Today I did my first punch biopsy which was surprisingly simple. If you’ve ever made Christmas cookies, you can do one of these. I thought I saw a Kaposi’s Sarcoma which is basically a skin cancer that’s really only seen in AIDS patients. I’ve only ever seen the like in pictures, but man it looked exactly like that. We won’t know the results for a while but I’ll keep you posted. There’s always a fun patient and today was no different. We had a middle aged white guy who was taking Percocet, Soma, AND Methadone! Those are three highly abused drugs, and Soma, a muscle relaxant, doesn’t really help anything according to most doctors I’ve spoken with. They say it’s just a worthless drug fraught with abuse. Whoever prescribed all of these meds to this guy (it was a pain management doctor who I won’t name) should lose their license in both Dr. Leonidas’ and my opinion. He described a terrible shooting arm pain with movement that went, I’m not making this up, straight across from the medial to lateral mid humerus… He was totally jacked (and was trying to convince me to give him extra testosterone despite elevated testosterone labs), had no pain on palpation, no decreased grip strength, no decreased range of motion, and not even a flinch when in “8/10 pain” (even with just a few days of posts I hope you can see my appreciation for the pain scale). He had to wear a neck brace at night and a back brace throughout the day which I highly suspect came off immediately upon leaving the office. What’s amazing about him is that he actually expected us to give him more meds and was angry when we wouldn’t. Clearly he had no problems (other than abusing multiple drugs), was on much much stronger meds than I would ever have prescribed in the first place, and was lying through his teeth to get more. It’s just sad to see someone who has nothing wrong taking up the time slot in the day for someone that legitimately needs help.
Today we practiced IV caths by jabbing each other with needles again and again. I thought it was fantastic. It was a great way to learn and nice to know that we were going through extra pain so our patients wouldn’t have to. I, being the one least phased by needles on account of growing up with them all around (don’t worry, nothing illegal haha) in addition to having tunnels for veins, was the volunteer for anyone who was struggling to get them in. Basically, we had lots of fun and laughs as people totally missed veins and gained a new appreciation for the nurses and techs that are able to insert IV caths with ease. I, too, failed on my first attempt. Thankfully though, with some quick needlework and manipulation I was able to get it in without having to pull the needle out and restart. I always figured I would get it right away though and was shocked when I didn’t see the flash of blood immediately. Next time, I’ll get it perfect (probably not but will try!). Following this we had one of those riveting three hour lectures where a doctor who didn’t grow up with a computer teaches us how to open excel documents and how to right click… Not kidding. All you can do is laugh and move on. We then worked on projects and dermatology slides for a couple hours. After that, went home, watched Dr. Dustyn Williams. Dustyn is basically the up and coming Goljan (known by all young docs and residents, a legend for the basic sciences) for rotations and Step 2/3. Third year is just about time management and caring about people. Work hard and learn throughout the day, get a work out and something fun in, see/talk to the people you care about, study, wake up and do it again (and find time to write a blog post!). Tomorrow, I start seeing all my patients on my own! Hurray!
Family Med Rotation
Cancer, cancer, cancer. That was the name of the game today. Two probable prostate cancers (one of which had a PSA of 287!!! Normal is less than 4.0), hepatocellular carcinoma where the patient decided not to show for his appointment with the oncologist following a biopsy, and a prolactinoma (typically benign, hormone producing tumor in the sella turcica). One of the men with prostate cancer just stopped seeing his oncologist years ago when he didn’t like chemo and is now showing up to us because he isn’t doing well… Who would’ve thought? It’s tough to see that this guy isn’t likely to make it just because he wouldn’t go through with treatments when it could actually be treated. We had a few train wrecks to start the morning but then this 47 year old black male came in for a diabetes follow up. He had gained a considerable amount of weight and his HbA1c had spiked. I figured this would be the typical interaction we have with a DM (diabetes mellitus) patient where we just beg them to exercise, diet a little, and do the things that everyone knows to do. But this man shocked me by saying, “Look doc, I’ve been really struggling with my weight. I know what I’m supposed to do, and I’ve done it before. Is there any way I can come in and see you once a month just so I can have some more accountability?” I just sat there stunned; this is exactly the type of patient that people go into primary care to see. Of course I get irritated with patients when I see them eating and lounging themselves to death, but when someone is really willing to try, I’m going to do everything I possibly can and then some to help them.
Day 1 – Family Med
Never would have guessed I’d like my first day so much. My preceptor’s a solid young doc fresh out of residency that has a great perspective on patients and medicine and just seems to want to help people. I’ll call him Dr. Leonidas throughout this rotation (not his actual name of course). Who would’ve thought on the first day of my first rotation I’d be doing pelvic exams and the like? Already have multiple interesting patient interactions but the one that stood out was a white 50 year old lady that came in with fibromyalgia AND rheumatoid arthritis AND multiple car accidents resulting in neck pain AND a heart murmur AND mental slowness AND excruciating right lower abdomen pain for one month… Needless to say, she had a high pain tolerance and rated the pain as a 7 on a ten point scale while in no apparent discomfort (nor any sweating, elevated HR/breathing). I love patients like this, you realize that it’s all just a mental thing but it’s still real to them (I should point out that the heart murmur was very real and she gets a nice visit to cardio) and so you’ve got to figure out how to treat them without giving drugs with abuse potential. What’s really irritating though is when they use these “pains” to collect disability and then sit at home smoking multiple packs a day and watching TV… haha and then get mad at you for running late despite offering free (or almost free) services. So besides that we had a young black male with a full set of gold grillz coming in with orchitis (swollen testicle) and discharge after multiple unprotected sexual encounters with multiple partners… not in multiple weeks. What really “stood out” about him was, well, let’s just say we later had a laugh as we asked the nurse what was going on before we got in the room if you catch my drift. Well, hopefully my stories were entertaining for you today. To sum it all up, my first day of my third year of med school taught me a valuable lesson: a glass of red wine, walk on the beach, and romantic dinner with extra virgin olive oil and French vanilla candles in a dimly lit room do more than a pill ever could.