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Day 11 out of working 11 in a row. See yesterday's log. Also yesterday I said, day 9 of 11 and it was day 10 out of 11. Musta been a little stressed.

Ok, believe it or not, the meeting at 4:45 with the hospital/clinic CEO, COO, my office manager and on my side Dr. P (the ONLY female doc who I have ever seen who is liked by BOTH docs/administrators AND nursing/front desk staff) and me. So, the issue was that I have been in a continuous tantrum and agitating ever since the hospital rapid process improvement committee with admin, front desk, nurses and "providers" (docs and PAs and ARNPs) said we had to see 18 patients a day.

First of all they said that CONGRESS said we had to see 18 a day. Well, they lied. Or misled. They are extrapolating from congress's saying that an "normal" patient panel is 4200 patients for a "full-time" doctor who works 5 days a week. They take that and divide it out after subtracting all the leave weeks (6?) so 46 weeks and if I work 4 days a week, 4/5 of 4200 is 3260 and 3260 divided by 46 weeks times 4 days a week is 17.7 patients a day. I didn't grok this until something Dr. M said made me understand it. I had been just furious thinking congress had passed a law -- well, the admin had said that congress would cut medicare payments across the board. If that's true, I'm still going after congress, just slightly more discreetly. Slightly.

So, the COO and I went back and forth a bit. What was my plan to meet the standard that the hospital had set under pressure from the community and from congress (and from the economy), yada, yada. I finally said, "Are you going to let me talk?" She did. I listed what I'd done so far. She pushed back, actually displayed anger (whoa!) and said how was I going to meet the standard? I said, "The meta message is that either I get on board with the standard and try and meet it or I leave, right?" She was taken aback, but thought about it and then said, "Yes." The CEO then tried to make us all play nice and he and Dr. P said that since I have so many high risk OB patients now and because of the upcoming travel issue and etc, too much pressure shouldn't be put on me right now, and if I'd just play nice and work with people instead of bitching and fighting it would all work out, and everyone was really trying to help me, and they poured oil on troubled waters.

I said that I understood the situation (though I didn't add that I hadn't until yesterday afternoon), that I apologized for publicly denouncing the 18 people a day thing (though I still think it's stupid and insane) and that I would work with the clinic and hospital and everyone was so nice and gosh I'd been under stress in my private life yada yada. Since the latter is true with bells on, this was slowly accepted. Some plan details were discussed. Follow up meeting in 5 weeks with numbers. Two Wednesday clinics to be blocked out (already half days) so I could catch up on damn back log, but not THIS week because I'm already booked to gills.

The other issue was that the COO's agenda had included something about inappropriate emails. I thought it was the stuff I was sending her, which was suggestions for how admin could help, I'd sent her 7 and she hadn't replied AT ALL. She said, no, no, that the docs from The Clinic That Got Rid Of Me (TCGRM) had emailed her. I was confused. "Why?" She said that I'd sent two emails to all the med staff, about two patients who are imminently dying. With names. The two TCGRM docs had objected, saying they didn't want the burden of this knowlege and HIPAA, HIPAA. I was floored. They want me to put "pop-ups" on the chart instead, so if they open the chart at night, they can see the person is dying. I said this was an ethics question that our medical director (think he was one of the two that complained) would have to address. One problem with the pop up is that you don't have access if you aren't near a computer. I nearly never am on the weekend, I'm a single mom. Secondly I don't have home computer access. Third, and most important, comfort to the dying and the families ranks so far above HIPAA ethically for me that HIPAA didn't even occur to me. And if we are combining call groups by June, this will need to be addressed. I don't want to take call with those TCGRM docs. So there.

Lastly I wanted to bring one more thing up. This was the icing on the cake. I said that in over nine years I had never once gotten an answer to a question posed by email or voicemail to the administration, and that I always had to schedule a meeting to get anything answered. I said that I'd learned this and could cope with it, but just thought that sometimes it was inefficient and that it was frustrating to drop the email suggestions into the dark hole where they never got answered. The COO essentially said, "You've got me," and that actually she could maybe occasionally acknowlege that she had received 5 or 10 emails from me and was thinking about them. So that was very funny, at least it tickled me, and is progress from my perspective.

So it's 3:30 am. Only have 17 patients on today's schedule and then to drive 100 miles. Yee-ha, think I'll make it. Hope the zebras are quiet today, really.

Oh, I did try to bring up the zebras, but they didn't get it. Tried to explain that when I go in a room with someone with, say, toe pain, I don't follow a template. My template is: "Why are you here?" So then sometimes it turns out it's burning pain, I check a blood sugar, it's 350, I have to tell the person, "gosh, you have diabetes," and all of a sudden a 20 min toe pain visit goes over because you can't DO it in 20 min. But the CEO said, "Oh, all the other doctors are paying attention." Well, yes and no. I LIKE the zebras, so I am wondering if patients sense my openness to weirdness and they tell me. That would explain why I get more zebras than anyone else. Because I really do get more. Or notice more. (I had an 88 yo woman open up recently at a hypertension visit and tell me about the three times her now dead thank god husband tried to kill her, once with arsenic, she peed black and took a sample in and she cried and said it was the first time she'd cried. I cried. I said if he was alive I'd like to punch his face. And gosh, the visit went over 20 min. And I just don't think it's even ETHICAL to say, "gosh, why don't we schedule another visit and we'll address this next time." Can you even imagine?) CEO put fingers to ears and said, "La, la, la, I don't want to hear this." Oh, well, eventually it will bother the really ethical doctors enough that they will say, dang it, how do you DO that. I have to wait.

So I don't think I could have planned it to go better. Whew. Am I glad THAT's over with. And we got done by 6 pm, believe it or not. And the meeting was AFTER I saw and finished all the charts on 15 patients. After the meeting I had to do chorus dress rehersal. Couldn't remember any words to anything. Bed at 8:30 pm, wiped and whipped.

They still tingle sometimes. It isn't often, but they do. I don't particularly mind the tingling, but sometimes, I notice, and then I remember. I don't always like remembering. And I never like constant reminders. It's okay though. Just another bunch of days to ignore until they go away. Like the people in the funnel pipe. We made it you know, just barely, but we did. And now no one else can. But everyone's floating away into the blue blue sky and we're just getting lost. Where does this go? I can wait, I suppose. It's not like there's anywhere particular I'm heading. We. I keep forgetting dear, please remind me every once in a while that you're still here? Oh, so polite indeed. Save the cats guys, I rather like the rain. But won't it ever stop? Too soon to worry about that. Too soon. The storm will come and we'll be stuck here, out in the cold, but it'll go away. I guess. I suppose. Too early to worry about that. Too soon. Is it time to check out? No dude, we just got here. So much further to go. And the sky turns purple.

"I like this view"
"Yeah"

Goodbye. But it isn't. I guess. I suppose. I mean, it is only one sky, right? How big can it be? And we're still only so far away. We could reach out, couldn't we? I think so, but what's out there anyway? Umm... the others? What others? Suddenly, everyone's gone. Engulfed by an inky infinite sky. And I stayed too long. There are always the birds. At least, I think they're out there. I can hear them sometimes, but it's too dark to see. When will the moon come out? Or perhaps I am on the moon. Perhaps we all are. After all, the moon has a dark side, doesn't it? That's a lie. Matter of fact, it's all dark. And no one knew what was on the other side. Blind leaps of faith(?), except we never came down. Fairy dust can make you fly. Way to go Peter.

Except you forgot... We never got to Neverland, and now it's too dark to see. You never taught me how to stop. Us. You never did. We didn't ask, but you weren't supposed to forget either. And we're still floating on the clouds. Maybe it's still too soon to worry about getting down. Maybe you'll remember.

Maybe I'll forget. I think I am forgetting. Maybe I do know, but just can't remember. If I tried so hard to forget, there must have been a reason, right? And this is so much easier, like floating on a cloud. And the storm will come and it'll go away. Maybe we'll miss it completely because we're here. Maybe we can watch it from above and marvel at the lightning flashes. What would it be like to see lightning from above? I guess the moon would know. Too bad she never tells. She must have her reasons I guess. Don't we all? No. That would be a little too simple to watch for an eternity. Perhaps it's just an anomaly. Perhaps we all are just anomalies and the dinosaurs were all there was supposed to fucking be to it. At least they'd just try and snap your head off (literally) instead of tripping you to death. Like on a plank. No one goes insane. You're driven insane. I'd like to meet the driver.

There's not enough time, but there's just so much of it. It's too little time to do anything and too much time to do nothing. Like the ten minute breaks, you know? Perhaps that's all life is, a ten minute break. Imagine that. And we just wasted so much of it complaining how short it was, when we could have just managed a tea and a smoke. Except it's so hot. Why won't it rain? I thought it never stopped. Interrupt - interrupt - interr- Never mind.

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