Reflections on a zoo of an afternoon, and the flu is back

I’m thinking of what I will do,

The cases are more than a few

            The fever will bake

            With a cough and an ache

The diagnosis is the return of the flu

If I thought people were behind it, I’d say that my afternoon had a bad script writer. 

Old patients, new-born patients, middle-aged, middle school, high school, and college patients.  Migraines that turn out to be sinusitis, sinusitis that turns out to be dental abscess.  Back aches suspicious for much more serious disease, simple back aches.  White patients, off-white patients and very dark patients.  Testosterone deficiency, thyroid deficiency, B12 deficiency, Vitamin D deficiency, Lyme disease, depression, sexual dysfunction, upcoming divorces, upcoming marriages, grief reactions, heartburn, ankle fractures, two pre-op physicals with neither given enough time.  Worried patients, happy patients, manic patients, depressed patients.  Patients speaking English, patients speaking Spanish, patients speaking neither, patients speaking both. Rheumatoid arthritis, sore throats, runny noses, innocent coughs, not so innocent coughs.  Patients with one, two, three, four, five, or six problems (for complaints number 4,5, and 6 I said, “Can you come back on Tuesday?”).  Male patients, female patients, gender confused patients.  Homosexuals, heterosexuals, bisexuals, and asexuals.  High iron, low iron, more abnormal CAT scans than one doctor deserves in a day.  Alcoholics recovering and active.  Smokers, non smokers, and ex smokers.  Caffeine addicts.  Gratuitous low-level dehydration.  Dizziness, abdominal pain.  Can’t wake up, can’t go to sleep.  Diabetics.  Can’t pee and can’t stop peeing.  Slim people with bad cholesterol, heavy people with good cholesterol.  Ear infections.  Students, teachers, lawyers, cops, criminals, doctors, nurses, industrial bosses, industrial employees, farmers, welders, cooks, mechanics, unemployed, self-employed, underemployed, and overworked.  Patients I’ve never seen before, patients I’ve known for 22 ½ years.  Patients who want days off and patients who want to go back to work.  And two cases of influenza.

It’s a grand adventure, there’s no predicting what will come through the door, and those people best at predicting aren’t the ones hired to do the scheduling.  And even if they were, all bets are off when the influenza hits. 

A day that starts at eight and ends at six and runs full speed is not nearly as fun as the same day with four fewer patients and time to enjoy them.

The pandemic H1N1 has circled the globe, and, as predicted, it’s back.  We don’t know if it’s going to be deadly or not.  And we don’t know how bad either the seasonal H1N1 or the seasonal H3N2 is going to be.  We don’t know how reliable the diagnostic tests are going to be.  But we know that a lot of people will get sick at the same time.

The worst flu I can remember was 1993, when the nursing home patients died a half hour after the cough started.  I will probably see at least one more really bad flu before my career is over.  The key is to decrease the intensity so that I can keep working another twenty years.



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