Merrily Merrily Merrily....

The Blog Muse hasn't been around these parts much lately. My time has been filled recently with studying and doing some case write-ups (read:worthless busy-work) for this rotation.

After 3 weeks with one attending, we have switched and I am now rotating through the Intensive Care Unit. We will continue to switch every 2 weeks in an apparent effort to avoid any continuity whatsoever. This week hasn't been too bad however. The patients are more complicated and their management is quite more involved. Other than that, the rotation muddles along with the never ending series of lectures and conferences to attend. I cant really complain, things could be a good deal worse I suppose.

On the home-front things are going well. Kathy starts her new job next week, so we will once again be able to afford such luxuries as electricity. Joy! This being poor thing is overrated. I don't recommend it at all.

Rileigh is getting bigger before our very eyes and most days she works on perfecting her imitation of a hurricane- running around the house wreaking her pint-sized brand of havoc and leaving a swath of scorched earth and debris in her wake.

Here she is learning to master her mother's favorite mode of transportation:



(yeah, yeah, I know I'm gonna pay for that joke- but I can't help it. It never gets old ;-) )

And her she is sporting her trademark, "Look Dad, someone scattered my toys all over the living room"

Internal Medicine Week 1

The last week has found yours truly busier than a priest at a summer camp full of boy scouts. [What? All I meant was that boys at that age seem to need a lot of guidance; and priests are wonderful counselors of our youth. ;-)]

Anyway, the dearth of posts is a direct result of my trying to keep a bunch of balls in the air [OK! Knock it off you filthy minded juvenile!]

Internal Medicine has turned out to be much more demanding a rotation than previously advertised and has required a bunch of hours of reading at home to keep up. At the end of the first week, I have only a few impressions. Firstly, Chaos seems to be the team motto at Internal Medicine. There are about 18 minutes throughout the day of focused work, punctuated by hours of running from conference to conference and making sure you make it back for rounds. Rounds, at least for our little group, are quite good. Our attending happens to be the Assistant Chair of Medicine and has quite an enjoyable teaching style. He maintains a good mix of scathing sarcastic criticism with asking questions and making sure the big-picture remains in focus. In what was one of my favorite bit of ranting on his part, he accused a resident who was futilely trying to correct electrolyte abnormalities without understanding the underlying condition, of practicing "Hospice Medicine". This is particularly funny since the patient in question is not terminally ill. Truly a man after my own heart. Another student and I had to stifle fits of laughter when he came out with this little gem.

The most interesting patient that I encountered this week was a poor soul who presented to the ED with a series of ulcers about his legs that were doubling as a hatchery for these guys:



In case your entomological skills aren't quite up to snuff, these are maggots. It seems that along with the myriad of physical maladies this patient is suffering from, he also has a serious case of self-neglect. Interesting note: it wasn't the wriggling of his wounds that brought this man to the hospital, it was his anemia-induced weakness that prompted him to seek some medical attention.
The mind boggles.

OB-GYN...Check!

Well, today was the last day of my OB-GYN rotation and it went rather well. I must admit I have enjoyed it much more than I originally thought I would. Not enough to consider it as a career, but as far as the rotation went, it wasn't too bad at all. There was a nice mix of clinic, delivery room, and operating room experiences that kept things pretty interesting- I imagine this is one of the draws of the specialty.

Academically, it was not incredibly taxing at all. My advice for those going into this rotation is: pick a good book ( I used Blueprints for OB/GYN) and read a chapter or two everyday. Most, if not all, of our weekly didactic lectures mirrored material in the book. I abandoned my trademark procrastination and actually stayed ahead of the curve with the reading and it paid off. I have done a bunch of sample questions and it seems I have learned some stuff about the old vertical smile during my time with the fine folks of the Vaginas and Pending Humans Department at Brooklyn Hospital. ;-)

Next up : 12 weeks in Internal Medicine starting Monday.

2 Quick Rileigh Pics

Giving Pooh bear a hug:




Showing off her sign language skills (her version of 'Daddy')

Seeing the Forest Through the Vagina

I don't consider myself to be a particularly wise man; in fact, even the most cursory of conversations with my wife will convince you that the converse is quite true.

I have however, gleaned a few important gems during the 19.7 or so odd million minutes I have been spewing out CO2 on this lovely little rock. For instance:

• Toast will always land on the buttered side when dropped onto the floor.

• Plumbers and proctologists should NEVER bite their fingernails.

• You are most certainly more drunk than you think you are- and on a related note, signing voices rarely improve under the influence of ethanol.

• It is universally accepted that the Emergency Department(ED) is the red-headed, bastard step-child of the hospital.

It is well established that the ED is the bane of many a medical specialties collective existence. After all, they are called to the ED to evaluate patients for for either admission (the horror!) or consultations as to recommendations for further care. This of course means more work, and that is seldom appreciated. This is but one of many the reasons that EDs have the much maligned reputation they do.

A brief disclaimer:
Since I have spent a goodly portion of my professional career working in and around emergency departments, I admittedly have a soft spot for those who suffer the slings and arrows of outrageous fortune while mired knee-deep in a wonderful concoction of bodily fluids and human pathos in the trenches of America's hospitals. I assure you there are no finer a group of people you want to be around when the shit decides to hit the proverbial fan. These are my brethren! ;-)


Last night, I was once again, On-Call with the fine folks in The Vaginas and Pending Humans Department(VPHD). As usual, as if scripted, there was to be a battle with the ED. I would love to regale you with another yarn of how the ED in all of its glorious righteousness was simply "misunderstood", but alas kind reader, this was not the case.

It seems a young lady presented to the ED with complaints of sudden onset chest pain and associated shortness of breath. She also happened to be in the first trimester of a pregnancy. Perhaps this is what confounded the situation. The ED physician on duty "admitted" her to the VPHD with the presumptive diagnosis of r/o pulmonary embolism. Seems reasonable, right? Well, in this particular case the only treatment or diagnostics performed were a chest x-ray, the insertion of an IV and CBC and basic chemistry panel. Nary an ABG, EKG, cardiac enzymes, d-dimer, venous doppler, VQ scan, spiral CT or anti-coagulant was ordered.

I had 2 questions:
1. Is the OBGYN team the most appropriate choice for the management of a potentially life-threatening medical emergency?
2. While I understand a possible sense of reluctance to perform tests and or treatment that may be harmful to the fetus, isn't maternal death harmful to a first trimester fetus? I'm just sayin'.

The vagina, and in particular-the gravid vagina, continues to mystify and perplex!

Oh Yeah Buddy, That's COOL!

I am On-Call tonight Yay! It is just about midnight and not much is going on here in the wonderful world of waginas. I got to scrub in on 1 D&C and not much else is happening.

I saw this at the front of the hospital and asked one of my fellow medical students to snap the pics for me with her phone and email them to me so I could share this with you.

As a matter of fact, let's have some fun with this one. Feel free to add your own picture caption in the comments section.

My personal theory is that each skull represents some "playa hata" that "dis-ed" his "phat ride"

Coming this Fall on MTV: Pimp My Scooter

Hanging Off The Edge of the Earth

Despite rumors to the contrary I have not fallen off the face of the earth. A number of factors have conspired to keep yours truly of the intertubes. Until yesterday, we didn't have internet access at home. Thanks to the fine and customer-friendly folks over at Time Warner Cable we now are plugged back into the matrix.

Not a whole hell of a lot of news lately my days are going by very fast at the hospital and between my On-Call shifts and trying to catch up on sleep the days are blending into each other.

This week I have been stationed on the Labor and Delivery floor and let's just say that Brooklyn is in no immediate danger of a population decline. I have been able to scrub in on a half a dozen or so C-sections and a bunch of vaginal deliveries.

Last week the girls came to stay with us for the week and I took advantage of a day off from the hospital to take the family over to see the Statue of Liberty. Here are a couple of shots I took:

One Down, Five to Go

Well week one of the OB/GYN rotation is in the books and it has gone much like I thought it would. Since I have been in the Women's Health Clinic this week, it has pretty much been taking histories, doing vaginal exams, pap smears, and other assorted things. Nothing too exciting or challenging. The high point of my time at the clinic so far was finding the fetal heart beat with a doppler (think small microphone that you put against the abdomen which is attached to a speaker) and wathcing the woman's face light up as she heard her baby's heartbeat for the fist time. This kind of thing never gets old I imagine. It was a real Hallmark Moment. Another couple weeks bobbing up and down in this sea of estrogen and I might possibly have shed a tear. ;-)

NAH!

Thursday night I was On-Call.

For the uninitiated, On-Call is what the hospitals now impose on its residents in the aftermath of other, more colorful, draconian methods of torture having fallen out of favor or having been campaigned against by Amensty International. There is no good reason that medical students need to be On-Call, by the way. I suppose it is just a combination of initiation/hazing to, you know, get us acclimated to the suffering; and a brief respite for the beleaguered residents to have eager students around to help them complete the endless list of doctor-ry things they are required to do every night the On-Call demons have them chained to the grindstone. Misery, that promiscuous whore, loves company I suppose.

Thursday was my first of many On-Call nights and it was pretty interesting at least. I got to scrub-in on 2 surgeries. The first was was a D&C on a woman who had a miscarriage a few days before and was still bleeding. The next case was a bit more interesting. A woman who had a C-section a week ago came back with a rip-roaring infection around the incision. (a word of advice: those antibiotics the cute little doctor gave you, don't actually help in the paper prescription form- you actually need to trade that in at the pharmacy for some pills. Some folks need practical advice!)

Her infection was so advanced that she needed to be taken to surgery for Radical Wound Debridement- which is doctor-speak for "We're gonna cut all that infected shit out." (actual quote used by a surgery resident). The procedure involved re-opening the incision and removing large hunks of infected tissue, cleaning out the area with the surgical equivalent of a Super-Soaker with built in suction abilities. (think: handheld upolstery steam cleaner- only with warm water) and packing the wound cavity (now the size of a football) with gauze and leaving the abdomen "open". She will be taken back to the OR in a couple days to rinse and repeat just like it says on the shampoo bottle. It was unsettling to watch the surgeon weild his tools with all of the genlteness of a lumberjack that failed out of his Anger Management classes; but as he explained to me (he must have seen the bewildered look in my eyes across the table) "You can't be ginger with these infections, my good man" and proceded to hack and pummle away at the considerable panniculus (BMI= 52!)

I even got to do a little retracting and suctioning; and the whole event would have been far more enjoyabe were it not for the considerable assault my olfactory bulb was under during the whole procedure. The smell from the infection was so bad that, given the choice, I would have to seriously consider being locked in a phone booth with a goat herder. In August. Who had eaten chili the previous night- to be less offensive to my sense of smell then the fragrances wafting out of this poor woman's wound!



Ain't medicine fun!

Vaginas, and Tigers, and Bears...OH MY!

Today's title, besides guaranteeing me some fun search-term traffic, of course is referring to today's auspicious beginning of my Obstetrics and Gynecology rotation. Yes, for the next 6 fun-filled and glorious weeks I will be all about the "lady-bidniss" section of our anatomy texts. This rotation is split among 2 weeks in the Women's Care Clinic, 2 weeks on the Labor and Delivery floor and 2 weeks of Gynecology surgeries. I am doing this rotation with 5 other students from St. George's Medical School and Locksmithing Academy (of course I am kidding- throwing stones in glass houses and all)

Today was orientation; and other than some rather petty squabbling about the on-call schedule, it went rather well.

One chief resident gave us some pretty sage advice when it came to the Labor and Delivery portion of our rotation:

"There are basically 3 ways to approach this rotation: First- you are the type that has known that OB/GYN was your life's calling from just about the embryonic stage. You know beyond any shadow of a doubt you will chose this for your residency. To you, I say get as many deliveries as you can. Make sure you show some hustle and try your best to shine, and make sure you get a good letter of recommendation.

Secondly, perhaps you are in the group that will NEVER, EVER, EVER, EVER, EVER, and did I mention, EVER, chose OBGYN as a career. If it came down to not matching or OB/GYN at Harvard you would sit out the year. If this applies to you, my advice is: get as many deliveries as you can, I mean you will never get to do this again, and after all, it is pretty cool- at least you will be able to say 'deliver a baby, yeah, I can do that'.

Lastly, maybe you are undecided and have not ruled out OB/GYN and aren't sure if it is for you or not. My advice here is......(wait for it)....get as many deliveries as you can. This is the only way to know if you will like it.

There is a certain elegance to his argument; although one could counter that I need not smash certain parts of my own anatomy with, say a ball-peen hammer for instance, to know I will not enjoy it- but I digress.

In Almost a Fortnight....

Well gentle readers (both of you) a great many things have transpired since my last post. To recap what you may have missed here are the highlights:

• The kind and friendly folks over at the NYPD Traffic Enforcement Division were admiring my car so much they decided to pick it up with a tow truck and take it on a test-drive. $300.00 later and some disagreement over the difference between 4 feet and 10 feet from a fire hydrant, I now have the car back.

• Rileigh turned 1 year old last week!

• I finished my first rotation with, nary a corpse in my wake- I might add.

• We finally loaded up the truck and moved to Beverly, Brooklyn that is. We are now denizens of the quaint little community of Bay Ridge in Brooklyn.

Understandably there has been little time for blogging and other such pursuits.

After we complete the unpacking epic I will post some pics of our new digs. In the meantime here are a few photos:

Before:

After:

Our new and highly cluttered kitchen:

Our first trip to the neighborhood playground:




We have got to keep Rileigh from watching those Discovery Channel nature specials: