IT'S A BOY!!!!!!!!

Well, not really a big surprise since we knew this little bundle of joy was sporting a Y chromosome, but today he officially arrived!

Given her obstetrician's concerns about the baby's size, we opted to have an elective C-Section today and forego the induction of labor, that may have resulted in a(n)[emergent] C-Section anyway. So after several delays, (other emergent C-Sections that bumped our place in line for take-off) at 17:33 EST our little guy took his first non-liquid breath. Happy Birthday buddy!



Tipping the scales at 8lbs 5 oz, he is not quite the behemoth that was predicted, (of course it isn't MY pelvic ring that he would have had to go through...) but he is noticeably bigger than any of his siblings were. (and yes I DO remember back that far!)

Mom and baby are doing just fine.



There were some visitors...

Rileigh and mommy:


John finally gets to hold his little brother


Meagan is taller than 2 of her siblings...for now!



Kaitlyn and her baby brother


One of my favorite moments:



Kathy's proud parents:



The Brood is complete:



Oh yeah, I was there too:










Time for a nap already!



Dylan James McDonough
March 31, 2009
8 lbs 5 oz 22in

Welcome to the family little guy!

Sunday News...

There have been several developments since last we last left our hero.

Thursday night I was on-call and had a relatively quiet night as far as trauma goes. I'll chalk that up as a win. 8 weeks down and only 4 more to go.

Friday night I drove down to spend the weekend with the kids while my VERY pregnant wife was left behind to ..work (I know, I know, I am a MONSTER! but she is still feeling pretty good and we do need the money- thank goodness for supportive wives!)

Saturday night Meagan and Kaitlyn had their Freshman/Sophmore Formal at school and dad was there to function as chauffeur. My little girls are growing into beautiful young ladies- in what seems a blink of an eye! Speaking of chauffeur duties, I let Meagan, with freshly-minted-permit-in-hand, drive us around while I ran some errands Saturday afternoon. Aside from some fingernail marks on the passanger side seat, she put nary a scratch on the car. Actually she has proven to be quite the decent little driver. Stangely enough, I didn't hear any of the colorful language or curteous hand guestures that seem to be the hallmark of my driving, must have her mother's Driving Gene.

John, Bruce and I watched the Villanova - Pitt game and it was a barn-burner. I wish the same could be said for my Ping-Pong skills. Over the course of the weekend, John has beaten me, as they say, like a rented mule. I think at last count it was something between 25 and 30 games. ( with 2 EXTRA embarrassing shut-outs!)In. A. Row. Does anyone know where a man can find himself a ping-pong coach?

Lastly but not leastly, Kathy went to her Ob/Gyn on Friday and they have decided to induce her on Tuesday! Although she is only 39 weeks (of the usual 40) there is concern that the baby is getting to be big enough to replicate the scene from Alien (the ultrasound measurement Friday has the little guy tipping the scales at 9lbs 5oz; but I have my doubts about the accuracy of this latest measurement) At any rate, tomorrow we will find out the details of what time to be at the hospital on Tuesday. We re getting pretty excited and can't wait to meet him.


Stay tuned.

Interventional Radiology

Yesterday I spent the day in the Interventional Radiology Department. The IR department is a pretty cool place where technology and medicine collide. In short, they use cutting edge imagining techniques to assist them in diagnosing, and more importantly, providing treatments in the form of various procedures.

I got pretty lucky yesterday since there were a wide array of cases. There was a femoral and aortic angiogram, a percutaneous drain placement in the gallbladder, a kidney biopsy, and very interesting catheter thrombolysis of 2 whopping Pulmonary Emboli. I was told by the Radiologist just how fortunate I was since they do not do too many of these procedures- he guessed maybe only a dozen or so last year- since clots of this magnatude are usually fatal.

The patient was a previously healthy woman in her early 70's hwo presented with shortness of breath. It was discovered that she had massive bilateral PE's; the one on the left was occluding just about 100% of the pulmonary vasculature. Basically only one of her lungs was working at all and it was pretty compromised at that.

The procedure we performed yesterday involved placing a long catheter in her femoral vein and threading it up through the right side of her heart and into the left pulmonary artery. Although I have known for a long time about the capabillities of IR, it was still nonetheless impressive to see it done right in front of me. The neat part involved using a specially designed catheter (threaded to the same place) that had the ability to 1) deliver TPA (a clot dissolving agent) directly to the clot and 2) consisted of a internal core wire that plugged into a machine the size of a small carry-on suitcase that caused the internal wire to emit very high frequency pulsations- in an effort to physically break op the clot. This was to be left in place for a number of hours and then another catheter would be used that alternates very rapidly shooting saline solution and suctioning it back out- in essence pressure washing and vaccuming out the clogged artery.

Although this procedure carries a fairly high mortality with it somewhere around 15-30%(given the very sick nature of the patients who need it along with the risk of complications etc.) the pateinet did well, at least until I left for the day- She was still in the letting the catheter vibrate out her clot phase of the treatment.

I was rather impressed with my day spent with the IR guys. I recommend it to anyone who has the opportunity during your rotations.

Below is a picture I snapped with my cell phone of the IR control room. In place of the standard white plastic light difusers you see all over the hospital that cover the flourescent ceiling lights this is what they have in IR. I guess they have a few more dollars in the old budget for "ambience".

Thug Life

I survived another 25 hour shift on-call Saturday and slept the sleep of the dead today. I am having some weird experiences lately with having a tough time separating things that actually happened and dreams I have when I am extremely tired. Is this the begining sings of psychosis? I hope not. Most likely I have been just really tired and having very realistic dreams lately.

Although it was fairly busy last night, there was not too much in the way of terribly interesting cases. I scrubbed in on an appendectomy and a cholecystectomy during the day yesterday and the OR was fairly quiet besides those cases.

Last night we had several traumas including 2 gun shot victims. Somewhere around 3am this morning a young woman in her 20's was brought in with a gunshot wound to the side of her neck with an exit wound to the opposite shoulder. Since she was fairly stable for the moment we took her to get CT scans to further evaluate her injuries. She later went to the OR for exploration of her wounds and did quite well and is recovering today.

While we were waiting for the scans to complete I asked one of the other students with me, Dave, if he had noticed the tattoo our patient had in her arm. He had not. I explained to him it was a picture of Winnie the Pooh sitting holding an overflowing honey pot with bees circling around. The caption above and below the picture read:
"Get Rich or Die Trying".

To which he said, "So far its Get Rich: 0, Die Trying: 1" (giggle-snort)

To no one's surprise, we get along pretty well.

Spring is in the Air and in the Old Folks

Despite being the first day of spring I woke up this morning to snow flurries grrrr. I am ready for some nice weather, this winter-although not too horrible- has seemed to drag on forever.

Today I was scheduled to be in the surgical clinic and it turned out to be a pretty good day. I got to do an Incision and Drainage of a pretty nasty abscess, but taking the prize today....

I saw an interesting man with an even more interesting hernia. The patient was a 72 year old male who came in for evaluation of a suspected hernia. I began asking him a bunch of questions and somewhere during my little interview he told me he is remarried and has 2 children with his new wife. I must have had my "big fat hairy deal" face on because he seemed to be waiting for some sort of reaction, after a few seconds he then proceeded to tell me their ages [drum roll please]...............4 and 3. Years. Holy Tony Randall, Batman! I could feel my facial expression change into my "you've gotta be shitting me!!" face but I couldn't help myself. Apparently, his hernia has not affected the Michael Phelps-ian ability his own 'little swimmers'.

For some reason all I could hear in my head was the haunting, "VIVA....... VI...AGRA" song playing over and over!(it's a curse.) He then dropped this little pearl in my lap:

"I don't go to the gym, I go to the bedroom!"

Now all my head could do was hear a Budweiser Real Men of Genius commercial playing:

Here's to you, Mr. Getting it on and cranking out kids as a septuagenarian......While other guys your age are trying to shoot pool with a rope, you're long, strong, and built to get the friction on!

I dont think I heard much of what he said for the next several minutes, as I was still composing the Budweiser comercial in my head. (Im telling you, it is a curse!) I finally got around to the physical exam and I was equally impressed by the size of his hernia! It was, in medical parlance, Friggin HUGE!

After a few more questions I discovered that he forgot to mention that he had had a CT scan done recently, so I excused myself and went to talk to my attending. I pulled up the CT scan and lo and behold: a whopping hernia. Only this hernia contained a goodly part of his bladder that was hanging out of his abdominal wall. Impressive! He is scheduled for surgery that will invole a Urology surgeon as well as a general surgeon to repair this.

So, godspeed, Mr-Works-out-in-the-bedroom-at-the-age-of-72! I hope the recovery doesn't hamper your um.........ahem... 'exercise'!

St Patricks Day...

Greetings, and happy St. Patrick's Day to you.

May the the green vomit that covers your shoes tomorrow morning not be yours.


My St. Patrick's day began with my arrival home this morning after a 26hr shift on-call at my Friendly Neighborhood Trauma Center. Making last night especially painful was the fact that 2 of the 4 students scheduled to be on-call, called in sick. That left just 2 of us to shoulder all of the junk medical students have to do. As if the trauma gods knew there were only 2 of us, and one of us was up WAY past his bedtime... we had 5 trauma patients last night including a man who was struck in head with a subway train (poked his head out to (I assume) see if it was coming...duh!), a couple of falls that resulted in various intercranial bleeds, and the most interesting case was a man who was found at the bottom of his basement steps that, upon arrival to the emergency room, had the most rip-roaring case of subcutaneous emphysema I have ever seen in an alive person. He had air all the way down to his hands and let's just say that the scrotum is an amazingly elastic area! For this reason he was referred to lovingly as the""Michellin Man" for the rest of the night. As of this morning he was doing reasonably well all things considered.

I got to sleep until about 3 this afternoon and then Rileigh and I took a walk to the playgroud to let her burn off some energy running and climbing. It seems to have worked because she went to bed with no protest at all a few minutes ago at 8:30 (although it could have been my singing to her)

In other news, my oldest daughter Meagan (officially pronounced meggggggin[wink]) has officially obtained her learner's permit. After spending several hours with a driving instructor (whose bravery must rival that of a professional stuntman medicated to the gills and wrestling a grade 3 death-wish) she has been given the green light (pun intended) by The People's Republik of New Jersey to operate a motor vehicle.

Drivers, pedestrians, livestock, property owners, Fish and Game Commission and local law enforcement, You have been warned.

May god have mercy on our souls!

Thank goodness she does not like Taco Bell, or else....

The Ides of Surgery...

Tomorrow will be the end of the 6th week of my Surgery rotation, the halfway point. Time sure does fly. All in all, it's been good. Sure, I am getting up at a wholly demonic hour, and feel like a very old man every night- but the rotation has been interesting.

Since last Monday, I have been on the Trauma team again and therefore did not have to take on-call shifts this week. That all ends this Monday. The trauma bay has been unusually slow this week and the traumas that came in were not incredibly serious. I did get to suture some poor soul's head laceration which bore a striking resemblance to a large Mercedes-Benz logo. (if it were drawn by a Parkinson's patient)

Just like on TV, the ER was incredibly busy and there was "no room at the inn;" so I got to do my Betsy Ross impression right there in the hallway. I did a pretty good job and was feeling pretty proud of my handiwork- the resident came over and looked at the now handsomely-closed wound gave it her blessing. Yup, I was feeling pret-ty proud of myself...until.

Since I was suturing him in the hallway I used a basin to catch the fluid I used to irrigate his wound with and when I was done instead of taking the extra minute to go discard the bin full-o-stuff, I set in down on the floor next to the counter. Of course everyone knows that: basins full of urine, feces, vomit, or bloody-saline and betadine have mystical magnetic properties! During my cleaning up- I was throwing out all the supplies I used; and right before I was finished- I kicked the basin over and splilled it ceremoniously all over the floor! Dumbass! Lesson learned.

Basin: 1 Ego: 0

Good for the "Goose"

Yesterday I scrubbed-in on my first "marathon" surgery. It was by far, the most interesting thing I have seen. It was an Ivor-Lewis Esophagectomy***, and required two surgeons to work in concert- one in the chest and one in the abdomen.

This procedure is done to remove a diseased portion of the esophagus (the tube that connects your mouth with your stomach. The disease is usually Esophageal Carcinoma). It is fairly complicated and done in several steps- that on their own, could be considered a surgery unto itself; but I will attempt to simplify:

Typically, a large incision is made in the abdomen and the goal here is to "free-up" the stomach. This means separating the blood vessels, and connective tissue attchments. Then through a thoracotomy incision, the stomach is pulled up into the chest cavity. The diseased portion of esophagus is cut out. After some creative work by the surgeon trimming the stomach down to become a "replacement esophagus" crudely speaking, the cut ends are sewn back together.

Several factors made this particular patient's surgery more complicated. For starters, the abdominal portion of the surgery was done via laparoscopy- No small feat considering all the work that needed to be done. Secondly, a series of equipment problems seemed to plague the surgery to such an extent, that toward the end of the surgery, it looked like the scrub nurse had some sick type of Noah's Ark fetish, since there were 2 of everything crowding the room : video monitors, laparoscopes, harmonic scalpels, electro-cauteries, et cetera, et cetera, et cetera.

The surgery began at 10:20am and lasted just shy of 12 hours! I would love to tell you I hung in there for the entire thing, but I would be lying. There were 2 medical students scrubbed-in on the case and we were offered after about 5-6 hours a "break" to scrub-out, grab a drink or use the bathroom. We both refused since the case was very interesting. (and we are both closet masochists) However at hour 10 1/2 my bladder had ideas of its own and I gracefully bowed-out.

Standing for 10 1/2 hours in an OR, gowned and gloved, is no small task- I assure you. I now have an even greater appreciation for those surgeons engaged in these sorts of procedures.

I still think I am destined to beocme an Emergency Room physician, but if it were not for my age, family status, and presence of emotions, I could certainly see myself becoming an entirely adequate surgeon.

Oh, I almost forgot, the title of this installment of inanity.

It took me several times before I finally caught on, but the surgeons kept referring to the "goose", as in "this is goose", or "the goose should be free now". Aparrently, in surgeon-speak the "goose" is esophagus; as in, "esopha-goose".

It seems the cyborgs possess a sense of humor....hhmmm.

I spoke to a fellow student who is working in the Surgical Intensive Care Unit and I was pleasnatly surprised to learn that this patient is off the ventilator,awake, and is doing reasonably well for being a hexagenarian who underwent 12 hours of general anesthesia. Godspeed sir, godspeed.



*** For the geeky among you, this is a cool link that chronicles the whole procedure with a series of pictures. (although they did an open abdomen)

Batten Down the Hatches

10 minutes ago it began snowing here. The forecast is calling for about a foot of snow overnight. Holy Global Warming, Batman!

Thankfully our car is parked in our garage; so Rileigh and I will not have to be out in blizzard-conditions cleaning off the car at 5:30am before we drive to the hospital to pick up Kathy and drop me off. There are few things I enjoy less than cleaning snow off a car. I suspect this poor bastard feels the same way: