Wednesday, October 22, 2014

Scut......

Scut is term, leftover from medical residency, referring to any list of unwanted tasks, as in:  "What kinda scut's on your list?  I have 6 IV starts, 2 EKGs, a STAT blood draw and that infection in room 202 needs another new bandage...."  It's a list of the stuff they make students do all night long, or at least they used to, as a form of convoluted payback for the privilege of paying money to stay up all night trying to learn how to keep people from dying by being sent to do useless scut while people who already know something keep people from dying.  I remember being told it was an acronym for 'Some Common Useless Task." 

This should, of course, be differentiated from a 'Learning Experience'.  A 'Learning Experience' was doing something that NO ONE would ever want to do, as in, "Hey, let's have the student figure out how to get the maggots out of that drunk guy's leg wound.  That's a REAL "Learning Experience!"  In this case, scut might be translated, "Some Common Unpleasant Task." (And the kicker at the end of THAT particular 'Learning Experience' might be when the chief surgical resident explains, with some degree of asperity, that he would like you to leave his maggots where they ARE thank-you-very-much because they were doing a great job of debriding the wound and YOU just made his job that much harder, you moron.  And then you realize that the guy who gave you this 'L.E.' knew that, the effin' bastard.  Yes, this is how they train doctors.)

What, you ask, brought on the reminiscent ranting?

When I left work at 6:30 last evening there were 13 'tasks' left on my computer.  When I arrived at work today at 7:45 AM there were 57.  This does not include the 40 charts I need to review for my NP and my PA.  These do not include the stack of disability, school physical and handicap sticker request forms on my desk, nor the inch-thick stack of lab and x-ray reports that need to be looked over.  It doesn't include all the billing forms that patients walked out of the door with last month that I need to look up a note for, rebill and sign.

I saw about 20 people today.  I took about 10 minutes for lunch, and I'm pretty sure I made it to the  bathroom a couple of times.  There were two empty cans of seltzer on my desk, and an open jar of peanuts, so I clearly took fluids and nourishment.

But I kept tabs - I always do, to some extent.  I cleared over 150 separate tasks - chart notes, prescription refills, recommendations to the worried well (no, really, you won't get Ebola at Walmart), deciding if that fall from a crib warrants an ER visit, adjusting medications for Hospice patients - finally getting to the bottom of my in box for the first time in weeks.  There are still 15 tasks on the computer list, the 40 charts still need review, and about 5 more forms.  I left at 7:30.  And I get to do it all again tomorrow.

I guess there are differences between then and now.  Now, it's 'tasks' and not 'scut'.  And I'm paid to do it instead of paying to do it.  And I get a little more sleep. 

But I can't say it's an awful lot more fun.

DeeDee

Thursday, October 16, 2014

Citizenship.......

"I hereby declare, on oath,

I want to tell you a story.  It is an entirely true story.

 that I absolutely and entirely renounce and abjure all allegiance and fidelity to any foreign prince,

Once, many years ago, I awoke from a very vivid dream of a little girl with curly hair.  Somehow, I knew that she was my little girl.

potentate, state, or sovereignty,

I already had a lovely little girl, but I knew that there was another one out there.  So I started looking for her.

of whom or which I have heretofore been a subject or citizen;

I looked in India.  She wasn't there.

that I will support and defend the Constitution and laws of the United States of America

I looked here at home.  She wasn't here.

 against all enemies, foreign and domestic;

I looked for a LONG time. 

that I will bear true faith and allegiance to the same;

An adoption agency sent me a picture of a little Colombian girl with a lollipop, and a long, sad medical history.  If the story was true, she was going to die whether she came home to me or not.  So, heavy hearted, I said, "No."

that I will bear arms on behalf of the United States when required by the law;

But that little girl DID have a curl on top her head...and she didn't look like she matched the long, sad history.  So I suggested some extra medical tests.  And I went back to looking.

 that I will perform noncombatant service in the Armed Forces of the United States when required by the law;

And a few months later, the agency called me back.  Those tests are all negative....so....what do you think?

that I will perform work of national importance under civilian direction when required by the law;

I think she needs to come home. 

and that I take this obligation freely,

And yesterday, with her little boy on my lap, I watched her take her Naturalization Oath of Allegiance to the United States of America and prove she is a US Citizen.

without any mental reservation or purpose of evasion;

And all the way home my heart was squeezed tight full of gratitude to God for the gift of my beloved Curlygirl.

so help me God."

DeeDee

Saturday, October 11, 2014

Itty Bitty Blessings....

A few weeks ago I notice that the heat in the car wasn't working.  The AC was fine, but there was no way to take the chill off in the morning.  But, hey, it was summer, so most of the time I just forgot it was a problem. 

Getting up at 5 AM to go to the gym in October, however, would be more pleasant with heat in the car.  Seat heaters are awesome, but they don't defog the windshields, right? 

Friday morning I scraped frost off my windshield and discovered that my 'defroster' was adding layers of frost to the inside of the window, making it difficult to forget that I had a problem, so I took it straight to the car doc.  At the end of the day, they called me.

"Good news!  Your car has heat!" 

Good news indeed.  "What's that going to cost me?"

"Hope you're sitting down." 

Gulp.

"$25"

Huh?

Apparently some wire was bent.  He bent it back. 

Give the man credit.  He could just as well have told me that he had to replace the hunkafundkle and the solenoidal sinus and charged me $322.50 and I've been none the wiser.  So praise be to God for an honest mechanic and an affordable car repair.

DeeDee

PS Babygirl and I both had a rare day of excellent brain function.  She commented on it almost as if it seemed impossible.

Wednesday, October 8, 2014

Miserable Migraine....

I've had a couple of days this week where I feel  like somebody beat the crap out of me.  Muscles I didn't know I have have been cold and crampy and achy and tired.  I worked Monday and called in sick yesterday with a combination of headache and muscle pain.  I went to bed at eight last night and got up and went to the gym this morning.

(Aside story:  If you swim regularly, you kill bathing suits, especially since the people who make a plus-size suit apparently assume you will wear it for 10 minutes at a time once a year rather than actually exercise in it.  At this time of year, the only place to get a suit is online.  I ordered two, and one of the new ones seemed rather generously sized on the bottom and snug on top, opposite to the usual fat girl sizing.  It wasn't bad, but I discovered that breathing and swimming at the same time were not compatible activities in this suit.  The good news is that the ocean will NEVER be able to remove this suit, so it will go to the beach next time.)

I went to work, and toward the end of my first patient's visit, I got that telltale ache at the base of my skull on the right side (I nearly typed 'left'.  When I get these things it's almost always the right side and I almost always say left.  I don't know why).  It was followed by the sensation that the back of my scalp was wrinkling, with a crawling sensation (one of my least favorite auras).  I immediately took my migraine medications and moved on to my next patient.  I had barely finished when the side effects of the meds and the migraine hit together along with a massive wave of nausea, and I was done.  Nurses move fast when you say, "I'm going to throw up."

They had to walk me to a dark room where I watched the light show behind my eyelids and kept my ears covered against all the noise.  They shot me up with anti-emetics and called Hubby from work to come and get me.  He bought me a cup of full-strength coffee, and I went to bed and slept until three PM. 

My tongue is still tingling.  My head is still sensitive and noises are still a little much.  Time keeps jumping around.  Last time I looked it was four, and now it's six.  Babygirl has her own headache and s laying low.  Hubby is ordering pizza because it's the least noisy thing to make. 

I see the doc in the morning.

DeeDee

Tuesday, October 7, 2014

Coming Back...

Yesterday's lab reports represented an improvement:  Creatinine is down from 1.3 to 1.1 with her baseline being 0.8 (and normal for age 0.6 or less).  Potassium back to normal at 4.3 (but we had a better phlebotomist - our man Frank was there and he doesn't fool around.  The girl the other day did a lot of the vein-patting delay-tactic stuff that can cause an artificial rise in potassium due to trauma).  She still has too much acid, but that's better also.

The good news is that they aren't immediately calling us to Philly. There was a grumble about the fact that our next appointment isn't until the end of November, so after the team chats this morning, that might get shifted.

Babygirl wasn't up to school but she was very productive with the math tutor (the poor young lady whose first experience was to watch her cry the other day).  She says Babygirl covered four days of math.  Yippee, I say. Now she's only TWO weeks behind in one class, and three weeks behind in eight others, but who's counting?  TutorGirl was a bit startled by this take on reality, and she's not in charge of the big picture, but he sent a text to Babygirl's advisor outlining my ongoing concerns about ALL of her classes. 

Meanwhile, I'm on day three of some kind of crud that makes me feel like someone ran me over with a truck, and I just cannot get warm.  Who gets goosebumps on just one half of the body? I swear they are rolling up and down from my right ankle to my shoulder.

DeeDee

Sunday, October 5, 2014

Day Of Rest.....

Babygirl has spent today recovering.  Headaches and tummy aches off and on with the sniffles that mark the end of the cold that's been riding in the background of the past two weeks.  She ate dinner and we're watching some TV, waiting for bedtime. 

I spent my day curled up with a book.  I couldn't get warm, so I finally got out the heating pad and plugged it in underneath myself while I read.  I've been too tired to read, which is very unusual, so I've been stuck on the same page for weeks.  It was a relief to finally finish something - an almost overwhelming sense of accomplishment.

I reset my brain with a handful of Sudoku puzzles. 

I stopped crying.

It's not much.  But it's the best I can do. 

I think I'm ready to face the week.

DeeDee

Saturday, October 4, 2014

Grateful Relief....

On the way into work on Thursday morning I was in a dark place - exhausted, discouraged, sad and hopeless.  An optimist by nature, this is a hard place to get to, and I'm so rarely there that I don't have a lot of plans for getting back OUT.  I climbed out of my car into a pile of bright yellow leaves and even THAT didn't make me smile.  On the way into the building I struggled to find something, ANYthing, I could sincerely and without a trace of snark tell God I was thankful for. 

As I contemplated the number of patients I knew were loaded into my schedule against the amount of paperwork backed up on my desk, I rewound the weeks' workload and realized....very few of my scheduled patients had actually kept their appointments. 

"No Shows" are a chronic problem in our office.  Our patients are poor, mentally ill, careless, overstressed, and overbooked.  They run out of minutes, pay their rent ahead of their phones, don't get reminder calls and take extra work hours when they are offered.  And sometimes the 'no shows' come in clusters.  The only reason I'd been able to manage all Babygirl's phone calls to the school and all her docs was because my patients weren't there.

So I stopped, and said a 'thank you' for the no shows. It wasn't much, but it was, honestly, the best I could do. 

Babygirl's neurologist called, concerned about the medications and the kidney.  The bottom line is that he doesn't want to be responsible for wiping out her kidney function.  He's not.  But he's freaked, a little.  Nephrology didn't call.  The school called.  I told them not to send a tutor.  Babygirl's still just too sick.

Friday morning, after 24 hours without the lisinopril, Babygirl awakens with a small tummyache and a small headache, overall, an improvement.  I asked her if she could handle a tutor and she said yes, so the school sent one over for a couple of hours after school.  Nephrology called and said they want the kidney retested Monday, so we won't know if the kidney damage is permanent or temporary until then.

Last night we went out for dinner.  Babygirl ate a salad and part of a bowl of soup, the most I've seen her get down at one sitting in over a week.  We went to Barnes and Nobles and she bought a Manga, getting into an animated conversation with the sales clerk about his 6-month stay in Japan.  It was beautiful, heartbreakingly beautiful, to see.

Crawling up out of any hole takes time.  Each battering we take lays open scars laid down by the last one and revives fears barely buried.  We keep walking.  Falling.  Crawling. 

Lord, give us the strength to get back up. Again.  And again.  As many times as it takes.

Amen.

DeeDee