I signed for a shift in the night
It finished way before light
But a single request
Came from points west
The slip it was Freudian. Quite.
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 further travel and adventures in temporary positions in Arctic Alaska, rural Iowa, suburban Pennsylvania, western Nebraska, Canada, and South Central Alaska. I split the summer of 2019 between hospitalist work in my home town and rural medicine in northern British Columbia, followed by vacations. Till the pandemic resolves telemedicine occupies my professional time. Any identifiable patient information, including that of my wife, has been used with permission.
I went to work at 9:00PM, the first time I’d done night work in over a year. In the next 5 hours, I cared for a record 28 patients, with not even a single technical problem.
More than half the patients came from Texas; Florida came in a respectable second, with only one patient from my home state.
COVID-19 accounted for less than half the clinic load, but donated more clinical work than any other source.
Unable to diagnose 3 patients with chest pain and one with abdominal pain, I sent them all to their respective nearest emergency rooms with the instructions to get there as soon as possible; all turned down the offer of an ambulance.
I understand people’s preference in bringing a genital problem to a remote physician rather than making an in-person visit. To my surprise, the vast majority of those problems can be handled without direct visualization or physically touching the patient. Further to my surprise came a request, a bit past midnight, to work on such a problem going back months. Experience tells me that in such situations I should dig into the person’s social history, and indeed I asked some open-ended questions which the patient demonstrated an unwillingness to answer. I didn’t pry.
In the last few telemedicine sessions, I saw an astounding number of people with real sinusitis: asymmetric facial pain radiating to the teeth, lasting more than 10 days, accompanied by fever. More often I spend lots of time explaining to the patient why antibiotics would more likely hurt than help.
When I started work, the clock had just truck 6:00PM in Alaska, and when I finished, New York had just seen 3:00AM come round. Yet not a single patient from anywhere west of Omaha requested care. I kept asking if patients had access to 24-hour pharmacy services (most but not all did).
Of all the physiologic aspects of aging, I miss my resilience to sleep deprivation the most. I just don’t bounce back from a night of call the way I used to. I had to explain to Bethany that I had made a mistake in accepting the shift, that I had thought I would start at 9:00AM rather than 3 hours shy of midnight.
But if complete honesty governs my thoughts, I would have to admit that a lot of mistakes have a Freudian tinge.
I just have to figure out why I would do such a thing to myself.
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