Archive for April, 2015

Finding work and meeting ex-patients

April 17, 2015

The hardware she helped me select

Then noted a pain in her neck

I derived such enjoyment

At her place of employment

No charge for a three-minute check

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 out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I went back to adventures in temporary positions until they have an Electronic Medical Record (EMR) I can get along with. I just got back from a 3 month stint in Nome, Alaska.

I returned from Nome to Sioux City ten days ago; Testing my immediate employability theory, I woke up Monday morning with nothing on my schedule, and tried to have work by Wednesday. My time frame incorrect, in less than a week I had work lined up from the 3rd week in April until the last of September.

I don’t write in detail about these jobs until I sign contracts, sometimes not until I see plane tickets. Five out of 6 jobs fall through. This summer I’ll work Urgent Care in 12 hour shifts, from 3 to 5 days per week. And, if things go according to plan, much of my summer I’ll spend working in Pittsburgh.

I’m also talking with a Canadian recruiter. Most American docs reflexively vilify the Canadian single-payer system but few understand it. I want first-hand experience despite the fact that with one exception, every Canadian physician I’ve met hated their system.

But every day I see former patients.

At the gym, a fit-looking, slim, middle-aged woman came up to me while I sweated on the elliptical. “You saved my life,” she said, “It was eleven years ago I stopped smoking. I fist-bumped with her, genuinely glad she changed her life. Yet I believe that if my patient gets better, 80% of the credit goes to my patient, and 20% to me.

Last week at Sam’s Club, a young man approached me with the good news that he’d stopped drinking soda pop and had started drinking more water. He looked healthy.

Yesterday a former patient reminded me that 25 years ago to the day I ushered her into the world. I had the great good fortune to diagnose pregnancy, do the prenatal care, attend the delivery, and perform the well child exams. She has grown into a strong, competent, attractive young woman with an impressive array of skill sets. An asset to the city, her family, and the health care industry, I feel privileged to have watched the process.

Today at the hardware store, a staffer complained to her co-worker about knots in her neck. (She gave me permission to write this.) “I’m a doctor,” I announced, “and I can make those knots go away.” I sat her on a stool at the back of the store and put my hands onto her shoulders, finding the usual set of painful lumps, starting with the upper inside corner of the left shoulder blade, the cluster of four between the shoulder blades, along with the characteristic tightness along the back of the neck. I used a routine that I developed over the years, progressively massaging the head’s support muscles, finishing with a standing upper back crunch. She thanked me profusely.

At the end, I said, “Making your neck knots go away, that took three minutes and it’s free, but it doesn’t address the whole question of why you’re not sleeping well, which is the root cause of the problem and would take 20 minutes.” She wanted to know where I work, and I had to tell her I’m between jobs.

I didn’t tell her I so enjoy making people feel better that I quit charging for spinal manipulation. But I left my business card, and encouraged her to read my blog.

Foxes, itches, triumph, and hunter: on the cusp of leaving Nome

April 1, 2015

On the med list I’m pulling a switch
‘Cause my patient came down with an itch
Now they’re getting the sleep
That’s restful and deep
And for trazodone I found the right niche

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 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 (EMR) I can get along with. Right now I’m back to Nome from temporary detail to Brevig Mission.

I took care of a patient with a very bad diagnosis and a very bad itch. I will leave it up to the specialists to try to change the course of the disease, here in Nome I will try to relieve suffering. Because itch in the context of unrelenting pain constitutes torture. We looked over the med list.

Me: Aren’t you allergic to codeine?

Patient: Yes, it makes me itch, real bad. Same with the hydrocodone.

Me: Stop picking at yourself. Why do you take the oxycodone?

Patient: Beats me. Doesn’t work. That’s why I finished ’em early.

Me: If they don’t work, why do you take it?

Patient:

Me: Maybe oxycodone is making you itch. Let’s try stopping it.

Patient: But how am I going to sleep?

Me: How are you sleeping now?

Patient: I’m not. Those pills don’t work.

Me: Maybe we should stop them.

Patient:

Me: How about if I give you a sleeping pill to help you sleep and you come back next week. How about trazodone?

It took some explaining, but the patient came in, looking fresh and happy and focusing a lot better, having slept well 4 nights in a row, and now having much less pain. Because (everyone knows) that good sleep helps a person deal with pain.

And another demonstration of the principle of ABCD (Always Blame the Cottonpickin’ Drug).

***

I can post this about the young man because I got permission from him and his mother and because everything is on Facebook. Well on the way to being a hunting legend at age 14, he got his first polar bear at age 11, same year he got his first bowhead whale. He has lost track of the number of walruses he’s gotten so far this year. I still won’t publish his name or what he came in for.

***

I stepped into my cubicle about 10 in the morning and saw a red fox run past.

Foxes hunt at night, any abroad by day raises suspicions of rabies. At home, if I see raccoon, skunk, or fox outside of dusk, dawn, and night, I will seek a weapon to dispatch the animal. In Barrow, we assumed rabies in all arctic foxes.

The furry red animal ran along the north side of the building, around to the west. I said, loudly, “There goes the fox!” and strode briskly to the other end of the clinic to try to get another look; I worried it might head to town. I didn’t see it again, and decided it dens either under the hospital or in the maze of construction dross nearby.

****

The first patient of the day felt really, really good after the vitamin B12 shot yesterday. Best in years; better sober after that shot than drunk.

Which made my day.

***

I leave tomorrow after an abbreviated afternoon clinic. Staffers have come in to wish me well. I got a great going-away card, a very trendy tote bag, and a pair of hand knit socks. Along with the story of the wool (starting with the sheep) and the WWI-era sock knitting machine.