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.