Halfway

So tomorrow I am officially halfway done with my first rotation. It has been the strangest three weeks of my life. I've learned more than I could have possibly imagined, but at the same time, I feel like a little minnow swimming in an ocean of medicine that I can never digest. For everything that I do right, I do two more things wrong. I'm actually ok with that for now, which is surprising...usually I'm pretty Type A about that stuff.

Anyway, my preceptor had to fill out a mid-rotation evaluation for me and he gave me pretty darn good marks, which I was thrilled about. Now, however, he wants ME to give HIM an evaluation of how he is doing as a preceptor. That's only slightly intimidating, seeing as he still controls my life for the next 3 weeks. I was thinking about what I might say....
-you scared the crap out of me the first time I met you, and I think you did it on purpose.
-your office looks like a dilapidated house on the side of the road (sorry, but it really does).
-you are probably the smartest, most experienced PA in the history of the world, and I am the damn luckiest first rotation student out there.
-you still scare the crap out of me, even though now you try to be nice.

Recently I've been thinking about what it would be like if I were to live in Oakridge. I would have like 10 acres, definately some chickens, maybe a couple of horses. I'd have to buy a truck....and maybe some cowboy boots and a hat. Oh! And I would DEFINATELY have to have an RV, everyone here does. I'd go camping every weekend in the summer, and snowshoeing in the winter. I could use phrases like "you've been rode hard and hung up wet too many times," and my patients would know what I was talking about (I still don't really get it...something to do with getting old).

But then I think of all the people I love and how much I miss them, and all I want to do is run back to Seattle, grab a starbucks, and drive around in the hellacious traffic for an hour so that I can meet a friend or family member for dinner. I can't wait to come up to visit Seattle in August...should be about the 2nd week (pencil me in!).

Anyway, tis bedtime for me, and tomorrow is a big day. After a long day of work I'll be hitting the road to go home to the man and the dog. Hopefully the sun will come out and we can have another picnic in the park, as has become a mini-tradition. Otherwise, movies and sleeping in will be the most strenuous thing on my agenda. Life is not so bad...

Jen

A note about HIPPA

So I have been delicately and appropriately reminded that even though no one in this town knows I have a blog...I should be more careful about describing some of the patients I see. Everyone in this town knows everyone else, and if someone happened upon my blog by chance, it wouldn't be hard to identify some of the people I talk about. So, I swallow my pride and admit I was wrong.
On the other hand, that won't mean I can't still write about what I'm seeing and doing here...I just need to be a little more vague about the details. Sucks, but reality is such, and my future career is way more important than my need to vent right now.
Jen

Where A Kid Can Be A Kid

Tonight I dined (and played) at Chuck E. Cheese's. While I wish I could say it was the coolest drug rep dinner ever, this event was purely social in nature...

I had such a fantastic 3-day weekend at home with CJ that I got all fuzzy-headed and left my laptop charger in Hillsboro. Being that I had to do a research project for my preceptor on Symlin (diabetes drug), and I do all of my chart notes on my own laptop, it wasn't going to be a very productive week without battery power.
CJ, being that knight in shining armor that he is, agreed to meet me after work (with my charger) in Salem at the Chuck E. Cheese that his parents own with his uncle and aunt. For those of you that don't know, CJ's parent's also own 2 Chuck E. Cheese's in Tri-Cities, WA. He grew up in them, was working at one by the time he was 11, and managing one by the time he was 18. Needless to say we got free tokens to play all the games we wanted. It turned out to be a fantastic little date for us, even if it took us both an hour and a half drive.

In other news...my rotation is almost 1/2 way done. I can't believe it, on Friday I will get my mid-point evaluation. I'm very curious to hear what my preceptor has to say about me...I know I'm not doing terribly, but I also know he really wanted an experiened student, so the little mistakes I make must be glaringly obvious to him. Still, I'm earning my independence in this clinic, slowly but surely. At this point I usually see the patient before my preceptor does: I do the history and physical, then come out and present the case to him, and then depending on the sitaution he will just help me formulate a treatment plan and let me finish the appointment, or he will come in and repeat the exam and finish the appointment himself. Other times it is a patient that he knows well who has a complicated history, and I will just observe how he manages their appointment. I'm okay with that, because some of his patients have more diseases than a medical dictionary, and I know I'd just be wasting their time trying to figure it out in one 15 minute appointment.

One thing I do know for sure is how lucky I am. This is going to sound cheesy, but it's true: my preceptor is an extremely intelligent, experienced provider with a good set of ethics and an excellent, patient-centered practice. His staff has warmed up to me quickly, and have offered me plenty of encouragement, (as well as given me permission to drink some of the Diet Pepsi they keep stocked in the fridge). Finally, his patients have been extremely approachable, willing to teach and forgiving of my mistakes. This is probably one of the better rotations in the whole program, and I honestly do feel so thankful to have gotten it. I know there are some of my fellow classmates who are having a difficult time getting any guidance from their preceptors, and I can't imagine how difficult that must be. So today, I am thankful. It's good karma to thank the world for what it has given you, even if you were cursing it yesterday when you realized you left your laptop charger at home.

This is rambly because it's 11pm and I need to go to bed

Jen

Yawn, snore, Zzzz

I'm exhausted. I wake up tired, and go to bed the same way - its the damn abundance of trees around here (I have a nasty case of hayfever). Going along with the whole "doctor, heal thyself" thing, I decided to finally admit I that I suffer from allergies, and bought some Claritin. But I was already at the grocery store so I also picked up a Red Bull, some dove chocolates and a bag of Mike & Ike's. Oops. So much for health.
Not that my actual schedule hasn't been exhausting too. Between the drug dinner that I went to last night (which I didn't get home from until 10pm) and the karate class I went to tonight (ow, ow, ow), I'm just worn out and unmotivated.
On the plus side, tomorrow is a 1/2 day (boss man isn't in tomorrow and the other provider is leaving at noon) and we are actually closed on Monday (yaaaaaaaaaay!). I'll be in Hillsboro for the next 3 days, laying on the couch, if you need to find me.
By the way, I'm still loving the clinic up here, and my preceptor is still working me hard - physically and mentally. Today's victories: a successful pelvic and pap, and the two steroid injections that I was allowed to do unsupervised. Tomorrow's goal: be able to find the proper treatment for someone's ailment in my own brain, rather than consulting my preceptor/PDA/the internet, etc.

I miss every single one of you.

Jen

BUNKO!

(Today's picture is the result of a google image search for "gout,").

So I finally played Bunko for the first time tonight. Michelle (my new temporary roomie) invited me to play with her group and I was thrilled to go, because I've heard a lot about it but never had the chance to play. I enjoyed it, and would play again....but maybe I didn't drink enough, because it was just ok. Perhaps it was because I only knew 2 of the other 11 people there, or the fact that I didn't win a single prize, but like I said, it was fun, and I'd play again.

Moving on...the last two days at work have been pretty good. On Monday my usual preceptor was not there, but instead it was a female PA who is actually a graduate from my school. She comes in twice monthly to do a bunch the women's annual exams, because a lot of the ladies in town don't feel so comfortable with a male doing their PAPs, especially a male who is their neighbor. She ended up being great: super laid back, full of good advice and really friendly - which made for a great day.

Today Edwin was back and we tackled a reasonably full schedule. I wasn't doing a whole lot before lunch, mostly shadowing him, and I actually had an hour during lunch to come home and take a super quick power nap (rare!). After lunch, it was like my preceptor had read my mind, because he threw me into a bunch of work! I ran a couple of appointments mostly by myself, did another male rectal exam (the poor gentleman was so nice about it), and even wrote up about half of the chart notes for the day. Oh, and at the end of the day we had a very precocious 8 year old boy come in who had a big gash on his head...I was the lucky one who got to inject the anesthetic around the cut before we stapled it...try getting an 8 year old to stay still while you're sticking a needle into his head!! I have to laugh though because the kid was trying to be very brave, so despite the fact that I probably injected the anesthetic all wrong, he insisted that it didn't hurt. Points for me.

I realize more everyday that there is a lot I need to work on, but I'm ok with that. So what if I thought a case of gout was a staph infection? So what if I had NO CLUE what the treatment for gout was?! I'll know next time, right? Besides, these patients just crack me up. For some reason there is a disproportionate number of senior citizens in this area. And I don't mean your average 65 year old. I see a handful of people in their 80's and 90's every day. Today's superstar senior was a 95 year old guy who couldn't hear a word of what I was saying. I was talking so loudly to him in the exam room that all the office staff had heard me word for word. So much for patient confidentiality. Either way, as much as I've sworn I'd never go into geriatrics, I can definately appreciate that the older folks don't bitch and whine. They've been through so much in their lives that dealing with an idiot PA student isn't the worst thing in the world....and I appreciate that.

Tomorrow is a busy day in the office as the family nurse practitioner, Mitch, will also be there all day. There is barely enough room for just Edwin and his staff, but add Mitch and I and it just gets hectic. On the plus side, I get to go with whoever has the most interesting patient, so it should make for an interesting day.

-Jen-

Picture from my weekend in Hillsboro

Picture from our picnic in Rood Bridge park, and trying to teach Mary to swim at Sauvie Island. What a great weekend!!!!

Seriously

This is on the backdoor of the clinic when I'm training. Not at all a joke.

Hiii-YAH!

*This picture taken on the drive home from the karate class I went to tonight."

Yes, karate class. Near the end of my first day with my preceptor, he learned that I work the mixed-martial arts fights in Oregon and he about freaked out because he is some black belt, fancy-pants karate guy. Anyhow, he teaches a karate class Mondays and Thursdays and invited me. I was too busy to go the first night, but I promised to go Thursday. I found out through the course of the week that our receptionist at the clinic also takes his class and has been for 7 years. Needless to say, I was a little intimidated when I got there, but having not worked out the whole time that I've been here, I knew I needed to get some physical activity. So, karate it was. Most of the class was actually exercises and stretches, and with the high heat today and the humidity in the room, I was sweating buckets in no time. Then we moved on to some punches and attacks, then choke defenses. I was paired up with a very slim girl whom I would guess is about 12, and I think I almost killed her. She was a good sport though and a very cheerful little thing. She reminded me of myself at her age and I loved her enthusiasm, especially seeing as she was the only youngster in the class (well, if you don't count me). It was quite the experience and I definately think I'll go back to the class again, though maybe not twice a week. I like my preceptor, but everyone needs a little time away!

Today at the clinic was a half day because the supervising doctor was in for his once-monthly visit. My preceptor is a PA and owns the clinic, but in order for things to be legal, he has to have a physician on staff who reviews 10% of his charts each month. So, once a month, Dr. Adamo comes in to work in the morning and review charts in the afternoon. He was an alright guy, but only a moderately effective preceptor. He had some words of wisdom for sure, but very obviously didn't have the desire to passionately teach - he just kind of wanted to get through the day. Either way, I got to see some patients and practice, practice, practice. But when the last patient was done by noon, all I had to do was finish up my chart notes and I was out of there!

So what did I do to celebrate my freedom? I went home, ate some leftovers from my drug rep dinner the other night, then took a nap. A fabulous 2 hour nap that completely wasted the sunniest, hottest day of the year so far. And I don't regret it. After I got up I did some research for a presentation I have to give tomorrow on the role of incretins in type 2 diabetes (yawn, I know) and then went to karate. And now I'm watching the finale of the Office, so I'm done.

Love to you all,

Jen

Pictures

A couple pics of the view from the house where I'm staying!

Snakes, stitches and shots (the injected kind)

Sooooo....three days in and I'm loving this rotation so far. It's definately not easy at all, but that is probably what I like about it. The first day I was there was a 10.5 hour long adrenaline rush. It just happened to be kind of a nutty day: 2 emergency wounds that required stitching, both of which happened right in the middle of lunch when I was there and my preceptor was not. Not that I treated either of them by myself, but it sure put the fear of God in me when I saw someone's belly ripped right open!!! Luckily my boss was just across the street and he was there within a couple minutes to take care of it, and he even let me put in a few stitches too, which was very generous of him.

So far its been kind of a "see one, do one" thing in the office. I watch Edwin (my preceptor) do a shoulder exam for someone, so the next time a sore shoulder comes in, I do the exam, and then he critiques. Luckily, this also goes for procedures, so I've gotten to do 2 trigger point injections (shots of novocaine into a spasming muscle), freeze some precancerous lesions and as previously mentioned, put in a few stitches. As cheesy as it sounds, however, I really do value the opportunity to do the simple stuff over and over: looking in ears, eyes, throats and noses, listening to lungs and hearts, and conducting the patient history. Today I got to see a ruptured ear drum on a 7 year old, and that was the coolest thing I saw all day!

Now....living in this town, let me tell you...there is no need to do any sort of a social or family history on ANY of the patients because everyone knows everyone. Seriously, it's such a small town, I can't quite even comprehend it yet. My preceptor has practiced in this town for 16 years and he knows everyone on a professional and personal level (so much for HIPPA). I really dig the small town way of life though, today the nurse's 8 month old daughter had fallen off a bed. so the nurse took her in to work for the first part of the day, and that was perfectly ok with everyone. When an elderly woman who doesn't drive needed a medication that was super expensive at the local pharmacy, but was only $4 at the Walmart in Eugene, the office billing specialist offered to have her husband pick it up in Eugene for the pt., because that is just what they do here. There was even a 4 foot bull snake right outside the clinic door today sunning itself (see picture above). Welcome to small town, Oregon!

Anyway, this is long enough, and I'll update again soon. As great as Oakridge is, I'm so looking forward to going home for the weekend to see my man and my dog! I love you all and hope you're doing well, and enjoying the sunshine that is trying to peek out.

-Jen-

Day 1 is tomorrow!

I arrived in Oakridge, OR this evening around 7pm, and my new roommate (a 28 year old medical coder named Michelle), was there to welcome me with a smile, instructions for the remote control, and my very own key on a Bud Light bottle-opener key chain (my kind of girl). And then she promptly left to spend the night at her boyfriend's house....which made for a quiet house. It did give me time, however, to unpack and set up a bit, and I've already grown fond of my new bed that comes complete with an Army patterned comforter. Fortunately, I was able to get online (obviously) and chat with a couple of classmates who are also just as nervous and out-of-place as I am. I think I have a better situation than most people (cool roommate, already met my preceptor, etc), but it is hard for all of us to just uproot suddendly and do something completely different than we've ever done before.
It will be an adventure, and I'll try to document it as best I can here in both words and pictures. I don't feel ready for this, but I'm sure not willing to go back to the days of 12 hours in the classroom, so here I go.
-Jen-
(Picture is my new room!!)