clinic was OK today..

I thought maybe I'd post something positive for a change this week... because this has been a strangely and amazingly positive week for me.

I felt the thing. "The thing" = satisfaction.

I was in clinic a lot over the past 2 weeks, which I have described in the past as a rather painful experience, as illustrated below..

*Post-menopausal Vaginal Bleeding, oh and by the way I also have a weird rash on my butt and I no longer want to have sex with my husband. Fix me. 8 minutes.

*My back hurts. I realize I weigh 450lb, but my degenerative joint disease is totally genetic, all of my relatives also have it. I can no longer walk. I ride in an automatic wheelchair that was given to me through Medicaid. I do not work. I can't. The pain is too bad. Make the pain stop. Fix me. 6 minutes.

*My tummy hurts. The surgeons have now taken out every possible piece of my gut that could possibly be instigating this pain. "If I had known the surgical recovery would hurt this bad, I never would have done it...." I take Percocet 10/325mg every 4 hours, and wake up in order to keep this on schedule.. **SURGEON, RED FLAGS!!! **** My surgeon says for the PCP to manage the pain. Fix me. 3 minutes.

*I have diabetes, I think. I was here last November, and my A1c was 12. I take my Metformin and Glipizide PRN and never check my sugars.. so PRN means when I feel bad. I also have a giant corn on my toe that I would like removed. I love beer and to ride my Harley. I really don't want to have a heart attack like my brother did at my age, which is why I'm here. Fix me. 20 minutes.

*I have had "shingles" outbreaks since I was 21 years old. At least 10 episodes. No one has found any source of immunodeficiency to explain this. I haven't had sex once since the last time I was checked for HIV in 2003. I have had a positive ANA in the past with a Rheum consult, but I have no idea what that entailed, nor do I have any record of it. But I don't think they found anything wrong. I need a refill of Acyclovir. Fix me. 7 minutes.

*My stomach hurts. I think it is ovarian cysts, because I have been told I have these. Also I have 2 kids that have been taken away because I have a heroin addiction. I am morbidly obese at 28 years old. I wonder if my thyroid is off. I haven't had a pap smear in 6 years. Fix me. 12 minutes.

*I can't sleep. I work 14 hour night shifts as a charge nurse for the cardiac unit. I have tried every lifestyle, alternative, and prescription remedy for this problem, but I still cannot sleep. I don't want to stop working nights because that is the only way I'll ever see my kids. My most recent, doctor, a PA, started me on Xanax and I can get about 3-4 hours of sleep off of that. But I'm afraid of getting hooked on Benzos. Also, I have Vitamin D deficiency. Should I be taking Vitamin D supplements. Fix me. 17 minutes.

*My grandkid is complaining of knee pain. She actually fell yesterday because of it. I don't know of any injury. She is on Seroquel for psychiatric issues at age 8. She lives home with grandma, mom -who is more messed up than words can describe -,and brother - who has the worst eczema I have ever seen. I need to go pick up these kids' mom, my daughter, at the hematology clinic because she is getting IV iron transfusions. No one can figure out why she is so iron deficient. Fix me. And my granddaughter. And her little brother. And her mom. 9 minutes.

*My stomach hurts and I am having massive diarrhea and bloating. I only speak Russian. Also, I have lost 40 lb over the past year unintentionally. I have never had a colonscopy. I can't completely empty my bladder. I think this is all because I am sad my 11 yo granddaughter had to go back to Russia. Fix me. 35 minutes.

*I am having trouble urinating. I live in Africa, here visiting my son for a few weeks. I have been told my blood pressure is high. It is now 170/100. I have no other known medical history. I have no insurance and a few hundred dollars to spend. Fix me. 22 minutes.

*I have had a terrible sore throat for 4 months. All the doctors are ignoring me because my rapid strep is negative. I'm so sick of feeling this way. Why do I feel this way? Fix me. 5 minutes.

*I drive trucks. Driving through town, visiting my girlfriend, and noticed my DOT license is expired. I need a new license. I don't know what is required in order to get one. Fix me. 16 minutes.

*I am moving to Saudi Arabia. I need x3 extensive and original forms filled out of all the same information, they cannot be photocopies. I also need tests of everything on this list, unfortunately it is all in Arabic. Fix me. 32 minutes.

This is a list of common examples from my clinic. Not comprehensive at all. But just to illustrate a point.

You might look at that list and think, Pain. Well, that is precisely what I usually think. Pain. And it's true, it sucks. How in the Hell am I supposed to cure all of society's dilemmas, in a time crunch, under these circumstances, with financial constraints, when I am completely and totally burned out?

Blah. Nausea. Pain.

I am a card dealer at a casino..

But this week. I noticed something different!

I was curious about these problems again... I find myself thinking about solutions.. And some of them are not unreasonable or unattainable.. This has not happened to me in a very. long. time.

I am healing. Thank God.

Because honestly, of course I did not address everything on that list in that time-slot. But I did address some of them.. And guess what, no one else is. Including the person who has the problem..

I spent something like 10 hours doing clinic charting on Friday night..

Why do I spend such an absurd percentage of my life charting? This has been a problem with this job from day #1. First and foremost, I am OCD to a fault.. about certain things. Like charting. I like for the ROS to be after the HPI, because that is the way it makes the most sense. I like the PMH to be after that, then SurgHx, then SocHx, then FamHx, then a complete and accurate medication list. This is the patient's story. If the MA puts in that stuff wrong, I have to delete it all and rearrange it. I like for my assessment to include what I think is most likely going on, then all the other things it could be -- the differential. Then, I like to have an itemized (and italicized? i don't know why.) plan of action.

-We did this today.

-They will do this at home

-I will do this at home.

-If test results show this, we will do A.

-If test results show that, we will do B.

-They will come back at this time, at which point we will move on to C.

Being OCD is a separate issue, though, from trying to do this job reasonably well. It's true. When I was a young kid, I used to have an obsession about counting stars. I also had a notebook in which I would write down numbers, chronologically, with a goal of getting to 1 million. I decided to dig a swimming pool in my front yard because it was so cool that the water was already there the second you dug a tiny hole in Louisiana, so I painstakingly calculated out the area of the pool I would dig, and the number of cellophane rolls it would take to cover the sides of it. I was a little upset when my mom told me I couldn't do this, but not really because the satisfying part was thinking it up. I was sad when it dawned on me that writing numbers until 1 million would probably take me years to complete. I have to be careful with knitting, because not only does it feed my OCD but it also feeds my brain with lots of time. I knitted 12 of the exact same hats last year because the pattern was so perfect and satisfying to complete. My mom worried about me and still does... Valid.

But I think probably the real reason I go through these motions and organization tools, aside from my personality disorder, is because it allows me time to think. When I am re-arranging the order of the note, I'm not thinking about that task. I'm thinking about the visit. Same with all of that stuff. That's my story and I'm sticking to it.

As I chart, I Think.

Because, of course, I do not have time to Think in clinic. It is a completely absurd possibility to have time to think about anything in clinic.. I sometimes wish patients had to follow us around once just to see what it is like while they are skimming the magazines in the exam room...

This is all I think in clinic... "what could be really bad right now, in this instant, that I also may have some power over to change..." and..."is there something not so bad that I might also be able to change at some indistinct point in the Future..." and "how can I get this person out of this clinic as efficiently as possible so that I can move over the next room and the next list of problems.."....

Clinic charting Friday night was interesting. I did not want to stop updating problem lists and I wanted to think up solutions.. This has not happened to me since about the first 3 months of residency. I mean, I do it, but I never want to.

I have been accused in the past by attendings, including my program director, of having "pretty notes." She said to me once, "I am giving you permission to have less organized notes if it allows you some more free time..." Another attending told me, "you have very prosaic notes. They are very descriptive of what you are thinking, which is nice."

I guess I can't say I am surprised that my notes are a bit prosaic. Meaning, specifically "Straightforward; matter-of-fact; lacking the feeling or elegance of poetry"

That is exactly how I feel toward my job. And as unexciting and unfulfilling as it has been 98% of the time, that percentile has recently begun to decline..

I was doing the same thing I always do, but thinking about it differently. Finally. Like instead of "pain. nausea. disgust. hopelessness. powerless." I was thinking, "maybe, if only."

This weekend, after all that charting and thinking, I had opened several (about 6) telephone encounters to remind me to call people about things I thought about after they left my clinic that I wanted to be sure I talked with them about...

4 separate patients told me, completely independantly, that they were grateful that I was listening to them about what was going on.. That they were so honored that I was calling on my "off-hours" to tell them what I was thinking.. "off-hours"... I almost forget sometimes that people really do think that way and do not expect you to always be thinking about all of their problems at all times... A friend recently described to me how angry he felt that he checked his "work email" and found something that should be dealt with sooner rather than later... another friend, who is a teacher, said that he was upset and burnt out that he was staying at work until 5pm, but he was still not willing to sacrifice his "lunch break.".. to which I thought, "but what does he mean? Is he talking about some protected time to eat away from his job?....how interesting..." And I always feel sad and envious when people tell me things like that, but this week I was also hopeful that I might also be doing something good.

Anyway, enough of that and maybe it will be something sustained for a while... I would like that.

Hospitals and bouncebacks and rounding and admissions and discharges are away from my life for now.. Forever?

Will it be brief snapshots into another person's life now forever, with hours of reflection about the possibility of potential gain?

This is better. possibility. potential. change... To replace the notion and mindset of: fix. cure. TURF.

"Follow-up with your PCP"....