PRACTICE DIARY

Chapter 55

 

Fam Pract Manag. 2004 May;11(5):59.

Skunked!

I usually begin my day with holes in my schedule. This is not purposeful open-access scheduling; I work in an over-doctored town, and it’s a buyer’s market. Many of my colleagues are seeing their censuses shrink as more providers come into our area and compete for patients. However, I generally find that patients seeking same-day care call in and fill most of my open slots, especially in the mornings. If my afternoon is light, I just go home early and play. That’s one of the perks of being self-employed and semiretired.

On this particular Friday I had a full plate, starting at 9 a.m. with Matt. He was a noncompliant patient with type 2 diabetes, and he didn’t show. Next up was Phil, a logging truck driver who had been scheduled for a Department of Motor Vehicles physical. His boss at least had the courtesy to call to say he had sent Phil out of town to deliver some heavy equipment. Following Phil, I was supposed to see Jerry, who was coming back for follow-up after a wellness exam. His wife appeared instead to say that the surgeon I had referred him to the previous day for an inguinal hernia consultation had advised an immediate repair; Jerry was in surgery that very moment. She asked whether I could give her Jerry’s wellness exam results, as they had just moved out of town and wouldn’t be coming back anytime soon. I did, but didn’t feel right about charging her for the visit. Then Laura came in for her wellness exam follow-up, but since she hadn’t completely filled out her wellness questionnaire when she had her physical two weeks earlier, I hadn’t entered her data and she had to be rescheduled. Ditto for her husband James. Nancy, my friend and decorator, showed up unannounced wondering if I could take her blood pressure and give her some migraine medicine. “Do you want to charge me for the visit?” she queried.

“Nah,” I said, “Your $45 co-pay is more than I’d get from your insurance company. Take me to lunch sometime.”

At 11 a.m. Richard tried to cancel his hour-long annual exam because he had forgotten and eaten breakfast that morning. “No way,” I told Dalia, my office manager. “Have him come in anyway and we’ll do the fasting blood draw on Monday. I’ve got to have something to show for my accounts receivable today.”

A Good Samaritan

I had just finished playing four games of racquetball and was looking forward to a relaxing sweat in the steam room. As I approached the glass door, I saw a pair of legs on the tile floor. There was too much mist to see much else, and I remember thinking that was sure a strange way to take a steam bath. As soon as I opened the door, it all became crystal clear. Don, a 59-year-old racquetball player with no known health problems except prostate cancer, was sprawled out unconscious and barely breathing. I had lost to him in two doubles matches earlier that morning and had seen him leave the courts just five minutes before I did, saying he was done in and going home. It was surreal.

I rushed inside. My first thought was that he had fainted from the heat, but he didn’t respond to shaking, slapping or being doused with cold water. I immediately felt for a carotid pulse; there wasn’t any. This was no syncopal episode. This was a full on cardiac arrest.

In my career, I have put in over 25,000 hours in the emergency room but never before had to do CPR outside of the hospital. Patients I resuscitated were brought in from the field, with an intravenous line and endotracheal tube in place. And, if an inpatient coded, I always had trained help at hand. Suddenly, I was the “Good Samaritan,” trying to do what I could, without any assistance or technology, to keep someone alive.

“Call 911!” I yelled, as I started doing chest compressions and ventilations. “And send in someone who knows CPR!” After a few minutes, a young woman joined me and took over ventilating Don while I continued compressing his chest. Another few minutes passed and two female paramedics arrived. Other club members filtered in to see how they might help. Finally able to stop my part of the resuscitation and come up for air, I realized that Don and I were the only naked people there. “Will someone please throw me a towel?” I hollered.

Sadly, Don didn’t survive his episode of sudden death, which was listed as a coronary thrombosis in the coroner’s report. At his funeral several days later, his wife came up to me comfort it is for me to know that you were there for Don. I know you did everything that could have been done for him, and I never have to wonder if he would have made it had someone other than you found him first. You gave him his best shot.” Despite her gratitude I still felt badly, but I saw that she was right; sometimes we physicians can be a source of great solace even when we can’t save a life.

Dr. Brown, a solo family physician living in Mendocino, Calif., is a contributing editor to Family Practice Management. These excerpts from his journal illustrate the many characters, stories and lessons family medicine has to offer. No real patient names have been used.

Conflicts of interest: none reported.

Send comments to fpmedit@aafp.org.

 

Copyright © 2004 by the American Academy of Family Physicians.
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