Posts Tagged ‘No heroics and no surgery’

Call, Storm, Flood, and Nursing Home Rounds

June 19, 2018

Bad sleep when on call is the norm

Made all the worse by the storm

Far from a dud

It gave us a flood

But incidentally watered the corn.

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. After a month of part-time in northern Iowa, a new granddaughter, a friend’s funeral, and a British Columbia reprise, and my 50th High School reunion, I’m back in Northwest Iowa.  Any identifiable patient information has been included with permission.

The call from the ER at 5:00AM didn’t exactly wake me. The thunder did that hours before, and I tried dozing after.  But I never sleep well on call, and the lightning flashes came through my eyelids, strobe lights through a red curtain.

I should have slept well. My clinic day segued directly into ER call at 5:00PM.  One patient, of my generation, came in with a dramatic history, full of the ironic pains that only the power of human love mixed with inevitable human fallibility can bestow.  Stressed people get sick, sick people get stressed, and I needed 21st century technology, from CT scans to telemedicine. In the end, we finished with a mystery, a neurologic conundrum we do not understand but Hollywood loves and misrepresents.

I still have a lingering feeling that I shouldn’t complain when I have a 12-hour day; earlier this decade I had harder 38-hour days in much more hostile environments, and I kept going.

Still I could have used another couple of hours between the sheets. At the guest house door I looked across the parking lot to the hospital.  With no hat, my white lab coat, more sponge than tarp, offered no protection from the wet.

Damp but not soaked after 50 paces in the rain, I arrived in the ER seconds before the patient.

The presenting problem required much lab and x-ray. I called a fellow ER doc in another city for reality testing.  A subtle but definite physical finding that many would not have noticed complicated the diagnostic picture; a solid, sharp patient with a strong sense of reality clarified it with declarations of no heroics and no surgery. Later, a medically literate relative helped to enforce the decisions.

With the patient tucked into a hospital bed at 7:00 AM, I found the cafeteria had run out of eggs, and I returned through a light rain to the guest house, to make breakfast, and take a too-short nap.

At 9:00AM the clinic manager and I drove 15 miles out to a neighboring town with a nursing home. The cornfields, run emerald riot with perfect temperature and generous rains, had low spots turned to streams and rapids by 6 inches of precipitation in 3 hours.

In the course of the morning I cared for 10 patients. I stopped 4 medications, and started 2 but left orders to stop 3 more.  I had the honor of attending 3 people who had survived the 1918 influenza epidemic. I ordered lots of lab, with little hope of more than a 10% pick-up rate.

I look forward to my next visit, when I’ll be able to see the effects of adjusting some neurologic meds, and I’ll get to talk some more to alert, sharp people born before the Depression.

I hope I get to their age with their faculties.