Posts Tagged ‘Scrabble’

I take call and end up a patient.

April 23, 2017

At the end, it wasn’t a stroke

It was gone when I awoke

The symptoms were brief

Avoiding much grief

And I got to tell a crude joke.

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.

 

Tuesday evening while on call, I got up to play Scrabble and I couldn’t make my right leg work. It didn’t feel heavy, numb or weak; it felt too light so that any effort to move it got exaggerated.   I sat down to do a neurologic exam on myself.  I found nothing other than my right leg ataxia.  I called Bethany from the next room, and told her the situation.  She helped me dress, and drove me to the ER.

The ARNP covering the ER did the same neuro exam I did, which wasn’t impressive until I demonstrated my gait.

She did all the right tests. The first EKG showed an old heart attack, which disappeared with proper lead placement.

She also found a heart murmur.  It hadn’t been present 5 years ago, but the PA at the VA found it a couple of months ago, and I called her attention to it.

My blood work had no surprises. She offered me the choice of staying in Clarinda or going into Council Bluffs, and I chose to go.  In terms of game theory, if something happened in the middle of the night, I wanted to be close enough for timely intervention.

In the process I had to make arrangements for someone else to take call.

I napped off and on for the ambulance ride, which almost got derailed twice by herds of deer. I bypassed the ER at Jennie Edmundson Hospital.  At 2:00 AM I had gotten settled, my IV had given me a couple of quarts, the second set of labs had come back and I’d had a good visit with the hospitalist ARNP.  Just before being tucked in, I offered the nurses a choice between a clean joke, a clean joke with a bad word, or a dirty joke.  They chose the last option, and I gave them the funniest crude joke in my large arsenal.

I don’t get to tell that joke as a physician, no matter how funny it is. But, as a patient, I can get away with it.  The punch line drew gales of laughter.

By then, motor control of my right leg was functioning at about 90%.

I slept for a couple of hours and had breakfast.

The neurologist arrived, and with economy of motion, did a thorough exam. He advised an aspirin a day and starting a low dose migraine medication.

The morning parade of tests started. By the time Bethany arrived I had done the basic neurologic exam six times and the symptoms had resolved except for the funny feeling inside my head.

I had an ultrasound of my neck, a consultation with the dietician (whom I amazed with my six pieces of fruit a day and my two ounces of salmon at breakfast), a consultation with the Occupational Therapist, and then the Piece de Resistance, the MRI. In between, I napped because I’d slept so lousy.

The hospital feeds its patients on the room service system; I ordered a lunch of soup, sandwich, and fruit, and within a half hour a young Guatemalan arrived with the food. We had a brief conversation in Spanish, I introduced my wife.

And we waited. The hospitalist came back, and went over the results.  Ultrasound demonstrated clean carotids (neck arteries).   The MRI didn’t show anything conclusive.  He also recommended an aspirin a day.

We waited for echocardiogram results. The hospital public address system announced a severe thunderstorm warning, and then a tornado watch in effect till 10PM.  The internet and the TV weather agreed that severe weather approached from the west.  At 4:45PM we decided to leave before the storm arrived, without the echocardiogram results.  We didn’t want to spend the night in the hospital, nor did we want to risk hitting deer on the way back to Clarinda.

Bethany drove. We enjoyed dramatic skies and listened to a Continuing Medical Education CD.  We ate at Clarinda’s premiere restaurant, J Bruner’s, ordering off the appetizer menu.

I returned to work the next day, the episode completely resolved, making it a transient ischemic attack (TIA), also call a reversible ischemic neurologic event (RIND).  Except I noticed my handwriting was much clearer.

I don’t think anyone else noticed.

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Ketchikan to Metlakatla

April 12, 2016

We came across on the ferry

At leisure, and then we could tarry.

Some food we bought more

With a trip to the store

And we found some good prices on dairy.

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 (EMR) system I can get along with. I spent last winter in Nome, Alaska, followed by assignments in rural Iowa. The summer and fall included a medical conference in Denver, working Urgent Care in suburban Pennsylvania, and Thanksgiving in Virginia. So far this year I worked assignments in western Nebraska and southwestern Alaska; I just arrived in southeast Alaska.  Any specific patient information has been included with permission.

We took the ferry from Ketchikan to Annette Island, the only Indian Reservation in Alaska. In 1887 an Anglican missionary, motivated by doctrinal differences, led a thousand Canadian Tsimtshians on a search for a new home.  They found this island, moved legally, and in 1906 petitioned for, and received, reservation status from Congress.

Fortunate enough to have no mineral wealth that economic interests wanted to steal, they maintained their reservation more or less inviolate until WWII, when they got an air base, and a promise to build a road to the other side of the island so as to link up with the Alaska Marine Highway system. The road took eleven years to build and finished 8 years ago.

We learned these things from the Security guard who drove the 15 miles from the clinic to pick us up, and also took us on a tour of the town.

Falling timber prices shut down the logging and sawmill operations.  The salmon cannery, the casino, the school, and the clinic provide the most jobs.

We passed the gas station, the schools, the churches, but no bars or liquor stores.

Perhaps because of fewer freeze-thaw cycles, perhaps because of better maintenance, the roads lack the crater-grade potholes we find back home in the spring.

The guard helped us drag the luggage up the stairs to the apartment. We unpacked briefly.  We ate the snack that Bethany had the foresight to bring, then we walked to the grocery store.

We hadn’t expected a well-maintained, well-stocked, brightly-lit facility.  The prices, a big higher than Ketchikan’s, didn’t look so bad compared to what we’ve paid for the last two months.

Then we settled in. We tried the TV and found no service, and we had no idea whom to call about the Internet password.  We played Scrabble, ate some salmon we’d brought, and found ourselves exhausted when the sun went down.

In the same time zone, but we definitely faced jet lag.

A 200 kilometer wild goose chase. I don’t mind. Really.

June 2, 2011

It was late when I got the call

About a person, a car, and a wall.

     When I did arrive

     After quite a long drive

My skills were not needed at all.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  On sabbatical to dance back from the verge of burnout, I’m having adventures and working in out-of-the-way places.  Right now I’m living in Amberley, and working the last week of a four-week assignment in Waikari, less than an hour from quake-stricken Christchurch, in New Zealand’s South Island. 

Yesterday my clinic hummed along at a steady pace.  I saw a lot of farmers and a few teachers and school kids.  The younger children make up a fair chunk of the patient load.

Now in the last month of Southern Hemisphere autumn, the sun goes down early, and I loaded the PRIME medical kit into the car for my last night on call here in Waikari/Amberley.

I stopped off at the clinic in Amberley to pick up my two beepers; one of the receptionists informed me that, under the mistaken impression I would work an evening clinic, I had a patient at 5:45.

I don’t get annoyed with one-time (or, as the Kiwis say, a one-off) flubs any more.  I nodded, waited for the patient to arrive, had a great conversation, made some lifestyle modification recommendations, and refilled a prescription. 

I drove home in the dark. Bethany and I went to the Thai restaurant and afterwards played Scrabble.  I was about to start practicing my (borrowed) saxophone when one of my two beepers went off.

The St John Ambulance dispatcher sounded a bit abrupt over the phone, and in places, hard to understand.  A motor vehicle accident, she said, and specified a location.

Without geography you’re nowhere.

I had her repeat the location, which still didn’t make any sense, but, hey, OK, not mine to reason why.  After all, I have a GPS.

Hold on, I told her, and I called my back-up.

You’ll do fine, she told me, if you have your ATLS certification that’s more sophisticated than PRIME.

I called the dispatcher back.  The more I tried to find out where I needed to go the more annoyed she got with me, but, darn it, I’m not about to set off in a hurry to an undisclosed location. 

I didn’t recognize the name of the town, and she had to spell PARNASSUS.  But, feeling it an emergency, I had no time for internet map research.

Bethany, thankfully, volunteered to come with me.

With the revolving green light on the roof we set off north.  Ten kilometers out of town, I had Bethany call the ambulance people again.  Where?

“Ten kilometers north of Parnassus, which is ten kilometers north of Cheviot,” I heard Bethany repeat as I passed the sign saying CHEVIOT 59K at a speed in excess of the 100 KPH limit.

As the kilometers whizzed by at the rate of 1.6 to a mile, I thought things through and realized that minutes wouldn’t make a difference.  I fell in behind three semis and had Bethany unplug the light.

North of Waipara the road grows tight curves and a one-lane bridge.  We sang some Bob Dylan songs.  We passed Cheviot and Parnassus, and 11 kilometers later came to the scene.

Three fire engines and four police cars flashed their lights.  I drove on the wrong side of the road past the backed-up traffic, announced myself to the cop with the STOP sign, and parked behind a fire truck.

As I got out of the car, a paramedic came to me from the ambulance.

The patient, already aboard the helicopter, would take off at any moment. 

I stood on the asphalt as the chopper lifted, fingers in my ears, clinging to the bill of my cap, with walls of limestone setting the stage for the brutal reality of theater in the streets, grateful the patient hadn’t needed my services.

We drove back at a more sedate pace.  I filled the tank in Amberley in case I received another 200 K round-trip call.  After three hours on the road we came back to the flat with jangled nerves, and slept poorly.

Adrenaline kept me going through the day; at my exit interview this evening I learned I could have refused the call for being too far away.

The problems of time: crossing the equator, avoiding jet lag, caffeine as an ally, and not celebrating March 11.

March 12, 2011

I messed with my internal clock,

With the advice and support of my doc.

     One late night so fine

    We crossed the Date Line,

And went for an evening walk.

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.  Just back from a six-week assignment in Barrow, Alaska, the northernmost point in the United States, we’re now in New Zealand.

I didn’t celebrate March 11 this year.

I graduated from medical school on March 11, 1979, and every year the day evokes vivid, euphoric memories, the savor of the occasion lingering with me from the time I awaken till I fall asleep.  I remember the day, and the night that followed, well.  My brother, my father (also a physician) and I went out for Chinese afterwards; my fortune cookie said, “You will have great power over women.  Use it wisely.”

But I didn’t mark the occasion this year because I crossed the International Date Line from March 10 directly to March 12.  Most of the people on the airplane remained fast asleep, but I kept looking up at my TV screen from my Droid/Kindle book.  I watched the icon of the plane cross the line on the map at a 30 degree angle, skipping March 11 without even a feeling of turbulence.

New Zealand has one time zone and two islands. Six o’clock Sunday afternoon in Sioux City happens at the same time as Monday noon in Wellington.  The summer here ends when Iowa’s spring begins; the Vernal Equinox at home corresponds with the New Zealand Autumnal Equinox. 

An eighteen hour time difference boils down to a six-hour time difference for the sake of calculating jet lag.  In the Los Angeles airport we drank Pepsi, ate chocolate, and played Scrabble so we wouldn’t fall asleep once the plane took off.  With consultation and prescription from our doctor, we took eight milligrams of Rozerem (a prescription version of melatonin) and ten milligrams of zalpeplon (a four-hour sleeping pill) eight hours before we anticipated the dawn at our destination.  Shortly prior to our early morning landing we each ingested two hundred milligrams of Provigil (a stay-awake pill for shift workers and jet laggers).

Once we’d overcome the SNAFU at Immigration and cleared Customs, we trudged two kilometers from International to Domestic terminals in Auckland.  The flight from Auckland at the north end of the North Island to Wellington at the south end of the North Island went boring well. 

We fought the natural urge to nap after we showered at the hotel.

Nor did we sleep till after we’d eaten and exercised and the sun had gone down.  By that time we’d wandered around downtown Wellington.

I didn’t have my March 11th celebration this year, and I didn’t miss it.  If all works well, I won’t be jet-lagged when I meet with the New Zealand Medical Counsel tomorrow.