On call

Wednesday, August 30, 2006
First call day. It's nearly 4 PM and our only issues were a woman who ran out of home oxygen and a woman who delivered last night having post-partum complications (incredibly huge labial hematoma - we had to call Gallup Medical Center to talk to OB and find out if they wanted us to send her up for evacuation).

I did talk a lot with one of the older faculty here. Dr. K. He is really a great guy. Jewish. I talked to him about the community and tribal feel and he reminded me that the Jewish people are truly a tribe. That we have our religious customs, our own language, history, etc. It was pretty neat. I didn't get on the topic of tribal land, though that may have been an interesting conversation. He also apparently has a gay sister who works up in Gallup. We also talked about family medicine, residencies and the like.

There was a patient today who concerned us for psychotic break. Apparently psychosis isn't common here but somatization and conversion disorders are very common. Dr. K was telling me about how he has seen stokes and codes that were really psychosomatic. Apparently their psychiatrist isn't here anymore (the coming and going of valuable specialists is an issue I might touch upon later) but they have a psychologist who has seen a lot of this. According to Dr. K the theory behind the prevalence is that it is acceptable and even preferable to express grief and emotions with huge outbursts. Hysterics and hyperventilation are the norm for people grieving or with other psychological issues. Each doctor I spoke to seemed really impressed with the amount of conversion disorders they've seen in their time here. I have seen only one case at UM (pseudoseizures coupled with Munchausen's and by proxy - the kid was admitted too) and was under the impression that most docs don't see very much of true conversion disorder. I am thinking this might make an interesting topic for my presentation and chart review I have to do before I go.

Food update: ate well yesterday. Had green beans and pasta for lunch and that sandwich at the café for dinner. Breakfast today was frosted miniwheats, lunch and dinner was hospital food with some southwest flavah (pear juice - yum! Dried out breaded chicken - not-so-yum.) Found a vending machine that dispenses coffee. Not much better than the instant at home but it's the only option here.

Note: today I'm on call and haven't really done anything at all. Well, not true, I have done a lot of AMSA and pathology stuff. However I feel like such a slacker sitting at the desk here all day just typing away, emailing. I share my office with other docs here and they come and go and bring charts in and such and aside from a few hours here and there I have just been sitting in the office.

Well... it got busy. Urgent care was pretty packed. Not like Henry Ford or anything but there was a steady stream of patients. I did three knee exams, an eye exam, a bunch of respiratory exams, and other stuff. Pretty basic. I taught the nurse how to play Go Fish (little Eliza would be proud) and he taught me Zuni Speed (we played cards while I was waiting to present to the attending). I stayed an hour later than scheduled but we cleared the rack so it was worth it.

I really love this kind of hospital. Everything in one place, All close by. The Lab is so cute and small but they do all the important stuff. The whole place is so easy to navigate and the patient load is really manageable for a couple providers (I think only one or two max are on at night). And I really love the Zuni. Dr. K and I discussed a bit about Zuni and how they are joker and laughers (compared to the more aloof nature of the Navajo). I really like it, I joke around a lot and don't feel like I'm crossing any boundaries. There's lots of friendly teasing and such. It's just such a pleasant environment - soooooo different from the stodgy academics of UMHS.