Coinciding with this time was the peak of the flu season. While running the hospitalist service during flu season, St Paul's was at surge capacity. We had so many patients in the hospital with positive flu swabs, the hospital quarantined the bulk of them on a floor, and in corners of wards to prevent them from spreading it. My roommate was sick for the majority of January and half of February fighting off respiratory infection after respiratory infection. The irony is that she's a respiratory therapist. I thankfully remained immune, but it was a stressful time to be surrounded by so many contagions.
Health is important to me, not just as a doctor, but as a human being who prides themselves on being well overall. I like taking care of myself through good habits and being able to up the ante when I know I'm on the cusp of coming down with something. My family in general lives similarly. We weren't people who went to the doctor often. So it's always been the assumption that we're all healthy and well.
Medicine has a great way of throwing every kind of situation at you that you're rarely ever taken off guard, whether by an illness or someone's story, you see and hear it all. A young female 6 weeks post partum with bilateral pneumonia and pyelonephritis soon becomes old hat by your next shift. It's best not to overreact or get emotional. It helps you keep calm and make good decisions. You say to yourself "Hmmm this is different, I wonder what's going to happen next" so that you can anticipate and plan. Such was the case a late Friday night in January.
It was the night before the CaRMS interviews at UBC. I agreed to help Amanda with the open house by manning an info booth with her and delivering a powerpoint presentation to interviewees curious about the program. I was at home reviewing the slides and rehearsing my points, making sure I was within the time limits. I changed into my PJs in anticipation of going to bed within an hour when my phone rang. I looked at the caller ID and said "Hmm this is different, I wonder what's going to happen next" It was a call from my brother. To clarify, I don't speak to my brothers on the phone often or ever. We text, and even that's a rarity. So a phone call at this time is certainly unique.
"Hey Just, what's up?"
"Dad fainted, he's bleeding from the mouth, and now he's confused saying the same things over and over."
I grabbed my pen and notepad as if I were responding to a page.
"Ok, when did this happen?"
"10 minutes ago"
"What happened?"
"I don't know. I was downstairs when I heard a thump and then mom talking loudly. I went upstairs and there was a pool of blood on the kitchen floor and dad was in the bathroom looking at himself in the mirror repeatedly asking mom what happened. What should I do?"
"Call 911, you say dad had an unwitnessed fall, hit his head, and is confused. Let me know when they leave the house and I'll meet them at the hospital."
Medicine did that to me. It taught me to avoid the emotional knee-jerk reflex, distill information to get the key points, and make decisions to benefit others.
Being a 5 minute walk from VGH (the closest hospital to my parents' place), I beat the ambulance to the ER. I got report from the paramedics, I saw my dad bloody mouth, cussing, repeating sentences. Justin showed up shortly after and 30 mins later, Gavin arrived. Long story short, dad is ok. Broken teeth, but he's got connections (perks of being a dentist I presume). It was likely a vasovagal syncope as his labs, ECG, and CT head were all normal. Healing is coming along slowly but surely and this will be old news soon enough.
 |
| The evidence of the clash between the kitchen floor and my dad's front teeth |
The next Saturday, I woke up early in the morning as I was scheduled to work that day, which isn't rare, except for the fact that upon waking, I soon realized that my hearing had severely diminished in my right ear. I popped my ears, but found no relief. Otherwise, I felt fine. I worked the day and night, managing with one good ear though desperately missing the ability to auscultate heart and lung sounds effectively. Sunday things seemed to be a bit back to normal so I chalked it up to an off day. Monday, I woke up with that same muffled feeling as the Saturday and thought I felt liquid moving in the ear canal. I took some tissue over my pinky, did the ol' pinky twirl in the ear, and found the tip saturated in blood. WHAT THE FUCK?!!? How did this happen? What is going on? I was blindsided and confused. I went to work and immediately told Jenny what I was experiencing and that I wanted her to look in my ear to see if my ear drum is perforated. Unfortunately, we were at surge capacity (essentially for all 4 weeks) and so work took a priority and the ear exam would have to wait until we were both done our initial rounds. Close to noon, we found a few minutes to find an otoscope and she took a peak.
"There's a decent amount of blood and erythema. I think I see a perf"
I sat on that information while I carried about my work, with the state my ear and hearing loss screaming from the back of my mind. Finally when I finished my errands, I pulled the resident (preferential treatment) card and called the ENT resident taking consults that day. He was so cool about it. He squeezed me at in the Clinic within a few minutes. Had to suck out a significant amount of serosanguinous fluid to fully visualize my ear canal and ear drum, and told me I had an acute otitis media aka an ear infection aka the kind of thing you get as a kid that rarely ever develops into a perforation. It was bizarre. Neither of us know how this happened and progressed so rapidly, but the treatment doesn't really change. I was prescribed a course of oral antibiotics along with antibiotic-steroid ear drops.
I spent the majority of the week hearing impaired and not enjoying it one bit. In some ways, it can be a lonely experience. Mid-week, I met up with Maddy and Amanda for dinner and found I couldn't participate in conversation because I couldn't quite hear what they were saying. Granted, Maddy talks so fast that even with my hearing fully intact, I have to ask her to repeat herself. Music through my ear buds sounded so empty without my right ear working. The harmony lines or the backing riff or accent rhythms were missing. Cranking the volume would only exacerbate the discrepancy of what components were in present in the left earbud and what I wasn't hearing in the right. I remember back when I was a youth leader, one of the girls asked "Would you rather be blind or deaf?". I immediately said blind. Hands down, my hearing is far more important to me than my sight.
After recovering from the ear infection, I started my ER rotation which is quite the shift in work style from the hospitalist service. I went from having my own patients and managing their care for weeks to seeing stranger after stranger with no follow-up. Sometimes that's a nice change. You don't have to worry about being so "on" in your personality. You have to be quick and efficient and sometimes that means getting to the point and skipping superfluous pleasantries. We get all kinds of characters in the ER. People who think they have a wealth of information that you should listen to. For example a patient who presented for a prescription for antipsychotics that had run out but wanted to talk philosophy stating it was equally as important as the meds. I don't have time for philosophy in the ER, so I said no and walked out of the room despite his pleas to stay. Then you get people who think they're helping you by answering a different question.
"Are you having any pain with urination?"
"I'm dizzy and have headaches and am not feeling well in general"
"Ok, but are you having any urinary issues like pain or blood in your urine?"
"I drink a lot of alcohol, I would know. So you should probably give me some Ativan before I go into withdrawals"
She was diagnosed with pyelonephritis secondary to urinary tract infection
You get people who don't think they need our help and insist they can manage fine. The diabetic with ketoacidosis who in their obtunded state, insists they know their body and when they need their insulin and when they don't need it (hint: if you're on insulin, you're probably going to need it every day). And last but not least, you get those precious flowers who think their minor complaints warrant a visit to the ER. I had a 19 year old come in at 3am who opened with "I have tonsilitis and need antibiotics". The guy was speaking fine, in no acute distress, tolerating solids and liquids. Oropharynx mildly erythematous, tonsils not enlarged, no exudates, no lymphadenopathy. Buddy essentially came in with a sore throat and cough aka what you and I get at least once a year. At 3am, I have no problem laying on some condescension.
"Do you have a family doctor?"
"Yes"
"Did they tell you to come to the ER?"
"No"
"So what made you come to the ER in the middle of the night?"
"I have tonsilitis"
"And you think that requires emergent treatment at a hospital?"
"Yes"
"Interesting"
Labs were normal. He got tylenol. Buddy just cost taxpayers hundreds of dollars for something he didn't even need to see his family doctor for. While his health "scared" him enough to come to the ER, his lack of discernment and social responsibility scares me.
As a medical professional, part of my duties include being a good steward of taxpayers' money. I don't want this point to be lost on the general public. It's important to teach people to think beyond themselves and to think about the system of healthcare we operate in. A reasonable person should be able to know what merits an Emergency Room visit vs. a doctor's office visit vs. something you can manage yourself. Part of doing that is as simple as looking at the definition of "emergency" and being objective about the symptoms experienced. In the case of my father, there are emergent things you need to rule out e.g. arrhythmia and stroke as causes for the fainting and brain bleed for the head trauma; all of which could be deadly or permanently debilitating if not diagnosed and treated in a timely manner. In my case, my ear, while distressing and atypical in presentation was by no means an emergency. My position allows me access to specialists who graciously took time to examine me. If they didn't have time to see me, I would have made an appointment with my GP. What "scares" us is allowed to be subjective, but our reaction to those scares ought be to thought through.
