Shuffle: Off

Much of medicine is like listening to an iPod on shuffle. One minute I am interviewing a talkative 73 year old about her breathing problems and long list of medication refills. The next room over, I might encounter a shy 2 year old, clinging to her mom’s leg. Shuffle in some diarrhea, some dental pain, some fancy new medicines with lots of Z’s and X’s in their names and some old school procedures like suturing up a hand. In other words a day can take you from Beethoven to Brittney and back with the knock of an exam room door. The ER is a shining example of this randomness. Things happen, hangliders crash, hearts attack, and the doors are never locked. People come and go all day. And despite the inevitable frequent flyers, most are brand new customers. Like hearing that good song on a shuffling iPod….and never hearing it again.

But some albums just require listening in the right order. Pearl Jam’s Ten or Pink Floyd’s Dark Side of The Moon, for example. Maybe they have a message, certainly they have a flow. Before the days of shuffle, the end of one song would have you humming the beginning of the next, before it started. A certain level of expectation is then satisfied when sure enough, it plays. Life is certainly more random, but sometimes in primary care medicine, while often a day is chaotically scheduled, sometimes it feels like listening to an album in the correct order.

Even as a “short-timer” student, inhabiting the clinic for a few months I have a case in point:

Seeing a pt for her last 2 or 3 prenatal visits, and then following her to the hospital for post term induction. Learning to read her “bad strips”, and then watching her c-section. Doing a newborn exam on her little baby boy, a bit banged up from delivery, with a possible broken clavicle. Seeing everybody back in the office a few days later for a weight check, then assisting with his circumcision a few days after that. I could anticipate the next song. If I hung around for a few years, I could anticipate a few colds, maybe some asthma. Lots of shots. Throw in a broken arm from snowboarding, some questions about puberty, and a weird rash. If I hung around for a few years after that I might anticipate some low back pain, a consult to an expert in Portland, and some advice as he starts his own family.

So while an individual day might have that feeling of shuffling through 20 gigabytes, the overall picture has an underlying rhythm. And while, impossible to truly anticipate the next song that will arise in a patient’s chart, just experiencing the album in order is satisfying.