Dear Patients: Please Stop Asking Me for Sick Leave

Dear Patients,

Please stop asking me to write you sick leave and then getting disgruntled when I say no. If I don’t think you’re sick enough to stay home then that is the medical opinion you have paid/waited in line for. If you don’t like it you can go and pay/wait in line somewhere else. Please stop asking us (doctors) to compromise our ethical standards (and potentially risk losing our license to practice) for your benefit. It’s considered fraud. I wouldn’t show up to your place of work asking you to break the rules; I only want you to extend the same courtesy to us.

Sincerely,

‘Doc’

P.S.

While we’re at it, please stop asking me to write your prescription in someone else’s name. It’s not just that your boyfriend clearly has no medical use for the vaginal inserts I’ve prescribed for you, it’s also insurance fraud. Thank you.

 

An Aside on Jamaican Culture (potentially upsetting imagery)

When I was on my Junior Surgery rotation, we had a 94 year old lady who presented with Stage IV breast cancer after having had a mastectomy for cancer in the other breast.

The tumour this time was a rock solid, fungating mass that had already changed colour, and I had to wonder as I often did and will how a patient waits at home for their situation to deteriorate this badly before coming to the hospital. Breast cancer is a terrible thing – any illness is. But patients keep presenting at such late stages, all hope is almost lost.

Just like the countless diabetic patients who present with severely infected feet days or weeks after the initial problem. Sometimes they show up so late, the only option is to amputate the limb.

We have this pervasive culture of “I going to watch it likkle first” whenever we see something going wrong. Then we sit and watch and watch until it becomes so much bigger than anything we thought we could handle. Like another patient who had to piece together brassieres to fit her growing tumour until she finally presented with one breast twice the size of the other.

I don’t know if it stems from the general antipathy toward doctors that we have as a nation (especially Jamaican men!) or if it is just that we underestimate the problems we are faced with. Jamaicans do have a tendency to put troublesome things out of their minds until we can bear it no longer.

Whatever the reason, we need to stop it. The business of healthcare is prevention, not intervention. Doctors don’t want to have to cut the foot off. Or remove the breast. We want you whole and healthy and happy.

But your health is your responsibility.

Thank you for your footprints

Sometimes being a medical student is a thankless job. More often than not it involves a lot of bowing and scraping, yessir-ing and yesma’am-ing. Trying desperately not to look like an idiot in front of the consultant, staying on the residents’ good side, befriending the interns and obliging the patient all have to be juggled on a daily basis at the hospital. It’s all a part of the job.

Did I say job? I meant it’s all part of the paid humiliation disguised as learning.

Don’t get me wrong; it’s not all bad. It feels good to answer a difficult question correctly, to be commended on a good examnation, and to site your first (successful) intravenous access. These are the priceless achievements for which we sweat and toil. And the payoff is usually worth it.

But you still have to put up with the consultant forgetting your name, the resident stealing your pen and the patient whose endoscopy you’re assisting passing gas on you for the fifth time in five minutes.

Why is a Raven like a Writing Desk?

Because the emergency room is like a stage. And we poor players just strut and fret our hours.

I have been called “nurse” so often in the last three weeks that I have begun to ignore it. Most of my conversations end like this:
“No, sir, I don’t know if you can leave now.”;
“No, ma’am, I don’t know when the doctor will see you.”;
“Sorry, I can’t help you. Let me get you an actual nurse.”

Welcome to Cornwall Regional Hospital, where the patients are many and the beds are few. But don’t worry, the emergency cubicle is always ready and waiting. Oh, the anecdotes I could share.

For instance, once we were assisting the resident on duty to suture a three-year old’s facial laceration. Assistance at these procedures is mostly about restraining the screaming, kicking (biting) child while the resident tries to avoid putting his eye out with the needle. We assistants were actually being assisted by the toddler’s mother, grandmother and aunt and we were still having a hard time. On top of that the grandmother kept telling the little boy to behave because the nice nurse was fixing up his face for him. She said it like five or so times, and then the aunt started saying it too. Finally the resident tells them, “I’m a doctor, ok? Not a nurse.” at which point the grandmother goes “Oh, okay.” And five minutes later says, “The nice nurse soon finish, don’t worry.”

So there was definitely humour around the Sisyphean mountain of work. In between trying to site intravenous accesses (fondly termed “drip” by our patients), interpreting electrocardiograms and taking histories, we made friends and we made memories. I realized that I love the touch-and-go aspect of emergency medicine. I thought I would; I’ve never fancied holding on to patients indefinitely and inundating them with repeat blood test after repeat blood test, but it’s good to know. This feels more like ‘proper doctoring’ because we get the patient as they walk through the door – without the benefit of a preliminary diagnosis – and the detective work that ensues is like watching a piece of art take shape.

Okay, that might be a bit much. Suffice to say, that I find it all really, really exciting.

And all too brief. This week is the end of the rotation, and I feel like there’s so much more for me to learn. (There definitely is more for me to learn for my exams on Friday, actually). Like my three week stint on Gastroenterology, I just feel like staying in this department forever. I can learn to deal with sleepless nights and uncooperative patients. I just want more. I, I . . .

True story: this gif makes me want to cry every. single. time.