Work on the glorious 4th

At one time I really liked running
The effect can be rather stunning
But a fracture from stress
Can make an ankle a mess
And test out all of one’s cunning.

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. I spent the winter in Nome, Alaska, followed by assignments in rural Iowa and suburban Pennsylvania. After my brother-in-law’s funeral, a bicycle tour of northern Michigan, and cherry picking in Sioux City, I’m back in Pennsylvania.
Any patient information has been included with permission.

I started running in high school. My then undiagnosed hypermobility syndrome, combined with inadequate shoes, a penchant for running on pavement, my obsessive tendencies, a teenager’s natural urge to test limits and my sheer stubbornness resulted in stress fractures of my lateral malleoli, the outside ankle bones. I gave up running after my first (and last) marathon in 1981, and in ensuing years I have diagnosed stress fractures in fewer than half a dozen patients.
Thus my first patient on July 4 and I had a runner-to-runner conversation about stress fractures, the meaning of running, and what to do when you can’t run.
The pace of the holiday picked up after that, with 5 or 6 patients per hour. I got further and further behind on my dictations. I plowed ahead, happy to be back at work after two weeks absence.
The holiday did not bring an appreciable change in the case mix or demographics: lots of poison ivy and respiratory infections; about 40% of the patients under the age of 18. Nor did I see a single fireworks-related problem. But I saw more out-of-towners and people just back from vacation.
While I sewed up a laceration, I had an excellent discussion about knives and cooking with the patient. I got to recount the part of my New Zealand adventure involving sharpening knives to a razor edge on the back of a china plate.
About 1130AM I started calling to find out what Asian restaurants would deliver on the holiday. Too hungry for my own good, I splurged on sushi, but didn’t get a chance to get to the break room till 2:00PM, when the PA arrived. I bolted soup and seaweed salad and sushi, and, as the pace slowed down, I started catching up on my documentation, having fallen 14 behind.
I cleared the backlog. I joined the conversation. One of the nurses made a Dunkin Donuts run (I didn’t participate, but I finished off my sushi). With patients trickling in at 1 or 2 per hour, a quiet tension set in, waiting for the 759 PM deluge that never materialized. I left, hungry and tired, at 803 PM and drove right to the hotel.
I ordered a burger in the hotel restaurant at 820PM. The waiter visited me 5 times in the ensuing hour, while I read Teddy Roosevelt on my smartphone. The chef had variously just gotten back from break, gotten swamped, or gotten the order wrong. I found trying to stay awake harder than enduring the hunger. I started munching my sandwich, too exhausted to taste, at 920PM.


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