my first viagra prescriptions (PG-13)

So a group of colgueges were discusing the fact that viagra (sildenafil) is used to treat not only erectile dysfuction, but also pulmonary hypertension. In order to avoid the stigma of taking viagra, the same medicine has a different name when it is prescribed for pulmonary hypertension. Someone wondered outloud if the latter is cheaper. He said that he had a lot of diabetic patients with ED that have trouble affording ED meds. I thought to myself - wow, I've never even written a prescription for viagra... and I have plenty of middle age and older diabetic males that I see in clinic. I never ask about it, perhaps I should ask more often, or perhaps my being a female makes my patients less likely to bring up the topic themselves.

Well... within one week of that conversation I wrote my first 3 prescriptions for viagra (without changing any of my history taking habits).

On gentelman, ironically was sitting on an exam table that had 'viagra' paper roll covering the table. This is very uncommon in my clinic, in fact that was the first and last time I've seen that. Usually it's the generic white exam paper roll, and on very rare occasions a pediatric print with animals or something. Now whether or not the advertisement prompted the request or whether it was already on his agenda is anyone's guess.

Another gentelman was preparing to marry a woman he described as 20 years his junior and "frisky", he actually asked me if he could have and unlimited supply of viagra. I also had the pleasure of teaching him proper sexual terms. When I asked if his problem was getting an erection, he asked 'is that when that stuff come out?' .. no sir, that's called ejaculation. 'oh so you talking about when the dick get hard' .. yes, that's called an erection. He thanked me for teaching him the right words.

My third encounter was in Spanish, and while I know a lot of words in Spanish and pride myself on being fairly fluent, erection is not in my Spanish vocab. So the ED discussion consisted of me talking about the pene duro or the hard penis. I was hoping the patient could enlighten me on how to say erection in Spanish, but he either didn't understand what I was asking him or did not know the word himself (errecion - should have guessed!). So perhaps pene duro was better understood anyway as had been the case with the 2nd man!

I haven't seen any of these gentelmen back since ... I guess they got what they wanted ;)

feeding the babies

so I keep telling myself when I'm on my newborn nursery rotation that 'when I finish my work' or 'when things slow down a little' that I'm going to sit in a rocking chair and just feed a baby - gosh dang it! It just looks so relaxing.

For the babies that are in the nursery the nurses and sometimes volunteers take that job, and I'm always stuck doing exam after exam, checking bilirubin and other labs, doing paperwork. And of course there is never a 'when I'm finished' or 'when things slow down' (or if there is I'm on call and that's when I'm sleeping!)

some of my collegues make time to feed babies because they want to. a couple even swing by the nursery when they aren't on that rotation, but they'er nearby and want to feed/hold a baby.

so perhaps I'm just not the type that feeds babies... I have yet to make time for it. Though I'm sure I'd make time for it if it were my own baby!

Seriously....

So the other day I had a patient who complained of headache. Here is how part of the conversation went (and might I mention that this is an adult patient):

Dr: Do you have any problems with your vision?

Pt: What's that?

Dr: When you see is it blurry or is it normal?

Pt: Oh, I don't know.

Dr: When you look at things, can you see them ok?

Pt: Yea, I can.

So either the education gap between me and this patient was large, or I really need to work on my communication skills...! I was having a hard time thinking of any other way to ask the question or be more clear. Really more a sad story than I funny one.

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!