So when I woke up this morning it had just started snowing....and now it is 8:30pm and it still has not stopped. We had gotten 4" by the time I was trekking home for lunch, and given the fact that my drive was a little treacherous, I decided not to return to work for the afternoon (we only had two patients scheduled anyway: a "discuss back issues" (yawn) and "sinus infection" (double yawn)). I doubt my preceptor cared that I missed out.

I just went out and measured the snow and it was almost 9 inches deep. I haven't seen snow like this FOREVER! What kills me is that everyone here has trucks and snow tires so they are running around like it's no big deal. Meanwhile, I'm refusing to leave the house because I'm pretty sure all I would have to do was START my car and I'd get into an accident.

I took some pictures about an hour ago, so add another inch or so of snow to these pics and that is what it is now:



My car is buried.
I also wanted to post some pictures from the wine party we threw last weekend. It was a lot of fun with great food and some pretty awesome people. We ended up having more jello shots than wine, which was pretty fantastic. The girls and I dressed up....here is me in my T.J.Maxx find...
...and here is me 2 hours later when I decided it was waaaay too cold and I changed back into jeans:
The girl in purple on the L is Sabrina (roommate #2), and the girl in red on the R is Amanda (roommate #1 - the owner of the house).

It's still snowing...

Jen

SNOW

Well, the day I've feared since realizing I'd be in Coeur d'Alene, Idaho all winter long has finally arrived....It SNOWED!

Why fear snow, you ask? Well because I have never had to drive in more than 1" of snow, I own a Corolla and cannot afford snow tires....

Still, when the big fat flakes started falling today, I felt only mild trepidation...

Mostly, I felt the same childhood joy and excitement that I used to feel when we would get blizzards in Toronto (where I lived from age 5-10).

So...I took pictures:

Here is the view into our clinic parking lot from under the covered entranceway:
Here is the other side of the parking lot, facing Kootenai Medical Center's parking lot:

And the view from the front door of my temporary home (yes, I made it home in the snow):
Ok, so maybe it only added up to an inch or so, but it was REALLY snowing there for a while, and the forecast is for:
More snow (6-12 inches) tonight and tomorrow
Freezing temperatures (ie: negative numbers at night, single digits for the highs during the day) for Sunday - Thursday
Freezing rain in there somewhere....and more snow next week!

I better get my fill of fun in this week though, because in 7 days I'm driving my lovely, little green Corolla HOME!!!! (Until I come back to Coeur d'Alene on Jan 4th....)

Love,
Jen

Updates from the Field

Well, all has been well in my little world lately. I had the pleasure of going home to Seattle for the weekend to celebrate my best friend and my sister's birthdays. If Ambur ever gets around to sending me pictures of our night spent drunkenly scootering all over Mercer Island, I'll post a few on here. Otherwise, you'll just have to use your imagination. My sister's brunch celebration was notably more low-key, but just as enjoyable.

At work, things are going pretty smoothly. The schedule seems to have picked up a bit and I'm quite a bit more busy, especially when I'm writing 90-100% of the notes each day. The preceptor and I are getting along much better and even discuss politics now and then. He has made a few comments in the past week or two about the amount of workload I've taken on and my taking initiative...I appreciate the recognition more than he knows. In turn I've been asking him more questions and seeking out his advice more often, and I seem to be awakening the teacher in him a bit more. He's done a better job of explaining his decisions lately, and I appreciate that too.

I've also seen a few more interesting patients. Most excitingly, I got to see my first well-child check yesterday. It was on the sweet little 2 month old I saw last week for a URI. Turns out WCC's aren't nearly as daunting as I thought they might be. Still, I need to brush up on my milestones so I know what to look for more specifically. Also, today I got to see a sweet little 7 year-old girl for eczema. She had eaten some blueberries prior to her arrival, and they'd stained her face from the nose down. I praised her for making good food choices.

Yesterday I made a cop almost vomit after illiciting "intense" pain when I palpated the sciatic nerve tract down into the superior buttock region. Strangely, he'd never been diagnosed with sciatica...

Then there was the 30-something muscley manly-man who came in and was on the recieving end of a 5mm punch biopsy for a dermal cyst. Poor guy looked like he might faint just thinking about the procedure. Some sweat (on his part) and lidocaine later, he was quickly sutured up and sent on his merry way.

My favorite encounter of the last week or so, however, was a woman who was coming in with severe anxiety. She was mid-thirties without a history of depression or anxiety. Some situational life stressors, however, had left her with some pretty severe palpitations, racing thoughts and chest pressure. She was crying during the appointment, and mentioned a few times that her husband thought it was silly to use medications and that they were just a band-aid, but she couldn't handle it anymore so was coming in for some help. Just as the appointment was ending, the nurse announced that her husband was here....a surprise to both the patient and I. The patient asked me to stay and help explain her situation to the husband....

He was open and honest about his belief that medications were not necessary to control one's stress. Still, he listened to me as I explained her acute stress reaction, the physical toll it was taking on her, and how a short course of medications could help get her back on track without becoming a permanent crutch. Now, I really don't think a word of what I said made him change his mind or think differently....but his wife was SO thankful to have that conversation with some help from a medical (student) provider. I was a little overwhelmed and probably looked a little nervous, but I got through it and felt as though I may have actually helped (a little).

So, while the majority of the patients I see are still sinus infections and back pain, I am learning to enjoy the little quirks of family medicine. It isn't everything I hoped it would be, but that is just at this clinic. I still consider it to be one of my top three choices for practice specialty, along with dermatology and something else yet to be determined, (peds? cardiology? urgent care?). I'm still waiting on what my elective rotation will be....

Sending love out to my fellow PA students as we hit the halfway mark of clinical rotations,

Jen

Ok so I forgive you

The first thing my preceptor did when I walked in after lunch today was apologize. Apparently when I left the drug rep-sponsored lunch early to go home today and check my email, he thought I was leaving because he was involved in some anti-Obama talk with the drug reps (who are apparently acquaintances of his at this point). While the conversation was not my favorite, I have learned to keep my mouth shut about such matters, and that was not at all why I was leaving. I really appreciated his sensitivity in the matter, however, and he was very sincere in his apology. Bonus point for the preceptor.
This afternoon was a little bit more interesting than the morning. No cool procedures, but I got to do some good patient education (my favorite, I'm so hokey), and I kept pretty busy. I'm definitely learning to run an appointment faster and still managing to get my notes done, so I'm proud of that. Definitely need to be studying up on my medications more, and I need to learn to remember to not forget the details....is that possible?

On a completely unrelated matter, today I took a step class at the local gym. Now, I'm not a "step class" kind of girl. I'm much happier doing squats and bench presses and all the "boy" type stuff with weights and what-not. My cardiovascular fitness is lacking, however, and I know that in a class I am way too competitive to not keep up, so I got my little steppy thing and planted it down in the very front row. Unfortunately, I did not look around to notice that everyone else had only put one lifty thing (riser) on each side underneath their step. I...the genius that I am...had placed two on each side, creating a much higher step.

Everyone else:

Me:

Bad idea. Let me first say that the woman teaching the class was overweight AND six-months pregnant. She still managed to kick my ass for 50 minutes of hell. I left the room with jello legs and a cherry-red face. I would say "never again," but the sick and disgusting part was that it was the best cardio work-out I have had in years, so I'll probably go back...because I'm competitive like that.

PS - my class was NOT this cool (but I wish it had been):


The End.

Ups and Downs and global warming "theories"

Until today, I was having a fantastic week at work. There was the giant sebaceous cyst, the new-onset atrial fibrillation, some positive feedback from patients and I was actually staying busy enough to ignore my preceptor.

Then there was this morning (its only lunchtime now). I was so excited when the first appointment of the day was a mole removal....turns out it wasn't. It was an irritated, pigmented skin tag that the patient wanted a DERMATOLOGY referral for. I could have cut that thing off with a pair of kitchen scissors and my eyes closed!!! But no....no fun for the PA student.
Then there was the "lump on finger" that was a cyst of some sort. It was so small and ready to pop that I was able to drain it out of the needle hole I'd made to anesthetize the area (ps - the pt literally screamed and MOVED HER HAND when I was injecting her with a 30-gauge (tiny tiny tiny) needle). DO NOT MOVE YOUR HAND WHEN I'M STICKING NEEDLES IN IT! Are you five years old? Are you retarded? No, you're 61. I know you've had worse....
Then there was the "palpitations." Now, yesterday when I saw this same chief complaint it was a 91 year old lady with new onset A. Fib. Today, just a 31 year old male with a boring old run of PVC's that wasn't even happening anymore. Some patient education and a hand-out on "palpitations" later, he was gone.

BOOOOOOOOORING.

Then there is my preceptor.....
Chief complaint: sore throat. Doesn't look like strep. Strep screen is negative. What does he do? He prescribes an antibiotic. I believe this man may single-handedly be responsible for drug resistant organisms everywhere. It is unbearable to watch. Why does he do it? Because the patient came in for antibiotics and they won't be happy until they get them. Apparently this isn't medicine, it's customer service and the patient is always right.

Time to go back for some afternoon fun...will try to check my attitude at the door.

Jen

PS - today my preceptor was talking to a drug rep and called global warming a theory, which, were he a child of science at ALL he would know that
1) a "theory" is a hypothesis that is generally regarded as true, though cannot be proven
2) global warming is REAL

The Smell....

The first pt this afternoon was a "re-check cyst." This guy is in his 60's, in a wheelchair and has Parkinson's. But none of that is relevant.

He had a HUGE cystic mass on his chest wall, over the lower ribs, halfway between the sternum and mid-clavicular line. The mass was easily 6cm, firm, semi-moveable with surrounding erythema.

TIME TO INCISE AND DRAIN!!!

Luckily, my preceptor was quite happy to let me do the whole thing, without supervision. He knows I like derm stuff, and I get the feeling that he doesn't.

A little betadine and lidocaine later, I was stabbing the mass with my #11 blade. Then I squeezed...

EIGHT FEET. The sebum from this highly pressurized cyst flew 8 feet across the room, just as I had been warned time and time again that it could do. There was no stopping it. Even if my gauze had been properly placed, the exudate probably would have ripped through it like a comet through the atmosphere. It came out with the speed of a bullet train.

And oh god...the smell. I have a STRONG stomach, but this was up there with the smell from the autopsy I observed.

I spent 20 minutes squeezing an un-ending amount of just disgusting crap out of what turned out to be a golf-ball sized abscess in this man's chest wall. Easily 40-50 cc's...unbelievable. I then packed in 20cm of iodinated gauze, and even though it wasn't really enough, I had made the premature mistake of cutting the gauze prior to packing, so 20cm was all I was going to get.

After the pt left, the exam room had to be closed for 2 hours because of the smell. Seriously, every surface was wiped down and the garbage was taken out. The nurse who had to retrieve my instruments almost vomited just being in there for 20 seconds. My preceptor told me I got an A plus-plus-plus-plus on the procedure. I think he was just impressed I didn't blow chunks all over the pt and his wife.

IT WAS AWESOME!!!!

Jen

Where is rotation 8???

A month or two ago I discovered that my 8th rotation (my elective - dermatology) was no longer on my schedule...it was just blank. I received an email from the staff asking me what I would like my new elective to be ("and by the way," they asked, "why haven't you seen many pediatric cases?")

I responded that I STILL wanted dermatology, but seeing that I have seen almost no children on my rotations (I don't know why...you tell me!) that I would be ok with my elective being derm OR peds. How flexible is that?

Well, the response I got was "it will be difficult to get you either of those areas this late in the game."

WTF?

Either way, its now been well over a month since that email exchange and there is still no information for rotation 8.

I'm starting to get a little nervous.

PS - my family practice rotation is making me dumber. Is that normal?

Jen