The place so nice, they named it twice

Welcome to Walla Walla, Washington!

For all those travel bugs and foodies out there, just wanted to give a shout out to Walla Walla, the town I did my third year clinical rotations at!

If you ever get the chance, here are some great things (mostly food) to check out in town:

Food

  1. Graze
    • I LOVED the Vegetarian Torta – my absolute favorite!! I must have gone here every week for this sandwich. It is mind blowing – great bread with chipotle, avocado, black beans, pickled daikon and carrot, sprouts, tomatoes… my mouth is watering just thinking about it
    • They are a sandwich and salad place – pear salad is really good too!
    • http://www.grazeevents.com/
  2. Grandma’s Kitchen
    • Fresh, non-greasy, super tasty Mexican food – you can get nopales! You pick a filling (nopales, black beans, varieties of meats) and pick what you put it into: burrito, sopa, taco, etc!! Yum!!
    • http://wwgrandmaskitchen.com/
  3. Maple Counter
  4. Bacon and Eggs
  5. Fine-ly Made
  6. Walla Walla Bread Company
  7. Sweet Basil Pizzeria
  8. Olive
    • My roomies loved this place. A place to sit and study as well. Lots of baked goods, salads. I think after 8 or 9 pm, some of the baked goods are reduced price!
    • http://olivemarketplaceandcafe.com/
  9. The Marc
  10. Dora’s Deli
    • This is a hole in the wall place. So good – their food is authentic and tasty!!
  11. Whitehouse Crawford
  12. Sipid Bites by Sarah

Events

  1. Gesa Power House Theater
    • Loved this theater – I think we went to a Shakespeare production here. It was fantastic!!
    • https://phtww.com/
  2. Little Theatre of Walla Walla  
    • Went to see a Christmas play here with my adoptive parents from Walla Walla! It was awesome!!
    • https://www.ltww.org
  3. Symphony / Chamber Music 
  4. Corn maze
    • This was super fun! Go with friends!

As you can tell, I did a lot of eating…. 🙂 There are also beautiful places you can explore, hike, and enjoy! Walla Walla is a great town – lots of vegetarian options, family friendly, safe, and happy. And for those of you who love wine, it’s got a lot of it! The downtown is especially nice to explore. I really enjoyed my third year here and am grateful for the experience I had!!

Happy exploring!!

-P

Advertisements

EKG Basics

You give me premature ventricular contractions – Emma, No Strings Attached (film)

I was never really confident reading EKGs. But after one week and 300+ EKGs later, I can finally say, without a doubt, that I can read an EKG on my own! One small step as med student in training, one big step for future Dr. Jenny!

Most of you are probably much better at reading EKGs than I am, but I just wanted to make this video as a short refresher. Plus I might need to look back on it some time in the future … I regret not making a radiology video when the material was still fresh. So I always have to go back and read Priya’s blog post. Hope you all enjoy!

Short overview incase you couldn’t catch it in the video:

1. Is the patient in Sinus Rhythm? – Check for positive P waves in leads II, III, aVF
2. Heart Rate
3. Axis deviation – Check leads I & aVF
4. Left Anterior Fascicular Block? – Check lead II
5. P wave + PR intervals – are they long? are they short?
6. QRS complex – are they wide? more than 3 small boxes?
7. ST/T wave changes

I hope that helps. I wanted to read more samples of EKGs but then this video would be a bajillion hours long.

It’s a wrap! (almost)

Hello All!

Hope you are all doing well! It’s been a while since I’ve posted and have since completed Surgery, ER and OMM! I’m on my final rotation–psychiatry at the State Penitentiary–and it’s going to be interesting, only four more weeks to go!!

Just to recap, surgery was a great rotation, I learned a ton and had a great preceptor. It was AMAZING to help resect a patient’s bowel and anastomose it, make incisions and suture them back up! The challenges were that surgery is sooo physically exhausting; my feet were killing me at the end of every day and the days were really long. I also realized how complex and incredible the human body is and how brilliant surgeons are to know what to cut or bovie. It’s hard work!

OMM was four weeks and was mostly like a family med rotation except that we spent Tuesdays and Thursdays with a fantastic preceptor who spent 4 hours reviewing material and going over techniques. It was like being in OPP lab again but everything came easier since we had learned it at least once before. I really like working with this preceptor twice a week, she was also an attending at a family medicine residency program for years and was able to give us a lot of insight and advice on applications and programs!

ER was four weeks as well and was great. We work 3 shifts/week or whenever our main preceptor is on shift. We do 12 pm- 12 am shifts which allow us to see the most. I got to fix a nursemaids elbow (the family was super happy), stitch up a prisoner’s face who got pummeled at the penitentiary, do OMT on a MVA patient, and learn a ton! It was awesome.

Now that my last rotation is here, I’m really grateful for the time I’ve had in Walla Walla. Our dean is so encouraging and our coordinator is fantastic–so organized! The doctors have been incredible teachers and I can’t express how much I appreciate all our patients and their patience!

So now it’s onto board exams, moving, weddings (Congrats, Jenny!), audition rotations and electives. I have a feeling that in the craziness of it all, I won’t get the chance to blog, so here’s to EDC. Could not have pushed through without the love and support of family and friends!  Wishing everyone an amazing end to an amazing year and luck with the next leg of our journey!

-Priya

 

Internal Medicine – Inpatient

Hello All!

Hope you are all doing well. I recently finished my inpatient IM rotation. It was awesome. We have locum hospitalists who come to Walla Walla and stay for a week at a time, living at the hospital and then having a week off. I worked closely with 2 doctors (they kept switching off) and had a great time. The lifestyle seems great–I just know it’s not for me–I wish I could be disciplined all the time, but if I had a week off, I would probably not go to the gym and eat a ton of junk food… imagine if that was every other week?!

Anyhoo… Got to see some incredible things: like an infected pannus (it was huge, like a third leg), GI bleeds, strokes, ACS, alcohol withdrawal and toxicity, possible poisoning by spouse (probably not, but we hypothesized…), vancomycin rash, bowel obstruction, CHF exacerbation, COPD exacerbation, idiopathic chorea, lots of falls, sepsis, and cardiac cath procedures (our cardiologist let me get gowned up too!).

I saw a patient pass away from iatrogenic causes 😦 sometimes medicine can do so much harm!

I also got to help with a peds case–we had a newborn with congenital diaphragmatic hernia and lung hypoplasia. I got to help with resuscitation, putting in an umbilical art/vein cath, and shipping him out to a NICU in Spokane. I think he’s doing OK. This case was intense; I was really lucky that the nurses told me to go check it out and that I got to help out with it.

Our hospital also has a daily care conference where the doctor, nurses, social worker, outpatient scheduler, home health, and other coordinators all meet for an hour to discuss each patient and the next steps in the care. It’s a great way to touch base and ensure that no patient falls through the cracks, especially as hospital work has shift changes (the docs, nurses, etc)!

My next rotation is surgery, and to be honest, I’m scared and excited. I’m really looking forward to using my hands (hopefully my preceptor lets me do more than just hold retractors). Plus I’ve got a new preceptor…. so it’ll be an adventure for us both! Wish me luck!! 🙂

Have a great week and happy valentine’s day!

-Priya

Munchkins!

Hello All!

My last rotation for 2015 was Pediatrics. This was probably one of the best rotations I’ve had–my preceptor was not only engaging and enthusiastic about having a student–he was also calm and thoughtful. He asked me tons of questions throughout the rotation, he even wrote up a dermatology quiz just for me! He also invited me to join his family for Thanksgiving and it was wonderful.

Peds is awesome. The kids are sweet, parents are (mostly) easy to work with, and the doctors are all unbelievably compassionate. I’ve also seen some interesting pathology–Trisomy 21, hypospadias, holoprosencephaly, scabies, seizures, Rubinstein-Taybi, the list goes on… There have also been some really tough cases. We had a patient come in for a sexual assault workup a week ago, she was only five years old. 😦

I guess with the good comes the bad and it’s up to us what we choose to focus on. I will walk away from this rotation remembering that five year old girl forever; but I will also remember the child who came in for an ADHD work up and gave me a huge hug, the adopted 21 month old from Asia who blew me a kiss to say goodbye, the parent who came back to clinic the day after her son’s appoint to thank me for making him feel comfortable, and the preceptor who treated me like a daughter.

Last week, two foster sisters (1 Caucasian, 1 African American) came into clinic and were so intrigued to see a dark-skinned female greeting them (their foster mother pointed this out to me). As I got to know them and their history, I shared a little about myself and my journey. I told them that they can do anything they set their mind to, no matter what their home life is like. We talked about loving ourselves and accepting our flaws and having the courage to reach our potential. It was a good lesson for me, because it is so easy for me to tell myself that I’m not good enough or that I’m not going to succeed. I guess when we love ourselves, we can be our best selves and help others feel loved too. So, in honor of them and all children (at heart) everywhere, a quote from the most famous doctor of all time:

Remember, you’ll move mountains and YOU are worth it!

Have a great holiday season!

Priya

Is this really what I want to do with the rest of my life?!

Hi All!

Hope you’re doing well!

Ob/Gyn was my third rotation here in Walla Walla and it’s been a very interesting experience. I walked into the rotation extremely unsure of myself, and in retrospect, I think I was having a mid-med school crisis. This was it. The big rotation. It was finally here, what I had thought I’d wanted to do since high school. I had built it up so much in my head and I was so afraid of failing, that I struggled so much in the beginning.

The docs that I worked with were two were male physicians, who had been doing this for a number of years and a female was fresh out of residency. One of the physicians challenged me a lot and I learned a ton. I felt like this was the rotation where I grew immensely.

Why it’s AWESOME: Lots of procedures (IUD, Nexplanon, C-Sections, Hysterectomies, Tubals, Cystectomies, etc.)

Why it’s TOUGH: High emotions, High stress, High risk!

There was one experience I would like to share with all of you. We were in the OR and I was assisting with a cystectomy. The procedure was laproscopic, though it did need a uterine manipulator. When the procedure was done, I got to close the laproscopic incisions and do the final speculum exam to check the cervix. Everything was going well; I was calm the whole time, sutured the incisions well, and found the cervix (yay!) no problem. It was then that the unthinkable happened. As I was unscrewing the speculum (it was one I had never used before) to take it out, and I went too far and dropped the screw in the bag of urine down below. It was terrible! I felt like such an idiot. We had to drain the urine and my preceptor had to reach in and grab the screw for me. 😦

But then I stopped to think about what had just happened, I kept calm and did not harm to the patient. My sutures and speculum exam were on par with what the physician wanted. That’s when I realized how much I enjoyed using my hands.

And as the weeks went on, things just got better. I got to help deliver over 7 babies vaginally, help with a ton of hysterectomies, c-sections, and other procedures. I got over the “eww” factor with time and was able to view everything I did as helping mom and baby!

So, maybe I do want to do this for the rest of my life. 🙂

 

 

A Little Spark of Madness.

Hello Women in Medicine,

I’ve just completed my Psych/Behavioral Medicine rotation and have many thoughts to share. Warning: it’s a doozy.

First: I loved psych.

  • This was not a complete surprise to me, but I didn’t think I would seriously consider going into this; I’m not Frasier.
  • I really enjoyed interacting with the patients. After just a few short conversations with this patient population, I was quickly endeared to many of them. Their honesty and realness and the challenges they face truly set them apart from the general patient population. Plus, I’ve always had a soft spot for quirkiness.

Second: I was able to see mental health care in a variety of settings

  • Outpatient visits at long-term housing locations and outpatient clinic:
    • Patients in a long-term facility were especially prone to being taken advantage of by the staff, their families, or sales persons. Many of the patients had difficulty forming safe networks and were often subject to being indebted to the likes of their family members, the facility for snacks, or Avon sales ladies. To be clear, these patients don’t have a lot of money, they are either on Medicaid or Medicare and have never held full-time jobs or lived independently in a safe space. It’s really sad.
  • Court hearings at Western State hospital:
    • Patients would be brought before a judge to assess whether they need to stay longer in an Inpatient setting (Western State) or can return home under a court order (Less-Restrictive Alternative – aka LRA). Patients on LRAs are required to take their meds and see their docs/ARNPs on a regular basis and this is often a really helpful option for many of them… until they are off their LRA, which often has devastating consequences.
  • Crisis Intervention team.
    • Waited for phone calls from patients that were immediately suicidal or struggling with their mental illness. The first patient we saw was suicidal but without a clear plan and it was essential for her that we established care for her with a Counselor. However, in order to meet with a Psych doc or ARNP she was required to see the Counselor at least 3x. If she was acutely psychotic or suicidal w/ a plan, she would go to the closest inpatient unit.
  • Mobile Health Unit:
    • See regularly scheduled appointments for patients with mental health illness that need care by a PCP.
    • Many of the anti-psychotics, anti-depressants, and mood stabilizers have serious side effects to the body and it’s important for a PCP to address these as managing their side effects can be much less complicated than changing the dose on their anti-psychotic.
  • Outpatient care for Cambodian and Vietnamese refugees:
    • Many of these patients had PTSD and major depression from being in refugee camps or seeing many of their loved ones die needlessly under ruthless government regimes.

Third: This is a topic close to my heart.

  • I think my mom has been grooming me to go into Psych since I was 8 years old. She is a Psych ARNP and has helped me to understand how psychosis shapes a persons life and what the expectation for their rehabilitation can look like.
  • Mental illness has touched both of my younger siblings, my former foster siblings, and recently one of my good friends. I spent the last half of my rotation trying to help this close childhood friend through a very rough spot in his life. Battling major depression and unaddressed bipolar disorder, he has been living out of his car and in despair for the past few weeks. There’s not much I was and continue to be able to do for him besides offer support, resources, and encouragement. It is devastating to watch someone you’ve known for your entire life succumb to their mental illness and refuse to accept mental health assistance. I drove home crying way too many nights.

Lastly: working closely with my favorite preceptor yet: my mom. I know we don’t look alike.  She has always told me, “If I didn’t laugh, I’d be crying.” This mantra, though not always funny, is very true and indicative of the constant challenges faced by many of those in the mental health profession. behav me and mom

Challenges in Behavioral Medicine:

  • Limited Resources.
    • Funding in behavioral health is consistently being cut, leaving practitioners and patients without resources or motivation to seek help.
  • Convoluted system and patient management.
    • There are a lot of players involved in the management of a single patient and depending on the patient, can get really involved.
  • Many patients in this population do not get better.
    • It is a sad reality and is one of the reasons that psych can be so challenging.
    • My mom has had a lot of the same patients for 25+ years and they will continue to need her support and social services for the duration of their life.
    • Continuity of care is essential to the long-term maintenance and well-being of these patients and understanding this can help make sense of your role in their lives.

COMAT Tips: 

I found that doing COMBANK COMAT questions + UWorld Questions was pretty adequate. The test itself felt much more relevant and specific to psych than the Family med COMAT.

Resources:

  • Case Files: Behavioral medicine
  • COMBANK COMAT Q bank
  • UWorld Q bank
  • Onlinemeded.com: sign up for free videos and lectures, very helpful.
  • Clerkship Review compliments of the University of Texas Health Science Center.

Glimpse through how psychosis can impact someone’s life: Mad Medicine. Enjoy! 🙂