I needed that. I needed to remember that not every physician's practice is full of people who don't want to be there, drug-seekers and crotchety old people who've been picked up because we don't know what else to do with them. Especially since I've now been hassled by my entire class about the fact that I have like 10 patients who are a nightmare and call all the time. It was good-natured but a nightmare nonetheless.
We met two women these last few weeks who mentioned something funny: I don't know if you've ever heard, O Best Beloved, people saying that chewing ice is a sign of anemia - it's one of those things that pops up now and then in conversation. The thing is, it's true. It's a form of pica, or unusual cravings for non-food substances - a list that includes dirt, starch, and a myriad of other normally inedible objects. And both of these women said to me "I've just really loved chewing ice recently." One was a woman presenting with a long history of heavy periods, most recently lasting for a month (a hint for the incoming medical personnel on my list: if a woman has always had long periods with lots of bleeding, she will tell you she has normal periods. Always ask how long, how much, and other icky questions like that). The other was a lovely little 91-year-old lady who felt "just fine, thank you, no problems at all". Both mentioned the ice-chewing. Both got office hemoglobins drawn. A normal hemoglobin is about 12-14 or so in a woman; the old guidelines were for transfusion at a hemoglobin of 8. The new guidelines say to use your good judgment and transfuse symptomatic patients, or those in real danger.
Patient A had a hemoglobin of 5.6; patient B had a hemoglobin of 6.4. Both of them went to the hospital for transfusion and some workup. It was nice to see how it worked - patient A went to another hospital because she was being admitted by OB-GYN, but B went to the hospital, got her blood and a million labs, got a heme test on her stool, and went home to finish her workup. We have to keep our staff medicine folks in the hospital because we don't know if they'll ever see a doctor again.
It's different down there. I see some of the same patients I have in my clinic, and rumor has it that I'm going to wind up with folks like that no matter where I go. Something about my bedside manner seems to attract difficult patients, and that just seems to be the way it is. They like me, depressingly enough, and then they come back. But these are the people who like me and don't do anything to change their lives, which is not the way I wanted this to go. It's disenheartening, O Best Beloved, to look at a clinic schedule and know that you're going to see the same people for the same problems and they'll have the same excuses. I can bend over backwards for them, do phone calls and referrals they should be getting for themselves, and they'll forget - or be out of gas - or not think to call and cancel or reschedule. It's maddening.
"Real doctors" are only a little bit better off, unfortunately. It's a phenomenon of the populace that we seem to want a magic pill that will fix everything and make us all better - but that we don't actually want to purchase it, pay for it, or remember to take it every day. We see men who work in the lumber mills who complain that all the sawdust has damaged their lungs and made them short of breath and they can't afford $40 a month for antihypertensives, completely discounting the 3 packs of cigarettes a day they continue to smoke. We see mothers who won't bring their children in for shots or routine office visits but go to the emergency room for a splinter. We see people who will take Vicodin eight times a day for back pain but can't be bothered to go to therapy. We see it all.
But ultimately, this is what I wanted to do - how I chose to spend my life - and I'm still not sorry. I'm just tired, today. Tired and cynical, because I see it in me as well. And I don't quite know how to fix it...