Atypical Day

I used a clever title for this post I think.

I am going to blog about my day today and I don't really have a "typical" day but they are all typically.....ummm.....atypical. Ya know?

Anyway...here goes......

5:15 - My work cell phone alarm went off. I shut it off and rolled over. I know John has his radio alarm set for 5:21. :) So when it went off....I still did not pop right out of bed. I listened to the music for a while. It wasn't until John got up and rudely flipped on the light that I finally rolled out of bed groaning. It was about 5:40. I showered, gussied up, ironed my clothes, couldn't find my name tag, ate a quick breakfast of OJ and an English Muffin, grabbed my purse, told my fellas goodbye and was out the door....running late and in the car at 6:40. This is all unfortunately very typical so far.

6:50 - I arrive at the office and gather up the charts that I need for the day at the CSC Clinic. I had an add in for the first appointment of the day and searched for his chart but couldn't find it. I checked the email to make sure no students had emailed that they were coming to the CSC Clinic this morning and brought up my Outlook Calendar to orient myself to the day and meetings etc that I needed to be aware of. I grabbed my half full fizzed out Pepsi from the day before out of the frig and I was off to the hospital.

6:59 - I arrived at the hospital and my favorite parking space was open and waiting for me. :)
It was a beautiful morning and I waved to my friend who walks in the park by the hospital every morning. I unlocked the CSC Clinic which is only the CSC Clinic from 7 to 9 am. The rest of the time it is either the Telehealth room, Immunization Clinic, or Dr. Lias' (surgeon) office and clinic. It is a multipurpose room hidden in the basement of the hospital tucked into a corner off of Home Health and Cardiac Rehab. The excercising grandma's were already there logging their miles on the treadmill and bikes and watching CNN recap the Presidential debate.

7:05 - My students/patients for the morning start to show up. I have eight scheduled for this morning. (But we had 10 that we saw by the end of CSC Clinic) I have two exam rooms so I start setting the patients up in the rooms and do regular stuff like Temp, Blood Pressure etc. I ask about medications allergies...you know....the usual. I also try to ask about school and how things are going. Sometimes things are not going so well and they need to know about offices on campus that can help them navigate academic issues or housing issues or whatever. I always ask about Tobacco use and Alcohol use and a "yes" answer will bring the follow questions of "how often and how much".
I don't have a lot of students that smoke but today I had a 1/2 pack a day smoker that had been smoking for two years. He is 19. So I asked if he is interested in quitting. He is not right now....but he did say he had cut back quite a bit. "Good Job!" I say....and tell him that if and when he is ready to quit and needs any help to let us know. Nuff said. Seed planted. The alcohol answers are varied. We have a lot of students that report not ever drinking and some of them are not lying. We have several that report moderate drinking behavior...like 1 or 2 times a week with the amounts as 1 to 3 drinks a night. Then we have some that are brutally honest and report 3 to 4 nights a week with the amounts between 6 and 20 drinks a night. Yes, I said 20. None of those students think they are drinking to excess. My response to all of the students is "the reason I ask that question is so that if a student is "binge" drinking I can let them know that not only is that dangerous but it tanks your immune system and may be a part of the reason that you are in to see us today" I don't know if it helps....but I am all about planting seeds.
When I leave the room I tell them who the PA is that day and that they will be right in and I always say "I'm sorry you're feeling crummy." I don't know why. But it's true. I am sorry they feel crummy. The international students usually look at me blankly....crummy is not in their word bank....yet.

7:15 - My PA for the morning shows up and I have two students already waiting to be seen. I had her review some lab on a student that needs a referral to an endocrinologist for diabetes (he wants an insulin pump) and sign a request for patient assistance for one of my non-trads that needs an MMR vaccination. While she is in seeing the first two students, I tracked down some lab results on one of the students scheduled for a little later this morning. We breezed through the first couple pretty quickly - they both had sinus infections and left with prescriptions to fill at Walmart, Safeway or Petersen Drug. The CSC Clinic doesn't cost them anything but if we have to do lab or xray through the hospital or if they have a prescription then those costs are their responsibility. All in all it is a pretty sweet deal. Anyway..the next student was a follow up that we had seen last week and had lab and an EKG done for a sinus tachycardia (fast heart beat) based on those results, my PA ordered a Holter monitor for 24 hours so we can get a better look at her heart rhythm. She will probably end up being referred to a cardiologist. The next student had an ear infection. I had a student not show up for his 7:30 appointment and I called and left a message on his cell phone. The next two were follow ups....one had a pretty bad case of athlete's foot that we had been treating and the other had twisted his knee when he fell in a hole last week and had been on crutches and in a brace. Today his pain was not improved and the PA wanted an xray and also set him up for an MRI. I put him to work filling out paperwork for the hospital since that would have to be billed and got the next two students (one was a walk in complaining of shortness of breath with activity) set up in rooms then took him upstairs to xray and dropped off his paperwork at the front office. One of the two I had set up had bronchitis and got antibiotic and an inhaler prescribed and the other had a sore throat so while my PA was upstairs looking at the knee xray I swabbed his throat and checked for strep and since he had had a sore throat for a week I also poked his finger for a blood sample and checked it for mono. Both were negative. I have a few CLIA waived screening tests that I do there in that clinic and we don't charge for those either. The students all pay a health fee so that is how we are funded. Pretty much socialized medicine on a small scale but it is working for us in this population. My PA came back and assessed the sore throat guy and covered him with antibiotic....his throat was looking bad for sure. So....that was our eight....but then the 7:30 no show walked in (it was 8:45) and another student with shortness of breath walked in so we went another round. The one had sinus infection and the walk in is probably going to need a sleep study.....but we are going to follow up with him on Friday. The PA visited with him. Had me do an Oxygen sat...and ordered a chest film and a repeat oxygen sat after I had walked him briskly. She had to jet to get to her regular job at the downtown Medical Clinic and I finished up....more paperwork.....the brisk walk.......repeat the oxygen sat...all normal and then I cleaned up the rooms, finished up charts, restocked and locked the clinic and headed to my office on campus. *While we were doing paperwork at about 8:55 Barb called from my office and had a student there complaining of abdominal pain and lightheadedness. I had her call the Medical Clinic and set up an appointment for her there and make sure she had a ride.

9:30 - I arrive back at my office. The student with abdominal pain was worked in first thing and was already at the Medical Clinic so I checked email, got my phone messages and returned a few then gathered up what I needed for a meeting with Human Resources.

10:00 - I headed over to HR for my meeting. I am going to try to get the Office Assistant position in my office increased from a 1/2 time to a 3/4 time position. We are busy and getting busier all the time it seems and I don't see that changing so I needed to find out what steps I need to take to get this accomplished. The trail is not easy...of course, but important I think so I will do the justification work and then set up a meeting with my boss.

10:45 - Back to the office and I had a couple more phone calls to return. I called the student that had gone to the Medical Clinic - she had just gotten home and had a ruptured ovarian cyst. She wanted me to email her instructors but I told her they wanted to hear from her if she was able and then if any of them needed me to verify then she should let me know. If I were to email instructors for students that were missing class.....that is all I would get done all day long. So the policy is only to inform instructors of those that are unable to email them due to hospitalization or those that have missed more than 3 class periods due to illness. There are, of course, exceptions. Sometimes the instructors themselves request the student to get "a note from the nurse" for a class they missed last week when they had a headache or were sick. That tends to make the nurse irritated....especially if the student has never darkened the door of her office before. Grrr. But I get over it. Ok....moving on.

11:00 - I emailed Dr. Roweton to cancel a meeting that we had set for this afternoon to explore a grant application for money to start up a pilot project that I am working on with Community Health. The project would partner with Merck - the company that makes Gardisil vaccine - to target the 19 to 26 year old female population and offer the vaccine to that age group. Merck will replace our vaccine but we have to purchase the start up supply. They are about $125.00 per dose and it is a series of three shots. Dr. Roweton is the grant guru so I wanted to talk to him. I would like to have about $2500 to get 20 doses and then go from there.....we will reschedule in the next couple of weeks. My week was just getting filled up and I needed to be in the office this afternoon to catch up a little bit....or a lot.

11:30 - I left for lunch. I almost always leave for lunch because, well, I need the break and frankly if I am here...somehow people know that. So today I actually went home for lunch. That is not really typical. By the time I drive home and drive back in I am only home for about 1/2 hour but today I wanted to start a load of laundry and eat the leftover spaghetti. :) I accomplished both.

12:30 - Back to the office. Barb, the Office Assistant works 7am to 12pm M-F so she was gone by the time I got back and I am by myself in the office for an hour before a workstudy comes. I pretty much manned the front desk.
I had a student fill out a Medical Waiver for Immunizations. We made it a temporary exemption until he can get clearance from his Dr. to receive an MMR shot.
I had a request for a pregnancy test....positive. Those are always tough ones. She was doing ok. She will call her parents tonight. I encouraged her to start Pre-Natal vitamins asap and make an appointment for her first OB visit asap. She is about 6 weeks pregnant. She has good support and a good head on her shoulders but it is still not what she planned on so it probably won't go down as a favorite day for her.
I had a student stop in that needs a required shot to complete his admission. He wants to get in a class and wanted me to lift the hold on registration for him so he could do that. He swore that he had an appointment this weekend to get that shot. I did not fall for that one. I can't say that I never have....but I feel smarter.....and meaner these days. I said I would give him the shot. Forty bucks. Take it or leave it.....or register for your class next week AFTER you have brought in the proof of immunizaton. He left to get his money. He may or may not be back we will see.
I had a student stop in with "lumps" in her armpit. Infected. We made an appointment for her to be seen at the CSC Clinic in the morning and I gave her ibuprofen and told her to use a hot (not burning) wet washcloth to soak that area. Ouchy.

1:30 - Alyssa, my new freshman workstudy came and is manning the phone and the front desk and working on filing and shredding and the bulletin board in the hallway. So now I can do my follow up calls and finish up some charts and loose ends from earlier today.
But wait....the Registrar just brought in a letter requesting all the health records on a former student. This happens about 6 times a year. Litigation. Not because of us but one side or the other is digging for info. We just have to retrieve the file from the archives, copy it, attach it and send it back to them. Just time.....I put a note on it for my other workstudy to do when she comes in at 3. She is the archive queen and has been here for 4 years. This is her last semester though. I will miss her greatly. But she will be an awesome SPED teacher.
The student needing a shot came back in and we got that taken care of and he headed right down to the Registrars to sign up for a class. We are currently chasing about 120 or so students that have not completed their immunization requirements. As of last week they have a hold on their registration so usually they find us after that is done. You just have to find their motivation.

2:45 - Ok now I am ready to finish up those loose ends but first I get some caffeine. Today's drink of choice was ice tea. :)
I pulled the files from the cubby labeled with tomorrow's PA so I can call and get them scheduled for the morning. I currently work with 3 different PA's a week....the days vary. I also have a Nurse Practitioner usually but she is on maternity leave and I probably won't see her on the schedule until next month sometime. She had a little boy the last week of September. She is a busy mama with this being her 5th child and working full time.
I made a bunch of calls and even called the follow ups for Friday's CSC Clinic because I have a lot of meetings on Thursday so my time will be pretty crunched.

3:30 - Helped a student try to locate his immunization records. It was a hard case. He was homeschooled so they were never on file at a school, he got some at his grandfather's clinic and that clinic is defunct and the records were dispersed to previous patients and his family had a house fire a few years ago and lost everything. So.....we called an ER where he had gotten a tetanus booster and we called the hospital where he was born, we called his Mom to make sure we weren't missing something and finally located a few with the Wyoming Department of health. We faxed off releases and when it is all said and done he will still probably need one MMR that they are all sure was given at Granpa's clinic but the records are lost. The old adage for Nurses is...."If it isn't documented....it wasn't done."
Saw a student with a wasp sting.
Saw a student that had burnt his hand. He was in the Glass blowing lab and the piece he was working on broke or started to bend and he grabbed on to it. No...that isn't the first time we have had that happen. He has no insurance and was doing all the right things so we will see him in the morning at the CSC Clinic and follow him pretty closely. We had to fill out an accident report since it happened on campus. Paperwork. My nemesis.

4:00 - I am supposed to go home now. But I am not quite ready.
Had a call from a student that wants to do a Breast Cancer Awareness deal in her class.
Had a colleague stop by to talk.
Had a voice mail to return a call to Merck about the Patient assistance app I had faxed in.

4:45 - I looked over my clinic schedule for tomorrow and pulled charts to get ready for that....because if you remember.....the only typical thing is that I WILL be running late in the morning. :)

4:50 - My day here is done. It was a good day. Not crazy busy but just steady. I had a good mix of issues to deal with. I got to take a full hour for lunch. I really do love working with college kids.....but I am going home now.