Last day of Surgery.... :(

Today was my last day in surgery and I'm filled with mixed emotions... soooo sad to leave such an awesome rotation and yet soooo happy it's break and I'm officially 1/2 way through clinical year! My preceptor and really all the surgeons were so fun to work with, if I can find a surgical position with people 1/2 as awesome I'll be lucky.

Seriously my favorite EVER

That's it.... I'm sold..... Surgery is where it's at and all I want to do! I can't imagine not doing this every day. I love every single minute. I wake up early and hop out of bed excited to start my day, I can't wait to get to work, anticipating what the new day will bring. A giant puss filled abdomen from a ruptured gangrenous appendix... perhaps a gastric perforation...... or even a hepatic abscess! Who knows, but what I do know is that this is what I've been waiting for. I've found my place, my niche, the job that I feel lucky to have and so fortunate I'll be one of the people who actually LOVES their job. I get to do this everyday!!!!!!

Surgery is my FAVORITE!

So far this is my favorite rotation and I knew it would be, simply because I get to see, cut on, suction out and sew up patient's insides. You all know what a freak I am about doing the gross stuff and this rotation is maxing out the gross factor for me, today I had poo on my shoe... and I couldn't be happier :)

The surgeons and PA I'm working with are all extremely friendly, nice, helpful and informative, answer all my questions (even the dumb ones) without making me feel like an idiot. What's even better is the OR nurses are super nice too! In the OR the scrub nurse is the boss, if you touch, move, turn wrong and become "unsterile" she's all over you. Luckily I haven't done anything that has warranted a chastising. One of the nurses even said I "look comfortable in the OR" I was so proud that I fake it so well ;)

During surgery on my first day I developed a tickle in the back of my throat (fortunately we had discussed what to do in this situation during our practice day in school). So I stepped back from the table to cough and as I did everyone in the room stopped and turned to look at me. I'm sure they were watching to see if I was going to faint or vomit or something. So when I coughed they all turned back to what they were doing, it was funny and at the same time extremely unsettling to have the eyes of the entire OR staring at you waiting for you to crash and burn.

I also did "rounds" for the first time on Friday, I was supposed to be in the office observing post-op appointments but the Dr. decided I wasn't going to learn anything from a few patients with no complications, so sent me over to the hospital to "pre round" on the patients that had been admitted. Now I've never done rounds before, the rounds in Browning were...... let's just say extremely informal, so I wasn't exactly sure what to do, so I figured I'd just wing it. Lucky for me at least one of my presentations was "good" so I'm going to consider that an overall win. :)

At the end of my first week I've seen a Laproscopic cholecystectomy (gall bladder removal with cameras) Breast cancer lumpectomy, Hernia repairs (inguinal and umbilical - groin/belly button) Hemicolectomy (small section of colon removed) Sigmoid colectomy (last part of the colon before the rectum) and a couple skin lesion's removed. I've gotten to feel tumors, colon, small bowel, gall bladder, gall stones, nerves, lymph nodes, and liver. The last surgery today I got to suture up the three holes made for the "ports" used during the laproscopic portion of the sigmoid colon resection. I've been told by all the surgeons and the PA that pretty soon I'll be doing closing, writing the post op orders for in-patient and outpatient surgical procedures. I'm pretty excited and I can't wait to do more. For now I'll continue to practice my subcuticular suturing technique, so when the time finally comes I'll be ready to roll.

Aaaaaand I'm OUT!

last day of work at Blackfeet community hospital today and it was fantastic! Spent the day with ENT/craniofacial/Plastic surgeon Dr. Santin, doing surgeries and seeing all the most interesting/difficult ENT cases Browning has to offer. I learned a ton of new things and Dr. Santin helped polish my OR etiquette so I don't look like an idiot in my next rotation.

After I finished my day with Dr. Santin I made my rounds saying goodbye and thanking all the Doc's and staff members that have made this rotation such a wonderful experience. I even got a little choked up during my goodbyes to a few of the the Doc's and a couple MA's that were really good to me during my time here. I will miss the people, the beautiful views and lelou the stray dog who walked me home everyday, Goodbye Montana, goodbye Blackfeet Indian Reservation, goodbye Browning, I AM SO EXCITED TO GO HOME!!!!!

A little preview

Today I spent the entire day in the OR, I figure this is a wonderful little preview of how my surgery rotation is gonna go, and man oh man do my feet hurt! 5 hrs standing, I even wore my most padded, comfy, old lady, easy spirit walking shoes and they still ache. Despite the ache in my feet and back I LOVED it today. This morning I watched the podiatrist debried a mid-tarsal amputation that developed a giant "hema-tomato". This is the 3rd surgery on this patients foot in 1month and I've got to say, I honestly think this guy has some kind of death wish. He's way beyond being "non-compliant" he's a nightmare to treat. He sneaks out of the hospital to go and get drunk, pulls out the drain and then walks close to a mile on his freshly amputated foot. Then when they put him in a room next to the nurses station to better monitor him, he unhinges his window and sneaks out again, so it's no surprise he ended up with osteomyelitis and a giant hematoma! It's hard to watch because he's really a nice guy, he's just an alcoholic and keeps making horrible decisions.

Anyway back to my day...

So I watched the pretty blood foot surgery, got to hold the debris bucket and work the suction tube. Then what was supposed to be a quick Lap Chole I was just going to observe became the highlight of my day! The other Doctor who was supposed to assist the general surgeon couldn't make it so I got to be the 1st assist!! I ran the endoscope camera and one of the grabbers holding up the liver and the fundus of the gall bladder. Unfortunately the super inflammed gall bladder was being tricky and we were having a hard time keeping ahold of it. The general surgeon decided it wasn't going to work laproscopicly so we went in Old School and did an Open Chole!! Giant almost 12" incision across the right side of the abdomen and I held the retractors and ran the suction, while he cut and cauterized the bleeders. The toughest part was standing for 3 1/2hours and pulling on the retractor for 1hr. My feet were killing me and my arms and hands got so tired. But getting to sick my entire hand in the patients abdomen was totally worth all the pain. After we finished he suture closed the facia layers and I stapled the entire incision and then a suture into the two smaller incisions where the ports were from the laproscopic attempt. Today rocked, can't wait for surgery to start in 12 days!!!!

Halfway through

So I've reached the halfway point for this rotation and still can't believe how fast it's gone and how much I learned in such a short period. Today I spent the day with the ENT (Ear, Nose and Throat) Nurse Practioner Mr. McDivit. He is fantastic, funny, super knowledgeable and a great teacher. I watched him do a layrngoscope exam and watched the vocal cords move as the patient said "eeeeeeee" and "aaaaaaaaaa" it was very, very cool. I also learned how to do the Dix hall-pike maneuver for BPPV (Benign Paroxysmal Positional Vertigo) which started a long and interesting conversation about dizziness and nystagmus (eye bouncing) and all the different kinds of things you can tell from putting people in certain positions and watching their eyes.... AMAZING!!! I also will be getting the opportunity to watch tonsil/adenoidectomy, ear tube and cleft palate surgery right before I leave because the ENT surgeon who volunteers to come up here and do ENT surgeries 2x year (FOR FREE) will be here the day before and the day I leave. So I am extremely excited about that!

Well better get back to studying, I was given a book and 4 articles to read tonight about "practical management of the dizzy patient" so tomorrow I will be better informed on the subject and ask some more "good questions". Here is what I got to see in person (this is however NOT the actual exam I witnessed, I just thought it was a good example to see what I saw )

How I spend my days

There are a great many things I love about this rotation, but I think the top 2 have to be my freedom at the hospital and the Native American culture I've been immersed in.

1. I have, at my disposal, every department in the hospital, virtually no student competition (Hugh, the medical student spends all his time in the ER) and everyone has been extremely willing to have me come by and hangout for a few days, take their time and teach me. I'm taking this new found freedom for all it's worth and trying to spend my time where I think I would not otherwise have the chance to see at all. For example I got to hang with the podiatrist last week and next week I'm going to spend 2 days with the amazing ENT NP and the Optometrist as well as some OR time with the OB/GYN Doc's. We have rotations in major/general fields of medicine but not much time to spend with the specialties and I'm trying to get as much of that as I can while I'm here.

I have spent most of time with OB/GYN outpatient doing ultrasounds, prenatal checks, pap's and some IUD insertions and removals and I know what your thinking... yes going out onto rotations when asked what area I would like to focus on and practice in I stated with confidence "anything but OB/GYN or Pediatrics" and yet as you can see I have spent quite a bit of my time in the very department I so adamantly denied interest in. Well to ease your suspense, the answer is NO I have not changed my mind about this. I do think it's an important area to understand and so I am forcing myself to spend some time there. What I have learned is a great deal because the Doc's are wonderful and also it's not as bad as I thought... but I still don't want to do it :)

2. Last night I went to my first Pow Wow! It was really a very moving experience actually. Hugh and a friend from the pharmacy went down to the local high school where people were all dressed up in elaborate traditional/not so traditional Indian garb singing and dancing. Another friend I've made from the pharmacy was actually dancing later on but he sat with us and explained the history of the dances and some of the outfits, about the singing and Pow Wow's in general. It was fascinating and really enjoyable to watch. It's so heart warming to see some of the younger kids embracing their roots and learning some of the traditions of their culture. One of the nurses is going to bead my stethoscope as a memento of my time here and I have enjoyed every second of it.

Life on Le Rez...

is interesting to say the least, be it the packs of stray dogs and wild horses, the long abandoned boarded up houses and stores or the ER escapee patients carrying their IV bags, the Rez is like no place I've ever been before.

First things first let's break down my living arrangements

I live in a trailer or mobile home on hospital property it is 656 steps door to door ( I know this because I counted them... why you ask, I guess because I was curious, moving on) The trailer itself is much more spacious than I had thought it was going to be, it is on the other hand not the cleanest of places, but livable (there is no housekeeping staff so it is up to the rotating students who cycle through here monthly to keep it clean). There are 6 bedrooms and a common living room and kitchen space. When I first arrived there were 3 Pharmacy students and a Dental student all of whom have now left, a 4th year Medical student from Israel arrived the same day as I did and will be here for 4 weeks.

I walk to the hospital every morning and so far the weather has been really nice, I don't even need a jacket. Although I'm told this is really unusual weather, it's apparently something to do with the warm "Chinook winds" that come down from Canada. Speaking of wind it is really very windy here everyday all day long the wind blows, it's like living in the gorge, and according to the locals this is MILD wind. Anyway I get to watch the sun come up over the plains to the east and looking to the west I see the giant mountains of Glacier Park. It's the best commute I've ever had :)

Even though the hospital is pretty small it took me about two days of scavenger hunting to find all the different departments and be able to navigate from one side to the other without getting lost. It's mostly one level but there are a 3 main corridors with different places off each one, once you get those down your golden.

Every one has been very friendly (aside from the podiatrist, who really isn't even that bad, he just makes a horrible first impression) Dr. Obied (FM) and Dr. Masterton (OB/GYN) have been the best right from the start. It was difficult to get going at first because this is really a self directed rotation as in it's supposed to be my Primary Care rotation but I can go to any department I want. This is a wonderful opportunity but could also be it's downfall, when they say "self directed" they mean it, from start to finish! Granted the orientation is good and they give you a schedule for every practitioner in the hospital but the leg work is all up to you. There is no one to check in with, no one keeps track of your hours, who you work with, what time you leave ect.... you could work 80hrs/wk or 15hr/wk and I doubt anyone would know the difference. So it's completely up to me to make my own schedule with the different Doc's each week. I've watched/assisted in a few surgeries and done some clinic work in FP, Peds, OB/GYN, Rhumatology. That's the coolest and hardest thing about this rotation, just setting up my schedule.

This is my first weekend here and I'm trying to take advantage of the nice weather while it lasts. Today I drove around to the other side (west) of Glacier National Park to drive on the "Going to the Sun" road through the middle of the park but it's closed 16 miles in and it was 25$ entry so I turned around and did some fishing instead. Even though I didn't catch anything it was still very rewarding to spend an hour or two by the side of the Flathead river, breath in that crisp fall mountain air and relax. Tomorrow the medical student and I are driving up to St. Mary's on the east side of "Going to the Sun" road so we can drive up to Logan Pass and hike up to hidden lake.

On the Res

So I have just arrived on "the Res" set up my room and figured out how to use my phone as a hotspot so I have internet while I'm here, otherwise I think I'd have to drive over to the library for internet. Although I'm not sure how the charges work, I'll have to figure that out soon before I rack up a hellatious phone bill.

Last Day of ER rotation #3

Today is a sad and exciting day... last day of one of the greatest rotations I think I'll have the whole year and the end of #3 means one more rotation closer to graduation!! Yesterday was great, worked 16hr shift with PA Fish (a Matriarch of the profession, though she would give you the stink eye if you ever called her that) an AMAZING teacher. I helped her set a Fast Track ED record 36 patients seen by a single PA in one shift. I have so many things I'd like to write out but my eyes are stinging so I think I shall call it a night get a few hours rest for my last day at Madigan ED.

ED madness!!!

I am LOVING the ED (even if it is just the fast track side). There are 10 PA's and 3 Doc's that I have been working with for the past 4 weeks and they all are amazing teachers! Each one takes lot's of time to discuss great teaching points with me, I don't get "pimped" very often and even when I do it's for my benefit rather than to punish or embarrass me. The medic's are all really supportive and happy to help me find things and with procedures (except for one who I think hates his life and everyone else, so at least it's not just me). The best part is being the only student around, so when cool things to do or see come in the medic's or the PA themselves will come find me.

The coolest stuff I've done and seen so far is ( in no particular order):

Cathed a 3yr old girl - Successfully placing my first IV without help or hesitation - removing a small rubber block from a 2yr old boys nose - I & D'ing lot's of squirting gross abscess's - Every set of sutures - seeing a patient with osteogenesis imperfecta (their blue sclera is amazing) - watching a 4yr old be sedated with Ketamine - The first time I called a consult - Finding a fracture missed by radiology (and having the resident apologize)

The worst moments have been:

Cathing a 3yr old girl - sutures on a 4yr old boys forehead - watching the 4yr old get sedated with Ketamine and repacking her abscess - Patients who are irritated I'm "just a student" and don't want to see me (but what's new) - saying the PR interval is normally 4 seconds ( instead of .4 - that one was really bad. The 4 PA's in the room just about died laughing at me) Calling the wound culture swab a "wand" that one got some chuckles as well.

All in all it's been a really great opportunity to be here and I'm going to make the most out of my last 2 weeks here. This weekend I will be preparing for a "super pimp session" on EKG's I have demanded in order to redeem myself for the PR interval debacle. I'll update as to my success or failure.

Mt. Rainier

Since I had a few days off in the middle of the week I took that opportunity to #1 Do some homework and study #2 See Mt. Rainier and since I don't think anyone wants to be bored with the former and no words are adequate to describe the later I'll just post some pics.

The ER

So now that I've completed my first week up here in the ER let's find out what I have learned shall we.... We can break it up into two general categories 1) Military stuff and 2) Medical stuff.

1) What I have learned about the Military from my first week -

- Enlisted personnel do not have names - When seeing enlisted patients I have learned that you do not address them by name you call them by their rank. Which also means I have had to learn the the Army's ranking system. Thanks to the help of my awesome boyfriend I can now tell you what rank people are by how many chevrons and rockers, if there's a diamond or a star or even the officers ranks one silver bar, gold bar, two bars, gold leaf, silver leaf I can tell you all of them!!! (yes, I am quite proud of that)

- Ma'm and Sir are only for Officers, when you call enlisted people that it's almost offensive and you get told "no, I work for a living". I guess it's like a blue collar, white collar kinda thing?

- Apparently the longer you've been in the Army, as in the higher your rank the less likely you are to be a big whiny faker and therefore we should take your complaints of illness or injury as probably legitimate. As in if a First Sergent comes in with ankle pain he's probly has something going on because if he needed a day off all he'd have to do is yell at some underling to do stuff for him - so not a lot of incentive to "play sick" on the other hand if a Private first class comes in with the same type of complaint he might coincidentally be going into the field tomorrow or on a "ruck march" neither of which is a easy or pleasant experience.

2)What I have learned Medically in the first week -

- How to call a consult - Be concise and quick, give them all the objective information and then be very direct as to what you want them to do about it. If you start jabbering away with lot's of extraneous information they will get impatient and start interrupting you, get rude, condescending and generally unpleasant if you do it wrong.

- Always look for fractures in the Talur dome of the ankle for inversion injuries, cause the resident radiologist missed it and you don't want that to be you!

- How to reduce a dorsally dislocated phalange..... (wait for it).... WITHOUT anesthetic, this is the Army after all!

- Medics and Nurses run the show and they are awesome! They do all the actual work with the patients and I am extremely grateful for their help.

- PA's are on the "Fast track" side of the ER and the Dr.'s and medical students are on the Trauma side..... I'm hoping to change that ;)

It's been a good week #1 hopefully it'll keep getting better!

Madigan

So yesterday was my first day at Madigan, which consists mostly of a scavenger hunt. To start things off Andrea, a fellow PA student from Pacific who is doing the notorious surgery rotation there, and I showed up on Sunday to try and get a parking pass so Monday would go a little smoother. Unfortunately, as I am learning, that is unlikely to be the case up here. So, as we were unable to acquire said parking pass we had to wake up at the butt-crack of dawn (4:45) and arrive at the Military DMV to wait for around 1hr for the 6wk parking pass. After the DMV we struggled to find Madigan, within the self contained city that is Ft. Lewis, taking many wrong turns and then pulling some U-ies, we arrived with enough time to find the cafeteria (which is AMAZING) for some breakfast snacks and then begin "In-processing". Even though it was a rough start, the rest of my day was extremely productive, I managed to complete my scavenger hunt, acquiring all the necessary passwords, ID badge, and computer training for the 5 different computer systems that the military health system uses (so complicated, redundant and ridiculous I'm still in shock). Since they allow for 2 days of In-processing and I am (of course) NINJA quick and finished all of it yesterday, I plan on spending today prepping for the rest of my time here, organizing my room, getting a head start on some homework and grocery shopping. Luckily I'm staying in a fabulous house with several other PA students from school so I shouldn't be as lonely on this rotation. Also I get to do 4 10hour shifts so that means 3 day weekends WOOOOOOOO HOOOOOOOOOOO!!! This is my ER rotation so I'm super excited to see and do a lot this time around. (keep your fingers crossed for some nasty lacerations and giant abscesses for me !!! :)

Ladies your disappointing me....

Perhaps it's because I'm in Idaho, perhaps it's Family Practice, or maybe it's just a coincidence but I'm a little disheartened at the number of females who come into the office in "hysterics" and I really HATE using that term, but it's accurate. I hate that word because of it's sexist origin and what it imply's about women in general. But unfortunately the shoe fits. I am really shocked at the number of female patients that have random vague complaints, are panicked about it, cry and expect... no demand some kind of pill to treat it. I think of myself as feminist ( NOT the porn and striping is empowering to women, all men are potential batterers, rapists and child abusers kind but MORE the old school gender equality, women aren't either a virgin or a hooker dichotomy and women aren't irrational simply because they are emotional, kind of feminism) but geeez, ladies your killing me with the melodramatic sob stories and absurd reasoning.

Things like stating in a very dramatic tone in all sincerity and tears welling up in your eyes, your afraid your going to die because you've got a rash on your hands... really the small bumps on your hands that itch, THAT is what you think is gonna do you in?? hhhmmmm cause I'm gonna say the fact that your skin reminds me of an orange leather jacket from the 70's is gonna swing my vote for death by cancer. OR Yesterday you had a fever of 103, all your muscles and joints ached, you had severe back pain 10/10 on the pain scale, your vision was blurred, you had a slight headache, your throat was so swollen you couldn't even take a Tylenol to bring your fever down, but today every single symptom you had is now miraculously gone... WTF?!?!?! First of all, if everything is fine why are you here now, why not yesterday? and now that everything is fine what the frick do you want me to do for you!? Come on! Beside that this is the 4th flippin visit in 2 months and you haven't had one single abnormal objective thing wrong with you! OR The complaint of a bump, you perhaps think it may be a cyst that needs to be removed or an abscess that should be drained. Alright that's reasonable.... until I see the area in question and I cannot see or feel anything, literally there is NOTHING there and I'm not talking in a "medically trained to distinguish nothing from something" nothings there, I mean the only requirement to know there is nothing there is you be sane. And then after the most detailed, gentle and polite explanation of how there is no way to treat it because there is nothing to treat, somehow I am still looking into eyes that say " yes that's nice, now what antibiotic will I be getting for my rabid MRSA infection".

Is it denial, ignorance, somatization disorder? Possibly, but it's the panic, the agitation the unreasonable conviction all together that I just don't get. Why ladies.... why? and I can't believe how many there are, that's what really kills me. At least one a day, but more consistently 2-3. I'd like to say their all just whack-a-do's but most of them seem extremely normal everyday people, and then that shuts off and crazy just starts pouring out of them like the Deepwater Horizon oil well. I guess in part I feel frustration because I cannot treat them, there is no disease or infection to look at test and treat. And I'm not a counselor, I do my best to poke around to find a relationship issue, work strain/stress, something, anything, I can think of that might be there disguised as crazy. I just don't have an hour to spend sifting through make believe physical complaints in order to get to a real reason someone comes in. It's soooo much better if people could just be honest, you get better, more efficient and effective treatment when your honest. Besides with all the balancing work, family, kids, parents, committee, wife, house, yard blah blah blah women do I understand exhausted, depressed, anxiety, insomnia ect... and any of those look far less "crazy" than being convinced you have some obscure fatigue disease you found on the internet caused by rodent poo and requires a 600$ test to confirm.

Nearing the end of Family Practice

So I'm now 14 working days away from the end of my first (and second) rotation. I finally got to do a few sutures last week which was fantastic and I managed to do a fair job, as in I only needed a small amount of guidance with the first tie. I can now leave the rotation feeling confident I got a health dose of "bread and butter" patients (colds, sore throat, asthma, allergies, muscle aches, ear infections ect..) and at least one chance to practice suturing and I & D. So for the last few weeks I'll be reviewing and organizing my "personal scut" or my black book of cliff notes on all the things I've learned in the last 10 weeks. I can't wait to get home to see my boyfriend and family as well as my fantastic class mates so we can all share "war" stories and revel in the newest leg of our journey to become PA's.

Baby June

Another exciting weekend for me! I had the awesome opportunity and honor of being present while my best friend Shellee had a successful VBAC on July 4th! Beautiful baby June was born on the fourth of July at 12:21pm. I was so proud of how amazing Shellee was during labor, she remained calm and did so good pushing right up till the very end. I actually surprised myself by getting quite teary eyed when the baby began to cry, Adam announced it was a girl and Shellee cried out "I have a baby girl!" It was a very tender moment and I am so happy I was there to share it with them. Now as much as I adore Shellee I couldn't help but watch and listen for the objective medically interesting part of the VBAC... Shellee told me later (while she made beeping computer noises)she could see my "medical mind working" and it's true I would phase in and out of getting wrapped up in the emotion of watching my closest friend have her child and my medical student brain analyze the prep and procedures going on in front of me. I think right after baby June was out and laid on Shellee's chest and the tears of joy receded, my brain kicked into full student mode and I was very focused on the "after birth" procedures. (Since she is my friend I'll restrain myself from further detail) This was the first birth I have witnessed and it will suffice to say I don't think anything will be able to top that experience for many many years. Congratulations to Adam and Shellee and their beautiful baby girl!

Birthday dinner, ice cream and pus.. what a great day!

Today is my birthday and though I am far from home ( well not actually that far only 480 miles, but still) I had a pretty darn good B-day. My loving and considerate mother got in her car at 3am Sunday morning to drive up here to see me for my birthday. I drove her around the city and attempted to show her downtown without realizing it was the day of the Iron Man competition up here (which made the city chaos) so that was'nt happening. Instead we had a picnic in the local park, layed in the warm sun, looked for shapes in the clouds and talked for hours. Then I introduced my sheltered mother to Cold Stone ice cream, mmmmm deliciousness in a creamy, decadent, tummy acheingly, good cup from heaven! This morning she wished me Happy Birthday and sent me off to work.
Today I got to do my fist I & D (incision and drainage) on a wicked awesome abcess! I've been waiting 6 weeks to get something with a little gore to it and how coincidental it finally happen on my birthday! I did learn that when pressing on the abcess be sure to stand diagonal to the hole you've made otherwise you get sprayed with chunks of sebum and a beige colored stream of puss. I know I'm a freak show and I get a not-so-secret pleasure from really gross stuff like watching a mountain of red flesh with a flow of yellowy, cream colored ooze out from an incision I just made. And I understand that it's odd I get a giddy enjoyment from rupturing the pockets of fluid and squeezing the surrounding tissue so a shower of a chunky mixture of blood and exudate comes exploding out of the hole. I get it. But I look a it this way... If it were me I would rather have someone who was excited to see my infected mound and enjoyed relieving my suffering than someone who was grossed out and disgusted by what they were being forced to do because it is unfortunately thier job. So yes I'm a freak but you should be glad I am!
So after my exhilerating day at the office I came home to decide how I should spend my birthday evening all alone. I was all set to have a nice sushi dinner by myself when Travis the son of my landlord/roommate Rich invited me upstairs for dinner. It was a nice surprise to enjoy a bbq dinner on the patio on a warm summer evening with some much welcomed company. Now I'll settle in for an evening of red wine and movie time. So today turned out to be a very good birthday, considering I'm away from everyone I love.

Meeting the Elks

So today after work I headed over to Spokane to visit Blair, Sammy and the Elks for Taco Tuesday! After hearing Blair's description of life in the trailer park I had to go and experience it for myself. As I pulled into the lot Blair and her massive Mastiff Sammy came out to great me! I was given the grand tour of the their "Home Sweet Trailer" which was actually not a bad set up, it was much more spacious than I had imagined. We then headed into the lodge for those famous 1$ Tacos and a cold Budweiser. We were warmly greeted and Blair introduced me to all her new friends, who were happy to share their table and some stories. As we dined on our tasty tacos 4-5 older gentlemen strapped on guitars, electric, acoustic, and one with a harmonica and began to play and sing some old country songs I was completely unfamiliar with (except for a few Johnny Cash classics). It was really one of the most fun and entertaining meals I've had since I've been here. After dinner we bellied up to the bar where the fabulous bartender made us one of the stiffest White Russians I've ever had and Blair and I played a handful of "pull-tabs" which according to our friend Emily are all the rage in the Midwest. (they're kinda like scratch-it lottery games, but without the scratching). I had never heard of them, neither had Blair so of course we had to try our hand at it. Alas the "Ice queen" struck again and no big winners for us. Half way through my mostly vodka white russian I realized it was 7 o'clock on a Tuesday and I was drunk! Blair and I retired to her trailer where she made me some toast and we chatted for a few hours while I sobered up. As my evening with Blair and the Elks came to a close I can tell she's in good company and I am very happy she's well taken care of by some very friendly and kind hearted people. I'm super glad we have a least few weeks to hang out together before the next leg of our clinical journey begins. So raise a glass for the Elks of Spokane and cheers to cheap food, stiff drinks and good friends!

Best Weekend Yet!

It was sooo nice to have girl friends from school come visit this weekend. Em came over from Moses Lake Friday night and the moment she pulled up I was grinning ear to ear. After sitting next to her 5 days a week, 8 hours a day for an entire year, not to mention late night freak out phone calls before a test, cram quizzing the morning of the test and margaritas after it, sharing stories of frustration with school, boyfriends, husbands, roommates and parents, tears of sadness leaving for break, tears of shear joy from laughing so hard you nearly pee your pants, she's hands down one of my two closest friends from school. And I can hardly describe how good it was to spend some quality time with her.
We headed to downtown Coeur d'Alene and strolled up and down the main street, Sherman Ave, which was teaming with activity. With the Coeur d'Alene resort only blocks away the ave had your mix of middle aged tourists with fanny packs and "Coeur d'Alene" T-shirts, young sex-pot women and men dressed to the nines scoping each other out, teens out on summer break in their freshly washed/waxed cars cruising the strip cat calling as they roll by at 2mph.
We popped in and out of art galleries with wine tasting, eclectic little shops with a variety of huckleberry flavored everything, and boutiques with jewelry, clothing and crafts from local artist's. By the time we decided on dinner at "Scratch" I already had a buzz from all the free wine. We sat outside on the patio/sidewalk and enjoyed the warm evening air, the food was fantastic the wine was delicious the entertainment was... entertaining? We were "treated" with a performance by a street musician playing the guitar and singing across the street. Unfortunately he seemed to know only one melody and simply adapted every song to it. Imagine the creativity it takes to conform the lyrics of "Hey ya" by OutKast to the melody of "jumper" by Third Eye Blind... it's impossible yet he somehow found a way.
The next day we took a hike around Tubb's Hill a short mellow hike with a nice view and a cool breeze coming off the lake. Followed by a stroll down the boardwalk type area adjacent to Independence Point park. That evening we were joined by another awesome friend from PA school, one of the most genuinely nice people I've met in my entire lifetime. Blair, who's working in Spokane stopped in for dinner, some wine and a little shop talk. She's an amazing girl, I don't know how she deals with some of the situations she's been confronted with and what's even more inspiring... she does it with a smile (although I've learned she can definitely be a hard ass when she needs to!!)
Today Em and I went on another hike near Wolf Lodge Bay the "Mineral Ridge" trail which was more wooded but the view from the top was impressive. It gives a pretty good perspective of just how big Lake Coeur d'Alene really is. We stopped at Crickets bar/restaurant in downtown on our way home for some lunch. We should have split something cause the portions where HUGE and the drinks were tasty!
Finally the time came to say goodbye for Em has a long drive ahead of her. Saying goodbye to her this time around wasn't as bad because I know I'll be seeing her again in a few weeks for Professional Practice Seminar (PPS week) in August. It was just so nice to have someone to talk to who really and truly understands what your going through and share your new experiences with. That's really the best thing about school, all the wonderful friends I've made. So THANK YOU Em! THANK YOU Blair! I had the BEST weekend yet and it's all because of you!

YES.... I am a student

NO.. I don't know EVERYTHING yet, that's why I'm doing rotations, and how do you expect any Doctor, PA, NP, RN ect... to learn anything if everyone is to good to be seen by a student! Don't get me wrong I totally understand when people are dealing with something uncomfortable and would prefer to have their regular physician see them or do probing exams, believe me I UNDERSTAND! But when I can see and hear the disdain they have for me as a student it bothers me. Why on earth would you snear at someone who's sitting in front of you with empathy and desire to help in anyway they can??

Me: Ok, no problem I'll go and get my preceptor to do the exam/history, would you mind if I sat in and learned during the exam
Patient: Well if he's the one doing the exam and making the decisions I don't see why you need to be here.

Really? Seriously?, did you not hear me say TO LEARN? do you not understand what a students job is?? Luckily this is an extreme minority of the patients, in fact out of the 4 weeks I've been here there have only been 1-2/wk that prefer I either not do the exam or step out for part of it, which I don't mind at all.

The Air-mattress Debacle

So after my fabulous long Memorial day weekend at home I returned Monday evening to find my air-mattress half deflated which is kinda odd since I haven't had to re-inflate it since I got here 2 weeks ago. Regardless I chalked it up to being cold down here in the basement ect... so I filled it up and began unpacking, chatted with Ryan on Skype looked over and realized roughly three hours later the air-mattress was again deflated. WTF! So I strip my bed, inflate it again but this time I go hunting for a leak. I eventually find a small roughly 1 cm rip on a seem, I figure it's 11pm not much I can do about it I'll just fill it up and go to sleep. So during the night every 2hours I would wake up in a different position the first time I awoke at 2am and was falling off the head of the bead because I was sleeping to close to the top, I shifted and fell asleep only to wake up at 3ish to find my legs had somehow migrated to the left and I was diagonal across the bed and I was being suffocated by the sides of the bed like a sandwich. Finally at 6am I awoke due to pain in my hip as I was now firmly resting on the floor. My 2ft high Air-mattress was almost completely flat... Awesome. So the next day I go to the store find myself a vinyl patch (seeing as how my cheap-O one didn't come with a patch) Patch up the mattress and attempt to sleep on it the next night. This goes fairly well the patch mostly holds, it's only half deflated in the morning I figure I'll do the water test on the weekend when I have an entire day to deal with the sucker. I've been sleeping on it through the week and it's not bad. This morning I wake up at my normal time 6am out of conditioning but decide I'd like to sleep in a bit so I get out of bed to fill up the mattress so I can sleep a little longer. About 20 seconds in I hear a loud noise and see part of the covers jump and there goes the bed... rapidly deflating. I pull back the covers to discover the small hole along the seem just completely blew out. All I can say is at least it happened on a Saturday.

Patients are interesting..

even the ones that just have a lame cough and runny nose you've already seen a hundred times. It's amazing what you can learn from people if only we had the time to listen. As a student I get extra time with patients cause I'm still a little slow. I ask a lot more questions and do a much more though job than other practitioner's which is good and bad at the same time for everyone involved. Good for me cause I need to practice honing my skills at decision making, which answers to follow up on which one's are a rabbit trail and the stuff that is just random bits of information that I don't even know why their mentioning it to me. It's those random bits that sometimes are the most interesting and occasionally yield a pearl. I'm liking Family practice in part because now that I've been here 3weeks I'm starting to see some of the regular patients for a second time and getting to know these people is a wonderful part of the experience. Some of the elderly patients are a bit feisty but I'm amazed at the good humor most of them share with you. There are a few people my supervising PA has mentioned "I remember when that one was only a week old... now look at 'em all grown up and having one of their own" I think one of the greatest assets health care can have is investing in Family Physician's. Some one who knows you, is invested in making sure your treated with the care that everyone deserves... (even if they are a pain in the tookus) Keeping people healthy should be the goal not waiting until their sick and then spending a ton of money to just manage what could have been prevented or pull them back from the grave. I'll probably end up saying this about every rotation but I'm thinkin' Family Med looks like it's pretty rewarding... might this be it for me?

Where I live in Coeur d'Alene

I Have No Idea What I'm Doing

I've never been one for consistantly writing in a journal.... so we'll see how well I do with this!