Doctoring General Medicine

When docs are "taken-up"…

It is that time of year again.

School is back in session; the little virus vectors are out of their basements, off their video games and back amongst themselves in classrooms. In harboring infections, school-age children are like petri-dishes.

Yes, as if there was need for further proof that doctors are human, I present as exhibit ‘A,’ our inability to avoid “being taken up” by common infectious agents.

It started early this week as a painful sore throat. Shoot. “Where are the cough drops?”  It lingered, on the brink of disappearing, but sadly it did not.

Somewhere in the distant past, in medical school, or perhaps it was elementary school at the school nurses office, or was it at grandmother’s house, someone once taught me that resting facilitated the body’s ability to fight viral invaders. Yes, somewhere, sometime I learned that.

Yep, Wednesday night cyclocross was a mistake. How is a body to heal when jacked around with a heart rate of 170 beats per minute?   Do as I say, not as I do!

But what does a doctor do when taken up by a viral invader?

How sick am I, really?

Surely not sick enough to go to the doctor, hey…Dr Rob?  How ironic that Dr Rob’s post today asked why patient’s bother coming to the doctor for symptoms of a cold.

Although cardiologists are not burdened with the problem of patients seeking treatment for colds, (we do have 350 pounders seeking treatment for their shortness of breath walking up stairs), we are often faced with the problem of deciding when we are too sick to work. It is not an easy answer these days. There are conflicting forces at play.

On the one hand is the problem of overcrowded schedules. Most electrophysiologists (insert most doctors) have long wait times for appointments. Patients are scheduled well in advance, and in many cases they have taken a day off from work for their appointment. Rescheduling is not that easy, as upcoming office days are booked as well. Even worse, is when you have muscle aches and fever the day of an AF ablation. In this case, the patient may have been waiting months, and they have arranged for not just a day off, but rather an entire week off work.  And no, there aren’t AF ablators available at the ready. Suffice it to say there are pressures to buck it up, take the tylenol, and eek it out.

But on the other hand, there is society’s new found aversion to all things infectious. Sure, I get the hand sanitizer thing in the hospital, or in the vet’s office, but it seems a stretch to be worried about clean hands at the auto-repair shop or bait shop.  It seems people have forgotten that we have an immune system for a reason.

But not coming to work sick isn’t just about the worry of spreading infections.  There is the question of whether (or how much) your illness affects your game. Like in this extreme example:

Fellowship was right in the rear view mirror; I had been in town only a few months. I was in my proving days with the new “firm.” After being ill for two weeks, I was reduced to sleeping in the family room adjacent to the fireplace so as to ward off the chills and nocturnal rigors. It was a miserable winter outside, cold damp and grey. I would try and run, but would only cough and wheeze. 

That Monday morning was worse than usual, but I had decided that it was just a single chamber pacemaker. I could get through it. I was the new guy and I was a 32 year-old bad a** triathlete. The pacer-rep said, “you don’t look so good.” It was just a VVI pacemaker, thirty minutes…tops.

The last I remember was seeing that she had a very nice cephalic vein. Then, kaboom, I am on the floor. Man, those OR lights are bright. The first stop was the surgeon’s lounge couch where one diagnosis after another was bantered about. Then, I was off to the ER, where the doctor said I had a pneumonia. “May I see the film, please.” There it was, a big white triangle, where there should be black, in the right middle lobe. 

I call Staci, who was two days from having our second child, now a thirteen year-old boy. “Where is that hospital,” she asks? (Remember, this was before iphones and blue dots.) What happened to the patient with the big beautiful vein? A very kind surgeon, whom I did not know, nor did he know me, jumped in and finished the surgery. Many years after, the patient would remind me every time I saw her that I was the doctor who passed out during her surgery.

Surely that day I was too sick. And I would never make that mistake again. But the edges are grey.

How sick is too sick?

In the real-world, outside the cubicle, or think tank, it is a tough call.