A toddler will try, I suppose,
To stick jelly beans up in the nose
With patients in stacks
We take out ear wax,
While outside the arctic wind blows.
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.
Long before dawn (the sun rose about ten today), with the mercury firmly at -28 F (-33 C), the physicians of Barrow sat down together in the hospital’s Commons Room.
We start clinic days with a conference, an hour discussion of patients who need to be brought to the group’s attention. Sometimes the debate runs hot. No two docs have the same range of skills; we all come away from the discussion better physicians.
The hour, for the last week, now features a five-minute starter from the Case Manager, giving us updates on the patients sent to Alaska Native Medical Center (ANMC) for hospitalization.
We don’t talk about drama and irony nor contrast and meaning, though we talk about the impact of illness and injury on people’s lives.
We focus on diabetes and smoking, emphysema (which we call COPD or chronic obstructive pulmonary disease) and steroids, heart disease and the interplay of factors that bring a person to illness. Occasionally we’ll talk about tragedy and trauma and domestic abuse.
Narcotics seeking behavior comes up a lot, but as a group we’ve evolved a way to deal with the problem. Part of the solution includes the doctors communicating with each other.
One doc gave an erudite rundown on congestive heart failure, renal physiology, and hypertension. He did it as casually as giving directions to the gas station. An in-depth round table on practical parasitology followed
Morning appointments follow morning conference.
My last patient before noon survived burning, stabbing, shooting, being run over by a riding lawn mower, and falling from a roof and bouncing (and gave me permission to use more information than I’m including ). After all that trauma, his lifestyle choices threaten his life more than anything else that has happened. I called a specialist in another city, and, in the spirit of full transparency, included the patient in the conversation by leaving the speaker phone on.
The specialist said a lot of things he wouldn’t have if he’d known the patient were listening, like using the phrase, “stupid idiot,” but he also gave a good if emotional rundown of the physiology in the case. I watched the patient’s face, he seemed neither offended nor surprised. I respect him as a man of remarkable emotional and physical resilience, whose intelligence has not been ruined by schooling. But I disagree with a lot of his choices.
Afternoons, the clinic opens to walk-ins with no appointments necessary or available.
Ears, nose, and throat problems dominated the afternoon. One patient left cured after ear wax removal. Four others had ear infections.
The mother of a young girl gave her OK to post the following: the child inserted a jelly bean into the nose. Toddlers imitate reflexively though their first response to a command is No. I held one side of the mother’s nose shut, with a tissue guarding my hand, and had her blow through the other nostril. Given the opportunity, the kid did the same thing, and the jelly bean, its colorful sugar coat dissolved, shot onto the paper.
I don’t often get the chance to cure patients before they leave.