Yes, it's been awhile since I've blogged. I lost my motivation during Peds Anesthesia at CCMC and the Thanksgiving holiday season, but I'll try to provide a quick recap.
CCMC was not a lot more down time than Adult anesthesia at Manchester Hospital. I had to compete for procedures with residents from Pediatrics and Denistry. Two intubations seemed like a good day. And that usually required a lot of running around between rooms. At least I was able to read a fair amount and almost finished the Secrets book for Emergency Medicine. I even learned a few things along the way. All in all though, my dexterity got up to speed on adults. The kids were easy and just helped build muscle memory.
The last week of Peds anesthesia I had my Dad and step mother in town, so that kept things busy; entertaining them and showing them a bit of Hartford. It was a very nice visit, but as with all family visits, a bit chaotic.
That led directly into my CICU rotation at Saint Francis Hospital. After my Internal Medicine rotation there, there was a bit of dread over Call nights and scut. Especially since my first and last nights of the rotation were Call shifts. In the end, I think the rotation was MUCH better than Medicine.
I learned a lot more that is relavent to EM about treating AMIs, CHF, arrhythmias, angina and post PCI patients. The faculty Attendings, Cardiology Fellows, Residents and even several of the non-faculty Attendings were great teachers. It was an order of magnitude better than medicine and debunked a lot of the stereotypes about cardiologists being ornary and demeaning. The nursing staff got on my nerves for the hourly calls through the night about mundane lab values or routine changes in vital signs, but even the Call nights were much better.
An added benefit is that I actually had some time to study on my own. I read some UpToDate articlesNEJM issues and some EM articles. It felt like the scut was reasonable (vs. all encompassing) and educational in short.
A good example is my night on CCU. I arrived at 8am Sunday to a pretty full service. The Saturday crew admitted 5 new patients to our service. We divided the patients up and got progress notes out in reasonable time. Then the Resident (moonlighter) and I transferred four patients off our service and admitted three new patients. This took us through about 8pm. I wasn't feeling great so I grabbed a late dinner and went to sleep instead of studying or watching a movie on my iPhone. I was called couple times through the night from the nursing staff but they were easily handled from my Call room. Things got a little crazy in the morning though. We had two admissions come in shortly before we were supposed to sign out to the day team (the normal CCU team of a Resident and 3-4 Interns). I would have normally stayed on as one of the Interns, but like the moonlighter, I needed to sign out get off to another hospital for my new rotation. By the time we got finished examing the new patients, getting histories, putting in orders and filling out the History & Physicals is was way past signout time.
I arrived at Hartford Hospital around 9am and thankfully the Psychiatry Attendings were understandable. I had a quick introduction and they sent me home to rest up post Call.
Now I'm off to two weeks of Psychiatry. Staring with a crazy day tomorrow. I have three hours of Psych evals, then a meeting regarding my scholarly project on the new EDIS implementation, then four hours of conference lectures, then a meeting on updating our International EM web pages, then swimming at the JCC with the boys, and finally stopping by West Wings for the 'night before' gathering with the following days' interviewees for next year's EM class. Whew!
The last month and a half has continued to reinforce my confidence in selecting Emergency Medicine as a specialty. The money, hours (lifestyle) and daily patient care are the best combination I can think of for me. It feels like a good fit and I'm continually motivated to improve my skills, learn more and provide provide better patient care.
Even the New England winter, thus far, hasn't dampened our spirits. The leaves are down, the frost is on the windshields every morning and we've had to buy some winter clothes (sweaters, coats, slippers, etc.), but the family is settling in well. Becky is excelling at the Hispanic Health Council, the kids are busy with honors classes, swimming and music and we are all getting in better shape. And Christmas is right around the corner...
Monday, December 01, 2008
Thursday, October 09, 2008
Anesthesia
I've been on adult anesthesia for over a week now. It has been a desperately needed recovery period from Internal Medicine. I've gotten some sleep, a couple of workouts in and seen my family a ton more.
Once I got familiar with Manchester Memorial Hospital and the OR staff, I've been able to go from OR to OR doing endotracheal intubations (tubes) and laryngeal mask airways (LMAs). The first few days I was learning lots of tips, but missing some tubes due to lack of confidence as much as anything. The last couple of days my confidence has gotten better and I've been getting the tubes placed much more quickly and gracefully.
It like I've learned my "feel" and my muscles have gained the memory and dexterity to do what I need of them.
Just as enjoyable, my days start at 7am and are typically over with by 2pm. I'm loving the time to get my head back on straight before I head back to Saint Francis next month for CCU. At the moment, I still have a couple days of adult anesthesia left, to build on my 20 intubations thusfar. Then it's off to CT Children's Hospital Center (CCMC) for two weeks of pediatric anesthesia.
Once I got familiar with Manchester Memorial Hospital and the OR staff, I've been able to go from OR to OR doing endotracheal intubations (tubes) and laryngeal mask airways (LMAs). The first few days I was learning lots of tips, but missing some tubes due to lack of confidence as much as anything. The last couple of days my confidence has gotten better and I've been getting the tubes placed much more quickly and gracefully.
It like I've learned my "feel" and my muscles have gained the memory and dexterity to do what I need of them.
Just as enjoyable, my days start at 7am and are typically over with by 2pm. I'm loving the time to get my head back on straight before I head back to Saint Francis next month for CCU. At the moment, I still have a couple days of adult anesthesia left, to build on my 20 intubations thusfar. Then it's off to CT Children's Hospital Center (CCMC) for two weeks of pediatric anesthesia.
Medicine Month
It's been over a week since I finished my month rotation in Internal Medicine at St. Francis hospital, but I still remember much of it vividly.
The first was chaos. I couldn't log into systems, didn't know how to get anywhere or any information and the job as foreign to me as Tokyo. The worst part of the month though, was the incredibly inefficient use of time and lack of learning. At least I had a pretty decent resident and one good Attending.
I ended up arriving each day by 6am to pre-round on my patients. Since I was the only Intern on my team (there was supposed to by two to share the load) I had to write Progress Notes on 5-6 patients as quickly as possible. Usually I just got vitals and new labs/procedure notes by the time my Resident arrived at 7am (7:30am in my case since he was always late). So 7-8am was wasted repeating my previous hour or trying to understand what the heck the Resident was trying to achieve as he mysteriously entered orders.
At about 8:30am we officially rounded with the first Attending. This Attending was a total waste. Didn't learn squat, but ran around chatting with everyone. Finally, we had 9:30am Attending rounds where we actually saw patients, but only the Housestaff patients. This system made no sense and seems even now detrimental to patient care. It also meant that I typically any lecture prior to lunch so that I could finish up Progress Notes by the noon deadline.
After lunch, we ran around trying to nail down details, implement our Attending's suggestions for Housestaff patients and make treatment plans for Private patients' clueless Doctors. Sometimes we got new admissions or transfer patients around this time as well. What should have taken a couple hours and allowed to get out by 3-4pm usually got dragged out until 5pm or so. My Resident loved to chat, write book length notes and move at a pace that made it obvious he was in no rush to get home.
These were the weekdays, when I didn't have Call, which came every fourth day. Weekends I had off, but given Call I really only got one weekend off. The other three included Call time. Call was pretty typical with little sleep and a chaotic mix of admitting new patients and dealing with cross-cover issues for the other Interns' patients. The nurses were a mixed bag, with many calling me at all hours for inane questions.
Again, if we were efficient and hard-working we could have left by 10-11am most mornings post-Call. But my Resident was in no rush. He certainly provided exemplary patient care. But I usually was dragging myself around until 1-2pm the following afternoon. Shifts lasting 30-31 hours take a couple of days to recover from. Even I managed to get 3-4 hours of sleep it was fitful sleep in my shirt and tie frequently interupted by pages from nurses with questions that could usually be answered over the phone or with an order.
I expected the hours, resentment for the archaic dress code, hospital inefficiency and politics, but I was surprised by how little I actually learned the whole month. Time constraints, exhaustion, a bad teaching Attending and a Resident with little teaching experience are probably to blame. But it seems like an opportunity lost.
In any case, I've paid my dues. IM is behind me and I should never again have to be the Intern covering the floors over night. And every day I had that moment where I felt my decision to go into Emergency Medicine was validated.
The first was chaos. I couldn't log into systems, didn't know how to get anywhere or any information and the job as foreign to me as Tokyo. The worst part of the month though, was the incredibly inefficient use of time and lack of learning. At least I had a pretty decent resident and one good Attending.
I ended up arriving each day by 6am to pre-round on my patients. Since I was the only Intern on my team (there was supposed to by two to share the load) I had to write Progress Notes on 5-6 patients as quickly as possible. Usually I just got vitals and new labs/procedure notes by the time my Resident arrived at 7am (7:30am in my case since he was always late). So 7-8am was wasted repeating my previous hour or trying to understand what the heck the Resident was trying to achieve as he mysteriously entered orders.
At about 8:30am we officially rounded with the first Attending. This Attending was a total waste. Didn't learn squat, but ran around chatting with everyone. Finally, we had 9:30am Attending rounds where we actually saw patients, but only the Housestaff patients. This system made no sense and seems even now detrimental to patient care. It also meant that I typically any lecture prior to lunch so that I could finish up Progress Notes by the noon deadline.
After lunch, we ran around trying to nail down details, implement our Attending's suggestions for Housestaff patients and make treatment plans for Private patients' clueless Doctors. Sometimes we got new admissions or transfer patients around this time as well. What should have taken a couple hours and allowed to get out by 3-4pm usually got dragged out until 5pm or so. My Resident loved to chat, write book length notes and move at a pace that made it obvious he was in no rush to get home.
These were the weekdays, when I didn't have Call, which came every fourth day. Weekends I had off, but given Call I really only got one weekend off. The other three included Call time. Call was pretty typical with little sleep and a chaotic mix of admitting new patients and dealing with cross-cover issues for the other Interns' patients. The nurses were a mixed bag, with many calling me at all hours for inane questions.
Again, if we were efficient and hard-working we could have left by 10-11am most mornings post-Call. But my Resident was in no rush. He certainly provided exemplary patient care. But I usually was dragging myself around until 1-2pm the following afternoon. Shifts lasting 30-31 hours take a couple of days to recover from. Even I managed to get 3-4 hours of sleep it was fitful sleep in my shirt and tie frequently interupted by pages from nurses with questions that could usually be answered over the phone or with an order.
I expected the hours, resentment for the archaic dress code, hospital inefficiency and politics, but I was surprised by how little I actually learned the whole month. Time constraints, exhaustion, a bad teaching Attending and a Resident with little teaching experience are probably to blame. But it seems like an opportunity lost.
In any case, I've paid my dues. IM is behind me and I should never again have to be the Intern covering the floors over night. And every day I had that moment where I felt my decision to go into Emergency Medicine was validated.
Lot to catch up on, starting with vacation
Wow, time has really flown. It's already a month and a half since my last post. So I'll start where I left off and see how far I get toward catching up.
The whole family spent a few days in Cape Cod. Our hotel was a disappointment, but the area was, near the tip of the peninsula, was great. Next time we'll have to stay in Provincetown, a cool little tourist town a lot like Key West. Free spirits, great restaurants/shopping and homosexuals holding hands in their underwear. We also rode our mountain bikes on some of the beach trails. But the highlight for the boys was definitely swimming in the surf. The water was a little colder than Naragansett, but not too bad.
All in all, it's a place we'd like to return to with better lodgings.
Then we drove up to Freeport, Maine to see what everyone was talking about. I enjoyed shopping at the discount shops surrounding L.L. Bean's flagship outlet store. I was able to find a few winter clothing items at huge discounts, but the rest of the family didn't do as well. Then we went on a ferry trip to an artists' haven. It was funny in that we expected scenery and seals and all we got was rural village with a lack of services. We found a trail and walk and eventually saw some seals from the roof of the ferry on the way home, but it was a waste of a day. We even tried a fresh lobster meal at the coastal town the ferry started from. It was fresh, but we got kinda grossed out trying to clean our freshly killed lobsters. Again, a cheap substitute for Dungeness crab.
I don't think that Becky or the kids are too interested in getting back to Maine anytime soon. It may be that coming from Seattle and the Northwest, Maine isn't anything special. It's basically a poor man's Puget Sound.
At least we got to spend some time together and relax. I brought some medical reading material but got through very little. Instead, I slept well and managed to get in some good exercise. And all in all, I did manage to find some tasty seafood. The scallops here are fantastic!
The whole family spent a few days in Cape Cod. Our hotel was a disappointment, but the area was, near the tip of the peninsula, was great. Next time we'll have to stay in Provincetown, a cool little tourist town a lot like Key West. Free spirits, great restaurants/shopping and homosexuals holding hands in their underwear. We also rode our mountain bikes on some of the beach trails. But the highlight for the boys was definitely swimming in the surf. The water was a little colder than Naragansett, but not too bad.
All in all, it's a place we'd like to return to with better lodgings.
Then we drove up to Freeport, Maine to see what everyone was talking about. I enjoyed shopping at the discount shops surrounding L.L. Bean's flagship outlet store. I was able to find a few winter clothing items at huge discounts, but the rest of the family didn't do as well. Then we went on a ferry trip to an artists' haven. It was funny in that we expected scenery and seals and all we got was rural village with a lack of services. We found a trail and walk and eventually saw some seals from the roof of the ferry on the way home, but it was a waste of a day. We even tried a fresh lobster meal at the coastal town the ferry started from. It was fresh, but we got kinda grossed out trying to clean our freshly killed lobsters. Again, a cheap substitute for Dungeness crab.
I don't think that Becky or the kids are too interested in getting back to Maine anytime soon. It may be that coming from Seattle and the Northwest, Maine isn't anything special. It's basically a poor man's Puget Sound.
At least we got to spend some time together and relax. I brought some medical reading material but got through very little. Instead, I slept well and managed to get in some good exercise. And all in all, I did manage to find some tasty seafood. The scallops here are fantastic!
Saturday, August 23, 2008
Second Month
Well August isn't officially over, but I'm now on vacation! Time to relax, sleep and exercise.
This month started with two weeks of ED shifts, eight at Hartford Hospital, three at Connecticut Children's Hospital and one EMS ride-along.
The first three shifts were exhausting. For three nights straight I worked for the first in large EDs. It was a little overwhelming learning new processes, staffs, Attendings, charting, locations of everything, etc. Oh, and I got to take on stroke patient whenever they dropped in (no traumas yet). At least that is over. I've now worked in every ED I will work in during residency.
I am a bit disappointed that I didn't get many procedures in. However, I did manage to learn a lot. And I haven't been very good at reading this month, that's something.
I also had three nights in a row. The shifts were fine, but getting back into a good sleep cycle has been more challenging. My pool closed, unfortunately giving me an easy excuse to not work out. Next time I have a series of night shifts, I will try to use exercise a little better and see if I can get back into a regular day cycle easier.
This last week has been Dentistry. I've learned a lot about giving oral nerve blocks. I'm confident I can numb up any area of the mouth to work on lip lacerations, provide comfort for broken teeth or just to get a patient through until Dentistry (OMFS) can see them. It was also very easy hours. With my mom in town for the weekend that has been nice.
Finally, my biggest time sink this month ahs probably been getting my new iPhone up to speed and organizing my music collection into iTunes. The latter is an ongoing project. I have a bout 11 GB rated and organized with probably another 10Gb or so to go. It's a project long past due.
This month started with two weeks of ED shifts, eight at Hartford Hospital, three at Connecticut Children's Hospital and one EMS ride-along.
The first three shifts were exhausting. For three nights straight I worked for the first in large EDs. It was a little overwhelming learning new processes, staffs, Attendings, charting, locations of everything, etc. Oh, and I got to take on stroke patient whenever they dropped in (no traumas yet). At least that is over. I've now worked in every ED I will work in during residency.
I am a bit disappointed that I didn't get many procedures in. However, I did manage to learn a lot. And I haven't been very good at reading this month, that's something.
I also had three nights in a row. The shifts were fine, but getting back into a good sleep cycle has been more challenging. My pool closed, unfortunately giving me an easy excuse to not work out. Next time I have a series of night shifts, I will try to use exercise a little better and see if I can get back into a regular day cycle easier.
This last week has been Dentistry. I've learned a lot about giving oral nerve blocks. I'm confident I can numb up any area of the mouth to work on lip lacerations, provide comfort for broken teeth or just to get a patient through until Dentistry (OMFS) can see them. It was also very easy hours. With my mom in town for the weekend that has been nice.
Finally, my biggest time sink this month ahs probably been getting my new iPhone up to speed and organizing my music collection into iTunes. The latter is an ongoing project. I have a bout 11 GB rated and organized with probably another 10Gb or so to go. It's a project long past due.
Tuesday, July 29, 2008
Intern Picnic
Becky and the kids returned from a week in Seattle yesterday. It was nice to have some company, besides the dogs, in the house again. Most importantly, Colton got to have a birthday party with most of his cousins and two of his grandmothers, a tradition he loves.
Today is actual birthday, but the focus seemed like it was my Intern picnic. In the morning I participated in a suturing and splinting workshop at Hart Hospital that one of our Chief Residents put on. I made it back home just in time to make a few sushi rolls and pack the sushi making gear along with some extra clothes. Then we all hopped in the van and drove the 45 minutes to our Program Directors home.
UConn has a tradition where every year the new Interns show off a "talent" at a picnic during orientation. The picnic had to be postponed until today due to weather. And today was a beautiful day for it. Nonetheless, we Interns have spent a lot time trying to come up with something simple, entertaining and not too cheesy. Needless to say, in general medical students talents are primarily reading and test taking. So my idea was a quick presentation on sushi making, something I really knew nothing about a month ago!
I purchased a kit online that looked braindead simple and practiced once before today. I also purchased a decent rice steamer, fresh seafood and supplies (nori, wasabi, soy sauce, vinegar).
As we were forewarned the picnic started off with some good food and lots of people getting tossed into the pool. I finally tossed one of the chiefs in with myself, hoping that my self-sacrifice will the damage the Chief does to shift schedule in the next year for retribution. We played some volleyball, frisbee and bean bag toss, socialized with spouses and families and, surprisingly, kept the shop talk to a minimum.
The talent show went over pretty well. Everyone put in some effort and we all enjoyed some laughs. Then many of headed for work, or in my case, family priorities. Colton was desperate for his present and some play time. Moreover, Becky needed time to review paperwork and prepare for her first day on the job as Chief Admin Officer at a local non-profit.
Otherwise it has been a pretty quiet day. I've got two more shifts at the UConn hospital, then it's two weeks of Hartford Hospital Emergency Dept shifts, a week of denistry and a week of vacation. We're hoping to use the last week in August for a trip to see the Cape and Maine before the kids start school. So time to get some sleep, five days of shifts in a row is going to be pretty tiring, especially since the third through fifth shifts are all in EDs I'm not familair with; Hartford Blue Pod, Gold Pod then the Peds ED across the street.
Today is actual birthday, but the focus seemed like it was my Intern picnic. In the morning I participated in a suturing and splinting workshop at Hart Hospital that one of our Chief Residents put on. I made it back home just in time to make a few sushi rolls and pack the sushi making gear along with some extra clothes. Then we all hopped in the van and drove the 45 minutes to our Program Directors home.
UConn has a tradition where every year the new Interns show off a "talent" at a picnic during orientation. The picnic had to be postponed until today due to weather. And today was a beautiful day for it. Nonetheless, we Interns have spent a lot time trying to come up with something simple, entertaining and not too cheesy. Needless to say, in general medical students talents are primarily reading and test taking. So my idea was a quick presentation on sushi making, something I really knew nothing about a month ago!
I purchased a kit online that looked braindead simple and practiced once before today. I also purchased a decent rice steamer, fresh seafood and supplies (nori, wasabi, soy sauce, vinegar).
As we were forewarned the picnic started off with some good food and lots of people getting tossed into the pool. I finally tossed one of the chiefs in with myself, hoping that my self-sacrifice will the damage the Chief does to shift schedule in the next year for retribution. We played some volleyball, frisbee and bean bag toss, socialized with spouses and families and, surprisingly, kept the shop talk to a minimum.
The talent show went over pretty well. Everyone put in some effort and we all enjoyed some laughs. Then many of headed for work, or in my case, family priorities. Colton was desperate for his present and some play time. Moreover, Becky needed time to review paperwork and prepare for her first day on the job as Chief Admin Officer at a local non-profit.
Otherwise it has been a pretty quiet day. I've got two more shifts at the UConn hospital, then it's two weeks of Hartford Hospital Emergency Dept shifts, a week of denistry and a week of vacation. We're hoping to use the last week in August for a trip to see the Cape and Maine before the kids start school. So time to get some sleep, five days of shifts in a row is going to be pretty tiring, especially since the third through fifth shifts are all in EDs I'm not familair with; Hartford Blue Pod, Gold Pod then the Peds ED across the street.
Thursday, July 17, 2008
Loving EM
Well it's been about two weeks of shifts now. I'm starting to get the hang of the computer system, the hospital specific idiosyncrasies and how to survive eight hours of 100% focus. I've also learned a ton of medicine, procedures and interesting patient presentations.
All in all, my community hospital month is a great way to start residency. The attendings have been great. I'm getting lots of accolades from patients about my bedside manor and patient care. The attendings seem to believe I'm doing a good job as well. Best of all, I feel like I'm in the right place. If I end up practicing in a community hospital, I would be quite happy.
There's not as much trauma or opportunities to practice procedures, but the lifestyle is great and well suited to me.
Becky also got a job offer today, so that a financial relief for the family. It's just about the salary we were hoping for, but with much more time off than we expected. Again, I think the offer is very well suited to Becky and our family.
Now, I just have to solidify some good habits; working out 5-6 days a week and study most nights. With a sunburn from bodysurfing with the family at Naragansett, RI last weekend the former has taken a hit. And now, I'm boning up for a PALs course next week, so the latter has slowed down as well.
These are short term things so no big deal. The progress we've made here is great so far. I just hope that the kids get settled in with more local friends, Becky's job turns out as good as it looked during interviews and my last couple of weeks at John Dempsey Hospital go well.
All in all, my community hospital month is a great way to start residency. The attendings have been great. I'm getting lots of accolades from patients about my bedside manor and patient care. The attendings seem to believe I'm doing a good job as well. Best of all, I feel like I'm in the right place. If I end up practicing in a community hospital, I would be quite happy.
There's not as much trauma or opportunities to practice procedures, but the lifestyle is great and well suited to me.
Becky also got a job offer today, so that a financial relief for the family. It's just about the salary we were hoping for, but with much more time off than we expected. Again, I think the offer is very well suited to Becky and our family.
Now, I just have to solidify some good habits; working out 5-6 days a week and study most nights. With a sunburn from bodysurfing with the family at Naragansett, RI last weekend the former has taken a hit. And now, I'm boning up for a PALs course next week, so the latter has slowed down as well.
These are short term things so no big deal. The progress we've made here is great so far. I just hope that the kids get settled in with more local friends, Becky's job turns out as good as it looked during interviews and my last couple of weeks at John Dempsey Hospital go well.
Friday, July 04, 2008
First three shifts - and Happy 4th of July
Finished what I expect to be the hardest shifts of my career. Sure, the first few shifts as an attending will be stressful and chaotic, but at least I'll know how to help patients.
These first three shifts were crazy because you know no one, the computer systems and hospital processes are foreign, and you really don't know that much medicine (especially since each institution does things a little different).
However, the three shifts couldn't have gone any better. The Attendings were great; helpful, respectful and proactive teachers. The staff is very nice, while I feel like I hardly had a chance to get to know them. And it's all electronic, so there's very little written charting.
The best part is that I'm gaining a reputation already as the procedure guy. The first night I did a nice I & D, then an external jugular central line, then a three layer closure on a lip laceration. The second night I intubated a patient, then did a foreign body removal from a cornea (metal shavings). The third night I did a lumbar puncture. The procedures all went smoothly and were very confidence building for me.
The only thing I haven't done, and that I need practice on putting in plain old IVs. I plan on getting some practice this week, along with getting better charting on the IBEX computer system. The last night I was managing up to five patients at once, or trying to. It's hard to make sure everything is progressing on each patient while keeping up on charting and everything else. I missed that one patient's CT was delayed and one patient's blood draw kept getting messed up. Each situation resulted in two hour delays.
My feedback from the Attendings after each shift was very positive. And I think I learned a lot. It also gave me incentive to read up on patients cases and study more. One case may end up being my case report for the year. An elderly lady came in with a supposed drug reaction, but ended up having encephalitis! Some permanent synaptic connections were definitely made working up that patient.
I have today, the 4th of July off. The family and I went for a long walk with the dogs at a nearby park. We're trying decie if we should go see any firework shows since the clouds are low and threatening to rain. The walk was good exercise, and let me recover a bit from the last week of running, weight lifting and swimming. I'm a bit sore but happy to feel the body getting back into shape.
I guess I still don't know what to expect for the first week. But I do feel my first week has gone very well. I'm getting a little confidence and feeling confident telling patients or consulting specialists I'm one of the Residents. I couldn't have asked for a better start to residency.
These first three shifts were crazy because you know no one, the computer systems and hospital processes are foreign, and you really don't know that much medicine (especially since each institution does things a little different).
However, the three shifts couldn't have gone any better. The Attendings were great; helpful, respectful and proactive teachers. The staff is very nice, while I feel like I hardly had a chance to get to know them. And it's all electronic, so there's very little written charting.
The best part is that I'm gaining a reputation already as the procedure guy. The first night I did a nice I & D, then an external jugular central line, then a three layer closure on a lip laceration. The second night I intubated a patient, then did a foreign body removal from a cornea (metal shavings). The third night I did a lumbar puncture. The procedures all went smoothly and were very confidence building for me.
The only thing I haven't done, and that I need practice on putting in plain old IVs. I plan on getting some practice this week, along with getting better charting on the IBEX computer system. The last night I was managing up to five patients at once, or trying to. It's hard to make sure everything is progressing on each patient while keeping up on charting and everything else. I missed that one patient's CT was delayed and one patient's blood draw kept getting messed up. Each situation resulted in two hour delays.
My feedback from the Attendings after each shift was very positive. And I think I learned a lot. It also gave me incentive to read up on patients cases and study more. One case may end up being my case report for the year. An elderly lady came in with a supposed drug reaction, but ended up having encephalitis! Some permanent synaptic connections were definitely made working up that patient.
I have today, the 4th of July off. The family and I went for a long walk with the dogs at a nearby park. We're trying decie if we should go see any firework shows since the clouds are low and threatening to rain. The walk was good exercise, and let me recover a bit from the last week of running, weight lifting and swimming. I'm a bit sore but happy to feel the body getting back into shape.
I guess I still don't know what to expect for the first week. But I do feel my first week has gone very well. I'm getting a little confidence and feeling confident telling patients or consulting specialists I'm one of the Residents. I couldn't have asked for a better start to residency.
Friday, June 27, 2008
Settling in and Orientation
Our first in West Hartford consisted of unloading the MoveX truck that shipped our belongings to CT with the assistance of three of my fellow EM interns. we got very sweaty but finished the job before lunch. Becky and I bought two of them lunch, had a couple beers, then started the huge job of unpacking and settling in.
I will admit that there were many more hassles and obstacles than I anticipated. The blinds were removed, the humidity was stifling even at 75 degrees. The refrigerator was broken. And Becky's Monday morning interview went well, but only resulted in a second and third interview with no decision in sight.
On the plus side, the area is great and our house's location is perfect. We purchased new appliances at Sears around the corner, purchased groceries at Trader Joe's next door to it, played with the dogs at Wolcott Park a short walk away and started back into swimming at the Cornerstone Aquatics center 3-4 miles away. The packing certainly filled in my three days before orientation started. And the nights were spent buying supplies and putting together Sauder style furniture.
I was exhausted and a little down when we started orientation on Wednesday the 18th. However, my fellow interns turned out to be terrific. We've gone out for lunch, a beer or a dinner with spouses almost every day. I have had a great time bonding with the other eleven physicians in my class and look forward to growing into Emergency Physicians with them.
Orientation itself has been ok. I guess I shouldn't expect too much from the logistics of getting into four hospitals. I now have computer training, privileges and IDs for Hartford Hospital, CT Children's Med Ctr, St. Francis and UConn's John Dempsey Hospital. Moreover, I now have my ATLS and ACLS certifications completed. I was a little stressed about preparing for them and the written and oral exams at the end, but ATLS, especially, reminded me of how much I've learned thus far.
The worst day by far was today, our last day. We had to prepare for St. Francis's computer training with 6-7 hours of online lessons and quizzes. Then we spent another two hours onsite ( and paying $4 for the privilege) to go through a workbook of the same stuff overseen by an incompetent administrator that had no idea what we were doing. It was very frustrating. Children's in the afternoon was better, but more than a little boring.
Lat night Becky and I attended the PGY-3's graduation banquet. My class got a chance to know the outgoing seniors and see what they've done throughout residency. It was fun to see the awards that nurses, faculty and classmates handed out to them and the reasoing behind it. The kids also started a Lacross camp two days and are loving it. Becky said she's never seen them so sweaty. While it's very humid, the weather is still great for working out and playing outside this summer.
Now I have three days until I start seeing patients at John Dempsey Hospital at UConn. Three day to relax and get back into the student mindset. It's exciting and stressful. I'm going to have to wear business casual clothes with my new long white coats for the first few weeks until my embroidered scrubs arrive. It will be nice to be called doctor, but scary to look like an attending with one one hundreth their kowledge.
I will admit that there were many more hassles and obstacles than I anticipated. The blinds were removed, the humidity was stifling even at 75 degrees. The refrigerator was broken. And Becky's Monday morning interview went well, but only resulted in a second and third interview with no decision in sight.
On the plus side, the area is great and our house's location is perfect. We purchased new appliances at Sears around the corner, purchased groceries at Trader Joe's next door to it, played with the dogs at Wolcott Park a short walk away and started back into swimming at the Cornerstone Aquatics center 3-4 miles away. The packing certainly filled in my three days before orientation started. And the nights were spent buying supplies and putting together Sauder style furniture.
I was exhausted and a little down when we started orientation on Wednesday the 18th. However, my fellow interns turned out to be terrific. We've gone out for lunch, a beer or a dinner with spouses almost every day. I have had a great time bonding with the other eleven physicians in my class and look forward to growing into Emergency Physicians with them.
Orientation itself has been ok. I guess I shouldn't expect too much from the logistics of getting into four hospitals. I now have computer training, privileges and IDs for Hartford Hospital, CT Children's Med Ctr, St. Francis and UConn's John Dempsey Hospital. Moreover, I now have my ATLS and ACLS certifications completed. I was a little stressed about preparing for them and the written and oral exams at the end, but ATLS, especially, reminded me of how much I've learned thus far.
The worst day by far was today, our last day. We had to prepare for St. Francis's computer training with 6-7 hours of online lessons and quizzes. Then we spent another two hours onsite ( and paying $4 for the privilege) to go through a workbook of the same stuff overseen by an incompetent administrator that had no idea what we were doing. It was very frustrating. Children's in the afternoon was better, but more than a little boring.
Lat night Becky and I attended the PGY-3's graduation banquet. My class got a chance to know the outgoing seniors and see what they've done throughout residency. It was fun to see the awards that nurses, faculty and classmates handed out to them and the reasoing behind it. The kids also started a Lacross camp two days and are loving it. Becky said she's never seen them so sweaty. While it's very humid, the weather is still great for working out and playing outside this summer.
Now I have three days until I start seeing patients at John Dempsey Hospital at UConn. Three day to relax and get back into the student mindset. It's exciting and stressful. I'm going to have to wear business casual clothes with my new long white coats for the first few weeks until my embroidered scrubs arrive. It will be nice to be called doctor, but scary to look like an attending with one one hundreth their kowledge.
Six days across America
Monday morning we finished packing the minivan early and saying our goodbyes to our Glendale, AZ home. At four years, it was the longest Becky and I lived in one house together. The van once again showed how it was the ultimate vehicle when it comes to functionality. We had our luggage and camping gear packed into the Thule luggage carrier on the roof as well as stacked in the back with the third row folded down. This left just enough room for Cedar and Artemis our Golden Retrievers to curl up behind the boys' captain chairs in the middle row.
We also had the bike carrier in the 2" trailer hitch in back with all four mountain bikes aerodynamically positioned behind the van (LOL). Finally, our alternator had to really work this trip. We had the GPS, satellite radio, Xbox, dual screen DVD player and multiple rechargers (phones, Nintendo DS, iPod, etc.) all hooked up. As a bit of foreshadowing, the Xbox failed from the moment we tried to turn it on. We thought it died, but only upon arriving in Connecticut did we find out that the van couldn't provide sufficient power for it with everything else draining amps.
The trip started fine with a nice drive from Phoenix to the Grand Canyon. The boys got a bit restless as I kept wanting to jump out of the car for another photo opportunity. They and Becky had already seen it, and the former weren't overly impressed. The dogs and I had fun running around the vistas for a couple shots before jumping back into the running car (turning off the motor makes for a serious interuption to the movie watchers in back). We only needed to give the dogs one dramamine (Artemis) along the way. They were otherwise troopers.
A late start and my sight seeing put us in Durango just past dark. We managed to put up the tent (18' x 10') in the dark without getting into too many arguments or creating too many comparisons to the Waldos for the spectators who were for the most part all comfy in their campers.
The night ended up being very cold but all six of us slept fairly well the first night on the road. We peed close to the tent, stayed bundled up and only ran around when Cedar threw up near the head of Becky's sleeping bag in the middle of the night. We're assuming it was from the stress since he's been through this before and was fine from that point on.
Anyway, the morning was very cold, and it took us quite a while to take down the tent, find breakfast and hit the road. Once we did though, the spectacular Colorado mountains entertained Becky and I. The boys were in non-stop movie watching mode and only occassionally looked up to humor me with a; "oh, yeah, cool Dad." The highlight of the day was Ouray, known as the "Switzerland of America". It is a small city in a bowl of huge, rugged mountains surrounding it. It was one of my favorite landscapes in the whole country. Unfortuantely road construction severly slowed our progress North and East towards Boulder. In the end, we had to forego some of the scenery and take the main freeway going into Denver from Grand Junction. First, this made us appreciate not Matching into the family residency in Grand Junction. Second, we still got to see some great sights along the interstate. The canyons, Vail and the twisty roads around the Rockies kept me entertained in the driver's seat al day.
We finally made it to the Rocky Moutain National Park close to dark. Our site was right on Granby lake and the wind was blowing pretty hard. We frantically put up the tent before bundling up for a glass of wine under stars. The sky looked clear and the stars were beautiful, but Becky noticed some forboding stars on the horizon and jokingly mentioned how it would be funny if they were snow clouds even though it was warmer than Durango.
As fate would have it, we woke up earlier for our longest drive of the trip to light snowfall. In record time we packed the tent and hit road. Our GPS kept telling us to turn back towards the Interstate (I-70) and Denver, but I wanted to take the scenic shortcut over the Rocky Mountain pass taking us just North of Boulder with a straight shot to Highway I-80 and Nebraska. The Ranger at the park took our $20 and assured us that the there may be some winds on top of the mountain, but the pass was clear - and heck, it was June!
With a couple miles, the snowfall became a storm and visibility dropped to about 20 feet. About this time, we realized that the van's heater was broken. After all, it had probably been years since it had been used, the Fry's guys who installed our satellite radio looked pretty amareur. So in sandals, freezing temperatures and the air conditioner on to defog the windshield, we raced to the top of the pass only to find it had just closed!!
The only bright spot in our two hour frigid detour was seeing a whole herd of deer running down the mountain to escape the same snow storm. The three big buck, 7-8 doe and 4-5 fawn were a great way to break our dejection and frustration. Actually, one side benefit of the delay was that Denver rush hour was long gone by the time we drove through.
The rest of Colorado and the first half of Nebraska were smooth sailing. Luckily we were concerned enough about our delay that we made hotal reservations in Omaho knowing Dew Moines would be tough to reach not even considering we'd have to put up the tent at our camp site there. We realized how smart that call was not far from Lincoln, NE. The rain started coming down in sheets and I took the opportunity to tempt fake by joking how it would be wild to have Tornados and snowstorms on the same day.
Cars and semis started pulling over under the overpasses. But as long I could follow semis and see they weren't hitting deep water, I kept ok. It got so dark about this time (at around 5pm when it should have been sunny) that we switched to the local radio. That was when Becky and the boys got really nervous. Reports of flooded roads, tornados touching down and warnings to pull off all roads made for some stressful driving. Just past Lincoln I finally decided to pull over and see about stopping for the night. Even with only 20-30 miles to go until Omaho, I was getting worried. The first gas station and hotel off the interstate looked flooded so we headed to the other side of the overpass. There was a huge crowd in the station with a police officer making recommendations. I thought to myself how unprepared I was as a newly graduated doctor for any kind of disaster.
We stuck around for awhile until the rain lesseded a bit and we thought we'd try for a hotel nearby for the night. However, as we got started I realized the weather have improved significantly and the truck drivers were pulling out and hitting the road again. Not to ignore the Police Officer's recommendations, but the professional drives in CB contact with other truckers around the state seemed to be the safer bet. Becky kept in almost constant with her family through the whole thing and I still don't whether that helped calm or stress her out more. But in the end she didn't protest my decision too badly. We had little trouble following one semi the half hour to our reservation in Omaho.
Showers and beds were a nice way to start one of our shorter days. My cousins, aunts and uncles in Chicago were dealing with a lot of their own surprises so we drove straight through Illinois to Southbend, IN where Tucker and his family had just moved into their new house for residency. Their truck had just unloaded all of their belongings earlier in the day so, it was a bit chaotic but Tucker would never pass up an opportunity to help a friend. Not only did we get a nice dry place to stay for the night, we had a great time watching the kids and dogs play in their huge yard while we had a chance to talk as couple starting a similar big new adventure.
It was hard to leave the next day. We stayed way past the time I had hoped to get rolling, but the kids had a great time running around and playing. It was hard to separate them. Once we got rolling I realized the trip to Wellsburg, WV was pretty short.
We arrived at Great Aunt Gerry's 1911 mansion, Morningside, around 3pm or so. The boys and dogs had a great time exploring the huge place and settling into their own 1950's styled rooms. We all went for a swim at Gerry's son's house, the orginal housestead on the compound built in the 1850's. Then we went to dinner on the Ohio River. The rain followed us, but it was still a wonderful evening spending time with relatives we hadn't seen in a long time. Aunt Gerry had hosted a family reunion 12 years ago, when Connor was only five months old. That was the last time we had been out to Morningside.
Day six started slow as usual for us. We hit the road around 10am, pretty average for us. But we had a great time with Gerry and her daughter Tina over breakfast. The day's drive to West Hartford was pretty uneventful except for the almost constant rain and a close call. Becky drove most of the day so I study for my upcoming ATLS class. In hte afternoon she noticed a newly rolled over SUV alongside the road with several good samaritans trying to help out. I agreed we should stop and ran over to see if I, the barely graduated doctoc, could lend a hand. I located the driver and found him to be fine, walking around the vehicle and impatiently waitin for EMS to show. He politely refused my offer of assistance.
We arrived at our new house in West Hartford late on Saturday evening. After a nice 8-9pm dinner at Olive Garden to celebrete our arrival we camped out on the 1940's hardwoods of our new Cape Cod home.
We also had the bike carrier in the 2" trailer hitch in back with all four mountain bikes aerodynamically positioned behind the van (LOL). Finally, our alternator had to really work this trip. We had the GPS, satellite radio, Xbox, dual screen DVD player and multiple rechargers (phones, Nintendo DS, iPod, etc.) all hooked up. As a bit of foreshadowing, the Xbox failed from the moment we tried to turn it on. We thought it died, but only upon arriving in Connecticut did we find out that the van couldn't provide sufficient power for it with everything else draining amps.
The trip started fine with a nice drive from Phoenix to the Grand Canyon. The boys got a bit restless as I kept wanting to jump out of the car for another photo opportunity. They and Becky had already seen it, and the former weren't overly impressed. The dogs and I had fun running around the vistas for a couple shots before jumping back into the running car (turning off the motor makes for a serious interuption to the movie watchers in back). We only needed to give the dogs one dramamine (Artemis) along the way. They were otherwise troopers.
A late start and my sight seeing put us in Durango just past dark. We managed to put up the tent (18' x 10') in the dark without getting into too many arguments or creating too many comparisons to the Waldos for the spectators who were for the most part all comfy in their campers.
The night ended up being very cold but all six of us slept fairly well the first night on the road. We peed close to the tent, stayed bundled up and only ran around when Cedar threw up near the head of Becky's sleeping bag in the middle of the night. We're assuming it was from the stress since he's been through this before and was fine from that point on.
Anyway, the morning was very cold, and it took us quite a while to take down the tent, find breakfast and hit the road. Once we did though, the spectacular Colorado mountains entertained Becky and I. The boys were in non-stop movie watching mode and only occassionally looked up to humor me with a; "oh, yeah, cool Dad." The highlight of the day was Ouray, known as the "Switzerland of America". It is a small city in a bowl of huge, rugged mountains surrounding it. It was one of my favorite landscapes in the whole country. Unfortuantely road construction severly slowed our progress North and East towards Boulder. In the end, we had to forego some of the scenery and take the main freeway going into Denver from Grand Junction. First, this made us appreciate not Matching into the family residency in Grand Junction. Second, we still got to see some great sights along the interstate. The canyons, Vail and the twisty roads around the Rockies kept me entertained in the driver's seat al day.
We finally made it to the Rocky Moutain National Park close to dark. Our site was right on Granby lake and the wind was blowing pretty hard. We frantically put up the tent before bundling up for a glass of wine under stars. The sky looked clear and the stars were beautiful, but Becky noticed some forboding stars on the horizon and jokingly mentioned how it would be funny if they were snow clouds even though it was warmer than Durango.
As fate would have it, we woke up earlier for our longest drive of the trip to light snowfall. In record time we packed the tent and hit road. Our GPS kept telling us to turn back towards the Interstate (I-70) and Denver, but I wanted to take the scenic shortcut over the Rocky Mountain pass taking us just North of Boulder with a straight shot to Highway I-80 and Nebraska. The Ranger at the park took our $20 and assured us that the there may be some winds on top of the mountain, but the pass was clear - and heck, it was June!
With a couple miles, the snowfall became a storm and visibility dropped to about 20 feet. About this time, we realized that the van's heater was broken. After all, it had probably been years since it had been used, the Fry's guys who installed our satellite radio looked pretty amareur. So in sandals, freezing temperatures and the air conditioner on to defog the windshield, we raced to the top of the pass only to find it had just closed!!
The only bright spot in our two hour frigid detour was seeing a whole herd of deer running down the mountain to escape the same snow storm. The three big buck, 7-8 doe and 4-5 fawn were a great way to break our dejection and frustration. Actually, one side benefit of the delay was that Denver rush hour was long gone by the time we drove through.
The rest of Colorado and the first half of Nebraska were smooth sailing. Luckily we were concerned enough about our delay that we made hotal reservations in Omaho knowing Dew Moines would be tough to reach not even considering we'd have to put up the tent at our camp site there. We realized how smart that call was not far from Lincoln, NE. The rain started coming down in sheets and I took the opportunity to tempt fake by joking how it would be wild to have Tornados and snowstorms on the same day.
Cars and semis started pulling over under the overpasses. But as long I could follow semis and see they weren't hitting deep water, I kept ok. It got so dark about this time (at around 5pm when it should have been sunny) that we switched to the local radio. That was when Becky and the boys got really nervous. Reports of flooded roads, tornados touching down and warnings to pull off all roads made for some stressful driving. Just past Lincoln I finally decided to pull over and see about stopping for the night. Even with only 20-30 miles to go until Omaho, I was getting worried. The first gas station and hotel off the interstate looked flooded so we headed to the other side of the overpass. There was a huge crowd in the station with a police officer making recommendations. I thought to myself how unprepared I was as a newly graduated doctor for any kind of disaster.
We stuck around for awhile until the rain lesseded a bit and we thought we'd try for a hotel nearby for the night. However, as we got started I realized the weather have improved significantly and the truck drivers were pulling out and hitting the road again. Not to ignore the Police Officer's recommendations, but the professional drives in CB contact with other truckers around the state seemed to be the safer bet. Becky kept in almost constant with her family through the whole thing and I still don't whether that helped calm or stress her out more. But in the end she didn't protest my decision too badly. We had little trouble following one semi the half hour to our reservation in Omaho.
Showers and beds were a nice way to start one of our shorter days. My cousins, aunts and uncles in Chicago were dealing with a lot of their own surprises so we drove straight through Illinois to Southbend, IN where Tucker and his family had just moved into their new house for residency. Their truck had just unloaded all of their belongings earlier in the day so, it was a bit chaotic but Tucker would never pass up an opportunity to help a friend. Not only did we get a nice dry place to stay for the night, we had a great time watching the kids and dogs play in their huge yard while we had a chance to talk as couple starting a similar big new adventure.
It was hard to leave the next day. We stayed way past the time I had hoped to get rolling, but the kids had a great time running around and playing. It was hard to separate them. Once we got rolling I realized the trip to Wellsburg, WV was pretty short.
We arrived at Great Aunt Gerry's 1911 mansion, Morningside, around 3pm or so. The boys and dogs had a great time exploring the huge place and settling into their own 1950's styled rooms. We all went for a swim at Gerry's son's house, the orginal housestead on the compound built in the 1850's. Then we went to dinner on the Ohio River. The rain followed us, but it was still a wonderful evening spending time with relatives we hadn't seen in a long time. Aunt Gerry had hosted a family reunion 12 years ago, when Connor was only five months old. That was the last time we had been out to Morningside.
Day six started slow as usual for us. We hit the road around 10am, pretty average for us. But we had a great time with Gerry and her daughter Tina over breakfast. The day's drive to West Hartford was pretty uneventful except for the almost constant rain and a close call. Becky drove most of the day so I study for my upcoming ATLS class. In hte afternoon she noticed a newly rolled over SUV alongside the road with several good samaritans trying to help out. I agreed we should stop and ran over to see if I, the barely graduated doctoc, could lend a hand. I located the driver and found him to be fine, walking around the vehicle and impatiently waitin for EMS to show. He politely refused my offer of assistance.
We arrived at our new house in West Hartford late on Saturday evening. After a nice 8-9pm dinner at Olive Garden to celebrete our arrival we camped out on the 1940's hardwoods of our new Cape Cod home.
Friday, June 20, 2008
Graduation!
Well, I trying to play catch-up after an exhausting couple of weeks. Graduation was June 6th, exactly two weeks ago. It seems like ages ago because so much has happened. So for this post, I'll try to keep it to graduation week and not confuse stuff with subsequent events.
Graduation week was a bit chaotic. I had my mom and Becky's mom arrive on Wednesday in the midst of packing. They joined in the tornado and packed everything in sight. My mom became the shrink-wrap champion. Three thousand feet of shrink-wrap is enough to encase almost every item in a household!
Wednesday night Becky and I went to a small get together with some of my classmates at school. It was a fun night for graduates and spouses put on by Jill. She even had personalized presents for each of us based on medical school notoriety and where we were heading.
Thursday, June 5, we spent the day making final preparations for graduation and the move. In the evening we left the boys at home while mom, Marge, Becky and I went to the graduation banquet. It was a big event with almost the entire class and faculty, plus families. We sat with Tucker and his family near the front.
After all the formal presentations and awards Tucker did a great job giving the class President's speech and then introducing the video presentation he and the class officers put together. In between all the he received five or six awards for his outstanding performance and everything he's done for the class. (It really was the Tucker show.) I even received and academic award, Sigma Sigma Phi. Dinner was ok, but the video was definitely the highlight of the evening for most of us. I hope I can snag a copy from Tucker at some point. While we were there, Dad and Susan flew while we were at dinner to take the kids to dinner.
On Friday we had to get going so I could get to graduation by 9am. It didn't actually start until 10am so we had plenty of time to socialize with classmates I wouldn't be seeing again for a long time, and probably never again as one group. It was cool to see everyone dressed up and in gowns.
AZCOM went first, so there were a few short speeches by faculty before we lined up for hooding and diplomas. Our favorite faculty members (6) were up on stage to help hood. Drs. Walter and Middleton helped me when I got to the stage. Then I was introduced walked to Dr. G. where I got a photo taken as she handed me a fake diploma. Once everyone went through the line, we turned our tassels together and got to enjoy a short applause. The colleges of Pharmacy and Biosciences then had to have there own processions and hooding ceremonies. Luckily the whole thing only took about two hours.
Afterwords, the family a lot of pictures together on stage and in front of the building. Several of us took a bunch of pictures with an inflatable version of one of our classmates who couldn't make graduation. It was poignant to have a dozen or so of us on stage with a gowned and hooded doll saying "we wish you were here Dave".
It then took well over an hour to fight traffic out of the place to get to lunch with the family. It was a good time and very relaxing after all the commotion. The afternoon gave us time for naps and a change of clothes into casual attire. Becky had made reservations for all of us at "the best" seafood restaurant in Phoenix, the Salt Cellar. It was great food, but I can't vouch for the best. My fish was great, the boys had a fresh Dungeness crab and Beck had some outstanding shrimp. It was great to spent some time with the family.
I also enjoyed my Dad's comments about how proud he was of me and how proud my grandfather and grandmother would have been had they been alive. That was right up there with Becky mentioning how my mom teared at the ariport when she dropped her off on Sunday. My mom said shehad been able to keep it together until, but she was so rpoud it got her all emotional.
Saturday morning Becky took Marge, my dad and Susan to the airport while we started staging boxes and furniture in the garage. My mom continued her marathon shrink-wrapping.
Sunday Becky, the boys, a neighbor and I loaded the semi container with our household goods. It took over six hours of exhausting work. We even needed the truck driven at one point when we got our heaviest couch stuck in the stairway coming down from the second floor. We were all wiped out, but I felt we did a great packing job and no one got hurt.
While Becky was dropping my mom off at the airport, I drove the Accord on to the back of the truck and helped to strap it down.
So began our six day adventure across the country with a campout in our empty house, save sleeping bags, two boys, two dogs and heavily laden mini-van.
Graduation week was a bit chaotic. I had my mom and Becky's mom arrive on Wednesday in the midst of packing. They joined in the tornado and packed everything in sight. My mom became the shrink-wrap champion. Three thousand feet of shrink-wrap is enough to encase almost every item in a household!
Wednesday night Becky and I went to a small get together with some of my classmates at school. It was a fun night for graduates and spouses put on by Jill. She even had personalized presents for each of us based on medical school notoriety and where we were heading.
Thursday, June 5, we spent the day making final preparations for graduation and the move. In the evening we left the boys at home while mom, Marge, Becky and I went to the graduation banquet. It was a big event with almost the entire class and faculty, plus families. We sat with Tucker and his family near the front.
After all the formal presentations and awards Tucker did a great job giving the class President's speech and then introducing the video presentation he and the class officers put together. In between all the he received five or six awards for his outstanding performance and everything he's done for the class. (It really was the Tucker show.) I even received and academic award, Sigma Sigma Phi. Dinner was ok, but the video was definitely the highlight of the evening for most of us. I hope I can snag a copy from Tucker at some point. While we were there, Dad and Susan flew while we were at dinner to take the kids to dinner.
On Friday we had to get going so I could get to graduation by 9am. It didn't actually start until 10am so we had plenty of time to socialize with classmates I wouldn't be seeing again for a long time, and probably never again as one group. It was cool to see everyone dressed up and in gowns.
AZCOM went first, so there were a few short speeches by faculty before we lined up for hooding and diplomas. Our favorite faculty members (6) were up on stage to help hood. Drs. Walter and Middleton helped me when I got to the stage. Then I was introduced walked to Dr. G. where I got a photo taken as she handed me a fake diploma. Once everyone went through the line, we turned our tassels together and got to enjoy a short applause. The colleges of Pharmacy and Biosciences then had to have there own processions and hooding ceremonies. Luckily the whole thing only took about two hours.
Afterwords, the family a lot of pictures together on stage and in front of the building. Several of us took a bunch of pictures with an inflatable version of one of our classmates who couldn't make graduation. It was poignant to have a dozen or so of us on stage with a gowned and hooded doll saying "we wish you were here Dave".
It then took well over an hour to fight traffic out of the place to get to lunch with the family. It was a good time and very relaxing after all the commotion. The afternoon gave us time for naps and a change of clothes into casual attire. Becky had made reservations for all of us at "the best" seafood restaurant in Phoenix, the Salt Cellar. It was great food, but I can't vouch for the best. My fish was great, the boys had a fresh Dungeness crab and Beck had some outstanding shrimp. It was great to spent some time with the family.
I also enjoyed my Dad's comments about how proud he was of me and how proud my grandfather and grandmother would have been had they been alive. That was right up there with Becky mentioning how my mom teared at the ariport when she dropped her off on Sunday. My mom said shehad been able to keep it together until, but she was so rpoud it got her all emotional.
Saturday morning Becky took Marge, my dad and Susan to the airport while we started staging boxes and furniture in the garage. My mom continued her marathon shrink-wrapping.
Sunday Becky, the boys, a neighbor and I loaded the semi container with our household goods. It took over six hours of exhausting work. We even needed the truck driven at one point when we got our heaviest couch stuck in the stairway coming down from the second floor. We were all wiped out, but I felt we did a great packing job and no one got hurt.
While Becky was dropping my mom off at the airport, I drove the Accord on to the back of the truck and helped to strap it down.
So began our six day adventure across the country with a campout in our empty house, save sleeping bags, two boys, two dogs and heavily laden mini-van.
Sunday, May 25, 2008
Two weeks to go!
It's been a relaxing couple of weeks. Some exercising and lots of video games along with a ton of errands for the Connecticut home purchase. There's also been a fair number of things to do for graduation and in preparation for residency: health checks; exit surveys; and paperwork.
The bottom line is that we've purchased a second home in CT, leased out this house and got most of our ducks in a row for a June 6th graduation followed by a June 8th truck loading and June 9th departure for a six day minivan trek across the country. We are getting a dual screen DVD player, and hopefully a satellite radio for the 52-hour drive with the family and two dogs. It's about 2700 miles. We may even get to visit some of my relatives along the way, in Chicago and Wheeling, WV.
But that after we fill 40 small boxes, 40 medium boxes, 25 large boxes, 6 wardrobe boxes, 2 dish boxes, then load them, furniture, household belongings and a Honda Accord into 32' of container truck.
Yes it's going to be a very busy two weeks. Before we even get to CT for unloading, getting organized and starting residency, but it's exciting. The adrenalin is starting to kick in.
It's weird to think that in less two weeks I will forever be referred to as Dr. Grady.
The bottom line is that we've purchased a second home in CT, leased out this house and got most of our ducks in a row for a June 6th graduation followed by a June 8th truck loading and June 9th departure for a six day minivan trek across the country. We are getting a dual screen DVD player, and hopefully a satellite radio for the 52-hour drive with the family and two dogs. It's about 2700 miles. We may even get to visit some of my relatives along the way, in Chicago and Wheeling, WV.
But that after we fill 40 small boxes, 40 medium boxes, 25 large boxes, 6 wardrobe boxes, 2 dish boxes, then load them, furniture, household belongings and a Honda Accord into 32' of container truck.
Yes it's going to be a very busy two weeks. Before we even get to CT for unloading, getting organized and starting residency, but it's exciting. The adrenalin is starting to kick in.
It's weird to think that in less two weeks I will forever be referred to as Dr. Grady.
Sunday, May 04, 2008
Finished with Medical School!!!
Woohoo, finished my last week of my last rotation (Anesthsia)! No more medical school, no more short white coat and no more tests (at least until the second of internship)!
Feels so good, I'm thinking of inviting some classmates over for a short white coat burning party next weekend. In the meantime we're going to have Tucker and his family over for a pool party/celebration.
Everything else seems to be going ok. The house purchase in West Hartford will be finalized once the Appraisal is done. My leg is healing up well. I'll have a nice scar from the I&D, but the triple antibiotic treatment did it's job. We went on a family bike ride today and it felt great. First real exercise in three weeks, since the whole thing (venous insufficiency + MRSA?) started with my leg. I'm getting used to wearing compression stockings most of the time.
Even the last week of Anesthesia went well. Lots of time off, but some interesting surgeries and a couple more intubations. Would have been the perfect to end medical school except that Friday's pneumonectomy kept me at Banner Baywood, an hour away from Glendale, until 8pm.
Graduation is still a few weeks away, but there's plenty to do around the house. Becky is still looking for work in Hartford, so I might be able to help a bit with that. There's packing for the move. And I definitely need to get into an exercise routine and skip a few deserts/meals.
My primary goal though is reduce stress and get mentally prepared for the start of residency. Dr. Grady has been a long time coming.
Feels so good, I'm thinking of inviting some classmates over for a short white coat burning party next weekend. In the meantime we're going to have Tucker and his family over for a pool party/celebration.
Everything else seems to be going ok. The house purchase in West Hartford will be finalized once the Appraisal is done. My leg is healing up well. I'll have a nice scar from the I&D, but the triple antibiotic treatment did it's job. We went on a family bike ride today and it felt great. First real exercise in three weeks, since the whole thing (venous insufficiency + MRSA?) started with my leg. I'm getting used to wearing compression stockings most of the time.
Even the last week of Anesthesia went well. Lots of time off, but some interesting surgeries and a couple more intubations. Would have been the perfect to end medical school except that Friday's pneumonectomy kept me at Banner Baywood, an hour away from Glendale, until 8pm.
Graduation is still a few weeks away, but there's plenty to do around the house. Becky is still looking for work in Hartford, so I might be able to help a bit with that. There's packing for the move. And I definitely need to get into an exercise routine and skip a few deserts/meals.
My primary goal though is reduce stress and get mentally prepared for the start of residency. Dr. Grady has been a long time coming.
Saturday, April 26, 2008
Anesthesia interupted
I've actually only spent a day and a half on the first half of this rotation. About ten days ago I thought I had the start of a case of phlebitis in my right leg. The anatomy there is a bit messed up after a crush injury 20 years ago. But I've had no problems following a fasciotomy, bone graft, skin graft, internal/external fixation and five surgeries.
So after my Critical Care post-rotation exam on Tuesday I went to the local ED expecting some imaging would be required to figure out what was wrong. They did a full leg ultrasound and found nothing (good news). So I left with a copay for $150, a prescription for Keflex and a diagnosis of cellulitis. It was just starting to get red and warm so this made sense.
Wednesday stayed home while I continuing my regimen of warm compresses, elevation and aspirin (plus the antibiotic) because the pain was worse, even excruciating whenever I tried to stand for more than a few seconds.
I attempted to work on Thursday meeting my Preceptor at Arizona Heart for a 3-vessel CABG. After I intubated the patient, my Preceptor noticed that I could only observe for a few minutes
before the pain got too much. So I showed him the now very red muscle compartment where I had had the fasciotomy. He sent down the wound clinic where I received a second antibiotic, Bactrim, in case the infection was MRSA. The Doc said it wasn't fluctuant but could turn into an abscess anytime.
Thursday evening I noticed the first sign of puss with a little whitehead like dot on my skin. By Friday there was frank puss under the surface of my skin, but the red area had shrunk. The pain was still excruciating when I tried to stand. So I went back to the ED for an I&D.
It fun talking to the ED physician about my starting at UConn shortly, however she only checked out the cellulitis and added Clindamycin to my antibiotic cocktail. Her PA (Physician's Assistant) actually performed the I&D and she was vicious. One stick, but she jammed the needle in to the hub and pumped the Lidocaine in hard. Then she stabbed into the muscle (which without the overlying fascia, was just beneath the skin and abscess). No mercy. Worse, she one of those prissy, attractive Scottsdale types. No bedside manner.
I have to return tonight to have the packing taking out and make sure the three antibiotic cocktail is working. I hope she's not on, or I may have to request someone else.
So I really only saw two surgeries this week. A very long and interesting cervical laminectomy and vertebral fusion on Monday, then bits of a CABG on Thursday. At least I successfully intubated on the latter. The highlight of the week though, was getting a Pass on that Critical Care post-rotation exam.
It goes without saying, I hope I'm well enough to do more during my last week of medical school education. My Preceptor is great, so I hope to learn a lot and get in a few more intubations.
So after my Critical Care post-rotation exam on Tuesday I went to the local ED expecting some imaging would be required to figure out what was wrong. They did a full leg ultrasound and found nothing (good news). So I left with a copay for $150, a prescription for Keflex and a diagnosis of cellulitis. It was just starting to get red and warm so this made sense.
Wednesday stayed home while I continuing my regimen of warm compresses, elevation and aspirin (plus the antibiotic) because the pain was worse, even excruciating whenever I tried to stand for more than a few seconds.
I attempted to work on Thursday meeting my Preceptor at Arizona Heart for a 3-vessel CABG. After I intubated the patient, my Preceptor noticed that I could only observe for a few minutes
before the pain got too much. So I showed him the now very red muscle compartment where I had had the fasciotomy. He sent down the wound clinic where I received a second antibiotic, Bactrim, in case the infection was MRSA. The Doc said it wasn't fluctuant but could turn into an abscess anytime.
Thursday evening I noticed the first sign of puss with a little whitehead like dot on my skin. By Friday there was frank puss under the surface of my skin, but the red area had shrunk. The pain was still excruciating when I tried to stand. So I went back to the ED for an I&D.
It fun talking to the ED physician about my starting at UConn shortly, however she only checked out the cellulitis and added Clindamycin to my antibiotic cocktail. Her PA (Physician's Assistant) actually performed the I&D and she was vicious. One stick, but she jammed the needle in to the hub and pumped the Lidocaine in hard. Then she stabbed into the muscle (which without the overlying fascia, was just beneath the skin and abscess). No mercy. Worse, she one of those prissy, attractive Scottsdale types. No bedside manner.
I have to return tonight to have the packing taking out and make sure the three antibiotic cocktail is working. I hope she's not on, or I may have to request someone else.
So I really only saw two surgeries this week. A very long and interesting cervical laminectomy and vertebral fusion on Monday, then bits of a CABG on Thursday. At least I successfully intubated on the latter. The highlight of the week though, was getting a Pass on that Critical Care post-rotation exam.
It goes without saying, I hope I'm well enough to do more during my last week of medical school education. My Preceptor is great, so I hope to learn a lot and get in a few more intubations.
Saturday, April 19, 2008
Finshed Critical Care
Done with my last "real" rotation. Critical Care was a grind, especially when I'm at the end of MSIV with a Match in hand. I just want a pass and to be done with it.
I managed to miss two 4:30am mornings and an overnight call with our house hunting trip to Hartford. After returning Monday night, I've had four boring days following one patient. I've learned a few things from the Attendings at Rounds, but it's mostly been a waste of time.
Luckily, I didn't have to stay overnight for call last night. One of the MSIII on Surgery did his required night of Trauma last night relieving me of boring scribe duty.
I think what made the rotation such a drag was the immature surgery residents. I'm sooo unimpressed with Good Sam's residents. We have a couple good graduates from AZCOM there, but in general they have huge lack of real world common sense or people skills. It's like Good Sam goes after the bright snobs and hope to mold them into decent physicians.
The attendings were fine, but nothing extraordinary. Same with the facility. The patient population was average at best from a learning standpoint.
So now I have a couple days to study for my last test, the Critical Care shelf test. I start two weeks of anesthesia on Monday and then Medical School is over!! Hopefully I can get some intubation, peripheral IVs, and/or central lines in, and then head by noon or so.
Lots of To Dos for the home sale/rental here, home purchase in CT, UConn residency stuff (physical), graduation, etc.
I managed to miss two 4:30am mornings and an overnight call with our house hunting trip to Hartford. After returning Monday night, I've had four boring days following one patient. I've learned a few things from the Attendings at Rounds, but it's mostly been a waste of time.
Luckily, I didn't have to stay overnight for call last night. One of the MSIII on Surgery did his required night of Trauma last night relieving me of boring scribe duty.
I think what made the rotation such a drag was the immature surgery residents. I'm sooo unimpressed with Good Sam's residents. We have a couple good graduates from AZCOM there, but in general they have huge lack of real world common sense or people skills. It's like Good Sam goes after the bright snobs and hope to mold them into decent physicians.
The attendings were fine, but nothing extraordinary. Same with the facility. The patient population was average at best from a learning standpoint.
So now I have a couple days to study for my last test, the Critical Care shelf test. I start two weeks of anesthesia on Monday and then Medical School is over!! Hopefully I can get some intubation, peripheral IVs, and/or central lines in, and then head by noon or so.
Lots of To Dos for the home sale/rental here, home purchase in CT, UConn residency stuff (physical), graduation, etc.
House Hunting in CT
Becky and I spent last weekend (Th-Mo) in Hartford, CT. I signed my contract and dropped it off at UConn while Becky interviewed with a recruiter on Friday.
Then Saturday we toured around West Hartford with our real estate agent looking at homes. At first is was a little discouraging. Basically there were two types of homes. Ones that had been on the market for 40 to 100 days typically had something wrong with them. Then there were homes that had been on less than a week which were better but priced at the top of our range.
We ended up spending Sunday looking back through two homes then seeing several new ones at Open Houses. Surprisingly, the one we liked the most was a split level, but it had recently been updated throughout. The best part was that it has a great location. Two blocks from the freeway, then only five miles into downtown Hartford. And less than two miles to shopping and the huge aquatics center.
Becky and I really liked West Hartford. The people, community and location are ideal. Plus, right near the split are the two best shopping areas in the Hartford area. Near the freeway is a mall with Trader Joe's and Nordstrom's. Two miles North toward the center of West Hartford is this cool walking mall with tons of little shops and great restaurants.
Oh, and the High School the boys would attend is only a stone's throw down the street from the split.
Monday morning on our way out we drove by the split one more time and talked to some more neighbors. There is a ton of kids in the neighborhood. It is very safe with lots of kids Connor and Colton's ages. Plus, since the neighborhood is a dead end circular block, kids are running all over.
We put a verbal on the house yesterday after arranging some creative financing (Becky of course doesn't have a job there yet) and researching prices. Our agent talked us into offering about 10% less than the asking price by showing the comparable sales in the area. We hope to hear a response this weekend.
Even the boys are starting to get excited about the city of Hartford and living in West Hartford.
Then Saturday we toured around West Hartford with our real estate agent looking at homes. At first is was a little discouraging. Basically there were two types of homes. Ones that had been on the market for 40 to 100 days typically had something wrong with them. Then there were homes that had been on less than a week which were better but priced at the top of our range.
We ended up spending Sunday looking back through two homes then seeing several new ones at Open Houses. Surprisingly, the one we liked the most was a split level, but it had recently been updated throughout. The best part was that it has a great location. Two blocks from the freeway, then only five miles into downtown Hartford. And less than two miles to shopping and the huge aquatics center.
Becky and I really liked West Hartford. The people, community and location are ideal. Plus, right near the split are the two best shopping areas in the Hartford area. Near the freeway is a mall with Trader Joe's and Nordstrom's. Two miles North toward the center of West Hartford is this cool walking mall with tons of little shops and great restaurants.
Oh, and the High School the boys would attend is only a stone's throw down the street from the split.
Monday morning on our way out we drove by the split one more time and talked to some more neighbors. There is a ton of kids in the neighborhood. It is very safe with lots of kids Connor and Colton's ages. Plus, since the neighborhood is a dead end circular block, kids are running all over.
We put a verbal on the house yesterday after arranging some creative financing (Becky of course doesn't have a job there yet) and researching prices. Our agent talked us into offering about 10% less than the asking price by showing the comparable sales in the area. We hope to hear a response this weekend.
Even the boys are starting to get excited about the city of Hartford and living in West Hartford.
Sunday, March 30, 2008
First week of Critical Care
After the excitement and emotional exhaustion of Match week I barely managed to study for my IM shelf test at all. I rested and started to get back into an exercise, but didn't even want to think about school.
Monday I made my way to Banner Good Samaritan hospital at the appointed hour of 8:30a hoping that the folks there knew we fourth year students just wanted a pass at this point. Senioritis had hit me strong. I soon learned that Trauma Critical Care is not the place to expect leniency.
First, I was frustrated with the amount of running around for badges and paperwork. Then my Resident had no idea was coming. Oh, the schedule is basically 6am every morning but Monday and Friday when it starts at 5am. Thursday are Grand Rounds, so coat and tie are required. Moreover, Friday we are on call, so I will be spending the night and doing rounds in the morning. In other words, Friday's shift is from 4am when I wake up until Saturday around noon when I can go home!
The PGY-2 surgical Resident and I are on different planets but I'm trying to be nice to her. And I am learning stuff. It's just that she's young, strong-willed and extremely confident. No life experience, lots of book knowledge and ambition. As the week progressed, I proved I do the work, write good notes and even perform procedures adequately so I earned some respect.
I was able to do my first central line (left subclavian) , suture a big laceration and do an I & D. I also learned quite a bit from the Resident and our Attending on rounds. Didactics were pretty poor this week, but the PD was on vacation so we'll see how this week goes.
So I'm already tired and dreading my Friday night, expecting no sleep and lots of scut work. The evening started with me fetching dinner, paid for by the Attending, and charting a couple minor traumas. Then I got to sleep in my own immaculate call room. I was woken up once for minor call and then went back to sleep. My Resident even sent me home in the morning saying she would round on my patients! It was like being gifted a day in your life you nevre expected to have.
I was fairly rested and got home before 9am. I took a long nap and got a lot of home stuff done. It was great. I know Residency is coming and won't be nearly so forgiving, but as a fourth year with about 70 days until graduation, I really want to slack and enjoy myself.
Tomorrow starts at 4am, in five hours so time for a little sleep before another long day. I hope to get the OK for a house hunting trip back to Hartford that will take a few CC days and one Friday night call. That would make this month a little less painful.
Finally, no one came through the house this weekend, even after lowering the price to $249,000. Looks like we won't have the cash to go to Europe before graduation and will have to scrape by to pay for the move to Connecticut. Becky is starting to job hunt and we're hoping for a good bump in her salary. So both the house and the job are hanging over our heads at the moment.
Monday I made my way to Banner Good Samaritan hospital at the appointed hour of 8:30a hoping that the folks there knew we fourth year students just wanted a pass at this point. Senioritis had hit me strong. I soon learned that Trauma Critical Care is not the place to expect leniency.
First, I was frustrated with the amount of running around for badges and paperwork. Then my Resident had no idea was coming. Oh, the schedule is basically 6am every morning but Monday and Friday when it starts at 5am. Thursday are Grand Rounds, so coat and tie are required. Moreover, Friday we are on call, so I will be spending the night and doing rounds in the morning. In other words, Friday's shift is from 4am when I wake up until Saturday around noon when I can go home!
The PGY-2 surgical Resident and I are on different planets but I'm trying to be nice to her. And I am learning stuff. It's just that she's young, strong-willed and extremely confident. No life experience, lots of book knowledge and ambition. As the week progressed, I proved I do the work, write good notes and even perform procedures adequately so I earned some respect.
I was able to do my first central line (left subclavian) , suture a big laceration and do an I & D. I also learned quite a bit from the Resident and our Attending on rounds. Didactics were pretty poor this week, but the PD was on vacation so we'll see how this week goes.
So I'm already tired and dreading my Friday night, expecting no sleep and lots of scut work. The evening started with me fetching dinner, paid for by the Attending, and charting a couple minor traumas. Then I got to sleep in my own immaculate call room. I was woken up once for minor call and then went back to sleep. My Resident even sent me home in the morning saying she would round on my patients! It was like being gifted a day in your life you nevre expected to have.
I was fairly rested and got home before 9am. I took a long nap and got a lot of home stuff done. It was great. I know Residency is coming and won't be nearly so forgiving, but as a fourth year with about 70 days until graduation, I really want to slack and enjoy myself.
Tomorrow starts at 4am, in five hours so time for a little sleep before another long day. I hope to get the OK for a house hunting trip back to Hartford that will take a few CC days and one Friday night call. That would make this month a little less painful.
Finally, no one came through the house this weekend, even after lowering the price to $249,000. Looks like we won't have the cash to go to Europe before graduation and will have to scrape by to pay for the move to Connecticut. Becky is starting to job hunt and we're hoping for a good bump in her salary. So both the house and the job are hanging over our heads at the moment.
Friday, March 21, 2008
Match Day!
Yesterday was crazy! I'm so glad I took the day off. First, I thought the results were released at 9am, the same time we learned if we Matched on Monday. So we had a few frustrating moments until I realized we were an hour early. Their was also a bunch of family e-mails flying around asking for news. And the kids were feeding off the stress by making a commotion with their two friends who were over for a play day (one kinda invited himself somehow).
So around 9:45a I get a text message from a classmate that she got her first choice. I'm excited for her, but jealously wondering why I haven't received anything. A few minutes later the text messages really start to fly and I'm hitting refresh constantly, alternating between my e-mail account and the NRMP website. Finally, around 9:55a I refresh the NRMP site and instead of saying "Congratulations, you've Matched" as it had for the last three days, it adds three new text lines under this:
Program Code: blah blah blah
Emergency Medicine
U COnnecticut Hlth Ctr
I Matched UConn!! I will admit there was a moment of disappointment as I had been getting used to the idea of having the name Hopkins on my CV. But I remembered how much I liked the area and the people. I matched one of my top three EM programs! There was a frenzy of text messages flying among classmates. I even started texting friends I had met along the externship and interview trails. I especially enjoyed talking with Jeremy with whom I both rotated at UMass and interviewed at UMass. We had similar feelings about it and UConn where he was going to medical school. So it was fun to talk, for the first time, with a fellow incoming intern.
I also had to look up some of my notes on UConn to refresh my memory on the program. I didn't do a second look there, so some of the details were muddled up with the other ten programs I interviewed at. Finally, there were lots of family e-mails, cell phone calls and Skype calls. Becky was overjyoed with relief. The boys were a bit ambivalent because they just didn't grasp the significance of the whole thing.
About 10:15a as fate would have it, a real estate agent called about showing the house. So in the midst of the Match frenzy and the four wild boys we had to clean-up the house for a showing - that ended up as a No Show anyway.
I then went to lunch with three of my closest friends in the class. We had a nice lunch congratulating eachother, texting friends/family and even fielding calls from the programs welcoming into our new programs. It was a little weird in that the three had more certainty about there choices going in and ended up getting their first choices. I felt I had a good chance at Hopkins, but wasn't certain at all. So my feelings were a little more mixed.
I went home after doing a few errands and got ready to have Tucker and his family over for dinner. We went very casual but made sure to have a good stock of wine on hand. I got pleasantly tipsy as we talked the night away about Southbend, ID for him, and Hartford, CT for me.
It's kinda scary in that I still feel a little sketchy about the program I'm going to be starting at as a new intern in three months. There's not much on the web and I don't know any of the Residents well enough to call them for a long chat. But I know I felt very comfortable there and confident of receiving a great education.
The previous week I probably averaged 4-5 hours of sleep a night. In fact, I caught a cold from the lack of sleep. However, last night, after some wine and the relief of knowing where I Matched, I slept almost 10 luxurious hours.
So around 9:45a I get a text message from a classmate that she got her first choice. I'm excited for her, but jealously wondering why I haven't received anything. A few minutes later the text messages really start to fly and I'm hitting refresh constantly, alternating between my e-mail account and the NRMP website. Finally, around 9:55a I refresh the NRMP site and instead of saying "Congratulations, you've Matched" as it had for the last three days, it adds three new text lines under this:
Program Code: blah blah blah
Emergency Medicine
U COnnecticut Hlth Ctr
I Matched UConn!! I will admit there was a moment of disappointment as I had been getting used to the idea of having the name Hopkins on my CV. But I remembered how much I liked the area and the people. I matched one of my top three EM programs! There was a frenzy of text messages flying among classmates. I even started texting friends I had met along the externship and interview trails. I especially enjoyed talking with Jeremy with whom I both rotated at UMass and interviewed at UMass. We had similar feelings about it and UConn where he was going to medical school. So it was fun to talk, for the first time, with a fellow incoming intern.
I also had to look up some of my notes on UConn to refresh my memory on the program. I didn't do a second look there, so some of the details were muddled up with the other ten programs I interviewed at. Finally, there were lots of family e-mails, cell phone calls and Skype calls. Becky was overjyoed with relief. The boys were a bit ambivalent because they just didn't grasp the significance of the whole thing.
About 10:15a as fate would have it, a real estate agent called about showing the house. So in the midst of the Match frenzy and the four wild boys we had to clean-up the house for a showing - that ended up as a No Show anyway.
I then went to lunch with three of my closest friends in the class. We had a nice lunch congratulating eachother, texting friends/family and even fielding calls from the programs welcoming into our new programs. It was a little weird in that the three had more certainty about there choices going in and ended up getting their first choices. I felt I had a good chance at Hopkins, but wasn't certain at all. So my feelings were a little more mixed.
I went home after doing a few errands and got ready to have Tucker and his family over for dinner. We went very casual but made sure to have a good stock of wine on hand. I got pleasantly tipsy as we talked the night away about Southbend, ID for him, and Hartford, CT for me.
It's kinda scary in that I still feel a little sketchy about the program I'm going to be starting at as a new intern in three months. There's not much on the web and I don't know any of the Residents well enough to call them for a long chat. But I know I felt very comfortable there and confident of receiving a great education.
The previous week I probably averaged 4-5 hours of sleep a night. In fact, I caught a cold from the lack of sleep. However, last night, after some wine and the relief of knowing where I Matched, I slept almost 10 luxurious hours.
Wednesday, March 19, 2008
Twelve more hours!
I finished my Internal Medicine rotation today. It ended pretty uneventful. However, as always, there are a couple patients I would follow as their diagnosis is established. Now, with a week to go before the shelf test, I have to get serious about studying.
But that isn't going happen for the next day or so. At 9am tomorrow, noon East Coast time, I will hear where I matched. Becky and I have taken Thursday and Friday off from work and the kids are on Spring Break. So we will celebrate and commiserate together. Then we're having some friends over tomorrow night for a small get together. Friday, the whole class is having a get together at a restaurant near campus. Finally, Friday night the whole and everyone's families have been invited to large gathering. I'm not sure if we'll make all three events, but it will be nice to release some tension with fellow classmates.
Becky is pretty stressed. I've come down with a cold from poor sleep secondary to stress. According to the common paradigm, I go into my cave when stressed, which for me has been playing World of Warcraft online. Unfortunately, I'm not very at releasing stress by working out more or doing something more productive. But at least it will be over soon.
Once we learn where we're going, it will time to get serious about selling or renting the house, studying for the shelf test, getting in shape, house hunting wherever we're going and helping Becky start to look for a new job. The listing sure hasn't started a stampede. We've had about five showings in two weeks. The financial news has been terrible, culminating in Bear Stearns imploding in the last week. On the good side, the Fed has reduced interest rates around two points in the last month so loans, if you have good credit, are pretty affordable.
Oh, most importantly, Becky and my entire family, our friends and acquaintances all want to hear exactly where we're going the moment we learn the Program we've Matched. So from about nine am until probably noon I'll be on the phone and sending out e-mails.
But that isn't going happen for the next day or so. At 9am tomorrow, noon East Coast time, I will hear where I matched. Becky and I have taken Thursday and Friday off from work and the kids are on Spring Break. So we will celebrate and commiserate together. Then we're having some friends over tomorrow night for a small get together. Friday, the whole class is having a get together at a restaurant near campus. Finally, Friday night the whole and everyone's families have been invited to large gathering. I'm not sure if we'll make all three events, but it will be nice to release some tension with fellow classmates.
Becky is pretty stressed. I've come down with a cold from poor sleep secondary to stress. According to the common paradigm, I go into my cave when stressed, which for me has been playing World of Warcraft online. Unfortunately, I'm not very at releasing stress by working out more or doing something more productive. But at least it will be over soon.
Once we learn where we're going, it will time to get serious about selling or renting the house, studying for the shelf test, getting in shape, house hunting wherever we're going and helping Becky start to look for a new job. The listing sure hasn't started a stampede. We've had about five showings in two weeks. The financial news has been terrible, culminating in Bear Stearns imploding in the last week. On the good side, the Fed has reduced interest rates around two points in the last month so loans, if you have good credit, are pretty affordable.
Oh, most importantly, Becky and my entire family, our friends and acquaintances all want to hear exactly where we're going the moment we learn the Program we've Matched. So from about nine am until probably noon I'll be on the phone and sending out e-mails.
Sunday, March 16, 2008
Match Week!
Work at St. Luke's has been going ok. Reasonable schedule, occasionally an interesting patient and free food. But my sleep, studying and working out has started to suffer. Becky noticed before I did that I was going into my usual 'stress survival' mode. I didn't even realize how much stress I was feeling.
I just don't do well when everything is out of my control. It's just a waiting game now. Tomorrow (Monday), by noon, I should hear that I've Matched at one of the 11 programs on my ROL. If not, Tuesday at noon, the Scramble starts for 48 hours of hell. I would be clinically depressed at that point.
Assuming all goes ok and I hear I Matched somewhere tomorrow, it's three more long days of waiting. Thursday by noon, I hear where we are actually going. I'm scheduled to work on Thursday, but will try to get off early. I already got permission to take Friday off.
I can't predict how I'll be feeling on Friday, but I'm pretty sure working won't be high on the list. Our class has a party planned for Friday night. But I may not wait until Friday to start celebrating.
Residency Match is an exciting time, but nothing is as much fun when the outcome is totally out of your control.
I just don't do well when everything is out of my control. It's just a waiting game now. Tomorrow (Monday), by noon, I should hear that I've Matched at one of the 11 programs on my ROL. If not, Tuesday at noon, the Scramble starts for 48 hours of hell. I would be clinically depressed at that point.
Assuming all goes ok and I hear I Matched somewhere tomorrow, it's three more long days of waiting. Thursday by noon, I hear where we are actually going. I'm scheduled to work on Thursday, but will try to get off early. I already got permission to take Friday off.
I can't predict how I'll be feeling on Friday, but I'm pretty sure working won't be high on the list. Our class has a party planned for Friday night. But I may not wait until Friday to start celebrating.
Residency Match is an exciting time, but nothing is as much fun when the outcome is totally out of your control.
Tuesday, March 04, 2008
House on the market
We put the house on the market last weekend after several weeks of Becky's mom (and her BF) doing lots of little repair jobs around the house, then the four of us doing some thorough clean-up for the last two weeks.
The house looks great. I still have to do a little bit of exterior touch-up painting out back, and we've managed yet again to kill much of the lawn. But our agent, the same one we used to buy the house, likes the property and the price we are asking.
We'll make a little if we don't have to come down much. But the stories going around sound like it could be months on the market unless we are ready to negotiate. At least with the Match, we know the outcome will be decided on March 20th. With the house we have no control over the timeframe.
The house looks great. I still have to do a little bit of exterior touch-up painting out back, and we've managed yet again to kill much of the lawn. But our agent, the same one we used to buy the house, likes the property and the price we are asking.
We'll make a little if we don't have to come down much. But the stories going around sound like it could be months on the market unless we are ready to negotiate. At least with the Match, we know the outcome will be decided on March 20th. With the house we have no control over the timeframe.
Internal Medicine
The schedule this month is much more enjoyable than Trauma. I get in around 7am, have breakfast in the Doctor's lounge and meet the team at St. Luke's ICU around 7:30am. My preceptor and I then efficiently see the 14-16 patients we have until lunch time. Another decent and free meal in the Doctor's lounge follows.
In the afternoon we see any stragglers, but I able to leave by 3pm at the latest. Traffic is still surprisingly bad from downtown back to Glendale, but I have time to do swimming with Connor at LA Fitness or help the boys with their homework. The former is a real treat.
The whole family put on weight while we had relatives in town. And even though I seem to be the only one that can say no to bad food, my travel schedule and lack of consistent exercise (the month of flu and pneumo didn't help) leaves me with an extra 10-15 lbs to shed before residency. So Connor and I share a lane and workout together. He's a very swimmer and so far it's been fun and motivational for both of us.
I couldn't swim tonight as I'm healing from a dumb abscess. After sitting on it for a week, I finally went in to an Urgent Care and an I&D and some Keflex. Now I can empathize much better with my patients about how the lidocaine burns, and it doesn't always numb the pockets that have to be opened up for drainage. Anyway, tonight I was able (forced) to coach Connor from the poolside. It was nice to provide some tips on his stroke and see what he can do.
As for my duties on this rotation, I get to write out H&Ps on new patients and SOAP notes for current patients. I see the patients, do a quick exam and write as good a note as I can. No procedures and very little teaching. Not much time for studying up on cases or my post-rotation exam objectives either. So it's a mixed bag. But I'm digging the schedule and REALLY glad I'm going in EM versus IM/hospitalist.
In the afternoon we see any stragglers, but I able to leave by 3pm at the latest. Traffic is still surprisingly bad from downtown back to Glendale, but I have time to do swimming with Connor at LA Fitness or help the boys with their homework. The former is a real treat.
The whole family put on weight while we had relatives in town. And even though I seem to be the only one that can say no to bad food, my travel schedule and lack of consistent exercise (the month of flu and pneumo didn't help) leaves me with an extra 10-15 lbs to shed before residency. So Connor and I share a lane and workout together. He's a very swimmer and so far it's been fun and motivational for both of us.
I couldn't swim tonight as I'm healing from a dumb abscess. After sitting on it for a week, I finally went in to an Urgent Care and an I&D and some Keflex. Now I can empathize much better with my patients about how the lidocaine burns, and it doesn't always numb the pockets that have to be opened up for drainage. Anyway, tonight I was able (forced) to coach Connor from the poolside. It was nice to provide some tips on his stroke and see what he can do.
As for my duties on this rotation, I get to write out H&Ps on new patients and SOAP notes for current patients. I see the patients, do a quick exam and write as good a note as I can. No procedures and very little teaching. Not much time for studying up on cases or my post-rotation exam objectives either. So it's a mixed bag. But I'm digging the schedule and REALLY glad I'm going in EM versus IM/hospitalist.
ROL list
My Rank Order List is submitted. The one thing I changed in the days preceding the Feb. 27th deadline was to put Maricopa higher in the list. While I have some concerns about the hospital it sounds like they have addressed all but 6 of the original 30 or so problems JHACO identified. Even more importantly, the RRC (residency review committee) for the EM program gave Maricopa it's highest approval rating.
Maricopa would have some additional benefits that weighed on me over the last few weeks. The weather here in Phoenix is just perfect this time of year. We can do anything outdoors now; bike, run, hike, etc. Selling the house is going to be as stressful as the Match given the awful housing and financing market. Lots of nightmare stories getting thrown around. So we could keep stay in the house and commute until the right buyer or renter came along. Finally, Becky would have more flexibility of when to leave St. Mary's Foodbank.
The final ROL came out as:
1) Hopkins: tough call with #2, but the name, prestige and integrated fellowship may really help my career later on. Also, between Baltimore and DC, Becky has lots of options.
2) Christiana: I would be thrilled to go here with no reservations whatsoever. It just doesn't have the name, especially on the West Coast, that Hopkins. The program though is equal or better IMHO.
3) UConn: the people are terrific and the program is top notch. Again, I wouldn't have any problem ending up in Hartford, CT.
4) Maricopa: old facility, some problems with the hospital and questions about a few of the residents, but #4 for the reasons mentioned above.
5) UMass: incredible facility and lots of great residents, I just didn't like that so many of the Attendings seemed focused on moving patients with little interest in teaching residents.
6) Case/Metrohealth: the tie-in with Cleveland Clinic makes this a top notch program. The area is my biggest concern.
7) St. Vincent's: like Case, great program in the wrong location but even more so. I really like people and the program (great incorporation of moonlighting into training), but the area's economy follows Detroit and there's little to love about Toledo.
8) Cooper: I would much rather end up here than scramble for a spot, Camden is a rough town.
9) Baystate/Tufts: great recreational area, but the place is in shambles and no seems to care.
10) Morris: tiny program that felt like a tight knit family.
11) Drexel: Phili would be doable, but I would be disappointed if I matched this far down my list.
Maricopa would have some additional benefits that weighed on me over the last few weeks. The weather here in Phoenix is just perfect this time of year. We can do anything outdoors now; bike, run, hike, etc. Selling the house is going to be as stressful as the Match given the awful housing and financing market. Lots of nightmare stories getting thrown around. So we could keep stay in the house and commute until the right buyer or renter came along. Finally, Becky would have more flexibility of when to leave St. Mary's Foodbank.
The final ROL came out as:
1) Hopkins: tough call with #2, but the name, prestige and integrated fellowship may really help my career later on. Also, between Baltimore and DC, Becky has lots of options.
2) Christiana: I would be thrilled to go here with no reservations whatsoever. It just doesn't have the name, especially on the West Coast, that Hopkins. The program though is equal or better IMHO.
3) UConn: the people are terrific and the program is top notch. Again, I wouldn't have any problem ending up in Hartford, CT.
4) Maricopa: old facility, some problems with the hospital and questions about a few of the residents, but #4 for the reasons mentioned above.
5) UMass: incredible facility and lots of great residents, I just didn't like that so many of the Attendings seemed focused on moving patients with little interest in teaching residents.
6) Case/Metrohealth: the tie-in with Cleveland Clinic makes this a top notch program. The area is my biggest concern.
7) St. Vincent's: like Case, great program in the wrong location but even more so. I really like people and the program (great incorporation of moonlighting into training), but the area's economy follows Detroit and there's little to love about Toledo.
8) Cooper: I would much rather end up here than scramble for a spot, Camden is a rough town.
9) Baystate/Tufts: great recreational area, but the place is in shambles and no seems to care.
10) Morris: tiny program that felt like a tight knit family.
11) Drexel: Phili would be doable, but I would be disappointed if I matched this far down my list.
Sunday, February 17, 2008
Trauma surgery and second looks
One more week of trauma surgery to go at Maricopa. Since I missed one week for second looks back east, I've really only been on the service for two weeks. However, it has been more than enough time to confirm some things for me.
First, I'm sooo glad I didn't go for surgery. I still love the OR and surgical procedures, but the amount of BS during residency, even with the 80-hour work week limits, is ridiculous. It's like two years of hazing, then three years servitude, constant testing (and pimping) and constant time draining hassles. Residency paperwork, students, inadequate staff, off-service residents, hospital bureaucracy and the usual political battles between doctor groups, administrators and out placement agencies is never-ending. Even the chief (a PGY-4) spends a lot of time watching Attendings doing the cool stuff in the OR.
Second, Maricopa is a decent program but not one I'm crazy out. If I end up here, I'll rise above the adversity and get the education I need. But JHACO problems, EM residents that don't wait around for placentas to be delivered and general lack of professionalism (not just in EM) have me concerned. The facility is also in pretty poor shape and their U/S training is behind the curve.
On the other hand, my second looks were very confirming. I spent a day at Christiana and loved it. I almost didn't want to like Hopkins so I could rank Christiana #1 (which I still might). The people are awesome, he training second to none and the program very resident friendly. Finally, only three years, great benefits and moonlighting would lead to a reasonable lifestyle. Since I didn't rotate at Hopkins I was a little fuzzy on many aspects of the program and much less prepared for how the second look would go. But that's why the second look at Hopkins was so important.
After getting lost in Baltimore, I worked Wednesday night with the U/S director and one of the Chiefs I got to know during the initial interview. For 3-4 hours at Bayview Hospital I asked tons of questions while we handled a few patients. The facility was decent, the staff seemed fine and everyone got along well. The answers regarding the program and the area were predictable and gave me a pretty positive feeling.
Thursday I worked at the main Johns Hopkins Hospital for a few hours. The Attending was a recent Hopkins graduate and the intern was another John. Even though it was very busy, I had time to ask lots of questions and observe a lot of the ED operation. Again, while the facility was nothing spectacular and no one aspect of the program screamed at me, I had a good gut feeling for the place. I really wanted to make sure I wasn't being swayed by the Hopkins name and family/friends' awe about the institution. The two days in the main EDs were very confidence building in this respect.
Friday morning I attended Hopkin's weekly on conference day. The lectures were great, like Christiana's, and I really enjoyed hanging out with the residents. It probably didn't hurt that I was there on the day the residents consolidated their impressions of the applicants for the department. I think I made a good impression on everyone there.
The program director was out of town, so I had to catch up with him by phone a week later. I don't trust platitudes and goodwill for a decision this important to my career, but I got a really good feeling from him. Everything feels right and I've heard time and again from residents that you have to trust those feelings. Every RRC approved program can train you, but you've got to be comfortable to do your best while you're there.
After the conference I drove around Baltimore a little and stopped by a Remax office to talk with an agent in one of the neighborhoods recommended to me several times for good schools, family activities, access to Baltimore and DC and affordability. Becky was even encouraged by initial looks at job prospects based on openings listed online.
I've got 10 more days until the ROL has to be finalized and submitted for the Match. So there's plenty of time for nagging doubts about four years of residency at Hopkins without moonlighting (as of now) to change my mind. In the meantime, the house goes on the market in a week. Crazy times for the whole family.
Speaking of family, Becky's mom and grandmother left a week ago, just as they got hit with the influenza bug that Connor and I had a few weeks ago. The vaccine doesn't seem to be active against this year's strains, so there's epidemics all over the country. Like me, they acquired a pneumonia super-infection like I did. However, her grandmother is 91 years old and is now in the ICU with possible hypoxic heart damage. At that age you just don't have the immune system to fight these infections, and you go downhill in hours.
Time to get a little sleep before the five o'clock alarm. Six o'clock rounds every day for five years would be torture for me. That's not including Wednesdays where rounds start at five, lecture is from six to nine and turnover to the night crew isn't until six in the evening, thirteen hours later!
First, I'm sooo glad I didn't go for surgery. I still love the OR and surgical procedures, but the amount of BS during residency, even with the 80-hour work week limits, is ridiculous. It's like two years of hazing, then three years servitude, constant testing (and pimping) and constant time draining hassles. Residency paperwork, students, inadequate staff, off-service residents, hospital bureaucracy and the usual political battles between doctor groups, administrators and out placement agencies is never-ending. Even the chief (a PGY-4) spends a lot of time watching Attendings doing the cool stuff in the OR.
Second, Maricopa is a decent program but not one I'm crazy out. If I end up here, I'll rise above the adversity and get the education I need. But JHACO problems, EM residents that don't wait around for placentas to be delivered and general lack of professionalism (not just in EM) have me concerned. The facility is also in pretty poor shape and their U/S training is behind the curve.
On the other hand, my second looks were very confirming. I spent a day at Christiana and loved it. I almost didn't want to like Hopkins so I could rank Christiana #1 (which I still might). The people are awesome, he training second to none and the program very resident friendly. Finally, only three years, great benefits and moonlighting would lead to a reasonable lifestyle. Since I didn't rotate at Hopkins I was a little fuzzy on many aspects of the program and much less prepared for how the second look would go. But that's why the second look at Hopkins was so important.
After getting lost in Baltimore, I worked Wednesday night with the U/S director and one of the Chiefs I got to know during the initial interview. For 3-4 hours at Bayview Hospital I asked tons of questions while we handled a few patients. The facility was decent, the staff seemed fine and everyone got along well. The answers regarding the program and the area were predictable and gave me a pretty positive feeling.
Thursday I worked at the main Johns Hopkins Hospital for a few hours. The Attending was a recent Hopkins graduate and the intern was another John. Even though it was very busy, I had time to ask lots of questions and observe a lot of the ED operation. Again, while the facility was nothing spectacular and no one aspect of the program screamed at me, I had a good gut feeling for the place. I really wanted to make sure I wasn't being swayed by the Hopkins name and family/friends' awe about the institution. The two days in the main EDs were very confidence building in this respect.
Friday morning I attended Hopkin's weekly on conference day. The lectures were great, like Christiana's, and I really enjoyed hanging out with the residents. It probably didn't hurt that I was there on the day the residents consolidated their impressions of the applicants for the department. I think I made a good impression on everyone there.
The program director was out of town, so I had to catch up with him by phone a week later. I don't trust platitudes and goodwill for a decision this important to my career, but I got a really good feeling from him. Everything feels right and I've heard time and again from residents that you have to trust those feelings. Every RRC approved program can train you, but you've got to be comfortable to do your best while you're there.
After the conference I drove around Baltimore a little and stopped by a Remax office to talk with an agent in one of the neighborhoods recommended to me several times for good schools, family activities, access to Baltimore and DC and affordability. Becky was even encouraged by initial looks at job prospects based on openings listed online.
I've got 10 more days until the ROL has to be finalized and submitted for the Match. So there's plenty of time for nagging doubts about four years of residency at Hopkins without moonlighting (as of now) to change my mind. In the meantime, the house goes on the market in a week. Crazy times for the whole family.
Speaking of family, Becky's mom and grandmother left a week ago, just as they got hit with the influenza bug that Connor and I had a few weeks ago. The vaccine doesn't seem to be active against this year's strains, so there's epidemics all over the country. Like me, they acquired a pneumonia super-infection like I did. However, her grandmother is 91 years old and is now in the ICU with possible hypoxic heart damage. At that age you just don't have the immune system to fight these infections, and you go downhill in hours.
Time to get a little sleep before the five o'clock alarm. Six o'clock rounds every day for five years would be torture for me. That's not including Wednesdays where rounds start at five, lecture is from six to nine and turnover to the night crew isn't until six in the evening, thirteen hours later!
Thursday, January 31, 2008
January 2008 coming to a close
It's been a busy month. For the first couple of weeks, my "cold" continued to get worse - to the point that I think I had walking pneumonia. My preceptor (Dr. Wiss) wrote me a prescription for a Z-pack and in 24 hours I was feeling 100% better. I'm sure my immune system was weakened by the stress and exhaustion. The ironic thing is that I had two of my easiest rotations yet over January.
The first two weeks of the New Year were supposed to be Neuro. However, my preceptor, Dr. Winograd, took vacation over the first week so it ended up as a one week rotation. I saw a lot during that week though and gained a new appreciation for neurology. It was actually quite fun, but would be too narrow to interest me from a career standpoint.
Becky's relatives then arrived for an extended stay. Her mom and significant other (S.O.) started working on a long list of home projects that we needed done to get the house ready to sell. it was a great help since I was worthless between being sick, traveling, new rotations and playing with the kids. In fact, I've been a terrible host.
The second half of January was a rotation in gastrointestinal medicine. However, the preceptor, Dr. Wiss, didn't make me go to the hospital for colonoscopies and procedures. Normally I would have loved to get in some procedures. But in this case I could rest and try to recover. The second week I missed most of my clinic time with my last two interviews, to St. Vincent's and Case/Metrohealth/Cleveland Clinic. In the end I worked one full day and three half days!
The interviews went great. I really enjoyed seeing many of the residents I got to know at St. Vincent's and they made it clear they would love to have me. The only reason I'm not ranking the program high is that Toledo is in a depression, like Detroit and most of Michigan, so Becky would have a difficult time getting a job. In fact, the program is very similar to UConn: friendly, great training, good facilities, good patient volume and some good attendings.
Case Western was new to me and I ended liking it more than I expected. The program seemed very good with great didactics and friendly residents, attendings and staff. It felt like this familiar attitude is a Midwest culture thing. And for a county program (Metrohealth) it is pretty cushy and well supported. Moreover, you spend 1/3 of your time at Cleveland Clinic (they pay 1/3 of your salary) and, while not as glitzy as I imagined, the place is pretty impressive. Finally, while Cleveland certainly offers more job opportunities for Becky than Toledo, the city sure showed signs of economic hardship. At this point, I will probably rank it fourth or fifth.
I enjoyed a rare couple weeks of being a slacker by sleeping more, riding our new mountain bikes on family trips to local mountain trails and playing some World of Warcraft with the boys. They are now at the age that they enjoy social games, whether playing with me or friends from school. And while WOW isn't that impressive from a graphics or class/race aspect, it plays on even my dinky three-year-old ultralight notebook.
This week I started Trauma Surgery at Maricopa county. It's kind of like a long second look at the EM residency program and a warm-up for residency. However, I'm feeling like a glutton for punishment when senioritis is starting to take over. We start at five or six am everyday and end at five or six pm. Then it's at least a 40-minute commute into downtown. Worse, with PAs, PA students, interns, residents and fellows on the service with me it's very slow. I've had one patient each day this week and got to do a couple procedures for the first time today: a foley and a bronchial lavage of blood from an motorcyclist vs. semi victim (without helmet of course).
Maricopa isn't looking too impressive at this point. I like the residents, but the volume is slow, the facility adequate at best and, worst of all, the hospital is on probation with JHACO. When residents joke about the place closing down, you really have to consider the implications.
I'm just getting up to speed now and tomorrow, on day five, we have three new residents replacing the experienced ones that were doing most of the work this week. Tomorrow I will one of the "experienced" people on the service! I'm just thankful that I will miss most of nest week while I travel to Christiana and Johns Hopkins for second looks. I may ask for Monday off even though I don't fly until Tuesday just so I have a day to rest up.
I got a 92% on my neuro test, so now it's time to start studying for Critical Care test. That is once I get used to my new schedule. I'm exhausted because I can't fall asleep until 11 or 12 and then get up at 4 or 5. And I still need to find a way to fit workouts in during the week. I finally stopped by an LA Fitness to swim after work today only to find the pool was an unattended facility off by itself with a bunch of ducks swimming laps! Obviously that wasn't going to do, so I'm still looking for something outside of our weekend mountain bike rides to keep healthy.
The first two weeks of the New Year were supposed to be Neuro. However, my preceptor, Dr. Winograd, took vacation over the first week so it ended up as a one week rotation. I saw a lot during that week though and gained a new appreciation for neurology. It was actually quite fun, but would be too narrow to interest me from a career standpoint.
Becky's relatives then arrived for an extended stay. Her mom and significant other (S.O.) started working on a long list of home projects that we needed done to get the house ready to sell. it was a great help since I was worthless between being sick, traveling, new rotations and playing with the kids. In fact, I've been a terrible host.
The second half of January was a rotation in gastrointestinal medicine. However, the preceptor, Dr. Wiss, didn't make me go to the hospital for colonoscopies and procedures. Normally I would have loved to get in some procedures. But in this case I could rest and try to recover. The second week I missed most of my clinic time with my last two interviews, to St. Vincent's and Case/Metrohealth/Cleveland Clinic. In the end I worked one full day and three half days!
The interviews went great. I really enjoyed seeing many of the residents I got to know at St. Vincent's and they made it clear they would love to have me. The only reason I'm not ranking the program high is that Toledo is in a depression, like Detroit and most of Michigan, so Becky would have a difficult time getting a job. In fact, the program is very similar to UConn: friendly, great training, good facilities, good patient volume and some good attendings.
Case Western was new to me and I ended liking it more than I expected. The program seemed very good with great didactics and friendly residents, attendings and staff. It felt like this familiar attitude is a Midwest culture thing. And for a county program (Metrohealth) it is pretty cushy and well supported. Moreover, you spend 1/3 of your time at Cleveland Clinic (they pay 1/3 of your salary) and, while not as glitzy as I imagined, the place is pretty impressive. Finally, while Cleveland certainly offers more job opportunities for Becky than Toledo, the city sure showed signs of economic hardship. At this point, I will probably rank it fourth or fifth.
I enjoyed a rare couple weeks of being a slacker by sleeping more, riding our new mountain bikes on family trips to local mountain trails and playing some World of Warcraft with the boys. They are now at the age that they enjoy social games, whether playing with me or friends from school. And while WOW isn't that impressive from a graphics or class/race aspect, it plays on even my dinky three-year-old ultralight notebook.
This week I started Trauma Surgery at Maricopa county. It's kind of like a long second look at the EM residency program and a warm-up for residency. However, I'm feeling like a glutton for punishment when senioritis is starting to take over. We start at five or six am everyday and end at five or six pm. Then it's at least a 40-minute commute into downtown. Worse, with PAs, PA students, interns, residents and fellows on the service with me it's very slow. I've had one patient each day this week and got to do a couple procedures for the first time today: a foley and a bronchial lavage of blood from an motorcyclist vs. semi victim (without helmet of course).
Maricopa isn't looking too impressive at this point. I like the residents, but the volume is slow, the facility adequate at best and, worst of all, the hospital is on probation with JHACO. When residents joke about the place closing down, you really have to consider the implications.
I'm just getting up to speed now and tomorrow, on day five, we have three new residents replacing the experienced ones that were doing most of the work this week. Tomorrow I will one of the "experienced" people on the service! I'm just thankful that I will miss most of nest week while I travel to Christiana and Johns Hopkins for second looks. I may ask for Monday off even though I don't fly until Tuesday just so I have a day to rest up.
I got a 92% on my neuro test, so now it's time to start studying for Critical Care test. That is once I get used to my new schedule. I'm exhausted because I can't fall asleep until 11 or 12 and then get up at 4 or 5. And I still need to find a way to fit workouts in during the week. I finally stopped by an LA Fitness to swim after work today only to find the pool was an unattended facility off by itself with a bunch of ducks swimming laps! Obviously that wasn't going to do, so I'm still looking for something outside of our weekend mountain bike rides to keep healthy.
Tuesday, January 01, 2008
New Year's Eve - it's 2008!
I had many possible choices for my New Year's resolution, including getting into shape, graduating from medical school, getting one of my top residency selections and staying healthy (this cold is still holding me back). I'm going attempt all of them for an ambitious 2008.
Tucker and his family came over for the evening. The kids get along great and seemed to have a great comparing Rock Band for the Xbox and Guitar Hero III for the Wii. The former has drums and a microphone, but the latter has much better songs.
It was a pretty laid-back evening with some wine, a baked potato bar and a lot of socializing. Tucker and I agreed that our motivation for medical school is pretty low right now. Fourth year you just want to get your residency slot, not get as many patients as possible on rotation or work your tail off to impress attendings. Makes me wonder what I was thinking when I scheduled three tough rotations for end of fourth year: Trauma Surgery; Internal Medicine Sub-I; and Critical Care. At least I have May off for our long-awaited family vacation.
We celebrated New Year's on New York time so Tucker and his family could get home at a reasonable to avoid the drunks and have the kids in bed before midnight. The boys and I stayed up until New Year's local time and watched the apple, but it was kinda anti-climatic.
Here we are on January 1st, 2008 and we're just lounging around. Becky went for a run, I'm filling up Kleenex boxes with used tissue and the boys are playing Xbox.
My most important goal for today is get my Thank You cards out for the New England interviews I had two weeks ago. The holidays, being sick and the PE exam slowed me down, but the cards are my desk and the task has been in the back of my mind for days and days. Time to stop procrastinating. I finally got caught up on this blog, so that's a good start.
Tucker and his family came over for the evening. The kids get along great and seemed to have a great comparing Rock Band for the Xbox and Guitar Hero III for the Wii. The former has drums and a microphone, but the latter has much better songs.
It was a pretty laid-back evening with some wine, a baked potato bar and a lot of socializing. Tucker and I agreed that our motivation for medical school is pretty low right now. Fourth year you just want to get your residency slot, not get as many patients as possible on rotation or work your tail off to impress attendings. Makes me wonder what I was thinking when I scheduled three tough rotations for end of fourth year: Trauma Surgery; Internal Medicine Sub-I; and Critical Care. At least I have May off for our long-awaited family vacation.
We celebrated New Year's on New York time so Tucker and his family could get home at a reasonable to avoid the drunks and have the kids in bed before midnight. The boys and I stayed up until New Year's local time and watched the apple, but it was kinda anti-climatic.
Here we are on January 1st, 2008 and we're just lounging around. Becky went for a run, I'm filling up Kleenex boxes with used tissue and the boys are playing Xbox.
My most important goal for today is get my Thank You cards out for the New England interviews I had two weeks ago. The holidays, being sick and the PE exam slowed me down, but the cards are my desk and the task has been in the back of my mind for days and days. Time to stop procrastinating. I finally got caught up on this blog, so that's a good start.
Playing with Santa's gifts
The weekend before New Year's was spent riding our new bikes, fixing their flat tires and playing Rock Band. The boys are also playing their new single player games as well, but Rock Band is the most popular, especially with their friends.
I did get some news. My Neuro rotation won't start until January 7th because my preceptor is taking the week off. So my rotation is basically going to be one week. If I can get motivated, that should give me plenty of time to read my Neuro book in preparation for the post-rotation exam.
I'm writing this from my notebook as we manged to confirm that the desktop PC is dead. The kids and I would love a new mid-level gaming PC, but it's going to have to wait after an expensive Christmas. I might have to forego the iPod Touch again and get a new PC for mine and Connor's Birthday presents.
I did get some news. My Neuro rotation won't start until January 7th because my preceptor is taking the week off. So my rotation is basically going to be one week. If I can get motivated, that should give me plenty of time to read my Neuro book in preparation for the post-rotation exam.
I'm writing this from my notebook as we manged to confirm that the desktop PC is dead. The kids and I would love a new mid-level gaming PC, but it's going to have to wait after an expensive Christmas. I might have to forego the iPod Touch again and get a new PC for mine and Connor's Birthday presents.
Level 2 PE in Philadelphia
I left on Thursday the 27th for Philadelphia and finished reading the FirstAid book's mini-cases on the plane. However, I had acquired a nasty virus that was wearing me down. By the time I go the hotel I was exhausted and hadn't started to practice writing out the full cases.
After a long nap I managed to write out 4-5 cases and review another 10 or so. I didn't feel well prepared but knew that passing is all I need and sleep was probably more important. Luckily the cold and nap didn't keep me from getting a decent night's sleep.
The proctors running the exam were nice enough and really explained everything in detail. None of us examinees were nervous when it was time to start. After the first four cases we had lunch. Then four more cases before a short 15-minute break. After the last four cases, I left as quickly as possible to catch my flight back to Phoenix.
The PE exam seemed like most things in the osteopathic world - a joke designed to pad AOA egos and save face for them in front of AMA MDs. I am pretty disgusted that I had to spend over $1500 and two days for a brain-dead test with actors worse than the ones we had for on-campus standardized cases. I found the cases in the FirstAid book on the USMLE Step 2 CS much tougher and more realistic.
If the AOA and osteopathic community were really interested in improving patient care and physician education they would have tried something new instead of just copying the allopathic tests for millionth time.
My irritation with the NBOME and AOA was almost enough to make me forget how irritated I was with their preferred hotel, Marriott, for nickle and diming me bill to the point of being a rip off.
The flight home was fine and allowed me a chance to read up on my forthcoming Neurology rotation. But to top the trip off, I arrived home to find out that our four year old desktop PC had died.
After a long nap I managed to write out 4-5 cases and review another 10 or so. I didn't feel well prepared but knew that passing is all I need and sleep was probably more important. Luckily the cold and nap didn't keep me from getting a decent night's sleep.
The proctors running the exam were nice enough and really explained everything in detail. None of us examinees were nervous when it was time to start. After the first four cases we had lunch. Then four more cases before a short 15-minute break. After the last four cases, I left as quickly as possible to catch my flight back to Phoenix.
The PE exam seemed like most things in the osteopathic world - a joke designed to pad AOA egos and save face for them in front of AMA MDs. I am pretty disgusted that I had to spend over $1500 and two days for a brain-dead test with actors worse than the ones we had for on-campus standardized cases. I found the cases in the FirstAid book on the USMLE Step 2 CS much tougher and more realistic.
If the AOA and osteopathic community were really interested in improving patient care and physician education they would have tried something new instead of just copying the allopathic tests for millionth time.
My irritation with the NBOME and AOA was almost enough to make me forget how irritated I was with their preferred hotel, Marriott, for nickle and diming me bill to the point of being a rip off.
The flight home was fine and allowed me a chance to read up on my forthcoming Neurology rotation. But to top the trip off, I arrived home to find out that our four year old desktop PC had died.
Christmas 2007
My dad and stepmother came into town from California and stayed for a few days. It's always fun to have company for the big holidays and this was no exception. For Christmas Eve we started a new tradition of having salmon and then had a more standard honey-baked ham on Christmas Day.
Christmas Eve we let the boys open their presents from relatives and us. They knew the bikes were the big ticket item, but we pleased to get two of their most desited Xbox 360 games and a few appropriate books. I gave Grandpa a hilarious book from the Onion called Our Dumb World that the adults laughing to tears while the boys tried out their new games.
Christmas morning we had our traditional one present from Santa and several "love presents" in their stockings. The one present was the hard-to-get present for 2007 that we managed to snag from at a local vendor. Rock Band doesn't have as many good songs as we expected or would like, but the kids love using the guitar, drums and microphone to score points (get fans). In the sleep-overs they have had with friends since Christmas, they played for hours screeching out REM, the Clash and the Who. It is quite funny to watch and hear.
I started playing an online game on the PC afterwards as a way to procrastinate from studying for my PE exam on Friday the 28th. That and buying replacement tubes for bikes.
Christmas Eve we let the boys open their presents from relatives and us. They knew the bikes were the big ticket item, but we pleased to get two of their most desited Xbox 360 games and a few appropriate books. I gave Grandpa a hilarious book from the Onion called Our Dumb World that the adults laughing to tears while the boys tried out their new games.
Christmas morning we had our traditional one present from Santa and several "love presents" in their stockings. The one present was the hard-to-get present for 2007 that we managed to snag from at a local vendor. Rock Band doesn't have as many good songs as we expected or would like, but the kids love using the guitar, drums and microphone to score points (get fans). In the sleep-overs they have had with friends since Christmas, they played for hours screeching out REM, the Clash and the Who. It is quite funny to watch and hear.
I started playing an online game on the PC afterwards as a way to procrastinate from studying for my PE exam on Friday the 28th. That and buying replacement tubes for bikes.
Getting ready for Christmas and Level 2 PE
I spent the vast majority of my time preparing for Christmas, not the PE exam. I inconsistently read the FirstAid book for allopathic version of the test, USMLE Step 2 CS. But didn't get very far. Instead, Becky and I laid out the plans for Christmas and I got to shopping.
The big item this year ended up being mountain bikes. We are all having a rough time getting back into shape and definitely ate too much crap (me while traveling the last fours months). I haven't gone swimming or biking more than a couple times each even though Becky now has a road bike and the kids are old enough to leave them home alone for an hour or so. Moreover, the kids had gotten a little tired of swimming, and we of forcing them to go to practice.
So I decided that mountain biking would be something we could all do as a family on weekends an the boys could even do after school in the local "wash". That's a Phoenix term for overgrown drainage ditches. They are the size of a river to handle floods, but are dry 99% of the time, so coyotes, rabbits and human use them most of the year.
This was an expensive decision for us at this point, but Becky and I committed that we'd get our tushes out of the house on weekends and spent some quality with our kids. The boys and I visited the top local store, Swiss American Cycling, and the immediately fell in love with the idea of mountain biking. Probably more accurately, with the idea of getting new bikes. Colton had always had hand-me downs from his brother, so he was ecstatic about gettin a cool new bike.
We picked them up on Saturday before Christmas so the boys would have something to do other than start their two week break glued to the TV. We managed to get the bikes home and surprise them, only after realizing that we'd be getting a new bike carrier. After very minimal set-up the boys and I went out for a quick ride.
They were tentative, Colton less so, but really enjoyed it. On Sunday Connor had a head-over-handlebars crash in the street and hurt his wrist, so Colton and I went exploring. The following day all four of us went for an easy ride. I still felt the boys were excited, just not as passionate about it as I would have liked. That changed after Christmas went to some BMX trails by AZCOM with lots of obstacles, jumps and gullies. Now they boys are huge fans and can't wait to go riding every day. It's starting to feel like money well spent.
Our biggest hassle has been popped tire tubes. I'm putting on Slimes now, but we had 1-2 punctures per ride for the first week! That gets old fast.
The big item this year ended up being mountain bikes. We are all having a rough time getting back into shape and definitely ate too much crap (me while traveling the last fours months). I haven't gone swimming or biking more than a couple times each even though Becky now has a road bike and the kids are old enough to leave them home alone for an hour or so. Moreover, the kids had gotten a little tired of swimming, and we of forcing them to go to practice.
So I decided that mountain biking would be something we could all do as a family on weekends an the boys could even do after school in the local "wash". That's a Phoenix term for overgrown drainage ditches. They are the size of a river to handle floods, but are dry 99% of the time, so coyotes, rabbits and human use them most of the year.
This was an expensive decision for us at this point, but Becky and I committed that we'd get our tushes out of the house on weekends and spent some quality with our kids. The boys and I visited the top local store, Swiss American Cycling, and the immediately fell in love with the idea of mountain biking. Probably more accurately, with the idea of getting new bikes. Colton had always had hand-me downs from his brother, so he was ecstatic about gettin a cool new bike.
We picked them up on Saturday before Christmas so the boys would have something to do other than start their two week break glued to the TV. We managed to get the bikes home and surprise them, only after realizing that we'd be getting a new bike carrier. After very minimal set-up the boys and I went out for a quick ride.
They were tentative, Colton less so, but really enjoyed it. On Sunday Connor had a head-over-handlebars crash in the street and hurt his wrist, so Colton and I went exploring. The following day all four of us went for an easy ride. I still felt the boys were excited, just not as passionate about it as I would have liked. That changed after Christmas went to some BMX trails by AZCOM with lots of obstacles, jumps and gullies. Now they boys are huge fans and can't wait to go riding every day. It's starting to feel like money well spent.
Our biggest hassle has been popped tire tubes. I'm putting on Slimes now, but we had 1-2 punctures per ride for the first week! That gets old fast.
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