CDA

I ran away from Havre this morning, and it was the greatest thing that ever happened to me.

I'm a fan of talking to no one in particular while driving, and quite enjoyed telling the town of Havre to "piss off" as I sped out onto the highway.

My drive: Havre to Great Falls to Helena to Missoula to Coeur D'Alene (rest stop for the night).

I ate dinner at a sushi restaurant here. I missed sushi.

I now rest in my very nice room at the Shilo Inn, finishing up my paper and attempting to convince myself that I actually will still work out before the night is over.

My 5th and 6th rotation will be in a building less than a mile from where I lay right now. I drove past the building today to get familiar with it --- looks pretty nice! I'm excited to do family medicine here because I will be with a PA, and it is only 4 hours away from Tri Cities (CJ's home town, where we can meet halfway on some weekends to see each other).

Tomorrow: free hotel breakfast, quick drive through downtown Coeur D'Alene (after talking to my dad, I realized I had completely missed it), then CDA to Tri Cities, where I will join CJ's mom and sisters for lunch at Azteca, then on to Hillsboro, where I will likely be welcomed by this:

I can't wait!
Jen

A fitting ending... (plus some glacier pics)

Today, my last real day working in Havre, was terrible. Of course.

I started out with the radiologist, a different one than last time. Wow, what a class A jerk. 20 minute into my being there, he dumps me off so obviously that one of the ultrasound techs turned to me and said, "so, you got dumped, huh?" The guy is just a lazy pile (the radiologist) - I saw him get himself coffee more times than not in the course of the 3 hours I spent there. Hanging out with his techs I found out they didn't respect him much more than I did.

Fortunately, I did actually see a couple interesting things. The first was an ultrasound to confirm a case of fetal demise. The woman was 11-13 weeks along, but at yesterday's appointment with her OB, no heartbeat was heard. I quietly observed the ultrasound from my place hugging the wall, and even as an idiot student, could see that the fetus was completely still....a bad sign. The tech turned on the sound, and there was nothing. I know it is odd, but I felt somewhat privileged to share this moment with the grieving couple and the all-too experienced tech. She knew the right things to say, and I tried to learn from her ways how to be graceful when delivering bad news. It was sobering, to say the least.

The next hour or so was spent with the CT tech watching a scan done for liver masses. The masses had been first detected last year, and were most likely benign hemangiomas (for the nerds). Today's scan was to check up on them and make sure they weren't changing (a bad sign). The CT tech was obviously passionate about what she did, and enjoyed explaining a lot of stuff to me (like how it was redundant to say "spiral" CT, and why it is now a CT scan, not a CAT scan). Anyway, after it was done I lied and said my meeting with the PR person was at 11am (not 1pm) so I could get the hell out of there. I shook the radiologist's hand before I left, silently hoping his schedule was packed and he'd have to stay late, just out of spite.

When I went back for my 1pm meeting with the PR person from the hospital, she wasn't there. She had forgotten about our meeting and I was informed that she wouldn't be back to the hospital for the rest of the day. Not the best public relations, in my opinion. A truly fitting ending.

Plans for when I get home:
-a picnic in the park with CJ and the dog
-pedicure
-visit my first clinic in Oakridge for lunch with preceptor and staff (I'm keeping my contacts -- I would still love a job offer there eventually)
-a trip up to Seattle
-catching up on 6 weeks worth of TIVO

Jen

PS: a couple pics from Glacier....


Honing my horsemanship on the Blackfoot Indian Reservation.

Stop looking at me, goat.

About 6 miles into an 8.5 mile hike that just about killed me.

It was the time of my life.
Jen

Are We There Yet?

At the library (inside it this time)...I can (for some strange reason) no longer access their wireless internet.

My hunch is that there is an evil conspiracy to keep me from communicating with the rest of the world.

It is Tuesday. I'm leaving to come home on Thursday. Literally only hours remain.

It is still too long.

Tasks to distract myself:
-wash my car, with special attention paid to removing the thousands of bugs I've splattered on my bumper over the last few weeks (I bought a special "bug remover" car washing sponge).
-laundry
-finishing those pesky internal medicine assignments (why are they so numerous!?)
-finish my box of wine (may interfere with the above task)
-pack
-make mundane lists such as this one to waste time
-purchase and write thank you cards for the office

48 hours should just FLY by!

Tomorrow is radiology and a meeting with the hospital's PR person to have my picture taken and a little blurb written about me in the hospital newspaper, (better late than never?) She especially wants me to discuss what PAs do, since (in her own words), "not many people around here know what a PA is."
(ya think?)

Jen

I'd like to thank the academy...

As things here in Havre wind down, I'd like to take a moment to thank the people who have kept me sane. Whether you're a parent of mine, giving encouraging words on the phone, or a best friend who keeps me up on the gossip while I'm away, I appreciate it all.
I must also throw a special shout out to Erin Cramer, whose blog reminds me that I am not the only one having a shitty time on rotation #2. I love your lunchbox, Erin. Never be ashamed.
I'm sure you were all expecting some super long blog entry about Glacier, but the truth is, I can't muster the energy to write it all down yet. I'm still processing the awesomeness of it all. I took 70 pictures, saw (up close) 15-20 mountain goats, 4 rams, 2 white tail deer and countless varieties of little squirrely-chipmunky things.
No bears.
Did a 3 hour trail ride on a horse before doing a 9 mile hike on Sunday....can't walk very well today.
That's all for now,
Jen

Running off

I'm in my hotel in Kalispell after a long day yesterday of driving, then oohing and aahing and eventually, a short hike.

I wish I could write all about it now but I was so exhausted that I passed out quickly last night, and now I'm off to get breakfast before today's adventures.

I had dinner at Applebees again last night (my fave out of town spot). There is also a story to go along with this.....

A couple of quick pictures to wet the palate:The "weeping wall" on Going To The Sun road.Avalanche Lake....the final destination of my hikeThe wildlife here isn't scared of people. I was speechless at how close they were to me.

More to come,
Jen

Last day with preceptor

So, today was my last day with my preceptor. I still have one week (actually just less than a week) left, but she is taking next week off as her son will be leaving for a year abroad in Italy and she wants to spend a few days with him before he goes.

On Monday I'm going to spend the day with the hospital's diabetes educator -- I figure its a perfect time to figure out all these crazy drugs and different kinds of insulins...then I'll spend Tuesday with one of the internists who does a ton of procedures on Tuesdays -- should be a lot of colonoscopies, EGDs and a few sigmoidoscopies. Wednesday will be another day in radiology (*groan*) but it will be with a different radiologist, and hopefully he won't be quite as boring as the last one. Thursday will be observing more procedures in the morning with the internist, then I will leave that afternoon for Coeur D'Alene. I hope to get in before dark and find the place where I will be spending my family practice rotation. The next morning its up early and off to the Tri Cities to have lunch with CJ's family before heading home.

Before I get ahead of myself though, I have a big trip to Glacier National Park tomorrow! Its a good thing that my camera didn't end up needing a new battery....because it never came (its apparently still in-transit). Damn gauranteed 3 day shipping -- they are refunding the shipping cost at least, which is nice because it was more than the actual battery.

The medical student and I got together this evening after work and walked to the local frozen yogurt shop, then went around town and found a book store that was open. I bought 4 books - a little ambitious maybe, but I still don't have TV or internet at my apartment, and I'm tearing through my current book.

Will have tons of picture to upload soon from one of the most beautiful places in North America!!!

Jen

Dictate This! (pt 2)

In the spirit of reducing my whining, I have good news.

Today I dictated on the phone on 3 patients, and it actually went ok.

Probably because I drank a margarita beforehand (this was done after work, of course)

Damn nerves.

Jen

Sisterhood of the traveling whiny-pants

I've decided to stop whining temporarily about my situation here in Havre, MT. I was getting sick of listening to myself.

The light at the end of the tunnel is getting so much brighter, and as an added bonus, my preceptor confirmed today that I can leave a day early.

WAHOO!

Jen

Irony

Ironically, my camera started working the moment after I put a rush order on a new battery for it. Either way, now I get to post pictures of the bar night and the rodeo, YEEHAW!

From L to R: my preceptor's nurse, Janet, Dr. Latkovich and me.


Dr. Latkovich's son, Luka, and her husband (the pathologist) Predrag with the infamous painted sugarbeet on the sidewalk (aka: angry carrot). Predrag is holding a "fishhook," as having a "fishhook party" is apparently some kind of navy tradition for when people get promoted, though I think they got banned for bad behaviors taking place. You military folk would know more than I do.

The bucking broncos.......followed by the bull riding.

This guy was a horse trainer who was getting his horse to "roll over." I have never successfully been able to train a DOG to do that.

That's all for now.

I made my reservations for a hotel near Glacier National Park...I'm getting so excited!!!!!!

Jen

A case of the Mondays.

Remember that bug bite I talked about in my last entry, the one that swelled up and looked bruised? Well, apparently my body thought it was a mutant death mosquito as well - I've got a fat, sore pre-auricular (in front of ear) lymph node on that side of my face now. Damn Montana bugs.

Yesterday I had the pleasure of attending my first Demolition Derby. It was super crowded in the stands, and over 90 degrees, which was really just about unbearable. The whole scene was just hilarious though - and I learned that cars can really keep driving even without all 4 wheels or with radiator fluid spewing out of the hood (I think it was radiator fluid...). Glad I went, but didn't stay for the end - it really was that hot.

Today is supposed to be hotter, around 100 degrees. I had decided already to just hibernate in my apartment (unfinished as it is) with the central air on and take a nap (work gets out early on Mondays). Well, I got to my apartment, and found the door open. Two men were in there, "finishing" my apartment. Well, as fantastic as that is, I wish someone would have TOLD me!! I had my dirty laundry sitting in a pile on the floor right in the middle of the hallway, waiting to be washed. All sorts of unmentionables were just hanging out in plain view. Fantastic. That wasn't embarrassing.

So, now I'm at the library. I just ordered a battery for my digital camera off of ebay because, of course, it died. Thus my pictures of the rodeo and angry carrots will have to wait. Next weekend I'm taking myself to Glacier National Park though, so I put a rush order on the battery. Until then...boring, text-only entires.

My apologies,

Jen

Insert swear words here.

Either I did something really terrible in one my past lives, or I'm storing up some really good karma for the future, because life in Havre, MT keeps going awry.

I moved again. The fourth time in as many weeks. Before I did my 3rd move I was told that on July 18th (yesterday) I would be moving into the North apartment, and could have said apartment for the rest of my stay. So yesterday when I visited the woman who is making my life Hell (hospital administrator/housing person) I was surprised when she started talking about how a nurse anesthetist is now staying in the North apartment, and so I'd have to move into a different apartment. This is the proof I needed that she has been bumping me out of my housing for other people, but it gets better.

The apartment isn't "finished."

Apartment 304 has a bed, a 2 drawer nightstand, a chair and a TV stand. No TV though. Or internet, or cookware, flatware, dishes, towels, basic cleaning supplies, or really anything else necessary for living. In fact, it doesn't even have curtains over the windows, so I had to hang the sheet off my bed over the window in the bedroom for some privacy. It does have a microwave in the kitchen....that doesn't work. None of the outlets or light switches have the plastic plates that go around them. There are paint chips on the kitchen floor and some strange looking gravel-looking dirt in the bathtub, (pictures to come soon).

Confirmed: my theory that this woman hates me.

So, I moved in (I can't exactly afford to stay in a motel for the rest of my time here). I spent a disturbing amount of money at Walmart on some flatware, a few dishes, a pot, a frying pan, cleaning supplies and a microwave (90% of my cooking skills revolve around the microwave). After putting away all my stuff and throwing up a few framed pictures of the loved ones in my life, I felt a little better. Then I went to cook up some ground turkey for tacos tonight and found that the only big coil on the stove doesn't work, so I had to rotate the meat around in the pan so it was over a 4" diameter area of heat produced by the small coil. It took over 20 minutes cook, for crying out loud.

Anyway, so in order to have the internet, I'm now parked outside of the county library which has free wireless (but is currently closed, hence being parked outside).

Moving on. Last night was the big night out with the docs and some of the office staff. My preceptor's husband is in the Navy reserves and got some big promotion, so we all went out bar-hopping to celebrate. First we BBQ'd in a park though, where I was chatting with everyone and drinking a beer when suddenly my doctor's nurse slapped me on the forehead (hard). "Mosquito," she said. Well apparently it was some mutant mosquito, because 20 minutes later everyone was asking me what I had hit my head on. My forehead was swollen and bruised like I'd had been hit with a softball. (24 hours later it is now an almost normal bite...the size of a quarter. On my forehead.) Anyway the night was really quite fun, and my doc's 19 year-old son came along so I had someone to chat with. He's a really nice kid, and was tagging along as a designated driver for his dad, so I got to ride along too - yay for responsibility!

I'm still trying to figure out what to do with the rest of my weekend. I'm sort of lost in an apartment without TV or internet...I can only read so much. Oddly enough, I still have the key to the sleeper room in the hospital which DOES have a TV, so I might just go there to relax for a while before going back to my apartment to sleep. How weird.

Oh, which reminds me: I found the strangest high school mascot ever - a sugar beeter. See, last night's bar-hopping excursion was in Chinook, a small town about 20 minute outside of Havre. I thought I was getting way too drunk when I realized that every 10 yards or so on the sidewalks of Chinook there was a painted, angry looking carrot. Alas, I wasn't hallucinating (though it was apparently a sugar beet, not a carrot), Chinook high school actually has a vegetable as its mascot, they are the Chinook Sugarbeeters. I took pictures and will soon be posting them....hilarious.

2 weeks. 2 weeks. 2 weeks.........

Jen

Shifting Winds

The last few days have been so different than my first 3 weeks here in Havre.

First of all, I'm living with another fantastic temporary roommate. PA Debbie, my host and savior for this week, is just awesome. She is so friendly! We just make dinner and chat and watch TV in the evenings, or just do our own thing. I feel so comfortable here, and it is so nice to have company. I'll really be a bit sad to be moving back into an apartment by myself for the remainder of my rotation. Plus, I'm really going to miss the little dog (even if it does yap a lot).

Secondly, I've been working with a different internist (Dr. H) this week while my preceptor lets her niece shadow her. (Sidenote: her niece, a 20 year-old pre-med student, has shown up to work in "skinny" jeans every single day. Today she also wore "skater" shoes with those thick, brightly-colored shoelaces - a truly excellent display of professionalism (and poor style...skinny jeans are so last summer)).

Anyway, so Dr. H does things completely differently than my preceptor: instead of me seeing every patient, doing the history and physical, and then presenting the case to him, he has me see only 3-4 patients a day. At most. He picks a patient who is complicated, lets me observe the appointment (or rarely I can start the H&P) or review the chart, and then has me spend about 2 hours studying the disease process/labs/medications involved in the care of that patient, while he sees all of his other regular patients. I thought it was a pretty interesting teaching method at first, until I realized that I was spending 8 hours a day with my head in the books.......which is what I did all last year. Nonetheless, I am now a regular expert on aortic stenosis, nephrolithiasis, inborn errors of bilirubin metabolism (especially Gilbert's syndrome), chronic inflammatory demyelinating polyneuropathy and treatment-resistant heart failure. Then again, I've only seen about 6 patients in the last 2 days. Not exactly the clinical experience I was hoping for.

Tomorrow morning is business as usual, and in the afternoon, Dr. H is receiving training on using the electronic medical record system that will be initiated next week. I plan on sticking around and learning it at the same time, because quite honestly, my regular preceptor is (more than) a bit technologically-challenged, and things will go much smoother if we've both had some instruction.

This evening I finally got to meet up with the medical student from Seattle who is rotating up here. She's actually really nice and not as shy as she had seemed on the phone. I showed her around town a bit (ie: where the Walmart is) and then we went to dinner at a diner and shared stories of rotations and life in general. She is going to try and come with PA Debbie and I to the fair that is in town tomorrow night (there's a rodeo!!)

Things are looking up.

Jen

I see dead people.

Well a lot has happened since I last wrote...first of all, I did my few hours in the pathology lab on Friday, and accurately identified a basal cell carcinoma (non-invasive skin cancer). Then I went home, did laundry and packed up to leave apartment #2 and move into the sleeper room in the hospital for the week. I decided that I would probably have a panic attack if I stayed in Havre for another weekend so I made a reservation to stay in a hotel down in Great Falls (2 hours south) just to get out of town for a bit.

I quickly moved my stuff into the sleeper room on Saturday morning, then immediately left for Great Falls. Despite seeing skin cancer under a microscope just the day prior, my only plan for the weekend was to lay out by the pool of my hotel and get a tan. My hopes were dashed when I got there and realized it was an indoor pool. Being crafty, desperately white and shameless, I took my bikini'd self to the park across the street and proceeded to lay out there, even though there was nobody else at the park. A little weird, maybe, but it was worth it.

I wasn't sure what to do with myself that night, so I went to the place I always feel at home, Applebees. I sauntered up to the bar and ordered a drink and some food, and soon after a guy in his 30's sat down and did the same. I was dying for social contact at this point so I remarked on how I thought I'd be the only person alone at the bar on a Saturday night. He responded, "oh, I do this all the time." Odd. Finally had some conversation and learned he travels for business, which made much more sense. Not the most exciting feller, and I drank him under the table, but it was good to talk with someone under the age of 50 (something I don't often get in Havre). I took a brief walk along the Missouri River at sunset before heading back to the hotel:



I got up the next morning and after skimming the greasiest, most disgusting breakfast buffet in the history of mankind (I chose the grapefruit halves out of pure desperation), I left for "home," (Havre). When I got here, I just couldn't make myself go to the hospital yet, so I went to a local park to read. When I couldn't stand nature crawling all over me anymore, I got into my car and that was when I saw it: a voicemail.

It was the PA at the clinic (an under-30!) asking me what my plans were for dinner. I called her back and when she realized that I was staying in the hospital sleeper room for the week, she demanded that I go get all of my stuff and come over to her house, that I would be staying with her instead. Seriously? Yes, she was serious. Her husband is out of town until Friday anyway, and she could use the company (maybe a lie, but I chose to believe). A few hours later I was settling into my new guest bedroom and feeling elated at this turn of events.

We hung out and did grocery shopping, ate tacos and watched TV. She said she remembered what it was like to be a PA student on rotations, traveling all the time and being away from home. I could have kissed the ground she walked on for being so nice to me. Plus, she has a little Maltese dog that is just the cutest little thing ever. I love big dogs, but this thing snuggles and loves me already, so I'm quite happy to run around with it in my arms like some sort of Paris Hilton wannabe. (This is "Hunter"):



Today I followed another internist during rounds, because my preceptor is letting her 20 year-old niece shadow her this week for some school requirement (um...hello? Couldn't have possibly scheduled that some other time?). It was a little awkward because I felt very "passed around," but at least we were done quickly and he was pretty nice to me. After that I met up with my preceptor's husband, (the pathologist) to observe him doing an autopsy. He thought I was crazy for wanting to see it, but I couldn't pass up the opportunity.

Wow. I'm not easily grossed out, but wow. The smell is still stuck in my nose. I don't know how, but I managed not only to avoid passing out or throwing up, but I actually got in there and identified some anatomy and observed dissections of coronary arteries, etc. The plaque on the wall reading, "investigate the dead to save the living," became my silent mantra. I really may never forget that smell...a thousand times worse than the cadaver lab. I will never volunteer to observe another one. Big lesson learned, but still a good experience overall, I guess.

17 days left.

Radiologist for a day.

I learned so much today working with the radiologist...here is just a sampling:


1) There are 2 sesamoid bones under the distal end of the first metatarsal. Totally didn't know those existed.


2) There are lots and lots of very common "extra" bones in the foot. (the little one identified here by the black arrow is the os peroneum).



3) There is a very important difference between "haziness," "infiltrate" and "consolidation" on a chest x-ray, (it's a spectrum).

I'd call this consolidation:


4) A CT of the lungs with contrast looks a bit like a star-filled night sky:

5) And last, but most importantly...radiology is incredibly boring.

Communication Breakdown.

Today was a strange day...my preceptor had to leave by 11am to go to Great Falls, where she was going to catch a flight to Yakima, WA. So after doing rounds and seeing one patient in the clinic, I was done for the day.

After briefly introducing myself to the radiologist I will be shadowing tomorrow, I was off on my adventure for the day: going to Walmart (*shudder*) and "the mall." I put "the mall" in quotations because it isn't a mall, it is a small shopping center, with a Sears and a Claire's and not much else. Fortunately, it had "The Athlete's Foot," so I was finally able to buy the new running shoes my feet had been begging for (damn plantar fasciitis). My debit card wouldn't work though, and the salesman explained to me that some idiot had cut a huge fiber-optic line about 60 miles south of here, and knocked out power to 14 cell towers and internet lines over a huge part of northern Montana. I quickly pulled out my cell phone and was horrified to see that he was right: No Service. After paying with a check (I'd almost forgotten how to write one) I raced home and discovered my internet didn't work either. I was going to have to make this a communication-free day...

First I tried to tackle one of the four assignments I have to do for school while on this rotation. I got about a 1/2 of a page written and decided that I should really just accept my procrastinating ways and wait for the last week to get started. Then I laid down to read a book, but after 45 minutes I gave in and just took a nap. I swore it would only be for an hour.......

Two and a half hours later I got up. I am so bad at naps. Cell phone service was intermittent at best at this point, and without my phone actually ringing, I heard a beep informing me that I had a voicemail. The PA from the clinic was inviting me to the town square where there was going to be a BBQ and a band this evening. After about 4 attempts at calling each other without luck (cell service was still atrocious) I gave up and went to the gym. By the end of my workout, my phone was working a little bit better and I was able to get enough details from Debbie (the PA) to make my way downtown to the fun.

And it WAS fun...it was so nice to get out and hang out with people in a casual atmosphere, without worrying about being all professional and student-y. I wore jeans and flip flops and a shirt that shows my belly when my arms are raised. AH, FREEDOM!!! There were casual mentions of grabbing a beer sometime, and perhaps even filling in on a rookie golf league tomorrow with the PA. Two and a half weeks in Havre, and I am finally getting out...and thank goodness, I was beginning to forget what it feels like to be 24!

So, obviously, when I returned home, my internet was finally working and my phone seems to be with service more often than without. It was an interesting 9 hour experiment without any form of communication to the outside world, but I'm glad it's over. Then again, this means I have no more excuse not to update my patient logs...blech.

Jen

Just a quickie...

It's past my bedtime.

Today I observed a bone marrow biopsy. Yay for my preceptor's husband being a pathologist at the hospital (he is the one I observed)...gets me the total "in."

Today's outpatient work was less boring than usual, for some reason. Perhaps it was because there were no PAPs to do...a miracle, really.

I also met the new med student (who took my apt), today. She is actually pretty nice, around my age, and she looked so nervous on her first day. She is doing a 6 week family practice rotation with the doc who drilled me on MY first day (a tough guy, but good doc). I told her I'd leave her a note at her apartment with my phone number, and that we should go out to dinner or something. Hoping she will let me crash in the 2nd room of her apt. next week until another apartment opens up on the 18th, which I will be able to stay at until the end of my rotation. Mrs. Administrative-ruining-my-life mentioned that she talked to the student about it and she will more than likely be ok with having a roomie. Looks like I may avoid living in the hospital after all...(I feel slightly bad for all my bitching...).

Got invited to go out with the docs next weekend...the aforementioned husband of my preceptor is in the Navy reserves and got some fancy promotion, so we are all going to some small town near here called Chinook and going bar hopping to celebrate. Should be unbelievably interesting. I will be the youngest person there by at least 20 years. Mrs. Administrative-ruining-my-life is coming...perhaps we can patch things up over some drinks.

Quick note: CJ told me today that he joined our homeowner's association board of directors. How grown up is that? I'm so proud!

Tomorrow is a short day, and then on Thursday and Friday my preceptor is gone. One of the days I will be spending with the radiologist looking at CT scans, MRIs and x-rays that look like gobbly-gook to me (hence why I'm spending the day learning with him). The next day I will spend with the other Dr. Latkovich in the pathology lab, looking at more gobbly-gook I don't understand under the microscope.

This was supposed to be quick....on my way to bed.

Two days until there are only 3 weeks left!!!!!!!!!!!!

Jen

An exciting day! (with explanatory pictures)

So, I stayed up until 1:15am doing laundry last night, which ended up being a poor decision because my preceptor called me at 8:45am to say she was already on her way to the hospital. A quick shower and some cereal later, I too was on my way to Northern Montana Hospital.

The first stop was ICU, where we had 3 patients: a man in his sixties in atrial fibrillation with fluid in his lungs, an adult woman who needed her gallbladder out (but we had to stabilize her blood sugars first) and a woman in her 70's on a ventilator for pneumonia on top of emphysema. Two of these patients required a surgical consult, one for a thoracentesis (putting a big needle in the chest wall to draw out fluid from around the lungs) and one for a lap chole (laparoscopic gallbladder removal). Thus, I met the surgeon on call, a new doc to this hospital who is a general surgeon nearing the end of his career. I asked him if I could observe him when he did the thoracentesis and he said yes, to meet him in the ICU at 2pm.

So up to the medical floor we went to round on all of the internal med patients (ten of them!). Nothing quite as exciting as in the ICU, but we discharged 3 patients which is always nice. We finished up there around 1:45pm, so I quickly headed down to the ICU to observe the thoracentesis.

THORACENTESIS:

The surgeon was really cool, explaining to me why he was doing everything as he did it, and we ended up pulling out 750mL of yellowish looking fluid from the patient's chest cavity. It was very cool to see, and it was just bedside with the patient awake and everything (he had local anesthesia). The surgeon and I then went to radiology to look at the chest x-ray taken right after the procedure to see how much fluid was still in there, and to make sure we hadn't collapsed his lung on accident. All looked great, even though it seems we only got about 1/2 the fluid out (surgeon says that is par for the course). I thank him for allowing me to observe, and I happened to mention, "so, you have a chole today too?" (the gallbladder surgery). He casually says "yeah, do you want to watch that?"

The right answer to that question is ALWAYS yes, even if you have already been at the hospital for 6 hours and haven't eaten lunch. Luckily there was enough time to sneak off to the doctor's lounge and sneak a sandwich from the fridge.

I got all dressed up in the hospital-provided scrubs, put on the disposable booties over my shoes, a mask on my face and a cap over my hair. There weren't any mirrors in the dressing room, but I'm willing to bet I looked pretty sharp.

I didn't need to scrub in because I was just watching, so I took my place in the corner and watched the surgery on the two TV screens. About 15 minutes into it the anesthesiologist came over to me and I scooted back, assuming he needed to pass by me. Instead he grabbed my shoulder and told me not to be so scared. He asked me to spell the surgeon's name for him, so he could record it properly...then invited me to stand by him at the head of the surgical table so I could get a better view. In the world of medicine, it isn't often that someone will stick out their neck to help a student, so I was thrilled.

I watched the rest of the surgery from a fantastic viewpoint, feeling like I was with the "in" crowd. I quickly realized I'll need some more comfortable shoes while I'm on my surgical rotation, but other than that, I actually enjoyed surgery much more than I thought I would. I abdominal cavity is really much prettier than one might think.

CHOLECYSTECTOMY: (the cartoon version, as to not completely gross out the non-medical personnel reading this)


Anyway, so I finally got out of the hospital around 6pm, and just as I was writing this, my doc just called to say we have 2 more admissions. Before I could say anything she told me that I didn't have to come if I was tired...I told her that I had stayed for the surgery so, for once, I was going to pass on the admits and just stay home. She was perfectly happy with that and told me to go sleep.

Instead, I'm going to pack up all my belongings because tomorrow I switch apartments. I'll actually be moving into the apartment of the nurse anesthetist who was so nice to me today. He is a traveling nurse and his stint here in Havre is over tomorrow. Funny how things work out.

Jen

Havre picture-mentary, Pt 3.

The 3rd and final installment:

9) Some of the more affordable housing in Havre...


10) My apartment building...which used to be Havre's hospital way back when:



11) I like to think that this car parked in my apartment's parking lot is some sort of art piece on sustainability...


12) And finally....Happy 4th of July! (In small town Montana, EVERYONE puts out their flags)


Love,
Jen

Havre picture-mentary, Pt 2

My Havre picture project, continued...

5) The whole reason Havre exists, the BNSF railway...


6)...with a scary safety record:


7) The farmer's grain exchange...


8) The nicest building in town is, of course, a church - seen here in the distance.


Look for the 3rd installment, coming, well pretty much now.

Jen

Havre picture-mentary, Pt. 1

Today I followed through on my promise to post more pictures to document this little town, and here are the results:

1) Starting with the Havre Chamber of Commerce...



2) What is a dossar???



1) The girl scouts headquarters in a suspiciously addressed, crack house-looking building:

2) Something here doesn't make sense....


To be continued...

Dictate This.

Well, I tried to avoid it completely, but I eventually ended up having to do my first phone dictations today. Let me just say, the poor person who has to type out my ramblings full of "uhs" and "sorry, scratch that" is a saint, and I'm sorry. It is so hard to dictate! I wrote the first note out and just read it off my computer screen, but convinced myself that doing that was cheating, so instead I just read off the notes I had scribbled during the patient visit. The first note I did that way actually got cut off by the recording service - I think I took too long or something. The second note went a bit better - I chose a very simple appointment and think it might have turned out not as terribly (at least I hung up on the answering service, not the other way around). Thankfully these notes wont go into the actual chart - my preceptor will do a proper dictation. These are for my own practice so that when they get printed out I can show them to my doc and have her critique them.

My apartment is a disaster zone at the moment. I have dishes everywhere, socks on the kitchen floor and books and papers scattered all around. I'm not sure if I'm rebelling against having to move out by just refusing to clean up, or if this is a physical manifestation of my emotional state. It sounds deep...but mostly I'm just still writing about this to avoid having to clean. It's going to take forever.

Tomorrow my preceptor said we could come in late because we don't have to work at the clinic, but we still have to visit all the patients in the hospital. Unfortunately, her idea of "late" is 9am. So much for that big party I was going to throw (ha!).

As of today I have 4 weeks left (assuming my preceptor doesn't figure out that my last day is Aug 1, not July 31). I'm totally counting the days. I wish I could have a better attitude about it, but that really is just too much to ask at this point. I did get to have a good (quick) chat with the PA who works in my docs office though. She is young, just having graduated a year and a half ago, and I grilled her about whether or not she does on call, how much PAs are allowed to do in Montana, if her schedule gets filled daily and basically, if she gets respect as a PA. Her responses were pretty encourging - she acknowedges that internal med is a new spot for PAs and that it took her a bit to establish herself, but that now she has a full schedule most days without having to do call. It sounds exactly like what I want!! A nice 8-5 schedule that fulfills my career aspirations without sacrificing my home life. Good stuff...

I need to put more pictures here for those of you who aren't big on wordiness. Perhaps if I take lots of pictures of Havre, I can better convey my misery to you all by demonstrating the utter dismal-ness of this town. There goes my Suzy Sunshine attitude again...sorry!

I was thinking recently that there have been a few things I've learned about myself since being in Havre. #1) I'm really messy....I knew this, but it is now cemented and I'm ashamed. #2) I can cook better than I thought I could. #3) I can distract myself from completing necessary tasks unbelievably well. #4) I can survive on my own, but never want to have to.

Thanks for the phone calls and messages of support.

Jen

A bit put off...

I wrote a big long whiney blog entry, then realized it could really be summed up in just a few sentances:

1) I don't like internal medicine. There is minimal variety...and that doesn't fly with my attention span. I miss treating people under the age of 55.

2) I don't like having to defend my decision to become a PA rather than an MD, especially to the people that are supposedly trying to train me to become the best PA I can be. My preceptor is one thing: she is just passionate about having more female physicians in this world, and is a little overboard about it. But when the administrator (who has been making my life hell anyway) tells me that "PAs just aren't given much respect, you should really consider medical school instead," I wanted to scream. WHY THE HELL would I spend over 2 years and $100,000 to become a PA, just to turn around and go to med school?? That isn't even intelligent, which is generally the hallmark of a doctor anyway, right? It doesn't make sense.

3) I'm getting kicked out of this apartment on Monday morning, but can move into another apartment in the same building on Monday night....for a week...until I have to move out of that one, at which time I may or may not have another apartment to move into. Did I mention that the administrator is making my life hell?

4) Not all is terrible in my world.............there are some fantastic reality TV shows starting up soon. That has to count for something.

Jen

Happy Canada Day!

Well, it turns out I'll have to be out of this apartment by Monday, and move into the "sleeper room" at the hospital. On the plus side, I've decided I'm just going to store food in the refrigerator in the doctor's lounge in the hospital, so that I won't have to completely give up making food for myself. Its either that, or I eat at Taco John's and Dairy Queen every night for 4 weeks -- not my ideal. There isn't even an Olive Garden here....

Also great news: my preceptor seems to think that my last day here is Thursday, July 31st, instead of Friday, August 1st. I'm not going to correct her. Going home a day early is ok for me!!!

I'm on call tonight, and I know for a fact there are a couple of admissions coming in, so I'll be back to the hospital as soon as my phone rings. Until then, its time to Typhon (log all of the demographics and diagnoses of the patients I saw today....sooooo incredibly time-consuming).

Jen