True Life: pediatrics

My Mon, Wed, Thurs, Fri are long, my Tuesdays are short meaning I am done by 5-5:30 - yay!
I like peds. I am getting so much more familiar with well child exams - good ones, thorough and actually looking at some of the developmental reflexes that I hadn't been doing during family medicine fro the last 3months. Kind of makes me think maybe mine and the doc's WCC exams were sub par. I'm trying to remember when to give what vaccine but with all the combination vaccines having different names it's kind of hard to keep track. My favorite infant reflex: the Gallant reflex (spelling?) It's like a mini hip shimmy. Very fun to show parents - plus it makes them forget that it looks like I am going to drop their child on the floor. -which I haven't done.

I saw a kid who had a tracheoplasty done at age 6months with lots of complications. She also has a G-button and I cauterized the granuloma on it with a silver nitrate stick - sorta fun - even though she screamed. She was also my last and very late patient at 6:30 tonight.

Had a family of 4 decide all 4 children needed to be seen. Did I mention they are Spanish-only. Ages of the kids: 9mo, 15mo, 5, 8 = small exam room.


On the family front:
Shawn was asked a month ago to join a chart review team. Very cool, what an honor. He hasn't worked at AMR for very long, a little over a year. He found out why he was asked to join this special group. During his probie period (probation) his charts were reviewed in this same committee and they decided his charts were so good, they needed to have him on the CRT too (chart review team). I am so very proud of Shawn. All of his hard work and effort and dedication are paying off tremendously. I wish I were home to share in these joys but in just 8months I will be home permanently to enjoy all the wonderments our lives bring.

By the way...

Well you see doctor (in a thick/heavy Asian accent - I say this only so you can get a true feel and so I don't have to try and write the actual broken dialogue) I just don't think the Straterra was working so I stopped it. So I started Concerta then he throw up. (He threw up after the Concerta asks the doc?) No he threw up before and after, so which came first chicken or egg? Then I made him take another Concerta and for an hour he talked - a lot - the babysitter said he talked too much so I don't think it's working. Should it make him more talkative? I hope not, but if it's not suppose to make him more active or talkative why did it do that? (ummm, because the 9 yr old wanted to talk without his mom telling him to be quiet? I don't know I thought to myself and the doc says: well Concerta takes an hour or so to kick in, he's on the lowest dose possible, we should try increasing his dosage). Why keep the same medicine if it 's not working? I think we need a new medicine. And he's vomiting and has a cough and his throat hurts. He quite eating and drinking - well he eats but very little, he's lost 5 pounds and won't drink. He refuses his milk only wants pop (well we need to be careful about giving him too much pop - diet would be better if you have to) No it's the only thing he drinks and then he only drinks 2 sips and throws it away. And he's constipated. The entire encounter seemed to last forever (almost an hour) after a strep screen (negative) a talk about not treating viral URIs and how to fix constipation (she was totally prepared to do a fleet's right then and there) we escaped the room. We were handing mom some flyers on other ADHD meds and some miralax samples on her way out of the office (not just the room but office)when she dropped this bomb: so what do we do if the concerta doesn't work at the max dose? Doc: well it will take a week or too to get to that dose and then a month to really tell how it's working. Mom: Yeah, but we're moving to Indiana on THURSDAY so what do I do with him?
Gee lady this would have been really good to know an HOUR ago!!!
Just goes to show that they may wait until you have your hand on the door leading out of the Office, not just the room to drop a bomb.

I also managed to hand a kiddo back just before she puked (all over mom) and proceeded to have a blowout in her diaper (also all over mom). Good timing?

I flew home Friday-Sunday. It was the best 3 days...in a long time. I needed it - our taxes needed it and me, shawn and the dogs needed it even more. Times flies, but no complaints, it was 3 nights I wouldn't have had with him or the doggies. Life is good!

Adaptation

An adaptation from Eric Cartman: " screw you guys (PA school), I'm going home"

And I am. See ya!

first peds impressions

A few words to sum up the last 2 days - my first 2 days in peds.
120+ patients in 2 days. Whoa.
2 admissions to the hospital
1 kiddo sent to the children's hospital for exacerbation of hypoplastic left heart syndrome: O2 sats when arrived to the clinic 75% and wheezy(normal for her upper 70's-low 80's), had step 1 of 4 cardiac surgery can't complete other steps due to pulmonary hypertension. After breathing treatment: 58% - NOT GOOD. CXR - hell if I know how to read it - the radiologist had to send it to a pediatric radiology specialist for cardiac congenital problems. Last heard - on the vent.
Everyone else: otitis, strep, URI and RSV.
I haven't met the preceptor yet - went on vacation.
Just learned where the bathroom is in the clinic today - had to follow a kiddo since no one has had time to show me where anything is.
I overdosed on pink laffy taffy's today from the kids' candy drawer - tomorrow probably sweet tarts.
To quote my preceptor today "Council Bluffs is a cesspool."
Should be an interesting 6weeks.
Holding on for Thursday to commence my plan.

Check out Time

Unfortunately I think I checked out too soon. My mind is totally somewhere else. As I am listening to a patient and then that becomes passive listening to finally I just hear them talking and then I find myself just watching their lips move, no sound. That's never a good sign. grrr. As they would say (or sing rather) in High School Musical (the first one) "getcha getcha head in the game". Sad I am quoting that show. I have to focus...like Ford. not funny. sorry.

In exactly one week I will be starting my rotation with the little poisoned-nose dwarfs - that's what my microbiology teacher called them, I always found it funny and laughed out loud and once even snorted.

So I am now going to attempt to refocus.

Final Stretch

Here we go - the final stretch. I'm so excited!! Staying with my grandma has been a wonderful and eye opening experience. I have a whole other appreciation for families that are taking care of an elderly member. I am exhausted making three meals a day, plus clinic and homework. I was here for her during her knee replacement which was great and she helped cut down on my expenses tremendously which I do feel a little guilty for since she's on a fixed social security income. Bless her. I've sewed and spent time with my mom too which living so far from everyone has been wonderful.

I'm ready to move on from family medicine. I think family medicine could be for me, knowing I could do more than I did as a student but I didn't make any decisions in the last 12 weeks so maybe not. I'm nervous about moving on to peds next week, I feel like I haven't done enough in the last 12 weeks to be prepared. I will be on my own the first day, the clinic called to tell me I had my own list of patients to see after spending the 1st hour with the office NP since my preceptor will be out of town. I was given the option to not come in, but I will be using that for leverage that first week so I think it will all play in my favor.

But before I put my mind into the next rotation I have to stay focused this week - hard to do for multiple reasons - but more to come of that later in a couple weeks.
I'm holding on to my ace in the hole....

I was going to help with another doc's delivery on Friday - I got a call at 3:14am saying she was ready to push. I jumped up threw on clothes while I pottied and sped to the hospital, ran up to L&D made it there by 3:24 and already heard the cry of the newborn. The RN popped out of the room and said everything's done, nothing to see now. So I left about 15min later - there's nothing worse than walking in postpartum while the doc is sewing up a 4th degree tear so I didn't even go in.

So here I go, 5 days. I was on call this weekend so really only 4 1/2 days, since I don't go in until 1pm tomorrow - oh and let's not forget my scheduled 1/2 day on Wed. YAY!

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.