Time to Tumble Down - Again

Well, it's time to officially close this blog as the next chapter of my life begins. I realized this after the last post focused on residency issues and had little to do with medical school.

I have ascended to the highest rungs of medical education to this point and can no longer content myself as I look down on those still struggling to make the ascent. I don't even have an ID any more for my school, so it's time to move on.

Unfortunately a new challenge, a new totem pole, a new hurdle awaits and I must, regrettably, begin again at the bottom.



So thanks to everyone who linked me, read my ramblings and bitchiness, and gave support at times when I was down or celebrated as events came and went. It's been a helluva ride so far.



Everyone's welcome to come over to The Chloroform Rag, where I'll start posting from now on. See ya there.

Well, Okay Then

Received my schedule for the ER last night. It's not bad - i.e. no call and nothing more than 12 hours at a time with several days off - but it made Wife make one comment.

"You're sleep schedule is going to be all fucked up. You know that, right?"

She was referring to the accurate identification that I have shifts all over the place - including one that ends at 4am. One day I'll be working in the morning/afternoon then come back to the overnight, then back again. It's easy to see how my body is going to try and revolt over this.

But whatever. It's internship - and this is probably the best schedule I'm going to have all year. Plus everything that I thought would happen hasn't - like starting out on call, in the ICU, and working July 4th weekend. Thinking that these were inevitabilities they haven't happened. Interesting.

Necessary

I've often wondered if the 4th year of medical school is really necessary. Many medstudents spend the majority of this year taking electives in their respective desired fields, easier rotations during interview season, and often have months off with little to no patient interaction leading up to July. It's clearly no wonder that a July syndrome is often seen in many incoming interns.

I've been reviewing over the last few months, but it's hit and miss. There are things that come up and I feel guilty trying to study about diseases and physiology when the family has come home - I won't have this much time with them again in, well, probably ever. So I close the review books (because by now I've admitted that I just really should review the basics again before getting too in depth on anything) and head outside to play one-on-one with my son, teach my daughter how to ride a two-wheel, or take care of wife.

I think that a full year of 4th year, while nice in the time off you often get, really is a hinderance to many students. I knew far more and was multitudes more ready to enter the "real world" of medicine last July, not this one.

Personally I think it would be better for programs to have earlier interview times in the early fall, find out where you matched in December, and then enter your program in January or February. The students would be better prepared, less rusty, and far more capable of handling the first couple weeks of internship. The syndrome would still be in place, but not as pronounced as it is currently.

Hell, if there was a real consideration to drop the 80 hour work week to 56 we could lengthen the residency training based on reducing some of the 4th year requirements and letting med students into training 6 months earlier.

So, is a full 4th year really necessary? I don't think so.

Hoping Beyond Hope

There are several items that I hope don't happen - even though I know there's a very good chance that they'll occur anyway. Like gas stopping its ridiculous and out of control move towards $4 and $5 a gallon.

What I really hope is just merely a rumor mill is this, a cut of work hours from 80 to 56 per week. I found this link from Medschool Hell - who, naturally, is in support of the move.

I've already blogged about this topic in the past, so I will allow you to read over that post and refresh yourselves. Clearly I do not believe cutting the work-hours anymore will lead to significant changes for the better.

What it will do is just lengthen an already long process with residencies adding additional years, create further punch-clock mindsets in residents entering the work-force, and leave a large topic of discussion still on the table: debt repayment.

Hell, as it is the government has been trying to get underpaid residents to pay back on loans by reducing the years that they can defer or forbear or simply removing the option of "economic hardship" from the list of reasons. So adding more years will do what? Create more financial burdens, reduce the chance to moonlight, make residency akin to a 40 hour a week job where-in doctors will become even more hesistant to do anything past 5pm? Is that what we really want?

Think about it before you'd say that working a few less hours isn't that bad.

Oh Yeah Moments

I'm starting to think that the people who designed the home we've moved into had a few "Oh Yeah, we need that." moments.

For instance - both bathrooms are small, lack drawers, and give the impression that the architect suddenly recalled needing to have 2 bathrooms.

Today, after getting a new washer and dryer delivered I tried to run a load of laundry. Unfortunately I couldn't open the dryer door - the hinge-door on the dryer side would not allow the left to right opening that is customary on many, many, many dryers. But, after unhooking the sliding feature on the door I could swing it wide open and, with care, open the dryer. These appliances aren't anything too large, too fancy, or too anything - normal sized.

Ah yes, the Oh Yeah moment hits again.

Purification by Fire

This is the end, my beautiful friend, the end.

The coats burned nicely, soaked with lighter fluid, and a large plume of foul smelling, blackish smoke arose as I exorcised the drug-resistant demons from within. Thanks for the memories, short white coats, I hate you still.

Graduation

So the grad ceremony was nice - if not long - and my family was able to be here to watch Wife hood me. Thankfully my back, which had been acting up the last week and kept me from working out for the last 8 days, did not hurt as much as I had thought - given that we stood for an hour before walking into the arena and then stood again while 100 of us were called, walked across the stage, were hooded, and then recited the Hippocratic Oath (updated version).

I felt a swell of pride as Wife placed the hood on me, I turned and walked down the stairs and kissed her. It felt like we had arrived, but I still don't feel like a doctor. I'm sure that feeling won't come anytime soon until I hear the pager go off endlessly or am asked to assess a patient that I feel completely underprepared to deal with - wait, scratch that, I won't feel like a doctor for a while...if ever.

My parents took tons of pictures and many of the classmates and friends were in the backrooms snapping away while we readied ourselves. It was sad that so many of us had been through so much, and now we're heading off into different cities, different specialties, and different lives. I hope to keep in touch with some, but I'm not optimistic.

So, one more month and then I begin orientation. July 1st is coming fast. I think I'll post some more on this blog until June, then I'll turn the attention to my residency blog. After all, I'm no longer a medstudent.

I am a Doctor

Nothing more needs be said. Well, it will, but just not right now. I've got some partying to do!

Obesity - Dangerous To Your Health

Fat people are a danger to themselves. Health not withstanding (diabetes, hypertension, stroke, cardiac disease, arthritis, etc. are all shown to increase in patients with, um, largess) there are many more practical and truly understated reasons to remain thin:

1) radiology equipment may not be able to accomodate your size (CT or MRI scanners that can't handle the weight/ size)

2) getting any central line placed is much harder due to obliteration of normal anatomical landmarks by fat and once obtained many healthcare workers won't want to remove it even if a "potential" infection is suspected leading to possible catheter related infections

3) peripheral IV's are often obtained only through multiple, painful attempts and frequently are 22 gauge size or smaller, in the fingers or feet, lending them to being subpar for any real utilization if acutely ill

4) intubations are harder, messier, and patient's tend to decompensate faster with larger body habitus - plus bag masking is harder on someone who's chin doesn't really exist anymore

5) lumbar punctures, epidurals, spinals, etc. are much harder to obtain as, once again, normal anatomical layouts are obliterated by fat

6) beds may not be able to support you unless "special" ones are obtained which could leave you waiting in uncomfortable chairs, wheelchairs, or stretchers for prolonged periods while one is obtained

7) moving patients from stretchers to OR tables requires more personnel and once on the table you have a higher chance of falling off due to weight balance being less central

8) when incapacitated, being turned, changed, etc. is harder on the nursing staff, requiring more staff to accomplish the job, and therefore lending to potential reductions in care over time and bedsore formations

9) harder to hear heart and lung sounds - plus radiographs tend to have abnormal shadows and lines from rolls of fat which can impair diagnosis of conditions

10) many drugs are given based on ideal body weights and larger status leads to variable dosage delivery. Fat is also large storage pool for many drugs which can lead to reduced effective concentrations intially only to then have an increase as the drug stored in fat is released and joins the already circulating concentration with resultant overdosing.

Just some things to consider when the current culture tries to tell us to be "happy with yourself just as you are". Be happy, but work towards losing weight - it's best. Humans are not naturally fat.

Scary As Hell

Just found out that I will be starting July 1st in the...wait for it...

EMERGENCY DEPARTMENT! (dramatic, scary music plays as audience gasps and shrieks in horror)

Stay away from the hospitals, people, stay away.

Nothing like starting out in the level 1 trauma center for half your state and portions of bordering states, in July, when the amalgam of drink, warm nights, and fireworks will work itself into a frenzy.

More Political

As noted in the last post, the problem with gas getting this high is that the US is not, and most likely will not be for a very long time, equipped to handle a huge increase in price due to city structure.

We have focused on autonomy, little on public transportation, and many people live at least 30 minutes out from their jobs. It's quite rare to have a city that can actually move a tremendous amount of people efficiently during the rush hour and all day. I believe a couple cities on the coasts are the best examples, but not much else.

So then, what are we going to do? Mass influx into the crime-ridden and impoverished inner cities? Nope.

Demand our city planners make transportation miraculously affordable, available throughout the day, and easy to use? Not likely in many areas.

Buy motorcycles and scooters? Dangerous and honestly not a good option.

Hybrids? This should have been done years ago, but was constantly being put off by "Big Oil" influence amongst both parties. The cost of purchasing one currently offsets any savings in gas they might provide as many are pricey. For me, having paid off my car, it's completely ridiculous to even consider for many years.

As was pointed out, some Eurpopean countries are paying almost $8-$10 a gallon. Yet, even though they're paying a lot more we should understand that Europeans have paid more for years (I remember my brother telling me that gas was as high as $6 or $7 a gallon in Switzerland when he was there for a year - 9 years ago), are far more accustomed to other methods of transport (like bikes, trains, etc.), and are much smaller than the US. We're huge - some countries across the pond are the size of Maryland or even Rhode Island.

I listened in yesterday to a debate about "the pain at the pump" as two senators from the Dems and Repubs argued how to help out 'our consituents'. Both raised interesting ideas, that are all doomed to fail. Our leadership in this country has no real good idea to help us - they've been sucking up to the oil companies for too long and little has been done to plan for this inevitability.

In my 30 years, I don't recall a worse time. Thankfully, for all the bitching and whining I do about medical training, I have a rather secure job ahead of me. My wife, however, is seeing the impact on her job as hours are cut, people lose jobs, and more is expected to compensate for declining cash flows.

Whomever the next president is, I hope they understand how important these next 4 years will be for our country. It's make or break time and I'm scared that all involved won't have what it takes to turn us around.

Where Will It Go?

While driving my daughter to preschool today I passed a gas station that, just yesterday, was selling gas for $3.55 a gallon. Today? $3.70. Where did the 15 cents come from?

I'm actually in an area that's not been hit as bad as others - we've yet to reach over $4 for 87 octane, but I'm not holding my breath that it won't happen in the next couple weeks. I wonder, when's it going to end and why is this happening in the first place?

I mean, as I'm sure all Americans are wondering right now, what the fuck is going on here? Are there no more controls? Are we at the mercy of every CEO who controls energy in this country since the Bush-era arrived to pillage the country into extremis?

Before gas would rise based on "situations" that would invarably be used as excuses. Now I don't even hear anything - just expect it to keep going up. Bend over and take it, America, you're fucked and we're getting rich as hell doing it.

A sign I read the other day stated that gas was about $1.50 a gallon in 2000. While looking over some of my daughter's baby book I noted that we had placed gas at $1.75 a gallon. She is 4 years old. More than a 100% increase in over 4 years.

I wonder where it's going to eventually end. If we had better public transportation here (meaning it would leave early enough so that I wouldn't be late getting to the hospital for rounds) I would have ditched driving a long time ago. As it stands I have to budget a certain amount, fill up to that, and hope I don't have to get gas again for another 7 days. Anymore than $4 a gallon and I don't know what's going to happen to a lot of people commuting. Unemployment will surely rise, the economy will continue to falter and fail, investors will be ruined while the companies they invested in will be "saved" by the gob'mint, and the Bushies will thump their chests, smoke their cigars, watch their children get married in lavish ceremonies, and laugh all the way to the bank.

More Truth Than Not

I read this article when a couple blogs posted about its topic. Some were naysayers, stating that it painted a bleaker future than really necessary, others were more open to the advice. I noticed that many of the younger bloggers identified with the article than the "dinos" who, of course, viewed this with a grumpy hurrumph! and went back to their job of trying to keep their investment portfolios from completely going under.

Of course I kid, but there is a lot in this article that I've identified over the last few years, which several physicians warned me about, but I didn't listen. If anything - to those out there not in medical school or medicine, it's really important to review information like this before deciding to go into medical school. Take a look at some of the comments as well, that will give you a good idea what people think of doctors.

Oh, and happy mother's day.

The House of God

The book, The House of God, is one that many medical students, residents, healthcare professionals, and people all over the world have noted as being a standout read regarding the trials of internship. Sure it's dated - since it was first published when I was born - but it's still considered a benchmark against which many medical writers are compared and is often listed as a "must read" for medical students and wannabes.

But I don't see it.

I've been trying to get through this book the last couple days and have just tossed it aside more often than I'd have thought. I find it infantile, neurotic, sloppily constructed with poor transitions, and just not a book that I must finish.

Perhaps I want to understand more what's going on than having a skim-job whereupon the author enters into emotional turmoils over the latest "insult" yet will go into florrid detail about their sexual achievements. I know intern year sucks, but some more information related to the actual crushing process might have been nice rather than learning how nuns teach nurses to deal with erections. Instead I feel that the reader is merely shown a glimpse and then ferried away hurriedly - as though it's more than we could handle.

And another item: was there really that much sex going on in hospitals back then? I can begin to comprehend where some of these TV shows developed the lustful nurse-doctor relationships after reading pages upon pages of bawdy behavior and descriptions. It seems like a pubescent fantasy rather than a beacon of light into the process of medical training.

I don't know if I can finish reading this book. I'm halfway through, but it just grates the nerves to continue. I should be reviewing other items anyway - like movies that I've not seen in a while...and perhaps a medical chapter here and there.

Home Sweet Home

Pics of our new home. Nothing yet related to the white coat burning, as it hasn't happened, but I will post just as soon as it's done.

These are in order:

1) the front of the home with a small view of my car (only the front yard has much grass - like we wanted - so the upkeep will be minimal and mowing is not much more than an hour to do at most)

2) entrance view from the front door with wood-burning fireplace (will be nice in the colder months to save on electricity)

3) kitchen with Daughter's fabulous kitchen magnets all over the fridge - on the left by the wine glasses you can see Geebo our Betta - and in the sink is the larger bowl I'm preparing for him

4) hottub left by previous owners - which is very nice to soak in after some unpacking along with an ice cold beer, but I think it might get a little annoying to keep up with when the shit hits the fan later

Haven't Earned It

A recent conversation that Wife told me about went something like this:

Wouldn't know their ass from a hole in the ground guy: "You know you're husband isn't a doctor yet. Just because he's graduating doesn't mean he's a doctor."

Wife: "Umm, yeah he will be. He's getting an MD in a couple weeks. He'll be called doctor by everyone including patients, nurses, doctors, etc. He will be a doctor."

WKTAFAHITGG: "Well, he'll be called that, but he's not a real doctor. He hasn't put in his time yet. And I don't think they should be allowed to call themselves doctors either - it's like lying to patients."

Wife: "What the hell do you think 4 years of medical school is if not putting in your time? Just because he has to do a residency doesn't mean he can't be called doctor."

WKTAFAHITGG: "I bet he's going to get a real fancy-pants car, isn't he?"

Wife: "No, he doesn't like cars that much and would prefer to drive his for as long as it will allow. Then he might get a truck or something."

WKTAFAHITGG: "Yeah, so he can dump your body after he's found a few nurses to cheat on you with."

This was an actual conversation that Wife told me about while dealing with a vendor at her job. I have no idea why the guy is saying these kinds of things, but I warned her that if I ever run into him we're having it out. He's an ass, has been for too long, and this last bitty broke the camel's back.

It's like he thinks we're fighting over the same woman - who is MARRIED TO ME - and he feels that downplaying any accomplishment we've had will earn him points.

The other fact that just chafes is that he felt I hadn't "earned " the right to be called doctor. Then what the fuck is medical school for? What is the purpose of any post-graduate education that bestows a doctoral degree on someone if they haven't "earned it"? Just because he clearly feels inferior doesn't mean that 8 years of higher education doesn't count for something.

I'm serious - I'm going to have it out with him should I ever see him. Enough's enough already.

Ugly Celebs

Found this recently and think it's kinda funny. Have to agree on most.

VIP

We had a VIP who, even though he was in the ICU, still didn't want to have his beauty sleep disturbed. The following was a message placed on his door:


DO NOT awaken patient between the hours of 11pm and 6am unless absolutely necessary.

Lab techs, nurses, and various personnel didn't know what to do with this and kept waking up the on-call resident to get direction. Keep in mind that, in the ICU, the nurses have to do hourly checks as part of their guidelines and regulations. Most of the night they were concerned about getting in trouble just to give someone their restful sleep.

Even better for me was the fact that this patient was a still practicing physician, but had no idea what his meds were for, and had to have everything explained to him plainly - akin to layman's terms. Watching this scene play out you realize how the CME requirements are a good thing - because there are people who're practicing medicine circa 1970's.

What's the Deal?

Graduation is looming close. The frenzied e-mails are rocketing across the web alerting the seniors to their "week" and all the party atmosphere that befits a graduating medical student. A multitude of official people are hosting lunches, brunches, dinners, and the ever popular gala in our honor - all expenses paid (I believe in part by the class dues).

It reminds me of the events surrounding my undergrad when I was allowed to finally leave without having to harass another dean about credits. And once again I'm filled with the enormous feeling of, ah, what's that word? ah yes...triviosity.

Graduating is a big deal - I guess - but I'm really not looking forward to the splendor, the hullabaloo, and the party. After all, it's just another accomplishment in one's life that, while young and fresh, seemed quite splendid, but now reeks of "tradition" and disappointment.

I feel that, if not for my family coming in to town to witness this miraculous transformation, I'd prefer to not even be there. It's going to be long, boring, and filled with self-congratulatory diatribes and praise. Shudder.

Plus we get the extra pleasure of witnessing both the dental and graduate studies schools graduate at the same time. Like I care about people I've never, or rarely ever, dealt with. Let's just get it over with already.

Step Back

I decided after posting earlier today that, despite taking a few days and rehashing the topic a few times, it was just not a good post to have published and needed to be taken down. So I did just that.

I understand the couple commenters opinions - but still think it was blown out of proportion. I won't go any further than that here.

Race is a touchy subject to write around and I realized only too late that this published post would not be viewed well by many simply based on its subject matter. I wish that we could get beyond our differences, stop addressing "offenses" that are little more than naive opinion, and allow racial harmony to happen. Because at the moment, when we segegrate so many people in our society purposefully (award shows, TV channels, reality TV gimicks, magazines, etc, etc, etc) we not only focus on the color of people's skin or their ethinicity, we also perpetuate stereotypes and hatred. That was the meaning I was trying to derive from the afforementioned post which I saw was quickly being lost by the subject.

Oi

Moving sucks. Even if you're moving just a few miles down the road and have a trio of men lifting your heavier items, it still sucks. I find that I'm more lethargic than I'd have imagined and trying to mentally put anything together is murder. Study? Ha.

Yesterday was a day to relax as our internet and TV service was installed. We switched internet from DSL to cable and we added a local cable connection in lieu of landline phone service so that we can actually see the people on TV and not just their snowy shadows. The cable guy hooked us up - we get basic in any room we want without any extra charge. I didn't even realize he was letting us in on the goods while he was talking to me. I found out an hour later when I was channel surfing (now I just hope that someone from the cable company doesn't come out and demands that we turn it off or pay for the extra rooms).

When I was surfing the web I had tons of e-mails that needed to be responded to days earlier. God, since when did graduating become such a big deal? And why do we have 3-4 different meals during "senior week"? With gas being as high as it is, I'm most likely not going to be driving that far just to get some food.

I finally put together the lawn mower we purchased from Lowe's a month ago and got around to mowing our field this morning. I call it a field as the "real grass" is few and far between the numerous patches of crab grass and weeds. I think we also have some hay sprinkled in there as well - so we won't call it a lawn, just the field.

I've also hand washed both cars (something that gets really hard to do when living in an apartment) and actually waxed my car (never done in the last 6 years I've owned it). I'm tired, but it's a good kind of tired that's not associated with the whole process of moving. I'm really over that fatigue.

A Look Back

I thought that it would be a good idea to publish a little post about my accomplishments in the last 4 years. I don't think of this as self-aggrandizement; rather it's more like self-stimulation of the mind. But anyway...read on if you care to, but if you think this is a load of tripe, then don't - I'd rather not receive nasty comments about my boastfulness.

1) 3.9 GPA

2) >240 step 1 and 2 scores

3) AOA inductee 2007 - 08

4) Award received for being in the top 4 of my class after freshman year (I believe I'm still in this range, though the school makes a large to-do about not ranking us)

5) Highest performance on shelf exam in pharmacology; shared in pathology and physiology

6) Matched at number one choice of residency at a program that historically has not been too keen on students from my school

7) Persevered in 3rd year despite the death of my sister and close cousin within 2 weeks of each other while finding out that my dad had cancer

8) Didn't get divorced

9) Out of the 4 in my gross anatomy group that began medical school, 2 of us matched into residencies, and 3 of us will graduate. I'm quite amazed at the attrition from this group.

10) Started med school wanting to be an Orthopod with a smidgeon of interest in anesthesia. Had varying interests in internal medicine, pediatrics, emergency medicine, and surgery during this time. Ultimately came to love Anesthesiology once I understood what the hell was involved (not well taught in pharm and hardly any exposure in clerkships until 4th year).

11) No one died from my actions

12) Started at 205 pounds 7/2004. Gained 15 pounds over 3 years to an all-time high of 221 pounds. Lost 20 in 4th year to 201 - hoping to get to 190 before residency starts.

13) My pre-entrance physical demonstrated 20/20 vision. Beginning of 4th year my vision was 20/60, requiring me to get glasses.

14) Pre-entrance lab work: total cholesterol of 299 despite being on low fat diet. Total cholesterol checked in family med clinic 10/2008: 201. No drugs were ever used.