Sunday, January 03, 2010

Mama, what do you DO all day?

That's a question The Pooter asks me frequently, upon greeting me at the end of the day, "Mama, what do you DO all day?" It's part curiosity, part challenge, I think. Like she's thinking, "What can this woman possibly be doing for the whole time she's apart from me?" After all, not everyone can have a jam-packed, exciting day at pre-school. Work, even organ donation, pales in comparison with the fun of dress up and arts and crafts.

When I ask her the same thing, invariably she just gives me an enigmatic smile and says, "Nothing."

What DO I do all day? People all seem to have the same response when they ask what I do for a living. Transplant Coordinator. Sounds important. Then I try and explain what I do and a small shadow passes over their face, sometimes ending with rapid eye movement and a small stream of drool from the corner of their mouths. "Well, you know, I make phone calls. I make sure people know how to live with their transplant, blah, blah." They must think to themselves, "and they PAY you to do that?"

Sometimes I ask myself what the heck I'm doing all day. I do spend a large part of the day on the computer and fielding phone calls.

Call #1:

"Hello, Kidney Transplant. How can I help you?"
"Hi, this is Beavis McButthead. I'm vacationing in Borneo and it seems I've just plum forgotten to pack my prograf. Can you overnight me a prescription? And please make sure it's written in Malay, I don't think the pharmacist here can read English. And make sure I get it before noon, we're rafting after lunch."

Call #2

"Hi, Kidney Transplant."
"Hi. Can you please fax my latest lab results to my nephrologist? And my cardiologist, endocrinologist, neurologist, personal trainor and taxidermist? Thanks."

Call #3

"Hi, this is Ima Nofollowup. I haven't been to clinic in 4 years, but you did my transplant 4 years and 3 months ago. For the past 6 months I've had swelling in my legs and my blood pressure's up and I hardly ever pee there something you can give me for that? Can you call something in? What do you mean I need to go to the emergency room. I can't sit in there all day, I have things to do." *

Lest I give the impression that my patients are all sluggards and dimwits, this only represents a SMALL FRACTION of my patients. And yet, they are the most memorable. The ones that make me scratch my head and wonder if a career in food service is for me.

So what do I do in my 40 hours a week? When I was on the procurement side of the organ biz, I wrote many and lengthy posts on my exciting job. So I figured it was time I at least mentioned what the heck I'm doing and, believe me, it's not surfing the internet and drinking coffee, like some people I won't mention who live with me seem to think. Here goes, I hope you can handle the excitement.

Clinic 8am to 12noon. We see probably 30-40 patients, some new, some out for many years and in between. Everybody gets blood work, then sees one of the post coordinators and one of the docs. All the labs are hand transcribed into their charts. Don't ask why-now excuse me while I use my abacus to calculate this drip rate.

I start transcribing at about 10am, in between patients. At noon, I take my charts and head downstairs to my office, grab a bite to eat and listen to my phone messages, which are legion. I check the fax and mailbox to see if any outside labs have come in. Then I keep transcribing until the prograf levels come back, about 1:30pm. Then we review everybody's labs with one of the docs. Depending on the amount of patients and the doc in question, this can take as little as an hour or last until 5pm. Then I call EVERYBODY and say, "increase your prograf or decrease your magnesium or get a biopsy panel next week and drink more water." That sort of thing. Then I go home and dream about potassium levels until morning.

Is catch-up day. I go through my follow-up book to see if all the folks who were supposed to have repeat labs or tests or biopsies actually did them and that they were reviewed. Not a big deal, except I have a case load of about 250 people, give or take, with maybe 100 who are active and in my radar at any one time. And remember, I'm using an abacus. Next budget, we intend to ask for some papyrus, but perhaps that's just a pipe dream.

More catch-up in the am. In the afternoon, we have our big, multidisciplinary meeting where we listen to the cases of people who were recently evaluated for transplant and decide if we are going to list them. I always thought this would be fraught with tension and excitement, that we'd be debating the ethics of who should get a kidney or not, but mostly it's pretty boring. Occasionally we get someone who is in a bad way, medically speaking, and we turn them down because they probably wouldn't survive the surgery, but mostly it's just listening on and on about stress tests and cardiac clearances and such. NOT that this isn't terribly exciting for the person who wants a kidney, I'm just saying it lacks the drama of House or Three Rivers. (I expect, anyway. The only medical show I watch is Scrubs, because it's the most realistic).

Same as Monday, but I cover 8am rounds of the in-house patients.

Rounds again, and sometimes more meetings. Wednesdays and Fridays are nice in that I sometimes actually take an hour lunch, away from my desk, sometimes with other people. That's nice. But Fridays are busier because we do a lot of teaching on Friday, especially with living donors and their recipients.

The initial teaching takes a few hours. I split the bulk of it with the pharmacist. We cover wound care, monitoring I&O's/vital signs/blood sugars(which the patients have to do on their own at home), activity, diet, OTC meds, transplant meds, signs and symptoms of rejection, how and when to call the office, clinic schedule and routine, infection control, ureteral stents and a little something called "lifestyle modification".

Lifestyle modification covers everything from washing your hands frequently to not having a bird (too many diseases) to what to do when your kids get a live vaccine to whatever. It depends on the individual. We had a guy who inspected garbage dumps for a living(who knew!) and needed to wear a certain type of mask when he was on site inspecting. Transplant patients have left behind chronic disease only to replace it with life long immunosuppression. Usually, that is a change for the better, but it comes with a lot of risks, including strange, nasty infections that the non-compromised have never heard of. It's a lot to cover. Of course, it's not just one day of teaching, the teaching is ongoing and we see them in clinic twice a week for several months, so we're always reinforcing things. That's a nice nursing term-reinforcement. But it's true, living with a transplant is a lot different from having a knee replacement or even a cardiac bypass and that's why, tedious though it may be at times, the patients get a coordinator.

Inevitably, it is Friday afternoons when I get the 4:30pm emergency. The nephrologist walks in and tells me I need to book a patient who's in rejection for IV solumedrol over the weekend or someone calls that they're going to the ER and I have to call round and let the team know. Then I'm off, for two glorious days we call, thanks to unions, the weekend. There, I'm officially a 9-5er, a corporate slave, a cubical dweller. It does not sound great, but in truth, I do like it. If I can think of a way to tell you without violating any HIPAA laws, I will, but that's another post.

(*All calls are fictitious and represent a composite of calls I may or may not actually receive. All patients are theoretical and not actual. Also, objects in mirror may be closer than they appear. Thank you."

Friday, January 01, 2010

Happy 2010!

Well, maybe it'll be the year I make contact, anyway.

Happy Happy! Pooter is especially excited that I'm off today. "To celebrate the New Years?" she asked. Yup. I'm grateful for two 3-day weekends in a row(three, actually, I took the 18th off, also).

Off to play. May your year be full of blessings and goodness.