Sunday, February 23, 2014

Are You A Physician Or A Secretary?

I'm no economist.  In fact I have never taken any business or accounting classes in my life.  But it doesn't take a formal education to get this.  We are speeding down the wrong path.

The call at three in the morning woke me from a deep sleep.  I fumbled and strained to hear the whispered voice of the apologetic nurse.  Apparently Mrs. Thompson had scraped her arm against the wheel chair, and suffered a minor abrasion.  No harm, no foul.  Except that ever since the state had come in  and eviscerated the nursing home protocols, extra precautions were being taken.  Some things just won't be left till the morning anymore.

My early trip to the hospital was no better.  My personal assistant called to say that I had to re do the form to get one of my patients a walker.  Although I had signed it by hand, we had typed in the date.  Apparently the medical equipment company required that the date also be written in ink.  It sounds minor, but I had to find a fax machine, wait for the fax to arrive, write in the date, and fax back.  All, of course, needed to be done immediately.

Luckily my hospitalized patient was getting better.  And since it was neither an admission nor discharge day, I just might escape without wasting too much time on paperwork.  As I was putting on my coat, the head nurse stopped me in my tracks.

"I just need to notify you that your patient claims she is missing fifty dollars, and can you sign this form acknowledging that you have been informed."

What?  Since when did I become a policeman?  Since when did take charge of all criminal activities that take place inside the hospital walls?  

Healthcare is being overrun.  Government induced regulation and documentation are creating mental gridlock.  The dictates of our forms and procedures are tying up those with the physical and intellectual know how to care for patients.

Why can't you get an appointment with your doctor?  Why are diagnoses being missed?  Why is the quality of healthcare in the United States declining rapidly?  Stop querying big data and start looking at the hunched backs and sore shoulders of the people who are inputting that data.

We are turning our physicians and nurses into scribes, field workers, and secretaries.  Those who create the most value, who took the most time and money to train, are being overloaded with menial and level inappropriate tasks.

No small business would be naive enough to operate this way.

Why then, should one of the largest sectors of our economy.

Sunday, February 16, 2014


The drink you spilt all over me
"Lover's Spit" left on repeat
My mom and dad let me stay home
It drives you crazy getting old

Sometimes I pretend, in the moments before waking, that I am a child once again.  That instead of this old hapless body, I am unencumbered by the chains of longevity.  In these unconscious waves of semi reality I am unaware of the degraded muscle and brittle bone.  I jump up and down on the bed and than race out the door through the endless fields of corn.  My father, the stocky build of a farmer, runs after me.  Before his skin became old and sallow.  Before I watched them lower his body into the ground.  I was middle aged by then.

This dream isn't feeling sweet
We're reeling through the midnight streets
And I've never felt more alone
It feels so scary getting old

They are all dead now: mom, dad, my sister.  After my son died, they brought me to this place.  They thought that I was mute after the stroke.  I guess it had never occurred to all those doctors that I may not have wanted to talk.  And of course, if you don't speak, you must be stupid.  

The staff comes to my room and yells at me in loud, slow tones.  I stare at them determinedly but don't dare make a sound.  Who would believe it now?  I whisper in the midnight darkness to no one in particular, it reminds me that I am still here.

Everyone I know has died.  A hundred years of motion, it appears that my body doesn't know how to follow them.

I want them back (I want them back)
The minds we had (the minds we had)
It's not enough to feel the lack (I want them back, I want them back)
I want it!

The only one who comes to visit anymore is the doctor.  He clucks quietly as he examines my belly underneath the sheets.  I see the wrinkles.  The skin of his jowls hang down like mine.  He is the  only other soul in the building as old as me.  After he visits he asks the nurse to sit me up in front of the window.  I watch the cars slow down and the breaks lights before turning the corner.  

I am alone.

You're the only friend I need (you're the only friend I need)
Sharing beds like little kids (sharing beds like little kids)
We'll laugh until our ribs get tough (We'll laugh until our ribs get tough)
But that will never be enough (but that will never be enough)

That will never be enough
That will never be enough
That will never be enough
That will never be enough
That will never be enough 

*Lyrics courtesy of Lorde, from Ribs

Saturday, February 8, 2014


The first thing I become cognizant of is motion: the beating of the heart, the contraction of the muscles as I place the phone back onto the base or into my pocket, the shallow breaths that willow past the lips.  Only then do I contemplate notifying the family and giving my condolences.

Death has followed me from childhood.  Not as a specter lurking in the darkened corners but more like a willing companion in a yet undisclosed game of strategy.  And as far as professions go, there is a false intimacy in doing what I do.  To experience the aftertaste of mortality on such a regular basis without partaking in the bitter nectar, to place the little white cancer stick to ones lips and yet never inhale.

We are disconnected, I and those I tend to.   It is never so apparent than in those seconds after the last breath is taken.  There is a undeniable stillness in death. Anyone who has been present in the moment immediately can tell the difference.  There is a transition from the living, breathing, and circulating to inanimate object.  No matter how much we slow our bodies, blood still pumps, oxygen exchanges, and diaphragms pull down.

We look to the ephemeral, talk of such things as spirit and soul.  I am at a loss in such conversations.  Because as the warmth returns, I take a deep breath and make the phone call.  I stumble through the words I have mumbled so many times.

I am so sorry for your loss.  It was an honor and a privilege to take care of your loved one.  If there is anything I can do to make this better..

But in reality my oft repeated words carry a certain hollowness.  In an ocean of uncertainty they are merely tiny flecks of wood bobbing up and down in the great vastness.

They are utterances, vocalizations, vibrations that remind both speaker and listener that we are not yet standing upon the abyss.

They are motion.

Sunday, February 2, 2014

I Did All This

Home visits are hard, there is no doubt about it.

I felt like I had been driving for hours.  The thirty minute travel time showing on my GPS was woefully understated due to the arctic temperatures and colossal snowfall.  My jacket and clothes felt caked with dried salt rubbed off from the car or somehow accumulated from the ether.  I pulled the key out of the ignition and braced for the subzero temperatures.  My bag, recovering on the passenger seat, was bulging with equipment: stethoscope, blood pressure cough, prescription pad.  The edges of the satchel were frayed from being inebriated  with excess.  My first month into the new practice, I was unsure what I really needed to bring.  Should I take the EKG machine every time?  What about the printer?

I was lucky to have found the house in the first place.  Tucked between a driveway and a bunching of overgrown trees, my GPS had to rejigger three times to deliver me to the wrong side of the culde-sac.  The glory daydreams preceding the start of this practice receding, I hunkered down to the business of building a business.

Thankfully, the kindly face that opened the front door was a familiar one.  I had come to the right place.  I knocked the snow off my boots on the cement ledge before walking into the warm confines of the house.  After a few pleasantries, I opened my bag of wonders, took out the computer, turned on the wifi hotspot on my phone, and produced a pile of documents that needed to be signed before any clinical visit could begin.


My hotspot was malfunctioning.  My MacBook couldn't pick up the network.  Anxious to maintain composure to the innocent patient who had graciously signed on to continue under my care,  I made small talk as I nervously refreshed the network button.  Two, three, four luck!  I was going to have to do this one blind.

I stared blankly at the computer screen, and than turned my attention to the patient sitting in front of me.  The encounter was more stressful than I had planned.  Without access to my medical record, I had to piece together a med list and clinical information.  Upon finishing my exam and doling out a few prescriptions, I apologized for my technical difficulties.

He assured me that it was no problem.  Everyone had mobile issues in his area.  It seemed that the thick air smothered the hubris of technology.  My head hung low as I gathered my things to face the cold air and blowing snow.   I felt the wind had been stolen from my sails.

As I reached out for my coat and shoes, my patient pulled me aside.

Here, come to the basement, I want you to see this.

He raced down the stairs forgetting that he had the knees of an octogenarian.  I followed in slow motion trying to keep up with this suddenly invigorated senior.  When I got to the bottom, it took a moment to adjust to the brightly lit studio.   The basement was filled with beautiful landscapes, oil on canvas, water color, mixed media.

All the sudden, looking a few decades younger, the old man stared at me.  His eyes were laughing, speaking without words.

I did all of this!

And indeed, I thought to myself silently,

so had I.