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Am Fam Physician. 2022;106(2):190

Author disclosure: No relevant financial relationships.

8:00 a.m.

I receive a message about Mr. Bell, who is recovering from COVID-19 and was transferred to our Hospital at Home program yesterday. We treat patients who have minimal IV medication requirements and don't require ICU-level care from the comfort of their home via telemedicine resources and paramedic teammates. Mr. Bell called the virtual nurse with an oxygen reading of 90% and is feeling short of breath.

8:30 a.m.

The paramedic reports that Mr. Bell's oxygen tubing was not correctly attached, and the patient has unknowingly been breathing room air. The paramedic attaches the tubing correctly and we discuss Mr. Bell's clinical course.

9:30 a.m.

My next patient is visibly short of breath and fatigued. The paramedic presents her vitals and recounts the patient's report of spending the past hour cleaning out her refrigerator. We increase her oxygen to 6 L per minute via nasal cannula, the maximum oxygen requirement for our Hospital at Home service. She will use her oscillating positive expiratory pressure device and lie prone every two hours during the day, and we will check back this afternoon.

11:00 a.m.

I share with my next patient that she is my only patient of the day without COVID. She laughs and shakes her head in disbelief. We are helping her recover from a recurrent joint infection that requires daily tests and IV antibiotics. She is responding to treatment and is happy to be able to do this at home with her young children and spouse.

4:00 p.m.

I do a brief mental check-in with myself before logging on with my last patient of the day. We delayed her visit so she could attend her nephew's virtual funeral. She is on 3 L per minute oxygen by nasal cannula and experiences desaturations with any prolonged exertion. We share a moment of silence for her nephew as she gathers her thoughts and thanks me for listening.

8:30 a.m.

A patient in her 60s follows up to discuss her colposcopy results. She discloses a history of sexual trauma and admits that she feels unsafe and pressured in her current relationship. I spend time making sure her home environment is safe, that she has a support system, and give her some resources. I am grateful she is comfortable sharing her story.

10:00 a.m.

I have two well-child visits for teenage siblings on my schedule. Both have painful and irregular periods, and their parents are reluctant to use medications, including ibuprofen. After visiting with each of them alone, I deliver my period spiel to the whole family, which involves simple drawings and basic information about the menstrual cycle, oral contraceptives, and pain control. They agree to a follow-up visit after trying NSAIDs.

10:30 a.m.

I am excited to see my youngest patient—a baby boy I delivered two days earlier. He was in the high-risk zone for hyperbilirubinemia, and we are rechecking his total serum bilirubin and weight today. The mother will also receive breastfeeding support from our lactation consultant.

1:30 p.m.

I discuss herd immunity with a young, healthy, 22-year-old man. As a result, he agrees to get his first COVID-19 vaccination today so he can protect his grandparents. Success!

4:15 p.m.

My last patient is an 80-year-old woman with biliary colic. She is having a hard time finding a surgeon who will remove her gallbladder electively. Finally, she asks me, “Doctora, I trust you. Why don't you just do the surgery?” As she leaves, she calls out, “I love you, see you soon,” and my heart fills with warmth.

8:00 p.m.

I quickly heat up some leftovers and head out to meet some of my coresidents at a candlelight live music event honoring Día de Los Muertos. What a special evening!

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This series is coordinated by Jennifer Middleton, MD, assistant medical editor.

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