Sunday, July 31, 2011

Boom! Take That, First Rotation!

For most of July, I worked in a Family Practice clinic with a doc who uses OMM (osteopathic manipulative medicine) for some of his patients.  After two years of having my face in a book, it was exhilarating to actually be in a clinic and working with patients.  There were times when I felt like an actual doctor and, as expected, many times when I realized just how little I know.  It seems that most of the patients we saw had the problems you'd expect: diabetes, hypertension, hyperlipidemia.  My doc was a former flight doc and a great guy.  Literally, he'd bound down the hall and into a patient room.  Often, I'd have to run to remain hot on his heels. He taught me a ton and didn't make me feel like an idiot.  Occasionally, I'd do that on my own.

Valsalva and the Fluid in the Ear
One patient came in with a complain of fluid behind her ear.  After taking a brief history, I looked in her ear.  Sure enough, I was able to see a little fluid bubble behind her ear drum.  My doc asked me to have her perform a Valsalva maneuver and see if the tympanic membrane fluttered.  I thought it a little strange but, as I was looking in her ear, I asked her to "bear down" with her abdomen to increase pressure.  She looked at me a little funny.  "Bear down," I repeated.  "Sort of like when you're having a bowel movement."  Her face looked at me with the same confusion that I felt inside.  What the hell does a bowel movement have to do with an eardrum?  Why do a Valsalva for this?  I made eye contact with the doctor who was staring at me like I was a total moron.  As he walked over and took the scope from me, he said to the patient, "Just hold your nose and swallow."
"I didn't know that was also called a Valsalva," I whispered.

Saturday, July 30, 2011


Didn't want to jinx anything by writing.  I've passed my Step 1 boards.  The silence is over.  I'm back with stories from the field.