ARCHIVES - 1996 to FOREVER

Beautiful weather-wise, of course, but who has time to enjoy? Not me, I'm too worried about tomorrow, which is pretty damned silly.

Too many patients to enjoy, I'm afraid. Can't enjoy a good patient relationship when the premium is on... getting the patient off of the table and the next one on. I try really hard to give each patient something, a touch, a word, a smile, whatever it takes, to make their visit a little less ominous, a little more friendly, just something between them and me.

And I really can't do that with the pressure that's endemic right now.

"Hi, my name is Doug, I'm gonna do--- and you'll feel this when I do that, you might have some loose stools from the drink that I gave you, thank you, have a nice day."

All that I can afford to give them is the bare minimum, and I really hate that. I have a lot more to give to my patients, these people who are worried about their health, about their very lives. A lot more.

But no time, no time.

Gotta get that next patient on the table, gotta keep up with that schedule. Gotta get the ER patient done, they need a diagnosis pronto. They are our number one priority.

A doc calls. Why isn't his patient done? That should be our number one priority.

The floor calls. Why isn't their patient done? The doc is waiting for the results. It was ordered STAT. That should be out number one priority.

The interventional radiologist calls. Why isn't his patient done? That should be, as usual, our number one priority.

Sorry, folks, somebody has to go first, someone has to go last. I've gotta set the priorities here, dammit. Everyone wants their patient to be next, and I've gotta figger out which one it will be. And I have to use my own best judgement, knowing that I will be castigated by everyone in the chain that isn't chosen.

Well, fuck them.

If they wanted their patient to be done first, they should have ordered it sooner.

I have to do the triage, me and my co-workers, and unfortunately, the squeaky wheel, well, they get the grease.

But not always.

We, after all, are in the business of saving lives.

Very peripherally, but still, that's what we are doing.

And I figger that the patient who needs a study done for a pulmonary embolus has priority over a patient who possible has appendicitis, even if the surgeon is standing in the ER waiting for his patient to be done. That's really hard to explain to the surgeon, whose billable time is like a thousand dollars an hour. But sorry, the patient who had a total knee two days ago with shortness of breath and a DDIMER of 1300 is gonna get done first.

And when we get written up by the surgeon?

We take the fall, yes we do. Simply because the PE study was negative and the appendix study wasn't.

And this is not just something that happens occasionally, it happens on an hourly basis.

And it takes it's toll, yes it does.

Every decision that we make has the potential to get us fired, quite literally.

And a hundred times a day, we make those decisions.

I just thought that you all might like to know why I'm bone weary all of the time. It's not really the physical work, although that is a factor. It's quite simple the stress.

And the stress isn't really knowing that we can get fired for a bad decision, no, it's because someone could die because they didn't get the proper diagnosis in a timely fashion. The ER patient with the surgeon standing by? They could burst that appendix and have a fatal reaction to the drug used to control the infection, and that would be on my head. Because I chose to do the PE study on the orthopedic patient instead of doing the appendix study.

No, I don't have to do this. But I love it anyway. And I wish that I could do it forever. But the toll....

No, I just want to have my little wood/work/shop, and do stuff that doesn't involve the course of human lives.

And I'll be there in seven years, yes I will.