February Newsletter

I have big news! I was accepted to a traditional internship year in West Palm Beach, FL! I had to scramble since I didn't match anywhere. The match is the process by which training programs rank their choices of applicants, applicants rank their choices of programs, the rank lists are input to a computer, and the computer does some occult magic before spitting out the results of who's in what program.

Coming directly out of medical school, one option for the fresh doctor is to do an internship year, consisting of month-long rotations in the major specialties, then re-apply for a residency in the next application cycle. The other option is to start right into a residency. Or, if you're like me, the latter isn't much of an option. Anyway, the process is more convoluted for some specialties, but that's how it works if you're going for orthopedic surgery.

February's rotation fulfilled my Rural Medicine requirement. It was Family Medicine out on the eastern plains of Colorado. I know I was all excited last year when I finally finished what I thought would be my last interaction with Family Medicine, but I liked this rotation. My favorite part was having a large amount of freedom, handling many patient visits alone. The attending would always touch base with the patient, too, but for simple cases and ortho-related cases, she would mostly defer to my clinical skills and decisions.

Some of the more exciting cases pertained to toenail removal, oddly enough. One girl had an ingrown toenail and I got to remove a section of the nail. Another girl had somehow broken her nail during sports practice and most of the distal section separated from the underlying nail bed, and I got to yank it the rest of the way off (this case was also neat because the patient was reluctant to have the procedure done and I was able to talk her and her mother into deciding to do it. I don't condone strong-arming patients into decisions they oppose, but when you know a certain treatment would be best in the long run and the patient just has trepidation about the short-term unpleasantness, it's satisfying when you're able to talk them through their fears).

In both toe cases, I had to do a digital block before proceeding. A digital block consists of injecting anesthetic just past the MP joint near each of the four main nerves supplying the digit. I used lidocaine, which is shorter lasting, but sets in faster. Another option would be to use a longer-acting agent like bupivacaine, which also takes longer to take effect. If you want to be really slick, you could use both so you could start the procedure sooner and the patient would be pain-free longer. "So, why didn't you do that?" you ask. No, I'm not a monster; all we had was lidocaine coming out of our ears and one single vial of bupivacaine that had expired. Besides, when I was a kid, for anesthesia, you were lucky to get a stick to bite on, you had to walk uphill in the snow both ways to get to the doctor, and...

Speaking of anesthesia, at the end of February, I started a two-week rotation in anesthesiology. So far, it's not been as overwhelming as I anticipated. I have a good attending who likes to explain concepts and get me involved in patient care. Hopefully I'll get to intubate some patients and do arterial lines (placing the air tube into the patient's trachea and placing a catheter in an artery, respectively).

Keep it secret, keep it safe. Most of all, keep it real.

Scott