The Last 48 Hours

Tuesday was my last night on call at my current job. It was all going okay until 12:30 am when I got a call from the nursing station:

"This is Karen at the Hospital. I have a 58 year old woman here who stubbed her toe at 7 pm, and now she wants it looked at."

I rarely swear around my coworkers, but on this occasion it seemed called for. "You have got to be ***** kidding me." Why in the world didn't she come in during the day time?" I got dressed as slowly as possible in order to let myself cool off. I took care not to tidy my hair or rub the sleep from my eyes so that the patient would hopefully notice this was a human they were disturbing for their "emergency" -- a human who has to work a full day tomorrow. As it turned out, the patient was a very sweet lady whom I had met several times in clinic before. She has had the most terrible of luck and has suffered through both a bone marrow and a kidney transplant. The prednisone she has to take daily has thinned her bones to the point that she actually broke her ankle when she stubbed her toe. She was trying to tough it out at home, but the pain was too much. so she finally called a friend to bring her in. Maybe it could have waited until the morning, but I couldn't help but feel like a jerk for being angry at her.

The rest of the night and the next day went downhill from there. I saw one non-emergent emergency after another. Each time I finished seeing a patient I would lie down just long enough to think maybe I would get a few precious hours of sleep only to be awoken by another phone call. Eventually the sun came up, the puppies started stirring, and it was time for a new day. I faced my clinic without a badly needed shower, behind before I started, and still trying to catch up from last night's workload.

I started my clinic day with an elderly patient's son informing me that he didn't agree with my assessment and care of his mother's ankle fracture. I had shown him the x-rays, and because of his extensive carpentry experience he was certain that he knew how things should line up. He felt that the radiologist and I were both wrong in our assesment of the fracture and its healing progress. I tried my best to be empathic and to explain to him that the disagreement about the x-ray read was really moot, and it wasn't going to have any impact on her fracture healing or management. He told me that the more I talked the more he distrusted me, and what's more, he thinks I should have had her moving her ankle sooner. Moving her ankle sooner? Did he learn that through carpentry too? Outwardly I nodded and offered a referral for a second opinion. Inwardly I could not fathom how he ever got so confident with reading x-rays, here I thought you had to go to medical school for that.

I walked out of that patient's room to find one of my partners waiting for me to ask if I could see one of his patients for him. Today was his day off, and the family was very anxious for an appointment. Sure, no problem, I said. As it turns out the patient was quite complex. I spent over an hour with his wife and strongly opinionated daughter about his not one, but two cancers as we tried to come to an agreement about the best care plan for him. The family had been through a lot trying to get his bladder cancer worked up. They had waited over a month to see a specialist in town, only to have that specialist cancel his visit. They then found a specialist over 3 hours away. They packed up their confused, agitated and frail loved one and toted him all the way to Fort Collins. When they got there the doctor told them he would not see the patient because he had not received his records and CT scan reports from our clinic. They turned around and came home. I ended up hospitalizing the patient as much for the family's comfort as for the patient's, all the while knowing that I would later have to fight with the social worker and insurance company to justify the admission.

After finishing up with this patient I hurried to the next room where a heavy set man greeted me like this:

"I've been sitting here 30 minutes already. A man could be dead by now!"

He had walked into the clinic without an appointment because his back was hurting. He thought he may be having a heart attack. It turned out he just strained his lumbar spine. I carefully examined him and offered my opinion and advice for care. He huffed off, never thanking me.

Another patient left without a word before I ever got to see her. I had gotten terribly behind, and she was simply tired of waiting I guess. She came back over the lunch hour, and I saw her then instead of eating a proper lunch.

I went home tired. I fell asleep on the couch at 6pm and didn't wake up until 5:30 this morning.

I started today by seeing my Alzheimer's patient in the hospital. I had more information back from the various lab tests, and I was better able to treat him and to give the family a more accurate prognosis. The respiratory treatments and antibiotics we put him on had helped him breath more comfortably, and he was eating again. The family agreed to have him go to the nursing home with hospice care. They smiled and laughed and seemed so much more comfortable with everything. His wife thanked me over and over for being compassionate and for explaining everything to them so well. She had tears in her eyes when she told me she was so glad that she had met me. I did almost nothing except just listen.

I finished my clinic. It would be my last here in Wray. Some of my patients told me they were sorry to see me leave and they shook my hand and thanked me for their care. I went downtown for lunch and a lady stopped me to thank me for taking care of her neck and arm pain. The physical therapy was working. She felt like I listened to her better than anyone had before.

It doesn't take long in medicine to realize what a roller coaster ride it can be. There are too many days when people are ungrateful, frustrated, distrustful or simply a challenge because their diagnosis is elusive. When I do get thanks and praise, my initial reaction is to shake my head, because I know I am only doing what anyone in my position would do, and because I know how truly limited I am in most cases. At the same time though, I also force myself to soak it in, because those are the reactions that I need in order to feel like my work has meaning, and those are the reactions that I need to let me know that maybe now and then I do have a positive impact on people's lives. Those are the reactions that make the 12:30 am phone calls worth while.