Comfort Zone

Chapter 42

Positive predictive value, my new best friend. Both Miriam and Ursula Taylor knew there was no reason to order a routine chest x-ray before Ursula's cosmetic surgery. Because she was healthy, the PPV of the test was too low. But instead of protesting the surgeon's request, it was simply easier to order the test.

And once it was done, a cascade of events began that no one was brave enough to stop. The lung CT showed the mass, so we ordered a biopsy instead of waiting for a follow-up scan, Miriam thought. We can't blame the lawyers for that. We weren't worried about a lawsuit. It was just our fears, insecurities and inability to NOT know that led to ordering it. The biopsy caused a collapsed lung, the chest tube caused pain, and the narcotic caused a fall out of bed which caused a broken wrist.

The wonderful news of course was that the biopsy was entirely negative. Taylor didn't have a cancer, just a scar likely from a childhood infection.

Dr. Taylor had gotten her wrist casted and instead of going home insisted on going to the office to catch up, saying to Miriam as she left, "Just don't go into any medication rooms again!"

It was Monday, after a weekend of unsettled thoughts and unsettling weather—thunder, with broiling hot and airless alternating with broiling hot and wet. Miriam, with a nod to Alison Lerner, planned an outing to the Botanical Gardens to soak up some nature, but ended up soaking up air conditioning instead.

She had to catch up, too. She once read that procrastination was good, it got you out of things you didn't want to do, things that weren't so important in the first place. But that didn't apply to paperwork, or botwork, or whatever you chose to call it. The work simply didn't go away, and had to be done.

The patients were gone and Miriam watched Belle tidying up and dusting her fish. She thought about sharing all her fears and questions about everything going on in the hospital, but decided not to burden her already overburdened helper.

She called good-bye as Belle left to meet her wife for dinner, and quickly got to work. Finally, her last task: a hospital discharge summary. She arranged the pertinent information for Mr. Vega in front of her, and prepared to launch into the dictation. Dictations were passé except among a few holdouts (whether rebels or Luddites Miriam couldn't decide), but the glitch in the hospital EHR temporarily prevented her from entering notes in the computer; she'd even been forced back to paper and pen to write her daily progress notes. She'd forgotten how messy they looked. Maybe EHRs weren't so bad after all.

About to lift the receiver, weariness suddenly overcame her. For all their shortcomings, paper and dictated notes tended to be more colorful than electronic ones. Bland, factual documentation might be essential (as per every administrator and defense attorney), but Miriam had collected a bunch of vibrant favorites over the years for moments like this, when she needed inspiration and a quick laugh:

"The patient is not in the room. What is in the room is a Pizza Hut box with three quarters of the pizza gone, an open bag of potato chips (nearly empty; I checked. I'm hungry too), and a liter bottle of Pepsi, half full. Where could the patient be? Possibly down in the cafeteria."

"The patient is signing out of the hospital against medical advice. I strongly disagree with his decision to go home, but out of my good nature will write his prescriptions." JK had written this one.

"Patient is irritable, and irritating."

"...frankly, I don't know what the hell's wrong with this patient, and can only hope one of the many specialists I've called figures it out."

Smiling, Miriam put down the papers and picked up the phone to dictate, then put that down too.

I don't know what the hell is wrong either, she suddenly thought, and I wish I had a specialist to call to figure it out.