Next rotation: Hospice

This should be interesting and will definitely test my ability to keep it together.

I still haven't recovered from my month in the country and very little sleep. I am tired all the time.

The end is near!

For this rotation at least. My preceptor has relegated to me observing him and listening to heart and lungs sounds for 90% of the 10-12 hours I put in each day. I get the impression he doesn't like me, but then again his interpersonal skills are thin. He just seems very uncomfortable speaking to patients and carrying on small talk with anyone. He staff is irritated with him often because he is NEVER on time for anything. I wait at the office 15 minutes to 2 hours for him to come in or to call to tell me where to meet him. He runs through mid-levels fairly regularly and some of his office staff were openly wondering how long his newly hired, yet very experienced PA would last. Seems his PAs and NPs don't stay for longer than a few years at most. I truly look forward to moving on and putting this rotation behind me. It is as close to a waste of time as medical education could be. It's shame too because he knows so damn much. He's just too busy to share it.

Interesting patients

The town I am doing my rotation in this month has maybe 10,000 residents. Many are poor, most are older. Almost all have been very pleasant and friendly. The other day however I was asked to see a patient while my preceptor saw a couple of worker's comp patients. I knew I was in for something when the MA gave me a look of pitty as walked past her to greet the patient. Actually the patient came out into the the hall to meet the "PA student working here for the next month." She was agitated and came at me full bore, demanding to know my name, where I was from and what kind of student I was. I shook her hand and brought her back into the exam room to find out what brought her in that day. She was there with her 11 y/o daughter, there because she was again in pain and needed medication. She pulled a curling iron out of her jacket, plugged it in and began to curl her thinning hair in large loops. She explained to me that she was in pain but that my preceptor had cut her off from narcotics because she had just tested positive for cocaine. What she didn't know was that her test also revealed she wasn't taking any prescribed pain meds either. Her phone then went off and she answered it, and described to the person on the end of the line the quantity and size in milligrams of a substance she could provide to the caller. Soon she answered another similar call and replied to a text message too. She then went on to explain that because she could no longer get pain meds from the doc that she had to "hustle" to get her pain taken care of adequately. After 30 minutes of learning that she had a terrible childhood, had lived in the same town I had when I was young, was the same age as me, that her daughter's dad had been murdered and that she hid nothing from her daughter, I began to wonder where my preceptor was. The patient then showed me a text message from a "friend" looking for some help with their pain from her. One minute she was friendly and smiling, the next she was confrontational and aggressive. Her daughter was embarased, quiet, friendly and smart. She tried to read a book while her mom cursed and rambled and spilled her guts to a stranger. After talking to her for 45 minutes I went to look for my preceptor and to seek a break from the intensity this patient exuded. I waited for 20 minutes for my preceptor to finish with his patient and then we went in together to talk to her. While my preceptor, with his back to us for most of the time, reviewed her meds and medical conditions, she had her daughter apply a fentanyl patch to her back and then she dug through a large prescription medication bottle filled with meds of varying sizes and colors of tablets. She pulled out a few tabs and swallowed them without water. She was now very friendly yet apparently reeling in pain, unable to sit or stand still. I spent this time to talk to her daughter about school and her favorite subjects, while my preceptor sifted through her chart and made notes while occasionally asking a question of the patient. I felt bad for this young girl who would be lucky to have her mom around for her highschool graduation. I was mad at this woman for being so selfish and vile and manipulative. I was frustrated with my preceptor for having me spend and hour and a half with a patient that he never wanted to see and had made wait an hour before he sent me in to talk to her. And I was disappointed with myself for letting any of them make me feel they way I had. She left without any new meds, undoubtedly as frustrated as i was, but for different reasons. I wish i had learned something valuable form the experience but I didn't. It only reinforced my feelings that some people are shit and will not hesitate to put people - loved ones and strangers- in positions they shouldn't be in to meet their own selfish needs. It reinforced the notion that innocent kids everywhere have crappy parents and must beat all the odds just to have a decent life. I also learned that my preceptor is passive aggressive and puts off doing what he doesn't want to do by placing a student in a crap situation just to prolong the inevitable. Thank goodness for the many kind and truely friendly patients I hve met during this rotation.

rural family practice

1) meeting lots of really nice people. really nice.
2) bought my SP a wireless router so I can do school work at the office rather than at mcdonalds.
3) bought a can of raid to kill the multitude of beetles that invade my living quarters.
4) doing a little more now on this rotation. SP a bit more social and friendly.
5) lots of the same here compared to the "city" - chronic pain and worker's comp mostly.
6) small town = lot's of old folks, not too many young folks.
7) miss my son like nobody's business.
8) rides back home with classmate are entertaining, enlightening and awakening.
9) not a damn thing to do or places to eat at 10 pm when I finish for the day
10) can't sleep for heck with the beetles and trains
11) bonus - ALL learning experiences are valuable.