Divine tutorials

Maybe I'm meant to do this whole nurse practitioner thing. It seems to be total providence that I'm exposed to learning opportunities every which way without even trying... I'll explain.

Last night, at the end of my shift, one of my co-workers got a bunch of orders from a doctor to give calcium, D50, and insulin to a hyperkalemic patient (someone with high potassium in their blood). I looked at my co-worker, confused. I had never heard of giving insulin to decrease potassium. I look this up on my iPod touch and am reminded that patients with hyperkalemia have peaked T waves on their EKG. I come home and before bed, I watch an episode of Grey's Anatomy and whaddya know! The emergent patient who codes in the OR with a junctional rhythm has peaked T waves. New medical resident speaks up to mention he thinks the patient's hyperkalemic and they give... calcium gluconate, D50 and insulin.

So maybe that might have been a freak coincidence.

Last Monday, I had a clinical rotation with a doctor that had been unable to come up with a diagnosis on a woman with a skin rash from her hands to a clearly demarcated line on her forearm. She also had a rash from her face to her neck, also with a clearly demarcated line, like a sunburn. This was the second time he had seen her, after trying to treat her with an antihistamine (Benadryl). The rash had not gone away and he was considering steroids this time. Stumped, he asked me what I thought. I asked her about sun exposure and chemical exposure, cleaning products. Asked about new lotions, perfumes. She was unemployed. Nothing significant.

Today, on the New England Journal of Medicine's main page (which is set up as my home page on firefox), I see that the image challenge of the day is exactly what I saw that day. It's a niacin deficiency. This deficiency is called pellagra and shows up like a sunburn.

This stuff excites me. And amidst work and my limited time to study, I truly feel like God is helping me out... giving me some tutorials here and there.