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.
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.
Sunday, December 23, 2007
New England Interviews
I had a direct flight that got me into Hartford, CT around 11pm on Sunday, December 17th. Luckily, I missed several days of snow from a major storm. Getting my rental car and driving to the hotel went smoothly. But I heard lots of stories of people stuck in traffic for hours after 13 inches fell in eight hours during the workday.
It was a little crazy getting the 2-3miles to UConn Monday morning due to the snow and icy conditions, plus I missed a turn-off. It was a little stressful but I made it to the interview exactly on time.
I started out not being too impressed with the UConn program for the initial didactic lecture we sat through the PD's program overview. But during the interviews and lunch the warm fuzzy feeling about the people returned. By the end of the day, they were right back at the top tier of my ROL and I was looking forward to driving Tuesday for dinner with some of the residents.
I spent the night in Springfield near the Baystate EM offices. The Baystate/Tufts also gave me the warm fuzzies about the people, but I just wasn't as impressed with the actual program. I was actually irritated that they made applicants get on the hotel shuttle at 7am and sit around the ED offices for an hour and a half while the PD drove in. The cooridinator, a nice lady, did the program no favors by mentioning how the facility was falling apart and one resident almost got by falling ceiling debri while snoozing in the oncall room. As I remembered from my previous visit, the place is packed and very efficient in an old school way. They put more patients through fewer beds than any other program I know of. By the end of the day, after mentally bouncing them up and down my ROL, they returned to the same I had them before starting the trip.
I headed back down to Hartford for the UConn resident dinner and had a chance to ask lots of questions that came up during the interview. I had a really good time and enjoyed the people and atmosphere a lot.
Then I drove an hour or so to Worcester, MA. It sure looked familiar having finished my month there only 6-7 weeks ago. I arrived on time for my UMass interview of the trip and immediately got the "wow" impression I had had from reading about the program and my initial visit. The offices, ED and hospital are all brand new and gorgeous. The new sim lab being built in the new building across the street will likely be just as impressive. Like the other applicants, I was on their leash through the PD's introduction and the resident slideshow. On paper, the place has everything going for it including a month in HI for a PGY-III hyperbaric elective. I even enjoyed the interviews. However some of the problems quickly came to the forefront. The Attendings don't do much teaching and you don't see them at conferences. Jeremy, whom I had rotated with, and I compared notes afterwards and came to the same conclusion. There is great training, but it isn't a warm place and do get very busy moving meat in the ED.
So the I started to question the value of the whole trip since all three programs ended exactly where they had started in my ROL. Of course I had to make the interviews in order to rank the programs, and I will rank all three. It just seemed like a lot of time and energy for not a lot of new information or gut feelings.
My drive back to Hartford, night at the hotel and flight back was uneventful. I shouldn't have scheduled a 5:30am flight because I had to get up at 2:30am East Coast time. But I managed to sleep a bit on the plane and start studying for my upcoming COMLEX Level 2 PE exam the following week.
It was a little crazy getting the 2-3miles to UConn Monday morning due to the snow and icy conditions, plus I missed a turn-off. It was a little stressful but I made it to the interview exactly on time.
I started out not being too impressed with the UConn program for the initial didactic lecture we sat through the PD's program overview. But during the interviews and lunch the warm fuzzy feeling about the people returned. By the end of the day, they were right back at the top tier of my ROL and I was looking forward to driving Tuesday for dinner with some of the residents.
I spent the night in Springfield near the Baystate EM offices. The Baystate/Tufts also gave me the warm fuzzies about the people, but I just wasn't as impressed with the actual program. I was actually irritated that they made applicants get on the hotel shuttle at 7am and sit around the ED offices for an hour and a half while the PD drove in. The cooridinator, a nice lady, did the program no favors by mentioning how the facility was falling apart and one resident almost got by falling ceiling debri while snoozing in the oncall room. As I remembered from my previous visit, the place is packed and very efficient in an old school way. They put more patients through fewer beds than any other program I know of. By the end of the day, after mentally bouncing them up and down my ROL, they returned to the same I had them before starting the trip.
I headed back down to Hartford for the UConn resident dinner and had a chance to ask lots of questions that came up during the interview. I had a really good time and enjoyed the people and atmosphere a lot.
Then I drove an hour or so to Worcester, MA. It sure looked familiar having finished my month there only 6-7 weeks ago. I arrived on time for my UMass interview of the trip and immediately got the "wow" impression I had had from reading about the program and my initial visit. The offices, ED and hospital are all brand new and gorgeous. The new sim lab being built in the new building across the street will likely be just as impressive. Like the other applicants, I was on their leash through the PD's introduction and the resident slideshow. On paper, the place has everything going for it including a month in HI for a PGY-III hyperbaric elective. I even enjoyed the interviews. However some of the problems quickly came to the forefront. The Attendings don't do much teaching and you don't see them at conferences. Jeremy, whom I had rotated with, and I compared notes afterwards and came to the same conclusion. There is great training, but it isn't a warm place and do get very busy moving meat in the ED.
So the I started to question the value of the whole trip since all three programs ended exactly where they had started in my ROL. Of course I had to make the interviews in order to rank the programs, and I will rank all three. It just seemed like a lot of time and energy for not a lot of new information or gut feelings.
My drive back to Hartford, night at the hotel and flight back was uneventful. I shouldn't have scheduled a 5:30am flight because I had to get up at 2:30am East Coast time. But I managed to sleep a bit on the plane and start studying for my upcoming COMLEX Level 2 PE exam the following week.
Finished plastics
Get getting around to this rotation summary a week and a half late. My Emergency Medicine post-rotation exam and several interviews side-lined me for awhile. I passed the exam and will blog about the interviews next.
Well I am very impressed with Dr. Kotoske's practice. It's almost unique in medicine today to have a sole practice with its own operating room and over twenty employees (6-8 at any given time). But cosmetic surgery, as cash pay service, is one of the last truly lucrative fields in medicine.
More importantly, Dr. Kotoske has a great reputation for his Quicklift procedure, breast augmentation and tummy tucks. I also saw him do one nose job (rhinoplasty) on a gorgeous young lady that had had a life-long complex about a slight asymmetry. But who has a naturally symmetrical nose anyway?
Breast jobs are just fun. You take young, generally already attractive females and give them these large, shapely breasts that are incredibly attractive. But the best part is seeing their new self-confidence and huge smiles (many times with smiling significant others present as well) at the post-op visits a couple of days after surgery. I guess if I was a breast guy I would find the artistry more appealing. I'm just not a perfectionist like Dr. Kotoske when it comes to breasts.
The Quicklifts are a great invention. They are the perfect surgical treatment for the majority of women over 50 that want to look 10 years younger. I might be interested in one myself someday, except that I'd need something for my forehead wrinkles. I don't see myself doing botox anytime soon.
The tummy tucks were the most physically demanding procedures and the most "barbaric" on the patient. Lots of flank and abdomen liposuction followed by blunt dissection of the abdominal tissue from belly button to ribs. Then two big, generally several pound, flaps of flesh get removed. Finally, there's a multi-layer closure with multiple deep sutures and staples on the skin.
All the patients looked great at the post-op visits, were thrilled with the results and couldn't stop thanking Dr. K. for his work. Not a bad gig!
If it wasn't so competitive and cut throat to get into with a masochistic residency I would be tempted. However, Emergency Medicine is definitely a better fit for me and for the family. It was an easy rotation that convinced me cosmetic surgery isn't too vain and Dr. K. is one of the surgeons I would consider using for myself someday.
Well I am very impressed with Dr. Kotoske's practice. It's almost unique in medicine today to have a sole practice with its own operating room and over twenty employees (6-8 at any given time). But cosmetic surgery, as cash pay service, is one of the last truly lucrative fields in medicine.
More importantly, Dr. Kotoske has a great reputation for his Quicklift procedure, breast augmentation and tummy tucks. I also saw him do one nose job (rhinoplasty) on a gorgeous young lady that had had a life-long complex about a slight asymmetry. But who has a naturally symmetrical nose anyway?
Breast jobs are just fun. You take young, generally already attractive females and give them these large, shapely breasts that are incredibly attractive. But the best part is seeing their new self-confidence and huge smiles (many times with smiling significant others present as well) at the post-op visits a couple of days after surgery. I guess if I was a breast guy I would find the artistry more appealing. I'm just not a perfectionist like Dr. Kotoske when it comes to breasts.
The Quicklifts are a great invention. They are the perfect surgical treatment for the majority of women over 50 that want to look 10 years younger. I might be interested in one myself someday, except that I'd need something for my forehead wrinkles. I don't see myself doing botox anytime soon.
The tummy tucks were the most physically demanding procedures and the most "barbaric" on the patient. Lots of flank and abdomen liposuction followed by blunt dissection of the abdominal tissue from belly button to ribs. Then two big, generally several pound, flaps of flesh get removed. Finally, there's a multi-layer closure with multiple deep sutures and staples on the skin.
All the patients looked great at the post-op visits, were thrilled with the results and couldn't stop thanking Dr. K. for his work. Not a bad gig!
If it wasn't so competitive and cut throat to get into with a masochistic residency I would be tempted. However, Emergency Medicine is definitely a better fit for me and for the family. It was an easy rotation that convinced me cosmetic surgery isn't too vain and Dr. K. is one of the surgeons I would consider using for myself someday.
Thursday, November 29, 2007
Maricopa
I'm starting feel like life is getting back to normal. However, I still have mail and magazines stacked around the house. And my diet and exercise routine aren't up to snuff. After all, it's not like things are "back to normal".
I started a new job on Monday. My plastic surgery rotation is going to be interesting, but I don't get to do anything since these are patients paying cash for a celebrity plastic surgeon to work on them. And there isn't a whole lot of wound care going on, it's all cosmetic procedures.
I've seen four "Quicklift" facelifts over two days. Very interesting procedures and a very lucrative business model. Dr. K. has patented the procedure with a partner, so they get royalties from othe surgeons around the country and can exclude the run-of-the-mill surgeons from messing up the procedure's reputation. A local news host had the procedure done and was back on TV in two days. Can't get better marketing than that! Anyway, I have enjoyed talking with Dr. K., his surg tech, the anesthetists and the circulating nurses, all of whom have been great. And the results are fantastic. Heck, I might have to get one of these in 10 or 15 years!
If plastics wasn't so darn competitive I would probably put up with the long, difficult residency/fellowship and go for it. I can see myself doing these procedures easily. The cosmetic operations make the mint and the reconstructive stuff makes you feel good (or at least removes the guilt). Plus you're working with a great patients (healthy, cash pay and frequently already very attractive), being creative and owning your own business. Dr. K. advertises the "eyes of an artist" while employing 21 people (most part-time) and operating his own private, JHACO approved, surgical suite. No surprise here I'm sure, but he drives a nice Porsche as well. Not bad!
Becky and I went to Maricopa's pre-interview dinner on Monday night with a big group of current residents and fellow applicants. Dave Levin from my class was there as well. He's been rotating there for two months, so I was the one asking all the questions. Becky was a bit bored, but we had an ok time. The dinner was just mediocre.
The interview on Tuesday went well. I really like the Program Director, whom I met in Seattle at the ACEP Residency Fair. The tour went fine. It's a county ED, but not a bad as I feared. They will be building a new one well after I'm done with Residency, but the current one, curtains and all, will suffice. I was pleasantly surprised by how well the department is funded and how strong the leadership throughout the county system. I feel confident I could get a great education there. The regional (southwest USA) burn center is a unique factor I like. They teach EM residents how to do fasciotomies and skin grafts! Finally, we would save a ton of time and expense because we could stay in our current home. The commute is much more doable than I thought and many residents live further away than we do now.
Maricopa will definately be in my top five, likely in my top three. The big decision comes down to whether we want to put Hopkins #1. Becky and I have been talking a lot about that lately.
Today I mostly relaxed. I could have gone in for office visits of patients following up on surgeries. But understandably Dr. K. doesn't want a student in the room when he's having potential patients baring their souls and skin as he makes his pitch. So I stayed home and finalized travel plans for the COMLEX PE test at the end of the month and my five remaining interviews, three in New England and two in Ohio. I still need to cancel MCG. But right now I'm torn between finishig Wired magazine or playing an Xbox 360 game...
I started a new job on Monday. My plastic surgery rotation is going to be interesting, but I don't get to do anything since these are patients paying cash for a celebrity plastic surgeon to work on them. And there isn't a whole lot of wound care going on, it's all cosmetic procedures.
I've seen four "Quicklift" facelifts over two days. Very interesting procedures and a very lucrative business model. Dr. K. has patented the procedure with a partner, so they get royalties from othe surgeons around the country and can exclude the run-of-the-mill surgeons from messing up the procedure's reputation. A local news host had the procedure done and was back on TV in two days. Can't get better marketing than that! Anyway, I have enjoyed talking with Dr. K., his surg tech, the anesthetists and the circulating nurses, all of whom have been great. And the results are fantastic. Heck, I might have to get one of these in 10 or 15 years!
If plastics wasn't so darn competitive I would probably put up with the long, difficult residency/fellowship and go for it. I can see myself doing these procedures easily. The cosmetic operations make the mint and the reconstructive stuff makes you feel good (or at least removes the guilt). Plus you're working with a great patients (healthy, cash pay and frequently already very attractive), being creative and owning your own business. Dr. K. advertises the "eyes of an artist" while employing 21 people (most part-time) and operating his own private, JHACO approved, surgical suite. No surprise here I'm sure, but he drives a nice Porsche as well. Not bad!
Becky and I went to Maricopa's pre-interview dinner on Monday night with a big group of current residents and fellow applicants. Dave Levin from my class was there as well. He's been rotating there for two months, so I was the one asking all the questions. Becky was a bit bored, but we had an ok time. The dinner was just mediocre.
The interview on Tuesday went well. I really like the Program Director, whom I met in Seattle at the ACEP Residency Fair. The tour went fine. It's a county ED, but not a bad as I feared. They will be building a new one well after I'm done with Residency, but the current one, curtains and all, will suffice. I was pleasantly surprised by how well the department is funded and how strong the leadership throughout the county system. I feel confident I could get a great education there. The regional (southwest USA) burn center is a unique factor I like. They teach EM residents how to do fasciotomies and skin grafts! Finally, we would save a ton of time and expense because we could stay in our current home. The commute is much more doable than I thought and many residents live further away than we do now.
Maricopa will definately be in my top five, likely in my top three. The big decision comes down to whether we want to put Hopkins #1. Becky and I have been talking a lot about that lately.
Today I mostly relaxed. I could have gone in for office visits of patients following up on surgeries. But understandably Dr. K. doesn't want a student in the room when he's having potential patients baring their souls and skin as he makes his pitch. So I stayed home and finalized travel plans for the COMLEX PE test at the end of the month and my five remaining interviews, three in New England and two in Ohio. I still need to cancel MCG. But right now I'm torn between finishig Wired magazine or playing an Xbox 360 game...
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