tinkll1 (tinkll1) wrote,

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The Last Day

Good things I have done.
1.) Seen the last of two patients with Medicare for the fourth time in April so that I can get paid my full and maximal fee. While doing that, I saw another patient for the fifth time, for which I will get no fee, and another patient for whom the number of times I see him doesn't matter, as long as it's once, as they don't distinguish, in reimbursement for one visit, or five visits. I find it difficult to treat patients differently when my income is affected, and generally try to ignore the obvious inconsistency. That's a good thing, because the demographic that I serve has too few Medicare patients and too many Emergency services only, MediCal patients, who compound their care by not speaking English, and complicate and burden their lives by the lack of educational and economic opportunity.
2.) Obtain and print out a Humanist Haggadah for Passover for use at our seder today
3.) Water my sunflowers, including the little greenhouse starters
4.) Mail a copy of The Flying Greek by Steve Pisanos to my friend, Don, in Minnesota, who is married to my old schoolmate, Sannee (Anastasia and honors their tradition by flying a Greek flag beneath the American flag, at their home in Eagan. Steve, I've actually met, and I've been waiting forever.... 6 months....for the publication of his book that covers his flying career in the Eagle Squadron of the RAF, and subsequently the USAF. Amazon, mistakenly, honored two orders which were submitted when the publication was delayed, so on the same day I received 2 copies, sending one on to Don.
5.) Went with Lin & granddaughters, Kayla and Samantha, to a children's production of High School Musical
6,) Did not curse out loud when I got paged by the dialysis unit in the middle of Act II to tell me that a non-tunneled catheter in the neck of one of my Mexican patients, which had been placed the previous day by the interventional radiologist, because the vascular surgeon was not available for immediate declotting, did not function! What should they do? Well, I'm on call for executive decisions. I made one. Get the interventional radiologist to intervene! Let me watch my play! Okay! But the patient has to be admitted to the hospital. So, admit him! Okay.
7.) Did not curse out loud (#2) when I got paged at the climactic moment when the brainiacs win the academic decathalon and the drama group selects the heroine for the key role, and the basketball team wins its critical game, to audience applause... which I heard from the corridor, as I comforted the nurse who was trying to get admitting orders from a patient who is blind, and doesn't feel that it's his responsibility to remember the 10 different medicines that I have prescribed for his 8 different conditions and filled out several prior authorization forms, of course without reimbursement, so that he might not get 3 different complications of poorly controlled diabetes. Nor did his accompanying 11 year old son feel it was his responsibility to carry a paper with the medication list on it. He was just fulfilling a filial responsibility. But, maybe there's hope. Son noticed my Obama button, and said with an unusual sparkle, "So you're voting for Obama!" Hmmm.
8.) Raced through the required history and physical while Lin and the girls sipped Starbucks, and did not again, curse (unsaid curse #3) the nurses for not retrieving the medications list which was there, all the time, in the computer.
9.) Did not curse (#4) the transporter who seized the patient's chart, and the patient, so that the interventional radiologist could carry out his intervention, before I was finished with it.
10.) Did not curse, out loud (#5) when the page to interventional radiology went off in the concrete and steel parking structure as I sprinted from St. Joes' to the minivan to resume the afternoon with Lin and the girls who were waiting at Starbucks, to be taken to an Indian dinner.
11.) Did not curse, out loud, (#6), when the radiologist told me that the catheter was working just perfectly, all along, and was kind enough not to say in words, "Why the hell don't your nurses know how to use the catheter that I put in, and why the hell do you have to call me in for nothing (so, what if you get paid more for that hour than I get for my hour and four visits each month, put together, and you have 3 guys to share call with, and I work by myself!) Yeah, well, I chose it, didn't I? And I like it, don't I?
12.) Chatted enthusiastically, and grandfatherly with family through dinner.
13.) Ignored frightful missive from raging daughter who feels that I've let her down repeatedly in her difficult journey through life, and only have empathy for my patients while ignoring her needs and the needs of her two half-brothers, who are successful deputy district attorneys with families of their own, and one of whom regales his six year old son with tales of how he has learned his fathering skills by what he didn't receive from me after his mother moved off to Des Moines and Seattle, after our divorce, and I placed my marriages, to the women, in my life, ahead of fathering. He will be working on another cold-case, no doubt, using some of the reservoir of righteous indignation that I stoked and encouraged by what I had not provided for my children, so, though his wife, a physician, and his 2 children will attend, he will not attend the family seder at our house. This is the son who wanted me to endow a chair at the USC School of Medicine so that he might get into medical school with less than sterling grades, but who has really found his niche as an extremely successful and effective prosecutor. Gee, I did that, too, while he worked his way through school, with a little help here and there, maybe. Huh? Family legends being born right before my eyes.
Tags: family, john, laurie, medicine, rants
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