More low folic acid deficiency

It came from I don’t know where

It’s a disease, it’s ridiculous rare,

If to you it’s the same

I’ll leave out the name

But perhaps I’ll publish and share.

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 3 Community Health years, I took temporary gigs in Iowa, Pennsylvania, Nebraska, Canada, and Alaska.  Since the pandemic started, I’ve done telemedicine off and on in my basement, staffed a COVID-19 clinic in southeast Iowa, visited family, attended funerals, worked at the Veterans Administration in South Dakota, held a part-time position close to home, and worked 10 weeks in western Pennsylvania.  After a couple weeks off, I’ve got another gig in Northwest Iowa.

The patients I refer to gave permission to use more of their information than I have. 

Six weeks ago, I met a patient with a long medical history who just didn’t feel well.  I listened to the story, and physical exam did not give any information on which to base a decision.  I requested a bunch of lab.  All but one of the abnormal results didn’t constitute a surprise, but the folic acid was low.  I prescribed one of the cheapest, safest medications I know, and achieved spectacular results.  Walking into the room, I found it hard to believe I was looking at the same patient.  Clear skin showed effective, restful sleep.  Happiness dominated the conversation and brought news of a new grandchild. 

The next patient had a left ventricular assistive device.  While I know such things exist, I had never met a person with a machine that keeps the heart pumping blood.  My stethoscope on the chest brought more of a hum than the familiar lub-dub lub-dub.  The machine keeps the human involved in society, doing useful work and staying employed, and has done so for the better part of a decade. 

It’s stuff like this, making people spectacularly better, and having new experiences, that keep me in the game when many of my colleagues have burned out. 

The rest of the day did not go as smoothly as the first two people.  I dealt with difficult patients with difficult problems and unforeseeable time crunches.  Puzzling diagnostic information filled my in box.  At 5:00 I should have taken a dinner break and a nap, and returned refreshed and efficient, but I didn’t.  I tried to power through and get things all done before I left.  Such was a bad strategy when I was 40 years younger, and it’s worse now.

I’m glad I didn’t have to take care of more patients when tired, because I had exhausted my empathy.  I do my best work by good listening. 

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The information age has made researching rare diseases easier.  One of my patients has a problem so off-the-beaten-track that to name the condition would name the patient.  I struggled with the spelling the first couple times I used Google after finding nothing in Wikipedia.  The patient’s unusual presentation didn’t help me get therapeutic information.  I am considering writing a short paper for publication, mostly so that other docs will find more than one item on the entire information highway.