OB/Gyn

Welcome back to real life!  I just finished having 2 glorious weeks off, and now it's back on rotations, for the first time at Parkland Hospital.  I'll have three weeks of obstetrics at Parkland, then three more of gynecology at a clinic in Oak Cliff after Thanksgiving.  I'm somewhere between super excited and scared out of my mind.

"Hey PJ, what did you do during your 2 weeks off?"  Well I'm glad you asked.  WE MOVED!  So the first half of my break was packing, and the 2nd half was moving and unpacking.  But it wasn't all drudgery and work, it was pretty restful.  Time to build up some bonus sleep before I lose it all on OB, I guess.  So we're officially out of our apartment in Dallas, and into a nice little rental home in Richardson.  We finally have a yard for Sully and Gumbo, which we are all enjoying very much.  As soon as we're sure they can't find a way out, they'll be able to hang out in this nice weather while we're out instead of cooped up in their kennels the whole time.  Aside from the typical stresses of moving, I had to rent a chainsaw to clear some branches away from our power and cable lines... I'll see about getting that picture uploaded somehow.

After a Monday full of orientation lectures (blah), we met at 0630 this morning to meet with our team, practice scrubbing - just what it sounds like... a ten-minute hand/arm washing - and get to know our way around the floor.  This will be my first experience working on a team with 3rd year medical students (or "MS-IIIs", and I'm looking forward to it!  I think PA students all want to get along with the MS-IIIs, but also innately yearn to outshine at least one of them at least once. ;-)  Stay tuned for when that happens.  My chief resident Heather seems very nice and has high expectations of us.  So I expect to learn a TON and be more motivated than ever to not look dumb.  And with that, I'm going to hit the books!

Overreaching goals of OB - don't be late, not even once; do some standard and Caesarean deliveries, kick butt on my test.  That's a good start anyways!

grace & peace

ugh

I cannot wait to be done with this.  That is all.

life in the psych ward

There's a lot that goes on in the West Tower (Mental Health Ward) of the Jail.  Much of it isn't really fun to talk about, which is my excuse for slacking on the blog updates lately.  Lots of suicide thoughts, painful back-stories, just lots of stuff nobody should read and I don't really want to write about.  But this week has been really interesting!

Tuesday - Went to Juvenile.  Thought it was going to be fun, and it might have been if the first 2 patients I saw were these two punks.  The "diagnosis" is called "Oppositional Defiance Disorder" and it basically is a psychiatric condition of being a snot-nosed, disrespectful delinquent.  Can you tell how sympathetic I am towards teens suffering from this horrible disease? Please.  Granted, most of these kids have drugged-out parents and pretty rough childhoods, so they don't exactly have the raw materials to become decent citizens.  Still, it's an easy decision for me to choose a different area of medicine to spend my career.  I'm just not patient enough for that kind of attitude.  There are plenty of kids with actual conditions that I'd love to take care of, but I didn't get to witness any of those.  So I'm pretty much done with that idea.

Wednesday - Visited Zale-Lipshy (a hospital) to check out a really interesting treatment for patients with long-standing severe depression... Electroconvulsive Therapy.  VERY COOL!  That morning, I met 3 medical students who were also there to observe ECT.  The four of us met up with the treatment team who explained the treatment, then the patient was anesthetized.  Electrodes were then held to the patient's head and a seizure is induced.  There's very few contraindications, side effects, and the treatment works really well!  One 82 year old patient, with major depression since age 6 (wow), had ECT in 1977 and it didn't recur for almost 15 years!  Beats meds if you ask me.

Today - Talked to a guy who was SUPER DUPER delusional.  Man oh man, he went on and on about this knowledge he has to make meth for really cheap, to make revolutionary electric car and plane batteries (an idea he was presenting to the Marines), to cure heroin addicts using purified OxiClean, and, without getting into too many specifics, was related to the creator of the Mexican Mafia on the west coast.  Yeah... lots of stuff going on with this guy.  In fact, the floor officers were chuckling about the guy before we even saw him. "Oh man, you'll love this patient... verrrry interesting..."  First time I've seen that kind of unbridled psychosis.  Good stuff!

In non-rotation news, I'm really enjoying hanging out with my Jr High youth group guys.  We're playing some paintball this weekend!  Can't wait!

grace & peace,

this is for reals

Among the things I'm learning on rotations is the fact that everyone has different electronic medical records (EMR) systems.  Talk about confusing!  I'm a bit computer retarded too for a 25 year old (weird... I'm halfway thru my 20's?!), so it's even more of a learning curve.  But anyways, this morning I learned how to change medications, order lab studies, and schedule follow up appointments for patients all with a few clicks.  On the drive home it hit me how much power that gave me... especially the meds!  Geez, can they really entrust such important stuff to me?  As the rotations experience becomes more real to me, it's making me feel quite grown up.

Speaking of grown up, I've just begun as a Junior High Youth Group adult leader!  It's something I've been thinking about for over 6 months now, which is my cue that it's not one of my frequent fleeting interests that pans out as nothing more.  But Jr. High is really where I took off as far as my relationship with the Lord goes, and i owe a lot of that to the adults who led us and goofed around with us and loved on us each week.  So I'm really pumped to serve another group of young men and hopefully give them the kind of experiences I had.  Who else voluntarily spends time with a dozen 7th grade boys?  Yeah, I thought not.  You're welcome, society.  :-D

Update: I got to spend some time with the Swahili-speaking patient, (we'll call him Mr. G), today.  He felt better about his general situation, and was very thankful for the verses we had given him.  Praise God for that!!  He asked today for passages from Ephesians, so away I went to print off 3 chapters of the book.  It really makes me happy to do that.  I wonder if it would make me just as happy if the Bible was just another book to me... As in, I wonder if the satisfaction lies in being a provider of comfort for the patient, or if it's magnified to me since the Scripture is also a big part of my life.  Interesting.  That's the best part of psych to me, the close follow up on patients' well being day by day.  I don't know if that'll be enough to steer me towards psychiatry as a career.  Don't hold your breath, haha.  Not going to rule anything out prematurely, of course. ;-)

grace & peace

amazing opportunity

I had an incredible opportunity today.  One of the case workers and I visited with a patient who was on watch for suicide ideation.  We were unable to really speak with him because his English was so limited - he speaks Swahili.  So we got permission to call a third party translation service that enabled us to have a conversation.  How cool is that?!


When we interview patients who've previously made comments that they want to hurt themselves, one of the most important things is to get a grasp of whether or not they are still feeling that way.  So it's paramount that we find out if the patients have family to get back to, future-oriented plans, or reasons out there to hope.  If those things are present, then the patient is less likely to attempt suicide.  It was really neat to sit in on such a unique time in a person's life.  We sat in the same room, in 3 chairs grouped together, and I held the translator on speakerphone in my hands as the case worker and patient talked about the most serious of issues. It came out through our conversation that the main thing holding him back from hurting himself was that he thought Jesus didn't want that.  He asked for a Bible to help him find comfort and wisdom, but a Swahili version wasn't readily available.  So that's when I got thinking.


Hoping that it wouldn't be against the rules, I went back to my cubicle (yep, I have a cubicle!) and searched online for Biblical references regarding suicide.  I found that there aren't really any that specifically address the topic, but a couple verses relatable enough that he might find comfort in them.  I wrote for him a document beginning, "Until we find a Bible for you in Swahili, I hope these verses provide you some comfort.  I hope the translation is accurate."  With the help of Google Translate, the patient got 7 or 8 verses in Swahili to have for today, and hopefully for life. We're going to see him again tomorrow and I can hardly wait to speak with him again!


What an awesome opportunity!  I'm really thankful that my superiors were OK with it... in fact, the case worker had a similar idea and printed off his own sheet for the patient.  Wow.  
Praise be the God of all nations!  


grace & peace

go directly to jail... do not pass Go, do not collect $200.

I was prepared for there to be a striking difference between the pediatric clinic in Irving and the Psych Ward at the Dallas County Jail.  I guess I ignored how striking of a difference it is between seeing kids and seeing adults, or seeing patients who's biggest problems were tummy aches and pimples.  This is a total 180, and it's really interesting to see the populations back to back.

I get to the jail around 0600 and I'm usually done around 1400, so that's a nice change.  Gives me more of a 'day' to speak of afterwards.  I'm still in the process of meeting the staff of psychologists, psychiatrists, social workers, etc.  Everyone's been really nice, encouraging, and low-stress there.  Over the last few days I've tagged along with various people as they interview severely mentally ill patients and some that aren't (at least, at the moment) as severe.  The biggest subgroup of patients I've seen thusfar has been those on suicide watch. I'm still getting my feet wet, but after hearing some of the short snippets of their lives, it sure makes my problems seem a lot smaller.  And it makes the stuff other people (mostly celebrities) complain about seem totally retarded.

The most interesting thing so far has been seeing how different males and females present with their psych issues.  At this point, I think women psych patients are WAY more interesting than males.  Shouldn't be surprised I guess - higher highs and lower lows is kinda the norm, isn't it?  Maybe on a broad scale. (This is me covering my rear to any female who's reading this and getting offended.)  But my preceptor, Cathy, wants me to be really good at assessing suicidal patients, whether they "really mean it" or are just trying to get the perks of saying they are (extra meds and care, their own private room, etc.)

Alright, definitely bedtime.  More interesting stories later.  I have a feeling that mornings after Monday Night Football are going to be tough each week, but tonight I have no excuse.  So in closing:  Try not to go to jail.

grace & peace

Peds in a nutshell

Pediatrics in review

Well friends, the pediatrics rotation is officially in the books!  And now that I'm on this side of the test, I can now proclaim that I DID NOT get peed on, barfed on, or contract anything other than a 4 day virus!!  <Applause>

Whether I unconsciously planned it or not, it was really nice to finish the summer semester in the classroom studying pediatrics and then turn around and have my first rotation in the fall be pediatrics.  Still don't know my test grade from this morning, but I'm sure I'll have enough to pass.  Which, for the first time, is the name of the game from this point on!  Got a 98% on that test?  Nice.  Got a 78% on it?  Just as good, according to our future diploma.  Bit of a paradigm shift to aim for passing, but I think that aspect is going to go a long way for my sanity on weeks like this past one.

OK, so peds in review:  Good!  I liked it.  Kids are (most of the time) so fun to work with, and you get to have funny moments come out of nowhere that brighten your day.  It has its problems too of course, but all in all, children have good attitudes and are good patients.  As it was phrased, "Plus, kids are hard to kill."  Which is totally true!  Maybe its a lack of knowing their own mortality, but those kids can survive almost anything.  A nice caveat that isn't always true in medicine.

In peds, you'll see whatever common conditions are in season, i.e. if you go in the wintertime, expect more croup, flu, rotavirus, asthma, etc.  Since I was at the start of school, I saw lots of viral URIs, allergies, and of course, scabies.  Everyone can plan on seeing lots of allergic rhinitis, eczema, and that ultra common stuff.  

Advice:  For your patients, know the following - keratosis pilaris, pityriasis alba, and tinea vesicolor.  For your test, google the condition and get a good look at lots of different presentations so you'll be ready for anything.  All pityriasis rosea does not look exactly alike!

Finally and most importantly, a HUGE thank you to my preceptor Tamara, as well as Wendy and Jennifer (the other 2 PAs at the office) at Irving Pediatrics.  You allowed me a great and unique opportunity, to see any and all of your patients on my own with my limited experience and burgeoning knowledge.  I know each of those hundreds of visits was a direct reflection on you, and I'm truly humbled by your trust in a guy who'd never before changed a diaper.

Peds in a nutshell:

So now we close the Pediatrics book and reach for the Psychiatry book.  I start a four week rotation next Monday morning at 6am... on the Psych Ward at the Dallas County Jail.  

grace & peace

the home stretch

Hard to believe six weeks of peds is almost under my belt!  I'll be going in for my last day tomorrow and I'm hoping for a really good one.  It's been a good experience, a learning experience for sure.  


My focus lately has shifted to preparing for the test on Friday and trying to figure out the hodge-podge of paperwork to turn in, "reflective essays" to write, and online forms to fill out.  It's really confusing!  Luckily, those who've come before me in the program have told me it gets easier once you kinda figure it out the first time.  Also this week I'm having to fill more paperwork out before the start of my next rotation - Psychiatry... at the Dallas County Jail.  A far cry it will be from the happy little Irving Pediatrics Clinic.  Get excited for some good posts, haha!


I'm about to start another new thing (in all that free time I have).  Amanda and I just became members of out church, and today I met with the Jr. High Youth Minister to discuss me being a helper in that program!  I think it's going to be a lot of fun, and something the God's had on my heart for 6 months or so.  More to come on all this, but just FYI.


Alright, short post.  It's time to put on some coffee and get back to the books!


grace & peace

just keep swimming, just keep swimming...

Lately I've been finding myself being more agitated after a day at clinic than when I first began.  It's really not fun to spend the evening in a  grumpy mood, and I'm sure it sucks for Amanda too.  After a little soul searching, I've made an observation.  I have a tendency to let negative attitudes exhibited by my colleagues at the clinic work their way into my own attitudes.  Maybe it's because I've been on their turf long enough that they don't feel the need to 'shelter the new guy' from their opinions of all the drama in the office.  Or maybe it's just that all the frustrating patients have waited to all come in together over the last few days.  (We have had some real winners lately, lemme tell you...)

Certainly can't pass all the blame off myself, but I do notice when the atmosphere in the office is ticked off, I get ticked off right along with it.  I guess that would be my prayer request - to rise above the negative thoughts, jaded opinions of medicaid abuse, and irritation with ignorance; and instead be filled with peace and warmth, which translates into better care for the patient.  And a better mental state for me when I come home.  And lower blood pressure.

I wrote down some of the more "memorable" cases over the last 5 weeks.  No names, no confidentiality violations, just some head scratchers.

• Mom is told to go to the ER because her son has a potentially life-threatening heart arrhythmia.  Mom calls the next day around 3pm to ask, "OK, when should I go to the ER?"
• Still breastfeeding son at age 32 months.
• 10 year old girl, weighs over 300 pounds.  (seriously, we couldn't weigh her... the scales only go up to 300)  When told to eat more vegetables, she asks if she can dip them in chocolate.
• Mom (and grandma) stubbornly attribute the wildly out-of-control behavior problems in a 3 year old girl to being traumatized by a house fire when the girl was ~6 months old.
• Dad bring in his son for a checkup, during which time he asks why his son's penis isn't bigger, and what treatments there are to fix this.  The boy is 6 and a half years old.  He also denies any provider from actually looking at it to see if there's an actual problem.

There are so many wonderful patient encounters, then there are those where you just want to bang your head against the wall.  But those folks are patients too, so they deserve proper care too.  And that concept I'm sure follows all providers throughout their careers.  So when healthcare gets frustrating, just help me remember the great aquatic philosopher, Dory: "Just keep swimming, just keep swimming...."

grace & peace

overcoming the inevitable

Whether you know it already or not, there are no more successful bioterrorists than children.  Petri dishes, they certainly are.  The faculty told us up front that it was basically inevitable that we'd be sick at some point on our pediatric rotation, and they were spot on.  And as DFW schools open their doors, the kids employ the Kindergarten lesson of sharing.  Everything.  Including their adenoviruses.  So I coughed and sneezed for a couple days, had a 24 hour fever, and that was about it.  All in all, if I HAD to get sick, that's probably one I'd pick.

Which bring me to scabies... another thing kids are learning to share, and one I would NOT pick.  It's a microscopic mite that bores into and then lives in skin, causing unholy, supercontagious, frustrate-you-for-weeks-because-you-absolutely-cannot-sleep kind of itch.  The textbooks nickname it "The 7 year itch."  Enough said.  So when we get kids coming in for checkups, and as we finish up the whole exam and mom says, "Oh and by the way, he has these itchy bumps on his arms..." we gasp under our breaths and say a quick prayer that their scabies do not become our scabies.  Then we quarantine the room for the rest of the day.  How lovely!  A rare infestation that we saw I think 5 times last week!  Luckily I didn't catch it, though I doubt I've seen my last scabies patient.

*Fellow students, when a parent says "Oh by the way..."  it's never good, haha. ;)

Spanish is coming along really well.  I'm starting to pick up the little connector words and phrases, so I sound like less of a robot.  Starting a calendar year ago, we began taking medical spanish classes a few times per week.  Man was that a great class!  Our prof Cristina had the task of teaching to everyone from fluent speakers to those who could barely order at Taco C, and I was somewhere in between.  But today I got a nice compliment from a dad on my spanish!  So at least I'm now good enough to be able to recognize a compliment.  All props to Cristina! :)

Peds is fun.  I like kids.  Well, not the punks.  But I like most kids.

grace & peace

school is in session!

With all of Dallas, Irving, Las Colinas, and every other public school district opening their doors this past Monday, we've seen a markedly reduced patient flow.  Last week it was swamped with shots and checkups, now there's a bit of a lull before we get slammed with the viruses kids share with each other.  Strep throat is starting to show up already, so I'm now proficient at running those tests in our closet/laboratory/side room.  Not quite as proficient in gagging the poor kid with the swab to get their throat sample, but that's probably because I'm worried too much about hurting the child or getting puked on.  Another one of those things that becomes second nature with practice, I'm told.
Speaking of practice, I'm slowly getting better at ears!  I've checked... geez I don't know how many by now.  Probably an even number.  Anyways, my preceptor Tamara has been really great at fetching me from wherever I am to come see a really good bulging ear infection, a classic bacterial strep throat, roseola rashes, and all those good "textbook" cases.  Our patients have been really gracious with me as well, just glad to have someone care for their child I suppose.  And if you're a classmate reading this, get your spanish ready!  There's LOTS of it.  It's just another lesson in being comfortable in being uncomfortable.  But emersion into the language and having to figure out a way to communicate has really been helping me learn quickly.  And not just medical words like we were taught in class, but mostly the little connector words that piece together a thought.  It's a steep learning curve, but there's always nurses and MA's that are fluent and helpful if I'm really in a bind.
Amanda's birthday was last week, and she was surprised by a visit from her mom and sister!  Gifts you ask?  Shoes, James Avery, yellow roses delivered, a book, a card, and the secret about her visitors.  (I think that's everything).  Her first birthday as a married couple... hope I did ok!  :)  Her family coming up was great timing as well, since her classroom needed a few extra hands to get everything set up for the start of school.  This week has been long and rough on her, but I think it's been better than last year.  First weeks always stink.  We've both been so busy it's almost like we've barely seen one another.  sigh... Only a day and a half til the weekend!
Alright, gotta go!  A Mazda dealership is giving away Rangers tickets for test drives!  No brainer?  You betcha!

grace & peace

the beginning

Starting my rotations in Pediatrics has revealed itself to be a real comfort.  Seeing a patient all by yourself for the first time is very nerve-racking, but in Peds I walk into the room and see a little kid!  I got to thinking, "Well I guess it's pretty hard to look dumb in front of a kid." And that helped give me some confidence.  This past week was the week before all the public school districts in DFW start, so the schedule is completely packed full of immunizations, well checkups, sports physicals, and all that stuff.  I've probably done 30 well-child exams since Wednesday, and I'm feeling pretty good about it so far.  Hardest part is looking into teeny little ear canals to check for ear infections.  Especially with the 2 year olds that hate being restrained by 3 people and prodded with the otoscope.  Sticking something into a thrashing kid is scary - I'm just hoping I don't poke too far and gib they bray dablage.

My preceptor is a PA named Tamara, who is pretty much the head honcho at the clinic.  She's been a great teacher so far and very patient with me as far as charting and documentation goes; for that I'm very thankful.  We're actually kinda similar from what I can tell so far.  Caring and big on patient education, but frustrated with ignorant and stubborn parents.  They say in Peds that working with kids is the easy part, it's the parents that you're really treating - 100% true.

There were too many highlights from last week to pick, but if I had to pick three...  The first has to be correctly diagnosing an otitis media with effusion (fluid in the middle ear).  #2 would be the checkup I did Friday on a 3 day old boy.  Which means he was born during my second day on rotations.  Ridiculous!  And only 5 lbs 14 oz too; tiny!  The biggest highlight of the week was seeing my first Down Syndrome patient.  The boy was probably 3 or 4 years old, and I was a little unsure of myself going in for the exam.  But he was so happy and sweet, his mom was the nicest parent I saw all week, and while I listened to his heart he giggled and played with my stethoscope with a huge smile on his face.  I heard the same heartbeat as with any other "healthy" little boy.  It was a really powerful and simple lesson God had for me.  As I left the room, he laughed and waved 'bye-bye' to me like it was going out of style.  Totally made my day. :)

Week 2 starts in the morning, and I'm excited to see and do even more!

grace & peace

the pilot

Welcome to the blog!   


I thought this would be a fun way to chronicle my thoughts and experiences while on clinical rotations for the next 15 months.  I hope it becomes a means by which I can stay connected with classmates, and maybe help them out by giving a fellow student's perspective on things.  Most importantly, I hope it becomes a way friends and family can keep up to date with Amanda and I as we move through the early years of marriage.  We love and appreciate your prayers and thoughts for us.  So please subscribe, comment, and keep us in mind! 


OK, so one week of rotations is in the books!  MUCH more on that later.  
After an 0700 meeting Monday morning it was off to my site for the next 6 weeks - Irving Pediatrics. Best news: all scrubs!  Really nice because when I inevitably get puked or urinated on, at least I'm not wearing slacks and a tie.  I felt really nervous and unprepared the entire morning, but was assured that was normal.  Dave Klocko, a faculty mentor, put everything in perspective, as he so often does: "Embrace the chaos."  Good advice! :D  Ordinarily I'm not one to stress out, but the idea of starting a 6 week peds rotation (pronounced "peeds") was a little intimidating considering I've never changed a diaper before.  Anyways, it was on the way to the clinic that morning that I first had the idea to blog about rotations!  So here's to the start of a new endeavor!


grace & peace