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.