Flu and less than fluent Mandarin

There was an old lady who contracted the flu

She went to the doctor who knew what to do.

He said, “What is best,

Are fluids and rest

And perhaps a drug that is new.”

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. Assignments in Nome, Alaska, rural Iowa, and suburban Pennsylvania stretched into fall 2015. 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, and short jobs in western Iowa and Alaska, I am working in Clarinda, Iowa. Any identifiable patient information has been included with permission.

The havoc that influenza wreaks each year impacts the entire medical system. Predictably, the epidemic starts in the north and works its way south, spending about 3 weeks in a population center.  If multiple strains circulate, each one follows the pattern.

The CDC follows the annual flu disease activity by watching the death rate; when it spikes to 150% of yearly average, we know that the influenza has arrived. It represents the peak demand on the medical infrastructure.

Some of those excess deaths come directly from the flu, but we also see spikes in the rate of mortality from heart attacks, strokes, and just about everything else. If a person has been clinging to life, hanging on by a thread, the influenza is the knife in the hand of the Grim Reaper that cuts that thread.

At 745 on Tuesday, I discovered I had 6 inpatients including three new ones who would need a complete history and physical. Still pretty green with the hospital computer system at that point, I wandered electronically till I popped up a patient list of 10 names.

The worst flu I ever saw came in 1993. I had responsibility for 45 nursing home patients in 3 different institutions at that time.  One morning I received a call at 930 saying that a patient of mine had, that morning, developed a dry cough, fever, and muscle aches.   I ordered a flu test and amantadine (a good flu drug for more than 30 years, but it had a lot of side effects and about 8 years ago it completely lost its effectiveness).  At 1000 the nurse called back to tell me the patient was dead.

I visited that nursing home for regular rounds a week after that. I could read the shock and loss on the faces of the staffers, the grave stones in their eyes.  The had lost, on average, a patient a day for the last week and a half.

Twenty-four years later I faced a hospital census in the middle of flu season.  I don’t wager, but if I did, I would have bet that most of those who had sickened to the point of needing hospitalization did so directly or indirectly from the influenza.

But I still had a clinic schedule. I got a lot of exercise between my clinic office and the inpatient nurses’ station. At the end of the day I left the hospital with sore ankles and a backlog of documentation.

Bethany and I and a med student (who has been staying in the hospital guest house) walked a mile and a quarter (2 km) to a Chinese buffet. But I strolled for the sake of conversation instead of racewalking. We had some really excellent food, and I got the chance to show how badly I speak Mandarin.




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