I Am So Very Very Tired

Yesterday I saw 19 patients in 5 hours.  That's 15 minutes per patient, with just a few seconds to breathe between appointments.  I examined an EKG with 2mm ST depression in leads I, V3 and V4 in a man with only one patent coronary artery (documented on cardiac catheterization in 2008), but didn't have an old EKG for comparison to help figure out whether this was chronic or acute ischemia.  I diagnosed new-onset atrial fibrillation and congestive heart failure in the same patient.  I told countless parents that their children had viral respiratory infections that did not need antibiotics.  I removed several pesky moles and a misbehaving IUD.  This whirlwind of activity makes the day go by quickly, but it doesn't allow any time for reflection.  My streak of back-to-back appointments ended only because I got called to the hospital to admit a new patient: an 84-yr-old male who was seeing his PMD for a routine diabetes check when he described a 3-day history of epigastric pain radiating to his left arm, but refused to wait for the results of his cardiac enzymes to see if he was having a heart attack.  It was only when he got home, slipped on ice, and broke his hip, that he ended up getting hospitalized.  [His troponin peaked at 15, by the way!  A definite heart attack-worthy level!]