Do you ever have those days?

[Guest guest]

..

Eight patients today:

1) New patient. 23 years old, 300lbs, irregular periods,

has a beard. Scheduled for “headache”.

Says no doctor has ever asked her about any of the above…

2) Mother who witnessed her 13 year old son’s

sudden cardiac death 6 weeks ago from what turned out to be long QT syndrome. He survived ACLS and now has an AICD. She is having panic attacks. Duh..

3) Adult ADD on boatloads of Adderall and Wellbutrin. “OBTW do you think this is

broken? Showing radius/ulna with new 30 degree angle …about 2cm proximal

to her “other wrist”

4) 82 year old lady whose husband just came

home from 2 months in the unit and 3 open heart surgeries. She “had chest pain all last night

so I want an EKG, and I had a TIA last Thursday so I want ultrasound of my

arteries, and you have to do one of those swabs of my vagina because I feel a

little funny there again and I peed in a cup already because you need to make

sure there is nothing wrong with it and I need you to help me find someone who

will clean my house because the Home Health nurses are so messy and they won’t help at all……..”

5) 70 year old lady with extreme paranoia

associated with her Alzheimer’s is acting out and tried to throw a chair

at her husband, probably gave herself a lumbar compression fracture in the

process….She couldn’t hit me this time because she is moving pretty

slow, but she refuses any imaging test….

6) Diabetic smoker already s/p left AKA now with

dusky foot all around her non-healing foot ulcer despite all maximal

revascularization efforts by the vascular surgeon, and refusing further

treatment by anybody but me because she just got a $14,000 bill from her last

catheter based cryoplasty and stenting

intervention…Like I can work miracles..

7) Thank God! A simple sinusitis!

8) New patient: “My doctor is nice and

all, but she doesn’t try to find out why: I am tired all the time, I hurt

all over, I can’t sleep, I have a headache the time, my arms are numb, I’m

constipated, I have irritable bowel and reflux, I can’t breathe, my white

blood cell count is always high, my mother dropped dead of a heart attack last

summer, nobody has ever checked my cholesterol, I need albuterol

4 or 5 times every day, but all it does is make me shake and I want to know

what causes all this.” All

this from a 36 yo lady with a BMI of 23 who didn’t want me to do a fundascopic exam because it would mess up her mascara.

9) And this one wasn’t even on the

schedule: Owner of a local shooting

range who carries concealed weapons, dropped by to express her anger that I

sent her a reminder about the colonoscopy she never went after I referred her

in the fall because of rectal bleeding and a family history of colon cancer. She is angry that I “bothered”

her about that when she was just found to have metastatic

melanoma. I had just gotten a note

from the surgeon last Friday (a couple weeks after the reminder went out), and

she hadn’t called me when she developed inguinal nodes on the side from

which her primary was excised 3 years ago

I would say “just

shoot me”, but that last lady probably would.

I think I will

just crawl under a rock.. As an IMP, I can do this stuff and feel at the end

of the day as if I have been beaten up, but at least (I think anyway) that I

have met the extraordinary needs of these “high maintenance”

people. I don’t know

how anybody who sees 25 or 30 patients a day can deal with a panel like this….I

sure couldn’t

Anybody got a cigarette?

Annie

_,___