Two Docs at the practice, one NP. The Docs were on vacation Monday, so I worked with the NP who seriously rocked the Universe. Very impressive. The head Doc came back today and was just as impressive. He speaks 8 languages and his brain just doesn't stop. We had a great conversation at lunch about student protests. I met and spoke with the other Doc later in the day, he is definitely intent on my knowing my textbook page for page. I LOVE that.
I got to interpret in ASL for a deaf patient yesterday, that was cool. I was reminded how little I use my ASL! Practice makes perfect and ... I hadn't practiced in a while. But we got through it and mission accomplished.
I'm really looking forward to this rotation, it will consist of clinical care (prenatal care, annual exams, etc) and surgical (deliveries including c-section). The Docs and NP say they have a motto ...'don't read, do. read later.' So, I'm gonna be busy, but I will definitely try to post weekly updates.
Tuesday, March 30, 2010
Sunday, March 21, 2010
Next up ... Ob/Gyn
I've been working on my graduate thesis over the last few weeks, and just today started to hunker down in my readings for the next rotation.
There's a lot.
There's a lot.
Tuesday, February 23, 2010
It is what it is.
I'm not allowed to say too much about this rotation for legal reasons, but I will say that I've developed a serious respect for the clinicians who deal with this patient population. There's a fine line between patient and offender here, and I'm trying my best to observe and sort it out in my mind. This rotation is just about the complete opposite from my last one, but it is allowing me to get a closer look at a darker side of both psyche and pediatrics. Knowledge is power, and I'm definitely learning a great deal.
Sunday, February 7, 2010
Tomorrow is a new day.
I just heard back from my classmate who last finished the Psych rotation I'll be starting tomorrow. She said it was a lot of observing ... very little one on one interaction with patients. You are with the Psychiatrist almost all of the time, and it's all mental status exams that are performed monthly/weekly, there are few to no physical examinations (the internal medicine Doc handles all of that). She did say that it was difficult being around the patients, as those in the building where we rotate are either criminally insane, pedophiles, or violent sex offenders.
Anyhow, she was very reassuring and told me that as long as I watch my back at all times that I'll be fine, and that there will always be adequate staff around. She mentioned that there are back exits and entrances which she utilized a lot. She also said that a majority of the cases involve schizophrenia, so I'll be reading up on that this evening.
Here goes ...
Anyhow, she was very reassuring and told me that as long as I watch my back at all times that I'll be fine, and that there will always be adequate staff around. She mentioned that there are back exits and entrances which she utilized a lot. She also said that a majority of the cases involve schizophrenia, so I'll be reading up on that this evening.
Here goes ...
Monday, February 1, 2010
Almost finished.
And sorry to say it. It's been a great experience, not just because it's Pediatrics but also because of my preceptor. A D.O. with many years of experience, he is intelligent, caring, thoughtful, and perhaps most importantly, lacks ego issues. He has been open to discussion, even to learning. I consider him a bit of a role model and colleague, as I too try and live the same way ... I don't ever want my ego to come in the way of my acquiring useful knowledge.
I've seen a lot of 'less serious' conditions ... many viral in origin. Still, I've also seen RSV bronchiolitis turn into serious bacterial pneumonia, as well as other more urgent conditions. The young girl with septic arthritis who we sent directly to be admitted. The woman who has been sleeping a lot, only to find that she's pregnant. So many details that can't be overlooked.
My time on this one has been both a challenge and an honor. Next up ... state mental institution for Psych. I've been warned to be on the watch for patients in the dementia unit who like to "cop a feel". Then again, maybe the convicts deemed criminally insane will be easier. I think I may miss family practice *gulp* ...
I've seen a lot of 'less serious' conditions ... many viral in origin. Still, I've also seen RSV bronchiolitis turn into serious bacterial pneumonia, as well as other more urgent conditions. The young girl with septic arthritis who we sent directly to be admitted. The woman who has been sleeping a lot, only to find that she's pregnant. So many details that can't be overlooked.
My time on this one has been both a challenge and an honor. Next up ... state mental institution for Psych. I've been warned to be on the watch for patients in the dementia unit who like to "cop a feel". Then again, maybe the convicts deemed criminally insane will be easier. I think I may miss family practice *gulp* ...
Friday, January 22, 2010
Mid-way thru ...
Anyone who thinks Pediatrics is 'easier' has another thought coming. Younger humans have less developed anatomy and physiology, including immunity. Babies can get pneumonia. Peritonsilar abscesses can stay hidden behind enlarged tonsils. A 5 year old can develop rheumatoid arthritis. It takes a keen and careful eye to stay on constant alert. So far, I've done very well.
Something I've always heard as rote from others is "oh, I love the kids ... it's the parents that I can't stand!" For the most part, parents have been wonderful. There have been a couple of nightmares ... the ones who let their daughter crawl around on the dirty floor, the ones who smoke in the car with the windows rolled up. There was one couple with triplet boys ... when the boys were kicking the table they were sitting on, the mother told them to stop. They didn't listen and continued, so I said, "hey you guys, listen to your mom." She let off into me, telling me I didn't know how to deal with children. I was astounded, considering that I was backing up her attempt. Anyhow, they were spoiled kids and eventually she'll understand that ... or maybe she won't. That's the other part of Peds, you can do your best to help in any way you can, but in the end they leave and go out and live their own lives.
Do I still want to do Peds? Definitely. I have had so many good experiences so far, and learned so much. I'll be sad to see this one end. Next is a State Mental Institution that houses convicts who've had their pleas of insanity granted. Gonna be quite a change from cooing and gurgling babies.
Something I've always heard as rote from others is "oh, I love the kids ... it's the parents that I can't stand!" For the most part, parents have been wonderful. There have been a couple of nightmares ... the ones who let their daughter crawl around on the dirty floor, the ones who smoke in the car with the windows rolled up. There was one couple with triplet boys ... when the boys were kicking the table they were sitting on, the mother told them to stop. They didn't listen and continued, so I said, "hey you guys, listen to your mom." She let off into me, telling me I didn't know how to deal with children. I was astounded, considering that I was backing up her attempt. Anyhow, they were spoiled kids and eventually she'll understand that ... or maybe she won't. That's the other part of Peds, you can do your best to help in any way you can, but in the end they leave and go out and live their own lives.
Do I still want to do Peds? Definitely. I have had so many good experiences so far, and learned so much. I'll be sad to see this one end. Next is a State Mental Institution that houses convicts who've had their pleas of insanity granted. Gonna be quite a change from cooing and gurgling babies.
Friday, January 8, 2010
The beginnings.
Doc had me see a 5 day old yesterday, I love those visits. Just checking things, making sure everything's working out. He then gave me a 6 month old patient with developmental issues. The infant was at the level of a 4 month old, with some musculoskeletal and other developmental issues. I noticed almond shaped eyes but ... anyhow, when we went in together, he showed me how it's done. He was very calm and cool, pleasant, and then asked, "so whose eyes she got, she got Daddy's eyes?" in his Italian way. The mother and aunt said no, and he just smoothly then asked if there had been any genetic testing? No. He said he wanted a CT of the brain, and that he also wanted to test for Down's. He broke it to them very coolly, basically. They were so down, it was hard for me. I noted her improvement since the report of the last visit, where she had obviously gained strength, but they kept shooting it all down as not meaning much. I disagreed with them, saying that it meant more than they were making it out as. You couldn't tell in usual ways when she was smiling and laughing, but she still made it obvious when she was. They knew that, and it was obvious that they still loved her very much ... it was just a big disappointment with daunting overtone.
So, I went into the big texts and looked up all the genetic defects possible. I searched and searched for anything else it could be, something less major. I searched my handheld device that I enter all the patients I see into, and searched for something like, 'developmental delay'', anything that could offer better hope. Well, when I got home I searched Down's syndrome and pulmonary issues, since the baby's lungs had sounded like bellows. Sure enough, a majority have them. So, I gave up and went back in and changed the diagnosis officially to Down's. It might actually be Mosaic Down's (she didn't seem to fit all the criteria for Trisomy 21), those individuals tend to have IQs 10-30 points higher than those with Trisomy 21. Either way, there's hope.
The whole thing was like the antithesis of the 5 day old who was the perfect little baby. Still, altho their lifespan is sometimes relatively short due to oftentimes having congenital defects, with therapy and work Down's children can grow into productive people all their own. Some go onto independent living situations. Some have even won best actor awards (Cannes, BAFTA). I hope I was able to impart some hope and caring to that family's darker day. I hope I get to see them again so I can relay all the information I've learned since we saw them.
Anyhow, I've worked in and around Emed for so many years now that it was the majority of what I knew clinically. But I knew by the end of my second day on this rotation where my calling lies. I had a feeling before even starting that this would happen, and it did. Not to say that I won't work in the ER as well, part- time. Anyhow, let me work on graduating and getting my license before I start working anywhere at all ;) But it's almost as if my appetite for medicine has been whet all over again. Not only do you get to practice medicine with all the age ranges up to adult, you get to work with their families. You're there to help drive an important point home that the parents have been trying to impart with their child not listening. And likewise, you're there to help block some of the blows parents can sometimes unwittingly impart towards a child who is simply beginning to explore life as a young adult. And most important, I get to cure pneumonia. I'm home.
So, I went into the big texts and looked up all the genetic defects possible. I searched and searched for anything else it could be, something less major. I searched my handheld device that I enter all the patients I see into, and searched for something like, 'developmental delay'', anything that could offer better hope. Well, when I got home I searched Down's syndrome and pulmonary issues, since the baby's lungs had sounded like bellows. Sure enough, a majority have them. So, I gave up and went back in and changed the diagnosis officially to Down's. It might actually be Mosaic Down's (she didn't seem to fit all the criteria for Trisomy 21), those individuals tend to have IQs 10-30 points higher than those with Trisomy 21. Either way, there's hope.
The whole thing was like the antithesis of the 5 day old who was the perfect little baby. Still, altho their lifespan is sometimes relatively short due to oftentimes having congenital defects, with therapy and work Down's children can grow into productive people all their own. Some go onto independent living situations. Some have even won best actor awards (Cannes, BAFTA). I hope I was able to impart some hope and caring to that family's darker day. I hope I get to see them again so I can relay all the information I've learned since we saw them.
Anyhow, I've worked in and around Emed for so many years now that it was the majority of what I knew clinically. But I knew by the end of my second day on this rotation where my calling lies. I had a feeling before even starting that this would happen, and it did. Not to say that I won't work in the ER as well, part- time. Anyhow, let me work on graduating and getting my license before I start working anywhere at all ;) But it's almost as if my appetite for medicine has been whet all over again. Not only do you get to practice medicine with all the age ranges up to adult, you get to work with their families. You're there to help drive an important point home that the parents have been trying to impart with their child not listening. And likewise, you're there to help block some of the blows parents can sometimes unwittingly impart towards a child who is simply beginning to explore life as a young adult. And most important, I get to cure pneumonia. I'm home.
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