70%

Been back at the clinic for a little bit now, and I'll only be there for a little bit more. For an FP guy, he's pretty busy and the support staff can be described as being under "controlled chaos." As a shadow, I never knew what it took to keep the practice going as smoothly as it does. After working with his staff for a while, I've got a greater appreciation for what they do. Now what do I do? I work mostly with patients and progress notes. The rest of the staff deals with all the phone calls, voicemails, refills, and forms/paperwork. Oh, did I mention paperwork? That, and more of it. Now some of the phone calls/voicemails I've overheard are just sad, and if I had to handle shittons of it, I'd get irritated every now and then too.

Example 1. Oh, you've got chest pain, shortness of breath, and a tingling left arm? What, you want to know if you can be seen today? No no, your next stop is the ER - because that's where we'd end up sending you anyway.

Example 2. Yes, ma'am, 200mg equals two 100mg pills. Yes, take two of the 100mg pills and you'll be at the dose we're looking for. ... Hello? Yes, take two pills to get to the correct dose. (At this point I hear a head hitting a desk.) Yes, I'm sure this is correct. 100mg and 100mg does equal 200mg, and that's what we want. Hello? Ma'am?

Like I said, the vast majority of my time is spent working with patients and working with their related progress notes - and this is why I like the job so much. Yeah, there can be a lot going on at the nurses' station, but whenever I'm with patients, all that stuff disappears and it's all about the patient. Sure there are annoying and malodorous patients, but overall it's worth it. And that's what keeps bringing me back and keeps me wanting to get those two letters after my name. Now I wouldn't say I've become really close with any patients, but there definitely a few that I remember. Like here, I definitely remembered CLS and felt closer to him than the average patient that comes through the office.

Another patient I remember from rounds was M.E. Now ME was in the hospital once or twice over the summer, and I ended up remembering the name. When I saw her on the list of patients to be seen one day last week, I felt a small sense of familiarity. While taking her vitals and noting her presenting complaints, she didn't look too well and her daughter and care-taker confirmed this. She'd been dealing with a medicated, unresolved, and worsening cough over several days (among other things). And in taking down some history, she had recently been in the hospital. After leaving the room for her to be seen by Dr. Parks, I got back to taking patients into rooms and finishing up with them after they were seen. When ME was done being seen, a couple of orders were heavy on the respiratory side: chest xray, oxygen saturation; there were quite a few other orders noted also. ME's pulse-ox was noted to be about 70%. Now you always want that to be as close to 100 as possible, with values less than 90 being cause for concern. 70% in an elderly patient such as ME, is just outright alarming. After this, she was sent to the hospital, and the paramedics came out to the clinic for transport. The next day, we continued the routine of seeing patients during the day and catching up on paperwork after that. Late in the afternoon while I was working on patient notes for that day, I got a message from Dr. Parks. I figured it would be some sort of request for lab values, radiology images, or a patient's note from the day. But in looking at the patient concerned in the message, it was ME and the message title was "flag chart." I double clicked on the message, and all the message said was "deceased."

Now, I know that in medicine, be it emergency medicine or family practice, you will lose patients. I even remember following a patient on rounds last summer, Dr. Parks telling the family that she was close to death, and then her finally going. This patient was HC, and it was my first real experience with death and the loved ones' family. But getting that message about ME in my inbox still caught me by surprise. I don't know why, but it did. I wasn't extremely close to her and like I said, I had been exposed to death previously. I guess the fact that I was talking to her less than 24 hours prior to me getting that message had something to do with it. Maybe the fact that I looked into her eyes (I make eye contact with all patients to keep their confidence/trust) just a day earlier. The fact that I was taking her blood pressure and helping her with her sleeve a day before. And now she's gone. The finality and abruptness of it. Mind you, I'm not terribly distraught over this or anything, but it affected me more than I thought it would. My sincere condolences to ME's family and especially her daughter, because I could see and hear the concern when I was talking to her.

A quote from Scrubs' J.D. from a different situation, but with similar sentiment: "I'll never forget that moment, the way he looked exactly the same...only completely different. The shame that all I could think about was how hard this was for me. ... I just wanted to help people."