Winter Storm

For my first nineteen years of practice, somebody else took weekend call when the big snowfall hit, then last year, my final one at Christiana, the lot fell to me.  I stayed overnight there for two nights, handled one emergency from ten miles away and scratched the fender of my car on a snow bank.  Now I am in Philadelphia where I take call half the weekends so having to cope with the Big One becomes inevitable.  So it is this afternoon.  I knew that the white downpour would arrive at about mid-day so I went to Mercy Philadelphia Hospital a little earlier than has been my Sunday custom, saw all the follow-ups and three new consults, then headed home with the expectation that I will be devoting tomorrow morning to shoveling rather than office patients.  I'd have closed my own office in these circumstances as few people can get around, though a few hardy folks always manage to show up.  Somebody is on site at the hospital so people receive the care they need though often from somebody who will need to catch up on sleep as soon as the relief crew arrives.

This time also offers an opportunity of a few hours without the usual intrusions.  It becomes a chance to do things that are important when most work days are devoted to shuffling the urgent.  Time has come to set the semiannual tasks, work on my two upcoming talks, tone down my ornery disposition by a vigorous session or two with a white driveway.  No need to arise as soon as the alarm buzzes tomorrow.

Hanukkah

We lit the first candle last night.  This year, in our silver oil menorah, we used shabbos candles instead, as the oil can be quite messy and the shul's gift shop did not have any this year.

Hanukkah has multiple themes:  victory by underdogs, living on one's own terms, recognizing the value of small amounts of good oil when usable but defiled oil exists in abundance, adding a new candle each night as there is more to celebrate as the days proceed.

In the late afternoon, not long before the sun set, one of my favorite pharmaceutical rep pairs who used to call on me to Wilmington stopped by the suite at Mercy to deliver some Novo insulins and Victoza samples.  I was having a wicked day, ultimately seeing a personal record of eight consults before I departed for home long after most people had kindled their first Hanukkah light and munched their first latke.  I interupted my tasks in the hospital to visit them for a few minutes.  Drug reps make good spies, since their rounds take them to many places and they hear a lot of candid comments from doctors and office staff.  So I caught up on some poop at Christiana and the welfare of my former colleagues.  While I am rather content with my surroundings, despite not having the day to day control of my activities that I had in my own office, I've been treated rather well thus far and really like the people I've met along the way.  All eight of the patients I saw as new consults probably benefited from what my skill provided them.  I suspected that my colleagues at CCHS struggle more with their employer than I do with mine.  That turned out to be the case.  I think at least half of them are virtual serfs, tilling the exam rooms and wards under difficult circumstances, seeing large volumes of patients who get processed through more than they receive the individual attention than my partner and I are able to give and who need the medical care a lot less than most of the people that I have been seeing.  While my path of least resistance as my office became less viable last year would have been to have them annex me, that shidduch was not to be.  Those left on the outside but with a mission in mind sometimes really do triumph over the dominant players.

Weekend on Call

My first weekend on call at Mercy.  It was definitely a quieter place than Christiana, with four new consults and about eight others who needed some kind of personal attention.  There were not a lot of consultants or even ICU people or surgeons milling around by early afternoon, with the assigned hospitalists and a few residents assuming most of the patient care.  On Saturday afternoon, the hospital hosted a community health fair so I agreed to occupy the ASK A DOCTOR table for about 90 minutes.  A few folks came by including a couple of diabetics who needed some professional attention, but mostly folks with minor events that would not ordinarily incur a medical visit but as long as somebody is there to look at the rash or sore shoulder for free, why not.  A physician who charges nothing is worth nothing (Bava Kama 85a), though that comment comes in the context of just compensation for an injury which includes payment for medical care, which by Talmudic requirement has to be mainstream care.  I must say, I enjoyed being at the table, watching the people go by as I sipped on a Diet Coke.

Then Sunday I did real on call type of work, a slower pace that enabled me to think about what I was doing, instead of the Christiana burden of just getting through the enormous census and unending cell phone interruptions.  Definitely a more civilized experience, and I suspect a lot better for the patients to have a doctor who is thinking more about them than about the tasks that lie ahead.