Goals of care

I'm now on ER service. The first two shifts were brutal. 14 hour night shifts. I'm used to 12hr max ER shifts, which is what residents are supposedly allowed to do maximum of. But it's not like I can take off at 6AM when my staff is there until 8. I get paid a whooping 40$ per extra hour I work. Whoo... I'd pay that much for a place to sleep.

As a med student, the promise land where residents get paid seemed so glorious. Now that I'm actually here, turns out we barely scrape minimum wage, especially compared to Ontario. Hah. My on call hours is definitely sub minimum wage. We're also 2 weeks behind our pay schedule so I'm still relying on my line of credit to stay fed...

Today I had a patient who changed their goals of care on me several times. It wouldn't normally be a huge issue but this was an unstable patient that was deteriorating rapidly. More than most, the people in front lines healthcare understand that having an advanced directive, as it's so delicately put, is of immense importance. How much do you want over eager/terrified med students, hefty paramedics and strung out night call teams to be pounding on your chest and smashing rib cages when you're 50? 70? 90? When you're healthy versus when you have diabetes, previous heart attacks, and failing kidneys?

It's a painful talk but it's being honest with yourself. Will you have a good outcome? Is the outcome probabilities in your favour enough, that you want to chance it? How good is your health, really, and are you the kind that wants to hold out for any miracles, or prefer to go on your own terms?

Also, I'm starting to notice that ER patients come in waves. Yesterday and today we had two separate waves of almost identical patient populations, all with similar symptoms, all presenting around the same time.

On a more pleasant note, Newfoundland still boggles my mind. It is breath stealing beautiful. Every corner you turn there's a moment of 'holy crap how can something like this exist and why has it taken me so many years to find it'.

A few days ago my coresidents and a few dentists drove down to Salvage. WOW. There was a moment as we pulled out of Terra Nova to cross into Eastport. One of those golden, framed moments of glorious summer and youth. On the bridge over water, the ocean before us, the cliffs behind us. Windows down, sun bright and just a couple of 20 somethings, all finally escaping the drear of the hospital.