whoa...we...whoa

I've mentioned in previous posts is that recently I finished a doctorate program while working part time and thought that short of having a newborn...it seemed unfathomable I could be as tired as I feel after my first full week as a primary care provider.  I get off of work and feel as though my head might explode, starting this new career has been way more mentally draining than I had ever expected.

Because I have a completely open schedule, when patients call the clinic wanting to be seen that day, they see moi.  What I feel most comfortable doing are well women exams....history taking, physical including a pap and then a discussion on birth control options.  I would have been over the moon if I had several of these said appointments on my schedule to begin my first week.  Start with what you know right, then work up to the hard stuff? Wrong-o.  No, I get to start with the acute illness patients...I walk into a patient's room to find a man who got jammed in the abdomen by his boat's anchor or the blind, bilateral below the knee amputee (bbka), type 1 diabetic has severe bone pain under his dentures....WTF?  As I am taking their history, I'm multi-tasking with listening to what they're saying whilst shitting my pants a little trying to figure out what the hell I'm going to do for this patient.  Luckily there are 5 other providers in my practice and one day, I asked each one of them 5 separate questions about 5 separate patients.  Thought I would share the love a bit (read: I don't want them to all think I'm a complete idiot). Honestly, is there ever going to be a day where I know what the f%&k I'm doing?

The crazy part of it all is...I write prescriptions...and sign them...and the patient goes to a pharmacy and fills them.  This is an odd sensation.  I mean the last three years of my life have been spent sitting in a provider room, shoved in a corner, attempting to be completely out of the way....sucking down an iced quad americano trying to appear cool, calm, collected and awake.  If I was lucky I would get to interview my patients alone and return to my preceptor with a case presentation and a plan of some sort, which would be commonly be responded by: "well...that's a good point but, we are actually going to do this (insert their plan)...nice try".  I spent hours writing the perfect SOAP note which no one read except a clinical instructor who got her jollies off by making me cry.  Basically my point is this, I've spent three years without responsibility of making critical clinical decisions without someone looking over my shoulder.  Now, I have my name on stationary, business cards and prescription pads.  How did I get here?

Don't get me wrong...I've never felt more certain that I've taken the right path for myself, it's a solid fit.  ER nursing had me pretty burned out, I enjoy the ability to build relationships with patients and my A#1 goal is to keep my patients out of the ER for an unnecessary ailment.  However, it is tough.  One night after work I found myself swimming laps thinking with each stroke resonating over if I had put a patient on the right medication that day...ugh.

I have a fun weekend planned...hitting the famous PSU farmers market and a run in the park with Amiee...and my sister is coming down Saturday night.  Hoping to catch up on some Z's too.  Until then...one day at a time.