medicine

Thoughts In A Pandemic

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Pandemic fatigue has set in as I’m sure it has for all of my medical colleagues. Telephone medicine is getting harder. Patients are worried, fed up and demanding more and more with every phone call. Everyone is stressed out and there seems to be no end in sight.

We are well into the second wave now where I live. Only this time is seems very different. Back in March the government declared a state of emergency, everything shut down to “flatten the curve” yet many of our elderly in long term care died, some in horrible conditions. The kids were pulled out of school so they didn’t get sick and spread it to their parents and we all hunkered down and tried to adapt.

There were conflicting messages about wearing masks. Don’t wear a mask it won’t protect you. Oh no, actually yes, wear a mask. Keep a physical distance of 6 feet if you can’t wear a mask. Don’t have people in your home who aren’t in your bubble. Now it’s okay to increase your bubble. Now it’s not.

It’s no wonder people are confused and tired of this. Did the initial lockdown actually prevent widespread death and illness or did it just delay it? Should we just go about our business as usual and see how it plays out? I wish I knew.

My province has now shut down all indoor dining and gyms for 28 days. To what end I wonder? What happens when they open again? This virus is not going to disappear. It won’t burn out. It will lie in wait to spread again when restrictions ease.

Our kids need to stay in school. People need to work. Hospitals need to keep operating rooms open. The backlog of elective surgeries from the initial lockdown is rumored to take years to get through. We can’t afford another large scale lockdown.

On the other hand, if we do nothing to curb the spread and our hospital ERs start overflowing with sick patients and ICU beds aren’t available – what then? Who decides who lives and who dies?

A New Normal

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Oh no, not another COVID-19 blog!

Nah. Plenty of other people are doing that. I won’t belabour that point.

Hi folks! Been a while, I know. Frankly, haven’t really had the time to sit and write. I’ve wanted to, a lot, but didn’t think I had anything to say that would interest anyone. And to be honest, I still think that. But here I am anyway.

I’m home a lot more now, like most people. Working from home 4 days a week, for a long time from a make-shift ironing board-turned desk in my bedroom. That was fun. (Not really). The ergonomics were terrible, I suffered with brutal upper back spasms for almost 2 months. Should have gone to see a doctor! 😉

But then, after months of lock-down, my husband masked up and went to a furniture store and got me a desk. It’s great! Far more functional than the ironing board, and far sturdier too. Even the cats agree!

Trixie
Coco

As much as they can get in the way, the cats really have been wonderful company for me as I sit for hours every day doing telemedicine. Occasionally they’ve knocked over my phone, spilled my water and licked my snacks, fought with each other, you know typical feline behavior.

But they seem to have a knack of knowing when a particular phone call gets tedious and exhausting, because they’ll do something funny to distract me.

I suspect this new normal will be with us for a while. I have gotten used to my cats being with me, so used to it in fact, that I actually miss them when I physically go in to work to see patients 1 day a week. It’s amazing to me how fast we can adapt to change. I’m not sure I want things to ever go back to the “old” normal.

Revelations.

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This summer marked 12 years since I became a family physician.  I have had my family practice, whereby I am primary care physician for close to a thousand patients, for the past 10 years.  I have learned a tremendous amount this past decade but over the past couple of years I have come to realize that I cannot be everything to everyone.

Let me state that again.

I cannot be everything to everyone.

In the early days of practice, I used to believe that if I couldn’t help a patient that must mean I failed them in some way.  After one patient yelled at me because I wasn’t helping them enough, I nearly broke down.  I was just back from my first maternity leave and struggling with my own post-partum depression.  To be yelled at in my own office and basically told that I was a shitty doctor, well it was the first time I came to tears while seeing a patient.  I had to excuse myself and take a breath.  Thank goodness for my colleagues present in the office that day.  After I composed myself and debriefed with one of them, I walked back into the exam room.  I listened to his concerns and formulated a plan for him.  The appointment ended.

I learned a valuable lesson that day.  I can’t fix people’s lives and while I believe that many patients don’t really expect me to, there is often an unspoken expectation that because I am a physician, I somehow have the answer to all that ails them.

Let me be perfectly clear on this….  I do not.

I can’t fix your life.

I can provide you advice, counsel and recommend options to you – all this in about 15 minutes, sometimes half an hour.  I just can’t delve into your life and pick the up the pieces for you. I can’t do that for one patient, let alone close to a thousand patients.

Having said that, I still do sometimes want to be able to be present for and participate in all aspects of a patient’s care –  to be there when their baby is born; to be there when the breast cancer is surgically removed; to be there when the chemotherapy is administered; to hold their hand as they take their last breath.

I want to do it all.  I want to be that all-encompassing physician who does it all.

But I can’t.

I need to come to terms with that.

 

Let’s Talk

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January 25 is Bell Let’s Talk Day.

One day a year the world comes together to help end the stigma of mental illness.

One day a year, a large corporation donates $0.05 for every tweet and hashtag that says “#BellLetsTalk” towards funding mental illness.

Meanwhile the province I live in is underfunding mental health across the board.  I can’t get a delusional/psychotic patient timely access to a psychiatrist without sending him to the ER or placing him on a Form 1 (ie involuntary 3 day hold).  I can’t get the chronically depressed and suicidal middle-aged woman a psychiatrist to follow her and manage her 3 psychotropic medications.

So yeah, let’s talk about mental illness.

Why don’t psychiatrists actually do what they are trained to do?  Why don’t they follow patients and see those that need weekly psychotherapy? Why doesn’t the Government adequately fund mental health?

How about we talk about mental illness every day of the year and not just one day?

Let’s talk.

I’ll be Damned.

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I have a decision to make.

Do I vote yes and be complicit in accepting a 4 year agreement that knowingly under funds health care and continues to reduce my income;  or do I say no and be subject to further unknown unilateral fee cuts for the foreseeable future.

Not so easy a choice is it?

Better to be screwed facing your attacker? Or better to be blindsided from behind?
Because that’s essentially what the physicians in my province are facing.

Damned if we do. Damned if we don’t.

I am not political. Never have been and really, never want to be.  But I just can’t stay quiet on this any longer.

I am being asked to trust a government that has grossly mismanaged health care for years now and wastes taxpayers money on scandal after scandal.

I am being asked to help manage utilization of health care resources.  What does that mean? Do I tell a patient that they can’t have that ultrasound because we have exceeded the budget for that month?  Do I close my office one day a week because I am exceeding the budget for that month? Do I tell my staff to take an unpaid vacation day once a week because I can no longer afford to pay them for 40 hours of work anymore?

My head hurts.

Changes.

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It’s been a while!

Hard to believe it’s almost the end of June. There’s been a lot going on in my world, most of it pretty good.

My dad is on the mend from his kidney stone issues and has remained pretty stable with respect to his memory and the Alzheimer’s disease (AD).  Two rounds of infection, two general anesthetics, mild delerium and his memory testing was the same!  Unbelievable really. The thing with AD is that the patient kind of remains oblivious to the reality around him.  He recognizes that his memory has declined but he doesn’t understand anymore the impact it has on everyone else, his wife especially.  If there is any blessing with AD it is that the patient loses their higher executive, frontal lobe functioning early.  It is quite the opposite for the family.  My mom is a strong woman though and she is managing pretty well; she goes to her weekly support group, my brother works from their place once a week and she visits the kids when it gets too much.  I wish there was more I could do for her and for my dad.

As for me,  I’ve done two races this month with decent results, given how awful the winter was with my running.  I have another 10K race this weekend and I am not expecting to do any better than 1:15 but that’s okay.  It’s an opportunity to have some fun, run on the highway and get a cool T-shirt and medal!

I’m starting a new part-time job next month in addition to my family practice.  It is an opportunity I sought out and I am excited about. It is an opportunity to grow as a physician, learn about a different model of care and will be a great change of scenery for me.   I’ll be a lot busier, working 5 days a week (instead of 4) but I think I’m up for the challenge.  The future of primary care in my province is looking hazy right now and I am a little worried. We have been without a contract with our Government for over two years and they are planning on implementing change to how primary care is delivered without consulting the front line workers, ie me!  I felt it was time to start looking at other opportunities where my work is actually appreciated.

I’ve missed the blog.  I hope you missed me too.

 

Sympatico

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“Hi Doc,” she said, in a hoarse voice.

“What brings you in today?”

“Wow, you sound terrible.  Are you sick?”

“Oh, you know, ’tis the season.” I cleared my throat, turned to cough in my elbow, then returned to the patient. “So, what’s going on with you today?”

“I lost my voice a few days ago and it’s just not getting better,” she said.

After a thorough exam, I diagnose resolving laryngitis.

“It’s a viral infection and will get better over the next 5-7 days.”

“Can you give me something to speed up the process?”  she implored me.

“No, I’m afraid not,” I said, turning to cough again. “It’s a virus and will run it’s course.  Drink plenty of fluids, get some rest and you should be better in about a week.”

“Oh, okay I guess.  You probably shouldn’t be working, you sound terrible.”

Uh huh.

Thanks.

And you don’t need to see me for a cold either.

 

About those kids… 

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It’s two days before Christmas. We haven’t quite finished getting the kids’ presents and nothing has been wrapped. 

I had a fitful 4 hours of sleep last night while husband lay next to me with the chills. As if things couldn’t get worse he is sick with whatever flu-like illness I had a few days ago. 

The kids have been cooped up so this afternoon I took them to an indoor play center so they could run around and you know, be kids. 

On the way there, I told the older kids that their Pappou (grandfather) is sleeping at the hospital and that I was there very very late last night when they were sound asleep. Of course the older one asked why and I tried to explain. 

My 4.5-year-old son: “Mommy you should have told me you were home. We could have talked and I would have gone back to sleep.”

The 7-year-old daughter: “Wow, mommy that sounds like a long day.”

Sometimes I underestimate my kids. They understand a lot more than I give them credit for.