Posts Tagged ‘influenza’

When is influenza Work Comp?

November 7, 2017

A recurring problem, I fear,

Is the flu I get every year

Am I a jerk

To say I got it at work?

I don’t want to be a pain in the rear.

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. After 3 months in northern British Columbia, and a month of occasional shifts in northwest Iowa, I have returned to the Arctic.  Any identifiable patient information has been included with permission.

Friday I worked but not very hard. I saw more people off the schedule than on due to the number of no shows.  I attended as many people with respiratory problems as with bone-and-joint problems.  As the day wore on I felt, more and more, the aching from yesterday’s 3-hour walk on the ice-covered road leading out of town.  I resolved walk more.

After work Bethany met me in the hospital cafeteria for the weekly prime rib dinner. As Iowa beef snobs we rarely leave home to eat it.  We made an exception; it turned out to be very good, and my piece of meat came large enough to overwhelm.

But my cough, gradually improving over the last 8 weeks, came back stronger than ever on the short walk back to our apartment, and I realized that my tundra-seeing expedition couldn’t account for the ache in my upper back.

I started to shiver, my nose started to run, and my cough worsened. At 9:00 PM I called the Veteran’s Administration for permission to go to the local ER.

I spent 40 of my prepaid phone’s 200 minutes on hold.

My fever and aching worsened, I took Tylenol, I broke into a sweat and I felt better. Which I told the nurse when she answered.

The nurse had no concept of Alaska’s vastness.   She asked if I could get to the VA facility in Palmer, Wasilla, or Anchorage; I told her that I was a good deal closer to the Russian border than  to any of those places.

She knew more nursing than geography.

Eventually she advised fluids, rest, and Tylenol.

Every year I get the flu shot; it’s about 50% effective at preventing flu but it’s 90% effective at preventing death from the flu. And every year, I get the flu.

I got sicker on Saturday evening and went to the ER. I anticipated and got a flu test.

During the wait for results my chills cycled with sweats twice. I took my first oseltamivir (Tamiflu) pill before I left the ER.

But as I had signed in, the slip of paper wanted to know if the problem were work-related.

So many times in the last year I asked sufferers who sought my advice if they wanted the problem put onto Work Comp (or, in Canada, onto the WCB, Workman’s Compensation Board). The vast majority refused; some feared being fired in reprisal, some didn’t want to hassle Human Resources, and some felt their regular insurance would take care of things.

I have almost no social interaction outside the hospital, and I deal with the infected on a daily basis. Until now, I understood the perspective of the self-employed: fear the Work Comp insurance rates will go up.  This time, though, I stood in the shoes of the employed.  And I understood the hesitance.

I didn’t check YES or NO. I wrote, Let’s talk.

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Flu and less than fluent Mandarin

February 24, 2017

There was an old lady who contracted the flu

She went to the doctor who knew what to do.

He said, “What is best,

Are fluids and rest

And perhaps a drug that is new.”

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 short jobs in western Iowa and Alaska, I am working in Clarinda, Iowa. Any identifiable patient information has been included with permission.

The havoc that influenza wreaks each year impacts the entire medical system. Predictably, the epidemic starts in the north and works its way south, spending about 3 weeks in a population center.  If multiple strains circulate, each one follows the pattern.

The CDC follows the annual flu disease activity by watching the death rate; when it spikes to 150% of yearly average, we know that the influenza has arrived. It represents the peak demand on the medical infrastructure.

Some of those excess deaths come directly from the flu, but we also see spikes in the rate of mortality from heart attacks, strokes, and just about everything else. If a person has been clinging to life, hanging on by a thread, the influenza is the knife in the hand of the Grim Reaper that cuts that thread.

At 745 on Tuesday, I discovered I had 6 inpatients including three new ones who would need a complete history and physical. Still pretty green with the hospital computer system at that point, I wandered electronically till I popped up a patient list of 10 names.

The worst flu I ever saw came in 1993. I had responsibility for 45 nursing home patients in 3 different institutions at that time.  One morning I received a call at 930 saying that a patient of mine had, that morning, developed a dry cough, fever, and muscle aches.   I ordered a flu test and amantadine (a good flu drug for more than 30 years, but it had a lot of side effects and about 8 years ago it completely lost its effectiveness).  At 1000 the nurse called back to tell me the patient was dead.

I visited that nursing home for regular rounds a week after that. I could read the shock and loss on the faces of the staffers, the grave stones in their eyes.  The had lost, on average, a patient a day for the last week and a half.

Twenty-four years later I faced a hospital census in the middle of flu season.  I don’t wager, but if I did, I would have bet that most of those who had sickened to the point of needing hospitalization did so directly or indirectly from the influenza.

But I still had a clinic schedule. I got a lot of exercise between my clinic office and the inpatient nurses’ station. At the end of the day I left the hospital with sore ankles and a backlog of documentation.

Bethany and I and a med student (who has been staying in the hospital guest house) walked a mile and a quarter (2 km) to a Chinese buffet. But I strolled for the sake of conversation instead of racewalking. We had some really excellent food, and I got the chance to show how badly I speak Mandarin.

 

 

Tagalog, flu, and a staff meeting

February 14, 2017

The patients still suffer the flu,

And I know just what I can do

Though to prevent what they’ve got

We’ve a pretty good shot

But I’m hoping for some drugs that are new.

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 short jobs in western Iowa and Alaska, I am working in Clarinda, Iowa. Any identifiable patient information has been included with permission.

Most sick people want to get well, and even more don’t want to be around strangers. I’m filling in for a doc whose patients love her.   They won’t come in until they feel sick or worried enough, and I haven’t had time to build a reputation in the community.

I attended one patient every half-hour from 9:00 till 11:00. I ran 5 lab tests, and ordered one x-ray.  Half the patients got prescriptions, half of them got advice because pharmacologic management would have been a good deal more dangerous than helpful.  With the unseasonably warm weather, I advised two to get over the counter Flonase for allergies. Another patient got a simple 5-day prescription that may very well save a life.  One patient has me puzzled and awaiting labs.

I exhausted my very meager Tagalog vocabulary on one person (who gave me permission to write this), prompting my patient to ask me if I’d lived in the Philippines. I explained that the most educated immigrant minority in this country are the Philippino, with a disproportionate number of doctors, nurses, and pharmacists.  Of course I’ve had colleagues from that country.  And, inexplicably, on the North Slope of Alaska, the Tagalog speakers dominate the taxicab business..

Three patients smoked; for each one I held my forefingers 18 inches apart and said, “On a scale of 1 to 10, how ready are you to quit smoking?” No matter what number they came up with, I asked, “Why not 2?” but had to explain that the doctors had already told them the bad things about tobacco, and I wanted the patient to tell the doctor something good about it.  One patient shook her head and said, “You’re good.”  I had to admit that I’d gotten the technique from an educational CD.

We had our monthly med staff meeting from 12:30 to 2:00. They announced my successful vetting (in the trade, we call it credentialing).   We went over changes in the Emergency Medical System (EMS), and talked about criteria for blood transfusions.

The flu came up briefly; the annual epidemic started about 3 weeks ago. It’s weakening but it’s still going.

I had no patients on the schedule after 2:00, and I started reading the handbook that HR gave me. I had two patients after 430, finishing at 6:00 sharp.  I walked out with all my work done.

No flu yet, but it’s coming

December 3, 2016

I await the arrival of flu

But still, there’s plenty to do.

There’s joy that is pure

That comes with a cure

Or from following up on a clue.

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. A winter in Nome, Alaska, assignments in rural Iowa, a summer with a bike tour in Michigan, and Urgent Care in suburban Pennsylvania stretched into the fall. 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, I am back on the job in western Iowa. Any identifiable patient information has been included with permission.

 I had a very good clinical week, despite the fact that it didn’t start till Wednesday.

A front line doc like me doesn’t get the chance to save a lot of lives, and when I can do so, especially with a small, inexpensive intervention, it makes my day. My two favorite diagnoses, vitamin B12 deficiency and hypothyroidism, bring a smile to my face and a bounce to my step whenever the lab comes in.

OK, the truth is that I break into a happy dance, and I stay annoyingly cheerful for a couple of days.

I also really like finding a problem I can legitimately treat with antibiotics, and, as time goes on, fewer and fewer people meet the criteria for applying those agents in cases of ear infections, tonsillitis, urinary tract infections, and pneumonia. But this week I saw more than a half-dozen.

A surprising number of people came in with back pain, the problem arising, not in the back, but in the bursa at the point of their hip. I make this diagnosis of trochanteric bursitis easily by pushing on the point of the hip and saying, “Does this give you the same pain that brought you in?” I recommend ice and anti-inflammatory drugs. But I also search for the root cause, which, more than half the time, turns out to be footwear or a change in activity, or both working together.

I drew on my own experience in Adult Children of Alcoholic Parents to help a patient deal with some pretty heavy drama and irony. I established credibility by describing two family members I’d never met as cold, controlling and distant. And I observed that, if a parent dies, the child most distant geographically, also the most distant emotionally, will make the most trouble because they have the most unfinished business.

Three patients came in with fever, aching, and cough, and not one of them came up positive for influenza.

I uncovered the cause of significant liver pathology, only by careful and empathetic questioning.

I examined a toddler with pain and fever and didn’t use force to look in the ears.

At the end of the week, I got into the car as darkness gathered and the snow started to fall.

 

 

Leaving Nebraska. For now.

September 6, 2016

On the plains I worked for a week

The enjoyment was close to my peak

A lot of folks I befriended

But then the need ended

And new work I’ll now have to seek.

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, travelled 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. A winter in Nome, Alaska, assignments in rural Iowa, a summer with a bike tour in Michigan, and Urgent Care in suburban Pennsylvania stretched into the fall. Last winter I worked western Nebraska and coastal Alaska. Getting my wife’s (benign) brain tumor treated took a large part of the summer, then a week each in urban Alaska, Pittsburgh with family, and western Nebraska.  Any identifiable patient information has been included with permission. 

 

A week passed quickly on the plains of Western Nebraska.

A respiratory virus, looking for all the world like influenza, with fever, cough, and ache, but also with runny nose, and lasting the better part of a week, provided 1/6th of my clinical material.  I really didn’t do anything for those patients except recommend Tylenol, fluids and rest.

Seasonal respiratory allergies accounted for an equal number. My two favorite drugs in that regard, Zyrtec and Flonase, now available without a prescription, have high quality evidence to support their use.  Still I gave instruction on how to use Flonase based on personal experience.

I took care of a patient with an agricultural injury, and, in the process, learned about Stewart’s Wilt, an important corn disease, which originated not far from where I worked.

I sent two patients to the new MRI, and, surprisingly, both scans picked up significant pathology.

I didn’t get a chance to take care of any hospitalized patients, but I did get the chance to talk to a couple of new doctors with a passion for rural medicine.

I had a wonderful conversation with an Army linguist, and found Arabic has 3 Hs. I got to talk about how Navajo has the only click outside of Africa (the initial consonant in string and goat, the middle consonant in blue).  We had a marvelous time tossing jargon back and forth and singing praises of Rosetta Stone.

I used my massage skills to make one of my patients better before leaving the clinic.

I started a complicated endocrine investigation, and will probably not know the results.

I kept at least one patient out of the hospital with Gatorade.

One twelfth of the patients came in with dermatologic problems. I recounted the remarkable experience my son-in-law, my daughter and I had at a Continuing Medical Education event in Pittsburgh, where the lecturer announced that we can now treat pityriasis rosea (with the same antivirals we use on herpes viruses).  He went over his daughter’s experience with a red rash in a “Christmas tree” distribution just before her wedding, with no time to change her backless, strapless wedding gown.  He told her nothing could be done; twenty smart phone minutes later she showed him his error.

All in all, I took care of 36 patients, the same number I used to consider optimal for a day’s work in private practice. In those days clinic hours went 9 to noon and 1:00 to 4:30, with two hours dictation after supper.

I had a great time. I bonded well with staff and patients, but, towards the end, though the installation might invite me back when one of their docs takes a vacation, I realized they don’t need my full-time services now.  My experience exemplified the success of the locum tenens concept.

I even got out a couple of hours early. On a Friday afternoon.

 

 

 

 

Aching and waiting for the CT scan

February 17, 2015

It starts with a drip from the nose

And progresses with an ache to your toes

What should you do

When contracting the flu

While waiting for the clinic to close?

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, travelled 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 am back having adventures in temporary positions until they have an Electronic Medical Record System (EMR) I can get along with. Right now I’m in Nome, Alaska.

My nose starts dripping at 4:00PM, while finishing a visit with a patient with a knee problem. I blow my nose, wash my hands, and apologize. A vague sensation of not feeling quite right accompanies an explanation of how to apply a cold, not frozen, can, not bottle, of regular, not diet soda to an area of overuse.

I exit the room, have my nurse print the patient’s depart papers, and ask about the afternoon’s first patient.

I started with that patient on time at 1:00PM. While I washed my hands, I noticed shortness of breath. I listened to the account of all the things that had happened since a recent surgery. After examination, I told that person my concern for a possible blood clot in the lungs, then started in the process of ordering a CT of the chest (and, because of other problems, other places).

The welcome assignment to Same Day duty brought my most intense day since arriving in Nome. Starting with an empty schedule, the morning filled with people who had sickened or worsened in the last 72 hours. I moved efficiently, discharging the last morning patient promptly at noon. I bolted up the stairs to the cafeteria, inhaled lunch, and descended to finish the morning’s documentation. With satisfaction every time I hit the SIGN box, I started the afternoon with no morning leftovers.

Nothing happened quickly for that first afternoon patient. While I cared for others with respiratory infections, orthopedic problems, rashes, and psychiatric conditions, complicated by betrayal, bitterness, and overwhelmed emotional resilience, we had delays getting the lab to draw the blood, and delays getting the results.

The nurse tells me that the patient hasn’t yet gotten the IV for the contrast.

However late, we need the result before the patient can leave.

I start with my 4:00 PM patient at 4:05. At the end I discuss the difference between sinusitis and the common cold. I describe the relationships between stress, alcohol, marijuana, tobacco, and the immune system, and make recommendations.

I sit down at the computer and I start the depart orders for that patient: diagnoses, medication reconciliation, follow-up, and patient education.

I wait for the CT scan to start while I start the afternoon’s documentation. At 5:00 my nose has gone from dripping to running and I worsen. My forehead warms my palm, but I keep keyboarding.

At 5:15 I ask the nurse for a portable thermometer and receive, to my surprise, real mercury in real glass.

The patient enters the CT scan while I mutter that I don’t feel good; at three minutes the thermometer reads 99.0. The glass bulb stays under my tongue.

Long ago I learned to keep the thermometer in till it quit going up. I keep computing, checking the silver line every three minutes, till 5:45. The worst of the documentation ended, I await the viral onslaught with a near fever, 99.5.

At 6:10 I can tell the patient, “You have no blood clot in your lungs, and the rest of the studies showed no surprises.”

At 6:15 I walk out, feeling even worse. The dry, hacky cough (confirming my diagnosis of influenza) starts while I crunch across crusted, packed snow in the gathering subarctic, subzero gloom. The half-mile back to my lodging takes me 15 minutes. After 2 acetaminophen, a Tamiflu and a liter of fluids, I crawl into bed and don’t crawl out till morning.

Feeling much better, I walk back to hospital in 10 minutes, arriving before business hours. Funny lab results bring me to research multiple myeloma until 8:30 when I call the infection control nurse. She comes to my cubical.

My story recounted, I ask, “Do you or don’t you want me seeing patients today?”

“What would you tell a colleague?” she counters.

To answer a question with a question constitutes a dodge, but, in this case, a legitimate one.

I said, “Generally I send folks back to work when fever free for 24 hours, and I never actually ran a fever.”

And in fact the worst part of my contagiousness happened in the 24 hours before my nose started to drip.

Flu season and I got it, too.

December 30, 2014

Not sure on what I should do,

My temperature serves as my cue

And another good reason

At this time, it’s the season

To suspect that I’ve gotten the flu.

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 for adventures working in out-of-the-way locations. After jobs in Alaska, New Zealand, Iowa, and Nebraska, I returned home and took a part-time position with a Community Health Center, where I worked for 3 years and left because of a troubled relationship with the Electronic Medical Record (EMR) system.  Now I’m back from a road trip, working a bit with one of the rural docs, and getting ready for another job in Alaska.

Shaking chills didn’t set in till after I left the clinic.

I hadn’t felt well most of the day, with a cough and runny nose and violent sneezes.  But I kept track of my temp, and no matter how badly I felt, it never strayed north of 99.3.

Despite the muscle aches, headache, and loss of appetite, I thoroughly enjoyed the morning.  I got to treat anxiety that bore no relation to alcoholism or other self-defeating behaviors.  People came to me with colds and coughs; I listened to what they said and I listened to what they didn’t say.  I got to treat a case of pneumonia appropriately with antibiotics, and I avoided antibiotics for those who didn’t need them.

Although snowy roads and the consequent crawling traffic got me to the rural clinic 30 minutes late, patient flow proceeded well.  The nurse and I stepped into the bitter cold about 11:00AM to walk the 30 yards to the nursing home.

I napped after my midday sandwich, but I slept longer than my usual 18 minute power nap.  The original schedule listed one patient after lunch, but the update brought one at 1:45 and another at 2:30.

I didn’t feel my best and I didn’t mind that more patients came.  In fact I reveled in my work, though between patients and dictations I kept asking the nurse to check my temperature.

I would have left if I had had a fever.

The final patient tested positive for influenza A.  I prescribed oseltamivir, called in my last dictation as my voice plunged into the subwoofer range, and accepted the nurse’s proffered Tylenol.

I thanked the staff for a great day; I had enjoyed myself immensely, and we agreed we’d done a lot of people a lot of good.  We went over the patients we’d seen, the stubborn headache relieved, the back pain addressed, the surprising results of a urine drug screen.

I slipped my fleece jacket over my white coat and stepped out into the bright afternoon sunshine and single digit temperature.

But I shivered violently as I pulled onto the state highway; I had a good hunch I’d contracted influenza despite being on preventative oseltamivir.

Forty minutes later, as soon as I got home, I crawled into bed.  By then my temp had gotten to 100.5; barely a fever but enough to make me feel lousy.

Next morning my doctor confirmed my suspicions, bumped my dose of the anti-viral, added in a second anti-viral, and advised Is hydrate well.

Fourteen hours of a zoo of a day.

February 17, 2011

I don’t do this because of the pay,

Going straight into the fray

     From eight until ten

     Like the old headless hen,

It’s been a zoo of a day.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  Avoiding burnout, I’m taking a sabbatical while my one-year non-compete clause winds down, having adventures, visiting family and friends, and working in out-of-the-way places.  Currently I’m on assignment at the hospital in Barrow, Alaska, the northernmost point in the United States.

I’m writing this after fourteen continuous hours of caring for sick people trying to get better, sick people trying to stay sick, well people pretending to be sick, and a few well people just wanting to go back to work.

I tried to take care of five people who came out and said they didn’t trust me, then tried to bully me into narcotics prescriptions.  I pointed out to them that if they really didn’t have confidence in my judgment they wouldn’t accept anything I would prescribe, and the only thing they should take from me is an arrangement to see another doctor.

A recurring theme today, just like an episode of a TV doctor show, involved a schizophrenic with a horrendous medical problem that cannot be dealt with on the North Slope.  We discussed the patient at morning rounds, I made several calls to Anchorage and received varying combinations of arrogance and sympathy from the Big City.

I placed a cast with the advice to the patient for prompt follow-up if the cast got too tight.  Which it did.

Influenza and post influenza problems saturated the walk-in clinics.  People slip on the ice and sometimes break things, but mostly just hurt for a couple of weeks.  I explained to a lot of people that if it didn’t hurt bad enough to come in for the first five, six, or eight days that they didn’t narcotics today, and they should expect to be sore for several days.

The Inuit smoke a lot of marijuana, which has marginal legality here.  But they smoke it now like hippies smoked it in the sixties and a lot of folks haven’t been unstoned for decades.  Some of them hunt stoned.  I see health problems related to cannabis abuse.

Instead of eating dinner, I waited twenty minutes to talk to a pediatrician at ANMC (Alaska Native Medical Center) because the phone operator didn’t read the call schedule correctly.

When I finally connected to the surgeon/gynecologist/pediatrician, I received cogent, useful advice in a time efficient fashion.

Seventy percent of my business came from tobacco, alcohol, or marijuana. Twenty percent came from influenza.  Ten percent came from bad luck or overeating or both.

And I saw something I’d never, ever seen before.  I didn’t even ask for permission to write about it, even if the answer had been yes, I wouldn’t have written the details.

The clinic runs hot and cold

February 15, 2011

 

I hardly think that it’s fair

If I’m delivering medical care,

    To get heated by steam,

    Just like a bad dream

Working with too much heat in the air.

 Synopsis:  I’m a family practitioner from Sioux City, Iowa.  Avoiding burnout, I’m taking a sabbatical while my one-year non-compete clause winds down, having adventures, visiting family and friends, and working in out-of-the-way places.  Currently I’m on assignment at the hospital in Barrow, Alaska, the northernmost point in the United States.

At the Clinic Formerly Known As Mine, in summer the cooling system kept certain zones cooler than others.  My exam rooms and office, till four years ago, ran consistently cold.  In June and July, when on really hot days I’d be working in the fifties, I’d take my lunch break in my car in the parking lot with the windows rolled up.  I finished my dictations while the temperatures soared high enough to roast almonds on the dashboard.

Here in Barrow I face the same but opposite problem; when the mercury plunges outside, the normally hot clinical area becomes even hotter.  After a hot day in the clinic Friday I had to go out at into a twenty below night to cool off.

Last night the wind howled and I when I woke up this morning to look out the window, I knew that a white-out had Barrow in its grip.

Even without hearing the wind, I would have known about the cold from the way my patients dressed today.  People who have lived sixty or seventy winters here told me how cold the weather is.

The weather defines Barrow as much as the people, the sea, and the whales.  It remains a constant, undeniable fact.  In fog, white-out, or high winds, airplanes can’t come in or leave, and emergency medical transport goes from reality to hypothetical.

One of my elderly patients complained of cold; the hands were cool to the touch, and since I started to write this, I received lab notification for a critically low hemoglobin/hematocrit (very thin blood).  The patient will return for transfusion.

The temperature in the clinic today did not exceed reasonable limits of tolerance, in fact the place had good air temps all day.  I put in a twelve-hour day and faced difficult patients: four narcotics seekers, five patients who didn’t trust me, a person with very real mental illness and a very real medical problem, more influenza, and a mysterious viral illness causing alarming blisters in the mouths and hands of children. 

But I didn’t overheat, and I finished the day with my morale intact.

Full mornings and evenings in clinics, walks in the evening, and a jam session

February 9, 2011

We’re seeing more cases of strep

At the end of the day I’ve lost pep

   But here is an upper

   I pause briefly for supper

Or else burnout becomes the next step.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  Avoiding burnout, I’m taking a sabbatical while my one-year non-compete clause winds down, having adventures, visiting family and friends, and working in out-of-the-way places.  Currently I’m on assignment at the hospital in Barrow, Alaska, the northernmost point in the United States.

The outpatient section of the hospital in Barrow has six exam rooms and two ER bays.  The morning schedule contains only appointments, the afternoon schedule is open to walk-ins.  Not surprisingly, we see more patients in the afternoons than in the mornings, and in the mornings we have lots more time to spend on each case.  Sometimes questions pop into my head.

When government agencies keep statistics, I wonder how they classify Barrow injuries.  Does a broken leg from a snowmobile rollover count as a motor vehicle accident or a hunting injury?  Do we file a finger laceration sustained while preparing muktuk (whale blubber) for consumption as a whaling injury, a fishing injury, or a cooking injury?  If two snowmobiles collide in mid-air, do we have to report to the FAA?  How do we classify a crick in the neck from pulling out a whale?  Should we be keeping stats on the number of people constipated from eating muktuk?  Does a hunting accident for a subsistence hunter qualify as on-the-job injury?

I would not have believed the number of people I’ve met here who survived plane crashes.  People here cannot believe the number of patients I’ve had who survived lightning strikes.  Residents in the bush spend more time flying than those of us in the lower 48.  They also spend more time on boats.

Walk in clinic brought a few more cases of influenza and a lot more cases of strep.  People slip and fall on the ice and sprain and break things.  Most of the worst injuries come from snow machine accidents; collisions hurt more than trying to turn too fast.  I haven’t seen a car-snow machine injury, but I’m sure I will.

Two days into the week and I have 19 hours on my timesheet.  Afternoon walk-ins routinely last two hours longer than planned.  I have stopped trying to work all the way through the dinner hour; to do so is to take the first step back towards burnout.

I returned to the walk-in area after my fifteen-minute break, helped my colleagues care for the outpatients, then I came back to the apartment.  I suited up to walk Bethany to her Tuesday knitting group, a mile away at the library.

With a light snow, the temperature had risen to almost zero Fahrenheit (minus 15 Celsius), and I knew I had overdressed before we’d gone two hundred meters.  I left my parka and my bib overalls unzipped but my arms sweated.  On the way back I took off my mittens.

I picked up my saxophone and went to my guitarist friend’s house.  We played some popular and some esoteric tunes, and by the time my lip started to fail I had more energy.

I walked back to the hospital in the gentle cold and snow of the Arctic night.  I felt like dancing because I’m not carrying a beeper.