Urgent Care Clinic

The patients scheduled for my urgent care clinic were:
1. Young man with left hand tingling/numbness
2. Middle aged lady with "mold spot" growing on her head and "bruises all over."
3. Youngish woman with "malodorous vaginal discharge" x 1 week
4. Middle aged old lady for follow-up after breaking her foot
Summary: dammit!!!

So the first thing's first in urgent care clinic: you hope for no-shows.

All of my patients showed.

Excellent. Yay patient care yay. Yay.

Anyway, so the first guy is huge- he's like 7 feet tall. He leans on his left elbow all day at work, then comes home and leans on his left elbow for another six hours while he watches TV. He has tingling in his left fourth and fifth fingers that sometimes radiates to the elbow. Any takers? Any takers?

Boom- ulnar neuropathy! Done! Easy!!!

Next lady shows up. Early. Thank goodness, I didn't want to miss out on this head "mold." So first of all, it's a small, discrete, brown "stuck on" appearing growth.... a seborrheic keratosis (benign ugly growth). She is happy to hear this. Next: she has "bruises all over." Ah, she actually has one tiny bruise on her outer arm and another little one on her knee. Show me someone who DOESN'T have any little bruises over any of their extremities. Next, she wants to talk about what her future treatment options are for her chronic sciatica. Then she wants to talk about what some good recommendations are for exercise she can do to-OKAY, THAT'S ENOUGH THANK YOU, this is URGENT CARE clinic, not BRING ALL YOUR UNSOLVED LIFE PROBLEMS Clinic.

Next lady. "Malodorous vag discharge" for a week. Great. That's the best! So after the attendings jokingly (kind of) argue between the two of them about who should have to staff this one, eventually we get the vag infection taken care of. But oh wait, as soon as I try to leave the room she mentions she has this weird neurologic past medical history and OH BY THE WAY, part of her face has been tingling for a day. Daaaaaaammit. Ok then, tell me about your face. Ok, came up with a plan for face problem. Good. Try to leave again- OH BY THE WAY, she doesn't know if she believes in taking antibiotics and wants a convincing argument. Ok, done. Try to leave the room again- OH BY THE WAY, she wants to know what her weights have been trending over the last several months because she thinks she's losing weight. !!! So I look up her weights and show her clearly that over the past two years, her weight has been the same. She insists on getting a recommendation for nutritional supplements to safely gain weight. Okay. Whatever you want. Try to leave again- OH BY THE WAY ($#%&*@!!!) she has breast lumps that come and go and she's been told they were benign and that is normal, but is it REALLY normal??? SWEET JESUS! Once again, this is not "BRING ALL YOUR UNRESOLVED LIFE PROBLEMS TO CLINIC DAY." We were just kidding when we said "Urgent Care" clinic, what we really meant was "Let's Relax and Sit Down at a Table and Just Talk About Every Problem You've Ever Had in Life Over a Cappuccino" clinic. Let me know when you're done with your life problems so we can get started on mine!

AAAAA!!!

Ok. Fourth lady (by the way, somehow I am almost an hour behind at this point thanks to 1 million + 1 problems lady). She was diagnosed with a broken foot at an Outside Hospital. Outside Hospital took an xray, gave her a brace and some vicodin, wished her good luck and told her to take her problems to University Hospital (where I work). This was more complicated than it sounds (sigh) and took some time to sort out. As I'm presenting her to the attending- GUESS WHAT- she volunteers that she has had intermittent numbness and tingling in the left hand. OH LORD. She also volunteers she has been having blurry vision. At this point the attending asks, "Okay- are there any other problems that you're going to share with us?" It took several more minutes to elicit the history that the tingling also occurs alternately in her right hand, and it is precipitated by LEANING ON HER ELBOW. BUGGAR!!! Ah- also, her fundoscopic exam is normal and her vision is 20/30 bilaterally. Oh how I wish that my vision could be that "blurry." Anyway, after several more minutes of talking to her it sounds like what she meant was that her vision had been gradually getting worse over the course of a long period of time.

Somebody must have told her about the cappuccinos....