Saying goodbye

Last week I said goodbye to the clinic I'd been working in for the previous 8 weeks. It was an interesting feeling - I was tired of the outpatient setting, but at the same time I felt like I was leaving something undone. In all my previous rotations I felt like I was taking up space rather than helping. Don't get me wrong, I didn't expect more than that when I started my clinical year. Students can help out a little, but for the most part we take up extra space, time and effort. Which makes preceptors that are willing to take on students wonderful people.

Anyway, back to my previous rotation. Instead of taking up space and time I was actually practicing medicine and helping people. My patients were truly grateful after seeing me. By saying that I'm not bragging, I'm being honest. These people have nowhere else to turn for affordable medical care, so they are happy to have someone take the time to listen to them and treat their ailments. About halfway through my rotation, I was talking to my preceptor about patient compliance and other issues and he said to me, "You have to understand that this clinic is a third world country. We are not in America when in this building. It's a third world country and you have to remember that when treating our patients." The staff and I had a chuckle at this common phrase but its a very true statement. The clinic had quite a few resources, but it was somewhat limited in what it could do. Also, most of the patients are the 1st or 2nd generation to live in America. They bring with them a lot of differences in culture and beliefs about medicine and healthcare. It makes for a fascinating mix of patients and always an interesting day.

My last day the staff had a cake and a card for me. I've never had anyone thank me for being on a rotation before! The past 8 weeks has been interesting, frustrating and oh so rewarding. And now its time to move on. But first - spring break! :)

Let me introduce you

to my new toy! It just arrived in the mail this afternoon and I immediately tore open the box to start playing with it. It took all my patience just to wait the 2 hours to let the battery charge. I probably made Lacey go blind from the flash while playing with the camera tonight. Unfortunately I have a test and 2 standardized patient encounters on Thursday so I probably won't get to play with it much again until Thursday afternoon at the earliest. Thankfully I got the camera before heading out of town to visit my sister and her family - now I'll get lots of good shots of her 3 beautiful girls (plus her and her husband)!

Here are some pictures I took while fiddling with it:




Of course, I couldn't forget this guy:

The Road Ahead...

...is looking quite busy but rather fun! We have so much going on right now and even more headed our way! Next week brings tax day - no biggie, we finished our taxes in January (Corey never turns down on opportunity for money!). Unfortunately for him, he works in the retirement industry and thus the week leading up to tax day is hectic to say the least. He's not looking forward to it, but things will slow down significantly come Friday. The week after I'll finish up my outpatient rotation by taking an exam and having two standardized patient encounters. Then we might take a short trip up north to visit some family for a weekend. The last week of April Monica is finally coming to visit! She has not been out here yet and I've been bugging her to come out, so I'm extremely excited. Plus, the weather should be beautiful for any sightseeing trips around DC. Following her visit, I'll be moving up to the northern part of MD for my final 8-week rotation. The next weekend is Corey's step-brother's wedding in Hilton Head. We are pretty excited about that weekend because its a chance to spend time with Corey's family again (especially our little niece!) The day after the wedding Corey will most likely be driving his way back to TX in order to start his new JOB on the 10th! (He got a phone call on Thurs letting him know the "official offer" would be extended some time this week) The weekend after the wedding is my "graduation" in DC! I have a feeling it will be a little strange wearing my cap & gown with hood and listening to the commencement speech knowing I still have 3 months before I truly graduate. However it should be pretty fun, especially since both my mom and my mom-in-law will be out that weekend to help me celebrate. Whew - all that in just one month! In June we have a wedding to attend and in July we plan on moving all our things into a new apt in TX plus I'll start my final rotation in TX. In August I'll graduate and we'll be done on the East Coast! It's hard to believe its coming down to my last 4 months in school!

And what would make all this fun stuff even more exciting? Documenting everything with my new camera! That's right - using some "perks" that Corey has earned via his company we were able to buy a fancy schmancy SLR camera without having to spend any real money. It should arrive sometime next week and I can't wait to play with it! Be prepared for lots of pictures of the beautiful spring landscape around here and the pup - she's usually a willing subject, especially when asleep ;)

Affirmation

As I've previously said, this rotation has been frustrating, tedious, interesting and so satisfying. This past week proved all this yet again. There are times when I get patients who, no matter what I do or say, will probably go home and continue being non-compliant with either their meds or diet/exercise. Sometimes I feel like I have to threaten diabetics with the possibility of putting them on insulin in order to get them to actually take their meds as prescribed and eat correctly. For so many, though, this diet changes are hard either because they don't understand exactly what they can and can't eat or because they are so used to living a certain way that they are resistant to change. Also, many of my patients come from areas of the world where rice and bread are staple foods - telling them to give these up is pretty unrealistic. I've taken the approach of telling them to change to brown rice, whole grain breads and increasing their vegetable and fruit intake. I know I'd be more receptive to someone telling me to alter what I eat, rather than telling me to give up something all together.

There are certain patient encounters I am sure I will remember the rest of my career - I had one of those this past week. I picked up the patient's chart, read through past notes and my interest was immediately piqued. The last time they had been seen it was determined that they had a condition for which surgery was most likely necessary and sooner rather than later. I was expecting to walk into the encounter to hear all about what the surgeon said/did. As I started to question the patient, I quickly realized they had not followed any of the recommendations laid out for them six months earlier. I tried not to get frustrated, but it was tough. As it turned out, the patient eventually admitted that they did not do anything after they left because they were just so overwhelmed by all that had been recommended . I took that moment as my opportunity to educate them on just how serious their condition was, and just how important it was to get proper treatment. I put it in terms they would understand as well as explaining to them that there were some things that could wait. We talked about what needed to be done now and what could wait a week or month. Before I left to present the patient's story to my preceptor, they stopped me. They said, "Thank you so much. I prayed before I came here and God blessed me with you." With that statement, I was filled with various emotions: pride, humility, sadness, and hope. I was proud that I was able to do something to reach this patient and help them in some small way. I was humbled by the realization that it wasn't just the patient and I in that room, God was working through both of us. I was sad for the patient's situation and lack of funds/support/transportation, etc. But I was hopeful that perhaps this encounter could do something for the patient that previous healthcare interactions couldn't. Hopeful that there was still time to intervene without life-altering surgery.

Although my preceptor and I couldn't convince the patient to head directly to the ER for immediate hospital admission and surgical evaluation, they did promise to go first thing Monday morning after organizing some things. Before they left, the patient hugged me - the first time a patient has ever done that.

So will they actually show up to the ER on Monday? While I hope my effect on the patient was strong enough that this will actually happen, I am realistic. I am only one person. I do my best to make a connection with each and every patient. I try my hardest to educate them, encourage them, and enable them to make healthy decisions. But at a point it comes down to the patient and at that point I cannot do any more. It is hard to accept, but that is how it works. I will say a prayer for my patient this Monday morning to give them the strength and courage to admit themselves to the hospital. No matter what happens (and who knows if I'll ever find out what happens), I will be forever grateful for this interaction.