One of the more benign conditions I saw in the ER last week, was a 3-month baby with a hair tourniquet. A strand of someone’s (usually the mother’s) hair becomes entangled around a toe such that blood-return through the veins is impeded. The toe swells up, and becomes acutely painful. Thankfully, it’s usually recognized, easy to treat, and rarely causes permanent damage. The ER physician used a magnifying glass and forceps to carefully remove the offensive hair. With no further risk of blood-flow restriction, swelling decreases in the toe over a period of a day or two. Perhaps some readers will have heard of this condition before, since I’m told it’s fairly common.

I’m racing to keep up, both on my feet and mentally. The Charge Nurse gives the doctor a quick run-down of the patient being brought in by the paramedics. While we wait for the ambulance to arrive, the ER Resident comes over, gives a quick but thorough description of her patient, and asks the doctor for guidance. One of the Nurses interrupts, and asks for clarification on an order. There are three patient areas to monitor. The waiting room is filling, and the Triage Nurse has been separating those out with Flu-like symptoms for segregation to a private H1N1-designated area. The doctor I’m observing with turns to me and, to my amazement, apologizes because of how slow an evening it has been! I suppose ER Docs like it chaotic.

Observerships are an incredible opportunity for us students. Meeting a real patient is incomparably more impacting (and more memorable) than anything we can learn in the classroom. They are the best chance for us to practice our skills at taking histories, examining patients, and using problem-solving clinical reasoning. Depending on your preceptor, they may also be your first chance to learn a new skill! Such was the case this past Wednesday, when the ER Resident was generous enough to teach me how to suture – first time on a real patient! The experience was exhilerating. Particularly as, the laceration was to the patient’s face, and so an aesthetic result was paramount.

Observerships also give a window into the lives of various specialities. My superficial observations of the ER team, are that they are generally fun-loving, easy-going, and active people. They’re also super friendly! After our shift, the entire doc team went for beers together (and invited me!); I understand they do this regularly! Seems like a fun group of people.

Usually the law takes time. Just the words “court case” conjour up impressions of a long, arduous process. So I was fascinated to learn that in rare cases, some court rulings can be made tremendously fast.

The example I learned about involved emergency care for a child. More specifically, care for a child whose parents are Jehovah’s witnesses and don’t believe in blood transfusions. While there are provisions in the law for any capable adult to refuse treatment for themselves, parents cannot refuse treatment for their children when it is deemed medically necessary.

Surely this would be a terribly difficult line to take, since saving the child would, in the parents eyes, be condemning them to hell. But the Canadian legal system has determined that parents who refuse medically-necessary treatment for their children are guilty of child abuse.

In these cases, the law can be applied tremendously quickly from the bedside. I’m not even sure who does it (lawyer?, judge?), but someone comes to the emergency department, assesses the situation, and appoints an alternative attorney of care for the child when necessary. I was impressed to learn that the law could act so quickly.

NOTE: All of this presumes that the child is not capable of making their own decisions! There is no cut-off age for consent. Assessment of capacity is made on an individual basis to decide whether the child is mature enough to make their own decisions.

Recently I helped a future classmate move to Kingston. She is a paramedic herself, and so were a few of the others helping. Thus I had the opportunity to, very briefly, learn a few small things about paramedicine!

Paramedics work hard! They are scheduled for twelve hours at a time, which can become longer when calls come late in the shift. The medics that I was talking to work in Toronto, where they tell me that the calls come frequently with little time between. The job can also be physically demanding, for example carrying stretchers or doing CPR compressions.

One thing that struck me, was how confident these paramedics have become at performing procedures that strike me as terrifying! One of them told me how easy he found it to intubate a patient in the hospital after practicing the procedure in the field under more difficult conditions. Having no clinical experience myself, I was in awe of their competence and confidence!

It seems that there is a frustrating amount of bureaucracy that goes back and forth between paramedics and hospitals. Medics are required to stay with a patient until they are given a hospital bed in the ER. Lacking space and staff, the hospitals abuse this policy by putting patients into an “offload delay” that locks the paramedics into looking after the patient so that the ER staff doesn’t have to. More than one of the people I talked with said that hospital bureaucracy is their least favorite part of the job.

It was a huge pleasure to meet these professionals! It will be very many years before I even begin to learn some of the skills and knowledge that these people have acquired through experience and training.

I had hoped that a post titled ‘My First Stitches’ would describe the first sutures knotted by my own hand, probably on a raw chicken breast or a banana for practice. Fortunately, life has a sense of humour! So – you guessed it – the title of this post refers to my first stitches received, not given.

While volunteering at a kids camp near Sauble Beach this week, I was helping in the kitchen when I slipped with a pizza cutter and gave myself a nice gash at the base of my left thumb. It was really exceedingly brilliant on my part to be cutting towards my own hand! But that is a realization that can only be made in hindsight. Of course, the accident occurred while making the final cut to the final tray of peanut crunch bars.

Although thin and clean, the cut was deep and refused to stay closed. So, we took a trip to the ER in Owen Sound. On this particular day another patient had been brought in with spinal injuries after being trapped under a hay bale. Understandably, the ER docs were thus occupied until the patient was flown to London for treatment by a trauma team.

When finally reached, my turn was largely anticlimactic. The numbing needle wasn’t very painful, only four stitches were needed, and the cut is already neatly closed and healing (see picture). I did get to watch closely, and ask a few questions about the suturing! One surprise was the amount of blood involved – each suture drew two new flowers of blood from the poke holes. Now with the cut almost completely healed over, I can have the stitches out on Friday.