Eat Plants

I remember there was a time where I kind of scoffed at vegan-ism and said that I would never go that far.  But, since that time, more research has been done and I have been better informed regarding nutritional aspects of eating plants, along with the negative effects of eating animal protein, like casein, which is not only in meats, but in dairy products too.  My recent scare with cancer (Melanoma, caught early, thank goodness) and my significant family history has me jumping on the band wagon to put up as strong of a defense as I can.  But it's hard!  I don't do too bad in the meat department -- my biggest difficulty would be giving up sushi, otherwise it is usually when I'm unprepared and have to eat out, or am looking for something quick that I end up eating meat (think fast food, turkey sandwich or salad with chicken).  I am not going to give up sushi.  It's kind of a special occasion type thing anyway and fish has beneficial properties as well.  Now dairy on the other hand, is a whole different beast.  Cheese!  Cheese and other dairy products are one of those things you can add to just about anything and bring it to a different level -- sandwiches (swiss? munster?), salads (blue cheese!), soups (sour cream?), fruit (cottage cheese?), pasta (parmesan!)... But alas, it does not do good things to me.  Cheese and I are in a battle and that is where I am at right now.  We will see where this leads.

Living on the edge........ of one of the worst neighborhoods in the country

Moving to the ghetto was probably not the brightest idea for someone who was already struggling with being hyperalert.  I'm trying to think maybe it will be good for me.  I don't want to be looking around every corner, imaging someone lurking in every shadow...  I know this attitude has probably kept me safe at times, but some things you just can't prevent.  And I don't want the stress.  I do like our studio, and I think I may meet some cool neighbors eventually.  If everything works out with our parking spot and plug for our electric car, I think it will be worth it.  Not to mention the additional $600 in my pocket every month.  Thus far though, we are negative one Cannondal road bike worth $1000.  Neighborhood 1: Loft 0.  And the battle continues.


Noises, I play within my head
Touch my own skin and hope that I'm still breathing
And I think back to when my brother and my sister slept
In an unlocked place the only time I felt safe
--ellie goulding, lights

sunshine = trauma.

i love working in the ER. it's so alive. you have absolutely no perception of time nor hunger - day, night, who knows?

i sutured today. apparently i remember how, after more than 1.5 years of not suturing. i must say, it was a beautiful suture job (chin laceration).

i also learned new things. like how to do an ear block (numb the nerves going to the ear to make the entire ear numb).

and i caught rhabdomyolysis in a guy that would have gotten sent home otherwise. (he was getting rhabdo because he did PCP earlier that day). instead he got admitted.

but, now that i'm not in the ER anymore and have left the time-suck... its starting to feel like it is actually 11:39pm and time to go to bed. back to primary care in the morning.

debrief.

i decided i need to blog more. i need to debrief myself of what goes on through the day. to avoid any HIPPA violations or other problems, stories will be left vague and key details will be changed. you should know that i now have two jobs -- one is at an outpatient clinic in the suburbs at an underserved clinic. our population is about 80 percent spanish speaking, and only 30 percent have any type of insurance at all -- 2/3rds of those have medicaid. 70 percent are self-paying out of pocket (or just not paying). the other job is at an urban trauma one center emergency room.

a man came to the ER for a bump on his penis. when i asked him why he was there (meaning, what brought you in, what is your chief complaint?) he responded, "because i don't have insurance". the ER becomes not only an emergency medicine department, but a primary care, OB-gyn, opthalmology, social services, STD clinic and homeless shelter. the ER is always the money-suck for a hospital. completely non-profitable. this is ONE of the reasons healthcare is so expensive. we need more preventative care. people need primary care providers.

that being said... there are also some really shitty ERs out there. a patient who had shoulder surgery done in the past which included some hardware fell and dislocated a screw that had been surgically placed inside his shoulder. he went to the ER. they discharged him to see me (at an outpatient clinic) with a metal screw sticking an inch to an inch and a half through the skin out of his shoulder, surrounding by a pus oozing abscess. really? because he didn't have insurance, and they didn't have the proper people on-call, they send him to me. what did they expect me to do... whip out my phillips and screw it back in?

other notable patients since i began working include a mother being seen for depression when the story comes out that her brother has been sexually abusing her daughter (his niece) and now her mother won't speak to her, because she reported it and her brother (mother's son) is getting in legal trouble. her chief complaint began as an ulcer on her toe. you never know how its going to go down once you get in the room.

i also had a new patient walk in (to my outpatient primary care clinic) with a wound vac (vacuum suction like device that attaches via a hose to an open wound in the body, usually covered with a sponge -- it helps it heal faster) attached to a wide open 6-8 inch wound in his chest, which he told me was from a sternumectomy (they removed his sternum supposedly because he had so many bypass surgeries). his chief complaint was that he "needed to establish care with a new doctor" -- his old doctor didn't take medicaid anymore and so he was sent to me.

this is why i am a proponent of single-payer healthcare. not to mention an electronic medical record system that is equivalent across the country would save so much money, provide for more efficient, better quality healthcare, and reduce mistakes.

still haven't lost the desire to get my eyebrow pierced.

this still might happen.

early afternoon sleepy morning breakfast

i love living with this man.

life as a PA.

i'm about 2 months into my first job as a physician assistant.

the transition in general has gone pretty well. first few weeks were stressful -- first getting used to a new place, figuring out what paperwork needs to be done when and who goes where. it was really overwhelming at first to be responsible for care and not have anyone to just be like OK, sounds good or yes, that's right. i felt like i was just totally guessing and trying stuff out to see what was working-- which is scary when it comes to healthcare. thing is, i guess i still feel like that... its not that i got more confident in my decisions, i just got more comfortable with the feeling of guessing.

someone who is not in healthcare probably finds this really scary. to be honest that was my biggest lesson during rotations -- no one else really knows what they are doing either. nothing is for sure in medicine. you have your base knowledge and then you just have to do your best to adapt to each patient and presentation being different and do what you can while trying to "kill as few patients as possible" as my boyfriend would say.

overall, i like my job, i think. i like being a PA. i like most of my patients. its just at times that its a little too stressful and frustrating. not because of my patients though, i think its more because of the "system". for one, i don't have enough time with my patients. its go-go-go all the time, we have walk-ins coming out of our ears, and 15 minute appointments, half of which are usually taken up by the MAs getting the patients ready, so that leaves me with 7 minutes to go over the 3 chronic illnesses and 2 acute problems the patient is likely to have, examen them, confirm all the meds, write prescriptions and orders and shoo them out the door before i have to run to the next one. oh, and most of the time this is all done in spanish. and for two, we can't get any of the tests we need done. our patients have no money and no one in the area is willing to see them for specialty care. so a lot of the time i'm just the holder of risks and bad news with no real outcome or direction to go in besides "wait and see".

my chart/documentation skills have definitely gone out the window, but my spanish is getting pretty good.

i think that it will be a good experience. its kind of like throwing me into the fire and seeing what happens... but i think it will turn out OK. i don't plan on staying too long-- i'd get way burnt out, but it will be good while it lasts.