My first day on call started with a bang. On call means we are the Emergency Medicine physician, the Internist that admits patients from the ED (ourselves) to the hospital (ourselves), the OB triage nurse and the Obstetrician, the Pediatrician and the Emergency Radio Doctor.
And it’s All. On. Paper. Sheets and sheets of paper. I know this was the common standard before and still now in small rural hospitals, but since I was pretty much brought up on electronic health records, I’m not very efficient in navigating paper. It’s akin to a kid raised on computers going to do a a research project in a library. I know I’ll get it down~ it just takes time. I still need to learn how to dictate!
Today I saw eight patients in the ED (which doesn’t seem like much, except that of those I admitted three of them (to myself)…all three related to alcohol). Additionally, I had two OB preterm labor rule outs, which is more intense, because we do not have the necessary equipment to take care of premature babies, and it’s important make the right call. I had several emergency radio calls from the villages, and a few of them I (with help from my superiors) decided to send to Nome. One by MedEvac, and three by commercial airplane, which takes longer, but is more cost-effective.
The breakdown of types of patient visits:
1 Ortho (axed finger with open fracture)
2 EtOH withdrawal
1 Pancreatitis (related to EtOH)
1 Rule out TB
4 Emergency radio calls
But everyone was so willing to help, and so kind and encouraging. The nurses (again) jumped in to help me out and to back me up. I was surprised at how many of them were fairly new as well! There were plenty of support staff, awesome medical student and PA student to help me with patients. And the A-mazing long-term doctor was doing things behind the scenes constantly to make sure everything was completed, calling social work, arranging transportation and accommodation for our pediatric patient, whose parents were unable to be his guardian, and his uncle (who had a barrier against him staying in housing provided by the hospital, because of past crime) was his guardian. So a lot of social work needed to be done. What would I have done without all of them!?!
The paramedics and flight team helped stabilize a young man who was going through alcohol withdrawal and delirium tremens (Latin for shaking frenzy). This is a life threatening condition in the extreme of alcohol withdrawal. I haven’t been the one *in charge* of caring for DTs before. While it’s not necessarily difficult, it’s scary.
I shuffled through papers, lost a few (somewhere between the two floors that we work on), and I shuffled my brain trying to figure out the paperwork. I feel quite disorganized and lost in a paperwork system! I don’t have my own system for this yet–I need a clipboard and paper files and a way to carry papers around among four departments without losing them. 🙂 I really miss electronic health records; it’s so clean and relatively seamless—everything can be found (labs, admission orders, notes, templates, communication from other providers, consults, phone numbers, fax numbers, consultant numbers…etc). in one desktop, anywhere. It’s
Overall it was a great day. I think about the need and what can be done for a community for public health education, empowerment, raising health literacy (the capacity to obtain, process, and understand basic health information and services to make appropriate health decisions (CDC)), providing input and investing into the system to help wherever it is needed.
In spite (or maybe because) of me feeling a a little bit overwhelmed, the new radiology tech (from Belarus) was so kind. He told me that I radiate positive energy (and I trust someone like him to know about energy radiation). 🙂 I hope it endures.
The Radiologist and I had a fun conversation about Papua New Guinea–he is brilliant and interested in lots of things. He taught me an interesting case–where he diagnosed twins on x-ray! (they had to do an x-ray for something else, and the patient had not had an ultrasound yet, so that’s how they discovered that there were two babies). I have never seen an x-ray of fetuses inside a mother before.
Also, some of the nurses invited me to a village cultural event in Teller this weekend! I am so excited to get to see some of the local culture. 🙂