Last Week



Doc's Progress Notes

Week of February 28, 2000

Last Updated: 3/5/2000 at 7:20 PM PST

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Monday February 28, 2000

I feel like a resident again. That is good and bad; good because it is familiar to me and bad because I am having to learn where everything is and who everyone is all over again. I spent the day admitting patients from the Emergency Department and trying to round on the ones already in the hospital between admitting new patients. I quickly got on first name basis with everyone in the ED, the nurses told me they just wanted to hear me talk because of my accent (and here I thought I had lost a lot of the Arkansas accent). I could stand a little less contact with them tomorrow, not because I don't like them but because that would mean I was not down there admitting as many patients and have more time to see the ones already in the hospital.

So what kind of patients did I admit today? Most had multiple problems and their workup will be complicated and require multiple consultations. The easiest one was a 19 year old girl who needed to be detoxed from heroin before entering an inpatient treatment program on Friday. They do not do the acute detox at this program, that is left up to our hospital. She was accompanied by her grandmother who was there to be certain she complied with the plan. Part of the program is admitting to her grandmother, with whom she lives, that she is a heroin addict and needs help.

Another patient I admitted was a 40 year old man with chest pain that could be heart related but probably isn't. We need to do some tests on him in the hospital to be sure before telling him not to worry about the pain. He does admit to being stressed, having lost his job of 20 years last Friday. I innocently asked him what he used to do, he told me he had been the director of the Information Management Department for the corporation that owns my group. We are continually reminded that we do live in a small town. His chest pain is most likely not cardiac in nature and has been brought on by this extreme new stress in his life. I can't get him his job back and I did not know that he was an employee, much less an ex-employee. I can help him understand that the body is capable of showing stress many different ways.

Tomorrow should be busy again,especially with the new patients I admitted today. I must get things ready now. See you later.....

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Tuesday February 29, 2000

Leap Day.

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Wednesday March 1, 2000

I was too tired to write a post last night after getting home a little after 10 PM. Yes, Leap Day was a very long day with about 15 minutes for lunch and no dinner until I got home. Dan Bowman sent me an e-mail last night asking who had won the game. I replied that the only way I knew the Lakers had won was because I saw the highlights(or lowlights, depending on your point of view) on ESPN Sportscenter as I was eating my dinner. I'm sure the Blazers-Lakers were on TV here locally but I had no access to a TV until I got home, long after the game was over.

The patient who recently lost his job and had chest pain, did go home yesterday as predicted. He had no evidence of heart disease, I believe his pain is entirely stress related but, since his father died young in an accident, we will put him on a treadmill and do a treadmill stress test to be certain there is no gross evidence of heart disease when he is exerting himself.

The girl admitted for heroin detoxification is also doing well. She is looking much brighter and is interacting more with the other patients after being very withdrawn the first 24 hours. Plans are to discharge her early Friday morning so her grandmother can take her to the residential treatment program in Aberdeen.

Another patient I admitted Monday morning appears to have pulmonary hypertension which is a condition where the pressures in her lung arteries and veins goes very high and can lead to heart failure unless it responds to treatment or the patient has lung transplants at some point in the future. Pulmonary hypertension is a disease caused by several things including drugs of abuse like cocaine and metamphetamine and the Phen-Fen diet pill combination used in the past. Hers is very severe very suddenly at age 47 which is typical for the kind caused by the above drugs and she has both abused drugs and used the Phen-Fen combination for about 6-8 months in the past. She is getting a very extensive workup to be certain there are no other causes and at some point she will require referral to a center where lung transplantion is done.

Here at home, we got some very bad news yesterday. Our septic system is going to have to be replaced. Despite the inspection two years ago before we bought this house stating the system was in good working condition, the tank has rusted out and collapsed and will no longer function the way it is supposed to. Actually there were two tanks, with a newer one that had been added about ten years ago also in the same shape. No one can explain why the newer tank was also metal because ten years ago most installers were using fiberglass or concrete tanks which of course do not rust. Depending on what exactly has to be done, the replacement cost will be between $4000 and $8000. Suddenly, all plans to upgrade computers in the future have gone out the window. We will now take this house off the market, after all why spend that much and more on this house and then turn around and sell it and not be able to recoup the money we will have invested in it this year. We can only hope our house in Arkansas sells very quickly so we can pay for these repairs and some remodeling we will try to do in association with the carpet replacement downstairs and the plumbing repairs upstairs. Oh, one more piece of good news yesterday, the company that had allowed us to purchase a home warranty on this house each of the last two years is refusing to renew the warranty for another year. They've had to pay out more than the premium each of the last two years so I guess this house is a bad risk for them.

That's enough for tonight. I need to go to bed so I can get up early and spend another day being a resident again. If you see anyone looking for a family to give $10,000 to with no strings attached, send them our way.

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Thursday March 2, 2000

No update can be posted yet. That's right, for the first time since I started this page three months or so ago, my web hosting service is down. That means I don't know when you are going to be reading this but I will write it anyway. This also means that my main e-mail address is also down so I am using an alternate address, Delanae's e-mail address, or my e-mail address at work. Of course, by the time you read this, my main e-mail address will be functional again so just disregard the last sentence. I'm still a little shell-shocked from the news yesterday about the septic tank.

I finished my IPP week today. Today was actually kind of slow but I have two people left over to send home tomorrow. I am leaving one person for my associate coming on tomorrow and then of course whomever is admitted tonight. It's been fun but I am ready to get back into the office full-time also. I have met a lot of nurses and other hospital staff this week and can now put faces with names and they now know me a lot better. I also have gotten to know a lot of the physicians in town outside and in out group a lot better and vice versa. I will look forward to my next IPP shift but would not like to do it any more often than what we are presently doing.

Plumbing repairs are well underway here. There is a large hole in the master bathroom wall and some pipes have been replaced. The water pressure seems to be better in there already. They have not started putting in the new septic tank yet and it looks like a race to see if they can get it in before we have to stop using our own bathrooms here and find others to use instead (neighbors, health club, freeway rest stops, whatever!).

I must get to work getting the data ready for our accountant so I can get it to him early next week. Unless I am completely wrong, we should have a refund which will help pay for the new septic tank. Later...

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Friday March 3, 2000

As you can see, my page is back. Now word yet on what happened but the servers were still down at 6:15 this morning. Everything, including e-mail, is working fine now.

It was good to be back in the office today. Kathy and I got mostly caught up from not going through all the paperwork all week and I had a steady but not overly hectic day. I discharged the last two patients I was responsible for from my days as IPP so I have no one to see at the hospital this weekend.

Delanae has a big auction to go to tomorrow. Actually, the auction is done by her radio station and the stores donating the items get advertising credit based on the value of the item. Then, she gets commission on the price that the item brings in the auction. That way, both she and the station come out winners. She has put in a lot of work on this over the last month. Besides her, Stephen is helping with the moving of the items and will get paid for that. Stacey helped by doing a commercial for one of the stores donating items. When I heard my little girl on the radio she sounded so professional even though it was her first time to cut a commercial. She's sounding more and more like her mother each day.

We're still waiting on the new septic system. The company installing the new tank needs a crane to lift it into position and they are waiting for the crane operator to be available to do this. In the meantime, they are coming back tomorrow to pump out the collapsed tank(s) so we don't have a repeat of the episode in December when the septic system backed up onto the basement carpet. Hopefully, the new system can be put in next week.

Tomorrow looks like a full day for all of us. I need to get our tax data ready to send off and you already know what Delanae and Stephen are going to be doing. I'm also putting some new memory into Delanae's computer. See you tomorrow....

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Saturday March 4, 2000

For some reason, computer memory and I don't get along or something like that. After taking the kids to the auction today so Stephen could help with the moving of items and Stacey could help her mother bid on items, I came home and finished doing the tax data. I am finished with everything but Delanae's mileage which she has stored in a program at work and promises to get to me next week (after the auction). After finishing that and a letter that needed to be written, I set about adding the memory.

First, I had to spend a few minutes finding how to get into the Packard-Bell case. I was tempted to use brute force but found the screws on the bottom of the case which allowed easy access. Then, I found the memory expansion slots and realized both were filled with 16Mb DIMMS. I had a new 32Mb DIMM from Crucial that was specifically for the motherboard in that computer and I had wanted to upgrade the computer to 64Mb with this. Obviously I could not, so I settled for installing the new DIMM in Bank 1 and left the old DIMM in Bank 2. Well, on rebooting the computer I now only had 24Mb of memory according to the Award BIOS and Windows, not the expected 48 or even the default 32. Being resourceful and reading the instructions from Crucial which said if only half the new DIMM is being recognized, then try switching the modules, putting the new one in Bank 2 and the old one back in Bank 1. I did this and now I only had 16Mb according to the BIOS and Windows. Drat!!!!!!

Thinking that maybe I could get back to the original 32Mb I put back the original DIMM's and rebooted; now I only had 8Mb according to the BIOS and amazingly Windows booted with that little memory. I rebooted again, don't ask me what I was thinking then, and now Windows would only boot into SAFE mode, when it tried to boot into regular mode I got an error saying invalid VXD call to a certain device and suggesting that I run Windows Setup again. This computer has a bad CD-ROM drive so I can't use the Windows CD to run Setup at the present time so I can't reinstall Windows. I have now gone from having a machine that ran fine with 32Mb of memory to one that won't start Windows and only thinks it has 8Mb of memory, all in the space of about one hour. I have given up for the night, and probably the weekend as I need to write my article about MD Consult tomorrow since the deadline is Mar 10, not the 13th as I had originally thought.

Delanae had a great time at the auction and came home with a new chair for downstairs, a new sewing machine for Stacey, a leprechaun doll for Stacey as payment for doing the radio commercial, and a small telescope so we can see the ships passing on the Columbia River better. She has also graciously forgiven me for what I did to her computer, I have offered her the use of this one until hers is operational again. She will use this one to update her web site and check her e-mail. She is very tired now, so we are going to sit on the couch and watch a movie.

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Sunday March 5, 2000

The article is finished and sent off. I ended up writing about 850 words which fit into the 500-1000 word format that was asked for. With it went my picture and a short bio to be published with the article. I will post a link to it when it is published in the online edition of the journal. The actual bound journal comes out April 10, I believe, so it will be some time after that.

It looks like we have a pregnant hamster. Actually, Stacey has what appears to be a pregnant dwarf hamster. She found the two hamsters "mating" and now one is acting like pregnant hamsters do according to the hamster book that came with them. I have not done a pregnancy test on her(?) but we should know soon if the diagnosis is correct. The book says that they can have from 2-15 babies at a time. Stacey wanted to take the hamster to the vet for a checkup but I think I can handle this problem. I would like to find a way to sterilize the hamsters so this doesn't happen again. I don't have microsurgery instruments so I think surgery is out of the question. Anybody looking for a dwarf hamster as a pet once it's weaned?

Delanae's computer is still sitting there turned off. As predicted, I have not had time to do anymore with it and probably won't at least until Wednesday at the earliest. She tried to get onto her site earlier but their servers were down. As soon as I finish here, I will let her try again and also get her e-mail.

Tomorrow, I have two hospital patients to see then our monthly group meeting at 7:30 AM. Following that is an all day Leadership Council "retreat" at one of the local restaurants' meeting room. We will be discussing plans for the upcoming fiscal year including converting to electronic medical records and installing desktop computers in every exam room. Following that, we have worship team practice so tomorrow will be another long day. I must go and get ready for it now.

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