This season of dropping temperatures, snow squalls, and ice brings back memories of the first ice storm in Milwaukee my second year of residency. A quarter inch of ice on the streets made me late for my day in the emergency room. I fell awkwardly at the back door, landing on my derriere.

“The morning we left down there, Mr. Jackson bagged a raccoon. His family has a tradition of roast coon for the holiday. We packed it in the ice cooler and when we arrived here, we threw it straight in the back of the freezer. Today, I reached in to get some frozen vegetables and I got bit by the coon. I need a rabies shot.”

Dr. Chen was at the door waiting. “So, you are the lucky resident this year, Dr. Houkom. You will get every orthopedic patient that comes in to see us today. By the end of your shift you will know all you need to know about orthopedics.”

By the end of my 10-hour shift, as I recorded my encounter list for the day, I listed three broken wrists, two broken ankles, a cracked rib, and five sore tailbones (six with my own). I had written several clinical rules in my handy pocket notebook, rules I used my entire career.

But the most useful rule I learned was with my last patient. Two minutes before my shift ended, the nurse handed me a chart and pointed to room 203. “Finally, Doctor, your last case isn’t an orthopedic one.”

The chart described a 62-year-old woman with the chief complaint of “I need a rabies shot.”

Seated very erect on the straight-backed plastic chair was a woman in a burgundy winter coat with matching hat. She had a brown grocery bag carrying the Pick ’N Save logo on her lap, her hands clutching the scrunched top tightly.

“Hello, Mrs. Jackson. I am Doctor Houkom. The nurse wrote that you think you need a rabies shot. Please explain.” I was dubious of this need in December in the middle of a large city.

“Yes, I am Mrs. Jackson. My husband is from Mississippi. Jackson, Mississippi, in fact. We just moved here to Milwaukee to care for my elderly mother. She can’t stay alone anymore in her house. The morning we left down there, Mr. Jackson bagged a raccoon. His family has a tradition of roast coon for the holiday. We packed it in the ice cooler and when we arrived here, we threw it straight in the back of the freezer. Today, I reached in to get some frozen vegetables and I got bit by the coon. I need a rabies shot.”

“Bitten or scratched?”

“Don’t matter. I need a rabies shot.”

“Mrs. Jackson, the good news is that at the low temperature in the freezer, rabies cannot survive.”

“Then I need a tetanus shot, doctor.”

“Tetanus cannot survive, either.”

With that, the sack made a loud thud as she dropped it on the floor beside her. She lowered her head, looking at her folded, empty hands in her lap.

I studied the chart as I calculated what I should do. I noticed that the bag was turning dark brown at the bottom from moisture.

“Mrs. Jackson, is that the coon in the bag?”

“Sure is.”

“Well, you heard the good news already. But I also have some bad news.”

“Hmm,” she murmured, not looking up.

“OK. The bad news. You need to go back home and tell Mr. Jackson that the young doctor at the emergency room felt that he must confiscate the coon so the lab can run some tests – to make sure you’re safe.”

She jumped out of the chair like a jack-in-the-box and gave me the biggest burgundy winter coat hug I had ever received. “Oh, thank you, doctor. Thank you so much.”

As she escaped to the door, she turned her smiling face to me. “And you have a very merry Christmas, Doctor. A very merry Christmas.”

As I left the room to chart the encounter, I recorded my most valuable clinical rule of the day: “RULE #5. The patient doesn’t always tell you what she really wants.”

Everin Houkom, a retired family physician living in Chippewa Falls, is the author of two novels, Daddy Didn’t Come Home and Crazy Music.

---

Thinkpieces are reader-submitted reflective essays. A wide variety of ideas, analyses, and notions are welcome. Submit your essay for consideration to giffey@volumeone.org.