Not a leap year

My mom's birthday is Feb 29... sounds cool in theory to have a birthday on a day that only occurs every 4 years but unfortunately it doesn't mean that time is standing still in those passing years, so she actually gets jipped - aging without a special day to celebrate although I say she should celebrate for the last half of the day of 2/28 and the first half of 3/1 or get two days to celebrate every year she doesn't actually have a birthday. When I was a kid, I thought it was kind of neat that we celebrated our 10th birthday in the same years, mind you we weren't both turning 10.

March is practically here and that means just 4 more weeks until Mesa AZ!! Can't wait!! Sunshine, vacation and most importantly, Cubs baseball - the last few games before the start of the regular season!

Return to Os

Did 2 paps today - a third one scheduled for tomorrow - only after I sheepishly told the MD that I (and 2 nurses) couldn't find the speculums yesterday (and the last provider told me we had none because we dono't do them) and he opens one drawer that I didn't even know existed and woot - there are 15 speculums - egg on my face, guess I will be apping my RLQ abdominal pain with a white count and some other random woman complaint. Hadn't done any since Ecuador - I was worried I had lost my skill and I was in a bit of dread knowing that sometimes personal hygiene is not on the top of my populations to do list. But all in all great success - all on my own with my cytobrush and spatula in hand I followed the yellow brick road to the land of Os - even managed to find a retroverted one. Yay!

The Boss

My supervising doc called me The Boss about a week ago and has proceeded to occasionally call me boss when I'm in clinic... I do for all intensive purposes run the clinic - with his guidance of course, but I am not the boss of the clinic. So perhaps good readers one can empathize with me in my frustration when I get over ruled to send someone to the ER for a possible ostemyelitis or septic ankle joint. Slightly elevated white count at 13, no osteomyelitis on the xray - just evidence of an old fracture, no abscess, and a couple pieces of hardware. The ankle is now warm, red, pt is afebrile, still weight bearing, and is no other medical concerns(transient HTN) but I know if I saw this person in clinic - I would send them straight to ER. But in my setting we do things a smidgen different - the object is not to send them out, do as much as we can in house as it poses a threat to the community, the hospital and officer safety for people to go from our facility to one in the "free world". I may sit on a chest pain until troponins are sent back and read elevated from a stat lab, despite not having any change on the ECG. I wait on a hyperkalemic patient until they are above 6.2 - even though at 6 they can have fatal ectopy, not sending someone with lower right abdominal pain with a fever until blood work is back and a KUB, which both turn out to be normal. It's a slippery slope and an awkward phone call to a seasoned professional to say doc, I think the pt needs to go, because I am uncomfortable and you have not seen the patient, the command staff is asking me to override you.

In light of the not 1 but 2 or 3 contorted articles in the paper about a particular facility, I cringe knowing there is a slippery slope being a PA, using my best judgement but working and consulting with a physician - someone who is seasoned to make the best decisions to present to the patient. This is the one and only time I have thought to myself, I wish I were the doc right now.

What's up homie?

I think my doc and I are bonding. He's calling my JZ (he thinks he's the first to call me this and I decided after telling him my former classmates now colleagues have been calling me that) but hey it's "cool" and now I call him Dr. G (out loud), so it's all good. Maybe I should start calling my nurse Snoop.

Random story - cultured some weird foot lesions that i thought were totally vascular in nature but honestly was stuck and had no clue what else to do, so cleaned it up and stuck the lesion with a 27g and cultured what came out of it - blood. There are multiple lesions on the feet only, following superficial veins and no Roth spots... Low and behold heavy bacteria growth. Still not sure what the heck it is but hoping 7 days of Clindamycin will kick it... or at least give the patient diarrhea - i know exactly what to do with this.


Made first loan payment - sigh... I feel lost in the world of loans. I owe so much money. To consolidate or not... that is the question. First third of my check to taxes, then the next third to loans... sad day. Learned my site doesn't qualify for loan repayment after all - need more high or medium security peeps.
Peace out!

Distance

Can be a good thing, or a bad thing, depends on what we're talking about. Example of distance being good: not buying a property next to an existing home with a shoddy barn with aluminum roof and siding used for playing with street raced cars - just not a good idea, guess I'm not a "let me hear your engine rev" kinda person (so goodbye lot 48 I think). Example of distance being bad: between us and our family and friends.

On Friday I found myself caught in the middle of good distance. I really care about my patients, I work hard to mange their health care even though many, if not most, work hard to undo my hard work both while in my care or out of my care doing their not so legal recreational activities. One patient in particular caught me off guard - history of heavy meth use, brittle insulin dependent diabetic. I've been revising insulin therapy daily, then on routine labs the A1C is down 3 points yay! but the potassium is high at about 6, chronic anemia not a huge deal, the kidney function crappy, creatinine over 2.4, ECG normal, looks no worse for wear than normal. Thinking these critical lab values are an error in part to shipping labs off to a place 3 hrs away, I redrew them the next morning and sent them stat to the local hospital - only to get a phone call with even higher values. Now off to the ER to get sorted out although most likely won't be returning to our facility and maybe not even back to life as apparently kidney function has continued to decline and critical electrolyte levels on the rise. I was upset and me being me I cried when I got home, I felt frustrated and took it personally that everything was out of whack although I know the chain of events wasn't all under my care. I have to find the balance of distancing myself with patient's care or I'm afraid I will burn out.

Shawn and I had our first mutual patient. Canine dog bite - he scooped 'em up and I took care of the patient the next morning at "the facility". Cool.

What's in a name?

Apparently my new nickname amongst my patient population (or code name if you will) is "peas and carrots". If you can name the movie it came from - gold star to you, I think it's much better than Bunny Ranch - the title a former PA held.

The firing has begun or to be more PC the " we're are hiring someone else to do your job and there's not another job opening for you" needless to say the last week has been tough, especially after the article in the Columbian last week that (and I am paraphrasing here, but same gist) ... we (clark county) weren't happy with the current company and they cost too much money for their services, there were also 10 custody officer jobs on the line, so we went with a company that came in $700,000 less that will replace RNs with CNAs to save costs and all ten officer jobs and the 100 beds were saved. Didn't sit to well with the nursing staff considering the new company told them they weren't cutting any ones job. So now it's anyone's guess to see who stays and who goes, although I've heard I am safe, our health service administrator was informed she won't be staying as of today. I'm very grateful to have a job, hope it's all true, I love what I am doing and I really enjoy the people I work with and the patients - it's never a dull moment (well sometimes reviewing 40+ charts daily gets a little monotonous).

The name of the new company is catchy... Conmed. Maybe us PAs can open our own outpatient clinic for followup care called Ex-con med? Just a thought.

And that's all I've got to say about that.

Welcome 2010!

It's already 2010! YAY! Not that 2009 was bad, because it was really pretty great with lots of new beginnings, a few endings and as always some great Zupfer adventures. We're excited to see what 2010 brings. There are lots of things to look forward to like Cubs vs Seattle in June, family visiting us, us visiting family, learning if Jenni keeps her job with the new company but the top three things on our list to do: find a house to move out of our apartment, car for Jenni and expanding our family by way of a two-legged addition (we're finding we may have to try harder than those who can look at the opposite sex and succeed). So happy New Year everyone wishing you peace, joy and happiness each and everyday of the year!