Posts Tagged ‘wine’

Valuable lessons learned from an unreliable cell phone

April 17, 2011

Whether tool or weapon or crutch

For patients and family and such

     It’s not that I’d shirk,

     But if my phone doesn’t work

I don’t worry about being in touch.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  On sabbatical to avoid burnout, while my non-compete clause ticks away I’m having adventures, visiting family and friends, and working in out-of-the-way places.  After a six-week assignment in Barrow, Alaska, the northernmost point in the United States, I’m working on the North Island of New Zealand. 

In residency, a mentor who rightfully commanded a great deal of respect talked about the responsibility of being on call.  One evening early in his career he’d had a glass of wine with dinner, and when duty brought him into the hospital for an after-hours call, the patient smelled alcohol on his breath and commented on it.  Subsequently, that doctor would never drink in town.

One evening, during those days, I came back to my apartment exhausted after a hard night of call followed by a long day of work, and fell into an iron-clad sleep.  Two hours later a patient’s relative phoned.  I tried to talk intelligently but it took me a good five minutes and a review of everyone on my census before I had fully awakened.  I tell the story sometimes because it gets laughs, but I can still remember the active struggle for consciousness, the feeling of mental molasses behind my eyes.

Eight months later, while on OB call, after I had given myself whole-heartedly to sleep in the residents’ call room, the phone rang at 2:30AM.  I kept falling asleep trying to get out of bed, tie my shoes, and get out the door.

A few more embarrassing incidents like those taught me how to not fall completely asleep.  I think most doctors have similar experiences during their training; for one reason or another, most of us cannot sleep well when we have call.

I knew a doctor who slept as well on call as off; he said he just told himself he wasn’t on call right before he went to sleep.

Another physician of my acquaintance avoided accessibility.  To the consternation of his partners, he refused to get a cell phone.  His beeper’s notorious unreliability came from failure to charge and failure to carry.  In the last year, I’ve come to understand that his cheerful good humor and the depth of his emotional resilience stemmed from his ability to get restorative sleep on call and off, and his capacity to relax and recharge when not working.  I don’t think he’s capable of burn-out. 

Three companies provide cell phone service in New Zealand.  My agency issued me a cell phone when I arrived; and, whether from hardware, software, or service issues, it didn’t reliably receive calls.  Frustrated at first, I learned how to not worry if I went out without it.  I have since become accustomed to not having a piece of my mind devoted to vigilance.  Though the agency replaced that phone with one from a different company, I sleep as if no one’s life depends on me awakening promptly.  If I’m on call, I’m on call, and I stay at the clinic.  When I’m not on call, we walk away from home and I don’t bring my phone.  We stroll down to the beach and I don’t run up out of the water to check my beeper. 

Yes, I work 40 or 50 hours a week.  I still feel like I’m on vacation.

Of leisure skills, Hospice, coq au vin, Barrett, Ellington, and drug reps

January 7, 2011

I sent patients from Hospice alive,

I visited my old clinic hive.

     So that I’m not alone

     I got a new phone,

And served dinner at fifty past five.

I started my day by getting a new phone.

I had to replace the old one with a smart phone that would let me use a drug database.  It can also function as a camcorder, take excellent pictures, act as a GPS, remember more music than I’ve had time to listen to in my life, and browse the net.  I rate it Pretty Miraculous, but I realize I’m starting at the bottom of the learning curve and that it can do a lot more.  I’ve missed every call I’ve gotten so far today because I changed my ringtone.

I did well at my saxophone lesson.  My teacher, Diane, and I played some pretty great music; we did a duet by Barrett and it came out well.  Then we jammed some Ellington.  I allowed my analytic hemisphere rest and I let the horn find the notes.

My teacher continues to be a beacon of life lessons.

I stopped by the Clinic Formerly Known As Mine, I got lots of hugs and told my tales.  I also ate the lunch the pharmaceutical manufacturers’ representative brought, but I didn’t talk to the rep, and as I walked away from the clinic I realized that in the last eight weeks, the amount of time I hadn’t spent talking to drug reps totaled forty hours.   On the other hand I know of four new drugs on the market that I need to learn about, possibly more.

I’m still the Medical Director at Care Initiatives Hospice; while on my epic road trip I attended meetings by Skype.  Today I enjoyed having a real meeting.  I feel we do a good job; we let another patient out of Hospice alive.  We cut dosage or eliminated a medication six times.  A Hospice meeting brings lessons in the human condition, eternal verities about drama and irony, and, as always, great stories.  I won’t write those stories because demented people cannot give their permission.

Back at home I cut up chicken hindquarters.  I poured tablespoons of garlic salt and black pepper into half a cup of flour.  After dredging the chicken in the flour, the pieces browned nicely in canola oil at the bottom of a Dutch over.  I took the pieces out and dumped in a pound of sliced Portobello mushrooms  and two chopped white onions.  After sautéing those till the onions were translucent I put the chicken back in, dumped in a bottle of white wine, and pressed in a dozen cloves of garlic. The covered pot went into a 350 degree oven.  Two hours later the house smelled lovely; by then I had two loaves of take-and-bake baguette bread ready, and the rice cooker had done its job.

Our friends, Dolf and Mercedes and their children came over for dinner.  They talked about the Florida adventure they’d just been on and I told about my 6000 mile, 7 week road trip.

Dolf has a strong work ethic but he also possesses an enviable set of leisure skills.  About a year ago I went to him for advice in that realm.  He said, “I got one word for you:  practice.”

I’m taking his advice.

A wrist, a splint, no xrays. Yet

February 21, 2010

A fellow on the friends’ list,

Gave a call, and here is the gist:

     “I have this pain

     I’m sure it’s a sprain,

I know I didn’t fracture my wrist.”

The call comes at quarter past eight from a friend who knows me well enough that not only does he know I have wrist immobilizers for each side, but he probably knows where I keep them.  He fell from his horse yesterday, he has been icing and elevating, but it hurts like the dickens.  He’d like to borrow the splints.

Five years ago our Tae Kwon Do instructor suffered a serious case of testosterone toxicity one evening, and we did push ups till we could do no more.  Tendonitis followed shortly thereafter, and I’ve never thrown away the wrist immobilizers.

My friend is absolutely positive it’s not broken because he has great range of motion.  I’m not so sure.

He knows my Sunday schedule, and knows where to meet me.  I’ve not seen a sprained wrist in this particular anatomic location, my fingers push and probe and I determine that the anatomic snuffbox (the hollow at the base of the thumb) isn’t tender.  I have ruled out the worst wrist fracture.  Despite his assurances, the wrist doesn’t move well, and the swelling is obvious.

I loan him the splint, slipping it on and velcro’ing it in place, and I watch relief play across his face.

Because I know him so well, I can rely on him to show up to the office tomorrow morning to get xrays.  It’s a relief to him to bypass ER and Urgent Care, and to take care of it on a flexible basis.  For my part, I’ve taken a history, and done as much physical as is needed; the only piece of the puzzle I’m missing is the xray.  He can come in tomorrow on his schedule, get the xrays taken, and I can review them at my leisure.

I enjoy doing stuff like this with my friends.

Late in the day, after a good long workout and a short nap, Bethany and I stop by the grocery store for a bottle of wine; we’re going to dinner at the house of another set of friends.

I drink very little, I know nothing about wine, but I’ve decided on a price.  I snatch a bottle of Simi from the shelf.  Later I will find out I made a good choice.

In the checkout line I stand behind a retired doctor.  I recognize him, he doesn’t recognize me.  He moves unsteadily as he buys his four large bottles of vodka, and I see hopelessness and hangover smeared across his face.  I smell the alcohol on his breath though I stand at arm’s length.  I remember when he retired.

If a person chooses to believe in signs, he can see signs of whatever he wants wherever he looks.  Still, it is difficult for me to ignore what I’ve just seen.  I don’t want to end up like that.  Even if it doesn’t involve alcohol, I don’t want to see out my last years with that kind of despair.  Clearly, I have to slow down my pace of work and I have to have something to fill the void.