Weekend At The Cabin

Last weekend was a switch weekend, which is the weekend between switching from one service (surgery) to the next (psychiatry). To celebrate the weekend off, Cami and I invited Sean & Ashley and Fernie to the Callister cabin in beautiful Twain Harte, California right outside Sonora. It was a lot of fun.

We took off Friday after Sean, Fern and I finished our surgery shelf. We drove up to the cabin and enjoyed the weekend with no responsibilities. We did all the typical things one usually does up at the cabin: we used the rope swing, we went sledding, we watched movies, ate lots of food and sat in front of the fire (that took FOR-EV-ER to get started). All in all, the kind of vacation you would like after working 14 hour days for 2 months.

A funny story: We were all having a good time on the zip-line behind the cabin. We were trying to have races to see who could make it from one end to the other the fastest. However, after everyone had gone a couple of times, the zip-line had lost a lot of tension and we had a difficult time making it to the other end. Fernie stalled out about 3/4s of the way across and decided to just let go of the rope so that he could run the rope back. He was explaining something to us about we should spray the pulley with more WD 40, when he let go of the rope. Well, the picture tells the story really. He miscalculated the length of the rope and when he let go, it sprang upwards and a huge knot that had been tied in the rope nailed him right in the crotch. Yeah, ouch is right. He dropped to floor and stayed there for quite some time. Fortunately, there was plenty of ice and snow around to keep the swelling down.

As far as sledding is concerned, we drove up to Strawberry and had a good time, though we barely avoided a pretty nasty snow storm. I remember sledding being a lot easier on the body as a kid. That was either because I was 70 pounds lighter or I just didn't try so sled some of the crazy trails we sledded. Either way, I think it was a little rough on everybody and we were all a little sore that night. Seriously, is there a faster way to break a tail bone than going sledding? I think not.

Lastly, this blog wouldn't be complete without a shout-out to Grandma Callister for supplying the cabin with an automatic card shuffler. We played a lot of board games and would have wasted a ton of time if it weren't for that little contraption. Thanks a lot, Grandma.

The Most Beautiful Girl In The Room

I just discovered these guys a few days ago. They are hilarious.



"You're so beautiful, you could be a part-time model... but you'd probably have to keep your normal job."

Humiliation

We had Sean, Ashley, and Fernie over for Valentine's Day dinner on Thursday. It was fun to have the chance to sit and chat with everyone. Sean, Fern, and I are all on our surgery rotation together and we got to talking about how humiliating being a third year medical student can be. I was actually glad to discover that I was not the only idiot in the third year class. Fernie confessed that he accidentally cut the cast of the wrong patient. Sean told us he spent 20 minutes trying to figure out how to turn a thermometer on. Cami and Ashley just laughed and laughed. They just don't understand. It is not easy being an MS3. And the worst part is, even the easy stuff is difficult.

Allow me to demonstrate:

Just last Monday I was taking overnight trauma call with the trauma surgery team. My last trauma call experience was a nightmare as we got 8 911 calls and I didn't sleep a wink the entire night. This evening was a lot slower, but around 10:00 Monday evening, we got a call about a woman coming in after being run over in a Walmart parking lot. For the uninitiated, the job of a medical student in the trauma bay is usually pretty simple. Your responsibilities are: 1) Cut the clothes off anyone who comes in, 2) Grab warm blankets for the now naked patient, 3) Be as helpful as possible, and 4) Do not get in the way. While the team was assessing this poor woman who had her pelvis fractured into 23 little pieces, I was busy trying to do my job.

After I had completed assignments 1 and 2, I very dutifully tried to accomplished task 3 while not interfering with task 4. At the height of the madness, my resident looked up at me, while pointing at the supply stand, and shouted: "Tim! Grab the lytes!"

Desperate to help, I stared at the supply stand and frantically searched for whatever the heck the "lytes" were. Unfortunately, none of the very-clearly-labeled items on the supply tray were titled "lytes." I shot a questioning glance back at my resident, she reiterated, "Tim, get the lytes!" I redoubled my efforts, but for the life of me, could not find those friggin' lytes. Starting to panic, I was opening drawers and moving trays. After all, this was a life and death situation! My resident reminded me a third time that she needed those lytes NOW and I became afraid that my failure to find these lytes might ultimately cost this poor woman her life.

Just as I was starting to think I was an absolute idiot, a trauma nurse (who clearly knew I was an absolute idiot) rushed past me and, while giving me one of those "How on earth did you ever make it past the admission's committee?" glances that only a nurse can give, flipped on the lights. The lights. Say this one like Chandler Bing: Could I possibly BE any dumber?

Perhaps the powers that be have decided that humiliation is the only acceptable form of education at the MS3 level. That may be true, for the next time someone asks me to "get the lytes" I will know exactly what they are talking about.

One More Thing

I meant to add this to the previous post, but it got a little long. So I add it here:

I'm working at the VA hospital in Sacramento. The other day, my intern asked me if I'd ever taken the staples out of a patient. I remarked confidently that I had done so. She then asked me if I'd perform said task on a patient who was to be discharged that day. Now, in reality I have removed staples from a patient, but to be perfectly honest, I'd never removed staples from a patient who was conscious. Not that it should make much difference, but I think this particular patient would have preferred it.

For those who have never either A) removed skin staples or B) had skin staples removed, the process is so simple a monkey could probably be trained to do it. The staple remover is designed to bend the edges of a staple outward so that they pop out of the skin with minimal pain/damage (see diagram at left). However, in the OR, you don't use the staple removers, you just use clamps to spread the staples open. It probably hurts more, but the patient is drugged and it doesn't really matter. Suffice it to say, I wasn't 100% sure how to use a staple remover, but figured it couldn't have been that difficult.

Confidently I strode into the patient's room and informed the guy who had his colon taken out that I was going to remove the staples in his stomach so he could go home. Confidently I put on my latex gloves and got my tools together. Confidently I grabbed the staple remover and comforted the patient that this shouldn't be too painful. Then, ever so confidently, I grabbed the staple remover UPSIDE DOWN, and instead of removing the staple, I clamped it down even tighter, nearly burying it into his skin.

The remainder of the encounter, unfortunately, played out a little something like this:

Patient: "Geez, doc! That really hurt!"
Me: "Yeah, um, sorry about that. This one looks like it's in there pretty good. Uh, it may take awhile to get it out..."
[Tim struggles for several minutes trying to grasp the buried staple with the staple remover. Unfortunately, the staple is bent so much into the patient's skin as to make it nearly impossible to grab with the staple remover.]
Patient: "Wow, it feels like that staple is buried in there!"
Tim: [sweating] "Yeah, it's in there pretty good. Sorry, this may hurt a little."
Patient: "Yeowch!"
Tim: "Hmmm... this staple is really stuck in there..."
Patient: "Yeah, it feels like it!"
Tim: "Uh, let me try a pair of scissors..."
[Tim grabs a pair of scissors and tries in vain to cut the staple]
Patient: Ooooh!
Tim: [more nervous now] "Wow, that thing is really in there..."
Patient: "Yeah, tell me about it... I'd like to talk with the doc who put that thing in there!"
Tim: [evasively] "Oh, I'm sure he didn't mean to do it... but I'll, uh, pass the word along to him..."
[Tim, wiping the sweat from his forehead, switches tactics and instead of trying to cut the staple, tries to spread it open]
Tim: "Alright, one last try. This might hurt a bit..."
Patient: "Ow! Ow! Ow!"
[Much to the patient's and Tim's delight, the staple finally comes out]
Tim: [relieved] "Aha! It's out! All done!"
Patient: "Wow, doc. That really hurt!"
Tim: "Yeah, that one was a little tough, but, you know, the rest of them shouldn't be as difficult."
Patient: "Really?"
Tim: "Uh, yeah, I'm pretty sure..."
[Tim proceeds to remove the next 16 staples, this time holding the staple remover correctly. The patient experiences no pain]
Tim: "There we go, all done. See, except for that first one, this wasn't so bad!"
Patient: "Yeah! But that first one was tough! You be sure and tell whoever screwed up that first staple that I'd like to talk to them!"
Tim: [quickly packing up his supplies and moving towards the door] "Oh, I am sure it was just an honest mistake! Anyone could have done something like this... Well, I'd better go. I hope you feel better soon! And lets hope you don't need any staples removed any time soon!"
Patient: [sincerely] "Yeah, thanks a lot, doc!"

Honestly, I am not sure who had it worse: the patient or me. I was really sweating for awhile there. Thankfully, it's over and there's another mistake I won't make again.

Decision 2008

I've wanted to be a doctor for as long as I can remember. As early as third grade, I remember quite confidently stating that I was going to be a doctor when I grew up. I went through junior high and high school under the same presumption. It was, after all, the only thing I'd ever considered and I couldn't even imagine myself doing something different.

When I got into college, I realized I was intimidated by the process of actually getting into medical school. Nationally, less than half of those who apply actually matriculate (44% in 2006). To be honest, I was apprehensive about actively pursuing a goal, where, despite my best efforts, I could end up a little short. Nevertheless, I knew deep down that it was what I was supposed to do. I worked hard, volunteered, took the MCAT, applied to schools and was fortunate enough to get into a great program at UC Davis. When I got that first acceptance letter, I was thrilled to know that I was actually going to be a doctor (my loving sister Cindy reminded me that I was only going to be a medical student, but congratulated me all the same). I figured all the big decisions were over.

I didn't realize how difficult it was going to be to actually choose what kind of doctor I was going to be. I hadn't really thought about that, I just wanted to be a doctor. The "Careers In Medicine" website my school has given us access to lists over 120 medical specialties. Everything from surgical endovascular neuroradiology to pediatric hematology/oncology to congenital cardiac surgery to geriatrics. It's overwhelming. Then when you consider all of the additional variables: lifestyle, patient population, reimbursement, length of residency, competitiveness... becoming a doctor is not quite as straightforward as I had anticipated.

I've been struggling with the idea of what kind of doctor I've wanted to be. I've wanted to be honest with myself, my limitations and abilities. I wanted to give everything a fair shot. After 8 months in the hospital, the OR, on the wards, in the clinics, I now have a much better idea of what I like and what I don't. Though this might not be a surprise to anyone who reads this blog regularly, I've decided that I want to be an Otolaryngologist. It hasn't been easy to come to that conclusion. ENT is a tough specialty to get into, and I've been a little intimidated by the prospect of trying and failing (much like I did when applying to medical school). But again, I feel like this is what I am supposed to do.

I won't know until March of 2009 whether my bid for a residency spot is successful, but at least I know what I'm working toward... and that kind of feels good.