Doc's Progress Notes
Week of June 12, 2000
Last Updated: 6/18/2000 at 9:35 PM PDT
And today started out so well. I was at the hospital by 6:30 AM which gave me time enough to see my two hospital patients and then make my 7 AM meeting on time. One patient turns out to have a small bowel obstruction from what is presumed to be diverticulitis. When he came in on Sunday the physician thought, appropriately so, that he had a diverticulitis that had not responded to outpatient antibiotic therapy. He started him on an IV antibiotic and obtained a surgical consult. The surgeon suggested a CT scan of his abdomen but told the patient there was about an 80% chance that it would be normal or show only the swelling of the colon which is seen with diverticulitis. Well, it showed a small bowel obstruction also so now chances are greater that this patient will need a surgical procedure during this hospitalization. He now has a tube through his nose down to his stomach to drain the fluid and gas off the intestine to see if the obstruction will spontaneously open. He has a pretty good chance of that happening, but if it does not by Wednesday afternoon he will need the operation to relieve the obstruction.
The other patient has a cellulitis or skin infection around his right knee. The source is unknown although he has a scrape over the knee which has not looked infected. He began having pain and redness around the knee Friday and did not improve with oral antibiotic so is now in the hospital for IV antibiotic therapy. There is some concern that he might have an infected bursa over the knee so an orthopedist is seeing him and may have to drain the bursa over the next 48 hours, especially if he develops fever.
Back to the meeting. About halfway through the meeting I get a call from Delanae that the car she is driving will not start. She is parked in a parking lot and the car will not crank over. All the electrical devices work fine but it just won't crank over. I take the Jeep that I am driving and go to it and sure enough it won't crank over for me either. I then call the BMW roadside assistance program which sends a vehicle to haul it to the dealer in Portland for repair. It is a 1995 BMW which is still covered by its extended warranty, thank goodness, so all this is covered by the warranty. I suspect it is the starter that has gone bad but I have not heard back from the dealership yet. Once it is repaired, then I have to find a way to Portland to pick it up and drive it home. I will deal with that when it is fixed. Until then, we are a one car family. Wednesday, my day off, I may have to ride my bicycle if I want to go by the hospital and run some other errands.
Tomorrow morning, Delanae will be taking me to work so I will try and run early in the morning. I have a hospital medical staff meeting at 6 tomorrow night then I will walk to the church for worship team practice. She will have to pick me up late tomorrow night after the practice. I had better get to bed so I can get up and run in the morning.
The BMW has a bad battery. Or, that is what the dealer says was wrong. Delanae has now been in the driver's seat of both vehicles when the batteries went bad. She has a complex about them now. I thought the battery in the BMW was new when we bought the car last summer but the dealership says it is the original battery which is now more than 6 years old. Of course it went bad but it did it between times starting the engine. There was no warning that it was fading, just not enough power to cause the starter to crank over the engine. Just enough power to power the other devices like door locks, radio, etc. Anyway, we get to go down tomorrow and pick up the car. It will have to be a quick trip as we have to be back by 4 PM and won't be leaving until 1 PM. I will ride my bicycle downtown tomorrow morning and meet Delanae there to leave for Portland.
My patient with the cellulitis around the knee finally has accumulated enough fluid on the knee to drain it. The orthopedist took him to surgery late this afternoon to accomplish that but I have not heard how much fluid there was yet. That sure dramatically improve the way his leg looks. Both the orthopedist and I were getting worried because it was not looking better but there was no apparent fluid or pus to drain.
My other patient feels better with the NG tube in draining off the fluid and gas but he is not opening up yet. Unless there is dramatic improvement by tomorrow he will go to surgery tomorrow afternoon to unblock the section of small intestine that is currently blocked. Although he doesn't want to think about surgery, he is getting tired of this problem and wants to get it taken care of.
I went to my first hospital general medical staff meeting tonight. This is the first one in more than two years and it was just like the ones we used to have in Harrison, Arkansas. Only there are more physicians on staff here and more attended the meeting. The meeting was prolonged long past the time it needed to be because some people had to speak up and delay things. Their points were not always very valid but they had to say their piece. Sometimes, what they were saying had nothing to do with what the discussion was really about. Luckily, here the general staff meetings are only held quarterly not monthly like they were in Harrison.
The keys to the cable we use to lock a bicycle to a stand seem to have disappeared since the last time it was used. They are not in their usual place and everyone vows innocence about who took them out and did not replace them. I need the key to use the cable tomorrow when I ride downtown. Hopefully, the keys will turn up in the morning after getting some sleep tonight. Good night.
Long day, short note. I feel like I have been running around all day. We went to Portland and got the car which now runs fine with a new battery. Got home in time to then take Stephen to his appointment this afternoon, then got home in time to grab a bite to eat then go to church. Now I am paying a couple of bills and updating this web site before going to bed. I will have to be up early tomorrow to run, then I am on call tomorrow night so who knows when I will be home. I did get to ride my bike this morning and ended up having to go by the bicycle shop and buy a new cable to lock it to the stand. I have hidden one of the three keys to this lock so no one can misplace all three keys. At least that is the plan.
Tomorrow I meet with our medical director for my annual (I think) evaluation. He has already told me he is going to ask me to take on some administrative work and chair a committee. I am planning on saying yes as I will be given time during the day for the work and I already go to this committee's meetings. We'll see what else comes up. Good night.
I was wrong about the annual evaluation. Today's meeting with our medical director was not my annual evaluation, it was just an interim evaluation. Actually, the main topic was whether or not I would accept the committee chairmanship. I said I would and then I was handed a 12 inch tall stack of data to review and see if I could make heads or tails out of it. I will be paid a little bit extra for this but the position could grow into something with a lot more compensation in the future. It could also become a very thankless position if our group gets into providing an insurance product which I hope we never do.
Here's one for the newspaper. I saw a man today who, Tuesday night, was riding his motorcycle after dark and was struck in the right eye by an owl. He was knocked unconscious for at least several minutes if not longer. He was wearing a helmet but no face shield so he has a lot of bruising around his eye but the helmet probably saved his life. He is having headaches, which is to be expected, and some memory loss due to the concussion. The owl is worse, laying in three pieces by the side of the road. The man's(not the owl's) wife called around to area hospitals when he didn't come home as expected and found him. Neither he or she know who the person or persons who found him lying in the ditch were. He does not remember anything after seeing the owl until he woke up in the hospital. Luckily, there does not seem to be any permanent damage.
Call tonight, so far, has meant answering a lot of phone calls. I have not admitted anyone yet but the night is still young. Unfortunately, one of my partners earlier admitted a 13 year old girl with new onset diabetes. She had to miss her last day of school complete with a party. She will be started on insulin and will need to be on a diabetic diet so her days of eating party food have just been reduced. Hopefully, a viable pancreatic islet cell transplant to cure juvenile onset diabetes will become a reality before she reaches adulthood. See you tomorrow.
Strange night last night. I did not admit anyone to the hospital while I was on call and got no calls after 11:15 PM. I woke up this morning when the alarm went off wondering if my beeper and the telephone were both still working. They were. I am always thankful when a night like that happens. The night before, the physician on call was at the hospital until after midnight.
One of my patients went home today. He was the man with the infected bursa over his kneecap(prepatellar bursitis). He is much better and was itching to go home. He should do fine as he recovers his strength in the right leg lost with the non weightbearing while his knee hurt so badly. My other patient continues to recover from his operation to relieve the small bowel obstruction which did turn out to be due to diverticulitis (an infection in the large bowel or colon). I will not be seeing him this weekend but he should be improved when I see him Monday morning.
Tonight I was taken to dinner by my family to celebrate Father's Day before the kids leave for Arkansas tomorrow. I had salmon penne pasta as a main course but had to bring the choclate cake home in a doggie box because I was too full to eat it at the restaurant. I was told that I had to have the dessert by order of my family and the restaurant. I was also given a tiller with the not so subtle hint that I can work on getting the yard in shape again after the installation of the septic system . I will also use it to get the garden ready for some tomato plants. They need to be planted this weekend while it is finally warm enough that they might grow.
The kids' plane leaves tomorrow afternoon so we will be driving down to Portland early in the afternoon tomorrow. They are still packing tonight and probably will be repacking again in the morning. Stacey invariably packs too much then we have to make her take some out to get everything to fit in the suitcase she is taking. Delanae and I are trying to find an oriental restaurant to eat at after the kids leave. I have been unable to find the address of the one we had heard about and wanted to try. No luck on any of the online search engines yet but I will keep trying. Goodbye for now.
The kids are about to land in Kansas City, Missouri as I am writing this, or at least they are scheduled to. Their plane left on time from Portland this afternoon and it was completely full. No standby passengers were able to get on it. For some reason, everyone wanted to fly to Kansas City today. They left in beautiful weather with the highs in Portland in the upper 80's and low humidity. They are going to where it is hotter with much higher humidity. Another great thing about the Pacific Northwest, when it is sunny the humidity goes down.
After the kids' plane left, Delanae and I went exploring. We found the chinese restaurant we had been looking for since it was listed in the real yellow pages but not the online ones. We also found a walking path down by the Columbia River on the Washington side. We hope to find some other walking and biking paths this summer. There are supposed to be some great ones on both the Washington and Oregon sides of the river.
Tomorrow, I get to mow the lawn by myself for the first time since they were gone last summer. I will also try and put together the tiller and do some work in the garden. Hopefully, this warm weather will make the garden grow some. I still don't have the tomato plants, must remember to get those tomorrow also. That's all for tonight, have a great Sunday wherever you are.
The tiller is operational. It is much easier to use than the one I tilled the garden with originally two months or so ago. I got it together correctly and it started on the first pull. The garden did not take very long with it since reverse works very well. I ended up tilling up a couple of rows of seeds that were not growing so the garden looks much nicer if not somewhat barer. I did get tomato plants planted today and started tilling the part of the yard torn up to put in the new septic system. It is a little too hard to till right now so next time will have to water it first. I mowed the yard this afternoon and Delanae ran the weed eater to get rid of a bunch of weeds around flower beds. The yard is done until next weekend but I will need to water the garden twice a day to get the tomato plants started.
The kids got to Kansas City fine last night. They called about midnight their time to tell us they made it. We probably won't hear from them again for a week or so now although we will send messages to Stephen's e-mail address. Stacey has an e-mail address but never checks it.
Tomorrow, I am the inpatient physician for our group again. That means I have no responsibilities in the office tomorrow, just to the hospitalized patients. As of 6 PM there weren't many but that may change overnight. My patient who had surgery last Wednesday is still hospitalized but improving.
Tonight I am doing some optimizing on this computer. I am cleaning some junk off that was installed by Stephen and which he does not know how to uninstall. Winamp is one offender due for uninstalling since it does not behave nicely and close all its running applications when you exit from the program. I am going to put the MP3's and probably Winamp on a Jaz cartridge and let him run it from there. That way I can free up some more room on this hard drive.
That's about it for tonight. See you tomorrow.
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