Wearing Thin

Perhaps it is the six weeks of driving to Pueblo and lugging my stuff in and out of the hotel or maybe it's the ever growing number of chronic pain patients on my schedule, but this week is wearing on me. I'm seeing about 14 patients a day, which pales in comparison to the 22+ I'll see if I take a job in a Denver community health center. The bottomless basket of charts "to review" is a welcome relief from the patient visits at the end of the day. And tomorrow I have to see my least favorite patient: a 40 something yr old who is convinced something is seriously wrong with her and derails all of my attempts to take a history with her tangential thought processes. I am just waiting for her to file a grievance against me and call her lawyer (which I heard she has done in the past).

Depending on your view of musculoskeletal medicine, the prison population is either a treasure trove or your worst nightmare. (For me, more of a nightmare.) There are very limited means to treat chronic pain here, so I end up telling everyone to exercise, lose weight, and take NSAIDs. Luxuries like PT, massage, accupuncture, and pools are not an option. (Even social support is hard to come by.) Occasionally it seems like a brace would be helpful, but the inmates have to buy these from "canteen" with the money they earn working in prison. Often, they say can't afford what I recommend and it's usually true because I can see how much money is in their account (one funny difference compared to medicine "on the outs.")

There are a wide range of jobs in prison including "porters" who clean the offices, cooks in the kitchen, harvesters on the "farm crew," and the "pusher" who pushes the wheelchair of a diabetic with an amputation, plus many more. Nearly all of the MRIs and outside consults I have requested to orthopedists or podiatrists have been denied by the prison insurance company. Which leaves me with, as I recall hearing in medical school, "the most powerful tool in modern medicine...the human hand." (Being an osteopath would be extremely helpful!)

Today I attempted a knee injection and a ganglion cyst aspiration. Hopefully they'll fare better than the lady whose trochanteric bursa I injected a few weeks ago. She had no improvement and was tearful and frustrated yesterday. I think I absorbed all of her frustration right into my trapezius. Six weeks in prison have left me feeling like I have fibromyalgia. At least I can soak in the La Quinta hot tub and sleep on a decent mattress, so I'm grateful for that.

Just one more day of work this week and then I'm off to "headquarters" in Colorado Springs for a provider meeting on Thursday.