An extremely short commute and a frightening first patient.


Sometimes I need to talk fast

When the ambulance is tuned up and gassed

     It’s like a commercial,

    But not controversial,

It resembles a blast from the past.

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.  On assignment on the North Island of New Zealand, I’m living in an apartment attached to a clinic in Matakana, north of Auckland.

I got up early for my weekly meeting with Care Initiatives Hospice; with a seven-hour time difference, my 6:00 AM corresponds to Iowa’s 1:00 PM.  The meeting went well; we got through the material for two dozen patients efficiently, and when things ended I stayed online, tidying up email and doing some literature research. 

I stepped through the clinic door at 7:00, before arrival of staff or patients, to shower.  We breakfasted with time to savor our food, and at 8:00 sharp I walked ten steps from my breakfast table to my desk and booted up my work computer.  The first patient showed up at 8:30.

Within one minute I suspected a problem requiring prompt treatment in order to avoid death, walked the patient across the hall to the treatment area, requested a diagnostic test and an IV, and said, “Call the ambulance.”

Four minutes later I had proof of diagnosis.

I called the medical registrar (the equivalent of a US senior resident on the internal medicine service) at the North Shore Hospital, an hour away in Auckland, and a minute later she had accepted the transfer. 

In the late ‘60’s I dedicated three years to college radio, and in the process learned a great deal about human communication, lessons which have served me well.  Presenting a patient to a consultant by phone resembles a sixty-second radio commercial; I can communicate everything in a minute if I’m organized.  By now I have had a great deal of practice.

My colleague at the end of the line came across as crisp, professional, knowledgeable and friendly, and agreed with my diagnosis and plan, much like every transfer I’ve arranged here. 

By contrast, I remember during my Indian Health Service days when I had a patient with Reye’s syndrome.  I had the diagnosis in the first thirty seconds, forty-five minutes later I had the lab tests to prove it, but it took me two hours to work my way up the hierarchy ladder to the overworked chief resident.  I repeated the clinical story, the history, physical, and lab results for the fourth time.  At 2:30 in the morning, the remote hospital quiet but for a life-and-death drama, with no other connection than the telephone, I could hear the break in the overworked doctor’s voice, along with it something shattering in his soul, when he realized he couldn’t dodge the admission. 

I think the difference between the two scenarios boils down sleep deprivation; pediatrics residents in the early ’80’s worked 110 hour weeks when things went well, and the medical registrar I talked to sounded rested and motivated.

Twenty minutes after I called the patient back to my exam room the EMTs wheeled him out the front door, oxygen and IV going.

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