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?