Last Week



Doc's Progress Notes

Week of March 19, 2001

Last Updated: 3/25/2001 at 10:02 PM PST

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Monday March 19, 2001

I had a nice day off other than having to get up early this morning to take Stephen to school and then go to the Leadership Council meeting. The meeting was actually very productive and informative. We did get the agenda ready for our retreat next month so we can concentrate on making the decisions we need to make. They will be important since they will deal with changes to our compensation plan to make it more fair to everyone. The members of the Council, like me, are assuring the other members of the group that we are not planning to cut anyone's compensation but we must find a way to value what members do to make the group better but doesn't directly lead any reimbursement for that time by a patient or insurance company. Included in that is time spent serving on committees that help ensure that we are a high quality group but which may take us away from direct, reimbursable patient care.

I also spent time today getting the information ready for our accountant so he can do our taxes for 2000. We always extend beyond the April 15 deadline so by no means are we waiting until the last minute. It should be ready to be mailed tomorrow which will clean some junk off my desk. I got some more filed away today so I am making headway on my office.

I am also still learning how to use my iPaq. I can synch my home and office computers using it but I still am able to use only the serial cradle on both. I cannot get USB working on either computer. On my home computer I keep getting the error message "The NTKERN.vxd device loader for this device could not load the device driver" when I check Device Manager despite deleting and reinstalling the correct driver for the card (a Belkin PCI two USB port expansion card). I have also deleted and reinstalled the device with no success; both of these solutions were recommended by the Microsoft Knowledge Base for this error message but neither have worked. I am running Windows 98SE on this system and am afraid I am going to have to reinstall the OS to get this driver to load.

On my office computer, the iPaq will simply not connect using a USB port. It simply says the Windows CE device is not supported although it calls it by its name. This is a Windows 98 SR2 system on which other USB devices have been used successfully in the past. I am going to try and delete the AutoSynch software then reinstall it and see if that works. I have searched the Web for a solution to this problem but have not found one yet except to wait until the corporation upgrades to Windows 2000 which will hopefully cure this problem with its better USB support. Hopefully, sometime this week I can get the USB cradle working on one computer so I don't have to carry the serial cradle back and forth when I want to synch my schedule on the two computers.

Tomorrow will be a day to do some work outside. It is supposed to be near sixty here and sunny. I need to get the lawn mower ready and mow our yard before it gets too tall. I am feeling better now and was able to exercise on the Nordic Track this afternoon. Hopefully tomorrow I will feel like running a little again. See you tomorrow.

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Tuesday March 20, 2001

I got a lot accomplished today. The tax information has now been sent off to our accountant so that is one task over for a year again. That also clears out some clutter from my desk. It isn't quite spring cleaning here but it will be soon.

I did go in to the office today to get some paperwork out of the way before tomorrow. I got a lot done but there is a lot more to do starting tomorrow morning. I went in to also go to a continuing medical education program at noon today but that program got cancelled and I got no notice until I got to the office. I am now ready for my committee meeting at 7 tomorrow morning though.

I also got the part of the lawn mowed that needed it the most. I ran this afternoon but am still very tired afterward so I know I am not completely well yet. Delanae and I have both been hoarse today, she has gone around saying she sounds like a bullfrog but I tell her that is impossible, at least the bull part. Stephen played his first JV tennis match this afternoon and won. I watched all of it and Delanae got to see a lot of it.

I did find the problem with the USB cradle at the office. Frank McPherson sent me a link to a support page on for Pocket PC's, which did not come up when I searched that site yesterday, and after following the link through several pages there found the statement that ActiveSync 3.1, which is the latest version and the one I have, does not support any Windows 95, even SR2 which added USB support. Since our OS at the office is Windows 95 SR2 that explains why I cannot synch there using the USB cradle and I won't be able to until we switch to Windows 2000.

Meanwhile at home I thought I had found the reason why the USB card driver would not load. I found a Microsoft Knowledge Base article about why a USB intellimouse would not work properly and it gave the same error message as I am getting when trying to install the driver for the USB card. It said the hidusb.sys file needed to be installed in the Windows\System32\Drivers folder if it was not found there. I searched and sure enough it was not there. So, I installed it from the installation disk for Windows 98 and rebooted the computer hoping the USB card driver would now install. Alas, it did not. When I get some time later in the week I will try searching the Belkin website and see if they have any answer to this problem. Until I get it solved I will be left with having to take the serial cradle to the office and back or buy a serial synch cable but I want to use the USB cradle which I bought for use at home.

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Wednesday March 21, 2001

Back to work today. Not a bad day as far as being too rushed. My two meetings this morning went fine. One of them will lead to an all day meeting in early May in Bellevue again which means travel up there and back in one day again. Hopefully, Delanae will go with me this time, she is thinking about it as it would give her a chance to talk to some people there about Locality. The downside would be having to drive around all day in the Seattle area traffic which is horrible.

I did have one very interesting patient this morning, interesting because we found something potentially life threatening which needs to be repaired very soon. She told me that she had had a "bad" headache two weeks ago which had lasted about two days then resolved. She had another one beginning Monday and was getting worse with coughing or bending over and not resolving like the other one did. She looked very uncomfortable and was already scheduled for an MRI of the brain next week which had been arranged by one of my partners Monday while I was out. I didn't feel comfortable with waiting after talking to her so we got our radiology department to do a CT scan of the brain instead this morning. The radiologist called me back with the report I thought I might receive. She had evidence of bleeding within and around the brain, most like due to an aneurysm that had partially ruptured earlier. Interestingly, her mother had died of a ruptured cerebral aneurysm in her early 50's which was also how old this woman was. I called a nerurosurgeon in Vancouver, WA and sent her there for an arteriogram today to find out where the aneurysm is and if it is operable. Hopefully, I will hear something else about her tomorrow. The neurosurgeon told me that since two generations of her family have now had documented cerebral aneurysms then her children also need to be screened for these as they are at risk. There is documented evidence that if there are cerebral aneurysms in two generations then there is considerable risk that they will also be present in the third. The screening test of choice, according to him, is magnetic resonance angiography which combines magnetic resonance imaging of the brain with contrast in the blood vessels to show the small, balloon like dilations of the arteries which are referred to as aneurysms. These have thin walls compared to the rest of the artery so are at high risk to rupture because of the relatively higher pressures in the arteries in the brain.

This excitement took me through lunch so I grabbed something from the cafeteria and ate it at my desk as I was doing paperwork before my afternoon patients starting arriving. The afternoon patients were sort of anticlimactic after that. Most of them were in with colds or pain of some sort. One did not want to believe that her back pain could not be corrected surgically so I will let someone else reinforce that to her. All in all an interesting day.

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Thursday March 22, 2001

No update.

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Friday March 23, 2001

Yesterday was a very long and busy day. It continued the tradition of Thursday as my busiest day of the week and latest day. When I started my afternoon patients I still had about six charts left to dictate from the morning. The day began with two patients of my partner's to see in the hospital, both of whom needed to be discharged. Both had had strokes and therefore needed a lot of details worked out and since I had never seen them before I had to spend a lot of time finding answers to some questions.

I was supposed to have a meeting at noon, one which has been postponed twice already. I did not make the meeting so it has been rescheduled yet again. I ended up getting home about 8 last night then Delanae and I talked until 11.

Today I was the inpatient physician again. I had to admit three patients for detox from alcohol today, two just as I was supposed to be finishing this evening. All of them had been through this at least once within the past month, two more than once. So why will this time be any different? Odds are that it won't, they will go out and resume drinking again and return again in the very near future. Pardon my pessimism but I have seen this happen over and over again. It is hard not to become callus about these alcoholics and other drug addicts and not resent them taking up my personal time when I could be doing something else. The reimbursement is miniscule and I tend to think about all the taxpayers' money being spent on repeated hospitalizations for detox for the same people. Sorry for the rant.

Tomorrow and Sunday will be more of the same. Thankfully, I am not on call tomorrow night due to trading with another of my partners'. He will cover Saturday night in exchange for me taking a Thursday night call for him. Hopefully, I will feel like writing more tomorrow night.

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Saturday March 24, 2001

Not much excitement today at the hospital. I discharged three people today which was exciting for them as it meant they got to return to their homes. Our admissions so far today have been for threatening suicide or drug detox. It seems we are in a pattern right now broken only by the occasional patient who is both threatening suicide and needing drug detox.

Tomorrow I get to do this again. One of my partners is supposed to cover for me tonight in exchange for me taking a weeknight call for him when he is on vacation. I just discovered that the call schedule did not get changed so it still shows me on call. He was supposed to take care of having it changed but it obviously did not get done. I will be calling him in a few minutes to find out what happened and why wasn't it changed. We had talked about this again earlier this week. .....Now everything is OK, I am not on call tonight so will not get interrupted my phone calls in my sleep tonight. See you tomorrow.

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Sunday March 25, 2001

I made it through the weekend, now I only have the regular week to go. I continued in the detox pattern today as well as another stroke patient.

Tomorrow morning I do not have a meeting. That is news in itself. I have called my partners and told them about what patients they have in the hospital to see tomorrow. I have called the person who will be the inpatient physician for the next four days and told her about the patients she will inherit. I have exercised for one hour on the Nordic Track. I have paid bills and addressed envelopes to send them in. I have now finished this update so I will bid good night and see you tomorrow.

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