Friday, February 1, 2008

Sorry we don't have that!

I've mentioned previously that one of the nice things about rural practice is that when you're in a jam you can 'phone a friend'. Sometimes it's a local friend, someone with specific experience that might be useful in a certain situation. In Iqaluit we have a General Surgeon for surgical consultations and GP-anesthetists for patients who need intubation or if we need assistance with critical care (that would be Dr. H). For all other consultations we make a phone call, usually to Ottawa.

Specialists in Ottawa tend to be helpful (or at least try hard to be helpful), but sometimes they aren't exactly sure where I'm coming from. 'You're phoning from where?' 'There's a hospital way up there?' For doctors accustomed to working in large tertiary care settings it can be hard to imagine that we're trying to practice medicine in such a remote environment. Sometimes their most well intentioned suggestions are simply impossible because we lack the medications or equipment to do what they suggest....

Milranone for a cardiac patient? Sorry, don't have that.
Add dobutamine to the mix for a shocky patient? Uh-uh.
Fomipazole for that guy who drank anti-freeze? Sorry, I have him on an ethanol infusion, we don't have fomipazole (although I have been agitating relentlessly for fomipazole for about 6 months now).
Dialysis? Haha.
CT-scans? Oh, my, no.
Okay, well maybe put in an arterial line and monitor the patients pressure until he can be sent out? No no no, we don't have a transducer, sorry about that.
How about a quick ECHO? Oh please.
Well, I guess just put the patient on your med-evac jet and send him down to the Ottawa ICU then? Well, we actually have to get a med-evac jet to come from Montreal then fly back down to Ottawa, shouldn't take more than 12 hours as long as the weather cooperates!

Sometimes it's a bit frustrating. Sometimes it raises the blood pressure of everyone taking care of the patient. Usually we just do what we can and hold on tight until the med-evac jet finally arrives. We do our best with what we have, though I think sometimes the specialists in the big hospitals in Ottawa must think it's all a little behind the times...


Liana said...

You're telling me... I remember getting a nasty lecture from the plastics guy in big city which shall remain nameless "What do you mean you don't have plastics on call 24 hours a day? That's completely unacceptable." Yeah, thanks big city doc. If you think it's so unacceptable, maybe you'd be kind enough to come down here and help us out with a locum!

mw said...

Hi GUys!! come back soon- I miss you. I just read your post this morning, after being told once again last night by an ottawa neurologist that i practice in the "dark ages"- and i'm sure he wasn't referring to our short winter days!


ps, email me today- i have a very exciting offer for you that involves the use of a car for a week
pps, i haven't won the canadian north drawn yet if you can believe it!

Midwife with a Knife said...

Wow. I would think that having dopamine and a transducer for an a-line would be something they would keep on hand in the hospital for the times that they have to stabilize someone for 12 hours until they can get a med-evac.

Dr. J. said...

Oh we have dopamine (but not dobutamine).....that's the one thing we do have.....lots of it. It's when a second pressor is called for that things get dicey. An epi infusion anyone??
I'm not exactly sure why we don't have a transducer. We have very nice monitors that can accommodate one. Running any pressors with automated BP measurements with a cuff is a little dark ages, but it's what we've got...
Dr. J.