Busy week

We continue to move along at work on the computerized medical record or EMR as we call it. This was supposed to be the first week of using it exclusively, without all of the paper processes. But one of our Medical Assistants just returned from her maternity leave. She hasn't had any EMR training until now, so we elected to stay at 60-70% EMR until we could get her up to speed. I've been doing all of my pts "electronic" for the past 2 weeks, so it is starting to get easier for me. I think it's really funny to come out of my little hallway to the main, open area of the nurses station and see all of the Medical Assistants and Nurses with their heads down, fingers pecking away at their respective keyboards, as they type in all of the information that previously got recorded in pen. Call me a Luddite, but I'm going to miss all of the inscrutable handwriting that dotted our charts previously. I consider myself somewhat of an expert on bad handwriting, my own being pretty poor at times when I am in a hurry (One of my mentors told me that my handwriting only looked illegible at first glance and that once you really tried to read it, it was actually pretty clear as opposed to those folks with handwriting that looks neat at first glance, only to be undecipherable upon further inspection. Ever wonder why our handwriting is so bad? I did. But one day I counted the number of times I had to write or sign my name; I stopped counting when I got to 300, but I digress). Just out of curiosity, I am doing a desk audit every week now to see when my supervisor's desk is clear of paper charts. She is one of those people with stacks and piles all over her desk. I know that once those are gone, we will be fully electronic.

I have been thinking about my Aunt Mary Alice who would have celebrated her birthday this week, her 60th I think. She died several years ago from alcohol abuse, accelerating her own drinking after Uncle Tommy died of alcoholic pancreatitis just weeks before his retirement from the Postal Service. Aunt Mary Alice was my Godmother, favorite aunt, and a role model with her secretary to Vice President career path despite never going to college. When I was really young, maybe 6 yrs old or so, she took me to work with her, which I thought was the most fun in the world-playing with the telephones, sitting at a desk, and getting to write on official paper with company pens (surely bad handwriting then too). It seemed so adult and real world, which I just loved. But we also went to the fair and roller skating and camping-all things I adored as a kid. And I often got to do them without my twin sisters, just me and Aunt Mary Alice and Uncle Tommy escaping together. I was so heartened when she stayed sober for several months after my Uncle Tommy died, but eventually, she relapsed-drinking more and more and more until she just died one day. I checked her name on Google today to see if there was any mention of her, the way one might look for info on an old classmate or friend. She wasn't there. She is still with me though; I just wish she were still with us.

Today's photo: Lenten Roses in my garden in Asheville

The Attitudes

Holly and I are in Asheville for the w-e, and we are allowing ourselves a rare afternoon to just hang out at the house and do nothing. Well we aren't really doing nothing since I'm writing a bit, and she is looking at old photos, but you get the idea. We did our run around Beaver Lake this morning, going backwards since Holly was bored of doing it the same way every w-e. It always amazes me how different a route can look when you do it backwards. You see such different views of everything-the houses from another angle, different mtns in your view, and the downhills suddenly up instead.

Work has been going really well the past few weeks. I am happy to report that our transition to the Electronic or Computerized Medical Record is speeding right along. The people I work with are so terrific, and they have fully embraced this transition, though it was difficult at first. We are over the hump now and are all just waiting for the last remnants of the paper processes to be gone. Marnivia, our EMR trainer, continues to be helpful and positive; again, I lament the day she leaves to go help our next clinic with the system. Hopefully we have her for another week or two, not that we are using her much these days. But when you need her, you really need her, and it's a relief to see her sitting at her cart in the hallway. Sometimes I like to just peer around the corner, down the hall to see her sitting there at her cart, even when I don't need her help. It just makes me feel better. She had a birthday this week, and we didn't even know about it until later. I left her a bag of chocolates and a card on her cart to surprise her the next morning. It was the least we could do.

I've had a couple of interesting patient encounters this week. I was doing a physical exam on one of my female patients, a 49 yr old black woman who I've seen several times over the past 2 years for her blood pressure and smoking. As I was examining her, she was telling me about her hot flashes and trouble sleeping. I commented that she is probably going through menopause. "I know I am, " she said "because I have The Attitudes." Now if ever there was a phrase that better defines a condition, I don't know what it would be. She gave me such a chuckle with that one, and I asked if I could use her phrase. I know exactly what she means, and I suspect every woman who has been through menopause does too (and maybe some people living through menopause as a bystander.) I mean if ever there was a time when you feel defensive and offensive at the same time, it's menopause. There ought to be a sign for menopausal woman; it would say "Watch out! I have THE ATTITUDES."

I also got reconnected with one of my longtime patients who had been seeing one of our other doctors while I was out. Though he is my age, he looks much older because of his medical problems. Ivan has end stage COPD/emphesema, so he wears a nasal cannula or plastic tube to supply extra oxygen for his breathing. I'd read his chart the day before I saw him and was sad to see that his condition had detiorated considerably during my 7 month absence. He's had 3 hospitalizations just in the last 2 months for confusion and low oxygen levels since his lungs can't clear infection well. When we saw each other yesterday, I think we were both relieved to see each other back. He gave me a big hug and told me that he had missed me. I hugged back and assured him that I was glad to be back and glad that we were both still around to see each other. I commented on how much weight he had lost and how much softer his voice was now. He said it had always been this way, but I know that he has weakened in the intervening months. He told me that the other doctors had tried to "mess with his medicines" and that he was glad to have me back since I "know everything about him." Honestly, I didn't make one adjustment to his medicine regimen yesterday, but I did refer him to exercise therapy to strengthen his leg muscles. It will makes his body better able to extract and use oxygen, a precious commodity in his chronically ill state. It is difficult to express how much joy he gave me-something about being happy to see me, something about being happy that he is still around, that I can do something, anything to make his life a little better. When I feel like that, I am so appreciative that I got to do this for a living. And I feel like I should be paying him for the visit, not vice versa. It's the best.

Today's photo is some turkey tail fungus on a log from one of our recent hikes.

Attraversiamo

I finished a couple of books this past week. One was the interesting memoir of her year in Italy, India, and Indonesia by Elizabeth Gilbert. That one is called "Eat, Pray, Love" and it's been (rightly so) on the NY Times bestseller list for a while now. I wrote about it here briefly while I was reading the Italy section at the beginning of the book. Apparently it is being made into a movie with Julia Roberts, which I can so easily see with the quips, humor and winsome stories she packs in that little volume. One of my favorite parts is how she just loved learning Italian-you know, it's not a language anyone really needs to know unless you just want to. She loves the way it sounds, its beauty mimicking the beautiful countryside, people and food. She gets enamored of the word "attraversiamo" which means "let's cross over." She likes it so much that she is always saying it and pulling her walking companion from one side of the street to the other. It's a metaphor, too, for all of the transitions she undergoes that year, the real point of the book, after surviving a terrible divorce. I like the word too because it seems so hopeful -all about moving forward. I'm doing that too, settling into work again and home routines. My repeat blood work today was beautiful so I can stop thinking about that for another month. Attraversiamo.

Today's photo is from the Black Mtn/Montreat hike we did up Graybeard trail.

iTouch

On this holiday to love, I know not one, but two people who are getting married today. One is my coworker (in her 20's) getting married in the little church where she grew up, all out in the country near one of our health centers, as a matter of fact. The other is the mother (in her 70's) of a friend who is marrying a gentleman (in his 80's) she met when she moved to Asheville to live in one of our retirement communities. I just think it is so romantical (not a word but it should be) and sweet to pick Valentine's Day as your wedding day. And I think it is wonderful that people in their 20's can say they want to be with someone FOREVER and that people in their 70's and 80's still believe in love enough to commit to each other in a ceremonial way. You go guys!

I am just starting to get patients back in my clinic who never knew I was gone. Most of them are seen infrequently, for example, only for their yearly physical and pap smear, or to get their year's supply of allergy medicine. This week I saw a really nice lady who teaches French at Elon College. After I had finished her exam, she commented that my hair is much shorter than last year when I did her exam. “You look like a different person,” she said. “I almost didn’t recognize you.” I told her that I am a different person, almost, and then explained what had happened with me since she saw me last year. She expressed relief to hear that I am doing well and that I could come back to work. I sure do enjoy being back again, where I was last year- in some ways the same, in some ways different. Gosh I've been through alot to arrive back where I was, and the hair is only the tip of the iceberg as far as that is concerned.

My sweetie got me an Apple iTouch for a Valentine's gift, as you can see from the photo. Such a nice, fun new toy from a truly sweet partner.

Mighty but Mini

The last several days have been warm here in the Triangle as well as in Asheville. We arrived to snow still in our backyard for the w-e on Friday, but it melted quickly with the 60 degree days we enjoyed Saturday though Monday. We made good use of the warm weather, running around Beaver Lake on Saturday and then walking around downtown with everyone else heading outside to enjoy the sunny day. We ate dinner at the Laughing Seed restaurant which is just about the best vegetarian place I've ever encountered. Everyone else was eating outside at the Mellow Mushroom (a pizza place) which is always full of tourists and towns people who want to sit on their patio when it is warm and sunny like it was this past weekend (despite it being February). We even saw a bit of live music at the French Broad Brewery, but the guy playing wasn't as good as our usual group Brushfire Stankgrass, which plays a mix of acoustic rock and bluegrass. Still it is always fun to catch a live show. The warm days in February and March really make it worth living in the South. Try finding that in Vermont or New Hampshire which are mired in snow and gray skies all of winter and into Spring too.

Sunday we did some hiking in the Black Mtn/Montreat area with Susan, Jan, and their respective dogs. We must have been a funny looking group with Lucy the big, fluffy shephard type dog and Riley, the mighty but mini black and tan dachshund. The trail heads up, up, up as they do over there in the Greybeard area, then flattens out a bit along the old Trestle road and then heads steeply down. Susan sent me an email today asking if we were sore and telling us that her triceps were the most sore. That's what you get for using those fancy hiking poles to help you down the hill. You should have taken your chances and hoped that your downhill muscles would hold you like the rest of us (tee-hee). We did something like 1000 ft of down in only 0.87 mile so you can imagine the steepness of that. I'm just crazy enough about hills to wonder what it would be like to go up it next time. I'm always up for a challenge (no pun intended, really). I'll throw in the photo some nice college gal took of us at the top (though mighty but mini is cut off in the photo, sorry Riley).

I'm reading a terrific book Susan suggested, that has been on the NY Times bestseller list recently. It's "Eat, Pray, Love" by Elizabeth Gilbert. She writes about her year traveling to Italy (to eat, what else), India (to pray) and yes you guessed it to Indonesia (to love)-all after suffering through a horrendous divorce which she doesn't really detail except to say that it felt like a car accident EVERYDAY for 2 years. I'm thinking my sister needs to read it too. The author is funny and insightful and not preachy though she really does find God with a capital G. You'll have to read it for yourself, and enjoy it too. I've laughed outloud in many places, always a good recommendation for a book.

Feb 7, 3 years Cancer Free from Breast Cancer

Today is an anniversary of sorts for me. Three years ago today I had a lumpectomy to remove a 2.1 cm mass in my right breast. Gosh was I a groggy, nervous mess. I had never been sick or had any kind of medical procedure prior to that, and even though I have alot of familiarity with medical issues, I didn't know what to expect. Fortunately, my mom and two sisters came to be with me (they had all had surgeries before of one type or another) and Holly stayed with me in the waiting room, then the pre-op and post-op holding areas. I had the kind of surgery where they inject a little dye right into the breast mass to see which lymph nodes are closest to the cancer. They biopsied those when they took out the whole tumor. Fortunately for me, I had no cancer present in my lymph nodes, and they were able to get all of the tumor with the lumpectomy. Later that same day, they sent me home with percocet for pain, which I promptly threw up and then threw away since the pain was better than the stomach upset from that drug. I don't know how people get addicted to that medicine but they do; it induces horrible nausea and vomiting for me. Anyway, I am happy to be far, far away from all of that breast cancer stuff-the difficult chemo that would follow, the surgical site that pulled apart and had to be packed by one of my colleagues who had been a wound nurse in her previous job, and the daily radiation that started my day for 7 and 1/2 weeks.

Today is also the anniversary for two of my friends who are together. Happy anniversary to you two as well. Hope you are celebrating and basking in this glorious day too. I'm really happy to be here seeing the birds at the feeders, running around Beaver Lake while the Audubon folks gawk at the geese, and soaking in my big porcelain bathtub to rest my sore muscles.

Today's photo: a wire dachshund that my pal Donna W gave me at Christmas; she has a little black and tan too.

Every Tuesday I try to peruse the NY Times for the articles in their Health & Science section. Many of the articles are written by prominent doctors or leaders in healthcare and the late, breaking medical news is always helpful too. There are columns about wellness, prevention, and nutrition as well as difficult cases written by MD's or personal experiences of the healthcare system written by patients. Lately I’ve been reading a very interesting series by a journalist who is being treated for prostate cancer. He writes openly about his experiences as a patient, and it is very revealing to read about cancer from a man’s perspective. He has had surgery as well as chemo, hormone therapy, and radiation, so he knows a thing or two about long treatment and side effects. He writes openly about how the hormone shots have killed his libido and how the surgery left him (sometimes) incontinent and (sometimes) unable to have sex (add hot flashes to that and I’d swear he was in menopause). Soon he will have his first real follow up blood test, the PSA, to see if his cancer is in remission.

He has written recently about all the doubt he feels, especially his doubt about the future and whether he will remain cancer free. Hopefully he'll get good news and then his cancer will take up less and less space in his life like mine has as it gets further from the last treatment. I spent a lot of time around men with prostate cancer when I was having radiation for my breast cancer in 2006. We were all sitting in the same hallway at the Radiation Oncology clinic waiting to receive our daily radiation treatments. One thing I noticed about the men is how little they interacted with each other. They were always talkative with me and any of the other women being treated (there was a elderly woman getting her colon cancer treated at the same time) but almost never with each other. It was like they were too embarassed to share all that they were going through with each other. I wondered then, and I wonder now, how much harder it must be to go it alone as they seemed to do. Me, I was happy to share my experience with anyone who asked, even the lady at Lowe’s who commented on my bald head (“yup, I have breast cancer and I’ll be done with treatment in July. Thanks for your concern…”) Once, I even had the conversation with a woman at one of the rest stops on I-40 who noticed my bald head and asked if I had breast cancer (“No, this time it’s leukemia but I’m doing well…) What’s my point? Don’t suffer in silence. Share your struggles with those who ask in concern. As a doctor, I am amazed how often people just want me to listen to them and validate what they are going through. I'm paid to listen, and I still get a kick out of that.

Later today we will drive up the mtn to Asheville for the w-e. Hopefully we'll get to see some pals and hike like we did last w-e. Today's photo is from the hike we did last week with Susan and Donna in the Pisgah area, the Slate Rock trail.

Marnivia and her Cart

They sent us this heavenly woman named Marnivia to help us learn to use the new computerized medical record we are adopting in our office. When I first came back to work in January, they had me meet with her several times to catch up on the training sessions I had missed. She has the perfect temperament for this kind of work. Marnivia is consistently upbeat, positive, and optimistic. She always has a big smile on her face which is a plus when you're teaching a bunch of clueless doctors how to do something new. In addition, she is non-threatening and approachable despite the simplest question. She has really been a help to me as I’ve tried to catch up to everyone else already using the computer system.

Now that our center has moved from the training phase to the implementation phase (called a Go Live), we are actually using the new system to document our patient visits, to order labs, and to write prescriptions (yeah, we are now part of the 21st century just like the Jiffy Lube down the street). As you can imagine, things don't always go so smoothly. Fortunately, Marnivia is still hanging out in the clinic everyday to help us troubleshoot. She grabbed a rolling cart that we use for unloading supplies and parked it directly in front of the nurses area along one of the walls. It is also near our patient rooms, so we can dash out to ask her help if we get stuck, which happened ALOT the first day that we started using the system in the clinic. Not everyone would be willing to work everyday on a rolling supply cart, but Marnivia is that helpful, practical type. She even has a card laminated with her kids' photos that she brings everyday to place on the cart near her laptop. There are no cubicle or pod walls for hanging photos in her makeshift "office" but hey, she's not letting that stop her. I'm already lamenting the day she'll leave us to help the next clinic, lucky guys.

I do think that our first week of the Go Live has gone remarkably well. Imagine trying to use a computer for EVERYTHING you ever did on paper, and you about have the size and dimension of the task. One of the doctors joked that she had bumbled through a visit and felt the need to assure her patient that yes, she did actually know how to be a doctor. Funny how that feels like the "easy" part now. Well I thought we did pretty well in our first week, and soon it will all be the easy part.

Today’s photo: Marnivia at her cart in the center hall helping me with the computer.