Doc's Progress Notes
Week of September 4, 2000
Last Updated: 9/10/2000 at 9:55 PM PDT
Short update today since this is a holiday and I spent the day mostly resting. I slept in this morning without waking up once in nine hours. That is unusual for me, I must have been tired from the weekend. Anyway, I am now caught up on my rest so it is time to get started on a new week.
Delanae got up and fixed us breakfast this morning. We were all very grateful for the pancakes, bacon, and scrambled eggs. Thanks again, honey.
The rest of the day was spent reading, watching the U.S. Open on TV, and running. Then we had worship team practice this evening. Stephen also had football practice this evening. After worship team and football team practice we headed to Baskin-Robbins for ice cream, then home to post this and go to bed. We all have an early start tomorrow. See you tomorrow night.
Monday on a Tuesday, as I could have predicted. We played catch up all day on leftover phone messages and refills from the three day holiday weekend. I had a huge stack of charts on my desk all day, no matter how I tried to keep the stack small by working on them throughout the day. We made it through them all by 6PM tonight but I did not get home until after 7 since I still had some phone calls to make and one patient to see in the hospital.
In hosptal news, my patient over the weekend who had chest pain and diabetes had his cardiac catheterization today. Only about a 30% blockage in one artery was found so he will not need any other treatment except for lifestyle modification to bring his diabetes and high lipids under control. He has won a reprieve, I hope he realizes how lucky he is and really changes his lifestyle to lessen his risk of more coronary artery disease.
My other patient, the one with the GI bleeding who we had to send to OHSU to get his bleeding under control, left against medical advice today. He wanted to go out and smoke with my approval even though he almost died Friday night and then developed a pneumonia over the weekend. I told him I would not OK him a pass to go out and smoke while he had pneumonia so, later in the day, he decided he needed to smoke more than he needed to be in the hospital being treated for his pneumonia. Any bets on when he comes back either trying to bleed to death again or having problems breathing? And what should we do at that time; cheerfully provide him the best care that we know how so he can go right back to his habits which will cause his premature death and cost us, not him, (remember he has no insurance or job) literally thousands of dollars before then? And, before anyone asks, yes, we did provide him nicotine replacement patches and gum so he would have no physical withdrawal as well as medication to minimize his withdrawal symptoms from the alcohol.
Also, today I had a visit from an attorney and his client who is a patient of mine. She has been trying to get me to say that her back pain is all due to an automobile accident she had 18 months ago now. I refuse to say that since she got over her pain completely within six months of the accident, then came back in to me after injuring it again at home. This sequence of events is well documented in her chart and she still can't understand why I won't say that her ongoing pain is due to her accident. Thankfully, her attorney finally told her it was time to go since I was obviously not going to say everything they wanted me to say.
In another development, today I found out that one of my patients had been using different names to go to different doctors in town to get pain medications. She tried to get some from my partner on call for me Monday but his nurse got suspicious and called some pharmacies around town and found out she was using the same name with other doctors and a different name for others. All in all, she got quite a number of narcotics before being found out. Amazingly, she called us today and left a message saying she needed more pain medication since she was going to have to go to Oklahoma for up to a month because of the death of an uncle. We, of course, refused. People like her are what make it difficult to treat each chronic pain patient as telling the truth from the moment you meet them and the reason why some doctors simply elect to not treat chronic pain.
I now have Stacey's volleyball schedule. Unfortunately, most of the games are in the afternoon which means I will miss some of them. Fortunately, two are being played the week I will be off while my mother is here later this month. She is arriving her on the 19th and will be here a week. She has never seen a volleyball game and I have never watched a volleyball game, played by official rules, in person. We will all have to learn the rules as the season goes along. Stacey is also playing in the local Youth Symphony so will have Monday evening practice weekly throughout the year beginning next Monday, I believe. The nights are getting busier and busier for Delanae and I.
What happened today? Well, this morning was occupied running errands like getting a haircut and taking Stephen to an appointment. In between these, I ran by the office to check my e-mail there and take care of a couple of phone calls left over from last night since all the other physicians' offices were closed when I left last night. I have two patients who belong to one of my partners to round on at the hospital in the morning since he is off tomorrow. Stephen is also about to start a 7AM weight lifting class at the high school and needs to be there at 6:50 so he will start going in with me it looks like. That also means that I will probably have to get up earlier on my day off to take him to the class. Of course, next week I don't have a day off since I am the Inpatient Physician Mon-Thurs and the week after is when my mother is here and I am on vacation that week. It looks like I will be getting up early every weekday morning, at least as long as he is taking the class.
Thought I would update everyone on how NetFlix is working out. We have been very pleased with the service so far. The DVD's get to us in about two business days since they are mailed from San Jose, CA and the return postage is prepaid so all we have to do is drop them into the mailer provided and drop them in the mailbox. We have had about six or seven total now which has more than paid for the monthly cost if we had tried to rent them here. We have one which was supposedly shipped last Wednesday which has not showed up yet. I just reported it as lost in the mail so we will see how they handle something like this. All the DVD's have been very good quality with no scratches and no problems with the picture or sound. At this point we plan on continuing our membership with them.
This afternoon, I still need to pay some bills then run as well as do some weeding in the garden. I am about to have a lot of tomatoes ripen in a hurry so there should be plenty for when my mother is here. I don't know if any of the green beans will be ready and there will probably be a little corn but not much. Next spring, I will know how to plan the garden better. I must go now and do some work around here. One more thing though........
Happy Birthday Richard!
Just blame my absence the last two days on call Thursday night. Yes, I had the kind of night we hope and pray doesn't happen very often. I get home around eleven and get a couple of hours sleep then get a call that I need to come in and admit a thirty-five year old man who had taken 80-90 Amitryptilline tablets as well as some other medications in an attempt to kill himself. His family did not find him until two or three hours later at which time he was very drowsy. They brought him to the Emergency Department where charcoal was instilled into his stomach to try and absorb any unabsorbed drug still in the intestinal tract. Unfortunately, he began to vomit soon afterward so had to be put on a ventilator to assist his breathing. By the time he was stable enough for me to leave it was 5:30 AM and I just had time to come home, take a shower, and go back to the hospital. It was a long day yesterday after having gotten so little sleep. Fifteen years ago, when I was a resident, it did not affect me as much as it does now. We could operate on that little sleep two or three nights in a row and still function pretty well. I did OK yesterday but still felt the fatigue.
Last night we watched a movie then I went straight to bed. We watched "The Siege" which was the DVD that had been lost in the mail. It finally came Thursday, just five days late. An OK movie in my book but nothing special. I would not watch it again if I had to pay money to rent it.
Today is football day. Stephen's team opens their season tonight in Renton which is just southwest of Seattle. He had a meeting from 9-11 this morning then had to be back at 1 PM to leave around 2 on the bus. Delanae and I are driving up a little later to attend the game. We will probably get rained on tonight but then the weather is supposed to clear off and warm up again for next week. Tonight we will be bundled up however. Stacey has decided she does not want to go because she would be bored at the game. Too bad, Delanae and I will just eat at a nicer restaurant if she isn't with us.
I have been watching some college football today after running this morning while Stephen was at his morning meeting. Notre Dame is giving Nebraska a real game; I am not a Notre Dame fan but it has been a fun game to watch. Arkansas is off this weekend so I will try and catch some of the Washington-Miami game before we leave in a little while. I can root for the Huskies but they will never replace the Razorbacks in my heart. Just checked and Washington is beating Miami in the third quarter 21-3. Go Huskies!
Results yesterday were mixed. Stephen's team lost their game in overtime 33-32. It was played on artificial turf in Renton. The team he played had a lot more speed in their backfield and the turf worked to their advantage. He got to play on the kickoff coverage and PAT teams. He made no tackles but got to pile onto a couple of pileups. Delanae used her digital video camera to take some snapshots which was the first time she had tried that. She spent most of the game learning how and experimenting with it. She ended up having a lot of fun doing that since she is not a football fan. Anyway, we did not get to bed until two o'clock this morning after picking up Stephen from the locker room here after he got back on the bus. That made for an early morning when the alarm went off at 7 AM this morning.
The Washington Huskies did go on to beat Miami yesterday and the Seahawks lost today. The Arkansas Razorbacks will be back in action next Saturday.
After church today, we napped most of the afternoon, trying to catch up on the missed sleep. I did watch some of the Seahawks-Rams game and some of the U.S. Open men's final before I finally gave up and slept. Tonight, we had dinner at a local restaurant with a couple of my partners and their wives along with a husband and wife doctor couple who are interviewing for two open positions we will have next summer when they finish their residencies. They are currently in Memphis, Tennessee and are originally from Madison, Wisconsin. They are looking for a non-metropolitan area where they can do outdoor activities. This area will fit what they are looking for if things work out and they accept offers. We will see after they spend the day tomorrow with other physicians in our group and go home and think about their other offers. Anyway, the food tonight was excellent as was the wine.
Tomorrow morning, I start four days as the inpatient physician again. Stacey's volleyball season also starts next week and Stephen has a game Friday night, luckily at home. It will be a busy week for us again. It is now time for me to get to bed so I can get up early in the morning and be functional. See you tomorrow night.
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