The greatest empowerment I had in doing warfarin was Thanksgiving weekend 1997. My clinic had been in operation three months. I had a referral from a doctor on Wednesday afternoon on a woman with a mechanical valve (fairly new so she didn't know enough to help me). The doc had gotten her INR to 9.2 and was at a loss as to what to do. The only thing that I knew to do was to hold her warfarin for Wed, Thur, (we were closed Fri), Sat and Sun. I was scared to death. All I could think of was that she was going to have a stroke and that my clinic would be closed and I'd be sued out of everything. Guess what, on Monday her INR was still 1.8. She had remained in range almost all that time because her doc had been giving her 5 mg daily and it turned out that she needed only 2 mg daily. She is still on 2 mg daily after all this time. She has probably made over 100 visits to the clinic and now she is helping train my students. We occasionally laugh about how she was just as scared as I was the whole holiday weekend. We've been through amiodarone toxicity, two unsuccessful ablations and who knows what other sorrows and joys. If she occasionally gets an INR of 5 and the student starts to panic, we just laugh. We have stared-down a lot of worse stuff.
The shots hurt (not the injection, but afterward)
