A day and a half I’m on call
I know I can’t do it all
I take wax from the ears
I give Kleenex for tears
And then I just hit the wall.
My long day on call grows no shorter as I write.
I get to the office most days before 7:30; I review lab results and scanned documents, and I read a medical journal. Patients start at 8:30.
A reasonable morning opens with a sequence of 5 diabetics in several linguistic and ethnic groups. I do a lot of tearful goodbyes.
A thank-you note and card comes from an Hispanic family; the note verbatim reads Para: Dr. Gordon. De familia (family name deleted) le deseamos mucha suerte en este nuevo camino que enpieza Gracias por todo lo que nos alludo en nuestra salud. Lo vamos a extranar.
The few brief sentences carry much warmth.
A patient, whom I have known for many years, comes in with arm pain and no trauma. I get an x-ray on a hunch; most times such studies yield little information but this time the pattern of light and dark suggests something very unusual and much deeper. I show the films to my partners, we nod and say, “periosteal elevation.” I arrange for a CT of the arm for the next day.
Urgent Care calls me about noon to ask if I’ll work there; illness disrupted regular coverage. I can’t say no because of my job description.
The drug rep brings lunch and after my sandwich and chips we chat, mostly about my future.
The afternoon stars six people with earache. Four have normal eardrums, and, speaking from personal experience, I ask them if the short, sharp, stabbing pain, severe enough to make them wince, comes at random intervals. I explain the problem with temporal-mandibular joint dysfunction, I get to the bottom of the problem, and treat without medication.
Two of the people with ear pain have ear wax stuck, hard, in the ear canals, and I have the satisfaction of curing the patient before they leave.
At five Bethany shows up and I let her know about my late shift. We go across the street to the grocery store for Chinese food.
We get the Senior Two Entree Special (I’m 60 now), an enormous amount of food, and two sets of chopsticks. We sit in the corner dining area and share the small intimacies of our days.
Back at the office, I finish my documentation from the afternoon, and at 6:00 the first of the evening patients arrives.
I move quickly while the dusk gathers outside. I speak Spanish and English to the patients, some of them my regular clinic patients who couldn’t get in to see me on a timely basis or who can’t take time away from work. I send a patient with puzzling abdominal pain and chest pain to the hospital for consults with specialists, and I wonder what I would do with that patient in Barrow with the nearest surgeon 800 miles away.
Three more patients with ear pain: one with TMJ problems, one with wax packed hard enough to have turned to stone, and one with an actual ear infection.
I face the dilemma of treating smokers for cough.
At 8:23 I go back to my office and I try to finish my afternoon’s documentation. I answer and dispose of email. At 8:58 I shut down my computer, hoping to leave promptly at 9:00
But I find the fourteenth and last patient ready at 8:59.
At 9:10 I walk out of the clinic, into the deepening night, and I smell spring running riot. My back hurts, not as bad as it did 20 years ago. My feet hurt, but they hurt worse 30 years ago because now I have rigid orthotics. I’m tired, but not like I was tired 15 years ago; within striking distance of the end and I have slept much better since I gave up OB. I walk straighter and stand straighter than I did when I was half my age. Even when I’m tired.
I miss my workout at the gym, the hour and a half to sweat and watch TV.
At home I take care of more ework and roll into bed at 10:30.
In the middle of the night I take a call from the nursing home about a patient with a significant change in condition since striking their head in a fall a few hours earlier; I instruct the nurse to send the patient to the ER.
At 5:55 I get an alarmed call from St. Luke’s Labor and Delivery: come for a STAT C-section. I am dressed and brushing my teeth in the car 4 minutes later. I exceed the speed limit.
I arrive just as the crew gets into position, and I have time to pull on booties and scrubs before the actual surgery starts.
With a very good obstetrician at the helm, I have absolute confidence as the secondary member of the team, and the baby arrives in short order but distressed. Stabilized in less than 10 minutes and up to the NICU, we sit down to debrief at the nurse’s station at 6:30.
We discuss inexplicable physical findings during the labor. “I want to know why,” the OB says. Then, “God humbles me weekly. If not daily.”
I talk about how every day I see something I’ve never seen before.
When I get home at 6:50 in the morning Bethany has my lunch packed and is finishing breakfast. I shower, eat, leave the house half an hour later than usual and have to face traffic. My commute takes 18 minutes instead of 13 and I arrive at the office sleep deprived with hoarse voice and a sense of humor even weirder than usual.
More people with ear problems, and the nurse and I marvel at how many of those I’ve seen in the last few dozen hours.
Gridlock seizes my rooms from 10:40 to 11:25. A patient with chest pain needs x-ray and EKG; a patient with pain on urination needs a urinalysis; and a patient on Coumadin for a blood clot needs a protime. I feel trapped with both lab and x-ray backed up. The people in the waiting room get angrier and angrier. I twiddle my thumbs, powerless.
The CT scan results come back for the patient with the arm pain from yesterday; non specific abnormalities can only be elucidated with MRI, which I order.
Then the lab and x-ray start to move again and by neglecting my documentation I manage to get the last morning patient out by 12:10 PM.
By that time day has gotten longer and my voice has deepened into the subwoofer range.
Chinese food comes to the break room courtesy of a drug rep who doesn’t even stay to pitch his product. I eat too much of it and then I eat the fabulous sandwich Bethany has sent me (green chile, avocado, artichoke heart and baked chicken on fresh chipotle baguette). Fatigue drives my appetite runs out of control.
I power nap for 20 minutes, then I go back to my documentation.
The afternoon brings more earaches, loss of hearing, and dizziness. I take out plugs of wax as big as the patient’s little finger.
A patient with broken ribs contracts pneumonia.
My tongue sticks to the roof of my mouth as I feel dehydration set in, but I can’t slow down long enough to get to the water cooler.
A bipolar alcoholic patient with migraines, and a problem of just not feeling right also has chest pain, a main complaint that can’t be delayed. The amount of clinical material exceeds any reasonable time limits for one visit.
Patients with borderline personality have limited emotional resilience and come at a time in my day when I am pressured, fatigued and running behind. That patient wants to get everything taken care of right now, and when I resist, threatens to leave without being seen.
Which, of course, is a ploy. If not a short timer, I would grit my teeth, get through the visit, and send a termination letter while I still upset. I let the patient manipulate me. I don’t have long to go and I don’t have to fire anyone.
Sore throat, cough, and two well-child checks.
The Hispanic well-child checks constitute a problem; a lot of the parents don’t speak English, and none of my partners speak Spanish. Like all my patients since February, I have to arrange for follow-up after my departure. I send a lot of the children to a pediatrician who speaks Spanish well.
After I finish documenting the last visit, I walk out of the back door into the sunshine and an absolutely perfect afternoon, and I drive through the spring warmth to the gym for a workout. I lose myself on the elliptical machine and the stationary cycle, sweating out the exhaustion.