Shared delusions and eggs over easy

April 25, 2018

It’s called a folie a deux

When delusions are shared by two

Or possibly more

But who’s keeping score?

When our breakfast we’re trying to chew.

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. I followed 3 years Community Health Center work with a return to traveling and adventures in temporary positions in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska. 2017 brought me adventures in Iowa, Alaska, and northern British Columbia. After a month of part-time in northern Iowa, a new granddaughter, and a friend’s funeral, I have returned to British Columbia.  Any identifiable patient information has been included with permission.

During my work time here, I get housed in a hotel a short kilometer walk from the clinic. The accommodations comprise what amounts to a 1 bedroom apartment.  We have a small kitchen, a stove with a real oven, and a decent-sized refrigerator.  The bedroom has a door that closes.

But the room also comes with a continental breakfast at a nearby restaurant. You can’t call the meal fancy, but we can get eggs cooked to order.

The hotel business runs light at this time of year, a far cry from last summer when one could hear loud conversations around the building all night. We haven’t had to share the breakfast room since before Bethany got here.

Today I greeted another breakfast guest as we walked in; he promptly said, “You look like an old professor.”

“I like to teach,” I said, “but that’s not what pays the bills.”

We nodded at another patron as we put bread in the toaster.

The owner by now starts my two eggs, over easy, as soon as I walk in the door.

As we sat down, the two other customers started an animated conversation, in volumes large enough to fall far from the bounds of what could be called a restaurant voice. In short order, I recognized the linguistic tells of mania (rapid speech, flight of ideas, grandiosity) for one and schizophrenia (in plain English, he didn’t make tracks) in the other.  But they found each other’s conversation fascinating.

We didn’t interrupt or join in. We just listened.

The manic customer very quickly convinced the schizophrenic customer.

You can find bipolar disease at the same frequency in every population in the world. My opinion runs something like this: in the manic state the bipolar functions as an irresistible leader with an uncontrollable libido.  He or she can convince the group to go places where, literally, no man has gone before.  On arrival, that person leaves a disproportionately high number of offspring with the same propensities.

At the restaurant, I listened to the founding of a folie a deux. Where insanity usually runs a solo game, a folie a deux relies on a two person delusional system.  Such cases notoriously resist treatment.

But I did not serve as their physician and thus cannot claim them as patients. They spoke loudly in a public place.  And, after all, such a scene almost certainly played out in more than one venue today.

So I can write about it. Rules of confidentiality do not apply.

 

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Corneal numbness and a schizophrenic hitchhiker

April 24, 2018

You might think cocaine’s a prize

The truth is it’s a thing I despise

You’ll hallucinate bugs

On that class of drugs

And you might try to pry out your eyes.

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. I followed 3 years Community Health Center work with a return to traveling and adventures in temporary positions in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska. 2017 brought me adventures in Iowa, Alaska, and northern British Columbia. After a month of part-time in northern Iowa, a new granddaughter, and a friend’s funeral, I have returned to British Columbia.  Any identifiable patient information has been included with permission.

Before and after clinic, and between patients, the docs in this clinic congregate in an office with 6 chairs and computer stations.   You can find quieter, more efficient places to dictate or keyboard or research under this roof, but, still, docs who have work stations elsewhere come in frequently during the day.

Earlier this week, at the beginning of the day, I brought up the subject of eye pathology. In the course of a referral to an ophthalmologist, I learned that cocaine abuse can numb the cornea, and I spoke the new knowledge to my colleagues.  The information amazed them just as it had amazed me.  And then the clinical stories started.

Cocaine and other drugs like unto its kind, such as meth, speed, or crank induce hallucinations and delusions. Paranoia, of course, runs rampant, but so does the sensation of insects or foreign bodies in various parts of the body. Most people who have known tweekers know that they pick at themselves, giving rise to “speed sores.”  They also pull out hair (trichotillomania).  But then we all listened, rapt, while one physician talked about a heavy cocaine user who had used a screwdriver to try to remove a non-existent contact lens.  We all shuddered, shook our heads, and muttered, “drugs.”

Canada stands on the verge of national legalization of marijuana, and I see no good coming from it.

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I got called to ER for 2 patients in the early morning hours. The second patient recognized and greeted me by name.  “Were you gone for a while?” she asked.

Within 24 hours two more patients made the same mistake: they thought I had permanent status rather than temporary. The place is starting to feel like home.

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I picked Bethany up at the airport in Prince George Friday evening. We stayed the night, went grocery shopping at Costco on Saturday, and got on the highway.  Just outside of town, we picked up a hitchhiker.

Last summer we picked up a couple from Europe, working their way across Canada for a year.

This time, at about the same place, I pulled over for a middle-aged man with backpacking gear.  We chatted as the kilometers slipped by.

Residing in some of the more violent, drug-ridden, lower-rent sections of East Vancouver, he’d lost several bicycles and his wallet to theft. In years past, he’d driven motor vehicles, from garbage trucks to RVs, from the Midwest US to Anchorage, Alaska.

Then he started to talk about how dizzy he got when surrounded by too much technology, especially wi-fi.

He planned to take the Dempster Highway north through the Yukon to Inuvik, the capital of Nunavut, the Canadian Territory that belonging to the Inuit.   He wanted to work along the way.

As the now familiar highway slipped past, I listened to his delusions coming with increasing frequency, without contradicting.

I strongly suspect untreated schizophrenia.  He can function in society, even if he functions marginally. He can hold a job, even if not for very long, and he has chosen a path that leads him away from high availability of drugs.

We dropped him off in an area with decent traffic flow. I looked up the Dempster Highway when we got back to town.  I hope he times his river crossings right, otherwise he’ll be waiting a month for a ferry or an ice bridge.

 

 

Where FedEx doesn’t go

April 17, 2018

My summer plans just fell through

There’s a thing or two I should do

It takes hours and ages

To fill out the pages

To serve at a clinic that’s new.

 

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. I followed 3 years Community Health Center work with a return to traveling and adventures in temporary positions in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska. 2017 brought me adventures in Iowa, Alaska, and northern British Columbia. After a month of part-time in northern Iowa, a new granddaughter, and a friend’s funeral, I have returned to British Columbia.  Any identifiable patient information has been included with permission.

My original summer plans fell through but another opportunity arose, slightly closer to home. If all works right, I’ll take 24 hour call Wednesdays, with clinic on Thursday and Friday.  I would face a 38 hour work week, perilously close to the 40 hour norm.

For me, every work place change involves applications and credentialing. I worked on the packet, and put together 59 pages with 2 passport pictures I just happened to have.  While I could receive the forms electronically, the hospital wants what is now called a “wet copy:” the actual signed forms rather than scanned/emailed or faxed.

FedEx gets as far as Prince George. Using the Canadian Postal interface slows down mail to the US by weeks, and, from experience, sending things Express across the border involves a time frame that could be paired with the word Pony.

Purolator courier service, however, does a lot of business here. While they don’t have an office in town, they do have a driver.

The hospital has an account. With my Monday free as a reward for my weekend on call, I stopped in to the front office to inquire about Purolator.  Come back at 1:00PM, they told me, when we expect the pick up.

I walked to the mall and found an adequate manila envelope. I stuffed and addressed it and walked back over to the hospital at 11:00AM to find the Purolator van parked in front and the agent doing business in the parking lot.  When she finished delivering a C.O.D. package, I approached her with my packet.  She knew exactly what to do, but had run out of international labels in her van.  She had other stops to make, and asked how she could contact me.  I gave her my business card, and we agreed to meet in the hotel lobby in an hour.

She arrived on time, to the minute. Her consummate professionalism did not get in the way of her Canadian small-town friendliness and sense of humor.  I don’t think she expected me to have weighed the envelope (320 grams) nor to have called and found out the charge ($53.28CD).  Neither did the hotel front desk staffers who watched the transaction.

Everyone knows everyone here. I answered questions about why the package would go to Texas if the job were in Iowa.  I found out I don’t have to have my own Purolator account to send packages.

 

Weekend call: propranolol, Mounties, x-rays, Dave Brubeck, and geographic confusion

April 16, 2018

Geography knowledge is rare

And even those doctors who care

Have recommendations

That get emendations

With exclamations of “WHERE??!!”

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. I followed 3 years Community Health Center work with a return to traveling and adventures in temporary positions in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska. 2017 brought me adventures in Iowa, Alaska, and northern British Columbia. After a month of part-time in northern Iowa, a new granddaughter, and a friend’s funeral, I have returned to British Columbia.  Any identifiable patient information has been included with permission.

Another weekend on call has passed. The heaviest day was Saturday; I attended 13 patients.  For the most part people came in a steady stream, yet I got breaks for lunch and supper.  With no regrets, I took every opportunity to nap.

I saw 4 Workman’s Compensation cases and 3 others from a motor vehicle crash. I don’t know why, but  I stand to benefit from laws governing reimbursement these two classes of injuries.  They represent the only two Canadian system areas lacking crystal-clear transparency.

My broad background helps me connect with a wide variety of patients. I relied on my short musical career to help one patient.  In the ‘60’s the Dave Brubeck Quartet’s artistry enchanted me into relentless listening of the ground-breaking album, Time Out.  I advised the patient to check two cuts on YouTube, Take Five and Unsquare Dance, examples of drum solos in difficult, unconventional rhythms (5/4 and 7/4) taken to artistic extremes.

I used my 7 years’ experience attending Adult Children of Alcoholics meetings to help another person. I pointed out that, just as perfect people rarely come to see me, perfect people rarely choose to become doctors.

I dealt with patients with neurologic, respiratory, infectious, psychiatric, blood, eye, gut, skin, and bone problems. I ordered and interpreted 3 electrocardiograms (all normal) and two x-rays (both abnormal). Four people had viral illnesses, expected to resolve with no treatment.   I ran 2 urine drug screens, results from one but not the other had surprises.

I sent one patient by ambulance to Prince George.

I called the Mounties once.

I ordered two CT scans for the upcoming week, fairly confident that one will come back normal and concerned that one might not.

I sought consultation from a Vancouver specialist who gave me a series of recommendations. After I hung up I called back.  She hadn’t realized the geography involved.  Just as well.  The patient (rationally, I felt) refused those measures.

I prescribed propranolol twice. With the blood pressure indication eclipsed by better drugs in the same class, it still has a lot of off-label uses: migraines, ADHD, stage fright, performance anxiety, premature ejaculation, rapid heart rate, tremor, and buck fever.  It stands as the first-line treatment for over-active thyroid.

I drove rather than walked the kilometer to the hospital. Temperatures have stayed close to freezing, with daytime thaws since I arrived, and frost coated the car windows after sunset.  This car rental didn’t include a scraper so I used a movie rewards card.

Raising TV-free Kids

April 12, 2018

The visit finished just swell

Not needed were my tricks than can quell

That interruption

That brings conversation corruption

‘Cause the children were behaving so well

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. I followed 3 years Community Health Center work with a return to traveling and adventures in temporary positions in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska. 2017 brought me adventures in Iowa, Alaska, and northern British Columbia. After a month of part-time in northern Iowa, a new granddaughter, and a friend’s funeral, I have returned to British Columbia.  Any identifiable patient information has been included with permission.

A visit with multiple children in the exam room can challenge the most patient of doctors. Those of us with ADHD can find our enjoyment of children threatened by chaos and noise.  I have developed strategies.

I have a yoyo and I know how to use it. I tell any children not involved in the business at hand that I’ll do yoyo tricks if they don’t interrupt; the first trick follows about 45 seconds later, the second one 3 minutes after that, and the interval keeps getting longer.  The strategy works on kids who can’t tell time, and it works better on girls than on boys.

This week I took care of 3 of 4 patients in the room, a mother with her three very young children. The kids sat quietly and didn’t interrupt.  Neither I nor the mother needed to chastise, bribe, or threaten.  I worked through the patients one by one.  While explaining clinical findings, diagnosis and plan to the mother I noticed the middle sibling kiss the older one on the back.  Before I could finish my sentence, the youngest one had kissed the middle one.

When I finished with the heart of the visit, I asked the mother, and found out, that the household had no television.   Then I requested and received permission to write about a family with well-behaved, well-disciplined, loving children raised in a TV-free home.

I congratulated her, and told her my wife and I raised our three daughters with no television. Actually, in the course of time we partly raised 3 others as well, but I didn’t mention them.  We talked about how children love stories and generally prefer them to television.

I didn’t tell her about working in a First Nations community, where I repeatedly saw siblings treat each other with love and respect. Nor did I make the observation that children mirror their parents, and such behavior as I saw spoke well of the way that the parents treated each other and their children.

And I didn’t tell her the real reason that Bethany and I have lived without television: we have a problem with it. If present, we will watch it to the exclusion of eating, sleeping, marital bliss, and parenting.   We are TV addicts, and we do fine if it isn’t available.

 

Morning crisis, skin biopsy

April 10, 2018

It’s hard to make sense when you’re stressed

And sickness makes you depressed

I won’t interrupt

Nor be abrupt

If you’re in crisis, I will do my best.

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. I followed 3 years Community Health Center work with a return to traveling and adventures in temporary positions in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska. 2017 brought me adventures in Iowa, Alaska, and northern British Columbia. After a month of part-time in northern Iowa, a new granddaughter, and a friend’s funeral, I have returned to British Columbia.  Any identifiable patient information has been included with permission.

Depressed people get sick, sick people get distressed. Just as a bridge fails under maximum load, people come to see me when they come to a breaking point.  To do the best for a patient in crisis, I have to listen, and to listen, I cannot interrupt.  People in emotional turmoil frequently don’t know what they want to say, and if they do, they have trouble articulating.  Often, the first patient of the day fits this description, and the time required invariably spills into the next patient’s time slot.

While I can take pride in my work by handling the situation well, I have to apologize to those whom I kept waiting.

Later that morning, a patient expressed concern about a mole (and gave me permission to write about it) that had radically changed in the last two weeks.

When we evaluate moles, we talk about the ABCDE (asymmetry, border, color, diameter, and evolution) criteria to separate the worrisome from the mundane. Even a perfectly symmetric mole with a regular border, homogenous color, and a diameter less than 8 mm deserves biopsy if it changes.

The mole in question had rapidly expanded until I could not cover it with my thumb, spots of black and white marred the overall pink color, in places the edge wandered. All in all, the worst mole I’ve seen so far this century: almost certainly malignant melanoma.  I strongly recommended biopsy, with the intention of doing the procedure immediately.

Last century, at a different clinic, I spotted a worse mole the size of my hand on the back of someone sent to me (rather than his regular doctor) for a work physical, and recommended he get it taken care of definitively as soon as possible. He returned 18 months later for a biopsy, and ever since, if at all possible, I do the biopsy the same day.

Moving to ER, scrubbing, anesthetizing, removing a 5 mm circle from the mole, and putting in a stitch took less time than finding the equipment.

I finished the morning more or less on time but with no documentation done.

And the documentation came harder; in succession I had seen two patients of the same ethnicity, age, and gender, with similar problems but very different diagnoses. I relied on notes I jotted during the visits.

April 7, 2018

Of the patients there’s never a lack

I can tell you it’s good to be back

I think that it’s neat

When the patients repeat

And I can see that they’re on the right track.

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. I followed 3 years Community Health Center work with a return to traveling and adventures in temporary positions in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska. 2017 brought me adventures in Iowa, Alaska, and northern British Columbia. After a month of part-time in northern Iowa, a new granddaughter, and a friend’s funeral, I have returned to British Columbia.  Any identifiable patient information has been included with permission.

Today I cared for 12 patients, 1/3 of whom I had cared for either last summer or in December. Respiratory problems dominated the clinical landscape, but I also saw 3 who came in to find out test results and five who needed prescription refills.

I recognized the first patient and without prompting opened the visit in French. He gave me a heartfelt grin.

I recognized one patient as a New Zealander by his accent. At the end of the visit I got into geographic specifics, and in short order we started talking about Warkworth (pronounced Walkwith), Leigh (pronounced Lee), Matakana, Omaha Beach, the Kauri Museum, Pakiri Beach, and Whangarei (pronounced Fahnga Ray).

Three patients discussed travel to Mexico, either completed or anticipated.

In December I posted about a patient whom I gave the opposite of my usual dietary advice; she returned to see me today. The plan worked, and the problems related to excessive weight loss disappeared.  We discussed favorable labs, and she requested I write about her in more detail.

A quarter of the patients use marijuana regularly. The only smoker wanted to quit.  Nobody admitted to excessive alcohol.

I did yoyo tricks for my one pediatric patient.

The return to work came as a relief after two months without employment. Including those seeking casual medical advice, I averaged less than 3 patients a week since February 1.  Today I fell into the rhythm of my usual questions: tell me about it, tell me more, what else?

News of my Immigration problems circulated here even before I published my last blog post. Patients, staff, doctors, and bystanders commiserated with me.  I pointed out there are few better places to be stuck than Vancouver.  We all agreed if you have to get turned away at a border, none can beat the US-Canada border.

A lot of people, in the clinic, the hotel, and the mall, asked after my wife, Bethany. She made a lot of friends during our last two stays. I got the feeling people missed her as much as they did me.

It was good to be back at work, in a system centered on patients and not cash flow. And it was good to be with a bunch of my colleagues, talking about cases and learning from each other.

At the end of the day, pleasantly tired from the action, but far from exhausted, I stepped out into bright sunshine and temperatures just below freezing. I had finished all my documentation.  I didn’t have to think about anything else but the weekend.

 

 

Neither best nor worst case

April 4, 2018

The missing piece I would mention

For my hopes were placed in suspension

Now I can stay

Till the second of May

But at least there is hope of extension.

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. I followed 3 years Community Health Center work with a return to traveling and adventures in temporary positions in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska. 2017 brought me adventures in Iowa, Alaska, and northern British Columbia. After a month of part-time in northern Iowa, a new granddaughter, and a friend’s funeral, I have returned to British Columbia.  Any identifiable patient information has been included with permission.

Even familiar travel routine involves chaos.

I don’t pack until the night before departure. I gather my professional gear first: stethoscope, otoscope, yoyo with strings, head lamp and white coats.  Next come seasonal and exercise gear followed by everyday clothes.  Then I ask Bethany to get everything in the suitcase, which she always does, and always to my amazement.

Staying up late to pre-synchronize with my destination time zone comes easily because sleep before travel comes hard.

Freezing rain delayed departure, so I got to the gate in Chicago just as the Vancouver plane started to board.

I arrived emotionally prepared for a glitch at Vancouver Immigration: I lacked one of the myriad moving parts, which could send me back without a work permit and hence without work.

I sat down at the end of a line of fifty people seeking entrance into Canada. I listened to conversations in Hindi, Russian, Cantonese, and Mandarin while I waited.

The agent who helped me spotted the glitch immediately and had me take a seat close by. My case used an inordinate amount of staff time.  Another 50 people came and went.  The agent, noting the dryness of my voice, gave me several glasses of much-needed water.  The afternoon wore on.

The business and practice of medicine punctuated my wait.   A skin lesion photograph sent to a collegium of 3 docs came through.  We asked questions, asked for another picture, and came to a conclusion: probably not fungal, viral, or parasitic and therefore probably bacterial.

I got a welcome call from a colleague, whom I told about my work permit problem. South Dakota, just like rural Canada, maintains a standing shortage of primary-care physicians, and he offered me work if the BC job fell through.

With texts and emails I continued a correspondence to hopefully lead my path back to Alaska in August.

At the end of the day, the agents looked frazzled and ready to go home. They surprised me with the option of staying in Vancouver for 2 days in hopes the missing piece would materialize.  I had feared being put on the next plane home.

I arrived at the hotel and started to hydrate and catch up on email.

Next day Immigration called me back to the airport to issue an unusual short-term work permit, requiring I show up in Vancouver in 28 or 29 days with the permit and my boarding pass for my flight home.

It’s more than I hoped for, giving me a month’s work under wonderful conditions, and leaving open the possibility of extension.

 

What not to do for bite wounds

March 24, 2018

I’m at leisure, but I’m not at rest

And I always still try my best

By day or by night

Don’t sew up a bite

Just leave it cleaned up and dressed.

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. I followed 3 years Community Health Center work with a return to traveling and adventures in temporary positions in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska. 2017 brought me adventures in Iowa, Alaska, and northern British Columbia. After a month of part-time in northern Iowa, I’m taking a break to welcome a new granddaughter, deal with my wife’s (non-malignant) brain tumor, and attend a friend’s funeral.  Any identifiable patient information has been included with permission.

 

Even without a regular office or practice site, people ask for my expertise. I can’t discuss the people without their permission, but I can discuss, in general, certain medical conditions.

Dogs, cats, and humans inflict the vast majority of bites in 21st Century USA, not surprising as these comprise the species with the most human contact.  Cat bites almost always cause infection, and human bites, though less dangerous than cat bites, carry large amounts of really nasty bacteria.  Dog bites carry less than half the risk of infection of the other two, but still deserve a good course of antibiotics.  I prefer amoxicillin/clavulinate for bite wounds.  I always have to consider if the bite was provoked, and, in the case of pets, the vaccination status.  Running tap water and soap cleanses wounds as well if not better than sterile water or peroxide, and drug stores sell the best dressing supplies.

(In Africa, the most common fatal bites come from hippopotami).

I don’t suture gaping skin wounds from bites unless on the face or genitals; I advise the patient they’ll have a scar. Sewing the wound predisposes to having a wound infection, and having that infection turn ugly.

When I treat overuse athletic injuries (including workman’s compensation cases) I rarely recommend complete cessation of the activity, partly because athletes won’t listen. I advise decreasing the stress (whether by duration or intensity) by 1/3 for 3 weeks, then increasing by 10% or less per week.  Perhaps those under 18 can bounce back faster, but mostly I deal with the others, the ones who comprise the “aging athletes.”

Then comes the eternal RICE protocol: Rest, Ice, Compression (such as an Ace bandage), and elevation. For cooling, I prefer a cold (not frozen) can (not bottle) of regular (not diet) soda.

The medical profession has used those principles for 40 years, they still work and have few side effects.

Several decades ago I completely some surveys (really, very thinly disguised marketing ploys) and in return received, as compensation vouchers for medical equipment. I now own seven stethoscopes, four head lamps, and two splinter removal kits.  Those kits have extremely sharp tweezers, which make extracting slivers of wood from the skin much quicker than using a hypodermic needle.  Which I can use, in a pinch.

Yoyo memories at the meat counter

March 21, 2018

For a child hiding under a chair,

A technique that I use with much flair,

With the yoyo, a trick

For the well and the sick

The resistant are ever so rare.

 

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. I followed 3 years Community Health Center work with a return to traveling and adventures in temporary positions in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska. 2017 brought me adventures in Iowa, Alaska, and northern British Columbia. After a month of part-time in northern Iowa, I’m taking a break to welcome a new granddaughter, deal with my wife’s (non-malignant) brain tumor, and attend a friend’s funeral.  Any identifiable patient information has been included with permission.

Bethany and I went grocery shopping and stopped at the meat counter for lamb shanks. The butcher who served us recognized me immediately as his former physician (and gave permission to recount the interaction).  After he took our order he recounted with delight how I could soothe his children with my yoyo tricks.  I reached into my pocket and brought out the toy.

Of course the string had tangled in my pocket, and I had to disassemble the yoyo to straighten things out. To my horror, the bearing dropped off the axle and went rolling across the floor.

Even to the best eyes on the planet, finding an object as small as a yoyo bearing (about 5mm) on a place as big as a grocery store floor come with difficulty, and I don’t have the best eyes on the planet. Bethany and I looked, and then encouraged a couple who just wanted to buy meat to engage the butcher.  When I had given up, I found the shiny metal piece on the linoleum, reassembled the yoyo, and wound the string.  By then my audience included the butcher, my wife, and the other couple.

I chose my single most elaborate (not most difficult) trick: Around the world sideways twice followed by double or nothing.  A great visual but not as hard as it looks, I do it with my eyes closed and invariably draw applause; in this case small applause from a small audience.

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Over the years I developed a system to establish rapport with children, eventually I figured out how to do so even with the sick ones. After 1991, the yoyo found a key place in my armamentarium.

Many children come to me after bad interactions with the health care profession, whether dentists or other docs or nurses, and many of those hide under chairs before I walk in. Generally, I just get out my yoyo and play with it and talk to the parent until the kid gets curious.  Regretfully, once or twice a year a child arrives so traumatized that my best tricks don’t work.

At a funeral I ran into a parent of one of the many children I charmed out from under a chair.