Farm Thinking

One of the things I learned on the farm was to think on my own. It's something you don't get taught in a book, how to problem solve. It was taught to me sitting in a field with broken down equipment, waiting for my father to arrive and help me. It was taught every morning as my brothers and I planned out how we were going to get our work done the fastest that day. It was taught watching my Dad do things others pay mechanics thousands of dollars for, he has no formal training in many of the things he's adept in, yet he has a sharp mind and like me, his father taught him to problem solve. It's a characteristic that seperates me from many of my peers, both young and old. I pride myself on solving problems others give up on, problems we weren't schooled on solving, things as simple as finding a way to communicate with a swahili immigrant when we don't have interpreters on hand to figuring out what mysterious ailment is hurting my patient and evading detection.

A couple of months back I was between a rock and a hard place. A patient my team was caring for very likely had a GJ-Tube malfunction (a tube that goes directly from the outside abdomen into the stomach and then courses down into the small bowel). My patient's GJ quit flushing and his abdomen became increasingly distended. Stopping GJ feeds allieviated the distention, but how was my very ill patient going to get food? You can give nutrition many ways, but giving it through the gut is the healthiest and sending him to get it fixed requires that we have diagnosed there is a problem with the tube. This is a catch 22 when there's no in house radiologist to perform the study on the weekend. After some inquiry I found it requires a radiologist in house to inject a XRAY contast material down the tube and then take some "pictures" of the abdomen. When confronted with this problem they suggested I leave my patient on IVF over the weekend and get the study monday (There's so much wrong with that thinking that it would be another blog post entirely). As I sat there pondering the stupidity of the situation, I asked why they needed a radiologist to inject the material, they can easily do the XRAY without him. The tech responds, well it's hospital protocol to that only a doctor do this. 1 hour later we have had the patient rolled down to radiology, I simply push a syringe of yellow stuff into his GJ and we take 3 pictures...was that so hard? Apparently it is to some. The problem now is truly "diagnosed" and the IR doctor (who is in charge of fixing the GJ) begrudgingly agrees to come in to help my patient out. I write about this because the other day I was in cardiology watching them in the cath lab when I heard the IR tech complaining about how the peds residents were now doing these G-tube studies by themselves over the weekend and causing more work for them...I smiled secretly to myself...Thanks Dad!

Newbie Doc