A little bit of practice….

I love being in clinic. Seriously its so much fun. I hope I still love it in 10 years… I even didn’t mind being in a family med clinic, although I did get very excited when we saw kids…

Chronic Pain Clinic

I saw three or four patients who had pain contracts with my attending. One patient had a form of Elher-Dalhoe’s (kind of distantly like Kniest) even. Despite my constant attempt to suppress the little judge that lives just south of my spleen, he was very persistent. I couldn’t help but compare their situations to my own and I couldn’t help but look at their decision to take neurotics as a negative one. I tried so hard to remain neutral and impartial but it was so difficult. I felt a little sad each time a patient would leave with more drugs and would not hear of any alternative to them. My attending who himself has a chronic health issue (very different than mine) told me that my response was completely normal and that I had a right to an opinion on the topic. He said I would become more impartial as time wore on although no less secure in my own standards. I hope he is right.

Kids, kids, kids!!!!!!!!!!!!!!!!!!!!!!!!!

Every time a kid would come in, I would get so excited. We did a handful of well child checks in which my attending would allow me to participate more and more in as the 2 weeks went on. I realized as time went on that I had never really attempted to examine a kid and for all my talk about peds had no clue what I was doing in the beginning. On my last day there we had 2 kids come with URIs, he handed me their chart and told me he was going to take care of the elderly woman in the next room. It was 2 brothers a 3 yr old and a 5 mon old. I walked into the room and tried to act like I knew what was going on. I got a decent history from the Mom/ 3 yr old. Then came the PE part. Now my PE skills have improved dramatically and I have a half decent shot of doing things well on an adult. But as much as I love kids, its hard to get them positioned and cooperating for a good PE. I was totally blessed with the world’s most cooperative 3 yr old. He was completely ok with having his ears, mouth, heart and lungs examined. I didn’t even have to put him in his Mom’s lap. Then came the 5 month old. He was not as easy but after some play with my stethoscope and sitting with Mom, I got at least a glimpse  of everything I needed to see. I presented the cases to my attending and was throughly pleased with myself. I had not done a perfect job but in 2 wks I went from having never laid hands to examine a child to doing a full URI work up on a pre-schooler and a infant on my own. And I generally enjoyed the extra effort and creativity it took to get the kids to cooperate.

I had one kid from the class I teach at church show up in the clinic. And it was really neat to see him another setting and be a part of his care.
Heart Sounds, Blood Pressure and UTIs (Urinary Tract Infections)
Med school is at times a very, very FUTILE endeavor! I know that I don’t know that much about anything yet but there were times where I was still very frustrated with how little I knew. My attending asked me, “What is the most common cause of UTIs?” And I admit, I have no clue despite the fact I have already had micro. He says, “Ok let me give you a hint, gram negative, lactose fermenting rod.” And I think in my head E-coli…but NO it can’t be e-coli that causes various forms of GI distress. So I come up with some alternate answer… the answer is of course e-coli. I go home at lunch and I look up my e-coli lecture. There are 30 slides on EHEC, ETEC, EPEC….(traveler’s diarrhea in various varieties of severity), there is one sentence about E-coli being the most common causes of UTIs… UGH! How frustrating. The UTI fact is much more important relevant yet that fact was not on my exam.

I knew my heart sounds knowledge was weak. We have not done cardiac phys  yet and I really had only heard normal heart sounds. So I  was somewhat ashamed at my igorance when my attending started asking me what part of the cycle murmurs were from. But by the end of 2 weeks my skills had again improved dramatically and I was getting at least OK at differentiating systolic and diastolic murmurs.

My worst part of PE coming into my clinic experience was taking Blood Pressures. There is simply too much to do. I can’t hold on to everything and listen all at the same time. But I finally figured out that if I have the patient hold the bell of the stethoscope, I could actually  quite accurately get the BP. I am so grateful that this problem has finally been cleared up.

Procedures: Pap Smears, Heamatomas, Stitches and More

I have the world’s coolest attending who for some insane reason let’s me a mere first year get all kinds of hands on experience. I can talk to people all day long. I can take histories and listen to people’s stories till the cows come home but put a needle in my hand and I panic. To some degree I have a complex, I have had folks telling me since I decided to go into medicine that my hands will make procedures difficult and thus I believe they will. But the truth is I am not half bad at procedures, in fact with practice I am half decent.  I managed to tie my first suture, do a pap smear, 3 blood draws and drain the biggest hematoma I have ever seen…. Ok picture this, 25 yr old big atheletic guy gets his leg pinned to a wall by the tailpipe of a car. The guy is fine except for the fact his leg is three times bigger than the other. After a ultrasound, we discover he has a massive (like 1.5 ft by .5ft) hematoma. A week after the accident the leg had still not gone down so we decided to try to drain a little off. My attending sticks an 18 gauge needle in and nothing happens. He takes it out and all of the sudden blood spurts across the room, after quickly finding a basin, our patient proceeded to “leak” 500 ml of fluid. We stopped the bleeding at that point. 2 days later 500 more and 3 days after that, my attending handed me a 16 gauge needle and said GO. Scary…I know, me with a 16 gauge needle in my hand….

Surprise, surprise, surprise…

I was shocked how much I enjoyed taking care of elderly patients. I enjoyed listening to them and taking their histories. Not because they were complicated and usually had a variety of medical problems but because a good portion of their therapy seemed to be talking to someone about it all. Even the ones we could do next to nothing for seemed to leave genuinely pleased that we had taken time to at least listen to their problem and acknowledge their situations.

I quickly realized that continuity of care and variety are both important to me. I really thought prior to this that neither of these two aspects were all that important to me. But I really enjoyed building relationships with patients. One of my favorite patients turned out to be the guy with the hematoma because he was there every 2 days so I had a chance to get to know him and his family. The other than I really loved about family med was the variety. Take one hr of last Wed morning: 9 mon old well child check, STD check on 22 yr old Gay college student, med check on a 80 yr old, Pap smear and check up on a 40 yr old.  I loved the randomness of the primary care setting. I thought I would get bored in a primary care setting and there were mornings where I had 3 Back Pain cases in a row or 4 URI (colds).

The Thursday before I started clinic I shadowed a pediatric genetics specialist and although I enjoyed that too. I enjoyed family med so much more. I really think I will either end up in general peds or family med. It will be interesting to see how much I still love family med after 8 weeks of it in a foregein  language.