On Paper, I'm a Paramedic.

Everyone who donates will be entered into a random draw to win one of four Martin & Bosco calendars for 2022 (Canadian & international shipping is included). My mom selected the thirteen photos so it’s a Mom’s Choice edition of the calendar. We’ll also mail you a colourful Martin and Bosco postcard with a personal note as a thank-you because it’s fun to receive “real” mail.

An earnest shout-out to my Multiple Myeloma followers! I don’t offer you much content on this crazy blog but you know I understand how brutal this cancer is on a loved one. I will fundraise for Myeloma Canada for the rest of my life. I’ll never have the opportunity to apologize to Martin for not being able to help him; his suffering was inhumane. Fundraising is a way for me to make that weight a bit less heavy.

Here’s the link to donate.

That word DOES NOT MEAN you’re making it up. It doesn’t mean you’re imagining the symptom. What it means is that the symptom ISN’T DIRECTLY CAUSED BY ANY OF THE THINGS THAT WOULD NORMALLY CAUSE IT.

I fought to get a PCOS diagnosis for 2 and a half years. For the ENTIRE time I was fighting, I was dealing with 3 cysts that were not going away by themselves and eventually required surgery to remove. At one point close to the end of the battle, I suddenly went blind. I was visiting my parents and was standing on the veranda looking out over the tree we had planted in memory of my dog and suddenly I got one of the shooting pains that I was quite frankly used to at that point and my vision started to go dark. It was like the sun was setting while being completely hidden behind storm clouds but it was 2pm in the middle of Summer on a clear day. Within about 30 seconds I couldn’t see ANYTHING. I was 27 years old and I was screaming for my mother.

My mum raced me to her doctor (he was a 15 minute drive away as opposed to 45 minutes to the nearest hospital) and he quickly worked out that there was nothing wrong with my eyes and what had happened was totally unrelated to them. Then he said it was psychosomatic and I freaked out, yelling that I was NOT making this up and I definitely wasn’t imagining it. Very quickly he calmed me down and said he believed me and I had misunderstood. He explained that whatever was going on with my abdominal pains (he suggested PCOS which I hadn’t even heard of at that point) had been ignored for so long that my body was starting to do things other than the normal pain response to try to draw my attention to the problem. My sight going was my body basically jumping around in front of me going “HEY ARE YOU EVEN LISTENING TO ME HELLLOOOOOOO??????”

He gave me some prescription strength painkillers and my sight started to come back as soon as they started to kick in. About 45 minutes after it started I could see well enough to walk around without help and within a day and a half I was back to normal. On top of that I finally had a scan booked to figure out what the hell was causing all the pain.

When I was 18, only a few months after graduating from high school, I started having seizures. Serious, triggered at the drop of a hat, knock me unconscious for an hour or more and leave me dazed for days kind of seizures.

I was rushed to hospital two or three times within the space of a week after passing out in the middle of cooking dinner or talking with my family, but the hospital could not find anything wrong with me. I spent a week in the hospital in a planned admission, connected to an EEG monitor for 23 hours a day with the doctors hoping to catch my seizures in action and finally figure out what they were. I don’t know how many seizures I had during that week, but at the end of it, they said that even after all that, there was nothing wrong with me. After that, they sent me to a psychologist.

I was diagnosed with PNES - Psychogenic Non-Epileptic Siezures. Essentially, it was explained to me, I had been ignoring my anxiety and PTSD for so long that my body was acting out just like @kamorth ’s had. When they started treating me for anxiety and PTSD, my siezures eventually turned into panic or anxiety attacks, and then stopped altogether.

The final diagnosis was inflammation of my endometrium, which can happen with my connective tissue disorder but is rare. The cause? Apparently 6 solid months of long hours, long commutes, emotional distress due to several family situations, and anxiety manifested in this weird way because I am really good at ignoring my body’s warning systems. My body started with some panic attacks, which I ignored. Increased migraines- I just upped my ibuprofen use. I had pain in every ligament and tendon in my body at one point, and I just powered through. My body finally threw up its hands and yelled, “OK UTERUS, UNLEASH HELL” and I was completely unable to ignore it.

1. War Doctor

By David Nott

Image Source: Pan Macmillan

This book is a real eye-opener for the extremes seen in medicine, and despite Nott’s department from the day-to-day NHS lives of other doctors, the relationship struggles and raw emotions depicted by Nott are something any healthcare worker can relate to. The book documents emergency surgeries, humanitarian crises, Nott’s own struggles with PTSD and even personal negotiations with an autocrat in an effort to relieve the life-and-death scenarios overseas we in the West often neglect. Unlike other author-doctors whose works I’ve read, you can feel the emotional investment and care Nott has for the issues he tackles with, and does not shy away from the emotional struggles that come entangled in the job. What’s more, the nature of Nott’s work makes this book an absolute page-turner, whether you’re invested in medicine or otherwise, so I recommend this book to all and everyone. If you are a medical student or are aspiring to be one (like myself), I encourage you to note the empathy Nott feels for his patients and colleagues, and try to mirror this in your everyday life. More often than not medical professionals are told to limit their emotions in order to deal with the tough nature of the job, but Nott directly challenges this; his work argues that, as medical decisions involve human life, the empathy we all experience as humans must be encompassed within our decision making due to the consequences such decisions could ensue. We must know the value of human life through empathy and emotion before making a decision which could affect it forever. This book is brilliantly written, and I encourage all to give it a good read!

2 & 3. Complications and Better

Image Source: The Guardian

By Dr. Atul Gawande 

I’ve recommended this author before due to his unique and captivating writing-style, and his former books from the bestseller ‘Mortal Beings’ are equally enticing! Unlike Mortal Beings, Complications and Better encompass a greater variety of medical issues, and I encourage aspiring medical students to give all of Atul Gawande’s books a good look. True to form, Gawande begins each chapter by discussing a new modern-day medical problem that healthcare institutions from all over the world face; this has ranged from chronic pain, to the obesity epidemic, the advent of new surgical techniques and much more. Gawande then uses scientific literature and his own personal experiences to give a more rounded view of the topic, and suggests new research opportunities to pursue in the future. Both of these books are fundamentally interesting reads (I polished them off in a week!), tackling the major issues of our time with a highly-engaging writing style. Honestly, Gawande could write about the most boring subject matter imaginable and still form an absolutely enthralling book! Recommend to those in science and the science-interested; you don’t have to be a medical professional to read his work! Gawande writes in such a manner that his work and meaning is clear to all, so if you’re just dipping your toe into the science pool, that’s okay and definitely give this a read!

4. T’was the nightshift before Christmas

Image Source: bookedupgirl.com

By Adam Kay

I’ve recommended this author before also, and I’m sure you know why; Kay’s writing is absolutely hilarious. I’m not going to lie, you won’t gain much medical insight from this little novella, but you will get ALOT of laughs about the ‘activities’ patients get up to when Christmas comes around. The book features the same bluntness about the harsh realities of medical life as Kay’s previous work, and so really does knock the naïvety out of the system about life as a doctor. This book, however, is more focused on getting the reader to laugh about the ridiculous cases NHS staff see around the holidays, and it really is a joy to read. I also hope this book convinces some to really appreciate the NHS and the staff that keep it afloat, and hopefully stops people binge-drinking around the holidays and putting enormous stress on the system. But this is not the main purpose of the work, which the book hilariously succeeds at. If you need a bit of cheering up, give this a read, and I promise you will not be disappointed!

5. The Sick Rose

Image Source: www.spectacularoptical.ca

By Richard Barnett

This is the only book on the list that could also be recommended to art students or those interested in illustration! ‘The Sick Rose’ is a book encompassing a culmination of illustrations depicting diseases long since forgotten, such as syphilis, measles, bubonic plague, smallpox and many more. With the advent of the anti-vaccine movement this could act as a harsh reminder of the deadly diseases are ancestors lives were often claimed by, and is a highly interesting read documenting a history of medicine, and providing a window into its past. For those interested in history, medicine or both give this one a good look; you’ll be stunned by the grisly yet oddly beautiful detail it encompasses. But if you have a weak stomach, I’d definitely give this one a pass: the author does not shy away from any facet of human anatomy, or the gruesome effects of these historical epidemics. Either way, this book is a highly interesting read!

If you are a medical student, aspiring to be one or are curious whether medicine is the path for you I highly recommend giving these books a good read. Not only are they all extremely well-written, but also document intricate details about the lives of extraordinary doctors, and give vital insight into the world of healthcare. I thoroughly enjoyed every one of them, and I hope you do too!

-The Dressing Station by Johnathan Kaplan

-Empty Hands by Abigail Ntleko

-Bandaid for a Broken Leg by Damien Brown

-anything by Oliver Sacks

-Tale of the Dueling Neurosurgeons by Sam Kean

- Fire in the Blood is on Netflix and all medics everywhere should check it out. It’s the story of how ARVs became available in SA. This is 10000% worth the watch no matter where you are in the world.

For the American perspective, try How to Survive a Plague.

Most of the medical research was done on white males and their response to medicine. This is why medical books should only serve as a framework but clinical expertise matters more.

A patient came in after taking a 60 day supply of 25mg Carvedilol. He presented with a heartrate in the 50's, and a blood pressure, well, also in the 50's. 50/30 was the lowest. He was drifting in and out of consciousness, so we pushed atropine, the first line drug for bradycardia, to no effect.

You know it's gonna be fun when you call poison control, you tell them what's going on, and their first response is "ooooo that's not good." Poison control recommended Glucagon, 5-15mg IV push followed by a drip of 5-15mg every hour. This comes in 1mg vials, so we had to mix and draw up a lot of these vials. (See below)

He did respond. His pulse was now around 80, and we kept his blood pressure between 95 and 105 systollic. He was placed on a drip of 10mg/hr. I feel sorry for the pharmacist that had to mix the bag of 30mg of Glucagon. Central pharmacy also told us they only had 6 more glucagons in stock after making this bag, so if he wasn't better in 3 hours, we would have a problem.. but that was a problem for ICU to handle (I love you, ICU nurses)!

Glucagon has inotropic effects that bypass the beta blockade, this allows it to increase heartrate and blood pressure even in the presence of beta blockage. Glucagon also counteracts the negative effects of the beta blockade on a patients blood sugar.

Physics: More pencil tricks

If you take the thing out, they’re going to bleed a lot more.

SO. DONT.

News Flash from the Medical Help ™ — we don’t touch it either! Unless the object they’re impaled with is literally too big to fit in the ambulance, We. Don’t. Touch. The. Thing.

The only people qualified to Take-The-Thing-Out are surgeons. End of story.

Okay, but for the love of God, please, PLEASE, if you did, if you panicked and took the thing out…. DON’T…. PUT IT BACK IN.

Blood pressure is the pressure inside an artery (the kind of blood vessel that carries blood away from the heart).

You may have seen it displayed as one number on top of another, like “120/80″. When the heart contracts with each beat, it sends a wave of blood through the body’s arteries. This wave is called a pulse, and it temporarily increases pressure inside the arteries, which drops between beats. The top number of the blood pressure is the pressure at the peak of the contraction. The bottom number is the pressure in between contractions.

There are several methods to measure blood pressure, and they all involve putting pressure on an artery and measuring when that pressure cuts off blood flow.

Traditionally, we have used a cuff that wraps around a limb (usually an arm) to cut off the blood flow. To use this, we pump air into the cuff to a pressure higher than we think the top number of the blood pressure is going to be. We then put a stethoscope over an artery just below the cuff.

At this high pressure, there’s no blood flowing through the artery, so we can’t hear anything. We start to slowly let out pressure until we can hear (auscultate) the pulse. This sounds kind of like a whooshing sound caused by the blood pushing through the part of the artery narrowed by the cuff. We record this pressure as the top number (or ‘systolic’), because we know it means that blood is getting through the artery, but only when the pressure is at it’s highest point during the pulse.

As we let out more air, the sound of the pulse gets louder, then begins to soften as the artery opens up enough to let the blood through completely unimpeded. When we stop hearing the pulse at all, we record this as the bottom number (or ‘diastolic’) because hearing no sound means we are no longer impeding any blood flow, even at the lowest pressure the artery will hold during each beat.

Mechanical blood pressure cuffs work similarly, but instead of using a stethoscope, there is a sensor that detects the vibration caused by the blood trying to flow through the narrowed artery. 

OP is talking about a way to estimate the systolic (top number) blood pressure if you need to know a blood pressure, but don’t have a mechanical cuff and it’s too loud to hear the blood pressure accurately with a stethoscope.

This method involves putting your finger on a pulse below the cuff and inflating the cuff just until you can no longer feel (palpate) the pulse. Being unable to feel the pulse means you’ve hit a point where all circulation has been cut off- the systolic blood pressure. Since there’s no way to estimate a diastolic blood pressure this way, this is recorded as “120/palp” or “120/P”.

Physics: More pencil tricks

If you take the thing out, they’re going to bleed a lot more.

SO. DONT.

News Flash from the Medical Help ™ — we don’t touch it either! Unless the object they’re impaled with is literally too big to fit in the ambulance, We. Don’t. Touch. The. Thing.

The only people qualified to Take-The-Thing-Out are surgeons. End of story.

Okay, but for the love of God, please, PLEASE, if you did, if you panicked and took the thing out…. DON’T…. PUT IT BACK IN.