The end

I ended my externship last week in a bit of a blur...I saw lots of patients because the third years I had been working with were all done on Wednesday morning, so from then on it was just me and the attendings every day.  My kid with appendicitis came back for a check-up and is doing well, I saw several kids with hilariously interesting names, and I dealt with several more clueless parents.  I admitted a 12 year old to the hospital the day before her birthday--she showed up that morning for an allergy shot just like she does every week, but the 1.5 mile walk to the bus stop that she and her mom took her get her here (just like they do every week) was too much in the heat and sent her into a massive asthma attack.  It was scary and sad at the same time.  

Now I have a week at home and then Saturday we leave for family vacation in Florida, which should be a lot of fun.  The rest of my family is already there--they go for two weeks, but D could only get off of work for on, so we'll meet them down there.  This ends up being ok, because it gave us the chance to celebrate D's birthday (which is Wednesday) with his family last night, and that was a lot of fun.  

Today (and probably every day this week) I am going to be helping drive my grandmother around, because my grandpa is still--yet again--in the hospital.  He went in on June 1st for a hip replacement and was in for about a week.  He was doing well, got transferred to a rehab facility, and was moving right along with his therapy--but after about a week developed an infection from all of the antibiotics he'd taken to prevent the incision site from getting infected.  He went back to the hospital last weekend, stayed for a week, and then this past Friday went back to the rehab facility.  He was doing ok there, but Saturday morning when he tried to stand up his blood pressure was apparently so low that he collapsed, so now he's back in the hospital again, where they're trying to get his blood pressure up and continue to fight the infections.  It's getting very tiring for everyone, not least because the longer he stays in the hospital, the more disoriented and confused he gets and the worse off he becomes mentally.  We all want him to just come home, so if everyone out there in internet-land could say a quick prayer to your favorite deity, it would be much appreciated. 

Weekend Stories

Our anniversary celebrations turned out to be lovely--on Saturday, we ate lunch with my mom and sisters so that D could run out to the store alone (mumbling something about presents) while I went with my mom to pick up our anniversary cake.  Now, before you get all excited thinking that I am ridiculous enough to go out and buy another wedding cake just for our first anniversary, let it be known that our fabulous baker actually included in the price of our wedding cake last year that on our first anniversary they would make for us (free of charge) a tiny round mini-wedding cake, lest we have to undergo the awful tradition of freezing the top layer for a year.  Gross.  So instead, we had a lovely little chocolate cake that tasted much like our wedding cake did last year!  Hooray!  

Upon meeting back up after said cake-retrieving and gift-getting, we exchanged gifts--I got D a video game and the game Parcheesi (a long story--something he's wanted for a long, long time and we've never been able to find).  D got me a gift card to Walgreens so I can print photos (because I always want to but never have the money) and a book about Florence with the promise that we will put enough money in savings this year to book a trip for next Spring Break.  This is why I love my husband.  We played Parcheesi, got fancied up, and went out to a fabulous dinner.  It was a lovely day.  

Sunday we celebrated Father's Day with each of our respective families, and then yesterday it was back to work for my last week in clinic.  And oh, but there were a couple of gems...mainly that of the mother with her 2 month old baby who informed me that the baby was crying all the time and eating too much.  The baby was currently taking 8 oz. of formula every 1-2 hours (note: normal would be 4-5 every 3-4 hours at that age) and they were feeding him oatmeal because he "just went through food too fast otherwise and we can't afford to keep buying formula."  Holy.  Cow.  FYI:  2 month old babies should NOT be eating solid foods.  Especially things like oatmeal.  Jesus.  We had a loooooong talk about the fact that babies sometimes cry not only when they're hungry, but when they're in pain--like perhaps if their bellies are so stretched out from being overfed that they feel like they're going to explode.  

People crack me up sometimes.  

Anniversary

It's hard to believe, but tomorrow will be one year since D and I got married.  We're celebrating today, because tomorrow is Father's Day and our presence will be required elsewhere.  It's hard to believe out wedding was a year ago--but it's been a fantastic year.  We have a beautiful house, D's been promoted (twice!), I've survived a year of medical school, and we have settled into a fabulous "married life."  It's fun to reminisce about how much fun we had at our wedding.  It's even more fun to look forward and imagine what the next fifty years might bring.  

Here's to us. 

One of those days

Yesterday morning was one of those days where everything just clicked.  I saw three patients in clinic, and they were all interesting and different and had something (or multiple somethings) going on beyond the typical check-up.  The first was an early-teenage boy with high blood pressure, weight problems, and who was still occasionally having trouble with bedwetting (surprising fact:  as many as 1% of 15 year old boys still wet the bed and--medically--it's totally normal.  They just grow out of it later than most.).   The cool thing about him was that I knew what to do for each of his problems and it felt like I knew how to manage this complicated patient pretty much by myself (although part of it was easy--convincing his mother to actually give him all of his BP meds before his heart explodes on him).  Second kid was a 1 year old in for a check-up, mom was great, kid had an ear infection and cold, which I successfully diagnosed and knew how to manage.  Third was a very young teenage girl whose mom wanted her on birth control because mom was sure she was having sex and not telling anyone.  Turns out, she was (frightening)--and I felt really accomplished because we ended up having a very candid conversation about being up front with mom and up front with us so we could keep her safe, what she needed to do to protect herself, etc.  I think we may have actually gotten through to her on some level.  

I think I paid for the awesome morning with the afternoon, because my second patient (at about 2 or 2:30) was a 17 year old female with lower abdominal pain.  Those in the medical community will know that this complaint on this person is a recipe for a headache for any physician/resident/student/nurse/bum on the street, mainly because there are approximately 8 Trillion things that could be wrong and you have to work up for all of them because they're all BAD.  PID, ectopic pregnancy, appendicitis, STDs, gastroenteritis, colon cancer, the list goes on and on and on and on and on...you get the idea.  Luckily for us, we were able to narrow it down and ended up treating her in the office--but with all of the workups we had to do it took FOREVER.  By the time I saw my last patient (at 4:00), the mom was so cranky from waiting so long that I thought her eyes would shoot daggers at me when I introduced myself as the medical student.   

Days like this make me love my job.  

Trivia domination and the wonders of modern medicine

My trivia team won for the third week in a row last night, which was awesome.  My dad got us t-shirts and we wore them like the complete dorks we all are.  

No really exciting stories from yesterday--it's actually kind of odd, but without a particularly interesting or different patient, now that I've sort of hit a stride and gotten used to the routine of things, a lot of my patients seem to blend together by the time I get home and it becomes difficult to recall exactly what I did during the day.  The "different" patient yesterday was a 9 month old baby who was born at 23 weeks gestational age (note: 24 weeks is considered to be the threshold of viability...and even then, only about 5% of babies born that early survive).  She's still on oxygen and has lots of lung troubles--like lots of preemies--but it was amazing to see a kid that used to be less than a pound, who lived in an incubator for a long, long time with skin so fragile you could barely touch it, doing so amazingly well that she could show up to my office and look pretty much like any other baby.  Things like that make medicine pretty darn awesome.  The rest of the day was mainly spent doing well-child check-ups.  

The one other thing that did stand out about yesterday was the fact that another one of the doctors told me I was doing a good job (even better than some of the third years), and that if I was interested in peds he thought I would make a fine pediatrics resident.  Nothing like a shot to the ego, but in all seriousness it did make my day and get me out of the rather bored "i've only seen one patient all afternoon" slump I was in at the time.  And then I got to go talk to two sisters in for their check-ups who were actually lovely and polite and mom was great and they had some issues but were working on them and doing well.  Those are the patients that make the annoying, awful parents totally worth working through and forgetting.  

Weekend Ramblings

Yesterday at clinic was uber-slow...I saw a few kids in the morning there for weight checks and labs (read: they're overweight and we're trying desperately to do something about it before they're too old to care), and a few in the afternoon who were mildly ill but nothing too exciting.  Hoping today is more interesting.  

Our first wedding anniversary is on Sunday, so I went out yesterday and bought D's gift--a new video game he's been wanting and the board game Parcheesi.  Doesn't sound like much, but the Parcheesi is kind of a sentimental gift because it's something he's talked about wanting for about forever, but could never find and would probably never buy for himself.  So I'm hoping he likes it.  I wanted to get something really sweet and thoughtful--like a really nice watch that I could engrave or something--but we limited ourselves to $50 and he already has a watch anyway.  Pbbttthhh.  He can keep the card for touching memories, I suppose.  :-)

The weekend was nice--my in-laws brought over our amazing new bookcase/desk for the spare bedroom, so I'll post pictures of that once we get our absolutely ridiculous number of books and movies onto it and the room is half decent once more.  For now though, I'll apologize for the relatively boring post and get back to my regularly scheduled life-saving (*crosses fingers*). 

Holy Appendicitis, Batman!

The past two days have been fun, but busy, and I was going to write about all the cool stuff I did yesterday last night, but then I got sick.  Excuses, excuses.  Feeling much better this morning, but unfortunately I don't have much time to blog because I have to leave earlier than usual for our morning conference (essentially, a brief lecture meant to help us med students actually learn something about diseases and whatnot).  

The cool thing about yesterday was that I saw a lot of sick kids and actually got to think and learn about diagnosis and treatment a lot.  One kid came in with vomiting, diarrhea, and fever for the past 5 days for which he had been to the ER--where they told him he had a virus and sent him home with ibuprofen.  He went back two days later--same thing.  Two days later, he came to us, whereupon I poked around on his belly and he said it was tender.  The doctor poked around on his belly and asked him to point to where it hurt the most--at which point he stuck his finger right smack in the middle of his right lower quadrant.  We called the ER and told them we were sending the kid over for a CT and surgical consult for appendicitis immediately.  I know he had really, really atypical findings (most kids with appendicitis have more rapid onset of symptoms, and their pain is much more localized) but christ, you'd think someone at an ER would have thought at least on the second go-round that this kid might need to get some imaging done just in case.  Oy. 

Yesterday was also the day of the chromosomally challenged--I saw a kid with DiGeorge Syndrome who also had Tetralogy of Fallot and a heart murmur you could hear from across the room, and another kid with Williams Syndrome.  I also saw one kid whose adopted mom spent the entire time complaining about all these behavior problems he had and being pretty much the most negative person in the world--at which point we all wondered how much the kid was really acting up and how much he was just reacting to her negativity.  Saw a couple of cute babies for check-ups, and got told by one of the doctors that I'm doing better than the third years and everyone loves me. 

Love it when things just work out.  

ETA: Today, we found out that our suspected appendicitis kid was just that--a ruptured appendix with an abscess.  I may have actually contributed to the saving of a life.  I may, in fact, be the coolest person on the earth right now.  :-)

Thank You, Captain Obvious

Some highlights from yesterday at the clinic:

--14 year old kid complaining of headaches.  No other symptoms, absolutely nothing else apparently wrong with him.  Aleve seems to help.  

Me: "I see you failed your vision screen, do you have glasses?"  

Kid: "Yes." 

Me: "Do you wear them?"  

Kid: "No."  

Me: "Well, I think I might have figured out your problem..."

--9 year old who weighs 30 pounds more than I do comes in complaining of allergies.  

Me: "Is she currently on any allergy medication?"  

Mom: "Yes, she takes Allegra."  

Doctor: "Does she take it regularly?"  

Mom: *looks at kid*   

Kid:  *shrugs*   

Doctor:  "Did you take it today?"  

Kid: *nods*  

Doctor:  "Did you take it yesterday?"  

Kid: *shrugs*  

Doctor:  "Did you take it Saturday?"  

Kid: *shrugs*  

Me: "Well, I think I might have figured out the problem here..."

--10 year old in for labs and a weight check, as well as exercise and diet counseling (as kid is severely overweight).  

Me: "One of the easiest things you can do is just not keep junk food in the house.  Having healthy snacks on hand for when she gets hungry is the best option; then she won't want to binge on candy later."  

Mom: "Well I give her like a bag of carrots and some fat free ranch to snack on, and she'll just eat the whole bag!"  

Me:" Ok, well it might help to have some individual portions set aside in baggies so that she knows what a good portion is.  Or maybe you could do something like give her an apple for an afternoon snack so that once she's done, she's done."  

Mom: "But fruit has more sugar than candy!"  

Me:  *bangs head on table*  

But the real kicker here was that after the nurses drew blood and we discussed all of the different things she could do and work on to lose weight, Mom, Kid, and Sibling marched out the door as I walked down the hall to return to the charting area, and behind me I overheard mom saying, "Ok, let's go to McDonald's!"  *weeps*

Shoes and other adventures

The last couple of days this week were also really good--after Wednesday afternoon's experience doing things on my own, I basically just stepped up to do everything the third years were doing on Thursday and Friday.  And overall, things went really, really well.  I feel like I'm getting the hang of things and it all just comes relatively naturally.  I don't even get nervous walking in to visit the patients like I anticipated--everything just flows and I feel (again) like this is just my place in life.  

The only frustrating thing comes from the fact that the third years I'm working with are somewhat...well, just not very fun.  None of them want to do pediatrics (in fact, I'm pretty sure both of the guys are heading to ortho, and if you've ever heard of stereotypes in medicine, that should tell you something), and while I understand that it's probably been a long year for them and they're tired and all, they just seem so bored and out of it all the time.  It makes me hope I don't become jaded by the end of my clinical years and can actually still enjoy medicine as much then as I do now.  

Highlights of the past couple of days:

• I diagnosed a kid with strep throat!  Finally, a sick kid and a diagnosis that was overall pretty darn easy, since I've had it myself so many times.  
• Mostly saw a lot of well-baby checkups, but several were very, very cute.  
• Learned (and did) a couple of teenager check-ups and sports physical, including how to do the "turn your head and cough" and "safe sex/don't do drugs/don't be an idiot" discussion. 
• Saw a 16 month old baby who weighed upwards of 30 pounds and whose guardians informed me that feeding him a jug of juice every day was not the cause of his weight gain and diarrhea, and also that the idea that sleeping in the same bed with a small baby can kill them was "an old wives' tale."  *Bangs head against table.*  Even the doctor had trouble with that one. 
• Had the director of the clinic inform me that I was doing a really good job, especially for being only a second year (which she didn't realize prior to going over my note with me).  

Finally, the absolute highlight of the weekend was these:

which were originally $275 at the department store, where I have coveted them for a long, long time.  I had promised myself quite a while ago that once I graduated from med school and became a resident, upon receiving my very first pay check (the majority of which will all be spent entirely on paying off my inordinate student loans) I would head straight to the store and splurge, because they are not only lovely, but also the single most comfortable pair of shoes I have ever tried on.  Cole Haan got together with Nike to make a pair of pumps that feels like you're wearing tennis shoes, or perhaps walking on air.  Seriously, I have lusted after them.  So today, when I found them at TJ Maxx for a mere $50 (!!!!), I immediately purchased them.  And now, they sit in my closet, making me an incredibly happy camper.  

...And I did!

Lo and behold, yesterday afternoon the third year students had lectures and so I ended up being the only student around, along with 2 of the attendings.  As a result, I got to see all the patients on my own for the first time and do the typical 3rd-year thing.  It was really cool, and I honestly think I did a pretty good job.  I mean, there are questions I sometimes forget to ask and I don't know differential diagnoses from a hole in the ground, but I'm getting pretty decent at taking a pediatric H&P at the least and also getting better at writing a note the way they want one written.  In fact, while I'm sure it's still rather awkward and whatnot, I feel like I really do a good job of just talking to people, which is half the battle.  And more than that, I really enjoy it--it feels right, like this is what I'm supposed to be doing--which is a good feeling. 

Yesterday's list o' patients included a 2-month old for a check-up, a 9-month old for a check-up and follow-up on a previous URI (upper respiratory infection), and an 11 year old for a check-up and school physical.  It was nice to branch out with the 11 year old, because up to then all I had really seen were babies and really young kids.  Today, I'm hoping to get a sick kid or two since I haven't really done one of those yet.  Alas, with all the rain we've been having today will probably be slower than even yesterday (which was pretty slow).  

I could do this better (and other thoughts)

As yesterday was my second day at the clinic, I walked in not knowing for sure what I was supposed to be doing.  When I asked my director, she responded, "What do you want to do?"  Thanks.  I'd like to see patients please, but the manner of doing so doesn't matter so much.  She informed me that I could follow attendings, follow students, see patients on my own, pretty much whatever.  Again, not so helpful.  I mean, I can be proactive and all, but it was my second day and a little direction just to clarify to everyone else what I was there for might have been helpful.  Anyway, I took charge and immediately turned to the other female med student (who was getting up to see her first patient of the day) to ask if I could tag along.  I did, and we saw a couple of patients together.  On the third try, I grabbed the info to enter into the growth chart, and she asked if I wanted to do the work on this one.  And so, I did.  History and physical for an 18-month old well child check-up (aka a "shots visit").  And I wrote the note (with some help) and I presented it to the attending for check-out, and it all went pretty ok.  I felt good about it.  I also felt good about the fact that I am better at taking a history and talking to parents like they are people and not just drones than most of the other students I'm working with.  

After that patient, we went and had lunch, and I resolved that when I returned in the afternoon I would make an effort to see a patient or two on my own.  Unfortunately, there were very few patients scheduled for after lunch, and the other students/residents grabbed the first few up.  But then!   A patient!  And no one else was around!  I grabbed the chart, saw that it was a well-baby check up (easy to do, something I know), and sat down to do the growth charts and whatnot.  At that point, I realized that this patient's name seemed Hispanic in origin, and I looked at previous info to see that, indeed, the doctor they had seen previously was one of our attendings who speaks fluent Spanish.  Being an intelligent person and not wanting to jump to conclusions, I went to the room, knocked on the door, and asked the parents if they spoke English.  Apparently they did speak some, but I decided to double-check with the doctor.  She was busy, but essentially told me to get the physical and any info I could, and she would come later to help with the interview.  Awesome!  Unfortunately, another doctor standing with her (who hadn't been in that morning) stuck her head in to say, "She's not allowed to see people by herself.  Send another student."  Not awesome!!!

Now, I know that Dr. A this morning informed me that I could see patients if I want.  And Dr. B wasn't around to hear that and was pretty much going on the information she had yesterday, which was that I was supposed to shadow.  But still, it was so frustrating when all I wanted to do was take a history.  Alas, I am not one with balls enough to argue with superior attendings, and so I dutifully went with another student, whose history-taking skills seemed incredibly subpar.  No offense to this person, but he just...I don't know, just kind of went through the motions.  I mean, I know these guys have been doing this for a year now, and I know they're probably burned out majorly, and I know they're not interested in pediatrics as a specialty, but you'd think they'd at least talk to the parents with some level of confidence, even if they're faking it.  Just saying.  Anyway, he took the history with a little help from me (since Mom did speak really good English) and then let me do the physical, which was fun.  9 month old babies are hilarious.  We presented to Dr. Spanish and she came in and answered any questions the parents had that they couldn't articulate as well in English.  

The rest of my afternoon was spent learning about diagnosing and treating asthma, since we didn't have any patients.  It was actually really informative and fun, and I felt like I really learned something about medicine.  Hooray!

Other highlights:

• A mom who brought in her baby because he "just didn't look right."  Now, I know that parents know their kids best, but really, we're pretty sure she just fed the kid too much and he was feeling too full. 
  
• Watching one of my fellow students remove sutures from the finger of a really smart elementary-school aged kid, who commented on the whole process throughout. :-D
• Doing a well-child check on a young kid whose entire family came with to the visit--mom, dad, and three very young brothers and sisters who decided that my history would be the perfect time to start screaming and fighting.  It was actually pretty hilarious. 

First day

Yesterday was my first day at my externship, and while it felt a bit slow, I think it's going to be a good experience, especially once I am allowed to start doing more.  Essentially, here's how things work.  There are three third year students (who are really for all intents and purposes fourth years now--this is their last rotation of the year) working in the clinic currently, several attendings, and me (and some residents in the afternoon, but we don't really work with them).  When patients' charts get brought back to be seen, one of the third years picks it up, enters any pertinent information, and goes and does an initial history and physical.  They write a note and present the patient to the attending (in the medical world, "present" basically means tell the doctor above you everything you found out about the patient, including what's going on with their current illness, any past medical problems, family history, etc., and also what you think might be wrong, and how you think you can treat it).  Then, the attending and third year combo return to the patient, the attending checks them out (it's two check-ups for the price of one!) and either oks what the third year said or adds to it if necessary.  

Now, I'm not a third year yet and, while I know the essentials of a head-to-toe physical exam and history, I haven't done many H&Ps on kids or babies.  So for the first couple of days, the head attending of the clinic basically decided to have me simply follow attendings around, and then I'll get to pick up some responsibility and act more like a third year doing my own thing.  Unfortunately, while I'm simply following folks around, the day can be a bit boring because the attendings don't usually see all that many patients without a third year doing it first.  As a result, I'm rather chomping at the bit for some real action.  I did at least learn how to differentiate between iron-deficiency anemia and thalassemia!

Despite the slower nature of the day yesterday, I did get to see some interesting stuff:

• 2 month old and 2 year old kids whose parents spoke no English, in for their check-ups and shots (saw these with a really nice doctor who actually let me enter info into the chart/note)
• 6 month old who was decidedly against my looking into any orifice of his body
• 8 year old with asthma who I got to listen to and do a pulmonary function test with
• Several well-baby visits
• a kid with a previous UTI

Things of note:  parents can be incredible in every sense of the word.  Like the parents who spoke no English, who clearly cared so much about their kids that they drove a pretty long way in order to see a doctor who spoke enough Spanish that they could understand properly how to take care of their child's anemia.  Or the overweight mother of the overweight toddler who explained that the only reason the kid was gaining weight was probably because he liked juice a lot, because otherwise he ate healthy (*smacks forehead*).  Fun times.