Tuesday, October 13, 2009

Palpable LN

Oy - came down with a rough case of acute rhinosinusitis yesterday which is being controlled pretty well with Aleve-D, my Neti pot, and lots of hot tea and cold water. I'm not sure of the percentage, but I'm inclined to say >90% of rhinosinusitis cases are viral in origin which is why there's no point in going to the doctor for these things (unless you want a shot of decadron) and there's especially no point in asking for antibiotics. Anyway, all that was to say that I've been regularly checking my supraclavicular and cervical (neck) regions for palpable lymph nodes and wouldn't you know it - this afternoon I found 2! I've been skeptical of my LN palpation skills ever since I read Mom's Marijuana by Shapiro. After his diagnosis with lymphoma and subsequent stays in hospitals he commented on how most physicians never palpated with enough pressure to pick up his nodes, but he always knew where they were.

Fell in love with psychiatry today when the resident realized I was sick and immediately sent me home and told me to come back in a day or 2 when I felt better. Hooray for thoughtful residents. I could get used to this...

Monday, October 12, 2009


Whoa - didn't realize it until today but it's nearly been 2 months since I posted. My sister called me out. Told me that I was still stuck in surgery in blogland. I decided that must be remedied immediately!!! So here's a quick rundown of what's been going on lately.

Finished surgery, took the test, class average was a 67 - most definitely the lowest our class average has ever been on any test. Very surprising to me.

Started and finished my family medicine rotation. We do 2 weeks at a big hospital with the family medicine residents and attendings. Then we go off to a "rural" location. Most everyone picks their hometown since they have a free place to stay. I did this and the funniest part to me was that 1/2 way through my 4 weeks, one of my relatives (not telling which one, wouldn't want to have a HIPPA violation!) ended up becoming an inpatient. Not just any inpatient, but a patient on my attending's service. That means I had to go see them every morning and afternoon, get the pertinent info, write the note, etc... It was pretty funny. Here's the breakdown of hours for each part for those of you who want to know what you have to look forward to :)

Big Teaching Hospital: arrive around 6 or 6:30. See 2 patients (no matter how many are on the service, which is AWESOME). Write notes. Go to morning conference at 8. Usually a specialist of some sort would come in and teach for 15 minutes. Then we'd head down to the doctor's lounge and run the list/dry round over delicious breakfast. FREE delicious breakfast. They really know how to treat students and docs over there! Then we'd go on work rounds. Then we'd have class. Then free lunch. Then class. Then home by 3ish. It was pretty relaxed.

"Rural" Medicine: Get to hospital between 6 and 7 depending on how many inpatients we had. My preceptor and I would split up the patients or "divide and conquer" as he liked to say. I'd usually see 2 or 3, write their notes, then he'd look it over and tell me what orders to write. Then he'd sign them. I really enjoyed getting to know the entire staff at the hospital there. It's so different from being at a big teaching hospital where noone really knows each other. Anyway, then we'd go to clinic and see about 15-25 patients from 8:00-4:30 or 5:00. Then it was time to head back to the hospital for afternoon rounds. I usually got home around 6. All in all not a bad experience, but I'm not sure it's for me. Think I would approach burnout very quickly. Not so much from the hours worked, but from the patient population. That's a long story for another day though. Let's just say I'll be okay if I never have to hear about low back pain EVER, EVER again... My preceptor was incredibly nice, liked to quiz, liked to teach, and trusted my work which was exciting and scary all at once. I did most of the admitting H&Ps on new patients coming in and a few of his discharge summaries. He'd usually sign orders before I wrote them after going through a care plan with me. Very strange to write orders and have nurses ask you, seriously, what tests you wanted done, IV fluids, etc...

Now for a fun update - this past weekend the stars and planets must have aligned just right because for once:
1) I had no responsibilities, technically (I guess I could have been studying for well, anything)
2) My husband was able to take off Friday, Saturday, AND Sunday
3) His grandparents just so happened to have rented out a 3 bedroom suite overlooking the Gulf Coast.

Fun times ensued. K's grandparents, 2 brothers and their wives, aunt and uncle all ended up staying for the weekend. There was a huge car show so the girls pretended to be interested for a few hours on Saturday morning. Then we split from the guys and headed to the mall for a good long while. After that we all met back up and headed to the beach to play for a while. There were hardly any waves and the tide was so far out you could walk on all the little sandbars close to the shore. K and I were kind of amazed we were still finding debris from Hurricane Katrina so long after it happened. He found a cool little piece of a 2x4 that was smoothed and rounded like sea glass. Sad :( Anyway, after our romp on the beach the 3 brothers and their wives went to a restaurant overlooking the ocean that we just knew would be awesome, but alas (frylime, that one's for you) that was not the case. However, the margaritas I made back at the condo later were quite tasty. The next morning we had to get up and leave, but we stopped at the outlet mall on the way home and shopped our little hearts out.

This post is getting terribly long, and I've got a killer case of acute sinusitis that reared it's ugly head today. (Thank you to Caden, my 2 year old niece who thought it was funny to wipe her boogers all over me this weekend) Those of you who know me well know how much that almost killed me...

Psych started today and I'm really happy with my partners and rotations. Wahoo!