The past few weeks have been a whirlwind for me, and I haven't logged it, so this is a long post. The first adventure was riding with the Queensland Ambulance Service on a Friday night. Since our territory was downtown and the Valley (think Whyte Ave in Edmonton), we saw an awful lot of intoxicated/drugged people, and lots of vomit. Only one broken ankle, also brought on by inebriation. It was a busy night, and the attendant I was with allowed me to do blood sugars, blood pressures and ECG leads.
I also allowed myself to fulfill a desire of 19 years, and bought myself knee high Doc Martens black boots. They are fantastic, and I always feel a little wicked when I wear them. They seem to have broken me in, starting with a blister that covered most of one heel. Now they are super comfy, and I love them as much as a woman can love a pair of boots (which I’ve heard is a lot)
The exam preparation was a crazy week of stuffing my head full of stuff. Lots of caffeine and chocolate went into it. And a little wailing and gnashing of teeth. The exam itself was spread over two days, and was mentally exhausting. After it ended, I gave myself the best present possible, and had an hour long massage. Heaven! Then packing up began. I am putting all my things in storage over the Christmas break, and Rob and I will find a new place to live in January.
I am now doing my elective placement in Bundaberg for 4 weeks. I start off with two weeks of Palliative Care, and the 2 weeks of Emergency. I drove the 4 hours north of Brisbane on Saturday, and took Apollyon with me, as I found a place that would let me keep her. She was distressed to be in the car at first, but then found her favorite spot was on my lap, co-piloting. So cute. My first day on the wards was definitely interesting: psychosis, uncontrolled cancer pain, dysfunctional family dynamics and Cheyne- Stokes breathing. I was paired up with a Dr. John Chapman, and we had what he would call a hectic day. We had 4 admissions from home, via the ER. They were all terminal cancer patients having breakthrough pain that was not being controlled, and 1 had difficulty breathing because the cancer in his lungs were squeezing his windpipe shut. One lady thought she was in India and that people were trying to poison her and begged us to take her to the hospital....
We are expecting a few departures this week. I have learned an awful lot about morphine and all its opioid equivalent friends. And that terminal cancer pain requires a LOT of morphine. For example, one patient is getting 300 mg of morphine per day, plus Fentanyl patches worth 450 morphine mg equivalents. The average ER visit type trauma pain would get you 2.5 mg of morphine. And unfortunately, when they land in ER, that's ALL THEY GET. Can you imagine the suffering if you were at those levels and then bumped down like that??? Unfortunately, these palliative patients are sometimes dismissed as drug seekers, or worse, subjected to rafts of tests and scans and probes to heroically find out the problem and "fix" them. The problem is they are dying, their bodies are changing in preparation, and it's just not fixable. The palliative care area has evolved to help make the last months, weeks and days as comfortable and the least distressing for the patient as possible. That does not include stuffing them full of IV fluid which ends up swelling their legs and bellies (i.e. not in their blood vessels), and subjecting them to painful and invasive tests that will not change the course of their disease or its management. So we spent a fair amount of time in ER rescuing patients from earnest doctors.
The end of the first day was good, satisfying, but I was exhausted. I went home at 7pm, put on my jammies and went to bed. The second day was also a lot of running around, but I don't feel nearly as tired. I guess it's just the transition from sitting on my butt studying all day to actively seeing patients. I am LOVING every minute of finally getting to interact with real people!!!