Psittacosis

Getting Worked

Yesterday was one of those days.  I got worked.  I showed up to work, and I got worked.  This was big-kid medicine.  In an attempt to gain some control of the situation, I followed the advice of many sage and elder doctors before me, and wrote down my clinical questions.  The trouble is, I couldn't answer even the most pressing because THE INTERNET was BROKEN.  What?  I thought the end of the world was going to be in December 2012.  I was not ready for this.  And it's not like I have room in my doctor bag for Harrison's Textbook of Internal Medicine and Williams Obstetrics and that other Pediatric text what with all the diapers and Thai coins and ACLS cards and 57 different name tags in there.  Here is a small sample of the things I want to review from yesterday: How to safely taper patient off s***-load of diazepam patient has been taking for 10 years while avoiding seizures and panic attacks. How to convince patient this is a good idea. Does Mirena cause low libido?  I know "it doesn't." But does it? How to know if a headache in a hyperactive kid who's been exposed to NAT 9 months ago is ominous or not. It was a day of breast lumps, profuse diarrhea, hypoglycemia to 25.   It was a day of telling people all day long to drink water only, and no soda, and not to eat cookies.  And spending so much time on nutritional advice that for lunch I didn't have time to go to the natural foods store.  So instead found some cookies and soda.  Really. And I hid in the corner and ate them.  On the plus side I walked out of a room to find someone had brought their pet hawk along to their doctor's appointment.  He demonstrated how not to get the bird to bite you.  He had a cage, leather gloves, the whole bit.  If I had known it was show and tell I would have brought my.... rock collection? Who am I kidding, I can't top that. My last patient of the day came in concerned for breast lumps.  Turns out she'd also had some systemic symptoms lately, fever, and diarrhea.  Or not.  Sometimes people live with a vague idea of what is happening in their body, and sometimes you are meeting them for the first time.  The hardest thing in our job sometimes is to decipher what's really going on in someone's body (and in their mind).   I was sufficiently concerned.  I fell back on my triage basics.  Hospital or no?  Urgent work-up or non-urgent?  I decided what I needed to do and discussed with the patient.  She agreed, then I ordered the appropriate labs, imaging, and referrals.  Then I left the room and went to look for cookies. The lab folks found me soon after and told me the patient wasn't going to be able to do the labs because she couldn't afford them.  And if we could only do one or two, what would they be?  I hate these sorts of decisions.  I mean, are we in the developed world or not?  Why should how I treat people depend on their ability to pay?  I like to think it doesn't.  But if they can't afford something and so I cancel some of the labs, then it does.  It just does.  This sucks.