4 Months Later..

4 months have past since my last post. Therefore it is difficult to find a direction for this renewal post. I am sitting in the living room waiting on broccoli cheddar soup to finish cooking while Lydia is napping. It is nice to have a day off from "working." Also, I am thankful for this pinterest website because it has led to a new found interest in cooking for Aubrey.

Since my last post, here is a summary of events that have happened leading up to today:

- Finished ER rotation in Branson, MO.

- Packed up a 26ft penske truck and moved back to Texas.

- Stopped in Tahlequah on the way back and stayed in a cramped furnished apt.

- Which leads me to the next adventure..Spent 5 weeks in Tahlequah, OK, 4 of those being by my lonesome while Aub and Lydia stayed in Texas. Traveled back and forth frequently and eventually dominated an 18 wheeler tire in the middle of the highway at midnight just outside of Muskogee while driving 80 mph in the Honda accord. Fortunately was still driveable and was fixed a couple of weeks later.

- Moved into our old apartments in September and the returned to Tahlequah and Springfield for a couple of weeks before finally settling down at home with Aub and Lydia in Tyler.

- Then I did a family practice rotation in Chandler and enjoyed it for the most part.

- All the while I was applying for different Jobs.

- Had a job interview at Good Shepherd ER that went really well

- So well that they offered me a full time job in there ER.

- Finished my FP rotation in Chandler and returned to Springfield to take a couple of tests.

- Started my final elective rotation at Mother Frances ER on Saturday.

- That brings me to today...

Still in negotiations with the job at Good Shepherd and trying to tie up all the loose ends to prepare to finish this "Journey to Missouri."

Snap, Crackle, Pop...Owe My Eye!

It feels like a lot has happened since I last updated. Probably because I have spent 66 hours in the ER over the last week. Here is a brief synopsis of some of the activities I was able to partake in: shocked a guy's heart back into a normal rhythm, drained several abscesses including a pilonidal(which is the nastiest abscess to drain at the top of the butt crack), removed a fish hook from a leg, relocated a dislocated shoulder on a 15 year old kid, sutured several people including a 1 year old girl who was bitten in the face by a rottweiler, a girl after an atv accident, a guy who dropped something on his toe and burst the end of it open like a grape. I also saw a man who blew half his hand of with a giant firework (it looked like a grenade went off in his hand), saw a young guy who lost his sight after a firework blew up in his face(will need a corneal transplant if he ever wants to see again), a girl who stuck a hot sparkler in her eye(?), and a lot of other people who didn't need to come to the ER at 2 O' clock in the morning. So, it has been pretty enjoyable for me to get to see a wide variety of things. I'm about to go back in for another 12 hours and then we leave for Texas tomorrow night. I am looking forward to the break but I also feel like I have a lot to learn and that I should spend every waking moment reading about emergency medicine.

Real stories of the Branson ER

I have noticed that the patient population is a bit different up here in Branson vs Tyler ER. Yeah we used to get a crazy one every night or two at Mother Frances but this place is so much different. I would venture to say that half of my patients are crazy. By crazy, I mean what they come to the ER for is not their real problem. For instance, I had a 26 year old guy who came in because he suddenly got short of breath and he has these strange pains on his legs and arms. Well his real problem is that he shoots up meth, morphine, dilaudid, fentanyl and anything else he can get his hands on. He also had some other problems secondary to his drug abuse. I really did feel bad for this guy because he got the standard drug addict treatment: make sure nothing bad is wrong, give some fluids, kick them back out on the street. This is a guy who just has an addiction problem unfortunately. Another lady came in for an "asthma attack" that suddenly started when she went out into the heat(it is actually cold air that can trigger asthma). Well she started hyperventilating(because she was having an anxiety attack) and "rolled" her ankle getting into her car to come to the ER. She was CRAZY. I breathed on her ankle and she winced in pain. She wouldn't take a deep breath so we couldn't hear her normal breath sounds. She was whispering and panting like a dog but was not in any respiratory distress. I had a feeling she had played this game plenty before.

On a brighter node, I drained an abscess in a guys mouth and another one on another guys butt and they were both very relieved and appreciable. I performed a dental block on another guy with severe pain that was also appreciable. My favorite patients last night were a 15 year old kid with a dislocated shoulder and another guy with an irregular heart beat we call Afib. I helped reduce the kids dislocated shoulder which he was very thankful for and I shocked the other guys heart back into a normal rhythm and he said he didn't feel a thing(because we doped him up).

So all in all, the good overcomes the bad and it is all about having the right attitude toward everyone no matter what there underlying problem is. On that note, I am going to take today off and spend a little time with my wonderful family. I can't wait until our trip back to Texas next week for a little R&R.

ER Day 1

I thought I would go ahead a post a little something about my first day down in Branson. Alcohol is the word of the day. My first 3 patients consisted of 2 really drunk guys and one guy who needed to be drunk. Well that is of course because he had a seizure since he hasnt had a drink of alcohol in 2 days. That's strange you say, giving a guy alcohol because he had a seizure? Well yes, because this guy has been drinking at least a pint of vodka a day for 6 years. His body is used to a certain level of alcohol and therefore reacts oddly (seizure) when he doesn't drink. I saw how alcohol has destroyed the lives of these three men. One of whom has been drinking an insane amount daily since he was 11 years old! No joke.

On the brighter side, I really liked the ER and docs I worked with today. They just let me have at it and do my thing. I am really exhausted for some reason. I left the house a little after 7 this morning and got home about 7 this evening. Tomorrow I will probably work 11-11. My shifts will be long, but I can come and go as I please for the most part. Unfortunately for Aubrey, since this is my specialty of choice, I will probably work much more than I should just to learn as much as possible. Therefore, pray for Aubrey that she can make it through this next month of me being gone all the time. Well I am tired and I have to look some stuff up so I will shut this one down. Later.

Saturday Night Fever

Emergency room, Branson, Missouri here I come. Yes, I did in fact make it through that unsatisfactory surgical rotation I once spoke of. My last week was probably actually the best one. Not just because it was my last, but also because it was relatively more relaxing due to a lower patient load. I did however have the pleasure of assisting on a 4 hour double mastectomy on Tuesday. The problem was, our patient had very, very large breast. To give you an idea, the incision to remove each breast was about 12 inches long. We removed one and I closed/sutured the incision while he started on the other side. As you could imagine, this took me a while. I wanted to make sure I got a good cosmetic result since that is all the patient notices after a surgery like this. I finished my test on Thursday and did okay. Now I just have to finish my rough draft for my research/thesis project. I know my readers are dying to know the topic so I will share. Approach to Nephropathy in the Type 2 Diabetic Population. Riveting for all you non-medical junkies.

The family had an outing to Branson last night and enjoyed our favorite mexican food in the area, Cantina Laredo. Today we did the usual around the house stuff. Tomorrow we are going to take a trip to Joplin to see one of my classmates and his wife who have a 3 month old boy. Then, Monday I begin my almost daily driving back and forth to Branson to crash the ER. I will try to post more frequently on my encounters from the ER for all you adrenaline junkies.

Tomorrow will be day 40 of our countdown to The Missouri Exodus of 2011. We are excited to say the least. I'm hoping Lydia will be walking by then so she can help load the moving truck. We will be having our first ever garage sale in a few weeks to help lighten the load hopefully. Well I am now going to wrap this Saturday night diatribe up. To God be the glory, great things he has done!

8 weeks away

After one the the most physically exhausting weeks of the year for me, I decided to sleep in today until after 10. Of course we went to bed kind of late and I was severely lacking sleep/rest since Monday. I only got to see Lydia yesterday for 20 min or so. That was a bummer because I really enjoy my father-daughter time. I inherited tickets to a musical at the Springfield Little Theatre last night so we decided to get a sitter and go out as just a married couple. I was not all that excited to see a musical but it was actually very good and laced with talented youngsters. It was nice to spend some time with the wife and we hope to do some more of that when we get back to Texas. Speaking of that, we are 8 weeks away(hence the title) from moving out of this humble abode in Missouri. That seems very much within reach and I can't believe our time here is already coming to an end. That being said, it's not a moment too soon.

So I have just completed 4 weeks of a 6 week rotation in surgery. Fortunately my preceptor is on vacation all next week. Therefore I am taking the opportunity to complete a required 1 week rotation in palliative care/hospice. That means I will only have 3 more awful days of surgery until I finish this rotation. One thing I have learned is that I do not particularly care for working in surgery. This is the only field where as a PA, you really are more like an assistant. You are at the mercy of the surgeon you work with and I don't like it. I prefer to work autonomously and make the final decision on my patients. Of course my disdain probably has a lot to do with my current overinflated, arrogant, never wrong, sinless, only fellowship trained breast surgical oncologist in the region, curer of cancer surgeon that I have the pleasure of working with. He literally makes me laugh and sick all at the same time as I listen to his arrogance all day long. I will now bless you with a quote said in all seriousness during a surgery this past week. "I don't have a good feeling about these (lymph) nodes, I just hope that I'm wrong for once in my life." And boom..there you have it folks. Reminds me of a book titled "When People are Big and God is Small." Lord have mercy on me and forgive me for any arrogance that I feel inside and display outwardly as well.

I should now eat something(because I feel malnourished from the past week) and work on some school work. Really and truly I will probably play with Lydia for a while and then piddle around the house. Adios y vaya con Dios.

Update

Update: I am currently doing my surgery rotation and the hours are rather horrible. Got home after 10 pm last night after doing what we thought was going to be a routine appendectomy. Come to find out when we got in the belly, the guy actually had a rare complication from a rare problem called a meckel's diverticulum. Had to do a small bowel resection but everything turned out okay. We are also on call today. Fortunately I don't have to be in until 11 but I probably won't be home until late into the night. My saving grace is that my preceptor is on vacation next week. Therefore I am going to complete a required 1 week rotation in hospice in the interim. Morbid, yes. Hours are great though. That will give me time to catch up on studying and write a research paper that is due in a couple of weeks. My next rotation which starts in less than 3 weeks is emergency medicine in Branson. I have really been looking forward to this one. It feels like I am going home to my comfort zone.

Another exciting thing going on in life right now is the fact that we will be moving out of Springfield in 8 1/2 weeks. Seems unbelievable yet overwhelmingly exciting as well. Before we move out we would like to do a few things as a family. We want to go visit St. Louis together and the last free zoo in the Country. Also, take Lydia to the Buffalo river since we are so close. I would like to visit Kansas City also because I hear it is kind of pretty. Unfortunately we are limited on funds and at the moment, time to complete these missions.

That is all for my current update and on a side note..Don't go visit a surgeon unless you want your gallbladder taken out. KSkinn out

Healthcare Reform..What?

I almost managed to get through my peds rotation with nothing more than a month long runny nose. Then, yesterday afternoon I felt the dreaded sore throat coming on. It was more than confirmed this morning when I woke up. Thankfully it is not strep again (swabbed myself at the clinic) and maybe it will be short lived.

2 more days of pediatrics for me. I will certainly miss a lot about this rotation. One thing I will not miss is the parents bringing their kiddo in stating "oh they just have a little cold." Which in my head I am thinking "yeah, no kidding, why in the world did you bring them in?" Am I wrong to think that every lay person out there knows that we can't do anything for a cold and it just has to run its course? What makes it all the worse is that the only parents that do this are those whose kids are on medicaid. Therefore it doesn't cost them a dime to come in every day if they want. Unfortunately, this is exactly the reason for rising healthcare costs and why expanding medicaid is a terrible idea. Now, you ask why this would bother me as a healthcare provider, that just means more business and money for me right? Wrong. Medicaid hardly reimburses the clinicians for all the work and liability. For example, the uninsured cash pay cost of a newborn baby exam in the hospital is several hundred dollars. How much does medicaid reimburse for that same exam on one of their patients? $20. Just an example of how screwed up our system is. I didn't mean to make this post about the state of healthcare in the US today, it just happened. I feel knowledge on any subject gives us the ability to contribute an educated opinion. This is a big subject that impacts all of us.

Daddy Daycare

Today was Daddy day for Lydia and I. I got her out of bed this morning and fed her morning milk and fruits. We enjoyed some good playtime together while we listened to Alistair Begg on Truth for Life. Later in the day, we let Mommy go to target by herself while we played together some more. Finally, I gave Lydia her every other day bath. Aubrey also cooked some fantastic lasagna. We had a bit of a role reversal day and I enjoyed it. Tomorrow I am back to the 8-5 grind and Aubrey will resume her daily routine.

Less than 3 weeks now until we visit Texas again. I am really looking forward to this visit. It is like I need a recharge from home to get me through a few more months up here. When we get back I am going to start my surgery rotation with a guy who specializes in breast oncology. Then on to the ER in Branson before we move outta here. Last stop before home is Tahlequah, Oklahoma. What I've heard from classmates from Tahlequah is than you are given a lot of freedom..maybe even too much for some students. They have a surgery clinic that people without insurance wait months and months to get into for skin lesions to be removed. Some days, the PA or med student is the ONLY provider in the clinic to remove lesions. That means no help from an attending. That's what I call sink or swim medical training. That is all for now on this Sunday night from Miss-er-ry.

Autonomy, How you Elude Me

If you notice my counter, today I have exactly 8 months until I graduate. That is less time than it takes to grow a baby in the womb..and we all know how fast that goes. I am not typically eager for time to fly by, but I'm getting to the stage where I want to be finished more than ever.

My rotation is still going well but some things just make me squirm. For instance, we had a girl come in on Thursday with an abscess on her arm (you know, the red bumps everyone thinks is a "spider bite.") So I went and saw her and told my doc it needed to be opened and drained (which it did.) Well, instead of letting me cut it open with a scalpel he opted to scrape the head of the abscess off with a needle and painfully try to milk the pus out. Not only painful for the 11 year old girl but painful for me to watch. Over my years in the ER and hundreds of abscesses that I have seen drained (and done a few myself), I have never seen this poor technique. Therefore, to finally get to the point, next year at this time when I see a patient with an abscess I can do whatever I want with it and not have to clear it with anyone. I can't wait to be autonomous.

Another point to bring up here is that we all have our strengths and weaknesses. My current preceptor has only been out of residency about 1 year now. There are some things he knows really well, like asthma, but there are certain diseases and procedures that I have more experience with than he does. I think I get more out of being taught by someone like him though because we are both still in the learning mode. Just because doctors go through mandatory residency training, there is still a big learning curve with they get out on their own just like when I am let loose next year. The good thing is that as newbies, we are constantly reading texts and reviewing diseases. Another plug here, don't feel like you are getting shafted if you have to see a PA or NP instead of a physician. It all depends on the individual and their personal experience. There are horrible PAs and NPs just like there are horrible doctors. This medicine thing is not all that difficult if you just realize that you will never know everything. It is simply a matter of "Do no harm" if at all possible and know when to get another opinion. We shall see how I feel in 8 months but I already feel competent enough to treat about half of my patients on my own. Thank the Lord, I really love my job.

Tip of the Day:

Cat bites are nasty. Literally about 50-80% of them get infected. Cats carry a bacteria in their mouth called Pasteurella multicida. This combined with the sharp fangs, it is like getting an injection of bacteria if you get bitten. Therefore, if you have cats around (gross) make sure the toddlers aren't pulling tails or ears. If you get bitten, you will need an antibiotic called Augmentin..so don't call me because I told you so.

The Titleless blog entry

All of you M-F 8-5 people out there, I feel for you because I don't like it much. This is the first rotation I've had that I actually leave the house by 8 (sometimes 645 if I have to go to the Nursery) and do not get home until after 530 most days. My last rotation I had off on Friday and my 1st one was only half day on Wednesday and Friday. I would rather have 3 long days per week and have some days off. However, since I am enjoying my rotation so much, I think I can handle the american standard 8-5 schedule for a while.

I gave a 7 year girl a big shot of penicillin in the bottom this week for her strep throat and I'm pretty sure she handled it better than I did a few weeks ago. Very impressive. Saw another little 4 year old boy who was developmentally delayed and didn't particularly like me examining him. Afterward, when I was talking with his mom, he walked up to me and gave me a huge hug..it was very sweet. We also did a circumcision on a little 5 pounder and I was responsible for numbing up the penis with lidocaine. This was a little trickier than I expected because I had to hold the penis and inject medicine in 4 different spots around the base of the penis. Not usually a big deal, but the poor little guy had a tiny weewee and it kept slipping out of my grip. It worked out though and he didn't cry a bit when we trimmed him up. Speaking of circumcision, apparently the Midwest has the highest rates of circumcision at about 60-80% whereas California is more like 30%.

On a Cuter note, Lydia sure is getting big. My favorite time of day with her is getting her out of bed in the mornings because she is adorable and playful but in a docile sort of way. I don't get to do this much but I always look forward to seeing her when I get home from clinic. She is at the stage where we can set her down in the middle of the living room floor and look up and she's over near the wall.

Mommy Tip of the Day: If you or your little one comes down with with a virus that causes several days of diarrhea, you probably want to avoid dairy products. We become temporarily lactose intolerant during an episode of gastroenteritis. The Lactase enzyme responsible for breaking down lactose lives on the end of the villi in our intestine. All of the diarrhea sloughs off that enzyme causing us to not tolerate dairy very well until we get over it. So avoid the dairy or switch to soy for a few days.

The World of Pediatrics

Well, I shall eat my words. I love my peds rotation! I think it is a combination of the amazing kids I see, the pediatrician I am working with and the clinic. This past week I saw a lot of interesting cases aside from all of the strep. Including a 14 year old girl who got a liver infection after the sexually transmitted disease she acquired traveled from her pelvic region to her liver which is called Fitz-Hugh-Curtis syndrome. Also saw a 10 year old boy who still poops his pants-called encopresis. I felt so bad for this boy coming from a broken home living with his single mother he was incredibly overweight and claimed he had no friends because they called him fat. Lots of other interesting things and cute kids I get to play with all day long. We did a 9 month old well check on girl who had been walking "for a while" claimed the mother. As well as a 5 month old check on a boy who was crawling..wow. The doc I am with is probably not much older than me since he finished residency this past July. He is great though and enjoys teaching a lot. He makes our pediatrician look second rate for sure. Since I am learning so much about kiddos, I will include something pertinent for all my little motherly readers out there at the end of my post for the next 5 weeks.

On another bright note, literally, the sun is finally shining today and it is over 70 degrees. I honestly can't remember the last time we had a day like today in Springfield. So amazing that I have tried to spend a majority of it outside. I backpacked(not a literal backpack but one of those carrier things) Lydia around the nature center earlier with Aubrey. Of course we heard all sorts of comments including a kid saying "look mommy, a backpack baby." We all enjoyed it and look forward to many more sunny days to come this Spring and Summer.

Mommy Tip of Day:

The oil from Mango skin can cause a rash in some hypersensitive people that can look similar to poison ivy/oak. So make sure to peel the mango good and wash your hands afterwards. If your going to give your kid and un-peeled fruit to play with, better avoid the mango.

Moving on

My OB/Gyn section is now complete after taking my test this morning. Therefore my blog should become less vulgar and abhorring. My last day in ob/gyn was last Thursday and I was able to finish up by delivering one more baby just after lunch. Everything went pretty smoothly except her epidural was not working all that great. However it didn't hurt me a bit. My final take home lesson from obstetrics is that babies are very slippery just after removing them from a vagina. Thankfully I never dropped one, but it seems like it would be easy to. That brings me to my next invention idea. A pair of rubber gloves that have better gripping ability on the palmar surface just for catching babies.

Next up is pediatrics. I will be spending 6 weeks in a pediatric clinic seeing all those little runny noses and coughs. I would be lying if I said I was ecstatic about it. I am looking forward to learning more and getting more comfortable seeing kids, but it is definitely a different ballgame. Most of the time the kids can't tell you what is wrong, you have to deal with the parents and the well child checkups are a bit mundane for an adrenaline junky like myself. It is all just part of becoming a PA and I welcome the learning opportunities.

Down and Out

I have Strep pharyngitis (strep throat.) This is by far the worst I have ever felt in my life. I broke down and went to an urgent care today where I got a torturous strep swab of the back of my throat followed by the most painful shot of my life in the booty. Oddly enough I asked for the shot knowing its reputation for being very painful. The alternative is taking antibiotics 2x a day for 10 days. No thanks.

So I rushed back to Missouri from Texas on Sunday afternoon only to leave after about an hour in the clinic on Monday morning because I felt horrible. I have not been back. Here I sit, alone in Missouri, feeling more miserable than ever, trying to find the energy to go to the pharmacy to pick up my nausea medication. And there you have it. I just lost my motivation to continue writing.

You be the Judge

Some would jump at the chance to deliver a baby, others would run away. I find my stand somewhat neutral actually. Don't get me wrong, I will catch one any time or place necessary but It just doesn't do it for me like other aspects of medicine. Hence the reason I will not be working in obstetrics and gynecology in the future. I can be as graphic as anyone wants as far as the details and reason behind my love-hate relationship with OB/Gyn but I will keep it somewhat palatable.

My day Friday morning started at 7 am. We were on call for the group of doctors for labor and delivery as well as seeing our own patients in the clinic. There was a very sweet lady we had in labor with baby #5 all morning. When we finished our morning clinic we went to the hospital and broke her water. My preceptor thought it would be a good idea to hang around since she was nearly completely dilated and looking ready. About 1 pm we suited up and I got to catch my first baby. Pretty routine really. The doc leaned over and whispered in my ear "Don't drop the baby." I have to say it was kind of a duh moment until I got a handful of that greased up water balloon. I was constantly having to re-grip the little slippery pete. Fast forward until 9 pm when I was sitting at home snacking. Phone call from my preceptor announcing "We have four in labor and two are getting close." Boom, off I go to labor and delivery. It was about 2 hours later when I caught the second one of the day. Then my doc just had me assist with the next 2 deliveries since they weren't technically our patients and were first timers. Here comes the good part and my reasoning for this not being my favorite area of medicine. Also not for the squeamish.

Delivering a baby has a unique smell, period. The body part that lies just below the birth canal or vagina is the rectum and anus. Let me paint a picture for you. Before birth, think of an "innie." During and immediately after birth it looks more like an "outtie." Not cool. I also saw an prolapsed hemorrhoid hanging a couple of inches outside the anus. It was my job to deliver and look over the placenta as well to make sure it was intact. The placenta smells awful. Our 3rd delivery of the night, her vagina blew up. Not cool. Took us 30-45 minutes to put it back together.

So, that was my 1st of 7 on call nights. I will enjoy and soak up the next 3 weeks and then kiss OB/Gyn goodbye. Not entirely of course because it makes up a pretty big piece of emergency medicine. Indefinitely I will keep everyone abreast of the excitement to come.

The Things I Must Do to Become a PA

Done with my first week of OB/Gyn. Although it was not exactly as I had hoped, it also wasn't bad either. Especially since my preceptor has Friday's off. That is unless we are on call. Speaking of call, over the next 4 weeks I have six 24 hour on call days in addition to the regular schedule. When I say on call, I mean getting a 2 am wake up to go to the hospital for a patient in active labor. It should be fun and hopefully I will get to deliver lots of babies. This week was a bit awkward to say the least. My preceptor just had me observe for the most part. Therefore, I was that guy that all my patients saw when they looked down between their legs just awkwardly gazing at their most private regions. It is much different when I am actually performing the exam. I dare say that I don't look or feel like a pervert when I get to do it myself. The awkward moment award goes to a few encounters I had on OB day. That is when we see all of our OB patients, which means they typically bring the man along. As I'm sure you can imagine by now, there I am standing at the end of our patients bed trying to look intrigued but not to enthralled. All the while, I am getting eyeballed by the young husband just looking for a flinch in my facial expression. Need I say more.

I'm scrubbing for my first total abdominal hysterectomy with bilateral salpingoopherectomy on Monday. That means we are taking out the uterus, fallopian tubes, ovaries and cervix. That should be fairly interesting.

Next time you are in an awkward situation at the store or over at the in-laws, just remember me. My situation would be hard to top, unless of course you haphazardly exposed your nipple to a church friend.

One Down, Seven To Go

I have officially completed and passed my end of rotation exam for my very first Family Practice rotation. I learned/reinforced a great deal of pertinent knowledge. Including how to perform an excisional biopsy. I was able to excise moles/abnormal skin lesions off of 2 different patients. I, like most other practitioners, enjoy doing the procedures. It is a break from the monotony that goes along with normal medication rechecks. Tomorrow I venture into a realm a bit more mysterious to me, OB/Gyn. My comfort level is minimal in this area because all those years I spent in the emergency room and working with patients, this was an area off limits to a little ol' male scribe. In order for me to become a legitimate practitioner, I must get very comfortable with performing normal and abnormal pelvic exams. That being said, In six weeks from now I am almost certain I will be way more comfortable than I ever thought possible. Not to mention being first-assist for all of the C-sections, hysterectomies, tubal ligations, etc. Of course I will keep my blog updated on the interesting cases and patients of my OB/Gyn rotation. That is all for now. Until next time, Adios.

Welcome to Parenthood

The next paragraph is aimed at the Johnsons'. It is simply a collection of thoughts that popped into my head a few days ago while I was getting ready for clinic and thinking about their current situation. This reflection is based upon my thoughts about becoming a parent.
The days become short, the nights long. You anticipate the next sound or cry she is going to make. Sleep eludes you. You know you love this child, but in a strange kind of way. Like a gift from God intended to push your body and mind to the limits. At times you know not what to do. Blindly you try everything you have heard or read in attempts to soothe that feeble cry. Time. Time is what it takes to learn the lessons of parenthood. Your love for this child will grow exponentially in time to an almost euphoric and tangible feeling. It is easy to set goals for the future. As if your current situation is not perfect enough. The thought of six months down the road she will be able to sit up and eat solids and most importantly sleep through the night. However, it is the long nights, the soothing her when you can't soothe yourself, the moments right now that are building that undescribeable almost supernatural bond you will feel more and more every day. God bless you and your child always.

What has healthcare become?

This musing comes after a relatively benign day at the clinic. However, something interesting happened that made me question the entire healthcare system. That is because, unfortunately, what happened is similar to what goes on in "Doctor's offices" around the nation.

I went to see a patient this morning whom I was informed was "self pay" prior to me going in. That is to say that the patient doesn't have insurance, so he will probably not want any blood work or much done. Or does it? This was a 60 year old truckdriver who had a full page worth of medical issues including chronic pain from an accident. He had never had any routine screenings or even a rudimentary prostate and hernia check. This would be unacceptable for any other post-50 year old man WITH insurance or medicare. So what did I do? I listened to all his ailments and decided it was pertinent to check him for a hernia and to check his prostate since he had never had it done and had symptoms relevant to the exam. For the first time ever, my preceptor comes knocking on the door wandering what is taking so long. I finished up and left the room. The first thing I hear from my Doc is "What took you so long?" "He is self pay, you can't be spending time asking him a bunch of questions and checking his prostate." So after I was a bit blown away, I rebutted with "I was doing him a service since he has never had a full physical or been checked out very well since he is self pay." A bit of a slap in the face to my preceptor since he has been seeing this guy for years. But his only response was, "True."

My lesson is that I shall decide now, as a student to always treat my future patients the same, whether insurance or not.

Stick a fork in me..

I'm a little overdo for an update...but it will have to wait a bit longer. I'm swamped, sleepy and should be doing other things instead of interneting it. The DuToit's are on their way to Missouri for the first time and I'm way behind on studying, sleep, exercising, spending time with Lydia and anything else that may be enjoyable. However, things are about to change. I'm going to try and relax for a few days while our friends are here and I'm thinking the Johnson's will have a new addition before the end of next week. We shall see. But I hope everything with the delivery goes as smooth as that little baby bottom is going to be. Anyhow, I will update later about life at the clinic. Adios.

Dual Roles

I have, as a matter of fact, learned something on my rotation. My preceptor informed me what the term "props" is short for. As in "I gotta give you props for that." In case you didn't know, it means "proper respect." Intriguing. I also have become far too familiar with the male prostate exam. This is a right of passage for all men turning 50 and then yearly thereafter. If most men only knew the poor sensitivity of this exam, they would probably be much less cooperative to "bend over and rest your elbows on the table." Unfortunately, the sensitivity of the exam is highly dependent upon the body habitus(build/shape) of the patient, the length of the clinicians examining tool(finger), and how well the Dr/PA know's what he/she is feeling for. Until we come up with something better, the dreaded finger wave continues.

As a side note, it is amazing how many people struggle with depression and anxiety. I have to keep up with all of the patients I see and their ailments. So far, I have logged 4 times as many depression or anxiety diagnosis than any other! I was given a bit of an open door today to encourage a struggling patient who mentioned that he had been a Christian for 12 years but just doesn't feel happy overall. I'm really not sure about my boundaries as a student and medical professional talking about Christ, but God gave me the opening and I couldn't ignore the opportunity. I told him that even as Christians we still struggle with stressors of this life, maybe even more so because of conviction. But that Christ took on our ultimate sin burden so that we can trust in Him fully to provide for us in every aspect of life. We went on and on and talked for about 45 minutes about his life and struggles. I just pray that something I said could be an encouragement for this man. God has blessed me in my life and I pray that he gives me a great ability to counsel those patients in need.

Studying is always on the back of my mind. Therefore I will close this session so that I can review some medical literature. I do believe I will first check to see if the snow has begun. We are supposed to get 2-4 inches tonight and tomorrow. We shall see.

Christmas and PA School Part Deux

A lot has happened since my last update 3 weeks ago. The Skinner trio had a successful and enjoyable trip to Texas. We thoroughly enjoyed spending some time with our family and friends. We chose to drive at night during Lydia's sleep time. This went off without a hitch on the trip down. Although Lydia slept well on the return trip, it felt like torture for mommy and daddy between the hours of 2 am and 415 am. I think the running around for 2 weeks finally caught up with us on Interstate 44. Thank the Lord, he must have drove us home because I think we slept.

Upon our return to Missouri, I began my first 6-week clinical rotation on Tuesday morning in family practice. I see most all the patients myself and then check out to the physician. Now, on Thursday, it has become enjoyable for me to see my own patients. I think it just took a couple of days to get comfortable with everything. The patients seem to find favor with me, even as a student. So that is comforting. So far I have frozen some warts off a guys foot and given someone a flu shot. I was going to do an excisional biopsy on a suspicious mole on a female patient, but she declined because it was very near her genitalia. Oh well, there is always next time. This experience has been a bit frustrating for me because I am a slight perfectionist and have always been good at answering on-the-spot questions. So far I feel like I have failed miserably at answering several easy "pimp" questions from my preceptor. Hopefully it is only temporary because I know the answers, but I haven't been able to regurgitate some of the info immediately. Maybe it is God's way of humbling me before myself and others. Point taken.

I am trying to balance life better now since I have a pretty consistent schedule. Trying to workout 3-4 times a week, do more things with the family, even cooking and watching movies. Not things that we were able to do much the past 6-12 months. God has blessed our family tremendously and I am still amazed at how he has made a way for all of this to happen so easily. I pray for boldness in Christ so that I may leave His mark on this Missouri community before I leave. Adios y vaya con Dios.