For the patient, here is the plan
Forget the equivocal scan
I don’t need much urgin’
To call up the surgeon
With the results of the tests that we ran
SYNOPSIS: I’m a Family Physician from Sioux City, Iowa, making a career transition to avoid burnout. While my one-year non-compete clause ticks off I’m traveling, doing locum tenens, and having adventures. Right now I’m working at Van Buren County Hospital in southeast Iowa, where there are no stop lights or fast food.
I’m on call in Keosauqua, Iowa, where the mid-level providers (Physician’s Assistants and Nurse Practitioners) take first ER call, and the MD or DO provides back-up and more definitive care.
The day till now has run on a low stress level. As with any other day I care for patients, I came across a physical finding I’d never seen before, a soft lump where I should find hard bone. The MRI machine comes in a trailer tomorrow and will give me an answer.
I hesitate more about ordering MRIs now than I did when I owned a part-share in a scanner, but I seem to order the same number. I’m likely to fill out the paperwork and jump through the insurance company hoops when back pain goes down the leg and doesn’t get better, when mysterious physical findings can’t be denied, or when the patient worsens. I find a lot of occult fractures, that is, broken bones that didn’t show on x-ray.
I remember patients I sent for MRI when I had profit motive to do so; scans showed problems malignant and benign, and surgeons prolonged or saved lives.
Keosauqua has growing Amish and Mennonite populations. They call us English even if we aren’t English, we call them Pennsylvania Dutch even if they don’t live in Pennsylvania and they aren’t Dutch. Their economic basis depends on subsistence farming; their agricultural methods qualify for the trendy buzzword sustainable. I haven’t seen horse-drawn vehicles on the roads here but I have seen traditionally dressed people at the café and in the hospital waiting room.
A call comes from the ER for me to evaluate a Mennonite patient. I find the family straightforward, respectful, and friendly. I’ve seen the problem at hand hundreds of times. The CT scan, ordered before I saw the patient, comes back equivocal, but my exam makes a firm diagnosis requiring a surgeon.
Our surgeon and I have come to similar places in our careers: we want to work but we want to slow down. His solution to the full-time-means-eighty-hours problem led him to work two weeks out of four, while I intend to go to a forty-hour week when I get back to Sioux City.
Thus, the patient arrives while our hospital’s surgeon is en route to Florida.
I admit my surprise when the matriarch pulls a cell phone from her skirt pocket. You should have been there. The family requests a surgeon across the state line in Missouri.
I make the call requesting a transfer, speaking to the surgeon herself. My presentation of the patient comes off smooth and articulate.
The family drives into the night, subsistence farmers with hard copies of lab results and a CD copy of the CT scan.
Contrast is the essence of meaning.