Bits and pieces from a couple of days in Urgent Care


I explained the news in a flash

About laws confusing and brash

With circumstance and pomp

In workman’s comp

We’re not allowed to take cash.

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 (EMR) system I can get along with. I spent the winter in Nome, Alaska, followed by assignments in rural Iowa. This summer included a funeral, a bicycle tour in Michigan, cherry picking in Iowa, a medical conference in Denver, and two weeks a month working Urgent Care in suburban Pennsylvania. Any patient information has been included with permission.

I’ll leave out the tortuous background story of why I came to speak Spanish fluently, but I find myself in 21st Century USA with a talent highly valued in the medical profession.

While the United States recognizes an employer’s moral obligation to take care of workers’ on-the-job injuries, each state has a different system and the best of them have Byzantine and incomprehensible nuances.  I have little legal vocabulary in English, and my only Spanish legal vocabulary comes from reading the translation of John Grisham’s Runaway Jury.  English language explanations carry a high level of difficulty that goes to mind-boggling on the other side of a language barrier.  The front office called me up to translate; it got worse when I explained that acceptance of cash for this particular case would have broken the law.

I got a chance to talk to a patient from Uruguay.  The mention of the patient’s hometown brings back wonderful memories and we talked with relish about the high-quality cheese and yogurt that come from the government dairy monopoly.

Occasionally the nurses need me to explain urine drug testing in Spanish to prospective new hires.

But sometimes a day or two goes by without speaking Spanish, and I miss it.

I took care of a patient with a straight-forward ear problem.  After successful resolution I confessed that making people better before they leave keeps me in the game; it’s the doctor’s moment.  Maybe because I listen well, or maybe because my face encourages people to talk, or maybe because the patient was ready, at the end of the visit I listened to a story brimming with more irony than drama but plenty of both, and not reflecting well on my profession.  I explained that as a front-line doc, someone else always knows more than I do about, for example, escalating abdominal symptoms.  At home, I said, I know exactly which doctor I’d send you to.  And then I talked about the inherent problems of being a team player and knowing nothing about the local talent.

Towards the end of the day I attended  a child.  The medical problem soon taken care of, I reached into my pocket and brought out my yoyo, as I usually do at the end of a visit if children are present.  For the first time ever, the parent brought out the telephone video camera to bring back a visual for a sibling.

I attended an English teacher, and I mentioned my writing. We agreed on the difficulty of writing to both genders, and how males in the school system get left behind when it comes to literature. I assured the patient that without me, the inciting medical problem would resolve eventually, but reading West With The Night by Beryl Markham would make for a richer life. We would both like to see English teachers have more input into curriculum.  I talked about the importance of effective written communication when physicians have to send letters or emails to non-physicians..

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