Monday, April 12, 2010
Thursday, April 8, 2010
Coast Mini Tac LED Light Giveaway. Starting Thursday April 8, ending Monday April 12.This mini Led flashlight is perfect while trekking on your next backpacking trip, your next camping adventure, vacation, or your glove box. This LED flashlight uses one AAA battery, that last 18 hours. The LED bulb also lasts much longer than the old school incandescents of yore. The light bean is also white, not the yellow of other bulbs. I have owned a light similar to this and it is indispensable. You can use it as long as you want at night in your tent while backpacking or camping in the mountains. I always take one with me on my hiking trips, its a piece of gear that can’t be left behind. Enter below for this required piece of camping gear.
Description of the Coast Mini Tac LED Light from the Coast site:
- Crystal Reflector Tube System
- High-quality LED; white beam
- Rear on/off switch
- Tactical lightweight aluminum casing
- 15 lumen output
- Over 20 hour battery life
- 2.9 inch length
Full review on candlepowerforums.com.
Saturday, January 2, 2010
Update: Radiology is my specialty. I'm hoping to end up close to home in the Northwest, and have interviewed at ten different programs with a couple of interviews left to go. It's so exciting to be this close to having my MD, having a career, being done with borrowing money, and for once, having an income - marketable skills!
Sunday, July 12, 2009
The C-sections were my first surgical experience. There's nothing like watching the experienced surgeon extract a baby in distress. He shuts out all of the emotional drama, focuses in on the task at hand, and swiftly slices his way through the various layers with big, broad strokes of the scalpel. Everything is nicely tensioned by the expansion of pregnancy and falls to the side to expose the uterus, in which he makes a small incision, just enough to allow the amniotic fluid to gush forth like a fountain. He then inserts two index fingers and proceeds to rip it open with perhaps a grunt or two (yes, studies show blunt dissection, not sharp dissection, seems to work better for the hemorrhage-prone uterus) and then pushes on the upper abdomen sometimes with the help of extra hands, and pops the baby out in just minutes. However, the baby is of no concern to the OB doctor. He hands it off like a football to his running back and doesn't glance back, turning full attention to the mother's needs while the pediatrician attends to the baby.
Neuro: The single most notable event during neurology was the death of my first patient. I was following an octogenarian female who had a traumatic intraparenchymal hemorrhage (bleeding in her brain from a fall) that would probably kill her without surgery. Her brain was beginning to swell from the trauma and bleeding, and she wasn't quite herself. She had lost vision entirely in one eye and had partial loss in the other eye. Her family talked with her at length and agreed to move forward with the surgery, knowing there would be significant risks involved. During the surgery, I will never forget the surgeons' conversations. It all sounded so cold, so blunt, as they joked about their recent low success rate with octogenarians. Even as they were evacuating the clotted blood from a hole in the back of her head, they doubted she would ever wake up and all of this would be for naught. They were right. Although I did meet a few neurosurgeons who were practically as noble as saints, the majority struck me as insensitive pompous jerks. Perhaps this is just something that occurs in our neurosurgery department?
Psych: I worked the Psychiatry Consult service and found this rotation to be especially challenging. Rather than focusing on the cold hard science of psychiatry, I found myself becoming emotionally involved with my patients and having a difficult time believing that what we were doing was meeting the true needs of my patients. I saw a lot of emptiness, loneliness, heartache, and despair, and I wanted to fill that emptiness with a message about Jesus Christ. Being a young medical student, though, with my career in jeopardy, I found it nearly impossible to initiate any sort of religious discussion. It seems that such topics are particularly taboo on the psychiatry service. I must say, there seemed to be almost a dichotomy of personalities among the residents. Some were consistently and genuinely compassionate, while others seemed to be quite the opposite. No doubt, I heard more swearing and saw more unprofessional behavior while on the psychiatry service than any other thus far - although this may just be an isolated occurrence.
Primary Care: Our medical school is famous for promoting Primary Care. We have one of the highest percentage of students choosing primary care specialties nationwide. Our country sorely needs more good primary care doctors - I did seriously consider pediatrics for awhile, but I found the field of radiology to be much more intriguing and fitting. Anyway, this rotation was a nice break. I had Fridays off and my days were typically 8am to 4-5pm or so. My wife at times wanted me to consider primary care, perhaps thinking our career life would reflect the med student life during this rotation.
I learned that the American culture and way of life creates many scenarios that lead to chronic diseases such as diabetes, heart disease, stroke, and cancers, and that the primary care physician is often powerless when it comes to changing a patient's lifestyle in order to get them back on track toward health and longevity. I learned that, despite our advances in understanding of disease processes and prevention, we still cannot get much of our population to follow even the most basic advice (e.g. colonoscopy starting at age 50). Primary care just wasn't for me. I felt like most of our time was consumed by the tasks commonly relegated to the social worker - getting a patient into a nursing home who can no longer be cared for adequately by the family; helping a patient get access to meals on wheels and other senior services; helping a parent understand why their teenage daughter needs to have some time alone with the doctor; dealing with drug seekers whose real needs are social support and home health visits.
The family practice doctor whom I shadowed was an older female - about my mother's age - whose patient population was skewed toward her own type. From day one, she assigned me the task of pelvic exams and pap smears on all women who would agree to subject themselves to my inferior exam skills. This is one thing I was never eager to learn or do especially on the younger women, and although I thought I became quite proficient after two months, there were always those women whose cervix just seemed to evade and shy away from my cold metal speculum and shaky hands, and I'd have to give up and turn to the attending for help. My favorite by far, as always, was working with the children. It seems that I have a natural ability to understand a child's fears, misconceptions, and pains.
Medicine: The internal medicine rotation reinforces most of our first two years of bookwork - pharmacology, pathophysiology, microbiology, epidemiology, genetics, biochemistry, physiology, and other subjects. While primary care touched fairly lightly on most of these subjects, internal medicine delves deep into all of them and requires an extraordinary effort to re-learn, re-memorize, and master the basic concepts of patient management. The shelf exam in this rotation is great preparation for the USMLE Step 2 (United States Medical Licensing Exam). I read several different textbooks and carried three or four different handbooks, and read or skimmed through hundreds of articles online in search of appropriate treatment plans for patients according to the latest research available.
I was assigned 2-4 patients at a time, many of which were liver failure (transplant candidate) patients due to our busy transplant service. I would occasionally get what we call a "rock" of a patient (because they don't move, ever, and they're nearly impossible to get out of the hospital). One such patient, "Mrs. Rogers" was my most challenging patient. A 65 year old grandmother, she went to her local ER in a small outlying town with acute abdominal pain. Morbidly obese but otherwise "healthy," the doctors couldn't figure out what was going on but decided to do exploratory surgery based on the fact that she had a cholecystectomy (gall bladder removed) several decades ago, and they thought she might have scar tissue (adhesions) from that, causing an intestinal obstruction. A few insignificant adhesions were found, her normal appendix was removed, and she was sewn back up. Unfortunately, this was the beginning of her problems. Several days later, her abdominal pain worsened and she spiked a high fever - she developed intra-abdominal abscesses as a result of her exploratory surgery and spiraled down into sepsis; surgery was done to clean out the abscesses and she had a hypotensive (low blood-pressure) crisis during surgery - her kidneys didn't get enough blood and they died of hypoxia.
She eventually stabilized in the ICU and, once stable enough, was life-flighted to our ICU. Our interventional radiology team placed four drains into her abdomen to help remove the abscesses that remained, and she battled a minor case of pneumonia among other things. About a month after arrival, she finally arrived on my general medicine floor and was assigned to me. She had several drains which continued to leak purulent yellow fluid, and despite a BMI of 45, she was starving and weak, and had lost much of her muscle mass to her sickness. Mrs. Rogers didn't want anything to do with me, hated being woken up so early for morning rounds, and refused to take part in our treatment plan. Worst of all, she refused to eat ANYTHING. I recommended a psych consult - they recommended antidepressants. We had physical therapy, occupational therapy, even speech therapy, a social worker, and a chaplain. Nothing could get this lady to exercise, eat, or open up to us. I would come back in the afternoon when I had more time and she would often ask if I had brought a gun so she could shoot herself and get it over with. The best thing I did was discover that she had two horses, whose names I wrote down and asked about frequently. This seemed to help, a little. She wanted nothing to do with religion or prayer. Eventually, I made a recommendation that we often used during my psych rotation - we began giving her small doses of Ritalin (a stimulant used for ADHD and controversially for weight loss), hoping it would provide her enough energy to engage with the physical therapists and perhaps work up an appetite. I never did see her get out of bed, and the only time she sat up was when three of us strained to lift her to a sitting position for the sake of a proper lung exam (which, honestly, was nearly impossible through the thick folds of adipose tissue). After a few weeks on our service, we determined that her abscesses were sufficiently resolved, pulled her drains, and sent her to a long-term care facility for rehabilitation.
One of my favorite patients was a young 45-year-old Native American man who drove himself and his girlfriend from a small town several hours away to get better treatment at our VA. Despite his circumstances, he was the nicest and most appreciative patient I have ever encountered. He was thrilled to have the privilege of being visited by a student doctor, and even more thrilled when I announced that I would present his case at our weekly conference. He arrived with the longest list of symptoms I had ever recorded - we have a form for "review of systems" and he had some sort of complaint involving 90% of his bodily systems: leg swelling, itchy skin, bruising, dizziness, shortness of breath, chest pains, abdominal pain, bloating, constipation, change in stool caliber, burning with urination, general weakness, insomnia, restlessness, muscle twitching, generalized muscle pain, and a recent onset cough. I was convinced he had something bad - perhaps an advanced case of leukemia due to the 7 months of weakness and bruising. We have this very rudimentary way of distinguishing patients - sick or not sick - and this guy looked sick. He wore sweats and a t-shirt and his hair was pulled back into a long, thick, shiny black braid. He reeked of cigarette smoke and who knows what else, and his clothes were blood-stained and tattered. He had what appeared to be ascites, or free fluid, in his abdomen making him look pregnant, and skinny, wasted extremities more typical of a 90-year-old. He had sunken eyes, bruises on his face, and multiple deep, dark bruises on all extremities. He had fresh excoriations (scratches) oozing dark red blood - and yet he continued to scratch at them, collecting dried blood under his smoke-stained fingernails. His physical exam was not too helpful otherwise, except that I was most intrigued that there were no lung sounds at all from the left half of his chest. He also had hypertension - which he said was new. Interesting!
Our first challenge was to correct the Native American man's potassium. It hovered just above 2 despite our best efforts - oral supplements, bag after bag, and yet it would come above 3, then drop right back down. Then we focused on managing his pain appropriately with morphine injections, and providing benadryl to hopefully help with the persistent itching. The chest x-ray finally came back and revealed a 7cm x 7cm mass in the left lung (no wonder I couldn't hear anything!) which appeared consistent with cancer. Here's where this case gets interesting - I had it all to myself since the intern and others were busy with new patients, so I read about the lung cancers that appear centrally. I read about small cell lung cancer and decided that, based on the rapidity of his symptom development, it had a good chance of being small cell - the most aggressive type. Trying to tie it all together, I considered the possibility of an ectopic hormone causing his other symptoms and, the more I read, the more I realized that the picture fit with ectopic ACTH syndrome, which is exceedingly rare. In other words, his lung cancer was producing a hormone normally produced by the hypothalamus that plays the role of stimulating the adrenal glands to produce cortisol, a stress hormone, our natural steroid. His body was being overloaded with steroids, causing all sorts of metabolic and hematologic derangements. This accounted for the low potassium, the new high blood pressure, the itching, muscle aches, and bruising.
Upon discovering these correlations, I excitedly called the attending physician and he gave me the awful task of bearing the bad news - the diagnosis of terminal lung cancer at an advanced stage - to the family. All this business of ectopic ACTH syndrome sounded very exciting to him as well, although he remained skeptical. He did allow me to order the test for it, which came back positive. Bearing the bad news was an excellent experience for my learning. I used all of the techniques we were taught and, although they had questions I couldn't answer, it went well. Since the cancer was so advanced and the chances of living longer than 3-6 months were very very slim even with the best treatments, he decided to choose palliative care (relieve the pain but allow the cancer to take its course) which is exactly what I would have done if it were me.
Surgery: I thoroughly enjoyed my time with the trauma surgery team to which I was assigned. Treating victims of high-speed car accidents, falls, horse-riding injuries, and work accidents required a little bit of quick thinking followed by a lot of watchful waiting. Most patients very predictably improved and left the hospital a few days after arrival. We'd get hammered with high numbers of new patients through the weekend, then they'd slowly taper off until Friday evening around 10pm, and then it would all start up again. It was nice to treat patients whose bodies were young and responsive to injury. Most were grateful for their care, felt lucky to be alive, and cooperative with treatment.
One of my most memorable patients was a man who shot himself through the head "on accident" and survived with nearly full cerebral function. Due to damage to his frontal cortex, however, he seemed to be somewhat disinhibited and seemed quite frank and open about everything. He would simply speak his mind no matter who it might offend. He reminded me of the case of Phineas Gage who survived a freakish accident in which a 3-foot-long 13-pound iron tamping rod speared his head, entering the right cheek and exiting the top of his head. This man shot the bullet through one temple and it exited the other temple, blowing out one of his eyeballs but otherwise causing little neurological dysfunction. He was expected to make a good recovery and possibly return to work. We treated him in the ER trauma bay but then turned him over to the neurosurgeons.
As part of trauma surgery, I also spent a week in the burn unit. The art and science of skin grafting became my subject of study each evening. Burn surgery is a very messy process. We always wore long booties to protect our shoes from the cascade of blood and skin that was sure to follow. The first order of business in a burn surgery is to remove all dead tissue. Using something similar to a cheese grater, one shaves away whatever looks dead - hopefully just the outer layers of skin, but sometimes all the way through the skin and down into the subcutaneous fat and muscle below. The result is what looks like a skinned arm, or leg, or back, or face. Then, we would shave off a paper-thin slice of healthy skin often from the thigh, send it through a meshing device, then stretch it out and place it over the denuded flesh to seed new skin growth. The graft is stapled in place on the edges and sometimes glued in place using an incredibly expensive fibroblast-stimulating collagen-based spray-on glue. It is an art to get the pieces of skin graft to fit on just right, trimming them to size and using the extra trimmings if possible. The big challenges in patient management are pain control, fluid replacement (it all leaks out of the burns onto their bandages, bedsheets, and gowns), infection control, and physical therapy (to prevent scar tissue from freezing joints in place). It's a constant battle, and if the patient is "on board" and in good spirits, things go so much better. It's amazing what a difference it makes when a burn patient has the will and determination to get better and get back into life!
Friday, July 10, 2009
Here is some of my recent work featured on iStockPhoto:
Thursday, September 25, 2008
Tuesday, June 10, 2008
Wednesday, April 2, 2008
With all the places I've been and photos I've taken, I have always thought I'd be able to make some money off of it somehow but I have been somewhat unsuccessful. I make an average of $3 to $4 per month on iStockPhoto (see my portfolio here). Due to their new, more stringent quality standards, the vast majority of my photography isn't iStock quality. There are subtle effects created by the smaller lenses and in-camera processing of my compact digital that I can only avoid by purchasing a digital SLR camera, which, at this time isn't practical as I wouldn't really have time to benefit from it.
Recently, since we purchased a Mac (we "needed" it-- first computer I've purchased since my old 486!) and got the Adobe Creative Suite, I've spent some free time doodling (and dawdling) on Illustrator and have applied to submit some of my creations for resale on iStock. Not sure why, but having a creative outlet is something I seem to really benefit from, maybe it's because I have recently been bombarded by a frightful amount of scientific information, virtually all of which is "left-brained thinking" and the right half of my brain is feeling left out? Anyway, here are a few things I've worked on: hand-tracing and stylizing an Arches National Park photo I took a long time ago, and creating my own versions of the famous Caduceus medical logo:
Tuesday, April 1, 2008
--The New Physician, 1982
We just received our schedules for 3rd year after much anticipation and debate. It's a lottery system and this is what I got. The latter half of my third year will be considerably more difficult than the first half. I will be in one of the four big hospitals in Madison most of the time, or travelling up to an hour's drive outside of the city for certain clinic-based rotations.
7/7 to 8/15 -- Pediatrics
8/18 to 9/26 -- OB
9/29 to 11/7 -- Neurology (includes Ophthalmology)
11/10 to 11/21 -- BREAK
11/24 to 12/19 -- Psychiatry
12/19 to 1/4 -- CHRISTMAS BREAK
1/5 to 2/27 -- Primary Care
3/2 to 4/24 -- Medicine
4/27 to 6/19 -- Surgery
Classes end May 14th, and I'm already well into my studying for Step 1 of the U.S. Medical Licensing Exam. I'm signed up to take it on June 20th, but it's quite tempting to push that date back and have more time to study! Heather and I look forward to an amazing vacation some time in late June because just two weeks after the big Step 1, I'm on the wards.
Friday, February 15, 2008
Heather and I are now officially consumers of green energy. Our electricity provider has invested in wind and solar power and we decided to support this investment by paying an average additional $1.77 per month to allocate all of our electricity usage to these environmentally friendly sources. Go green!
Thursday, February 14, 2008
Tuesday, February 5, 2008
Sunday, January 20, 2008
Friday, January 11, 2008
Monday, December 17, 2007
We spend two full years studying almost entirely from our books, handouts, and powerpoint slides, with very limited clinical contact, and are required to retain the anatomy, biochemistry, physiology, pathology, microbiology, pharmacology, etc. so that we can enter the 3rd year with the tools necessary to treat and manage patients of all kinds largely on our own. During almost every lecture, I find myself just wishing I could meet someone suffering from a Borrelia burgdorferi (Lyme disease) infection so that I could relate more to the humanistic side of the disease, and understand the importance of the antibiotic regimen that will ease their pain, restore their sanity and perhaps save their lives.
I anticipate the satisfaction and excitement of 3rd year that will solidify my clinical reasoning and help elucidate my specific interests in specialties, but dread the upcoming boards (USMLE Step 1 of 3) that function as the gateway into 3rd year, the judgment bar of med school, the standard of comparison by which our future opportunities in residencies will, in part, be determined. My goal is simply to keep as many doors open for as long as possible, because currently I have no idea what specialty I will choose, though I know at least it will be one that allows for more family time. That's what matters most to us.
Sunday, December 9, 2007
Heather and I make smoothies all the time. They're great! They're usually something like 1 and 1/2 cups frozen fruit, a 6 oz yogurt, 1 cup milk, a banana, a spoonful or two of sugar (sometimes), and sometimes some vanilla. We wait for the big sales on frozen berries and then stock up, blueberries are my favorite! Partly because they taste so good, partly because they're packed full of cancer-fighting antioxidants and other fun vitamins. My favorite thing about smoothies, though, is they make Heather cold, and then she has to cuddle with me until she gets warm again.