Saturday, October 26, 2013

Pediatric Clinics

For the last couple of weeks, I have been working in primary care pediatric clinics and I am loving it! Unfortunately, my time in pediatrics is coming to an end in the near future. I have my SHELF exam on Tuesday and on Friday I switch to my next rotation, rural family medicine. The last couple of weeks has reinforced my love for children, but reminded me that I still have so much to learn. Speaking of which, I should totally be studying, but I have Christmas fever. Anyone who knows me knows how much I absolutely love Christmas! Basically the first weekend in November I consider the beginning of Christmas season. I started shopping weeks ago and hope to be done shopping by the end of November. I don't really like the crowded stores. I prefer being able to enjoy my search for the perfect gifts without having to navigate my way through a bunch of other people. Plus unhappy people ruins my Christmas spirit. So the realization that next weekend will my decoration weekend has me a little side tracked today. I'm thinking a red and white Christmas tree this year and I am trying to figure out the best place for my Christmas village. This time next week I will be rearranging furniture, listening to Christmas music, and sipping on hot chocolate. It would be a total waste of time to try to convince me that it is too early, I totally respect everyone who waits until after Thanksgiving, but in my house it is hard enough to wait until after Halloween.
Speaking of Halloween, I am getting excited for the trick-or-treaters. I plan on decorating my door and have my bowl of candy waiting for the little ones. I just hope I get home in time to give out candy.
So back to pediatric clinics and perhaps a small snap shot of my 2 weeks of nursery. I learned a lot while on nursery and it comprises a good part of our exam, so I am glad I have that opportunity. However, I know that nursery is not in my future.
I have seen some really wonderful parenting in the last month. While in nursery, we were doing the last exam on a baby before the family went home when the dad and big brother came in. The big brother had to be about 2 years old and he was carrying in flowers for his mom. Talk about heart melting! While in pediatric clinic, I did a double well child visit for a 2 month old and her 3 year old sister. Both parents stood by listening, participating, and interacting with their children. The 3 year old continuous was saying either "hi mommy" or "hi daddy" and the parents would say hi back with a chuckle. Never getting frustrated with the constant interruptions which I found adorable. While examining the baby, mom read the 3 year old a book and with each turn of the page she would get excited and start jumping around. You could simply tell that the kids were well loved and thriving. I am a total sucker for cute kids, happy families, and successful parenting. It is a reminder that happiness and good parenting has nothing to do with economic status.

Things I have learned in clinic:
1. 2 year olds love pen lights. I mean seriously they could be entertained for hours. One kid shined it straight in his eye and laughed. All I could think was does that not bother you?
2. Ear exams are tricky. That being said, if you are examining an infant and need them to look the other way simple move your head to that side and they will turn to see what you are looking at.
3. There are way too many people out there co-sleeping with their infants.
4. Giving the "this is puberty" talk is a lot more awkward if you have define words.
5. There is nothing more encouraging than to sit and tell the doctor you are working with all the advice you gave the family and have them sit there and smile and nod their head.
6. There are doctors out there who are like me. Aware of our social issues and want to save the world.
7. It doesn't matter how hard I have to work, how early I have to be there, or how late I have to stay as long as I enjoy what I am doing, I am happy.
8. When I am on my A game, I do super well and parents will tell me everything. When I am not on my A game, apparently I am awkward.
9. I am still able to run down 2 flights of stairs and across a parking lot for a code even in my new dress shoes that have a heel on them. Glad I tested that out.
10. Pediatrics is such a happy place to be. Okay I already knew that.

Even though my pediatric rotation is coming to an end, I still have so much to look forward to and so much I have enjoyed. I learned a ton during this month, worked with some impressive physicians, got a recommendation letter, received tons of advice, and improved my clinic skills greatly. Next month, I get to go home and stay with my grandparents while working in my home town. I'm excited to be able to actually be part of my family for a few weeks. On December 1st, my father and I are going to my first NFL game which just happens to be one of the biggest games of the year. And I'm getting closer and closer to the time where I will get to spend all of my time either in pediatrics or the emergency room. Back to studying!

Thursday, October 10, 2013

Time Off

Apple Cider Press

Time off from rotations, studying, and my part time job is almost impossible to find, but I got a couple days off this past weekend to see my family. Every year on the first Saturday in October my grandparents put on a Annual Apple Cider Party. They have been throwing these parties for more than 20 years. My grandpa has an apple cider press that is probably 150 years old that he has attached a motor to and my grandma spends days cooking in preparation. When I was a kid there was no motor on the press and so making apple cider was hard work. You had to cut the apples up and then hand crank the press. The motor really cuts down on the labor, but every once in a while you will get someone who wants to try to hand crank the press and my grandpa will put the handle back on.
There is nothing quite like homemade apple cider. For me, fall officially starts every year on the first Saturday in October.
For the last several years I have only been able to make it to the party for a few hours because of studying or work, but this year I really needed a whole day with my family. No matter how much you love what you are doing everyone needs a break. My 18 month old niece has become a walking, jabbering toddler while I've been studying. She has an very interesting group of known words and runs straight for the stairs even though they aren't her strong suit yet. I helped the kids put apple into the cider press which basically becomes a game of basketball between 5-8 year olds. I get the same questions every year about how much longer I have left and how things are going. This year I was excited to field those questions. I'm loving what I am doing and I only have a year and half left of this part of my journey. I enjoyed a long conversation with my grandpa's best friend who happens to be a dentist about what it is like to have conversations with non-medicine people. Apparently, non-medical people don't like to talk about guts at mealtimes. Who knew? And I was only asked once if I was going to get married any time soon. At sun down the 2013 Apple Cider Party was declared a success.
When the guests started to leave and the press shut down, we moved the get together into the house and continue on with drinks and cards. My whole family plays pitch and it normally gets a little wild in there. Lots of trash talking and telling of embarrassing stories. Laughing and sulking. It never gets old, but even I have joined the "old" crowd and when it hits 11 I'm exhausted.
Come Sunday I was able to sleep in before heading over for a little breakfast and goodbyes. Then off to my mom's for Sunday dinner. It has been weeks since I have been home for dinner and it was nice to have some home cooking. My nephew is also walking, but only a couple steps at a time. It is as if after he takes 2 steps he is surprised and falls down. My parents also adopted a little boy and girl who are 5 and 7 now. They spend from the moment I walk in until the moment I leave attached to my side. Nothing beats the excitement of children. They both are loving school and ready for halloween. We played several boards games and though the little guy normally likes to quit in the middle when he gets bored he made it through several games before dinner time. We found that Janga is right up his alley.
It's always hard to say goodbye when I know it will be another month before I will be home again. With my upcoming Pediatric Shelf exam and lots of hours left to put in it will be impossible for me to sneak home again until November.
Last week and this week I am spending in the Well Baby Nursery. Newborns are a whole different kind of world. Though initially I thought it would be difficult to flip a baby over to do the full exam, I have found it is pretty simple. Newborns are very peaceful. I spend a couple days in the NICU next week and then I am off to primary care pediatric clinic.

A little time by the fire
Lots and lots of cider

Tuesday, October 1, 2013

It's The Little Things

It's the little things that make the days worthwhile. Medical school can  be tough on the psyche because there is so much pressure and a big push to be perfect, to get everything right. Sometimes you don't get a whole lot of feedback and you are basically clueless how you are doing and what other's think. More than half of your clinical grades are based off of people's opinions and sometimes it is hard to make an impression and even harder to make a good impression. While other students fight this by being very assertive, I have never found that to be my strong suit. So when I'm drowning in stress and worrying about what people think it is the little things I count on. It is the little things that tell me I am doing the right things and on the right track.
Originally when I was thinking about this post I wanted it to be all about 1 simple statement a family made to my attending my last day of inpatient pediatrics, but then sitting down I realized throughout the month there were several times where I felt good about where I am in my education. I think the first statement was made by a nephrologist. During my first week of speciality team, I only saw endocrine patients for several reasons, but when given the opportunity to see a nephrology patient I was hesitant. The renal attending for whatever reason intimidated me. He seemed more formal and I thought it was much more likely I would "fail" seeing one of his patients then seeing one of the endocrine patients. I remember after I saw my first nephrology patient I was nervous about presenting and not knowing the right answers. By this time I was comfortable with my residents who I loved working with so that helped with the confidence level. I felt like I really clicked with the family and had a good rapport with them so that also helped. After I gave my presentation and was able to answer any questions he had I felt better. But it was the quick moment as we walked out of the room where he simply said, "that was very good" that made the difference. It was that moment where I felt very accomplished. A simple statement that made me want to do even better.
I continued to feel good about how I was doing on speciality inpatient rounds and by the end of those 2 weeks I felt confident in my ability to talk to kids, come up with plans, and give presentations. As I mentioned in a previous post, it was hard for me to see those 2 weeks end and part of that was because of the really good residents I worked with. I still feel like I owe a lot of my growth during this month to them making me comfortable and pushing me to progress. It was the last time that I saw my intern that was another one of "those" moments. In her goodbyes, she said "I am very impressed."Another moment where I knew I was doing okay.
Then there is the moment that inspired this post. It was my very last afternoon of inpatient pediatrics. We had a child come in with pneumonia and associated empyema who would need a chest tube for drainage. I went in first to talk with the family, get the history, and see how the little one was. The child was obviously uncomfortable and the family was very concerned. They had lots of questions and requests. It was very touching to see a room full of people who clearly really cared about this child. I answered all the questions I could and assured them I would get the answer to any of their other questions. The first thing I did was ask the attending to put in orders for some of the parents requests to get the ball rolling. After a quick presentation, a couple of phone calls, and entering some orders, the attending and I went in to see the family together. It was a nice moment when she told the family the same kind of thing that I told them. It made me feel like I had given them the right information and was on the same page as the attending. But the big moment for me was as we were leaving, the father said, "I just wanted you to know that your student did really well answering our questions and reassuring us. We felt a lot better after she came in."It was a moment of encouragement. I had given accurate answers, said the right things, and made a difference in the care of my patient. It is moments like this that make me want to work harder, to learn more, to be more. It is moments like that where all the stress, pressure, and exhaustion are worth it.