First day being at the Psych hospital and seeing patients. Today and tomorrow i am in the 'outpatient' facility which is patients that come to process groups during the day but go home for the night. interestingly, medical then medicare patients [which are most of them...as their mental illness counts as a disability] covers every single day at these outpatient groups which they stay at from 10am-3pm and the amount they can take are unlimited. they do so because it is cheaper to do this then to have them overdose, relapse, attempt suicide, etc. and need to be placed in an inpatient facility. but, all the other insurance companies cover only 12-15 sessions a year. sad.
first group i sat in was an adult process group that were medium-high functioning adults, in the afternoon i sat in on a substance abuse group. each had young [18yo] to old [60s]. the dynamics were interesting and everyone definitely had issues they were trying to get over. im sure i will have some interesting stories to remember once this rotation is over...
Thursday, February 16, 2012
Wednesday, February 15, 2012
IM Overnight...while on Psych. lame.
night shift went well, admitted 4 patients. one of them was jaundice...like legit had yellow eyes and body from pancreatitis 2/2 gallstones. also admitted a patient that really had no reason to be admitted...but i have found that that happens a lot [gotta pay hospital bills somehow...]
the night would have been EPIC because the overnight intern had to do 2 central lines and she said i could do them! around 1am she told me to go to bed and get some rest and she would call me around 3am and we co do them. unfortunately, she called me at 5:30am instead for another admit and when i asked about the lines she said BOTH patients refused the procedure. i have been here for over 1 month and i have not heard of any patient refusing a central line. just my luck. grrrrr
morning rounds ended around 8:30am, i grabbed some breakfast and went home. Wednesday is a freeeeee day :)
the night would have been EPIC because the overnight intern had to do 2 central lines and she said i could do them! around 1am she told me to go to bed and get some rest and she would call me around 3am and we co do them. unfortunately, she called me at 5:30am instead for another admit and when i asked about the lines she said BOTH patients refused the procedure. i have been here for over 1 month and i have not heard of any patient refusing a central line. just my luck. grrrrr
morning rounds ended around 8:30am, i grabbed some breakfast and went home. Wednesday is a freeeeee day :)
Monday, February 13, 2012
Psych day 1
welp, first day of Psych rotation but at the same hospital i just did IM at. still have to show up for 7am morning report and listen to the PD scold the interns as he goes over the patient census and then we drive over to the psych hospital which is nearby. thank god nicole tan and justin are with me, the old crew is reunited once again. we help each other survive for sure, IM would have been a lot easier if i had them around....
so in the psych hospital i will do a week in the 'outpatient' groups, a week in the adolescent unit and then two weeks in the adult units seeing the high and low functioning adults. my day will be mostly sitting in on group sessions listening to the counselor and the patients. today we spent the morning doing an orientation of the hospital [again for me] and then an orientation and watching videos at the psych hospital. we were dismissed at 2:45pm... i am going to love these hours.
im on call tomorrow night [valentine's day...] and am kinda sick so im gonna skip out on morning report and then show up for my shift at 7pm, then ill get home wednesday after morning report. its kinda ridiculous that this hospital makes me do IM calls when i am on a psych rotation but hopefully i will do and see something cool.
so in the psych hospital i will do a week in the 'outpatient' groups, a week in the adolescent unit and then two weeks in the adult units seeing the high and low functioning adults. my day will be mostly sitting in on group sessions listening to the counselor and the patients. today we spent the morning doing an orientation of the hospital [again for me] and then an orientation and watching videos at the psych hospital. we were dismissed at 2:45pm... i am going to love these hours.
im on call tomorrow night [valentine's day...] and am kinda sick so im gonna skip out on morning report and then show up for my shift at 7pm, then ill get home wednesday after morning report. its kinda ridiculous that this hospital makes me do IM calls when i am on a psych rotation but hopefully i will do and see something cool.
Friday, February 10, 2012
last day of IM....sorta
today was my last day. thank god.
spent some time in the ER [see previous post], admitted my old pt then admitted one more elder hispanic female with a UTI and PNA. i got a scare at around 6pm of potentially getting another admit [they usually take about 2 hours] but didnt end up having to do it so i left around 6:30, one of the earliest times i have left the hospital on a normal shift.
so thats it, IM is over and i got a pretty good evaluation from my intern. sad thing is, i am at this same hospital again on Monday but on the Psychiatry service so my hours will be waaaaaaay nicer. unfortunately, we have to do 2 IM calls during our Psych rotation so I will be doing IM admits again in the near future. actually, i just saw the schedule and found out i am on call overnight on Valentine's day. good thing i didnt have any plans...
spent some time in the ER [see previous post], admitted my old pt then admitted one more elder hispanic female with a UTI and PNA. i got a scare at around 6pm of potentially getting another admit [they usually take about 2 hours] but didnt end up having to do it so i left around 6:30, one of the earliest times i have left the hospital on a normal shift.
so thats it, IM is over and i got a pretty good evaluation from my intern. sad thing is, i am at this same hospital again on Monday but on the Psychiatry service so my hours will be waaaaaaay nicer. unfortunately, we have to do 2 IM calls during our Psych rotation so I will be doing IM admits again in the near future. actually, i just saw the schedule and found out i am on call overnight on Valentine's day. good thing i didnt have any plans...
ER, IVs, Needles
i've been hanging around the ER trolling around for things to do and have been asking nurses to watch and potentially do an IV. well, after watching some, I was finally able to get a nurse to offer to let me do it and talk me through it. Ironically enough, i ended up doing it on a very familiar patient.
it was the 30-something year old that I admitted about 2 weeks ago. the one that put himself into heart failure and had diabetic retinopathy from her uncontrolled diabetes [he cant see shit and he only has himself to blame.] granted, he is a really nice guy, just doesnt take care of himself at all. its very sad actually.
so i went in with the nurse when he initially was brought into a room and i asked him if i could start his IV. he had no problem as he remembered me from taking care of him before. I pretended to be confident and i did it, got a flush on my first attempt and put in the IV catheter. i think the nurse was pleasantly surprised i didnt miss or infiltrate the needle. i was proud of myself.
needless to say, i ended up admitting this pt to the floor again as his blood glucose was around 500 and he has PNA.
after hanging out in the ER some more, i buddied up with the intern and went in to see a 'finger pain' patient. this 24 year old, uncontrolled diabetic, had a fat swollen finger that looked infected for sure. we presented to the attending and learned a ton from him about finger anatomy and injuries. then watched him do a finger digital block on the patient who was terrified of needles. the attending handled it so well and was hilarious while doing it, such good bedside manner, something i hope to be exactly like. so he numbed up the finger with lidocaine, cut a big slice at the end of his finger and squeezed and drained everything out. the infection was to far under his nail so we had to remove it too release the pressure. so i watched him tear off a perfectly normal fingernail which actually takes a good amount of force. it was gross and cool at the same time.
it was the 30-something year old that I admitted about 2 weeks ago. the one that put himself into heart failure and had diabetic retinopathy from her uncontrolled diabetes [he cant see shit and he only has himself to blame.] granted, he is a really nice guy, just doesnt take care of himself at all. its very sad actually.
so i went in with the nurse when he initially was brought into a room and i asked him if i could start his IV. he had no problem as he remembered me from taking care of him before. I pretended to be confident and i did it, got a flush on my first attempt and put in the IV catheter. i think the nurse was pleasantly surprised i didnt miss or infiltrate the needle. i was proud of myself.
needless to say, i ended up admitting this pt to the floor again as his blood glucose was around 500 and he has PNA.
after hanging out in the ER some more, i buddied up with the intern and went in to see a 'finger pain' patient. this 24 year old, uncontrolled diabetic, had a fat swollen finger that looked infected for sure. we presented to the attending and learned a ton from him about finger anatomy and injuries. then watched him do a finger digital block on the patient who was terrified of needles. the attending handled it so well and was hilarious while doing it, such good bedside manner, something i hope to be exactly like. so he numbed up the finger with lidocaine, cut a big slice at the end of his finger and squeezed and drained everything out. the infection was to far under his nail so we had to remove it too release the pressure. so i watched him tear off a perfectly normal fingernail which actually takes a good amount of force. it was gross and cool at the same time.
Thursday, February 9, 2012
Wise words?
"Everyone gets sued, if your not sued that means your not seeing enough patients"
-during a lecture from Dr. A, a cardiologist
-during a lecture from Dr. A, a cardiologist
Monday, February 6, 2012
Central Lines continued!
i just watched Dr. S put in 2 more central lines and after the second one was done he nonchalantly said,"ok, you've seen 3 now with me so you can do the next one ok?" i was stunned and replied, "yeah, ok, no problem."
i tried to act cool but i was doing cartwheels inside. :)
i tried to act cool but i was doing cartwheels inside. :)
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