Posts Tagged ‘high blood pressure’

Locks on the Clothes, Keys on the Shoelace: the dress of a millwright.

July 9, 2017

The millwrights has many a key

For the mill cuts up many a tree

On the machine go the locks

Preventing visits to docs

And keeping the workplace accident-free

 

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 traveling and adventures in temporary positions. Assignments in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska have followed.  I finished my most recent assignment in Clarinda on May 18.  Right now I’m in northern British Columbia, getting a first-hand look at the Canadian system. Any identifiable patient information has been included with permission.

Thursday I took care of 17 patients. One pediatric patient required all my patience, skill, and accumulated experience to get the job done without alienating the kid.  The oldest patients barely qualified as septuagenarians.

I wrote a lot of prescriptions for blood pressure drugs.

I used my deep-breathing techniques on three patients to bring blood pressures into the acceptable range.

Though only 15% of Canadians smoke, the nicotine addicted comprised more than half my patients.

I wrote several back-to-work slips, all employees in the timber industry.

I cared for even more millwrights and former millwrights. Changing logs into useable products involves a lot of dangerous machinery, and the people who fix the machinery come in loaded with padlocks on their clothing.  They lock a machine before they work on it, to make sure it won’t start accidentally.  Spare keys get carried where they can’t get lost, such as tied into shoe laces.  During the work day, a “whistle” signals a need for a millwright.

One of my patients in frustration said, “Can you give us a referral to see a specialist we can actually see?’ and we laughed after I asked for and received permission to use the quote in my blog. While I know my way around the human body, and most of the things that go wrong with it, I don’t know the local medical community.  Yet the permanent doctors trained near here, and know the consultants personally.

There’s also a province-wide network providing phone-in advice for docs . The consultants get paid on a fee-for-service basis; the patient has a unique identifying number, and the doc has a bunch of unique numbers (I have 8), one of which is the right one to use.  Computer algorithms coordinate compensation.

Sick young men

May 5, 2013

 

In came the sickest of blokes,

He drinks, he gambles and smokes

Before he’s wise or he’s sage

He’s at such a young age

And I broke the bad news to his folks.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  In May 2010, I left my position of 23 years, and honoring my non-compete clause, traveled for a year doing locum tenens work.  In June of 2011 I joined up with the Community Health Center, which provides care for the underserved.  I’m now working part-time, which, for a doctor, means 54 hours a week.

The clinical theme of my weekend call has run into the realm of young men with very bad disease.

Any serious illness comes with a certain sense of irony and brings drama to the family context of the patient.  Advanced age lessens drama; a heart attack in an 85-year-old doesn’t carry the same emotional weight as a heart attack in a 35-year-old.

Most of these patients have problems with alcohol and tobacco, and their sum total of illnesses reflect more their life style choices than their heredity; some of the worst problems, though, showed up gratuitously, unannounced and unexpected.

So common do the three problems of diabetes, high blood pressure and high cholesterol run together that when I transfer information from one source to another the number 3 serves as my notehand for those three diagnoses.  That single digit showed up in more than 80% of the work-ups I have done so far this weekend.

But that trifecta in and of itself doesn’t lead a person to hospitalization, but the sequelae from narrowed arteries can bring on heart attacks, stroke, coma, and respiratory failure.

As the day waned and the sky darkened, I sat and talked with a justifiably worried family about a very sick young man.  The relatives didn’t hear the implication of the possibility of a fatal outcome until I stated it explicitly, and I had to endure looks that could kill messengers.

Any family conference involves a lot of questions.  Most interviews start with questions about the illness but progress more and more to issues with emotional content.  Those last parts tax my skills as an interviewee the most, but they bring me a sense of where the person fits in the web of their family; they take a lot out of me emotionally.

An hour later, In the ICU of the hospital on the other side of town, I interviewed and examined a young man who looked twenty years older than his real age.  The things the medical community had warned him about as a teenager had come to pass.  He didn’t wrestle with existential questions, nor did he want to change his lifestyle.  When I finished with the patient, I found no family to explain things to. 

A physically sicker patient in a sociologically healthier context brings a sense of tragedy more fulfilling than that of the ailing loner.   Contrast remains the essence of meaning.