Anal glaucoma

It's late Friday night, and I'm tired in a content kind of way. I helped deliver my fifth baby tonight after a long clinic day here in Storm Lake. Yesterday, I drove a total of six hours round-trip to spend Thanksgiving with my family in Marshalltown at the Iowa Veterans Home, where my grandfather moved to recently. And last weekend, I returned to DC for a four-day AMSA board meeting, a great time with fabulous people and little sleep. This weekend, I hope to explore the downtown shops, photograph the lake under a full moon, and road trip a few miles up the road to visit Linn Grove, where my grandpa Hughes and great-aunt Ferrol grew up, and Sutherland, where my great-grandparents are buried. All in all, Storm Lake is treating me well; I'm learning a GREAT deal on family medicine (and reinforcing how much I DON'T know) and am thoroughly enjoying getting to know my host family. And not to mention the killer view from my den bedroom --- the lake lapping the shore just a few feet away. Too bad it gets dark (and cold) far too early around here to really enjoy it.

So, on to a few tidbits from the past few days ...

* I knew I was going to get along with my preceptor the moment I walked in to his office. It wasn't the mounds of drug sample boxes or medical journals strewn about everywhere that convinced me of this or the dusty hunting paintings and statues decorating his walls or even the coffee mug stained permanently black. It was the skeleton. Dr. David Crippin some time ago dressed a three-foot human anatomical model with a tie and jabbed a pinwheel through its rib cage. I couldn't do much but laugh when I saw that one ... and if you never hear from me again, assume I have fallen amidst the three-foot stacks of paperwork and am rotting away.

* There is too much to know in medicine ... risk factors, pathophysiology, signs and symptoms, physical exam findings, lab findings, diagnosis, treatment (Drugs --- I particularly dislike the drugs ... and drug reps, but that's another entry entirely.), and complications. How do people keep this stuff straight? I certainly don't ... can't ... haven't yet. Sigh. I look forward to the day when some of these things begin to click. Take, for instance, this past Monday. After every patient, Dr. Crippin wanted a ten-second synopsis and then would ask what I thought was going on and what I wanted to do about it. Of the "umpteen" number of folks I saw that day, I nailed one diagnois ... ringworm. I'm fairly convinced, however, that it doesn't take one thousands of dollars in tuition to arrive at that conclusion! I also am particularly weak at reading x-rays. That same day, I found myself standing in front of a chest x-ray for a woman with suspected pneumonia. I noticed several wire loops in the center of the film and asked him about them, thinking along the lines of sternotomy wires. "Those?" he smiled wryly. "Those are bra clips." Brilliant, Hughes, just brilliant.

* I seemingly have quite a bit of time to kill in the OB nurses' changing room digging through drawers for pants that are longer on me than mid-calf crop pants (I am quite the laughingstock for the nursing staff.). In one such dig, I noticed the following sign posted to a closet door and couldn't help but sharing it! (I hope this comes in handy for some of you ...)

Anal glaucoma:

"A woman calls her boss one morning and tells him that she is staying home because she is not feeling well.

'What's the matter?' he asks.

'I have a case of anal glaucoma,' she says in a weak voice.

'What the hell is anal glaucoma?'

'I simply can't see my ass coming in to work today ...'"