Clerkship week 10

It's been a very long time since my first blog. I would like to tell you that in the last 10 weeks, I have gained my confidence back and am blowing through things with killer technique and form.

goal #3: Write more often!

I will say this: the doctor told me never to spend more than 20 minutes looking up something for him ever again. He told me to respect my time as a person and not be a student ALL of the time. This will be hard for me to grasp. Some days I'll study a ton, some days I won't do anything academic at all. The truth is, I still haven't learned how to learn. Or maybe I have but I haven't recognized it in myself yet.

Summary of FP: I did a ton of shoulder injections. I injected an old woman's hip. I am able to fish out the real story from people who lie consistently to their doctors because they just really like talking to me. I don't like patients who don't want to get better. I have learned to read people in mere seconds. I can listen to a history and come up with the three most likely causes of those symptoms, and treat all three things (of course you pick one and go with it for the patient's sake)

Mantra to live by: The three most common causes of cough: Post-nasal drip, Asthma, GERD (memorize this...)

Sometimes, I know more than the doctor, which is a fair statement since the theory is that I just got done learning the most up to date information, whereas he's been out of school for a while.

The other thing I did was round on patients while they were admitted to the hospital. My favorite story about that follows:

I had just finished Didactics on Thursday afternoon (The one day I go to class instead of to work), and I get a phone call from the physician I am working for. "are you done w/ class yet?"
"Yes I just left, I'm driving, whats up?" "i have a patient that you'll be seeing tomorrow. She's dying, you have to save her"

I wanted to say "did i NOT just say I'm driving....?" Nothing like putting the med student under pressure. He went on to explain to me her condition (renal failure), tell me all the things he wanted me to look up, he also asked me to find a formula that might save her life.

He then told me I had to go to an office function that night at a bar, and socialize, before I could look anything up.

I went, had dinner, didn't drink, excused myself by 8 pm, went home and watched Greys and looked up all the answers.

Not only did I have the answers he was looking for, but I apparently went above and beyond the call of duty with my research. The lady turned out to be just fine (you can all relax now), and I learned that one can never be too prepared.


The last day was very sad. They bought me a present, gave me a card, and a ton of hugs. It was also very hectic, as everyone was leaving early to go to the Boston Red Sox/Cleveland Indians game. I've never thought of Cleveland as a "hop-skip and a jump" away, but its only 2 hours.

I got Honors in family practice.

At the end of family practice, I had a little bit of confidence, a huge white coat that weighed easily 20-30 lbs, and had lost 15 lbs. Go me!

~~~~Side note~~~~
I mentioned before that sometimes I can see in other people's apartments. This became an issue during FP. One morning, it was very dark out, and I was up making coffee before work, and I was looking out my window. It was like 5:30 AM so no one else was awake in my apartment complex, and I was looking at the stars. All of the sudden, a light flicked on, and there, directly across from me, through my window and theirs, were two naked figures. An couple in their late 40s had just woken up and forgotten to either A) put clothes on or B) close their blinds. It was horrible. I pulled my blinds very quickly and then later told my landlord to go discuss w/ them privacy. They moved out a week later.

Also, I met my neighbor downstairs. I thought it would be nice to have a friend, so we decided to go to a bar together that friday. He introduced me as his GIRLFRIEND. I'd known him 3 days! Then he proceeded to call me every day (or text me if I didn't answer... and I never answered) and then he started to know things about my apartment he shouldn't. I'd never let him in before, he'd never even been to the door when i was home. He started telling me what i was having for dinner, or asking to borrow things I had in my hand. It creeped me out.
Finally, one night I came home around 11:30 PM, I had been out with family, and I creeped into the apartment. I tiptoed upstairs, having already silenced my phone. I slowly opened and closed my door, just to make sure he couldn't hear that I was there. I looked at my silenced phone and I had a text message from the creeper. "Little louder, I almost didn't hear you come in..." WHOA! so I called the police. Then I told him off and told him to leave me alone (on the advice of the police officers.) I haven't heard from him anymore, but I did see him outside once gazing into my 3rd floor apartment window from the parking lot. CREEPY!
~~~~~~~~ end of side note

My next rotation was Urban Medicine. This rotation is supposed to be family practice, but in an inner-city location.

Almost all of these patients don't have insurance, have been kicked out of other practices for either no showing or drug seeking, and are as stereotypically ghetto as Flava-Flav's tv show.

The first shocking patient I had was a drug seeker. She was in her late 50s. She had back pain. She walked with a walker, and she had just been booted from her previous physician for skipping too many appointments. Our office policy is that we do not give out narcotics on the first visit. She kept asking "but doctor, what should I do for my pain?" but refused to see a pain management specialist. It was frustrating.

Then I saw a 16 year old girl with her grandmother. The sixteen year old was pregnant. Her grandmother was so excited for it. I dont' know where the mother was. I didn't ask. Usually you dont' see the moms, just the grandmother/granddaughter combo.

These were recurring patients. Not the actual same patient, but the same patient profiles.

Some good lines from the office:
"Thank you Jesus for my tylenol 3s"
"ma'am we want you to record your blood sugars..." "But doctor, I can't read or write"
"well I think my smoking 2 packs a day causes my breathing problems, which causes me to use my albuterol inhaler more frequently, but I can't afford the 4 dollar perscription at walmart because I'm spending so much on my cigarettes" *D'oh*

I saw a man for ED (erectile dysfunction). He was morbidly obese. I"m not sure that he'd seen his penis in the last few years, let alone know if it was "able to get up" or not. When he began to discuss his condition, I asked politely if he wanted me to leave (because some men are not proud to have this sort of problem) and he told me I could stay. Then when the resident I was working with that day said we needed to do an exam, the man just dropped his pants in front of me. I just backed away and let the resident earn his money. lol That was crazy.

The third week of Urban Medicine, I got to work in-house (within the hospital). This was a lot more fun. We saw whatever patients were there already or admitted over night (usually between 0-2). Then we would just hang out and study all day. On the third day we got word that there was to be a delivery that evening. So we waited around all day, and at about 5 pm, I got to see a baby enter this world. It was amazing! That was probably the best moment of this rotation. I couldn't believe I got to see a baby born.

Overall, it was just more family practice, but a different patient population all together. The trickiest part of this rotation was that you presented to a different resident/attending combo every single day or half day. The resident you were assigned to changed every 1/2 day, while the attending changed daily. This made consistency an issue. I was afraid that because the attending that graded me only saw me on a few occasions that she wouldn't know me well enough. But that wasn't true, they do discuss us, and she told me I was working at the level of an intern or resident (just as Dr Workman asked me to), and told me I did great.

I got Honors in Urban Medicine.


So, now I'm back in Athens for a weekend, taking an escape from the world I'm not used to back to the world I love and know. It's great to be home. After six years of Athens, I just think it will take time for me to adjust to Toledo. I'm just not familiar with it yet. But I think that will come with experience and time. At any rate, I'm alive, and so far mostly unscathed.

I start Pediatrics on Monday... which should be good since in general, I don't like kids... lol

Have a great weekend! GO BUCKS and GO BOBCATS!