Patient 1, Internal Medicine rotation.

* Image from Google Images

**While the following case is based on a true patient, the true identity of the patient has been changed in the interest of privacy.


Dr. B: "Kimberly, how good are your powers of persuasion"?

I knew as soon as Dr. B asked this question I was once again being tasked with talking to a patient with serious medical "issues". Ironically, the exact same thing used to happen over 25 years ago when I volunteered at a rural health clinic. Why folks seem to think I'm skilled in this area I don't know, but I like a challenge, so I accepted not being sure of what I was agreeing to.

Doc201X: " I think I'm pretty persuasive...........hang on, what am I agreeing to?"

Dr. B: "Thank you Kimberly, you've just volunteered to talk our 400 pound patient into getting out of bed twice a day."

And with that he proceeded to give us the clinical presentation of Mr. Hernandez as we surrounded him at the "cart".

Dr. B: "Mr. Hernandez is a 450 pound well nourished Hispanic male, whose chief complaint upon admission to the ER was severe back pain. After an X-Ray, it was determined that Mr. Hernandez has a compressed spine likely due to his excessive weight. Kimberly, we've been trying for almost a week to get Mr. Hernandez to get out if bed, do you have any ideas"?

Doc201X: "Sure......Maybe, but I'll give it a shot anyway!".

As soon as I took one long survey of Mr. Hernandez's extra large bed with a mini crane looking attachment, I immediately identified the problem with Mr. Hernandez getting out of bed.

Dr. B:"Buenas Dias, Señor Hernandez, como' estas?"

Doc201X: "Buenas Dias, Señor Hernandez."

Mr. Hernandez: "Something in Spanish I did NOT understand".

I immediately looked at Dr. B in utter confusion because while my Spanish is pretty good, I can't understand a lick Mr. Hernandez is saying because Mr. Hernandez has NO teeth.

Dr. B: "Lo siento señor Hernández. ¿Ha tratado de salir de la cama hoy?

Mr. Hernandez: "No, mi espalda todavía me duele mucho. Y me caí de la cama cuando trataba de ponerse de pie."

Doc201X: "Perdone, pero no entiendo porque estás hablando muy rápido". Habla mucho despacio por favor."

He repeates himself slower this time.

Doc201X: "Lo seinto, señor. ¿Te gustaría una cama más baja?"

And with that, Mr. Hernandez's problem may have been solved. He was about 5'3" tall and his VERY large bed looked about 2 feet off the ground. So with him being so large, he would practically fall out of bed trying to get out of bed, hence his reluctance to get out of bed. DUH!!!

The assumption of the team had been that Mr. Hernandez was just being lazy. Which may have been true to some extent, but how no one noticed how high the bed was off the floor and how short/large he was in realtion to it, still boggles my mind when I think about it. I get why the Doc could have overlooked this because he has a thousand other patients to think about. But for the others to joke about the guy and write him off as lazy just rubbed me the wrong way. So after finishing up with his patient record and discussing what they knew of his life and history, it occurred to me to ask if a Psych eval had been done on him. The team looked perplexed by the question, but Dr. B asked me why I thought it was necessary. I responded that no one I know wants to be 450 pounds and given what we had discussed about his history of using the ER as a primary care facility and other family/medical issues, that perhaps he needed a Psych eval. Dr. B mulled it over for a second, then ordered the Psych eval.

Clinical medicine, here I come!

I almost forgot to mention that I'm interviewing for a Bioinformatics Informatics fellowship tomorrow!!!

At a lost for words!

* Image from UA med school

And that pretty much sums up my half-day rounding in IM at the local county hospital. Absolutely AMAZING, clinical care here I come!!!

Man, where do I begin? I'll start with the obvious; the serious patient risks of not having culturally competent Doctors costs lives, absolutely NO doubt about it! Not only were half of the patients I saw Spanish speaking, they were mostly minority, which probably doesn't come as a surprise considering that most of their funding is from Medicaid/Medicare. So I got a chance to brush off my Spanish speaking skills and my ebonics skills too, LOL!! Honestly, if the Doctor can't communicate with the patient because the translator can't be everywhere at the same time, how in the hell can they effectively provide care?

Anyhoo, during rounds I suggested ordering a Psych eval, thyroid panel, hormone status ie menopause, and a couple other things. And what became glaringly obvious not just to the team that I rounded with but the Attending as well, is that my life, educational, and professional experiences puts me FAR ahead of the average med school applicant in terms of just knowing what to do when what to do isn't obvious. I also think my ability to relate culturally helped too. Sure, my group had me "beat" in many of the clinically obvious things because this is what they've been doing full-time for the last 3 to 5 years. But those basic or gut instinct skills that typically come with age/wisdom, they just didn't have because they haven’t been around long enough or had enough life experience to know anything different. And this is the point older premeds need to emphasize in interviews. All that said, Dr. B my Attending, who's also the professor for my healthcare course, not only speaks fluent Spanish, he's got compassion "on lock". There wasn't ONE patient he didn't easily communicate with and I think that speaks to the kind of person/Doctor he really is.

I almost forgot to mention the computer cart AKA point of care cart, Dr. B used to both review and immediately enter patient data into the EPIC EHR, an image of which is shown below:

Again, I was TOTALLY AMAZED, I had finally seen the EPIC EHR in action in a real life medical setting and it's honectly not as bad as MANY Docs say it is. So the way our rounds worked, is that Dr. B gathered us all around it to discuss the patient, look at labs, xrays, ect. The monitor appeared ot be about 27'. Then we would go see that patient, ask them how they were doing, any complaints, ect, then we returned immediately to the cart to enter the pertinent data. Again, VERY cool!

So after giving me kudos for thinking of differentials on patients that neither he nor the team had thought of, I told Dr. B that I was taking the MCAT in the fall and applying to med school. At almost 50 years old. His response was "what does your age have to do with anything, I think that's a fantastic idea". And with that, I really did continue to enjoy rounding with the team. And they must have enjoyed me too since they asked my professor if I would be coming back. :) And that made me feel real good because I had hoped that I didn't come off as a "know it all", and clearly they didn't think that way. So in the next few days, I'll be setting up a regular schedule to round with Dr.B!!

LIFE IS GOOOD!!!! :)

Hell no I won't sign off on this!

And with that statement, I'm now feeling like I have a big ass target on my back as far as my current job is concerned (considering I've been pretty much ordered back into the lab by this coming Monday). Anyhoo, when I ran the Ebola suit suggestion by my Primary Care Doc she essentially said that she will NOT sign off on me wearing that in the lab, even if I do have on an Ebola suit. And there's a damn good reason she said this and I can't get into why that is here. Suffice it to say that my Doctor clearly isn't stupid enough to risk me working in there for fear of being sued should something else go wrong.

So today I work at a leading cancer center. Who knows what tomorrow is going to bring.........................................

In other FAR more appealing news, tomorrow morning I head to county hospital which treats indigent patients for my Internal Medicine rotation and I can't wait! :) As soon as I have time, I'll be sure to update my experiences. And I have a feeling that I'm going to have a LOT more free time in my life soon at least until my next blessing comes along! ;)

May I help you ma'am?

The elderly woman I saw earlier today wandering the halls of the surgical oncology (surg onc) floor just broke my heart. I could tell she had been crying recently and was lost so I offered to help her find her husband in the recovery area even though I still get pretty lost myself.

It turns out that lately, I've been spending a LOT of time with one of my sista' mentors (that I'm trying to convince to apply to med school) because she's considered one of the organizational experts in pathology informatics. And she works on the surg onc floor, so it was her office I was leaving when I ran into the lady looking for her husband.

So just as the lady and I were about to get SUPER lost, my sista' mentor appeared and offered to help both of us find our way. And that meant that I had an unofficial tour of the surg onc recovery area. Well, you can probably imagine "how in the right place" that felt for me as I was looking for the woman's husband. The patient's wife had forgotten almost everything about her husband and could barely speak except to say his name. And I'm pretty sure that the Doc probably talked so far over her head that whatever she did understand was likely quite overwhelming based on the seriousness of what brought her husband to this facility in the first place.

When we finally found her husband she was so thankful and it became obvious that she and her husband were there alone. And that's real sad because I'm certain the wife was pushing 75 or 80. Easy. At any rate, it felt good to be able to help someone who obviously needed it. But I think meeting this woman and being in the recovery area did far more for me than I did for her. And the next time, I'm going to be SURE to get the name of the person I'm offering to help. Because little details like that help people feel so much better!

And this experience reminded me that if I didn't work where I do now, I wouldn't have the opportunity to have these kinds of VERY rewarding experiences. And as tough as it can be to deal with life's challenges like those I'm experiencing on the job now, the rewards are that much better. But more than that, it's absolutely WON-DER-FUL to have a constant reminder of my ultimate career goals!

Beware of laboratory hazards! Especially the human ones!

I don't have words for how happy I am that this week is finally over!! Yeah me! But it basically ended with what I'm now fairly sure is the fact that employment wise, I need to Seek. Life. Elsewhere. And I'm cool with that.

The bottom line is that I'm expected to wear something like the following so that I may be able to work in the lab again with the venting chemical tank. The same type of venting chemical tank that blew up in another research lab a few years ago, but I digress. Here's my new work gear:

When I was presented with my new lab work attire, I chuckled out loud and asked "where's the Ebola"? That got a laugh out of the HR and ADA reps, but the person over my new and old Supv's didn't find it so funny. Her bad, LOL!! However, they know DAMN WELL that's it's going to be DAMN NEAR IMPOSSIBLE for me to work comfortably or efficiently in the lab at the bench, hood, or at my desk which is also now being relocated back near the venting chemical tank. So I translated all that to mean that what they're really saying to me without directly saying it is this: "we really don't want to work with your Black a$$ anymore, so please get da' hell on". Because I know as a Chemist for the last 20 years that the chemical being vented from the tank doesn't require anything close to this and I know this because over the years I've worked in chemistry and pathology labs with far more dangerous chemicals, that nothing remotely like this is required. OTOH, I've NEVER worked in such close proximity to/or around such a substantially large volume of a chemical like this either. And when I say large volumes, I mean tanks like these in a space around 450 square feet in area:

And yes, there are TWO of them almost as tall as I am (and I'm almost 5'8").

So allow me to be clear, my primary "issue" isn't that I'll have to work in a room with this thing on, people do it every day (for a hellva LOT more money than I'm making). My primary issue today is the same when this all started, the lab skills/safety challenged person charged with running the lab. Put another way, this individual is the ~ 3rd person in an almost 25 year lab career whose presence in the lab scares me $hitless. The fact that it doesn't really vent, it SPILLS air on a regular basis in such a small, averagely vented space is my second concern. The third and most important is the location of the tanks near the ONLY way into/out of the lab. If these tanks were to blow there's a damn good chance that the ONLY entry/exit into the lab would be blocked. Yet I was told today that basically, "too bad for you put on your "Ebola suit", this is what you're going to have to work with". So, I'm praying REAL HARD that God removes me from this situation ASAP and ask that you pray for me too. Fortunately for now, I haven't been ordered back into the lab soon because I need to run this by my Doc (and probably a lawyer too) to get some consensus about what I really need to wear in the lab or if I should be in there at all. In the meantime, I'm applying for jobs just like I don't have one...........................

Moving on, I had the most amazing week to date in my clinical healthcare class!! While cramming/reviewing for my midterm this past week (I got an "A" on my exam), I gained more insightful revelations about a couple clinical medical specialties. And again, I'm SO excited that pretty much any clinical specialty is a realistic consideration for me now that my kid is almost an adult. I went through iterations of becoming a Psychiatrist, Intensivist, or just a regular ol’ Family Doc this week. And this reminds me of the stories I’ve heard over the years from third year med student about what they think as they’re doing their clinical rotations. So for my first rotation, I’m going to be at the local county hospital working with the very population of folks, poor, minority, hispanic, I hope to serve one day as a Physician. In fact, it isn’t lost on me that I could end up as a student, Resident, or Attending, at this very hospital one day! :)

Doin' it Cowgirl style!!

* My Cowgirl hat, complete with Tiara, ROTFL!!!


Last Friday at work, many people came in wearing cowboy/cowgirl gear in celebration of the rodeo being in town (did I say that right, LOL??) But I hadn't purchased cowboy anything yet so I didn't participate. Yesterday, I had every intention of going to work for a few hours then going to the rodeo which was only a few blocks away. But once I parked my car and smelled the bar-b-q being cooked from 6 blocks away, I passed on that idea and headed stright for the rodeo! Yummy!

Being a North Carolina girl (by way of Cali), I KNOW good bar-b-q when I taste it. And being the extraordinary southern cook that I am, I can make a mean bar-b-q sauce myself. ); But this Texas bar-b-q is different, owing to it's Mexican influence. And for the most part it's a big FAIL for me because I prefer bar-b-q without the salsa influence. But the free bar-b-q they were serving at the rodeo was quite delicious! I also had a super long corn dog and a funnel cake with a TON of sugar, which means that all I ate for lunch today was a bananna. :(

Overall, it was a good day, nice and cool weather wise, full of friendly people and great food! I heart Texas!!!

Yeeeeee-haaaaaaawwwwww!!! :)

Natural hair, don't care!!

Over the past few years, I've become known to family and friends for going from wearing a wig (see my "about me" pic) to wearing my natural hair. And I've recently decided to not only wear my natural hair more often, but grow it out very long the way I wore my hair when I had a perm.

Ironically one of the first things I noticed about Black women in Texas is that very few of them wear their natural hair which coming from the East Coast/Metro DC, is VERY strange to me. You would think the opposite would be the case especially in a place where during the month of August, having 100+ degree days for the entire month is not unheard of. And I know from personal experience, wigs are hot as hell in the summer months!

Movin' on, after learning yesterday that my assignment to a new Supv is temporary, I've decided to jump ship as soon I can to another cancer research group. That is unless my department decides not to do that and that's a real possibility given that everything in my department is in such a flux. My readers may also have noticed that I haven't mentioned the type of cancer I'm studying and that's because of the politically charged nature of it at my current institution. Whoda' thunk that political game playing would play such a STRONG role in the quest to "cure cancer". But it does. It really, really does and that in my mind ends up costing lives.

I'll also finally be starting my clinical rotations for my health informatics course and that is so SUPER DUPER exciting, that I can hardly contain myself!! I'm starting with Internal Medicine which is ironically the field of medicine I feel most likely to pursue after med school. I'll also be shadowing my prof and I'll probably let him in on my "secret" to pursue med school after finishing my PhD. And no, I'm not worried about what he's going to say about it, in fact, I don't really give a $hit what he thinks about it. I'm just that laser focused after MANY years in the premed game.

So I think I now have not just a plan for completing this dual degree program, but a GOOD PLAN THAT FITS MY LIFE AT THIS POINT. And I think that's an important distinction to make for a nontrad premed. So here goes my year by year plan:

Summer/August 2014 - Take MCAT

Fall 2014/Spg 2015 - PhD courses

Fall 2015/Spg 2016 - PhD courses

Summer 2016 - Apply to Med school

Fall 2016/Spg 2017 - PhD Courses/Finish PhD

Summer 2017 - Matriculate in Med school

And this is my "worst case" plan, my first choice plan is to apply to med school in the summer of 2015 but wanted to give myself some wiggle room due to some other personal plans I have on the table.

The other highlight of my week was the rooster in the above photo that kept me from getting into my car the other day. I have NO IDEA where this thing came from because there aren't any farms nearby. And I didn't think roosters could fly all that well so how he got here is my lingering question. Needless to say, this thing scared the hell outta' me and it took about 15 mins for to get into my car because he was chasing me around the car. And I'm certain I looked like a fool running away from a rooster. URGH, LOL!!!