Duke Trip #5

I came back from a trip to Duke a few weeks ago, thought I would share a few more details of what I do during these trips! (Also apologies in advance as this will be kinda long).

I was actually looking forward to this trip to North Carolina; I've been to campus enough times now that I feel comfortable and familiar with the trip, navigating the town and medical campus, and my classmates are my friends. So even though it was still technically "school," I was really looking forward to just enjoying the trip, spending time with my classmates, and taking advantage of all the learning opportunities!

My flight left Boise on a Tuesday morning (earrrrly) and I got to Raleigh by the afternoon. I picked up my rental car then drove to Durham (~25 minutes) and checked into my hotel and unloaded my things. My women's health program had a "meet and greet" about an hour after I got to the hotel, so I ran over to campus to meet some of the classmates I hadn't met yet, and chatted with my advisor for a bit. It was fun to meet people in my cohort I hadn't had the opportunity to meet yet!

Goodbye West Coast!!

After the meet and greet I went to the grocery store to load up on groceries for the week and buy water bottles. I spent the rest of the night resting and reviewing about 60 pages worth of articles about headaches and migraines (particularly in the pediatric population) for a lecture the next day. 

Side entrance to the School of Nursing

The first day was filled with lots of lectures and workshops. Billing and coding, diagnosing and managing headache complaints, and a really fascinating lecture about new biologic medications.

Awkward shot with a water bottle...lol!

After a morning of lectures, they provided us with lunch catered from Panera. No complaints from this girl!

Again, poor picture quality here...oops :)

After lunch we had a "wound management" workshop. The largest part of this workshop included learning suture, but we also practiced staples, punch biopsies, and incision and drainage. Loved it ;)

Here you can see my simple interrupted sutures, one staple, and my punch biopsy (that little hole in the right middle)
Instruments on the field are the scalpel, needle driver, scissors, and surgical punch.
All the little black strings are from previous sutures that I pulled out to keep practicing

After the wound management workshop, we held a panel to talk about taking care of vulnerable populations in healthcare. Our panelists included a social worker from an HIV clinic, a manager from substance abuse rehab, and a mother of two children with sickle cell disease. It was really interesting to hear about their stories and perspectives in their line of work. I especially appreciated hearing the mother's personal perspective about the healthcare her children have received and assumptions from healthcare workers about their pain and complaints. 

That marked the end of our first day. A few friends and I decided to go out to eat, so we drove to downtown Durham to some hip little pizza place. It was delicious. We had a nice chat about policies in obstetric management over dinner like it was the most normal thing in the world. I'm pretty sure grad school has ruined all my normal social skills!

garlic, kale, spinach and sausage with white sauce

Day #2 on campus (Thursday) started out with insulin pumps. Since I'm enrolled in an endocrinology specialty, I also had workshops for my diabetes class this trip. We were required to wear insulin pumps the last two days we were on campus, so on Thursday morning we met with some reps from the company who showed us how to attach them and program them. It was a really interesting experience. The pumps were filled with saline instead of insulin, but they were on and running like we really were diabetics. For those last two days we had to check our blood sugar with each meal and bolus our "insulin" accordingly, taking into account our meal or snack intake. I was thinking about the pump all day, and even though I'm not diabetic it had me worried about what my blood sugar was going to be and how it would react to the food I was eating. It would be so overwhelming to know this was a disease you'd be living with for the rest of your life. We even had to wear these pumps home with us that night, sleep and shower with them, etc. It was a really valuable experience that I think will better help me manage my diabetic patients.

After getting trained on the insulin pump, I had to go back to a few OB workshops. We had some pregnant patients at various weeks gestation where we got to practice palpating the presentation of the baby in their abdomen. We also practiced finding fetal heart tones with a handheld doppler. These rotations were pretty easy for me because I did them every day as a labor & delivery nurse ;). I also didn't need much help in the lactation station; I've probably had 12 hours class-time of professional breastfeeding training, in addition to well over 100 hours of helping patients breastfeed on the floor as an RN. We practiced pap smears and then had a display table with all these different contraception options. The tables were so pretty, I had to take pictures! (again I apologize, for some reason when I upload the pictures onto my blog they're pretty grainy and hard to read!)

This shows a few different options for intrauterine devices - these ones are the Mirena and Paraguard

This section was mostly about diaphragms

These CycleBead bracelets are so neat!!

Such a cool chart, I want one some day! Each slice of this "pie" talks about a different birth control method

LARCs (long-acting reversible contraception devices) are by far the MOST reliable methods of contraception (except of course absence of ovaries/uterus or abstinence)

AND THEN...my favorite part of the day! Practicing IUD insertion. They gave us lots of goodies to take home and practice with. 

IUDs for everyone!

Also P.S. this didn't take place at Duke but last week as part of my OBGYN rotation I got to place my first IUD on a real person!! It was awesome.

Placing an IUD can be pretty painful, but good news is the pain is only short term! 

After our OB workshops, I had to head back to my endocrinology cohort for some lectures about carb counting and adjusting insulin treatments. One of the dietitians we had talk to us is a Type I diabetic herself, so it was nice to ask her questions about her experience as a patient and characteristics she thought were helpful in a provider giving care to diabetics. We did a bunch of complex case studies for the rest of the day. When it was time to go home, many of my classmates were going out to barbecue for dinner (I wanted to go so bad!!) but we had a test the next morning that I didn't feel prepared for at all. So I declined and went back to my hotel to study. Turns out I was exhausted and fell asleep around 8 pm. Whoops!

My walk to the medical school on Friday morning...it was a pretty overcast day at the Duke Medicine Circle (it literally is a circle). That large building is Duke Medical Center. It is in-between the medical school and the nursing school. Duke University Hospital is down the road a bit. 

The next morning I got to start out my day with a test. Not "test" in the traditional sense of the word, but a standardized patient. This is a common method of testing comprehension and skill for medical students and PA/NP students. Basically the school hires patients and trains them to run a patient encounter for us. We go into their patient room like we would at the clinic and ask them why they're there that day, then continue to collect their history, do the exam, reach a diagnosis and discuss treatment with them. We usually have a time frame to do this (15-30 minutes) and there is a camera in the room so our faculty can observe and grade us from another room. After our time is up the faculty comes into the room, we present the patient to the faculty like we would to our preceptor in clinical, and then get feedback from the hired patient about how comfortable they felt around us, things they did or didn't like, etc. 

These standardized patients take place in a wing of patient rooms built just for this purpose in the medical school building. So that's where I spent most of my Friday morning!

Trent Semans Center of Duke School of Medicine

It was an interesting experience because this was testing our competency as an endocrine specialist, not just a primary care provider. In other words, how well would we manage this patient after receiving a referral from a family practice provider. In case you're wondering, I aced it. I had been so worried about not being prepared, but I had completed a case study before coming to campus that was very similar to the patient situation I ended up getting. 

After the patient encounter, I had to write up the chart note to document the visit (we get graded on those too). I stayed in the lobby of the medical school to finish it up before heading back to the nursing building on the other side of the medical campus. 

Working at the bottom floor of the medical school...the building you can barely see the top of through the middle pane is the roof of Duke Chapel!

The rest of my Friday was spent with my endocrine cohort. We got to go to Grand Rounds for the endocrinology department of Duke Medical Center...it was so neat! I left feeling totally inspired and in awe of everything that physicians learn. Hearing a discussion among these fellows and attendings about just one protein and how greatly it can impact our function or create disease was truly fascinating. 

The last bit of our day on campus we spent talking to reps from several different insulin pump companies. It was really helpful to handle several different types of pumps, insulin delivery devices and methods for continuous glucose monitoring. It did make me a little sad though to see how the market for these items is a little corrupt, and many patients don't get options to choose which pump they want even though they all cost the same (it has to do with insurance...surprise surprise). After the reps left we finally got to take our insulin pumps out and debriefed about our experience using them. That wrapped up my three days on campus!

When we finally finished I took a walk over to Duke Chapel, because I can't not visit there if I'm on campus. Seriously, it is SO beautiful! Campus was buzzing during my walk over there because people were heading to Cameron Stadium for the Duke football game against Miami. I mean seriously, SO MUCH BLUE on campus. Everyone was wearing their school gear. We lost, but hey. 

I spy with my little eye...some more Blue Devil shirts.

And that wraps up my trip to campus! I left early the next morning (Saturday) to come back to Idaho and then started my first OBGYN rotation that next Monday. It was exhausting, but I love seeing the progress I've made and I'm feeling very excited about my future career!

Helloooo North Carolina

FRIENDS. It has been forever since I posted anything.

Right now, I'm sitting at a hotel in Durham eating a chicken bowl from Chipotle and watching the Holiday Baking Special on Food Network (yes, I'm one of those people). I finally have a few hours of a guilt-free break so I figured I'd catch up here! I had planned on doing more touristy things in NC this time around but I didn't take into account daylight savings. It got really dark really early, so maybe another time! There's still about a hundred trips left to come to campus.

In honor of being in the South, how about a little country song...love this lady. And this song.

Anyway, an update.

I am almost one semester closer to becoming a nurse practitioner. Let me tell you what, my advanced physical assessment class has made that feel real.

For example, today we practiced acute and chronic cases all day. We haven't learned how to diagnose yet, but we're supposed to start practicing what questions to ask and what body systems to examine based on the patient's complaint. This is how my first case went:

(Also, this case is made up and not a real patient...my classmates and I just made up stuff for each other to practice)

Me: Hi, I'm Sarah. I'm the nurse practitioner student working with you today, what brings you to the office?

Patient: I've been having some really bad nose bleeds.

Me: Oh really? How long has this been going on?

Patient: Well, I've had 4 nosebleeds in the last 12 hours.

Hold up. WHa???????

Sit and think for a few seconds before asking more questions.

How do I find the cause of this? I mean, I'm thinking this could be hypertension or allergies but this also could be something totally different. WHAT IF SHE HAS CANCER. (Don't worry, I didn't even consider that the patient might have stuck something up their nose, which is a very likely explanation. Tunnel vision at its finest).

And then I continued to ask several questions and did a physical exam and felt suuuuper overwhelmed about the responsibility of this job. This was only a nose bleed but it could've been diabetes, irritable bowel syndrome, meningitis...you never know what's going to walk in the door.

I looked up the top ten reasons people visit their doctor, and I found things like fatigue, lower back pain, abdominal pain, headache...there are so many things that could cause any of them. I realized the magnitude of my responsibility as a nurse practitioner before starting the program, but truly...you can't afford to miss stuff. There is so much to know. And I'm actually really excited to learn it all.

One of the main points of this campus visit was to pass off our comprehensive physical exam we practiced last month and I passed, so at least there's that. I will actually learn to diagnose and come up with treatment plans in future classes.

Also, North Carolina is beautiful. Specifically, Duke is beautiful. It's not anything like I'm used to...I still think Idaho is my favorite place ever...but North Carolina probably has more than it's fair share of the beauty ticket.

The gardens on the Duke campus are breathtaking. It's literally 50 acres of the garden of Eden, and it smells sweeter than candy. Not to mention the school buildings are old and charming and have a gothic feel to them.

that little cottage is for the caretakers...how cute is that??

And guys, THE CHAPEL. The first time I accidentally drove down the wrong road on campus, the chapel was right at the end of the road...what a spectacular sight.

Not to mention that their new nursing building is phenomenal. State of the art equipment. I got to peek inside the OR simulation lab and that was the coolest thing ever...I mean who has a simulation room that looks and functions like an operating room??? Another wing of the building is like a hospital wing, complete with a nursing station and everything. This is seriously an amazing school with a great program. I feel so blessed.

Anyway, school and work is pretty much all that's going on in my life. If you've been trying to get a hold of me and I haven't answered or gotten back to you it's because Duke owns my soul.

Love to you all!