Let me preface this by saying that it's going to be much more entertaining to those of you who watch It's Always Sunny In Philadelphia, which puts the entertainment value at only slightly more than will be outweighed by the time and energy it takes to read this. but... you're here already, right? so read on....
To those of you familiar with the mystery of 'who pooped the bed' from season 4, i believe, of It's Always Sunny In Philadelphia, I had a similar mystery the other day. No, I did not poop the bed, nor did someone sleeping next to me poop the bed, mainly because nobody sleeps there next to me, but more than that, the mystery poop appeared at work. And no, again, it did not appear in a bed... there aren't beds at the clinic, and no, it did not appear in the toilet. That's not a mystery.
It was toward the end of the day, when I was in the office, down the end of a long hall which is lined by exam rooms. The hall leads to the front nurses station, and office, which are separated by a door, and front desk that meet the waiting room, full of toys, pretty landscapes painted on the wall, and a large tropical fish tank. It is easy to see that this is a Children's Clinic. I sometimes wish I could play in the waiting room. They even have a Plasma HDTV. Not too shabby.
Despite my wishes of waiting room playtime, I was stuck at the other end of the hallway, in the Physician's/Physician Assistant's office where we do our dictating, and whatever it is we do when we have a free moment. There are no toys in this room.
From my seat, I can peer out the door, and see most of the way down the hall, except for one room, which is hidden by a twist in the hallway. Other than that, I can see if I have a patient waiting for me...
It was in a peek such as this, that the other day I noticed a patient was waiting to be seen by me. So, I got up off my lazy butt, grabbed my stethoscope and headed meaningfully toward the room in which my patient was waiting. As I got only a few steps down the hallway, painted with leaves, hills, blue sky and birds.... I heard a "step carefully!" from one of the docs, and then noticed in my pace toward the exam room, a new piece of flare decorating the hallway; a turd.
I danced around it, no problem.
"Don't wanna get that on my shoe" I thought.
In retrospect, I'm surprised I didn't think it was weird, or gross, or even that funny. It got funnier later, when I had a second to think about it. But upon first pass, I just thought... "whoa, don't step on that log in the hallway."
And it was a log, not a little pebble of a turd, not a smear from a diarrhea related spurt from a little kid who just couldn't hold it. This was a solid, whole, formed adult sized poop.
It was only on the way back from seeing my patient, when I passed by the scene of the crime that I had a moment to think about it, to think of scenarios as to how turd ended up in the middle of the hallway. And, more than that, how no one seemed to know how it got there. It just appeared out of nowhere.
My mind thinks in movies... small movies, you could call them short, independent films, the kind that don't get released throughout the entire US, but just the trendy cities. They might win some accolades, some nerd movie awards, but not this one. All I could picture was some poor little kid, but not too little, judging by the size of the excrement, in the doctor's office for one reason or another. He's hating life, simply because he's here, probably for a runny nose - because that's what they're usually in for.
I sometimes picture them in the waiting room, these 3 year old kids, playing in the waiting room, like a prison yard.... "What are ya in for?" one would ask the other.... and after the obligatory "I'm innocent, I aint sick... my mom screwed me over, got me thrown in here!" one would admit, albeit reluctantly, after sneezing and creating two extraordinarily large green snot bubbles at the end of his nose.
"OK, I might have a runny nose."
And after a good ribbing by the innocent one, he'd get far too into his verbal assault and laughing that he'd suddenly vomit directly onto the pile of blocks with which they'd both been playing. He'd just look at the other.... "You didn't see NOTHIN'! Got it?!"
(Movies... you see. It's entertaining.)
Where was I... OH yea! So I imagine this poor kid, probably around 5 or so, much too old for a poop accident like this. He's sitting in jail, for something he didn't do, when it hits him.... "gurgle....grumble, grumble."
"Oh, sh..."
and in comes the doctor, "what's the deal with this runny nose?"
"gurgle, gurgle gurgle..." say his insides...
and he's much too little, and shy to say, "Please excuse me, I need to use the restroom." So he rides it out, just hopes that the schmuck hurries up with the listening to the lungs and wh.... wait, wait, why are you listening to my belly, no, no... it's fine, it's fine... for the love of GOD don't push on it!
"gurgle, grumble, grumble!" It's too much!
and just like that, it's over. the mystery poop has begun it's journey by escaping from the large colon, through the gates of sphincter, and into the dark, warm recesses of underwear-ville.
Now Brandon is in real trouble. He can't tell his mom that he pooped in his pants. he'll be in HUGE trouble... these are new underwear! He can't tell the doctor, he'll probably give him a shot! And he's not sure how, but the nurses are in on it too.
His only option is to escape, quietly and quickly, just the way he came in. Right down the long hallway, and out the front door. He'll have to dispose of the poop somewhere between here and home, cuz mom will surely smell it in the car on the way home.
The quandary of where to unload the poo is fleeting, for like the quandary itself, the poo doesn't stick around too long. It senses it's chance to go down in history as the mystery poop when Brandon slinks off the exam table.
Underwear be damned! It's all about pant leg now!
A short couple of steps later, behind mom, the turd finds freedom as it slips past the shoe and his the floor rolling, in all it's smelly, mysterious glory.
at least that's how i like to think about it. And i like to think about all the panic Brandon went through, and then the eventual triumph he must have felt in his perceived success.
it's a great story of, um... poop... and as Frank Reynolds once said "Poop is funny!"
I hope you enjoyed it.
Merry Christmas
Wednesday, December 17, 2008
Thursday, December 11, 2008
a painful realization
i accidentally sliced my thumb open today while trying to chop up an onion. It was a really sharp knife, and it went sort of deep, into the pad of my thumb.
I proceeded to wash it out with some soap and water and let it bleed. and, knowing a thing or 3 about this kind of thing, i knew it would be best to irrigate the heck out of it. I started to do this by spraying water directly into the cut, and quickly came to the realization that I will always anesthetize a person before irrigating.
it did not feel good.
i did have some suture, which might have been a little overkill, but i also had some krazy glue.
i must say, the krazy glue worked quite nicely. it's the poor man's dermabond.
cn
I proceeded to wash it out with some soap and water and let it bleed. and, knowing a thing or 3 about this kind of thing, i knew it would be best to irrigate the heck out of it. I started to do this by spraying water directly into the cut, and quickly came to the realization that I will always anesthetize a person before irrigating.
it did not feel good.
i did have some suture, which might have been a little overkill, but i also had some krazy glue.
i must say, the krazy glue worked quite nicely. it's the poor man's dermabond.
cn
Tuesday, December 9, 2008
Where it's at...I got two turn tables and a dictaphone.
I can remember, way back when, in a far off land that they call Ohio... a land of farms, amusement parks, people with unusually southern accents; a swing state... I can remember at this first rotation of mine hearing a doctor dictate so fast, that he sounded like the guy from the old micro-machine commercials. If you were a baby of the 80's... you know what I mean. If you weren't, or don't for some reason, youtube it here...
http://www.youtube.com/watch?v=mlRgbU3ZJ5g
I was quite amazed, anyhow.
I can remember even further back, having to muddle my way through a number of dictations for school. It was painful, even with a cheat sheet. I could not believe that this would actually save time... and I certainly felt a little bit weird about the whole thing. It's more awkward than you'd think, Captain Kirk-ing your way through a patient encounter.
"Beeedle-dooodle-dee! Captain's log, star date 23.9, rounded off to... the nearest decimal point....." I have picked up this little gray device, and, started speaking into it... really fast, disregarding all human contact, or other occurrences in the room.
Weird.
Well....... that's what I thought at first.
But it didn't take more than a day for me to love it.
What's this? No more hand writing SOAP notes!?!? No gigantic H7P for a well child check?
Awesome.
Stellar.
Fantastic.
Fantasmagorical!
Don't call me captain kirk... but you can call me Captain Nerd. I don't care, dictating is sweet.
CN
http://www.youtube.com/watch?v=mlRgbU3ZJ5g
I was quite amazed, anyhow.
I can remember even further back, having to muddle my way through a number of dictations for school. It was painful, even with a cheat sheet. I could not believe that this would actually save time... and I certainly felt a little bit weird about the whole thing. It's more awkward than you'd think, Captain Kirk-ing your way through a patient encounter.
"Beeedle-dooodle-dee! Captain's log, star date 23.9, rounded off to... the nearest decimal point....." I have picked up this little gray device, and, started speaking into it... really fast, disregarding all human contact, or other occurrences in the room.
Weird.
Well....... that's what I thought at first.
But it didn't take more than a day for me to love it.
What's this? No more hand writing SOAP notes!?!? No gigantic H7P for a well child check?
Awesome.
Stellar.
Fantastic.
Fantasmagorical!
Don't call me captain kirk... but you can call me Captain Nerd. I don't care, dictating is sweet.
CN
Friday, November 28, 2008
broken boys and ala carte healthcare
I thought that I was in Pediatrics, and done with Trauma. In fact, I'm pretty sure I just got done with my 6 week stint at Legacy Emanuel Trauma. I shouldn't be seeing broken bones, at least acutely, right? I should be dealing with well child checks, runny noses, and maybe dealing with asthma.
maybe not...
a couple of days ago, I stitched up the toe of a girl who managed to slice it on a mirror. I don't know if she saw her reflection, and like a young kitten, not knowing it was her in the mirror, freaked out.... hissed and batted at it like a flurry of right and left crosses, then somehow in the chaos sliced her toe.
or maybe she was practicing her karate kicks in the mirror, and got a little too close. in any case, I stitched her up.
And on the same day, I stitched up another kiddo's knee after a horrible recess time football accident. It was gruesome.... after three sutures, I realized we were in the clear, and we wouldn't have to amputate.
He was thankful.
Then, just this Monday I saw a 17 year old guy who was in an MVC, going about 30, went into a ditch. He went to the ER that night, Saturday, and got worked up and sent home. They told him to follow up with his PCP on Monday. They gave him a clean bill of health after, what I can gather, a few x-rays. He said that everything came back negative.
He still had low back pain, and noticed a bump on his head. He didn't lose consciousness, nor did he remember smacking his head. He was belted, and there wasn't too much damage to the car.
He didn't have any pain other than in his lower back... he moved around the room slowly and deliberately. He had a limited range of motion as I watched him move.
At Emanuel, they would always feel the spine before sliding the folks into the CT scanner, looking for step-offs and other deformities of the spine, as well as trying to illicit any pain response from the patient. These things being clues for a fracture. What you really look for, as far as the pain response is concerned, is tenderness on the bone, not in the muscles, but right on the bone.
At Emanuel, the surgical resident or the trauma PA did this... not me. So I didn't feel the patient react to pushing on their back, but I saw it.
I've done plenty of back pain exams now, in the ER and in clinic, and that's something you always check for.... that spinal tenderness. I've never had a patient react in such a way that I've been concerned that they have a broken back. Even the whiners.... it's just never been impressive.
"Does it hurt when I push here?"
"OHHHHH... uhhhhh, ahhhhh..... yeaaaa...."
"How about here?"
"Ehhhhhhhhhhh, yes." they'll groan.
No real reaction.
But this kid..... I have him sitting on the exam table and start pushing on his spine.... around L1... working my way down.
"Tell me if it hurts anywhere."
As I'm pushing, and working my way down his spine, I get to about L4, and he doesn't have to say a word... I push, and he JUMPS away from me. He moved faster than he had the entire time he'd been in there with me. I had pushed right on the spinous process of L4 and he was through the roof.
Anywhere else I pressed didn't bother him.... The muscles surrounding L4, the other spinous processes... nothing. No pain, no reaction.
ooooops.
"So, in the ER, did they do any CT's? You know, where you lay down on a table and they slide you into what looks like a huge doughnut?"
"Nope. They did X-rays."
"Well, you're gunna get one today."
He does... and the results came back via phone call from the radiologist.
L4 compression fracture with no posterior involvement (which is good) but with some anterior wedging/displacement.
It's basically stable, and there's not really any worry for this type of fracture paralyzing this kid. But it still warrants a spine-guy consult. Which we get all set up for him.
another little kiddo, well, about 11 years old, strolled in around the same time. He fell playing basketball, and hurt his arm... a quick x-ray later, we found that he had a torus fracture. we splinted him, then sent him off, only to come back in a week so we can cast him up once the swelling dissipates.
so, i've discovered that pediatrics can be more interesting, and varied, than i thought. i should have realized that kids tend to get hurt.
some kids that come in however, are not hurt, but act like it.
we had a teenage girl come in with her mom. She had been seen in the pediatric night clinic... (like urgent care, for kids) and was diagnosed with a sinus infection. she was given antibiotics and sent home. though, at the clinic, she and her mom were asking for an IV.
"I know my kids, they crash fast. and this one, she'll perk right up when she gets filled up. I mean, I know they do it for athletes, it's not a big deal. She did this the last time too, and Lisa gave her an IV, and she popped right back up! We asked for an IV last night, but they wouldn't give her one."
I'm thinking, as she's saying this, "she does NOT need an IV. that's just a waste of time, money and resources. It's an unnecessary risk (albeit a small one) for a placebo effect, and to appease the mother and child. This is NOT a McDonald's... you can't just order what you want!"
Or, i guess you can.
i should have known... well i did know. but it bothers me.
So I present the patient to the preceptor and say that they came in with the hopes of getting an IV, anything less than that will leave them upset. So, we bolus the girl with 1 Liter of NS. the NON-dehydrated girl.... and all was well in their world. It's amazing how a liter of salt water can make a sinus infection better. i guess i should have checked UpToDate... it's the preferred treatment, after all!
well, i've made a short story long, but.... turns out, i like peds more than i thought i would. even despite some of the silliness that is made-to-order medicine. That's just the way it is, in every field. It's not Doctor knows best, it's, "what can I do for you today? no matter if it's unwise, dangerous or just silly, it's your care! let's do it!"
In my practice, I won't fold so easily, I won't enable this kind of behavior. But, I'm just a student in a 6 week rotation. I'm not out to change a practice. I'm just out to practice.
cn
maybe not...
a couple of days ago, I stitched up the toe of a girl who managed to slice it on a mirror. I don't know if she saw her reflection, and like a young kitten, not knowing it was her in the mirror, freaked out.... hissed and batted at it like a flurry of right and left crosses, then somehow in the chaos sliced her toe.
or maybe she was practicing her karate kicks in the mirror, and got a little too close. in any case, I stitched her up.
And on the same day, I stitched up another kiddo's knee after a horrible recess time football accident. It was gruesome.... after three sutures, I realized we were in the clear, and we wouldn't have to amputate.
He was thankful.
Then, just this Monday I saw a 17 year old guy who was in an MVC, going about 30, went into a ditch. He went to the ER that night, Saturday, and got worked up and sent home. They told him to follow up with his PCP on Monday. They gave him a clean bill of health after, what I can gather, a few x-rays. He said that everything came back negative.
He still had low back pain, and noticed a bump on his head. He didn't lose consciousness, nor did he remember smacking his head. He was belted, and there wasn't too much damage to the car.
He didn't have any pain other than in his lower back... he moved around the room slowly and deliberately. He had a limited range of motion as I watched him move.
At Emanuel, they would always feel the spine before sliding the folks into the CT scanner, looking for step-offs and other deformities of the spine, as well as trying to illicit any pain response from the patient. These things being clues for a fracture. What you really look for, as far as the pain response is concerned, is tenderness on the bone, not in the muscles, but right on the bone.
At Emanuel, the surgical resident or the trauma PA did this... not me. So I didn't feel the patient react to pushing on their back, but I saw it.
I've done plenty of back pain exams now, in the ER and in clinic, and that's something you always check for.... that spinal tenderness. I've never had a patient react in such a way that I've been concerned that they have a broken back. Even the whiners.... it's just never been impressive.
"Does it hurt when I push here?"
"OHHHHH... uhhhhh, ahhhhh..... yeaaaa...."
"How about here?"
"Ehhhhhhhhhhh, yes." they'll groan.
No real reaction.
But this kid..... I have him sitting on the exam table and start pushing on his spine.... around L1... working my way down.
"Tell me if it hurts anywhere."
As I'm pushing, and working my way down his spine, I get to about L4, and he doesn't have to say a word... I push, and he JUMPS away from me. He moved faster than he had the entire time he'd been in there with me. I had pushed right on the spinous process of L4 and he was through the roof.
Anywhere else I pressed didn't bother him.... The muscles surrounding L4, the other spinous processes... nothing. No pain, no reaction.
ooooops.
"So, in the ER, did they do any CT's? You know, where you lay down on a table and they slide you into what looks like a huge doughnut?"
"Nope. They did X-rays."
"Well, you're gunna get one today."
He does... and the results came back via phone call from the radiologist.
L4 compression fracture with no posterior involvement (which is good) but with some anterior wedging/displacement.
It's basically stable, and there's not really any worry for this type of fracture paralyzing this kid. But it still warrants a spine-guy consult. Which we get all set up for him.
another little kiddo, well, about 11 years old, strolled in around the same time. He fell playing basketball, and hurt his arm... a quick x-ray later, we found that he had a torus fracture. we splinted him, then sent him off, only to come back in a week so we can cast him up once the swelling dissipates.
so, i've discovered that pediatrics can be more interesting, and varied, than i thought. i should have realized that kids tend to get hurt.
some kids that come in however, are not hurt, but act like it.
we had a teenage girl come in with her mom. She had been seen in the pediatric night clinic... (like urgent care, for kids) and was diagnosed with a sinus infection. she was given antibiotics and sent home. though, at the clinic, she and her mom were asking for an IV.
"I know my kids, they crash fast. and this one, she'll perk right up when she gets filled up. I mean, I know they do it for athletes, it's not a big deal. She did this the last time too, and Lisa gave her an IV, and she popped right back up! We asked for an IV last night, but they wouldn't give her one."
I'm thinking, as she's saying this, "she does NOT need an IV. that's just a waste of time, money and resources. It's an unnecessary risk (albeit a small one) for a placebo effect, and to appease the mother and child. This is NOT a McDonald's... you can't just order what you want!"
Or, i guess you can.
i should have known... well i did know. but it bothers me.
So I present the patient to the preceptor and say that they came in with the hopes of getting an IV, anything less than that will leave them upset. So, we bolus the girl with 1 Liter of NS. the NON-dehydrated girl.... and all was well in their world. It's amazing how a liter of salt water can make a sinus infection better. i guess i should have checked UpToDate... it's the preferred treatment, after all!
well, i've made a short story long, but.... turns out, i like peds more than i thought i would. even despite some of the silliness that is made-to-order medicine. That's just the way it is, in every field. It's not Doctor knows best, it's, "what can I do for you today? no matter if it's unwise, dangerous or just silly, it's your care! let's do it!"
In my practice, I won't fold so easily, I won't enable this kind of behavior. But, I'm just a student in a 6 week rotation. I'm not out to change a practice. I'm just out to practice.
cn
Saturday, November 22, 2008
catlike speed and reflexes...
A naked baby is a dangerous baby. The business end is ready to blow at any time. It's simply frightening to see a diaperless baby for any length of time. When I do well child exams, I make sure to be quick when it comes to diaperless baby time. I'd rather not get pooped or peed on, if at all possible.
I am constantly reminded of the fragility of my non-poop-covered clothes. In pushing on a the belly of a little 2 month old the other day, I created such an uproar inside her, that a gurgle turned into a largre rumble and a quite adult sized fart.
Yes, we all had a good laugh, mom, myself and the child. but the consequenses would have been dire had she not been wearing that huggies. I was right in the line of fire.
But I'm really only fooling myself if I think I'm going to make it out unscathed. I've already been soiled in other rotations, and in this one. So what I should really be practicing (other than my body-washing technique) is my speed and reflexes.
Anticipate that the little baby boy is going to try pee on you when the flippin' thing is aiming right at you like a little flesh colored fire hose. (with seemingly the same amount of power. It could definetely clear a rowdy crowd nearly as well as the conventional fire hose.)
I need to know that blank look of confusion and anticipation that appears on the face of a snot covered three year old just before they sneeze right in your face. Cover up, be damned!
I need to be like Neo, in The Matrix, time needs to slow down, just a bit, for me. I need to recognize the signs of impending disgusting, and maneuver through the air in such a way to avoid all the contaminated fluid flying my way.
So here I come, with my catlike speed an reflexes, I'm betting this kid has strep, but to be sure I need to shove that horrible, long q-tip down his throat and make him gag.
I should get a face shield... like that of a fire-fighter.
I don't.
"Hey there you little germ monger... I"m gunna cram this thing down your throat, and it's gunna make you gag... I know, I know, it sucks. I HATED this as a kid, but it's quick, and then it's all done. Just try not to barf on me."
Now I don't say this, in so many words, but close. I'm definetely thinking it.
In goes the q-tip, and here comes the gag.... and an instantaneous cough... I feel my face peppered with spit.
crap.
shoulda worn the fire-fighter helmet.
4 mintues later, I find out that the cough shrapnal was indeed teeming with strep.
excellent.
I had already washed off my face, and hands.... but, alas, it was too late. the next day... with my sinuses plugged, sore throat, and headache, I headed back for more.
you got me, kid, you got me. if it wasn't you, it was one of the other 20 something i see per day. but you know what... I like it.
I just need to work on my matrix moves. I need to be more like Neo, and less like Chris Farley in 'Tommy Boy'.
"I was checking the a ... specs on the end line.... for the rotary...... girder. I'm retarded."
http://www.youtube.com/watch?v=K9mBn9bMB-g
I am constantly reminded of the fragility of my non-poop-covered clothes. In pushing on a the belly of a little 2 month old the other day, I created such an uproar inside her, that a gurgle turned into a largre rumble and a quite adult sized fart.
Yes, we all had a good laugh, mom, myself and the child. but the consequenses would have been dire had she not been wearing that huggies. I was right in the line of fire.
But I'm really only fooling myself if I think I'm going to make it out unscathed. I've already been soiled in other rotations, and in this one. So what I should really be practicing (other than my body-washing technique) is my speed and reflexes.
Anticipate that the little baby boy is going to try pee on you when the flippin' thing is aiming right at you like a little flesh colored fire hose. (with seemingly the same amount of power. It could definetely clear a rowdy crowd nearly as well as the conventional fire hose.)
I need to know that blank look of confusion and anticipation that appears on the face of a snot covered three year old just before they sneeze right in your face. Cover up, be damned!
I need to be like Neo, in The Matrix, time needs to slow down, just a bit, for me. I need to recognize the signs of impending disgusting, and maneuver through the air in such a way to avoid all the contaminated fluid flying my way.
So here I come, with my catlike speed an reflexes, I'm betting this kid has strep, but to be sure I need to shove that horrible, long q-tip down his throat and make him gag.
I should get a face shield... like that of a fire-fighter.
I don't.
"Hey there you little germ monger... I"m gunna cram this thing down your throat, and it's gunna make you gag... I know, I know, it sucks. I HATED this as a kid, but it's quick, and then it's all done. Just try not to barf on me."
Now I don't say this, in so many words, but close. I'm definetely thinking it.
In goes the q-tip, and here comes the gag.... and an instantaneous cough... I feel my face peppered with spit.
crap.
shoulda worn the fire-fighter helmet.
4 mintues later, I find out that the cough shrapnal was indeed teeming with strep.
excellent.
I had already washed off my face, and hands.... but, alas, it was too late. the next day... with my sinuses plugged, sore throat, and headache, I headed back for more.
you got me, kid, you got me. if it wasn't you, it was one of the other 20 something i see per day. but you know what... I like it.
I just need to work on my matrix moves. I need to be more like Neo, and less like Chris Farley in 'Tommy Boy'.
"I was checking the a ... specs on the end line.... for the rotary...... girder. I'm retarded."
http://www.youtube.com/watch?v=K9mBn9bMB-g
Thursday, October 9, 2008
no use for a name
day off tomorrow... gunna enjoy it.
also, working trauma makes me think of all the ways i could get hurt, and how incredibly lucky i am to NOT be hurt.
so, while i'll be having fun tomorrow... gunna step correctly.
later, monkeys.
cn
also, working trauma makes me think of all the ways i could get hurt, and how incredibly lucky i am to NOT be hurt.
so, while i'll be having fun tomorrow... gunna step correctly.
later, monkeys.
cn
Sunday, October 5, 2008
Vanilla Bear, loose in the hospital
I'm beginning to like hanging in the hospital with the folks in the ICU and TRACU.
Thrown into it on Monday, not knowing anything about the patients other than what I could extract from ridiculously sloppy notes; mostly illegible... well, it was tough. And I felt like I wasn't really taking care of these people, more than just hoping the attending didn't point out my inadequacies as a PA student. Hoping I wouldn't miss something that would hurt them, and make me look like the fool I feel in the process.
But now, I'm starting to get the feel of things here. I'm not making so many wrong turns in the hospital, which makes me look, and feel, less foolish.
I'm understanding how to pick apart the paper chart, and dig through the outdated electronic record, to find the information that I need.
I'm remembering people's names.... staff and patients alike.
I starting to feel like Vanilla Bear. I just need a Brown Bear to pal around with... would love to try world's most giant doctor.
I ran into a patient of mine in the hall... he's a wheeling-machine. He's recently become a paraplegic, which is sad, but he's got such a good attitude, and he's always rolling around the hospital, getting exercise and talking to folks. I stopped and talked with him for a bit, just made me like him more.
Then another patient of mine, a girl who is recovering from a traumatic brain injury.... she's becoming more and more lucent every day, and now has begun talking to me every morning when I round on her. The first day I saw her, she wouldn't say much at all, only a nod and a shake of the head here and there. She's one of my favorites. She can now rememer me... it really makes me happy to see her progressing so well. I saw her today the atrium (a sort of indoor courtyard, next to the coffee shop in the hospital,) as I meandered to the resident call room, and wanted to swing over and say hello... but it looked like she was with some family and friends, so I thought I'd leave them to their own devices. This was the first time she's been out of bed in about a week....
I guess what I've found out during this inpatient trauma rotation, is that I really like getting to know the patients, despite being under such less than ideal circumstances. Though, many of them have few places to go but up, and that's a great ascent to watch.
plus i got to pull a chest tube today, which really isn't anything, but it was fun...
"Mrs. America, are you ready?"
"I suppose...."
"Okay," I say, reassuringly.... "In just a second, I want you to take a deep breath, and hold it in. Then, I'm going to count to three. When I start counting, exhale. On three, I'm going to pull the tube out, okay?"
"Okay..." she says, nervously.
"Deep breath..." I coach.
She inhales as deeply as her broken ribs will allow.
"One........ TWO!" as I simultaneously pull the chest tube.
It sounds bad, right? well, I DID go on two, that's for sure. But that's how I was taught.
"Go on 'two' so they can't bear down, and make it harder to pull out, and do it fast. If you don't get blood on the wall, you pulled too slow." This coming from the resident.
I didn't get blood on the wall, but it was a big room.
cn
Thrown into it on Monday, not knowing anything about the patients other than what I could extract from ridiculously sloppy notes; mostly illegible... well, it was tough. And I felt like I wasn't really taking care of these people, more than just hoping the attending didn't point out my inadequacies as a PA student. Hoping I wouldn't miss something that would hurt them, and make me look like the fool I feel in the process.
But now, I'm starting to get the feel of things here. I'm not making so many wrong turns in the hospital, which makes me look, and feel, less foolish.
I'm understanding how to pick apart the paper chart, and dig through the outdated electronic record, to find the information that I need.
I'm remembering people's names.... staff and patients alike.
I starting to feel like Vanilla Bear. I just need a Brown Bear to pal around with... would love to try world's most giant doctor.
I ran into a patient of mine in the hall... he's a wheeling-machine. He's recently become a paraplegic, which is sad, but he's got such a good attitude, and he's always rolling around the hospital, getting exercise and talking to folks. I stopped and talked with him for a bit, just made me like him more.
Then another patient of mine, a girl who is recovering from a traumatic brain injury.... she's becoming more and more lucent every day, and now has begun talking to me every morning when I round on her. The first day I saw her, she wouldn't say much at all, only a nod and a shake of the head here and there. She's one of my favorites. She can now rememer me... it really makes me happy to see her progressing so well. I saw her today the atrium (a sort of indoor courtyard, next to the coffee shop in the hospital,) as I meandered to the resident call room, and wanted to swing over and say hello... but it looked like she was with some family and friends, so I thought I'd leave them to their own devices. This was the first time she's been out of bed in about a week....
I guess what I've found out during this inpatient trauma rotation, is that I really like getting to know the patients, despite being under such less than ideal circumstances. Though, many of them have few places to go but up, and that's a great ascent to watch.
plus i got to pull a chest tube today, which really isn't anything, but it was fun...
"Mrs. America, are you ready?"
"I suppose...."
"Okay," I say, reassuringly.... "In just a second, I want you to take a deep breath, and hold it in. Then, I'm going to count to three. When I start counting, exhale. On three, I'm going to pull the tube out, okay?"
"Okay..." she says, nervously.
"Deep breath..." I coach.
She inhales as deeply as her broken ribs will allow.
"One........ TWO!" as I simultaneously pull the chest tube.
It sounds bad, right? well, I DID go on two, that's for sure. But that's how I was taught.
"Go on 'two' so they can't bear down, and make it harder to pull out, and do it fast. If you don't get blood on the wall, you pulled too slow." This coming from the resident.
I didn't get blood on the wall, but it was a big room.
cn
Wednesday, October 1, 2008
Wednesday, September 10, 2008
Surf, Turf and Veins
I know it's been a while, I know. I don't feel like it so much, but it must be that I have less free time on this rotation than I did on the last. That being the case, my ramblings have been fewer and lower in quality and length.
don't judge me.
Let's bring you up to speed...
On the slave labor front, I've been in Cardiothoracic Surgery for 3 and a half weeks now, and love it. I'm still getting to do more and more everyday. I had no grand illusions that I would be doing too much during the actual surgery, I mean, it's heart surgery!
I knew I wouldn't be doing much more than watching and helping close at the end, if I was lucky. And I knew for certain that I wouldn't be harvesting the Great Saphenous vein for the graft conduits....
but then again, I've been doing much more than expected these past few weeks. After I finished helping Dr. Gately open, I switched sides to watch Alec take the saphenous vein. He was midway through, about at the point where he'd switch tips on the scope so he can cauterize any side-chains of the vein, and then extract it from the leg...
It was right then, in a moment of silence (save for the music playing in the background) that was shattered by Alec's voice, "Here, you do this. I'm bored." As he hands me the scope.
YES!
He wasn't bored, he was just being nice, giving me an opportunity to become familiar with the equipment. In the process, he made my day.
It came easy to me, it's like playing a video game. Just watch the screen, and react with your hands. It's like the medical nerd's version of Nintendo Wii. And we nerds happen to think it's much more fun.
So, in a nutshell, that's work lately.
On the extended work front, they let me attend a free (St. Jude Medical sponsored) dinner last night, (with a 'pro St. Jude prosthetic valve' lecture, of course.)
WORTH IT.
"I could get used to this." I thought while watching my free Fillet Mignon arrive to the table, preceded by appetizers, a salad, and followed by a wonderful dessert; homemade cheesecake and a chocolate ganash.
Apparently, El Gaucho is the most expensive steak house in the city. I can't tell you if this is true for certain, but the food sure made a case for that argument, as did the service. As soon as I walked into our private room, a man in a tuxedo asked if I'd like something to drink.
"Why yes I would, how about an IPA..."
It was a good evening.
Though I seem to be more busy this rotation, I did carve out time for fun this past weekend. I went surfing with my roommate, Ryan, near Canon beach on Saturday. It was a beautiful day at the coast, at least where we were. It was my first time surfing, and I did manage to catch quite a few waves. I'm hooked.
The only problem is that I must have zipped up my wetsuit with a kink in the neck somewhere, because it managed to rub off a good part of my skin on the back right side of my neck. It looks ridiculous, and kind of hurts still.
I hope it heals up enough by Saturday, cuz I'd love to go again.
That night I met up with a Minneapolis friend who was in town, and got to spend the next day with her too. Had a great time...
I guess that's all for now folks... I'm in need of food, and I think my chicken has got to be thawed by now.
Sorry for the lack of insight, wit, humor and life lesson... but I'm fresh outta those right now. Maybe later.
cn
don't judge me.
Let's bring you up to speed...
On the slave labor front, I've been in Cardiothoracic Surgery for 3 and a half weeks now, and love it. I'm still getting to do more and more everyday. I had no grand illusions that I would be doing too much during the actual surgery, I mean, it's heart surgery!
I knew I wouldn't be doing much more than watching and helping close at the end, if I was lucky. And I knew for certain that I wouldn't be harvesting the Great Saphenous vein for the graft conduits....
but then again, I've been doing much more than expected these past few weeks. After I finished helping Dr. Gately open, I switched sides to watch Alec take the saphenous vein. He was midway through, about at the point where he'd switch tips on the scope so he can cauterize any side-chains of the vein, and then extract it from the leg...
It was right then, in a moment of silence (save for the music playing in the background) that was shattered by Alec's voice, "Here, you do this. I'm bored." As he hands me the scope.
YES!
He wasn't bored, he was just being nice, giving me an opportunity to become familiar with the equipment. In the process, he made my day.
It came easy to me, it's like playing a video game. Just watch the screen, and react with your hands. It's like the medical nerd's version of Nintendo Wii. And we nerds happen to think it's much more fun.
So, in a nutshell, that's work lately.
On the extended work front, they let me attend a free (St. Jude Medical sponsored) dinner last night, (with a 'pro St. Jude prosthetic valve' lecture, of course.)
WORTH IT.
"I could get used to this." I thought while watching my free Fillet Mignon arrive to the table, preceded by appetizers, a salad, and followed by a wonderful dessert; homemade cheesecake and a chocolate ganash.
Apparently, El Gaucho is the most expensive steak house in the city. I can't tell you if this is true for certain, but the food sure made a case for that argument, as did the service. As soon as I walked into our private room, a man in a tuxedo asked if I'd like something to drink.
"Why yes I would, how about an IPA..."
It was a good evening.
Though I seem to be more busy this rotation, I did carve out time for fun this past weekend. I went surfing with my roommate, Ryan, near Canon beach on Saturday. It was a beautiful day at the coast, at least where we were. It was my first time surfing, and I did manage to catch quite a few waves. I'm hooked.
The only problem is that I must have zipped up my wetsuit with a kink in the neck somewhere, because it managed to rub off a good part of my skin on the back right side of my neck. It looks ridiculous, and kind of hurts still.
I hope it heals up enough by Saturday, cuz I'd love to go again.
That night I met up with a Minneapolis friend who was in town, and got to spend the next day with her too. Had a great time...
I guess that's all for now folks... I'm in need of food, and I think my chicken has got to be thawed by now.
Sorry for the lack of insight, wit, humor and life lesson... but I'm fresh outta those right now. Maybe later.
cn
Wednesday, September 3, 2008
it's just not in the air
It's awfully nice out today, or terribly nice out. Neither adjective seems to quite make sense when paired with 'nice' if you think about it. Terribly nice? Terrible? Well, who cares.... I guess I do, since I'm writing about it.
Anywho, it's fantastically nice out, and I'd very much like to be playing some badmitten in the backyard, or throwing a frisbee around in the park. But, as it turns out, we're all too busy to partake in these types of afternoon adventures. Instead our adventures consist of staring out the window from time to time while reading about all the things that we didn't quite grasp during the 'work day'.... or the 'getting WORKED day.'
At least I have some nice scenery to gaze at.
AND
At least I'm still really diggin' my rotation. I could really see myself working here. It's totally radical.
But, man, I really wanna work on my frisbee toss... or my golf swing.
maybe this weekend.
Anywho, it's fantastically nice out, and I'd very much like to be playing some badmitten in the backyard, or throwing a frisbee around in the park. But, as it turns out, we're all too busy to partake in these types of afternoon adventures. Instead our adventures consist of staring out the window from time to time while reading about all the things that we didn't quite grasp during the 'work day'.... or the 'getting WORKED day.'
At least I have some nice scenery to gaze at.
AND
At least I'm still really diggin' my rotation. I could really see myself working here. It's totally radical.
But, man, I really wanna work on my frisbee toss... or my golf swing.
maybe this weekend.
Thursday, August 28, 2008
chasing the wind with suture
i like CT surgery.
i like the people there.
I like that they're letting me do things.
I like that the things get to be more and more each day.
I like that I'm learning copious amounts of information, in and out of surgery.
I like that Dr. Swanson made a comment about something I don't remember, but it went something like this...
"It's like suturing farts to moonbeams."
I like it all.
i like the people there.
I like that they're letting me do things.
I like that the things get to be more and more each day.
I like that I'm learning copious amounts of information, in and out of surgery.
I like that Dr. Swanson made a comment about something I don't remember, but it went something like this...
"It's like suturing farts to moonbeams."
I like it all.
Thursday, August 21, 2008
attack! heart...
it's a sabbatical of sorts that I've been on... for the first two weeks of August anyway.
The first week was spent on a midwest tour with friends and family, which was jam-packed full of fun.... and went by too quickly. The second was spent with my classmates here in Portland, and too, went far too quickly. Both were quite enjoyable.
In stark contrast, for the past week i feel as if I'm living in the hospital. I suppose, for me, there would be worse places to live. Unlike most people, (normal people), I like the hospital. I don't mean that I enjoy being in one myself, sick or injured, or visiting a loved one... but for a place to work... it's great.
I love a big hospital, one you can get lost in.... it's simply wonderful. Cafeterias are open practically all night, the crew that is up late with the cafeterias is even more cool than getting a burger at 4 AM. and the nurses.... OOOOOOOOO.... beautiful. Is it a requirement? I'm not sure... but I approve.
The big hospitals are always so new, clean and modern. You can walk around just about anywhere when you're wearing scrubs and a white coat.... it's amazing. You'd be surprised at the areas that you can get into by just dressing and acting the part. I guess it's kind of scary. I think though, it's just the white coat that affords me such range in the hospital.... Nurses thell me things about their patients as if I'm some sort of authority. I'm not.
It's great.
well... whatever the reason is, I like my new domain. I feel at home.
So it was in this domain that I've been roaming the past 4 days. Doing rounds at 6 AM until 7... then in Surgery from 7 until around 5 PM, then more rounds until about 6 or 7.... I'm getting the hang of things now, in and out of the surgical suite. And so far, people have been great. The PA I've been working with is a smart guy, and a good teacher. The Surgeon is appoachable, friendly and sarcastic. And best yet, he's a Packer fan. He was born and rasied in Madison Wisconsin, where I just so hppened to go toundergrad. (it's nice to have something in common with your preceptor.)
So, everyone there has been in good spirits the past week, despite being awfully busy... jokes are constantly being cracked during surgery, even by the surgeon. I suppose a happy, even relaxed work environment is a good one, even if you are operating on someone's heart. Though, the juxtaposition of the gravity of heart surgery with the levity of off color humor, that comes as easily as at your favorite bar's happy hour, well.... it's interesting. I don't know how to describe the scene, and the feeling that accompanies it. To the person who is not in the medical profession, it may seem crass, but it's not. Maybe it's how we distance ourselves, maybe it's just a different breed of people who end up in surgical gowns for a living, or maybe it goes to show that no matter what carreer you create for yourself (even one as consequential as heart surgery)... there will always be room for dirty jokes, to break the silence and repition of the day to day routine. Because even with heart surgery, there is routine, there is boredom, there is repitition and there is a need for a laugh.
It's odd that this type of silliness can occur during such a serious, delicate and life threatening surgery, but it does.
It was on day three where I, almost unwillingly.... or maybe, well.... my mouth was ahead of my mind when i jumped in neck first. For it could have been my neck that was on the line if my comment didn't fly with the surgeon.
I was assissting with an AVR (aortic valve replacement), and at one point there are about 36 sutures, or long strings being tied and thrown over the open chest cavity where they will wait to be cut by him upon finishing all the knots. So I was at one of three spots where these groups of ties would be flung. Somone will corral the tosses (which are usually dead on, the surgeon has done this hundreds of times, if not thousands) and then give them back to the doc when he is ready. So, just as he's about to toss the first suture my way, he asks...
"Did you play any sports, Chris?"
"Yeah..."
"What did you play?" he asks as he flings the first suture towards my open hand. It lands perfectly in my palm. I fold my thumb over the sterile white thread that would hold this man's new valve in place.
"Baseball and football," I reply.
He flings another thread at me, which misses my motionless hand.
"Well why didn't you catch that one?!?!" He shoots sarcastically.
'Mess with the newguy huh? Well two can play at that game sir! You may be a surgeon, and he's only a PA student, and this may only be his third day.... and, sure, you hardly know him, so maybe this will crash and burn... but I am Chris' BRAIN, and sometimes I work quickly (not often) but today, possibly to Chris' dismay... I will defend him! I will show you how witty I can BE! I won't take your Tom-Foolery lying down! If you wanna fling one my way, I'll toss one right back I'll just go ahead and bypass Chris' good sense here..... and take THIS!'
Now, I didn't hear this going on in my head, I didn't even think it.... All I heard was what came out.... and I remember thinking, mid sentence.... 'oooooooohhhhhh, maybe shouldn't have said that... hope it goes over well.'
............
"Well why didn't you catch that one?!?!" said the lifelong Packer fan.
"It was a classic Brett Favre underthrow!" I bite back, quickly (too quickly.)
It seemed like forever from when the first word left my lips, to the terrifying thought of the surgeon slicing my heart out in less than 4 strokes, to the burst of laughter that came from not only the surgeon, but the rest of the crew.
WHEW!
It didn't take forever, and the only akward silence was in my mind. In actuality, I think he liked the bantor, and realized I was just zinging him back for zinging me. It's all in good nature, and we all know it. At least, I knew it for sure after the Brett Favre comment.
Meanwhile, during the stand-up comedy going on, the patient's heart is completely stopped, as well as their lungs... Their chest is spread open about 8 inches, they're hypothermic, they have tubes going in and out of their heart, face, neck, wrist, and urethra, and the biggest artery in their body is sliced wide open. By all means, they shouldn't be alive... and they kind of aren't.
It's like a mullet in reverse.
All business down low, and a party up front. Strange.
anyway...... that's all for now, I'm tired, and I'm hungry, and I need to learn more about heart surgery.
see you all later rather than sooner, and this is something i regret.
cn
The first week was spent on a midwest tour with friends and family, which was jam-packed full of fun.... and went by too quickly. The second was spent with my classmates here in Portland, and too, went far too quickly. Both were quite enjoyable.
In stark contrast, for the past week i feel as if I'm living in the hospital. I suppose, for me, there would be worse places to live. Unlike most people, (normal people), I like the hospital. I don't mean that I enjoy being in one myself, sick or injured, or visiting a loved one... but for a place to work... it's great.
I love a big hospital, one you can get lost in.... it's simply wonderful. Cafeterias are open practically all night, the crew that is up late with the cafeterias is even more cool than getting a burger at 4 AM. and the nurses.... OOOOOOOOO.... beautiful. Is it a requirement? I'm not sure... but I approve.
The big hospitals are always so new, clean and modern. You can walk around just about anywhere when you're wearing scrubs and a white coat.... it's amazing. You'd be surprised at the areas that you can get into by just dressing and acting the part. I guess it's kind of scary. I think though, it's just the white coat that affords me such range in the hospital.... Nurses thell me things about their patients as if I'm some sort of authority. I'm not.
It's great.
well... whatever the reason is, I like my new domain. I feel at home.
So it was in this domain that I've been roaming the past 4 days. Doing rounds at 6 AM until 7... then in Surgery from 7 until around 5 PM, then more rounds until about 6 or 7.... I'm getting the hang of things now, in and out of the surgical suite. And so far, people have been great. The PA I've been working with is a smart guy, and a good teacher. The Surgeon is appoachable, friendly and sarcastic. And best yet, he's a Packer fan. He was born and rasied in Madison Wisconsin, where I just so hppened to go toundergrad. (it's nice to have something in common with your preceptor.)
So, everyone there has been in good spirits the past week, despite being awfully busy... jokes are constantly being cracked during surgery, even by the surgeon. I suppose a happy, even relaxed work environment is a good one, even if you are operating on someone's heart. Though, the juxtaposition of the gravity of heart surgery with the levity of off color humor, that comes as easily as at your favorite bar's happy hour, well.... it's interesting. I don't know how to describe the scene, and the feeling that accompanies it. To the person who is not in the medical profession, it may seem crass, but it's not. Maybe it's how we distance ourselves, maybe it's just a different breed of people who end up in surgical gowns for a living, or maybe it goes to show that no matter what carreer you create for yourself (even one as consequential as heart surgery)... there will always be room for dirty jokes, to break the silence and repition of the day to day routine. Because even with heart surgery, there is routine, there is boredom, there is repitition and there is a need for a laugh.
It's odd that this type of silliness can occur during such a serious, delicate and life threatening surgery, but it does.
It was on day three where I, almost unwillingly.... or maybe, well.... my mouth was ahead of my mind when i jumped in neck first. For it could have been my neck that was on the line if my comment didn't fly with the surgeon.
I was assissting with an AVR (aortic valve replacement), and at one point there are about 36 sutures, or long strings being tied and thrown over the open chest cavity where they will wait to be cut by him upon finishing all the knots. So I was at one of three spots where these groups of ties would be flung. Somone will corral the tosses (which are usually dead on, the surgeon has done this hundreds of times, if not thousands) and then give them back to the doc when he is ready. So, just as he's about to toss the first suture my way, he asks...
"Did you play any sports, Chris?"
"Yeah..."
"What did you play?" he asks as he flings the first suture towards my open hand. It lands perfectly in my palm. I fold my thumb over the sterile white thread that would hold this man's new valve in place.
"Baseball and football," I reply.
He flings another thread at me, which misses my motionless hand.
"Well why didn't you catch that one?!?!" He shoots sarcastically.
'Mess with the newguy huh? Well two can play at that game sir! You may be a surgeon, and he's only a PA student, and this may only be his third day.... and, sure, you hardly know him, so maybe this will crash and burn... but I am Chris' BRAIN, and sometimes I work quickly (not often) but today, possibly to Chris' dismay... I will defend him! I will show you how witty I can BE! I won't take your Tom-Foolery lying down! If you wanna fling one my way, I'll toss one right back I'll just go ahead and bypass Chris' good sense here..... and take THIS!'
Now, I didn't hear this going on in my head, I didn't even think it.... All I heard was what came out.... and I remember thinking, mid sentence.... 'oooooooohhhhhh, maybe shouldn't have said that... hope it goes over well.'
............
"Well why didn't you catch that one?!?!" said the lifelong Packer fan.
"It was a classic Brett Favre underthrow!" I bite back, quickly (too quickly.)
It seemed like forever from when the first word left my lips, to the terrifying thought of the surgeon slicing my heart out in less than 4 strokes, to the burst of laughter that came from not only the surgeon, but the rest of the crew.
WHEW!
It didn't take forever, and the only akward silence was in my mind. In actuality, I think he liked the bantor, and realized I was just zinging him back for zinging me. It's all in good nature, and we all know it. At least, I knew it for sure after the Brett Favre comment.
Meanwhile, during the stand-up comedy going on, the patient's heart is completely stopped, as well as their lungs... Their chest is spread open about 8 inches, they're hypothermic, they have tubes going in and out of their heart, face, neck, wrist, and urethra, and the biggest artery in their body is sliced wide open. By all means, they shouldn't be alive... and they kind of aren't.
It's like a mullet in reverse.
All business down low, and a party up front. Strange.
anyway...... that's all for now, I'm tired, and I'm hungry, and I need to learn more about heart surgery.
see you all later rather than sooner, and this is something i regret.
cn
Monday, July 28, 2008
I must have done something right...
Today was a good day...
"Do you want to do your evaluation now?"
"Sure." I say kind of excitedly.
I'm sort of like Angela from 'The Office' in that I think I thrive on being judged. It's not something I'm proud of, but it's sort of true. I think it stems from the fact that I feel it necessary to continually prove my worthiness as a PA student because of my less than stellar Undergrad grades.
Let's just say I pulled down my class average.
So, from that point on, I worked hard to make sure that any judgement passed upon me, as a PA student, would be positive. And if it's not, then I deserve that too... and I can take it and make the necessary changes to become the best PA I can be.
So, Bring it on Kalauawa... bring it.
I guess it's unfair for me to say that I had worry running through my mind, he had already said that he'd given me a good review, and I was one of the best students to come through the joint. (wow... I've got him fooled!) And I must say, that made my day.... REALLY made my day.
don't let it go to your head, dummy. you still have it in your amazing screw-up power to SCREW IT UP.
So I followed him down the hall to his office. I have a seat in an old wooden chair. It matches the rest of the clinic perfectly, in that it appears old, worn and unimpressive. But once I get into it, once I give it the smallest chance, I love it. It's as comfortable as any office chair I've ever sat in. It exceeds expectations.
Before I can even get a word out....
"Off the record, I think all this stuff going on between the Vikings, the Packers and Favre is crazy. They're all talking to eachother... I think Favre will end up with the Vikings."
(He is a huge Vikings fan.)
This is NOT the first time we've talked football, and this conversation lasts a few minutes. When it's over, both agree that if Favre can't play in Green Bay (which we both think is the right thing to do) that we want him to play for Minnesota.
He then, sans segway... save maybe a little sigh fading from the tail end of a laugh, shows me my ratings.... all above average, except for one, which is average. He tells me this is the best rating he thinks he's ever given. He gives an 'average' rating if you are where he expects for you to be, as a competent student.
Now, at my last rotation, I received all 'Superior' ratings... but that was kind of meaningless. They didn't put the time and effort into it that Dr. K did. I think they just liked me. Not that I did poorly, they told me that I did well, but I doubt that I was 'Superior' in all aspects of the rotation.
Whatever the case may have been then, after hearing Dr. Kalauawa's review of my performance, I'm flattered, happy, proud... and feel like a fraud - all at the same time. I think they're all valid things to be feeling at the time. This, I've decided after more than a few minutes to think on it.
But then came the whammy...
"So what I'm saying is that when you're looking for a job, if you want, you've got one here."
I'm speechless, really. They told us at school,before the shoved us outta the nest, that this might happen, and yet, I was not expecting it.... not at all.
"Wow, thank you! That REALLY means a lot to me."
As one of my old stand-by bands, Relient K, once said, "I must have done something right..."
Shoot....
it did occur to me that maybe he says the same dang thing to everyone who rolls through threre, but hey... it made my day none the less.
Now I just have to finish my flippin' geriatric mental health case study thing..........ughh. did the day just get worse?
"Do you want to do your evaluation now?"
"Sure." I say kind of excitedly.
I'm sort of like Angela from 'The Office' in that I think I thrive on being judged. It's not something I'm proud of, but it's sort of true. I think it stems from the fact that I feel it necessary to continually prove my worthiness as a PA student because of my less than stellar Undergrad grades.
Let's just say I pulled down my class average.
So, from that point on, I worked hard to make sure that any judgement passed upon me, as a PA student, would be positive. And if it's not, then I deserve that too... and I can take it and make the necessary changes to become the best PA I can be.
So, Bring it on Kalauawa... bring it.
I guess it's unfair for me to say that I had worry running through my mind, he had already said that he'd given me a good review, and I was one of the best students to come through the joint. (wow... I've got him fooled!) And I must say, that made my day.... REALLY made my day.
don't let it go to your head, dummy. you still have it in your amazing screw-up power to SCREW IT UP.
So I followed him down the hall to his office. I have a seat in an old wooden chair. It matches the rest of the clinic perfectly, in that it appears old, worn and unimpressive. But once I get into it, once I give it the smallest chance, I love it. It's as comfortable as any office chair I've ever sat in. It exceeds expectations.
Before I can even get a word out....
"Off the record, I think all this stuff going on between the Vikings, the Packers and Favre is crazy. They're all talking to eachother... I think Favre will end up with the Vikings."
(He is a huge Vikings fan.)
This is NOT the first time we've talked football, and this conversation lasts a few minutes. When it's over, both agree that if Favre can't play in Green Bay (which we both think is the right thing to do) that we want him to play for Minnesota.
He then, sans segway... save maybe a little sigh fading from the tail end of a laugh, shows me my ratings.... all above average, except for one, which is average. He tells me this is the best rating he thinks he's ever given. He gives an 'average' rating if you are where he expects for you to be, as a competent student.
Now, at my last rotation, I received all 'Superior' ratings... but that was kind of meaningless. They didn't put the time and effort into it that Dr. K did. I think they just liked me. Not that I did poorly, they told me that I did well, but I doubt that I was 'Superior' in all aspects of the rotation.
Whatever the case may have been then, after hearing Dr. Kalauawa's review of my performance, I'm flattered, happy, proud... and feel like a fraud - all at the same time. I think they're all valid things to be feeling at the time. This, I've decided after more than a few minutes to think on it.
But then came the whammy...
"So what I'm saying is that when you're looking for a job, if you want, you've got one here."
I'm speechless, really. They told us at school,before the shoved us outta the nest, that this might happen, and yet, I was not expecting it.... not at all.
"Wow, thank you! That REALLY means a lot to me."
As one of my old stand-by bands, Relient K, once said, "I must have done something right..."
Shoot....
it did occur to me that maybe he says the same dang thing to everyone who rolls through threre, but hey... it made my day none the less.
Now I just have to finish my flippin' geriatric mental health case study thing..........ughh. did the day just get worse?
Saturday, July 26, 2008
a serious case of the spins...
Just a few things I'd like to mention to whoever might be reading this....
1. I made pasta tonight for dinner, and made a nice little white sauce to go with it. It ended up tasting pretty good, but my foot paid the price.
I feel like Michael Scott; I burned my foot in a cooking accident. Really.
I can't say I did it by stepping on a George Foreman grill, or that I'm wearing bubble wrap on it.... or best yet, that I tried to stick it in a CT scanner while a friend of mine was having his head checked out, but it happened. I was busy chopping garlic with that crazy Emeril chef guy... and before I knew it, my pan was HOT, and the olive oil was smoking... so I turned it down a bit, and realized I might need a BIT more olive oil. So I went to pour a bit more on there....
Well, I must have been going for a long distance pouring record, subconsciously... because the force that the oil built up on its seemingly endless fall to the screamingly hot pain was enough to send smoking hot oil flying from the pan, to the top of my unsuspecting left foot.
Poor left foot, he was just down there, minding his foot business... keeping me properly balanced on the floor... maybe he was even enjoying being naked... who knows! (I bet he was) Well, if he WAS, he must have quickly wished that he had been wearing his ol' buddy socks and shoes as soon as that soaring glob of pain found its way to the top of his bare skin.
I think I heard him call out in pain....
He's been bathing in ice for a while now.... and feeling better.
2. I watched a homeless guy spin circles in the park yesterday.
He would spin counter-clockwise for about 3 or 4 minutes, occasionally slowing down just a bit so he could take a drag off his cigarette, then he would start spinning clockwise for another 3 or 4 minutes.
His footwork was amazing.... and so was his whole ensemble.
He was wearing some fire engine red shorts, they looked like swim trunks, and were a little too short. He accompanied these with white socks up to mid calf and then some classic tennis shoes. He, of course, was shirtless. and this 60-something must have been in the midst of some massive beard-off with a friend or two of his... because this thing was amazing... almost as amazing as his equally long hair, which only paled in comparison to his spin moves.
Tony Hawk, watch out! A 1080 is child's play.
Once he was done spinning, he quickly started talking, to, well... nobody. but his hand gestures were grand, as if he were in some sort of terribly heated debate. They were swaying this way, and that. Up in the air, over his head as if appalled. Then he'd point with his right hand, still clasping cigarette, as if to accuse his adversary of some terrible deed.
I'd look to where his gaze and hand gestures were landing. I only saw birds.
Those birds must have really done something to deserve the tongue lashing that they were getting from this guy.
They didn't seem too scared.
3. DVT guy still has not gotten all his results back yet. We still don't know why he made a massive clot. Which brings me to my next point; I made my first house call the other day. I went to DVT guy's house and checked up on him, his leg, his heart and lungs. The clot did move up a bit, according to the second ultrasound, but it sure isn't in his lung. But his leg is awfully swollen (for you nerds, it's about 2+ pitting edema) and it's still hurting him. poor fella.
Hope that all gets resolved soon.
4. Anyway friends, I don't like any of you, not even a little bit, and I'm certainly not excited to see you all very soon. Nope, not excited at all.
P.S. Figure out which one is the lie.
1. I made pasta tonight for dinner, and made a nice little white sauce to go with it. It ended up tasting pretty good, but my foot paid the price.
I feel like Michael Scott; I burned my foot in a cooking accident. Really.
I can't say I did it by stepping on a George Foreman grill, or that I'm wearing bubble wrap on it.... or best yet, that I tried to stick it in a CT scanner while a friend of mine was having his head checked out, but it happened. I was busy chopping garlic with that crazy Emeril chef guy... and before I knew it, my pan was HOT, and the olive oil was smoking... so I turned it down a bit, and realized I might need a BIT more olive oil. So I went to pour a bit more on there....
Well, I must have been going for a long distance pouring record, subconsciously... because the force that the oil built up on its seemingly endless fall to the screamingly hot pain was enough to send smoking hot oil flying from the pan, to the top of my unsuspecting left foot.
Poor left foot, he was just down there, minding his foot business... keeping me properly balanced on the floor... maybe he was even enjoying being naked... who knows! (I bet he was) Well, if he WAS, he must have quickly wished that he had been wearing his ol' buddy socks and shoes as soon as that soaring glob of pain found its way to the top of his bare skin.
I think I heard him call out in pain....
He's been bathing in ice for a while now.... and feeling better.
2. I watched a homeless guy spin circles in the park yesterday.
He would spin counter-clockwise for about 3 or 4 minutes, occasionally slowing down just a bit so he could take a drag off his cigarette, then he would start spinning clockwise for another 3 or 4 minutes.
His footwork was amazing.... and so was his whole ensemble.
He was wearing some fire engine red shorts, they looked like swim trunks, and were a little too short. He accompanied these with white socks up to mid calf and then some classic tennis shoes. He, of course, was shirtless. and this 60-something must have been in the midst of some massive beard-off with a friend or two of his... because this thing was amazing... almost as amazing as his equally long hair, which only paled in comparison to his spin moves.
Tony Hawk, watch out! A 1080 is child's play.
Once he was done spinning, he quickly started talking, to, well... nobody. but his hand gestures were grand, as if he were in some sort of terribly heated debate. They were swaying this way, and that. Up in the air, over his head as if appalled. Then he'd point with his right hand, still clasping cigarette, as if to accuse his adversary of some terrible deed.
I'd look to where his gaze and hand gestures were landing. I only saw birds.
Those birds must have really done something to deserve the tongue lashing that they were getting from this guy.
They didn't seem too scared.
3. DVT guy still has not gotten all his results back yet. We still don't know why he made a massive clot. Which brings me to my next point; I made my first house call the other day. I went to DVT guy's house and checked up on him, his leg, his heart and lungs. The clot did move up a bit, according to the second ultrasound, but it sure isn't in his lung. But his leg is awfully swollen (for you nerds, it's about 2+ pitting edema) and it's still hurting him. poor fella.
Hope that all gets resolved soon.
4. Anyway friends, I don't like any of you, not even a little bit, and I'm certainly not excited to see you all very soon. Nope, not excited at all.
P.S. Figure out which one is the lie.
Thursday, July 17, 2008
thumbs down...
The thing that I do like about Internal Medicine, or Family Practice, is that I get to see the end of the story, instead of being left with endless cliffhangers like in the ER.
It was always like I got to watch half of a movie, and just when it was getting good, just when I was hooked, some jerk turned off the TV... or the sattelite cut out, or the DVD was scratched beyond repair. I once actually had lightning strike right outside the door of my place where I was watching a movie, not 20 feet away. It fried the VHS right in the VCR. (yea, it was in the VHS days.) That was a serious let down... what happened to the protagonist? did he get the girl? did he achieve his seemingly impossible dream? did he survive the barrage at Bastogne? who knows..... and now that the tape's fried, you're not gunna.
well, that's how it often was in the ER. we could often figure things out, stabilize and such. but even with a diagnosis, there was often further workup and treatment. I never knew what happened to these folks. Did the guy with the AAA we found make it through surgery? Did the lady in DKA ever get out of the ICU? well, who knows... so pop in another movie... 37 yowm, overdose, just barely breathing...... wonder how this one will end. however it ends, i'll never know.
But in the clinic, I get to see page one to page done. well, at least for certain things. Diabetes isn't ever going to just end... COPD... these things go on, but there are tenable endpoints and concrete answers to certain questions here.
Take for example my 31 year old male who came in a few days ago for leg pain. He had run home from work a few days ago, and woke up the next morning with what he said felt like a pulled groin. So he'd been trying to take it easy, but still had been going to work where he's on his feet all day. So now his calf and part of his hamstring were bothering him. He figured he'd been sort of compensating for his hurt groin... walking differently, using different muscle groups.
Well, this sounded about right to me. His history sure made sense for this, and his physical was pretty normal, his calf was awfully tender to palpation though... awfully tender. and is that R calf looking a bit larger than the L? hmmm.
I go back and talk to my preceptor, who's an awfully good PA, and told her what I found on HX and PE. I told her what I thought it was, most likely, and what I wanted to do. (On a sort of side note, she asked me what I thought about Homan's sign, and I said it was bogus... that it had a low specificity and sensitivity, so I didn't do it. Thank you Prof. Randolph.)
So we go back in there and tell him that we are going to give him something for the pain, that it's most likely a musculoskeletal injury like he thought. We went on to tell him that to be on the safe side, we wanted to send him for a right leg ultrosound to rule out a DVT.
Tick, tock.... tick, tock.
A few more minutes pass in the movie.... our protagonist is off to battle.
A few more minutes elapse on the DVD.... (2 days pass) and our hero returns.... I see him limping through the waiting area. It seems his wounds aren't yet healed.
He arrives to the nurses station, looks over at me, and after a smile and "Hey!" from me, he smiles back, but gives me a double thumbs down as he shakes his head.
I already know what has happened.
"Not good news, huh..." I sigh.
"Nope." he replies, with a sort of sad smile.
"I'll be in to talk to you in a minute."
It turns out that our friend did actually have a popliteal DVT. Which explains the extreme tenderness to palpation of his calf, worse as you neared the popliteal fossa. It also explains why his right calf appeared a bit more swollen than his left.
He had already been started on Lovenox the day prior, right when he got the diagnosis (an anti-coagulant for you non-geeks.) and he was here for another round of shots, 80 mg subQ of Lovenox. We also started him on Coumadin (another anti-coagulant, but one you can take in pill form.) so we could get him off the heparin in a week or so, once the Coumadin was in its therapeudic range.
He's only 31 years old, a 5 pack year smoking history, (a kind of wimpy smoking history). NO other risk factors for DVT. This meant that our movie is not quite near the end.
We needed to do some more looking.... this meant bloodwork for things that could cause a hypercoagulable state, one of the most likely being a coagulation cascade factor mutation called Factor V Leiden. So we got more blood from him, sent it off to lab, and sent him home.
The story will continue tomorrow.
Lets pray this isn't a 'Lord of the Rings' trilogy... Let's pray it's a shorter movie... shorter is better for this hero. Lets pray that this movie ends with a Factor V problem, he can live with this. If everything comes back clean, and the movie gets longer, it's because we need to go cancer hunting... I don't want to go cancer hunting.
I'm in the mood for a good thriller of a movie, some mystery, some suspense... but I'm a sucker for a happy ending. I live for the happy ending.
I'll let you know if this has a happy ending. But at least I get to see the rest of this movie, because I'm hooked.
*the previous story is HIPAA compliant. names have been excluded, dates, sexes, ages and such have been changed to protect the innocent. (and they always will be on this blog.)*
It was always like I got to watch half of a movie, and just when it was getting good, just when I was hooked, some jerk turned off the TV... or the sattelite cut out, or the DVD was scratched beyond repair. I once actually had lightning strike right outside the door of my place where I was watching a movie, not 20 feet away. It fried the VHS right in the VCR. (yea, it was in the VHS days.) That was a serious let down... what happened to the protagonist? did he get the girl? did he achieve his seemingly impossible dream? did he survive the barrage at Bastogne? who knows..... and now that the tape's fried, you're not gunna.
well, that's how it often was in the ER. we could often figure things out, stabilize and such. but even with a diagnosis, there was often further workup and treatment. I never knew what happened to these folks. Did the guy with the AAA we found make it through surgery? Did the lady in DKA ever get out of the ICU? well, who knows... so pop in another movie... 37 yowm, overdose, just barely breathing...... wonder how this one will end. however it ends, i'll never know.
But in the clinic, I get to see page one to page done. well, at least for certain things. Diabetes isn't ever going to just end... COPD... these things go on, but there are tenable endpoints and concrete answers to certain questions here.
Take for example my 31 year old male who came in a few days ago for leg pain. He had run home from work a few days ago, and woke up the next morning with what he said felt like a pulled groin. So he'd been trying to take it easy, but still had been going to work where he's on his feet all day. So now his calf and part of his hamstring were bothering him. He figured he'd been sort of compensating for his hurt groin... walking differently, using different muscle groups.
Well, this sounded about right to me. His history sure made sense for this, and his physical was pretty normal, his calf was awfully tender to palpation though... awfully tender. and is that R calf looking a bit larger than the L? hmmm.
I go back and talk to my preceptor, who's an awfully good PA, and told her what I found on HX and PE. I told her what I thought it was, most likely, and what I wanted to do. (On a sort of side note, she asked me what I thought about Homan's sign, and I said it was bogus... that it had a low specificity and sensitivity, so I didn't do it. Thank you Prof. Randolph.)
So we go back in there and tell him that we are going to give him something for the pain, that it's most likely a musculoskeletal injury like he thought. We went on to tell him that to be on the safe side, we wanted to send him for a right leg ultrosound to rule out a DVT.
Tick, tock.... tick, tock.
A few more minutes pass in the movie.... our protagonist is off to battle.
A few more minutes elapse on the DVD.... (2 days pass) and our hero returns.... I see him limping through the waiting area. It seems his wounds aren't yet healed.
He arrives to the nurses station, looks over at me, and after a smile and "Hey!" from me, he smiles back, but gives me a double thumbs down as he shakes his head.
I already know what has happened.
"Not good news, huh..." I sigh.
"Nope." he replies, with a sort of sad smile.
"I'll be in to talk to you in a minute."
It turns out that our friend did actually have a popliteal DVT. Which explains the extreme tenderness to palpation of his calf, worse as you neared the popliteal fossa. It also explains why his right calf appeared a bit more swollen than his left.
He had already been started on Lovenox the day prior, right when he got the diagnosis (an anti-coagulant for you non-geeks.) and he was here for another round of shots, 80 mg subQ of Lovenox. We also started him on Coumadin (another anti-coagulant, but one you can take in pill form.) so we could get him off the heparin in a week or so, once the Coumadin was in its therapeudic range.
He's only 31 years old, a 5 pack year smoking history, (a kind of wimpy smoking history). NO other risk factors for DVT. This meant that our movie is not quite near the end.
We needed to do some more looking.... this meant bloodwork for things that could cause a hypercoagulable state, one of the most likely being a coagulation cascade factor mutation called Factor V Leiden. So we got more blood from him, sent it off to lab, and sent him home.
The story will continue tomorrow.
Lets pray this isn't a 'Lord of the Rings' trilogy... Let's pray it's a shorter movie... shorter is better for this hero. Lets pray that this movie ends with a Factor V problem, he can live with this. If everything comes back clean, and the movie gets longer, it's because we need to go cancer hunting... I don't want to go cancer hunting.
I'm in the mood for a good thriller of a movie, some mystery, some suspense... but I'm a sucker for a happy ending. I live for the happy ending.
I'll let you know if this has a happy ending. But at least I get to see the rest of this movie, because I'm hooked.
*the previous story is HIPAA compliant. names have been excluded, dates, sexes, ages and such have been changed to protect the innocent. (and they always will be on this blog.)*
Wednesday, July 16, 2008
what's in a number?
I've spent a good part of my day today crunching numbers. So now, my head hurts... oh, not because of the numbers, or the math.
I'm a math-a-magician. echem... right. My head hurts because I smacked it on a cupboard as I was standing up to put a pan on the stove.
BAM!
"Not now, Emeril! I just hit my head you JERK! and always with the 'bamming' and all the food.... ugh!"
that's beside the point, I'll survive, and I won't even have a mark to show for it.... but the point is this.
I don't have one.
At least I don't have one anymore, maybe I did when I started... but I've forgotten now. Maybe I'm tired, it's tough to sleep when a jerk Chef is always yelling and cooking and going on and on about garlic into the wee hours of the night. Or maybe my head is hurt worse than I thought.
In any case, I'm out of words for the night. More to come later...
love.
I'm a math-a-magician. echem... right. My head hurts because I smacked it on a cupboard as I was standing up to put a pan on the stove.
BAM!
"Not now, Emeril! I just hit my head you JERK! and always with the 'bamming' and all the food.... ugh!"
that's beside the point, I'll survive, and I won't even have a mark to show for it.... but the point is this.
I don't have one.
At least I don't have one anymore, maybe I did when I started... but I've forgotten now. Maybe I'm tired, it's tough to sleep when a jerk Chef is always yelling and cooking and going on and on about garlic into the wee hours of the night. Or maybe my head is hurt worse than I thought.
In any case, I'm out of words for the night. More to come later...
love.
Thursday, July 10, 2008
it's hammer time...
today, while at my favorite subject (unmolested the entire time) I was quite entertained for precisely 60 seconds.
I was sitting at a small table, in the shade, between the beach and the utlra-wide sidewalk to accomodate all the tourists. It seems to me that this sidewalk is, at least at high tide, wider than the actual beach at Waikiki. It's not that the sidewalk is that incredibly wide, but it's that the beach is excessively narrow. (Waikiki Beach is actually not all that impressive in 'Beach Quality.' It IS however, quite high in 'People Quality.') There are MANY people, too many people in my opinion. To lay on Waikiki Beach and try to get some sun seems to remind me of the national geographic channel. I mean that these people remind me of Elephant Seals, splayed out in, often times, disgusting positions, sweating on and snarling at those who come too close to their space; which is everyone. There isn't a grain of sand that goes untouched in any given day. This is good for people watching from the sidelines, but this is not a Hawaiian beach, at least as I imagine it. It's a meat market.
So it was at this meat market that I was eating today, as I do everyday, when a clatter arose from behind me. There was a large group of what appeared to be highschool aged kids.... there were at least 50 of them surrounding my Elephant Seal observation deck. (Most of the Seals kept on sleeping, rolling and snorting away... paying no attention.)
I, on the other hand, wondered what the heck all these kids were doing here.... When all of a sudden, I cracked a smile in excited realization. I also chuckled a bit as I watched some dumbfounded people and their even dumber looking reactions to the newly created statues in the middle of the widest sidewalk in Waikiki.
I had seen this on the internet, maybe I-am-bored.com, or ebaumsworld.com, but either way, it's pretty cool. The first time I'd seen it done, it was in Grand Central Station, and involved a few hundred people I believe... however many it was, they were the majority in the station.
In Waikiki today, it was on a smaller scale, but cool none-the-less.
The students had just a moment before been chattering and milling about, around the sidewalk, into the grass near the palms, onto the beach... not straying too far from eachother, when all of a sudden, with seemingly one conciousness, they froze. They froze in whatever position they were in: mid-sentence, mid-step, in the middle of double-knotting a shoe, talking on the phone... whatever, they froze. Statues.
Baffled passers-by spun slow circles, gawking at the frozen clan as they navigated through the scene that was somewhat reminiscent of Pompeii (without all the death and destruction.)
I laughed at them for looking befuddled.
And just like that, sixty seconds later... they all, as one, continued on.... finished their sentence, hit their stride, tightened that knot, and continued that phone conversation. All of it, like nothing had happened, like time hadn't stood still for them.
turns out it was something like "take 60 seconds to think about big tobacco" it was an anti-smoking campaign... and boy howdy, it wasn't lost on the crowd. After they had frozen and reanimated, they eventually came back and handed out anti-smoking flyers... not a minute later there were six people within spitting distance of me smoking.
don't think the campaign worked, but the display of human art was cool none-the-less.
oh... and on a completely unrelated note, I got to use the phrase "toxic megacolon" in a real discussion today with a patient.... he had the megacolon, just not toxic. cooooooooool.
I was sitting at a small table, in the shade, between the beach and the utlra-wide sidewalk to accomodate all the tourists. It seems to me that this sidewalk is, at least at high tide, wider than the actual beach at Waikiki. It's not that the sidewalk is that incredibly wide, but it's that the beach is excessively narrow. (Waikiki Beach is actually not all that impressive in 'Beach Quality.' It IS however, quite high in 'People Quality.') There are MANY people, too many people in my opinion. To lay on Waikiki Beach and try to get some sun seems to remind me of the national geographic channel. I mean that these people remind me of Elephant Seals, splayed out in, often times, disgusting positions, sweating on and snarling at those who come too close to their space; which is everyone. There isn't a grain of sand that goes untouched in any given day. This is good for people watching from the sidelines, but this is not a Hawaiian beach, at least as I imagine it. It's a meat market.
So it was at this meat market that I was eating today, as I do everyday, when a clatter arose from behind me. There was a large group of what appeared to be highschool aged kids.... there were at least 50 of them surrounding my Elephant Seal observation deck. (Most of the Seals kept on sleeping, rolling and snorting away... paying no attention.)
I, on the other hand, wondered what the heck all these kids were doing here.... When all of a sudden, I cracked a smile in excited realization. I also chuckled a bit as I watched some dumbfounded people and their even dumber looking reactions to the newly created statues in the middle of the widest sidewalk in Waikiki.
I had seen this on the internet, maybe I-am-bored.com, or ebaumsworld.com, but either way, it's pretty cool. The first time I'd seen it done, it was in Grand Central Station, and involved a few hundred people I believe... however many it was, they were the majority in the station.
In Waikiki today, it was on a smaller scale, but cool none-the-less.
The students had just a moment before been chattering and milling about, around the sidewalk, into the grass near the palms, onto the beach... not straying too far from eachother, when all of a sudden, with seemingly one conciousness, they froze. They froze in whatever position they were in: mid-sentence, mid-step, in the middle of double-knotting a shoe, talking on the phone... whatever, they froze. Statues.
Baffled passers-by spun slow circles, gawking at the frozen clan as they navigated through the scene that was somewhat reminiscent of Pompeii (without all the death and destruction.)
I laughed at them for looking befuddled.
And just like that, sixty seconds later... they all, as one, continued on.... finished their sentence, hit their stride, tightened that knot, and continued that phone conversation. All of it, like nothing had happened, like time hadn't stood still for them.
turns out it was something like "take 60 seconds to think about big tobacco" it was an anti-smoking campaign... and boy howdy, it wasn't lost on the crowd. After they had frozen and reanimated, they eventually came back and handed out anti-smoking flyers... not a minute later there were six people within spitting distance of me smoking.
don't think the campaign worked, but the display of human art was cool none-the-less.
oh... and on a completely unrelated note, I got to use the phrase "toxic megacolon" in a real discussion today with a patient.... he had the megacolon, just not toxic. cooooooooool.
Tuesday, July 8, 2008
Attracting unwanted attention
Usually, one of the best parts of my workday doesn't happen at work at all. I'm about to make myself sound like, and feel like, that 1st grader who when you ask him, "Hey Charlie, what's your favorite subject in school?" and the little scamp replies "Recess!" or "Lunch!" Well, that's me. I like lunch the best-est.
Don't get me wrong, I feel like I'm learning something new every day here at the clinic, and everyone is great, from MA's to PA's to the doctor. It's nice to get to work with 2 Pacific grads.... smart folk they are. Anyway, that said.... I like lunch. See, I'm in Hawaii, but I work long days, (like the rest of you) and I don't get much time during the week to actually BE in Hawaii... but at lunch.... OHHHHHHHH at lunch.... I get to go to the beach, grab a seat, and enjoy my lunch. I start to relax, I watch the waves crash in along the white sand, (and I relax a bit more.) I watch the sailboats slowly pass along the horizon.... (getting more comfortable...) I watch surfers ride the waves as they track to the shore... (could almost fall asleep.) I watch the girls walk by in little bikinis... (am I in Heaven?) I watch a homeless man walk towards me and sit down across the table from me, and begin to me stare me down.... and I rel... wait, WHAT?!?!
I snap out of my dream-like state, with a "huh"... thinking "buddy! you're blocking my view." He says something about getting out of the sun, and I reply with something stupid like, "I hear that."
Oh no... I've opened the door to conversation.
Now, please, it's not that he's homeless that I don't want to talk to him, if he were rich, I'd be just as upset. It's that he's ruining my favorite subject; lunch. I think the only guy that I would've enjoyed talking to then, (that I don't know and love already) would have been Vince Vaughn, or Chris Farley (if he were still alive) or Will Ferrell... but if you're not them, keep on walking. now if you're a girl.... that's a different story.
So, this guy, whose name I still don't know, begins to stare at me some more, and talk to me, slightly incoherently. And, well, I'm not happy..... but I'm not going to ignore him.... I may be rude and frustrated in my mind, (and on this "blog") but I don't act that way towards him.
I'm a pushover.
So I start talking to him....
"How long have you been here?" says the guy.
"About 2 weeks.... 5 more to go. I'm working at the Waikiki Health Center for school."
He looks puzzled.
"Like a medical internship," I say.
"Ohhhhhhhhh." he sighs.
There is a glint of understanding and a flash of something that tells me I've opened up a can of worms
Nuts! this guy aint leaving.
He proceeds to tell me all about his medical problems, and the problems he faces in getting care. (which is sad, and a comment on our medical system. But much of it too can be attributed to this guy himself.) I find out he's a Navy Veteran, 60 years old, and moved from Chicago 3 years ago without a penny, or a plan. He doesn't talk to his family, he thinks that his brothers don't care about him at all. He doesn't want to go the VA because he thinks they don't know anything, he doesn't come to the Waikiki Health Center because he said that they turned him away (which they don't do there.)
He starts showing me the scabs on his hand... the scars on his ribs and so on and so forth.
Meanwhile, I'm plotting my escape....
He rambles on and on...... and on.
I look at my watch.
I miss my quiet lunch... i miss the waves, the waves, the girls. I feel like I'm at work! Is this guy really about to show me this lump on his butt? I'd be HAPPY to see this guy in the clinic, but not at the beach... I'm not sure that this is appropriate, or legal...
I look at my watch again.... YES
"Oh, LOOK at the time..... I've got to go, next patient is in 10 minutes. It was nice talking to you." (Lie.) sorry God, and Mom... But, it was a little white lie. and I WAS terribly polite, and talkative... he'll never know I was frustrated with him. but oh, I was.
So anyhow... i was left wondering two things.....
1.) Was my compassion only limited to the clinic, or was I maybe just having a bad day?
and
2.) Should I take the Thumper approach, "If you can't say anything nice (and in my case, mean it) don't say anything at all."
and the answer is.... I don't know.
all i know is that i missed my quiet, relaxing lunch today.
-pray for my humanity-
cn
Don't get me wrong, I feel like I'm learning something new every day here at the clinic, and everyone is great, from MA's to PA's to the doctor. It's nice to get to work with 2 Pacific grads.... smart folk they are. Anyway, that said.... I like lunch. See, I'm in Hawaii, but I work long days, (like the rest of you) and I don't get much time during the week to actually BE in Hawaii... but at lunch.... OHHHHHHHH at lunch.... I get to go to the beach, grab a seat, and enjoy my lunch. I start to relax, I watch the waves crash in along the white sand, (and I relax a bit more.) I watch the sailboats slowly pass along the horizon.... (getting more comfortable...) I watch surfers ride the waves as they track to the shore... (could almost fall asleep.) I watch the girls walk by in little bikinis... (am I in Heaven?) I watch a homeless man walk towards me and sit down across the table from me, and begin to me stare me down.... and I rel... wait, WHAT?!?!
I snap out of my dream-like state, with a "huh"... thinking "buddy! you're blocking my view." He says something about getting out of the sun, and I reply with something stupid like, "I hear that."
Oh no... I've opened the door to conversation.
Now, please, it's not that he's homeless that I don't want to talk to him, if he were rich, I'd be just as upset. It's that he's ruining my favorite subject; lunch. I think the only guy that I would've enjoyed talking to then, (that I don't know and love already) would have been Vince Vaughn, or Chris Farley (if he were still alive) or Will Ferrell... but if you're not them, keep on walking. now if you're a girl.... that's a different story.
So, this guy, whose name I still don't know, begins to stare at me some more, and talk to me, slightly incoherently. And, well, I'm not happy..... but I'm not going to ignore him.... I may be rude and frustrated in my mind, (and on this "blog") but I don't act that way towards him.
I'm a pushover.
So I start talking to him....
"How long have you been here?" says the guy.
"About 2 weeks.... 5 more to go. I'm working at the Waikiki Health Center for school."
He looks puzzled.
"Like a medical internship," I say.
"Ohhhhhhhhh." he sighs.
There is a glint of understanding and a flash of something that tells me I've opened up a can of worms
Nuts! this guy aint leaving.
He proceeds to tell me all about his medical problems, and the problems he faces in getting care. (which is sad, and a comment on our medical system. But much of it too can be attributed to this guy himself.) I find out he's a Navy Veteran, 60 years old, and moved from Chicago 3 years ago without a penny, or a plan. He doesn't talk to his family, he thinks that his brothers don't care about him at all. He doesn't want to go the VA because he thinks they don't know anything, he doesn't come to the Waikiki Health Center because he said that they turned him away (which they don't do there.)
He starts showing me the scabs on his hand... the scars on his ribs and so on and so forth.
Meanwhile, I'm plotting my escape....
He rambles on and on...... and on.
I look at my watch.
I miss my quiet lunch... i miss the waves, the waves, the girls. I feel like I'm at work! Is this guy really about to show me this lump on his butt? I'd be HAPPY to see this guy in the clinic, but not at the beach... I'm not sure that this is appropriate, or legal...
I look at my watch again.... YES
"Oh, LOOK at the time..... I've got to go, next patient is in 10 minutes. It was nice talking to you." (Lie.) sorry God, and Mom... But, it was a little white lie. and I WAS terribly polite, and talkative... he'll never know I was frustrated with him. but oh, I was.
So anyhow... i was left wondering two things.....
1.) Was my compassion only limited to the clinic, or was I maybe just having a bad day?
and
2.) Should I take the Thumper approach, "If you can't say anything nice (and in my case, mean it) don't say anything at all."
and the answer is.... I don't know.
all i know is that i missed my quiet, relaxing lunch today.
-pray for my humanity-
cn
Saturday, July 5, 2008
My impression of a tomato...
Today I'm laying low.
I can't say it's because I'm sick of the beach yet, or because I've mastered surfing, or because it's terrible weather outside. Nope. It's because my belly looks like a tomato. Or maybe it looks like I had a run-in with a bully who favors the "pink belly" as his form of torment. Or, for those of you who remember, it's reminiscent of the day a few summers back that I lost the fight with the pine tree and plummeted, belly first, into the Mississippi. But whatever the analogy, I'm like a human furnace, or, my stomach is. It seems that somehow the rest of my torso was spared. So, my stomach alone is putting out heat like a blast furnace. It's funny how quickly it heats the cold shower water (because I can't tolerate any warm water) into a very steamy hot-tub-like liquid that I can't take. It's actually pretty incredible. I think there's a good chance, maybe slightly more than 50/50, that you could fry an egg on my stomach, though it would taste terrible I imagine, due to the copious amounts of aloe I've been slathering on. I guess what it boils down to is that a very white guy like myself needs something greater than SPF 15 if I want to spend and hour and a half in the sun, at least until I get a bit of a base.
Woe is me....
So here I am, on an island surrounded by beautiful beaches, cobalt blue waters and waves fit for surfing.... and I'm sitting on the Lanai (hawaiian for porch) out of the sun, away from the beach, nerding around on the computer, trying to get some schoolwork done. At least I'll have a week here after my rotation to see the island.
So I thought I'd create this 'blog' (wow, i hate that word) so I could keep you updated on my vagrant year. Should have done this earlier, I know, but better late than never I suppose. So, let me give you a bit of a recap on my year so far.
First rotation; Circleville Ohio, ER.
-I sutured more than a couple of people up, and found 3 was the magic number. It took 3 times before my hands stopped shaking. "Oh no, me, nervous? No, no...no, I've done this many times, just had a bit too much coffee. Night shift, you know...."
-80% of visits aren't emergncies....
-Really like not having to chart ANYTHING
-Very much enjoyed the ER
Second rotation; Waikiki HI, Internal Medicine.
-It's warm here, and I'm very white.... need to take the sun thing slowly, (much more slowly.)
-Need to think of the big picture, not just 'treat and street'
-Wow, I'm really missing the times when I didn't have to chart
I'll keep you updated on the rest 'as it happens.' But for now, I need to re-apply another layer of aloe.
Peace in,
CN
I can't say it's because I'm sick of the beach yet, or because I've mastered surfing, or because it's terrible weather outside. Nope. It's because my belly looks like a tomato. Or maybe it looks like I had a run-in with a bully who favors the "pink belly" as his form of torment. Or, for those of you who remember, it's reminiscent of the day a few summers back that I lost the fight with the pine tree and plummeted, belly first, into the Mississippi. But whatever the analogy, I'm like a human furnace, or, my stomach is. It seems that somehow the rest of my torso was spared. So, my stomach alone is putting out heat like a blast furnace. It's funny how quickly it heats the cold shower water (because I can't tolerate any warm water) into a very steamy hot-tub-like liquid that I can't take. It's actually pretty incredible. I think there's a good chance, maybe slightly more than 50/50, that you could fry an egg on my stomach, though it would taste terrible I imagine, due to the copious amounts of aloe I've been slathering on. I guess what it boils down to is that a very white guy like myself needs something greater than SPF 15 if I want to spend and hour and a half in the sun, at least until I get a bit of a base.
Woe is me....
So here I am, on an island surrounded by beautiful beaches, cobalt blue waters and waves fit for surfing.... and I'm sitting on the Lanai (hawaiian for porch) out of the sun, away from the beach, nerding around on the computer, trying to get some schoolwork done. At least I'll have a week here after my rotation to see the island.
So I thought I'd create this 'blog' (wow, i hate that word) so I could keep you updated on my vagrant year. Should have done this earlier, I know, but better late than never I suppose. So, let me give you a bit of a recap on my year so far.
First rotation; Circleville Ohio, ER.
-I sutured more than a couple of people up, and found 3 was the magic number. It took 3 times before my hands stopped shaking. "Oh no, me, nervous? No, no...no, I've done this many times, just had a bit too much coffee. Night shift, you know...."
-80% of visits aren't emergncies....
-Really like not having to chart ANYTHING
-Very much enjoyed the ER
Second rotation; Waikiki HI, Internal Medicine.
-It's warm here, and I'm very white.... need to take the sun thing slowly, (much more slowly.)
-Need to think of the big picture, not just 'treat and street'
-Wow, I'm really missing the times when I didn't have to chart
I'll keep you updated on the rest 'as it happens.' But for now, I need to re-apply another layer of aloe.
Peace in,
CN
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