This past week has definitely been a challenge for me. My preceptor has an odd way of communicating. He has an accent, plus he speaks in partial sentences and uses a lot of imperative statements, so it's hard figuring out what exactly he means even if you understand the words. He sometimes just stares at the patients or at me for seconds on end; these are always uncomfortable times. Plus, he asked one lady how she has been since the recent death of her husband, and after she talked a bit and stopped to cry, he just stared at her, then said, "Don't cry. It'll be all right," and kept staring. There's obviously a cultural gap, but he seems to be somewhat Spock-like at times, expecting people to act solely on reason and practicality rather than emotion and desire. My classmate is mostly amused by him. I tend to be bemused and irritated, but in any case, we both had a rough day today. On my part, it's starting to get to me that our preceptor seems to misunderstand me and respond in ways that indicate that he thinks poorly of me. I feel it's detrimental to be confrontational with him, but since he'll be evaluating me, I also feel it's detrimental to let him misunderstand me and get the wrong impression of my intent. Damned if you do, damned if you don't, I'll just be glad when this damned rotation is over. I hate internal medicine.
Anyway, with that off my chest, we get to go in later tomorrow. Also, tomorrow should be a lighter day with patients. Speaking of patients, the one I've been rounding on this past week has pressure ulcers on both feet as well as his sacral region. The ones on his feet had become infected, so the podiatrist debrided them and in the process discovered that the infection had spread to the bone. So the patient went back for bone debridement yesterday. He is usually chipper and energetic even when I wake him to talk, but today he seemed to just want to go back to sleep and he couldn't remember having had the procedure yesterday. I'm hoping it's just part of the procedure recovery process, but I'll find out tomorrow. The bacterial cultures of his bone came back with Staph and Strep, which are common in osteomyelitis from skin ulcers, as are anaerobes, gram negatives, and mixed infections. Osteomyelitis from a plain skin infection is likely to be Staph aureus or Strep, but when the skin is eroded away by a necrotic ulcer, it's a free-for-all in the unprotected underlying tissue. It's important to keep the skin intact as the first line of defense against invasive organisms.
I mostly needed to vent, but I figured some substantive info would be good, too.
Scott
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