Mile 14020 + 2482.6: Main Street

Above: Americana at its best. The aluminum-sided diner on a business-lined Main Street. Red Robin Diner, Johnson City, NY.

BACK TO THE
BIG CITY LIFE.

... more on that in a bit.

My four weeks in February were my first four weeks ever in New York. And to many people, when I mentioned that I was in New York, the first thing they ever thought was "New York City." And I was like no, there's more to New York than NYC. But I can understand, with NYC's metro area being almost twice the size of Illinois as a state itself in terms of population, there can't be much more. But to me, a traveling Midwesterner, I had to explore the world of upstate NY for myself.

So after four-weeks in the flat-land of Decatur, I found myself in Johnson City, New York. It was quite a change, being amongst the hills of the Appalachians, but I found it quite enjoyable. A part of me wished I could ski, so I could go up and take advantage of the hills, but I'll be honest, the beauty of the area was just awe inspiring. It was my first time to the Northeast ever, but the hospitality of New York State made my stay quite memorable (not to mention having someone at church giving me a genuine hug before a week before I hit the road!). Binghamton was one of the cities that had a culture and identity of its own while combining a small-town feel into the variety of things to do in a bigger town.

However, I wasn't there to simply enjoy myself. I had an Internal Medicine Subinternship to accomplish. A new routine had to be learned, but I was pleased I got to work with two groups I had limited interactions with in my past: 1) U.S. medical students - I had some experience with them in OB, but not as closely as I did here. 2) Osteopathic medical students and residents. As for the latter, I took advantage of my four weeks, and got to watch what made them exactly "different."

And to be truthfully, during rounds and having discussions, there wasn't much different there. So I asked one of the residents that I worked with, "What makes osteopathic medicine, osteopathic?" And all of a sudden, I found myself doing a process called "rib raising" on a patient with a ventilator. The philosophy (and forgive me if I get it wrong me being an allopathic student) is to give more room for the lungs to breathe air by increasing the space between the scapula and the spine. A very cool thought. I saw other osteopathic manipulations that involved very fine finger dexterity and sensation that I could only see years of practice mastering. I really enjoyed I could learn something new over the last 4 weeks, as I don't think there's only one right way to master the art of medicine. Somehow we all have an approach that works, and as doctors, we stick to it.

But one thing that I noticed about my 8 weeks on the road, was the value of overnight call. Yes, I would end up tired and pooped after 24-30 hours on board, but then I would realized the value of staying up. To interview patients and get those History & Physicals of unique in-the-middle-of-the-night cases was amazing. I remember in both the ERs of Decatur and Binghamton, I'd stand there at 3 AM figuring out how I should attack the history of a patient. Perhaps it was the novelty or even the academic satisfaction of getting my brain to work at such an early time in the morning. I learned a lot during those hours in the morning, and that's something I'm thankful for.

Now, my drive has brought me to the world of Columbus, Ohio. Where I'm doing ICU. More on how this rotation has a different way of looking at patients in my next entry.

Mile 14020 + 1804.2: Catching-Up

Above: A shot from one of the overpasses at UHS Wilson Medical Center in Johnson City, NY.

The whole last four weeks were both absolutely busy and awesome. So, here's a retrospective entry on a lot I haven't talked about, and we'll get caught up this week (hopefully). Due to the above, I left the odometer at the mileage before hitting the road today.

THE ROADS WEREN'T EXACTLY
FRIENDLY.

My last night in Decatur wasn't exactly just spent packing. I actually went to a journal club that night with a couple of the residents. A few of the discussions that they had really got me thinking. Now, I think that the current debate on how effective kyphoplasty and vertebroplasty actually are on curing pain for spinal fractures is a good one to look at (and right now the best study shows that it isn't). However, the whole time I was thinking... evidence-based medicine (EBM) against basic-science-based medicine. A lot can be explained with pathophysiology, but theoretical doesn't mean its proven. And that's where evidence-based medicine comes in, the proof that theory works (or doesn't). However, a lot of the ideas where studies for EBM come from either come from basic-sciences or practicality. So, in short, they both go hand in hand.

And 36 hours later after I finished in Decatur, I found myself amongst the Appalachian hills of Upstate New York. The trip wasn't exactly the friendliest, as snow dominated my trip on I-86 in Western New York. Some of the roads I passed only had one lane plowed, and I had to make the ultimate winter road trip decision... Take the plowed lane with potholes the size of montana, or the unplowed lane without them. But I ended up in Johnson City, NY safely. My four weeks on the wards of Internal Medicine for my Subinternship were quite intense, but very enjoyable. One of the things I liked about both of my Internal Med rotations (Core & Sub-I) was teamwork that's necessary to keep things running on the floors and in the hospitals. Somehow different combinations of residents, students, and attendings seem to always work out. But as I may have written before, every time I get into a rhythm of things, I have to move on for my next rotation. I can't wait for residency, as I finally can get into a rhythm with my colleagues for a good three years.

Well, I'm tired after a long day of driving... So, more thoughts on my last four weeks on Internal Medicine and on what's going on with my stop in Columbus tomorrow.

Mile 14020 + 638.1: Countrified Conversation

Above: Traffic in today's Decatur Rush-Minute.

YOU NEVER KNOW WHO YOU'LL MEET
AT A COFFEEHOUSE.

Ever since I started writing in this blog, I have always written about what I like about smaller communities. My stay in Decatur (about a medium size city) has been defined by amazing patients, great faculty, and a very intensive learning experience. The city perplexed me with not only having two Starbucks locations, but both locations are within 200 feet of each other (one is located within a Target, and there's a freestanding Starbucks right in front).

As I was studying in the freestanding Starbucks this week, I noticed one of the people that walked through the door looked familiar. That person came to sit down at the table next to me. It was then that everything clicked. I saw that person at the hospital and she was in the family of one of the patients that I saw during rounds. I ended up extending my hand out to that person and introducing myself...

"I don't know if you remember me, but I was at the hospital when..."

Her eyes lit up, and one of those looks where everything clicked appeared on her face. Another person related to my patient in the hospital also sat down with her. He shook my hand. Little did I know that just opening up to them would result in a hour in conversation about health care, patient education, and even stories about health care that either discouraged us or inspired us about the field.

Let me tell you, hearing about the healthcare shortage in rural areas meant so much more from people from the areas themselves than the media. I was hearing stories about how much family physicians were critical for care here in Central Illinois, stories about doctors moving out to urban areas for better support, and how much family practice meant a lot to this family. I really appreciated the open honesty and conversation we had.

They asked me what specialty I was considering to go into. When I told them I was strongly considering Family Medicine, the man held out his hand, and as I grabbed it to shake it, he said, "We need people like you here." The woman then said, "Are you coming back here?" I explained my love for Central Illinois (being a part of the alma mater) and told them that I would gladly come back if they let me back in. We all laughed.

Small / Medium sized cities have always caught my interest. Yes, Decatur may not have everything that Chicago has in terms of lifestyle, but the people are who make the difference in experience. It's not every day that one can run into patients at the store or in a coffeehouse, but its a part of the continuum of care: knowing that one can talk to his/her doctor even outside of the hospital is reassuring to our patients and helps build that patient-doctor trust.

(It was awesome to see that my Iced Coffee Property has some actual basis.)

Mile 14020 + 236.4: The Superdoctor

Above: January 2011. With winter approaching, borrowing our AWD Ford Freestyle was appropriate.

ALWAYS GIVE
150%.

With this entry being halfway-written during my time in OB, this entry will have a first-day feel, but it easily relates to my intial experiences in Family Practice.

All first days of my rotations seem to be just about the same. A bunch of students sitting around a room, some knowing one student more than others, with an aura of silence that surrounds the room. A man in a sturdy, well-pressed blue suit walks in. Wearing glasses, and sporting fine (but well groomed) gray hair, the man definitely has a presence. As he looks around at us, we all fall into a bout of silence. As we look up, a friendly smile develops across his face and he welcomed us into OB.

We then knew we would have nothing to worry about.

During that first day, he was an example of a model teacher. Some of the most inspiring doctors that I have observed during my time in clinicals have a degree of charisma, passion, and love for what they do that really inspire me. One of the most inspiring things about him was his concept of the "Superdoctor." A terrific doctor, to him, is a doctor which can only diagnose & treat conditions after they've occurred. However a "Superdoctor" is able to prevent those conditions from occurring in addition to being excellent at diagnosis and treatment. Education of patients and anticipation of sequelae of diseases are absolutely necessary to pull this off (and something that I hope to learn. He said to always give "150%" to your patients; I most certainly believed him.

And this is one of the places I've seen this has been at my Family Medicine Sub-Internship. This is one of the things I really admire about Family Medicine, the time taken to know the patients and where they come from and their lifestyles. I've seen how knowing a patient can contribute to better anticipation of how a disease may progress (i.e. how to adjust a treatment plan for a patient who has been non-compliant int he past). I've also seen attending physicians and doctors set good examples for educating their patients, spending the time to advise them on what else they can do (than just the medication) to help out with their health.

----

So, I'm sure you've noticed the mile formatting change above. Well due to winter, I ended up in a more "wintry" car for taking this cross country trip, so while my dad uses my car, I get to use an all-wheel drive car to make sure I stick to the road. So, after 14,020 miles in my Focus, it's time to pull these miles on the Ford Freestyle (the +236.4 and counting miles).

Living in Decatur has actually been pretty cool. With the wide range of patients that come to Decatur as a health center, I've met many patients from kids to adults and the stereotypical Midwestern family to the Amish. However, the patient population has been really receptive to the teaching environment, and not to mention patient. I really, really respect and appreciate that. This week, I participated in the resident clinic seeing patients. Next week, I get to spend some time with the interns on the inpatient floors.