FP

I am ending the rotation next week. It's been a great rotation for many reasons- FP is a nice sorta gig, as you can actually follow up and try to help a patient change their lifestyle so they might enjoy healthier living.

So, for the first week... My pt. (and this is the generic pt's- and believe me, there are a zillion just like this.)  DM-Type 2, NID, HTN Stage 1, add a bit of elevated BMI, a bit 'o drinking on the weekend- and maybe the weekdays. Maybe they smoke. Um. and the cardio they have (and this counts to them) is walking from the car to the door of their office.

Me:
So, you know that smoking (fill in the rest of the blanks) causes X,Y Z.
Pt:
Yes, I do. I have tried many times to stop. I just can't.
Me:
That's great! Keep trying. You can do it! There are ways that we can help you...(fill in the blank)
Pt:
Yeah, I got that patch/Pill/Gum once before. I stopped for a month/3 months/6 months and then started again.
Me:
Okay, well, I think that's great! Now, the next step is to try again.
Pt:
That sounds good.     Yeah, maybe I can do it.
Me:
Wow- that's great! So, comeon' back in 4 weeks, and we will talk again.

Fast forward 5 weeks:
Me:
So, how are you doing?
Pt:
Well, I tried x,y and z and I cut down to 19 instead of 20 a day.
Me:
Well, Good...now, what can we do to help that move along faster for you?
Pt;
Well, I am not sure.

So, reality is this: When they are motivated to change, they will. I hope that I motivated some one person to change their lifestyle just one smidge to make their lives healthier. But I am not sure. I admit my conversations now lean towards

Me:
Do you smoke?
Pt:
yes, about a pack a day
Me:
Okay, you know you're going to get the lecture. You know it's bad for you and I want you to know that when you decide to quit, we are here to help you in any way we can. Until you want to quit, there really is nothing I can do to help you.
Pt:
Thanks. I've heard it all before.

We all know that we shouldn't smoke. Should drink in moderation. Should exercise. Should not eat junk, but eat at home, healthy foods filling our diet. But we don't- okay, some do, and I admire them. But I know I don't always. This past year is a great example. I have been a sitting, unexercising, icecream eating slob. I swear that this will change- when?

When I am darn good and ready. But it's HARD and its internal. I know all the reasons to be good- including feeling better. But, other than that. it comes from an internal place that just don't have the ability to tap right now. So, developing the knowledge that it's hard- yet still mentioning it at each and every visit is essential. I also have to say I bring it up in my ED conversations (the joys of being a student- no clock on my head).  I hope to make an impression to my patients with advice on healthy living- and I'll keep trying to be an example.

That road to hell is well paved

Nick is officially a college Freshman, Jas has come and gone, and I have 2 more official FP days with Dr. B.  Hard to imagine that I am almost 15% done with the year. Um...really?

I don't know enough. That is what I know the most. The rest is just mush in my brain, and I am hoping at some point in time it clicks. As for now, Thank God for Epocrites and my other iPhone programs. I use them  a lot, and am ever grateful for the quick glance to make sure I "get" it- and hopefully get it right.

I had one day that I found difficult. A pt came into the UC facility that I was working with. He was young, and had 3 small children with him. There was no other family with him, and the kids were, well, kind to say, un-disciplined. Now, I give my kids (or rather gave...sniff. No more kids for me! One all grown and one ready to be an adult....) a fair amount of free rein. But, there were certain things that they knew crossed the line. And perhaps I might have flown off the handle a few times, who knows...(they might and I do), but overall, I was never horrified by them in public.  Actually, I have to say they usually made me proud.

So, this situation was tough for me. These kids needed to behave- Dad was in pain, sick, and needed a bit of a "best not to go to soak in the lake after getting a huge 'tat on your arm...and if it looks hot and inflamed and has smelly stuff oozing out of it- might be a good idea to head to your friendly ED/UC without your kids, before you have a full-blown abscess or 3 in your arm" kind of talk that you give to all your patients that come in. Well, maybe not exactly that, but...you can imagine something like that might be said to a supposed pt that might be presenting to you some day.  Just sayin'.

So, there was that line of pt needing my attention, and the kids demanding my attention. Kids won for a bit, only because I was afraid that they might end up needing a head CT from them bashing each others heads into the walls....

So, I left, and felt bad. My job was my patient- not the kids. My job was to take care of him, not his kids. My job was to treat him, not judge his parenting. For the first time, I felt that I learned something- from the patient, not a book. There is a great video...Every Person has a Story that says it better than I can- a training video from Chik-F-La. I have NO idea why that day I did not remember that important part of caring is...caring, but I am sure to remember from this point on. I have no idea what or how these kids got to be there, but surely they deserved more of me.

I would never have thought I'd have needed a lesson such as this- usually I am the one that points this out to others. But, in a very nice, yet direct way, someone showed me, and I appreciate it.

We learn more by being at the bedside than we learn from books. I am grateful...always.

What I say vs. What I do.

So I did indeed say I wanted to write more in the blog. I have evidence that this is a good thing -The Academic  Life in Emergency Medicine Blog- which has reference to blogging as being good for medical education and promoting self awareness, increasing compassion...which everyone needs more of, but I seem to have in abundance and actually gets in my way at times (how's that for a sentence!). The ED rotation work has shown me that I had best pick up the speed....but I care if they are anxious about their kids and their work and their...I digress again Argh!

Obviously I have not done this better blogging thing. But I have thought about it. That road to hell is indeed paved with good intentions. So, here I am. And I have over 100 pts to log, a garden to ready, and a week of grandkids, kids, graduation, parties, and...more. But the strange thing is I have been thinking about a few patients -a lot.

What has stuck is the patients that stick. Yeah, I know-terrible prose. But I have experienced a few patients with stories that have really stayed with me over the years-the ones that wake me and I think- what went wrong? Or right? or what could I have done now that might have made the outcome better? And so, I'll mention them again, maybe some for the first time but...and hopefully, when I have some time, I will expand on their stories as I remember them.  But for now....

There was the man who came in the the unit late one night- he was youngish, 50's? Had a hx of cardiac issues. He came in with his with his family-  all were scared. As the medics wheeled him past, he looked at me, and said...I am really scared I am going to die. 

Anyone that knows and heard this statement knows it's not one that you want to hear. Especially in this sort of pt. You'd think he'd be fine- he should be fine. But that sense of forebearing makes me nervous- always evokes that "thump" in the pit of my stomach. I was hooking him up and looked him right in the eye and said "we are going to do everything we can to make sure that does not happen."  Dangerous statement- because while we can do everything, some things can't get fixed.

So without details, he did indeed die. I, of course, felt I had let him down. But the strange thing was this: He was still there. I mean it. Still in the room, still felt totally alive. His heart pumped nothing, his lungs exchanged no O2, his brain had not one discernible electrical wave. I have wrapped many a body, and some I believe were long gone in spirit before we readied them for the family and the final visit.  This man was very much there, as confused as the other humans in the room when the code was called. This is a man that was not ready to die. Wanted to live. Wanted to see his kids grow, marry, and carry his grandkids. He wanted to do what most get to do, and don't even appreciate. His body died long before his soul was ready.

Often when wrapping a body, there is light talk, and sometimes laughter- it's a horrible task, really. That last zip as we close them inside the bag- it is so horribly finite. So, laughter can ease the time and stress of the task. There are some realities that happen at the end of everyones life that have to be taken care of. Some are not so nice, and really rather smelly. So, yes, while it seems terrible, there are some very bad jokes told- some bad situations that we've gotten into that do cause giggles to escape when it seems quite wrong.

For this gentleman, there was no talk, just whispers, and then, a soft prayer-for the transition he so badly did not want to take to go smoothly, because he was kicking and fighting the entire way. I spoke to him when doing my work- and I admit, tears were there. Because I really had let him down- a promise made that I could not keep...medical science had let him down. But finally, it was his body that had really let him down- while there are some things that can be fixed, so many can't. He could not be fixed.

He I will never forget.

Combined three into one.

So, I combined my blogs. No reason other than I already feel splintered, and having three blogs somehow made that feel even worse, and stymied any attempts to continue to chronicle things in my life.

Because what I know now, more than before, is that the things I value all meld together in some sort of pattern that is me. Sometimes, it feels disparate but overall, what is true is that all of the things that I value are all of the things I care to write about. So, hopefully they combined and it works. I'll try and tag correctly if I ever decide to go back and read something.

So a few things- First. I value and believe in HIPAA.  So, if there is something that refers to a patient, I have TOLD and ASKED that patient if it's okay that I write about them. And yes, even a few pictures! They knew obviously. Probably from this point on, there won't be patient picturess, as I am no longer a tech, but something between knowing nothing, and knowing something. (I assure you that I am more on the Nothing end of the continuum still, and am becoming more and more aware as the days pass that I had best put something between my ears that might indicate I know something.) If I ever DO have pictures, well, then, I have asked at least once and probably more than once, called my psychiatrist, discussed with friends, co-workers (who won't give a damn) and called my lawyer. So, if anyone ever reads this and things- OMG! She's crossed the line- remember the above, and add a bit of knowledge that I live in a world of guilt and if I ever did anything like "that" (dadada da...) I'd off myself.

Then, have to add that these are MY thoughts, my feelings, my everything, inc. misspellings, and errors of all sorts. So, forgive me. I am sure I will cringe and squirm when I read them, but perfection is not the goal, but the aim.

Then, I am going to link to a few really REALLY good blogs. Okay, these are mostly medical. But if I link it's probably worth the click. Because there are a few out there that A) know their shit, and B) do a good job, be it ernest or humorous. And are really good storytellers and sharers of knowledge. So, click and I promise to not lead anyone astray.

And finally, I am not anti- health care reform. I DO believe we waste resources. I DO think we need to get some control. I DON'T think Medicaid works well. I DID vote for Obama, and will again. I DO know we don't have the right formula. But I think we are getting there. I realize this is quite unpopular. But, so be it. You can quit now. I believe that we have to choose for ourselves how to die, and therefore, how to live. You choose to smoke, over eat, sit too much? Well, uh, I don't know what to say. I'll take care of you, but you will hear about it. Because that is my belief. We need to take care of us.

And while we all make mistakes, it's what we do when we veer from our path that is what we really are. I believe this. So- I try very hard to not judge what someone has done when they make a mistake, but rather how they are dealing with it.

I am pro-choice because I am pro-life. A wanted life is a good life.

So, there you are. Disclaimers now that it's an all in one.

First rotation starting....

And it's family practice with Doc B as he calls himself. I am looking forward to the experience, but also scared Si*tLeS* at the same time.  I don't even know WHAT to study- and therefore am feeling a bit- um, well, scared that he might ask me some sort of question right off the bat like..."So, this patient has a CR of 2.3, and blahblahblah and so what do you think is the real problem." I'd answer something like" well, I guess he is in renal failure of some sort?" and know that I know there are several sorts of renal failure but...what kind am I thinking of?

I would have NO idea. None.

Sigh. Got a lotta learning going on, I tell ya. Lots.

Doc

1Today, I was able to ride Doc...it's been forever, and I just am in heaven. AND...

LOGAN WAS FINALLY BORN! 8. 1 oz and 20.5 inches long. It's amazing. Its been an emotional day to be sure; tears thru huge smiles.

So, here is the video of Doc, at least I *think* so! He was an absolute ROCK STAR!!!

One thought!

It's the end of 3rd semester....yes, yes, yes.

Need a blog post on The Adventures of the POPES- because if life wanted to make sure that we are made quite aware that we are NOT in control, I can point out POPES and my adventures.

Til then...