It may be a little corny, if not melodramatic, to be talking about giving thanks at Thanksgiving.  But there is a point to all of this. You know the saying that you don’t know what you had until it is gone.  Well, it works both ways. You don’t know how bad things were . . . until they are better. I’ve shared openly about the uphill battle to get this ship upright and at sea. I can say, now six months later, that it is full steam ahead. I had lived through about 8 months of extreme stress.  I got to a point where I literally felt sweaty palms each time I opened an e-mail or a real letter. Over and over it was bad news.

So, I’m sitting in Mesa, Az waiting for my flight back home. We were just told that it will be another hour wait so  have time to chat. I was here for the Scottsdale Headache Symposium.  We finished early this morning (10 AM) so my wife and I hiked from the hotel to the top of Camelback Mountain (pictured). It was a 5 mile round trip hike.  The climb up the mountain is 2.5 miles of that. It is steep. Very Steep in places and 50% of the “hike” is bouldering. They have these strange metal rails up the steepest parts, which do help. So, I’m a bit tired. But this is also a respite from clinic climbing. My mind has been able to get away from the grind for time to reflect.  On Thursday night I did a presentation to a group of NPs and PAs about my process.  I was almost moved to tears when so many came up and said dumb things like “you’re my hero.”  I was moved to tears because I feel like for the past year I’ve been one of those adventurers who is skiing, solo, across Antarctica. It is nice to be with PAs and NPs who understand what I am talking about when I struggled with banks who would not loan to a PA who is trying to start a clinic, or malpractice insurers who couldn’t get their heads around the idea. I had some quality visits with my SP, whom I brought to the conference. I got to rub shoulders with many old colleagues.  It has been a good time. I’m going back feeling refreshed, and with a new zeal.  I see things I need to fix in the way we do business. I have some new dreams of expanding into different cities and into SE Alaska. It has been good indeed.

As a PA you know what it is like to be gone for a week. Then you come back and you have hell to pay for your absence. It is worse when you have no real backup. But this week is coming to a close and things should be better next. On the money front, I feel more encouraged since I posted last.  I had $4,000 come in on one day.  This will allow me to cover rent, payroll and taxes at the end of next week.  I’m still looking forward until the day that don’t have to hold my breath before each pay day. We are unraveling more and more problems with my old biller.  I ask myself often how I could have done better.  I took hiring a biller, very, very seriously. I tried hard to find the right one.  There were no warnings.  She was highly recommended by my office manger and others. But you can do a lot of damage as a biller if you don’t know what you are doing.  You can do far more if you cover your mistakes with layers and layers of deception. My SP today told me a story when the main hospital in town hired a head biller. They recruited very seriously and checked credentials.  She too was a fraud. She did not have the degrees that she professed. It took the hospital a year to discover that she didn’t know the first thing about billing because she covered her tracks so well.  So, she felt like it was worth her keeping her job for a year and earning 40K while she cost the hospital (her employer) millions in lost revenue.  How do people live with themselves? But, you have to pick yourself up, dust yourself off, learn some lessons and move on.  At least I know that our billing department is in very good hands now.

T omorrow I start my first vacation since opening the clinic. I’ve worked in the office every single day since June 1st.  I would have never scheduled a vacation at this point but I must do a family thing . . . celebrate my mother’s 90th birthday in Tennessee.  It will be a great family thing, all my siblings together, which is very rare.  All five of my children will be in the same place at the same time, which is another rarity. They’ve don’t even remember many of their cousins’ names. So I hope that I can, for the first time in months, take my mind off of business.

I  think it was the late Ronald Reagan who defined an optimist as a kid who steps in a pile of horse shit . . . smiles big and says, “Hey, there must be a pony around here somewhere!” I’m in the middle of a pile of manure right now with the clinic and my wife is perplexed while I seem to feel so positive about things. After all, I’ve struggled for months in frustration. Here’s the horse shit.