The patient, a he or a she,
At a party came up to me
Whilst I was feeding
I was stopping the bleeding
Performing a treatment for free.
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, travelled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I went back to adventures in temporary positions until they have an Electronic Medical Record (EMR) system I can get along with. A winter in Nome, Alaska, assignments in rural Iowa, a summer with a bike tour in Michigan, and Urgent Care in suburban Pennsylvania stretched into the fall. Last winter I worked western Nebraska and coastal Alaska. Getting my wife’s (benign) brain tumor treated took a large part of the summer, then a week each in urban Alaska, Pittsburgh with family, and western Nebraska. Any identifiable patient information has been included with permission.
I was seated at a catered social event enjoying a turkey sandwich when one of the staff approached me, saying, “I need you to be a doctor in the kitchen.”
Without hesitation I left my lunch.
Firmly entrenched in Sioux City Society, I have friends and patients amongst employers and employees wherever I go.
Most kitchen cuts happen to the non-dominant hand, and the patient (who gave me permission to write this) had cut the left ring fingertip half-an-hour before. The bleeding hadn’t stopped. In similar situations I have used Superglue with good effect, but in this case the knife had completely detached a couple millimeters of skin, leaving nothing to glue together.
I applied pressure to the fingertip with my thumb and forefinger and a generous helping of paper towel, holding the patient’s arm extended straight overhead. I made small talk and cracked few jokes. The internal blood pressure at the wound, weakened by gravity, could not exceed the external pressure applied by my pinch. After 10 minutes, I brought the hand down and, sure enough, the bleeding had stopped. I applied a Band-Aid tightly, held it in place with aging, weak adhesive tape, and had the patient put on a plastic food service glove.
Then I went back to my sandwich, sitting between a board-certified hand surgeon and my wife. Of course we discussed the case, talking about therapeutic use of superglue, the generic version of the much more costly Dermabond.
I won’t send a bill, I didn’t even get the patient’s name. I’m pretty sure Good Samaritan rules apply.
At another event, I fixed someone’s home glucose monitor, and four days later, I attended a sick child at my house.
I explained that in the absence of fever or severe pain, use of antibiotics for a one sided ear infection (in a patient over 18 months age) wouldn’t change the course of the disease, and wouldn’t increase or decrease the chance of complications. Acetaminophen and ibuprofen would do just as good a job. We discussed alarm signs along with the importance of fluticasone (brand name, Flonase) and a Neti pot for allergies.
I won’t send a bill for that patient, either. With no prescription to write, I didn’t generate a note.
While in private practice, a parent would frequently ask me to check the ears of a patient’s sibling. I would smile, and to establish boundaries, I would say, “A normal ear exam is free.”
In the era of evidence-based medicine, sometimes an abnormal ear exam is free. I love the work and good Samaritan rules apply. I couldn’t send a bill if I wanted to.