Today is the first day of my new rotation...except it isn't, because today I'm doing computer and HIPPA training with the office manager lady, and only for a half-day. I won't even meet my actual preceptor today, but all of this is ok because I've been battling a migraine for the last 24 hours and didn't sleep well last night because of it. Tomorrow I will be on my game.
This rotation will be my community medicine rotation, but it will be a lot different than most of my classmates'. Instead of going to some super rural town, I'm going straight downtown Portland. My underserved population of patients will not be the farmers, ranchers and loggers of rural Oregon, they will be persons carrying the diagnosis of HIV or AIDS. They are the people who cannot afford to pay for the treatment they need themselves, and are relying on the free services the health department provides. Many will have mental illness, some may be homeless, and a fair number of them may be victims of drug addiction.
I feel like I'm going home.....
I spent over a year during college volunteering at the local health department doing street outreach, STD testing and helping to run a syringe-exchange program. Then, after college and before PA school, I was a home health aide at an assisted-living facility for persons with AIDS who could not adequately care for themselves due to mental illness and/or drug addiction.
I enjoy working with this population because they are a challenge, and because they are so used to everyone ignoring them, (or worse), that when someone actually takes an interest in their health and well-being, they are often extremely grateful....something we don't often get from our regular patients.
So....bring on rotation 4. I'm ready to rumble.
Jen
Monday, September 29, 2008
Ready to Rumble
Posted by Jen B. at 10:41 AM 0 comments
Friday, September 26, 2008
Last 2 days
Yesterday was vein procedure day, which means that even though there were only 4 patients, I was there from 7:30am - 6pm, and we were so tight on time that the office ordered pizza for us rather than letting us go to lunch.
Luckily, I had company in the office. There were two extra staff people: an older gentleman who was an ultrasound tech, and an OR tech named Bree who was my age. It was great - my doc and the US tech talked all day about old man stuff like fishing and grandkids, while the OR tech and I discussed the finer points of how we met our significant others.
We performed 3 radiofrequency ablations and 2 stab phlebectomies (one patient got both procedures). Each patient took about 2 hours, not including the time to set up and take down the whole sterile field, instruments, etc...etc...holy crap my feet hurt from all that standing! I think vein stuff is incredibly boring, so it was definitely a long day.
Today was fantastic. We had just one surgery this morning - a routine laparoscopic cholecystectomy. It took two hours and then that was it for the day - my preceptor is playing in a charity golf tournament this afternoon....so I'm done. I'm home, and I'm done. No more surgical rotation.
A little sad............wait, no. It isn't. I'm so not cut out for surgery, and I cannot WAIT to get back to my fluffy little world of primary care. I miss my people!!!
Jen
Posted by Jen B. at 10:30 AM 0 comments
Wednesday, September 24, 2008
I see the cords...
Today was easily the greatest day of my whole surgical rotation, (and yes, I realize I'm sounding mighty fickle lately).
First off, my first case wasn't until 11am...it felt so good to sleep in!!!
Today I was in the OR while the patient was being prepped, doing the usual stuff (introducing myself to the surgical staff, getting my gloves and gown ready, writing my name on the board, etc), when the anesthesiologist asked me if I wanted to intubate the patient.
Me: Uh...I've never done that before.
Anesthesiologist: Here's your chance...
Me: I'LL TAKE IT!
He was fantastic, showing me step by step how to do it and promising me that he wouldn't let me hurt the patient. Amazingly, I saw the cords and got the endotracheal tube in on the first try. WHAT A RUSH!!! I was on a high for the whole surgery, especially because the anesthesiologist called me a stud in front of my preceptor. WAHOO!
A video demonstrating intubation: http://www.youtube.com/watch?v=_gokd8ooMVw
Then, after flying through the first surgery, we moved on to the next hospital and the next patient for ANOTHER inguinal hernia repair. My preceptor super pimped me on the layers of fascia in the abdominal wall...except that finally after 5 1/2 weeks I've figured out what the hell he is talking about, so I got like 9/10 questions right. The grumpy scrub nurse was even impressed. She says to my preceptor, "we should keep this one, she's smart." My preceptor says nothing for like 10 seconds, then says to the nurse, "Now, how would you know that? You've only seen her on one case."
Oh, whatever. I don't even care anymore. I did damn well AND my closure of the incision was almost perfect. HA!
Then we returned to the office to see a possible peri-rectal abscess that could have required us to work in a last minute surgery....but it was just a thrombosed hemorrhoid that was already resolving - no treatment required!
Cha-ching -- done at 4:15pm!
Jen
Posted by Jen B. at 6:01 PM 0 comments
Tuesday, September 23, 2008
Grievances.
So, how quickly my attitude has again changed to being unable to find ANYTHING to like about my surgical rotation...
Today just got under my skin. First off, my preceptor is only practicing because he is old (71) and thinks he will just whither and die if he has to sit at home. That is fine and all, but he spends so much time socializing with his patients that we get WAY behind. I don't particularly care, but his office manager starts to freak out, and usually directs her stress at me, as if I can do anything to hurry him up....
...if that isn't bad enough, he makes personal phone calls between patients that last FOREVER. Today it was arguing with a lady from some publishing company about a book that he was dumb enough to order twice off a website (because he is technologically retarded). He was on the phone for like 25 minutes WHILE PATIENTS WERE WAITING.
Then we finally get out of the office at 12:30 and we have a surgery at 1:30pm. I rush my ass through a crappy hospital lunch to make sure I'm on time. When I get there I find out that the surgical case in the room ahead of us is not yet finished, so I had to wait in the staff lounge where all of the nurses give me the stink eye. Interestingly enough, my preceptor didn't show up until way later....he had been called and told that the OR was running late. Did he call me to pass on the message? Nope. He just let me wait around for an extra hour twiddling my thumbs.
Now the next part is my fault: after celebrating my improvement in sterile fields in yesterday's post, I made a few rookie mistakes today in the OR which prompted the overly-moody surgical RN to mutter under his breath something about "have you ever BEEN in an OR?" He actually didn't finish the sentence, but I definitely heard "have you ever BEEN," and it was pretty easy to fill in the rest.
In the actual surgery, Dr. Conservative was nice enough to sharply increase my responsibilities in my last week as a 1st assist by letting me pull out the trocars at the end of the surgery today. For those non-medical types, this is something my 2 year-old niece could do.
(ie: pull black thing with white handle out of belly. Good job).
3 more days.
Jen
PS - Did you know that being a Jehovah's Witness means you're in a cult? This gem of information is courtesy of my doc's office manager. Faaaantastic.
Posted by Jen B. at 7:08 PM 0 comments
Monday, September 22, 2008
Another Ending
Today is the first day of my last week of surgery. Of course I'm not sad, but I've also pushed myself to find some positives about the experience, and concentrate on what I have learned...and I have learned. It may not have been what I WANTED to learn about, but it is important nonetheless, and I will be a better PA for it.
Plus, I'm not such a retard in a sterile field anymore, which is a total plus.
I look forward to my next rotation because it is a lot of HIV/AIDS and infectious disease. I happen to think infections and viruses are some of the most interesting things in medicine. In fact, at this very moment, I'm watching a show on the Discovery channel about a new virus called Nipah virus that has jumped from bats to humans in Bangladesh.
Yeah, I'm a nerd....and I'm proud.
Jen
Posted by Jen B. at 10:23 PM 0 comments
Wednesday, September 17, 2008
Barf On Typhon.
Today my preceptor's only surgery was at a hospital that I am not allowed to accompany him to.
DARN.
Instead, I slept in until 9:30am and was completely lazy for about 4 hours.
For the last 1.5 hours I've been catching up on Typhon (the program in which we are required to log the demographics, diagnoses and treatment of EVERY patient we see - super time consuming). Add this to the 3+ hours I spent logging patients yesterday and I'm almost caught up.
Got good news about my next rotation. My preceptor works at a different clinic on Mondays and Wednesday afternoons....initially I was going to work with his colleague at the health dept. on these days, but she apparently decided she was too busy to take on a student. Since the other clinic my preceptor goes to is one of those big HMO deals, it was unlikely that I would be able to accompany him because they generally require tons of notice before they will allow a student through their doors. Thanks to the magic of the Pacific PA program clinical team, however, they are speeding up the process for me and I will be able to stay with my preceptor, rather than having my rotation go belly-up just 2 weeks before it began. WAHOO!!!!!
So now I will be doing 70% HIV care, and 30% mixed family practice/urgent care. Sounds fantastic to me --- I'm just glad his other practice wasn't surgery ;)
Jen
Posted by Jen B. at 2:16 PM 0 comments
Tuesday, September 16, 2008
Religious (In)Tolerance
I realize that I am an extremist when it comes to religion, (I am an athiest), but I am a QUIET extremist, and I am respectful of other people's religious views. I believe strongly in the separation of church and state, and so I keep my religious preferences to myself in most situations.
My preceptor is also an extremist (evangelical Christian) who is quite loud about his beliefs, and will try to convince anyone he meets to convert to his ideals.
I knew this about him before going into the rotation, so I thought I was prepared. I thought I might be annoyed by his preachiness, but that we could easily and successfully work together as student and preceptor, and everything would be ok.
First off: my preceptor does not know I am an athiest. He asks EVERYONE he works with about their religious views on the first day of the rotation...but since he asked where I was from first (Ireland), he assumed I was a Catholic and left it at that.
In the last 4 1/2 weeks, I have seen this man preach his gospel to unsuspecting patients who were purely there for his medical opinion (on numerous occasions). He has also alluded to believing that an athiest is the same as a satanist. This man is so conservative that he refuses to perform vasectomies and once told me that birth control was responsible for the fall of our civilization.
I absolutely could not disagree with him more. Still I have remained true to my belief that (unless you're a church worker), religion has no place in the workplace. Therefore, expressing my own opinion on such matters would be hypocritical.
Today almost broke me.
A patient with severe gallbladder disease was in to discuss the possibility of having her gallbladder removed surgically. This surgery has been delayed time and time again due to her severe pulmonary and cardiac disease (COPD, CHF) which would make anesthesia very risky, and death during surgery not unlikely. While discussing her situation, she stated that she was told by a nurse that she should live with her symptoms because she would likely die if she had the surgery.
My preceptor: "well we all die at some point...the real question here is are you ready to meet your maker? Have you read the good book and changed what you need to change in your life? That is the real question...have you accepted God?" Obviously uncomfortable, the patient attempted to redirect the conversation back to her medical condition, but my preceptor was not to be deterred. He did not stop his questioning until she stated that she would start to read the bible more often. He then quickly went back to the issue at hand and promised to call around to see if surgery would be amenable to her other providers.
I wanted to storm out of the room in protest of his unethical behavior, but that would be dramatic and awkward, so I didn't. I kept my mouth shut, and stared at the ground, hoping the patient would not assume that I supported this man's hijacking of the appointment for his own personal desire to preach the word of God.
I mean, honestly...the world would be up in arms if every time a patient referred to God (which they often do) I challenged their beliefs and told them that their God did not exist. So why the double standard?
I find it ironic that my dear friend Curtis, a proud Christian, felt the need to vent on his blog about the media's left wing dismissal of religion, while I was facing the same prejudice on the other side of the spectrum. For the record, Curtis is a fantastic friend of mine and CJ's, and we have such a great friendship because we base it on our similar beliefs (ie: PA's are awesome, MMA fighting is too...), rather than our differences (Christian vs. Athiest, Beaver vs. Duck).
For the record, I believe that what you think exists, does. I think that since my preceptor believes in God and Heaven, he will be invited through the pearly gates. I also believe that the Buddhist who believes in reincarnation will find themselves reborn again. What does that make me?? Great compost....and I'm ok with that!!!
Jen
Posted by Jen B. at 2:38 PM 0 comments
Wednesday, September 10, 2008
Reason #283084230987 why I won't go into surgery.
Today:
5:50am - up and at 'em!
6:40am - leave the house (late)...realize halfway to the hospital that I have forgotten my wallet and my gas tank is dangerously low.
7:40am - arrive at hospital #1, 10 mins late for a colonoscopy. Fortunately, my preceptor is always late so I got there right as he did.
8:40am - leave hospital #1, head to hospital #2 for two more colonoscopies.
10:30am - leave hospital #2, head to hospital #3
10:40am - borrow money for gas from resident...slightly regret my disdain for him.
11am - arrive at hospital #3 for the fourth colonoscopy of the day
11:40am - leave hospital #3, head back to hospital #1 to scrub in on a GI case that my preceptor is co-surgeon on.
(no lunch)
12:20pm - 6:40pm - in surgery (Nissen fundiplication, esophageal myotomy and pyloroplasty...all on the same patient, at the same time).
Six hours in surgery almost killed me. I did, however, get to hold the camera for the pyloroplasty, do a little bit of suction after the myotomy, and help close the incisions with some rockin' running sub-q stitches.
Actually my stitches were kind of crappy...I was exhausted.
Tomorrow - to hospital #4 for 3 colonoscopies in a row.
Jen
Posted by Jen B. at 8:24 PM 0 comments
Tuesday, September 9, 2008
This one's funny...
Setting the stage: My preceptor, the resident and I are seeing a woman who is complaining of varicose veins after her pregnancy. She has her 5 month old baby with her, and is holding him in her lap.
Preceptor: "well I'd really like to take pictures of these veins, because sometimes the insurance companies want to see that."
(I retrieve the camera and start turning it on).
Preceptor: "Ok, why don't you (patient) stand up, and you (resident) take the pictures and Jennifer will hold the baby...(looks at me)...it will be good practice for you!"
Oh man...I had to try sooooo hard not to laugh. Mind you, I wasn't all that insulted because A) he is so old he doesn't know that what he said was insulting and B) I much preferred holding the baby because he was cute as a button and varicose veins aren't really interesting to me.
Had my mid-rotation evaluation today, which consisted of no conversation between the preceptor and I about how I am doing. Instead he just drew a line down one of the columns and handed the sheet back to me. At least it was the "good" column.
Jen
Posted by Jen B. at 3:00 PM 0 comments
Wednesday, September 3, 2008
Shed-yule
Having a normal schedule in surgery is impossible. A look at this week....
Monday - no work (holiday)
Tuesday - 8:15am - 8:00pm (was supposed to be until 5pm, but we had to admit a pt).
Wednesday - 8:30am - 2:30pm
Thursday - nothing....yes, nothing. All of my preceptor's surgeries are at a hospital that I don't have privileges at, so I literally CAN'T go!
Friday - 7:30am - ?????
I'm very surprised to realize that this rotation is almost halfway over already...it flew by a lot faster than I thought it would.
I have already emailed my next preceptor and, of course, he hasn't responded....this seems to be the status quo.
The resident who is also training under my preceptor is only here for one more week after this one, and thankfully so, because he is starting to get under my skin. I can't quite put my finger on why I dislike him so much, but I think it has to do with a mix of his nerdiness, cockiness and habit of touching people on the shoulder awkwardly, like he had to practice humanism and compassion in school or something. Or maybe its because when there was an abscess to be drained yesterday, he got to do the incision because he is the resident, (even though I'm confident I would have done no worse.....)
Bitter?
Jen
Posted by Jen B. at 4:52 PM 0 comments