Working in Two Worlds
Although I’ve spent most of my time as a GP/low-volume ER doc with the occasional MedEvac accompaniment, I also work as a locum hospitalist on Vancouver Island, BC.
They are very different jobs. The first is low volume, involves working with kids and elders from a culture totally different to my own, doing procedures like IUDs/biopsies/cardioversion/intubation/casting, rare/brief visits from specialists, and you never know what walks in the door (or comes in by helicopter!). Hospital work is more structured; I have a long list of patients for the day that I meet and care for, there are specialists and allied health professionals sitting next to me, I use a lot of my palliative care and internal medicine toolbox, there is access to lots of resources including MRI, and I don’t have to accept any patients (eg. if they are too sick) if our service isn’t equipped to care for them.
Both jobs challenge me and are differently rewarding. In Nunavut, the nurses and I (and maybe one other doctor) are it. We can call Winnipeg for help, but in an emergency, it’s really just us who stabilize the patient, and the MedEvac nurse (plus one of the docs, if the patient is very sick) who transport them to definitive care, like surgery. Real emergencies are not frequent but it is difficult enough to keep us really on our toes, and it is a really fulfilling part of the job to ‘rescue’ a patient from a bad state. Even though the work in Nunavut is low-volume, it’s very easy to invest a lot (too much?) of oneself. There’s a kind of attachment to the patients and to the staff that seems to happen in a small town; it makes it both more stressful and more rewarding.
When doing hospital care only, one can still be attached to patients and the care team. However, when I leave for the day, I really leave. I know the patients are in someone’s capable hands and I don’t worry about them overnight. And in my hours off, I’m off! I can even turn off my phone – something I’ve NEVER done in Rankin Inlet. But, then, I miss the culture of the north and the challenge of being somewhat isolated.
Both positions have a lot to offer, and apparently I’m not the only one to divide my time like this. Dr Mate pursues a more noble and more distant calling than I – a bit of inspiration for my future: A second day job half a world away: One hospitalist divides his practice between the East Side and Africa