I am blogging this, because there are a few places that are my GO TO places on the web.
So, First- Podcasts....
A Gobbet 'o pus Mark Crislip who would be the first to say the world needs a more of Mark Crislip... Mark is an ID doc, and he podcasts about 2 times a week. Great quick listening. The beginning ones have a lot of sound effects that he has removed from the most current ones. I liked the sound effects for the first 100 or so. Now, I appreciate just listening. He also has an app that I use a lot, as well as a QuackCast that I have not explored yet. Sure to be soon.
Emcrit- just spectacular. Always has a bevy of show notes that I refer to. This is geared to the ED /Critical care MD but I still find it great to listen to. Usually about 20 min long. Great Manny Rivers MD of Henry Ford Fame and his sepsis talk. Saved my butt a few times!
ERcast- another one that just is easy to listen to- lots of everyday, important info'
OOPS! Never finished this post...will do so later! But for now, enjoy what I have listed thus far!
Monday, February 6, 2012
Saturday, January 7, 2012
Babies...
This is not going to be an "in order" post, because I am really behind (and yes, I was taught do NOT start anything with an apology but I am starting this with one because clearly I didn't listen.)
I am with Dr. Mason. I was told (perhaps warned??) that I was going to love him. I do. It is one of the best rotations I have had, just because his patients adore him, he gives them every second they need, and he gives us every second WE need. How many people can do that? A lot to look up to and learn from.
First day? A lovely OP vaginal birth. Since it was my first birth that I was not...um...being the center stage of, it was interesting. And beautiful. And the baby was perfect. Hard birth (OP means, at least from what I a can tell thus far is that is it going to be hard, and pushing a face up baby is often REALLY hard.) But she did it with a lot of coaching. I am pretty sure I was more happy than she was at that point in time.
Monday brings a lot of scheduled births that are from high risk moms. Several were from clinic patients that we saw on Friday. I am very glad I get to see those births. I am really excited and I must say that being a part of bring life into the world is just...amazing.
There is a lot more to write, and I think I will be writing a bit more "personal" stuff soon, because a lot of personal stuff is happening. Not all of it's good (ah- a very atypical Annika Sentence!) so deserves a bit more explanation. But that will come next...
I am with Dr. Mason. I was told (perhaps warned??) that I was going to love him. I do. It is one of the best rotations I have had, just because his patients adore him, he gives them every second they need, and he gives us every second WE need. How many people can do that? A lot to look up to and learn from.
First day? A lovely OP vaginal birth. Since it was my first birth that I was not...um...being the center stage of, it was interesting. And beautiful. And the baby was perfect. Hard birth (OP means, at least from what I a can tell thus far is that is it going to be hard, and pushing a face up baby is often REALLY hard.) But she did it with a lot of coaching. I am pretty sure I was more happy than she was at that point in time.
Monday brings a lot of scheduled births that are from high risk moms. Several were from clinic patients that we saw on Friday. I am very glad I get to see those births. I am really excited and I must say that being a part of bring life into the world is just...amazing.
There is a lot more to write, and I think I will be writing a bit more "personal" stuff soon, because a lot of personal stuff is happening. Not all of it's good (ah- a very atypical Annika Sentence!) so deserves a bit more explanation. But that will come next...
Wednesday, November 23, 2011
The LOL Surgical consult
Call nights are long- often filled with incredibly boring periods, peppered by intense moments of trauma codes. This night was no different, we had more ER consults than trauma codes. A good thing for the people involved, but for us, at hour 19, well, a bit of trauma does the exhausted body good-caffeine? Ha! No need with a healthy dose of adrenaline- stabbing, gunshot or 3, housefire with a pregnant woman- that'll getcha going.
I got a consult on an older AA woman. She had an abscess- but it was not specified where. I have learned that getting in on the bread and butter cases, the ones that the interns and residents don't want, are the ones that I want. I can DO them- and learn from them.
I did my H & P. the history revealed no major medical issues. No surgeries or injuries save a broken tooth or so. 3 kids, all normal vaginal deliveries. +FM of the typical DM, CAD, HTN- but thus far, she had none of the above. Did not smoke, drink, do drugs. No waving red flags. Okay! I can DO this! So, her issuse seemed to be just isolated- painful and isolated.
This poor, tiny 78 year old woman had an abscess on her mons pubis. Big one. Denied waxing, was not sexually active. She was married, but her "man" had been living with another woman for the past 20 years. She was a-okay with this. No one else in her life-lived alone. She did call her husband when I was interviewing her to ask him what other meds she took- Vit e was pretty much it.
The PE revealed she had the worst...um...well, yeast infection that I had ever seen, and honestly, guys, hope never see again. It was..."impressive". Put that in your admission note and that'll catch someone's attention. As I said, she denied DM, however, just as I was beginning to ask all the questions, leading at least my differential that such an infection tends to come from in a woman who denied ever being sick, the RN pops her head in "Her BGL is 511". As I was being told this, she was grabbing her Big Oreo Pack out of her purse to munch on. I told her that Oreos are probably off the menu for a bit.
At least I had one answer to one of her problems.
Clearly, however, the other issue was going to be done in the OR. Poor thing. She had a red, hot, fluctuant mass, about 6cmX10cm. It did not go thru to bone from what we were able to assess in the ED.
Here is where it gets funny.
She had never been in the hospital. She wanted to take EVERYTHING home- the empty IV bags, the chucks, her phone was out-she was snapping pictures everywhere. I have one of her-she wanted to have one of both of us on my phone too so I'd never forget her. (Not like I could forget her...).
She was so cheerful, so optimistic, and upbeat. She was sitting up in the OR when we got in, talking to everyone a mile a minute. I am sure she was nervous, but none the less, a truly bright spot in the rotation for everyone who touched her that night.
Later, I found out she had been putting Icy-Hot on her "'fected part". I came into her room for her post op check and she had it out to apply it to the open drainage area. I can only imagine the pain that would have been. I had asked her on initial interview if she had done anything to make it feel better, I guess I needed to ask if she did anything to make it feel better that failed. That I would consider a fail to be sure. She then admitted to putting cabbage compresses on her "'fected part" too. Her post op went smoothly- her BGL were labile as would be expected, but medicine did their magic and they were eventually controlled.
And now, in all the ways that so many of the rotations went in Detroit, her story is so much deeper, sadder and still astounding to me.
Frankly, Sad.
Remember that phone? All those pictures? She had a chronicle of her life in pictures on her phone. If anyone ever got her phone, the things that they would see. She could hardly see her phone, but she took pictures still. When she was showing them to me, about 1/2 way back was a picture of a man in a casket.
I was taken aback...what in Gods name did she have that for? I asked of course (I always ask...just my nature). She knew him- he was her neighbor. He had been shot, in front of her, outside her apt. And yes, she had pictures of him on the sidewalk, dead. She knew who shot him. While telling me about this, she covered her mouth, asked if she was going to Hell because she had lied to the "Po-lease" because she knew that if she admitted she knew, she might be next. You don't live that long on the east side of D-Town if you're a dummy. She clearly is no dummy. If there is a God, this woman is certainly not going to Hell. She has been there- but her cheerfulness and joy in the world was bigger and greater than what surrounded her.
She said she had pictures of all the people she had seen at funerals. All her friends kids who had died. All the people in her building who had been shot and killed over the years.
She told me that she slept in front of the window now, watching to see if anyone was coming. I am a white girl from the country and I have one thought about guns besides ban 'em. I want FAR away from them- esp if someone I don't know is carrying them. Her thought was that if she saw who was coming, she could get away. She was scared but it is what she knew. Me? I'da picked a door. A solid door.
I don't remember her name, I have her picture still. I hope she is okay. She was discharged home after 2 days stay to get her glucose under control. I hope she followed up- and I hope that somehow she has found some peace and quiet in her life. Yes, I asked SW if they could somehow help, but no- nothing to do. She was A&OX3. Frankly, she was a great example of survivor, strong, beautiful, an optimist in the light of all that is so difficult about D-Town.
This happened well over 2 months ago. I am ending my stint of being in Detroit for rotations. Overall, I have gained such an appreciation of the deep recesses of humanity that exist downtown. Yes, it's a terrible place, but under the layer of grime and filth, there really is something very special about the city. The grit, the simple acts of survival that profoundly effected my rotations there. Certainly I learned something about medicine or at least I hope so, but I also learned a lot about people. I actually do believe that the city can be brought back.
There are a lot more stories- more blog posts to come. It's a lot of driving to get to and from- easy 2 1/2-3 hrs a day. I won't miss that! Makes for no time to write anything. A2 next month....
I got a consult on an older AA woman. She had an abscess- but it was not specified where. I have learned that getting in on the bread and butter cases, the ones that the interns and residents don't want, are the ones that I want. I can DO them- and learn from them.
I did my H & P. the history revealed no major medical issues. No surgeries or injuries save a broken tooth or so. 3 kids, all normal vaginal deliveries. +FM of the typical DM, CAD, HTN- but thus far, she had none of the above. Did not smoke, drink, do drugs. No waving red flags. Okay! I can DO this! So, her issuse seemed to be just isolated- painful and isolated.
This poor, tiny 78 year old woman had an abscess on her mons pubis. Big one. Denied waxing, was not sexually active. She was married, but her "man" had been living with another woman for the past 20 years. She was a-okay with this. No one else in her life-lived alone. She did call her husband when I was interviewing her to ask him what other meds she took- Vit e was pretty much it.
The PE revealed she had the worst...um...well, yeast infection that I had ever seen, and honestly, guys, hope never see again. It was..."impressive". Put that in your admission note and that'll catch someone's attention. As I said, she denied DM, however, just as I was beginning to ask all the questions, leading at least my differential that such an infection tends to come from in a woman who denied ever being sick, the RN pops her head in "Her BGL is 511". As I was being told this, she was grabbing her Big Oreo Pack out of her purse to munch on. I told her that Oreos are probably off the menu for a bit.
At least I had one answer to one of her problems.
Clearly, however, the other issue was going to be done in the OR. Poor thing. She had a red, hot, fluctuant mass, about 6cmX10cm. It did not go thru to bone from what we were able to assess in the ED.
Here is where it gets funny.
She had never been in the hospital. She wanted to take EVERYTHING home- the empty IV bags, the chucks, her phone was out-she was snapping pictures everywhere. I have one of her-she wanted to have one of both of us on my phone too so I'd never forget her. (Not like I could forget her...).
She was so cheerful, so optimistic, and upbeat. She was sitting up in the OR when we got in, talking to everyone a mile a minute. I am sure she was nervous, but none the less, a truly bright spot in the rotation for everyone who touched her that night.
Later, I found out she had been putting Icy-Hot on her "'fected part". I came into her room for her post op check and she had it out to apply it to the open drainage area. I can only imagine the pain that would have been. I had asked her on initial interview if she had done anything to make it feel better, I guess I needed to ask if she did anything to make it feel better that failed. That I would consider a fail to be sure. She then admitted to putting cabbage compresses on her "'fected part" too. Her post op went smoothly- her BGL were labile as would be expected, but medicine did their magic and they were eventually controlled.
And now, in all the ways that so many of the rotations went in Detroit, her story is so much deeper, sadder and still astounding to me.
Frankly, Sad.
Remember that phone? All those pictures? She had a chronicle of her life in pictures on her phone. If anyone ever got her phone, the things that they would see. She could hardly see her phone, but she took pictures still. When she was showing them to me, about 1/2 way back was a picture of a man in a casket.
I was taken aback...what in Gods name did she have that for? I asked of course (I always ask...just my nature). She knew him- he was her neighbor. He had been shot, in front of her, outside her apt. And yes, she had pictures of him on the sidewalk, dead. She knew who shot him. While telling me about this, she covered her mouth, asked if she was going to Hell because she had lied to the "Po-lease" because she knew that if she admitted she knew, she might be next. You don't live that long on the east side of D-Town if you're a dummy. She clearly is no dummy. If there is a God, this woman is certainly not going to Hell. She has been there- but her cheerfulness and joy in the world was bigger and greater than what surrounded her.
She said she had pictures of all the people she had seen at funerals. All her friends kids who had died. All the people in her building who had been shot and killed over the years.
She told me that she slept in front of the window now, watching to see if anyone was coming. I am a white girl from the country and I have one thought about guns besides ban 'em. I want FAR away from them- esp if someone I don't know is carrying them. Her thought was that if she saw who was coming, she could get away. She was scared but it is what she knew. Me? I'da picked a door. A solid door.
I don't remember her name, I have her picture still. I hope she is okay. She was discharged home after 2 days stay to get her glucose under control. I hope she followed up- and I hope that somehow she has found some peace and quiet in her life. Yes, I asked SW if they could somehow help, but no- nothing to do. She was A&OX3. Frankly, she was a great example of survivor, strong, beautiful, an optimist in the light of all that is so difficult about D-Town.
This happened well over 2 months ago. I am ending my stint of being in Detroit for rotations. Overall, I have gained such an appreciation of the deep recesses of humanity that exist downtown. Yes, it's a terrible place, but under the layer of grime and filth, there really is something very special about the city. The grit, the simple acts of survival that profoundly effected my rotations there. Certainly I learned something about medicine or at least I hope so, but I also learned a lot about people. I actually do believe that the city can be brought back.
There are a lot more stories- more blog posts to come. It's a lot of driving to get to and from- easy 2 1/2-3 hrs a day. I won't miss that! Makes for no time to write anything. A2 next month....
Saturday, September 17, 2011
The entire patient
is what we treat.
A pt came in to us. Seriously hurt because they had done something stupid when consuming a bit too much alcohol. Well, a lot too much, really. Lucky because no one else got killed. He hurt himself worst of all, but his companion will be feeling the pain for days. He ended up being surgical to fix some seriously broken bones in his face.
(you ortho-gods, bones, bone fragments, breaking bones, moving bones-def not for me.... I give you credit.)
As a good PA student, I researched his EMR thoroughly. It had been mentioned that he had an ID band on his wrist from our hospital when he came in. I asked him when he was alert enough if this was so, and it was indeed the case- he had been DC'd just a couple of weeks before. Shocking- admitted for another trauma that was associated with ETOH. And further back, in the past 6 months he had been in our ED over 6 times. Not always admits, but always trashed.
Each time for ETOH abuse/issues. Levels were all over 200. Each time. Some MUCH higher. And most of these incidents were involving a several thousand pound vehicle traveling at high rates of speed. Anyone seeing any red flags?? I was holding his hand, and thinking how much he had cost our system, how close he has come to killing people. According to his EMR, he would spit at MD's when angry. None of that right now, he was a scared kid.
He was younger than my daughter, older than my son. I talked to him about quitting. He said he wants to, but he tried and he couldn't do it alone. I told him this meant NEVER drinking. He said he knows. He said he wanted that. He wanted rehab.
I accompanied him down to the OR later. He was polite, we kind of knew each other at this point in time. I admit still being irritated with him, and feeling cynical- he was driving without a license, he was responsible for several other injuries we were treating that day. What made me think my simple little "You GOTTA stop drinking before you kill yourself or someone else" talk would make any sort of dent in his disease?
A family member was escorted into the room to see him. It was a woman, who right away went to his side and started to rub his back. I introduced myself and she told me she was his grandmother. She asked me a bit about his injuries, and what to expect. I reiterated to her some of what I knew, and what I had told him- his physical injuries were serious, but the most important thing was that he must stop drinking.
She looked right at me and said "He has to learn to love himself first, then the rest will be easy. I want him to get through this- he has a lot to deal with when he gets out of here. My only concern today is that he knows he is loved, and that he is loveable, and that I am here for him. That's my only concern today for him today. The rest will come."
She proceeded to tell him some of that, and I watched her bend over him, whisper to him, rub his back. While he was in and out of awareness, she told me a bit more about him. She was his dad's mom, that his mom was not a loving person, and that she had said to him after he had come into us that she wished he had died. Her son just had been getting help with an addiction to drugs. "He's stepping upto the plate- it's taken him a long time, but he's here." Her grandson had worked for the city but had gotten laid off with the latest cuts. When telling me the background, we both were teary. She then prayed over him-for his recovery, the surgeons hands and the calmness that is needed in the OR to make her grandson better. Her faith, despite mine being questionable, filled that cubicle. It was bigger than anything else in that hospital at that point.
His mom came, clearly inebriated. Grandma left then, so the rest of the family could come in.
During his post-op check, he was doing very well. He responded well, wounds looked great. I told him that his grandma had been there- and what a remarkable woman she was. He said he loved her.
I then told him this: To have someone love you so much is a gift. It's a gift very few have. It's provides more riches than most have. It may not put food on the table, but it puts something into your soul, your heart that is just not possible to reproduce. It's not something one should ever take lightly, and indeed it's a kind of responsibility to know that someone loves you that much.
For me, it was a reminder. A chuck under the chin to remember that the story is far more than the EMR might indicate. It's complex, sad, heartbreaking. But there are threads of golden woven through that glint thru the ugliness that permeates so many stories we see. Keep looking for the golden. You might find it.
A pt came in to us. Seriously hurt because they had done something stupid when consuming a bit too much alcohol. Well, a lot too much, really. Lucky because no one else got killed. He hurt himself worst of all, but his companion will be feeling the pain for days. He ended up being surgical to fix some seriously broken bones in his face.
(you ortho-gods, bones, bone fragments, breaking bones, moving bones-def not for me.... I give you credit.)
As a good PA student, I researched his EMR thoroughly. It had been mentioned that he had an ID band on his wrist from our hospital when he came in. I asked him when he was alert enough if this was so, and it was indeed the case- he had been DC'd just a couple of weeks before. Shocking- admitted for another trauma that was associated with ETOH. And further back, in the past 6 months he had been in our ED over 6 times. Not always admits, but always trashed.
Each time for ETOH abuse/issues. Levels were all over 200. Each time. Some MUCH higher. And most of these incidents were involving a several thousand pound vehicle traveling at high rates of speed. Anyone seeing any red flags?? I was holding his hand, and thinking how much he had cost our system, how close he has come to killing people. According to his EMR, he would spit at MD's when angry. None of that right now, he was a scared kid.
He was younger than my daughter, older than my son. I talked to him about quitting. He said he wants to, but he tried and he couldn't do it alone. I told him this meant NEVER drinking. He said he knows. He said he wanted that. He wanted rehab.
I accompanied him down to the OR later. He was polite, we kind of knew each other at this point in time. I admit still being irritated with him, and feeling cynical- he was driving without a license, he was responsible for several other injuries we were treating that day. What made me think my simple little "You GOTTA stop drinking before you kill yourself or someone else" talk would make any sort of dent in his disease?
A family member was escorted into the room to see him. It was a woman, who right away went to his side and started to rub his back. I introduced myself and she told me she was his grandmother. She asked me a bit about his injuries, and what to expect. I reiterated to her some of what I knew, and what I had told him- his physical injuries were serious, but the most important thing was that he must stop drinking.
She looked right at me and said "He has to learn to love himself first, then the rest will be easy. I want him to get through this- he has a lot to deal with when he gets out of here. My only concern today is that he knows he is loved, and that he is loveable, and that I am here for him. That's my only concern today for him today. The rest will come."
She proceeded to tell him some of that, and I watched her bend over him, whisper to him, rub his back. While he was in and out of awareness, she told me a bit more about him. She was his dad's mom, that his mom was not a loving person, and that she had said to him after he had come into us that she wished he had died. Her son just had been getting help with an addiction to drugs. "He's stepping upto the plate- it's taken him a long time, but he's here." Her grandson had worked for the city but had gotten laid off with the latest cuts. When telling me the background, we both were teary. She then prayed over him-for his recovery, the surgeons hands and the calmness that is needed in the OR to make her grandson better. Her faith, despite mine being questionable, filled that cubicle. It was bigger than anything else in that hospital at that point.
His mom came, clearly inebriated. Grandma left then, so the rest of the family could come in.
During his post-op check, he was doing very well. He responded well, wounds looked great. I told him that his grandma had been there- and what a remarkable woman she was. He said he loved her.
I then told him this: To have someone love you so much is a gift. It's a gift very few have. It's provides more riches than most have. It may not put food on the table, but it puts something into your soul, your heart that is just not possible to reproduce. It's not something one should ever take lightly, and indeed it's a kind of responsibility to know that someone loves you that much.
For me, it was a reminder. A chuck under the chin to remember that the story is far more than the EMR might indicate. It's complex, sad, heartbreaking. But there are threads of golden woven through that glint thru the ugliness that permeates so many stories we see. Keep looking for the golden. You might find it.
I'm glad you're here....
Yesterday I observed a surgery that was not performed by one of our surgeons, but one from another service. We had had this patient for as long as I have been there, and has been my patient since getting to our hospital. I asked the if I could observe the day before, and was told to page the attending to ask.
I don't do that. Call me chicken if you want. I'll take that rather than the wrath of an irate attending that is about to perform miracles in the OR on a patient I care about. I want that attending to be in a really good, balanced mood when they take that blade into their hand, not irritated with a student-much less a lowly PA student.
So, I went down to pre-op with the pt and waited for someone who knew something about anything. The resident showed up and I asked him when the attending might be there. He said..."I'm glad you're here. I already talked to him about it- he's cool with it."
I admit- I got a bit hot and bothered. In a good way. Those words made my day. Quite possibly my rotation. Not one other person has said that to me since starting rotations;I miss that feeling of being a valued part of the team. Even as a tech, the RN's would comment on my being there- that they were glad to be working with me that night. I know I make a point of telling people that their presence is a good thing- that I appreciate them caring if I see them do something above and beyond. When teching, I have even emailed a RID (Really Important Doc) and said how much I appreciate their care of a patient. That might have been a bit too "annika" but I don't really care.
So, thank you Dr. C, you made my week. I stayed late to watch the surgery, but instead got a boost of needed energy.
I don't do that. Call me chicken if you want. I'll take that rather than the wrath of an irate attending that is about to perform miracles in the OR on a patient I care about. I want that attending to be in a really good, balanced mood when they take that blade into their hand, not irritated with a student-much less a lowly PA student.
So, I went down to pre-op with the pt and waited for someone who knew something about anything. The resident showed up and I asked him when the attending might be there. He said..."I'm glad you're here. I already talked to him about it- he's cool with it."
I admit- I got a bit hot and bothered. In a good way. Those words made my day. Quite possibly my rotation. Not one other person has said that to me since starting rotations;I miss that feeling of being a valued part of the team. Even as a tech, the RN's would comment on my being there- that they were glad to be working with me that night. I know I make a point of telling people that their presence is a good thing- that I appreciate them caring if I see them do something above and beyond. When teching, I have even emailed a RID (Really Important Doc) and said how much I appreciate their care of a patient. That might have been a bit too "annika" but I don't really care.
So, thank you Dr. C, you made my week. I stayed late to watch the surgery, but instead got a boost of needed energy.
Surgery
So, as I said in the previous post, I am in surgery. I am surprised to say that I love the ED part most of all. I mentioned before that I had considered a residency in ED- one focused on Rural medicine that is in NY. I kind of dropped the thought off of my local radar, just because A)money-I need to make some of that green stuff and the sooner the better! and B) thinking that not having the continuity of patient care might limit my enjoyment.
Nope. Not so. It's actually good- I can care, and deeply care, about getting the patient better enough to get them to the next step of their recovery and that is good. I love the intensity, the need to bring all aspects of my (limited) training to the forepart of my brain, balancing the medicine, surgical aspects in the resus bay. I of course am watching and learning right now. But, my head is swimming with thoughts.
So, the thought of the residency is back. Strongly. I think it might be great. I think I might like it. And since nothing else has really grabbed me yet during rotations, maybe this is it. Stay tuned.
I also admit feeling like I have not learned nearly enough thus far in my rotations. Not nearly enough. I also admit that I wanted to be at UMMC for many of my rotations. Thus far, I have gotten none of them. Zero. I miss the U, miss the environment that that place provides. There were endless opportunities to learn there- endless. I miss that a lot. I also miss the caring that the U seems to have at the center. I am not seeing that out in the "real" world, and I find that sad.
So help me GOD....If I see/hear of another person slamming a NG tube down someone, without lube, and hurricane spray--forgetting lido-jelly even for a moment as a possible assist-and then wonder why the patient was so miserable and refusing another NG tube, I wish the NG curse on them some day. Because when I asked, I was told "it takes too much time". Oh boy...If I were not a student, and somehow could mention what I really thought, they'd get an earful. Say whatever you want, it's the wrong thing to do.
I have seen several surgeries but none of the usual suspects...no appy, lapchole, bowel obs for me! Nope, was in on a massive lac to the back of the neck where the C-spine was...right... there...and the clot that had formed was as big as a small baby. I kid you not. I have seen orbit repair with screws, plates, mesh. I have seen more I and D's- seemingly the bread and butter of surgery-forget hernias! I have seen an exploration of an orbit from a possible self-inflicted GSW...I'll tell that story at another date.
I have learned a lot I admit. Most of what I have learned is this:
Nope. Not so. It's actually good- I can care, and deeply care, about getting the patient better enough to get them to the next step of their recovery and that is good. I love the intensity, the need to bring all aspects of my (limited) training to the forepart of my brain, balancing the medicine, surgical aspects in the resus bay. I of course am watching and learning right now. But, my head is swimming with thoughts.
So, the thought of the residency is back. Strongly. I think it might be great. I think I might like it. And since nothing else has really grabbed me yet during rotations, maybe this is it. Stay tuned.
I also admit feeling like I have not learned nearly enough thus far in my rotations. Not nearly enough. I also admit that I wanted to be at UMMC for many of my rotations. Thus far, I have gotten none of them. Zero. I miss the U, miss the environment that that place provides. There were endless opportunities to learn there- endless. I miss that a lot. I also miss the caring that the U seems to have at the center. I am not seeing that out in the "real" world, and I find that sad.
So help me GOD....If I see/hear of another person slamming a NG tube down someone, without lube, and hurricane spray--forgetting lido-jelly even for a moment as a possible assist-and then wonder why the patient was so miserable and refusing another NG tube, I wish the NG curse on them some day. Because when I asked, I was told "it takes too much time". Oh boy...If I were not a student, and somehow could mention what I really thought, they'd get an earful. Say whatever you want, it's the wrong thing to do.
I have seen several surgeries but none of the usual suspects...no appy, lapchole, bowel obs for me! Nope, was in on a massive lac to the back of the neck where the C-spine was...right... there...and the clot that had formed was as big as a small baby. I kid you not. I have seen orbit repair with screws, plates, mesh. I have seen more I and D's- seemingly the bread and butter of surgery-forget hernias! I have seen an exploration of an orbit from a possible self-inflicted GSW...I'll tell that story at another date.
I have learned a lot I admit. Most of what I have learned is this:
- Who you work with is as important as what you're doing
- Driving over an hour to work is plain and simple NOT for me
- I need to be someplace where patient centered care is at the fore-front at all times
- I need to be someplace where you're striving to always be better, so the patients get better
- I need to always be able to learn, to push past what I get and enter into areas that I feel lost and need the compass of those wiser than me to survive and thrive
- Saying I don't know is okay as long as you make sure you will know soon
The rotations keep rolling
I am currently in my surgical rotation. Parts, I love. Parts I dislike. I have seen a lot of what I do not like in me coming out- dealing with one of the team members is quite challenging for me. I have 2 more weeks. I canwill be nice, and think good thoughts about this person and know at the end of it all, I would rather have me than that person taking care of my patients. And if you "know" me, that's saying a lot.
I finished psych. Outstanding preceptor, but horrible rotation. I am rotating in an area where despair is the norm, and the genetic pool is riddled with mutations. Psych is a hard one for me, because we can't fix it. Not one bit. Our meds might make a difference, but does it really change the illness? No, it'd be a fix, but not a change. In many ways, it's like a cancer, but a never-ending-never-changing sort of cancer. Lifelong CLL. But worse. I admit wanting to fix things, to make things better. Inpatient psych, esp as a consult service really can't do that, nor does it pretend to do this. Perhaps that's why there are so many tools and ways to pigeon hole the patients. A DX is essential, and knowing what their GAF is becomes important. How does axis III change axis II? I? Perhaps intellectualizing all this allows for the MP to keep some distance, and allows for better care. I don't know, and I know that I am not going into psych.
That's okay. I am ok with that- there are so many things I want to go into, ruling one out is in my best interest right now.
I finished psych. Outstanding preceptor, but horrible rotation. I am rotating in an area where despair is the norm, and the genetic pool is riddled with mutations. Psych is a hard one for me, because we can't fix it. Not one bit. Our meds might make a difference, but does it really change the illness? No, it'd be a fix, but not a change. In many ways, it's like a cancer, but a never-ending-never-changing sort of cancer. Lifelong CLL. But worse. I admit wanting to fix things, to make things better. Inpatient psych, esp as a consult service really can't do that, nor does it pretend to do this. Perhaps that's why there are so many tools and ways to pigeon hole the patients. A DX is essential, and knowing what their GAF is becomes important. How does axis III change axis II? I? Perhaps intellectualizing all this allows for the MP to keep some distance, and allows for better care. I don't know, and I know that I am not going into psych.
That's okay. I am ok with that- there are so many things I want to go into, ruling one out is in my best interest right now.
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