So sue me I'm venting, I'm entitled to vent

You may as well not read this if you are looking for an up-beat, sun-shiny type post about how I love PA school and saving patients from themselves or about how much I love my husband and my doggies and am very grateful for my loving and supporting family - all of which are true this isn't that kind of post. Ye be warned.

I chose Pacific university because of the vibe I got at interviews. My interview was the hardest most unpleasant experience of all my interviews (thank you Prof. LaBoy)and almost turned me away. But I felt like the school cared for me as a student but also about my personal life. Family? No problem, we know you have a personal life. This sentiment held true through my didactic year. The outpouring of support when I didn't have enough money for rent or food because my loan was lost in processing and my husband despite his hardworking efforts in the midwest just couldn't pay the expenses of his wife living on the west coast, then my father in law had aggressive prostate cancer - need a couple days from school, no problem - we understand. My fears about being out on rotation and my dad being released from prison - very scary. No worries - your safety is our #1 priority! Want to set up your own rotations in family med and peds - we'll help you get the paperwork done! All this sounds great right? All that changed when we(me and my classmates) went on rotation. Allow me to elaborate.

My first rotation was a complete bust. Anyone who read our blog early on read of my nightmare of a surgeon who by chance hated women, used his PA like an MA and yelled at me - a lot. There was little to no hands on experience. I called the cavalry who came and did a site visit during week two and told me - no worries more hands on experiences - you're doing great, you're expectations are too high for the 1st rotation. So I sucked it up - gained little to no experience and considered my 1st rotation a total wash. In the meantime (without divulging into details) I have been let's say "ill" and needing some medical attention back in August. My schedule as it stood had me away for the remainder of my rotations - and not just somewhere in the NW, all in the midwest - 1800 miles away. To avoid me from having to miss almost a week of a rotation to take care of this my ID rotation was changed to Legacy Trauma in PDX. Hell yea! Leave it to nature to screw up everything. Hurricane Ike and an emergency evacuation - and the school didn't give a rats ass more like hurry up get back and get back to rotating. Some may say I am exaggerating but I'm not - I was completely scared for my life during the hurricane - no shelter, no power, no protection, no water and holy cow the winds in my upstairs bedroom. They sent me to Dr. G who although I was terrified I actually had a great opportunity there and a job opportunity from Dr. G himself On to legacy when I was suppose to squeeze in medical appts and an outpatient surgery - but anyone who has been on that rotation knows what a schedule that is and to top it off I came down with another illness - the MRSA jaw thing with an oral surgery etc etc. So I was too sick to have my other needs tended to (was told if I missed a half hour of PPS weak - a complete waste of my time week - I would be knocked a whole letter grade - what BS!). Switch to vignette # (oh geeze I lost count)When I found out who I was going to OH with I was nervous. So I talked to the grand and glorious clinical team about my concerns and was told no worries - it'll be fine - this was in August. Well flash forward to now. I am still stressed out about it. Thought I had a chance of it changing closer to home for the original medical concerns - but no such luck (unless I want to take a LOA - um I think not - but a clinical professor sure can go on maternity leave at a most peculiar time). I tried again expressing my concerns that I will be on my own for this rotation which is like my other away rotations but right now, will be costing me more than going to Ecuador. Hmmmm. that doesn't make sense. Basically told too bad, so sad you are on your own there - but don't worry this rotation will be great. Really? There's no where else you can send me - like oh closer to home to cut down on the $$? Aside from that the ethics of paying to stay on the preceptor's property is an ethical mindboggle to me. Our primary housing option is to stay with the preceptor who is making a minimum of $4200 profit from having PacU students stay there. Not cool. So if we don't stay there - does that somehow affect our grade or other opportunities for other students? Good question.

I am stuck. I feel abandoned as a student. I am upset about the ridiculous amount of turnover in the program. I loved LaBoy and Gietzen and thought Prof. R was around way too long. The other Prof R is more worried about her maternity leave the next class entering clinicals and the class of 2011 coming in than the students out and about rotating. I am the consumer and I am not satisfied but there is no one to turn to. I am not the only student who has had a frustrating time. Bless those who too are consistently away with no support and those with an award winning 3 family med rotations.
I feel much better now, somewhat. At least I got it out instead of keeping it in.
So to put it like another classmate - we're getting out just in the nick of time. Or in Gietzen's words - Justin Thyme.

I love technology

I love that I can watch my 4-legged furbabies on the web. It may not be streaming (meaning it's a little choppy) but I can see them live playing and romping and being themselves. Cubby was running around occasionally peeing and when the sitter got off the chair up he went to sit on the chair watching all the happenings from his prime real estate spot. Little Wrigs is putting her rump in the air as she playfully bows to other dogs inviting their play. As Cubby sits perched on his plastic lawn chair, she run to him and checks to see that he is ok. She puts her paws up on the chair nuzzles her brother and off she goes but she'll be back when she's tired. She will either try to vacate her brother from his spot or lay at the foot of the chair. Maybe Shawn should go to daycare and play too so I can watch him for as much as I miss the dogs, my babies, my little ones, I miss Shawn even more. I miss his face, his smile, his eyes (one brown, one blue). Even if I couldn't touch him, just to see his shining reassuring face would do wonders at this point. Once I make it to Friday only 4 weeks until I see him. That seems so far away but hopefully it will go quickly. So until then I will sit and peacefully enjoy watching two little creatures that melt my heart and bring a tear to my eye play and romp.

"No Day But Today"

Today, despite the frigid temperatures outside and snowfall in the land of Oz, within the warm walls of the clinic, the clouds parted and the Heaven's sang when a little girl finally found what she's been looking for in the land of Os.... it was glorious.

Also within the warm walls of the clinic was a man who had been diagnosed with pneumonia this weekend in the ER. Fevers for 10days, lobar interstitial infiltrate, possible small effusion. Hospitalized for 3 days with IV Rocephin and went home on a Zpack. No biggie, right? Well the ER and the docs in the hospital seemed to have overlooked some major history and physical finding. This patient had esophageal cancer, had 90% of the esophagus removed and his stomach made into a pseudo esophagus and his colon and small bowel repositioned to accommodate the new stomach positioning. The entire procedure was performed abdominally. Shortly after this procedure, the distal end of the incision became red, hot and grew to a small ball which had to be drained as an abscess had formed underneath it all - healed up all better. Fast forward to this past weekend - patient goes to the ER for a cough and fevers but everyone seems to overlook the bright red bulge at the distal portion of the previous incision which coincidentally opened up after he was discharged began draining - cultures obtained - growing staph - waiting for sensitivity reports (probably MRSA my guess). The opened area is big enough to sick my finger in - I was tempted, but I didn't, you could see into the subdiaphragmatic area if you flashed a penlight at it, thankfully nothing waved back at me. Sent him off for immediate abd/chest CT and sure enough has a subdiaphragmatic abscess. Needless to say he will be seeing the surgeon who performed the original surgery like tomorrow.

My patient joy for the day: 45yr old male, overweight, uncontrolled DM - HgbA1C (the lab test that looks at how sugars have been controlled for the past 3 mo)was 10.3% (<6.5% is goal) and trying to watch his intake. His fasting sugars have come down from 160-200 to 120's. He said to me: I just take it one day at a time, I don't worry about what I am going to do tomorrow or next week, just focus on today - I can do it, I have to do. I shook his hand, shed a tear as I turned away to wash my hands and carried on with the exam.

There may not have been any congratulatory moments from my preceptor or patients for finding the elusive cervix or for maybe changing someone's life for the better but I know I should give myself props for both - something that I have a hard time doing. It was a reminder why I am becoming a PA - not an MD(a question I have struggled with during this journey) - I took the time, made the difference. It was a good day in clinic today and so with that I leave you with a few lines from my favorite Rock Opera of all time - RENT:

"There's only us

There's only this

Forget regret - or life is yours to miss.

No other road

No other way

No day but today"

Finding Nemo

In the last 5 days of clinic I have seen more gosh darn rashes than ever - some I can identify, others, well here's a kenalog shot, hope it helps. 2 pityriasis rosea, 2 Fifth's disease of two sibling's who's mom has a viral rash too, a guy with an unknown atopic dermatitis with something else on top of it - kenalog worked, a lady with a circumferential rash on her thighs only, and the list continues but without pictures it's really not as much fun to just write about it.

By the way I love women's health but I can't find a damn cervix for the life of me - but I can do successful post-hysterectomy paps all day!

Today I had my first myasthenia gravis pt- he had an appointment after clinic today in KC with an ocular neurologist - whoever knew there was such a thing.

I also had a patient today who apparently was recovering from Strep Nemo. I tried to correct him in saying, you mean strep pneumo? No he replied, Strep Nemo, just as it's written here. He then produced a small slip of folded paper -his lab results from a bronchoscopy for a productive cough that wouldn't go away and sure enough at the bottom of the paper read streptococcus nemonia. Stunned, I wasn't sure how to react and told him I would look it up because I was unfamiliar with that type of infection. Even my doctor was stunned and unsure of what to say and no amount of rassurance that it was probably pneumo not nemo seemed to help. So tonight I am trying to find "nemo" - wish me luck!

1/2 or 3/4

Depending on how you look at it that's where I am now in fam rot. I'm ready to move on although yesterday may have been the best darn day in family medicine yet. This was in part due to my preceptor being out of town and I went with another doc who actually encouraged me to make some decisions, stick with them and write the scripts myself - all things which I presume my other classmates are already doing. It was great! Too bad I go back to my preceptor on Monday and back to the monotony of 15minutes in, and my exam/assessment doesn't matter since he is walking into the room before my 15sec of presenting are up.

It's been an interesting week. I brought grandma back from the hospital today after having her Right TKA. She still has some rehab to go but she's doing pretty gosh darn well. I spent all morning cleaning and organizing so anything I had misplaced while she was gone would be back in order. I hope she doesn't notice I emptied the fridge. She was seriously eating things that expired in 2002, but most things were only a couple-three years old. I also dusted anything that requires a ladder. Last thing I need is her up on a ladder while I'm at work.

I ran up to Omaha the other weekend. I had an EMS refresher to attend although there was nothing refreshing about it. Two 16hr days of blah blah blah. Refreshers are hoops and I am just the lion in the act. I did however get to stay with one of my dearest friends from college and her husband, and wacky cat named Zee. It was great to see her (and their beautiful house)and catch up after a 2 1/2 yr hiatus. I wish we lived closer - her and her hubby are homebodies like me and Shawn and I think we would have a lot of fun dining with them or having a game night. Bless their hearts I babbled most of the time I was there.

Something I learned recently from clinic (although the common sense part of me says I already knew this): the use of a pipe cleaner does NOT clear male urinary tract infections (although it's unsure if there was infection prior to the pipe cleaner incident) it also does not dislodge stones from the ureters.

Family Practice Musical

Wednesday is my half day, which, after yesterday was a good way to work back into the groove of things. I must have missed the sign outside that said "all who enter [the clinic] must sing a song." There were only 15 patients today but at least half of them were in a sing-songy mood not to mention the nurses who were singing to the radio on in their office. I walked in on two of my ladies singing to themselves, one of my older gentleman (78 to be exact) sang me a song his grandkids affectionately taught him to sing when he wears his "pimp hat" which ended with "I'm just a mother----in' PIMP" Nice I thought to myself, just what this old sailor needs to be singing while his wife sits at chemo - way to go grandkids. Another one of my patients (upper 70's too) sang me the song from Cinderella that Jack the mouse sings to Gus Gus (because he prefers to go by that name) "Cinderelly Cinderelly, night and day is Cinderelly, make the fire, fix the breakfast wash the dishes do the mopping..."

Had I known it was going to be musical day I would have prepared something. We probably would have had more people with nausea and vomiting or tinnitus had I tried to give my care in musical fashion. Can you imagine what clinic would be like if it were like a small musical? I may write lyrics and share them later...but until then don't hold your breath for Family Practice the the muscial opening in a theatre near you!

Guilt

I sort of feel guilty that I skipped out on "work" today. My grandma is having her knee replaced today. I was offered a chance to scrub in but after a long thought process I decided that would be a little too weird..although how many people can say they watched or helped put in their grandma's knee. I probably could have gone to work this morning, but I was lacking in motivation a bit and felt I should spend my morning with grandma until she goes at noon to check in at the surgery center, although between my workout at the rec center this morning and catching up on a little typhon I haven't seen her much - this all sounds like slacking but reality is my doc - my grandma's family doc - thought long ago I should just take the day - no sweat off his back really and he knows this could go smoothly or well, the opposite of that. So there's my confession for playing hookie this morning (which was a planned missed day) - not to be confused with the act of hooking (with a new Sheriff voted in I don't think that will be happening as much in this small town). On a side note I remember my Senior yr cheer coach giving us advice on how to spend our weekends after the games: "I don't want you girls hooking about the town" I don't really know why she use to say this but it made us laugh every time.