In a strange way, I'm glad finals are upon us. I feel as if I have been studying for weeks - ok, semesters. It's good just to push it and knock down these tests. Ok, the one yesterday was gently pushed over, or perhaps it pushed me. However, 1 down, 1 today - and then 2 more.
Thursday evening will be sweet, sweet joy.
More soon, when it is all wrapped up.
Tuesday, December 18, 2007
Tuesday, December 11, 2007
me, a quarter, and a spinning brain
Today was my last day of Gyn clinical and I am making a big pot of soup, preparing to hibernate until December 20th when exams are over.
The semester simultaneously feels like it is winding down - and gearing up. We have 4 exams next week - one each day - and the preparation feels both overwheming and underwheming. Underwhelming in the sense that I am not excited about it - and overwhelming in the typical, I'm about to take four big tests, kind of way. My brain is spinning, and not so articulate, but I will try to eek out a bit before hitting the books.
I put in my first IUD today. To those of you not in midwifery school(which means everyone who reads this as I have not gone public yet) and are not doctors (who put central lines in on the regular, and other fun things) putting in an IUD is a pretty big deal. Perhaps it won't be on the 4th or 5th - but the first time is a make-the-palms-sweaty kind of moment. It entails tenaculums (think: big huge pinchers. ouch), betadine, some pulling, some ouchieness, some measuring of the uterus, and some chutzpa. (wow, that didn't get a red underline, I can't believe I spelled chutzpa correctly on the first try). My victim, er-um, patient, was an adorable 19 year old girl who just delivered her first baby 6 weeks ago. She prepped correctly with a bunch of ibuprofen, and seemed to do well. If she had been yelling, I would have been yelling, and then it might not have been so smooth...
That was my first patient of the day - and the rest, as if a gift, were all happy cases as well. No "I slept with 6 men and have some nasty critters and huge heap of medical problems" kind of patients. I saw a grinning 18 year old with a doting boyfriend at one of their last prenatal exams, I saw a 62 year old woman with no real complaints except constipation (yeah! I know what to say about that), and some other benign cases that all blend into one...
So the first semester, 1/4, of my clinical experience is now finished. I do not feel like 1/4 midwife yet - or, well, perhaps I do.
Yes, 1/4 done is exactly where I am - and when exams are over, being 1/3 done with coursework will feel just fantastic.
The semester simultaneously feels like it is winding down - and gearing up. We have 4 exams next week - one each day - and the preparation feels both overwheming and underwheming. Underwhelming in the sense that I am not excited about it - and overwhelming in the typical, I'm about to take four big tests, kind of way. My brain is spinning, and not so articulate, but I will try to eek out a bit before hitting the books.
I put in my first IUD today. To those of you not in midwifery school(which means everyone who reads this as I have not gone public yet) and are not doctors (who put central lines in on the regular, and other fun things) putting in an IUD is a pretty big deal. Perhaps it won't be on the 4th or 5th - but the first time is a make-the-palms-sweaty kind of moment. It entails tenaculums (think: big huge pinchers. ouch), betadine, some pulling, some ouchieness, some measuring of the uterus, and some chutzpa. (wow, that didn't get a red underline, I can't believe I spelled chutzpa correctly on the first try). My victim, er-um, patient, was an adorable 19 year old girl who just delivered her first baby 6 weeks ago. She prepped correctly with a bunch of ibuprofen, and seemed to do well. If she had been yelling, I would have been yelling, and then it might not have been so smooth...
That was my first patient of the day - and the rest, as if a gift, were all happy cases as well. No "I slept with 6 men and have some nasty critters and huge heap of medical problems" kind of patients. I saw a grinning 18 year old with a doting boyfriend at one of their last prenatal exams, I saw a 62 year old woman with no real complaints except constipation (yeah! I know what to say about that), and some other benign cases that all blend into one...
So the first semester, 1/4, of my clinical experience is now finished. I do not feel like 1/4 midwife yet - or, well, perhaps I do.
Yes, 1/4 done is exactly where I am - and when exams are over, being 1/3 done with coursework will feel just fantastic.
Tuesday, December 04, 2007
eating is healing
Sometimes healing involves eating, hiking, cooking, and more eating... which is just what we did for 4 days in New Paltz over thanksgiving. I have been let in on a fun and long lasting tradition of Caleb's family and have been taking full advantage.... (the whole 2007 crew above)
The making of Lumpias (it doesn't decrease the deliciousness to see this pot of oil)
Turkey Trotters pre race.
Liz by her electric stove - The joy of kitchen duty
Saturday, December 01, 2007
balance
There is a sad difference, while training to be a nurse-midwife, or any health care provider, I suppose, between what is practiced and what is preached - or taught - in the classroom.
In our primary care class, we are taught to always look at the whole person - a theory to which I subscribe fully - if a woman comes in for a specific complaint: an itch, an earache, a pregnancy test, some pain - we should deal with the complaint... and then pay attention to her picture as a whole. Is she obese? Is she depressed? or does she have a history of mental illness? which co-morbidities does she have? can we manage them today as well? How are her relationships? Is she at risk for abuse? We have learned tricks and tools and resources for dealing with all of those things - wonderful, great, I'm ready to go...
But then, in my clinical site, I have barely enough time to diagnose and manage the one complaint- let alone target anything else about her history. When I launched into weight management discussions with a 342lb woman who came in to use for an STD check because the was 'trying' three men currently... I was told to hurry - we had 3 folks waiting. But how can I feel comfortable sending her out with an antibiotic prescription (indeed, she did have some critters) and not addressing this 28 year old woman's diabetes, high blood pressure, and obesity. The STD check, while important, seemed almost to be the least of her problems. My preceptor, when I pushed it, told her to make another appointment with the medical clinic and another one to go get labs drawn. With a full time job, and 2 kids with no father figure, I don't hedge my bets that she will keep them. She was in our clinic, here, now, with an acute complaint, and I just wanted to start her process...
I gave her my 30 second schtick, a pack of condoms and a rx for flagyl 2g POx 1 - and sent her on her way. Lamenting the gross difference between practice and ideal, and the way in which to pressures of low income health care surely does necessitate less than optimal care.
In our primary care class, we are taught to always look at the whole person - a theory to which I subscribe fully - if a woman comes in for a specific complaint: an itch, an earache, a pregnancy test, some pain - we should deal with the complaint... and then pay attention to her picture as a whole. Is she obese? Is she depressed? or does she have a history of mental illness? which co-morbidities does she have? can we manage them today as well? How are her relationships? Is she at risk for abuse? We have learned tricks and tools and resources for dealing with all of those things - wonderful, great, I'm ready to go...
But then, in my clinical site, I have barely enough time to diagnose and manage the one complaint- let alone target anything else about her history. When I launched into weight management discussions with a 342lb woman who came in to use for an STD check because the was 'trying' three men currently... I was told to hurry - we had 3 folks waiting. But how can I feel comfortable sending her out with an antibiotic prescription (indeed, she did have some critters) and not addressing this 28 year old woman's diabetes, high blood pressure, and obesity. The STD check, while important, seemed almost to be the least of her problems. My preceptor, when I pushed it, told her to make another appointment with the medical clinic and another one to go get labs drawn. With a full time job, and 2 kids with no father figure, I don't hedge my bets that she will keep them. She was in our clinic, here, now, with an acute complaint, and I just wanted to start her process...
I gave her my 30 second schtick, a pack of condoms and a rx for flagyl 2g POx 1 - and sent her on her way. Lamenting the gross difference between practice and ideal, and the way in which to pressures of low income health care surely does necessitate less than optimal care.
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