I have been quiet on the blogging front this month as I try, somewhat unsuccessfully I might add, to reach my goal of 50,000 words on my new book this month as I participate in NaNoWriMo.  I have started my second book with a working tile of “Magpies in the Eucalyptus”. It seems I have become somewhat bogged down in the process of researching, and the writing is going much slower than I had hoped.

But….something very interesting has occurred.  My stream of consciousness writing seems to have infiltrated into the documentation at work.  I get up every morning at 5:00 to write for 90 minutes, until I have to get ready for work.  I arrive at work about 8:00 still thinking about what I have written earlier in the morning.  And then the race is on, to see the patients, write the notes and all this time, in the back of my mind I am thinking about an Australian boarding school, Aborigines and all kinds of things that have absolutely nothing to do with Otolaryngology.

So here is where the problem lies.  As writers we are told we must show, not tell, but as a provider of medical care, our documentation must tell, not show.  See where this might become a problem, if one can’t separate the two and they become muddled together?

To demonstrate how big a problem this has become, I offer two examples of medical documentation.  The first one is prior to NaNoWriMo, the second is during NaNoWriMo.  Please be aware that this is all made up and does not violate anyone’s medical privacy.

Pre NaNoWriMo

Timmy comes in with his parents complaining of intermittent otalgia to the right ear for 1 month.  Mom states he has been diagnosed with two ear infections since his last visit 2 months ago.  His ear pain is associated with fever, malaise, decrease in appetite and irritability.  He is otherwise a healthy boy.

Past Medical History:  Born full term, no hospitalizations or surgeries.  He did pass his Newborn Hearing Screen.

Family Medical History: No problems with bleeding disorders or complications with anesthesia.   No hearing loss.

Exam:  Active, alert 3 year old male, in no acute distress, holding his hand over right ear.

Ears:  Right ear – tympanic membrane is injected, bulging, landmarks are not visualized, +effusion

Left ear – tympanic membrane pearly grey, translucent, landmarks visualized, no effusion noted.

During NaNoWriMo

Sitting in the exam room, is a slight boy of about three years old.  He looks up, with apprehension flitting across his brilliantly blue eyes.  He slides closer to his Mom, as if seeking additional protection from my presence.  He is wearing a Spiderman shirt, with matching pajama pants, and Ninja Turtle slippers.  It seems he has been hurriedly pulled out of bed, based on his attire and the lack of attention to his hygiene.  His whitish blond hair, juts straight up from the crown of his head.  His mother, a rather burly woman wraps a reassuring arm around his shoulder.  She has dyed black hair, with streaks of magenta and purple.  Her face shows signs of exhaustion, despite the heavy foundation and eyeliner.  As I move closer, to sit on the stool in front of them, I see the creases around her eyes where the foundation has been compressed out. At one time she might have been a fairly attractive women, but the piercings in her eyebrows and lower lip, along with the lines of exhaustion around her eyes are evidence of a life that has dealt her some heavy blows, perhaps a life of finding her way, of self-expression and the needing to be noticed.

I ask Mom what has been going on since we last met.  She tells me a tale of sleepless nights, of Timmy crying soulfully, seeking comfort in the dark because of the pain from his ears.  She tells me of the frequent trips to their Primary Care Provider, the fight and struggles that have ensued in trying to give Timmy his antibiotics as he flails and splutters in an attempt to ward off the onslaught of sour tasting medicine being forced into his mouth. She says they are offered a brief respite from the frequent night awakenings when the antibiotics do their magic, but as the efficacy of the medicine wanes the nightly routine of waking, comforting, and administering ibuprofen doses returns.

I move closer to Timmy to examine him.  He looks up at me, his blue eyes are veiled with thick translucent blond lashes. Around him wafts the faint aroma of ketchup, fried foods and old cigarette smoke.  I wonder what their home smells like.  But I also detect the lingering fragrance of laundry softener rising up from his Spiderman shirt as he moves even closer to his Mom.  The smell reassures me that although some of his family decisions are not so brilliant or wise, they at least make the effort to keep him clean and comfortable.

After letting him explore and touch the otoscope I am holding in my right hand, I gently reach up with my left hand to retract his ear back ever so slightly.  He jerks away, and whimpers a small “Oww.”  His Mom holds him tighter and whispers, “Its okay, she is just trying to help.” I notice when she speaks, the ring in her lip moves side to side.  It’s unnerving.  After several attempts he allows me to inspect the right ear.  It is quite obvious his ear is exquisitely tender and any movement at all of the ear is quite painful.  Upon inspection of the inner workings of his ear, I see the tympanic membrane bulges with pink tinged fluid, the land marks are shrouded in angry red capillaries that wind their way down the ear drum.  I can almost feel the heat emanating out his tiny ear canal.

I remove the otoscope gently from his ear and look up at Mom, as I push away on stool, providing a safer distance between the two of us to converse.  “Timmy has another ear infection Mom, our conservative measures did not work at all.”  Mom nods, as if I am just confirming what she already knew.

There you are.  This is the writing demon with which I battle at work.  I much prefer the second version, but if I had to write notes like that I might be there all night.  I must learn to separate the two worlds, the world of NaNaoWriMo and that of medical documentation.

Photo credits:

elitemedicalscribes.com

wikiart.com