I have been wondering whether to try to work again. It’s risky.
I asked the pulmonologist from Swedish Hospital if there was any way to keep from getting pneumonia number five. “We don’t know.” Is it safe for me to return to work? “We don’t know.” I like the plural in the answer, is he speaking for pulmonologists or Swedish or what? Anyhow, the risk is pneumonia number five and death or ending up permanently on oxygen or needing a lung transplant or something stupid like that.
It’s not raining yet and I promised not to even attempt to return to work until it rains.
I saw my cardiologist yesterday. He thinks I should return to work. Early on he said that I am smart, “like one of those old fashioned internists who read everything.” I laughed, because yes, I am a science geek. At the next visit he said, “The family doctors aren’t always as thorough as they could be.” I replied, “I don’t know, after all, I’m a Family Practice Doctor.” “Oh.” he said, “I thought you were an internist.” Which made me laugh because it’s a sort of back handed compliment. Cardiologists do a three year internal medicine training and then more years of sub specialty to become a cardiologist. Most specialists seem to scorn Family Practice a bit, though not all. And I have definitely had specialists ask me for help. A perinatologist: “How do I help people stop smoking?” I laughed at that, too, and replied, “Do you want the five minute , the ten minute, the thirty minute or the one hour lecture?” A med-peds doc asks me to put a cast on a child’s arm because even though she is board certified in internal medicine and pediatrics, she has almost no orthopedic training. I was at that clinic to see obstetric patients that day, but was happy to do the cast too. I love the broad training and the infinite variety of rural Family Practice. It is SO INTERESTING and OFTEN FUN THOUGH NOT ALWAYS. Sometimes it’s sad.
Here is an article about a physician doing what I want to do: https://nymag.com/intelligencer/article/long-covid-treatment-lisa-sanders.html. She thrives on complexity, she thrives on diagnostic puzzles and she writes the column that the television series “House” was based on. When I watched House, what I noticed was the nearly all of the patients on the show were either leaving something out or lying. In reality, I think it’s just that sometimes we need a lot of time to pull together the complex picture and clues. I always pay attention to the pieces of the puzzle that do not fit and sometimes those are the key to finding a diagnosis that is unexpected. Dr. Sanders spends an hour with a new patient. That is what I did in my clinic for the last decade, because that hour gave me so much information and it allows people to feel heard. A ten or fifteen minute visit doesn’t let people speak. It’s slam bam here is your prescription ma’am. What I see in the multitude of notes from all the doctors I’ve seen since 2014 is that they leave most of the conversation out of the note. Things I think are important. I think most of the clinic notes about me are crap and the physician is not listening and doesn’t know what to do. I include the stuff that doesn’t fit and doesn’t seem to make sense in the notes I write. Patient appreciated, when I gave them their note at the end of the visit. “You got all that?” Oh, yes, I tried.
One of the Long Covid symptoms that Dr. Sanders mentions is people “feeling like they are trembling inside.” I’ve seen that before Covid-19. That was a symptom that I did not pin down in a particular patient, but now there is more than one person complaining of the same thing. Really, why don’t physicians include those complaints? It’s egotism to cut out anything you don’t understand and most patients want help so are motivated not to lie. Ok, they might admit that they’ve been out of their blood pressure medicine for two weeks and that’s why their blood pressure is too high, or they’ve been drinking mochas and that’s why their blood sugar is way too high, but they are really in to get help. I think it is a terrible disservice not to document what they say, even if it’s not understood and the physician thinks it’s unrelated to their specialty and they don’t know what to do.
So: I want to do a Long Covid Clinic, with an hour for the first visit, and longer than usual follow ups. Part time because of my lungs and the fatigue. We shall see, right? I am going to look for grants to help set this up.
Think of how much work went in to this statue and this church. The Basilica di San Marco took at least 400 years to build and decorate!
KO Rural Mad As Hell Blog 
P.S. The sculpture above — it’s the most orgasmic sculpture I have ever seen. Simon Schama does a very good video on Bernini, the artist.
WOW!
The whole story is amazing! Thank you!
You’re welcome! Simon Schama’s series, “The Power of Art” is amazing. I learned a lot from watching it.
A long Covid clinic? Wow… I don’t even talk w/my doc about it and I like and trust her. I still have shaky mind days and I still don’t feel like I have “my” personality, but I figure I have/am what I have/am and here goes. I would LOVE to have someone to talk to about it. I’d love to have a group — a real live group of maybe five people with a doctor who has some knowledge. In my opinion, there is something to be learned from long haulers that could be useful in the future and might shed light on lingering effects of other infections. Sometimes I want to cry over the parts of Martha that seem to have gone for good, but what’s the point? Yeah. A doc with knowledge — or even one who’s building knowledge — would be a great thing.
Actually they did a CME yesterday about an 8 week Covid Group that one place does. They are willing to share their curriculum. I was pretty jet-lagged but listened anyhow.
Helpful suggestions can be less than helpful, I know. But it would be a shame if you did not work again.
But, are there ways in which you could work ( or places ) where you’d be safer?
One thing I was thinking about ( maybe because of the OR guy still resident in me) was would the amount to ventilation and air filtration make a significant difference in creating a safer work space for you (understanding that there is no zero risk space)?
Question? – Would you consider a role as a healthcare educator? Your writing abilities, experience and interests seem to suggest that you’d excel at it.
I would love to teach med students and residents but have not figured out how to break in to that, plus I live two hours away from the nearest, in Seattle. I’d be happy to listen to suggestions about that. I tend to try to translate medicine into English and really medical education glories in complex obfuscating language, but I would be an advocate for rural medicine because I love it.
As I said, not all “great” ideas are good, or applicable. Soooo…her’s another one! Have you thought about medical journalism?
Two things would protect me: not working full time (since the chronic fatigue doesn’t allow it) and having patients mask and stay masked. I had mine mask from 2014 on in my clinic if they had any upper respiratory thing and that worked. What took me out was the combination of going full time on the temp job and fully half the patients had their masks off when I walked in the room. I thought, oh, boy, I am in for it. I complained to the head doc and head of nursing and asked my nurse to help, but it made zero difference.
My ophthalmologist requires patients to be double masked due to his medical issues. the staff you see when you walk in make it clear to you when you walk in. No mask, no appointment. the attitude of the staff can make or break the success of masking.
Agreed. I only had one person in my clinic say that he would not mask during Covid. I say, “You don’t need to, sir, but I won’t see you. You may go to Urgent Care.” He decided to mask.
My GP is an internal medicine doctor. But I only see her once a year and now not even that, since she has her NP seeing Medicare patients. Seems the Medicare Wellness check takes too much time. So now my GP/Internal med doc is a Nurse Practitioner? And if I decide to skip the Wellness check, what then? Gets a bit crazy, doesn’t it?
I actually like the wellness visit, once I realized that it’s based on the top ten causes of death in the US. So that’s why it’s such a weird mish mash of topics: heart, cancer, and then I think Covid was third for a while. Dementia, suicide, diabetes, it’s kind of a weird list, but they do cover screening tests for all of it.
While I extol the virtues of not working, not working because I got a better offer was very different from being told I couldn’t do my work anymore (though the subsequent career change turned out to be a good thing).
Your clinic idea sounds great. I worked with an Infectious Disease doctor and we had a patient who was so weak he couldn’t lift a fork to his mouth. The ID sleuth figured out that he had a fungal infection from raking leaves at his northwoods cabin – a leaf mold that grows in a very limited area and he inhaled spores while raking. He got better (slowly) with the proper treatment.
My neighbor is an MD who works as a high school science teacher. As a resident he spent a long time with a patient who came in with a shopping bag of medications. She didn’t know what they were, why she was taking them, or if she still needed to be taking all of them. He sorted them out with her and sent her on her way. His supervisor yelled at him for spending too much time with her. He quit. If he had to practice medicine that way, he’d rather teach kids and know he was doing some good without rushing those he was supposed to be helping.
Good luck with your decisions. As you well know, you can listen to everyone’s advice, but you still have to do what seems (to you) best for you.
I know a blogger who is a pediatrician turned 3rd grade science teacher. There is a whole conference I could go to that is all about non-doctor careers for doctors, sigh. We are going to be short for a while post Covid, doctors, nurses and practically everything else. Praises to all the people who were on the front lines, including grocery store checkers, taxi drivers and all the others.