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)
Wednesday, August 20, 2008
Tuesday, August 19, 2008
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 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.
Monday, August 18, 2008
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)
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)
Sunday, August 17, 2008
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.
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.
Saturday, August 16, 2008
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.
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.
Sunday, July 13, 2008
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!
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.
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