Brown Bag Delights

I just described working in a community health center as "jumping into the trenches and trying to dig yourself out." Not, of course, to any of the patients here. I was explaining to a fellow colleague. It sounds so dramatic but sometimes it does feel that way. Now the upside to that is that you do a lot of digging and in the process learn a ton. But other times I just look at my schedule, see 25 names swimming before my eyes, and imagine all those names as mere obstacles impeding my progress towards home where I can collapse onto my couch and watch trashy television. But I repeat, I'm learning lots. And lots.

Par exemple:
Should my colpo patient on coumadin (that's an interesting duality, right?) be bridged with lovenox? Yes, according to her very kind cardiologist who instructed me in properly orchestrating the lovenox bridge. His parting words to me were, "I think that will work. Hopefully she won't bleed out on you in clinic." Uhhh... (insert sweaty palms)

What further work up should I do on my 37 year old patient with premature ovarian failure? Still working on that one, but it seems a repro endo consultation with possible genetic counseling and karyotyping may be in order. Not to mention some serious calcium and vit d supplementation.

I am also learning to love the geriatric brown bag visit. This is where an adorable (in this case Asian) octogenarian brings in a brown bag full of empty or near-empty pill bottles for me to sort through. Talk about a grab bag o' fun. It gets most exciting when I pull out a medication for which there is no indication and definitely some potentially adverse side effects. Today the offending med du jour happened to be plavix. My patient had no good reason to be on this med, some very good reasons to not be on the med, with agreement from the cardiologist to boot. The most fascinating part of it all (aside from most of the pill bottle being in Chinese) was that the patient was convinced the medication was simply aspirin. Did she ever wonder why her aspirin was costing her $150 per month?

Food for thought. There is plenty of that to go around here in the wonderful world of the community health center. It's a good thing too, since there isn't much time for indulging in food of any other kind!