I'm not a clotter

Today I had the day off because my preceptor had some board review thing he had to go to...so instead I slept in, then wandered into my own doctor's office to get some good news:
I do not have prothrombin gene deficiency G20210A.
You see, this is good news because both my mom, sister and maternal uncle have this genetic mutation that makes them susceptible to clots, and therefore more predisposed to deep vein thromboses (and as a result, pulmonary embolisms). My mom has already had a PE...which is how we found out this happy little mutation runs in our family. But, enough about that, because today I learned that I'm safe. Phew.
Moving on....

As a shout out to Curtis, I'm going to give yesterday's patients a "theme"...and it is:
"Grossest pelvic exams ever."
As you can imagine, that is all the detail I'm going to go into.

My preceptor was really helpful yesterday while we were at the family practice at Kaiser. He was totally not letting me get away with anything and was pushing me to be faster, but in a nice, "this is to help you" kind of way. It is helpful to have a bit of a fire under my ass because I felt like I had kind of stalled in my learning over the last few months. I mean, I know I'm still learning a ton, but I guess I'm getting frustrated about how much I still DON'T know! I don't feel like I am almost halfway though my rotations...but I am, and that scares the bejesus out of me.

Perhaps I need to be spending a little bit of time at home studying (I fell off that wagon during rotation 2).

Jen

Still Alive

Well, apparently I have a lot less free time than I used to during my surgical rotation because my number of blog posts has decreased significantly.

Today was all urgent care, and after a disaster of a day yesterday (nothing like going to do a pelvic exam and realizing that there is no lubricant on your mayo stand...I think the nurse set me up for failure), today was a bit of redemption.

I saw 6 patients in total:
1) 21 yr old women with severe abdominal pain that warranted a CT to rule out appendicitis...turned out to be constipation.
2) 10 year old boy who fell on his back off some playground equipment. Correctly diagnosed that it was probably just a thoracic spine contusion, but my preceptor wanted an x-ray to r/o a fracture, which I had been too hesitant to order (I thought he was being a bit dramatic, as kids will do). X-ray was normal though, so that was good.
3) 70 year old male with upper respiratory infection. Easy as pie.
4) 29 year old female with anxiety disorder complaining of bumps on her tongue. Turns out she is on Lamictal (for her bipolar disorder) and has been warned over and over about Stevens Johnson type reactions, and she had read too much stuff on the internet. She had a super duper mild glossitis (tongue irritation) that was due to a viral URI she was having. I reassured her like a pro. A+.
5) 16 year old male with recurrent strep throat...always a confidence builder when a little 10 dollar test gives you the diagnosis.
6) 33 year old female complaining of a lump on her lady parts. I had no idea what it was. Plus, I couldn't work the damn table. I failed that appointment, but didn't beat myself up over it, so that in itself is progress.

That is all for now. Things are generally going well, but I've lost a little bit of confidence because the HIV stuff is quite complicated and difficult, and I haven't made much progress in conducting patient appointments on my own. Family practice is awesome though, and I'm getting better at urgent care.

I'm getting excited about Coeur d'Alene as I have my housing all set up, and I'm going to be shopping for snow tires and winter wear soon! I'm looking forward to spending some time in a new setting and even though I'll miss CJ, I'm feeling pretty positive about it.

Then again...ask me the day before I have to leave.

Jen

Earning My Wings

I will keep this short...so short, in fact, that I'm going to use bullet-points:

• I really dig my new rotation. I spend 1/2 my time at the HIV clinic at the health dept. and 1/2 my time doing fam practice/urgent care at Kaiser. I really enjoy both, but actually think I enjoy the kaiser work the best---shocking, really.

• My new schedule requires an hour-plus commute which means I'm leaving the house at 6:40am and not getting home until 6 or 7pm. I'm f-ing exhausted.

• My preceptor threw me into a few appointments by myself the last few days and I apparently did ok, because he is giving me a lot more freedom lately. It is actually taking me a little while to get back into the routine of MEDICINE after suffering the intolerable stupidity that is surgery, but I'm getting there...

• Gay men are officially the best patients ever. This is a large portion of the patients I see at the HIV clinic and they are almost all so happy to let me practice on them, even when it involves poking and prodding in uncomfortable places. I could not be more grateful.

• My preceptor is pretty much fantastic. His co-workers are pretty darn fantastic too. I couldn't ask for more.

• Did I mention that I'm tired? I've taken up a daily coffee habit.......I held off for so long, but now must have my daily tall, 2 pump sugar-free vanilla, extra-room americano. If only I still worked at Starbucks.....

I love you all. I especially love keeping up with everyone's blogs, even if I don't always have the energy to write in my own. Keep on keepin' on!!

Jen

Ready to Rumble

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

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

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

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.