Work Hard, Play Hard Part 6

ER was a very busy month, but so much fun! I loved being at work and it was nice having a friend there doing the same rotation. It was fun to swap stories and funny moments...like spraying lidocaine in my eyes while suturing. Thanksgiving fell during this rotation so I got to go home for a few days and spend some much needed time with my family.

Adam and I celebrated our 2nd wedding anniversary this month! xoxo

Regan and Ollie bonding during Thanksgiving. So adorable.

Mom came to visit and we went to the KY Horse Park for Southern Lights and camel rides.

Southern Lights.

Adam and I went to an awesome Zac Brown Band concert with friends which was so fun!

ER Etiquette 101.

You know all those Martha Stewart books about etiquette and manners and party planning etc.? Well, here is a little guide I would like to send to everyone who ever plans on going to an ER. These are based off real events.

(First, I would like to put a sign outside of every ER that says: STOP! This is an EMERGENCY room, if you do not have an EMERGENCY, please return to your vehicle.) Apparently that would be inappropriate, but much needed in my opinion.

1. If you have had leg pain for 5 years, it is not an emergency. Please go see your PCP, if you don't have one, go to the health department.

2. If you have dry skin, it is not an emergency. No, I am not kidding.

3. If its raining outside and you want a turkey sandwich, it is not an emergency.

4. If you come in spitting at nurses like a pit viper, you will get a net put over your head which is not a good look.

5. If you need to get abscess I&D'ed, yes it will be uncomfortable, but please do not scream your head off like your dying. You are not dying. Please remember the person draining your abscess is armed with a scalpel so while you are flailing around like a crazy person, think about that. Also, a 14yo boy sat through it like a champ and so can you.

6. If your drunk, that's fine, but don't be rude. Just sleep it off quietly and don't bother anyone else.

7. If you think you are pregnant, that is not an emergency. The sticks you pee on from CVS work just fine. If you can't afford those, maybe you should think twice about having unprotected sex....I hear babies are kind of expensive, just sayin.

8. If you are a new parent and your kid is sick or acting weird and your scared, please bring him/her to the ER. Even if nothing is wrong, you will not be turned away and we understand. Kids can get real high fevers over something as small as an ear infection and that's scary.

9. Please save the ambulances for those with chest pain, trouble breathing, burns, stroke, trauma, and not for your "finger pain" or vomiting.

10. Be patient. Lab results and radiology reports aren't magical documents that appear out of thin air, someone has to interpret them and relay them to your provider. If you've been waiting a long time, politely ask for an update. Remember, you catch more flies with honey than vinegar.

Awkward Ambulance.

I apologize for the blogging hiatus, ER life was busy which was followed by an exam and a practice board exam (5 hours eeek!). I would like to tell you about the world's most embarrassing ambulance ride that ever happened....yes, mine.

As a requirement for our ER rotation we have to spend a day riding along with an EMS crew and go on runs in an ambulance. It was an awesome experience and thankfully I was with the best group of guys. I got there at 7:30am and spent the morning running errands and getting coffee and breakfast. We didn't go on our first run until 11 or so, which means we just did whatever basically. Well, we decided to go to Home Depot to get a wreath for the front of the ambulance, ya know add a little Christmas cheer. I was walking through the parking lot, slipped on ice and face planted hard skinning my hands and knees....ouch/embarrassing moment #1.

Embarrassing moment #2 happened a couple hours later after we picked up an elderly woman who fell at work and hit her face on a door frame. She had some lacerations on her face and a broken hand that was pretty deformed, poor thing. She had dried blood all down her face so I thought it would be nice to clean her up a little bit before she got to the hospital, no lady wants to roll into an ER looking like chainshaw massacre just happened on their face.....well it was a nice thought but while cleaning her face I just re-opened her lacerations so instead of dried blood running down her face she had fresh blood pouring down her nose, whoops. I made that a lot worse.

Finally, embarrassing moment #3: We go to pick up a woman with terminal cancer with chest pain...so sad. It was the longest run of the day and I was riding back with the patient because we were trying to get an IV and I wanted to start it, well after being back there for about 20 minutes I was EXTREMELY car sick. We got to UK Chandler and I thought okay I just need to get out and walk around for awhile, but I never really felt better. We get back in the "buggy" as they call it and they wanted to get lunch so we go to Moe's. I figured eating something might help, but tacos are never a good idea. One taco later and I thought I was dying.... the ambulance went on diversion (meaning they weren't going on runs) because I needed them to pull over at Smash Burger for me to get sick..... I thought I was literally going to die of embarrassment. I was drenched in sweat and hanging out the back of the ambulance window going down New Circle while it was snowing. They were the nicest guys ever and were going to give an IV of phenergan and sleep in their bunks but after my day I just wanted to go home. I felt sick to my stomach for the next couple days because I had to travel a lot during Thanksgiving and just had WAY too much time in the car. Anways, I survived but was humiliated. At least I can laugh about it and actually saw all those guys again when they dropped someone off at Good Sam and we all laughed even though I wanted to hide.

Untold Stories of the ER; Kaitlin style

Hi friends,

Well, this first week in the ER sure has been eye opening. I have seen more chest pain and shortness of breath than I could imagine, and more drunks than my whole four years at IU....ok, I'm exaggerating that last part.

Also, pink eye is running rampant through Lexington this week so don't go rubbing your eyes in or on anything suspicious...or if you do, don't say I didn't warn ya.

I have seen so many different things this week and learned so much. First of all, the staff at Good Sam UK are so great. It is such a cozy little ER and everyone is so friendly. They bought me dinner the other night for going to get food for them, that was so nice. Anyways, I didn't exactly know what to write about since you get new patients all the time and the severity of the patients ranges from "my toe hurts" to actually having a heart attack to a drunk man singing amazing grace so I am just going to list my Top 5 cases that were either the most interesting/confusing/entertaining etc.

1. Amazing Grace: This man came rolling in on a stretcher and I honestly thought he was mentally handicapped. Then he starts belting out Amazing Grace at the top of his lungs which he later switched to 50s show tunes. You guys, the man could sure carry a tune for blowing a 0.47!!! Are you kidding me? He was too drunk to properly blow, but that was his initial reading and that's what they went with. He had no idea,who he was, where he was, or that his pinky toe was hanging off. Shout out to my girl Brittany who sewed it back on after I left. Also, he asked me to watch him pee, and asked the PA on duty for some heroin. Bold move, sir. Needless to say I'm sure he provided great entertainment for everyone last night.

2. Superior Mesenteric Artery Syndrome: I have never heard of this, so when I looked it up I was very intrigued. Apparently, the SMA comes off the aorta at around a 30 degree angle, but in those who have this syndrome, the angle of the artery is much smaller and compresses the duodenum causing excruciating pain. This poor 20yo girl came in screaming and writhing in pain all while vomiting uncontrollably. Essentially the artery mechanically obstructs the duodenum which leads to the vomiting. She wakes up like this pretty frequently and has been seen in the ER A LOT. All anyone can really do is control her pain and vomiting, GI has suggested she go to Mayo clinic because this problem is so rare and the surgery to correct it has an extremely high mortality rate. Once she had IV pain medication and zofran she was a new person, I didn't even recognize her. I just hope she gets the help she needs from physicians who are more familiar with this condition.

3.I'm Pregnant, want to tested for cancer, and also need some lunch: Okay, this is one of the HUGE problems of the ER, especially those like Good Sam. I'm not saying that homeless people don't deserve health care, of course they do, but what they don't deserve, or anyone deserves for that matter is an all inclusive stay in ER. This girl, who happens to be homeless, has a chronic cough. But also thinks she could be PG. So we do a urine PG test and the specific gravity of her urine was too low so we needed to do a blood test. She doesn't like needles, so she wants an ULTRASOUND!!!. No way, honey. Talk about healthcare spending. Then, gets off the phone with her dad and says, "my dad wants you to order a test to check me for cancer." I just simply told her there is no test for that. She already had a chest X-ray. We gave her some antibiotics because she did have a nasty cough and it had gotten worse over the last week, but says she can't get a ride to meijer to get it for free and can't afford the $4 at Walmart. It is terribly sad that she is in that situation, but what else could we do ya know? Then said she was starving and wanted to order a lunch tray before she left which of course she got.....just kind of hard to wrap your head around. She was on her CELL PHONE the whole time.

4. The atypical presentation: Teaching moment!! So, we have all been told time after time that not everyone presents in a textbook way. But the first time you really see it, it sticks with you. This lady came in with a chief complaint of "pain all over my body." I walk in and she won't really even talk to me which was very frustrating because I could not figure out what was going on with her or where she was hurting. I put my hand on her leg and she said don't touch me, so obviously the exam was difficult. She kept telling me  the inside of her mouth hurt, her neck, her ears, her arms, and everything was burning, steaming, and on fire. She has a very complicated past medical hx, recent pneumonia with steroids so her blood sugars were out of control and to me her pain sounded neuropathic. The only information I could get was from her husband. I had no idea what was going on so I got my preceptor who then gets the attending and eventually narrow down that she is having chest pain and her ECG showed slight ST elevation in lateral leads and she was sent emergently to the UK cath lab. In hind sight, I should have realized her "mouth pain" may have been radiating pain to the jaw, but at the time I had no inclination that she was having a heart attack. It was a humbling experience and a very good teaching moment for me and for everyone really. I keep thinking about her and wonder how shes doing now.

5. The world's biggest pleural effusion: My friend and I watched this man get about 1800cc of fluid drawn out of his pleural space. It looked like apple juice, which apparently is a good thing. I don't know how he could breathe at all with all the fluid in there, what a trooper.

Work Hard, Play Hard Part 5

I can't believe another rotation has come to an end. I LOVED being at Methodist Hospital and doing inpatient internal medicine. Looking forward to going back for geriatrics. Up next is ER here in Lexington and I am so nervous, but also super excited! I'm sure there will be many "I don't know what to do with my hands" moments as I will be back to messing up sterile technique and shaking through procedures. woo! I apologize for the lack of posts last month, I honestly worked a lot and then spent my free time playing house with Adam.  Hopefully I will be able to get back into my blog flow this month. Even though I spent the majority of my free time watching TV and cooking with Adam, below are some fun pics from the last month.

 Celebrating my precious grandpa's 91st Birthday! Love him times a million.








Night out on Mass Ave. with my brother.





 Quarter Horse Congress with my mom. Tradition we have done forever and so happy I was able to go back again with her.

 My sweet husband used his magic legs and completed his first full marathon! Run Adam run!

                       Steph comes to visit Bloomington! Hanging out at the Sample Gates.

Game night at the Diskey house! Cards Against Humanity is the best/most messed up game ever.

Warning: Graphic Description Included

Holy tired. I have worked the past 7 days straight and after not having a weekend, made me realize how important those precious two days are to my mental health. I'm so thankful to have the day off today to catch up on sleep, laundry, and school work.

Let me tell you about one of my most interesting/awful/"you will probably never see this" cases this week. I'm sure everyone in my PA program remembers the very graphic slide during the urology lecture with the heading "Fournier's Gangrene." If you don't, google image it...I'm pretty sure the "you will probably never see this" line came shortly after but I could be wrong, or maybe I was just hoping I would never have to see it. So, when I was handed my patient list and saw "Fournier's Gangrene" as the reason for admission my heart sank.

Basically, Fournier's Gangrene is necrotizing fasciitis of the perineum...usually in men, but from what I've read there is a type that has affected women too. So, this poor man (who I might I add is the most kind-hearted man and has the best attitude I've ever seen) wakes up a couple weeks ago on a Saturday and felt like he had the flu, just didn't feel good but didn't think much of it. He noticed he had a bruise on his butt but couldn't remember hitting anything or any injury. Fast forward to the following Wednesday and he still doesn't feel well and the bruise is getting bigger. He decides to go to a family practice office who thinks it is probably an abscess or cellulitis and gives him oral antibiotics but does some lab work just in case. Lab work comes back really not okay and the doctor worries based on his clinical presentation and lab work that he could have a really bad infection and sends him to a local ER. He is immediately taken to the OR for two debridements at the local hospital. That hospital just did not have a good feeling as the scrotum was now becoming involved and the infection was spreading rapidly. He is transferred to Methodist and again immediately goes to the OR for another debridement. He is in the ICU for a couple days and then gets his 4th debridement. Throughout this time he has been medically stable after his last debridement they transfer him to the PCU where I pick him up.

The first time I saw him, he was covered up and his wounds were dressed so I couldn't see the severity of the infection/depth of the debridements. He was still medically stable so I honestly just sat with him for awhile, but he had some leg pain so we worked that up to make sure the joint was getting infected, thankfully that was all okay. I asked the PT wound team if I could be called when they dressed his wound so I could examine them and watch how they did it. I think my jaw dropped open. I don't know how this man could endure such pain with such grace and kindness. The majority of his right buttock had been removed, at least superficially, which extended down into his perineum where again the majority of his scrotum had been removed. His testicles were free exposed without any covering other than what the wound care team could provide. The wound continued to extend up the lateral aspect of the scrotum into the left side of his mons pubis. To say it was horrific was an understatement. No one on the internal medicine team had seen anything like it.

His cultures grew a very sensitive strand of E.Coli thank God, so the his IV antibiotics were able to knock out the infection to stop the spreading. All his blood cultures were negative. The wound care team took such great care of him and were so gentle and thorough. The major problem/concern which led to quite the debate between the surgeons vs. everyone else was what was going to happen when this man had a bowel movement. The wounds only spared the rectum by two finger breadths. He already had a suprapubic catheter in place, and would for a long time, but the majority of those taking care of him thought he needed a diverting colostomy placed so he could have bowel movements without worrying about contamination. The surgeons did not agree and did not want to go that route and thought he should be able to have BMs and be cleaned up immediately following and to discuss the colostomy if contamination became an issue. So far it hasn't....I just worry about him when he is transferred to a small rehab facility if they will have the staff on hand to provide him with such prompt care every time he uses the bathroom. He has already had a consult with the plastic surgery team so that when the time comes he can have a scrotum reconstructed...that is a ways down the road though as his other wounds try to heal.

He has such a long recovery process ahead of him I almost can't imagine how he can think about the future. Again, you wonder why bad things happen to good people....its really hard to wrap your head around it sometimes. He is an incredibly special person and I know he will get through this, but I'm sure he will have bad days when he is so mad and frustrated and in pain and I just hope he is taken care of once the way he deserves once he leaves Methodist.

So, I'm not happy I saw a "you will never see this" case, but it was a great learning experience. I learned about wound care, and cultures and antibiotics and pain control from the hospital setting...but from the patient I learned so much about gratitude and strength. He would say "thank you" after his wounds were dressed and he was biting his finger so hard through the pain I thought it would bleed. If I'm ever a patient I hope I will treat the staff as kindly as he did, what an incredible person.

I Don't Know What To Do With My Husband???

Most of you know that Adam and I got married on 12/10/11, and I moved to Lexington by myself on January 2nd 2012. Pretty short "honeymoon phase." It was quite the adjustment at first going from such a wedding high to a grad school low...ha. But, we are living together now until Nov. 13! Woo! And in hindsight, moving away for grad school was probably the best thing I could have done. I have fallen in love with Lexington and the people there, and Adam is very distracting haha. I love him to death, but we are such goofs that if we would have been together the whole time I would never have gotten anything done.  He loves to cook big dinners every night, watch every movie that comes out, go for walks, go shopping, work out, create our own happy hour with fun cocktails, play with the dogs....anything other than me sit down and study. I'm playing house, so sue me. 

Eventually I will need to crack open the books when I get home from work like I normally do, but I can give myself one more week of house right? Sure, why not. 

Also, Adam is about to accomplish a huge goal this weekend....he is running his 1st marathon!!! I'm so incredibly proud of him. He has worked so hard, and didn't even do a 1/2 marathon first, just going for it. Of course I have to work this weekend so I told him if he has to call 911 I will already be there, aren't I supportive? Pretty bummed I won't get to be there on the sidelines, but I bought him lucky socks so they better work. Run, Forrest, Run!!! (Forrest Gump is my ALL TIME FAVORITE MOVIE ever....yes, I walked down the aisle to the theme song, so it's only natural that my husband becomes a runner.)

Hi, Methodist. You are fab.

Sorry for the delay friends...I have been busy with this rotation, actually working 10 hour shifts instead of the 6-8 hours I have been working. I am so thankful I got this rotation approved at the last minute. I am on the hospitalist team at IU Health Methodist Hospital in downtown Indianapolis and LOVING it.

My preceptor right now is again, like my surgery rotation preceptor, someone I NEED. My first week went something like this.

Preceptor: So, the first week you are basically just going to shadow and get the hang of things right?
Me: Yep, sounds good but I have been doing H&P's on my own since July so I'm comfortable doing that whenever you need me to.
 Preceptor: (Day 2)- Okay so here are your patients for the day, look them up, do the consults, write the notes then I will sign off.

So....no shadowing then? Woo hoo!

Kind of stressful at first, but I am so grateful for preceptors who trust you and let you participate. It is so nice to not sit on the sidelines and actually be a part of the healthcare team. I have had other experiences where I wish I were utilized more and that was kind of frustrating. I am such a nervous person that preceptors who push me off the dock and force me to swim on my own are what I need to get a lot out of the rotation....and man am I getting a lot out of this one.

First of all, Methodist is in the top 1% of hospitals in the nation. It is such a great experience to see such a "well oiled machine" do its thing. The computer system for EMR here is so efficient and I have barely heard any complaints about it which is kind of unheard of. It is so user friendly I basically taught myself how to use it after a 10 minute tutorial. Second, this hospital is "team based" to the max. Every morning we have a "huddle" where EVERYONE involved in the patient's care meets very briefly just to touch base on how the patient is doing medically, when is discharge expected, what does PT think, do they need OT, where are they going when they leave, are there any barriers, do they need a PICC line before they go, what is the insurance approving etc.? Its so awesome how everyone works so well together. Third, and not to sound unprofessional, but all the patients are a mess....otherwise they wouldn't be there. Hello every problem possible with contradicting treatments for each one. I start looking through their history and chart and feel like I'm going to pass out because my head is spinning, but that is also what makes this rotation so interesting and motivating. I also get the "ICU pick ups" right when the patient leaves the ICU....so just barely not trying to die, right? Okay, yeah, sure no problem.....or something....

Side note, most of my patients are >85 which makes things even more complicated, but we all know about my almost pathological obsession with the elderly....I LOVE THEM TO PIECES. Yes, Mr. 90 year old, please hold my hand throughout your entire exam you precious man.

So, this rotation is awesome, I'm exhausted, my preceptor is great, Methodist is the bomb.com all of hospitals, and I'm living with my husband for the longest stretch of time yet since we got married in 2011. WIN.

Work Hard, Play Hard Part 4

Its that time again, time to move on to the next rotation. Time is seriously flying... which is bittersweet. Everyone looks forward to graduating, but Thursday night TV nights curled up on the couch with your friends will sure be missed.

Pictures from fun events that happened during this week are below. And, I think I am done with weddings for the year...nope take that back I promised my mom I would be her date to one in December. That will be my 8th wedding this year! I love love so weddings are way fun :)

                                    Celebrating Amanda's Bachelorette Party in Nashville, TN.

                                           Horsey love and line dancing at Wild Horse Saloon.

Rehearsal dinner at Chateau Pomije.

                                       Amanda's wedding weekend with my forever friends in St. Leon, IN.

Beautiful wedding details from Chelsea's wedding in Bloomington, IN.

                                              Corey Smith concert for Brittany's birthday!

Birthday girl, Brittany.

My last Thursday Night Live :(

                                                               Pumpkin patch in Indy!

Adrian's Orchard.

Raynauds...Or something.

Hello dear friends. Yes, I am on my psych rotation which has nothing do with Raynauds ( a condition where your fingers turn various shades of blue, white, red due to vasoconstriction brought on by cold temperatures, stress etc.)

I do however, have a friend who shall not be named who had an awesome encounter with Raynauds and I wish I would've been there. Don't worry I have permission to blog about this on their behalf. 16yo girl presents with dusky fingers and not feeling well at school. Her mom brings her in and they go through family history, other relative symptoms, all that good stuff. Friend who shall not be named is convinced this girl has Raynaud Disease, and mom is convinced too.

In walks Mr. Preceptor who looks the patient up and down, barely even speaks to her and goes to the drawer and starts looking for something. Pulls out an alcohol wipe, swipes it over her fingers and says, "you haven't washed those jeans yet have you." It's a miracle, she was cured! :)

Ahhh yes the ever so common dark denim wash vs. Raynauds on the differential diagnosis. So trendy.

20 Second Time Out

Alright I've decided this rotation will be very a dull time for blog posts. Yes, I hear wild and unbelievable comments all day, but it just isn't appropriate to post on here. These veterans have been through more than I can imagine and although sometimes they even laugh at the things going through their minds, turning it into sarcasm or a blog post just seems wrong.

To be honest, I often leave work feeling depressed because when the patients unload all of their problems and feelings off of their shoulders I kind of feel like they land on mine. I have to seriously shake it off on the drive home so when I get back I can play with my sweet Abby dog and not just curl up in a ball and go to bed.

So, for the next couple weeks I probably won't be posting much. I think its safe to say psychiatry won't be the specialty I choose although I greatly appreciate all the help they offer to their patients. I get too attached to people and think I would bring work home too often....

Meds for the win.

Saw the power of some medis yesterday, and in a non-addictive, non-benzo, non-narcotic, non-ambien kind of way. Wait, is that possible? Yeah it is so someone better alert the masses that other medications besides Xanax can help. You can try but no one will believe you. 

I met the coolest, brightest veteran yesterday. Talk about someone who didn't let the horror of war bring him down. He went to college, got an advanced degree, and got a great job. Unfortunately he was injured on the job pretty severely and got a head injury. He was then fired from the job and started the process of recovery. He had a terrible time with his speech and memory after he was hurt which led to a terrible depression period. He was suicidal, put on a safety plan, given gun locks the whole deal. He was prescribed an anti-depressant and a non-habit forming anti-anxiety medication and came back for his 1 month follow up this week.

He is doing incredible, and not that I had anything to do with his care, but I am just so proud of his provider and of his will to keep fighting and trying to recover. He goes to therapy for the speech problems and isn't struggling very much in that regard at all. He will be okay, and his life will go on. He is a big success story at the VA because not many veterans who suffer from mental illness are able to recover like he did and his attitude and drive played a huge role. Good job, Mr. Veteran!

Long month ahead.

Oh boy this is going to be a long month. I'm one whole day into my psych rotation and already kind of shook up. The things I have heard today I won't be able to forget for awhile...these patients at the VA have been through, witnessed, dealt with so many terrible/unfortunate/life changing circumstances its honestly kind of amazing they can even get out of bed in the morning.

I am very moderate when it comes to politics and "hot topic" conversations and usually stay right in the middle on most issues and can see both sides. I have a feeling this rotation will make me change a lot of my own views on some of these hot topics. Seeing someone "in crisis" even making very general/vague threats about violence is scary. Seriously, it is scary. I needed my beta blocker like whoa because my heart started racing. I am such a non-confrontational person that it was hard for me to watch such anger and hatred....and also broke my heart. By the end of the session the patient was calm and reasonable and I was amazed at the transformation that took place in 50 minutes. The nurse practicioner I was with today is literally an angel in Danskos. The way she was able to methodically soothe this patient into having a reasonable conversation and push pause on the rage button was incredible. I am so thankful there are providers like her who can take care of these patients....I don't think I'm cut out to do it, but I know I'm about to learn a lot and see a whole new perspective.

Work Hard Play Hard Part 3

Another whirlwind of a month has gone by, and my first Internal Med rotation is over. The exam has come and gone thank goodness, and it's time to move on to Psych at the VA. This month promises to be interesting and eye opening I'm sure.

This month was once again filled to be the brim with academics, patients, work, studying, and with a lot of fun squeezed in too!

                         Off the Smoky Mountains for a fun Labor Day weekend at Brittany's cabin.

Bromance.com

Cabin love.

Downtown Gatlinburg at Burro Loco.

Dog Paddle with Timmy and Abby.

Celebrating Brittany, and Baby Quinn.

                                            Honestly though, could she be a prettier princess?

Oktoberfest (in September?), complete with the world's best funnel cake.

Slow and Steady Wins the Race

Over the past 3 1/2 weeks I have worked in a wound care clinic two days a week. These patients come in every single week and see a 1cm difference on a good week. I can only imagine how difficult it is for these patients to drag themselves into the office (the majority of them either wheelchair bound or amputees) week after week to see such little progress. BUT....the wounds do heal, slowly but surely. Seeing someone get discharged after coming there for 4 months etc is such a good feeling and they are so happy.

One of my favorite little ladies is 91 years ago and is brought there by her daughter who is 70 something, can you imagine that dynamic duo? They are beyond precious. When I first started seeing her she would yelp in pain as her wound was cleaned and it was terribly sensitive. Today, it was so tiny and didn't hurt anymore. She didn't make a peep. After getting double layer compression wraps to get the swelling down from her venous insufficiency, the wound was able to heal.

I will tell you though, the saddest and most heartbreaking patients in wound care are the nursing home patients. God bless them. Pressure ulcers are a horrible thing to witness, and I didn't realize how easy it was to get them (we had a couple people who had them simply from sitting so long during dialysis treatments). The nursing home patients/paraplegics are bed bound or wheelchair bound 24/7 and get no relief from putting pressure on they bony prominences. Or, they have deformities and contractures and their own skin rubs together in a way that causes the ulcers. Its hard for me to handle it, because there truly is not much you can do. They become palliative cases and you just try to avoid infections or progression, but the wounds don't usually heal completely. In these patients I honestly wasn't as concerned about their wounds as I was just talking to them and patting their hands. I will think about them for a long time to come.

I learned an incredible amount about wound care, something we aren't taught much in school. I will be able to take a lot from my experiences at the wound care center and apply them to those patients who have chronic wounds from diseases such as diabetes, venous insufficiency, peripheral vascular disease, osteomyelitis, etc....because we all know those things run rampant in healthcare and they're are lots of patients who need to be treated.

Baby Eli

There is a precious family I know from my hometown who have an adorable 2 month old, Eli, or "nugget" as they like to call him. He was born in July with hypoplastic left heart syndrome and hasn't left the CICU of Children's Hospital in Cincy since. He underwent open heart surgery at about 10 days old and has had an up and down battle since then. His family loves him with their entire hearts and I think of them all day as I see other families fight hard times and struggles with medical problems. I believe Eli underwent his 5th intubation this week as he has been having issues with his lung collapsing. His mom puts pictures of him up almost every day and he is just a little angel and looks identical to his older brother. I ask that you please take a second and send up a little prayer for this family, The Kleckner's, and baby Eli. They have barely been able to hold him and I want so badly for them to take their little boy home to play and snuggle. If you don't know much about HLHS, there is a link below for more information. xoxox

http://www.mayoclinic.com/health/hypoplastic-left-heart-syndrome/DS00744

Small victories

As a student, doing or saying anything correctly is always kind of surprising and just feels awesome, ya know? After all the times I contaminated myself, looked like a moron, used the wrong size speculum, got lost, stabbed myself, etc. it is just nice to know at the end of the day you really are contributing. Sometimes you surprise yourself with how much you do know, what you aren't afraid of, what doesn't gross you out, and what you step up to do. For me, who is typically a scared little church mouse, these small victories add up to feel like big accomplishments....even when I know they aren't. This week I did about a million Tdap injections, influenza vaccines, 1 UA, learned to to do an ear wash, went back to my neuro stomping grounds and did an MMSE, diagnosed an acute gout flare, recognized an acute CHF exacerbation and knew the poor thing was going down hill (she got admitted), made a medication suggestion that ended up being what was prescribed, and was told, "thank you for being so thorough." In the big picture of life these things become the mundane and routine parts of medicine that get taken for granted and receive no pomp and circumstance. So for right now I'm just going to be proud of myself for doing some good things and not having the opportunity to break sterile field (because we all know that would have happened....again.)

I Got 99 Problems But a Lortab Addiction Ain't One.

DO NOT GET HOOKED ON LORTAB. DO NOT START TAKING LORTAB, DO NOT LOOK AT LORTAB, DO NOT GO NEAR LORTAB, DO NOT SPELL THE WORD LORTAB BECAUSE YOU WILL GET PREGNANT AND DIE. (If you didn't catch that Mean Girls reference, I'm sorry...please go watch that movie.)

Lortab is not Ibuprofen, it is not Aspirin, it is not candy, it is a NARCOTIC. I'm sure you are probably thinking um duh everyone knows that...well, no they do not. It is not okay to take Lortab every time you stub your toe or have a cavity. Also breaking news, it is not okay to take your mom's Lortab which she gets prescribed via a pain management doctor for her severe back pain after a car wreck, IF IT IS NOT YOURS DO NOT TAKE IT. These are rules we learn in first grade and yet it seems to be very challenging. Gosh, I sound angry don't I? I'm really not I promise and I 100% agree that there is a time and a place for narcotics...just not after toe stubbing.

Kentucky laws regarding scheduled medications are crazy strict you guys. Indiana folks would go on a rampage if it were this difficult to get some "tabs." Watch out Hoosiers, if you don't start backing off the pain pills we might just roll out the red carpet for these strict laws and welcome them with open arms. I can really see how the strict prescribing laws of KY, which took effect in Oct. 2012, have made a difference for patients and providers alike. It makes everyone's lives more difficult and adds a lot of inconveniences, but it really cuts back on the prescriptions of controlled substances. You don't know how many times this week patients have "no showed" to their appointments because they knew their controlled substances wouldn't be filled, or they don't want to bother with all the 3 month follow up protocols because its not worth the inconvenience to take Ambien every day. To the people who TRULY need those medications, they come. The random urine drug screens sure do take some people by surprise, kind of a red flag when they refuse to do that huh? (I could go on and on about the pros and cons of these stipulations but I will spare you.)

Moral of the story is prescription drug addiction is not a joke, it is a real, troublesome problem that needs to be corrected. I think KY is off to a good start, and I have learned so much about these new laws the past couple weeks.

Nuts and Bolts

So after my first two rotations which focused on pelvic exams and surgical procedures, it was time to get back to the nuts and bolts of medicine....you guessed it....diabetes and heart disease. Would there even be medicine without diabetes and heart disease? Eh, yeah okay fine I'm sure there would be.

Anyways, Internal Med has a lot of diabetes and heart disease. It's not a bad thing, there are actually some patients who are very compliant, have great lab work, lose weight and live happily ever after. I wish I could say that was the majority, but sadly it isn't. Maybe they truly do not understand the risks they are taking with their health, maybe their insulin regimens are too confusing, maybe they don't have the proper supplies or equipment they need, maybe they cannot afford fresh produce or a gym membership, maybe they don't care....I think about all of these things when I see an A1c of 11. Honestly, it can be frustrating, challenging and exhausting. Even as a healthcare provider you can only do so much and that is not an easy pill to swallow.

My goal for this rotation is to be encouraging to these patients and to be their cheerleader. I know that after many years of experience all healthcare providers get a little bitter and a little worn out with non-compliance and I can't blame them. But I'm not there yet so I can still be upbeat and positive and help these patients realize that blood sugar checks and not eating milk shakes for breakfasts is the best dang thing in the entire world. Gooooooo Metformin!!!

Work Hard, Play Hard Part 2

This past month was full of weddings and other fun things. I was fortunate to have a surgery rotation that had a manageable schedule so I still had time to play every now and then. Next up, Internal Medicine which starts bright and early tomorrow morning! Looking forward to it!

                                     St. Louis weekend, for Jen and Ryne's wedding celebration!

                                   My own personal heaven with the world's best carrot cake. Ever.

                                 This was the their first dance, obviously. Just kidding, guys.

                                                                   Alpha Phi reunited.

PA girls at Thursday Night Live.

                                                       Kyle and Courtney's wedding in IN.

                                                 My mom, the best person in the world.

                                               Abby and Timmy are smitten with each other.

Fashion Police

Okay, how many of you wake up in the morning and think to yourself, "Gosh you know what would go great with this outfit? A great pair of chunky leather clogs." No? You don't do that? Probably because big black chunky leather clogs do not look nice with anything....ever.  I vowed to myself that I would never personally own a pair of Danskos. Guess what I am the new proud owner of? Yep, those heinous Danskos. And guess what else I'm going to be the proud owner of? A not broken back and feet that I can walk on.

I still stand by the fact that the shoes are atrociously ugly and ruin all my outfits, BUT I wore them for one day in the OR and my back already didn't hurt. They are kind of hard to break in, meaning they are literally hard material. I understand why everyone in medicine wears them....standing for hours and hours takes a toll on your body. I don't think I can justify wearing them in an office setting at this point (I'm sure I will eventually, they are carving out a soft spot in my heart), but for ER and OR they are a must have folks. Invest in the darn things already and invest in your back as well. Hey, you can even get them brand new on eBay. AND...rumor has it Steph Smiy from www.whitecoatwardrobe.com will doing a Dansko giveaway soon!

Until then, just imagine me parading through some hospital in these. Awesome.

A Great Day

Last Thursday was my last day in the OR with my preceptor. This week we have clinic and I spent today in the colonoscopy/endoscopy suite, but no more one on one OR time. I never thought I would say this, but I'm kind of sad about that. Last Thursday was actually a lot of fun in the OR. I thought the world was ending or something because I found myself actually enjoying surgery...didn't think that would ever be possible. It was kind of awesome, at least I felt awesome because I was armed with a stapler and felt invincible. You try putting 25 staples in and not feeling like a total rock star....just stayin. I don't think they have ever seen someone get as excited about a stapler as I did. They got to see full on bubbly, cheerleader Kaitlin....over a stapler.  My preceptor let me close 2 other cases and even make the laproscope incisions and insert the trochars by myself. I've been doing a lot of nursing things as well such as removing drains and NG tubes, putting in catheters and wound care. I kind of like it?? No no no I highly doubt I will be the next Meredith Gray, but at least I have survived my surgery rotation and actually enjoyed going to work every day instead of hunkering down in a corner and crying like I thought would happen. Since I am currently being overly positive about my feelings on surgery, I will also add that it is nice to legitimately fix someone. These patients are in pain, miserable, have an infection etc...and they wake up all better. See ya appendicitis, adios abscess, never liked you anyway pilonidal cyst. They don't need years of treatment or to make drastic lifestyles changes, you just fix the problem and most of the time you have one happy patient to send on their merry way. :)

Not Free Pizza

Last week Steph and I were offically hazed by the ER frat party. You get a group of guys together, young or old, and it becomes some type of frat I swear. Whether you are a medical professional or a khaki shorts and sperry wearing IU guy, you still have the same capability to bro out when needed. By "bro-ing out" I mean playing jokes on the PA students to make them look like idiots. (Obviously I am making this out to be a bigger deal than it is because I it was embarrassing/funny and cost me $4.25 hello!!)

1. It is not polite to tell two little PA students that the pizza is free when in fact it is not.
2. It is also not polite to leave said PA students after you obtain your own free pizza and leave them to beg helplessly to the cafeteria employees to give them free pizza.
3. Cafeteria employees will not give you free pizza because you are "junior doctors" and not real doctors and only they get free pizza.
4. Those rules are stupid.
5. Today was again "not free pizza" day and I looked longingly as all the doctors got to enjoy their Dominos and I ate my peanut butter crackers in silence. One day I will be worthy of free pizza you just wait.

When Needles Attack.

"Welcome to medicine :)" That was the text I got after I informed my clinical coordinator I was sitting in the ER going through needle stick protocol. Don't get me wrong, exposure to another person's bodily fluids is never a good thing and there is definitely risk involved, but this happens every day and typically is not an issue if you follow up like your supposed to. But, then there's me.

I was in the OR assisting on a port placement for chemotherapy and I went to access the port with a Huber needle. My preceptor told me it was difficult and to really choke up on the syringe so I did. But as soon as she told me that I knew something was going to happen, I could just feel it. I don't know if I didn't choke up enough or what because it happened so fast, but I was struggling to pull the needle out of the port and the next thing I knew I jabbed my own hand with a pretty sizeable needle. Had blood in my glove instantly and had already pulled the patient's blood into the syringe so as the ER doctor told me, "this is a moderate risk exposure." Holy embarrassment. I had to leave the case and immediately wash my hands while the RN called the ER and told them I was coming. Still, not a huge issue because it happens. Cue my crap veins.....

After a needle stick you have to get blood from the patient and your own blood drawn right away to check your baseline liver function, HIV screen, Hep panel etc... I'm a hard stick on a good day, but after being in the frigid OR all morning I was frozen and dehydrated and no one could get a vein to save their life. It got to the point where the ER doctor came in the room, took off my socks and checked the veins in my feet....still not good. Then, he put the bed in Trendelenburg and started scoping out my external jugular vein in my neck. I said absolutely not, sir. I almost lost it at that point. After six attempts, hot packs, a bottle of water, and three blankets, a precious angel nurse finally got a vein in my arm. I felt like a pin cushion and still had 2 injections waiting for me. Blah, anyways everything worked out fine and the nurses in the Georgetown ER are so sweet, they tried so hard.

So, all you little PA students out there, stay hydrated before you go sticking yourself with needles :) My only hope is I can make it out of this rotation without doing it again because I know there are multiple port placements next week....yikes.

Win!

Had some big wins this week in surgery...don't worry, had a big loss too because of my stupid hands that STILL end up being in the wrong place at the wrong time (read next post for my recent catastrophe).

I, Kaitlin Diskey, did not contaminate anything this week. I repeat, I did not contaminate anything this week. It is a Christmas miracle!!! I put in the foley catheter prior to surgery and all I could think about was how I was going to contaminate something major on the surgical field but I didn't!! Praise the Lord! Funny side note, the tech asked me if I knew how to open the sterile gowns...I look at him like duh, obviously I can open a package. So I tear the top off and hand it to him so the gown is poking out and he can just grab it out of the package and he just starts laughing. Apparently I had a stroke or something in that moment because he wanted me to remove the gown completely, unwrap it like a banana and then hand him the unwrapped, sterile gown. Fail.

Other than not contaminating anything, I assisted a lot in surgery this week and am feeling more and more comfortable. Dare I say I almost had fun? In surgery? I just might have....but read on to see why surgery is still not my thing and an occupational hazard.

Procrastinating....

I really need to be writing my progress notes from today, but it was a really complicated case and I know I will get frustrated so I will just write about the gem of a man I met today.

We shall call him, Mr. R. I'm calling him this because his real first name and his nickname both start with R and he gets confused signing his name because he doesn't know which one to put down. So precious. Anyways, Mr. R has stage IV cholangiocarcinoma which is terminal. He is receiving palliative chemo every couple weeks to control his pain.  I saw him today because he is getting a port put in soon because his veins are getting hard to stick and this will make things more comfortable for him. Why is it that the most beautiful souls and wonderful people get cancer? God must pick them for a reason but it sure is hard to understand. Mr. R has a smile that melts your heart and calls you mam. I know he is exhausted and in pain but you would never even know he was sick. I had the pleasure of "driving" him back down to the infusion center after our consult. By that I mean I pushed his IV pole and wheel chair. He asked to see my license and registration. He wanted to make sure I had driven one of  "those things" before and said he would navigate (it was the next door down the hall). I loved him instantly and really hope I have the pleasure of seeing him again before his surgery.

Thinking about him and what he is going through doesn't make writing this heinous progress note seem so bad...

Yoga and Champagne

Whoever thought of this idea is a pure genius in my book. I really wish I was a hard core athlete and worked out intensely on the reg, but...I just...don't. I do however love yoga and of course champagne (in my opinion, champagne is always an appropriate drink because if you think really hard you can usually find something to celebrate). When I got the text that the studio where I have tried Barre Amped was trying this for the first time I was all in. It was fabulous, and I hope to go back every Friday if they continue to offer it. The best part, it was only $5! Is that real life? Yep. The class was so relaxing, but you still worked up a good sweat all while sipping on some pink bubbly. Cheers to fitness classes that don't make you hate your life the next day because you can't move. :)

Feels like home.

No, the OR does not feel home and probably never will. BUT, the hospital where I am working, Georgetown Community Hospital does feel like home. Where is home? I have moved around a lot in the past couple years, but my hometown, and the place that will always feel like home is Lawrenceburg, IN.

Growing up my dad had his surgery practice at Dearborn County Hospital. It is a small hospital and when things get too complicated or traumatic, the patients get sent to Cincinnati. This is how Georgetown is...and I honestly LOVE the small town feel. Don't get me wrong, Gtown is capable of quite a few surgical procedures (ortho, eye, general, ENT etc.), but they do not do any cardio or vascular, and all traumas get sent to UK.

When you walk into Gtown, there is always a friendly face to greet you at the welcome desk and ask what they can do to help you or where you need to go. As a student, I cannot overstate how much easier this makes your first day. I didn't wander down some sterile hallway and have to ask multiple nurses where the heck I was, little mister greeter just directed me to exactly where I needed to go. I was given a full tour of the hospital, told who to get scrubs from, where the locker rooms are, where to get scrub hats and shoe covers. The little things make such a difference.

I'm sure it sounds silly, but I just feel at home here. I feel like I'm in Dearborn County where everyone knows you and is happy to see ya. I look forward to going to work every day because I have been treated so kindly and since Gtown doesn't have many medical students, the staff get excited when students are around....much different experience than I had last month. Also, the communication is good. If I am supposed to follow someone else or go be with anesthesia they are told ahead of time so when I show up I don't get the "who are you and why are you here" looks.

So, thank you Georgetown for a nice couple days. Your kindness is greatly appreciated by this little PA student who doesn't know what to do with her hands.

Work Hard, Play Hard Part 1

One of the hardest things in grad school is learning to balance your school life, social life, personal life, family life etc. It isn't super easy, especially being from out of state. It is difficult to make it to everything, but I do my very best. If you are ALL school 24/7 you will go insane, so here are some fun pictures from the last month. I want to do this every month for multiple reasons 1. To show the world that I actually do have some what of a life every now and then. 2. To remind myself that even though there are some really stressful days, there are some really fun and enjoyable days too. I'm very thankful to have a loving and understanding family and supportive friends who are always there to grab dinner or a cocktail with when I'm at the breaking point or have something to celebrate.

                           Amanda's Western Bridal Shower, can't wait for your big day!!

           Fourth of July cook out with the girls. Steph and Adam were the cornhole champs.

                         Shock Top Saturday with my brother and cousin at the lake house.

                                                           Lake Tippecanoe

 Sometimes when you start for your 1st rotation and are studying for the bar exam, you need some cosmic bowling and a ridiculous cover band to make life better. Love that she is in Indianapolis for good now.

 Swings with my niece, Reagan. Still bitter that she can say Adam's name ("Ado") before mine. So adorable.

 Trail ride with my man, Chief. Aren't all paint horses named Chief? Is that some sort of rule?

                                         Weekend at Hueston Woods with my better half.

Women's Health Wrap Up

Well, that went by quickly. Women's Health is over. Came back for End of Clerkship (EOC) lectures and exams. Feels good to have my first Exam Master test under my belt. These exams are just ruthless. You know it's bad when you only have to get a 60% to pass and anything above that makes you jump for joy and scream to the heavens with excitement. Just rude.

Anyways, I actually loved Women's Health a lot more than I anticipated....other than the OB aspect. Just not for me. The precious angel babies that come into this world are darling and adorable but the process of getting them here just....isn't. I need to mentally recover from some of those images. The GYN primary care aspect of Women's Health is more my pace. Don't worry there is much more to it than speculum exams....every woman's worst nightmare. We actually did a lot of primary care such as TSH, routine labs, cholesterol, health maintenance etc. I like the idea of being in a "specialty" that is also geared towards preventive care and working with women. Having your patients feel comfortable with you and talk to you about things they don't feel like they can say to anyone else is pretty rewarding.

Next Up....Surgery. I made a deal with a friend that every day I can make it without contaminating myself I get a treat from Dairy Queen. Surgery is also terrifying to me and to be honest I'm glad its one of my first rotations so I can get it over with, know that I can handle it, and then hopefully put that chapter, and its ridiculous attire and rules about touching things, behind me. <<<world's biggest run on sentence.

Whoa Baby Part 3

Annnddddd I'm done. I have barely done any OB this rotation and let me tell ya that is fine with me. The first experience was a couple C-sections, the second time was an afternoon doing ultrasounds, and this third and final time was a vaginal delivery and an attempted external cephalic version. I've said it before, I cannot keep seeing all this if I am ever expected to have my own kids. Surrogate, anyone?

External cephalic version is a procedure that can be done when a baby is in the breech presentation after 37 weeks. For the mother it is like getting ran over by a semi, having the semi back up, then get ran over again. And this lady was a champion. If it were me I would have killed someone. And she didn't even want an epidural. Props to you girlfriend and for your sake I hope that baby does a back flip before next week.  ECV is only successful about 50% of the time, and unfortunately this one was not successful after 3 attempts. My only job during this was to supply goo for the ultra sound machine and not pass out. Mission accomplished.

The vaginal delivery was pretty flawless actually. Which is so weird to say because from the end I was at.....I will spare you the details. I think I held my breath the whole time and almost blacked out. The whole thing is so emotional. I was in a state of utter shock staring at....yeah you get it....and then just wanted to bawl my eyes out in utter joy at the sight of this perfect little angel who just came into the world. At least Adam and I are in COMPLETE agreement that if he even thinks about taking a single step past my shoulder he is in BIG trouble. You just can't come back from that.

My mother wants grandkids someday so in order for that to happen I need to stay far away from labor and delivery until it's my turn to be there.

I cannot believe I only have 3 more days of Women's Health, time is flyingggg.

Bad News.

Delivering bad news is one of the toughest parts of the medical profession. Unfortunately, I have had to witness this twice since I started my Women's Health rotation. It hurts every time, and I honestly don't see it getting any easier. I have always gotten attached to people very quickly and for my own heart's sake I have to do better about keeping an emotional distance.

1. Leiomyosarcoma: Google it. It is a rare, soft tissue malignancy and in this particular case began in the uterus. Luckily, the CT scan was negative so it has not spread which is the only real silver lining. The patient is asymptomatic and it was an incidental (blessing) finding when her uterus was sent to pathology following a hysterectomy. She will need to see a GYN oncologist in Indianapolis to manage her case and will likely join a clinical trial because these cancers historically do not respond well to chemotherapy or treatment in general. It was just so shocking to the patient and her family because she feels great, but is then told she has a rare cancer which doesn't have a good prognosis. She is a wonderful person and has an amazing attitude which will help her fight this battle.

2. Miscarriage: This couple came in for an ultrasound for their initial prenatal visit....She was 9 weeks pregnant and there was no heart beat visible on the ultra sound. They did a transvaginal ultrasound just to be sure...still no heart beat. One of the hardest parts is knowing what you are looking at on the screen and knowing the news they are about to receive and you look over at this smiling, elated couple who has no idea . Everyone in that room had a broken heart in that moment. There were tears, questions, and disbelief. I almost lost it too.

I haven't been able to get these patients off my mind this week as I wonder how they are doing after receiving such bad news less than a week ago. I hope they are coping, I hope they have someone to cry to, a shoulder to lean on, and a support system. 

Whoa baby! Part 2

It's official, I have baby fever. As long as they keep me out of C-sections and deliveries I think this fever will continue for awhile. Don't get your hopes up kids that isn't in the plan for a few years. 

My preceptor is on his way to retirement so when he goes golfing on Wednesday afternoons I get to hang out with whoever will take me...seriously it's like pass the student because who wants a student following them around all day? (answer: no one) Anyways this Wednesday I got to hang out with an ultra-sound tech to see what actually happens/what they see during the bazillion ultrasounds we order.

BABIESSSSSS!!! That is what they see. They get to see those adorable little angels before they enter this scary world and seeing those parents view those images for the first time is awesome. The It's a Boy or It's a Girl appointments are just the best and the moms come in wearing pink and the dads wear blue and it was so fun. One couple ever brought in a video camera which is just funny that people actually do that and its not just something you see on the movies. It was a good day and fortunately all the ultrasounds that afternoon were filled with happy news. 

I am so excited for whenever that day comes in the Diskey family and I will probably be over the top obnoxious and pass out pink or blue balloons to everyone I see that day.

Wardrobe Malfunction

Okay, lets be serious...the medical field needs some fashion help. Luckily my girl Steph Smiy with her blog www.whitecoatwardrobe.com is trying to help us. Anyways, lately the only accessories I have been able to work with are scrub caps and masks with face shields. Not cute, folks. Hello this is my Women's Health rotation which I figured would be my only opportunity to wear fun outfits since I am with women all day. Boo.

So on Monday I was in the OR as usual and my scrub cap started falling down over my eyes. Since I am a hot mess in the OR anyways and never know what to do with my hands I just started making these ridiculous scrunching facial expressions to try to push it back up my forehead....didn't work. See you can't touch your face once you are scrubbed in because it isn't sterile. The circulating nurse noticed my ridiculous maneuver and came over and fixed me...another embarrassing moment in the OR, whatever keep em' coming.

Then the next case my mask had a face shield on it to keep bodily fluids from flying into my eyes...lovely I know. Well apparently I didn't pinch the nasal bridge area tight enough over my nose because the mask starts riding up over my eyes. Hot. Mess. Again, the nurse notices me fidgeting around with my face and being weird so she comes over and pulls my mask down, squeezes the nose part tighter, and re-ties it. Have I mentioned I need a babysitter in the OR? By the time I stop making a fool of myself it will be time to move on to the next rotation and these poor people will be left shaking their heads at how "special" I was.

On a less helpless note, I got to close up some laproscope incisions. Yeah, yeah I know they are practically invisible they are so small, but it was a small victory and those count too.