Thursday, January 17, 2013

Day 215 - reversing the scale

Today was a fairly unspectacular day. I did have my first embarrassing evidence that I did forget some things while I was out on leave today. We were talking about chronic kidney disease and I reversed the stages of kidney disease, putting 5 as end stage when it's 1 that is end stage. How embarrassing. I did remember the GFR numbers that go with each stage, just had the numbers reversed. Still. Would I want a doctor treating me who couldn't keep straight in which scale smaller numbers are healthier (ECOG, cancer staging, MELD) and in which they are less healthy (CKD, PPS, FAST)? There are obviously a lot of scales and arbitrary numbers to keep straight and in my head. How many of them are important? What does it mean to be 90% at keeping them straight? (lower is less healthy) Now that I am not doing general medicine on a daily basis, especially after a six month hiatus, what of my general medicine knowledge will atrophy and what of it? Will I know it if too much is lost? Maybe I better get studying for those boards right now.
I also had the experience of filling out hospice eligibility forms that I used to fill out (Pre-L) so frequently that they were almost automatic. I had a whole stack of them and had the feeling of "I'll just tear through these" and kept getting held up by wondering "Did I remember the part about chosing a hospice plan of care on all of these forms?" "Did I include the verbiage about expected prognosis of six months of less on every form?" There are like touchstones of Pre-L and After-L that I can use to directly compare what was it like last time I did this activity? Another one is walking into the bathroom at the Epping Starbuck's where we stopped on our way to Manchester one day when I was feeling horrible and looking worse. Every time I see myself in the mirror as I walk through the door there, I remember how startled I was that day in September and how I felt then and how I feel now without having any of the intervening feelings to confuse me. The pre-, during and after- versions of me feel very different in some ways--both good and bad. I read an article in the NYT where they said people imagine their personalities developing towards what they are in the present, as though their current self was the goal. They don't realize that in ten years, they will feel about their current self the way they feel about their ten years ago self now. I'm not sure I buy that for myself. The researcher didn't look at specific populations of people, for example, people who had had a serious illness to see if they had the same view of their personal development. It might have been interesting.
As for the rest of today, I worked seven hours which feels like the limit. I managed to talk with a consultant I know a bit who I haven't spoken with in seven months without telling them I had had leukemia.
For myself, for tomorrow, I am hoping to feel for sure my brain is working well. For you, I hope that you are reassured about whatever your biggest worry is.

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