Spelling fail

On a new patient's paperwork, where we ask about previous surgeries: Sea-section.

I got the giggles reading it.

I attract the STOOPID

All of these are actual phone calls today.

Case 1. a lady who I examined in the office on Wednesday for abnormal bleeding. I'm starting the work-up for a potential hysterectomy. Called yesterday complaining of "Bleeding to death." Told at that time to go to ER. Called again today (interrupting dinner) with same complaint. Did not go to ER yesterday. Also tells me she's pale and dizzy.

Talked to ER just now. Her hemoglobin is 13. I guess it's a slow bleed. ;)

Case 2. First trimester gal with n/v. Called in some phenergan suppositories. SHE CALLED BACK TO DOUBLECHECK IF IT WAS OK TO TAKE IN PREGNANCY!!!!!!!! No, I'm just going to call in something that will cause your child to have 3 eyes and 1 ear. I mean, WTF?

Case 3. Lady just d/c'd from hospital yesterday by her internist. Having similar issues as to what put her into the hospital. I specifically asked if she had any GYN problems. Nope. Please call your family doc, since I can't help you.

Monday 5 pm can't come soon enough.

Thanksgiving

My favorite holiday. A reminder to step back and be thankful is something that we all need.

I'm hosting the 4th annual Unthanksgiving Feast today. I always do it on the Saturday. It's just easier. This year, we'll have 10 people here.

There is a lot to be thankful for. The ability to walk (amazing what several consecutive days of rest can do). Food on our plates and a roof over our head. Friends who take a week's vacation to care for you. Healthy kids. Unconditional love from dogs. A husband who lives his wedding vows fully and without complaint.

I should go stick the turkey in the oven soon.

Good timing

My "drive-through" (a patient who arrives on L&D complete and ready to push) arrived at a time when I could get home and get the turkey in the sink of water to finish thawing.

I actually like drive-throughs...yes, it is disruptive during office hours, but it goes so quickly, I usually end up being only 10-15 minutes behind. And in the middle of the night, I LOVE fast deliveries.

Nurses like drive-throughs too - less charting! My assessment and plan on the written H&P: Labor. Delivery. Gotta love going through the paperwork after the actual event.

Can't do it all

And I finally admitted it.

I called my PCP and got my meltdown out of the way. I left with a script for an SSRI.

I started it this week...hopefully it will help. I was talking to one of my favorite L&D nurses and evidently there had been a betting pool on how long it would take me to admit that I'm really stressed. Thanks guys!

On the upside, when I lay on my back all day, my knee doesn't hurt. ;) I'm on call again this weekend and hosting turkey day...how much do you want to bet that I end up needing to leave my own party?

Hair pulling

Are the new guidelines published by the task force. We now have multiple competing guidelines on mamms, worried patients, an avalanche of papers to read before I decide to change my practice (I am a thinking doctor, after all).

And buried deeply in the back of a practicing docs head...the knowledge that a missed breast cancer is a leading cause for lawsuits.

It adds up to one big, hot mess.

OTOH, I'm glad the pap smear guidelines got publicized. It makes sense not to do paps on teens. For years, I've been trying to avoid doing them. We know that the natural course of HPV is clearance in these young girls. Now if I can only convince people that they need a pap every 2 years. I've had an easy time with post-hysterectomy patients, they are thrilled to know that they don't need a pap.

I have to say, I'm sick of talking about it already. Reminds me of the HRT debacle back in 7/02, when those studies were published.

Have to brag

About my daughter, the 4th grader. Honors report card, reading at the 9-10 grade level, and well behaved in class. Her teachers report that she is one of their favorite kids.

And our boy is a great kid too, very sweet and loving. He's very silly and can always get us to laugh. We're lucky to have two great kids.

No control

That's the essence of OB call, like Grumpy said. It really sucks.

Take this weekend. I had a huge FAIL on the rest and elevate your leg. Why? Multiple spontaneous labors leading to deliveries and then an ER hit last night at 8 pm, who ended up in the OR. I got home at midnight.

And I have office starting at 8 am.

Two steps forward...

And three steps back. Gordon put me back on crutches. I have to admit, I can really fly using those things, so I'm faster with them. But I'm frustrated at my lack of progress. I gave him an earful due to the frustration, which is out of character for me. He's so damn cheerful, I don't think it phased him. My knee is still tender and swollen...he measured it Friday and it's actually larger than when I started.

He told me I need to stay off my leg. And then I broke loose, telling him about mom moving in and needing to caretake her. I have too many people to take care of to be down. The original plan was get surgery in October, recover, and then have mom move in after the holidays, but she's unable to be alone now so plans changed. He just shook his head and told me to rest as much as I can.

So I'm trying to rest this weekend. And babies being babies, are not allowing me to do that. Spontaneous labor is awesome compared to induced labor, but it causes havoc in my schedule. At least they were both delivered before 9 pm yesterday. ;)

Dammit, now I have to round today since they came in last night. :(

Every time

I write about how much I love the OR, I must piss off the OR gods.

Multiple vag hysts today. I hate vag hysts. A latex-allergy case in the middle, so all of the previous cases also have to be latex-free. I hate latex-free cases.

grumble.

Nice delivery

My two favorite places at work are the OR and L&D rooms.

So I had primip last night, being induced (yes, I know. Overdue by a couple of days and I had a moment of weakness to whining in the office. I'm not perfect.) No health issues. Happy couple. Happy baby during labor. Checked her after office hours and before I went to PT. She was 7 cm. Told the nurse about my appointment and that to call me only if the head was out. ;) If she was complete, I didn't want to know.

So I go to PT and get tortured. As I'm sitting there at the end with the ice and electric stimulation, I call. She hasn't checked her but told me "She started having earlies about 15 minutes ago."

SWEET!

Finish PT, wander back to the hospital. Head is at +4 station. Pt pushes for only 20 minutes with a happy vigorous baby. Daddy is sobbing. She kangarooed while I got the placenta out and stitched her up.

Nice delivery.

Still slow

So Mom moved in. And thus far, she is still alive and I am still sober. We'll see how long that lasts.

But she had a list of things that she needed/wanted from the store. So off to Walmart I went. And no, I was wearing jeans and a sweatshirt, definitely not People of Walmart worthy. ;)

I'm thinking I'm not going to be doing any more shopping in the near future. It hurts walking through a big store like that!

2 hours

And counting until DH comes back her with my mother.

And let the fun begin.

Held back!

I was supposed to graduate from PT this week - yesterday was visit #12. And my ROM is back, which is nice. Most of the swelling is gone, but there is still a difference between knees.

But my right leg is still pretty weak. It's amazing how you can compensate (and not even realize it). I still hate stairs. My biceps and upper back are getting awesome because I've been using them to go up and down flights of stairs. Balance and proprioception is off if I'm forced to close my eyes. If I'm walking without crutches, I'm staring at the ground to doublecheck position of that leg. Gordon called me out on cheating during squats - all of my weight was on my left leg...I didn't even realize it.

And objectively, that right leg is a total loser! During the strength testing, he could move my leg any way he wanted to move it. I couldn't hold it in position to save my life. Left leg is just fine and stayed put.

The end of the world

I thought I recognized a patient on the People of Walmart site. It's the right state and it looks JUST LIKE HER.

Thanks, Grumpy.

Mothers drive you insane

And that's my plan for when my kids get older. ;0

She's doing better. On Vanco for presumed infection. Got 3 units of PRBCs thus far, last hgb was 7.9. Her white count is up to 1.1.

And I browbeat her into moving in with us. More accurately, I told her that and she finally stopped arguing.

It will be easier to keep an eye on her here.

Readmitted

I'm starting to dread these phone calls at night.

Grrr.....will go up to Mecca after operating on Wednesday and say "WHAT THE HOLY HELL WOMAN?!?!?!?!?!?!?! IF YOU HAVE BEEN PASSING OUT FOR OVER A WEEK, WHY THE HELL DIDN'T YOU TELL SOMEONE?!?!?!?!?!?!?!?"

Another neutropenic fever.

I am aging too rapidly here.

And yet another PSA

Kicking your doctor in the delivery room is NOT appreciated.

Thank-you.

I was proud of myself - I didn't cuss outloud, although I really, really wanted to. She got my bad knee!!!

I want to claim credit

We do a lot of practical jokes on L&D. Docs, nurses, techs, the vast majority of us love to pull pranks. And we do them frequently. Birthday folks have to be especially wary (hence the reason they still after 4 years, don't know my DOB). We have a rubber snake that is making its way around. If we have a willing patient, nurses have been known to convince her to place it between her legs and then send the doc in for a cervical check. Lockers have been known to be stuffed full of popcorn.

So last Halloween, another doc had a labelmaker out. He made nametags saying "Boo" for all of the nurses. Bea was working that day, and he had made one for her too. He even offered to affix it to her nametag. She looked at her name badge and read "Boo Bea" from it and turned bright red.

I so wish I had thought of it first!

Slow Learner

That would me.

I had told DH last night, since he had an early morning meeting, that I could easily get the kids off to school since I had no office and only a PT appointment at 9. Other than that, a wide open calendar until my hair appointment in the late afternoon.

Remember the previous post about the GDER? It ended up being a torsed ovary in a pregnant gal. Initially thought to be an appy by the ER doc, but since she was pregnant, I got to admit her and promptly consult general surgery.

I quick get the kids hustling to get dropped off at school (forgetting my cell at home in the process and needing to go back to get it). I gimped onto L&D, where the surgeon has beaten me into evaluate her. Quick dictate the H&P.

Eric (the surgeon) looks at my crutches and starts in on me. First words out of his mouth : "I heard from Jeff (the orthopod) that you aren't supposed to be working!"

L&D nurses lean in to hear my reply. I admit that I am not the best patient, but that I need to take of my patients. Eric arches his eyebrow, but doesn't say anything.

Eric and I then go into the patient's room. By this time, I've left the crutches at the nurses station, since there's not much room in triage. And Eric looks at me, big ole gleam in his eye and tells the patient "Dr. ER's Mom really likes when patients do what their doctor says. Compliant patients heal better." The nurse in the room bursts out laughing. I'm giving him the strongest stink-eye that I can give.

He ended up taking her down to the OR, agreeing with the ER doc that it was an appy. I offered to assist, but he said he would call me if it was a GYN issue. So, I looked for my phone (DAMMIT! Left it in the car!!!!) and told him that I would stay on L&D and round. By this time, it's 10 minutes before my PT appointment, so I call and cancel, apologizing up the wazoo.

15 minutes later, I'm in the OR dealing with a torsed ovary.

AURGH!

They should know better...

Than to fight when I am on the phone talking to the GDER.

Grumble...

Poor ER doc heard an earful while I yelled at the kids to quiet down.

And it is a grind

Horrific call the other night. Even though the full moon had passed uneventfully for my cross-coverage, my call brought out the stoopid. Correction. The STOOPID. When we got out of bed (please note I did NOT say woke up, because by that time, we had had zero sleep), hubby was cursing the call gods and my cell phone. He wasn't the only one.

I spent the day operating and trying to remember why I agreed to do these surgeries. Now, I'm a good surgeon and I know my limits. I am happy to refer on if I don't think I can technically do a case. So I'm doing a hysterectomy yesterday and every other sentence coming out of my mouth was "Need to work on patient selection." or "Why did I agree to do this one?" Also said frequently by the scrub nurse "I need more suture thrown!"

But it is a great feeling when you get that last piece of the puzzle and the case gives way, surrendering to your skills/tenacity/patience (take your pick). We were finally able to remove the uterus and my assist and I high-fived each other. Anesthesia was just happy the blood letting was completed. Big fibroidy uteruses usually have large, multiple blood supplies and this one was no exception. I'm guessing the uterus weighed 2-3 pounds, when they normally weigh around 1-2 ounces.

The remainder of the case, you go on semi-cruise control. Pedicles hemostatic. Check. Lap count correct. Check. Close peritoneum. Check. Close fascia. Check. Reapproximate sub-q tissue. Check. Close skin. Check. There is always a point in a surgical case where it's almost automated.

Oh, and I went without crutches for the first time. Let's just say that was a huge mistake and I took a couple of my hoarded pain pills after I got home. I have about 8 left...I am rationing them for the truly bad days. I refuse to be the PITA patient and ask for more.

Back to the grind

You know, most people are basically decent. So they won't ever catch themselves being made fun of in the blogosphere of grumpy docs, nurses, profs, salesclerks, etc.

But then there are the special ones.

The wholly self-absorbed assholes.

I caught wind of a few of these the past week. I have been canceling office hours the last few weeks because I was physically unable to work. And most folks have been very understanding. But the few that haven't been have truly exposed themselves to be snail slime.

Case 1. New patient, transferring to me from another doc from the next town over. Transferring because previous doc "Isn't taking me seriously." Whatever. So my nurse is stuck calling (3 days ahead of time) to cancel and reschedule. And the patient can only do certain days at certain times. Which means it will be a few weeks since other people were previously scheduled for those days/times. Per my kick-ass nurse a direct quote "Well, hopefully she'll be at THAT appointment! I've been in pain since August!" Bite me.

Case 2. A PITA who followed me from my previous practice. Called the day before my surgery to ask for a refill on a medicine. My cross-coverage didn't want to fill. Fine, it's not life-or-death urgent. Demands to speak to me that day (um, no way in hell). I had left the office by then. She called again Monday, asking for a refill, which I then OK'ed THAT VERY DAY SHE CALLED. And then she bitched to my nurse that "I had to WAIT for you to deal with my problem!" Jen tried to explain the concept of sick doctor, but it's all me,me,me to this woman. "It took her FOREVER to agree to the refill." Fuck you.

And then there are the folks who arch an eyebrow as they watch me hobble into the room, ask what's wrong and I explain that I had knee surgery. And these folks tell me "You came back too soon! Why are you working?" I had one patient literally smack me upside the head and tell me I was stupid. Another patient made up some story about how I was busy saving the lives of these triplets and that's how the doc who delivered her child ended up on crutches. I think the story involves me as a superhero flying into something.

GO VOTE!!!!

Thank-you.

A Public Thank-you

To my Dearest Husband, who has been taking care of me for the last few weeks.

I owe ya one.

I love you with all of my heart and I truly appreciate the work you've had to do the last 3 weeks. Thank-you.