The H1N1 influenza is still mightily upon us. Fortunately we now have enough vaccine to offer it to the masses. It will take additional time during visits to draw the stuff up, inject it, and document. There is never enough time.
My first two encounters of the evening put me behind immediately. The first involved an assault on a nine year old boy. The details were so murky, the physical evidence was not much there, and yet I had to believe that there was something behind the story. My best detective work is not done by rapid firing questions but more from being conversational and relaxed. Alas, there is no time for my kind of sleuthing.
I ended up sending the child with his mother to our local medical center, where I asked for a social worker to be in attendance. She called me at the end of the evening and was just as baffled as I. The factor which raised the most suspicion for me was the itinerant, spotty medical care that the child received over time. At least there is now an official evaluation and documentation on the records, for whatever substantiation might be needed in the future.
My second encounter involved an older teenager with a pregnant girlfriend. He had intense lumbar pain. I wondered immediately if this guy was drug seeking and I had good reason to believe that in part, it was. I couldn't dismiss the degree of agony he appeared to be in, as well as the fact that he had sustained a broken lumbar spine and pelvis last year in an MVA. Sifting out what is going on is tricky. With consultation from a clinician who knows this young man, he too was sent to the hospital for evaluation. At the very least, he could have IV narcotics there.
The rest of the evening had its baffling moments. Am., who I work with infrequently, had her fair share of problematic patients. The pediatrician who we were working was ill and I had to listen to her chest and make recommendations to her as she is in mid-pregnancy.
I don't mind all this up in the air business, but it is hard to find the time to effectively ascertain some semblance of truth, or to develop some strategy for dealing with confounding issues. All the while, more patients are drifting in and telecom is calling us with more to come.
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