True story

Do you ever feel that perhaps the people making the rules never have to follow them and really want to see just how many inefficiencies they can add to my already 14 to 16 hour days?

Please review the care provided by our government to seniors on Medicare and the VA system very carefully before allowing the government to control healthcare.  

Two days ago I could pull 2 pages of typed orders from a drawer and have my patient admitted , the family updated after surgery, and an operative report dictated in about 10 minutes.   Today there was a line of four doctors (thank God I was there first) for the one computer in the recovery room to enter orders that literally printed out in 8 pages and were placed on the chart by the nurse who then had to FAX them to admitting and pharmacy.  

Did we miss the part in school called NETWORKING?  How in the land of iPad, iPhone, and wifi do we have a computer system that when I hit send it doesn't automatically route to the proper department so that a nurse isn't busy faxing 4 times as much paper than she did two days ago to different deparents?

So then I have to find a chart to write a note because there is no clinical entry available for progress notes.   By the time I walk out to talk to family it's been twice as long as I told the family it would take for surgery and they think something is wrong when literally I have been typing orders for an hour in the computer.  I could just spit.  They told me if I just enter it once and save it to favorites it would remember what I entered.   Well
They lied.

And what's more is that when we called to complain that we had four doctors waiting for orders  on the one computer in the physician area, administration walks over and says "just tell the girls at THE DESK to get up so you can do your orders."  My response " you mean you want me to tell the girls doing THEIR JOBS at a computer to get up because my stuff is more important right now because I'm a doctor."  I think that will improve the moral.  We'll give it a try tomorrow!  And the other solution is "well you just need to walk around til you find one. "

I'll walk til I find one alright, at the hospital down the road.

Perspective

Perspective comes from experience; some experiences we wish we didn't have to endure and others we wish we could re-live every day.

Since I last wrote, I became a married woman. My perspective of the "institution" changed dramatically from a girl who wanted to wait until all was settled with my career to a girl who realized how life short can be and if you cannot spend it with the one you love, you aren't really living. Now my perspective of being a newlywed has been a bit skewed because my husband and I have lived in different states since the union. My perspective on marriage will change again starting tomorrow as he will be here for an indefinite period of time. I'll let you know about perspective on this subject in the coming months.

But as these changes come in my personal life, I have had some new perspectives in my professional life. I can be accused of spending too much time at work. In fact my husband who gets called on my way home every night would tell you it's significantly more than I'll admit to. And he is right. I got up at 2 am on a Monday morning to drive to the hospital to sit with the husband of a critically ill patient on scant sleep after a prolonged call and knowing I would work another 36 before going home again. My husband asked why I did this to myself. So I had to give him a bit of perspective. I told him if it was one of us laying there, I would hope the other would have the support of a medical provider that they knew and trusted throughout their care to help them with tough decisions. I cannot do this job without caring. Period. The day I stop caring is the day I quit.

That night moonlighting, when all I wanted to do was sleep, I got called to the bedside of a crackhead with no prenatal care with prolonged preterm premature rupture of membranes (her water broke at 30 weeks). Now if you've ever heard me tell a story, you know that my pet-peeve is no prenatal care because every pregnant female qualifies for Medicaid insurance so there is really no excuse for no care. She told me that she thought her baby was dead because it hadn't moved since the last time she used crack a couple of days prior and she just kept repeating "I'm going to hell." Her baby was alive, and as I sat by her bed waiting for her to be ambulance transferred to a higher level of care hospital, I talked to her about changing her life and about adoption.

Perspective. The close knit group that I completed the first two years of medical school with has all gone in different directions but when I called them in January for my last minute wedding, they all showed up in Florida with less than 2 weeks notice. We shared an experience that will forever bond us to one another in medical school and hope to continue that through out lives. Now as a resident in a group of only 8, we spend more time with each other than with our spouses. Our group gained new perspective in the last couple of weeks as to what really matters. Illness among us may have broken our spirits momentarily, but we will rally. For all those people who have offered prayers, lit candles, and all the hugs even when they brought tears, we appreciate it. Hopefully there will be a blog soon enough to keep us all updated to her treatment. We love you Flash!

And so perspective has a cost. The cost often seems much more at the time of onset, but eventually perspective develops and in the end, life is a closet full of things we found at the time we needed them most.

Coupon Math Trickery

I have a friend who takes one dollar and her coupons and shops and K-Mart during double coupon days to see how much stuff she can get (double coupons up to $2 now until 8/22).

Today was my first effort trying this little task with the collection of coupons I had gathered from the Sunday paper (my effort to keep the printing presses of America alive) and nifty online printable coupons.

The day began with the printing of online coupons, which was very frustrating because I misread expiration dates of 9/18/09 to mean yesterday instead of next month and hated the online sites for wasting my time.  I cussed then threw all the COLOR printing on the floor; very frustrating wasteful new task.  I had the "aha" moment regarding the expiration date in the shower and then thought to myself "online coupon sites are the best thing since sliced bread."  

So tonight me and the coupons go the Kmart for said double coupon sale... and lets just say the tally for being a super shoppe:  Kmart and coupons 1 : Alisa 0 

The retail price of the things I bought tallied to $73 dollars before 6% tax so I would have spent about 78 dollars and my total walk out the door price was $48 dollars.  I bought a 9 dollar clearance lamp for our lounge which was a super savings since it was regularly 39 dollars.  

So I saved $30 with my coupons, and technically $30 on the lamp but I feel like I still spent a great deal on four bags of cleaning supplies and 100 calorie cookies.  When the check out boy told me 48 dollars, I asked him to double check and see if my coupons doubled... and they had.  I was the victim of my own coupon math trickery!  

I drove home, saw a 2 foot tall package on my front step with my welcome mat draped over it like it was hiding a very large key in a box.  (why not just set the box on top of the rug... the jig is up that there is something under my mat)  My new work shoes!

So as I danced around in my new patent leather fuchsia and floral Sanita clogs (the old dansko) I thought to myself "well that 60 dollars I saved tonight pays for 1/3 of these" so I'll just keep cutting coupons until they are paid off and continue the coupon math trickery.

  

Those pesky gowns....

So today was my first half day back to work sans GB (without gallbladder ) post op day 4 and it was a great day.  I was told no heavy lifting or somersaults and the most I lifted was a lube coated speculum despite being very tempted to pick up an adorable and very chubby six month old that would not stop smiling and cooing.  I digress.

The Hospital Gown.  If you were in the ER, which way would you wear it?  Open to the front or open to the back?  If you were spending the night in the hospital would you wear it open to the front?  The open front hospital gown is one of my biggest pet peeves in women's health (don't even get me started on a paper open front gown).  Are we so busy as physicians that if we have to do more than simply move the gown to the side to do a breast exam we are wasting time?  How hard is it to slip the gown off an arm or use those buttons on the shoulder?  

  

I have long held two beliefs about the annual exam.  

1.  The first time you meet your doctor you should be in your clothes and then change into a gown.

2.  Gowns open to the back.

These are just plain etiquette.  Number 1 is a no brainer, do you agree?  My argument for belief number two is simply this.  As you lay on the table with the gown open to the front, waiting for a cold handed physician to walk in to complete an exam that you have probably waited quite a while to have,  you are also struggling to cover yourself with the skimpy sheet you were handed.  This fight is important mostly because it's cold but also deep down all of us feel self conscious, sometimes scared of discomfort or diagnosis, and very exposed at this moment in our year.  When the doctor arrives and you finally have to let go of the sheet with one hand and place it above your head for your breast exam with the gown splayed open as you struggle to hold on to the sheet with the other hand, listen and answer their questions, and decide if eye contact and talking is okay, there isn't really a word to describe what you feel except exposed.  

It it is okay to wear the gown the right way for your annual exam - open to the back just like you would in any other office.  I believe it helps make one of life's pesky days a little easier.

Now if I just blog some etiquette beliefs about colonoscopy, Wal-Mart, and bars the world would be fine once again.  

****please forgive all run on sentences, grammar errors, and mis-spellings****

The Surgeon has surgery.

I was recently advised by my brilliant boyfriend that I was actually an okay writer and should consider a blog.   Here is my attempt to show you how I see the world and entertain you with the life that I am blessed to lead.

Let's start with the reason I actually have two minutes to do this.  Three days ago I had a laparoscopic cholecystectomy.  Yes, I am a 30 year old ob/gyn resident and had pesky gallstones that at random moments in my life caused a burning pain (like a small spewing volcano in my right upper quadrant) to other times causing nausea and vomiting that for the most part lasted less than one hour at a time.   Then the pain came with nausea and vomiting and lasted 10 hours and then 5 hours and so on and well you don't look very professional in a shirt hugging a trash can crying in pain.  So that is how we got to today.

It was very different to be in the backless drafty gown and not scrubs in my base hospital.

My only previous surgery prior to this was my wisdom teeth extraction in graduate school.  I walked to the surgery center from my apartment.  I was then yelled at by the receptionist because I didn't have x-rays as they had not been sent over by my dentist.  I started crying, cried all the way to get new x-rays, and didn't stop crying until they gassed me to help me relax.  My roommate picked me up and I was eating egg drop soup that night.  

I was very worried about crying before this surgery much like I did when I had my wisdom teeth out.  But for those who were working in the ER Tuesday, I was kind of out of tears from my visit then.  It is very scary to be alone in a city 8 hours from family, 12 hours from your boyfriend, and be sick, surgical sick.  I cried from the moment I left my rotation on Tuesday until hours after I arrived in our ER.  It is amazing how much you can work yourself up.  I cried about not knowing how I was going to get home that night after IV narcotics, I cried about missing work and other residents having to work harder, I cried about crying in front of the staff in the ER, I cried because I thought the ob/gyn residents would not know I was in the ER until the workup was done, but thanks to gyn ER consults, they were all there to see me getting wheeled in from ultrasound.  I cried some more.  I cried because nausea returned despite IV meds.  Then they gave me IV phenergan and I woke up the next day at 11am with no tears.

So with the help of a little pill bottle and a box of anti-nausea butt rockets I made it to Friday where I was surrounded by the most comforting people in the pre operative area (my fellow residents, my attendings, and the OR staff, faces that I have seen daily for the past 2 years and 2 months).  And I did not cry... That I know of. 

And then it all gets a little fuzzy... I had refused all drugs to the point of being wheeled back to the OR.  I wanted to meet my anesthesia provider before I was given something that would alter my memory.  I meet her, and she hugged me, gave me a warm blanket, and then I woke up in recovery with no pain, no nausea, and for a long time couldn't lift my limbs.  I was a little concerned that they didn't do surgery because nothing hurt.  The surgeon came by and said it went well, and all my friends appeared again as blurry faces but I remember them.

I don't know if other people even wonder how they acted when they woke up, but I do.  Everyone says "oh you were fine" but I wish I could have seen for myself and know that I treated them as well as they treated me.  And that perhaps I did not say anything too silly.  And then in the back of my mind I think, did I feel a bit of gas before going in but all this wondering makes we weary.     

After being awake, there were still a few things to take note of.  

You might forget to breathe with one Percocet.  

Looking at photo albums is helpful for remembering to breathe, but the tripping on narcotics part was a little wild and perhaps Daniel, I need to take another look at those Africa pictures. 

Naps in the lounge are always fun.

Yogurt is always a good dinner.

You know that dream where you show up to work naked.... yeah.  I think this counts as living it.

My favorite part about the whole day was getting my clothes back.

At this point in time, if I had another gallbladder to spare, I would do it again.