Tuesday, October 31, 2006
Halloween 2006
Let's start with this...the idea for the costume came from the librarian at the Forensic psychiatry center early today. Apparently, her husband used to make such a costume and sit by his front steps. As kids came by trick-or-treating, especially older kids, he would wait until they walked past him and rang the door. He'd then tug at their sleeve and scares the crap out of them!
If this showed up at your window, would you open the door?
Well, my neighbor did!
And she allowed me to eat her newborn just to get this picture:
Halloween, was a rousing success with some help by my neighbors and ML. They controlled the moving ghost and spiders that were on separate pulleys. I decided that I was going to be an attraction and cut open the bottom of my 10 pound pumpkin. It did get heavy at times, however, let me state for the record that it did not get stinky! Several people asked me if it was "stinky in there?" It just smelled like light pumpkin goodness! The costume did make about four little kid cry their eyes out! And, taking off the pumpkin did not seem to help.
This year, the parade (of little kids dressed up in their costumes) ran in the opposite direction that is has in the last three years past, so my yard design was a little less than optimal, but it worked well enough. We took some pictures with are film camera, so it will be a while before I can post those. There's a little movie my nieghbor made, but I'll have to reduce the size before I can post it.
Monday, October 30, 2006
I'm getting ready for Halloween 2006!
Saturday, October 28, 2006
One of those moments
Flashback to Texas, one more time (at least). Going out to lunch with one of my old buddies: we decided to extricate her son from high school to join us. (You know you're getting old when you hear yourself saying things to your friend's kids that your parent's friends used to say to you.) With the car parked in front of the school, my friend went in to the front office to check-out her son. I believe the excuse she used was that he had a doctor's appointment. (I, apparently, was the doctor.) My friend comes out from the office, alone. She walks up to me and says, "Elliott, there's a student in the front office that is having some problems. They've called EMS, but I thought you might want to take a look." Good thing I was wearing scrubs. I walked in and explained to the people in the front office that I was not with EMS, that I was a medical student and offered to help. They told me that she was experiencing abdominal pain and difficulty breathing and they let me in to the back room.
I squatted down next to the young girl lying on her stomach who he was obviously in pain. Her father was already there and he seemed very nervous. He told me that she had asthma and was worried about her breathing. I introduced myself to her and asked her if I could help. (You practice that when you're doing the CPR training and it just pop out of my mouth.) I asked her to tell me what was going on. She was breathing very rapidly as she described an intense cramping pain in her tummy. As she spoke, I could tell that she was not having an asthma attack because she was actually hyperventilating because of the pain. She was also pushing good air as she spoke and groaned in pain. I asked her to roll over and point to where the pain was. Writhing in pain, she pointed to her pelvis. I starting thinking about ovarian torsion, ectopic pregnancy, renal stone and hernia (my differential diagnoses). I asked if she had ever had this before and she said she has had pain like this when she menstruates, but never this bad. I asked her if she was menstruating now, and she said yes. I asked if the flow had been normal for her. It had. At this point, the differential changed a little to have Toxic Shock syndrome up higher and ectopic pregnancy less likely. I asked if she used tampons (she did) and if she had changed it recently and regularly (she had). I heard that EMS had arrived so I tried to reassure them that she was going to be okay. I told her that I knew she was in a lot of pain, but she was going to get some help soon because EMS was here to take her to the hospital. She apologized (she did that the whole time) and I told her it was okay and there was no need to apologize. I walked out to meet EMS and told them that she did not seem to be having any difficulty breathing, other than hyperventilating and that her pain was pelvic pain, not abdominal pain.
After lunch, where I had fun getting to know the young adult my friend's son was becoming, I went up to pediatric radiology because I expected "my patient" to have had some imaging and I figured enough time had passed that she would be up there. She wasn't and they did not know anything about her.
I made my way over to the ER and explained the story to the nurses at the nursing station, they told me she was in room 30 and doing well. I, of course, had to ask where room 30 was. The pediatrician overheard the story and introduced herself and told me that she was doing quite well and that she was just having really bad menstrual cramping. I started walking toward the room which had a sliding glass door. The curtain was drawn so I could not actually see in, and, for some reason, I thought the door would automatically open as I walked up to it. Sort'a like Star Trek. But, it didn't. So, after asking exactly how to open the door (I was convinced there was some trick to it, which there was not), I knocked and entered. As I walked in, there was a person sitting in the corner to my left who caught my eye. It was the secretary of one of the centers I used to work with in Texas before I entered medical school. With my head tilted to the side in an inquisitive manner, I said hello to her (the lady in the corner).
I walked up to the father and the girl and they looked a little puzzled. I could tell they did not recognize me. I said that I was the medical student that saw them at the high school, when the father jumped up and said, "Oh! You're the guy! Thank you so much! I told them that there was a guy there before the ambulance..." (I thought to myself, they must have thought this poor father was really loosing it.) He thanked me again and again. The young girl apologized for not recognizing me, she said that she actually never opened her eyes when I was there. She was feeling much better and looked much more comfortable. It would turn out that she was the niece of the secretary I mentioned above. It sure is a small world at times.
Flashback to Texas, one more time (at least). Going out to lunch with one of my old buddies: we decided to extricate her son from high school to join us. (You know you're getting old when you hear yourself saying things to your friend's kids that your parent's friends used to say to you.) With the car parked in front of the school, my friend went in to the front office to check-out her son. I believe the excuse she used was that he had a doctor's appointment. (I, apparently, was the doctor.) My friend comes out from the office, alone. She walks up to me and says, "Elliott, there's a student in the front office that is having some problems. They've called EMS, but I thought you might want to take a look." Good thing I was wearing scrubs. I walked in and explained to the people in the front office that I was not with EMS, that I was a medical student and offered to help. They told me that she was experiencing abdominal pain and difficulty breathing and they let me in to the back room.
I squatted down next to the young girl lying on her stomach who he was obviously in pain. Her father was already there and he seemed very nervous. He told me that she had asthma and was worried about her breathing. I introduced myself to her and asked her if I could help. (You practice that when you're doing the CPR training and it just pop out of my mouth.) I asked her to tell me what was going on. She was breathing very rapidly as she described an intense cramping pain in her tummy. As she spoke, I could tell that she was not having an asthma attack because she was actually hyperventilating because of the pain. She was also pushing good air as she spoke and groaned in pain. I asked her to roll over and point to where the pain was. Writhing in pain, she pointed to her pelvis. I starting thinking about ovarian torsion, ectopic pregnancy, renal stone and hernia (my differential diagnoses). I asked if she had ever had this before and she said she has had pain like this when she menstruates, but never this bad. I asked her if she was menstruating now, and she said yes. I asked if the flow had been normal for her. It had. At this point, the differential changed a little to have Toxic Shock syndrome up higher and ectopic pregnancy less likely. I asked if she used tampons (she did) and if she had changed it recently and regularly (she had). I heard that EMS had arrived so I tried to reassure them that she was going to be okay. I told her that I knew she was in a lot of pain, but she was going to get some help soon because EMS was here to take her to the hospital. She apologized (she did that the whole time) and I told her it was okay and there was no need to apologize. I walked out to meet EMS and told them that she did not seem to be having any difficulty breathing, other than hyperventilating and that her pain was pelvic pain, not abdominal pain.
After lunch, where I had fun getting to know the young adult my friend's son was becoming, I went up to pediatric radiology because I expected "my patient" to have had some imaging and I figured enough time had passed that she would be up there. She wasn't and they did not know anything about her.
I made my way over to the ER and explained the story to the nurses at the nursing station, they told me she was in room 30 and doing well. I, of course, had to ask where room 30 was. The pediatrician overheard the story and introduced herself and told me that she was doing quite well and that she was just having really bad menstrual cramping. I started walking toward the room which had a sliding glass door. The curtain was drawn so I could not actually see in, and, for some reason, I thought the door would automatically open as I walked up to it. Sort'a like Star Trek. But, it didn't. So, after asking exactly how to open the door (I was convinced there was some trick to it, which there was not), I knocked and entered. As I walked in, there was a person sitting in the corner to my left who caught my eye. It was the secretary of one of the centers I used to work with in Texas before I entered medical school. With my head tilted to the side in an inquisitive manner, I said hello to her (the lady in the corner).
I walked up to the father and the girl and they looked a little puzzled. I could tell they did not recognize me. I said that I was the medical student that saw them at the high school, when the father jumped up and said, "Oh! You're the guy! Thank you so much! I told them that there was a guy there before the ambulance..." (I thought to myself, they must have thought this poor father was really loosing it.) He thanked me again and again. The young girl apologized for not recognizing me, she said that she actually never opened her eyes when I was there. She was feeling much better and looked much more comfortable. It would turn out that she was the niece of the secretary I mentioned above. It sure is a small world at times.
Thursday, October 26, 2006
My father pointed out that it was difficult for him to believe that ML and I could have spent an entire month in Atlanta, with my family, and not have ANYTHING to say about it. Obviously, it was the corporate version of the blog that had been posted, as he pointed out.
I suppose I should address the fact that the month was the longest stretch of time I have spent back in Atlanta after leaving in June of 1991. And, this time, I was there with my spouse. I suppose the only thing to report (as pathetic as this sounds) is that it when quite well! In reality, since I was working full time, there was little difference between this trip and others where I don't have to work. I suppose I was a little concerned that ML would have had some difficulty with the trip, but she did not. I think the best part of it was getting to know my nephews much better. I also got to spend some quality time with my grandma and the rest of the family. For the most part, they all play along together quite well. (You can read that however you want and it will be true.) Really, we spent so much time running around that there was little opportunity for anything to go "wrong." I think the worst part, which has been true of every trip back to Atlanta, was that there had not been time to see all of the people I would have liked and ML and I did not get to enjoy doing "things" in the city as I would have liked. I suppose one of the questions to be answered was if I thought I could continue to thrive being "home" again if I were lucky enough to garner a residency position there and I think the answer was a yes for me and ML. Alas, who knows what the future holds for residency.
=========================================
On my way back to Ann Arbor, I realized that I was left out one important story from my Radiology experience. Let me tell you about defecography! "What is that?" You say. Well, let us analyze that word. We know it is taking place in a radiology department so it probably has some aspect (or "asspect") of imaging to it hence the suffix of graphy. Defeco- sounds like the prefix of defecate, no? You think? Well, you are right! So, this is imaging of someone defecating. Who would have thought? Can you imaging writing the seminal paper on such a subject?
There was a patient who, as the store goes, fell on to a cactus. Yes, that is the story. I leave it to the reader to decide if there may be alternate versions of the story. I tend to believe the original story. (Or maybe that is what I want to believe.) As a result, the patient became secondarily infected around the rectum and one of the spines apparently initiated a fistula tract. The patient was given a diverting ostomy several months ago and now the question posed by the physicians' was whether the patient's anal sphincter was competent.
Suddenly I see this plastic, toilet-like, object being taken into the fluoroscopy room and I start putting the pieces of the puzzle together. The Radiology attending starts to describe how they are going to take a thick barium paste and inject it into the rectum with a caulking gun. (Yes, an actual "caulking gun." It seems to me that one should never put a cactus near that part of the body and, by similar logic, one should not put a caulking gun there either. I suppose the latter only applies if the former has been thoroughly observed.) After injecting the barium with a caulking gun, the patient was placed on the "toilet," the fluoroscope was positioned and turned on, and the patient was told to defecate.
The offer was made for me to go into the room to watch the procedure. I responded, "I think I have a sufficiently clear image of what is about to take place and, if I were in the patient's position, I think I would appreciate as few spectators as possible. After all, I can watch the remote monitors!" Thank goodness for remote monitors.
Unfortunately, the defecography revealed a very incompetent sphincter in addition to highlighting the fistula tract. (A fistula tract is an extra pathway of lower back pressure than the "normal" route of evacuation that bowel contents can travel and can end in an opening at the skin surface near the anus.)
I suppose I should address the fact that the month was the longest stretch of time I have spent back in Atlanta after leaving in June of 1991. And, this time, I was there with my spouse. I suppose the only thing to report (as pathetic as this sounds) is that it when quite well! In reality, since I was working full time, there was little difference between this trip and others where I don't have to work. I suppose I was a little concerned that ML would have had some difficulty with the trip, but she did not. I think the best part of it was getting to know my nephews much better. I also got to spend some quality time with my grandma and the rest of the family. For the most part, they all play along together quite well. (You can read that however you want and it will be true.) Really, we spent so much time running around that there was little opportunity for anything to go "wrong." I think the worst part, which has been true of every trip back to Atlanta, was that there had not been time to see all of the people I would have liked and ML and I did not get to enjoy doing "things" in the city as I would have liked. I suppose one of the questions to be answered was if I thought I could continue to thrive being "home" again if I were lucky enough to garner a residency position there and I think the answer was a yes for me and ML. Alas, who knows what the future holds for residency.
=========================================
On my way back to Ann Arbor, I realized that I was left out one important story from my Radiology experience. Let me tell you about defecography! "What is that?" You say. Well, let us analyze that word. We know it is taking place in a radiology department so it probably has some aspect (or "asspect") of imaging to it hence the suffix of graphy. Defeco- sounds like the prefix of defecate, no? You think? Well, you are right! So, this is imaging of someone defecating. Who would have thought? Can you imaging writing the seminal paper on such a subject?
There was a patient who, as the store goes, fell on to a cactus. Yes, that is the story. I leave it to the reader to decide if there may be alternate versions of the story. I tend to believe the original story. (Or maybe that is what I want to believe.) As a result, the patient became secondarily infected around the rectum and one of the spines apparently initiated a fistula tract. The patient was given a diverting ostomy several months ago and now the question posed by the physicians' was whether the patient's anal sphincter was competent.
Suddenly I see this plastic, toilet-like, object being taken into the fluoroscopy room and I start putting the pieces of the puzzle together. The Radiology attending starts to describe how they are going to take a thick barium paste and inject it into the rectum with a caulking gun. (Yes, an actual "caulking gun." It seems to me that one should never put a cactus near that part of the body and, by similar logic, one should not put a caulking gun there either. I suppose the latter only applies if the former has been thoroughly observed.) After injecting the barium with a caulking gun, the patient was placed on the "toilet," the fluoroscope was positioned and turned on, and the patient was told to defecate.
The offer was made for me to go into the room to watch the procedure. I responded, "I think I have a sufficiently clear image of what is about to take place and, if I were in the patient's position, I think I would appreciate as few spectators as possible. After all, I can watch the remote monitors!" Thank goodness for remote monitors.
Unfortunately, the defecography revealed a very incompetent sphincter in addition to highlighting the fistula tract. (A fistula tract is an extra pathway of lower back pressure than the "normal" route of evacuation that bowel contents can travel and can end in an opening at the skin surface near the anus.)
Monday, October 16, 2006
It's still raining...
Still on the road but this time over in Texas: I am trying to extend summer temperatures as long as possible, but I may have pushed the limits this time. I was slammed last night with a Texas-sized rain. It's hard to explain to someone that has not experienced it, but it can rain on the order of an inch an hour. It was so bad last night that the car had to be moved from under the house to a higher spot in the yard and it was still in a few inches of water. Under the house, the water was about six inches deep. The rain continued almost all night and, in a house that is on 14 foot stilts, you feel like you are something of a bon-bon for the tornado-gods. And, if one hits, there is no where to go since all of the culverts are filled with water. So, you either die in your crumbing house or you die by drowning while having your crumbling house land on top of you.
As such, I was not able to report into work/school today: makes me (almost) wish I had rented a truck instead of compact car.
I am almost done with my general Radiology rotation down here in Texas. (To keep anonymity, I will not say exactly which program, but if you know anything about Texas, you can probably figure it out.) There had been some significant changes (read RIF's) shortly before this rotation and even bigger changes since my arrival including the resignation of the dean and the president of the medical school. I happen to think this will drive something of a Renaissance for the University, but I am often accused of being too optimistic. Despite difficulties in other areas, the Radiology department continues to be healthy and the residences all report being happy and satisfied with their experience.
Being on a general radiology rotation, there is not enough time to really grasp any particular subspecialty, but one does get to see a great variety of images. The general Radiology students also gather daily to present unknown radiographs. Since the UM blocks do not line up with this institution's, I started a week late. The professor gave me an unknown and said to watch the other students present and I would get the hang of it. Each student started by presenting a patient history and then describing how each of the findings fit into the disease process (or the list of possible diseases if the radiograph could not define the diagnoses). The odd thing was my unknown did not come with a patient history. It was about two minutes before my presentation that I realized the other students were making up the histories. The way I had understood the course description, most of the unknowns came with a history, but some did not. I quickly derived a story to fit my image and hoped it was on target.
Now, I am just waiting for the water to recede so I can drive into school without having to worry about killing the rental car: giving me a little time to write.
