Rural Doctoring

The Ugh of March

I spent most of the last 48 hours lying around my house in a goopy puddle of depression. Not clinical depression, just everyday "what's the point?" anhedonia. Here's a few reasons why:

Case: My Life on the D-list

Today I worked up a 50-ish man who was admitted with altered mental status, cystitis and acute renal failure. He'd been in the hospital for just over twenty-four hours without much improvement. He wasn't hallucinating anymore, but restless, agitated, strange.

Interferon Diary, Day #20

Today Noo receives the last of twenty doses of IV interferon! This signals the end of daily weekday schleps to the infusion center, and the beginning of the real endurance trial: eleven months of thrice-weekly subcutaneous doses. She's done so well with the IV doses, I think she'll weather through the rest of the year's treatment in similar fashion. Our emotional landscape--at first so overwhelmingly dark, when we got the diagnosis--has almost returned to normal: mostly sunny, some overcast days, scattered showers.

Dr. Santell's Rounds: Still My Conscience After All These Years

This isn't a story about Dr. Santell, but it illustrates why the memory of Dr. Santell is so important to me, and why sometimes I pretend he's still alive and only a phone call away. I know this is nothing more than childlike fantasy, but it gets me through some long days and--as this story shows--keeps me honest on the job.

Twenty

I'm nearing the end of a gnarly run of hospitalist days. Our census has been averaging 21 patient encounters every day, all of whom need to be seen by moi. For those of you who have never made rounds, that's a lot of patients to see, data to track, decisions to make. Personally, I'd rather limit my rounds to no more than 15 patients, because I notice that's the number at which my performance peaks. The problem is we're a small hospital, with a correspondingly small hospitalist program, and right now we only have one person staffing during the day. Ow.

Warning: I Blither Aimlessly in This Post

Last week was odd, to say the least. Noo started interferon therapy, and this went smoothly--she's taking it like a champ, side effects and all. We're lucky to have some help, in the form of our Girl Friday, who can take Noo to the infusion center when I can't. However, I was able to go with her three out of the five treatment days last week, which is pretty good considering I was covering night shifts for the hospitalist service.