Intro into October

We're almost done with 2008. Is it just me or do the years seem to get shorter and shorter? It's kinda hard to believe that over a year ago I started PA school and now I'm half way done and already working in different clinics. Many friends have moved out of the state and are attending their respective graduate programs, everyone's married off (I know I'm a slacker, but I'm O.K. with that), my little nephews are growing and picking up on new things every day, and, unfortunately, the boat is being put away (if Daniel is reading this the boat being winterized early is not my fault. Dad decided that since I wasn't going to be down until the end of October he was going to get it out of the way. Everyone knows if I had my way I'd try to hit the lakes one more time this year. Se la vi.)
So here it is, first few days into October and one week into my second rotation. I'm working out of an outpatient family practice clinic in Idaho Falls. It's a community health clinic funded by the government and so it serves a lot of people who are financially troubled. Because of the increased Hispanic population I get to use my Spanish a lot more. It's been over a year since I used my medical Spanish in an every day setting and I can tell you it has gone quickly down the crap hole. Words and phrases that I used to use in my sleep now take some actual thinking on my part and it's not as fluid as it used to be. That really is a disappointing thing to come to terms with. I don't think it will ever be as good as it was while I worked as an interpreter.
This switch to outpatient medicine from psych has been a challenging one. The interview process and questions are different and I actually have to perform a physical exam. That's probably been the best part of the change. Even though my exam skills are rusty and I'm still learning the nuances and intricacies of the physical exam, that hands on medicine is quite satisfying. I'm not going to lie when I said that I was a little scared and nervous going into this rotation because of my lack of the vast amount of knowledge required in this field. However, as I said back in my psych rotation, going through the history and physical exam usually leads you to the next question that you need to ask. It's amazing how everything seems to fall into place.
For it being my first week I've got to do some pretty simple, but still exciting, procedures. My second day I got to remove an ingrown toenail. Not that difficult or exciting of a procedure, but I was still pretty excited to do it, it being my first one and all. It truly is something else to forcibly remove the nail from the nail bed by simply jamming and blunt ended instrument between the two, all while the person has no feeling whatsoever because of the lidocaine injected into the foot just minutes earlier. As I sat there ramming this tool under the nail to clear it away from the bed so I could cut it out I was amazed at how much pressure I actually had to apply to get it up there. It wasn't a simple push either; it was a shove, pull out, then shove again maneuver, like picking away at ice with an icepick. At one point I pushed hard enough to get completely through the bed and under the cuticle. As I heard the popping sound and sudden release of pressure as the instrument freely flowed under the nail until it came to a stop just after going under the cuticle I for sure thuoght I was going to be kicked by a screeming teenage girl. Nope, she didn't feel a thing. Her father was even amazed at the proceedings and he also thought she was going to screem. I cut the rest of the nail out, debrided the wound and then bandaged it up. A simple procdure that I was excited about for the rest of the day. Other simple things that I was able to do were cut off a little kids cast and trim some pretty horrific onychyomycotic (fungal infected) toenails.
After a couple of days I was feeling pretty confident about my history and PE skills but still pretty shaky on my assessments and treatment options. With the help of a couple good preceptors, good advice, study, and practice that has all changed. By then end of my fourth day I was pretty confident about my findings and treatment plans of all my patients except for one difficult case that needed some extensive work up. Even my preceptor agreed with me that this was a difficult case and he didn't know what was going on either, hence the extensive work up.
So that's what's been going on in the professional life. The personal life is still there and chugging along. I was down in Ogden a couple weeks ago. Unfortunately I wasn't able to partake of the pristine waters of Pineview because of lack of a boat crew. That's what happens when everyone moves off to college, the boat suffers. So instead I hung out and played with my little nephews for a little bit on Saturday.

I also attended an 80th birthday party for my grandpa. The man doesn't look or act like he's 80 so I was a little skeptic of the party but all the paperwork checked out. It was good to see some family and enjoy of their company for a while.

After that I took a girl I've been dating (yes I still find time to date with all that's gonig on, contrary to the rumors believed by my ISUPA classmates) out and we saw a play down in Salt Lake. The next day we took a drive up Ogden canyon after church to see the changing of the leaves brought about be the fall weather.
Then it was back up to Idaho for me.

I took the bike out one beautiful Saturday afternoon up Gibson Jack canyon (one that I've previously done) again to see the difference in colors due to the weather. It was a great, challenging ride that I enjoyed even more this time due to the change in scenery. While up there I got to thinking about the beauty that this impending death brought about (if you want to read more on those thoughts just check out my other blog site here). And then the rest of the weekend was spent studying.
So that's the update for now. Things are going well and I'm liking this current roatation a lot. One thing I forgot to mention was the constant Spanglish used at the clinic. All of the staff know Spanish and many of the patients uses some type of English in their speech so it's not uncommon to hear "ayer cuando me fui to work me fijaba que my arm was doliendo," or, "dice que you need to give la paciente something para relajarse." It's great!