Oh outpatient

I've just made it through my first 2 weeks of outpatient medicine and it's been quite an interesting ride thus far! I'm working at a community clinic in MD that serves the uninsured, low-income population. The patients have to pay a copay for each visit, then get a discounted rate for bloodwork and other testing. I would say almost all of the patients I have seen thus far were born outside of the US and English is not their first language. I've treated people from Iran, Sierra Leone, Mexico, Guyana, Nigeria, Cameroon, India, Pakistan, and many many more. (I try to make it a point to ask each patient where they are originally from) I've seen things I probably would not have seen in a family practice/internal medicine practice seeing all insured patients. For instance we had a patient walk in with a blood pressure in the range of 200/120 who had not been on high blood pressure meds for several months. I've had more than one patient who had an initial hemoglobin A1C of >12% (normal being less than 6%). It's also great because my preceptor LOVES to teach and he tries to give me at least one lecture a day on something ranging from reading EKGs (and what abnormal findings indicate) to the workup of a thyroid nodule. Despite all this interesting stuff, there are downsides - like the fact that most of my patients don't speak the best English making getting a reliable history out of them difficult. Also many have little medical knowledge (or what medical knowledge they have is more of a cultural belief regarding certain diseases such as diabetes and high blood pressure) making their compliance to medications and diet/exercise recommendations less than ideal. I can't tell you how many times I've sat with patients for an extra 10 minutes explaining what medications are their BP medicines vs their "sugar" medicines vs their cholesterol meds. But, despite the negatives, at the end of the encounter - no matter how frustrating or time-consuming, the patients are sooo grateful to be seen and treated. I've had many patients thank me profusely for doing something that many of us with easy access to medical care can take for granted. They appreciate the time spent explaining things and truly listening to them.

I've made some observations through these two weeks and have some tips to share. The next time you go see your friendly physician or, better yet, PA please remember the following:

1. If you are going to the Dr to complain of a sore throat or cough, please brush your teeth! There's nothing worse than getting a noseful of stinky breath

2. Please shower within 24 hours prior to your Dr's visit - stinky patients are no fun for anyone. And on the same note - try to clean your feet - we do have to look at those too

3. If you must have your young children with you in the exam room, please don't ignore them while the scream blood murder - it makes it very difficult to hear your heart and breath sounds with a screeching toddler in the background

4. Please please please - know your medicines and what they are for - and if you don't know - ask! Telling me you take that "little green pill for cholesterol I think" does nothing to tell me what medication you are actually taking

5. If you are told at your previous visit to bring something with you (whether meds or blood sugar logs) bring it with you...we don't just tell you that you need to bring it for fun - it really is important information

6. If you have diabetes - check your blood sugars regularly...we don't tell you to do this in order to torture you - it's important that you monitor them and it is important that we know this information to keep your blood sugars controlled

7. When you are told to get labwork before returning for your next visit - get the labs done...they really are good for something, I promise!

8.. Please don't quote Dr. Oz or Oprah or Dr. Phil for that matter...I realize that all these people are probably quite knowledgeable but they don't know your case, your medical problems and are getting paid lots of money to say what they say. If you really want to treat your medical problem with their advice try to get an appointment with them, not me.

9. And finally - we like treating you and we really like it when you thank us. There is not much better than seeing a patient smile and thank you as they leave when they came into the exam room looking rather wary

*[Note - the above tips were meant to be somewhat tongue-in-cheek...no offense was meant by any of it]*

I've gotten lazy

Yes, I've been incredibly lazy when it comes to updating this thing...its just that every time I sit down to write, I go blank, despite the many things I have to share. Well here goes.

First things first - my mom is done with all her treatments! She's been through surgery, lots of blood work and x-rays, several rounds of chemo, and a week of radiation treatments twice a day. She spent countless hours in various doctor's offices over the last 6 months. All to kick the breast cancer and make sure it never comes back. Thank you to everyone for your thoughts, prayers and words of encouragement for her and our family.

This year's Valentine's Day with Corey was exceptional! He decided he wanted to have Valentine's day on Friday instead of Sunday because I wouldn't be home during the day and he could work his magic. So, long story short, I get a couple phone calls while I'm running errands on Friday asking me where various food products could be found in our house. If you know Corey at all you know he's not a top notch chef...he can make pasta and rice, and that's about it. I get a little curious and worried after his questions because I'm wondering what it is he's trying to make. Well, I get home to find the apartment practically spotless (score!), purple and white tulips on the table (double score!) and Corey standing in the kitchen with 4 chicken breasts pounded flat, a bowl full of flour, bowl of eggs and bowl of bread crumbs. He also has a pan with oil sitting on the stove. Turns out he was ready to cook up some chicken parmigiana using a recipe he found on foodnetwork.com but got nervous so he decided to wait til I got home. We cooked it together and it turned out fantastic. It was my first time frying anything and it was pretty easy! We never cook together, and we had a blast. After dinner we went to see Valentine's Day (the movie) which was pretty cute. It was such a simple night, but it was one of the best nights we've had together.

On Sunday he had flowers, chocolates and a teddy bear delivered to our door. I sent him on a scavenger hunt around the apartment for his V-day gifts and made some dinner. It was such a fantastic weekend!

This week I finished my surgery rotation. It was extremely interesting, a lot of fun and an overall positive experience. Sometimes the drama around the staff could get to be a bit much, but I was able to avoid it for the most part. I got to see a ton of different surgeries, from colon resections to lung lobectomies to fracture fixations (pins and screws) and much much more. They also let me do a ton of suturing so I got lots of practice! I liked it much more than I ever thought I would...possibly enough to do it as a job. They actually offered me a position, and asked for Corey's phone number so they could convince him that we should stay in the area after I graduate. I told them that it wasn't going to happen, but it was extremely flattering to be courted like that. I did tell them that I would be okay with giving me contacts in TX, but they didn't have any. Oh well.

Now I'm onto outpatient medicine for the next 8 weeks. I'll be working at a community clinic in MD that takes mostly patients without insurance. It should be an interesting experience because this isn't a patient population I'm used to. After that its inpatient medicine for 8 weeks, 2 weeks of didactic stuff on campus and 4 weeks in my Final Clinical Preceptorship. Before you know it I'll be done and graduating! I can't believe its so close! Now I just have to decide what I want to do....

More Snow?!?

Say it ain't so...we were already buried in snow!

So my story starts about a week ago. The local weathermen were forecasting a large snowstorm for the weekend - starting Friday morning lasting through til Saturday night. They were predicting it could be as large as our huge dump just before Christmas (which netted us almost 2 feet of snow and paralyzed the entire DC area for a couple days). Well - they were wrong - it was bigger than the December storm! We got over 27" in our neighborhood, while other towns got almost 3 feet. Absolutely crazy, let me tell you. It was so bad that I couldn't get out of the neighborhood to get to work on Monday (mind you the storm ended Saturday night). Well, during the weekend storm there was some talk among the weathermen again that we could get some more snow Tuesday-Wednesday, but nothing compared to what was happening at the time. Then Tuesday morning they were predicting 10-20" of snow across the DC area with larger amounts expected in the Baltimore area. This threw the entire area into a bigger frenzy! Schools shut down - some for the remainder of the week. City governments closed. Corey's office even closed - and they don't close for anything usually. I was told not to go into the hospital because of the driving conditions and they canceled all elective procedures for Wednesday.



This morning we woke up to snow covering what few spots had been plowed/shoveled in the previous couple days. And to blizzard-like conditions. At one point we could barely see the outline of the building across our parking lot from us. Talk about a sight to see!


I took Lacey out last night and today and threw some snowballs around for her to chase. Turns out she thinks that is quite the fun activity! She even tried to carry some of the more solid snowballs around in her mouth for a short while. I only wish we had a yard so she could run around off-leash chasing the snow.



Turns out we have surpassed all previous records for winter snowfall totals in DC - and its only mid-February! Last year we got our largest snowfall in early March. Let's just hope we are winding down with all the snowstorms! Oh and they are forecasting more snow for next Monday!

My mind is blank

So lately I've been trying to think of something exciting and interesting to blog about...as you can probably tell from my lack of posting, not much has come up in my brain. Despite my lack of posting, life has been pretty busy as of late. I'm still on my surgery rotation - some days I love it, other days I can't wait for the end of my shift. I really like that they let me do so much - like suturing on almost every case and I'm seeing tons of great anatomy. But I'm also tired of assisting on total joint replacements for the 20th time in the last 6 weeks. I did get to watch a craniotomy and brain tumor resection this past week which was pretty cool. I forgot how long neurosurgery cases can last! I'm hoping this week to observe a coronary artery bypass graft (heart bypass surgery) and possibly take trauma call with one of the PA's. Who knows - maybe I'll get to see a really cool case that I wouldn't have otherwise seen.

Just about 2 weeks ago I found out I was assigned to travel to West Virginia for my 2 month outpatient rotation to start the first week of March. This wouldn't be so upsetting to me, except for the fact that I am scheduled to do my 2 month inpatient rotation 2 hours away from home immediately following. My advisor is "working" on getting me a rotation in town so I don't have to be away from Corey and Lacey for 4 months straight, but I haven't heard anything from her recently, so I'm not getting my hopes up. I've come to terms with the fact that I may have to be gone for quite some time. I know I will make the best of whatever site I end up rotating through, but would definitely prefer to see my husband on a regular basis :)

On other good news, I was able to set up my final preceptorship in TX which means I'll be back there in July rather than August - hooray! Corey has been in contact with some managers from his previous job and is trying to set up interviews for his ideal position. Unfortunately there are no positions open at this time and they don't know when they will hire any new people. He is okay with taking another position if one opens up in other departments, though, so he's keeping his options open.

I've started looking ahead to getting a job and taking my certifying exams. Although it's pretty far off, I have a feeling it will sneak up on me. It's been pretty stressful for me, so I think I'm going to take some time away from looking for jobs and try to focus on deciding what it is I really want to do when I graduate. I've had a lot of questions about this and its really hard to decide what I like best. I really really enjoyed peds and think I want to work in a pediatric specialty, but what that specialty would be - I don't know. I do like surgery, but some of the environment in surgery can be pretty frustrating. I like (and have some experience in) ER, but haven't worked much with children in an ER setting. I haven't yet done inpatient medicine, but think it might be something I'd like - who knows. I've also heard getting jobs in peds right out of school can be tough, so that adds more stress to my decision-making process. But all this reminds me of one of the great things about the PA profession - whatever I decide to do as my first job doesn't have to be my career. There is a flexibility in the PA world that allows us to change specialties with relative ease.

Oh and we got absolutely dumped on by a huge snowstorm this weekend! We got about 27" in our neighborhood while other cities nearby got up to 34"! It's crazy! This morning I went out to shovel my car out of its snowy parking spot and it took me 1.5 exhausting hours. Corey's car is going to have to wait (he's been sick all day with a stomach bug, so its up to me to do the heavy labor around here). And to top it all off, there is another storm headed our direction which is supposed to dump multiple more inches on us Tuesday night through Wednesday morning. It's kinda cool to be living here at time with all this record snowfall, but its hard when we are not well equipped! We don't own snow gear (other than a ski jacket I have from many years ago) like shovels, waterproof gloves, good boots/shoes. Luckily we have great neighbors who are more than happy to lend us their snow shovels! I've made a decision after all the cleanup this morning -- if we ever live in an environment that gets more than a few inches of snow a year, we are buying a snowblower, period.

Okay, so maybe my mind wasn't all that blank after all :)

Food...yum yum

Lately, I've been having a lot of fun mixing up some great concoctions in the kitchen. Although my rotation is pretty exhausting, the hours aren't too long, which means most nights I can come home and make dinner at a decent time. I tend to get bored with certain foods pretty quickly so I've been trying a lot of new recipes. Take tonight, for instance. I made homemade split pea soup and cheddar biscuits from scratch (with help from an Ina Garten recipe). Both were quite successful! The biscuits were a little on the salty side, so next time I'll cut back a little on the salt or cheese, but they were so easy to make and super yummy. Click here for the recipe. Last night I made Brinner - aka breakfast for dinner - waffles, eggs and turkey bacon. The waffles were made with the Golden Malted flour from Williams-Sonoma and were the best waffles I've ever made! I've learned that the key to fluffy pancakes and crispy waffles is separating the eggs, beating the egg whites until nice and airy, then folding them into the rest of the batter just before cooking. Corey and I love breakfast foods, but never make breakfast because I'm just not a morning person. We decided to start our own tradition of making Brinner every weekend - I'm excited to find and try a bunch of breakfast recipes!

Other yummy things I've made lately include herb-crusted pork tenderloin with roasted butter potatoes, ground turkey enchiladas, steak marinated in soy sauce & garlic with sticky white rice, chocolate chip pancakes, cranberry muffins (sooo yummy!), turkey chili, pizza bread, beef & barley soup, mint chocolate chip cookies....and the list will just keep growing. Sure, I've had some flops, but not too many, thankfully! And Corey has been great about trying everything I've made :) If anyone has any favorite recipes they want to share with me that would be awesome! I've found a couple blogs of people who cook then post their recipes and pictures, so I've had lots of fun reading those. I've only tried one recipe from them, but plan on trying lots more. Only problem is many of their recipes are baked things, and I'm trying to cut back on the sweets, so it will take me a long time to try every recipe I'd like. I'll get there though!

Thankfully we just received the treadmill we ordered after Christmas (using money we received from the in-laws and money Corey's company gives to employees to spend on fitness equipment or a gym membership). Our goal Saturday was to assemble it in our guest bedroom/office. It took a couple hours, some arguing and frustration and a couple curse words, but we were successful! We also set up a TV Corey was able to get using some credits from his company to watch while working out. Both of us worked out on it today and are pretty pleased with the machine! So now despite this cooking I plan to do, maybe I'll not only not gain weight, but hopefully lose some (as I have managed to pack on more pounds than I like in PA school).

Thoughts on Surgery

I've completed 2 weeks of my surgery rotation which means I'm 1/4 of the way through and I'm still loving it! Most of the past week has been spent doing ortho cases with a few general cases sprinkled in between. Thus far I've scrubbed in on total knee replacements, total hip replacements, a partial knee replacement, an ACL repair, a rotator cuff repair, a open reduction and fixation (ORIF) of a tibia fracture, just to name the ortho cases! I have also scrubbed in on a few hernia repairs, a mastectomy with lymph node biopsy and excision, a breast implant exchange, a laparascopic cholecystectomy and a nephrectomy. I've done more on some cases than others - like doing some drilling or hammering on the ortho cases, stapling or suturing some cases and others just holding retractors or sucking smoke out of the operative field (the smoke is caused by a tool that cuts and cauterizes tissue). I was even put on a case this past week as a first assist (no other PA with me, just the plastic surgeon and I) and was complemented by the surgeon. He even let me do some sutures on the breast implant exchange and told me I did a "respectable job." I'll take it!

Things I've determined in my time in the OR:
1. Plastic surgeons are by far the nicest and most charismatic surgeons I've come across thus far (with the ortho guys coming in second)
2. I haven't gotten used to the smell of burning flesh
3. Total joint replacements are cool to see the first few times around, but can get a little old after that
4. I need more upper body strength to be an ortho PA (Lots of lifting, holding, manipulating legs when the patients are practically dead weight)
5. Scrub techs/nurses don't trust students and won't ever trust students - but I don't blame them, I'm sure they've had many a student contaminate themselves or the field!
6. There are a lot of egos that must be stroked while working in the OR including, but not limited to, the surgeons, the scrub techs/nurses, the anesthesiologists and the reps from various biomedical supply companies
7. Bone bleeds a lot when cut/sawed
8. Ortho and plastics guys are fanatics about preventing infection (kudos to them!)
9. Some people love working with students and others would prefer to never see them in their workplace. How to handle those who don't like me? Smile and kill them with kindness :)
10. I find surgery fun and interesting because its something new everyday - will I still like it in 6 weeks? We'll see!

Hello 2010!

Lots has happened since my last post!

First, Corey and I headed down to Hilton Head, SC to spend New Year's with Adrienne and Shane (Corey's sis and her husband). After a scare that Corey might miss his connecting flight and not make it back to NC, we jumped in the car and made great time on our drive farther South. We had a ton of fun with Adrienne and Shane - Adrienne and I spent some time shopping at the outlet malls while Corey and Shane watched football and drank beer. On New Year's Eve we had a GREAT dinner at a really cute restaurant then went to a bar for some drinks. It was pretty crowded and not too fun so we walked the few minutes back to condo and finished off the night there. I may have had a little too much fun that night and definitely paid for it the next day. We spent most of New Year's Day sleeping, lying around, reading and watching some football. We finally made it out that night for some dinner. Unfortunately we had to leave the next day, so after packing up and having a late breakfast, Corey, Lacey and I headed back to VA. When we left Hilton Head it was a very comfortable morning in the 50's, when we reached VA the wind chill was 4 degrees! Made us want to turn around and head south again! We had a day to relax, run errands and prepare to go back to work.

On Monday I started my 8-week surgery rotation. I was pretty nervous about it because I didn't think I would really like surgery. Although I found neurosurgery to be very interesting, I often found that I did not like the environment of the OR. Since starting though, I've enjoyed it greatly! The other PA's that I'm working with have been super nice and helpful and the surgeons aren't too bad! Actually the second PA I met my first day is a Boise State Alum and, knowing I was a TCU alum, he greeted me by showing me his Boise State scrub cap. My first day was just orientation with learning to scrub (despite me already knowing all this) and learning different kinds of sutures and knot tying. The second day I scrubbed into four orthopedic surgeries and LOVED it! I got to drill a hole into a guy's knee for an ACL repair - awesome!!! I also scrubbed in for a total knee replacement - also a cool surgery. It is pretty brutal because they literally open up the entire front of the knee from the thigh down to the mid shin and then cut into various things and shave away a ton of bone from the femur and the tibia. There is literally bone dust and pieces flying all over the place :) The next day I scrubbed in on a really cool case which involved a new procedure for closing hernias. It was a long case, but crazy interesting. One of the surgeons was super cranking and mean to me, but it was mean to everyone in the surgery so I didn't take it personally. Funny thing - I was scrubbed in on a case with him this morning and he was so nice! He even thanked me and complemented me - he's an odd little old guy, but very cute. Tomorrow I'll be scrubbing in on a mastectomy and reconstruction which will have special meaning for me because of my mom's current fight with breast cancer. (Luckily her cancer was caught early enough that she did not need a full mastectomy)

We are looking forward to what 2010 has in store for us because there is a lot up ahead for our family. We have several weddings to attend, including Corey's best friend, Corey's step-brother, and some college friends. Also, our best man from our wedding just proposed to his girlfriend so they might be getting married this year too! We are also expecting a new niece this year (due in March) and will be celebrating our 2 year wedding anniversary. Soon Corey will start to look for jobs back in TX, I'm hoping to get a final rotation in TX and then before we know it I'll be graduating (in August), and we'll be moving back to TX - woohoo! Then it will be time to get a job, take my certifying exam, travel to Europe, and, finally, start a real job with a real paycheck! And I'm sure there's lots more I'm not even thinking of! Like I said, we are very excited for all that will be happening this year :)