I'll see you in the ICU!

Crazy is as crazy does

Hello All!
It's been a while, eh?
Let me tell you all that it's been nutty, nutty, nutty.

This semester, they've split us up into groups (divide and conquer!?) and there are 5 rotations to do between this and next semester. My first rotation is Community.

I am actually really liking community! I find that it fits right in to my altruistic, Buddhist nature--I'm at the Urgent care clinic near school, so it's an easy 10 minute walk for me.

Where last semester I was in a group of 9 to one preceptor, this semester it's strictly 1:1. I'm the only one coming to this clinic to do the rotation. While I thought the pressure would be on to be a know-it-all, I find that I'm having a really good time and actually learning more this way.

My preceptor has only been there once out of the four times I've been there, taking the first, third and fourth day off for an emergency personal day (whatever) but the rest of the people in the clinic have taken me under their wing and are quite marvelous. They like what they do, are good at it, like each other, and believe in what they are doing--they offer the patients the best care possible, regardless of that person's ability to pay or not.

On my first day, they were short staffed, so I got to watch the nurse triage for about half an hour and then was told to triage on my own...to ask if I needed any help.

!?! excuse me !?!

So, boy--what an amazing experience!

Let me back up and explain what Urgent Care is to those of you whom might not know--When people don't have insurance, they usually go to the emergency room and, for lack of a better word, clog up the system, with non-emergent complaints like "bronchitis" or general sprains/etc.

So, in an effort to spare the ER for real emergencies, New York Presbyterian has set up this Urgi-care clinic, where no one is turned away. This is amazing.

So many people do have insurance, but because of language barriers, or the confusion of dealing with the insurance companies, or waiting for enrollment periods, they somehow slip thru the cracks and never figure it out. The Urgi-care staff not only sees them, but they work on a sliding scale and fees are set by what they can afford to pay. They also have staff that helps everyone find out what insurance they qualify for and helps them fill out the forms so that they do get the ability to set a primary care physician and go to the doctor for health maintenance, not wait for things to get terciary and then end up in the ER. They walk out with what they need--medications sometimes, perscriptions they can afford (we look up not only effective meds, but most affordable meds for folks that we know will have to pay out of pocket)Medicare/Medicaid forms filled out, if they qualify, and referrals and appointments for follow up care with a primary physician. Many people get such good treatment that they keep coming back and we have to explain to them that this facility is for people that don't have what they have gotten last time they were there...but we treat them again, just the same, and urge them to go to the referral appointments we have set up for them.

So, my first day, I got to do triage--this is essentially the first step in the process of seeing a nurse or doctor. I don't think I spoke a word of English that day--everyone was from the Dominican Republic. One NYPD officer with stitches to remove, several pregnant women who complained of spotting two months into their pregnancy and they were worried. One person with shortness of breath, another complained of having a persistant bitter taste in her mouth.

I checked their names, date of birth, asked them their chief complaints, about the pain/problem--to describe it, localize it, give it a number...took their vital signs, and sent them back out to wait for the doctor to call them.

The next day, I got to pull stitches out all day long. It's funny to me how all the cases clump together--one day it's 9 people who all come in on the same day to remove stitches...the next day, it was unexplained itching...back and legs--no rashes, just itching. Another day it was all unexplained discharge--and plenty of pelvic exams.

So far, the bulk of it has been STD checks. Taking urine samples, doing chlamydia/gonnorhea tests, several pregnancy tests.

An interesting case was a fellow who came in with a chief complaint of an odd balding pattern--turned out to be Tinnea capitis, a fungal infection, but when you get the guy in the exam room he tells Joseph, the Nurse Practitioner I was following around that day, that he's really there for an unexplained sore on his penis, that's hurting like mad. So, we look at it--Herpes. And, he's not only got sores there, but around his anus, and fissures--all of a sudden, he starts to look very thin to me...and just then Joseph asks him if he's ever had an HIV test. Never, he says.

We did several tests on him for STDs, he had no insurance so we had to decide which tests to do; which would be affordable for him--and where to refer him for free immediate HIV testing. We chose inexpensive drugs to prescribe him, and wrote down the names of things he could take over the counter for the Tinea.

I walked home from clinic thinking about that young man. How in fuck could this happen that in this day and age, someone doesn't know to take precautions...and gets possibly infected with HIV, certainly with Herpes--outrageous.

I was sad, but on the flipside, I had to think about all we did for him--he was better off walking out than he was walking in.

I realized that everytime I walk to, or from clinical this semester, I have a smile on my face. I feel good about what I'm doing, and I love the feeling of making a difference. I'm glad I left architecture. I never once smiled on my way to or from work then--even on the good days. That's saying something.

posted by sketchmonkey @ 11:32 AM