant. I will not seek forgiveness for wanting a clear-cut plan as to how
one advances in a career.
4)
It is a global market. Ireland/the HSE and
whatever system that takes over when the HSE is/might be dissolved in the
coming year need to recognize that people have become mobile. For me, I’m going
home. It’s an easy move. But for the Irish medics that are leaving in droves,
it’s not because they aren’t good enough to practice here. It’s a silent
strike. A slow brain-drain. And five years from now, the country is going to be
in big trouble.
5)
I have spent the past 3 years ticking the boxes,
filling the holes, and acting as a workhorse for every department I’ve found
myself in. I put my heart and soul into my work. But unfortunately, I have come
to expect something in return… be it financial, educational, career advancement,
a little bit of positive feedback. And I’m not really seeing that. I have seen
my responsibilities doubled, my workloads doubled, my time doubled, and my
paycheque halved. I find myself tempted to do the bare minimum and get by, as
long as I don’t get yelled at, it’s a success. I am too tired to keep this up.
There was a time when you could justify the sacrifices, because of compensation
and I’m just not seeing that anymore.
Perhaps my classmates graduating from their Residencies back
home is hitting me hard. But I can’t squander the next decade hoping there’ll
be a job at the end of it. More than anything, I will not be blackmailed.
Blackmail comes in many forms. There’s emotional blackmail –
the form used that has NCHDs cross-covering, picking up calls when someone is
sick, working late so a co-worker can leave for something important. There’s
moral blackmail – the form that leaves you holding an arrest bleep 2 or 3 hours
past your shift being done while you wait for the late coworker to get in; you
don’t claim all of the hours you work, because you possibly could have worked
harder/faster and the hospital is broke and you feel bad asking for the
overtime. Then there’s pure extortion – the form that has you ask your
consultant (the person who signs you off at the end of rotation, that writes
your recommendations, that decides if you advance in your career) to put their
name down on your overtime hours, where you take your research home to do it
there so you can’t be asked to do ward work even three hours after shift ended,
where you aren’t paid for the hours you claim… Actually, that’s not blackmail,
that’s actually just criminal. But I’m not going to let anyone suggest that my
taking time to make an international career move is damaging to my job. Jobs come and go. This is my career. This is who I am. This is my life. And I'm putting on my tiara.
“As I lie in bed each morning and ask
myself why I should put both my feet on the floor, there are precious few
reasons that I’ve ever come up with. The chance to escape Jordan’s morning
breath, sure. Scotch. It’s too early to drink it, yes, but it is never too
early to think about. And, of course, the ever-present possibility that I might
finally happen upon Hugh Jackman and give him the present I’ve been holding for
him. *Bam!* Still, the most persuasive argument I’ve ever been able to come up
with is that I get to come to this hospital every day and help keep people
alive.”
Scrubs, Dr. P. Cox
Sunday, April 28, 2013
Fading memories...
Hi. You probably don’t remember me, but I was there when
your baby was born. I was the one in the scrubs at half-eight in the morning that
made sure your baby was breathing after a difficult delivery. Yours was one of
thirty babies born in that day, and one of fifteen that I checked on as they
were born. You may not remember me, but
I was the one talking to the new mother in the next bed over at one in the
morning, talking her through breast feeding, and reassuring her that the new
baby was fine. You may not have been awake at three in the morning when the
baby across the room became ill, needed to go to the ICU, needed tests and
antibiotics, and I was there to explain that to the parents throughout the
process. You may not remember me, but I was the one that checked your baby the
next day at lunchtime to say they were safe for home; I was the one that
checked twenty other babies before I stumbled home to rest for the first time
in thirty hours. And I was the one that was back in the next morning to do it
all again.
You may not remember my name, I introduced myself by my
first name, I was the doctor on call in the emergency department in the middle
of the night. I was the one in chucks and scrubs that listened about the
coughing your child has suffered from for the past week, the sore throat, the
runny nose, the wheeze, the fever. I looked at the rashes and explained the
difference between dangerous rashes and common rashes. We had the conversation
about crèche and viral infections, about eczema, about wheezes with head colds,
about vaccinations. I was the one that changed my scrubs after your child had a
vomiting bug and I wasn’t fast enough getting out of the way. I was the one that examined your child’s arm
when they fell off the slide, the one that put six stitches in your child’s leg
when they tripped, the one that watched, observed, held onto your child after
they crashed their bike, making sure they were well before home. I was the one
that saw thirty children during my shift and came back the next night for
another shift.
You hopefully don’t remember me, but I’m the one that was
first to your child’s hospital bed when they stopped breathing. I was there to
admit them to the ICU when they were sent over from another hospital. I was the
one that gave them an injection that stopped the seizure. I was the one that
met them coming out of the ambulance after the car flipped over on the
motorway. I was the one on the phone to other doctors, looking for the best
care for your child. I was the one that explained to you that your child had
been drinking with friends and was quite intoxicated and we were concerned
about them. I was the one that ran to three emergency arrest calls overnight,
continued working, and drove home the next morning to an empty house.
You might not remember me, but I remember when you
continually called me a nurse. I remember when you told your child that if they
did not sit still, the doctor would stab them with a needle. I remember when
you shouted at me, because you had to wait too long to be seen by me. I
remember when you told me I was too young to know what I was talking about. I
remember when you yelled at me for hurting your child when they needed a
cannula for their medication. I remember when you insisted that your child
needed antibiotics, they wouldn’t need their vaccinations, that you couldn’t
possibly make your child take medicine and I needed to do something else. I
remember physically standing between your child and someone that meant to harm
them and being terrified that I wasn’t enough to protect them.
Maybe you do remember me. I would be flattered. I’m one of
the doctors being accused of not caring enough, of not working hard enough, of
not working fast enough, of being greedy and money-grubbing. Let’s be frank: I
cry after bad days, I study during my days off, I do the three people’s jobs
(four when someone is sick), and I would make more money working these hours at
a fast food chain. I get the sneaking suspicion, though, that you won’t
remember me when I leave Ireland. I’ll become a statistic. One of the foreign
doctors that was here briefly and went back home… You probably don’t remember
me.
Sunday, February 3, 2013
Enter the week of insanity! And Pictures from HOME!
Welcome to February!
Honestly, I have no idea where January went. I've been in my "new" job for 3 weeks. I've done 4 calls. I've done 6 clinics. I've baked cookies and cupcakes. I've cleaned the kitchen... And my to-do list is just building!!!
I have some complaints for whomever put together the 2013 calendar.
We took the 2 weeks preceding Christmas to go back to the States (then returned to actually work on Christmas). This is becoming somewhat of a norm for me. But early Christmas has suited my family in the past few years, so I can't argue with it. Plus, I get paid extra for working holidays... Though, as it is a holiday, Murphy's law applies.
First week was spent down in NOLA. It was a pleasure as always, and a nice slow ease into the central time zone. It was chilled out, and restful. I felt pretty good after the week... Well, I felt really full, actually, because the food was just too good! Before we headed to NOLA, we'd made a list of places to eat (it's an extensive list that will take months to complete) and we endeavored to hit a few of them up. I'm not going to talk about every meal I ate, but big highlight: Cochon. (Yes, it means 'pig' in french) The food there was perfect... and pork... and so good. I ate way more than I should have, and had my first go at eating alligator (surprisingly good). Other bits to mention, went to the shooting range (that was a new experience); had a creepy walk through the riverfront when it was next to abandoned; got my Christmas cards printed; midnight showing of the Hobit in 3D; did I mention the food? Small side note... If you fly on Delta, don't eat the chicken mole poblano, aka "hot chicken meal"... just don't...
Second week was in MN with my fam, the whole fam actually. It's rare that we all get to be together (partners and all), so it's something to be enjoyed. Where NOLA was more relaxed, MN was a tiny bit hectic, people everywhere, things to do, cold weather to avoid! And it was my nephew's first Christmas (and my first time meeting him face-to-face). He's a little dote. I haven't met a baby as chilled out and cool as he is (and while I realise that most of the babies I meet are unwell and therefore cross, even the well ones aren't as cool as he is. Much of the visit revolved around spending time together, eating dinners, going to the movies, playing boardgames (train game!), and sneaking in time to finish making a Christmas present. I highly recommend going to the West End for movies, the VIP section where you can have a bloodymary while watching a 3D movie is pretty excellent (as is the Bacon Popcorn). I also recommend taking an afternoon off and letting your boyfriend make dinner for your whole family, because, let's be honest, he likes messing in the kitchen, and your family likes eating! (Plus, his gumbo is pretty fantastic). So I'm going to tack on some family togetherness photos, and maybe just one or two of my nephew, as he is the coolest. Enjoy.
Honestly, I have no idea where January went. I've been in my "new" job for 3 weeks. I've done 4 calls. I've done 6 clinics. I've baked cookies and cupcakes. I've cleaned the kitchen... And my to-do list is just building!!!
I have some complaints for whomever put together the 2013 calendar.
- Super Bowl in New Orleans... Do you not know that the Mardi Gras festival is a few weeks long there? Serious NFL, you're screwing with traditions that are ancient, beloved, and thinly veiled racist slurs... Oh wait... it's competition?
- Why is the Super Bowl on right before my call? I was on call the night of the BCS Championship. And now I'm on call immediately following the Super Bowl? I can't be awake for 48 hours and maintain my empathy.
- St. Bridget's Day - Feb 1
Groundhog's Day - Feb 2
Super Bowl Sunday - Feb 3
Mardi Gras - Feb 12
Ash Wednesday - Feb 13
Valentine's Day - Feb 14
... Do you see where I'm going with this? Could you not have spaced it out, just a little bit? Do you have any idea how much baking is involved with these holidays?! - Easter in March... I'm not sure about this now... But I'm going to hold my judgement until appropriate.
- "The Gathering" ... ... ... Really? ... ... ... You've changed the registration plates on the car, because you're too superstitious to have "13" on every plate. And you're going to invite ALL people of Irish descent back to Ireland that year... *sigh*
We took the 2 weeks preceding Christmas to go back to the States (then returned to actually work on Christmas). This is becoming somewhat of a norm for me. But early Christmas has suited my family in the past few years, so I can't argue with it. Plus, I get paid extra for working holidays... Though, as it is a holiday, Murphy's law applies.
First week was spent down in NOLA. It was a pleasure as always, and a nice slow ease into the central time zone. It was chilled out, and restful. I felt pretty good after the week... Well, I felt really full, actually, because the food was just too good! Before we headed to NOLA, we'd made a list of places to eat (it's an extensive list that will take months to complete) and we endeavored to hit a few of them up. I'm not going to talk about every meal I ate, but big highlight: Cochon. (Yes, it means 'pig' in french) The food there was perfect... and pork... and so good. I ate way more than I should have, and had my first go at eating alligator (surprisingly good). Other bits to mention, went to the shooting range (that was a new experience); had a creepy walk through the riverfront when it was next to abandoned; got my Christmas cards printed; midnight showing of the Hobit in 3D; did I mention the food? Small side note... If you fly on Delta, don't eat the chicken mole poblano, aka "hot chicken meal"... just don't... |
| Stocking holders |
 |
| Christmas mittens... So exciting! |
Second week was in MN with my fam, the whole fam actually. It's rare that we all get to be together (partners and all), so it's something to be enjoyed. Where NOLA was more relaxed, MN was a tiny bit hectic, people everywhere, things to do, cold weather to avoid! And it was my nephew's first Christmas (and my first time meeting him face-to-face). He's a little dote. I haven't met a baby as chilled out and cool as he is (and while I realise that most of the babies I meet are unwell and therefore cross, even the well ones aren't as cool as he is. Much of the visit revolved around spending time together, eating dinners, going to the movies, playing boardgames (train game!), and sneaking in time to finish making a Christmas present. I highly recommend going to the West End for movies, the VIP section where you can have a bloodymary while watching a 3D movie is pretty excellent (as is the Bacon Popcorn). I also recommend taking an afternoon off and letting your boyfriend make dinner for your whole family, because, let's be honest, he likes messing in the kitchen, and your family likes eating! (Plus, his gumbo is pretty fantastic). So I'm going to tack on some family togetherness photos, and maybe just one or two of my nephew, as he is the coolest. Enjoy.
 |
| My aunt is the COOLEST! |
 |
| You win some, you lose some |
 |
| Christmas socks! |
 |
| Awesome Christmas hat |
 |
| Damnit, mom! I want to open my present! |
Friday, January 25, 2013
Sunday, January 6, 2013
Nothing like a little flood on a Friday
I'd
say that most people are familiar with Murphy's Law. If you're not,
I'll give you the wiki summary: Anything that can go wrong, will go
wrong. As a universal law of truth and inconvenience, it's exponentially
more applicable on a Friday afternoon in an Irish hospital (as you may
also be aware, hospitals in Ireland function like banks--open M-F 9-5
and anything outside of that is met with out of hours limited services
and staff). And in the spirit of good humour and the fact that I have to
laugh or I'll cry, I'd like to recount the last few hours at work on
Friday afternoon.
Having finished the post-round ward work, mostly involving poking babies for blood tests (as the phlebotomists that work in regional hospitals rarely are comfortable doing the same), I took a rare but on-time lunch break. This break resurrected a forgotten Friday tradition (Ursula, I miss you!) of getting a giant take away baguette sandwich for lunch with fellow SHOs to celebrate Friday (though, no one found the 'full fat coke' comment as amusing as Ursula). Having celebrated the last Friday together (as 2 of my co-workers are on holiday next week and the following week we will be scattering to new jobs), we trudged back up to the ward to finish all outstanding work before (hopefully) making a swift and on-time departure home.
Afternoon work is mostly cleaning up the stuff left over from the week, the stuff not addressed on the ward round, the results of the bloods from the morning, and reviewing any radiology... I was waiting patiently for one of the babies to return from ultrasound, writing up discharge summaries, signing lab reports, and searching for the name of a patient that had been in hospital months prior... These things haunt my dreams.
Fire alarm sounded... Something that happens ridiculously often, given the propensity for toast to burn at tea time, and is frequently ignored. All the fire doors shut, but the sound of the alarm is more of a warning than an alarm of immediate action and it seems that one of the other wards has set it off... Noted, ignored. The alarm stops mere moments later and we re-open all the safety doors, and get right on back to our jobs. I desperately search for the chart of a patient that has returned from ultrasound, but sans chart. There is important information I must record if I want to leave today! ... Does it feel damp in the building today? I get the relieving call from x-ray that the chart happened to be left down with them on the ground floor, so I'll just wander down there and fetch it (I have nothing better to do... she says sarcastically).
Now, I'm used to things breaking, I'm used to lights being off, I'm
used to computers running amok, I'm used to things shutting down, I'm
used to seeing weird things around my place of work... However, I was
still (somehow) surprised to walk to the center of the paeds ward and
find the ceiling tiles bulging with water and a slow but steady rain
coming from above... Of note, there is a floor above us in the hospital.
Thankfully, we have a quick thinking nursing staff (yeah... this crap is their job too). The lights had been shut off, the computer had been moved to a safer location, the charts and papers had all been moved from the ward desk (above which the rainstorm seemed to be focused) to various dry higher-ground. Things seemed "under control," so I dashed past this mess to the elevators. I needed that chart!
I took the larger, older elevators (they seemed to be closer to dry ground) to reach the ground floor. And the doors opened into the main ground-floor meeting area/chapel area/cross-roads... Oh the horror!
Across from the old elevators is a single new elevator that is quite small (but quite fast in comparison) with only enough space for 4 people. It's not terribly practical in a hospital, since you've no hope of fitting a wheel chair, but I like it for its size and stealth. From my little, stealthy elevator poured a flood of water. Nothing like what was seen in Hoboken (yes, that picture is from the floods that followed Sandy), but a nice, steady stream of water. And surrounding the open doors and pool of water was a perplexed looking custodial staff. Not much for me to do there, but I did tell them that the water was coming from the 6th floor, given that it was raining on the 5th.
I
quickly retrieved my chart from the radiology department, and took the
large elevators back up to my 5th floor haven... Flooding haven. It was
getting messier. I wrote my notes and fetched my coat... There was no
work left for me to do, and the buckets had been placed under the bulk
of the leaks, but not before an inch of water had collected on the
floors. I should have worn my wellies to work. I waded through the water
to take the elevators down to the ground floor... I think I was one of
the last to use the elevator that day. They locked them on the ground
floor afterwards to keep people from getting stuck... A hospital with
only one working elevator (reserved for theatre use)... On a Friday
afternoon... Three thoughts crossed my mind: 1) What are they going to
do with the elderly patients up on the 6th floor? 2) Who broke the fire sprinkler that set off this floor? 3) Boy, am I glad I'm not working this weekend...
Having finished the post-round ward work, mostly involving poking babies for blood tests (as the phlebotomists that work in regional hospitals rarely are comfortable doing the same), I took a rare but on-time lunch break. This break resurrected a forgotten Friday tradition (Ursula, I miss you!) of getting a giant take away baguette sandwich for lunch with fellow SHOs to celebrate Friday (though, no one found the 'full fat coke' comment as amusing as Ursula). Having celebrated the last Friday together (as 2 of my co-workers are on holiday next week and the following week we will be scattering to new jobs), we trudged back up to the ward to finish all outstanding work before (hopefully) making a swift and on-time departure home.
Afternoon work is mostly cleaning up the stuff left over from the week, the stuff not addressed on the ward round, the results of the bloods from the morning, and reviewing any radiology... I was waiting patiently for one of the babies to return from ultrasound, writing up discharge summaries, signing lab reports, and searching for the name of a patient that had been in hospital months prior... These things haunt my dreams.
Fire alarm sounded... Something that happens ridiculously often, given the propensity for toast to burn at tea time, and is frequently ignored. All the fire doors shut, but the sound of the alarm is more of a warning than an alarm of immediate action and it seems that one of the other wards has set it off... Noted, ignored. The alarm stops mere moments later and we re-open all the safety doors, and get right on back to our jobs. I desperately search for the chart of a patient that has returned from ultrasound, but sans chart. There is important information I must record if I want to leave today! ... Does it feel damp in the building today? I get the relieving call from x-ray that the chart happened to be left down with them on the ground floor, so I'll just wander down there and fetch it (I have nothing better to do... she says sarcastically).
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| Photo not actually from hospital... |
Thankfully, we have a quick thinking nursing staff (yeah... this crap is their job too). The lights had been shut off, the computer had been moved to a safer location, the charts and papers had all been moved from the ward desk (above which the rainstorm seemed to be focused) to various dry higher-ground. Things seemed "under control," so I dashed past this mess to the elevators. I needed that chart!
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| Photo may be greatly exaggerated... May be... |
I took the larger, older elevators (they seemed to be closer to dry ground) to reach the ground floor. And the doors opened into the main ground-floor meeting area/chapel area/cross-roads... Oh the horror!
Across from the old elevators is a single new elevator that is quite small (but quite fast in comparison) with only enough space for 4 people. It's not terribly practical in a hospital, since you've no hope of fitting a wheel chair, but I like it for its size and stealth. From my little, stealthy elevator poured a flood of water. Nothing like what was seen in Hoboken (yes, that picture is from the floods that followed Sandy), but a nice, steady stream of water. And surrounding the open doors and pool of water was a perplexed looking custodial staff. Not much for me to do there, but I did tell them that the water was coming from the 6th floor, given that it was raining on the 5th.
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| Again, not actual footage, but the most accurate photo yet |
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