Posts Tagged ‘sunrise’

Rounds from Dawn to the Newborn Nursery.

July 26, 2012

 

Sunrise in the ICU

I started the day making rounds

Checking the lungs and heart sounds 

 

It started with dawn,

Where has the day gone?

Beauty is where beauty is found.

 

 

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 48 hours a week.

I started so early that when I saw my first hospital patient, a perfect sunrise broke as I entered the room on the top floor of the hospital.  The water content of the atmosphere blocks the view of the sun most days till the red disc has ascended well above the horizon, but with the hot dry weather we’ve had, there was the sun, just peeking up.  And the ICU offered a spectacular view of the city in the morning.

The patient couldn’t speak and could barely respond.  Even if the patient can’t talk, I speak to him or her, tell them who I am, the date, where they are and why they’re there, and I try to give a few headlines from the news.  In this case I called attention to the phenomenal sunrise, but the patient didn’t look. 

From the ICU on 6th floor I went to see a new admission on 5 Medical, and discharged a patient who had recovered enough to go home.  Striding down the corridor to the opposite end of the hospital I came to 5 Behavior Health, the psychiatric service.  I did medical consultations on two patients admitted during the previous 24 hours.

The psychiatric portion of the service consists mostly of people who didn’t ask for their problem but got it anyway.  A surprising number of schizophrenics also qualify as bipolar.  More than 90% smoke, and a lot of them come down with type I diabetes as their pancreas withers away.  They lose years of life.  A majority of schizophrenics also have drug and alcohol problems, and they can’t learn from their mistakes.

Our society has failed our schizophrenics.  At one time institutionalized, they were turned onto the streets when the institutions closed, and went right into the criminal justice system.  The ones who stay out of incarceration use a lot of health care.

Fourth floor holds the oncology (cancer) and surgery nursing units on the south.  Contrast being the essence of meaning, I talked to those who know they have no cure and to those with a reasonable expectation of cure.

The pediatrics wing sits on the north end of the fourth floor, and I had no patients there.  Fewer and fewer children need admission to the hospital as the years wear on.  Vaccinations have prevented most measles, mumps, chickenpox, polio, rotavirus, pneumococcal, and meningococcal disease.  We see a tenth of the croup that we used to.

On the third floor orthopedics unit I did two consultations for people after total joint replacement, and on the second floor I took care of two newborns.

Death, the ultimate drama and the ultimate irony, came to three of my patients during the day.  One in middle age died surrounded by grieving family.  One went unexpectedly and alone.  A third died so old and full of years that few remained to note the death, though many, on reading the obituary, will sigh and reflect on how the passing impoverished the world. 

 

 

Highlights of six weeks in Barrow

March 1, 2011

You might say it flew far like a sparrow

Or fast and straight like an arrow.

     But either way time

     Like a vacation sublime

Went fast while we were in Barrow

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 just finished an assignment at the hospital in Barrow, Alaska, the northernmost point in the United States, and I’m in Anchorage for two days.

Six weeks in Barrow, Alaska, has flown by.  We arrived at the end of the two-month Arctic night.  We went out in -75 degree F temperatures, and we stayed inside while the worst blizzard in four years raged outside.

Gone!

Blizzard in Barrow

I worked 360 hours while here, but the other doctors worked more hours than I did.  I received the lightest load on the call schedule.  I didn’t work any nights.

I saw a lot of broken ankles, from snow machine accidents and falls on the ice.  I picked up two cases of vitamin B12 deficiency, nine cases of vitamin D deficiency, two cases of hypothyroidism, and not one case of frostbite. 

I took care of people from all over Alaska, including Barrow.  I also saw those from Tonga, the Philippines, Hawaii, Korea, California, Tennessee, Kentucky, Mexico, Canada, Puerto Rico, Florida, England, South Africa, Colombia, and Ireland.

I met people who had survived plane crashes and gunshot wounds.  I made personal acquaintance with more than a dozen whaling captains, and more than two dozen who had personally killed whales.

A lot of the men had taken polar bears, most at close range with low-powered rifles, many in self-defense.  One had killed a polar bear without a firearm at all.  

I talked to women who sew the seal skins onto umiak frames, and the men who hunted the seals.

When a white-out shut the town down for four days, I suited up and went outside.  Twenty paces from the building I thought better of the venture and turned back.

I didn't have to go out in a blizzard to ice up.

We watched the first dawn after sixty-three days of darkness on the afternoon of January 24, and watched it set less than two hours later.

First sunset and first sunrise in 63 days, at the point. January 23 2011

The medical community viewed the Superbowl in the Commons room, farther north than any other medical staff activity in the country.

I talked to other hunters who shot caribou, wolf, goose, duck, wolverine, seal, and walrus.  Several people had been hunted by polar bears, but lived.

We saw the Northern Lights, I for the first time and Bethany for the second.

We attended Kiviuk, the Messenger Feast that happens every two years.  I saw dancers passionately portray heroic stories with their dances.

Afterwards, while the Northern Lights swept mutely across the sky, we watched the best fireworks display I’ve seen.

While we were here we saw pressure ridges form in the ice on the Arctic Ocean.

For every active drunk I took care of I met two in recovery.

Bethany taught sign, Inupiak, Special Ed, third grade and fifth grade.  She made a lot of new friends, one of whom she started into knitting.  She got a lot of exercise.

I drove twice, a total of less than fifteen miles.

We had the best Kung Pao chicken and Mongolian beef we’ve ever had.

Both of us lost a few pounds.

Sunrise comes with sunset; the day really is too short when it’s 75 minutes long

January 25, 2011

We watched the darkness go away

At the side of a lagoon or a bay.

     Forget solar power,

    It’s only up for an hour

The twilight is longer than day

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  I’m taking a sabbatical to bring myself back from the brink of burnout, while my one-year non-compete clause ticks away, having adventures, working in out-of-the-way places, and visiting family and friends.  Currently I’m in Barrow, Alaska.

Barrow’s annual sixty-three days of darkness ended Sunday with sun-up a little past one in the afternoon, followed shortly by sun-down.  Another doctor, a guitarist, Bethany and I went out to watch, with a temperature of sixty-five degrees below zero.

The Arctic Circle runs slightly north of Fairbanks, dividing the land of the Midnight Sun from the rest of the world.  At the Equator, the sun shines twelve hours daily, and days last as long as nights.  As one travels north or south, day length during the summer grows, and during the winter shrinks, until at the Poles day and night each last six months.  In Barrow, halfway between the Anchorage and the North Pole, the summer sun stays up 82 days and the winter sun goes away for sixty-three days.  If light did not bend in the atmosphere, the darkness and light would be more symmetric.

Thus, the local joke about the detective questioning the suspect, starting with, “Where were you on the night of November to January?”

We dressed for the cold and set out from the hospital after lunch.   

Humans exude water, and in extremely cold weather groups of humans and their activities create what the meteorologists call “habitation haze.”  We left Barrow shrouded in fog, but three miles from home, clear of the ground cloud, we could see the tip of the disc peeking out from the horizon, and we turned east.

Punchy with the thrill of seeing the sun for the first time, we got out of the SUV, leaving the engine running and the heater going full blast. 

I underestimated the cold.  After forty-five seconds trying to use the camera bare-handed, I realized how close to frostbite I’d gotten, and I went back into the vehicle.  After I warmed up, I buttoned my parka, put on my aviator’s mittens, and went back out.

Such cold becomes a sharp presence, and the slightest breath of wind hones its edge and it cuts like a razor.

But the angle of view, towards the south, meant that the habitation haze of Barrow interfered with the best view.  We got back into the SUV and headed north towards the point, laughing and joking and giddy with daylight.

We stopped in the parking lot where the road ends, and angled the windshield south.  Out in the bitter cold, with a full view now of the sun, we watched it climb to its zenith, not quite clearing the horizon, taking pictures, while our breath condensed into white crystals on our outer layers.

We observed the sun’s descent from inside the vehicle, the robust SUV heater struggling against the cold. 

The colder the air, the more it refracts, and the horizon appeared further away than expected; rather than dropping away in the distance, it rose.

At quarter past two in the afternoon, the day ended, and we headed back to town. 

We’d been out all day and we still got back in time for football.

Relating to a patient at the end of a long day.

December 7, 2010

As I came to the end of the day,

I heard my clinic nurse say,

    It’s hard to believe,

    But it’s not time to leave,

One more patient is on the way.

I walked to work this morning. 

I reside a half mile from the hospital, along roads with no sidewalks.  I awoke rested, without an alarm.  I cooked and enjoyed my breakfast, did my morning dishes, and suited up for the cold.  On a day with no wind, a temperature of 8 F didn’t challenge me.  I watched the sunrise over the Des Moines River. 

Sunrise over the Des Moines River, viewed from Keosauqua, December 7, 2010

One of the other doctors and I have decided to discuss patients first thing in the morning.  He talked about his patient from the day before and I went over my chest pain admission from yesterday.  I discharged the patient by 9:00 AM.

The morning went well, mostly adults and children with coughs.  Pertussis, or whooping cough, appeared in the school system last week, but none of the patients showed anything like a typical case.  I told lots of people to quit smoking, and I wrote ALL SMOKE OUTSIDE as a prescription four times. 

I left the clinic area at noon for the cafeteria.   I enjoyed my lunch, I talked to the staff members and received many subtle and not-so-subtle hints that I should move to Keosauqua. 

I had finished with afternoon patients and documentation by 4:30 this afternoon.  While considering whether or not I’d leave early, the nurse told me one more patient, a very complicated one, remained, but wouldn’t arrive for a while yet.

I sat down at the computer, unfazed.  Paid by the hour with no other agenda for the evening except supper and laundry, I had no grounds for annoyance.  If such had come to pass eight months ago, I would have seethed, frustrated that the goal posts had moved, and worried about paying staff overtime.

Tonight, I focused on taking care of the patient. 

I listened to the history without interrupting, then did a thorough exam.  Enough time elapsed during the visit that a critical lab result arrived before the patient left.

Ninety percent of what we know about a patient comes from the story the patient tells, eight percent comes from the examination, and two percent comes from lab, x-ray, CT scans, and ultrasounds.

During the visit I recalled my experience with ankylosing spondylitis.  At age seventeen the back pain started, accompanied by morning stiffness.   Three years later my body temperature dropped to 94.8 F.  I dealt with relentless symptoms for the next thirty years, and in the process acquired a first-hand appreciation for chronic pain, ruthless non-restorative sleep, and fibromyalgia.

I talked to the patient as one who has “been there.” I trust my words brought hope. 

I left the hospital under black, starry skies.   After supper at the restaurant around the corner from the apartment, I returned to do laundry, and I thought about a list of diagnoses that no-one wants to have.  

Ten-hour days reasonably paced beat ten-hour days rushed.