Another last day


My month now draws to an end
What a great way my vacation to spend
I might be a geezer
Enjoying his leisure
But I’m sure enjoying the trend.

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, sold my share of a private practice, and, honoring a 1-year non-compete clause, went to have adventures in Alaska, Nebraska, Iowa, and New Zealand. I returned to take a part-time position with a Community Health Center, now down to 40 hours a week from 54. Right now I’m in Petersburg, Alaska, on a 1 month working vacation.

The month of March flew by in Southeast Alaska. This trip’s last day passed in a leisurely fashion.

I cared for 8 patients in the course of both sessions and none in the last two hours of the afternoon.

Confidentiality limits what I can say about patients, but I can write about clinical matters. When all else fails, examine the patient, even the hard-to-examine autistic. Meatal stenosis (a narrowing of the hole through which the urine passes) requires a surgery so simple that I could probably do it. Phyctenular keratoconjunctivitis, an unusual cause of a red eye, comes no more commonly than rosacea of the conjunctiva. Allodynia (where light touch produces pain), unusual to start with and even less common as back pain, demands more than symptomatic treatment. If the original plan fails to fix the patient, the three most important steps are re-evaluate, re-evaluate, re-evaluate. Hemoptysis (coughing up blood) in a former smoke demands a chest x-ray, even if the smoking stopped ten years ago.

I got the chance to speak Spanish; I told a joke involving a pun involving ratito meaning both a small period of time and a diminutive rodent.

In the middle of the morning I stopped into the lab to get my PPD (TB skin test) read. Every health care institution demands periodic testing for tuberculosis among its workers in 21st century America and my previous test lapsed a little over two weeks ago. The small geographic size of the operation here made getting the poke in the forearm much easier than such a test at home. After all, it takes 14 steps to get from my office to the lab, and at home I would have to drive to my doctor’s office.

I ate lunch down the hill at Coastal Sea Foods, deep-fried halibut and fries. A construction worker shared my table and we talked a lot about the vagaries of the weather in the Alaska Panhandle. The place filled up during our discussion, and I finished my meal surrounded by commercial fishermen.

In the last half of the afternoon I cleaned up both my physical and electronic desktops. I tried to log in to the provider portal at my clinic back home. When the request came to change my password because of brevity, I fired off a quick note saying that 9 characters had sufficed for 3 months, and I wouldn’t accede to a request for more.

My sojourn here coincided with a family emergency for one of the full-time permanent doctors who returned today. I expressed gratitude that I could help.

I had a good time. If all works well, I go fishing tomorrow.

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