Emergency Room

Five days into my Canadian worklife I had my first shift in the ER of St. Mary's Hospital in Sechelt. Used to an enormous accident and emergency department in London with the usual big city problems - drunks, heart disease, rather inappropriate objects in various orifices and even the aftermath of bombings - nothing could prepare me for my first morning in my new ER. 

As the only doctor in the department I was responsible for everything - from sore throats to cardiac arrests - there was no handy colleague to ask advice, no superspecialists who could take responsibility for various organ issues and difficult transport issues to Vancouver. There was a freshman fear I had not felt for some time - images of my first drip, my first appendicectomy and my surgical vivas sprang to mind and the knot in my stomach took a while to dissipate.

One of my early patients was an equable elderly man with leathery skin and his hand wrapped in what appeared to be an old tea towel (dishcloth for those in the US...). 

"Hey Doc" he smiled affably.

"Hello Mr S. What seems to be the problem?"

"Aaawh, just a case of the old butterfingers while I was doing a little bit around the house, eh?" (I don't want to myth-bust the Canadian myth-busters, but there are still a few souls on the Coast who do say 'eh' with reasonable frequency). 

"May I have a look?"

He gingerly unwrapped his hand to reveal his index finger practically hanging off and a jagged wound into his palm. He smiled again.

"Is it salvageable, eh? I don't have that many left!!"

I noticed that he had fingers on both hands which were various lengths. 

"I was a circular saw operator in my day," he grinned again. It turns out missing fingers are a pretty common thing on the coast - with a paper mill, forestry and Gilligan's pub it seems inevitable.

"Ah, I see. And this injury?"

"Just a little chainsaw accident".

The only time I have ever seen a chainsaw is in an 80's slasher movie and I gulped slightly. After a little local anaesthetic and about 25 stitches later, his hand still looked a little like something from Dawn of the Dead. 

"Thanks Doc, back to work then, eh" he jumped off the bed after a quick tetanus shot and ambled out of the ER.

I was faring no better later. A woman came in with a worried frown.

"I have a tick on my leg". A what?"I have been told that a doctor should take it out so it can be tested".

I peered closely to see a body and wriggling legs protruding from the skin of her shin, rather like a little fat child with his head stuck in a the toilet bowl. 

"Just one moment" I quickly whispered to the excellent male nurse on call with me,"um, what does one do with a tick? Can I just pull it out?"

"Oooh, no. You will leave the head in and then it will be impossible to remove and will get infected. The tick also has to be alive to test for Lyme disease." Ah, Lyme disease. I read a leaflet about that when visiting the Redwood forests of Northern California and was convinced I had it after seeing a small red bite on my arm much to Craig's chagrin, "you have to take tweezers and gently extract it so no more bacteria gets into the bite". After another first I was left with a live insect in a pot with holes pierced in the lid and a piece of damp cotton wool - the lab tech took the sample with nary an utterance, suggesting it was a common occurrence. 

Rural doc had begun and I half expected a live pig or bunch of carrots as a thank you, but actually received a polite thank you note from the man with no fingers and a simple hug from the lady who did not in the end have to worry about Lyme disease. My initiation was complete for now, but that's not to say there were not surprises in store.