Distance otoscopy

July 29, 2020

If it’s truth in the ear that you seek

There’s a way remotely to peek

The canal for some,

For others, the drum,

Use electronics, ever so chic.

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 further travel and adventures in temporary positions in Arctic Alaska, rural Iowa, suburban Pennsylvania, western Nebraska, Canada, and South Central Alaska.  I split last summer between I split last summer between hospitalist work in my home town and rural medicine in northern British Columbia, followed by vacations. Till the pandemic resolves telemedicine occupies my professional time.  Any identifiable patient information, including that of my wife, has been used with permission.

Last week a patient (who gave me permission to write more than I have) said, “I can show you the inside of my ears.”

I had heard of the technology: an electronic otoscope that displays the image of the ear canal and the eardrum onto a tablet computer.

The patient disappeared from my screen and returned 10 seconds later with a ear piece connected to a device.  In short order, the physical findings confirmed the diagnosis.

I mentioned this piece of available, off-the-shelf technology a half-dozen times a day but until today hadn’t had the chance to see one.

That day I cared for 41 patients in the course of 10 hours.  Every session my dexterity with the electronic medical record system improves. Med refills and back-to-work slips take very little time.  Even a visit for a urinary tract infection goes quickly.

About 20% of my patients connect from a vehicle.  On two occasions I had to ask the patient to pull over.  On two other occasions the call failed for patients in a moving vehicle.  Mobile connections are inherently harder than stationary.

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The pandemic continues to rage and to strength as it does.  I have attended 3 patients remotely who needed ICU attention immediately; two refused to go.  For others with residual coughs I can prescribe inhalers if they wheeze, but otherwise I recommend honey as the equal of any cough suppressant.

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Summer brings allergies.  My private practice summer allergy business evaporated when Zyrtec (cetirizine) came on the market, and what little I had left disappeared when Flonase (fluticasone) went over the counter.  Still some people have itchy eyes.  I tell them that if we have 16 products that will treat the same problem, probably none of them are really great.  I generally end up recommending Opticrom (cromolyn eye drops) which are available without a prescription.

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I see a lot of poison ivy, but not nearly as bad as the summer of 2015 when rain and warmth combined to give western Pennsylvania a really great crop of the three-leafed terror.  I learned the depth of my ignorance about the condition.  I don’t like prescribing steroids (things like cortisone) that effect the entire body, but when the rash and blisters covered more than 10% of the total body surface area, I prescribed 14 days of prednisone.  I learned that the rash stays that long, and a shorter course of steroids (such as the Medrol Dose-pak) will give rise to rebound rash when finished.  A very large quantity of resin can get through the skin and into the lymph system; thus the spread doesn’t always come from scratching or residual clothing contamination; it can happen internally.

 

 

 

A linguistic show off in Telemedicine

July 13, 2020

I knew it was a Navajo name,

But my error put me to shame

It didn’t make sense

Cause I used the wrong tense

When my story I tried to declaim.

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 further travel and adventures in temporary positions in Arctic Alaska, rural Iowa, suburban Pennsylvania, western Nebraska, Canada, and South Central Alaska.  I split last summer between hospitalist work in my home town and rural medicine in northern British Columbia, followed by vacations. Till the pandemic resolves telemedicine occupies my professional time.  Any identifiable patient information, including that of my wife, has been used with permission.

I had a good week of telemedicine.

About half my patients call from Texas, a lot of them with Spanish surnames.  I politely ask in both English and Spanish what language they prefer; the vast majority of Texans prefer English.  Still, I relieved one patient by using Spanish; and I code shifted with two others.

Earlier in the week I looked at the patient’s identifying data, and recognized a Navajo nickname, converted to a last name for the purpose of doing business with a society preoccupied with names.  I asked, in rusty Navajo, “Do you speak Navajo?”

The rejoinder came back, “Why do you speak Navajo?”

I replied, in Navajo, “A long time ago I worked at Hauling Water.”  Except I forgot to put the particle at the end of the sentence to designate past tense, thus marking my speech as non-native. As if the accent weren’t a dead giveaway.  If I spoke the language fluently, one of the 32,000 tenses applied to “work” would have sufficed to designate how long ago, and for how long.  Still, I impressed the patient, whose Navajo language wasn’t as good as mine.

One day ¼ my business consisted of various vaginal problems.  I assured the patients that I couldn’t give a firm diagnosis, that the treatment was based on a best guess, and if it failed they would need to see a doctor in person.

I can diagnose problems with the eyelid but not with the eye.  Double vision, something in the eye, or a scratch on the cornea has to be taken care of face-to-face.

In particular with abdominal pain I miss the ability to touch the patient.

A half-dozen times this week I could see thyroid swelling on the neck of a person who did not know their thyroid had a problem.  Then I have to deal with complicated logistics because I can order blood work but I can’t order an ultrasound or CT.  In every case I advised the patient to take the results, when available, to their primary care physician to determine the next step.

Half my patients this evening came from the part of Nebraska with a very low population density, and I surprised them by knowing the geography.  I have a friend who ranches in the Sandhills, a place of unearthly beauty and quiet and sparse population.  Most people in Omaha haven’t heard of the landform that covers 1/3 of their state.  Still I dropped the name to one of my patients, and surprised us both by making the connection.

Fish story: true or false?

July 5, 2020

It was out on a bow fishing cruise

And the fish lost all it could lose

It was at Snyder’s Bend

It exacted revenge

Producing a large, painful bruise.

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 further travel and adventures in temporary positions in Arctic Alaska, rural Iowa, suburban Pennsylvania, western Nebraska, Canada, and South Central Alaska.  I split last summer between hospitalist work in my home town and rural medicine in northern British Columbia, followed by vacations in Israel, San Francisco, Iowa, Miami, and Galveston. On the advice of my doctors, I’m avoiding face-to-face patient care until the COVID-19 danger has passed. Any identifiable patient information, including that of my wife, has been used with permission.

As a doctor, I see a lot of bruises and scars.  For whatever reason, patients do not always tell the truth about those injuries, particularly in the case of domestic violence.  Sometimes I have to think hard.  Sometimes all I have to do is listen.

The left buttock had a black-and-blue mark bigger than my palm, big enough to call a hematoma, not quite the size of a suggillation.  The 70-year-old’s story about the mechanism of injury?

“Well you know how those Asian silver carp have invaded the Mississippl River drainages including the Missouri?  Even the oxbow lakes?  Well I finally got a friend to take me bow fishing.  Those things really jump!  And in still waters like Snyder’s Bend they get huge!  There was this one place, right by the bird watching station, where they school and they just fly when the boat goes past.  I missed one and I was reeling in my arrow when a 3 ½ footer jumped right in the boat but landed on the throttle hard enough to accelerate the boat and I went down on the afterdeck, hard.  I thought I would go into the drink!”

An unlikely story.  But given internally consistent, given without hesitation, and brimming with details.  I had to believe him.  Even about the scrape on the shin from another carp landing in the boat and repeatedly flopping against his tibia.

Especially because it happened to me.  I was the man with the bruised butt cheek and the barked shin.

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Working as an independent contractor for a telemedicine firm I got 7 new licenses in an afternoon.

So far most of my telemed patients have come from Texas, and the majority of the rest from Iowa.  Still I’ve had a few from two other states with very low populations.  I did not expect a patient from a place with a census in the low triple digits, nor did the patient expect I’d have familiarity with the area and a friend (not a patient) whose name I could drop, and ask to pass on my greetings.

A sweet spot between 2 and 84

July 2, 2020

A few hours of work is a treat

Too many makes me feel the heat

But I’ll tell you, matey

Twixt 7 and 80

There’s got to be a spot that is sweet.

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 further travel and adventures in temporary positions in Arctic Alaska, rural Iowa, suburban Pennsylvania, western Nebraska, Canada, and South Central Alaska.  I split last summer between hospitalist work in my home town and rural medicine in northern British Columbia, followed by vacations in Israel, San Francisco, Iowa, Miami, and Galveston. On the advice of my doctors, I’m avoiding face-to-face patient care until the COVID-19 danger has passed. Any identifiable patient information, including that of my wife, has been used with permission.

 

I do spot labor for a telehealth concern.  A lot of docs onboarded at the same time demand dropped.  Once or twice a week I get a text telling me I can join an ad hoc shift.  I get the option of 15, 30 or 45 minutes.

The text only comes through when the patient wait time goes too long.

I miss the face-to-face medicine.  I have found no substitute for touching the patients where they hurt.

And I miss getting in on the drama of people’s lives.

Still, the inherent limits of the medium make for much more efficient visits.  And, apparently, meeting the patients’ wants.

I have licenses in Alaska, Nebraska, South Dakota, Wyoming, Iowa, and Texas, and, so far, I’ve used all but two.  Most of my calls come from Texas, about half from Spanish-surnamed people.  I ask in both English and Spanish the patient’s preferred language, proclaiming myself a linguistic showoff in both idioms.  So far, no one has requested Spanish.

And so far, nobody has called in under the influence of drugs or alcohol.  Fewer than ¼ of the patients smoke.

Two needed nothing but back-to-work slips.  Others, for good reason, wanted tests for Covid`19.

One frightening afternoon half of the 6 patients I attended remotely needed much more medical care than I could provide via computer.  In each case I said, “I’m being paid to think of the worst things I can think of. I’ve been doing it for years and I’m good at it and you don’t want to have any of those things I have imagined.  Go immediately to the ER; this is more than Urgent Care can handle.  Go now.”

In private practice or in most locum tenens situations I would eventually find out the diagnosis.  But I don’t in these cases.  Thus in many ways, telehealth has come to resemble Urgent Care without the lacerations or x-rays.

The electronic medical record (EMR) platform for the most part performs well, but slows when I want to prescribe.  Nonetheless I’ve been able to take care of up to 6 people in an hour, including time spent on documentation.

One evening the text came through at 9:00 PM, just as Bethany and I sat down to play Scrabble.  I worked, delighted, for 2 hours, a far cry from the 84 hours per week I put in when I started this blog.  I’d like to find that sweet spot, somewhere between 2 and 84.

 

Bicycle repair as a substitute for clinical work.

June 21, 2020

I needed something to fix

In the back, 5 speeds or 6

A couple of deals

For a machine with 2 wheels

From parts that can match and can mix.

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 further travel and adventures in temporary positions in Arctic Alaska, rural Iowa, suburban Pennsylvania, western Nebraska, Canada, and South Central Alaska.  I split last summer between hospitalist work in my home town and rural medicine in northern British Columbia, followed by vacations in Israel, San Francisco, Iowa, Miami, and Galveston. On the advice of my doctors, I’m avoiding face-to-face patient care until the COVID-19 danger has passed. Any identifiable patient information, including that of my wife, has been used with permission.

I had no idea how much exercise I get in the course of my normal work day until the pandemic struck.  During usual times I go out of my way for a daily hour or two sweat.  Year round I hit the elliptical at the gym, and in season I ride my bicycle.

In 1975 I bought a good frame, a Paramount from the last year Schwinn offered an all-chrome option.  During student poverty I cobbled together a decent touring bike from pieces I found at garage sales, flea markets, and police auctions.  I scraped up the cash for new Suntour bar-end shifters, and rode from Denver to San Diego in 11 days.  Over the years I added a decent set of wheels.  Conservatively I’ve put 50,000 miles on it since I built it.

Two weeks ago, front derailleur wear gave so much flex it could not function. In the aftermath of making it work without fixing it, the rear derailleur suicided into the spokes.  I got minor abrasions and a bent right rear drop-out.

I can fix anything on a bicycle except bent and rust.  I took my broken heart and bent frame to the bike shop and left with an uncertain prognosis.

Then I started looking for a replacement.  In the absence of clinical work, I needed a project.  It would have to fill my time, utilize a talent, and give me a sense of accomplishment.

Before mass market fat tire bikes, I pieced scraps onto a Peugeot frame for winter riding.  After a day wrenching and tweaking, I concluded that adequate for Iowa, ice, and 10 below did not equate to summer functionality.

I turned to social media when those with time on their hands choose to get rid of stuff they don’t use.  A very brief transaction got me a bike from 1978, when the Japanese had started building respectable bicycles.

I found initial assembly errors that would explain a first season’s riding cut short followed by 40+ garage years.

I’ve never overhauled an easier bike; it had age but absent the chain, no rust.  Derailleurs and brakes needed major adjustment.  I overhauled hubs and bottom bracket; original grease had hardened to wax.  The new chain and seat put together tripled the initial cost.

I rode out early on a windy, quiet, cool morning.  Shifting 10 speeds came simple, clear and direct.  The machine rolled well but, compared to my Paramount, accelerations were mushy.

I stopped 12 miles into the ride to raise the seat 8 mm.

Two days later, I got my Paramount back, rolling as well as ever and shifting better than it has for at least 20 years.

Use makes wear inevitable.  The best components eventually wear out.

Not working is not working. For me.

June 12, 2020

I’m starting to feel distraught

I’m twitching awaiting a slot

The jobs that I get

Are found on the net

This thing of not working? It’s not.

 

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 further travel and adventures in temporary positions in Arctic Alaska, rural Iowa, suburban Pennsylvania, western Nebraska, Canada, and South Central Alaska.  I split the summer between hospitalist work in my home town and rural medicine in northern British Columbia, followed by vacations in Israel, San Francisco, Iowa, Miami, and Galveston. On the advice of my doctors, I’m avoiding face-to-face patient care until the COVID-19 danger has passed. Any identifiable patient information, including that of my wife, has been used with permission.

 

I joined up with a telehealth outfit, at the same time a lot of other doctors did.  I find the work stimulating and interesting, but inadequate in frequency and duration. I only get alerts one or two days a week, and only for an hour or two, almost always on Thursday or Friday.

So far the patients come from Texas and Nebraska.  Skin and respiratory problems predominate, though one day half the business consisted of urinary tract infections.

I received feedback that says “Very thorough” 3 times.  The best feedback came when the patient didn’t know the call hadn’t ended and said to someone off-screen, “He was so nice.”

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I took a fall on my bicycle, the one I’ve ridden since 1975, resulting in a bent frame piece (for the inquiring minds, the right drop out lug) and some minor abrasions.  With the gym effectively closed, my main exercise outlet consists of cycling.  The machine I maintained as a spare, adequate for riding at -10 F, is not OK for summer excursions.  Tonight I bought a Facebook Fuji, vintage about 1978, for $30.  It needs work, which gives me something to do.  I hope to be back on the road before the weekend finishes.

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Like many boomers sheltering in place Bethany and I are cleaning stuff out of the house, divesting ourselves of clutter.

I could attack any given pile of procrastination, subjecting it to a cataclysm, but more often I act as the force of erosion, resolving at least one problem every time I pass.

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Despite maintaining social distance, we have visitors most days.  We sit on our back patio, frequently with lemonade or cookies, separated by more than 6 feet.  We have briefer visits on the front stoop.  We set up chairs in both places.   In rainy weather, we move the cars out of the garage, sweep the floor, and bring out seating.

But we have stopped having company on Friday nights, a major contrast from the previous 2 decades.

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The hardest task we face on a regular basis amounts to dealing with other people, which requires us to use language, read facial expressions, and make inferences from body positions.  Strangely, we interact with others more easily than we handle isolation.

Those people who found work stressful now find not working more stressful.

The chronically socially isolated probably haven’t noticed any changes.

A start into telehealth

May 11, 2020

The care I gave was remote

Where they travel by air and by boat

A change it is such

Care without touch

All done by electronic note. 

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 further travel and adventures in temporary positions in Arctic Alaska, rural Iowa, suburban Pennsylvania, western Nebraska, Canada, and South Central Alaska.  I split the summer between hospitalist work in my home town and rural medicine in northern British Columbia, followed by vacations in Israel, San Francisco, Iowa, Miami, and Galveston. On the advice of my doctors, I’m avoiding face-to-face patient care until the COVID-19 danger has passed. Any identifiable patient information, including that of my wife, has been used with permission.

Last week I had 45 minutes of telehealth work.

I’ve done it before.  Alaskan Natives call it “radio traffic” even though the conversation with their villages uses telephones.  Each one has a clinic with staffers trained in physical exam.   The system started before WWII.

I’ve worked in several Emergency Departments with video links to referral centers.  I thought they did a good job with psych, and I appreciated the help with trauma.

While on call in New Zealand I used a protocol based on reasonable to take care of patients by telephone, at least until the clinic opened.

And even in private practice, when snow shut the city down, from time to time I would prescribe based on phone call info only.

I signed up with two companies that broker physician services via computers.  Both onboarded a lot of doctors at a time when the demand for services dropped.  I have been contacted twice when the wait times get too long.  The first time I couldn’t sign on.  The second time I attended 3 patients, all female, and all in a very large state (not Alaska).

The first requested a reasonable medication for a longstanding problem, noting that she didn’t want to get exposed to the SARS CoV2 virus by going out, and that her doctor’s office wouldn’t see her for a non-life-threatening problem.  One had to do with COVID-19, and I ordered testing.  One had three problems, only two of which could be dealt with remotely.

Only in casual conversation last week did I realize I could get unemployment payments.  Self-employed but sidelined by the pandemic, I qualify for insurance benefits.

All in all, I would really rather take care of patients.

Bethany and I continue to shelter at home.  Friends have started to stop by for socially-distanced outside conversations.  We have lawn chairs in the front and back.  Depending on the spring weather, we layer up before we go out.

I started the vegetable garden, just in time to get possibly frosted twice and so had to cover the plants.

Wind and rain kept me off my bicycle last week but today I went 20 miles with temps barely into the double digits Celcius (50 Fahrenheit), and strong winds.

Pestilence literature and the pandemic

April 23, 2020

I called up my friend, he’s named Dave,
To discuss Camus’s  novel, The Plague
Don’t believe what he’ll tell us
About the bacillus
He writes people right, by the keg.
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 further travel and adventures in temporary positions in Arctic Alaska, rural Iowa, suburban Pennsylvania, western Nebraska, Canada, and South Central Alaska.  I split the summer between hospitalist work in my home town and rural medicine in northern British Columbia, followed by vacations in Israel, San Francisco, Iowa, Miami, and Galveston. On the advice of my doctors, I’m avoiding face-to-face patient care until the covid danger has passed. Any identifiable patient information, including that of my wife, has been used with permission.
I called up my best friend from high school, Dave, to discuss a book, Albert Camus’s The Plague.
Dave and I had the same series of English teachers.  We learned how to read in depth.  We had tough teachers with high standards for expository writing.  We learned great study habits and how to work under pressure, how to read in depth, and  good grammar.
But life is all about trade offs.  It took me years to learn how to work when not under pressure.  I read in depth, and I appreciate well-crafted writing, but I have difficulty admitting  I enjoyed a shallow thriller or beach book.  After reading a book once through, I can summarize plot, characters, theme, statement, symbolism, and liet motifs.  And I can recall those years later.
I have no ambivalence about the efficacy of good grammar.
While doctors have lots of schooling, few understand literature.
Camus’s 1947 book chronicles a fictional outbreak of bubonic, then pneumonic plague in Oran, French Morocco.  I picked the book up because of the current covid pandemic.
I had trouble with Camus in high school.  Possibly because we were depressed and sullen in an all-boys school we didn’t like reading that the only meaningful decision of a man’s life was whether or not to commit suicide.
Fifty years later the same author came across as a warm and understanding writer, touching on how the essence of the human condition comes out when faced with extraordinary circumstances.
The plague breaks out.  Officialdom and the population meet the news with denial  Even when the death rate starts to soar, the government maintains a cavalier attitude that the problem will burn itself out shortly.  Only when the epidemic rages out of control does the city shut its gates.  Quarantine measures  demand the sick go to hospital and the contacts to camps.
I saw plague in New Mexico.  Our IHS facility never missed a case.  I can say Camus, like most non-physician authors, got the medical details wrong.
But he got the human details right.  The living suffer almost as much from enforced separation as they do from the disease.  Officialdom fails to deal effectively with the problem until it’s too late.  Profiteers proliferate.  People try to skirt the rules.  The doctor works himself into exhaustion. Ambient death hardens people to the occurrence of strangers dying while sensitizing them to an awareness of past misdeeds.
Above all I was struck by the character who fell in love as a teenager:“The common lot of married couples. You get married, you go on loving a bit longer, you work.  And you work so hard that it makes you forget to love.”
So when I talked to Dave, who has a Master’s in English Language and Literature, our conversational road traveled the robust pavement of rigorous literary analysis, on the heavy-duty roadbed of a shared background.   In the face of a pandemic, both of us began a review of pestilence literature.
He had just started the same book, but he had two years of French.  We talked about how, in critical junctures, either the translation let the author down or the author let the readership down.
We discussed Poe’s The Masque of the Red Death and DaFoe’s A Journal of the Plague Year.  He mentioned Gabriel Garcia Marquez’s Love in the Time of Cholera, which I’d never heard of.  He has two copies, one each in Spanish and English.
I ordered the book.  I have time to read.

Quarantine days 9, 10, 11

April 13, 2020

Today we looked out on the snow

Social distance?  There’s nowhere to go.

With so many icicles,

Forget about bicycles

Never mind your arrow and bow.

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 further travel and adventures in temporary positions in Arctic Alaska, rural Iowa, suburban Pennsylvania, western Nebraska, Canada, and South Central Alaska.  I split the summer between hospitalist work in my home town and rural medicine in northern British Columbia, followed by vacations in Israel, San Francisco, Iowa, Miami, and Galveston.  Just back from Texas via airplane, we’re self-quarantining for 14 days. Any identifiable patient information, including that of my wife, has been used with permission.

 

Quarantine days 9-12

Prepped for and observed two Passover Seders, and the subsequent Sabbath.  Rested 3 days running.

My chronic back pain has flared and I’m getting almost no exercise.

Our friends are also maintaining social distance.  `Electronic virtual Passover Seders reigned as the norm this year.

Today I didn’t eat breakfast.  The blizzard raging outside prevented archery and cycling.

I did, however, start the day with 6 hours of Continuing Medical Education (CME) and have cleared out 6 print journals.

The most interesting content had to do with music therapy for depression.  Passive (listening to) and active (playing) music brought improvement to counseling and medication.  The evidence comes as no surprise but now I can recommend music along with socialization, mindfulness, and exercise as non-pharmacologic treatment for depression.

Bethany and I both have problems with TV like alcoholics have problems with alcohol.  So we’ve never owned a television as adults.  The six months when my deceased mother’s TV and VCR resided in my home awaiting my brother’s retrieval taught us that we shouldn’t have one.  Nonetheless we binged last night on Netflix.  If worst comes to worst we’ll cancel our subscription.

Touching base with long-lost friends via email has become a new normal.

I’ve certainly learned a lot more about the SARS CoV2 virus in the last 24 hours.

We’re looking forward to the end of our quarantine in 2 days.

 

Quarantine day 8

April 8, 2020

In the future, Bones says to Spock,

Through the stars we roll and we rock

But only a fool of a denizen

Prescribes his own medicine

There’s a reason I’m not my own doc.

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 further travel and adventures in temporary positions in Arctic Alaska, rural Iowa, suburban Pennsylvania, western Nebraska, Canada, and South Central Alaska.  I split the summer between hospitalist work in my home town and rural medicine in northern British Columbia, followed by vacations in Israel, San Francisco, Iowa, Miami, and Galveston.  Just back from Texas via airplane, we’re self-quarantining for 14 days. Any identifiable patient information, including that of my wife, has been used with permission.


Quarantine day 8

Breakfast.

Cycled about 14 miles.  The city has some nice trails, mostly flat, but we live on the high ground between them.  I check the weather report before I take off and I try to have the wind at my back at the end of the ride. Clear skies, winds under 10 MPH, I waited till the outside temp hit 50 Fahrenheit.

I bought my bike frame 45 years ago, and pieced together a decent machine from salvaged components.  Less than 2 miles into today’s ride, zipping down a hill, one of the plastic pieces on my rear brake snapped.  I made it work well enough to finish the ride but it will take an hour or two and a lot of creativity to make it dependable.

The geese have returned to the waterways around town, and the bike paths show it.  4 miles from the end of the ride I saw a goose fly under a bridge to make a water landing on a creek in a secluded area.  Not far from houses, but isolated by dense undergrowth and steep banks.

The cycling I did on the flats in Galveston did not prepare me for the topography of home, and today’s ride brought more change in elevation than the two months of biking in Texas put together.  I surprised myself: I didn’t have to dismount and walk to get home.

By the time I got back the thermometer was in the mid 70s.

We started cooking for Passover, which starts tomorrow evening.

A circulating meme, with many variations, predicts at pandemic’s end we’ll have a lot of great cooks and people with alcohol problems.  I predict significant overlap.

We tried to make aioli in the evening.  Then I went to YouTube and found some much easier versions than Joy of Cooking.

But I also constructed chicken soup, that also led to chicken salad.

Bethany and I fixed a recalcitrant window treatment.

I had a televisit with my doctor.  I have enough symptoms that she wants me to get Covid 19 testing.  I thought that a bit excessive, but after I hanging up I started feeling feverish.  The thermometer went to 99 Fahrenheit and stubbornly stayed there.  Not a fever, but a significant deviation from my normal of 97.4.

There’s a good reason I’m not my own doctor.

I took some acetaminophen and napped for a bit and awoke feeling better.