Later in the morning, I received a call from his mother who said she was amazed that whoever had evaluated him at the hospital Emergency Department did not feel he was either homicidal or suicidal. She told me he had threatened to kill her and to kill himself and she was afraid of him. She was refusing to try and bail him out of jail for her and his own protection. She is also leaving for California for two weeks to get away from this area and hopes none of his friends will agree to bail him out. Later in the day, the police did take him to a local mental health clinic who will hopefully admit him for observation; otherwise I fear he is a threat to himself and others. He has been very despondent about his father's recent death from cancer and somehow is now blaming his mother partly for his father's death.

Next, we get a call from another mental health clinic about a patient who had called us in November saying he had left a bomb in our office. You may remember that he then came into our waiting room where he was arrested by the police and no bomb was found. Well now this clinic is calling to tell us that he still has some "medical problems" and would we see him again. Our office manager grabbed the phone from the receptionist and told them emphatically NO. This man has schizophrenia and is still free so no one is monitoring whether he is taking his medication or not; when he called in the bomb threat, he had stopped his medication.

This afternoon, I saw a diabetic who has had diabetes for almost nine years and has not really been very concerned with keeping it in control. Despite dietary teaching and diabetic education, she has chosen to not try and control her diet, to not exercise, and to haphazardly take her medication and check her blood sugars. All of a sudden, she is having a change of heart, wants her diabetes controlled and is now worried that her blood sugars are up to five times what they should be. Unfortunately, she is already showing some complications of uncontrolled diabetes including nerve damage and problems with her eyes. I was forced to tell her that it may be too late to begin worrying about her control but hopefully by getting her into good control we can slow the progression of her complications. I expect her to next develop heart disease and probably kidney failure. She is an example of why I start out with each new diabetic by explaining to them that they have to control their own disease, I cannot control it for them with just medication. I am here to advise them but they are the ones who have to control their disease.

Also today was the woman who lives about 300 miles southeast of here in Oregon who wanted me to evaluate and treat her breast lumps by telephone, the woman with panic attacks who was curled up into the fetal position earlier in the day unable to cope despite medication but did not want me to send her to a psychiatrist for a consultation, the 61 year old woman who works here in the hospital and was finishing up a nine day stretch of working 12 hours a day and was feeling tired and lightheaded and wanted me to tell her over the telephone that it was not exhaustion, and several of my chronic pain patients who wanted me to call in refills for them although the contracts they had signed clearly stated that I would not call in refills, I would only write them after seeing them. These are true stories and all were telephone calls today that I had to answer. See why I just know there is a full moon although with the cloud cover I can't see the moon. Hopefully tomorrow will be better but I don't hold out much hope.

Finally, I am going to close with a joke again. This is two days in a row that I have received a very good joke (in my opinion). I told this one to our medical director who really enjoyed it and is going to tell it to his 80ish year old mother so she can tell it to her Sunday School class. She depends on him for fresh jokes to tell them. Anyway, have a good night everyone and I will see you tomorrow.

Subject: Poor Old Couple...

The little old couple walked slowly into McDonalds that cold winter evening. They looked out of place amid the young families and young couples eating there that night. Some of the customers looked admiringly at them. You could tell what the admirers were thinking. "Look, there is a couple who has been through a lot together, probably for 60 years or more!"

The little old man walked right up to the cash register, placed his order with no hesitation and then paid for their meal. The couple took a table near the back wall and started taking food off of the tray. There was one hamburger, one order of french fries and one drink.

The little old man unwrapped the plain hamburger and carefully cut it in half. He placed one half in front of his wife. Then he carefully counted out the French fries, divided them in two piles and neatly placed one pile in front of his wife. He took a sip of the drink, his wife took a sip and then set the cup down between them.

As the man began to eat his few bites of hamburger the crowd began to get restless. Again you could tell what they were thinking. "That poor old couple. All they can afford is one meal for the two of them." As the man began to eat his french fries one young man stood and came over to the the old couples table. He politely offered to buy another meal for the old couple to eat. The old man replied that they were just fine. They were used to sharing everything.

Then the crowd noticed that the little old lady hadn't eaten a bite. She just sat there watching her husband eat and occasionally taking turns sipping the drink. Again the young man came over and begged them to let him buy them something to eat. This time the lady explained that no, they were used to sharing everything together.

As the little old man finished eating and was wiping his face neatly with a napkin the young man could stand it no longer. Again he came over to their table and offered to buy some food. After being politely refused again he finally asked a question of the little old lady. "Ma'am, why aren't you eating. You said that you share everything. What is it that you are waiting for?"

She answered, "the teeth".

The two ICU patients are actually my associate's who will be off for the next two days and needs someone to look in on them. Since they are in the ICU, most of their management will be by a critical care consultant but I still need to look in on them the next two mornings. My other patient is the one who I am meeting with the family and her, a spiritual care consultant, and a discharge planner. We will be working out details of a plan to keep her out of the hospital but also keep her comfortable during her last weeks of life. She has endstage emphysema and all we can do is support her and make sure she does not suffer. She does not want to return to the hospital, she just wants her death to be dignified and without suffering which is exactly what I want to guarantee also.

Tomorrow night, I am taking my daughter Stacey to Portland to watch the Blazers mop up on the Utah Jazz. We are both looking forward to it. I am especially looking forward to watching the Blazers run circles around Karl Malone who I know has a lot of talent but I am tired of watching him whine and fake fouls so he can get to the free throw line. He spends more time flopping to the court than he does staying upright. It should be a good game and a large crowd.

I may or may not have an update tomorrow night. No promises at this time. You'll have to check back late tomorrow night to know for sure. I've got a lot more work to do before I can call it a night tonight so good bye for now.

You probably already know that the Blazers did mop up on the Jazz 85-75 with the game not as close as the final score would indicate, at least not the fourth quarter. Karl Malone was a non-factor, scoring only about 15 points and missing a lot of the game with foul trouble caused by him trying to keep up with the younger, more athletic Blazers. He tried some of his classic flops and was ignored for the most part by the referees. The crowd in the Rose Garden booed him everytime he touched the ball and he seemed to get very frustrated with the crowd. The Jazz coach, Jerry Sloan, was not around to see the end, having been tossed out of the game for a profanity laden tirade at the referees.

The Blazers, already very deep, found another star last night. Jermaine O'Neal played a lot of minutes and was the high scorer for them. He had a couple of very athletic alley-oop dunks which really fired up the crowd and generally played the best he has played since he has been in Portland. His presence allowed Mike Dunleavy to really rest the other big men for the Blazers and they all had much fresher legs than the Jazz big men all night.

Stacey seemed to really enjoy going, especially the cotton candy she bought and the noise makers that were given away to the people, like us, sitting behind the backboards. I got up this morning to find a note on my keyboard thanking me for taking her. All in all, a very fun time last night.

Yesterday during the day was a different story, however. I went in to round expecting to find two patients to see and be done with them early so I could get to my interview with the physician candidate early. Well, I found that there was another patient admitted to me in the ICU with diabetic ketoacidosis. She was comatose, with her diabetes completely out of control due to a large abscess on her leg as it turned out. Anyway, by the time I got things arranged and saw the other two patients I had planned on seeing, I was 15 minutes late to the interview. She turned out to be an excellent candidate and had a lot of questions so by the time I got finished there I was now 35 minutes late to the office.

I finally got caught up by noon, but then the afternoon fell apart. We had planned on leaving at 4 PM so Delanae had Stacey there right on time, but I still had two patients to see and several charts to dictate. My carefully arranged afternoon schedule had somehow exploded, as they are want to do when I am trying to get out on time. Somehow, I managed to finish all but two of the charts, see the patients, and check on another in the hospital and we still got away at 5:05. No traffic problems on the way so we got to the Rose Garden in time to eat and get to our seats 15 minutes before tipoff. Whew!

This morning, I transferred care of the ICU patient to her primary doctor, saw my one remaining hospital patient (who I sent home late this afternoon), and then got the last two charts from last evening finished as well as the messages that had not been answered yesterday. Thus caught up finally, we embarked on another busy day which ended at 7 PM tonight after I discharged the patient from the hospital.

Today's highlight for me was the new patient I saw this morning. She had her four year old daughter with her and, after discussing her low thyroid state, I found out she and her husband were natives of India and had been here for about three years now. They had just moved here from Milwaukee after having been in Boston and Seattle before that compliments of the company he works for. She wants to go back and finish up her college degree in computer science once they settle in one place long enough for her to do just that. The marriage to her husband had been arranged by her family but, luckily, they fell in love before the wedding. Prior to the wedding, they were only allowed to hold hands, no other sign of affection was considered proper in their culture. They are very happy here in the US and their daughter speaks three languages already, his Indian dialect, her Indian dialect, and English. While in the office, she slipped in and out of each language with ease.

Stacey has four little girls spending the night with her and they are running in and out of here while I am typing this. I am also catching up on my e-mail which has gone unanswered for two days now as well as catching up on the sites of the other Daynoters. Lots of interesting things there, my home coordinates for those of you interested are 46.17665 N and 122.96766 W. Tomorrow afternoon, Delanae and I are going to the Blazers-Spurs games then Sunday we are hosting a Super Bowl watch gathering for some people from our church. All this is going to keep us busy this weekend but I will try to find time to update this site some. Good night everyone.