The Same Mistakes

The last 3 days I have been completely sunk in work.  I don’t know what happens that causes this, but there will be cycles like this, during which there will be emergency after emergency, and our schedules in the office will get really crazy and unmanageable.  Then, just as mysteriously as the cycle began, it will end.  Full moon?  Bad weather?  Who knows.  The last 3 days was one of those bad cycles for me.  It reached fever pitch yesterday, when I was the only doctor in the office, which just compounded the matter.

I think everything is pretty much okay now.  Yesterday started out particularly badly, with a patient in terrible pain as my first patient.  I had her come in before office hours even were supposed to start, but it took her longer to get there than she expected, and managing the problem was complex, so I started my regular visits late.  Of course, that sets the schedule for the rest of the day.  I managed to take care of my patients and their needs and to run only a little bit behind all day.  It was the peripheral stuff that became a problem.

At 6 pm, I was finally alone in the office, but I was on the phone.  And I was fighting with an insurance company about pain medication for that first patient of the day.  They didn’t want to pay for her meds, for which there is no generic form.  She has already been on all the medications for which there are generic forms, and they are not working.  So I spent half an hour on the phone with a very nice woman who was just doing her job, explaining to her why my patient needed this medicine and why I had no other options.  My staff had already tried to do this earlier and had gotten nowhere, which is why I was doing this myself.  And at this time of night, there were no pysician medical directors available for me to discuss this with, so I had to be very, very patient.  This woman is not a doctor, or a nurse, or a pharmacist.  And she’s just doing her job.  Finally, she said, “Okay, I see.  I will fax you the forms, and it should go through.”  Oh, THANK YOU.  So I then spent another 10 or 15 minutes filling out the forms, which by the way asked questions that really made no sense, and faxed them back.  Maybe now my patient will get her pain medicines.  Twenty four or forty eight hours after I prescribed them.  She’ll be in pain an extra day or two.  What’s it to the insurance company???

After that, I returned non-urgent patient calls for half an hour.  Then I tackled all the charts I didn’t have time to complete during the day when I was trying to stay on schedule.  The charts went all the way back to the early morning.  I keep some notes from each visit, so I can go back and complete my notes.  I worry that I will reach an age where my memory is not good enough to do this, though.  What if I can’t remember at 7 pm all the things I did at 8 am?  Well, right now I still can, so I guess worrying is silly.

I finally went home about 8, answering a page or two on the way home.  I thought about my day while I was in my car.  Even though it was stressful, it was a good day.  I did a good job.  I took care of my patients well, and met needs.  I communicated with a few other providers where it was important.  The thing that was deficient?  My self-care.  I was totally depleted.  I only took 10 minutes for a lunch break, and I was making phone calls while I ate. I hardly drank any water because I didn’t want to take extra bathroom breaks.  I was eating candy at 7 pm, not because I was hungry and that was the only thing available, but because I was tired, and the sugar fix kept me going.  And it didn’t get better when I got home.  I ate a crappy dinner in about 5 minutes, ate more candy, and crashed with exhaustion.  I did talk to my daughter and husband.  Probably the only positive thing I did for myself all day.

I’m usually better to myself than this.  Even under stress.  Today, though the stress is considerably lower, I feel exhausted.  My own fault.  I know better.  My mantra:  If you don’t take care of yourself, you can’t take care of anyone else.  I’m going to try to compensate today.  And keep trying.  No matter how old I get and how much I know, it seems like I keep making the same mistakes and correcting them over and over again.  Oh well, here we go again.