Bits and pieces, clinical and otherwise

After shaving off all the head’s hair,

My patient said, “What is this there?

For my scalp is so sore

I can’t touch anymore

And the smallest exertion’s a chore.”

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 54 hours a week.

I met a person with the last name of Jeffords. 

“Any relation to Tom Jeffords?” I asked.

Yes, came the reply. 

Tom Jeffords carried US mail in Arizona Territory back when the Apaches didn’t hesitate to expend ammunition when showing disapproval of the new invaders.  After the Chiricahua killed a couple of his carriers, he rode his horse into Geronimo’s camp and demanded the depredations cease.  Geronimo, impressed at the personal courage and straightforward approach, agreed, and the mail went through unmolested.  The two men became fast friends.  When his Apaches went to their new reservation, Geronimo requested Jeffords as his agent, Jeffords accepted, and, to the best of my knowledge, became the only Indian Agent to remain uncorrupted by his position.

I knew the story in far greater detail than the Jeffords I talked to.  Tom Jeffords still holds my admiration for personal courage and integrity; we agreed that such characteristics come rarely and we wished we could find men like Tom Jeffords in prominent positions in our government.


Today I took care of a patient who noticed tenderness in the scalp after shaving (in the 21st century, make no assumptions about age or gender of the patient).   This unusual complaint puzzled me, but remembering the adage, “When all else fails, examine the patient,” I reached out to the touch the indicated area and found it warm and swollen but not red.  I looked at one side then the other, and realized that the temporal artery stood out on the right.

Temporal arteritis remains a mysterious disease; for unknown reasons the arteries throughout the body become inflamed.  As a result those afflicted feel run down, have morning stiffness, and lose strength in their shoulders and hips.  As I queried my way through the list of symptoms the patient became more and more puzzled that I would even ask such questions (the patient also gave me permission to include a great deal more information than I have).  Front line docs don’t see a lot of it, maybe a case every couple of years, and we usually refer to a rheumatologist if available.  Head-shaving, increasingly popular through many segments of the population, occurred rarely during my training years; it made the physical finding visible which before were only tactile.


I started early without trying this morning at 6:15AM, and finished my share of hospital rounds at 8:15.  While I could have conceivably taken the morning off, I used the windfall hours to catch up on hospital documentation.  At 10:30 I had made great progress and went over to the office and worked on my paperwork backlog till patients started at 1:00PM.  For some unknown reason one hospital began sending me lab summaries from patients hospitalized as far back as last July. 

I can pull up the patient’s electronic chart and see if the information has already been downloaded, but given the peculiarities of our system, it goes faster to sift through the data as if I’d never seen it.  Not to say it goes fast.  It doesn’t. 



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