Thursday, July 28, 2011

The Floor Is Yours

A few years ago my post on physician extenders and their role in medicine got quite a few comments. Most of them from angry nurse practitioners and physician assistants who didn't agree and took particular glee in noting my spelling errors.

The truth is my feelings have somewhat changed. I guess it's all about percentages. Both the top and the bottom five percent of primary care practitioners, from a quality perspective, are probably MDs. Most physician extenders, as well as physicians, fall somewhere inbetween.

I guess my problem is that I expect all MDs to be part of that top five percent (and strive myself to reach that goal). But that's not reality.

My expectations in the past were so high that I was very unaccepting of those who tried to practice the same medicine but with less training.

However, as I get older and encounter our medical system as a patient, family member, and even consumer I realize that many MDs don't live up to my (unrealistic?) hopes.

So I give up.

A message to all nurse practitioners and physician assistants....

You want to practice primary care without overview?

You want my job?

Go for it...the floor is yours.

But one question still remains.

Why ever would you want to do something so all consuming... and so frustrating...with less training and for less money?

Monday, July 25, 2011

Something People Do Every Day

The recycling container was already full. But I had two more bags to stow before lugging the bin through the gate and into the front yard for pick up. My button down shirt untidy and bulging out from the waist. My long khaki pants felt like a fur coat in the ninety plus Chicago humidity. It was 4pm and I had just arrived home from work, dropped my computer in the doorway, gathered up the last bit of recycling, and headed for the door.

As I struggled to force the trash into the container my pager began to vibrate. I pulled the bin to the stairs and sat down on the steps. I fumbled with my phone and awkwardly punched in the numbers on the display. The sweat formed on my forehead and slowly waltzed down my face.

I recognized the number. An eighty year old woman with end stage lung cancer. Her care had been overseen by hospice for the last few weeks. But we still talked from time to time. And when she became too sick to talk her daughter would call.

The end was near. Her family huddled around her bedside and waited for her last breath. The inevitable conclusion to eighty years of constant motion.

Now her daughter was on the phone crying. Her mother had just passed. And we talked. The serenity and calm of my backyard a contrast to the turmoil of the conversation.

I concentrated to distill all that I had learned about death. All that I knew as an internal medicine physician who takes care of the aged and dying. How it always hurts to lose a parent. Even if you are expecting it. How when your second parent dies you feel lost....alone...disconnected. How the terrible pain will eventually abate. How one day the memories will make you smile instead of hurt.

But all that wouldn't help now. So instead I told her that I was sorry. That it was both a pleasure and honor to take care of her mother. And that If there was anything I could do.....she should call.

Then I hung up. Slipped the phone back into my pocket. Stood. Grabbed the trash bin and struggled toward the gate.

And continued on with my if this wasn't out of the ordinary...

as if this was something....

people do every day.

Tuesday, July 19, 2011

I Would Not Be a Doctor Today

Out of the corner of my eye I glimpsed something familiar. The unmistakable dance of syncope. An effortless falling. A surrender to gravity. Her body arched as her young companion lunged forward. Supporting her from behind he gently walked/carried her to the cabana.

And I watched from my chair at the pool. I reached reflexively for the stethoscope around my neck but then realized it was thousands of miles away. My children played at my feet. My quiet vacation in Mexico interrupted by my profession. My mind spinning, calculating...should I intercede?

The women was now laying face down in the cabana with her head hanging over the side. A bucket had been propped under her mouth. Her young companion sat next to her and stroked her graying hair. An older gentleman approached. They laughed and chided without worry. They shared a passing resemblance. Father and son?

A man in a life guard uniform approached with walkie talkie flapping in front of his face. He was met by two security guards who hoisted the woman and carried her agilely toward an adjacent building. The companions continued a heated converstaion as if nothing had happened.

I turned to my wife whose head was buried in a book.

"Did you see that?"

"See what?"

My children entered the shallow end of the pool. I lifted the Corona to my mouth and took another swig.

It was 10am on a Monday morning.

I pulled my hat over my eyes and reclined like the rest of the tourists sitting poolside...oblivious.

For the first time in years I felt permission to relax...

I would not be a doctor today.

Friday, July 15, 2011

I'm Pretty Sure

He stood tall like a great oak. Maybe six foot five. His trunk was slender but solid and his limbs long and thin.

His gait was effortlessly awkward. Almost drunk. A marionette with his torso pulled upwards but his master had apparently cut the strings to his arms so they flopped toward the ground.

But this man had no master.

His clothes were tattered. Untied gym shoes with woolen socks pulled to the ankle. Beige shorts with the fly carelessly left open. A short sleeve shirt left unbuttoned with bare chest brazenly exposed. A hat perched on curly hair.

His face was expressionless. His eyes devoid of life or love. Dark clouds swirled underneath his brow.

He sauntered past my car oblivious.

And I'm pretty sure....I saw the devil this morning.

At the corner of Green Bay and Central.

On my way to work.

As I sped past I sighed deeply...

and I didn't dare look back.

Tuesday, July 12, 2011

I have no illusions

I have no illusions. About my writing (or spelling for that matter). I don't picture myself a poet laureate nor Pulitzer prize winning author. I am what I am.

But my writing is important. To me at least. It allows me to express the unpredictable, unexplainable, and often hurtful parts of my life.

I certainly don't expect to receive support or feedback for what I write here or elsewhere.

So I was surprised the other day when I googled my name (which I do from time to time) and came across this blog.

The author, Michelle, was not only kind enough to mention my poem, Fake, but also to record a reading.

It gives me great pride to know that something I wrote has been released into the world. It waits to be discovered by someone half way around the country. To have meaning. To be notable.

To be shared with others

Friday, July 8, 2011

I love her

I love her

The vase on the counter is half full. The shadow of a women sits perched over her wheel chair in front of the nursing station. Her repetitive movements and verbal ticks another sign of a brain overcome by plaques and tangles. She sings her pathetic love song to a soul long lost to dementia. Her relentless arms intertwined in a meaningless embrace.

Her words bounce off my skull and penetrate my neck muscles. Stiff and painful. I yawn. Its 5:30 in the morning and I am making rounds at the nursing home. The last time I looked at a clock it was 2am and I was lying down for a moment.

My insomniac brain is restless.

But it wasn't my patients that kept me up last night. I mean mostly....I still had two late admissions.

This time it was my family. I packed her unwillingly into my car and took her to the emergency room. I have now become the chief medical officer of the family. The youngest of five...previously the follower. I am now the leader.

I love her

I love her

It's surprising to realize that even doctors struggle with our medical system. How I, the physician, can no longer find appropriate care for my family. Care givers who demonstrate a modicum of depth and have actual skin in the game.

I don't want to organize my family's health. I don't want to be the one to make sure that every test has been has been ordered, accurately assembled, and integrated into a finite whole.

But if not I...who else? There is no longer a wise, gray haired, bearded physician with a friendly smile and an easy demeanor. No sage to give guidance. They have all disappeared. How naive to once kneel at the alter of Ayn Rand and her silly drivel....But yet Atlas has shrugged.

And I continue to carry the weight of the world. I will finish my work at the nursing home and then round at the hospital. With heavy heart I will attend to my patients in the office and answer phone calls. Then I will return to the nursing home for afternoon rounds.

Somewhere in between I will call my Mother's doctors. Schedule tests and appointments.

And hopefully at the end of the day....

I will spend some time with my children

I love her

I love her

Saturday, July 2, 2011

Doctors Are Lame!

It wouldn't be an exageration to say that when my wife wants something....she usually gets it. It's not because she works at it. She just decides that something is going to happen a certain way. And low and behold it does.

So when she told me she wanted to go to Ravinia for the Maroon 5 concert I had little doubt. I called the box office the next day but there were no tickets left. Not even the lawn seats were open.

Days and weeks passed and I forgot about the concert. Until I got a notice in the mail. The professional staff office at my hospital was putting on event for all the physicians. The night included entrance to Ravinia, food and beverage, and lastly pavillian tickets to the Maroon 5 concert. All I had to do was return the card stating my interest and I would be given two tickets. Supplies were limited so I had to act fast.

I quickly filled out the card, added a stamp, and dropped it in the mail and waited. And waited. And waited. But no tickets. So I called the staff office. Three times to be exact. Finally I reached the person organizing the event.

They had received my card. But had withdrawn my request becuase I was not up to date on my professional staff dues. Supposedly they had been trying to reach me for weeks. Sent certiied letters and emails. Ofcourse I recieved nothing.

I immediately gave my credit card number and was promised the tickets were in the mail. The concert was in one week. Although I lived 5 minutes from the administrative offices, days passed and no tickets.

The day before the concert I was assured that tickets would be waiting for me at the box office. I packed up the kids and dropped them at their grandmother's house and set off for Ravinia.

We had gotten a late start and upon arrival found the parking lot was full. So we meandered fiftee minutes offsite and took a shuttle in. Our tickets were waiting as promised and we headed towards the tent set up for my hospital.

As we entered I found myself surrounded by people I hadn't seen in years. An ecclectic mix of physicians fromt three different hospitals. Ages varied. I chatted easily with old acquintances and enjoyed a good meal and a few beers.

Then it was off to the pavillian. Thousands scrambled into their seats to see the warm up band. But the real excitement started when Maroon 5 came on stage. I looked up and down at the seats around me. Mostly older physicians and their spouses but also some young people. The seats in our section were all reserved by the professional staff office.

As Adam levine stepped on stage the crowd rose and started to cheer. Ninety eight percent of the pavillion was on its feet and screaming at the top of their lungs. The other two percent sat quietly with confused and uncomfortable looks on their faces.

The other two percent were the bewildered physician participants who had been invited as part of our event. As the music started my wife and I stood up and began to dance. We stood alone in a group of fifty people. These fifty people formed an island of seated concert goers surrounded by thousands of screaming adoring fans swaying back and forth above their neglected seats.

Within minutes most of my colleageus had left the concert prematurely. The rest left at the end but missed the encore.

And my wife and I danced for what seemed like hours. Eventually when the show was over we left the pavillian with smiles on our faces and convinced that while Maroon 5puts on a hell of a concert, in general.....

Physicians are lame!