Doc's Progress Notes
Week of March 20, 2000
Last Updated: 3/26/2000 at 10:05 PM PST
Today began slowly but built up to a crescendo before it was over. I had no one in the hospital this morning so I was able to check out the other Daynoters sites from my work computer before I saw my first patient this morning. I was also able to go through the small amount of paperwork left over from the urgent care clinic this weekend and from the office Friday. Then, on to see my first patient and start the morning. I had a couple of no shows after that first patient but compensated for it by having a workin patient who ended up having to be admitted. He has abdominal pain which will probably turn out to be diverticulitis but he needed pain control and bowel rest so he is in the hospital on IV fluids and antibiotics.
I got caught up again and was able to eat a fairly leisurely lunch for a day at the office. Then, this afternoon the day came to a crescendo. I was steadily busy all afternoon then had a new patient show up 45 minutes late. He had been referred to me by the Emergency Department social worker who had set up the appointment and his transportation. Unfortunately that transportation was late so he showed up at the office very late. This social worker did not bother to call me and tell me any of this, however so I was going merrily along thinking I was on time. When I went into the room and looked at the chart I knew this was not going to be a simple visit. This man had had chronic pain for 14 years due to multiple trauma to the face and was on, literally, fifteen medications, all of which he needed new prescriptions for. Besides writing the prescriptions, I had to go through his entire history and talk to him about a narcotic contract and change some of his medications around some. All this took an hour, which made me that late seeing my last patient who patiently waited for me through all this.
After finishing up with the last patient and dictating the three charts I still needed to dictate and going to check on my patient in the hospital, I was able to get to worship team practice at seven. Unfortunately, I did not get to run and enjoy the almost sixty degree day with sunshine this afternoon due to the above story. Tomorrow, I won't have time to run because I am on call and that begins at 6 PM. So, I will now miss two nice days in a row, then Wednesday the rain will be back.
To top of this day, the carpet installer did not come today which means he will come tomorrow which means I will be trying to move furniture around tomorrow night sometime after 11 PM unless I am back at the hospital admitting someone. GRRRR!!!! And this day had such a promising start. Don't expect an update tomorrow.
Another beautiful day here again, or so I was told, and I missed it again. It was in the low 60's and sunny with no threatening clouds according to reports. Me, I didn't even see the sky all day and did not get finished early enough at the office to run before I went on call. I am now home doing this between telephone calls hoping I won't have to go back to the hospital tonight.
My hospital patient is a mystery. He is still having abdominal pain and fever and this may turn out to be appendicitis although his pain is mostly in the left side of his abdomen and his white blood count is normal still. With appendicitis, the pain is normally on the right and the white blood count is high. Unfortunately, not every patient reads the textbook so they don't always have all the classic symptoms and signs of appendicitis. There is no single test for appendicitis, if the surgeon is suspicious enough, the appendix has to be taken out to make the diagnosis for sure. If this man's abdominal pain and fever are not gone by morning, he will end up having his abdomen explored to see if he does have appendicitis. We don't want him to have a ruptured appendix, if it can be helped.
I spent some time today calling other physicians about my new patient from yesterday with the chronic pain. I was calling to check up on his story and his use of medications in the past. So far, he checks out as legitimate.
On the home front, we now have two rolls of carpet downstairs but none installed yet. At least I don't have to move furniture tonight but now I am beginning to wonder just exactly how long this installation is going to take. We are paying him by the square yard installed though not by the hour but we would like the carpet in before the weekend so we can move furniture around this weekend.
Just answered three more calls between paragraphs. At this rate I had better post this before I have to leave again. See you tomorrow.
Sorry for not moving the most recent tag yesterday, it stayed pointing to Monday rather than yesterday. Delanae called this to my attention this morning. I just forgot to move it last night.
Last night quieted down after 11 PM. I did not have a call after 11 PM which means I got to sleep until 7 AM this morning. You cherish the nights on call that that happens since it doesn't happen often. I only admitted one patient last night and she belongs to one of my partners who took over her care this morning.
I went in and saw my patient who is much improved. His fever has come down and he is less tender. The surgeon and I want to wait now and see if he continues to improve. Then, we will do a barium enema to see if he indeed does have diverticuli which are little pockets that develop off the large intestine or colon. If he does, then we will simply treat him with an oral antibiotic for a couple of weeks; if he does not, that means he has had a case of appendicitis which he is getting over and will need an appendectomy in 4-6 weeks to prevent recurrence. Yes, it is now known that a few people have appendicitis and recover from it without surgery. The numbers are low enough, however, that surgery is still recommended on an acute basis for more than 95% of the patients with appendicitis. The reason is that most patients who have appendicitis will perforate their appendix and end up with a generalized infection of their abdomen called peritonitis if their appendix is not removed acutely. Peritonitis was uniformly fatal in the days before antibiotics and still has an unacceptably high rate of mortality.
After seeing my patient, I went by the medical records department and signed the charts that needed signing and dictated a couple of charts that I hadn't gotten to do at the time the patients were discharged. This keeps me current and allows the hospital to get a bill out to these patients and therefore get paid as soon as possible. The bill usually goes to an insurance company rather than the patient but payment is still accelerated this way. Incomplete charts can stack up quickly if a physician doesn't go by on a regular basis and sign them. Unfortunately, not all physicians do this so the medical records staff spend a lot of time trying to get them to come by and take care of their charts.
Then, it was time to go and get my teeth cleaned at the dentist office. I am having to have this done every three months for a while since I make plaque very fast and have had some fairly significant gingivitis which is now getting much better. It is not much fun but is necessary. Then, off to get my hair cut and pick up my new glasses. After that, it was back to the hospital for the monthly meeting of my team of physicians with the clinic manager. Finally, I got to come home and run in the rain and now I have time to do this update before church. Unfortunately, we still don't have any carpet installed downstairs. I will talk to the wife of the man who is supposed to install it tonight at church and find out what the problem is. We have furniture to be moved onto our new carpet this weekend and two offices to set up.
So, that is how my day has gone. After church tonight, I have some bills to pay then tomorrow looks to be fairly routine, at least right now. Check back tomorrow night and see how routine it was.
Short update tonight since it is so late. We spent this evening moving furniture around again since one room downstairs now has carpet down. We had to move furniture out of Stephen's bedroom so it can be carpeted tomorrow (hopefully). With any luck, tomorrow night and all day Saturday will be spent rearranging downstairs and putting it back together right. It looks to be rainy both days and nice Sunday so Sunday will be a good day to rest and, hopefully, enjoy some sunshine. I hope my back holds out with all this moving planned.
My hospital patient continues to improve. He is trying to eat regular food tonight and tomorrow morning and if he doesn't run any more fever, his white blood cell count stays down, and he doesn't get bloated eating the food, I will let him go home tomorrow on oral antibiotics. He is most likely still going to require an appendectomy in six weeks or immediately if he worsens.
Tomorrow's coming soon so I will close now. Hopefully, I will have time to write more tomorrow night. See you later....
Looks like I missed putting up an update last night. It was a long day consumed by patients and by the time I got home all I wanted to do was "veg out". I did run before I came home so I did not get home until after 7:30 PM. Stephen had a friend stay over for the night even though they both had to sleep on the floor since Stephen's bed cannot be put back up until the carpet is completely down in his room. That will hopefully be Monday. The pizza was cold by the time I did get home but I was hungry enough to eat it that way, then Delanae and I sat down and watched a movie ("Inherit the Wind"). After the movie was over, I was too tired to think about writing anything so we went to bed.
Since the carpet is not down in all the rooms yet, we could not move any furniture today. Instead, we spent the day "landscaping" the back part of our property. Delanae hates vines and wild blackberry vines especially that try to choke out the rhotodenrons so she spend the afternoon removing the vines that had grown back over the winter. Stephen and I replanted some trees that had to be dug up for the septic system installation and mapped out the new location for the fire pit. We also now have room for a garden spot so we will be renting a rototiller in the very near future to till up the spot and start planting. We probably need to do that here in April. The rain doesn't stop until after the fourth of July so everything is later here than it is in Arkansas. My father always had a huge garden, even after it was just two people at home. This will be the first time we have attempted anymore than a few tomato plants. We will have pictures posted as soon as the garden is in; I know Brian and Marcia Bilbrey will be interested in them <G> even if no one else is.
We will have to do the rest of the landscaping in stages over the next couple of years or so since we cannot afford to do it all at once. Now that we have decided to stay in this house, we will spend some time and money on the property but again do it in stages and not all within the next year. We still have a new septic system to pay for before we can spend any money on landscaping.
Almost forgot to tell you that my patient with the abdominal pain went home yesterday. He will be on oral antibiotics and I will see him back Tuesday and order some sort of contrast study of his colon to see if he has appendicitis, in which case he will need an appendectomy in about six weeks, or diverticulitis, in which case he will not need the appendectomy. Of course, if he has fever, increased pain, or his white blood cell count is going up then we have no choice but to operate.
Tomorrow is supposed to be sunny here, so we are planning to go to the lake in the center of town after church tomorrow and take some family portraits again. We'll keep praying that it actually turns out to be sunny. See you tomorrow...
Today did turn out to be sunny with the high in the low 60's which is warm for this time of the year around here. It will be raining again tomorrow, which is good for the replanting we did yesterday. Then, cooler until Thursday when it is supposed to warm up again to near 70 F before cooling off again for the weekend. How's that for a five day weather forecast?
We did go to the lake and take pictures today. You can see them at Delanae's site here. At least you can see the ones taken with the Sony Mavica, the more traditional ones have not been developed from the film yet. One of my partners and her husband happened along and took some of the pictures for us, but none of the ones you will see, the ones with all of us in them were taken using the timer feature of the Mavica.
After the modeling session we had a business meeting of our church. In keeping with our tradition of being a nontraditional church, the meeting was held at a pizza parlor a couple of blocks from the church. Nothing controversial was discussed, the church is in better financial health than a year ago which is a relief (but more of one to our ministers).
After the meeting, we came home where I graciously let Delanae use the computer first. I watched the Academy Awards show and did some laundry while she was working. Now, it is my turn to write this quickly so I can get to bed because tomorrow is an early day with a Leadership Council meeting beginning at 7 AM. Sorry for the short update, but that about sums up my day. See you tomorrow...
Send any questions or comments to:
Copyright © 1999,2000 Jim Crider All Rights Reserved