Well it started again today - the good old fam rot part II. I can't imagine the rotation without the 2 week holiday break in the middle - obviously family med might not be for me.
Holiday break was great, went by way to fast. I met Shawn in Omaha the 26th we did Christmas with his family and we flew back to the NW late late late on the 29th. After a day of lounging, the dentist, a New Year's eve party, Shawn working a couple days and buying a fricking huge TV for our own Christmas present (and a dresser although not as cool as our new TV) it was time for me to return back to the land of Oz. The plane rides back to the midwest would have been fine except the dead sprint I made from one plane to the next in Denver ( I was A15 and not about to get bumped from being the first person on the plane) and the lady who came in last on the plane and sat next to me endlessly telling the girl on her other side how sick she was in the last two days - and i know first hand now how sick she was since I missed day one back at the ranch - I couldn't even keep down water. Feeling pukey but ready to go again this morning I strapped on the white coat and headed to the office. I know I'm sick when I passed up the chocolate glazed donut they saved just for me.
It was an average day in clinic. I lopped off a few skin tags and a seborrheic keratosis and cauterized them with the bug zapper. I saw a few WCC and made the mistake of calling a pint sized summo wrestler a he not she (in diapers there is no way to tell really). I got back into the swing of dictating - which believe it or not I can't imagine writing one single hand note ever again. Why was dictating so scary before? My favorite patient of the day - a 92 yr old lady in for her routine 3 month check. "well hello dear how are you? It's so good to see you! come here and give me a hug" She talked to me like we were long lost pals the entire time just catching up on things. And as the doc and I were exiting the room she grabbed my hand and pulled m into a long hug as she told the doc how sweet and kind I was and what pretty hair.
Two of my new year's resolutions: 1. make better use of my time (not that finishing my first quilt top wasn't good use of my time - just not sure how that will serve me academically. I can see my interviews now: well I have no idea how to treat that or what medication to use but I can make my points match in a tossed nine patch!), 2. more positive outlook. I tend to complain about this and that and everything in between. Bottom line - I am ridiculously homesick - even though I was just home. My husband is my best friend, confidant, my solid rock, support and greatest love of all - how could I not miss being around him and our routine and everything else about home? I've been hard on my rotations too. I think I'm just afraid that I'm not going to know what I should know or that my fellow classmates will have a better experience than me making them more prepared than myself or that in the end of this I will still feel clueless. Jobs? That's an entire other discussion. I am terrified about finding a job - one that I like, pays well enough to pay off my loans and a great place to learn, a place where I feel like I amm making a difference - all close to our home in Washington. - Like I said, another discussion.
So here we go, round two, 5 more rotations left - 1 of which is a graduate project, 1/2 of family med, peds, ER and Ecuador. I can do it. One day at a time....
Tuesday, January 6, 2009
Wednesday, December 17, 2008
easy street
This week has turned out to be a fairly easy week - works for me. Monday was supposed to be blocked out for surgery - when it was canceled only a handful of patients filled the slots, I was home by 5:30, Tuesday: hysterectomy in the am fairly easy day - oh and it snowed - a lot (so much for a trace to nothing), Today: half day, plus special guest lecturer about Alzheimer's from a doc who does clinical trials for namenda - yummy lunch and actually a great lecture - learned a lot. Tomorrow I start between 9:30 and 9:45 at the health dept for family planning clinic - whoo, it'll make the day fly, Friday - workplace potluck - whenever there is food it makes the day fly! It's a good last week, I may or may not go the extra mile and go to clinic on Mon and Tues since I will be here....we shall see.
This afternoon I made white chocolate dipped pretzels with peppermint sprinkles for grandma and myself. She was adamant to have something to give everyone...the bus drivers who drive her when I have the car, the cooks at the senior center, the janitors at the senior center, the coffee group, the hair dressers, neighbors, etc. My quaint plate of pretzels will accompany my cheeseball for the potluck.
I'm already tired of the cold and snow...a high of 10 or less is just too much for me. We weren't suppose to have any snow and woke up to 6inches the other day - at least I have avoided having to shovel. The hysterectomy I scrubbed in for was a good learning tool - although the OB lived up to his reputation of being an oinker: in case you weren't aware this is what the female parts look like - are you familiar with these parts? ...later on...do you know what purpose the uterus has?(I thought - seriously did you just ask that?)
I personally founded the first to be a loaded question...not sure what I said but looked around for a lift so I could actually see above his towering 6'5" frame -
It would probably be wise to write some of those papers that are due at the end of the 12wks, although I am a stellar procrastinator and would rather start sewing on my quilt instead.
This afternoon I made white chocolate dipped pretzels with peppermint sprinkles for grandma and myself. She was adamant to have something to give everyone...the bus drivers who drive her when I have the car, the cooks at the senior center, the janitors at the senior center, the coffee group, the hair dressers, neighbors, etc. My quaint plate of pretzels will accompany my cheeseball for the potluck.
I'm already tired of the cold and snow...a high of 10 or less is just too much for me. We weren't suppose to have any snow and woke up to 6inches the other day - at least I have avoided having to shovel. The hysterectomy I scrubbed in for was a good learning tool - although the OB lived up to his reputation of being an oinker: in case you weren't aware this is what the female parts look like - are you familiar with these parts? ...later on...do you know what purpose the uterus has?(I thought - seriously did you just ask that?)
I personally founded the first to be a loaded question...not sure what I said but looked around for a lift so I could actually see above his towering 6'5" frame -
It would probably be wise to write some of those papers that are due at the end of the 12wks, although I am a stellar procrastinator and would rather start sewing on my quilt instead.
Monday, December 15, 2008
cheerios
So today one of our patient's family members learned the valuable lesson that you can't piss in a surgeon's cheerios and then ask him to eat them(although pissing in anyone's cheerios is not advised). Case in point: we were scheduled to help with a colon resection today for a giant diverticuli abscess (whoohoo) with one of the surgeon's (A). on admit, the patient's family was told by one of the RNs Oh I wouldn't have Dr. A do that, Dr B is much better. whoa! That' what a ballsy move. That problem seemed to get ironed out, and the family agreed to go with Dr. A after all. Well apparently last night at about 9:30, this same family member decides to call my doc and the surgeon and say - we want Dr. C to do the surgery tomorrow - yea totally do-able crazy person. Well turns out Dr A signed off this morning for Dr. C who turns out will be out of town until at least tomorrow - family member asks: well isn't there a third surgeon available? That's Dr. D. That doc was on call all weekend and wasn't available. SO family member asks - Well I guess we'll just have Dr. A do it. What?!!? Um, no, you already pissed in his cheerios this morning, and now you want him to slurp it down - nope not an option. So they prefer to wait until Dr. C gets back in town, whenever that may be risking sepsis, infection, and long term colostomy. Great POA and patient advocate - must be a big inheritance on the line... oops, that wasn't nice, but I was thinking it. So no surgery for me today but tomorrow I get to help with a hysterectomy with Dr. I hate women (why women choose this doc as an OBGYN I have no idea)! I'm just glad it's at the surgery center with the super cute scrubs.
On another note only 11days to go until I see my shawnee, I held my 1st 2mo old kiddo today and didn't break her and almost halfway done with this rotation!! YAY!
On another note only 11days to go until I see my shawnee, I held my 1st 2mo old kiddo today and didn't break her and almost halfway done with this rotation!! YAY!
Friday, December 5, 2008
Control
I realized today that my preceptor has a bit of a control complex - I think, especially for procedures. Here is my rendition of Prince's song "control": "ohhhhhhhhh Procedure control" (only Prince - or the artist formerly known as - used another P word). It must have been sebaceous cyst day - we had several - all between two patients. Our first patient was in for a check up for an infected sebaceous cyst midsternal intermamillary (right at distal end of the sternum) that the doc I&D'd while I was gone for Turkey day. It still felt - gelatinous I think is how I described it in my note - I wanted to stick it again or squeeze the hell out of it - I could see the opening, but being the good student that I am, I refrained from popping that yummy bit of heaven. When the doc went in - he stole my thunder... my heart sank as he squeezed and it erupted like a volcano with sebaceous material and keratin. She'll be back in 6weeks though to remove the whole thing - hopefully I can have my turn then. I never did quite figure out how to dictate my note to professionally portray how he popped the cyst like a zit.
Our next lesion removal planned today was potentially going to be lots of fun- I only gathered this from the hour and a half block of time that was scheduled out of our day. Not that curing HTN, DM, and hyperlipidemia isn't enthralling but I find more satisfaction from poking and cutting things and putting them back together. In my trauma rotation I could just engulf myself in a my own little world and sew away... Anyway, our patient today had 2 sebaceous cysts that needed to be removed on the back - one large, one small. two itty bitty ones on the face - which may have well been left be, and skin tags (about 12) under the L armpit and 3 in the groin. We started with the large cyst - holy cow - I've never seen something so large come out of someones back! When all was said and done the cavity that remained was about 3cmL X 2cmW X 2cmD. the cysts was huge! With a cavernous hole such as that I was carefully plotting how I would close and offered to close the first hole why he created another. Once again "oh no I'll just do it real quick." Not that I'm an expert or anything but I could have closed the inside part much better and my external nylons would have been a little more even but hey I'm just the PA student. The second tiny little thing he did let me throw a suture telling me exactly what to do where to do it and somehow managed to always have either his fingers or scissors right where I needed to be and he was standing in the ideal place to actually perform -but I'm not really complaining I would rather have all the misdirection and get to do a suture than none at all - (in my head I was warning him to step back or I might suture his finger to the patient's back).
Today we had a "pod" meeting. Basically - free food and peer review of pharmaceutical company's research/literature used to make their product look good. When asked what I thought of the material and for any questions I had: I simply asked what the confidence intervals were, where were notes about patients lost to follow up and if research was being conducted beyond the 6-8weeks of the study. After a silence that could kill a large city the rep moved on and talked about something other than the literature. Whew - off the hook I thought to myself, I guess I paid just enough attention in EBM class. As I was enjoying my 2nd helping of "Four Legs Up" BBQ brisket and special scalloped potatoes I realized why and how I have gained 5pounds and my pants are a little snugger - not that grandma cooking for me almost daily has helped my weight cause either.
2 Other things learned this week (or just reinforced) of what not to do with grandma around: 1. bottom out the car in a low lying area on main street - twice, watch tv dramas like grey's anatomy ( they must have said the word sex like a hundred times in one segment), and on a random learning note - if you are in the frozen arctic and you accidently touch your knife to your hand and it gets stuck - don't pull but pee on it, this of course doesn't work if you get your knife stuck to your tongue, unless you have a friend who will pee on it for you(Thanks Bear Gryles). Thank goodness it's the weekend.
Our next lesion removal planned today was potentially going to be lots of fun- I only gathered this from the hour and a half block of time that was scheduled out of our day. Not that curing HTN, DM, and hyperlipidemia isn't enthralling but I find more satisfaction from poking and cutting things and putting them back together. In my trauma rotation I could just engulf myself in a my own little world and sew away... Anyway, our patient today had 2 sebaceous cysts that needed to be removed on the back - one large, one small. two itty bitty ones on the face - which may have well been left be, and skin tags (about 12) under the L armpit and 3 in the groin. We started with the large cyst - holy cow - I've never seen something so large come out of someones back! When all was said and done the cavity that remained was about 3cmL X 2cmW X 2cmD. the cysts was huge! With a cavernous hole such as that I was carefully plotting how I would close and offered to close the first hole why he created another. Once again "oh no I'll just do it real quick." Not that I'm an expert or anything but I could have closed the inside part much better and my external nylons would have been a little more even but hey I'm just the PA student. The second tiny little thing he did let me throw a suture telling me exactly what to do where to do it and somehow managed to always have either his fingers or scissors right where I needed to be and he was standing in the ideal place to actually perform -but I'm not really complaining I would rather have all the misdirection and get to do a suture than none at all - (in my head I was warning him to step back or I might suture his finger to the patient's back).
Today we had a "pod" meeting. Basically - free food and peer review of pharmaceutical company's research/literature used to make their product look good. When asked what I thought of the material and for any questions I had: I simply asked what the confidence intervals were, where were notes about patients lost to follow up and if research was being conducted beyond the 6-8weeks of the study. After a silence that could kill a large city the rep moved on and talked about something other than the literature. Whew - off the hook I thought to myself, I guess I paid just enough attention in EBM class. As I was enjoying my 2nd helping of "Four Legs Up" BBQ brisket and special scalloped potatoes I realized why and how I have gained 5pounds and my pants are a little snugger - not that grandma cooking for me almost daily has helped my weight cause either.
2 Other things learned this week (or just reinforced) of what not to do with grandma around: 1. bottom out the car in a low lying area on main street - twice, watch tv dramas like grey's anatomy ( they must have said the word sex like a hundred times in one segment), and on a random learning note - if you are in the frozen arctic and you accidently touch your knife to your hand and it gets stuck - don't pull but pee on it, this of course doesn't work if you get your knife stuck to your tongue, unless you have a friend who will pee on it for you(Thanks Bear Gryles). Thank goodness it's the weekend.
Thursday, December 4, 2008
no fun for the PA student
I realized today that I will not be doing anything truly "fun" on this rotation. There were lots of fun things that came in today, but even after a flat out "oh I've done that a few times would you like me to do this one?" it was a "no I'll just do it real quick" response. There go my toenails, lesions, cryo-freezing and popping abscesses. 8 more weeks of this. Such is life. I did a sports physical for perhaps one of the most challenging and demanding sports a highschool sophomore could participate in - bowling (he didn't need a physical for chess he went on to tell me - and reassured me that we weren't playing tackle-chess in this part of the country). The glasses and pocket protector and bad hair cut I couldn't help but feel bad for the kid, I'm sure he endures some degree of teasing at school so I encouraged his bowling aspirations and my a few jokes about how I can't hit any pins without the bumpers and sometimes the ball goes across the lanes - both true stories.
I had a favorite, well interesting patient today, I'm sure if I saw her more than once I would go crazy. I no more than stepped in the door and I am ambushed by the 7month old's grandma with a detailed minute to minute update on eating, stooling and vomiting habits including exact ounces of food and what kind and what type of spoon or bottle used of her grandson for the last 24hrs. All of which was relatively unrelavent since the poor kid was eating and pooping and peeing just fine except for two small urps this morning. When I realized I could be lost in the abyss of the room forever I kindly asked if I could have her stack of papers to review in the hallway for a more thorough understanding. Is it bad to lie to a patient's grandma like that? I gently placed them into the chart and passed it on to my doc. Apparently she does this at every appointment, she keeps a running tab of every movement, hiccup, burp, sleep time, positioning, food, formula, you name it - it's there. Sometimes she even has pictures like smiley faces and a face throwing up and sleeping positions.
2 interesting websites to check out (thanks to the drug reps):
www.stopmrsanow.com
www.notinmyhouse.com
As what I consider almost the half-way mark of this arduous journey I can't help but think I'm not ready. There is no way I have enough experiences, no how or smarts to pass the boards and let alone work in a practice of some kind. There is so much I have forgotten and have so much to re-learn. When does it all come together. I even feel like my physical exam is slipping since I am trying desperately to keep us on schedule. I can't help but think my fellow classmates are soaring above and beyond me and I will be left in the dust and I am miserably failing the program in some way. I know I'm not miserably failing but I am definitely not on my game and not sure how to get back on. I keep waiting for it to come into place but no luck yet - when does this happen I wonder?
I had a favorite, well interesting patient today, I'm sure if I saw her more than once I would go crazy. I no more than stepped in the door and I am ambushed by the 7month old's grandma with a detailed minute to minute update on eating, stooling and vomiting habits including exact ounces of food and what kind and what type of spoon or bottle used of her grandson for the last 24hrs. All of which was relatively unrelavent since the poor kid was eating and pooping and peeing just fine except for two small urps this morning. When I realized I could be lost in the abyss of the room forever I kindly asked if I could have her stack of papers to review in the hallway for a more thorough understanding. Is it bad to lie to a patient's grandma like that? I gently placed them into the chart and passed it on to my doc. Apparently she does this at every appointment, she keeps a running tab of every movement, hiccup, burp, sleep time, positioning, food, formula, you name it - it's there. Sometimes she even has pictures like smiley faces and a face throwing up and sleeping positions.
2 interesting websites to check out (thanks to the drug reps):
www.stopmrsanow.com
www.notinmyhouse.com
As what I consider almost the half-way mark of this arduous journey I can't help but think I'm not ready. There is no way I have enough experiences, no how or smarts to pass the boards and let alone work in a practice of some kind. There is so much I have forgotten and have so much to re-learn. When does it all come together. I even feel like my physical exam is slipping since I am trying desperately to keep us on schedule. I can't help but think my fellow classmates are soaring above and beyond me and I will be left in the dust and I am miserably failing the program in some way. I know I'm not miserably failing but I am definitely not on my game and not sure how to get back on. I keep waiting for it to come into place but no luck yet - when does this happen I wonder?
Wednesday, December 3, 2008
slow down
I love being in new places and seeing how different the pace of life is between the two. Life is much slower here and choices for things are limited. There are only a few clothing stores;Buckle, Maurices and a JC Pennys. In the Buckle today I spent the first 20min of my 30 min looksie talking with the three gals working there trying to explain my journies as a PA student (sorta like Elf : through the forest of swirly twirly gumdrops and thru the Lincoln tunnel...) anywho it was rather refreshing if if the variety was less than stellar. Another notable thing today - the Herb Shoppe. Now in most big cities(especially in a hippie city like PDX) a store named as such would indicate a shop where one could find paraphernalia for a fun Friday night, but this shop was full of spices and delicious smells. There are three main streets: Broadway, 10th and Main St. You can pretty much get to everything you need if you can navigate these streets. The side neighborhoods are reminiscent of the older days, cobblestone streets in some areas, stop signs are few and far between, no gutters, no sidewalks and in some cases no mailboxes - in fact grandma clothespins her mail to the side of the house for the mailman - who walks house to house - will pick up sometime on the route. My routine in the office feels slowed down, which is nice but I like to have a little edge to my day - it's funny that my preceptor gets excited for me to see a patient with cerebral palsy (he thinks I've never seen that before) or a patient that has a complex heart history but doesn't get too excited for giant boils under people's arms or third nipples. It might be a generation thing. My preceptor is the true meaning of a family doc complete with black doctor bag. He makes house calls, he delivers babies, up until a couple years ago still did some general surgery stuff, he goes to the nursing home, works long hours and knows his patient's ins and outs (literally). It's really a slower pace of life - may not be for me, but different.
Still home sick...that's not going to change but it helps putting that in writing.
Still home sick...that's not going to change but it helps putting that in writing.
Monday, December 1, 2008
Wanna take it for a test drive?
I wasn't really anxious for today to start, after all, it's the Monday following a holiday weekend, and I am still in the really lonely, when is 3 weeks up kind of mood when it comes to my husband.
I rolled in and saw a couple patients and as I walked out of one room I was met with a "ready to go?" I quickly searched my mind of where I was suppose to go and I remembered oh yes, off to watch a colonoscopy. I thought we were just walking across the street to the hospital so I only grabbed my sweater and white coat. Nope I was wrong - off to the surgery center across town. The surgery center may be small with only 3 ORs, but very functional - in fact they even have a total joint room and do one or two a day. Anyway after I found the small locker room which really was no bigger than a small room (you walk in and can't avoid but seeing someone changing - there's no way to hide.) I put on my adorable scrubs - seriously super cute stylish light blue pants with a light blue top with brown red and blue circle patterns I walked out to the lounge which looked like a small coffee room. I wasn't anticipating doing much but hovering and maybe practicing my stellar scrubbing skills. We said hello to the patient and waited some more. I listened as one of the anesthesiologist ranted about how we PAs and NPs are over stepping our boundaries (he complained mostly of the WSU students - the big PA program in KS just 2 1/2 hrs away whom he use to take students but some were too stupid he sent them back I secretly hoped he wasn't our anesthesiologist and wouldn't pimp me right there and then - and he wasn't and didn't) after nearly an hour of listening as to why PA programs shouldn't be master's programs and why PA programs should only accept the number of students that can be placed in jobs in that state or students applying should commit one year to a truly underserved population before being accepted it was time to go. I thought we were just walking into the room to make sure things were set up correctly but turns out it was the real deal. No scrubbing in, no sterile gloves, no face masks (being my 1st colonoscopy maybe I'm just to sterile-minded for this type of thing) I just went with the flow and remembered to double glove. After my stellar prostate exam it was scope time. The doc I was with is a partner of my preceptor he steered and maneuvered and biopsied two small polyps. we made it all the way to the end and with no scope left he looked at me and asked "wanna take it for a test drive? " Um, yes please! I had no clue what I was doing and I quickly realized my dexterity and lack of video game playing as a kid was going to be a hindrance to the process of backing the scope out the exit only spot (which was marked as such by the patient prior to surgery - gave everyone a chuckle, especially since he woke up part way through the procedure and made some comment about it and how he was going hunting in 15minutes.) I did ok minus the suction polyp I created which was creatively named a Jennifer polyp (that's how it was labeled on the picture). Could have been worse I suppose, I could have perforated the bowel. After sadly leaving the cute scrubs behind and eating a delicious catered chili lunch the surgery center was serving it was back to clinic where I almost got to remove...wait for it.... this is good... probably won't see this again.... a third nipple from the midaxillary region about half way down the chest(or medically an accessory nipple). I think my preceptor thought I had already had too much fun with the other doc for the day and was jealous and so he did the excision himself, but I got to watch at least and called dibs on the next accessory nipple that comes along.
On a side note:
I hate overweight patients who think there should be a pill to kill obesity because exercise is just too much work.
So overall for a Monday it was pretty good.
Anyone want to go to Ohio in my place? I am serisously done with being away from home.
I rolled in and saw a couple patients and as I walked out of one room I was met with a "ready to go?" I quickly searched my mind of where I was suppose to go and I remembered oh yes, off to watch a colonoscopy. I thought we were just walking across the street to the hospital so I only grabbed my sweater and white coat. Nope I was wrong - off to the surgery center across town. The surgery center may be small with only 3 ORs, but very functional - in fact they even have a total joint room and do one or two a day. Anyway after I found the small locker room which really was no bigger than a small room (you walk in and can't avoid but seeing someone changing - there's no way to hide.) I put on my adorable scrubs - seriously super cute stylish light blue pants with a light blue top with brown red and blue circle patterns I walked out to the lounge which looked like a small coffee room. I wasn't anticipating doing much but hovering and maybe practicing my stellar scrubbing skills. We said hello to the patient and waited some more. I listened as one of the anesthesiologist ranted about how we PAs and NPs are over stepping our boundaries (he complained mostly of the WSU students - the big PA program in KS just 2 1/2 hrs away whom he use to take students but some were too stupid he sent them back I secretly hoped he wasn't our anesthesiologist and wouldn't pimp me right there and then - and he wasn't and didn't) after nearly an hour of listening as to why PA programs shouldn't be master's programs and why PA programs should only accept the number of students that can be placed in jobs in that state or students applying should commit one year to a truly underserved population before being accepted it was time to go. I thought we were just walking into the room to make sure things were set up correctly but turns out it was the real deal. No scrubbing in, no sterile gloves, no face masks (being my 1st colonoscopy maybe I'm just to sterile-minded for this type of thing) I just went with the flow and remembered to double glove. After my stellar prostate exam it was scope time. The doc I was with is a partner of my preceptor he steered and maneuvered and biopsied two small polyps. we made it all the way to the end and with no scope left he looked at me and asked "wanna take it for a test drive? " Um, yes please! I had no clue what I was doing and I quickly realized my dexterity and lack of video game playing as a kid was going to be a hindrance to the process of backing the scope out the exit only spot (which was marked as such by the patient prior to surgery - gave everyone a chuckle, especially since he woke up part way through the procedure and made some comment about it and how he was going hunting in 15minutes.) I did ok minus the suction polyp I created which was creatively named a Jennifer polyp (that's how it was labeled on the picture). Could have been worse I suppose, I could have perforated the bowel. After sadly leaving the cute scrubs behind and eating a delicious catered chili lunch the surgery center was serving it was back to clinic where I almost got to remove...wait for it.... this is good... probably won't see this again.... a third nipple from the midaxillary region about half way down the chest(or medically an accessory nipple). I think my preceptor thought I had already had too much fun with the other doc for the day and was jealous and so he did the excision himself, but I got to watch at least and called dibs on the next accessory nipple that comes along.
On a side note:
I hate overweight patients who think there should be a pill to kill obesity because exercise is just too much work.
So overall for a Monday it was pretty good.
Anyone want to go to Ohio in my place? I am serisously done with being away from home.
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