for some mysterious reason, clinic always seems to be harder/longer when i'm on rotations with no extra time to spare! although maybe some of that is psychological . . . whatever the reason, i had a rough day yesterday. i only saw 5 patients, but i still felt like i didn't get to spend enough time with any of them, and yet i couldn't have spent any longer because we were already running WAY behind and i didn't finish seeing my last patient until 6 pm. as it was, parents were complaining (to me, even though i saw everyone as soon as i possibly could and didn't stop for a second all afternoon) about how late we were running -- and refusing routine services on their kids like labs!
i guess every day is not going to be perfect, but it was frustrating feeling like i was providing sub-optimal care, which is what happens when a well-child check is rushed due to time constraints and parental pressure to 'finish up with my kid already, i've been here since XYZ!!!'. exams are quicker, and anticipatory guidance is less detailed, in part because a parent running seriously late for their next engagement simply is not going to listen to my advice on water heater temperatures (parents of young children: set yours at 120 degrees or below!). also, my focus on each patient definitely DID waver as the clock ticked on (ie: my mindfulness wavered). next time i'll try to work on that. i can't control the passage of time or the parents' frustration, but i can work on my own perception and reaction to it.
aaaaaaaaaaand i'm on call today. let's hope i don't run into any of this:
this diagram is so simplified it borders on hilarious, but i didn't want to show pictures of dead bowel! from centracare health library, whatever that is.
NICU word of the day: as promised, our NICU word for the day is NEC, which is cute little acronym for necrotizing enterocolitis, an extremely un-cute phenomenon that happens most frequently in preemies. it is not well understood, but thoughts are that immaturity and sub-optimal blood supply put the bowels at risk for basically blowing up and dying. the treatment is either medical (antibiotics, bowel rest, fluids, medications to keep blood pressure up) or surgical (if the baby is stable enough and the damage is finite, sometimes surgery will remove a portion of affected bowel). babies who recover from NEC often have feeding issues in the future, and sometimes removing bowel can cause absorption problems known as short-gut syndrome.
ok, off to work!
workout: i arrived home at 7 pm and initially was going to skip my run, which really annoyed me because HELLO, it's only day 2 of the rotation and that's just sad! however, since josh wasn't home yet, i decided to just go anyway despite the late-ish hour. and as always, i'm glad i did. 5 miles with 3 miles @ tempo pace on the treadmill, 0.5% incline, while reading every day with rachael ray:
- 1 mi warmup @ 8:57/mi
- 3 mi tempo @ 8:00/mi
- 1 mi cooldown @ 8:57/mi
reading: some NICU feeding protocols in the 20 minutes i had before clinic started
cooking: nada. but we still have tons of good leftovers from monday night. great for on call!