November 8th, 2007

Nescafe rabbit

From the road...

So to speak.
LiveJournal just released a client for Windows Mobile, which means that potentially I can use some of my Sudoku time to compose journal entries, which rumor has it are sorely missed.
I'm currently in $rural_county where my mother in law works, reviewing the possibilities of coming down here in a year and a half after I do my OB fellowship (assuming that nothing goes horribly wrong). Today is my afternoon to visit the next county north, where I'll be delivering, if I come, since this county doesn't have a hospital with an OB wing. They have an obstetrical group up there, which is good, except that that means I'll be trying to convince the OB-Gyns that they want to share call with a family doc. I wonder if the fellowship will mean anything to them.

It's a different world down here, in rural Indiana. My mother in law had a patient in the hospital, first day I was here. She shows me the blood gas. pH low, pCO2 high, oxygen sats borderline. "What do you think?" I think she's going to need intubated. Did you try her on BiPap?; She smiles slightly. "Guess I'll call $major_hospital..." It's an hour away, to the big city. There was a long pause while I processed this. They don't have an ICU here. They can do BiPap, but the only ventilators in the place are the two in the ER, for short term stabilization. ICU patients get transferred. This hospital averages 5 inpatients at a time...not even enough to cap our Medicine service.

I'm spending the mornng with Dr. Y, who's in the hospital employed group. It's a nice office, all new and shiny, with electric tables and twisty otoscopes, and you couldn't offer me enough money to use their paper charts. As much as I hate our current EMR, I'm beginning to see its finer points. Things like our electronic prescribing and tracking. And labs. I miss being able to track labs on one page. At least the community health center here has electronic charts, even if they don't know how to use them effectively.

It's beginning to become real, O Best Beloved. Before long there won't be any supervising faculty...
From the road...