tag:blogger.com,1999:blog-87233997411036976162024-02-19T09:51:33.483-05:00Living La Vida VinceRandom thoughts, observations, rants, complaints, and occasional news.<br>
Have a peek inside my head.Vincehttp://www.blogger.com/profile/04164939988793331231noreply@blogger.comBlogger285125tag:blogger.com,1999:blog-8723399741103697616.post-85448267542927800012010-04-19T13:43:00.002-04:002010-04-19T13:46:22.149-04:00Lessons My Kids Teach Me. Part 712<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEij4nTUNRqZ0j8UtVkhb6bORsZmuyee4swrjanrrrov_8tm21fTqu1D5Njkg_2QsaB3ZsqvRi4M9GhAr6EJqX4DLxjuG451IE48hgyoJ-KnZzmKP052G10zX8xuxx2MnSeAU8IL0did9as/s1600/rileigh.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEij4nTUNRqZ0j8UtVkhb6bORsZmuyee4swrjanrrrov_8tm21fTqu1D5Njkg_2QsaB3ZsqvRi4M9GhAr6EJqX4DLxjuG451IE48hgyoJ-KnZzmKP052G10zX8xuxx2MnSeAU8IL0did9as/s320/rileigh.jpg" /></a></div><br />
I wanted to make a pit stop at the grocery store but, as is common among those in my age group, I forgot. I remembered just as I passed the road that that led to the store. " $%#&*@!" I mumbled under my breath (or so I thought)<br />
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<span style="font-size: small;"><b>Rileigh:</b></span> <i>What, dad?</i><br />
<span style="font-size: small;"><b>Me:</b></span><i> Nothing honey.</i><br />
<b><span style="font-size: small;">Rileigh:</span> </b><i>What wrong daddy?</i><br />
<b>Me:</b> <i>Nothing's wrong baby.</i><br />
<b>Rileigh: </b><i>Oh. </i>[pause]<i> Then why you say that: sonofabitch? </i><br />
<b>Me: </b>Uh, what?<br />
<b>Rileigh:</b> <i>You say sonofabitch.</i><br />
<b>Me: </b> [removing one hand from the wheel to slap self in forehead] <i>Oh, I forgot to turn back there so we can go to the food store.</i><b> </b><br />
<b>Rileigh: </b>[in her patronizing, conciliatory tone- that sounds remarkably like what you would hear when someone is talking to a 5 year old who has just spilled his milk] <i>It's okay daddy, we can go an "utter" way.</i><br />
<b>Me: </b>Yes honey, we sure can go another way.<b> </b><br />
<b>Rileigh:</b> [giggling now] <i>You're silly, daddy!</i><br />
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Yes, indeed I am silly.Vincehttp://www.blogger.com/profile/04164939988793331231noreply@blogger.com5tag:blogger.com,1999:blog-8723399741103697616.post-75103283244527041732010-04-18T09:16:00.000-04:002010-04-18T09:16:15.413-04:00It's That Time of Year Again...<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi0MIRapfGZxSaSQ6Jz48IWSsTplRtem81SZJzIB7VsUF11EP7baXO7z6VEOguVU-jzJFU67DbzivwplJz-3AAEhay3i8Uzf1CUDmz4fnWIlkM7QWlluZXsEWLc8Irf8lpbBeHq5rzHMT0/s1600/relay+Logo.gif" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi0MIRapfGZxSaSQ6Jz48IWSsTplRtem81SZJzIB7VsUF11EP7baXO7z6VEOguVU-jzJFU67DbzivwplJz-3AAEhay3i8Uzf1CUDmz4fnWIlkM7QWlluZXsEWLc8Irf8lpbBeHq5rzHMT0/s320/relay+Logo.gif" /></a>Time for my annual <i>Bleg <span class="Apple-style-span" style="font-style: normal;">(blog+beg)</span></i><br />
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<i><span class="Apple-style-span" style="font-style: normal;">Meagan is, once again, captaining a team for <a href="http://main.acsevents.org/site/TR?sid=1030&type=fr_informational&pg=informational&fr_id=20752">American Cancer Society's Relay for Life</a>; and like last year, has recruited us to be team members. In the previous 2 years we have raised almost $4000. Thanks, in part, to the generosity of readers of this blog. This year our team has set a lofty goal of trying to raise $3500. With your help I know we will do it!</span></i><br />
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<i><span class="Apple-style-span" style="font-style: normal;"><a href="http://main.acsevents.org/site/TR/RelayForLife/RFLFY10EA?px=15442168&pg=personal&fr_id=20752">To make a donation click here.</a></span></i><br />
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For those of you who do not know- Relay is a 14 hour event where one member of our team will be walking around a 1/4 mile track at all times. To learn more about Relay for Life you can click the above link and read previous posts about it <a href="http://vincentmcdonough.blogspot.com/2009/06/relay-for-life-pictures.html">here</a> and <a href="http://vincentmcdonough.blogspot.com/2009/05/relay-for-life.html">here</a>.<br />
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Thanks in advance for your generosity!<br />
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</i>Vincehttp://www.blogger.com/profile/04164939988793331231noreply@blogger.com2tag:blogger.com,1999:blog-8723399741103697616.post-53602391541604156712010-04-07T16:00:00.000-04:002010-04-07T16:00:35.424-04:00Watch Porn<span class="Apple-style-span" style="font-family: Arial; font-size: small;"><span class="Apple-style-span" style="font-size: 13px;"><br />
</span></span><div><span class="Apple-style-span" style="font-family: Arial; font-size: small;"><span class="Apple-style-span" style="font-size: 13px;">I'm sure the title of this post will result in a few disappointed teenagers with unrestricted access to Google but this is what turns me on!</span></span></div><div><span class="Apple-style-span" style="font-family: Arial; font-size: small;"><span class="Apple-style-span" style="font-size: 13px;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Arial; font-size: small;"><span class="Apple-style-span" style="font-size: 13px;"><br />
</span></span></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgCSRAnha0FshERP85p_c07ZdlLgx7uZTICWDG_v4iX73WS1QzYaTxOEVIfH3u4AwQ7jZhRcht68LmqjiQKHv5dQUuAXWgrM2PzH9WTM3jyo-B0GXmYcvuSdn3_453QkSboOrXKi3YbxDw/s1600/tagheurcarrera.gif" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="444" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgCSRAnha0FshERP85p_c07ZdlLgx7uZTICWDG_v4iX73WS1QzYaTxOEVIfH3u4AwQ7jZhRcht68LmqjiQKHv5dQUuAXWgrM2PzH9WTM3jyo-B0GXmYcvuSdn3_453QkSboOrXKi3YbxDw/s640/tagheurcarrera.gif" width="640" /></a></div><div><span class="Apple-style-span" style="font-family: Arial; font-size: small;"><span class="Apple-style-span" style="font-size: 13px;"><br />
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</span></span></div><div><span class="Apple-style-span" style="font-family: Arial; font-size: small;"><span class="Apple-style-span" style="font-size: 13px;">WANT!</span></span></div><div><span class="Apple-style-span" style="font-family: Arial; font-size: small;"><span class="Apple-style-span" style="font-size: 13px;"><br />
</span></span></div><div><span class="Apple-style-span" style="font-family: Arial; font-size: small;"><span class="Apple-style-span" style="font-size: 13px;">If any of you happen to have an extra $4K lying around burning a hole in your pocket, and you want to turn a middle aged man into a giggling, happy little girl....I'm just saying.</span></span></div>Vincehttp://www.blogger.com/profile/04164939988793331231noreply@blogger.com2tag:blogger.com,1999:blog-8723399741103697616.post-70685332779019378892010-03-18T20:13:00.001-04:002010-04-02T16:45:50.035-04:00MATCH DAY 2010<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjhJ0CtK131-O3SrQvgZekDRdKXriPkxPmZUOieC1rEGaw3EnpJw70GYEoaRPS52CPu639-fn3gertNaJEQLAGPyaJFRTStum6NEzoCNS7bd_boRfS1NR7IzXez7KTrQEqkfbgc9DdfFlY/s1600-h/Drexel_logo.gif" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjhJ0CtK131-O3SrQvgZekDRdKXriPkxPmZUOieC1rEGaw3EnpJw70GYEoaRPS52CPu639-fn3gertNaJEQLAGPyaJFRTStum6NEzoCNS7bd_boRfS1NR7IzXez7KTrQEqkfbgc9DdfFlY/s400/Drexel_logo.gif" width="363" /></a></div>I found out today that I am a member of Drexel University College of Medicine's Emergency Medicine resident class of 2013!<br />
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I am thrilled!<br />
<br />
I have something in common with the program it seems, we both began in 1971! It is one of the oldest Emergency Medicine residency programs around- and while possibly not the oldest resident to come through I'll wager I am certainly to the far right of that curve.Vincehttp://www.blogger.com/profile/04164939988793331231noreply@blogger.com6tag:blogger.com,1999:blog-8723399741103697616.post-22298524508276748902010-03-15T12:30:00.000-04:002010-03-15T12:30:27.159-04:00Matchmaker, Matchmaker, Make Me A MatchIt is official! After quite an anxious morning of watching the minutes tick by....<br />
<br />
I MATCHED!<br />
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Now some more waiting until Thursday at 1pm to find out where I will be going.<br />
<br />
One thing is certain- Come July, I will begin training as an Emergency Physician.Vincehttp://www.blogger.com/profile/04164939988793331231noreply@blogger.com8tag:blogger.com,1999:blog-8723399741103697616.post-80788581631983776222010-03-14T12:55:00.006-04:002010-03-14T13:08:46.027-04:00Confessions of a Geeky DadI am stuck inside on a rainy Sunday on this Match Eve trying not to think too much about the 24 1/2 hours that remain until I find out if I matched into a residency program. Fortunately I have Chemistry to keep me company.<br />
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No not drugs. Chemistry- as in High School Chemistry. <br />
<br />
Kaitlyn was having a little trouble with some chemistry homework and came to yours truly looking for help. Poor her. I have a reputation for handing out the "bonus plan" when I help with homework. Today's Bonus Lecture was about Avagadro's number but more on that later.<br />
Invariably, I go off on some topical tangent until they get that glazed-over look in their eyes. utter, "Thanks, Dad", quickly gather their books, and dart out of the room like they stole something. <br />
I admit it. I can be a bit of a geek and I still get excited about some concepts that I think are pretty cool and it truly is a thrill for me to see the look in their eyes when they finally understand something for the first time or look at something in a new way. Anyway...<br />
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Her class is working on determining empirical formulas given percent composition. <br />
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An example: <br />
Calculate the empirical formula of a compound composed of 38.67 % Carbon, 16.22 % Hydrogen, and 45.11 %Nitogen (For those that are interested a brief explanation follows the break.)<br />
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During my explanation I asked if she was familiar with Avagadro's Number and I was happy that she was. Of course I felt the need to fill in some of the blanks and connect a few dots. I found a paper I wrote on the subject from back in my undergraduate chemistry class and read some of it to her. The little kid in me loves the visualizations and examples used when trying to understand the enormity of scale that 6.02 X10<sup>23</sup> represents. Here are some of my favorites:<br />
<ul><li>A mole of beer cans would cover the surface of the earth to a depth of 200 miles!</li>
<li>A mole of un-popped popcorn kernels would cover the suface to a depth of 9 miles!</li>
<li>If you covered the entire state of Texas (roughly 260,000 sq mi.) with fine sand- there would be 1 mole of sand grains.</li>
<li>Counting at 10 million per second...it would take 2 Billion years to count up to 1 mole</li>
</ul>and my favorite:<br />
<ul><li>In a 8oz cup of water, there are more molecules of water present than there are cups of water in the entire Atlantic Ocean. (roughly 5000 times more) </li>
</ul><br />
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<a name='more'></a><b>Example problem:</b><br />
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<b>Calculate the empirical formula of a compound composed of 38.67 % Carbon, 16.22 % Hydrogen, and 45.11 %Nitogen.</b><br />
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First, it is important to realize that the percentages given represent mass. That is, the compound consists of 38.67% Carbon <i>by mass. </i> <br />
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Since different atoms have different masses (see periodic table) we first have to establish how many of each atom is represented by its particular percentage of mass. <br />
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Once we know how many of each atom (how many moles) are present, all that remains to do is observe the mole ratio in order to arrive at the empirical formula.<br />
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Since the percentages are literally parts of 100- we can use 100 of anything 100 tons, 100 pounds, or 100 kilograms. Since the molar masses are in the grams scale it makes sense to use 100 grams. So:<br />
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In our problem we see that of the total mass of the molecule, 38.67% is carbon- said another way for every 100g of molecule, there is 38.67 grams present. The same goes for Hydrogen and Nitrogen respectively.<br />
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Now we have to figure out how many atoms( in moles since there are so very very very many) are present in each percentage of mass. Let's take Carbon- we know that 38.67g are in each 100g of molecule. Looking up the molar mass (how much 1 mole of Carbon weighs) we see that 1 mole of Carbon = 12.01g. some quick arithmetic:<br />
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38.67g 1 mol<br />
X ----------- = 3.220 moles<br />
12.01 g<br />
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Doing the same for Hydrogen and Nitrogen we get 16.09 moles Hydrogen and 3.219 moles of Nitrogen.<br />
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Our formula right now would be C<sub>3.22</sub> H<sub>16.09</sub> N<sub>3.219</sub><br />
<sub><br />
</sub><br />
using a greatest common factor of 3.2 we simplify to: CH<sub>5</sub>N<br />
<sub></sub>Vincehttp://www.blogger.com/profile/04164939988793331231noreply@blogger.com3tag:blogger.com,1999:blog-8723399741103697616.post-34985592715855029652010-03-10T13:11:00.003-05:002010-03-10T21:53:03.260-05:00He'll Roundhouse Kick his Candles out!70 years ago today, the world's baddest badass was born.<br />
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Chuck Norris.<br />
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<div class="separator" style="clear: both; text-align: center;"><img border="0" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjiv029Xg5T91fPxSC_-c6WR9zOhLQPjAAY8bwXHq9xS-VHy6nFcYxO7UgxKnk149eTduI8-CzLU8YQQ1-m6fokTsnp8tUeOCdIPJKaOomBuE_4z5YMT6sRX4VolzUuEhdn1tKLeZHSzcg/s640/chuck-norris-12.jpg" width="640" /><a href="http://www.chucknorris.us/chuck-norris-photos">Photo Credit</a></div><br />
If you haven't been living under a rock, I am sure you have come across the internet phenomenon known as Chuck Norris Facts. I have listed a few below:<br />
<ul><li>Guns don't kill people. Chuck Norris Kills people.</li>
<li>Chuck Norris once kicked a horse in the chin. Its descendants are known today as giraffes.</li>
<li>Chuck Norris destroyed the Periodic Table of Elements because he only recognizes the element of Surprise. </li>
<li>Chuck Norris doesn't read books. He stares them down until he gets the information that he wants.</li>
<li>Chuck Norris has 2 speeds: Walk and Kill. </li>
</ul>and possibly my favorite:<br />
<ul><li>There is no such thing as Evolution; just a list of creatures that Chuck Norris has allowed to live.</li>
</ul>For more fun filled facts check out <a href="http://www.chucknorrisfacts.com/">this site</a>.<br />
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<div class="views-field-value"><span class="field-content"></span><br />
<form accept-charset="UTF-8" action="/chuck-norris-top-50-facts" class="fivestar-widget" id="fivestar-custom-widget-49" method="post"><div><div class="fivestar-form-vote-298 clear-block"><div class="fivestar-form-item fivestar-average-stars
fivestar-processed"></div><span class="field-content"><input id="edit-destination-49" name="destination" type="hidden" value="chuck-norris-top-50-facts" /> <input class="form-submit fivestar-submit" id="edit-fivestar-submit-49" name="op" style="display: none;" type="submit" value="Rate" /> <input id="form-31ff1e6454d02300bf138372fa0cd397" name="form_build_id" type="hidden" value="form-31ff1e6454d02300bf138372fa0cd397" /> <input id="edit-fivestar-custom-widget-49" name="form_id" type="hidden" value="fivestar_custom_widget" /> </span></div></div></form><span class="field-content"></span> </div>Vincehttp://www.blogger.com/profile/04164939988793331231noreply@blogger.com3tag:blogger.com,1999:blog-8723399741103697616.post-65327821491306593062010-03-08T10:30:00.008-05:002010-03-10T21:53:20.988-05:00The Final Countdown / Mysteries of the Match RevealedIn a shade over 169 hours I will be frantically logging on to a website to find out if I "Matched"<span style="font-size: large;"><span style="color: red;">*</span></span><br />
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It feels surreal that all of the work and sacrifice leads to this one moment next week that will determine the rest of my career. But, I suppose that life is just a series of these moments. I am strangely calm at the moment but my serenity is occasionally punctuated by brief moments of sheer terror. Stiff upper lip and all that..<br />
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<span style="font-size: large;"><span style="color: red;">* <span style="color: black;"><span style="font-size: small;">I have received a bunch of questions about the whole match process so I have decided to include a overview on how this whole thing works. I hope this helps.</span></span></span></span><br />
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<span style="font-size: large;"><span style="color: red;"><span style="color: black;"><span style="font-size: small;">Every year medical students graduate from medical school and subsequently begin their Residency training. </span></span></span></span><br />
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<span style="font-size: large;"><span style="color: red;"><span style="color: black;"><span style="font-size: small;">Residency is where physicians complete several years of training in their chosen specialty. This training, is for instance, where family doctors become family doctors, surgeons become surgeons, and psychiatrists become weird. (I kid because I love!) Prior to residency, we are all pretty much the quintessential lump of clay which requires a great deal of molding (preferably by a scantily clad <a href="http://www.youtube.com/watch?v=xhFdhfwRVhQ">Demi Moore while Unchained Melody plays in the background.</a>..but I digress...)....where was I ? Oh, yes- molding- right. In order to become anything resembling useful physicians we need residency training.</span></span></span></span><br />
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<span style="font-size: large;"><span style="color: red;"><span style="color: black;"><span style="font-size: small;">So how is it decided who will become surgeons and who will become OB/Gyn etc. ? (fighting the urge to do a 'head-injury' joke here) Well, we get to choose. </span></span></span></span><br />
<span style="font-size: large;"><span style="color: red;"><span style="color: black;"><span style="font-size: small;">Sort. Of. </span></span></span></span><br />
<span style="font-size: large;"><span style="color: red;"><span style="color: black;"><span style="font-size: small;">After doing some soul-searching (no offense meant, surgeons) each one of us decides which area of medicine we would like to pursue and then we apply to residency programs in said specialty. </span></span></span></span><span style="font-size: large;"><span style="color: red;"><span style="color: black;"><span style="font-size: small;">For some</span></span></span></span><span style="font-size: large;"><span style="color: red;"><span style="color: black;"><span style="font-size: small;">, deciding on a specialty is one of the hardest steps in this whole process- lifestyle, salary, work environment, patient population, competitiveness of the applicant, and about a million other factors must be carefully weighed so each student can figure out which specialty suits their preferences best.</span></span></span></span><br />
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<b><span style="font-size: large;"><span style="color: red;"><span style="color: black;"><span style="font-size: small;"><underscore><u>The Process</u></underscore></span></span></span></span></b><br />
<span style="font-size: large;"><span style="color: red;"><span style="color: black;"><span style="font-size: small;"><b>Step 1 : Drowning in a sea of paperwork</b> (July-Sept)</span></span></span></span><br />
<span style="font-size: large;"><span style="color: red;"><span style="color: black;"><span style="font-size: small;">The July of medical student's 3rd year they begin working on their applications to residency programs. Transcripts, Letters of Recommendation, personal statements etc. are all gathered and submitted to <a href="http://www.aamc.org/students/eras/">ERAS</a> a central web-based application service. Beginning in September, applicants choose which programs to submit their applications to. This is a fairly simple matter of selecting programs from a list within your specialty and clicking on a box. ERAS takes care of the rest (transmitting all of your application info to each program). </span></span></span></span><br />
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<b><span style="font-size: large;"><span style="color: red;"><span style="color: black;"><span style="font-size: small;">Step 2: Waiting is the hardest part</span></span></span></span></b><br />
<span style="font-size: large;"><span style="color: red;"><span style="color: black;"><span style="font-size: small;">After an applicant's applications are sent out, begins the waiting phase. Each program has its own unique timetable to do things so this is an anxious period. Programs review applications and based on what they are looking for choose which applicants to invite for interviews. </span></span></span></span><br />
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<span style="font-size: large;"><span style="color: red;"><span style="color: black;"><span style="font-size: small;">Much angst surrounds exactly how programs choose which applicants to interview. Is it test scores- is there a cut-off number? What about personal statements? What about my letter of recommendation from my High school guidance counselor/ Psychic/ Oral Hygienist? If you are looking for a great source of entertainment hang out in the cafeteria in September and sit at a table full of Medical students. You will learn that, "<i>according to my friend's girlfriend's roommate's uncle- who is the program director's gardener....</i>" that the actual process used by programs to select applicants to interview is a proprietary blend of alchemy, remote viewing, dark magic and the use of a random number generator. Good Luck!</span></span></span></span><br />
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<span style="font-size: large;"><span style="color: red;"><span style="color: black;"><span style="font-size: small;"><b>Step 3: 12 cities in 9 days? Sure I can do that!</b> (</span></span></span></span><span style="font-size: large;"><span style="color: red;"><span style="color: black;"><span style="font-size: small;">Sept-Jan Interview Season)</span></span></span></span><br />
<span style="font-size: large;"><span style="color: red;"><span style="color: black;"><span style="font-size: small;">Once applications are submitted, slowly but surely (hopefully) invitations for interviews will start rolling in. This is an exciting time- you have at least "made the cut" and the program has an actual interest in meeting with you. Applicants will begin traversing the country in a whirlwind manner and doing their best to make great impressions with each of the programs they interview at. This is the opportunity for each applicant to see the program up close and personal, kick the tires, talk to the current residents, and see if they would like to spend the next several years there. The flip side of this, of course, is that from the program's point of view it is a chance to discover the hidden sociopathic pathology that your personal statement glossed over. I was actually told on an interview, "We just want to make sure you're not a douche."</span></span></span></span><br />
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</span></span></span></span><br />
<b><span style="font-size: large;"><span style="color: red;"><span style="color: black;"><span style="font-size: small;">Step 4: I like you...as a<i> friend</i></span></span></span></span></b><br />
<span style="font-size: large;"><span style="color: red;"><span style="color: black;"><span style="font-size: small;">After all of the interviews, each applicant has an idea of which of the programs they liked the best and begins to formulate a list of their top choice, second choice etc etc. Using another web based computer system, the National Resident Matching Program, NRMP, each applicant actually submits their Rank Order List, ROL. In turn, each program will similarly rank each of the applicants it has interviewed. Yes, they actually rank in order the applicants they have interviews in order of preference. This year's deadline for submitting your ROL was February 24th. </span></span></span></span><br />
<span style="font-size: large;"><span style="color: red;"><span style="color: black;"><span style="font-size: small;"><i> </i></span></span></span></span><br />
<br />
<b><span style="font-size: large;"><span style="color: red;"><span style="color: black;"><span style="font-size: small;">Step 5: THE MATCH.....The answer is: ...... <a href="http://en.wikipedia.org/wiki/Phrases_from_The_Hitchhiker%27s_Guide_to_the_Galaxy#Answer_to_Life.2C_the_Universe.2C_and_Everything_.2842.29">42</a></span></span></span></span></b><br />
<span style="font-size: large;"><span style="color: red;"><span style="color: black;"><span style="font-size: small;">The last step is the most exciting. Armed with each applicant's ROL, and each program's ROL the NRMP computers follow <a href="http://www.nrmp.org/res_match/about_res/algorithms.html">an algorithm</a> to "match-up" applicants with programs, hence the name. For those who will be applying next year, do yourself a favor and check out the link explaining how the algorithm works- this is another one of those pet topics that medical students seem to have nothing but misconceptions about. (For the last time, spelling out obscene words using the fist letter of each program on your ROL will NOT GUARANTEE YOU A SPOT at John Hopkins Dermatology!)</span></span></span></span><br />
<span style="font-size: large;"><span style="color: red;"><span style="color: black;"><span style="font-size: small;">This year on March 15th at 12:00 noon EST the results of this Matching algorithm will be made known!</span></span></span></span><br />
<span style="font-size: large;"><span style="color: red;"><span style="color: black;"><span style="font-size: small;">Sort. Of.</span></span></span></span><br />
<span style="font-size: large;"><span style="color: red;"><span style="color: black;"><span style="font-size: small;">March 15th each applicant will find out IF they have matched with a program or NOT. Applicants will not find out WHERE they have matched until March 18th.</span></span></span></span><br />
<span style="font-size: large;"><span style="color: red;"><span style="color: black;"><span style="font-size: small;">Why the built-in days of agony? The interim period is known affectionately as The Scramble- this is an opportunity for those applicants who have not matched to a program to have access to the still-unfilled spots at various programs and serves as a last ditch effort to secure a residency spot. </span></span></span></span><br />
<br />
<span style="font-size: large;"><span style="color: red;"><span style="color: black;"><span style="font-size: small;">I hope this helps to clear up some of the questions regarding this whole process, like: </span></span></span></span><br />
<span style="font-size: large;"><span style="color: red;"><span style="color: black;"><span style="font-size: small;">"<i>Have you mathced yet, Vince?"</i></span></span></span></span><br />
<i><span style="font-size: large;"><span style="color: red;"><span style="color: black;"><span style="font-size: small;">"Where are you going to be working, Vince?"</span></span></span></span></i><br />
<i><span style="font-size: large;"><span style="color: red;"><span style="color: black;"><span style="font-size: small;">"Why are you curled up in the fetal position, Vince?"</span></span></span></span></i><br />
<br />
<span style="font-size: large;"><span style="color: red;"><span style="color: black;"><span style="font-size: small;"> </span></span></span></span>Vincehttp://www.blogger.com/profile/04164939988793331231noreply@blogger.com8tag:blogger.com,1999:blog-8723399741103697616.post-11385787711334605792010-03-06T10:56:00.000-05:002010-03-06T10:56:29.580-05:00It's Good to be BackSo, I had the best of intentions for migrating this blog over to a new server and giving the whole thing an overhaul. I also had hopes of posting on a regular basis. Well, you know what they say about the road to hell and all of that. This blog began almost 3 years ago as a means to keep family and friends informed about my journey through medical school. Now that I have completed medical school I have been busy with my new job as stay-at-home dad, and frankly writing blog posts got pushed to the <i>way-back</i> burner.<br />
<br />
But fret not gentle reader, I realized that I miss scribbling some of my vacuous thoughts here on the intertubes for both of you guys to read. So... to steal from the great bard, L.L. Cool J,<br />
<a href="http://www.youtube.com/watch?v=vimZj8HW0Kg&feature=related"><quote>"Don't call it a comeback, I've been here for years!"</quote></a><br />
<br />
<quote>What have I been up to you ask?</quote><br />
<quote> </quote><br />
<quote>Well- as I said I have been up to my newly graduated physician elbows in<a href="http://vincentmcdonough.blogspot.com/2008/03/north-american-carpet-shark.html"> Carpet Shark</a> taming. This full-time, stay at home dad thing is no joke- I officially bow my head in reverence to those of you who have been doing it for years- I always understood it was a tough job- don't get me wrong. It is just one of those things in life that you just have to learn for yourself to truly understand. </quote><br />
<quote> </quote><br />
<quote>Meanwhile there are only 9 days left until Match Day- where yours truly finds out if he was fortunate enough to secure a residency- or if it is time to dust off those Welding School applications I have hidden in my sock drawer!</quote>Vincehttp://www.blogger.com/profile/04164939988793331231noreply@blogger.com1tag:blogger.com,1999:blog-8723399741103697616.post-84267514320122123562010-01-06T13:34:00.002-05:002010-01-06T13:39:50.177-05:00This Blog will be MOVINGIf there are any of you out there who still read this please stay tuned for an update. I will be migrating this blog onto a different server. I am in the process of setting up the new blog and will post the new address soon.Vincehttp://www.blogger.com/profile/04164939988793331231noreply@blogger.com0tag:blogger.com,1999:blog-8723399741103697616.post-79102777652164241282009-12-10T20:13:00.003-05:002009-12-10T20:32:58.845-05:00Moving Right AlongAs promised, albeit a little later than I planned, another post this millennium from yours truly.<br /><br />Where to begin, I suppose an update of sorts is in order. I have just under 2 weeks left of medical school. My official last day of this rotation is December 25th but with the holiday, and missing a day for an interview- I have only 8 more days at the hospital until I am finished with the whole ball of wax. It still doesn't feel completely real just yet.<br /><br />I are gonna be a doktor soon!<br /><br />The interview season is in full swing and I have just returned from a trip down to Florida for an interview. The weather was amazing, the city was very cool, and the program was pretty impressive. The interviews there went well and I received a great deal of positive feedback, for what that is worth. A few more of these interviews and I can put this whole process behind me.<br /><br />We are going to be moving back to the Philadelphia / So. Jersey area at the end of the month since there is no longer any reason to stay in New York and we want to be close to family for a while until I find out where I will be doing my residency in March. New York is a great place to visit and I suppose it is not too horrible to live here for a while, but I am ready to leave.<br /><br />All that remains is finding a job for Kathy and a place to live.........details!<br /><br />Until next timeVincehttp://www.blogger.com/profile/04164939988793331231noreply@blogger.com0tag:blogger.com,1999:blog-8723399741103697616.post-12726771259988892502009-12-02T23:37:00.005-05:002010-03-10T21:54:02.098-05:00Uno Mas!Earlier this week I began what will be my final rotation of medical school.<br />
<br />
It sounds weird. My LAST rotation! Yes, in just a few short weeks I will finish medical school. The reality hasn't fully set in yet.<br />
<br />
For those who are following along at home, when last we left our hero he was up to his pons in reflex hammers and MRI scans during the Neurology rotation. After 4 weeks of diseases of the brain and nervous system, I began Hematology/Oncology.<br />
<br />
This was not a very enjoyable rotation for a few reasons, not least among these was the rather depressing nature of seeing patient after patient in the throes of their terminal illness. It becomes almost surreal after a while. It was interesting to observe how different physicians interacted with the patients. Styles varied but most seemed to deal with the death issue very well. One can learn a great deal just being around people I suppose. From a medical student perspective, the rotation was fairly educational and the attendings were laid-back and focused on teaching. The schedule was rather long and most nights I was there way longer than any self-respecting 4th year with <span style="font-style: italic;">senioritis</span> should have been.<br />
<br />
Anyway, that is all behind us now and this week I began ...I'll say it again...my final rotation of medical school- Endocrinology.<br />
<br />
So far it is completely enjoyable. There are only a few disorders that make up the lion's share of the patients we see- Diabetes, Thyroid derangements, the occasional pituitary abnormality nothing too exotic so far. The management is pretty straight forward and not too mentally exhausting, even for a medical student. Our attending is quite personable and has an excellent rapport with both his patients and his students. He seems never to be at a loss for a story, ready at a moment's notice, to illustrate a point, or teach a lesson. Most are pretty amusing . Tuesdays are spent at his private office in the heart of Brooklyn- quite an interesting experience.<br />
<br />
Each of his patients seemed to come straight out of Central Casting. More caricatures than actual people, I half expected to hear a laugh track begin playing after each question and answer exchange, or perhaps a rimshot.<br />
<br />
Some of the actual exchanges between our attending and his patients :<br />
<br />
<span style="font-style: italic;">So what brought you in today?</span><br />
"The bus"<br />
<br />
<span style="font-style: italic;">And how do you take your metformin? ( a diabetes pill)</span><br />
"Orally"<br />
<br />
<span style="font-style: italic;">You have diabetes, high cholesterol and high blood pressure; is that right?</span><br />
"No I don't HAVE high blood pressure- I GIVE high blood pressure, I'm a carrier [points to his wife]<br />
<br />
...and so it went.<br />
<br />
Each patient seemingly trying to outdo the last in this Vaudevillian banter. I'm not sure if it was just the patient's personalities, or the fact that they had an audience in us [the medical students], but I suspect that this was part of the normal relationship our attending has with his patients. It was nice to see. Quite a refreshing change compared to my last rotation.<br />
<br />
I realize I haven't posted in a while and have yet to mention anything about the whole applications/interview process- stay tuned. I apologize to the 3 of you who actually read this and may be interested in such things.<br />
<br />
More posts are coming soon. Really. I mean it this time.<br />
<br />
Trust me, I'm almost a doctor!Vincehttp://www.blogger.com/profile/04164939988793331231noreply@blogger.com9tag:blogger.com,1999:blog-8723399741103697616.post-45664258612432953782009-11-04T09:42:00.008-05:002010-03-10T21:54:50.510-05:00Halloween PicsAs requested, some Halloween pictures:<br />
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<div style="text-align: center;">One Cute Little Pirate</div><br />
<div style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEikczPq4TQYpX_fakq5A_gTRNU8GXBTbVO2FqYP9-8-xUQPtL_9dkZ-EO266HBbRM-HVfNFblRP4g7XUOO-dVfAEFvWJUGD9BKt1nG3l6BJWvomTVPa-NpMYvaRe0SdmsowUnk9-RV69Bc/s1600-h/IMG_4047.JPG" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5400267794356043186" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEikczPq4TQYpX_fakq5A_gTRNU8GXBTbVO2FqYP9-8-xUQPtL_9dkZ-EO266HBbRM-HVfNFblRP4g7XUOO-dVfAEFvWJUGD9BKt1nG3l6BJWvomTVPa-NpMYvaRe0SdmsowUnk9-RV69Bc/s400/IMG_4047.JPG" style="cursor: pointer; display: block; height: 400px; margin: 0px auto 10px; text-align: center; width: 300px;" /></a><br />
One Not-So-Amused Elephant<br />
<br />
</div><div style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhxr4ve3b899LXHGZxzYTGTQaBt8EJ7xXsdFNtNeLi1xbJ3WRp79Pj68FuA7GOa6zoU7xkK7HpJgHYUR8p_TW0HzqWny1bwDvVPLDG1ptaBj29PVZ5MACQxECD69_XR4-wIeGqc3VlYFho/s1600-h/IMG_4051.JPG" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5400267796949273330" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhxr4ve3b899LXHGZxzYTGTQaBt8EJ7xXsdFNtNeLi1xbJ3WRp79Pj68FuA7GOa6zoU7xkK7HpJgHYUR8p_TW0HzqWny1bwDvVPLDG1ptaBj29PVZ5MACQxECD69_XR4-wIeGqc3VlYFho/s400/IMG_4051.JPG" style="cursor: pointer; display: block; height: 400px; margin: 0px auto 10px; text-align: center; width: 300px;" /></a><br />
In Search of: Candy</div><br />
<div style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiznDQ8NA0e5LNBxru_irIrRMwkw0WhijTOeiSMHS9aADwjQ7a0MYFzt8N23LDcZHD8xfWib8WbZJ6DWIdmEGaMXXOnOzekB1H66klOgdbJxtwVNyl-QcFpGuuQb5ulnFgMsl6-rCXjR0U/s1600-h/IMG_4052.JPG" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5400267801826994146" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiznDQ8NA0e5LNBxru_irIrRMwkw0WhijTOeiSMHS9aADwjQ7a0MYFzt8N23LDcZHD8xfWib8WbZJ6DWIdmEGaMXXOnOzekB1H66klOgdbJxtwVNyl-QcFpGuuQb5ulnFgMsl6-rCXjR0U/s400/IMG_4052.JPG" style="cursor: pointer; display: block; height: 300px; margin: 0px auto 10px; text-align: center; width: 400px;" /></a><br />
<br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh7zXqSDcHdc6BuFzNYbpB2KJTyeQZ4I644gvbycDnpvfowEqEAHlG6qxWWjev7QOkZvGNLX8QPhzpNlFdgVyzMKunhyjZ3NVJab7d_2GF0EGjfjr6po7SaQW6c-RTj2oc55fhibUok3D4/s1600-h/IMG_4057.JPG" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5400272422184082738" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh7zXqSDcHdc6BuFzNYbpB2KJTyeQZ4I644gvbycDnpvfowEqEAHlG6qxWWjev7QOkZvGNLX8QPhzpNlFdgVyzMKunhyjZ3NVJab7d_2GF0EGjfjr6po7SaQW6c-RTj2oc55fhibUok3D4/s400/IMG_4057.JPG" style="cursor: pointer; display: block; height: 300px; margin: 0px auto 10px; text-align: center; width: 400px;" /></a></div><br />
This year: (click the play button to see video)<br />
<br />
<div align="center"><iframe allowfullscreen='allowfullscreen' webkitallowfullscreen='webkitallowfullscreen' mozallowfullscreen='mozallowfullscreen' width='420' height='366' src='https://www.blogger.com/video.g?token=AD6v5dx5BzmLByKyQM9G2bq5qUIzjPEOf2E9IbnTT9dIZ1lCz_5K-jE56Wf26vjtf0lK-aJv1yvjq_5gNPBWd0wCpQ' class='b-hbp-video b-uploaded' frameborder='0'></iframe><br />
<br />
<br />
<div style="text-align: left;">Quite a difference from last year:<br />
<br />
<div align="center"><iframe allowfullscreen='allowfullscreen' webkitallowfullscreen='webkitallowfullscreen' mozallowfullscreen='mozallowfullscreen' width='420' height='366' src='https://www.blogger.com/video.g?token=AD6v5dw1WnEptplz7UnbdJ8cb_fEZflIcjSC4vFzJxB-HSm_AKawhrZCXmKQB6lxjB2i4NgG7G6TXxpC5jSoF09BLg' class='b-hbp-video b-uploaded' frameborder='0'></iframe></div></div></div>Vincehttp://www.blogger.com/profile/04164939988793331231noreply@blogger.com3tag:blogger.com,1999:blog-8723399741103697616.post-47400193879310497822009-10-05T19:55:00.003-04:002009-10-07T23:33:27.360-04:00Okay..New PlanI'll stop promising to blog more frequently and you'll stop pretending to believe me.<br /><br />John Lennon said, "Life is what happens when you're busy making other plans."<br /><br />I truly understand what he meant.<br /><br />On the medical school front, I have just started my antepenultimate rotation: Neurology. ( ok fine- <a href="http://dictionary.reference.com/browse/antepenultimate">look it up</a>, ye non Lovers-of-Latin)<br />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.<br /><br />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.<br /><br />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).<br /><br />Kids update:<br /><ul><li> 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" ]<br /></li><li>Meagan is being inducted into the <a href="http://www.nhs.us/s_nhs/">National Honor Society</a> 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.<br /></li><li>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 <a href="http://www.thehockeynews.com/imgs/dynamique/photos/original/article_27595_2.jpg">someone who is missing his front teeth....</a> I suppose it could be worse.<br /></li><li>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 <span style="font-style: italic; font-weight: bold;">Toddler Tricks to Horrify, Frighten, and Annoy your Parents </span>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 <del>screaming</del> 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.<br /></li><li>Dylan is growing like a weed and at this rate will be as big as Rileigh any day now.</li></ul><br /><br />That's it for now.<br /><br />Tune in soon.Vincehttp://www.blogger.com/profile/04164939988793331231noreply@blogger.com4tag:blogger.com,1999:blog-8723399741103697616.post-36767445675573895482009-09-09T14:41:00.002-04:002009-09-09T15:04:41.293-04:00I'm not dead...Much has happened since my last posting.<br /><br />I received the results of my USMLE Step 2 exam and I couldn't be happier. All the studying paid off!<br /><br />I finished my GI rotation and now in the second week of Cardiology.<br /><br />My oldest daughter, Meagan turned 17, passed her driver's license exam, and bought her first car- all in the same day!<br /><br />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!<br /><br />That's all for now- I hope to post more frequently now that I have a little more free time.Vincehttp://www.blogger.com/profile/04164939988793331231noreply@blogger.com4tag:blogger.com,1999:blog-8723399741103697616.post-42595512727386831352009-08-18T16:38:00.004-04:002010-03-10T21:55:19.414-05:00And 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 <span class="minusOne">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 <span style="font-style: italic;">this</span> 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.<br />
<br />
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.<br />
<br />
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 <del>snip and hack through tissue</del> 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.<br />
<br />
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.<br />
<br />
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 <a href="http://www.youtube.com/watch?v=GVTN5o9Kgu8"><span style="font-style: italic;">Sexual Healing</span></a>.<br />
<br />
And then came this lyric:<br />
<br />
<span style="font-family: arial; font-size: 100%;"><span style="font-style: italic;">"You're my medicine. Open up and let me in. </span><br />
<span style="font-style: italic;">Darling you're so great, I can't wait for you to operate.</span><br />
</span></span><span class="minusOne" style="font-family: arial; font-size: 100%; font-style: italic;">I can't wait for you to operate. Baby, </span><span class="minusOne"><span style="font-family: arial; font-size: 100%;"><span style="font-style: italic;">I can't wait for you to operate."<br />
<br />
</span><br />
I guess you had to be there.....<br />
</span></span>Vincehttp://www.blogger.com/profile/04164939988793331231noreply@blogger.com3tag:blogger.com,1999:blog-8723399741103697616.post-61769136311909310342009-08-15T12:29:00.004-04:002009-08-15T13:12:59.127-04:00The Word of the DayYou 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."<br /><br />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 ;-)<br /><br />Anyway, the word of the day is :<br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhpsmRVvmqCxFEjjdMnsE5qXkSf5SZRtCTe4HDpBg2Jl0Keh-k7D9Dx2meGl4saelNE2K6zekpYvwGwtdiFZOXvoKESpvFbc_vGX0_1fNVrHVTIAytpaHhqrLCiqQv2QSNt_Qz131Mk2-Y/s1600-h/fiber.jpeg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 400px; height: 320px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhpsmRVvmqCxFEjjdMnsE5qXkSf5SZRtCTe4HDpBg2Jl0Keh-k7D9Dx2meGl4saelNE2K6zekpYvwGwtdiFZOXvoKESpvFbc_vGX0_1fNVrHVTIAytpaHhqrLCiqQv2QSNt_Qz131Mk2-Y/s400/fiber.jpeg" alt="" id="BLOGGER_PHOTO_ID_5370239122306631890" border="0" /></a><br /><br />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.<br /><br />This Public Service Announcement brought to you by concerned colons everywhere.<br /><br /><br /><a href="http://www.nlm.nih.gov/MEDLINEPLUS/ency/imagepages/19691.htm"><span style="font-size:85%;">Picture Credit</span></a>Vincehttp://www.blogger.com/profile/04164939988793331231noreply@blogger.com1tag:blogger.com,1999:blog-8723399741103697616.post-9435910070192030312009-08-07T11:39:00.003-04:002009-08-07T12:02:34.686-04:00The Weight of the WorldI woke up this morning and something was different. I actually got a decent night's rest, something I sorely missed.<br /><br />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<span style="color: rgb(255, 0, 0);">*</span>. What a relief!<br /><br />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.<br /><br />I suppose I will know for sure in about 3 weeks when I get my results.<br /><br />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 <a href="http://www.brotherjimmys.com/">Brother Jimmy's</a>.<br /><br />Up next, I am reunited with my friends in GI starting Monday.<br /><br /><br /><span style="color: rgb(255, 0, 0);">*</span> assuming I passedVincehttp://www.blogger.com/profile/04164939988793331231noreply@blogger.com1tag:blogger.com,1999:blog-8723399741103697616.post-13614236764333823892009-07-30T16:00:00.005-04:002010-03-10T21:56:06.769-05:00Is that The Eye of The Tiger playing behind me?<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhEoF83vAMVKGoL7eHVHAoog9kVhSoI5m0Pi37l0VC4z1YOHcCMz0Fn7YAHSc13JKBa3LX0rb6OP3ph4HJfKy3Z3Ld-1Jy2Qmfqyy-SK-OxaE8gBtXMVuZighRCJxIgzBofptnihO_mcPE/s1600-h/rocky-iv.jpg" onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5364367140456574898" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhEoF83vAMVKGoL7eHVHAoog9kVhSoI5m0Pi37l0VC4z1YOHcCMz0Fn7YAHSc13JKBa3LX0rb6OP3ph4HJfKy3Z3Ld-1Jy2Qmfqyy-SK-OxaE8gBtXMVuZighRCJxIgzBofptnihO_mcPE/s400/rocky-iv.jpg" style="cursor: pointer; float: right; height: 218px; margin: 0pt 0pt 10px 10px; width: 400px;" /></a><br />
If my life were a movie, this is where the <a href="http://www.youtube.com/watch?v=8AemCeiuI_k"><span style="font-weight: bold;">Big Training Montage</span></a> scene would go.<br />
<br />
With only 6 more studying days until my big <del>fight</del> test, the studying has been in high gear for a while.<br />
<br />
Actually, it is almost around the clock, literally. Between my usual dose of insomnia and Dylan's 2 <span style="font-style: italic;">middle-of-the-god-damned-night-feedings</span> 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.<br />
<br />
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.<br />
<br />
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.<br />
<br />
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.<br />
<br />
Yes, I am so ready to get this test over with and reclaim just a small part of my life.<br />
<br />
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!Vincehttp://www.blogger.com/profile/04164939988793331231noreply@blogger.com4tag:blogger.com,1999:blog-8723399741103697616.post-63275053204192283532009-07-27T14:13:00.006-04:002009-07-28T22:33:29.785-04:00Weekend Update # 716....This past weekend Kathy, Rileigh, Dylan, and I drove down to spend a few days at <span style="font-style: italic;">Chateau de Exwife </span>. 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.<br /><br />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.<br /><br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgUKnD_Bz5udRb3hrzbz707RUonJ5liq4M98MOVg55BT1A6QzZHZLLZVmrQJw9CBVMFCWZk7QalFg6GW8lOZHS-L2ekNOq6-O1CYksP5mA-IX3CQJ9Ls-yX880yvkghtYburEGojIYGecc/s1600-h/crazydriver.gif"><img style="margin: 0pt 0pt 10px 10px; float: right; cursor: pointer; width: 172px; height: 174px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgUKnD_Bz5udRb3hrzbz707RUonJ5liq4M98MOVg55BT1A6QzZHZLLZVmrQJw9CBVMFCWZk7QalFg6GW8lOZHS-L2ekNOq6-O1CYksP5mA-IX3CQJ9Ls-yX880yvkghtYburEGojIYGecc/s400/crazydriver.gif" alt="" id="BLOGGER_PHOTO_ID_5363211296411726914" border="0" /></a>Speaking of my mother... Let this be fair warning to all:<br /><br /><span style="font-weight: bold;">It now may be unsafe to drive (or walk, for that matter) about the streets of Philadelphia. </span><br /><br />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!<br /><br /><br />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, <del>July</del> 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!<br /><br />Lastly, file this under "David Hasselhoff, I ain't!"<br /><br />While enjoying some barbecue yesterday in the back yard at <span style="font-style: italic;">Chateau de Exwife</span>, 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.<br /><br />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."<br /><br />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.<br /><br />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.<br /><br />Lessoned learned.Vincehttp://www.blogger.com/profile/04164939988793331231noreply@blogger.com4tag:blogger.com,1999:blog-8723399741103697616.post-54299478845602789262009-07-19T09:54:00.004-04:002010-03-10T21:57:46.308-05:00On losing one's mind...<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhz9tOJW8ANUCq-4X3fG3TfHcfFE6xXnu5pvNPsFnpFiXFY85SoemQyRkk18HJAIUyTw45o4qplp9QGvI-Ydwwg7FsBaWbGF-H1i1y_5T-VmyXwWvrG4twVijZEeg2-f1Dqu_ccqsIl_Jw/s1600-h/straight_jacket_clip_art"><img style="margin: 0pt 0pt 10px 10px; float: right; cursor: pointer; width: 363px; height: 400px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhz9tOJW8ANUCq-4X3fG3TfHcfFE6xXnu5pvNPsFnpFiXFY85SoemQyRkk18HJAIUyTw45o4qplp9QGvI-Ydwwg7FsBaWbGF-H1i1y_5T-VmyXwWvrG4twVijZEeg2-f1Dqu_ccqsIl_Jw/s400/straight_jacket_clip_art" alt="" id="BLOGGER_PHOTO_ID_5360193142347649250" border="0" /></a><br />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.<br /><br />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.<br /><br />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.<br /><br />While I am fairly confident going into this exam, everyday it seems I uncover <span style="font-style: italic;">yet another</span> 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 <span style="font-style: italic;">everything</span>, 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.<br /><br />I have a particular mental block when it comes to a few topics, try as I might they slide through the steel <del>trap</del> sieve that is my mind:<br /><br />The glycogen storage diseases- once upon a time I could prattle on about them, now... nada.<br /><br />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!<br /><br />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!<br /><br />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.<br /><br />By no means is this list complete, the sheer weight of what I don't remember would sink the <a href="http://en.wikipedia.org/wiki/RMS_Queen_Elizabeth_2">QE2</a>.<br /><br />Despite my selective amnesia, I push on, ego in tatters, and like <a href="http://en.wikipedia.org/wiki/Sisyphus">Sisyphus</a>, I am condmened to watch the boulder of my memory roll back down the hill. Maybe today some of it will stick.<br /><br />Maybe.Vincehttp://www.blogger.com/profile/04164939988793331231noreply@blogger.com6tag:blogger.com,1999:blog-8723399741103697616.post-83153049392156132022009-07-07T21:37:00.004-04:002010-03-10T21:57:59.468-05:00X-Ray From Last WeekThings 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.<br /><br />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:<br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhwm1mMygsrKkrpLrMQ9jj35du6F3GUfv1AabG4XlzxbMfr3gwZHEPtW1rhgKjxzRFKjOtn5Np05ax8VM5DzZw42On4HI-ik4XhyOV0MNiwdgY7t4u3GspSfdzpWG_lSLcfaH_K8HBbNSo/s1600-h/xray2.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 300px; height: 400px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhwm1mMygsrKkrpLrMQ9jj35du6F3GUfv1AabG4XlzxbMfr3gwZHEPtW1rhgKjxzRFKjOtn5Np05ax8VM5DzZw42On4HI-ik4XhyOV0MNiwdgY7t4u3GspSfdzpWG_lSLcfaH_K8HBbNSo/s400/xray2.jpg" alt="" id="BLOGGER_PHOTO_ID_5355900101596705250" border="0" /></a><br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhTi5UsCTr9xzWmspnv2cPjxvXHUiqkOSttPKSCqsiNv0kyO9xFZTKpoFx4DAg5evF9O3NigjxkYua8p8-5TXhChyphenhyphenplze1m9v-EwT_-2AOcliRZdRBfLQtneconiq2M7ZH6jqU1kQDvnq4/s1600-h/xray1.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 300px; height: 400px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhTi5UsCTr9xzWmspnv2cPjxvXHUiqkOSttPKSCqsiNv0kyO9xFZTKpoFx4DAg5evF9O3NigjxkYua8p8-5TXhChyphenhyphenplze1m9v-EwT_-2AOcliRZdRBfLQtneconiq2M7ZH6jqU1kQDvnq4/s400/xray1.jpg" alt="" id="BLOGGER_PHOTO_ID_5355900100410117746" border="0" /></a><br />Click on the images to enlarge them, if you are having trouble seeing, there is subcutaneous air in the soft tissue.<br /><br />Diagnosis: Gas Gangrene. Pt was scheduled for amputation of the leg above the knee for the morning.<br /><br />Reason # 419 to keep your diabetes under control.Vincehttp://www.blogger.com/profile/04164939988793331231noreply@blogger.com2tag:blogger.com,1999:blog-8723399741103697616.post-66138901034697532062009-06-29T23:28:00.004-04:002010-03-10T21:57:59.468-05:00EM week 2 begins...Today I began my 2nd week of Emergency Medicine with an all-day student lecture marathon. They rotated in several of the residents/attendings in throughout the day and each one conducted a lecture. The topics were pretty good for the most part, but sitting a very warm and stuffy room for 8 hours is not my idea of a good time. Tomorrow I am scheduled for the 7am-7pm shift I suppose it will go by much faster than today did.<br /><br />Tonight is Kathy's first night back at work since having Dylan; and we have recruited Kaitlyn to come up and lend a hand watching the kids in the overlap between when I leave for work in the morning and when Kathy gets home. Rileigh is thrilled to have her big sister here to <del>torment</del>  play with! So far Dylan seems to be cooperating, and hopefully we will all get some sleep tonight.<br /><br />Speaking of sleep...Vincehttp://www.blogger.com/profile/04164939988793331231noreply@blogger.com1tag:blogger.com,1999:blog-8723399741103697616.post-90778890171332303172009-06-24T17:54:00.008-04:002010-03-10T21:57:59.468-05:00Thumbs Up!<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhyFvu7Wz_A3zUiAAqQIaloFNThVTbWFKdKH05YGNLc-XbCnvF7S2wIR9sTvUmGgMBBPbQRH1CW9PYs2QWdvodcU6AO1hljAsaxFH3gkxXE7wsyZqgbBtmv9AJ8fqxFnZ0DpwuxToscDVg/s1600-h/Thumbs_up.jpg"><img style="margin: 0pt 0pt 10px 10px; float: right; cursor: pointer; width: 280px; height: 400px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhyFvu7Wz_A3zUiAAqQIaloFNThVTbWFKdKH05YGNLc-XbCnvF7S2wIR9sTvUmGgMBBPbQRH1CW9PYs2QWdvodcU6AO1hljAsaxFH3gkxXE7wsyZqgbBtmv9AJ8fqxFnZ0DpwuxToscDVg/s400/Thumbs_up.jpg" alt="" id="BLOGGER_PHOTO_ID_5351064802355741682" border="0" /></a><br />Last night I spent my shift in the "Urgent Care" area. Every hospital has its own nomenclature- but this falls somewhere between the "Fast Track" and the "Acute area"(where I spent my first shift) in terms of acuity. The Urgent Care area is where patients with a low likelihood of admission are seen- but who still may require some type of work-up / intervention. I was stationed there with one other student, a resident, and of course, the attending physician.<br /><br />It wasn't incredibly busy, and my first impression was that my evening would be spent with a lot of down time; and not much in the way of learning on this particular night. So, I decided to make the most of things and grabbed a copy of<span style="font-style: italic;"> Blueprints in Emergency Medicine, 2nd edition </span>and proceeded to do <span style="font-style: italic;">all </span>the questions at the end of the book in between evaluating patients<span style="color: rgb(255, 0, 0);">*</span>.<br /><br />There was a fairly steady flow of patients and I was able to see my share throughout the night. Granted, they had nowhere near the acuity of the previous nights' patients, but that is the nature of the beast. Fortunately, the attending physician was into teaching and began early-on with the interactive teaching sessions.<br /><br />Several topics were covered including the management of the acutely intoxicated patient( and legal ramifications thereof), the differential for invasive diarrhea, and the evaluation of shoulder injuries. Since I am the <del>whipping boy </del> sub-intern, most of the questions were directed straight at me. I was feeling pretty confident since I was fielding them without any trouble at all. This of course was about to come to an abrupt end.<br /><br />The patient in question was a female in her 30's who sustained a small laceration to the tip of her thumb 4 days ago. She was prescribed an antibiotic by her primary care doctor 2 days ago, when the thumb began to swell and became more painful. I conducted a brief history and exam. The thumb did not look that bad, there was no local collection of pus, and there was only minimal restriction of her range of motion while sensation in her thumb was not grossly affected. I was working on a diagnosis of local cellulitis. After quickly confirming the absence of any fevers or drug allergies(I was anticipating a change in antibiotics) I was on my way back to the attending to present the case to him. [<a href="http://www.imeem.com/people/CreWqi/music/kpTLLIUu/chopin-funeral-march/">Cue Chopin</a>]<br /><br />After what I thought was a rather complete and concise presentation, the attending said, "Let's go see her." I thought I detected a certain glisten in his eye.<br /><br />The attending introduced himself to the patient and proceeded to put her through a very similar physical exam that I had just conducted. After which, we went back to the <del>witness stand</del> desk where the questions began:<br /><br /><span style="font-weight: bold;">Attending:</span> So, what is your diagnosis?<br /><br /><span style="font-weight: bold;">Me:</span> It doesn't look like an abscess, I think it is just a mild localized cellulitus<span style="color: rgb(255, 0, 0);">**</span>.<br /><br /><span style="font-weight: bold;">Attending:</span> Mmm Hmm... [this is never good] So, what would you be concerned about given the location of the injury?<br /><br /><span style="font-weight: bold;">Me:</span> umm...err...duh....I suppose It could to progress to a <a href="http://emedicine.medscape.com/article/782537-overview">Felon</a> ?<br /><br /><span style="font-weight: bold;">Attending:</span> OK fine, that is right it <span style="font-style: italic;">could</span>, but what would be a<span style="font-style: italic;"> serious</span> complication of her wound? [holding back frustration in a not-so-subtle-way]<br /><br /><span style="font-weight: bold;">Me:</span> I suppose it is unlikely, but perhaps <a href="http://en.wikipedia.org/wiki/Osteomyelitis">osteomyelitis</a> would be fairly serious.<br /><br /><span style="font-weight: bold;">Attending:</span> [doing his best to fight the overwhelming urge to call my lineage into question] That <span style="font-style: italic;">would</span> be "rare". Have you ever heard of Tenosynovitis?<br /><br /><span style="font-weight: bold;">Me:</span> [cue crickets chirping... as I desperately apply my "conversational Latin skills" to the problem] That is inflammation of the..uh.. tendon..[trailing off] and the... synovial space?<br /><br /><span style="font-weight: bold;">Attending:</span> [wearing the look of a chess grandmaster who sees imminent victory] Close-But. Why dont you go ahead and look that up for me- and tell me<a href="http://www.wheelessonline.com/ortho/kanavels_four_cardinal_signs"> Kanavel's 4 Cardinal Signs of Tenosynovitis</a>, why it is important, and the management. I'll give you 5 minutes, then you will tell me. And then you'll teach the 3rd year when he comes back from seeing his patient.<br /><br /><span style="font-weight: bold;">Me:</span> Uh, Sure. [I like this guy]<br /><br />Needless to say, I looked up all there is to know about Tenosynovitis and was able to sucessfully answer the question, and proceeded to teach my fellow student about the diagnosis and management of the dreaded, Tenosynovitis. Thankfully there was a <span style="font-style: italic;">5-Minute Consult</span> on the bookshelf.<br /><br />I have to say, I think it will be a good long while before I ever forget to consider that diagnosis again.<br /><br />Tuiton for clincial roatations: <span style="font-weight: bold;">~$1000.00 per week</span><br />Cost of Dansko Clogs (inserted firmly in the mouth): <span style="font-weight: bold;">~ $90.00 </span><br />Having your ego kicked in the nuts- but actually learning something that may save a finger or a hand someday: <span style="font-weight: bold;">Pricelesss.</span><br /><br /><br /><br /><span style="color: rgb(255, 0, 0);">*</span><span style="color: rgb(255, 0, 0);font-size:85%;" >If you are interested, there is a typo in the answer key- answers #33 and #34 are transposed.</span><br /><br /><span style="color: rgb(255, 0, 0);font-size:85%;" >** For the record, my diagnosis <span style="font-style: italic;">was</span> correct; but I was wrong not to consider( or even know about) the more serious differential.</span><br /><br />Picture credit: WikipediaVincehttp://www.blogger.com/profile/04164939988793331231noreply@blogger.com1tag:blogger.com,1999:blog-8723399741103697616.post-65999618992515644762009-06-23T11:11:00.004-04:002010-03-10T21:57:59.469-05:00LUCY...............I"M......HOME!At long last, my Emergency Medicine sub-internship has started. Last night was my first shift and despite what<a href="http://en.wikipedia.org/wiki/You_Can%27t_Go_Home_Again"> Tom Wolfe said</a>, it was EXACTLY like going home again!<br /><br /><span style="font-style: italic;">Home</span>- assuming your home was a chaotic, loud, disorganized, subterranean outpost of the hospital where the teeming masses of the sick and injured (and not-so-sick-or-injured) are congregated on stretchers that appear to be engaging in some constant breeding program and occupying just about every square inch of real estate. If your home is filled with the cacophony of ringing phones, beeping monitors, wailing patients, colorful language and smells like a cross between a Calcutta sewer and a North Philadelphia manhole cover, then yeah- it is <span style="font-style: italic;">just</span> like home.<br /><br />I can't believe how much I have missed this!<br /><br />My shift started at 3pm. There were several students there some 3rd years and some 4th years. We met with the attending who was working that evening and since he is also the administrator in charge of the medical students, he gave us a brief orientation. It was your basic "<span style="font-style: italic;">Welcome to the ED</span>" kind of orientation, but he did tell us that they expected a bit more from the 4th year students doing the sub-internship. They expect us to be completely be involved in all aspects of our patient's care. They made a big emphasis on procedures as well. The 4th year students are supposed to get the first shot at any procedure that their patient may need, central lines, intubation, sutures, etc. More important than this in my opinion, is that we really are expected to function at the intern level. We see patients independently, come up with a differential, formulate a plan and then present directly to the attendings. We then go back and "do" all of the things in our plan: if the patient needs an IV we insert one, if they need blood-work, we do it, ditto Foley catheters, NG tubes et cetera, et cetera. This is probably done just as much out of necessity as it is for educational value. There is a high volume of patients and there is only a finite number of nurses. So I suppose it works out for everyone.<br /><br />After our brief orientation I was handed a chart and told to see my first patient. A patient that the test writers at Step 2 CS would love! ( I promise I will post about my CS experience very soon) She had symptoms that easily covered about 5 diagnoses. A great medical student case.<br /><br />My next patient was a woman who elderely woman who only complained about "not feeling well". She was not the most easy pateint to get info out of and kept saying very ambiguous things like "I am just not feeling up to par". After a long list of questions from me including her opinion on East coast versus West coast Rap, I was only able to get her to admit to slight shortness of breath. OK on to the exam. Lungs: rales at the bases..hmmm. Heart: systoloic murmur, irregular and kinda quick...the plot thickens. Of course she was in a A-fib with rapid ventriclular response with a rate of about 160. Interestingly enough, after some rate control with cardizem her CHF got worse and she teetered on the intubate/no intubate fence for a while before she finally started to improve.<br /><br />Not to be outdone, my very next patient was an 80ish year old man sent from a nursing home for evaluation of an isolated extremity injury, seemingly a pretty mundane case except when his EKG printed out:<br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj-VppIat95_2JP_IiNYJ9N9tl6itFGkOM0ZlylpWU5CWTm3jCIpLNsRcdO0om8YRdy2p42nyEzDbaDA2P6DNQPTdWJtKH_R-RfuTKfQIzbmF6C4VnAS7yJ9HV0cyV7EUwHAytI7eoBb84/s1600-h/ekg.jpg"><img style="cursor: pointer; width: 300px; height: 400px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj-VppIat95_2JP_IiNYJ9N9tl6itFGkOM0ZlylpWU5CWTm3jCIpLNsRcdO0om8YRdy2p42nyEzDbaDA2P6DNQPTdWJtKH_R-RfuTKfQIzbmF6C4VnAS7yJ9HV0cyV7EUwHAytI7eoBb84/s400/ekg.jpg" alt="" id="BLOGGER_PHOTO_ID_5350571999622395682" border="0" /></a><br /><br />The patient was asymptomatic (as much as an 80 year old demented man can be asymptomatic).<br /><br /><br />Not a bad way to start a shift. I got to do a bunch and saw some pretty high acuity for my first night there.<br /><br />I entered med school with the idea that I wanted to do Emergency Medicine. I did try to keep an open mind and stay receptive to the possibility of another specialty, but nothing is as satisfying to me as EM. For me, I suppose the choice was made long ago. But if I was on the fence about what to do, last night would have sealed the deal- not because I saw some interesting patients or the 'excitement' of treating a high acuity case. For me the thing that stood out was how comfortable I felt to be back in an ED doing what I think I am meant to do. It was like putting on a very comfortable broken-in pair of jeans.<br /><br />To the uninitiated, the ED must appear simply chaotic where there is no chance of anyone receiving anything even approaching decent medical care. With stretchers packed in one practically right on top of the next and only a thin curtain to distinguish where one patient's "room" ends and the next one begins it must look more like some makeshift M*A*S*H unit from days gone by, than a modern American hospital. Despite all of this, if you watch closely enough you start to see some order in the chaos, and somehow, however unlikely, people are cared for and the staff seems to have a handle on what is going on. Make no mistake, the ED is not without its share of problems and given the current state of health care in this country is likely to be one of the targets for any real reform.<br /><br />Emergency medicine is not perfect, far from it, I know; but somehow (perhaps because I am so very far from perfect) I feel like we are perfect for each other.<br /><br />I am actually <span style="font-style: italic;">looking forward</span> to my shift tonight. Sick, I know.Vincehttp://www.blogger.com/profile/04164939988793331231noreply@blogger.com2