Isit at my desk and allow my eyes to drift down over the list of patients I saw today, the last day on a job I have held for 20 years in a pediatric practice I helped to create.
My first patient of the morning was a 16-year-old boy who came in for suture removal. He had tripped and fallen on his chin. The laceration was closed at a local ED 5 days ago. Today the boy was accompanied by his grandmother. His mother is Ukrainian. I have taken care of this boy and his younger brother since they were infants.
Next I saw a brother and sister for their annual physical examinations. One year ago, I diagnosed the 5-year-old boy with a retinal anomaly and sent him off to the ophthalmologist. Today he's wearing glasses to correct a partially improved amblyopia. His sister, now 8, developed diabetes 3 years ago. She's well maintained on an insulin pump, although she did require hospitalization this past winter to correct a mild dehydration secondary to gastroenteritis. In the midst of all of this, their mother was diagnosed with breast cancer. So far she's survived both the disease and the ordeal of treatment.
Midmorning, a 20-year-old college student appeared for his annual sports exam. This year his school is requiring him to get a sickle cell test, even though he's been asymptomatic his entire life—another added cost in the brave new world of liability protection on the undergraduate campus. I asked him about the new tattoo on his arm. He told me it signified faith and trust; his sister got the same tattoo on the same day.
In the adjacent room I met a new mother for the first time. She thought her 2-month-old baby might have thrush—and she was right. I noted the small, white cottage cheese curdles pasted on the insides of the cheeks, lips, and palate. I calculated the correct dosage for the medication and explained how she should give it to the child.
That afternoon a 10-year-old boy came in with a chesty cough. The family was leaving on vacation and the father wanted to have the boy looked at. I noted the history of asthma and asked about medication. He had no inhalers at home. I found two samples in the drug cabinet and jotted down a set of instructions on how to take them. The father was appreciative for the free medications. “Even with our co-pays these things are expensive,” he said. I wished them bon voyage, knowing that I would most likely not see them again.
There were others, of course: a 7-year-old boy for evaluation of a halo nevus and whose worried mother had an atypical skin lesion removed from her own arm; an 18-year-old with cellulitis of the hand secondary to a cat bite; a 5-year-old boy whose father suffers from traumatic brain injury incurred during a tour in Iraq; a new patient who just learned that hereditary hemochromatosis runs in the family and wanted genetic testing; an 18-year-old adolescent who needed a dose of meningococcal vaccine before starting his course of collegiate study toward a career in the health professions.
My last patient of the day was a 3-year-old girl who had just developed fever that afternoon. Her grandmother brought her to the office for immediate evaluation because the child's mother and father were on their way home from the hospital with their new baby. Although the girl checked out well on exam, I suggested that she be kept away from the newborn until her fever broke.
There will always be new babies, I reflect. Kids come and kids go; kids grow up and move out into the adult world to face their own particular set of circumstances and struggles.
After 2 decades, this practice that I started with my supervising physician is being sold to a regional health consortium. In the interest of trimming the corporate fat, my salary will be cut 45%. At 60 years of age, I will be offered an incentive plan. If I'm conscientious, if I pump out even more patients and generate more revenue—more in excess of the $500,000 I generated last year—the new administrators will drop a few additional corporate crumbs on my plate. No equity, of course. That's reserved for the elite.
And so after 20 years I've elected to resign my position. I clean out my desk; I pack the well-thumbed medical textbooks into my car. I place the office keys on the credenza and snap off the overhead lights.
The last thing I take with me is my self-respect.