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