bittersweet

My time in Guam is quickly coming to a close. It has been a wonderful time here and it seems like my schedule is so full once I'm almost to leave! I have dinner's here, meetings there, work here and there, and some serious snorkeling to do! There's so many other good snorkel spots that I haven't been to.

The docs here are so nice! I learned that one of my preceptors is the Grandpa of my Taco Bell Buddy from college! What a small world, eh?! I've leaned tips about casting, infections, abscesses, diabetes, scarlet fever, and much more to list. I've also learned about the red-footed booby, and traveling on a remote island!

A bittersweet parting it will be. Bitter to leave such a beautiful, tropical paradise, and yet so sweet to come home and have not only friends and family, but also my Greggy-pooh nearby.

Tonight I need to exchange pictures with the nursing students that are here from Andrews. We've had some fun times! I'll have to post some pics...

swearing

I had a patient tell me that he waited 4 days to get in to see us. He would rather wait and go the the SDA clinic because here the doctors do not swear at their nurses or at all. Granted... he probably should have gotten in to see someone sooner - anyone, he had a huge ulcer on his leg. But still, that's nice.

cherry red

Went snorkeling at Dog Leg Reef Sunday. Beautiful place! It had rained a ton so the original plan of hiking was kind of sloppy. :( After a scenic drive, I was in the water at Dog Leg. It was rainy and cloudy, so I was oblivious to possible sun exposure. The reef was amazing! So many different kinds of coral! And there was a large, unidentified, long, blue, pointy-nosed fish that had teeth, and swam right past me. Whoa. So, the amount of time snorkeling? I don't really know, but I think it was around 3 hrs. After we had dried off and were headed out, Eric realized that his calves were red. I thought to myself...awww... poor guy. But soon realized my calves were also burnt, and other things on my posterior. Oh my, I was getting more tender every minute.

So now I officially have a painful, heat-emitting burn. It makes me tired. It makes me crabby. On top of that I had the worst day at work today. I should have had a good day because I was able to see a lot of patients... but I was crabby, had a headache, was uncomfortable, hypoglycemic, and just plain cranky. Bah. I didn't get out of work until 8pm. That is 12 straight hours of clinic.

hiking action

We



Are the people who hiked to here



It was a beautiful



and quite interesting hike, with many friends!



Our trail was also shared with ATV's. Can you believe they drove here?


Finally we were almost there! But as you can see it's down quite a hill.


It was a small challenge to get down




But a great reward at the end!




All in all a wonderful hike! With great company, variety, and beauty!

unshaded

Today when I hopped in my car to run home for lunch I actually broke a sweat - doing nothing, mind you, just sitting. No, it's not because I am out of shape (although that could play a factor), it was just so hot in my car! I need to park in the shade.

best and worst purchase

My best purchase today.
I absolutely love snorkeling. Who knew there was a whole new world under there! Today I snorkeled all afternoon with a friend that I met on the flight over from Hawaii. I saw him in the parking lot, we went to K-mart, picked up some gear, and hit the beach. It worked out well! I totally have to get an underwater camera to share the joy. It's like a gigantic saltwater tank - beautiful fish everywhere you look!

On a sad note, look at the prices below. Everything is that way - it's kind of depressing.

Guam Beaches

I'm aghast at the beauty of the beaches here. I've alway been a lover of the beach and love to visit the beach of California when I can, but this is something else. They're so clean and white! Not like the beaches that smell like... well, fishy or like stale salt water. WEll... I guess I do have a cold, so perhaps they do smell and I just can't tell. I'll have to update you on that later when my nose is back to proper functioning. :) Here are a few pictures from just our trip home from church.

Guamin'

I leave Nebraska at 530am Thursday. I didn't change my watch during the various time changes so that I could see how long I was traveling to get here. But when I arrived I was just a little confused... what day was my watch on? And was it am or pm in Nebraska? After some deep consideration, I think I arrived at what would have been about 5:30am Friday morning (in Nebraska) but was actually 8:30pm Friday night here in Guam. What a long day. The sun only set once and it was just a couple hours before we landed in Guam.

I made it safely!

There were wonderful people to meet me! They put flowers around my neck, took me to my new place, showed me around, and brought me my car. Am I spoiled or what?

It's Sabbath Morning and I just found out that I have internet in my apartment, but I have to get ready for church they're picking me up soon!

horsin' around

Seems to be the trend that I find a horse to ride on my various rotations, wherever they may be. Well, this time it was the Doctor himself who provided the fun horse to ride! This horse's name is Dusty, and although he hadn't been ridden in a couple years, he was a perfect gentleman! It was rather cold that day, and it took my legs about 4 hours to defrost after the ride, but it was great fun. I love riding :)
He was a sucker for a good scratch and would curl his nose in delight. What a cutie!

clarification

As to the below posting, there were a few factors in the event of my temporary lack of consciousness. Since it was the first day of my rotation and the location was about an hour from my house, I decided to drive there in the morning. Being the procrastinator that I am I didn't finish packing until quite late. Then, had to arise quite early to be beautiful and there on time. Breakfast for me was around 5:30 and consisted of quickly eaten cold cereal along with a rather large cup of coffee.
Upon the event of my passing out, I was hungry, thirsty, tired, and there was quite an unpleasant smell emanating from the examined portion of our patient which was making me nauseas. It was too much for my poor system to handle.

White Fluffy Kittens

Yesterday was my first day of my surgery elective rotation. I am with a new preceptor and, well, everyone is new. On this, my first day, I fainted cold right in the middle of surgery. When I awoke I was stretched out on the OR floor with concerned faces peering down at me. The first thing out of my mouth was "I was dreaming of kittens." And what a nice dream it was.

Almost

I performed surgery. Wow. It was the last day of my surgery rotation, and we were doing a lipoma excision. Basically, we were taking out a benign, fatty tumor. Usually, I get to retract things or control the camera, or suction or hold intestines (see last post). But this time, the doc handed me the scalpel and said, "Here, take this." And I thought, that's weird. And then he let me perform the whole surgery! From the initial incision to the final sutures. Ah! It was amazing. The PA later told me that I've officially performed more surgery than he has as a member of staff. Wow. I love surgery. It almooooost, makes me want to go to Med School and become a surgeon. Almost.

Indigo

I held intestines.

We were taking down a colostomy, which is basically attaching the colon back together. There is a very large midline incision for visualization, and those darn intestines just keep getting in the way.

This surgery, in itself, is a pretty interesting surgery - cool procedures, nifty equipment, but it became a much more interesting case when, as we were dissecting around the rectum to clear a spot for anastamosis, we could see the foley (catheter placed in the bladder). Uh-oh. Apparently the bladder had, after the origional colostomy, adhered to the blind pouch which was the rectum (I wish I could draw a picture so you could know what I'm talking about). It was basically wrapped around the rectum - the site we wanted to reconnect to. So now there's a tear in her bladder.

After some swearing, we sutured it shut and consulted the urologist. He came in to take a look, put a camera inside and filled the bladder with saline. It was amazing to see the bladder looking down from the open abdomen! It was full and you could see the light from the camera inside. Up on the screen the images were being shown of the interior of the bladder. The repaired tear was identified and it was closed well, and then we looked at the inlet for the ureters.

Just as we were looking at one of the ureters it shot out a blue liquid! The urologist had ordered Indigo blue when he got in the room and apparently it takes about 5 minutes to get through the system and through the kidneys. As we peeked over to the other ureter it shot out some blue urine as well. Wow. It was pretty much amazing! We now know that we did not cut any of the ureters, and the bladder is in wonderful condition. The patient peed blue for quite a while.

The rest of the surgery was, although amazing, uneventful (which is good... for the patient).

I like surgery.

lap banding

Today was my first day of Surgery. It was so exciting! I was able to scrub in on various cases from a sebaceous cyst removal to laparoscopic banding of the stomach. Good times. I really think I'm going to like this rotation.
Tomorrow I'm taking out a few gallbladders.

Welcome to Ardmore, OK

My car made it! I've started to get used to the wiggle in the steering wheel. Anyway, I'm here for Internal Medicine/Preventive Health. I think I am going to learn tons! I'm already seeing my own patients! Today I saw a patient whose temperature had peaked at 107.7 - WOW. That was yesterday. Now she's feeling fine, well relatively fine. :) It sure is lonely here away from y'all... but I'm fixing to bury myself in learning the books to forget the pain.

Welcome to Holdrege, NE

I'm supposed to be on an OB/GYN rotation. I was at the office at 8am Monday morning to find that my doc was out all week, except Wednesday. Hm. So I ended up working with the PA and another doc. Learned a lot... about migraines, spinal problems, gastric feeding tubes, and wart removal! Today I saw my first lady patient that was there for lady things. Finally! But alas, it was only one. Tomorrow will be my first real day of OB/GYN! I'm getting nervous all over again!

On another note today I saw a duck. I saw a duck because I went on a walk out by a lake and it was beautiful. This duck had two little ducklings and they were so cute. They sure follow their mom wherever she goes with no hesitation. Funny how human children don't do that.

The Best of NC

As the sun rises


I'm back from my adventures in the south. I miss the southern hospitality and the fun people I worked and played with every day! Since NC I've been traumatized by quarterly exams, informed by peer presentations, humbled by exam results, and am now in Omaha doing a ER rotation. It's great! I was there for no more than 30 minutes before I saw my first stab wound! With air bubbling out of the side of the patients chest, my mouth was gaping open. Wow. Then I watched as they expertly slipped a chest tube in to drain the blood building up around the lungs. Wow. Wish I could have taken a picture to share, but alas. HIPPA.
Here are a few more pictures of NC. Just to finish out the trip!

My facility of learning


The office


My office! (for the first 2 weeks, then I got booted by the new partner ;)


Me and the Doc


The Papa of the PA program



Ode to cardio


Me and the priest - Messiah's Mansion Tours!



Another view from the office window - do you see why they are called the Smokey Mountains?


My first whitewater rafting experience took place in this raft



A map of pure fun



My NC mama!











High falls - I downclimbed that!


On top of high falls

hope you're not eating

Today we drained a cyst behind a guy's ear. When we cut into it all this pus came bursting out mixed with blood. It was about the size of a really large grape. So gross. Then we stuck this long q-tip with hydrogen peroxide and iodine on it into the huge hole (after squeezing it like a pimple) and cleaned it all out. After placing a piece of cloth-like flattened string half in and out (so as to let the wound drain) we put 4x4's over it and sent the guy home. Wow. I love my job.

stitches

Today in the office I took out stitches. There were about 17 of them from an ATV accident. He had a total of 52 stitches! But they weren't all ready to come out yet. This guy wasn't even a patient of ours, in fact, he was a drug rep! How about that.

On another note, it looks as though I'm going to have 2 weeks vacation coming up soon! Oh boy!

~nancy