All new inventions start with fledging prototypes fraught with flaws. With time and innovation they can evolve into the “must-have” televisions, smart phones, and iPads of today.
Take, for example, the first Model T. The earliest cars had radiators that froze and exploded in the cold of New England winters. Treadless tires got stuck in March mud and popped regularly from the rocks of country dirt roads. When the auto traversed steep hills, the gas choked off, and the car sputtered to a stop. In short, these early “Tin Lizzies” left many horse-and-buggy owners shaking their heads and saying, “I’ll stick with good ol’ Bessie, thank you!”
Thankfully, after a century of innovation, we now enjoy reliable Toyota Camrys and Honda Accords, and except for the Amish, no one relies on horse-and-buggies anymore.
Remember the party telephone lines of the 1960’s where nosey neighbors listened in on your phone calls or demanded you get off the phone because they had an important call to make? (True confessions: as a little girl, I used to listen in on the neighbor’s phone calls for entertainment! Eavesdropping was fun!) Now I own a smart phone with applications that can direct me to Las Vegas or count my calories!
Did you know Orville Wright’s first Kitty Hawk airplane flight lasted only 12 seconds and soared a measly 20 feet off the ground? Now planes fly at 550 miles per hour at an altitude of 35,000 feet! We’ve come a long way, baby!
Except with Electronic Medical Record (EMR) software.
In 2013, the Rand Corporation performed a massive study of physicians across America and were surprised to discover the number one complaint of American doctors was not their pay, not their long hours, not government mandates, not threats of lawsuits, or even difficult patients. It was their EMR!
And here’s the rub: As of January 1, 2015, Medicare is now paying physicians who still use paper charts (such as myself!) 2% less than those who have converted to electronic medical records.
Not one to willingly throw away 2% of my salary, I recently performed an E-X-H-A-U-S-T-I-V-E search of all available EMRs. I came away disgusted. Why? The currently available programs are still at the level of Orville Wright’s first wobbly Kitty Hawk flight. As I checked out one EMR after another, I kept hoping I’d find “the one”—like a woman finding her soul mate through e-harmony. But so far, all I’ve done is kiss frogs! For example:
E-clinical Works: Too expensive. The 2% penalty costs less than this pricey EMR.
Athena: Since I was friends with two internists whose large medical group had recently chosen Athena, I decided to spare myself the misery of a pushy salesman and call my friends.
“I HATE it!” Dr. Johnson said. “I have to click on a zillion boxes and templates just to document strep throat. My fingers literally ache at night. It takes forever to document the simplest of problems. And a new patient? Pfft! Takes me an hour and a half! Whatever you do, DON’T GO WITH ATHENA!”
Maybe she’s just not tech-savvy. I’ll call my other doctor friend…
Unfortunately, her assessment was even worse! She whispered conspiratorially, “We call Athena the ‘Doctor Killer’ around here. Since management forced us onto Athena, three of our older doctors prematurely retired. Dr. Jones got so frustrated, he flung his computer against the wall and stormed out sputtering, “Life’s too short to put up with this!”
O-kay! I quickly scratched Athena off my list! With a daughter to fund through college and vet school, there can be no early retirements!
Amazing Charts: Amazing Charts got high ratings in my research for being user-friendly. Better yet, my new nurse practitioner used it for four years at her previous job and didn’t hang herself in the broom closet. That’s a good sign, right? Optimistic, I set up a one-hour demo.
Less than five minutes into the demo I found the fatal flaw: a registration process that would force my receptionist to key in all the patient demographics, instead of allowing the patient to enter the data using an iPad (if they were able to do so.) Thus, my already overworked receptionist would now be required to transcribe all the names, addresses, phone numbers, social security numbers, e-mail addresses, and insurance cards amid answering the phone, scheduling appointments, checking patients in and out, and fending off phone calls from PESKY EMR salesmen who have sniffed out a potential victim. “Why would I sign up for an EMR that ADDED to my receptionist’s workload?” I griped to the salesman.
“Yes, that’s the biggest complaint we get from our doctors…” he conceded.
“Why don’t you fix it?” I asked.
“We’ve been swamped with ICD-10 coding changes and government Meaningful Use mandates,” he replied lamely.
Swell! So the government is happy, but the doctors who pay for the EMR are miserable! Thanks, but no thanks! I’ll check out another EMR.
Kareo: Kareo has ads everywhere touting its virtues, and unlike E-clinical Works, Kareo is affordable. Encouraged, I signed up for yet another one-hour demo. Within minutes, I located the first fatal flaw: To get to a symptom template, I couldn’t just type “weight loss” or “tendinitis” into a search bar. Kareo expected me to scroll through an entire alphabet of medical symptoms (about150!) before I finally reached my desired template. Imagine having to do that 20-plus times a day! It would be like going to Amazon’s website to buy a book, but instead of typing “Wuthering Heights” into a search bar, you have to scroll through the entire alphabet of available books before you finally get to the “W’s.” How many books do you suppose Amazon would sell if they forced their buyers to put up with such a cumbersome design? But that’s what Kareo expects us doctors to do!
When I asked the salesman why their templates didn’t have a search bar, his sheepish response? “Yeah, that’s the biggest complaint we get from our doctors…” You think???
“So why don’t you fix it?” I demand.
You guessed it—government mandates and ICD-10 are taking up all their time! I ended the call frustrated. What about Practice Fusion?
Practice Fusion: This software is free (which I like!) but loaded with ads from drug companies (which I don’t like!) Can you spell TACKY? Worse, in 2012, the company extracted the e-mail addresses of the patients in the EMR and sent out physician evaluations that the doctors knew nothing about! Imagine discovering your EMR vendor sent out emails to your patients IN YOUR NAME and you knew nothing about it! Way to build up doctor trust!
I won’t bore you with the inherent flaws of the other eight EMRs I’ve checked out. I’ve about decided my true calling may be EMR tester—like Good Housekeeping test kitchens home economists that check out blenders or toilet cleaners. I seem to have an uncanny ability to find what’s wrong with an EMR in twenty minutes flat!
I’m not opposed to EMRs. In fact, I WANT to buy one! I’m tired of my basement looking like an episode of “Hoarders.” (Physicians are required to keep the record of every patient for 10 years.) I’m tired of losing 2% of my salary just because I still use paper records. But I won’t commit to a half-baked product that wastes my time or costs a fortune. Thus, I will check out EMRs again in a year and hope the “Tin Lizzies” have evolved enough to not drive me into early retirement!
What is the number one complaint of patients about their doctors? Their miserably long wait time. “Why can’t you doctors stay on schedule?” an angry patient once hurled at me.
Why, indeed! Yes, in a perfect world, I would see patients in a timely manner. But here’s a typical Monday morning:
8:00 AM: The first patient no-shows.
8:15 AM: The second patient no-shows.
8:25 AM: I glance at my watch and scowl. Where is everybody? “Did you forget to call and remind the patients?” I ask my receptionist. That goes over big! Tanya slams a chart on her desk and informs me with clipped tones that yes, all the patients were notified! I apologize for even asking such a ridiculous question and slither back to my office.
8:30 AM: Madeline Sorenson, the 8 AM patient, waddles in thirty minutes late, dripping with sweat, gasping for breath, and sputtering about the terrible rush-hour traffic. Instead of apologizing for her tardiness, however, she glares at Tanya as though it’s her fault I-40 is a nightmare every morning! Tanya politely asks Madeline to pay her $25 co-pay. Madeline slaps her forehead and says she accidentally left her pocketbook in the car. Interpretation? No $25 co-pay! Not unless we make her waddle back to the parking garage, thereby putting us further behind schedule. Since Madeline is 400-pounds, arthritic, and looking like she’s one step from a stroke after her hundred-yard hike from the parking garage, Tanya takes pity on her and hands her an envelope stamped with our address. “Just mail us your co-pay.” (We won’t hold our breaths, however, as Madeline is notorious for “accidentally” forgetting her pocketbook and “accidentally” losing the envelope she is handed.)
8:30 AM: Josephine Smith, a sweetheart from Kentucky, arrives thirty minutes EARLY for her 9:00 o’clock appointment because she allotted extra time. “I know how bad the interstates into Nashville get this time of day, so I planned ahead.” She hands Tanya a check to cover her co-pay without even being asked! She then offers up a bag of homemade blueberry muffins for the entire staff saying, “You all do such a marvelous job I wanted to do something nice for you.” We love Josephine!
8:30 AM: The 8:15 AM patient barrels in complaining about rush hour traffic AND the 95-year-old man in front of her in the parking garage. “That old geezer took forever to meander the garage corridors. I thought he’d never find a spot.”
8:30 AM: The 8:30 patient arrives on-time and with her checkbook, but then insists she has to be out by “nine at the latest” so she won’t miss her 9:15 Mammogram.
8:30 AM: An unscheduled patient shows up wheezing, coughing, and gasping for breath. She’s endured a severe asthma flare all weekend and from past experience knows she needs an aerosol treatment and cortisone shot ASAP, or she’ll wind up in the ER.
I groan. I now have five patients waiting for three exam rooms after twiddling my thumbs for thirty minutes!
Who do I see first? The 8 a.m., since she’s first on the schedule? The 8:15 because she’s the first to show up with her copay? Sweet Josephine Smith who is never late, always pays her co-pay, and comes bearing goodies? (Shouldn’t we reward good behavior?) Or, should I see the 8:30, who has to be out by nine or she’ll miss her Mammogram? And what about the patient who can’t breathe and is so wheezy she’s scaring the other patients in the waiting room?
I tell my nurse to bring back the asthmatic patient first (severity of illness takes precedence over schedules) and to prepare an aerosol breathing treatment and cortisone injection while I bring back the 8:30 patient so she can make it to her Mammogram. I will then see the patients in order of the schedule (which means sweet Josephine gets seen last, and late, irritable, co-payless Madeline gets seen first! No body said life is fair!)
10 AM: I’m now one hour behind schedule–in part because of my late start, in part because of the asthmatic emergency, and in part because Dorinda Cassidy, who was scheduled for a simple “Well-Woman check”, comes in brandishing a list with no fewer than ten problems to address. Well-woman, my eye!
11 AM: A pharmaceutical rep walks in. On hectic days like this, I normally would just sign for the drug samples, and the rep would leave them in the drug closet. As luck would have it, today she is escorted by her manager. Her eyes plead with me not to blow her off and say I’m too busy to hear about bladder control drugs. While I scribble my signature on the sample request sheet, I tell the boss what a fabulous rep Cassie is, and how I prescribe her drug all the time. “There’s no need to review the merits of Vesicare today,” I inform him, “because Cassie has done such a splendid job selling me on the drug at a previous visit.” She beams an appreciative smile, while I pat myself on the back for coming up with a way to avoid a mind-numbing, time-robbing dissertation about incontinence drugs.
11:30 AM: Jessica, a harried mother of three, is here for her yearly physical. As always, her cell phone is glued to her ear when I walk in the room. She acknowledges me with a smile and a nod but continues to blather away with her twelve-year old. She informs him, “I need to go. The doctor just walked in. Bye!…No, I won’t forget to pick you up after soccer….Wait! You need me to bring your sneakers to the practice? Did you forget to pack them in your backpack again? Nolan Fairchild, how many times have I told you to bring your sneakers on Mondays?” She sees me squirming in my chair and says, “Listen, I’ve got to go. The doctor is waiting.” She listens to another thirty-second pediatric monolog before adding, “Yes, I can bring you a snack…..I’ll bring you an apple.” More listening. “No, I won’t bring you Cheetos. How about a yogurt?”
I want to clap my hands and exclaim, “Yogurt it is! Now get off the phone!”
But no! They now discuss which flavor of yogurt! Raspberry or lemon swirl.
I’m an hour behind schedule, and I’m wasting time listening to the snack choices of a twelve-year old?
I stand up and head toward the door mouthing, “I’ll be back when you’re done.”
Jessica eyes my hand on the doorknob and holds up a hand in protest. “Dr. Burbank, wait! I’m done! I promise.”
Except she’s not!
She continues her phone call, only this time with more insistence. “I really do have to go, Nolan. The doctor is literally standing here and is about to walk out if I don’t get off the phone.” She listens to Nolan before adding, ”I won’t forget your sneakers and snacks, I promise.” She moves the phone to her other ear, listens a few seconds then shouts, “You got a D on your Social Studies test?”
Swell! That’ll be good for another ten minutes! I wave at her and whisper, “I’ll be back!” Outside the door I hear her shouting, “I told you to study those Civil War battle sites! I knew you weren’t ready for that test.”
Yup! It was one of those days.
11:40 AM: While I wait for Jessica to end her phone call, I’ll run see Alisha, a healthy college student, who is hopefully just here for a quick refill on her migraine medication. Maybe I can make up a little time. I walk in, but she doesn’t even acknowledge me. Her eyes stare like a zombie at her cell phone, and her thumbs text frantically. I say hello and ask how she’s doing, but she only grunts, and her thumbs continue to fly across her screen. I ask how the Imitrex is working for her headaches, but she’s too distracted to answer.
How rude, I fume. At least Jessica acknowledged I was in the room!
Finally, Alisha glances up glassy eyed and mumbles, “Oh, sorry! Did you ask me something?”
I repeat my question, but instead of putting her phone away, Alisha attempts to text and answer my questions. After every other question she mutters, “Sorry! Can you repeat that?”
Exasperated, I suggest, “How about you put that phone down for five minutes so we can complete your evaluation without distraction?”
Thumbs flying, eyes pasted to her phone she responds, “I can’t. This is really important. My niece just graduated from pre-K, and my sister needs to know today what I’m bringing to the picnic tomorrow.”
Right! And this momentous decision can’t wait five minutes?
I grit my teeth and make a mental note to tell my own college-aged kids to NEVER treat a doctor this way! Or anyone else, for that matter! I inform Alisha I’ll be back in ten minutes, once she’s done her can’t-wait text message.
I listen outside Jessica’s exam room and almost tap on the door when I overhear her still raking Nolan over the coals: “I told you to review those Civil war Generals, but you blew me off and wasted your night playing Minecraft. I am so taking that stupid video game away from you!”
Maybe I should examine the last patient of the morning while Alisha finished her text message and Jessica finished her tongue lashing!
At least Agnes wouldn’t be on a cell phone!
How do I know? Agnes was born when Woodrow Wilson was President, and she has the hearing of a tombstone! She owns expensive hearing aids but refuses to wear them because they squawk like territorial geese in a barnyard tiff.
12:45: While devoid of cell phones, my visit with Agnes is exhausting; I have to holler each question in a volume loud enough to make me deaf as a tombstone before she can hear me. Even then, her comprehension leaves a lot to be desired:
Me: “HOW ARE YOUR KNEES FEELING?”
Agnes: “My niece is doing well! In fact, she just graduated from nursing school.”
Me: “No, I said, how are your kneeeeees.” I point to my knees for emphasis.
Agnes: “Gloria doesn’t have knee problems! She’s fit as a fiddle.”
I inhale deeply and count to ten. Is Alisha done with that text message yet?
People wonder why doctors run behind? Now you know!
***All names have been changed to preserve patient confidentiality.
Barbara Jackson,* a pleasant woman with high blood pressure and diabetes, called my receptionist shortly after lunch one day and insisted she needed to be seen right away. “I look like Daffy Duck!” she insisted.
Sure enough, twenty minutes later, in rushed Barbara, her upper lip swollen to five times its normal size. She whispered to my receptionist, “Can you get me to the back quick? I don’t want people seeing me like this!”
I whisked her into an exam room and tried my best to act nonchalant so Barbara wouldn’t feel like a circus freak. After listening to her lungs and checking her airway to ensure she wasn’t going into anaphylactic shock, we dove into finding the culprit.
“Could you have been stung by a wasp or hornet?” I asked.
“If I did, I never felt it or saw the insect. Plus, my lips were fine this morning.”
“A new lipstick, perhaps?” I suggested.
She shook her head. “Nope. Same brand I’ve used for years! And no new toothpastes or mouth rinses, either.”
I pursed my unswollen lips in thought. Food allergy, maybe? “What did you eat for lunch today? Anything new?”
Barbara raised her palms skyward and shrugged. “Just my usual Yoplait yogurt and Wheat Thins. Trust me, I’ve racked my brain on the way to your office trying to figure out what caused this, but all I’ve come up with is a big, fat zero.” She formed her hands into a giant circle. “Nada.”
I drummed my fingers on the examination table, then suspicious, I flipped through Barbara’s chart until I came to her medication list. Bingo! There, staring me in the face, was Barbara’s culprit: Lisinopril–her blood pressure medication!
I glanced across the exam table at Barbara. “Did you by any chance take your Lisinopril at lunchtime today?”
She nodded. “Since I take my diabetes medications in the morning, I’ve started taking my Lisinopril at lunch.”
When I explained my suspicions to Barbara, her brow furrowed. “But I’ve taken Lisinopril for years! Why now?”
“I know it seems strange, but angioedema can occur months, or even years, after the drug is started. It’s an idiosyncratic reaction.”
“How weird is that?” she exclaimed.
How weird indeed!
Lisinopril is an “ACE inhibitors” and is commonly used to treat high blood pressure and congestive heart failure. It has even been shown to reduce the risk of kidney damage in diabetics. Because of its effectiveness and low price (FREE at all Publix pharmacies and $4 a month at Kroger’s), forty million Americans are now on ACE inhibitors. But the drug has two quirky side effects. First, it can cause a dry, hacky cough in 10-15% of patients. Second, it causes a weird swelling of the lips called “angioedema” in 1 out of every 1,000 patients. Interestingly, those of African descent have five times the risk of Caucasians. Laymen call the condition “Daffy Duck syndrome!”
In the five minutes it took to explain all this to Barbara, her lip had doubled in size! I hollered to my nurse to inject a large shot of cortisone and Benadryl. STAT.
I’ve only seen five cases of angioedema in my 26 years in practice, but it grabs my attention every time! It is also unknown why a patient can suddenly develop the syndrome after being on the drug uneventfully for months.
Thankfully, Barbara’s story had a humorous ending. Ever the comedian, Barbara decided to play a prank on her friends. At the end of our visit, she told me she was going to snap a photo of her swollen upper lip and post it on Facebook! She would tell her friends and family she had always wanted full, sexy lips like Angelina Jolie, and had seen an advertisement for a brand new dermatologist in town who would perform filler lip injections for half the price of other dermatologists! Barbara would pretend she was “thrilled” with her fully, seductive lips and see how people responded! “I’ll find out who I can really trust to tell me the truth!” she said laughing.
I predicted most would “like” her picture, but then insist on knowing the name of the dermatologist so they’d be sure to NEVER set foot in the place!
Thankfully, within a day of her cortisone shot and Benadryl, Barbara’s lips had returned to their normal full, but not clownish appearance! I can hardly wait to hear how Barbara’s Facebook friends responded. How many, not wanting to hurt her feelings, will tell her she looks great??? What about you? Would you lie to be kind, tell the truth, or say nothing???
*The name “Barbara Jackson” is a pseudonym to preserve patient confidentiality.
Below is a picture of Angioedema of the lips:
I had aced my three-month Pediatric rotation and devoured textbooks on effective child rearing. According to the books, disciplining children was a cinch: set reasonable and clear boundaries, use time-outs, and divvy out firm but consistent consequences mixed with encouragement and affection.
How hard can it be?
Now a self-proclaimed expert on all things pediatric, I confidently dished out parenting advice to frazzled mothers at the outpatient pediatric clinic. Some seemed one step away from dumping their kids off at the nearest orphanage. In my know-it-all tone I insisted, “Above all else, never, ever lose your temper and resort to spanking. Stay calm and in control. Remember who’s the adult,” I said, pointing to my head. The mothers all nodded and agreed as though I were Dr. Spock himself.
Thus, when I became pregnant, I knew my children would be well behaved, respectful, and nothing like the little heathens I saw acting up in church or throwing temper tantrums in the aisles of Kroger’s! My children would say, “Yes, Ma’am” and dutifully do exactly what I asked with adoration shining up from their sweet little faces.
When I actually had a child of my own, however, I wanted to SUE the lying authors who wrote all those useless parenting books—their advice proved nothing more than slicked up hogwash. Take for example:
Time-out: According to all Pediatric textbooks, spanking should NEVER be done. Use time-out instead, they insist. So when my 2-year old ran away from me in a busy mall parking lot heading straight for a busy intersection, where, exactly, was I supposed to DO the time-out—in the middle of said busy parking lot or intersection? I think not!
When Steven was around two, he sassed me big-time. Per instructions, I put him in the corner and told him he would stay in time-out until he apologized and showed some respect. While in the corner, he shrieked loud enough to make the neighbors need hearing aids. Per instructions, however, I completely ignored him—until he got so mad he ripped a large chunk of wallpaper right off the wall! He was reaching for another bubble in the paper when I dashed over to stop him.
What was the punishment for ripping wallpaper off the walls during time-out? Stick him back in the corner so he could finish the job?
I snatched up his naughty little flailing body and spanked him! Or tried to spank him! Steven had this annoying but impressive ability to contort his body like a circus performer, his arms fanned behind him like a shield, until my palm could never quite make contact with his rump. But hopefully, from the steam pouring out my ears, he knew I was mad. (As in angry, not insane, though he was rapidly pushing me toward the latter meaning!)
With my own words coming back to haunt me, (“never ever, lose your temper and resort to spanking”), the next time Steven sassed me, I decided to give time-out one more try. Maybe this time, it will work.
I put him in his bedroom and closed the door and informed him he couldn’t come out until he apologized. This time, he left the wallpaper alone, but in an act of defiance, slammed a toy metal truck into the wall above his bed and bashed in a large hole! I galloped in before he punched through the wall a second time. So what was I supposed to do now—put him back in time-out so he could turn his bedroom wall into Swiss cheese? And where was my husband when I needed him?
I picked up Steven’s rebellious hide, but yet again, my talented contortionist managed to twist and turn out of my grip, leaving my hand slapping at the air multiple times before I gave up in frustration. I gripped his arms, my eyes no doubt demonic, and informed him if he ever bashed holes in the walls again, I’d spank him even harder! My spankings were a farce, of course, but peering up at my venomous expression, Steven must have concluded he oughtn’t press his luck by laughing in my face. I then administered the real punishment: making him sit through a tedious dissertation on appropriate ways to express anger, with ripping off wallpaper and bashing holes in the wall NOT making the list.
Luckily, Nathan and I survived the terrible twos (and threes, and fours and fives) with only a couple more walls disasters. Just don’t ask us about Steven’s creative use of squirt bottle ketchup to add a garland to the Christmas tree…
When Eliza was born things spiraled downward into endless sibling squabbles—24/7— and about the STUPIDIST things: whether to eat at Burger King or McDonalds, who got to feed the kitty, and my favorite, who got to pull the lint from the dryer trap. Ever the diplomat, I suggested Eliza could pull off half the dryer lint, and Steven could pull off the other half. Sounded reasonable, except Eliza pulled off 75% of the lint, and Steven roared, “No fair! That’s not half! Mom! Eliza stole my dryer lint!” I wanted to scream and bang their heads together, but instead pointed out through clenched teeth, “What difference does it make? It’s just dryer lint! It’s all landing into the rubbish bin anyway!”
Odd/Even: Exasperated with my squabbling duo, I asked a patient of mine—a clinical child psychologist—what she recommended. She dished out the following brilliant advice: “Assign each child to either an odd day or an even day. If it’s the 3rd of the month, for example, the odd child gets to choose. If it’s the 4th, the even child gets his way. Makes everything fair and squabble-free,” she said, raising her hands skyward, a giant smile plastered across her face. I went home elated and informed my husband, “Our parenting nightmares are over.”
I explained the clever plan to my kids and waited for their enthused endorsement. Instead, the following conversation ensued:
Steven: “I’ll be even, and you can be odd. Even Steven—it rhymes!”
Eliza: “No way! Even begins with “E” and so does Eliza, so I should be even, and you can be odd.”
Steven: “No, it should be Even Steven and Odd Eliza.”
Eliza (arms crossed indignantly): “Odd Eliza? I’m not odd. Odd means strange. Like an oddball or weirdo.”
Steven: “Well, I’m not odd! You’re the weirdo.” He then pointed and taunted, “Liza is a weirdo! Liza is a weirdo!”
Eliza: “Mom! Steven called me a weirdo. Make him stop.”
I flopped my head into my hands. How had the best parenting advice ever degenerated into this? Then it dawned on me…maybe all wasn’t lost…
Perking up, I slapped my forehead with my hand and with a cheery voice said, “You know what? Mommy got it all wrong! It wasn’t supposed to be even and odd, ‘cause no body wants to be odd, it was supposed to be even and non-even days. And guess what? Today is a non-even day, so whoever chooses non-even gets their way today.
You guessed it—now they squabbled over who got to be non-even, especially after Steven pointed out that with 31 days in January and six other months, he would get his way seven more days a year than Eliza. That went over big…
My conclusion? Even the best parenting advice from America’s top pediatricians and child psychologists failed miserably for me. Time-out may work great for most parents, but if I’d continued with it, our house would have ended up condemned by the Health Department. And spanking proved more effective for swatting mosquitoes than punishing children.
Thus, I muddled through their childhood on a wing and a prayer and did the best I could, hoping I demonstrated by example how to become a well-adjusted, happy, caring, productive member of society. I prayed daily they didn’t end up serial killers or on the couch of some psychiatrist lamenting their dreadful childhoods and adopting Kelly Clarkson’s song, “Because of You” as their theme song.
Somehow both my children have evolved into wonderful adults, despite, and not because of, any great parenting skills on my part. I think my deep, unconditional love for them, plus a lot of fun and laughs and meaningful discussions along the way, must have atoned for my many mothering faux pas. It is written, “Love covers a multitude of sins.” Thank God!
If it hadn’t been for Abigail Norris RN, the patient would have died—in five minutes flat! All across America, experienced nurses oversee the hospital orders of newbie interns, and thank God they do!
On my first day as an intern, my overseeing resident, James, said, “I just want to make sure you know you should never, ever, under any circumstances, infuse more than 10-mEq of potassium chloride per hour.”
I stared at him, a tad insulted, and refrained from snapping, “Duh! Doesn’t every intern know that?”
Internal medicine 101: Infusing too much potassium chloride at one time will flat line someone’s EKG. We’re talking immediate cardiac arrest.
I informed my new overseeing resident that yes, I did know not to kill a patient by infusing potassium chloride too quickly.
Then James told me this harrowing tale: In July of last year, he oversaw a less than brilliant intern. Mrs. Smith came into the ER severely dehydrated after several weeks of severe diarrhea and vomiting. The woman’s serum potassium came back dangerously low at 1.8 (normal range is 3.5-5.0). James had methodically taught his new intern how to calculate the TOTAL potassium deficit using the woman’s weight, kidney function, and serum potassium level. “We’ll need to infuse a total of 100- mEq to get her potassium level over 4,” James explained. He then made the mistake of assuming the intern knew to infuse those 100-mEq over a minimum of 12 hours, monitoring her blood levels carefully.
Unfortunately, the less than brilliant intern wrote the following order in the hospital record: “100-mEq Potassium Chloride IV push STAT.”
Abigail immediately called the intern to question the order. “Do you really mean you want to give her all 100-mEq at one time?”
The intern insisted, “Yes, my resident and I calculated how much potassium Mrs. Smith needs to normalize her level. She needs 100-mEq.”
“But surely you don’t want to give it all at one time,” Abigail insisted. “You’ll flat line her.”
Besides being less than brilliant, the intern was cocky. “Look, just infuse it exactly as I wrote it,” he insisted. “I’m the doctor, and you’re the nurse. I’ve gone to medical school, and you haven’t, so do as you’re told!”
Fortunately, in her 20 years as an RN, Abigail had weathered her share of cocky and incompetent interns. Thus, instead of following orders as commanded, Abigail called James to double check the order. Since he was an excellent doctor, she couldn’t imagine he’d told the intern to write an order for 100-mEq IV push.
When James learned of the frighteningly dangerous order his intern had written, he nearly went into cardiac arrest himself! “Thank God you called! That would have killed her! I assumed he knew to never infuse more than 10-mEq an hour!”
“Afraid not, but since I’m just the lowly nurse who hasn’t gone to medical school, your jerk intern told me to just follow orders,” she couldn’t help but toss out, still fuming at the twerp’s condescending words.
James profusely thanked Abigail for using her excellent medical judgment and calling him. He apologized for his intern’s miserable behavior and promised to talk with him.
The next day, a shame-faced intern apologized to Abigail. Hopefully, he learned the hard way that an experienced RN is the best ally any doctor has.
This is just one example of the behind-the-scenes work that competent RNs do to save patient lives. Careless and dangerous orders are not infrequently written by distracted, tired, or newbie interns and doctors. Nurses work tirelessly to ensure quality and compassionate care, often while understaffed and underpaid. They are America’s unsung heroes. I, for one, will sing their praises!
Few patients—but every doctor—knows you should never, ever, under any circumstances get sick and go to the emergency room during the month of July.
Why, you ask?
The answer is simple: Interns! Medical students! Every July 1st, a new crop of green students is released onto the unsuspecting public to practice their fumbling skills for the first time.
Aren’t they trained, you ask? Well…I suppose if you call watching someone else performing a procedure as training, they are technically trained. But do you want your spinal tap to be the first attempt of an inexperienced medical student?
Trust me, you don’t!
How do I know? Because I once was that terrified newbie! With shaking hands and perspiring brow, I stuck a needle into the back of a man with possible meningitis. Unsuccessful on my first attempt, I had to jab the needle into his spine three times before I finally saw spinal fluid drip into the plastic tube. Thank God, I hadn’t hit his spinal cord!
I don’t know who was more elated—me, or the patient! The whole time I performed the spinal tap, I prayed fervently to God, Jesus, St. Frances of Assisi, St. Augustine, St. Raphael, and Mother Mary—and I’m not even Catholic! Had I known about Saint Anthony, the Patron Saint of Miracles, I would have added him to the mix.
Unfortunately, what goes around comes around!
My fourth year of medical school, in the month of July, I developed viral meningitis. I was so terrified an incompetent student would perform my spinal tap, I refused to go to the ER! My neck stiffened to the point where I couldn’t turn my head. My temperature hovered at 105 degrees. And talk about a killer headache! I knew I had meningitis, but I didn’t tell my husband, or he might drag me to the ER.
My efforts to fool Nathan failed miserably when I put away a sink full of filthy plates and pans—unwashed! I vaguely remember seeing the dishes in the sink smeared with spaghetti sauce and French dressing and wishing someone would deal with them…I have no recollection of stacking the sauce-smeared plates into the cupboard unwashed!
I learned of my minor mishap when I heard banging around in the kitchen, then my husband’s pronouncement of, “Gross!” He stormed into our bedroom and informed me of the dirty dish disaster. Hands on his hips he snapped, “That’s it! You’re clearly delirious. I’m taking you to the ER!”
“No!” I screamed, as though he had threatened to sell me into slavery. I refused to crawl out of bed. “It’s July! If I go to the ER, some incompetent medical student will do my lumbar puncture, and I’ll end up paralyzed for life.”
Okay, I was exaggerating, but it got his attention!
Unfortunately, Nathan was not as easily bamboozled as I’d hoped. “Sally, this is serious! If you have bacterial meningitis, you could die. We need to go to the ER and rule it out.”
“Forget it!” I snapped, rolling over in bed and pulling the covers over my head. I knew it was most likely viral meningitis because ten days earlier, a child with viral meningitis sneezed all over me. (I was on my pediatrics rotation.) Since there’s no effective treatment for viral meningitis, I saw no reason to subject my spinal column to the fumbling attempts of a greenhorn. Of course, if I’d been wrong and it really was bacterial meningitis…. I wouldn’t be alive to write this blog!
With grave reservations, Nathan tossed up his hands in defeat. “You’re the one with the medical training, so I’ll defer to your judgment.”
One might question how reliable the judgment of a delirious medical student could be, but I didn’t point this out to him!
Thankfully, even delirious, my judgment was correct–either that or Saint Anthony was looking out for me! Within two weeks, my headache, fever, and stiff neck were gone. But the lesson I learned that day remained—never get sick in the month of July!!!
Just when I thought I’d heard everything, in walked Keri, a tall, beautiful brunette dressed in a mini-skirt and three-inch heels. She sashayed to her exam room sporting legs so long and sexy they could rival Tina Turner’s.
With a body like that, she could be a model, I mused.
“How can I help you, Keri?” I asked, wondering why this picture of health would need a doctor.
Keri immediately tugged up her mini-skirt and yanked down her panties to reveal lobster-red splotches all over her buttock and bikini line. She showed similar hives all across her bra-line.
It didn’t take a Rhodes scholar to figure out Keri was allergic to the fabric of some new bathing suit. “I’d donate that new bikini to Goodwill and go back to your old swimsuit,” I advised. “You’re clearly allergic to the new fabric.”
I pulled out my prescription pad and scribbled out a script for a potent cortisone cream. “Apply this to your rash twice a day, quit wearing that new bathing suit, and your rash will be gone in ten days,” I reassured her. Problem solved, I stood up to leave.
Keri raised a hand to detain me. “Wait! It’s not that easy.”
She then informed me the new “swimsuit” was actually a skimpy Latex panties and bikini top she was required to wear as her “costume” at a men’s strip club in Atlanta where she worked every Friday and Saturday night as an exotic pole dancer. Latex, she informed me, allowed the men to tuck bills into her costume without the money falling out. Only problem? Keri was severely allergic to Latex!
“Couldn’t you wear a non-Latex outfit?” I inquired.
Keri shook her head. “All eight pole dancers are required to wear matching outfits. Since I’m the newbie in the dance troop, I don’t dare to complain or I might lose my job. My boss already thinks I’m the least talented dancer, so I can’t give him an excuse to fire me.”
Least talented dancer! How much talent does it take to shimmy down a pole flaunting one’s body parts?
Plus, how discriminating could a bunch of drunks in a smoky strip club be? I’ll bet none had ever judged an episode of Dancing with the Stars. Most wouldn’t know a pirouette from an arabesque! But who am I to judge? Maybe slithering down a pole took more talent than I envisioned.
The feminist in me fumed. Why would any woman degrade herself by working at such a sexist, demeaning job?
Keri answered my unspoken question. “I know it’s degrading work, but I need this job. I make more money working eight hours a week at the club than I did working full-time as a pre-school teacher. This way, I get to be home with my baby full-time. My mom babysits little Abby from Friday night until Sunday morning, so she never has to go to daycare. I purposely work in Atlanta instead of Nashville so I’ll never be an embarrassment to my daughter. I also use the fake name ‘Bambi’ when I’m in Atlanta. And in case you’re wondering, I never have sex with my customers. Lap dancing is as far as I go.” She grinned at me and added, “A girl’s got to have some ethics.”
She then informed me the boss had offered to pay for her to get breast augmentation surgery as a “fringe benefit”, if she would sign a three-year contract with the club! Ironically, the club did NOT cover sick days or health insurance!
I was taken back! What a sad commentary on American values that a pole dancer made more in eight hours than a pre-school teacher did working full-time! Plus, I’d never heard of anyone choosing to work as a pole dancer because she wanted to spend more time with her baby! Keri wanted to be a full-time mother. It almost sounded like….family values!
In case you’re wondering, to prevent Keri’s allergic rash from continuing, I had her apply cortisone cream and then a thick coating of Vaseline before she donned her “costume.” The Vaseline would act as a barrier. I instructed her to use non-Latex gloves to protect her hands while pulling her outfit on and off then shower immediately to remove any residue.
Keri called me a week later to inform me the preventive treatment worked. She also thanked me for not judging her. “I’m not proud of what I do, but if it allows me to be home full-time with Abby, I’ll do it.”
While I wasn’t wild about Keri’s career choice, I was paid to doctor her, not to judge her. Who’d have thunk pole dancing had provided her the chance to mother her baby full-time?
Art Linkletter once wrote a book called Children Say the Darndest Things. As a doctor, however, I maintain that patients, under the influence of anesthesia or mind-altering pain medications, say the darndest things!
Take Joseph, a fifty-year-old banking executive. After being doped up with Versed, a potent tranquilizer, he underwent his first screening colonoscopy. While awake, but still groggy from his anesthetic, Joseph was informed a large, pre-cancerous polyp had been discovered.
Joseph’s shoulders drooped and his face fell. “I had a polyp? Shucks! That’s so sad! Dad’s doctor said he had a beautiful colon with no polyps at all. I wish I had a beautiful colon.”
Taken back by Joseph’s whiny tone, the proctologist enthused, “Well, I removed that big, ugly polyp, so now you do have a beautiful colon! Isn’t that wonderful?”
Joseph clapped his hands in child-like glee. “Oh, goody! Now I have a beautiful colon, too!”
The proctologist laughed when telling me about the exchange. “Perhaps I should market myself as a plastic surgeon for the colon,” he quipped. “It certainly sounds classier than a proctologist!”
I heartily agreed, though secretly hoped I wouldn’t utter inane remarks like Joseph’s when I obtained my upcoming colonoscopy!
Unfortunately, not all patients become merely whiny or silly under the influence of pain killers. Some patients become downright mean. Charles Dawson, the minister of a huge church in Nashville, was hospitalized to receive pain meds and chemotherapy as treatment for his virulent pancreatic cancer. Wouldn’t he be scandalized to learn that under the influence of morphine he had the following exchange with his nurse:
Nurse (with cheery lilt): “Time to take your medication, Mr. Dawson.”
Patient: “Buzz off and leave me alone!”
Nurse (in a patronizing tone): “Now Mr. Dawson, if you want to feel better, you need to take your medicine.”
Patient (arms crossed and glaring at nurse): “If I wanted to feel better, I’d kick your bossy mouth and fat ass out of my room! Now scram!”
Concerned that a prominent minister would talk to her with such vulgar and insulting words, the nurse paged me. I reassured her that in his right mind, Mr. Dawson would never have uttered such tasteless remarks. “He’s one of the nicest patients in my practice,” I insisted. “It’s got to be the morphine.” We stopped the drug and chose an alternate pain medication. Soon Mr. Hyde had transformed back into Dr. Jekyll.
Charles Dawson wasn’t the only patient of mine to have a personality change under the influence of narcotics. The funniest case occurred when I was still a medical student. As one of five students making hospital rounds with our attending physician, Dr. Parrish, we entered the room of Olive Gleason, a ninety-two-year-old with a large, painful diabetic foot ulcer.
“Hey, there, medicine man,” Olive crooned to Dr Parrish. “You want to roll in the hay with me before I keel over dead from this foot ulcer?”
Dr. Parrish’s eyes widened, but he politely informed her that no, he was too busy teaching medical students to have time for a roll in the hay.
Olive scowled and crossed her arms in disgust at his rebuff. “Pfft! No real loss. You’re balder and fatter than suits my taste anyhow, but at ninety-two, I figured I couldn’t be too choosy.”
I chomped on the inside of my cheeks to keep from laughing. How would Dr. Parrish handle being dissed by a nonagenerian in front of a gaggle of medical students? Talk about embarrassing!
Without missing a beat, Dr. Parrish said, “Olive is clearly receiving too much morphine. Perhaps we should turn down her infusion pump before she informs me I’m too stupid and clumsy to meet her high standards, as well.”
We all released a nervous laugh grateful he’d handled her insult with insight and humor. Thank goodness Dr. Parrish knew doped up patients say the darndest things!