Starfish of Death

Not an actual medical term you would find in Harrison's (trust me I looked) but cool none the less. Pt synopsis: single motorcycle crash - wearing a skull helmet - found down w/ agonal respirations was flighted in oh and body habitus = 120+kg. End result: skull cap helmet NOT effective, massive head bleeds, so much in fact in several vies of the CT there is no differentiation between the grey and white matter and you can't see the ventricles in the brain - bad sign and in several CT pictures the starfish (of death was pointed out). Other than the massive head injury nothing else going on. Lifeflight needled her 4Xs - and missed the pleural cavity with all four due to body habitus. She didn't have a pneumo though until she was getting PEEPed. Then two attempts at a chest tube. Literally this pt was was a small framed gal with a fat suit on - where you would think the 6th intercostal space was based on her size was in fact the liver/diaphragm - which I felt when rummaging my finger in the hole trying to feel the lung.
I also got to staple her head shut which was interesting trying to maintain C-spine and staple her occipital lobe nadn I watched a bolg be drilled into her head which measures intracranial pressure using a hand drill you can buy at Lowe's or Home Depot.
We also had a pedi trauma, which come to find out was a clark county original - not Shawn's but kind of fun to share patients. Speaking of Shawn. He worked 2a-2p yesterday and his usual 7:30a-p 12 shift today and tomorrow. I basically got home in time to say good morning, I love you and have a good day. This rotation will suck for family time for sure and I will be feeling these long hours for a while even after I'm done. I'm also still trying to save my brain - one antibiotic at a time - now I've got super high doses of septra too oh joy!

I saved my brain today.

The last 3 days my nose has hurt. Not like rubbing my nose too much and it's raw, more like I got smacked in the nose super hard. Sometimes I think I might be borderline hypochondriac - although I don't usually complain until it's really bad and then I start to read. Reading can be good, but I have tried really hard while in PA school not to over-read or to hold other clinicians to the same level that I treat patients - thoroughly and with up-to-date knowledge. The nose thing started abruptly, no digital trauma or any type of trauma except for maybe a week ago one of our dogs accidentally bumped me in the nose - but it never got sore. Then my nose started to bleed a little, then last night I ran a little fever and was a little pukey. Today, my cervical LN are sore and it hurts my neck to lift my chin. I've already done the research and my primary concern: facial cellulitis. i then notice a slightly erythematous area on the bridge of my very sore nose that's a little warm. I had to give in and go to the doc. Shawn was super proud of me - I hate going to the doc and pretty much never go unless it's life or limb. To make the appointment I have to try and explain these symptoms as concisely as possible and words get lost in translation and when I arrive to my appointment the MA says "so you have a cold huh?" Um, NO. My heart rate was 125, temp 99 and BP 110/70. The MA was sure the pulse was wrong but I could feel my heart racing in my chest as it done in the last 24hrs. Once again I tried to explain things to her. I don't think she was even listening - you can't listen if you are interrupting. (LaBoy's golden rule right? - Just give me 90seconds for goodness sake). Provider comes in (NP) - so I hear you have a little cold. Strike #2. I really hope I do a better job listening to my patients than this - how annoying. After I proceed to tell her how my nose hurts too bad to even touch it lightly she wants me to lay down to jam the speculum in my nose. Seriously? C'mon. She feels my cervical LN which are grapefruit size (ok not more like shelled walnuts or ping pong balls) and gets one more peak into my nose. Result: major septal infection, RTC 3 days to see if my septum perforated. High dose of Keflex and a little pseudophedrine. Not one mention of any cautions about using atbx - especially in a female of child bearing age from her or the pharmacist or mention about the risk for colitis as with all the cephalosporins. She didn't check a system above and below (inside my throat, ears), she didn't even listen to my heart for good measure. So what does all this mean - besides the fact I saved my brain from having an infection spread to it by going to the doctor... it means that providers lose something along the way. As a student we are extra careful in our exams, even as a beginning clinician I suspect we will give a little extra documentation and diligently ask questions and do a stellar physical exam. But when does this honeymoon period of exercising all those great skills we learned from the Great Gietzen or LaBoy end? I hope never. I hope my patients never feel cheated in my time with them or my thoroughness. I know there is a time and place to be quick and a time and place (like in prison) where you can't meet every whim of each patient - but I sincerely hope that my skills that I have learned in both communication and exam and decision making will never falter and compromise my patient care. The 50 y/o pharmacy tech showed more compassion and care and overall customer service in our short meeting than the provider or the MA. What's wrong with health care? So many things have to change and so many of these things won't change depending on who we elect in Nov to reform our failing health care system. I realize how very opinionated I have become regarding health care even more now as a PA student than even as a paramedic (although I have many sentiments about the flaws in that system too). Some of my gripes about health care may seem insignificant, and others may seem biased or crude or even discriminatory, but I haven't come to these conclusions all on my own. I listen to the patients and their complaints (like why are there grossly overweight providers preaching about the need to lose weight or how one patient refused to be treated by anyone on the floor that appeared to be obese.), I am a consumer of health care and I see first hand how I can be a change in the health care system and it drives me to hope that one day I can make more change (like insurance companies not punishing consumers for well checkups - how ridiculous!). I may not be able to change the world, the system or health care as a whole. But I can rest assured knowing that I can provide the best damn health care I can - the kind I would want to be given to me and in knowing I saved my brain today so that I will be around to implement this change.

Fly like paper, get high like planes

I have this song in my head, thanks to my husband. It's probably a good thing I didn't go to clinic today because I doubt any of my patients or the docs would have appreciated my rendition of the song Paper Planes. Yesterday's clinic or rather hospital experience was interesting. One of my brain patients had a moment in the morning where he told everyone to put a gun to their heads and try to fly and it was our fault that the hospital didn't float. A little ativan and oxycodone and he was back to normal and he has no recollection of the event. The other brain patient is making some progress, a capped trach - he's on his way to recovery, it's just a question of how much of a recovery will be made. In the midst of writing my notes, 2 things happened. #1 I found that the resident extern is learning to write a note - this person actually asked me how to write up the ROS. It may just be me, but I thought they taught that in med school. Perhaps not. #2, another patient, not mine, who had been sitting pretty at a HR of 42 all morning decided to have a 15sec period of asystole, then knocked himself back up to the 50s and 60s. Um, pacemaker perhaps? I also rounded on a new admit for another doc, this pt's pretty simple: uncontrolled DM with retinopathy and peripheral neuropathy, partial midfoot amputation of one foot, and a recent horrible trimalleolar fracture of the other with ORIF, she is also on peritoneal dialysis and has a cardiac history. The nephrologist (this cute little old guy) had to come in to teach everyone about peritoneal dialysis - fairly interesting the inter workings. Thankfully I had read up about it shortly before he came in and was able to ask him about the prospect of the Toronto nocturnal heme dialysis being a more viable option for those who failed Peritoneal dialysis but did not care for the inconvenience of heme dialysis. We had an interesting discussion and the other docs slowly walked away from the immediate area - seems they had been pimped by the nephrologist and failed before I happened upon the learning session.

Nothing much else is new. I am slowly preparing myself for my next rotation which will be quite a change from anything else I have done thus far. I am relishing every moment with my husband and the pups knowing the next 6 weeks will fly by all too quickly. Once I leave this time, I don't know when I will be coming home - holidays maybe, but doubtful. KS X 12wks, IA X 6wks, OH X 6wks, then home again for 6wks until I head to Ecuador for the last 6 wks. I am actually having 2nd thoughts about this Ecuador business. Interesting opportunity but just not sure I want to spend the extra money to be so far from home.

Here's a link so you too can have this great little ditty in your head.
http://www.youtube.com/watch?v=7sei-eEjy4g

Task Oriented

So through my short stint of rotations I have found how task oriented I really am and how much I enjoy task oriented jobs. My whole prison rotation was task oriented and thankfully this little stint with Dr. Patomd is sort of task oriented too. Like today for example I had 4 patients to round on and write notes - I did that, gave report and was outta there. Nice. I did have some things to do like figure out why my computer decided to crash when I got home from TX, so it all works out well. It's a nice little break anyway before my trauma rotation which will be busy busy busy, but reminiscent of my paramedic days.

Bored on the floor

Well, I have survived 2 days with Dr. "I hate PAs" and I actually feel bad for calling him that for now, so I will have to think of a new name. He's been ridiculously nice to me. He actually showed genuine concern and (gulp) compassion towards my TX endeavor. He's asked a few questions I didn't quite know, but he didn't make me feel all that stupid for not knowing them. I even heard him crack some jokes today and have some inflections in his otherwise monotone voice. Sure he still throws out info to make him look like a super smart doc and me a lowly stupid PA, but really not as bad as I thought. The PA, well he's God's gift to the PA and medical profession. He threw a few things at me, that I don't know anyone would know unless they just recently read about the EXACT mechanism for prednisone action and its effect in developing PCP. But after answering a few more routine questions, presenting 3 patients and writing some stellar reports he hasn't bothered me much since. In fact, I am completely on my own, rounding on patients and writing notes. My three patients are on autopilot basically but they all have something unique to offer. I got a new Admit that Dr"need a new name" asked me to admit and write an H&P. Talk about the longest note I've written - almost 5 pages. Quick rundown of info of this new pt. under 40 male, PMH of DVT that lead to massive PE, had clot in PFO (patent foramen ovale), ended up having open heart to remove clot and fix PFO - coded with Vfib arrest CPR for 10min, saved, suffered anoxic brain injury and now basically non functioning. He has a trach, PEG tube and likes to pull things out so he's in restraints, he follows commands - some of the time, but completely nonverbal, especially now since we took out his PassyMuir valve on his trach. 22 medications. Probably the most difficult Neuro exam I've ever done - trying to figure out if receptive or expressive aphasia or both or to what extent the damage is. Keeps it interesting.

As I was leaving today, I had a brief conversation with the PA, basically, I am welcome back anytime b/c I have good notes, and have done a good job and been a great help since I came - yesterday. Dr. Patomd (that name will stick for awhile) told me to come back whenever I need to if I need hours b/c "it will keep you out of those clinics which can be really boring" Hmmm, glad I chose not to tell him how bored I was rounding and writing notes - despite the incredibly interesting patients. Oddly enough I miss prison medicine. I wonder how my secondary syphilis guy is doing or how the unknown etiology rashes are and if any of my other mixed pot patients had more interesting pathology.

Oh and in family news - we bought a new (to us) car - a 2006 Jeep cherokee Laredo with 18,000miles. Coincidentally we found out after the purchase (because we were too enamored with the price and mileage and immaculate condition of the car)that it has a V8 and nearly every bell and whistle that possible on that model. Heated seats, mp3 player, trail rated everything! Holy cow! I am so proud of Shawn for working so hard to make it happen and so soon! It's so cool to know that when we have kids, it will be this first car they ride in and will come home strapped in their carseat in the first car we've ever really owned. I feel so grown up.

From one hell to another

I finally escaped TX and the remnants of Hurricane Ike. I am very grateful to be alive and home with my husband. It was much worse than predicted and the area I was staying suffered so much damage, they are still picking up pieces, waiting for everyone to have electricity and only has 1 gas station open, which currently has no gas. Hopefully the raw sewage has been cleaned up too. The gravity of the situation didn't really hit me until I saw the news when I got to Dallas where my mom and grandma met me and then again when I got home and threw my arms around the love of my life, who I was afraid during a couple points through the storm that I may never see him again. Some may accuse me of being melodramatic or over the top about the whole experience, but until you lived through the 100mph winds yourself in the direct path of the hurricane, I beg to differ. I didn't ask to go to TX, I tried to get out but couldn't, and it's not like I am being compensated for my time spent away from my family - infact I paid the school for my TX adventures and paid even more to get an emergency flight out of there. I am so lucky to have a husband, mom, grandma and inlaws that love me so much.
Now that I am back in Portland I now have the luck to be spending the next week with Dr. "I hate PA's" who use to be our medical director (and at one time a PA) but has now moved on to squashing PA-students. Oh joy, can't wait. At least I know I won't lose me life or limb with hell#2.

In joyful news, we're buying a new car soon (new to us anyway) can't wait!!

Another Hurricane

Even though I got let out of clinic early today to evacuate, I find myself sitting at the computer in a house full of people NOT evacuating. I didn't do my presentation (haha) and I didn't get to share my fruit salad - what a waste. I have a flight out of Houston Hobby airport to Amarillo TX (where my mom would get me and take me to KS) but I can't get to the airport. No one will take me and a cab is way too expensive (I just don't have $900 in cash). Stupid Hurricane Ike. I have a stockpile of water in my room, but no boards for my window to ride the storm. I would say about 2/3 of the houses I passed on the way home today were boarding their windows, including the neighbors (the ones not related to us). I was also instructed to stop eating my lunch today because if we lose electricity (and we are more than likely to lose it) there will be no working toilet. But don't worry folks we have x-tra water for drinking stockpiled in an emptied kitty litter container. I feel safe and secure so much in fact I was wishing I had stayed at work and had someone at work swing by my house so I could pick up a suitcase and then they take me to the airport or go home with someone that lives further inland. No matter where it hits, we are on the dirty side. Lucky us. Apparently my family rode out the storm with Rita a few years ago with flooding, roof damage and no electricity. I can't say riding out a hurricane is or was on the top of my lifetime achievements. If I can escape the house tonight I am going to wal-mart for some canned goods and poster board. I am making a sign that says "hi mom, I love you Shawn, and please send me home to the NW." in case I am stuck on the roof of the house after the fact. So look for me on TV I guess. Maybe the storm will fizzle and be nothing, but then again I am not looking forward to the aftermath if it is bad. I may be out of touch and unreachable (and without clean clothes) for a bit.

Nothing new happened in clinic, my one sick call today was a man with hx of GERD/dyspepsia, waiting to get a GI consult in Jan '09. He's also HIV+. He was super gassy, so I gave him an anti-flatulent. Whoo. I did have my most complicated intake I have ever had though, lots of paper work and labs to be ordered: HIV, HTN, TB+ (s/p prophy 9months), SZ disoder, mental illness (thank goodness not my dept), bisexual (in for prostitution - important to know for safety reason, just glad he wasn't on estrogen) and currently on lifetime prophy for PCP. He took an hour.

Each morning I drive to work I try to catch a segment on one of the radio stations call "whatchya doin' at the courthouse" it has a catchy jingle that I found myself singing along with today. And the short bit is exactly what it sounds like. The radio DJ (Sara) asks people why they are there. Some are good, others are stupid and some, well only in Texas I'm sure. Here's a couple stories from today: a man accidentally caught his house on fire, when he poured gasoline in his doorway to keep out a friend of his that he was fighting with. The vapors caught fire from the hallway heating unit. Charge: arson. Next person was charging the police officers who tazed him when he was running from them for use of excessive force. Sara gave him a couple scenarios of would you rather... and here they are: would you rather have to bike to work everyday or be tazed? - ride bike. Would you rather go to jail for 6mo or be tazed - go to jail. would you rather be on the Maury Povich show to see if you are a lady's baby's daddy or be tazed - tazed - in fact you can taze me twice. A woman trying to get child support from her baby's daddy. She was asked how many kids she had - 5, and how many baby's daddy's? 6 (apparently there's one on the way - must be a lucky guy)

To compliment a half day

I received my first compliment from my preceptor today: "You write a good note"
YAY! Victory for Jenni. I think complimenting me may have been too much for her, because she sent me home after lunch since we had no more patients. Usually I watch someone do backdoor paperwork and review lab tests when there are no more patients. Too bad I'm not at home for these half-day miracles I could be playing golf with Shawn! Although Dr. M did send me home with one little caveat - work on my presentation. So I probably should do that. I also have to make a fruit salad for work tomorrow, I was invited to the staff pot-luck, I guess I received enough votes from the staff to attend, so yay! Which makes me remember that I won't be giving my presentation tomorrow afterall, since there is a luncheon. Hmmm. Nope better prepare just in case.

I would also like to mention that I gave a lot of education today to the patients I saw today. It was incredibly rewarding. I spent almost 30minutes with one patient talking about HIV and hepatitis. I felt reassured that I had done my job both as an educator for these diseases, but also for what he was being seen for as I made him repeat back to me his understanding of everything I had talked about. All the information was there. There is something about giving people information to improve their lives and then to see the light bulb go on when a patient "gets it" or figures it out a little - even if this pt is a convicted inmate. Oh the other side of the coin, I am slowly learning that it's ok to stop pushing for people to take control of their healthcare and not feel like I have to save everyone I see, it's their choice and future choices. I can give them the tools and resources but ultimately it's up to them. In some respect, that's why we have natural selection, too bad that can't kick in sooner for some populations.

Guy #7 and a missed birthday

Just last week I was 6/6 (6 pts in 6 hours). Not a bad showing, but today I saw 6 patients in about 2 1/2 hours and the 7th, well, he took a long time, so I didn't add him into the mix, and #6 took longer too as I had to make sure I ordered his scabies treatment just right. He said he got the rash before prison, but it looked a little more fresh than 3weeks - head to toe Permethrin for you!

Anyway Guy #7 was interesting - as most of the people here are. He presented to the clinic with blistering and swelling on his left foot (so bad he could barely move his toes and ankle and the circulation was poor). He's an uncontrolled diabetic. over the age 50, also has HTN and has a laundry list of ailments he came into jail with (ie hx of colon cancer and bowel resection). The foot was very painful and the blisters were oozing with exudate pouring down his foot. (Is it lunchtime yet?) There are small punctate lesions on the front of his shin and there are some new eruptions of something behind his knee. He is covered with Tinea versicolor, probably one of the worse cases I have yet to see. He has scaling on nearly every inch of his chest, back , head and neck (classic DM Tinea here). His other foot untainted by disease. What to make of this. Fungal infection gone wrong? Allergic reaction to fungal cream he borrowed from someone else? Stasis ulcers from uncontrolled diabetes? I had no idea, so I did what all good PAs do when they are in over their head - consult their Supervising doc. "Looks like shingles to me" she says with a brief look. I felt like an idiot , only to realize that is the most bizarre presentation of shingles I have ever seen and considering she has been a Dr. longer than I have graced this Earth, she should pick up on that right? No, I should have seen that the blisters and little bumps were following almost a classic S1 dermatome pattern. But it was still wicked cool to see this presentation, even if I did miss the dx.

So what did I do with my last 3 hours of work today? Busy work. One of the PAs, decided to give me three random patients he pulled that showed anemia in their labs. My job was to find out why these patients were anemic. He thought it sounded like a neat idea. I sat down scoured the labs and notes. I came to very specific conclusions from each one, jotted down a couple notes of interest from each and even looked up a couple of things so that when I presented them I could throw in that little touch of something extra (or make me look smarter than I actually am). I returned to present them, only to find that he himself had not read any of the charts or knew anything about the patients. I realized then that this was going to take awhile. One by one he sifted through the information, all of which I thought I had done a fine job in presenting. He disagreed with me in anearly every aspect, only to recant every statement when he went to look things up for himself to see I did in fact have a clue. One aspect he even wanted to consult the doc on (this had a lot of potential for making me look really stupid)he was concerned why a sickle cell pt had high levels of HgbF (fetal hemoglobin) I had to double check this myself and had infact looked it up and according the Harrison's the Bible of Internal Med: Hgb F can be elevated in states of hemolytic anemia, active erythroid balh blah blah and so on. ANother book: HgbF is elevated because the O2 demand is higher the body is trying to compensate by making more HgbF to carry more O2 (HgbF is great for carrying O2 in low O2 environments like in utero). The PA says: Dr. the student has a very interesting theory on why this lab is elevated. I told her what I thought and she says, no I don't think so, why don't you look it up. I wish I had looked up as I read from Harrisons proving I did have a clue once again, but I didn't. She had no reply. I thought - Haha - got you sucker!

My rash guy from Friday that was yanked from my exam room came back yesterday and his rash was worse but not as wide spread (which in most books would make it better). Sometimes I wonder if the inmates sit in their cell and rub themselves with something right before they come in or in the waiting cage just to make it look like they have something wrong. Who knows, I gave him 3 days of benadryl anyway. I also got what I perceived as a comment from my preceptor yesterday, "looks like you saw a few patients this morning, I guess you are getting the computer system."

In other -more important news (ie: NON work related)

1. It's Wrigley's 1st Birthday and I'm missing it!!! I am so sad. I did send her a banana bread cake, but it just won't be the same. I guess we will have to celebrate her 1 yr and a month b-day.

2. I'm suppose to go to the Astros vs Cubs game this weekend in Houston with the fam I am staying, I even ordered a shirt that should arrive just in time so I can be sure to support the one and only team - The CUBS. But as luck would have it there's another stupid Hurricane coming this way and looks to actually hit TX this time. Great, just great - I may have ordered a shirt for nothing.

3. Shawn is finishing his '8days in a row working' marathon. Bless his heart. I only pray his jeep can last a few more overtime shifts. I wish I could send him my extra time off to use as he chooses - mine is being wasted here in Tejas.

Pictures - Wrigs as a pup and Wrigs as a big girl playing with her Brother at the beach.

Just a wee little thing.

Happy Birthday Wrigley!!

Half Way There!

It's the halfway point! YAY! THis also means ist was evaluations day. How can one evaluate something they have not witnessed themselves? Well somehow they can through there telepathic powers or hidden video camera I suppose (neither of which any of the 3 preceptors have). Secondly, if you are doing a medical rotation is it really fair to ding someone for asking questions about how to use the computer? Apprently so. At least the evals today made my preceptor realize she has not read any of my notes or seen me do any type of assessment. C'est la vie - 3 weeks to go thankfully.

Today was short but long. There was no intake today for reasons beyond me having to do with the hurricane that hit Louisiana earlier in the week. I really don't understand the logistics, but I am sure the Asst. Warden (whom I actually saw today) or the other powers that be had good reason. So second sick call of the day, the guards started doing count. It was only 9;30 or so, which is really early for the midday count. Next thing I know I am told all inmates to the front to be racked (back to their cells). Confused, I asked what all this meant. No one else seemed to know. Perhaps count was off, there was a situation in which an officer was assaulted, it was a random sweep for contraband, there was a threat to the complex or a drill. Then we were told to lock our doors and go up front for us to be accounted for. Next thing we know we are escorted outside and wait until we are cleared to go back inside (still not knowing what the heck is going on - but apparently the pseudo-SWAT team at the jail was clearing the medical unit). Back inside we go. Then incomes the Asst. Warden (picture Jim Carey from Me, Myself and Irene) he was with a small entourage of guards, and other people in jeans and polos and boots. They were practicing a hostage drill. Oh joy. But at least the new officer recruits got a chance to practice in their fatigues, Kevlar and weapons. This took about 2 1/2 hours. So we went to lunch in hopes that after the drill and the midday count we could resume our office visits. We waited until 1pm and they were still doing count, which we were told may be off which meant lock down. It was time to go home. Everyone will be rescheduled on Monday. Maybe my 2nd guy's rash will be gone by then and I won't have to treat it. It was rash week all week. Strange funky rashes that have no etiology what so ever but look really bad, they spread all over their body by about a week and don't go away and make me feel incredibly itchy all over.

If that's the worse thing I ever do in medicine...

Apparently the state frowns upon ordering a $300 free and total PSA when the $6 serum PSA works just fine. Who knew? I didn't yesterday when I ordered it. But now I know and I figure if that's the worse thing I ever do in medicine, I think I'll be alright. I can think of a whole lot of other things that would be much much worse. I was even the bigger person and didn't mention to the Dr, after she finished chastising me that one of the PAs occasionally orders what I now know is the wrong (more expensive) lab test. I say take it out of my paycheck.

Today was busy and yet slow for a Thursday - or maybe that was just my work pace. One of the PAs (same one who is ordering the spendy tests) dumped one of his patients on me. That's fine, but what irked me the most is that he passed off my treatment plan and idea off as his own, which was a 180% different than what he wanted. Pt scenario: uncontrolled diabetic bumped shin when getting out of bunk - a month ago. Now has cramping calf pain, swelling on the medial (inside of the leg) calf and tender to palpation. I think he's just a poor wound healer - he still has some bruising on the shin - I also ruled out why it's not a DVT which was the PA's thought (he wanted to try and ship him out to have an ultrasound). So time to consult the doc and Mr. PA changes his mind - which is fine, we can have a change of heart, but I had the exact same findings as he did. Who knows. Interesting case for the day: 19y/o with no testicles. Pt's story: had undescended testes as an infant - bilaterally - never had surgery to bring them down. Flash Forward to 17 years later, he had laparoscpoic abdominal exploratory surgery to find his testes for removal since they put him at higher risk for testicular cancer and I guess they looked and looked and they couldn't find them. His testosterone is low, hasn't hit puberty yet and has slight gynocomastia(man boobs). He started testosterone, shows up at our door and voila! I also had my first quasi famous person in today for intake (former pro-baseball player). Oh and one of the patients I saw today had the most bizarre presentation of tinea versicolor and scabies - regardless these patients always make me feel itchy.

I am thankful tomorrow is Friday. It's the 3 week marker for this rotation. Whoohoo! I should probably catch up on Typhon. I'm only, oh, 3 weeks behind.

6 in 6

Well, today, nearly 3 weeks into my rotation I had an entire day of seeing my own patients. 4 intakes - 2 of which were almost as complicated as they come and then I took 2 sick calls neither of which were super brain pickers, but navigating the formulary and the computer is enough! Sure I made a few mistakes on coding due partly to the fact that no one told me I had to go through a whole different area to input a new diagnosis- but I think I did alright considering how steep the learning curve is for the damn computer system. I saw 6 patients in about 6 hours. It sounds like I didn't do much, but between finding things on the computer and double checking with 3 different people on the labs to order and looking things up in the formulary I got a lot done today. The important thing is I am seeing all my own patients now - well at least when there is an open office/computer. Otherwise I observe while I sit in my designated orange rollie chair labeled ZUPFER on the back. Yeah that's right - that' s my orange rollie you silly nurses so quit stealing it!
I also saw the most wicked abscess in someones armpit today, I watched this one get drained and packed - I get to do the next one. It spurted everywhere!! There was a huge crowd too - although one of the female guards nearly fainted as the chunks poured out.

Good news for me - Shawn finally got a computer. So we have another means of conversation and entertainment for his sake - if he has time - the silly boy is working 8days straight. Gosh I miss him so much and the kidlets too. But, after this week, only three more weeks...so close, I can almost count days.

Pseudo-sister

Well, Gustav never showed, here any way. Which is a good thing I suppose. I admittedly was looking forward to a potential extra day off, but even just thinking about that extra day I'm sure steered Gustav to Louisiana. We didn't even get rain yet (if ever).

Yesterday, I experienced something really neat. My family I am staying with has 3 kids, one who is a couple years younger than me and she's married, a HS senior who is never here due to football practice and a girlfriend and a HS freshman in need of new shoes for school. Like any non-girly girl (I can totally relate) shopping isn't really her thing. She also has a very unique-goth-ish style. She and her mom had already been shopping earlier in the day with no luck - at all. I think someone may have even gotten tired of being at the mall, but I wasn't there to say that's a fact. I recommend a new store in town (Kohl's - which is one of my favorites!) to check for canvas-type or more rocker-type shoes. There was a lot of pessimism in the car as we drove 15minutes to the next town. Not a whole lot of luck at first, but then she found a pair of Vans with some interesting designs on them. I tried not to hover and give her space. I went my separate way and eventually we met up in the juniors department, I saw her mom had picked out a few items. She went to try them on and out of nowhere I felt this compulsion to look for clothes (in her style) that I thought she might like, or maybe wouldn't have tried on had they not been picked out for her. I found some really cool t-shirts and a couple outer pieces. I finally had to contain myself, this poor girl was cornered into a dressing room with some cousin throwing clothes at her from the other side of the door. I was really having fun. I guess I felt like I was a pseudo-sister for the hour that we were there. It was a good warm and fuzzy kind of feeling. (And she liked almost everything I picked out!! Blanca and Mereya both thanked me for helping).
I am really sad I don't have siblings or cousins that I grew up close to. It just seems like it would be so nice to do things with siblings or at least have them to talk to. I found growing up my stuffed animals didn't talk back, or miraculously said exactly what I wanted to hear.

The family I am staying with has been very hospitable and warm. I am so grateful to be staying with family!