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!