Just before I got to the office prior to the meeting I realized I had forgotten my stethoscope and that it was still sitting at home. I could turn around and go home and be late for the meeting, try to go after the meeting, or try and borrow one from someone else in the office. I chose the latter since I still had three patients to see. Luckily, one of my partners had a spare one and allowed me to borrow it. It felt strange in my ears all day but I made it through.

By the time the meeting was over, it was time to start my office hours so I did not get to see my three patients until noon. I wolfed down a sandwich and then saw them. One was ready to go home so I took care of that discharge and the other two are still hospitalized. One will go home tomorrow if she is able to eat tonight and get up and around pretty much by herself. She is in her early eighties and lives alone so she needs to be able to do most everything for herself. The other patient is a lady with Alzheimer's Disease who is very demented and hallucinating. We have had her in the hospital to start her on medication to reduce her hallucinations and aggressive behavior to her caregivers. We finally have her very near her baseline function I think so will be discharging her on Friday to go to a nursing home near Seattle where she lived most of her adult life. She actually lived on Whidby Island there and the nursing home is on the island. Her husband still lives there but she no longer knows him.

Finally, after I finished at the office, I went home and picked up Delanae and she and I went to worship team practice. There, I got to play bass with the full group for the first time in a long time since the regular bass player is gone this weekend. This was the first time I had played with a drummer in a long time and it was very different. The drummer for the group is a LOUD drummer and really sets the tone and rhythm forcing me to follow him. That is the way it should be but I have gotten accustomed to playing without a drummer so it took some adjusting. I still feel kind of lost but it will work out for Sunday and is a good learning experience.

I met some interesting people today. They were new patients either transferring from the group member who left a couple of months ago or ones who had had no local physician previously. One lady, who was only 39, had seven children, the youngest 12, and six grandchildren, all under the age of six. She said all her children called her daily so I asked how she had time to do anything else other than talk on the telephone. She laughed and said she had a very long cord for the telephone so she could do her household work while she talked. The other one was a man, who with his live-in girl friend, had five children living in the house. They had just moved into a bigger house so the oldest could finally have room for his own bed rather than sleep with his younger brother all the time. The best part of being a family doctor is that you get to meet these families and interact with them.

Tomorrow morning looks busy. I need to go by medical records and sign a bunch of charts and dictate one chart that I know of. Then I need to make nursing home rounds and try to clean off my desk at work a little. I also have to go by the post office, get a haircut, and meet my pastor for lunch at noon. All in all, it looks like a busy day off tomorrow since I need to spend the afternoon in the garden again weeding it before the rain comes back this weekend.

After finishing up nursing home rounds, I went to get a hair cut. When I got there, I was told I was an hour late; sure enough on my Palm Pilot the hair cut was scheduled for 10:30 not 11:30. I had gotten in such a habit of going at 11:30 on Wednesdays that I did not look to see if the time was different. I apologized profusely and she was slow enough at the time that she was able to work me in. I made sure that it is scheduled for 11:30 the next time.

After that, I had lunch with our pastor then home to work in the garden for awhile. Not much more is coming up as the weather has not been warm enough for any extended length of time to allow everything to germinate. I am learning that here in the Pacific Northwest one has to start the warm weather plants indoors to get them to germinate then plant them outside once they have germinated. There's always next year I guess. I will have peas this year and maybe a little corn as well as some lettuce. I will put out some tomato plants around the first of June and hopefully we will have some tomatoes before the summer is over.

I also got to take a nap this afternoon which is an uncommon occurrence on a weekday. It was wonderful and I had a nice run afterward. Worship was very good tonight and the prayer time afterward was also very good. Now, I need to get ready for a busy day tomorrow and I will be looking forward to a long three day weekend coming up. Since it will be raining here we will probably use it to catch up on some work inside including straightening up my office and writing some letters that need to be written. See you tomorrow.

The morning then was steady but not crazy. I did find one note left over from late Tuesday that had not been addressed until this morning and the caller was not told I wasn't in yesterday. Our receptionists are supposed to tell patients who call if we are off on that day and ask if it can wait until we are back. We called the patient's father back and told him about the mistake and that if he felt he needed to be seen to bring him in during the afternoon. We even gave him a time. I then went off to lunch.

After lunch, I come back to find the patient and his father there along with the regularly scheduled patient and another work-in who felt she couldn't wait a couple of hours. So, I was behind before I started. I finally worked through them and hopefully soothed any hurt feelings in the process. I will bring this topic up to our clinic manager again since to not communicate with patients about when they can expect to hear back from us is simply not good patient care. It is something we must go over and over with people who answer the telephone.

Then, I look at the rest of my afternoon schedule and find there is a patient scheduled for cast placement as the last patient of the day and that patient had not been on the schedule this morning. I proceed to ask what is going on and am told by the nurse that the patient had been to the ED the night before with a swollen hand secondary to a fracture and they had put it in a splint. The patient was unhappy with the splint so had called to come in for a cast. Rather than come and ask if it was the proper thing to do, the nurse had simply scheduled him. I proceeded to explain to her that I could not cast the hand if it was still swollen and it was probably still swollen if it was swollen the night before. I then had her call the patient back and explain to him that I would not cast it as long as it was swollen and it would take up to five days for the swelling to go down so we would see him next week when it was the proper time for casting. I then again requested that if there was any question at all to come and ask me before scheduling someone it that you are not absolutely sure about. Was I irritated some by this time? You can bet I was.

Then, another patient showed up thirty minutes late for their appointment and wanted to be seen. She is someone who had never been seen in our office before and had scheduled a new patient appointment before, which is a long appointment, and then had simply not shown without calling us to tell us she could not come. Ordinarily I am very lenient about people being late if they let us know because I am late more times than I'd like to admit. I draw the line, however, with this type of behavior so I refuse to see her. I find out later that she is doctor shopping for someone to prescribe her pain medications and has repeated this behavior at other offices around town.

Finally, I finish up seeing patients and try and return some phone calls. No one is home and the few who are have busy signals on their lines. I don't complete a single call by talking to a live person, only answering machines so they will know that I did call back. So I left a large stack of charts to call back on tomorrow which will make the day before a long holiday weekend even longer. I can't wait to see what happens tomorrow at the office. Details tomorrow night.

Unfortunately I had to leave some phone calls unanswered again this evening as there was no one home when I called back. I will try and call a couple of people back tomorrow but the others will have to wait until Tuesday since Monday is a holiday. None of them had emergencies just questions.

Sorry for the short post but I am getting very sleepy. We had several teenagers in our home tonight to watch a movie with Stephen so I was unable to get to the computer until now. I will try and make up for this short post tomorrow. It looks like rain here so it will be an inside day. Hope you have a great holiday weekend wherever you are.