So, here I am... continue to truck my way down the path of my Clinical Year. I'm at mile 7 of 10 and lately, I've certainly been experiencing that combination of feeling like I've come so far, learned so much, grown in capablity and skill + sensing that I still have so far to go.
Only three more rotations remain for me now:
Rotation 7: Internal Medicine here at Scripps Hospital in La Jolla, CA
Rotation 8: In-patient at Tuality in Hillsboro (Portland), OR
Rotation 9: Acupuncture and OB/Gyn at Wenzou Medical College Hospital Center CHINA
Rotation 10: Elective Rotation- MYSTERY????? (though I've requested either Internal Med or the NICU... we'll see! Stay tuned!)
So I'm yet again, in a new location. Ryan came to Portland to help me make the drive from Oregon to California and we had a GREAT roadtrip. We broke up the 20 hour drive with several awesome stops along the way. First we drove to Redmond, OR where Ryan's Grandpa (aka "Papa") and his wife Linda live. Linda's grandkids are all big BMX-ers and they basically worship the ground he walks on ;) But for real, they are all so cute and they really do look up to Ryan so much. It's so cute to see them bombard him with questions and show him all of their riding pics on facebook. We had a great time hanging out with everyone for dinner. Sadly due to our time restraints we couldn't stay long and had to take off at 8am the next day.
There really itsn't much to say for the the drive from eastern Oregon to Northern California. It was baren, flat and boring. BUT after 8 hours we finally got to Sacremento/San Fransisco area- where we met up with our friends Amber and her husband Matt. Amber is a Medic in the Airforce and she and Ryan used to work together in the ED on base at Elmendorf. Matt is a maintenance crew chief and used to work on the F-22's in Alaska, but since transferring to Travis Air Force base he's off fighter jets and on the bigger transport planes. Apparently he really misses working on the jets- I don't blame him. ;)
We had such a great time catching up with them. They are in base-housing and Ryan and I were both saying we can only hope the base housing in Virginia is half as nice as their place! We went out to dinner and had hung out at their amazing place afterwards where we enjoyed a bottle of wine from the vineyard where we'll be having the wedding this August. Ryan and I stopped by the winery on our drive in Oregon and got a little tour of the grounds by their weddings manager. It was awesome! And after smoozing and tasting some of the wines we'll be serving at the wedding, she surprised us and sent us home with a bottle! Since Amber will deploy in June and won't be able to make the wedding, it was nice to bring some of it to them.
Again, our stay was an all too short overnight-er before we carried on to our final destination in San Diego which was 8 hours away. Again... boring drive... how did we drive through 18 hours of the state of California and NOT see any amazing vineyards, wineries, ocean coast or Napa?!?! And the traffic in L.A. - I thought Ryan was going to have an anyerysm and rightfully so. I truly don't know why ANYONEEEEE lives there.
Arriving in San Diego, we were welcome by my bestest cousin Joe and his girlfriend Marci- who graciously let us crash in their home despite the fact they were in the middle packing for a big international move coming up next week. Joe - host with the most that he is - of course instantly whisked us away to one of his favorite watering holes :) After wine-ing and dining in the hip university area, we all slept it off til 10am Sunday morning and after a pot of coffee and a recovery breakfast of scrambled eggs and toast, we were recharged and ready for some tourism. Joe was our inside naturalist guide to Point Loma look out point. Where we also scaled down the cliffs to the tide pools and saw all kinds of sea urshins, starfish, shrips, crabs and seals!
I had to take Ryan to the airport all too soon on Sunday, and he flew back to Anchorage as I got settled in my new digs - thanks to Blair and her connections with a friend from college. I get to live with Blair's friend Jessica and her husband Adrian and their ADORABLEEEEEEEEEE 2 year-old son, Gabriel. I could NOT be more blessed with this living situation. Jess and Adrian are such FANTASTIC generous, fun, welcoming people and they are such great parents - it's nice to witness such a dynamic and fun young family and I am SO lucky they were willing to welcome a complete stranger into their home.
So far, I have one week under my belt in Internal Medicine - and I am LOVING it. My preceptor is a wonderful and BRILLIANT doctor... though a little scatterbrained and nutty-professorish ;) I'm learning a LOT. Internal Med is so interesting because you're not just dealing with health people who just happen to sprain their ankle or get a cold... these people might have those things happen to them, but they have a schlew of med's and prior/chronic disease processes to consider in your management and treatment of them. It really makes you rack your brain- I can feel it growing all ready!- and of course will keep you all posted for the adventures (and mis-adventures) along the way.
Love you all!
xo
Mego
Saturday, February 19, 2011
Thursday, February 3, 2011
Judgement...
So yesterday was quite the eventful shift. It started out easy/ normal enough. A few MI rule-outs, an Alzheimer's patient from the nursing home that split her head open when she tripped on her comforter, a few toddlers with over-zealous/ hypochondriac patient looking to get their kids scanned and treated for the few HOURS they'd been exhibiting MILD symptoms... And to spice things up, there was the 72 year old nursing home patient that was vomiting green-gatorade (medical code for Bile) and probably had TB (I was gowned and masked most of the day. Blach)...
Well, now that I've ruined your appetite (sorry if you're reading this on your lunch break or hanging out post evening meal)... then there was the highlight / low-point of the shift (depending on your prospective).
I was already 15 minutes past my scheduled shift end, when we had an ambulence come in code 3 with a 15 month old, who was actively seizing with a Grand Mal seizure. She wasn't breathing on her own, had no reflex or tone, just completely limp and unable to handle her own secretions. After the Doc leading the code got the endo-tracheal tube down her (soooooo want to get my shot an intubation... but maybe next time) and then I started baggin' her (aka breathing for her by pumping and ballon and inflating her lungs every 5 seconds)... as our team of Respiratory Therapists and Nurses worked on her, and as I was trying to pay attention to pumping the balllon and counting every 5 seconds I was trying to ask the Mom about the childs history and what happened. The mother was 23 years old, with 3 kids, age 7, 4 and the 15month old we were working on. While clearly concerned and upset by what was happening, it was realllyyyyyyyyyy hard to try to work on the kiddo and NOT be all judgy judgy of Mom. She was a total space cadet. Deverting questions, pretending she didn't know the answers to simple questions like :
"Has she ever had a seizure before?"
M: I don't know
(come to find out the child had had 5 in the past 3 months...)
"How much does she weigh?"
M: I'm not sure she was here in Novemeber do you guys have it in the chart?
(she's 15months old! At that age kids can grow up to 1-3lbs per WEEK so her weight in November is now OBSOLETE so I went a different route asking "What size diapers do you buy for her" - thinking that would at least give us a weight range. Mom said "5's..." - finally the most definitive answer yet)...
And I get being traumatized that people are poking and tubes and computer screens and monitors are all over your kid and it kind of sends you into shock, but I have a feeling if I stop her on a random night in TARGET she wouldn't be able to answer any more coherently.
Come to find out the child has had 5 seizures since early November - each time precipitated by a viral/cold symptoms. And the child's older sister (the 4 year old) has had the same seizures and has been evaluated with EEG's (which is like an EKG for your brain instead of your heart) with no diagnosis concluded - other than the fact that they confirmed she does NOT have epilipsy.
The baby had been in our ED twice for seizures like this (just not as bad as this current one) she had been evaluated by a neurologist and given anti-seizure medications - not to be taken every day - but to be given should the mother notice she was starting to have symptoms. The mother simply let the prescription run out (again... hard not to judge). So when the child began seizing in the car as the mother picked her up from daycare she had no way of stopping the progression. Why you would just "forget" or "let" a prescription such as that just run out - especially when its for your child - is beyond me. I just kept counting ***1,2,3,4,5... breathe... 1,2,3,4,5..."
Finally I asked:
"Is she up to date with her immunizations?"
M: Oh, we don't do vaccines
I soooooooo wanted to reply, But clearly you do you DO do menigital seizures??? UGGGGGG (again REALLY REALLY hard not to be judgy... 1,2,3,4,5... breathe... 1,2,3,4,5... )
I think when I become a Board Certified PA, I want to hold local conferences FREE for parents to educate them on the true SAFETY and NEED for vaccines. The main reason most people don't get their child vaccinated is because they think they'll develop autism. There is absolutely NOOOOO link whatsoever to Autism and vaccines and this has been proven by numerous scientific studies. ONE study about 10 years ago done in the UK suggested this original link and start the wide spread mis-informed panic that now exists about immunizations. The manuscript has since been withdrawn from the archives of medicine because the study was biased and the data so flawed and manipulated that its authors were reprimanded with suspensions of their medical licenses and fines. Those people who withhold vaccines are putting their own children's health and LIFE in jeapordy - not to mention the health and life of every child and person they go to school with, walk down the aisles of the grocery store with, etc. I think anyone who CHOOSES to withhold vaccines from their child, should first have to spend 2 weeks at a hospital in a 3rd world country and see the babies gasping their last breath from pertussis, or seizing with a seizure from diptheria.
As the great movie "Parenthood" once quipped: "you need a license to drive a car, buy a gun, hell you even need to register to vote... but any butt reeming asshole can be a parent..."
Unfortunately, I see the truth in this satire daily. Cases like the little girl I was breathing for last night just make it extra sad... 1,2,3,4,5... breathe... 1,2,3,4,5..
The girl stopped actively seizing after we gave her some IV medications, but she never regained consciousness, and never started breathing on her own again during my watch. The transfer ambulance came to take her on the 30 min ride to OHSU's pediatric ICU- our hospital doesn't have a pediatric ICU- and the paramedics took over for me... 1,2,3,4,5... breathe... 1,2,3,4,5...
Well, now that I've ruined your appetite (sorry if you're reading this on your lunch break or hanging out post evening meal)... then there was the highlight / low-point of the shift (depending on your prospective).
I was already 15 minutes past my scheduled shift end, when we had an ambulence come in code 3 with a 15 month old, who was actively seizing with a Grand Mal seizure. She wasn't breathing on her own, had no reflex or tone, just completely limp and unable to handle her own secretions. After the Doc leading the code got the endo-tracheal tube down her (soooooo want to get my shot an intubation... but maybe next time) and then I started baggin' her (aka breathing for her by pumping and ballon and inflating her lungs every 5 seconds)... as our team of Respiratory Therapists and Nurses worked on her, and as I was trying to pay attention to pumping the balllon and counting every 5 seconds I was trying to ask the Mom about the childs history and what happened. The mother was 23 years old, with 3 kids, age 7, 4 and the 15month old we were working on. While clearly concerned and upset by what was happening, it was realllyyyyyyyyyy hard to try to work on the kiddo and NOT be all judgy judgy of Mom. She was a total space cadet. Deverting questions, pretending she didn't know the answers to simple questions like :
"Has she ever had a seizure before?"
M: I don't know
(come to find out the child had had 5 in the past 3 months...)
"How much does she weigh?"
M: I'm not sure she was here in Novemeber do you guys have it in the chart?
(she's 15months old! At that age kids can grow up to 1-3lbs per WEEK so her weight in November is now OBSOLETE so I went a different route asking "What size diapers do you buy for her" - thinking that would at least give us a weight range. Mom said "5's..." - finally the most definitive answer yet)...
And I get being traumatized that people are poking and tubes and computer screens and monitors are all over your kid and it kind of sends you into shock, but I have a feeling if I stop her on a random night in TARGET she wouldn't be able to answer any more coherently.
Come to find out the child has had 5 seizures since early November - each time precipitated by a viral/cold symptoms. And the child's older sister (the 4 year old) has had the same seizures and has been evaluated with EEG's (which is like an EKG for your brain instead of your heart) with no diagnosis concluded - other than the fact that they confirmed she does NOT have epilipsy.
The baby had been in our ED twice for seizures like this (just not as bad as this current one) she had been evaluated by a neurologist and given anti-seizure medications - not to be taken every day - but to be given should the mother notice she was starting to have symptoms. The mother simply let the prescription run out (again... hard not to judge). So when the child began seizing in the car as the mother picked her up from daycare she had no way of stopping the progression. Why you would just "forget" or "let" a prescription such as that just run out - especially when its for your child - is beyond me. I just kept counting ***1,2,3,4,5... breathe... 1,2,3,4,5..."
Finally I asked:
"Is she up to date with her immunizations?"
M: Oh, we don't do vaccines
I soooooooo wanted to reply, But clearly you do you DO do menigital seizures??? UGGGGGG (again REALLY REALLY hard not to be judgy... 1,2,3,4,5... breathe... 1,2,3,4,5... )
I think when I become a Board Certified PA, I want to hold local conferences FREE for parents to educate them on the true SAFETY and NEED for vaccines. The main reason most people don't get their child vaccinated is because they think they'll develop autism. There is absolutely NOOOOO link whatsoever to Autism and vaccines and this has been proven by numerous scientific studies. ONE study about 10 years ago done in the UK suggested this original link and start the wide spread mis-informed panic that now exists about immunizations. The manuscript has since been withdrawn from the archives of medicine because the study was biased and the data so flawed and manipulated that its authors were reprimanded with suspensions of their medical licenses and fines. Those people who withhold vaccines are putting their own children's health and LIFE in jeapordy - not to mention the health and life of every child and person they go to school with, walk down the aisles of the grocery store with, etc. I think anyone who CHOOSES to withhold vaccines from their child, should first have to spend 2 weeks at a hospital in a 3rd world country and see the babies gasping their last breath from pertussis, or seizing with a seizure from diptheria.
As the great movie "Parenthood" once quipped: "you need a license to drive a car, buy a gun, hell you even need to register to vote... but any butt reeming asshole can be a parent..."
Unfortunately, I see the truth in this satire daily. Cases like the little girl I was breathing for last night just make it extra sad... 1,2,3,4,5... breathe... 1,2,3,4,5..
The girl stopped actively seizing after we gave her some IV medications, but she never regained consciousness, and never started breathing on her own again during my watch. The transfer ambulance came to take her on the 30 min ride to OHSU's pediatric ICU- our hospital doesn't have a pediatric ICU- and the paramedics took over for me... 1,2,3,4,5... breathe... 1,2,3,4,5...
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