Reveling in the ‘Q Word’

Monday, New Year’s Eve, was pretty quiet around here.

“Don’t say the ‘q’ word!”

I remember from days long ago working as a resident, the nurses used to yell at us if we said things were “quiet”, superstitiously fearing opening the floodgates of patients coming in this would cause, but I think it’s safe to say it in retrospect, after the day is done.

When I arrived at the office early Monday morning, I knew that most of the faculty in our practice and most of the residents were scheduled to be off, on vacation, or out of practice.

There were only a handful of attendings seeing patients, and only a few residents mostly doing interim coverage, and in fact in my little area of the practice, I was the only one there.

A real skeleton crew.

We had blocked off most of the time on our schedules, to ensure that we had adequate space for urgent visits, and looking at the schedule for the day there were only about 80 patients scheduled to see us all, compared to the usual 300 or so.

About a dozen patients were scheduled for anticoagulation clinic, since anticoagulation monitoring takes no holiday, and interestingly there were four patients on the schedule listed for an “annual examination.” These were the folks that realize at the last minute that they absolutely, positively have to use their free annual physical appointment before the clock strikes midnight, or they lose that benefit.

There were appointments for blood pressure checks, asthma exacerbations, vaginal bleeding, cold symptoms, and quite a few pre-operative clearance visits.

One patient of mine came in for a “regular checkup”, until we realized that I had last seen him nearly 6 years ago, so it was more a “get to know you again” new patient appointment.

There were a few rapid discharge appointments, for people being seen who had just recently been sent home from the hospital and needed to be checked up on, and a few appointments that had been collected by the on-call resident and attending over the weekend, who were told to come in to be seen first thing Monday morning.

Most of what we did that morning and into the early afternoon before sending everybody home was a lot of telephone and patient portal message coverage.

Lots of patients had spent the holiday week before with relatives out of state, where “everyone was sick,” and a lot of people needed to be talked down off of the Z Pak ledge.

We were called for constipation, fatigue, shortness of breath, chest pain, headaches, “something in my eye,” urgent STD testing, and more.

There was panic to reach a provider before the mid-week holiday, and some needed to be reassured they were heading into the new year with nothing bad brewing.

For the most part, it felt very much like any other day, except my footsteps echoed when I walked down the hallway to the bathroom, since no one else was there.

I got to look into the charts of many of my partner’s patients, since covering them I needed to know a little bit about these patients, and I got some new and sometimes really interesting insights into how differently we all practice. “You prescribe this medicine for that?”

Sometimes it took some digging to figure out what was going on, but other times the clarity was there, the clinical intent was clear, the notes made it easy to assume the care of those patients for this brief time.

Throughout the day, my email and social media sites were constantly popping up with New Year’s advice, and I was amazed at how often it reflected the same messages that I was giving.

For a healthy 2019, get plenty of rest, keep hydrated, minimize alcohol, don’t smoke, exercise, meditate, take your medications, do your health screenings, take your vaccines, wash your hands, build healthy relationships, do the right thing. I felt a lot like Dr. Google.

As the afternoon began to slow, and we prepared to roll over our telephones to the answering service, we ordered pizza and folks gathered to recharge with some carbohydrates and cheese.

Everyone was looking forward to their evening plans, whether they were snuggling on the couch at home with family or out partying in Times Square in the rain, and much as we all love doing this job, everyone was looking forward to a day off in the middle of the week.

Most Mondays at our practice are very different from this, with our exam rooms and waiting rooms packed with patients, and practitioners scurrying around trying to keep up, trying to get everything done, trying to do what’s best for our patients.

On this particular Monday, no one was getting prior authorization, we were just trying to keep things going until the new year rang in.

Like every other year, and every other holiday, we made it through, and our patients and our providers all seemed to handle it pretty well.

The patients we spoke to, either on the phone or electronically, all seemed incredibly appreciative that we were there for them on that day when most of the city slept.

Now we start 2019 with a clean slate, the schedules this week and next ramping up with more and more patients to see us, and it’s time once again to tackle the challenges of working to build a better healthcare system for all of us.

And as much as it was kind of cool feeling like (pretending like?) I was handling it all alone, it’s good to have the full complement of everyone on our healthcare team back where we belong.

Away we go.