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.
Saturday, April 26, 2008
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.
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