Signing Up A Storm

Work no better today...apparently I put policies over people, need to get in touch with my humanity, and do not care about my patients' needs. (Translation: I maintained that a patient would indeed be leaving against medical advice since we are not yet sure that the very serious infection is gone.) Thank goodness for my very supportive senior residents and attending. And the lovely comments I've received from you, dear readers.

I did have a good, though looong, outpatient clinic in the afternoon. I really love having my very own patients. We can start working on something at one visit, and then I can see them again to follow up next month! This kind of continuity, and the ability to work on something incrementally, is why I am doing primary care, and it is thrilling. I'm also learning to slip in preventive care at every opportunity. Here to discuss back pain...how about a flu shot? Perhaps a colonoscopy? Maybe a lipid screen along with your headache medicine?

Brynna is also thrilling. She is learning things so quickly! Her repertoire of signs is expanding by the day. She does rather conflate "more," "help," and "again," but in her world, those are often interchangeable in any given situation. She now does "please," which is very sweet. She has also just learned "sleep," and since she has a bit of a cold, actually used it to ask for both of her naps at daycare today! She has also developed a sign for "dog." She pats herself on the chest, which is a version of the patting-the-thigh sign that Miss A and we have been using for dogs. She does it when she sees Jasper, but also when she sees other dogs and when she sees pictures of dogs. This evening we were also working on "cat," which uses the fingers to sketch out whiskers on the cheeks. We were turning the pages of a book back and forth between dog pictures and cat pictures, and practicing the different signs. It's so amazing to watch her figure these things out!

Other signs she knows..."all done" and "milk" have been around for months. "Eat" for awhile, too. There's also "up" and "down," "book," "change" (a diaper), and she is working on "share" and "thank you." She points at things (often signs "help" and then points, or "please" and then points). She also understands "dance," "sit down," and "stand up" though she doesn't make those herself yet. And she connects signs, like "please-more." Miss A has even seen her do "please-more-eat."

Because she communicates so well with signs, she hasn't had to work too hard in the talking arena. We certainly talk to her all the time, including while we sign, and she babbles a fair amount and is starting to do much more imitation. Today she said "boo" when she was showing me a book, and last night we were quacking together as we played with her rubber ducky. We know that she understands tons of spoken words. So I don't have any worries about her talking—it will come in time! In the meantime, the signing helps prevent frustration. Though sometimes she waves her arms around, clearly trying to convey some message, and we have no idea what she is trying to tell us!

We'll try to get some video of her signing soon, since it's pretty cool to watch!