Final Days

I can't believe my first rotation is finishing up. It's a busy time. I'm sad to be done and nervous to be perfectly honest. The transition to the next rotation won't be easy, but hopefully I can get things figured out in good time. On the "home" front, my second cousins are visiting, so not only do I hang out with kiddos all day, I have a couple greeting me when I get back. It's tiring no doubt. They're certainly fun, but sometimes you just need a break from the little people or people in general being more of an introvert.  I just don't have as much energy as they do to last all day matching their enthusiasm.
I'm trying to look back and think about all that I've learned so far. This rotation was pretty amazing. I had a lot to figure out - coding, some documenting, immunizations, developmental milestones, other minor common illnesses (how to treat and recognize them), as well as dealing with kids that aren't the most cooperative patients in the world. I got lots of practice at doing a history and physical and seeing babies. Thanks to our patient tracking system on the computer, I know that so far I've seen more than 175 unique patients. My preceptor said I've come a long way and have made her life easier in the last couple weeks which is great to hear because sometimes I feel like I get in the way and slow things down because it takes me longer to do things being a newbie. I don't always have the right answer, but I feel like I have improved somewhat. Of course I still have a lot to learn. Here's hoping the next one proves to be just as good. I've had some difficulty getting the scoop so that I'm ready to start in July, which obviously doesn't ease my worry. All I can really do though is wait and see.

Events

Today I got a late start to the morning. The clinic opened later than normal because they were participating in a community event advocating for the prevention of childhood illnesses.
I had the opportunity to do a wart removal cryotherapy treatment. It even meant wielding a scalpel. Yikes. Slowly, but surely I'll get better at this business of caring for all sorts of health related things.
Also had a site visit today. I can't believe I only have 1 week left before I jump into an entirely new rotation. I've seen more than 100 patients already. I have my ups and downs, but mostly I'm loving it. It's reassuring that I've found a career path that I'll enjoy for a long time.
Sometimes things make you wonder more about the parents than the kids. We saw a 4 year old who still uses a pacifier and there's really only so much you can address in a 15 minute time slot.
This weekend I'll be in the Milwaukee area, running a half marathon! I did the same one last year and it was miserably hot, but they've made some changes for this time around. Here's hoping for good weather and strong legs that last the whole 13.1

What did you do?

O kiddos. They are so amusing.
I was home over the weekend with it being Father's Day and all. I went to the store to find a greeting card for the holiday. Whilst in line to check out, my mom and I observed two young boys with their dad. They were in the shopping cart. Once the other items were removed from the cart, one of them started jumping. The other one had a cup of chicken nuggets in his hand. When he saw what his brother was doing, he did the same thing - bouncing up and down. Monkey see, monkey do, right? In doing so, the chicken nuggets went flying everywhere. Whoops. My mom and I tried to hold in our laughter at their bemused expressions and predicament to no avail. We were cracking up which probably didn't help matters so we found a different line to check out in. I feel bad for the poor dad - who turned around and said something to the effect of "What did you do? You made a mess!" It's tough trying to shop with 2 little boys.
Today, we had a few interesting cases. One in particular is funny enough to share. The chief complaint was "my child has bad breath." Upon inspection the NP thought - the malodorous scent is actually coming from her nose. She asked the child - "did you put anything up your nose?" To which the little one said, "No." A bit later the conversation continued something along these lines, "what do you think is causing the 'greenish, blue gunk' to come out of your nose?" I'm taking liberties here because I wasn't actually present in the room, but my patients weren't quite as exciting today.
Child responds "um, maybe it's from the dog toy." Oh really? "Yeah, the dog chewed up a stuffed animal and it had green stuff inside." "Did you stick it up your nose?" Shakes head "No." "Did it tickle when it went up your nose?" The kid finally nods - essentially admitting what she had been denying fervently up until that point - she didn't put anything up her nose.
The proof was in the pudding as they say when the NP managed to pull a chunk of a greenish substance that no human body can naturally produce from the kid's nostril.

In other news, at the end of last week, I administered my first injection on a 1 year old. Poor thing. No one likes shots. We try to make it as quick as possible, but they still shriek and wail. Half the time you can hear them down the hall so everyone probably wonders "what kind of torture are you putting that kid through?"

Not one of my better days

It wasn't awful, but wasn't great. The kiddos I saw today were either sick with something that made them feverish or have a rash or it was just a check up. Two of them I saw initially I thought had ear infections, but the NP came in and said they were fine. Well not fine per say - just no ear infection. Shooting my confidence in my diagnostic prowess. Yesterday I actually successfully identified 2 ear infections, so I thought I was maybe getting it figured out. Everyone says ears are tough. For one thing, it's hard to get a good look because hardly any kid is going to keep his head still. No one particularly enjoys having something poked in their ear canal.
One little girl was ill and we still don't know for certain what she has. As the MD says, "with kids, they usually get better and we never know what it was that made them sick, or they get worse and then we can figure it out." She had to come back for additional testing after getting some blood drawn and her mom was in tears at that point too. Peds seems to be playing to get the kids to cooperate with you for an exam, but mostly dealing with the parents.
A couple boys came in for a well visit. Their parents are going through a nasty divorce. So despite being relatively healthy from a physical appearance standpoint (with the exception of the younger brother being significantly larger than the older), from an emotional standpoint - not so much. Unfortunately, there's little we can do for that. Days like today we wish we had a magic wand to make everything better.

Circ

Today I got to see more little ones and even help out with doing medication follow ups. After the clinic closed, I went over to the hospital with the MD for a circumcision on a baby boy. Just to observe something you don't see every day. Due to a minor complication that the MD hadn't experienced before, he bled a bit more than usual and understandably wasn't happy. That was interesting. I'm sure I could make many jokes about it if I wasn't so tired from the longer hours. Without an extra computer at the office today, I still have to do all my documentation for the day as well. Ah homework. It never seems to end.
We also discussed some other interesting cases today - everything from ethical dilemmas to handling developmentally delayed children. There's so much to keep track of - insurance issues, medication interactions, etc.

Difficult cases

I wondered what it would be like working in Pediatrics. I love kids. They can be so much fun. They can be pests too, but mostly I find their energy and creative entertaining. I worried about seeing them when they are sick, because then they are pretty miserable - crying, screaming, dripping, etc. It's just tough to see someone so little in pain. I guess I'm lucky I only have to deal with them for brief intervals. Mostly they are a joy to work with - only a handful are difficult. That's where some coaxing comes in. The nurses have the task of giving the dreaded shots.
Today was a bit more challenging. We had a 6 year old girl come in. She didn't want to be touched at all and was hesitant to answer questions. She was even ashamed to admit certain things. Her mom had some concerns and reason to believe that her daughter had been molested by another person in the house. Abuse is awful and tough. It's not something you ever want to see or hear about. For me, it sucks the air out of the room. How do you put on a happy face and move on after a child's innocence has been tampered with? I think it's hard even to hand over a report to someone and not know if justice will be made. The other providers are great at handling such a delicate and important subject.
It's overwhelming and heartbreaking. And it's only Monday. This could be a long week.

Babies

Some of my favorite patients are the smallest ones. It's exciting to see newborn babies and a little scary because they are so tiny and vulnerable. As someone without any kids and so new at this PA business, sometimes I feel like I need as much reassurance as the new parents do. They often have lots of questions. I'm supposed to have the answers, but don't quite feel qualified yet. Their babies come in all shapes and sizes - lots of variability still equals "normal." One of my highlights from the week was seeing a baby boy on Monday and again later in the week to monitor his growth. We'll see him again next week probably as a 2 week check up is pretty standard. It's cool seeing the same faces even when I'm only here a few weeks.

Mini victories

Today I saw a few more patients on my own at first. One guy I was particularly excited about because he came in with a growth on his toe. It was a wart! There is something immensely satisfying about being able to reach a diagnosis and have a treatment plan ready to recommend. Most of the time when I went in the room, I wasn't sure what was going on and wanted to double check with the Doc, to see what they think, but this time I actually knew what I was doing. Obviously, it's still early on, so the MD comes in afterward anyway and goes through everything to make sure I haven't missed something and performs the necessary procedures, but soon enough I hope to get to be doing that stuff myself.
It's funny that when I'm shadowing, I'm thinking "yeah I could totally do this" and then when it's just me in the room I'm nervous and forgetting the basics. Hopefully that will go away with time and experience.
Something else interesting has been the number of kids with ADHD and other behavioral problems that are on medications. It concerns me to mess with their brain chemistry from such young ages by having them on drugs. I guess I can't always tell from a brief session what their needs are in different settings like the home and school.
More mini victories ensue when I could tell what a drug is that the NP didn't recognize. That sort of thing doesn't happen often. Most of the time I'm clueless when I hear the MDs throw around a medication name because we didn't learn all of the brand names for drugs in pharmacology. Even when they tell me what class of medication it is - I feel like I'm still fumbling around, wracking my brain to find what it is associated with - the side effects and that sort of thing. I suppose that's normal since it's so early on in the year, by the end hopefully I'll have more of it down. Even then I won't know everything. It's a constant learning process.

day 2: some firsts!

Today was my second day of rotations ever. I got to see a couple patients on my own briefly to report back to the MD I was with. It's nerve wracking when you are the one doing it. I'm still working on getting a routine down and getting familiar with the computer system. The other major new thing that happened was that one of the patients we saw today was diagnosed with leukemia. This little boy had been in for a few visits, with some other health concerns that didn't really point to the cancer diagnosis. From the diagnostic tests today, it revealed this abnormality. Uff. Try explaining that one to concerned parents. Goodness. No one wants to hear that they have cancer, much less their child. Fortunately the prognosis is pretty good, with treatment kiddos tend to do well. It was the first time my precepting physician had to give that diagnosis to her clients. Rough. Working in health care - you get to see the behind the scenes stuff that physicians do - like trying to check with the insurance company to see where they can refer this patient for oncologic services to be prepared with information for the concerned party.

My first day

Today was my first day of clinical rotations. I guess that means it's official, I'm in my second year of PA school. Most of the day was just spent shadowing the MDs and NPs that work there - getting familiar with how they do things. As the weeks progress, I hope to do more - seeing patients on my own first and comparing notes with the providers. It's a small practice, but everyone seems really nice. I tried to get oriented and help as much as I could. I was complimented by the nurse who found me cleaning up in one of the exam rooms and I even showed the MD where she could find a mask from my exploration in the cabinets and drawers.
With the other health care providers I saw newborn babies and kids up to 18 years old! Quite the variety. I'm learning a lot - there's a ton that I don't know. We also had a patient that required a Spanish interpreter. For a small community like Beaver Dam, I wasn't expecting it, but I guess they have a decent Hispanic population that they cater to with materials in Spanish. I definitely like to see that.

Rotations are tough though. People always say it's like an extended job interview. Sometimes, students are offered a job at the end of their rotation if they are well liked by the providers and such. By the end of the day, I'm exhausted from trying to absorb so much information and trying to recall just as much information that I theoretically learned over the last year. Then I have to do a lot of documenting as well as other projects and try to study up on things. I'm not sure how I'll manage to keep up my energy and enthusiasm, much less my health. Being around so many sick kids can't be good for my immune system - no matter how much handwashing and sanitizing you try to do throughout the day.