Thursday, September 21, 2006
Three Posts in One!
It's been way too long, but I'm about to vomit up a long posting whichwill, hopefully, make up for it.Anesthesia went well. I learned a bunch (about drugs and intensive care) and got to do a handful of procedures. I discovered that it is (in my book) significantly easier to intubate a child than an adult: especially if the adult is heavy with a thick neck. The early mornings took almost the whole month to get used to, but the worst part was I was getting up a 5:00a on the weekends! That really burned. But, it made Monday a little easier than if I had shifted back to a normal schedule. I got along very well with many of the faculty members, which is always a nice thing. However, you don't get to spend much time with any one faculty member, so it can be a little difficult to form an opinion of them and for them to reciprocate. Which, of course, translates into the residents having a higher opinion of the student than the factulty, but that is nothing new. Grading is bizarre and that's all there is to it. Well, for that matter, I have not received my anesthesia grade so I will reserve judgment.Unlike some of the other rotations, there were not a lot of particular events to share. One of the things I have discovered along the way is that most of the "surgical" patients are pretty healthy and, in that respect, were not particularly interesting to write about. (That is not necessarily a bad thing.) Along those lines, the surgical patients tend to be healthier that those that may be found in the ER or on a medicine floor. I should note, however, that all of the patients I was involved with were planned procedures. I'm sure that dealing with the emergent surgical patient would lend itself to more dramatic writing.
Over the course of the month I learned about the fine art of quickly establishing rapport with the patient before the procedure and I witnessed some good examples of it. I even got to practice it myself several times, but one of the best parts of the rotation was getting to know the first resident I followed. I say that because, as we found out on our first day together, we both were transplants from the same state, we went to neighboring high schools, we graduated from high school the same year, and we both had prior careers. We got along famously and had a blast! He taught me a ton about critical care of cardiac patients, which I hope I can retain and use when I start my cardiac critical care sub-internship.
Oh! How could I forget the paper and oral exam at the end?! Maybe because I was trying to pack for two months of away rotations and get my residency application complete at the same time. More about that in a moment.
Part of the anesthesia grade is based on a patient write-up where you choose one of the procedures with which you were involved and discuss the anesthesia aspects of case. I choose a pneumonectomy (removal of the right lung, in this case). The key to the paper is to pick something that is not overly complex, but not too straightforward. For this case, the most significant issue involved post-op pain management. The patient had already been on opioids for chronic back pain and an epidural had been placed just before the procedure. However (as one might expect) the patient had a significant amount of pain after waking up. After all, one of the lungs had been taken out. It was not clear after the procedure if the epidural was still in the right place and there was no good way to test it. Finally, a bolus (several, actually) of IV Fentanyl was able to bring the patient’s under control. I kept on eye on the progress notes and the patient made a fantastic recovery and was released about a week later.
The paper discussed the complexities of the pain management as well as critical aspects of pre-op assessment (surgical candidacy). After all, if there is not a sufficient amount of working lung after the operation...surgery may not be the best option.
Next was the oral exam. Each student is given the case and the series of questions that will serve as the bulk of the exam. Thus, it is a known quantity. I think the real object is to get the students more familiar with the oral examination process. It was still a bit stressful, but beneficial none the less.
==============================================
As I alluded to in the last post, we hit the road. The last three weeks have been spent in an out-patient dermatology/MOHS clinic. I was expecting it to be fairly low-key, but there has been a smattering of excitement. We had one patient that seemed to have erupting xanthomas (boil-like cysts filled with cholesterol), however, it turned out that the patient had leprosy! Granted, the patient was from Brazil, which has the second highest prevalence, but what was most surprising is, in Georgia, leprosy is not a reportable disease! We called the CDC, which is based in Atlanta, and the Georgia health department and neither seemed to care. By the way, the disease is not nearly as contagious or as fatal as the religious text would lead one to believe.
The following week we had a second patient that visited Brazil and contracted cutaneous larva migrans. Basically, a worm gets under the skin and crawls around until it dies. Even funkier, the patient could occasionally feel it move. Gross as it sounds, it is easily treated.
There were also patients with neurotic excoriations, cutaneous T-cell lymphoma and Sweet’s disease. (Search the web if you’re really interested.) I suppose my point is there was more than Botox, biopsies, collagen, moles and skin cancer going on. There was one MOHS patient where the surgical site was between the nose and eye. That was a little difficult to watch, but otherwise, they do a lot of nice procedures with a descent amount of plastic-surgery-like closures. I’ve also gained a much clearer understanding of how various skin cancers present and what can be done to treat them. Topical agents have come a long way since the days of Neosporin. (I used to bathe in that stuff when I was a kid for all of the scrapes and bites.)
Atlanta has become significantly more populated than when I left for graduate school. I have been taking public transportation to and from work and I am fairly certain that it cuts the trip time in half. But, standing in a hot train for 40 minutes after standing all day, does get to be a bit much.
The people I work with are great and they must have quite the reputation since I have encountered many of Atlanta’s upper-crust. The patient population does really run the gambit. As a matter of fact, we had one patient that had an enormous collection of warts (the size of a head of cauliflower), which is why the patient came to see us. After letting it slide for about 10 years and none of other doctors he had seen knew what it was or what to do. My MOHS doctor called it right away, but he also knew that were was too much to treat in the clinic. What made this patient most interesting was they (yes, I’m trying to hide the sex) had TWO ROWS OF TEETH!!! Just on the uppers, but there was two rows of incisors and canines! It was way cool! Yes…this patient was a land-shark.
Next week we will pack our bags to go to Texas for a month of general radiology.
=========================================
Residency
If applying to medical school was not strange enough, the process of gaining a residency is even more bizarre. I think you’ll just have to follow step-by-step as I go through it. At this point, I have completed and submitted my ERAS (electronic residency application service) forms. It includes things like the programs (universities and communities training hospitals) to which you wish to apply (I have chosen to apply to Radiology, in case that was not mentioned earlier), CV-like accomplishments, contact information, letters of recommendation and the dreaded personal statement. I found it very difficult to summarize my life in one page in a way that would make any sense. Fortunately, I started drafting it about three months ago and went through about 15 complete rewrites until it became something I was willing to have others read. My understanding is the personal statement is one of those items that is unlikely to help significantly, but could hurt your prospects significantly. It was mostly completed by the time I left for Georgia, but it did go through one more revision here.
The letters of recommendation were another challenge. I started lining them up before summer started and had most of them in my file about a month before I left, however, one of them did not make it until the week before I left. The professor had dictated it, but, had failed to actually push the record button. So it had to be dictated again taking another three weeks for that opportunity to come around again. Actually, that is not all entirely true. There was one letter that I originally had not requested, but was spontaneously offered by the professor and completed after I left: I felt honored.
After some discussion with my better half, the programs were identified and I reviewed the list with my two Radiology advisors. Yes, I have two. Yes, they know about each other. Yes, they’re cool with it. Yes, it does feel a little strange. The benefit is I don’t have to flood either one with a load of questions and they both have different realms of wisdom from which to draw. The list is long, probably a little larger than it needed to be but, but it only costs a fraction more and trying to decide which dozen programs to drop just isn’t worth the effort. They are all good programs and statistics are always against the applicant.
The application can go out as early as September 1st, but I know of a few fellow students that are still working on their application. I submitted in the late afternoon on the first in most part because I tried to have as much of it finished as possible before leaving town and I was told that many radiology programs do not even start processing the applications until the 15th. That does not stop you from checking e-mail q30m (every 30 minutes) for that first interview invitation.
It's been way too long, but I'm about to vomit up a long posting whichwill, hopefully, make up for it.Anesthesia went well. I learned a bunch (about drugs and intensive care) and got to do a handful of procedures. I discovered that it is (in my book) significantly easier to intubate a child than an adult: especially if the adult is heavy with a thick neck. The early mornings took almost the whole month to get used to, but the worst part was I was getting up a 5:00a on the weekends! That really burned. But, it made Monday a little easier than if I had shifted back to a normal schedule. I got along very well with many of the faculty members, which is always a nice thing. However, you don't get to spend much time with any one faculty member, so it can be a little difficult to form an opinion of them and for them to reciprocate. Which, of course, translates into the residents having a higher opinion of the student than the factulty, but that is nothing new. Grading is bizarre and that's all there is to it. Well, for that matter, I have not received my anesthesia grade so I will reserve judgment.Unlike some of the other rotations, there were not a lot of particular events to share. One of the things I have discovered along the way is that most of the "surgical" patients are pretty healthy and, in that respect, were not particularly interesting to write about. (That is not necessarily a bad thing.) Along those lines, the surgical patients tend to be healthier that those that may be found in the ER or on a medicine floor. I should note, however, that all of the patients I was involved with were planned procedures. I'm sure that dealing with the emergent surgical patient would lend itself to more dramatic writing.
Over the course of the month I learned about the fine art of quickly establishing rapport with the patient before the procedure and I witnessed some good examples of it. I even got to practice it myself several times, but one of the best parts of the rotation was getting to know the first resident I followed. I say that because, as we found out on our first day together, we both were transplants from the same state, we went to neighboring high schools, we graduated from high school the same year, and we both had prior careers. We got along famously and had a blast! He taught me a ton about critical care of cardiac patients, which I hope I can retain and use when I start my cardiac critical care sub-internship.
Oh! How could I forget the paper and oral exam at the end?! Maybe because I was trying to pack for two months of away rotations and get my residency application complete at the same time. More about that in a moment.
Part of the anesthesia grade is based on a patient write-up where you choose one of the procedures with which you were involved and discuss the anesthesia aspects of case. I choose a pneumonectomy (removal of the right lung, in this case). The key to the paper is to pick something that is not overly complex, but not too straightforward. For this case, the most significant issue involved post-op pain management. The patient had already been on opioids for chronic back pain and an epidural had been placed just before the procedure. However (as one might expect) the patient had a significant amount of pain after waking up. After all, one of the lungs had been taken out. It was not clear after the procedure if the epidural was still in the right place and there was no good way to test it. Finally, a bolus (several, actually) of IV Fentanyl was able to bring the patient’s under control. I kept on eye on the progress notes and the patient made a fantastic recovery and was released about a week later.
The paper discussed the complexities of the pain management as well as critical aspects of pre-op assessment (surgical candidacy). After all, if there is not a sufficient amount of working lung after the operation...surgery may not be the best option.
Next was the oral exam. Each student is given the case and the series of questions that will serve as the bulk of the exam. Thus, it is a known quantity. I think the real object is to get the students more familiar with the oral examination process. It was still a bit stressful, but beneficial none the less.
==============================================
As I alluded to in the last post, we hit the road. The last three weeks have been spent in an out-patient dermatology/MOHS clinic. I was expecting it to be fairly low-key, but there has been a smattering of excitement. We had one patient that seemed to have erupting xanthomas (boil-like cysts filled with cholesterol), however, it turned out that the patient had leprosy! Granted, the patient was from Brazil, which has the second highest prevalence, but what was most surprising is, in Georgia, leprosy is not a reportable disease! We called the CDC, which is based in Atlanta, and the Georgia health department and neither seemed to care. By the way, the disease is not nearly as contagious or as fatal as the religious text would lead one to believe.
The following week we had a second patient that visited Brazil and contracted cutaneous larva migrans. Basically, a worm gets under the skin and crawls around until it dies. Even funkier, the patient could occasionally feel it move. Gross as it sounds, it is easily treated.
There were also patients with neurotic excoriations, cutaneous T-cell lymphoma and Sweet’s disease. (Search the web if you’re really interested.) I suppose my point is there was more than Botox, biopsies, collagen, moles and skin cancer going on. There was one MOHS patient where the surgical site was between the nose and eye. That was a little difficult to watch, but otherwise, they do a lot of nice procedures with a descent amount of plastic-surgery-like closures. I’ve also gained a much clearer understanding of how various skin cancers present and what can be done to treat them. Topical agents have come a long way since the days of Neosporin. (I used to bathe in that stuff when I was a kid for all of the scrapes and bites.)
Atlanta has become significantly more populated than when I left for graduate school. I have been taking public transportation to and from work and I am fairly certain that it cuts the trip time in half. But, standing in a hot train for 40 minutes after standing all day, does get to be a bit much.
The people I work with are great and they must have quite the reputation since I have encountered many of Atlanta’s upper-crust. The patient population does really run the gambit. As a matter of fact, we had one patient that had an enormous collection of warts (the size of a head of cauliflower), which is why the patient came to see us. After letting it slide for about 10 years and none of other doctors he had seen knew what it was or what to do. My MOHS doctor called it right away, but he also knew that were was too much to treat in the clinic. What made this patient most interesting was they (yes, I’m trying to hide the sex) had TWO ROWS OF TEETH!!! Just on the uppers, but there was two rows of incisors and canines! It was way cool! Yes…this patient was a land-shark.
Next week we will pack our bags to go to Texas for a month of general radiology.
=========================================
Residency
If applying to medical school was not strange enough, the process of gaining a residency is even more bizarre. I think you’ll just have to follow step-by-step as I go through it. At this point, I have completed and submitted my ERAS (electronic residency application service) forms. It includes things like the programs (universities and communities training hospitals) to which you wish to apply (I have chosen to apply to Radiology, in case that was not mentioned earlier), CV-like accomplishments, contact information, letters of recommendation and the dreaded personal statement. I found it very difficult to summarize my life in one page in a way that would make any sense. Fortunately, I started drafting it about three months ago and went through about 15 complete rewrites until it became something I was willing to have others read. My understanding is the personal statement is one of those items that is unlikely to help significantly, but could hurt your prospects significantly. It was mostly completed by the time I left for Georgia, but it did go through one more revision here.
The letters of recommendation were another challenge. I started lining them up before summer started and had most of them in my file about a month before I left, however, one of them did not make it until the week before I left. The professor had dictated it, but, had failed to actually push the record button. So it had to be dictated again taking another three weeks for that opportunity to come around again. Actually, that is not all entirely true. There was one letter that I originally had not requested, but was spontaneously offered by the professor and completed after I left: I felt honored.
After some discussion with my better half, the programs were identified and I reviewed the list with my two Radiology advisors. Yes, I have two. Yes, they know about each other. Yes, they’re cool with it. Yes, it does feel a little strange. The benefit is I don’t have to flood either one with a load of questions and they both have different realms of wisdom from which to draw. The list is long, probably a little larger than it needed to be but, but it only costs a fraction more and trying to decide which dozen programs to drop just isn’t worth the effort. They are all good programs and statistics are always against the applicant.
The application can go out as early as September 1st, but I know of a few fellow students that are still working on their application. I submitted in the late afternoon on the first in most part because I tried to have as much of it finished as possible before leaving town and I was told that many radiology programs do not even start processing the applications until the 15th. That does not stop you from checking e-mail q30m (every 30 minutes) for that first interview invitation.
