Mile 24318: Call me Erwin

Above: Graham crackers are in ready supply on the surgery floor.

"ERWIN... JOHNNY...

ALMOST."

- My attending on a fellow medical student calling me by the wrong name.

Last year, during my Internal Medicine Rotation, I found myself eating a horrible breakfast a lot of mornings when arriving at the hospital.   However, it was the most easily accessible: potato chips and cups of juice (that in truth were only 10% juice) stared right at me in the resident's lounge.  It was a terrible combination. Well, during my Anesthesia Rotation, I've gotta say that I worked on it. I'm getting more nutritious by keeping my energy levels high through Graham crackers. These wonderfully available packets (above), kept me going through taking patient histories, inserting LMAs, and following through with patients in the post-op room.  Pretty potent for a small packet, I may say.

And here I am, after a full sixteen weeks of Surgery, currently in a 2 week break before hitting the road to Columbus.  As much as I'm not going to go into Surgery, the folks at St. Anthony have really taught me an appreciation for it (with or without the graham crackers).  I'm not going to forget how the masks and scrub uniforms on the nursing staff made people look completely different than when seeing them outside of the hospital.  That perhaps led to my last nickname, Erwin, when a fellow medical student couldn't come up with my name.

Erwin... It works.

However, my last four weeks in anesthesiology were quite interesting.  Originally, my perception of a day in the specialty consisted of placing some tubes and watching the patient as they fall asleep, then waking them up, and you're pretty much done for the day.  I ended up seeing their jobs are much more important then orignally thought, making me appreciate the rotation much more.  If you think about it, just a couple ounces of anesthesia, if placed into the wrong part of the body or if dosed wrongly could put the patient in danger.

I've talked about the "art of medicine" before from my perspective, as much more of a clinical thinking concept, but the "art of medicine" in Anesthesia I saw was one of procedure.  Many of the procedures, such as spinal or nerve blocks, or even the classic intubation require a lot of muscle memory and hours of practice.  Everything they do needs to be accurate and precise, or a lot of wrong could happen.  But it doesn't.  The doctors and nurses in the anesthesia department at St. Anthony were pros at their jobs.

And with that, I'm entering back into the realm of medicine, and taking a Cardiology elective at Grant Medical Center in Columbus, OH.  This is the start of the last big road trip I will make during my medical school career, and the start of the last three rotations ever.  My journey through medical school has been amazing so far, it can only get better toward the end.

Mile 23344: Shortie: A Steaming Summer

Above: I get double dared both on paper and in person on the surgical ward. This is the paper version.

I'M 8/10 IN USING MOTOR SOUNDS
TO KEEP BABIES HAPPY.

Well we jumped the 20000 mile mark just about a month ago, during surgery. However, studying for the big Step 2 CK exam which is coming up this month, so time has been limited to write. That doesn't mean that the writing is over. I finished my surgery rotation a month ago, took 4 weeks off to study, and right now am back in business with doing an anesthesia rotaiton here at Saint Anthony Hospital in Chicago, IL.

This is just a quick note to say I'm alive and I'm still counting miles (we're quite up there right now).

The summer has also brought some unexpected surprises.
- I'm now a Godfather to a beautiful baby boy, Joshua. I attended his baptism in June. He loves motor sounds. However, little did I know they only work on most babies. I learned that fact quite quickly at the baptism.
- Old Silver is now New Blue... Long story put short, my old 2002 Ford Focus needed to be retired, so a 2012 is now my new mode of transportation. However, my mile counting still sticks dead on the dot accurate mile for mile.
- It's match season, so applying to residencies is in play currently.

Another surprise: this summer has just been plain hot. And I'll be honest, with all this work to do, it's tough to get out there and enjoy it. However, I believe that work will pay off. And I certainly hope it does. More soon.

Dry Bones

"ORGANIZE YOUR THOUGHTS... THINK SYSTEMATICALLY."

Week 2. Right now, I’m typing this entry on the our hour-long ride back to Portsmouth. I usually spend my morning ride looking over some board material, while on my way back I usually end up falling asleep after a long day at the hospital... thus, risking my head falling over and plopping on top of one of my friends shoulders. However, I got some stuff on my mind, so I decided to take the time out to pre-blog.

On my mind this week are our rotations in Anesthesiology. Right now, the job seems to be exactly as I had painted in my head: come in during the beginning of a surgery, do some needle poking, talk to a few nurses, check that the patient is responsive to the treatment, and then head out the door to perform the treatment on another set of patients… Perhaps its just the Dominican way of doing things?

Remember that picture I painted of Princess Margaret Hospital last time? Little did I know that beginning my work in the Operating Room department would be so completely… different. The operating room facility is located in the same building where we have our fifth semester lectures, but on the second floor. Outside, it’s a giant cold-looking white colored building, with a tin-sheetmetal roof. To get to the operating room, we need to enter two glass doors, with their glass panes painted over in white. However, after entering, it literally is a different world. The décor features modern pastels, modular plastic cabinets, a standard glistening white floor, and most importantly updated and modern equipment. According to the poster located in the hallway to the three different operating rooms, the site was remodeled in 2001 (in fact the ICU I visited last week was in the old set of operating rooms).

Anyway, back to what I was thinking. Our rotation group was standing in our scrubs, gowns and caps in front of a patient about to undergo an obturator nerve block in preparation for removal of his medial meniscus ligament in the knee (The Dominican's looove their Cricket). Our attending Doctor looked me directly in the eye and asked me, "Tell me everything you know about Propofol." So I started saying, "Well its quick acting, and used to initiate anesthesia, and its better than Thiopental..." and he stops me saying:

"That's right, but ORGANIZE YOUR THOUGHTS... THINK SYSTEMATICALLY."

Remember that childhoold song, Dry Bones, which goes: "The toebone is connected to the anklebone..." and so on and so forth? I remember singing - and annoying the hell out of my classmates -with that song all the time. Well, medicine - even the hardest stuff - can be thought of in that manner. A good example in Anesthesiology goes like... "The Haloflurane goes with the Succinylcholine to make 'Malignant Hyperthermia' which results in Metabolic Acidosis, Accelerated Muscle Contraction, Tachycardia & Hyperthermia."

(Now try to sing it to the tune of the aforementioned song!)

Okay, medical blabber to some of you, but to me it makes complete sense because the logic is there! The point is Everything in medicine links together. I believe that's one of the best parts of medicine, its a never-ending web, but the essence of it can actually be captured by categorized, systematic thinking... Organized thought makes going through the "files and files" of thoughts in your head easily accessible in one sweep. Imagine disorganized thinking: it's like trying to find a needle in the haystack... Well, I still need to get acquainted with this way of thinking, but I see this as the reason why your doctor can just look at you and tell you what's wrong with you with the snap of two fingers.

Now don't be amazed if I shoot medical thought blabber at you next time I see you... you can always shoot the lyrics to Dry Bones in return back at me... We'll call it even.