Category: Uncategorized

When the weather gets cooler I find myself unable to resist wandering into the various area nurseries. 

On other fronts, I spent much of the day proofing a paper and pulling it into the proper format to submit to an asthma journal.  Wanted it submitted today but discovered I didn’t have certain info about my co-author… so it’s on a back burner while I’m waiting for that info.  Spent a little time pulling together some info to renew my hospital privileges and going over some other work-related stuff.  Probably need to put in a couple more hours this evening; despite putting in a full day there were things I didn’t get finished to my satisfaction.

On operation aescetic, I loaded up a bunch of stuff we never use into my car.  Hopped in to drive to the Goodwill to donate the stuff, and a block from my house the lens spontaneously popped out of my glasses.  Hard to drive like that.  Pulled over, fixed glasses, then arrived at the place 5 minutes after it had closed.  Sigh.  So I’ll try to take care of that stuff in the AM.

Spoke to a potential DJ for the wedding.  Talked a friend into being the minister for the wedding, and convinced him he didn’t want to wear tie-dye robes while doing so.  Still need to figure out invitations, flower-girl dresses, and the actual vows themselves.  But things are coming along.

Skipped working out – figured the hour of sweating in the garden, digging holes and hauling around 30-pound sacks of mulch was probably adequate.

Gee, it’s almost 9.  I should eat dinner.

My family book club read The Cloister Walk by Kathleen Norris this month. It’s a series of observations and thoughts that came out of the author’s experience of living and worshiping in a Benedictine monestary.  Which is interesting, as the author is female – it’s never quite explained why she chose a community of monks rather than a community of nuns, but that’s neither here nor there, I guess.

Unexpectedly, I have been enjoying the book. I’m fairly ignorant about catholicism, so there’s much to be learned.  She shifts back and forth between a very personal viewpoint, in which she talks about her own experience of religion, and a much more objective viewpoint where she considers the religion as a social and cultural phenomenon.  Her ability to speak objectively is one of the things that has made the book tolerable for me – I generally react badly to preaching of any sort.

The Benedictine lifestyle is an ascetic one, in which your belongings and activities are honed to the essential minimum. This has got me on an organization tear.  Like most Americans, I am surrounded by stuff and am rather overwhelmed by most of it.  The physical clutter contributes, I think, to a mental clutter.  I have been trying to reduce the clutter in small ways, like trying to create paperless filing systems (get bills electronically, save them on disk rather than printing them out, for example).  But I talked to K tonight and he’s agreed to go through the whole house with me, and just do a more major purge. I will donate the stuff immediately to charity because without taking the time to catalog and value it, because if I try to do the documentation (for tax purposes) the stuff will sit there for months waiting for me to have time.  It’s worth it to me – the tax deduction might be worth as much as a few hundred bucks if we really donate a lot of stuff, but the relief of having the job finished may well be worth that to me.  People pay that kind of money to get home organization specialists to come help them with their homes, after all.

Not that I’ll ever be an ascetic, of course, but perhaps it’s time for me to define exactly what I am.

So sad to post a grumpy clinic post so soon after a nice one… I’m on call, at home but have the electronic medical record available to me.

A woman calls asking for a medication to be called in.  I see that she has been calling all week and my colleague (her primary care doctor) has told her multiple times that she needs to be seen in clinic before we give her any more medicine over the phone.  The woman launches into her explanation of her problem; when she pauses to take a breath I told her “I have all of Dr. W’s notes here in front of me, if that helps with our explanation”.  There’s a pause as she absorbs the fact that I’m aware she’s been told three times now that she can’t have this prescription, and that I’m aware she’s trying to go behind her doctor’s back to get something he recommended against. Then she says stiffly “I think this conversation is over”.  I agreed politely. 

Politeness is, after all, the camouflage for one’s real feelings, which in this case were… not complimentary.

On the bright side, I did finish a few tasks today and had a decently productive day.  Too bad the “to-do” list grows longer than the “done” list!

I have posted several complaints about my job, so I thought I’d post a story about why it’s such a cool job after all…

Friday afternoon, I’d wrapped up with my last patient and was looking around to see what else needed doing.  A colleague had one of my patients on his schedule (I’d been full up); I was finished with my schedule, so I offered to see her. 

So… the patient is an elderly lady that I had seen only once before.  The previous visit had been difficult in a heart-rending way – she was deaf, with no hearing aids.  Her cataracts make it difficult for her to see with any precision so she can’t really read lips or make out hand-written questions. Further, she seemed determined to conceal her disabilities, so she’d smile, nod, and make agreeable noises in response if anyone spoke to her.  Effectively, then, it was impossible to get any information from her about her own health.  Her son, who is her caretaker, wasn’t a lot of help – he works long hours so only sees her a couple hours a day.

So amid her attempts to be congenial (patting my knee and saying “I think you’re a sweet person, I really do!”), I practiced my best veterinary medicine, and told the son firmly that he needed to get her a hearing aid. We agreed to meet up again in a few weeks.

Then she developed a nasty bronchitis, and there were several phone calls from the panicked son, unsure whether Mom was delirious or just confused… which led to this follow-up visit.

The good news was that her bronchitis seemed to have resolved, so the main reason for the visit was moot.  In addition, I saw a lovely hearing aid poking out of her right ear, giving me hope that she’d be able to participate a bit more in this visit.  No such luck.  Shouting into the hearing aid didn’t seem to be working – she still gave vague, senseless responses.

So I went about looking her over to be sure the infection was truly gone.  Thumped her chest, listened to her lungs, peered into her mouth and nose and the left ear.  Then popped out the hearing aid from the right ear, and peered in to see a monumental wall o’ earwax.

Popped the hearing aid back in, put my mouth next to her ear, and hollered “Do you mind if I clean out your ear?”

She nodded politely and smiled.

Unconvinced, I tried again “Your EAR needs CLEANING.  Want us to CLEAN it?”

She popped out the hearing aid and handed it to me with a smile, saying “well, they just cleaned it but if you think it’ll help…”

I took it, popped it back in her ear, and tried once more.  “Your EAR.  I want to clean your EAR!”

She gave a baffled smile and said “Whatever you want, doctor.”

With that dubious consent, we popped the hearing aid back out again and dropped in some wax-softening solution.  I went off to take care of other things while my assistant did the irrigation.

When I came back to the room, there she sat, still smiling.  I didn’t see the hearing aid anywhere.  I asked where it was and got the same blank smile.  I looked around for the hearing aid; seeing that I was looking for something, she helpfully started patting her lap and moving things around as if she was looking too – which might have been helpful if she’d any idea what we were looking for.  Eventually we found the thing by frisking her pockets.  I popped the thing back in, cranked the volume a bit, and said in a normal voice “OK, how’s that?”

The most amazing expression of wonder crossed her face.  She looked me full in the face and said in a crisp, precise voice “That’s wonderful!”

Then we had a pleasant conversation with her son (who’d managed to mysteriously disappear for the ear-cleaning ritual then return just in time for the moment of discovery) about scheduling her for cataract surgery. She followed the conversation with delight, participated appropriately, and glowed with joy – until that day, she hadn’t realized that there would be a way to get both hearing and sight back, so she’d been resigned to living out the rest of her life in silent, blurry isolation.

When I helped her to her feet so they could leave, she abruptly threw her arms around me and said “You’re beautiful, you are!” I returned her hug and told her to tell me that when her eyes were fixed, and she laughed all the way to the door.

So I wrote a week or so ago about the patient who called me for a refill of a medication, then when I said she needed to be seen by a doctor she scheduled with a specialist instead of me.  OK, so one way or another she’s taken care of, right?

Nope, she calls in again yesterday for the same medication.  Again I refused it, and offered to see her; when my nurse got ahold of her she said “oh, I have that specialist appointment today”.

I guess she was hoping I’d forget the conversation from a week ago, and would give her the med and she’d be able to skip the specialist appointment. Of note, I’d have seen her within a day or two of the original call.  Instead she’s waited a week – if she truly has this problem she self-diagnosed, she’s been sick for a week now.  Where’s the sense in that?

As long as I’m griping, I’ll mention the patient who was asked to come back in to follow up initial treatment for a rather serious problem.  She skipped the appointment and then called on the phone to “ask a few questions”.  I offered her an immediate appointment; she scheduled the appointment, no-showed again, and called again asking for advice by phone.

Phone medicine is infamous for leading to bad diagnoses and patient harm.  This woman has a serious problem; she needs a professional to help her with that problem.  And, call me crazy, but I think that professional deserves to be paid for delivering that help.

Grumph.

Last night, we had a dinner for the group of college freshmen I’ll be mentoring this year.  So there’s leftovers in the fridge.  The salad seemed most likely to spoil, so I had a big salad around 11:30.  Was starving by 2.  So had another big salad.  It’s now a bit past 3.  Starving.  At least this will finish off the leftover salad!

Walk in, turn in jury summons and sign in.  Sit for ten minutes.  Rise for judge.  Judge spends another 5 minutes mumbling over some sort of paperwork, calls out a couple names (no one answers).  Then judge tells us we can all go home.

Ah, civic duty…

K’s birthday was last weekend and he dealt with it (as he does) by sitting down and engaging me in an long discussion about what things he wanted to accomplish over the next year.  Somewhere on the path of very pragmatic discussions about how we’ll handle getting the dying tree removed and the roof repaired and scheduling time for grant writing and so on, we found ourselves discussing the details of our wedding.  In the midst of putting together a plan for notifying our friends and family, I realised I was engaged. 

Ah, well, I guess I’m just not the “pick a romantic moment and surprise the heck out of me by getting on your knees and proposing” type.  At least this time, the words “Shit or get off the pot” didn’t enter into the discussion…

Also struck by how un-dramatic it feels. Happy, of course, but not particularly worked up or excited.  I’d already decided to spend my life with him, he seemed to feel the same, and getting married just seems like another step in that process. 

So probably will be posting random bits about planning a wedding over the coming months… I understand it’s a big task.  Last time, Mom did it all for me.  Hopefully she can share a few tricks!

Ah, people’s attitudes towards their doc.

Had a call from a patient – wanted me to refill a medication.  I had my staff respond by explaining that this medication is intended to be used once only for a very specific type of infection; if she thinks she has this infection again she should set up an appointment so we can test her for it.  If she has it, we should figure out why she’s had it twice in such a short time.  If she doesn’t, we should figure out what’s making her feel bad and give her a more appropriate treatment based on that.

So the return call simply said she understood and had set up an appointment with X specialist to be evaluated.

Excuse me?  I’m good enough to call in medicines (for no compensation) for your own self-diagnoses, but not good enough to actually pay to come see? 

Uh-oh, I’ve been tagged! This is from ciaracat

1. Grab the nearest book.
2. Open the book to page 123.
3. Find the fifth sentence.
4. Post the text of the next 3 sentences on your blog along with these instructions.
5. Don’t you dare dig for that “cool” or “intellectual” book in your closet! I know you were thinking about it! Just pick up whatever is closest.
6. Tag three people.

First book I grabbed had a list of chapter headings on P 123.  So cheated and reached a little further..

Designing procedures to make errors visible can also improve safety.  Although human beings will always make errors, procedures can be designed so that many errors are identified before they result in harm to patients. For example, pharmaceutical software can alert the prescriber to an incorrect dose or potential interaction with another medication (ref).

OK, that’s a  boring book… Institute of Medicine’ “Crossing the Quality Chasm” report.   Should have known better than to do this at the machine where I work.  Instead, let’s look for the closest “fun” book…

The desk work required of an acting lieutenant had not helped the muscle tone in Jim Chee’s legs, nor his lungs.  He was tired. He stood at the rim, looking across the saddle, dreading the long climb down.

That from Tony Hillerman’s “The First Eagle” which is sitting by my desk so I can print up a book-crossing label for it before releasing it to the wild!

Hm…OK, I’ll do some tagging.  How about follybard, arenson9, and drelmo?  I bet y’all read interesting stuff…