Thank you Gustav!

So due to the hurricane, the Typhon offices in New Orleans are closed and hence, TYPHON is down. Oh sad, tear, cry, sob. I wish Gustav could linger for the next 12months! Oh darn, guess I won't be entering things into TYPHON in the next few days. Oh darn.

Hurricane approaching = dumb people.

I never thought I would have to send the clinical team a warning that I might have to miss a couple days of clinic due to a hurricane. Well it won't be a direct hit where I am, but apparently we will most likely get some very nasty rain, wind and flooding. They have closed the schools down in the past for this terrible weather. My family stockpiled food, canned goods, bottled water, batteries and anything else they thought was necessary in case we are house bound for a few days. I really can't see how this will be all that bad where I am and maybe since I have forewarned the clinical team back in OR and my mom and of course my hubby that I may be out of touch for a bit, nothing will happen and Tuesday, bright and early I will be headed to prison as usual. (In the picture - I work in Humble and live south of I-90 by Baytown)

Did I mention we also filled all the cars with gas? Apparently the first things to disappear with a storm like this are bottled water, gas and ATM access. I think the news left out the part how people's common sense disappears too. Here is my gas station story (watered down version).

Went up the street to fill the miata up, I use my debit card, pick up the nozzle, press the grade of fuel I desire and before I even get the nozzle into the car, the numbers start going up. Puzzled, I hang up the nozzle and press the help button as my receipt prints. "Um, no gas came out and yet the numbers went up" I tell the voice on the other end. "Try another pump" I'm told. "Yeah, but I was charged for gas I didn't receive." I reply. "Not my problem, try another pump." Like hell I'm going to try another pump I thought, so I drove down the road a bit turned around with no gas station in sight and stopped again at the same station. This time, no gas, no charge. I asked what the trick was to using the pump because no gas was coming out (Until moving to the NW I had pumped my own gas for nearly 10 years and am quite familiar with how to operate a gas pump). "Must be operator error" echos the voice. After peeling out of the gas station, I drive 15min in the opposite direction to another gas station. Upon approach I could see it was really busy, must be all the Louisiana residents coming off I-10 to fill up. I pull behind a lady in her truck. It is sweltering hot, the AC isn't blowing cool air when I am just sitting in park. Long story short, turns out the lady in front of me decides to wash her Ford F350 with a squeegee, I am blocked in at every possible angle by a truck, a trailer or a truck with a trailer, thanks to the hurricane zoo at the gas station. I'm stuck. I'm getting impatient - I've been here 20mins. I'm really hot, sweat is pooling on the leather seats and the lady, squeegee in hand, waves at me. You've got to be kidding me. Get me out of TX now before I go postal (oh no, that wasn't in TX, they have psycho cheer moms down here) So get me out of here before I go "cheer mom."
After a few more incidents I finally got my gas. I was gone so long that my family called me to make sure I was ok, still alive and not lost. That was very thoughtful of them.

Bring your glory Gustav!

Sacrifice

6 weeks is a long time to be away from Shawn. He's working extra hard while I am in school to provide for us and make sure everything is ok and save so we can by a house in the near future and maybe a car. He also has to take care of the dogs, which has proven to be more of handful than once anticipate (well at least one of them). He typically works 12 hour shifts as a medic but lately has been trying to pick up extra time here and there, sometimes extending his days to 16 or 17 hours not including the extra 45minutes in the morning before work to get the dogs walked and fed and the hour or so at night to clean Wrigley (who has apparently not myelinated the neurons leading to her butt to hold her poop even on a normal 12hr day) and then he plays with them extensively, eats, showers and maybe he can squeeze in a little down time before going to bed and doing it again the next day. I owe him big. I don't know how I am going to repay him, but I will -one day and it will be big. I couldn't ask for a more loving, supporting husband. PA school is a much bigger sacrifice than I thought it would be. I'm glad I didn't have this reality before I started, I'm not sure if I would have gone back to school. I miss my family in the NW and I am praying that this year goes quickly.

AMR is deploying EMS help down here and in Louisiana in anticipation of a category 3 hurricane hitting, but Shawn isn't on the list to go, plus those darn puppies would have to go somewhere for 2 weeks.

Preparing for Gustav

Fridays are always hit or miss I have determined in my short two week stint. Although we were caught up with our double intake on Thursday (thanks to the LBJ holiday) all of the sick call supposedly was moved to Friday. My goal was to not crash the computer when doing intake physicals. I managed to make it through the first physical ok, nothing too exciting, just trying to get the flow of things, I like it when they are young and healthy, not too much to take care of, less computing if you will. I wish I could quietly go from person to person and ask how many medical problems they have and pick out the good apples, unfortunately I don't have that luxury in the free world or in here. Too bad when I was given step by step instructions on how to input patients would have included tricky ones or involved ones but no it didn't, those two days they were all simple. My next guy (my final guy I should say) 50 with a history of mental illness, Hepatitis C, TB+ status post prophylaxis with TB meds, seizure disorder and hypertension. Holy cow. Where to start? As I went through his problem list to ensure everything was accurate he said "I don't think I got that Hepatitis C, I took 3 shots for that" This is a common misconception here, the 3 shots are to provide immunity for Hep B, not C. So I explained this. Next I told him when the labs were drawn to confirm Hep C to which he replied "Oh, well now I remember I just had a touch of the Hep C but I'm better now." This is also a misconception here. Everyone seems to think that you can have a touch of Hep C, a touch of HIV like you might have a touch of a cold. It would be the same as saying I'm just a touch pregnant. (which I'm not at all for the record) Back to remembering what to do for this patient -I remembered to order the PSA, offer a rectal and get the inevitable refusal signed, order intake labs, change his complexity satus from a 1 to a 3. Then I knew I had to schedule a chronic care clinic visit within 30 days, but wasn't sure how, order repeat labs every month for his liver problem, again not sure how and so on and so forth. So while I waited for someone to show me these things I wasted 45min, and probably the opportunity to see at least one more. On the plus note I finished it just in time to be asked by the doc to take off a toe nail. Whoohoo!

His toenail wasn't as rotted as the last, and removal isn't exactly the treatment for this guy, but there just aren't any other options here in the captive world. The doc had me do a new technique to deaden the toe and asked me to put in a ridiculous amount of lidocaine into his toe to deaden it. The patient was a total baby and I was so nervous as she hovered overhead I made a couple stupid mistakes when injecting, like going through the toe completely on one side. Despite my mistakes and for being told "you're being way too gentle" I manage to get the entire nail off in one piece - a small victory in my book. I was feeling good but it was about 20min later, out of the blue when I started getting reprimanded about my poor technique for anesthetizing the toe and for not just grabbing on and going for it (being gentle) and how I caused a couple extra drops of blood from being too gentle. I thanked her for her (less than tactful but insightful) comments and quickly tried to find another room to observe from, but neither PA was in their office, so back to sitting with the Doc. We had a couple sick calls, and a couple chronic care visits which turned out to be very complex with a new diagnoses of Hep C. (again, the patient said he had shots for it and stated matter of factly "so now I have just a touch of Hep C" sigh).

After clinic was done we were instructed to prepare for the pending hurricane (Gustav) which may make landfall near or far from us Mon or Tues. We are about 100miles from the Gulf (where I'm staying is a tad bit closer). But I guess if we are north of where it makes landfall there is a large chance for tornadic activity and of course wind and rain, lots and lots of rain. We covered all of the computers with plastic bags, and put X's made of tape across all the windows (which are double plated anyway) and unplugged all electronics and wrapped the cords in plastic bags too. All important papers had to be accounted for and anything you value should go home. I was surprised at all the hype, I guess I thought we were far enough away to not have to worry about anything, but I suppose it's better to be safe than sorry. I'm actually a little worried about the house I live in, or at least the area around us flooding if we do get heavy rain. With just a normal storm we flood and we have what I call Lake Corman right in front of our house. Should be interesting - as everything seems to be around here.

crash and burn

Today I learned the computer system. Sounds simple enough but the EMR (electronic medical records) at the prison is semi-confusing. To get to point A you must first go to point A1, A2 and then A3 and finally arrive at point A. The computer system is linked to the main computer hub in Galveston at UTMB and incidentally the computer has been known to suck a chart note or set of orders or in my case my intake physical and order sheet from the computer and launch it somewhere into cyberspace never to return. The computer system is also known to crash, a lot which basically requires that all notes be printed, copied multiple times, signed by 6-8 different people, and hand scanned into the computer and filed online. Today I learned the computer system - I also crashed the computer system, single-handedly. The IT people told me not to worry, it happens almost always when a new person logs in and tries to sign their note. Unfortunately due to this malfunction, I only got to do one intake physical today. On the other hand I got to enter the patient in twice since my first note is lost somewhere over the hard drive.Too bad I forgot to re-enter a few key things onto my note. I was feeling a little bit scattered brain when trying to fix my note with the IT guy sighing into the phone while he waited for me to try again. My first intake, minus the computer meltdown, went great. I remembered to ask the few key questions, remembered to have him stand on the X in the middle of the floor and for my own sake remembered to have him turn his head when he coughed during the hernia check. I was actually relieved that he deferred the rectal. I even remembered to give the don't use too much soap lecture that I am all too familiar with now that I have watched 2 weeks of intakes.

Despite waiting for IT to figure out what to do with me, the time I spent waiting was not all lost. The inmates sit in chairs lining the walls of the hallway waiting. There is a big sign that says "NO TALKIN" (the "G" is really missing from the paper) but it is rarely enforced. Today two young guys were waiting in the hall, chatting it up. One was a 23 yr old who just lost his nursing license for whatever it is he did and is now worried about the 3 mouths and wife he left behind in the free world. Next to him was the younger guy who was in for stealing a $13 pizza from a delivery person (I make it appoint not to know what they're in for, it was mentioned in the conversation and hence I repeat it). The first guy was telling the younger that he needed to do something with himself, get his GED, make something of the 10months he would be spending behind bars. The young kid laughed (which did earn as sssshhhhh from the unit secretary) but the older and obviously wiser 1st-timer continued urging the young guy to fill himself with knowledge and gave him word after word of encouragement to rise above this one mistake and not make it a habit. He pointed out the tattoos and said "I have tattoos too, but where have they gotten you? Here, behind bars, but education, that will take you farther." This continued on for quite sometime as the older 20-something told of his story and how he would vow to help anyone else like him out there in the free world that was like him - young, educated and headed down the wrong path. Overhearing this conversation was interesting. Most of the guys I have seen have one of three attitudes. 1. I'm here because this is how the world works, I can't change it, 2. Oh poor me, I'm in jail and now my life is ruined or 3. What's 2-15more years here? So to hear just one youngster really get it, to know that he has the power to make better choices and to use the time wisely was really refreshing. It's hard not to have this counselor mentality when a young guy comes in for the first time, there are so many things that cross your mind that seem like a natural thing to say in a situation like that, but it's really not our place. I have heard my preceptors remind the younger ones and first timers it's not too late, but I'm not ready to make that leap yet even though I believe there's hope for some of them.

Other interesting items from today: pt with large cysts on his head - almost looked like horns, could be HIV related but I doubt it. The biopsy I did last week - Basal Cell Carcinoma. Oh hooray! So tomorrow I will spend 30minutes educating the patient on what that is and what can be done. I had my first polydactyly patient (I will double check the spelling of that and correct nomenclature - it's where multiple fingers are fused together making a pincher-like claw for each hand). Also had my first possible dwarf (with a wicked heart murmur) - not sure why this is interesting, but it was, probably because he came in after our 6'11 pt.

Enough jailhouse news. It's super humid here in TX and the miata heats up like an oven during the day - I think it's from the burnt orange leather seats. Even worse than the humidty though are the mosquitos. Oh how I dont miss those little buggers. I have giant reminders that they are out there lurking, just waiting for me. They are particularly heavy in the morning and night - as soon as the door opens you are swarmed, I even manage to get 4 or 5 in the car with me, which explains the 2 or 3 new bites I get each day on my way to work.

Shawn has picked up some extra shifts to fill his time while I'm away. It worries me he works so hard, but I think it's just awesome to know he is busting his tail so we can travel and get a house when I graduate. I feel like such a deadbeat wife.

Oh and awkward moment for the evening, watching the first part of the movie "knocked up" with your cousin and her mom...

Happy Birthday LBJ!

I am celebrating LBJ's birthday today in holiday form meaning no work. Don't ask me why the prison system uses this as a holiday, but they do so I am relishing in the fact that instead of making my usual 45min-hour drive I slept in and will start working on in-puting my patients into Typhon and working on my next oral presentation (which may be entitled; Really cool opportunistic infections HIV pts get). What a birthday party huh?

Yesterday my presentation went ok, I think the preceptors words were, "interesting, not what I expected but interesting." Hmmm. Well given the fact that I almost never spoke for more than 3 or 4 minutes at a time before being interrupted by my audience or people barging into the lunch room I guess interesting is better than anything else. I know my presentation did earn me two presentations per week for the rest of my rotation. Whoo.

Patients have been dull lately. The usual scamming to get a low bunk or get new restrictions. We also haven't had that many patients outside of intakes which have also been straight forward. Due to the lack in patients we've been getting done early around 2 or 3pm. I still haven't figured out the EMR though, it's tough. But tomorrow I will be trialed by fire in learning as I will be seeing some of the intakes myself, in my own office. We have double intake tomorrow since we are celebrating LBJ's birthday today. And my preceptor won't be in on Thur or Fri as she is helping conduct a research experiment on the vomit comet for NASA.

I'm off to do more celebrating!

I'ze gotsta J-up

That's TX prison slang for, I need to get a job. The first time I heard this phrase was Friday, and I thought the man was speaking a foreign language. The phrase all ran together, thank goodness I recognized the term J-up from my pre-rotation prison slang reading packet. The patient who said this was a relatively large white possibly hispanic male who put in a sick call (office visit here in jail) because of a hernia. He has been working in the kitchen for the last year or so and has found that when"lifting cans of slop I feel my insides come through my belly button" oh and his lower back hurt. Medical personnel can't change someone's job, but can place restrictions if legitimate. For example, those with HIV, Hep C and TB can't work in medical, those with documented seizure disorders have high bunk restrictions, etc. Further on in the interview, "I can'ts be liftin no more cans of slop, I'ze be gettin written up for not going to work cuz my back hurts and for not doin my job, I'ze gotsta J-up with the yard crew, they sez I can do that" TRANSLATION: I've had disciplinary action taken on me for not going to work due to my back pain and for not lifting the vats of food, I need to get a job with the grounds crew mowing grass or trimming"

Not all of the inmates have such an interesting dialect, but many of them do. Some even sound like this in the hallway when waiting and then are incredibly proper with impecable grammar during the actual office visit.

Friday was pretty bland. I did 1 urethral swab for an STI. The guy was such a baby. Shawn told me to not be so callous about the whole thing and I wasn't trying to be, I'm sure it's uncomfortable, but really, it can't hurt if I'm not touching you and the whole thing only takes 2seconds or less. In retrospect I should have said to the patient 2 seconds of swabbing or lifetime of impotence - your choice. This same guy was shocked to learn that HIV is spread the same way as chlamydia and that HIV can in fact be spread through unprotected heterosexual sex. I was shocked to find that a 20-osmething didn't know this, and still wasn't convinced after the doc told him so. Anyway, it's funny how some of the inmates look at me like I haven't seen certain parts before - the PA tells them "don't worry she still has her brick." For some reason the saying in our facility is: if we see something we've never seen before we get to throw a birck at it - and we still all have our bricks. Don't ask me why this saying works but it does.
We also had some strange labs come through, an almost 50 y/o who dropped their Hgb 3 points in 3 weeks (he's at 9), the kidney is shutting down (Creatinine 1.9)and a few other things are way off. WE do have our share of lab errors, and the guy didn't look ill when he came in, no complaints either. We're working him up to find the cause of the anemia, hence the presentation I should be working on, but I really just don't want to read anything else about anemia. Could be colon cancer, some type of deficiency, maybe undiagnosed Liver disease, HIV, something. We'll see.

Only 12 more months and I too will have to J-up.

It's official!!

That's right ladies and gents it's official, I will be doing my next rotation (#4) in Portland! Funny how things work out. I was originally going to be in TX another 6 weeks (which at the time meant I would ship my car down here to drive up to KS and then to IA), then that was changed to ID( ok, so it screwed the car shipping idea, but saved me money and I would only be 8hrs away from home), and now Portland for a trauma rotation! Woohoo!! I have already noticed a boost in my morale knowing that not only am I counting the days to get out of this God forsaken land known as Texas but I will be going home for 6weeks. And even though I know the hours of this upcoming rotation are going to kick my butt, at least I will be home, in my own bed with my husband and the dogs. There is nothing more comforting than that, well maybe the fact that I will be at home during baseball playoff season - like a cherry on a sundae.

I have a big presentation tomorrow that my preceptor assigned me - talking about the approach to anemias and differentials. Whoo hoo (sarcasm anyone?) I got up today at 4:45 to jump on the computer first (it's tough to get the Internet around here with 3 teenagers) and do some research, including cutting and pasting from my online textbooks. I did some research and reading yesterday, but I went to one of my cousin's 6th (Olympic-themed) birthday party which inadvertently lasted for almost 7hours between the hour and a half party at the gymnastics place, going to my cousin's house to unwrap presents and then out to dinner. On the plus side, I got to do some flipping at the gymnastics place, which is a great release of energy and so far my body doesn't hate me for it. So onward ho I go! Once I finish gathering my info not only do I get to put together a reasonable presentation but then I get to enter 70 patients into Typhon! OH goody, I can't wait!

Go Cubs Go

Chicago was awesome! Shawn's parents and the two of us saw two of the most amazing games ever, not to mention our incredible seats! The weather was perfect while we were there, not too hot, but sunny and the clouds and wind came in after the second game on Sunday. We left the city before the tornado brushed Navy Pier and cleared out Wrigley Field on Monday, but not soon enough as to miss the thunderstorms which consequently delayed our flight a couple hours.

Shawn's parents are Cubs fans too (although they don't have two dogs named for them to prove it). It was there first time at Wrigley Field. Karen (Shawn's mommy) was just hoping for a win out of one of the two games so she could hear and sing Go Cubs Go at the end of the game. Well, lucky for her, she got it both days. There really is nothing better than being on your feet almost non-stop through a baseball game and nearly losing your voice form the yelling, cheering and singing.

Although both games had their high and low points, a couple key players were clutch in both games. First, my favorite center fielder Reed Johnson and the rookie catcher Geovany Soto. Big Z pitched a great game on Sunday too. Johnson should get a raise for his clutch batting moments for these two games alone. So in game two, Cubs are tied, 5-5 (thanks to Soriano making a half-assed play earlier in the game), it's the 7th inning. Daryl Ward was suppose to come in and pinch hit, but wait, there's a pitching change and Lou decides to bring in Johnson to pinch hit - and he hits the game winning two run homer!!! The crowd went wild!!! This is just one of the many on-your-feet moments of the two games.

So after our fun-filled, adventurous weekend, we go back to our hotel to get our luggage and travel by the L - the train - to go to a hotel closer to airport. WE had taken the train in and around town, no problems, it's a little more complicated and confusing than the Max but still cheaper than a cab ride (and usually less sketchy). So we are on the train, waiting for our stop to transfer to the red line. Something doesn't feel quite right - can't put my finger on it. I suddenly felt like a minority on the train and their were a couple sketchy guys on there too. Our stop is next. All of sudden, some guy starts walking in front of us messing with his pants, doors open and he doesn't move from standing right in front of the door. I try to say excuse me, but he ignores me as he continues to fiddle with his pants. I finally push past him and walk out with my luggage. I look back to see a commotion behind me only to find out later that the other guy and train tried to snatch my mom-in laws purse as the other guy distracted us. Luckily Shawn's quick hands grabbed the offenders arm and saved the purse, we were lucky that everyone involved returned to the train, being below ground a few stories is the wrong place to be to have trouble. We have a couple flights of stairs to go up to get to the next platform - everyone was breathing a sigh of relief that we had escaped a major catastrophe. All of a sudden their are some 20 young kids (ages 13-17 or so) rushing up the narrow stairs were on (with all of our luggage), they're pushing and shoving and somehow I get knocked down and trampled. Shawn quickly snatched me up to save me from being more injured than the bruise and scratches on my elbow.
We decided that at this point we should just take a cab home. It was very scary and tainted the end of trip. But other than all of this the trip was AWESOME!

This the Cubs' year!!! I love the Cubs, but I don't want to be in the city when they win the series, there will be riots, and they may accidently burn the stadium down.

(This post is a little late, things got a little crazy after we got back, like school and rotations starting again so Shawn's harped on me long enough to finally finish it. )

I love prison! (but I love my husband more)

It's never a boring day in this rotation (4 days in), never. I was so afraid I would have to journal about the landmarks I use to get to work and make the right turns along the way (which are in fact interesting themselves, so that may come one day)

I'll cut to the chase, here are the TOP 4 great things about today's work (I had a hard time putting these in perfect order, so I consider them all close to equal)
4. 30 with new onset DM based on intake labs and random finger sticks - seems run of the mill but he was the first patient I have yet to have that actually was concerned (tears in his eyes) about this diagnoses and wanted to know how to "beat the disease." It was fun educating him about diabetes and how losing weight (5'7, 256 lbs), exercising by walking vigorously in the yard and taking control over his medications for HTN, Hyperlipidemia and now DM would be very important, as well as checking his feet daily and keeping them dry. I hope he keeps his motivation.
3. The patient was seen on intake a couple days ago and complained of being nauseated and vomiting, a few of his intake labs looked a little off, so some repeat labs were ordered, and in only a couple days his labs became even more skewed from severe dehydration in the last two days. Even with his phenergan (anti-nausea med) he wasn't able to keep anything down. So it was time to ship him off to one of the prison hospitals. Knowing it would take awhile (5hrs in the end), we decided we could start by giving him a little IV fluid to help rehydrate him. So I was sent to escort him to the "ER" room in the unit and start this order. The pissy nurse reluctantly agreed to do it but verbally complained that it would be impossible to start the IV due to his dehydration, he was freezing cold and he was a former user. She pulled out two 22 gauge catheters and sat down mumbling about her job. (22 is almost the smallest catheter made for adult IVs - normally an 18 would be appropriate for this type of thing) After two attempts with the same needle, and no success, the Dr. walked in and the nurse said, no luck, can't give him fluids, and the doc says, well didn't you know she (meaning me) was a medic before going to PA school? In a huff, the nurse said no and said it's all yours with such a snotty tone I almost offered her a kleenex. I popped on the tourniquet, saw a beautiful AC, politely asked for a larger catheter (to which the reply was you won't get anything in him, so I'm not wasting a 20gauge) I had a brief chat with the patient that if I did get this IV, he would have to keep his arm straight so we wouldn't lose the site, and I was only going to take one stab at it, so he had to hold still. He agreed and with a 1,2,3 count it was in and fluid was running (albeit slowly with a 22, but running nevertheless). It felt good to know I still had my IV skills.
2. Punch biopsy (fancy name for using a small device the has a circular metal blade on one end, place it on the area of skin in question and make gentle twisting motions back and forth to go 1-2mm deep then lift the circular area, snip and send to pathology). The suspicious lesion in question today started 2 months ago with a honey crusted lesion that was oozing, that seemed to appear out of no where, was treated heavily with atbx, which although it dried it up some, the lesion itself has not changed in size and now has a crusty center with hypertrophic edges (sort of looks like thick scarring around the crusty). I did the whole procedure by myself, local anesthetic, biopsy and then...
1. Placing two sutures with 5-0 Nylon to close the punch biopsy - my first stitches!! Finally!


All in all, a great day! And there may be even more great news on the horizon, but I musn't speak of these things yet until another email arrives...

In non-work news, Shawn said he was going to take the pups to the park, I'm jealous. I miss them, and apparently Cubby has been giving him the "I bet you buried mom in the back yard" look - I miss the Cubster (and Wrigley too) but most of I miss home.

there's a moat around our house and lake in the front yard.

It rained last night, a lot. When I woke up this morning I had no idea I would be wading to the miata through the new marsh/swamp that is now the front yard (wouldn't be so bad if there was a sidewalk!). I hardly had time to admire the lake that had formed in the front yard or the moat encircling the house. I suppose I should also mention that the other day when learning to drive the miata I noticed that there are deep runoff trenches along the side of teh road I am living on with no margin for error meaning no shoulder, at all. These trenches are roughly 4 feet or more deep on both sides of the road. I remember thinking to myself, gosh it would really suck if I went off the road and into the ditch. Well, today the ditches were full and overflowing in some areas, I guess they weren't deep enough. I will post pictures when possible.

So here was the list of intake physicals today ages ranging a 25 yr span. I had 40% who had new +TB skin tests, only 2 with Hep C, 2 coming down from heroin and only 1 with HIV. Not too bad. We tapped a knee that had an effusion (fluid in and around the joint) and this guy had his patella removed after a fracture repair went south and became infected. The penile discharge was pretty run of the mill although watching the poor kids face when we said we are going to have to put this long qtip up your urethra (it's only a few cm, really, how bad can it be), a few acne cases, one patient completely enraged that the newbie he had been ministering to and helping find Jesus gave him scabies, and then the last 3 were more interesting. Allow me to set up the first case.

It's loud in jail, especially at night in the dorms, and some people actually want to sleep and not stay up hootin' and hollerin' as is the case of my ex-marine corp pt. So the only logical thing to do at night is to make ear plugs out of toilet paper and shove it in your ears to drown out the noise. The gap in logic lies in the fact that toilet paper was meant to disintegrate/break down when it gets wet. This property of toilet paper doesn't change even when it's in the ear. The humidity allows the homemade ear plug to shrink and harden, shrink and harden until it becomes stuck. Our pt today came in with ear pain and decrease in hearing in both ears. One ear was so full of wax we couldn't get the speculum in his ear, and the other had a thick yellow cottage cheese substance completely obstructing the entire canal and even draining a little.

Next interesting one I guess isn't that great, but I got to the I&D on him, so he makes my top three. Long story short: carbuncle formed on bridge of nose (long standing problem) after his face was reconstructed with bone grafts from his hip following a nasty car accident. The little spot is growing and draining and has grown some interesting cultures in the past, so with an 18g needle and some culture tubes I had at his face. Can't wait to see what grows.

3rd and final guy (perhaps I should have left the earplug inventor for last, this may be anticlimactic), he was in an altercation yesterday and now has no use of the tip of his pinky finger. During his punch he hyperflexed (bent as when you make a fist) and ruptured the extensor tendons at the distal end of the pinky. It's not really debilitating, in fact now he has the perfect finger for nose picking, but the finger is still really swollen and there may be a small area of bone that came off with the tendon, so off to ortho hand specialist he goes (in a week).

That's all folks!

(On a sad note, I hate the 2 hour time difference, I go to work too early to talk to Shawn, and by the time he gets off I"m ready for bed, sigh. I miss my Shawn and the dogs)

My first pat down

Well today, I got my first pat down. One of the two bathroom keys went missing, so security went from person to person patting them down to find it - it still hasn't been found.

I like my preceptor, and I actually like working in the prison - once I get past walking down the "bowling alley" by myself being completely open and vulnerable- the bowling alley is the long concrete yard in between the bunk houses. Walking into the medical facility is equally unnerving, you walk in next to "the cage" which is where the inmates sit and wait (or is it more p.c. to say offender? who knows). In the morning it's full of the new intakes who have come from county. I sort of feel like a piece of meat walking past them, waiting anxiously for the next officer to open the door. Today I had to wait. I hate waiting - makes me nervous. I don't know which is worse, waiting and having to face them, or waiting facing the door, either way you feel like 60 pair of eyes are staring you down.

Pretty run of the mill day - intake physicals and then sick call. We had one deaf guy, one who faked having seizures to get a low bunk (but confessed after realizing how often he would need blood draws to check med levels in his blood) and a whole lot of non specific dermatitis caused from - washing too often with too much soap. This is really common because, well it's hot here in Houston in August, and super humid. These guys wash 2,3 some even 4 times a day, scrubbing with some state given soap that does nothing but dry the skin out. So many of the inmates had "dry skin" or have scratched at the dry skin enough to get a small bacterial infection on the skin or in the hair follicle. I never thought I would be giving repeated patient education on the importance on not showering so often and not using the soap except in the groin and underarms, daily or every other day. Sadly there are no good soaps or lotions available in the commissary to help alleviate this problem, I guess they should have thought of that before they got caught. (I'm becoming hardened already)

So back to liking my preceptor, she's upfront and honest and direct. She has a sense of humor and has been working in corrections since she graduated 25 years ago. She's been in this particular facility for 13 years and once a year she does research with NASA on the vomit comet to see how to mix IV fluids in 0 gravity. She's really easy to talk to and today, for some reason she decided to give me the gossip about some of the other people in the unit - this may sound unprofessional, but I think she was actually using it to educate me on the diverse group of people working in the med unit (it does take a special breed of person) such as - the lesbian wickan couple, or the lady who is a nudist (obviously not during working hours), or the people who's spouse, son, brother or nephew might be in the TDCJ system just to name a few. And these people aren't shy about any of it. Why just today, the nudist lady mentioned something about "thank God I don't have to worry about tan lines, how annoying" mind you she is over the age of 50 - the only image I had was Magda from There's Something About Mary. I suppose I should leave you with that image.

I'm Ms. Zoop-fer

Today was my first day. Despite the fog I managed to make it there and despite the heavy rain make it back in the tiny little miata(although I did managed to get lost on the way home and my family had to establish a small search and rescue mission to find me). I had to wait to be escorted to the medical unit entrapped between two steel doors. Thank goodness an LVN was there waiting with me as my official clearance came through. She gave me some of the most useful advice and reminders: Chin up, shoulders back and last name only. That was a big adjustment to introduce myself as Zupfer (no one has pronounced my name right, but it may be the heavy accents) I also have to learn to ask permission to go to the potty, the security guards hold the key to the throne, I may need to limit my water intake in the morning, I would hate to have to ask for the key more than once in a day.

I learned some new terminology and abbreviations today that I am certain I will never use outside prison: KOP - keep on person, J-up = get a job, FW = free world to name a few. I saw a lot of scamming today to get meds, albuterol inhalers are the hot commodity here right now - it's amazing how the inmates can make sounds that replicate airway diseases, but then again I guess they have a lot of free time so to speak.

Already I have done some exams in Spanish, although not your typical exams, I have to remember to ask the patient to stand up turn around, put their arms up lift their chin and (do the hokey pokey) breath quickly and deeply just to listen to their lungs and I have seen patients with HIV, Hep C and gave an explanation of emphysema and demonstration on how to use inhalers and what they are for. Who knows what my day will consist of tomorrow.

The most difficult part of today was surprisingly not trying to look scared out of my mind but grasping the idea that the inmates here have a right to health care, and in many cases better access to health care than those of us living in the free world. This may take awhile for me to wrap my head around, and more of this to come later.

(And PS- it's pronounced Zup-fer, like zup as in cup)

Prison bound

Well I made it here and so did my luggage. So I'm off to a good start. I am settled into my relatives place which is about 5 or 6 miles from Crosby or Baytown. The set up here is pretty neat in that I am staying with one of my grandma's brother's sons and his family who happen to live next door to the previously mentioned brother and his wife. So yesterday, my first night here, I was able to see some family I haven't seen in awhile and some more cousins and their kids too. Family is so great, I am so lucky to be able to stay with them even though life here is a little different than I'm use to. After sleeping in today, I went to the store to buy some groceries and a lot of ziploc baggies. I have to pack anything and everything in a clear bag when I go to the prison. Today I also received a very important lesson - driving lesson. See originally I was going to be using the family car, then when I got here I was told I would have to rent and then this morning it was decided the family would somehow make the car thing work (which is great because it saves me $1200). The only hurdle to using one of the family's care - I would have to learn how to drive a stick. So after dinner, Tim, the dad, took me to the primary school parking lot for me crash course in how to drive the Miata. I did pretty well having never driven a standard before, and I didn't kill the engine until I had to reverse to turn and then go again, unfortunately I killed it perpendicular to traffic - maybe I need a sign that says student driver. And after only 15minutes of circling the parking lot Tim took me to the highway where I opened it up - ha ha no - but I did manage to get going up to 60 with relative grace and style. Then it was back home. So now, after my 37minute crash course in driving I am ready to hit the open road tomorrow, throw the top down, sunglasses on and head to prison. Can't wait. I am pretty nervous about this rotation, although if I weren't nervous I would think something was seriously wrong with me.
Despite all the fun I had today, the best part was talking to Shawn. I feel homesick already, I swear I feel like I have been gone a month. As soon as I got on the phone with him he said "wanna hear Wrigley bark?" and she did with some persistent growling as well. He had her so wound up before he got on the phone with me so I could hear her. It was very sweet, but it did make me miss the three of them (especially Shawn) all the more.
Well, it is getting late, I should probably get some rest before the big day tomorrow. And now that I think about I'm not sure if I am more nervous about driving or the actual rotation. Beep Beep.

Time Traveler

Well it is time to test my abilities to journal more frequently with more pertinent information for basically the next year of my life. The last 3 months have just been a warm-up, so let's play blog!

I am beginning the next chapter in my clinical rotation journey - the one I have been dreading and secretly hoping was missing from the book known as the clinical year. I am off to enjoy the next 6 weeks in a state prison in TX - hopefully the warden will let me go in 6weeks for good behavior so I can excitedly move on to start a rotation in Idaho. I will spare the details of one of the most emotional departures in history as I said farewell to Shawn. Let's just say that the tears and sobbing, although very characteristic for me when I have to bid adieu to my best friend, soul mate and love of my life, today the waterworks seemed so much worse. As I was boarding the plane with my tear and mascara stained face the lady taking tickets asked me if I was going to be ok to fly. I boarded, buckled my seat belt and snuggled into a good book - the correctional managed care manual.

I left this morning at 7:45 from PDX and am now sitting in the SkyHarbor C terminal waiting for the next 3 hours before my next flight to Hobby airport in Houston TX. The first leg of the flight was relatively uneventful. The usual people who go to the airport completely unprepared and people who can't count to 60 to stand in numerical order to board the plane. I like flying into Phoenix because you fly up above you can really see the intricate and meticulously placed grid of homes and roads. I'm kind of fascinated by it actually. It was a cool 92 degrees here at 10:20 when I arrived this morning, thank goodness the airport's air conditioner is working. I am sitting at a comfy little station typing away and people watching. I wish I could take pictures of some of the interesting people I can see around me. Approximately 75% of the people in the C16 area are Latino, and the only language I can hear is Spanish, so perhaps the next flight from here is to Mexico, with a stop or two in between (it's actually to El Paso, so close enough). Another group of 3 girls and 3 liaison ladies spark my interest. Two of the girls, both under the age of 7 have bilateral leg casts in bright colors. One has a walker to ambulate with her short leg casts, the other in a wheelchair with bilateral leg casts - she's carrying a doll with identical purple leg casts. The third girl, is older, perhaps 13-17 and has a short cast on just one leg. My first thoughts on seeing this - is she on oral contraceptives, have a recent surgery or smoke because she should really makes sure she moves around during the flight. One other interesting scene is the older lady, perhaps 55 waiting with her tawdry sequence bag and stiletto heels and newly purchased DVD player whom no one wants to sit next to. I have seen 4 or 5 other people sit next to her waiting to board and within a minute of two and some brief conversation have promptly relocated to the other side of the waiting area. These people's flight is about to board, and I wonder who will be lucky enough to sit next to her - there are only so many places you can relocate to on a plane.

Tejas, here I come!

Oh and on a side note, I managed to smuggle chapsticka nd lip gloss, not in a clear plastic baggy through security - this was an accidental happening - I found them in my bookbag. I'm sure this will catch up with me later and somewhere at sometime I will be privelged to experience the airport security's personal pat down service.