We eventually make people happy in the ER. They come in hurting. They wait around until they are hurting and frustrated. Then we poke and prod at them so they are hurting, frustrated and bleeding. Then we give them Percocet and they leave stoned and smiling, thanking you for all your hard work. Another satisfied customer, ready to spread the word of the great care they received at Whidbey General.

(Graph is from Typhon and shows my prescribing trend in the last 9 days.)

The Top 3 Reasons Why The ER Nurses Hate Me

1. I still haven't brought donuts (insert derogatory comment about them needing more celery sticks and less donuts)

2. I haven't gotten kicked in the face by a psych patient yet, which when it did happen to a previous student was apparently quite entertaining to the nursing staff, and furthermore has set the standard pretty darn high for future students (and future psych patients).

3. I ordered 4 enemas last night. I think there is a salad shortage on the island. Things got messy. I click a button to order it and they put the face shields on and head into the trenches, not happy.

Started my shift yesterday with a 66 yo with no previous history of anything in cardiac arrest. CPR, shock and epi on scene, now he has a perfusable rhythm and a BP of 220/112.






Ended the shift with a felon. Doc lanced it, I only watched. next one is mine.













Today's theme: Prison, which is where I am headed next. Just emailed them. Still seems like a long way off. For a preview check out www.dontjust.blogspot.com

Saw a 12-ft fall from tree, and a dog bite. Apparently on Whidbey, the falls and the bites can get a lot worse. I will be waiting with my Morphine and Sea Lion Anti-Venom at the ready.

Click to make the Whidbey Island Wonders bigger!

Intros

You walk in to the room and introduce yourself as the Physician Assistant Student. How do you enunciate and emphasize these three words?

a)physician assistant student…they think you are speaking a foreign language, you must emphasize something!
b)PHYSICIAN assistant student…they think you are the doctor
c)physician ASSISTANT student…they think you are the MA or nurse or clerk
d)physician assistant STUDENT…they tell you their neighbor’s son also went to Med School and..
e)PHYSICIAN…ASSISTANT…STUDENT…..they are offended that you think they are deaf & dumb

Answer: I have been going for option d) as it highlights the most important word and lowers the patient expectations to a level that I can hopefully meet or even exceed.

You reap what you sew

Sewed up my first patient today.
All week we couldn’t buy a good Newbie PA-S laceration.
“Oh this guy bit his cheek and he’s on Coumadin and the lac is about halfway down his throat…”
“Oh now this one is on a 23 month old kiddo and mom and dad are freaking out”
“Oh this one is on the finger of a old OR nurse who got fired from here and has anger issues and she’s been telling everybody how looooong she’s been waiting (1hr30min) and she’s mad and she wants an ortho consult and she…..”
“And this one….”

I wondered if I was going to have to go down to the Coupeville Butcher, buy a pig’s foot, put a gown on it, slather it up with some Hibiclens, slap it down on an exam table and start sewing to get my fix. But no, I was just waiting for the right patient to arrive. And arrive that patient did, tonight. No, not a 23 year old macho guy. No, not a scruffy red-nosed fella too drunk to know he’s not still at the bar. No, not even a 17 year old who thinks a scar is like a ticket stub proving you paid your way into manhood. My perfect patient for my first sew job? 10 year old girl. Talking about ponies the whole time. And kitties. Bravest patient of the night. Inquisitive, but trusting. Scared, but not whiny. Dad in the room with calming words but a look on his face that told me he wasn’t coming anywhere near the bed, the needles, or his daughter.

From the moment she dropped the sharp garden shears and they plunged into her calf, I think she knew she was getting stitches. What she didn’t know was that she would have a skaky, sweaty, nervous PA student put them in.

I write this from bed with a celebratory beer on my left and Henri, the big black dog on my right.

Learning Curve

Entering two days worth of data into Typhon before I go to work in an hour has stolen time from creative writing so here's a couple quick things I learned over the last 2 days:

If your wife is choking down a big horse pill and you give her the heimlich, you will still have to come to ER to treat the broken ribs.

If your mother is nice enough to give you her kidney, DO take the meds they tell you to, and DON'T take the kind they sell on the street, if you want to keep your mother's kidney working.

If the PA student before you brought the nurse's donuts you will not make friends with said nurse's until you also bring donuts to said nurses.

A 2 year old can be easily restrained with a properly used pillow case.

If your furniture store is having a Memorial Day Sale and your employee is out with the dreaded H1N1 flu, do not attempt to move 300 lb furniture all by your lonesome.

Gotta go learn some more...bound to get a little nutty w/ the holiday "island" crowd.

My weekend came early, so I’ve been playing tourist. The owner of this house spends Tuesday through Thursday in Seattle & Bainbridge Island, so the place is all mine. From where I sit and type this I have an expansive view of Admiralty Bay, the Keystone Ferry Terminal, and the beginnings of the Strait of Juan de Fuca. From here I watch huge cruise ships carry people out to sea and Navy warships sneak around. I watch the Port Townsend Ferry come and go, and the orange wind sock at the marina keeps its steady westerly position. A virtual variety show of unidentified birds fills the prairie in front of the house, but continually pay visit to our deck and birdfeeders. Deer lay around the backyard under the shade of an apple tree and watch the rabbits poke around the grass. I can’t make this stuff up! Even the house is like a shrine to nature. I am surrounded by what we call Natural Wonders. Driftwood, shells, rounded glass, buoys, old bottles, feathers, rusted scrap metal, skulls, rocks and dried leaves are intertwined into this living space of furniture, artwork, plants and appliances, with the artistic eye of a museum curator, the naturalist eye of a park ranger, and the beachcomber eye of somebody who has spent decades strolling the shores of Whidbey Island.

And what did I see underneath the Hawthorne Bridge in downtown Portland that one might think I would see here on the Island? If you guessed Sea Lion, you’d be right. Apparently they make 3-4 day hunting trips (some from as far away as San Francisco) for the spring runs of several fresh water fish. We were fortunate to see one surface as we rode our bikes over this city bridge last week.

I swear I am studying medicine, not wildlife biology. While it’s been fun being a beachcomber, hiker, birdwatcher, and coffee shop dweller for the last few days, I am ready to get back to the hospital and be a PA student again.

From: 1:32, Tuesday, May 19th
It’s after 1am and I am wired from my first ED shift, so before I sleep it off, let me unload: First, not much sleep last night (nerves + sore throat + chills). Second, early morning to get to the hospital for HR paperwork, etc. Third, as my shift starts one of the docs says to me: I’ve never started a shift this busy. My preceptor comes an hour later and we hit the ground running. 22 patients:
Vertigo
N/V/D x 2
Can’t swallow after tonsillectomy
Syncope
Snowblindness
Back pain x 2
Cellulitis x 2
Chest Pain x 2
Humerus Fracture
Toe vs. Soccer Ball
Dystonic Drug Reaction
IBS x 2
Pneumonia in Lung Cancer Pt
Viral Syndrome x 2
Hypertension and swelling
DVT
The youngest was 4 months and the oldest was 88 years.
I got my first pimping an hour into it. “What kills patients with aortic dissection?” I got it wrong, incorrectly guessing that it ruptures and the patient exsanguinates. He knew the answer, because just the shift before he had cracked some dude’s chest in the middle of the ER and released the pericardial tamponade. He was the talk of the town and the buzz was still palpable in the ER. It was a fair question.
I won’t typically bore you with a list of patient diagnoses in future posts. But I thought this would give you an idea of what I may see in the ER. Plus, without the camera cable I have no pictures yet. Thus, I am working on the 1000 words necessary to match what could have been uploaded in a few seconds.
I am off the next two days. Goals are 1: kick this cold (only had one during didactic year, hoping this is my one for clinical year). 2: review some things like ortho that I have forgotten all about. 3: Explore WI. 4: Resist the temptation to go snowmobiling, run out of gas, get left by friends high in the mountains without goggles or sunglasses and burn my corneas.

'Twas the night before....

Made it to Whidbey today. Time 4 hours 20 minutes, slightly longer than the 3 hours I had been telling myself. Got stopped by a draw bridge heading out of town, but made up some time by pulling into the ferry dock just as the ferry was pulling up. Tammy's house is beautiful, expansive view of the snow-capped Coast Range, the sound with cruise ships, sailboats, and ferries coming and going, and an abundance of birds, gardens, art and comfort. I can't wait for Audrey to come visit, as it will feel like a little island vacation for us.

Right now sitting in the parking lot of the local (and closed) coffee shop that must have some wifi. Downside to my digs: No Internet. I may have to blog via MicroSoft Word, then make a stop by this coffee joint to upload. Oh and so far the only thing I have forgotten from PDX is my camera to computer cable. Upside: I didn't forget my stethoscope. Downside: You will have to wait a week or so to see the crazy pics this place has to offer. Here is one lifted from the web that feels the closest to what I saw today. Cheers-CD

From Sitting to Running

Tomorrow is the last day of clinical seminar week, thus concluding our didactic year of PA school (didactic can be loosely translated to the act of sitting on one's duff, being annihilated by 238 slide PowerPoint presentations, then going home to read obscure medical texts until you wake up in a pool of drool). In summary of this year, I feel like I have learned a ton, met some great people, and pushed myself to do things I thought previously impossible.

The true clinical year starts on Monday morning when I report for duty at the Emergency Department on Whidbey Island. This will be the start of 15 months of a whole different story. I expect no sitting, and no PowerPoints.

I have recently found out several new rotations on my schedule. Listed on the right of this blog, you will find the dates and locations. They have been left generic for a reason. Places, names, and specific information will be left general, generic, and at times completely made up . HIPAA (privacy laws) as well as common sense dictate this. I would like to be candid about how my rotations are going so that the reader gets a feel for how life on rotations actually is. If I listed doctor's names or specific clinic names I would put my anonymity in jeopardy. You can help by not using any known/specific names in of your comments.

So here is a quick rundown of my newly scheduled rotations:
#4 in La Jolla, CA....hopefully a mix of surfing, spanish, and internal medicine, not likely in that order. The hospital is a few miles from this point.

#6-#7 in Hood River, OR.....I will likely be living in Portland for this one, making the wintertime commute through the Columbia River Gorge each day. Will be worth every mile to sleep in my own bed, while still having a great rotation in a cool town that has been on our list of "potentials" for a while.


#8 in Portland doing my clinical project. This will be a nice reprieve. I picture myself hanging out in a coffee shop drinking espresso and surfing the InterVebb. It may actually be more work than that.

#9 Trauma. 12 hours+ a day x 6 days, switching between day shift and night shift. As this rotation is in Portland, I will technically be sleeping at home, but essentially living at the hospital.

#10 Ecuador. Can't Wait.

Disclaimer: Any and All of these rotations can and will change, at a moments notice. The more I get excited about any particular city, clinic, afterwork activity, or housing situation the more likely it is to change.



Stay tuned....thanks for reading, thanks for your support!!