First, there was an e-mail from Sally (Araceli), my trusted office manager-aide-Girl Friday, received on Tuesday, or Wednesday, when I was in Copenhagen. When was I coming back to the office? I thought we had settled that one before I left, but I will take the responsibility of acknowledging that the tentative return date which I said that I would confirm, I filed to....net result: 8 or 10 patients showed up at the office on Tuesday expecting to see me. I feel really terrible about this, and I think that this is the first time in 41 years, short of rare illness, that I don't remember, that I haven't been in the office, often late, and breathless....but there!
I started Thursday off with the usual 6:30 AM trip to Davita Santa Ana, to see two patients on dialysis, one of whom was still on vacation, somewhere, hopefully getting her scheduled dialysis. I was driving Lin's Lexus SC430, which has great air-conditioning, but does not respond like a Porsche. The Porsche gets washed in our driveway by the car washing service, and I needed an early start. Next stop was Davita Orange to see 4 patients, then on to St. Joseph Hospital to see 2 more patients. I then stopped for coffee at McDonalds, read the sports page in the Register and the dwindling Los Angeles Times, (USC favored to be #1; Bruins rebuilding....don't expect too much!) and then off to Westminster Davita to see one patient.
At this point I called the physician who was covering for me and learned that I had 2 patients in St. Joseph and 1 at Western Medical Center Santa Ana. One patient, who had been in the hospital for 36 hours, still needed to have a history and physical done, and had been the victim of an assault, complicating her usual problems of chronic kidney disease requiring dialysis, problematic vascular access and sever peripheral vascular disease. So, I went on to the second shift at Davita Santa Ana and saw one patient, to WMSA to see 1 complicated patient who was not in her room but in the GI lab having an endoscopy, and went over the chart sorting out 6 or 7 problems, which were not as clearly defined as I, in my OCD fashion, would have liked. Then on to Davita Tustin to see 2 dialysis patients, back to SJH for 2 patients on the second shift, and then to the hospital itself, to see one patient on the 4th floor in building one and the second on the fourth floor in building two. Both very complicated and requiring much the same problem delineation that had been needed at WMSA. Many, many loose ends, crying out for solution or to be swept under the rug. Like, a report on a carotid ultrasound without the doctor's signature that said 70% stenosis of the right common carotid in the documented findings, only to be interpreted as "mild stenosis" in the impression. No excuse that I'm a nephrologist an this problem was neurological...maybe. The patient had recovered from what was termed a TIA, and an MRI showed no acute process, but no neurologist had seen the patient, and I couldn't rely on the patient to tell me why the studies were done, or the progress notes to take me to the same place. These were mere "details" that occurred while I was in Europe. A neurologist will see the patient before she goes home and the report will be corrected, and if she needs angiography, stenting or surgery, she will get it before she goes home. I am detail-oriented, heaven help me!
Somewhere around this time, and certainly after weighing myself at least 3 times, in shock, I decided to have lunch.... still fresh peach pie time at Polly's so lunch was 2 cups of coffee and a piece of Equal fresh peach pie. Then off to the office for 10 patients, 40 or more charts to review, 3 or 4 phone messages, including one to set up a patient review program for 6 patients at SJH. I will not detail the frustrations of lab slips not being available, patients not knowing the names of the drugs that other doctors had prescribed for them, my limited Spanish, their limited education, and the usual notion that I cared more about the health of 70% of the patients that I was seeing, than they did, or that they were capable of following the instructions that might optimize their health.
It was at about the 2nd or 3rd patient of the day when the thought occurred to me, that for what I was getting paid,the burden that I was carrying was absolutely crazy! I had the desire to run for the door, don my lifejacket and leap over the side. Call it dieting, lack of sleep or maybe, just a glimpse of reality, I was ready to quit.
I didn't, I just dug in and did the best I could with the patients and the data and plowed on through the day. At 5:30, I went back to SJH, did the H&P and contacted a gynecologist who speaks Spanish and would do a consult on a victim of an assault who was on Medicaid/MediCal. He would. I was ready to kiss his speculums...well not quite. By 7:00 PM, I was back at SJH dialysis to see the last 3 patients on the 4th shift.
Then I came home, ate a Corner Store Harvest Chicken Salad that Lin had waiting for me. Somehow, she had managed to keep a commitment as a fill-in Bunco player (card game, I think.) I fell asleep to the Jim Lehrer News Hour. The mail had not been delivered, but Amazon had replaced Eric Brown's book whose binding had fallen apart.
I could look forward to Friday, no office patients, and only 14 dialysis clinics between Norwalk, Anaheim and Santa Ana. Oh, and the Governator just reduced the generous payments for my MedicCal patients by 10% Well, gas is down to about $4.30/gallon premium, and my Porsche is very clean!