In the course of my work, I sometimes feel like one of those circus clowns, running at full speed, dodging the other performers, and juggling numerous fragile plates in the air over my head as I continue to smile. It's a true juggling act of keeping multiple threads woven in my cerebral cortex, trying my best to remember the myriad details that need my attention: this one needs bloodwork; this one has an abnormal CAT scan that needs follow-up; the other needs a referral for the surgeon; and now my beeper is going off and cell phone ringing simultaneously as I'm paged overhead to meet a patient in the waiting room.
The patient in the waiting room has advanced AIDS that's perfectly under control, but his blood pressure is 170/112 today, and he fell yesterday during a dizzy spell and lacerated his shin. I check the wound which looks clean and is covered with steri-strips placed by an ER doc. His narcolepsy seems poorly controlled today as he nods off while on the exam table, and his wife says that they just can't remember to call me for refills of his Ritalin which helps keep him alert. I make a mental note to pay them a home visit soon to look over his meds and see where they've become confused. He failed his Hepatatis C treatment so that's one less thing to worry about in terms of meds, but I remind him that if he doesn't take care of his blood pressure, it will most likely kill him way before the AIDS ever does. (They're not joking about the "silent killer of hypertension".) I remind him of his appointment with the vascular surgeon for his horrible varicose veins, and also for the orthopedic surgeon for his herniated disk. Does he have the MRI films? Yes. Does he know where to go on Tuesday? He thinks so. Will he come in on Monday for a blood pressure check? OK. Keep those steri-strips dry and change the bandage every day, why don'tcha.
Meanwhile, another of my patients has come in to see his primary doctor, unbeknownst to me. The doctor finds me while I walk down the hall, letting me know that our mutual patient couldn't walk on his right leg for three weeks and never bothered to call us or go to the ER. He's feeling somewhat better, but we send him for a stat ultrasound of his leg and it's immediately confirmed that he has a deep vein thrombosis (DVT) from his ankle to his knee (a long clot traveling up a major leg vein). He's very lucky that a piece of the clot didn't break off and travel to his lungs. He would have died within minutes. We send him home with a prescription for Coumadin (blood thinner) and remind him to come in for bloodwork on Tuesday, without fail. By the way, we tell him, call us right away if you start having uncontrollable nosebleeds or your gums bleed while brushing your teeth. And please be careful shaving, OK?
The man with the DVT is followed by two of my favorite patients. A married couple, both infected with AIDS. She "bought in" early on and has fully suppressed virus and no side effects. He played around with his meds and failed a few regimens of AIDS drugs, and then came to me a year ago, desperate to try again, losing weight and wasting away. I had to scare him and tell him he had less than a year to live unless he worked with me closely, with great concentration and attention to detail. He decided to do it, and here we are. With frequent follow-up and a good rapport, they're a success story, with the virus under control for them both, their kids in school, newly approved Section 8 housing, and a sweet relationship. Our visits are peppered with laughter, jokes, and an ease which makes our time together flow smoothly and easily. I prefill his meds in two one-week boxes, give her an injection of Depo Provera, check their weights, and send them on their way. Hasta la proxima!
Papers and charts are piled on the desk. I make a few notes in my Palm Pilot, scribble some Post-It notes to leave on my desk for Monday morning, file my encounter sheets for the day, and turn off the computer for the first time since 9am on Monday.
The chaos and busy movement of the day are winding down, the phones are routed to the answering service, the beepers cease their sound, laughter fills the room, and we bid one another adieu, leaving the clinic to return to our families for the weekend, only one of us burdened with taking urgent calls until Monday morning rolls around again. It's been a job well done. I feel fairly crispy myself, perhaps medium well at this juncture.....
I arrive to the home fires burning in the woodstove, my lovely wife cooking yet another wonderful meal, the dogs wagging their tails, and the feeling of gratitude for a welcoming domestic scene which draws me in with its wholesome and restful embrace. We catch the end of "The Buena Vista Social Club" on the Independent Film Channel, and I cry as the group takes its well-deserved bows, having accomplished so much and brought joy and music to so many. My cup runneth over.
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