Scrappy Blog

Just wrote, then revised, then revised again, an email to a fellow who’s rapidly making his way to my “never work with” list.

Hopefully this will shut him up. I don’t like alienating people in my field but if he responds with more condescending bullshit I will have a hard time avoiding an unfriendly response.

Grrr.

Splinters. 

The advice I give to patients who are under the weather is “Stay home from work.  Let yourself rest and get better, and when you think you’re well again stay home one additional day to be sure”.

Granted there’s a few people who will abuse that advice, but most people need permission to take care of themselves.

For example, I hadn’t taken a sick day in over 3 years.

So, I came down with some sort of nasty tummy bug last night.  Wasn’t up to par this AM, and actually decided to call in sick.  And when the office manager asked if I would be back tomorrow, I…. took my own advice.  And cleared tomorrow’s schedule.

So now I can get a good night’s sleep and actually have a day to finish getting well and to catch up on missed work and to clear up some of the debris from sitting around feeling sorry for myself.  Kind of nice, really.

On other fronts, have decided to sell my chipper-shredder.  I don’t use it enough to justify owning it.  Just have to figure out a reasonable way of putting it out on the market…

Started with a productive day; after breakfast with friends I managed to put together a set of recommendations that I’d been putting off for a few weeks. Stopped to pick up a gift at the bookstore and had lunch with my students.  Got another long-standing, niggling task out of the way in the afternoon.

Also managed to drag an enormous pile of brush and branches from my backyard to the front curb:  tomorrow’s “large trash pickup day” which occurs once a month.  I keep forgetting about it so the pile has become rather enormous.  Now there’s a nice empty spot in my yard which will (hopefully) cover over with nice lawn and stop being an eyesore.  The realization that we’ll be hosting a large number of out-of-town relatives and friends in a few months has rather galvanized me to action…  I’m trying to arrange for an attractive home and yard to impress people I don’t see that often.  Which doesn’t really make a lot of sense; wouldn’t it be more motivating to impress the people I see all the time, since they’re obviously more important to me?

So instead I’ll make it my goal to create a garden that nicoleallee will want to sit in on a long, lazy fall/spring afternoon.  When the ligustrum isn’t in bloom, of course.

K has promised that we’ll do a sweep through the house and get rid of stuff we haven’t been using for years, over the weekend.  I’m good with that. However, if I’m to be truly honest about this process I probably should sell the chipper-shredder, which hasn’t been used in a year and takes up a lot of space in the garage.  It was a thoroughly frivolous purchase, after all.

At this point, though, I’m inexplicably exhausted and not feeling great – so will probably sleep early and hope to feel better tomorrow.

I was walking through the med center, enjoying the fact that the weather’s cooled off and glorying in the fact that my meeting ran only a half-hour longer than scheduled. 

Ahead of me I saw K, leading a group of people – he appeared to be giving a bit of a tour or something.  I didn’t know any of the people.  As they drew closer I heard him discussing what a friendly city we live in, how the people are so nice and accomodating, even if you don’t know them. 

So as they drew even with me he barely paused, just reached out and swept an arm around me, planted a big kiss on my lips, then released me and continued on his tour. 

Only a little eeeevil.

A little further along, found a little old man limping along.  “Excuse me, miss, is this the way to the VA hospital?”  He was at least two miles away from the VA, and not looking really very fit.  So I walked him across the street (I’m a regular boy scout!) and to the bus stop, queried the people at the stop about which line made it all the way to Holcombe and Almeda, and made sure they all knew to help the guy get onto the right bus.  He said he had a bus pass so I didn’t bother to give him a dollar for the fare.  He also said he had a ride home after his appointment at the VA, so I don’t have to worry that he’ll be stuck there forever.

The people at the stop were a little reticent at first but this guy starts rambling on about how without our help he would’ve found himself walking in the wrong direction “doing a Gump, you know, like that guy who was in that movie The Right Stuff?  He’s such a good actor…”  I asked “Are we talking about Tom Hanks?” (was he even in The Right Stuff?) and he lit up “Yeah, that’s the guy!” and somehow by now the half-dozen people at the bus stop were all paying attention and all smiled and laughed when he started going on about Tom Hanks… so I think I left him in friendly hands.

‘Cause when you get down to it, this is a friendly city.  It is the kind of place where you can ask a stranger for directions and feel fairly sure they’ll be given.  They may not be correct, mind you.  And they’re likely to contain useful phrases like “turn left where the old Bellaire Theater used to be”.  But they’ll be given.

Now to get some work done…  On call tonight, bleah.

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.