"I'm allergic to clinic"

Young Dr. Z would proclaim that outpatient medicine "gave me hives"

"The slow pace!  Waiting to get roomed, for prior authorizations, for follow up from your referrals - it drives me insane!"

I ran for inpatient-only practice straight out of graduation and reluctantly turned back when I found my dream teaching position.  My first day of clinic - a hectic Tuesday during which I managed to see three whole patients was terrifying.  "When do you give pneumovax again?  Do I even remember how to do a pap smear?"  I worried my outpatient skills had atrophied beyond saving.

And while the sight of a prior authorization forms do drive me to compulsive and destructive behavior (usually in the form of eating the always-at-hand candy and treats) my stance on clinic has softened in the last decade

Mostly because of Mario.

I first met Mario in the hospital, as one does in any residency program - having heard from my colleagues about this sick frequent flier patient.  An unfortunate combination of two organ systems working against each other meant every other month hospital visits, all of Thanksgiving weekend on my service instead of with his family.

And the two week follow ups as we struggled in vain to keep him healthy.  We carefully reconciled and titrated meds, went over outpatient subspecialist recommendations... but it was a losing battle.

Counts dropped, symptoms worsened and I could see the fight go out of Mario's eyes just before Christmas.  He was at his core, a dedicated Family Man - but it was LEGOs that broke him.  "I could deal with the not working thing, Doc.  I knew it was my job to get healthy.  But if I don't have the strength to play with my kids, I can't do this anymore."

And so we put him in one last time.  Heroic efforts.  Transfer to the regional experts, the Quaternary Referral Center.  "Mario - we're your doctors, and we're not abandoning you.  But you need someone with more firepower than what we have."

And I left him with the line I had used as a hospitalist so many times.  The one I pulled out when I really believed the patient would recover, even when they didn't.

"I know things seem bad right now, but this time next year, it's going to be a bad memory.  That's it.  You can get past this."

Thing is, when you work inpatient only, week on-week off, you almost never get to read the last chapter of the book, much less the sequel.  I never knew whether or not "July of 2016" ended up as an unpleasant time to look back on or something worse.

I did know Mario was a fighter, that he had people to live for, and he would not give up until every option was exhausted.  But in the depths of that very cold winter, my belief wavered.  I wasn't sure that Important Bigname Hospital had what he needed, if we could push back against pathology that had shrugged off every attempt at control.

But the snows melted.  Spring bloomed.

And on a Very Happy Tuesday Afternoon - during the clinic spot I had actually started to look forward to as I mentored a great group of residents through our clinic shenanigans and found my Outpatient skills were not as atrophied as I'd feared - Mario came back.

We had both changed in that time - his changes certainly more stark and physical, but light was back in his eyes.  He looked... like a person.   We as Doctors are so used to seeing our patients in the anonymizing gowns and beds, to see him in a Def Leppard t-shirt and jeans drove home just how much the disease had taken from him.

"I remembered what you said Doc.  That thing about it being a bad memory at some point?  That really kept me going.  So here I am, and I wanted to thank you."

In that moment, I was HIS Doctor.  Not just another person covering the service, admitting or taking over care.  We were a team.

When I became an "Allergy Mom" I learned young children with allergies - even those with complete intolerance can "grow out of" their allergic reactions and can come to enjoy the things they avoided for so long.  Good to know the same can happen with young doctors and the incredibly rich and rewarding world of the clinic.