ED - Finishing Week 1

5p-1a
The first week started a little slow but ended with some cool stuff. I got to help insert a Central line (IV in the neck) by holding the US and flushing the lines. I also got to remove an intraosseous IV (IV in the bone). We talked about intraosseous IV lines in school but I had never actually seen one. There was a little blood splatter on my white coat - I felt like I had been "anointed" into the ER! Thankfully it wasn't a big deal and I was able to roll my sleeves to cover it up.

I had another patient that complained of numbness and tingling in his fingers. We ended up doing a full stroke and heart check on him. Thankfully it all came up clean, but we didn't get any answers for the numbness and weakness in the hand.

Lots of chest pain. A patient with odd symptoms that ended up being a UTI. A young person who pulled some muscles in their back while moving furniture. AA lady who OD'd on narcotics. A woman in her 30's with chest pain that we had to do a full work up for MI.

End of Week 1 - I got to go home to be with my family for the weekend. Tomorrow we will finally celebrate my birthday - so nice to be with everyone to share the cake! One of my nephews is making me a special cake. I can't wait to see what they planned!

July - ED - Week 1

So I thought I would document some of the cool things I saw/did in the ED this month.

My first day, I only worked a few hours.

Chest Pain with a complete Heart Block

Kidney Stone - recurrent

Headache - new onset, sounded like a cluster headache, checked for acute narrow angle Glaucoma

Generalized Weakness, increasing confusion - unknown cause

Day 2 - 12p-10p

Headache - possible migraine, CT normal

Chest Pain - admit

Gallstone - non-unobstructed

Nothing else of note

Day 3

Attempted Suicide - cut neck with a buck knife extended from side to side. I got to go to the OR to see it repaired. Saw a laryngoscope as a trach tube was inserted.

Rollover Car Accident - Head Laceration that peeled the forehead back. Later found out she had a skull fracture

Threatened Abortion - 5 week pregnant woman with bleeding.

Dementia - Elderly lady that no longer swallows and doesn't eat or drink.

Seizures - elderly lady with seizures and DNR

Cellulitis - bilateral lower extremities with cellulitis, tense red skin and peeling skin. Bacterial infection with satellite lesions - called Infectious Disease

This may not be as interesting to you, but I know this will be a good resource when I graduate :-)

3rd Year has Begun

June was a busy month. I started my first rotation June 1st with Pediatric ortho at Children's Hospital. I worked 12-13 hours a day, 5 days a week. I learned a lot about Cerebral Palsy and other congenital disorders that cause limb and muscle deformity. I also learned a lot of surgical skills.

In my 3rd week, I was able to do a small surgical procedure by myself - from cut to close. It was a hardware removal of the distal tibia. I actually got to do almost 100% of the other leg too. It was so cool! Someday I will look back on this and wonder what I was so excited about but when you are just beginning, every little task is "cool".

I have also gotten to read a lot of x-rays, a hip US, and a hip MRI. I am getting better at finding fractures and classifying them. There is still so much to learn, it is almost daunting.

I spent many late nights in surgery and writing progress notes. All part of being a real PA, except I don't get paid. One morning I went in at 6am to do rounds on our patients. It was a really good experience to talk to families alone. I know I can't answer every question but it is fun trying.

My final eval was very encouraging. My preceptor commented that he felt I would be a great Orthopedic PA, which means a lot to me coming from him. It is what I really want to be and I pray God will provide a job in that specialty when I graduate!

High Stress

Somehow I missed the whole month of February. Wow! Since then I have started, and finished, a parenting class. It has been an interesting class because it comes from a secular point of view. Without God there is no compass for behavior. I don't understand how you are supposed to tell your kids not to do something without a reason - especially when the common trend is no spanking or any other adverse consequence, besides a "time-out". Several people in my class mentioned having their mouths washed out with soap to deter bad words - evidently this is not supported either. I really don't think I would have been very obedient if the only consequence was sitting in a corner. The class was a great way to learn what parents are learning these days, even if I don't agree.

I am also in a "Psychosocial" class that talks about the "Softer" side of medicine - family background and personal impacts, especially on kids. I am even more confident that pure pediatrics is not my gifting. Did you know that a lot of pediatrics is dealing with school, home and friend issues. I had no idea that parents turn to their Pediatrician first! I feel I have so many other people in my life I would ask first.

Next week I start "Long-term Care". The next 2 weeks will be the busiest of the semester. I will learn a lot through hands-on experience and high stress. Hopefully I can rise to the occasion :-)

Then it is Spring Break - that is the light at the end of this stressful "tunnel". I am really looking forward to it!

Kindergarteners

This month I am volunteering in a Kindergarten class not too far from my apartment. If you are ever feeling bad about yourself and want a little boost, go into a Kindergarten classroom to help out! The second I walked in, small children got out of their seats to say hello, give me hugs and ask me to sit with them. Throughout the morning, I repeatedly received random hugs and requests to participate in their activity. For example, going to music class with the children was optional because the teachers often need help prepping in the classroom but I was "dragged" into music class to sing songs and dance around the room - the dancing/skipping/jumping was a little awkward...

Next week I have a final in one of my classes. This is not a typo and it is not a midterm. My last day in Neuro is next Thursday. Kind of excited about checking one more class off the list.

One more week of volunteering with small children....I think I will miss it.

Spring Semester 2010

So I have started another semester...actually we started January 4th with only one class: Neuroscience. It sounds pretty dry but we have a great professor that makes the information very practical and fun. She allows us to ask all sorts of questions: i.e. why are some sounds soothing? We have looked at nerves throughout the body, including motor and sensory and the nerves to special senses (i.e. hearing). We have also looked at reflexes and then some of the pathology that goes along with all of these areas. It is very interesting. Neuroscience will end February 4th, which will be nice. One less thing on my plate! Considering this semester has 22 credit hours – anything off the plate helps!This semester we are doing something called "Lifespan" which means we will do rotations with newborns and the elderly. Each month is something different. This month, I start with volunteering. My program allows us to pick an area of interest and spend 20 hours helping out, but we have to work with people! We can't just sit in a corner stuffing envelopes :-) I have chosen to volunteer in my church nursery and help a friend in her Kindergarten classroom. I will also be helping at a soccer clinic for a local elementary school and possibly helping with a science day at a school in Colorado Springs. A lot of opportunities and I am looking forward to them!

My next rotation will be in parenting classes. It might sound odd but my program focuses on pediatrics. Many parents ask their health care provider for advice with child behavioral problems. I am not sure how these classes will go because I don’t agree with modern discipline techniques but I need to know what I am allowed to tell parents. It doesn’t mean I would have to treat my own kids, one day, like this.

After that I spend 2 weeks in Long-term care, 2 weeks in the nursery, and then 4 weeks in Palliative/hospice care. It will be nice to have something different each month, but my schedule will always be changing. That is life in the medical field though! I am most looking forward to the nursery. I love newborns and I look forward to doing assessments on them.

The end of 2nd semester

This week was the end of 2nd semester. I had 4 finals - one each day this week. What a week! Having been out of the undergrad schedule of finals, this was a lot for me! 1 was completely accumulative - Microbiology. This required knowing the organism, what it looks like, all the diseases or problems it can cause, and how you would test for it in the lab.

2 of them were semi-accumulative: Neonatology and the Physiology/Biochem class.

Neonatology consisted of 2 exams for the entire semester. I had a TON of slides to memorize but it was more than that. The exams were more application, which is good but hard to study for. For example, a 36 week gestation baby is born with X vital signs (Blood pressure, pulse, respirations, etc.). The mom has a history of X and had X complications in pregnancy. The baby is now having trouble breathing - what do you think the problem is or what kinds of tests would you order?

Physiology and Biochem was the class I was most concerned about but it went really well. The exam is all write in/short answer. Sometimes it is hard to know what the prof wants because the questions are a little too vague.

The last exam was in Women's Health and that one went well too. It was just a regular exam but after a week of studying for other exams, my brain was just shot! :-) I needed sleep and my brain needed a break! It is hard to keep cramming information into an overflowing brain. I have never been so ready for a break than right now.

Wednesday night (the night before my Women's Health exam), I took part of the night off to go to my campus Bible Study where we read the Christmas story. We each had a part to read. I hadn't done that in a long time and it was a lot of fun! It is easy to lose the Christmas spirit when there is so much going on in the season. I am thankful for all this time off before Christmas to "get in the mood" and prepare (mentally) to celebrate the birth of Christ.

Now I have a little over 3 weeks until I have to be back so I am visiting my grandparents. It is nice to be away from school, relax, sleep in, and hang out with my grandparents. Being so busy throughout the school year, I have very limited chances to see them.