My first toenail removal

My first toenail removal was amazingly easy. The patient had an infection under the nail and it was almost falling off by itself. I didn't really know the steps of the procedure but my attending walked me throug it and before I knew it I was shoving a hemostat under the nail and prying it up. After that all I had to do was pull and there it was. Thank goodness for my masterfull anesthesia skills, a good digital block is key to a good nail removal.

Never a Dull Moment!

So one day I was working at a walk-in clinic on a Friday afternoon and I had the following patient encounter:

Nurse: What are you here for today?
Patient: My back hurts.
Nurse: Where does your back hurt?
Patient: I dunno, up here (touching upper back) and down here (touching lower back)
Patient: Do you think the doctor will give me some pain medicine? Because if I can't get any pain medicine I don't know what I'm doing here, I should just leave.
Nurse: I really don't know what kind of medicine the doctor might give you, how long has your pain been there?
Patient: Well about 2 weeks, but this pain in my low back has been there for like 2 years!
****
Nurse (to doctor): Just to let you know the patient in room 5 is asking for pain medicines.
Doctor: Well, I'm not going to give narcotics, but I'll talk to them and check it out.
****
Doctor: Nice to meet you, what brings you to the clinic today?
Patient: I need some more treatment for my herpes.

So Many Stories, so little....

There are so many random, interesting, funny, sad, whatever stories I've meant to archive in this space, but obviously it has not been happening. I could make a whole list of excuses... to little time, interest, energy, motivation, etc. But the stories are still there floating around in my memory, they won't be 'fresh' when I finally write them, but that is probably just as well. So coming someday... I will continue the "my first" series, like my first delivery, circumcision, suturing, death, chest tube, toenail removal ext. and also the "The other day I saw or did ____" series for other stories. So hopefully my memory will hold out until I can get whatever it is I need to write them down!

Paying back my sleep debt

during the month of june all of the hospital employees must complete our 'net learning'. On-line power point presentations about compliance, code pinks, & stroke team activation, each with a quiz at the end. the carrot they dangle in front of us is 'no christmas bonus if you don't complete all the modules!'

residents have a special module called SAFER which stands for something about sleep.... blah ..blah... residency.

in addition to recomending the impractical if not impossible (ie-you should never drive yourself home post call!) the SAFER module teaches that a person needs 8 hrs sleep per night, and when he does not get those 8 hours he incurs a 'sleep dept' that must be paid back!

well my debtor has come for payback for all of my intern year. My second year started on July first, and for my first month I work 8-5, M-F, no call. You'd think I'd be loving life and partying and using all that extra time for fun stuff. I feel just as, if not more exhausted now than I did all year! So apparently the time has come to begin paying back my sleep debt. I really have no idea how much I owe, but I've been getting about 9-10 hrs / night, so I've started to slowly may a dent in the surely massive sleep dept of internship.

off to bed with me!

baby overdose

recently I completed the required 6 weeks of pediatrics at my hospital's residency program. Our pediatrics rotation should really be call Newborn Nursery because all we see are newborns, even during our pediatric clinic hours we see the same babies we sent home just days before with a few 2 year old check ups sprinkled in and on a very rare occasion a sick visit from a 6 year old. But the morning rounds before clinic is the real exciting part: doing the exact same exam, writing the exact same note, and giving the exact same instructions to a dozen babies and moms every morning.

Even though I was blessed to have vacation during my time on pediatrics it was still too much, too many babies, too many bili's, too monotonous. That's how you learn, or so they say, by repetition. I do have my ER warnings speel down in Spanish and English!

During my rotation I told myself that I would take time out from the monotony of the paperwork and Ballard's exams and actually sit in a rocking chair and enjoy feeding one of the babies ... but it never happened, oh well. The take home lesson from the rotation is that I am so happy that I will not be a "Newborn Nursery" doctor full time, is anyone? if so how can they stand it?

an important deadline

so my economic hardship deferment paperwork on my medical school student loans is due soon. Because the sum of my student loans could feed a small country for a year, and my current salary can feed only a small household for a year, I get to put off paying back my loans for another year or 2 (and allow even more interest to accrue!) Good thing I love what I'm doing!

What I've learned this year.

So in response to Angie's invite, here are a few of the wonderful things I've learned this year as a Family Practice Intern:

Ditto to Angie's list, and I've learned....

- sometimes you don't know the answer, and sometime your upperlevel and attending don't know either, and sometimes the answer is irrelevant anyways.

- communication is key (with other docs, nurses, patients, families, secretaries, RTs, etc.)

- when in doubt, ask for help.

- when in doubt, don't let the med student do it.

- discuss code status in terminal patients.

- sometimes stopping to eat is more important than patient care. (you can't care for other if you don't care for yourself right?)

- the importance of staying informed about every patient I'm involved with. (ie. it's best to know if the mom had a C-Section, vaginal delivery, normal baby, sick baby or stillbirth before entering her room)

- complaining does not change things and usually does not make you feel better either.

- while carrying five different pocket manuals around in the white coat pockets is a great security blanket, it will also give you significant neck and back pain... and do I really use them that often anyways?

- to value my vacation time and days off and use that time wisely.

- it's almost impossible to read your scriptures every day as an intern, and it IS impossible to go to church every week... but it's worth trying.

- medicine is truly a profession of life-long learning. Patients, procedures, diseases, and treatments change every day!!

My First Prescription

The first prescription I did not even write... it was for GoLytely. I was doing pre-op exams for patients getting colonoscopies. So everyone got a prescription for a gallon of the laxative that cleans out your entire colon so that we can stick a camera up and look for polyps! Guaranteed to have you sitting on the toilet for hours! So I stamped the prescription pad with the "GoLytely" stamp, placed a patient label on the top and just signed my name on the bottom line.

One of those days

So here is what I ate today:

6AM - out the door with a pre-packaged smoothie drink in my hand.

9AM - I manage to swing by the cafeteria and pick up a breakfast burrito, (the other food I picked up went into a near-by frige on telemetry, only to be forgoten until I got home).

1PM - I stuff my face with a package of gram crackers and mini package of penutbutter that were in my white coat pocket from the day before.

7PM and 8PM - I pop some tic-tacks, not very filling.

10:30 PM - finally I'm at home, and I enjoy some real food. I love my husband!!

A Good Quote

"The dedicated physician is constantly striving for a balance between personal, human values, scientific realities and the inevitabilities of God's will."
David Allman

On Medical Blogging

Here is an interesting article by NPR about privacy issues. (Morning Edition March 12, 2008). Found by surfing over to White Coat Rants, one of the 'pro' medical bloggers.

And the Countdown begins

The first several years of a career in medicine revolve around exams. If I added up all the money I've spent on exams alone I could probably buy a car. Add up the money spent on books to study for the exams and and I could get a bran new car! Add up the money spent on classes to study for the exams and that would buy a house or two!


Well, COMLEX 3 is behind me! Assuming I pass and assuming the great state of Texas will accept my petition and $$$, I will be getting my very own medical licence at some point in the future. But the fun doesn't stop their!! Now the countdown begins to my next exam for board certification in Family Practice, which will be at the end of residency in 2010!

Yet Another Exam...

So my future is partly resting on the third step of my licencing exams, which I will be taking tomorrow morning....

Their are three levels or steps of Medical Licencing Exams. The first is at the end of 2nd year of medical school, the second some time during 4th year, and the 3rd sometime during or after internship. As they say: you study 2 months for the first, 2 weeks for the second and 2 days for the third. I know that is meant to be a reflection on the accumulative nature of the knowledge... but I've realized it's more a reflection on the time and energy available for studying as one progresses through the stages of course work - clinicals - and internship.
In other words, the fact that I have not even studied for the recommended 2 full days is because I have not found (or made) the time!

I take solace in the fact that I've got 9 months of working at the county hospital under my belt. Also, being in Family Practice means I know a little bit about everything - or at least I'm supposed to! And their will be a lot of everything on my test I'm sure. Wish me luck!

It's okay, I really don't mind...

So the other day when I was on call I responded to a page from a nurse. I could tell from her voice that she was probably a couple of years older than me. She presented her patient and asked me her question. It was something easy like the patient needed pain medication, or something to help him sleep. I gave a telephone order for the medicine. She asked my name again and wrote it down. "Great, thank you Ms.Ross ... ur..um" "No problem" I responded and ended the conversation. I suppose if I were mean I could have gotten upset, but for a phone conversation (ie. not in front of a patient), it's not a big deal to me.

Now on the other hand, here is a setting where, for some reason, I DO mind! I received some mail from my alma mater soliciting contributions, and it was addressed to Ms.Ross!! Hello!?! I attended your institution to earn a degree, remember? and I graduated from YOUR medical school so now I'm Dr.Ross. Needless to say I will not be participating in the latest fundraising spectacular.

Continuity

I love 'continuity of care'. I guess that should be a given because I'm a Family Pracitce doc. As they say "My Family Doctor is a specialist in ME!"

As an intern, I only have minimal continuity in my "Continuity FP Clinic" because I only have about one half day of clinic per week! I've gotten a fair amount of continuity of care during my intern year mearly from doing all my roations in the same hospital! For example...

I saw a lady in the ER and I made her an appointment to see a specialist at the OB/GYN clinic - a month later I'm doing my OB/GYN rotation and she's at the clinic seing me.

Another lady I saw on my Surgery month got a referal to OB/GYN, here appointment took three months to set up- but there I was again, back on my 2nd month of OB/GYN and seing her again!

There have been patients I've admitted while on the medicine service and then I see them as a surgical consult.

I saw a pregnant lady in the OB clinic and then took care of her baby on my Pediatrics rotation.

I even have had continuity from when I was a medical student rotating at the same hospital! I've taken care of a particular patient with bipolar disorder twice, once in my 3rd year of medical school on the psychiatry service and then again as an intern.

I've seen a psychiatry consult at a later date in the Operating Room.

There are a small handfull of 'ER continuity patients' at my hospital: mostly homeless people who come in regularly trying to get food, shelter, or pain med: which they rarely get away with because the whole ER staf know them. (However the trick is to say you have Chest Pain or want to kill yourself, they we have to let them stay for at least a little while...)

Some hospital patients (the ones who are worth seeing again!) I've invited to my clinic and they've actually come :)

and my favorite one: I saw an extra patient in clinic that was not a patient of mine (a walk-in visit). The lady had her todler who was sick. The mom looked really familiar, but I could not place her. I asked how many children she had. "well, I just had twins a couple weeks ago" and after that we both had a light bulb go off- I took care of her on the post partum floor after she delivered!

It's a small county hospital after all.

And the Family Practice Intern is an Obstetrician, Surgeon, Internist, Psychiatrist, and Pediatrician all it one!!

I'm not alone

I've only recently joined the bloggin world... I knew that there are millions of blogs and bloggers out there- but I had no idea how many MEDICAL blogs there are. Just take a look at the list I've collected so far:

http://fatdoctor.org/

http://becoming-a-doctor.blogspot.com/

http://medstudentitis.blogspot.com/

http://aliendoc.blogspot.com/

http://northmed.blogspot.com/

http://lonecoyote11.blogspot.com/

http://thehappyhospitalist.blogspot.com/

http://www.angrydr.blogspot.com/

http://doctoranonymous.blogspot.com/

http://doctorrw.blogspot.com/

http://blogborygmi.blogspot.com/

http://codeblog.com/

http://www.placebojournal.com/

http://www.cut-to-cure.blogspot.com/

http://www.medlogs.com/

http://www.docnotes.net/

http://blogmd.samblackman.org/

http://plasticsurgery101.blogspot.com/

http://www.drdork.blogspot.com/

and for lack of time (which aparently the above blogers have an abundance of!), I will stop there....

An Easy Post

It's been a while since I've posted anything. I've got plenty to say... just haven't made the time to sit down and write!

So here is a forward I got today from a colleague (he stole it from another blog - the reference is noted). Pretty funny! and sad as well.

"Pulling Teeth"

Do you have any medical problems like heart disease, blood pressure problems, diabetes? No.
Anything you take medicine for on a daily basis? No.
Have you ever had any surgery? No.
Your chest x-ray shows that you have a pacemaker. Why do you have that? Because my doctor put it in.
When was that? When I was in the ICU about five years ago.
Why were you in the ICU? My heart stopped during an operation.
What operation was that? My gallbladder out.
How long were you in the ICU? About 3 weeks. It’s all in my records.
Which hospital? Oh, one of those in New York…I don’t really remember.
Do you have any family who might remember which hospital? My son. He’s dead.
Anybody else? I don’t know.
Do you smoke? No.
Did you ever smoke? Yes.
When did you quit? Yesterday.
How much did you smoke? Couple packs a day.
For how long? Oh, I don’t know. More than 50 years.
Why did you decide to quit? I don’t know. I may start again.
Would you like a nicotine patch while you are here? No. I’m not addicted or anything.

http://fatdoctor.org/2008/01/25/pulling-teeth/