As my Granny once said before my family took a cruise to Alaska, "button up your lip, and buy a new hat." It's Granny's version of if you can't say anything nice, don't say anything at all. I've tried to keep my blog from becoming Negative Nancy's Pity Party @ blogspot.com since I started my job almost 5 months ago, but I'm done buttoning up my lip! (Not done buying new hats, however...)
My sunny, optimistic last blog makes me laugh. Every month at my job has presented new challenges, a steep learning curve, and bipolar-like swings on my job satisfaction scale. First I had to adjust to seeing more patients per day than ever before. This has given me time to reflect on my cushy schedule in residency and in prison (10 patients/day? Ha!) as well as a new skill set -- cutting people off. All too often, patients, with laundry list of ailments in tow, try to derail my 20 minute appointment. I'm improving my ability to interrupt and suggest they schedule a follow-up. I feel bad about this, but it's a reality in my 17.5 patient/day world.
Just when I thought I had a handle on clinic, I started taking inpatient call and doing OB at a community hospital with about 100 beds. My call schedule is quite variable in terms of calls/week. I also do some medicine only calls and some medicine/OB calls. Most of our inpatient service is moms and new babies, with about 1-3 medicine patients at a time (so far anyway...the winter is sure to increase our census, and winter arrived in Denver last night in case you've been watching the news.) While this may sound like a manageable feat, and occasionally it is, OB overrides everything. It's tough to take care of the medicine patients when I'm tied up assisting in multiple C-sections. I am missing my intern to help divide and conquer the work!
One of my biggest gripes is the fact that my clinic expects us to carry on with our clinic schedule post call, no matter if I have a normal "8" hr clinic day (read 10) or 12 hr clinic day (usually 13ish) afterward. I've been struggling to figure out how the other docs maintain this schedule or how they work around it. Sometimes I wonder what planet I'm on altogether. (Do these people really think it's reasonable to work 36 hrs without sleeping?! I'm a basketcase after 24 hrs on.) I have one day a week off, so apparently this is supposed to make up for working nights and weekends. However, my Monday fun day doesn't really soften the blow of a brutal post call Wednesday, unfortunately.
Which basically brings the blog up to speed with the present day. Yesterday I had a 24 hr med/ob call where I delivered 6 babies and was up all night. While I had high hopes of a quick 2 hr 4 am nap, the morning ended in the worst post partum hemorrhage I've ever managed. The patient had a large tear from her delivery, which I repaired, but she continued to have brisk bleeding. I called the obstetrician to come in and help, and we spent an hour or more in the operating room trying to stop persistent vaginal pulsing and oozing. She lost about half of her blood volume. I think she will recover well, but it was terrifying. Then I changed out of my bloody scrubs and put on some clinic clothes. My misery peaked when I had to rescue my Subaru, discovered in the parking lot with the help of automatic key clicker as Scarlet was entombed in 7 inches of ice and snow. Turns out wear clogs wasn't a great choice for the first day of winter. I didn't last through much of my clinic day, but I did hear some neat comments like "you look so tired" and "oh, your hair is different." Indeed the red rimmed eyes and post call frizzy ponytail were, at best, unbecoming.
To avoid the aforementioned NNPP blog, I'll end on a positive note. The only patient on our hospital service right now is my own - a 40 ish yr old guy with moderate developmental delay and low potassium due to a month of diarrhea. One of the nurses must have told him I delivered a baby because when I checked on him later in the night he said with genuine awe, "You delivered a baby? Wow! That's AMAZING! I'm so proud of you! Wow! You do EVERYTHING!" I was touched and will try to keep in mind that my job is full of special, privileged moments, despite its demands.
Hopefully my next blog won't be so delayed!
Wednesday, October 26, 2011
Tuesday, June 14, 2011
New Directions
Hello from week 2 of orientation! After some much enjoyed time off visiting friends and family in Cincinnati and Seattle, I have returned to the land of the working. My new clinic is part of federally qualified community health center organization that runs 4 clinics just outside of Denver. From humble beginnings with one provider in a small house with a curtain dividing the living room, our clinic has grown to provide over 170,000 patient visits yearly. About 40% of the patients are uninsured, 40% have medicaid, 15% have medicare, and a few have private insurance. I was surprised to learn that 98% of of our patients are below 200% of the federal poverty level. The clinic's mission is to be the medical provider of choice for low income people in our service area.
All new providers go through a 3 week orientation before being turned loose. This orientation includes 12 training sessions with my sworn electronic health record enemy, NextGen. I used this system for a year and a half in residency and made a little promise to myself that I wouldn't ever take a job that used NextGen. Alas, that promise has been broken, and I'll have to get over it. The real boon of NextGen is that you can use it for billing and data generation, despite its lack of user friendliness. (Click, click, click...Epic, I miss you...sniff, sniff.)
The first day of orientation, I had a skype meeting with our clinic scheduler who happens to work remotely...in Israel. I've also spend a lot of time shadowing the providers, medical assistants, front desk workers, and case managers at my clinic in addition to meeting with various people in the administrative office. Today I met with the finance department, HR, and the development director. Apparently, it takes 14 full time people in billing to collect our revenue!
Last week the CEO, who has worked in his position for over 20 years, took me to lunch at a local sandwich shop. (I don't think a CEO of anywhere else I've worked has ever said boo to me, much less bought me an artisan sandwich.) The clinic is all about teamwork, and they've done a good job to assure I have a good understanding of how the team functions.
I've been impressed by the many innovative problems that the clinic has been pursuing for the last 10+ years such as group visits, an integrated behavioral health program, and patient registries for diabetes, depression, hypertension, and pregnancy that generate quite a bit of data to support our quality outcomes.
And best of all, the clinic is about 20 minutes from my apartment!
To quote Annie, I think I'm gonna like it here!
All new providers go through a 3 week orientation before being turned loose. This orientation includes 12 training sessions with my sworn electronic health record enemy, NextGen. I used this system for a year and a half in residency and made a little promise to myself that I wouldn't ever take a job that used NextGen. Alas, that promise has been broken, and I'll have to get over it. The real boon of NextGen is that you can use it for billing and data generation, despite its lack of user friendliness. (Click, click, click...Epic, I miss you...sniff, sniff.)
The first day of orientation, I had a skype meeting with our clinic scheduler who happens to work remotely...in Israel. I've also spend a lot of time shadowing the providers, medical assistants, front desk workers, and case managers at my clinic in addition to meeting with various people in the administrative office. Today I met with the finance department, HR, and the development director. Apparently, it takes 14 full time people in billing to collect our revenue!
Last week the CEO, who has worked in his position for over 20 years, took me to lunch at a local sandwich shop. (I don't think a CEO of anywhere else I've worked has ever said boo to me, much less bought me an artisan sandwich.) The clinic is all about teamwork, and they've done a good job to assure I have a good understanding of how the team functions.
I've been impressed by the many innovative problems that the clinic has been pursuing for the last 10+ years such as group visits, an integrated behavioral health program, and patient registries for diabetes, depression, hypertension, and pregnancy that generate quite a bit of data to support our quality outcomes.
And best of all, the clinic is about 20 minutes from my apartment!
To quote Annie, I think I'm gonna like it here!
Tuesday, May 17, 2011
Getting Paroled
It's the eve of my last day in prison and my emotions are mixed. I am happy that I will be "free" of the long Monday morning commute and being away from home all week, but I am also sad to leave the friends I've made (nurses, not inmates) and leave the patients without a doctor. Someone will come to fill my worn out Dansko clogs before too long I hope. And sooner or later, I know I will run into an inmate on the street or in my next office.
Overall, I feel really grateful to have been employed for the last 7 months and to have had this experience in prison. The correctional population has definitely experienced the health effects of poverty and being uninsured and I have enjoyed getting to take care of people who have no one else looking out for their medical needs (and often haven't been getting any primary care on the streets for years before they came to prison). I am constantly surprised and saddened by the number of women who attribute their long term health problems to physical abuse and drugs. I saw a 27 yr old today who had all of her teeth pulled and didn't qualify to get dentures in prison. I started talking to her about nutrition and eating fruits and vegetables, and she told me the kitchen doesn't given her any because she can't chew them. She broke my heart. It also seems like 90% of the women in prison are mothers, which I also find to be very disheartening. What choices and circumstances led the middle school school English teacher I saw today to end up in prison?
I had to laugh to myself yesterday when I walked through the prison yard and a diabetic inmate said to me "Bye, Doc!" and then, to her friends, "That's my doctor!" (Like there is any other doctor in our prison...) There have definitely been some satisfying moments, heart breaking stories, a few good laughs, and many patient tears, plus a few of my own. I leave with gratitude for my time in the slammer and excitement for my next adventure.
Hasta la vista, La Quinta!
Overall, I feel really grateful to have been employed for the last 7 months and to have had this experience in prison. The correctional population has definitely experienced the health effects of poverty and being uninsured and I have enjoyed getting to take care of people who have no one else looking out for their medical needs (and often haven't been getting any primary care on the streets for years before they came to prison). I am constantly surprised and saddened by the number of women who attribute their long term health problems to physical abuse and drugs. I saw a 27 yr old today who had all of her teeth pulled and didn't qualify to get dentures in prison. I started talking to her about nutrition and eating fruits and vegetables, and she told me the kitchen doesn't given her any because she can't chew them. She broke my heart. It also seems like 90% of the women in prison are mothers, which I also find to be very disheartening. What choices and circumstances led the middle school school English teacher I saw today to end up in prison?
I had to laugh to myself yesterday when I walked through the prison yard and a diabetic inmate said to me "Bye, Doc!" and then, to her friends, "That's my doctor!" (Like there is any other doctor in our prison...) There have definitely been some satisfying moments, heart breaking stories, a few good laughs, and many patient tears, plus a few of my own. I leave with gratitude for my time in the slammer and excitement for my next adventure.
Hasta la vista, La Quinta!
Tuesday, May 10, 2011
The Mother Load
If you are unsatisfied with the medical attention you have received in prison, should you:
A) send excessive kites, each with more capital letters spelling URGENT and exclamation points that the last
B) write a "grievance" stating your complaint, which must be answered in a meeting with the nurse supervisor
C) have your mother call the warden and threaten that if the warden doesn't call back in 30 minutes, your mother will go to the media
All of the above have happened, and choice C (+/- media or lawyer contact) occurs to a surprising degree. I mean what business does the mother of a 38 year old former methamphetamine user with chronic leg pain have calling the prison medical clinic? I am totally appalled by the number of parent phone calls my boss fields for FULL GROWN INCARCERATED ADULTS. (It's not like the teenagers' parents are calling.) I mean, I know my mom has my back, but if I went to prison, I think I'd have to make my prison bed and lie in it.
A) send excessive kites, each with more capital letters spelling URGENT and exclamation points that the last
B) write a "grievance" stating your complaint, which must be answered in a meeting with the nurse supervisor
C) have your mother call the warden and threaten that if the warden doesn't call back in 30 minutes, your mother will go to the media
All of the above have happened, and choice C (+/- media or lawyer contact) occurs to a surprising degree. I mean what business does the mother of a 38 year old former methamphetamine user with chronic leg pain have calling the prison medical clinic? I am totally appalled by the number of parent phone calls my boss fields for FULL GROWN INCARCERATED ADULTS. (It's not like the teenagers' parents are calling.) I mean, I know my mom has my back, but if I went to prison, I think I'd have to make my prison bed and lie in it.
Monday, May 9, 2011
Welcome to Prison!
Recently I attended a provider training meeting at a department of corrections facility called the Denver Reception Diagnostic Center. While it may sound like a place where pepperidge farm cookies and lemonade greet you while you wait for a mammogram, the DRDC is actually the prison where all of the inmates get a physical exam before being sent to other prisons around the state. It is surrounded by a double fence with many, many rows of razor wire. Not so friendly. Initially, I was hoping to be placed at that prison since it's a short commute from my apartment, but it wasn't in the cards.
The provider meetings are a nice opportunity to chat with the other prison docs, NPs, and PAs and to compare experiences. The prisoners seem to get very good healthcare in prison, even for all the bureaucracy required for specialist visits and non-formulary medications. I do feel like I've won when a patient I've referred to a specialist has surgery (and I receive a legible consult note!), even though that's not supposed to be the most gratifying part of primary care. Seeing improvements in hemoglobin A1cs has also made me feel like I'm "doing something," which is also satisfying.
The guest speaker at the meeting was a retired infectious disease specialist who now works for a drug company. One might think that a drug company doesn't stand to benefit much from having a relationship with the department of corrections and its limited drug formulary. However, with oral Hepatitis C drugs on the market, there is a lot of money to be made, especially if a large organization like DOC starts incorporating oral anti-virals into its Hep C protocol.
Another interesting stat I learned at the meeting:
1/4 of HIV positive patients interact with the justice system in a given year. This represents an exceedingly high burden of disease for the corrections population. All prisoners get testing for HIV, syphilis, Hep C, and Hep B on arrival to the reception diagnostic center. I did get to tell a very relieved patient last week that her HIV test was a false positive (after an indeterminate Western Blot and an undetectable viral load x 2 over 6 agonizing months of not knowing for sure). My HIV patients are actually super stable and will be more like to die with HIV than from HIV. It's amazing how well HIV can be managed, especially when detected early. Hard to believe 20% of people in the U.S who are living with HIV don't know it. (Shout out to Aurelie and our grand rounds!)
The provider meetings are a nice opportunity to chat with the other prison docs, NPs, and PAs and to compare experiences. The prisoners seem to get very good healthcare in prison, even for all the bureaucracy required for specialist visits and non-formulary medications. I do feel like I've won when a patient I've referred to a specialist has surgery (and I receive a legible consult note!), even though that's not supposed to be the most gratifying part of primary care. Seeing improvements in hemoglobin A1cs has also made me feel like I'm "doing something," which is also satisfying.
The guest speaker at the meeting was a retired infectious disease specialist who now works for a drug company. One might think that a drug company doesn't stand to benefit much from having a relationship with the department of corrections and its limited drug formulary. However, with oral Hepatitis C drugs on the market, there is a lot of money to be made, especially if a large organization like DOC starts incorporating oral anti-virals into its Hep C protocol.
Another interesting stat I learned at the meeting:
1/4 of HIV positive patients interact with the justice system in a given year. This represents an exceedingly high burden of disease for the corrections population. All prisoners get testing for HIV, syphilis, Hep C, and Hep B on arrival to the reception diagnostic center. I did get to tell a very relieved patient last week that her HIV test was a false positive (after an indeterminate Western Blot and an undetectable viral load x 2 over 6 agonizing months of not knowing for sure). My HIV patients are actually super stable and will be more like to die with HIV than from HIV. It's amazing how well HIV can be managed, especially when detected early. Hard to believe 20% of people in the U.S who are living with HIV don't know it. (Shout out to Aurelie and our grand rounds!)
Wednesday, May 4, 2011
Know the Code
Hello from National Correctional Employee Appreciation Week!
This week, to thank us for our hard work, the prison is providing daily treats. Today was rootbeer float day...tomorrow nachos....Friday BBQ. Some of the other prison workers will be enjoying a steak dinner...others, a shoeshine. I think I would prefer the shoeshine to yesterday's "pop and popcorn," but the breakfast burritos on Monday were tasty!
And now, a fashion lesson from a recent prison email:
"With the warmer weather upon us it is a good time to revisit 4469-01, Appearance and Dress Code, particularly with respect to non-uniformed staff. The regulation does allow for wearing of "dress gauchos or capris" and provides the following definitions:
Capris/Crop Pants: A style of pants that is loose fitting and designed to end mid-calf or just below the calf with slightly flared legs.
Gauchos: A style of pants that is loose fitting and designed to end mid-calf or just below the calf with legs that are flared to resemble a skirt.
With both definitions, the key points to remember the fit (LOOSE), the length (MID-CALF) and that they are to be "dress" versions of these garments. To be allowed, the article of clothing must meet these definitions, regardless of how they are marketed."
For my remaining two weeks, I'm sticking to slacks.
This week, to thank us for our hard work, the prison is providing daily treats. Today was rootbeer float day...tomorrow nachos....Friday BBQ. Some of the other prison workers will be enjoying a steak dinner...others, a shoeshine. I think I would prefer the shoeshine to yesterday's "pop and popcorn," but the breakfast burritos on Monday were tasty!
And now, a fashion lesson from a recent prison email:
"With the warmer weather upon us it is a good time to revisit 4469-01, Appearance and Dress Code, particularly with respect to non-uniformed staff. The regulation does allow for wearing of "dress gauchos or capris" and provides the following definitions:
Capris/Crop Pants: A style of pants that is loose fitting and designed to end mid-calf or just below the calf with slightly flared legs.
Gauchos: A style of pants that is loose fitting and designed to end mid-calf or just below the calf with legs that are flared to resemble a skirt.
With both definitions, the key points to remember the fit (LOOSE), the length (MID-CALF) and that they are to be "dress" versions of these garments. To be allowed, the article of clothing must meet these definitions, regardless of how they are marketed."
For my remaining two weeks, I'm sticking to slacks.
Tuesday, April 26, 2011
Work Holiday Proscription
Prisoners of many faiths can continue to celebrate their religious beliefs while doing their time. I receive many emails with lists of offenders who will be allowed a day off from work for religious Holidays; thus, a work Holiday proscription! These informative emails provide the prison staff with some information about the traditional Holiday practices. Occasionally, there is a special meal... or a fast. Some of these Holidays have included Native American Sweat Lodge, Wiccan Samhain, and Passover.
One can also purchase various religious items from the prison canteen to aid in her practices. Perusing this list is like taking a mini-lesson in comparative religion. A Buddhist meditation cushion and Sacred Path cards are the most expensive items on the list, setting you back about $58 and $40 respectively. Religious texts cost about $20. Other interesting items include Thor's Hammer, 2 oz. of Earth (68 cents), a prayer shawl, numerous herbs, and cedar shavings.
I frequently check my patients' canteen lists when they request that I prescribe medications that are available on canteen (mainly prilosec). I can't say I've seen a lot of religious items on their lists, but they do buy a lot of cup of noodles and something called "hot crunchy cheese," which can't be good for the old GERD.
So in case you were wondering, there is some shopping in prison! Looking forward to the horticulture hanging basket sale in a few weeks.
One can also purchase various religious items from the prison canteen to aid in her practices. Perusing this list is like taking a mini-lesson in comparative religion. A Buddhist meditation cushion and Sacred Path cards are the most expensive items on the list, setting you back about $58 and $40 respectively. Religious texts cost about $20. Other interesting items include Thor's Hammer, 2 oz. of Earth (68 cents), a prayer shawl, numerous herbs, and cedar shavings.
I frequently check my patients' canteen lists when they request that I prescribe medications that are available on canteen (mainly prilosec). I can't say I've seen a lot of religious items on their lists, but they do buy a lot of cup of noodles and something called "hot crunchy cheese," which can't be good for the old GERD.
So in case you were wondering, there is some shopping in prison! Looking forward to the horticulture hanging basket sale in a few weeks.
Monday, April 25, 2011
A Gravy Train with Biscuit Wheels...
Our new nurse manager is a capable, compassionate, and sassy Southerner with a lot of energy to whip our clinic into a well oiled machine. When I told her that it seemed like the prison nurses had a tough job, she told me that compared to other jobs she had, this one was "a gravy train with biscuit wheels" (except that with a Southern accent it sounds like "wils," which is even funnier. In fact, I have been laughing about this all weekend and every time I see her.) I started thinking that maybe my prison gig is also a gravy train with biscuit wheels and perhaps, in my four weeks left, I should adopt a better attitude. Sure, all my patients are not as pleasant as homemade mashed potatoes, but it's time for a new coping strategy....humor!
There are many funny moments in the prison clinic amidst the drama behind bars. One patient started our visit the other day by recounting a dream she had the night before about bags and bags of chocolate candy. Another patient told me the color red triggered her asthma. I replied, "Good thing I didn't wear red today." She then responded "um, I mean red dye..." (She now reminds me of this every time I see her.) There is a lot of construction on our campus right now withe a few pieces of heavy machinery strewn about. I heard during one lock down, some ladies were holed up in their cell houses looking out the window for the "bobcat," which they believed was loose on the prison campus. While I have seen various wildlife including rabbits and cats running through the yard, the only bobcats I've spotted are made of steel.
There are many funny moments in the prison clinic amidst the drama behind bars. One patient started our visit the other day by recounting a dream she had the night before about bags and bags of chocolate candy. Another patient told me the color red triggered her asthma. I replied, "Good thing I didn't wear red today." She then responded "um, I mean red dye..." (She now reminds me of this every time I see her.) There is a lot of construction on our campus right now withe a few pieces of heavy machinery strewn about. I heard during one lock down, some ladies were holed up in their cell houses looking out the window for the "bobcat," which they believed was loose on the prison campus. While I have seen various wildlife including rabbits and cats running through the yard, the only bobcats I've spotted are made of steel.
Monday, April 18, 2011
18 days and counting
As they say in prison, I'm going to "kill my number," which means serve my time until my maximum release date, May 19th. (Well, this is a self selected release date.) I will be starting a new job closer to Denver at a community health center where I can enjoy such benefits as sleeping in my own bed! And not getting up at 4:30 on Monday morning! My cell phone can even come to work with me. (Maybe I should go wild and get a smart phone...the flip phone was a big upgrade for me 4 yrs ago...)
I feel a bit ambivalent about leaving the prisoners without a doctor, but it's time to say adios to La Quinta and work closer to home. A primary care nurse practitioner is also departing the prison for a new job, leaving only the affable nurse practitioner gynecology specialist to deal with the medical needs of the ladies. Hopefully they can recruit (and retain) a provider soon. This was always a temporary position for me, which I let the inmates know, but I still always feel guilty leaving patients. With our residency transitions, I already have "broken up" with patients 3 times in my short career so far.
The demands of the inmates and this job are wearing on me. On my way out last week, two ladies brazenly stopped me in the yard with various demands. One stuck her tongue out and wanted a diagnosis for the coating on her tongue. The other woman irritably asked why she hadn't been scheduled for an appointment yet. Many of the prisoners lack boundaries, and I was not too happy about being asked to perform a tongue exam in the middle of the prison yard. (Although I could also imagine this happening on the outside in a grocery store or the gym...) Today I hopped aboard the "ambulance" golf cart and caught a ride out of prison, skillfully avoiding probing questions. Just 18 more walks out of the prison, and 4 more early morning commutes!
I feel a bit ambivalent about leaving the prisoners without a doctor, but it's time to say adios to La Quinta and work closer to home. A primary care nurse practitioner is also departing the prison for a new job, leaving only the affable nurse practitioner gynecology specialist to deal with the medical needs of the ladies. Hopefully they can recruit (and retain) a provider soon. This was always a temporary position for me, which I let the inmates know, but I still always feel guilty leaving patients. With our residency transitions, I already have "broken up" with patients 3 times in my short career so far.
The demands of the inmates and this job are wearing on me. On my way out last week, two ladies brazenly stopped me in the yard with various demands. One stuck her tongue out and wanted a diagnosis for the coating on her tongue. The other woman irritably asked why she hadn't been scheduled for an appointment yet. Many of the prisoners lack boundaries, and I was not too happy about being asked to perform a tongue exam in the middle of the prison yard. (Although I could also imagine this happening on the outside in a grocery store or the gym...) Today I hopped aboard the "ambulance" golf cart and caught a ride out of prison, skillfully avoiding probing questions. Just 18 more walks out of the prison, and 4 more early morning commutes!
Tuesday, April 12, 2011
Another day, another trichomonad...
A few things have changed since I started working in prison. My signature has become abbreviated from its full 19 letters to a squiggly line. I've also gotten better at telling people No. (No, you can't have a note to get out of work/a bottom bunk bed/neurontin/medical snacks...) Unfortunately, I may also be becoming more callous. Too many patients with "excruciating, shooting pain down the bag of their legs" last week almost put me over the edge.
One good thing that has changed is my skill in microscopy. I always found looking at slides of vaginal discharge to be rather time consuming and fairly low yield for diagnostic purposes. I mean, is there really clue cell in there or not? How come yeast never looks as obvious as it does in books? Somehow, I've gotten by. However, the number one prison kite is for "discharge, odor, help!" so I've had to make many a slide over the past few months. This slightly laborious process has occasionally been rewarding, like a month ago when I peered through the scope and saw the flicker of a tiny protozoan moving independently in the slide. Trichomonas!!! Finally! They always teach you to look for something moving on the slide, but usually the whole process is a big let down. Today I was very suspicious for trichomonas based on this patient's exam. I searched all over the tiny slide until I saw it, a trichomonad, ticking repeatedly under the cover slip with its flagella.
After I broke the news to the patient and handed her 2000 mg of flagyl, I called in a nurse to check out the slide. One of the nurses is studying to be a nurse practitioner so I thought this would be a good teaching moment. Then all the nurses came in to look and were fascinated, making comments like "look at it's little whip tail!" and "is that a phagocyte?" Even a prison guard wandered in to see what all the fuss was about. She started rattling off things she had seen under a microscope, which included an amoeba and a worm. She was happy to add protozoa to her list. I was happy to actually see something I could recognize and treat.
Check out this narrator's sweet Northern Ohio accent:
One good thing that has changed is my skill in microscopy. I always found looking at slides of vaginal discharge to be rather time consuming and fairly low yield for diagnostic purposes. I mean, is there really clue cell in there or not? How come yeast never looks as obvious as it does in books? Somehow, I've gotten by. However, the number one prison kite is for "discharge, odor, help!" so I've had to make many a slide over the past few months. This slightly laborious process has occasionally been rewarding, like a month ago when I peered through the scope and saw the flicker of a tiny protozoan moving independently in the slide. Trichomonas!!! Finally! They always teach you to look for something moving on the slide, but usually the whole process is a big let down. Today I was very suspicious for trichomonas based on this patient's exam. I searched all over the tiny slide until I saw it, a trichomonad, ticking repeatedly under the cover slip with its flagella.
After I broke the news to the patient and handed her 2000 mg of flagyl, I called in a nurse to check out the slide. One of the nurses is studying to be a nurse practitioner so I thought this would be a good teaching moment. Then all the nurses came in to look and were fascinated, making comments like "look at it's little whip tail!" and "is that a phagocyte?" Even a prison guard wandered in to see what all the fuss was about. She started rattling off things she had seen under a microscope, which included an amoeba and a worm. She was happy to add protozoa to her list. I was happy to actually see something I could recognize and treat.
Check out this narrator's sweet Northern Ohio accent:
Monday, April 11, 2011
Spring PrisonBreak II
Just so you know, this isn't turning into a travel blog (although that would be a more fun read than my recent posts...) I wanted to share some pics from my recent trip to CA and will bring you back behind bars at the end.
Zion National Park
Angel's Landing
Kolob Entrance
From Utah, to Anaheim...
We didn't get to go to Bahrain, but we did take a happy cruise around the world.
It's a small world, after all...........
This lively Huntington Beach street performer hammered a 4 inch nail up his nose, reminding me of the importance of regular tetanus shots.
As we made our way from the O.C. to San Diego, we stopped in San Clemente for a picnic with some goods from Trader Joe's. (How I have missed TJ since moving to Denver!) Walking toward the beach, we noticed some conspicuous orange jumpsuits the words "California Department of Corrections Prisoner" on them. Just a hard working prison work crew digging a hole on the beach. There was 1 guard for about 12 prisoners, who each took turns digging in the sand for unclear purposes. I'm sure you have to be a well-behaved inmate to get assigned to a beach work crew.
A few prisoners can't rain on my picnic.
In San Diego, the correctional system good times continued. Here I am in front of a jail cell in Old Town. There's no escaping this rusty steel box. Later that night, I watched my first episode of Prisonbreak. We also met some self proclaimed "bad guys" at a bar in San Diego while watching the San Diego State v. UConn basketball game. I overheard them talking about their brother who was doing time. A few pitchers of beer later, we nearly witnessed a brawl between one of the ex-cons and an old guy in sandals regarding whether or not the older guy was really from San Diego. (He bet against the Aztecs.) Later, he was kicked out of the Ye Old Plank Inn Bar and was told to "come back tomorrow." We, and the Aztec basketball team, were out.
Back through AZ and NM on the way home...
Vistas from Petrified Forest National Park. Warning: Don't take any petrified rocks or you'll be thrown in the slammer!
All good vacations must come to an end...
Zion National Park
Angel's Landing
Kolob Entrance
From Utah, to Anaheim...
We didn't get to go to Bahrain, but we did take a happy cruise around the world.
It's a small world, after all...........
This lively Huntington Beach street performer hammered a 4 inch nail up his nose, reminding me of the importance of regular tetanus shots.
As we made our way from the O.C. to San Diego, we stopped in San Clemente for a picnic with some goods from Trader Joe's. (How I have missed TJ since moving to Denver!) Walking toward the beach, we noticed some conspicuous orange jumpsuits the words "California Department of Corrections Prisoner" on them. Just a hard working prison work crew digging a hole on the beach. There was 1 guard for about 12 prisoners, who each took turns digging in the sand for unclear purposes. I'm sure you have to be a well-behaved inmate to get assigned to a beach work crew.
A few prisoners can't rain on my picnic.
In San Diego, the correctional system good times continued. Here I am in front of a jail cell in Old Town. There's no escaping this rusty steel box. Later that night, I watched my first episode of Prisonbreak. We also met some self proclaimed "bad guys" at a bar in San Diego while watching the San Diego State v. UConn basketball game. I overheard them talking about their brother who was doing time. A few pitchers of beer later, we nearly witnessed a brawl between one of the ex-cons and an old guy in sandals regarding whether or not the older guy was really from San Diego. (He bet against the Aztecs.) Later, he was kicked out of the Ye Old Plank Inn Bar and was told to "come back tomorrow." We, and the Aztec basketball team, were out.Back through AZ and NM on the way home...
Vistas from Petrified Forest National Park. Warning: Don't take any petrified rocks or you'll be thrown in the slammer!
All good vacations must come to an end...
Wednesday, April 6, 2011
Two pieces of chocolate cake, yes please
Since returning from my roadtrip, I've had a rough few weeks. Perhaps there was an influx of demanding inmates (or a release of some of the nice ones). Maybe it was the high drama of many people crying in the office due to pain, or the many people I have sent to the emergency room for evaluation. Regardless, I am feeling burned out and haven't been much up for blogging. So I couldn't pass up chocolate cake today when two pieces came my way. One of the nurses brought a chocolate cake made with sauerkraut, which was actually quite good. Then another nurse had me over for dinner and served a double layer chocolate cake. It was a nice treat.
Today I went searching for the results of a few studies I ordered. Unfortunately for me, but fortunately for the inmates, two of the ladies had been released to the community corrections program, where people are living in a half way house type setting. The medical file goes back to storage in Denver upon release so I may never see labs or studies I've ordered if the patient leaves before it can be reviewed. One particular patient had a complaint of a breast lump about a month before she left. I sent her for a mammogram and ultrasound, and she left prison two days later unbeknown to me. I requested the result today and it turns out she had a suspicious nodule that should be biopsied. I had to call her at her halfway house to break the news, and then send a certified letter with the results. They often have no insurance and very limited access to medical care once they are out of prison, so I have no idea how she will follow-up. It also frightens me to think what might have happened had I not remembered to check up on that result. I order a lot of studies here and can't be sure I always review the results before the patients disappear into the abyss of community corrections and the charts go back in to the ether. Sounds like a good way to get sued, which I am desperately trying to avoid. Yesterday a patient casually mentioned her ACLU medical malpractice lawyer during our visit. Not a good way to win over medical staff and impress others.
Today I went searching for the results of a few studies I ordered. Unfortunately for me, but fortunately for the inmates, two of the ladies had been released to the community corrections program, where people are living in a half way house type setting. The medical file goes back to storage in Denver upon release so I may never see labs or studies I've ordered if the patient leaves before it can be reviewed. One particular patient had a complaint of a breast lump about a month before she left. I sent her for a mammogram and ultrasound, and she left prison two days later unbeknown to me. I requested the result today and it turns out she had a suspicious nodule that should be biopsied. I had to call her at her halfway house to break the news, and then send a certified letter with the results. They often have no insurance and very limited access to medical care once they are out of prison, so I have no idea how she will follow-up. It also frightens me to think what might have happened had I not remembered to check up on that result. I order a lot of studies here and can't be sure I always review the results before the patients disappear into the abyss of community corrections and the charts go back in to the ether. Sounds like a good way to get sued, which I am desperately trying to avoid. Yesterday a patient casually mentioned her ACLU medical malpractice lawyer during our visit. Not a good way to win over medical staff and impress others.
Monday, March 28, 2011
Spring PrisonBreak I
The Saudi Arabian military may have foiled my spring trip to Bahrain, but they didn't stop me from taking a epic roadtrip to my birth land in place of the Middle Eastern excursion. Matt and I stocked my car with camping gear, beach towels, and a cooler of diet coke, and set off west on a 10 day roadtrip. We spent two days at Zion National Park enjoying the dramatic canyons and awesome hiking. Instead of camping in the windy 30-50 degree weather, we opted for an extra night at the Zion Lodge. Matt, typically a hardy soul, even snubbed the Lodge's rustic "western cabin," opting for the "motel" room with a flat screen TV so he could watch the NCAA tournament. I was just happy to be warm. Save the camping for the summer!
We also ventured in the nearby town of Springdale, Utah for some bumbleberry pie at a sprawling complex containing a hotel, gift shop, bar, and theater. When forced to choose between a raucous St. Patrick's Day party and a slice of bumbleberry pie in the coffee shop with old people, I chose the pie. Future patrons, choose your a la mode flavor wisely.
Matt: "We'll take the 'giggle bush' ice cream with the pie."
Bumbleberry Sales Clerk: [firmly] "That's not ice cream. It's sherbert. And it doesn't complement the pie."
Me: "Uh...I guess we'll take the bumbleberry ice cream?"
BSC: "Good choice....I guess I shouldn't be so controlling..."
Anyone can read on a 5 ft sign in the store that a bumbleberry is a cross between a burpel and a binkel, grown on a giggle bush. http://www.bumbleberry.com/
We also ventured in the nearby town of Springdale, Utah for some bumbleberry pie at a sprawling complex containing a hotel, gift shop, bar, and theater. When forced to choose between a raucous St. Patrick's Day party and a slice of bumbleberry pie in the coffee shop with old people, I chose the pie. Future patrons, choose your a la mode flavor wisely.
Matt: "We'll take the 'giggle bush' ice cream with the pie."
Bumbleberry Sales Clerk: [firmly] "That's not ice cream. It's sherbert. And it doesn't complement the pie."
Me: "Uh...I guess we'll take the bumbleberry ice cream?"
BSC: "Good choice....I guess I shouldn't be so controlling..."
Anyone can read on a 5 ft sign in the store that a bumbleberry is a cross between a burpel and a binkel, grown on a giggle bush. http://www.bumbleberry.com/
Wednesday, March 16, 2011
American's Most Histrionic
There are times in prison when I feel like I'm on a new reality show called America's Most Histrionic. I have to remind myself to be patient with the dramatic wincing during gentle exam maneuvers and with the high volume of tears shed in my office. My first patient yesterday has been challenging to care for during our many visits. Aptly named, her last name is a synonym for "hit," and her chief complaint at our first visit was "punched the wall 20 times." This visit went fairly well; at least I didn't feel like punching a wall 20 times.
The drama continued out in the "yard" during the afternoon. Perhaps its the beautiful 75 degree weather or the fact that the entire campus is under construction to make it more disability friendly, but the ladies are a little testy. I was walking through the rubble to get back to the sidewalk when I witnessed and out and out brawl between two offenders in the grass during the evening medication line. It seemed like I was watching it in slow motion and thinking "hmmm...that's odd...are they fighting?!!!" I motioned to the guards, and another inmate broke up the fight. The ladies were then hand cuffed and likely taken to "the hole." Not a typical sight during my stroll across the yard. As they always say in prison emails, "be vigilant and stay safe."
I had my first prison nightmare last night. I was involved in some kind of theft and had to go to prison for 1 day. When I got there, they told me I had to stay for 5 days, and I was devastated. I woke up in a panic, thankful to be safe in La Quinta without a rap sheet.
The drama continued out in the "yard" during the afternoon. Perhaps its the beautiful 75 degree weather or the fact that the entire campus is under construction to make it more disability friendly, but the ladies are a little testy. I was walking through the rubble to get back to the sidewalk when I witnessed and out and out brawl between two offenders in the grass during the evening medication line. It seemed like I was watching it in slow motion and thinking "hmmm...that's odd...are they fighting?!!!" I motioned to the guards, and another inmate broke up the fight. The ladies were then hand cuffed and likely taken to "the hole." Not a typical sight during my stroll across the yard. As they always say in prison emails, "be vigilant and stay safe."
I had my first prison nightmare last night. I was involved in some kind of theft and had to go to prison for 1 day. When I got there, they told me I had to stay for 5 days, and I was devastated. I woke up in a panic, thankful to be safe in La Quinta without a rap sheet.
Tuesday, March 8, 2011
Morse Watchman Keywatcher III
For those who can't keep track of their keys, consider installing the Morse Watchman Keywatcher III. A personal electronic code allows access to the box, which guards thousands of prison keys. I have not yet figured out what the massive 4 inch key above my set opens.
Wednesday, March 2, 2011
Elite Status
Exciting news in the land of hotel living....I got an email saying I am two stays away from reaching Elite Status at La Quinta. This includes such fabulous perks as bottles of water and craisins in my room, free upgrades to my king suite, and a 30% point bonus. Tara at the front desk said she knew I was getting close to upgrade my status from Gold to Elite. With my rewards programs and roller bag, I feel like George Clooney in "Up in the Air." (Although I definitely don't operate by his "let go of the baggage weighing you down, unload the backpack" motivational strategy. Never known for my light packing, I come in every week dragging at least 5-7 bags of weekly supplies. A girl's gotta eat, knit, and blog...)
Tuesday, March 1, 2011
Reason for Visit, Part I
A patient in prison or on the outside has to state a reason for the visit when making a doctor's appointment. This statement then gets transferred to the doctor's schedule to explain why the patient is being seen. Somehow this seemingly simple bit of information can be lost in translation and transformed into a bit of medical hilarity.
My favorite reason for visit in residency was "Patient says the emeralds you made her don't fit and she needs new ones." No, I actually wasn't carving gemstones or making jewelry in the exam room (although that sounds fun!) The emeralds were actually ear molds that my patient requested I help her make so she could send away for hearing aids. (She lived alone and her overweight and beloved service beagle, who came to nearly all of her visits over 3 years, couldn't help her with that task of daily living.)
My prison schedule has some equally amusing reasons for medical appointments including:
"I am really not trying to be a pain in the behind, but the pain in my knees overide it all."
"States 'insides' coming out. Was in reference to her vagina."
18 year old male:
"Complains of pain in his vulva."
(Apparently, he was told by some other teenage offenders that the proper term for pain in his left upper quadrant was his 'vulva.' Poor guy.)
My favorite reason for visit in residency was "Patient says the emeralds you made her don't fit and she needs new ones." No, I actually wasn't carving gemstones or making jewelry in the exam room (although that sounds fun!) The emeralds were actually ear molds that my patient requested I help her make so she could send away for hearing aids. (She lived alone and her overweight and beloved service beagle, who came to nearly all of her visits over 3 years, couldn't help her with that task of daily living.)
My prison schedule has some equally amusing reasons for medical appointments including:
"I am really not trying to be a pain in the behind, but the pain in my knees overide it all."
"States 'insides' coming out. Was in reference to her vagina."
18 year old male:
"Complains of pain in his vulva."
(Apparently, he was told by some other teenage offenders that the proper term for pain in his left upper quadrant was his 'vulva.' Poor guy.)
Thursday, February 24, 2011
Where medicine meets discipline
Medicine on the outside is based upon principles like confidentiality, trust, privacy, and justice. Being a prisoner compromises one's rights, obviously, but when the roll of the clinic staff swings from care provider to disciplinarian, I become uneasy.
Inmates can get "charged" while serving their time for breaking the prison rules. Some infractions can result in being "written up" or "thrown in the hole" (the seg unit) for a period of time until an internal court evaluates the offender's behavior. These violations are then considered when the offender is evaluated for parole. There are many rules to be broken. Inmates are forbidden from touching each other in any way. Hugging is viewed as sexual misconduct. (I doubt anyone would ever give me an accurate sexual history due to concerns for disciplinary action...I ask anyway). Sharing medicine or food is also not allowed. I still haven't figured out where the line is between a patient's right to autonomy and willful noncompliance, which can result in a write-up.
Another interesting charge is "abuse of clinical services." Sending excessive kites or being disrespectful to staff can result in this charge. I have had more than one patient complain about a nurse who has singled them out and written them up for abusing our clinic. At times, I tend to sympathize with the patient, as I have occasionally observed aggressive nurses antagonizing certain difficult patients.
I had my own run in with a difficult patient last week during a diabetes visit. After just a few questions about her peripheral neuropathy, the patient became frustrated and basically went off on me about her chronic pain in a hostile way. I left the room and asked the nurses to show her out. This nurse then wrote the patient up for being verbally abusive. The next day, the same patient tossed her used insulin syringe through the slot in the med window, and now she is in the hole.
While I agree that inmates need to be respectful of staff and it is totally inexcusable for them to be tossing sharps around, I am sure that any therapeutic relationship I might have had with this patient has been destroyed. It's a strange and uncomfortable position to be in. The ethical challenges of prison medicine are tricky to navigate.
Inmates can get "charged" while serving their time for breaking the prison rules. Some infractions can result in being "written up" or "thrown in the hole" (the seg unit) for a period of time until an internal court evaluates the offender's behavior. These violations are then considered when the offender is evaluated for parole. There are many rules to be broken. Inmates are forbidden from touching each other in any way. Hugging is viewed as sexual misconduct. (I doubt anyone would ever give me an accurate sexual history due to concerns for disciplinary action...I ask anyway). Sharing medicine or food is also not allowed. I still haven't figured out where the line is between a patient's right to autonomy and willful noncompliance, which can result in a write-up.
Another interesting charge is "abuse of clinical services." Sending excessive kites or being disrespectful to staff can result in this charge. I have had more than one patient complain about a nurse who has singled them out and written them up for abusing our clinic. At times, I tend to sympathize with the patient, as I have occasionally observed aggressive nurses antagonizing certain difficult patients.
I had my own run in with a difficult patient last week during a diabetes visit. After just a few questions about her peripheral neuropathy, the patient became frustrated and basically went off on me about her chronic pain in a hostile way. I left the room and asked the nurses to show her out. This nurse then wrote the patient up for being verbally abusive. The next day, the same patient tossed her used insulin syringe through the slot in the med window, and now she is in the hole.
While I agree that inmates need to be respectful of staff and it is totally inexcusable for them to be tossing sharps around, I am sure that any therapeutic relationship I might have had with this patient has been destroyed. It's a strange and uncomfortable position to be in. The ethical challenges of prison medicine are tricky to navigate.
Monday, February 14, 2011
All you need is Love...and Candy...and a Heart Biopsy
Happy Valentine's Day! Cupid has nice 50 degree weather for flitting around Colorado this week. I was delighted to drive to Pueblo today on clear, dry roads. Thawed out windshield wiper fluid is a beautiful thing....and so are my Valentine's flowers from Matt. Even the La Quinta left me some V-day treats (despite giving my precious room 120 to a management trainee for the next 3 weeks!)
I arrived at work to meet the usual morning morning ambush. Some of the prison heavy hitters had their typical medical problems and ER visits over the weekend...seizures, chest pain, pseudoseizures...I have been trying to get the epileptic lady under control since Christmas, and I thought we were finally making head way. Apparently not quite yet. The lady with chest pain is a total wolf-crier with the potential to have a heart attack. She does have heart disease and a stent, but each biweekly episode of chest pain yields an ER diagnosis of "non cardiac chest pain" and a script for benzos (which we don't have in prison anyway).
My most interesting patient today was a young woman in her 30s with a history of congestive heart failure. She also told me she had 3 strokes during the same hospital stay "due to stress," which sounded ridiculous. However, she actually did have some past medical records which confirmed her hospitalization for strokes and CHF. Unfortunately, no cause was ever identified for her heart failure at the age of 32, but I suspect many years of meth use might have been at play. She's the only patient I've encountered who underwent a heart biopsy as part of her work up. It's not every day you get a heart biopsy! Gives a whole new meaning to "Take Another Little Piece of My Heart, now baby...." She seemed to be doing pretty well clinically with some minor shortness of breath with exertion. Hopefully her echocardiogram will get approved so we check on the status of her big heart.
I arrived at work to meet the usual morning morning ambush. Some of the prison heavy hitters had their typical medical problems and ER visits over the weekend...seizures, chest pain, pseudoseizures...I have been trying to get the epileptic lady under control since Christmas, and I thought we were finally making head way. Apparently not quite yet. The lady with chest pain is a total wolf-crier with the potential to have a heart attack. She does have heart disease and a stent, but each biweekly episode of chest pain yields an ER diagnosis of "non cardiac chest pain" and a script for benzos (which we don't have in prison anyway).My most interesting patient today was a young woman in her 30s with a history of congestive heart failure. She also told me she had 3 strokes during the same hospital stay "due to stress," which sounded ridiculous. However, she actually did have some past medical records which confirmed her hospitalization for strokes and CHF. Unfortunately, no cause was ever identified for her heart failure at the age of 32, but I suspect many years of meth use might have been at play. She's the only patient I've encountered who underwent a heart biopsy as part of her work up. It's not every day you get a heart biopsy! Gives a whole new meaning to "Take Another Little Piece of My Heart, now baby...." She seemed to be doing pretty well clinically with some minor shortness of breath with exertion. Hopefully her echocardiogram will get approved so we check on the status of her big heart.
Wednesday, February 9, 2011
The Darndest Things...
The youthful offenders have a lot of scars and tattoos. Today the 5 offenders were all under 20 and had scars from abuse, stabbings, and cutting. One 18 yr old had some peculiar linear scars running down his anterior forearm from elbow to wrist, like faint train tracks. I examined him and inquired. His response? "I was high on meth in Canada and some girl cut up my arm to suck my blood on 4th of July. No one ever believes me." I could not keep a straight face, but I did believe him.
The morale of this story: Don't go to Canada on Independence Day. And meth is bad too.
The morale of this story: Don't go to Canada on Independence Day. And meth is bad too.
Tuesday, February 8, 2011
It's a Lady's Prison
In case there is any confusion, I am definitely working in a women's prison. Our prison also houses boot camp for youthful offenders and a few adult men passing through on their way to other prisons (or waiting for colonoscopies). Nearly all of my patients are adult women age 20-74, with most of the women in their 30s-40s. (The lady in her 70s just showed up last week...I gave my first mini mental status exam in months.) Tomorrow the clinic will again turn into day one of boot camp as another crop of tachycardic teenage offenders arrive at boot camp.
My typical day will include chronic care visits, a few people with various medical complaints (usually pain), and a few procedures a week (skin excisions, joint injections). Since physical therapy is not often approved and getting a brace requires a small army, I will stick a needle in almost anything to inject steroids or to aspirate a joint. My biggest success story so far: uric acid crystals on an MTP aspiration! She's got the gout.
I had never aspirated or injected this joint before, but thought it might give her some relief. By some small miracle, my aspiration actually yielded some clear viscous joint fluid. I smeared it on a slide and slapped on a cover slip. To ship the slide to the lab, I put it in a big test tube. With the slide sticking out and the lid taped on, I was thinking "the lab is never going to accept this." But by a second stroke of luck, the lab did take my sample and spotted some negatively birefringent crystals. Her presentation of gout wasn't classic, so I was quite surprised to get the results. None of this has helped her symptoms yet, but she is following up tomorrow. Stay tuned.
My typical day will include chronic care visits, a few people with various medical complaints (usually pain), and a few procedures a week (skin excisions, joint injections). Since physical therapy is not often approved and getting a brace requires a small army, I will stick a needle in almost anything to inject steroids or to aspirate a joint. My biggest success story so far: uric acid crystals on an MTP aspiration! She's got the gout.
I had never aspirated or injected this joint before, but thought it might give her some relief. By some small miracle, my aspiration actually yielded some clear viscous joint fluid. I smeared it on a slide and slapped on a cover slip. To ship the slide to the lab, I put it in a big test tube. With the slide sticking out and the lid taped on, I was thinking "the lab is never going to accept this." But by a second stroke of luck, the lab did take my sample and spotted some negatively birefringent crystals. Her presentation of gout wasn't classic, so I was quite surprised to get the results. None of this has helped her symptoms yet, but she is following up tomorrow. Stay tuned.
Monday, February 7, 2011
Hotel for Dogs
After more than 12 weeks of living la vida La Quinta, I have finally requested to have the same room each week. I have been trying out different rooms with the same king suite including "micro/fridge." I thought settling on the same room might make my stays seem more homey and ease my weekly battle with the thermostat. (Every room is slightly different, and this white noise addict likes the rooms with the built in fan).
Paradise found? Not so sure...
For you animals lovers out there, the La Quinta is very pet friendly. According to the online pet policy, "pets are welcome at most locations nationwide." (Good thing I'm not working at a prison in Manhattan, Queens, Monterrey, or San Antonio...)
Most weeks I have crammed demands such as "no adjoining door, first floor please, no pets" into the "special requests" field on my online reservation. Guess I had to forfeit those preferences when I put all my chips on room 120. While I did buy milk bones for Audrey the Pomerian who lived downstairs at my last apartment, these pooches aren't getting any treats from me. And they better keep the yapping down.
I am reminded of the experience of the nurse practitioner, who also travels from Denver. "I got sick of those barking dogs at La Quinta, so I moved to the Wingate." (While the nearby Wingate does offer a better breakfast, I found their manager to be less than accommodating when I requested to not have a paper thin adjoining door. I checked out and never looked back.)
Time to bust out the ear plugs and set the fan to high.
The joys of hotel living are still better than living in prison.
Paradise found? Not so sure...
For you animals lovers out there, the La Quinta is very pet friendly. According to the online pet policy, "pets are welcome at most locations nationwide." (Good thing I'm not working at a prison in Manhattan, Queens, Monterrey, or San Antonio...)
Most weeks I have crammed demands such as "no adjoining door, first floor please, no pets" into the "special requests" field on my online reservation. Guess I had to forfeit those preferences when I put all my chips on room 120. While I did buy milk bones for Audrey the Pomerian who lived downstairs at my last apartment, these pooches aren't getting any treats from me. And they better keep the yapping down.
I am reminded of the experience of the nurse practitioner, who also travels from Denver. "I got sick of those barking dogs at La Quinta, so I moved to the Wingate." (While the nearby Wingate does offer a better breakfast, I found their manager to be less than accommodating when I requested to not have a paper thin adjoining door. I checked out and never looked back.)
Time to bust out the ear plugs and set the fan to high.
The joys of hotel living are still better than living in prison.
Wednesday, February 2, 2011
Frosty!
Hello from sub-zero Colorado! It was a frigid drive down to Pueblo this week and the 1/4 mile walk from the guard station to the clinic is simply bone chilling. Despite the excellent efforts of the inmates in snow shoveling, the campus is treacherous. They do use some device to clear the path that looks like a cross between a broom and a floor buffer:
Tiny yellow bristles litter the path to clinic...and the twisted ankles and wounded knees from ice injuries are trickling in.
So far in prison, I have basically been an internist with a fairly narrow scope of practice. All psychiatry is handled by the mental health department. The only "peds" I do is the sports physicals on the teenagers. OB patients get shipped to Denver faster than you can say "oops, she's 31 weeks pregnant." And gynecology is done by the gynecologist nurse practitioner, an affable lady who was more than happy for me to come on board to take over the inmates' primary care concerns. For example, she remarked more than once, "I don't want to remove any toenails unless they are up in a vagina." However, while she is out having knee surgery, I will be doing all the paps, colposcopies, and answering kites stating, "I am not buying nothing until I know what is going on down there." It should be a nice change of pace and a good chance to brush up on my gyn skills.
Tiny yellow bristles litter the path to clinic...and the twisted ankles and wounded knees from ice injuries are trickling in.
So far in prison, I have basically been an internist with a fairly narrow scope of practice. All psychiatry is handled by the mental health department. The only "peds" I do is the sports physicals on the teenagers. OB patients get shipped to Denver faster than you can say "oops, she's 31 weeks pregnant." And gynecology is done by the gynecologist nurse practitioner, an affable lady who was more than happy for me to come on board to take over the inmates' primary care concerns. For example, she remarked more than once, "I don't want to remove any toenails unless they are up in a vagina." However, while she is out having knee surgery, I will be doing all the paps, colposcopies, and answering kites stating, "I am not buying nothing until I know what is going on down there." It should be a nice change of pace and a good chance to brush up on my gyn skills.
Wednesday, January 26, 2011
Scourges of Humanity
There are many days when I feels satisfied to have chosen primary care as my field. I can brush off questions like "are you JUST a family doctor?" and "aren't you going to specialize?" with ease and even a touch of primary care pride. However, feeling like any medical ailment COULD be within my domain also causes a bit of anxiety for this newly minted family doc attending. Of course, there are limits, but in prison I might be the only doctorly eyes that see a patient for sometime.
Uncertainty in medicine has always bothered me. I want to know the answer to every question, even the mundane ones. I'm beginning to make a list of the scourges of humanity, problems which plague my patients and, therefore, are plaguing me because I can't answer them with a snappy diagnosis. White lines on your nails? Excessive hair loss? Numbness "everywhere"? Dizziness? Eyelid twitches? Well, that's clearly... hmmmmm... Don't sweat the small stuff, right?
Prisoners also often try and cram as many vague and random complaints as possible into a single visit to avoid being charged for multiple visits, which is not unlike patients on the outside. I have to set limits with the number of things I'm willing to address but that doesn't always go over so well. A lady earlier in the week got huffy because I wouldn't refill her prilosec or talk about her GERD after we were wrapped up her visit on pelvic pain. She was bad mouthing me all the way out the clinic. Why battle over prilosec? Well, I don't want to, but you can buy it on canteen -although pricey- and the visit was over by the time she brought it up. I felt my usual chocolate heart turning a bit stony. Perhaps I should attend the upcoming Swedish CME about maintaining empathy...
Uncertainty in medicine has always bothered me. I want to know the answer to every question, even the mundane ones. I'm beginning to make a list of the scourges of humanity, problems which plague my patients and, therefore, are plaguing me because I can't answer them with a snappy diagnosis. White lines on your nails? Excessive hair loss? Numbness "everywhere"? Dizziness? Eyelid twitches? Well, that's clearly... hmmmmm... Don't sweat the small stuff, right?
Prisoners also often try and cram as many vague and random complaints as possible into a single visit to avoid being charged for multiple visits, which is not unlike patients on the outside. I have to set limits with the number of things I'm willing to address but that doesn't always go over so well. A lady earlier in the week got huffy because I wouldn't refill her prilosec or talk about her GERD after we were wrapped up her visit on pelvic pain. She was bad mouthing me all the way out the clinic. Why battle over prilosec? Well, I don't want to, but you can buy it on canteen -although pricey- and the visit was over by the time she brought it up. I felt my usual chocolate heart turning a bit stony. Perhaps I should attend the upcoming Swedish CME about maintaining empathy...
Tuesday, January 25, 2011
Plotting my escape
A great way to remind yourself that you're not actually in prison is to take a weekend trip to Seattle. My friend Alyson was flying in from Boise for a baby shower so I decided to join her for a weekend getaway to our former stomping ground. We enjoyed a fabulous weekend catching up with our friends and trying restaurants I missed while living in the Emerald City(Hi-Spot, Harvest Vine) plus some new ones (Cheeky Cafe). We even went out for more hours on Friday night (9hrs!) than I worked on Thursday (8 hrs). Who doesn't enjoy some Capitol Hill bar hopping, junk food munching, and karaoke singing with a bunch of doctors? We also stopped by our favorite markets and only needed our rain jackets one day!
Then Monday morning...back to prison. The lockdown was still in effect, so I only saw two patients yesterday. Today was a "modified lockdown," so the medical clinic was open for business. I don't know if any more shanks were found, but I hear some hooch was found in a coffee pot. (Homemade hooch is popular prison contraband...I'm told it can even be made out of metamucil...blech!) We have a lot of medical appointments to make up, so the rest of the week should be busy.
I also heard a piece of depressing news today: our best nurse has put in her 2 weeks notice. She is my go-to nurse, the most reliable one, the only whose judgment I value most. And she looks after my schedule. I think current nurse drama has a lot to do with her departure. I also am plotting my next career move and have had a few interviews at a Denver community health center. I like the prison work overall and am beginning to see improvements in diabetes control, results of labs/studies I've ordered, and am learning alot, but the early and icy commute to Pueblo is wearing me down. As much as I enjoy collecting La Quinta points (to be used to stay in a hotel near the slopes soon), it would be nice to see my apartment walls for longer than the time it takes me to repack my suitcase. And Matt. I like him too.
The pros of this job: 3 day weekends without call, autonomy, and a relatively light clinic schedule. The cons (other than the ones staying here): no peds or ob patients, the commute, and being gone 3 nights a week. Break even trade offs: patients can get all meds, imaging, and consults within reason without having to pay for it, tempered by having to wait a fairly long time and me having to get permission from the insurance company and pharmacy committee.
I will keep you posted if I make a permanent break for Denver.
Then Monday morning...back to prison. The lockdown was still in effect, so I only saw two patients yesterday. Today was a "modified lockdown," so the medical clinic was open for business. I don't know if any more shanks were found, but I hear some hooch was found in a coffee pot. (Homemade hooch is popular prison contraband...I'm told it can even be made out of metamucil...blech!) We have a lot of medical appointments to make up, so the rest of the week should be busy.
I also heard a piece of depressing news today: our best nurse has put in her 2 weeks notice. She is my go-to nurse, the most reliable one, the only whose judgment I value most. And she looks after my schedule. I think current nurse drama has a lot to do with her departure. I also am plotting my next career move and have had a few interviews at a Denver community health center. I like the prison work overall and am beginning to see improvements in diabetes control, results of labs/studies I've ordered, and am learning alot, but the early and icy commute to Pueblo is wearing me down. As much as I enjoy collecting La Quinta points (to be used to stay in a hotel near the slopes soon), it would be nice to see my apartment walls for longer than the time it takes me to repack my suitcase. And Matt. I like him too.
The pros of this job: 3 day weekends without call, autonomy, and a relatively light clinic schedule. The cons (other than the ones staying here): no peds or ob patients, the commute, and being gone 3 nights a week. Break even trade offs: patients can get all meds, imaging, and consults within reason without having to pay for it, tempered by having to wait a fairly long time and me having to get permission from the insurance company and pharmacy committee.
I will keep you posted if I make a permanent break for Denver.
Wednesday, January 19, 2011
Shank you very much
Wikipedia defines a shank in several ways, including a poor golf shot or a cut of meat, but in prison, a shank is a makeshift knife fashioned by prisoners. Because of these shenanigans, all of an offender's property is meticulously catalogued by the property department. All medical supplies like wrist braces or hearing aids must be inspected and then engraved with the prisoner's ID number. Shanks and other contraband are taken very seriously, and due to the past month's events including the discovery of a shank, we were placed on a full lockdown today.
For me this meant, that all of my patients were cancelled, which caused me to squeal in delight. (Yesterday a nurse saw my schedule and basically told me to brace myself.) Instead, I got to catch up on some chart reviews and chase down missing consults. I did see two emergency visits...one vomiting teenager and one woman who had, as they say in Spanish, fallen pregnant. Oops. Apparently she became incarcerated during the fall and had a few negative pregnancy tests at a county jail, reportedly. Then she was transferred to our prison and had not been seen in the medical clinic since she arrived. Her growing abdomen roused her own suspicion, but denial is an extremely powerful force, as I learned in residency with another pregnant patient. It's been a while since I've gotten to do prenatal care so I enjoyed trying to remember what to do with a 31 week pregnant lady. Basically, she will be transferred out of our facility as swiftly as possible and will deliver at a Denver Hospital. On the bright side, at least she did not become pregnant while in prison. I've heard that has happened and that is, well, frowned upon.
While I was seeing my two patients today, the inmates underwent strip searches looking for other contraband. The entire facility is being searched from top to bottom. I hear the lockdown may last for sometime. Emergency medical visits only.
Our Warden stopped by the medical staff meeting today. She is a dynamic, no-nonsense woman who spoke about the "evolution of the prisoners" and how prisoners are becoming more brazen. She reminded us that the offenders are not our equals and that we must not become complacent. It is a good reminder to stay vigilant, which is probably the biggest difference in working in prison compared to the outside.
The most humorous exchange of the day was between me and a new agency nurse, who is studying to become an RN. I asked her if she had given the tylenol and the phenergan to the vomiting teenager yet. She had not, so I said, "you can probably just give those tonight, prn." She looked bewildered and replied, "I don't think I can given a suppository through the cell window." Apparently, she thought I had meant "PR," which is per rectum, instead of PRN, which means as needed. It reminded me of some medical jargon misunderstandings of my own when I started my clinical rotations in med school, which I know caused a few chuckles and smirks on rounds.
For me this meant, that all of my patients were cancelled, which caused me to squeal in delight. (Yesterday a nurse saw my schedule and basically told me to brace myself.) Instead, I got to catch up on some chart reviews and chase down missing consults. I did see two emergency visits...one vomiting teenager and one woman who had, as they say in Spanish, fallen pregnant. Oops. Apparently she became incarcerated during the fall and had a few negative pregnancy tests at a county jail, reportedly. Then she was transferred to our prison and had not been seen in the medical clinic since she arrived. Her growing abdomen roused her own suspicion, but denial is an extremely powerful force, as I learned in residency with another pregnant patient. It's been a while since I've gotten to do prenatal care so I enjoyed trying to remember what to do with a 31 week pregnant lady. Basically, she will be transferred out of our facility as swiftly as possible and will deliver at a Denver Hospital. On the bright side, at least she did not become pregnant while in prison. I've heard that has happened and that is, well, frowned upon.
While I was seeing my two patients today, the inmates underwent strip searches looking for other contraband. The entire facility is being searched from top to bottom. I hear the lockdown may last for sometime. Emergency medical visits only.
Our Warden stopped by the medical staff meeting today. She is a dynamic, no-nonsense woman who spoke about the "evolution of the prisoners" and how prisoners are becoming more brazen. She reminded us that the offenders are not our equals and that we must not become complacent. It is a good reminder to stay vigilant, which is probably the biggest difference in working in prison compared to the outside.
The most humorous exchange of the day was between me and a new agency nurse, who is studying to become an RN. I asked her if she had given the tylenol and the phenergan to the vomiting teenager yet. She had not, so I said, "you can probably just give those tonight, prn." She looked bewildered and replied, "I don't think I can given a suppository through the cell window." Apparently, she thought I had meant "PR," which is per rectum, instead of PRN, which means as needed. It reminded me of some medical jargon misunderstandings of my own when I started my clinical rotations in med school, which I know caused a few chuckles and smirks on rounds.
Tuesday, January 18, 2011
Having a Fit
There must be something in the water because the number of patients having seizures in the last two weeks is out of control. Almost daily, it seems that the nurses are called on the radio to go to the scene where an offender is seizing. This causes the nurses to grab the crash kit and hop in the golf cart "ambulance" and take off speeding. Several of these folks have been taken to the ER in a real ambulance....Then they come back to me later in the day with no records, a patient education hand out for "neck pain," and a prescription for some narcotics we can't fill. Neat. I think last week they loaded up a "seizing" patient with some drugs because she was so groggy and hypotensive when she came back that I transferred her to the infirmary at another prison. (God bless that infirmary doctor, who lives in a Winnebago, for accepting the transfer.) I had to call him today to transfer another seizer who I can't get under control. He then traded me back the first lady who hadn't seized at all while she was there. I'm not surprised because her description of her seizures was vague and didn't quite compute ("I called the guard and said, 'hey i'm having a seizure!'...[insert fully body shaking])
Did I miss all of the lectures and didactics in residency about primary care management of epilepsy? I've been trying to read up and consult more experienced prison docs but don't feel that confident in the fine tuning of anti-epileptic drugs regimens. I did order my first EEG recently on another possible epileptic who is "seizing in her sleep" and wakes with "sore tongue and gums." We'll see what the EEG reveals...most of the imaging studies I have ordered have reported normal findings, save for a few arthritic joints and two cases of osteoporosis in relatively young women. I guess that's a good thing.
Things to look forward to: Mexican pot luck with the nurses tomorrow and my first trip back to Seattle this weekend!
Did I miss all of the lectures and didactics in residency about primary care management of epilepsy? I've been trying to read up and consult more experienced prison docs but don't feel that confident in the fine tuning of anti-epileptic drugs regimens. I did order my first EEG recently on another possible epileptic who is "seizing in her sleep" and wakes with "sore tongue and gums." We'll see what the EEG reveals...most of the imaging studies I have ordered have reported normal findings, save for a few arthritic joints and two cases of osteoporosis in relatively young women. I guess that's a good thing.
Things to look forward to: Mexican pot luck with the nurses tomorrow and my first trip back to Seattle this weekend!
Monday, January 17, 2011
On the Bright Side
It's always a little hard to make the early morning trek to Pueblo after a fun weekend in Denver. Inevitably, the 4:40 am alarm comes too early. Compared to last week's bone chilling sub zero temps (which made me think I was locums'ing in Alaska), the lovely 50 degree weather made my commute down I-25 easy breezy. I also enjoyed the sunrise over the Colorado plains. It's getting lighter at night, so when I leave the sun is setting over the foothills. Here's the Pueblo downtown Riverwalk looking pretty
Other high points of today include getting paid time a half for working on MLK day and an interesting mix of patients. From osteoporosis to HIV and refractory seizures, these patients are keeping me on my toes. Too many patients told me I was nice today, which always raises a red flag that they might be after something. Flattery will get you no where in prison! Not even with the chocolate heart doctor.
In other breaking prison news, 15 tylenol #3 tabs were stolen from the clinic med room over the weekend. No one knows how this theft occurred, but an empty baggie was found in the dumpster. There has been a big to-do in clinic about the missing T3s (the only narcotic we have). When anything goes wrong, the poor "agency nurses" become the scapegoats since they have limited experience at our facility. This theft prompted the Warden and Associate Warden to drop by and offer some observations. (They are both women, and the Warden is a nurse who worked her way up the ranks.) The mystery of the missing pills continues...I'll be on the look out for tylenol toxicity...
Other high points of today include getting paid time a half for working on MLK day and an interesting mix of patients. From osteoporosis to HIV and refractory seizures, these patients are keeping me on my toes. Too many patients told me I was nice today, which always raises a red flag that they might be after something. Flattery will get you no where in prison! Not even with the chocolate heart doctor.
In other breaking prison news, 15 tylenol #3 tabs were stolen from the clinic med room over the weekend. No one knows how this theft occurred, but an empty baggie was found in the dumpster. There has been a big to-do in clinic about the missing T3s (the only narcotic we have). When anything goes wrong, the poor "agency nurses" become the scapegoats since they have limited experience at our facility. This theft prompted the Warden and Associate Warden to drop by and offer some observations. (They are both women, and the Warden is a nurse who worked her way up the ranks.) The mystery of the missing pills continues...I'll be on the look out for tylenol toxicity...
Tuesday, January 11, 2011
Prison Runway
One of my patients today is the prison seamstress. She is responsible for crafting all of the fashionable prison "greens." A typical prison outfit is comprised of a dark green top and pants --very similar to scrubs. Each outfit is emblazoned with the offender's name and DOC number. Prisoners also sport bright yellow t-shirts, gray sweatshirts, and carhart jackets.
However, if an offender is in trouble, she is taken to the seg unit in an orange jumpsuit, which is also the outfit of choice if she has to be taken off the prison grounds to the ER, for example. When people are out of seg but still in trouble, they wear orange pants with their green tops, similar to a scarlet letter.
Prison footwear leaves much to be desired, especially for the slew of people I've seen lately with bunions, MTP arthritis, and plantar fasciitis. Most people are given a pair of black boots, but it is possible for the offenders to buy New Balance sneakers. Today I tried to order a wider pair of shoes for an inmate...we'll see how that goes.
Just because personal expression may be limited by fashion doesn't mean the offenders don't go all out with eye shadow. They have some of the best applied eye shadow I have ever seen. I could use some smoky eye pointers. Many kinds of make up are available on canteen for purchase. Some ladies had the great foresight to have make up tattooed right on before they came to prison, eliminating the need for pesky eyebrow pencil.
I learned on one of my first days in prison that, although incarcerated, prisoners still want to look nice and feel good about their appearance. One lady broke my heart when, during her asthma visit, she asked if her "face would always be like this." She developed Bell's Palsy a year and a half ago and still has some noticeable motor deficits in the left side of her face. My heart broke when she started crying after I told her that she probably wouldn't see much more improvement. I definitely take cranial nerve VII for granted.
However, if an offender is in trouble, she is taken to the seg unit in an orange jumpsuit, which is also the outfit of choice if she has to be taken off the prison grounds to the ER, for example. When people are out of seg but still in trouble, they wear orange pants with their green tops, similar to a scarlet letter.
Prison footwear leaves much to be desired, especially for the slew of people I've seen lately with bunions, MTP arthritis, and plantar fasciitis. Most people are given a pair of black boots, but it is possible for the offenders to buy New Balance sneakers. Today I tried to order a wider pair of shoes for an inmate...we'll see how that goes.
Just because personal expression may be limited by fashion doesn't mean the offenders don't go all out with eye shadow. They have some of the best applied eye shadow I have ever seen. I could use some smoky eye pointers. Many kinds of make up are available on canteen for purchase. Some ladies had the great foresight to have make up tattooed right on before they came to prison, eliminating the need for pesky eyebrow pencil.
I learned on one of my first days in prison that, although incarcerated, prisoners still want to look nice and feel good about their appearance. One lady broke my heart when, during her asthma visit, she asked if her "face would always be like this." She developed Bell's Palsy a year and a half ago and still has some noticeable motor deficits in the left side of her face. My heart broke when she started crying after I told her that she probably wouldn't see much more improvement. I definitely take cranial nerve VII for granted.
Monday, January 10, 2011
Strike?
How do you know when the roads are "too bad" to go work? Do doctors ever get snow days? After 5 years of receiving emails reminding me that I am "essential personnel" and must find a way to get to work even during the apocalypse, I have a hard time throwing in the towel due to bad roads. Would a foot of snow in Denver and a unplowed highway make good excuses? The usual 1 hr 40 minute early A.M. drive to Pueblo took me 3 hrs and was harrowing to say least. (Matt suggested I pack some snow shoes in case I got stranded). Thankfully, only one stop to clean the windshield was required, and I didn't end up in a ditch. I would say the day was a success. If I could only finagle a way for the prison to pay me for my drive time...
Today in prison, I had some nice patient visits. My first patient was a lady in her 50s brought in from the "seg" unit, where she spends 23 hrs/day in her cell. She had a black eye and was wearing a seg unit uniform - the orange jump suit. She had also been on a "hunger strike" for a week. I guess the purpose of hunger strike is to make some kind of statement. After seven days of striking, she was eating a grilled cheese sandwich in the exam room. (The nurses have protocols for all kinds of medical evaluations...including the hunger strike. I think it involves daily weights, vitals, urine dips and measurements of fluids.) This patient has severe hypertension, and I wondered if she was also on a "medicine strike" since she took her blood pressure pills 8 out of the last 30 days. Not advisable when you've already had 2 heart attacks. We actually had a productive visit where she set goals of "eating" and taking her pills "29 out of 30 days" this month. Ambitious for someone who maybe took that many doses over the last 3-4 months, but I am cautiously optimistic.
I also saw a teenage medical mystery for follow-up. Last week, he had his boot camp physical and other than hypertension and slightly large liver, he was quite well with no pertinent past medical history. Then, over the weekend, he developed redness on his arm and, later, on both feet and ankles as well as ankle swelling. The on call doc ordered labs and treated him for cellulitis, which seems totally reasonable, but it just didn't seem like cellulitis. He never had a fever and had a normal white count. Apparently he looked a lot better today, but still had purplish feet, a vasculitic looking ankle rash, and pedal edema. His only lab abnormalities were an elevated AST and slight proteinuria. Today the proteinuria had resolved, and his blood pressure had improved. I am chasing down a rheumatologic rat with more lab work, but I imagine this might be a wild goose chase.
Today in prison, I had some nice patient visits. My first patient was a lady in her 50s brought in from the "seg" unit, where she spends 23 hrs/day in her cell. She had a black eye and was wearing a seg unit uniform - the orange jump suit. She had also been on a "hunger strike" for a week. I guess the purpose of hunger strike is to make some kind of statement. After seven days of striking, she was eating a grilled cheese sandwich in the exam room. (The nurses have protocols for all kinds of medical evaluations...including the hunger strike. I think it involves daily weights, vitals, urine dips and measurements of fluids.) This patient has severe hypertension, and I wondered if she was also on a "medicine strike" since she took her blood pressure pills 8 out of the last 30 days. Not advisable when you've already had 2 heart attacks. We actually had a productive visit where she set goals of "eating" and taking her pills "29 out of 30 days" this month. Ambitious for someone who maybe took that many doses over the last 3-4 months, but I am cautiously optimistic.
I also saw a teenage medical mystery for follow-up. Last week, he had his boot camp physical and other than hypertension and slightly large liver, he was quite well with no pertinent past medical history. Then, over the weekend, he developed redness on his arm and, later, on both feet and ankles as well as ankle swelling. The on call doc ordered labs and treated him for cellulitis, which seems totally reasonable, but it just didn't seem like cellulitis. He never had a fever and had a normal white count. Apparently he looked a lot better today, but still had purplish feet, a vasculitic looking ankle rash, and pedal edema. His only lab abnormalities were an elevated AST and slight proteinuria. Today the proteinuria had resolved, and his blood pressure had improved. I am chasing down a rheumatologic rat with more lab work, but I imagine this might be a wild goose chase.
Wednesday, January 5, 2011
Back from Hiatus
After a lovely trip to Ohio for the holidays, I am back in prison. I can't say that I'm glad to be back at work, but I'm working on my attitude as part of my new year's resolution. Some prisoners did remind me yesterday that I "was free" and should have had a great new year's, which I did.
I think the trifecta of a bad day for me in prison is the intersection of difficult patients, less than ideal nursing staff, and computer problems. I've hit 2/3 of those daily this week...but not the dreaded 3/3...yet...thankfully. (I'm sure there are many more serious things that could go wrong, but I'll just fret about the mundane, annoying things for now). There has been a shortage of nurses lately due to people quitting, being sick, and just not showing up, which leaves "agency nurses" (the locums of nursing, or travel nurses) and new prison nurses in training. This week is an exercise in patience.
Things improved a bit once my computer got fixed....just in time for the drill sargents to bust into the clinic yelling at the 9 youthful offenders I had to examine. I usually split the exams with a nurse practitioner, but she wasn't in. Today I learned several things: the average pulse of a youthful offender is about 102. Secondly, I can reduce the overuse of "ma'am, yes ma'am" by telling the offenders to cut out the ma'ams at the beginning of our visit. Simple, but brilliant! It also seemed to quiet the guards during my exam, making our interaction feel more clinical and less tense for me and the patients. (As soon as they left the exam room, the guards would start up again with the "stop eyeballing me! Toes to the wall!") I can't help but feel bad for those kids, even if they are hardened teenage criminals.
I was pleased that a teenager on dialysis didn't show up for a physical today. I heard he is still coming despite many attempts to prevent him from the YOS program. Dialysis? Boot camp? I just don't think those are compatible. Next month I'm going to have a fit if I see a kid in a yellow jumpsuit with a canteen over his head and a palpable thrill in his arm...
I think the trifecta of a bad day for me in prison is the intersection of difficult patients, less than ideal nursing staff, and computer problems. I've hit 2/3 of those daily this week...but not the dreaded 3/3...yet...thankfully. (I'm sure there are many more serious things that could go wrong, but I'll just fret about the mundane, annoying things for now). There has been a shortage of nurses lately due to people quitting, being sick, and just not showing up, which leaves "agency nurses" (the locums of nursing, or travel nurses) and new prison nurses in training. This week is an exercise in patience.
Things improved a bit once my computer got fixed....just in time for the drill sargents to bust into the clinic yelling at the 9 youthful offenders I had to examine. I usually split the exams with a nurse practitioner, but she wasn't in. Today I learned several things: the average pulse of a youthful offender is about 102. Secondly, I can reduce the overuse of "ma'am, yes ma'am" by telling the offenders to cut out the ma'ams at the beginning of our visit. Simple, but brilliant! It also seemed to quiet the guards during my exam, making our interaction feel more clinical and less tense for me and the patients. (As soon as they left the exam room, the guards would start up again with the "stop eyeballing me! Toes to the wall!") I can't help but feel bad for those kids, even if they are hardened teenage criminals.
I was pleased that a teenager on dialysis didn't show up for a physical today. I heard he is still coming despite many attempts to prevent him from the YOS program. Dialysis? Boot camp? I just don't think those are compatible. Next month I'm going to have a fit if I see a kid in a yellow jumpsuit with a canteen over his head and a palpable thrill in his arm...
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