Munchausen in the morning, narcotics seekers, and long distance snowmobile back pain.

Here’s an intelligence spark

To keep doctors out of the dark.

     The information we share

     In the hour we spare

About which patient is seeking which nark.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  Avoiding burnout, I’m taking a sabbatical while my one-year non-compete clause winds down, having adventures, visiting family and friends, and working in out-of-the-way places.  Currently I’m on assignment at the hospital in Barrow, Alaska, the northernmost point in the United States.

The doctors’ mornings in Barrow start with an hour-long colloquium.  We discuss patients by name, talk about history, physical findings, and differential diagnosis (the list of possible diagnoses).  We talk about problem patients, consultations we’ve received, and interesting lab findings.  Every admission, delivery, and transfer gets discussed.

I keep my presentations short. 

When I worked in radio, and I could sell a commercial to a sponsor, I never got more than a minute to get the message across.  I learned to distill the communication to its essence, keep my sentences short and not repeat myself.  If you can’t say it in less than a minute, I used to lecture trainees, you’re not sure of what you want to say.

I named a patient and described an injury at morning rounds today, and how the patient copped an attitude when I refused a prescription for the requested narcotic.  As soon as I said the name the room erupted into spirited groaning.  A Munchausen, my colleagues said, who diverts the pills to a (named ) household member.  Then they told me about the self-inflicted injuries they’d seen.

Munchausen’s syndrome got its name from a fictional character in a 19th century play who went from doctor to doctor, making up symptoms to get attention and treatment.  In the 21st century, a patient with the diagnosis of Munchausen or Munchausen’s syndrome has demonstrated a willingness to injury him or herself, feign symptoms and alter lab findings.  Most of the pathology comes down to attention-getting and narcotics-seeking behavior.

I’ve had Munchausen patients in other places.  One’s (I won’t say where, I won’t say when) skills at feigning an abnormal neurologic exam were so good that a previous doctor ordered a seizure drug intravenously.  The drug went into an aberrant artery, instead of a vein, that ran on the inside of the elbow, and the patient lost a hand.  The tragic story unfolded over the course of a week, and as I used the telephone to close in on the truth the patient signed out of the hospital, against medical advice, never to be seen again. 

I talked about three other patients, I received advice on whom to call at Alaska Native Medical Center (ANMC), and learned some fine points about bush medicine.

The other docs with more experience here discussed what to expect during Qiviuk, the Messenger Feast that started today. 

Several hunters, who had been out for meat to provide for the feast, came in with medical problems related to their activities.  One had back pain from riding hundreds of miles on a snow machine in the pursuit and retrieval of a caribou, and gave me permission to write about it.  I’m sure if I’d been that long on a snowmobile I’d have the same physical findings.

I told him my thoughts on the importance of hunting to Barrow, how it sustains the people nutritionally and how it gives the men in particular and the town in general direction.


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