Doc's Progress Notes
Week of June 19, 2000
Last Updated: 6/25/2000 at 10:05 PM PDT
Lots of chest pain today, very little else. All my admissions to the hospital today were because of chest pain. They ranged in age from 43 to 90 and most were women. I don't think that all of them had heart pain or angina, most had chest pain that was not related to their heart. No one had a heart attack and the 43 year old went home late this afternoon after we ruled out angina for her. The rest will probably go home tomorrow or maybe Wednesday at the latest.
My patient who had the operation because of the obstructed small bowel will go home tomorrow. He is now eating regular food and had his first BM today in more than a week. He says the food never tasted so good and the ...... well you can fill in the blanks. He will need to have a section of colon taken out in about three months to prevent this from happening again. By removing the section of colon which has now gotten infected twice in the past few months and caused the small bowel obstruction, we will most likely prevent this from happening again. If it does happen again it has the potential of being much worse and he could wind up having to have a lot of bowel taken out rather than a relatively small amount. Plus, if it is done as an emergency, he would probably require a colostomy (wear a bag on his abdomen) whereas if it is done electively, he would not have to have the colostomy as the surgeon could simply reconnect the two good ends of the colon back together during the surgery.
The Lakers won tonight, proving the West is dominant in the NBA again this season. No surprise, except I wanted the Portland Trailblazers to be the champions. Shaquille O'Neal had a truly MVP season and Finals and I salute him and the Lakers. Next year should be a real war between the Lakers and Blazers.
Today is a slow news day otherwise. I will close now and see you tomorrow.
I missed doing an update last night, did anybody notice? I was just too tired by the time I got home near 10 PM so just crashed on the sofa. By the time I got up it was time to go to bed. I have been more tired lately as I have recently increased my running to get ready for my big birthday physical challenge. I need to do some biking also but there are simply not enough hours in a day at the present. Anyway, with the increased running I am feeling more physically tired but that should pass pretty quickly as I get in better shape. I also know I am not bouncing back as quickly as I did five or ten years ago.
This week has continued to be chest pain week. It seems like that is what everyone has who is being admitted to the hospital. I don't know why that diagnosis is so popular right now but things do run in cycles. One of the patients admitted yesterday, though, was a lady who went to our cardiologist's(heart specialist) office for an appointment because she had been experiencing an irregular heart beat. While sitting in the waiting room her heart decided to go into ventricular tachycardia (an abnormal rhythm not compatible with life in some instances) and she then had a respiratory arrest. A "code" was called to the waiting room and she had two cardiologists, two other physicians, and a variety of nurses working on her. They got her heart "shocked" back into a regular rhythm and then took her down the hall a short ways to the intensive care unit which is conveniently on the same floor as their offices. Tomorrow she will be transferred down to a hospital in Portland to have an automatic implantable cardiac defibrillator placed in her body to stop this from happening again. This device will automatically shock her heart to get her out of her abnormal rhythm if and when it happens again. It probably will since she has an enlarged heart (cardiomyopathy) probably due to a viral infection at some time. As an aside, one of my patients in Arkansas was one of the first in that state to have one of these devices placed and she is till alive now thanks to it. The first few times it went off she would come to the hospital but has stopped doing it now since it is so commonplace. It does deliver quite a jolt to a patient when it goes off.
Today, I took care of a patient who was quite a social challenge. She was admitted during the night after consuming too much cognac, passing out, then vomiting. The problem was she was two months pregnant and spoke only Vietnamese. We managed to communicate with her through an interpreter provided by the telephone company through their language line and found out she was not trying to kill herself or her baby. She was simply depressed about not having any family support so drank the cognac to feel better not knowing it could affect the fetus. Thankfully, the baby appears to be fine and the mother now has an appointment arranged with a counselor who speaks Vietnamese and a physician to care for her during her pregnancy. She has two more children at home and does not know where the father of this baby is.
Tomorrow is my last day as inpatient physician. Friday, I will try and see everyone who could not get in to see me these past four days. I always hear about it when I am gone out of the office for any reason. Just wait until late September when I will be gone almost three weeks between being inpatient physician for a week and my mother coming to visit for ten days. I can hear the grumbling from some of the patients now.
First things first. Congratulations go out to John Doucette on getting a new job. Hopefully it will be one that he loves and will turn into a permanent position unless something better comes along or he wants to move.
I finished up my four days as inpatient physician today. No major problems, actually it was rather slow today. Most of the patients with chest pain have now gone home after we proved it was not heart related. There is one left who will have a cardiac catheterization tomorrow since hers may very well be coming from her heart. She has had previous coronary artery bypass grafting thirteen years ago and may have plugged up one of her grafts since she has not exactly taken care of herself in the interim. For example, she only quit smoking two months ago and has not tried to keep her cholesterol down. We should find out for sure tomorrow.
Stephen's report card came today. There was a time when we were afraid to see his report card. Now, nothing lower than a B and a total grade point average of 3.45 out of a possible 4.0. We are very proud of him for actually raising his grade point average the last half of the academic year. I am proud of him because he is really trying to raise his grades, not just passing. Hopefully, he is catching the vision that for college he needs to have his grades as high as he can get them through high school. He has already told me that he will be taking college preparatory courses his junior and senior years and not just goofing off with courses he knows he can get decent grades in without trying.
Tomorrow promises to be a long day at the office. Kathy, my regular medical assistant, is off tomorrow and the medical assistant who would be taking her place and works in our team is in the hospital recovering from emergency surgery. That means I will probably get someone from another team who is not used to working with me and knowing what I like and what she can do without me telling her to do it. Since my schedule is already packed that will make it a longer day. I told Kathy she owes me big time for this. She just laughed and told me about where she and her husband were going this weekend for a big trail ride. This will be the first weekend in a while that they have gotten to take their horses out on a long ride. However, I wouldn't trade our train trip to Seattle and the baseball game this weekend for anything. Oh, I forgot to tell you that Delanae and I are taking an Amtrak train up to Seattle for the Mariners-Orioles baseball game Saturday. There will be lunch on the train and the train station there is only a couple of blocks from Safeco Field. After the game, we do not have to fight traffic to drive back, just walk to the station and board the train to come home. I have not ridden on a train since I was in elementary school and am looking forward to a relaxing ride up and back and a chance to see the scenery. The weather promises to be warm and sunny Saturday which should make for a great day.
You're right, I missed last night. Yesterday was a long day in the office partly due to my medical assistant, Kathy, being gone. I had to work with someone who doesn't normally work with me and while their basic duties are the same each clinician does things a little differently and gives their medical assistant more or less responsibility. Holli did not know what all I was accustomed to Kathy doing for me without being asked or told to which is not her fault, just the way it is. Therefore, it took me longer to see patients than it ordinarily does and I had to stay later at the office than I normally would have based on the number of patients I saw. No real excitement or interesting stories from yesterday in the office.
After running on the way home, Delanae and I watched Man on the Moon which stars Jim Carrey as Andy Kaufmann. It is a very interesting movie and Jim Carrey certainly did a great job looking and acting like the Andy Kaufmann I remembered. I remember him on Saturday Night Live and remember how strange he seemed on the first one. It was good to reminisce about what was going on back in those days.
Delanae and I are getting ready to go on the train to Seattle for the Mariners-Orioles game. We catch it at 9:30 AM but need to be at the station at least twenty minutes early. I must go get a shower and get ready. See you later today.
As you can see, I did not get back to this journal yesterday. Our trip to Seattle, by train, went well. We got to the station there about thirty minutes or so late so we got to the ballpark at the end of the first inning. The problem with that is that all the runs scored by the Mariners and Orioles were scored in the first inning. The final score was 2-1 Mariners. It was a pitchers duel after the first inning which bored Delanae but I found to be intriguing. Alex Rodriguez came up with a great play to start a double play and save a run one inning. Delanae thought that was great but the rest of the time it was too dull for her. She likes actions sports like basketball.
The train was very slow getting home. The trip home took almost three hours but we did not have to fight any traffic getting out of the Safeco Field area or on the interstate. We got to just sit in the train and drink water or a soft drink and let someone else do the driving. A great way to go to Seattle and especially to Safeco Field. I almost forgot, they close the roof at Safeco Field after the game just to let the fans see it close. It is quite a sight!
Today, after church, was spent outside mowing the yard and weeding the garden. I also replanted a row of beans to see if they will make anything this time. It may be too late for beans this year but it is not staying warm most days. If they are going to germinate it should be now. The corn, lettuce, and peas are growing with me watering them every day.
Tomorrow looks very busy at the office. I have to round on two patients in the hospital and be in a meeting from 7-9 then start immediately in the office. Also, there are only two physicians in our team tomorrow due to vacations so that will mean I will be even busier. It looks like it will be a long day tomorrow. Delanae made raspberry cobbler today so I am going to go have a piece then go to bed. See you tomorrow, I hope.
Send any questions or comments to:
Copyright © 1999,2000 Jim Crider All Rights Reserved