First one down

My family practice clerkship ended today, and I'm very glad to be moving on. I enjoyed an increased level of responsibility and patient interaction, and got some much-needed practice walking through the therapeutic paths for which patients present to their doctors. I didn't learn a whole lot that I didn't know; the practice was the real benefit to me.
The shelf exam yesterday went relatively well - I haven't gotten my scores back yet (obviously), but it was certainly easier than the step. There were of course some things I'd never heard of, and some things I simply hadn't thought to study, but overall, the difficulty of the questions seemed commensurate with my knowledge level at the end of 5th semester. It was held in Ross' building in South Miami, so Nicole and I had to drive all the way across town, and being back in the old neighborhood certainly brought back memories.
After the exam, we went over to Sports Authority to pick up some new running shoes for me. The cushioning in my old Nikes is as flat as cardboard, and running had just gotten to be painful (I guess I don't replace them soon enough). Then we headed out to Havanna Spice Cafe for the Cuban food Nicole's been craving since we returned to Miami, and sat down for a quick lunch of ropa vieja, arroz, maduras, y frijoles negros. Then it was off to the real goal of the shopping trip - Macy's tie sale. I found out a few weeks ago that all Macy's are nowhere near created equal, when, as Nicole was looking for shoes in the South Beach Macy's, I realized that I couldn't find single tie I liked. The Macy's at Dadeland Mall is supposed to be the largest in the state of Florida - their selection was, of course, fantastic. I picked up a few Tasso Elba ties that I simply couldn't part with, and we headed back to Miami Beach.
Nicole wanted to drive the long way home, so we could see all of Collins Avenue at night, but forgot that it's the middle of spring break, so we found ourselves snarled in some gnarly traffic as soon as we hit the causeway. Once in the heart of downtown, there was nothing to do but crawl along at a snail's pace, staring at all the drunken college kids and very expensive cars.
Something I ate at Havanna Spice must have really disagreed with me - I thought initially that I'd just eaten too fast and so felt uncomfortably full, but half-way through Gray's Anatomy, the food poisoning kicked in - and didn't let me rest until 6 in the morning. This isn't something that happens to me all the time, but there's nothing that sucks like night-long GI distress. It must have been the maduras (plantains), because Nicole didn't have any - that was the only obvious difference between our meals - and she was fine. The last time I remember feeling that bad, I was stuck on a fishing boat with my father and uncle out on Tampa Bay. This wasn't as bad as that; apparently, seasickness hits me just a tad harder. Anyway, I got an hour of sleep and just decided to suck it up and go see patients, finishing out the clerkship on a strong note, and sat around with the other med students discussing various types of preformed enterotoxins. Fortunately, today was relatively light.
If I'm feeling up to it, we'll head up to Sawgrass Mills Mall tomorrow - it's supposed to make the Simon outlet malls near my home look like a run-down flea market. And then there shall be reading on the beach. Life is good!

NKA: No Kids Allowed, or No Known Allergies?

I should have been reviewing for the family practice shelf the day after tomorrow, but (1) I have zero motivation, (2) it doesn't count for our grade, (3) we haven't really received any guidance on what to study, and (4) it's supposed to be the single most difficult clinical shelf exam. I've been reading all along, but we'll see - hopefully, The Essentials of Family Medicine has prepared me well (despite the negative reviews on Amazon. But what can I say? It was required).

I've made some realizations. Toddlers actually do fear the white coat - I tested this. One of the office ladies had her little one in at the end of the day, and I went to play with the kid. He saw me coming and immediately became incredibly shy, so I went back to our break-room and doffed the white coat. When I came back, the kid played with me like I was a different person. I first noticed this when, a few days ago, a patient's 18 month old daughter cried every time she looked at me. Her older sister(she was six) and I, however, got on smashingly - that must be my target age group (I got along well with another six year old yesterday).

I've realized that, even though I don't speak toddler, I'm apparently fluent in doctor. Last time we were in Miami, Nicole and I rotated with a GI doc who took us out for Cuban food, but that was just because he was a nice guy. At this clinic, there's one doc with whom I get along particularly well. Do I say that because he shares with us his Cuban coffee? No. Do I say it because he seems to prefer spending time observing my interviews with and examinations of the patients, or because he just seems to like me in general? No. Do I say it because he took me out for Subway at lunch today? Close, but no. I say it because he asked me to help him update his will.

I must speak doctor, because another doc at the clinic today specifically requested me for a sensitive task. Apparently, he likes the way I work, because he sent me to interview and examine a 10 year old who'd been hit by a bus and suffered some severe left-sided trauma and neurological deficits. Recall that this clinic does a lot of insurance physicals and such - the mother needed documentation from his doctor in order to keep him in a certain program at school; the district was trying to throw him into regular classes, and there was clearly no way that was going to happen.

This is all refreshing - of course it's nice to reaffirm that I'm good with patients, but it's also nice to know that, since such a huge portion of our grade is subjective, I'm making friends in high places.

I have also realized that I'm going to have to do a lot of reading for OBGYN, which starts next week. I sat in while Nicole interviewed a patient, and it was like they were speaking Sanskrit. It wasn't just because Nicole's a great student, but it's because, being a woman, she'd been inundated with women's health all her life. I have not. It's foreign to me - a completely different culture. I know a few phrases like "last menstrual period", and "family history of breast cancer", but I don't really understand all of the connotations that go along with them. I'm just faking, essentially.

"Que?"

This little clinic at which I'm finishing out my family practice rotation does a lot of IMEs - independent medical examinations for insurance companies. They also do bus-driver physicals, and one gets sick of the rigmarole after a while - however the doc who's supervising gives a lot of leeway, which I like. Instead of being so pressed for time that he has to move at lightning pace through the patients, he allows us to sit and think about the best course of action, whether it be simply a lifestyle modification, adding a drug, changing a dose, or referring, and discuss it with him. With every patient I get more comfortable with the mental algorithm necessary to plot a favorable outcome, and with every physical exam, I hone my skills.

My Spanish has gotten a little better every time I've been back to Miami, though I dislike being forced to speak a different language in my own country. More than that, I dislike it when people can understand some English, and just say they can't; it's very frustrating. Roughly half of the patients in this clinic speak English - another quarter only speak Spanish, and another quarter only speak Creole (somehow, this close to little Haiti, we only have one medical assistant who is able to translate for us. She's kind of the boss). I can't imagine going to a foreign country and getting medical care without knowing how to communicate - especially if I was planning to live in that country. Forever. However, when two guys in short-sleeve shirts and ties come to my door on a Saturday morning with pamphlets and ask if I speak Spanish, I don't.

Down with the Sickness

I just finished the second of my three 2-week rotations for family practice. This clinic was a significantly different brand of medicine than the first two weeks - whereas the first placement was a wealthy retirement home, full of bed sores, dementia, and medication lists as long as my arm. We just finished at a clinic attached to homeless shelter. Only, it wasn't a homeless shelter per se; it was more of a rehab program - we saw people from all over the country, and from outside of the States. The illnesses were more of the flu-variety - Nicole and I both got sick on the very first day, and spent the rest of the two weeks recuperating (this was the first time that I was truly grateful for all of our required vaccines).

Fortunately, the clinic didn't have us working days that were as long as the last clinic. The information wasn't exactly mentally stimulating, but I loved it because of the autonomy. We went and saw the patients, did an H&P (history and physical), formulated a plan, and then came out and presented to the attending physician. The best part of it was the practice - constantly writing up SOAP (Subjective, Objective, Assessment, Plan) notes,tying in pertinent positives and negatives, getting a pointed physical exam, and figuring out how to connect the dots of their physical presentation were perhaps the best parts of it. Also, the reading and researching became much more streamlined - instead of going over dementia and COPD, I got to review things that were a little more common in family practice - differentials for cough, diabetes, hypertension, and the differences between viral and bacterial upper and lower respiratory infections. This was all covered on Step 1, but the clinical aspect helped to cement things. It's one thing to know theoretically that you give antibiotics for bacteria, but it's another thing entirely to have a patient who presents with a two-day history of cough hack up some sputum, so you can see if the color warrants a Z-pack or just water and bed rest.

Also very positively, this clinic was run by one of the docs who taught us during our 5th semester. This gentleman is so personable, he's gotten other docs to come volunteer at this clinic, and is responsible for setting up some of the rotations we did in 5th semester, as well as, possibly, some of the clerkships we may or not soon be getting in Miami.

After the last day, Nicole and I drove up to drop off our patient logs, site reviews, and the paper we had to do, and turned in the paperwork for our next clerkship: OBGYN. After that, since we took a little drive up to Costco. The goal of the trip was to get to Sports Authority, so I could get an E-Z curl bar and some weight plates - I'd been trying to work out with some resistance bands I'd gotten at Target, but they snapped. Anyway, there was a Costco close by, and Nicole loves her Costco. So we walked around, lite-shopping with a friend, and were caught in a torrential downpour. The clouds were black and ominous when we left the clinic, but by the time we finished shopping at Costco, it was the Biblical flood all over again. I should have listened to the girls; they were telling me to keep the cart along the sides of the parking lot, next to the cars, but deep down inside, I'm still a little boy - giving the cart a big shove, I figured I might be able to just ride it through the rapidly accumulating lake. Much to my chagrin, the car stopped right in the middle of the ankle-deep rainwater. Fortunately, it was more hilarious than frustrating. After draining our shoes, we made our way to the sports store, and then I drove barefoot all the way home.

Yesterday, a friend came down and we all walked down the Boardwalk to Starbucks, making the most of the day. I can’t help but be pleased that I’m not up north, despite how I’d thought things would be - I prefer Ocean Avenue to snow any day. After she left, I took Nicole out to eat at Catina 27. I had an interesting salmon-farfalle, and then we went for a walk. Nicole had really wanted to go to theVan Dyke Cafe, so we went ahead and stopped in. Apparently, it's incredibly difficult to get in to listen to the live music, but we didn't have any trouble. Tony Succar and "El Grupo Mixtura Latin" threw down their singular brand of Afro-Caribbean jazz, and we made our way back down Lincoln Road to home.

Promised Pictures

Here are the pictures I promised - it's the pathway from the street, into our building, through my room, to the sea. It's really rough living down here....I know....