Emergency medicine = sleep deprivation

Not a whole lot to update on right now. I have gotten to sew a few things up and have been complimented on my steady hand and sutures, so that's always nice. I was actually kind of nervous to do some suturing, as I hadn't done any since August, but I was obviously happy and eager to do it.

Nothing too exciting has really happened in the last week-ish. Couple STEMIs, broken bones, a-fib, drug-seekers. Saw a woman the other day with an H&H (hemoglobin/hematocrit) of like 6.8 and 20 something, so she obviously needed transfused. Saw a woman come in with abdominal/rectal pain, which her OB/GYN blew off as constipation and "the baby growing". The baby was growing, only inside her fallopian tube. It turns out she had an ectopic pregnancy and was bleeding into her abdomen. Um, I've seen a couple UTIs, a quadricep tendon rupture, and just a lot of nonspecific things like dizziness, headache, nausea, vomiting, weakness, etc.

On Monday and Tuesday I worked overnight. Wasn't too exciting, especially on Tuesday, which was a  very, very slow and long night. Overnights always mess my sleep up. I think I went like 30 hours without sleep, then got like 1-1/2hrs of sleep after my first overnight shift, then was up for another 15 hours for my second overnight shift. Then I went home and slept for like 8 hours straight and was up until like 4AM this morning before getting up at 7. And I always forget the day of the week, which screws me up even more.

Working again tonight from 4pm-12, and then tomorrow I think from 7am-3. Hoping to go home this weekend and see family before my last week in the ER and starting my surgery rotation the week after. I think I'll miss the emergency room, especially this one because I really like the people who work there, but I am very excited for surgery! Will obviously update again if anything exciting happens, but this may be my last ER post!

emergency med update #2

So far I am LOVING emergency medicine! There are still a lot of things I do not know how to manage, but I'm still learning!

I'm starting to get used to the structure and pace of the ER at Forbes. And I love working with my preceptor and seeing familiar faces around the department. I've met several PAs in multiple departments, including ED, trauma, and neuro, so far. It's cool to see how our field is branching out into specialties and how they are all working together. I would've loved the chance to rotate with trauma so maybe I'll get to do a little bit of that when I'm in my ortho surgery rotation.

I haven't seen too many "crazy" cases yet…Well, at least given my own definition of crazy. Last week we had a guy come in with a first time seizure, which ended up being from a large brain tumor. That same day we found out that a woman we had seen the previous day had a thoracic spinal mass that was compressing her spinal cord and causing numbness and weakness in her legs. I also saw a trauma case in which a guy was stabbed in the neck and chest. Apparently he had completely severed his jugular vein and had a tension pneumothorax. Needless to say he was rushed off to surgery. Today I witnessed my first death. A man came in with severe CHF (congestive heart failure) and he went into cardiac arrest and died after the techs spent 20 minutes trying to resuscitate him. I also witnessed a woman have a spontaneous abortion (miscarriage), and even was able to see the fetus/POC (products of conception) after they were expelled. It's a little surreal at times, seeing some of the things I see. It's like I almost remove myself from my body so that things don't phase me like they would other people. I don't know how to explain it.

Other cool things I've seen include subarachnoid hemorrhage, superior vena cava syndrome, crush injuries, incarcerated inguinal hernia, colovesicular fistula (imagine your colon being connected to your bladder and then trying to pee), hypertensive urgency, and appendicitis, among many other things.

So far I've seen a lot of sick patients that have to be admitted, so I'm hoping to switch over to fast track for a couple days and try to see some patients that I can "fix" in some respect. I'd like to sew some people up and drain abscesses. All that fun stuff. Some day next week or the week after I'm hoping to ride along with the EMS in the ambulance for a shift. I think it'd be fun and a good experience to see what is done to a patient before they arrive at the ED. 

That's pretty much all I can think to update about right now! This week I'm on 11AM-9PM tomorrow (in addition to Mon and today), Sat and Sun. Then next Mon and Tues I'm on from 9PM-7AM. I'm actually excited for the overnight shift because I know I really liked it while at Children's. So hopefully it goes well and I get to see some cool stuff. I'll be sure to update again when I get the chance!

Emergency Med

Can't say how excited I have been for this rotation! (and really nervous at the same time!) From my experience at Children's ED, I learned that I loved the busy-ness, chaos, pace of emergency medicine…the crazy hours, sleep deprivation, skipping meals, mixing up days of the week. I would not have originally imagined that I would like these things, and maybe I do complain about them some, but in the end, I love the thrill of the emergency department.

I started my rotation on Thursday. Arrived at 7AM only to find out my preceptor had told me the wrong day. So I played tag-along with other doc and then a PA-C. The structure of this ED is a bit different than that over at Children's. At CHP, I had a computer that I worked on. I used this station to sign up for patients, look through their history and triage, document, and discharge pts. Additionally, the docs used the computers to order labs/imaging, review results, order meds/fluids/etc. The computer told you where the patient was at, what was being done with them, what was coming up, and when diagnostics were ready. At Forbes, you triage on paper, document on paper, write orders on paper, review labs on paper. When you want to know what's being done with a pt or where they are, you ask. When you're ready to d/c a patient, you tell the nurse. Then the chart is dictated over phone to be typed up and entered into the pt's chart on the computer. But I'm slowly getting used to the system!

My first actual day with my preceptor was Sat, then I also worked Sun, and Mon from 4PM-12AM. A lot of geriatrics come in for various reasons. I have seen several falls, geriatric and adult, alike. One woman had fallen in a parking lot and sustained bilateral humeral neck fractures. Ouch. Then I've seen several older folks that had fallen and remained on the ground for several days, sustaining muscle injury, infection, fractures, and multiple abrasions. So far I've seen 2 STEMIs (heart attacks) and 1 stroke. Today I saw a case of appendicitis, a woman with a blood alcohol level of 490 (>80 is equivocal to a DUI), and a young girl that took 10 tabs of 325mg aspirin and 5 tabs of 550mg naproxen, among others.

Sun and Mon I was able to see pts on my own. After getting their histories and doing an exam, I then present to my preceptor and he may or may not ask what I think and what I want to do. Then we see the patient together, order labs, and review them when they're ready. My preceptor is very smart, and good humored. Really easy to get along with, as are the other docs and nurses. Compared to CHP, the ED at Forbes is much smaller and closer knit. One thing I do like is that there are not a lot of students, so I see more pts and have more opportunities to learn from the doc. There was a 4th yr med student there today, which as actually nice, so hopefully we'll get to work together a bit in the future.

I just got home from my shift a little after midnight and I'm still not exceptionally tired, which is why I'm writing this now. Working in the ED drastically messes with the body. Tomorrow (well today) I work 1-9PM, day off Wed, then 7AM-3PM shift on Thur and Fri. Almost tempted to ask the doc if I can work with the PA over the weekend, but we'll see! That's about all I have to say for now! Will post again with any exciting stories!

Here's to a new year!

Once again, sorry for my lack of updating! Nothing too exciting happened during my last few weeks in OB/GYN. I must say, I am really glad to be out of KY for good and onto new things! Not that OB/GYN is completely disinteresting to me or anything…I just was not a huge fan of my site and preceptor, though I do feel like I learned a lot about OB/GYN. I will say that my preceptor was an excellent teacher, so that matters most!

At the end of the rotation we had a big summative exam of 200 questions. It was not an easy exam and it was a big reminder that I still have a long ways to go in terms of studying to prepare myself for the boards. One thing to add to my New Year's Resolutions….

Christmas break has been incredibly relaxing! I hardly feel like doing much of anything that is super productive…Just a lot of spending time with family and relaxing (and watching a lot of Netflix)! It's been really refreshing, and I'm hoping to feel rejuvenated for my upcoming rotations in Pittsburgh. Headed back there next Sunday. Crazy how fast this break has gone!

Looking back on this past year, it's seriously crazy how far I already am into my second year of PA school! In total I'm about 75% done with PA school! AHHH! It's been a very challenging year, but also a year full of new and fun experiences that I'll never forget! I feel like I've learned so much, and that I've grown up so much since summer 2012 when I was first starting school in Pittsburgh.

So here's to a new, refreshing, and hopefully exciting 2014! Looking forward to my upcoming rotations in emergency med, internal med, surgery, and ortho, and to graduating later this summer! Also looking forward to the FIFA World Cup in Brazil! Viva Espana!

Hope everyone has a fantastic day tomorrow, and wishing you all the best in the upcoming year!

P.S. I'm turning TWENTY-FOUR tomorrow! Crazy! Feeling so old right now...

BABIES!

Well since I've last posted I have gotten to observe a few more c-sections and even FIRST ASSIST during one! I really think I'm going to like my surgery rotations, but we'll see! I've also gotten to see a few vaginal deliveries. I must say, they look so very painful, but it's amazing witnessing little babies come into the world and taking their first breaths! They are just so cute. I love seeing all the babies in the nursery when I get to the hospital for rounds. I never get to hold them, which is fine because I always seem to make babies cry for some reason! haha. But yesterday I watched a circumcision and it was one of the most pitiful things I've ever seen. They strapped his arms and legs down, and he just lied there crying while the doc did the procedure. He didn't even give the poor thing any anesthesia. It was so sad.

Um...That's pretty much all that is new to be honest. I don't get to do a lot, but slowly the doc is letting me participate more. In the c-section I assisted in, I got to suction, retract, and cut sutures. Hopefully I'll get to do some more and take histories and do pelvics and cultures myself.

This is one of those rotations where I've probably gotten the most frustrated with my preceptor. There is something about the way he talks to patients that almost comes off as condescending or judgmental, whether he's aware of it or not. And he complains ALL THE TIME. Yesterday he called me his soundboard, or something like that (someone for him to vent to), and I straight up told him I don't want to be his soundboard, so hopefully he'll quiet down a bit! haha. His problems are not my problems. But I guess everyone has their flaws and you just gotta deal with it. He is a great teacher, though, and  I feel like I'm learning a lot about OB/GYN.

Only two works days left until a much needed Thanksgiving Break! Looking forward to seeing my family and stuffing my face with turkey and pumpkin pie!

first week in KY!

Well last week was my first week of women's health in eastern KY...It was probably one of my worst weeks throughout my entire clinical year so far. All I will say is that I was not a fan of my substitute preceptor and it just was not a very fruitful week at all.

Today was my first day with my actual preceptor and it was great! Mainly because I got to head into the OR for the first time and watch a c-section! It was awesome. The baby was ginormous but had a full head of hair! It was great. And my preceptor asked the students questions while performing a tubal ligation, which was just great. He used to teach, so the whole day he was asking me tons of questions. This is something I haven't really had with my other preceptors, so I'm really looking forward to all I'm going to learn.

Eastern KY really hasn't been as "out of this world" as I imagined. People are very friendly. They do have very strong accents, but otherwise they are completely normal! Haha. So far I really like the nurses and other people working at the clinic. Um...There is not much to do around here, which I guess means more time for studying. It snowed for the first time today! Which was kind of painful waking up to because I hate warming up my car and cleaning off the snow and driving when its wet and cold...But snow makes everything look pretty so that's nice! It does also make me really excited for Christmas! I've been listening to Christmas music for a couple weeks already. Now my goal is to find myself a really small pitiful Christmas tree to decorate.

Tomorrow I have to get up and make the 40 minute drive to work. Ill be starting with rounds at the hospital and then head over to the clinic. I don't know if my preceptor has any more surgeries this week, but I REALLY hope so! I think I'm going to enjoy my surgery rotations next year!

Um...That is really about all I have to say for now. So hopefully the next time I write I'll have a ton more interesting and cool things to share! Oh, and I forgot to mention that, although there aren't any other Asians in eastern KY that I've seen yet, there are several people that are originally from Ohio in my office alone! So I'm not completely alone! Yay!

A day in the ER

So I thought it'd be nice to share about what my days are like in the ER at Children's.

If I work a 10AM-6PM shift, my day usually starts out uneventful. Only red and orange are open and  not as many patients come in during the morning hours, so I'm usually not needed. So, during those hours I normally just study. At 11AM yellow opens, so more patients start coming in and so I get the chance to see some of those patients. When I see an open patient on the monitor, I quickly sign up for them and ask the preceptor if I can see them or not. If they say yes, I open a note, jott down the patient info and vitals, and record the time I go into the room. Then I go in, introduce myself, and do my history and physical exam. 

Once I'm finished with that, I present to my attending and tell them my assessment and plan. At times the attendings get really busy and so sometimes I have to wait awhile before I can present. During the morning hours it's usually pretty easy to get in touch with them. After I present I will either go into the room with the attending, or they will go into the room while I write up my note. Then once the patient has been seen, the attending will let me know what kind of orders they are going to get. And from there everything depends on lab results and patient status.

When mid-afternoon comes around, it starts to get a bit busier. And then once evening comes around, the ER is usually pretty swamped, especially during the transition between day and evening shift students and residents, because there is some overlap in our schedules. So when 5PM comes around, we have a TON of people working. From this time to around 1-2AM, the ER is really busy. It has been especially hard, in the last couple of days, to find attendings and present, get labs ordered, patients discharged, and etc. It's chaotic at times. 

Then once it starts to get into the early morning hours, things start to quiet down. Working the 11PM-8AM shift is probably my favorite because it doesn't feel as rushed, there are less patients, and less people working. So I get to see a decent number of patients during these hours, and it is also much easier to get in touch with the attending and get things done. Surprisingly, it has been very easy for me to stay awake during these hours. It's probably a combination of staying busy, drinking coffee, and not ever knowing what time of day it is.

Most of the time I will only take on 1 or 2 patients at a time, but sometimes I'll have 3 if things are busy.  On average I see about 3 or 4 patients a day. Not a lot, but good enough considering the circumstances. Usually the patients I get are not emergent and can get in and out in decent timing...Usually like 2 or 3 hours. Sometime they have to stay longer if they have labs or imaging, or if we have to observe their condition or admit them.

When I'm not dealing with patients or talking to the attendings, I'm writing up notes, researching, talking with residents or other PA students, or getting consults from ortho, plastics, cardio, etc. Then once patients are ready to go, I print discharge instructions, sign my note, and alert the nursing staff that the patient is ready for discharge. Then I go in and talk to them, give final instructions, and let them go home.

Sometimes I'll get to a point in my shift where I won't be able to take on any more patients (like if my shift ends at 6 and I discharge my last patient at 5:30), so sometimes I'll leave early. Other times I'm too lazy to sign my patients over to another resident or student, so I'll stay up to an hour and a half after my shift is over sometimes. I really don't mind it, though, because I like being there and working. When my shift is over, I head home eat, sleep, or do hw, depending on what time of the day it is. 

This week I worked 5 days. Mon 5-1AM, Tue 11-8AM, Thur 10-6PM, Fri 5-1AM, and Sat 5-1AM. So it's been a fairly busy week. Just got home about 1 1/2 hours ago (around 1:45AM) and decided I wasn't tired yet, so that's why I'm writing this now. I may even do some homework while I'm awake, but we'll see. Fortunately I don't work tomorrow, so I'll have the chance to get caught up on some assignments/studying. This coming week is my last week in the ED, which is crazy! Kinda sad because I do like this setting and I love all the cute little kids that let me examine them, but also glad to be moving onto sometime other than pediatrics.

Some things I've taken away from this rotation: 1) I love acute care, but the ER scares me sometimes. 2)  you lose all sense of time while working in the ER. 3) You no longer know what weekends are or what they're meant for. 4) kids are cute, but screaming kids are not. And kids that spit on you because you're trying to take their IV out are also not cute. 4) Examining a baby is torture. 5) Not all attendings are nice. 6) Parents LOVE reassurance. 7) the ER is abused by people with nonemergent complaints that are virtually a waste of your time, although you can't tell them that. 8) The good thing about the ER is the wide variety of complaints, which keeps things interesting. And 9) Working in the ER is tough.

Children's update #2

So the more I'm working in the ED, the more I like it. I still am not seeing a ton of patients on my own, but that's okay. I'm meeting more and more residents and attendings, and so far I really like them all. They're all really helpful, and the attendings are great teachers (well, most of them). Haven't seen any really interesting cases yet, but hopefully I'll get to observe a few traumas before the rotation is over.

On Thursday I worked my first overnight shift, 11PM-8AM. I tried to sleep in that morning, but it didn't really work. Luckily I barely even got tired during the night. I also worked that shift with a friend from my class, so that also made it easier to stay awake, and it was just a lot of fun. It's been fun getting to work with other students and residents, which surprised me, because I thought I would hate it. Anyway, that night I always had at least 1 or 2 patients, so I stayed busy pretty much all night. I saw a total of 6 patients that shift, which is a lot compared to what I've been seeing on a normal day. I liked that there were only a few people working, because I got to see more patients and it was easier to find my preceptor and get patients in and out on in a timely manner. That shift was also the first time I got to work with my actual preceptor for the rotation. He is nice, but doesn't talk very much. I kind of like having a lot of different attendings because they each give you a different experience, but at the same time, it is hard to gauge how much you're improving.

When I got home Friday morning I tried to stay awake for a little bit, but that didn't happen. I slept for like 3 hours and then stayed in bed for a bit and watched netflix. Then I just didn't feel well at all...I think I might of got food poisoning or something. So I stayed in bed basically the whole day and fell asleep around 7PM for the night. I must say, even though I loved working the overnight shift, it really really messed up my sleep. Kind of sucks I only work 1 more 11-8, but also kind of glad to not have my sleep cycle messed with.

This week I work 4 days and then I'm off 3 days. I'm going to Hocking Hills for our annual fall family reunion, so I'm pumped for that. It's always a lot of fun, and Hocking Hills (or Old Man's as we call it) is always so beautiful this time off year. Hopefully it cools down for the weekend, as it's been a little too warm for my liking lately. 

Well that's pretty much it...Hopefully this week is more interesting so I'll have some stories to share next time I write!

Children's ED Week 1

So this week I started my pediatric rotation in the Children's Hospital emergency department here in Pitt. The first day was just orientation, where we kind of got familiar with the electronic records and how to get around the unit. Not a whole lot of instruction from the preceptor. Basically he just said that we'll be acting as hired PA's and to just show up and start working. Which was a very scary thought and still kind of is!

Tuesday was my first day actually working. I showed up at 10AM. I only saw 2 patients on my own throughout my entire 8 hour shift! It's really hard to get signed up for a patient because there are always so many attendings, residents, med students, PAs, PA students...And since the PA students have to first get permission from an attending, the residents always snatch up the patients before we get the chance to even ask. So that's a bummer. But it was nice having my own patients and being in charge of their care. My first patient was a 15-year old male with a shoulder injury. The second was another 15-year old kid with costochondritis. The patients that we are allowed to see are the pretty easy ones...We're not allowed to do procedures or handle complex or critical cases. I'm okay with this, because emergency medicine is very intimidating to me! Although I would like to be able to do procedures! There are a lot of people that come in with abscesses, and I wish so badly we could do INDs!

The next shift I worked was on Thursday, 5PM-1AM. When I got there, I think there were like 18 providers working my unit. It was insane. Needless to say, I did not get to see any of my own patients for quite some time. I did get to shadow some residents and see patients that way, so that was nice. Then I also got to assist in a fracture reduction. It was a 7-year old girl who broke her arm. After she was sedated, the orthopedic reset the fracture and casted it. All I did was hold her arm, but it was still cool to watch. The only patient I saw on my own was a 9-year old boy with an asthma exacerbation brought on by a virus. Nothing too crazy.

So far I have had really awesome attendings. They are very helpful and willing to teach you. So far they haven't criticized my presentations, which I am bad at, but rather have focused more on the information I am presenting and what things I may have missed. The only bad thing is that there are only 2 attendings working at a time in my part of the ED, so it's really hard to find time to present or ask for their advice/help, etc. All of the residents and other students have been great too. All have been very nice and are willing to let you shadow or to answer questions about documentation, etc. Hopefully I can get involved in more cases with the residents and really get a better sense of what the Dr/PA relationship is like.

Overall, my experience so far has been mediocre, but hopefully things will pick up! I'm not sure how I feel about emergency medicine, but I definitely like the acute care setting. So, we'll see what this next week holds. I work tonight 5-1AM. Then I have 2 days off and then work 3 shifts in a row: two 10AM-6PM shifts and one 11PM-8AM shift. I'll be sure to update next week and let everyone know how the week goes!

Psych: coming to an end

Sorry for my lack of updating! Honestly, not much has changed since I last wrote. I will admit that I don't hate psych as much as I did before! So that's progress. But it doesn't matter now because tomorrow is my last day and I must say that I am actually pumped to get back down to Pitt. Rotation #4, here I come! I will be down working in the Children's hospital emergency department, so it should be an interesting rotation for a couple reasons: 1) first emergency med rotation; 2) I'll be working with several other students; 3) I don't know much about peds; and 4) I don't like peds that much. Bet that last one surprised you, considering the family I come from :)

So yea. That's pretty much it. I'm only really writing because I'm putting off remediations, but I guess I should just finish them.  So wish me luck! Hopefully I'll have lots of funny stories to share!

Psych update #2

Well, I’m now 2 weeks into my psych rotation. Not a lot has really changed. I’ve been observing a lot of med checks/evals and writing and dictating my notes. I did, though, start my in-patient rounds at the hospital on Monday.  There is a guy there now who is schizo and thinks that there is bad stuff in his body. So, to deal with this, he’s been eating inedible objects like coins, lighters, paper, etc because he thinks by doing this the bad stuff will come out. There’s also a woman that has grandiose delusions and thinks that she used to be really rich but had all her money stolen, used to write plays, be really accomplished, sell insurance annuities, know famous people, etc. The sad thing is that she doesn’t think that anything is wrong with her. It’s amazing sometimes how the mind plays tricks. Other than these patients, I haven’t seen anything too crazy. Mostly because the patients I do see are already medicated and fairly stable.

I will say that even though things haven’t been too exciting, things have been pretty stressed at the office. There have been some serious things going on that I can’t talk about, and that has really changed the mood and tempo. Getting very backed up on some days, and a lot of people are cancelling or not showing up. Hopefully this slum doesn’t carry over into next week…

Only 3 more weeks to go! Then I’m off to Pitt for rotation #4. Originally I was supposed to be in Mount Vernon for my peds rotation, but it got cancelled. So now I will be at Children’s Hospital emergency department. It’ll be interesting how that goes. Even though I have a lot of kids in my family, I’m really not interested in working with them haha. We’ll see.

That’s pretty much it for now! Hopefully next time I’ll have more interesting things to talk about!

P.S. Still don't like psych that much.

ok, psych.

So on Monday I started my psych rotation in New Castle, PA. The first part of the day consisted of getting badges made and getting my drug screen. Then I observed my preceptor as she did her psych evals and med checks. Honestly, it was not a very interesting first day. Maybe because it really was just a boring day, or maybe because I really don't like psych that much right now. Time will tell, I guess.

On Tuesday I observed still some more. Although this day was more interesting than the first because we had a fellow referred over to crisis because he was having homicidal thoughts/plans. He ended up getting angry with the crisis guy and walked out of the office. Eventually the cops were involved and the fellow was taken over to the hospital. That was my first patient of the day. From there I observed and took notes, then wrote up my notes, and then dictated my notes. I was a bit nervous dictating on the phone for the first time, but it got easier each time I did it.

There is another student with me, so that means, for the first time, I have to share my preceptor. But anyway, she is very nice and we get along well so far. My preceptor is very nice and I like her a lot. Although I am a bit disappointed she has not asked more questions about psych conditions and medications. Maybe all that comes a little later.

The rest of the week I am off because my preceptor won't be in the office. Kind of nice because it's extra time I have to get homework/reading done. Except, I have done a very minimal amount of that, so it really hasn't been all to productive. I did, however, go to a Mumford & Sons concert last night! And let me tell you, it was absolutely phenomenal. It was at an outdoor venue, and completely packed. All kinds of different people showed up for this thing. And the band was amazing. They sound even better live than they do on their records, which says a lot. True talent.

Right now I'm in the library because I don't get wifi in my apartment. I absolutely hate the library for anyone who didn't know already. It's just a weird place and way to quiet for me. But it'll have to do for this rotation I guess. Oh, and I forgot to mention that I have two roommates. They are female PT students doing their rotations at the hospital. Both are very nice! But it's kind of an inconvenience because I'm currently sleeping on a pull out bed in our very tiny apartment. Again, it will do for now. At least it's free:)

That's pretty much all there is to say for now...Wish me luck as I try to conquer this psych stuff!

MUMFORD @ First Niagara Pavilion

back from Alaska!

So I just got home from Alaska on Sunday. I had the time of my life and loved every second of my time there! I absolutely loved working at the Urgent Care and learning from my preceptors, who were both eager to teach and help you out in any way. The staff there was also one of a kind, and I was so surprised by how welcoming each and every one of them were. The camaraderie I experienced there was some of best and I will really miss working with such amazing individuals.

Juneau was also a huge eye opener for me in terms of health care access. Even though Juneau is the capital of Alaska, it is not big at all and there are limited health care services available there. There is 1 hospital, and this hospital is only a level 4 trauma center. The emergency department has only 1 doc for each shift, and 60-100 people are seen there each day. All major cases have to be flown out to Anchorage, Seattle, or somewhere else that offers the appropriate services. Additionally, specialists only come into the city every so often, so when they do come into town, there is a long wait time and they are always completely booked. To compensate for all this, there are the PCPs. They manage a TON of stuff. It just goes to show how much need there is for primary care services in order to reach all the residents and tourists alike.

The weather in Juneau was fantastic and some of the best they've had in awhile, so I got very lucky! It didn't get dark until almost 10:30-11 PM, so I was able to do A LOT of stuff while I was there! I was also lucky to have some really good friends to share in all the fun with :) They truly became like family to me and I will really miss spending time with them all. Lots of late nights, fun times, laughter, and good conversation. Can't ask for much more than that!

A lot of firsts took place in Juneau, and I wouldn't change any of those experiences! First time in Alaska, boating, seeing bears and eagles, suturing, draining abscesses, eating king crab, standing in the Pacific ocean, standing on top of a glacier, drinking fresh water straight from a stream, and so many others. Love that I got to experience so much!

Things I will miss the most about Juneau:

-mountains in every direction

-amazing sunsets

-the smell of the sea

-working in the clinic

-walking around downtown

-hiking

-my Puerto Rican family

-brunch

-Front Street Clinic

-seafood

-Sunshine Lattes from Heritage Coffee

-pretty much everything :)

The one thing that will not be missed: the prices!

Loved Alaska so much and hopefully I'll get to go back someday. But for now, my psych rotation in New Castle, PA awaits me. 2 rotations down, 7 to go! Bring on the new adventures!

more fun in Juneau

So on Friday I finished my first full week at the clinic! It was a great week and I already love where I'm working and all the people I'm working with. I've been getting to see a lot of patients on my own, which has been awesome.

On Thursday I headed downtown to work at the homeless clinic. I'll be there every Thursday. It is A LOT slower paced with a much lighter patient load, but this is because the NP really wants to establish a good relationship with her patients. After work I got to walk around downtown Juneau a bit, which was fun. It was a bit chilly and overcast, but cool because it's very touristy and there are a lot of foreigners because of the cruise ships that dock there.

Friday I started working with the other doctor in the clinic. I will be working with him while my main preceptor is away. Every 2 weeks he heads home to NY and the other doctor comes in. It wasn't a super busy day, but it was very relaxed and overall a good end to the week.

On Friday night I headed downtown to see a movie with some of the other younger folk that live in the building. I don't know if I mentioned this, but there are several people that live in the clinic. My preceptor owns the clinic and rents out some of the rooms upstairs and downstairs. Most of us work in the clinic, which is fun because it's close-knit and friendly. I currently have two apartment mates. One is the doc's nephew and the other is another PA student that just arrived. Then next door is another girl who works down in the clinic with me. Today we all went down to the Glacier and hiked around in the rain, which was cold and wet but fun at the same time. We then came back and had a "family dinner". It's nice having some friends and I think we'll have a good time together over the next couple weeks exploring Juneau and doing fun things outside. I have a feeling I'll be sad to leave this place because I already love it so much.

It's supposed to rain pretty much all week, which is a bummer because it was sooo nice the first few days I was here. Hopefully it won't be too rainy and I'll still be able to get out and do some stuff. At least I'll be working most of the day, so I won't be too antsy to get outside in the rain haha. Well I think that's really all for now. Here are some more pictures!

 Salmon Hatchery

 Mendenhall Glacier

 Nugget Falls. I was soaked wet here!

 Downtown Juneau harbor.

ALASKA!

So a lot has changed since I last posted, with the biggest change being that I'm currently in Juneau, Alaska!

I ended my rotation in Coshocton last Thursday. I think overall it was a good way to start my clinical year because I saw a lot of different things and I was able to observe the way the MD manages each case. Wish I could've done more, but I think I'll be making it up during this rotation.

Saturday morning I woke up around 3 AM, got ready, loaded up the car, and headed to the airport. My flight to Detroit was scheduled for 6:30 AM. I then had a layover in Detroit, followed by Seattle, and then I arrived in Juneau at about 2:30 PM Alaska time. That evening I got to meet some of the staff, including my preceptor, who was working weekend clinic hours, and got settled in my room, which is located directly above the clinic (which is sooo nice).

On Sunday I pretty much just worked on hw most of the day. Then that evening once the clinic closed, I went boating with some of the other people in the building. It was a lot of fun! My first time boating, I think. I got to see several whales surface and got to go fishing, although I didn't catch anything. And I was just able to relax and get to know some of my housemates, so to speak. Oh, and the view was absolutely gorgeous! Mountains all around, clear skies, awesome weather, beautiful sunset. It was just great.

Today was my first day at the clinic, and what a day it was.  Working hours here are 8 AM - 7 PM. Totally opposite environment from what I was doing in Coshocton. It was time to put all my skills into practice. I saw handfuls of patients on my own today and got to present to the preceptor and come up with an assessment and plan. I was able to suture for the first time, assist in the removal of a fish hook from someone's hand, debride wounds and dress them, pack an animal bite wound with gauze, administer local anesthesia, and do lots of charting. I made several mistakes, but they are mistakes that I'll learn from. And looking back now, I'm glad for all of the observation I was able to do at my previous rotation because I didn't always go into the room with the doc. So I'm glad I have that experience.

So all in all, it was a great day. Busy, but great, and I learned a lot. Hoping the rest of the rotation is just as good. Only bad news I received today was that I apparently missed a spectacular display of the northern lights last night, because I had fallen asleep while writing my remediations. Ugh.

That's pretty much all there is to say right now, so I'll post some pictures instead! Juneau is beautiful! Love it here.

 View from one side of the clinic, and below is the clinic I'm living/working at.

 Holding a rockfish that I didn't catch, but wish I had.

check out more pictures on my facebook!

ultimate Alaska playlist

Of Monsters and Men

"Dirty Paws"

Looking for some music to add to my "ultimate Alaska playlist". This song right here is one of my current favorites and definitely makes the cut. 

What are some songs you would add to your "ultimate Alaska playlist"? Leave a comment here or on facebook with your suggestions to help me create mine!

patience with the patient.

I've just finished week 4 of my first family medicine rotation. Only 2 weeks to go!

There really isn't much to say in terms of what all I've been doing and seeing... I'm still observing A LOT and still seeing a lot of diabetes, COPD, hypertension, back pain, etc. Kind of disappointed I haven't been able to do more, but such is life.

One thing that has been nagging at me is my attitude toward this rotation. One thing that I really looked forward to was being able to assess a patient's condition (by asking questions and performing a physical exam) and formulate my own assessment and plan. Although I already do that in my head, I was hoping for more opportunities to present my ideas to my preceptor (which I don't get to do often). I was also hoping to get "pimped" a lot on all the common things that I will see in primary care (pimping is when the preceptor asks tons of questions in a row and essentially makes you feel like an idiot). This also does not happen often. So I'm kind of bummed, but whatever.

Another thing that I really need to work on is patience. Now, I don't really show when I'm impatient, but I definitely feel it a lot. In particular, I am very quick to judge and become suspicious of patients who need pain meds. In my head, THEY ARE ALL DRUG SEEKERS. Or people that just complain all the time about everything. They come in with aches and pains all over. 

Do you have headaches? "Oh yes I get migraines all the time." 

Okay, well have you been feeling tired? "I can't seem to stay awake!"

Do you have any numbness or tingling in your legs? "Both of my feet are numb right now."

...Alright, well do you have any back pain? "I've had back pain since my slipped disk 10 years ago."

Suspicion, suspicion, suspicion.

But really they're just people with vague complaints that want some relief.

As a health care provider, it's so important to lay those prejudices, judgments, and suspicions aside and treat all patients with the respect and care that they deserve. It's our job. It's our job to take a person's vague complaint and turn it into a diagnosis. People really do have problems and they really do need our help. Some people really do need percocet and vicodin. Pain is real. Sometimes it really seems like people are faking because sometimes things don't quite line up as they should, but that's medicine. Patients are different and medicine is variable. It would be unacceptable to turn a patient away because of suspicion when they really do need our help. So, I'm working on that.

I'm also working on getting ready to go to ALASKA! Woo! I'm going to be in Juneau for a 5-week family medicine rotation. So pumped. Mountains, glaciers, hiking, kayaking, whales, exploring the beaches and downtown, working in the clinics, and so on. Alaska is going to be fantastic. The only downer is that I'm going to be alone a lot of the time. So, if anyone knows people in Juneau that will go exploring with me, call them up right now! I'm so desperate for a hiking buddy that I've even gone to the extremes of couchsurfing.com. No kidding. But companion or no companion, I'm sure I'll still have a great time.

Alright, well that's pretty much all I have to say for now! Thanks for being "patient" with another long post. I promise I'll try to keep it shorter next time!

3 weeks late...oops.

A little late, but I'm finally posting something!

So, I started my first clinical almost 3 weeks ago. I'm currently in Coshocton, Ohio for my family medicine rotation. If I could describe my experience in three words, they would be diabetes, hypertension, anxiety. Pretty much EVERYONE I see has at least one of these if not all. Oh and COPD. Everyone smokes! 

I'm currently at two clinics and following three preceptors. They are all very young and currently working their first real jobs. Two are medical doctors. One is particularly interested in internal medicine, and the other did a fellowship in sports medicine. Then I'm also following a nurse practitioner. It is interesting for me to see the differences in the way all three of these preceptors practice, even when they are all so young. Some are a lot more conservative in their management, while others are not.

Since this is my first rotation, I'm still mostly observing and trying to soak everything up. A lot of the appointments I see are to manage chronic conditions, so they consist of medication changes/refills, lab work follow-ups, and stuff like that. A lot of zoloft, a lot of percocet, a lot of insulin being prescribed on a daily basis. Many patients may walk out of the office with 3-4 new prescriptions in hand. It's insane. Every once and awhile I will get to go into a room myself and ask the patient questions and perform a quick exam. I've correctly diagnosed a few patients, so I'm pleased with that! But more often than not, I don't quite know what exactly is going on with the patient. Hence, the reason why the clinical year is a learning experience! I've also been able to assist in a few things, like knee injections, skin lesion removals, and I've even done a few pap smears on my own. Call me nerdy, but I love it all!

Most of what I have learned so far during this rotation is not necessarily medical knowledge, but rather practical knowledge that will help me be a better provider to the patients. Putting the patient first can be difficult at times because a lot of times you're just thinking about trying to fix the problem when you should be dealing with the patient as a whole. Every patient is different, so the listening part is really important. But it can be so hard though, because a lot of patients will literally talk your ears off! But I think forming that relationship is very important, especially in family medicine because you're managing chronic conditions, and essentially, a person's life.

When I'm not at the clinic, I'm studying, or trying really hard (or not so hard) to finish assignments and study. There was a point in time where I thought, "Oh, I'll have a ton of free time during clinicals to read books and what not!" NOT TRUE. Although I have spent a lot of time watching Grey's Anatomy. Oops.

Overall, this has been a good rotation. It started off slow, but has been getting better as time goes by. I'm just trying to make the most of the experience and get what I can out of it. I'm sure all of my rotations will have something different to offer that will be beneficial to my career :) Well, that's it for now! Props to you if you made it all the way to this point! I will try to write more often so they are not as long!

pretzels.

 Dough ball.

 letting it rise.

 meanwhile...highlander grogg...

...and pinterest. 

done rising! 

 rolling them out.

post-oven. 

topped off with cinnamon sugar.

That's what I did today.

What did everyone else do?

{life} lately.

this right here...completely taking over my life.

beautiful fall days.

apple cider. mmm.

kayaking on the allegheny.