Monday, November 24, 2008

Four Weeks of Leonard PA-C

It's time I wrote about how Leonard is doing at the clinic.

We work just down the hall from each other. It's nice because I can pull him into a room to consult about an abscess, and he can call my extension and double check the facts of when a blood test needs to be drawn after starting a new medication.

It's nice having someone around who I'm not ashamed to look stupid in front of. Leonard is as important a resource as my palm pilot or my stack of medical books.

Our first two weeks were crazy and frantic, but after a month we're getting more into the swing of things. Here are some highlights of Leonard's first month:

Leonard's stats:
# of patients seen per day: up to 16! Our patient load recently increased.
% of patients that only speak Spanish: 65-70%
Clinics Leonard works at: Nampa Clinic (with me) 3-4 days/week, Caldwell clinic 1-2 days/week
# of patients seen with real insurance (not including Medicaid or Medicare): ~7 total

Funniest presenting symptoms:

-abdominal pain starting in the belly button and spreading outward but only when the patient eats eggs x 3 years
-Bell's palsy (a transient paralysis of one side of the face) in a 17 year old female, which the mom was convinced was because she always held her cell phone on the affected side of her face.

Coolest procedure so far: Toenail removal (Leonard is really good at these)

Most frustrating experience: Trying to convince a gentleman that he needs to go on insulin for his very uncontrolled diabetes. Leonard has seen the man about three times now, and has spent a long time trying to educate the him about his disease and the possible complications, but the man won't budge. Leonard came up with a compromise: The patient is doing a two week trial of aloe vera juice which he is convinced will help. If it doesn't he agrees he'll start the insulin. Leonard can't help but wonder if the next time he'll be seen will be in the hospital after he's admitted for complications from his diabetes.

Proudest moment: Diagnosing a pyogenic granuloma (a benign but weird-looking growth, see below) on a patient's leg just from looking at it. The pathology report just came back, and sure enough, Leonard was right. Thank goodness for dermatology rotations during PA school.

Toughest transition - introducing himself multiple times as "Hi I'm Kyle a PA, used to be a PA student, now I'm a PA, um...what brings you in today?"

Leonard has realized that some patients are not very self aware:
He had a pt come in and while going over her current medications she stated:
"Yes, I'm taking some natural supplements. The three "G's":
Ginseng, Green Tea, and, well there's a third one that they use for memory but I can't remember what it's called." (Leonard and I assume she meant Ginko Biloba). She had no idea how ironic that sounded.

Saturday, November 15, 2008

Leonard the Bully

One of the first things I learned about Leonard when we were dating is that he was a relentless teaser to his siblings. He would relate the stories with strong regret - picking on a pint-sized Louis until he cried, a young Adam calling his mom on vacation because Leonard just wouldn't leave him alone.

"I knew I should stop bugging them...but I couldn't," he once confessed.

I learned very quickly that this wasn't just an older sibling phase.

It's a lazy Saturday morning - Leonard is eating cereal, my head in his lap. I slowly stretch my arms above my head. Sensing my vulnerability, Leonard swiftly sets his cereal down, and grabs both of my wrists with one hand. With the other he taps his finger on my forehead in quick, successive beats.
"Name 10 fruits," he says.
"I can't Ky, don't!" I protest.
"Name 10 fruits!!!"
"O.k., o.k., um, Strawberry, Plum, Banana, ow!, um, Peach, Apple, Pear..." I trail off, my concentration completely altered by the distracting tapping.
"Four more!!" He says encouragingly.
"Um, um, Raspberry, um, Cantaloupe, Mango, Papaya!"

The tapping stops immediately, and relief washes over me.
"Good job!" he says, and I realize he still has my wrists.

"Now name 10 cereals!"
The tapping quickly picks up again.
"No, no, I can't!"
"Just do it!!!!"
"O.k., O.k."
The subject matter gets more and more difficult. When he wants me to name 10 shampoos I completely refuse.
"O.k., then, name 10 liver diseases and I'll let you go."
No problem, I think.
I fail to realize how difficult it is to access the medical part of my brain with the tapping.
"I can't! I can't concentrate!"
"You can do it Megs, I know you can!"
"O.k., o.k., um, Hepatits A, Hepatitis B, Hepatitis C," (I completely forget about the uncommon Hepatitis D and E), "um, ow!, liver cirrhosis, liver cancer, um,"
Dang it, knowledge! Where are you?
Leonard cuts in, "Intrahepatic cholestasis of pregnancy."
Show off, I think. He has the luxury of uninterrupted concentration.
"Budd Chiari" I respond defensively. "Non-Alcoholic Fatty Liver Disease, um, Hemochromatosis, um, um.." Just one more "Gilbert's Disease!" I shout triumphantly.

The tapping stops, but Leonard doesn't let go of my wrists.
"Now, name 10 Himalayan Prime Ministers" he grins.
I scowl at him and he lets me go. I sit up, rubbing my forehead.

At least I didn't get a noogie or a wedgie this time.

Monday, November 10, 2008

Doris Day Monday

Sometimes our days are meant to be themed.

I wasn't thinking about this concept this morning when I walked into the Boise Antique Mall. I had the day off. My mom met me there and together we walked through row upon row of antique and vintage items. The amount of stuff was overwhelming - old kitchen tools, a black mourning dress from the 1920s, oddly shaped glass figurines, vintage costume jewelry, worn Christmas ornaments, etc. I loved perusing and marveling at a time when women were glamorous and homemaking was an art form that women around the world worked on perfecting daily.

Around noon I received a phone call from Leonard. He'd had a rough morning - he was working in a satellite clinic with limited resources and a few tough cases this morning had put him be
hind. Though he's rarely not in a good mood, I could tell he was still frustrated when I received this text message at 12:42 pm:

I am at the post office and apparently they thought it was a good idea to hire the slowest human being alive.

And then at 12:46 pm:

Seriously this man looks and moves exactly like a sloth
. It's probably the government's way of saving on wages. Minimum wage only applies to humans, not sloths.

I texted Leonard back, telling him it would get better and promised him a delicious dinner when he got home. Mom and I went out to lunch and then to a wallpaper store. Afterward I hurried home and put away my new vintage items:Some magazines from the 40s and 50s - for future sewing inspiration

A pair of big clip-on earrings

This head band/hair accessory thingy

I'll figure out an occasion to wear it.

My favorite find - a wall hanging for the guest bathroom

The clock was ticking. I put on my apron, hummed a cheerful tune, and prepared dinner as efficiently as I could. The menu was going to be a hit: Butternut Squash Soup, Cornbread, and Fruit Salad. I just wanted Leonard to be able to come home, enjoy a hearty meal, forget about his day, and relax. All was going well until:

The bottom of the blender wasn't screwed on correctly as I was smoothing out the second half of the soup, so the entire contents gushed out making a huge mess. The humming stopped. Large beads of sweat appeared on my delicate forehead. One shirt change, three washcloths and numerous paper towels later the mess was cleaned up. Luckily I had enough soup from the first batch.

When Leonard came home I greeted him with a smile and a kiss, wearing my new earrings.

And this is what he saw:

Take that, Doris Day.

Friday, November 07, 2008

My First Two Weeks

Here are some highlights from my first two weeks seeing patients on my own:

My Stats:
# Patients seen daily: 10-13 (this will increase over time)
% Spanish speaking only patients: ~40%
% of patients that are homeless : ~15-20%
% of patients without any insurance: ~80%

First prescription ever given under my own name: Vicodin (hopefully this isn't a trend!)

Weirdest Moment: Getting hit on by a 400lb. toothless man with uncontrolled diabetes.

Most Frustrating Moment: Getting yelled at by the husband of one of my patients. She was new to the clinic and was requesting extreme amounts of pain medication for her chronic back pain. I had run a Board of Pharmacy report which showed that she had been to multiple providers over the course of a few months and had received hundreds of opioids and strong anxiety medication. I wasn't going to give her the medication she was requesting, so she ended up sobbing and he was yelling. At one point I literally had both hands out in front of me, palms facing forward saying things like "we're going to try out some of these other medications first," and "I really think physical therapy would help you" but to no avail. They walked away upset and she didn't show up to her next appointment.

Saddest Moment: Seeing an 8 month old baby for her well baby check, and learning that her 14 year old mom had been feeding her cow's milk as she couldn't afford formula. The baby ended up having iron deficiency anemia. This is a pretty big deal in babies this young, as they can end up with impaired mental development even if the iron deficiency is corrected.

Proudest Moment: Diagnosing a very grumpy 54 year old man with vertigo after he'd been previously diagnosed with a viral stomach infection twice. I gave him some Meclizine, called him the next day, and he was feeling better and sounding much less grumpy.

Coming Soon: Leonard's First Two Weeks