After a crazy week of traveling back to Vallejo to be on campus for two days, the long drive to Seattle, and two clinic days with my new preceptor I am starting to feel settled again.
I was researching quotes about first days (because during this year I will have eight first days, thursday was my third) to end the blog with and a found several with this concept. Each day is a once in a lifetime event. I can't say I have really ever thought about life in this way, however clinical rotations has made this very apparent. I am constantly learning new things about medicine and becoming a better practitioner. I am making mistakes and receiving gentle guidance from my patients and my preceptors on how to improve myself, and I LOVE IT! I am so grateful for all the time and energy my preceptors are willing to put into my education. I can't think of another time I have ever received one on one training that was this in-depth. I have spent two full days with Dr. Addison, he picks me up from the office around 8:30 and we are off in his car for the day. When we are done for the day he still has to return me to my car, thus leaving us a lot of time for discussion. We have discussed different diagnoses in detail, politics of medicine and running a successful practice, office politics, and the list goes on. I am excited to see what the next five weeks has to be discovered.
Thursday was my first day of Rotation 3, here in Seattle I will be working in geriatrics. Each day of the week I will be at a different skilled nursing home, assisted living facility or making house calls with Dr. Addison. Thursday we spent the entire day in a skilled nursing facility covering for one of his partners who is on a sabbatical. This was a great introduction to geriatrics because all of these patients were new to Dr. Addison so we did A LOT of chart review. I found this to be particularly helpful because in pediatrics and obgyn the charts are not as extensive as in geriatrics. I saw two patients on my own thursday. One was a new admit, she recently fell and broke her femur and will be in this facility until she is able to bear weight and be independent again. I spent about 45 minutes with her doing an extensive intake and physical exam. Right before I went to go see her Dr. Addison gave me her most recent labs and told me to "figure it out." What he wanted me to figure out was why her ESR (erythrocyte sedimentation rate) was greater than 140. ESR is generally a marker for inflammation, but is rarely >20. (To read more about ESR, click here). After I saw her I returned with Dr. Addison, he did a much shorter physical exam then asked me what I thought. I was still puzzled by this ESR. He had made a diagnosis, then as we discussed the ESR and her symptoms, everything changed. His demenour regarding her diagnosis changed. Instead of a furuculosis (a bacterial infection) being the cause of her rash we were suddenly discussing vasculitis. Her hematoma was no longer just a hematoma but possibly another symptom of vasculitis. He walked me through his thought process and asked how I would treat her, this I knew... Prednisone!
Friday we spent the day making home visits all day. I see why as a geriatrician it would be easy to be overweight as many of our patients had treats for us. My favorite was homemade pear pie and it was delicious!
The weather has been absolutely beautiful since I arrived, in the upper 70's to 80's and sunny. Today is my first day of Seattle rain and it is supposed to rain all week. I had a beautiful welcome to Washington and now I get to experience what the weather is really like here!
"Each new day is a blank page in the dairy of your life. The secret of success is in turning that diary into the best story you possibly can."
- Douglas Pagels
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