Last Week



Doc's Progress Notes

Week of April 3, 2000

Last Updated: 4/9/2000 at 10:45 PM PDT

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Monday April 3, 2000

Michigan State certainly proved they were a better team than Florida in tonight's NCAA Championship Game. Congratulations to the Spartans but I am sure that Florida will learn from this experience and be back in the title game again, perhaps versus Arkansas for the national championship in the future. Michigan State will have to rebuild however so it may take them longer to get back to the Final Four. </end sports commentary>

I was wrong. The boy from across the street suffered a fracture of the shaft of his left femur rather than the surgical neck. He did have a rod put in yesterday, the surgery was successful and he is doing well. I went by and checked on him today and his mother and I talked about the accident. He will have to be on crutches for six weeks with only minimal weight on the leg but should have a complete recovery. As it turns out, just the day before he had had a wreck on his bike and already had scrapes on his right leg.

The Leadership Council voted to offer a contract to the oncologist inviting her to join our group. I voted with the rest of the Council after hearing more information about the business plan and projections for how many oncologists would be needed in our area. I also found out that the only oncologist in the area not affiliated with our group is very likely going to leave the area after June 1. Given this new information the correct decision was to bring in another oncologist.

The hospital service today was slow. Of course, the whole hospital is slow probably due to this week being spring break for the high schools throughout our area and the near 70 degree(F) weather we have had for the last 4-5 days. I only had three patients to see all day, one of whom I discharged and the other one I admitted this afternoon. Forgive my pessimism but the admission was probably a waste of time since it is the ninth admission for him to be acutely withdrawn from heroin, the second in a week. He has been using heroin since age 13. He is now 29 and has heart failure due to the multiple drugs he has been addicted to. Despite this, he keeps going back to the heroin despite all types of addiction treatment programs in the past. The last time he simply walked out of the hospital and went straight back to the heroin which is what I expect him to do this time. He says that nothing we give him gives him the "high" that heroin does. This is true, of course, and it is something he will have to overcome if he ever wants to truly get off the heroin.

I am finally getting over this virus. Stacey has been fine today so it looks like she will get off lighter than I did. The weather is supposed to change tomorrow so I may be busier and I should be better able to handle it now. See you tomorrow...

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Tuesday April 4, 2000

No update.

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Wednesday April 5, 2000

As you have no doubt seen by now, there was no update for yesterday. I chose to sleep rather than write an update. I may be compulsive but not THAT compulsive. Delanae may argue with that last statement, however. During the time I normally would be writing in this journal we were instead discussing child rearing. No, not arguing, just making sure we were being consistent in what we were telling the kids. Stacey, who will be twelve next Tuesday, is beginning to test her limits just like her brother has been doing for several years now. It is a shock for both of us to see our baby girl one moment be very affectionate and the next moment saying she didn't like us. Ah, the joys of puberty!

The hospital service has picked up some but is nowhere near as busy as the last time I did it. Most of the patients at the present time are in for detoxification from one or more substances they are abusing. In this case, abusing means they are sacrificing everything(homes, families, jobs, etc) for the next dose of their substance of choice. Most of them have gone through this multiple times before and relapsed. We keep doing it though in hopes that this time will be the time they are able to get off the substance and stay off it. Odds are that for most this is not the time. I wish there was some reproducible way to predict with reliability if this was going to be the time they would stick with the treatment program. If there was, maybe those of us who have to see these patients over and over would not get so cynical about their chances of success. This cynicism is something we have to fight daily, trying to keep an open mind about these patients who consume so much of our time and resources.

What resources you say. Well, take for example one patient who is currently in. This is his ninth admission that I can count within the last two years, his second in the past two weeks. He is basically homeless, has no income source, and no possessions since all the money he can somehow muster goes to pay for heroin. Every time he says he is ready to stop using the heroin, he comes in for acute detox which is paid for by Medicaid funds. Then, arrangements are made for heroin treatment program, in his case a methadone replacement program which will again be paid for by Medicaid. He does not show, goes back to heroin and the cycle begins again. Medicaid is funded by our tax contributions of course, so his repeated hospitalizations are being paid for by all of us but since he does not work he is not contributing anything toward this cost. The hope, of course, is that one day he will, with treatment, become a functioning member of society, helping, with his taxes, to support Medicaid also. Well, he is not there yet. In his case, he may never be since he has a failing heart due to damage from the heroin over the years. Even if he is able to finally get off the heroin for good, his heart may not allow him to be employable.

What about time? A real life example. Tonight, I was supposed to pick my son and two of his friends up at 6:30 PM to take them to youth group at our church while the adult service was going on. At 5:45 PM I finish admitting a 15 year old girl with a severe asthma attack (by the way, she had just finished treatment for substance abuse also but that is beside the point). Then, I get a call from the Emergency Department saying that there is another alcohol abuser who wants to admitted again to get off alcohol. She had finished a two month inpatient treatment program two weeks before then went home and started drinking again (her pattern for the past 15-20 years as it turns out). This was her seventh trip to the ED in the past three days and now she wanted treatment again. Ask yourself how successful she will be in treatment this time. Anyway, I finally left the hospital at 6:40 PM and I still have more work to do in the morning regarding this admission. I try very hard not to resent this probable waste of my time and energy (here I am getting cynical again) and am very aware that if she had been having a heart attack I would not be complaining a bit about having to stay late and being late to pick up my son.

So, do I have an answer? No, I just needed to vent and you were lucky enough to come to my web page and read this. Thanks for allowing me to vent and I can only hope that tomorrow will be different but I doubt it.

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Thursday April 6, 2000

Short post tonight. Delanae and I just got home from a dinner for a recruit. She is from my home state, Arkansas, and is looking at opportunities here in the Pacific Northwest. Her husband is from near Portland originally and would like to return to this area. They both seemed friendly and interested. The real interviews will be tomorrow, tonight's dinner was really a get acquainted, unwind sort of dinner after they had had a full day of travel and real estate tours. Their biological clocks are still two hours ahead of ours so they are really tired.

My four days of hospital service are now over. The 15 year old girl with the severe asthma attack is better but still in the intensive care unit. The substance abusers are still in the hospital, one should be discharged tomorrow. He still says this time is different than all nine of the other times, we will see. Last night's vent helped me, I was able to deal with them rationally again today. Delanae made the point today that few of my readers would have much sympathy for me given the income we physicians make. Actually, that was not the point I was trying to make, that my readers should feel sorry for me. My point was more how much can we as a society and a nation afford to spend on people who go back to their addictions after multiple thousands of our tax dollars or private insurance dollars are spent on their treatment. These moneys are being spent multiple times on the same patients over and over. I was also venting about my frustrations with the time and energy I sometimes feel I waste on repeated efforts to get them to change. I know the potential for success is less than 50% and yet society still expects us to try, at least at the present time.

Tomorrow afternoon, I head to Eugene for a conference tomorrow on internet usage by physicians. I am driving down with our medical director and we will be having a dinner tomorrow night with the chief executive officer of the corporation that owns our group. We will be driving back right after the conference ends Saturday afternoon so I will not have an update tomorrow night. Hope everyone has a great Friday and it looks like our weekend here will be sunny so hopefully we can get the garden spot tilled Sunday afternoon after church.

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Friday April 7, 2000

Out of town at a meeting so no update today.

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Saturday April 8, 2000

I'm back from Eugene. The meeting focused more on what is available on the Internet for practicing physicians now and what the future likely holds. There was not a lot of technology discussion, mostly how medical professionals could use the present technology better. There are still many physicians not using e-mail to communicate with their patients. One speaker told how using e-mail had freed up time for him to spend more time with the patients in the office. Using e-mail had cut down on the number of phone calls and the time it took to answer them. This was all very evident to me but was revolutionary to some at the meeting.

The speakers also talked some about the future use of the Internet for health care. There are beta software packages for allowing patients to access their own medical record on the 'Net. One is being tested in the Portland area but so far only about 20% of patients with the access to their record are actually logging on and looking at it. My company's vision is that one day the medical record will be a community health record, open to all who need the information to care for the patient as well as the patient themselves. To integrate all the data from many different sources is still the stumbling block in building this CHR. Chances are that the attendees at today's meeting will be pioneering some new ideas in their respective healthcare organizations.

We went to our neighbor's house tonight and brought back his tiller to till up the area to plant a garden in tomorrow. Hopefully, the weather will hold and it will be dry and sunny tomorrow afternoon. I managed to get home early enough to rake off all the large rocks and pieces of wood. There are still small rocks however so tilling may be very slow tomorrow.

Time to go to bed now, we have to be at church early tomorrow since our worship team is leading worship tomorrow. See you later....

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Sunday April 9, 2000

Move over Brian and Marcia, we now have a garden spot tilled up. I accomplished this today and it looks good if I may say so myself. While I had the tiller running, I also tilled up some areas so Delanae can plant some flowers. Now we will put some fertilizer on the garden section this week, retill it next weekend and then plant vegetables. I am anxious to try and grow some tomatoes again in honor of my father who used to have a huge garden every year. I hated working in it when I was young but now miss the fresh vegetables tremendously. This year will be a learning experience for us since we have never put in our own garden before.

Also today, we moved furniture around in preparation for getting our upstairs carpets shampooed which is another task in the cleanup. We took advantage of the moving to change our bedroom back like it was over a year ago. It seems to give us more room and opens up the room some. My back will probably be sore tomorrow with the furniture moving, tilling, and some use of the pick and shovel to replant a couple of shrubs and level out part of the garden spot.

I forgot to tell you last week that my patient with the abdominal pain that we thought might be appendicitis did indeed have appendicitis. He had his surgery last Tuesday and the surgeon found a ruptured appendix behind the colon where it had basically walled itself off and there was no collection of pus. That is why his white blood cell count never went up and he had no abscess on CT scan. His surgery is curative and he should have no further problems now. He went home on Friday, doing well.

Tomorrow I begin my day with a 7 AM meeting again, then I am on call tomorrow night. This will make for a long day tomorrow so I am going to close now. Hopefully, I will get a chance to add something tomorrow but since I am on call, no promises. Have a great Monday!

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