The Weekly Sign-Out
~a documentation of my clinical rotation experience~
weeks 31-40
Week 40: May 23 - May 29
two-thousand-and-twenty-one
The Highs: ​
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Working with Dr. Smith, Dr. Ulmer, Dr. Adams, & Emily
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More teaching by Dr. Goel!
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Treating a Chest Pain admission with OMT...and curing him!
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Nailing my final IM presentation
The Lows:
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Long hours
Overall rating of the weeks: 9/10
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Week 39: May 23 - May 29
two-thousand-and-twenty-one
The Highs: ​
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Managing my own critical patients with Dr. Tyer
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Learning from a great preceptor
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Ultrasound Escape Room with Dr. Heesun Choi
The Lows:
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Only getting a week with Dr. Tyer
Overall rating of the week: 10/10
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Started my last rotation of the year!! It's Internal Medicine, and I had it set up with Sandi (my coordinator) to do 1 week of hospitalist medicine with Dr. Tyer, one week of Inpatient with NCFM, and two weeks with Dr. Panah, a GI specialist! This week was all about Dr. Tyer -- he's an RVU alumnus who also graduated from the Greeley NCFM program, and is now a hospitalist at NCMC!
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Week 38: May 16 - May 22
two-thousand-and-twenty-one
The Highs: ​
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One last circumcision
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Diagnosing a short leg in a peds patient using OMM!
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Burn patient
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Soar like an eagle
The Lows:
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Saying goodbye, once again.
Overall rating of the weeks: 9/10
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New residents this week! I was back working with Dr. Jessica Smith, PGY-1, and a new chief, Dr. Michael Renecle, PGY-3! This was great because both of them were amazing, taught me a lot, and were very encouraging. Jess let me have her circumcision one day, and I was able to do it from start to finish with minimal help or correction from both her and Dr. Bradfield, the NCFM attending. That felt amazing!! I really enjoy procedures, so it was really great to be able to showcase how much I had learned from Dr. Money, Casey, and Meggie during my last week on Peds.
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The one super different/interesting patient I saw was a teenaged boy who transferred from a hospital in Wyoming to our hospital because he sustained partial 2nd and 3rd degree burns on his body. Apparently, he was attempting to light a cigarette with a camping gas-canister-lighter-thing (what are those called again? I can't remember right now), and the whole thing caught on fire. It spread from his hand to his arm, melted his shirt and pants, and went all the way down to his legs. He was on FIRE. He threw the camping gas-canister-lighter-thing away from him right before it exploded. He got super lucky because he had just taken an ice bath before doing this, and still had water in the tub. He ran into his house and immersed himself into the ice water bath to extinguish the flames. Anyway, Greeley hospital has a fantastic Burn center, so he was treated in the peds ward and was also followed by the Burn specialist. I was able to help him redress and clean all of his skin and wounds in the burn shower, which was such a cool experience. Surprisingly, the patient tolerated the entire process very well, and was in minimal pain despite the amount of skin damage he had sustained. He also had the best attitude and was very kind and respectful toward everyone on the medicine team. The patient had recently gone through very challenging experiences with his friends, but he had such a positive outlook on life, which was remarkable to witness. He was discharged after a few days with us, and went back to Wyoming with his mom. I definitely won't be forgetting his case for a long time.
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The other cool story I have to tell is from clinic! I was seeing a patient who was coming in with knee pains and leg pains. His grandmother thought he might just be having growing pains, but parts of his story just didn't seem to add up. On my physical exam, I decided to really evaluate his feet, knees, and hips. Initially, his medial malleoli were pretty even, but his hips were a little lop-sided. So I reset his hips and did some muscle energy on his pelvis to make it all realign. Then I looked as his feet again, and sure enough, the left leg was definitely shorter than the other! After I finished my exam and went out to present to Dr. Chmura, she thought my findings were a little suspicious, but when she herself went to check and reexamine him, she agreed that he had a short leg! The patient ended up with a referral to ortho, and once he left, Dr. Chmura gave me the biggest high five and said some amazing, encouraging words to me. I think she was really impressed by my OMT skills, and I was glad that I was able to prove my worth, but ALSO treat a pediatric patient with OMT! That was a great feeling, and I felt so, so proud to be a DO.
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Honestly, the amount of people I've been able to treat and help this year using osteopathic manipulation has been crazy! I certainly feel like I have an incredible asset, being able to treat people with my hands. More and more, I'm grateful that God put me on this path. I know I don't usually get religious in these posts, but really, He's never once let me down. I remember being disappointed in myself for not getting into an MD program when I was applying for medical school. I remember how discouraging it was to have to keep explaining to people over and over that being a DO is essentially the same as being an MD. I remember my mom not being an ounce excited when I got my first medical school interview from a DO program. But now, I remember all the people I've treated, the people I've made feel better, my parents who I've helped, my friends, and my fiance, who have all benefitted from my training in OMT. I'm so, so proud to be a DO.
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Anyway, back to Peds. :P
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I took my shelf exam on Friday afternoon, and once it was over, immediately went back to see Dr. Money at the hospital. There were some questions that I had from my exam that I just didn't know the answer to, and wanted his input. He was surprised to see me, but I think was happy to have me come back to discuss more Peds topics. :P Honestly, I've never done that before- go back to see a preceptor after the shelf just to talk about it. But I felt comfortable enough to do that with Dr. Money, and knew he would be supportive. Haha.
On the thank you card I wrote for him, I made sure to draw an eagle on the back. On my end-of-rotation evaluation and Dean's letter comments, he wrote that I would no doubt soar like an eagle (inside joke). :P I loved this rotation so much, and I'm really going to miss everything about it!
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Peds Clinic!
L-to-R: Candace, me, Dr. Chmura
"You have brains in your head and feet in your shoes. YOu can steer yourself in any direction you choose!"
-Dr. Seuss
May 20, 2021
L-to-R: Dr. Michael Renecle, me,
Dr. Jessica Smith
May 20, 2021
The one and only, Dr. Money!
May 20, 2021
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Week 36-37: May 1 - May 15
two-thousand-and-twenty-one
The Highs: ​
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Got to do another circ!
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Finding my stride on Peds
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Lots of interesting cases on the peds floor!
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Working with a dream team
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Dr. Money's lectures are 11/10
The Lows:
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Not many this week! :)
Overall rating of the weeks: 9/10
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I'm writing a double-week post because I got to work with new residents during this time! I met Dr. Tyler Ulmer, a PGY-1, and Dr. Margarite Bechis (chief). I actually wasn't even aware that the residents were switching last week, so I was quite surprised when I walked into the resident call room on Monday morning to a new group of people. However, I was really taken aback by how well Tyler, Meggie, and I worked together! On the first couple of days, we actually had no patients admitted, which meant that the residents were helping out on OB and I was left study on my own. That was actually really nice though, because I got to finish my Uworld questions early and get through my flashcards before clinic.
It wasn't until around Wednesday that we had our first patient of the week, and I was able to prove my worth to the residents by nailing my presentation on the one patient I saw--Peds isn't the busiest of wards, but I was actually really lucky that I got to see a good number of kiddos on my rotation. By the end of the week, we had two really interesting cases. One was a 2 year old girl who was presenting with several days of a high fever, a rash, and conjunctivitis. Everyone was thinking Kawasaki's disease, and she ended up getting all the viral work-ups that we had. She ended up being positive for Adenovirus of all things, and her rash had completely resolved. She wasn't a slam-dunk Kawasaki's because she didn't meet all the criteria for the disease, but dang it would've been really interesting to see. We most feared the complication of a coronary artery aneurysm, but because her status was improving and she didn't meet full criteria, we held off on the echocardiogram as well as the IVIG and Aspirin. She was treated with supportive care and ultimately was discharged home in the next few days. Her case had another level of difficulty due to the fact that her mother only spoke Rohingya, an Eastern Indo-Aryan language. We had to use a virtual language interpreter to communicate with mom, which was another high-learning experience. My global medicine lab that I had during my 2nd year of medical school, in which we practiced a standardized patient who spoke a foreign language, came in really handy for this. Body language and eye contact were of the utmost importance, and it was also very important to make sure to talk to the patient, not the video screen with the interpreter. I felt like Tyler and I did a really great job of doing just that whenever we talked with mom.
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The other interesting case I saw this week was a 4 year old gal who was white as a ghost! She was very fatigued all the time, and it turns out that mom was giving her nothing but cow milk to drink because that's all the patient wanted. She was drinking close to 35-40 ounces of cow's milk daily. Mom said she even tried to switch her to powdered cow's milk once the patient started to show symptoms of anemia, which we had to compassionately educate her that powdered milk is still milk. This little girl had a hemoglobin level of 4.3 and had severe iron deficiency anemia! Initially, Meggie, Ty, and I were freaking out, thinking we needed to transfuse her immediately. However, upon presenting this patient to our attending that day (Dr. Goyle), he told us that in children of our patient's age, a Hgb of 4 was not critical. I think all of us were kind of shocked. But, we fought our case and convinced him that she needed to be transfused. So, our little lady got 1 unit of packed RBCs given extremely slowly throughout the day (so as not to fluid overload her tiny body and cause worse outcomes), and by nighttime, she was running up and down the peds halls.
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Before my day ended in the hospital, Dr. Goyle, who liked to pimp me and test my knowledge, gave me a scenario - he said, "Ok, you have a patient who comes in with several days of fever, with no rash, and-" immediately I interrupted and said, "It's Roseola!". He looked at me, stood up, raised his arms, and said, "Ok Liz, you get Honors!" Haha. That was a great moment for me. :P
When Dr. Money returned back to the floor the following week, we sat down in his office and did more of his teaching lectures. Brent, my colleague, recommended that I ask Dr. Money for his "Winter is Coming" lecture, so we spent time getting through that. Gosh, these lectures are honestly SO good. I was also incredibly appreciative of the time Dr. Money took to run through these lectures with me because it showed me that he was definitely invested in my learning, and that really stood out to me. I really think that no other preceptor has taken as much time to teach me as he has. It won't be forgotten.
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Also, funny story - I told Dr. Money and Tyler about my mom buying me an eagle poster to hang above my bed while I sleep. She's very superstitious about those kinds of things, and kept telling me that I needed an eagle in my room so that I would "SOAR HIGH! And get a HIGH board score this year!". *Shakes head*. This definitely became an inside joke between me and Dr. Money, and now I hope that he'll think of me every time he sees an eagle. Haha!
My Peds Dream Team!
Dr. Margarite Bechis, me, Dr. Tyler Ulmer
May 14, 2021
Week 34: April 18 - April 24
two-thousand-and-twenty-one
The Highs: ​
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Plastibell Circumcisions
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Moving back to Greeley
The Lows:
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Saying goodbye
Overall rating of the weeks: 9/10
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What in the world... I was not expecting this rotation to be full of so many great opportunities. I've absolutely loved every day of getting to see the patients, working with Leslie, Blanca, Jess, Dr. Poupore, and Dr. McDonald, and the OB nurses. I'm sincerely going to miss working in this hospital with these people, but as much as I love them, I'm also ready to go back home to Greeley. I'm immensely grateful to Sandi for pushing me to do rotations in Sterling and in Brush, and am just wowed by the amazing patient population here. I'm definitely considering applying to both EM and FM because of this rotation. The only down side is that I don't want to practice in a rural area full term, and I know that there aren't many full-scope family medicine practices in California. However, I think I could do FM if I needed to, at least until I find my way back to the ER. :P
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The highlights this week were doing three circumcisions with Dr. McDonald! Two of the babies that I helped deliver last week (Patient A and B's), plus another one that I missed the delivery for because I was attending EM bootcamp. Dr. McDonald endorses the Plastibell technique for circumcisions because of the decreased likelihood for adhesions to form as well as the protection it offers the head of the penis during the healing process. I learned that the beginning steps of a circumcision are all the same regardless of what technique you use (Mogen, Gomco, Plastibell). We first anesthetize the penis with lidocaine, then clamp both sides of the foreskin and pull up. We induce ischemia of the foreskin at the 12 o'clock position so that we can make an incision to cut the foreskin. It's after this step that things change. With the plastibell, we insert the bell into the cut foreskin, then pull up so that we get some excess skin that hadn't been cut. We tie the foreskin really tightly with a piece of rope around the bell to induce ischemia, and then we cut the excess foreskin around the penis off. The handle of the bell breaks off, and we tell the parents not to touch the penis at all. The bell will come off on its own within a week, and then the circumcision is complete! Dr. McDonald showed me how to do the first one, then let me assist on the second, and I got to do the third all by myself. Crazy! The only other circumcision I'd seen was back during my first rotation with Dr. Nwizu, and he used the Gomco technique. The Plastibell was for sure easier to do, and required less instruments than the Gomco. I definitely like this method more.
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Anyway, I made cupcakes for the staff and Dr. McDonald on my last day with her. They turned out wayyyy too sweet though, because I tried something new by injecting the middle of them with strawberry jam. Too sweet, too SWEET! I called them diabetes cupcakes. Lol. Still, they were enjoyed by everyone who ate one. I truly learned so much from working with Dr. McDonald, and also grew to appreciate the privilege it is to care for generations of patients. That's one of the nice things about working in a clinic in a small town - everyone knows everyone and you care for entire families. Also, I learned that you have to advocate not just for your patients, but also for yourself while you're working. Dr. McDonald was incredibly unhappy for a few years until she figured out how to maintain her own wellness and health. She also taught me that no service is for free, and was kind enough to walk me through how to find financial stability as a family medicine physician. These are lessons that can be applied no matter what field I go into, and I'm grateful that she taught me not just about medicine, but about life, too.
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On my last day in the clinic, Dr. Poupore brought us doughnuts. She was honestly one of the most thorough, smart, patient-oriented doctors I've worked with, and she was definitely one of the sweetest, too. Also her clinic notes are amazing. I learned so much just by reading them! I admired how much she cared about her patients, how knowledgeable she was whenever she talked with patients, and how much she advocated for them too. There was never a day that Dr. Poupore didn't go above and beyond, and I learned a lot by watching her interact with each of her patients. Her bright personality was infectious, and I can only hope to have that much energy when I'm in my future practice!
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Honestly, if I could work in a hospital environment similar to Brush, just not IN Brush, I think I'd be really happy. >< Alas, the end to another rotation, only 2 left! Peds and my second month of Internal Medicine. We're on the final stretch now....!
The BEST FM Team!
Left: Dr. Poupore and Jess
Middle: Blanca and Dr. McDonald
Right: Leslie
April 20, 22, 2021
Week 35: April 25 - May 1
two-thousand-and-twenty-one
The Highs: ​
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Started my Pediatric rotation!
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Working with residents again
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Back in Greeley
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Interesting inpatient and outpatient patients!
The Lows:
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Schedule is tough!
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Exhausted
Overall rating of the weeks: 8/10
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Whew! The pediatrics rotation in Greeley is no joke! I wake up around 4:45am every day so that I can be at the hospital for sign-out at 06:00. Then, around noon, I have lunch, then drive over to Banner Summit View for afternoon clinic, which usually goes until 5-6pm. Once I get home, I have to study, so there's not much time between the day to relax. To say it's been exhausting is an understatement! However, I am enjoying it. It's really nice being back in the hospital environment, and I love seeing my friends and other people I've worked with again. This week, my residents are Jess Smith, David Nitschmann, and Jenni Adams (chief). It took a little bit to adjust to the hospital work pace again, but it didn't take too long to fully acclimate! My attending physician/preceptor is Dr. Money, who literally signs his name with a $ in his emails, something that I think is so badass. Lol. He was initially a chemical engineer that applied to medical school and became a pediatric hospitalist. He definitely has the aura of an engineer, but once he's around kids, his entire demeanor changes. It's kind of awesome to watch.
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This week, we had a couple of interesting inpatients. One that "accidentally" stabbed himself by falling onto a butcher knife in his bedroom (he ended up having an ex-lap but miraculously missed his bowels and any other organs). Another on Tuesday that was admitted for an actual suicide attempt, in which he took a large handful of Tylenol. We treated the second patient with N-acetylcysteine, which was interesting to re-learn and read up about. We also had a 7 year-old who came in with a grade 3 supracondylar fracture on Wednesday, which was great to see because one day prior, I attended a pediatric splinting and casting lecture put on by Dr. Graves, orthopedic surgeon. One of the fractures he talked about (the most common upper extremity fx in kids) is the supracondylar fracture. He taught the MAs, Dr. Chmura, Dr. Fels, and I how to properly splint that fracture, and how to tell if it's a grade 1, 2, or 3. So, it was neat to be able to put it together in a real patient the very next day! I also got to do a ton of newborn baby exams with Dr. Money in the mornings, and observed him perform two Mogen circumcisions. Initially I was really nervous for the patient because it seemed easy to cut off the wrong part of the penis, but after seeing it, I think I now prefer the Mogen over the Plastibell technique! On Thursday, I ran into Dr. Casey Weiser, PGY-2, again, who was on her rotation in the NICU. She let me accompany her in doing a Mogen circumcision with Dr. Money, and then told me to come work with her in the NICU on Friday! That was great! I got to see how NICU patients are treated, and Casey taught me how to utilize the bilitool and bilirubin rebound calculator. She also said the NICU is very particular about when you can and cannot wake up the babies; we literally go off of the nurses' schedules so as not to upset them, which I thought was interesting. I also learned that you have to scrub (like in the OR) every morning before you see patients in the NICU. This makes sense, but it was still new to me.
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In the clinic, I was paired with the lovely Dr. Chmura! Gosh, I really lucked out! She's the sweetest, and so kind to everyone. After awhile, I came to the conclusion that she talks and dresses a lot like Pam from The Office. Haha. Anyway, we had a couple of cases of isolated hematuria this week, which was weird! One ended up needing a renal ultrasound, and was found to have multiple large, interconnected cysts all over one of her kidneys. It wasn't polycystic kidney disease, but actually the consequence of having chronic hydronephrosis to that one kidney. The rest of the patients were either well child checks or sick ones that had whatever viral illness has been going around. Lately it seems rhinovirus, adenovirus, and norovirus are the top culprits. Gotta PPE it up so I don't get sick!
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Overall, it was a pretty good start to Peds! My favorite parts were working with Casey in the NICU, learning about toxidromes with Dr. Money, and getting to do a circumcision. My residents are pretty cool, but turns out they're changing next week. Hoping I get to work with some others that are just as awesome as these are!
Week 33: April 11 - April 17
two-thousand-and-twenty-one
The Highs: ​
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Helped with vaginal deliveries
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Delivered a baby on my own!
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One scary situation that was still a high - neonatal resuscitation
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Reinforced my Why.
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Saw Dr. Hostetler!
The Lows:
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Exhaustion
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Personal health stuff
Overall rating of the weeks: 9.5/10
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Okay, hands down one of the best overall weeks of my entire third year. It's been delivery after delivery after delivery, but it's also been so great!
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I've determined that clinic isn't my favorite, but I do kind of enjoy OB clinic, and I do enjoy delivering babies. It's definitely fun and rewarding, but can also be kind of scary when things aren't quite 100%.
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On Monday, we ended up inducing one of our patients who was about to have her second baby. We'll call her Patient A. She was most likely going to hit bingo (10cm) quickly, and once she did, she would also most likely deliver quickly.
Another one of our pregnant patients came into L&D on her own because her water broke. We'll call her Patient B. She was a first time momma, so we expected her labor to go very slowly and for her to push for a long time.
A third patient ended up coming into L&D Triage because she was having persistent lower abd cramping. This is Patient C. She was barely 28 weeks along, but had a history of premature rupture of her membranes, so we were keeping a very close eye on her. She also looked like she was in so much pain. We ended up doing a full work-up on her, consulted Dr. Groff, considered transferring her to Greeley, etc etc. She even got a CT scan of her belly because most of her labs were normal, she had no evidence of ruptured membranes, and she still had RLQ abd pain with concern for an appendicitis. Luckily, her CT was normal, so Patient C went home on Monday.
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On Tuesday, Dr. McDonald and I were surprised to see that Patient B had hit bingo before Patient A! She ended up pushing for 4 hours, and despite having an epidural, looked like she was in so much pain. Both Dr. McDonald and I thought that the epidural wasn't working properly, or that she wasn't getting enough medication. But she pushed like a champion, and the baby literally popped out so unexpectedly that Dr. McDonald barely had enough time to get her sterile gloves and gown on to catch the baby! She looked at me and was like, "Gown up!" So I stopped holding her leg and also went to put on sterile materials. She let me help clamp the umbilical cord and obtain a venous blood sample for a VBG. I also got to deliver Patient B's placenta, and essentially do the second half of the delivery. Patient B gave birth to a handsome baby boy with quite the cone head, haha.
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Shortly after Patient B delivered, Patient A decided it was her turn. This momma told Dr. McDonald I could do the entire delivery if I wanted to, which was so exciting! Earlier that morning, I got to break her amniotic sac using a neat little tool that looks a lot like a knitting/crochet needle. A small amount of clear looking fluid spilled out of her, which was surprising since we were inducing her at 39 and 1 due to the finding of polyhydramnios on her previous ultrasound. Alas, when she hit 10cm, Dr. McDonald and I both gowned up again, and awaited her baby. She pushed him out in two contractions! It was crazy! I was able to catch the baby (hold the neck and then hold onto one leg, and you'll never drop the baby, per Dr. McDonald) The baby actually had his cord wrapped around his neck, but it was too tight to pull over him, so we delivered through the cord. Once he delivered, a huge gush of fluid came out-- well, there was the rest of it, I thought. :P It took a little bit of agitation, but we got him crying, and laid him on mom. I did my part by clamping in three places, cutting, and collecting the blood sample. However, while doing all that, we noticed baby wasn't as responsive as we would've liked. His heart rate was fine, but after multiple attempts at suctioning, he was still satting <85%. He was brought over to the baby warmer where he received positive pressure ventilation. I was still delivering mom's placenta, and as soon as that was done and it was checked to ensure it was intact, I stripped my gown and went over to help Dr. McDonald with the baby. We were BVM-ing this baby and called RT to come and help. The Respiratory Therapist ended up deep suctioning baby a few times, but he still remained tachypneic, tachycardic, and his sats were low. We resuscitated him for a good 30-40 minutes before he was able to maintain sats in the low-mid 90s. We got a chest xray which was read as having hyperexpanded lungs, but no respiratory distress. Patient A was crying a lot while watching all of this happen, and it took everything in me not to leave baby's side to console mom. Once thing I did notice though, again, is how calm I am in these situations. I'm given a task and I stick with it, I don't lose focus, I don't let my emotions get in the way. All that matters in those high stress moments is doing what I can do ensure the survival of the patient. It's hard to describe the feeling I get, but it's almost like I'm just operating in a hyper-focused state. I feel extremely calm, I think very clearly, the answer for what needs to happen next just comes to me. It's moments like these that make me think I'm going to be a great EM doc someday.
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The baby ended up having what we think is Transient Tachypnea of the Newborn, which can happen to term babies that deliver too quickly (2 pushes!). He ended up being totally fine after that, and his vitals completely stabilized. Dr. McDonald ended up having to cancel all of her clinic that day because of these patients, but I was definitely not complaining!
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Another NP, Kristin, ended up seeing one of our patients that we had to cancel on today. I actually saw this patient twice during my rotation for her weekly OB checks. She was about 38, going on 39 weeks along, and had borderline gestational hypertension. That day in clinic, her BP was also very elevated, so she was being admitted for an induction. We'll call her Patient D. She came to L&D with her other son (just the cutest thing), and was excited and ready to get baby out! We watched her for awhile after she first got Pitocin, but then went home in the evening to rest. I got a call from Dr. McDonald around 2am that Patient D was getting close to 10cm, so to come over to the hospital.
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By the time I got there, I got to rest for about an hour before she was complete. Around 3:30am, Patient D was ready to push, and since this was her 2nd baby, delivered in maybe 4-5 pushes. Out came another beautiful baby boy, and both she and her husband were so happy. A little after her delivery, which I got to help a lot with, I was getting ready to go home and go back to sleep. Outside her room, her husband came out and said, "Oh, I have something for you, one second!". I was very confused, because I had never met her husband before that evening, and wasn't sure if he was actually talking to me. I went to put my blankets and pillowsheet in the soiled linens area, and when I came out, he was waiting for me. He handed me a gift that I'm going to carry with me forever. In my hands was his army medic arm band that he wore when he was on tour in 2011, treating victims of a mass casualty incident. I was getting teary eyed as he explained this to me, and shared with him my connection to MCIs, bringing up the victims of the Isla Vista shooting and the Borderline Bar incident in my hometown. God works in mysterious ways. This person had no idea of my history, and yet he was giving me a piece of himself that meant so much to me. It completely, 1000% reinforced why I'm doing this, why I want to be an Emergency Medicine physician, why I love medicine so much. This is something that I hope to carry with me and embed in my first white coat or set of scrubs as a physician. Gosh, what a moment. Incredibly moving and pivotal in my career.
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Later that day (Wednesday), I drove back to Greeley because I had a lot of doctor's appointments. I went to the radiology dept at UC Health to get my Brain MRI and my Liver US. The MRI was negative, but the US showed several small hepatic cysts, which I think are hepatic adenomas (benign). Otherwise, I'm healthy as a pickle. I also had an appointment with Dr. Hostetler in Loveland, which also went great! It was so good to see her, and we got to catch up a little bit which was also really nice. Afterwards, I met with Hannah for a little bit before driving back to Brush.
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Clinic during the rest of the week was wonderful because I got to use my OMT skills a lot! I also saw one young patient who had PNES, or psychogenic nonepileptic seizures. She actively went limp and "seized" multiple times while in the clinic room. She had no tremors or shaking, but would just pass out, then gasp and come to. She was with her fiance, who would catch her every time she "lost consciousness". Still, it was very interesting to witness, even if they weren't real seizures.
Anyway, this week was amazing. Loved how much OB I got to see and do, and loved that I created a memory that I'm going to remember forever. Kierstan and Evan, you guys are awesome, and thank you for letting me be a part of your life story, even just for a snippet.
Evan's Army Medic Band
Banner Hospital, Brush, CO
4-14-2021
Week 32: April 4 - April 10
two-thousand-and-twenty-one
The Highs: ​
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Helped with a vaginal delivery
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Diagnosed a stroke in a patient in the clinic
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OMT for the WIN!
The Lows:
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Living situation
Overall rating of the weeks: 9/10
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This week was a blur! So much ended up happening, I don't know where to start! I ended up having a wonderful Easter weekend at home in Greeley. I got to see my roomie and spend some good quality time with her, catch up on some much needed sleep (in my own bed!), and get my ducks in order for next week -- VSAS opens for Emergency Medicine rotations, and I'm nervous as heck about applying for Sub-I's. Really just praying that I get one, since that's all I need. Also really hoping something works out with USC. It would be SO AMAZING if I could do my residency there, or even just a Sub-I. I think it would open a lot of doors for me, and I'm just praying that's something in God's plans for me.
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Anyway... our patient came in for her induction on Sunday night. By Monday evening, she was ready to deliver! She gave birth to a gorgeous baby girl, Summer, and was just overjoyed. Dr. McDonald was going to let me help sew her 2nd degree laceration, but the patient's husband stepped in and requested that just she do it. I totally understood, but was also slightly disappointed that I wouldn't get the opportunity to learn how to do that. Still, it's always amazing to watch these deliveries happen; there's something surreal about the entire process. Part of it makes me yearn for a baby, but part of me also wishes I never have to go through labor. I just know I'll be in it for awhile, and it's going to be a painful process, that's for sure. :P
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The most exciting thing that happened to me this week was correctly diagnosing a stroke in the clinic. The first patient of the day was a middle-aged gentleman who was complaining of severe dizziness and loss of balance. I was thinking vertigo, but then when I was doing his physical exam, I asked him to take down his mask so I could check his cranial nerves. That's when I noticed a right-sided mouth droop, which he says he wasn't sure when it started. He's bald, so he rarely looks in the mirror, and can't remember if he had that morning. (He had a great sense of humor despite the gravity of the situation). He also had a positive Romberg's and a L sided pronator drift on my exam. I quickly left his room and went to find Dr. McDonald, who was seeing another patient at that time. Knowing that time = brain, I knocked on the door and asked to speak her urgently. She quickly finished up with the other patient, then I told her I thought my patient was having a stroke. She went in to evaluate him, and told him that we were sending him to the ER right away. In the ED, he had a full work-up and was actually admitted to the hospital. By the time he got to the floor, his symptoms had completely resolved and he was diagnosed with a TIA. But like HOLY moley, I caught that! If I hadn't asked him to pull down his mask, and identified his droop, I'm not sure I would have been confident enough in my skills to accurately diagnose him with a stroke. This just emphasized to me the importance of my clinical exam skills and the importance of making sure to go through every step, even if you think the findings will be normal. I felt incredibly proud of myself, and also was so relieved that the patient didn't have a worse prognosis or outcome.
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For the rest of the week, we saw bread-and-butter FM patients with a handful of OB. I was also able to treat one patient who came to see Dr. Poupore for severe lower back pain. It turns out she had a major sacral torsion, and I was able to treat her sacrum with muscle energy as well as work on her lower back. At the end of her treatment session, she asked me if I had my own practice and if she could come see me in my office! I was so flattered, haha. She said no one has ever treated her like that, and my OMT gave her instantaneous relief from pain that she'd had for the last several days. I told her I'd ask Dr. Poupore to give her an OMT referral in Greeley, and was insanely proud to watch her walk out of the clinic without a limp!
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This week has just honestly been awesome. It's been great seeing the progress I've made in my clinical skills as well as my OMT skills. I feel confident treating patients with my hands, and feel overjoyed that I've been able to make a difference in these patients' lives. Dr. Poupore has come to get me a couple of times now, saying she's got a perfect patient for me to see and treat with OMT. It feels good to be recognized for my skills, and I'm just so excited to BE here.
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Week 31: March 28 - April 3
two-thousand-and-twenty-one
The Highs: ​
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Started my second Family Medicine rotation in Brush, CO!
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Finally saw a C-section!
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Learned how to do knee injections!
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Awesome preceptors
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OMT for the WIN!
The Lows:
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Living situation
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Missing home in Greeley
Overall rating of the weeks: 8.5/10
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Alright! Moving on to my last month of Family Medicine! I was placed in Brush, CO, another very rural site, even more so than Sterling! This time, I had to apply for housing through AHEC, the student housing for healthcare professionals-in-training. Luckily the place I was moving to was only a 5 minute drive from the main hospital, but I was less than impressed when I initially drove up. The owner of the house was incredibly sweet though, and her two dogs, Valentine and Felix, were also very welcoming. I think I was just a little disappointed because I wasn't used to the smell of dogs, and I also wasn't used to having dog hair everywhere!
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I felt more homesick than usual at the start of this rotation; I think all the traveling over the last two months was finally starting to catch up to me. As much as I loved exploring new cities and towns, I was missing my own bed, missing my cat, missing seeing my roomie every day, and missing spending time with my fiance Michael on a more regular basis. Alas, this would be my last "out of area" rotation, so I was going to try to make the most of it. I also did something crazy and started a Keto diet this week! It's been really difficult to adjust to the extremely low carb diet (I also miss garlic bread, ugh!) but I know I need do this for my health and so I can slim down before my wedding next year!
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Onto actual rotations...
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Monday was interesting because I had to travel to the Fort Morgan Banner clinic. And it turns out, my preceptor, Dr. Poupore, was actually at the Brush hospital due to a patient that came into L&D triage. It was almost 9am and the patient was in early labor, so she asked me to come to the other hospital. (Lots of traveling that day, haha). Here I finally met Dr. Poupore as well as the only official OB-GYN in the area, Dr. Groff. I ended up not being in clinic at all on Monday, and instead got a review on the stages of labor as well as how to read a Fetal Heart Tracing by Dr. Poupore. After lots of waiting around, the patient was finally ready to push. Dr. Groff lead the delivery as I observed, and afterwards, Dr. Poupore and I did the newborn exam together. The patient had a beautiful baby girl, and she was absolutely healthy and perfect! I finally got home late that evening after a long day on the OB deck, but was invited back on Tuesday by Dr. Groff to see a C-section. I was so stoked since I didn't have the opportunity to see any C-sections on my actual OB rotation. The entire process wasn't as gruesome as I thought it was going to be; in fact, it was more interesting than anything. The patient underwent a longitudinal transverse c-section. I watched as Dr. Groff dissected away to the rectus abdominis, then make an incision into the uterus. All of a sudden, a baby popped out, and was placed quickly onto mom's chest. It took less than 5 minutes into the procedure to get the baby out, which was remarkable! The rest of the hour was spent removing the placenta, then carefully sewing each layer of muscle, fascia, and skin back together. Dr. Groff is one of the few who sews all 5 layers individually to minimize adhesions and rupture of the layers. Because of that, the surgery took longer, but the patient will likely have less adverse outcomes in the long run.
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Once the C-section was complete and I was dismissed by Dr. Groff, I headed back to Ft. Morgan for clinic in the late morning/afternoon. I met Jess, who was Dr. Poupore's MA, and actually got to see her husband as a patient. He was complaining of back pain, so I was able to OMT him and was told on Thursday that he felt so much better! Though I only popped a couple of vertebrae in his T-spine, I was happy to hear he got so much relief from that. I also was able to diagnose and treat a UTI, and witness a young father drop his two twin babies on their heads. Yup. That happened. The mother was horrified and so angry. The babies were fine though, and we did their well child checks and assessed them and determined they would be okay. Still just awful, but they're okay.
On Thursday, I met and worked with my official preceptor, Dr. McDonald. She's also an RVU graduate and is just so good at her job! We had a few interesting cases during the second half of the week - a child with growth hormone deficiency, a patient with a history of neurofibromatosis, and another patient with a possible superior vena cava syndrome! Who knew that there would be such a variety of pathology out here in Brush?! I also got to treat more patients with OMT, perform papsmears on pregnant women, and also learn how to do corticosteroid knee injections (which are so much fun and so easy to do!)
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Overall, I ended up having a great first week here in Brush, and despite my initial hesitations, I feel like I'm going to get so much out this. I also forgot to mention all the OB patients we have this month! Several of them are due to deliver, so I'm even more excited to participate. We're inducing one patient on Sunday, so hopefully she'll deliver on Monday or Tuesday.
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