First Few Days of ER

Today an attending told me about a four-month-old he had seen in the ER. The mother's only concern was tachypnea, and on exam, the kid didn't show any other signs or symptoms. The doctor normally doesn't get lab work on kids that young, but he decided to and just happened to catch a case of DKA, which is very rare in this age group.

Patients I've seen include a drowning victim, a burn victim, a young adult with DKA, a depressed/psychotic patient who can only say three words, and an infected thumb laceration. There have been many others, and I appreciate the diversity of cases in the ER. One pregnant patient was exposed to low levels of carbon monoxide, and though she was fine, she had to stay a while as we figured out what to do about the fetus. Hemoglobin prefers binding CO over oxygen, and fetal hemoglobin binds both gases with higher affinity than adult hemoglobin. My attending had me call poison control, and they didn't have specific recommendations for a pregnant patient. We got in touch with a OB/GYN, and my feeling is they didn't know what exactly to do, either. I looked it up later on UpToDate, and for mild to moderate exposure, there seems to be no adverse affect on the fetus.

I plan on getting my newsletter posted today amongst reading, so I'm cutting this post short.

Scott

Paperwork on the Road

For all the papers I have to fill out and send in for rotations and residency lately, it would have been nice to have a portable printer/scanner that I can use while away from home. I have to print things off, sign them, and fax or email them in. I'm looking into getting a small printer/scanner so I can fill out and sign a hard copy, scan it back in and either send it as an email attachment or fax it via an online fax service. There's at least one website that rents you an individualized fax number and you can email in a document to be sent out via that fax number and receive electronic versions of documents faxed to the number.

These are ideas I've toyed with in the past, and now I wish I had devoted some funds to them in the past so I wouldn't have to shell out so much money right now when I've got travel and other big expenses fourth year.

Scott

Late-night, End of Rotation Studying

I am up late reading about metacarpal fractures. I was worried that I would have trouble studying in sleep-deprived mode during residency, but I think I can hack it if it's ortho related. This stuff just clicks in my mind. It's so much more concrete than the rest of medicine, and holds my attention better. I'm nearing the end of this month, and it looks like I won't get the time I had hoped to recover from the drive back home. I'll be starting an emergency medicine rotation two days after I get home, and the kicker is it'll be 50 miles away from home. Thankfully, I was able to set up free housing in the area so I won't have to commute the full distance.

I've seen some interesting knees lately. If you don't know what the typical radiographic signs of arthritic change are, you should look them up. Osteophytosis, sclerosis, subarticular cysts, and joint space narrowing are the four big ones, and I've seen these pretty bad of late as my attending is a big knee and shoulder guy. One young adult patient in particular had a nasty case of bilateral arthritis, the severity of which normally wouldn't set in for another 30-40 years. Another doctor had recommended moving straight to knee replacement, but the patient didn't want to use that drastic of treatment right away. This patient came to clinic for a second opinion and my attending explained that usually there is a progression in treatment from conservative measures like steroid injection, physical therapy, viscosupplementation, and bracing, to more intermediate treatment with arthroscopic surgury and "cleaning out" the joint, to more radical treatment like knee replacement. The pateint appreciated this approach a lot more and understood that conservative measures may fail, but we could cross that bridge when we come to it. My attending said some patients come in and can't be talked out of knee replacement, so he's willing to do that, too if it's indicated. You can't force a patient to adhere to a certain treatment regime, so matching the proper management with each patient is part of the art of medicine. That sounded less cheesey in my head.

I was thinking a bit ago that as I progress in my medical career, anything I distribute publicly can be taken as medical gospel and cause liability for me,which I would like to reduce when possible. Hence the ugly disclaimer at the top of the page.

Hopefully I'll have some more ortho cases to post about and maybe some ER cases before my next newsletter.

Scott

July Newsletter

I know, I'm late. No excuse. July was designated by my school as a study month to prepare for our next round of boards, which I thought was a universal concept. Apparently*, other schools don't waste... I mean, utilize the month in this way. I'm over the bitterness; it's not like I was chomping at the bit to go straight through the year on a rigid schedule anyway. In any case, since July was just a study month, I don't have any exciting clinical stories to share, but there was some excitement in the form of getting my motorcycle license and buying a motorcycle. The following conversation always ensues when I tell people I bought one: What did you get? It's a Kawasaki KZ750 LTD. Oh, so it's a crotch rocket? No, it's not a crotch rocket. So, what kind of motorcycle is it? A cruiser. Which is what exactly? The stereotypical around-town and cross-country bike.

If you have further questions, the internet is infinitely more knowledgeable than I and your favorite internet browser would love to guide you to the answers. More details of my entrance into the world of motorized bicycle riding are here.

In more academic/medical news, I'm getting a crash course (no intended reference to the afore-mentioned motorcycle riding) in applying to residencies. Becoming a doctor is a long, arduous process of gracefully navigating a series of applications. I'm pretty sure the rest is just details. The latest installment will decide where I will spend what are purported to be the most difficult consecutive five years of my life. No biggie. Here are more details on applications.

Right now, I am halfway through the second week of my first audition rotation, which happens to be in Las Vegas (WHOO VEGAS!!). The "audition" modifier refers to the fact that I'm trying to impress the director and anyone else involved with deciding who gets into the ortho program here. So far, I have no idea how I'm doing. Again, no biggie. It's just the rest of my life. Speaking of the rest of my life, I learned a valuable lesson on the Vegas (WHOO VEGAS!!) strip. I lost what I consider a profane amount of money in a casino after initially doubling my starting amount of $20. My compulsive side kicked in and I kept thinking I just needed to hold out for the big win and I could get back the increasingly large amount I had lost. Thankfully, I finally snapped out of it and left, my deflated ego and the damning atm receipts trailing behind me (yes, Sister, I kept the receipts). I was just talking with a friend who pointed out that I could think of my losses as having sacrificed a vacation to, say, Arkansas. Not a devastating loss, but if I keep it up, I'll lose Hawaii, then Europe, etc. Actually, I need to save up so I can make a trip to Scotland with my mom and sister next year. Ramen noodles for me, I guess.

Back to studying.

Scott

*My little cousin (cousin's daughter) didn't know what "apparently" means, so my Granddad and I explained it to her and I now think of her every time I use this word. She and her siblings are cuties; I thought only women were supposed to have biological clocks.

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