Two cups of coffee after a bird strike.

A bird sure made our plane late

We missed by a hair at the gate

So a bit of caffeine

Kept my wit keen

With a steady patient flow rate.

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 travelling back and forth between home and Pennsylvania. Any patient information has been included with permission.

The smallest bird striking the largest commercial aircraft in the US in the 21st century demands an airframe inspection.  The regional jet coming into Sioux City ruined the day of a dove.  And so we sat in the departure lounge for a couple of hours till the inspection and the inevitable paperwork.

In medicine, the documentation takes as long as the visit, and I would imagine in aviation it takes longer.  I napped and I read.

Late to leave, late to arrive, we got to Gate H1 in Chicago O’Hare just after the flight closed.  The gate agent took care of the rebooking cheerfully and professionally.  He gave us meal vouchers and better seats.  We strolled the airport for a while, I got a torta and guacamole.  We settled down in the seats designed for discomfort.  I napped and I read some more.  We took off on time and got into Pittsburgh just past midnight.

I had slept much of the day at that point.  Connie, the GPS, took us on slow back roads that would enhance a leisurely Sunday afternoon, but doubled the drive time.  We wasted no time at check in but didn’t roll into bed till 2:00AM.

I had not one but two cups of coffee with breakfast.

It doesn’t sound like much but, outside of chocolate, my body doesn’t see much caffeine.  Thus a little goes a long ways.

I nearly fell asleep before the first patient arrived at 9:30.  After that a steady, reasonable pace kept me awake and engaged and despite my initial dread I found myself grinning in the afternoon.  The PA arrived at 2:00, and the reasonable pace continued.  We took care of 48 patients in the 12 hours.  I got to speak Spanish with 2 (though both spoke English well).

This late in the summer, poison ivy continues to bring misery to multiple patients per day.

Sometimes patients with chronic pain ask for opiates, drugs in the same class as morphine.  But as time has gone on we’ve found that while such medications can ease pain in the short-term, in the long run they fail to relieve pain and they ruin functionality.  Frequently the patient will say in one breath that they need more of a drug that doesn’t work.

I wrote a prescription for a 5 day supply of hydrocodone for a person with a broken bone.  I hadn’t needed my DEA number for more than six weeks.

I give a lot of warmth and understanding to the people who have chronic pain at the same time I explain why opiates are a bad idea.  I print off a copy of my post,  I get mixed reactions.  Those serious about pain management read it carefully, those serious about just getting the drugs pitch a fit and stomp out.  And I can’t predict who will do what before hand.

I left the clinic at 8:37, ready for bed.

If you use caffeine rarely, it will serve you as an ally.  If you use it habitually you will be its slave.


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