Posts Tagged ‘gold’

Vicodin found on a plane

December 18, 2016

You wouldn’t believe the stuff that I’ve found

On the road, the sidewalk, or ground

But it gave me a chill

When I picked up a pill

That was tan, not square, and not round

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 a couple of gigs in western Iowa, I’m back in Alaska. Any identifiable patient information has been included with permission.

During my med school years at Michigan State, the student paper carried a piece written by a runner. He kept a journal not only of his mileage, but of the money he found.  The piece pointed out that as time progressed and the value of the dollar decreased, he found more and more change.

I read that before I knew about complex systems, and while I took his point, now I realize that as time went on, he probably improved his money finding skills.

I find money, too, but I don’t run any more. And the amounts that I find progress with the years, so that what I found this summer, in the triple digits, stands as my all-time record.

I’ve also found gold and diamonds, but so rarely I can tell you the weather on those days.

Cycling or strolling, I find tools, as well. I pick them up because I usually end up needing them.  An acquaintance says I find things because I’m a hunter.

Getting onto the plane in Omaha, I found a pill on the floor. It didn’t require a lot of skill; the tan color didn’t match the blue carpet.  After we settled into our seats, I pulled out my smart phone and used the Epocrates pill ID app.  I entered the imprint and the shape and discovered I’d picked up a Vicodin HP, containing 300 mg of acetaminophen (also called Tylenol) and 10 mg of hydrocodone.

We have a nationwide epidemic of opioid addiction; the government has acknowledged that fact to the tune of billions of dollars of funding. Hydrocodone is one of the most popularly abused drugs.  Physicians, pushed by the Pain, the 5th vital sign initiative, and driven by patient-satisfaction survey-driven reimbursement, bear most of the responsibility for this epidemic.

I had to wonder about the person who lost the Vicodin. Was it the one it was prescribed for?  Did they want it medically or recreationally?  What did the patient say to the doctor to get the original prescription, and how many times did that particular pill get remarketed? What drama and irony went into the backstory?

I hope that the fact of finding that pill doesn’t signal the ease with which doctors prescribe such meds, but I suspect it represents the inflation of the supply side of the abusable drug market in this country.

Syphilis and gold: finding what you look for

April 2, 2014

Across the car park I strolled
In the rain and the wind and the cold
The thing I did find
Brought hope to my mind
And turned out to be real gold.

Synopsis: I’m a family practitioner from Sioux City, Iowa. I danced back from the brink of burnout in 2010, and, honoring a one-year non-compete clause, went to have adventures and work in out-of-the-way locations. After jobs in Alaska, New Zealand, Iowa, and Nebraska, I returned home and took up a part-time position with a Community Health Center. I just returned from my second locums trip to Petersburg, Alaska.

On my first Monday back from Alaska I went into the office to catch up on the miscellany that accumulated in my absence. I found 320 clinical items on my electronic desktop along with 78 administrative emails. In the quiet of the early morning, when my body clock should have screamed for sleep, I dug in and started plowing through the items one by one.

About half had to do with bad things that had happened to my patients, requiring hospitalization, while I vacationed. Every admission generated an ER note, a history and physical, progress notes, lab and x-ray reports, and a discharge summary. I could not determine the importance of each item without reading it.

I ran into some surprises.

Three patients received malignant diagnoses, and I judged each cancer gratuitous. None of them did anything to deserve their tumor.

One person’s syphilis tests came up positive. I followed the communications; saw that my partners had done the right thing through the health department notification, the lumbar puncture, and the penicillin injections. I look forward to seeing if the patient’s symptoms improve.

When my father attended medical school, his professors would lecture, “Know syphilis and know medicine,” but since then the frequency diminished to the point where we rarely think about it, and sometime we forget to look for it. Lyme disease brought a resurgence in testing because searching for one justifies testing for the other.

I left the clinic at 1230 to go home for lunch, and as I got into the car, I saw a faint gleam of yellow on the pavement. Smaller than a dime, when I picked it up I saw it had suffered from passing car tires grinding it into the gravel. But it had a milled edge, which marked it as a coin.
At age 9 I found a dollar bill in the street in front of our house, a powerful experience at the time, and even more so because of the large purchasing power it represented in 1959. I started looking for more. One finds things that one looks for.

During med school, the Michigan State school paper published a piece by a student who also found money and who kept track of it; he commented that as inflation eroded the value of money he found more and more. Perhaps because of its lower worth, and perhaps because I keep getting better at spotting it, I find a lot more money than I used to.

When I came back to the office, I stopped in at the pawn shop across the street, and asked my friends there to check the tiny item for gold content, which came, to the surprise of all, as 22 karat; I accepted the spot gold price and walked out a happier man.

I worked through till 530, when I cleared out the last of my electronic communications, thinking about how one find things that one looks for.

Every CV should be verified.

April 28, 2011

 It would seem when you get to this stage

And you’re way past the minimum wage

     It can’t be a must

     To just take things on trust

When we’re all in the digital age

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  On sabbatical to avoid burnout, while my non-compete clause ticks away I’m having adventures, visiting family and friends, and working in out-of-the-way places.  On assignment on the North Island of New Zealand, I’m living in an apartment attached to a clinic in Matakana, north of Auckland.

When the Maori arrived in New Zealand about a thousand years ago, they found two islands with no land mammals aside from three species of bats; birds dominated the ecology.  The Maori brought dogs and the Pacific rat, and the ecologic destruction began. 

After work last evening Bethany called me into the back yard to see an animal and asked me for identification.

Hedgehogs cause enough damage in their native environments that they have no legal protection.  Some misguided soul thought enough of the idea of importation that New Zealand now has hedgehogs, which wreak terrible havoc with birds and local plants.

This particular specimen appeared unsteady on his feet.  I had to get close to produce a decent image with my wide-angle lens.  Bethany warned me not to get too close; she remembered the day I came across a raccoon with the blind staggers (I had to shoot the animal on the assumption it had rabies).

Hedgehog in Matakana, at a distance of twenty centimeters

But it didn’t look like it could move very fast, and I got a good photograph. 

We took a walk for a half hour in the cool, clear, clean air, then we drove the harrowing narrow road back to Leigh for a dinner gathering.

We arrived early and I volunteered to cut vegetables.  I’m good at sharpening knives, and on this trip I learned how to use the back of a ceramic plate as a hone.  I sharpened four knives to razor edges, and Bethany gave me the signal that I’d done enough.

I sat next to a geologist.

New Zealand’s volcanic activity includes hot mineral springs that actively deposit gold, in stark contrast to most of earth’s gold, whose deposition dates back two billion years.  Both of us agreed that the most likely source of life on earth were the extreme environments of undersea volcanic vents.  I learned that most DNA sequencing is done using a thermophilic bacterium isolated from a hot spring with temperatures suitable for making hard-boiled eggs. 

New Zealand built a prison in a bog where the heavy metals borne from the earth’s interior include mercury.  The liquid metal can be found in places near the site, and the peat has enough to qualify as mercury ore.  The committee that placed the prison ignored the recommendation of the geologists.

The Southern Alps, the main range of mountains on the South Island, lie on a fault where the earth moves an inch or two a year.

Eventually, the conversation touched on groups, leadership, and credibility.  I talked about my experiences getting my medical credentials in New Zealand.

In short order the conversation at the table buzzed about the scientific head of the New Zealand Defense Technology Agency, who got his position on the basis of a fraudulent CV and held it for five years.

No one checked his bona fides.

I said I hoped the information I put on my forms hadn’t been taken on faith, that in the digital age it could have all be verified or generated via the internet, so why the heck would I have to fill out the form in the first place?

I guess because I’m a doctor, and not a top government scientist.