The Forgetting

As I was totally feeling sorry for myself (oh, poor Dr. A), I was asked to see Isabel at the nursing home at the end of my morning. She has Alzheimer's which I would say is in the intermediate stages. She was having some arm pain and had a question about a cortisone shot for her shoulder.

I'm thinking to myself, "Oh great, just another thing that I have to fit in. How am I going to do that? I have to drive back and forth from there and make sure I'm not late for my afternoon office hours."

Following her exam, I thought she had a pulled muscle and prescribed some physical therapy and analgesics. She then asked me, "How long am I going to be here?" As I was frantically writing in the chart, "Well, we talked about this the last time I saw you. It is unsafe for you to go home because your husband has a lot of medical problems as well, and he cannot take care of the both of you."

"No, doctor," she looked right at me, "How long am I going to be here?" "Oh," I paused a long time before speaking again. "I don't have any idea on that. The Alzheimer's may slowly or rapidly progress. You're on the best medicines we have right now."

"What would happen if I wanted to stop all my medicines?" she asked. "Likely," I said, "this would probably progress rapidly for you." "I certainly don't want to live like this in a nursing home when I used to be independent, and yet I want to be around for as long as I can -- especially for my grandkids."

This is one of the tragedies of Alzheimer's -- when people are not mild, and yet not severe. They feel themselves slipping away as they forget more and more and, in addition, they start to lose their bodily functions.

If you know little about Alzheimer's, here is a link I want you to check out. It has a video clip that's about 3 minutes of a PBS program called, "The Forgetting." It really personifies what this tragic disease is all about.

Isabelle and I and a nice discussion and ultimately she made a decision that I went along with. Needless to say, after this humbling experience, I was brought back to reality and then went back to the office to continue my day....

Why

Why do manipulative patients wait until 5 minutes before the office closes to call for a medication refill?

Why does poor planning on someone else's part constitute an emergency on my part?

Why would a clueless patient page me at 3 o'clock in the morning and ask me for a test result that happened 2 wks ago?

Why do I have to stay calm as people are yelling at me through the phone?

Why do arrogant specialists only want to talk about the car that they're driving?

Why do helpless primary care docs only bitch and moan and not be proactive to come up with a solution to the problem?

Why is it when I walk around the hospital that the only thing I hear staff concerned about is when they're going on break?

Why doesn't it bother me that radiologists sit in a dark room all day?

Why do hospital case managers bug me every day about discharging patients because they do not meet "criteria" for hospital admission?

Why does hospital administration only care about quality data and federal/state regulations?

Why does the hospital security guard always give me that look when I enter and leave the hospital?

Why do I even get up in the morning after a rough night of call?

BA at Waikiki beach

Aloha! T.J. from dogscatskidslife is graciously hosting the latest edition of the Blogaholics Anonymous meeting from Hawaii -- specifically Diamond Head and Waikiki Beach. There are great pics on the site already. I'm really jealous and wish I was actually there. T.J. says that dinner is prepaid, so get there right now before the tab is closed.

Grand Rounds

Grand Rounds 2.43 is hosted this week by Chronic Babe and she had a theme, "It's All About the Ladies." I can't believe I'm taking abuse over this.
Here's healthpsych: "So, an honorary girl after all? (Grand Rounds theme - It's all about the girls)" Ouch!

Anyway here's the snipet from today's Grand Rounds post:

Doctor Anonymous works with an elderly patient to decide her best course of care. "Whatever you decide is probably as good or better than anything I would say," he tells her. In the end, she decides to leave things be.

Thanks to Chronic Babe for hosting this week. I haven't seen anyone announced for the host for next week. Hmmm.....

Space spatula

Saw this story from an Australian website (good stories from Australia today). Apparently last week, an astronaut lost a "space spatula" that is now orbiting the earth...

The $2700 spatula drifted out of Sellers's tool kit while he was conducting repair tests outside the shuttle Discovery on Wednesday.

"My spatch has escaped ... it was tethered to me," he reported to ground controllers during his 7hr 11min spacewalk. "It's gone, gone, gone. Nobody's going to find it."

First of all, a $2700 spatch? Where's NASA shopping at these days? They can save a lot of money just by going to the dollar discount store (how much do things cost there anyway?).

In a related story, after Discovery landed at Kennedy Space Center in Florida this morning, Sellers was overheard saying, "Has anyone seen my car keys?"

Obesity & asthma

I just read this interesting article from WebMD. Here's a quote:

July 13, 2006 -- A lung-irritating protein made by fat cells may be the missing link between obesity and asthma, say Australian researchers.

Obesity makes it about three times more likely a person will have asthma. And when obese people with asthma lose weight, their asthma gets better, says Michael Rolph, PhD, one of the researchers on the study.

The article goes on to say that there's a protein made by fat cells that causes inflammation of the lungs which then worsens asthma. This is very interesting because if this protein can really be isolated, then more treatment options may be coming along for those with asthma.

I'm seeing more and more kids overweight and more and more kids having diseases like asthma and diabetes and others. There are many scattered theories on the origins of the obesity epidemic, but unfortunately, there is not united agreement on a solution to this problem.

(Don't forget, Grand Rounds is tomorrow. And, a little birdie told me that my submit made the cut. Hmmmm.... Stay tuned to find out.)

I love the 70s

Ok, so I was innocently watching college championship frisbee football when a commercial break came. I decided to do some channel surfing and I ran into this show called I Love the 70s on VH1. For those of you who have never seen this, it's a bunch of has-been celebrities commenting on the pop culture moments of that decade.

I started at 1972 and got hypnotized into watching the rest of the decade. What's wrong with me? I just could not turn the channel. They just kept talking about the movies and music and TV that I remember from back then. I could not stop myself. Help!

But, I was thinking, 30 years from now, I could be on a show like that.....

Hey, Dr. A, what did you think of:
World Cup 2006: "You know all I could remember was that guy from France head-butting that guy in the chest in the final game. What was that guy thinking? 'Oh yeah, like no one is going to see me do that.'"

American Idol: "This was the hottest show on TV. This was the only time in my life where I wish I could actually sing. I only watched the show a couple of times, because I was totally intimidated by Simon. The guy totally scares me. In fact, I still have nightmares about him, 30 years later..."

iPod: "Oh yeah, I remember my first iPod, I put all of my CDs on it (you remember CDs don't you?) and I was amazed that I still had room on the thing to put other music. And, then the screen scratched and I cried the whole weekend and thought that my life was over."

Sign me up! I'd be great at this show. Or, maybe I just need to turn the channel back. There's got to be something on that's not so hypnotizing...

Lazy Sunday

You know, it's really refreshing to get some time off every now and again. Before this weekend, I was worked 12 days in a row with hospital and/or office responsibilities (sometimes 12-14 hour days). Don't get me wrong, I'm not looking for sympathy, just sleep. And, boy have I taken a break this weekend.

I was really thinking of not blogging today, because, hey, I've really got nothing going on -- and for me that's news. I'm used to the go,go,go schedule and no time to take a breath. Don't worry, I'll be returning to that tomorrow.

But for today, maybe I'll just hop around the blogosphere (and catch some blograys and work on my blog tan), or really start that diet/exercise program I've been meaning to do, or take more of a break today. Oh well, I guess it's my choice. What are you doing today?

Hotel Coffee

I logged into bloglines this morning and saw an update of my favorite podcast called Hotel Coffee. Dan O'Leary is a pilot who works in the western United States. I don't know anything about aviation, and it's SO different than medicine. It's been very interesting listening to all the technical aspects of the show. And, I've enjoyed learning about the life of a pilot.

Podcasting is an entirely different medium than blogging. I have to be honest -- at first I was drawn more toward podcasting rather than blogging. I like listening to books on CD and hearing someone's voice telling a story (and also added music) definitely gives a lot more layers than reading a story on a page.

I finally e-mailed Dan this week and I got mentioned in his show. Very exciting -- my first podcast plug! I know this is going to sound really cheezy, but it was because of Hotel Coffee that I decided to start blogging. Earlier this year, I was really exploring podcasting and I found out that there was a lot of technical stuff that my patience probably couldn't handle.

I heard from a lot of different sources, including Hotel Coffee, to just start writing (meaning blogging) because it doesn't really matter what you say or if anyone reads it. And now, it's almost four weeks later of blogging and here's where I'm at!

Thanks to Dan for mentioning my fan mail on his podcast and putting my link up on his website. (BTW, Welcome to all the Hotel Coffee listeners!) I encourage you to check out his site and his podcast. I load up Hotel Coffee every week on my iPod and I know you will enjoy it, too.

BA at the nurse's place

We're having a lot of meetings this week, aren't we? May from about a nurse has graciously opened her blog doors to host the latest edition of the Blogaholics Anonymous meeting. As always, bring your food and beverage of choice, and I'll see you there! She's got pansit, do you know what that is? Head on over and find out...