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| New year... new blog. Hopefully the novelty of the new-ness will get me writing more often and more usefully. Wish me luck!
http://caveatdoctor.wordpress.com - Let the doctor beware | | |
| 2007 in review - first sentence from the first post of each month:
January: A pre-Christmas photo I wanted to share: someone dropped $50 into the Salvation Army kettle! I wish I could do that.
February: Dammit! Why couldn't I have been on-call last Wednesday-Thursday?
March: Taking a study day off from clinic and the OR - need to do some extra reading in prep for getting pimped by the attending staff.
April: Thursday, yesterday.
May: Week four of Internal Medicine, and I haven't done anything else at all the past seven days.
June: Caught this foliage of posters along Fort St - it's that film guy from Toronto!
July: Ortho call - this time, and for the last time, at the General, and again no residents for Internal Medicine or General Surgery here, nor for Obstetrics either.
August: Things I learned in Trauma Surgery today.
September: I kept putting off writing about Trauma Surgery and am regretting it.
October: I am usually not given to profanity, but I have been getting increasingly frustrated and outraged after the PTSD stories I get at the military base, and today's Ontario electoral reform referendum just pushed me over the edge.
November: Walking home from VGH - about an hour along a deserted W Broadway Av (where did everybody go?), across a ridiculously-busy Granville St bridge (why is everyone in a hurry?).
December: Rural Family Medicine in Masset.
If it's not obvious from the above, all in all I thought it was a pretty neat year. Got to live in three totally new places, two road trips through the Rockies, climbed my first real mountain, satisfied my Singapore and New York itches (though they're both starting to flare up around now...).
And of course, the whole doctor thing was neat too - catching babies, straightening out war stress, patching up gunshots, and just this weekend, reattaching a 12-year-old's amputated fingertip - and not screwing up too much along the way. And when I did, managed to spin it as "teaching" for the other residents and med students, and somehow got a pat on the back and a plaque out of the mess. (It says "2006", but it's supposed to be "2007".)
And most of all, didn't get on anyone's bad side, I don't think; and if I did, got back onto their good side, or failing that, got forgotten entirely - deleted from their MSN, facebook "friends", etc.. A cousin got married, my brother is heading that way, and the family's closer than ever before. Made strangers into acquaintances, acquaintances to friends, friends to better friends.
And crushes? Managed to dodge that bullet. For the most part, anyway - close calls bumping into ML just starting residency in Victoria too; and JP having the misfortune of sharing Obstetrics call with me one crazy night - close, but fortunately no relapse into DTs. As they say, if the military wants you to have a relationship, they'll issue you one.
So, to you, and to 2008. Excelsior! Not officially on-call tonight, but who am I to turn down a chance to hang around and sew up the cuts and cast the broken bones of the usual New Year's revelry? | | |
| Christmastime in Masset. There's a pine tree out by Cemetery Beach that the hospital staff sort of "adopted" as its own. As you'd expect from a community that respects nature and revels in the beauty year-round (it is the main draw out here, getting away from such things like chain stores and restaurants and traffic lights), instead of chopping down a perfectly good and healthy tree just to lug it home and dress up the dying foliage with tinsel and bits of plastic and metal, only to toss the lot into a shredder the next day, they actually go out themselves to the tree and celebrate:
It also gets the dogs out too:
I think Masset's a great place to be a dog. You (ie a dog) can go around leash-free, and the people being all nature-lovers they'll feel guilty if they don't take you out for walks, so you don't have to worry being locked in all the time. There's lots of beaches to run around on:
And there's lots of other dogs to play around with:
And deer heads - apparently dogs are all over deer heads when they find them on the beach:
My preceptor and his wife have a Talhtan Bear Dog, named Tooya:
It's one of a handful of breeds native to Canada. You probably know about Labradors, Eskimo Dogs, and maybe the Nova Scotia Duck-Tolling Retriever - you can tell by the names whereabouts in the country they're from. The Talhtan Bear Dog is named for the Talhtan natives of northwest BC who raised them; they're not a bear-dog hybrid (I thought that at first, like a liger or a tigon), but dogs actually raised to hunt bears. They're extinct according to Wikipedia, but if you know whom to ask around here, you can find one. You'll recognise them by their dark coats and pointy fox-like ears.
Pretty tough to face up a bear, but very people-friendly too - every time I've met Tooya, she always comes up and puts her paw on my foot, like a handshake. Until now I was never sure if I would be a cat or a dog person, but I'm pretty sure someday I'd like to have a dog like that. I'd love to now, but I don't think I'm ready for that kind of commitment. I can't even bring myself to getting a plant for my apartment yet. Much less figure out how to get into one of those "relationships" things I've heard so much about and seem to keep missing the sign-up list for.
Being an island I don't think there were any dogs indigenous to Masset and the Queen Charlottes, and there wasn't any mention of the Haida natives using dogs, but according to the display at the Haida Heritage Centre most of their diet is seafood and fruits and such, not so much game that would need dogs for baiting and hunting. In fact the deer that are on the island were introduced from the mainland just recently (ie the 1800s or so).
The Haida Heritage Centre officially opens next summer, but you can already visit now. It's on the Skidegate reserve, right in the heart of the Haida homeland - unlike most museums and galleries in Canada (and around the world, I guess), instead of taking artefacts away from their natural environments (and their people) to put them in faraway display cases for others to see, the focus here is repatriation, and interpretation right where the pieces are supposed to be.
Woodworking small and large has artistic and practical significance. There's weaving
and bentwood boxes
which have more in common with modern-day plastics than wood - instead of cutting and assembling boards into boxes, you take a single plank, notch the inside, and heat it up over hot rocks so you can bend it into the sides of the chest. Like this:
Being an island people, boats and paddles go without saying
and with the lush forestry around, tree trunks small and large make totems
The poles are a signature part of Haida architecture, fronting each longhouse, which are also signature of Haida design. The Heritage Centre itself recreates the form of a traditional waterfront village:
Some of the houses on the reserve today have their own poles too:
In fact, when you walk around the reserve you see that Haida culture and language are alive and well - a far cry from the stereotypical third-world-like depressed and forgotten parcels of land First Nations were sentenced to in the 17-1800s. There's street signs
local business
and most importantly - children (or at least evidence thereof - there happened not to be any when I stopped by)
and a school to keep language and culture (for they go hand in hand, you can't have one without the other) alive
Apparently the language school is open to everyone, Haida and non-Haida alike - another measure of a culture's vitality, whether or not it's within grasp of "outsiders". Especially working with stoic, skeptical elders, learning the language can open doors. Even if others remain forever closed, like at the Skidegate cemetery - no non-residents allowed, and no photography
In fact, aside from the federal-standard post office box module
the town probably wouldn't be too unfamiliar to its residents' ancestors
Even the long, shallow lines of the BC Ferries ships at the terminal nearby recall the lines of traditional Haida canoes
More photos on the 111-skidegate album. I wonder what the feeling's like, of living on one's "motherland", where everywhere you look and everything you touch, feel, smell, you knew your parents, and their parents before them, and so on, also experienced themselves. What does that sense of history feel like? To be grounded... to be "home".
Maybe it's how I felt coming back to Victoria - catching the last flight off the island before Christmas
delayed 'til nightfall, but in time to escape another 100mm of rain and 100km/h winds, and transfer to a weird rectangular-shaped airplane, with huge ceiling to seat windows
and sliding doors to the cockpit
landing at a newly-renovated Victoria terminal
and riding in a new Prius taxi!
Not only environmentally-friendly, but with the electric motor output display and the on-the-fly fuel consumption calculator, entertaining. Step on the gas, it shoots up briefly to ~20L/100km, before settling down at cruise to 0. Zero consumption! Damn! I've never been in one before: quiet electric motor + tight suspension + Victoria's butter-smooth roads (temperate weather = no potholes, ever!) = feeling like riding a private light-rail train. With leather seats! Lucky it was a good ride, because the fare's fifty dollars airport-Downtown.
Just a quick one-night stopover before going back home home Mum and Dad's for Christmas the next day. Finally cashed in my frequent diner stamp card at The Noodle Box - where the defining taste of med school was Cambodiana, in residency it would be the Singapore Cashew Curry (mild-plus heat, with tofu)
Stopped by the best bookstore anywhere, with the best bargain books collection anywhere - Munro's on Government Street, with its legendary Special Values shelves
and finally a quick walk 'round the Inner Harbour
After that pricey taxi ride the night before, taking the bus would be equally environmentally-friendly but a bit easier on the wallet
and up, up and away
powered on "Jet Fuel Rocket Chips / Destination chili-citron Grignotises qui donnent des ailes"
Whoopee, all of 14g! At least crappy airline snacks will make home-cooked Christmas feasts all the more yummy and satifying. Wonder what Mum and Dad are cooking up tonight. Kind of the traditional Christmas greeting 'round my place, I guess - "Merry Christmas! So what's for dinner?"
And to you, too - Merry Christmas! (What's for dinner?) | | |
| Mr S passed away. I only ever met him twice, but he was down to a tee the stereotypical Native Elder - spoke little but said much, warm in his weathered old smile, hobbled knees and wrists suggestive of a life lived hard, but rippled arms pumping his wheelchair along reminding you there's still a lot of life in there.
At least, until he fell short of breath, suddenly, this morning, in bed. I wasn't his doctor, but I overheard him talk to the lab tech - I think it was the cute one from Jasper, just in for a few weeks - coming in to take a picture of his chest. "Can you come back after lunch? I'll be up and you won't have to fight to get me sitting up then." Well, she didn't - he passed away, quietly, found two this afternoon.
The nurses were shocked. "Anyone but him, anyone but him." That means a lot when nurses and doctors feel that way when they lose a patient. I mean, we all feel bad when we lose someone, but to feel genuinely sad, to feel a loss like that, that's something special. Usually when patients die it's a relief - the sickest patients are usually the ones hardest to manage, the most depressing to see.
But Mr S was none of that. He was the patient the nurses would fight over, they would take him out for walks in his chair around the park. Again, not saying much, but having that presence you just wanted to be around. They talk about "heartsink" patients that drain you; but I guess he was the kind that reminded people why they got into medicine and nursing.
Now, they're negotiating who'll get time off to attend his funeral. I never knew him, but I might just go, just to get a sense of this man so dearly loved by everyone.
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Equilibrium in the world: one Masseter out... one Masseter in. It's our expectant mum, and it's showtime.
It's been hanging over our heads the past few weeks since she last came in - this mum going to deliver any minute, and bleed bleed bleed, on a doctor and nurses who haven't had obstetrics or neonatal experience in a very long time, in a hospital with no surgical or specialist backup. She checks in, it's kind of the feeling before a big exam: all those nights of late cramming and restless sleep are over, just get through the next three hours, and you can sleep easy tonight.
Take home message: Respect the grand multip cervix.
When a mum who's had 6 deliveries is coming out with number 7, it will be fast, and you'd better be ready. I wasn't. She came in with decent powerful contractions every minute and a half, with baby's heart rate totally normal each time. I checked her, she was only 4cm dilated, head nicely against the cervix, with a bulging membrane peeking through. "As soon as my water breaks he'll come right out", mum said. I believed her - six-time mums would know.
I stepped out to call my preceptor at home - I figured, if I could break her waters myself, then I would be sure I'm in the room when baby comes. Plus, if there's meconium (foetal faeces) in the waters, I'd know to take baby straight to the resus bay right away, instead of the usual letting dad cut the cord. (Of course, I knew the cord wasn't behind the bulging membrane - you don't want to pop that, or have baby press through it on the way out.)
Line's engaged. Oh well, only 4cm, plenty of time.
From down the hall: "Doctor they need you!!!"
Lesson learned: Respect the grand multip cervix.
Baby's head is already out, the nurse and doula are unwrapping the cord from baby's neck. I managed to get on a pair of gloves, and plop! That's the sound of 3 930g of baby boy catching on your hand. Weak cries, but pick up a bit when I hand him over to the doula to wipe down. They didn't have enough time to give mum a shot of oxytocin to help stop her uterus from bleeding; knowing that 7-time stretched womb is likely to bleed bleed bleed, I had my eyes fixed on watching for flow, hand on her belly.
They didn't have time to get the delivery tray out either. Cord clips please. And scissors, please. I find I always say "please" extraneously when I'm nervous and giving orders. Another nurse has to run out to get it. The doula grabs over my shoulder for suction and oxygen, but I don't notice - I'm still worried and fixed about that bleed bleed bleed I'm expecting.
A whole minute later another nurse brings in the two plastic cord clips. On they go, scissors to dad. Would you like to cut the cord dad?, I start, still watching for bleeding.
Over my shoulder, the doula - "Doctor, this baby needs resus now!"
Oh! Baby! Blue! Not breathing! But I could swear I heard cries earlier.
Clip and snip the cord myself, jump with baby over to the baby warmer. Feel around the belly button - no pulse. Mask goes over baby's blue lips, and I start bagging. Nurse swings round and feels the belly.
"No pulse." [Bag, bag, puff, puff.]
"No pulse." [Double check the mask placement, puff, puff, puff.]
"Sixty... One hundred... One forty."
Phew! I can breathe again.
Back to mum: just a wee trickle of blood. Oxytocin's in, and the uterus is doing its thing. Placenta comes out - no lab tech, so no cord gases, but we take a sample anyway - and I check the damage. Little wee tear, no stitches. And still, just a wee trickle.
And the uterus is hard as a rock. Not floppy. Not bleeding to death.
Nice.
He's our New Year's baby - first delivery of 2007! Can't even remember when the last one was. Kind of a neat feeling, signing off typewritten (!) template orders from a delivery pack over 15 years old. And what's more, likely the last ever delivery in this hospital, before the move to the new one next month. I fill in the "Notice of Birth (or Stillbirth)" - place of delivery, Masset Hospital - my signature a little mark on town history.
And I, and the rest of the nursing staff, and a happy mum and new baby boy, can sleep easy tonight. | | |
| Managed a little MacGyver-esque trick: the UBC web proxy gets you past the firewall! Hence this post. Still can't get YouTube video or photobucket uploads or anything else that needs Java or Flash to work (need an IT admin guy to unlock the terminal controls), but at least I can go to the sites and if not actually see what I'm missing, read the descriptions and comments. Two steps forward, one step back...
So that pregnant 28-year-old I mentioned earlier... I have no idea where she is now. I mean, I know how far along she is (38wk 5d), but I don't know where she is. As in, location. She's definitely due any day now, I just changed my pager battery for a fresh one, wrote a briefing note for the nursing staff about what to expect (post-partum haemorrhage protocols, and updates to neonatal resuscitation flowcharts), got some tips from Mum (veteran obstetrics nurse, she'll know more than I ever will), the birthing room is reserved, there's room at the inn... but impending delivery or otherwise, she's still not coming in for the standard weekly check-ups. Maybe she did go to Vancouver on her own after all. Who knows?
Like many people who spend too much time on the Internet nowadays, I decided to vent about Mrs I'm-too-busy-being-pregnant-to-go-to-prenatal-checkups by changing my facebook status - I'm neither pro-choice, nor pro-life - just pro-responsibility. And managed to get some heat about it. Unexplained one-liners are like that, I guess. Nice to get some feedback though.
What I meant was, the "right to choose" was won after years of lobbying that choice directly impacts a woman's Charter right to "life, liberty and security of the person". But the corollary is that women, in order to protect their life, liberty and security, must choose, and choose responsibly. Just "letting things happen" - not having an abortion, but not attending pre-natal care and ignoring the risks of labour and delivery - is not a responsible choice.
That's what I mean about being pro-responsible - if you don't want kids at all, don't have sex, or use birth control. There is no reason why I as your doctor, and the rest of society as taxpayers into Medicare, should have to cover abortions or child support for kids you don't want or can't keep.
(Don't insult me, and survivors of abuse, rape and incest, by thinking I would say this with cases like theirs too. You know what I mean.)
If you get pregnant, and you don't want a kid, and you didn't use birth control, I will give you a firm but supportive talking-to, and if you want an abortion, I'll refer you. If you want pre-natal and Obstetrical specialist care, I'll refer you too. But you must want one or the other. Maybe not right away - I will help with counselling and options - but you must choose.
Anyway, spending more time in the hospital (or at least very nearby) than I'd like, but still managing to see a bit of the town. It's close enough to the hospital that not having a car, or even a bike isn't an issue. (Photos from 109-R2-7-masset-1 and 112-R2-8-masset-2; text shamelessly ripped off an email to BML. Sorry! It's just that it's easier to write to you sometimes than to blog here.)
Masset used to be a military base, one of the coastal monitoring stations where big radars and antennae used to point west over the Pacific and north to the Arctic to watch for Russians. The base mostly closed down in the '90s, but there's still an automated listening station you can see from the plane coming in.
It's really the only practical way in, by plane: the ferry takes a whole day from the mainland, which is ok for the bi-weekly supply of produce and meat (chicken days are Mondays and Thursdays: beat the rush and/or stockpile or you'll be waiting 'til the next boat). Not a bad ride though: can be rough with the rain and coastal winds (~100km/h), but a nice view of the mountains on the way in, tapering to boggy marshland around the town. And coming in from Vancouver at least, they don't even bother with security. You just walk right on. Crazy!
The airport must've been someone's cabin once; the attic/loft now the control tower, and the living room the arrival/departure lounge. (I took these photos when I first got here back in November - turns out a bunch of the people there are my patients!)
Being an ex-military base, all so appropriately uniform, the duplexes and streets, like out of some 1950s suburb.
The hospital actually bought out a few of the units ("PMQs" - private married quarters) so temporary staff like me, and most of the nurses, X-ray techs, lab techs, etc have places to stay closeby on postings. They even still have National Defence bedding inside:
The military buildings were all like mobile home modules put together like Legos; the haphazard shapes make them look so flimsy and weak, ready to fall down, but the peeling paint and weathered siding show they were built to last. There's an eerie ghostly feeling around the abandoned barracks and parade grounds... slouch and the ghost of a long-gone Sergeant Major will bite your head off!
A couple of the modules became a rec centre, with swimming pool and yummy, yummy cafe with huge portions I'd send my patients carrying twins and triplets and eating for three or more to:
And another few became a community college:
The hospital is one of those Lego buildings too. It seems like there was a Emergency Room module, a Ward module, and a Clinic module (which is where I'm writing now).
There's a memorial plaque in the middle to an aeromedic crew and a resident (like me) who died on a medevac flight trying to get a patient out during a storm, which are frequent here (like right now), being on the coast and getting the brunt of tsunamis and such.
If the tsunamis don't get you, the asbestos will:
Inside, the elevated floor, low ceiling and narrow hallway make you feel like you're in a trailer home (which, essentially, it is):
Old bilingual signs from the military days:
And also military, the United Nations Declaration of Human Rights poster:
The Emergency waiting "room" is as you'd expect for a 10-bed cottage hospital:
But it's fairly well-equipped to handle everything - from coughs and colds to the aforementioned Mrs-too-important-for-prenatal-care, to full-on MVCs and trauma:
Managed to make the local paper ("paper" = 30-page booklet newsletter) for a trauma that came in, pretty neat! Definitely wouldn't happen anywhere else - definitely the nicest trauma patients anywhere are right here!
The town has a similar austereness to it. The main roads to town have a genuine, rustic charm. There's a British Columbia government sign that's a bit over the top, with the "Towns for Tomorrow" and "The Best Place on Earth" provincial branding; but the stuff that's actually local, are much more true, what-you-see-is-what-you-get.
No bus service, but at least the Village government takes care of bumming a ride for you, you can just wait nearby and keep your thumbs warm:
I can't think of any movies or other towns to describe it, except those generic dusty main streets on old Western movies where people used to have gunfights. I can picture that happening along Main St:
It's a similar desolate feel here, except instead of a saloon, there's a government liquor store:
Instead of wooden boomtown storefronts, it's converted houses, and cement-block and metal bunkers:
Instead of cattle rustlers, there's fishing, crabbing, scalloping and lobstering (?):
There's also art: locals are pretty famous for printmaking, carving, metalwork and jewelry. Sometimes individual artists go up to obvious non-local people (like me) and offer sales; otherwise there's a few galleries in town:
Instead of a jail, there's a mounted police outpost. With the flag at half mast: another constable (only 20 years old!) was shot and killed, in a similar northern outpost the day before I took this photo:
And a court house. The slopy thing isn't really a skylight, just a fake superfluous roofline, probably to hide a roof-mounted air conditioner below:
No traffic lights, but there's a stop sign for all the trucks and 4x4s around:
No chain restaurants or franchises of any sort, but the little home cooking cafes you also see in rural areas across North America. "Pearl's Chinese-Canadian cuisine", one says.
There's a bank:
And post office:
The postmen don't actually deliver mail on the island, instead everyone has a mailbox at the post office. Another picture where I later found out everyone there is my patient too!
There's a Legion Hall:
And a cute little library, which I haven't been to, but apparently does have Internet access so I could've tried to get around the hospital firewall there:
The Village Office and the volunteer fire brigade share another cement bunker, near the park:
Across the street is the Council of the Haida Nation office. The town itself isn't a First Nations reserve (Old Masset, about 5km north is), but it might as well be, since half the town is Haida. Awesome logo!
The Old Masset reserve is actually one of the more "genuine" reserves I've seen. Back on the Prairies reserves aren't any different from really run-down suburban neighbourhoods. Old Masset has it's share of run-downness, but there's still some true-to-life signs of Native tradition. Totem poles:
And I think another one about to be worked on:
At the cemetery, Haida figures (? I don't know the right word for it) mingle next to the usual headstones - some going back to the late 1800s:
Not much in the way of business in Old Masset - smaller population, because non-Aboriginals can't buy land or own property being a reserve, plus any First Nations working there wouldn't have to pay income tax, which wouldn't be fair for any non-Native residents anyway. There is at least a nice cafe though - too bad I came a bit too early to check it out:
There's a new hospital going up right in the middle between Old Masset and Masset - presumably as a compromise for residents of both towns who don't want to travel as far. On paper it seemed like a good idea, especially for resolving the optics of having the hospital so far away from the Old Masset reserve.
The downside being it's in the middle of nowhere, so now the long-term/palliative care patients are totally bedbound, because they have nowhere to go on walks; you can't just pop out for a quick coffee break since there's no restaurants or cafes around; all the doctors (and me) who live in town have to travel further for emergencies; all the temporary staff who come to the island for 3wk-3mo stints (ie most of the staff) because of the permanent shortage will need cars... But it looks nice though:
Maybe if the Northern Health Authority gives everyone their own 2008 Ford Escape to get around when on official business (like they did for me - not bad, not great, but up here, probably better than my Rabbit) it'll be ok. A fleet of new SUVs - your Medicare dollars at work! | | |
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