Got gas. Drove to school. Found the Urgent Care clinic and Dr. C, who staffed most of my 3 patients this morning, and Dr. R, who staffed the other. Realised I'd left my otoscope at home, silly me. There were two other med students, one resident, and the two doctors. Between us, we had two working otoscopes. Then Dr. C's died. Whoops.
I saw two otitis media and a little black boy (the black is important) with a funny rash and fever. His mother is in a near-panic. After reassuring his mother that no, he does not have West Nile, I examine J. He's playful and fairly cooperative, and does indeed have a rash all over. Got a peek in his throat, it's bright red. Found tender lymph nodes on his neck, and talked to Mom. They smoke at home. Explained patiently and in detail the disadvantages of smoking around small children. Mom was suddenly abashed and worried. Suggested to her that - because quitting smoking is a hard thing to do - she should start by making a smoke-free home. Smoke outside. Change your clothes after smoking and before picking up your children. Start with that. She thought it was a very good idea. Maybe I made a difference. I hope so; he's a very nice little boy and she's a very nice woman.
Consulted the books on rashes while waiting to be staffed. Little black boys are a sort of dark brownish shade, which makes it quite difficult to tell whether the rash is erythematous or not. Nigh impossible, in fact, so much so that the books showed an extra picture of the rash in little black children in some places. Formed a differential diagnosis of Erythema Subitem, Scarlatiform rash, or viral exanthem. Bet heavly on scarlatiform due to streptococcal aetiology. Dr. C came back to staff with me. She looked in his throat, asked him to take off his shirt so she could see his rash. He was uncooperative. His mother frowned. "I'll tell Jesus." And with that, he shaped right up. I'm a little disturbed.
Hit it dead on. The rapid strep was just a formality, from the looks of him. Discussed why Amoxicillin was bad to give mono patients (something that would have been in the differential without the characteristic sandpapery rash) and felt like I had done something worthwhile.
Got a giant hot dog for lunch (I need to stop and get some shakes or something that I can just drink for lunch, less hassle) and set about trying to kill 4 hours. Went to the bookstore and bought books. Got a Harrison's on CD for Taika, and a new card on H&Ps that came with a tiny CD. Also got the ACLS text I needed, but couldn't remember what pocketbook fyrfitrmedic said I should get. The ACLS book comes with some cards, at least.
Then came back here to the medical science building and have now killed one hour on the only working computer in the lounge. I saw someone come by a little bit ago and peek at it, but she walked off without me having a chance to ask if she wanted it. Should, however, go. Maybe I'll nap a bit before going back to work 4:30-10. Maybe I'll see more patients then. This morning went surprisingly fast, all things considered. Maybe this evening will do likewise.
Angel, expect delivery of a book and a badge holder soon. I'm anticipating both eagerly. And we need to get a white coat picture for an icon for me :)