Feet First

“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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    Wednesday, January 26, 2005
    Multiple Hats

    It occurred to me that the events of today might make a good story to convince you that I really do do other things besides primary care medicine. My other roles are listed in italics.

    Woke up 5 am, got ready to walk with my neighbor. (Neighborhood Walker and Nosey Parker - we call ourselves the Snoop Sisters.) We canceled at the last minute (that would be 5:45) due to rain, but she told me to come over around seven so that I could practice giving her cat an insulin shot -- it's diabetic -- while she's out of town. (Local Cat Nurse.)

    Stepped out of house at seven to see said neighbor standing in road over body of dead cat (not hers - it's a neighborhood cat) gesturing the trash collection truck to drive around it. My comment: "You looked like a peace protestor!" I looked up the number for Animal Control and phoned them to collect the poor cat. (Public Health Official.)

    Finally got to work and reviewed Urgent Care charts from the night before (Clinic Manager) and then greeted the resident who's been working with me for the last two weeks seeing patients (Medical Educator). I'll tell you more about working with residents some other time.

    Saw patients all morning. Bolted out of the office to drive to Tertiary Medical Care Center to attend a lecture on Medical Imaging, a.k.a. Radiology (I am the licensed Medical Radiologic Supervisor in our office). I have to attend these lectures once a month to get the required number of medical credits to keep said license.

    Finished work. Over the course of the afternoon I coped with multiple emails regarding an administrative problem at our church's parish school (Vice President, School Board) about which the less said, the better. (For privacy reasons.) Played a few rounds of FreeCell to relax (Card Shark) and went home. Stopped off at neighbor's house, fed cat and shot it up - see above. In passing, it's remarkably easy to give a cat a shot. Gather up the loose skin at the back of the neck and jab the needle in - the cat won't even feel it.

    Wrote this. (Blogger.)

    The End.

    Tuesday, January 18, 2005
    Email from Down the Hall

    My three day Weekend from Hell is over. Being in the office today almost felt like a vacation.

    Lately it's been too busy for V. and I to chat much. Our offices are in different suites on opposite ends of the hallway, so we don't normally see each other at work in the course of the day.

    We do email a lot. (What did we do before getting our PC's? We only got individual computers a few years ago. We must have used smoke signals.)

    Today I got a three-word note from her:

    Are you alive?

    I sent back the following:


    I'm glad it's over. I was too tired to fix dinner last night, went to bed at eight and did not move till I woke, stiff as a board, at five.

    Saturday, January 15, 2005
    How to Survive Weekend Hospital Rounds
    by Dr. Alice

    1. Wear pants. (No pantyhose.)
    2. Wear comfy flat shoes - you're going to walk a lot.
    3. Get up early. Day shift starts at seven a.m., I try to get to the hospital by six to get my head together. This is particularly helpful if one is hit with an admission at the start of the shift, as I was this morning.
    4. Eat breakfast. Just do it, you'll thank me later.
    5. Don't drink too much coffee. Do drink a lot of water.
    6. Don't, for the love of God, forget your call manual containing all the specialists' pager numbers! You idiot!
    7. Eat lunch. You've worked six hours in the morning, you have another seven to go till dinner. Eat lunch.
    8. Take notes as you go (who's been discharged, what nursing home did they go to, who's their regular doctor, etc.)
    9. Hit the patients who are likely discharge candidates first. The others can wait, they aren't going anywhere. Your chances of thinning the service population go up exponentially if you do this.
    10. Make notes of who had radiologic studies and do X-Ray rounds on everyone at the same time. This way you aren't running down to the basement repeatedly.
    11. Be nice to the ER staff. It will pay off big time. (Ditto for the nurses.)
    12. When you finally do finish for the day, resist the temptation to stay up late reading. Go to bed early because you're going to have to get up and do it all again tomorrow.

    So guess how I'm spending my weekend. At least it isn't raining.

    Tuesday, January 11, 2005

    that was one of the busiest call nights I've ever had. I was called to admit six patients before midnight. I admitted five of them, and would have admitted the sixth had I not found out, after half an hour of history-taking and examination, that he belonged to a different physician group (insurance issue; I'll spare you the details).

    Got to bed at three a.m. Paged at five-thirty for another admission. I got in at seven forty-five, after four hours' sleep. Fortunately, night shift finishes at seven a.m. so I was able to relax and not worry about yet another admission.

    While I was in the ER Saturday morning, the red phone on the wall rang. (That means unstable patient coming in by ambulance.) I saw the notes the nurse took: full arrest, intubated. Hmm. A minute or so later, in came the paramedics with the patient, one of them doing chest compressions but not with any sense of urgency. I overheard that the patient had been "found down" at a nursing home and the paramedics had been called.

    "Were they doing CPR when you got there?" asked the ER doc.

    "No," said the EMT (emergency medical technician), rather disgustedly.

    Oh well, he's had it then I thought, and went back to my admission.

    That he had, as I found out about twenty minutes later. I had forgotten all about the DOA patient as I got absorbed in my admission and treatment plan, when out of the corner of my eye I saw the ER doc talking to a woman off in a corner. A minute later the sobbing began.

    "He was fine yesterday," she managed before they walked her into the room to be with her - father? Grandfather? I wasn't sure. At that point I felt like a louse for treating his death so casually, but I was too tired to beat myself up for more than ten seconds. It's an occupational hazard, treating death like a pest or a mildly interesting event. Or, worse, an annoyance. ("This guy had to go and die and screw up my hospital rounds!")

    Please God, let me not get that anesthetized to other people's suffering.

    Friday, January 07, 2005
    Brief Update

    One hour into night call and I've got three admissions. Plus, I'm taking telephone call Saturday and Sunday (covering outpatient calls for the doc who'll be rounding this weekend), so I'll have idiots nattering at me for the next two days.

    This sucks. Oh well, I'm getting paid.

    Rainy Friday AM

    We got a pass on the weather for a couple of days, but this morning I woke early and heard it: Patter patter. Yep, rain is back. By the parking garage at work this morning, I see no little green parrots (wonder where they're hiding?) - just dripping eucalyptus.

    I head across the street to the hospital cafeteria to get breakfast for my secretary while she makes the coffee. In the building lobby, a burly Russian snarls "Stupid winter!" before heading out into the rain. This makes me grin - a Russian complaining about a Southern California winter? But that's what living here does to you. You start to expect sunshine every single day. It's almost a God-given right. Come the rains of winter, we snarl and grumble. It reminds me of a Deep Space Nine episode I saw years ago, sent on a "pleasure planet" where the weather was always perfect. When the computers that control the weather patterns are sabotaged, suddenly it rains constantly and everybody's gloomy and cranky. I'm sure the writers of that episode were satirizing Los Angeles.

    I bring the food back (bacon and eggs - it's cold out there) and my secretary eyes my coffee mug.

    "What's in there?"

    "Rewarmed coffee from yesterday," I reply. (I will drink damn near any coffee, even a day or two old.) "Mmm-mmm!"

    She shakes her head, takes the cup and returns in a minute with fresh brewed. "That'll put hair on your chest." She stalks out.

    I drink it and stare absently out the window at the rain and wind, esconced in my warm little box. I'm thankful to be inside.

    UPDATE. One of the nurses: "Wow! Have you looked out your window?"

    Me: "I know. Wuthering Heights."

    Thursday, January 06, 2005

    ... to Tim Blair, who has a day job effective Monday after working freelance for four years. (Or should that be 'condolences'? I offered to send him a tie for work.)

    Monsoon Season

    One of my patients once referred to California's rainy winters as "monsoon season." He hated them. I'm starting to agree with him; we've had days of rain, punctuated only by New Year's morning sun (yes, Pasadena pulled off its annual miracle once again). I find it hard to do anything in weather like this: I spent New Year's weekend either on call or moping around the house staring at the rain. Lately, instead of writing, I've been mindlessly clicking on other people's blogs. No doubt you've noticed.

    Must. Snap. Out. of Seasonal Affective Disorder. What shall we talk about?

    Hmm. I never told you about the Christmas Eve disaster at my sister's house. The night of December 23 it froze hard (she lives in Colorado). The pipe under the kitchen sink froze, but thanks to quick action and a space heater, it was thawed and a rupture was averted. We thought. My father came to pick me up at the airport the morning of the 24th, told me the story and complained about the cold overnight; we stopped off at a mall so Dad could do his last minute Christmas shopping, and I checked in with my mom by cell phone. That's when we learned that another pipe had frozen. And burst. And the guest room in the basement had flooded. (All my parents' stuff was in there.)

    My brother-in-law, Mr. Fixit, got the water turned off and the pipe repaired with the help of his dad and mine. We spent Christmas Eve mopping up, doing laundry to dry all my parents' clothes, and shopping for a new mattress. Interesting marketing fact: apparently the Christmas shopping season is a big time to buy mattresses. We had to go to two stores to find the size we wanted (there was not a queen size to be had at the first store).

    Other than that things have gone on without too much excitement. I wound up covering a lot of urgent care shifts the last two weeks since all the residents left town like lemmings for the holidays and decided at the last minute that they didn't want to work. As for the patients: cough, sniffle, wheeze. What you'd expect.

    I also have been coping with a couple of traffic tickets, of which more later. Gotta start seeing patients.

    Sunday, January 02, 2005
    Public Health and Tsunamis

    The single most critical issue post-disaster, as it turns out, has been that of clean water. This is not a new concern; for centuries clean water has been perhaps the issue affecting public health. (With the possible exception of overcrowding and bubonic plague.) Think of polio, cholera and any number of other diseases. I Googled a website for you here with a great deal of info about clean water and how it routinely affects public health around the world.

    Donate if you can. It makes a huge difference. (Just on general principles, I would recommend Doctors Without Borders - they do good work.)