MONDAY dawns and my drive to the
hospital is accompanied by the early rising of the late
autumn sun. I have a 4th year student who begins a month
long elective today. It forces me to look at my work
with fresh eyes. Simon is a pleasant young man who is
considering a career in Rural Family Medicine. His willingness
to work and learn is complemented by a natural friendly
manner with patients and staff. He seems ideally suited
to this work. We spend the morning in the OR, seeing
inpatients and chemotherapy outpatients. In the afternoon
he sees patients at my clinic and we review his work
after each case. I'm instantly struck by how well he
handles himself with each patient. They in turn are
happy to be involved in his education. The novelty of
his presence somehow makes their visit more meaningful.
TUESDAY is a busy one. We see an
elderly man with Parkinson's, mild dementia and a classic
history of paroxysmal nocturnal dyspnea. Simon and I
review the management of heart failure in outpatients
and our patient is pleased with the amount of thought
and deliberation that goes into his care. He leaves
with his wife, well-satisfied that things are under
good control.
On WEDNESDAY, half of our small
ED seems full of my patients awaiting a bed. There's
an 80-year-old with urosepsis, a 70-year-old with a
bowel obstruction and a third patient with syncopal
spells. In addition we have a 29-year-old with what
looks like a basal cell tumour on her neck, which we
excise. We then drive to the retirement home to see
a bright 97-year-old lady who charms my student with
her excellent manners and pleasant demeanour. Her cognition
is razor sharp and she tells him about her early childhood
in mainland China and subsequent life in Vancouver,
England and Montreal. She never married and cared for
her aging brother until his death a few years ago.
That evening a colleague and I
drive into Ottawa to listen to a talk on influenza given
by Dr Ron Lowe. For a brief while we get caught up in
what constitutes most epidemiologists' worst nightmare:
a pandemic. The most memorable slide of the evening
is a graph of human longevity in the 20th century. From
1900 the graph shows a steady increase in life expectancy
from 46 years in 1900 to near 80 in 2000. The only significant
dip in this steady climb occurs in 1918, a result not
of the Great War, but of the flu pandemic of 1918. We
run through the hemagglutinin and neuraminidase coated
shells of the RNA virus to its eight strands of easily
mutated RNA that are the brains of the virus core. We
get embroiled in the controversies of prophylaxis, treatment
and disaster planning. We worry about what will happen
in our hospitals and clinics and our homes should (or
should I say, when) the outbreak emerges. Dr Lowe experienced
the SARS outbreak up close, both as a physician and
a patient. His talk is very well-received by the medical
audience.
THURSDAY is a repeat of Tuesday
— chaotic. Everyone and their dog wants to be seen
and to complicate an already busy situation the police
come in with a distressed 16-year-old girl. The girl
had received death threats over the internet from two
other girls at her school, so her mother called the
police. When they eventually arrived, the girl, in typical
adolescent fashion, was belligerent to the police and
they responded by handcuffing her and taking her to
the hospital to be assessed under the Mental Health
Act. The doctor on call agreed with the mother that
the police had acted most inappropriately and their
adventure ended with a very upset teenager, an angry
mother and a pair of God-knows-what-they-were-thinking
police officers.
When I saw them I was really just
a listening post to allow them to vent and to address
the girl's mental health. Her already low self-esteem
was shattered by the death threats from her so called
schoolmates and her treatment at the hands of the law.
I listened, tried to reinforce some of the good things
which might come from this event, and agreed with her
mum that some time away from the schoolbus trip was
probably not such a bad thing. I know that counselling
will help in this case. Unfortunately, the environment
that triggered this crisis remains (this mother and
daughter are not exactly 'model citizens') and I fear
we'll go from crisis to crisis in this person's young
life.
So today Simon got to see firsthand
how messy family practice can sometimes be. He says
he's pleased to have the opportunity to see all this
'stuff.' Personally, I'm pleased to get through clinic
in time to grab a quick snack before we head off to
the nursing home.
FRIDAY I'm off to a conference
on medical education and facilitation and leave my patients
in the care of the physician covering call for the weekend.
Simon will spend the day in the capable hands of my
OR colleagues.
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