Eat Dirt!

It's spring, and anyone reading this knows that means I'm out in the garden as much as possible.  Now with a toddler in tow, there are new and unpredictable challenges.  Namely the eating dirt dilemma.  Some parents out there know of something that goes like this:

1.  Child plays with dirt.
2.  Child determines that some activity resulting in dirt entering mouth is fun.
3.  Parent calculates just how dangerous having dirt in the mouth is.
4.  Child looks to parent sensing that something may be wrong ('testing the waters')
5.  Dilemma unfolds:

Chastising child may cause him to not enjoy gardening.
Is the particular dirt dirty?  (Are there toxic or dangerous items?)
What are the long term effects of eating dirt?  Are there any benefits?
If dirt eating is bad for you, would ignoring the behavior normalize it or speed its demise?
Where is my camera?

So apart from my conclusion on the spot that this is just another good way to build up my son's antigen diversity, I opted to point out to him that he was eating dirt, but not the stop himself from doing it.  I was fully aware of the content of the dirt (no New Haven toxins, no glass, no chemicals) so was able to remove that level of concern. 

But now I'm wondering, is there anything to this antigen diversity business?  Or is that just another excuse from a lazy parent?

G. O. T. O. E. R.

After a refreshing spring bicycle ride in for my 7am shift, I observed the oddest thing I've encountered in a while. (Keep in mind that as an ER doctor, I work amongst oddity.)

In the shadow of Yale-New Haven Hospital, directly opposite the emergency department entrance, a woman was sitting in the driver's seat of her early 90's model subcompact, bundled in a winter parka, surrounded by her belongings, with an Ouija board on her lap. I regret not pausing to read the message being transcribed by the planchette's movements. Would have the divining changed?


I'm trying to craft this encounter into a poem or short story. If only I had more time...

The Exams That Never End...

Yes they go on and on, my friend...
Someone started writing them not knowing what they're for
And now we'll keep on taking them forever, asking them for more...

Exams that never end...

I'm taking my in-service exam this Wednesday. It's in the neighborhood of four hours long, and is all about emergency medicine. The best part is that it happens to be in the midst of the New Haven portion of my vacation! Thankfully, the number of exams has diminished to the frequency that makes them useful for self-improvement. I expect that there will be plenty of room for improvement between this year's and next year's installments.

And you thought exams ended with graduation. Medical residents in all specialties take in-service exams once yearly, and generally in the same week.

But wait! There's more!

We also must take the third installment of the licensing board exam at some point. It is a general topic exam that covers all specialties. Fortunately for ER doctors, there is not a lot that we don't see walking through the door.

When it comes time to be board certified in emergency medicine, however, there is a whole new round of EM boards, which include oral exams in a hotel in Chicago!

When I think about it, though - keeping myself sharp enough to pass these difficult exams is just another way to do justice by my patients. Who wants a doctor who forgets (insert important medical fact here) when said patient experiences (insert relevant medical condition here) in the middle of the night?

For any of my EM colleagues who happen their way to these parts, good luck this week!

And for other New Haven residents (i. e. my neighbors), we know that the tests that we sometimes complain about actually make us better docs!

This Crazy Town

Everything's connected.

Earlier this month, I spent a week in the back of ambulances learning about pre-hospital medical care. As part of that, I was on the scene at two rather large fires in the city of New Haven. The first was well-reported by the New Haven Independent. I helped take care of guys that had been battling the blaze for hours. We monitored heart rates and blood pressure, gave oxygen, and transported guys with vital signs out of range to local hospitals just to be checked out. The second fire I was present for occurred early one morning and happened to be across the street from a neighborhood where both one of my senior residents and one of my professors live. The former took this photograph of me looking happy about the smoking building in the background. Really, I was just happy to be outside of the back of the ambulance cab...

The very next call that day was for a person who was feeling like she might hurt herself. She had a history of feeling suicidal and had been hospitalized before, so we took her to Yale, where she would presumably be connected with a psychiatrist who could help her. Hopefully it would not be the self-proclaimed "Savior of Death," who was arrested a few days ago about 2 blocks from my home. Evidently, a well-respected psychiatry resident was involved in an altercation in a local bar and found to have an unlicensed firearm on his person. Any person who is charged in the care of others who makes threatening gestures suggesting danger to those individuals or others in the public may be arrested and be searched without a warrant. A subsequent search of this individual's home revealed a stockpile of firearms and ammunition. He lived about a block from me. The instigating incident goes to show that everyone can be affected by alcohol or mental illness - even physicians.

The arrest was made at the same time that the news conference announcing the discovery of Annie Le, the unfortunate victim who has put Yale on the front page of the nation's newspapers and other news sources. The continued media presence around the police headquarters in New Haven has provided additional unlikely casualties in this story. No fewer than two people from the television news industry have presented to the Yale-New Haven Hospital for carbon monoxide poisoning. I treated a cameraman who was thinking slowly and just wanted to go to sleep. It's the time of year that we ER docs need to think more about that colorless, odorless gas that causes more people to wake up dead than any other poison. (Check your heaters for leaks and please don't burn kerosene or gasoline inside!) The cameraman (and his friend, a union representative) asked me what I knew about the occupational dangers of CO. I know that no significant studies have shown ambulance drivers (who often leave the rigs' engines running in closed spaces) to be at risk, but that smokers and firefighters tend to be chronically exposed and sometimes need to be monitored as such.

Which reminded me of the ambulance ride-alongs I did earlier this month.

The Double Life

The other day my neighbor saw me biking home at 8:00 AM. It wasn't that I'd been up all night working a shift a the Yale emergency department. I'd actually forgotten my lunch. Wednesdays are when the formal teaching in my residency occurs. We have 5 hours of lectures starting at 8:30 AM. Sometimes they are all in the same cavernous lecture hall at the Yale Medical School. Last week, we split up into small groups and did some simulation cases before two hours of standard lectures. (In the sim session, I resuscitated an 83 year old woman who was toxic on her digoxin heart medicine and who also had a gastrointestinal bleed. My feedback consisted of, "You have the best bedside manner I've ever seen for a plastic mannequin.") But I digress.

My point is that residents' schedules are known to be strange. It was natural for my neighbor to ask me yesterday if I was coming off a shift when he saw me biking in spandex and toting a full backpack away from the hospital. He was on a morning walk with his wife and young son. In fact, Wednesday was the only day that had a semblance of 9-5 for me. The rest of the week, I worked 4PM to 2AM. The carrots and hummus on my kitchen counter would be no good staving off the hypoglycemia (low sugar) antecedent to nodding off during the lectures. I did worry I'd be late for the first session when I turned around. Fortunately (for me AND everyone else in the program), I had plenty of time to change out of my spandex for the first small group. Emergency physicians are intent on being on time at shift change, but organizing a large group of night-owls at 8:30 AM takes more than coffee...

The same neighbor was washing his car while I was turning up sod for a new garden. We chatted about work hours, the economy and generally of making lemonade out of lemons. (He gets to prepare for his classes and spend time with his son more than he did when business was booming; I always have interesting patients to see in the ED.) We've only lived in New Haven for two months, and have not met many people, but it's nice how often we see those who we have met. We see them when we work in the garden, or when they are walking dogs, or commuting, or on evening strolls... it's nice to live in a neighborhood. I'm not intent on figuring out how to reside in it during normal hours. But even an off-hours resident can connect without that much work.