A Day at Work

7/9/07:
Today I started with Mr.S. He had a stroke about 4 years ago, and has a totally occluded right internal carotid artery. I have him on Coumadin, blood pressure medicine, and cholesterol medicine. We've managed to decrease his smoking from 3 packs per day to five cigarettes per day, which I can live with. He's a cantekerous person who has a very dry sense of humor. He is very stable, and I see him rarely (every 6 months). I enjoy his visits. He is a "success" to me. There isn't the great glory from some of the patients, but we're preventing him from another stroke; at least we have for the last four years. I told him, "You're doing great!" He said, "Sure, until I drop dead tomorrow."

I saw Ms. S. She is only about 19. She was in a car accident about one year ago, and injured her spinal cord - just a little. It causes her to be in a moderate amount of constant pain and she suffers from extreme sensitivity to heat. That's hard, since she works at McDonald's. I don't want her to work there, because I think that's contributing to her fairly severe obesity. That, in turn, is contributing to her chronic back pain. In about twenty years from now, it will also contribute to her stroke, high blood pressure, and diabetes. I hate McDonald's. I think they (and their kind) are causing more harm than the tobacco companies.

Mrs. B: She comes in for an every day headache. She is 71 years old. Her 95 year old demented mother is in a nursing home; She visits her mother every other day, but it's unpleasant. She (her mother) has a lot of delusions, which are difficult to deal with. Also, she doesn't remember that "B" was there just a day ago. Her husband had a stroke 7 years ago, and is very depressed. He wants her to wait on him hand and foot. She hates that. She says she's very lonely and unhappy and stressed. She's been with her husband since she was 16 years old, but he's changed. She doesn't feel that she can motivate him to even try anymore -- he's "given up." I told her that I think her headaches are due to stress: "tension headaches". Her psychiatrist already has her on Zoloft - a pretty high dose of it. I suggested they both go to counseling together. I suggested that she takes some time off, for herself, to relax. I don't think she was completely happy. She wanted something a little more magical to cure her. This doesn't really count as much of a success.

Mrs. M: She is very overweight, and has pretty bad diabetes, and has a lot of diabetic neuropathy problems. She is very frustrated that her pain won't just go away. We are sending her to be evaluated for a research trial. It is hopeless to try to get her to lose weight. Most of the medicines we've tried with her don't help very much.

Mrs. K: New patient, who is extremely weak -- she can't go up stairs at all. She is very overweight and diabetic. She has high cholesterol and is on cholesterol medicine. I'm not exactly sure at this point why she's so weak. She needs some tests done. There is a chance for making her stronger.

Today there weren't too many great success patients.

Sometimes I feel like I'm battling the culture, not the diseases. So much of what I see is our environment: the over-eating and the under-exercising. There is too much TV and not enough walking on the beach. There is too much stress and not enough sleep. Sometimes I feel like I'm battling the insurance companies and medicare. It's not good when I'm in a battle. Today, I wasn't. I was aware of how much of my practice is dealing with the "American Way" and its ultimate poisoning of my patients. Usually that will make me feel like it's a war (a losing war). It's a war against the TV, the advertisements, the big business food, the grocery stores, the restaurants, and even the zoning laws that make everyone drive everywhere. It's not good for me to be at war. So I have to notice that there are poisons in the environment that are out of my control. That's how it is. I just need to try to help my patients with what I can help with. It's important not to lose sight of that; not to get lost in the frustrations.