"I need to go"

"I need to go...Joe and the boys are waiting for me"

I looked up from the computer as one of my nursing home patients zoomed past with a veteran nurse running behind her. The nurse's brow was sweaty and she was huffing to keep pace. Her barely perceptible limp a remnant from a distant ankle fracture she suffered one late night while on duty.

"Sarah....Sarah...Joe is gone, he died long ago."

Sarah stopped in her tracks as her face momentarily hardened and then became blank.

"The boys...I have to get to the boys!"

The nurse was now sitting. She sat with her ankle up on a chair and looked over with both sadness and exasperation.

"They're dead...they all died before you came here".

Again Sarah paused. For a moment you could see the realization enter her face. She lifted both arms and gently cradled her own head as if in slow motion.

"OK then.....where's Mary?"

Mary, her sister who had lived with her in the nursing home until just a few weeks prior, had died quietly in her sleep.

The nurse was now back on her feet and held Sarah's waist and started to walk her back to her room. Her voice almost a whisper.

"Mary....Mary," you could see her take a moment to think it through, "Mary died".

Sarah's stooped posture jerked upright. A look of anger entering her face as she shrieked,

"Mary is not dead!"

A certified nursing assistant hearing the commotion jumped from an adjacent chair and lunged forward as the nurse began to talk again.

"Of course she's dead...I took you to the funeral!"

Sarah was now thrashing..pushing away restraining hands.

"You lie...I did not go to her funeral...I did not go to her funeral!"

Multiple nursing home staff closed in and gently guided Sarah back to her room.

The nurse came out a few minutes later and limped toward me. As I stared I felt both annoyance and great compassion . She was now sweating profusely and her gait abnormalities had become more prominent.

She crumpled into the chair next to mine and sighed loudly. A few moments later we both shuddered as the door flew open and Sarah burst out of the room in full sprint and ran toward the door...

"I need to go....Joe and the boys are waiting for me!"

On Being A Doctor/Father

It takes its toll on me...this being a doctor....I think as I wait in the Indian restaurant buffet. My son is curled on my lap. Uncharacteristically tired...later he will develop a fever and I will realize why he is so warn out.

It takes it toll on me. I wouldn't say I am a stressed out person but I certainly live with stress. Most of it is self inflicted.

It's just that I can't help feeling responsible. For those few thousand people who have placed their lives in my hands. I know I am not god. I know that Doctors can only do so much. But that doesn't stop me from worrying.

It doesn't stop my mind from racing at night as I pour over the problems of the day. And it doesn't stop the guilt. Every time someone gets sicker then expected. Every time someone dies. And boy do they die. All the time.

I guess that's what happens when you take care of people in their eighties...and nineties...and hundreds. And when you spend a lot of time in nursing homes.

I always ask myself what could I have done different. How could I have been better. Was I enough?

Mostly the answer is yes. Occasionally the answer is no. But I always ask the question.

It takes a toll on me.....the stress. The sadness. And sometimes I wonder what this is doing to my mind. My body. Am I causing in myself that which I spend so much time fighting in others. Will the stress raise my blood pressure. Clog my coronaries. Herald in a major depressive episode....uncontrollable anxiety.

But how can I complain. My life has meaning. I struggle daily with the essence of life. And I get paid a comfortable salary to do so. I get to help people....at least when things are working at their best. I get to reach out to my fellow man.

And I get to do it on my own terms. I work when I want to work....and rest when I want to rest. Sure I spend my share of weekends and nights. But I am usually home by 4pm...no later then 5.

I can count the number of times I have missed dinner with my children on one maybe two hands...ever. I am present. I put them to sleep at night. I see them on the weekends. They know me. They love me.

And maybe that's worth it. The stress...the worry. The physical and emotional burdens of this lifestyle. Maybe its worth it because it has afforded the ability to be there. For my children. For my wife. Such that my son will walk over to me when he is hurting.

He will climb up on my lap. And place his head on my chest. And he will feel safe.

Because I am always here.

Of all the things this profession has allowed....

It allows me to be present.....

In my families life.

Why I Feel Shame

Why I feel shame:

1)Because every damn health care article I read somehow finds a way to quote "To ERR Is Human"

2)Because every discussion about torte reform ends up being a soliloquy about those "Bad Doctors".

3)Because every year a new governmental regulation adds a new piece of paper I have to fill out or a new computer screen I have to click through to do my job. Now to discharge a patient I have to fill out three separate forms. Last year it was two. The year before I could give a verbal order (the quality of care has not changed).

4)Because the government gives lip service to improving primary care but just doesn't get it. Now to get home health for my patients I have to fill out even more paperwork....this is not stopping people from using home health inappropriately.....it is just taking up more of my time.

5)Because when I send my patient to have a swallow eval, the speech therapist sends them to a pulmonologist for their cough, and then the pulmonologist sends them to a neurologist for their dizziness. And after thousands of dollars of workup the specialists come to conclusions that I had already told the patient and documented in the chart but no one took the time to ask me because what does a primary care doc know anyway?

6)Because for some reason when patients get sick and die the first question society asks is....Who messed up?

7)Because sometimes I get so involved in using my emr, figuring out eprescribe, or making sure that I have documented correctly for billing purposes that I don't "hear" what my patient is so desperately trying to tell me.

8)Because sometimes, god forbid, I am having a bad day and may not perform to my peak level....somehow that doesn't feel OK anymore.

9)Because I am deathly afraid of my government...breaking down my doors, looking at my records, and asking for money back. Even though certified coders themselves rarely agree with each others findings.

10)Because I used to practice under the assumption that I was being look at under a microscope...now I feel like I am practicing under the gun.

11)Because I secretly worry....that with all the doctor bashing and painting us as knaves in the media...one day a disgruntled patient will walk into my office with a gun and start shooting.

12)Because I went into this profession with such pure and innocent motives...

I wonder how it all became so convoluted!

The Way I See It

See A piece I wrote for Medical Economics Feb 25Th issue. The Way I See It (page 86).