Monday, February 26, 2007


Wow. The return to work is overwhelming. Again. The layers of need seem endless, and the requests from patients keep coming.

This one has nausea, vomiting and diarrhea. This one seems to be having an anxiety attack and can't breathe. Another feels suicidal and wants to be hospitalized. Another's blood sugars are enormously high. Still another begins Hepatitis C treatment today and is in for the ride of her life in terms of side effects.

A patient with AIDS who has been MIA for quite some time manifested himself in our office today. Vague symptoms of "burning" on one side of the face and some discretely hidden fluid-filled vesicles on his scalp led us to suspect herpes zoster---"Shingles". I have never seen zoster on the scalp before, especially not without some active lesions elsewhere, like the arms or face or side of the trunk. The doctor can't be 100% but he is shuffled off to the ER for isolation at the hospital and empiric treatment with IV antivirals until proven not to have shingles. In his condition this could be fatal if left untreated. And to think I could have just turned him away in my crazed preoccupation with multiple simultaneous crises this morning.

It was a wild day, punctuated with a 90-minute reprieve for a lunchtime talk on recent AIDS treatment research at a local restaurant. "Reprieve" is questionable---the pile of charts on my desk and rapidly filling voice mailbox attested to my ever so brief absence from active duty.

After finishing my day's notes following a delicious dinner lovingly prepared by Mary---my favorite cook---the rest of the evening is about recovery, and steeling myself for the 'morrow.
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