Back to nights: the space to think and teamwork

I had mixed feelings about returning to nights 2 weeks ago, however, as my preceptor, who has the exact voice of Quagmire from Family Guy stated, "you have time to critically think on night; days you just try to survive."

The first night I was able to successfully handle 2 sick ICU patients on my own which was the boost in confidence I had been seeking. I also participated in a code on another night where I did chest compressions for only the second time in my life. It was a well orchestrated dance that I felt like at least I knew my own moves instead of being in the way.

The end of orientation is 2 weeks away, but now a definite point on the horizon. Although I'm not looking forward to flying solo the teamwork is incredible and I'm thankful to be working with such nice competent people. 

This quotation fits well with tonight's mood and is one of my little brother's heroes:

"My work is all about adventure and teamwork in some of the most inhospitable jungles, mountains, and deserts on the planet. If you aren't able to look after yourself and each other, then people die" 

- Bear Grylls

Gratitude and Happiness: Say thank you today!

Quotation for a Friday

Why are American health care costs so high?

A free upgrade from bronchitis to atypical pneumonia and why Zoomcare is still awesome....

Today I have been working on mandatory education for work from my computer. My throat is still raw, I sound like I have been smoking for 40+ years, and my lungs are tired of cough-cough-coughing. The upside is my rib cage muscles will be buff and my abs are getting an extra workout.

Low and behold the nurse from Zoomcare called me to check up on how I was doing. First off I have never ever had this happen with primary care. Obviously they are concerned that their patients get better after they leave.  The nurse was concerned that my symptoms had not improved much since Sunday and said she would have the MD call me.

An hour later I chatted with the MD and explained that some of my symptoms had changed, but not improved per se. She said it sounded like I was dealing with atypical pneumonia, not bronchitis, and that she was calling in a prescription to my pharmacy right away for azithromycin. And that she will be calling me back on Friday to see how I am doing.

I am so pleased at the care I have received!

Zoomcare: An unwanted adventure in really great primary health care

I have been battling bronchitis x10 days. I officially lost my voice at the beginning of my three days of work this week. It made for a frustrating 3 days of work since I talk ALL the time. I fortunately was able to not cough during those 12 hour shifts due to antitussives and decongestant meds and continued to wash my hands incessantly but I barely slept last night as it all caught up to me and I turned into a phlegm monster.

I popped online Sunday morning around 0445 to figure out just where I could go on a Sunday to have an MD confirm the fact that I have an infection and whether it was viral or bacterial. My hospital does have employee health and an urgent care clinic. Both are closed on Sundays. Not helpful!

I happened to notice a few weeks ago a Zoomcare in downtown Boise. I booked an appointment online from my cell phone in bed . It's a one time flat fee for service. No hassle or haggling with insurance. And I'm not going to ER for something minor and clogging up the system meant for traumas, severed limbs, and septic shock.

Overall, the experience was incredibly satisfying and the service was superb and I am serious when I say every town in America should have an urgent care clinic like Zoomcare. I walked in for my appointment at 11:00am and I saw the PA at 11:05am. No waiting. Although I was totally disappointed that my bronchitis is viral (meaning that I will be miserable for another 2-3 weeks) they were helpful in giving me an albuterol inhaler to help with the shortness of breath I have been experiencing. So now I'm on the road to recovery and can breath again.

Environmental behavior : walking & biking

"Walking is man's best medicine."

~Hippocrates 

I might add "bicycling" to that quotation too! According to my Noom app for my phone in the last 7 days I have walked 26 miles and biked 15 miles. This doesn't even take into account the thousands of steps I take during a 12 hour shift at work. 

These last few moves have reminded me how often human behavior is shaped by the built environment. In our previous location I was in my car at least once a day to do anything. Additionally,the idea of walking the dingoes was a chore fraught with stress as dogs would come out of their yards to attack my pups; walking on the street rather than sidewalk was a somewhat safer option but still unpleasant when dodging vehicles.

Our new neighborhood has nice sidewalks that encourage activity and neighborhood community. Like our Portland home, we have met the neighbors and know their names! Parking in downtown here takes just as long as a bike ride to down town and one is definitely better for your blood pressure than the other. Additionally, bikes are fairly common here and cars know to watch for cyclists. I maybe drive 1-2 times per week for errands that require a vehicle - like groceries for the week.

In our ongoing national critique of obesity the human environment is often missing from the discussion. Food deserts breed fast food and unhealthy food options when grocery stores are lacking. Unsafe, unpleasant streets breed more driving rather than walking or biking. It's not surprising our population struggles with its waistline when we spend more time behind the wheel. 

The last 7 months of living rural were terrible for my health and now I'm slowly chipping away at the 30 pounds that I gained there from not enough exercise (despite dogs walks) and the amount of time I spent driving to get anywhere (even if it was to go hiking or walking my 5-7 miles a shift). It was a self study in how environment shapes behavior and it was humbling.

Although in the ICU I do a lot less teaching than I did in the IMCU, this is a consideration that I keep in the back of my mind - where do my patients live? Just like air pollutants or water pollutants can poison the human body the built environment constructed without regard to human body can cause an equal amount of damage. 

There is not an easy or quick solution to these - sidewalks are not poured over night and bike lanes are expensive to build, but the conversations are definitely the beginning.