ski day!

my first attempt at shooting video and editing....not exactly great, but a super fun day on mt. hood with weather to match. (sorry shannon and t, i would've gotten more footage of you guys if you didn't go so damn fast....)

cast of ladies:

harsono- riding a bamboo board

shannon- a blur in most shots

t- AT rockstar

me (there are no words)

settling in

week 7, things are feeling quite homey. i've never had this much time to settle into a rotation, and some slightly medically complicated patients i'm now seeing for the 3rd time- and for the more neurotic ones, 5th and 6th times. sometimes we talk on a weekly basis...one pt on an almost daily basis for constant reassurance and for notes to her work allowing for all of her weird nuances. at first it was sort of a drag, but now it's getting really interesting to see what more we can come up with...and i wonder how long her employer will continue to smile and nod. it's also quite interesting to track how her new medications seem to be taking effect. it's far more fascinating than i ever thought it could be.

also, when you see 30+ patients a day, something interesting is bound to pop up beyond the sinus and ear infections. like patients who get botox injections for overactive bladders but it backfires and instead they end up with chronic UTI's due to their inability to really void...or the pt who ends up in renal failure because her naturopath family member put her on medications without checking her kidney function first....

it's good stuff.

also...more overheards, since they are kinda fun...

pt: "thank you for looking, but when is the real visit going to start, the one with the real doctor?"

pt: "i feel like you have really been listening, and i appreciate your concentration, trying to figure out what's wrong with me today."

me: "oh sure, no problem. has anyone ever told you that you have the same voice as owen wilson? i feel like i'm talking to lightning mcqueen. ha ha ha"

pt: "who?"

me: "ahem. nevermind"

preceptor: "wait a minute...is that why you spent so much time with that pt?"

me "yeah, maybe. on an unprofessional scale of 1-10, how would you rate that?"

preceptor: "6."

i feel like i have more stored somewhere in my brain, but it's late and there are olympic level distractions and spring! is currently going off outside. i'll get back to these soon enough.

overheard

It's been an exciting week in the wide and wonderful world of psychology, i mean, family medicine. here are some of my favorite things i've heard this week:

pt: "are you the doctor?"

me: "no, i'm...."

pt: "well if you're not the doctor then the least you can do is get me some coffee. black."

pt: "i keep gaining weight. i don't know why i keep gaining wt."

me: "ok, let's try to sort through this and come up with some ideas and strategies so you can lose that weight.....(long interview inserted here, blah blah blah) ...so tell me about your caffeine use..."

pt: "i drink 2-3 liters a day"

me: "of what?"

pt: "soda."

me: "of regular soda??"

pt: "yes, well i read on the internet that diet soda is bad for you."

and my personal favorite...

pt: "i have sort of a weird question for you, please don't take it the wrong way..."

me: "nothing is sacred. shoot."

pt: "um...do you guys have any body bags you could loan me?"

A quick pic from the new hood- the park this was taken from is 3 blocks from our place. have i mentioned that we love it here?? today i wore heels to work with my fancy new haircut...damn i feel all growed up. for like the first time ever. it's almost exciting. painful, but exciting.

back by popular demand!

For those who have requested a new post: here it is, the past month in summary:

1. finished up in newport, WA- a great rotation. amazing people, which is like 90% of any experience...even though i was forced to sing karaoke at the ER christmas party. and the remaining 10% was all fun and guts encompassing good times in the ER, surgery, inpatient, long term care, and labor and delivery. 4 baby girls came into the world with my (limited) assistance. i hinted to ben that maybe it was a sign...and he says yes....that the world is clearly overcrowded with them. nice try.

2. back to NH for the holidays to see friends and family, which was super fun despite the fact that it was FREEZING cold the whole time we were there. or maybe i've just become a wuss. to be honest, i've been a wuss for some time now, just able to hide it well. call a NW winter whatever you want, but you don't have to shovel rain and i have yet to wear a hat or gloves here. in a nutshell, it was a whirlwind of sledding, gingerbread, champagne, cousins, lobster, vegan gluten free carrot cake, captain underpants, more champagne, and a few parties involving christmas cookies and more champagne. it was good to be back, good to see old friends, good to see how things have changed in our absence. good to be in sunapee harbor, fun to be in a beautiful rural locale in new england, totally normal rockwell'ed out.

3. fast forward a few weeks to the insanity of coming home new year's eve, making into town and into the warmth of our friends home just in time to ring in the new year. the new-improved-don't-look-back-this-one-is-gonna-ROCK! year. since i have nothing nice to say about 2009, i won't. but i am super hopeful about what's coming down the line, and it was nice to have a solid delineation. i'm not really much for new year's celebrations, but i had a little celebration at every single time zone we crossed on our flight back.

and now we're settled into our new (slightly longer term) place in sellwood, the neighborhood we've sort of been coveting for a year now. it's like a dream come true. walkable, bikeable, eatable, drinkable, playgroundable...pretty much hits all the major checkpoints for a place we want to live in, PLUS a sock emporium. what's not to love?

take the photo tour:

http://www.portlandneighborhood.com/sellwood-moreland.html

my current rotation, the biggest of the year, a 3 month family practice gig, is a short commute away and so far seems to be a gem of a spot. most of the pts are intel/yahoo/nike employees...and totally normal, nice people. a good international mix, lots of interesting life stories. i see it all, at a high volume. so it's nice to get a little bit of everything. from thyroid disorders to hypertension to diabetes to toenail removals to depression to rashes and the dreaded well child checks...it's good stuff. i get it. it's a comfy spot to be in. the light is getting brighter at the end of the tunnel and the track is smooth at the moment, so i'm chugging along quite nicely.

after this rotation, things may or may not get a little more roller coastery, but that remains to be seen as i have at least one unfilled rotation, and the other could be iffy depending on how things shake out in eastern africa over the next few months. but my passport is all renewed, ready to go just in case.

life is good. i feel like i haven't been able to say that for a while. i'm rolling with it. cause i finally can. phew.

northern exposure

so....

3 weeks here and i've finally found some wireless internet....at the hospital. where i work. all day. every day. and now, on my day off, here i am.
it's not so bad when you can show up and not have to think.

otherwise, it's a struggle. for a rural town in northeastern WA/northwestern ID, there sure are a lot of interesting cases. mostly cause people up here do what they want and only get medical care when they really really really need it. which is great for me, bad for them. huge cans of worms lurking around every corner. and people my age who look 50. 50 year olds who look 70. very few 70 year olds....

other than that, it's kinda fun. no surprise here, i love rural medicine. i love that providers choose to be here and are compassionate and not assholes about it. and that they laugh about things that 90% of the population really would not find funny. i love that they love teaching me cool stuff. i love that it's a small community that you could easily integrate right into. i love that i see pts in the ER, follow them to inpatients, through the OR and back out on the other side. i love visiting the folks in long term care and delivering babies in the same day. and i can't beleieve that i haven't seen the same pt twice in the 3 weeks here.

and truth be told, i love assisted living. there would be a gold mine to be made for anyone who wanted to create some sort of post-college age assisted living sitaution i think. it's just so easy. amazing how much time you can spend doing things you like when you're not worried about keeping things neat and clean, or cooking for yourself. for single people, it's pretty much the holy grail of living, i'd say.

i like this town. granted, there's not a whole lot here, and i haven't seen the sun in 3 weeks. but there is a nice safeway. i don't get out much cause i don't have a car, but the surrounding area looks nice. lots of mts, lots of trees, lots of snow. the assisted living place i'm staying is right across from 3 churches and a funeral home. one stop shopping. everytime i venture outside the town smells of pine trees and woodsmoke, not a bad combo. other than that, not much going on. i feel like it may as well be alaska, minus the grizzlies. they've got everything else here...i run into deer around town all the time. fortunatly, none of them have run into me.

i work, i eat, i sleep a little bit inbetween so i can go home a week early. i was adopted for thanksgiving and it was nice. lots of babies to squeeze. my own babies have been busy running amok in seattle and being city kids through and through. i think about bringing them to a place like this and wondering how it would all shake out. would they be outfitted in camo and bringing me home some elk by first grade? would we live on a ranch? have horses and tractors? would they ever be clean again ever?

my slightly humorous note of the day involves a little scenario that went down last wednesday, the day before thanksgiving...we're sort of sandwiched between 2 reservations here, and i had a native american patient who came in that day who wasn't exactly the easiest to talk to but we muddled through the encounter and came to the end and not really thinking about it, i said goodbye. and wished her a happy thanksgiving. and then walked away and tried not to cringe. can you do that? was it bad form? politically incorrect? it was sort of funny in retrospect, though...

gearing up for the big ER x-mas party next weekend. will try not to make an idiot of myself, but can make no promises. in the meantime, i plan to relax for the rest of the day, turn on the TV and pretend like sitting on the couch for the rest of the day uninterrupted with my bag of lucky charms is somehow a luxurious endeavor. and then right back at it tomorrow.

home in a week and a half. i can't wait, even though i'm dreading another move during the holidays....to who knows where....

Dime a dozen

Dime a dozen
Originally uploaded by Nikki McLeod

hawaii's got nothin' on oregon in the fall and spring. ok, maybe the ocean temp. but as far as rainbow state rivals, i would wager hawaii could just get cozy in that back seat. my commute is beautiful. and, at least one trip of the day is done in daylight hours, so that's a bonus.
in the dark it is kinda creepy on the back roads.

last week i hit a possum on the way into newberg. it got to me more than i ever thought it would, mostly because it was not by any means a small possum, but i pushed it neatly under the figuritive rug.

until today, when my first legitimately *crazy* patient showed up with some sort of acute psychosis going on. after ruling out she wasn't seizing (generally not a bilateral movement phenomenon that one can talk through) i tried the old cure for pseudo-seizure my preceptor recommended...smelling salts. and hey, they work! imagine that. snapped my patient right out of it long enough to get out of her that she was having these constant visual hallucinations....of dark places, with animals with red eyes....

and dammed if the first thing i thought of was that unfortunate possum.

and her fear became real to me. i got it. it would really suck to be stuck in that world forever. i'd probably be shaking non-stop too.

acute onset schizophrenia? maybe. it sure fit. not up to me to make that diagnoses, and i'm glad it never will be. admit to psych. done. yikes.

in other news, the boys are madly whittling down their halloween preparations...initially it was supposed to be some sort of scooby doo holiday, but now we might be going in another direction altogether...tomorrow is the deadline. we shall see. liam rode around the neighborhood this afternoon making a map of the super decked-out halloween decorated houses, so we're gonna hit those up first. last year they lasted about 2 blocks before the desire to eat the candy outweighed the desire to get more. this year, mommy has a chocolate quota that needs to be met, cool decorations or no.

if i'm going to be shipped out to newport, WA for a northern exposure stint in 2 weeks without my family, then i will need all the emotional and cocoa-bound nutritional support i can get. will enjoy the scenery and the sugar in the meantime.

some swine with that cheese.....

ER celebration humor
Originally uploaded by Nikki McLeod

oh ER humor.

swine cakes in celebration of ER nurses week showed up today. painstakingly and wonderfully handmade.... including the pink marshmellows. touche, martha.

i might add a sad note, however, that last week, in honor of PA week, there was nothing. not one treat. this week it might as week might as well be halloween, valentines and easter all rolled up into one sugary gooey morsel. and the one PA who i actually wished a happy PA day to responded, "oh, ok. wait, what? we have a day?"

who needs recognition, anyway. i can steal the nurse's treats and be just as happy.

besides being ignored by hospital administration as a professional, however, i have been having quite a fabulous time in the ED. more fun that i thought i would have. seeing more craziness than i thought. rural ER's are fun that way, since the weird is usually funny and interesting instead of...really weird. ie... drunk/stinky/psychotic.

gunshot wounds, eyeball foreign bodies, GI foreign bodies, broken bones from tripping over the dog and falling off tractors, GI bleeds, heart attacks, miscarriage, lacerations, car accidents, ginormous hernias gone unchecked for 8 years, lumbar punctures, central lines, NG tubes, and today, icing on the cake, an addisonian crisis. i mean....that's good stuff. i might be in love.

except for the swine flu bit. these patients are everywhere. probably a 3:1 ratio to all the fun stuff is flu symptoms. and these people are miserable, but sent home. and not accounted for, cause that only happens in the state of OR if you're admitted. fun fact for the day. huh.
my favorite are the patients that come in after trying to battle it out for a day at work and then realize they're too sick. nice. move. people.

i have yet to be immunized for that. i'm sort of hoping that i'm getting enough exposure to sort of boost my immune system just by showing up. i am intrigued by the RN's tales of consequences at the hospital, and at other hospitals about what will happen to them if they don't get the H1N1 immunization. like having to take vacation time if they get sick, or in extreme circumstances, being fired. it's quite a controversy these days, and i think it's weird that it seems to have landed on the RN's shoulders the hardest. this as we admitted 5 patients on my shift alone today and then had to divert the rest since the nursing staff in the rest of the hospital was too depleted to fill the remaining 10 beds that were open....8 RN's called out sick on one floor alone today. i thought the nursing supervisor was going to lose it completely.

so
fingers will remain very clean and crossed from here on out.
except for when they're covered in chocolate and pink icing...