Doc's Progress Notes
Week of August 14, 2000
Last Updated: 8/20/2000 at 8:52 PM PDT
I had more than I expected this morning, patients that is. Last night I knew that I had three patients to see today but by this morning I had two more for a total of five. Luckily I went in early enough to get them all seen before my first appointment in the office. One had just had a heart attack but is stable and should do well. He may need an angiogram to see how much blockage he still has in other arteries that could cause another larger heart attack.
The other newer patient is a man who had an infection in his shoulder the last of June and unfortunately the infection got into his bloodstream and caused a weakening of an artery in his abdominal cavity. He therefore bled into his abdomen and had to be transferred to OHSU Medical Center to be cared for by the vascular surgeons there. He recovered from this but had to be on intravenous antibiotic for five weeks afterward. He finished the antibiotic course Saturday then started running a fever early Sunday afternoon. Last night he was admitted and placed back on the antibiotic and his fever went away. This afternoon we found that the intravenous catheter placed in his chest for the five weeks of antibiotic therapy had become infected and was the source of his fever after the antibiotic was stopped. The catheter was being removed by one of our surgeons as I left tonight. The man should now recover without problems but I will reserve the right to change my mind until after I see what organism is growing out from this catheter.
Day one of the survey passed without problems, as far as I know. There was an e-mail going around the intranet about what questions were being asked in the clinics surveyed today. One question was where was the notice of the survey being done posted. Now that is important to know for quality patient care! Now you can see what I was talking about last week when I mentioned this survey would not necessarily improve patient care.
Tomorrow I still have all five patients to see early in the morning and one or two to send home before office hours start at 8:30. I must get to bed early so I can get up early. Hopefully tomorrow night's post will be a little longer but no promises since I will be home late tomorrow night again since it is mens' meeting night. Bye for now.
I am very frustrated by the radiology department in our hospital. It is hard to get the right x-rays done every time anymore. Today, for example, I checked on x-rays that were done Monday and not all the studies that I ordered were done even though it was specified on the order I sent them. In addition, the radiologist complained that I had included no history with the order although I know I wrote some history on the order but it did not get transcribed onto what he saw when reading the film. This has happened more than once to me lately and I have complained before that the proper studies weren't being done the first time. This problem has not been satisfactorily addressed in my opinion so I will keep complaining until the problem is addressed and a solution found. An occasional error is human but this looks like a consistent breakdown in the proper process for doing x-rays.
No surveyors have been in our clinic as of late this afternoon. They were supposed to tour all the clinics this afternoon. We keep hearing that they are here but I have not seen them yet. In my opinion, that is good since they would interfere with our normal patient flow. Surveyors should be seen not heard.
My hospitalized patients are doing well. One went home today, the lady who had the TIA. She has recovered her speech completely and is walking around normally. I will follow up with her in a couple of weeks to go over everything with her and her husband again. They looked sort of lost with all I told them before they went home today. I should be able to send at least one of the others home tomorrow and the other two Thursday or Friday. I will be making rounds tomorrow on my day off since I have so many in the hospital and the kids have their sports physicals tomorrow morning early. They are not looking forward to having to be up to leave at 8 AM tomorrow for the first time in several weeks. They didn't believe me when I told them that was late for me, I have been leaving about 6:30 every morning this week with so many to see in the hospital. That way I can be done before 8:30 so I won't be late for the office.
Today in the office I saw one of Stephen's coaches as a patient. We had a talk about Stephen as well as about the coach's problems. This is Stephen's favorite coach since he is single and just out of college a couple of years. He also teaches history and Stephen had him in a class the last semester of last year. Stephen thought he was a tough teacher but still likes and respects him. The coach likes Stephen also but recognizes he has some problems with saying no to his peers. He does see a lot of potential in Stephen as do we.
I have run out of things to say for now. Therefore, I will close this entry and journal until tomorrow. See you then.
I discharged two more patients today, which leaves me with only one in the hospital unless someone gets admitted overnight tonight. That should make rounds a little shorter in the morning but remember that Thursday always seems to be very busy for me. Stephen and I have to go to a parent-player meeting tomorrow night that is mandatory for all the football players. Their head coach will talk about the upcoming season and I will hopefully get a schedule for the season so I can plan my time off to make the games.
Otherwise, today was a fairly lazy day after running errands all morning. I ran this afternoon when it was in the low 70's, then Delanae and I walked tonight while the kids were at their youth service. Our beautiful weather is supposed to come to an end for a couple of days Friday and Saturday when it will be cloudy with a chance of light rain. If it does rain, it will be the first time in almost two months. We have a group picnic scheduled for Saturday so it would be just our luck to have it cloudy and possibly wet as well as 8-10 degrees cooler than it has been this week. No one could ask for a more perfect summer than what we have had here this summer unless you just love triple digit heat.
It is getting late so I will close for tonight.
Rounds at the hospital were shorter today. I only had one patient to see and he is very stable. He had a heart attack over the weekend and was getting a stress test today before going home. I don't know what the results are yet but he has gone home as of this afternoon. For some reason the cardiologist did not call me after the stress test to tell me how my patient had done. I will have to get on to him for that tomorrow. Since hospital rounds were shorter this morning, I was able to go by medical records and get all my charts signed so I have none waiting to be signed for another two weeks.
The survey is over. The preliminary news is that we won't be surveyed again for three years which is the maximum time between surveys in order to maintain accreditation. Our clinic did not get surveyed although others did. I was lucky enough not to see a surveyor for the four days. Tomorrow, the hospital is sponsoring a special lunch for all employees to celebrate the end of the survey and the two years of planning and preparing for it.
My day in the office was busy but not as hectic as other Thursdays have been. I did not feel as rushed as other Thursdays have been but we saw as many patients as we have been on Thursdays. I don't think we had quite as many refills to do or phone messages to be answered as we had the last two Thursdays. I got finished before 6 PM which is a real change for me on Thursday.
I then went and picked up Stephen after his football fitness testing and took him for some ice cream before the parent/player football meeting at 7. Before the meeting started he did something that really warmed my heart and all fathers out there will appreciate this. He will be sixteen next week and likes to hang out with his friends. Tonight however, without any prompting, when the meeting was getting ready to start he came over and sat down by me rather than go sit with his friends elsewhere in the bleachers. This with no prompting from me. I don't think he even realized he had done it or what it would mean to me.
Tomorrow evening no one has any plans. We will finally get to stay home and relax before two-a-days start next week and every night Stephen will be getting finished after 8 PM which means I will probably be picking him up and not getting home until after his practices are over. This will only be for one week, however, as school starts the following week and he will be practicing after school until 5:30 PM. I will still be picking him up but at the time I am normally coming home. I don't know yet when Stacey's volleyball practices will be but hopefully Delanae will be able to pick her up earlier. We'll figure this out next week. Good night all.
The last paragraph of last night's post mentioned that we had no plans for tonight. Wrong! Stephen asked to go to an acoustic concert by one of the local Christian bands and we decided to allow him to go for two hours as one way of winning back some trust. He accepted the time limit without any resistance and thanked me for letting him go. This means one of us has to take him down and one has to go back and pick him up. So much for staying home and relaxing all evening. Taking him down did give me a chance to run, however.
The reason I did not get to run earlier in the evening is because the sickest patients come in at the most unexpected times. My morning was steady but not overwhelming. One of my patients who I had told I would not prescribe narcotics to again because he had violated his treatment contract with me came back this morning and wanted me to be his physician again. I told him I would not prescribe narcotics for him again and he accepted that and still wants to see me for other problems. So, after lunch some things start to fall apart. A patient of mine had called our triage nurse, who handles phone calls about medical matters during the day then conveys messages to us, and reported that his foot was swollen and a little more numb than usual. She came back to ask me about it and was prepared to tell him to elevate it over the weekend and see me Monday. I told her something didn't sound right and I wanted to see him today. Well, when he came in something wasn't right. He had a cold foot with one toe beginning to turn purple. I sent him up for an ultrasound of the arteries of the leg and he had very little flow below his knee. This is due to gradual blockage of the arteries due to his diabetes and smoking to the point where he has had some sudden closure of the arteries and risks tissue loss (toe and maybe below the knee) if this does not open up. He is in the hospital now, on Heparin which is a blood thinner to try and open up the arteries. If this does not work by Monday, he will probably have to have surgery to bypass the blocked vessels. This man is only 51 but has not taken care of his diabetes for years since he did not feel bad so he figured that the diabetes was doing fine. Now, he risks permanent disability due to the combination of diabetes and smoking. He also has coronary artery disease if he has the blockage in the arteries in his legs, he just doesn't know about the coronary artery disease yet but we will need to study that after his foot has blood back to it again.
Anyway, I spent a considerable amount of time this afternoon getting him the correct study and the vascular surgeon to see him, all the while trying to see a full afternoon of patients. I managed to do it but was not able to finish up at the time I had hoped to so I had to run later this evening. Stacey fixed fish sticks and macaroni and cheese for dinner tonight and I had to be home in time to eat them fresh off the stove. We are asking the kids to fix dinner a couple of nights a week so they can learn to cook for themselves and take on some responsibility around the house. Unfortunately, that means that sometimes we have to have meals they come up with and want to fix because they like them. They are learning from this experience.
Tomorrow is our group picnic on the banks of the Columbia River. Unfortunately, rather than being sunny and warm it is supposed to be cloudy and in the mid 60's. At that park downstream from here about thirty miles closer to the Pacific Ocean, it will feel cooler than that. We are supposed to have good food and it will be nice to spend some time with the other physicians and their families outside the hospital environment. I just pray that it is not raining!
I took the day off from posting yesterday. We did go to the picnic yesterday and it rained on us for about the first hour, then it cleared off and was sunny by windy the rest of the afternoon. We had wonderful grilled salmon with hamburgers and hot dogs for those there who did not appreciate good salmon. It was a nice park that we had not seen before and would like to go back to again. It would be a great place to watch the Navy ships come by on their way to Portland for their annual Rose Festival since the River channel is very close to the beach at the park and therefore the ships come very close to the park. We saw a large cargo ship pass by yesterday and it was almost close enough to reach out and touch.
This is birthday week here. Tomorrow is my birthday and Tuesday is Stephen's birthday as well as my mother's. We are delaying celebrating Stephen's birthday until next Sunday when we plan to take him to the Experience Music Project in Seattle. That is what he wants to do for his birthday and will be our gift to him. We hope to arrive there just after they open on Sunday morning so we can see a lot of it before the crowds hit.
It will also be a very busy week with Stephen having twice a day football practice through Saturday which means we will have to get him back and forth twice a day. His second practice most days will not be finished until 8 PM which means he and I will both be getting home late. I also have one call night this week, Thursday. Luckily, school starts next week and practice will be from 3-5:30 PM daily so I will be able to pick him up after work most days.
There may or may not be a post here tomorrow. I will see how tomorrow unfolds.
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