Hello out there

Hey Mandy (and any of you other voyeurs out there). Seems kind of lonely out here in blogger world. Miles is almost five months old now and trying to push up to a crawl. I'm in my pediatrics rotation, boosting my immunity at that petri dish also known as Wee Care. And the snow is flying, so I'm trying to resist the urge to compete with Benjamin for most days skied this season. Life is good. Looking forward to the break, although the masters project is a bit of a shadow looming over any thoughts of complete relaxation. Hope you all are well. Sully

Iowa Ice Storm

Well, this is what it looked like outside this morning as I left for work. I spent 20 minutes cleaning off my car, then 20 minutes driving 5 miles to work, only to find out the clinic was closed. Thanks for the call people!! The freezing rain is supposed to continue until 6pm tonight, so it should be pretty crazy by the end of the day. Looks like I'll stay in our apartment and finally start some pediatrics reading...or watch TV. One of the two is sure to happen. :)

Babies!

Okay guys, it's been a while since I've seen any updates here. I want to know what's going on with everyone.

I got a picture today of one of the babies I delivered in September. It turns out I'm going back to the same rotation in January and I'm really excited.

Happy Holidays to you all. I hope your rotations are going well. Post an update if you get a minute!

Deer on the Run

Hey all! We get to see each other next week - if it weren't for the testing I'd be excited! Anywhoo, speaking of testing, I should be listening to murmurs and reviewing EKGs or something, but before starting that I went on a run today. There is this extensive trail system that goes right through where we live and is all tree covered and such. So I'm about to finish my run when right out of the wooded-stream area along the trail runs a deer! It was a near collision! I was a little startled and stopped abrubtly, but I think she was startled, too, because she stopped right along the trail and stared at me staring at her. Then one of her little friends came along and they both stared at me. So I took a picture with my camera. They aren't the greatest pictures and for some reason they look further away than they were and I don't know if you can really make them out that well, but it was kind of cool. Cooler than studying EKGs for sure. (If you click on the pictures it enlarges them and then you can make out thier blurry deer bodies).

End of life

I had an elderly gentleman roll in to clinic today at the VA. We have been following a pretty large non-healing surgical wound due to advanced peripheral vascular disease to the left leg for the last month. Last week it looked manky with exposed bone at the tip of his second toe, but there was some improvement in the wound over last week so the podiatrist I was working with that day sent him back to the nursing home with instructions to the nurses re: bandage changes and a course of Cipro.
In clinic today that toe looked awful and smelled mighty interesting to boot. Worse, the patient was now A&Ox 1 with a temp of 102F. ER admit, right? Below the knee amputation to the offending leg and hope there's enough circulation that high up to allow the wound to heal this time? The family responded that they didn't want him admitted. They didn't want any surgeries. That we should send him back to the nursing home.
My first thought was that the family didn't really understand what was happening, that they were going to kill their grandfather through ignorance. After a long phone conversation however it sounded as though they wanted him to be admitted too. Their grandfather and they had had multiple conversations about future hospitalizations, future surgeries, and live extending procedures and it had been his wish not to undergo any further amputations. (Like I said, bad PVD and it showed.) We finally sent him back to the nursing home. I with a sinking feeling in my heart.
So I think I'm most astonished with the fact that I was standing next to a patient today who made a rational, thoughtful decision about how he wanted to end his life; a patient who has the beginnings of a septicemia and will now die soon.
I was surprised at how outraged I had felt that the family didn't request heroic life saving measures for their loved one. And yet I KNOW that even if successful it would be the beginnings of the end for this particular patient. I KNOW that the most money spent by Medicare is done in the last weeks of a patients life. Spent wisely? Spent with the patients' quality of life in mind? Or is it spent preserving a life because we don't know how to do anything else?
I'm glad that the patient had discussed his wishes for end of life care. It definitely felt creepy sending him home, but hopefully that's what the patient wanted instead of being left in the forceps of modern medicine.

Noah

Just a quick follow up to my new country life- thought you'd like to know that we get a monthly subscription to TrailerLife for our waiting room. Swear to Gumby.

Hey gang!

I've been up at the Coalville clinic with Wain (yes, that's how he spells it) Allen. I really like him. First- he's a total smart ass, so we get along there. Second- he wears cowboy boots and jeans to work, so I wear mine now too. And third- he knows and loves Caddyshack as much as I do.

We've been doing hospice care in Heber on Monday mornings, and Thursdays are spent in Kamas. We even do house calls. There's a decent amount of mullets and handlebar mustaches in the area, which is nice. Wain is also the bishop, and he entered veggies in the fair. Gotta love small towns.

So I'm in clinic the other day, and my patient is a sweet old gentleman (I'm talking like 90+ old) in with abdominal pain, so I had him lying down and, being the good student, I wanted stethoscope on skin. So I was pulling up his t-shirt, and pulling up his t-shirt.. finally I get to something that looks like cotton paneling when I realise I've just given this poor old one piece garment wearing feller the power frog-eye wedgie of his lifetime. Of course he's not saying anything- still just smiling up at me. Then he says "Miss, you're not Mormon, are ya?" I turned beet red and apologized, but didn't have the courage to un-do my damage so I left the room so he could re-adjust. I think he just thought it was funny, and maybe even a little exciting. Anyways, I blame Darin for not covering that in cultural competency (or did he? Guess I wouldn't know).

Looking forward to seeing your mugs in a few weeks. Cheers- G

Labor: There ain't nothin' natural about that

So I delivered my first baby yesterday. I have to say, so far (one week) I have really liked Ob/Gyn. Didn't think I would be that interested, but I am. After originally thinking I wanted to do FP or IM after graduating, and then going through my last month of inpatient IM, I am now thinking that there is just WAY too much info to know in general practice. Maybe a specialty is a better idea...

Anyway, back to the baby story. My doc had been out of town the previous week, so he didn't have time to "beat the bushes" as he puts it (maybe a poor choice of words in this context) to get inductions set up. Dr. Hoegh likes inductions. A lot. He sees no reason for a woman to go past 39 weeks if she doesn't want to. His day for L&D are Fridays (there are seven docs in the practice, they each take a day doing L&D for anyone that goes into labor and anything scheduled, and the rest of the days they see patients in the office). Alas, he had been out of town, so he couldn't convice all of his 39 weekers to come in and get induced this Friday, so we only had two inductions (reportedly 10 is more his style). They both went pretty quick and I stood by and observed on the first one. The next one was thirty minutes later. Dr. Hoegh got the head out and then stood up from the stool, turned to me, and said "take a seat." (I'm thinking of the poor woman in labor at this point. If I were her I would be thinking 'What the f&@*! Why is he letting a student deliver my kid?? But I guess maybe she had other things on her mind, like a baby half sticking out of her vagina.) So I sit down, suction the kids nose and mouth, put my hands around it's neck like Dr. Hoegh instructs, and start (gently) wrenching the thing up and down to get the shoulders out, and out that little sucker flies.

Now, I admit is was a cool experience and I look forward to doing it again. However, anyone who says childbirth is the most natural and beautiful thing that exists is a damn liar. There is nothing natural about something that size squeezing its way through the vaginal canal, or the bones of it's skull folding over each other, or a head sticking out of someone's legs with the body still inside. There is nothing pretty about 2nd degree lacerations or gushes of amniotic fluid and blood. Nothing. It's weird, it's freaky and it's hard to believe anyone can survive such a thing - baby or mother. Dr. Hoegh says that I am going to want kids by the time I finish my rotations with him. After yesterday, all I have to say is, there ain't no effing way that is going to happen.

A Fond Experience

Let me set the stage: Labor Day weekend in the middle of southern Utah’s natural playground. That means everyone and their brother must ride around the sand dunes on dirt bikes and ATVs. Alcohol is a requirement and helmets are for the weak. The alignment of the planets at this time also gives everyone the notion that they are as talented as Evil Knievel. A 24 hour on-call ER shift was going to be lots of fun!

A young woman showed up around 10 pm to have a baby. This was after a full day of caring for the following: “I was trying to run alongside my bike as I did that jump and…”, “this bee sting is just getting huge and I only took one Benadryl 16 hours ago…”, “I couldn’t take her temperature, but she felt warm and she had a runny nose…”, and “I just didn’t feel right this morning…”.

Her family had been passing through three days ago when their truck broke down. She and her significant other (another big no-no down here is having 3 children with a man that you do not call husband) decided Kanab was a wonderful place to settle down and canceled the rest of their trip. They were currently staying at a local motel.

Quick facts about Kanab: 1) there are no taxis or public transportation; 2) you can walk to the motel in about 10 minutes; 5 minutes at a nice jog.

Dad paced around the ER and got angry at our kind secretary because he didn’t believe she was really trying to get him a ride back to their motel paradise where his other two children were being watched by a man they had recently met. He had just found out that the babysitter was a registered sex offender. As a concerned parent, he waited 45 minutes for us to arrange a ride for him to save his children. Please refer to # 2 of the last paragraph.

Back to the delivery room. After two pushes a slimy, blue, hairy thing popped out from another slimy, pink, hairy thing. All seemed well until we realized the cord was wrapped around the baby’s head twice. No panic. The doc cut the cord, suctioned like the dickens, and gave the silent, slimy object to the nurse.

As the poor nurse was trying to get a response from the infant the incompetent PA student was asked to get a heart rate. Heart sounds were ok, but there was still no breathing or crying. The doctor came over and after what seemed like forever we got a slight gurgle and cough. Finally, he gave a good cry, turned pink, and we stopped bagging.

Unaware of the babysitter issue at this time, I asked where dad was. Mom said she called the Motel of Impeccable Customer Service and asked the owner to tell her “husband” she had the baby. Being the kind, compassionate, and completely sick of the damn ER person I was at the time, I said, “If he doesn’t come in 20 minutes, let me know and I can go down and tell him. He can bring your boys up and I’ll watch them so you and your husband can have some time together.”

“You would do that for me?” the sweet, angelic mom said weakly. Man, I am so nice!

More facts: Kanab is a safe town. One month ago, they had their first-ever mugging reported. Turns out the victim had just fallen down in his drunken stupor. All of a sudden, I was at risk of a gunshot wound or other terrible demise as I informed the staff of my plan to see dad. They agreed to let me go if I went with the secretary. By agreed, I mean I just left.

Two minutes later, we were in front of room 16. I knocked on the door and shirtless Larry appeared. I told him he had a new son and mom wanted him to visit. He said the boys were sound asleep and he didn’t want to wake them. No shit. I told him if he changed his mind, I would be at the hospital and could watch them.

I told mom that Larry wasn’t coming and then fixed her a chicken sandwich. I was hoping she would get tired and want us to take the baby to the nursery so I could have some baby time. I could be patient. Besides, I had a full day of Typhon to do.

At 3:30 am mom requested my presence. When she saw me, she smiled and asked, “Could you do me a huge favor? Will you go down to Larry’s and get a cigarette for me?” Was she f-ing nuts? Did she really think I would drive back down there at this hour for a cigarette!

My response, “You’re in the hospital and just had a baby.”

“I know, but I really need one,” she whined.

I stood my ground. “I can’t allow you to smoke right now. You just had a baby and we’re monitoring your blood pressure. You’ll have to wait until later to smoke.” Now I just wanted to take the baby and run!

She let out a big sigh and said, “It’ll be morning soon and Larry’ll be here.”

Good ole Larry. I replied, “When he gets here you can have all the cigarettes you want against medical advice.” I marched back down the hall feeling bewildered. I told the story to a wise nurse who stated, “What is appreciated today is expected tomorrow”.

How true. I learned my lesson. Never be nice to patients. Treat them all like crap because it’s always the ones you bend over backwards for that will sue your @$$ off in the end anyway.

Lunar eclipse, loony preceptor! ;)

This is a picture of a lunar eclipse. Why am I posting it here? Well, because I'm guessing most of you didn't see it last night, as you also didn't have the pleasure of the following conversation with your preceptor:

Cell phone rings in the middle of the night, I look at the caller ID, it's Dr. Horner -

Me: Hello?
Horner: Griffin!
Me: yep
Horner: Horner!
Me: (no shit) uh huh. what's up?
Horner: You like lunar eclipses?
Me: Sure...
Horner: Well get up and go outside! Look west about 11 o'clock. There's a lunar eclipse right now!
Me: Okay, I will...
Horner: Alright, see you in a few hours! Bye!

I hung up, looked at the phone - 5:06am. What the hell? Who does that? So now I'm wide awake, it's 5am, so I go outside. There's a lunar eclipse. Great. I can't go back to sleep. Oh, and I was also at the hospital with Dr. Horner until 10:30pm that night. I see her at the hospital at 8am and she's like the Energizer Bunny as always - "Wasn't that elclipse amazing?!?!?" Uh...yeah.

So, just incase your preceptor didn't wake you out of a blissful sleep to see the elcipse yourself, it looks pretty much just like the picture above. Didn't want y'all to miss that apparently important part of our clinical education. :)

So the rumor says...........

Sorry guys I finally figured out how to post. Honestly I just am prioritizing time to catch you all up on the last couple of weeks. My rotation at Layton IHC is going very well. A little overwhelming at times and feelings of I know I learned that somewhere but just can't spit it out with my preceptor pimping me. Otherwise things are going very well.

Here's the official announcement, to dispel any rumors that may have been spread. I am engaged to be married on November 20, 2007. My fiance' is Scott Sorensen, so yes my name will be changed by graduation. Anyone who wants more information or an announcement just email me and give me your mailing address if applicable.

Can't wait to see you all in October!!

Jen M.

Here's an attempt at a picture of the ring. It has a princess cut diamond in the center and 3 small round diamonds on each side.

Week Three!

I am lovin' Boise! Sure, we're covered in pea soup-like smoke every few days from forest fires but it's a good honest smoke! Clinic is partly painful but mostly fun. I remember that I've been lectured on all the diseases I saw last week, I just can't remember any of the important stuff. Otherwise I'm surrounded by a bunch of crotchety old guys who all know a think or two about killing another human-being. God help me if I forget to refill their Flomax prescription.

Noah

Iowa State Fair

Hey Guys! Iowa is going well. My first rotation is a bit like jumping into a fire pit. My preceptor is a hospitalist, so I'm not even seeing patients in a clinic - just rounding in the hospital all day and taking H&P's on new admits. It is a little bit insane, as is my preceptor, although she is also incredibly brilliant. She likes to half-run down the hallways of the hospital while making you rattle off the major causes of high anion gap acidosis. She's like a petite drill sargent. Great for learning though. Also, people in the hospital are really sick. Who'da thunk it? Yesterday we took an admit on a guy with prostate cancer with mets to his bones and he came in orange as a pumpkin with a total bilirubin of 26. Probably mets in his liver now. Anyway...Josh and I went to the Iowa State Fair this afternoon and I thought I'd post some pictures. We're back in the Midwest for sure!!

Who knew cows could be so pretty?

This is a big bull. The biggest in fact.

It's going to take a two-handed Keahey sign to handle these guys.

You think you've seen one set of pig testicles you've seen them all? Think again. :)

Baby pigs. Cute.

Cow made out of butter.

Harry potter made out of butter.


Me, eating a pork chop on a stick. You can get anything on a stick at the state fair.

Well, I hope everyone is doing well. Keep posting and keep in touch.

Hi guys, just trying this out, never did a blog before. I think I'm going to love it, it's so nice to know that we can continue staying in touch and helping each other. I just caught on those darling pics of our proud papa...congrats!! what a cute little angel. And thanks Mandy for organizing the blog. How is Des Moines and how are you getting settled? You do know I'm sure that Des Moines is French for The Monks...ha!ha!
Luce

Miles of Smiles

Hey y'all! How's it going? Hope that clinics are going well, you're having fun and learning tons. It has been a whirl wind for us this past week. We are all home now, safe and sound. Thanks for all the support. It means alot! Below is a picture book of the past couple of days. Hope you enjoy it as much as I did making it ;-) Peace.

4:15 pm thursday "Labor is going to be fun"

4:15 am Friday "Are we having fun yet?"

12:28 pm Friday "Elmer Fudd arrives!"

12:29 pm Friday "It was all worth it"

Proud Papa

Mr. Wiggles the Worm

Sleeping Beauty

1 pm Wednesday "Proud Mama"

10 am Friday "angel....for now"

A little bit of Thanks

Thanks Mandy, can't wait to see what great stories and pics we have. We should have an award system, complete with pre-selected and qualified judges, to determine the best story and best picture. Just joshing. Let's all have fun, like get naked and start something. Gina, I'm kidding. I will miss seeing you guys around and hope for those that are here in SLC or pass through we can get together and party down like rocker kids to ac/dc records.

I love you guys,
joel

Mandy, This is wonderful and it sure makes me feel better about leaving all my wonderful friends! Thanks so much for doing this- and I can't wait to hear all about the exciting year ahead
-Candace

Class Blog

Time is winding down for our little group. I think we are all happy about this (a quote from Mark Twain I recently found sums up how most of us probably feel - "I'm glad I did it, partly because it was worth it, but mostly because I shall never have to do it again." :) However, I know I have also talked to a lot of you about how much we will miss knowing what is going on with everyone. I am sure we will all have great stories over the next year and beyond from clinics, along with updates on our personal lives. Being among those who are going far away, I would love to keep updated on the goings-on of our class. Since it is hard to always email everyone, I though maybe we could start a class blog. Our Yahoo group has been fun, but it's not always conducive to picture posting, etc. So I thought I'd start this website, and I can add everyone as authors so you can add your stories as they come. If you would like to participate (and hopefully you all will) just give me a permanent email address (so probably not the utah.edu one) and I'll put it together. Any other ideas, let me know.