Long time, no Blog. The World's Oldest ER Doc just got a year older. I am now 62. 34 years since I completed my Emergency Medicine residency. I have recertified 3 times. My current job will most likely be my last before retirement. I am working as a 0.6 FTE (fulltime equivalent). This means 8 shifts per month. I hope to power down to 6 shifts per month in January 2015. The Valley is a nice little community hospital. 16,000 visits per year with low acuity. The nights are 10 PM to 7 AM. I have had 1 patient nights and 16 patient nights. I work with a great nursing, ancillary and secretarial staff. The other docs in the group are smart, collegial and cooperative. My director is a peach. He is hard working, supportive and actually listens.
The Mega General has undergone many changes since my forced departure in 2011. It has absorbed the Apostle's Medical Center, Mega General's former rival. The patient census for the 2 campuses is 90,000 +. Mega General's main campus opened a new ER organized into pods. Closing pediatrics, OB, and the cardiac cath lab at Apostle's has spiked the census at the main campus and left Apostle's with fewer patients and a lower acuity. My friend Ajax still works for my former group. The Weasel has taken over the physician group as the sole owner. Promises of a partnership were squashed by the Great Rat and his butt boy, the Weasel.
I am employed by a for-profit corporation. This is my first job working for a for-profit since I was in college working for United Plywood as a sales/inventory/clerk. My initial skepticism has been replaced with admiration. Promises are made and kept. Compliance issues are clear and easily followed. Compensation is based on actual targets and incentives.
Many of my current patients would have treated by the Physician Assistants at Mega General. I have to do my own suturing. Minor injuries and illnesses are my bread and butter. Thanks to the low census, I see my patients shortly after their arrival. The slow pace allows me to truly listen and make a connection with the patients and their families.
I don't arrive to find a 3-4 hour wait. My stress levels are very low. The Valley's ER may be low volume but it is still an ER. I have treated traumatic, cardiac, pulmonary, surgical and even OB emergencies. We delivering a baby when the mother presented with back pain and didn't know she was pregnant. Emergencies Happen!
The future is finite. My board certification will expire when I am 67. I hope to retire before then. I feel fortunate to have the opportunity to continue my career with good people, a supportive employer and mental and physical health intact.
Thursday, October 2, 2014
Friday, February 8, 2013
Sexagenarian
The World's ER Doc is chronologically old. 33 years in the trenches of Emergency Medicine and I can see the proverbial light at the end of the tunnel. After my ejection from LGH, I landed in a low volume, low acuity ER a mere 10 miles from my home. The nurses, docs, techs and support staff welcomed me. I'm 18 months into what will probably be my last ER job. My Emergency Medicine boards are good till 2019. The schedule is 11 nights a month from 10PM-7AM. My beloved stills works as hard as ever. Being out earned by ones spouse is a good thing.
I have no delusions as to the inevitability of entropy. Wrinkles, glasses, aches and pains, forgetfulness and personal losses are all part of aging. I see my 93 year old mother every week. She knows me and is happy to spend time together. She has lost her memory of her life as a daughter, sister, cousin, and wife. She loves to look at pictures of the past. She recognizes my father but cannot recall there life together. The saving grace is that she doesn't remember what she has forgotten.
My "best friend" for 12 and a half years looked at me last week and told me that he couldn't get up. I lifted him to his feet but his hind legs wouldn't support him. He kissed my face and I knew it was time to say goodbye. My wife and I brought him to the vet. Dr Mike, who had cared for MO since he was a puppy, eased his passage to eternity.
If Life is a play in three acts, I am in the final act. The important components are still present: a loving wife, multi generations of family to enjoy, good books, my camera, a fulfilling job, and a great bottle of scotch for the nights when I am home. I will accept life as it unfolds. Stay Tuned!
I have no delusions as to the inevitability of entropy. Wrinkles, glasses, aches and pains, forgetfulness and personal losses are all part of aging. I see my 93 year old mother every week. She knows me and is happy to spend time together. She has lost her memory of her life as a daughter, sister, cousin, and wife. She loves to look at pictures of the past. She recognizes my father but cannot recall there life together. The saving grace is that she doesn't remember what she has forgotten.
My "best friend" for 12 and a half years looked at me last week and told me that he couldn't get up. I lifted him to his feet but his hind legs wouldn't support him. He kissed my face and I knew it was time to say goodbye. My wife and I brought him to the vet. Dr Mike, who had cared for MO since he was a puppy, eased his passage to eternity.
If Life is a play in three acts, I am in the final act. The important components are still present: a loving wife, multi generations of family to enjoy, good books, my camera, a fulfilling job, and a great bottle of scotch for the nights when I am home. I will accept life as it unfolds. Stay Tuned!
Saturday, March 3, 2012
The Business of Medicine
My life as a physician began 35 years ago when I graduated from medical school. I treated patients and was compensated with a salary and benefits. It may be my failing memory, but there seemed to be very few administrators back in the 70's and 80's. The directors were actual doctors and nurses. No MBA or MHA was needed to be a boss. Recent events have highlighted the current paradigm of health care. The triumvirate of Government, Insurers, and Hospital Administrators control health care.
The cost of health care in the USA is out of control. Tests, and procedures pay. Primary preventive care doesn't. A physician with $250,000 in loans will be much more likely to choose gastroenterology (scopes pay) than primary care internal medicine. Private health insurers are run by highly paid executives whose goal seems to be the denial of care to their subscribers. Folks stay in jobs they hate because they are afraid of losing their employment-tied health coverage. The new job's insurance may not cover a pre-existing condition. So called "Obamacare" tried to make coverage less capricious and more transportable. It did not change the ever increasing cost of health care.
The other big trend in health care is consolidation. I work for a company that owns multiple hospitals. My services are based on a contract that was more than 12 pages in length. There are expectations of continuous improvements in the timely provision of care to our clients/patients. Health care is a service based industry. We, the providers, will be judged by meeting or exceeding standards and expectations of the industry and the consumers.
The city of Lowell, MA witnessed the consummation of the very long courtship between Lowell General Hospital and Saints Medical Center. The later has been unsuccessfully trying to find a partner for many years. My employer was a recent suitor but was jilted at the altar. As a resident of the Greater Lowell area, I have an interest in how this merger will play out. The financial problems at Saints (bond rating in the junk bond range) would seem to give the larger and solvent LGH the edge to deciding how services will be divided between the two "campuses". Redundancies must be eliminated to make the deal financially advantageous for both partners. I fear that some of my friends' jobs, at both facilities, will be phased out as the merger progresses.
MGH "buying" Cooley Dickinson Hospital in Northampton, MA was also in the news recently. Baystate Medical Center in Springfield will lose business because of this affiliation. Partners, the 800 pound gorilla of Massachusetts health care, seems to be on a perpetual mission to add more hospitals to its portfolio.
I am just an old ER doc; 32 years and counting. I like my current position. I work with a group of nurses, techs, secretaries and physicians who provide high quality health care in a small community hospital. My coworkers are bright and friendly. They have made me feel welcome. We are also consumers of health care and pay for our insurance, co-pays, and deductibles. Buckle up folks, it is going to be bumpy road to the future for health care in America.
The cost of health care in the USA is out of control. Tests, and procedures pay. Primary preventive care doesn't. A physician with $250,000 in loans will be much more likely to choose gastroenterology (scopes pay) than primary care internal medicine. Private health insurers are run by highly paid executives whose goal seems to be the denial of care to their subscribers. Folks stay in jobs they hate because they are afraid of losing their employment-tied health coverage. The new job's insurance may not cover a pre-existing condition. So called "Obamacare" tried to make coverage less capricious and more transportable. It did not change the ever increasing cost of health care.
The other big trend in health care is consolidation. I work for a company that owns multiple hospitals. My services are based on a contract that was more than 12 pages in length. There are expectations of continuous improvements in the timely provision of care to our clients/patients. Health care is a service based industry. We, the providers, will be judged by meeting or exceeding standards and expectations of the industry and the consumers.
The city of Lowell, MA witnessed the consummation of the very long courtship between Lowell General Hospital and Saints Medical Center. The later has been unsuccessfully trying to find a partner for many years. My employer was a recent suitor but was jilted at the altar. As a resident of the Greater Lowell area, I have an interest in how this merger will play out. The financial problems at Saints (bond rating in the junk bond range) would seem to give the larger and solvent LGH the edge to deciding how services will be divided between the two "campuses". Redundancies must be eliminated to make the deal financially advantageous for both partners. I fear that some of my friends' jobs, at both facilities, will be phased out as the merger progresses.
MGH "buying" Cooley Dickinson Hospital in Northampton, MA was also in the news recently. Baystate Medical Center in Springfield will lose business because of this affiliation. Partners, the 800 pound gorilla of Massachusetts health care, seems to be on a perpetual mission to add more hospitals to its portfolio.
I am just an old ER doc; 32 years and counting. I like my current position. I work with a group of nurses, techs, secretaries and physicians who provide high quality health care in a small community hospital. My coworkers are bright and friendly. They have made me feel welcome. We are also consumers of health care and pay for our insurance, co-pays, and deductibles. Buckle up folks, it is going to be bumpy road to the future for health care in America.
Sunday, February 5, 2012
Doc Quixote Part 5: Super Bowl Domingo
It has finally arrived. My request to be unassigned from the hospice on this day, 5 Febrero, was placed 6 months ago. At that time I had no delusions that our futbol gladiators Los Patriots would be in the great game. As a mucacho growing up in La Massachusetts, Los Gigantes was my team. The only team shown on the local television stations. YA Tittle, Sam Huff, Frank Gifford and the coach Allie Sherman were my heroes. When the two leagues merged, my loyalties became exclusively tied to Los Patriots.
The emergency sala at all Hospices will be much less busy during the contest. After the struggle concludes, the trickle of supplicants will become a great river. The presence of Los Patriots in the Super Bowl will guarantee victims of strong drink and testosterone fueled battles. Win or lose, youths of our land will celebrate or mourn with violence. The rivalry between the two cities represented by los equipos heightens the passions of the fanatics.
Los Rojo Sox vs Los Yanques, Los Celticos vs Los Knicks, Los Osos vs Los Guardas are rivalries that define the sports of the nation. In parts of the world, wars have been fought over such combatants. Volumes of words are written to document these contests. Billions of dollars are spent to see the games, buy apparel with the names of our sports teams and heroes, and purchase food and drink to consume before, during and after the games.
In my humble casa, there will be only Dulcinea, my brother by marriage Senor B and my faithful Perro Viejo, Magnus. I will cheer for Los Patriots. I will pray for my comrades in the Hospices and La Policia who must cope with the fanatics during and especially after the game. Let the Game begin.
The emergency sala at all Hospices will be much less busy during the contest. After the struggle concludes, the trickle of supplicants will become a great river. The presence of Los Patriots in the Super Bowl will guarantee victims of strong drink and testosterone fueled battles. Win or lose, youths of our land will celebrate or mourn with violence. The rivalry between the two cities represented by los equipos heightens the passions of the fanatics.
Los Rojo Sox vs Los Yanques, Los Celticos vs Los Knicks, Los Osos vs Los Guardas are rivalries that define the sports of the nation. In parts of the world, wars have been fought over such combatants. Volumes of words are written to document these contests. Billions of dollars are spent to see the games, buy apparel with the names of our sports teams and heroes, and purchase food and drink to consume before, during and after the games.
In my humble casa, there will be only Dulcinea, my brother by marriage Senor B and my faithful Perro Viejo, Magnus. I will cheer for Los Patriots. I will pray for my comrades in the Hospices and La Policia who must cope with the fanatics during and especially after the game. Let the Game begin.
Thursday, January 12, 2012
MMXII
Happy New Year! A momentous year? It is the 200th anniversary of the War of 1812. My grandniece will enter first grade. I will celebrate my 36th wedding anniversary and my 60th birthday. 2012 is the year of my 35th medical school reunion. We citizens will be inundated with exaggerations, half truths and damn lies as this is an election year.
My friends and former colleagues will be moving into their new ER. More rooms, more space, a new entrance and the same inept administration. The patients will be waiting at least as long but will be more likely to be on a stretcher than in the waiting room. I treated a young woman recently who lives 5 minutes from LGH and has a primary care doctor on the LGH medical staff. She had been vomiting and having diarrhea. She called the LGH ER and was told that the wait was at least 3 hours. Unless the policy has changed, giving wait estimates is not allowed. She drove 20 minutes to NVMC and was placed on a stretcher on arrival and was seen and began treatment within 5 minutes. Press-Ganey gold.
Today I received an e-mail from the ER director of LGH. It was a reminder of the schedule and agenda for the next two ER department meetings. The fact that I haven't been a member of the LGH ER department since June 2011 seems to have escaped his attention. He, of course, was the person who fired my aged ass. Removing me because I was labelled a "disruptive physician" does not seem to have resolved any of LGH's ER problems.
It has been a strange winter. Warmer than usual and with almost no snow. The flu season seems relatively benign. A particularly nasty and wide spread gastroenteral virus is keeping the ER census high. Many health care workers have experienced the misery of this "GI bug". A national dilemma of shortages of common medications has added to the burden of this epidemic. NVMC ran out of injectable Zofran.
The reports in the mainstream and medical press has given many reasons for the shortages. The drugs are all generic and therefore have much lower profit margins that newer, patented meds. Middlemen, who take their cut between the pharmaceutical manufacturers and the hospitals, clinics and pharmacies, seem to be price gauging. Money is the root of all evil.
One of my new duties is reviewing charts for patients who return to the ER within 48 hours. Many are for continuing symptoms of their initial visit. Some ran out of their pain meds and need more of the same. The purpose of this quality assurance exercise is to try and find issues that may lead to better clinical practices. The slow pace of the night shift af NVMC gives me time to do my part to improve care for our patients.
The world's oldest ER doc wishes everyone a Happy, Healthy and prosperous 2012.
My friends and former colleagues will be moving into their new ER. More rooms, more space, a new entrance and the same inept administration. The patients will be waiting at least as long but will be more likely to be on a stretcher than in the waiting room. I treated a young woman recently who lives 5 minutes from LGH and has a primary care doctor on the LGH medical staff. She had been vomiting and having diarrhea. She called the LGH ER and was told that the wait was at least 3 hours. Unless the policy has changed, giving wait estimates is not allowed. She drove 20 minutes to NVMC and was placed on a stretcher on arrival and was seen and began treatment within 5 minutes. Press-Ganey gold.
Today I received an e-mail from the ER director of LGH. It was a reminder of the schedule and agenda for the next two ER department meetings. The fact that I haven't been a member of the LGH ER department since June 2011 seems to have escaped his attention. He, of course, was the person who fired my aged ass. Removing me because I was labelled a "disruptive physician" does not seem to have resolved any of LGH's ER problems.
It has been a strange winter. Warmer than usual and with almost no snow. The flu season seems relatively benign. A particularly nasty and wide spread gastroenteral virus is keeping the ER census high. Many health care workers have experienced the misery of this "GI bug". A national dilemma of shortages of common medications has added to the burden of this epidemic. NVMC ran out of injectable Zofran.
The reports in the mainstream and medical press has given many reasons for the shortages. The drugs are all generic and therefore have much lower profit margins that newer, patented meds. Middlemen, who take their cut between the pharmaceutical manufacturers and the hospitals, clinics and pharmacies, seem to be price gauging. Money is the root of all evil.
One of my new duties is reviewing charts for patients who return to the ER within 48 hours. Many are for continuing symptoms of their initial visit. Some ran out of their pain meds and need more of the same. The purpose of this quality assurance exercise is to try and find issues that may lead to better clinical practices. The slow pace of the night shift af NVMC gives me time to do my part to improve care for our patients.
The world's oldest ER doc wishes everyone a Happy, Healthy and prosperous 2012.
Saturday, December 17, 2011
Lazy Saturday
Due to the vagaries of the scheduling fairies, I haven't worked since 9/7 night shift. I will return to Nashoba on Monday and then will be working 11 out of 15 nights. Never volunteer to work the holidays. A and I are in Starbucks while our housekeepers are earning their Christmas bonus.
No fantasies today. I am anchored in the reality of the present. A has been home, sick with the flu this past week. She did get a flu shot but only 1 1/2 weeks ago. Word to the wise, get your flu shot in September. The immunization takes up to 6 weeks to reach maximal effectiveness.
I felt sad on Thursday night. I was not in attendance at the LGH ER Xmas party. Sally's pictures were a bitter sweet reminder of happier times. I don't miss the chaos of the LGH ER, just the many wonderful people who work there.
I wonder if Nashoba's Christmas eve will be decked with sick kids and depressed patients. My thoughts will be with our friends the H's who host an annual "Feast of the Seven Fish" on Christmas eve. I am sure that my buddy Scott will send a care package with A for my Christmas day meal.
The World's Oldest ER Doc loves Christmas. The music, the food, the lights, "White Christmas", "It's a Wonderful Life", the spirit of good will, all make for a joyous holiday season. I reminisced with my mother yesterday about my childhood holiday memories: playing dreidl with the rolls of pennies and nickels from my Grandpa; sharing the wonderful food prepared by our neighbors the Pace's; hoping for snow on Christmas morning: and knowing that my mother, not Santa filled my stocking on Christmas eve.
To my friends, readers and people of the blogosphere. Have a wonderful Christmas, a happy Chanukah, a Kwanzaa with joy, and to all a Happy, Healthy, and safe 2012.
No fantasies today. I am anchored in the reality of the present. A has been home, sick with the flu this past week. She did get a flu shot but only 1 1/2 weeks ago. Word to the wise, get your flu shot in September. The immunization takes up to 6 weeks to reach maximal effectiveness.
I felt sad on Thursday night. I was not in attendance at the LGH ER Xmas party. Sally's pictures were a bitter sweet reminder of happier times. I don't miss the chaos of the LGH ER, just the many wonderful people who work there.
I wonder if Nashoba's Christmas eve will be decked with sick kids and depressed patients. My thoughts will be with our friends the H's who host an annual "Feast of the Seven Fish" on Christmas eve. I am sure that my buddy Scott will send a care package with A for my Christmas day meal.
The World's Oldest ER Doc loves Christmas. The music, the food, the lights, "White Christmas", "It's a Wonderful Life", the spirit of good will, all make for a joyous holiday season. I reminisced with my mother yesterday about my childhood holiday memories: playing dreidl with the rolls of pennies and nickels from my Grandpa; sharing the wonderful food prepared by our neighbors the Pace's; hoping for snow on Christmas morning: and knowing that my mother, not Santa filled my stocking on Christmas eve.
To my friends, readers and people of the blogosphere. Have a wonderful Christmas, a happy Chanukah, a Kwanzaa with joy, and to all a Happy, Healthy, and safe 2012.
Saturday, December 10, 2011
Doc Quixote Part 4
Despite signs to the contrary, I am not delusional. I am aware of the current year. It is my choice to view the world from a unique perspective. The age of my corpus is not the same as the age of my animus. The chivalry of my hero Don Quixote serves as a guide for my writing.
My aged mother, the duenna Dulce, resides in a residence for the elderly. Her physical and mental frailties are commensurate with her advanced years. We sat together in the sun room yesterday and I shared a cine of her great grandchildren dancing. Her creased face shone with joy. She was her usual pleasantly confused self. Her worsening memory, she counts as an asset, as she says that she doesn't remember the bad times. When I arrived at the elder hostel, she insists that she must attend to her hair. Only when she has brushed and combed her snow white locks, does she feel ready to face the day.
The shallowness of youth was the weapon that wounded a cherished friend. A former health giver at the hospice on the Merrimack, this sharp witted, compassionate, and scarlet haired damsel was wounded by a knave. The seniorita was betrayed by one she loved. The cad violated the trust that binds a couple beyond the formalities of the church or the state. My friend's heart will heal. My fondest wish is that someone worthy of her love will enter her life.
On arriving at the Hospice of the River Valley on a recent night, my presence was urgently requested at the bedside of one who's breathing tube had become dislodged. I rushed to the unit of intensive care and beheld a person of considerable weight. The short, thick neck and low level of oxygen gave me pause. The learned anesthesiologist, S Rao Mallampati and his associates had developed a score that predicts the difficulty in passing a breathing tube into a patient. The most challenging airway would rate a 4 on this classification. The unfortunate sufferer in front of me was a 4. The one advantage of my advanced years, is the more than three decades of experience that resides in my mens. With the assistance of the excellent nurses and respiratory therapist, I was able to insert the needed airway. I returned to my work station in the accident ward. Minutes later, the UIC called to tell me that the collar that seals the airway had failed. Once more I attended to the penitant's bedside and using a long wand placed through the defective tube, I removed that damaged hose and passed a new (carefully checked) tube over the wand.
Most nights at the Hospice of the River Valley, the penitants that seek care are few and their needs, though urgent to they and their loved ones, are usually not a threat to life or limb. My boon companions in the accident ward, the nurses and clerks, and I stand ready to offer relief, and compassion to those in need.
My aged mother, the duenna Dulce, resides in a residence for the elderly. Her physical and mental frailties are commensurate with her advanced years. We sat together in the sun room yesterday and I shared a cine of her great grandchildren dancing. Her creased face shone with joy. She was her usual pleasantly confused self. Her worsening memory, she counts as an asset, as she says that she doesn't remember the bad times. When I arrived at the elder hostel, she insists that she must attend to her hair. Only when she has brushed and combed her snow white locks, does she feel ready to face the day.
The shallowness of youth was the weapon that wounded a cherished friend. A former health giver at the hospice on the Merrimack, this sharp witted, compassionate, and scarlet haired damsel was wounded by a knave. The seniorita was betrayed by one she loved. The cad violated the trust that binds a couple beyond the formalities of the church or the state. My friend's heart will heal. My fondest wish is that someone worthy of her love will enter her life.
On arriving at the Hospice of the River Valley on a recent night, my presence was urgently requested at the bedside of one who's breathing tube had become dislodged. I rushed to the unit of intensive care and beheld a person of considerable weight. The short, thick neck and low level of oxygen gave me pause. The learned anesthesiologist, S Rao Mallampati and his associates had developed a score that predicts the difficulty in passing a breathing tube into a patient. The most challenging airway would rate a 4 on this classification. The unfortunate sufferer in front of me was a 4. The one advantage of my advanced years, is the more than three decades of experience that resides in my mens. With the assistance of the excellent nurses and respiratory therapist, I was able to insert the needed airway. I returned to my work station in the accident ward. Minutes later, the UIC called to tell me that the collar that seals the airway had failed. Once more I attended to the penitant's bedside and using a long wand placed through the defective tube, I removed that damaged hose and passed a new (carefully checked) tube over the wand.
Most nights at the Hospice of the River Valley, the penitants that seek care are few and their needs, though urgent to they and their loved ones, are usually not a threat to life or limb. My boon companions in the accident ward, the nurses and clerks, and I stand ready to offer relief, and compassion to those in need.
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