Long days journey into night.....
Nov. 13th, 2012 07:36 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
osodecanelaIt's been one bloody long ass day.
I was in bed last night shortly before 10, as I had to be up at 6 this morning; had not one, but two repeat c-sections on for this morning. I'd dictated the history & physical for each patient before leaving the office last night. I also had a lot of in-hospital patient care to get done today, separate from the c-sections. I figured I would shoot to be at my office by 2 this afternoon. Pipe dreams as it turned out.
At 12:30 this morning the phone rang. T'was the ER and I was the poor schmuck on for the call group. Turns out to have been one of my patients and he'd had a seizure, something new for him, though not unheard of in someone who's had a stroke, such as he had 15 months ago. The ER doc gave me a list of meds my patient was allegedly that made little sense, including several meds I pretty sure I had discontinued, BUT, I was in bed without access to this man's chart and I NEEDED to get back to sleep, so I didn't argue with him. The patient was sleeping due to the sedatives he had been given and would not be taking anything by mouth until he awoke in the morning. I gave the RN holding orders and went back to sleep - or at least tried to. After tossing and turning for half an hour or so, Morpheus was kind to me and gathered me back into his arms.
A nuclear device My alarm went off at 6:15. I got up and threw myself into a shower. I was dressed and out the door by 7. Amen, I had time to stop for coffee on the way in.
A call to L&D confirmed my first fear. We weren't going to start at 7:30 as I'd hoped; it would be 8. That left me time to stop at my office on the way to pick up two things I'd forgotten the night before. I splurged last year and got myself Birkenstock's knockoff of Crocs to wear just in the OR & L&D, thus alleviating the need to wrestle the canal boats I call feet into shoe covers. It's always a challenge to get shoe covers over my size 14's and I've just gotten tired of it. Unfortunately, I usually forget to bring them, so they were still sitting all nice and shiny in their box. I'd also neglected to take baby tees for my newborns, and for the colleague that just had a baby with her wife, just in case she was working in L&D today. (And SHE WAS!)
The first section went flawlessly, once we got started at 8:30. It was a boy and once the surgery was over, paperwork completed and the baby tended to, I had time to run cross town to see patients at the other hospital, including Mr ER. I grabbed some b'fast in the MD lounge in the basement, and sat down to the computer there to review the charts, then dashed to the first floor to see one patient, then the second floor to check on the man from my practice who'd had his gall bladder out the evening prior. By the time that was done, there was just enough time to see that MR ER was awake & stable and could now be fed and have his meds restarted, but not enough time to really sit down & do his full admission. That would be after section number two.
Drove back across town, changed back into scrubs and dashed into the OR for section #2, which was a bit dicier, as it was her third child and third c-sect. Plenty of internal scarring & adhesions; it took my OB consultant & I almost 30 minutes to deliver her daughter and another 40 to close her back up. The child is gorgeous and healthy. Both mom and dad both were firm it was time to close the store. For that, I'm grateful. This is one abdomen I hope never to see the insides of ever again.
Post the c-section, I found out a man from my practice had a heart attack over the weekend and was just coming out of the CCU/ICU, so that was my next stop. When finished there, it was time to drive cross town again, hopefully catch some lunch in the MD's lounge and then finally fully assess and attend to Mr ER. The chafing trays were empty then I got to the lounge, but it was already 3:30. At least there was an organic bean & cheese burrito in freezer and while that heated, I hit the computer to look at Mr ER's labs and studies. Then it was back to the second floor, to actually look at him, but not before someone from the administration called me to discuss him with me. I'd admitted him for observation, a 24 hour admission generally used to watch people who just couldn't go home from the ER because of things like being over sedated. In our day and age, I have to justify to an insurer why I have someone in the hospital. The phone call was to see if there was something I could find that would justify a full admission instead of the hold. The hospital gets paid significantly more that way, but as I had not actually seen the patient yet, I couldn't answer his questions. I did say, from every thing I had read in his chart and heard from the ER, I suspected I would not find that justification once I saw the patient, but I'd call him back once I had. The guy is another family doc, who's doing this work while trying to get his own practice off the ground. Given that he does patient care himself, we do speak the same language.
Well, it was as I thought. I wound up doing an admit/discharge note, just changing the doses of two of his meds and eliminating a third. The man is already on a seizure med for pain issues and I'm now going to increase it, so it does double duty to stop further seizures as well. Got my office staffer to call in his med changes, rather than have the floor RN do it; that'll alters his med list in my office's electronic medical record, leaving the RN one last thing to do tonight & me one less thing to do tomorrow. I DO have to send a note to the man's neurologist updating him the the seizure he had yesterday and what I have done about it.
So, that's been my day. I finally got to my office at 5:45. Got a couple of things done that had to be done, like sign off some charts and get the insurance on the house and our cars (mine and my husband's) paid. Put them on the credit card I'll to pay off this Friday, which means another 2500 airline points on my account, and since Chase owns both my credit card and my insurer, I don't feel like I'm robbing a small business by putting all of it on the card.
Plus Chase is sending my husband and I to NJ for Thanksgiving.
Time to head for home. It's going to be another bloody long ass day again tomorrow. There will be 5 people to see in one hospital and two in the other. Oh, and my first patient in the office is at 9:30.
I was in bed last night shortly before 10, as I had to be up at 6 this morning; had not one, but two repeat c-sections on for this morning. I'd dictated the history & physical for each patient before leaving the office last night. I also had a lot of in-hospital patient care to get done today, separate from the c-sections. I figured I would shoot to be at my office by 2 this afternoon. Pipe dreams as it turned out.
At 12:30 this morning the phone rang. T'was the ER and I was the poor schmuck on for the call group. Turns out to have been one of my patients and he'd had a seizure, something new for him, though not unheard of in someone who's had a stroke, such as he had 15 months ago. The ER doc gave me a list of meds my patient was allegedly that made little sense, including several meds I pretty sure I had discontinued, BUT, I was in bed without access to this man's chart and I NEEDED to get back to sleep, so I didn't argue with him. The patient was sleeping due to the sedatives he had been given and would not be taking anything by mouth until he awoke in the morning. I gave the RN holding orders and went back to sleep - or at least tried to. After tossing and turning for half an hour or so, Morpheus was kind to me and gathered me back into his arms.
A call to L&D confirmed my first fear. We weren't going to start at 7:30 as I'd hoped; it would be 8. That left me time to stop at my office on the way to pick up two things I'd forgotten the night before. I splurged last year and got myself Birkenstock's knockoff of Crocs to wear just in the OR & L&D, thus alleviating the need to wrestle the canal boats I call feet into shoe covers. It's always a challenge to get shoe covers over my size 14's and I've just gotten tired of it. Unfortunately, I usually forget to bring them, so they were still sitting all nice and shiny in their box. I'd also neglected to take baby tees for my newborns, and for the colleague that just had a baby with her wife, just in case she was working in L&D today. (And SHE WAS!)
The first section went flawlessly, once we got started at 8:30. It was a boy and once the surgery was over, paperwork completed and the baby tended to, I had time to run cross town to see patients at the other hospital, including Mr ER. I grabbed some b'fast in the MD lounge in the basement, and sat down to the computer there to review the charts, then dashed to the first floor to see one patient, then the second floor to check on the man from my practice who'd had his gall bladder out the evening prior. By the time that was done, there was just enough time to see that MR ER was awake & stable and could now be fed and have his meds restarted, but not enough time to really sit down & do his full admission. That would be after section number two.
Drove back across town, changed back into scrubs and dashed into the OR for section #2, which was a bit dicier, as it was her third child and third c-sect. Plenty of internal scarring & adhesions; it took my OB consultant & I almost 30 minutes to deliver her daughter and another 40 to close her back up. The child is gorgeous and healthy. Both mom and dad both were firm it was time to close the store. For that, I'm grateful. This is one abdomen I hope never to see the insides of ever again.
Post the c-section, I found out a man from my practice had a heart attack over the weekend and was just coming out of the CCU/ICU, so that was my next stop. When finished there, it was time to drive cross town again, hopefully catch some lunch in the MD's lounge and then finally fully assess and attend to Mr ER. The chafing trays were empty then I got to the lounge, but it was already 3:30. At least there was an organic bean & cheese burrito in freezer and while that heated, I hit the computer to look at Mr ER's labs and studies. Then it was back to the second floor, to actually look at him, but not before someone from the administration called me to discuss him with me. I'd admitted him for observation, a 24 hour admission generally used to watch people who just couldn't go home from the ER because of things like being over sedated. In our day and age, I have to justify to an insurer why I have someone in the hospital. The phone call was to see if there was something I could find that would justify a full admission instead of the hold. The hospital gets paid significantly more that way, but as I had not actually seen the patient yet, I couldn't answer his questions. I did say, from every thing I had read in his chart and heard from the ER, I suspected I would not find that justification once I saw the patient, but I'd call him back once I had. The guy is another family doc, who's doing this work while trying to get his own practice off the ground. Given that he does patient care himself, we do speak the same language.
Well, it was as I thought. I wound up doing an admit/discharge note, just changing the doses of two of his meds and eliminating a third. The man is already on a seizure med for pain issues and I'm now going to increase it, so it does double duty to stop further seizures as well. Got my office staffer to call in his med changes, rather than have the floor RN do it; that'll alters his med list in my office's electronic medical record, leaving the RN one last thing to do tonight & me one less thing to do tomorrow. I DO have to send a note to the man's neurologist updating him the the seizure he had yesterday and what I have done about it.
So, that's been my day. I finally got to my office at 5:45. Got a couple of things done that had to be done, like sign off some charts and get the insurance on the house and our cars (mine and my husband's) paid. Put them on the credit card I'll to pay off this Friday, which means another 2500 airline points on my account, and since Chase owns both my credit card and my insurer, I don't feel like I'm robbing a small business by putting all of it on the card.
Plus Chase is sending my husband and I to NJ for Thanksgiving.
Time to head for home. It's going to be another bloody long ass day again tomorrow. There will be 5 people to see in one hospital and two in the other. Oh, and my first patient in the office is at 9:30.
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