Month 1...Completed!

Its official. Mat and I have survived a little over a month in Roanoke. Its not so bad after all. We are really enjoying this so called "city" life and are starting to adjust to the southern accents of all the folks down here. Lots to catch you up on. Here we go!

Mat started his job last Monday. Every Monday morning he has a safety meeting where they get to learn "all about safety." He learned how to walk on ice. Now you may laugh at this as this is an easy thing for Western folk...but I truly believe this was an appropriate learning point for the southerners. You should see them walk on ice...no joke. Mat told me "you slide your feet not pick them up." I would like to tell Roanoke folks "you won't fall through the ice on the concrete, and pick up the pace." He is enjoying his job...as it is not the same as working for Darrell and now he actually has to talk to people. He has "real great" people to work with (I say that with a southern accent) and gets his own van. I call it his molester van, but it truly is nice. He came home on the first day and said "Alissa I couldn't understand the electricians." Now we have heard rumor that some of the accents from down deep in Virginia are so thick you need a translator. We didn't believe it. Mat has confirmed this is true. He met some nice meth head while working at cash and carry, got to save K-mart from a leaky roof, and even spent some time at Motherhood Maternity replacing ceiling tiles. He gets a list in the morning of work orders and then heads out to complete them. They are really liking him as he is fixing things the right away and giving them suggestions on what truly needs to be fixed. Mat thinks he lucked out on getting this job, but I truly think this company lucked out on getting him.

It's so funny that I come home and say "you have to hear about my day" and Mat says "wait till you hear about mine." It's fun sharing our daily stories.

I have been packing my head full of information from lectures for the last two weeks. Between how to calculate anion-gap (so over my head) to reading EKGs (getting better), Chest X-rays (good here), how to deal with penetrating chest wounds, to how to call CPS. Woowh! Every hour each day is a new speaker, new topic. Kind of overwhelming but I am sure it is all important. We spent 8 hours the other day learning how to do a FAST exam. I was just excited to know what FAST finally stood for...Focused Assessment with Sonography for Trauma. The black and white image looks a little bit more clear now knowing what I am looking at. We also learned how to place lines with ultrasound (way easier then I thought). Everyone looks with everything with bedside ultrasound. I am just pumped when I find a kidney. I spend two weeks in a ultrasound rotation this summer. Thank goodness.  Instead of telling you about terrible lectures and good ones I just am going to sum up what I took away the last two weeks. Hear we go.

1) Never, ever, for any reason call a seurgon at 2am and tell him a story of why the patient came in. All he wants to know is the diagnosis and why the patient needs surgery (this was a 1 hour lecture).

2) Never soak a wound in iodione or hibacleanse as the risk for infection greatly increases. Lots of tap water or NS flowing over the wound is best.

3) Never order a D-dimer if you suspect this patient has a PE.

4)CK-CKMB are worthless in diagnosis of Acute Coronary Syndrome or MI. Don't order!

5) Camo is Virginia's State Color

6) If a patient has a high lactate they are septic.

7) Some super sweet splint techniques.

8) The presenter can launch his presentation to your Ipad while he is lecturing and have you participate in question/response.

I got to travel to Christensburg to do a 3 hour shift of shadowing at another Carilion Hospital called NRV. The lobby has waterfalls and the cafeteria has a spiral staircase. Shadowed a PA who saw 3 patients. Not too exciting. Followed a Peds ED MD on monday for 4 hours at Carilion in Roanoke. That was super fun and we saw a lot of sick kids (actually sick). I wish I could describe to all of you how big this ED is. Lets just say it may take a few months before I know my way around. While I was there on monday they were holding 33 to be admitted the next day and it was only 6pm. I thought 7 was bad!!! It was a super busy completely crazy ED...I so wanted to jump in and get my hands dirty.

Miley has been chewing off her fir, so I finally ran her to the vet to find out she has some stressed induced parasite infection that is plugging her hair follicles and making her hair fall out. I guess moving her across the country caused this. So now she is on a parasite fighting medication for the next 28 days!! Poor thing. Otherwise she is doing well and thinks its great fun that we have to go outside with her every time she needs to go pee.

All and all we have been having fun. We have been trying to go for a run each day and enjoy this downtown experience by walking to dinner on the weekends. We had an amazing burger where the crispy cream doughnut was the bun. Best thing ever. Picture to follow. Still looking for a new place to call "church" as the cinnamon rolls down here just aren't nearly as good. Hope all is well with all of you. Had the best time face-timing with the Deaconess gals last week.  We miss you all and plan to have better stories after next week. Wish me luck on my helicopter rides. I start monday!!

3 Weeks Already!!

I apologize for not updating you earlier in the week but computer training is very boring. Mat's mom and grandma B came on Friday from North Carolina as they were there on vacation/work. Grandma B had a great opportunity to go to Dale Jarretts hall of fame party and Trudi has clients she was visiting in NC. What an honor to be able to go to Jarretts private party.

We went out to dinner at a really fun burger place just down the street. This has ornate burgers including fried bologna with coleslaw on your burger. And the best part is we are able to walk. Grandma B and Trudi stayed at the Roanoke hotel. This is the oldest building in Roanoke and it is beautiful. It is only a bridge and a block away. We didn't think 500 ft.² could hold four people and one dog but later we find out it truly does. It was really nice to see familiar faces! We didn't know how much we truly missed faces we knew. We had a blast with them exploring Roanoke on the roads and through the restaurants. Lots of great meals and good laughs. I even got to treat my first patient (grandma B) as she slid into home plate on the sidewalk. Hope the steri-strips provide minimal scarring! On sunday they were suppose to fly out but due to mechanical problems they were able to stay with us one more night. And yes...we all fit in 500 square feet.

Monday was Epic training again. This is a very smart and fantastic computer program that is suppose to make charting easy. In the ED, they have "scribes" who are real humans who's job is to do the charting for the practitioners. I guess this helps you get your charting done much faster. Tuesday was lecture from 8-5...whoowh hadn't done that in a while. We first met with 2 ED nurses who gave us the "lay of the land." They warned us to be nice to nurses as they can throw us under the bus or help us out. I truly feel they scared the other two fellows. Later I found out we get to spend 2 days learning what ED nurses do. Hahahah! My program director said, "Alissa I know you were and ED nurse but it may give you a different perspective." I said, "yeah I will show them the Alissa-way to do everything." He said, "Oh God." As he knows no ED nurse likes to be told how or what to do and I will be the first one to tell you that. The ED has a 2 or 3 patient per nurse ratio pod in groups of 3 pods. Each group has a paramedic and a tech. And yes...techs can transfer telemetry patients to the floor. This is mind-blowing....not all EDs have 4 patient pods. The paramedics do all neuro checks, IVs, and triages. Nurses pass meds and do assessments. Seems pretty organized. Following the nurses lecture we had 8 other doctors come and give lectures. It was great and you learn so much from their great cases. A pediatrician told us about last month how she had a "not acting right" two month old with mild abdominal tenderness. Turned out she had and ovarian torsion. WOW! Never would have put that on my differential for a 2-month old. We learned what to say to patients, how to be nice, all being important in not getting sued.

Wednesday I was sent home early in preparation for the storm. Mat read in the newspaper that it was crucial to go get our eggs, milk, and bread. So we did this at 1 PM on Wednesday just to follow suit. We thought this was some crazy idea and the snow wasn't going to scare us. By 5 PM that day almost all grocery stores in Roanoke Virginia where out of milk and bread. I can now say you know you live in the south when they announce overhead "y'all come and get your meat now down here." Couldn't have heard anything funnier. That night we got about 11 inches of snow. I got a call from my fellowship director that I do not have to come in on Thursday due to this devastating snowstorm. Mat and I took a walk around town on Wednesday evening and everything was shut down. We enjoyed watching the man ride his moped in a few inches of snow down the street. Guess he didn't see the warning for the last three days that there was going to be this devastating snow storm. Nothing was open downtown and a busy street was now bare. Southern folks truly take this white stuff seriously. Thursday we got 8 inches for a grand total of 19 inches before 3pm and another call that I did not have to come in on friday due to this large amount of snow.  5 day weekend here we come!!! Thursday night Mat and I really didn't have much good food for dinner and all grocery stores were still closed. So we went to a local burger joint downtown that was jam packed with everyone else who didn't go to the grocery store. The burgers are crazy. I had nachos in-between my burger. Amazing!

So basically to end all Mat and I have been locked up in 500 square feet for the last 3 days. I think it is more like 400 square feet now. Things just started opening up today as people started to un-bury their cars. I do have to admit this is an unbelievable amount of snow for this area whom is not equipped to handle it. We have enjoyed walking around the piles in town wishing we would have packed some sleds, or even some boots!

Hope y'all have a great weekend.  Some fun pictures to follow.

Day 1-3

Well I made it to the first day!! Boarded the trolly about 7:30 am for my 10 min ride to Carilion Memorial. Most people at this time of the morning are riding the trolly into town, I am riding away. Carilion Memorial has over 12,000 employees, so parking at other facility sites is limited. Carilion a few years ago started paying for this trolley system in Roanoke to help this parking crisis. There are many administrative offices as well as outpatient clinics around town. Many!! So the trolly helps to eliminate this parking crisis. Back to my story. Arrived at Carilion and met my co-fellows. Patrick fresh out of PA school grew up in North Carolina but moved to Roanoke 3 yrs ago for PA school. Amber, a PA from North Carolina, used to live near Seattle as a child. We walked into the board room to have a Mac Box sitting on our desk with a brand new Mini Ipad, a running jacket, a backpack, and a binder. I was blown away...and Ipad. Oh and P.S. Our brand new Iphones will be here Friday or Monday. WOW!! Of course I love the technology so I was super excited. "Its all to enhance our learning." Next we met with a psychologist for 2 hours to help analyze our personality. Actually was pretty cool. I had a feeling they would want to ditch me after analyzing my personality...They warned us what kind of people we will have conflict with and how to deal with these people. They teach you to recognize personalities rather then getting upset. We learned to cater to different personalities. Guess this could be helpful with difficult patients and staff members.  Got to meet with someone who gave us all the numbers and stats on patients. Get this...on Monday Carilion Memorial Hospital Emergency Department saw 270 patients!!! I thought 120 patients was crazy. They see an average of 250 per day with over 20% being admitted (guess that is high). Don't tell Adam (they accept all transfer patients and hold them in the ED calling it the TBA unit (to be admitted) until they have a bed. After all this, the head guy took us all out for drinks and appetizers. Great end to a first day. 

Wednesday we began the day by learning LPs, Intubations, Central Lines, and Chest Tubes. Okay little credit back to the doctors. Not as easy as it looks. Don't tell them. Pretty sure I will be the worst intubater ever as my left arm was shaking so hard as I am trying to hold the "Mac" (curved like the c in Mac) and Miller (strait like the l in miller) and shove the tube down the right hole. Its kind of like placing a foley...you got to get all the stuff out of the way to see the right hole. The girl who taught us was a senior ED resident that was awesome. She told us the "quick and dirty" of what we need to do to get the job done. Reality check, I need to start lifting weights so I can see the chords. Don't think Mat will let me practice the whole intubation thing on him. Later we met with HR to sign up for benefits. Okay, ready....how much or benefits per pay period for Mat and I together. $200? $400? Nope! $44 per pay period. I thought the lady was joking. I was blown away. She didn't think I was so funny. And free gym membership (2 gyms in town Carilion owns, 7,000 square feet each, indoor and outdoor pool, plus two smaller gyms downtown.) So not a bad two days.

Today, Thursday was didactic day. 8 hours of pure learning! I took the trolly again. Love this whole transportation thing. Today I walked out my front door to see the trolly at the stoplight which means I had 30 seconds to run a 2 min walk. And...I had a dress on and highheel boots. I went sprinting down the street, around the corner chasing the trolly. It was five minutes early! The security guard that I met the other day told me "slow down" in her southern accent, "they still have to unload." Then one man told me running in my dress "was f-ing hot." Oh boy. Then a homeless man (seriously its like riding with the folks from the Mission or the Carlile to Carilion) introduced himself and told me his fascination for forensics, multiple times. Each morning they all get off at this unmarked brick building. Today...I found out it is the outpatient psych unit. LOL. Now it all makes sense. I got to go to case review with the 20 ED residents for Carilion. They went over some great cases. "Oh how the nurses always triage sick patients to a level 5, and don't always believe what the nurses say." They got many eye rolls from me I am sure. I wanted to say, "tell me about a time with a nurse saved your butt." Like when you ordered aspirin IV? They then took us out to lunch with the CEO who was amazing! She was a nurse for 30 years. She makes things happen! Then had lecture from an MD about the eyeball, headaches by the medical director, and how to make good medical decisions. During the last lecture I see my phone buzz from Mat, "Bad News." I couldn't text him back as there were only 3 of us in this lecture. Make me wait 2 hours for bad news!! Well Mat has to go buy a toolbelt (that was the bad news) as he got a job today. He will work for a family owned construction company as a "Field Service Technicion." He explains it as a "handyman." So excited as this is right up his alley. He wears nice clothes and gets his own van. I will take a picture on his first day. No worries!! 

We are finding time to enjoy some warm weather (sorry it has been so cold there) by running and wearing out Miley. Missing our family and friends! Mat's mom and grandma come this weekend. We are excited to see familiar faces.

We Made It

Sorry I have not completed a blog and a few nights as we have been busy unpacking and getting settled in our new home. We left Cincinnati Ohio at about 7 AM hoping for an early arrival in Roanoke Virginia. There are three routes we can take and we chose one. Likely it was the most beautiful drive we had this far. It was along the Appalachian Trail. It was kind of fun to see this Mountain range as not very many people lived here. Dr Croshaw had me read a book on the Appalachian Trail as he said I would be getting a lot of weird people from this area. We got to go through Charlottesville West Virginia and it was a gorgeous town with a beautiful river and lots of bridges. We might have to go back to this town as it is only about two and half hours away. We got to see Virginia Tech that is only about 45 minutes out of Roanoke. It was a nice-looking school and look like a fun school to go to. Finally, we arrived in Roanoke Virginia at 35 Cambell Ave. apartment number 417. We were so excited to find out it truly was in the heart of downtown. We met our apartment manager outside the front doors his name is Jake. Jake had done so much for us I truly believed he didn't know if we existed. He took us up to our apartment and we were so excited as we loved it right away. Jake had the movers organize all the boxes by what room they were marked at and had them pile them high in the center of each room. This was helpful in the unpacking process. We signed paperwork and got right into unpacking everything. We also had to go pick up our parking pass down the street. We get to park in the Martin Luther King parking garage that is only a bridge away. It is skyrocketing $11 per month. That night we stayed up late putting the bed together and unpacking the kitchen. We got up nice and early the next morning to get everything unpacked and were completed by about 7 PM that night just in time to clean before bed. It was fun to FaceTime my family and show them our new pad. Our bed faces the downtown and it is fun to see all the city lights right. There are no windows in the living room or kitchen but we don't notice the light from the windows in the bedroom shine through. All in all we love our new loft. Pictures to follow. 

Thursday evening we had a chance to go grocery shopping. I told to check out Kroger's as it is just like Fred Meyer's on the West Coast. This was packed with people. It was interesting to see how much more expensive groceries are over here. But it was very fun to buy milk and a glass bottle. Felt like we are in the olden days again. We also had some meat cut from the deli. Never had the white meat for sandwiches. The lady thought I was hilarious when asked if I had to buy the whole thing of meat. You get to pick your thickness one through 10 we chose five. Ask the lady was the best thickness. I was not sold on this grocery store but I also think I am pretty picky being a Trader Joe's fans. The nearest Trader Joe's is 90 miles away. So this won't be a stop we go every time for grocery shopping. That night we had our first dinner in our loft! Nothing better than spaghetti. 

Friday was my first day at Carilion Clinic. It was only a two hour day as a lady drove me around town making multiple stops to fill out paperwork get my blood drawn and take pictures etc. I was so impressed that I got to have a professional photo shoot for marketing. Maybe could've done my hair a little bit better that day. The lady was very very nice and very helpful she even dropped me back off at the loft on her way home. 

We are so impressed about how nice everybody has been here and how helpful everybody has been.  people are so polite always opening doors, saying good morning and thank you. Friday night Mat, Miley and I went on a run down the railroad track's hoping to connect with the Greenway. The Greenway is a running trail that goes around Roanoke. Long story short we ended up in a very bad neighborhood with multiple needles lying around and couldn't run any faster to get out of there. this railroad does not connect with the Greenway. 

Saturday morning we walked downtown about two blocks and went to the Saturday market. This market happens every day during the week but the most popular days are thursday, Friday, and Saturday. We bought some bacon from a local butcher. Also bought a blueberry pineapple Apple cake from a nice man from Georgia. He was very fun to talk to. He could not believe where all the way from Washington state and it was only our second day here. He asked," have you had your culture shock yet." Roanoke has a large African-American community unlike Spokane. Some may even say we are a minority here. After the market I got to go have a pedicure downtown. It is so weird to walk two blocks to have a pedicure. This is a nice spa and will be a frequent stop for me I am sure.  You make all your appointments online. They are so technologically inclined. Saturday evening we went on a much better run the right way towards the Greenway. This is a nice run through an old neighborhood. We made it downtown just in time to get a few things before the stores closed.

Sunday we got to climb to the top of New mountain. This was a 4 mile round-trip hike. It was a beautiful day as it was 63° out. This is a very fun hike. This is a hike to the biggest man-made star in the world. Pictures to follow. We found out that Roenoke is Virginia City of trails. We decided we better go on a new hike every weekend to explore the hills of Roanoke. They called the mountains but we call them hills. We got invited to the penthouse in our building for a  Super Bowl party. It was fun to meet all the people in our building as they are all about our same age. The penthouse was gorgeous. Much bigger than our apartment and the outdoor deck was just as large as our apartment. 

All and all we have been adjusting well here in Roanoke. :-) Miley is getting used to not to growling and barking every time someone walks by our door. Now she just cowers down as we have been spraying it with the spray bottle. We are getting used to taking her outside on a schedule to use the bathroom. She knows her way to cross the road and go potty. Mat has been quizzing me on which streets run run which way and how to get home from multiple directions. He learns the stuff way faster than I do. 

Today Mat has been vigorously applying for jobs. I had a few homework assignments to complete before tomorrow. Tuesday is my first day. Today we rode the trolley to see the route to work I will take on the trolley each morning. Turns out it will take me about 10 minutes to arrive at the Carilion clinic.

I will keep you updated this week of my first week at Carilion. I know is I just have another photo shoot tomorrow. Cracks me up. Enjoy a few of our pictures. Wish you were all here...