Horse collisions, running eyes, and my best work

During the rut, if it’s too late to veer

You might run into a deer

But more serious of course

To run into a horse

Which is even worse than a steer.

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, traveled 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 went back to adventures in temporary positions until they have an Electronic Medical Record (EMR) system I can get along with. A winter in Nome, Alaska, assignments in rural Iowa, a summer with a bike tour in Michigan, and Urgent Care in suburban Pennsylvania stretched into the fall. Since last winter I’ve worked in Alaska and western Nebraska, and taken time to deal with my wife’s (benign) brain tumor. After a moose hunt in Canada, I am back on the job in western Iowa. Any identifiable patient information has been included with permission.

I went to bed early last night. Aching at the end of a day marked by my left nostril plaguing me with a clear but slimy river and launching attack after attack of violent sneezes, I took Tylenol and slept fitfully.  I awoke with my left eye stuck shut.  I applied hot compresses, and, two hours later, strode a couple blocks to the hospital.  Until noon I worked in fear that my eye would start to run again and I’d have to go rest.  But it didn’t.


Most of this country suffers from too many whitetail deer, and their bodies litter the highways, especially during this, their breeding season. Mention a deer collision, then sit back and enjoy to the flurry of stories.  Sometimes the deer hits the car.  Sometimes, on a two lane road, a deer struck by one vehicle flies across the pavement and into the path of an oncoming vehicle.

Most people survive collisions with deer and antelope, and, for that matter, cattle. Horses and moose, however, stand higher and tend to come up through the windshield.  Moose stray but rarely this way, but horses remain a fact of life, and terrible damage results when they wander onto a roadway.

I cared for such a patient this week, and a very subtle neurologic finding prompted an investigation.


Today I ran into the first drug seeker I’ve seen here, and a reputation that keeps them away speaks well of the docs. The literature can give you plenty of red flag clues that the patient might want drugs for other than medical purposes: geographic instability, getting care from multiple providers, symptoms not objectively verifiable.  The research has yet to define the speech pattern that rings my alarm bells, but when a person talks like other addicts I’ve known I get suspicious.

I listen carefully even to stories with obvious contradictions. I sort data based on experience, knowing that I play a game of incomplete and imperfect information.  At the end of the day, as I clicked my way to the bottom of my electronic messages, I came across lab results so startling that I swore.

Perfect people don’t come to see me. Those with psychiatric problems, low intellect, poor social skills, inadequate education and unhealthy lifestyle decisions get sicker than others.  And all of them deserve my best work, every time.


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