Applications

As this month is a study month for me, I've not had many clinical encounters to comment on. What I have been doing is studying for the next board exam, which is currently scheduled for September 6th. Nothing new there; I imagine we all have an idea of what it's like to study. What has been sort of new is beginning the long, arduous process of applying to residencies. I say "sort of" because I have done an important, extensive application every few years for the last decade. College wasn't too hard to get into, med school was much harder, and residency is looking to be at least on par with med school.

I have just revised my curriculum vitae based on suggestions by our dean of clinical affairs. We have a mandatory meeting with a dean to touch base and make sure our dean's letter is as accurate and as supportive as possible. Also, we get feedback on our CV, personal statement, generalities about which letters of recommendation would be good to use, etc. I received feedback on my personal statement, too, but I decided to revise the CV first because that came down to simply reformatting a list of facts about my life. For the personal statement, not only had I barely written anything, but I was headed in the wrong direction. The dean said I shouldn't focus on the past and what has led to my choosing medicine and ortho, but instead should focus on "Why ortho, why now?"

So, I need to justify why I'll be a good orthopedic resident and ultimately ortho surgeon, and explain what is currently driving me to seek orthopedics. Marketing myself has always been awkward, and now trying to explain why I want to be an orthopod without dragging up the fact that this has been my goal for half of my life will be a challenge. Perhaps residency directors are looking to see that applicants have actively re-evaluated their desires and skills instead of just defaulting to what sounded good in high school. I think I may incorporate my insight during my EMT training, which confirmed that I need to have more than a technician's level of understanding. Then in med school, I wavered in my drive to become an orthopod, initially because I was worried about being competitive enough, then because I realized I had little experience with many specialties and should at least keep an open mind to other avenues. After stepping back and re-evaluating my career goals, I ended up choosing ortho anyway. Until just now as I'm writing this post, I thought of my "wavering" as a liability and wanted to sweep it under the rug as a possible indicator that I can be easily swayed from my goals. I now think I will include that experience as a demonstration that I am able to re-evaluate my direction in life and don't blindly continue pursuing plans that were based initially on ignorance.

Back to it.

Scott

No medicine, just life

Getting back to the details of my motorcycle, I bought it off Craigslist. It's a decent-sized motorcycle with a good amount of power. A freind said its looks match my personality, and I rather agree. I wish I could post a picture, but it's in the shop getting tuned up. It was a whirlwind of a few days leading up to my buying it. A was on a hike with a friend who reminded me that I had wanted to get motorcycle training, and I realized I could do so this month. On a Tuesday, I bought a helmet. Wednesday, I started a two-day class which included the requisite testing to get a motorcycle-endorsed driver's license. At the end of class Thursday, I went to see the motorcycle and arranged to pick it up the next morning, then bought motorcycle insurance online and planned out the next morning. Friday, I had to get cash to pay for the new license, go to the DMV to update my license, get a cashier's check to buy the motorcycle, then drive out with Dad so he could drive my car back as I rode the bike. The couple selling the bike had built thier own house, and Dad, having worked in the housing development business, started talking about the home building process. The wife was only too happy to give us a tour of the whole place while I was only too anxious to get the motorcycle and ride it home. I finally did just that, taking the long, slow way home so I could enjoy the bike longer and not kill myself getting used to it at 80 miles per hour. I can't remember the last time I drove a vehicle and could feel the acceleration when I opened the throttle. It's a good feeling.

In more personal news, I have had a general upturn in my mood since April and have gradually been reconsidering the idea of getting in a relationship and even (gasp) eventually getting married. For the last year or so, I've been growing closer to a friend and becoming more attracted to her, contemplating asking her out, when out of the blue someone I knew several years ago gets in touch and it turns out she wants to re-connect and possibly start going out. So, now I'm trying to figure out what to do without hurting anyone, damaging relationships, or being a fence-riding sleazeball. Whenever I see a happy-go-lucky bird singing contendedly, I wonder what it's like not having to worry about taking motorcycles to the shop, applying to residencies, or navigating relationships. Then I realize it's pretty good being able to enjoy the deep complexities of the human experience. I'm just hoping I clear the hurdles as they continuously pop up. And maybe learn to pick a metaphor and stick with it.
Scott

Motorcycle

I GOT ONE! I'll post details soon, by I wanted to share the exciting news while it was still fresh. Briefly, it's a 750cc that's older than I am, but it's got a lot of power. I'm not used to opening up the throttle and actually feeling the acceleration. Anyway, that's one thing I can cross off my bucket list.

Scott

June Newsletter

My sister is getting married today!
Getting on to my comparatively mundane news, June has been fun. I again took electives, this time two weeks of radiology with an interventional radiologist, and a week of orthopedic surgery with an orthopedic oncologist who happens to be my uncle. I liked the hospital-based nature of this radiology practice, compared with the strictly outpatient setting of a radiology center that I experienced before. The radiologist still did the routine of sitting in front of a computer reading imaging studies, but he would get called away to do procedures, even more so than a typical radiologist, since he did interventional. The interventional aspect entailed more invasive studies than just barium swallow or enema. He would put central lines and other invasive catheters under fluoroscopic guidance and biopsies under ultrasound and CT guidance. The intravascular work was painful. Poking a hole through the skin into the vessel was the most exciting part, and then it's a tedious series of threading a guide wire into just the right vessel branch, sliding a catheter over it, taking out the original guide wire, inserting a different guide, then removing the catheter, then placing a wire-guided whatever, then taking that out, then putting the catheter back in, then taking the wire out.... I'm glad there are people who enjoy this type of work because it's not my cup of tea. It was a good experience to see what the interventional side of interventional radiology is like.
Working with my uncle in orthopedics reaffirmed again that I need to be an othopod. Every time blood gets splattered or bones get hewn, I grin from ear to ear. This type of barbarism would normally land you in an asylum for the criminally insane, but you can actually improve patients' quality of life by playing wood shop on their internal parts. Working with my uncle, who knows and I assume trusts me better than a typical attending would, I was allowed to do more than a typical third/fourth-year would. The procedure that stands out the most was an above-elbow amputation for synovial cell sarcoma of the elbow. I did the large-scale work and my uncle stepped in when more finesse was needed. I could go on for pages about orthopedics, but I'll finish by saying arthroscopic procedures are a lot harder than they look; I wore myself out hardly doing anything.
Off to studying and wedding preparations.

Scott

May Newsletter

May was an interesting experience for me. I had two two-week rotations and both of them were electives. I'm not sure if this is always the case, but both preceptors repeatedly told me I had all sorts of latitude on activities and duties since I was doing electives. I've had the past week off and have been trying to sort out which residencies I want to apply to. Once I figured that out, I was able to work on the more immediate step of applying for audition rotations at those sites so I can hopefully impress them and improve my chances of getting into the residency. I finally finished all of this so I just have to wait to see which ones will allow me a rotation. Next is packing to go to El Paso to work with a radiologist my uncle knows there, as well as working with my uncle, an orthopod, so I can have some clue of what I'm doing when audition rotations start.

July is designated as a study month at my school, which I assumed was standard practice among med schools, but apparently not. The bummer is that our "study month" eats up a potential audition month. I guess it will be good to have time to read up on orthopedics plus study for part two of the boards.

Life is hectic right now, as may be apparent from this hastily-written, brief newsletter, but it's all just a part of the process. What really got to me recently was looking at the various programs' weekly schedules for orthopedic residents and how very convoluted they can be. There is an 80-hour cap on the work week; earlier in med school, I was annoyed that the work week had been shortened because of the decreased patient contact and learning time. I may feel differently when I start next July. Regarding the work week, residents keep track of their own hours, and yes, there's an app for that. I just downloaded HoursTracker and it seems quite handy.

Scott

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