Halloween Pics

As requested, some Halloween pictures:

One Cute Little Pirate

One Not-So-Amused Elephant

In Search of: Candy

This year: (click the play button to see video)

Quite a difference from last year:

Okay..New Plan

I'll stop promising to blog more frequently and you'll stop pretending to believe me.

John Lennon said, "Life is what happens when you're busy making other plans."

I truly understand what he meant.

On the medical school front, I have just started my antepenultimate rotation: Neurology. ( ok fine- look it up, ye non Lovers-of-Latin)
Ailments of the brain and nervous system are what my world will be about for the next 4 weeks. So far the rotation started out very disorganized but when we finally got around to rounding it was rather good. My only complaint would be the hours, since I barely made it home in time for Kathy to hand-off the kids to me and head to work.

I finally completed the application process for residency and currently I am in sit-around-and-wait-mode. I have heard from only one of the programs that I applied to with a nice little email letting me know they are reviewing all the applications and will not be offering interview invitations until the first week of November. From what I hear this seems to be the modus operandi of many of the programs in Emergency Medicine, so I have not begun to worry yet.

The family is doing great and I am enjoying all the extra time being with them since my schedule has been a little easier (up until today anyway).

Kids update:

• After quite possibly the longest ping pong losing streak in history (151 games- just ask him) Johnny's systematic trouncing of the old man came to an end! I was finally able to beat him. I promptly decided to retire from play and go out on top;-) [update: My retirement was short-lived and a week later I was back to "coming in second" ]
  
• Meagan is being inducted into the National Honor Society this Wednesday, we are all very proud of her. As several people were quick to point out, she must get her brains from her mother.
  
• Kaitlyn is also doing very well in school, this is no small feat- considering that she spends almost every waking moment trying to become the world's greatest Flyers fan. Apparently she is in "Daddy, you just don't understand" kind of LOVE with several of the players and has even roped me into taking her to a Flyers practice. Not sure how I should feel that my daughter is all starry-eyed smitten with someone who is missing his front teeth.... I suppose it could be worse.
  
• Rileigh is doing quite well with the potty-training and aside from the occasional mishap, I believe that we are just about home-free. From the most recent entry in her Toddler Tricks to Horrify, Frighten, and Annoy your Parents playbook, our little darling painted her face with White-out (don't ask) and then got a hold of Dylan's tub of formula powder and decided to eat some with the convenient little scoop provided and as I was running from the other side of the room screaming attempting to redirect her, it must have sounded to her like "dump all the powder on the floor just before Daddy gets there, sweetie!" because ...yeah that is just what she did.
  
• Dylan is growing like a weed and at this rate will be as big as Rileigh any day now.

That's it for now.

Tune in soon.

I'm not dead...

Much has happened since my last posting.

I received the results of my USMLE Step 2 exam and I couldn't be happier. All the studying paid off!

I finished my GI rotation and now in the second week of Cardiology.

My oldest daughter, Meagan turned 17, passed her driver's license exam, and bought her first car- all in the same day!

Meanwhile I have been busy working on my application for residency- I am happy to say the process is just about complete and all that is left for me to do is sit around and wait for interview invitations. Hopefully some will come!

That's all for now- I hope to post more frequently now that I have a little more free time.

And When I Get That Feeling....

This week in GI, I am doing consults. It is a nice change of pace from the non-stop onslaught of colonoscopies and esophagogastroduodenoscopies. Basically, whenever one of the managing medical teams decides that their patient has a problem that may benefit from the GI service they request a consult. It is the medical world's equivalent to "Hey take a look at this and tell me what you think". There is a fair amount of consults that come into the GI service everyday so they are only too happy to let the medical students "help them out". Anyway, during a lull in the consult action I was asked to head back to the endoscopy suite to lend a hand. I was soon joined by another medical student and after taking some H&Ps we were observing a fairly routine colonoscopy.

The endoscopy suite resembles a small operating room. There is a large video monitor on the wall, a stretcher in the middle of the room, the endoscopy machine is stacked neatly on the counter, and a full array of tools, wires, hoses, and scopes are hanging neatly on the wall. The thing that makes the endoscopy room a bit different is once the procedure begins the lights are all turned down really low. I made a joke my first day there that at least they provided a little mood lighting before impaling you with large medical instruments.

Having music playing in the operating room is a fairly common thing. Many surgeons have their "pet music" that they need playing in the background while they snip and hack through tissue practice their healing arts. The endo suite is no different. Most of the doctors there are content to leave the radio on; tuned to some "office-appropriate" adult contemporary station.

The low lights, the music playing in the background, and my somewhat twisted sense of humor came together in a perfect storm today that almost had me laughing out loud.

In the middle of a procedure that involves passing anywhere between 4 and 6 feet of unfriendly colonoscope into your "Holyiest of Holyies", I happen to catch the song that was playing on the radio. I tried to stifle a giggle as I looked over at the other student and told her to listen. As luck would have it, Marvin Gaye was crooning on about his need for Sexual Healing.

And then came this lyric:

"You're my medicine. Open up and let me in.
Darling you're so great, I can't wait for you to operate.
I can't wait for you to operate. Baby, I can't wait for you to operate."


I guess you had to be there.....

The Word of the Day

You hear about in throughout medical school: The medical student closet hypochondriac who, upon learning about a disease, is JUST CONVINCED that he has said affliction. I have witnessed this phenomenon to a mild degree with a couple of my classmates. You know what they say, "a little knowledge is a dangerous thing."

But after spending the last week watching enough colonoscopies to last several lifetimes, I got really concerned. Seeing countless diverticula, polyps, hemorrhoids, and abnormal mucosa, well, it was enough to scare the sh...well you get the idea ;-)

Anyway, the word of the day is :



Do you and your colon a favor and jam your face full of oat bran, vegetables, fruits, beans, tree bark- whatever. Just be sure to shoot for 30-40 grams per day.

This Public Service Announcement brought to you by concerned colons everywhere.


Picture Credit

The Weight of the World

I woke up this morning and something was different. I actually got a decent night's rest, something I sorely missed.

After what seems like an eternity of endless studying, I finally have come to the day where I no longer have to worry about the USMLE step 2 exam*. What a relief!

The exam yesterday went pretty much according to plan- after over a thousand practice questions, the test seemed to go by pretty quick. There was however, a series of about 5 questions near the beginning of my first block that felt like a stiff boot to the pills. They asked some off-the-wall curve-ball questions that were more of the Step 1 variety. Aside from that I felt pretty comfortable with the material and I didn't think it was too horrible.

I suppose I will know for sure in about 3 weeks when I get my results.

My son John picked me up after the exam and we met up with Jersey Pete to did a little post-exam celebrating over a few beers and the Yankee game at Brother Jimmy's.

Up next, I am reunited with my friends in GI starting Monday.


* assuming I passed

Is that The Eye of The Tiger playing behind me?

If my life were a movie, this is where the Big Training Montage scene would go.

With only 6 more studying days until my big fight test, the studying has been in high gear for a while.

Actually, it is almost around the clock, literally. Between my usual dose of insomnia and Dylan's 2 middle-of-the-god-damned-night-feedings while Kathy is at work, I find myself watching review videos or reading by computer light while the little guy hungrily chows down a bottle. Afterwards, as I toss and turn, trying to fall asleep, I will inevitably think of something I wanted to look up or a practice question I got wrong. It will fester until I eventually give in to my compulsion and... out come the books.

I have been at this pace for a good while now and I seriously can't wait until this particular test is in my rearview mirror.

You always hear about the Herculean effort and multiple sacrifices that are needed to get through medical school. I wasn't naive. I understood what kind of work it was going to take. I knew what I was getting into. I entered into this journey eager, and with eyes wide open. Don't get me wrong, there have been a bunch of sacrifices and our road was not without its share of bumps, but frankly, I never felt like this whole thing was that bad . I'm not sure if it is because I have a supportive family around, or because I had a good bit of clinical experience before starting, or just that I am too damned old to get flustered about things. Whatever the reason, I had it all under control. Things, they are starting to change.

I am sure this is a very common feeling for most students around this time in their careers. So close to the end (or beginning, actually) and each next step is a bit harder to take. The feeling like it is NEVER going to end, and the mountains of tasks- still left to be done.

Yes, I am so ready to get this test over with and reclaim just a small part of my life.

So, if you are in the neighborhood of the Prometric Testing Center in Manhattan next week, and you spot a man with blood-shot eyes, sporting a "playoff beard", who smells of regurgitant breast milk and baby powder, mumbling to himself manicaly, "Yo, Adrian!", as he walks out of the building- just smile and nod and let me have my moment- I've earned it!

Weekend Update # 716....

This past weekend Kathy, Rileigh, Dylan, and I drove down to spend a few days at Chateau de Exwife . As usual we had a great time. We got to spend some time with the whole family before Susie, Bruce, and the girls head off for their annual vacation- this time it is Mexico for 10 days. Color me jealous.

Friday I spent the day at my mother's house taking care of a list of things she needed me to do: running some new pipes for a water spigot in her garage, repairing her kitchen faucet, replacing a dimmer switch in her dining room, replacing the toilet flange and re-mounting her toilet, and some other manual labor type things. Thankfully Bruce had the day off and offered to come along and help me get things done quicker. Everything got fixed and nary a trip to an ER- it was a good day.


Speaking of my mother... Let this be fair warning to all:

It now may be unsafe to drive (or walk, for that matter) about the streets of Philadelphia.

It seems those wacky, fun-loving pranksters over at the PA Department of Transportation thought it would be a good idea to issue her her first Driver's License! Congratulations, mom!


Because of an upcoming change to the test format, begining on August 10th, people who take Step 2 will experience a significant delay in score reporting. I wanted to avoid this and so I have re-scheduled my Step 2 exam for Thursday, July August 6th. Hopefully the 4 days of forsaken last-minute studying won't have an impact on my score. I can't wait for this to be over!

Lastly, file this under "David Hasselhoff, I ain't!"

While enjoying some barbecue yesterday in the back yard at Chateau de Exwife, Rileigh somehow managed to crawl underneath the ad hoc security gate at the bottom of the steps that lead up to the pool deck. She was up just about at the topmost step when we noticed her. My dad instincts took over and I lept up from the table stepping over a Sleeping Dylan in his carrier seat, and sprinted across the lawn to the steps. I'm not sure what exactly possessed me, but I hurdled over the gate at the bottom of the steps and nearly tackled poor Rileigh up on the deck. She was quite startled because she was only headed up the steps to retrieve a toy and here comes her dad barrling down on her like she stole something. After catching my breath for a second I recieved a strange message from my lower back.

It said, "You idiot! Apparently, you think you are some sort of athlete who can sprint off and go hurdling over things. You are so wrong. You will pay."

Almost immediately, I felt the wonderful searing hot pain of old age and deconditioning racing across the right side of my lower back. So today I am hobbling around half-crippled and hoping this goes away soon.

The safety gate has been repositioned and she can no longer get by it (for now). Sadly, I imagine my lower back will take a bit more effort to get back in shape.

Lessoned learned.

On losing one's mind...

Friday night was my last shift of my Emergency Medicine rotation. Unfortunately, it went out with a whimper and not a bang. My last 2 shifts there were uncharacteristically slow. I suppose that is a good thing for the citizens surrounding the hospital, but not necessarily how you want your shifts to go when you are an eager medical student. (paying not a small sum of money to 'get your learn on') The whole rotation went really well however, and it has been the most enjoyable rotation by far. I am looking forward to another ER rotation assuming I can successfully schedule one.

With only 5 months of rotations left, I am starting to see the light at the end of this tunnel. It is a pretty exciting time. I must admit my excitement is tempered a bit by the stress of all that remains left to do. There are personal statements to write, lists of residency programs to weed through, letters of recommendations to secure, applications to fill out etc. The seemingly endless administrative tasks are the bane of my existence, but a necessary evil so I'll stop whining now.

Before I can dedicate the time needed to get my applications in order, I have to tackle the USMLE Step 2. August 10th is my test date. I have been trying to study as much as I can and have been doing practice questions for almost 2 months now- squeezing in a block of questions whenever I could. Since I am rotation-free for the next 3 weeks, my studying will ratchet up to a full-time job (in addition to my Mr. Mom duties while Kathy is at work) so this should be a very interesting few weeks. I have been doing pretty well so far on the practice questions and I did well on the sample exam that you can download from the USMLE site; so far so good.

While I am fairly confident going into this exam, everyday it seems I uncover yet another piece of medical knowledge that yours truly has simply... forgotten. The information is gone and all that remains is the phantom of a memory, mocking you, like a dream you can barely remember. The harder I try to recall, the fuzzier the details get until I find myself at my desk drooling on myself and realize half an hour has passed. I realize that no one is expected to remeber everything, and I'm sure everyone has moments like these, but it is of little consulation when you feel the cruel grip of senility taking hold. Studying for an exam like this is quite the gut-check. I think half the battle is hanging on to your sanity.

I have a particular mental block when it comes to a few topics, try as I might they slide through the steel trap sieve that is my mind:

The glycogen storage diseases- once upon a time I could prattle on about them, now... nada.

The serological markers and the auto immune diseases they are associated with- anit-dna, ana, anti-centromere, smith, rho, jo, anca...calgon take me away!

The congenital adrenal hyperplasia enzyme deficiencies- 11, 17, 21...22 23 whatever it takes. ( I have drawn the chart about a bajillion times over the last 4 years- you think I would remeber... any of it!

The relationship of gnrh, fsh, lh, estrogen and progesterone in the menstural cycle/pregnancy. This one I can usually recall after a mini "drooling session" but it seems that my lack of understanding of women doesn't end with The Mystery of the toilet seat left in the UP position and the psychotic break it precipitates in those afflicted with 2 X chromosomes.

By no means is this list complete, the sheer weight of what I don't remember would sink the QE2.

Despite my selective amnesia, I push on, ego in tatters, and like Sisyphus, I am condmened to watch the boulder of my memory roll back down the hill. Maybe today some of it will stick.

Maybe.

X-Ray From Last Week

Things have been a bit on the busy side. I have switched to night shift in the ER for the next 2 weeks and have been struggling to get used to being awake all night again. Things are going really well on this rotation and time is flying by- as I imagined it would.

This was a case I had last week. I saw a gentleman with a bad venous stasis ulcer who had just been discharged from the hospital. He was returning because the ulcer had just started to drain some rather purulent material despite being on some antibiotics. After taking his history and doing a physical I went and looked in the computer system for a x-ray of his leg- since he had an old distal femur fracture that he chose not to have repaired for some reason. I saw the x-ray and it was quite an impressive fracture but other than that, the area of his leg where the ulcer was looked pretty good. When I presented the case to the attending I mentioned that I would like to get another x-ray even though the one on file was less than a week ago. He agreed, and I ordered the films. A little while later I went to pull up the x-rays and this is what I saw:




Click on the images to enlarge them, if you are having trouble seeing, there is subcutaneous air in the soft tissue.

Diagnosis: Gas Gangrene. Pt was scheduled for amputation of the leg above the knee for the morning.

Reason # 419 to keep your diabetes under control.