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: