Back in the saddle...

so technically it's a chair not a saddle but here I am again, sitting in a classroom listening to lectures. This week is a recap back at school, when we here a few lectures, network with people from class, learn about contract negotiation and writing a CV, discuss plans for our graduation party, awards, and take a boards practice test. Some good stuff to review yet.... I'm sooooo done with sitting in a classroom!!! After being out there and doing, it's tough to come back and sit passively receiving information. At least I get to see my favorite people again, that's the biggest plus of PPS (Professional Practice Seminar) week.

Ok class is starting now, so back to the learn'n

Breast-Specific Gamma Imaging vs. Mammography

I cannot upload my poster because the formating is not recognized. So I'll just tell you that BSGI is more sensitive and specific (ie: better at finding breast cancer) than mammography, especially in women with dense breast tissue. It is similar in cost to mammography and thousands less than MRI. oh and lastly it doesn't require crushing breasts into pancakes.... yeay! here are some images off the web so you can see the difference in images produced.

Almost complete

Capstone paper is nearly done, the bulk of the work is finished. After meeting with the writing consultant all that's left is just the finishing touches. Last is the poster, which I plan on being done with tomorrow. I am also thinking about actually submitting my paper to a journal for publication after a few professors comments. But honestly I really don't feel like what I produced is truly journal material. The biggest issue is I think a lot more work to spruce it up to make it journal worthy would be required and that's a big "NOT gonna happen" from me. But at least I chose a topic I didn't end up loathing and I learned a ton doing it. ( I'll post the poster when I'm done if anyone wants to get a synopsis of what my paper was on)

Tonight I did a shift at Essential Health clinic, the free clinic our university works with. Two professors and two first year students were there with me. It was a little rough to get back into the swing of writing SOAP notes and presenting after having a 6 week break from it. But in no time at all I was back on my game. High/Low lights of the night included an interesting case with a pregnant woman (they always present more of a challenge) and a Digital Rectal Exam (I've done probably 10 of these and I think I'm kinda done with the butt, really I don't ever want to do another one ever again).

So now I have around 2 weeks of blissful vacation before I start trauma! I plan on studying my ACLS and Trauma algorithms and cleaning up the house. But the evenings belong to Ryan and I, so nice to have so much down time to spend with him these last few weeks. It's like I got my life back. And ooohh how I missed my life with him!!!

Oh other important milestones.... I just got my ticket to KENYA!!! That's right 59 days and counting until I'm on a jet plane to Africa!!!

Paper of ..... procrastination!

ugh I HATE this paper! I find myself procrastinating at every opportunity. The topic is interesting and I enjoy reading the articles but writing this is torture! I just want to get through it so I can have a few weeks of leisure time, but I can't seem to make myself sit down and power through it!

Bad News.....

it's tough to give to patients, this is one of the most difficult things I've had to do here in prison. I've been out in the world treating patients (true it's only as a student, but still..) for almost 10 months and this is the first time I've had to give people bad news. Not, "yep you have a broken bone" or "looks like you have pneumonia" ... or even "you're a diabetic now". Nope I'm talking about telling people chances are they will soon die. It's a lot harder than I thought... and I didn't think it was gonna be easy in the first place.

The first time was the worst, giant tumor in the middle of their chest, Anaplastic Thyroid cancer, the invasive kind = Not good. I gave myself the pep talk and tried to remember... "go slow, don't use medical jargon, don't forget to talk about DNR (do not resuscitate) and for God's sake don't say anything stupid! It was so hard to do, I remembered once you say the word CANCER you just have to stop and let that sink in, cause anything you say after that falls on deaf ears. You have to give them time to process what that means and it's really hard to watch. I could see it in their eyes... they went all glassy and distant, the brow furrowed and they looked away, seconds felt like hours and it's all I could do to make myself keep quiet. I wanted to ramble about "what type of cancer it was on the pathology report, the most common treatment, the 5yr survival rate based on age and health factors and blah, blah, blah, shit that wasn't going to mean beans to the patient.... but oooohhh how I wanted to fill up that horrible silence!! When the patient finally came back from thought and began asking questions I fell into the medical jargon trap.... I rattled off a bunch of statistics and half way through realized I need to stop and make sure the patient understood. I managed to only put my foot in my mouth once, and unfortunately that was one of the things that stuck with the patient cause they repeated it back to me.... twice Uuuuggghhh! why oh why did I say "worst" even though it was true ( it's really rare and less than 5% of patients have a 5yr survival rate) I still shouldn't have said that. But I got through it and I'm sure it wasn't the best but it couldn't have been the worst "you have cancer" talk ever.

I guess I was just kinda surprised by how affected I felt coming away from that talk. I really didn't know the patient it was only the second time I'd ever met them and after it's not like I'm the one who has cancer.... It was a weird feeling.... I guess the closest I can come to describing it was a feeling of guilt... like I was somehow responsible for giving them cancer and there's nothing I can do to make it better. Usually when I give not-so-good news to people I always get to say "now here's what we're gonna do to get you better". But not being able to say that just leaves me with this unfinished feeling, like a job you left incomplete. Then as if to add insult to injury it's a virtually necessity to let it go and move on to the next patient! I'm telling you it was a really difficult day to get through. Afterward my fantastic preceptor Robert told me " you can't carry it with you... you gotta let it go or it'll drown you. It's good that you feel it, just don't take it home with you."

The last patient I had the talk with has the wicked combo of TB and AIDS, unfortunately this combination of diseases is pretty awful. The dangerously low CD4 count (T-cells) means they're susceptible to opportunistic infections and because her immune system is low it's like a free pass for TB to start acting up and rampage through her body. I was much better this time around and I thought the patient took it amazingly well... until I left the room. As I started to walk away I heard them break down and begin to sob, and that guilty feeling came gurgling up from my gut.

I know I said it was great to see all the super sick patients, with their complex diseases and super rare conditions... but I don't know how I'll ever get used to giving the truly bad news. but unfortunately I'm pretty sure someday I will.

The Big Easy..

New Orleans... jazz and jambalaya, hurricane drinks and voodoo... I wish I had had more time with this amazing city. Guess I will just have to go back, the sooner the better :)

Life in PRISON...

Well not so much for me but those are the people who's care I am now responsible for. So here I am on my Internal Medicine rotation at the Carole Young Medical Facility (CYMF). So I figure I should start off with a little about the prison itself. CYMF is a minimum security prison facility for inmates with chronic diseases, terminal conditions or post-op wound healing. It also houses 300 female inmates most of whom work in the hospital doing house keeping, janitorial and kitchen work. There are 5 "pods" or wings of the hospital with roughly 50 - 100 inmate/patients per pod. I was surprised to learn that most of the patients are men, there is only 1 pod for females and most of them are post op for some kind of surgery or are cancer patients in between rounds of chemo/xrt (radiation treatment). I was a little apprehensive knowing that most of the patients I'd be treating were going to be male, until I saw the patients. Most of the male inmates are seriously sick, 70+ and look emaciated, amputee's or can barely walk... needless to say they aren't very intimidating. However that doesn't mean I'm not uneasy or stay vigilant while in the room with them. When I see patient's I always have a guard with me and the door is always open. I have never felt unsafe, threatened or really had any trouble with a patient at all. According to our Preceptor staying at this facility is highly coveted, apparently its one of the nicer facilities and so inmates don't act up for fear of being transfered. So now you know a little about the place, here's a little about what I'm doing.

This place is FANTASTIC! I'm getting to see all kinds of crazy stuff!! These people are really, seriously ill and dying. A little morbid and kinda sadistic I know, but you have to look at it from where I'm at... I've never seen any one with Hep C in liver failure with a gigantic belly that needs to be tapped, and then I get to help do the paracentesis! I have seen Myasthenia Gravis a disease so rare only 10 in 1 million people have. I have a patient with Schizophrenia (and you all know how much I love the crazies!!) a patient with TB and AIDS another with Hodgkins lymphoma. It's amazing to see so much pathology, every patient I get has some kind of seriously horrible disease. Most family med practitioners, in their entire career might see, if their lucky/unlucky enough, one or two of the patients I've seen just in the two weeks I've been here. I'm learning soooo much, how to treat really sick people, rare diseases, how to admit, discharge and some of the outrageous ways our tax dollars are spent on inmates. Like the illegal alien who is basically a vegetable. When prisoners are brain dead, terminal and close to death they are paroled to hospice and the family takes over care and fee's for their end of life stage. However since the patient is an illegal he is not eligible for parole and the state will have to pay for his comatosed ass until he dies. Moving on.. There's also lots and LOT'S of wicked, nasty wounds to clean and dress. Now I'm a freak for the gross stuff, but there are a couple wounds here that made MY stomach churn, mostly it was the indescribable foul stench that got me. However I still loved it ;)

Well we have a long weekend coming up and I'm not sure what I'll be doing ( Austin? New Orleans? Oklahoma?) but I'll be sure to post when I get back.