A few weeks ago my rotation schedule was falling apart before my eyes. Boston was canceled for reasons unknown to me, NY was no longer a possibility and I received the dreaded email from Tracey (my clinical coordinator) saying she was going to be reworking my rotation schedule. I was holding myself together but was pretty nervous. I trust Tracey, she is amazing at her job and truly cares about ensuring we receive a great clinical experience. Tuesday I received my rotation schedule with a few changes and one hole. This hole is my next rotation... thats right, I am moving in one week and I have no idea where I am going. There were a few changes to my schedule, rotation four will now be cardiology in San Francisco at a Sutter clinic, where it looks like I will receive inpatient and outpatient exposure, and I am no longer going to Las Vegas (unless of course that is where I am going next). I am happy with the changes in my schedule but wish I knew where I will be moving next, mostly so I can find a place to live...
On a lighter note. This week I saw a patient who was menopausal, her last period was over two years ago (by definition menopausal is when a female has not had a period for 12 consistent months). She had a laundry list of complaints, but her entire physical exam was normal. The most amusing part of the visit was when she decided she might be pregnant and that is why she hasn't had a period in TWO YEARS!!!! She also had no other signs or symptoms of pregnancy... I might have had a good giggle when I was a safe distance from the patient room. Sometimes I cannot comprehend where patient complaints come from, but the majority of the time they are warranted complaints that need further investigation. We did order a pregnancy test and several labs to confirm she was menopausal and canceled her procedure because of the possible pregnancy. Patients keep medicine interesting in many ways including, but not limited to the following: when they present with a condition that is not common, when they present with a common condition but in an uncommon way, when they have absurd complaints that are normal physiology (these usually require a lot of patient education) and when they let their minds wonder and come up with very unlikely explanations for symptoms they may have.
My last day with Dr. Lickness is Tuesday, I drive back to the bay Wednesday, call backs and end of rotation exams are Thursday and Friday. Block two is under my belt, time to pick up and move on again!
Saturday, April 27, 2013
Sunday, April 14, 2013
Quantum superposition
My homework for the weekend from Dr. Lickness consisted of many things including Schroedinger's cat, a thought process based on quantum superposition. Which states something like this... a physical system, such as an electron, exists partly in all is theoretical states simultaneously, however when measured it gives the result of only one of the possible states. So bring in Schroedinger's cat. A cat is placed in a room (or a box) with a radioactive element (these are unstable and likely to breakdown), and a Geiger counter (a particle detector that measures ionizing radiation) that is connected to a device that will release cyanide gas when radiation is detected. In this state the cat is dead and alive until the experimenter opens the door to determine which state the cat is in. However, by opening the door the experimenter has interfered with the experiment. Therefore the expriment must be described in reference to the actions of the experimenter. Schroedinger's motivation for this paradox was to criticize Copenhagen's interpretation of quantum mechanics.
Mind blown...
Mind blown...
Thursday, April 11, 2013
Yoga
On saturday afternoon I attended my first yoga class since my departure from Austin in July 2011. It felt so good to be back. I took a gentle class to ease back in to my practice. I had a great instructor that played music by many of my favorite artists. In the middle of the class I was in a deep twist and one of my favorite songs came on. I started to get emotional. I have had many profound moments in PA school but nothing compares to caring for yourself. I bought an unlimited package and have been back to another class. I forgot how at ease I can be with stress when I am taking yoga classes. I feel a sense of balance that I have been missing in my life. My mind and body are happy and calm!
Thursday, April 4, 2013
Transitions
As I begin to do exams in the specialty of obgyn there are a lot of things I am reflecting on. Each specialty is different, each practice is different, each specialty requires different history questions and physical exam skills. Sometimes something as small as pulling out the foot rests for a pelvic exam can be challenging and take three times longer than it should. I am hoping as my clinical year continues these small challenges become fewer and far between and I am able to use my time more efficiently. Until then I will continue to clumsily find my way to the table controls, the light switch, the speculums and the stirrups. I guess I would rather have issues with these things and perform a good physical exam than vice versa.
Wednesday, March 27, 2013
Interesting fact
Dr. Lickness gives me homework assignments. Yesterday it was a history lesson after I told him I would be heading to Boston for my next rotation and today some fun facts.
Todays homework assignment: why is everything in the OR including your scrubs blue or green?
The answer: Prior to the 1950's all OR attire was white, to symbolize cleanliness. The problem with this was that in a very brightly light OR with all white scrubs and linens, surgeons eyes would fatigue, resulting in eye strain. Therefore surgical attire was changed to light blue or green, to create a high contrast environment. The inside of the surgical field is varying shades of red. Blue and green which reside on the opposite side of the color wheel create contrast therefore decreasing the strain on surgeons eyes.
Todays homework assignment: why is everything in the OR including your scrubs blue or green?
The answer: Prior to the 1950's all OR attire was white, to symbolize cleanliness. The problem with this was that in a very brightly light OR with all white scrubs and linens, surgeons eyes would fatigue, resulting in eye strain. Therefore surgical attire was changed to light blue or green, to create a high contrast environment. The inside of the surgical field is varying shades of red. Blue and green which reside on the opposite side of the color wheel create contrast therefore decreasing the strain on surgeons eyes.
Tuesday, March 26, 2013
Moving on... Pediatrics, OBGYN and Pismo Beach
Life has been pretty crazy since last week.
As a parting gift from pediatrics one of the kiddos finally gave me a GI bug. It was minor and I avoided vomiting with some OTC meclizine but it knocked me out for most of the day Friday. I really enjoyed pediatrics, it is challenging in many ways that other areas of medicine are not. In school, we learned a very organized physical exam, typically from head to toe. However, in pediatrics there is no such thing as a head to toe exam. You simply examine the area the patient is presenting to you and work around that. For example, if you walk into a room to a baby that is sleeping, examine the abdomen, heart and lungs first (all the exams that you need the child to not be screaming for so you can hear through the stethoscope), then start moving the baby around and hope you can finish most or all of the exam before you have completely agitated them. Also most peds patients don't have the ability to tell you what they are feeling or do they have the intuition to understand why they maybe feeling the way they are, this can be challenging. As a practitioner when you are treating a child you are also treating their parents, in case you dont understand, that is TWO+ patients per visit. One of the greatest physical exam tools I learned in pediatrics, if a child will not open their mouth to allow you to see their throat, simply stick a tongue blade between their teeth, slowly push it towards their throat and gag them. The gag reflex is strong, if you gag someone they WILL ALWAYS open their mouth. Although I did not enjoy eliciting this in children, it is very effective.
Saturday I packed my belongings into my car and moved down to Pismo Beach. I arrived later in the afternoon just in time to see an amazing sunset. I went to bed early as I was still recovering from the GI stuff and needed to be well rested for the day of work I had ahead. I woke up early Sunday morning, found a local coffee shop near Shell Beach and started the long day of work. All of our assignments for school are currently submitted via mail and must be postmarked by their due date. I had three large assignments due Monday and I had been working on all of them but also procrastinating on all of them.
Yesterday I had my first day of OBGYN. I started the day with hospital orientation, walked into the office around 10:15, met the office staff and Dr. Lickness and off we went. We made three trips to the hospital yesterday in the hopes that twins would be born before 5:00 pm, after two trips to the hospital and two false calls the twin boys were born vaginally at 5:17 and 5:30 pm. It was a crazy and exciting first day!
Day two I saw another baby boy born via Cesarian section and two tubal ligations. My lunch was a sprite that I drank at 2:30 pm simply because the OR was running behind for the second tubal that was scheduled and Sprite was the only item available in the OR lounge.
Although seeing babies born is really exciting, my favorite part of the last two days is seeing a couples reaction the first time they get to hear their baby's heart beat or see their baby on ultrasound. The joy they feel fills the room and has brought me to near tears twice. Although I have been told that my empathy for others will be a challenge for me as a practitioner, I have yet to experience this "challenge" and I am so glad that I have been allowed to share these amazing moments with patients.
"Too often we underestimate the power of a touch, a smile, a kind word, a listening ear, an honest compliment, or the smallest act of caring, all of which have the potential to turn a life around."
- Leo Buscaglia
As a parting gift from pediatrics one of the kiddos finally gave me a GI bug. It was minor and I avoided vomiting with some OTC meclizine but it knocked me out for most of the day Friday. I really enjoyed pediatrics, it is challenging in many ways that other areas of medicine are not. In school, we learned a very organized physical exam, typically from head to toe. However, in pediatrics there is no such thing as a head to toe exam. You simply examine the area the patient is presenting to you and work around that. For example, if you walk into a room to a baby that is sleeping, examine the abdomen, heart and lungs first (all the exams that you need the child to not be screaming for so you can hear through the stethoscope), then start moving the baby around and hope you can finish most or all of the exam before you have completely agitated them. Also most peds patients don't have the ability to tell you what they are feeling or do they have the intuition to understand why they maybe feeling the way they are, this can be challenging. As a practitioner when you are treating a child you are also treating their parents, in case you dont understand, that is TWO+ patients per visit. One of the greatest physical exam tools I learned in pediatrics, if a child will not open their mouth to allow you to see their throat, simply stick a tongue blade between their teeth, slowly push it towards their throat and gag them. The gag reflex is strong, if you gag someone they WILL ALWAYS open their mouth. Although I did not enjoy eliciting this in children, it is very effective.
Saturday I packed my belongings into my car and moved down to Pismo Beach. I arrived later in the afternoon just in time to see an amazing sunset. I went to bed early as I was still recovering from the GI stuff and needed to be well rested for the day of work I had ahead. I woke up early Sunday morning, found a local coffee shop near Shell Beach and started the long day of work. All of our assignments for school are currently submitted via mail and must be postmarked by their due date. I had three large assignments due Monday and I had been working on all of them but also procrastinating on all of them.
Yesterday I had my first day of OBGYN. I started the day with hospital orientation, walked into the office around 10:15, met the office staff and Dr. Lickness and off we went. We made three trips to the hospital yesterday in the hopes that twins would be born before 5:00 pm, after two trips to the hospital and two false calls the twin boys were born vaginally at 5:17 and 5:30 pm. It was a crazy and exciting first day!
Day two I saw another baby boy born via Cesarian section and two tubal ligations. My lunch was a sprite that I drank at 2:30 pm simply because the OR was running behind for the second tubal that was scheduled and Sprite was the only item available in the OR lounge.
Although seeing babies born is really exciting, my favorite part of the last two days is seeing a couples reaction the first time they get to hear their baby's heart beat or see their baby on ultrasound. The joy they feel fills the room and has brought me to near tears twice. Although I have been told that my empathy for others will be a challenge for me as a practitioner, I have yet to experience this "challenge" and I am so glad that I have been allowed to share these amazing moments with patients.
"Too often we underestimate the power of a touch, a smile, a kind word, a listening ear, an honest compliment, or the smallest act of caring, all of which have the potential to turn a life around."
- Leo Buscaglia
Wednesday, March 13, 2013
Self defense
Last thursday night I traveled into San Francisco to go to a self defense class with Kat. I thought it would be smart to have some idea how to defend myself since I will be moving to a new city every six weeks for the next year. Although I am generally very aware of my surroundings, which is the key to prevention, I thought I would ease some of my anxiety (and my mothers) by taking a self defense class. The class was great, we practiced yelling STOP as loud as possible ( I was able to wake up my cheerleading yell after allowing it to sleep for about 10 years) and learned several maneuvers to use if ever attacked or in an uncomfortable situation.
Another form of self defense I will be learning throughout the clinical year is how to protect my heart while allowing myself to be available to emotionally support patients for the brief time I have with them. One of my professors described this as being like a teflon pan, having the ability to hold the space while with the patient but allowing the emotional aspect to slip off at the end of the day. In essence being able to leave work at work. I know this maybe a challenge for me as a provider because I am very empathetic but, I am hoping I can recognize the importance of my mental health, and that to best care for my patients I must be able to perfect this process.
This week I have been doing a lot of counseling with parents and their children regarding diet, exercise and weight. This is an aspect of being a practitioner I have come to realize I really enjoy. I feel like these parents hear me, at least for the ten minutes I am speaking to them. The real test comes at the follow up visit to determine if they have made the changes with their families to lose weight and gain health. Unfortunately, I will not be here in four weeks to determine if there has been any change.
I am seeing most patients on my own each day, Dr. Mahdavi then comes in the room to check over my work and add to anything that I might have missed. Although I have made several wrong diagnosis, I have made several right ones. Dr. Mahdavi is very positive and praises me for my efforts (right or wrong) and will quietly mark out my wrong diagnosis. He is a great teacher and I am so grateful for my time in this clinic!
Another form of self defense I will be learning throughout the clinical year is how to protect my heart while allowing myself to be available to emotionally support patients for the brief time I have with them. One of my professors described this as being like a teflon pan, having the ability to hold the space while with the patient but allowing the emotional aspect to slip off at the end of the day. In essence being able to leave work at work. I know this maybe a challenge for me as a provider because I am very empathetic but, I am hoping I can recognize the importance of my mental health, and that to best care for my patients I must be able to perfect this process.
This week I have been doing a lot of counseling with parents and their children regarding diet, exercise and weight. This is an aspect of being a practitioner I have come to realize I really enjoy. I feel like these parents hear me, at least for the ten minutes I am speaking to them. The real test comes at the follow up visit to determine if they have made the changes with their families to lose weight and gain health. Unfortunately, I will not be here in four weeks to determine if there has been any change.
I am seeing most patients on my own each day, Dr. Mahdavi then comes in the room to check over my work and add to anything that I might have missed. Although I have made several wrong diagnosis, I have made several right ones. Dr. Mahdavi is very positive and praises me for my efforts (right or wrong) and will quietly mark out my wrong diagnosis. He is a great teacher and I am so grateful for my time in this clinic!
Subscribe to:
Posts (Atom)