Strike?

How do you know when the roads are "too bad" to go work? Do doctors ever get snow days? After 5 years of receiving emails reminding me that I am "essential personnel" and must find a way to get to work even during the apocalypse, I have a hard time throwing in the towel due to bad roads. Would a foot of snow in Denver and a unplowed highway make good excuses? The usual 1 hr 40 minute early A.M. drive to Pueblo took me 3 hrs and was harrowing to say least. (Matt suggested I pack some snow shoes in case I got stranded). Thankfully, only one stop to clean the windshield was required, and I didn't end up in a ditch. I would say the day was a success. If I could only finagle a way for the prison to pay me for my drive time...

Today in prison, I had some nice patient visits. My first patient was a lady in her 50s brought in from the "seg" unit, where she spends 23 hrs/day in her cell. She had a black eye and was wearing a seg unit uniform - the orange jump suit. She had also been on a "hunger strike" for a week. I guess the purpose of hunger strike is to make some kind of statement. After seven days of striking, she was eating a grilled cheese sandwich in the exam room. (The nurses have protocols for all kinds of medical evaluations...including the hunger strike. I think it involves daily weights, vitals, urine dips and measurements of fluids.) This patient has severe hypertension, and I wondered if she was also on a "medicine strike" since she took her blood pressure pills 8 out of the last 30 days. Not advisable when you've already had 2 heart attacks. We actually had a productive visit where she set goals of "eating" and taking her pills "29 out of 30 days" this month. Ambitious for someone who maybe took that many doses over the last 3-4 months, but I am cautiously optimistic.

I also saw a teenage medical mystery for follow-up. Last week, he had his boot camp physical and other than hypertension and slightly large liver, he was quite well with no pertinent past medical history. Then, over the weekend, he developed redness on his arm and, later, on both feet and ankles as well as ankle swelling. The on call doc ordered labs and treated him for cellulitis, which seems totally reasonable, but it just didn't seem like cellulitis. He never had a fever and had a normal white count. Apparently he looked a lot better today, but still had purplish feet, a vasculitic looking ankle rash, and pedal edema. His only lab abnormalities were an elevated AST and slight proteinuria. Today the proteinuria had resolved, and his blood pressure had improved. I am chasing down a rheumatologic rat with more lab work, but I imagine this might be a wild goose chase.