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