Kevin's Brother and Sister Visit

We had a blast! Chris, Joey, and Kevin got in lots of fishing, but forgot to take lots of pictures. Perhaps the highlight of the trip was our 20 mile ride on the Trail of the Coeur d'Alenes. Of course, Bonne and I visited several quilt shops and spent some time making our embroidered bags. Seems like their 5 day stay went so quickly. We can't wait until the next time we get together.

Wordless Wednesday

Summary Saturday

Hi. I got the idea for organizing blog entries from my neice Lacey. She uses Wordless Wednesdary (for pictures) and Flashback Friday (as an oldfolk I should have lots of these) and I am going to add Summary Saturday. I want to encourage all my other peeps (you know who you are to do this) because it will help keep our blogs going when it feels like there is nothing to say.

Anyway, since it's Saturday, I shall summarize...

Kevin has been fishing twice and caught 8 trout both times. He has a new boat and new trolling techniques. He says he likes it because he can go at 7:30 in the morning instead of 4 AM. I always though the 4AM thing was insane.

We are getting ready for a visit from Kev's sister Bonne and her husband Joey, and his brother Chris. Its been 6 years since Bonne and Joey came (for James' and Leanna's wedding) and 19 years since his brother was here. We are planning to go biking on the Hiawatha Trail and Trail of the Coeur d'alene's and of course, since Bonne is a quilt nut, we will go on a shop hop. There are at least 4 very nice quilt shops within 50 miles of here.

I had a record setting month in June for billings and so that will make for a nice fat paycheck for the next few paydays. Health care is certainly recession proof, but unfortunately, I am seeing alot of stress related illnesses due to the recession. Also saw two cases of the Swine flu last week and so got my exposure, but did not develop it.

Got a fab new Software from Bernina called "My Label". You take 47 precise measurements and a 3-d model morphs into your body. Then there are pattern styles that you can create to fit your body exactly. There is a steep learning curve and lots of possibilities. I made a terrific fitting and flattering pair of pants for work last week, but I'll admit, there have been a few duds made before that. There is a lot to learn, but that's what I like. Bernina is having a webinar on July 7 on pattern alternations and I can't wait. Had to go out an buy a headset for VOIP to participate. All this learning really helps me feel young and keeps my mind sharp.

Went to the North Idaho Quilters show this last weekend. It was great. I could have spent alot more time there, but my long suffering husband started getting bored within a half hour and humming in his bored way. I wanted to leave him at home, but he said he wanted to come (I'm sure to keep an eye on me that I didn't spend too much.)

While there, I saw a saying, done in sparkles, meant to be affixed to fabric...

"Born Free...Now I'm Expensive". Its true, its me, but...how many other females who are like that actually make the money to support their habits?

Now I have had to put my sewing stuff away until after Bonne and Joey and Chris leave in order to clean up and get ready for them. Oh...I am really missing it.

Lauren is doing fabulous. She is 23 weeks pg and has been following her gestational diabetes diet and doing a great job in addition to being a great mom to Natalie and working 36 hours a week. I'm very proud of her.

We took Natalie out for her birthday last Friday and I gave her all her pets. She is such a sweet child, but I have to giggle, because now, everything out of her mouth sounds like it came from a Barbie princess movie or Pretty Ponies.. It is sooooooo sweeeeeet. She is going to be a great big sister. I think even though Lauren didn't plan her babies 8 years apart, its going to be a good thing because each child will feel special.

My son James is doing awesome as usual, although the recession may have put a damper on his Chief ambitions for awhile. Chiefs aren't getting out of the military so the E-7 rate is overmanned in Persion. His 27th birthday is coming up and I don't know what to get him. Any ideas anyone?

Well, if James birthday is coming up that means mine is too! Will be 53. Sounds old, but doesn't feel that way. I remember my mom always said the 50's were the best years and so far I agree with her.

Well, enough chatting. I'll sign off and leave you with one picture from the week, taken with Kevin's new camera.

Maybe Its Not Them, Maybe Its Me

Okay, self-reflection time.

One of my doctor pals was telling me about a USA Today article he was reading about "difficult patients". He said that the longer a provider was in practice, the fewer difficult patients they thought they had. The article also said that female providers felt they had more difficult patients.

Then he said that its likely that difficult patients are attracted to females because they are more likely to listen and try harder to "fix" them. And of course, the patients love them for it.

If you add a nursing background to the female part, its probably even worse. Nurses are taught to be tolerant and to a certain extent, sacrificial, as part of their professional training. I think that is at the core of why I've been feeling frustrated lately.

I'm being manipulated and taken advantage of by a just a few patients. But my feelings about that and them overshadow all the pleasure I get from all the other patient interactions. For example, a patient on Thursday (at 4:10 PM) said he needed a letter for his FAA physical and it needed to be ready when he came in for his labs at 8AM Monday.

I told him that dictation would not be back by then. If I had cajones I would have left it at that, but noooooo. I said that if it wasn't back by Friday I would type it up myself. By Friday afternoon, I was so busy that I wasn't able to get to it. I was toast and just not able to face staying even later to get his letter done. So tomorrow, I'm going in on my day off to get the letter done. To top it off, I'm not getting paid for any of it.

Who fault is this problem. MINE!!!! Geez, I've really got to get a spine. How hard would it have been to say, "I'm sorry, I just won't be able to accomodate you with so little notice."

I have a few others like him, who are always pushing me to do things for them that require extra work or are against my better judgement....like the lady who demanded the MRI in the previous post. Or the patient who wants a refill on their pain med before it is due...

If I'm going to survive in this role, I've got to grow a spine.

At lunch today, the new nurse practitioner and I were discussing these things and she is struggling with the same issues. The docs we work with are supportive and they do seem to understand how hard it is for us. My husband pointed out that it is ironic though, because as nurses, doctors were the people we had to put up with and couldn't say no to.! Perhaps I'll ask them to pay for a few hours of counseling for us to teach us how to say no without feeling bad about it or angry because we didn't say no.

Rant

As a family nurse practitioner, I'm in the trenches of health care. As my family and friends know, I work with several ex-pat Canadian physicians who came to this country to escape socialized medicine. I do support president Obama on many things, but socialized health care is not one of them. There could be many benefits to socialized health care, such as more emphasis on prevention, ie, free immunizations and low cost colonoscopies and smoking cessation meds. You know, spending health care dollars on the things that really make a difference. However, I also know from personal experience that the American public has a long, long, long way to go before accepting the realities of socialized medicine.

I'm quoting another one of our physicians here, not a statistic, so I can't vouch for its validity, but he says that we've got to get our priorities straight...that 80% of health care dollars are spent in the last 2 weeks of life. Before we adopt socialized medicine, we have to have a national discussion about prolonging life at any cost. For example, today I saw a very nice woman, with non-Hodgkins lymphoma, somewhere in her 70's, who told me that her oncologist wants to do a stem cell transplant after she is done with this round of chemo. (5 weeks in the hospital and hundreds of thousands of dollars). She didn't say so, but I could tell she is ready to throw in the towel. And I say, that is an honorable and perfectly reasonable decision. One that should be supported with every loving resource we can provide to her. Death will come to us all. Expensive cures for cancer and transplants only delay the only certain outcome for all of us. Where do we draw the line? Should we do cardiac bypass surgery on 50 years olds- 60 year olds - 70 year olds - 80 year olds?

Should we even do a stem cell transplant on a 70+ year old woman if she wants it? Who is going to pay for it? She is Medicare age, so every working American pays for it. Don't even get me started on Octu-mom. In socialized medicine, we will have to pick and choose how we spend our precious tax dollars and that does not mean that patients will get everything that they feel is their right. Seems to me that none of the politicians are addressing this most important question. They tried to address these questions in Oregon once (land of the liberals). They said that there was only so much Medicaid money and they rank ordered medical care according to the least expensive/most productive (immunizations) and the most expensive/least productive (providing medical care to a baby born without a brain). Then they drew the line at #100 (or something like that). Guess what? People couldn't live with the lines being drawn. The lines were declared unconstitutional. So everybody had the right to full medical care. Now, people on Medicaid seem to get the most medical care. People who do not have insurance often go without or go begging. (I'm thinking of my young diabetics patients who call me up begging for insulin or test strips they can't afford because they work somewhere where that doesn't provide medical insurance. They need those $100 bottles of insulin to live!

I have been dealing with a patient who came to her first appointment with me five weeks ago defiant and confrontational and demanding a MRI after a fall that caused painful sensations in every limb of her body. She had a perfectly normal neuro exam. I had no doubt that she hurt. I gave her pain meds. But what would I MRI? When something goes wrong after a fall, there is pain on one side or one limb and there are usually neurological changes. An MRI costs 1800 dollars. When the insurance company said she had to try conservative treatment (PT or chiropractic, and NSAIDS) for 3-6 weeks, she wrote them an angry letter and threated to sue the insurance company. Then, she said I pissed her off because I ordered an electrodiagnostic study in an attempt to try to pinpoint where her problems were coming from in order to order the right MRI. It cost her $900 and she has a $3000 deductible so she had to pay for it. She wants an MRI! Well, she can have an MRI if she wants, but her insurance company is not going to pay for it. I have spent lots of unreimbursed time on this situation and she is not any happier.
I think its like homeowner's insurance. We can't just call up our homeowner's insurance and say...I want a new roof. I'll sue you if I don't get a new roof. You can get a new roof if there is objective evidence that you need a new roof.

So many people are angry and demanding. I get that times are very hard. However, many people demand antibiotics for viruses and x-rays for painful knees. (Even though time and ibuprofen take care of most things). They often bring in a 5-6 item list of problems they want to discuss (in addition to the problems we need to discuss, like their blood pressure or diabetes) because their visit will cost them a $40 co-pay and they want to get their money's worth. But they are scheduled for a 15 minute visit. After the appointment, which goes long because we are trying to deal with everything, we rush into the next patient room and that patient is upset because we are late! Frequently when the patient hands in their carefully considered prescriptions, we will receive a rejection notice from their insurance company, because the medication is not on their formulary. Of course, we don't know what the patient's formulary is because they don't bring it in, but often the patient is angry when he or she can't fill the prescription we gave them. Actually they could, but they would have to pay for it. People forget that they can have anything they want if they are willing to pay for it.

Health care has become so contentious. Some patients say..."well, you should just see fewer patients. Then you would have more time for me. Why do you have to see so many patients every day? " Because the first three patients an hour pay for overhead. The forth patient is when you get paid. If there is 1 cancelled appt or no show in an hour, the doctor or NP works for nothing. I'm told that in Canada, physicians see 1 patient every 6 minutes.

When socialized medicine comes, patients will have to make an appointment for everything and only 1 problem will be discussed. If the patient wants to bring up another issue they will be told to make another appointment. How do I know this? Because they is how it is done in Canada.

My Canadian doctor collegues say that this hell that we are working in now reminds them of what happened in Canada before socialized medicine began. And we are mixing this time of social change with the Baby Boomers growing older and needing more medical care...the Baby Boomers, who grew up thinking the world revolved around them and that they are entitled to the best of everything.

But there is simply not enough money to go around.

I made a similar comment once on Fat Doctor's blog. She wrote me back personally and commisserated. But my comments received several angry responses from people who said I should get out of medicine if I felt this way.

How I feel about this has nothing to do with caring for my patients. I've grown very fond of most of my patients and am priviledged to share their trials and joys with them.

But I'm pretty sure most everyone in health care is feeling this way lately. And I sure do not know what the future will bring.

Sewing Fun

Well, I finally feel pretty comfortable with my serger now. In fact, I love it! Its the race car of sewing machines. How thrilling to sew, cut, and finish a seam so quickly. (I'm easily thrilled).

I wanted to post a picture of my latest quilt, Amythest Fans made for my co-worker's wife who was just diagnosed with breast cancer. It is a paper pieced adaptation of "Grandmother's Fan" and if you look closely, you can see a little pink ribbon heart embroidered on the lower right side. It was designed using a computer software program called Electric Quilt which is pretty cool. Actually, its pretty amazing. I've still got alot to learn about using it though.

I'm working on a multiblock quilted wallhanging by McKenna Ryan called "Petals of my Heart". I'm thinking of hanging it on a big wall at the office, but probably will take an anonymous vote of staff first, since I'm well aware that not everyone thinks these things are pretty. Some patients really seem to love them though.

Sometimes my work is very stressful and sad. Now that my practice has grown and I have a relationship with my patients, its sad to hear when they get cancer or die. This week, two of my patients were diagnosed with cancer and one other patient died suddenly. That sadness is the downside of caring about your patients. I think that's why this hobby gives me such joy. Touching the fabric comforts me, dreaming about what to do next distracts me, and making something beautiful, especially for someone else, seems to balance out the bad stuff. Thanks goodness my husband is so understanding and really supportive. He really is my sweetheart.

Happy Valentine's Day!

What you might not know about my spouse and me.

What are your middle names? Nolan and JoAnn
♥ How long have you been together? Married 35 years this comming July
♥ How long did you know each other before you started dating? a few weeks I think. It was a long time ago.
♥ Who asked who out? Kevin was the pursuer.
♥ How old are each of you? I'm 52 and hes 56
♥ Whose siblings do/did you see the most? Mine although we keep trying to get Kevin's brothers to come to visit. They're very stubborn.
♥ Do you have any children together? Two grown up wonderful kids
♥ What about pets?Three dogs so ugly they're cute.
♥ Which situation is the hardest on you as a couple? Changing roles with Kevin as homemaker and me as full time worker. Pretty much everything we have argued about in our marriage comes down to power struggles.
♥ Did you go to the same school? No
♥ Who said I love you first? He did. He was so sure of his love that it frightened me.
♥ Are you from the same home town? Close enough
♥ Who is the smartest? We're both smart but in different ways. He has a photographic memory which works well since I never remember where I put anything!
♥ Who is the most sensitive? Me, sometimes overly so.
♥ Where do you eat out most as a couple? We're eating out alot less these days. We like to go to Sonic.
♥ Where is the furthest you two have traveled together as a couple?Alaska cruise
♥ Who has the worst temper? I do, but Kevin definately has his moments and doesn't put up with my crap as easily as he used to when we were first married.
♥ Who does the cooking? Kevin
♥ Who is more social? Neither of us is that social. We enjoy each other's company mostly and we both can act real nice.
♥ Who is the neat-freak? Neither of us. Kevin likes to pile things up. I like to organize things but can never be neat. are
♥ Who is the most stubborn?I think Kevin is but I think he thinks I am!!
♥ Who hogs the bed? The dogs.
♥ Where was your first date? Not sure, probably a drive in movie.
♥ Who has the biggest family? Kevin does, but they are not as close as my family
♥ Does your husband send you flowers? No. Kevin is romantic in a different way, like the time he drove to my work in Ice Storm to scrape my windshield for me and the way he makes me breakfast every morning.
♥ Who do you spend the holidays with? Always with each other.
♥ Who is more jealous? Neither. We are pretty secure in our love and fidelity.
♥ How long did it take to get serious? Kevin was serious right away but I took a little convincing.
♥ Who does/did the laundry? Kevin
♥ Who’s better with the computer? Definitely me!
♥ Who drives when you are together? Kevin

I just wanted to let everyone know how much I love my husband. Happy Valentines Day Kev!