clinic

I started back at clinic yesterday as part of my women's health month. It's been several months since I've done any clinic, and almost a year since I've seen adults in clinic. It quickly reminded me of why I'm going into peds.
So I'm supposed to focus on women's health this month, but my first patient yesterday was a middle-aged guy who had diabetes and "oh, by the way" (the dreaded phrase) had a thrombosed hemorrhoid that needed immediate attention. I saw three women who openly admitted they had endured physical and sexual abuse, and four more who were probably abused but didn't discuss it. I saw women who were so desparate to get rid of their pain that they were willing to have hysterectomies (one of them was twenty-one years old).
Our bodies break down, some faster than others. Adults are so much harder because there is ALWAYS more than one problem, and taking care of one problem, especially with meds, often makes other problems worse.
I know that not all kids are healthy, but at least in a pediatric practice you get to see SOME healthy people.

nerves

Tomorrow I leave town for my final two interviews. I'm excited, but surprisingly nervous. Not that surprising, I suppose - both of my parents are nervous travelers. Residency is one of the biggest decisions of my life, and it's not entirely my decision. I haven't had any really difficult interviews yet, so if one of these programs is more...ahem...stringent in their interview process, I'm going to be unprepared.
Luckily, I have lots of support. The non-interview portions of this trip should be fun. My dad and Tom are going with me, and I have family in Milwaukee and Phoenix, so there will be plenty of non-medically-related fun to be had.
I had to present morning report (a case of congenital CMV) today. It did not go well. I felt ultra-prepared, but of course, there were things I had overlooked that I was asked about. And it was a depressing case, for which there is no good treatment, so there was no happy ending. I didn't get a lot of feedback, and my attending didn't say a word after my presentation, so I think he was less than impressed. I better get used to being less than impressive - I think that will be the story of my life next year.
After reading "Intern Blues" I am dreading next year. I know life is better for interns now than when the book was written (1980's), but it's still hard. The issues are the same. We're still expected to work our hardest at the time in life when many of us are hoping to start (or continue) families. I should be enjoying my fourth year instead of worrying about the future, but I can't shake this sense of foreboding, and that book certainly did not help.
Hopefully by my next post I'll be relaxed and rested after my travels.

extended absence

After an extended absence and a few requests from my dad, I'm back. I had no excuse for not writing, really, except that it's a harder habit to keep than it is to break.

It would be impossible to sum up nine months (I guess pregnant women do it all the time), but here are some of the highlights.

I finished out my third year of medical school with a surgery rotation. I lucked out and spent most of the eight weeks away from the Med Center (where the surgeons are notoriously harder on med students, especially those who have no interest in surgery). I spent four of those weeks observing pediatric surgeries, which will be very useful when I have to explain procedures to anxiety-ridden parents next year. I also became more familiar with Children's hospital, which helped a LOT during subsequent rotations. I spent two weeks on vascular surgery, which was really interesting. I had no idea what vascular surgeons did (yeah, something with veins.) Basically they monitor a lot of clogged arteries and veins and get out the roto-rooter when they need to.
My final two weeks of surgery were spent on ... colorectal. That was exactly two weeks too many. The faculty were fantastic, it's just the subject matter I couldn't stand. Any office that has special tables just for looking up butts is not an office I want to be in. And the surgeries - well, it's a good thing everyone in the OR wears a mask.

I had a nice relaxing week at the lake between third and fourth year, and then it was off to pediatric endocrinology. That was the first time I ever thought seriously about specializing. I loved being in clinic, I loved the attending, and I loved most of the patients. I still think I'll end up in general pediatrics, but it was nice to realize that there was a specialty I could see myself devoting my career to.
Pediatric infectious disease was next. Terrible hours, laboriously detailed histories, smelly pus-filled diseases. More power to them, because I couldn't do it. The bright spot of the month was when my brother got married. The wedding was beautiful and romantic and fantastic and fun. Matt and Molly are really good for each other.
NICU and subintern stories will have to wait, but I'm going to be able to keep up on this a lot better now that I'm on a "self-directed learning" month. Ahh, the life of a fourth-year.

so glad

I am SO GLAD to be back in Omaha!! I loved hastings and all, but i have never been so glad to climb into my own bed in my whole life. the first seven weeks, i tried to be really positive, at least to the people in clinic, and when they asked me how the dorm was i would always be really vague and say something like, "it's a good place to sleep" or some bs like that. this week, though, i couldn't hold back any more, i couldn't fake it. i was telling everyone how excited i was to go home. and i was!! and now i'm home and i have a test today but i don't even care because i never have to go live in a small town by myself ever again!
Also, i finally finished my paper on asthma, which is contributing to my euphoric state. it's kind of a sorry excuse for a paper, but i really did enjoy learning more about asthma and i think i came up with an intervention that could theoretically be used. (it's just a sheet to keep track of peak flows and meds and stuff like that. simple, but practical.)
and, to top it off, this weekend we will be attending the berkshire hathaway festivities. you know, because we own all that stock. it will be a good excuse to put on a dress (i don't know if i've ever actually said that last phrase out loud) and do some good people watchin'.
i know, i never finished my jamaica stories. i will this weekend, when i'm not trying to write a 20-page paper.

Yeah mon

I'm back from Jamaica. It was a fabulous trip, at least until the last 24 hours. I didn't write anything during the trip so I want to make sure I get it on e-paper now, before the memories fade.
Twelve students, four doctors, and four "Friends of Jamaica" traveled to Falmouth, Jamaica, to run a primary care clinic for a week. We (the students) functioned as triage nurses, physicians, pharmacists, and educators. I think I actually learned more by performing the non-physician functions - reinforcing the importance of taking accurate vital signs, solidifying my knowledge of basic medications, and learning how to convey basic health information despite language barriers. (Jamaicans speak English for the most part, but less-educated citizens speak patois (patwa), which is rooted in English but not entirely comprehensible to my ears).
I also gained experience as the sole provider for my patients. Most of third year consists of gathering information from patients and deciding what could possibly be wrong. This gets presented to an attending who decides what really is wrong and what will be done about it. In Jamaica, I was responsible for my patients from beginning to end, from coming up with a diagnosis to choosing a medication and actually getting it from the pharmacy. I hope that I can continue to see my patients in this light without reverting back to third year ways.
Okay, enough "what I learned on my vacation" stuff. Tomorrow I'll talk more about the fun stuff we did.

Small Town USA

yikes! i must be busy, it's been almost two weeks and no news.
i spent the first two weeks with the tasmanian devil and now i'm with bugs bunny.
what i mean to say is that doc 1 was very, very fast, with a touch of ADHD and a passion for life and, as he put it, the "gift of gab".
doc 2, on the other hand, is more laid-back, kinda relaxed, spends more time with his patients, and asks for consults far more than doc 1. both of them are great doctors, and i feel that i'm certainly benefitting from seeing the different styles.
it's hard to summarize all that i've learned since i've been here. i can say that i feel more comfortable with invasive procedures. i still don't really like doing shots or drawing blood or putting in stitches, but at least my hands don't shake like i have parkinson's anymore. i'm also much better at dictating (the transcriptionist said i was the best student they've had) and i'm starting to be able to organize my thoughts better during a patient encounter.
i'm learning a lot. i just wish i could relocate all of this good learning back to my home. i like my home. i miss my home. i miss my husband and my dog and my own bathroom. it's not that i'm weepy or sad about it, there's just a low-level uneasy feeling that something's not right. it's like the groundhog who saw his shadow. six more weeks of winter. *sigh*

hastings

I made it to Hastings. I think I would have to post at least twice a day to capture everything that happens, but I'll have to settle for whenever I can get to a computer. I have this afternoon off, hence the post.
I found a great coffee shop that has wireless internet access (and really good coffee slushies) within walking distance from the "dorm".
I put "dorm" in quotes for two reasons: First, I haven't lived in a dorm for eight years (how's that for making me feel old?) and I am still adjusting to the sharing of bathrooms, showers, etc. Second, when I did live in a dorm, I was in a monstrosity of a thing with many other people and a giant cafeteria, you know, a dorm. Here, there are six other people in the whole building. It's more like a big house, only with really small crappy bedrooms and even worse beds. Luckily I sleep like the dead, I don't know how I would survive otherwise. There are train tracks through the center of town and I don't know why but all trains apparently run in the middle of the night. And they all have to blow their whistles on the way past. The bed looks kind of like this (scroll down). But hey, it's a room, and it's free, and the dorm lady is very nice, and other than the trains it's quiet.
So, let's see, the doctors. When I got here yesterday (an hour early - it only takes two hours to get to Hastings), I had a hospital tour, moved my stuff in, and headed to the clinic. The clinic manager introduced me to everyone and we finally got to the doc I was supposed to be with (this was around 3pm), who told me to "jump on in", meaning I had to see patients and dictate notes. Ok, no problem. Then I had to go to a drug rep speaker/dinner because they had already told the drug rep that I would go. So I didn't get back to the dorm until 9. I'm going to learn a lot, though. The doc I'm with this week is so incredibly overbooked that he saw more patients in that two hours than we sometimes saw in a whole day in Fremont. But, like he said, if he didn't see them, what would they do? There just aren't a lot of options here. Everyone in the office seems very nice and accomodating. They're going to make me do blood draws and other things that I don't want to do but have to do to graduate. Just this morning I drew blood (well, I tried anyway), took off a cast, saw a joint injection in a knee, sat in on some diabetic education, and learned all about the lab. And the doc I was supposed to be with wasn't even here! (Wed are his day off).
I should get some research done during my "study afternoon". More to come.