High Points

A decidedly non-medical post. After 2 weeks of seeing 20+ sniffly kids a day, I am little burn out. Would rather post some photos of decidedly non-medical trips we've taken over the last year in a half. So here is a Northwest Volcano Pictorial:

Mt. Adams from a fire lookout

Mt. Baker from a ferry

Mt. Hood from a ski tour

Mt. St. Helens from Mt. Adams

Mt. Adams after our car almost almost caught on fire.

That's all. Will now resume regular programming as scheduled.

Rising Waters

9am-5pm Day Clinic; Saw twenty kiddos in varying states of stress, illness and general outrage toward me and my otoscope.

6pm-9pm Night Clinic; Saw seventeen kiddos with varying degrees of vomiting, diarrhea, and general fluids erupting from orifice.

10 pm Home in Cold Attic; I learn that the waters are rising on the Chehalis River and the Newaukum River. River will reach flood stage tonight or early tomorrow a.m. Interstate 5 may close which would prevent me from getting to the clinic. Apparently if the Skookumchuck River gets to Phase 2 (not that high) then I will not be able to leave the house, as the small Dead End street I live on will be surrounded. At least I live in the attic.

Photo from Today's Lewis County Newspaper

Breathtaking

Nurse Practitioner (NP) student comes barging in out of breath, late on her first day. To be fair, the fact that she is an NP student doesn't mean anything. She could be a PA, MD, DO, PT, MA, or MSW student. She could be a law student or a MBA student. I don't care. But, truth be told, she is an NP student. And she is a train wreck.

Within 10 minutes she is already starting an argument with the PA about how much better NPs can and will be because they can practice independently.

Within 20 minutes the clinic staff have all heard how amazing she is and how much vast experience she has as a nurse, including how many IVs she has started in her life.

Within 35 minutes, I begin to wonder why she is still out of breath.

Within 36 minutes, I realize that perhaps she is out of breath because she is about 6'1, 260 lbs, built like a linebacker that doesn't do any linebacking anymore. I think she has COPD.

Within 2 hours, I have learned that she owns 5 boats, owes next to nothing on her house, and is for the most part the master of all things disease. At this point, I begin to think she is just out of breath because she never stops spewing words out of her trachea. Her poor vocal cords are too busy vibrating to let in some good old Room Air.

Within 11 days or so she will be gone, as her program only requires 90 hours per rotation. I will stay for another 20 days and 150 hours. But then again, I am not the master of disease. And I don't even own 5 boats.

Attics and Locusts

I find myself alone in a cold attic bedroom, in a strange town halfway between Portland and Seattle. Life as a traveling PA student, at the mercy of the next clinic, the next preceptor, the next dress code, the next temporary landlord, the next temporary landlord's water heater.

Can't complain too loudly, as I've got hi-speed wifi, a roof keeping out the incessant Washington rain, and plans to drive back to Portland tomorrow. Saw my first kid today who was born with meth in his system. Now there is somebody who could reserve the right to complain. His insides don't work so hot.

Shared the clinic with a NP student today. Wow. That is all I am saying for now. If I give it a few days, I will have material for miles.

On a historical note, this is my second rotation in a rural county seat. The first one was known for a Great Fire. This one apparently had a Great Flood. I feel like I am on a tour of modern day Plagues. If my next rotation has locusts or frogs falling out of the sky, I'm done.

Sin Numeros

"You guys and your numbers...", Audrey says after skimming my blog, something she claims to do anytime there is medical jargon or numbers involved. It is true that my audience is likely a mixed bag: A few fellow students that may think it's neat that I saw a twelve year old with pulsating pupils with adrenal insufficiency and some family or friends that just like updates assuring them that I am not locked up in a Tijuana Jail.

So, for the mixed bag I try to bring a mix. I may write "UTI" one day and "bladder infection" the next. I am a little biased to "UTI" because: a) it sounds like I know what I am talking about b)it is shorter to type c) it's less gross then "bladder infection". Funny how the laymen term is more descriptive, a little more "in your face."

Heart Attack = MI
Anal Warts = Condyloma acuminata
Patient wants to Kill Herself = Suicidal Ideation or SI.

I'd rather have Condyloma twice then anal warts ever. I could go to the Walmart Clinic for an MI, while I may need an ambulance for a heart attack! People see SI and think you have a nice magazine subscription, not a need for anti-depressant prescription.

So I walk the balance of not freaking you out, not boring you to death, and not sounding like a total dork. So you will notice not one single number in this post. I even typed out the word "twelve". Enjoy, because tomorrow we may be back to statistics, percentages and other not-so-titillating minutiae of medicine.

Oh and I watched a circumcision today. Which is medical jargon for strapping a baby to a board, stabbing needles in and around the groin, slicing, dicing and removing his foreskin, and leaving behind a bloody penis, then handing the baby back to the Aunt, because the mother is too freaked to watch any of it, and you don't blame her.....see it's just easier to type "circumcision".

Day 1 Again

First day, continuing with some more numbers....

7 viral URIs, ages 2,3,4,6,6, 7,11

2 ear infections

1 strep throat. I love the Centor Score.

19 yo F dysmenorrhea. Preceptor was surprised she would talk to me.

18 yo F tooth pain. Get a dentist.

11 month old new patient for the HinnyVax

17 yo F "Influenza A" , orthostatic, dehydrated, IV start, first one in a while. She was too lethargic to care. Just like my first IV ever, oh wait he cared but he was just wearing handcuffs.

Unlike internal medicine these people are young and "under-medicated". The drug rep sharks could be circling outside the clinic. Fast, fun day. Oh and the somewhat creepy picture below are not my patients, but a visual clue for anybody that didn't realize I am now in my pediatrics rotation. I promise no more blooming christmas tree shaped pediatric poster children.

Numbers

Rotation 4 by Numbers:

Miles Driven: 3,358

Patients seen: 182

Tamiflu Prescriptions Written: 1

Patient’s with Dengue Fever: 1

Vaccinations Given: 0

Vaccinations Received: 2

Visitors: 3

Combined years knowing the 3 visitors: 75

Surf Sessions: 41

Fish Tacos Eaten: 8

Leopard Sharks Swam With: 54

Incidents involving lacerations: 2

Sutures Received: 7

Rotations Sites Left: 4

Pediatrics is next…on to the 7 year olds, after a rotation full of 70 year olds! Ears, rears, and mother's fears here we come!

TJ

After a great visit from brother Chris, there was only one thing left to do. Vamos a Mexico! Turns out, I should have taken Cialis orders for a few patients.



Against the advice of my preceptor, I walked into Mexico, alone. Last time they gave me a Wednesday afternoon off, I returned with stitches, so I understand the hesitation. But a two hour stroll across the border simply provided lots of family friendly entertainment. I was offered Vicodin at least 8 times, among other various legal and not so legal substances. One hombre called to me "hey guy my friend I have what you are not looking for." Exactly.

Felt the endorphins kick in with the sound of Spanish, the ripe smell of diesel exhaust mixed with garbage, the sight of rifle-wielding cops, the awareness that I was the foreigner. Smiled at the hucksters and the cabbies and the pharmacists. Love the way people drive and honk, love the music blaring from each empty cantina and love the mariachi band members getting their shoes shined on an otherwise boring Wednesday afternoon. Spent exactly one american dollar while here, on a Tecate. It was cold, refreshing, and funny how they always taste better south of the border.

Got back to los estados unidos in time for an evening surf session.

Now I am officially ready to head North. Get me out of here.