Friday, December 28, 2007

My Christmas Song

Please sing along:

On the twelfth day of Christmas Tacoma General gave to me...
12 chest pain rule outs,
11 CHF-ers,
10 renal failures,
9 overdoses,
8 DKA-ers,
9 altered elders,
8 gastro barfers,
7 asthma wheezers,
6 UTI's,

Fiiive MRSA wounds!....

4 restrained prisoners,
3 rectal masses,
2 septic homeless...

And a with-draw-ing drunk in room three!

Merry XMas and Happy New Year!

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Tuesday, December 11, 2007

Compliance

Given my intense workload, life's little pleasures have been increasingly hard to tease out of the everyday. This leads me to the logical conclusion that internship is really and truly soul-sucking. I don't care where you are, what you are doing (pathology, peds, ortho, ER) working 80 hours a week or more and nothing seems fun anymore - except maybe sleeping, eating and getting a day off to sleep and eat.

I have to say that it doesn't help the burnout factor when 75% of the patients I see in clinic are drug seeking (I wish I was just being cynical, however this is surprisingly true in our patient population). It also doesn't help when a large majority of all my patients are also non-compliant.

Ah. Non complaince...
What does this term mean, you ask? Literally it means they don't comply with instructions. There are levels of this. Obviously, as a physician, I am not the boss of a patient, however the issue of non-compliance can be very frustrating on many levels.

Sometimes non-compliance is a physician's problem: e.g. a patient comes and says they are depressed. The just want to talk about it. The Doc prescribes an anti-depressant, thinking if the came to the Doc they obviously want meds. The patient, not wanting meds one bit, doesn't fill this prescription and leaves feeling dissatisfied. The follow up visit patient is still depressed, and upon hearing that the patient hasn't taken their meds the doc, not really understanding the real issue (obviosuly this is not a family doc) chalks the patient's persistent issues up to non-compliance.

Sometimes, non-compliance is the patients problem. A diabetic who has failing eyes, failing kidneys, and multiple amputations should be taking his insulin. He knows he should be taking it. But he doesn't because he doesn't feel like it. It's a pain in the butt counting carbs and shooting yourself up. So his sugars stay high, he risks losing more limbs, and now is in the hospital with a heart attack that may have been prevented if he had just taken his insulin. We catheterize his heart, stent a blocked artery, put him on his supposed home meds plus a blood thinner - explaining, of course the reasoning behind each and the importance of all. He looks great, we send him home in decent shape, then he comes back two months later, stent glogged, sugars sky high, and here we go again...

Sometimes it's a communication error. Doc says you have high blood pressure, take this pill. You (the patient) say ok and takes the pills just when you feel bad, which surprisingly isn't all that often. Then you comes back to the doctors office and your pressures are still sky high. (this scenero is amazingly common and sometimes hard to tease out. If this issue is missed then sometimes doses are upped and and the patient's blood pressure becomes notoriously hard to control when i reality, it's just a compliance issue).

That's compliance in a a very simplified nutshell (other Docs feel free to contribute). And it's this issue of non-compliance that has been killing me lately.... That, and all the drug-seeking chronic pain patients allergic to everything under the sun except that one medicine that begings with d and ends with ilaudid. This issue could be ten posts long, but I'm just going to let it go, because my gentler readers can only handle so much cynicism.

Update later on horrible no good rotten birthday weekend and the excitement and redeeming power of co-residents on my birthday proper. With pictures I hope.

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Sunday, December 02, 2007

The Update

It's been a long time since my last post.

Every so often something pops in my head and I think, "I should blog about that." But it just never comes to fruition. I have, however, been receiving a lot of inquiries as to what I'm up to and what ever happened to my car. So a quickie to get this blog ball rolling again.


The Car
I got my car back. Insurance company still hasn't paid up but my personal lawyer (thanks Dad!) took over the case and essentially dog-birded them until they agreed to pay for repairs. I won't believe it until the check arrives, but after two months I think he's finally made some progress. The woman at AAA that made our lives hell just had to be bypassed (I'm not insinuating anything murderous here, but I can't deny I had the feeling once or twice). I still get hypertensive thinking about her (flashback: "I got your wimpy fax"). My car is, however, still stereo and speaker-less as, out of pocket, my incredibly helpful family spotted me the most basic repairs to get my Civic on the road.

The good news is I do sometimes entertain myself quite well in the silence of my vehicle. Last night, in fact, I was so excited to go home and go to bed I sang a range of patriotic tunes (Yankee Doodle Dandy for instance) where all the words were "bed". Much more fun than hearing the latest Fergie booty song for sure.


The Rotation

I'm on that FP rotation I talked about. It's as hard as they said it would be. If I really, really work very, very hard and I have only managed once, in the 3.5 weeks of the rotation, to get out of work in less than 12 hours (that's not including the occasional 30-hour shift of course).

I've been pretty exhausted. My life has resorted to eating, sleeping and working. Thanksgiving on call was rough as well. But the best part was that I got to have a belated Thanksgiving with my mom and Chuck who came to visit over the following weekend. I may come back and insert graphic turkey-stuffing pictures.

I'm anxious for this rotation to be over, and along with it the very first Christmas I can't make it back to my dad's house. I'm half way done with my 7 weeks as of this evening. And I'm 2 days into my 12 days before my next day off.

And that's the quickie. Hopefully more to follow.

And a happy Hannukah to all you Jews and Gentiles out there!

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