Medicine changes but the disease doesn’t

The kid knew me, no delay

By my toy, he’d seen me play.

It’s distinctive, my yoyo

And the way that I throw, though,

It might be the things that I say.

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 out0of-the-way places in Alaska, Nebraska, Iowa, and New Zealand.  I followed 3 years Community Health Center work with more travel and adventures in temporary positions in Iowa, Pennsylvania, Nebraska, Canada, and Alaska.  2019 included hospitalist work in my home town and rural medicine in northern British Columbia.  Since the pandemic started, I did 10 months of telemedicine in my basement, staffed a COVID-19 clinic in southeast Iowa, visited family, attended funerals, and worked as a contractor for the Veterans Administration in South Dakota.  Recently returned from a family visit to Israel, I currently hold a part-time position in northwest Iowa, reasonably close to home.

I got permission to write about a couple of patients. 

I make no secret of using my yoyo to establish rapport with my pediatric patients.  Today, I walked into the exam room, and, first thing, set down my yoyo.  The patient, masked, said, “I know you.”  And in fact, I had treated him at another facility in northwest Iowa.  But the last time I worked there, I had a full beard and no mask.  Still, he knew me by my distinctive yoyo. 

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In another century, in a different town, before HIPAA, early in my career, I took call for my group on Christmas.  Late in the evening, I accidentally saved a patient’s life because, during the work-up for Fever of Uknown Origin, the radiologist found a malignancy in its earliest, most curable stage.  I don’t think that patient ever forgave me.

Earlier that same day, as the shadows lengthened, and night fell, I cared, for three young men  successively who turned out to have a disease in common.  I had not seen a case prior, and I have not seen a case since that one day in the 80’s.  But I’m pretty sure I found one today. 

Medicine has changed in the meantime.  Back then I carried two medical references in my white coat pockets.  When the first patient came in through the ER, I pulled the one for adults, the Washington Manual of Medical Therapeutics, generated some ideas, then took the stairs to the Medical Staff Library. I pulled out the latest edition of Harrison’s Textbook of Internal Medicine.  Within a half hour I had the basics down, knew which labs to run (with an eye to practicality to see what would come in soon enough to be useful).  I took the stairs back up to the first patient’s hospital room.

In the 21^st century, and especially during a pandemic, we don’t hospitalize patients if they can possibly be taken care of at home.  The labs that would have taken a week to run back then will be back tomorrow; a few won’t result out till Thursday.  I dialogued with the patient as I searched the Internet to see the latest in diagnosis and management. 

Medicine may have changed, but the disease hasn’t.  We don’t know why it happens or why it comes in clusters, but we have good criteria for diagnosis.  The treatment remains the same.