Thousands dead in Launceston...

Ugh.

I hate taking antibiotics-- they are for the weak. What kind of hypocrite would I be if I told my patients there's no need for antibiotics and then took them at the drop of a hat? Besides, I absolutely believe that the end of humanity will come in the form of wars over water and resistant bacteria (or flu...?). So, it was with a great amount of soul-searching that I finally started a course of macrolides the other day. I'd been sick for almost 16 days (initially just a little swine flu...) and getting worse. Finally I was asked to stop coming to work because I was making the patients feel bad for me. Luckily, I have a few days off to convalesce. To be fair, I guess I would've diagnosed me with sinusitis or pneumonia (no chest xray, but I guess it's pretty bad when you can hear localized rales in yourself?) if I'd come in. The big thing was I was sleeping all day whenever I was off. Eight-to-ten hour shifts and I'm asleep from one to the next! What kind of New York (medical) Resident am I? Getting a little better, and no longer an infectious risk to patients (don't work for a few more days). But unfortunately I haven't felt like doing anything except laying around at home, not accomplishing any thing (car, salary packaging, running/gym...).

And I'm assuming that's when they knew it was time to strike...

Yup, completely frickin' overrun. Don't worry, after making the video I had the stamina to dispose of the bodies, so that's nice. But the live once are still crawling over the computer and in the Gatorade. I only just was feeling like walking down to the store to pick up the traps, which so far do not appear to be all that useful. I've heard it said that by mass (not just number) there are more ants on the planet than people. Well, that's certainly the case in my apartment.

So funny little anecdote: I was working with an Irish-derived locums the other day, and the ICU team comes down to talk to us about the case. We're around the PACS and talking about the case when the Aussie ICU guy says "Whoa, I didn't realize I'd have to bring a translator!" The team started laughing and I didn't get it until I realized that here, the Irish guy and I are the ones with the accents...

For the ED docs reading-- just a tiny example of how we do things differently here. 88 yo woman feeling unwell for a few days. Found to be in new afib, cheap pneumonia on chest XR, and very cheap troponin leak. You guessed it-- ED ROMI, po abx as an outpatient, start metoprolol/aspirin, and check in w/ GP in 2 days to see if afib persists and discuss A/C. WHAT?!?!? I guess that's one way to handle it... The big differences are not ones in medicine, just practice. It's a little like having the rug pulled out from under you. ED is all about disposition and what/where to do/send next. Since that's a little gone for me, I feel like I'm starting residency all over again. I keep getting frustrated that I'm sometimes allowing the fact that I don't know a lot of things (not necessarily about medicine, though sometimes that, but also management here) erode my confidence about things I do know. Common practice on how to handle persistent neck pain in a low risk MVC w/ (-) imaging? Tony once accused me of using “the Shannon Criteria” for clearing a collar. The SC for c-spine pain was basically “I don't buy it.” Here, I've been reluctant to use that criteria, but what do I say when the consult does? I guess it takes the burden of responsibility off of me, but 1) not really (still my patient and I the treating doctor) and 2) it makes the consult think I'm wasting their time. And, due to erosion of confidence, make me think I'm wasting it, too. Sigh-- so that's frustrating.

But, now that breathing is improved and hemoptysis ceased, I'll be on my feet again to run the Burnie 10 km and learn guitar (oh that's right-- you heard me...). There's always a positive. To quote myself from the other night, “Hey, if a patient's going to smack you in the face with a urinal, just be glad it was pre- and not post-.” Medicine is so glamorous and sexy.... Until the next time. --aws