Ahead of Print: Brandt's Rants
2022; Lippincott Williams & Wilkins; Volume: 44; Issue: 4B Linguagem: Inglês
10.1097/01.eem.0000829000.42947.e7
ISSN1552-3624
Autores ResumoFigure: Orf causes crust-type lesions, left, and fluid-filled raised vesicular lesions.FigureWorking in a rural New Zealand hospital for six months has been remarkably similar to working in a large U.S. city. Oops, wait. My computer glitched for a second. Just go back and change the words “remarkably similar” to “jaw-droppingly, sheeptastically, and bamboozliciously different.” Ah, now that is closer to the truth. Here in good ol' Gisborne, we are several hours from the closest major trauma center. We are several hours from pretty much anything but fantastic surfing and lots of friendly sheep, so we must fly out anyone who is critically ill. Unless, of course, there happens to be too much rain or too much wind or any of a number of reasons patients cannot fly. Then, of course, it is up to us to treat them. I must admit, I miss having specialists. We have no cardiology. Also, we have no neurology. And no intensivists, interventional radiology, nephrology, pulmonology, urology, and most other specialists. We do have one ENT and two ophthalmologists, so we have that going for us, which is nice. Physicians working in rural emergency departments across the United States (and world) are the truest BAFERDs of our specialty in my humble opinion. Rural communities are often older, sicker, and have less access than our urban cohorts. My respect for those working in those difficult areas has only increased since starting my career here. I am fortunate; I still have an abundance of resources that many do not. But the interesting stories and unique cases that appear in a small rural ED can be stunning. Also, being separated forces some self-reliance and close relationships with the specialists I do have. Our surgeons also function as the GI, urology, and vascular doctors, and knowing what can and cannot be done requires open communication and cooperation. I felt burned out back in the United States, and my experiences here have rekindled my love for medicine. All that aside, the job is remarkably similar. Whoops, there goes that glitch again. Orf? Granted, much is the same. We see an abundance of chest pain, abdominal pain, and 92-year-olds feeling unwell. On the other hand, I have not seen an angry inebriated patient in six months, opioids are rarely prescribed, and all prescriptions are five bucks. But working in a new country also presented diseases I had never seen before. I recently cared for a nice kid with a rash. His mom wanted to know if it was measles (many are unvaccinated in our community). It sometimes feels like every viral rash on the planet must come into the ED. But this little guy had weird spots going up his arm that just did not go away after a few weeks. Huh, that seemed odd. You guessed it, sporotrichosis. Honestly, not usually at the top of my differential for rashes. But here, just another patient. Yes, this case could have presented in any U.S. ED, but the zebras seem to appear here commonly. I had not heard of my next case until moving to New Zealand, but nearly all emergency physicians here had already seen several cases. My next patient had orf. You know, orf! Good ol' orf. What the heck is orf? It sounds like something a sick seal might say when asked how it is feeling. “How are you feeling, Mr. Seal?” “I'm feeling a bit orf. ORF! ORF!” If you knew orf, congrats, but for the rest of us, orf is a poxvirus that causes large scabby lesions anywhere the virus-laden wool touched. It looks like an abscess, but never pop it. I learned to let orf run its course. It is seen in people working with sheep, which is remarkably common here. Fun fact: New Zealand has more than five sheep for every person. Palm Thorns? Then there was the phoenix palm. I had never heard of this plant. The fronds like to go into skin but not come out. My patient had been weeding and accidentally stuck himself in the base of his finger. His swollen finger appeared quite painful, and I had suspicion for an early flexor tenosynovitis. I know some U.S. hand surgeons would yell at me for calling without even trying to get it out, but I called the orthopedic surgeon anyway. The call went something like this: Me: Hi. I have a patient who hit his hand on a phoenix palm. I'm worried about.... Orthopedic surgeon: Oh, those plants are right bastards. No problems, we'll admit, and he'll have to go to theater for a washout. Me: (surprised gurgling at how easily it went) Um, thank you. Ortho: Cheers. The great thing about small rural EDs are the people. We all know we have limited resources and that we are in this together. The camaraderie is fantastic, and the dedication to helping our community is uplifting. The experiences so far have been enlightening, encouraging, and rejuvenating for me as a physician. Every place has its quirks and unique challenges, but if I had to choose to do it again, I would jump at the opportunity. Cheers!
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