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Ladies man

2011-10-30T15:50:00.000-07:00

Today was the primary program and I didn't have to work!! I was excited to see Zeb sing all the songs I have been practicing with him. It was really fun to watch him sing his little heart out. Those sunbeams have such a hard time sitting through the entire sacrament meeting up on stage. It is a lot to ask for them to sit up there with no snacks and things to color or play with. They actually set up some risers in front of the podium and put chairs on them for the sunbeams. Zeb was sitting next to his really good friend who has the same last name. They have had a few play dates together and he thinks sharing the same last name is awesome. Half way through the program he reached over and held her hand. They held hands for the rest of the program and Zeb could not stop smiling and giggling. It was so distracting but so funny!! Leisy was trying to get his attention to let go when they started swining their hands up and down. I can't even tell you how many comments we got after the program about Zeb being a little ladies man. It was too funny!!

I love fall!

2011-10-29T13:58:00.000-07:00

Fall is the best time of year - I absolutely love it! Pumpkin patches, colored leaves, jacket weather, Halloween, my birthday and so much more to look forward to! Despite my ridiculously crazy schedule we have really taken advantage of everything Ohio has to offer this time of year. It makes me very grateful we are not sweating through 85 degree weather in Texas. I just completed my 4th rotation of residency. I have seen some unique pathology: Lupus cerebritis, pyelonephritis causing fever of 107.2 degrees, Kawasaki disease, Crohn's disease, and Trisomy 18. I am also becoming very comfortable treating asthma, bronchiolitis and constipation. I have seen kids with failure to thrive for a multitude of reasons. I've seen children taken away from their parents and I've counseled a lot of crying parents. Life in residency is nuts but it has been amazing and I'm learning so much.

I'm a Doctor!!

2011-10-01T10:45:00.000-07:00

I am now 3 months into my residency program and loving it! It is everything I expected it to be. It is really hard work, I'm learning a ton, and I love what I'm doing. I've spent most of the time thus far either in the peds clinic or at the hospital on general peds hospital admissions. I've worked nights, I've worked days and feel like my internal alarm clock will never be the same. I've seen lots of babies and kids for well checks and I've taken care of some pretty sick kids with crohn's disease and small bowel obstructions. It has been a long road getting here and I'm still not done, but people now call me Dr. Miller. My white coat has been upgraded from a short waist length student coat to the full length Dr. coat. Here's a picture of me in my coat following up with some lab results:

I really think Pediatrics was the best career decision I have ever made, secondary to joining the Air Force. They both fit my personality very well. I am training with some of the best Pediatricians I have ever met. I can't imagine why people go through medical training outside of the military!! Residency is extremely overwhelming, the hours are long, I feel tired and stressed most of the time - but I like it. Leisy is the most supportive wife in the world. I am extremely lucky to have her helping me. She keeps me sane and always finds amazingly fun things to fill my spare time.

2011-03-06T19:02:00.000-08:00

Reason #1 I joined the military: Travel!
One of the first times I contemplated the military scholarship for med school was during my first year at BYU. I took a "premed prep" class that basically introduced various aspects of medicine and how to go about preparing for medical school. It was a 7 AM class and I honestly slept through most lectures. They had all kinds of specialists come tell us about their careers. One morning they invited a doctor who spent 20+ years in the military. He had pictures from all over the world, not just traveling but actually practicing medicine! The military offers all kinds of opportunities to practice international medicine and I can't wait to see more of the country and hopefully other countries as well.

2011-03-05T13:54:00.000-08:00

The other day Ike would not be consoled. He was trying desperately to get something in the kitchen and Leisy and I had no idea what he wanted. Leisy insists I'm better at translating Ike's jibber-jabber, but together we couldn't make sense of his words. His words quickly melted into frustrated screaming and tears so I picked him up and had him show me what he was after. He opened the freezer and rummaged in the crowded top shelf until he found one of these:I had no idea we even had any of these left - they were from last summer. When I opened it the thing was covered in ice frost and looked disgusting, but he started laughing through tears and declared "popsicle - Yay!" which sounded NOTHING like "popsicle".

The red, white, and blue reminded me about posting the reasons I joined the military. Maybe my desire to serve the country started from a young age when my parents bought me this:
Does anybody else remember this book and tape?!? I thought of this the other day and how much I loved listening to it. I wish I still had it so I could start indoctrinating Zeb and Ike! I really have tried to find some of these songs online but haven't had much success. Anybody out there have access to these songs?

My little helpers

2011-03-03T18:42:00.000-08:00

These boys want to help me do everything - especially when I make cookies. They are so interested in what I'm doing from the second I walk in the door. They are so much fun right now. They can be so demanding and so frustrating at times but they really are the best little kids in the world. They are also the best of friends. Tonight Zeb said our family prayer and Ike knelt next to him with his arms folded and eyes squeezed shut and repeated everything that Zeb said - it was adorable. I love these little cookie monsters.

2011-02-28T13:10:00.000-08:00

It has been much harder to stay focused on school now that I have matched and found a house. It feels like my mind is already in Dayton at times. My fellow classmates still haven't found out where they will be going - they won't find out until March 17!! Maybe the stress of not knowing keeps them working hard on their rotations. I think it wouldn't be so bad for me except I've used up all of my Pediatric time for 4th year and have to find adult rotations that A) haven't filled up and B) are interesting to me. So this is how I've spent my time since January:

PM&R - Physical Medicine and Rehabilitation
I wasn't able to get a Neurology rotation so I thought I would see a lot of neurological disorders through this rotation. I saw several people who were debilitated by strokes, multiple sclerosis and spinal cord injuries who needed coordinated care with a doctor and their therapists (physical, occupational, speech). We took care of their medical needs to make sure they were healthy enough for therapy. I also saw many patients post orthopedic surgery who were recovering. I saw A LOT of chronic back pain and people trying to manage their lives while taking narcotics - I think it will be difficult to judge who deserves narcotics and who doesn't. Luckily chronic pain in pediatrics is not as common as it was during this rotation!

Ophthalmology
I spent two weeks with the ophthalmologists (12 at the office I worked in) learning about all kinds of different eye disorders. We really don't get that much exposure to eyes during medical school, even though eye disorders are fair game on all of our board tests. I spent several days during this rotation with a pediatric ophthalmologist studying various conditions like strabismus, amblyopia, nasolacrimal duct obstruction and others. I even spent a morning in the NICU evaluating the preemies for retinopathy of prematurity. I finally understood why my sister worked with an eye doctor and a plastic surgeon in her office; plastic surgery is a fellowship within ophthalmology that specializes in surgeries from the neck up.

Forensic Pathology
I spent a few weeks in the Coroner's office learning about death. Every morning was the parade of dead bodies to autopsy and determine their cause of death. I saw drug overdoses, victims of car accidents, suicides, even a murder. The murder investigation was just like you see in movies! The detectives were there with cameras, fingerprinting kits and DNA sampling. The victim was shot in the head and put in the trunk of his own car. He wasn't discovered for several days - luckily it has been super cold and his body was frozen. I can only imagine how a dead body stuffed in a trunk for several days in the hot, humid, mid-western summer would smell. Blech! I even saw an autopsy of a three year old. This was so difficult to watch. I thought of Zeb the entire time. This little boy was sick at home, climbed into bed early in the morning with his dad, and was found unresponsive 30 minutes later. I couldn't believe how teeny tiny and pristine all of his organs were. Holding his little heart in my hands was surreal. This rotation offered a lot to learn about general anatomy, pathology and forensics. I loved it - but couldn't do it for a living.

I figured if I didn't get the rotations I really wanted, and I can't do any more pediatric rotations, then I'm going to look for rotations with easy hours. I have really enjoyed sleeping in, long lunch breaks and early afternoons (or afternoons completely off)! I have spent lots of time with Leisy and the kids, spent some extra hours in the gym, and have read for leisure for the first time in years. I'm really enjoying 4th year! I realize I will have quite the rude awakening when residency starts - but at least the crazy hours will be pediatrics!!

2011-01-30T05:15:00.000-08:00

It's been over a month since we found out I will be doing my residency in Dayton, Ohio. We really couldn't be happier about the results. I loved everything about the program: the location, I liked everyone I had a chance to work with, and I especially love the fact I will get to work at a children's hospital.I also liked the program in San Antonio but they only had a base hospital with a children's floor and didn't have an entire hospital dedicated exclusively to pediatrics. I also don't think Leisy would have faired too well in the hot San Antonio summers.

I had heard all kinds of horror stories about the military and how it was a mistake to join. People told me I would be forced into a residency that they wanted me to do and I wouldn't have a choice in the matter. Other people warned the only way I could get my top choice of residency was to complete several GMO (general medical officer) years, which would ultimately delay and discourage me from other specialties. I'm happy to announce this wasn't at all true for me and it wasn't true for the other students in my class with the military scholarship. There are 6 other HPSP (Health Professional Scholarship Program) recipients in my class and every one of them got their top pick for residency. They matched into really competitive specialties too: Radiology, General Surgery (in Hawaii), Orthopedic surgery (x2), OB/GYN, and Family med. Last year the two Air Force students got their top picks as well. One went into OB/GYN and is in Dayton now - he actually turned down an interview at Yale because he loved the program at Wright-Patt so much! The other student last year didn't want to do a military residency and was able to get his top pick in general surgery outside of the military. So, I don't really buy into the "you're-ruining-your-chance-to-do-what-you-want-because-you-joined-the-military" hullabaloo. I'm really happy with my decision to join the military. I'm going to have wonderful training in peds, I'm looking forward to serving the country by taking care of service men and women's children, and it's really really nice to finish med school with zero debt! There are several other reasons for joining that maybe I'll blog about someday.

I've been reading this book Leisy got me for Christmas about a pediatric surgeon in the Air Force. He was deployed to Iraq on two different occasions and his experiences are fascinating. It would be so hard to be away from family for so long, but such a neat opportunity to take care of children who have been so devastated by war. It's a great read to find out what a Dr. might do in a war zone or during a deployment.

Heme/Onc

2010-12-13T15:17:00.000-08:00

Today I started the second week of adult outpatient Hematology/Oncology. I have a normal 9-5ish schedule and see patients in the clinic for visits regarding their cancer or blood disorders. I have seen many things from breast cancer to colon cancer, polycythemia to pancytopenia, anemias, leukemias, myelomas and lymphomas. I have spent some time in the hospital's infusion center with patients getting chemotherapy treatments and time with the pathologists looking at certain cancers under the microscope.

It has been an interesting rotation so far and I have enjoyed reviewing all these different disorders. However, I totally miss pediatrics. Adults just aren't as patient and fun to work with. Most adults don't expect you to make them laugh and giggle when you listen to their heart and lungs. A lot of them roll their eyes and ask when the actual doctor is going to be in. One very interesting thing about this rotation is seeing the various ways people deal with difficult diagnoses. I have seen patients who are so optimistic and so prepared to do whatever is necessary to defeat their disease. They are motivated and inspirational. I have seen other people who succumb to the disease and act defeated before they even have a complete diagnosis.

The physician is an integral part of these people's lives. I was present when a physician encouraged her patient to mend her broken family so she could have support during her illness. I have seen another physician lecture his patient about putting his life in order so he wouldn't lose his health benefits. These are very complex diseases and affect more than just the body - they affect the patient's entire life. It is exciting to realize how much trust and confidence these patients give to their doctor. It is humbling when patients open up and share the most intimate and private parts of their lives in order to fix their problems.

In other news - we finally got the snow we have been wishing for!! I love the snow and am so excited for Christmas. The snow makes it feel like Christmas is actually on it's way. This week is match week for me!! I should know where I will be doing residency by the end of this week. I'm so anxious it's all I can think about. Luckily I have a normal work schedule that allows me to get to the gym and deal with my anxiety that way.

Can't say no

2010-12-02T08:37:00.000-08:00

I finally finished my crazy 3 month block of Pediatrics. One month in Texas, one in Dayton and one here in Toledo. It was exhausting and I worked some fairly long hours. I did managed to find time for fun on the days I was off. I knew I was going to need a break after those three months and I can't believe that that break is over! My two weeks of "flex" time allowed me to recuperate and get some things in order. However, I got roped into presenting an "interesting case" that I saw earlier this month. The Pt was only on my service for one day and decompensated quickly. He spent 2 days in the PICU (different service) and when I found out I would be presenting his case he was being transferred to the University of Michigan for some intense therapy. He survived (I thought he would die for sure) and now I have been busy trying to pull information from the PICU, Michigan and his Primary Care Provider. I finally pulled it all together this morning (I present tomorrow) and I no longer care how this presentation turns out for several reasons: He never had an actual diagnosis, I'm totally done with the rotation, the presentation will (should) not reflect on my evaluations, and the Military has already convened and my residency fate is already decided!! I should find out in 2 weeks where I will go. Needless to say, this presentation tomorrow should not affect me. It just has taken up a lot of my flex time to put together (grrrr). I need to learn how to say "no" to attendings!! I hope to get a good letter of recommendation from her - I don't need it, but maybe I can keep it in my journal or something.

Miller Emotions at it again...

2010-11-04T17:32:00.000-07:00

I need to start off by saying the Miller emotion gene is hyperactive. If you have ever been around my family you will know that it is not uncommon for us to blubber through a hallmark hall of fame TV special, or cheer during the Olympics trying to not let the person sitting next to you notice the tears in the corners of your eyes, or become verklempt listening to Christmas music. I've done so much better and have gained much better control of my emotions than in years past. I rarely cry anymore, and I thought I had suppressed this Millerism. The other day it got the better of me and caused quite a scene.

I was on call and had been at work for 16 hours and had 14 hours still to survive. I was already tired and when I'm tired my emotions are harder to control. I was called to evaluate a 7-year-old who had just been sent to the hospital by her family doctor to be evaluted by a Heme/Onc doctor. I was to go obtain the child's story, do a physical exam and begin the admission orders for the doctor to come review. I walked into the room to find the cutest little family sitting together on the bed. They all had matching blue eyes and blond hair. The oldest daughter sat on her Mom's lap and looked ghastly pale. The apprehension in the room was palpable and I tried my hardest to establish good rapport and to build their confidence in me. I asked the patient about school, her favorite things to do and her friends. I talked to her and her little sister about their Halloween costumes. Then I started asking about her symptoms and how she ended up in the Heme/Onc ward late at night. The symptoms had been present for several months and were all very non-specific: persistent cough not relieved with albuterol and singulair, increasingly tired, strange skin discoloration on the chest and neck, cervical lymphadenopathy. In short the Mom told me she "just wasn't the same".

I was thinking of possible reasons this girl could be here and why her family doctor would want an Oncologist to evaluate her. I thought of ALL (acute lymphoblastic leukemia) which is the most common childhood cancer. I started thinking of some of the complaints associated with this disorder (all of which she had already described). I asked about fever and bruising and other things. I then asked about bone pain and Mom's hand flew to her mouth and she said, "Oh my gosh!! Yes! I had totally forgotten about that. She was complaining about hip pain and leg pain". The Mom started tearing up and she started to lose the composure she had maintained up to this point. And guess who else started tearing up and developing a shaky voice and had to pause in order to continue?!? ME!! My emotions swept over me and I nearly started crying along with this mom who was trying so hard to hold it all together. When I started the exam she had to get up and go into the bathroom to compose herself. When I finished, the attending was outside waiting for me and we talked a great deal about ALL and how this very well could be cancer. We ordered a number of different labs and had to wait until morning to find out what was going on.

I left this family thinking for sure their daughter was going to die. Can you even imagine your Doctor crying when you explain the symptoms you have been having. Hello Kent?!? Can you even imagine how scared and how little hope this family had after I left the room. I tried my best to help them not imagine the worst and to explain some of the other possibilities. The attending talked to them about some of the other possibilities. I'm sure it was the stupid med student crying that stuck in their minds that night - not anything we tried to comfort them with later. So did she end up with ALL and a chemotherapy protocol put into place? No! She had Iron deficiency anemia. She was started on iron and had a nutrition consult. simple. easy. case closed. I was pulled in so many different directions the next morning I didn't get a chance to see her before her doctor discharged her. I'm sure they still think I think she has cancer. Grrr... Miller emotions are not going to be the best thing to have as a doctor.

10/10/10

2010-10-11T09:57:00.000-07:00

I got an extended weekend thanks to Columbus Day; the base clinics are all closed! Leisy made sure to make my Birthday weekend extra special. We had a blast and it was a party everyday I was home. I was entirely spoiled and it was a lot of fun. It's no wonder Ike and Zeb love when I come home.

Thanks for making my Birthday perfect, Leisy! I love you so much!

2010-10-06T14:15:00.000-07:00

Yesterday morning one of the Pediatricians took a small group of us to the animal lab on base. They taught us how to insert chest tubes and intubate babies. In order to practice these skills we put chest tubes in cute, fluffy bunnies and stuck tubes down the ferret's airways. Yes, the animals were as cute as the pictures I found online. Keep in mind that I worked as the animal Nazi for several months and killed countless numbers of animals. I now kill with no remorse. The poor rabbit had a chest tube placed on either side. We were to introduce air into his pleural space which created a pneumothorax. We observed the physiological change and then tried to evacuate the air. The animal was anesthetized and was lying comfortably on the table. When the lung was collapsed it became tachypneic, tachycardic and had prominent nasal flaring. The intern went first and I followed on the other side. I think the rabbit had expired before I even made my first incision. So much for saving the rabbit and nursing it back to health after the procedure!! The ferrets were also sedated and after several intubations may have nasty sore throats but should continue to live happy ferret lives in their quaint ferret habitat. I will see you again next year little ferret.

Dayton!!

2010-10-01T08:31:00.001-07:00

My first week in Dayton is almost complete. I have a longer lunch break today so I thought I would update my blogitty-blog. I have been at Wright-Patterson Air Force Base in Dayton, Ohio for the past week. My two week "easy" rotation in Anatomy in Toledo went WAY too fast. The smells and sounds of working on dead bodies reminded me why I was so excited when I successfully completed Anatomy during first year. I was glad to be done, but I was also glad to have a light rotation and spend a lot of time with Leisy, Zeb and Ike. Our Animal Safari adventure was ridiculously memorable. This is the Hospital on base. The pediatric department has all of its clinics for general pediatrics and for specialty pediatrics in one location. They also have child psych and a peds immunization clinic in the same location. Unlike my rotation in Texas, this hospital does not have inpatient pediatrics. All of that is done at a "civilian" hospital in Dayton not too far away from base. Dayton Children's hospital is a beautiful children's hospital where any patient from the base who needs to be admitted will stay. My training would consist of time at the military base and time in the civilian hospital. To me, this is a great advantage to get the "best of both worlds" during my training.

So far I have loved every thing about this program. The staff are approachable, easy to work with and seem to have a great work dynamic. The residents seem to be a part of one big cohesive team. I love the area - Dayton seems to have surprises hidden around every corner. At night I venture out around base and have done a fair bit of exploring. I get excited every time I see a new Metropark, shopping center or restaurant. They have a Cheesecake Factory!!! Traffic is not bad, and the neighborhoods seem pleasant. Dayton has a lot of trees and they are all changing right now. I LOVE Ohio in the fall. The air is crisp, autumn smells are everywhere, I need a jacket when I go outside. What could be better?? Getting accepted to this program and having my family here with me - that's what could be better.

I have constant butterflies in my stomach. I want to come to this program so badly and really these four weeks are a time to prove myself to the program. I'm constantly on edge trying to impress and seem interested and engaged 100% of the time. I also try to play off that I'm nervous about getting in. I try to be interesting and seem like a team player. I know that I just need to relax and be myself - I'm trying to do that, I just want to make sure I'm being my BEST self ALL of the time. (The woes of a hopeful resident).

I have been working in the pediatric clinics and spent all of yesterday in the nursery. I watched some circumcisions and also participated in a C-section and new born examination. Today I worked with the developmental pediatrician which specialty I knew little about. It is a really cool specialty and combines some interesting aspects of pediatrics (psych, genetics, general peds, social and physical development). They have me rotating through many different things to help me get a broad view of the program. I'm looking forward to working with the Cardiologist, GI doctor, and the Adolescent specialist. I'll spend some time in the NICU, PICU and inpatient units at Dayton children's.

Upgrade

2010-09-16T07:54:00.000-07:00

Minutes before boarding the plane in Texas, my name was announced over the overhead speakers. "That's strange", I thought. I made my way to the boarding gate and they smiled and asked to exchange my boarding pass for a new one - a first class ticket. What?!? I immediately thought of officer training and being warned to NEVER fly first class in uniform. It just looks bad to have military members acting pretentious on the government's dime. I politely refused and told them I was in uniform. They insisted and said it was perfectly okay, it was Sept. 11, and they thanked me for my service. In my head I thought, "What service?? I haven't done anything yet!" When they called us to board they asked that all military personnel board first. I boarded the plane with 5 other service members including a full bird colonel who gave me a surprised look when I stopped at my first class seat. After he walked to the back of the plane I suggested to the stewardess that maybe the colonel should have my seat. She told me to sit down and relax. "You were probably nicer at the gate than he was", she hypothesized. I felt ridiculously guilty when I stretched my legs out, reclined my seat and washed my face with a heated towel. I continued to feel guilty when I declined wine with my gourmet lunch and guiltier still when they brought out freshly baked cookies. It was the best flight I have had in my life. Maybe I earned it since I was away from my family for 28 days. However, all of my class mates are gone for the same amount of time and they have to pay for everything themselves. So really I didn't earn anything. Maybe someday when I'm deployed and away from my family I will think back to that flight and say - now I've earned it!!

Tropical Storm

2010-09-07T19:17:00.000-07:00

"Tropical Storm Hermine gave a wet and windy punch to Texas today. Although the storm hammered Houston and San Antonio today, it's expected to weaken to a Tropical Depression overnight."

The storm was fairly intense. I was in the hospital all day long, but the wind and rain sounded crazy. When it was time to catch the shuttle home it picked us up 10 minutes late. A few sections of freeway were shut down because there was so much water on the road. By that time the rain had slowed to a drizzle. It was still suffocatingly hot and humid, but there were plenty of people in jackets and sweat shirts. Come on(!!) people of San Antonio - a few degrees drop in temperature with rain does not warrant the use of a sweat shirt. It was still ridiculously humid and warm. Hermine - do what you will with Texas for the next few days. Just let me go home in peace on Saturday!!!

Have a mentioned how much a love Pediatrics?!? I'm so excited to know what I want to do for the rest of my life; it's crazy how close I am to being an actual Doctor. This time next year I will have my very own patients and I will be responsible for their care. This week we had a 3 year old with Kawasaki disease. I was so excited because this is something that I swear pops up on every single pediatric test I have yet encountered. It can be fatal if misdiagnosed and even with treatment can have severe consequences. Only early recognition and early treatment has shown to reduce the long-term sequelae. So this little kiddo had the classic presentation: 5 days of fever, conjunctivits, big swollen and cracked lips, strawberry tounge, polymorophous rash on his trunk and extremities, edema of the extremities and lymphadenopathy. He looked miserable but was the sweetest little kid ever. 48 hours later with IVIG and high dose aspirin the kid looks so much better. I spent some time playing Toy Story dominoes with him this afternoon. His mom asked me to write my name on the white board because she wanted to remember "the good things that happened during this horrible experience. You are one of the good things". She just had a baby three weeks ago and her husband left for the weekend after she insisted she would be fine. I'm glad that I was able to help make her miserable week a little better. He had a cardiology consult because Kawasaki can mess up your heart vessels. He had only minor changes that should resolve but they will follow him closely.

Free things in SA

2010-09-05T07:49:00.000-07:00

"Here's to the Heroes"

For my last Saturday in San Antonio, I decided to save the biggest "free thing to do" for last:

Sea World!!

As an active duty military member, I can get myself and three other guests into Sea World free once a year. Too bad I didn't have my family with me today. We would have all gotten in!

I saw a lot of animals, made myself sick on some roller coasters, and watched Shamu the Killer Whale show. It would have been so much more fun with my family - but I still had to go check it out. It was FREE!

2010-09-04T18:57:00.000-07:00

Congratulations Leisy!! Leisy ran her second "official" half-marathon and scored a personal best! She also got a plaque for fisnishing in the top three of her age division. I'm amazed that she finds the time to put in so many miles to prepare for things like this and can still keep two crazy kids healthy and happy. I love Leisy!! I wish I could have seen her cross the finish line. Great job жена!!

30 hours later...

2010-09-01T19:28:00.000-07:00

I am now working in the hospital on the Pediatric floor. We have been super busy and yesterday completely filled the unit. 16 beds were full and our two over flow beds were filled as well. The attending physician stayed way late to help discharge two patients to free up some beds. I was on call last night and helped fill those two vacancies. We were busy with a full unit and then got called to the ER around 1AM to see a patient. This little girl was swollen everywhere, had really bad edema and needed to be admitted. We often get tested about Minimal Change Disorder and I finally got to see it first hand! We had another girl roll in around 3AM and her admission consumed the rest of the morning!

I get on the shuttle at 5:30AM to make it to morning check out around 6AM
See patients and then have morning report at 7:30
Round on patients until lunch
In the afternoon we check up on patients (and I had an interview with one of the program directors)
Check out to the night shift at 5:00
I stayed on with the night shift - was kept busy all night.
Quick cat nap from 4:30 - 5:30 - had time to prepare for morning check out
Morning report at 7:30
Round on patients until lunch (luckily we ended a little early around 10:45)

I was then allowed to go home to sleep. I slept for 4 hours and forced myself to get up so I would still be tired to sleep tonight! Being on call is rough!

I got my Step 2 score back!!! It's the last graded exam of medical school!! I'm happy with my score and I'm done with tests for the rest of the year!!!!! WAHOOOOOOOOOOOOOOOO!!!

Halfway!!

2010-08-29T09:35:00.000-07:00

I have reached the halfway point on my San Antonio journey. 2 weeks down! 2 weeks to go! I learned a lot working in the clinic these past two weeks. I saw a number of different things, got a lot of experience with sport's physicals and hopefully made a good impression. I learned a lot, but most importantly realized that I love working in the pediatric clinic as much as I remembered from last year. Now it's on to the wards - I will be working in the hospital on the pediatric ward for the last 2 weeks. I'll be up before the sun everyday for the next two weeks.

It's not really fair that once the weekend arrives I'm totally commitment free and can do as I please. Not fair because Leisy is stuck at home with two demanding children that won't leave her alone for 2 minutes. Not fair because I don't have children to wake me up at night. It's just not fair. I wish I could fly home every Friday night and give Leisy a reprieve from Motherhood. She is doing a fabulous job and I can't imagine anyone who would do better without a husband for weeks and weeks.

This Saturday I went and saw the world's largest pair of cowboy boots. These puppies are 40 feet tall and 35 feet wide. Their official name is "Giant Justins" and were built in 1970. I was trying to get a good shot with me and the boots, but becuase they are so big I was having a hard time capturing the shot. Some nice people took pity on me, pulled their truck to the curb to jump out and snap this pic. (Leisy would have been mortified!!)

I also went to the McNay Art Museum. It is a beautiful mansion that has been converted into a museum. The grounds are vast and have fountains and all sorts of sculptures. The back of the mansion is an extension of the museum. It has a lot of really cool art including some Monet, Picasso, O'Keeffe and other big names. There is also a lot of funky modern art like the exploded tire below. I loved walking through the house and the inner courtyard. This place also charges $8 a person and might be worth it, but I got in free because I am active duty military!!

Sorry Leisy that I can't jump on a plane and come home on the weekends. It doesn't make it any easier for me to be gone when I get to go do fun things without you. Really this weekend was boring and I would much rather be at home with you!!

A few self portraits

2010-08-25T18:30:00.000-07:00

I got a package!! It really feels like I'm on a mission when I get a package full of goodies! Not only that, it took about a week to get here. Who would have thought the mail would take so long to get to me on base. Thank you Mom and Family!! I stuffed myself full of pistachios!!

In my attempt to see as much as San Antonio for free, I paid a visit to the San Antonio Museum of Art. It's a big museum and fairly close to the Alamo. They charge eight dollars to get in ($8?!?!) but Tuesday evenings are FREE!! I would only have to pay $5 with my military discount - but $5 is too much for this museum if you ask me. On the fourth floor they have a walkway that gives a nice panoramic view of San Antonio.
I only have 2 more days of the pediatric clinic. I still really enjoy the clinic. Most people either hate it or love it. I start working on Inpatient Peds at the Army base next week. I have really enjoyed the hospital being 2 minutes from my bedroom. Now I have to catch a 30 minute shuttle to work in the mornings. blech...

Mormon Mafia

2010-08-22T18:33:00.000-07:00

I first heard of the existence of the so-called "mormon mafia" when I was applying to med school. Interviewing can get really expensive, with airfare, hotels and rental cars. If you can connect with someone in the church they can save you a lot of money and provide you with valuable info. Like when I interviewed in Toledo - I had a ride from the airport, a place to stay (thank you Andrew!) and was immediately put in contact with several other mormon med students (including one on the admissions committee) who could share experiences and what they liked or disliked about the program. Once I was accepted to med school, I became a part of the "mormon mafia" and helped similarly strapped-for-cash interviewees.

I discovered today at church that the "mormon mafia" is even bigger in the military. As soon as I walked into the chapel I was greeted by a member of the bishopric. He found out why I was here and he introduced me to one of the pathology residents, who introduced me to one of the pediatric residents, who introduced me to a pediatrician who just graduated from the program I'm interested in, who also knows the program director of said program who just happens to be the Bishop in his ward. (phew... follow all that?) My phone was soon full of new contacts with e-mail addresses, telephone and pager numbers. All these people were more than willing to answer any questions I had and made sure I could contact them if I had any more.

It looks like I choose a good ward to attend on the first Sunday here. It is full of young families in the military. Most of the residents from Wilford Hall attend this ward. They welcomed me and all asked about my wife home alone with two toddlers. Many of the wives here can empathize with Leisy being all by herself right now. It's hard! Especially on Sundays. Love you and miss you жена моя.

The Alamo!!

2010-08-21T14:27:00.000-07:00

For my day off today I explored some of historic San Antonio. I made my way into downtown starting at the Alamo. (I, like Pee-wee Herman, was devastated to discover the Alamo has no basement!). I refused to pay $10 for parking so drove a few blocks away to find free parking. I had one hour to tour the Alamo and part of the River Walk. I moved fast and kept thinking of my parents trailing behind me when we were touring Brazil. It's a good thing they weren't with me today because there was no way I was paying for a taxi! ;)

I then drove to the other four Spanish Missions: San Jose, San Juan, Concepcion and Espada. I made it to all of them without GPS. I'm not sure if my in-laws would believe I didn't get lost once - but I did fairly well. I'm directionally challenged so exploring new places is good for me. Maybe it's Leisy's giggling that distracts me and when I get lost she giggles even more. It's a downward spiral. Downtown San Antonio is a busy place. It looks like there is a lot of fun to be had, and a lot of money to be spent. I'm determined to see as much of it and spend as little as possible. I don't like spending money all by myself.

Info on the Five Spanish Missions

Check out the rest of my pictures on facebook.

Back to School!

2010-08-20T19:47:00.000-07:00

School starts on Monday for most of the kids around here. That means we did a lot of back to school physicals in the clinic today. They had the whole clinic set up this afternoon with various stations to get things checked off before seeing the doctor. The hallways had footsteps leading to each station (vitals, immunizations, vision screening, etc.) It was really fun to sit and chat with the teens going back to school and find out what sports they were involved in and what they were most looking forward to. It's nice that they give me 30 minutes with every patient! I can actually get them to open up. One 17-year-old after his visit was over said to my attending, "Are there comment cards anywhere, 'cause this guy is da'bomb!" It kind of made my day.

I have the whole weekend off. I hope to explore San Antonio and find some cool stuff to do. I found a site that had a list of all the free things to do while in San Antonio. I may be going to Catholic Mass if time allows!! One week down. I'm sure it felt much longer to Leisy than it did for me. I have stayed busy. Weekends not working away from home make the time drag by. I miss Leisy and my boys!

First full day!

2010-08-18T18:54:00.000-07:00

My Day:

Morning report and lecture - 0730 - 0900
Interesting case of a 5-year-old with unilateral facial droop. Stroke? Bell's Palsy? She had a crazy rare inoperable brainstem tumor. Rare and very poor prognosis.

Joined the NICU team rounds - 0900 - 1130
Quadruplets were among the little ones we rounded on this morning. All have feeding issues and are fed with a tube that goes into their stomachs. They are going to let them try to feed on their own soon. The little tiny ones are so fragile. It seems like a different world in the NICU.

Lunch
In keeping with local customs I decided to try these cup fruits that were all the rage. A nurse came and asked us for orders. The attending was almost jumping up and down he was so excited. An assortment of fruit with lime juice and chili "spices". Interesting. When my fruit cup arrived it looked strange enough to be good. I nearly threw up a few times with the first bite. Not what I was expecting. It somehow robbed the fruit of it's sweetness and left a nasty, spicy aftertaste in my mouth. But I kept eating... Nothing better than a bowl full of fruit. I just pretended the spices weren't there.

Afternoon peds clinic 1245 - 1600
I had my own office with a computer and a patient bed. It was awesome. I would go out to the waiting room and call the patient back. The nurses had already triaged and got vital signs. I have 30 minutes with the patient before I present to the attending. Then the attending comes in and we see the patient together. I love working with kids. I love teaching parents about their children's illness or development. I'm so excited to be a pediatrician. Now I just need to learn how to be a good one!

Exploring, workout and studying 1600 - 2100
I got off base tonight and explored a little more. This is a such a different place. It's unlike anywhere I have ever been. I'm excited to get into down town and explore some more. San Antonio is huge. I love having free membership to a gym. Such a stress reliever at the end of the day! Time to hit the books.

The Lone Star State

2010-08-17T18:03:00.000-07:00

Howdy from the great big, hot state of Texas!!

It was so hard to leave my family on Sunday! I had to choke back the tears as I waved goodbye to Leisy, Zeb and Ike from the window of my airplane. I was in full uniform and I didn't want everyone to think I was leaving to Iraq for several months. I'll only be gone for 28 days! However, with only three behind me 28 seems like an awful long time.

I was so nervous about putting my uniform back on. What if I wasn't wearing it properly? What if I forget to salute someone? What if I get yelled at for not doing something properly??? But once several people in the airport thanked me for my service I remembered how much this uniform represents and how lucky I am to wear it. People stepped out of line to shake my hand, or to tell me good job, or just to tell me how beautiful my family is. Tonight after a busy day of running around trying to get proper computer access and security clearances for both hospitals, I stepped out of my car just as the National Anthem started. I stood at attention and saluted all alone in the parking lot. A sense of pride filled me, and I realized again what an honor it is to wear a uniform that represents the courage and bravery of so many Americans.

I'll be rotating in general peds and pediatric infectious disease while I'm down here. The San Antonio program is a combined Army/Air Force program. I will spend half of the time at Wilford Hall Medical Center and the other half at Brooke Army Medical Center. The docs I will be working with are all really cool. I met most of the pediatric team this morning at morning report. One of the infectious disease docs is Mormon! He seems really cool but will be leaving to Haiti next week so I won't get to work with him. (If I stay in the Air Force long enough I may be able to go on several mission trips like he has!!) I am anxious to actually get started now that I have been here doing nothing but busy work. I'll spend tomorrow morning in the NICU and the afternoon in the peds clinic.

WHMC (Left) BAMC (Right)

The heat is super intense. Everyday is over 100 degrees. I'm not sure if Leisy could live here during the summer. She may need to take extended vacations if I end up here!! Yikes!! San Antonio does seem really cool and has a lot of fun things to do for visitors! I'll go check out the sites this weekend. The Alamo, the famous river walk, Sea World maybe??? Anybody been to San Antonio and can suggest cool things to see?

2010-02-11T19:40:00.000-08:00

A 66 yo white female presented to the urgent care with 10 days of of increasing pruritus (itchy skin all over), yellowing skin and white part's of eyes, and pale stool. She is admitted to the hospital because of jaundice. The patient has felt fine and her only complaint is being itchy. She has no past medical history and has never been hospitalized in the past. She has never had any history of gallstones, hepatitis or cirrhosis. She had never smoked and rarely drinks alcohol. Physical exam is essentially normal except for discoloration of skin and scleral icterus. She had no abdominal pain on exam. She had tons of labs done but I'm just including LFT's:

Results	Units	Reference Range
	TOTAL BILI	7.2 H	mg/dL	.2-1.2
	DIRECT BILI	4.8 H	mg/dL	.0-.3
	ALBUMIN	3.1	g/dL	3.1-4.7
	ALKALINE PHOSPH	816 HH	IU/L	40-125
	ALT (SGPT)	305 HH	IU/L	4-42
	AST (SGOT)	257 H	IU/L	10-39
	TOTAL PROTEIN	7.3	g/dL	6.0-8.0

Which of the following diagnoses is most probable and which, if present, has the worst/best prognosis?
A. Choledocholithiasis
B. Pancreatic cancer
C. Klatskin tumor
D. Liver cirrhosis due to a combination of hep B and C
E. Gallbladder cancer

Amazing!!

2010-01-16T04:39:00.002-08:00

Toledo Dr. will take team to Haiti for help

Dr. Paat is one of the amazing doctors I have had the chance to work with out here in Ohio. He is such an incredible person and a great physician. He is a great example to me. I wish I could drop everything and head to Haiti right now!! ($20,000 just lying around wouldn't be bad either). Click the link and watch the news report. He is an awesome guy.

My pediatrics rotation ended before Christmas break and I already miss working with little kids! I'm now on Internal Medicine for the next three months. My first 2 weeks of outpatient clinic have flown by. Time is marching steadily on and I am freaking out trying to get all of my military rotations scheduled and lined up for this fall. I'm trying to get everything squared away before I start working in the hospital in February. I'm going to be working longer hours and won't have extra time to work on scheduling rotations.

I have been working in a general internal medicine clinic, an infectious disease and nephrology clinic. One of the biggest signs that I was no longer working in Pediatrics was the difference in "prizes" people get at the doctor's office. Little kids get to look through baskets of toys and stickers after they see the doctor. Some age groups actually get books after they have seen the doctor! I loved finding out what the kid's favorite cartoons were while I examined them so I could hand select the books! Adults in the infectious disease clinic get baskets full of condoms to look through. They are just sitting on the table in a little basket identical to the baskets that used to be full of stickers! They're just hanging out in all of their crazy varieties: all sorts of flavors, glow in the dark, his'n'her pleasure and MEGA!! At least in adolescent medicine they were discreetly hidden in a jack'o lantern trick or treating bucket.

Another major difference between pediatrics and adult medicine has been dealing with patient's apathy about their health. Most little kids want to get better, and if they don't their parents sure would like them to. Adults, after some predetermined age, no longer care about their health. Taking care of one's health just seems to be too big of an inconvience after some mysterious time. I saw a guy with end-stage kidney disease, COPD, high blood pressure, elevated cholesterol, congestive heart failure, depression and a myriad of other problems. We were meeting with him to discuss why he couldn't breathe at night when he lays down to go to bed. He wanted that fixed but seemed irritated when he was reminded that he has been delaying kidney dialysis, gained 20 pounds since his last visit, and wasn't taking his medications like he should!! I need to discover a new perspective during this rotation. How am I going to find the desire to help those who aren't willing to help themselves??

Good intentions...

2009-10-15T16:23:00.000-07:00

So much for my attempt to keep everyone informed about my clinical experiences!! Things got SO SO busy with the ER rotation. I was working all sorts of crazy hours and trying to study for a ridiculously difficult test. I had no time for anything!!

Family Practice! Much, much better! I was starting to wonder if I had gone into the wrong career, because I was not loving my time in surgery. Thank goodness I am loving Family Practice - there is something about medicine I really do love. I actually get to talk to patients!! (ER was really fun as well, just busy). I have met some great people and have been able to see a lot of different things. I love it so far.

I am, however, realizing that some people take their health about as serious as I have taken to updating this blog - not at all! Some people just expect other people to do the work for them. (I'm glad Leisy keeps up the blog so well!) Some people just want Dr.s to fix them, but aren't willing to actually do anything about it; they don't want to take their medications, don't want to monitor sugar levels or BP, and forget about diet and exercise!! Just fix me doctor!!

Long, long week

2009-08-23T18:45:00.000-07:00

My long week was topped off with a Sat to Sun 24-hour call. I accumulated 84.5 hours this week - it's amazing they make us pay tuition to work this much!

While I was on call I was able to work with a resident who was covering surgery from multiple services. This means I got to see surgical issues outside of bariatric surgery. A lot of elective surgeries are done on weekdays, so I wasn't in the operating room as much as normal. I only saw one surgery. It was a neck lymph node excisional biopsy of an AIDS patient who probably developed lymphoma. AIDS is a devastating disease and wrecks havoc on the body. I'm not sure what it is about infectious disease that fascinates me, but I was enthralled with this man's case. I read through his chart (which was basically a novel), and was able to review several infectious agents and the diseases they cause (Cytomegalovirus, Mycobacterium avium, Cryptococcus neoformans, and many more). AIDS completely destroys the immune system leaving its victims vulnerable to all sorts of crazy infections. It is an infectious disease doctor's dream... or nightmare... patient.

I spent most of my 24 hours in the ER working with Traumas and potential surgery candidates. As a student I basically collect the patient's history and perform a physical exam. I am able to formulate a diagnosis and a plan of action, and then present that to the resident. The resident then assesses the patient and changes or confirms my diagnosis and plan. This has been far more exciting for me than standing in surgery for hours at a time holding a retractor or camera. I love talking to patients, seeing the clinical manifestations of disease, and figuring out a solution to solve the problem. Actually fixing the problem (at least surgically) has been less exciting for me. I guess I'm not intended to be a surgeon...

We only had one trauma last night that was very minor. I guy was loading a scooter into a truck and it fell on him. As the trauma team assessed his condition I was able to help by cutting his clothes off, putting in a foley catheter, and cleaning up his wounds. I really enjoyed my night in the ER and I'm excited to spend the next month there. I'm really just excited to see new cases that don't involve surgically altering people's stomachs!

Surgery continues...

2009-08-16T18:45:00.000-07:00

I'm half way through my general surgery rotation and counting down the days for it to end. I'm really not loving it and I'm not sure what is wrong with me. The hours are insane and the residents and surgeons are some of the most self-centered, unfriendly people I have ever worked with. If this rotation is a true glimpse into the life of a general surgeon-then count me out!!

I am currently working with a bariatric surgeon. I see lots of gastric bypass surgeries and a lot of complications from previous lap band surgeries. Almost all of the patients I have been working with are morbidly obese and the doctor I work with treats obesity strictly as a disease rather than a result of lifestyle. This perspective has been interesting, but not one I fully embrace. I do believe that certain people are more prone to weight gain than others, but to call it a disease seems strange to me.

Obesity is one of the leading preventable causes of death worldwide and is viewed as one of the most serious public health problems of the 21^st century. A lot of health problems are directly associated with weight: particularly heart disease, type 2 diabetes, sleep apnea, certain types of cancer, and osteoarthritis. People eliminate a number of health problems simply from losing weight. I was reading about obesity as a disease and came across "treatments" for this disease. The primary treatment for obesity is dieting and physical exercise. If this fails, anti-obesity drugs may be taken to reduce appetite or inhibit fat absorption. In severe cases, surgery is performed or a lap band is placed to reduce stomach volume and or bowel length, leading to earlier satiation and reduced ability to absorb nutrients from food.

These seem more like weight management options than disease treatments. In my opinion people have chronic diseases because of weight and not the other way around.

Seeing the surgery side to losing weight has left me disappointed. Surgery isn't the best solution in my opinion. I have seen far too many complications from bypass surgery, eventual weight gain after initial weight loss, and chronic problems from these surgeries. I feel like people choose to undergo surgery before they have exhausted other resources. I saw a surgery performed on a 21 year old! The doctor I'm working with feels like he is curing obesity by doing these surgeries. I think it is wonderful for people who use the surgery to lose weight, get off diabetes and blood pressure medications, and make a complete life style change. However, I have seen too many people who don't do these things and end up worse than they were before surgery.

These two people are heroes around here, and have proven that weight loss is possible without surgery. Mike and Ron from the biggest loser visit Toledo, Ohio!! Click Here!

Babies, Bagels and Bloody Bowels

2009-08-09T14:42:00.000-07:00

My pediatric surgery rotation ended last week, and I am quickly finding out how spoiled I was. My new rotation in general surgery is going to be insane. I've been on this service since Wednesday and have worked 53 hours!! I was lucky enough to get Sunday off.

I already miss working with little kids. My last week in pediatrics got really busy and I never blogged about some of the exciting things that happened. Our little preemie who was born at 25 weeks didn't do as well as expected with the drains they put in and ended up perforating his cecum. His X-rays showed a ton of free air in his abdomen - not a good sign. The little one went to the OR as soon as they could get an opening. The surgeon didn't know exactly what was wrong but knew he had to operate because of the X-ray. This was going to be an exploratory abdominal surgery to find out what was wrong. Can you imagine an exploratory surgery on a 25 week preemie?!? This little kid would consider my two hands held together as spacious. This whole experience was surreal. Half way through the surgery I thought I had entered a really bad dream. Here was this little tiny creature with a hole in his belly and little iddy biddy bloody intestines spilling out all over the operating area. They found the defect and sewed the ascending colon to the ileum and began to put him back together. When I left the hospital that day I ran into the parents in the elevator. They were anxious to hear any additional insight into what took place. The mother started crying when I told her the surgeons were very pleased with the outcome. It made me hold my boys a little tighter when I got home that night. I'm so lucky to have such healthy children.

There were plenty of other surgeries during that last week: Intussuception, volvulus, appendectomy, hernia repairs, circumcisions, and the most heartbreaking - perianal wart excision of a 2 year old. These weren't just a few warts. These were finger like projections sticking out of the girl's bum. I don't even want to imagine diaper changes after the surgeon was finished with her. This case almost made me consider becoming an advocate for the HPV vaccine. "One less, one less"

My diet during the pediatric rotation consisted of a lot of bagels. They always had free bagels in the resident's hall. Whenever I had a chance, which wasn't often, I would run up and grab a free bagel. I discovered the free PB and Jelly from the cafeteria condiment bar worked great on the free bagels! PB&J bagel sandwiches!! No free bagels at my new rotation. :(

PICU

2009-07-25T14:44:00.000-07:00

If I spend any more time in the pediatric intensive care unit (PICU), my kids won't be able to do anything fun when they get older! I can't believe how many kids have been seriously injured from ATV accidents in the short 2 weeks I have been there. I don't think I want my kids on ATVs - ever. They are very fun, but even with the proper equipment a simple accident can turn deadly.

So kids, stay away from ATVs, avoid climbing on washing machines, always wear your seat belt, and watch out for mom's abusive boyfriend. Those are just a few of the reasons I've seen that put little kids in the ICU.

This week has been slow as far as surgeries are concerned. We have a lot of sick patients to watch closely. If things get worse for any of them they get rushed to the OR. The only surgeries I saw this week were hernia repairs in little tikes. I was prepared to see a pyloric stenosis correction but it was canceled because the baby had an electrolyte imbalance. They will probably do that surgery on Sunday when I'm off. No call this weekend - hooray!

First week finished

2009-07-19T07:44:00.000-07:00

With a 24 hour call last night, I spent 79 hours at the hospital this past week. Students aren't to exceed 80 hours in one week, so I guess I had an extra hour to spare. This week has been a rude awakening to clinical medicine. I'm not used to working 11-12 hours everyday!! I've been so tired all of the time. It's too bad I don't drink coffee because I really needed it this week. I'm sure I will acclimatize, but right now I am exhausted.
I've been able to see some really cool surgeries. This week I was introduced to laparoscopy. The surgeon can put a camera into the abdomen and do an entire surgery through tiny openings in the skin! It is really cool to see everything done on the screens. I was assisting with the camera during one surgery and half way through the Dr. asked me to go clean the camera on the kid's liver. So I navigated the camera to the liver, wiped the camera a few times against the liver, and came back down with a cleaner view. It was super weird to clean a camera on somebody's liver.

I saw an appendectomy, repair of a belly button so urine would stop leaking out of it (Urachal cyst), insertion of an abdominal drain in a preemie baby (born at 25 weeks), and insertion of a subcutaneous port. The subcutaneous port is a cool device that allows medicine to be injected directly into the heart without a needle stick in a vein every time. This is helpful in people who get a lot of shots: chemotherapy, regular transfusions, etc.

Surgery

2009-07-13T16:44:00.000-07:00

My second day in the hospital was so different than my first. Friday was absolutely crazy! I scrubbed into 4 different surgeries and was running around the hospital all day. For now during surgeries I mostly just watch. Occasionally I help retract things or cut sutures and eventually I'll be able to do more.

Today our attending physician had to go to a different hospital for a complex surgery and left my resident with nothing to do - which left me with nothing to do but study. I'm so glad I decided to pick up some books this weekend. The hospital downtown is really nice and has been a lot of fun exploring and finding my way around. So far I have learned that I really love being in the hospital and I love seeing patients. I'm really glad I get to start with pediatric surgery and have these experiences to compare to working with adults well before my actual pediatric rotation begins later this year.

On Friday I met my resident who grew up in the Bahamas. He's the guy that I will be spending all of my time with over the next four weeks. He's a really nice guy and will be a lot of help. He seems willing to help me learn and is patient when I have no idea what is going on. I chased him around all over the place on Friday. I saw a circumcision, an umbilical hernia repair, an omphalocele closure, a neck abscess drained, and pancreatic ascites fluid drained. We bounced around from patient to surgery to patient and back to surgery. We also saw a little girl who had fallen out of a first story window and hit her head. The CT scan came back normal but they kept her overnight for monitoring. The little premature baby with Beckwith Wiedemenn syndrome is a sad case. He was born with all of his guts hanging out of his belly (the omphalocele closure I saw in surgery), a huge tongue that won't fit into his mouth, and severe hypoglycemia. He has had his guts suspended above him for the past week to prep them to slide back into his abdomen. Friday I saw the doctor sew them back in. It is crazy to see this little tiny body with a surgeon's hands inside it's belly.

Today was so slow. We rounded twice, saw all of our patients and created their plans for the attending to approve, and then sat and waited for him to return from another surgery. While sitting and waiting I was able to get a lot of studying in. We did get a new patient - a 6 year old boy was riding his dirt bike off jumps and crashed directly onto his handle bars. He looked and acted fine - just had a bad stomach ache. The CT scan was super impressive. It showed a huge liver laceration. On a scale of 6 - he was nearly a five. Level 6's are so serious that people with those types of injuries usually die before they can make it to the hospital!! He is in bad, bad shape but it isn't physically apparent. His parents were convinced he had a small tear on the liver that was of little consequence. We had to scare the parents to let them know how serious his injury really is. They have not been very successful in helping their son comply with the Dr.'s orders.

6AM - 6PM is a long day. I was spoiled in school to have one hour lunch breaks. I realize that eating is a privilege. If I have a chance to eat I need to take advantage.

More orientation...

2009-07-09T16:59:00.000-07:00

While all the other students got to start working with patients, all of the students on surgery had an additional two days of orientation and lecture. These days have felt even longer than the first two days of orientation. We have had all kinds of lectures: Sepsis, Suturing, Postoperative care, Urology, Breast cancers, Skin cancers, Thyroid cancers and others. We also did some fun things throughout the two days: We were given a complete tour of the hospital, practiced scrubbing in and gowning up, we were able to practice suturing on pig's feet, and they had a number of different procedures for us to practice. Some of the required procedures I must experience before successfully completing this rotation are starting IVs, placing NG tubes, and Foley catheters. They also showed us how to place a chest tube (something we won't have to do yet). I'm sure Mom will just laugh when I say how daunting these procedures are going to be! I have never even given someone a shot and I have to start an IV?? Not to mention thoroughly cleansing someone's nether region to shove a tube up his or her urethra!! I wish I could come to work with you for one day Mom and just do procedures with you assisting me.

The hospital attached to my school doesn't have pediatric patients. I selected pediatric surgery for my first rotation so I will be at St. Vincent's which is a hospital downtown. I start tomorrow at 6 AM!! I have mixed feelings. I am super excited but exceptionally nervous. It doesn't help that I've never been to this hospital, don't know where to park, and will have to wander the halls looking for some lady named Karen who will teach me the scrub in procedure for their hospital. And I don't know how I feel about working with surgeons. During one of our lectures today one of the surgeons told us we went into medicine only for the money or we would have chosen another way to "help" people. He went as far to say that if any of us choose family medicine or pediatrics we might as well learn how to change the oil in our cars so we won't have to pay someone to do it. The stereotype of the arrogant surgeon has already reared its head. Tomorrow I find out who I'll be with for the next 4 weeks and I can only hope he or she isn't as bad as the one who taught that lecture.

I promised myself this blog wouldn't be super negative - I don't mean to complain constantly. I did come home to a wonderful dinner and some amazing kids. My boys are growing up too fast!! Ike is huge - I want that little tike who could curl up on my chest. I was in charge of putting him to bed and Leisy took care of Zeb. When I went to put Ike in his crib the bedroom door wouldn't open!! Zeb had gotten out of bed to play with his toys and totally crashed next to the door. I had to wait for it to get dark (or he wouldn't have stayed asleep) before I roused the boy to get him back in his bed. Silly kid.

Paging Dr. Miller...

2009-07-07T16:40:00.000-07:00

My introduction to 3rd year wrapped up today. The orientation consisted of two long days of many presentations by Doctors, Nurses and PhDs explaining various aspects of what will be expected of us as students. I'm really excited to get on the floors and "start touching" patients (as one of the presenters worded it). I'm really nervous about being thrown into the middle of everything and expected to perform. I imagine it will be like jumping out of a moving vehicle and trying to run fast enough not to fall. (I've successfully done this many times but my Dad may remember the time I wasn't so successful at staying upright. Let's hope I don't incur road rash during my surgery rotation!). Topics covered writing orders, working in sterile fields, review of the physical exam, review of generating a working differential diagnosis, dangers of spreading germies (like C-diff) from patient to patient, how to access (and keep private) our patient's electronic records, intro to the radiology department, review of heart murmurs and ECGs, many many many more presentations, and to complete the day a (graphic) video of how to insert a foley catheter.

The orientation was officially over when we recieved our pagers!! Every student was given a pager to carry with us wherever we go. I guess I'm officially on my way to becoming Dr. Miller. At least I will be able to pretend to be Dr. Miller for the next two years.