Posts Tagged ‘flu’

Harrowing transfers

January 14, 2018

It’s the time of year for the flu

If it’s that, we know what to do

But in transferring out

We have without doubt

The stressors come out of the blue.

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. I followed 3 years Community Health Center work with a return to traveling and adventures in temporary positions in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska. 2017 brought me adventures in Iowa, Alaska, and northern British Columbia, and now I’m living at home and working 48 hours/week in rural Iowa. Any identifiable patient information has been included with permission.

With bad weather promised in the forecast, I decided to drive to work the evening before rather than the morning of. Fog shut down visibility and I crept the last few miles into town and hotel to await the impending major winter storm.

Overnight the temps plummeted to double negative digits, and the wind rattled the windows. I awoke to a scene of a blowing snow, but the worst of the wind had passed and the gusts stayed under 40 miles per hour.

Not surprisingly, clinic load dropped with the mercury. Through the day I cared for people with the problems of abdominal pain, a cold, a rash, another cold, the flu, a cough, another cold, ankle pain, yet another cold, and an irritated eye.  Two of the patients spoke Spanish; one of them first spoke an indigenous dialect before he started to learn Spanish at 15, thus making us equally Hispanic.

At the end of the day one of the permanent docs and I went to the Mexican restaurant. We talked a lot  about hunting and Alaska and the pragmatic parts of medical practice.

I had almost 45 seconds at the hotel before the call summoned me back to the ER to care for another person with a respiratory infection.

I took care of 3 more patients before midnight, one psychiatric and two respiratory. I did not ask for permission to write about any of them.

But I can write about the problems inherent in rural practice. Small hospitals lack the resources to deal with life-threatening problems.  Whether in Iowa, Canada, or Alaska, patient transfers can be the most harrowing part of the job: you don’t have to send well patients to referral centers.

Here I have to do a complete history and physical, just as if I intended hospitalization. I get the basic labs, and, if necessary, x-rays.  I ask the nurses where to best send the patient.

Sometimes neither nearest nor best-equipped means the same as best.

Then I make the first call. Sometimes a secure video link, much like Skype, opens up.  I generally have to go through a nurse to get to the doctor, who has final authority to say, Yes or No to the transfer.

Depending on the context, ambulance and/or law enforcement personnel need to be enlisted.

Then the harrowing wait begins. The helicopter, airplane or ambulance never shows until I have hit the outskirts of emotional exhaustion.

When the patient leaves, I start keyboarding my history and physical into the computer as fast as I can. I hand the printed copy to the nurse with the request to fax it to the accepting physician.

Then I dictate the same information into the dictation system.

I got back to the hotel shortly after midnight, too wound up to sleep. I studied for an hour and a half.  I slept surprisingly well before going back to the clinic to discuss legal threats with the manager.


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.