Medicine-ERA: Any Docs/Nurses/other medical professions around here?

[ElementaryDerision]

Weirdest case? I dunno, what can you share?

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Well, there's the trauma stories, the psych stories, and the sick medical stories.

For example, I was in triage the other day and a gentleman calmly walks in and tells me his house was broken into and he was stabbed with an axe. An axe. I look down at his arm and see a little scratch and wasn't too worried but then when he lifted up his arm to show me the wound his shirt armpit was covered in blood. He lifts up his shirt and has a monstrous gaping 12 cm wound that goes all the way down to his ribs but did not, by miracle, penetrate his pleura. Incredible. We offered him a wheelchair to the trauma bay but he insisted on walking.

Neurosurgery PGY-5

Tired all the time. Always on call. Operating every day.

Love my job.

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I'm sorry man. By the way, I have a consult for you.

 

[ElementaryDerision]

We can move it to this thread. PGY-4 in Emergency Medicine, currently at our national conference. Looking forward to real life.

 

[Tribes of Trusty]

Hey there. Actually last year of med school (9th year), just need to present my thesis in order to get my PhD.

Spoiler

if only I had a subject T_T

 

[lootenplunder]

Awesome, I'll be applying to med school in June. Looking forward to this thread.

 

[Morrison71]

Generalist Lab Tech here, graveyard shift. It's a smaller hospital too so I have to draw a lot of blood as well. I'm just two years in, it's been a lot of fun. Sure beats the days of working at a Wonderbread plant for years.

 

[Juan29.Zapata]

We offered him a wheelchair to the trauma bay but he insisted on walking.

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Adrenaline is one heck of a thing. I always try to remember to check for injuries in armpits and between the legs precisely because of stories like this.

You know, you just made me remember a story told to me when you mentioned the psych stories. A patient had become agitated in the ER at night, apparently because of the use of psychoactive agents, and only two nurses were available to contain him (two big guys I was told), the patient began to bite one of the nurse's finger, and ended up amputating it. During this, a gush of blood went straight into the other nurse's eye. The patient swallowed the finger. The catch? The nurse who lost the finger is HIV-positive.

I'm sure both the nurse and the patient received prophylaxis, but I have no idea how following tests turned out.

 

[ElementaryDerision]

1. That sounds horrifying.
2. How is that nurse allowed to work in the ER?

 

[Deleted member 176]

1. That sounds horrifying.
2. How is that nurse allowed to work in the ER?

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???
Becaude they have HIV? People with HIV can work anywhere, unless a part of the job is mixing bodily fluids with other people lol (There is no job like this)

 

[Patrick Bateman]

Hey there. Actually last year of med school (9th year), just need to present my thesis in order to get my PhD.

Spoiler

if only I had a subject T_T

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9th year? Where do you study?

 

[ElementaryDerision]

???
Becaude they have HIV? People with HIV can work anywhere, unless a part of the job is mixing bodily fluids with other people lol (There is no job like this)

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Sure there is. I wouldn't be able to work because my job involves performing procedures on patients with the risk of needle stick to me and then the patient, putting them in potential harm. Not performing these procedures is more harmful if the procedure is life-saving. I would have to switch my specialty to something not necessitating procedures (e.g. Pathology). Similarly, ER nurses place IVs in critically ill patients with higher risk of stick. This is a risk of mixing bodily fluids in this high-risk environment. My patients come first, not my employee rights.

 

[Deleted member 176]

Sure there is. I wouldn't be able to work because my job involves performing procedures on patients with the risk of needle stick to me and then the patient, putting them in potential harm. Not performing these procedures is more harmful if the procedure is life-saving. I would have to switch my specialty to something not necessitating procedures (e.g. Pathology). Similarly, ER nursed place IVs in critically ill patients with higher risk of stick. This is a risk of mixing bodily fluids in this high-risk environment.

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You shouldn't have a job as a nurse if you have any chance of sticking yourself and then your patient with the same needle. I don't even know how that would happen.

 

[ElementaryDerision]

You shouldn't have a job as a nurse if you have any chance of sticking yourself and then your patient with the same needle. I don't even know how that would happen.

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Inherent human fallibility. Every healthcare worker sticks themselves at one time or another. You might stick yourself and bleed into an open wound (e.g. laceration repair). Every surgeon I've known has done it. The risks exists, but we want to minimize it, you know?

 

[IAMtheFMan]

Hey all, so Ambient80 and I will try to see if we can merge the 2 threads. :)

 

[Deleted member 176]

Inherent human fallibility. Every healthcare worker sticks themselves at one time or another. You might stick yourself and bleed into an open wound (e.g. laceration repair). Every surgeon I've known has done it. The risks exists, but we want to minimize it, you know?

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So a person who has HIV shouldn't be able to be a surgeon either? That's such a low risk that its ridiculous to deny someone working a job as constantly in demand as an ER nurse because of it. You thinking there are a lot of nurses out there getting a deep stick with a needle and then turning around and using that same needle to put in an IV instead of just getting a new one? That's just being a bad nurse.

 

[bgbball31]

I've completed all pre-med courses, but haven't had the courage to take the MCAT yet :-(.

 

[Tribes of Trusty]

9th year? Where do you study?

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France, system is different from the US.
You have an entrance exam at the end of the first year where only a certain number of people can be accepted. You can only try twice.
First cycle is the first two years.
Second cycle is the four following years ("Externat" or intern) where you begin to work as a slave medical student at the hospital.
At the end of the second cycle you have another exam where you choose your specialty of exercise depending on your rank. You may only try once (or twice if you're lucky).
Third cycle is the "Internat" (resident) and can last three to five years depending on what you do. You're now a slightly more efficient slave resident working at various hospitals and have to present a thesis.

 

[Ambient80]

Hey,

I posted an OT in the Hangouts area too. Hope to see you there though this thread probably has more visibility.

https://www.resetera.com/threads/ph...-for-students-mds-dos-pharmds-rns-et-al.2093/

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Hey guys!

To follow up on this, myself and IAmtheFMan talked and we are going to request a thread merge (I just messaged Shinobi about it, although I'm not even sure if it's possible? We'll find out!). The resulting thread will be posted in the more General OT section for a couple weeks, before being moved to the Hangouts section. This way we can all be in one place to share our dark humor and gross stories, ;)

 

[Patrick Bateman]

Wow, I always thought that Germany had the longest med school with 6.5 years.
But it's actually pretty similar: First two years are preclinical with chemistry, biology, physics, anatomy, BC etc. The following four and a half years are the clinical part with all other subjects like surgery, urology, neuro etc. After the third state exam you are pretty much free to choose whatever speciality you want. You work as a resident for 4-6 years and then you're specialist or senior physician.

 

[Tribes of Trusty]

Ah it's pretty similar then (about ten years) it's just that as residents we still have some classes about our speciality and we are encouraged to get some additional diplomas

It's cool that you can choose your speciality rather than it be decided by a rank, but I've read an article about med school in Europe and your system looks a little complicated, doesn't it ?

 

[ElementaryDerision]

So a person who has HIV shouldn't be able to be a surgeon either? That's such a low risk that its ridiculous to deny someone working a job as constantly in demand as an ER nurse because of it. You thinking there are a lot of nurses out there getting a deep stick with a needle and then turning around and using that same needle to put in an IV instead of just getting a new one? That's just being a bad nurse.

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It's not as though I'm pontificating for pleasure. Medical ethics prioritizes the patient's well-being. Legally, policies regarding disclosure vary by country and region (and even institution). But I would consider it an ethical violation to knowingly put patients at risk, however small, if it is avoidable.

I did give you an example of how an accidental finger stick could lead to patient exposure. Transmission of infectious disease occurs in many ways, not always blood to blood. Mucosal membranes, particularly the eye, are very sensitive.

Is there a personal example or reservation that you're drawing from? I'd like to hear about it if that's the case.

 

[Juan29.Zapata]

1. That sounds horrifying.
2. How is that nurse allowed to work in the ER?

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Yeah, I can imagine that is pretty horrible.

And I don't think any employers (including hospitals) are supposed to discriminate due to diseases in my country. Most likely the nurse receives treatment and with recent studies stating that HIV infection is unlikely if viral levels are undetectable, I think there's no problem of him working with patients.

It wasn't even the nurse's fault as well, the hospital should be prepared to contain agitated patients at any time.

Also, one can talk about medical ethics, but the law is able to dictate otherwise. Like for instance, euthanasia shouldn't be allowed on the ethical grounds of Medicine, though the jurisprudence of many countries allow it.

 

[Sgtpepper89]

Im a nurse student in 3rd and last year. Currently working on the exam essay for the bachelors degree and the article search is killing my soul.

Time goes really fast and I have no idea in what field I want to work.. its not helping that the lack of nurses is so big that I can work wherever I want..

 

[Patrick Bateman]

In Germany we have a thing called Hochschulstart. You register there. 20% of med students are able to enter university via grades they got in their matriculation examination. 60% are able to enter via a mix of grades and tests. 20% are allowed to enter via waiting time, meaning that if you wait for a long time, you'll be able to enter no matter what your grades were.
You are allowed to register or take most tests as often as you want. And even if you don't succeed there you are allowed to enter after waiting for like 6-7 years.

After you finished university you are allowed to do any speciality you want. You just apply at a hospital that wants you and that's it. Most hospitals and most specialities are looking for young docs, so we don't worry about getting our dream job.

 

[ElementaryDerision]

Yeah, I can imagine that is pretty horrible.

And I don't think any employers (including hospitals) are supposed to discriminate due to diseases in my country. Most likely the nurse receives treatment and with recent studies stating that HIV infection is unlikely if viral levels are undetectable, I think there's no problem of him working with patients.

It wasn't even the nurse's fault as well, the hospital should be prepared to contain agitated patients at any time.

Also, one can talk about medical ethics, but the law is able to dictate otherwise. Like for instance, euthanasia shouldn't be allowed on the ethical grounds of Medicine, though the jurisprudence of many countries allow it.

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Yeah, I'll concede the disparity between law and ethics. And while I think workplace protections are important, I would also be curious about say, a pilot with well-controlled epilepsy.

 

[Deleted member 176]

It's not as though I'm pontificating for pleasure. Medical ethics prioritizes the patient's well-being. Legally, policies regarding disclosure vary by country and region (and even institution). But I would consider it an ethical violation to knowingly put patients at risk, however small, if it is avoidable.

I did give you an example of how an accidental finger stick could lead to patient exposure. Transmission of infectious disease occurs in many ways, not always blood to blood. Mucosal membranes, particularly the eye, are very sensitive.

Is there a personal example or reservation that you're drawing from? I'd like to hear about it if that's the case.

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You're think nurses are gonna cough up blood on their patients eyes? Spit onto a needle before they put in an IV? Even if the person with HIV has no viral load control, the chance of transmission is so small with even the simplest level of caution and common sense that it would be ridiculous to even suggest someone get a different job because of it.

Maybe it's different in surgery, but having worked as a nursing assistant before I can't imagine any situation that a nurse would get their blood on a patient that couldn't easily be avoided, outside of situations like the above where the patient starts violently attacking them. And even then, the nurse with HIV could easily have their viral levels at a level where chance of transmission is essentially zero. The reverse, where you're getting a blood sugar and a splash of blood comes near your eyes or where a patient could knock away a needle after you've already used it into your finger or shoe isn't unlikely. But getting your own fluids onto the patient? The only way it could happen is purposeful neglect on part of the nurse.

I may be coming across a little agressive, but from where I'm standing it seems like you're trying to use bad logic or one in a million scenarios to discriminate against people with HIV. For some reason people only pull these really weird "what-if" scenarios out when discussing HIV, and that ain't right.

 

[ElementaryDerision]

You're think nurses are gonna cough up blood on their patients eyes? Spit onto a needle before they put in an IV? Even if the person with HIV has no viral load control, the chance of transmission is so small with even the simplest level of caution and common sense that it would be ridiculous to even suggest someone get a different job because of it.

Maybe it's different in surgery, but having worked as a nursing assistant before I can't imagine any situation that a nurse would get their blood on a patient that couldn't easily be avoided, outside of situations like the above where the patient starts violently attacking them. And even then, the nurse with HIV could easily have their viral levels at a level where chance of transmission is essentially zero. The reverse, where you're getting a blood sugar and a splash of blood comes near your eyes or where a patient could knock away a needle after you've already used it into your finger or shoe isn't unlikely. But getting your own fluids onto the patient? The only way it could happen is purposeful neglect on part of the nurse.

I may be coming across a little agressive, but from where I'm standing it seems like you're trying to use bad logic or one in a million scenarios to discriminate against people with HIV. For some reason people only pull these really weird "what-if" scenarios out when discussing HIV, and that ain't right.

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No, I understand where you're coming from. I just think that things still happen, even with the best of intentions and training. And without fault. I think working as an NA is perfectly possible--I suppose you're right to say that we can't account for every possible scenario; but I do think we can mitigate risk by assigning people to environments which maximize their efforts and skills while minimizing any potential risk to the patient (you pointed out its small with HIV, which is true and I'm very happy about that).

I'm coming from the position of being knee deep in a trauma resuscitation with twenty people in a room shouting and needles everywhere (and god forbid an agitated patient). It's not a controlled environment, and people have cut themselves in the middle of a thoracotomy, for instance (if not on a scalpel then on the patient's rib).

On the other hand, surgery is probably the most controlled thing we do. But the frequency of motions that risk cutting is so much higher. I don't know the numbers and there are a lot of places where we also have need.

And let's not forget hepatitis and the rest of our transmissible friends, where the rates are a bit higher. HIV is a sensitive topic for obvious reasons.

 

[Tribes of Trusty]

In Germany we have a thing called Hochschulstart. You register there. 20% of med students are able to enter university via grades they got in their matriculation examination. 60% are able to enter via a mix of grades and tests. 20% are allowed to enter via waiting time, meaning that if you wait for a long time, you'll be able to enter no matter what your grades were.
You are allowed to register or take most tests as often as you want. And even if you don't succeed there you are allowed to enter after waiting for like 6-7 years.

After you finished university you are allowed to do any speciality you want. You just apply at a hospital that wants you and that's it. Most hospitals and most specialities are looking for young docs, so we don't worry about getting our dream job.

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That sounds like the Swiss system then.

I didn't get the rank I was aiming for so instead of the specialty I wanted to do I settled for GP but now 2 years after I'm perfectly happy with that choice

 

[TheNotoriousAFG]

NJ represent! Got my MCATs score back a few weeks ago, and am satisfied! Need to start prepping for my gap year stuff and applying to schools next year, but I'm aiming to make the most of my senior year here in the meantime.

 

[Juan29.Zapata]

Yeah, I'll concede the disparity between law and ethics. And while I think workplace protections are important, I would also be curious about say, a pilot with well-controlled epilepsy.

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That is an interesting case, I honestly do not know about jurisprudence to answer that, specially since we're both from different countries probably and laws can vary.

 

[Deleted member 176]

No, I understand where you're coming from. I just think that things still happen, even with the best of intentions and training. And without fault. I think working as an NA is perfectly possible--I suppose you're right to say that we can't account for every possible scenario; but I do think we can mitigate risk by assigning people to environments which maximize their efforts and skills while minimizing any potential risk to the patient (you pointed out its small with HIV, which is true and I'm very happy about that).

I'm coming from the position of being knee deep in a trauma resuscitation with twenty people in a room shouting and needles everywhere (and god forbid an agitated patient). It's not a controlled environment, and people have cut themselves in the middle of a thoracotomy, for instance (if not on a scalpel then on the patient's rib).

On the other hand, surgery is probably the most controlled thing we do. But the frequency of motions that risk cutting is so much higher. I don't know the numbers and there are a lot of places where we also have need.

And let's not forget hepatitis and the rest of our transmissible friends, where the rates are a bit higher. HIV is a sensitive topic for obvious reasons.

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It probably does really matter on the environment. Like even different ERs are probably wildly different depending on hospital size/location. Have you ever heard of someone being denied a job because of disease? I mean yeah there's HIV/Hep, but I'm wondering if there are people doing surgery with really bad heart conditions and stuff like that which could be a huge disaster in a stressful situation. Does a pathologist get fired if they start showing signs of dementia?

 

[EarthBound64]

Like for instance, euthanasia shouldn't be allowed on the ethical grounds of Medicine

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Just popping in to say **** that.

I can see individual doctors delegating that responsibility to someone else.
But to say that it "shouldn't be allowed on the ethical grounds of Medicine" - I don't agree with that at all.

Full disclosure: Not a doctor, just someone who strongly believes in a patient's right to die.

 

[Juan29.Zapata]

I do gotta say, guys, you really make me want to study ethics. Very interesting points you make.

 

[Gozert]

I was in the last few months of my internship (in and around Rotterdam) when I had to take a break because of fatigue problems. After a visit to my family doctor, being bounced back and forth between internal medicine and cardiology and a second opinion I was finally diagnosed with postural orthostatic tachycardia syndrome (POTS). This process took around 18 months and the situation got a whole lot worse, including syncope, severe palpitations, memory issues, concentration issues and speech impediments. Thankfully, I've made a lot of progress over the last year and life is starting to become somewhat normal again. I don't know if I'm ever able to function at the same level as before, but even then I don't know if I want to finish med school. I have to start my internship all over again (the full two years), and I will also need quite some time to brush up on my knowledge and skills before that. I also have some serious doubts about all the stress and long hours that come with the job. The last few years have really changed how I view life in general, and I'm not the same person I was before I got ill. :/

 

[Juan29.Zapata]

Just popping in to say **** that.

I can see individual doctors delegating that responsibility to someone else.
But to say that it "shouldn't be allowed on the ethical grounds of Medicine" - I don't agree with that at all.

Full disclosure: Not a doctor, just someone who strongly believes in a patient's right to die.

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Oh please, don't believe I hold that belief! I'm a strong supporter of euthanasia. But the Hippocratic Oath does have a part of no administration of poison. I also believe that even if the oath says "first, do no harm", I think that some diseases can do more harm in certain cases if euthanasia is not allowed.

 

[EarthBound64]

Oh please, don't believe I hold that belief! I'm a strong supporter of euthanasia. But the Hippocratic Oath does have a part of no administration of poison. I also believe that even if the oath says "first, do no harm", I think that some diseases can do more harm in certain cases if euthanasia is not allowed.

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What about mental/emotional harm?
Is it right to keep someone alive in absolute torture and agony, as opposed to allowing that to be ended?

 

[Juan29.Zapata]

What about mental/emotional harm?
Is it right to keep someone alive in absolute torture and agony, as opposed to allowing that to be ended?

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That's what I refer to as well. We agree.

EDIT: You reminded me the case of a Belgian woman who suffered from depression and she asked for euthanasia, and it was approved. That's something I agree with.

 

[EarthBound64]

That's what I refer to as well. We agree.

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Sorry, read your previous post wrong, mea culpa.

But, yeah, it doesn't even necessarily have to be "administration of poison" - it can simply be removal of things in place to prolong life.

 

[Deleted member 13628]

Just popping in to say **** that.

I can see individual doctors delegating that responsibility to someone else.
But to say that it "shouldn't be allowed on the ethical grounds of Medicine" - I don't agree with that at all.

Full disclosure: Not a doctor, just someone who strongly believes in a patient's right to die.

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Then those patients can seek their own means to do so. I don't ever want to consider myself or my profession as executioners.

If someone has a terminal disease, then we stop futile treatments and focus on keeping them comfortable and pain free. There is no reason, from both a medical and ethical point of view, to execute a patient.

 

[EarthBound64]

Then those patients can seek their own means to do so.

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And how do you propose a patient to do that if, for example, they're paralyzed?

 

[Deleted member 13628]

And how do you propose a patient to do that if, for example, they're paralyzed?

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I don't. Because it's not my job to assist in someone's suicide.

I also want to add, just because a patient asks for something, doesn't mean the physician has to comply. That is actually not one of their "rights". Patients ask for all kinds of things all the time, that are not medically indicated or even harmful. What does fall under their rights is the right to refuse treatment.

 

[EarthBound64]

I don't. Because it's not my job to assist in someone's suicide.

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Then, as I said:

I can see individual doctors delegating that responsibility to someone else.

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There's a difference between "I personally don't want to do it" and:

There is no reason, from both a medical and ethical point of view, to execute a patient.

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Which I believe is very wrong.

 

[Juan29.Zapata]

Then those patients can seek their own means to do so. I don't ever want to consider myself or my profession as executioners.

If someone has a terminal disease, then we stop futile treatments and focus on keeping them comfortable and pain free. There is no reason, from both a medical and ethical point of view, to execute a patient.

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I think euthanasia is a pretty grey topic. It is true, one should resolve as best as it is possible the patient's suffering, but in some cases, even with the best care, it is not possible. Take for example the Belgian woman who suffered from depression and was granted euthanasia.

I also don't think patients should have to turn to their own means. Imagine if State-sanctioned executions can be botched, imagine a lay person trying to calmly end their lives. The pharmaceuticals used for euthanasia are also very well controlled by anti-drug organizations. All of which make it very complicated for the patient and his or her family. I think that as long as you can morally object, there's no issue, because there are others who can do it.

Sorry, read your previous post wrong, mea culpa.

But, yeah, it doesn't even necessarily have to be "administration of poison" - it can simply be removal of things in place to prolong life.

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No worries, I should have stated I didn't share that belief.

On your other paragraph, you would be confusing euthanasia with palliative cares. Palliative care is not euthanasia, and many physicians who do palliative care are not supportive of euthanasia. Many times patients ask for euthanasia but when you resolve their physical pain, they stop asking for it. It's a very interesting topic!

 

[Deleted member 13628]

Then, as I said:




There's a difference between "I personally don't want to do it" and:



Which I believe is very wrong.

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"My job" is in it's not the job of a healthcare provider.

 

[EarthBound64]

"My job" is in it's not the job of a healthcare provider.

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And I strongly disagree with that.

I also don't think patients should have to turn to their own means. Imagine if State-sanctioned executions can be botched, imagine a lay person trying to calmly end their lives. The pharmaceuticals used for euthanasia are also very well controlled by anti-drug organizations.

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Seriously, yeah.

"Then those patients can seek their own means to do so." is just beyond absurd.

 

[laoni]

I'm a strong supporter of euthanasia, and have made the plans to do so, in the event my cancer comes back and is terminal, or can't be treated without bankrupting my family. I'd live as long as I can while my body cooperates, and then kill myself when my quality of life has deteriorated past an acceptable level.

But I also entirely understand doctors not wanting to be the ones to administer it. Were it legalised, I'd advocate heavily for physicians to be able to not do it.

 

[Deleted member 13628]

I think euthanasia is a pretty grey topic. It is true, one should resolve as best as it is possible the patient's suffering, but in some cases, even with the best care, it is not possible. Take for example the Belgian woman who suffered from depression and was granted euthanasia.

I also don't think patients should have to turn to their own means. Imagine if State-sanctioned executions can be botched, imagine a lay person trying to calmly end their lives. The pharmaceuticals used for euthanasia are also very well controlled by anti-drug organizations. All of which make it very complicated for the patient and his or her family. I think that as long as you can morally object, there's no issue, because there are others who can do it.

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I don't like the idea of suicide. I am not in favor of any state sponsored suicide. That's beyond horrible.

My point is that if someone is to the point where the only "solution" they see is ending their life, then they should not be turning to healthcare providers. They're looking at the wrong people.

 

[EarthBound64]

But I also entirely understand doctors not wanting to be the ones to administer it. Were it legalised, I'd advocate heavily for physicians to be able to not do it.

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I completely agree with this - I don't believe any individual doctor should be forced to do that, for any reason. And that's very reasonable.
But some would deny a patient that right entirely - which I believe is inhumane.

I don't like the idea of suicide. I am not in favor of any state sponsored suicide. That's beyond horrible.

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And that's you.
Other people - obviously - feel differently.

 

[Jombie]

I've been a paramedic for about 10 years and work at a government facility. Some of the posts in here really put my life into perspective haha..

 

[Juan29.Zapata]

I don't like the idea of suicide. I am not in favor of any state sponsored suicide. That's beyond horrible.

My point is that if someone is to the point where the only "solution" they see is ending their life, then they should not be turning to healthcare providers. They're looking at the wrong people.

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I understand that. And you, as a health care provider, can refuse to do it on the grounds of your morals, because at the end of the day, the patient's rights cannot go over your rights to refuse (and let's not get into the debate if it's moral to refuse, because that's a whole other beast).

But as a human being, I cannot in good consciousness tell a patient to search for other means, that can be violent and traumatize his or her family and not allow them to grow and transcend beyond his or her death. I personally do not find that moral.

So that's the good thing, if you refuse, which you can, someone like me can takeover and everyone wins.

 

[KujoJosuke]

I worked as a nursing assistant for 10 months and just couldn't handle it. I had plans to go to school for nursing and be a nurse but it all fell apart. Mom has been a nurse for 44 years and has been doing hospice for 15.

She's seen enough to "definitely" (i just asked her) believe in medically assisted suicide.