Friday, February 29, 2008
Clarkston Bantams!
Just wanted to say congrats to my brother-in-law Bren (if you guys are even reading this)!! He is the varsity basketball coach at Clarkston High School and in addition to his team making it to state, he was also selected as Coach of the Year in his league. They play tonight for 1st or 2nd seed for state! Congrats and good luck! :)
LONG OVERDUE!!
Yesterday was my last day of cardiology. I cannot believe how fast 4 weeks went by. I was hoping to write at least once a week and that clearly did not happen. I have every intent of doing that for ER, my next rotation, but maybe I'm being optimistic. This rotation went incredibly well and I received very good feedback, especially considering it was my first rotation! I saw a lot of interesting cases, worked with great preceptors and the hours were very forgiving. I left around 7:15-7:30 in the morning and was usually home by 4pm, some days even earlier. After one of my last posts, several of my "readers" wanted to hear more about the presentating process.
My days in the hospital would go about like this. Arrive at 7:45-8:00am (Adam only beat me there on 1 day) and get a list of patients to see that day. Adam would pick 3 or 4 and send me to see them on my own. I would review their chart, see what other services had seen them in the past day, what orders had been given, etc and then I would see the patient and write my note. The hardest part of the note for me is the management plan - especially since as I student I don't want to write it in ink for everyone else to read if I'm totally off. Then the fun begins...I would meet up with Adam and "present." An ideal presentation should be concise but thorough enough so that the preceptor knows what is going on and they are always done in the same order (the notes we write are called SOAP notes - S = subjective findings, O = objectives findings, A = assessment and P = plan). Here's an example......
"Mrs. J is a 45yo female who presented to the ER complaining of chest pain. The pain started 1 hour ago while she was shoveling snow and is still present. She tried taking some ibuprofen and resting but this did not relieve the pain. She also admits to nausea, diaphoresis (sweating) and radiation to her left arm. (does anyone know where I going with this?). She rates her pain as a 7/10 and has never experienced this before. She has no past medical history and no previous surgeries. She smokes 1/2 pack per day and doesn't drink alcohol."
From there you give the physical exam, usually just presenting abnormal findings. At this point Adam would interrupt me and ask "SO what's your differential diagnosis?" This is all the possible things both common and rare that could be causing this (this is the part that always makes me nervous!!!). If any labs have been done or ordered you should also mention these in your presentation. Then comes my favorite question, "So Michelle, what do you want to do with this patient?" This is challenging, especially as a cardiology student. There's a fine line between saying a patient with a cardiac complaint is okay and can go home and saying they need a heart cath. Of course, the questions don't stop there...after Adam sees the patient and either agrees or disagrees with my note, he always had more questions. In this case, it might be "so why would be give this patient drug A vs. drug B?" or "why did I order this particular test vs. this one?" Usually these questions would come as we were walking down the hall or up the stairs to my next patient and my overloaded brain is trying to answer the question and remember everything about the upcoming patient at the same time. I can't believe how much I learned in 4 weeks and hope that I retain even 50% of it. It's encouraging to work with Adam, who has only been out of school a little over a year and to see the knowledge base he has built already. It's way to early to say, but cardiology might be near the top of my list!
My days in the hospital would go about like this. Arrive at 7:45-8:00am (Adam only beat me there on 1 day) and get a list of patients to see that day. Adam would pick 3 or 4 and send me to see them on my own. I would review their chart, see what other services had seen them in the past day, what orders had been given, etc and then I would see the patient and write my note. The hardest part of the note for me is the management plan - especially since as I student I don't want to write it in ink for everyone else to read if I'm totally off. Then the fun begins...I would meet up with Adam and "present." An ideal presentation should be concise but thorough enough so that the preceptor knows what is going on and they are always done in the same order (the notes we write are called SOAP notes - S = subjective findings, O = objectives findings, A = assessment and P = plan). Here's an example......
"Mrs. J is a 45yo female who presented to the ER complaining of chest pain. The pain started 1 hour ago while she was shoveling snow and is still present. She tried taking some ibuprofen and resting but this did not relieve the pain. She also admits to nausea, diaphoresis (sweating) and radiation to her left arm. (does anyone know where I going with this?). She rates her pain as a 7/10 and has never experienced this before. She has no past medical history and no previous surgeries. She smokes 1/2 pack per day and doesn't drink alcohol."
From there you give the physical exam, usually just presenting abnormal findings. At this point Adam would interrupt me and ask "SO what's your differential diagnosis?" This is all the possible things both common and rare that could be causing this (this is the part that always makes me nervous!!!). If any labs have been done or ordered you should also mention these in your presentation. Then comes my favorite question, "So Michelle, what do you want to do with this patient?" This is challenging, especially as a cardiology student. There's a fine line between saying a patient with a cardiac complaint is okay and can go home and saying they need a heart cath. Of course, the questions don't stop there...after Adam sees the patient and either agrees or disagrees with my note, he always had more questions. In this case, it might be "so why would be give this patient drug A vs. drug B?" or "why did I order this particular test vs. this one?" Usually these questions would come as we were walking down the hall or up the stairs to my next patient and my overloaded brain is trying to answer the question and remember everything about the upcoming patient at the same time. I can't believe how much I learned in 4 weeks and hope that I retain even 50% of it. It's encouraging to work with Adam, who has only been out of school a little over a year and to see the knowledge base he has built already. It's way to early to say, but cardiology might be near the top of my list!
Monday, February 18, 2008
Crab cakes and cupcakes
I've been meaning to post these pictures for a few days now. For Valentine's Day, Steve and I made dinner together at home -- crabcakes (from the McCormick and Schmick cookbook), rice and red velvet cupcakes! The crab cakes turned out great - despite Steve wanting to add every seasoning in the cupboard to them.
The beautiful roses in the center are from Steve and the fancy, festive glasses are from my mom :)
Notice the poor cupcake missing it's top...I bet you can guess who did that :)
We attempted to take our picture but my chin was lost
The beautiful roses in the center are from Steve and the fancy, festive glasses are from my mom :)
Notice the poor cupcake missing it's top...I bet you can guess who did that :)
We attempted to take our picture but my chin was lost
Tuesday, February 12, 2008
"The Terrible, Horrible, No Good, Very Bad Day"
Does anyone remember that book? Poor Alexander :( I felt a little like Alexander today. Thank heavens for my very patient and loving husband who had to hear the brunt of my frustration when I got home tonight. It's not like this is the first sour day I've ever had in my life but it just didn't go as planned....
I knew we would have a snowstorm last night and I knew the roads would be slick on the way to Perrysburg this morning but for some reason I didn't really adjust for that. And as Steve continued to tell me to leave or I was going to be late...I continued to ignore him...so I was late for the first time today (Caroline, I know what you're thinking). No big deal. But then...I hurt my first patient of the day. :( It was the worst feeling! I was examining this older gentleman who, to make a long story short, is on chronic steroids for one of his conditions. One of the side effects of being on these drugs long term is thinning of the skin. Combine that with a physiologic thinning of the skin due to aging and this man's skin was about this thickness of tissue paper. I was trying to help him up and must have grabbed his arm too tightly because he lost an entire layer of skin and started to bleed profusely. I can't explain how awful I felt...I just wanted to leave the room in tears. The rest of the day wasn't much better. I'll spare you the rest of the details, but I survived. I'm hoping the dark, gloomy cloud doesn't follow me again tomorrow. Maybe a good night sleep and a little better planning in anticipation of a snowy morning tomorrow will do the trick :)
I knew we would have a snowstorm last night and I knew the roads would be slick on the way to Perrysburg this morning but for some reason I didn't really adjust for that. And as Steve continued to tell me to leave or I was going to be late...I continued to ignore him...so I was late for the first time today (Caroline, I know what you're thinking). No big deal. But then...I hurt my first patient of the day. :( It was the worst feeling! I was examining this older gentleman who, to make a long story short, is on chronic steroids for one of his conditions. One of the side effects of being on these drugs long term is thinning of the skin. Combine that with a physiologic thinning of the skin due to aging and this man's skin was about this thickness of tissue paper. I was trying to help him up and must have grabbed his arm too tightly because he lost an entire layer of skin and started to bleed profusely. I can't explain how awful I felt...I just wanted to leave the room in tears. The rest of the day wasn't much better. I'll spare you the rest of the details, but I survived. I'm hoping the dark, gloomy cloud doesn't follow me again tomorrow. Maybe a good night sleep and a little better planning in anticipation of a snowy morning tomorrow will do the trick :)
Saturday, February 9, 2008
Week One
I survived my first week of cardiology!!! After my week of hard work, I figured I deserved to sleep in this morning. I awoke up around 10am which felt like noon. It was fantastic!! I hadn't slept very well all week -- partly due to nerves, but mostly because I was worried I would sleep through my alarm. For those that know me, I can be pretty difficult to wake up. My mom would attest to that (does a really annoying Tasmanian devil alarm clock sound familiar?). I made it my goal to be at the hospital before my preceptor.
I couldn't have asked for a better first rotation. The cardiology group that I am rotating with is awesome! The PA, Adam, (my main preceptor) and all of the doctors are great! Really nice, excited about teaching, and not in the slightest bit mean when I don't know the answers to their "pimping." I am liking cardiology more than I thought I would and like the role of the PA in this practice. Adam spends 2-3 days a week in the office and the other half of the time rounding in the hospital. Seems like a good mix. So here's a rundown of what I did/got to see this week.
I saw 25 patients in the office - about half were 6 month follow-ups for various complaints and the other half were "sick calls" (patients coming in for specific complaints)
The first day in the hospital I rounded with Adam and saw 5 patients.
On Friday, I was on my own in the hospital for 2 hours, rounding on 3 patients and writing notes and then meeting up with Adam to "present" the patients. There's an art to presenting to your preceptor that I'm not comfortable with but I hear it's get easier.
I helped with 10 nuclear medicine stress tests
Watched 4 cardiac cath procedures (entering through an artery in the leg and injecting dye into the coronary arteries to look for coronary artery disease)
Watched 2 stent placements into the coronary arteries
Interpreted about 20 EKGs (I probably only got about half right)
and the HIGHLIGHT of my week....I got to shock someone! It was a patient in an abnormal heart rhythm that I got to "cardiovert" back into a normal rhythm. That was pretty exciting!!
Sound like enough for 1 week? It was a busy week -- we started between 7:30-8am and ended somewhere around 5-5:30 (except for Friday when I left around 2pm). I don't have to take call on the weekends so I'm spending the weekend cleaning, hanging out with Steve and reading. Not sure who all is reading this but we miss everyone!!
More later - Michelle
I couldn't have asked for a better first rotation. The cardiology group that I am rotating with is awesome! The PA, Adam, (my main preceptor) and all of the doctors are great! Really nice, excited about teaching, and not in the slightest bit mean when I don't know the answers to their "pimping." I am liking cardiology more than I thought I would and like the role of the PA in this practice. Adam spends 2-3 days a week in the office and the other half of the time rounding in the hospital. Seems like a good mix. So here's a rundown of what I did/got to see this week.
I saw 25 patients in the office - about half were 6 month follow-ups for various complaints and the other half were "sick calls" (patients coming in for specific complaints)
The first day in the hospital I rounded with Adam and saw 5 patients.
On Friday, I was on my own in the hospital for 2 hours, rounding on 3 patients and writing notes and then meeting up with Adam to "present" the patients. There's an art to presenting to your preceptor that I'm not comfortable with but I hear it's get easier.
I helped with 10 nuclear medicine stress tests
Watched 4 cardiac cath procedures (entering through an artery in the leg and injecting dye into the coronary arteries to look for coronary artery disease)
Watched 2 stent placements into the coronary arteries
Interpreted about 20 EKGs (I probably only got about half right)
and the HIGHLIGHT of my week....I got to shock someone! It was a patient in an abnormal heart rhythm that I got to "cardiovert" back into a normal rhythm. That was pretty exciting!!
Sound like enough for 1 week? It was a busy week -- we started between 7:30-8am and ended somewhere around 5-5:30 (except for Friday when I left around 2pm). I don't have to take call on the weekends so I'm spending the weekend cleaning, hanging out with Steve and reading. Not sure who all is reading this but we miss everyone!!
More later - Michelle
Tuesday, February 5, 2008
Cardiology Day #1
Monday morning I felt like I was starting 1st grade all over again. My clothes were nicely laid out the night before (as I'm sure I did 19 years ago -- Dad, does that make you feel old??), my bag was all packed and ready to go, the alarm went off entirely too early (5:50am, on this particular day) and I barely slept because I was so nervous. In fact, little was different on Monday from my first day of 1st grade, other than that I wasn't wearing a black stretch jumpsuit that matched my best friends and my mom didn't make my lunch.
I set out for Toledo Hospital at 7am. I may have left a little early but I definitely didn't want to be late. My legs were shaking so badly that I could barely drive. I arrived about 10 minutes early and while waiting for my preceptor, decided my hair looked awful and had to be pulled up (after 1 morning of blow-drying at 6am, I am sooooo ready to chop it all off). When my preceptor Adam, a PA, arrived (who is only 2 years older than me), a joke about my very shaky handshake calmed my nerves enough that I was actually able to talk. We talked briefly about my goals for the rotation, and then it was off to the floors to round on patients who had been admitted over the weekend. For the majority of the morning, I watched, asked questions and became what most preceptors refer to as their "shadow."
The rest of the day went about the same, except then it was his turn to ask me the questions. This is referred to in medicine as "pimping." I had been forewarned about this -- the Dr. asks really tough, random questions and your heart begins racing because you have no idea what the answer is. All in all, the questions weren't too bad -- I knew a few, I took a lucky guess on a few and the remainder I had no idea. The day flew by and at 4:30pm I was out the door with my reading assignment for the next day. If the assignment had required my parents' signatures, it definitely would have been like 1st grade!
Monday, February 4, 2008
Ann Arbor Getaway!
A couple of weekends ago, Steve and I headed to Ann Arbor, MI for a two-day getaway! We explored the downtown area (despite it being the coldest weekend of the year), enjoyed dinner at a couple of great restaurants, drank some local microbrews (Steve's favorite was the Red Snapper at Arbor Brewing Co.) and even squeezed in a trip to the mall and a movie (27 dresses!). Here are some pics!
Steve at American Apparel pretending to be a model
Brews and the NFL playoffs at Grizzly Peak Brewing Co.
Steve enjoying one of many microbrews...it's impossible to say where this one was at
At a great Irish pub that has traditional Irish music on Sundays
Steve at American Apparel pretending to be a model
Brews and the NFL playoffs at Grizzly Peak Brewing Co.
Steve enjoying one of many microbrews...it's impossible to say where this one was at
At a great Irish pub that has traditional Irish music on Sundays
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