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!