This week seemed long, but was ultimately good. Last weekend was absolutely insane, and I was basically over in the hospital or ER all day on both Saturday and Sunday. Then the clinic was crazy on Monday and Tuesday because my preceptor was the only provider there - one was on vacation, and the other was at a conference. Anyway, we were booked more than solid for two days straight, and I ended up being there for about 11 hours both days. On Wednesday I was looking for some relief, since we normally do nursing home rounds on Wednesday mornings. Well, we never made it to the nursing home...my preceptor was on call, and four different people came into the ER throughout the morning. Nothing was too wild, but one person did get sent down to Billings and some others got admitted after an extensive workup. Plus, we had five patients in the hospital and they were all being kind of complicated that morning too! So it was an extremely busy few hours trying to get that all sorted out in time for clinic in the afternoon.
The patient that got sent down to Billings that morning was the most stressful experience I have witnessed yet on rotations...this 1.5-year-old girl was brought to the ER by her mom to have a CT done of her head, since she had happened to hit her head in the same spot three separate times and her mom had noticed she was sleepier than usual lately. Also, she had started to notice these blue spots in the corners of her eyes. So, naturally, she was worried about some kind of bleed and wanted to have it checked out. The best way to do that (that we have available at the hospital here) is a CT. But what 1.5-year-old wants to sit still long enough for a CT? We had to use conscious sedation on her to get her to stay still so the pictures would turn out well enough to interpret. So the nurse puts in the first dose of Versed....no response. The kid is still screaming and squiggling all over. So she gets the second dose...still nothing. Then she gets a dose of a different sedative...still no response. Then she gets another dose of the first sedative, and still no response. They are getting ready to give her another dose of the second sedative when all of a sudden she just drops and stops breathing right there on the CT scanner. Her oxygen saturation dropped to about 76%. Everyone rushed in and started bagging her and pushing the reversal agent. I'm not sure how long it actually took to bring her back, but it felt like an eternity! It's just so unnatural to see a little kid laying so still and unresponsive. Eventually she did come back, but she coughed up a bit and aspirated and was then coughing some more. She was still pretty strung out on the sedatives, and we decided to send her out to a bigger facility. Talk about a stressful morning!
The afternoon and the rest of the week was much more chill. Today was busy, but not bad! Hopefully tomorrow is calm so I can get some things done for school. I'll miss it here when I leave, but I definitely can't wait to have weekends to myself again, and to be near my friends! :)
Saturday, March 29, 2014
Saturday, March 22, 2014
An interesting week!
First of all, the best news: I got engaged last weekend!! My boyfriend came up to Montana to visit me, and we went skiing, and he had come up with the most amazing proposal that I was not expecting!! I was completely surprised and so, so happy!! :)
This week was full of interesting cases! Well, really just one very interesting case, and some other mildly interesting things. One (male, elderly) patient came in earlier this week, and the reason listed in the computer for his visit was "lump on left breast". Reading that, I thought it was going to be something like a lipoma, cyst, abscess, or some kind of dermatological complaint. So, I go into the room, all ready to take a look at it, tell him what it was and what to do about it, and get out of there in 10 minutes or so. When I get into the room, I start asking the patient about it, and he tells me that it's been there "Oh, for a while" and that he thought it would go away but it didn't, and his wife made him come in today. He said that it's "kinda red" and doesn't bother him really, but it itches sometimes. So, I ask him to pull back his gown so I can take a look, and there is a giant mass the size of my fist on the lower part of his left breast. It's red, lobular, and fixed, and there was nipple retraction...in other words, it looked exactly like a terrible, very advanced breast cancer. I went to get my preceptor after I finished the rest of the exam, and he came in, and was visibly shocked at what he saw. We ordered a CT scan, and it looked even more like cancer on that...and we saw a smaller lesion on his right side as well. We immediately referred him to a general surgeon for a biopsy. We'll see what happens, but it doesn't really look good.
Otherwise, this week was pretty uneventful, though I did see a baby with pyloric stenosis today. That's a condition that's pretty rare, and happens in babies when they have a congenital narrowing of the valve at the end of the stomach where food goes into the small intestine. These babies vomit up basically everything they try to eat, because there's not enough room for the food or formula to get through. They are also constantly hungry and parents report that they are "constipated," though it's really just that not enough is even getting through to be excreted. Anyway, one of the cool (for me to see) physical exam findings for pyloric stenosis is an "olive-shaped mass" in the epigastric area (from the dilation of the end of the stomach from all the pressure of the food not getting through), and this kid had it! It was pretty interesting.
I'm only here for four more weeks, and I'm starting to get a little sad about it. I don't think I would ever want to live here, but the clinic/hospital itself is really nice, and I like the staff a lot - even my eccentric preceptor. I will definitely miss it when I leave!
This week was full of interesting cases! Well, really just one very interesting case, and some other mildly interesting things. One (male, elderly) patient came in earlier this week, and the reason listed in the computer for his visit was "lump on left breast". Reading that, I thought it was going to be something like a lipoma, cyst, abscess, or some kind of dermatological complaint. So, I go into the room, all ready to take a look at it, tell him what it was and what to do about it, and get out of there in 10 minutes or so. When I get into the room, I start asking the patient about it, and he tells me that it's been there "Oh, for a while" and that he thought it would go away but it didn't, and his wife made him come in today. He said that it's "kinda red" and doesn't bother him really, but it itches sometimes. So, I ask him to pull back his gown so I can take a look, and there is a giant mass the size of my fist on the lower part of his left breast. It's red, lobular, and fixed, and there was nipple retraction...in other words, it looked exactly like a terrible, very advanced breast cancer. I went to get my preceptor after I finished the rest of the exam, and he came in, and was visibly shocked at what he saw. We ordered a CT scan, and it looked even more like cancer on that...and we saw a smaller lesion on his right side as well. We immediately referred him to a general surgeon for a biopsy. We'll see what happens, but it doesn't really look good.
Otherwise, this week was pretty uneventful, though I did see a baby with pyloric stenosis today. That's a condition that's pretty rare, and happens in babies when they have a congenital narrowing of the valve at the end of the stomach where food goes into the small intestine. These babies vomit up basically everything they try to eat, because there's not enough room for the food or formula to get through. They are also constantly hungry and parents report that they are "constipated," though it's really just that not enough is even getting through to be excreted. Anyway, one of the cool (for me to see) physical exam findings for pyloric stenosis is an "olive-shaped mass" in the epigastric area (from the dilation of the end of the stomach from all the pressure of the food not getting through), and this kid had it! It was pretty interesting.
I'm only here for four more weeks, and I'm starting to get a little sad about it. I don't think I would ever want to live here, but the clinic/hospital itself is really nice, and I like the staff a lot - even my eccentric preceptor. I will definitely miss it when I leave!
Saturday, March 8, 2014
Quick update!
Hello all! Nothing has been amazingly exciting here, but it's time for an update anyway. We did see a couple cool cases yesterday...one finger dislocation that we pulled back into place, and one guy who had some metal shavings in his eye that we removed! In school you learn that if there's a foreign body in the eye, you make sure the patient is stable and call an ophthalmologist. In Montana...you try to take it out yourself! All we did was numb his eye and then use this metal hook thing to try to pry the small piece of metal out. It worked!
Nothing too interesting has come into the ER recently, either. I haven't been able to do any hands-on stuff like suturing or stapling in a while. But I've been getting lots of experience diagnosing colds, sinus infections, mono, and the flu! And, amazingly, I haven't come down with any of those things (yet!). Every once in a while there's a case that's more interesting clinically, but most of it is pretty simple. I'm starting to feel pretty confident with primary care, since at this point I've had quite a bit of exposure to it! I'm even getting better with little kids, which is nice. I don't think I'll ever want to work in pediatrics, but it's obviously a good skill set to have.
Anyway, this weekend I'm going to try to explore the area a little more, and maybe venture up to Canada! Then next weekend I'm going on a skiing vacation in southern Montana with my boyfriend, who's flying up to visit for a long weekend. I'm sure this next week will fly by!
Nothing too interesting has come into the ER recently, either. I haven't been able to do any hands-on stuff like suturing or stapling in a while. But I've been getting lots of experience diagnosing colds, sinus infections, mono, and the flu! And, amazingly, I haven't come down with any of those things (yet!). Every once in a while there's a case that's more interesting clinically, but most of it is pretty simple. I'm starting to feel pretty confident with primary care, since at this point I've had quite a bit of exposure to it! I'm even getting better with little kids, which is nice. I don't think I'll ever want to work in pediatrics, but it's obviously a good skill set to have.
Anyway, this weekend I'm going to try to explore the area a little more, and maybe venture up to Canada! Then next weekend I'm going on a skiing vacation in southern Montana with my boyfriend, who's flying up to visit for a long weekend. I'm sure this next week will fly by!
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