See ya later, suckers December 25, 2009

Today I left work with a clean desk, an “out of the office” auto-reply on my email and zero unfinished progress notes or forms. Yea! Granted, I worked for 6 straight hours after my last patient and was the last one to leave the building, but hey…the job is done. Now it’s time for a vacation. (‘Vacation’ is a loose term when it involves multiple family commitments on several consecutive days, but I figure any time off is good time off!)

May you all have a Christmas free of drunken family brawls. And try to keep your blood sugar under 300.

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The Xmas edition of the Totally Innapropriate Comment December 22, 2009

Me, to new patient: “Do you have any medication allergies?”

New patient: “Yes. Haldol, thorazine, fluoxetine, zoloft, percocet and vicodin.”

Actual comment: “Mmmhmm. What were the reactions to those medications?” Totally inappropriate comment: “Wow, Haldol and Thorazine? Got a touch of the mental illness, do ya?”

Patient returns for follow up after a lab result 2 weeks ago that showed BUN/Creatinine of 60/7.4:

Me: “After we got your lab results, a doctor called you and asked you to go to the ER for your kidney failure, right? Did you go?”
Patient: “No, I feel fine. I don’t know why you told me that.”

Actual comment: “Well, your kidney function got much, much worse over the past few months. Even if you can’t feel it, your kidneys are doing terribly. I’m going to check a stat kidney function right now and call you this afternoon.” Totally Inappropriate Comment: “Jesus, man! You’d better hope your kidneys just experienced a Christmas miracle or you are seriously fucked!” (Btw, his stat BUN/Cr came back at 72/8.2–no Christmas miracle here)

Reason #87 Why Trans-affirming Providers Are Important: December 17, 2009

Transgender patient with a rash: “I was going to call and ask if you knew of a dermatologist in my town, but then I realized that this was probably going to be a pants-off situation, so I decided to come see you instead.”

Me: “Glad to be of service.”

(Mental note: try to work the phrase “pants-off situation” into conversation more often!)

‘Tis the season… December 16, 2009

…for depression.  Yup, the annual holiday depression has set in for my patients.  I spent the past couple of days being as reassuring as possible, repeating “You’re not alone in this.  Many people find the holidays stressful and depressing.  Not everyone is happy, even though they all look like it on t.v.”  It’s a combo of family stress, financial worries and the omnipresent image of the happy family enjoying conflict-free togetherness that pushes people over the edge.  Let me just repeat for good measure: YOU ARE NOT ALONE IN FEELING SAD AROUND CHRISTMAS.  PEOPLE LOOK HAPPY, BUT MANY TIMES THEY ARE JUST AS SAD AND CONFUSED AS YOU ARE.  It’s ok.  The season will come to an end, and people will stop being jolly.  Hang in there a little longer.

Nice try December 12, 2009

Arrived at the clinic yesterday to find this phone message: “Patient states that he was walking outside with his dilaudid and spilled it in the snow.  Requesting refill.”

Ah yes, when I take my morning constitutional, I always bring along an open bottle of a powerful narcotic.  Good luck with that refill request.

Gotta love adolescents December 7, 2009

Sometimes I miss working with adolescents.  When you work with them–as I did with a new, 18-year old patient last week–they say the most delightful things.  Like this: “So I have a question…if you have anal sex, does it still pop your cherry?”

And also this: “Um, I was wondering, when I had sex for the first time, it didn’t hurt and I didn’t bleed.  Is there something wrong with me?”

Bless her little heart.  Those comments gave me the perfect segue into discussing the STD risks of anal sex, along with the concept of the intact hymen as the basis for virginity.  (And in case anyone is wondering about my response to the cherry-popping question, I said “Good question.  If you’re asking if having anal sex will break your hymen and make you not a virgin in your vagina, then the answer is no.  But it is possible to pop someone’s cherry during anal sex, if you’re using that to describe having sex for the first time.  And if you’re asking me if I think that anal sex is really sex, then the answer is yes.  Anal sex is real sex.”)

Point taken, Universe December 4, 2009

Just one day after I wrote my last post about people still dying from AIDS, I had a surprise visit from one of my erstwhile patients.  She’s a HIV-positive woman who has struggled with substance abuse for most of her life.  The last time I saw her in clinic was a year ago.  Her last appointment with the infectious disease specialist was 18 months ago.  From what she tells me, she stopped taking her HIV meds 6 months ago–although I suspect she might have stopped a while before that.  She came in because the pain in her throat had become too much to bear.  When she opened her mouth for the exam, I wanted to weep.  Her throat was covered with thrush, and the pain in her throat and chest indicated that she had developed esophageal candidiasis.  She lost 40lbs in the past year.  I drew some labs, and today I got the results.  Her CD4 count is less than 10. Mine is probably 800.  It’s like she’s a walking illustration to my point that HIV meds only work when you can actually stick to the regimen.  Somehow it doesn’t feel good to be vindicated.

One of the things that keeps me going at work is a sort of cynical optimism.  I don’t think she’s going to survive much longer.  But that didn’t stop me from thanking her for coming in, starting her on anti-fungals and antibiotics and making plans for follow up.  As long as she’s alive, I can keep trying…as long as she does.