Friday

Wine Pairings

Sometimes at the end of a work day, you look around you and say, “What the hell just happened?” Usually this is a Friday evening.

Fridays are awesome. It’s like the last day of a Storewide Clearance Going Out of Business Sale!!! Folks want to get it while the getting’s good. The afternoon gets exponentially more exciting and intense, ending with a whirlwind of needing to do a breathing treatment on someone and finding it’s already 6pm and you’re alone in the building with the patient. And damn if you know how to even find the machine.

Today was about the guy who really wants to talk about erectile dysfunction. And, oh, there’s blood in his stool and he had a heart attack in the last 10 months since he saw a doctor. And diabetes and hyperlipidemia and uncontrolled hypertension. But let’s talk about erectile dysfunction, and toenail fungus. And my favorite almost 70-year-old, who was doing well, by gosh, up until she started falling over last week. A let’s-help-you-not-get-pregnant while-you’re-still-using-cocaine discussion. And a your-skin-is-just-dry-try-lotion pep talk. And then an OB visit. Covering for another provider. Third trimester, pregnant after failed tubal, uncontrolled epilepsy, hasn’t heard back from neurologist, malar rash not going away, positive ANA screen, GDM with broken glucometer, elevated blood pressure, hypothyroidism. 15 minute appointment: go!

My 21 year old type 1 diabetic with sugars that were either 65 or 270 seemed positively glowing with health by comparison.

Next came lupus. Confession: I am afraid of rheumatology. It is like a black box for me. Here is what I know about lupus: the name sounds like the latin for wolf. You need 4 out of 11 things to diagnose it. There is not room in my brain to remember what those 11 things are. It is bad. Different organs can be affected. Women are disproportionately affected, much as we are with lines in public restrooms.

So now I’m managing lupus. Because it’s me or no one for this young man without insurance and who missed his consult appointment because it cost $450. And I’d phone a rheumatologist to curbside but it’s after five.

Here’s what I can do. Print a patient information sheet in Spanish from the aafp website. “Thanks for coming in guys. I don’t know what the f*** to do but here’s some informational pieces of paper to freak you out a little. See you in a few weeks.”

And I thought I was done. But the two nurses found me in the dictation room trying to work the printer.

“Your last patient has a blood sugar that won’t compute on our machine which means it’s over 500 and he wants oxycodone and says his pain is why he isn’t taking his insulin and it says here on his chart ‘do not give narcotics.’”

WHAT??? “Um, last patient?” It’s 5:45. Everyone has left the building.

The nurses recommend to him that he go to the hospital. Thank. Goddess.

And that, my friend, is Friday. I consider myself lucky. I had a hot date for my birthday already lined up. After dictating in record time I made it out to the fancy-pants restaurant GB had picked out.

The waiter recommended wine pairings for the food we were eating. I couldn’t stop giggling. GB gave me the evil eye. “This is what I do all day,” I told him. “’Here, try this. Here’s your diagnosis, and a prescription to match.’ And I look really sincere and scientific about it but really sometimes it’s just a guess.” Fruity ketone notes with undertones of bilious emesis. Best paired with insulin and IV fluids. Now lupus? Hmmmm. How about a gin and tonic? Giggle giggle snort.

Obviously I do not get out much. Nor should I be allowed out.