August 5th, 2003

Nescafe rabbit

A lovely ending...

Chris and Aura, being the wonderful, beautiful people they are - of the genre I should surround myself with more often - agreed to take me in for the days I'll be needing a room, save just one. Chris's parents will be here one of those days, and I was offered a mattress downstairs if I couldn't find anywhere else to stay. I'll stay with Mike that one night, he says it's fine, and that means that I'm all settled for my sojourn down here.
Plus, I went to the parking services garage today, prepared to have to buy a monthly pass for these two weeks since I'd lost my summer pass. I bought the annual pass and told him I'd lost my summer pass. He laughed and scolded me and gave me a free two-week temporary pass.
I have to go to the bookstore and pick up a book for ACLS class at the end of the month. I should buy Nelson's...or I could just order it online, which is what I did.

Chris heated up pork loin for dinner with me. Laura fed me a popsicle and some Triscuits. The cat came and napped with me while I waited for my headache to go away. I feel at home, welcome, comfortable. And the wireless router is set up and working nicely. Yay for that :)

Will probably not take Shain with me tomorrow, as I have only four hours between shifts that I could use him, and he is quite heavy, not to mention expensive. Will instead take an old-fashioned book.
Tomorrow: Urgent Care Clinic in morning and evening. Must remember to get a key from someone, if possible.
  • Current Mood
    happy happy
Nescafe rabbit

It's called a scarlatiform rash, ma'am.

Woke up this morning. Put the computer to sleep, after checking on Ayradyss (Level 23 Will O'the Wisp Voodoo Princess, Expodrine) and Ceylon (Level 12 Will O'the Wisp Tongueblade, Spoltog). I have a guild on ProgressQuest now, and it's neutral. You may join, if you're in a guild-supporting realm (Oobag or Spoltog) - just hit Ctrl-B and enter Arcana for the Guild name. Then I climbed out of the house - no levelling for me today.
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 :)
  • Current Mood
    accomplished accomplished
Me and Angel

"Grandmas are dangerous, man..."

Got to the clinic at 4:20, there were still three students, four residents, and two doctors standing around in the staffing room. I made four students, and tried to stay out of the way. After about half an hour, at five, we were down to two or three residents, two or three doctors (I'm not quite sure who was what when), and me. We eyed the basket off and on, and played with board review questions. Shigella, Salmonella, Yersinia, and Campylobacter cause bloody diarrhoea. We eyed the basket some more, and saw patients, every now and then when there were some. I learned some Important Spanish Medical Phrases like "Abre la boca" and such. I was paid a compliment.
Went in to see a patient who'd been wheezing and congested. He was a 25-week preemie, now two years old, and had a history of asthma. I didn't hear any asthma. I saw a small, skinny boy with a cold, and I went back and told my Dr. H so. She went in and saw him and got into a long conversation with his parents about his asthma regimen and how she was going to put him on 5 days of corticosteroids. I was, to say the least, nonplussed.
Back in the staffing room, she turns to me, and says:
You're going to be frustrated with this one. Your exam was perfect, I want you to take that away with you. You described to me exactly what I saw. Your presentation was also very good - to the point, without leaving any thing out. What I'm acting on here is my experience. So I'm sorry, because this is not a good teaching case. You did everything right.
Thank you, Dr. H. Thank you for taking the time to apologise and thank you for letting me know that I'm presenting the cases in an acceptable manner. I've been so worried. And thank you for reaffirming that in your criticism of my write-up. It was far more helpful to hear "You had such a good case history in the oral, I would have liked to see more of it written down." than to be criticised.

Heard the story of the 14-year-old who was just sitting around doing nothing when some persons unknown came after him. So he went inside and locked the door. And they kicked it in, and they beat the crap out of him. Oh, and took his money. And now he's here in the ER. Apparently persons unknown beat the crap out of him a couple of months ago, while he was just sitting around doing nothing too. As the resident is telling Dr. B the case presentation, he comes to his plan, and says: "And my plan tonight for the human piñata is..." We all fell over laughing. One of the other residents says I can tell you what you'll never find me doing: walking down the street, by myself, minding my own business. That's when everything happens.
The police came and everything. And shortly after that, in the silence of an empty Urgent Care Clinic, Dr. B turns to me and says "Do you want to go home early?" Hell, yes. "Sure," I say, like a Good Medical Student who remembers that when they say "Go home early," you're supposed to go. So I was home by nine, and had delicious enchiladas, and it was a Good Day.

Have been beseiged with comments and questions about amoxicillin and mono. I'll begin by reminding you, O Best Beloved, that infectious mononucleosis - mono for short - is a viral infection that causes some interesting abnormalities in the cells in one's blood. Its most serious complications include viral meningitis and a ruptured spleen. There is no treatment, but when the tonsils are enlarged to the point of being disruptive to the patient's health, corticosteroids can be used. Giving antibiotics is pointless.
Giving antibiotics is done sometimes, often when mono is mistaken for strep throat - as they have similar presentations - or when there is a concurrent bacterial illness. This is often seen in children who have mono (anyone down to the age of 2 and up to about 40 can commonly get it, and the youngest case my staffing docs have seen is 4 months).
The deal is that 3-15% of patients with mono get a most disturbing allergic-type rash. It's relatively benign, but frightening. If you treat a patient who has active mono (Epstein-Barr Virus infection, most of the time, although there's a cytomegalovirus variant) with either amoxicillin or ampicillin (amoxicillin with clavulinic acid), the chance of that rash occurring goes up to 80%.
It is far better for the patient's psychological health, and from a treatment standpoint, to use a different antibiotic. There are lots that one can use, as strep throat is exquisitely sensitive to antibiotics. And that's the mono story. You can get a longer version here.

Am now going to go play Scrabble with LC.
  • Current Mood
    lonely lonely