The other night I woke to the sound of my 16 month old German Shepherd puppy named Dio clacking my Kiehl’s lip balm top around in his mouth & immediately thought, 'This would be a good Medelita blog topic: adverse drug reactions.' After I wrangled the punctured plastic from his mouth, I wondered how much pear lip balm an 82lb dog can eat. Mind you, this is 2am, on a Friday night after a long workday and I want to go back to bed. About an hour later, I hear the sound of ripping paper as I discover Dio tearing one of my bedside AAPA journal covers. Obviously, my brain is in overdrive because this second incident inspires an idea of ‘proper bowel regimen review with surgical patients’ & how THAT would be a good blog topic. I work at Sibley Memorial Hospital in Washington DC, 7 miles away from my home in Virginia. The DC Metro area is known for politics, education, traffic, and well-connected movers and shakers. As a Surgical Staff PA, I have the opportunity to work with amazing nurses, NPs, CRNAs, Physicians and Surgeons. Thanks to a great and flexible boss, I have been able to focus my clinical efforts primarily on preoperative medical care. I love interacting with patients and their families, and take great joy in offering them a sense of personal empowerment through patient education. Today, I was reminded that patients can also teach us great lessons. One of my patients was an add-on for a joint I&D. This patient had classic signs & symptoms of a septic joint: an exquisitely painful, hot, red, swollen joint, with limited range of motion. Despite these issues, the patient was extremely polite, articulate, and pleasant. As anyone who has ever had surgery can attest, surgery can be scary and can make patients react adversely to members of their medical team. Typically, their reactions aren’t personal - it's just fear, anxiety, and/or pain. My patient’s attitude was totally different, however, and told me, “My surgery can either make me better or not. Nothing I can do to make the odds any different.” Given that this patient was so helpful & the case, so interesting, I found one of our PA students and brought her in to see this patient. I still remember many of the 'Come here - you gotta see this!!' cases from my own clinical rotations in graduate school. Some of the most memorable include: the look (and smell) of necrotizing fasciitis, dental signs of methamphetamine abuse, metastatic cancers, and uncontrolled schizophrenia. Needless to say, my student was thrilled because she had never seen a textbook septic joint and furthermore, the patient was earnestly pleased to show her. During my student's exam, I thanked the patient for “teaching” in such an indelible way. Two days after midnight lip-balm massacre, I took Dio to the vet for his checkup & rabies shot. The vet assured me the only major damage the Kiehl’s could do to my young 4-legged thief was to 'grease his pump' so to speak; no major adverse drug reactions. I appreciated that his early morning mischief session had such a benign outcome. In truth, lessons can be learned anywhere, anytime, from anyone. So, I thanked my dog for being such a good teacher, rubbed his tummy and gave him a vet and PA-approved doggie treat. Charlotte Lemmert, MPAS, PA-C lives in Virginia & is on Surgical Staff at Sibley Memorial Hospital in Washington DC. The next big thing in her life will be moving, cross-country, to Northwestern Washington State in January 2012 with her husband, dog and plants in tow.
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