A Country Doctor Writes:

Several patients Wednesday made me reflect on how fortunate I am to be doing what I do for a living.

There was the young man with chest pain, skin problems and unusually long fingers. Could it be that he had a syndrome I have never diagnosed before?

There was the woman with a platelet disorder and new onset atrial fibrillation. The cardiologist had recommended against using blood thinners because of the woman’s low risk for stroke based on her CHADS score, but had deferred to her hematologist and me because of her thrombocytosis. The hematologist couldn’t be sure that her hydroxyurea treatment completely neutralized her risk for blood clots, and wanted to defer to the cardiologist and me. I was able to pull it all together for her by showing her the NNT, or number needed to treat, for patients with her CHADS score. She chose to go with aspirin alone and left the office visibly relieved that nobody was trying to make her take warfarin.

There was also the young mother who wept about the loss of her grandmother a few days earlier. “Gram was my best friend”, she said, adding “I need to keep it together for my two-year-old daughter”. The woman’s presenting complaint of cough and shortness of breath didn’t seem to be a sign of anything dangerous. At the end of our visit I pointed out how fortunate she was to have been that close to her grandmother while growing up. I encouraged her to help her little girl know the importance of family the way she did.

My last two patients were a husband and wife, both around eighty years old. He had almost crushed his lower leg in a farming accident, and came in for a wound check and some pain pills, which he had declined on his first visit.

“I’m too stoved up to wrestle with my cows now. The shape I’m in, I couldn’t even wrestle the rooster”, he muttered in his thick local accent.

His wife’s blood pressure checked out okay, and I asked her to come back in the spring for a recheck. She looked me square in the eye and said:

“I’ll call you if I need you”.

There was enough time left to take care of all the incoming laboratory and x-ray reports, prescription refills and other chores well before five o’clock.

I wished my nurse, Autumn, “Happy Thanksgiving” before calling my wife to tell her I was on my way. I turned out the office lights and locked the clinic door behind me. My Thanksgiving was already well under way.