It's going to be a very long day......

By the end of yesterday afternoon I had a headache the size of Cleveland. Two Tylenol did absolutely bupkis. So I went home and pulled the covers over my head.

Actually, I made LJ and I a light dinner (can we say Lean Pockets?), and then I got into bed. Just before I arrived at the house one of my staff called to let me know that Claudia thought she was in early labor. After three previous deliveries, she ought to know. I sent her to labor and delivery.

Claudia was right. She had broken her back of water, and was just beginning to contract. I got into bed, figuring I would be called and sometime during the night. I was right.

Labor and delivery called me at midnight to give me report, 3:30 a.m. to tell me she wanted an epidural, and then again an hour later to say it was time for me to come in. So, at 4:30 AM I was up, at 4:35 AM, I was out the door, at 4:59 AM I was at the hospital, and at 5:19 AM Arianna Michele made her entry into the world.

Claudia pushed once, but then again, this was number four. All very calm and very civilized. Our labor nurse was rather amused by everything. Claudia and I spent the 20 min. between my arrival & Arianna's arrival trading wise cracks.

"You know each other rather well, I take it?" She asked.
"Well, I've been taking care of her since she was 13." I responded.
"13? Since I was nine! Get a grip Doc, you're getting old. What's the matter with your memory?"

Claudia's now 34. As I said, we've got some history.

So it's 10 min. of eight in the morning, and I'm now seated at my desk at my office. I had a almost 7 hours of sleep last night, not counting interruptions. I will try and juggle things about, like trying to move some of the afternoon into the lunch hour, in order to get out of here by three. I really could use getting horizontal and unconscious.

The state audit went all right yesterday. Hopefully it will be a very long time before they come back. It was a lot to prepare for, and frankly I would be happy never experiencing another one ever again.

So that's the news from Lake Wobegon, my hometown, where all the women are strong, the men are good-looking, and all the children are above average.

Question #1

How does the reality of being a doctor compare with your original vision of becoming a doctor?

I spend much more time doing paperwork than I had ever expected. Also I spend a tremendous amount of time justifying treatment regimens to insurance companies, when what I want for a patient varies from what a clerk has been told is approvable. That takes time away from providing care to other patients.

I have learned along the way though that paying very close attention to costs is crucial. So many of the people I see are insured one month and not the next. Will they be able to afford the therapy or intervention I recommended if their coverage evaporates? When is a generic alternative the right choice for an individual, when is it not & when is it better than nothing?

What had been driven home to me in spades is how much my role as a primary care provider is that of an educator. That was my bent when I entered med school (no surprise for a former teacher!). However, I had no clue how hard it would be to do, not because patients aren't hungering for it, but rather because finding the time to do it is so hard.