Sunday, February 23, 2014

No Offense But I Really Can't Stand Adult Patients

I consider myself a good person....most of the time.  But I really dislike dealing with adult patients.  I'm sure you're wondering "Why did it take you so long to figure that out?  Haven't you been dealing with adults in all your other rotations besides Peds?"  The answer to this question is yes, I have been dealing with adults but I was either cutting them open in surgery or caring for pregnant ladies (who come with infant included so have already earned a few points in my book) or they were crazy (which if you read my early posts crazy people can be quite entertaining).  I mean really think about it...I've done general and orthopedic surgery, ob/gyn, psych and peds.  I'm not sure what this really says about me...that I only like you as a patient if you are anesthetized, are carrying a child, or are amusing me with your hallucinations?  I'm choosing not to dwell much more on that...

This month I entered family practice.  And it's just not my favorite thing.  I'm use to working at a fast pace and being go go go all day long.  I mean I pulled over 80 hour weeks during surgery.  And even in my general peds rotation I was seeing at least 18 patients a day.  This last rotation a really full day had 10 patients.  I should be happy for the break and feel less stressed but instead I feel bored.  I know I shouldn't be complaining, but it's my blog so I'm going to.

Most of my patients are older with multiple chronic diseases.  It's all about managing medications and logging blood pressures and blood sugars.  I have a hard time telling the 82 year old woman who is already on 15 different medications that we have to add another one.  It is also difficult and very frustrating dealing with non-compliant patients all day long.  I don't know how many times someone comes in for a high blood pressure check and they don't bring any logs from home.  A very typical encounter:

Me: "Have you been checking your blood pressure at home?"
Patient: "No, not really."
Me: "Are you following a low salt diet?"
Patient: "No."
Me: "Do you have an exercise routine?"
Patient: "No."  
Me: "Are you taking your meds?"
Patient: "Sometimes."  

I then walk out of the encounter throwing my hands up thinking 'why do I even bother?  What's the point when they don't listen?  Why should I care about their health when they clearly don't?'  I get that you can only do so much and that whole 'you can lead a horse to water but you can't force them to drink' but job satisfaction is very low with this mindset.  I'm just not cut out for family practice and that's ok.  There are people out there who are and I for one am grateful for them.  God bless those who enter family medicine!  But it for sure won't be me.   My calling is pediatrics.  I have endless patience for children and their ridiculous behavior.  I have less patience for adults acting like children.  The highlights of my day are when there are kids in the office.  Every now and then there is a well child check or an acute complaint.  It quickly became known around the office that I like working with kids and so all of them were funneled to me.  I called those encounters my little moments of happiness.  I also got to deliver a few more babies and unlike with Ob/Gyn, I was allowed to follow the infant to the nursery for the newborn exam.

So now that I'm done whining, it has to be said that overall I had a really good experience this past month.  My attending was really smart and very nice.  She taught me a lot and let me do a lot.  I got to perform many procedures by myself.  She really took the time to teach me.  And we share an Alma mater!  She graduated from DU the year after my mom did.  One of those 'it's a small world' moments.  Everyone in the office was nice and I enjoyed my time there.  They even surprised me with having lunch and cupcakes brought in on my birthday.  It was really sweet.




Pretty flowers!
Speaking of my birthday, I am now 25 years old.  Half way to 50...  It was a good day.  There were many small surprises throughout the day.  It also happened to be my last day of this rotation.  It was like all the patients knew it was my birthday and they behaved.  As I already said, the office had a small lunch celebration for me.  My parents had flowers delivered to me at the office.  I had no plans for the night since most of my med school friends had an exam the next day.  Around dinnertime a grade school friend who was transferred to Fort Carson up in Colorado Springs a few weeks ago called me up.  She insisted we do dinner together.  So I drove up to the Springs and we went to the Melting Pot with two of her housemates.  I was very surprised when we were shown to our table and there was a gorgeous bouquet of roses and a Happy Birthday balloon waiting there for me.  It was so sweet of her!  And totally unexpected!  We had an amazing dinner and had our first sleep over together since high school.  It was fun reminiscing about the "old days" together.  It was a perfect day.  A big thank you to everyone who helped to make it a special day!    
 

Thursday, February 13, 2014

The Best Rotation Ever (aka CLARITY!)

So it's official....I want to be a pediatrician!!!!  Now I know some of you are rolling your eyes right now just thinking to yourself "Well of course you do Danelle.  You have only been telling us this since you were six years old."  But some of you know how hard I struggled with this decision.  Though I come across as calm, cool, and collected, for the past few months I was panicking inside.  I fell in love with Ob/Gyn in October and for a while there I could really see myself doing that forever.  Then my pediatric rotation in Texas just confused me more because I didn't absolutely love every moment of it.  I was disappointed that my first day walking into the Children's Hospital a choir of angels didn't light up in the sky singing "Alleluia".  I mean I thought my life calling would come with some sort of grand sign.  But alas, it didn't.  So I spent the last few months making lists, thinking about what I really wanted and how I pictured my life in the future, and doing some serious soul searching.  And then I finally had that moment of clarity where a choir of angels dropped from the sky singing.  Ok in reality giant stuffed animals dropped off of shelves to the melody of screaming babies.  But it was just the sign I was waiting for.  And it all happened at a pediatric clinic at home...

I was extremely lucky to complete an elective rotation at home.  I lived with my parents for the month of January and worked in Santa Rosa at a general pediatric clinic.  Back in October I thought I had a rotation all set up but then it unfortunately fell through due to legality reasons.  The amazing doctor I was coordinating with for that rotation then took it upon himself to find me something else in Santa Rosa.  He felt that it was unfair for legal reasons to hold me back.  That's how I ended up at the best clinic ever.  The director there took a chance on me and I will forever be grateful for that.  It was there that I fell in love with pediatrics.  I never saw myself doing general peds, but I loved everyday in clinic.  I have to work with children.  They are just amazing little creatures.  They are candid and funny and speak whatever is on their mind.  You can't help but smile working with them.  And they are so smart!  I learned so much from the munchkins.  One of my favorite interactions was with a little four year old girl who needed her Kindergarten shots.  I start every encounter with "So tell me why you're here."  She just sighed and said with a very serious and brave face "I need shots."  She then continued "I'm ready.  I'm prepared."  She looked shyly up at me and asked "Do I still get a sticker if I cry?  I'm going to try really hard not to but I might cry."  I wanted to give her all the stickers at that moment.      

I got into a nice routine while home.  Every morning at 5 am my parents and I would go to Boot Camp together.  After sweating for an hour and questioning "why am I doing this?", we'd come home.  It seemed so much easier when I was in high school getting up for 5 am ice time at the rink.  Now that I'm all old and stuff my body protests getting up before the sun.  But I pushed through telling myself that if my parents could do it without complaint then so could I.  Once home, Dad and I would get ready for work while mom made breakfast and packed our lunches.  It was like being in school again.  I was spoiled for sure.  Then dad and I would carpool into work.  He would drop me off at the clinic and pick me up to head home.  Mom would have dinner ready and then the evening was spent studying with an early bedtime to do it all over again.

This pediatric clinic mostly treats the under-served community and is open until 9 pm five days a week and then until 3 pm on Saturdays.  The majority of the families are Spanish speaking only.  Challenge number one - learn Spanish, fast.  I got this app on my phone to teach me.  My dad and I would practice together on our way into work.  My favorite was to try speaking with the 5-8 year olds because they thought I sounded funny but would correct me and teach me.  The parents were too polite to tell me I was saying things wrong.  So I now know many medical words and can ask very personal questions in Spanish like "How long have you had diarrhea?" (cuanto tiempo ha tenido la diarrea?) and "Does it hurt when you pee?" (le duele al orinar?).  Wonderful everyday conversation, right?  All the providers and MAs were bilingual.  The MAs were also super helpful in teaching me Spanish.  The key to a successful clinic operation most definitely starts with good MAs.  They work hard for very little praise.  They were always there to assist the doctors with whatever they needed.  The MAs at this clinic totally rocked and were really nice to me.  They helped me out several times without making me feel like a complete idiot.  

Everyday I would work with a different provider.  This clinic has 8 providers but only 4 working at a time and all are ladies.  (Girl Power!)  And from the moment the doors opened in the morning it was busy!  On my busiest day I saw 28 patients!  A "light" day had about 20 patients.  The rule of the clinic was no walk in was ever turned away.  I learned a lot and got to see many different doctoring styles working with the different providers.  All the providers are amazing ladies and great doctors and nurse practitioners.  After shadowing my first day, I was put to work the next seeing patients by myself and creating a plan.  I documented everything I did in the computer.  I learned how to prescribe medication and write school notes and send referrals.  I almost always felt behind but I loved being that busy.  The more I saw the more I learned.  All the providers were super friendly and they have connections with pediatric residencies in California so it was a great networking opportunity for me.
They treated me like one of the team and I am super grateful to have met them all.  On my last day they even got me a cake and sang "For She's a Jolly Good Fellow".  It was so sweet and really touched me that they would go to the trouble!  And for the record, it was a delicious cake!  (Almond cake with apricot filling and white chocolate butter cream - Yum!)  As you can see they also gave a nod to my newly acquired Spanish skills.

Overall this has been my favorite rotation so far.  I think it meant just a little bit more to me because I was working in the community that I grew up in.  I can't express in words what this rotation meant to me.  It made me realize not only my love for pediatrics but my love for my community.  I haven't lived in Sonoma County for 7 years now but it will always be my home.  And who really knows what the future will hold but as of now I would be very content and honored to come home and work in the community that raised me.  It was very special all around.  And the best bonus was being able to spend time with my family and friends.  The older I get the more I realize how awesome my parents and older brother are.  I love them all so much and I cherish this new "adult" relationship we have.  And my grade school friends.  It was wonderful being able to spend time with them again.  It's been so long with all of us leaving for college and now work and grad school.  Even though we have spent more time apart than together these last 7 years, our friendship is as strong as ever.  The month went by too fast but I am so thankful for everything I experienced!


  



         

Monday, February 10, 2014

Holiday Special

I have decided that since every music artist and TV show have a holiday special, I get one too.  And fair warning - this post has nothing to do with medical school.  So if that is the only reason you keep reading, I'm sorry to disappoint.  You can stop reading now, or not....  As Captain Planet says, "The power is yours!"  But let's not kid ourselves, I really just wanted to share all my fun pictures with everyone.  The words are not that important.

Anyways, my family got the pleasure of my company for the holidays!  They were extremely happy.  Especially my parents, for we all know that without me their lives have no purpose (love you mom and dad!)

The holiday season started with a gift exchange party among my college friends in Denver.  I met these five amazing people my freshman year of college.  I am very fortunate that they have remained friends with me through my crazy moods and schedules of medical school.  For the past two years we have had a rotating Sunday night dinner.  We take turns hosting and cooking.  It's been great having them as a consistent support group.  And they know me so well!  I got a lunch box that says Human Organ for Transplant and a doctor nutcracker.  The next week I took my exam and hopped on a plane home.


We of course had the annual Wilson Holiday Party.  Mom and I baked up a storm the day after I got back.  I was extremely pleased with our Christmas tree made out of rice crispy treats.  It was great seeing family and friends again after being away from so long.  And the weather was perfect unlike last year when our party got rained on.  This year the Wilson Family had a Holiday staycation.  We went to a fabulous Christmas Eve party, had a lazy Christmas morning, enjoyed dinner with the extended family.
The next few days were spent doing things local that we haven't done before, like exploring point Reyes and taking CJ to the beach for the first time.  I was even home for my mom's birthday.  We went to the Melting Pot and ate tons of melting cheese and chocolate.  Overall it was perfect.
Christmas Morning



I was real lucky to be able to catch up with some high school friends I haven't seen in years.  My bestie recently got engaged so my other bestie and me threw her and her fiance a surprise engagement party.  We made a pretty good party planning team.  Fall back job for sure if this whole doctor thing doesn't work out.  Boy was she surprised!  The timing just worked out perfectly with everyone being home for the holidays.  It couldn't have gone better and was really fun play 'what have you been up to these last 3 years' with everyone.
The Party Planners

New Years was pretty laid back.  I hung out with friends and played board games.  I learned this new intense game that involved aliens with special powers trying to colonize other people's galaxies...it was confusing, but fun!.  Though that might sound lame to some of you, that's my idea of a rockin' night.

Well, that was my Holiday Special!  Hope you enjoyed it even though it is a month and a half late.