From MSNBC.com, Teen Girls Charged in Nursing Home Abuse

ALBERT LEA, Minn. - Two teenage girls who worked at a nursing home have been charged with abuse, accused of taunting, spitting on and groping the breasts and genitals of residents who suffered from Alzheimer's disease and other dementia disorders.

According to the criminal complaint, filed Monday, 19-year-old Brianna Broitzman and 18-year-old Ashton Larson laughed earlier this year as they spat in residents' mouths, poked and grabbed them, and at times mocked them until they screamed.

Broitzman and Larson worked as part-time aides at the home

What. The. F#$%.? Who on earth behaves this way? And who on earth would think this is funny? I find no humor in abuse. What on earth were these kids thinking?

I might find this more offensive than most people - I was a Nursing Aide for almost five years before I went back to school. I took care of people in the local nursing home, and when on o work as a home health aide and provided care for people in their homes. My inspiration for going to medical school was my patients! They inspired and encouraged me to become a doctor. And today, I read this? It doesn't matter that I don't know any of the parties involved - my patients are the same population as these abuse victims. It is as if these girls abused my patients, and spit in my face.

And here's the kicker:

Broitzman and Larson are charged with assault, abuse of a vulnerable adult by a caregiver, abuse of a vulnerable adult with sexual contact, disorderly conduct and failing to report suspected maltreatment. All are gross misdemeanors.

If found guilty, Broitzman and Larson "most likely will face suspended jail sentences and probation, so they'd have the threat of jail hanging over them if they get in more trouble," Freeborn County Attorney Craig Nelson told the Star Tribune of Minneapolis.

WHAT?!?!?!?! PROBATION??? I don't think so!! They need to go to jail, see how funny it is when they get pushed around and beat up by the inmates when they find out these ignorant brats abused elderly people! I cannot, for the life of me, figure out what this County Attorney is thinking. A slap on the wrist for repeated abusers?

What on earth is this world coming to?

Whoa. I can't believe it's been almost a year since I updated this thing. Let's see, what have I been up to.....

	Psychiatry: Psych was excellent. Had a great preceptor who loved to teach and had a great sense of humor. Spent the mornings on the inpatient lock-down ward, and the afternoons in a private clinic. Got to go to court and watch a conservatorship hearing (at the same time Britney was having her psych melt-downs, but that wasn't the case I saw.) Interesting, and fantastic experience.
	Infectious Disease: excellent, had great preceptors who trained in third world countries and had stories that would make just about anyone want to be like "bubble boy." For my end of rotation presentation, I gave a 30 minute talk on Mycobacterium Avium Complex, and quoted the heck out of one of my personal heroes through all the research she's done. (Gwen, if you're reading, I read all your papers! I'll bring my PowerPoint for you to critique next time I am in Denver!)
	Internal Medicine: 28 days of masochism. After the first week, I figured that having a battery acid GI prep would be more fun. 30hour call every four days. Egos that rivaled the surgeons. I counted every day down until the end. On the schedule, it should have just read, "Abandon all hope, ye who rotate here."
	Pediatrics: LOVED Peds! Seriously considered doing Peds, and would have if I hadn't already arranged to do a bunch of family med "audition" rotations, and couldn't swing any for Peds. Pediatricians are about the coolest docs out there.
	OB-GYN: Luckily, I had some great preceptors, and while any rotation at a county hospital is wicked hard, I got to see a LOT of pathology, scrubbed in on some cool gyn surgery cases, and actually delivered some babies. Yep. Me, on the business end telling the patients, "You're doing great! Get ready to push!" while they yelled obscenities at their husbands and the nurses. And for the record, anyone who says that childbirth is beautiful hasn't been on the business end. I mean, seriously, nothing beautiful about it. Not a single thing. Worked with some awesome midwives that taught me some interesting things about deliveries. Became a "Pap Queen".
(Pretend there is a picture of a rash here. Really. It's ok. They all look the same anyway....)	Derm: 3 days a week, in San Diego county. 70 degrees every day I was there. The good news is that the rotation was almost all pathology, and none of that microdermabrasion/Botox/Restylane crap. The bad news was that I spent almost every minute of my patient contact time shadowing. However, I can spot an actinic keratosis at 50 yards.
	Family med x2: One site was so excellently outstanding. I worked my butt off, had my own clinic patients, got to do some outpatient surgery, was a camera operator on some endoscopies and colonoscopies, spent a day at a rural clinic. I fell in love with that site. The other was ok - had some great preceptors, and free food. The commute was hell.
	NICU: At county, had two fantastic preceptors. Had fun playing with the premies, got to see some interesting pathology, including a rare trisomy. There are reasons that those little buggers need to bake for 40 weeks. Learned the difference between "Cute" and "Precious" (hint, the latter is reserved for the "not-cute" babies.) Got to play in the newborn nursery with the fully-baked kids and thought, "my god, these 7-pounders are HUGE!"
Research: A nice, laid-back month. Recruited test subjects, gathered data, found a great bakery down the block that makes organic curry bread.	Mmmm... curry bread....
	Currently: on radiology. Have an excellent preceptor - he started medical school in his 30s as well, loves to teach, and has a crazy-busy rads practice a few miles away from home. Great hours, even better teaching. Oh, and got to spend a day with a radiation oncologist. They have cool toys.

On the horizon:

	EM. Yeah. Sounds... fun.... At least the hours are good. Otherwise, the ED is like being a sorter for the postal service - sort the patients, decide to admit and call the inpatient team to take over, or send them out the door.
	Ortho Surg. 12 hour clinic days. Only one day a week in the OR. Broken fingers, broken ribs, broken femurs and tibias. Disarticulated joints where bone is replaced with metal and screws, and the OR looks like the tool isle at Home Depot. And I'll spend all month trying to figure out why ortho guys are a bunch of moose. (Seriously. I can't figure out why the people who are attracted to ortho are over 6 feet tall, and over 200 lbs... they are GIANTS!!)
	Pain management: joint injections, pain med injections. Sticking people with needles...
	The great unknown. I haven't decided on my last rotation. I mean, it's the last month of my medical school career. Should I go out with a bang on a butt-busting whirlwind of medicine, or rest on my laurels, and take it easy? I'll have to decide soon...

Now, let me state something - surgery is very interesting... to watch. But. let's face it, I'm a clinician, and a primary care one at that. I like talking to patients, remidning them to watch their blood sugar levels, fussing over their blood pressure. I am not a surgeon. I lack the surgeon personality, and I don't like fixing a patient and never seeing them again. And, frankly, I'm quite miserable with 12 hour days and 30 hour on-calls. Thank heavens there are those who answer the call to the OR, but me? No thanks. I'm counting down the days to the end of this rotation.

In other news, we have a new addition it the family.

Introducing Miss Ailsa Lilly:

 

I forgot how nice it is to have a Scottie around the house. I also forgot how much of a pain housebreaking is. Oh well. Now I have three happy tails wagging when I come home from the OR everyday. It's worth it. And since we have the new pup, and being the high tech family we are, of course all the "kids" have their own webpages:

And for our Dearly departed girl:

Eric tagged me for a meme, I'll try and get it done tomorrow when I get home. And thanks to everyone who keeps leaving me notes. I wish I had more time to blog and blogwalk. I miss that.

(Not really a picture of Fred. Fred's much better looking, and cooler. This is probably Fred's twin, Scott. Scott's the model, but Fred's the smart one...)

May 2006

June 2007

Rank/Specialty/ Score 1 occupational med 48 2 rheumatology 46 3 nephrology 46 4 preventive med 45 5 aerospace med 44 6 thoracic surgery 44 7 radiation oncology 44 8 anesthesiology 43 9 hematology 43 10 physical med & rehabilitation 43 11 pediatrics 43 12 otolaryngology 43 13 orthopaedic surgery 42 14 pulmonology 42 15 plastic surgery 42 16 psychiatry 42 17 med oncology 42 18 general internal med 42 19 infectious disease 41 20 neurosurgery 41 21 ophthalmology 41 22 obstetrics/gynecology 40 23 dermatology 40 24 family practice 40 25 colon & rectal surgery 39 26 nuclear med 39 27 neurology 39 28 pathology 39 29 urology 39 30 radiology 38 31 gastroenterology 38 32 endocrinology 38 33 cardiology 37 34 emergency med 36 35 allergy & immunology 36 36 general surgery 36

Rank/ Specialty/ Score 1 hematology 47 2 rheumatology 46 3 pediatrics 46 4 occupational med 45 5 nephrology 45 6 med oncology 45 7 family practice 45 8 dermatology 44 9 radiation oncology 44 10 anesthesiology 43 11 psychiatry 43 12 physical med & rehabilitation 43 13 obstetrics/gynecology 42 14 orthopaedic surgery 42 15 preventive med 42 16 aerospace med 42 17 plastic surgery 42 18 general surgery 42 19 thoracic surgery 41 20 ophthalmology 41 21 pathology 41 22 nuclear med 40 23 neurosurgery 40 24 general internal med 40 25 colon & rectal surgery 40 26 emergency med 40 27 pulmonology 40 28 gastroenterology 40 29 endocrinology 40 30 cardiology 39 31 infectious disease 39 32 otolaryngology 39 33 radiology 39 34 urology 38 35 neurology 38 36 allergy & immunology 36

From the latest results, it seems that I should never even try allergy/immunology (fine by me, way too complicated). However, infectious disease has moved even further down the list (*cry*) but family practice has surged in the listing. I'd be happy in family medicine - it's cool that you get to see a little bit of everything, so each day is different. I can live with that.

•  I assisted on the circumcision of an infant. The first patient of the day, and I didn't realize it until I got into the office and saw the schedule. The first thing the the Doc asked me was "Did you eat breakfast?" I stated, yes, I had, and he went on to explain, "That's good. I've had a few nurses who have assisted with this, and thought it would be better to fast as not to upset their stomachs - they passed out." Luckily, I remained on my feet. Go Grapenuts! 
• I gave a tetanus shot. Yep, the medical assistant, bless her heart, asked if I wanted to be the one to give the patient a sore arm. I jumped at the chance - and the patient, I can report, is doing just fine with no adverse effects.
• I still can't tell the difference between different derm disorders. The damn things look the same to me. Just when I think I have one pegged, nope, it's something else. It's starting to make me mad.
• I've been doing a ton of Well Child Exams. At school, we never got a chance to examine kids - all of our standardized patients were adults. Adults are really good about remaining silent, taking nice deep breaths when you want to auscultate their lungs, and take direction very well. Kids, on the other hand, are really good at making noise, humming songs while trying to auscultate their lungs, and doing what they want when they want. Need to look at their throat? It ain't going to happen. I even say "ok, now this is your chance to make faces at me and stick out your tongue." Nope. And don't even think about trying to look into their noses. Ask for them to walk to the door and back to mommy? They skip, or walk like a peg-legged pirate. This, my friends, can be very frustrating. However... 
• I'm becoming a pro at doing Well Child Exams. Why, you ask? I'll let you in on my secret: tongue depressor stick puppets and latex glove balloons. Luckily, I haven't had to give them any shots... yet.....

Which Princess Bride Character are You?
this quiz was made by mysti

I guess this is the forerunner to the "You've Come a Long Way, Baby" marketing of Virginia Slims. It's really nice that they are praising the 7250 female docs in the US (whoa!) but.... still....

For more Physicians Choosing Camels madness, ckeck out The Visual Telling of Stories, Doctors and Cigarettes.

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As for me - three exams down, six more to go (in the next two weeks)......

So, once we can tie square knots quickly and, more importantly, correctly, we move on to our patient. Here is my patient, Babe, and my equipment - a needle driver, scissors, tweezers and a scalpel. 

In addition to our tools, we get little packs of sutures. Here's one of my packs. This one happens to be made of silk, which was nice and easy to work with. The most difficul one, for me, was the nylon - it doesn't cooperate as nicely. Also, there's all sorts of information to be gleened from the package - the gauge of the needle, and the type of needle (in this case, it's a cutting needle.)

So, we use the needle driver, which is a lot like a hemostat, to push the needle through the skin, then we tie the knots (called "throws") either by hand, or usng the instruments. Here are some examples of the types of sutures we did.

My first knot on my "patient".

 

Simple interrupted - used in general skin lacerations.

 

A simple uninterrupted - like a running stitch.

 

 

Mattress Sutures: the top most is horizontal, while the middle two are vertical. These are used in orthopedics, and other procedures when they want the tissues to "tent".

 

 

The final set is the subcuticular sutures - these are the "hidden ones". I was quite pleased with these - while they are a little bunched, my laceration stayed closed, while other students had some gapping, or the stutures weren't very secure. Also, these were done with the "disolving" sutures, so that's what that white thread is.

 

So, there it is - my adventures in suturing! In the meantime, I'll be waiting for my practice board to arrive so I can keep practicing my knots. Now, back to the other boards... the licensing boards!! 

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edited to add: AvocadoWookie posted this article about laceration repair in my comments that is a great read, and full of cool information (if you're one of those people who likes to know about everything in the universe!) Thanks, AV!

You tend to pursue many different activities simultaneously. When misfortune does happen, it doesn't actually dishearten you all that much.
You are a thoughtful and cautious person. You like to think about your method, seeking to pursue your goal in the most effective way.
You like following the rules and being objective. You are precise and meticulous, and like to evaluate decisions before making them.
You have a sunny, cheerful disposition.
What does your drawing say about YOU?

(actually, all mine really says it that it's a good thing I'm not trying to be the next Monet!)

Happy Sappy Day to all. And I hope you don't get anything from your sweetheart that is on this list.

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In other news, I got my third pick in the rotations lottery. I'm pretty happy about it - at least I get a portion of summer off to visit my parents, and the bulk of my clerkships are in my area, so not a lot of driving. Yay!

Also, this past weekend, I surpassed yet another Medical Student Milestone (TM) - the Annual Pelvic/Rectal/Breast Exam Day. First, my heartfelt thanks and appreciation to those individuals who volunteered to act as patients for us students. A lot of students get plastic models to practice on - we we blessed to have actual living people there for us to practice on. Second, my deepest gratitude to all of the physicians who gave up their weekend off to serve as preceptors to be there by our sides during each exam so that we have reassurance and support... and backup in case we pass out. Last, the support staff who keeps the wheels rolling - we'd be lost without them.

 The biggest thing I learned this weekend was to watch what words come out of my mouth. I had been working with a female patient doing a breast exam - the encounter went very well. My patient was very comfortable with me, I with her, and we were done quite quickly. I thought everything was great until my preceptor looked at me and said:

"From now on, try not to say things like 'everything feels good.'"

My jaw dropped. My patient burst out laughing, and stated that she hadn't noticed that I said that (thank heavens!) The preceptor went on to say that, especially in these situations, we need to refrain from using casual language with patients. Thus, words like "great", "good" and "fine" should be avoided, and only "normal" and "abnormal" should be used. He's got a good point - the last thing we need to have happen is to scare a patient with a misunderstanding. However, all was well - my patient went on to tell me that she thought I did great, and will make an excellent doctor.

I'm just glad that I was so nervous with my pelvic and rectal patients that professionalism overrode all, so that I did not make the same blunder. ("Ms. Doe, your ovaries feel GREAT!" ACK!!!) 

The sun is shining The grass is green The orange and palm trees sway. I've never seen such a day In Beverly Hills LA. But it's December the 24th And I am longing to be up North. I'm dreaming of a white Christmas...

• Christina has her "Reasons of the season" list up. While she's grooving on the Christmas music, I'm quite jealous of her frosted windows.
• Jeankfl had lots of snow at her home (so much so that it collapsed the roof of her dock.) I'd be out dancing in the stuff. She also has some good advice for the holidays.
• Speaking of snow, Bill got got more than his fair share. If he can figure out how to ship it, I'd be glad to take all of that off his hands!
• Aunt Tea has a wonderful Holiday Friday Fifteen AND Five Things She Enjoys About Christmas. And he space is all decorated for the holidays. I swear I smell gingerbread every time I stop by her Space!
• Dana needs some Christmas shopping advice: what do you get that person on your list who doesn't like anything?
• Aynde has created a monster. A shopping monster. I think the reason "the girl" is so girlie and shopping addicted is because she was susposed to be MY kid, but got impatient and jumped out of Aynde's womb. At least Aynde can send her to do the Christmas shopping in a few years!
• Katie has somegreat observations from the ER. Yeah, it's not holiday related, but it will make you laugh.

From SkyMaul - a hysterical book that mocks those goofy "SkyMall" magazines they have on airplanes. Because nothing says "shopping" like riding in a tin can with grumpy stewardesses while eating the three pretzels that came in the airline-provided snack bag.

When the University of Maryland's medical school opened 200 years ago, doctors had one big problem: They needed dead bodies, and there was no good way to get them.

In those early years, the school turned to grave robbing. More than a few corpses got yanked out of fresh dirt in nearby cemeteries and wound up on the dissection table for anatomy lessons.

So as U-Md. begins to celebrate its bicentennial and a distinguished history as the nation's oldest public medical school, it seems only fitting that one of the centuries-old cadavers has resurfaced.

In Michigan.

On eBay.

Everyone, it seems, has a skeleton in a closet. And even weirder: There are still people willing to pay for them.

 

This is a great article that gives an interesting overview of the history of one of the major rites of passage for every medical student - Gross Anatomy Lab. It's humorous and morbid at the same time, thus it is required reading for everyone this week.

 

From the "Not our object, you don't!" file:

"A Divisive Deal" - Philly Inquirer, By Stephan Salisbury, Inquirer Culture Writer

At least twice in the 1970s and 1980s, deep-pocketed buyers came knocking on the doors of Thomas Jefferson University seeking to purchase Thomas Eakins' The Gross Clinic

On both occasions, administrators consulted the alumni organization - which gave the world-renowned painting to the medical school in 1878 - about what to do.

And in both cases, the alumni said no to millions of dollars, according to several members of the university community. Absolutely not. No sale.

...Old school ties were not enough in 2006, however. University trustees announced Friday that they had agreed to sell the painting for $68 million. The news, said David Paskin, senior associate dean at the university, hit Jefferson "like a nuclear blast."

The Gross Clinic is an amazing piece of art not only because of the artistic skill behind it, but as an official record of medicine in the US before the turn of the century. While I don't have an issue with the painting being on display at the National Gallery (I couldn't think of a more fitting tribute) but the idea of The gross Clinic hanging in some "Gallery" in Arkansas makes me a bit cranky. Ok, well, it's not the fact it's in Arkansas, but the fact that the Spawn of Sam Walton (He Who Created The Bane of the Universe, WalMart, Evil Corporation, TM) would own it. For crying in the night, do they have to own *everything*? Yeesh.

However, it looks like Philly isn't going down without a fight - the city claims this painting like the long-lost parent of a child star, so be prepared for some fireworks. I hope they win (because nothing would give me more Schadenfreude than seeing someone from an exploitative family get a swift kick in the butt.

 

"The Gross Clinic"

- From WikiPedia