I called in sick for a shift

American ER Doc Gone Walkabout Episode 018

About two weeks ago a gentleman from Sydney visited Denver. He had left Sydney over a week earlier, spent time in Peru – where he gathered some mosquito bites, and arrived in Denver where he developed fever, shaking chills, and severe myalgias. He did have a bit of a cough, though not a prominent part of his symptoms. His pathology reports were pretty unremarkable except mild thrombocytopenia, and though he did not have the characteristic ocular pain, I though he probably had dengue, recommended that he use some Paracetamol and HTFU.

A few days later when I developed some myalgias, I though nothing of it, but the shaking chills, drenching sweats and progressively worsening fever and myalgias got more of my attention the following day and I contemplated a journal article on the person-to-person transmission of dengue fever – thus bypassing the lowly mosquito. Another day on, when every fourth breath was followed by a painful paroxysm of sputum producing cough I rethought that prospect, and – being a highly trained Emergency Physician, skilled self-diagnostician, and having broken slightly fewer than twenty bicycling helmets in my career – made a connection. Although we rarely think of influenza during the Colorado summer, this gentleman came from Sydney. I further recalled that it was winter – either on the other side of the date line, or the other side of the equator – since Sydney was on the other side of both, I didn’t bother to Google which. However I did check on Google Flu Trends (if you haven’t checked it out as a useful web site, do so – though Tasmanians will note that Tasmania appears to be grouped with Antarctica as being unimportant flu-wise – it also seems unusual to “google” “google flu trends” to get to the site, but it works) and found that indeed Australia is having lots of influenza.

So, having suffered through one shift with myalgias only, I thought that perhaps taking some oseltamivir ($100 for one day less of suffering is a bargain to me), and skipping my next ED shift might be good for me and my patients.

One note to my Aussie friends: American attending (consultant) physicians work night shifts along with our residents, so last Thursday night when I was scheduled to work 11 PM to 8 am, I decided that I really couldn’t HTFU enough to work all night and called a fellow faculty member, Comilla Sasson who worked my shift for me.

Now, there are few people in the world who can make the claim: “I called in sick for what would certainly have been the single most challenging and consequential shift of my career.” I, however, am now one of them.

I believe that even the Northern Tasmanian News carried the reports of another of the sickening repeats of American violence – the shooting in a theater of 70 people with 12 immediate fatalities, and many other severe injuries. Being the closest hospital, University Hospital received 23 of the victims. On my shift. And I was home sick. Thanks to an Australian who shared his influenza with me. Ouch. And Dr Sasson, now my hero, took one for the team. Thanks Comilla!

It’s something that we as ER Docs face periodically: should we be tough and do the job? Or call for help? Many of us have spent shifts working while getting Zofran and intravenous hydration so that we wouldn’t have to appear untough. (Probably a few of our patients later missed work when they were ill for a few days with nora, or salmonella – but we were tough.) But, sometimes it is wise to recognize our own morbidity. In this event, I did work one shift with chills and myalgias. But if, as I got worse, if I had tried to tough out another, I fear that a 65 year old, partly demented ER Doc like me, further hampered by chills and bouts of racking cough would not have been anywhere near the energy level required for a disaster of this magnitude. I might note that the temptation to be a tough guy may be greater in the US than in Australia where I did have paid sick time available, whereas in the US if you miss a shift – tough luck, Dude. We pay the guy who worked for you.

A few other differences between the US and Australia:

• In Australia, the hospital wouldn’t have to wonder how big a financial hit they would take in caring for these folks, they would all have insurance. A trivial concern in the midst of the crisis, but a not insubstantial one for the hospital and for the surviving victims and families who may be uninsured but try to pay their bills.
• In Australia this might not have any way of happening. I suspect that all of the military grade armaments that this guy had would be impossible to buy in OZ. Perhaps buying a 100 round magazine for a semi-automatic rifle would require a “Genuine Need” certificate for something like self protection from vicious wallabies, or attacking box jellies.
• Admittedly, you have your Port Arthur massacre, but that’s it. That quality of insanity seems to happen a couple times a decade for us freedom-to-do-anything-we-f#@king-well-desire Americans. The Monash University killings would hardly escape beyond the local news in the US.
• And, finally, God help us all if anybody in OZ would suggest, as in the US, that the reason that this massacre was so bad was that not enough people in the audience were packing concealed weapons with which they could shoot back.

On a lighter note, any Ozzies coming to the US for the ACEP Scientific Assembly 2012? It’s in my home area of Denver, drop me a line and maybe we can throw a few Rocky Mountain oysters (Google it) on the Barbie for you.

Next time:  The News from #ACEP12 Day 1