Women's Health, Newport, NH

I had heard good things about this rotation from both Alli and Nicole, so I had high expectations. So far they are being met. Day 1, my preceptor spelled out how things were going to work. Basically, I would focus on history taking when I roomed patients, and on the pap collection when we did an annual. She would take care of the heart and lungs for the exam because she wasn't comfortable with teaching that. Fair enough.

She also gives articles (several each week) for you to read, and she will go over them with you. She makes sure that she presents material to you in a way that you are comfortable doing most basic work ups (but is not condescending).

Day 3, welcome to the OR. First I observed a lap tubal ligation, then was allowed to scrub in on a hysterectomy. Its sounds sort of pathetic (and well it probably is) but I was really excited to "assist" by holding retractors and cutting suture material. When we got towards the end of the procedure the scrub nurse congratulated me on making it through my first surgery without passing out.

The next day it was IUD insertions. Not an overly fun procedure to observe (there really isn't anything to do to assist).

Week one, done and mostly uneventful.

However, in week two things start getting interesting. For one, I got to remove one of the IUDs that we had just barely inserted. The other was one of the hysterectomy patients was spiking fevers. The wound looked good, we didn't see anything wrong, so we let her go home (this was from an office follow up). She called later saying she had a fever again and was having trouble breathing...off to the ER she went.

Since that time, we have been dealing with a wound infection and an unknown pulmonary issue. Whenever this patient is reversed after anesthesia, she crashes. Her O2 sats drop precipitously. They will be fine, then boom down to 50...or lower. So far anesthesia has done a great job of bringing her back up, but we are trying to avoid more OR time. The last reversal, she was down to 21% saturation, definitely a scary situation. Why press our luck if we don't need to?

Internal Medicine, North Providence, RI

Back from a long hiatus.

So, Sherry and I are living together in a crack-style house with mattresses on the floor, and a picture of a dead Latina girl, who I have named Rosalita (She's currently buried in the floor boards). The main source of heat is the gas stove and there are ghetto light fixtures everywhere.

The rotation is going well, it's pretty much what I thought it would be: lots of acute on chronic disease pertaining to the kidneys, heart, and lungs. Cases I have seen run the gammit, but lots of pneumonia, acute renal failure, and CHF/COPD exacerbations. I have seen guillane bare (its a French disease), stage 3 lymphoma that ruptured through the colon, metastisized lung cancer, diverticulitis, MI, C diff, endocarditis, urosepsis, VRE, CNS lymphoma, BOOP, and the list goes on.

My preceptors are both nice and easy to get along with, one doesnt like to talk about the possibility of the patient's dying, and the other is a realist and will say things like: "he going to die 2 days" or "I sent him to hospice, he is going to die in a week". Days are long, but I think it is going to be a goo rotation.

Write soon!