24 August 2010

A man's best friend

Sometimes, information from odd sources comes together at the perfect time to effect a great good. I view these as minor miracles and am always grateful for the cosmic assistance.

I had a patient who believed he was suffering from empty-nest syndrome. His last child had departed for university and he was blue, often on the verge of tears, he said. He was also finding it hard to sleep. He visited me for some advice but was not amenable to any medicinal intervention, and there isn’t much a practitioner can do about the complaint of fatigue. I offered the usual naturalistic recommendations and reassured him that tincture of time is a great healer.

I saw him frequently around the embassy and usually asked how things were going for him, since I expected, as the days turned into weeks, that his sleep and mood would improve. But they didn’t. One day, we were chatting in a hallway and he mentioned that his dogs had been acting very strange at night and were adding to his sleeplessness. He told me that, when his child left home, he began letting the family dog sleep in his room and now, several times a night, the dog would jump on the bed, bark and wake him up. As soon as he spoke, the dog would lie down and be quiet.

Immediately, an article I had read about how dogs can sense medical dangers popped into my mind. Call it a hunch or an inspiration, but I instantly asked if he snored. Yes, he said, his child often complained about how loudly he snored. Returning to my office, I sent him the Epworth Sleepiness Scale and, wow, his score was very high! That was enough to get him scheduled in the sleep lab for evaluation of possible sleep apnea.

My colleague and his dog are now having peaceful nights, thanks to the CPAP that treats his severe sleep apnea. And, perhaps because of the passage of time, or maybe because he gets adequate oxygenation at night, his blue moods and fatigue are long gone.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

16 August 2010

And this is a SLOW week!

Another week has ended and, because it is summer vacation time and post transfer season, my clinic has been operating at a slower pace. I enjoy the occasional slumps, because they give me time to accomplish administrative work I’ve been putting in my “round tuit” file, catch up on journal reading and reflect a bit on what I’m doing.

Today’s reflection highlighted the virtual practice, of which I am part, and the global resources I enjoy. In my former U.S. practice, if I wished to discuss a case, I usually walked down a hall to speak with a fellow medical provider. Occasionally, I would phone a colleague about a particular patient but, almost certainly, that colleague was someone I would see face to face within a short time to continue the collaboration.

Most of my postings with the U.S. Foreign Service have been as a single provider, so when I require consultation, I pick up a phone to call medical staff people in Washington, D.C. or in another country. For example, this week I’ve collaborated by phone or e-mail with colleagues in Washington, Budapest and Kyiv. I’ve also discussed medical-supply problems with colleagues in Islamabad, Pretoria and Abu Dhabi, and worked through an administrative question with my counterpart in Bucharest. And this is a slow week!

I admit I am impressed with how truly universal and “virtual” this form of practice is. I take it for granted that the diabetes expert I rely on is in Jakarta, the neurologist is in Frankfurt and the pediatric guru is in Budapest. And, like a city toss, next year we could all be in a different location, but still readily available to each other and the patients we serve.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

02 August 2010

See the USA in a Chevrolet ... wait a minute, this is Prague!

Even though I live on the third floor of an apartment building located on one of Prague’s main streets, traffic noise is usually like white noise to me, excepting the occasional ambulance. But when I heard the successive revving engines, I immediately recognized it as something unusual. I looked out my window to see—a long line of Corvettes.

Corvettes? One after the other they came up the street and, when it continued for several minutes, I realized this was not just a quirky occurrence. Down to the street I went to see—as far as I could see in both directions—Chevrolet Corvettes!

Police had stopped the traffic so the spectacle could continue, unimpeded, to its destination, wherever that might be. People lined the sidewalks, pointing at various vehicles that impressed them and taking photos. For a full 20 minutes after I arrived at street level, they passed. There were vintage models and new ones, hardtops and convertibles, of every imaginable color, driven by men and women, some with a passenger and others alone. All the drivers and passengers looked rather serious and largely ignored the curious crowds on the sidewalks. Except for the drivers who were compelled to rev up their engines and jerk their vehicles forward by a foot or two, it was more like a funeral procession than a parade.

The scene was quite surreal. First of all, I am absolutely sure I have not seen any Corvettes traveling around Prague since I’ve been here. Secondly, the mighty Corvette, symbol of American automotive ingenuity and the most “macho” of sports cars, really stood out when contrasted to Prague’s cobble-stoned streets and ancient buildings. And, of course, despite the fact that this vehicle is distinctly American, here, in the heart of Europe, were a couple hundred of them passing.

I have since learned that the 10th International Corvette Meeting is this weekend, when proud Corvette owners from all over Europe come together to flex their engines and share their pride of ownership. I am still smiling from this unexpected treat.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.