Lessons in Pediatrics

They say you learn something new every day.  Well, when you are a newly graduated PA working in a pediatric ER during winter, that statement could not be more true.  Some days its a huge revelation or very important piece of information that I write down in my little black book (full of cheat sheet type notes).  Other stuff is more "street-smart" information.  So here are some of the more "street smart" things I've learned in my first month:

1. Kids are resilient.  Okay, in all fairness I already knew this one (my niece Lexie is one great example), but I guess I've just seen lots more proof of it.

2.  There are some crazy disorders out there.  Like crazy strange.  But they are fascinating.

3. Febrile seizures are surprisingly common.

4. Asthma, oh asthma...we'll just leave it at that

5. Bulb suctions are wonderful little devices and every parent should be taught how to properly use one before going home with their baby

6.  I really like procedures - give me an abscess to cut on and I'm a happy girl.  Getting all that nastiness out is so gratifying (its sick, I know...)

7.  Some consultants are great and helpful and so super nice, others....not so much...'nough said

8.  There's a black market for amoxicillin.  No joke.  Who would've thought?

9. I can't remember a 4 number sequence - like the extension of the phone I'm carrying each day.  Every time someone asks me for my extension or I have to type it into the computer, I have to pull the phone out and look at the little sticker on the back...its a little concerning to me

10. Having pharmacists in the ER who review your orders and discharge prescriptions is a fabulous thing.  Especially when dealing with weight based drugs (i.e. every medication given to peds patients)

11. A little reassurance goes a long way.  (True when dealing with patients and families and true for myself)


Beyond all these fantastic things, I've learned a ton of medicine.  Honestly, when I graduated PA school, I would say pediatrics was one of my weakest subjects.  It wasn't heavily covered in our didactic year and I only had 4 weeks in a pediatric office during clinicals.  However, I knew I loved working with kids and was willing to learn.  It keeps me on my toes every shift that's for sure!

Ho Ho Ho

What do tamales, game time, Goldschlager, 500 miles of road, a septic tank, bowling pins and a limping dog all have in common?  They each played some role in our Christmas weekend!

Christmas Eve was spent at a family friend's house having tamales and other yummy food while catching up and socializing with family.  There were tons of people, most of whom we didn't know, but we had a great time.  Here are a few pictures:

Grandad, Mary Alice (my mother-in-law),  C and Miss Lexie

Finally got a picture with her smiling!

Happy aunt and uncle!

Christmas morning we made our way to my other in-laws' house.  We munched on cinnamon rolls and opened the mounds of presents lying under the tree.  We also got to meet the newest extended family member, Dez, a beautiful black lab puppy.  As the afternoon rolled in, my brother-in-law pulled out a bottle of Goldschlager (cinnamon schnapps), and we started playing games.  Gametime got a little wild once the step-siblings and their significant others returned.  A great time was had by all.  Once dinner was ready, Corey & I scarfed down some delicious prime rib and ran out the door to hit the road. 

The whole gang wading through presents and wrapping paper

Having fun during game time

Having more fun during game time

Meet Dez

The boys

The game's getting intense

We jumped on the road in the direction of Austin to visit and stay with more family.  We got in late, but had some time to chat before heading to bed.  The next morning it was discovered there was a problem with their septic system.  So Corey's uncle and 2 boy cousins spent a big chunk of time digging around the pipes leading to their septic tank and diagnosing the problem.  We spent the afternoon bowling and having fun with the cousins.  After which we headed back north.  We stopped off for dinner with my cousin, his wife and their beautiful new baby.  The food, conversation and company were excellent.  Finally, we got back in the car and headed the 250 miles home.  

The weekend ended with me picking up our pup from my in-laws'.  As she came bounding down the hall to say hello, I noticed she was only walking on 3 legs.  She refused to put any weight on it and after inspecting her I figured she probably tore her puppy ACL.  Luckily, this morning she was using that leg again and the vet told me she probably just sprained/stretched it.  No tear = no surgery!  Whew, dodged a bullet there!

Now I just have to make it through 2 more work shifts before we head off to CA for the Rose Bowl and time with even more family and friends!

Merry Christmas Y'all!

Yeah, I know its only Christmas Eve, but starting this evening our weekend is jam-packed with Christmas festivities so no time to post!

This Christmas will be special for us for several reasons.  The last two years we spent Christmas on the East Coast - last year was in SC with my family and the previous year, it was just us two on Christmas at our apartment in VA.  This year we are blessed to be in TX spending time with the in-laws.  It will be our first Christmas with our 2 1/2 year old niece and we'll get to see lots of family.  We also decided to drive down to Austin on Christmas night to see even more family.  I can't wait!  I'm also extremely lucky to have the 24-26th off of work.  When working in a hospital, especially the ER, there is no guarantee that you will have holidays off.  Actually, its more likely that you will have to work.  So I am counting my blessings for sure!  And while we won't be spending Christmas with my family, we will get to see them in one week when we head out to CA for the Rose Bowl!  We have so much to look forward to!

As for today, all our presents are wrapped and waiting patiently under the tree.  I'm working on some last minute Martha Stewart style gifts then relaxing until we head off for a Christmas Eve party.

May you be surrounded by family, friends and blessings this Christmas!

Merry Christmas from our family to yours!

Big News!

We're buying house!

After months of searching online and two Sundays walking through a dozen houses, we found The One.  It's a little farther away from some family members than we originally planned, but its closer to others.  And the commute is just a few miles farther for both of us.

Deciding to put in an offer was exciting, then waiting for a response from the sellers was so nerve-racking.  I don't think either of us got much sleep those two nights we were waiting to hear back.  Luckily the sellers were motivated and their initial counteroffer was acceptable to us, so we didn't have to deal with any haggling.  We agreed on an offer last week then submitted the official signed paperwork and put our money in an escrow account on Friday.  We also received our mortgage paperwork that day - talk about killing trees!  There are so many forms to read through and initial or sign.  I'm pretty sure there was some clause in one of them requiring you to give them your first-born child.

This morning, after working an overnight shift, I met our realtor and the home inspector.  First off, not the best choice for me since I didn't get much of a nap on Sunday, but it needed to be done and with Christmas and New Years right around the corner we were pretty limited on times we could do it.  The inspection came back pretty good with just a few things that need attention, so we'll talk to our realtor about that in the coming days.  Luckily the house has a bunch of upgrades and decent paint in most rooms so we only need to do a few things to make it ours.  If all goes as planned (which it probably won't) we are scheduled to close at the end of January!

Here are some pictures I took while in the house today:

Looking into the downstairs study

View from the entryway

Formal dining room (we're planning hardwood floors here)

La Pièce de résistance - huge updated kitchen

Kitchen from the family room

Kitchen backsplash - pretty isn't it?

Downstairs family/living room with fireplace

Master bath - wallpaper has gotta go

Master bedroom - not sure why the picture is crooked

Upstairs family/gameroom 

Upstairs guest bath - just needs new paint and fixtures

Upstairs guest bedroom - needs new paint and light fixtures

Upstairs bedroom #2

Upstairs bedroom #3 - wallpaper is getting nixed

Corey's favorite part - built -in grill & fridge on the back patio

Does it get any crazier than this?

As most of you already know, our pup, Lacey, is crazy.  No bones about it - she's certifiable!  She does all these little things that we think are hilarious or cute, but I'm sure many people would find them strange or annoying.

She's got such a fun personality that we are constantly laughing at her.  There's little things, like the fact that she waits until both of us are home to eat.  Also, while playing she'll run and crawl under our bed to hide then start barking like crazy from under the bed.  We like to call this activity her cockroach routine because she scurries away like a little bug.  There are other things too: she loves sitting on the back of the couch, sitting by the patio door looking out on the world outside, and she hates being held or snuggled up to.  When Corey feels like picking on her, he will pick her up and lay her on his stomach.  She'll then start whining and crying until he lets her go.  

There are so many more little personality quirks that make us crack up daily.  Lacey is definitely an entertaining pet!  Here's the video I shot today of her "playing" with Corey's foot.  She does this on a relatively regular basis and usually it takes no provoking her.  She will just start barking or biting at his foot while he's lying on the couch. (I apologize for the terrible lighting - this is iPhone footage. Turn your speakers on for the full effect)

I'm sure some of these personality traits are common to her breed (shiba inu), but others are all her craziness.  Isn't it funny how animals can have such strong personalities? 

Confidence

"Its not who you are that holds you back, its who you think you're not."

- Author Unknown

Part of being in the medical field is being on a sort of stage constantly.   When you're a student you are performing for your professors, preceptors, staff and other students.  You are constantly put on the spot whether its doing presentations in class, answering questions on rounds or being pimped in the OR.  You're expected to know the answers to impossible questions and never show cracks.  Once you graduate, you're put on stage in front of your patients, colleagues and various staff members.  You are now the "the expert" and should always know the answers to every question possible.  Saying "I don't know" doesn't ever seem like much of an option.  All this performing takes quite of bit of self-confidence.  Every time something doesn't go as expected or when you really don't know the answer or have a plan, that self-confidence (and ego) takes a hit.  It can be a humbling and frustrating thing.

Well, being the new kid in the department on top of being a new graduate has done a number on my confidence levels.  I've gone from being a student, where I was expected to be knowledgeable but not an expert, to the professional (with letters after my name) who is supposed to know it all.  Its a really rough transition to make overnight.

My first several shifts I struggled mightily.  I couldn't stop thinking about how I should know the answers to every question, have an outstanding diagnostic and treatment plan for every patient presentation and know the pediatric dosing for every drug.  I also felt like I couldn't present a patient to the attending or talk to a consultant on the phone without tripping over my words, leaving out important information or giving too much trivial information.  My self-confidence was in the toilet and about to get flushed away.

Last Friday I had the chance to work in a different section of the Emergency Department where we see what's expected to be quick patients - i.e. orthopedic injuries, rashes, lacerations...you get the idea.  That day was a life-saver for me.  I finally felt like I knew what I was doing - I could finally ask the right questions, answer patients and parents concerns, perform procedures correctly, and make a decent plan.  I didn't get everything 100%, but I was in my element.  I sewed up a kiddo's face and was complimented by the parents on how well I did (yes!), I successfully reassured a parent who was concerned, I made accurate judgements and my treatment plans didn't need much tweaking from the attending.  I went home that night feeling great about the shift and my abilities.  I finally felt like I could do this.  My confidence was on the rise.

Since that shift, I've worked two other shifts.  My ego has taken some hits and that confidence has dwindled some, but when I sit back, take a breath and tell myself "You can do this," I truly believe it.  Yesterday, my first task of the shift was to perform a lumbar puncture on a patient.  I've seen a zillion, but have never actually performed one.  Despite my nerves and the feeling like there was no way I could do it, with some helpful guidance and careful supervision, I was successful!  It wasn't a champagne tap (meaning absolutely no blood in the fluid), but it was only my first, so I wasn't too hard on myself.

I still have quite a road ahead and a steep learning curve to master, but I'm surrounded by really supportive and understanding people who are patient and willing to teach.  Just gotta keep swimming.

"If we all did the things we are capable of doing, we would literally astound ourselves."

- Thomas Alva Edison 

And the tables have turned

As you may recall, when I interviewed for my current position, I was interviewed by a panel of all the PAs and Nurse Practitioners working in the Emergency Department.  It was super overwhelming, but somewhat social at the same time.  They went around the table, each asking one or two questions of me off a list of prepared questions.  But I also had the chance to ask them questions and felt like I really got a feel for the team and if I could work with these women.  It was a long and stressful day that included not only that group interview but also interviews with 3 separate physicians, the mid-level manager of the NICU and the HR manager.  I was exhausted but when all was said and done, I was rewarded with my dream job.

I say all this because today I got to experience the interview process from the other side of the table.  We interviewed two candidates for positions with our team.  It was quite the experience to be the interviewer rather than the interviewee (is that even a word?).  I felt kinda like an impostor.  Who am I to determine if this person is a good fit when I haven't even received my first paycheck yet?  

Despite my insecurity about my lack of experience and decision-making powers, I enjoyed being a part of the interviews.  My interviews were recent enough that it still feels like yesterday when I was the one sweating it out and giggling nervously.  I felt some sympathy for the candidates, but at the same time, I think I may have been a little harder on them than others.  

Today was just another reminder of my change of roles.  I'm no longer a student or a job seeker.  I'm a professional...ha!  Okay, that might be a stretch.  But I am employed, have a PA-C after my name, and as of Monday have a full license to practice in the state.  Still getting used to this growing up thing.  I think getting my first paycheck tomorrow will make the transition that much better :o)

Exciting things are happening around here

Today marked two very exciting milestones for our little family.  First, TCU accepted a bid to the Rose Bowl!!  And to make it even better:  we are taking a couple days off work, we bought plane tickets to CA, and have our names on the list for tickets...yes, ladies and gentlemen, the husband and I are heading to Pasadena to cheer on our team on New Year's Day!  We absolutely cannot wait!!  Plus, we get to see family and friends - what could be better?  Perhaps a TCU win ;o)  And maybe I can convince that wonderful husband of mine to get up bright and early to attend the Rose Parade.  I grew up about 30 miles away, but have never been...we shall see if I can work my magic on him.

So I said 2 exciting things happened today.  Our second milestone - today we officially began our house hunt.  We planned to meet with our real estate agent, go over questions and get a list of houses.  Turns out we had time and were able to get in to see some of the houses.  While we only bat .250 (only 1 out of 4 made the cut), we got a really good feel for what we want.  We are heading out again next weekend to look at the rest of the list from today and are working on adding more homes to the "to see" list.  Its an exciting but stressful time.  Thinking about a mortgage, down payment, closing costs and the utility bills that more than doubling our square footage entails can get a bit overwhelming.  But when we were standing in a huge kitchen with more cabinets than I would know what to do with its sooo exciting!

I'll keep you updated as we go through this journey to find a great first home for us, the pup and any (distant) future family members!

Baking Therapy

While some people turn to shopping, alcohol or exercise to relieve stress, I turn to my kitchen.  I find cooking, especially baking, to be very therapeutic when I'm stressed.  There's something about making various ingredients come together into a delicious dish that is just so satisfying. And I love to eat, so it results in a second benefit.

My 2nd week of work was a bit more stressful than the first.  It started off mundane enough with 2 days of computer modules (see previous post) and another day of classroom training.  After 3 days of working 8-5 and sitting in pretty terrible traffic each day I was exhausted.  I know it sounds pathetic, but my body is having a hard time going from sleeping til 8 or so each day to waking up at 5 or 5:30 and being functional until getting home around 6pm.

After three days of sitting on my bum doing various training activities I was looking forward to two clinical shifts.  Thursday went pretty smoothly but it wasn't terribly busy and all our patients were pretty straightforward.  Friday started off well but got a little too crazy for me at one point.  I ended up picking up two complicated kids and needed a lot of assistance from various persons including nurses, the chief resident and my attending.  Their care was never sub-par, it was more the administrative stuff like the ten different things that have to be done before a patient can be admitted.  Also dealing with consults was a bit difficult.  I felt totally lost and confused multiple times.  Anyhow, I survived, but it was a little much for me.  I'm glad that shift was followed by a weekend off.

This morning I decided the perfect way to decompress after my crazy and confusing shift was to bake up something yummy.  I had seen this Chocolate Banana Cake several weeks back and knew I needed to try it.  I had some browning bananas sitting on the counter and buttermilk in the fridge so it was the perfect day to make it.

In case you were wondering it turned out beautifully.  It has a rich chocolate flavor thanks to cocoa powder and chocolate chips with a mellow banana flavor peeking through.  Perfect with a glass of milk!