It starts with a drip from the nose
And progresses with an ache to your toes
What should you do
When contracting the flu
While waiting for the clinic to close?
Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, travelled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I am back having adventures in temporary positions until they have an Electronic Medical Record System (EMR) I can get along with. Right now I’m in Nome, Alaska.
My nose starts dripping at 4:00PM, while finishing a visit with a patient with a knee problem. I blow my nose, wash my hands, and apologize. A vague sensation of not feeling quite right accompanies an explanation of how to apply a cold, not frozen, can, not bottle, of regular, not diet soda to an area of overuse.
I exit the room, have my nurse print the patient’s depart papers, and ask about the afternoon’s first patient.
I started with that patient on time at 1:00PM. While I washed my hands, I noticed shortness of breath. I listened to the account of all the things that had happened since a recent surgery. After examination, I told that person my concern for a possible blood clot in the lungs, then started in the process of ordering a CT of the chest (and, because of other problems, other places).
The welcome assignment to Same Day duty brought my most intense day since arriving in Nome. Starting with an empty schedule, the morning filled with people who had sickened or worsened in the last 72 hours. I moved efficiently, discharging the last morning patient promptly at noon. I bolted up the stairs to the cafeteria, inhaled lunch, and descended to finish the morning’s documentation. With satisfaction every time I hit the SIGN box, I started the afternoon with no morning leftovers.
Nothing happened quickly for that first afternoon patient. While I cared for others with respiratory infections, orthopedic problems, rashes, and psychiatric conditions, complicated by betrayal, bitterness, and overwhelmed emotional resilience, we had delays getting the lab to draw the blood, and delays getting the results.
The nurse tells me that the patient hasn’t yet gotten the IV for the contrast.
However late, we need the result before the patient can leave.
I start with my 4:00 PM patient at 4:05. At the end I discuss the difference between sinusitis and the common cold. I describe the relationships between stress, alcohol, marijuana, tobacco, and the immune system, and make recommendations.
I sit down at the computer and I start the depart orders for that patient: diagnoses, medication reconciliation, follow-up, and patient education.
I wait for the CT scan to start while I start the afternoon’s documentation. At 5:00 my nose has gone from dripping to running and I worsen. My forehead warms my palm, but I keep keyboarding.
At 5:15 I ask the nurse for a portable thermometer and receive, to my surprise, real mercury in real glass.
The patient enters the CT scan while I mutter that I don’t feel good; at three minutes the thermometer reads 99.0. The glass bulb stays under my tongue.
Long ago I learned to keep the thermometer in till it quit going up. I keep computing, checking the silver line every three minutes, till 5:45. The worst of the documentation ended, I await the viral onslaught with a near fever, 99.5.
At 6:10 I can tell the patient, “You have no blood clot in your lungs, and the rest of the studies showed no surprises.”
At 6:15 I walk out, feeling even worse. The dry, hacky cough (confirming my diagnosis of influenza) starts while I crunch across crusted, packed snow in the gathering subarctic, subzero gloom. The half-mile back to my lodging takes me 15 minutes. After 2 acetaminophen, a Tamiflu and a liter of fluids, I crawl into bed and don’t crawl out till morning.
Feeling much better, I walk back to hospital in 10 minutes, arriving before business hours. Funny lab results bring me to research multiple myeloma until 8:30 when I call the infection control nurse. She comes to my cubical.
My story recounted, I ask, “Do you or don’t you want me seeing patients today?”
“What would you tell a colleague?” she counters.
To answer a question with a question constitutes a dodge, but, in this case, a legitimate one.
I said, “Generally I send folks back to work when fever free for 24 hours, and I never actually ran a fever.”
And in fact the worst part of my contagiousness happened in the 24 hours before my nose started to drip.