March 4, 2023

It’s a new month. I guess that means roughly 1/6 of 2023 has already gone by and I’m just at the point where I’m writing 23 rather than 22 when I’m dating things. I have to sign and date a lot of paperwork. Nothing happens in US healthcare without a physicians signed order resting behind it and, as I work in a specialty which requires a lot of coordination with outside agencies, the pieces of paper fly thick and fast toward my inbox, demanding a hastily scrawled signature and date. No one really cares what I scrawl as long as it’s something that can be attested to as my mark at a later date should any questions arise. Light days see 20 or 30 pieces of paper looking for my pen. Heavy days are closer to 75 or so. More and more of the intra-system works on electronic records and electronic signatures which are relatively easy but the minute you get outside of your home system, that all breaks down as no two electronic health records speak to each other and so off to the fax machine you go with your little pile heading off to home health agencies, assisted livings, hospices, and the like. We’re the only sector still dependent on fax as we’re still operating under 1980s and 90s rules regarding data management. Someday, they will be overhauled and we’ll join the 21st century. I’m likely to be retired by that time though…

I’m feeling a bit beat down by it all at work currently. My clinical partner is on an extended leave. We’re so short staffed this means I basically have to do both jobs until her return. We’re also onboarding new staff and are facing a move to a new suite in June. It’s always something. If the system were operating smoothly, all of us this could be handled in good grace, but it’s not. There’s a lack of both clinical and administrative staff which means referrals are not handled in a timely fashion. No senior living facility has adequate staffing at the moment meaning that those who live there are not as well monitored as in years past and are brought to attention at a later stage of disease making patients more difficult to care for. The pandemic driven consolidation in health care agencies has led to a noticeable decline in the quality of services available. The level of comfort with email and portal messaging on the part of patients and their families has led to an explosion in the number of contacts as they write in for every little thing, most of which are variations on normal. I really don’t need to review pages of unsolicited blood pressure readings and I really don’t need photographs of mom’s bowel movements. OK I’ve got that off my chest…

It will get better. My mood will improve or I’ll have a really good day at work or I’ll meet a new patient with a really interesting story about his or her life and I’ll be reminded why I do what I do. In the meantime, let me wallow a little bit. I think I deserve it. As long as it doesn’t continue for more than a couple of days…

I am slowly getting my backlog of projects under control. The financial records have all been collected for the taxes and my usual accordion file is ready for my accountant. I made my quarterly run to Costco. I got the shopping for the week done. I’ve reviewed the Sunday school lesson I need to teach tomorrow. (Pity the elementary class that gets me as their teacher). I finished up the legal case I needed to have done by the weekend. On the docket for tomorrow is getting the back broken on the talk I have to give in Augusta on the 14th. I have a basic gist of an idea in my head but I do have to get something on paper. As it’s going to be more or less about the importance of narrative in health care and senior services, I’m not going to prepare powerpoints or anything, I’m just going to talk and tell the story, but I sill need to have some signposts in front of me while I do that to be sure I don’t wander too far off into the rough. (See what I did there – Augusta – golf metaphor…)

I’m behind on my editing of volume 3 of the book. I should be able to get to that this next week. To be frank, I’m a bit scared to look over those entries. There’s this piece of me that’s afraid that I’ll read them and hate them all as they’ll be too repetitive and too filled with navel gazing to be of any interest. But there’s another piece of me that feels the story of the pandemic, as told in the book, remains unfinished and that third volume is necessary for the work to make sense as a whole. I’ll let me cognitive dissonance fight with itself for a while and something will eventually come of the battle. And what emerges usually ends up being pretty good.

I’m feeling the need to rant in depth on something in regards to the health system but I’m not sure what I can talk about that I haven’t already dissected in some way and I don’t want to repeat myself ad nauseam. Maybe I should move out of health care but the only other subject area in which I have significant learning is in musical theater and I’m not sure anyone wants my in depth analysis of the works of Rodgers and Hammerstein as compared to Kander and Ebb. If anyone has a request, I’ll take it under advisement.

A friend from opera circles made his Met debut today. I will never sing on stage at the Met (unless I join the cleaning crew) but I’m always thrilled when someone of my acquaintance attains that milestone. The combination of pandemic and finances has kept the Opera Birmingham chorus relatively silent in recent years but I should be back on an opera stage in 2024 (I know what the show is but I’m not authorized to reveal it). It will be the first time since 2019. There’s been some operetta in between but Covid pretty much knocked out most things the last few years and the 2022 and 2023 grand opera offerings used very small choruses and I’m not at the top of the list when you only have twelve slots. I have been back in voice lessons so my technique is improving slowly so by spring of 2024, I should be up to snuff.

I did get to sing once on a Broadway stage. I was invited backstage at the 46th Street Theater after a performance of Hamilton a few years ago. I made sure to go down to the lip and sing a few bars to the empty house so I could say truthfully that I have sung on Broadway… It counts, doesn’t it?

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