Pediatrics: Snotty Nose, Pee, Poop, and Cuteness Overload

Well, I am officially at the half way mark of my fourth rotation and in Pediatrics in rural Washington State. It has been fantastic in everyway.
First off, in stark contrast to my break-neck surgical rotation, this rotation has been hectic- but time-capped day's of 9-5 clinic, with some occassional Night Clinic (Urgent Care) and Hospital NICU check-ups thrown in for good measure. I've seriously had a BLAST and have had some great stories to tell of course, for which I apologize for not updating the blog sooner.
The best part of my job most definitely has to be the bebes! At this rotation, I've been able to go to the NICU and check in on newborn premies... I get to do the 1 week, 2 weeks, 1 month, 2 month... etc... well child check ups... and I tell ya, NOTHING is better for the soul than talking nonsense to a chubbie little baby for 15 minutes 10 times a day. That 17-year old brat in for acne medication, the demanding parent with their 4-year-old and a 1 day history of runny nose, the 7 year old that screams bloody murder because you're looking into his ears... all that stress goes away when you enter a room with a cute little baby that you get to play with for 15 minutes and then give it back before to the parent to take care of for the rest of the peep/poop/cry/ don't-put-me-down rest of the day. It's the best of both worlds! Exposure... without COMMITMENT! ;)
The kids are REALLY funny too. It's funny to see the differences in development and maturity (both mental and physical) in the kids even of the same age, from one to the next. Some kids are super outgoing and you barely get "Hello, I'm..." out before they're telling you all about how they get to be at the doctor to day, and they get a sticker if they're good, and if they get shots its ok because it only hurts for a minute and they protect you, and this is the book I have at school... lol And other kids burst into tears and cling onto their parents the second you look at them... Obviously, I relate a lot better to the former type of children :)
Some of my favorite quotes so far have been:
- "Some times when you do to the doctor they have to check your butt"
- "You smell pretty." (6 year old when I was looking in her ears...)
- "Are you a bodybuilder?" a Mom after I explained her sons pertusis treatment plan in detail and asked if she had any questions.
I've also had to get used to how things are done a lot differently in Ped's vs. my Family Practice. I was glad that I had Family Practice first before coming into Pediatrics, because I thought I'd see a lot of the same conditions - and I do- but there are noteable differences in practice. Among them:
1) No gloves... really ever... apparently they scare the kids, more than blood born pathogens scare the doctors.
2) You check the genitals of the babies without gloves
3) You can't remove in-grown toe nails, but you can give them IV's?
4) Instead of a can of pressurized nitro for wart removal, you dip a q-tip in a laddle of actual steaming boiling liquid nitrogen, a la Harry Potter, and place it on the kids foot as they screammmmmmmmmmmmmmmmmmm as loud as possible, kick you in the face, and 5 nurses are needed to hold down a 40-lbs patient. The wart removals are by far the most traumatic thing that goes on here
5) The patients agree to anything for the price of a Dora / Spiderman sticker.
6) Circumsions are done at 2 WEEKS... so far, this has been the most traumatic thing for ME in medicine.
Being rural medicine in the northwest, means that I also have a LOT of Spanish-only speaking families. I so wish I had my Blair Bear here to translate for me. I've had to get by with cherades and my broken spanish with a french accent.
And more so than Family Medicine, the volume of hyper-reactive hyperchondriac (parents) is out of control. "So nausea, vomiting and fevers? How long has this been going on?" response : "since lunch time..." (at a 2pm appointment)... well, you're kids sick... viral. What do you want me to do??? I also see a LOTTTTT of "runny nose / cough" as the cheif complaint on the chart. And these parents are SOOOOO concerned. For a RUNNY NOSE! You have GOT to be kidding me... I realize that in my up-bringing, only arterial bleeding, or loss of consciousness would have mandated a trip to the doctor - and sometimes not even then - so MAYBE I have a skewed view of things, but still... Runny Nose??? He's 5... What do you expect? Bring him back in 10 years if its still a problem.Uggg
Anywho. The Clinic itself is great! The walls are elaborately decorated with all these magical, fantasty murals, fairies, dinosaurs, wizards... A grand-mother of one of our main families donated her time to do them all. Even the hallways are done, there's not a square inch of white paint in the whole place. I will try to take pics one day after clinic to show you all just how cool this looks.
My preceptor is also, a huge part of what makes the clinic so awesome. She graduated from the same program as me at Pacific- about 10 years ago. She is knows her stuff and doesn't put up with any crap - from the patients or the parents - and they love her for it. I learn something from her everyday! She's amazing. How I keep lucking out with these fabulous rotations and even more fabouls people to work FOR but I can only hope they keep comin'! Each rotation is better than the next!
Stay tuned for more... and with a sooner interval between posts this time... I promise :)
XOXO
Mego

TGIF

Life has gotten WAY better ever since last Friday when Ryan came in to visit :) We spent all weekend with his grandparents. It was awesome! They live in the high-desert area of Oregon near Bend. The landscape is amazing, and we had some great weather to get out and enjoy it in. Not only that, but when we went to watch some friends of the family race bmx, Ryan ended up getting suckered into the race last minute. He hadn't raced in about 6 years - and he was dressed in a random pair of jeans and a walmart sweatshirt we bought that morning because it was cold ;) Needless to say, he was not prepared... but he still got a ginormous 2nd place trophy that I'll proudly be toting around to all my rotations the rest of the year hehe... enjoy the pics! and of course... more blogging to come soon! Stay tuned and much love! - Mego

Spoiled!

You'd hardly call working 14-17hour days all week 'spoiled'... but when your fiance` researches about 50 different spas in your neighborhood via internet and phone calls from Alaska and books you an hour massage because he knows you've been working an 80 hour week in non-supportive ballet flats and your sciatica is killing you... THAT's spoiled ;)

You can't really tell by the horriblely lop-sided pic I took with my phone here, but the place was AWESOMEEEEE! It was a Yoga Studio/ Spa. And they had the most amazing set-up. I got my robe and flipflops and - as the photo shows they had all kinds of treats for you in their little lounge waiting area. They also gave you free use of the sauna facilities included in your massage which was also, beyond fabulous.

I already knew this already of course- but Ryan, you really are the best fiance` ever! :) mwuah xoxoxo!

Where everybody knows your name... the view at "Pix"

Sometimes you wanna go...

So, with Surgery, comes the glamour of high-speed, critical patients, life or death decisions and exacting procedures that make you sweat just THINKING about what you're suppose to do to this person, let alone what it feels like when the scapel is in hand and you're about to cut skin! And then there's the long hours... and by LONG I mean, LONGGGGGGGGGGGG...

My day starts rounding on my in-patients at 5am. Throw in some dressing changes, a few unstable patients about to crump, and various people switching from one ward to the next and suddenly you're 50minutes into your 'lunch break' - which I have just deemed, "hour that normally people who have lives get to sit down and eat something, which I think is normally done around Noon???"...

Then, when you think you're exhausted and you've MORE than completed HealthParnters 10,000 recommended steps ten-times over... it's THEN time for you to do the FUN part - SURGERICAL CASES! Which IS fun, except that to have that fun it requires another 6+ hrs of standing... when all you want to do is lie down. Since starting in surgery - and I realize this is only day FOUR for me... but there is a funny paradox, in that STANDING is actually WAY more tiring then MOVING. In terms of fighting sleepiness, I'd so much rather see 40 bed patients running around to 8 different sections of the hospital, then STAND... in ONE spot for Four hours... it's grueling. It wears me out...

Which brings me to the point of this post. When the days get long and hard, and your separated from your Fiance, friends and family... you need an escape. Which I have found in my new favorite hang out - which is a) conveniently located on my bike ride home b) an obvious choice for it to win my patronage, because it is FRENCH themed! Yep... just like the bistros of Paris I miss so dearly!
They have Belgian beers you can only find on the old continent, make a MEAN true french style latte, and best of all -and I know Steph would appreciate this most if she could come out and visit me ;) - they have REAL French pastieres and chocolates and most importantly MACARONS! ;)

Plus they are open to Midnight and show free movies on Mondays, plus ample outdoor seating to enjoy the perfect Northwest summer nights. I've been hanging out there a lot after work to long in my patients, skype Ryan, etc... I look forward to it so much!

So here's a view of my post-work de-stressing session at "Pix"... ;) can't wait til tomorrow at 9pm for another round. Bisous!!!! - Mego

Surgery 101

So, today was my first day on my Burn Surgery rotation! And... it. was. awesome!!!!!!!!!
So most rotation schedules entail doing Clinic on 2-3 days, In-patient hosiptal visits on another couple 1/2 days a week and Surgeries the other 2-3 days... Well in my first day, I did ALL THREE!

I should up ready to roll at 7am... my preceptor had already been at the hospital since 5am. The only other resident in the service with me is a Surgical Resident (aka he's really far along in his studies, already has the title of Doctor, and is just doing an extra 5 yrs of SURGERY specific residency... so to say he is a 'resident WITH me' is a VERY relative term). The other 'resident' Dr Bonson has only been on board since last Friday so he and I were at least both lost as we checked in at the front desk and they immediately had us start rounding on Patients. We have 16 beds in the Burn Unit and another 10 beds designated as Burn ICU.

My preceptor is AWESOME. His name is Dr. Eshraghi. And he pocesses that rare quality in a Surgeon of being both WICKED smart AND entirely normal and personalable! He didn't pimp me too hard. Just taught me. And I just in general tried to keep up. I have shin splints for running around in my completely worn-to-the-bone zebra ballet flats (thanks Tom and Caitlin - Christmas 2008... LOL, yeah I need new shoes...)

In the morning, after rounding on our in-patients on the unit, we moved over to the clinic and saw pre/ post-op patients. Coming off of my Family Med rotation in Elmendorf, and the great face-time I got with patients, today- witnessing even someone as brilliant and wonderful as Dr. Eshraghi stumble over and foil-up patient encounters- I felt kinda proud to be a PA... like, in the back of my head, I was thinking : "Wow, I would have explained that proceedure and explained our treatment approach rationale SOOOOOO much better, faster and more appropriate to the patient's view point than you just did..." Even when your humbled and in the presence of greatness like a Burn Surgeon, there's definitely things a PA would do better. That kinda made me feel good ;)

The highlight of the day, was definitely the afternoon where I ASSISTED on my first ever surgery!!!!! It was over 3 hours long! Our patient was a 50 yo Female with complications of an abdominal wound. She had ovarian cancer and as part of her removal of the tumors, she had a colostomy bag. The incision from that and her tumor removal became infected and she developed fistuals and a large, gaping wound over a good 12 x 12 section of her abdomen. We used a new device in surgery today that I had never seen before, called a Versajet. Essentially it's a high powered water pic. And instead of 'cutting' the patient, the high-pressure water jet removes the tissue!!!! AMAZING!!!! I told Ryan about this and he said they used it when he was deployed in Afganistan too. It was a new toy to me though and I was super excited to see it in action.

While, I didn't get to play with the water thingymabob... I DID get to do a SKIN GRAFT! Yep, that's right, I scrapped off a piece of someone's leg, ran it through what looks like an industrial pasta roller and then glued it on to the patient's wound. Can you say AWESOME! Total highlight of my career thus far! And this is only day ONE! ;)

Who knows what tomorrow holds, but I can bet it will be just as crazy, scary, fun as this one... STAY TUNED! :) xoxox Mego

Sorry it has been FOREVERRRRRR since I've blogged!It's been a wild, crazy, fun month to say the least! My days in the Clinic have been full to say the least. Which I TOTALLY don't mind. But it would certainly be made more tolerable if I had cell/internet service in the hospital. I could fit in so much more if I could jump in to check an email, text a friend back home, look something up online, (and ok, ok... I'll say it - update my facebook! hehe) in my spare in-between minutes. Instead I now have to save all of these activites for the end of the day - at which point I'm busy logging in patients, working out, or just out enjoying Alaska. So thus my internet usage has gone to the way-side.I only have two more weeks left at Elmendorf here, and it's hard to believe. I've really lucked out with having this rotation first. While it certainly has been challenging, I know if PALES in comparison to the cut-throat, uber-competitive rotations that my other classmates have already been on. I'm very thankful to have started out with a rotation that has let me ease-in to this whole clinical medicine thing.My preceptors here have been phenomenol. Sadly, my two favorite ones, will both be leaving this site. One will deploy to Iraq for 7 months starting in September (Maj. Spencer). And the other will retire next July (Maj. Kubly). I'd say 25+ years with the Air Force is a good run and he deserves it. But it bums me out that the rest of my classmates won't get to work with these two amazing people.I worked with Major Kubly this past week and on my last day with him he hooked me up with a giant grocery bag of Alaskan salmon and reindeer saussage and elk links. All caught/ killed by him of course ;) Ryan and I grilled up the salmon last night and it really DOES taste better than the store bought stuff. I'm so lucky to have such amazing and generous teachers. And even luckier to have someone to help me eat it all! :)My next rotation is Surgery in Portland. Two weeks out, and I still haven't sewn up my housing or living arrangements... I should probably get on that... And with my next rotation I'm sure I'll be bored out of my mind without Ryan and all these outside adventures and exploring to go on. So I anticipate a full return to blogging at that time.Stay tuned! And as my final days in Alaska (for THIS round anyway) tick by, I'll try to post more pics and snippets.Miss and love you all! xo Mego