Let's Have Some Perspective

I got to do a hip injection on Tuesday. It was fluoroscopically guided so we could tell that we hit the right spot; the hip joint is deep and the bony landmarks are hard to palpate, so fluoro guidance is standard for hips. It was interesting to hear a radiologist's perspective on joint injection. He said he prefers doing all joint injections under fluoro to prove that he's in the joint space instead of accidentally injecting into surrounding soft tissue. This is a sharp contrast (no pun intended) to what the IM and ortho docs do. I wouldn't have given any credence to the idea that proper palpation and careful placement of a joint injection could miss the joint space in simple joints such as knee and shoulder. My radiology preceptor said he's had one or two cases where he was doing knee and shoulder injections and saw on fluoro that he wasn't actually in the joint capsule. Part of me thought, "Silly radiologist, leave the joint procedures to the orthopods, we'll do it right," but it's also good to know that something so simple can be a bit more complicated. Nonetheless, at this point in my training, experience, and understanding of things, I'm of the mind that it's not worth the extra time, expense, radiation exposure, etc, to use fluoro guidance for simple joint injections. This is a good example of how my fully-trained, well-experienced preceptors can arrive at different opinions of the best way to go about the same procedure. Extrapolating a bit, we arrive at the broadly-applicable "too many chefs spoil the broth" axiom.

This radiology rotation is only two weeks long, to finish off the month after my two-week nephrology rotation. I live in my primary rotation city, an hour from school, and my preceptor mentioned getting some hospital experience working with his partner at a hospital near school. I will soon do a rotation of nothing but hospital radiology, but a friend lives near school and I decided this would be a good opportunity to crash on her couch for two nights and spend time with her. Of course, we would get to talking, develop a deeper connection than we had yet discovered, decide to get to know each other better, somehow start dating long-distance, I'd get allergy shots to be able to deal with her cat, she would develop a love for sailing if she isn't enamored of it already, I would devise clever ways of cooking for her food intolerances, we would get married, sail the world, fulfill our mutual wanderlust with travels to far-off places and medical mission work, and have at least two kids.

I don't know how common this way of thinking is among med students, but I know several other student docs who plan a series of key events stacked back-to-back then catastrophize over the prospect of any one of the steps not playing out exactly according to plan. For example, a buddy was worrying about doing well on boards, so he'd be competitive enough to do an audition rotation at the residency location he wants, so he would have a better shot at getting into that residency, so he'd be better set up to get into the fellowship program at that location. Don't get me wrong, it's good to plan ahead, but I need to calm down and realize that there is more than one path to my ultimate goal and not freak out when one step along the way starts looking like it will fall through. To finish my earlier thought, I'm one night down, one to go staying at my friend's place, and I don't think we're connecting like I hoped. Now I'll never get married ;)

Scott

April Newsletter

April has been OB/GYN month, and I realized I had not given this specialty much thought in the past. I enjoyed it quite a bit, especially Obstetrics (pregnancy-related health). I got to catch about ten babies during the month, and saw several more delivered by C-section. I wasn't thinking I would use much of this knowledge beyond my tests, but I was talking with an old friend today about the work he does. He's a missionary pilot and the region he's going to be stationed in has some unhealthy childbirth practices. This is relevant to me because I was hoping some day to use his connections to do medical work overseas, and when you're in a third-world environment, "orthopedic surgeon," "obstetrician," "neuroradiologist," etc. are all seen as "doctor," and I'll need to be able to address at least the basic issues outside of my specialty area.

One memorable event this month was seeing the vaginal delivery of twins. There are so many things that can go wrong around the time of delivery with twins that at least one is usually delivered by C-section, but the stars or at least these two boys aligned just right and out they popped. Plus, since they were identical twins, they were the perfect teaching opportunity for me to learn to do circumcision. They made much less of a fuss than I would have expected, considering what the procedure entails. Of course, neonates' primary goal in life seems to be to fall asleep, regardless of circumcis... er, circumstances. Outside of medicine, a memorable event was heading to the airport with my preceptor in between surgery and clinic and taking a quick flight in his plane. The first time I tried flying a plane was with my uncle, and I did a lot better this second time, but I can see where one would need a lot of training and hands-on time with a more experienced pilot before being able to handle a plane solo. Anyway, it encouraged me in my desire to get into sailing by showing that I don't have to take a large block of time to engage in hobbies - I can fit them in a work day sometimes.

I was going through some old notebooks and wanted to share some funny quotes from a preceptor. Regarding a new medication compared with a discontinued one: "It's kind of worth it for it not to work as well to avoid the side effect of death." Regarding an insurance company's lack of coverage of psychiatric treatment by primary care providers: "[The company] doesn't take any mental health diagnosis codes, which is retarded."

This was the last of my required rotations for 3rd year, so I'll do electives now, starting with two weeks of Nephrology, then two weeks of Radiology to finish off the month.

Scott