I had this entry almost finished, and the computer ate it; we’ll see how important what I had to say was, whether I can remember it or not. This morning I was working with a different doctor; I’ve only been with her twice before; she happens to be the medical director of the clinic. Our first appointment was with an elderly couple, both with pretty serious health issues. After we stepped out, the doctor told me, “Go get the MA to help you give them flu shots.” I clapped my hands and exclaimed, “Oh, great, I’ve been longing to do that!” sort of like Anne of Green Gables. I think she thought I was being melodramatic, but it was quite true. She hadn’t heard about the previous discussions.

The MA got the syringes out of the refrigerator (fortunately the vaccine was already drawn up, so we never got to find out how good I am at measuring 10 ccs), and gathered the bandages, cotton swabs, consent sheet and warning paper (you’d be amazed how much paperwork goes into this simple procedure). She did the wife, and I did the husband. After that, at the end of every visit the doctor would announce, “Alice here will explain the medicines and give you a flu shot.” It was a great day. After the first two times on my own, I even remembered to bring the consent form and the warning sheet. The nurse manager never noticed me wandering around with syringes on my own, so she didn’t say anything, and if the MAs noticed, they didn’t tell her. And no one was seriously injured. It’s not complicated. The only things to remember are to stick the needle in with the bevel up, because it’s sharper, and to go quickly. You’d think to look at those long needles it would hurt less to stick it in slowly, but I’ve been told by several authorities that it’s better to jab the needle in quickly. I just remembered now my only mistake: in my carefulness to do it efficiently, I forgot the part about aspirating a bit before injecting the fluid, to make sure you haven’t hit a vein. But no one bled much, so that was ok too.

The other part, “Alice will explain the new medication to you,” I was not so happy about. My Palm ran out of battery halfway through the morning (perhaps as a result of me not charging it for two weeks?), so I had no way to look up the medicines. And she, being a conscientious, up-to-date doctor, was prescribing new medicines that I didn’t even know the generic names of, let alone their side effects. Perhaps I should have asked her. But the one I really had no clue about was one that a drug rep had just handed out samples of at lunch today, along with a nice lecture about how splendid it was, and if I had been listening to him instead of to the nurses’ discussion of good movies, I might have known what to tell the patient. I was too scared of her to let her know I hadn’t been listening. And the medicine was in a nice sample package, so I’m sure it said anything important. . . I hope. Oh bother.

This doctor is very kind to her patients, but very brusque and no-nonsense with the students. She won’t say anything if you get it right, but you can always tell when you’ve got it wrong. And I’d been getting it just a little bit wrong all day: forgetting to ask slightly key questions (ie, the patient’s back hurts, he thinks it was because he’s been sleeping in a chair; and I didn’t ask why he was sleeping in a chair; or a patient comes in on 20 medicines, and I didn’t make a note of all the medicines). The only good time was when she asked for the three signs of aortic stenosis severe enough to need surgery, and I knew the answer (dyspnea at rest, syncope, and angina; that means difficulty breathing, fainting, and chest pain) (which I only knew because the other doctor had asked me three times, and I missed it every time). But she’s a good teacher, too, exactly because she doesn’t let you cut corners, and she expects you to know things, and to look them up if you don’t.

One of our early patients had Parkinson’s, and she had just picked up a new patient admitted to a nursing home with Parkinson’s and progressive dementia, so she told me to “look up Parkinson’s.” What she really meant was to look up the difference between dementia caused by Parkinson’s, and dementia caused by Alzheimer’s. I stumbled on a good article, and gathered that Parkinson’s dementia has prominent visual hallucinations, frequent falls, difficulty with speech, and develops within a year of the motor symptoms of Parkinson’s (pill-rolling tremor, etc). So then she sent me over to the nursing home to talk to the poor fellow. I spent about an hour trying to get a history from him, and trying to get a mini-mental status exam (he was alert enough to tell me he was tired of people asking him what day it was, when he obviously didn’t know!), and doing enough of a physical exam to confirm that he had Parkinson’s. Then I talked with the nurses a little, and got his medication list (yes!). So far so good. Then when I got back and reported she asked what I wanted to do for him. I said as far as I had heard the Alzheimer’s medicines (Namenda and Aricept, most famously) don’t do much good, so it wasn’t really worth it to start them for him. She said, “You’ve obviously been listening to Dr. X;” and went on to say that she felt those medicines were very helpful. So now I’ve been assigned to look up studies on their efficacy. Which I suppose is a good thing to do. I better do that before the dance tomorrow night.

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