Yes, I would say that describes me right now in this stage of my training. Why a rock? Well, sometimes it's seen - if it's a big rock, but can easily be beaten by the harsh conditions of the crashing waves, sometimes even disappearing altogether. Secondly, if you throw a rock into the ocean, odds are it will sink and rather quickly to the bottom of the ocean. It may wash ashore at some point, in some form but most likely not. All that being said, I feel like a rock but not in the steady/sturdy sense. A few small defeats this week - I missed hearing faint crackles in the bases of an elderly ladies lung - I mistook it for my stethoscope rubbing on her shirt, I realize I have no clues about certain labs, but occasionally I order one or two that although long shots have merit, and I don't know dosages or best choice atbx off the top of my head which is frustrating. On the other hand, I have had a few small victories this week too. I found an air fluid level in an ear and bubbles behind the tympanic membrane, I also found severe hearing impairment in a wanna be truck driver (he couldn't hear the Weber test at all!!) - which consequently disqualified him until the audiologist sees him, I have even managed to make a big diagnoses this week ...drum roll please.... new onset seasonal allergies - oh yes, have a little Nasonex and Zyrtec. One of my other small victories is the amount of patient education I get to do - almost every patient talking about better food choices and a few naturopathic remedies my preceptor suggests. I've talked about those darn food choices so much we have completely changed how we eat at home - I felt like a hypocrite and fraud, so had to make the same changes I was endorsing.
I have met some really incredible patients and even have some "favorites" although I know Prof. LaBoy would be in disarray at that comment. I have even grown fond of a couple inpatients I have seen. I almost have too much freedom with the inpatients - why don't you go see so and so, write a quick note and recommendation, I'll read it later and then we'll discuss says my preceptor. So I have seen quite a few patients - by myself and (cringe b/c this is probably not all that ethical) without my doctor in-house. I realize it takes me frickin' forever to write up a "QUICK" note I have to sift through the chart, find the info I want, look somewhere else in the thick chart when I don't find it, write a little and look some more, it's never ending - and this is just the note, not to mention my exam and pt questioning. My 3 page SOAP note took almost 45minutes today (and I had to ask for more progress note paper - oops) - it's ridiculous - but to my defense, I was interrupted by the wound care specialist and the cardiologist and I had to make a lame attempt to interpret the lab report of 11oocc drained from around my patient's lung yesterday and the patient has a laundry list of ailments (admitted for a stroke, Afib w/ coumadin failure, CHF, dysphagia, and massive right pleural effusion). I guess my diligence paid off today I was praised for my thorough note and comments from various specialties. But still, 45min is unheard of.
One more brief note about another inpatient that I have found fascinating: admitted for pancreatitis, suffered a massive posterior occipital-temporal stroke, they found a large mass head of pancreas, major neuro deficit now, on bi-pap, major ascites in abdomen (the ascites is growing a strange yeast which is considered obsolete), and now has increasing Hypernatremia (160) with cause unknown. Seriously this lady should be dead if you went by the numbers and percentages. I am anxious to see if all of this is caused by Cushings, Diabetes Insipidus, some type of tumor or what not, although the neuro people said with such a large stroke the hypernatremia is pretty common, they aren't rooting for her speedy recovery - I hope she makes it to Monday.
So as I recover from my writer's cramp today I can push thru Typhon knowing I was given the weekend off!
I have met some really incredible patients and even have some "favorites" although I know Prof. LaBoy would be in disarray at that comment. I have even grown fond of a couple inpatients I have seen. I almost have too much freedom with the inpatients - why don't you go see so and so, write a quick note and recommendation, I'll read it later and then we'll discuss says my preceptor. So I have seen quite a few patients - by myself and (cringe b/c this is probably not all that ethical) without my doctor in-house. I realize it takes me frickin' forever to write up a "QUICK" note I have to sift through the chart, find the info I want, look somewhere else in the thick chart when I don't find it, write a little and look some more, it's never ending - and this is just the note, not to mention my exam and pt questioning. My 3 page SOAP note took almost 45minutes today (and I had to ask for more progress note paper - oops) - it's ridiculous - but to my defense, I was interrupted by the wound care specialist and the cardiologist and I had to make a lame attempt to interpret the lab report of 11oocc drained from around my patient's lung yesterday and the patient has a laundry list of ailments (admitted for a stroke, Afib w/ coumadin failure, CHF, dysphagia, and massive right pleural effusion). I guess my diligence paid off today I was praised for my thorough note and comments from various specialties. But still, 45min is unheard of.
One more brief note about another inpatient that I have found fascinating: admitted for pancreatitis, suffered a massive posterior occipital-temporal stroke, they found a large mass head of pancreas, major neuro deficit now, on bi-pap, major ascites in abdomen (the ascites is growing a strange yeast which is considered obsolete), and now has increasing Hypernatremia (160) with cause unknown. Seriously this lady should be dead if you went by the numbers and percentages. I am anxious to see if all of this is caused by Cushings, Diabetes Insipidus, some type of tumor or what not, although the neuro people said with such a large stroke the hypernatremia is pretty common, they aren't rooting for her speedy recovery - I hope she makes it to Monday.
So as I recover from my writer's cramp today I can push thru Typhon knowing I was given the weekend off!
( I took that pic of haystack rock - it actually looks kind of cool)
1 comment:
You will love going back and reading these entries at the end of your clinical year. You feel much more confident after the year is up. I promise!
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