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.

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.

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.

Ready to Dust Myself Off

Even though a few hours remain, I think it's safe to assume that the 65% of you who voted for me starting a new blog won't suddenly change you minds and try to sway the results. With that being said, I decided to start a new blog (for the record I find it interesting that those who felt I shouldn't start a new one were more likely to comment rather than just vote). Therefore I grabbed one under a new name that I will link with this one and vice versa.

In deciding to not keep with the God-complex/ delusion/ whatever-you-want-to-make-of-it persona I've created in the last 3 years of pathetic self-indulgence I shall be known, upon graduating May 17th, as Resident Anesthesiologist Guy (RAG)*. Cool, huh?

Now that you've had time to get over the awesomeness of this name and have picked your jaw off the floor, the blog shall be called The Chloroform Rag (get it, R.A.G.?) in reference to the infantile days of anesthesia when chloroform soaked rags were used as general anesthetics. I plan on using it as a tool to increase both awareness of anesthesia as a medical specialty as well as the process involved from being first called "Doctor" to that where it is not just a fascietious designation.

I hope that you'll make the trip to review my random postings and complaints as I finish one arduous climb only to get knocked off my high-horse into the dry and dusty dirt to begin another, harder trek.

*Actually I think RAG would work better if I where entering OB/Gyn, but whateva...

Do You Have This View?

Even though call sucks - mostly because I can't do much and sit on my hands all damn night long, waiting for something to do, ergo the 2 posts in one day!- I have to revel at the beauty I'm awarded from my call room's window on the 9th floor as twilight descends.

Taken from my cell-phone, so it's not the best pic, but this encompasses the older parts of the hospital, the dental school (building on the far upper left), and a portion of a university that is across the street (not affiliated with us). It is far more breath taking than this crappy shot demonstrates - trust me.

Reading Rainbow

So I hinted earlier about my uptake in pleasurable activities during this semester and the slip in my medical knowledge because of it. I was thinking about the amount of literature that I’ve read through and, while not epic in any sense, it is rather astonishing to regard the amount of reading I’ve undertaken in the last 6 weeks. My list of fiction that I’ve gulped down with child-like glee includes:

1) Cutting Remarks by Dr. Sid Schwab
2) Odd Thomas by Dean Koontz
3) The Face by Dean Koontz
4) False Memory by Dean Koontz
5) The Shining by Stephen King
6) ‘Salem’s Lot by Stephen King
7) Nobody True by James herbert
8) Mary Shelley’s Frankenstein
9) The Killer Angels by Michael Shaara
10) First, Do No Harm by Dr. Derrick Beech

Most of these have been excellent reads, but it staggers the mind to think how much time I’ve spent absorbing fiction. No wonder I’ve gotten a little rusty. Up next? Carrie.

Good Times

It’s nice to find out that you’re going to have a moving company work on moving you from a 3rd floor apartment into a home with stairs and a fairly steep driveway – all paid for by your program.

It’s wonderful to have signed on a home and know where you’ll be living for the next few years.

It’s fun to roll in the grass with my kids, despite the dangers of doggy poop landmines.

It’s exciting to complete items needed by your residency program – it makes it seem like you’re already there.

It’s fun to have sloppy joes for dinner when everyone is tired but starving. It reminds you of how simple life actually is and how complicated we tend to want to make it.

Their Take

Some bloggers have been posting some great topics recently. Rather than submit you to more of my drudgery, I offer their takes on a couple topics I've spouted off on here and there:

Psychiatry by the Half MD (posted under clinical rotations - you might need to dig a bit).

CRNA and MDA "relationships" by Mitch Keamy over at The Ether Way. *

Enjoy.

*And just so we're clear - I like CRNAs and think they provide a valuable service. But they're not MDAs and shouldn't think that they are as qualified - ever. It's the same problem that occurs in retail clinics - a few thinking they know more than they actually do with no one to tell them differently and believing they're doctors..

Dead Blogs

I'm toying with the idea of eliminating some of the blogs on my blogroll for being dead. I prefer to think of a blog as being dead if it hasn't had activity in 2 or more months and have a few on my list that meet or are close to meeting this criteria. Plus I've noticed that there are some blogs that aren't necessarily dead, but I just don't enjoy them as much anymore. We've grown apart, I guess.

So here's a fair warning to those blogs: you know who you are and you need to post something before next week...or off with your head!

Confessions

I read a post where an ER physician “confessed” their likes and dislikes. It received a great deal of feedback, both pro and con, and was a rather powerful post generator amongst several bloggers. Having some time to think while I attend mandatory “Doctoring” lectures left me with a desire to “confess” as well. So, here goes – hopefully it won’t be as negatively viewed by the powers that be…

1) I’m scared. Scared to death to start intern year. I’ve been losing sleep over this, staying up late trying to read on treatments, planning on making flashcards on drug dosages and when to use them, etc. I’ve gone through a few of my reference books trying to find the “golden book” that will house everything I need – and make me a doctor. But I know that one doesn’t exist and it all comes from experience and repetition. But it still doesn’t deter my mind from freaking out about not being able to handle the first day…or week.

2) I’m impressed with how I’ve grown over the last 4 years. I’ve seen slides, talks, and discussions related to certain aspects of medicine that, when I began, were completely foreign and mind blowing that I now understand a great deal. A slide of a surgery was once viewed with complete unfamiliarity that I can now view systematically and understand what’s going on – at least a little. It makes me feel pretty good.

3) I feel a constant guilt about taking my family through medical school. Wife and I fight about things that, normally, wouldn’t cause a great deal of trouble. I get mad quickly about any inference that she’s been betrayed or dragged along in this maddening process – and I lash out. Tax season lends itself to this more often than not – as I want to use the refunds towards future expenses or emergencies, while Wife has ideas of her own. It is, after all, her money. She worked for it, not me, and therefore should be able to use it as she deems fit. I get really upset when stuff like that comes up – I’m working hard too with little more than debt to show for it.

4) I hate the increasing belief that doctors are overpaid and that a great deal of what they do can be done by lower-level providers. Enough said about this topic.

5) Frequently I have fits of jealousy when I look at others. I constantly compare myself to what I don’t have and what I think others have. Living in an apartment, driving a car that looks trashed and lacks a driver’s side door handle, and struggling with mundane financial issues at the age of 30 infuriates me at times.

6) I think nurses are great sometimes and terrible others. When they do their job and understand the gamesmanship between them and the doctors they can rock. Others, either through time, jealousy, or just a bad attitude can be obnoxious and draining – leading to a lot of time spent maneuvering around them. I’ve found that if doctors can’t evaluate or hold a certain level of expectation on the nurses, the worse they are. I hate the fact that they can make life miserable without any fear from the interns/ residents - we are helpless and a bad nurse can really make a rotation godawful. Hopefully there will be less of those and more of the patient, tolerant, and kind nurses.

7) I hate pop culture music – R&B, rap, hip hop, etc. I find it absurd that white people buy a great deal of this music that promotes sexism, racism, and bigotry towards the white population. I find it even more deplorable that the literacy and grammar of the upcoming generation, buying into this cesspool, is becoming increasingly fragmented and acceptable. We pretend like they’ll be OK, using double negatives two or three times in one sentence, while secretly hoping that we’ll be dead before they take power. Our country has lost itself in trying to be PC and allow any form of stupidity to exist.

Low On Gas

Recently I took some of that golden free time over the holiday to try and drum up some more “MSG Worthy” blogs. Not that I’m all powerful and everyone bows down to my suggested readings located to the left. In fact, it would seem that no one pays particularly much attention to me anyway (as my siteviewer indicates an increasing drop in visitors), so it’s merely more of a “favs” for me when I'm away from my traditional PC. Now you get it – yes?

Anyway, I found that I had a rather hard time finding Anesthesia related blogs. I was fortunate in being able to find a couple that I enjoyed perusing and, even more fortunately, they also had a couple links here and there of other blogs written by Anesthesiologists that for one reason or another were relegated to "look at later".

But I’m concerned…just 3 blogs overall that I found worthy of being placed on my “read regularly” list? Where are all of the great Anesthesia bloggers? I know they have stories – just like surgeons – and are a great deal more well rounded than their said counterpart. Humour, intelligence, and personality abound in anesthesia, so why so few?

I tend to consider the nature of the job when I ask this question. I also find that most people really have absolutely no idea what it is to deliver anesthesia which, possibly, leads to a great deal of frustration. I mean, how many times have I read in Michelle Au’s blog a comment here or there where some commenter says something like: “Yeah, but you were like, a REAL doctor today!"? Far too often, I'm afraid.

I see these, read them again, and think: "WTF? Real doctor? Idiot".

Anesthesiologists are more than just technicians, but most people honestly believe we just put you to sleep and leave the room. Even amongst those we work with regularly I see an amount of ignorance - even if they do hold a great deal of respect for their colleagues - that I just don't understand.

Fortunately I'm hearing that more surgical interns are rotating through anesthesia for a month or two in order to gain a fuller appreciation of the nature of perioperative medicine and it's strengths/ pitfalls before they're too hardened. On top of that more anesthesiologists are also branching out into critical care medicine and other medical fields where the true nature of perioperative medicine can be utilized...maybe we really can all get along.

Perhaps it is the lack of understanding, even amongst our co-workers, that's the causation behind the diminished interest in the anesthesia field to author a weblog or, for that matter, in the reader to actively search out the “Gasman”. Surgeons and ER docs seem to hold a great deal of notoriety as the coolest docs out there and therefore seem to have more opportunity to capture an audience (look at Medblog Addicts "Calendar Docs" on her sidebar and you'll see what I'm talking about). Who cares about the guy who "watches the surgeon work"?

I guess that as I progress in residency I’ll loose a lot more readership since I'm entering a less than cool field (to you, not me), but at least I’ll be another voice in a specialty that doesn’t receive nearly enough acknowledgement or praise.

In With the New

As far as 2008 goes, I'm going to take it a little easier on myself - as far as resolutions go, that is. After all, 6 months from now I'm going to be getting dumped on in a manner I've never dealt with and I'm sure I won't have time to - you know - read more, eat better, exercise 5 days a week, etc. What I can change I hope will help with a lot of these anyway.

1) stop drinking sodas - makes my stomach miserable at times and there's a crap load of carbs, calories, and bad juju in those bottles.

2) tell my wife I love her everyday - regardless

3) don't sweat stuff that doesn't matter anyway - live and let live. Getting that fat bastard to understand that they have to take better care of themselves is important, but most likely not going to happen - so don't sweat it if they keep eating out. It's their life, after all.

That's it. Pretty simple.

To Do List

The family had a terrific Christmas yesterday. The kiddies were very excited Christmas Eve and were awake by 4am Christmas morning! Coffee, needless to say, was mandatory. Stepson was with us from Monday till noon on Christmas before he went to his dad’s. Once there he called after a couple hours and asked for us to bring over some of his gifts – he was bored. All I could think was, yes!

Wife, Daughter and I went to see a movie as well. We saw The Water Horse which was an OK kids movie. Daughter really liked it, but it had some weird parts where I thought, that's a little dark for a kids movie...but whatever. It was nice though, to get out of the house in the evening. Wife feels that Christmas evening is always a bit anticlimactic, especially since we don't have anyone we spend it with, and getting out of the house shakes things up a bit.

So I wish that I could relax today, but here is a small list of the items that I realized I have to accomplish by the end of this week (or maybe next week):

1) Register my car. I would like to avoid getting a ticket for expired registration by one day - like what happened last year - on the way to my first day of a rotation. I can use $140 for better things than citations.
2) Take Daughter to her doctor’s office. She has been sick for over a week now and I can no longer convince myself that it’s simply a viral URI. Especially since she started to complain about her ear hurting and, upon inspection, I found it to be angry, bulging, and red looking. Amoxicillin, 60-80 mg/kg bid-tid for 5-7 days, if I remember correctly.
3) Order copies of my birth certificate and have it express mailed. I was looking at my driver’s license the other day and realized that after 8 years without having to obtain a new one this expires in 2 weeks. Unfortunately in this state I have to have my first renewal at the DMV (bastards!) and can’t just get a mail-it-in renewal. I also realized that I can’t dawdle on this since I have to fly to a few more interviews in January, with one being the 6th-8th, and an expired license will no longer be accepted as identification! Crap.
4) Hang out with freaks at the DMV…see above.
5) Find out if my next rotation starts next week or the week after. An e-mail sent out last week stated we were starting 5 days later than the scheduled by the school. I’ll be out of town on that date and don't want them cutting me out of the class if I don't show the first few days.
6) Plan Wife’s birthday party and get reservations for dinner.

So as you can see…a few things to do. Some more important than others, but all important.

Interview Dribble and Random Thoughts

I recently cancelled some interviews. I was giving the dates that I’d be out to Wife in order for her to adjust her schedule for work and she began to freak. Six different dates in December, her biggest month and also the time of year when she has to work overnight per company guidelines, were just too much for her. I looked at the interviews, realized that I had one every Tuesday and Friday with dinners the night before during the next 3 weeks, some with 3 days of travel (flight cheaper that way), and analyzed my options.

I cancelled those that I could – those that weren’t as high on my list already or didn’t have a nonrefundable flight attached to them. If I hadn’t worried about rising gas prices a month ago I would have gone to a Texas program over one in Pennsylvania that I've already purchased a ticket for, but I’m stuck now.

For a pre-birthday gift Wife purchased me a Magellan Maestro GPS unit to help navigate during this time. Since I’m driving to a large amount of these programs it helps to have something that can get me around town and this is a great gift! I used it a lot this last week just to see how it works, going to places I knew how to get to already, but seeing where it would take me and if there were any problems. Dead-on every time and it worked quickly most of the time. A few times it stalled getting my information, but during the trips it was fantastic.

Getting an idea from GruntDoc, MD, I decided to do a dead blog update of my own. Basically if there hasn't been any activity for 2 months I deleted you from my sidebar. Those considered dead are:

• Adventures in Medical School
• Parcho, MD (let me know if you start again)
• Scutmonkey (went private)

So, being in an after turkey-day malaise, tomorrow I plan to get out the Christmas decorations, start to get the tree put together, study for my Step 2 CS in a week, and eat a lot of leftovers. On Sunday interviews begin - oh yeah.

Are You Smart Enough?

Thanks to Medblog Addict for this.

Lo Siento - mi amigos

If you haven’t noticed, which I’m sure most of you are painfully aware, the posts recently have been…well…of a poor variety. I attribute this to a phenomenon that I call “blog running.”

Blog running is essentially trying to keep a blog updated regularly, regardless of the content, while being too busy to really formulate anything of substance. The last few months I have been either too busy or too involved with interview crap to really do much meaningful writing. Unfortunately I don’t see that changing too soon – at least until my break in December (when I’ll be interviewing through most of the 1st 2 weeks so you're still SOL).

Part of the blame lies in the fact that I’ve tried to post while at home, when Wife is around, and have just typed as fast as I could while trying to not get caught. Remember, she still doesn’t know about this little project and I like it that way. So whenever I’m on the computer and believe I can get something posted in less than 5 minutes I try to get something out.

So I have to apologize for the lack of substance recently. I will try to keep some backburner drafts going in order to at least have one or two interesting articles.

BFE

Image of the parking lot at the hospital where I’m doing a rotation. I have to catch the shuttle from here to get to the hospital. Clearly the lot is so far away from any building that they feel porta-potties are needed – since you won’t be able to hold it.

Getting Back To Basics

So here’s the thing. I like writing posts where I know there might be some reaction. I like checking the comments to see who’s upset or what agreement, if any, there is amongst my few readers. It’s fun.

The last post was for me, but also for that simplistic pleasure. That’s part of the reason the heat gets going as a post continues– to get a rise out of you. Unfortunately I may have caused some of my med school buds to feel I don’t support starting a family while in school. Simply put – I completely support anyone who can juggle this craziness with kids. I don’t have any qualms about women having children during residency or afterwards either. My beef was not with med students taking time to have children or their need to have accomodations afterwards. My beef was with the student in question only - because she sued. What does that say about her? That was my point.

So, that’s that. If you’re still upset or irked then there’s nothing I can do. It’s my blog and I write what I want.

Anyways, the Tassimo poll has completed and basically more people have no idea what Tassimo coffee is than those who either love it or hate it (which tied BTW). No idea where to go with this information, but at least I know that I'm not the only one who loves it...

…and I’m looking at my veins as I type this dreaming about sticking large bore IV’s in those juicy ass rivers of blood. Part of wanting to be an Anesthesiologist I guess. 2 days from my first interview and I'm wondering why all of this is necessary. $4,000 in travel expense thus far without hotels for most trips - yet. Damn.

Random pics

A picture of the jack-o-lanterns that we carved while Wife's parents were here. And yes, that is Christmas wrapping paper on the table. We didn't have newpaper and this worked awesomely. I would recommend it - no leak through at all.

And here is the driver's side door handle on my car. Broke off a while ago during winter - just popped right off when I pulled on it in the morning. Lovely. I just absolutely love this vehicle (sarcasm - in case you couldn't tell). Everything has fallen off, broken, or just looks bad. Everything that is except the engine. 125,000 miles and it's running great. I hope to get 4 more years out of it for residency purposes. If not then I'm buying a clunker - no more new cars for a while. It's been nice not having a car payment.

BTW: this car is almost 6 years old. I drive a lot - especially when I was working and going to undergrad - over 100+ miles roundtrip 7 days a week for 1.5 years! I think that's where most of the miles were added on initially.