Thursday, July 14, 2016

Journal Entry Thursday

It was a hard start this week.  Monday was a rough Monday.  I thought Sunday was saturday.  I’d been a way the week before and this confused me.  I returned to 2-3 times the work I left and the week I left I had 2-3 x the work to leave.  It’s always been that way.
I remember talking to doctors who simply gave up taking holidays because the work was overwhelming to get away. So many of my rural colleagues can’t get locums.
Some of it too is that I go away for a week and I'm out of the mines, out of the routine, out of the flow.  I have to think about things again that were almost done on autopilot. I made a mistake with a medication yesterday that was just 'stupid', writing a totally different medication down that vaguely 'looked' like another. The pharmacist phoned to ask for clarification and I made the correction but it was essentially like a produce manager giving you a cucumber when you asked for tomato.  I was just renewing the script so it was obvious given the previous record, still. That's the sort of thing that happens and worries me so much with the homungus multiplication of details and paperwork.  In the community I get this more and more with 'parts' errors so common that I'm actually surprised when a store gives me the right one first time.  I remember my friend getting the 'wrong' part on a vacuum cleaner bag 6x.  I remember every single error I've made with medications and prescriptions and I've noted a couple a year more caught by staff, pharmacist or patient. None life threatening but all unnerving. I went years without a single error and now the 'system' holds these errors within the process of prescription renewal and the multiplicity of drugs, pharmacies, specialists.  I miss the days when I saw young patients principally and they were not seeing a dozens specialists and on only the medication I was prescribing and only one pharmacist was involved and I knew him or her as the case was.  I have to accept the stress is overwhelming at times and change whether good or bad increases stress.  A half dozen of my favourite colleagues and referral folk have retired. I didn't realize that most were 70ish. I thought of them as younger but they've closed their practices and no one is there to take their patients over.  I 'm taking a few simply because I admired one colleague and we worked in a similar vein.  Patients constantly tells me everywhere they go the system is functioning like a factory. "I'm only allowed one complaint."  "She only has 5 minutes to see me." "The psychiatrist only saw me the first time and since then it's a nurse or a group.'  The complaints are systemic. I live in fear of the hoards of regulators and police watching the police watching the police and the media watching everyone and no one doing the front line work anymore or those who do so often have no skills or experience.  It's all troubling but surprisingly things go along and most work out.  There is a sense of foreboding in the air. That general sense that something is about to burst.  All the debts and struggles to pay the rent.  Several of my patients are not eating more than one meal. They're on pensions, spent their lives working and now have to go without eating to pay their rent.  Always there's anger.
Then there were the suicides. Early in my career every time I took a month vacation with the university or hospital I’d return to some patient having been turned away by the ER or someone not taking them seriously so they hung themselves or overdosed.  I was devastated because they all sought help elsewhere but it was ‘my fault’ because I ‘abandoned’ them.  I was doing psychoanalytic psychotherapy extensively in those days with borderline personality disorders who’d had multiple suicide attempts and were always suicidal.  Relationship therapy was the basis of there getting better. They’d see me weekly and to their astonishment I’d not beat them up or have sex with them.  All their care givers before me, mother, father, uncles aunts, boyfriends, girlfriends, siblings and even some health care workers had done that. So they just assumed that I would.  They were full of rage.  So when I would be away they’d go to the ER and tell the doctor they were suicidal and really and he/she’d send them home with some ativan, (‘brush them off’), there were ‘no beds’.  This is a real reason , a real medical reason, for an admission.  I can still feel my anger at those days.  It happened each year and I was afraid while I was away, wondering if my patients would get care. The dynamics of these suicides were mixed in hate/fear and full of ‘transference’ but in the end my ‘counter transference’ was simply that I chose to take 2 week vacations at most. Nobody killed themselves when I was away only for 10 days or 2 weeks.  There have been exceptions. I was sailing for a month back from Hawaii with a 3 week window planned only to have the mast break but by then I wasn’t doing mostly psychoanalytic therapy and patients were a really mixed bag with mostly drugs and alcohol, ptsd, somatic issues and head injuries.  Most services were ‘enabling’ borderlines or having passive aggressively written them off so I wasn’t doing in depth therapy. I liked that the borderlines I treated back then went on to be rich famous leaders and success stories.  I always felt that craziness was just going in the wrong direction and if you could turn it around the person would be going as fast in the right direction.
Now I’m working with a lot of other doctors and less alone but still there are no back up resources.  The advantage now is that there’s coverage at the gp level or walk in clinic level.  Then the cell phone has made all the difference. I’ve had calls most days while I’ve been away and that seems to be enough for my chronically suicidal patients.  No one has killed themselves in years while I’ve been away for years. Thank you  Jesus.
All weeks been a little sluggish but that’s mostly been the weather. I’ve had a whole lot of work and been exhausted at the end of the day. I suspect that’s aging. I ordered a pizza and simply watched TV I felt so drained. Went for a walk with Gilbert and a friend.
Was really thankful Thursday had arrived. Wednesday the ‘hump’.
I’m looking forward to the weekend.
Hate being inside with the sunshine, now that it’s returned. Fear that I need to get every ray to bolster me for the dark and grim Vancouver rainy season.
All’s well.
I’m thankful for Thursday and that no one is killing themselves.  Suicide is such lonely social terrorism.  Like a bomb going off and everyone around hurt by the blast.
I do like the sunshine today.  Thank you Jesus

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