“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler






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Out of Time

I'm just dashing out the door for a week's vacation in Mexico. I wanted to blog this week, but it kind of all got away from me:

The downside of medicine during the holidays, when you see families taking a hit from serious illness. I sent one patient to hospice this week, and have worked with two women with metastatic breast cancer under the age of 40.

The crazy spam faxes we have been getting for temporary office help. One company brags about their "articulate medical receptionist" and "dependable medical assistant"; I'm fantasizing about companies that push their "dyslexic medical records filers" and "sullen, territorial front office staff who fight with the back office staff at every opportunity." Not that we've been having any of that around here or anything...

V.'s new hobby. She calls me up and reads me snippets of porn spam from her email, then complains, "They're offering to enlarge organs I don't have."

But this will all have to wait for 2006. Back in a week. I resolve to post more often this year! Happy New Year!
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Damn

I hoped it was true. It would have been so funny...

Claim: The horses in Young Frankenstein neigh every time Frau Blucher's name is spoken because "blucher" is the German word for "glue."

False.
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Blarrggghhhh

This is one of the worst call nights of recent memory; it's 3 a.m. and I just got home. I have no idea why I am compelled to post about this right now, but I might as well strike while the iron is hot. Be prepared for misspellings, cliches and general poor writing as there is no way I am going to proofread this when I am done.

I got admission Number One at 4:30 this afternoon (make that yesterday afternoon). He was no problem; an elderly gentleman who had fallen and sustained a minor fracture, also likely had a pneumonia. All would have been fine if I hadn't accidentally locked my keys in the car like a frigging idiot upon arrival at the hospital. I went ahead and saw the patient while frantically calling around for help. I struck out with Security and teh Parking Administration had gone home. As a last ditch, I called V. God bless you, V.! She had just arrived home but came back to get me so I could retrieve my spare car key from my house.

Back at the hospital, I finished up Admission #1, walked to the car, put my key in the lock and opened the door triumphantly --

and got paged for Admission Number Two. Elderly woman with sepsis from a urinary tract infection. Low blood pressure. Diabetes.

Okay, she's done. I stopped off at the grocery store to pick up something to eat for dinner, got home took out the trash. It's now, oh, 10:30 p.m. I was paged with Admission # 3 as I walked into the house. I ate dinner and as I did I was paged with Admit Number 4.

Somebody up there hates me.

Back at the hospital, it's now midnight. I deal with #3, a rule-out MI, and go on to #4, a patient with pulmonary edema (think a very fast, very severe case of congestive heart failure). As I got Patient number 4 finished up, the ER doc came up to me and informed me that #2 was ruling in for a heart attack, probably brought on by her extremely low blood pressure and sepsis. As I coped with that, another ER doc informed me that #3 also looked to be having a heart attack.

"What the hell!" I shrieked. "Is it something in the water?! Everybody's infarcting tonight!"

Did I mention there are no unit beds? NONE. The ER is "closed" - meaning that ambulances are not supposed to be taking patients to that particular hospital, since there are no intensive care beds available. Patients 2, 3 and 4 are still in the ER with no prospect of getting rooms tonight.

I have a full day in the office tomorrow. I'm going to bed. God knows whether I'll even be coherent when the alarm goes off in 3.5 hours.

Coda. The pager went at 6:15. Mambo Number 5: congestive heart failure. For God's sake, people, lay off the salt!

(I caved and signed that one out to the day doctor, who was very nice about it.)
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Schrodinger's Theorem of Outpatient Medicine

The patient in the exam room is neither dead nor alive until you open the door.

At which point, hopefully, they're not dead. (Though we actually did have that happen once, in our Urgent Care.)

Discuss.
posted by Dr. Alice at #

 
Thank God It's Monday

What a week. Details later.

I am sitting here clutching a mug of coffee in an attempt to thaw out my fingers enough to type this entry. I hate our office building. It's poorly designed - all windows with aluminum framing, which channels the outside temperature straight indoors. We're always hot in the summer and cold in the winter. Add to that the cheapo landlord who turns the heat off all weekend and you can imagine what it's like in here. I really feel sorry for the poor woman who comes in for a pelvic exam and has to disrobe in a sixty-degree room - and then gets a doc with ICY COLD HANDS doing her breast exam.

Good news is, we're moving soon. Things have been happening here that I haven't had time to blog about, and one of them is that we have signed the lease on new office space about a mile away in a more upscale part of town. It's going to need some serious renovation first, as the building was designed as business office space, not medical. We expect to move in in six months or so. On mornings like this, I can't wait.
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