On finding the right quest


Of this I have been impressed

Some people ended up stressed

Life might be breeze

They might do what they please

But they need to follow a quest

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  In May 2010, I left my position of 23 years, and honoring my non-compete clause, traveled for a year doing locum tenens work.  In June of 2011 I joined up with the Community Health Center, which provides care for the underserved.  I’m now working part-time, which, for a doctor, means 48 hours a week.

I work late Mondays.  I start at the hospital between 6:00AM and 7:00AM, leaving in time so that I can start clinic at noon.  I may or may not get a breather to eat, and I care for patients till 8:00 PM. 

Tonight I got a break when my last patient of the evening, who had never been seen at the clinic before, failed to show for the appointment.  I’d guess that a substance abuse disorder lies at the base of the person’s problems, but, having never met them, I can’t say for sure.  I used the extra time to catch up on documentation, but left before 8:00PM to go to the gym. 

Yet Mondays do not rank as my usual heavy day; that distinction belongs to Tuesdays, when I usually take call.  I generally roll up to the clinic before 7:00AM, and take advantage of the quiet to sort through arriving lab results and other paperwork.  Patients start at 8:00AM, scheduled till noon, and the afternoon session starts at 1:00PM and runs till 4:30.  I continue to document at my desk till the ER calls me for an admission.  On occasion I’ve left my desk at 6:00PM when my efficiency fails.

Today I found a census of twenty-two waiting for me at the hospital.  I rounded on eleven of them, discharged four, and then I headed to the clinic.  I turned the others over to our full-time hospitalist.

In twenty-first century Iowa, most people need to lose weight, but our patient population has such a grand mix of pathology that today I took care of two who needed to gain.  

To put on weight I advise three scoops of expensive ice cream at bedtime.  (If you need to lose weight, you’re never going to do it if your bedtime snack continues.)  All the folks I take care who have lost too much weight have an identifiable illness, though sometimes it doesn’t account for all the person’s symptoms. 

I sat and philosophized with a young person I had coaxed back up across the 100-pound line.  I had correctly identified the pathology and, working with the patient, had come a long way towards correcting it.  Yet a problem in the grander scheme of things remained. 

Sometimes I talk to high school health classes, I told the patient, and if I walk into a classroom of 35 students I can usually be sure at least one has set him or herself on a quest for wisdom.  Others are born musicians or artists, photographers or historians.  Whatever that person might do for a living, if they can’t also follow their quest, something inside of them dies.

The patient nodded and said, “That’s my problem.  I haven’t found my quest.”

I said, “But not everyone has one or needs one.”

 And in fact, most people don’t.

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