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A Day in the Life...
Someone recently posted and thought I was "retired" (I wish). If anyone is curious about my typical day, here is a A Morning in the Life…
8:32 AM
I arrived a bit late for work today; I forgot it was Garbage Day. If you forget Garbage Day, it will ruin your next week. Hauling a heavy can up a long slope is not the morning exercise that I should be doing. At least I didn’t need to stop for gas on the way to work.
8:34 AM
I logged into my computer, grabbed my stethoscope, and went to see my first patient. Olivia, the daughter of one of our medical assistants, was four years old and was very sick. She was just lying on the table. She had terrible cold, pink eyes, a cough, and a left ear infection – another on-going gift from day-care. The last time I say Olivia, she had shoved a large, blue, plastic bead deeply up her nose. Before torturing her with digging it out with some scary instruments, I tried an old technique of having Mom gently blow air into her mouth, attempting to bring the bead down to where I could grab it. Olivia, somewhat annoyed by having Mom blow in her mouth, and of course, this bead thing, decided she would just bit her mother’s lip nearly off! I put six or seven sutures into Mom’s lip and sent Olivia to the ER where she could be safely sedated for the bead removal. She did not bite anyone there.
8:45 AM
LM was just 16 years old, but he was heading off to college in Washington State; hoping to be a physical therapist. He was there for his college physical exam and a few missing immunizations. He was overweight (about 270), but was actively on a diet before starting college. I assured him that college cafeterias are typically not that good, so he should have any problem reaching his goal.
9:05 AM
Sammy was a year old and ate clam chowder for the first time yesterday. She loved it, but was rewarded with a good case of hives. (No, her skin wasn’t clammy!) She didn’t seem to mind them, but the day-care provider thought it was chicken pox. It was not. A little Benadryl and a note for the day-care provider sent her quickly on her way.
9:30 AM
JT, a 14 year old, didn’t show up for his appointment. Missed appointments are not that unusual for Monday mornings. I don’t know why I was seeing him, but the illness may have self-resolved, or perhaps, he didn’t come home last night. More likely, he slept in or the parents forgot.
10:00 AM
JT had a rash on his hands. This is starting out to be “skin day”. The parents were camping and God knows what this three-year old touched; could have been anything from poison oak to bear poop. The rash was limited to the palms of the hands, mostly the right hand (his dominant hand). There are no tests that will prove what he touched, so the only thing that can be done is to treat what you see. A good topical steroid cream should solve the issue.
10:12 AM
IL was here for an annual physical exam, but as luck would have it, he also had right ear pain and a bad cold. He is an active swimmer. Though uncommon, he did have otitis externa (swimmer’s ear) and a case of otitis media – a middle ear infection. He was given a prescription for some antibiotic-steroid drops for his ear, but since his middle ear infection was not that bad, I negotiated with the mother about a WASP prescription (means “Wait and See Prescription”). She was given a written prescription for an oral antibiotic and told not to use it unless he is getting rapidly worse, or not improved in three days. Getting parents to agree to use less oral antibiotics is very important.
10:25 AM
EV (and his mother) both had warts, and both were on their feet. Mother had been treated with a blistering agent (probably cantharidin) by her dermatologist and had painful experience. Cantharidin is an extract of the “blistering beetle”, also called Spanish Fly. I decided to do liquid nitrogen. This cryotherapy agent stings, too, but only for a little while. At the end, I use the leftover liquid nitrogen to freeze their hats or shoes, or throw it on the floor. It makes them forget the pain.
10:40 AM
LH is 8 years old and here for her annual physical, too. I had seen her several times for sore throat and ear infections, but now she was well. A year ago, she swallowed (and naturally passed) a good sized rock. What is it with kids and foreign bodies? If they have an object that could possibly fit into some orifice, they will try it. She says she is learning to play a guitar. When I asked her if she liked “rock music”, she laughed.
11:01 AM
KB is a two-year old who was brought in by her father today for a possible ear infection, although she has not been complaining about any ear pain. Because of a past history of ear infections, he was concerned because she had been feverish and crabby. Since starting day-care in September, KB has had a constant, green runny nose and a night cough. She did not have an ear infection today, but I was impressed by that ten month history of a green runny nose with huge amount coming down the back of her throat. Perhaps an exaggeration, but still, that is a lot of snot under the bridge. Her tonsils were huge and exudative (lots of white cheesy material). Her rapid strep test was negative. Rather than sedate her and order a sinus CT scan for a definitive diagnosis, I decided to treat her. I would bet that green snot will be history, or at least for a while, until she gets another day-care infection.
11:20 AM
Four-year old KB was crying when I came into the room. She was crying because Mom informed her that she will need some “shots” for kindergarten. I promised that I would give her “boosters” instead of shots (same thing, but a nicer word), and that I would use the needles that we used for babies instead. If any of those boosters hurt, all she had to do was tell the nurse and the nurse will take it out right away. Kids like to have choices, and some control. Who doesn’t? She left eating one of our sugar-free lollipops and seemed quite happy.
11:40 AM
My last morning patient was a translation challenge. Newborn baby with a large umbilical hernia that is very troubling to the Spanish-speaking grandmother. She has been tightly binding it (not a good idea). The mother, also Spanish speaking, happens to be deaf. My Spanish is not so bueno. Fortunately, the Internet was able to provide me with some excellent resources (in Spanish) about umbilical hernias.
12:10 PM
I am eating lunch at my desk; answering phone messages and checking lab work. Checked my postings on the WebMD Ear, Nose, and Throat board. Getting ready for eight more hours of patient care. These 12-hour shifts are not as easy as they used to be, especially since I do two of these in a row.
12:30 PM
Another person walked in without an appointment. It is a new mother, crying, with her newborn baby (age 12 days). Apparently, while changing her clothes, she accidentally pulled on the umbilical cord and it started to bleed a little bit. Fearing that she caused some major trauma, she wanted her to be seen immediately. Needless to say, the infant was fine, so I spent the remainder of my lunch calming down the distraught mother. Two belly-button issues in a row, and I thought this was going to be skin day.
1:00 PM
I have about a half hour to finish this Blog, before it is time for the afternoon and evening sessions with even more interesting patient encounters. Only eight more hours before I get to go home.
8:32 AM
I arrived a bit late for work today; I forgot it was Garbage Day. If you forget Garbage Day, it will ruin your next week. Hauling a heavy can up a long slope is not the morning exercise that I should be doing. At least I didn’t need to stop for gas on the way to work.
8:34 AM
I logged into my computer, grabbed my stethoscope, and went to see my first patient. Olivia, the daughter of one of our medical assistants, was four years old and was very sick. She was just lying on the table. She had terrible cold, pink eyes, a cough, and a left ear infection – another on-going gift from day-care. The last time I say Olivia, she had shoved a large, blue, plastic bead deeply up her nose. Before torturing her with digging it out with some scary instruments, I tried an old technique of having Mom gently blow air into her mouth, attempting to bring the bead down to where I could grab it. Olivia, somewhat annoyed by having Mom blow in her mouth, and of course, this bead thing, decided she would just bit her mother’s lip nearly off! I put six or seven sutures into Mom’s lip and sent Olivia to the ER where she could be safely sedated for the bead removal. She did not bite anyone there.
8:45 AM
LM was just 16 years old, but he was heading off to college in Washington State; hoping to be a physical therapist. He was there for his college physical exam and a few missing immunizations. He was overweight (about 270), but was actively on a diet before starting college. I assured him that college cafeterias are typically not that good, so he should have any problem reaching his goal.
9:05 AM
Sammy was a year old and ate clam chowder for the first time yesterday. She loved it, but was rewarded with a good case of hives. (No, her skin wasn’t clammy!) She didn’t seem to mind them, but the day-care provider thought it was chicken pox. It was not. A little Benadryl and a note for the day-care provider sent her quickly on her way.
9:30 AM
JT, a 14 year old, didn’t show up for his appointment. Missed appointments are not that unusual for Monday mornings. I don’t know why I was seeing him, but the illness may have self-resolved, or perhaps, he didn’t come home last night. More likely, he slept in or the parents forgot.
10:00 AM
JT had a rash on his hands. This is starting out to be “skin day”. The parents were camping and God knows what this three-year old touched; could have been anything from poison oak to bear poop. The rash was limited to the palms of the hands, mostly the right hand (his dominant hand). There are no tests that will prove what he touched, so the only thing that can be done is to treat what you see. A good topical steroid cream should solve the issue.
10:12 AM
IL was here for an annual physical exam, but as luck would have it, he also had right ear pain and a bad cold. He is an active swimmer. Though uncommon, he did have otitis externa (swimmer’s ear) and a case of otitis media – a middle ear infection. He was given a prescription for some antibiotic-steroid drops for his ear, but since his middle ear infection was not that bad, I negotiated with the mother about a WASP prescription (means “Wait and See Prescription”). She was given a written prescription for an oral antibiotic and told not to use it unless he is getting rapidly worse, or not improved in three days. Getting parents to agree to use less oral antibiotics is very important.
10:25 AM
EV (and his mother) both had warts, and both were on their feet. Mother had been treated with a blistering agent (probably cantharidin) by her dermatologist and had painful experience. Cantharidin is an extract of the “blistering beetle”, also called Spanish Fly. I decided to do liquid nitrogen. This cryotherapy agent stings, too, but only for a little while. At the end, I use the leftover liquid nitrogen to freeze their hats or shoes, or throw it on the floor. It makes them forget the pain.
10:40 AM
LH is 8 years old and here for her annual physical, too. I had seen her several times for sore throat and ear infections, but now she was well. A year ago, she swallowed (and naturally passed) a good sized rock. What is it with kids and foreign bodies? If they have an object that could possibly fit into some orifice, they will try it. She says she is learning to play a guitar. When I asked her if she liked “rock music”, she laughed.
11:01 AM
KB is a two-year old who was brought in by her father today for a possible ear infection, although she has not been complaining about any ear pain. Because of a past history of ear infections, he was concerned because she had been feverish and crabby. Since starting day-care in September, KB has had a constant, green runny nose and a night cough. She did not have an ear infection today, but I was impressed by that ten month history of a green runny nose with huge amount coming down the back of her throat. Perhaps an exaggeration, but still, that is a lot of snot under the bridge. Her tonsils were huge and exudative (lots of white cheesy material). Her rapid strep test was negative. Rather than sedate her and order a sinus CT scan for a definitive diagnosis, I decided to treat her. I would bet that green snot will be history, or at least for a while, until she gets another day-care infection.
11:20 AM
Four-year old KB was crying when I came into the room. She was crying because Mom informed her that she will need some “shots” for kindergarten. I promised that I would give her “boosters” instead of shots (same thing, but a nicer word), and that I would use the needles that we used for babies instead. If any of those boosters hurt, all she had to do was tell the nurse and the nurse will take it out right away. Kids like to have choices, and some control. Who doesn’t? She left eating one of our sugar-free lollipops and seemed quite happy.
11:40 AM
My last morning patient was a translation challenge. Newborn baby with a large umbilical hernia that is very troubling to the Spanish-speaking grandmother. She has been tightly binding it (not a good idea). The mother, also Spanish speaking, happens to be deaf. My Spanish is not so bueno. Fortunately, the Internet was able to provide me with some excellent resources (in Spanish) about umbilical hernias.
12:10 PM
I am eating lunch at my desk; answering phone messages and checking lab work. Checked my postings on the WebMD Ear, Nose, and Throat board. Getting ready for eight more hours of patient care. These 12-hour shifts are not as easy as they used to be, especially since I do two of these in a row.
12:30 PM
Another person walked in without an appointment. It is a new mother, crying, with her newborn baby (age 12 days). Apparently, while changing her clothes, she accidentally pulled on the umbilical cord and it started to bleed a little bit. Fearing that she caused some major trauma, she wanted her to be seen immediately. Needless to say, the infant was fine, so I spent the remainder of my lunch calming down the distraught mother. Two belly-button issues in a row, and I thought this was going to be skin day.
1:00 PM
I have about a half hour to finish this Blog, before it is time for the afternoon and evening sessions with even more interesting patient encounters. Only eight more hours before I get to go home.
1 Comments:
Hello Dr. Moser!
Thank you so much for your excellent blog. I am not a medical professional, and I am working on a project where I need to understand and write about 'a day in the life of a PA.' This post gave me great insight into exactly what you and your colleagues do on a daily basis - the types of patients you see, the problems, and the treatments.
I love how you handle the various dilemmas that come your way, such as the 4-year old that was afraid of getting a 'shot.' You have a great way of dealing with kids.
A question for you. I would like to use some of the examples you speak about in my project: which is in fact, a magazine ad. My ad concept is "A physician assistant's story" and consists of only a paragraph describing typical things a PA encounters during their day. What I am writing is fictional, so I have changed the names and used my own language. What I would liek to borrow from your post are the types of problems you see durying your day, like a child getting sick from daycare, swallowing a foreign object, receiving their first 'booster' shot and such.
My concern is this: anyone reading my story who has read your blog may notice similarities. How should I handle? Should I footnote you in my project? We are only talking about a paragraph condensation of your day - but it will appear in a magazine.
As a writer, I want to do the right thing and give credit where credit is due. But I don't want to footnote your name on a 'commercial' project if that is not what you wish.
If you'd like to read what I've written, I will gladly send it to you. If it helps at all, the product we are selling is endorsed by CAPA.
My email is: steve.marte@hotmail.com
Looking forward to hearing from you!
Sincere regards,
Steve
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