Wednesday, February 6, 2013

Day 235 - some milestones

Today had another milestone in it. I had to call a pharmacy to coordinate a patient's meds and for the first time in seven months, I pressed "2 if you are a doctor." I've been calling pharmacies a lot in the past few months--a real lot--and have had to press the patient number. I always hear the doctor number, taunting me, reminding me that I am not doing my profession, but have behaved well and not pressed it when I was calling as a patient. It was very exciting to press the doctor number again.
Another milestone is that I watched a patient of mine get on a gurney and get loaded up in an ambulance today. I have seen patients on gurneys since being back, but the last person I saw get on a gurney was me. He did much better than I did both times as he was able to stand and pivot for transfer. I realized as I watched him get in the ambulance that I was a little sad that both times I'd been in an ambulance, I was too sick to enjoy it. I suppose that would be the definition of a wasteful ambulance ride: if you are well enough to enjoy the scenery and the cool technology in the rig, you are well enough to get in a regular car.
The 1/31/13 NEJM has the article about myths, presumptions and facts about obesity that has been widely quoted. Sadly, it's not a free text article so I didn't link. I really think we know very little about obesity and weight loss, but we like to pretend we do.
Last night, I had a really nice conversation with my friend, Rob, about patients who are DNR having to reverse their DNR status before they have surgery or procedures. Several years ago, I had a patient who had reversed his DNR status for a procedure code during said procedure. I got to thinking about that day and how I had had 15 or so other patients to care for even though having a very nice, highly functional patient die, have attempted CPR and then have to talk with his elderly wife (who fortunately was not at all surprised) was a fairly heavy duty day, emotionally speaking, I had to keep going: admit, discharge, evaluate differential diagnoses, talk with patients and families, adjust meds, call consults, etc. for hours more. As I told Rob about it, I noticed my hands were shaking. There is so much stress to how we have to handle things sometimes--just shove them aside and keep going. I find it really a pleasant change that in hospice, as a more team oriented specialty, there are more people who understand the emotional situation I might be in with the patient in room E507 and who can then offer me some support. I think hospice providers are also trained more in providing emotional support and can offer it to fellow staff more effectively than non-hospice trained folks. I am very happy to be where I am. (Unrelated, but I do really find I miss hospitalist work.)
Today is day #3 of a so far 18 hour week. I am glad I will not be working tomorrow as I'm pretty excited about my bed tonight.
For me, for tomorrow, I hope only for restoration. For you, for tomorrow, restoration if you need it, otherwise, whatever you need instead.

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