Doc's Progress Notes
Week of November 20, 2000
Last Updated: 11/26/2000 at 7:46 PM PDT
Monday Tuesday
Wednesday Thursday Friday Saturday Sunday
Most Recent Update
No update.
No update.
I hope everyone is getting ready for Thanksgiving. I am on call tomorrow so I will be making rounds in the morning, then we will have our family Thanksgiving dinner sometime early in the afternoon. At six PM I will be on call by myself until 7 AM Friday. That means I will probably be at the hospital most of the evening but hopefully not after 11 PM. During the day tomorrow, my partner will cover so both of us can have some holiday time with our families. This means I won't have to do a Thanksgiving again for several years. I will be on call on Dec. 30 only for the Christmas-New Year's holiday season. I will be able to watch New Year's bowl games again this year.
It will likely get very busy tomorrow evening if past holidays that I have been on call are any indication. It seems that early in the day are fairly quiet then after the lunch time (1-3 PM) things really get busy. It's almost like people say "Well now we've eaten and have nothing else to do so let's go to the Emergency Room and get checked out". It is especially bad on Christmas Day; after the presents are opened, people start coming to the Emergency Room.
Planning for our holiday feast is finished. We have a smoked turkey that will not take a long time to cook and all the other trimmings will take about an hour or so. I will put bread mix in the breadmaker before I leave for the hospital in the morning so it will be ready. We have the pies for dessert, three different kinds this year; one is pumpkin for Delanae and we have an apple and a chocolate cream for me. Stacey has already told us that she doesn't like any kind of pie; too bad for the rest of us, this means there will be more that will have to be eaten.
In practice news so far this week, the physician I favored for associate director of family medicine for our group finally accepted the position. He had nominated me for the position but I told him he was a better candidate at this time and I really wanted him to accept the position. This will free me to work on information technology for the group and corporation. The corporation is looking at implementing physician order entry in the hospital within the next two years. This is a big project and they are in need of physicians to help standardize the process and help in convincing all the nonaligned physicians in the corporation owned hospitals that this will benefit them and their patients. There is ample research now that physician order entry does cut down on medication and treatment errors in the hospital. We are again on the cutting edge with this technology. There is a lot of pressure from health care purchasers in the industrial arena to implement this since it does cut down on errors. Our corporation and group has a vision to be the leading healthcare provider organization in the Pacific Northwest so we need to do all that we possibly can to increase the quality of care that we deliver by using technology which will help in that delivery.
Now, for my personal use I have about decided to go with a handheld device which will use the Palm operating system. I really like the Pocket PC's but don't think I would use enough of the features at this time in my life to make it worth spending the extra money on one. I will probably wait until December 1 to make the final decision and actually buy one. Right now I am leaning toward a TRGpro or one of the Handspring series. I favor those over the Palm Vx because they have expansion slots which can be used for applications, devices, or memory whereas the Palm Vx has no expansion slot. I will let you know what my final decision is.
Last night was Stephen's football awards ceremony. It was preceded by a potluck dinner at the high school cafeteria. It was encouraging to see that the freshman class had more football players in their class than any other. Hopefully, that means that the high school program will have more athletes in it next fall and they can build on their success from this year. This was their first time back in the playoffs in five years. Hopefully, the current coach is turning the program around and getting it headed in the right direction.
Happy Thanksgiving to everyone and be safe tomorrow if you are traveling.
Happy Thanksgiving
Just a quick note on this holiday. I made rounds this morning and saw nine patients while my partner saw eight more. We were finished by noon or so. Two of the patients went home this afternoon so they could have some holiday at home. One of the patients still in the hospital is 82 years old and has back pain which is chronic and probably due to severe degenerative disc disease. It is probably not curable and she will need pain medication daily in order to be able to get up and get around with only her husband to help her. When she came in the hospital last night she was unable to do that. They have no family locally so can depend only upon themselves and neither are strong enough to really help the other one. Hopefully we can get them some daytime help in their home so she can go home tomorrow. This afternoon we had our Thanksgiving feast. It was wonderful as always. I had to wait until now, about five hours later and after running in order to have room for dessert. That is all I may eat tonight as I am still full. I am on call now and will be until 7 AM tomorrow. I am working in the office tomorrow and we will probably be very busy since a lot of my partners took tomorrow off. Delanae is not working tomorrow and there is no school, of course, so I could sleep a little later in the morning if I was not on call tonight. That will have to wait until Saturday morning. I just hope to get a little sleep tonight. Hope all of you had a wonderful holiday and see you later.
No update.
No update.
Where to begin? How about with Thursday night. I was on call Thanksgiving night, as I have mentioned before this week, and ended up being at the hospital until about 3:30 AM Friday morning. Most of that time was spent taking care of one patient, a man with an abnormal heart rhythm that did not want to respond to medication, and still not as I have learned already tonight. He has remained stable but in the Coronary Care Unit during this time since the dysrhythmia is potentially lethal. Luckily, he is young enough and has a normal heart otherwise so he has remained stable.
Anyway, after I got home Friday morning I kept getting calls for the next three hours and I figure I probably got one hour's sleep altogether. I did OK Friday during the day, I was real busy Friday morning and not so busy Friday afternoon although the number of patients I had seen at the end of the day was about average for me. It just seemed slower in the afternoon. I have probably found another patient with lung cancer. She is a smoker who is in her early seventies and came in to see me Friday because she had been having low grade fevers for a few weeks. I did a chest x-ray on her and she has a pneumonia but it looks like the pneumonia is probably caused by something like a cancer blocking the main bronchial tube to her right upper lung. I won't know for sure until she has a bronchoscopy but the chest x-ray certainly looks suspicious.
After finishing with my office patients Friday, I had to go to one of the nursing homes and admit a new patient who had just transferred here from Austin, Texas. He is from Washington State originally but had suffered a heart attack in the Tacoma area. He went into a lethal dysrhythmia, ventricular fibrillation, at the onset of the heart attack and had to be shocked six times before he was restored to a normal rhythm. Unfortunately, he suffered some brain damage as a result of this and had been transferred to Austin to a rehab center. He has completed the program there and has improved but is unable to return home. His wife looked at sixty nursing homes here in Washington before she found one here that would accept him. At least he will be closer to her in the Tacoma area. I'm not sure what the problem was with the other nursing homes; he talks, although very confused, he is able to feed himself, and he can sit in a wheelchair and does not require any assistance to breathe. His family seems very supportive and want to take him to the University of Washington to investigate a brain rehab program they have there.
By the time I arrived home Friday night, I was pretty dead so ate something, watched some sports, read a little, and went to bed without touching the computer. Yesterday, the weather was gray and rainy so I watched some football and moved Delanae's computer upstairs and set it up in our dining room/den so she can use it there. She is getting a photo quality printer so she can do her scrapbook pages on the computer and print them out. It should be here early next week and then we have to find a place for it. Somehow, I never got around to doing an update here yesterday.
Tomorrow, I begin four days as the inpatient physician. That means I do not have office responsibilities or appointments (not totally true, I will be checking on paperwork and seeing a few patients in the office to help out my partners). That should catch you up on what I have been doing the last three days. Hope all of you have a great week and I will try to write something every day next week.
