Posts Tagged ‘epidemic’

Flu and less than fluent Mandarin

February 24, 2017

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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Fever, cough, aches, and plunging temperatures when the sun comes out

January 27, 2011

 

Epidemics of this are not new

But what is a doctor to do?

    With coughing and aches

    Till the high fever breaks,

The typical symptoms of flu.

Synopsis: I’m a family practitioner from Sioux City, Iowa.  I’m taking a sabbatical to come back from the brink of burnout.  While my one-year non-compete clause ticks off, I’m having adventures, working in out-of-the-way places, and visiting family and friends.  Currently I’m on assignment in Barrow, Alaska, the northernmost point in the US.

Three symptoms distinguish real influenza: fever, cough, and aching.  Each year the particular circulating strain will show some unique characteristics; last year, for the first time, vomiting and diarrhea accompanied most cases.  Some years headache happens to most of the patients, other years people complain of profusely runny nose.

Chaos mathematicians and complex systems analysts can explain why the flu in a community will reach a tipping point and go, well, viral.  We’re all familiar with the scenario; a few people get the flu, the first cases aren’t too bad; later cases get much worse.  At the peak of the epidemic, our co-workers stay out sick, the schools close, and we can’t get anything done.  Ninety percent of the cases occur within three weeks; the epidemic starts in the north and spreads south.

The scenario repeats itself yearly.  Except for last year, when the pandemic H1N1 “swine flu” turned out to be more of a sardine than a shark, most people got their flu shots and flu season went well.

Many years the tsunami of the flu season overwhelms the medical infrastructure; in 1993, at the end of the season, neither love nor money could have bought an influenza test kit, amantidine nor rimantidine and the chronically ill died by the score.

The virus has Barrow in its grip this week; more than half the patients I’ve seen in the last week were suffering with the same symptoms.  Today we received confirmation of influenza.

With housing in short supply in Barrow, people crowd.  Contagious diseases, especially those spread via the respiratory route, run rampant in these conditions. 

I’ve been working late every day; today I hit forty hours and went into overtime.  Yesterday I finished before supper for the first time since I got here.

I labor with some very good doctors, all hard-working team players.  We have a well-equipped hospital and a well-stocked pharmacy, and exactly six exam rooms.  Emergency medical transports, dramatic life and death cases, leave by air daily.

I wish I had more time to listen to each patient’s story.  I want to ask questions like, what did you find when you got there?  How many geese did you get and how did you get that many?  How can you load eight caribou to be pulled by one snow machine?  How do you find a wolverine?   What is the best way to use fur as a ruff on a parka?

Outside the temperature runs twenty-five degrees below zero till the sun comes up, and in the clear skies of the afternoon the mercury plunges and the radio warns people not to go out.