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