Doc's Progress Notes
Week of January 1, 2001
Last Updated: 1/7/2001 at 8:59 PM PST
Happy New Year! We are alive and well today having really started the new millenium. Stephen had about twenty teenagers total over last night for a bonfire and hamburgers. All but five left at or a little after midnight. The final five were all boys who stayed the night here. Delanae and I went to bed about 2:30 this morning after being certain that things were cleaned up and put away. They finally went to bed sometime around 8 AM but all had to get up and go home around noon. That was fun, getting up teenagers who had had very little sleep so their parents or various family members could pick them up and take them home.
After they all went home, Stephen finished cleaning up their mess and went back to bed. Delanae got up around 8 to check on the boys then went back to bed and did not get up until she had had her twelve hours of sleep so I got to watch football with no interruptions for most of the afternoon. Oregon State versus Notre Dame is on currently and I am checking on it while I am writing this but do not feel like being glued to the set any longer. I have had my fill of football until tomorrow.
I have two patients in the hospital to see tomorrow. My partner on call today has already called me to give me this information. Amazingly, I have no meetings scheduled for tomorrow but will make up for that on Thursday when I have at least three meetings scheduled.
Delanae gave me a great card for our anniversary yesterday. You can see an image from it on her page here if you are interested. I certainly looked different seven years ago, Delanae remains beautiful. Those images really are from our wedding. The poem on the inside she wrote herself and means so much to me. Sorry, I don't have a copy of it to post here.
Today was a real Monday on a Tuesday. The day began with me seeing three patients in the hospital, two of who I knew about last night and the third admitted during the night. I was able to send all three home today but had to go back at noon to send the third one home. Since I was late getting done with the morning patients that meant I had to grab a sandwich very quickly and go up and send him home. I then had about five minutes to finish dictating the morning's charts before I started on the afternoon patients. Since my first afternoon patient was a little late I did manage to get the last morning chart dictated while Kathy was getting him in a room.
Then, this afternoon I had some no shows again. I was booked solid but ended up with some downtime which I used to get my desk cleaned up some more. When I have many people complaining about how long they have to wait to get in to see me no shows who don't call really upset me. The ones who call sometime ahead don't bother us but so many never even bother to call and say they are not coming. Our computer system also managed to have problems with network connectivity during the afternoon which plays havoc with electronic prescription writing and reviewing medication and problem lists that are stored on the computer. Luckily by the time I left tonight the network was back up and running except my computer would no longer print to the printer it had been mapped to. I guess I get to call the IT desk tomorrow to have someone come reassign it.
My last patient of the day made me much later to get home then I had planned. Out physician assistant had seen a young male with abdominal pain that had begun in the upper part of his abdomen Thursday or Friday. He was seen in the emergency department Friday night and it was thought that he could have gallstones so an ultrasound of the gallbladder was done on Saturday. This proved negative but he developed right lower abdominal pain last night or this morning and came in to be seen this afternoon. George, the physician assistant, was unsure about what to do with him since he had a normal white blood count but was tender in the lower right side of the abdomen. I was just finishing up with my phone calls when he came in to ask me so I said I would take a look also. His exam worried me too as I was afraid he had appendicitis even without an elevated white blood count which is not what the book says happens with appendicitis but we had both seen other patients with normal white blood counts turn out to have appendicitis.
So, I called the friendly surgeon on call and he agreed to come down to the office from the hospital and check the patient right there in our exam room. Being attached to the hospital is a big advantage in situations like this, it was a short walk for him to come from the hospital or downstairs from his office suite. He examined him and agreed that he too was suspicious that the patient had appendicitis so he was going to admit him and do a laparoscopic appendectomy as that would allow him to look around in the abdomen and make sure there was nothing else going on. I will be anxious to find out tomorrow what the surgeon found. I am off tomorrow but, like most of my days off, I will be going in to see one other patient who got admitted to me during the day.
Everyone in this part of the country is very happy with the way the bowl games that the local college teams were in turned out. They are especially happy with Oregon State's rout of Notre Dame. I can agree with that especially since Oregon State was going to only its second bowl in 35 years and it was Notre Dame that they beat. I was also happy to see Oregon beat Texas since Arkansas and Texas have always been big rivals and I never mind seeing Texas lose. I think the three Pac 10 schools showed the rest of the country this weekend that there is some quality football being played in the Pac 10. I know they showed me.
Yes, you are right, no iPaq yet. Tomorrow I will call and see if I can get an estimate on when it might be here. I will let you know.
Tonight I will lead off with the bad news from today. I called about my iPaq today and was told that PC Connection has 1900 backorders for them and they are only getting a "few" each month from Compaq so they did not know how long it would be until mine was shipped. The helpful person in sales could not or would not tell me how many a "few" were or give me any reasonable answer as to where I was on their waiting list. She said if I could find one elsewhere that could be shipped immediately then they would cancel my order but since the check has already cleared they would have to refund the money directly back to the corporation I work for which would mean I would lose that money and a new purchase would be deducted from this year's expenses. That would defeat the purpose of spending last year's money before the end of the year so I would not lose it. I guess I am stuck waiting.
I have news about my patient from late yesterday. When he got to surgery the surgeon found that he had a ruptured appendix which was behind the large intestine in an uncommon position. That is why his history and exam were not classical for appendicitis. To further complicate matters, he also had gallstones so his gallbladder was also removed. He is doing well today but ,as with all ruptured appendix patients, his postoperative course will be a little more painful and he will need to be in the hospital longer than if his appendix had not ruptured prior to surgery. He was very appreciative that we had found his problem yesterday. This is one example of why we do not mind staying late when there is a good reason.
I am looking for a new Internet Service Provider. Any recommendations out there for a good national provider rather than using one of the local providers. I want one where I can consistently get a connection at more than 28.8K using a V.90 modem and I can connect to from multiple areas. All recommendations will be considered. See you tomorrow.
What happened yesterday? Beats me, for some reason I did not get anything posted so let me see if I can reconstruct the day. I began the day rounding on four patients in the hospital, one of mine and the others belonged to my partner with whom I share an office and was off yesterday.
After rounds were done, I spent the rest of the day trying to catch up in the office. Thursdays seem to be my heaviest days for paperwork including refills and yesterday was no exception. Add to that the fact I had meetings back to back from 1-3:30 PM and I didn't think I was going to ever get caught up. I finally managed to finish at 6:30 when it was time to be at the restaurant for the dinner with the physician interviewing for a position with our group. She seems very interested in coming here, says she is tired of living in Columbus, Ohio where she is completing a residency and wants to move somewhere where there are mountains and possibly an ocean. Our area would certainly fit that description. She is very friendly and all her references say she is an excellent physician. By the end of the evening she was making plans on where she would live here and what she would visit first. Now, we will see how she feels once she sees some other opportunities in other states and whether everyone else who met with her agrees with my assessment.
I got home from the interview dinner with just enough time to hop on the NordicTrack for an hour before I settled down to watch ER and hold hands with my lovely wife. I am reading John Grisham novels while on the NordicTrack these days to pass the time. I am currently reading The Testament. I only do the machine when it is too late or the weather is too bad to run which happens in the winter and more often as I get older and less tolerant of cold, dark evenings. <G> After watching ER, I decided it was too late to post because I needed to get SOME sleep before being on call tonight.
Today has been a lot like yesterday, without the meetings. I have had a lot of paperwork to do while seeing patients. It seems the paperwork burden increases monthly. We are slowly changing to electronic medical records but so far I have not seen much if any decrease in the paperwork load. It seems that the majority of the paperwork is generated by entities other than our group although there are certain forms that we have to fill out which are generated by us. Most of those are planned to become electronic in the near future.
All of the above was written at my office tonight between telephone calls about and to patients. I am on call tonight, having switched Friday nights with one of my partners who needed to be somewhere tonight unexpectedly. She will now take my scheduled Friday night of call later this month which means I will only have one night of call that weekend rather than the scheduled two. Hopefully I won't be up all night tonight and it will be worth having made the switch.
I am trying to reconstruct about three paragraphs now. This program page faulted on me just now and I had not saved any of today's post yet. Luckily, the bulk of it was sent in an e-mail from my office so I just copied and pasted that portion back in but lost the new paragraphs that I had just written. Very frustrating! I don't usually save until I have reached the end of a day's post.
Thanks to everyone who wrote to offer suggestions about Internet Service Providers that are nationwide. We have not made a decision yet on which one to go with. I was surprised that some, including my early favorite Worldnet, do not have local access numbers for an area that has more than 100,000 population. Go figure why a provider that calls itself Worldnet does not have a local access number for a county this large.
Now, what else had I written before this program page faulted? Tonight I am ordering a new hard drive for my system as I am running out of hard drive storage space. When I bought this system the 4 GB hard drive was HUGE. Now I cannot even find an IDE drive to buy online that is smaller than 15 GB. I am ordering a 20 GB Maxtor DiamondMax Plus 7200 RPM drive from CompUSA for only $99 to add to the system. I don't see how I will ever fill up that drive but plan to give the computer to one of the kids when I build my new one and I am sure they will find a way to fill up the drive. I should have it by next weekend when I plan to install it along with the ISA expansion slot card to add USB ports to this system.
That's it for tonight. See you tomorrow.
I had a quiet night last night. Just a few phone calls after midnight and no admissions. That is a quiet call night especially for a Friday night. I got up to call my partner taking over at 7 AM then was able to go back to bed for a couple of hours. Now I have no more Friday nights on call this month.
I had the opportunity to watch most of both NFL playoff games today. Too bad neither was close but the best team obviously won both games. Maybe tomorrow's games will be better and maybe I will get to watch them also. I do reserve the time to watch the Super Bowl although now that I think about it I may be on call that weekend. That's what I get for volunteering to fill a call slot left suddenly open when one of our former partners left the group last fall. Darn!
After watching the playoff games I installed a new center brake light in my car then got to do my run for the day. After getting back from the run, I installed the Britannica 2001 DVD which I had ordered on RBT's recommendation and received in two days. Very efficient service from them. It includes a free internet connection which I installed as a backup in case Delanae is unable to connect through our regular ISP but so far have been unable to log on to set up an account. The three local numbers have been busy but I will keep trying. I have a backup free internet access account on this computer that was given to me by a pharmaceutical company. I can have it as long as I log onto their site once a month which they think will make me read their ads there. I pay no attention to them.
I got to watch some NFL football again today. I saw part of both games, the Tennessee-Baltimore one before we left for church and the NY-Philadelphia one after we got home and were eating lunch which was a delicious roast prepared in the crock pot by Delanae. Thanks for a great meal!
Back to the football again, I was disappointed that Tennessee did not win. I thought they had a better team than the Ravens but Baltimore beat them at Tennessee's stadium so they truly deserve to move on. In the other game, the truly superior team won. I had no favorite in that one. Next weekend's championship games should be very interesting, I will just watch them with interest as I have no favorite left. The closest I can come is maybe liking Oakland since they are from the West Coast.
Tonight Delanae and I went to a concert at the church by The Imperials. I must confess that I did not know any of the songs they did but vaguely recalled that they were a gospel group in the 60's and 70's. I found out tonight that they had actually started what we now call contemporary Christian music. They were the first group to have drums, guitars, and keyboards onstage and were actually condemned by many Christians in the 70's as being from the devil because of this. To hear them now one would never guess that they set the stage for the excellent modern Christian music. There is one original member left and the other three, including his son, have been added in the last 18 months. It was truly a worship service rather than a concert and Delanae especially enjoyed it as she saw them in concert when they were outcasts from the established church due to their music. Yet another example of how religion has gotten in the way of messengers bringing God's message to the lost in this world.
Tomorrow night I am on call again. I have two Mondays in a row due to some strange reason. Something about the rotation being upset by some vacations or something. Part of it is also because we are down a couple of physicians right now but one is coming in April to start and hopefully we will get another new person in the summer. I hear a rumor that we might need one more after that but will see if that rumor comes to pass. I would be shocked if it does not happen.
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