Well, I've definitely fallen off updating in the past few weeks...maybe even a month! But there was Thanksgiving, the last two weeks of a hectic rotation, a giant summative exam (which I passed!), packing up and coming home for the holidays, and preparing for the holidays and celebrating numerous birthdays at home this week, so I've been busy!
The last few weeks of neurosurgery were great, though. I really liked all the PAs that I worked with! And I did get to go into the OR and see two more surgeries - a cranioplasty (putting pieces of skull back in that had been taken out previously, in this case for a patient who had been in an accident and who had had skull pieces taken out so his brain could swell and not get too cramped against the skull, which can cause damage) and a lumbar decompression (basically taking out bone spurs and arthritic changes in the lower spine to alleviate pressure on nerves and therefore back/leg pain). I got to scrub in (finally!!) on that last surgery, and even retract/suction/do staples at the end. So that was cool! Other than that, it was more of the same type of inpatient care that I've already talked about a lot.
So, I'm on break for about two more weeks, then it's back to Pittsburgh for a rotation in internal medicine! Sounds like it will be lots of management of chronic conditions, so nothing too exciting or fast-paced at all, but I'm sure I will learn a lot. I hope so, anyway!
Hope everyone has a very happy holiday season! :)
Thursday, December 19, 2013
Monday, November 18, 2013
A better end to last week, followed by another crazy Monday
Last week ended really well - I was seeing my own patients and writing notes on them, and most people were easy post-ops who ended up going home. On Friday, I even got out over an hour early because everything was done! I can see how the job would be rewarding (and even fun) on those lighter days.
Mondays are another story. Traumas from the weekend are in, and weekend traumas are usually the worst traumas. Car accidents involving young drivers, falls down stairs caused by alcohol intoxication, drunken assaults...you get the idea. And, today we had another consult from the ER for a man who had been drinking and had seriously uncontrolled high blood pressure - a terrible combination. He hit his head on a shelf while drunk, and because his blood vessels in his brain were already stretched to the max from his hypertension, they ruptured and he had a huge bleed in his brain. We actually went down to the ER right when he came in to evaluate him, and we saw him get intubated and whisked away to the OR for an emergency shunt placement to redirect the extra spinal fluid and blood caused by the trauma and bleeding. He had a GCS (coma score) of only 9, where 15 is perfect and anything below 10 is basically not good. The worst part was that he was only middle-aged, and that we had to tell his wife and daughter (who was around the same age as me) what had happened and what was likely going to happen next. I don't know what his status was when I left, since he was likely still in the OR. I really, really hope he does well, even though I know deep down that he probably won't.
Another patient who probably won't do well is a teenage boy who was in a car accident over the weekend. He has some serious bleeding on the brain, too, and even after bilateral craniotomies his brain is very swollen. So...I'm not optimistic. But, he's young, so you never know!
Hopefully the rest of the week calms down like last week did!
Mondays are another story. Traumas from the weekend are in, and weekend traumas are usually the worst traumas. Car accidents involving young drivers, falls down stairs caused by alcohol intoxication, drunken assaults...you get the idea. And, today we had another consult from the ER for a man who had been drinking and had seriously uncontrolled high blood pressure - a terrible combination. He hit his head on a shelf while drunk, and because his blood vessels in his brain were already stretched to the max from his hypertension, they ruptured and he had a huge bleed in his brain. We actually went down to the ER right when he came in to evaluate him, and we saw him get intubated and whisked away to the OR for an emergency shunt placement to redirect the extra spinal fluid and blood caused by the trauma and bleeding. He had a GCS (coma score) of only 9, where 15 is perfect and anything below 10 is basically not good. The worst part was that he was only middle-aged, and that we had to tell his wife and daughter (who was around the same age as me) what had happened and what was likely going to happen next. I don't know what his status was when I left, since he was likely still in the OR. I really, really hope he does well, even though I know deep down that he probably won't.
Another patient who probably won't do well is a teenage boy who was in a car accident over the weekend. He has some serious bleeding on the brain, too, and even after bilateral craniotomies his brain is very swollen. So...I'm not optimistic. But, he's young, so you never know!
Hopefully the rest of the week calms down like last week did!
Monday, November 11, 2013
Don't drink and drive...
One patient learned a good lesson the (very) hard way today. She's in her early twenties, and was driving home from a night on the town with a BAC of around 0.24. She ended up going the wrong way on the highway and hit four cars. She broke her odontoid process (part of the second vertebra in the neck), her collarbone, her wrist, and her leg. She woke up (still intoxicated) in the ICU this morning in what I can only assume to be crazy amounts of pain, and she was put in a halo this afternoon. Halos are these huge contraptions that literally screw into the skull and attach to a vest to keep the neck extra stabilized while the fracture heals. In her case, the bone fragment was too displaced for surgery to fixate it, so the halo was the only/best option. You have to wear the halo for 8-12 weeks, and as you can imagine, showering, getting dressed, and going out in public are pretty difficult with one of these things on. Not to mention the permanent scars in your forehead! She's lucky to be alive, and I obviously don't condone her actions at all, but I still feel bad for her. Hopefully she learned her lesson.
Another interesting/horrifying patient today was one who was trapped in a burning building last night and had to jump out from the third floor to survive. He ended up with a completely shattered pelvis, an L5 compression fracture, and a ruptured bladder. I'm not even sure how they fix the bladder...or his pelvis, really, since from what I saw on the images, it was completely destroyed. But hopefully they can! We are only involved for his L5 compression fracture, which is definitely the least of his worries right now. They won't even surgically repair it until his pelvis is taken care of, because without an intact pelvis there's nothing to fuse the lower spine to.
So! That was my Monday. I also saw a bunch of other (less awful) inpatients and took out some drains. I've started seeing people on my own and writing their notes, which is nice because I feel like I'm helping the PAs a little bit. Overall, I think I don't love this rotation, even though I'm learning a lot from it and I think brains are cool. The cases are interesting, but also sad. We spend way more time in the ICU than I would have thought, and the ICU is probably the saddest place on Earth. It's full of people who, for the most part, were doing just fine, and then something happened to land them in the ICU. For older people, it's usually a fall. For younger people, it's a car accident or some other sort of trauma. Either way, the patients (in most cases) were doing totally fine before the accident, and then, due almost completely to chance, they end up in the ICU and their lives are changed forever.
Another interesting/horrifying patient today was one who was trapped in a burning building last night and had to jump out from the third floor to survive. He ended up with a completely shattered pelvis, an L5 compression fracture, and a ruptured bladder. I'm not even sure how they fix the bladder...or his pelvis, really, since from what I saw on the images, it was completely destroyed. But hopefully they can! We are only involved for his L5 compression fracture, which is definitely the least of his worries right now. They won't even surgically repair it until his pelvis is taken care of, because without an intact pelvis there's nothing to fuse the lower spine to.
So! That was my Monday. I also saw a bunch of other (less awful) inpatients and took out some drains. I've started seeing people on my own and writing their notes, which is nice because I feel like I'm helping the PAs a little bit. Overall, I think I don't love this rotation, even though I'm learning a lot from it and I think brains are cool. The cases are interesting, but also sad. We spend way more time in the ICU than I would have thought, and the ICU is probably the saddest place on Earth. It's full of people who, for the most part, were doing just fine, and then something happened to land them in the ICU. For older people, it's usually a fall. For younger people, it's a car accident or some other sort of trauma. Either way, the patients (in most cases) were doing totally fine before the accident, and then, due almost completely to chance, they end up in the ICU and their lives are changed forever.
Friday, November 8, 2013
Attitude adjustment
Okay, so my first day of neurosurgery wasn't stellar. But, as I suspected, it got much better during the rest of the week. Still not ideal, but better!
Being there for rounds in the early morning made a huge difference, since I could see each patient and know what they were there for, and therefore just be more informed when my preceptor and the other PA were talking about them later in the day.
So, a typical day starts with sitting with my preceptor and looking up all of our patients in the computer to see how they did overnight. This includes looking to see if we need to order any labs or do any procedures (like remove a drain) that day. Then, at about 8:00, we round on all the patients with the other PA and an attending from the neurosurgery department. We see all patients on the Neuro Trauma floor, then go see our patients in the Trauma/Burn unit, the ICU, and other medical floors in the hospital. After seeing all of them and deciding what else needs to be done for each (usually about 25-30 people total), the PAs sit down to write their notes on each while the attending goes to the OR to operate. Note-writing usually gets interrupted by questions that arise from other consulting departments, consults from the emergency department, or who knows what. As of right now, I haven't been writing many notes, since the PAs said they usually have students just shadow the first week, but they said that next week they'll put me to work!
After the notes get finished (or at least mostly finished), the PAs go down to their on-call room to "run the list" - meaning they tell each other about each patient, so they both know everything that's going on with all of the patients. Then we eat lunch, and after lunch we just finish notes and see any other consults that came up during the day. The earlier shift (which is what I've been doing this week) is over at 2:30pm, so I go home after that!
The PAs on this service are incredibly overworked right now. Normally, there are five of them, but two are on maternity leave and one left for a different job. Hopefully I'll be able to help them more next week and relieve some stress! I hate having to just stand by and not be able to do much to help them. But, they're both really nice and easy to talk to. It's refreshing to finally see a PA in action, and so encouraging to know that I'll be doing what they're doing in less than a year!
Being there for rounds in the early morning made a huge difference, since I could see each patient and know what they were there for, and therefore just be more informed when my preceptor and the other PA were talking about them later in the day.
So, a typical day starts with sitting with my preceptor and looking up all of our patients in the computer to see how they did overnight. This includes looking to see if we need to order any labs or do any procedures (like remove a drain) that day. Then, at about 8:00, we round on all the patients with the other PA and an attending from the neurosurgery department. We see all patients on the Neuro Trauma floor, then go see our patients in the Trauma/Burn unit, the ICU, and other medical floors in the hospital. After seeing all of them and deciding what else needs to be done for each (usually about 25-30 people total), the PAs sit down to write their notes on each while the attending goes to the OR to operate. Note-writing usually gets interrupted by questions that arise from other consulting departments, consults from the emergency department, or who knows what. As of right now, I haven't been writing many notes, since the PAs said they usually have students just shadow the first week, but they said that next week they'll put me to work!
After the notes get finished (or at least mostly finished), the PAs go down to their on-call room to "run the list" - meaning they tell each other about each patient, so they both know everything that's going on with all of the patients. Then we eat lunch, and after lunch we just finish notes and see any other consults that came up during the day. The earlier shift (which is what I've been doing this week) is over at 2:30pm, so I go home after that!
The PAs on this service are incredibly overworked right now. Normally, there are five of them, but two are on maternity leave and one left for a different job. Hopefully I'll be able to help them more next week and relieve some stress! I hate having to just stand by and not be able to do much to help them. But, they're both really nice and easy to talk to. It's refreshing to finally see a PA in action, and so encouraging to know that I'll be doing what they're doing in less than a year!
Monday, November 4, 2013
An underwhelming first day of neurosurgery
So, today wasn't very exciting. At all. This morning, I had orientation for about an hour and a half, and apparently that was during the most exciting time of my preceptor's day (pre-rounds and rounds). So, by the time I got up to the neuro trauma unit, my preceptor and the other PA were basically just doing documentation and putting in orders. Since I obviously hadn't actually seen any of the patients they were writing about, it was hard to learn much from watching, and I obviously couldn't help them by writing any notes myself. So, overall, today was definitely underwhelming. I saw exactly two patients for a grand total of....three minutes. My preceptor was basically just checking in to see how they were doing (both were post-op). Not too exciting.
I really, really hope being there in the morning on every other day makes it more interesting...we will see! And I'm definitely going to ask about getting in on some surgeries if nobody asks me about it by the end of the week! Doing inpatient things for the entire six weeks of this rotation that I thought was going to be a surgery rotation (I mean, it's a neurosurgery rotation!) would be frustrating and, while I would still probably learn a lot, not as fun.
I really, really hope being there in the morning on every other day makes it more interesting...we will see! And I'm definitely going to ask about getting in on some surgeries if nobody asks me about it by the end of the week! Doing inpatient things for the entire six weeks of this rotation that I thought was going to be a surgery rotation (I mean, it's a neurosurgery rotation!) would be frustrating and, while I would still probably learn a lot, not as fun.
Sunday, November 3, 2013
Getting ready for neurosurgery!
Well, my emergency medicine rotation is over, and tomorrow I start neurosurgery at another hospital in Pittsburgh. This is one of my elective rotations, and I'm so excited!! I've always loved brains and found them fascinating, so I'm really excited to get a sense of what working in something in that area would be like. From what I can tell so far, it's going to be a good rotation, though it doesn't sound like I will necessarily get to see a lot of surgeries, which is a little disappointing. But, my preceptor (who's a PA!) said that the surgeons are normally pretty good about letting students come in on cases, so hopefully I'll get to see at least a couple while I'm there. At least I'll get a lot of experience with patient care before and after surgeries!
My last two shifts in the ER were more or less uneventful, though I did see one patient come in with a heart attack and get rushed away quickly to the cath lab, and I found out later that she arrested and died right outside the lab. So that was sad, of course. I also saw a couple of other codes, but they all ended successfully (with a living patient). While I liked emergency medicine, I'm glad I'm done with that rotation. It was strange working with a different doctor/PA every day, and I'm so glad I'll just be with one person on this next rotation, and that I'll have a consistent, weekdays-only schedule. I'll post tomorrow with an update on my first day!
My last two shifts in the ER were more or less uneventful, though I did see one patient come in with a heart attack and get rushed away quickly to the cath lab, and I found out later that she arrested and died right outside the lab. So that was sad, of course. I also saw a couple of other codes, but they all ended successfully (with a living patient). While I liked emergency medicine, I'm glad I'm done with that rotation. It was strange working with a different doctor/PA every day, and I'm so glad I'll just be with one person on this next rotation, and that I'll have a consistent, weekdays-only schedule. I'll post tomorrow with an update on my first day!
Monday, October 28, 2013
An ER weekend
This weekend, I was in the ER from 7am-5pm on both Saturday and Sunday. Surprisingly, it wasn't too crazy! Maybe it would have been busier, or there would have been more traumas that came in, if I was there overnight. As it was, though, I still got to see and do a lot.
The most interesting case from this weekend was actually the first one I saw on Saturday. It was a girl who was the same age as me who had attempted suicide by cutting her arm in a few places with a kitchen knife. Needless to say, this was a pretty touchy situation, and she was just quiet and subdued the whole time she was there. When I was stitching her up, she hid under a blanket and refused to look at her arm. She got 17 stitches total over four cuts, and a referral to an inpatient facility since that's the policy at the hospital I'm at. I hope everything goes well for her.
Another interesting case was when one man collapsed in the parking lot and went into cardiac arrest right outside the ER door. He was quickly brought into a trauma bay and resuscitated with CPR and defibrillation. After he was stabilized and put on a ventilator, he was admitted to the hospital, and I don't know what happened to him after that. But, he was alive when he left the ER, and that fact alone is pretty incredible!
Other than those two cases, there was nothing else super interesting or eventful. The rest of the patients were, as usual, either adults with something quick and easy to fix or older people with so many chronic conditions and vague symptoms that they just got admitted to rule out anything crazy. The big scary things (heart attack, pulmonary embolism, stroke, aortic aneurysm) can present very differently in older people, so most people with a couple chronic conditions (basically everyone) gets the workup for all of those things.
I really like the ER! I'm pretty surprised that I like it as much as I do, because I was dreading this rotation initially. But, it's pretty much always busy, and there's always something interesting to think about. I'm actually wishing I had only two weeks in urgent care and three weeks in the actual ER, because it's so interesting and everyone at the hospital I'm at is pretty nice.
Anyway, that's it for today. Just two more shifts left - tomorrow 7am-5pm and Wednesday 12pm-10pm! Then I'm headed to Kansas for a four-day weekend with my amazing boyfriend before my next rotation starts! :)
The most interesting case from this weekend was actually the first one I saw on Saturday. It was a girl who was the same age as me who had attempted suicide by cutting her arm in a few places with a kitchen knife. Needless to say, this was a pretty touchy situation, and she was just quiet and subdued the whole time she was there. When I was stitching her up, she hid under a blanket and refused to look at her arm. She got 17 stitches total over four cuts, and a referral to an inpatient facility since that's the policy at the hospital I'm at. I hope everything goes well for her.
Another interesting case was when one man collapsed in the parking lot and went into cardiac arrest right outside the ER door. He was quickly brought into a trauma bay and resuscitated with CPR and defibrillation. After he was stabilized and put on a ventilator, he was admitted to the hospital, and I don't know what happened to him after that. But, he was alive when he left the ER, and that fact alone is pretty incredible!
Other than those two cases, there was nothing else super interesting or eventful. The rest of the patients were, as usual, either adults with something quick and easy to fix or older people with so many chronic conditions and vague symptoms that they just got admitted to rule out anything crazy. The big scary things (heart attack, pulmonary embolism, stroke, aortic aneurysm) can present very differently in older people, so most people with a couple chronic conditions (basically everyone) gets the workup for all of those things.
I really like the ER! I'm pretty surprised that I like it as much as I do, because I was dreading this rotation initially. But, it's pretty much always busy, and there's always something interesting to think about. I'm actually wishing I had only two weeks in urgent care and three weeks in the actual ER, because it's so interesting and everyone at the hospital I'm at is pretty nice.
Anyway, that's it for today. Just two more shifts left - tomorrow 7am-5pm and Wednesday 12pm-10pm! Then I'm headed to Kansas for a four-day weekend with my amazing boyfriend before my next rotation starts! :)
Thursday, October 24, 2013
First three shifts in the ER!
Sorry I didn't update sooner, like I promised! The first day felt long, and I had two night shifts right after that, and between being tired and having some assignments to do for school, I just didn't feel like posting. Plus, the ER was nowhere near as dramatic as I feared it was going to be!
On my first day, I was with a PA, which was really nice. It was actually the first time I'd worked with a PA or even seen one in action since shadowing in college. He was really nice, and let me do a lot! I would go see each patient first, then present to him, then he would go see them and we would decide together what would be best to do. Unlike working with doctors, he actually seemed to value any input I had in terms of what should be done for workup, which was nice. Of course, I still have a lot to learn, but at least he asked me what I thought! We didn't see anything too stressful - a couple people with chest pain that wasn't likely to be a heart attack or pulmonary embolism (MI and PE, respectively, for future reference), some dental abscesses (way more common than I would have thought), one guy with pneumonia, and a couple hypochondriacs. Like I said, nothing too thrilling. What was interesting was how crazy busy the ER was! That first day, I was there from 8am-6pm, and people were just running all over the place all the time. Not really in a stressful life-saving way, just a busy way. It runs like a well-oiled machine!
My second day, I was there for a night shift (5pm-3am) with a resident. This particular resident was a little socially awkward and kind of timid at signing up for patients, so we only saw about seven people over the course of the 10-hour shift. There was a lot of downtime, especially toward the end of the shift, which made it even harder to stay awake! Our patients weren't even very exciting - mostly hypochondriacs, with one very intoxicated guy thrown in. So that night wasn't very fun, and trying to find street parking within a half-mile of my apartment at 3:30am when it was over was the icing on the cake.
But! Last night I worked the 5pm-3am shift again, this time with a different resident, and had a completely different experience. This resident was really nice, and totally on top of signing up for patients, so we were busy pretty much the whole shift. He also signed up for a trauma patient, which was exciting! There was a car accident with a bunch of young college girls (they got rear-ended by a drunk driver and the car flipped), and they all ended up in the trauma bay. No serious injuries - the girl we worked on just had a big cut on her knee. So I got to clean that up and put in a couple stitches, which was good! All of the other girls were fine, too, just scared. Other than that, we saw a bunch of dental abscesses, a nurse who passed out on the job and turned out to be pregnant, some chest pain cases, and a guy with HIV and a productive cough, so most likely PCP pneumonia (common in immunocompromised patients). The time seemed to fly by, and it was a much more interesting night!
Now, I have two days off before going back in on both Saturday and Sunday from 7am-5pm. Hopefully the weekends are busy!
On my first day, I was with a PA, which was really nice. It was actually the first time I'd worked with a PA or even seen one in action since shadowing in college. He was really nice, and let me do a lot! I would go see each patient first, then present to him, then he would go see them and we would decide together what would be best to do. Unlike working with doctors, he actually seemed to value any input I had in terms of what should be done for workup, which was nice. Of course, I still have a lot to learn, but at least he asked me what I thought! We didn't see anything too stressful - a couple people with chest pain that wasn't likely to be a heart attack or pulmonary embolism (MI and PE, respectively, for future reference), some dental abscesses (way more common than I would have thought), one guy with pneumonia, and a couple hypochondriacs. Like I said, nothing too thrilling. What was interesting was how crazy busy the ER was! That first day, I was there from 8am-6pm, and people were just running all over the place all the time. Not really in a stressful life-saving way, just a busy way. It runs like a well-oiled machine!
My second day, I was there for a night shift (5pm-3am) with a resident. This particular resident was a little socially awkward and kind of timid at signing up for patients, so we only saw about seven people over the course of the 10-hour shift. There was a lot of downtime, especially toward the end of the shift, which made it even harder to stay awake! Our patients weren't even very exciting - mostly hypochondriacs, with one very intoxicated guy thrown in. So that night wasn't very fun, and trying to find street parking within a half-mile of my apartment at 3:30am when it was over was the icing on the cake.
But! Last night I worked the 5pm-3am shift again, this time with a different resident, and had a completely different experience. This resident was really nice, and totally on top of signing up for patients, so we were busy pretty much the whole shift. He also signed up for a trauma patient, which was exciting! There was a car accident with a bunch of young college girls (they got rear-ended by a drunk driver and the car flipped), and they all ended up in the trauma bay. No serious injuries - the girl we worked on just had a big cut on her knee. So I got to clean that up and put in a couple stitches, which was good! All of the other girls were fine, too, just scared. Other than that, we saw a bunch of dental abscesses, a nurse who passed out on the job and turned out to be pregnant, some chest pain cases, and a guy with HIV and a productive cough, so most likely PCP pneumonia (common in immunocompromised patients). The time seemed to fly by, and it was a much more interesting night!
Now, I have two days off before going back in on both Saturday and Sunday from 7am-5pm. Hopefully the weekends are busy!
Sunday, October 20, 2013
Time for the ER!
Well, I'm all done in urgent care, and after a refreshing weekend at home, it's time to start in the ER as the second part of my emergency medicine rotation! My first shift is 8am-6pm tomorrow, so that's pretty normal, but then I have some night ones (5pm-3am) that should be pretty interesting. I've always been a morning person, and my productivity and attention span definitely dwindles at night, so hopefully I'll be able to reset my internal clock for a few days!
My last couple of shifts in the urgent care were great! I got to see a couple interesting things, and still got to manage some more "typical" urgent care cases. I got to sew my first face - a woman had fallen in her bathroom that morning, and had a 1.5-inch laceration through her eyebrow that I got to stitch up! It turned out great, and she was very happy with my work, which is always nice.
Something else that was pretty satisfying was correctly diagnosing a couple of different skin rashes - a lot of them look the same, and most urgent care/ER/primary care docs who see rashes just try to throw a steroid cream at it and hope it goes away, because they can't tell what it is. But! I recognized two different rashes that I learned about in school, which was pretty awesome. It's definitely rewarding to realize that something you studied in school paid off!
Other than those cases, there wasn't too much excitement in the urgent care last week. I'll post an update tomorrow on how my first ER day goes - I'll be with a PA, and I've heard that they tend to see more urgent care-type cases (at least at this hospital), so it might be more of the same things I've already seen. The remainder of my shifts in the ER are with doctors, though, so I will definitely get to see some trauma and more life-threatening things. Part of me is excited for it, but I'm also definitely a little scared! I'm sure no one will let me do anything that matters too much, which is reassuring at least. I'll post an update tomorrow!
My last couple of shifts in the urgent care were great! I got to see a couple interesting things, and still got to manage some more "typical" urgent care cases. I got to sew my first face - a woman had fallen in her bathroom that morning, and had a 1.5-inch laceration through her eyebrow that I got to stitch up! It turned out great, and she was very happy with my work, which is always nice.
Something else that was pretty satisfying was correctly diagnosing a couple of different skin rashes - a lot of them look the same, and most urgent care/ER/primary care docs who see rashes just try to throw a steroid cream at it and hope it goes away, because they can't tell what it is. But! I recognized two different rashes that I learned about in school, which was pretty awesome. It's definitely rewarding to realize that something you studied in school paid off!
Other than those cases, there wasn't too much excitement in the urgent care last week. I'll post an update tomorrow on how my first ER day goes - I'll be with a PA, and I've heard that they tend to see more urgent care-type cases (at least at this hospital), so it might be more of the same things I've already seen. The remainder of my shifts in the ER are with doctors, though, so I will definitely get to see some trauma and more life-threatening things. Part of me is excited for it, but I'm also definitely a little scared! I'm sure no one will let me do anything that matters too much, which is reassuring at least. I'll post an update tomorrow!
Sunday, October 13, 2013
Lots of suturing, and a weekend shift!
Sorry it's been so long since the last update! Like everything else, even urgent care gets routine after a while. Plus, my schedule has been pretty sporadic, so there never feels like a good time to write a post.
This past week wasn't too exciting, really, but I did get to do a lot of suturing! On Monday, I got to sew up a woman's arm in four places after she got bit by a dog. Fun fact: dog bites are way less likely to get infected (3-5%) than cat bites (70%) and human bites (80%)! So even though your gut might tell you that sewing up a bite wound is wrong, it's most likely going to be fine if it was a dog that had all its shots. Anyway, that woman got 11 stitches. Right after she left, a man came in after getting sliced in the arm with a piece of sheet metal at work, and he got 8 stitches from me. My preceptor let me do everything - cleaning out the wound, numbing the area, sterilizing the area, and sewing it up! Both patients were also super nice, and easy to talk to, which is good because the whole thing probably took me 45 minutes for the woman and 30 for the man.
Other than that, I've seen a lot of foot/ankle/knee pain this week, so I'm getting pretty good at evaluating that, and remembering all the "special tests" for the knee to figure out which ligament is sprained. We also saw a lot of kids coming in with a "boxer's fracture" (a break in the 4th or 5th metacarpal bone - the hand bones below the pinky and ring fingers) from punching walls! I think we saw three in the same day.
There definitely seem to be themes on any given day - so far, there's been corneal abrasion day, diffuse knee pain with no prior injury (AKA attention-seeking...or a DVT) day, upper respiratory infection day, etc. I worked yesterday, and weekends are definitely much slower than weekdays, which surprised me. I thought people would be more likely to come in on the weekend because they wouldn't have work or other obligations, but apparently not! Over eight hours yesterday (10am-6pm), we only saw 10 people. For reference, on a regular 12-hour day during the week, we usually see 20-24. So, yesterday was pretty slow. Luckily, I have my own computer and bring books to study with, so I never feel like my time is wasted! Plus, everyone that works at the urgent care is nice and fun to hang out with.
I'm working again today from 10am-6pm, and then two more twelve-hour shifts on Tuesday and Thursday. It's not a bad life! Then, next week I start in the actual ER, and I still don't know my schedule for that. I've heard that most people use the ER as an urgent care, so it might not be very different than what I've already seen. I may get to see some major traumas or chest pain/stroke patients though, so it should definitely be a learning experience!
This past week wasn't too exciting, really, but I did get to do a lot of suturing! On Monday, I got to sew up a woman's arm in four places after she got bit by a dog. Fun fact: dog bites are way less likely to get infected (3-5%) than cat bites (70%) and human bites (80%)! So even though your gut might tell you that sewing up a bite wound is wrong, it's most likely going to be fine if it was a dog that had all its shots. Anyway, that woman got 11 stitches. Right after she left, a man came in after getting sliced in the arm with a piece of sheet metal at work, and he got 8 stitches from me. My preceptor let me do everything - cleaning out the wound, numbing the area, sterilizing the area, and sewing it up! Both patients were also super nice, and easy to talk to, which is good because the whole thing probably took me 45 minutes for the woman and 30 for the man.
Other than that, I've seen a lot of foot/ankle/knee pain this week, so I'm getting pretty good at evaluating that, and remembering all the "special tests" for the knee to figure out which ligament is sprained. We also saw a lot of kids coming in with a "boxer's fracture" (a break in the 4th or 5th metacarpal bone - the hand bones below the pinky and ring fingers) from punching walls! I think we saw three in the same day.
There definitely seem to be themes on any given day - so far, there's been corneal abrasion day, diffuse knee pain with no prior injury (AKA attention-seeking...or a DVT) day, upper respiratory infection day, etc. I worked yesterday, and weekends are definitely much slower than weekdays, which surprised me. I thought people would be more likely to come in on the weekend because they wouldn't have work or other obligations, but apparently not! Over eight hours yesterday (10am-6pm), we only saw 10 people. For reference, on a regular 12-hour day during the week, we usually see 20-24. So, yesterday was pretty slow. Luckily, I have my own computer and bring books to study with, so I never feel like my time is wasted! Plus, everyone that works at the urgent care is nice and fun to hang out with.
I'm working again today from 10am-6pm, and then two more twelve-hour shifts on Tuesday and Thursday. It's not a bad life! Then, next week I start in the actual ER, and I still don't know my schedule for that. I've heard that most people use the ER as an urgent care, so it might not be very different than what I've already seen. I may get to see some major traumas or chest pain/stroke patients though, so it should definitely be a learning experience!
Wednesday, October 2, 2013
Emergency Medicine is a crazy ride!
My emergency medicine rotation started this week, and it has been crazy! My schedule is a little sporadic - I have three or four 12-hour shifts each week. For the first three weeks of my rotation I'm at an Urgent Care center and all of my shifts are 10 a.m. to 10 p.m., and the last two weeks will be in the actual Emergency Department in a hospital in downtown Pittsburgh.
So, this week I've already worked two 12-hour shifts, and have today off, which I desperately needed. Twelve hours, plus the never-accounted-for extra time at the end of the day for finishing paperwork and getting those last patients out, plus a 25-30 minute commute, is much more taxing than my last rotation!
The Urgent Care center I'm at right now is really great for learning because there's only ever one doctor there, so I just work with the doctor. That means I get to see more or less all of the patients that come through, and it can be a lot! The last two days, I think we had about 20-24 patients per 12-hour shift. Since it's Urgent Care and not an ER, I haven't seen anything too stressful or life-threatening, though we did have to send some people with chest pain over to the actual ER for further evaluation. I have seen plenty of corneal abrasions, ankle sprains/fractures, finger fractures, finger lacerations, a few cases of vertigo, and some abdominal pain. The doctors that work there are good about letting students do things, so I've done a bunch of injections (just tetanus boosters for people with cuts or burns), some suturing, and some eye staining/examination for the people with corneal abrasions. I've always loved eyes, and I finally got to use the slit lamp - the machine used by eye doctors - and it was so cool!!
I have noticed that the doctors here are more brusque than the other doctors I've worked with, and I'm not sure if that's the nature of medicine in a city, or just the nature of the typical ER doctor. They're still nice, but way more fast-paced and serious. Also, a LOT more tests and procedures are ordered here than would have been ordered in a place like Kentucky. The doctor I was working with on Monday told me that patient satisfaction is really important, and a lot of patients don't really care if a test is necessary or not, but will feel better if more is done. So...for example, a younger guy came in on Monday with a cough and sore throat...that had only started about four hours before he came in. It wasn't anything out of the ordinary for him, and his physical exam was fine. In Kentucky, he would have been told that he had a cold and it would clear up in a few days, and to take over-the-counter decongestants and cough medicine if he wanted. In Pittsburgh.....he got a chest X-ray and an inhaler to take home, and a note to get out of work for the afternoon. Talk about the rising costs of healthcare!!
But, I love the nature of Urgent Care. Lots of procedures, and most things are pretty quick fixes that leave people happy! Also, it's not super stressful because, like I said before, nothing is life-threatening. I'll get to see that in a couple of weeks, and I'll be glad to have that experience too, but for now I am perfectly happy diagnosing fractures and giving tetanus shots. I also love driving back into Pittsburgh at night - the skyline is so beautiful, and the city feels alive! I'm definitely glad to be back here. :)
So, this week I've already worked two 12-hour shifts, and have today off, which I desperately needed. Twelve hours, plus the never-accounted-for extra time at the end of the day for finishing paperwork and getting those last patients out, plus a 25-30 minute commute, is much more taxing than my last rotation!
The Urgent Care center I'm at right now is really great for learning because there's only ever one doctor there, so I just work with the doctor. That means I get to see more or less all of the patients that come through, and it can be a lot! The last two days, I think we had about 20-24 patients per 12-hour shift. Since it's Urgent Care and not an ER, I haven't seen anything too stressful or life-threatening, though we did have to send some people with chest pain over to the actual ER for further evaluation. I have seen plenty of corneal abrasions, ankle sprains/fractures, finger fractures, finger lacerations, a few cases of vertigo, and some abdominal pain. The doctors that work there are good about letting students do things, so I've done a bunch of injections (just tetanus boosters for people with cuts or burns), some suturing, and some eye staining/examination for the people with corneal abrasions. I've always loved eyes, and I finally got to use the slit lamp - the machine used by eye doctors - and it was so cool!!
I have noticed that the doctors here are more brusque than the other doctors I've worked with, and I'm not sure if that's the nature of medicine in a city, or just the nature of the typical ER doctor. They're still nice, but way more fast-paced and serious. Also, a LOT more tests and procedures are ordered here than would have been ordered in a place like Kentucky. The doctor I was working with on Monday told me that patient satisfaction is really important, and a lot of patients don't really care if a test is necessary or not, but will feel better if more is done. So...for example, a younger guy came in on Monday with a cough and sore throat...that had only started about four hours before he came in. It wasn't anything out of the ordinary for him, and his physical exam was fine. In Kentucky, he would have been told that he had a cold and it would clear up in a few days, and to take over-the-counter decongestants and cough medicine if he wanted. In Pittsburgh.....he got a chest X-ray and an inhaler to take home, and a note to get out of work for the afternoon. Talk about the rising costs of healthcare!!
But, I love the nature of Urgent Care. Lots of procedures, and most things are pretty quick fixes that leave people happy! Also, it's not super stressful because, like I said before, nothing is life-threatening. I'll get to see that in a couple of weeks, and I'll be glad to have that experience too, but for now I am perfectly happy diagnosing fractures and giving tetanus shots. I also love driving back into Pittsburgh at night - the skyline is so beautiful, and the city feels alive! I'm definitely glad to be back here. :)
Thursday, September 26, 2013
All done in Kentucky!
Well, today was my last day of family practice in Kentucky! It was actually a pretty busy day in the clinic, so that was good. Also, everyone at the clinic got me a cake! They also said they were all going to miss having me around, so that was really nice to hear. I like the clinic and the people who work there a lot, and I really did have a great time here. I'm sad to leave, but also excited to get back to Pittsburgh and to start my ER rotation!
Today, there were a lot of procedures, but nothing particularly exciting. I did a bunch of trigger point injections into sore muscles, and also did two punch biopsies of moles on someone's neck and then sewed them up so they would make prettier scars. It was good that I got to practice both suturing and doing a pelvic exam and Pap smear (yesterday) recently, since I'm sure those are two things I'll be doing fairly frequently in the ER. Earlier this week was also busy, but there wasn't anything that was super exciting. I did some knee injections for a couple of people, and saw some rare(r) conditions like gout and shingles, but that was about it.
As of right now, my car is 90% packed, so all I have to do in the morning is put the last two bags in my car and I'm good to go! I'm planning to leave pretty early so I can beat afternoon Pittsburgh traffic through the tunnel and into the city. It should be a beautiful drive, and there will be nice weather, so that's exciting!
Today, there were a lot of procedures, but nothing particularly exciting. I did a bunch of trigger point injections into sore muscles, and also did two punch biopsies of moles on someone's neck and then sewed them up so they would make prettier scars. It was good that I got to practice both suturing and doing a pelvic exam and Pap smear (yesterday) recently, since I'm sure those are two things I'll be doing fairly frequently in the ER. Earlier this week was also busy, but there wasn't anything that was super exciting. I did some knee injections for a couple of people, and saw some rare(r) conditions like gout and shingles, but that was about it.
As of right now, my car is 90% packed, so all I have to do in the morning is put the last two bags in my car and I'm good to go! I'm planning to leave pretty early so I can beat afternoon Pittsburgh traffic through the tunnel and into the city. It should be a beautiful drive, and there will be nice weather, so that's exciting!
Sunday, September 22, 2013
Getting ready to start my last week down south!
Not too much has been happening at the clinic, but I figured I should at least post something since I haven't in about a week! This past week was really fairly slow, and I think I was only actually at the clinic for about 28 hours total. Tuesday and Thursday were long 12-hour days, Monday was a half-day, and I didn't have to go in on Wednesday or Friday! Not bad...I could get used to the primary care lifestyle. :)
Last week was mostly regular check-up visits - there weren't even that many procedures. I did some trigger point injections into sore back/neck muscles for a few people, and cut off a skin tag or two, but that's about it. There was one pretty remarkable patient that came in on Thursday, though: she hadn't been to a doctor in about four years, except for one brief visit to our clinic back in March where she got some labs drawn but nothing else. She was complaining of fatigue, headaches, significant weight gain despite good diet and exercise, constipation, being cold all the time, trouble with her memory, hair being dry and falling out, irregular periods... pretty much all of the textbook symptoms of hypothyroidism. Turns out, she had been diagnosed with Hashimoto's thyroiditis when her son was born...11 years ago...and was never on medication for it. In Hashimoto's thyroiditis, the thyroid gets all inflamed and secretes too much thyroid hormone for a short time, but then the thyroid gets burnt out and can't produce enough thyroid hormone for normal function anymore - hence the resulting hypothyroidism like this patient was experiencing. Hypothyroidism is both miserable and potentially deadly for the patient, so it was good that this patient came in! The way you officially diagnose hypothyroidism is by checking a thyroid-stimulating hormone (TSH) level - if it's high, that means that the thyroid isn't producing enough thyroid hormone, so the brain is "stimulating" it to make more because it thinks the body needs it. Normal levels are typically between 0.5 and 4.5 mIU/L, depending on the laboratory and the guidelines you use. Turns out, her TSH level had been checked when she was in the clinic in March, and it was...are you ready? 29.4!!! This is absolutely unheard of, and it's amazing that she was still functioning at all with levels that high.
Anyway, that was pretty much the only excitement at the clinic last week. This coming week will probably be more of the same. My last day is Thursday, and I head back up to Pittsburgh on Friday morning! I'm excited to be back in Pittsburgh with some of my friends from school, and to see what medicine is like in a city environment. My next rotation is part ER, part urgent care...so the entire experience will be basically the complete opposite of what I've been enjoying in Kentucky! I'm looking forward to it, though, and I think it will be a good experience.
Last week was mostly regular check-up visits - there weren't even that many procedures. I did some trigger point injections into sore back/neck muscles for a few people, and cut off a skin tag or two, but that's about it. There was one pretty remarkable patient that came in on Thursday, though: she hadn't been to a doctor in about four years, except for one brief visit to our clinic back in March where she got some labs drawn but nothing else. She was complaining of fatigue, headaches, significant weight gain despite good diet and exercise, constipation, being cold all the time, trouble with her memory, hair being dry and falling out, irregular periods... pretty much all of the textbook symptoms of hypothyroidism. Turns out, she had been diagnosed with Hashimoto's thyroiditis when her son was born...11 years ago...and was never on medication for it. In Hashimoto's thyroiditis, the thyroid gets all inflamed and secretes too much thyroid hormone for a short time, but then the thyroid gets burnt out and can't produce enough thyroid hormone for normal function anymore - hence the resulting hypothyroidism like this patient was experiencing. Hypothyroidism is both miserable and potentially deadly for the patient, so it was good that this patient came in! The way you officially diagnose hypothyroidism is by checking a thyroid-stimulating hormone (TSH) level - if it's high, that means that the thyroid isn't producing enough thyroid hormone, so the brain is "stimulating" it to make more because it thinks the body needs it. Normal levels are typically between 0.5 and 4.5 mIU/L, depending on the laboratory and the guidelines you use. Turns out, her TSH level had been checked when she was in the clinic in March, and it was...are you ready? 29.4!!! This is absolutely unheard of, and it's amazing that she was still functioning at all with levels that high.
Anyway, that was pretty much the only excitement at the clinic last week. This coming week will probably be more of the same. My last day is Thursday, and I head back up to Pittsburgh on Friday morning! I'm excited to be back in Pittsburgh with some of my friends from school, and to see what medicine is like in a city environment. My next rotation is part ER, part urgent care...so the entire experience will be basically the complete opposite of what I've been enjoying in Kentucky! I'm looking forward to it, though, and I think it will be a good experience.
Friday, September 13, 2013
Procedures galore!
Well, life at the clinic hasn't been too thrilling in the past week, but I thought I'd write a short update anyway! As I've said before, most of my day consists of doing the history and physical on people who are just coming in for their three-month checkups for the holy trinity of primary care (at least in the southeastern U.S.): high blood pressure, high cholesterol, and type II diabetes. Most people are really nice, and I end up spending about 30% of the time I'm in the room just talking to them about non-medical things. And, occasionally, we do cool procedures!
Something that was a slight frustration this week was the number of pain medication-seeking patients we saw yesterday. My preceptor said that, for some reason, there seem to be days when everyone is coming in with "back pain...just everywhere, I don't know what caused it" and seems to know exactly what kind of pain medication they "need" and in what precise dose. I'm pretty gullible, and I always want to believe the patient, but even I know that those are red flags for abuse. My feelings about these patients are pretty complicated... I usually talk to them and sympathize with them, then let my preceptor tell them she's not going to give them anything stronger than Tylenol (unless, of course, she thinks they have legitimate pain). I just hope that I don't get too jaded, like a lot of practitioners, and write people off without listening to them.
Anyway, I got to see and do some pretty cool procedures this week! Earlier in the week, we had a patient come in with an injury he got at work (in an auto body shop) - apparently, something exploded and he had all these shards of steel embedded in his hands and arms. He had already removed a piece from his forehead and another one from his forearm at home (!!), but there was a persistent one right above a tendon in his hand that he wanted a doctor to take out. He knew it was there because he held a magnet over his hand and could see the skin tenting a little bit over the knuckle. So, my preceptor dug these tiny, tiny shards out of the man's hand, bandaged him up, and then he went right back to work. People in Kentucky are tough, and they work hard!
Another cool, but unexpectedly gross, procedure this week was taking off a man's ingrown toenail. Apparently, he had dropped some wood on it when he was splitting the wood in his backyard a few months ago, and the nail had broken off about halfway down and had grown back all ingrown and painful. I had never seen a toenail removal before and didn't really know what was involved, but I was feeling tough - I did, after all, just finish my surgery rotation! But I wasn't really prepared for this... my preceptor started by numbing the entire toe from the base, so the numbing medicine would get in the nerve and numb underneath the nail bed. Even watching her force 10 mL of lidocaine into a toe was painful, because there's not a lot of extra fat or room in people's toes, so it looked really swollen and even more painful before the toenail even came off. She also had the patient soak his foot so the nail was nice and soft ... then, she cut down the one side of the nail, and used a pair of hemostats (fancy surgery clamps) to grab the edge of the toenail, then rolled the clamps across his toe to pull the nail off. Gross!! And very bloody! Luckily, the patient was numb and didn't feel a thing.
Finally, on Tuesday I got to do an entire incision and drainage of an infected sebaceous cyst all by myself! My preceptor asked me if I had ever done one before, and I told her I had done a couple at my last rotation. We were really busy at the clinic, so she just showed me where all the supplies were and then told me to go do it. At first I was really nervous, but the procedure isn't actually that hard - just numb all around the area by injecting lidocaine, then slice into the infected area, push all the infected yucky stuff out, then pack the wound and dress it. Kinda gross, but it's really satisfying to drain all of that nasty stuff out and know that the patient is going to feel so much better when it's over. Anyway, I did it, and called my preceptor in to check my work before I dressed the wound and let the patient leave, and she said I did a really good job! There was another one today, and she let me do that one too since I did such a good job earlier in the week.
I'm looking forward to this weekend to relax - for some reason, this week seemed really long, even though it wasn't. I'm taking my general exam for the end of the rotation tomorrow, and then hopefully exploring another nearby state park and just getting some assignments done for school! It should be a nice, relaxing weekend!
Something that was a slight frustration this week was the number of pain medication-seeking patients we saw yesterday. My preceptor said that, for some reason, there seem to be days when everyone is coming in with "back pain...just everywhere, I don't know what caused it" and seems to know exactly what kind of pain medication they "need" and in what precise dose. I'm pretty gullible, and I always want to believe the patient, but even I know that those are red flags for abuse. My feelings about these patients are pretty complicated... I usually talk to them and sympathize with them, then let my preceptor tell them she's not going to give them anything stronger than Tylenol (unless, of course, she thinks they have legitimate pain). I just hope that I don't get too jaded, like a lot of practitioners, and write people off without listening to them.
Anyway, I got to see and do some pretty cool procedures this week! Earlier in the week, we had a patient come in with an injury he got at work (in an auto body shop) - apparently, something exploded and he had all these shards of steel embedded in his hands and arms. He had already removed a piece from his forehead and another one from his forearm at home (!!), but there was a persistent one right above a tendon in his hand that he wanted a doctor to take out. He knew it was there because he held a magnet over his hand and could see the skin tenting a little bit over the knuckle. So, my preceptor dug these tiny, tiny shards out of the man's hand, bandaged him up, and then he went right back to work. People in Kentucky are tough, and they work hard!
Another cool, but unexpectedly gross, procedure this week was taking off a man's ingrown toenail. Apparently, he had dropped some wood on it when he was splitting the wood in his backyard a few months ago, and the nail had broken off about halfway down and had grown back all ingrown and painful. I had never seen a toenail removal before and didn't really know what was involved, but I was feeling tough - I did, after all, just finish my surgery rotation! But I wasn't really prepared for this... my preceptor started by numbing the entire toe from the base, so the numbing medicine would get in the nerve and numb underneath the nail bed. Even watching her force 10 mL of lidocaine into a toe was painful, because there's not a lot of extra fat or room in people's toes, so it looked really swollen and even more painful before the toenail even came off. She also had the patient soak his foot so the nail was nice and soft ... then, she cut down the one side of the nail, and used a pair of hemostats (fancy surgery clamps) to grab the edge of the toenail, then rolled the clamps across his toe to pull the nail off. Gross!! And very bloody! Luckily, the patient was numb and didn't feel a thing.
Finally, on Tuesday I got to do an entire incision and drainage of an infected sebaceous cyst all by myself! My preceptor asked me if I had ever done one before, and I told her I had done a couple at my last rotation. We were really busy at the clinic, so she just showed me where all the supplies were and then told me to go do it. At first I was really nervous, but the procedure isn't actually that hard - just numb all around the area by injecting lidocaine, then slice into the infected area, push all the infected yucky stuff out, then pack the wound and dress it. Kinda gross, but it's really satisfying to drain all of that nasty stuff out and know that the patient is going to feel so much better when it's over. Anyway, I did it, and called my preceptor in to check my work before I dressed the wound and let the patient leave, and she said I did a really good job! There was another one today, and she let me do that one too since I did such a good job earlier in the week.
I'm looking forward to this weekend to relax - for some reason, this week seemed really long, even though it wasn't. I'm taking my general exam for the end of the rotation tomorrow, and then hopefully exploring another nearby state park and just getting some assignments done for school! It should be a nice, relaxing weekend!
Wednesday, September 4, 2013
"What's a carb?"
The past week or so has been pretty busy, which is why I haven't written anything in a while! Actually, I guess I haven't written since the first day of this rotation....sorry! Even though I'm in family practice, the hours are fairly long and I just get tired by the time I get home and do everything I need to do for school. Most visits are pretty routine--three-month checkups for chronic conditions and medication refills. Something I have been enjoying is getting to talk to the patients. My preceptor always sends me in first to get a feel for how the patient is doing, and if they have any other issues besides their chronic conditions and needing more pills. All of the patients here have been really friendly, and seem to enjoy talking to me. I think a big part of this might be that I go in there without a computer in front of me, so I'm actually looking at the patient and really listening to them. My preceptor, and other providers at the clinic, are always staring at their computers and just going through the checklists. While this has its benefits, like standardizing documentation and making sure every pertinent question is asked, I can tell that it definitely makes patients feel alienated and ignored. So, I think they appreciate someone taking the time to sit at their level, without a computer, and finding out how they're feeling.
One thing I don't like so much is that practically every patient will look a little confused when I start talking, and eventually they ask me where I'm from. My lack of a Southern drawl is pretty obvious in this town, and people always ask where I'm from, what I'm doing here, and if I think they're a hillbilly. I've had people tell me I must be rich because of my accent and the fact that I'm from "up North", and that my accent sounds "proper" so I must think everyone in the town is an idiot. This is all, of course, about as far from the truth as you can get. The people in this town have hard lives, and I have an incredible amount of respect for them. I don't like that people assume that just because I talk differently, I've already judged them and think less of them. But! I still really like it here, but it's definitely interesting to experience life as a very obvious outsider.
Last Friday, there was a festival downtown to commemorate the anniversary of the founding of the town. We went down for the morning and set up a table to check people's hemoglobin A1C levels (basically an average blood sugar level over the past three months) for free, so they could know if their diabetes was controlled, or find out if they had diabetes in the first place. At least 80% of people that we see in the clinic are diabetic, and it's really sad because a lot of them don't control it and have pretty bad end-organ damage, meaning that they're going blind, entering kidney failure, or losing sensation in their feet. What I didn't know was that most people really just do not know what diabetes is, how to prevent it in the first place, and how to control it...and they really do want the information, but have never gotten it. When we were at this table, there were so many people who came up and wanted us to tell them all about diabetes, how to control it, what to eat, how to cook healthy meals, etc. It was kind of nice to see people who were actively interested in their health and be able to help them out! And yes, people really did ask us, "What's a carb?" I guess I just took it for granted that I know the basics of nutrition, and while I'm not an expert by any means, I know what's good and what's bad. I really think that some people in this part of the country just don't know why certain things are bad, and might not ever be told that certain foods are bad for them. It was nice to be able to give people information that will be helpful, and hopefully prevent them from having to be in the clinic here so often!
I haven't done many cool procedures in the past week, just a couple joint injections here and there. But, I did diagnose a heart murmur on just a basic visit! It's nothing serious for the patient, but it was really cool for me that I could hear it. I told my preceptor, and she listened and agreed with me! I'm also getting better at remembering everything from our Physical Diagnosis class and doing a really good physical exam...it's something I was worried about, since I never had to check anything beyond the pelvis/abdomen the entire time. But everything is coming back to me, and I'm really enjoying primary care. I know I've said this every time, but I really could see myself working in an area like this. As much as I love the OR, I think talking to patients, managing their chronic conditions, and hopefully preventing the development of those chronic conditions is much more rewarding. :)
One thing I don't like so much is that practically every patient will look a little confused when I start talking, and eventually they ask me where I'm from. My lack of a Southern drawl is pretty obvious in this town, and people always ask where I'm from, what I'm doing here, and if I think they're a hillbilly. I've had people tell me I must be rich because of my accent and the fact that I'm from "up North", and that my accent sounds "proper" so I must think everyone in the town is an idiot. This is all, of course, about as far from the truth as you can get. The people in this town have hard lives, and I have an incredible amount of respect for them. I don't like that people assume that just because I talk differently, I've already judged them and think less of them. But! I still really like it here, but it's definitely interesting to experience life as a very obvious outsider.
Last Friday, there was a festival downtown to commemorate the anniversary of the founding of the town. We went down for the morning and set up a table to check people's hemoglobin A1C levels (basically an average blood sugar level over the past three months) for free, so they could know if their diabetes was controlled, or find out if they had diabetes in the first place. At least 80% of people that we see in the clinic are diabetic, and it's really sad because a lot of them don't control it and have pretty bad end-organ damage, meaning that they're going blind, entering kidney failure, or losing sensation in their feet. What I didn't know was that most people really just do not know what diabetes is, how to prevent it in the first place, and how to control it...and they really do want the information, but have never gotten it. When we were at this table, there were so many people who came up and wanted us to tell them all about diabetes, how to control it, what to eat, how to cook healthy meals, etc. It was kind of nice to see people who were actively interested in their health and be able to help them out! And yes, people really did ask us, "What's a carb?" I guess I just took it for granted that I know the basics of nutrition, and while I'm not an expert by any means, I know what's good and what's bad. I really think that some people in this part of the country just don't know why certain things are bad, and might not ever be told that certain foods are bad for them. It was nice to be able to give people information that will be helpful, and hopefully prevent them from having to be in the clinic here so often!
I haven't done many cool procedures in the past week, just a couple joint injections here and there. But, I did diagnose a heart murmur on just a basic visit! It's nothing serious for the patient, but it was really cool for me that I could hear it. I told my preceptor, and she listened and agreed with me! I'm also getting better at remembering everything from our Physical Diagnosis class and doing a really good physical exam...it's something I was worried about, since I never had to check anything beyond the pelvis/abdomen the entire time. But everything is coming back to me, and I'm really enjoying primary care. I know I've said this every time, but I really could see myself working in an area like this. As much as I love the OR, I think talking to patients, managing their chronic conditions, and hopefully preventing the development of those chronic conditions is much more rewarding. :)
Monday, August 26, 2013
A great first day of family practice
Today was great! It started out a little rocky, but got much better.
This morning, I got to the clinic around 7:45 since the clinic starts at 8. I walk in, only to find out that apparently my preceptor doesn't start until 1pm on Mondays - something she neglected to tell me when we were talking before I got here. But, a very nice nurse gave me a quick tour of the clinic, and then I just went back to the apartment I'm staying in and caught up on some things for school and did some reading, which was nice! So I just had a nice, relaxing morning to myself.
The clinic is really interesting. It's federally funded, so most patients who go there don't have any insurance at all, not even Medicare. They use a sliding fee scale to determine how much each patient pays. I think it works like this: whatever percentage of the poverty line a patient's income is, that's the percentage of the cost they pay. So, if someone makes 20% of the poverty line per year, they only pay 20% of their costs. The clinic gets a subsidy from the government, but it's not enough to cover all the costs - the clinic operates in the red most years, according my preceptor. I'm no economist, but I'm not really sure how that continues to work year after year. I guess it does, though, which is good for the people that need healthcare around here. Every patient I saw today was so nice, and so appreciative of the care they were getting. Most of them might come to a doctor once a year because that's all they can afford, and most of them like coming to the clinic I'm at because my preceptor does a lot of smaller procedures right in the office, which saves the money of having to go see a specialist.
Speaking of smaller procedures, today I did 10 injections (even though I was only there for about four hours). I did eight injections in a woman's neck for chronic neck pain, one in a woman's elbow for inflammation from holding too many heavy grandbabies for too long, and one in a man's shoulder who has a rotator cuff tear but can't take off work to let it heal (at his manual labor-intensive job) so he needed a quick fix. I also saw other patients who were just in for medication adjustments, and got to see them by myself before the doctor came in. My preceptor is really great because she just lets me do things and doesn't seem to question my ability to do it, which is definitely a confidence booster. I think I'll be able to learn a lot here!
This morning, I got to the clinic around 7:45 since the clinic starts at 8. I walk in, only to find out that apparently my preceptor doesn't start until 1pm on Mondays - something she neglected to tell me when we were talking before I got here. But, a very nice nurse gave me a quick tour of the clinic, and then I just went back to the apartment I'm staying in and caught up on some things for school and did some reading, which was nice! So I just had a nice, relaxing morning to myself.
The clinic is really interesting. It's federally funded, so most patients who go there don't have any insurance at all, not even Medicare. They use a sliding fee scale to determine how much each patient pays. I think it works like this: whatever percentage of the poverty line a patient's income is, that's the percentage of the cost they pay. So, if someone makes 20% of the poverty line per year, they only pay 20% of their costs. The clinic gets a subsidy from the government, but it's not enough to cover all the costs - the clinic operates in the red most years, according my preceptor. I'm no economist, but I'm not really sure how that continues to work year after year. I guess it does, though, which is good for the people that need healthcare around here. Every patient I saw today was so nice, and so appreciative of the care they were getting. Most of them might come to a doctor once a year because that's all they can afford, and most of them like coming to the clinic I'm at because my preceptor does a lot of smaller procedures right in the office, which saves the money of having to go see a specialist.
Speaking of smaller procedures, today I did 10 injections (even though I was only there for about four hours). I did eight injections in a woman's neck for chronic neck pain, one in a woman's elbow for inflammation from holding too many heavy grandbabies for too long, and one in a man's shoulder who has a rotator cuff tear but can't take off work to let it heal (at his manual labor-intensive job) so he needed a quick fix. I also saw other patients who were just in for medication adjustments, and got to see them by myself before the doctor came in. My preceptor is really great because she just lets me do things and doesn't seem to question my ability to do it, which is definitely a confidence booster. I think I'll be able to learn a lot here!
Sunday, August 25, 2013
Round three!
Well, I have arrived in Kentucky for my third rotation! Sorry for the lack of updates, I've been pretty busy with traveling and getting everything together.
My surgery rotation ended on a good note! My preceptor gave me a good evaluation, and my last patient with her was a mole excision - she let me do a punch biopsy all on my own! It was really cool. I got to numb the skin up, do the punch, and then glue the little circular hole together so the patient would have a more linear scar. It was a good way to end that rotation! Then, I flew from Kansas to home in New Jersey, then relaxed with family during our summer week off. Yesterday, I drove out to Pittsburgh, and today, I completed the journey to Kentucky - whew!
The area I'm in is extremely rural, even more so than the town I was at in Maine. It even seems more remote than Kansas, because at least in Kansas things are more flat, so you can see other buildings. Here, it's mountain after mountain with just the occasional building. The "downtown" section of where I am looks more like a ghost town, with empty storefronts and boarded windows. On the outskirts, there are a few bigger stores, but not anything major: one (small) grocery store, a couple gas station convenience stores, a Rite-Aid, and some family-owned auto repair businesses. Oh, and the clinic! It looks huge compared to most other buildings here, but it's still pretty small. I start tomorrow, and I'll be working with the one doctor that works there. There are also three nurse practitioners at the clinic. The hours are long (8am-7pm every day, except hours end at 5pm on Friday), so I'm pretty sure they don't all work every day.
I'll probably post something tomorrow about how my first day went, but I'm expecting it to mostly be shadowing, which is fine with me. This rotation is in family practice, and since my last two rotations were pretty specific (women's health and general surgery), I feel like I need serious refreshing on the rest of the body! There will definitely be lots of studying happening this week. :)
My surgery rotation ended on a good note! My preceptor gave me a good evaluation, and my last patient with her was a mole excision - she let me do a punch biopsy all on my own! It was really cool. I got to numb the skin up, do the punch, and then glue the little circular hole together so the patient would have a more linear scar. It was a good way to end that rotation! Then, I flew from Kansas to home in New Jersey, then relaxed with family during our summer week off. Yesterday, I drove out to Pittsburgh, and today, I completed the journey to Kentucky - whew!
The area I'm in is extremely rural, even more so than the town I was at in Maine. It even seems more remote than Kansas, because at least in Kansas things are more flat, so you can see other buildings. Here, it's mountain after mountain with just the occasional building. The "downtown" section of where I am looks more like a ghost town, with empty storefronts and boarded windows. On the outskirts, there are a few bigger stores, but not anything major: one (small) grocery store, a couple gas station convenience stores, a Rite-Aid, and some family-owned auto repair businesses. Oh, and the clinic! It looks huge compared to most other buildings here, but it's still pretty small. I start tomorrow, and I'll be working with the one doctor that works there. There are also three nurse practitioners at the clinic. The hours are long (8am-7pm every day, except hours end at 5pm on Friday), so I'm pretty sure they don't all work every day.
I'll probably post something tomorrow about how my first day went, but I'm expecting it to mostly be shadowing, which is fine with me. This rotation is in family practice, and since my last two rotations were pretty specific (women's health and general surgery), I feel like I need serious refreshing on the rest of the body! There will definitely be lots of studying happening this week. :)
Tuesday, August 6, 2013
A much delayed update
Sorry for the lack of recent updates! I've been busy with assignments for school, along with studying for and taking exams. Plus, my rotation hasn't been overly exciting recently. I mean, I still get to see and do really cool things, but it's a lot of the same kind of things over and over again, and therefore not really worth blogging about. But, I did see some cool surgeries yesterday!
The first one I saw was an arteriovenous fistula creation. That basically means that the surgeon takes an artery and a vein, and sews them together. They're used for patients who need to get dialysis because the vein becomes strengthened as a result of the fistula creation, and this makes for a better site to stick people for repeated dialysis treatments. Needless to say, the surgery was all very small cutting and sewing, but luckily I was allowed to sit right across from my preceptor and watch the whole thing, and also hold instruments and generally be helpful during the procedure. And after the surgery is done, the patient has what's called a "thrill" that you can feel under the skin. It's basically like a more diffuse pulse that kind of feels like what a cat purring sounds like, if that makes any sense. This particular fistula was so successful that you could feel the thrill right after everything was all sewed up. It was awesome!
The other surgery I saw yesterday that was new and exciting for me was a laparoscopic Nissen fundoplication. This surgery is used for patients with serious chronic acid reflux, and basically acts by wrapping the top of the stomach around the base of the esophagus to help prevent the backflow of acid from the stomach into the esophagus that causes the reflux symptoms (heartburn). The surgery isn't too complicated technically, but because of the area it's in, it can be a stressful procedure for the surgeons (the area where they're working is very close to the heart and lungs, among other things).
Something I really like about this rotation is that there are no other students here. That means I get all the attention from not only my preceptor, but the other doctors in her practice, too. I also get to scrub in on almost every case, and I get to suture nearly every case I'm scrubbed in on (that means I'm getting really good at suturing, which is an important skill for a PA!). According to some of my classmates that are also doing surgery rotations right now, that's pretty rare. If I was in a city, or a location with a nearby medical school or PA program, I would have to share all of these resources with not only other PA students, but med students too. I really like having it all to myself so I can learn the most! I have about a week left here, and I'm definitely going to make the most of it. :)
The first one I saw was an arteriovenous fistula creation. That basically means that the surgeon takes an artery and a vein, and sews them together. They're used for patients who need to get dialysis because the vein becomes strengthened as a result of the fistula creation, and this makes for a better site to stick people for repeated dialysis treatments. Needless to say, the surgery was all very small cutting and sewing, but luckily I was allowed to sit right across from my preceptor and watch the whole thing, and also hold instruments and generally be helpful during the procedure. And after the surgery is done, the patient has what's called a "thrill" that you can feel under the skin. It's basically like a more diffuse pulse that kind of feels like what a cat purring sounds like, if that makes any sense. This particular fistula was so successful that you could feel the thrill right after everything was all sewed up. It was awesome!
The other surgery I saw yesterday that was new and exciting for me was a laparoscopic Nissen fundoplication. This surgery is used for patients with serious chronic acid reflux, and basically acts by wrapping the top of the stomach around the base of the esophagus to help prevent the backflow of acid from the stomach into the esophagus that causes the reflux symptoms (heartburn). The surgery isn't too complicated technically, but because of the area it's in, it can be a stressful procedure for the surgeons (the area where they're working is very close to the heart and lungs, among other things).
Something I really like about this rotation is that there are no other students here. That means I get all the attention from not only my preceptor, but the other doctors in her practice, too. I also get to scrub in on almost every case, and I get to suture nearly every case I'm scrubbed in on (that means I'm getting really good at suturing, which is an important skill for a PA!). According to some of my classmates that are also doing surgery rotations right now, that's pretty rare. If I was in a city, or a location with a nearby medical school or PA program, I would have to share all of these resources with not only other PA students, but med students too. I really like having it all to myself so I can learn the most! I have about a week left here, and I'm definitely going to make the most of it. :)
Thursday, July 25, 2013
Another busy week! Well, the beginning of the week wasn't too bad, but yesterday and today were pretty busy clinic days. Clinic at this rotation is a little more intense than at my last rotation, because in-office procedures are way more common when you go to see a general surgeon. Today, for example, I saw a punch biopsy of a skin cancer, an incision & drainage of an abscess on someone's leg, and a breast biopsy, as well as removal of some venous catheters used for dialysis. Plus, we did another laparoscopic cholecystectomy this morning, and had a bunch of other regular clinic visits, like consults for surgery and follow-up visits from previous surgeries.
I've decided that I really like being sent down to the ER to take a history and do a physical before my preceptor gets down there to assess the situation herself. It's really cool to not know anything about a patient (except that a consult with my preceptor was requested) and just go into their room, talk to them, and figure out what's going on. Today, I saw a patient with an abscess, and even though they're pretty obvious to diagnose, it was still cool! Then, my preceptor came down and did the incision and drainage. Pretty cool!
I really like the surgery setting because you get to see a good mixture of things - clinic visits, ER consults, and actual time in the OR. Today I got a mixture of all three of those things in the same day! It would definitely keep things interesting as a career. However, I'm not really that crazy about all the gastrointestinal stuff and diseases... it's just not that interesting to me. I mean, I like it, but I'm not super excited about it like I think I was about women's health things. As of right now, if I had to choose between general surgery and OB/GYN, I think I would choose OB/GYN because you still get to see surgery, and the cases are more interesting (to me). But, this rotation is really great and I'm enjoying every day!
I've decided that I really like being sent down to the ER to take a history and do a physical before my preceptor gets down there to assess the situation herself. It's really cool to not know anything about a patient (except that a consult with my preceptor was requested) and just go into their room, talk to them, and figure out what's going on. Today, I saw a patient with an abscess, and even though they're pretty obvious to diagnose, it was still cool! Then, my preceptor came down and did the incision and drainage. Pretty cool!
I really like the surgery setting because you get to see a good mixture of things - clinic visits, ER consults, and actual time in the OR. Today I got a mixture of all three of those things in the same day! It would definitely keep things interesting as a career. However, I'm not really that crazy about all the gastrointestinal stuff and diseases... it's just not that interesting to me. I mean, I like it, but I'm not super excited about it like I think I was about women's health things. As of right now, if I had to choose between general surgery and OB/GYN, I think I would choose OB/GYN because you still get to see surgery, and the cases are more interesting (to me). But, this rotation is really great and I'm enjoying every day!
Friday, July 19, 2013
What a week!
Well, this rotation makes the longest days at my last rotation look like a joke! Every day this week has been at least 10 hours in the hospital, typically 11 and sometimes 12. It's nonstop - there's always something to do, even over the "lunch break." But ... I love it! The surgeries are so interesting and always different, and my preceptor and the other surgeons that work with her are really nice. I think she was just really stressed on Monday because it was her big operating day, plus she had to deal with some paperwork issues for me (on the hospital's end, nothing that was my fault!). She and her surgery partner have been really patient with me and have taught me a lot about suturing, knot-tying, and taking good patient histories.
One thing I really like about being in the hospital every day is that you get to see your same patients a couple times each day, and monitor their progress. For example: I got to check up on two of the colon resection patients from Monday each day this week. One of them recovered really well and was discharged yesterday, and the other is having a little more trouble and is still in the hospital. That patient is doing fine, but they just didn't bounce back as quickly as the other. It's nice to keep track of them and watch them recover, especially after seeing them before the surgery and being there during the surgery.
I've also been sent to see patients by myself a bunch of times this week, and I really like that. One person came into the ER with acute abdominal pain, and I got to take their history and do a physical so I could report to my preceptor in case the patient needed surgery. A resident from the ER had already seen them and taken their history, but I didn't read their note before I went down there, but I ended up asking the right questions and looking for the right things on physical exam and I correctly diagnosed them!! It's pretty exciting when textbooks and practice on classmates pays off. :)
Anyway, I am exhausted and am really looking forward to this weekend so I can relax and spend some time with my boyfriend!
One thing I really like about being in the hospital every day is that you get to see your same patients a couple times each day, and monitor their progress. For example: I got to check up on two of the colon resection patients from Monday each day this week. One of them recovered really well and was discharged yesterday, and the other is having a little more trouble and is still in the hospital. That patient is doing fine, but they just didn't bounce back as quickly as the other. It's nice to keep track of them and watch them recover, especially after seeing them before the surgery and being there during the surgery.
I've also been sent to see patients by myself a bunch of times this week, and I really like that. One person came into the ER with acute abdominal pain, and I got to take their history and do a physical so I could report to my preceptor in case the patient needed surgery. A resident from the ER had already seen them and taken their history, but I didn't read their note before I went down there, but I ended up asking the right questions and looking for the right things on physical exam and I correctly diagnosed them!! It's pretty exciting when textbooks and practice on classmates pays off. :)
Anyway, I am exhausted and am really looking forward to this weekend so I can relax and spend some time with my boyfriend!
Monday, July 15, 2013
On to the next rotation!
Sorry it's been so long since I posted anything... last week was full of end-of-rotation exams, packing, and traveling, so I didn't have much of a chance to write anything!
My last few days in Maine were uneventful but very nice. Monday and Tuesday were a lot of typical clinic visits (prenatal and annuals), and Wednesday was a light surgery day. However, I did get to see (and assist on) a ruptured ectopic pregnancy, which was pretty cool. I got to drive the camera and do some suturing!
Yesterday, I flew out to Kansas, where I am for my general surgery rotation. Today was my first day, and I think it went pretty well! My preceptor seems nice, but very intense. Everything she does is at lightning speed, and she wants everyone around her to be on the same wavelength. It was intimidating at first, but to be honest, it reminds me of how I'll be someday when I've been at a job for a while and am comfortable where I'm working. The rest of the staff at my new hospital is also very nice and patient with me, though they don't seem as eager to teach as the staff at my last hospital. Today was a long day - 11 hours - but luckily I recently bought compression socks so my legs and feet didn't get too sore!
Anyway, today I got to scrub in on four surgeries - two laparoscopic cholecystectomies, one laparoscopic colon resection, and one portacath insertion. I did sutures for all of them, and drove the camera for all of the laparoscopic procedures. I also helped to write post-op notes for all of these patients. This rotation is definitely different material from my last one - I really need to review my abdominal anatomy and disorders!
The surgeries were really cool! The colon resections were probably the craziest. They start out laparoscopically to separate the colon from the anterior abdominal wall, then open up to take out the big piece of colon they're removing. The way they reattach the remaining colon pieces together is pretty wild ... it's basically this big stapler that goes all the way around the bowel, then cuts it and staples it at the same time. They do that on both ends, and then somehow magically do one more between the two pieces and it joins back together as one tube. I'm still not entirely sure how that works ... something to watch on YouTube! But what I do know is that the patient ends up with a functional colon at the end of it, which is pretty amazing.
The cholecystectomies were also pretty cool, and pretty quick! Basically, after the four laparoscopic incisions are made, the gallbladder is just dissected away from the liver, the cystic artery and cystic duct are cut, and then the gallbladder is taken out in this little bag through one of the port holes! Then you just close the incisions. The portacath placement was interesting, and also really quick. It's for patients who are going to get chemo, and it's basically an easy way to get continuous access to a vein so the patient doesn't have to have an IV placed every time they go for treatment.
So, that's all for today! Tomorrow I'm seeing a robotic surgery of some kind, which will be a first for me, and Wednesday is a busy clinic day. Based on those facts alone, I'm thinking that the next time I write something will be Wednesday!
My last few days in Maine were uneventful but very nice. Monday and Tuesday were a lot of typical clinic visits (prenatal and annuals), and Wednesday was a light surgery day. However, I did get to see (and assist on) a ruptured ectopic pregnancy, which was pretty cool. I got to drive the camera and do some suturing!
Yesterday, I flew out to Kansas, where I am for my general surgery rotation. Today was my first day, and I think it went pretty well! My preceptor seems nice, but very intense. Everything she does is at lightning speed, and she wants everyone around her to be on the same wavelength. It was intimidating at first, but to be honest, it reminds me of how I'll be someday when I've been at a job for a while and am comfortable where I'm working. The rest of the staff at my new hospital is also very nice and patient with me, though they don't seem as eager to teach as the staff at my last hospital. Today was a long day - 11 hours - but luckily I recently bought compression socks so my legs and feet didn't get too sore!
Anyway, today I got to scrub in on four surgeries - two laparoscopic cholecystectomies, one laparoscopic colon resection, and one portacath insertion. I did sutures for all of them, and drove the camera for all of the laparoscopic procedures. I also helped to write post-op notes for all of these patients. This rotation is definitely different material from my last one - I really need to review my abdominal anatomy and disorders!
The surgeries were really cool! The colon resections were probably the craziest. They start out laparoscopically to separate the colon from the anterior abdominal wall, then open up to take out the big piece of colon they're removing. The way they reattach the remaining colon pieces together is pretty wild ... it's basically this big stapler that goes all the way around the bowel, then cuts it and staples it at the same time. They do that on both ends, and then somehow magically do one more between the two pieces and it joins back together as one tube. I'm still not entirely sure how that works ... something to watch on YouTube! But what I do know is that the patient ends up with a functional colon at the end of it, which is pretty amazing.
The cholecystectomies were also pretty cool, and pretty quick! Basically, after the four laparoscopic incisions are made, the gallbladder is just dissected away from the liver, the cystic artery and cystic duct are cut, and then the gallbladder is taken out in this little bag through one of the port holes! Then you just close the incisions. The portacath placement was interesting, and also really quick. It's for patients who are going to get chemo, and it's basically an easy way to get continuous access to a vein so the patient doesn't have to have an IV placed every time they go for treatment.
So, that's all for today! Tomorrow I'm seeing a robotic surgery of some kind, which will be a first for me, and Wednesday is a busy clinic day. Based on those facts alone, I'm thinking that the next time I write something will be Wednesday!
Wednesday, July 3, 2013
A crazy day... well, week!
This week has been really busy and stressful so far! Actually, Monday wasn't so bad, but I did see two deliveries that day, so that was cool! But we also had a ton of patients in the clinic, so it was a lot of running back and forth, and I was there for about nine hours of continuous work. Our clinic patients weren't anything very exciting, lots of annuals and prenatal visits as usual, so at least that was nice. The two deliveries were uneventful; both went really quickly and had no complications.
Yesterday, I got to the clinic and saw, much to my surprise (and, as I later found out, everyone else's), another student there! She is a nurse practitioner student who is almost done with her rotations, and she also previously was a nurse for many, many years. At first, I was a little annoyed that she was there, even though she was really nice, because she has way more experience than me and was stealing my thunder at "my" rotation! I quickly realized that I was just re-experiencing the older-sibling syndrome, however, and got over myself pretty quickly after that. It was actually nice to hear about some of her experiences from her previous job and her previous rotations, and we also traded names of helpful textbooks and pocket guides like true students do! Unfortunately, I think she rubbed my preceptor and his partner the wrong way a little bit, because they seemed annoyed by her presence (and the fact that she wouldn't stop talking during surgery! That's a big no-no for a student!!). Apparently, her program hadn't told them she was coming on that particular day, and they thought she wouldn't be there until after I was gone. Having two students in an already small office can get crowded, so I understand their frustration. We also had a surgery yesterday afternoon, which was strange for a Tuesday, and that was uneventful as well - a supracervical laparoscopic hysterectomy. As usual, I got to scrub in and hold things here and there, and close one of the incisions at the end.
Today was insane! We started out with a C-section, and that was really cool because I've been seeing the patient every week when she's come in for her regular visits, so I knew her and had seen her in the office four times already. It was really cool to see even a small fraction of the full-circle process! The C-section went well, and I got to scrub in and was placed in charge of sucking up all the blood (very glamorous). After that, we had a vaginal hysterectomy, and the NP student scrubbed in on that one (and had to hold the bladder retractor for 20 minutes, so I consider myself lucky for that!) while I watched. The next one was another supracervical laparoscopic hysterectomy with left salpingo-oophorectomy, and while the surgery itself was a pretty routine procedure, the patient made it difficult. She was morbidly obese and had severe diabetes, and her blood glucose was through the roof on her pre-op labs, which is never good. Also, because she weighed so much, anesthesia was very difficult, especially because the surgeons need the patient in Trendelenburg (head tilted down), which compresses the lungs even more, to get the bowels out of the way during the surgery. It was very complicated, and the two doctors were very stressed during the entire procedure. After that was all over (and I sutured two of the four incisions that were made), I was paged to OB for a delivery!
Originally, my preceptor had planned to let me do the delivery on my own while he watched. That's one of my goals for this rotation that has yet to be accomplished. So, I was really looking forward to it, even though I knew that this particular patient had a worrisome history with all of her prior pregnancies and this one, so I wondered why my preceptor thought I should be the one doing it. Anyway, I checked her and thought she was fully dilated because I could feel the head, and she started pushing. After a few minutes, though, the OB nurses weren't seeing the fetal heart tracing anymore, and that's when the panic started. Of course, not seeing evidence of the baby's heartbeat is scary. So, they put two monitors on the baby's scalp through the vagina, and then they were able to see the heart rate again. But then, they started seeing decelerations of the baby's heart rate, which is not good either. At that point, my preceptor was worried enough that he decided we had to do a C-section, stat. So everyone springs to action, calling the OR and trying to get everything set up. Meanwhile, the patient is screaming and moaning in pain, and she's even having pain between contractions, which is not normal. Luckily the husband kept calm, but he was very pale! And then, once everyone was there and ready to wheel her away to the OR, she said she needed to push right then! My preceptor checked her and said that she was actually ready for a vaginal delivery, and she could do it right then. So only about five minutes later, the baby was out! But the trouble didn't end there ... the placenta didn't come out fast enough because it was attached really securely to the uterine wall, and the cord wasn't attached to the placenta very well either, so pulling the cord to get the placenta out was out of the question. My preceptor ended up having to go in vaginally and manually detach the placenta and pull it out in two big, bloody pieces. It was a very stressful, very bloody delivery, but luckily both mom and baby came out okay.
And, after doing all the cleaning up and paperwork, my preceptor got us both ice cream. He said he needed it after such a long and crazy day!
Thankfully, we have tomorrow off. And another delivery should happen on Friday, so hopefully I will get to run the delivery myself! :)
Yesterday, I got to the clinic and saw, much to my surprise (and, as I later found out, everyone else's), another student there! She is a nurse practitioner student who is almost done with her rotations, and she also previously was a nurse for many, many years. At first, I was a little annoyed that she was there, even though she was really nice, because she has way more experience than me and was stealing my thunder at "my" rotation! I quickly realized that I was just re-experiencing the older-sibling syndrome, however, and got over myself pretty quickly after that. It was actually nice to hear about some of her experiences from her previous job and her previous rotations, and we also traded names of helpful textbooks and pocket guides like true students do! Unfortunately, I think she rubbed my preceptor and his partner the wrong way a little bit, because they seemed annoyed by her presence (and the fact that she wouldn't stop talking during surgery! That's a big no-no for a student!!). Apparently, her program hadn't told them she was coming on that particular day, and they thought she wouldn't be there until after I was gone. Having two students in an already small office can get crowded, so I understand their frustration. We also had a surgery yesterday afternoon, which was strange for a Tuesday, and that was uneventful as well - a supracervical laparoscopic hysterectomy. As usual, I got to scrub in and hold things here and there, and close one of the incisions at the end.
Today was insane! We started out with a C-section, and that was really cool because I've been seeing the patient every week when she's come in for her regular visits, so I knew her and had seen her in the office four times already. It was really cool to see even a small fraction of the full-circle process! The C-section went well, and I got to scrub in and was placed in charge of sucking up all the blood (very glamorous). After that, we had a vaginal hysterectomy, and the NP student scrubbed in on that one (and had to hold the bladder retractor for 20 minutes, so I consider myself lucky for that!) while I watched. The next one was another supracervical laparoscopic hysterectomy with left salpingo-oophorectomy, and while the surgery itself was a pretty routine procedure, the patient made it difficult. She was morbidly obese and had severe diabetes, and her blood glucose was through the roof on her pre-op labs, which is never good. Also, because she weighed so much, anesthesia was very difficult, especially because the surgeons need the patient in Trendelenburg (head tilted down), which compresses the lungs even more, to get the bowels out of the way during the surgery. It was very complicated, and the two doctors were very stressed during the entire procedure. After that was all over (and I sutured two of the four incisions that were made), I was paged to OB for a delivery!
Originally, my preceptor had planned to let me do the delivery on my own while he watched. That's one of my goals for this rotation that has yet to be accomplished. So, I was really looking forward to it, even though I knew that this particular patient had a worrisome history with all of her prior pregnancies and this one, so I wondered why my preceptor thought I should be the one doing it. Anyway, I checked her and thought she was fully dilated because I could feel the head, and she started pushing. After a few minutes, though, the OB nurses weren't seeing the fetal heart tracing anymore, and that's when the panic started. Of course, not seeing evidence of the baby's heartbeat is scary. So, they put two monitors on the baby's scalp through the vagina, and then they were able to see the heart rate again. But then, they started seeing decelerations of the baby's heart rate, which is not good either. At that point, my preceptor was worried enough that he decided we had to do a C-section, stat. So everyone springs to action, calling the OR and trying to get everything set up. Meanwhile, the patient is screaming and moaning in pain, and she's even having pain between contractions, which is not normal. Luckily the husband kept calm, but he was very pale! And then, once everyone was there and ready to wheel her away to the OR, she said she needed to push right then! My preceptor checked her and said that she was actually ready for a vaginal delivery, and she could do it right then. So only about five minutes later, the baby was out! But the trouble didn't end there ... the placenta didn't come out fast enough because it was attached really securely to the uterine wall, and the cord wasn't attached to the placenta very well either, so pulling the cord to get the placenta out was out of the question. My preceptor ended up having to go in vaginally and manually detach the placenta and pull it out in two big, bloody pieces. It was a very stressful, very bloody delivery, but luckily both mom and baby came out okay.
And, after doing all the cleaning up and paperwork, my preceptor got us both ice cream. He said he needed it after such a long and crazy day!
Thankfully, we have tomorrow off. And another delivery should happen on Friday, so hopefully I will get to run the delivery myself! :)
Wednesday, June 26, 2013
Today was a pretty routine day in surgery ... never thought I'd be saying that!
I saw three hysterectomies (two laparoscopic, one vaginal), and they were all pretty unremarkable. One patient had some pretty serious fibroids, but that apple-peeler thing I talked about last week took care of them, though they did go through two blades! I also saw a D&C and endometrial ablation, which was pretty quick, but I got to be the first assist on that one, so that was cool! It didn't really mean much more than holding things out of the way while the doctor did the procedure, but it's always nice to be able to help.
Also, today I did some more suturing on one of the laparoscopic hysterectomy patients, and I did so well that I got a high five AND a fist bump from my preceptor! It's so cool when he gets excited about something I've done well. I think he likes seeing my progress almost as much as I do! :)
Tomorrow will be a short day in the clinic, which is good!
I saw three hysterectomies (two laparoscopic, one vaginal), and they were all pretty unremarkable. One patient had some pretty serious fibroids, but that apple-peeler thing I talked about last week took care of them, though they did go through two blades! I also saw a D&C and endometrial ablation, which was pretty quick, but I got to be the first assist on that one, so that was cool! It didn't really mean much more than holding things out of the way while the doctor did the procedure, but it's always nice to be able to help.
Also, today I did some more suturing on one of the laparoscopic hysterectomy patients, and I did so well that I got a high five AND a fist bump from my preceptor! It's so cool when he gets excited about something I've done well. I think he likes seeing my progress almost as much as I do! :)
Tomorrow will be a short day in the clinic, which is good!
Friday, June 21, 2013
Surprise! C-Section!
Today was a great day! I got to see a C-section this morning, and I also had a really great day in the clinic. And, to top it off, tonight there were some fireworks in town that I watched with one of my new friends!
When I was driving into the clinic this morning, I felt my phone buzzing in my pocket, and noticed it was my preceptor. He told me that there was going to be a C-section this morning at 8:00 (it was about 7:45 at this point), and was I in scrubs? I wasn't, since I thought it was going to be just a regular day in the clinic, so he told me to get to the hospital as soon as possible, put on scrubs, and meet him in the OR. The patient had really low platelets, which was why she was having a C-section. After scrubbing in and putting on more protective gear than usual (including shoe covers that went up to my knees!), we got ready to start. And when I say "we," I really mean that the surgeons and nurses got ready, and I stood there and tried not to get in the way! I thought it was going to be a relatively calm procedure, but I was definitely wrong. Because the mother had to be under general anesthesia in this case, they were racing against the clock to get the baby out of the mother before her anesthesia medicine reached the baby. At 8:50am, the two doctors began slicing into the abdomen mercilessly, and my preceptor even had to rip through some tissue at one point! When they reached the uterus, they sliced through that too, and then popped the sac that holds the "water" (like when people say their water broke), which went everywhere. The whole thing was way more messy and bloody than I was expecting! At 8:52, the baby was out and had been handed off to the team of OB nurses and the pediatrician. After that, the doctors tied the patient's tubes with actual suture string - probably where the phrase comes from - and then sewed up probably 3-5 layers of tissue on their way out of the abdomen.
After that, we rushed back over to the clinic because my preceptor was already running a little behind in seeing his patients. The actual appointments today weren't anything too exciting - a bunch of prenatal visits and annuals - but I was doing really well at everything during those visits. I love when a patient is describing her symptoms, and I can come up with the diagnosis before my preceptor even says anything that would let me know what he's thinking in the moment. At this point, I feel like I have enough experience and have seen enough cases (and read enough!) to accurately diagnose at least 90% of what comes into the clinic. That's a good feeling! Also, I was doing really well at measuring fundal height and doing the Leopold maneuvers (feeling the belly and figuring out what parts of the baby are where), and also being able to find the fetal heartbeat quickly, so that was gratifying as well. Overall, I'm getting much more comfortable in the setting and starting to enjoy everything rather than just being a strange mixture of terrified and excited all the time.
Tonight, I met up with my new friend who's also living in the dorm, and we went to grab dinner in town. After that, she taught me how to play cribbage, which was really fun! Then, we walked downtown again and watched fireworks on a dock on the river. It was the perfect end to a really great week!
When I was driving into the clinic this morning, I felt my phone buzzing in my pocket, and noticed it was my preceptor. He told me that there was going to be a C-section this morning at 8:00 (it was about 7:45 at this point), and was I in scrubs? I wasn't, since I thought it was going to be just a regular day in the clinic, so he told me to get to the hospital as soon as possible, put on scrubs, and meet him in the OR. The patient had really low platelets, which was why she was having a C-section. After scrubbing in and putting on more protective gear than usual (including shoe covers that went up to my knees!), we got ready to start. And when I say "we," I really mean that the surgeons and nurses got ready, and I stood there and tried not to get in the way! I thought it was going to be a relatively calm procedure, but I was definitely wrong. Because the mother had to be under general anesthesia in this case, they were racing against the clock to get the baby out of the mother before her anesthesia medicine reached the baby. At 8:50am, the two doctors began slicing into the abdomen mercilessly, and my preceptor even had to rip through some tissue at one point! When they reached the uterus, they sliced through that too, and then popped the sac that holds the "water" (like when people say their water broke), which went everywhere. The whole thing was way more messy and bloody than I was expecting! At 8:52, the baby was out and had been handed off to the team of OB nurses and the pediatrician. After that, the doctors tied the patient's tubes with actual suture string - probably where the phrase comes from - and then sewed up probably 3-5 layers of tissue on their way out of the abdomen.
After that, we rushed back over to the clinic because my preceptor was already running a little behind in seeing his patients. The actual appointments today weren't anything too exciting - a bunch of prenatal visits and annuals - but I was doing really well at everything during those visits. I love when a patient is describing her symptoms, and I can come up with the diagnosis before my preceptor even says anything that would let me know what he's thinking in the moment. At this point, I feel like I have enough experience and have seen enough cases (and read enough!) to accurately diagnose at least 90% of what comes into the clinic. That's a good feeling! Also, I was doing really well at measuring fundal height and doing the Leopold maneuvers (feeling the belly and figuring out what parts of the baby are where), and also being able to find the fetal heartbeat quickly, so that was gratifying as well. Overall, I'm getting much more comfortable in the setting and starting to enjoy everything rather than just being a strange mixture of terrified and excited all the time.
Tonight, I met up with my new friend who's also living in the dorm, and we went to grab dinner in town. After that, she taught me how to play cribbage, which was really fun! Then, we walked downtown again and watched fireworks on a dock on the river. It was the perfect end to a really great week!
Wednesday, June 19, 2013
Another surgery Wednesday!
Sorry I haven't posted anything in a while, but the end of last week and beginning of this week was really uneventful. Mostly just routine visits - lots of annual exams and prenatal checkups. I'm getting much better at doing just about everything, though! Today was a cool day in surgery - I saw a tubal ligation that was done with this new-ish procedure that just involves putting little metal coils inside the fallopian tubes. Then, the tubes heal around the coils and block the tubes so fertilization can't happen! The procedure only took about 10 minutes, and it was cool because the doctor used a scope to see inside the uterus to place the coils, so that was interesting! Our next case was a more run-of-the-mill vaginal hysterectomy, and I got to hold the bladder retractor again. Thankfully, today I was standing so that I could use my right hand to hold the retractor instead of my left, so it wasn't as taxing as last week! The last surgery was a complicated one. It started out as just a regular laparoscopic supracervical hysterectomy, but once we were inside the abdomen we could see that there wer a ton of adhesions - meaning that the uterus was basically stuck to the abdominal wall. It took about an hour just to cut it free so they could start the actual procedure! There was also a lot of bleeding during the surgery. All in all, what should have been a 90-minute procedure ended up taking about three hours! The coolest part was the tool they used to take out the uterus at the end. I was wondering the whole time how they were going to do it - since the cervix was going to be left intact, and there were only four small incisions on the abdomen, I thought it would be pretty difficult to get a big uterus with multiple fibroids out. But there was this tool that basically carves the uterus into little finger-sized strips by spinning it around a blade, kind of like an apple corer. Then, the strips are sucked out through one of the holes in the abdomen! Pretty cool. After that, there was a delivery, so we went to go do that right after the hysterectomy patient was closed. The delivery was fairly normal, but the baby had aspirated some meconium during birth, and had to be monitored closely. When I left, the baby still wasn't 100% stable, but my preceptor seemed confident that he would make a full recovery.
Whew! It was a long day, but full of good experiences. It's also really great that my preceptor, along with the other doctor he works with and all the OR nurses, is really funny and nice. It definitely makes long, stressful surgeries easier to handle and more fun!
Whew! It was a long day, but full of good experiences. It's also really great that my preceptor, along with the other doctor he works with and all the OR nurses, is really funny and nice. It definitely makes long, stressful surgeries easier to handle and more fun!
Wednesday, June 12, 2013
Another day of surgery!
I think surgery day is my favorite day of the week. Even though I'm usually in the way and constantly worried about breaking the sterile field, it's really fun and a great experience. The hospital I'm in is pretty small, and they don't have any other students but me right now, so I get all the help and attention from the other doctors, nurses, and even the anesthesiologists! They all love showing me things, and they're very patient with me.
Today I saw a laparoscopic tubal ligation, and I got to drive the camera while my preceptor cut the tubes! I also got to practice suturing on a real person for the first time, which was intimidating because about four people were watching me. I did okay, but I was definitely shaky. Good thing the incisions were small and you can just use Steri-Strips to close them anyway! I also saw two vaginal hysterectomies, and I got to hold the bladder retractor both times. Holding the same strength and positioning for 30 minutes is not easy! My preceptor and the nurses said they were glad I was there, because normally one of them has to hold it. They were happy for a break, and I was happy for the chance to actually help and do something, so everybody wins! The other surgery I saw today was a LEEP, and that went really quickly. In fact, the whole day was over pretty fast! I'm currently on a break, but I have to go back to the clinic in about half an hour to see the patient with the infected C-section so we can change her dressing one more time. After that, though, I'm done for the day.
I really do think I like surgery, or at least assisting with surgery. I'm not sure I'd like to be the one actually cutting and making decisions, but I'm happy to watch and help! Guess it's a good thing I want to be a PA and not a doctor, then. :)
Today I saw a laparoscopic tubal ligation, and I got to drive the camera while my preceptor cut the tubes! I also got to practice suturing on a real person for the first time, which was intimidating because about four people were watching me. I did okay, but I was definitely shaky. Good thing the incisions were small and you can just use Steri-Strips to close them anyway! I also saw two vaginal hysterectomies, and I got to hold the bladder retractor both times. Holding the same strength and positioning for 30 minutes is not easy! My preceptor and the nurses said they were glad I was there, because normally one of them has to hold it. They were happy for a break, and I was happy for the chance to actually help and do something, so everybody wins! The other surgery I saw today was a LEEP, and that went really quickly. In fact, the whole day was over pretty fast! I'm currently on a break, but I have to go back to the clinic in about half an hour to see the patient with the infected C-section so we can change her dressing one more time. After that, though, I'm done for the day.
I really do think I like surgery, or at least assisting with surgery. I'm not sure I'd like to be the one actually cutting and making decisions, but I'm happy to watch and help! Guess it's a good thing I want to be a PA and not a doctor, then. :)
Monday, June 10, 2013
"I don't have a favorite song, or a favorite book that I read over and over, or a favorite game that I play ... what I love is what I do."
Today, I finally got around to asking my preceptor why he chose OB/GYN. His answer was simple: it's what he loves to do! I hope that someday I can find something that I love as much as he loves delivering babies and helping women. So far, I really like OB/GYN myself, but I wish I had the rotation a little later in my clinical year. Right now I feel overwhelmed by the concept of being on rotation, period, and I don't think I'll get to appreciate this specialty as much because I have nothing to compare it to. But, I do like it right now!
Today and Friday were just regular clinic days, nothing too spectacular. I've started going in on prenatal visits myself, which is nice because it makes me feel important and needed. Shadowing is great and everything, but I think I do best when I'm busy, so getting to do things makes me feel more involved and happier to be there! Plus, prenatal visits are easy and there's not much to mess up, so that's good. Also, today I changed the dressing on the patient with the infected C-section scar all by myself (with my preceptor's supervision, of course), and that was stressful. Obviously, it's painful for the patient for you to pull out the old packing material, clean the wound, and put in new packing material. But, it's necessary for the patient to feel better in the end, so even if the patient is groaning and crying you have to keep going, which kind of goes against your natural instincts. So that was stressful! But I did it, and bandaged her up again, and I'll do it all over again on Wednesday.
I'm also getting better at being more confident and forceful when it comes to exams. Last week, my preceptor would laugh at me for being too gentle when I was doing a pelvic exam or feeling a pregnant woman's abdomen. Now, I do it correctly and confidently, and he is proud!
Tomorrow is another clinic day, and Wednesday is surgery. This week I get to see a LEEP, as well as a laparoscopic tubal ligation. Pretty cool!
Today, I finally got around to asking my preceptor why he chose OB/GYN. His answer was simple: it's what he loves to do! I hope that someday I can find something that I love as much as he loves delivering babies and helping women. So far, I really like OB/GYN myself, but I wish I had the rotation a little later in my clinical year. Right now I feel overwhelmed by the concept of being on rotation, period, and I don't think I'll get to appreciate this specialty as much because I have nothing to compare it to. But, I do like it right now!
Today and Friday were just regular clinic days, nothing too spectacular. I've started going in on prenatal visits myself, which is nice because it makes me feel important and needed. Shadowing is great and everything, but I think I do best when I'm busy, so getting to do things makes me feel more involved and happier to be there! Plus, prenatal visits are easy and there's not much to mess up, so that's good. Also, today I changed the dressing on the patient with the infected C-section scar all by myself (with my preceptor's supervision, of course), and that was stressful. Obviously, it's painful for the patient for you to pull out the old packing material, clean the wound, and put in new packing material. But, it's necessary for the patient to feel better in the end, so even if the patient is groaning and crying you have to keep going, which kind of goes against your natural instincts. So that was stressful! But I did it, and bandaged her up again, and I'll do it all over again on Wednesday.
I'm also getting better at being more confident and forceful when it comes to exams. Last week, my preceptor would laugh at me for being too gentle when I was doing a pelvic exam or feeling a pregnant woman's abdomen. Now, I do it correctly and confidently, and he is proud!
Tomorrow is another clinic day, and Wednesday is surgery. This week I get to see a LEEP, as well as a laparoscopic tubal ligation. Pretty cool!
Thursday, June 6, 2013
Deliveries, surgeries, and more deliveries
It's been a busy couple of days! Let's see, where to start...
On Tuesday, I saw my first delivery (and my second)! The actual delivery went way faster than I thought it would, and even though it was pretty bloody I managed not to pass out, throw up, or get emotional! My preceptor let me clamp the cord so the dad could cut it, and then he showed me how to deliver the placenta. Pretty incredible! During the second delivery, he let me deliver the placenta on my own. That one actually happened at around 6pm, after we had all left the office for the day, but my preceptor called me after he got the call about the delivery and I went in to see it and help! The rest of our patients on Tuesday were mostly prenatal visits, which are pretty straightforward if the mom doesn't have any problems to report.
Wednesday was surgery day! I got to the hospital at 7:15am, ready to scrub in on the first surgery of the day at 7:45. When we learned how to scrub in at school, the whole process took 10 minutes and was very thorough... but I am quickly learning that real life is nothing like the textbooks! I had about a five-minute head start on my preceptor at the scrub sink, and he was done scrubbing in before me! The surgeries he did yesterday were two laparoscopic hysterectomies, and one TVT-O placement (basically a sling to hold the ureter in place for people who have stress urinary incontinence). The hysterectomies were really cool, because the way they do it is to actually put gas in the abdomen to blow it up like a balloon so there's room for their instruments. Then, when they put the camera in, the abdomen looks just like a textbook picture! For some reason I thought it would be more messy-looking or something, or more like the insides of a cadaver, but it looked just like everything I had seen in books. For the first one, I just watched, but for the second one I got to hold the uterus in place for a little while so the doctors could cut around it, and then help suture and put steri-strips on at the end. During the TVT-O, I mostly just watched, but also held some things in place for my preceptor while he did all the work. There was also a delivery that day, so we were pretty busy! The delivery took longer than the ones the day before, because this was the first birth for the mom, but it went well and I got to deliver the placenta by myself again. When I got home at 4:30, it felt like I had been to war! I didn't have anything to eat or drink all day, and was standing pretty much the entire day as well. I think I fell asleep at like 6pm that night!
Today was a more routine clinic day, lots of prenatal visits and a few consults for other problems. My preceptor has started to send me in on my own for prenatal visits, and I feel pretty comfortable doing everything he wants me to do for them. Our last patient of the day had had a C-section about three weeks ago, and was coming in because her incision site hurt really badly and was red. She had a pretty serious infection, and we ended up draining it and packing the wound. At first, it seemed like there would just be a little pus, but then my preceptor started pressing along the incision site and more and more kept coming! It smelled pretty terrible and there was a lot of it ... about 200 mL, which was the most my preceptor said he had ever seen in his 20-year career. But the worst part was when he was packing the wound later, because he had to stick the packing material deep into the wound with a Q-tip, and it was pretty gross. But the patient felt so much better afterward, even though she was in pain while we were draining it. So that was rewarding! Sorry if that was too gross of a description :)
So, I'm having a great week! Tomorrow is another clinic day, so it should be relatively calm. I'm excited for the weekend so I can explore the town where I'm staying!
On Tuesday, I saw my first delivery (and my second)! The actual delivery went way faster than I thought it would, and even though it was pretty bloody I managed not to pass out, throw up, or get emotional! My preceptor let me clamp the cord so the dad could cut it, and then he showed me how to deliver the placenta. Pretty incredible! During the second delivery, he let me deliver the placenta on my own. That one actually happened at around 6pm, after we had all left the office for the day, but my preceptor called me after he got the call about the delivery and I went in to see it and help! The rest of our patients on Tuesday were mostly prenatal visits, which are pretty straightforward if the mom doesn't have any problems to report.
Wednesday was surgery day! I got to the hospital at 7:15am, ready to scrub in on the first surgery of the day at 7:45. When we learned how to scrub in at school, the whole process took 10 minutes and was very thorough... but I am quickly learning that real life is nothing like the textbooks! I had about a five-minute head start on my preceptor at the scrub sink, and he was done scrubbing in before me! The surgeries he did yesterday were two laparoscopic hysterectomies, and one TVT-O placement (basically a sling to hold the ureter in place for people who have stress urinary incontinence). The hysterectomies were really cool, because the way they do it is to actually put gas in the abdomen to blow it up like a balloon so there's room for their instruments. Then, when they put the camera in, the abdomen looks just like a textbook picture! For some reason I thought it would be more messy-looking or something, or more like the insides of a cadaver, but it looked just like everything I had seen in books. For the first one, I just watched, but for the second one I got to hold the uterus in place for a little while so the doctors could cut around it, and then help suture and put steri-strips on at the end. During the TVT-O, I mostly just watched, but also held some things in place for my preceptor while he did all the work. There was also a delivery that day, so we were pretty busy! The delivery took longer than the ones the day before, because this was the first birth for the mom, but it went well and I got to deliver the placenta by myself again. When I got home at 4:30, it felt like I had been to war! I didn't have anything to eat or drink all day, and was standing pretty much the entire day as well. I think I fell asleep at like 6pm that night!
Today was a more routine clinic day, lots of prenatal visits and a few consults for other problems. My preceptor has started to send me in on my own for prenatal visits, and I feel pretty comfortable doing everything he wants me to do for them. Our last patient of the day had had a C-section about three weeks ago, and was coming in because her incision site hurt really badly and was red. She had a pretty serious infection, and we ended up draining it and packing the wound. At first, it seemed like there would just be a little pus, but then my preceptor started pressing along the incision site and more and more kept coming! It smelled pretty terrible and there was a lot of it ... about 200 mL, which was the most my preceptor said he had ever seen in his 20-year career. But the worst part was when he was packing the wound later, because he had to stick the packing material deep into the wound with a Q-tip, and it was pretty gross. But the patient felt so much better afterward, even though she was in pain while we were draining it. So that was rewarding! Sorry if that was too gross of a description :)
So, I'm having a great week! Tomorrow is another clinic day, so it should be relatively calm. I'm excited for the weekend so I can explore the town where I'm staying!
Monday, June 3, 2013
The First Day!
Whew! My first day was a long one, or at least it felt that way. I was only in the clinic from 8 until about 4:30, so it was a pretty normal day, but I was so tired and nervous (and hungry) that it felt much longer. But, it was really interesting!
My actual preceptor wasn't in the office today, so I was with the other doctor in the practice, and she was really great! Since it was my first day, I mainly followed her around during all of her visits. I did, however, get to listen to the heart and lungs on two patients, and also work the ultrasound wand on another. I was also able to feel a breast lump that was most likely a cyst. But even though there wasn't a lot of hands-on stuff for me today, I still got to see a lot.
Most of the appointments were for prenatal visits at varying stages, so I got to see a lot of pregnant people at various stages in their pregnancies. Honestly, I wouldn't have thought that this many people in rural, coastal Maine would be pregnant! It was really interesting to me, as someone who hasn't been pregnant, to hear what they had to say about what they were experiencing and how their pregnancies were progressing. Quite a few of the patients were even substantially younger than me and were on their second or third child, and I was amazed at how calm they were about everything and how mature they seemed. I got to do an ultrasound on one patient, and it was amazing! I had never seen one before, and it was really cool to see the baby's little face and fingers in there!
Other visits I saw included a woman with a breast lump (turned out to be just a cyst), and two women who were looking to have their tubes tied. Nothing too exciting or earth-shattering there, but still interesting. Tomorrow I'm going to see a delivery! A woman came in today with PPROM, so they are going to induce her tomorrow morning, I think. So ... that will be interesting! I'm definitely glad I have a little bit of a heads up - at least I know that I'm going to see a delivery tomorrow, so I can prepare and it won't be a surprise. I'm excited!
My actual preceptor wasn't in the office today, so I was with the other doctor in the practice, and she was really great! Since it was my first day, I mainly followed her around during all of her visits. I did, however, get to listen to the heart and lungs on two patients, and also work the ultrasound wand on another. I was also able to feel a breast lump that was most likely a cyst. But even though there wasn't a lot of hands-on stuff for me today, I still got to see a lot.
Most of the appointments were for prenatal visits at varying stages, so I got to see a lot of pregnant people at various stages in their pregnancies. Honestly, I wouldn't have thought that this many people in rural, coastal Maine would be pregnant! It was really interesting to me, as someone who hasn't been pregnant, to hear what they had to say about what they were experiencing and how their pregnancies were progressing. Quite a few of the patients were even substantially younger than me and were on their second or third child, and I was amazed at how calm they were about everything and how mature they seemed. I got to do an ultrasound on one patient, and it was amazing! I had never seen one before, and it was really cool to see the baby's little face and fingers in there!
Other visits I saw included a woman with a breast lump (turned out to be just a cyst), and two women who were looking to have their tubes tied. Nothing too exciting or earth-shattering there, but still interesting. Tomorrow I'm going to see a delivery! A woman came in today with PPROM, so they are going to induce her tomorrow morning, I think. So ... that will be interesting! I'm definitely glad I have a little bit of a heads up - at least I know that I'm going to see a delivery tomorrow, so I can prepare and it won't be a surprise. I'm excited!
Sunday, June 2, 2013
Anticipation!
Hi everyone! I arrived in my first location today, and even though I'm pretty tired and want to get some rest before my first day tomorrow, I thought I should write a short post.
I'm Kristen, and I'm a second-year PA student. I'm starting my clinical rotations tomorrow (!) and wanted to chronicle my journeys as a way to keep a record for myself, my friends and family, and any first-year PA students or aspiring PA students out there. The first year of PA school was tough, and I'm glad it's over, even though I miss all my friends from school. But, I'm glad that I get to enjoy traveling the country and actually practicing the things I spent almost a year learning about!
My first rotation is OB/GYN in coastal Maine. I drove up here from home (in NJ) over the course of two days, and had a really nice trip! I'm in a very small, very rural town that is extremely remote. I don't want to say the name of the town on here for HIPAA reasons, but it's really beautiful!
Anyway, I don't have much to say except I'm nervous, and excited, and don't know what to expect at all! I will definitely post more tomorrow with details about my first day in clinic.
Here goes nothing!
I'm Kristen, and I'm a second-year PA student. I'm starting my clinical rotations tomorrow (!) and wanted to chronicle my journeys as a way to keep a record for myself, my friends and family, and any first-year PA students or aspiring PA students out there. The first year of PA school was tough, and I'm glad it's over, even though I miss all my friends from school. But, I'm glad that I get to enjoy traveling the country and actually practicing the things I spent almost a year learning about!
My first rotation is OB/GYN in coastal Maine. I drove up here from home (in NJ) over the course of two days, and had a really nice trip! I'm in a very small, very rural town that is extremely remote. I don't want to say the name of the town on here for HIPAA reasons, but it's really beautiful!
Anyway, I don't have much to say except I'm nervous, and excited, and don't know what to expect at all! I will definitely post more tomorrow with details about my first day in clinic.
Here goes nothing!
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