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Doc's Progress Notes

Week of September 11, 2000

Last Updated: 9/16/2000 at 11:33 PM PDT

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Monday September 11, 2000

An IPP day today. For those who have forgotten, IPP stands for inpatient physician which means I have only responsibility for patients admitted to the hospital, no office responsibilities. This duty lasts through Thursday of this week then Friday I go back to regular duty which includes office work. Anyway, Monday of an IPP week is a day spent learning the patients who are in the hospital and trying to take care of things that got carried over from the weekend.

A lot of today was spent dealing with a year and a half old child who had been admitted on Friday by one of my partners and then seen by someone different over the weekend. Then today, I walked in since my partner who admitted her originally is about to have back surgery and will be off for 6-8 weeks beginning today. That left me responsible for seeing her. This child has had diarrhea for three months now, on and off worse. Now, during that time she is gaining weight but her mother is concerned that something is dreadfully wrong with her child and that we are not telling her what is wrong with the child. Children with something seriously wrong, especially with diarrhea do not gain weight, they lose weight. Mom will not listen to this however and thinks we are just not telling her and that this is an emergency and she needs to go to a Children's Hospital immediately. This feeling was exacerbated by the appearance that no one was in charge since she saw someone different every day. I bore the brunt of her frustrations today. We ended up going over all her tests today one by one so she knew all the results(which were negative). Then, I called a pediatric gastroenterologist in Portland and set her up with an appointment to be seen there. The gastroenterologist suggested another blood test which we had not done before she comes down there. That has been ordered. I do not know if mother is happy but I have done all I can to reassure her that the appropriate tests have been done and we do care about her daughter and if she were seriously ill she would have already been in the Children's Hospital in Portland.

The rest of my day is fairly uneventful. I do end up going to my office and wading through a large pile of paperwork that will get even larger if I do not wander in once a day and go through it. I also spend quite a bit of time lining up consults and checking on x-ray results. Transcribed x-ray reports are available online but I want to know results before they are transcribed. I do go down and look at x-ray studies that I feel comfortable interpreting by myself but have to seek out a radiologist on others. The radiologists are not always handy to ask about a result so quite a bit of my time is spent waiting for one of them to get free so he or she can talk to me.

Tomorrow is Stacey's first game. I asked her what position she will be playing and she tells me that she does not know, she will find out tomorrow. I am going to try and get away from the hospital long enough to catch a little of her game but we will see if I am able. I am also on call tomorrow night so it will likely be a long night again. I may or may not have an update tomorrow night, only time will tell.

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Tuesday September 12, 2000

No update.

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Wednesday September 13, 2000

As you can see, no update last night. I was at the hospital until almost 1 AM today. As you know, it has been a full moon outside and my experiences over the last two days confirm that. I have admitted strange cases over the past two days. I have been getting strange calls at strange hours. I think the OB floor has been quite busy the last two days delivering babies. All these are symptommatic of a full moon. I only have two more days to go this week and then I will be on vacation for ten days while my mother is visiting us here. I need a little mental rest, as well I need to catch up on some sleep sometime this weekend.

I missed Stacey's volleyball game yesterday. As I was trying to walk out the door of the hospital to go to it, I got paged for a patient in the Emergency Department that needed to be taken care of right then. Stacey's school won the three team match but her particular team lost. She says she played awful but her mother says she played well. Stacey tends to be very negative about her performances. Her next matches are this weekend and I will get to see those.

I have been asked to serve on another committee for the corporation. This committee will monitor our corporation's compliance with the electronic medical record provisions of the Health Insurance Portability and Accountability Act, as I understand it. It will be composed of representatives from each of the different regions of the Northwest that we have healthcare facilities in. I have not given them a definite answer yet, I am waiting to hear back from the lead person at the corporation headquarters about what all this will entail. I was told most meetings would be by V-Tel link and so it would not involve much travel at all. More later as I know more.

Now, I must go to bed and get some rest. Tomorrow is my last day as IPP and tomorrow night looks full again with everybody needing to be somewhere at the same time. See you later.

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Thursday September 14, 2000

IPP "week" is over. I finished it up in hectic fashion this afternoon. I admitted three patients between 4:30 and 6 PM this afternoon. I then had to sign out to two people, one on call tonight and one who takes over the IPP duties tomorrow morning. After that it was off to pick up both kids, drive them home and then come back downtown for my mens' meeting at the church which we have changed to every other Thursday night. I was only about thirty minutes late for the meeting.

Probably the most interesting of the three patients was one of my own patients who is only 48 but had coronary artery bypass surgery one month ago. He had three blocked coronary arteries around his heart which had to be bypassed or else he was going to have a heart attack. He is a heavy smoker who hates exercise and has a family history of heart disease. Anyway, he had done well post surgery but came in to see one of my partners at the office today with his ankles swelling and short of breath for a couple of days. It turned out he was in congestive heart failure with an abnormal heart rhythm called atrial flutter. While atrial flutter and atrial fibrillation are fairly common after open heart surgery, congestive heart failure in someone whose heart function was essentially normal at the time of surgery is not. We are checking to see if he suffered a heart attack at some time during the surgery or within the last month or if his heart is enlarging due to some other cause. This is not good news in terms of his long term survival. We should know more in the next couple of days.

Tomorrow is very likely to be a long day for me. It is my last day in the office before I go on vacation for ten days. I have tried to take care of a lot of stuff while I have been technically out of the office for the last four days by checking in at the office several times a day and answering phone calls and requests. I am sure there will be a lot tomorrow that I have missed. I have only been able to run one day this week due to my schedule and tomorrow does not look promising at all. Stephen's high school football team is at home tomorrow and the game starts at 7:30. I may have time only to finish up at the office and then go straight to the game. He is then going to a dance at the school right after the game. The dance is over at midnight so we will be up very late tomorrow night again. Saturday is Stacey's volleyball jamboree plus we have to get the house and yard cleaned up for my mother's visit next week. Luckily, the weather is supposed to be nice all weekend so we can get the outside work done without getting wet. It will be a busy weekend any way you look at it. Good night.

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Friday September 15, 2000

Ah, the end of the week and I am on vacation next week! To make it even more special, I was being observed today by someone who specializes in rapid process improvement. That means she was looking at the way I did things and will come back and suggest ways to streamline my day and make me more productive. This is actually something I asked for and should help me be more efficient with my time. I was just surprised to see her come today as I had been promised before that she would be at my office and no one showed. I do not know when I will hear back from her.

We did make it through the day, pretty much on time. I finished all the charts on my desk before leaving tonight and my medical assistant got out on time. She is working for another physician this weekend and a couple of days next week while I am gone. Then, she is taking some vacation until I return to the office on Sept 28.

My patient with the congestive heart failure from yesterday was much better this morning. He was going to be electrically converted into a normal rhythm this morning which should keep him out of congestive heart failure in the future; that is, if he will stay in a normal rhythm. He should since his heart is not enlarged and the ejection fraction (or percentage of blood that enters the left ventricle that is pumped out with each beat) appears to be normal. His atria (or upper chambers of the heart) appear to be normal size. He should go home tomorrow.

Tonight's high school football game was much better, at least if you were cheering for the local high school. Stephen's high school team beat the opposing team, from the Seattle area, 56-6. Last year they won 77-7 by way of comparison. Both games were played here in Longview. Stephen got to play some offense and defense tonight in the second half as well as playing on the extra point team in the first half. He is at the after game high school dance right now and I will need to pick him up in about a half hour.

Last night our dogs learned about porcupine dancing. Or rather they learned not to dance with porcupines. No, that's not true if you believe vets who know about these things, they say that dogs keep going back for more. Anyway, our dogs came in last night with porcupine quills adorning their faces. My dog, Dexter, had only about ten in his snout which I removed fairly easily and quickly. Delanae's dog, however, was a different story. He had at least fifty and many were inside his mouth, stuck in his tongue, gums, and roof of his mouth. I pulled out as many as I could with Delanae holding him, then tried to sedate him with some oral Xanax but he was not going to be sedated with oral medication. Delanae finally had to take him to Vancouver, WA to an emergency veterinary clinic open all night where the vet sedated him with IV medication and then pulled out all the quills in his mouth and nose. They arrived back about 4 AM. He is doing fine now although his mouth is probably still a little sore. The vet's office had a picture of one dog who had had more than 1000 quills in him which they had removed.

Time for me to go pick up Stephen. I will be back tomorrow.

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Saturday September 16, 2000

We burned brush today. Actually, it was a brush pile that we had been waiting to burn for a long time. Before we could burn it we had to create a firebreak around it since it was in the middle of growing weeds and trees. That was accomplished using the big tiller that Delanae gave me this year. The burn was accomplished without any collateral damage although one surrounding half dead tree tried to spontaneously combust but some water stopped that in a hurry. Now, we have one less brush pile to contend with when trying to plant grass.

Stacey learned how to pick tomatoes today. It was not her idea but I thought it was time she learned. She did OK until she found a slug under one tomato plant then realized that that slug could have TOUCHED the tomatoes she was supposed to be picking which ended that learning experience. There is a container full of tomatoes in the kitchen now and I have already asked the neighbors if they want some. Our pastor will take some more.

Stacey's team won at the jamboree today. They won five of their eight games during the jamboree. She played well and surprised her mother and me by hitting the ball as well as she did. We both remember a couple of weeks ago when she was afraid to hit it because it would hurt. The athlete in her is coming out.

That's about it for today. We are picking up the three kids who stayed with us for a month to take them to church tomorrow since their mother just had surgery and doesn't feel like going. That means we will have to take two vehicles and leave earlier than normal which also means getting Delanae up earlier than she will want to. She was the one who volunteered to pick up the kids however. We will see in the morning.

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Sunday September 17, 2000

Another day of brush clearing and burning. After church, of course. We now have four brush piles, one of which is huge and one of which is very small. All but one have fire breaks around them so they are ready to burn when we have time. Delanae is finishing burning one now, she is the arsonist in the family <BG>. Hopefully she won't be up past midnight again putting it out or waiting for it to burn down.

She did get up in time to go get the extra kids and bring them to church. Since she is not a morning person, she was not happy about having volunteered to do something that meant she would have to get up earlier than normal.

I am off tomorrow but that just means that I do not have to see patients in the office or hospital. I will be going in early tomorrow, after dropping Stephen off at school, for a Leadership Council Meeting. Then, I have to check on a couple of things at Stephen's school. I have some cleaning to do here as my mother is coming to visit Tuesday and staying for a week. I really need to straighten up this office a little whether she is coming or not. Then, tomorrow night Stephen has a junior varsity football game which means we will have to pick him up early, then take him back to the school in time to get dressed and warmed up before the football game. It looks like I will be doing errands tomorrow. I will try and keep this journal updated daily for the next ten days but if I miss a day I hope you will understand. I must now go and start removing blackberries from the vine for my mother so she can make us some blackberry cobbler while she is here. See you later.

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