Family Medicine: New Clinic!

My clinic has moved to a brand new building just down the street, and it's soooooo nice! The nurses' station is now twice as big as the old one; each MA and LVN/RN gets her own little desk and computer so that they don't have to share anymore. In the past we did all our charting at the counters; now we each have a little desk to work at. I even have my own desk and computer for the time being since the OB nurse practictioner won't be here until May =) We got the phone lines working today (so that we can page Dr. RR when a patient comes), and today the LVN put him on speakerphone when he answered the phone with a cheerful, "YO!" That made us all laugh.

One patient we had today was a middle-aged guy who smelled like he hadn't had a bath in days. Lupe had warned me about him beforehand and I thought it wouldn't bother me (it's not the first time I've had patients who didn't bathe), but when I had to get close to him to listen to his heart and lungs, I found that I really had to suppress my gag reflex. =/ It makes me feel bad to even say something like that; not everyone has easy access to a shower. We also heard back from the mother of the 3-month-old boy who died last week; the father, whom others had suspected of abusing his girlfriend and child, is now in jail. What apparently happened was that they were helping with a yard sale in Dallas, and while the mother was outside, the father was indoors with the baby. And when the baby began crying inconsolably, the father couldn't take it anymore, grabbed him, and shook him. The autopsy report showed evidence of fractured ribs from where the father had gripped him tightly, and that was enough to put him in jail. And yet...the mother is still staying with the father's parents because her own parents had kicked her out (she's only seventeen) and she has nowhere else to go. *sigh* This is a vicious cycle.

In other news, I was finally able to submit my Dean's Letter Profile today (after working on it until 1:30 a.m. last night and getting it critiqued this morning); it feels so good to get it done. I also got my TB test and a Tdap (required at certain programs before you can do an elective there) after this morning's quiz. I didn't think the Tdap would give me much trouble, but sometime in the afternoon I got a huge headache and ended up taking a one hour nap as soon as I got home from work. *sigh* Well, at least my TB test looks negative already =P

Family Medicine: Ear Pain

Oops, forgot to blog. Yesterday morning we had a lecture about Early Childhood Intervention (ECI), and somewhere in the middle of the lecture, Mani (who was sitting next to me) got up and left the room with his phone. At first I thought he got an important phone call, but about 5-10 minutes later he came back carrying food from the cafeteria in his arms. He left a lecture to get a freaking snack? Maybe others didn't care what he did, but personally I thought he was being disrespectful. I mean, even I waited until after class ended to give Elizabeth some Hi-Chews I bought from the HK Market over the weekend.

We're moving to a new clinic! For the rest of the week, the entire office and staff would be relocating down the block to a brand new building. For some reason, it was painful ear day among the pediatric patients; poor Lupe had to do an ear lavage on two young kids (ages 1 and 2) and it was not fun for her or the kid. The kids, of course, were too young to understand what was going on and screamed bloody murder during the lavage. Not to mention they fought back and needed someone else other than their moms to hold them down. Lupe shared a story of how Dr. RR had to hold down a 7-year-old during an ear lavage b/c she kept trying to run away. See, if I tried to do that at age 7, my parents would have punished me as soon as I left the doctors' office for bad behavior. *sigh* Kids these days. When we had a third patient come in with an otitis externa, Dr. RR called Lupe to the room and she was like, "You're kidding!" when she learned it was another ear infection. Fortunately this third kid didn't need a lavage.

Family Medicine: False Diagnosis

Today we had a patient come in with what I initially thought was a clear-cut case of flu (body aches, fever, nausea and vomiting), but when I palpated her RLQ, she nearly jumped off the table. My first thought was, "Oh, maybe this is appendicitis and not flu" and told Dr. RR so. He went to see the patient, then came out and said, "I think she has the flu." To that, I stupidly replied, "That's what I thought before I palpated her RLQ." Great, now he thinks I'm making excuses. I also got pimped on STD treatment, and Dr. RR asked me for the precise dosages of drug that I would give to treat these STDs. I didn't know them off the top of my head, but I'd written down and recalled them with ease.

Family Medicine: Researching

I'm now officially halfway done with family medicine, and I'd like to think that I learned something useful in my last three weeks at the clinic (hospital week doesn't count). If there's anything that I come across that I don't know, Dr. RR says, "Look it up." Case in point: today I got this eight-month-old infant who had a fever five days ago and broke out into a fine lace-like rash all over her body yesterday. I didn't know what it was, so I consulted Dr. RR's dermatology textbook (which I've become good friends with whenever I have to look up topics like pityriasis rosea, scabies, etc.) Sometimes I have no clue what I'm looking for, but for this rash I struck gold: roseola. Hopefully Dr. RR doesn't think I'm a total idiot (sometimes I have trouble distinguishing between a URI and allergies).

We had several follow-up patients from Friday come to see us. One was a 10-year-old kid s/p appendectomy who developed a fever 4 days after his surgery (he turned out to have lower lobe pneumonia). What struck us all as insane was that the nurse at the pediatric hospital gave him a shot of Rocephin just above his hip, rather than in the upper outer quadrant of the buttock as you're supposed to. Was it any wonder he had numbness along his entire left side where the injection went in? (Dr. RR suspected that it injured his latissimus dorsi) Thankfully he's doing better now (though I couldn't pick up the crackles in his lungs on the first try). Another patient had severe hip pain and couldn't even walk so we sent her to the ER. Fortunately she didn't have a hip fracture, and after some methylprednisolone her pain was much more bearable.

I drove to school during lunch to check my email and ran into Mike, my former lab partner. He told me he plans to apply for ophthalmology. That's a good speciality to go into =)

Family Practice: OSCE review

Today Dr. RR and I sat down to go over my OSCE performance. Overall, I asked most of the right questions, but during the physical exam I forgot to palpate/percuss the chest during auscultation, percuss for the liver, and listen for bruits. Yes, the physical exam portion was not my forte. Dr. RR was annoyed that we weren't given a grade sheet beforehand so that we didn't know what we were being graded on, and plans on giving future students a copy of the gradesheet beforehand so they'll do very well on their OSCEs. =P I got my CD of my OSCEs back, but whether I'll look at them anytime soon is another story.

Family Medicine: Another Day at the Clinic

If there's anything I've gotten good at on this rotation, it's how to calculate how much amoxicillin to give to kids with ear infections. I still don't do well on Dr. RR's pimp sessions (and considering how his last student was near the top of our class I feel even more like an idiot) but I'm glad to say I did pretty well in today's topic over fibromyalgia. A lot of the info I studied came straight from OMM, and I even told Dr. RR about Dr. KB and her approach to fibromyalgia (see what viruses they have, give them Transfer Factor and Cortef 5 mg QID), and he seemed interested in hearing more about it. If only Dr KB knew I was spreading the good word about her treatments and how they work =)

On another note, today was Match Day for those who applied to AMA residencies. My best friend and another high school friend both matched at their top choices. =) I don't have a top choice residency program in mind yet, but I hope this time next year, I'll be as happy with where I match as they are right now.

Family Medicine: Books vs Real Life

My assignment yesterday for Dr. RR was to look up differential diagnoses for RUQ and LLQ abdominal pain, and the list was long. But surprisingly, we got a few patients today who had abdominal pain, and it was my job to try to figure out what it was. One lady had chronic RUQ pain for years even though she had her gallbladder removed; the only thing to do for her was medical management. Another woman came in with frequent urination and abdominal pain in her LLQ, RLQ, and side. She had no history of strenuous activity, and when her UA came back negative, I really had no clue what to think. Later Dr. RR went and talked to her more in depth and was able to find that the main pain was the pain in the LLQ, which made everything suspicious for diverticulitis. To treat diverticulitis: clear liquid diet and antibiotics. *sigh* Dr. RR probably thinks I'm an idiot. He's already seen two of my three OSCEs and said that while I don't give the impression that I'm "green" (i.e. I don't have in the interview skills of a first year), there's several things I need to work on. I went ahead and apologized for being soft spoken on the CD since I had strep that week, but later I wanted to kick myself for finding excuses for a less-than-stellar OSCE. I never win.

Family Medicine: When Mothers Make Bad Decisions

Yesterday, a 17-year-old mother of a 3-month-old boy called the clinic to say that her son was not eating well and vomiting. This happened two days after "some window blinds fell on his head" and she wanted to know if she should bring him in to see Dr. RR. The LVN told the mother to take the baby to the ER. After the conversation ended, the nurses and MAs began talking amongst themselves. They suspected that this mother (and maybe her child) were being abused by her boyfriend; in the past, CPS even went to their home while the boyfriend was at work toke mother and child away for their protection, but the mother had refused to leave. At any rate, the story about "falling window blinds" was definitely suspicious, but there was nothing anyone could do but hope for the best.

This morning word spread throughout the clinic that the little boy, Isaiah, was dead. Instead of going to the ER after hanging up with the LVN yesterday, his mother put him to bed and came back hours later to find him unresponsive in his crib. They took him to Dallas Medical Center (why they drove all the way out there is beyond us) where he was pronounced dead on arrival due to cardiopulmonary arrest. CPS and police got involved when old bruises were found on the child's body; so he did get abused. *sigh* I hope the boyfriend got arrested. Regarding the mother, as much as I feel for her loss (no parent should know what it's like to lose a child, never mind a teenager), I can't help but feel angry at her for not protecting her child better. Maybe she didn't know how to protect him and was not a good parent because she was still young as well, but still...why didn't she just take him to the ER when the LVN told her to do so? The LVN was sad and angry for a good part of the morning. "I told her to go to the ER," she said. "I wish I could have done more." *sigh* The worst part is knowing that this could have been prevented, and now there's a seventeen-year-old mourning her child because of her actions. This baby's death will probably haunt her for the rest of her life.

That little boy was born in early December; for all I know, one of my classmates delivered him at the hospital. Back when I was doing ob-gyn, I never thought about what would happen to all those babies born in the L&D. I assumed they would all go back to loving families and parents who cared for them, that they would grow up and lead healthy lives (Dr. K even joked that some of the girls might reappear in the L&D 15-20 years from now, when it's their turn to give birth) The truth is that we really don't know what happens to these babies after they leave the hopsital. We hope that they are loved, since no one wants to think about babies being born to get abused and mistreated by the people who are supposed to care for them. In this case, this boy's parents were only 17 and 18; clearly they weren't mature enough to raise a child properly. Then who can say that maybe death was probably the best thing to happen to him? I won't go so far as to say that any child is better off dead, but at the very least, he's not hurting anymore.

Family Medicine: Back to the clinic

I was welcomed back to the clinic today by staff who had noticed my absence (wow, who knew?) and immediately got back into the swing of seeing patients. Dr. RR asked me to tell him about drugs for diabetes (my assignment for the week), and to my credit I knew all the classes and certain characteristics off the top of my head. With spring break in the air, a lot of kids came to the clinic today. One was a little seven-year-old girl with a bad case of anxiety (shortness of breath at rest, when her mind isn't preoccupied with other things) because she keeps thinking she's going to die. That's not something you can easily get rid of, so she'll be seeing a behavior therapist or something like it. One teenager had a boil near his butt, so Dr. RR drained it with a syringe (as opposed to the usual I&D). It really was nasty-looking; pus mixed with blood created a dark foamy mess, and it smelled awful. One LVN who went to the room later commented that it smelled like he hadn't wiped his butt all day. Another toddler was heard running down the hall screaming b/c her mom had told her she was going to get a shot today, and she screamed every time someone entered the room thinking she was going to get that shot. Note to future pediatricians: tell moms not to tell their toddler children that they'll be getting a shot; it'd make everyone's day (especially the LVN's, since she has to actually draw the blood) a lot easier.

Family Med Hospital Week: Last Day

This morning we started rounding at 9 a.m. and finished seeing our 14 patients two hours later. WOW. Why can't we get done this fast during the week? My two female patients were fine; just "being babysat" over the weekend until they can be discharged to home care or the nursing home. CH, of course, was still recovering from his open cholecystectomy. I was bit alarmed when I heard some rhonchi in his lung and asked Andie if I could order a CXR on him. She said yes, but Dr. V (the attending covering for Dr. T) asked me why (to justify the order). Thank goodness he heard the rhonchi, too, and agreed with my assessment. I felt like a real doctor today =) But man...hospital week was fairly brutal. We took care of lots of patients that will most likely be discharged this coming week, so the next group of students will probably have it easier than we did. (We did all the work). Despite that, I enjoyed this rotation, and I'm glad my patients seemed to like me. JB told me yesterday that I had a good bedside manner, and CH (whom I've been with since he came to the ER) said he'd miss me. I hope the next student takes good care of him =)

Tomorrow it's back to the clinic with Dr. RR. Who knows what I've forgotten about working in the clinic. It'll be another adjustment for sure.

Family Medicine: Saturday

On weekends, we have to be ready to round with the attending by 9:00 a.m., so I arrived between 7:00 and 7:30 to see my three patients. CH had an open cholecystectomy yesterday and was doing well when I saw him; he has a "T-tube" put into his liver (as well as a JP tube that I saw often during my surgery rotations) that is draining a lot of bile. He was moved to another room two doors down from JB, another of my patients, so that was convenient for me =) My third patient still has arm pain even though a recent doppler ruled out a DVT; they'll repeat that tomorrow. One of Lauren's patients became respiratory acidotic (pH of 7.21) and the nurses had to see if he had a DNR before intubating him. I don't know what they did in the end. We also had another patient, a school principal, who was supposed to be transferred to another hospital b/c his wife wasn't happy with the care he was receiving here, yet he was still on the floors this morning. Andie and MO weren't here today, so another third year FP took over for them. We were done rounding by noon (YAY!), so I got the afternoon to read.

Family Med Hospital Week: Winding Down

Our resident, MO, returned today from taking his boards, and since Andie was able to see one of my patients for me, I had 3 hrs to see 3 patients. I first saw CH, and when I sat beside him and asked where he came from originally (his accent isn't Texan), he launched into a long story of how he lived in England until his father was killed in WWII, and then his mother remarried an American and he relocated to the US. He then told me of how he married his current wife twice, once when they were much younger (they divorced 9 months later b/c he was in the army and she didn't want to travel and leave Texas), and a second time after their later relationships failed (the death of his son put a strain on his marriage to his second wife). They've been together for the last 13-14 years and couldn't be happier, and I know he wants to get his cholecystectomy over with so he can take care of his wife when she has her knee replacement later on. I could have listened to CH's stories all day (I was in his room for 30 min probably), since he loves to talk, but I had other patients to see. The other two will probably be leaving the hospital pretty soon, though one of them has a suspected DVT in her arm and will have to be monitored closely.

Andrew admitted a patient yesterday for nausea and vomiting, and today we found out she had an AAA that ran almost the entire length of her thoracic aorta to the bifurcation. It was crazy, and Dr. Y (surgeon) even stopped by to tell us exactly what he thought when he saw that CT. Apparently the case was too complicated for him to handle, b/c she's being transferred to the THC in Houston. At lunchtime, we had a fun discussing which actors Andie thought were good looking (and whether or not we agreed). MO even chimed in by agreeing that certain actors were hot (even though he's married with children); I thought it was pretty funny but I think Andrew and Mani felt a bit out of place in the conversation. We started rounding around noon and ended up finishing around 4:30 (EARLY!) CH went into surgery this afternoon; hopefully when I see him tomorrow he'll be well.

One of Mani's dictations never got through the computer system (he claimed he never got a confirmation number after he submitted it), so he had to go back and redo it. As he and Andrew left the elevator, he told the rest of us that Andrew can help him with the dictation. I thought, surely he should be able to do a dictation without someone holding his hand. MO clearly thought the same; as soon as the elevator doors closed, he said, "I don't trust him." Ouch. Can you imagine a resident or a doctor saying that about you?

Family Med Hospital Week: Rewards

Rounding in the hospital has become very routine now. I spend an average of 30 minutes with each patient, so with morning report ending around 8:00 a.m. and Dr. T not arriving until after 11:00 a.m., I had more than enough time to see my four patients. My favorite patient has to be CH, the man I admitted to the ER on Monday with acute cholecystitis; he had an ERCP done yesterday to remove one of the stones in his CBD and tomorrow he'll have a lap vs open chole to remove his gallbladder. He's eager to get the surgery over with since his wife will be having a knee replacement in a week or two and he needs to be able to take care of her when that happens. My other male patient, JC, is pretty much just waiting to get a brain biopsy for his lesion since there was no cancer to be found anywhere else in his body. My patient who had MRSA in the nose is finally off the nasal cannula and can probably go home in the next day or two. My 84-year-old patient in the CDU is a slightly sadder case; she spent some time today talking to me about how she wants to stay at PMC as long as she can since she has nowhere else to go (she can't move back to her own apt and the nursing home that she came from was not to her liking). This is her third hospitalization this year, and she has hinted that with her husband and daughter already dead, she's at peace knowing that she may not have terribly long to live. This made me sad, but Dr. T is trying to find a good hospice program that will take care of her.

The FP resident comes back tomorrow, and Andie is relieved to go back to becoming a normal med student again (instead of working like an intern as she has been this past week). She did, however, warn us that she won't be proofreading our notes to make sure we put in all pertinent details in tomorrow, so we'll be on our own. I'm not too worried; she's told me tw ice today that my notes are well-written, and I'm glad =) Mani is another story; he asked today how he was supposed to look up labs from the previous day, and Lauren was kind enough to show him. Andie and I exchanged looks that said, "How can he not know?!" I've seen his notes; they're pretty bare except for a few scattered lab values (other values are written in by Andie). Granted, maybe he never learned how to write a note properly b/c he never did a rotation at JPS, but still, this was ridiculous. He wouldn't last long at JPS without knowing how to write a note.

I later found out I didn't do a review of systems when I dictated CH's H&P, so after Dr. T dismissed us around 5:30, I went back to CH's room to ask him the required questions. He wouldn't have been in a state to answer them on Monday b/c he couldn't stop vomiting, but he sure was able to answer them now. "I like talking to you," he said. That made me feel good about what I'm doing =)

Family Med Hospital Week: OSCEs and Bad Students

This morning the family medicine students had their OSCEs. That was bad news for Andie when we told her yesterday (b/c we had lots of patients to see), so she told us to see two patients in the morning before going to the OSCE and two patients after we return. I fulfilled my end and saw two patients before driving to school for the OSCE. Let me just say, I hate OSCEs because I suck at patient interviews. I always forget to do something crucial. My first standardized patient even told me where I messed up at the end of the interview: i.e. I forgot to ask him the severity of his pain, I palpated the abdomen before auscultating, and I didn't ask how long his symptoms lasted. Oops. The other two fared slightly better (by the third one I was determined not to make more errors than I had to), but after it was over I still wanted to kick myself. I forgot to shake hands with my first two patients. I spoke softly b/c my throat still felt raw (but much better compared to the last two days). I forgot to do OMM. The list ran on and on. *sigh* And I'm supposed to watch this with Dr. RR and have him critique me? One thing he can't accuse me of not doing is auscultating under the patient's clothes; I kept that in mind during the whole OSCE.

I drove back to PMC in time to find a frazzled Andie jotting down lab values for one of my patients (the one with suspected brain mets). I took over so she could see her own patients and did everything Dr. T told me to do to my patient: palpate lymph nodes, do a fundoscopic exam (I failed; he had glaucoma and I couldn't see a thing), have him draw a clock (to make sure he had no right parietal lesions), and...a DRE. I thought I felt a nodule but wasn't sure; got to have Dr. T follow-up after me. Fortunately my patient was a good sport about it; both of my male patients are friendly and don't mind me poking at them. I don't think he has prostate cancer though; he said his prostate exams were normal in the past, and according to St. Francis's Guide to Inpatient Medicine, prostate cancer rarely, if ever, metastasizes to the brain (hehe, guess I did learn something from that assigned chapter) By the time I finished seeing all my patients it was 11:30 a.m. so I went to get lunch. On the way I saw Dr. T eating in the doctor's lounge as the door was closing, so I was glad that he was at least in the hospital.

There were actually plantains for lunch, so I was happy to get a few as part of a $3.99 special (one entree, two sides). At lunch, Andie was pissed at Mani (who fortunately was nowhere to be found); he had not written a single note all morning and she had to see 3 of his patients for him (on top of the 3 or 4 that were already assigned to her) this morning. Granted, I don't know the guy too well, but in the hospital setting, not pulling your own weight is just wrong. Andie was relieved when I told her I'd spotted Dr. T in the doctor's lounge, and we began rounding on patients shortly before noon. This day was very unlike the others; there was almost no waiting around for Dr. T. Andie let us all write orders for our patients and even call other physicians' offices for consultations (normally the resident's job but he's off taking USMLE III so it's our job now). Funnily enough, I ran into the oncologist I called for a consult on my brain lesion patient shortly after he paged Dr. T, and he told me that because my patient's CT/Abd/Pelvic scans were clean, he needs a neurosurgeon, not an oncologist. I was all too glad to relay that to Dr. T in person (he gets way too many phone calls), and Andie was gratified to know that she was right to want a neurosurg consult (Dr. T had originally said it wasn't necessary yet)

We ended up rounding on most of our patients by 3:00 pm, and one patient's room was full of homemade get-well cards from his 1st grade students =) He came to PMC for the flu, but now he's possibly descending into ARDS because his O2 sats are horrible and he needs a Bipap to maintain his airway. When we had a break, Mani went to dictate on one of his patients and we told him to meet us on the 7th floor later. We didn't see him again until about 30-45 minutes later on the 5th floor; he never called us after finishing the dictation to see where we were. I asked why he didn't call Andie, and he said it was b/c she seemed busy and didn't want to bug her. That's BS. I've called Andie for more insignificant things ("Did you leave your sweatshirt on 4? Where are you?"), and she always answered her phone. Andie was more annoyed by why it took him so long to do a dictation (it shouldn't take more than 10 minutes). "He needs to start pulling his s*** around here or he'll fail medicine," she said. She did report him to Dr. T, who said he'd speak with Mani afterwards. *sigh* For his sake, I hope he gets his act together.

(And for those of you reading this who happen to be friends with Mani, please do not rat my blog out to him. Only selected people are supposed to know this blog exists, and if I hear that classmates that I do not want to read this blog are reading it, I won't hesitate to delete it. I don't have to share my hospital experiences; I do it because I feel we can all learn from other people's actions and mistakes. And in this case, I already revealed the names of the people doing hospital week with me, so it's a little late for anonymity. So please, please keep this to yourselves)

I had a doctor's appointment at 4:00 pm and asked Dr. T around 3:40 if I could leave, but at first he didn't seem thrilled (Andrew already left at 2:00 for a doctor's appointment also). "We can't have two doctor's appointments in the same day," he said, asking how long I knew about my appointment. "Since yesterday," I said, and he replied, "Even though you knew you'd be on service with me all week?" Andie commented that originally I was going to ask him to check my throat but things got too busy (that woman's a lifesaver), but in the end Dr. T said I could go. Whew. For those of you who don't know, the Student Clinic is now at the new building since the professor who runs it now also runs the Radiology clinic there. As a result, the new exam room is large and cushy with wooden floors, and the waiting room looks like something in an executive's office. Awesomeness =P The doctor who saw me is one of the family docs (young blond guy with glasses) He examined my throat and said it still looked red, and while the strep test came back negative (thanks to 2 days worth of amoxicillin), he was still going to treat me for strep because my description of sore throat, fever, and bleeding/exudate-filled tonsils clinched the diagnosis. I told him the strength of amoxicillin my dad was taking so that he could write the exact same thing, because since I started on it, I should finish it the same way. Not to mention I need to return the number of pills I took from my dad back to him so he can finish his meds =P

Family Med Hospital Week: The Waiting Game

After yesterday's long-day disaster I had high hopes that today would be different, that Dr. T would be on time. It didn't happen. We started the day at 7:00 a.m., saw one patient, then went to morning report before seeing the rest of our patients. Andrew and I had four patients to see, but I managed to finish by 10:00, the time that Dr. T had given Andie as the time to start rounding. We all met in the cafeteria at 10:00, but Dr. T didn't show up, so we all got a snack (yogurt for me since my throat's still sore). He called to say he'd be there in 20 minutes, but as 11:00 rolled around there was still no sign of him. By now the smell of lunch was getting to us so we decided to get lunch early. I'll say one thing about Plaza: the food selection there is (compared to JPS, TSH, and Driscoll); the entree of the day was curry salmon or shrimp creole. Most of us got the shrimp creole; it was spicy, but really good =) But still, even after lunch, no one showed up. Dr. T simply sent a text message that read, "Delayed." How much of a delay? He didn't say, and we didn't know, so we just sat downstairs and talked, waited, or (toward the end) napped on the table. Doctors and residents passing by easily recognized us as "Dr. T's posse" because of how worn out and impatient we looked. Andie in particular looked like she was about to lose it; waiting around is not her style and Mani even told her flat-out that she had a Type A personality. If only he knew that Andie came close to losing her temper on him earlier in the day for keeping his progress notes on him instead of leaving them in the chart like he was supposed to. Still, by the 1:00 pm rolled around, we all agreed that waiting 3 hrs was just too much. I even had time to slip away and dictate on my patient from last night. Mani had to dictate one of Haris' patients from last week, but he took a longer time to dictate than I did. Thank goodness Terrell gave us some dictating experience.

By chance, we saw Pauline and Stephanie in the cafeteria and they told us they saw Dr. T "giving a lecture" in the classroom. So we all went up there only to find out that the "lecture" was more of a meeting. Oops...Instead we hung out in the classroom where Kyle and another intern were chatting about their psych experiences at TSH. I told them that my group had taken the TSH patients to the State Fair, and they were shocked. "You took psych patients to the State Fair?!" asked Kyle. Hey, I didn't think I did too bad a job of supervising =P Finally at 1:30 Dr. T got us to start rounds, then told us to go on ahead to the 3rd floor while he got something to eat at the cafeteria. I thought we'd only have to wait about 30 min at most. Instead...another hour wasted standing against the wall, looking like (in the words of several nurses) people lined up before a firing squad. I didn't bring anything to read so I was soooo bored. Finally he showed up and we began seeing patients, but around 5:00 pm, Andie told those of us who were not staying late (it was Mani tonight) to go home, or else we'd be in for another long night. So we did.

*whew* So this is what happens when the hospital is full of patients and the FP resident leaves the team for a week to take his boards. I got to admire Andie for taking over the role of an intern very well; this was supposed to be a laid-back PCP for her, but instead, she's running around double-checking our work and pushing Dr. T to sign orders and see his other patients (he likes to chat). Kind of reminiscent of Fallon pushing my lab partners and me to get serious whenever we didn't feel like dissecting =P Those were the days. Still, it worked.

I've started taking some of my dad's leftover amoxicillin for my throat (1st line treatment for strep, after all), and while I haven't noticed too much improvement, I haven't had a fever all day and it doesn't hurt as much to swallow. My tonsils still look like crap though. Andie originally said I could have Dr. T take a look at my throat and write a prescription, but after the 4 hr wait today I knew that it was out of the question. Instead, I made an appointment with Student Health tomorrow afternoon. Hopefully Dr. T will let me go early so I can get checked.

Family Med Hospital Week: Unbelievable

Today was the first week of my hospital week with Dr. T at PMC. After failing yet another family med quiz, I met Andrew, Mani, and Lauren O at PMC. There we met up with Andie (4th year) and Asma (PA), who gave us a list of patients and assigned us three each to check on. My first patient was an overweight lady with MRSA in her nose, so I had to gown up and glove up to see her. My next patient was a man who had TIA symptoms yesterday but feels fine now. His brain scan, however, also showed that he had a small 6 mm mass with vascular edema around it that suggested metastases (he has a 50 pack year smoking history) My third patient was in the ER for N&V, and I told her Dr. T would see her in the afternoon.

Sadly, that didn't happen. Dr. T was supposed to meet us at 11 for rounds; he didn't show up until 11:50. Then he saw about 2 patients before he left PMC to teach the 2nd years at school. From about 12:30 to 2:30 we rounded on all the patients and filled in any labs we might have left off the first time. He was supposed to meet us at 3:00 but instead didn't come until almost 3:50. And we had sixteen patients to see, of which he'd only seen 2. *sigh* Also, one student has to stay late everyday to take H&Ps on ER patients, and despite my better judgment I volunteered to stay (Andrew and Lauren hadn't wanted to do it and Mani didn't volunteer). At 5:40 pm I got called to the ER and did an H&P on a man presenting with what appeared to be acute cholecystitis (except his liver enzymes were elevated too). I finished with him around one hr later and only then did the rest of the team make their way down to the 2nd floor to see the ER patients. We didn't get out until 7:45 pm, and Mondays were supposed to be a short day.

On top of that, my health wasn't doing so well. I hadn't completely recovered from last night's fever, and in addition my head hurt and my throat was getting sorer by the hour, to the point where it hurt to swallow. As soon as I got home, I took my otoscope and took a good look at my throat. HOLY CRAP! Red tonsils with specks of white exudate...damn it, I got strep! Nooooooo! *sigh* Well, I can't go without seeing a doctor, so I'm going to show Dr. T my throat tomorrow and hopefully he'll let me take the afternoon off so I can go to the student clinic...assuming I can get an appointment. *cries* My life sucks

Sick Again

How is it that I only got majorly sick once or twice in the first two years of medical school, yet in the last five months I managed to get sick four times? I started getting a cough about 3 days ago (pretty sure I got it from my dad, who's been coughing for a week), but despite sleeping most of yesterday and today, I still got a fever. =( I don't have a thermometer so I don't know how bad it is (probably around 100; I'm pretty sure it's a viral dz again), but when the heater's on high and I'm shivering, that's a pretty good sign of fever. =( This sucks, and I have OSCE and hospital week in the next few days, too. Not to mention Dr. RR expects me to know everything about diabetic drugs and dosages by the time I return to his clinic next week; how am I going to be able to rest, recover, and study all at once? *sigh* One thing at a time, crescendo.

Family Medicine: TGIF

Because of yesterday's ice storm, the clinic did not open until 10:00 a.m. today, so I got to sleep in a little =) One of the employees at the clinic was expecting twins, so the staff threw her a surprise baby shower. Dr. RR didn't join in the festivities (he said baby showers weren't his thing), but there was ice cream, cake, and banana pudding to go around as the gifts were opened. I chatted with Sue, the PA, about Asian supermarkets and restaurants, among other things, for a while. The rest of clinic was fairly routine. One memorable case: a 15-month-old came in with what appeared to be a normal everyday rash, but when she started crying bigtime at the sight of Dr. RR and me, her entire body turned red and her rash appeared as noticeably red splotches. Another patient with pityriasis rosea. The baby had been breastfed not too long ago, and in the middle of all her screaming, she suddenly threw up on Lupe, one of the MAs. Damn. Another good reason not to become a pediatrician. Afterwards, I went back to the room to get the chart and found the baby getting breastfed again. Tawanna, one of the LVNs, told me that it was comfort nursing to calm her down. Usually most mothers stop breastfeeding around one year of age, but in reality they can nurse as long as they want to. Tawanna said she knew someone who breastfed until her kid was three; to me, that's too old and too big.

I set up a radiology elective for next fall at the cancer center near my house. The lady in charge promised me that the experience will be a good one, and I certainly hope so.

Family Medicine: Ice Storm

We all knew that a freak ice/sleet storm was on its way, but everyone at the clinic assumed that it wouldn't happen until later in the day. Imagine our surprise when we started seeing (and hearing) pea-sized hail tapping against the windows around 10:30 a.m. Some of the nurses worried about their cars, but fortunately the hail itself wasn't big enough to cause damage. Several patients didn't show up toward noon (naturally, in this kind of weather), but most of the afternoon patients braved the weather and came. We saw our last patient shortly before 3:00 (everyone was eager to leave), and when I got outside my car was covered with a thick layer of snow/sleet. Fortunately it hadn't frozen over yet, and the drive home wasn't too bad. *sigh* Stupid freak snowstorm. On a good note, the clinic doesn't open until 10:00 a.m. tomorrow. If only lecture would get cancelled, I'd get to sleep in.

Family Medicine: Tumor Board and more

This morning we had to attend the Tumor Board meeting at Plaza at 7:00 a.m. The education office was in a different building from the hospital and it was only thanks to me following Jacob that I knew where to go. It was a busy meeting; aside from the attendings, probably all the internal medicine residents were there, as well as classmates on their medicine rotation and family medicine rotations. There was also breakfast (donuts, fruit, pigs-in-a-blanket), so we helped ourselves to some food before sitting to listen to the attendings talk. Two cases were presented: a large lung mass that turned out to be a histiocytoma and another case about a man with metastatic lung CA with mets to the brain. Later I found Andrew and suggested we page the resident we'll be following next week, but Kim overheard us and told us where to go next week. It turns out there'll be four of us next week at Plaza: me, Andrew, Mani, and Lauren O. Kim told Andrew that Plaza will be a nice break for him, since he works long hours at the PCC.

I failed my self-study on murmurs...badly. Dr. RR asked me all sorts of details that I'd failed to study last night (i.e. what do S3 and S4 mean? How do murmurs present during a Valsalva?) and now have to read up on those (as well as liver cirrhosis) before tomorrow. *sigh* There weren't too many patients of note today. A few were follow-ups; the burned breast lady came back b/c JPS didn't fill her prescription and she was still having cold symptoms, and a little boy whose TM was bright red yesterday was much better today. I also saw a case of pityriasis rosea today, which was pretty cool even though I'd seen it before several years ago. Funny how I've been here less than two weeks, and already everything seems so routine.

Family Medicine: Lessons in Galactorrhea

The day was fairly unremarkable. Aside from the usual HTN/diabetic checkups or kids with fever, cough, and congestion, we did get a few patients with more unique problems. One girl came in with inflammatory tinea capitus (aka a kerion) that had been there for a year but recently got bigger, more painful. She was given grisefulvin, corticosteroid cream, and Bactrim. Another woman with the flattest affect I'd ever seen (she was on 3-4 antidepressants) came in complaining of a 2-month history of nipple discharge, even though we saw nothing on exam and she didn't get a mammogram b/c she didn't feel like it. Her prolactin levels were normal (hyperprolactinemia predisposes a person to galactorrhea), so Dr. RR and I couldn't figure out why she was having nipple discharge. Of her antidepressants, trazodone and fluoxetine could stimulate prolactin secretions, but again, her prolactin was normal. *sigh* Speaking of psych patients, the last patient of the morning wrote "Had a mental breakdown X 4 days" as her chief complaint; needless to say Dr. RR didn't let me see that patient.

Next week is my hospital week, but when I called the resident I was supposed to contact, I got a pager number. Great...now what? Am I supposed to leave my cell phone number and hope he calls back? We have lecture at Plaza tomorrow; maybe I'll try to page him again then.

Family Medicine: Quizzes and Acupuncture

This morning we had our first Family Medicine quiz. I'd read over the material last night and thought it wasn't too bad, but the questions themselves were tricky and I missed more than I should have. Ah well. I wasn't the only one who thought it was hard. I stuck around after the quiz to give Elizabeth some Morinaga Hi-Chews I'd picked up in Dallas over the weekend; those taffies are really addictive =) Then it was back to the clinic.

One of the first patients I saw was a middle-aged man with CAD complaining of a 2-week history of leg weakness, slurred speech, and pallor. It didn't really fit the profile of a stroke, and Dr. RR wasn't sure what was going on either...until he checked the medication chart. Apparently the patient saw two different cardiologists at the same cardio clinic, and each doctor gave him a prescription for a beta blocker. So in effect, he was taking twice as much beta blocker as he should have been. Yikes. This is what happens when doctors don't communicate with each other, and why PCPs are responsible for making sure all the medications are correct. Dr. RR immediately cut the patient's beta blocker prescription from 450 mg to 100 mg, and said he expected him to feel much better soon.

Dr. RR also does acupuncture, and I saw my first acupuncture patient today =) Dr. RR stuck several fine needles in specific points on the patient (both wrists, both feet, the arms, and one needle on the head), then put electrodes on the wrist/feet/arm needles (they are specifically paired, yin and yang) for electric stimulation for about 20-30 minutes (the patient rested in a darkened room while we saw other patients). Other patients seen today included an overweight little five-year-old girl (she was 75 lbs; I don't think I weighed that much until I was 10), a guy almost my age with cough-induced costochondritis (the "downside" of his cough was that he couldn't smoke his daily weed for 3 days), and a teenager with a bad case of folliculitis on her legs and arms. A common cause of folliculitis is shaving, and I'd asked, "Well, you don't shave your arms, do you?" Her mother: "Oh, yes she does." *sigh* The things you see in family med.