Tired

There have been fewer entries here of late. My new job is proving to be very tiring, and now when I get home, I basically just veg out on the couch or play mindless computer games. Some of the fatigue is physical, but there's more emotional fatigue lately.

I work in a primary care clinic for adults who have Iowa Care insurance. Iowa Care is a state funded insurance program for persons with incomes that at 200% of the federal poverty guidelines. A lot of our patients are unemployed, but many do work, most at jobs that pay minimum or near minimum wage.

Our clinic is located at the University of Iowa Hospitals and Clincs, Iowa's only teaching hospital. But all Iowa Care patients have to come here for care, so many drive two or three hour one way to get here. The's no transportation reimbursement for most.

Most of the people I see have had no health care for months or even years. Many have chronic diseases; diabetes, hypertension, dyslipidemia. Many have chronic pain. A few are drug seeking. "Vicodin is the only thing I'm not allergic to."

One of my patients is a twenty year old Type 1 diabetic since age 14 who was working as a waitress and going to a community college part time. She finally went to the ER when she ran out of insulin. She had been using half a daily dose of her long acting insulin and saving on the short acting by eating only one real meal a day. She couldn't remember how long she'd been using the same syringe. She had no strips f0r her meter. I asked her how she calculated how much short acting insulin to take without checking her blood sugar. She said, "I just guess." When I asked her how she was feeling, she said, "Hungry."

It's common to see patients who have been without their blood pressure and diabetes meds for months. We see many women who have not ever had mammograms or pap smears.

Before they come to us, many of these patients get meds and very basic care from free clinics. But when there are no samples, then there are no meds. My young diabetic patient didn't know if there was a free clinic in her town.

And then there's the 350# patient who wonders why she has back pain. Obesity is one of the hardest things to treat.

People wait two or three months for an appointment. Because many have a long drive to get to us, and because of the demand for appointments, there's lots of pressure at address as many problems as you can in a 40 minute appointment. There's never enough time. I'm always behind.

So that's my job. Exhausting, but still the best work on earth.

Image: Edvard Munch, The Sick Child, 1885 - 1886