9:00 am

A middle-aged woman presents after a hysterectomy that was complicated by a postoperative aortic thrombus. She tested positive for factor V Leiden sequence variation; she has a family history but tested negative 10 years ago. The hospitalist told her that the test is now more sensitive. She underwent an aortic graft, but this showered emboli to her feet, and she had to have further intervention with an embolectomy and stent to prevent amputation. She also has quit smoking. We wipe tears from our eyes after she recounts this horrifying experience.

10:20 am

I see a nonagenarian with incapacitating shoulder girdle and low back pain. I recently prescribed oral steroids for sciatica, and she miraculously improved. Now, the pain is more severe than ever. I obtain an erythrocyte sedimentation rate and restart the steroids for polymyalgia rheumatica. I am aggravated that I did not figure this out at her previous visit.

11:00 am

I see a 60-year-old man with hypertension, and I review correspondence from a specialist regarding his previous issue of disabling “tongue cramps.” The ENT informed me that sialadenitis was the cause of his pain. He recommended that the patient increase his fluid intake because mild dehydration was exacerbating his symptoms. He has not had issues with his tongue since.

12:30 pm

During lunch, I must deliver bad news to a woman I had seen after total knee replacement. Postoperatively, she developed edema in her right leg, which the orthopedic physician assistant told her was normal. Venous Doppler ultrasonography was negative for DVT but showed an enlarged inguinal node. Fine needle aspiration was positive for chronic lymphocytic leukemia/small lymphocytic lymphoma. I explain the results and order further workup and an oncology referral.

2:00 pm

I see a 7-year-old with URI symptoms. When I ask her if she is a little hoarse, she looks at me incredulously and whispers something to her mom. Her mother explains that she thought I was asking if she was a little horse. My patients make me laugh every day.

2:15 pm

My next patient is a young, postpartum mother with her newborn. The baby is healthy, but the mom is wearing a Lifevest. She has postpartum cardiomyopathy, and her ejection fraction plummeted to 27%. She must wear the vest for a minimum of 3 months until cleared by cardiology. She is on four new medications and has been warned not to have more children. She was told that her cardiac function will improve with time.

4:30 pm

Two older sisters greet me in the next room. The oldest one has cognitive concerns. Her younger sister found that she had purchased $5,000 worth of gift cards, taken pictures of them, and texted them to a newfound acquaintance. She is highly educated but is exhibiting memory loss and signs of impaired judgment. We decide to have the younger sister handle their joint finances. I have the older sister complete a Self-Administered Gerocognitive Exam and refer her for neuropsychologic testing.

5:00 pm

I see a patient who lacerated his hand on a piece of steel at work about 1 hour ago. He has a 3-cm laceration in the second and third webspaces, sparing the tendons and nerves. I clean the wound, anesthetize the area, and place 10 interrupted sutures. I make sure my premed medical assistants watch, because one will be starting physician assistant school and the other is applying to medical school.

6:35 pm

Today is a bonus lesson for a university medical terminology class where I teach premed students how to suture on bananas. Two of these students are off to medical school in the fall, and I have invited them to do their family medicine rotations with me in a few years. I love that they are interested, motivated, and having fun. I look forward to seeing where they end up in their careers.