April 23, 2009

Working day 9 out of 11.

On "phone calls" from Sat am to Mon am, 48 hours, considered "easy" call. Really it isn't because sleep gets disturbed, but obstetrics heated up too. Had one in house in labor Friday (Friday was working day 4) and admitted another to rule out preeclampsia. Bedrest and labs and started the 24 hour urine, called perinatology. Ran back and forth between clinic and labor patient and finally cancelled last clinic patient. Got to go eat with kids and went to a dance thing for an hour, then called in. Baby out around 1 am. After baby ok I sat down in OR to wait until C/S done and kept falling asleep, sliding down wall. Got to bed at 3. Woke 8 when phone calls started. Rounded in early afternoon, made plan on the other lady, not preeclamptic, gestational hypertension, discussed amniocentesis since her dates were not so good (24 week ultrasound, presented at 23 weeks) verses in or out patient bed rest. She went home with amniocentesis coordinated for Monday with Dr. H, ultrasound and lab.

I was not driving well by late Sat, so called for help and checked out phones to PA and obstetrics to Dr. H (She'd seen me falling asleep) and slept Sat night. Played music at the two church services on Sunday, exciting, and then beeper back on at 1 pm. Somewhat disturbed sleep on Sunday with phone calls. Another of my patients had a scheduled c/s at 8 am so I was there at 7:30. Baby a rose, fine. Then we tried to do the amnio, not enough fluid. IV hydration started and I checked out again at 10 am to actually start my day "off". Did some shopping therapy and got some sun, lunch outside. Amnio still wouldn't go later that day. She went home again.

Rounded on moms and babies Tues and then busy clinic. Didn't run horribly late. Had some lunch meeting, don't remember what, set pager for 20 min into it so alarmed and I could leave and eat in blessed peace. Didn't get many charts caught up on over the weekend what with phone calls and ob, so sent email to Partners-That-Are-Attempting-To-Be-Supportive explaining why I hadn't gotten caught up much and saying if they wanted to go to admin to get me a day off to do charts, was now fine with me. Also that I thought it was a catch-22 that we have the stone-ax EMR (electronic medical records) so that we can get the charts done in the room, but with the visit time lowered, I can't actually do it or if I do we run really late. Accumulate 3-5 min per patient and then see a zebra. Dang. Only one of the 3 partners replied, the one who will actually stand up. He sent reply to admin. They seem to have been taught in admin school never to answer ANY question that I've asked on email or voice mail for the last 9 years and 3 months. Think I'll take a voice recorder to next meeting and see what they do. COO had asked for suggestions on how they could "help me catch up" besides letting me see less patients or have a paid day where I did charts, had emailed 7 suggestions including could we please have a call room as we are not supposed to sleep on the patient beds, but reply? Nada.

Tuesday started with 7:30 meeting with coding auditors. Resent coming in at 7:30 when they will dock me leave if I leave 20 min before the end of the day. Also call does not count, ever. Auditors actually helpful. No one is coding enough level 5s. They think we're doing them. To my great joy they said that the bad part about EMRs is that without a typed narrative, the charting sucks. Hooray! I've been saying that for three and a half years! Met with them one on one at 4 and was told my charts are excellent because I avoid the templates as much as possible and type a narrative and they can follow the logic. Yee-ha. I have bent the damn EMR to my fierce will. Only took me three years. Billed one obstetrics patient wrong and they said one was undercoded. Next day coded a level 5.

Busy Wednesday and at very end of day, note from COO about agenda for tomorrow. Apparently they don't like me telling patients that I don't think congress should require us to see 18 patients a day. Apparently upsets staff and colleagues. I need to cease and desist and they want my plan for how I will build to 18 patients a day if indeed I accept the organizations rules. Seems like an implied threat to me. However, since the other obstetrics docs really need me since the call is killing them, don't think they'll fire me. Called Dr. P who is coming to meeting as my handler. Promised to look like Medical Borg, will wear easter egg yellow suit. Demure and 1940s, skirt below knees. Will bat eyelashes and say how I understand the hospital's position and I will stop making the suggestions by email that they asked for and will discuss all of the many things I have done to try to achieve compliance with 18 a day. (Hope to see 18 a day the day before I retire and not until then). Plan to ask for some family medical leave since that seems to be what people want. Ok, fine. COO says I need to treat partners and admin with respect, I will point out that the provider meeting two weeks ago where I was the only one among six people who did not know that I was on the agenda and it wasn't written down felt rude, crude and disrespectful, thank you very much. Resembled alcoholic intervention. Gosh, I drink an ounce or two of wine at least two nights a week. Jerks.

So have 15 on the schedule today, with three openings on the schedule this afternoon. If they fill them I'll be late for the meeting. Would not bother me very much, I have to say. Me, my family and the patients come first, damn it.

Bottom of the Ninth, Trailing 3-1

April 21, 2009, Coastal Carolina at Clemson

It's the bottom of the ninth inning with the home team facing their last chance to make up the two run deficit the visitors put up in the eighth. It has been a close game with both teams allowing scoring opportunities to pass without issue. The teams are evenly matched, with the home team ranked 20th and the visitors ranked 19th in the same national poll.

The starting pitchers did well. The home team's right hander Graham Stoneburner gave up one unearned run on five hits with five strikeouts in six innings. Hessler had done as well for the visitors, allowing only one run, also unearned, on two hits in five and a third innings. In relief, the visitors' lefty Rein kept the home crowd quiet by allowing only two hits and no further damage through the eighth. Ryan Hinson came in and was doing his job well for the home team, retiring the first five he faced, but then gave up a single followed by a homer to give the visitors a two run lead after eight innings.

In the top of the ninth, Clint McKinney came in for the home boys. The sidewinder righty struck out the side, allowing one walk, to get his teammates their last chance. But the visitors are bringing in McCully, their right handed closer, and look at the numbers that pitcher has put up this season: a 1.02 ERA, with three wins, eight saves and 34 strikeouts in nineteen relief appearances! The fair weather fans in the crowd have given up and left the faithful few to sit with waning hope.

First up is left fielder Wilson Boyd, hitting fifth in the line-up. The junior left hand batter has been hitting about .250 all season, but he is not having his best outing tonight, batting 0 for 4 so far, and failing to get the bunt down on a suicide squeeze in the sixth inning, leaving Ben Paulson a dead duck half way between third and home. Wilson also made the error that allowed the first opposing run to score in the top of the sixth. Boyd quickly flies out to center field on a 1-2 count. One out.

Next up is righty Brad Miller, the freshman shortstop. Brad is hitting .270 for the season and is 1 for 3 tonight. After looking at strike one, he lets two balls go by, fouls off strike two and looks at two more balls, earning a walk. One out with a runner on first. Batting in the seven slot is senior third baseman Matt Sanders. The right handed batter is having a good season, hitting .340. Sanders swings at the first pitch and gets a solid single to left field. After a brief consultation, Jason Stoltz takes Sanders' place at first as a pinch runner to gain a little speed on the bases. Runners at first and second, still one out.

Next in the line-up is Phil Pohl. The freshman catcher has been a defensive hero so far in this game. In the third inning he guarded the plate from a runner trying to score from second on a single to center field. The runner got there before the ball, but he bounced off Pohl like he'd hit a brick wall. Phil made the catch and tagged him out. Then, in the fifth, after a lead off triple and one out, Pohl again saved a run when the batter laid down a squeeze bunt back to the pitcher. Stoneburner fielded it cleanly and flipped it back to the waiting catcher for the out at the plate. And in the sixth inning, after Boyd dropped a fly ball in left to allow a run in, Pohl threw out another runner trying to steal third base, thus holding the damage to one run. But Phil is batting under .200, bats right handed, and does not have great speed. The situation is critical, so Coach Leggett decides to put Chris Epps in as a pinch hitter.

Epps is a utility outfielder in his sophomore season. He's only hitting .211, but he bats from the left side, is quick as lightning, and he has been showing great plate discipline lately as a pinch hitter, regularly drawing walks. Chris quickly gets a three ball count and watches strike one. After fouling off strike two, he fights off two more strikes with well placed fouls, then it's ball four. It's a great at-bat for Epps and now the bases are loaded.

Batting ninth is Addison Johnson, a redshirt sophomore center fielder who sat out all last year with a wrist injury, then pulled a hamstring in March and is only now getting his speed back. AJ is a great center fielder, but has been really struggling at the plate all season, hitting a paltry .225 from the left side. Johnson strikes out swinging on four pitches. So now the bases are loaded with two outs.

Sophomore Jeff Schaus platoons in the outfield with Boyd, but is the designated hitter tonight. This is only his second game starting in the lead off spot, where no one has seemed to settle in and get the job done this season. Jeff has been batting right around .300, with six home runs on the season. Today he is hitless in four attempts, but reached on an error and scored his team's only run so far in the third inning. When he steps into the left hand batter's box the only thing he is thinking about is a fastball. And here it comes. The first pitch. Big, fat, juicy, looking as big as a grapefruit coming right into his wheelhouse. He swings.

There is not much in baseball that can compare with a walk off grand slam home run. The ball flew high and long and deep over the right field fence. The remaining fans leapt and traded high fives and hugged with joy. The entire team met Jeff Schaus at the plate as he completed his circuit of the bases. And for a brief moment, all was right with the world.

Yesterday was my birthday. People at the office expect people to bring in birthday treats. Half the girls in the office are on diets so I thought that bagels would be good. The bagel place is not far from where I work. I stopped at the ATM to get some cash. This cute girl was walking up to the door at the same time I was. You know how some girls walk and some girls move their hips as they glide past you? This girl was the hip gliding kind. I wanted to get close enough to smell her shampoo but I didn't want her to think I was some creepy parking lot stalker. Her hair was down around her shoulders. She kept flipping it back. Why do women with long hair play with it so much? The other thing I was wondering is what she was carrying around in her big ass yellow purse. It looked new and I thought about asking her about it but I knew if I asked she would give me the look and tell me that she'd had it forever.

Standing in line with women is tough for guys like me. I want to talk to them but I don't want them to think I'm trying to hit on them even if I am. And not to put my own spin on things but why do women dress like that if they’re not out to pick up guys? The girl in front of me was doing the hair flip thing, she was standing closer to me than I thought she would. I kept picking up signals from her but I was also getting a big 'don't stand so close to me' vibe. Finally we got to the counter. It seems to me like women should make up their minds about what they want while they're in line instead of talking to their friends on their cell phones like the chick in front of me was. Her voice was low when she ordered tea and a pumpkin muffin. I was standing right behind her and I could hardly hear what she was saying. Half the time I was trying to hear what she was saying, the rest of me was checking out her ass.

Some girls wad up their money. I'm an insurance agent so that bugs the hell out of me but this girl had it all put together in her wallet. I think she must come here a lot because the people behind the counter were talking to her like they knew her. For a while I listened to the classical music playing overhead. The girl behind the register wasn't bad looking but she didn’t have the same whatever you want to call it that the chick in front of me did. I caught a glimpse of dark brown eyes. I'm colorblind in one eye so some colors look off to me. The girl was getting ready to pick her order up. My plan had been to get some juice because my throat was sore when I woke up. The girl in front of me pulled some napkins out of the dispenser. Her hair swung towards me as she picked up her bag.

Running for the door cost me my spot in line. I don't think the girl in front of me expected me to grab it for her. I like it when girls wear v necked shirts but this girl looked cold instead of sexy. I heard her cough when I stepped back. I felt kind of bad for her because it was friggin' cold outside and she had been coughing when she was on the phone with her friend. I stood there for I don't know how long holding the door for some chick I didn't even know. Today I ordered tea and a muffin instead of juice and a cream cheese bagel. I sat by the door and I waited for the longest thirty minutes of my new life but I never did get to see the girl I saw yesterday.