To reach my patients in the city, I walk and take the subway when the weather’s wet or if there’s an especially stiff wind. But otherwise even on the coldest days my favorite way to get around Manhattan, parts of Brooklyn and even Queens, is on my white “steed,” the sweet and surprisingly sturdy Dahon folding bike I snagged on Craigslist a number of years ago.
When it's really cold out, I don my light down jacket, careful to zip my phone into one pocket and my reading glasses into the other. To keep it from catching on the chain ring, I tuck the cuff of my right pant leg into the top of my sock. I enjoy dressing up a bit, cycling in heels even, or what are heels for me, shoes I wouldn’t wear to do much walking in, but ones that are ok on the pedals.
I might wrap a slim scarf lightly around my neck. My heavy black gloves don’t do much for my dexterity but they have never failed to keep my hands warm. I usually wear my helmet. If I wear a hat as well I almost always wind up taking it off after a short while. No matter how low the temperature, my body warms up fast as I try to make good time going uptown or downtown on the avenues or negotiating the sometimes hilly cross streets. Especially on weekdays, the avenues are clogged with taxis and trucks and buses, and it feels perilous and exciting to ride among them. It’s like Jurassic Park - they’re like big dinosaurs I try to keep my distance from. I never want to be invisible to them but I assume at all times that I am, that any false move could wind up being fatal.
But the thrill of riding is worth it. I love the feeling of my body doing the work. I love the wind in my face. I enjoy the familiar smell of the streets and the immense variety of people and dogs and other things that fill them. There is a sense of constant surprise that I find utterly delightful. Most of all I love the keen attention that riding demands. I feel truly alive as I dodge pedestrians, make split-second lane changes, and watch at all times for every possible danger. In the park it’s easier of course. When I can I ride through the park or along the river, or use one of the bike lanes that have multiplied around the city. No matter what, no matter how bad the traffic might be, no matter how hungry or tired I am, I am happiest riding.
And what do I carry in my bike's back basket? Everything I need.
My green leather satchel holds all the tools I use to make house calls - my laptop of course, and a cable to charge my phone. My wallet and some business cards. Especially if I’m walking I make sure I have my little umbrella. Neither my bike nor my bag signal that I’m a doctor making rounds, which allows patients some privacy and doesn’t alert ne’er-do-wells that I might be carrying controlled substances.
Into the same pocket as my computer I slide my patients’ charts, along with a folder with blank intake forms in case I get a call and need to see someone new on the fly. Alongside the charts I carry a couple of sturdy plastic folders. One is sort of like my notebook; it holds a sheaf of paper with my current notes on whatever projects are occupying me; the other holds a variety of forms - the ones I know for sure I will be needing that day along with the ones I find myself using with some frequency.
My frequently used forms include a Do Not Resuscitate form and a MOLST (Medical Orders for Life Sustaining Treatment) form; my favorite mental status test - the VA’s SLUMS (St. Louis University Mental Status examination), which is a little friendlier to administer than the standard Mini Mental Status Exam; Medicare’s hospice criteria for various conditions; and an opioid conversion chart so I can easily calculate equivalent doses of narcotics when switching from one to another. Of course I also have my prescription pad and a little personalized note pad for jotting down instructions for my patients and their caregivers.
In addition to written instructions I often leave caregivers with handouts about various common problems. Depending on the patient on any given day I may be carrying handouts on such topics as Constipation; Hiring Caregivers; End of Life Planning; Breathing for Stress Relief; Delirium; Dementia Safety Tips; Pressure Ulcers; How to Move Patients; or Pain and Symptom Tracking.
My iPhone is indispensable. I often use it to search the web or tether it to my laptop to get an internet connection. I use the phone's camera as a scanner or a copier, capturing documents, business cards and the prescriptions I write for controlled drugs. In the phone's contacts I keep numbers for mobile dentists, podiatrists, radiology, labs with mobile phlebotomy, along with hospices and home care agencies, and worthy home health aides.
I find I don’t need to carry much in the way of diagnostic equipment. Most days it's just my trusty green Littman stethoscope and a zippered bag with blood pressure cuffs in 4 sizes (since my patients can range from extraordinarily thin to the opposite). Also, a pulse oximeter, useful in cases of congestive heart failure or lung disease, though I use it on virtually everyone whether I need to or not. It’s small and noninvasive and when I slip it over the patient’s fingertip it gives me a chance as I begin the physical exam to hold their hand for a minute. This is a lovely way to start, to make a connection, to show a little affection.
What else do I carry? Gloves of course. Tongue depressors and an otoscope; disposable scalpels and hand sanitizer; swabs and a suture removal kit; syringes and needles. That’s about it. That’s all I ever need. At the end of a visit everything goes back into its proper place, Packed up, I say my goodbyes and head back out to the street. I breathe in the (relatively) fresh air, check my phone for messages, unlock my bike, secure my bag in its basket and I'm on my way to my next patient.
Zooming around on my bike with my whole clinic in my bag I am grateful for my most interesting life.