A move, a short commute, and two puzzling patients.


Sometimes it’s up to my care

For an unusual case here or there

     With symptoms so weird

     I’m left scratching my beard

For the patient has something rare.

 Synopsis:  I’m a family practitioner from Sioux City, Iowa.  On sabbatical to avoid burnout, while my non-compete clause ticks away I’m having adventures, visiting family and friends, and working in out-of-the-way places.  After a six-week assignment in Barrow, Alaska, the northernmost point in the United States, I’m working on the North Island of New Zealand. 

Bethany and I moved into the doctor’s quarters attached to the Matakana clinic.  Much like a parsonage, it features a kitchen, lounge (=living room in the U.S.), dining area, utility room and closet.  The yard has four citrus trees, which fruit will not ripen during my tenure, and a tree with ripe fiejoas. 

I won’t miss the drive from Leigh with the narrow, noisy, winding road where speeds of 40 kilometers per hour (24 MPH) amount to overdriving the visibility and traction and risking a spectacular flight into the sea.

My commute consists of stepping through a door into the clinic area. 

Few people do the math when it comes to their travel to and from work; perhaps Jack makes $12.50 per hour, but if he works an 8 hour day and has a one hour drive each way, he effectively makes 20% less than Jill who lives next door to the shop and does the same work.

Today I had the pleasure of working all day and never being more than fifteen steps away from my bedroom.

I cared for people aged six to eighty-five; most of the business, as always, stemmed from tobacco and alcohol.  Superficial skin infections, here called “school sores”, continue to be a major source of business. 

Several people came from the UK, a few came from Pacific countries.  I talked to one, not a patient, who had grown up in Matakana, and remembered the clinic building when it was home to a family with two deaf parents.

I took care of more than one puzzling patient; both presented with fatigue.  Both concern me, one more than the other. 

Sometimes a patient has a rare problem, or a common problem that presents uncommonly, or limited communications skills, but in any case presents an intellectual challenge.  My chance of making the patient better is inversely proportional to the number of years the patient has had the problem and the number of doctors the patient has seen.  Sometimes I nod sagely, reassure the patient that, for example, Mayo Clinic has done a fine job of making sure there’s nothing really serious.  From time to time, I finish convinced of a major disease ravaging the patient and equally convinced of my ignorance. 

I anticipated a difficult member of the “worried well,” and asked the nurse to sit in on the visit.  In less than three minutes I felt myself to be in the good company of a range of doctors who had missed a significant diagnosis.  I found several abnormalities on physical exam, but nothing straightforward. 

Galileo said he had seen so far because he’d stood on the shoulders of giants.  I told my challenging patients that if I found a rare diagnosis, it was because the other docs looked in the reasonable places first and I knew where not to look.

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