Tips for Introverted NPs

I entered the medical field because I had a knack for science.  In elementary school, I told questioning adults my favorite class was science.  In middle school, I was an avid member of the earth science club.  In high school, my favorite class was anatomy and physiology and I won an award for having the highest grade.  Science had always came naturally to me, so becoming a physician or nurse seemed like the best path for my career.  In college I majored in biology and I think I was the only student who actually enjoyed the second semester of O Chem.  Throughout my nurse practitioner program, my interest in pathophysiology and pharmacology was reinforced.  Yes, medicine was for me.  Then, it was time to start seeing patients.

I am an introvert.  My family and friends would say the same.  Unfortunately, no one had warned me about the social part of practicing medicine, you know, interacting with 30 or so patients every day.  I see a new person every 10 to 30 minutes of every day.  I found, and sometimes still find, the amount of conversation and social engagement required by my position to be one of its most demanding aspects.

Working as a midlevel in my practice requires a lot of acute and urgent care.  I do have my own patient panel, but it is not nearly as large as the physician's panels.  So, forming long-term relationships with patients has not been the norm.  I enter a patient's room and immediately have to develop report.  I introduce myself, shake a few hands, and survey the situation.  I ask questions about the patient's medical condition and work to instill confidence on part of the patient and the family (as they are likely thinking I look like I am 12 years old.)  For an introvert, this can be tremendously draining and I can get burned out.  I know there are other introverted health care providers out there, so here are some tips...

The great part about the conversations we have with patients is that they lend themselves to asking questions rather than forcing us to be the one to do the talking.  Introverts tend to be good listeners so use this aspect of your personality as an advantage.  I have found that I don't have to do much of the actual talking in the patient interaction.

Getting into a routine with how I conduct a patient visit leads to less effort.  Have a standard introductory greeting to explain who you are and the role you will play in the patient's care.  Have a set of questions you ask patients with common presentation of illness.  Develop explanations for pathologies of disease.  As you get in the habit of doing these things, you will exert less energy figuring out what to say leaving you with more left in the tank at the end of the day.

Communicating by email isn't typically an option for taking the stress out of patient visits, but when you find yourself facing a difficult conversation with an administrator or coworker, it may be.  Write down your thoughts to help plan the conversation.  As an introvert, this allows you the added time for reflection you may need to communicate your thoughts effectively.

The temptation to think "I'm the wrong person for the job" when I'm exhausted from talking to patients every day is real.  But really, it is a chance for growth.  God continues to try to shape me to be more like Jesus in giving me the ability to engage with and care for a lot of people at one time.  Being introverted is not a character flaw.  This challenge has helped me to grow professionally but also personally.  This is one situation where what you learn on the job just may benefit you at the next family get together or class reunion.

As an introvert, I require time to decompress at the end of a busy day.  I tend to feel exhausted and overstimulated.  Nothing that 30 minutes alone can't fix, which is why I am thankful for my commute to and from work.  Take the time you need to recharge at the end (or the beginning) of the day.  Make time for the alone time that you need.  This way you will have the energy you need to tackle your next shift. 

The Waynesburger.

Josh and I recently discovered a new, delicious gem of a restaurant called the Waynesburger.  If you live in Southcentral Pennsylvania, I would encourage you to meander over to downtown Waynesboro for some fresh, tasty food.  The Waynesburger is actually known for their gyros and other Greek food options contrary to the restaurant's name.  My personal favorite was the falafel platter; seriously divine.  You can also enjoy a gourmet burger or one of their 51 flavors of milkshakes.  Enjoy!

A day for mothers.

Today Josh and I traveled to have a Mother's Day lunch with my family.

We ate a delicious meal, talking and laughing until our bellies were full.  Mom even got to enjoy her favorite dessert, homemade chocolate eclair dessert.  Additionally while we were eating lunch, she got to see some of her high school friends.  Many of her friends said, "It is so nice you can have your children with you today."  She filled with pride as she realized that all of her children were in one place.

She has given so much time and support to her children.  For 20+ years she has spent an immeasurable amount of time being a "room mom," reading us books, or helping us with homework.  She has sat through countless dance recitals and sports games.  Volleyball, basketball, soccer, softball, track and field, even bowling.  My parents attended most of my home games when I played a sport in college!  She has withstood ceremonies, spelling bees, graduations.  She has always tried to support us through the mountain tops and the valleys of life.   She has always been our number one fan.

So much of who I am today is because of my Mom and my family.  May she always know that she is loved.

A Friend to All Rabbits.

Josh and I have two rabbits, Jack and (Fertile) Myrtle.  After being our pets for about one year, they have grown into very large adult meat rabbits.  They give us compost for our garden and entertain themselves with toys.  And by toys I mean inexpensive items like cardboard.   They are friendly to pet and jump around when I walk out the door in the morning.  Mostly, they are adorable and low maintenance.

Rabbits eat a high-fiber diet including a lot of hay, which is recommended for their GI tract and teeth.  Rabbit teeth grow continuously about 3mm per week; a nice way to maintain pearly whites at all times.  Chewing the hay helps to wear down the rabbit’s molars.  Luckily my sister and her husband are willing to give us an endless supply of alfalfa grass hay, which the rabbits love.  Jack and Myrtle also eat pellets and of course, fresh green vegetables.  A surprising fact is that rabbits are not to eat too many carrots, as this orange vegetable is high in sugar.  They need access to water 24/7.  Since we live in the Northeast, we had difficulty with their water bottles freezing over the winter.  So we invested in two heated bottles - cheap on Amazon and worth every penny.

Last year, Josh handcrafted their hutch.  Yes, I am that convincing.  Jack and Myrtle live in separate crates so we don’t end up with sixty rabbits.  Their gestation period is 28 DAYS (not 40 weeks).  The blue piece of plastic on the floor of their cage is to avoid “sore hocks” as rabbit feet are not made to stand on metal all day.   Josh also built two nesting boxes, which we filled with hay over the winter during the negative temperature nights.  Fortunately rabbits prefer the cold rather than hot, humid weather.  Jack and especially Myrtle love their nesting boxes.  Since rabbits think like prey, the boxes give a sense of security.

Their hutch is located over our compost pile so the rabbit dropping and left over hay eventually get mixed in with our other household organic waste.  Some people keep their rabbits inside the home and actually litter train them – I don’t have time for that.

So, rabbits are basically our favorites!  If you would like a rabbit, let me know….I am dying to let Myrtle have babies at least once. 

A splendid weekend.

We had a splendid weekend celebrating Spring with dear friends. They flew from St. Louis, Missouri to be with us and we loved every minute. Some guests leave and you're kind of relieved to get your house and routine back. Others you just wish could stay for a few more minutes... or a few more days - They are those kind of guests. We visited some of our favorite spots in Chambersburg, including a hike at Tumbling Run.

 

Brook and Josh,
We have much in common and it seems that we can pick up right where we left off. We loved our time with you...Kenzos, grilling dinner at home, Mrs. Gibbles Candies, homemade ice cream, the Dutch Fest, the farmers' market, the community. We are so blessed by your friendship and cannot wait for you to come back!
Lots of love,
The Rabers

Epiglottitis.

I have been seeing a lot of patients with the seemingly straightforward chief complaint of "sore throat" the last several weeks at the clinic.  Some patients are diagnosed with streptococcal pharyngitis with a rapid strep test, some are diagnosed as viral, while others' sore throats seem to be more seasonal allergy related.  Spring is finally here and I have already started my daily claritin!  While sick visits can be a good challenge and are enjoyable for me, the "sore throat patient" can seem a bit methodical.  So, I reminded myself to keep an eye out for rare "zebras."  You know, a diagnosis that seems simple but turns into something crazier than usual.  That's when I remembered learning about epiglottitis.  Since I have never diagnosed an epiglottitis in my practice, I decided to look it up again and why not write about it on my blog to further seal it in my memory?

Epiglottitis is inflammation of the epiglottis, the flap at the base of the tongue that keeps food from going down the trachea and into the airway with swallowing.   It is most often caused by Haemophilus influenzae type b but may also be caused by other types of bacterial infection.  You may have heard of Hib, because it is the name of a great childhood vaccine.  Non-infectious etiologies of epiglottitis are rare but include thermal causes, crack cocaine or marijuana smoking, foreign body ingestion and head and neck chemotherapy.  Providers must be capable of diagnosing epiglottitis quickly.  While initial signs of epiglottitis can be mild, the condition progresses quickly and is life-threatening.

Case Presentation: A 19 year-old female presents to your clinic complaining or sore throat and a muffled voice.  She states that she has difficulty swallowing.  Her symptoms began upon waking a few hours earlier.  The patient is generally in good health with no significant medical history.  She has a fever with a temperature of 100.8 and is tachycardic with a pulse of 112.
On exam, you notice the patient is unable to swallow secretions and is spitting.  She is in no respiratory distress but states it is difficult for her to breathe.  Her pharynx appears normal but you note cervical lymphadenopathy on examining her neck.  Her lung sounds are clear.  Based on the patient's symptoms, you order an X-Ray of the soft tissues of her neck which shows a "thumb sign" indicating epiglottitis.

So, the diagnosis of epiglottitis is based on clinical presentation and coorelated with imaging.  While X-Ray has traditionally been used to diagnose epiglottitis, laryngoscopy is now the preferred method. And that is when I call the patient who is sitting in the xray lab and direct them to the ER immediately. The enlarged, inflamed epiglottis can cause airway obstruction making airway management of utmost importance in treatment.  Patients need to be closely monitored in the ICU and may need to be intubated if they become unstable.

Third generation cephalosporins such as Rocephin are first-line treatment for epiglottitis.  Corticosteroid use in epiglottitis is controversial and has not been shown to be effective.  Antipyretics such as acetaminophen should be used to treat fever as necessary. 

Ok, now I really need to start studying for my ACLS recertification class that is scheduled for next week!

The Disease of Busyness

As a Nurse Practitioner, I am around people all day long five days a week.  Every ten to thirty minutes, I see a different face, hear a different story, create a different plan.  Recently a theme throughout many of my visits is busyness.  People are busy.  Too busy to follow a healthy diet.  Too busy to exercise for 30 minutes.  Too busy to take their medications.  Too busy to see a marriage counselor.  The list goes on and on...  And you know what?  I believe them.  Many of my patients feel busy because they are busy - They work jobs, take care of their sick parents, have a spouse, coach their child's sports team, try to put food on the table, pay their bills.  At the end of the day, there is not much time to allocate toward their own health.  I am not only speaking of physical health, but this busyness also affects emotional and spiritual health.

There are times when I see this same busyness in my own life.   My personal busyness comes from several commitments, like the demands at my workplace or being highly involved with church or other organizations in the community.  I have also found that much of my busyness comes from my tendency toward order.  I like my house to be tidy.  I like my car to be clean.  I like my yard to look, well, not like a jungle.  While this task-focused aspect of my personality is not a bad thing, if left unmonitored it can be destructive.  I end up doing meaningless tasks much of the time.  I tell myself that after my checklist has been completed I can sit, pray, go for a run, or spend time with people.  The reality is that the checklist never ends and I end up being too tired to do anything else.

My patients are weary.  I also feel overwhelmed at times.  No one is immune to the disease of busyness that is so prevalent in our culture.  I know, I know, busyness does not have an ICD9 code but you get the point.  Busyness prevents us from having intentional and meaningful relationship with our spouses and our families because we are already spent.  It balks at genuine friendship and community.  It eventually inhibits our ability to enjoy life and we forget to "smell the roses."  Even more importantly, busyness can keep us from communing with God.  When we neglect prayer and reading God's Word, we are more prone to fall to the temptations of our sinful nature.  At first following our sinful nature may be pleasurable, but ultimately our lives will be a wreck.  So much stress and sadness could be avoided if we started to say "no" to busyness and instead started to follow God's Word.

So, I am going to echo Socrates and say, "Beware of the barrenness of a busy life."  Let a few dirty dishes in the sink because sometimes it is worth loosening your grip on the checklist.  Don't let the disease of busyness steal what matters most.