We are getting a nice gentle rain here in Hillsborough so Holly and I have decided to stay in the Triangle area this weekend and work on the yard. We have woefully little grass after the big drought of the past 2 years, so this is an opportunity to reseed and fertilize. Also, we are planning to head out to one of the big landscape places for bushes, shrubs and trees to pick out some items for the open space behind the Hillsborough house. For the longest time, we had a big open lot behind us and only 3 or 4 other houses in the neighborhood. Now that space is partially occupied by a jungle gym for the kids and well, let's just say we aren't alone anymore either. About half of the lots have houses and there are many more families now. We want to enjoy our screened porch and backyard with a little privacy. Thus the trip to load up on bushes and trees. The sooner we get those carbon containing organic pieces in the ground, the sooner we'll have a screen of sorts.
As I've said before, I've managed to slip back into my old life again, especially at work. Primary care medicine has a way of taking over and before you know it, you're worrying about other people's lumps and bumps instead of your own. I have begun to notice a bit more chaos and urgency in the lives of my patients as they lose their jobs or have to pawn things to get much needed medical tests or dental work done. No sooner do I pat myself on the back for a job well done with one patient that I have to live with the frustration of not helping another. Yesterday I saw a woman back who I had diagnosed with a big stomach wall hernia that bulged and pouched every time she sat up. She seemed reassured several weeks ago when I sent her on to the surgeon to have it repaired. He had faxed me a form to complete giving her "medical clearance" for the surgery since she has diabetes and a few other medical issues. (Surgeons who are quite capable of deciding for themselves if they should operate have gotten into the habit of asking the medical doctor to "clear" the patient for surgery and anesthesia to limit their own liability if something happens during the procedure. I hate that they don't think for themselves and instead rely on our evaluation, though they don't pay us for it). Anyway, I had ordered a heart stress test on her, and it came back abnormal with areas of her heart not getting enough circulation. I referred her on to a cardiologist who will have to do a catheterization and likely stent one or more of her arteries. When she came back to see me yesterday, her comment was "I don't know when I'll be getting this original thing fixed but thanks to you, I have to get my heart situated first." I felt good, I have to say, because there are 900, 000 some odd heart attacks each year, and maybe she would have been 900,001.
On the other hand, I had this guy as my last patient who has HIV and gets his care from the UNC infectious disease clinic. He came in because we were the ones to pick up his HIV back in May of 2005, and he feels puny from his HIV medicines. He was upset because he is losing weight, the HIV meds make him feel bad, and other meds they gave him didn't heal his mouth ulcers or shingles when he got those. I tried to explain that his immune system is poor, but he just didn't get it (it is called human immunodeficiency virus afterall). This is a tough discussion even in english and doing it with my so-so spanish is near impossible. Round and round we went, him expressing his desire to be treated by us and me explaining that he needs the specialty care at UNC. Finally he gave up and took my prescription for weight gain. But I felt like he could just as easily have walked out muttering under his breath, "and no thanks to you." Well it gave the day that you win one, you lose one kind of feel. I think you can imagine it.
Today's photo: my desk area at the Drew clinic where I work
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