Saturday, March 08, 2008

It's March Already?

Damn, time is flying. Over the past few weeks I have been going to clinical, attending class, writing impossible papers and having panic attacks. Clinical is more fun than I ever expected, but it is a huge responsibility. The clinical that I work in is a community health clinic that takes appointments and walk-in's. Most of the patients we see are Federal Subsidy, which means that they have no insurance. Kind of sad, but we don't turn anyone away. It is amazing the volume of people we see for STD checks. Nobody uses condoms these days. I would say the other two top diagnoses are Hypertension and Diabetes Mellitus.

I am becoming proficient with the female pelvic exam, which is good considering that I plan on specializing in Women's Health. Men pelvic exams are still pretty uncomfortable for me. The first one I observed was a guy, he was probably 24 years old. His chief complaint was stomachache. My preceptor is a no nonsense kind of practitioner when it comes to guys with STD's. She starts out asking him about his stomachache and he asks where the regular Doctor is. She says, "I'm here so what is it?" He said his girlfriend said that he should go to the Doctor and get checked for Chameleon. It was almost cute, but the Nurse Practitioner didn't crack a smile. She directed him to drop his pants and underwear to his ankles. She started out palpating the lymph nodes in the groin, checking the spermatic cords and testicular descent/masses. Then she checked for urethral patency and took two LONG Q-tips and inserted them into the urethral opening about an INCH! I felt sorry for him, a little. She chastised him sternly about using protection all the time and the dangers of Herpes and HIV. He half listened and walked out with his prescriptions.

I still feel a little apprehensive about taking care of Diabetics. I am afraid of insulin and what could happen if they don't take the medications as prescribed. The one thing I can say for sure is that in primary care you get to spend as much time with the patient as you want. I can take as much time as I need to to put together a plan of care, but at the same time the longer it takes for me to see a patient, the longer it takes to clear the waiting room. I will be glad to get to a point where I can go into a patient's exam room and do a focused exam without forgetting anything (right now I run back and forth between the office and the exam room for missed info!), and I want to be able to write a prescription without having to ask what drug would be best all the time, Oh and I want to not be afraid of Diabetes. All these things will resolve with practice I'm sure.

I am on my own again. My mother got mad at me last week because she was not being very nice to my son and I called her on it. Then my sister had the NERVE to get mad at me too. I don't ask either of them for shit. Now my ex has this new baby, there is zero likelihood for him to sit with the kids when I work late. My daughter's father was useless when he was here, so I don't expect anything special now. I think he moved out just so he could buy the X-Box 360 instead of helping with the bills. Whatever...I live for challenges like this, I am re-vamping my life so I can do things without anyone. Still working out a few kinks, but I will get there. My kids are getting pretty good too! I don't have to remind them to get their homework done. I still have to remind them about laying their clothes out the night before and stuff like that. I could really get used to being awake from 9-5. I really need to get organized.

Alright, back to studying...

DiVa...I'm never on schedule but always on time!

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