Parents do the darndest things......

Like......have sex in the shower in the hospital room where their 6yo is currently residing. Nurse walked in on it. No joke.

Like......wonder what is wrong with their baby when we get meconium tests back from the baby that are positive for meth and pot and opiates.

Like......tell their kid that they are fat because they took steroids during pregnancy.....not because they drink 4 liters of soda a day.

Like.......bring one of their different 6 kids into the ER EVERY NIGHT for something different. Mind you some of thes "kids" are married and have kids of their own. Last night the one daughter thought that she had passed a tape worm. It is a long, crazy story.....and I mean crazy. She doesn't understand why she poops only every 2 weeks, but the tracks all over her arms tell me why (this is the daughter). Oh and mom's other kid needs a note for school so that he can take longer to write in class because his hand cramped up today while writing. No joke. These are dire emergencies people.

I'm sure I will have more to add to this. I have more Peds clinic and ER tomorrow.

For realsies.......

Before I go into my writing....you should take a gander at the newly added Mr.T quote of the day down on your left. Pure wisdom people. Also some good news for me. I found out that I will be in the Pacific NW for the rest of my rotations (except internal med. not sure where they are sending me for that yet). So either Portland or Seattle for me! Woohoo! That will certainly make things easier for me being close to my family and friends.

So many days on your rotations you feel like a student. There are simple questions that you will get asked by a patient or your preceptor that most times you THINK you know the answer to but aren't really sure. Then you check, verify that you were correct or missing something then relay the info to the patient. Then there are these little moments where you can answer a question with authority and know with confidence. It is these little moments where you actually feel like a practitioner. I think that first moment happened for me last rotation and is happening more and more this rotation. Then you will have a preceptor ask you a simple question like "what is pediatric dosing for Tylenol" I should know this off of the top of my head, but I have very little experience thus far with treating kids (which I will remedy this week). It takes only one little thing like that to remind you that you are a student and that you have so much to learn still.

I think about being done with rotations and is both excites and scares me. Exciting because I look forward to having more of a life and actually having a paycheck. Scary because there are great things that I learn every day that remind me the value that only comes with experience.

For those of you that aren't a PA student, the rest of this may get boring.

So some tidbits for you '11ers.

ALWAYS remove a baby's diaper. We found a gigantic abscess on this baby. She was septic and parents were presenting her as a cough and fever. Not sure if she made it or not.

Things not to miss on a baby's bootie. Petechiae.....could mean meningiococcus. Redness around belly button or umbilical cord (at 2-3 days usually. Pus from cord to) Could mean omphalitis (will kill a baby). A sacral dimple or sacral pit.....could indicate a neural tube defect.

You can give any age Tylenol, but can only start giving Motrin at 6 months.

You can give Zofran during pregnancy.

You can hear fetal heart tones at 12 weeks.

First time mom should feel baby kicking at 20 weeks......veteran mom might feel it sooner.

Later in pregnancy mom should count fetal movement. Baby should move 10 times in 2 hours. All 10 of those times can be right on top of each other, but it should be at least 10 times.

If someone comes in with a really painful sprain or break in their ankle, always palpate the up the leg to the fibular head. If they are tender here, get an x-ray. They may have a maisoneux (sp?) fracture. This fracture is not really treated anyway, it just means that there was enough twisting force that the ligaments between the tibia and fibula have separated and will need a couple of screws put in, even if there is no break in the ankle.

OH and a GREAT one!!!! Totally learn the physical exam for malingering for people with "back pain" aka drug seekers. Here is is in a nut shell. You have them lie flat on their back and you hold the backs of both ankles in your hands. Then you ask them to raise either foot (do one at a time). If they have true pain and are trying to lift their leg, they will push with the other leg in your hand for leverage. If no push, they are full of it. I did it tonight on a known case (she found out that if you get a tooth pulled they give you 6 Lortabs........she's all out of teeth now.....seriously). Anyway, I did it on her and it worked like a charm!! Through all of her moaning and screaming, and carrying on, she put on a show when trying to lift each leg, but absolutely did not try to use the other foot to push off with. I like those small victories. :-)

Hope and heartbreak.....

This week has been full of highs and lows of the human condition. I have been working really long hours this week because I had the flu last week and feel like I was slacking. There have been highs this week in helping to bring new babies into this world, helping soon to be moms come together as a group to become "team members" in a sense in their pre-natal care. It was a pretty cool group and I was happy to see its inception at this institution. "Centered" prenatal care has been studied and shown to end up in fewer premature births and healthier babies. Who knew?

And the lows. One of the first babies that I helped deliver was brought into the ER not breathing. The baby was taking breaths really only when stimulated and would kind of grunt, and then scream for a bit, and then stop again. Mom was furious that we "weren't doing anything" when we were doing everything that we could to stimulate baby and get all of the labs going. Mom even hit one of the nurses. Here is where it gets hard to be diplomatic. Baby has a partial cleft palate and I suspect a neural tube defect d/t the sacral pit (which I observed at delivery). Mom tested positive several times throughout pregnancy for drugs and alcohol and cannot understand what is wrong with her kid, and is furious because she thinks that we don't know anything and aren't doing anything. Very frustrating when a mom says to you "What is wrong with her, why is she not breathing?!" and you want to shout at her that if she actually gave a shit about her she wouldn't have done drugs during her pregnancy and that it is likely her fault that her kid has birth defects and is in trouble now. Baby had to be flown somewhere that has a NICU.

And tonight.....I had a pre-teen in that had severe abdominal pain. Foster mom says that she has had abdominal pain for about 2 months but that today it is worse, she is concerned about an ulcer. Kid is very histrionic and a poor historian.....everyone warns me that she has "a history". I love and hate cases like this. One because I don't like to go in jaded. 2, because I make it a point, jaded or not to work them up like everyone else, even when everyone else writes them off.....which it sounds like a couple other people did today. A high white count and a growing fever tell me that there is something wrong. Her pains everywhere aren't as reliable. She is saying that her tummy hurts but points to her vagina, then it is her flank, then it is upper quadrants. I decide to get a CT, just to be safe, but am thinking that maybe she has a UTI. Looks like she has free fluid in her abdomen and perhaps an abscess. Dx. appendicitis vs. PID. AND PID could be likely because the child has a history of being raped. So then there is a lengthy discussion between me and the foster mom about doing an exam to check for cervical motion tenderness. We don't want to traumatize her anymore than she already has been. So I suggest to the mom that we are going to operate and put her under anyway and approach things the same way, so why don't we talk to the hospital that she will be going to and suggest that they make all appropriate checks and swabs and such when she is under anesthesia. Mom thought that was a great idea. This poor kid literally needed hand holding and does not trust people, especially adults very much. I don't blame her. Her mom was a drunk and an addict, allowed her to be raped, and killed her 2 year old brother and drove around (with this little girl in the car) with the dead little boy in the trunk of her car for months. I spent about 3 hours with her explaining everything and reassuring her, talking to her, and hopefully helping her. She asked me if I would come with her to the other hospital because she was scared that they wouldn't take good care of her like I was. That was sweet and really flattering. I told her that I had to stay here to work, but that she should come visit me when she got better. It broke my heart. That poor sweet girl has a very long rocky road ahead of her. I wish only the best for her. At least, for my part, I feel like she could trust me for those few hours, and that there are people that want to help her, even if all I can do is take away her tummy pain.

Hoohah...

So I scrubbed in on gyn surgery this morning, and it was a beatuiful thing. Except for the nurse anesthetist, the OR was all women. That was pretty cool. I like the OB/GYN's, they are really good about letting me do stuff. Like today, I have never done an endometrial biopsy.....she was like, "It's easy, I'll walk you through it." Pretty cool. They are the same way during birth, they make sure I get my hand in there and feel what they are feeling. P.S. women.....gyn surgery looks kind of brutal. Avoid it if possible. 5 hours of surgery today and I was going to spend some time in the ER this evening, but I am a disgusting sneezy mess. At least I got some gym time in today. I think I am spiking a fever now though, so I decided to stay in and go to bed early. I want to be ready for tomorrow.

Tomorrow I am scrubbing into some foot surgeries then prenatal clinic in the afternoon. Cool thing is that the anesthetist is going to let me do the intubations tomorrow. I think that I need more practice before my trauma rotation when I will have to do them under pressure. I have only done one under pressure right now. It was fine but a little stressful.

Small goals....

Did a couple of surgeries this morning. Nothing major although we took this HUGE lipoma out of this chick's abdomen. It was cool, she was only sedated, so she would start squirming when we were getting deeper into her abdomen.....I am used to people being paralyzed and intubated.....that was different. Nothing more local didn't remedy though.

After morning surgery, spent an hour and a half in the gym....that felt great! I have missed the gym so much, and man am I out of shape! It feels nice to have that good kind of hurt back.

Decided that I would spend some time in the ER tonight. Right after I got there a blizzard started....no joke, can't see in front of you, white-out conditions. I though for sure that we were going to get some car wrecks in......the roads are completely black ice now.

Today was broken finger day in the ER. 3 of them. I got to practice splinting, so that is good. One cool thing is that I was dreading seeing the "depression" in room 1, but it turned out great. We were really slow so I actually spent almost an hour talking to this guy and his wife. He just started dialysis a few weeks ago and is really anxious and depressed....which is common. We talked about what he is doing about it and about positive strategies that he can take to start living his life and being an active participant in it rather than feeling like all of these things are happening to him.We talked about making little changes one at a time. I think that a lot of providers get so caught up that everyone needs to completely change their diet and exercise x number of times a week, etc....that they don't realize that all of that is too overwhelming for a patient. I say pick one thing, like...."Do you drink soda?" The answer is yes, so I say, why don't we start with cutting out the soda and substituting it for water (preferably) or unsweetened tea. Let's do that for 2 weeks and when that is a habit, we will move onto something else. That way, it is manageable. There aren't a ton of things to keep track of. It is one thing - no soda. Then when they do that, it gives them a small sense of accomplishment. It makes a goal that they have actually attained, and then the other goals may seem attainable too. Make sense?

Decided to go home now as it looks like we might have a hot appy brewing for surgery in the morning and I don't want to miss out on that!

Hopefully people will stay off of the roads tonight. I nearly killed myself in the 100 yards going home.

SO a lot of things have happened since I have been here. This rotation is great. My preceptor is awesome and very knowledgeable. I have already worked with some great people and saw some amazing things. I got to scrub in on my first c-section last night. Teenager with child number 3. Very difficult c-section, thought baby might not make it....but the strong little girl pulled through!! Got to scrub in on another one today. This one went much smoother. I definitely don't want a c-section! They are brutal! Some people I think are skeptical of me as an outsider, but seem to be fine with me once they see that I am here to help. Everyone is really nice. I am learning a ton!!

On a somber note, I accidentally stuck myself today. Bummer. In 12 years working with blood, I have never stuck myself. I am not too, too worried, but I will feel better once all of the tests are back re-confirming that all is well. After zoning out for a few, I went on with my day and powered through. No use in me making myself useless for the rest of the day and taking away from anything else I can learn. I did learn what never to do again when doing a paracentesis....that is the big lesson for the day!