This Preceptorship is coming to an end, and I'm a bit sad about it. Next will be Family Practice for 10 weeks and then that will be the last of my clinical year. We've endured some gnarly testing on campus over the last weeks, and I'm glad to have made it through. I've started applying for positions already, even though it's a bit early, and was surprised to receive two offers to interview should the positions be open after my graduation. One is in Pediatrics, the other in Neurosurgery. We'll see what happens.
Today we had a young woman who was in for a yearly physical that is required by schools in this area. She checked out, but something just didn't feel right. Her BP was low (90/50), but she was of very thin stature so I wasn't overly concerned. I asked her for a urine sample just for the heck of it and was so glad that I had. Her bilirubin level was high and there was protein spilling. Put it all together with the low BP and what do you have? Dehydration. I asked her if she drinks water during the day, she said, "yes." I asked her how many glasses, and she replied, "one." We sent her for bloodwork just to be on the safe side, along with instructions to drink 6 glasses of water daily. She said she doesn't like the taste of water, so I suggested splashes of lime, lemon, berry or other juice, or to throw in an herbal tea packet which will flavor and color even ice water. It's funny how some people don't understand that dehydration = organ death. Moving on ...
Another thing that's strange is the fact that there are parents in the world who refuse to believe that their children could have poor vision. Take the mom a couple weeks ago, when her daughter's eyes were 20/50 and I told them she would need glasses. The girl started balling and wailing, 'I don't wanna wear glasses!!" ... the mother says to her, "don't worry honey, you won't have to wear glasses." Wth lady, did you not just hear what I said? Of course I didn't say that, but I did say, "yes, she probably will", to which the young lady started bawling again. Then it turned into a little dance between the mom and I, of "no you won't", "yes, she will", for a minute or so.
Then today, we had a young man, age of 6, who was straining just a little too hard to read that 20/25 line. He mistook a C for an O, and read a couple other letters incorrectly, all which led to a visual acuity reading of 20/30. I had him read the lines over twice to be sure. The mom said, "oh, he just couldn't see the letters." She walks him up to the eye chart and asks him, "now tell me, what letter is this?" The young man says, correctly, "C." She looks at me and says, "see? he just needed to see it up close." "Ma'am", I said, "that's the whole point of the test." "No no", she persisted, "he just couldn't see what letter it was." "Right", I said, "that's what makes his vision 20/30." She finally got it, but she wasn't happy about it. The thing that boggles my head is, I understand you want your kids to be this or that, but would you really forsake their better health in an attempt to fool yourself? Oh well, it makes for amusing stories.
I saw Epstein's pearls for the first time today, in the mouth of a 1 week-old. Those are benign and will go away in a couple weeks, but his sclera and buccal mucosa were slightly jaundiced, so we're sending him for some blood work. More than likely it's just his physiology kicking in and getting started, but always better to be safe. Then a 1 month-old with some serious atopic dermatitis, and no, parents, you shouldn't be washing his clothes in Tide.
One of the most sobering things I encountered recently was a 16 year-old father. The mother was 17. He sat in the corner, looking like your typical teen, shaggy hair that hung over his eyes, black t-shirt with some rock band on it. Who would have figured that he would get up to change the baby and hold it protectively and lovingly before the exam started.
You learn something new every day.
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