Several things have conspired recently to encourage me to post to my blog again. The major one is my dearest friend, Charlie. We live far apart, but he says he sometimes reads my blog to feel close to me. I like that, and feel a little guilty that I haven't blogged in so long. Then contact with an old ex-friend and a visit to her blog made me miss blogging too. She writes amusingly and interestingly, and made my muse stir a bit.

Much has happened since the last time. I am in my sweet little house. I love it dearly. I have been fired (most unfairly!) from a job I loved, but obtained one I love even more. The Grub Club has resumed after many years of neglect. My sister-in-law's mother is dying. My stepdaughter's children are thriving. My own boys are doing well. My youngest is in love. I have added a Boston Terrier (gift from a patient) to my menagerie. I have sarcoidosis. I have been betrayed by someone I thought I could utterly trust. I have added skills as a nurse practitioner. Changes, big and small, I have lived through them all.

Work is often fun in my new circumstances as a partner in the business. Working for myself rather than for a big corporation has had a positive impact on my attitude toward patients. It is so much more personal now. The connection is direct. I like this change.

Doc and I work very well together. He is very good at figuring out complex regimens for people with multiple medical problems. I am very good at anything invasive. I go to him with my diabetic hypertensives with arthritis who can't take several needed medications and he helps me work it out. He calls out for me whenever anyone needs a pap smear, rectal exam, catheter, IV, removal of foreign body from orifices, drainage of abscess: anything that involves sharp instruments and bodily fluids. I swear, if I had it to do over, I'd be a surgeon. I like the simple, direct approach and the often gratifying results.

I am the balls of our outfit. Doc is kind. He hates to hurt anyone's feelings. He loves to make everything better for people. He likes to fix things, even non-medical things. (He has spent hours of research trying to find a purpose in life for my older son, while I am inclined to let the boy gradually find his own way!) I am more likely to go to a certain point in helping patients and to feel like from there it is up to them. (HOORAY! I am learning my limits!) But while I don't like to hurt feelings any more than Doc does, I am able to say no. Doc has ended up with many drug abusing patients because of his inability to say no. This can cause us trouble with the DEA. So I am given the task of dealing with abusers. The front desk ladies pretty much know who they are, and they schedule them to see me. They won't even let them near Doc. Anyone requesting pain meds is put through a sort of verification process. (This really sucks for legitimately hurting people.) They have to fill out a pain contract, and we drug screen them BEFORE they get a prescription. This weeds out many of them. We are up front with the fact that we will not prescribe any narcotics for anyone using street drugs. They say fine, but are a little surprised when we ask for a urine specimen. We have drug tests that can be done on the spot, with results in about two minutes. And many of them come back positive for marijuana and cocaine. These people are dismissed then and there. That is what Doc hates to do. He would listen to their excuses (which are AMAZING sometimes!) and let them have their drugs. I listen to them for a moment or two, then become a wall. I'm sorry, but you're still dismissed. It's time for you to go now, you've been dismissed. I won't argue with them. If you ever engage, it becomes just horrible. Many of these people are determined to simply talk you to death or acquiescence. It is better not to respond or argue.

I hate it. This is undoubtedly my most despised job duty. But I feel a perverse sort of pride that I CAN do it. I am becoming strong.

But give me a big ole ripe abscess to lance any day!