An inpatient care program drawing to a close


As I walk down a hospital hall

I think of the burden of call

What helps me to cope

Is a heart full of hope

That this month is the end of it all.

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.  Since August I’ve done a working vacation in Petersburg, Alaska, Continuing Medical Education (CME) in San Diego and Denver, and a trip to Mexico for our daughter’s wedding.

Our clinic’s inpatient program draws to a close in ten days.

The US remains the only industrialized country where primary care doctors attend hospitalized patients on a regular basis; for most of the world primary care ends at the hospital doors.

Community Health Centers, in particular, rarely send their docs to the hospitals.

I like making rounds, and talking to the specialists.  I have established a rapport over the years with physicians who know more than I do about their fields, and I enjoy the learning process.  On a usual basis I will leave the lunch table in the lounge a better doctor.  A tremendous amount of learning goes on in the peer-to-peer environment.   Once in a while I’m the teacher.

Today I saw 10 patients, ranging in age from 1 day to 77 years in one of the hospitals.  The problems included renal failure (both acute and chronic) abdominal aortic aneurysm, thoracic aortic aneurysm, COPD, cellulitis (face and leg), pelvic inflammatory disease, bipolar type I, alcohol abuse, tobacco abuse, hepatitis C, cirrhosis, chronic pain, narcotics abuse, amphetamine abuse, rectal bleeding, and pneumonia.  I greeted patients in Somali, English, and Spanish.   I got consultations, both curbside and formal, in cardiology, surgery, nephrology, and pulmonology.

Every patient came with a unique and fascinating back story.

I arrived at the hospital at 7:00AM and I left at noon.  Mostly I take the elevator to the 6th floor and work my way down, but today I took the stairs up to the nursery on the second floor, and worked my way up from there.

I discharged two patients.  In an irony of specialist vs. generalist, I did a consultation on a patient with a problem outside the expertise and field of the admitting doc.

I uncovered a few surprises, mostly to do with vitamin D and underactive thyroids.

I walked the hospital corridors and dictated into my hand-held recorder suffused with an existential awareness, which I can compare to the edginess of a high school senior in late May.

However much I find meaning and pleasure in the rounds of inpatient work, the afterhours call burden has become unsustainable.  I won’t miss the phone calls ripping me from sleep through the early morning hours and recovering from a bad night on call; it now takes me three days of a zombie fog in the wake of such a night.

After December 3, we’ll take hospital call only for pediatrics and newborns.  I’ll be able to exercise and sleep on the nights when I have call.

I hope.

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