Another great week.
Hey Yall.
Week 2 has been great. Last weekend Alayna and I went to the Smokies for a great 8 mile hike. After that we headed to Sevierville (Dolly Parton’s home town) for the Bloomin’ Barbeque and Bluegrass festival. That was loads of fun and loads of calories, but awesome after a long hike. Alayna even got a picture with Dolly (well, her statue).
Sunday we officially moved into our new place. Its great. Its very spacious and completely furnished. We spent about an hour at Walmart grocery shopping and picking up a few miscellaneous kitchen and bathroom items we needed. The house does not have TV or internet, and I get really shoddy cell phone service there-so we’ve been getting some reading done and joined the two local libraries so we could check out DVDs and a jigsaw puzzle-We are so cool. We keep really busy during the week, so it is nice to just relax in the quiet at the end of the day.
The house is kind of up on a hill and overlooks the mountains. I’ve still been really good about getting up early 3 days a week and going for runs, and there are a lot of great country roads to run on. There are very fe cars on the road early in the morning, but there are (literally) roosters crowing, cows grazing, woodpeckers pecking, etc. Its cool here in the morning, so perfect for running, and if I hit the road before the sun makes it over the mountain, there is beautiful mist that settles on the fields.
I am still loving my clinical (as expected). I am constantly challenged and constantly learning. Even the exams I expect to be routine (i.e. chief complaint: earache) often have a twist. When people make appointments, they usually just state one problem but when the arrive they more often than not have about 7 issues to discuss. Today a woman came in a few days after falling off a chair and injuring her wrist. She had been seen in the local emergency room a few days ago where she was told it didn’t appear she had a fracture but to follow up with her PCP in a few days. She came in today for a checkup and requesting pain meds. She walked out of there without a with a diagnosis of arm contusion (recommended motrin), had a pap, and was diagnosed with post-menopausal bleeding and given a prescription for estrogen cream. She hadn’t planned to mention her urinary symptoms, but I’ve gotten into (perhaps good/perhaps bad) habit of doing a quick review of systems regardless of the chief complaint, and so we stumbled upon a more pressing issue.
I was convinced that another patient had appendicitis. She had severe RLQ tenderness and rebound, nausea/vomiting/anorexia, and a few other positive signs suggestive of the diagnosis. Her WBC came back as normal, and a subsequent pap revealed severe cervical motion tenderness and right adnexal tenderness. She was diagnosed and treated for pelvic inflammatory disease. I’d never seen it before so I hadn’t thought of it-especially since it seemed so clearly like an appendicitis.
I am constantly reminded to stop before I leave a room and ask myself what I missed. I need to find the right balance of being thorough and being too thorough. If I ask a patient who is there for knee pain if they are having any trouble going to the bathroom, for example, that may open a huge can of worms where there need not be one. Then again, I’d hate to miss something important.
I've seen 39 patients on my own this week (and written 39 notes!). My comfort level overall has definitely increased-I’m not a very nervous person, but I definitely feel a little self conscious about things with which I have little experience. I’ve done a bunch of Paps this week, and am getting much better at them. I seem to finally be getting the cervical experienceJ. I heard an awesome aortic stenosis murmer the other day. One 14 year old patient I saw the other day said she hopes that I move down here because I am her favorite provider, and another patient yesterday scheduled her follow-up visit for a day that I come in so she can follow up with me before I leave. I even convinced a 78-year-old woman to who hasn’t had a pap in 15 years to have one (she was having vaginal symptoms, and has a history of cervical cancer but still has her uterus).
Also, I gave Mary my patient education tool for newly diagnosed diabetics that I created last semester for a class. She said she liked in and would use it as a patient handout in the clinic!
Last night, we went over to Sheila’s house for dinner and the Celtics game (did they win?? I fell asleep) and tonight we are going out with some of our new friends from the clinic. We are off to Nashville tomorrow for the long weekend to hear some amazing music, go to the Grand Ole Opry, and try out some country line dancing! On our way back were going to stop and hike to Virgin Falls-its an 8 mile hike with waterfalls all along the way, ending at a large one. It is supposed to be one of the most beautiful hikes in Tennessee.
I’ve updated my photo page if you want to take a peek at our new home. Hopefully I’ll have some good ones from this weekend. http://picasaweb.google.com/shana.kaplan/Tennessee2008