Psychiatry is improving...slightly

I'm still not loving psychiatry, but it's getting a little better than the first week. My actual preceptor is back from vacation, so that means that my classmate and I (plus two other PA students from another nearby school) get to see more patients and spend more time on the unit, which means that we feel more connected to the patients since we can follow them throughout the entirety of their stay.

The stories are still sad and I've decided that psychiatry is definitely not for me, but at least it's a little better. I was disappointed to learn, though, that my preceptor doesn't really do outpatient treatment much anymore - he does some pediatric psychiatry for a few hours a couple days per week, but it's in a different location and he said that students don't usually go with him to see that. Plus it sounds like it would be even more depressing than what we're seeing with a (primarily) adult and geriatric population!

So, even though almost all of the cases are sad, that doesn't mean they're not fascinating. Listening to people who are delusional can be pretty entertaining at times, and seeing some of the conditions we learn about in school - schizophrenia, borderline personality disorder, paranoid personality disorder, the mania aspect of bipolar disorder, etc. - is really interesting. The sad part is hearing the background stories behind depression/suicide attempts, or hearing how patients have gone undiagnosed or untreated because they don't have insurance or can't afford their medications. Mental health care is really difficult (and probably frustrating) for everyone involved - providers, nurses, and patients alike. I guess it can be rewarding when treatment works, but I still don't think I could ever see myself working in this field.

An underwhelming first week of psychiatry...

This is, technically speaking, the end of the first week of my psychiatry rotation, but I've only spent about six hours actually seeing patients, and all of that has been basically watching the doctor talk to patients. Granted, my actual preceptor is on vacation this week so we're only seeing the covering physician doing his rounds at an inpatient facility, so I'm sure it'll improve once he's back at the end of next week, but as of right now I'm not impressed.

Plus, the drive to get to this rotation is ridiculous. It takes about an hour and 15 minutes to get to the site...it does get pretty as you get into the suburbs, but it gets old. Luckily (I guess), I only had to make the drive three days this week!

The inpatient facility we go to (I say 'we' because one of my classmates is also at the site!) is really more of a holding facility, a sort of in-between for people that can't stay in the ER but either can't find a bed in a long-term inpatient facility or will be cleared to go home after just a few days of observation. This includes a lot of suicide attempts and people who would like to go to rehab for various addictions but can't find a place with an open bed. Those two groups probably comprise 95% of the patient's I've seen so far, and the other few are people from group homes who were violent and got involuntarily committed from their other institution.

As you can imagine, most of the stories you hear from these patients are just awful. It's not exactly an uplifting rotation. I'm hoping that when the actual preceptor gets back from vacation and we get to see some outpatient stuff that it gets a little better. At least in an outpatient setting you can see garden-variety anxiety and depression that is (hopefully) getting better with medication. I have seen some interesting things so far, though...including a (very paranoid) schizophrenic, and a person with borderline personality disorder. So that was interesting to see!

I'm really hoping that this rotation picks up next week. It might take until the week after to get really interesting, though, since the main preceptor doesn't get back until Thursday. But I'll be sure to post if something interesting does come up!

Goodbye, Montana!

Tonight is my last night in Montana! I am definitely sad to be leaving this rotation and this town, but I'm also really excited to get back to Pittsburgh and see my friends from school (and be able to shop in any of a number of big stores within five minutes of my apartment!). The nurses from the clinic actually threw me a party on Monday, which was so great!! There was a ton of delicious food, and everyone from both the clinic and the hospital came, which was really nice.

This week was relatively quiet clinic-wise, which was good because I had a lot of packing to do! The most interesting thing we saw was this teenager who came in for "sinus problems" and turned out to have this giant polyp (we think) between his nose and throat. He couldn't breathe through his nose at all, and it had been that way for a month! His CT was amazing to look at - the polyp must have been at least 2-3 inches in diameter, which is a lot of space for something to take up in the back of your throat. Anyway, he obviously got a referral to a specialist in Billings.

I'll really miss it here, especially my preceptor. He always told me to say, when asked where I learned a skill or fact that I learned from him, that I learned it from "that country doctor who was wacky, but wise." He's kind of eccentric, but he's easily the best doctor I've worked with on rotations, and I am truly grateful to have learned from him.

My next (and last!) rotation is back near Pittsburgh, and it's psychiatry! I'm sure I'll have some interesting and/or entertaining stories from that one, so stay tuned!

Winding down in Montana...

Well, believe it or not I only have three days left at the clinic here! Today was my last Saturday clinic day, and it was a busy one. Nothing too exciting, really - just a lot of the same types of things I've been seeing the whole time I've been here. We did have one person come into the ER with a persistent nosebleed, and I got to cauterize it using silver nitrate sticks, so that was cool!

Last week was actually relatively quiet in the clinic. I think it was because the weather finally got a little nicer, up to the 50s (and even low 60s!) most days, so people decided they didn't want to be sick or didn't want to come in. I actually got home by 5:00 twice last week! My previous record was 5:30, so that was pretty exciting.

I don't have much to say beyond that...I will definitely miss it here, though. I had a chance to drive around and explore a little today, and Montana is just beautiful. And the people are so nice! I've learned a ton of medicine here, too, and feel pretty well prepared to be a practitioner myself. Now I just have to make it through one last rotation, a few weeks of review, graduation, and the boards (and the job hunting process), and I will be! :)

Another good week!

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! :)

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!

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!