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.