Thyroid, not phosgene, and other non-compete delights

This insomnia’s got out of hand!

I think it might be a gland,

     It might come as a shock

     I can’t be your doc,

But I can certainly tell you who can.


Four days of being unemployed, I have the electric fence up and the vegetable garden in.  A soaker hose and planter paper to discourage weeds will keep it low maintenance. 

I met with the Care Initiatives Hospice staff to get my computer set up to Skype, so I can attend meetings without being present.  Much remains to be done to ready the computer; I have to finalize Skype, add Palm and Epocrates and transfer documents.

My office stuff is gradually coalescing into one section of the basement. I still have seven stethoscopes, a personal stereo amplifier, three headlamps and a lot of things from the walls.

My seven medical licenses (Iowa, Wisconsin, South Dakota, Nebraska, New Mexico, Colorado, and Wyoming) and the professional certificates take up more room than the framed photographs and artwork put together.  There are two boxes of books and three of files; one full head mount of an antelope, and set of antelope horns.

They wait in limbo till I have my next office.

My contract says that for the next year I can’t enter into competition as a family practitioner with my parent organization in Sioux City or for a 30-mile radius.  Without  that clause I wouldn’t be having nearly as much fun as I am; I would have made a hurried transition to another venue.  As it is I’m having a fabulous time and I’m building leisure skills.

Still, the mysteries find me.

While I was cycling at the gym I got a call from a friend living in a community just barely inside the 30 mile limit, who has never been my patient, concerned about insomnia.  Could phosgene, a common agricultural chemical, cause that problem?

I didn’t know, I said, could I find out more? 

Working with equipment fumigated with phosgene, the patient said, in a closed area, and just couldn’t sleep for the last three or four days.

Phosgene?  I asked.  Are you sure?

Yeah, phosgene.  Been working with it for years.

I don’t know much about phosgene, I said, but I’ll look it up.  Then I thought back to when my thyroid betrayed me, and I asked if there had been heat intolerance, heart racing, fatigue without being able to sleep, weight loss, and no sense of inner peace.

Well, yeah, the person said, all those things.  How did you know?

You need your thyroid checked, I said.  Who’s your doctor?

I don’t have one.

I said, You need one, not me, I’ve got this contract…

Yeah, I know, but who do you recommend?

I named three doctors in the system, paying attention to location. 

Later on I called again while looking at Wikipedia.  Are you sure it’s phosgene? I asked.

Yeah, positive.

Not possible, I said, you shouldn’t have phosgene anywhere outside a chemical plant.  And phosgene causes cough.

Well, maybe it’s phosphine.

I keyed that molecule’s name in and got a fumigant.  I believe you’ve been exposed to phosphine, but I’m sure it won’t give you insomnia.  Phosphine will interrupt  your lungs pretty bad before it hits your brain, and if it affects your brain it’ll put you to sleep, it won’t keep you up.  And if there’s that much phosphine, you should notice insect life dying off.

No, the person said, the bugs are doing just fine.

We hashed out what to expect from getting the thyroid checked, and the need to find a doctor soon.

The patient thanked me profusely and wanted to know what I was owed.

I didn’t want to take anything, and I used the non-compete clause as an excuse.


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