Now, I know what you’re thinking: “But Slim, it’s not like you’re treating these people purely out of the goodness of your heart! You’re well-paid by the Ministry of Health to provide these services!”

Yes, I know that. However, I say thanks when the operator puts my call through. I say thank-you whenever the guy at the service station fills my car’s tank with gas. I say thanks every morning when the woman at Tim Hortons hands me my bagel and coffee. Should it not therefore be reasonable for me to expect a simple thank-you for treating someone’s hemorrhoid, headache or heart attack?

One Sunday afternoon I was paged to the ER stat. I raced into the major treatment room to find a screaming 20-month-old boy with multiple second-degree burns all over his body. An older sibling had accidently knocked a kettle off the stove and doused him with boiling water. Large blisters were welling up everywhere and he was in acute distress. He needed immediate fluid resuscitation and pain relief. Unfortunately, he was an unusually chubby little fellow and there were no accessible veins in sight.

A few weeks earlier I had attended a pediatric trauma course and learned about a relatively new way to access the circulatory system of a child. It was called an intraosseous infusion. The technique involves drilling a large bore needle through the shinbone and into the marrow beneath it. Fluids and medications can then be administered directly into the bone marrow. From there they enter the bloodstream. As soon as I got back from the course I ordered some intraosseous kits for our ER. I figured they might come in handy someday.

Several attempts at starting a regular IV were unsuccessful, so I asked one of the ER nurses to open an intraosseous kit. The device consisted of a sharp, hollow, inch-long needle attached to a round, plastic handle. I explained the procedure to the boy’s mother. She gave her consent and went outside to wait until we were finished. The nurse immobilized the child for me. While I injected local anaesthetic into his upper shin, I reviewed the procedure in my mind. In the course I had taken we had practised inserting intraosseous needles into inert chicken bones, but this was the real deal – a shrieking, writhing toddler. I pushed the needle firmly into his tibia. When it was solidly embedded I began to twist it in deeper by rotating my wrist from side to side. I could feel the metal grinding its way through the bone. It was a strikingly unpleasant sensation.

Eventually the needle punched through to the marrow. After confirming proper placement we attached it to an IV bag and began infusing morphine and fluids.

As his condition stabilized we inserted catheters and applied dressings to his wounds. I contacted a burn specialist at a pediatric hospital in southern Ontario and had him flown down for definitive care.

Over the next several days we followed his progress via a number of sources, both direct and indirect. By all accounts he was doing well and was expected to have a satisfactory recovery. We were especially proud to hear the pediatric burn unit had been impressed with the quality of care he had received at our facility. We patted ourselves on the back for a job well done.

The only thing that bothered me slightly about the case was that the mother hadn’t thanked me for looking after her child in the ER.

“ But Slim, she had other things on her mind! Her son had just been badly burned!”

Yeah, I know. I was there, remember? Although I realize it sounds petty of me to even mention it, I still think a brief thank-you would have been nice. Oh, well. Life goes on.

Exactly one week later I was out in my front yard raking. My daughters were having fun running around and jumping into the piles of leaves. Suddenly an unfamiliar truck pulled up to the curb in front of our house. A man jumped out and strode purposefully across our lawn directly towards me. My kids stopped playing and eyed the stranger cautiously.

“Are you Dr. Gray?”

“Yes.”

“I’m Mr. Farquhar. You looked after my son Peyton last weekend when he got burned.”

I thought, "Oh, that's who he is! He's dropped by to say thank-you in person! Wow, isn't that considerate?"

He reached into his jacket pocket and pulled out a wad of forms.

“I need these completed ASAP so we can get our travel expenses paid. Can you do them right now?”

I was dumbfounded.

I was enraged.

I was hurt.

“If you drop those off at my office tomorrow morning, I’ll see to it they get filled out,” I said quietly.

“Sounds good.”

He turned around, marched back to his truck and drove off.

Snap!

Last Friday I was on call. During the day the emergency department was hopping. I zipped home at 7:00 p.m. for a quick bite to eat and a 30-minute power nap. At 8:00 I returned to see the evening crop of outpatients. I worked until 11:00 and then charted in Medical Records until midnight. When the paperwork was completed I dropped by the ER to make sure the coast was clear. A pink Post-It note was stuck to my knapsack. Those are never good. This one's raison d'être was to advise me that a patient named Mr. Yorke on unit 4 was short of breath and having a rapid pulse. Geez, how come no one paged me about this? I went over to the ward to investigate. As it turned out, Mr. Yorke was one hot mess and I ended up having to work on him for a couple of hours.

At 6:00 a.m. I was summoned back to the ER to stitch up yet another drunken Jethro. This particular genius had taken a swan dive onto a flotilla of empty beer bottles that had spontaneously assembled on his kitchen floor. By the time I finished with him there was hardly any point in trying to go back to sleep, so I raided the fridge on unit 4 and ate a couple of mystery-meat sandwiches at the desk. At 8:00 I started my ward rounds. I figured if I got rounds out of the way early I’d be able to enjoy the rest of the day with my family. Of the eight acute and chronic care patients I visited, Mr. Yorke was still the sickest. Our stockroom was fresh out of bags of IV Miracle, so I had to spend another hour or so getting him squared away. By 10:00 I was finished. Freedom! A sunny Saturday and no more work to do!

When I got home I asked my daughters if they wanted to ride their bikes to the park with me. It was looking like the perfect day to fly our new kites. Their answer was a resounding “Yes!” I went upstairs to get ready. Halfway through my shower the phone rang.

“Hello?”

“Hi Dr. Gray. We need a clarification on your order for Mr. Yorke’s potassium pills.”

After sorting that out I finished getting ready, rounded up the kids and herded them out the front door.

It’s not easy riding 15 blocks with a trio of girls ages five, six and seven. I was right in the middle of negotiating a busy intersection when my cell phone started ringing. I shouldered off my backpack and rummaged through its contents until I found it.

“Hello?”

“Dr. Gray, Mr. Yorke is refusing to take his potassium pills.”

Suddenly something snapped. A severely unhinged stranger who sounded a whole lot like me started caterwauling: “I don’t care! I’m not on call anymore! I did my call day yesterday! Get whoever’s on call today to deal with this crap!”

My kids goggled at me, their mouths hanging open. Passers-by edged away nervously. Small-town family medicine. What’s not to like?

Tough Call

One Friday night an elderly patient of mine presented to our emergency department with atypical chest pain. Her EKG had been chronically abnormal ever since a heart attack a few years prior, so it was difficult for the on-call physician to determine whether or not she was experiencing an acute coronary event. He increased her anti-anginal medications and watched her closely. After a period of observation in the ER she was admitted to the medical ward for further monitoring.