NYU and Benches

I hate Pharmacology. My test grades are all over the place, and we have a test every single week. I know -- wah, wah, wah. Every single one of his multiple choice questions were answered with A, or B or C or (A and B) or (A and C) or (B and C) or none or all. Really. I mean, fricking really. OK. Rant over. I'm in hate with that professor. Thank you Jesus for pass/fail. Other than that, I'm learning and things are progressing. I do see the growing pains of the program showing. For instance, I am learning such incredible detail on drugs for hypertension, heart failure and asthma right now (things I will never prescribe) and I wish I could put that time into psychotropics, which I will prescribe. Now, do I need to know and understand the drugs for medical conditions? Absolutely, but not at this level of detail. That's the key. Clinicals are just plain fun. At the student health center, we saw 8 sore throats in the four hours I was there. It was cool because one of them was strep and one was someone with chronic sinusitis and boy - did their throats and tonsils look different than the others, which were just the common cold. It was a terrific education in throat pathophys -- ha. And man, as I exclaimed to my preceptor, them tonsils can get HUGE. One guy's were touching (the strep case). And when you're dealing with this population, it's always an eye-opener. One of our patients comes in for a sore throat but tells us he wants an HIV test. Um....ok...but you have to come back for a full STI review and counseling session.
I went to a conference on mental health by the Hogg Foundation http://www.hogg.utexas.edu/. Some good learnings that I did not know:

• Mood disorders are the sixth most expensive health problem in the U.S.
• The top 3 underlying causes (lifestyle choices) of death are smoking, diet & exercise patterns, and alcohol. If you manage those well, you're probably in excellent health.
• Education is the greatest predictor of longevity, particular at the high-school level. If you didn't finish high school, statistically you will live a much shorter life than someone who finishes. Someone with a college degree lives much longer than both of them, etc.
• There's a lot of interest in the positive correlation of depression with chronic disease right now. For instance, they know that depression and diabetes go together, they even know that a depressed person is much more likely to get diabetes (instead of the reverse, as one would assume).
• Usually someone with a mental disorder is first screened by a primary care provider (a family doc, a nurse prac) and often they are referred to see a mental health provider. Sometimes the PCP prescribes anti-depressants or anti-anxiety meds, sometimes they aren't comfortable doing that. But they do usually say, hey you need to see a counselor/therapist. And guess how many don't go? Seventy percent. I was shocked at that.

So my lovely daughter was accepted at NYU. She's been offically accepted at Northeastern, NYU, and Texas A&M. UT rejected her (she's not top 8%). No comments, but needless to say, I'm not happy about UT's holding 75% of their freshman places for top 8% in every Texas high school. I think it's a stupid policy, but it's the legislature, not UT. Anyway, here's a pic of her with her mascara all runny on Wednesday, when she found out from NYU. Yes, her head really is that big now, I mean she's going to NYU! (kidding - I'm a bad photog with the iPhone!) The deal that we've struck with Dani is that we'll pay for NYU for one year if she comes back to an in-state school after that. I'm pretty sure that's what she'll do. (I mean, who wouldn't want to live in New York for a year?)

Funny things still happening at the gym. There is a bench outside the spin room where most of us sit to put on our cleats before class. The other morning, I went up to the bench and there's a guy standing by it, he grasps the bench by one end and yanks it way up in the air -- takes a good look at the bottom, like where a kid might stick his chewing gum -- and sets it down. I stand and wait patiently while he does this. Then he looks at me and says "I do things like that." Yep, there are potential patients for me everywhere.

Worms

I'm in the thick of school although I haven't written any papers yet. I've had two tests in Pharmacology and get this, here's my grades: 74 and a 90. Quite a disparity, huh? And he was trying to convince us to take the class for a grade instead of pass/fail. Um, not me, fella. It's one of those classes where I listen to his lectures as I drive. And write things on index cards to memorize as I stand in line. Every available brain cell called to action, every available speck of attention.

Clinical is so much fun. If ever I waver about doing graduate school, clinical always reassures me that I'm in the right place and that I can do this. I look forward to it so much. I mean, what's more interesting than people with problems? And you know what, as a nurse practitioner, I'm in a privileged position to walk thru that door to someone's inner life. That will be especially true as I focus my clinicals in psychiatric work next year, but boy, it's already happening as I work with FNPs.

Here's some examples. I had weird worm week. First, I worked at my RN job at a private psych hospital for the day and had an interesting patient experience. A young man called me into his bathroom to check out his feces. Something I've done before, no big deal, usually it's blood. Ah, but this is a psych hospital, right? First he says, better bring your gloves. I say, well, I can go back and get them if needed. I'm thinking it'll have to be something damn special for that, like a little alien fetus. But anyway, I take a look and it's pretty ordinary. He says, a hysterical edge to his voice, "See it?! See it?!". Uh oh. I say as calmly as I can, tell me what you see. He says, "It's worms, see them, see them?" There are no worms there. "You can't see them? Look, look, see the wiggling!" and with that, he reaches into the bowl and starts moving things around with his hands. I think I jumped back a foot.

The next day, I'm at one of my clinical sites and a young woman is there, fearing she got worms from her new puppy. Since I'm the newbie, before we see her, it's my job to do a little research. Can humans catch worms from dogs? Yes, they can. We saw her & collected a sample. It sounded positive to me, based on her description. Be careful with new dogs, especially strays & puppies. The following day, I'm at my other clinical site, a family practice office, and a middle-aged woman comes in and says that she is certain she has worms. She's seen them, wriggling. Has no idea how she contracted them. Catch another sample. Now, what are the odds of that? I really doubt if lots of folks walking out there have worms. Just my luck to encounter three of them.

It's going to take some adjustment for me to get used to dealing with college students as patients. A young woman came in for a chronic cough that we diagnosed as sinusitis, but during the assessment we asked her about everything (as we always do), and one question was how much alcohol do you drink. Notice we don't say do you drink. She says, Oh not very much. So Sheryl, my preceptor, says, how many days a week? "Every Friday and Saturday. Sometimes Thursdays." And then, how much? "Oh, four drinks....well, five. (A beat passes) ...at least." Sheryl just writes it down, says nothing. I feel like my hair's on fire. At least 5 drinks 2 or 3 nights a week?! She's only 5'2" and weighs 110 lbs. That must make her drunk as a skunk. When Ken & I go out to Vino Vino (one of my favorite places), we always order only 3 glasses between us. I usually drink about 2 of them, and I feel good. I mean, I'm in no shape to drive. How does she do that? But I'm thinking Sheryl hears that often. I better adjust my attitude. And well, it's the psych nurse in me.....I want to talk about it with this girl. But certainly that's not on her agenda. She's made it clear she just wants a z-pak. Patients are seen every 20 minutes so we're out of time anyway. Another thing is that I'm only there 4 hours a week, but Sheryl has already told me that we'll see at least one STI (sexually transmitted infection) every time.

I've been thinking about clinicals a lot lately, because they are taking up so much of my time. 120 hours this semester, and I'll actually get even more. That's just a minimum. Right now, I spend 4 hours a week at the student health center, and 6 hours at a family practice office. After spring break, I'll add 4 hours at a pediatric community clinic to that. That's 14 hours a week on top of my full-time school.
And next year those hours double. I've been told that you pretty much have to work on them on weekends or you just can't keep up. But I learn so much. I was thinking about when I first got my business degree at UT, there was absolutely no "clinical" to that at all -- just here's your degree, you've never worked an hour in this field, go out and be a professional. It was ludicrous. Let me tell you, I was quite clueless at my first job as an internal auditor. And I was a good student. I think healthcare really has this right -- some other fields are doing similar things. My sister got an electrical engineering degree from UT about 10 years ago and she had to do some internships (externships?) for her degree. In nursing and medicine, clinicals are so important because people's lives are in our hands. That's true, guess I couldn't kill someone with a spreadsheet. But it also so well prepares you for the workforce, I don't think other disciplines get that.