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!