Friday, September 08, 2006

Chaos, inside and out

What a crazy week! I'm still swimming, but it seems that the water is rising rather quickly! Forgive the rambling nature of this post, but try to remember that it is coming from someone who tried to put deodorant on her toothbrush this morning! Where is my brain? Often a "short" work week in our office means a couple of long days to play catch up. I'm not sure what it is about some patients, but they seem to really lose it if they are unable to talk to someone in the office for more than two days. I got paged all day long on Labor Day for insignificant minutiae that totally could have waited one more day. Maybe I'm just being bitter again, but I would just never page a physician at home on a holiday at 10 pm to talk about my "constipation" (once every other day, for the curious) woes. It truly boggles my mind. Maybe it is DMS, but people have really annoyed me all week long!

The week started on a high note with the win that FSU eked out over Miami. Neither school looked stellar, and I dread the coming season with our "offensive" coordinator at the helm. Of course, I stayed up way too late to watch the whole thing, overslept, and was almost an hour late rounding and getting to the office. From there I was jam-packed with patients all day long on Tuesday. I never stopped moving between the hours of 8 am and 7 pm. I'm not sure how it works in other private OB/GYN offices, but I know that seeing 40 patients in a day is almost more than I can handle. My partner sees twice as many some days (and his patients end up waiting 3 hours in the waiting room), and I have no idea how he pulls this off. He must not chart at all. My little one played in the office with my nurse while I finished charting. Poor thing, I hope she doesn't grow up feeling neglected. Tuesday night was spent dictating pre-op charts. I think that I put some laundry in the washer Tuesday night.

Wednesday was a big day in the operating room. Two hysterectomies and two c-sections. Talk about swinging between the extremes of a woman's life! I lucked out and got another physician to assist me on the (rather difficult) hysterectomies. It makes all the difference in the world to have an experienced assistant. On the first section, once the baby was out and the student and I were repairing the uterus; we noticed a bizarre hematoma on the top of the uterine fundus, well away from the incison site. It expanded to about the width and breadth of an adult thumb and then spontaneously ruptured and bled like crazy! We eventually got it stitched up and hemostatic, but it was like nothing I had seen before. My second section was for pre-ecclampsia and frank breech presentation. The patient and her family are extremely nice. She also happens to work in the hospital, and her family member is on the hospital board, so no pressure there! We actually had to do the surgery a week earlier than planned because of her worsening symptoms. Her pressures really never got much above 150s/90s, but her standard pressures are 90s/50s so it was a significant elevation for her. Luckily the early baby (a girl) had fantastic lungs and never had a bit of trouble with the transition from womb to world. In retrospect, Wednesday was a pretty good day, but ever so exhausting.

Thursday clinic was more of the same left over from Tuesday. If I have one more pelvic pain patient come to me with codeine, aspirin, and Tylenol (ha!) allergies, I am going to scream. I have only been here a year, so I know that I am considered "fresh meat" for the pain seekers. You can pull up these patients' med records on the hospital computer system and see dozens of ER visits for vague "pain" related issues. Thousands of dollars are wasted on unnecessary work-ups on these people, not to mention all of the wasted time and personnel, going through the motions with these leeches when there are honest-to-goodness *sick* people to be seen and attended. What they don't know is that I *so* was not born yesterday, and I do not play the narcotics game. At all. The strongest pain med they get from me is Naprosyn (prescription strength Alleve). If they require more than Naprosyn, then I offer them exploratory surgery. One of the patients actually exclaimed to my nurse as she was checking out, "Naprosyn? That's it?" It is unbelievable the things these people will pull to get narcotics. What is even worse is that some docs hand them out like candy. Can you tell this is a hot-button issue for me? It makes my blood absolutely boil, and I had more than my share of them this week.

I found the mildew-y laundry, still in the washer, this morning when I was frantically looking for underwear. My house is a sty, and the cleaning babes just came on Tuesday! I had a "short day" in the office, my last patient left at 2 pm. I spent the hours between 2 and 4:30 catching up on office charts and sorting through labs. I am on the bad girl list for discharge summary dictations, so I have to get those done this weekend or I can't schedule any more surgery. This weekend I also have to find, not one, but TWO different formal dresses for upcoming back-to-back "black-tie optional" evening weddings that will cover my gargantuan ass. In Mountainville, USA, where "High Fashion" is found at the local Elder-Beerman. I can't wear the same dress to both because the weddings are in the same circle of friends, and everyone will be at both weddings. Don't even get me started on the size of my ass. Exercise has become a four-letter word and my husband and I have both been "off the wagon" all week long. I shudder to think about what my cholesterol and blood pressure are doing at this very minute. I had to cancel my appointment with my own doctor because I have too many patients of my own to see on the day that I had scheduled. In a way, I am glad, prolonging the inevitable. You could say that I'm stressed. Thus, I am going to spend tonight stretched out on the couch.....after I start the laundry for the 3rd time this week. So how was *your* week? Are you up to the challenge? ;)Hopefully a little sleep will chase these grumpy demons from my psyche and I'll be fun and interesting again soon! Good night, 3 readers of mine!


medstudentitis said...

Sounds like a very busy week! I hate it when I find mildew-y laundry in my washer... especially when I can't remember putting it in there.

Maybe you could find a reversible dress :) two dresses in one?

dr. whoo? said...

Laundry is my nemesis! One dress down and one to go! I'm adding you to the blog roll. I'm reading your blog, and it really brings me back! :)

Anonymous said...

I'm sure that you have people who are really pill seekers. However not all of them are. I had a baby last year and ever since have had excruciating periods and excruciating pain at ovulation (YES I am STILL ovulating while on the damn pill and it was confirmed by US!). Baby was born at the end of June 05 due to severe PIH (35 weeks). Periods resumed in early August. However I had complications from the delivery. Uterine infection and ecoli that landed me a trip to the er and then eventually the or for a D&C. I was given Lortab for the infection pain and then for a spinal headache. I ended up using that with my PCP's permission for the excruciating periods till Jan (had 60 total starting at the beginning of July and ran out). Had my annual exam with my obgyn and all he offered me was Naprosyn as well.

Two days later I was in the ER with excruciating mid cycle pain. They called my obgyn at home and he authorized a shot of painkiller and a rx for Darvocet.

I spent the next 8 months following up every 3 months in the office, trying 5 different bcps, two different pregesterone pills, with no improvement. Not only were my cycles excruciating, they were also very very irregular. I have had bleeding in between cycles. Depo shot was nixed due to bad reaction to oral provera. Lupron was out of the question. All tests were normal except a small posterior fibroid. I also had to call into the office and update him each month and fax him a chart of cycles and pain. I called every single month from Jan on for a refill on Darvocet (15 a month). While it didn't kill the pain it helped.

Then a few weeks ago, my ob was out of town and I had no medicine for when it was that time of the month. The nurse at his office was less than compassionate and told me that no one there could or would write that rx for me (he had midwives with rx privliges work for him). She told me to deal with it and take motrin. She tried to get me to cancel an appt I had scheduled to discuss more options that just the bcp. I was in excruciating pain, in tears, and doubled over. My husband immediately took me to the ER. I had a wonderful ER dr and two wonderful ER nurses who were very compassionate. It was the conversation with the er dr that convinced me that I needed to have a lap done. My dr hadn't even discussed that with me yet. (It was one of the reasons I had made the appt). Just another bcp or a permanent solution. That ER did a lot for me that day. She told me she was not even going to put me through all the tests because my dr was treating me and if he wanted to do it he could. She was going straight for pain relief. She never did tell me what the narcotic was that she gave me. All I knew was that I felt much better but very out of it afterwards. Plus I got a shot of Toradol.

I followed up with my ob when he came back from vacation a week and a half later. The same appt that the less than compassionate nurse told me to cancel and that I didn't need. He went through the ER report. The shot was Nubain. He said that was pretty heavy stuff. Well he wasn't around, and I was in a hospital bed curled up in pain. He wanted to do the tests again. US, etc. I asked him, if it was endometriosis? I had brought up endo to him at my last appt and he said he didn't know yet. The ER dr and I had discussed it, what it was, treatment options, etc. I asked him if the only way to diagnose is to do a lap and he said yes. Then I told him that was what I wanted. He agreed.

I am going in next month for the surgery. I will still have to deal with one more period before then. I am trying to go continuous on the pill but I have broken through on every single one of the pills.

This is my story. Not every woman with pelvic pain comes to you looking for their fix. I have missed work, a lot of my baby's days, school and athletic events with my older child, holidays, parties, barbeques due to this. I can assure you that when I am doubled over and in pain from this, I am not faking it.

It really upsets me when I read that drs/nurses assume people are faking it. At times I thought my ob thought I was faking too (Especially when I asked him to up from 10 to 15 and he rolled his eyes). Till I ended up in the ER last month bawling because yes it was THAT bad. It felt like a knife stabbing in the lower right pelvic region. It was excruciating. It was worse than labor and delivery. Once that ER visit was done, we made the decision to do the surgery and find out what the heck was going on.

It took me a long time to get to the decision to do the lap. I wouldn't have jumped at it in January. As a friend of mine told me cause I am terrified of surgery, she told me I would know when the right time was. She was right. The period in August about killed me and I was out of town. Spent 3 days in bed in a hotel unable to do anything. Then the next one at the end of the month where my ob was out of town. Excruciating. I figure the pain of surgery can not be worse than what I go through every month.

That same nurse who was not compassionate saw me sitting at the table in the nurses area. They all know that is where surgery appts, etc are set up with the nurse. She got the ER report the next day.

Just please have some compassion. Some of us suffer from endometriosis. We are all not pill seekers. I don't even like to take the pills.

dr. whoo? said...

anon~ I'm sorry for what you have suffered, and forgive me if my tone seems without compassion. Please realize that this blog is an outlet for venting for me, and I certainly do not disregard patients with honest-to-goodness pain. I'm not speaking of women with endometriosis, or endometritis, or pelvic adhesive disease. As I stated in the post, if your pain isn't helped with anit-inflammatories, I proceed directly to diagnostic laparoscopy.

I'm speaking of narcotic seekers, and I see more than my share. Pelvic pain is exploited because it can exist without any visible cause; thus duping "compassionate" physicians for a short term fix. The ER visits are for tooth pain, headaches, abdominal pain, and pelvic pain. There is a recognizable pattern. I hope that you can be diagnosed, treated, and living pain free soon.

Anonymous said...

Thank you for your reply. I'm hoping to have an answer next month one way or another. I just wanted to say not everyone is like that. I would have been really upset and up a creek if the er dr didn't believe me. Fortunately she did. Course I offered up everything that had been done. I told her she could check the computer to see when I was there last (January). I was worried about even going in because the nurse from my own dr's office didn't believe me, why would she? She had my chart, charting it every month.

Anyway, thank you. I did send the ER dr a huge thank you note after I went back and saw my dr. I live in a really small town, so not to hard to forget different people.

Anonymous said...

Oh forgot to say, I have read through your entire blog and will keep reading!

dr. whoo? said...

anon~ You are welcome. I truly hope that you are on the road to recovery very soon. I wish you the best of luck, and thanks for reading! I'll be writing more once I'm back from vacation.