“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler






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Phones, Down

Our phone system has been f'ed up since last night. We can't call out, and very few patients can call in. This episode follows on the heels of another one two weeks ago, not quite as dramatic as today's - from minute to minute the phones would allow you to call out, then would not. Oh, and my cell phone is dead, so I can't even resort to that option to contact patients. We are lined up to use the red emergency phone in the reception area, which runs off a different circuit, for the most urgent calls.

In other words, I'm having a GREAT day. (Seriously, the silence is wonderful.)

In other news, this week I saw the reappearance of an old favorite illness. A woman in her fifties walked in complaining of not feeling well and having a rash that itched. She stated the rash was on her back and left cheek; when I examined her, I realized that she also had rash on her forehead, right cheek, and chest and shoulders. Staring at it, the phrase "dewdrop on a rose petal" popped into my head from nowhere... then realized it was an old memory aid from med school to diagnose chicken pox. Yep, it was chicken pox, and my subconscious diagnosed it! How cool is that?

Me, I had chicken pox at age seven, and I'm so glad I did. It has guaranteed me protection ever since. I was always the one sent in to examine the varicella and zoster patients all through med school, residency, and during my gainful employment since. I've never had a problem.

More later. I've got to check the phones again.
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Funny Link of the Day

Ten Ways Dick Cheney Can Kill You. (Via Tim Blair, or to be more exact, one of his commenters.)
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Vignette

As promised.

Each of my exam rooms has a bulletin board in it, usually reserved for unexciting reminders to patients such as "Please Turn Off Your Cell Phone" and "Please Bring All Medications With You At Each Visit." Lately I've tried to jazz things up (and give patients something to read) by posting newspaper articles on health-related issues. Today I walked into an exam room to find my patient standing at the board reading an article entitled "Caring for Ill Spouse Takes Toll on Health."

"You know, this is so true," she said, gesturing to the article. "My stepmother died of a heart attack just a week after my dad died, and she'd been taking care of him for years." She sat on the exam table and continued her story. Her father had been in decline for years with Alzheimer's disease and multiple other health problems and spent the last month or so of his life in the hospital. "She'd walk into the room and he'd throw things at her. At the end he was begging her to kill him."

I told her the story of a patient I'd had years ago, who walked into my office for the first time with a massively swollen stomach; it was clear that she had ascites. This woman's husband had just died of a chronic illness, and she hadn't been to a doctor in years. The moment I saw her I knew something was very wrong. It turned out to be metastatic ovarian cancer; she lived less than three months. She'd been ignoring her symptoms to take care of her husband.

"Yes, yes," said my patient. "My stepmom was running back and forth to the hospital, living on doughnuts and Chinese food! We kept telling her to take care of herself, but she wouldn't. After he died, she told me she felt like she'd lost her right arm and that she didn't have anything to live for. Then a week later - it was the last night of shiva - she'd been saying all day that she didn't feel well and that she felt 'pressure in her breasts.' They found her on the bathroom floor in the middle of the night."

She continued, telling me how guilty she'd felt. "I should have taken her to the hospital. I should have insisted, but she wouldn't do it."

I listen, nod, tell her how coronary artery disease in women often goes unrecognized. "If this ever happens again," I reassure her, "you'll know what to do."

She nods. "I feel better. I've talked about this before, but this really makes me feel better."

Her reason for coming to see me? A minor one - she wanted some blood tests - but the real therapy today was giving her a chance to vent. I'm grateful that I had the time to listen.
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Burn Out

Yeah, I know.

V. threatened me with physical harm if I didn't post. I got a lovely email from Jack (thanks, Jack) concerned with what was happening. Or not happening.

It's been a busy month. I had jury duty again - Los Angeles seems to be really churning their jury pool, it's been less than two years since my last stint. Got out of that one by telling the court about the time I was robbed and testified against the guy who did it, and mentioning that my sister is an assistant district attorney (both true; since I was called for a criminal case, that was enough for them to boot me).

I'm in a bit of a rut - not an unpleasant one, but a rut nonetheless. For the first time in over a year I have enough free time to breathe, and I haven't done any of the productive things I promised myself I would do. I have, however, managed to become addicted to 24; I have spent way too much time on the message boards over here. (Another reason why I haven't posted.)

So, anyway, I'm alive and will try to get back to posting more often, even if it's just little vignettes of what happens at work.
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Now Here's a Way to Celebrate Easter!

Peep Drinks.

(via Dave Barry)
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