85 Patients!!!

Most of the time, I enjoy my new job, but every now and then I have a truly horrifying day that takes the wind out of my sails.  On Monday, I arrived at the clinic to find that I had been completely and inexplicably locked out of the computer network.  While hordes of patients were piling up in the waiting room, I was on the phone with IT, desperately trying to log on to the network and then to the EMR.  When I finally regained access to the EMR, I discovered that I could only log on using one specific computer and that I was mysteriously locked out of the computers in all of the exam rooms.

Much of the day went like this: 5 upper respiratory infections, low back pain, the EMR sends error messages telling me my password is invalid, I spend 20 minutes on the phone with IT trying to regain access to the EMR, I see 5 more upper respiratory infections, shoulder pain, 4 bladder infections, and I'm locked out of the EMR again, I spend 20 minutes on the phone with IT....lather, rinse, repeat.

By 8:30 pm, we had so many patients camped out in the waiting room, we had to divert some of them to a different urgent care clinic.  It wasn't until 9:15 pm when the last patient left that I realized, in a sort of post-traumatic haze, that we had seen 85 patients.  You heard me: 2 clinicians, 85 patients!

It wasn't all bad.  There were certainly small triumphs, like removing a pedunculated growth (probably a small hemangioma) from a 14-yr-old's scalp--it had been present since birth, and the surrounding skin had gotten infected with impetigo, and it was such fun to watch her marvel over the newly smooth texture of her scalp after the procedure.

When I was in medical school, I developed coping mechanisms for stressful days on my 3rd and 4th year clinical rotations: my official theme song was Dean Martin's "Ain't That a Kick in the Head".  On my PDA, I had video clips of my friends & family saying silly things like "I'll see you in hell!" and "I'd like to order a CBC, a BMP, and a glass of red wine" which would inevitably make me smile, even on bad call nights.

My coping mechanisms this winter are as follows: I've fashioned a tiny bracelet from 1/4" white elastic and, using iron-on transfer paper, decorated it with the phrase "Mischief managed!" which is what Harry Potter utters when he wants to close up the Marauder's Map at Hogwarts.  It reminds me that, no matter how crazy my work day is, it does eventually come to an end.  I've also been watching episodes of "Make It or Break It", an ABC Family drama about teenage girls who are elite gymnasts striving to make it to the 2012 Olympics.  What I love about women's gymnastics is how the athletes get a big hug every time they complete a performance on the vault, the balance beam or the uneven bars.  When I'm dreading the long commute to work, I imagine myself as a gymnastics girl in a shiny leotard, with glittery eye shadow and a fluffy hair scrunchy, with my coach and teammates yelling, "You can do it!", "You've got this!" and "Stick that landing!" from the sidelines.  Silly, I know, but it does make me feel better.

Pattern Recognition

I recently saw a 36-yr-old female who had a 5-day history of vaginal irritation with a "burning" sensation.  She was seen a few days earlier and given diflucan for a presumed yeast infection, but her condition had not improved.  She told me, "It just really burns" and "When I try to pee, nothing comes out".  Her UA and GC/CT were negative.  On physical exam, her labia was erythematous and markedly swollen.  I suddenly remembered the last time I saw a patient with a similarly swollen labia and the same complaint of dysuria and urinary retention: it was a 14-yr-old girl who had come to the pediatric ED where I was doing a residency rotation. We initially suspected cellulitis.  She was in so much pain that conscious sedation was required for her pelvic exam.  After a meticulous search, we finally found a vesicular lesion: it turned out this young girl had the worst case of genital herpes in the history of the universe.

I did manage to find one shallow ulcerated lesion on my 36-yr-old patient's perineum which I promptly swabbed for HSV culture.  She was very skeptical about the provisional diagnosis of herpes, but she was willing to try taking acyclovir.  A few days later, the culture came back positive for HSV-2.