Learning to say no, but still saying yes.

My maturity is starting to show

I tell you I’m learning but slow

     If the patient’s deranged

     Their mind can’t be changed

But I’m starting now to say no.


Synopsis:  I’m a family practitioner from Sioux City, Iowa.  On sabbatical to dance back from the verge of burnout, I’m having adventures and working in out-of-the-way places.  Right now I’m living in Amberley, and just finished working a four-week assignment in Waikari, less than an hour from quake-stricken Christchurch, in New Zealand’s South Island. 

I worked this last month so the regular doctor could go back to the UK to get married; I wanted to leave an orderly desk so I arrived early.

The office staff booked me light for my last day.

In midmorning a patient came in for the first time since November requesting prescription refills.    When a person has press of speech, flight of ideas, over-detailing, and tangential associations, the differential diagnosis (the list of possible diseases) narrows down to mania, hyperthyroidism, and abuse of drugs like speed.  I told the patient my concerns, politely declined to renew his prescriptions, and sent him across the hall to get his blood drawn.

After lunch I stopped at the hospital on the way back to the clinic.  I signed off medications and drew blood.  The charge nurse told me there’d been a glitch in getting a patient transferred from Christchurch, and wouldn’t I be happy to do the admission?

I firmly and politely declined twice, but third and fourth time I said no I quit smiling.  So, she asked, should I phone them and tell them not to send the patient?

I wrestled with that one.  I could have succumbed to the guilt tripping.  But I didn’t.  I nodded.

Even though with the long holiday weekend, the Queen’s Birthday and all, she won’t get here till Tuesday?

I nodded again, and this time I smiled.

The afternoon went well.  I had breaks between patients.  The last person had eye irritation from a phlyctenule (she gave her permission to use this information).   I’ve written before about this rare eye disorder that comes from an infection in another part of the body.  I explained the problem, phoned the ophthalmology resident in Christchurch and wrote a prescription.

I had my computer shut off, my coat on and my hand on the doorknob when the receptionist stopped me with a message from the patient whose refills I’d declined.

I had a bad feeling about the call, but said yes.

His already rapid speech had accelerated; he made his anger clear, and held me responsible for his problems.  I walked across the corridor to the nurse and held the phone up so she could listen to him ramble.  After two minutes of non-stop diatribe, on her advice I said, “If you don’t let me speak I’ll terminate the call.”

Never argue with a crazy person, a drunk, or a woman in labor.  Pointing out logical inconsistencies to a person out of touch with reality does no good.  After interruptions and threats to ring off, I pointed out that he could talk to his regular doctor next week.

By the last minute of the conversation his mood had changed to friendly, he wished me well six or seven times.

I added unstable mood to the list of findings, but it didn’t help me make the diagnosis.


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3 Responses to “Learning to say no, but still saying yes.”

  1. David Sterling Says:

    Steve – The Dunes has been vacated. All persons have been moved out. Most have had trucks there to load out their furniture. Norman and Jack Bernstein have rented homes in Sioux City. Dan Lederman bought a home in Morningside. The outlook is that they will not be back for at least 3-4 months, if at all. If the levee does not hold, I doubt that any of the homes will be habitable after bein under water for that lenth of time. The Corp of Engineers stops all persons from entering the Dunes area. There is still a steady stream of trucks going up Hamilton Blvd to load dirt and a stream of loaded trucks in the opposite direction. The Engineers have helicopters loading 1,000 pound bags of dirt to extend and reinforce the levee. If the levee holds, no problem. But if it doesn’t, there is going to be a catastrophe. More than 1,000 families have been forced to move. I have been told that every vacant home and every motel room have been rented. John Potash mentioned today at the synagogue that there were some rooms in your home available if anyone needed a place. Yesterday the release of water at Gavin’s Point Dam was 85,000 cubic feet per second. Monday it will be 120,000 and the water level at the Dunes will be 3 feet higher. Release of water will be increased steadily to 150,00 cfs on June 15, and the water level will then be 6 feet higher than on Friday. This will put every home in the Dunes under water if the levee fails. But it should be noted that the current will be extremely fast by that time, increasing what is already a rapid flow of water. Jerry Weiner called our office yesterday to find temporary office space. His office is near the Dunes. With the millions of dollars spent on flood control on the Missouri River, what is happening now seems unreal. No one ever thought flooding was possible. My brother-in-law and his wife are planning a visit in July. They usually stay at the Dunes motel and have reservations. But as of now we don’t know what to expect and what to tell them.


  2. Katie Says:

    I could see that being difficult, especially when you’re not an established employee. But it seems that you handled the situation with aplomb! If you ever make it back to the States and want to continue locum tenens work, consider looking into Barton Associates. They do a great job matching physicians and nurse practitioners with health care facilities and have connections across the United States.

  3. Annye Harryson (@annyelordn) Says:

    We appreciate that all our candidates are highly skilled individuals who work long and hard hours and with this in mind we have a 24 hours a day 365 days a year phone line so no matter what time of day it is or what the problem maybe there will always be an experienced member of staff on the end of the phone ready to help with any request you may have.

    Locum GP Agency

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