Doc's Progress Notes
Week of August 28, 2000
Last Updated: 9/3/2000 at 8:04 PM PDT
Only one more day left until school starts again and the kids do not have to be transported to several places in one day. They will go to school early in the morning and finish with sports at 5 or 5:30 and can be picked up afterward. Delanae will no longer have to spend a lot of her time running around playing taxi driver and I will not have to on Wednesdays. Stacey will be in volleyball until 5 PM and Stephen does not get out of football until after 5:30 PM most weekdays. This week he has practice every afternoon until 5:30 then a practice game Saturday afternoon. I am supposed to be the inpatient physician Fri-Sun but will try and get out of the hospital long enough Saturday afternoon to watch him play for a little while. Stacey is very sore tonight after having to run today and not working out all summer. Tomorrow they have to run a half mile then final cuts will be made on Wednesday. There are about 29 girls trying out for 24 slots so only 5 will have to be cut. Since Stacey is so tall chances are she will be kept even though this is her first year to try and play volleyball.
At work I am still doing a fair amount of sports physicals for kids who obviously are getting them at the last minute and sometimes later than that. Seventh grade and up fall sports started today in all the local schools. I am still doing physicals for football players although none of them have been high school football players. One of Stephen's teammates still isn't allowed to participate in contact drills since he does not have a physical. I don't know who he and his family go to so I do not know why he is so late in getting one.
I did admit one patient today for detox. She is only 22 and uses several drugs and has been in detox and drug treatment before but always goes back to the heroin and crank. This time she has two outstanding felony warrants for robbery and wants to surrender but does not want to go through withdrawal in jail. So, we are detoxing her for a few days then she will go to jail after that. Her husband is already in jail on drug related charges and won't be released until the fall of 2002. I think she faces something like 29 months in jail. Her parents are already raising their three year old son and refuse to let her have him at home as long as she is using drugs. They may even have legal custody of him now. Anyway, it is a sad and frustrating situation for them and, since they are my patients, I have been aware of what has been going on.
It seems that Dan Bowman is discussing Arkansas Razorbacks in his post today. Somehow, he seems to be saying, being an Arkansas Razorback fan equates to being an expert on outdoor cooking. I wish that were true but it just makes one an intelligent person since we know who has excellent sports teams. Unfortunately, there is sadness out of Fayetteville, Arkansas today. In case you have not heard, an English professor at the University of Arkansas was shot to death in his office by a graduate student today who then killed himself (see details here). No motive has been advanced yet and the professor has been described as a friend to all of the graduate students in the department. The real motive may never be known in this case. Anyway, it will be a sad year at the University of Arkansas.
That about wraps up things here. I still have my running to do and some practice on the bass guitar as well as some e-mails to write. Tomorrow looks like a long day as usual but I should be able to get something posted tomorrow night. One last thing, I did get the rear surround sound speakers wired in last night and the room sounds awesome now.
Was today Thursday? It felt more like a Thursday at least as far as being rushed and feeling behind. The stack of charts on my desk seemed to be as tall as it is on Thursday but the calendar says only Tuesday. We had all the clinicians in the office today so I was not covering for someone else. My patient load must be getting larger as there are more and more things to do paperwork wise.
The new hardware for all the patient exam rooms was delivered today by the IT guys. They are desktops systems from Dell but I do not know what is inside them yet as I did not have time to turn one on due to all the waiting paperwork. We are not going to begin using them full time until November 1 when the rest of our electronic medical record system is in place but it is encouraging to see a computer now in every exam room. Starting November 1 we will be able to fax prescriptions directly from the computers as well as print them out. By February we are supposed to have all dictation online so we can look everything up on the computer rather than having to use a paper chart all the time. Hospital dictation has gone online effective last week and we will be authenticating all hospital dictation electronically in about ten days. The clinic dictation is taking a little longer since it is handled by an outside company and an interface had to be developed to import the dictation to the correct patient's chart. That has taken longer than expected according to our IT guys.
School starts tomorrow for both kids. That means they have to start getting up earlier every morning and going to bed earlier at night. Stacey finds out tomorrow if she made the volleyball team or not. She should find out about 5 PM. Stephen's class schedule is wrong, it shows him having the same class both first and second periods. He will have to straighten that out in the morning. He is supposed to be in Spanish first period but it mistakenly shows him in Health both periods. Tomorrow also begins his permanent practice time of 3-5:30 PM, except on game days. Delanae will be routinely taking them to school and picking them up after school and football practice since they both will be at school until 5 PM or later.
Tomorrow I have to make nursing home rounds and do my weekly signing in Medical Records. Tomorrow I may have one chart to dictate also as there is one chart on a patient that was discharged home for me by one of my associates. I may have to also send the patient from Hospice to a nursing home tomorrow. That should all make for a busy morning. Hopefully, the afternoon will be less busy so I can enjoy some of my day off. See you tomorrow.
Both kids got to their first day of school on time today. Neither are home yet, I am picking them both up in about an hour or so and then I will learn whether Stacey made the volleyball team or not. Even if she didn't, at least she tried and I am proud of her for that. Delanae was going to pick them up but she remembered this morning that she had to spend the afternoon at the Longview Country Club helping out with a golf tournament sponsored by her stations for local businesses that sponsor Portland Trailblazer basketball broadcasts on their AM station. Some of the Trailblazer broadcasters and maybe a player or two are supposed to be here to play. She is supposed to be driving a golf cart carrying the refreshments, I think. Anyway, she doesn't know what time she will be finished so I will pick up the kids.
I made my monthly nursing home rounds today. No big surprises today. Everyone is doing about the same. There were no crises that needed addressed. I did find one probably skin cancer today which will need to be taken off by one of our plastic surgeons. It is on the nose of a 91 year old man who had been out with his family the last two months when I made rounds so I had not seen him. The lesion was very obvious to me, don't know why someone hadn't noticed it before me.
My medical records are also current. There was one discharge summary to dictate, as I had thought. My patient, who is detoxing from heroin and alcohol, looks like she will be ready for discharge Friday morning. She has already made it through the most difficult part of the process without any major problem, specifically no seizures from alcohol withdrawal. Our hospital census right now is pretty light. That's OK with me as I have to cover it Saturday and Sunday so the less that are there the better. Also, that gives me a better chance of seeing some of Stephen's practice game Saturday afternoon. By the way, it is supposed to be raining this weekend which is football weather here in Washington.
I must go water the garden before picking up the kids. Maybe I can update you about Stacey later tonight. See you later.
Stacey did make the volleyball team! In fact, she made the "A" team. She's very happy and we are excited for her since this is her first time to play a school organized sport. It does mean more games to go to, however. We have to take the good with the bad. Must go and get to bed, tomorrow morning will come early.
Thursday keeps living up to its reputation. As usual, a long day with the busiest times saved for just before lunch and the time the office is supposed to close. I had a new patient before lunch scheduled as an established patient which mean I had half the time for a patient that would take at least twice the time. Then, my last patient of the afternoon had to be admitted to the hospital. I finally got home a little after 8 PM but only because I left some lab reports unreported to patients on my desk. None of it is critical, it is just a matter of sending them the lab results by mail and a couple need calls about skin lesions that I took expecting them to be benign and, sure enough, they were. I will do those tomorrow morning assuming I have time between rounding on hospital patients.
One of my partners is having back surgery to remove a ruptured disk the middle of September. He will probably be out about 8 weeks. That will put even more of a strain on us, to cover his practice while he is gone. We will manage but we will all have to do extra work during the fall. He did not choose this time and would much rather be working than having back surgery but he has been hurting for a long time and has not been a happy person with the pain. As things work out, Delanae and I will be having dinner with he and his wife and a doctor couple candidate to join us three days before his scheduled surgery. Delanae was remarking about it being his final meal or something like that.
One of my patients today is the husband of one of my partners. She is doing the right thing by not being his physician in addition to being his wife. He had some questions about moles and freckles so she sent him to me for an opinion. I ended up taking one off to be sure it is not an early melanoma which it will probably not be but we will be sure this way. Melanoma has a reputation of fooling you into thinking it is a benign lesion for a long time. I find myself biopsing more and more skin lesions just to be sure.
The weather here has made a big change. Today it was cloudy with rain and drizzle with more rain expected tomorrow. People had sweaters on today as the temperature never made it above the low 60's with more of the same forecast all weekend. It should be good football weather for Stephen's jamboree Saturday afternoon. Last year it was sunny and warm for his jamboree, as I recall. This is more typical end of summer Washington weather, at least on the west side of the Cascades. We closed up the windows in the house tonight and may need the furnace this weekend at night.
Delanae is busy writing a commercial and the kids are doing homework. It is very quiet in the house right now except for Stephen's music playing on his stereo. We should have quiet nights at least for the fall with both kids in sports so they will have to do their homework at night now. Stacey should have more homework this year and Stephen has already been warned that he will. Last night he had homework in four sujects; this after just the first day of school. Sometime he also has to find time to talk to his girlfriend on the telephone but he has strict time restrictions on that and no telephone in his room anymore. Someday, maybe he will earn some of those privileges back but it will be sometime yet.
Bedtime for me very soon. I am getting up earlier since I need to be at the hospital earlier and earlier to get everything accomplished. That means I am getting busier and busier which is good but bad for the personal time. No more philosophizing tonight, see you tomorrow.
Arkansas Razorbacks win 38-0.
It looks like the only way I am going to write an update this weekend is to write one from my office and send it home where I can FTP it to my web page. That is what I am attempting to do so if you are reading this Sunday night or early Monday morning then you know I succeeded in finishing the update. I have been the inpatient physician (IPP for short) since early Friday morning which also means I was on call from Saturday morning at 7 AM until Sunday night at 6 PM. It also means that from 7 AM until 6 PM each of those three days I am supposed to be physically in the hospital. Since my office is physically connected to the hospital if there is another slow time I can come here and do something like write an update for this page. As you may remember, in the early days of this journal I used to do that quite a lot. I have not been able to find the time to do that in a long time, however.
First off, what happened Friday? Let's see, I was fairly busy admitting and discharging patients, two of whom deserve comment. One is a forty five year old man who has had diabetes for five years and came in with chest pain. His chest pain is probably secondary to coronary artery disease(blockage in his arteries). He wants to minimize it but we have the real chance to prevent him from having his first attack. His father had heart attacks in his early fifties and this patient has very high lipid levels and may have even had symptoms of a TIA. He is also hypertensive but does not smoke. That puts him at very high risk for having coronary artery disease and, for that reason, we will be doing a cardiac catheterization on him Tuesday to find out how much blockage he has and to plan treatment. If Monday weren't a holiday or if he had recurrent chest pain here we would do it Monday.
The other patient is also forty five. He is an alcoholic who came to the hospital early Friday morning vomiting blood. After our gastroenterologist did an EGD and saw blood but no bleeding source that he could positively identify in his stomach or the first part of the small intestine and the man had received NINE units of packed red blood cells here in an attempt to keep up with his blood loss Friday morning, he was flown to the Oregon Health Sciences University Medical Center. There they gave him an additional six units but were able to identify the source of bleeding as an ulcer in the first part of the small intestine and cauterize the vessel in the base of it. Saturday afternoon he was transferred back to our hospital and has not bled again. He is going through alcohol withdrawal at the present and has a pneumonia probably from some of the blood he vomited at home getting into his lungs before he came to the hospital. Here, we intubated him to protect his airway from that happening before the EGD was done. Anyway, he has received a total of 17 units of packed red blood cells since early Friday morning which basically means he has had his complete blood volume replaced by now.
I have an ulterior motive for talking about these two patients. The second patient has no medical insurance coverage of any kind at the present while the first one does. We treated the one with no medical insurance as aggressively as the one with medical insurance but who pays for the unreimbursed care? Dan Bowman brought up the subject in his post Saturday but he did not really get to the heart of the matter (probably because he does not have any fire retardant clothing to wear anymore). He suggested that several of his readers had comments about the state of the medical care system in this country. May I suggest that the major problem with the medical care system in this country is how do we as a society afford to do everything that we can do. How do we (or do we) provide equal access to medical care for everyone? By virtue of being a resident of this country, is everyone entitled to all the state of the art technology that can be used to cure disease and/or prolong life? Again, how do we pay for this level of medical care? Do we allow the government to create a national health insurance program for everyone, no matter if they are employed or not, and administer it as well(not) as they have done with the Medicare and Medicaid programs?
I contend that it is the system that we use to finance medical care in this country which is the main problem with our medical care system. That will include medications too. We have a patchwork system of financing, partly by private insurance companies and partly by the government. Caught in the middle are those who cannot afford medical insurance because they do not qualify for government financed medical insurance because they have too much income but are unable to afford private medical insurance. Should we just throw all the money presently contributed for health insurance in this country into some huge pot and distribute it to pay for medical care rendered after that care is rendered? I don't know the answer to this question or any of the other questions but it is something we need to debate in this country. Unfortunately, the politicians in Congress have not been willing to take on such a hot topic. In the meantime, patients like the one whose story is linked to in Dan's post continue to fall between the cracks.
Enough ranting for now, what else happened this weekend? I did manage to get away long enough to go to the jamboree that Stephen's football team played in Saturday afternoon. It was played in rain showers and featured some real lightning. Delanae and Stacey had just gotten seated in the stands when lightning struck a transformer about a block away from the stadium in the full view of all of us on one side of the field. There was a huge BOOM, then smoke in the air. The coaches quickly hustled everyone off the field until the shower stopped, then they went back and finished their scrimmage. Stephen said it was nice to finally be hitting on someone new after two weeks of hitting the same people. His team looked surprisingly good on offense but still need some work on defense.
Today, I got away for an hour to get some family pictures made with the rest of my family. These will be antique sepia styled pictures (I think that is the right term) that were made with us dressed in old clothes then will be retouched by an artist to make them look antique. Delanae has been wanting us to do this for a long time and finally found someone who was coming to town and could do this. If I can get one of the final pictures scanned in I will post it when they are available.
Tonight and tomorrow will be time to catch up on my rest. We have no plans for tomorrow as it will still be showery here and Stephen has football practice starting at 5:30 PM. Delanae and I may have worship team practice tomorrow night, we will have to find out whether we do or not tonight. Hope all of you have a safe and happy holiday and drive carefully if you are driving.
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