The Road Ahead...

...is looking quite busy but rather fun! We have so much going on right now and even more headed our way! Next week brings tax day - no biggie, we finished our taxes in January (Corey never turns down on opportunity for money!). Unfortunately for him, he works in the retirement industry and thus the week leading up to tax day is hectic to say the least. He's not looking forward to it, but things will slow down significantly come Friday. The week after I'll finish up my outpatient rotation by taking an exam and having two standardized patient encounters. Then we might take a short trip up north to visit some family for a weekend. The last week of April Monica is finally coming to visit! She has not been out here yet and I've been bugging her to come out, so I'm extremely excited. Plus, the weather should be beautiful for any sightseeing trips around DC. Following her visit, I'll be moving up to the northern part of MD for my final 8-week rotation. The next weekend is Corey's step-brother's wedding in Hilton Head. We are pretty excited about that weekend because its a chance to spend time with Corey's family again (especially our little niece!) The day after the wedding Corey will most likely be driving his way back to TX in order to start his new JOB on the 10th! (He got a phone call on Thurs letting him know the "official offer" would be extended some time this week) The weekend after the wedding is my "graduation" in DC! I have a feeling it will be a little strange wearing my cap & gown with hood and listening to the commencement speech knowing I still have 3 months before I truly graduate. However it should be pretty fun, especially since both my mom and my mom-in-law will be out that weekend to help me celebrate. Whew - all that in just one month! In June we have a wedding to attend and in July we plan on moving all our things into a new apt in TX plus I'll start my final rotation in TX. In August I'll graduate and we'll be done on the East Coast! It's hard to believe its coming down to my last 4 months in school!

And what would make all this fun stuff even more exciting? Documenting everything with my new camera! That's right - using some "perks" that Corey has earned via his company we were able to buy a fancy schmancy SLR camera without having to spend any real money. It should arrive sometime next week and I can't wait to play with it! Be prepared for lots of pictures of the beautiful spring landscape around here and the pup - she's usually a willing subject, especially when asleep ;)

Affirmation

As I've previously said, this rotation has been frustrating, tedious, interesting and so satisfying. This past week proved all this yet again. There are times when I get patients who, no matter what I do or say, will probably go home and continue being non-compliant with either their meds or diet/exercise. Sometimes I feel like I have to threaten diabetics with the possibility of putting them on insulin in order to get them to actually take their meds as prescribed and eat correctly. For so many, though, this diet changes are hard either because they don't understand exactly what they can and can't eat or because they are so used to living a certain way that they are resistant to change. Also, many of my patients come from areas of the world where rice and bread are staple foods - telling them to give these up is pretty unrealistic. I've taken the approach of telling them to change to brown rice, whole grain breads and increasing their vegetable and fruit intake. I know I'd be more receptive to someone telling me to alter what I eat, rather than telling me to give up something all together.

There are certain patient encounters I am sure I will remember the rest of my career - I had one of those this past week. I picked up the patient's chart, read through past notes and my interest was immediately piqued. The last time they had been seen it was determined that they had a condition for which surgery was most likely necessary and sooner rather than later. I was expecting to walk into the encounter to hear all about what the surgeon said/did. As I started to question the patient, I quickly realized they had not followed any of the recommendations laid out for them six months earlier. I tried not to get frustrated, but it was tough. As it turned out, the patient eventually admitted that they did not do anything after they left because they were just so overwhelmed by all that had been recommended . I took that moment as my opportunity to educate them on just how serious their condition was, and just how important it was to get proper treatment. I put it in terms they would understand as well as explaining to them that there were some things that could wait. We talked about what needed to be done now and what could wait a week or month. Before I left to present the patient's story to my preceptor, they stopped me. They said, "Thank you so much. I prayed before I came here and God blessed me with you." With that statement, I was filled with various emotions: pride, humility, sadness, and hope. I was proud that I was able to do something to reach this patient and help them in some small way. I was humbled by the realization that it wasn't just the patient and I in that room, God was working through both of us. I was sad for the patient's situation and lack of funds/support/transportation, etc. But I was hopeful that perhaps this encounter could do something for the patient that previous healthcare interactions couldn't. Hopeful that there was still time to intervene without life-altering surgery.

Although my preceptor and I couldn't convince the patient to head directly to the ER for immediate hospital admission and surgical evaluation, they did promise to go first thing Monday morning after organizing some things. Before they left, the patient hugged me - the first time a patient has ever done that.

So will they actually show up to the ER on Monday? While I hope my effect on the patient was strong enough that this will actually happen, I am realistic. I am only one person. I do my best to make a connection with each and every patient. I try my hardest to educate them, encourage them, and enable them to make healthy decisions. But at a point it comes down to the patient and at that point I cannot do any more. It is hard to accept, but that is how it works. I will say a prayer for my patient this Monday morning to give them the strength and courage to admit themselves to the hospital. No matter what happens (and who knows if I'll ever find out what happens), I will be forever grateful for this interaction.

Happy Anniversary, Corey

Two years ago today we were married in front of family and friends. We promised to honor and love each other. Little did I know that day what the future would hold for us. Over the last 2 years you have been more than I could have ever expected or asked for. From helping me through the most stressful times of school to comforting me when I was feeling homesick, you have been amazingly supportive throughout all that life has thrown at me. The last two years have been amazing, fun, hard, stressful, trying and exciting. We moved away from everyone and everything we knew to start off on a great adventure. We knew it wouldn't be easy, and at times its been even harder than we thought. But through it all, our marriage and love for each other has grown stronger. I never knew I could experience a love like this. I am constantly amazed at how much you love me and how much my love for you continues to grow.

So I want to take this opportunity to thank you. Thank you for being my rock, my comforter and my cheerleader. Thank you for all the sacrifices you have made to allow me to chase my dreams. Thank you for loving me despite my imperfections.

I am so excited to spend the future with you. We have a lot in store this year and I couldn't imagine having all these exciting adventures with anyone else.

Happy anniversary. I love you!

Deep in the heart of Texas

Whew! This weekend was quite an exhausting whirlwind! Thursday afternoon I picked Corey up from work and we drove to the airport to catch our 7pm flight to TX. After what seemed like an eternity in security, we grabbed a bite to eat and boarded the flight. Corey's mom picked us up from the airport and dropped us off at his dad's place. We stayed up chatting with his dad and stepmom until pretty late. The next morning we met Corey's mom for breakfast. She was watching our niece Lexi, so we got to spend some time with her as well. Friday afternoon Corey had an interview at his old job. While he did that I got to spend some quality time with Emily, a good college friend. We did some catching up and had some good laughs. Corey's interview went pretty well, despite being surprised with an exam to take. Friday evening was spent with the combined Sacken/Meadows clan - all 11 of us went to dinner at a Mexican place with great fresh tortillas! After dinner Corey and I headed over to a college friends house to spend some time with a few of my girl friends. We had fun telling stories and catching up. It was nice to just relax and see everyone.

After a late night on Friday, Saturday morning came a little too quickly. We met up with Corey's friend Bill and his fiance Jennifer. It was our first time meeting her and she was great! A very sweet, easy going woman who was very easy to get along with. After breakfast, Corey and I decided we wanted to look at some housing developments under construction. See, we've been on a big house hunting kick, despite the fact that we won't be able to buy until the end of the year at the earliest. Anyhow, we thought it might be fun to just take a look at what there was. We looked at the model home in 2 different developments. It was pretty informative and fun just to look. It definitely made us want to buy that much more! After the house hunting we met Oliver and Claire for lunch. Claire and I talked wedding plans while Oliver and Corey discussed business and job stuff (boring!). Unfortunately we didn't get to spend as much time with them as I would have liked because we both had places to be! Saturday evening was the wedding of a college friend, Callie. The ceremony was short and sweet with a great pastor and some beautiful music. Of course the bride was beautiful as well :) The reception was held at a country club not too far away from the church. The best part of the reception was when the groom did a song and dance routine as a surprise for Callie. It was so cute - and he could actually sing!

The band didn't play much in the way of slow songs, so Corey spent much of the reception sitting down with Kyle (Dianna's husband). Nonetheless, Dianna Emily and I spent our fair share of time on the dance floor. Another great thing about the reception? They used the same cake baker as us, and had our favorite filling on the bride's cake! I thought it was pretty cool considering it was this weekend just 2 years ago when we were celebrating with all our family and friends.



This morning we crawled out of bed, packed up our bags and sleepily headed to the airport. The flight home was the best kind of flight - uneventful. Plus we had 3 seats for just the 2 of us so we were able to spread out a little. Finally, we made it back home. Our bags haven't moved from the spot we dropped them and I have done little to prepare for work tomorrow or my presentation on Tuesday. But I was able to get in a much needed nap this afternoon. Tomorrow it's back to the daily grind. Only a few more months until we are back in TX for good!

When it rains, it pours

In Virginia, you are required to get a safety inspection on your car every year and an emissions inspection every other year. This weekend Corey took his car in for the safety inspection - later that day we get a phone call from the auto shop saying he needed new front brakes and new windshield wipers in order to pass inspection. So instead of paying $16 for the inspection, he paid over $200. Ouch, right? Well today I took my car in for an oil change. As I was waiting I got the dreaded question - "Who owns the Mitsubishi?" I followed the mechanic to my car in the service bay where he proceeded to show me my cracked and leaking radiator. Great...just what I didn't need. Ouch again, right? Oh wait, there's more. I wait a few minutes then head to the desk to find out just how much this radiator is going to cost to replace. The friendly guy behind the desk informs me it will be $400 for the radiator (including labor) and, oh by the way, I needed my front brakes replaced too! He told me they would possibly get another 5,000 miles before it was metal to metal....Awesome. And he suggested I get a coolant flush to top it all off bringing the grand total to $870! Are you serious?!? I was practically in tears - you know what that much money can buy a grad student and her underpaid husband? So, of course, I tell the guy I need to call my husband. After a few phone calls between Corey and I, we decide to go ahead and replace the radiator and brake pads but forgo the coolant flush. We also are able to get a minuscule discount on the brakes, tell them no on a $60 air filter than can be bought at wally world for $20, and get him to lower some BS "shop supplies" charge. What's the grand total now? The low low price of $660 (hey its $200 less than the original, right?)

So, in the span of less than one week, we managed to drop almost $900 on our two cars, when we originally intended on spending only $45. But I'm trying to look on the bright side - at least we realized the radiator crack/leak before it got to a point where it messed up my engine or left me stranded on the side of the freeway to or from work.

Now I'm at home without a car trying to get everything in order for our trip tomorrow. Unfortunately I need to do things that require my being able to drive around town - guess when Corey gets home we are taking a field trip! After this week we are definitely looking forward to getting out of town for the weekend :)

Happy Spring!

Happy 1st day of Spring!! We've been blessed with absolutely beautiful spring weather to celebrate. We took advantage of the gorgeous day by heading out to a local lake. Corey and I had a picnic lunch while Lacey sniffed around the grass. After that we headed down to the water and walked around quite a distance of the lake. There were many places where Lacey could dip her feet into the water, so we let her when she wanted to. Then we went for a long distance where she couldn't safely get down to the water and there wasn't much shade, so she tired out pretty quickly. Eventually we turned around and she jumped into the water every chance she got. She had a ton of fun running into the water, then running out and shaking off. She'd repeat this several times then we'd walk a little further. Funny how she loves to run and play in water, but screams (and it really sounds like a scream/cry) when we give her a bath. Of course she was filthy by the time we made it back to the car, but she had a blast. And we had a blast watching her! Here are some pictures from our adventure:

Oh outpatient

I've just made it through my first 2 weeks of outpatient medicine and it's been quite an interesting ride thus far! I'm working at a community clinic in MD that serves the uninsured, low-income population. The patients have to pay a copay for each visit, then get a discounted rate for bloodwork and other testing. I would say almost all of the patients I have seen thus far were born outside of the US and English is not their first language. I've treated people from Iran, Sierra Leone, Mexico, Guyana, Nigeria, Cameroon, India, Pakistan, and many many more. (I try to make it a point to ask each patient where they are originally from) I've seen things I probably would not have seen in a family practice/internal medicine practice seeing all insured patients. For instance we had a patient walk in with a blood pressure in the range of 200/120 who had not been on high blood pressure meds for several months. I've had more than one patient who had an initial hemoglobin A1C of >12% (normal being less than 6%). It's also great because my preceptor LOVES to teach and he tries to give me at least one lecture a day on something ranging from reading EKGs (and what abnormal findings indicate) to the workup of a thyroid nodule. Despite all this interesting stuff, there are downsides - like the fact that most of my patients don't speak the best English making getting a reliable history out of them difficult. Also many have little medical knowledge (or what medical knowledge they have is more of a cultural belief regarding certain diseases such as diabetes and high blood pressure) making their compliance to medications and diet/exercise recommendations less than ideal. I can't tell you how many times I've sat with patients for an extra 10 minutes explaining what medications are their BP medicines vs their "sugar" medicines vs their cholesterol meds. But, despite the negatives, at the end of the encounter - no matter how frustrating or time-consuming, the patients are sooo grateful to be seen and treated. I've had many patients thank me profusely for doing something that many of us with easy access to medical care can take for granted. They appreciate the time spent explaining things and truly listening to them.

I've made some observations through these two weeks and have some tips to share. The next time you go see your friendly physician or, better yet, PA please remember the following:

1. If you are going to the Dr to complain of a sore throat or cough, please brush your teeth! There's nothing worse than getting a noseful of stinky breath

2. Please shower within 24 hours prior to your Dr's visit - stinky patients are no fun for anyone. And on the same note - try to clean your feet - we do have to look at those too

3. If you must have your young children with you in the exam room, please don't ignore them while the scream blood murder - it makes it very difficult to hear your heart and breath sounds with a screeching toddler in the background

4. Please please please - know your medicines and what they are for - and if you don't know - ask! Telling me you take that "little green pill for cholesterol I think" does nothing to tell me what medication you are actually taking

5. If you are told at your previous visit to bring something with you (whether meds or blood sugar logs) bring it with you...we don't just tell you that you need to bring it for fun - it really is important information

6. If you have diabetes - check your blood sugars regularly...we don't tell you to do this in order to torture you - it's important that you monitor them and it is important that we know this information to keep your blood sugars controlled

7. When you are told to get labwork before returning for your next visit - get the labs done...they really are good for something, I promise!

8.. Please don't quote Dr. Oz or Oprah or Dr. Phil for that matter...I realize that all these people are probably quite knowledgeable but they don't know your case, your medical problems and are getting paid lots of money to say what they say. If you really want to treat your medical problem with their advice try to get an appointment with them, not me.

9. And finally - we like treating you and we really like it when you thank us. There is not much better than seeing a patient smile and thank you as they leave when they came into the exam room looking rather wary

*[Note - the above tips were meant to be somewhat tongue-in-cheek...no offense was meant by any of it]*