What Did I Just Say?

I have a friend who works as a transcriptionist.  She blogs and occasionally talks about her work.  However, she talks about the business side of her work:  how much she makes per line, how she can’t understand what the doctor is saying, how she has to undergo QI, etc.  One thing she’s never mentioned is if she ever takes the time to think about what she’s transcribing.

I’m currently on rotation with a group that dictates their H&P’s along with their assessments and plans.  After a day or two of dictation (which by the way I hate to do because I can’t stand the sound of my own voice) I started to wonder if transcriptionists laugh at some of the content in dictations or if they’re like mailmen who deliver postcards without reading the back.  I know I sometimes chuckle when I get the transcribed note back to sign for the chart… especially when I read things like:

“Patient states they have been constipated for a whole month.”

“87 year old patient states she fell off a chair while painting her ceiling.  She states her bridge club was coming over and didn’t want them to see a brown water spot that was on it.”

“Patient states that she has vomited several times.  The last emesis looked like blood, or it could have been the cranberry juice she had been drinking just prior.”

“Patient denies any alcohol, tobacco or drug use, except for the occasional marijuana use whenever her son is in town.”

“Patient states he thought his abscess was due to an ingrown hair, so he shaved off his all the hair in his axilla thinking it would go away.”

“Patient presents asking for Tamiflu because “there’s a lot of sick people hanging around the grocery store.”"

Did I really dictate that…?  Yep, patients say the funniest things…

p.s. ;) Betty this is for you...

A Cowboy Needs a Horse

I never thought much about our “regulars” until I came back from vacation to find that one of them had died.  We’ll call him “the Cowboy.”

I met him when I was an intern.  He was the anginal patient with known severe coronary disease who had suffered from alcohol abuse for many years.  He would come in from time to time;  usually drunk, complaining of chest pain.  We would run some cursory labs and an EKG, let him sober up,  and then send him on his way.

As the months passed, he would start to come in more and more frequently;  trademark hat and boots in place as the ambulance gurney brought him in.  He had developed cardiomyopathy somewhere along the way and had an AICD placed.  He started coming in complaining of it firing frequently and chest pain.  He would be admitted and usually signed out AMA after a day or two.

Over the last 6 months, he was an almost weekly visitor to the downtown hospital, but then we started seeing him at the county hospital where we also have shifts.  The Cowboy started becoming one of those “repeater” patients that become annoying.  You’d see his name on the triage board, sigh, and then go in and ask, “Seriously, Cowboy, what is it today?”

About 3 months ago, though, he really started declining.  His prior history of medical non-compliance and signing out AMA was making it difficult to get him admitted even when his heart failure was severely affecting his health.  Somehow, we would convince the attending that he really did need to be admitted, and true to form, the Cowboy would get diuresed, refills on his nitro, and then sign-out AMA or abscond yet again.

Recently, though, on one of my admissions, I convinced him that he needed to stay for evaluation by the cardiac surgeons who had wanted to take him to surgery during the previous admission.  He agreed only to be told that his disease was so severe that only a specialized center like the Cleveland Clinic might consider his case.  He told me this about a week later when I saw him, yet again.

As soon as he saw me he said, “Wait a minute.  Before you say anything I did stay, and this is what they told me…”  As I was ordering his now routine chest x-ray, EKG, POC troponins and BNP, I looked at the Discharge Summary from his most prior admission.  The angio said it all.  He had severe disease of his left main, LAD and circumflex.  His right was open about 80%.  Basically, the Cowboy was surviving on one coronary artery.

He lived alone and didn’t have much family support.  He was practically homeless.  There was not going to be a life-saving trip to Cleveland.  We all knew he didn’t have long.  During my first shift back I was told that he had presented in fulminant pulmonary edema.  One of my colleagues intubated him, but there was nothing else that could be done, and he died.

I tried to think back to the last time I saw him.  Did I even pick up the chart, or did I leave it to one of the interns?  Did I make conversation with him?  Was I polite to him the last time I treated him or was he just one of the “regulars” who is quickly “treated and streeted” to make room for the “real” patients?  I really can’t remember now, but I know that he’s a patient I won’t soon forget.

So, ride on, Cowboy.  Keep riding;  riding, along.

Play to the End

I was thinking a lot today about a post I wrote some time last year in which I talked about a "good day to die."  The patient that prompted me to remember this was my last patient of the day.  Having just come back from 11 glorious days off, it was very hard to try to get back into the rhythm of things.  

Just at the last hour, we suddenly got a Mercy flight.  The report was a patient who had suffered a stroke.  As the helicopter landed, we began to learn more about our new patient.  They were in their 90's and had traveled with friends to a casino about 4 hours away from home.

While at the casino, they had felt suddenly ill and began to exhibit signs of a stroke (* I'll give a quick easy way to remember these at the end.)  EMS was called and the patient was transferred to us.  Unfortunately, they had suffered a severe bleed into their brain and their prognosis is grim at best.

Later, as I thought about this patient, I felt they'd had their "good day to die."  Or, at least, what I would consider a good day:  a trip with friends, gambling, probably a good buffet lunch, dressed to the nines... in their 90's.  Keep partying on, brother, keep partying on...!

*Signs of a stroke:

Think

F - face - is one side drooping?

A - arms - are you not able to hold one of them up?

S - speech - is the speech garbled or slurred?

T - time is brain,  get to a hospital as soon as possible

!!!

Weary Road Traveler

Ok, so we missed our flight due to delays in San Francisco, and we had to spend the last 7 hours at the airport.  Suffice it to say, it's been a looonnng 7 hours.  And, we still have another 2 hours to go.  Eeek!

I've been sitting here for the last several hours watching the droves of humanity walk to and fro, and I've come up with a few thoughts based on my own travel experiences.

  - Wear something comfortable and practical.  Low rise jeans that have to be constantly hitched up and short shorts that show everyone whether or not you've waxed recently do not make for comfortable clothing.  Me, I prefer the loose velour-type pants.  More stylish than sweats and more comfortable than jeans.  Scrubs will work in a pinch, but people keep asking if you're on your way to surgery somewhere.


 - Along that line, wear comfortable shoes.  Those three-inch wooden wedge heels look awesome with that studded denim mini, but when you fall over running to your gate, it's not going to be a pretty site.  Me, I like the slip-on tennis shoe.  Comfy and you can sprint like a track star when you need to.

 - I see a lot of people wearing the "I bought it at the airport" pashmina.  Now, while some may say they're not really still in style, I think there's nothing better than having something warm to wrap around your shoulders on a cold flight.  And, that's a good thing considering the scarcity, or high cost, of in-flight blankets lately.

 - Next, the travel bag.  Now while I am not a fan of the cat-covered "I bought it at the airport" tapestry bag on wheels, I can understand the attraction.  It's light.  It rolls.  It doubles as a floor mat for your feet.  No, really.  Anything small on wheels is all you should be taking on a plane.  Except for a tote... you can never have enough tote bags.

 - Or, for that matter, over the shoulder bags.  I have several in different colors, and I always travel with one.  Except for this trip I went with a tote.  Two actually.  Three if you count my handbag, but it's a Coach and I wanted to look stylish for my interviews.  But, I digress.  The shoulder bag provides plenty of pockets for your ID, pens, travel documents, cell phone, etc.  And, it can be unisexually stylish.  Well, except for this one, it's got horses on it.



Finally, the ultimate travel need:

 - the neck pillow.  The softer the better.  And, since I tend to like to sleep all through my flight, mine gets plenty of use.  Along with my face mask and slippers which I got in a travel pack with the pillow.  Did I mention I bought them at the airport Brookstone?

Interesting Road Sites

You never know what you are going to find when you drive willy-nilly along the road.  We were in no hurry as we made our way down the Oregon coastline, so we took the time to stop at various beaches, pull-outs and memorial plaques along the way.  Here's a few of our finds today:

 

I love sand dollars.  I collect them whenever I can.  We walked this whole stretch of beach and I did not find one intact sand dollar.  So I am bringing home a whole mess of partials for my collection.  Some interesting facts about sand dollars can be found here.

We stopped to take a picture of the marvelous ocean view and overshot the turn-off by several yards, but luckily there was a smaller turn-off which we were able to pull into.  As I was stepping around looking for the perfect spot, we came across this plaque on the ground.  I Googled the name and came across a few facts.  Here are two links telling the story of this local hang glider.

The obit and the Cascade Paragliding Club.

 

This is a monument in Depoe Bay memorializing two fishermen, Roy Bower and Jack Chambers, who went out to rescue another boat that was in distress and lost their lives.  The town honors all of the lost in their annual "Fleet of Flowers" which is held on Memorial Day every year.  Something about the quote (who is quoted I cannot say) really got to me, so I end with it here.

"It is not true. Life is not slain by death. The vast, immortal sea shall have her own, shall garner to her this expiring breath, shall reap where she has sown."

Recurrent Thought

My DH and I made our way through Mount Rainier National Forest today as we worked our way across the Cascades back toward the Pacific.

As we drove, for some reason the words of Thoreau passed through my thoughts several times;  especially as we walked through the Grove of the Patriarchs.

Here are the words and some of my pics:

 

"I went to the woods because I wished to live deliberately, to front only the essential facts of life, and see if I could not learn what it had to teach, and not, when I came to die, discover that I had not lived."

On the Road...

Just a few quick thoughts as my DH and I make our way around the Pacific Northwest...

I love Victorians

Purple never comes out in pics

I love the beach... any beach

I like helicopters... my husband, not so much

I really love bears, and Black Bear Diners

Sometimes you just have to do what your DH is into

My favorite time of the day is still early morning

Even crippled horses by the roadside have a certain beauty

Take the scenic road, you never know where it might lead

You can find simple beauty in unusual places

I thank God at the end of the day for allowing me to do all the things that I have been able to do in my life... And for allowing me to enjoy the splendor of nature.

Strangers on a Plane

Did you ever get the talkity talk seat mate while traveling?  I have been post 24 hour call or have just come off several night shifts in a row the most recent times I have traveled, so I have basically fallen asleep from just before take off to just before landing.  I have become conditioned to waking up the minute my ears start sensing pressure changes in the cabin.  Seriously, my ears start to pop, I wake up, the captain gets on the loud speaker and announces we're on final approach.  Sleeping is the only way to travel.  Wake up and you're in a whole new place.



However, I have been traveling with my husband lately, and we've been meeting a series of gabby travelers during our journeys.  We had the "Name Dropper" who talked loudly and passionately all the way from Chicago to Los Angeles about her friend's wedding, who was going to be at her friend's wedding, the Who's Who who would be at the wedding and how they were all connected to this other Who's Who, etc.  This is one of those times I am glad cell phones are not allowed to be used during flights.


We met "The Local" who spent the entire trip talking about local restaurants and hotels and recommending places we visit.  She was not discouraged at all by fact that we would only be in town for a day and continued to regale us with stories of places she had been 15 years before which she felt would probably still be open and as wonderful as she remembered them to be.  All this while pouring liquor from the two small bottles she brought on the 50 minute flight into her soda.


I am sure there will be more as we make our way across the Pacific Northwest... at least it's better than getting that baby who cries the whole trip... or is it?