Last night I hit my breaking point. I had been at my office for over ten hours, and was having one of THOSE days. Every person I saw was complicated, I was hungry, exhausted and my ankle was throbbing like it does before it rains. I was attempting to flush an ear, and was not being at all successful. My patients are mostly blue collar workers, and often have jobs that require them to use earplugs. Earplugs tend to pack and compress wax over time into a hard painful plug that is almost impossible to remove at home. I’ve become rather good at the removal of impacted cerumen over the years, but last night the ear was winning. Finally, I threw my hands up in defeat. I’m so sorry, I explained to poor Mrs. P. It’s just not coming out, but I’m going to give you some drops to use at home and have you come back in a day or two. I felt defeated and exhausted and when I looked up at her… I could see something peeking out of the ear canal. Hold on, I said, as I easily grabbed the protruding mass. And just like that, she was better. She left the office happy and I whispered furtively to my nurse as I rushed into the next room, "I think God just removed Mrs. P’s earwax."

The alarm malfunctioned this morning, and I rushed around my room thinking I was late for work. When I realized what had happened I burst into tears. My days are too hard, and too long to start off already shook up. I walked in to the office still out of sorts. My schedule, which is always overbooked, had two free appointments. And the computer had somehow blocked out my afternoon schedule, leaving it completely free. And, as I was marveling over this series of minor miracles, one of my most challenging patients called and cancelled her late morning appointment. Less than twelve hours earlier I had been at my breaking point. I consider myself a spiritual, but not religious person, but it was hard not to once again attribute divine intervention into the day. I was giddily explaining the situation to my nurse when Mr. L’s son came to the window and said his father was having a heart attack.

My rural office has these sorts of walk-ins almost every day. We’re twenty miles from the closest ER, so people tend to wander in holding their amputated fingers or clutching their chests. Why someone would head to a family practice office after wrecking their bike, getting shot, or having an anaphylactic reaction to a wasp sting is beyond me, but they do. I don’t have the equipment or staff to deal with most of the problems, but of course, the bleeding and/or wheezing patient gets taken right in, in spite of the fact that my other patients have been patiently waiting for weeks for an appointment. We act as a sort of triage, moving the bleeding but stable ones to the ER by car, and calling the ambulance for the rest.

So, the assertion that Mr. L was having a heart attack didn’t throw me too much. The difference today was 1) my schedule had opened up five minutes before he walked in the door, allotting me precious time and energy to deal with it and 2) Mr. L was actually and truly having a heart attack. Most of my walk in chest pains are a combination of heartburn, fear and drama, but Mr. L was diaphoretic, gray, tachycardic and hypotensive. His EKG showed changes consistent with an inferior MI. By the time the paramedics finally rolled in some oxygen and nitroglycerin had him looking a little less blue around the lips, but there was no question his status remained very grave. After he was rolled out the backdoor I gave myself a minute to sit down and be very grateful that he had not left the office less alive than when he entered. Maybe God wasn’t looking out for me when he gave me that breather. Maybe s/he was looking out for Mr. L, who deserved a doctor who wasn’t flustered and frustrated by his presence. I’m pretty sure that if there is a God s/he doesn’t really put that much effort into earwax, but then who knows?

Last night I had a dream that I quit my job and became a barista. I was good at it, and happy. It was a pretty awesome dream.