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.