8 days down...

Yesterday my preceptor called and invited me to dinner at her house with herself, her husband, her son and a young family friend who is visiting from Croatia. It was a little awkward, but I had to say yes, and it was actually a lot of fun. Her husband is also a doctor, a pathologist at the hospital, and their house was GORGEOUS....it had a pool and everything! Plus there were "vote Obama" signs in their front yard - SCORE!

My preceptor had prepared a feast: pasta salad, regular salad, bread rolls, greek salad and barbequed veggies. She is a vegetarian, so she had her husband cook the meat: a mixture of beef and spices and onions, very similar to Greek food. It was apparently a very authentic "Balkan" meal, and it was really quite good!! She had also made dessert - coconut pie as well as a blueberry bread thing. It was of course a little awkward at first because they all speak Croatian (she is from Belgrade, Yugoslavia, which is now Servia, and her husband is from Croatia). They were so nice though and spoke all English in front of me. Her son was especially nice...he is a sophomore at Montana State University and was giving me tips about how to spend my time in Havre, and actually tipped me off to where there is a gym here! Fantastic! Now if I would only go......

I also got to meet my preceptor's 3 dogs: a St. Bernard, a malamute and a husky/german shepard mix. Holy crap those a big dogs...full of slobber and love, totally made me miss home! (Both my Mary and CJ are slobbery and full of love!!!)

Perhaps the best part of dinner was my preceptor and her husband questioning why I didn't go to med school, "I mean PA is ok, but..." I took it as a compliment that they thought I could handle med school, but I had to laugh because I'm sure that isn't what the faculty and staff at my PA program hopes I'm hearing during my rotations. Oh well, LOL!!!

Anyway, 8 days down, 31 left after tonight.

Jen

Saved.

7 hours later and a visit from a repair man who smelled like varnish....the internet is once again mine.

*evil laugh*

Jen

For crying out loud...

So I finally met with the hospital administrative person today who is finally back from vacation. She is the one who had previously dropped the ball, and I can't say I am very impressed after our meeting today.

The first thing she tells me is that I will probably have to move out of the apartment tomorrow. WHAT!? You told me July 10th lady. Then she starts blabbering on about "oh maybe it is not until this date or that date, I forget." She's going to call me and let me know....

Then I get home and the internet isn't working!!!!! TERRIBLE NEWS. I'm currently at the local library, and not particularly pleased, if you can imagine. I've emailed this lady asking her who I can call for internet service fixing...I've tried all the usual measures of resetting the modem, etc. We'll see how timely she is in getting back to me.

I'm going to go ahead and spend part of today looking around at the local motels for their weekly rates. I saw the sleeper room in the hospital and it also has no internet access. With all the research projects and patient logging that I have to do for school, there is just no way to make that work. What a bummer way to start the week!!

I guess I will try to get as much research printed out as I can today, and finish all my assignments asap...

This is such crap.

Jen

Moving along...

Tomorrow will make 7 days that I have been in Montana...a full week, and though it seems like forever (seriously), I know that I am going to make it.

On Friday, things finally started to come together at my rotation. The people who work on the 5th floor of the hospital (the med/surg floor) are starting to recognize me, and therefore saying hi and smiling at me. This is all I need! I don't need to make best friends here - I've already got some of the best friends a girl could hope for...but it is so nice to be able to make small talk at work! Also, my preceptor's nurse, Janet, whom initially was incredibly intimidating, has really warmed up to me and I really like her.

My preceptor is still so hard for me to figure out. She is not incredibly touchy feely, and I sort of got the feeling that I was in her way all week. I can't blame her...having a little 24 year old in a short white coat (the sign of a student, when I graduate I'll have a long white coat) follow you around for 40+ hours a week must be annoying, but then she totally shocked me. On Friday, at the end of the day, as I was packing up my stuff to go home, she said "look, I wanted to tell you that I am very impressed with how you are doing. When I ask you questions, you know the answer a lot of the time...how do you know so much?" I was dumbfounded. I kept waiting for the "but," like "but, your physical exam skills are lacking," or "but, you really need to focus on learning cardiology," but there was no but....she was just paying me a compliment. I was on cloud nine, to say the least.

So, for all of my whining and self-pitying over the past seven days, I'm finally feeling good about being here in Havre. Perhaps the funniest thing about Havre so far is that all of the people I've talked to who live here seem to dislike it as much as I do. Honestly, when people find out I am from Oregon they sympathize with me for having been sent here. It cracks me up...just tonight while doing laundry in the buildings laundry room on the main floor, a woman in her fifties made small talk with me and was talking about how much she hated Havre and that there was nothing to do here. It makes me feel less terrible for not giving Havre much of a chance.

I did do a bit of exploring today - I drove to Beaver Creek park about 10 miles south of here, and spent some time reading a book in the sunshine. The park was really crappy, actually -- just a man-made lake surrounded by a dusty road and some picnic tables scattered here or there. I took a couple of pictures that probably do ti more justice than it deserves, but at least I got out and enjoyed some sun.

Tomorrow: groceries, homework and cleaning the apartment.

Hope you are all well!

Jen

One day left in week 1.

I'm going back and forth about this rotation...on the one hand, I am learning a lot, and being pushed to expand my knowledge. On the other hand, it just cannot compare to my first rotation. I enjoyed the patients in Oakridge so much more because they had a long standing, personal relationship with Edwin, and they trusted what he told them. Here, (like most of America), the patients come in already sure of what is wrong, and how it should be treated...and we just need to sign the prescription pad for them. It bums me out.

As far as learning is going, I have interpreted a lot of EKGs as well as a lot of labs, which are two of my weakest areas. I absolutely need the practice, and I am already slowly (but surely) improving. I am also getting a lot of practice doing women's annual exams. No, they aren't as exciting as some other appontments, but it takes a lot of practice to be good at them, and as a female provider I'll be doing a ton of them in the future.

Finally, I'm adjusting to Montana a little bit, but probably only because work is getting busier and I can kind of ignore the fact that I'm actually here. I'll have to kick myself in the butt to go explore a bit this weekend. I've been watching an unfortunate amount of TV in my off time. America's Best Dance Crew, anyone?

Only 36 days left....not that I'm counting.

Jen

180 degrees of difference

Well today was quite the opposite of yesterday.

Rounds this morning were a little less embarrassing, things went fairly well, and the other doctor who had pimped me so hard yesterday left me alone for the most part, save for showing me an EKG with ventricular tachycardia that I accurately identified after some stuttering.

We finally worked in the outpatient clinic and there wasn't even any shadowing - I was immediately given patients to do history and physicals on, which was a little intimidating but worked out very well. My preceptor seemed pleased which means I was pleased. Mostly it was simple stuff, but it amazing how different internal medicine is from a rural family practice. Almost every patient we see here gets sent for some sort of imaging (Xray, CT scan) or stress test or SOMETHING. Lots of labs to interpret, which is good as I need the practice. Almost no procedures (joint injections, etc) as that is just referred out to someone else.

I was absolutely exhausted by the time 5:30 came around and we were done. Today is my preceptor's on-call day so in between seeing patients at the clinic we were running over to the hospital to admit other patients. My doctor is a woman in her fifties who doesn't look particularly fit, but she runs on 110% all day long, and works at hyperspeed. I have no idea how she does it - I could barely keep up. All I know is I want some of whatever she is taking.

When I got home I immediately took a nap, which turned out to be a smart idea because at 8:15pm I got a call from the doc saying we had a patient who had come in with pneumonia and we needed to go back to the hospital and admit him. Well, when we got there at 9pm, there was a flood of other people who came in through the ER and needed to be admitted: DKA, hip dislocation, alcohol intoxication (a crazy lady whom the ER staff refers to as "bubbles").....we didn't end up getting out of there until 11:15pm. I'm getting good practice at writing admit orders though, which is priceless.

I think my preceptor sees that I am really making an effort, and she is doing the same with me by asking me lots of questions and giving me orders to write when we both know she would be much faster at them. I appreciate it a lot, and considering this is only day 2, I imagine that I will be learning quite a bit during my time here in Havre, MT.

So all in all, things are working out for the best as they always do. I was lucky enough today to be so busy that I didn't have time to be homesick, for the most part. Tomorrow is a regular day with no on call, but we need to be in earlier than usual because we have to check up on all the patients who were admitted tonight - so 7am or so it is....which is 7 hours from now, so bedtime it is.

Ok I lied, I'm still homesick....I miss you all, and thank you for the support and encouragement.

Jen

Why, why God? Cardiology!?!??!

There are a lot of things in medicine that I'm pretty good at. They make sense to me, or I can reason them out with some thinking.

Cardiology and EKG's are not one of those things. In fact, I would easily call cardiology my Achilles heel. I just plain don't get it.

So of course, this morning I was asked to interpret R-wave progression on an EKG, as well as listen to an infant's heart murmur and describe it. I was completely wrong both times...not very impressive.

I arrived a 8am this morning and thought I was to go straight to computer training but the woman who was supposed to help me out had no idea about it. It turns out neither did the computer training people. The woman who was supposed to be setting this all up left on vacation a few days ago....it appears she may have dropped the ball on me a bit in her hurry to go relax.

Things turned out alright, though, as my preceptor was paged to come meet me. She is a short woman in her fifties with a pretty thick Eastern European accent of some sort (Ukranian?). We were quickly acquainted and off to do rounds immediately. We visited one patient on the general floor, and while she was dictating her note, another doctor came over and told me to go listen to the murmur in room 50. Before I could even get to it, my preceptor and I were off to do a stress test. This is where I failed EKG interpretation, but it was interesting to see nonetheless.

While I am running around behind my preceptor as she gives me the fastest tour in human history (she is on hyperspeed) she gets paged...turns out it is the other doctor calling ME to see what I thought of the murmur (that I didn't listen to). Shame, shame....call him back after I've listened to it.

Visit patient in psych ward, starting to get my legs -- get my preceptor to talk about her dogs and rescuing homeless pets. Bonus points. Finally go listen to murmur...it's a 7 month old baby! I've never even listened to an infant's heart, but luckily this murmur is easy to hear. Lub-whoosh-dub. I call back other doctor. I describe the murmur as "lub-whoosh-dub." He states that he would have described it as a harsh, crescendo-decrescendo murmur (cardiology failure #2). He asks me what that murmur means....oh dear god...I have noooooo idea. He says its a ventricular-septal defect, and a small one at that because it's so loud. Could have also been aortic stenosis...good to know. Finally he asks me what else I'd noticed about the patient. Luckily I had seen on the patient listing that this infant had Down's Syndrome, so I mention her big head. I couldn't remember the verbage for medically saying big head, so I sounded pretty dumb. Uh huh, he says, what else? CRAP - I just went in to listen to the murmur, I didn't study the little thing!!! Apparently I should have noticed epicanthal folds, simian creases on her hands, a protruding tongue and maybe even some space inbetween her 4th and 5th toes. FAILURE. He asks me what all that means. I say Down's Syndrome. "Bingo," he says, "next time look at the whole patient." End of phone call. (Apparently this guy really likes to teach, and usually has 3rd/4th year med students, so I am going to assume he is just pimping me old school...make the student look dumb and they will study harder. I appreciate his efforts, and just hope he doesn't think I'm hopeless).

So after all that, I was sent home because my preceptor only has half days on Mondays. I go back in at 4:30 for computer training, though, which will be helpful because my preceptor is so fast that I couldn't for the life of me figure out how she was accessing all the patient's labs on the computer.

Tomorrow I meet with my doc and the other internists at 7:45 in the hospital chapel (odd meeting space) before rounds begin. She is on-call tomorrow and Thursday because one of the other docs is on vacation, so it will be a busy day. She told me I wasn't required to do on-call with her, but I know that the right answer to that is always "I'm here to work and nothing else, so count me in." We will be doing hospital stuff from 8-10, then the outpatient clinic from 10-5:30, with an hour for lunch (although she mentioned there is always some "stupid lunch meeting to go to,") plus whatever on-call stuff happens.

This is going to be okay. I think. My only hope is that after my first day fumblings, they will have low expectations. I know that is terrible to say, but seriously...I'm trying to find positives here.

Jen

A post with words...

Obviously enough, the apartment I am staying in has internet. Thank god.

Moving on - the drive was more horrible than I possibly could have imagined. It isn't that anything terrible happened, it just turns out I'm not the long-distance driving type. Looks like that 2nd career as a long-haul trucker is out of the question. The first day of driving (Hillsboro to Spokane, 6 hours) was actually ok. I only stopped once on the way, and when I got there I had a fabulous hotel waiting for me (thanks Hotwire.com). Unfortunately, a 14 year old girls soccer team was also staying there.....across the hall from me. I didn't sleep well.

Today was markedly more horrible. It started out reasonably ok. Idaho was beautiful, and when I crossed into Montana I was starting to feel "close." What a crock. It took me a full working day (with no lunch) to get from Spokane to Havre. I felt like I should be coming up on the Altantic ocean at any time...but I was STILL in Montana. It only got worse when I got here...

I had been told to go to the ER of the hospital and someone would have keys to my apartment for me. Nope. Turns out they only had keys for some traveling CNA named Martin. Faaaantastic. My legs are shaking at this point from lack of use, and now I'm homeless? Ok, so that is a bit dramatic. They called the admin person at home, and she told them where the keys were. Wahoo!

The apartment building is a converted hospital from the 30's....and you can tell. It's this big, old brick building with oddly narrow hallways and dim lighting. I was super creeped out when I first pulled up, and terribly disappointed. Then I got to my actual apartment though, and it is fantastic! It's a 2 bed/2 bath, fully furnished and totally medical'ed out. Point in case: on the desk in the living room is a huge Physician's Desk Reference and ziploc bags full of suture for me to practice with. I'm going to be devastated when I have to move out again in 3 weeks, but I'll deal with that then.

For now, its time for me to get to bed. Its another big day tomorrow, and I would rather not be late because I overslept.

Jen

Home #2 in 2 months.

1st Picture: the apartment building where I'm spending the first 3 weeks...it used to be a hospital in the thirties.

2nd Picture: ...and is thusly appropriately creepy. The hallways really are that dim.

3rd Picture: But the inside of the apartment is great!

4th Picture: The bedroom.

5th Picture: The ktichen and dining room.

A Picture Story

1st picture: Coming into Spokane last night...6 hours of driving later.
2nd picture: Entering Idaho this morning, still fresh adn full of energy.
3rd picture: Going over the Rockies in Montana. Turns out I'm scared as hell of mountain roads.
4th picture: Just outside of Great Falls....almost there!
5th picture: Home sweet temporary home!

Where I've been/Where I'm going.

So it took all the way until the last day, but I finally took some pictures of the clinic in Oakridge, as well as a picture with Edwin, my preceptor-extraordinare. It was really difficult to leave...I had cultivated such fabulous relationships with the staff, and I loved learning from Edwin. He is just so incredibly intelligent, it blows my mind. I will even miss the actual town of Oakridge. The people there welcomed me with open arms, and I am forever grateful for their kindness. I will especially miss my temp roomie Michelle. She didn't have to be a friend to me, but ended up being one anyway and it made all the difference.

So one adventure ends, and the next begins immediately. I went home Friday night to see CJ...we worked out and went to a happy hour, and I was so tired I was passed out by 11pm. This morning we did some laundry, stopped by the welcome picnic for the incoming PA class, and all of a sudden it was time to leave again. It was so difficult to have to say goodbye....AGAIN. This time, however, I had to say "I'll see you in 6 weeks," rather than "I'll see you at the weekend." It hasn't fully hit me yet, but it is getting there.....

It is a 14 hour drive from Hillsboro, OR to Havre, MT. Obviously that wasn't going to happen in one day, so today I drove the first 6 hours to Spokane, WA. I am laying here on my hotel bed, wondering how on Earth I'm going to get to sleep with so much uncertainty laying ahead of me. The only thing I know for sure about this rotation is that I'm to show up at 8am on Monday. I did get to read some of the evaluations written by prior students who have been to this rotation. So far I know that I will be doing rounds in the morning, then working in the clinic the rest of the day. My schedule will be something along the lines of 7-5:30. Oh, and my preceptor likes dogs. This was actually the best news of all...anyone who likes animals has to be a halfway decent person.

So, tomorrow I will get up, shower, dress, and eat myself silly at the breakfast buffet here before heading out on the road, no later than 9am (which means 9:30am). I will drive the remaining 7 hours and 20 minute to Havre, where my first stop will be at the emergency dept. of the hospital, which is where I will pick up the key to my first residence, the Parkview Apts. Once there, I will unpack, eat some dinner and try to sleep in preparation for the big day ahead.

I'm nervous, but if I wasn't, that wouldn't make any sense. I'm sad too...I'm not a big fan of being away from home. But......deep down somewhere I am excited too. And I know it will all be okay. This is the worst part - the anticipation.

My internet-ness in Havre is questionnable at this point...if it takes a couple of days for me to update, it means there is no internet at my apartment. The horror of it..............

Jen

My weekend in Oakridge with CJ.

CJ CAME TO OAKRIDGE THIS WEEKEND!! We had been invited to margaritas at my preceptor's (Edwin) house on Friday night, and CJ was supposed to meet me there, but Edwin's house was so out in the middle of nowhere that there wasn't any cell service. I ended up finally getting a hold of CJ and met him in town when he finally got here...then on our way back to Edwin's we had to wait on the road for a herd of Elk to cross....it was amazing, babies and everything. We had margaritas and saw Edwin's house, barn and land...it was amazing. He is pasturing his neighbor's horses at the moment, so Mary got her first experience with them, and was smart enough to keep her distance. Edwin's stepson had his dog there, a husky puppy, so Mary and the other dog just ran around the fields for hours while we socialized.

On Saturday, I had to get up early for the once-monthly Saturday clinic (just 9 to noon). It ended up being pretty busy, but CJ met me there and Mitch, the other provider, looked at his bum knee. Unfortunately we found out that its one of those "deal with the pain or go get surgery" deals. Sad news. After clinic was over, CJ and I went to lunch at the Trailhead cafe (which was very hippie...hand-painted chairs and tofu salads, etc). Then we came home and prepared for our hike.

We went on a hike that was recommended to us by Edwin's stepson, who works for the forest service. It was this amazing hike through the Willamette National Forest following the North Fork of the Willamette River. It was lots of ups and downs and the trail was pretty much one person wide most of the time. We hiked for over two hours and didn't see a single other person, but got lots of pictures and really enjoyed ourselves.

After the hike we came home to shower, then had dinner at the Chinese restaurant in town. The owner had remembered me coming in with my preceptor (3 weeks ago!) and was kind enough to sit down and chat with us for a while...very small town stuff. We came home and were so tired we just watched a movie ("8 seconds," a 1990-something movie about bull riding starring the one and only, Luke Perry). We were in bed by 10pm.

Today we went to the park and walked around some easy trails, then threw the football around (I'm getting good!). We had lunch at the Mexican restaurant (we literally ate at half the restaurants in Oakridge this weekend) and then went to Salmon Creek falls...but we couldn't find the trail, just the campgrounds...so we found an empty camp site to park in and just walked around a bit. We came home then and relaxed before CJ packed up to leave.

Now it's 6:00pm and I'm in the big empty house all alone. I'll clean a bit tonight, go get some groceries and then hopefully get some work done on my paper that is due at the end of the week. I can't watch TV because we couldn't figure out how to switch it back over after we watched the movie last night (CJ tried for like an hour!). That should help me focus, anyway.

My last week in Oakridge is upon me, and I'm really pretty sad. I think more than anything I'm sad that I don't get to go home when it's done. CJ and I both agree though that we just want to get Montana over with...because when it is done I can finally come back home to live for the first time in 12 weeks. I've been trying to come up with all sorts of reasons to enjoy Montana....I really have. I just don't have any that I really believe in yet. Yes my attitude sucks, but it's my blog, and I'll whine if I want to.

Jen

Speaking of...

Speaking of needing to be more social and not just sit around all day.....


My blog now has a template.

Some sun and a "burn."

This week my preceptor got "burned," or at least that is how he describes it. He tends to be a pretty aggressive provider - doing a lot of things in-office that might normally get sent to the ER, taking risks here or there, but usually his intuition is right and he does much more good than harm. Unfortunately, that was not the situation this week. Without giving too many details, he took a risk and the patient suffered some negative sequelae as a result. The patient will be fine, but my preceptor got a phone call from one of the patient's other specialty docs and got a verbal slap on the hand. It is very humbling to see the person you regard as so much more intelligent than you make a mistake. Everyone gets burned though. My own primary care doc told me once that a provider makes something like 500 decisions a day...and its just the law of statistics that sometimes it is going to make a wrong one. It was just weird to see it happen.

Tomorrow we have to tell a patient that he has skin cancer, though it should be easily treatable. We also just got a pathology report telling us that another one of our patients has breast cancer. She will have a rougher course of treatment, involving probably surgery and radiation...but there is certainly hope for a full recovery as it is in a relatively early stage. This probably sounds very odd, but I feel lucky to have the opportunity to sit in on telling these patients the bad news. It is a skill, and one that I will need to learn, so to observe a long-time practitioner and his method of delivering the news will be of great value to me.

In regular life, things are moving along swiftly. Only 7 1/2 days left in Oakridge. CJ will be up here for the weekend, and it is supposed to be so nice and sunny, which is exactly what I hoped for. We are going to go on hikes, do some sight-seeing, and go out to dinner, all the good stuff...and if we really get bored, Eugene is only 45 minutes away!

Last night my temp roomie, Michelle, invited me to dinner, which was really nice of her. We went down to the bar in the pizza parlor, ate and then met up with a couple of her friends at the other bar in town (yes, there are 2 bars....but only 1 grocery store?!?). I got invited to be a substitute again at Bunko tonight, and I said yes, which I kind of wish I hadn't. Still, it is good for me to force myself to be social, especially since I got off work early today so I'm just sitting around anyhow.

Which reminds me, I have a paper to work on.....

Jen

2 steps forward, 1 step back.

I've finally figured out that these rotations are not about getting better each and every day. They are, instead, about being fantastic and infallable one day, and a total idiot the next. Each day when I head into work I don't know which type of day it will be.
The last two days have been pretty good. I've removed an ingrown toenail (which my classmates might understand as being somewhat of a feat), excised a possible extra nipple (seriously), and did running subcuticular stitches (with visibly shaking hands). When I did the toenail, I broke it off without getting the whole nail out - preceptor had to fix. When I did the excision, I cut so deep that my preceptor accused me of trying to biopsy her heart rather than take off a skin lesion. The running subcuticular stitches were pathetic at best...but luckily they are subcuticular....which means they are just under the skin, where no one can see them. I'll call that a victory.
Another victory: today when I introduced myself to one of the patients, she dryly replied that she had already heard of me. Apparently I look confused, because she said "it's a small town, honey." All I could say was, "well, you're still here, so that's good!" She said she hadn't heard anything bad about me.......which isn't the same as saying she'd heard anything good, but nothing bad is a good enough for me, if that makes sense.
Finally, I nailed down my housing in Montana, and it's going to be quite the adventure. For the first 3 weeks I will be living in an apartment provided by the hospital. For the last 3 weeks, I will be living IN the hospital. Yes, my very own converted patient room with a TV, bed and shower. Apparently the ER docs use these rooms when they don't have time to go home between shifts. Bitchin.
Jen

Nature??

CJ and I took Mary to our new favorite park and decided to wander around some of the trails. We found a very interesting body of water (picture one) that didn't make sense until we saw the sign hidden in the long grass (picture two). This must be nature in the 21st century.

The rest of the weekend was pretty chill, with perhaps the most exciting outing being to Costco. We also watched Rambo (obviously CJ's pick) which was one of those movies that was actually ok just because I expected it to be so unbelievably horrible.

Starting week 5 in Oakridge tomorrow....only two weeks left before I head up to Montana. I'm super freaked out. I just map-quested it and its about a 14 hour drive from Hillsboro. I'm going to probably drive to Spokane, WA on the Saturday, stay in a hotel, then drive to Havre, MT on Sunday. I imagine my blog will become a public forum for my insane ramblings for those 6 weeks I'm all alone with the cows and wheat fields in big sky country. I apologize in advance.

Jen

Free chiropractics = fantastic job perk

So after Monday's tough karate class, my back was feeling pretty bent out of shape. Luckily, my preceptor noticed I was moving stiffly, and told me that he'd hook me up with the chiropractor who rents a room out of the office 2 days a week. Well, Dr. Powell, DC, is amazing. First of all, he insists on having everyone he meets tell him a joke. I couldn't think of one which wasn't a good start, but he filled me in on a joke another Irish patient of his had told him. It is apparently the shortest Irish joke ever: "An Irish person walked out of a bar...." And that's the joke. I have to admit, I laughed.
Anyway, he quickly identified that I have facet joint syndrome at L5-S1 (that's for you, Katie) and one of my legs is shorter than the other. Some adjustments, electrical currents and pelvic re-positioning later, I was almost as good as new.
The work week went pretty well - Wednesday and Thursday were pretty slow, but Friday was more busy and lots of fun. My preceptor is slowly but surely letting himself turn me loose more often. I'm passing his little tests here and there (for the most part) and every once in a while I get a pat on the back. Friday's success was when Edwin came out of a patient room, found me and motioned for me to come see the patient he was evaluating. He brought me in and said "tell me what this is." The elderly man sitting in the chair had quite a bit of swelling with some redness in his hand. I asked him how it happened, and he said he just woke up with it. The skin around it wasn't warm, and not really red enough to be an infection. So I looked my preceptor and said, "gout?" He threw up his arms and walked out of the room. I was right. Ahhh the glorious feeling.
I am already getting sad about leaving...I've really started to bond with the office staff and it is going to be hard to start over again with a whole new group of people in Montana. I have to just realize that as soon as I'm comfortable, it means my learning curve is flattening, and it's time to move on. Dammit.
Anyway, this weekend I'm home in Hillsboro, but next weekend CJ is coming down to Oakridge. Edwin, his wife, Kris (our office receptionist) and whomever else desires are going to go up to Edwin's house for margaritias, and we are invited. I'm also going to plan some good hikes and make sure CJ gets the whole depressed logging town in the middle-of-nowhere experience.

A last interesting tidbit...apparently Oakridge used to be a lot bigger and more booming, but then the spotted owl was put on the protected species list in the 80's, and that killed a lot of the logging industry up there. I should take some pictures of all the abandoned old buildings and businesses...it tells quite a story.
Jen

Peacocks and IVs

So my temporary roomie Michelle finally took me on a driving tour of Oakridge - there is so much more than I thought there was! We went up into the hills and saw all the fields and houses with land and horses and cows, and then some wandering deer and elk. The strangest thing we saw was some peacocks running around on the road - apparently someone keeps peacocks and they got out of the yard or something...way funny. I had to take a picture.

Moving on. Today was such a better day than yesterday. First appointment this morning was an urgent visit from an elderly woman who had been admitted to the hospital a few days ago for pneumonia, and was discharged yesterday. Well of course overnight she had shortness of breath and swelling in her feet, so she called us and was told to come right in. We wanted to keep her from having to go back to the hospital, so I started an IV (yes, me! And it was a good IV, no blood everywhere like when I practiced on poor McKenzie). Anyway, first we drew some blood from the IV, then I pushed some solumedrol and lasix. The solumedrol was to decrease inflammation of her airways, and the lasix was a diuretic so that she would pee off all the extra fluid. It was a wonderful success for the first appointment of the day...keeping someone out of the hospital is always a good thing.

The rest of the day consisted of giving an injection in the knee for pes anserine bursitis, an injection in the hip for trochanteric bursitis, two injections in the butt for a migraine, and I even managed to get a "you did a good job today" from my preceptor at the end of the day. It totally makes up for yesterday's flustered-ness.

Anyway, that's all for today. As usual, I miss you all terribly.

Jen

Stumble, trip, recover.

Today I had a few stumbles. Not big ones, no one died...but I wasn't the shining star that I hope to be every day. With one patient in particular my head just about exploded. He was a very nice elderly gentleman coming in with symptoms of a kidney stone. So, being up here in rural Oregon, we fix everything with the needle. Mr. kidney stone needed 10mg of morphine mixed with 50mg hydroxyzine injected into one butt cheek, and 60mg of Tordol injected into the other. This would decrease pain, inflammation and dilate his ureters for easier passing of the stone. Here's where I went wrong:
1) I thought that "10 of morphine" meant 10mL of morphine, when it really meant 10mg of morphine (which is only 1mL). I obviously figured it out when the morphine only came in 1mL vials, but still, I felt really dumb because I had already asked the nurse for a 10mL syringe. Oops.
2) I was going to give the morphine by itself, which we apparently "never" do - it has to be mixed with the hydroxyzine to avoid nausea and all sorts of other nasty side effects. Oops again.
3) I thought we gave morphine OR tordol, and had to be called back by my preceptor as I was entering the patient's room with only morphine...even better, I thought he was joking about me needing Tordol and accused him of trying to confuse me. Oops number 3.

My not-so-awesomeness did not go unnoticed by my preceptor or his staff. It was pointed out to me today that I "looked flustered," "confused," and "overworked." Of course all of these comments were said with sympathy and kindness, but still, it made me feel like a total newbie (oh wait, I am).

On the plus side, I saw shingles today, injected someone's wrist who had carpal tunnel, diagnosed 3 strep throats and did a pelvic exam. For most people that would be a pretty ordinary day....for me, it was practicing the basics, which I love. Something I have finally found that I don't love: managing chronic pain. It's really every family practice doctor's nightmare to have to manage someone who is taking obscene doses of opioids every day, but I really thought I'd be the provider who was all sensitive and great about it. Turns out I hate it just as much as the next guy. It isn't that I think all (or even most) of the patients are drug-seeking, its that I can't measure their pain, and I can't understand why the last pain medicine we tried isn't working. It is difficult to diagnose something based completely on a patient's own perspective, because a 10/10 on the pain scale for one person is a 6/10 for another. Food for thought...

Speaking of pain, I went to karate tonight (I've upped my attendance since my pants have gotten tighter recently). We actually did karate type stuff like learning Katas (the little punching routines you have to learn to advance to higher belts) and free-fighting. Mostly I watched the free-fighting, but was invited to try it right at the end. I was "spirited," but terrible. Still was quite fun, though! Definately something I never would have picked myself to enjoy, but I like learning new things, so it works. Perhaps my next preceptor will teach me sewing...

Jen

This is the copper river salmon that CJ barbequed on cedar planks on Friday night...stuffed with caper butter, lemons, limes, and all sorts of other deliciousness. I'm actually eating leftovers of it right now.

Thats what I did Friday night - got home around 8:30pm and ate dinner with CJ. By 11pm I was exhausted and went to bed.

The whole weekend was about relaxing and enjoying ourselves. We took the dog for a walk in a new park we found, went to dinner and drinks with a couple of friends last night, and today went to the local farmer's market before going to an Indian restaurant for lunch.

Tomorrow it's back go the grind, and I've got a little case of the "Sunday nights." I love my rotation, but I'm having a bit of an adrenaline crash. I was so amped up the first couple of weeks that now I'm just exhausted and a bit worn down. It doesn't help that the Sun hasn't made much of an appearance lately. Perhaps an investment in some vitamin D might be a good idea.

Alright this is boring,

Jen