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.

New Healthcare study

Shawn found the most interesting news report and seeing as we are both in healthcare, we felt obligated to share it with everyone. The bottom line of the study: children actually oppose healthcare initiatives.
http://www.theonion.com/content/video/study_most_children_strongly?utm_source=videomrss_74358

So keep this in mind when voting in the November election. Save the children!

Tickets

I am anxiously awaiting August 1st and not because it's the last day of this rotation - I really like this rotation and hope the rest are just like it. My dear husband set up an amazing surprise trip for us...WE'RE GOING TO CHICAGO to see the CUBS!! I am beyond excited! What a treat! He set it up all on his own, he tried to keep it a secret but couldn't, what a sweetheart!! He also bought his parents tickets to the game too (for father's day and his mom's birthday). It will be their first time at the 'Friendly Confines' I can't wait for them to experience the Cubbies up close and personal - our tickets are phenomenal!! Wrigley Field is amazing, the Cubbies are amazing (even though it's been a century since they won a world series), the fans are awesome, up on their feet cheering with one out to go in the bottom of the 9th, even if the Cubs are behind . And to hear the entire stadium erupt with the song "Go Cubs Go" after a great win - nothing tops it. I wish we could go see them play more often, but we named our dogs after the team so I guess that will have to do for now. Hopefully they will continue to play great following the All Star break (more like the Cubs vs Red Sox break).

In other ticket news, I just bought my plane tickets for Rotation #3 in Humble TX. Oh joy (with a large side of sarcasm). At least I will be with family and speaking Spanish daily.

Newborns, horn and corns

I have found it so much easier to give a brief synopsis about a few things here or there than try to rehash every moment of my waking day in clinic and as a reader I would think this would be a much preferred approach.

There is still no word about the TB pt, the pulmonologist is calling the "cavitary lesions" an anomaly of the mediastinum instead, they bronch'd her yesterday and her lungs were pristine. but there are these two large rubbery LN we still can't account for and a raging PPD. The surgeons won't touch her b/c she is self pay and would have to place a retainer fee of about $1000 min for them to even consider her, a CT scan is super expensive, and the radiologist won't touch her with a 10 foot pole without a CT scan. What to do? The Bronch result won't be ready till Monday, so I guess I will go see her Monday. Also have a newborn we've been seeing, perfectly healthy chunky baby. It' the family's 7th.
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My day started in clinic with a lovely man with a cutaneous horn. WOW. it really looked like a horn growing from this guys face. I was hoping to lop it off, but after doing some reading, it typically has a carcinoma in the base of it so of to derm - in a month, thank goodness the cancer is not invasive but the horn will grow at astronomical rates. Next pt, was suppose to be plantar's warts but low and behold just a corn, but she wanted us to freeze it anyway, so we did. http://www.google.com/url?q=http://www.visualdxhealth.com/adult/cutaneousHorn.htm&usg=AFQjCNEEmrHQ9p1ZvyE2fOMhMVVKOyqOVA
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The most interesting patient of the day came in around 9:45 ish (how he got her I'm not sure). Seemed like an easy enough pt - a f/u from urgent care for pneumonia/bronchitis, sounds easy enough, I was all over it. I walked in and was immediately taken aback by cologne? or is that Alcohol? I will go with the latter of the two. Turns out this guy has some interesting history - he had an ablation a couple years ago for a "short circuit in his heart" but had never heard of WPW, bummer that would have been cool, he's having some ED d/t a urethral stricture removal a few years back, some long term insomnia being wakeful for 3days at a time some weeks, oh and did I mention he's still sick with bronchitis? So all of these things seem pretty benign, but wait it gets better. He also brought in a letter he brought in himself that he had typed and wanted the doc to sign for him so he could return to work. I wish I could remember this letter word for word, but man was it entertaining. I bit the sides of my mouth when reading it as not to laugh out loud, I quickly confiscated the letter and wrote all over it. He had a family member drop dead of a massive MI at age 56 - this guy's 49. Hmmm, where to start. Well, I will exclude the thought process and the stern conversation about not coming to the clinic smelling of alcohol, he still had some major wheezing in his lungs - emphysema from a 35pk yr history of smoking or bronchitis? Hard to tell, give him a nebulizer treatment - the CXR should a nice barrel chest. As for the insomnia and shakiness, um, can we say DT's? To top off this lovely visit, he had brought in a form for the doc to sign that said he was competent to drive in order to get his license back. Umm gee let me think - No way! He earned himself a trip to the cardiologists for a regularly irregular heart beat I found and the extensive history.
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Thank goodness last night was date night with my Shawn. We get all dressed up, go to a fancy dinner and then go out for dessert! It can make even the longest weeks seem better!

Um, Have a nice life...

So a quick post about today. I am really behind on Typhon, just haven't felt like doing it, it's a pain or perhaps I just miss the days of my ortho rotation trying to put in 50pts per day (haha NOT). So the chick with questionable chest Xray, the one who I did the kindergarten-style Spanih H&P on came back for her PPD reading umm, 3.5X5cm at least and raised at least 1-2cm, yeah I would call that a positive test although the Radiologist seemed to have missed the glaring cavitary lesions on the CXR, but anyhow the patient was sent directly (with mask) to the hospital to be admitted and sequestered in full isolation and she was labeled as a (and I quote) "hot suspect," she may not have pulmonary TB, but there's something whack going on there, her house will soon be visited by the Washington county health department and checked too. In other news I did an H&P on a elderly priest - there is just something awkward about asking a Priest about bowel and bladder habits, luckily I remembered I didn't have to ask the sex questions - boy would that have been embarrassing, especially since he was wearing his collar. And on the final note of my day, my last patient walked out after my exam in tears - she didn't even stick around for the doc to see her (the doc was seeing the little sister who at a very young age has such rotten teeth from poor diet is having oral surgery to remove most of them). This pt who was not even old enough to drive, who started having sex before she was a teenager and is HPV + and has already had a colpo was the most defiant person I have ever met. I tried the gentle approach to her abdominal pain and quickly moved to a more direct approach when she told me I could go f-myself with the rest of the world, because she just doesn't care. So although I thought I was making headway to dx what I thought may certainly be PID or ovarian cyst and had her agreeing to give a UPT since her LMP was unknown and tender breasts. So I went to report to my preceptor and suddenly her mom went into her room and next thing we know they're leaving. Some words were exchanged with them and the doc and then he politely tells her "um have a nice life." I guess the lesson learned here was that at this age it's hard to convince them 1.that HPV is sexually transmitted, not something you get from drinking beer from the same cup, 2. it is possible to get HIV and other STDs even if you're not in college 3.UTIs every other week is not normal and 4. having promiscuous unprotected sex (among other things) aren't healthy choices.
My apologies for the slight ranting in this post...hasn't happened for awhile.