"Oh! Canada"

Happy post-Canada Day everyone!

Did a shift at Brigham and Women's yesterday - it was great!

I arrived at the hospital after a short cab ride and entered the Charlie unit. Today I would be on team Orange1. The ER is very new, upgraded a couple years ago and is unreal! All patient rooms are equipped to deal with everything from a runny nose to a full blown trauma. The layout has given me many ideas for the emergency department I plan on opening in town (a few years down the road).

I am hanging around the nursing and MD stations when I am introduced to a resident, Dr. A. Turns out, she's from Canada! (we also find out later that one of the nurses trained in Acadia). We wish each other Happy Canada Day, and begin to see patients.

Our first patient complained of chest + abdo pain and had a significant history of gastritis for which he had many previous hospital visits. During our initial H&P (history and physical) we find out that he had been self-medicating with... cocaine. Yes, what better way to relieve your bad guts... Anyways, I later would realize that this is not something that is too uncommon here. Since his crack did not help, he decided to come to emerg. We ordered labs and some scans to determine whether this was his usual gastritis or whether it could be something more serious such as a dissection, inferior MI, or pancreatitis. His EKG did show a flipped T wave in lead III, but all other diagnostics were completely normal. So, after a little bit of discussion with the senior resident and attending, we admitted him to a medicine floor.

Our next patient had a very peculiar chief complaint - "bat exposure." At first I was wondering whether this meant a baseball bat or animal, as bats (like vampire bats) are not all that common in NL. Apparently it's a very well known rule that if you wake up and there is a bat in your room you need to go to the ER. This is because they are disgusting animals that carry rabies. So, we gave the girl a rabies IgG and tetanus vaccine and prescribed 3 further vaccines at days 3, 7, and 11. The girl said something that caught me off guard as she was leaving: "Where do I pay?" It sounds weird, but it sent chills down my spine to think that someone would have to pay to ensure they do not develop rabies. Weird...

One thing that I found really different about their emerg was that they do rounds on their patients every hour or two so that everyone is on the same page. Also, they do team interviews with patients that usually includes the primary physician, attending, and nurse responsible for the patient. This way, the patient doesn't need to give their story to 4 or 5 different people. Something maybe we should consider?

P.s. our attending looked just like "Carter" off ER (Tracey, you would have died!).

One other patient I'll describe was a young lady who had been out drinking the night before and woke up the next morning with tremendous pain in her left hip. Important to note that she has a drinking problem and can drink about two 26Oz per night. She said she had been dancing all night and must have twisted or something. Picturing her dancing made me giggle a little, but I contained myself. We tried to do some physical exam on her, but when we attempted to get her up and walking she screamed and cried like an evil child. (note: I saw her walking in and then we saw her walking to the bathroom, with very little effort). After xraying her hip and determining there was nothing wrong with the joint, we informed her that she must have injured a nerve in her leg while she passed out for the night. We tried to discharge her, but she refused to leave and wanted some "oxy" for the road. Needless to say, we were close to calling security to have her escorted away.

Also of note is the fact that the Brigham ED has its own radiology department. Excuse me, what did you say? Yes, their very own CT scanner and multiple xray suites. They also have "teaching radiologists" on 24/7 who review the scans with clerks, residents, and attendings and teach them about the findings. It's not hard to tell that these hospitals are Harvard affiliated!

Oh yeah and the average wait time to be seen during my shift was: 0 mins. Yep, as soon as they arrived, they got a bed. Nuts.

That's enough about that shift! It was awesome and I saw some really cool things that I probably won't see too often at the HSC. And, a huge shout-out to Dr. A! You did a great job and taught me so much! I know you feel like you don't know anything, but (at least to me) you know lots!

I'm gonna write a separate post now about my travels to the mall today.

Zack