The weekend covers days three
And guess who’s on call? It is me!
With period and comma
I document drama
You wouldn’t believe the stuff that I see.
Synopsis: I’m a family practitioner from Sioux City, Iowa. I danced back from the brink of burnout in 2010, and, honoring a one-year non-compete clause, went to have adventures and work in out-of-the-way locations. After jobs in Alaska, New Zealand, Iowa, and Nebraska, I returned home and took up a part-time, 54 hour a week position with a Community Health Center. I’m just back from a working vacation in Petersburg, Alaska.
Scenes from a weekend on call
I sit in a hospital room with a new admit and I take a history. Sunlight streams through the window, the first day of fall gleams outside with perfect temperature. When I get to my 84-question Review of Systems, where I ask about every conceivable symptom, violence from the next room shatters the mood. A domestic disturbance has broken out in the adjacent room and spilled into the hallway along with items of furniture and things that can be thrown. A mother hurries away with an 8-year-old in tow. I read the child’s face and the look of wonder and awe, and I see he has been handed a script loaded with dysfunction. Overcoming what he accepts as normal will take intelligence, persistence, insight, determination, optimism, and, probably, help.
I sit beside the patient’s bed. “What do you think the CT showed?” I ask.
“I don’t know.”
“Do you want to guess?”
“I don’t know.”
The patient knows, and I know it. I make small talk and then start the trip around the track again. “What do you think the CT showed?”
After four laps I get the patient to say “cancer.”
“Yeah, I know I got cirrhosis and I know I should quit drinking but hey, you know, I was about oh I don’t know probably about 3 or 4 weeks and I hadn’t had a drink then, oh I don’t know, I got pretty hammered. But I didn’t do it that much and I only did it a couple of times. And sometimes, geez since July I blow up and then I’ll pee off like about 25 pounds and it comes and goes and now my belly hurts up here on the right.”
“I think she has decided to die.” The patient’s children look at each other and their faces carry nuance beyond description.
“We kinda thought that since we read that book.” They refer to Love, Medicine, and Miracles.
“I gotta be outta here tomorrow for a court appearance.”
I nod. I have a patient with a heart attack waiting for me in the ER across town and I need to move. “So how are things going for you?”
“You know, life in general.”
“Do you really believe that? When you just told me you girlfriend left with your kid and you have a court appearance?”
“Yeah. (pause) Well, no. No. I got a country and western song in my head. It’s my life.”
It’s past midnight and I’m talking to a judge by phone. I explain that the patient’s brain function, loosely connected by an accident of genetics, has not improved with a major electrolyte imbalance occasioned by and coincident with severe hypothyroidism and failure to take meds as prescribed by a psychiatrist and endocrinologist. After non-stop clinical work starting 19 hours previous I can remember the patient’s name and age but not birthdate. I can, however, relate details about the request for hospitalization, docility in the ER and a quiet hour on the medical floor followed by increasingly loud, bizarre, and violent behavior over the subsequent 2 hours (which responded temporarily to 1 mg of Haldol, but which will necessitate a 48 hour court hold). The call takes twenty minutes and ends at 1:30. Vigilance robs my sleep for the next 3 1/2 hours and then I get up, shower, eat, and start rounds again.