In reading the other Daynoters' sites today, I found that Brian had said his was the only home based website among the Gang. I assume he means the only one hosted on its own server at home, not the only one written and uploaded to a webpage hosting service from home. I do all my uploading from home since I cannot FTP from my work. I do write part of my update from my medical office when I have time during the day but probably the majority of this journal is written at home.

Today has been busy at the office, as predicted. Everyone wants their medicines refilled before the start of the new year and they want to be well before Christmas. Add to that the fact that several of the physicians are on vacation this week and it makes for long days and a long week.

Today began with my first Leadership Council meeting. This is the physician committee which governs our group. Today we talked mainly about coding issues. Our Medicare system requires us to submit our bills with numbers signifying the length and complexity of visits and the diagnoses for the patients. The problem is, Medicare has never been able to satisfactorily settle on a standard for what each level of service entails so they are open to interpretation by any number of people who keep changing the rules almost monthly. We can't keep up with what constitutes what level of service but are legally at risk for fraud if we bill the wrong level of service. The classic government quandary, you do what you think is right as a physician, we will tell you if it is right in our (the government's) opinion, then if we disagree with you we can charge you with fraud. We keep asking for concrete standards for various levels of service and Medicare keeps promising but so far have not delivered. Our group wants to stay away from being accused of fraud obviously so we are spending a lot of time and money trying to learn to code these visits correctly and make sure all the members of the group comply with what we learn.

The rest of the day was spent approving or disapproving refills for people and seeing the acutely ill. Well, not all were acutely ill. I did a couple of physicals on kids having dental work done under general anesthesia, presumably now during their Christmas holidays. I had a stretch of three chronic pain patients this morning, all of whom were feeling worse than usual because of the stress of the holidays. Then there was the 23 year old woman with two hyperactive children who wouldn't keep quiet or still and she had several complaints. She was a new patient who we had told we were putting her into a nonphysical appointment slot to take care of her most urgent problem. She still tried to get me to deal with all her problems today while the kids were bouncing off the walls, trying to roll me on my stool, and trying to throw her chart into the garbage can. I managed to deal with her most pressing complaint today, then she will make an appointment for a full physical WITHOUT the kids in the room. Of course, after talking to her, I think they inherited the hyperactivity from her.

Tonight we had practice for Wednesday night. The Wednesday night worship team will be doing traditional Christmas carols with fairly traditional arrangements. Tonight was the first time I had played many of them on my bass so it was a learning experience. I must practice more tomorrow night so I don't stick out like a sore thumb Wednesday night with all the veteran musicians. I'm been playing the bass for less than a year still and feel inferior when the other musicians go off on solos. The bass is not a solo instrument however so I really don't have to worry about ever being asked to do a solo, I just have to learn the songs well enough to keep up.

This afternoon was very busy with joint injections (I have been getting a lot of those lately and was wondering why. My medical assistant says the word has gotten out that the ones I do work and don't hurt as much as some done by other physicians. I didn't realize that I had that reputation until now.) and colds. One fifteen month old child turned out to have pneumonia but he is doing very well with it so we can treat him at home. In fact, he doesn't even act sick just has a bad cough.

Nearing the end of the afternoon, I found out that a patient with a chronic pain problem who had cancelled really hadn't. She called in wanting something done right then and said she was going to the Emergency Department so the nurse taking the call marked her off the schedule. Well, she left the ED before being seen and arrived back at my office at her appointed time and was put into a room by this nurse. Her appointed time had already been filled by two other people in the meantime due to the nurse's mistake. So, I got to deal with someone needing a LOT of extra time and other patients who were on time for their appointments. Needless to say, some had to wait longer than they wanted so I was apologizing right and left about something that was beyond my control.

So, the chronic pain patient has been using the ED as her private clinic to get medicine for her back and abdominal pain. The ED social worker calls me, who has seen this patient the grand total of once before, for a plan regarding future visits. I go in and talk to the patient and find out that she is still using metamphetamine from time to time but has quit drinking, she says. She has a history of ulcers and lately has been vomiting up blood and also having blood in her bowel movements. She gets high to escape the fear that she has a cancer causing her to have the blood and pain. She has been in multiple drug treatment programs in the past and has always gone back to the IV drugs again afterward. I tell her if she will agree to talk to the ED social worker tomorrow who will get her seen by a mental health professional for evaluation (I think she has a mental illness as well as an addictive personality) then I will go ahead and set her up for evaluation of her stomach and colon. Along with this, she has to promise to not go back to the ED for pain medication. She agrees this afternoon and is supposed to call me tomorrow morning for a schedule. Do I think she will comply? No, but I feel better having at least made the effort to reach out and help her, not just relegating her to the junk pile of souls beyond help. The time I spent with her hopefully was not wasted because it sure made me late finishing up at the office once again.

If you think I am sounding a little tired, you're right. My patience with people is running short now. I have to really be aware of my attitude to keep it from slipping and being short with people. I don't want to miss those people who are really reaching out for help and just don't know how to say it. They may come in with pain as their presenting symptom but are really asking me to look deeper and see what their real problem is. It takes a lot of psychic energy to stay up and feel like you want to help everyone get better and/or relieve their suffering. My supply is short right now, but I know something will happen in the next few days to recharge me. It always does, it may be someone who comes in and says thank you for listening. It may be someone who says their friend recommended me because I helped them. It may be a thank you card from a patient. Having two three day weekends in a row off will also help.

Driving home tonight, I was reminded of another reason why all the people needing so much are coming out right now; there is the brightest full moon we have seen for the past century and the brightest we will see for another century. It is true, the full moon brings out the real characters. Back when I worked in ED's quite a bit, we would dread these full moon times because we knew the kind of people we would be seeing in the ED. It also seems to make women go into labor and have problems during labor. It's times like these that I don't miss doing obstetrics. I do miss delivering healthy babies and being able to hand them to their happy parents to take home and raise.

I feel better now, thanks for listening. I must go now and practice the Christmas carols for tomorrow night (that will refresh me too) and get some sleep tonight. Tomorrow promises to be another long day.

Sure enough, some people said thank you to me today for being there for them. The woman who is the substance abuser showed up today and met with the social worker. That doesn't mean she will follow through but it is a definite step in the right direction. There are a lot of steps in front of her still however.

We had a team staff meeting today with cake for those in the team with December birthdays. Holidays are so much fun with all the baked goodies that show up at the office. Whenever people start complaining about eating too much, I remind them the holidays only come once a year and they shouldn't feel too guilty as long as they don't make a habit of eating like that all year long. And if they are feeling guilty still, they can bring their goodies to me as I don't feel guilty about eating it, especially the chocolate ones.

Again tonight the full moon was beautiful and bright. It is unusual that we can see the moon this well here at this time of the year. Normally, it is cloudy and rainy every day here but we have had beautiful clear weather here all week and the forecast is for the same to continue through Christmas Day. After that, who knows. We won't have a white Christmas here for sure. We may have a very cold New Year's however if the long range forecast holds. Very cold here would be lows in the teens and highs in the twenties and low thirties(F).

The Christmas carols went well tonight. Everyone enjoyed singing the old carols and I didn't make too many mistakes playing them. We did not have our lead guitarist tonight so the group was a little short but everything went well. We ended up doing some of "O Holy Night" somewhat like Rebecca St. James did. I had played her arrangement for the team during rehearsal Monday night and they had enjoyed it too. I think some of it was left in their memory banks and we just naturally went into it. The first part of the song was done acapella by a female vocalist then the band joined in for the rest of the song. We were asked to do it again to close the service so I guess everyone liked it.

Delanae is in on the couch trying to fight off the flu, I think. She did not get her influenza shot when I told her to come in and get it and see what happens when she doesn't listen to me. I gave her a flu shot one year but then she wouldn't let me me do it again after I told her I usually only gave one a year, to her. After that, only one of the nurses who do it all the time was allowed to give her a shot. Tomorrow I can put her on one of the oral antiinfluenza drugs that works for Influenza A(Amantadine or Flumadine) since Influenza A is in our community at the present time. They only work for Influenza A and only work if started within the first 48-72 hours. I try not to treat my own family since I can't be as objective about them but sometimes I am forced to. Hopefully, this way, she will be able to enjoy Christmas.

Speaking of Christmas, I got a call today that Stephen's Memory Man guitar pedal is ready to be picked up at the store in Portland. That means one or both of us have to go to Portland on Christmas Eve to pick it up. I haven't tried to shop on Christmas Eve in sometime (don't throw me out of the Gang for that admission, Bob) so it should be a bit of an adventure finding a parking place in downtown Portland and getting to the shop. I have a feeling I will be going by myself since Delanae is sick. We have decided to keep Stephen in suspense until Christmas morning rather than take him with me to pick it up.

One last thing before I sign off tonight. If you haven't already read it, check out Dan Seto's Christmas message here. It's a definite classic to be enjoyed for Christmases to come. Congratulations,Dan,for a job well done and we will now be expecting more classics from you in the future (don't feel any pressure now). Until tomorrow then.......

The hospital is busier than normal for this close to Christmas. Normally, the hospital starts to empty out by this time but the inpatient census is still high. Don't know if this means there are more, sicker people this year or if a lot have nowhere else to go. I know there are the usual large number of overdoses and/or drug detox patients. With the extra stress of this time of the year, I would guess that population will not change for the foreseeable future.

Delanae is still sick but I don't thinks she has influenza. She is not having the muscle pain which is one of the main symptoms that go along with influenza. I have not put her on an anti-influenza medication as a result. She is still very fatigued but did manage to cook dinner tonight. Afterward, Stacey and I went to the grocery store to stock up for Christmas dinner which we usually end up having mid-afternoon on Christmas Day. There were some items we couldn't find tonight though, so will have to make another run tomorrow.

Speaking of Stacey, I looked over at her riding in the front seat of the vehicle with me tonight and realized she is becoming a young lady. She is getting so tall that I had to look twice to be sure it was my daughter and not some other older girl. I hadn't realized that now I don't have to look down at her when she is sitting in the seat, her head is at my eye level. I catch myself still thinking of her as a little girl and guess I always will. For some reason, it is not so difficult to think of Stephen as being grown up. I guess it's that father-daughter thing, fathers not wanting to believe their little girls will grow up.

Tomorrow, Stacey and/or Delanae and I are going to Portland. We are going to pick up Stephen's Christmas present and return a couple of things we won't be giving him. It looks like we will be going by the grocery store again on the way home to get those things we couldn't find tonight. More after I get back tomorrow.

Wanting to really experience the joys of last minute shopping on Men's Shopping Day, I suggested to Stacey that we go to the Lloyd Center which bills itself as the largest mall in Oregon. She was game being almost a teenager and having her own money in her purse today, less about 30 cents of course, thanks to the meter. So we drive up there to find there are PARKING PLACES in the parking lot right next to the entrance. What's more the lot is less than half full of cars at 12 noon on Men's Shopping Day. Inside the crowds are no more than what I've seen on a weekday night other than the skating rink which is quite crowded. We went up to the Food Court and grabbed some lunch (Stacey loves Chick Fil A, go figure) then walked back through the mall and drove back to Longview.

Back home, we stop at the grocery store to get the things we couldn't find last night. There were the crowds, all the registers had long lines full of people with two or three shopping carts apiece. Must be doing Christmas and Y2K shopping at the same time. The bargain ice cream shelves were bare (wonder how they plan to keep the ice cream frozen if the electricity is out? No, it doesn't stay cold enough here to put it outside.), most of the meat was gone, and sweet potatoes were hard to find. You can form your own opinion about what that means about the people who live here; me, I don't care for sweet potatoes although I buy them every Thanksgiving and Christmas for Delanae. She fixes them for herself and we simply keep our eyes and noses averted.

Stacey and I have fewer than eight items so we go through the express lane, which is relatively fast, and home we start. We are interrupted by a call on the cell phone from Delanae asking me if I will go by my office to pick up two packages for the kids that someone, who shall remain nameless, from back in Arkansas had mailed to them at my office address. To make matters worse, it was to my old office address which is now a vacant building. The United States Postal Service had delivered them there then realized today that we weren't there anymore and had brought them to our current(new) office building. Luckily, one office is open today for urgent care so they took the packages and called our home. I picked the packages up and we finally headed home for good this time(or so I thought).

Having accomplished all I had set out to do today, I went out and ran after we got home. It was a good run since the weather is still clear here and the temperature near 50 degrees F. When I got home, Stephen says he needs to go get his mother something. Now, we are really into last minute shopping mode. The time is rapidly approaching 5 PM and sure enough the first place he wants to go is closed. Near there is a music store where he has won a drawing for something so we stop there and pick up his prize which is a CD by a band he has never heard of and I certainly haven't. Back in the car then and head to the nearest mall. His next choice is still open and he finds something that will work for his mother, I find something there too for her stocking, so we are out of the store thirty minutes before closing time. We stop at a table in the middle of the mall to have the gifts wrapped, hey, we're MEN after all(all the guys understand, right?), and then finally head home to stay.

Delanae is in doing her last minute wrapping as I am writing this. I asked her why she doesn't get up about 2 AM and do it then which is the traditional time for her to wrap the gifts from "you know who". She very firmly tells me that that tradition has died this year and will not be resurrected in the future. We will have leftovers tonight then probably curl up on the sofa and do something brainless like watch TV (maybe there is a game on). Then, we can sleep in tomorrow morning and open presents LATE in the morning, fix Christmas dinner for midafternoon consumption and again watch sports on TV. What a wonderful day! See you tomorrow.....