Kung Pao unrushed


A leisurely lunch can’t be beat
A time to savor, to rest, and to eat
With minutes to burn
And a good chance to learn
And send patients, fast, down the street.

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, where I’m working for an Urgent Care company. Any patient information has been included with permission.

The Urgent Care concern I work for has many locations, and each has a unique flavor. The spot I worked at last week and most of this week, for example, maintains a reasonable patient flow and rarely gets too busy; my experience over the holiday weekend qualifies as the exception. I had 40 hours in by the time I walked out Tuesday night.

Today I worked at a different site famous for its triple digit days.  Last month I had intense experiences here, which, all in all, I would prefer not to repeat.  I arrived with my metaphorical flak jacket on.

To everyone’s surprise, light patient flow graced the morning, and after the first four hours we all expressed disbelief. But a mood of tension enveloped us, in anticipation of really bad stuff.

At 11:00 I placed an order for Chinese food delivery; it arrived at noon and I got to eat it hot.

More than just food, lunch needs to be a time when the stress ceases.  In the last 35 years I bolted the vast majority of my mid-day nutrition, rarely tasting the food and certainly not resting.  Today I ate egg drop soup leisurely, then turned my fork on the Kung Pao chicken.

Things slowed down after lunch but the tension didn’t stop. I caught up on my email, finding the latest snag in my quest for a Canadian license.  My Community Health Center asked me to cover Christmas.

The number of people who came in with colds but who didn’t want antibiotics surprised and pleased me.

I saw a person with alopecia areata, a patchy loss of hair, usually on the scalp. It can happen anywhere on the body, but people notice it most where they have the most hair. When it regrows, which it does most of the time, the result is a white patch. I’ve known a handful of people with white eyelashes on one side. Today I had the time to go look it up; I hadn’t seen a case this century. In the Information Age, I could find out how little of what I remembered has stayed true. Topical steroid treatment, once controversial but now the standard of care, combines with minoxidil, the hair restoring agent now available over the counter.

Business picked up shortly after supper while rain beat heavily on the roof.  I remarked to several patients that I felt flattered by the confidence they showed, but, under the circumstances, the diagnostic capabilities of Urgent Care don’t measure up to those of an ER.  More than one needed CT scanning, ultrasound, and extensive diagnostic blood work.

Some problems don’t belong in Urgent Care at all.  People with chest pain, vigorous bleeding, major trauma, shortness of breath, and major neurologic changes, for example, belong in the Emergency Room (multiple examples of each have come my way in the last three months).  Yet I understand the tendency to come to us because of the horrendous wait elsewhere.  Yesterday, when I called ahead to the hospital regarding a life-threatening case, I learned that 94 people sat stacked up in their Urgent Care section.

I miss not learning the follow-up on the cases I sent out.  We can’t learn from experience without feedback.

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