Friday was a very giddy day for me - it was the last day I have to arrive to the hospital for 6am start time!!! Yes, that's right, starting on Monday, I don't have to be at the hospital until 8am!! Why? Because I start the Burn Unit on Monday, an experience that by all previous accounts will be both amazing, humbling and very rewarding.
And while I'm of course excited to learn a lot in the Burn Unit, it really comes down to this: 2 MORE HOURS OF SLEEP YO!!!
Everyone be aware: I will be much happier for the rest of the Surgery rotation.
Oh and one more thing: For all those who received a very holly, jolly, laugh out loud happy call from me last night in celebration of the end of 6am wake up time for at least a few weeks, please know that you likededed it.
Sunday, May 31, 2009
Tuesday, May 26, 2009
Day in the Life: Surgery
Surgery is unlike any other beast, in my admittedly limited medical school experience. You get to participate in front-line patient care on the hospital floor, just like the internal medicine doctors. But you also get to take what I call "breaks" - which are actually hours in the OR (operating room) helping a patient fix a very specific problem or issue. It is all fascinating, quite frankly! Here is a glimpse of a typical Tuesday or Thursday, which have morning lectures:
520am: My alarm clock starts singing the latest permutation of "I want to have sex with you in 18 different positions" hip-hop song on the radio. I have taken my friend NK's idea of putting my alarm just out of arm reach, so it forces me to get up at this unGodly hour!
530am: Actually get up to pee then return to bed. Yes, I know this is probably TMI for some of you, but if not for having to use the potty, I wouldn't move. I'd stay in bed for another 10 minutes. As it is, I return to bed for those precious minutes!
540-555am: Realize if I don't get up really quick, the ticker will add another tardy to my stone. Get up, shower, put some scrubs on, brush the teeth, comb the hair, grab the cell phone and start walking toward the door...turn back and grab the wallet and start walking toward the door...turn back and grab the house key and start walking toward the door...turn back and grab the car key and start walking toward the door...glance back to make sure I haven't forgotten anything else...exit and walk to car.
6-607am: Arrive to hospital, floor 4B for our AM rounds. Grab the "Lab Book" as it is my duty to rattle off the previous day's labs for each patient when prompted for them by the resident. I sure hope there is a question on the USMLE Step 2 exam about what button to click to make the computer give you the labs...because I will ACE that part of the exam! (And no, there are no questions about how to retrieve labs...please pick-up on the sarcasm here.)
7-8am: Lecture #1
8-10am: Lecture #2
10-11am: Lecture #3
7-11am on Monday, Wednesday, Friday: Go to the OR and find a surgery to scrub in and absolutely be amazed at what a human being's insides look like! It is really quite incredible to put your hand on the intestines or see the heart beating or see the lung inflating, or even to just stitch someone back together!
11am-12pm: Copy labs from computer to lab book.
12-1pm: Lunch
1-2pm: Study a bit in the library because I have a big exam coming up in about 3 months.
2-3pm: Afternoon lecture
3-?? pm: Go to another surgery, help on the floor
4-8pm: Usually somewhere in this window, head home.
Realize that this whole schedule gets turned on its head when a trauma arrives to the hospital. My location is a Level 1 Trauma, but we are in Staten Island so we're not seeing a steady influx of GSW (Gun Shot Wound) patients. Instead, we see a lot of falls or motor vehicle accidents, or once, the stab wound patient (see previous case files on the subject). As a med student, we usually are taking the History and conducting the physical exam on the patient as the surgeons/doctors are conducting the close inspection and giving the orders for what tests to do and when to do the next step in our assessment of the patient. It is always more interesting to see a surgery on a patient that you have followed from their initial arrival to the hospital, as opposed to seeing a random surgery where all you see is the small surgical window...sometimes, not even the face of the patient!
The goal after going home, of course, is to study. This is done with mixed results on most days. Sometimes I am able to accomplish my study goals for the afternoon. Most days, however, I'm just exhausted and get home in time to crash on my bed and go to sleep. The sounds of "Lets have sex in a restaurant" hip-hop song will ring in my ears before I know it.
520am: My alarm clock starts singing the latest permutation of "I want to have sex with you in 18 different positions" hip-hop song on the radio. I have taken my friend NK's idea of putting my alarm just out of arm reach, so it forces me to get up at this unGodly hour!
530am: Actually get up to pee then return to bed. Yes, I know this is probably TMI for some of you, but if not for having to use the potty, I wouldn't move. I'd stay in bed for another 10 minutes. As it is, I return to bed for those precious minutes!
540-555am: Realize if I don't get up really quick, the ticker will add another tardy to my stone. Get up, shower, put some scrubs on, brush the teeth, comb the hair, grab the cell phone and start walking toward the door...turn back and grab the wallet and start walking toward the door...turn back and grab the house key and start walking toward the door...turn back and grab the car key and start walking toward the door...glance back to make sure I haven't forgotten anything else...exit and walk to car.
6-607am: Arrive to hospital, floor 4B for our AM rounds. Grab the "Lab Book" as it is my duty to rattle off the previous day's labs for each patient when prompted for them by the resident. I sure hope there is a question on the USMLE Step 2 exam about what button to click to make the computer give you the labs...because I will ACE that part of the exam! (And no, there are no questions about how to retrieve labs...please pick-up on the sarcasm here.)
7-8am: Lecture #1
8-10am: Lecture #2
10-11am: Lecture #3
7-11am on Monday, Wednesday, Friday: Go to the OR and find a surgery to scrub in and absolutely be amazed at what a human being's insides look like! It is really quite incredible to put your hand on the intestines or see the heart beating or see the lung inflating, or even to just stitch someone back together!
11am-12pm: Copy labs from computer to lab book.
12-1pm: Lunch
1-2pm: Study a bit in the library because I have a big exam coming up in about 3 months.
2-3pm: Afternoon lecture
3-?? pm: Go to another surgery, help on the floor
4-8pm: Usually somewhere in this window, head home.
Realize that this whole schedule gets turned on its head when a trauma arrives to the hospital. My location is a Level 1 Trauma, but we are in Staten Island so we're not seeing a steady influx of GSW (Gun Shot Wound) patients. Instead, we see a lot of falls or motor vehicle accidents, or once, the stab wound patient (see previous case files on the subject). As a med student, we usually are taking the History and conducting the physical exam on the patient as the surgeons/doctors are conducting the close inspection and giving the orders for what tests to do and when to do the next step in our assessment of the patient. It is always more interesting to see a surgery on a patient that you have followed from their initial arrival to the hospital, as opposed to seeing a random surgery where all you see is the small surgical window...sometimes, not even the face of the patient!
The goal after going home, of course, is to study. This is done with mixed results on most days. Sometimes I am able to accomplish my study goals for the afternoon. Most days, however, I'm just exhausted and get home in time to crash on my bed and go to sleep. The sounds of "Lets have sex in a restaurant" hip-hop song will ring in my ears before I know it.
Saturday, May 23, 2009
Thursday, May 21, 2009
Case Files: Stab Wound
Presenting Scenario: 48 year old patient presents with a 2 inch laceration on the right lower quadrant of his abdomen. Patient reports that suspects the stabbing occurred that morning around 4am...it is now 1pm at presentation, due to "dizziness". Patient is lying comfortably on bed, seems to be in no apparent distress, but keeps asking for a telephone to call family.Trauma Room Decisions: The patient refuses to allow the Doctors to insert their finger into the wound and explore how deep it is. Patient becomes combative any time we try. This leaves us with a difficult decision. Either we take patient to CT scan to see if there are any deep injuries to internal organs that could result in a sudden change in status, or we just rush patient up to the OR (Operating Room) and start the operation there under anesthesia. Decision was made to take patient up to the OR.
Diagnosis: Superficial wound. Yes, we rushed the patient to the OR, put patient under general anesthesia, and then were able to stick our finger in the wound...to find nothing. The wound barely even got through any fat layer.
Surgical Procedure: Stitch up the wound.
Results: Patient is fine. Was offered alcohol and drug counseling due to addictions, but otherwise, is fine.
Note: Picture is not from the actual patient's wound.
Wednesday, May 20, 2009
Guest Post: Explaining Derivative Markets
If you are like me, the whole bank bailout business confused the dickens out of you and it doesn't seem to quite make sense why billions of tax dollars had to be spent to bailout a few banks that misbehaved and didn't follow sound banking principles. Luckily, a dear reader of my blog, DJA, sent this explanation to me regarding how it works. Enjoy!
Heidi is the proprietor of a bar in Detroit . In order to increase sales, she
decides to allow her loyal customers - most of whom are unemployed
alcoholics - to drink now but pay later. She keeps track of the drinks
consumed on a ledger (thereby granting the customers loans).
Word gets around about Heidi's drink now pay later marketing strategy
and as a result, increasing numbers of customers flood into Heidi's bar
and soon she has the largest sale volume for any bar in Detroit .
By providing her customers freedom from immediate payment demands,
Heidi gets no resistence when she substantially increases her prices for
wine and beer, the most consumed beverages. Her sales volume increases
massively.
A young and dynamic vice-president at the local bank recognizes these
customer debts as valuable future assets and increases Heidi's
borrowing limit.
He sees no reason for undue concern since he has the debts of the
alcoholics as collateral. At the bank's corporate headquarters, expert
traders transform these customer loans into DRINKBONDS, ALKIBONDS
and PUKEBONDS. These securities are then traded on security markets
worldwide. Naive investors don't really understand that the securities being sold
to them as AAA secured bonds are really the debts of unemployed alcoholics.
Nevertheless, their prices continuously climb, and the securities become
the top-selling items for some of the nation's leading brokerage houses.
One day, although the bond prices are still climbing, a risk manager at the
bank (subsequently fired due to his negativity), decides that the time has come
to demand payment on the debts incurred by the drinkers at Heidi's bar.
Heidi demands payment from her alcoholic patrons, but being unemployed
they cannot pay back their drinking debts. Therefore, Heidi cannot
fulfill her loan obligations and claims bankruptcy.
DRINKBOND and ALKIBOND drop in price by 90%. PUKEBOND performs
better, stabilizing in price after dropping by 80%. The decreased bond asset
value destroys the banks liquidity and prevents it from issuing new loans.
The suppliers of Heidi's bar, having granted her generous payment extentions
and having invested in the securities are faced with writing off her debt and
losing over 80% on her bonds. Her wine supplier claims bankruptcy, her beer
supplier is taken over by a competitor, who immediately closes the local plant
and lays off 50 workers.
The bank and brokerage houses are saved by the Government following
dramatic round-the-clock negotiations by leaders from both political parties. The
funds required for this bailout are obtained by a tax levied on employed
middle-class non-drinkers.
Finally an explanation I understand ...
Heidi is the proprietor of a bar in Detroit . In order to increase sales, she
decides to allow her loyal customers - most of whom are unemployed
alcoholics - to drink now but pay later. She keeps track of the drinks
consumed on a ledger (thereby granting the customers loans).
Word gets around about Heidi's drink now pay later marketing strategy
and as a result, increasing numbers of customers flood into Heidi's bar
and soon she has the largest sale volume for any bar in Detroit .
By providing her customers freedom from immediate payment demands,
Heidi gets no resistence when she substantially increases her prices for
wine and beer, the most consumed beverages. Her sales volume increases
massively.
A young and dynamic vice-president at the local bank recognizes these
customer debts as valuable future assets and increases Heidi's
borrowing limit.
He sees no reason for undue concern since he has the debts of the
alcoholics as collateral. At the bank's corporate headquarters, expert
traders transform these customer loans into DRINKBONDS, ALKIBONDS
and PUKEBONDS. These securities are then traded on security markets
worldwide. Naive investors don't really understand that the securities being sold
to them as AAA secured bonds are really the debts of unemployed alcoholics.
Nevertheless, their prices continuously climb, and the securities become
the top-selling items for some of the nation's leading brokerage houses.
One day, although the bond prices are still climbing, a risk manager at the
bank (subsequently fired due to his negativity), decides that the time has come
to demand payment on the debts incurred by the drinkers at Heidi's bar.
Heidi demands payment from her alcoholic patrons, but being unemployed
they cannot pay back their drinking debts. Therefore, Heidi cannot
fulfill her loan obligations and claims bankruptcy.
DRINKBOND and ALKIBOND drop in price by 90%. PUKEBOND performs
better, stabilizing in price after dropping by 80%. The decreased bond asset
value destroys the banks liquidity and prevents it from issuing new loans.
The suppliers of Heidi's bar, having granted her generous payment extentions
and having invested in the securities are faced with writing off her debt and
losing over 80% on her bonds. Her wine supplier claims bankruptcy, her beer
supplier is taken over by a competitor, who immediately closes the local plant
and lays off 50 workers.
The bank and brokerage houses are saved by the Government following
dramatic round-the-clock negotiations by leaders from both political parties. The
funds required for this bailout are obtained by a tax levied on employed
middle-class non-drinkers.
Finally an explanation I understand ...
Tuesday, May 19, 2009
TESTING New Site Design
I have a new post for today, located just below this one. But I wanted to make a quick acknowledgment of the new site design! There were a few hiccups in the transition to this new design - for example, I lost all my links to other blogs I read. I was able to recover some of them, but if I lost you and can't remember your web address off the top of my head, PLEASE email me and let me know your website address again! There are a couple other problems that I'm discovering as I go, so I may very well revert back to the old site design or try a different one altogether.
As you can see, the new design captures a beautiful site off the Brooklyn Bridge...something I get to see often! It is more hip and urban. It also allows me to display my Twitter updates more prominently while also allowing easier access to the Category links so you can more easily access past posts on the blog. Yes, "easy access" was key here (and "that's what she said!")
Please hit the comments and let me know what you think! If the majority don't like it, I'll go back to the old design...or find another new one!
As you can see, the new design captures a beautiful site off the Brooklyn Bridge...something I get to see often! It is more hip and urban. It also allows me to display my Twitter updates more prominently while also allowing easier access to the Category links so you can more easily access past posts on the blog. Yes, "easy access" was key here (and "that's what she said!")
Please hit the comments and let me know what you think! If the majority don't like it, I'll go back to the old design...or find another new one!
5 More Weeks
Today marks the official start of my unofficial countdown to coming home for the summer! I leave NYC on June 23 at 2pm and arrive into FAT (Fresno Air Terminal) at 7:25pm on American Airlines Flight 3017. I love NYC, but it will be nice to be home for the summer! My tentative schedule for the summer AND the rest of my medical school career is as follows:
Pediatrics: June 29 - August 7 in Fresno
USMLE Step 2 CS: One Day Mid July in LA
Exam Prep: August 7 - September 11 in Fresno
USMLE Step 2 CK: One Day Early September in LA
Psychiatry: September 14 - October 23 in LA
OB/GYN: October 26 - December 4 in NYC
NICU: December 7 - January 1 in Fresno
Peds Infectious Dz: January 4 - Jan 29 in Fresno
Elective: Feb 1 - Feb 26 Location TBD
Elective: Mar 1 - Mar 26 Location TBD
Elective: Mar 29 - April 23 Location TBD
Elective: April 26 - May 7 Location TBD
As you can see, after this summer, I will go straight from September all the way to May without time off...but it will payoff because come May 7, I will finally be known as Docta A!
But alas, this post is about coming home in five weeks! And of course, I will be using my favorite airline...because THEY KNOW WHY I FLY! (And PS: MAJOR kudos to anybody out there who can tell me the name of the American Airlines theme song in the video below and where I can get a copy of it. I love this song! Major kudos...like a Tiffany's ring!!!!)
Pediatrics: June 29 - August 7 in Fresno
USMLE Step 2 CS: One Day Mid July in LA
Exam Prep: August 7 - September 11 in Fresno
USMLE Step 2 CK: One Day Early September in LA
Psychiatry: September 14 - October 23 in LA
OB/GYN: October 26 - December 4 in NYC
NICU: December 7 - January 1 in Fresno
Peds Infectious Dz: January 4 - Jan 29 in Fresno
Elective: Feb 1 - Feb 26 Location TBD
Elective: Mar 1 - Mar 26 Location TBD
Elective: Mar 29 - April 23 Location TBD
Elective: April 26 - May 7 Location TBD
As you can see, after this summer, I will go straight from September all the way to May without time off...but it will payoff because come May 7, I will finally be known as Docta A!
But alas, this post is about coming home in five weeks! And of course, I will be using my favorite airline...because THEY KNOW WHY I FLY! (And PS: MAJOR kudos to anybody out there who can tell me the name of the American Airlines theme song in the video below and where I can get a copy of it. I love this song! Major kudos...like a Tiffany's ring!!!!)
Sunday, May 17, 2009
Case Files: Orchidopexy
Presenting Scenario: A 7 year old boy presents to the outpatient surgeon due to a referral from the Primary Care Pediatrician. He has a suprapubic lump on the left side. Patient's mother denies pain, nausea, vomiting, diarrhea. On physical exam, there is a palpable lump, easily movable, located just above and lateral to the penis.
Diagnosis: Prepubic undescended testicle on the left side.
Surgical Procedure(s) Ordered: Orchidopexy; the surgeon first makes an incision near the site of the undescended testicle, similar to how he might make an incision to fix a hernia. We carefully dissect through the layers of the fascia and muscle until we reach the testicle. Next, through a series of maneuvers that see the gubernaculum (100 points to whoever defines what this is in the comments) released from the testicle and pushing back the perineum and other structures in order to free up more of the spermatic cord so we can pull the testicle down through the scrotal sac. Finally, we stitch the testicle into place and then stitch the outer skin of the scrotum over it to make it look like normal.
Results: This patient had no surgical complications and is fine post-operatively! However, it should be noted that patients with undescended testicles have an increased risk for testicular cancer - even after we fix the undescended testicle. Therefore, this patient will need to be followed closely for the rest of his life. If there are any signs of the cancer, removal of the testicle will become necessary immediately. Some signs of testicular cancer include:
Diagnosis: Prepubic undescended testicle on the left side.
Surgical Procedure(s) Ordered: Orchidopexy; the surgeon first makes an incision near the site of the undescended testicle, similar to how he might make an incision to fix a hernia. We carefully dissect through the layers of the fascia and muscle until we reach the testicle. Next, through a series of maneuvers that see the gubernaculum (100 points to whoever defines what this is in the comments) released from the testicle and pushing back the perineum and other structures in order to free up more of the spermatic cord so we can pull the testicle down through the scrotal sac. Finally, we stitch the testicle into place and then stitch the outer skin of the scrotum over it to make it look like normal.
Results: This patient had no surgical complications and is fine post-operatively! However, it should be noted that patients with undescended testicles have an increased risk for testicular cancer - even after we fix the undescended testicle. Therefore, this patient will need to be followed closely for the rest of his life. If there are any signs of the cancer, removal of the testicle will become necessary immediately. Some signs of testicular cancer include:
- A lump or mass in either testicle
- Any enlargement or swelling of a testicle
- A collection of fluid in the scrotum
- A dull ache in the lower abdomen, back, or in the groin
- A feeling of heaviness in the scrotum
- Discomfort or pain in a testicle or in the scrotum
- Enlargement or tenderness of the breasts
Thursday, May 14, 2009
Lecture on How to Give Lectures
I was invited by the Surgical Program Director at Staten Island University Hospital, an awesome man who puts student learning first, to deliver a lecture today to all the Surgical Resident. The topic? How to Lecture.
Quite the honor! I felt humbled to speak in front of all these super smart people. There were about 30 residents and a handful of Attendings were also present since our M&M Conference (Morbidity and Mortality) was right afterward. Of course, you gotta impress people with a shnazzy title, therefore I called my lecture: "Increasing the Effectiveness of the Lecture Modality of Teaching". Pretty shnazzy, eh?
The highlight of my presentation came after I was done; this room full of amazingly smart people was extremely thankful for the ideas! They thought I was offering absolutely earth-shattering suggestions that will indeed move the Earth off orbit. Little did they know that for all of us teachers out there, this is "Maintaining Sanity in a K-12 Classroom: 101".
Unfortunately, I don't know how to link the PowerPoint to this post. If you want to see the PowerPoint, let me know and I can email it to you. But really, most of what makes any presentation by me tolerable and interesting to listen to, is my goofiness whilst presenting.
Sunday, May 10, 2009
Quickies: California Sunshine, Surgery Exhaustion, and Stupid Passengers
1. California Lovin': I was in California from May 1 to May 3 for a dear friend's wedding in LA. It was awesome. Being back in Cali really reminded me why I love California! I had not been back since October and, although I love NYC, there is no place like home. I can't wait to come back to Fresno on June 23...just in time for the ridiculously hot summer months!
2. Surgery Exhaustion: I was hoping to get a new post out before it happened, but alas, my good friend NK called me out for taking too long to post. I gotta tell you - having to report to the hospital by 6am really knocks the wind out of me for the entire day. I am NOT a morning person. Not trying to make excuses, just telling the honest truth: by the time I reach the end of the day, around 6pm, I'm totally and completely pooped! I haven't even gone to the gym for almost three weeks now. My weight loss goals are not being reached, my nutritional goals aren't being reached, and quite frankly, I can't even study as much as I would prefer. I would much rather work from 10am to 10pm rather than 6am to 5pm.
3. Stupid Passengers: OK, I absolutely CANNOT believe this. As you may know, a Southwest Airlines flight had to conduct an emergency evacuation after its right side tire caught on fire after landing. Luckily, all passengers made it off the airplane safely and nobody was harmed. All was good, thank God. BUT, UNFORTUNATELY STUPID PASSENGERS ARE ALLOWED TO TRAVEL. Take a look at the video below - feel free to fast forward to about minute 3:45 and then watch the back slide closely. That's right, it's a suitcase floating down the slide. And yes, that's right, there is a STUPID PERSON coming down and stopping to pick up the papers!!!!!!!!!!! Are you kidding me?!?! Really and truly - the TSA needs to add CT machines at the security check point just to make sure there aren't passengers loading the plane who are completely and totally missing a brain!
2. Surgery Exhaustion: I was hoping to get a new post out before it happened, but alas, my good friend NK called me out for taking too long to post. I gotta tell you - having to report to the hospital by 6am really knocks the wind out of me for the entire day. I am NOT a morning person. Not trying to make excuses, just telling the honest truth: by the time I reach the end of the day, around 6pm, I'm totally and completely pooped! I haven't even gone to the gym for almost three weeks now. My weight loss goals are not being reached, my nutritional goals aren't being reached, and quite frankly, I can't even study as much as I would prefer. I would much rather work from 10am to 10pm rather than 6am to 5pm.
3. Stupid Passengers: OK, I absolutely CANNOT believe this. As you may know, a Southwest Airlines flight had to conduct an emergency evacuation after its right side tire caught on fire after landing. Luckily, all passengers made it off the airplane safely and nobody was harmed. All was good, thank God. BUT, UNFORTUNATELY STUPID PASSENGERS ARE ALLOWED TO TRAVEL. Take a look at the video below - feel free to fast forward to about minute 3:45 and then watch the back slide closely. That's right, it's a suitcase floating down the slide. And yes, that's right, there is a STUPID PERSON coming down and stopping to pick up the papers!!!!!!!!!!! Are you kidding me?!?! Really and truly - the TSA needs to add CT machines at the security check point just to make sure there aren't passengers loading the plane who are completely and totally missing a brain!
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