25 July 2012
"You're such a terrible doctor, I can't believe you made my son cry. If I had known you were going to make him cry, I never would have let you look at him."
Yes, I whispered something mean into your 6-month-old's ear to make him cry.
You've been in our clinic 4 times in the past week because your kid has fever. Only he never ACTUALLY shows up with fever. Even though he hasn't had any tylenol in the past 12 hours.
And you're mad at ME for trying to help your kid?!
I have to check him and figure out where the "fever" is coming from. And yeah, checking his urine just might hurt him a little bit. But not checking it and missing a urinary tract infection would sure hurt him A LOT more.
Some people just don't get it.
Wednesday I walked into work and my Medical Assistant said "Oh, Shannon, you look different!"
"Good different or bad different?"
I guess I’ll just go with it.
I've decided I need to stop reading.
Whenever I was in school and I would read about one of the various diseases I was studying, it would suddenly appear in clinic the next day. I would recognize all the classic signs and symptoms, because I had just reviewed them in my book. Then I would look brilliant in front of the doctor I was working with, win some brownie points, and learn even more.
I thought that would end as soon as graduation happened.
I don't have anyone to impress anymore, so why do I need to look smart?
But Monday I did some continuing medical education on Mononucleosis, more commonly known as Mono, the kissing disease. I work in pediatrics, so its bound to happen to one of my patients at some point.
Problem is, it's super hard to differentiate from just a normal sore throat. And you have to run a pretty expensive test to look for it. And you treat it mostly the same, only you have to be sure to tell kids with Mono that they can't play sports in case they are at risk to rupture their spleen.
I came away with the knowledge of how to differentiate them and what exact test to order: an IgM and not an IgG test.
The next day at work I had a girl come back with a super sore throat,which pain medication didn't really help at all. She still had a high fever and her tonsils were HUGE and had lots of exudates. I thought she would have strep throat, but the test was negative, so I diagnosed her with a viral sore throat and she came back the next day because it was still SO painful.
I got Dr. Velez because I was worried that her tonsils were so big that they were touching in the back and I was concerned about how she would eat and breathe.
He told me to test for Mono and he pulled up pictures on google saying that usually Mono gives kids bigger tonsils, with lots and lots of exudates.
I just learned about Mono, only to miss it in one of my patients.
He told me to order a Mono test, and I was able to pick the IgM test, because I had just read about it.
It turns out, the test was negative. No Mono.
So I wasn't wrong!
This time at least.
But I better stop reading...because the other day I learned about a disease called HMP: Human Monkey Pox.
I'd hate for a kid to get that...
So one day, I had a kid who came in from the WIC (the Women, Infants, andChildren program) office with "Iron poisoning."
Only she didn't eat extra iron. She doesn't take iron supplements, and neither does her mom. She didn't ingest a nail.
In fact, she was completely asymptomatic. She didn't have pallor, fatigue, tachycardia, abdominal pain, or vomiting, which I only know to expect from iron poisoning because I looked it up just before I saw her...
Clearly, I'm still learning.
So, I did what I always do when I get a kid from the WIC office with anabnormal lab value, I repeated the lab. I wanted to have it documented. And because half the time they're wrong.
Turns out this kid just has high hemoglobin in her blood. Which WIC interpreted as Iron Poisoning and scared mom half to death.
A normal hemoglobin is usually between 10.5 and 12.5 in kids.
This girl had 19.
We had to run her blood 4 times because the machine wouldn't read it as a normal blood because her hemoglobin was so high. (But don't worry, we only had to take her blood once)
So, I was stuck.
What to do now?
Ask someone else!
So, I asked Lucia, who's been working at the clinic more that 5 years, she's pretty brilliant. But she didn't know. And told me to ask Dr.V. Who was at work, but had his door closed, meaning he didn't want to be disturbed.
But this is the kind of thing I have a supervising physician for. If he wasn't at the clinic I would call him. So I knocked on his door and he told me to come in.
I asked him what to do and he told me:
"I don't know, call the children's hospital's (CMC's) Hemotology (a fancy word for blood) team."
I always feel better about asking him something when he tells me that he doesn't know. Because he's a genius, and if the genius doesn't know, it's probably ok if I don't know either.
So, as I'm waiting for the attending physician to pick up the phone, I glanced through this kid's chart to look at her past values for her hemoglobin.
Surely this is a new thing.
Or surely not.
All 2 lab values we have for her were also in the 19s.
The attending physician at CMC for Hemotology, was an awesome Dr. named Dr. Buchanan who talked to me and genuinely cared about my patient. He told me it could be just a normal artifact for an extra protein she has in herblood, or it could be a weird childhood cancer.
So, we set up an appointment for my kiddo.
As if my day couldn’t get any better, the mom who told me I was a terrible doctor came back.
And she said she didn't want to see me. But she ended up in my room anyway.
Because no one else wanted to deal with her.
So I called in Dr. V for reinforcement.
He told the mom everything I said, and told her not to worry.
Good. Hopefully she stops coming in for fever when her child doesn't actually have one.
Did she keep the temperature log when I asked her?
She did know that only over 100.4 was an actual fever when Dr. V asked her.
I guess I taught her something.
Some days I save lives.
Not every day. Most days I just fix runny noses.
But this one 14 year old came in for a well child check up.
Along with his 3 other brothers and sisters who were pretty young. So he went last, letting the others go first. Polite.
Or he was just a chicken.
When I listened to his heart and thought I heard a murmur.
So I casually asked mom about it, the way I do when I’m pretty sure there’s a murmur there, but not positive.
Mom was surprised,“No one has EVER heard a murmur before!”
And she got that terrified look of a mom who has no idea what’s wrong with her sweet baby. (the same kind of face I think anyone would get if they had some doctor that looks like a child tell them that something serious is wrong with their kid)
I told her not to be alarmed, sometimes I just hear things that aren’t really there, I would get another doctor to listen.
And if it wasn’t a murmur, that’s fine, I make mistakes,
But if it is a murmur, he has had no serious symptoms, so he should be just fine, he’ll just need a checkup with a heart doctor.
So I grabbed a more experienced doctor, and sure enough, he has a murmur.
That is NEW at 14 years old.
So, I sent him to a cardiologist, and reassured mom about a million times.
I felt just like a superhero!
Especially because I had some cute Spiderman nail polish on :)
Then other times I don’tfeel like a superhero at all.
We had a kid come in that should have honestly probably been taken to the ER, but he was at our office, struggling to breathe.
I momentarily freaked out, he was wheezing so loud, I didn’t need a stethoscope.
I sent one Medical Assistant (MA) to get a machine to check his oxygen level and the other one to set up a breathing reatment.
Then I grabbed my supervising physician.
Who immediately sent another MA to get a Dexa shot.
Which is short for dexamethasone, which is a steroid shot that we give for super bad asthma kids when they’re having an acute attack.
He told me to look up how much to give.
Um, so his weight in kilograms is about 16. Um, how manymilligrams per kilogram is Dexa? 60?
No. it’s 0.6
I was so close. Just off by 100 times…
So the kid needs about 10 milligrams of dexamethasone.
Man, I’m slow.
And the worst part isthat they blamed my MAs for being the slow ones. I apologized for that.
I guess the super hero nail polish doesn’t always work…
Thanks to the new stickers that are on my books, printed in English and Spanish, less of my books have walked away!
But man, kids still find a way to destroy some of them and the moms don’t even care at all! Disgusting.
One mom was great though.
She asked me if I hadkids.
Because who owns board books when they don’t have kids??
This girl right here.
Maybe that’s why people trust me even though they think I’m only 15. Clearly, if I have books in my room, then I must have raised good kids that can read.
And therefore, I can be trusted.
That, and the fact that I’m SUPER white, but I can speak decent Spanish now.
Enough Spanish to geta few complements several times a week.
I HAVE DESCOVERED ALL THE SECRETS!!
AND USE BOARD BOOKS!!
No wonder I’m such a great Physician Assistant…
Sometimes I need to put things into perspective for myself.
I get frustrated that so many of my parents walk in with iPhones with their nails done up so fancy, yet they need government assistance to buy their kid’s food.
I need to give grace, because no culture is perfect, even people who work really hard need help sometimes.
A lot of my kids come in wearing hand-me-down clothes.
A lot of my kids don’t have their own phones.
A lot of my kids are in day-care so both their parents can work.
A lot of my kids come to the park right outside my apartment because it has a huge fountain that is free, instead of going to a water park. (I know this because my Medical Assistant knows where I live now, because she can see my high-rise apartment complex from the park where she and her friends bring their kids to play in the fountain.)
A lot of my parents are really trying hard to give their kids a good life, and they need help from the government to do that. Because two people working a minimum wage job can’t raise a 6 person-family without help.
And a lot of my parents have dealt with so much tragedy: gang killings of their eldest kids, kids that get into drugs and die from overdoses, girls that become mommies at the young age of 15 and 16.
Yes, their kids get free healthcare and medicine, but no, that doesn’t make their life easy.
I just have to remindmyself that.
We’re all given grace.
I need to extend it to everyone around me.
Even the people who let their kids shriek in the park fountain by my house till midnight and then don’t pick up their trash….
Ryan and I have been disagreeing.
There’s a road welive by that’s called Cesar Chavez.
I think it’s pronounced CAEsar, with an AE, and Ryan thinks it’s just CEsar, with an E.
I asked my Medical Assistant, since I’m clearly not yet an expert on pronouncing Hispanic names.
She told me it usually depends on how it is spelt.
Mmmm. Maybe Ryan wins again.
I really gotta find a book to help me pronounce these Hispanic names.
Although, thankfully, there are some names that I don’t need help pronouncing.
Take “SirCharming,”for example. His mom replaced the name Charming with another equally as great name.
Hopefully he has agood middle name he can go by.
Removing the soda stains on the roof of my car. A can of 7 up exploded. How was I supposed to know it would turn brown? I now have a new respect for anyone who paints ceilings.
The pup curled up in my blanket :) he loves mommy!
My superhero nail polish!
Sushi cooking class!
Some yummy rolls!
Ryan always made better looking rolls!
Our first try at home! It went pretty well!
08 July 2012
I think I’ve been pronouncing the word spoon wrong.
Only, no one ever corrects my usage of the word spoon, because I’m so fluent in Charades. I hold up my hand like I’m holding a soup spoon and put it in my mouth, and people instantly know I’m talking about a spoon.
Everything at our clinic ends in the suffix –ita, meaning little.
So when I take cuchara, which means spoon, and try to make it cucharadita, to mean little spoon or teaspoon, which is what I actually want people to use. My confusion comes when I look up the word for teaspoon in my handy google translate app. It also gives me the noun form of the word: cuchararilla.
Don’t ask me what part of speech cucharadita is if google translate calls cucharailla the noun form of spoon.
So now I need to consult one of the other fluent Spanish, and not Charade Spanish speakers at our clinic, to get the correct pronunciation for teaspoon.
Although, I’m starting to become more fluent in Spanish and not just Charade Spanish, because I’m finally able to make phone calls to patients in Spanish and get across what I’m meaning to say.
Without begging one of the medical assistants to help me.
Business as usual this weekend on Monday.
Until 5:30 when the waiting room still had 10 people in it and the lights flickered a few times.
Then, like something out of the twilight zone, the lights flickered again and went out, which was accompanied by numerous screams from around the clinic.
[This is a re-created version of what it looked like in our clinic. I was too busy saving lives at the time to actually take a picture]
All the exam room doors opened, and I looked to Ana, my college that constantly teaches me correct procedures for any variety of situations.
What are we supposed to do now?!
When you're a little kid in school, and the lights go out it's awesome. You don't have to do anything because you can't see your work.
Its just like that when you grow up and become an adult.
Only now you have to comfort a million screaming children, assure their moms that they can get seen the next day right away without having to wait in line again, and save the millions of dollars worth of vaccines your boss has stored in the refrigerator.
We finally convinced all the moms to come back tomorrow to get their kids examined, and that they wouldn't have to wait in line. That didn't really appease them, but they kinda understood it wasn't our fault the lights went out.
Then we set out to save the vaccines.
We went straight for the "Emergency action plan" written on the vaccine refrigerator.
We grabbed the coolers from the attic, ready to fill them with store-bought ice and liquid nitrogen until we could find a suitable fridge to store the vaccines in.
But the appointed people who were supposed to get ice were no longer working.
And the electric-powered gate that fences in our cars wasn't working.
Which meant we had to move on to plan B.
But there is no plan B.
We called the office manager, who didn't answer. Just as we were deciding to draw straws to walk for ice, the power came back on. Around 6:30 pm, about an hour later.
Ana and I decided to leave our charts open and deal with everything in the morning.
And I went to share stories and Sangria with my small group :)
So, I continue to have to gag children with sticks. It’s inevitable if I want to see the back of their throat or test them for strep throat. I always pray silently that I won’t make them vomit, especially since they’re usually already nauseous.
But one time, I guess I asked for it.
There was a 6 month old baby with a fever. Which means I have to pull out urine and blood artificially and test for roots of the fever unless I can find something on physical exam.
And I was SO excited because I found sores in the back of her mouth, herpangina, which is a viable and legitimate cause of fever. And just to be sure, and ease mom’s worries, I had mom come look in her daughter’s throat.
Only her daughter was fighting a bit now that she knew I was going to stick my tongue depressor down her throat, so I had to fight back, lest I get bested by a 6 month old, and as a reward for my efforts, mom got to see the sores, I got to confirm my diagnosis, and
Which I suppose is only a fair effect of my actions. Still, it was a first for me in all my clinical experience, so I had to document it.
What’s more fun than being a brand-new PA?
Getting to teach a PA student!
She spent one day a week with each of us, minus Ana, because Ana exempted herself from having a student.
Which I think is silly because sometimes the student was super helpful, even though my medical assistant kept making fun of me because I was moving slower than a snail.
Because suddenly, I wasn't the lowest person on the food chain! I had someone to paint floride on my kid's teeth. I had someone to counsel all of my obese children for me (after watching a few exams and deeming that she was good at it). I had someone to teach about asthma drugs. And someone to teach all the stuff they don't tell you in school.
Now that this student is gone, I can hardly wait for another one!
All day Friday at work, I kept smelling a rotten banana smell, and I couldn’t figure out where it was coming from.
I thought maybe I was having some kind of crazy delusion. So I looked through my desk and my bag and everything.
I must be crazy.
At the last minute, I decided to take my work bag to Philadelphia with me instead of my generic African bag purse. My work bag has more pockets in it for pens, power cords, and hot chocolate packets.
Which meant I had to clean it out.
Upon searching for my iPhone ear buds not ten minutes prior, I dug through numerous other bags, searching for them in miscellaneous pockets. I found 4 other sets of ear buds, but not the ones I wanted.
I also managed to find what I thought was a rock, but turned out to be a petrified clementine orange.
After giving up the search, I moved back to re-organizing my work bag.
That rotten banana smell?
Turns out, it was an actual rotten banana.
That I was about to leave in our closet all week.
Sometimes people complement me at work. I really love it when people smile and ask my name when they leave the room. It means they want to see me when they come back, which means I did a good job.
It’s probably my favorite complement.
But second to that one, I’d have to say, is when a teenage girl complements me on my eyes. Or, my eye makeup, really. I just think its so cute.
Who knows more about cute eye makeup than teenagers. And their moms who silently agree with them by shaking their head yes.
And it's 800 times better than the days I wear no makeup and people keep asking me what’s wrong and why I look so tired. Or asking me if I'm a student in High School and when the real doctor is going to come in the room.
But my 3rd favorite complement, making it a cooler complement that when people like my TOMS shoes, is when they ask me:
“How did you get your tummy so flat?”
The question usually follows a long visit talking about the sniffles their kid has or how their kid’s BMI is so high, it isn’t even on the chart anymore, and comes in ENGLISH even if the mom just spoke to me in only Spanish.
I usually talk about how I eat a lot of fruits and veggies.
Which I'm glad is a true thing.
Because I think admitting that I don’t have kids yet would be tantamount to your mechanic admitting he’s never owned a car. Even if he’s been to mechanic school, how good can he be if he doesn’t even own a car.
[Julia, who has been to 8 million other countries, visited our couch one night last week!]
[We all like Sunday afternoon naps]
[getting ready to go out in Oklahoma City!]
Our trip to New York City and Philadelphia!
[The view from Central Park, where we ate hot dogs from a street vendor!]
[He was so pleased by our visit to Central Park, that he came out of his home and posed for us!]
We were coincidentally in St. Patrick's cathedral just 2 days after Alec Baldwin got married; we're big 30 Rock fans]
And speaking of 30 Rock:
[Ryan and Micah made the light room at the Rockefeller Building blow up when they crashed into each other because they're so powerful.]
[The view from the TOP OF THE ROCK!]
[After enjoying the Apple Store but before enjoying gelato at Grand Central Station]
[Dinner with these people at Carmines = Winning!]
[Because we're so smart, we navigated the subway, and were serenaded on it]
["Give me your tired, your poor, your huddled masses yearning to breathe free"]
[Everyone told us to eat at Pat's in Philadelphia. I'm not a fan of cheese wiz so much, but I guess Pat wins because he is a king.]
[Hanging with the Fam in New Jersey. The kids liked Ryan a lot because he helped them beat zombies. I think they also like us because they got to dress up and be in our wedding pictures.]