Rushing Past

NYC subway

After every single electronic health record update I am left feeling betrayed. Is it the EHR company’s fault? Is it the healthcare system’s fault? I don’t know and I no longer care. I am just so tired of feeling ambushed. It never feels anything gets better or more useful. 

Just different and harder. 

They took away my layout colors, the nice neutrals. Instead there is garish pink and mint green and even deep blue sea creatures. An octopus in an electronic health record? Really? Do you know how disconcerting that is? 

Yesterday the patient summaries would not print until hours later, after the patient left. Used to be that referral information printed out with contact numbers for the specialists we were sending patients to so they could call instead of waiting to hear from an office that may or may not call them. That information is not on the summary anymore. Do you know how disruptive that is when you have a full day of patients scheduled back to back? 

And then there is all of the minutia… buttons changed, orders switched, WTF?

Mayhem. 

Insanity. 

There is a grieving process that accompanies every update. It starts with hope, shock, disappointment. Then the classic five stages of grief: denial, anger, bargaining, depression, and finally there is acceptance. I am a small fish in a big, big ocean and what I or my patients need means nothing. Someone else decides for me, for them. Maybe that is the meaning of those blue fishes on the background? Swim with the group or get eaten by the octopus…

The “updates” rush past whether I want them to or not. I can do nothing to stop them. 

Adapt and accept or die.

This morning I want to hide in my bed and not go to work. I am exhausted already. But I can’t. People depend on me to put on a brave face and muddle through. 

So endure I will, secretly seething inside.

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Owed

Refurbished part of the Ellis Island hospital

The VA medical system in the US is a shameful mess, not worthy of our veterans.

If we expect someone to lay their life on the line to protect our freedom and the freedom of others all over the world, we have a responsibility to provide for their medical care and that of their families even after their service in a way that is on par with the quality of care received elsewhere in the country. 

Instead there is corruption, waste, deception. Veterans die waiting for help. I have seen the effects of poor care.

Let’s stop ignoring it and do something about it. You want to do something meaningful for Veterans Day? Write to your elected officials and demand change.

As Long as You have Your health…

Alrighty, here is another reblog for the week just so you know I am not alone in my grumbling and paranoia. Enjoy!!!!

No Facilities

The perfect place and beverage to share some casual conversation.

If we were having a beer, you’d seem concerned about my health.

“Are you in a wellness program?”

“Why, is that a requirement for drinking here?”

“No, of course not. I was just wondering. My company just started one and it looks interesting.”

“I have access to a wellness program, but it’s not direct with our company.”

“Through your health insurer?”

“No, through the organization that provides the health insurance to our company.”

“Hey guys. Just so you know, it’s not like I’m not concerned about your health, but I am here to sell you adult beverages, barbequed chicken wings, pizza or pasta smothered in cream sauce.”

“Hi Cheryl. I’m not sure where this conversation is going, but before he condemns my poor choices, I’ll have a Yuengling.”

“And I’ll have a glass of Meiomi. So, what’s the scoop on…

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Going Places

IMG_1253

“Ok, I’m going to call it. Any objections?” 

Silence from the room. 

All motion stopped. No more CPR. No more rummaging for the next medication in the crash cart. The nurse on the phone calling for another two units of pack red blood cells simply stopped mid sentence and hung up.

I dropped the empty syringe that had spent the past hour and a half clutched in my right hand into the pocket of my white coat. The fingers were stiff and achy as I stretched them out. “Time of death….” I cranned my neck around the greying head of the house supervisor so that I could see the wall clock by the door. “…. 0325.”

“Good job, everyone. Let’s clean up so we can let the family back.”

Syringes were counted and recorded by the clerk to make sure the amount of each med given was accurately reflected in the log. Debris was swept up. Hands gently covered the emaciated body with a gown and pulled up the sheet, the eyelids were closed. A nurse took out the IV and another pulled the tubes from his nose and mouth, wiping the blood and mucous from the now lifeless lips. 

He looked so peaceful.

Cancer of the stomach. He had certainly suffered. He was not willing to die peacefully, refusing hospice and refusing to sign a “do not resuscitate” order. He fought even at the end. 

My wrist still hurt. 

I liked being around death. It was hard to explain to people. They would stare at me with a puzzled and slightly horrified look on their faces, lost for words so I stopped talking about it altogether. I always wanted to ask the dying to put in a good word for me when they got to where they were going, but I never did.

One by one everyone left the room.

In a minute I would go out to his wife and children and explain that we had done everything we possibly could but I needed a minute before facing the onslaught of grief.

I put a hand on his chest and said a silent prayer for his soul, then one for mine. I looked back up at his face. Strangely, his eyes were open. They were a bright blue. The bluest blue I think I had ever seen.

Then they blinked.

A hand grabbed my shoulder and pulled me closer. 

His hand. 

My heart skipped a beat as fear rushed through my body and into my fingers and toes. 

Then the hand let go and fell back to the bed with a flop, as if there was no more energy left. It must have been some sort of cadaveric spasm…

“She knows.” 

The rasping sound came from his lips but how could that be? He was still attached to the heart monitor, someone had forgotten that detail, and there was no heartbeat. I checked for a carotid pulse. Nothing. No breathing.

“What do you mean? Who is she?”

The eyes bore into me. 

His lips moved. “She knows…” I touched the lips. They were cold.

“Who is she?!?!??” I asked again.

No response.

My voice rose as I asked again and again but the blue eyes just stared back at me never wavering. I grabbed the shoulders and shook him but he still provided no answers.

Anger and terror rose up into my throat, swelling into a tight lump that lodged there. My brain raced from irrational thought to irrational thought. I could not breathe. 

Someone knew what I was doing? But how? I’d been so careful!

My hand touched the pocket with the empty syringe.

Rage. 

I grabbed his shoulders and shook him. Hard. I punched the chest. I yelled at the blue eyes, tore at his lips…

Someone pulled me away.

“Doc! What the hell is wrong with you?”

“She knows. She knows. She knows. She knows. She knows. She knows. She knows. She knows. She knows. She knows….”

Thursday Thoughts From the Throne 

Weight of the world

I dressed for the meeting carefully.

Sexy lingerie? Check.

Slimming black skirt? Yes!

High heeled black leather power boots? In place on my feet.

Hair perfect? Oh, yeah… definitely.

Make up perfect? Absolutely. Double check that no lipstick made its way onto my teeth and no bits of blueberry from my breakfast smoothie are lodged at my gum line? Done!

In my head, I am IT. I am a bad ass lady doctor, strong and capable. I feel the part. 

I make it through the meeting. I see a full day of patients. I joke around with my staff. I drive home.

When I get home I pause downstairs to admire my profile in the mirror one last time before heading up to change into shorts and a t-shirt.

What the heck?

My cheeks flush. All confidence sails out of my body. I feel weak in the knees. Suddenly, I am no longer strong enough to carry the weight of the world on my shoulders. 

Instead, I am crushed by it.

One little tiny button off on my vest and all of the rest were buttoned up cattywampus. THIS is how the universe conspires to keep us humble….

Perhaps it is time to invest in a full length mirror in my bedroom.

New Outlook

Lookout at Rockefeller Center in NYC

The beeps. 

I know those beeps.

From where? 

I don’t have the energy to find out. My head hurts something fierce. I slip away, choosing to remain in the darkness for now.

*****************************************

The pain at my sternum is excruciating. 

Make it stop!

Except that I don’t have a voice. There is a tube down my throat and I cannot speak. I try to grab the hand at my chest by my arms do not respond.

“Dr. Slaughter? Wake up. Can you hear me?” The voice is much too loud and the words are spoken slowly as if the man enunciating them were speaking to an imbecile.

The pain stops. Then I realize…

A sternal rub!

My eyes are open. He moves his face close enough to mine that I can smell his aftershave. 

“Dr. Slaughter? My name is Dr. Holcomb.” He was too young to be a doctor. Too young to be competent. “Wake up!” he shouts into my ear. 

The pain again. Stop with the damn sternal rubs you f***er! I AM awake.

*****************************************

“The patient is a 45 year old male who happens to be a local physician. A neurologist. He suffered a brain stem hemorrhage two weeks ago and is currently in a persistent vegetative state. He has no family we have been able to locate.”

*****************************************

I take inventory. What can I move? Arms? No. Legs? No. I try to tense my abdominal muscles. Nothing. A shift or a scoot to take pressure off of my hips. Not even a millimeter. Smile? No. Wrinkle the nose? No. Tongue? Not that either. Blink? Ok. Yes. A blink. I try to move my eyes. Left. No. Right. No. Up? Yes. Down? Yes. 

Not much to work with but it’s something.

*****************************************

My dog! Who is feeding my dog?

He was probably dead by now.

*****************************************

“Well, his catheter caught on the IV pole so when they were wheeling him down for the MRI, it got rippped right out. We have to place a new one.”

“Should we use the lidocaine jelly?”

“Nah. He can’t feel anything anyway.”

I felt it, bitch. I felt that catheter rip right through my urethra. Use the goddamn lidocaine jelly. Come on. Look at my EYES. See me moving them? Blinking? 

Please? Just LOOK at me. Really look look at me. Someone?

I can make tears.

The night nurses here suck. 
*****************************************

The woman is smiling at me. 

Who is she?

She’s gorgeous. Dark hair. Blue eyes. Long lashes. I have this strange feeling. I think I should know her. 

“Remember me?” She whispers. 

No. No, I don’t.

“I was the intern you came on to ten years ago. A newbie. You told me to go get some gauze and then followed me into the supply room, locking the door and forcing yourself on me. I made it seem I was flattered.” She fixed her gaze onto my eyes and leaned in closer. “But I wasn’t.” 

Her hand was under the sheet, stroking my genitals. An erection. Horror and pleasure washed over me.

Oh, God.

The heart monitor registered the increase in heart rate. A nurse stuck her head in. The hand was withdrawn.

“Oh! Dr. Rutherford. I didn’t realize you were in here.” 

“Dr. Holcomb asked me to see the patient.”

The nurse nodded then stepped out, drawing the curtain closed behind her.

“I hate you.”

Suddenly, fingers wrapped themselves around my scrotum and squeezed tight. Painfully tight. I closed my eyes, fighting the excruciating pain.

“You have locked in syndrome, don’t you, Dr. Slaughter?” She laughed. “You can feel everything but you cannot move. Well….” she chuckled again. “You can move your eyeballs up and down and blink but they haven’t figured that out yet, have they? You taught me well about so many things…”

Another squeeze. More pain.

“You probably know better than anyone that you likely won’t recover.” She smiles sweetly. “But I’ll be back to check on you. Every single day…”

Lift

Bomber

There are times when the anxiety overwhelms. Pressure on my chest. Can’t breathe. A dysphoric and irrational sense of impending doom falls like a curtain, separating me from the rest of the world.

I need to move, to escape. 

But I can’t. 

Why? Why now?

It comes in phases. There are times when I fly through the day, a smile inside and out. I feel the joy. I am the joy.

And then? The darkness descends.

You aren’t good enough or smart enough. Someone is going to figure it out. Then everyone will know your secret. You don’t belong here.

I can’t focus. I type words that aren’t right and don’t make any sense. I cannot follow the conversations people try to have with me. My brain is paralyzed. No. My brain is in overdrive running from one imagined catastrophe to the next. I cannot sleep because I cannot make it stop.

“Doc, it’s like you know me. How do you understand it so well when I am not even sure how to describe everything?”

Because I am you.

Sometimes there is good reason for it, an event which serves as trigger. Like a supoena to testify in a patient’s lawsuit against an multi billion dollar international corporation. Sometimes there are dozens of good reasons for it. Being on call, stressful patients, behavior issues at school with my kids, extended family conflict, pressure from the suits, my virtual desktop at work is overflowing, the WordPress app reader is frizzing out again and I am missing posts, … Very often, though, there is no good reason at all.

It is then that the pill calls to me.

Die to live another day…

I keep a bottle with my name on it. Not to literally kill myself. Just to make life easier. Kill the anxiety. End the suffering. A pill a day to make the anxiety go away.

But I am a coward it turns out. I am not good at taking pills. I try to do other things. I take a hike in the woods. Being among the trees often helps. Instead, I get a bad case of poison ivy. I try attending an opera, but I can’t enjoy that because of the itching from the poison ivy. I buy a new skirt but it doesn’t fit because of the steroids for the poison ivy. I want to hug my kids…. hugs from my kids often helps… but good squeezes set off the itching again.

All I can do is laugh. There is nothing else left to do.

Suddenly I am rising up out of the abyss. 

Broken Windows

Broken window at Ellis Island hospital

It irks me beyond measure that my eyes are aging to the point that to read posts from the WordPress app on my phone I now require glasses, that to look at certain skin lesions in clinic I need to run grab the red framed readers that I *affectionately* call my old-lady glasses. Adjusting to this new reality is taking some time. I still find myself stubbornly squinting at the screen as if denial will make it all go away… 

Friday the 13th

Ellis Island building detail

Every Friday the 13th I tell myself I am NOT going to work. I am so over the bad luck. 

Is it really that much worse than other days? Are people sicker? Is it maybe that everyone is walking around irritable and more afraid than usual and it boils over into how they interact with others? Am I just hypersensitive? Is it a self fulfilling prophecy? 

I dunno. 

All I know is that I don’t want to do it anymore.

Then it sneaks up on me. Every single dang time.

BAM! 

There is nothing to do but just get through it. Buckle down and get it done. 

Survive. 

And we do. 

We always do.

This Friday the 13th it was different, though.

“She looks yellow…” the medical assistant whispered as I pulled up the chart. 

I scanned her info. I’d never seen her before. Hypertension. Diabetes. Cholesterol. Nothing else remarkable.

Knocking authoritatively on the exam room door, I entered.

“Hi! I’m Dr. Denisof. Tell me what’s been going on?” I shook her hand, taking in her appearance. She was quite jaundiced. 

“I don’t know. I woke up this morning and pretty much freaked out when I looked in the mirror.”

“Any other symptoms?”

She shook her head. “Nothing.”

“No fevers? Abdominal pain? Nausea? Diarrhea?” She shook head no each time. 

“Hmmmmm.”

I started examining, working my way from her head down. Eyes, ears, nose, throat all fine. Lungs clear. Heart regular rate and rhythm, no murmurs. 

“Let’s have you lie down.”

She complied.

Her abdomen sounded normal. I pulled off the stethoscope and palpated her abdomen. No masses. Liver felt maybe a bit enlarged. No pain. 

I helped her sit up.

A strange look came over her face and she doubled over, gagging. Blood poured out of her mouth and into her hands, dripping onto her lap.

“Call the ambulance!” I yelled out the door then grabbed an emesis bag, thrusting it under her mouth. She gasped and the vomit stopped for a moment before another retch wracked her body, bringing up more. The room filled with the scent of rust and iron. 

“Need help?” An MA stuck her head in:

“You called 911?”

“Yes ma’am.”

“Can you print a chart summary and her last set of labs for the EMS?”

“Sure thing!”

“And let the other patients know I am going to be running late while we deal with an emergency.”

“No problem.” 

Sirens were audible in the background, growing louder. Having a clinic so near the fire station definitely had its benefits.

Another retch, more blood. 

I put my hand on the patient’s back and looked into her frightened eyes. “You are going to be OK.” She nodded but did not look convinced.

My mind was running through the differential diagnosis. Causes of rapid liver failure, fulminant hepatitis…. infection? Some sort of aggressive cancer? Drugs? A closet alcoholic? 

The sound of a stretcher came from outside the door and two hunky firefighters in dark blue uniforms stepped in. 

“What do we have here?” the tall one asked.

I gave the run down of what I knew, pointing at the bloody emesis bag. 

As I spoke four sets of eyes grew bigger and the firefighters suddenly backed out of the room. 

What the hell?

“Hang on, I’ll be right back,” I told the patient. I left the door cracked so I could hear any more vomiting or any sounds of distress.

One of the men muttered into a radio receiver on his shoulder. The other took a step toward me, his hands raised.

“Doc, we need for you to step back into the room.”

“Why? What’s going on.”

“You are quarantined.”

What?” More sirens. Through the windows I could see police cars racing into the parking lot, surrounding the building.

“Look, no one can leave this clinic. No one. The CDC will be here shortly and they’ll explain everything.”

*****************************************

The above was a bit of fictional doctor horror brought to you by the month of October…

Taking It

Looking up at the Statue of Liberty

“He just hit on me again…” She shook her head in disbelief as she sat down the phone receiver. “The man comes in with an STD and then wants my phone number so we can hook up after he finishes the medication.”

“Again? Did he hit on you when he was here?”

“Yep. Twice.”

“Was he disrespectful?” I caught myself. What constitutes disrespect? He didn’t call her a cunt or force himself on her but then isn’t continuing to ignore her refusal as sign of disrespect? Particularly given the context.

“I don’t guess so…”

“I can fire him or have the office manager call him up and tell him to stop.”

“No. That will affect our survey results… likelihood to recommend practice and friendliness of the medical assistant….” Her pay raises and evaluations were linked by the healthcare system to those patient satisfaction measures much like 5% of my income depends on meeting certain thresholds for patient satisfaction.

“Well, you already told him no. That’ll affect it, too.”

“True.”

I think back on all of the times I have laughed off unwelcome advances over the years, people who really and truly crossed the line, and I said nothing. I stood tall and laughed it off, not showing my displeasure.

What will he think if I tell him to back off?

“It doesn’t happen often does it?” people ask. 

Depends on if you meet their definition of “pretty” or not. Then there is the question how often is too often? How far is too far?

Admittedly, “Doc, you sure look nice today,” is a far cry from “I’d like to fuck you.” 

Complements are nice. 

Harassment is not.

It isn’t like my medical assistant wears short skirts and low cut blouses. She wears baggy scrubs. I wear professional attire. Pants. A skirt to at least my knees. A blazer. Maybe jeans on a Friday. We don’t flirt with patients. We aren’t asking for it.

In the past, I have considered these sorts of encounters a part of the job. Now I want to tell this man that what he is doing is crosssing a line but is that going too far?Maybe no one ever said anything to him before. Maybe no one ever will. Maybe he will become the president of the United States or a powerful media mogul in Hollywood. Maybe I am just being overly sensitive.