Rock Solid Since '03

A Little Piece of Home

2012-01-22T20:04:00.001-05:00

The best thing about Cami having an iPhone? Getting photos like this one sent to me during a brutal call weekend to remind me just how lucky I really am.

Research

2012-01-16T11:23:00.000-05:00

I began another block of research time this month. I will be honest, doing research has never really excited me. In fact, it has generally elicited the opposite response. During my career in academia, I have participated in a number of research ventures. I will be the first to admit that none of my research has been particularly noteworthy. This is likely due to the fact that my primary drive for participating in scientific research has generally not been to contribute to the general fund of knowledge, rather to check off the "Have you participated in research?" box on my medical school and residency applications.

As various research projects are a requirement of my residency training, I've given a lot of thought to the idea of "research" and what benefit my study (which investigates the effects of topical nasal anesthesia on swallowing studies) actually has for practicing physicians.

Though the concept has supposedly been around for centuries, the term "evidence based medicine" didn't pop up until the 1990's and has since become the buzzword in medicine today. The aim of evidence based medicine (EBM), is to "apply the best available evidence gained from the scientific method to clinical decision making."¹ In other words, medical treatment should be based on proven facts not theories.

EBM was conceived when the medical community realized that a lot of the medical treatments that have been administered over the years weren't really helping anybody. Though grounded in the sound scientific principles of the day, things like blood letting, frontal lobotomies, X-ray treatments, and other nutty treatments aren't generally used any more because they've been proven to do more harm than good.

Though I firmly believe that EBM has improved the efficacy of medical treatment substantially, there are a few people who seem to take the concept a little far.

I recently stumbled across an article in the British Medical Journal² which addressed this issue exactly. The article is titled "Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials." In this article a couple of cheeky British scientists question the validity of questioning everything by suggesting that since no randomized, controlled, double blinded studies have been performed proving the efficacy of the use of parachutes in "gravitationally challenged" individuals, we cannot assertively state that they improve survival.

In the words of the authors:

"As with many interventions intended to prevent ill health, the effectiveness of parachutes has not been subjected to rigorous evaluation by using randomised controlled trials. Advocates of evidence based medicine have criticised the adoption of interventions evaluated by using only observational data. We think that everyone might benefit if the most radical protagonists of evidence based medicine organised and participated in a double blind, randomised, placebo controlled, crossover trial of the parachute."

The idea of handing somebody a backpack which may or may not contain a parachute and convincing them to jump in the name of science made me chuckle. However, I can think of a couple people who I'd like to have volunteer for the study. There's some research I can get behind.

1. Health Aff. 2005; 24(1): 18-28
2. BMJ. 2003; 327: 1459-61

Omi & Opi

2012-01-12T15:41:00.003-05:00

My parents came out last week to pay us a visit. Well, I say pay "us" a visit, but I think they were really in town to meet the little dude. The picture below may not suggest as much, but Charlie did enjoy all the extra attention.

This is the first time my parents have made it out to NC for an extended visit since we moved here. They did swing by for less that 24 hours when they came for Laynie's graduation two Summers ago. Wanting to encourage this type of behavior, we did our best to show them a good time. We took them to our favorite restaurants. We visited local points of interest. We went on a shopping spree. We went to the movies. We introduced my mom to the game "Words with Friends." We watched a couple BYU basketball games. But mostly we let my mom play with Charlie while my dad cat-napped on the couch.

The focal point of my parents' visit was to be present for Charlie's big day on Sunday. As is customary in the Mormon faith, Charlie was presented to the congregation and given a name and a blessing. Charlie's blessing was a special experience and we were privileged to have my dad, Sean, Jordan, and Tyler assist in the administration of the blessing. Sean and Ashley were also having their daughter, Hailey, blessed the same day and we had the good fortune of having Sean's parents in attendance too. Even our Catholic friends, Fern and Rachel, came in from Durham to be there. It was a great day.

With so many parents around, we coordinated a dinner the night before (coincident with my 31st birthday) and invited everybody to be there. Who knows, the next time Sean's parents and my parents get together for dinner may be at Charlie and Hailey's wedding...

They say all good things must eventually come to an end and we did eventually have to take Omi and Opi back to the airport and say our goodbyes. The house is a little quieter with them gone (but not much, old people don't make that much noise anyway). We can't wait to see them again in June.

But our home won't be empty for long. We actually have a lot of family members who are now interested in coming out to North Carolina to visit us. I didn't know one of the fringe benefits of having a kid was that one instantly becomes more popular with the family. We are looking forward to upcoming visits from Cami's parents and two of her sisters.

Home Call

2012-01-11T00:06:00.002-05:00

Taking call from home is miserable.

When I was an intern, I despised being on call. A 24-hour weekend shift after a long week was almost torture. I didn't realize that taking call from home was going to be so much worse. In my mind, the ability to escape the hospital would far outweigh the inconvenience of having to occasionally come back in to see a patient.

I was so, so wrong.

You see, at least with in-house call, I can leave my hospital problems in the hospital and not be bothered by them at home. I am pretty sure that every page, and especially every ED consult, is 10,000 times more aggravating when it rips you from your home and forces you back to work.

After a long day at work, the only thing I want to do at night is do go to sleep. When that pager tears me from REM and summons me to the ED, all I can think about during my five minute commute is "I could be in bed right now." It is immensely frustrating. And when I get paged again on my way home from the hospital and have to turn my car around... I don't think there is a faster way to crush someone's soul.

When I took call in the hospital, I didn't plan on sleeping. Things were just too busy. As I didn't expect to sleep, I was never disappointed to have been awake all night. For some reason, despite my wealth of experience to the contrary, I always harbor some ridiculous belief that I am going to get decent sleep on my call nights or spend quality time with my family. Thus, many a call night ends up a horrible disappointment.

I freely admit, pitching a home call "no-hitter" isn't a rare event, by any stretch, but it isn't common either. It happens just frequently enough for you to get your hopes up that any given night might be a good one. It generally isn't.

I had been curious to discover how having a newborn was going to compare to taking home call. In fact, over the last two years, whenever Cami complained about my excessive fatigue and occasional moodiness, I reminded her that she may some day know what it's like to be this tired. Fortunately for Cami, my assessment so far is that baby call is a lot easier than home call. A baby cry is nowhere near as grating as a pager (interestingly, Cami doesn't hear my pager and I rarely hear Charlie's fussing). Soothing a whimpering newborn is also a touch more enjoyable than draining a peritonsillar abscess. And though Cami is on call every night, Charlie hasn't made it too rough on her. He's actually been a really good sleeper.

In conclusion, home call is terrible. I am desperately looking forward to the day when I am no longer the first contact person for the hospital (just six more months).

Holiday in Review 6

2012-01-01T07:53:00.000-05:00

All the presents have been unwrapped, the lights are coming down, 2011 is gone and 2012 is here... that means it's time for our annual Holiday in Review. Once again, in no particular order, the ten most noteworthy happenings of the 2011 holiday season.

10. Brashggie! We were super excited when Brad, Ashley, and Maggie informed us that they were going to be visiting North Carolina for Christmas. Brad had some vacation days that were set to expire at the end of the year and they couldn't think of a better way to spend them than to come visit us. They got here on the 22nd and stayed through the 29th. While they were here, we played lots of games, introduced them to Cookout and Milner's, lounged around, and basically had a great time. Maggie took to "Bebee Chah-lee" instantly and seemed pretty enamored by him. Going from two people in the house for Christmas last year to six this year made quite a difference. We loved it and have a standing invitation for any family members who want to join us next year.

9. Worst Christmas on Call. It's a good thing that Cami and Charlie had some extra visitors around for Christmas... they might otherwise have been pretty lonely. Having accrued a little seniority in the department, I didn't have to work Christmas morning this year. But I did have to work Christmas Eve and Boxing Day. And man, did I have to work. In addition to the dozen or so ENT patients we have in the hospital, I was fortunate enough to be consulted on a CSF leak, an aphthous ulcer, two peritonsillar abscesses, Ludwig's angina, dysphagia, invasive fungal sinusitis, a dog-bite to the face, tracheal stenosis, suppurative parotitis, two broken mandibles, two midface fractures, and a partridge in a pair tree. I was barely home at all Christmas Eve. What kills me though, was that a third of the patient's I saw in the ED Monday morning admitted to me that their "emergencies" started a day or two ago, but they didn't want to come into the hospital on Christmas so they decided to wait it out. Thanks, guys.

8. Snotsucker to the Rescue. Annoyed at how useless the hospital nasal aspirators are, and frustrated with the snot rattling around in Charlie's nose when everybody is trying to sleep, we decided to take matters into our own hands. On Leighanne's recommendation, we ended up buying a Frida Snotsucker on Amazon. This little piece of plastic and tubing is quite possibly Sweden's greatest contribution to the human race. Once you get past the initial "Ew" of sucking snot out of your kid's nose with a glorified straw, you realize how effective the device is. Cami swears it might be the only gift she ever gives at a baby shower again.

7. Nerf Guns. A year or two ago, I lamented that one of the downsides of growing up is that there isn't anything to play with Christmas morning. Helping me connect with my inner child, Cami bought Brad and me a couple of Nerf guns. These guns have come a long way since the ones that were sold when I was a kid. Everybody had a good time shooting and being shot with these things, even Maggie. We even set up a number of targets in the living room and had a friendly shooting competition (Tim 17 - Brad 16). Maggie also enjoyed biting the darts and rendering them utterly useless.

6. Tanglewood Festival of Lights . Every year Tanglewood Park puts on a big lights show for Christmas. We've heard people talk about it quite a bit and have been interested in going since we got here. We've also seen the huge line of cars outside the park and have been a little less than excited about waiting two hours in a car to see Christmas lights. Fortunately for us, the lines weren't nearly as long after Christmas. We made a trip to Tanglewood our New Year's Eve activity and were pretty impressed. Charlie slept through most of the drive. He probably wouldn't have appreciated it much anyway. Nearly one million light bulbs on display (we counted each one) may bring us back again next year.

5. One Large Bowl of Football. Charlie enjoyed the first of many football games with his dad as BYU beat Tulsa in the Armed Forces Bowl on a last second touchdown pass. From the quarterbacking controversy, to the Big XII/Big East conference invitation drama, to the thrilling USU win and the humiliating to Utah... this has been a long season for BYU fans. However, in contrast to year's past, I did not have to "watch" a single game by streaming KSL's internet radio feed. The ability to catch every single BYU game on either ESPN or BYUtv has made me a huge fan of BYU's football independence. Even though the schedule was a little lackluster, I think there are some good things in the works setting us up nicely for the future. With the perpetual optimism of a sports' fan: We'll get 'em next year.

4. Christmas Jam Sesh. For the last several years, Cami and I have made a tradition of a little Christmas jam session. I dust off the ol' guitar while she retunes the cello and together we "rock out" to our favorite Christmas carols. We are thinking about recording our rendition of "We wish you a merry Christmas!" and distributing it. Yeah, it's that good. Maybe next year we can even get Charlie in on the action. I bet by then he'll be able to play a mean rattle. Stay tuned...

3. Holy Moley! Regular readers of the blog may remember me recounting my frustration with Cami's refusal to let me remove a skin tag on her hip. In fairness to Cami, she eventually acquiesced and let me remove the blemish (which, she now admits, was not a big deal after all). A few months ago, she was describing the process to Ashley over the phone and Ashley suggested that she'd love to have a mole on the bottom of her chin removed. When Ashley & Co. got here, she reminded me that she wanted that mole removed. I gathered some supplies from the hospital and had Ashley de-moled in 10 minutes. Ashley was a little nervous about the shot, but Cami kept telling her it was no big deal and that she wouldn't even notice it. After we finished, I invited Cami to let me get that mole on her back since we already had all the stuff out. She politely declined.

2. Happy New Year 2012. Cami, Charlie, and I welcomed in the New Year on the couch. We had just finished watching a movie and tuned in to watch the ball drop on Times Square. What a difference a year makes. 2010 had been a pretty rough year for the both us. In light of a number of challenges, trials, and disappointments, we were not sad to see the year end and were hopeful that the next year would be better. Well, 2011 could not have been much better than it was. We are so grateful for the blessings that we've received this past year and are excited to discover just what adventures 2012 will bring... unless that whole Mayan calendar apocalypse thing is real.

1. Even More Rock Solid Than Ever. With the addition of Charlie to our family, we are still 100% Rock Solid with no end in sight.

Vrolijk Kerstfeest!

2011-12-25T06:39:00.001-05:00

Merry Christmas from the three of us.

In Case You Missed It...

2011-12-24T06:24:00.000-05:00

Our Christmas card/birth announcement this year.

One Month: Cami's Update

2011-12-22T11:59:00.001-05:00

Before Charlie was born, I researched lots of things. I studied up on pregnancy, labor, baby's feeding and eating schedules, and the best baby gear to purchase. Now that Charlie has been with us for one month, I have realized that I forgot to study the most important thing: how do you stop your baby from growing up? Or how do you stop time? I had no idea I would feel this way!

One Month: Tim's Update

2011-12-22T05:45:00.000-05:00

He's getting chubbier. He's smiling more often. He's flying through diapers. He's outgrowing his newborn onesises. He's holding his head up. His nasty umbilical cord stub finally fell off. He falls asleep instantly in the Moby wrap. He survived a couple Christmas parties. He loves car rides. He's a fast eater. He burps like a pro.

I Have Arms!

2011-12-09T05:25:00.001-05:00

How It All Went Down

2011-11-28T14:12:00.001-05:00

Now that things have settled down a bit, I have a few moments to talk about how things got from here:

to here:

I suggested that Cami write a few things down about all this, but she says she doesn't really remember most of it. I suppose she was a little preoccupied. So, for what it's worth, here is what happened last week as I experienced it.

As we were packing our bags to come into the hospital for Cami's induction, we were discussing what we thought labor was actually going to be like. I suggested that maybe labor really wasn't painful at all and that it was all just one big secret that mothers' around the world kept to garner sympathy from their husbands and keep their teenage daughters from getting knocked up.

We checked into the hospital at about noon and and Cami got hooked up to an IV. She got to put on her awesome argyle hospital gown. We ran through a bunch of questions with our nurse. Then, because her blood pressures were a little high, we had to check a bunch of labs. Once all those came back normal, Cami was hooked up to the pitocin. That started her contractions up pretty regularly, but Cami was a little surprised that her contractions weren't really painful. For awhile, we were thinking there might have been some validity to my labor conspiracy theory.

However, Cami's joy-ride through labor ended shortly after her water broke. Suddenly, things became very uncomfortable and within a couple hours she got an epidural. It was a good thing she got it when she did, because she flew through labor and might have missed her opportunity if she waited too long. With the help of the pitocin, she jumped from 4cm to 9.5 cm in a few hours. At about 11:00pm, concerned that she was progressing too quickly, they stopped the pitocin and let her labor on her own. I was convinced that the little guy was going to make it out by midnight.

I was wrong. Without the benefit of the medications, it took another four hours before Cami was far enough along for to begin actively pushing. Our nurse, Marlena, was a great help and really made the process a lot easier. Together we coached Cami through the grueling delivery process. Nearly three hours later, the doctor pulled out a slimy, screaming Charlie and placed him on his mom's chest.

I had no idea how intense this process was going to be. This was not my first time around laboring women, but I was nearly overwhelmed by the powerful emotional experience it was. Prior to the delivery, I could put my hand on Cami's belly and feel Charlie bouncing around in there, but it was more an intellectual awareness of his existence than an emotional connection with him. After supporting and encouraging Cami as she struggled to bring this little person into the world, then seeing him emerge and take his first few breaths... it forged an immediate and significant emotional bond to this little guy.

After all that hard work, the many disappointments, the years of waiting, hoping, and praying, we finally got to welcome our son into the world. One week later, I don't know how we got along without him.

We're so happy to finally have you here, Charlie.

A Few More Photos

2011-11-26T22:23:00.001-05:00

How are we supposed to get anything done around here, when this guy is taking up all of our time and attention?

Happy Birthday, Charlie!

2011-11-22T13:31:00.001-05:00

Charlie officially joined the family at 5:46 this morning. The little chunker tipped the scales at 9 pounds. He is 21 inches tall. He's got blond hair and dark blue eyes. Cami was a super star during the labor, which lasted about 8 hours.

Mom and Dad could not be happier to finally have this little guy in our lives.

More details and photos to follow.

40+ Weeks

2011-11-21T23:10:00.000-05:00

Cami had a doctor's appointment this morning. Her OB took one look at Cami's belly, swollen ankles, and expired due date and said, "It's time to get this baby outta here." We agreed and will be checking ourselves into the hospital.

So the little guy is getting his eviction notice today. He's got 24 hours to vacate the premises.

Or else.

Stages of Pregnancy

2011-11-16T11:07:00.001-05:00

Over the past nine months, I've noticed that the way strangers look at me has changed dramatically the more pregnant I got. I am not unaware at the glances at my direction every time I go grocery shopping and they have certainly changed. I told Tim about my observation and he thought I should blog about it. With his help, I present:

The 4 Stages of Pregnancy

Stage I: "Silently Pregnant"

At this stage, it was way too early for most casual observers to notice that I was pregnant at all. For the first 12 weeks I didn't show anything anyway. Nobody cared because I didn't really look any different or, at most, I was just slightly thicker in the waist. Life carried on as normal.

Stage II: "Possibly Pregnant"

This was when the baby bump started becoming more obvious. People's gazes started to linger and you can tell the wheels in their head were turning. Most people would probably agree that I was pregnant, but there was still that tiny chance that I wasn't. Because I didn't offer up any information their curiosity went unconfirmed. I've actually been pleasantly surprised with how responsible people were in refraining from asking the question that is blaring in the their minds. It's like the whole world finally got the memo about the risks of asking the "Are you pregnant?" question. Good job people!

Stage III: "Definitely Pregnant"
At some point my belly got large enough that people could confidently make the decision that I was indeed pregnant and not just getting fat. At this point, people would go ahead and bring it up in conversations without feeling like they were going out on a limb. Some people even tried to play it off like they'd known about my pregnancy for ages. There was lots of excitement in conversations and people wanted to know all about the pregnancy. This was especially true with women in their 40's and other mothers. During this phase, my belly was still in the "cute" phase, but it was large enough to give people the green light to use the "P" word. Checkers at the grocery store would ask me if I was having a boy or a girl. Random people felt licensed to touch my belly. Tim says my impending motherhood radiated warmth and I shouldn't blame everybody for wanting to bask in the glow.

Stage IV: "Bless her heart"
For me, I noticed this stage starting at around week 37. My belly isn't cute anymore, it's huge. Instead of warm smiles, I just get the looks of pity. The only question I ever get from a stranger any more is, "When are you due?" This really means, "You look like you are about to pop! Are you sure that baby wasn't supposed to come out a few weeks ago?" All that "glow" I had a couple weeks ago has disappeared. It's probably buried somewhere in my enormous ankles.

I am so ready for this baby to get here already.

To Do List

2011-11-14T15:23:00.001-05:00

Paint baby's room blue... Check!

Assemble crib... Check!

Buy a glider... Check!

De-assemble crib for and exchange it for a new one... Check!

Buy lots and lots of baby clothes... Check!

Assemble the new crib... Check!

Repaint baby's room a slightly different blue... Check!

Reupholster the glider because the green is ugly... Check!

Buy a car seat... Check!

Assemble a changing table... Check!

Hang curtain rod... Check!

Hem curtains because curtain rod was hung too low... Check!
Buy a baby monitor... Check!

Hook up baby monitor... Check!

Organize baby clothes... Check!
Buy a stroller... Check!

Shop for maternity clothes... Check!

Pick a baby name... Check!
Assemble baby bouncer... Check!

Purchase a Port-a-Crib... Check!

Attend baby showers... Triple Check!

Write 50 "Thank-you" notes... Check!

Read just about every baby book on the planet... Check!

Graduate from Birthing Class... Check!

Take a tour of the hospital... Check!

Figure out what the heck "My Brest Friend" is... Check!

Choose a pediatrician... Check!

Rearrange the guest room for parents and in-laws... Check!

Assemble a "Hospital Bag"... Check!

Battle with ankle edema on a nightly basis... Check!

Make a million trips to Baby's R Us and Target... Check!

Stock up on groceries... Check!

Have a baby...

To Dad

2011-11-10T09:31:00.000-05:00

I took care of a Hmong patient the other day. Despite the fact that western North Carolina is purported to have a higher density of Hmong immigrants, this was the first Hmong patient I'd taken care of since graduating from medical school. Having grown up in Merced, California, where it seemed like there were just as many Xiongs and Mouas in my school as there were Smiths and Joneses, the encounter left me feeling a little nostalgic.

My interaction with the patient was pretty straightforward. He was having difficulty swallowing and an outside hospital CT scan suggested the presence of an abnormality that needed to be worked up. The patient didn't speak any English and I watched as his son struggled to translate terms like "fiberoptic laryngoscopy" into Hmong. Language barriers notwithstanding, we were able navigate the examination fairly smoothly and I think I had all of the patient's questions answered. After finishing up things, I chatted a bit with the son and told him I'd stop by in a day or two to go over the results of some of the tests which had been ordered.

As I left the room, I started thinking about my dad, who, over the last thirty years, has built his practice largely around taking care of Hmong, Laotian, Mien, and other Southeast Asian patients. As I reflected on his career, I was suddenly overwhelmed with appreciation and admiration.

The huge influx of Southeast Asian refugees into the Central Valley following the Vietnam War made a significant impact on our community. Though I was too young to fully comprehend it at the time, I watched as my dad selflessly accepted these patients into his practice who neither understood English nor had any concept of what "Western Medicine" even was. Many of these same patients were turned away by other physicians who were unable or unwilling to care for them. As I got older, I grew to better appreciate what a challenge this must have been.

In addition to providing his patients the care they deserved, my dad was unique in his respect for the cultural differences of his patients and his allowance of their autonomy in making medical decisions. This earned him their mutual respect. Though it may not mean anything to anybody else, the phrase "It's their body" has greatly influenced me during my medical training and brief career.

A solo practitioner for much his career, my dad was always on call. As a kid growing up, that occasionally meant a delayed vacation or a missed ballgame. There were a couple Christmases where we were tantalized by unopened presents as we waited for my dad to get back from "delivering a baby" in the middle of the night. My dad worked hard to provide for his family by working hard to provide for his patients. I would like to think that lesson wasn't lost on me as a child, as I never felt neglected on account of my dad's occasional absence. I knew he would have been there if he could have been.

Perhaps my own impending fatherhood has filled me with a deeper sense of appreciation for the sacrifices my dad made. With our own little guy due to arrive any day now, I hope to be able to live up to the example my dad set for me in both my professional and personal life.

Thanks, Dad.

I'm Ron Burgundy?

2011-11-02T21:00:00.003-04:00

Last month, a few of the residents in the department were discussing facial hair. We all thought it would be a super funny if we decided to grow out beards and then trim them back to mustaches for the department photo in November. I don't think any of us thought the others were serious, but when we all showed up after the weekend with a the beginnings of a beard, we decided to make it official.

I've only really tried to grow a beard once before. It was two years ago while I was on the night shift for a month. I was never really impressed with my results, but it was kind of a fun experiment. I took it a bit further this time around and I think I had a bit more to work with this time around.

We had our department photos this morning. I think all of our hard work paid off.

Every mustache tells a different story, and clearly, some of those stories are better than others. We had a great time and I think most of the faculty thought it was pretty hilarious (except maybe my chairman... I may be looking for new employment next year). The photographer loved it and had us pose for a couple extra photos. Right before the above photo, someone yelled out "Do Anchorman poses!" Then someone suggested, "Stare plaintively off into the distance!" I guess I was the only one who took the first suggestion...

We had quite a bit of fun with the 'staches. Apparently, so did the Photoshop guys at Creative Communications, they filled in all the empty upper lips among the residents. It's almost hard to tell which mustaches are authentic. They emailed us the doctored photos later that afternoon. I think some of the ladies in the department actually look good with their mustaches.

In the process of doing all this mustache growing, I actually learned that November is the official month for mustache growing to raise awareness for prostate cancer. Who knew? Unfortunately, my gnarly 'stache (which was pretty much the best of the bunch) didn't survive the evening. I was growing tired of retasting everything I had eaten for lunch. And to be honest, I didn't think my patients could really take me seriously when I showed up for clinic looking like a slightly less-awesome Magnum PI.

Farewell, mustache! Until we meet again!

Halloween Night Musings

2011-10-31T20:03:00.003-04:00

1. What's up with kids not saying "Trick or Treat" and just thrusting a bag in your face? Greedy punks.

2. Do parents really need to collect candy too? What are they doing? Running it back to their own houses because they are too cheap to buy their own?

3. Would it be a total downer if next year I dress up as diabetes?

4. After hearing me complain, Tim told me that I was being a "Trick or Treat Nazi".

5. Well at least my costume is less disturbing than his...

Hiccups

2011-10-30T22:11:00.001-04:00

I was resting my pregnancy cankles, hoping the swelling would go down (which it didn't), when the above video opportunity presented itself.

Thirty, too!

2011-10-23T22:01:00.000-04:00

Cami turned the big three-oh today and I wanted to do something to surprise her. This was no small task as Cami has some sort of ESP when it comes to detecting surprises and discerning gifts. I am not proud to admit I had to lie through my teeth for two straight weeks, but at the end of the day Cami got a birthday surprise that I think she enjoyed.

It all started two weeks ago. Cami had provided me a list of what she wanted for her birthday and generally I don't stray too much from these types of suggestions. However, I had a hunch that what Cami really wanted wasn't on her little list. Cami has had a gimmicky phone since she dropped her cellphone in a glass of water. Unfortunately, her contract wasn't up yet for another five months or so.

My contract, however, had expired a few months ago and I had been waiting for the latest Apple product to be released. As I was ordering my own new phone, I noticed that the fee for upgrading Cami's contract early was pretty nominal. I decided this was just the opportunity for me to pull off a real birthday surprise. So I placed an order for two iPhones.

Cami knew I was expecting a package from Verizon with my phone, but I figured she would have been awfully suspicious if two similar packages arrived on my doorstep. I went to great lengths to keep this information secret. I conscripted Ashley to do drive-bys of our house in the hopes of intercepting the UPS delivery guy. Long story short*, I was able to surreptitiously procure the packages without Cami ever noticing that something was up.

On Saturday, I sent her over to Sixth Sense to get herself a pregnancy massage. While she was gone, I invited our good friends over to the house for an ol' fashioned surprise party. The neighborhood kids thought it was a lot of fun... even if we waited around forever for Cami to get back from her massage (little did we realize she was doing a little post-massage shopping).

When she finally got home, she was greeted by half the neighborhood in her kitchen. She was a good sport about it and didn't wet her pregnant pants when we all yelled "Surprise!" We all enjoyed some yummy homemade cake and ice cream (thanks to Ashley and Cianne, respectively). When everything had settled down, Cami got a chance to open her presents. For perhaps the first time in my gift giving career, I managed to genuinely surprise my wife with a gift she actually wanted... just don't expect that to happen every year. We've been having fun playing with her phone and getting to know the newest member of our family, Siri.

Congratulations on making it thirty years, Cam.

*Getting this package from UPS was a six day ordeal that involved multiple phone calls, discussions with two different supervisors, two trips to the UPS Customer Care Center, a 45-minute wait in a Big Lots! parking lot searching for a "broken down delivery truck," and a lot of consternation. UPS seemed determined to prevent me from getting my delivery or at least determined to spoil my surprise. Fortunately for me, they failed on both accounts. The worst part about it is, I have no recourse for their terrible service. I can't demand my money back, because I didn't pay for their service in the first place (Verizon did). I was hoping that I could get free shipping for a year or something... no such luck.

Facing the Truth

2011-10-21T17:28:00.001-04:00

I bumped into one of our scrub nurses in the hallway the other day. The both of us get along well and we've probably had hundreds of conversations over the past three years as we've been in the same cases together. I know all about her kids and family, many of her hobbies, as well as her likes and dislikes... I just had no idea what she looked like until I bumped into her in the hallway.

Which helps explain why I didn't recognize her until she said, "Dr. Tim... is that you?"

One of the problems with having to wear a mask in the OR all day, is that you can interact with all of the ancillary staff day in and day out and not even recognize them. Sure, you know their height, body-type, you can see their ears, eyes, and hair, but I am always surprised when I finally get to "meet" a nurse or scrub outside the OR.

I don't consciously try and fill in the missing details from all of the empty faces I interact with daily, but I clearly have some sort of image in my head because I always feel betrayed when one of my friends' faces is revealed to be something much different than what I had supposed. It's if my mind is telling my eyes: "Wait a minute! That's not what she's supposed to look like!"

This experience is disorienting and even a little awkward at first. Passing a "stranger" in the hall, you both look at each other quizzically. You wonder where it was that you met that person before, because something about them looks familiar. It doesn't click until you hear their voice and everything slams into focus. The person you know and a new face are instantly fused, and somehow, even after they put the mask back on, the person seems a little different.

It was the experience of discovering the new face of an old friend that made a recent lecture I attended so interesting. The division of surgery invited Dr. Bohdan Pomahac, who performed the first full facial transplant in the US, to speak about his experiences. He spoke of the four successful facial transplantations they had performed at Brigham and Women's Hospital and spoke about the medical, surgical, and social implications of his work. The pictures and stories he shared were both graphic and impressive.*

He and his team have done some amazing work with these patients and really changed their lives. But his lecture got me thinking: As hard as it is for me to accept it when someone else's face looks different than my expectations, what would I do if it was my own face that didn't seem right? After seeing my reflection for the last thirty years, could I ever see a different face in the mirror and successfully convince myself that it was now mine?

I hope I never have to find that out.

*So graphic and impressive, in fact, that some poor nurse who was attending the lecture passed out. After his neighbors noticed he had slumped over in his chair, they cried out for help. In a lecture hall filled with 400 surgeons, physicians, and anesthetists, this one patient got everybody's attention in a hurry. I thought it would be funny to yell: "Is anybody here a doctor?" but decided against it. After being revived, the poor pale-faced nurse was feebly escorted out of the hall. To add insult to injury, as he was leaving, the emcee announced to the audience that the guy had had a vasovagal episode and was going to be fine. However, I'm sure everybody just heard him say: "Hey guys! That guy just fainted! What a sissy!" He could at least have spared the poor dude's pride and said he was hypoglycemic or something. That guy will probably never live that one down...

This Little Piggy

2011-10-16T13:51:00.000-04:00

I got to take a trip back to Charleston, SC this past week for the Carolina Pediatric Airway course that is offered every year for residents. The course was open to residents from the 7 ENT programs in North and South Carolina and Georgia. It was essentially a two day symposium on dealing with pediatric airway issues. There were a number of lectures and work-shops, which were all pretty helpful. There was a cadaver lab where we were all given a larynx and allowed to perform various endoscopic procedures.

We also ran through mock airway emergencies on tiny little pediatric Manikins (essentially a life-like mannequin with $70,000 worth of computer technology and medical algorithms stuffed inside). These high-tech simulators are all the rage in medical training right now. Health care providers are able to practice clinical decision making in life-or-death situations without actually having to actually make a life-or-death decision. While you run through a hypothetical scenario, the baby on the table responds physiologically to the decisions you make. There's also a one-way glass in the room, where people behind it are checking monitors and giving either words or encouragement or derision as you navigate the road blocks they keep presenting. I'm happy to say that though I almost killed my little simulated baby, I'll be a little more able to deal with a similar circumstance should it happen in real life.

As accurate and lifelike as these scenarios are for clinical situations, we don't yet possess the technology to realistically simulate an operative environment. Which is where the pigs come in.

Part of the course involved performing airway reconstructions in the porcine model. Essentially, there were a half-dozen anesthetized and intubated piglets. These little piggies have lungs and bronchi which are similar in size and morphology to that of a two-year-old kid. The lab is invaluable training for performing laryngotracheal reconstructions on kids who are born with tracheas which are too small to allow them to breathe. Additionally, we also practiced removing foreign bodies from porcine bronchi (I guess I can now add Christmas light to my list of foreign bodies extracted). This was excellent practice as the aspirated foreign body removal in the pediatric patient tends to be a nerve wracking procedure anyway (as opposed to the ingested foreign body, which is just plain fun).

All of this made for very realistic training and will likely pay dividends for the kids I'll take care of during my career.

34 Weeks

2011-10-07T19:38:00.000-04:00

Spillage

2011-10-03T08:55:00.001-04:00

Cami has a little bit of a spilling problem. Neat, organized, and clean in most other facets of her life, for some reason food has been finding a way onto her shirts for years. Now that the surface area of her belly has increased dramatically, the likelihood that she escapes a meal with an unblemished shirt has decreased proportionally.

True to form, however, she doesn't let it phase her. We had a good laugh last night at Panera when some of her Asian sesame chicken salad managed to escape her fork and find its way to her belly.

A fringe benefit of her knack for saving morsels of food on herself is that she has become quite proficient at removing stains.

How to Have a Baby

2011-09-22T21:11:00.069-04:00

For the last four weeks, Cami and I have been headed over to our Ob/Gyn office every Thursday for a birthing class. It's a course which is taught by a nurse who has probably been working in labor and delivery for 40 years. Our instructor was great, but she kind of struck me as one of those old war vets who keeps telling the new recruits what things are going to be like "out in the field."

Our first week there, we were one of the first couples to arrive. As the 7:00 start time drew nearer, pregnant lady after pregnant lady came waddling into the little conference room. All of the women in the class were at least 7 months along and all of them were first time mommies. Pregnant women come in lots of different shapes and sizes and it was fun to watch the parade of bellies as everybody showed up. Equally entertaining, was watching all the dads-to-be saunter in. You could definitely see the relief on some of their faces when they stepped in the room and thought: "Phew! I'm not the only dude here."

Over the four week course, we were taught about all sorts of things: episiotomies, VBACs, station, latching, epidurals, colostrum, footlings, and a whole bunch of other stuff that people didn't know about when they were having babies for the last six thousand years but seems to be pretty important now.

One thing we went over a lot was breathing techniques. Our instructor had all the ladies get down on the floor as she went through various methods of breathing through contractions. As nervous husbands squeezed their expectant wives legs to simulate a contraction, the mommies all had to practice their breathing techniques. We were instructed to practice these techniques at home and I have taken it upon myself to randomly give Cami cow-bites and tell her to focus on her breathing. I think she really appreciates this extra practice.

We're coming into the final stretch here. Obviously getting pretty excited about the whole thing.

Save Me, San Francisco

2011-09-18T07:35:00.167-04:00

Every year the American Academy of Otolaryngology-Head and Neck Surgery has their annual meeting. One of the perks of being a third-year resident is that I was given to attend this meeting, contingent on my submitting a research project. Well, my case series on Polymorphous Low-grade Adenocarcinoma (something I'm sure you guys already know all about) was accepted for a poster presentation. This meant I got myself a free ticket to San Francisco for a week-long conference with several thousand ENTs from across the country. And man, otolaryngologists know how to party!

The conference itself was about as good as one might expect a conference put on by laryngologists, otologists, head and neck surgeons, rhinologists, cosmetic surgeons, and otolaryngologic allergists could be. I learned quite a bit about my chosen profession. The opening speech to the conference was actually given by a deaf actress, Marlee Matlin, who did a great job and made proud of my sister Laynie. I attended a bunch of other seminars and lectures and had a good time.

But when the lectures ended, that's when the party started. My co-residents, who are mostly all from the Mid-West, really wanted to live up San Francisco... and they did. We have a pretty liberal dining budget and as a result got to eat at some nice places. We went to a comedy club. I rode in a limo for the first time ever. Visited Alcatraz for the first time since I went for a CSF field trip back in 1994 (it's still a big concrete building atop a rock in the middle of the Bay). I rode through downtown, past the Botanical Garden, across the Golden Gate Bridge, and into Sausalito on rented mountain bike, which was actually a lot of fun. I also "chaperoned" several of my co-rezzies as they bounced from bar to pub to club to speakeasy* to dance hall... It was a really busy week.

Best of all, I got to rent a car and vist mom and dad for a home-cooked meal and a football game on TV. Being back in California did make me miss many of the amenities that the Golden State has to offer. Proximity to family and fresh California produce chief among them. And though I don't know if we'll end up back in California when this whole "residency thing" is over, I'm probably more open to the idea now than when we left the state.

All vacations come to an end, and waking up to go to work at 5:00 AM EST Thursday morning after having stayed up past midnight PST all week was rough. But it was a good time... and I look forward to my next AAO-HNS meeting in Vancouver 2013.

*A content teetotaler myself, I've never been to many bars, let alone a "prohibition style speakeasy." Nevertheless, the girls were really excited about going, so we all went to one. The entire bar had a 1920's theme and all the waitresses were dressed like flappers. Just like a true speakeasy, you even needed to know a password to get in the inconspicuous front door on Jones Street. Our password to enter the place was "spill." Spill? There are dozens of super cool 1920's terms you can choose from and our password was "spill?" I joined our little party a little late and made the mistake of complaining about the lame password. Some random guy sitting at our group took offense and tried to defend the password by stating that the bar only chose words which could be found in a 1920's dictionary. I countered that there were thousands of words in the dictionary in the 1920's, and though "spill" may have been one of them, it was a much lamer password than "the cat's pajamas" or "the bee's knees" would have been. The gentleman and I agreed to disagree and the topic was changed. It wasn't until after this random fellow left our party that the girls told me he was the owner of the bar. Whoops.

We Will Never Forget

2011-09-11T09:11:00.277-04:00

This being the tenth anniversary of the attacks on the World Trade Center, Cami and I have been thinking a bit about what we remember from 9/11/01. It's hard to believe that it has already been a decade since that unforgettable day. I was shocked to hear one of my brothers-in-law tell me that he was talking to some teenagers awhile ago, and realized that they didn't really remember anything about 9/11 because it was "so long ago." As a very small tribute to those who lost their lives on 9/11 and in the events that ensued, we decided to write about our very different experiences that day in September.

Cami's Experience:

It was my sophomore year of college. It was a Tuesday. I feel like it was just the second day of class, but looking at the calendar, it must have been the beginning of the second week of class. As a big sophomore, I had just moved into my first off-campus apartment and I was loving getting settled and playing with my five other roommates, Camille, Kim, Andrea, Rachel, and Danielle.

I was in my apartment that morning. It was probably one of those awesome semesters I managed to not have any class on Tuesdays. Kim (my cousin & roommate) and I had invited our cousin Brad over for breakfast and to celebrate him going into the MTC the next day. I don't remember exactly how I heard the news of the attacks first, but I think it was one of my roommates coming home from a class. Since we had just moved in, we still didn't have any tv channels hooked up. I had never been a big tv watcher, but I remember wishing so badly that I could watch what was happening. I felt very uninformed about the situation. As a few of us sat in our apartment wondering what we should do, somehow we came up with the conclusion that we should probably take a picture of ourselves on that day. Totally obvious, right? If you will notice the color scheme of our outfits, it wasn't even planned. All of us were already dressed when we heard the news. --editors note: I (Cami) is still looking for this photo. Where in the world did the box with all of my college pictures go?! It is making me crazy!

But here is what I remember most about the day. My roommate, Andrea, had an early morning class. She woke up and headed to class without any knowledge about the events of that morning, When she arrived at class she was asked to say a prayer to begin the class.

This is often done in classes at BYU, so it wasn't an indicator that anything unusual had happened. As she went to begin her prayer, her professor asked her to remember the people being affected by the tragedy. She had no clue what he was talking about. But, true to Andrea's character, she remained calm and cool and said her prayer including a very generic "bless the people in the tragedy", although I'm sure she added a little bit more sincerity than that. She closed her prayer and sat down feeling very awkward that apparently everyone else knew what was going on.

The other thing I remember about that day is that the terrorist attacks messed up all flights and travel. Brad was supposed to go into the MTC on Wednesday morning, but his parents weren't able to fly in and the MTC was just telling people to get there whenever they could. I remember he was feeling pretty unsettled by the whole thing.

Over the following weeks and months, I remember feeling like our country had united in a way I had never seen before in my lifetime. What comes to my mind are the American Flags that popped up everywhere, most commonly the stickers on people's cars. They were everywhere! I loved seeing them and being reminded that even though the attacks were tragic, it was an experience that bonded us as Americans.

Tim's Experience:

I woke up on 9/11/01 in Leipzig, Germany. I had been in Germany as a missionary for a little over a year and a half and had spent the last five months in the Missionsbüro. My tour of duty in Leipzig was coming to a close and I was scheduled to be transferred to Hof, a small city in the north of Bavaria, to finish out my mission. The office was particularly busy as we had just received a new batch of bright-eyed missionaries fresh off the plane from the MTC in Provo, Utah.

It was late afternoon and I was sitting in our office on Springerstraße talking with some of the new missionaries, when my companion came in the office and said: "The United States is under attack! They've bombed the the World Trade Center in New York!" I didn't really even know what to think about that, or who "they" were. I thought he was joking, but Elder Bailey had never been the practical joking type, so we all ran up four flights of stairs to the Missionsheim. When we got up there we saw that Präsident Hughes was watching the news. There on the TV screen were those iconic images that we've all seen now hundreds of times as they played the footage of the WTC towers collapsing over and over.

The rest of the evening was strange. The usually bustling Fußgängerzone in Leipzig was empty. We abandoned the city center and worked through neighborhoods instead. Going from door to door, we had several people invite us in to let us watch TV with them. Many of them expressed their condolences and asked if we had family or friends in New York. There was a hollow feeling that permeated the city that evening, and I can still recall it vividly. As we made it back to the Missionsheim later that evening, I learned that all the other missionaries in our mission had similar experiences.

I made it out to Hof the next day, but the bad news seemed to follow me. There were candlelight vigils at St. Marien in Hof the night my train arrived from Leipzig. All anybody wanted to talk about was politics. I learned words like Bin Laden, al Qaeda, and the Taliban, which really held no meaning for me. Without a TV or radio or newspaper, the only news I received was in weekly letters from home and the information that people wanted to divulge on the street. In Germany, things eventually calmed down and people lost interest in talking about die Terroristen after awhile.

Suffice it to say, I was amazed when I returned home a few months later, that America was still in the post-9/11 period. Driving home from the Oakland airport to Merced, I had never seen so many American flags on cars, billboards, t-shirts, and bumper stickers. This was a real cultural shock for me, especially since it was still considered taboo in Germany to display any hint of national pride. There was a palpable feeling of national unity that was comforting, even if it, too, was transient.

My mom showed me newspaper articles and magazine features she had saved detailing the events. I learned about the firefighters and first responders and countless others who played a role in the events surrounding 9/11. I was a few months late, but I was overwhelmed with pride and gratitude for the sacrifices people had made.

Eight is Great!

2011-08-23T05:44:00.000-04:00

Cami and I celebrate eight years of wedded bliss today. But she has to work late tonight and I have an evening lecture, so we had to celebrate a little early.

Last Saturday I let her take her big ol' pregnant belly over to a massage parlor to get a "pre-natal massage." I'm not exactly sure what that is, but she seemed to enjoy it a bunch. After that, we went out to Milner's, which is probably her favorite restaurant in Winston-Salem. We concluded the day by going to the Grand to see "The Help" which is based one on of her favorite books. Not a bad day for Cami.

Here's to one more year, Cam.

Huntin' Skeet

2011-08-21T17:35:00.002-04:00

Sean and I went on a Skeet hunt yesterday. It was quite the adventure.

Skeet are indigenous to North Carolina, but can be found throughout the greater continental US. I had mistakenly assumed that Skeet were related to the Common Snipe, an animal I had frequently hunted (unsuccessfully) as a youth during many a Boy Scout campout. In reality, Skeet are more closely related to the clay pigeon. The bright orange plumage of the North Carolina Skeet makes them easy to recognize. As they are not the fastest fliers, Skeet attempt to avoid being caught by predators with erratic flight patterns. In order to hunt Skeet, the successful hunter must first locate a Skeet nest. Fortunately for Sean and I, Cliff (a member of our ward who works for Remington), knew of a Skeet breeding ground and invited us to join him.

Once a nest has been located, the hunter can startle the unsuspecting Skeet into flight by yelling the word: "Pull!" The loud noise compels the Skeet to flee their nest and take to the air where skilled marksmen should be able to bring down the bird. Prior to our hunt, I asked Cliff if we would eating the Skeet we caught and whether Skeet meat was more gamey than chicken. He told me he wasn't entirely sure, but that I would be more than welcome to eat what I killed. As it was, I had Cami keep the BBQ on standby in case I was able to bring some bird home.

Neither Sean nor I had ever fired shotguns before, so after a brief introduction on shotgun safety, we were handed our 12-gauges and off we went. We both found the skeet to be a little elusive at first, but once we got the hang of our guns... those poor Skeet didn't stand a chance. We fired off about 50 shells apiece, and netted a fair amount of skeet. Unfortunately, I didn't have a retriever to fetch all the Skeet I hit and wasn't able to bring home the bacon (or bird) for my wife at home.

Sean and I were both feeling pretty good about ourselves and our Shotgun skills (clearly all those hours of Duck Hunt as a kid were not wasted), until we saw the geriatric crowd who started shooting after we finished. These guys were so old, they probably learned to shoot during the Civil War. They also probably hadn't put down their muskets since the Confederacy surrendered at Appomattox because they were lightening quick with their shotguns and right on the money. I don't think they missed a single bird.

After we finished watching the old guys, we went and shot some handguns for awhile. Cliff and some of his Remington buddies were showing us a couple of their pieces and letting us shoot at some targets. This wasn't nearly as fun as shootin' Skeet, but we had a good time nonetheless. Cliff even let us play around with his .357 Magnum revolver which I was pretty lethal with, as the evidence below demonstrates. It was a little too much gun for Sean to handle, so they had to find him something a little smaller to work with.

After the day was over, Cliff took us over to a place called Mickey's and we had one of the best hotdogs I've ever eaten. All in all, it was a pretty good outing... unless you were a Skeet.

The Legend of Blowing Rock

2011-08-18T14:34:00.002-04:00

About 90 miles West of Winston-Salem lies the community of Boone, North Carolina. Tucked away in the Appalachian Mountains, Boone is the access point to some very beautiful mountains and rock formations. One of which is The Blowing Rock. Blowing Rock is a rock formation above a huge gorge with wind currents which often blow vertically up the face of the rock. According to an old Indian legend, these peculiar gusts of wind take their origin from the pleas of a beautiful Chickasaw maiden:

It is said that a Chickasaw chieftan, fearful of a white man’s admiration for his lovely daughter, journeyed far from the plains to bring her to The Blowing Rock. One day the maiden spied a Cherokee brave wandering in the wilderness and playfully shot an arrow in his direction. He soon appeared before her wigwam, courted her with songs of his land, and they became lovers.

One day a strange reddening of the sky arrived at The Blowing Rock. To the brave, it was a sign of trouble commanding his return to his tribe. With the maiden’s entreaties not to leave her, the brave, torn by conflict of duty and heart, leaped from The Rock into the wilderness far below. The grief-stricken maiden prayed to the Great Spirit until one evening a gust of wind blew her lover back onto The Rock and into her arms.

Cami and I were so touched by this beautiful tale of star-crossed lovers that we decided to re-enact the important scenes.

Here, you see Cami, the beautiful Chickasaw maiden (who is apparently 26 weeks pregnant), praying earnestly to the Great Spirit for the return of her departed lover. You can really see the sincerity in her face. Cami did a great job modeling for these photos and probably would have made a pretty awesome Chickasaw maiden in real life.

In this photo, I represent the Cherokee brave being blown back up the mountain. I wanted to include a picture of Cami's wigwam, but decided against it. This is a family blog, after all. Absence of wigwams notwithstanding, I think our brief photo-essay captured the essence of the legend of Blowing Rock.

After we had wandered around Blowing Rock, we made a trip over to Grandfather Mountain. Purported to be "the most rugged mountain in the Carolinas," we made our way up to the top. Among several other things, Grandfather Mountain is home to the highest swinging bridge in America.

Crossing the bridge enabled us to access some of the beautiful vistas of the Blue Ridge Mountains. Despite being a little top-heavy, Cami was surprisingly nimble as she clamored out onto some of those rocky crags and outcroppings. I was quite impressed with my Chickasaw maiden.

We eventually left the mountain and made our way home after stopping for dinner. All in all, it was a great trip and a fun way to spend a Saturday.

Cami Update

2011-08-16T19:29:00.005-04:00

Favorite quotes from my pregnant wife during her daily emails:

"On my lunch break I got pretty tired so I laid down on my floor. I'm pretty sure I fell asleep."
"OMG! I feel like I have to pee like every 5 seconds."
"I do get to see the real Maya Angelou in person today. Hopefully I won't be starstruck, you know how I get around famous poets/authors..."
"I know I can't ask for any sympathy on this one, but I just can't seem to get my butt and very large and growing belly out of bed before 7am. Like seriously. This is ridiculous. Maybe tomorrow I'll show more discipline."
"Did I snore again last night? I'm pretty sure I did."

My wife is the best.

My Last Summer Adventure

2011-08-15T20:31:00.004-04:00

Summer of 2011 has been a good one, as most are. It started with a trip to California to visit family and go to Fernando & Rachel's wedding and a quick trip to Southern California to play with Katie's family. After returning to work for a week I left again and braved a week of girls camp at Camp Appletree. I went back to work for another three weeks that were interrupted by two weekend trips, one to Carolina Beach and one to Charleston. But all good things must come to an end and my summer adventures are now over.

However, I did end on a high note with the annual Jerry & Kathy Callister reunion (insert a picture of my dad's awesome yellow and blue "Welcome to the Callister Family Reunion" sign that makes an appearance at any event that can be considered a Callister family reunion... if I had one).

This year we all met up in Tahoe, and by "all" I mean everyone but Tim. Sad, huh? Tim always gets left out of these things. But the good news, is that hopefully this year was the last year he won't be there!

Brent & Melissa were in charge of the festivities this year and they chose "Heroes" as the theme (remember the video Tim posted a while ago?) The first night we were introduced to some pretty amazing heroes, as pictured below.

All of the grandkids got super hero capes, and there was even a special mini one for our baby yet-to-be-born.

And now for some Callister family reunion shout-outs. Shout out to:

Brent & Melissa for all of the planning

Black tights for somehow getting my Dad to wear you

Matt Magleby for guarding us against bears with his nerf gun

Jack Parker for successfully leading the cousins in a reenactment of "Tangled"...sorry we had to cut you off after the second scene (trust me though, I really wanted to sit there and watch you guys act out the whole movie during the talent show).

Tay, La, & Meg for officially infecting me with Bieber fever

Jake for being my roomie

My sisters for throwing me a "surprise" baby shower

Sadie for the best foot massage I've ever had

Doug for accompanying me on a sev run
The weather, for being SO much nicer than last time we were there
Cinda, for being the official photographer so the rest of us could be lazy
Northstar resort for mailing me my ipod that I left on the treadmill....pregnancy brain
Maggie for entertaining us every night
Tim for holding down the fort back in NC

The Electrolarynx

2011-08-07T20:48:00.003-04:00

I love the larynx. I love that the plural of larynx is larynges. I even enjoy it when Southerners call it a "lar-nix" and then look at you funny when you suppress a smile. I am fascinated that this complex organ is capable of producing the vibrations we know as our voice. It's also responsible for keeping food from "going down the wrong pipe," as well as a myriad of other things.

Laryngeal cancer can be a very devastating disease. A cancer in the voice box can keep you from breathing, swallowing, and speaking in relatively short order. Typically, a combination of surgery, radiation, and chemotherapy are needed to achieve a cure. Though we do everything we can to preserve the native structures of the neck, sometimes a cancer is so advanced that the only way to eradicate the disease is to perform a laryngectomy.

I've had several of my own patients come into my clinic with very advanced laryngeal cancers. After lengthy discussions about the pros and cons of each method of treatment, many of my patients have opted to undergo a laryngectomy with post-operative radiation. A laryngectomy is essentially a procedure where we remove the voice box (and the tumor contained therein). Patients who have had a laryngectomy performed refer to themselves as laryngectomees.

I have to be honest, my larygectomees are some of my favorite patients. They have all been incredibly positive and have dealt with their life-altering disease and treatment with grace. I love my laryngectomees! One of the biggest challenges they face, however, is learning how to communicate after their surgery. We have a great Speech and Language Pathologist (SLP) department at the hospital who help our laryngectomees master verbal communication after their voice box has been removed.

A little while ago, one of the SLPs came by to demonstrate the various means of post-laryngectomy communication to the residents. She had firm mastery of esophageal speech (essentially burp talking), a talent which she was not shy about demonstrating. She also let us play around with an electrolarynx.

You may have seen these before. I've always thought they were pretty cool. Some of my patients have become very fluent with their electrolarynges. Others... not so much. In their defense, it's not as easy as I thought it would be. Nevertheless, with a little practice, I was able to get the hang of it. At least enough to pose this very important question to my darling wife:

So, Cami, would you still love me if I didn't have a larynx?

When I Was an Intern...

2011-07-31T12:28:00.000-04:00

Interns today have it too easy.

The ACGME released new work-hour restrictions for interns effective July 1, 2011. The rules stipulate that interns cannot work more than 16 consecutive hours during any one shift and must have a ten hour break between shifts. They are still beholden to the 80 hour work/week limitation. Furthermore, they are henceforth prohibited from performing any patient care where they are not "supervised either directly or indirectly with immediate direct supervision available."

Congratulations on becoming MDs, new interns. Welcome to the fifth year of medical school.

This change has created some major headaches for every department in our hospital as we scramble to find ways to do the work the interns used to. Many departments are turning to mid-level providers to fill in the void (why a PA with two years of training is more capable than a new physcian with twice that is beyond me). As it affects our department personally, in addition to no longer be able to assess patients individually, interns are no longer allowed to take any home call. This responsibility is now divded amongst those who can. In other words, my job just got a little tougher.

Forgive me for sounding like a bitter old resident, but when I was an intern we were actually expected to work. We did our thirty hour shifts and we liked it. We were scutted out by our senior residents to complete tasks which were several standard deviations below pleasurable on a regular basis and we were grateful for the opportunity. We were the absolute bottom of the hospital food chain and we knew it.

I can't even begin to describe the number of times I felt wildly unprepared for a situation where I was told by a more senior resident to "go take care of that." But the fact of the matter is, it was those experiences that actually taught me a thing or two about being a doctor. I don't care how many times you read about it in the text book, treating atrial fibrillation is a lot different than knowing how to treat it. Deciding what to do with a stridulous patient at 2:30 AM is a much more valuable educational experience than reading about it at 2:30 PM. There is something about being forced to make a decision that, right or wrong, hammers home the lesson.

Though I was frequently put in situations that stretched me, I never felt like help wasn't available if something actually went wrong. I don't feel like I ever placed a patient in danger and I'd like to think I actually helped a patient or two along the way. And I certainly feel I am more able to care for my patients today having been through that than I would have otherwise been.

Now, I know my internship experience pales in comparison to that of physicians as little as a decade ago. The 80 hour work-week restrictions have only been in place since 2003 and I've heard horror stories about residents before then. While I think some limitations on work hours are healthy, I wonder how prepared graduating residents are now compared to ten years ago. I've heard rumors of a push to further reduce resident work hours down to 57 hours/week. I don't see how this could be done without extending the length of residencies by a year or two.

I don't know what the answer is or if a good solution even exists. I do know that my third year got a little busier than I had anticipated. I guess I should just be grateful for the learning opportunities...

Sterile Technique & Rhinorrhea

2011-07-26T21:21:00.006-04:00

Today I spent about eleven hours in the operating room. We were doing a total laryngectomy on one of my clinic patients and it went very well. The case was long, but rewarding. When I tell others about some of these marathon cases we do, I've frequently been asked how surgeons can spend all day in the OR without needing to take breaks, or go to the bathroom, or get something to eat.

The short answer is, we usually have time to do all of those things during our long surgeries. Occasionally, one of us will "break scrub" to grab a quick bite, or visit the bathroom, but you can usually make it through a case without any interruptions. Honestly, I am usually so engrossed in what is going on, that I kind of forget how long I've been working or how hungry I am.

Another reason to avoid taking breaks is the annoyance of having to scrub. Because most surgical procedures are considered sterile, we have to go through a thorough sanitation process to be able to operate. We call the process of not contaminating a patient's body during surgery using "sterile technique." This involves scrubbing your hands with soap, dressing in aseptic gowns and gloves, donning caps and masks, and not coming in contact with anything that is unsterile. Your hands should never fall below your waist, because all the germs are reported to hang out somewhere down there. We also scrub down the patient and drape them in sterile towels. It's a lengthy process and I tend to think a lot of it is just voodoo (the water out of the tap I scrub with isn't sterile, how then are my hands?).

My concerns notwithstanding, that doesn't stop me from doing it. There are more than a few scrub nurses who make their living preying on med students and residents who don't know what to do with their hands and frequently inadvertently "contaminate themselves" by touching (or almost touching) some non-sterile object. I've seen poor med students be forced to re-scrub four or five times in a row because the scrub Nazi had it out for them.

A young surgeon quickly learns to keep his hands to himself. One of the hardest habits to break (at least for me, anyway), was absentmindedly succumbing to the urge to itch, rub, scratch or otherwise touch my nose. Doing so would be a gross violation of sterile technique and likely bring the wrath of a scrub Nazi down upon me. There is something about having that mask on my face that makes my nose scream for attention. Through constant repetition, I have trained myself to ignore the itch or tickle in my nose... no matter how much I want to scratch it.

Worse still than an itchy nose is a runny one, such as the one that plagued me today. There is no way to stop the runny nose in the OR if you are scrubbed into a case. It simply drips and drips and drips. Sniff all you want. Annoy your attending with your constant sniveling. It makes no difference because you can't bring your hand to your face to do the one thing you really want to do: wipe your nose.

My nose dripped for eleven hours in a row today. I could just feel snot dribble down my upper lip and get absorbed into my surgical mask. I tried contorting and wiggling my nose in every way imaginable. Didn't help. Eventually, I was forced to lick the snot off my lip (I was even able to lick my nose, I don't think I've always been able to do that) and just go on with the case. By the time we finished, my mask was soaked with a half-day's worth of nasal secretions. Yuck.

Tomorrow is a clinic day and I won't be in the OR again until Thursday. Let's hope this runny nose resolves before then...

Our Hero

2011-07-20T08:44:00.002-04:00

Every summer during the third week of July, Cami's parents, her siblings, her in-laws, and all of her nieces and nephews gather for their annual reunion (referred to hereafter as "The Reunion"). As it is currently constituted, Cami's family consists of sixteen adults and nineteen children (with one more on the way). With thirty-six strong personalities running around a confined space, you can probably imagine that The Reunion is typically very crazy but also a lot of fun.

Unfortunately, July is a rough month for medical students and residents. It is the first month of the academic year and a difficult time to request time off. As a result, 2008 was the last time I was able to make a cameo at The Reunion. Last year, in an effort to make sure that some of my younger nieces and nephews didn't forget what I actually looked like, I made a "Top 10" video on YouTube which was played during one of The Reunion's nightly programs. Cami informs me that this video was well received.

This year, The Reunion is in Tahoe and the theme is "Heroes." Brent (who is responsible for planning the reunion this year) had requested that each family prepare a nightly message on our personal heroes. I believe the implication was that we each find examples of scriptural or historical heroes to serve as inspiration for our general self-betterment. Well, this was just the opportunity I needed to make an appearance in Tahoe (albeit remotely), speak about one of my favorite subjects, and dust off the ol' Sony HandyCam to create a little movie magic.

Please excuse me for waxing nostalgic, but as a kid, I loved making movies with my friends and my little sister Heather. Our videos were generally pretty hokey and had some semblance of a clichéd plot. They were also littered with lame "special effects" and dumb jokes... but they were so fun to make! From "Gnatman" to "There's Gum on my Shoe" to my feeble attempts at stop-motion animation, it was very easy to spend hours making those five minute videos.

Amateur video editing has since come a long ways since the days of turning up the volume on the tape deck to simulate a soundtrack or sliding my hand over the lens to "fade out" of a scene. With a digital camera, some video editing software, and a fair amount of time, it is not hard to piece together a fairly professional production.

I came up with the concept and Cami helped hash out the details. We enlisted the help of Sean and Ashley, and Izzy and Abbi, who did a great job in their respective roles. We filmed on location over the course of two days. Though I still think I look/sound weird on camera (do movie stars feel the same way when they watch their own movie premieres?), I'm happy with the finished product.

All of the above is merely a lengthy introduction to a short film. So, if you have about twelve and a half minutes to spare, I invite you to enjoy a little documentary:

Parotidectomies

2011-07-17T19:39:00.001-04:00

I had the opportunity to perform my first superficial parotidectomy a couple weeks ago. It went great! It was an awesome experience which went very smoothly and left me feeling pretty confident in my growing surgical abilities.

I performed my second parotidectomy two days later. It didn't go as smoothly.

The difference has a little to do with supervision and a lot to do with the facial nerve.

The seventh of twelve cranial nerves, the facial nerve alone is responsible for coordinating the muscles of facial expression. After leaving the brain, it winds through the temporal bone before exiting the stylomastoid foramen deep to the ear. En route to the twenty some odd muscles it innervates (including this mouthful of a muscle: the levator labii superioris alaeque nasi), the nerve splits into an upper and lower division. It then divides further into 5 main branches. It continues to divide and sub-divide until the the branches are no thicker than a human hair.

For no apparent reason other than to torture well-intentioned otolaryngologists, when the Good Lord drew up the blueprints for the human body, He decided to send the delicate facial nerve right through the middle of the body's largest salivary gland: the parotid. This makes removing tumors from the parotid gland a tedious and time consuming affair. Unless he intends to leave his patient with unilateral facial paralysis, the surgeon must be able to dissect the parotid tumor free from the delicate facial nerve. To be too timid is to risk tumor recurrence, overaggressiveness risks facial nerve injury. It is truly a delicate surgery,

As I progress in my surgical training, I am getting the opportunity to operate more on my own. Generally, by the time an attending lets you operate unsupervised, you have already demonstrated more than sufficient capability to perform the given task. You can understand the procedure backwards and forwards, but I am a firm believer that you don't really know how to do an operation until you do it on your own.

My first parotidectomy was well supervised by the chief resident and attending. It was also a straightforward case. I could act confidently because I had someone watching my every move and confirming all of my decisions. The second one became more difficult merely because I was unsupervised for good periods of time. Suddenly, every decision became my decision. Choosing to ligate a vessel or make a particular cut through gland weighed heavily on my mind. If that lady's face didn't work when she woke up, it was going to be my fault. That's an sobering thought, especially when you are already on the extreme edge of your comfort zone.

Learning to trust yourself and your judgment takes time and a lot of practice. However, as you continue to push yourself to the limits of your ability, your ability gradually increases. What was once a leap of faith, eventually becomes just another step when you pass by again. It's uncomfortable at the time, but it gets easier.

Fortunately for me (and for my patient), everything worked out fine. The tumor came out safely and her face works perfectly. Additionally, I was able to stretch myself and I grew because of it. When I truly couldn't go any further, I was able to get the help I needed. The assistance taught me how to address those roadblocks in the future, but also validated my progress to that point.

I certainly couldn't have done it all on my own, (and I still can't) but I am getting there.

Bad Things & Good People

2011-07-16T20:17:00.064-04:00

I got a call the other night that one of our next door neighbor's was in trouble. There are a few other Mormon families in our little housing development (all residents), and we are a close knit group. Turns out Andrea went up to check on her four month old son, Beckett, after putting him down for a nap. He wasn't breathing. She called for her husband, who happened to be home from work already, and he started CPR. Jordan arrived to help out shortly after the ambulance did. Beckett was rushed to the hospital and has been in the PICU for the last several days.

Things don't look good for the little guy. He probably isn't going to make it. Going to visit Tyler and Andrea in the PICU and bring them a change of clothes my heart broke for them. They were devastated. I can't even imagine the feelings of helplessness that must accompany a situation like this. One moment it is just another day, the next your entire life is turned upside down.

We have been helping babysit their three other children the last couple days. I was putting their youngest son, Coleson, to bed Friday night and he asked me if Beckett was going to die. How does one even begin to answer that question to a three-year-old? I told him I hoped not, but I didn't know what was going to happen. We said a little prayer together and I laid by him until he fell asleep.

This entire experience has left me feeling a little helpless and vulnerable. There isn't much I can do to alleviate their suffering and the inability to do anything substantive seems to make the heartache worse. I know that Tyler, Andrea and their kids will eventually recover from this experience. This is the type of wound that only time and the Atonement can heal.

My thoughts have been with them this weekend, but I've also been thinking about Cami and our unborn son. How does a parent rest at night knowing that the only symptom of Sudden Infant Death Syndrome is sudden infant death? I haven't even met my son yet, but this experience makes me wonder how I would deal with losing him. It would seem that opening your heart and loving unconditionally does leave you vulnerable to some pretty severe pain.

I don't know why bad things happen to good people. Though I understand that all things are for our good and will give us experience, this concept is not necessarily easy to embrace in the face of such a challenge. An abiding faith in the infinite love and mercy of our Heavenly Father is really the only way one can traverse such a trial. An understanding that this life is but a temporary experience appears to be the only way to extract fairness out of events such as these. There is a Grand Purpose. There is a Great Design. One day, we will see that clearly and recognize how what we endured in this life prepared us for our future role.

I don't know how everything will work out. I just know that it will work out in the end.

Charleston, SC

2011-07-12T16:02:00.021-04:00

I think I have a new favorite city in the South.

This past weekend, I attended the North Carolina/South Carolina ENT conference in Charleston, SC. I was presenting a paper on some research I did awhile ago and got to take an all-expense paid vacation... uh, business trip to the birthplace of the Civil War. Best of all, I got to take Cami with me to experience one of the coolest locales the Palmetto State has to offer.

The conference was held in a swanky hotel (just a hair nicer than the Carolina Beach Microtel), right in the middle of downtown Charleston. My presentation went just fine... except for the fact that I discovered my slides were a little mixed up during my presentation. My presentation had been well rehearsed, so the order change really confused me. It took me a couple seconds to figure out what slide I was looking at, then I started to get worried that all my slides were mixed up, then I started to worry that it was taking me so long to figure out what was going on that people were going to mistake my silence and staring into the distance for a stroke. Of course, that thought didn't help me much to focus my thoughts much. Though it only took about 20 seconds re-orient myself, it felt like forever. Fortunately, the rest of my presentation was much less eventful.

While I attended lectures every morning, Cami got to explore the city. The afternoons we had to ourselves. We spent them walking through town and window shopping. We got to tour the Battery Park and see the huge Antebellum houses along the water front. We took a trip across the Ravenel Bridge en route to Sullivan's Island and spent some time at the beach, played in the surf, collected seashells, and tried to "pop" a dead pufferfish that washed ashore. We also got to eat out at some pretty nice places on the company dime and the roast grouper I had at Hank's was probably the best fish I've ever eaten.

Megan and Leighanne, my two co-rezzies, were also at the conference. We had a fun time hanging out with them as they showed us all of their favorite Charleston spots. The ladies were very interested in doing some shopping and Cami was more than willing to oblige. Nothing was slowing those ladies down. At least until Megan hurt her knee and either had to be carried or crutched wherever she went.

Cami and I had a great time and would certainly go back to Charleston... especially if the department is willing to fund our travels again.

Gimme Five

2011-07-10T21:56:00.004-04:00

Apparently, for the last several evenings the little guy been playing in an in utero rugby league or something. His boisterous activity has been keeping his mother awake. I guess he had a great game Friday night because Cami woke me up to have me feel what was going on down there. Half asleep, I laid my hand on her growing belly and within seconds the little guy gave me a high-five. That comes in as a 9.5/10 on the awesome scale. I can't believe how real this is all getting.

Atta boy. You done your daddy proud.

Independence Day Weekend

2011-07-05T17:00:00.071-04:00

Since Sean and I both had the complete three-day weekend off for the the Fourth of July, we decided to take our delightfully pregnant wives with us on a little weekend get-away. We were all wanting to spend some time on the beach and the ladies were able to find us a nice discount on a ritzy hotel in Carolina Beach.

Yes, the Microtel at Carolina Beach offers one of the finest hotel experiences a vacationer might hope for. Offering only the finest amenities, we packed ourselves into a narrow, musty hotel room for a couple nights. To be fair, the Microtel did offer a mini-fridge, continental breakfast, pool (complete with hormonally charged, unchaperoned teenagers), and a creepy mirror running the length of our hotel room, which I swear was actually one-way glass. The quality of our accommodations aside, we had a great time at the beach.

One thing I am still getting used to (but absolutely love) about Carolina beaches is the temperature of the ocean. Since the water is so warm (and because the salt water keeps your fingers from getting pruny*), you can literally spend all day in the ocean. Which we pretty much did. Sean and I played games in the surf, while the mamas soaked up the rays. It was perfect. We were worried that the beaches would be extra crowded, but we were fortunate that our little corner of the Atlantic Ocean was not over-populated.

We decided that every Fourth of July should fall on a three-day weekend. This would, of course, necessitate permanently changing the name of the Fourth of July to Independence Day, but I think that is definitely doable. This way, Independence Day Weekend would always be a day everybody looked forward to, not just for the BBQ, fireworks, and celebration of our nation's birth, but also for a long weekend. What do you think, America?

*This is always something I've wondered about and have generally just chalked the answer up to simple osmosis. It appears, as is often the case, that the actual answer is much more complex. Though science doesn't quite completely understand it, it appears to be due to an intricate interplay between osmotic shifts, autonomic vasoconstriction, the stratum corneum, and sebaceous glands.

The Results Are In...

2011-06-29T20:21:00.005-04:00

I had to sneak out of work early to make it to Cami's ultrasound this morning. I had zero idea which Ob/Gyn office she was in and of course there were about three other Ob/Gyn practices in the medical complex where she was supposed to be. Unfortunately, my first and second guesses were incorrect (I felt like I had barged in on some secret girls only clubhouse. Pardon the intrusion, ladies!). I eventually strolled into the correct office about fifteen minutes late.

Fortunately, I hadn't missed everything. We learned that our unborn child has: four chambers in a healthy heart, a fused hard palate, ten fingers and ten toes, a well developed spinal cord, and a mean case of the wiggles.

We also learned that our little baby is a little baby boy.

For the sake of sparing our unborn son from future embarrassment, we won't plaster the ultrasonographic evidence of his manhood on the internet (you can thank me later, son). Cami and I were both very happy about the all of the above information. Though I wouldn't have claimed it publicly, I was a little more than "51% sure" that we were going to have a little dude based on our early ultrasound in Merced. Cami clearly had greater faith in my ultrasound interpreting skills than I did, because soon after I made my bold 51% prediction, she zeroed in on the idea we were having a boy. I was actually a little worried that I was dead wrong and that she would be disappointed.

Fortunately, there was no disappointment to be had. We are super excited about this new information, which has somehow managed to make this whole adventure seem a little more real.

Foreign Bodies

2011-06-24T17:57:00.003-04:00

Over the last twelve months, I have spent a lot of time fishing foreign bodies out of peoples' ears, noses, and throats. Whether in the OR, ED, or clinic, whether it's 2:00 AM or 4:00 PM, an adult or child, if it's in your face and isn't supposed to be there, chances are I can probably get it (or at least make you really uncomfortable trying). I found the great variety of objects I extracted to be so thoroughly entertaining, that I started collecting a list of my findings. Each item listed has it's own story, which I simply do not have the time to share. I'm no Chevalier Jackson, but I'd like to think my list is notable for merely a year's worth of effort.

Without further ado:

Tim's 2010-2011 Foreign Body Extraction List

(Number in parentheses represents number of objects extracted)

Bead (2)

BB (2)

Penny (3)

Tooth (5)

Play-Doh (3)

Styrofoam (1)

Cockroach (4)

Googly-eye (1)

Earring back (1)

Quarter* (0)

Water-gun stopper (1)

Straight pin* (0)

Petrified wood (2)
Fishbone (3)

Bullet** (4)

Game of Life game piece (1)

Wad of paper (1)

Popcorn kernel (1)

Button (1)

Piece of glass (2)

*These objects slipped across the border that divides otolaryngology from gastroenterology before I had the chance to grab them, and as such, they became somebody else's problem.

**While three of these bullets were removed the old fashioned way (surgically extracted from somebody's neck), the most recent was an absolute miracle. The poor gangsta had been shot point blank in the mouth. The impact of the bullet against his mandible shattered his jaw, but also stopped the bullet dead in it's tracks. The most amazing thing was: he actually swallowed it and got it caught in his throat. The CT scan was confusing, it appeared as if the bullet were in his neck, but it was just sitting in his esophagus. I fished it out with a laryngoscope and a pair of Magill forceps! True story.

California Love

2011-06-23T15:45:00.011-04:00

Our good friend Fernando got married in Sacramento earlier this month. He asked Tim and Sean to be in the wedding party. Since any reason is a good reason to go back home to California, we decided to take a week of vacation to visit friends and family.

Obviously, there was a lot of baby business to take care of. We had Tim's dad do an ultrasound while we were in Merced. The baby looks healthy (it's so crazy to see him/her wiggle around), but we were a little too early to tell the gender (I was barely 15 weeks at the time). Tim says he's 51% sure he knows what it is, we'll see if he's right next week when we have another ultrasound. My sister Ashley, who was also in California for the week, coordinated a Merced baby shower for me. We are very lucky to have so many generous friends.

We stayed in Merced for the first half of the week and then made it up to Sacramento for Fernando's wedding. While Tim and Sean did all of their groomsman activities, I got to spend time catching up with all my friends from campus events at UC Davis. We also met up with Sean and Ashley for breakfast at the "Fox & Goose" on Kelly's recommendation (excellent recommendation, Kelly). By the way, if we haven't mentioned it, Ashley is pregnant too. And get this: her due date is just two weeks before mine. Tim is already talking about having our children betrothed.

The wedding itself was nice. I'd never been to a Catholic wedding or mass before, so it was very interesting. Fern and Rachel looked happy and we're excited to finally see Fernie get married. The reception was held at the Sacramento Grand Ballroom. We had a good time and even danced a little bit (even if every song they played was at least 10-15 years old). Since Fernando's family is all from Costa Rica (or was it Mexico...?), there was definitely a very distinct Latin feel to everything. We had a good time, but all that staying up late made it harder to get up early to take Tim to the airport the next morning. Also, thank you to Tim's uncle Keith for letting us stay at his place while we were there. I hope we didn't bother the birds too much.

When it was discovered that we were going to be in the Golden State, Katie's husband Matt invited me to go down to SoCal and visit/help babysit Katie and her kids while he was on a "business trip" in Indonesia. This extended my vacation by several days (totally worth it). I got to spend time with Katie and her four kids, and Ashley and Maggie were there as well. Even if we did get put to work, we also had plenty of time to head out to the beach.

So that's pretty much our vacation in a nutshell. Big thanks to Tim for helping me write this blog.

Last Call

2011-06-19T15:07:00.002-04:00

Yikes. I can't believe it's already been a month since this blog was updated. Things have actually been incredibly crazy around here. We went on vacation a couple weeks ago and spent a week in California (details to follow). The vacation was great, but a little busy. When I finally arrived back in NC, I felt like I needed another vacation.

The next week and a half was miserable. I was on call six out of nine days (Monday night, Wednesday night, Friday night, Saturday night, Sunday night, Wednesday night again). Every single one of those evenings was terrible and each of them earned me precious little sleep. Consequently, the in between nights consisted of me going home and crashing into bed. The last night was particularly cruel. Not only did I spend the entire night in the emergency room and ICU bouncing from patient to patient, but I stayed in the OR the following day until 8:00 PM. Nearly 40 hours in a row on my feet.

As a result of my consistent presence in the hospital, I got to do a lot of really neat stuff (including a superficial parotidectomy nearly entirely on my own), and a few other things that made me feel pretty good about the job I have. Of course, the events of last week seem a lot less terrible to me now that I have paid back some significant sleep debt I had incurred.

The best part of it all? Wednesday night's marathon session was my last call night as a PGY-2. As of July 1, I advance to the next level of my residency training. As a PGY-3, I won't be expected to take nearly as much primary trauma call and will frequently have the benefit of a PGY-1 below me to field all of those annoying nursing calls. I cannot even begin to express how happy this makes me.

Amazing how quickly time flies.

Almost

2011-05-18T05:25:00.001-04:00

Of all the emergencies an otolaryngologist may face, the compromised airway is the one that makes me the most nervous. Airway emergencies tend to be chaotic affairs where split second decisions need to be made and every second counts. The price for indecision, even a moment's hesitation, can be extremely heavy. Fortunately, we are usually able to identify those patients who are likely to have airway issues and manage these appropriately well before a true emergency develops.

Unfortunately, we aren't always able to do so.

I was up in the residents' office the other day on the phone with one of my least favorite RNs. This particular nurse has a well-established reputation for overreacting to even the most benign exam findings and generally being a headache for patients and residents alike. She was doing her best to convince me that one of patients with a "fever" of 99.1º was in the throes of sepsis (or something equally as asinine), when the other phone in the office rang.

I only caught snippets of the conversation Jeanne (one of the PGY-3s) was having, but started to completely ignore the RN on my phone when I heard her say: "Well, Tim is up here. He can run down to OR 17 to help out, but if it's an emergency, you might want to page one of the chiefs..."

While my RN droned on, oblivious to the fact that I was now completely ignoring her, I asked Jeanne what was going on. She reported that an anesthesiologist was having some trouble intubating a patient in the OR and wanted us to help out. I asked if it was an emergency, to which Jeanne responded it was likely more urgency than an emergency, but she was short on details.

I immediately tried to cut the conversation with the RN short so I could head down to the OR. She became very irritated that I wasn't addressing her concerns adequately, so I just hung up on her (which, I must admit, felt pretty good). It only takes about three minutes to get to the OR from our office. When I got down to the main OR, I donned a surgical mask and cap, hung up my white coat, and walked into the room 17.

As I entered the room and purveyed the scene in the OR, I was a little overwhelmed. There were several nurses running around and hurriedly dropping sterile instruments on the field. A vascular surgeon was cursing up a storm. What immediately grabbed my attention, however, was the group of worried anesthesiologists at the head of the bed, slamming a bag-mask ventilator into a rather obese patient's face. The tension in the room was palpable and before I could even ask what was going on, I heard the senior anesthesiologist say, "Oh good, ENT is here." For some reason, that comment made me very nervous.

To help convey why this scene started my heart sinking down into my stomach, consider the following: Most patients undergoing any significant surgical procedure are given a combination of drugs to induce anesthesia (a reversible lack awareness), analgesia (control of pain), and paralysis (inhibition of muscle movement). Unconscious and paralyzed, patients are unable to breathe without the assistance of mechanical ventilation. This is typically delivered via an endotracheal (ET) tube which is inserted through the mouth and into the windpipe. Prior to inserting an ET tube, but after administration of anesthesia and paralytics, patients are bag-mask ventilated. This simply involves holding a mask to a patient's face and forcing air into their lungs by squeezing an oxygen-filled bag. While this technique can be used to temporarily oxygenate a patient, it is not a secure airway, as swelling, bleeding, a fat tongue, or any number of complications can prevent air from actually entering the lungs.

The senior anesthesiologist began explaining to me the situation they were in: Having already paralyzed the patient, they had made several unsuccessful attempts to intubate the patient. They were now finding it increasingly difficult to bag-mask the patient. I began to ask what the patient's airway looked like during their attempts, but I kept being distracted by the ominous sound of the patient's pulse-oximeter dropping like a rock.

That metronomic "beep... beep... beep" noise you hear anytime you watch a medical TV show is the pulse-oximeter. It measures how much oxygen is in a patient's blood and demonstrates how effectively they are breathing. To help doctors keep track of the level of blood oxygenation without having to watch a computer screen, the pulse-ox beeps with a pitch correspondent to the percent of blood saturation. The higher the pitch, the higher the oxygen saturation. On of the most nerve-wracking sounds in any operating room is a gradual descent down the chromatic scale as performed by the pulse-oximeter.

As I was processing all of the information, the pitch on the pulse-ox kept falling and the anesthesiologist started shouting, "We are not ventilating! We are not ventilating!" Despite their best efforts to push oxygen through the mask into the patient's lungs, the airway had been lost. Things began to deteriorate very quickly. I yelled at one of the nurses and told her to get a trach tray and started feeling the patient's neck for anatomic landmarks. The patient was starting to turn blue and if she didn't get an airway fast, she would likely die or at least end up brain dead.

The patient needed a slash tracheotomy, and I was considered the airway expert in the room.

As the pulse ox rang out notes lower than any I had ever heard before, I splashed betadine on the patient's neck. I forced myself to think about what I was going to do. Though I've done several tracheotomies, they had always been done in a very controlled environment in patient's with a stable airway. This was anything but a controlled environment and the patient's airway was anything but stable. I had never even seen a slash trach before and here I was about to do one.

Someone handed me a scalpel.

I didn't have time to really get nervous about it. I took a deep breath and said to myself, "Alright, Tim. You can do this." I felt strangely calm about the whole situation and almost felt a little detached from everything.

Just as I had committed myself to action, Drew, one of the ENT chiefs, arrived. He very assertively took control of the situation. I handed him the scalpel and he sliced open the patient's neck. She began bleeding like crazy. Undeterred, he dissected down to the patient's airway and made an incision into her trachea. Seconds after the initial incision had been made, I jammed an ET tube into the hole in her neck and hooked it up to the ventilator circuit. Her pulse-ox slowly started to climb and the color gradually returned to her lips. Although the patient was the only one hooked up to the ventilator, it felt as if the entire OR was finally able to take a breath as well.

With an airway established, we turned our attention to hemostasis. We prepped everything out and formally investigated her neck to make sure the tube was where it was supposed to be and there weren't any occult injuries. Confident everything was in order, we turned the case back over to vascular surgeons for whatever case they had already scheduled.

Though this felt like it had taken an eternity, I am sure this all played out in just a few minutes. I was pretty proud of Drew and thanked him for bailing me (and the patient) out. Drew confided that he'd never done an emergent trach either and was pretty nervous about it all. After digesting this piece of information, I realized I was also a little proud of myself. Though I didn't have to do the procedure, I almost did. More importantly, I was ready to do it and I am pretty sure that I would have been successful getting that tube in (though my approach probably wouldn't have been as smooth). Having now seen it done, I feel confident that I could take the situation on in the future. And that makes these airway cases a little less intimidating. If only just a little...

Amazing how much one can learn about oneself, without really even doing anything.

Gratitude

2011-05-15T14:30:00.007-04:00

I have noticed that I tend to complain a bit about a lot of the more aggravating aspects of my work. The fact is, I really do love what I do... it's just hard to remember that sometimes.

My job is not very easy. I work long hours for little pay. I am frequently required to make important decisions, which can mean the difference between life and death. Like many of my fellow residents, I frequently feel under-appreciated and I understand why so many of my cohorts have become so jaded and disillusioned with the practice of medicine.

But every now and again, a little something happens to remind me why I wanted to do all of this in the first place.

Cami and I went to the Winston-Salem Greek Festival this past weekend. We went with some friends of ours and their kids and had a great time eating gyros, loukoumades, souvlaki, salad and taking in everything the atmosphere. The highlight of the evening, for me at least, had absolutely nothing to do with anything the festival had to offer. Shortly after we sat down to eat, a small family of four came up to our group and asked me: "Are you Dr. Tim?"

I was a little confused at first, but answered affirmatively. She went on to explain that several months ago, I had taken care of her daughter in the ED by sewing up some lacerations on her face. She told me her daughter was doing wonderful and that she could hardly even see the scars anymore. She thanked me for taking good care of her daughter and for putting up with a worried mother in the middle of the night.

It probably didn't take much effort for this mom to say this, but her small act made my day.

The most poignant reminders tend to be rather small gestures, usually small expressions of gratitude that make all the difference. Whether it is a brief note of appreciation from grateful patient who is responding well to treatment, or a tearful hug from a overjoyed wife upon learning that her husband's cancer resection went as good as it possibly could have.

Would that every patient understood how much these small gestures mean to their over-worked health care providers. But then again, maybe it is their rarity that makes them more special. However frequently it comes, moments like those underscore the fact that even if it isn't easy, it is worth the effort.

A big thanks to an appreciative mom and her beautiful little daughter for that little reminder.

Official Statement #2

2011-05-09T18:00:00.018-04:00

Due to several rumors which have been circulating the internet and various tabloids, we have decided to release the following statement. This is the second official statement published by Tim & Cami, and the first since their merger in 2003. We hope that this statement will help clear the air about any misconceptions regarding the state of our union and future plans.

(AP) WINSTON-SALEM, NC.

Recently, it was reported that a leaked "Tim & Cami: Rock Solid Since '03" post has been circulating the internet. This posting was an internal communication and was not intended to be publicly distributed. The posting was immediately taken down after it's inadvertent publication. However, followers of T&C:RSS'03 who utilize the service Google Reader were able to access this information regardless. We have fielded multiple queries regarding the validity of this posting and wish to address these questions publicly.

Since our two parties joined forces in 2003, the Tim & Cami corporation has enjoyed immense success and prosperity, unrivaled by many similar unions. Over the past eight years, we have established successful branches in the Intermountain West and along the West Coast. With the recent relocation of our headquarters to North Carolina, we are happy to report that the Tim & Cami brand has resonated with the residents of the Southern Atlantic States and that the state of our union is strong.

As our popularity has grown, we have often been asked about plans for growth. We report that we have been exploring expansion for the purpose of strengthening our corporation with the mutual benefit of appealing to our parent companies. A task force was established several years ago to explore whether expansion was a viable option. After extensive analysis, our research indicated that growth was possible and that we could comfortably sustain a 50% increase in the size of our family. Based on these findings, the decision was made to move forward with the plan.

Unfortunately, since that decision was made, our efforts to grow the Tim & Cami family have been unsuccessful. This has been an incredibly frustrating and trying experience, but ultimately one that has left us stronger in ways that we could not have foreseen.

Over the last 18 months, we have intensified our efforts. This has been accomplished by investing significant financial resources into research and development and employing cutting-edge technology and medical expertise. Through this assistance, we recently invited nearly a dozen candidates to personally interview for the available position. Of these candidates, two were hand-selected for a trial membership in our organization based upon their potential for growth. We retained the resumes of the remaining applicants for future consideration.

We are pleased to announce that one of these candidates has chosen to accept our offer and is expected to formally join the Tim & Cami family in mid-November 2011. We are very excited about this new venture and eagerly anticipate our new arrival. At the same time, we cannot express how immensely grateful we are to family members and friends who have supported us during this lengthy ordeal. While we realize that this expansion will bring with it various challenges and trials of its own, we are confident that we will be equal to this task.

Refugees

2011-05-03T08:00:00.001-04:00

I am sure by now that most of you have seen the results of that devastating storm that rolled through Alabama. Some of the footage they have been showing on TV and the internet has been pretty impressive.

Fortunately for my sister and her family in northern Alabama, their home was largely unaffected by the tornadoes, though some neighborhoods close to theirs were hit pretty hard. Unfortunately, most of the state was without electricity and basic services for about a week as they recovery effort got underway.

Faced with the idea of having to entertain and provide for her four kids and husband without electricity, school, the internet, or television, Cindy called up her favorite brother (and her kid's favorite uncle) and asked if they could stay with Cami and me for a few days until things settled down again in Alabama. We welcomed them with open arms. After all, they may have been refugees, but they didn't have to live like one.

The refugees arrived Friday afternoon and stayed with us until this morning. Despite increasing the number of inhabitants in our house by 300%, it was been fun to have everybody here. We had to be a little creative to come up with sleeping arrangements. This involved a Chinese fire drill of sorts when Cami's early AM seminary students on Monday (we had to move the people sleeping on the couch upstairs before things got too noisy). It appears that, in their hasty retreat, some of the kids forgot to bring some essentials, we were able to work around this, too. Cindy regrets letting the kids pack their own suitcases and swears that for the next natural disaster, she will probably offer a little more oversight.

Entertaining the refugees hasn't been to challenging either. The kids were really interested in going to Carowinds (they used to live in Charlotte, just five minutes from the amusement park), and so we all went down there on Saturday. I had lamented previously, that roller coasters just weren't as fun as I remembered them... They were a lot more entertaining with a freaked-out trio of teens and pre-teens. I laughed the whole way around the Intimidator, as Emily and Brandon screamed their faces off.

We also watched movies, played games, talked, ate out together, and did a lot of other fun stuff during their impromptu vacation. Fortunately for them, they got word that their power had been restored Monday, and they packed up everything and emigrated back to their homeland. It was fun to see them arrive and it was kind of sad to see them go again. Hopefully, we won't have to wait for another catastrophic storm to see them all again.

Bureaucratic Idiocracy

2011-04-26T19:04:00.003-04:00

Please excuse the following rant, but I have to get this off my chest:

I DON'T WANT TO FILL OUT YOUR STUPID PAPERWORK!

All day long I fill out forms. I sign consent forms, write progress notes, dictate H&Ps, approve prescription refills, fill out work excuse notes, initial patients... it seems the only thing I don't do at work is practice medicine.

While I acknowledge the need for certain documentation, I am suffering a slow and painful death caused by a thousand paper cuts. I did not commit myself to four years of college and nearly a decade of post-graduate training so I could sign paperwork all day. I am beginning to understand how bureaucracies work: I am compelled to complete stacks of meaningless paperwork simply in order to support the people who require that I complete stacks of meaningless paperwork. Sadly, I feel my frustration with all this nonsense is only going to get worse.

To add to my utter consternation with the sheer volume of things I am required document and sign, because my place of employment is being audited, the paperwork Nazis are being über-vigilant and I've been coerced several times to run across the hospital to redo paperwork I already did to correct insignificant clerical errors. Can somebody please tell me: What on earth does any of this have to do with patient care?!

I am probably too young in my career to be pining for the "good ol' days" of medicine, but I sincerely doubt Hippocrates, Galen, Sydenham, or Osler ever had to deal with any of this stuff.

Easter Sunday

2011-04-24T08:04:00.004-04:00

“In our hour of deepest sorrow, we can receive profound peace from the words of the angel that first Easter morning: ‘He is not here: for he is risen.’”

We express our gratitude today for that empty tomb.

Agreeing to Disagree

2011-04-16T14:31:00.021-04:00

Last week, I used a bicoronal approach and helped raise a osteoplastic flap to remove a mass in a patient's frontal sinus. For those less familiar with the surgical terminology, we peeled a patient's forehead down off his scalp to expose a mass in a tumor right above his eye. It was a really cool case and I came home that day really excited about my job and what I am able to do.

Until I tried to convince Cami to let me take a skin-tag off her hip.

Since med school, I've tried to convince Cami to let me remove this dumb skin-tag. She's never been wildly excited about the idea of having it removed, but even less so about me doing it. To be fair, I probably wouldn't have let my med school self excise a skin-tag off me either. However, with recent operative events leaving me feeling somewhat confident in my surgical abilities, I collected some supplies from the hospital and announced to Cami after work today that I'd finally be excising that skin-tag.

To my utter surprise, she wasn't going to let me anywhere near her.

When I asked her why, she told me the thought of being injected, and cut, and sewn up made her queasy. I told her she was being silly. I did this kind of stuff all day long on people's faces. I've been told that I am pretty good at what I do and my patients have been happy with my work. Removing a skin-tag from her hip was such a simple procedure I could practically do it in my sleep. "It will only take five minutes," I explained. "The worst part will be the injection and I'll barely even need to suture anything."

She stood firm. "It's not that I don't trust your ability to do it... it makes me uncomfortable even thinking about it. I don't want to feel you cutting and sewing me."

For my part, I couldn't believe Cami didn't trust me enough to do this simple little thing. I addressed her concerns and told her the lidocaine would prevent her from feeling any of that stuff. I think Cami didn't really care for the skin-tag, but she certainly didn't hate it enough to submit to an operation no matter how small. We both stood our ground.

To put this in perspective, consider this: In seven-and-a-half years of marriage, Cami and I have never really had an argument. We just don't fight about stuff. We've had disagreements and we've expressed differing opinions on various matters, but I really can't say we've ever had to argue about anything. I've never said anything to deliberately hurt Cami's feelings, and I'm not even sure she even knows how to do such a thing. On top of that, we tend to agree on most things anyway. I think we're both pretty laid back about things and neither one of us has that overwhelming need to be right.

After some discussion, it became clear that Cami wasn't going to budge. Realizing that skin-tag wasn't worth letting our disagreement devolve into an argument, I decided give my wife a kiss and drop the subject. Looking back, I suppose it was unfair of me to expect Cami to willingly sign up for this kind of stuff. She wasn't asking me to do this for her, I just dropped it in her lap and expected her to oblige.

I suppose my rationale for even anticipating that Cami would go for this type of stuff has a lot to do with being a doctor's kid. I remember the stories of my dad sewing my fingertip back together on the kitchen table when I, as a toddler, ripped it up playing with the rabbit hutch in the backyard. I recall getting immunizations and booster shots in the living room during commercial breaks when my dad got home from work. And when my dad bought a radiofrequency loop for his practice, I again found myself on the kitchen table letting him zap away moles, warts, and other dermatologic blemishes.

I guess I trusted my dad wouldn't do anything to hurt me (too much) and for the most part, everything he did benefited me in some way. Cami didn't grow up in that environment and this stuff just makes her squeamish.

So, in conclusion, Cami still has that silly skin-tag on her hip. She's says that she'll "eventually" let me remove it, but I'm not holding my breath that "eventually" is anytime soon. I am sure, however, that one day she will give in and let me excise that thing. Then she'll probably see that it really wasn't a big deal after all and admit that she should have had it done years ago...

And then I'll bring up removing that small mole on her back.

*911

2011-04-09T18:01:00.012-04:00

My disdain for my pager is no secret. Day after day, night after night: It beeps me a phone number and I deal with somebody's problems. Having been around the hospital now for awhile, I recognize most numbers I receive and can associate them with the particular location in the hospital they were sent from. When MDs page each other within the hospital, they typically "tag" their pages with their own pager number, just in case they have to leave the phone before the page is returned. All of the hospital pagers start with the same three digits, so the tag is an asterisk followed by four numbers. I am starting to recognize a fair number of physician tags now, too.

I'm on call this weekend and was rounding on our service with Jordan this morning. He busy changing a patient's dressing, and I decided to start talking with the next patient on our list. No sooner had I stepped out of the room than my pager went off. With a sigh, I reached for my pager. My heart instantly started racing as I read the message:

64500*911

I recognized the location as the ICU. The tag wasn't a pager number, but it wasn't too tricky to figure out what those numbers represented: it was an emergency. I quickly trotted over to the nearest nursing station and dialed the five-digit in-house number.

Nurse: "Doctor Tim?"
Me: "Yeah, what's going on?"
Nurse: "It's Bed 10. You've got to get down here now!"

I could tell by the tone in her voice that I didn't have time to troubleshoot over the phone like I usually would. Some RNs have a reputation for wildly exaggerating the severity of an issue. Their "emergencies" can frequently be solved over the phone once you figure out what the problem is. ICU RNs are pretty good and generally very reliable, I knew this wasn't going to be good. I yelled across the hall to Jordan (he didn't hear me), told one of nurses where I was headed, and took off running down several flights of stairs to the ICU.

As I was scrambling through the hospital halls, I began playing out scenarios in my head. "What would you do, Tim, if the patient is apneic and de-satting?" Airway emergencies scare me more than anything else (few things will kill you faster), and I tried to navigate a hypothetical airway situation en route to the ICU. I'll be honest, it wasn't easy trying to concentrate on my imaginary emergency when I knew a real one was waiting for me. I kept thinking my time might be better spent offering up a pretty sincere prayer for help (which I did).

Though the *911 page effectively communicates urgency, it doesn't really communicate much else. I had no idea what I would see when I badged myself in the ICU.

I rounded the corner to Bed 10, there was blood everywhere. Bed 10 was bleeding profusely out of his neck incision. Remember how I said few things will kill you faster than an airway emergency? Well, a carotid blowout is one of them and I began to fear the worst. Two poor RNs were doing the best they could to stanch the bleeding. They didn't stand a chance--it was pouring out his surgical drains and mouth. I grabbed a gown, gloves, and started an investigation of the neck, but it was nearly impossible to see anything for all the blood.

Jordan arrived shortly thereafter. We grabbed a pair of scissors and some hemostats and went looking for the bleeder. No such luck. It became clear pretty quickly that this patient was going to exanguinate if we didn't get him down to the OR stat. The ICU's pretty good at facilitating this stuff and within minutes we were rolling Bed 10 out the door and down to the OR while I was holding pressure on his neck. The look in Bed 10's eyes spoke volumes. He couldn't talk (he had recently undergone a laryngectomy), but his eyes were screaming. They were pleading: "Don't let me die."

The scene in the OR was pretty chaotic. Nevertheless, we managed to get the patient on the table, put him to sleep, open his neck, and begin our search for this hemorrhagic vessel in earnest. The neck was a mess. Infection had eaten away at muscle and it reeked of rotten flesh. Within minutes of opening the neck, the attending on call arrived. She had gotten her *911 page in the salon (her hair was still wet) and it clearly had the same affect on her as it had on me.

Together, the three of us were able to get the bleeding under control. With hemostasis achieved, the intensity in the OR waned significantly. Fortunately for the patient, it hadn't been a carotid blowout (a situation he probably wouldn't have survived). We ligated the offending blood vessels and began debriding the dead tissue in his neck. Bed 10 got put back together and eventually returned to the ICU in one piece. He certainly isn't out of the woods yet, but he's looking a fair bit better. I stopped by his bed this evening to see how he was doing. He wrote a big "Thank you" on his dry-erase board. He admitted to being pretty scared. I told him I was too.

My first experience with a true *911 page was intense, but I suppose that is kind of the nature of the emergency tag. I really hope I don't have to deal with too many of those during my career, but it is nice that I am getting to the point where if the situation arises, I am able to.

Ultrasound #1

2011-03-24T05:31:00.000-04:00

Cami had her first ultrasound as a pregnant woman today. We came in to find out whether or not both of the eggs we transferred survived.

We left knowing that only one of them had. There may have been a hint of disappointment (we were both hoping for two), but that was quickly swallowed up in the realization that the events of the previous two weeks weren't a dream. Cami was pregnant with our baby... at least, we hope it's our baby. I am still a little nervous that whatever pops out of Cami's uterus might bear a passing resemblance to Dr. Y.

I think this ultrasound made things seem quite a bit more "real" for the both of us. It has alleviated some of the pressure and we are feeling a little more comfortable planning for a baby, not just a pregnancy. That's still a little hard to wrap my head around. And while we still aren't out of the woods, and haven't made anything official yet, we're feeling a confidence and calm that wasn't here previously. Let's hope it lasts...

My Day in Court

2011-03-22T09:11:00.004-04:00

I had my day in court today. The long arm of the law had nabbed me back in January for failing to come to a "full and complete stop" at a quiet little intersection on my way into work. The fact that nobody ever comes to a "full and complete stop" didn't seem to faze the officer who issued me my citation. Hasn't he ever heard of a California rolling stop?

My protestations aside, I was hit with a ticket and a court date. Trust me, I could have easily come up with a better way to spend $190 and 90 minutes than spending it in the Winston-Salem District Courthouse this morning (which, by the way, is an absolute eyesore).

Literally two days after getting my ticket, our mailbox was inundated with letters and advertisements from lawyers offering to represent me. I mean, I know my moving violation was a high-profile case, but this is ridiculous. I didn't really feel like calling any of these guys. Fortunately, a girl at work knew a guy who knows a guy who was "really good at fighting tickets." Though I could afford to pay the ticket, I couldn't really afford the insurance hike points on my license would garner, so I called this particular lawyer up and asked him what it is that lawyers do.

He told me that his work as a lawyer involves the practical application of abstract legal theories and knowledge to solve specific individualized problems, or to advance the interests of those who retain them to perform legal services. Though technically correct, that wasn't quite what I was getting at. I rephrased my question and asked what a lawyer might do for me in this particular situation. He said he'd show up at court and get my ticket reduced to a fine for "improper equipment," not a moving violation offense. When he told me that this service would net him some $300 out of my pocket, I asked if there was much difference between him going to the courthouse and me showing up and advocating for myself. His answer: "No, not really." Suffice it to say, I opted to take the law into my own hands.

Long story short: I waited in line for a long time. I chatted with a few other nervous citizens, who were concerned about their traffic violations. I eventually worked my way up to the front of the line and stepped into a closet that looked an awful lot like a Catholic confessional. Sitting inside was a guy with a New York Yankees hat on. I handed him my ticket. He looked at me for a second and the following conversation ensued:

"Have you ever had an accident?"

"No."

"Do you want this reduced so you don't have any points on your license?"

"Yes."

He stamped my ticket with his "Improper Equipment" stamp and directed me to the cashier. The encounter literally took 25 seconds.

I didn't have to call any witnesses, I didn't have to show him my clean driving record (a waste of $8 requesting that from the DMV), and I didn't even have a chance to deliver the closing arguments I had practiced (a real travesty, believe you me). But what really gets me is this: that lawyer was going to charge me $300 to wait in line for me. No wonder three quarters of my student ward at BYU were pre-law.

I suppose, if I wanted the charges actually dropped and not just reduced, I could have actually plead my case before a judge. But I've heard the song and I know how that one ends up. I'm glad this is all over with and I can get back to all this research I've been busy with.

Addiction: It's Real

2011-03-15T16:33:00.004-04:00

I am caught in the grips of a terrible addiction. I cannot kick the habit, despite my efforts to the contrary. I have successfully "quit" on a number of occasions only to return to my vice when the circumstances were ideal. My addiction: I can not stop twirling my hair.

A psychiatrist might diagnose me with some very mild form of trichotillomania. In fairness to those who actually suffer from trichotillomania, I suppose that my affliction is more an example of an minor obsessive/compulsive behavior. But this is just splitting hairs (no pun intended). Ever since I was a kid I have loved twisting and twirling my hair. I especially love twisting my hair into knots and then pulling those knots out. It's an absolutely guilty pleasure.

When I was a kid I got a fork stuck in my hair from twisting it in there. As a ten-year-old, my barber was surprised that I was already balding. She didn't know that I was actually pulling my hair out. My mom got on me for the behavior and told me I didn't want to be the only bald kid in school. She kept bugging me about it and things got better for awhile.

Over the last several years, my addiction has returned. I do it mostly when I am stressed or bored. Cami hates it. She says I leave hair all over the place. She also says I could quit if I wanted to. She's probably right, but most of the time I don't even realize I am doing it. On top of that, I like doing it. It's like a security blanket on top of my head whenever I need it. If you subscribe to the Transtheoretical Model of Change, I've probably been stuck between the contemplative and preparation stage for quite some time.

I was discussing this behavior with Cami this morning and came to the realization that if I'm going to kick the habit, I'm going to have to cut my hair. Unfortunately, they don't make a patch for hair twirlers, and taping my fingers hasn't proven successful in the past. I don't want to have to resort to a comb-over when I am 45 years old. Cami thought this was pretty drastic and thought that if I really wanted to I could quit on my own. But in all honesty, who is more likely to quit: The alcoholic who avoids the pub or the one who goes in but doesn't plan on buying a drink? Cami was obliged to agree with me.

So, thanks to a pair of clippers in our bathroom, I am now more aerodynamic, I have improved my shower efficiency, and hopefully I am one step closer to being an ex-trichotillomaniac.

In the Name of Scientific Progress

2011-03-13T21:52:00.004-04:00

I started my PGY2 "research block" at the beginning of this month. Essentially, what this means is that I am absolved from most of my usual clinical and surgical responsibilities for for 31 wonderful days. I do have to do my own clinic every Thursday morning, and I am still in the call schedule rotation, but other than that I get to stay home all day and "research." It has been glorious. Everybody, whatever their station in life, needs time dedicated to conduct such meaningful research.

What have I been researching, you may ask? Well, lot's of things. For example: I have examined the effects of of Jimmer scoring 50+ points on his team's overall performance (preliminary results are very favorable). I have investigated how long it takes for my butt to stop hurting after spending a few hours on my neglected bicycle (answer: two days). I have discovered the rejuvenating properties of sleeping eight consecutive hours. I have researched the financial impact of family vacations, fence construction, and lawn maintenance on our family budget. I am also getting ready to start a project where I seek to determine whether or not it is possible to watch all 67 games of the NCAA tournament this March.

The goal of my research block is to have some publishable data for some of the national conferences we attend during residency. If the American Board of Otolaryngology isn't interested in the above, I'm also busy working on a case series looking at polymorphous low-grade adenocarcinoma, as well as writing an IRB proposal for a prospective study examining the effects of nasal anesthesia on swallow as measured during FEES.

I can't believe this month is nearly half over already, I still have a lot of researching to do. And I think I am going to enjoy every minute of it...

The Answer

2011-03-10T17:36:00.000-05:00

It worked. Cami's pregnant.

It's hard to even believe that it's real. I don't even know what to think about it really. I talked with Cami about this on the phone. She's sort of in the same boat. Part of me is afraid to believe that it finally happened. We've had so many disappointments up to this point, I'm a little skeptical that this won't be different. Maybe it's just a defense mechanism. We've been hurt pretty deeply a few times these past several years.

The next couple months are probably going to similar to the past couple weeks. As time progresses, we may be able to let our guard down a little. I won't be surprised if it takes a while.

But at the same time, it worked. We're parents.

Finally.

Post Script

2011-03-09T17:32:00.000-05:00

Just a couple details from our big day yesterday.

Cami took the test first thing in the morning. She did not want to find out the results of the test at work and she didn't really want to be alone if the news was bad, so she had the lab leave a message on her cell phone which she wasn't going to check until she got home. I had clinic in the morning and when I got done in the afternoon, I started chatting with Cami online. She told me she had a message on her phone and that if I wanted I could access her voice mail and find out myself. But she didn't want to know.

2:13 PM Tim: how do i check again?

Cami: dial my number and when the voice mail message starts, dial #

then it will ask for my password

2:14 PM Tim: are you SURE you want me to do this?

Cami: I don't know.

I kind of just want this whole stupid thing to be over with.

Tim: i don't blame you

2:17 PM Cami: do you want to check?

Tim: only if you say: tim, i want you to check

2:18 PM and then only if we decide what to do with that information once i have it

Cami: well, I want to know, but all of a sudden I'm feeling emotional about it and I really don't want to cry a lot of work. so maybe we should wait. I can try to leave a little bit early maybe.

2:19 PM but part of me feels like that is lame, cause if the info is there, we should just get it.

Tim: it's not lame at all

if it's bad info, i don't want you to be crying alone

if it's good, i don't want you crying alone

2:20 PM Cami: okay, so wait.

Tim: i am happy to do that

i love you

2:22 PM Cami: but by the way...if you want to find out the info right now that is fine with me. just don't tell me you did it so I don't read into not hearing from you.

Tim: will you know if i did?

2:23 PM does your message go from new to old on your phone?

2:24 PM Cami: no.

plus, I'm not going to call to check again and my cell phone is off. so I won't know.

2:26 PM Tim: ok

but i don't know what i'm going to do

2:28 PM Cami: ok. just know you have my blessing to check.

2:29 PM Tim: alright

Of course I wanted to check, but I didn't want Cami to know. If the news was bad, I wasn't going to call her, but if the news was good, I don't see how I couldn't. Of course, if she knew this plan and didn't get a call, she was going to interpret things poorly. My heart was really racing when I called into her voice mail.

You know what happened next.

I didn't react the way I expected. When I called Cami and told her. She didn't react the way she expected either. We were both pretty subdued about it. Again, I think we are still coming to grips with the idea and bracing ourselves for any potential let down.

We sent off some text messages and phone calls to family and friends and let them in on good news. Most of them reacted a bit better than we did, I suppose. Sean and Ashley came over later that evening to celebrate with us. They were pretty funny about wanting to find out the results "in person." They've been a great support through all of this and in some ways I was kind of surprised by that. Well, I couldn't wait the four or five hours before they came over so I sent them a text: "Cami's finally been knocked up! Come celebrate with us tonight."

They showed up later that evening and even brought us some presents in honor of our "accomplishment." Two small little packages. We opened the first one and it was a baby onesie that Ashley made. It said "Baby Fife" on the front. Very cute. As she opened the second one, she said, "How cute! In case we have twins..." She turned it over and it said "Baby Tower" on the front.

Surprise!

Ashley is also pregnant and had found out the week before. It was like Match Day all over again. So crazy. We definitely reacted better for them than we did for ourselves. Funny. We all went out to dinner that night and talked about babies, and life, and growing up, and all that stuff that adults do. Things are going to change a lot around here.

The Wait

2011-03-08T10:09:00.004-05:00

Waiting is really hard. It is really, really hard.

Vacillating emotions and mood swings aren't easy either.

I think we've both gone from very confident in success to having a more guarded outlook. This is frustrating. Especially as there is nothing that we can do to change the outcome anyway. Except wait. And as I already mentioned, waiting isn't easy.

Cami has her blood test Thursday. Results should be done by the afternoon. We haven't figured out how we want to know. Cami doesn't want to find out at work and she doesn't want to find out before me. I'm on call Thursday night and even though I'm on a research rotation this month (no daily clinical responsibilities), I may spend much of the night evening in the hospital with this hanging over my head. Unless, of course, I violate HIPAA and read the results on the hospital's EMR on my own.

We had dinner with the Towers the other night. They informed us that after much thought and debate they want to be informed in person. I thought that was kind of funny. They've been very supportive throughout all of this. As have all of our family and friends. It's good to be surrounded by so many awesome people. I don't even know how people cope with these type of things without support.

The waiting game, however, continues...

Grossest Thing I Have Ever Done

2011-03-05T07:21:00.004-05:00

Warning: The following blog post contains some pretty graphic descriptions of the absolute grossest thing I have seen and done in my thirty years of existence. And I have seen some pretty nasty stuff. Please just skip reading this post if you have a weak stomach, are pregnant, are under the age of 16, or your first name is Kathy. Trust me.

I am fairly certain that last Friday I did the grossest thing I have ever done. Ever. And let's be honest, there are quite a few gross things I have participated in. I spent a few minutes trying to list the five disgustingest things I've ever done. It took a little thought, but I came up with a fairly impressive list. Interestingly, everything on my list has happened since starting medical school. Also, the majority of them involved horrendous assaults on my olfactory system. Nothing like stink to make a bad situation worse.

One of the more challenging aspects of otolaryngology is surgery of the temporal bone. Frequently, to operate on the middle and inner ear, we need to drill through the mastoid, which is the trabeculated bone behind the ear. This is a very compact space which contains the nerve that controls facial movement, taste, and hearing. To prepare for these surgeries we practice drilling on cadaveric temporal bones. Cadaveric temporal bones don't grow on trees, somebody has to "harvest" them.

We had a facial plastics course last week. The course included dissections, where we got to perform face lifts and rhinoplasties on cadaver heads (believe you me, they looked so much younger when we finished with them). Rather than simply throw those heads away after we made them look so beautiful, we decided to harvest their temporal bones for drilling practice.

I learned that harvesting temporal bones means taking a decapitated head down to the pathology lab and using an industrial band saw to cut those heads into small pieces. Everybody was too "busy" too help, so it was just Leighanne (one of the PGY-2s), me, and the band saw... and five frozen, decapitated heads. Without going into too much detail, that band saw cut through those heads like a hot knife through butter. It was disgusting! Every time I thought I had gotten past it, I inadvertently allowed myself to think, "This was somebody's face! I am cutting off somebody's grandma's face."

Leighanne nearly lost it a couple times. Fortunately, we were able to finish before the heads thawed too much. But honestly, the cutting was actually the easier part of this assignment. It was the clean up which proved most disturbing. There was hair, and brain, and muscle, and bone, and everything in between splattered all over that band saw, the walls, and floor. Worse yet: it had completely thawed by this point, making it wet and gooey. How do psychopaths and mass-murderers have the stomach for this kind of stuff?

It took 45 minutes, a toothbrush, a whole package of paper-towels and about four dozen Cavi-Wipes to clean everything up. I will never complain about having to clean up anything else ever again (maybe).

Code of Honor

2011-03-03T07:03:00.009-05:00

My basketball world has come crashing down. Shortly before going to bed Wednesday night, I read that one of BYU's star basketball players was being suspended from the team for "Honor Code violations." It was tough to swallow. This has been a phenomenal year for BYU basketball: a #3 ranking, the leading POY candidate, a potential number 1 seed in the NCAA tournament, and a lot of publicity and buzz. After the shellacking BYU received last night at the hand of New Mexico, a league rival we should have had no problems beating at home, a lot of that potential looks like it will probably go unfulfilled. That hurts.

But, despite all of this, it's a good day to be a BYU Cougar.

I'm proud of my alma mater. I've often people define integrity as the ability to do the right thing when no one else is watching. But I also believe it takes just as much integrity (if not more so) to do the right thing when everyone is watching, when many of those watching don't agree that you are doing the right thing in the first place. The University made a tough decision to stick to it's principles, even though it would have been convenient to just "postpone" any decision or punishments until after the basketball season. There has certainly been ample precedent set at many other universities for this type of behavior, especially those with "successful" athletics programs.

I've heard several commentators complain that the Honor Code is unrealistic, and that college students (let alone college athletes) can't be expected to live by it. I really don't see what all the fuss is about. Though some of the rules are a little silly (the beard restriction being a good example), the majority of them are values we would all do well to uphold.

Whatever your thoughts are about BYU's Honor Code, it's not a secret. Everybody who comes to BYU knows all about it before they ever arrive and the University makes sure you don't forget about it while you're there (I'm pretty sure 95% of BYU students could recite verbatim Karl G. Maeser's circle of chalk quote from the posters plastered all over the testing center). Every student, whether they agree with them or not, commits on his or her honor to abide by those principles. This is not an issue of whether the rules are realistic, it is an issue of commitment and honor. There is something to be said about an institution that has the fortitude to hold people to their commitment.

People are free to debate the value of the Honor Code. While there have been ample critics (both within and without the Church), I have been happy to see that many are recognizing that winning a game should not take precedence over honor, honesty, and integrity.

I am proud of BYU. I'm proud of our basketball team. I'm proud of the player who came clean, even though he knew there could be some devastating consequences for him and his teammates. In the end, this will be an experience that will make them all stronger... even if we have to lose some basketball games to get there.

The Transfer

2011-03-02T22:35:00.007-05:00

You are looking at two blastocysts that are currently taking up residence in Cami's uterus. These two dudes were hand selected from amongst their peers because of their excellent growth and potential. Seven of their brothers/sisters were also worthy of transfer, but have been put in the freezer for potential use in the future. The remaining ten are still on probation. If they can grow some more, then they'll be invited to the freezer too.

We were a little worried that Dr. Y wouldn't be up for transferring two blastocysts. We practiced our arguments in favor of putting two embryos in. I felt we had a couple salient points which might sway the decision to our favor. Turns out, we didn't need them. Dr. Y felt that Cami was doing so well, that after confirming that we wanted two, he went ahead and dropped them both in.

So, now the waiting game begins. We are hoping those blastocysts take to their new environment. We are offering them a nine month lease on the property. There are plenty of amenities, which I hope they will find agreeable. They are going to get a feel for their new digs and give us an answer next Thursday when Cami goes into the clinic for a pregnancy test. I am a little nervous about it not working. Cami says she's a little nervous it will. I think we're both cautiously optimistic.

However, I have a feeling it's going to be a long week...

The Harvest

2011-02-27T21:42:00.005-05:00

This is just the short version of everything that went on. Cami underwent the harvest last Wednesday. She did beautifully and they were able to collect 35 eggs from her ovaries. They were immediately sent to the lab and fertilized. Of the 35, 19 were successfully fertilized. They will continue to grow through the weekend. Come next Wednesday, the best of the best will be chosen to be transferred.

Cami is really hoping to have two eggs transferred. The physician is really pushing us to only do one. I don't think multiple births are looked upon favorably by reproductive health centers. They prefer singletons. And I am sure they have some legitimate reasons for that. They have really been pushing us hard to only go for one implantation. They have said that they are concerned about "ovarian hyperstimulation syndrome," which can be triggered by a multiple gestation pregnancy. I get the sense they tell everybody this, whether or not they are really concerned about it.

Never the less, I think the decision will ultimately be up to us. Cami has long felt that she is going to have twins (or at least has long wanted to have them). I guess our position is that we've been trying for so long to have children that having two at once would let us "catch up" a little bit. We've always wanted to have a big family with four or five kids.

Whatever happens, I think the numbers are in our favor. Both Cami and I have been blessed with a special peace about this whole process. I really feel like this is going to work. At the same time, I have the faith that regardless of what happens, it will work out for the best. We have plans B, C, D and E all laid out on the table. The Lord has taken good care of us up to this point, and I have no doubt He will continue to do so.

Cami is Awesome Day 2011

2011-02-22T16:32:00.004-05:00

I hereby declare today, February 22, 2011,"Cami is Awesome Day." Today we celebrate the awesomeness of my amazing wife and her extraordinary talents. On this day, we honor Cami's declaration of independence and wholeheartedly support her in her future endeavors.

Cami undertook a particularly strenuous challenge this past year. Realizing that she was horrendously overqualified for her employment, and somewhat dissatisfied with the work she was doing, she courageously determined to seek a new career. After assessing her strengths, interests, and talents (which are many), she elected to pursue a master's degree in counseling.

This decision required much effort and sacrifice on her part. First of all, she had to take the GRE. She studied vocabulary words with an unrivaled ferocity (there was a period of a month or two when words like "perspicacity" and "obstreperous" were tossed across our dinner table every evening). She flew through math review books like her middle name was Pythagoras. Analogies, essays, reading comprehension... you name it, she studied it. Without any fanfare, this past November she actually took the exam. Though she is far too modest to admit it herself, she totally rocked it.

After getting her scores, then came the whole headache of putting together an application: gathering letters of recommendation, writing a personal statement, and doing everything else applying to graduate school entails. (Oddly, she didn't ask me to write her a letter. I suppose this is a good thing because I would have been tempted to simply include a photo of Cami with a subscript which read: "Don't be an idiot. Pick her.") Cami was unfazed by all of these obstacles. Always punctual, she had everything collected and submitted to her programs of choice before the official deadlines. It should also come as no surprise to you that she also nailed her interviews.

Cami was worried that despite her amazingness, graduate schools might not accept her. Geographic limitations meant she could only apply to two programs and they were fairly prestigious. For what may have been the first time in her adult life, Cami was wrong.

I am pleased to announce that Cami was accepted to the Wake Forest University Master's Program in Counseling for the 2011 academic year. Wake has a great counseling program and a wonderful reputation. They are lucky to have her. As am I.

So, congratulations, Cami. You most certainly deserve it.

Big Week

2011-02-21T16:24:00.004-05:00

Retroactive Post: The following are explanatory emails we sent to family members describing our plans for the coming week. Everything I write on this subject tends to take a fair amount of effort, so when something is already written which sums up what is going on, I am more than happy to re-brand it as a blog post. In any case, I think some of the differences between the way Cami says things and the way I say things are pretty interesting...

Cami said:

As I'm sure you all know, Tim and I are in the beginning process of in vitro fertilization. The time line for when everything will happen is all based on the way my body responds to medications, so I've been trying to get more solidified details before sending out info. After an appointment today, the best they can tell me is that the egg retrieval will be this Friday or Saturday (but I think it will probably be early Friday morning). Then they fertilize the eggs and do the transfer after the embryos have grown for five days, which puts us in the middle of next week.

After that I believe we'll have to wait one week to find out if it worked or not. If it did work, we will have to wait another week to find out how many of them worked. Tim and I would like to transfer two, but I know my doctor wants to do only one. He thinks I'm young. He clearly does not live in the Mormon world.

The egg retrieval is considered a minor surgery, so I will be totally knocked out for that and then at home for the rest of the day. The transfer isn't very invasive, but my doctor recommends laying down/sitting on the couch for the rest of the day. No two weeks of bed rest, yay!

So far everything seems to be going as planned. We've done the shots before, so there really isn't any shock there. My stomach is starting to grow a little bit and my pants are kind of tight, but that is expected when your ovaries have 30 follicles growing on them. 30! That is a lot! And there will probably be more by the actual retrieval day.

Thanks for all of your love and prayers and thoughts. Please keep them coming! Tim and I have been fasting every Sunday recently, so if you feel like joining just choose a Sunday and join the fun! Lots of love to you all!

Tim said:

Let's hope this is the last time this subject needs be addressed. Long story short, we are probably clear for take-off on our most recent fertility treatment. After getting a couple shots a day for the last two weeks, it appears as if the 30+ eggs in Cami's ovaries are going to be harvested this Friday (possibly Saturday). The doctor is hoping to collect about 2 dozen or so (yes, even human eggs are measured in the dozens). They will instantly be fertilized and incubated and then the two choicest of those embryos will be transferred to Cami's uterus sometime around Wednesday of next week.

Since they aren't freezing the eggers this time around, chances are better that we'll have something to transfer (as opposed to our last failed attempt). Overall, we're looking at a 80% chance of pregnancy and 70% chance of successful delivery, which I think are pretty good odds. We'll find out about a week after the transfer what side of that 80% were on. There's also about a 40% chance, that if this works we'll get two for the price of one. Though we'd love to have twinners, we'll take what we can get.

Assuming it works, we should know within a few weeks of the transfer what side of that 40% were on. Cami and I have been fasting every Sunday this last month, and everybody is welcome to join us as circumstances permit. We appreciate all the prayers and support.

V-Day Dinner Featuring Jimmer Fredette!

2011-02-14T21:20:00.004-05:00

This year we continued the Callister family-born tradition of the Valentine's Day dinner. My contribution to the dinner was pretty much everything, including the sugar cookies with names on them. Tim decided to make me and all of our guests hand made valentines. I think he spent about 4-5 hours cutting and gluing (Camille, remember how in college we wanted to start a "construction paper & glue stick" major?). You should have seen the rug when he was done. I thought that maybe one of the valentines included confetti, but I was wrong.

Tim is an extremely creative guy, so it was no surprise that his valentines were pretty clever. However, I do think that the best one was the one he made me:

Side 1

Side 2

Feeling Dumb

2011-02-09T19:32:00.000-05:00

Without going into the details, I did something pretty dumb a couple months ago. Even thinking about it embarrasses me. Though what I did was an honest mistake (a mere testament to my surgical ineptitude) and didn't cause anybody save me and my pride any lasting damage, the disappointment in myself still stings.

I didn't discover my mistake until this past week, when I found myself the butt of a couple jokes by some of my co-residents. I don't fault them for teasing me, I probably would have teased me too (seriously, it was a really dumb mistake)... but it had been a rough day anyway and it was the last thing I needed that afternoon. Eventually everyone had a good laugh at my expense and went home for the night. On call that evening, I sat around in the office for awhile after everybody else left feeling frustrated and annoyed with myself, but mostly just feeling so dumb.

I think a couple of my cohorts felt a little bad about their teasing because later that evening I got several text messages from some of them revealing some of their biggest blunders. Of course, this felt more like pity than anything else, but I appreciated their confessions. Eventually, I figured I had to get over my mistake and just add it to the lengthy list of really dumb things I've already done in my medical education. It certainly won't be the last.

Residency is tough. I've discovered that there are several types of fatigue. In addition to being physically fatigued, I find that I am also frequently mentally and emotionally worn out. Of course, fatigue in any one of those areas leaves you more susceptible to fatigue in the others. We've all experienced the fact your mind is slower and you get crankier when you've missed a substantial amount of sleep. But I've also found that constantly concentrating and trying to learn is also physically exhausting. Additionally, consistent emotional stress leaves me tired and groggy.

Cami always wonders why I seem to be so tired all the time even if I've had several nights of good sleep. The answer is now obvious to me: "The Triangle of Fatigue" (I just coined that phrase, I think it is pretty catchy). Not only does this environment make dumb mistakes more common, it leaves those who make them less able to deal with them appropriately.

I am generally okay with mistakes that just make me look stupid but don't really hurt anybody else. In fact, I'm usually the first to poke fun at myself. Humor is my defense mechanism of choice and it has generally served me well. But as I start assuming more and more responsibility, I realize that some of these errors could really hurt somebody and that makes me nervous. Fortunately, as I've now heard many attending say as they patiently watch me make some of these dumb mistakes, "That's why a surgical residency is five years long."

I still have a long way to go. There's much to learn and do, but believe it or not, things are getting easier in many respects. Assuming the Triangle of Fatigue doesn't destroy me first, I may actually make it through the next three-and-a-half years in one piece.

Let's hope so.

The Dealio

2011-02-02T08:15:00.003-05:00

Retroactive Post: This is an email Cami sent after her ultrasound appointment. After a lot of discussion, thought, prayer and fasting, we decided to go ahead with IVF this month. Though I'll try and explain a lot of the factors that went into our decision at some point, we feel like this is the right time to try this... however it may work out in the end.

I went to my Doctor's appointment at 9am. First, I had to get lots of blood taken and pee in a cup. Exciting stuff. The good news is, Tim does not have any STDs, his lab work came back clear. Phewf! After that, Dr. Y (with onlooking nurse and med student "Kevin") did an ultrasound while injecting my uterus with saline solution. The goal was to see the condition of my uterus to make sure everything is ideal for a transfer and implantation. Back when he did the HSG, over a year ago, my tubes were fine and my uterus was too, but he just wanted to check the uterus again.

Turns out I have some polyps. He says they aren't really a big deal, but since we are going through the expense and work of IVF, we might as well create the ideal situation. So... I needed Tim to be available to drive me home from a surgery on Friday morning. Dr. Y is going to go in there and basically cut out all the polyps. He says it is kind of like a D&C, but it sounds like I will be totally out. Apparently this isn't that big of a deal and it shouldn't change our IVF schedule at all. Right now our schedule is looking like this:

Tomorrow: IVF orientation 5:30pm
Monday the 7th: Start Lupron, an injection
Tuesday the 8th: appointment with nurse to go over meds and timing of meds, etc.
Tuesday 15th: Start stimulation injection
15th-24th: lots of ultra sounds
Friday 25th: retrieval
Wednesday 2nd: Transfer

This schedule is all plus or minus a day or two, depending on how my body works. I'm not going to go to California in February like we ad planned. I'll already be doing some injections and it will just make this month so much more crazy and busy than it already is. Maybe we should just look into renting an RV and living in the parking lot of comp rehab for the month.

Honor Call

2011-02-01T19:39:00.015-05:00

As if training examinations weren't tough enough...

I had to make an honor call a couple weeks ago. It wasn't easy. Our annual Otolaryngology Training Examination (OTE) is coming up in March. This is kind of a big deal for ENT residents across the country. It's a lengthy exam that most programs use to gauge the academic progress of their trainees. Programs also like to boast about how well their residents do on these tests. Factor in the inherent competitiveness of the residents who take the test, as well as the fact that ENT residents are already some of the smartest kids coming out of medical school anyway, and it isn't hard to imagine why everybody stresses out about this thing.

For the last several years, the residents here have been accumulating questions from prior exams and compiling an OTE test bank. Prior to the test, they divvy up, answer, and review the questions together. Several questions end up being repeated from year to year, making this an effective means of test preparation. As everybody has been doing this for a couple years, I figured this would be a great way to study. Unfortunately, this year the questions were sent out via an email which was inadvertently forwarded to our residency program director.

Before our most recent grand rounds, our program director made a point of standing up and reminding us of the official position of the American Board of Otolaryngology about test preparation:

"The examination is confidential and copyrighted material under the 1976 copyright act, and the unauthorized possession, reproduction, recording, discussion, or disclosure of any material, or answers before, during, or after the examination is prohibited."

Though he wasn't explicitly forbidding anything, he was washing his hands of whatever was going on. Most of the other residents took this as a wink-wink kind of warning. After all, programs across the country are doing this and one of our attendings even gave the residents all the old test questions he had collected during his residency. They weren't necessarily cheating by remembering questions and re-studying the following year. And it wasn't as if they were bringing the information into the test.

I, however, had a harder time justifying that decision.

It would be lying to say I have never cheated on a test. I can remember "sharing answers" on dumb quizzes and homework assignments in elementary school and junior high. It would also be lying to say I felt good about doing stuff like that afterward. For the most part, those assignments weren't even worth the time, effort, or guilt associated with cheating on them.

Since then, I've always made a conscious effort to be honest in my academic work and feel like I've done a decent job at that. In fact, the last time I even came close to cheating on a test was in college. I was in a chemistry course, taking a make up test with a few other students. The professor asked us to turn the test into his desk when we were finished.

The test was difficult and the last question seemed particularly tricky. I finally settled on the right answer and walked back to turn my test in. As I was going to hand my test in, I saw another student's Scantron and noticed that he had recorded a different answer for number 20. I looked back at my test sheet and discovered I had actually misread the question. Reading the question correctly, the answer became immediately obvious to me. Since I wasn't taking information from another student, I justified changing my answer.

I turned it in and got an A on the test. I felt guilty for weeks. I knew I had known the answer to that question and I wasn't copying information from another student, but my hyperactive conscience has plagued me on this on for years. I don't think what I did was necessarily wrong, but it was close enough to make me uncomfortable. And that experience has been enough to prevent me from "coming close" for that past twelve years.

No matter how I tried to justify using these study questions, I just couldn't. I talked with a few of the residents whose opinions I respected and listened to their reasons for doing the questions. They were convincing arguments. But, the phrase "wrong is wrong, even if everyone is doing it" kept floating through my head. I knew that if I took part in using those questions, that no matter how good I did on that test, I would feel like I cheated. Though the answer wasn't easy, the answer was obvious. I quietly let my co-residents know that I wasn't going to participate in the group study.

The experience reminded me of a story Clayton Christensen once told. As a boy, he was playing basketball in England. He was one of the starting players on the team and his team was playing their way through a prestigious tournament. However, when the championship game was held on a Sunday, he made the decision to stick to his principles and not play, despite the pressure from his peers to make an exception "just this once." He said:

"...Resisting the temptation whose logic was 'in this extenuating circumstance, just this once, it’s OK' has proven to be one of the most important decisions of my life. Why? My life has been one unending stream of extenuating circumstances. Had I crossed the line that one time, I would have done it over and over in the years that followed. The lesson I learned from this is that it’s easier to hold to your principles 100% of the time than it is to hold to them 98% of the time. If you give in to 'just this once,' based on a marginal cost analysis, as some of my former classmates have done, you’ll regret where you end up. You’ve got to define for yourself what you stand for and draw the line in a safe place."

I don't know how I'll do on this test. But I do know I won't feel guilty about my efforts and I think that's worth a few points on the test that matters most.

Jimmered!

2011-01-27T13:39:00.005-05:00

I think I've been Jimmered.

I stayed up until past midnight last night watching the BYU/SDSU game last night (have I mentioned that trying to follow sports on the East Coast is miserable?). It was a highly anticipated match-up and I couldn't not watch Jimmer play. Though I felt absolutely exhausted this morning when my alarm went off at 5:00 AM, it was definitely worth it to watch that game through to the finish. Fredette was hitting threes and breaking ankles like it was nobody's business. The kid is fun to watch.

I've been able to follow a few BYU games on TV (have I mentioned that I am so happy that BYU will no longer be banished to the mtn. next year) and I have been simply amazed at the type of shots Jimmer can make. BYU's hoops success has made the long drought between college football seasons much more tolerable. And though expectations for a deep run in the NCAA tournament might be a little unrealistic, it sure will be fun to watch them play.

So, there you have it: I've been Jimmered. But I'm not the only one. It appears that Jimmermania is spreading.

On Calvin & Hobbes and C. Difficile

2011-01-22T06:17:00.007-05:00

As I was reading the news online the other day, I stumbled across an article about some scientist who is seeking to cure particularly resistant strains of Clostridium difficile infections by performing "stool infusion therapy." C. diff is a pretty common gastrointestinal bacteria in the hospital setting and it can be pretty devastating. Antibiotics can alter the normal flora of your GI system, allowing these buggers to multiply and run rampant once all their competition has been wiped out. The result is some pretty fierce diarrhea, but there are also a number of other complications which may arise.

Apparently, this Dr. Borody believes that a "transpoosion" could be just the cure some patients suffering from chronic C. diff have been hoping for. By transplanting poop from a person with a healthy colon (ie a person who's natural intestinal bacterial make-up isn't overrun with C. diff) into somebody with a diseased colon (the one with an unopposed C. diff population), the bacteria from the transplanted poop can recolonize their new environment and take care of the C. diff problem. Poop can be transplanted by an enema or by other methods...

Reading this article caused me to ponder all of the social, medical, and legal ramifications of such a radical therapy. What sort of screening process must be done to find suitable "donors?" Are donations anonymous? Are any pharmaceutical companies interested in picking up this treatment and how are their PR firms going to market it? And most interesting to me: How on earth would a physician broach this topic with his/her patient with a straight face?

While pondering this revolutionary new treatment modality, I was reminded of a particularly humorous Calvin & Hobbes strip, which seemed incredibly pertinent to topic at hand. Alas, despite owning every Calvin & Hobbes book ever printed (except the new hardback collection I saw in Costco a few months ago), I could not recall which book it was in. Fortunately, the brightest minds in research today have not focused all their efforts on fecal transplantation. The geniuses at Microsoft have developed what I consider to be one of the most amazing search engines in the history of the internet.

By entering specific search criteria, "Calvin & Hobbes: The Search Engine" scours every Calvin & Hobbes comic for matching terms. I queried the search engine for "snot" and found the comic in question. It appeared in the newspaper on June 9, 1992. I present it here for your reading pleasure:

I grew up on Calvin & Hobbes and consider it to be the greatest comic strip of all time. As a nine-year-old with a stuffed tiger of my own, I loved reading this strip. I still remember the day that the strip ended as a particularly sad one in my childhood. Nevertheless, Bill Watterson's creation played an influential role in shaping me into the man you see today. As a kid (and as an adult), I understood Calvin. I loved his sense of humor and his imagination. Perhaps as an homage to my comic-book hero, I even ruined a set of family Christmas cards as a kid by making ugly faces in every photo (Mom wasn't too happy about that one when the pictures were finally developed). At the very least, as was the case today, Calvin & Hobbes has always provided me with a good laugh and a temporary respite from everything else that goes on.

As a future otolaryngologist, who spends a good portion of his working day dealing with snot, spit, and all other forms of nasal and oropharyngeal secretions, I look forward to the day when the first mucus transfusion will be successfully performed. Just don't get me anywhere near a transpoosion.

(Does anybody else miss these two guys?)

Mr. Jekyll and Dr. Hyde

2011-01-19T17:45:00.004-05:00

I really don't much care for the person I become when I am on call several days in a row. Much like Robert Louis Stevenson's infamous character, my personality takes a drastic turn for the worse when I've only gotten a few hours of interrupted sleep over a weekend. Only in my case, the transformation from normal guy to über-cranky resident isn't preceded by the administration of some personality altering potion, it's caused by being overworked and overwhelmed.

Weekends on call are the worst and this past weekend was particularly evil. During the week, I can forestall this uncharacteristic behavior because I know a good night's sleep is waiting for me the next day. Such is not the case on the weekend, when I am on call from Friday evening through Monday morning. It is a true test of character and endurance, and sadly, it is one that I feel I have yet to pass successfully.

This last weekend was extended in honor of Martin Luther King, Jr., and as such, I was on call four straight days: from Friday through Tuesday morning. As each day passed, the fatigue intensified. My tolerance for even the slightest of setbacks and inconveniences diminished. I snapped at nurses and ED physicians. I kicked doors in the stairwell. I made snarky comments to the poor Physician's Access Line operators who called me 15 times in one six hour period. I fought off the urge to chuck my pager against the wall as hard as I could every time it went off (just the thought of doing that still makes me feel all warm and happy inside). All in all, the more tired I got, the more of a jerk I became. And as long as I was on call, it didn't seem like there was a thing I could do about it.

The worst part was that though my patience wore razor thin, my conscience refused to wane to a similar degree. I found myself wracked with guilt about my behavior and ended up spending a fair amount of time apologizing to nurses, Physician's Access Line operators, doctors, and one amazing wife who was probably wondering who this zombie was who kept sneaking in and out of the house at all hours of the night. Though my ill behavior pales in comparison to some of the fatigue-induced abuse I have seen some of my co-residents administer, this doesn't really make me feel a whole lot better about myself.

The upper-level residents in my department all keep telling me to "hang in there." They promise life gets easier as I progress and am no longer required to take primary trauma call. I hope they are right, because I'm not sure I could keep this up forever. We have our new applicants interviewing for intern positions arriving this week, and at my nadir this weekend, I could not think of anything positive to tell them about my job. In fact, I fantasized about confronting them in their dark business suits and power ties and yelling: "Turn back before it's too late! It's just not worth it!"

Fortunately, well before I crossed such an applicant, my four nights in a row on call ended and I was finally able to get a good night's rest. Amazing how simply closing your eyes for eight uninterrupted hours can completely change your whole perspective. I managed to remember why it is that I like my life. With this improved perspective on my responsibilities, I think I can make it. And I think I can do a better job not turning into a freakazoid every time weekend call rolls around... at least, I hope so.

Thirty

2011-01-10T18:04:00.006-05:00

Good heavens. As of last Friday, I celebrated the thirtieth anniversary of my arrival on planet Earth (thanks, Mom and Dad!). I thought turning thirty was going to be weird, but it didn't really feel all that different from the twenty-nine other birthdays I've had over the years. Yes, it is true, I have entered a new decade. But people have been saying for awhile that "forty is the new thirty." Therefore, I can proportionally assume that "thirty is the new twenty-two-and-a-half." I am feeling younger already.

I have clinic Friday afternoons, and had to deal with a few tricky patients (including making a phone call to a patient to tell her that her cancer had spread to her brain... only a couple hours after telling her that her MRI looked pretty clean). This was a bit of a downer. I didn't finish dictating all my notes until 7:00 PM. When I finally got home, I discovered that Cami had decorated the house with streamers, balloons and her trademark Construction Paper Letters. Way to go, Cami.

My birthday fell on a Friday this year. I have decided that Friday is the best possible day for a birthday to be on. Essentially, a birthday becomes a birthweekend. Friday night, we went out to dinner with Sean & Ashley. Saturday, Cami and I did a little B-Day shopping, then invited Sean & Ashley, and Fernando over for games and socializing. We then made it out to Red Robin. Sunday, we had the Wallins and Ashley (Sean was on call Sunday) over for some yummy BBQ.

By the time Monday rolled around, I was pretty much birthday'd out... I don't have as much stamina as I did when I was younger. The best part of all of this birthday business? I can officially become a Manther. As a thirty-something year old guy, I am toting a twenty-something trophy wife around... at least for the next ten months.

Holiday In Review 5

2011-01-05T18:05:00.003-05:00

As is now tradition, I present the ten best happenings of our holiday season in one neatly compiled blog post. Enjoy.

10. White Christmas. We'd been watching the weather reports the days leading up to Christmas and were holding out hope for some precipitation come Christmas morning. However, when we awoke Christmas morn, all was not white out. Despite the weatherman predicting a 50% chance of "wintry mix," it just looked awful drab outside. After opening presents and having breakfast, Cami complained: "When is it going to start snowing already?" We looked out the window and what did we see? Snow flakes fallin g on our lawn. It snowed all day and all night and by the next morning, we'd gotten about 6 inches of beautiful snow. It was a meteorologic Christmas miracle!

9. Christmas on Call. For the second year in a row, I was the lowest man on the residency totem pole come December 25th. I woke up at 6:00 AM to ensure that Santa visited our house, then I took off to round on the patients in the hospital. Fortunately for me (and for the patients), most of our sickos had gotten well enough to go home prior to Christmas, so I only had a handful of patients to visit. Throughout the day, I got called in a couple times to visit patients in the ED. I also took a few phone calls from some dumb-as-dirt ED physician about a patient with a bloody nose that wasn't bleeding. The good news was, that as the snow kept falling, fewer and fewer people made it into the ED and I stopped getting called altogether.

8. Tickle the Ivories Fund. For a very long time I have wanted to buy my wife a piano. However, pianos are very expensive. My wife is an accomplished pianist, and her talent has languished these last several years as she hasn't had the ability to hone her skills. Therefore, I took it upon myself this year to find Cami a piano. I found a decent keyboard (excuse me, "digital piano"), with 88 weighted keys and a host of other features that we'll never be able to figure out. Unfortunately, even digital pianos carry a substantial price-tag. Therefore, I started a foundation in Cami's honor and christened it the "Help Cami Tickle the Ivories Fund." Both of our families do a rotating sibling gift exchange, so I contacted the siblings assigned to us and proposed their contribution to the fund (thanks, Cindy and Katie!). Cami's parents, also eager to assure that the money they spent on Cami's piano lessons did not go to waste, also chipped in. All told, contributions and generous donations made Cami's digital piano a reality!

Of course, then there' s the whole issue of wrapping and hiding a giant digital piano box. Jordan and Cianne were kind enough to make their home the repository for Cami's gifts. On Christmas morning I wrapped the bench and included a little note which read: "Away in a Manger." A Christmas Carol themed scavenger hunt ensued which included such gems as "The Christmas Song" (near the fireplace), "Bring a Torch, Jeanette, Isabella" (in Cami's lantern collection), "Star of Bethlehem" (our Moravian Star outside) and "Up on the Housetop" (exactly where you think it would be). Cami is an excellent scavenger and she burned through my clues like it was nobody's business. She eventually found her gift in the guest shower.

7. Blogging on Paper. My sister Cindy was kind enough to gift me with a hardback edition of the first four years of this blog. It was one of the most thoughtful gifts I've ever received and Cindy did a bang-up job putting it together. She even included color photos. Reading back through the "Medical School Years" has been nostalgic and I'm glad I've kept this blog. We've certainly had our fair share of fun and interesting experiences. And while I am generally surprised how many people read this blog on a regular basis, I am pretty sure I could put together a fairly entertaining book based (loosely) on my own medical experiences... with some artistic liberties, of course.

6. Adventures in Traveling. Cami and I flew out of Charlotte and left the snowy East Coast behind us as we ventured West. I was expecting there to be some delays on the trip out there on account of the nasty weather. Nope. We made it out just fine. It was the trip back that was miserable. We were worried about heavy holiday traffic congesting the airports so we got there early only to discover that the Sacramento Airport was all but empty. So we waited around for two hours only to discover that our flight to Phoenix was going to be delayed for reasons yet to be explained. The real bummer in all of this was that meant we were going to miss our flight out to Charlotte. Even worse? The next flight East wasn't until midnight. We had to figure out how to waste eight hours in the airport.

Amazingly, we were able to keep ourselves pretty busy. We window shopped, walked laps around the airport, people watched, read our books, and chatted. We used our meal vouchers at Chili's and then rented a DVD player and watched "The Other Guys" and giggled in the middle of the airport with headphones on while people walked by. Eventually, time for check-in arrived and we boarded the plane. We slept fitfully and arrived in Charlotte at 6:00 am... the day after we were supposed to get there. The day after arriving was a mess. Cami spent all day in bed and wasn't able to get to sleep the next day. I was in such a hurry to get to work that I ended up getting a ticket for not coming to a "full and complete stop" at an intersection. I would have rather spent another eight hours in the Phoenix Airport.

5. Just Dance. Cami has been in love with the game "Just Dance" ever since she played it at Jordan and Cianne's house. When my mom was asking what I thought Cami would really want for Christmas, I knew exactly what to tell her. We had a lot of fun dancing around in front of the TV and sweating our faces off. In addition to being an accomplished pianist, Cami is also a kick-butt dancer. She seriously has some awesome moves. All of Cami's nieces and one particularly dance-happy nephew loved playing the game. Moms and Dads even got in on some of the action which only added to the overall entertainment value of the game. All in all it was a great gift and we enjoyed going to bed sweaty every night.

4. California Love. For the first time since I moved to the East Coast, Cami and I made it back to California. We were able to spend the week after Christmas at home. Going home is great. The best part, obviously, is the opportunity to hang out with family and friends. Two of my sisters and their families had come home, and Cami's house was packed with her siblings and their respective families. Other than the family, there are a lot of things I miss about California. Foggy winters, mountains, fresh produce to name a few. After arriving in Sacramento, we took a drive through Woodland, one of our all-time favorite places, before heading home. It brought back a lot of nice memories. Except, I was disappointed to discover that In-N-Out is not as good as I remember it (I am definitely a Cook-Out man now). If it wasn't for the taxes, high cost of living, and screwy politics, I think we would certainly come back to California when this whole residency thing is over... I guess we'll have to see how things look in three years.

3. New Year's Extravaganza. Since Cami's house was jam-packed with siblings and kids (15 kids under the age of 16), New Year's Eve got a little crazy. As is now tradition on Whitegate, Drive the New Year's celebration began several hours earlier than would be expected. I always wonder what Cami's parents' neighbors think about all the noise-making and "Happy New Year" wishing that goes on every December 31st at 9:30 is all about.

The evening kicked off with a talent show of sorts, although, "talent" may be a generous word. There was some singing, some dancing, but the talent show didn't last too long and the New Year's celebration began. The kids enjoyed jumping around, making all sorts of noise, and having a dance party with the soundtrack provided by "Alvin & The Chipmunks: The Squeakquel." Dancing around to what appeared to be Katy Perry on helium seemed a little strange to me, but everybody else seemed to love it. After the kids all went to bed, the adults rang in the New Year in a more subdued fashion. I don't know about anybody else, but I wasn't terribly disappointed to see 2010 go, and am holding out hope that '11 is a better year all around.

2. Quiet Christmas. For the second year in a row, it was just the two of us Christmas morning. If I were to rank my favorite Christmases of all time, this one would be up there. I don't know what made it so special, we didn't really do anything different. We had a great breakfast when I got home from rounds. We opened presents. We watched it snow. We listened to Christmas music. We finished a puzzle and played board games. We talked about the past year, our successes and disappointments. We discussed our plans and goals for the coming year. There isn't a person on the planet I would rather spend my Christmases with more than Cami. I am glad she feels the same.

1. The streak continues. This was our eighth Christmas together and we are still 100% Rock Solid.

Buon Natale!

2010-12-24T06:30:00.002-05:00

Have yourself a very merry Christmas.

Woulda, Coulda, Shoulda...

2010-12-23T16:46:00.003-05:00

You never know when it will strike, but there comes a moment at work when you've made up your mind that you just aren't doing anything productive for the rest of the day. With Christmas right around the corner, I hit that point in a bad way today. I had just hammered out four easy ear-tube cases with my attending and was realizing that I was completely done for the day. Sure there were things I could do, but I just couldn't bring myself to do them.

With all of my essential responsibilities done, I was hoping to get the green light to go home early. Fortunately, with every OR finished but one, I was given the go-ahead to leave. I changed into my civies and was about to leave when JT walked in the office. JT is one of the PGY-3's who I get along with pretty well. He was on consults that day and was in the midst of getting hammer paged by other services in the hospital. I figured I'd keep him company and stick around for awhile.

Sure enough, about fifteen minutes after deciding to "stick around for awhile," the remaining OR calls up to the office and asks for an extra pair of hands closing the patient. I was stuck. Had I left when I was given permission, I wouldn't have taken the call. Nevertheless, I enjoy operating, and figured I could muster the energy to do it. I changed back into my scrubs, while JT pestered me about how easily he could beat me up (something he does almost incessantly). I laughed along good-naturedly, and decided enough was enough.

As soon as his back was turned, I tackled him. JT weighs about 60 pounds more than I do and has at least four or five inches on me. He's no fatty either. Though I took him by surprise and slammed him into the book shelf, he eventually took care of me by putting me in a choke. Of course, I let him do that. In reality, I was laughing to hard to put up too much of a fight once the initial shock wore off. Out of breath, we shook hands as equals, and I ran down to the OR. It wasn't until I got there I realized that my ear was throbbing.

While scrubbing in, I looked at myself in the mirror and saw my ear looked pretty big, suspiciously like an auricular hematoma. I had gotten one of those before and had to have it drained twice. Since then, I have been a little self-conscious about the appearance of my right ear. I had already scrubbed, so I didn't have a great chance to inspect it before hopping into the OR. As I was sewing up the patient's neck, I kept thinking: "If I had left on time, I wouldn't have been called back into the OR. If I hadn't been called back into the OR, I wouldn't have tried to wrestle JT and I wouldn't be worrying about my ginormous cauliflower ear right now."

As if fate was listening to my internal dialogue, no sooner had I completed the thought than I felt a sharp prick in my left thumb. Ouch! The other resident I was working with accidentally poked me with the suture he was sewing with. I inspected my glove and sure enough, a bright red bead of blood started forming under my Biogel gloves. Perfect.

I had to go break scrub and wash my finger thoroughly. Then I had to march over to employee health and fill out a bunch of paperwork and submit some blood samples to make sure I didn't have HIV or hepatitis before getting stuck with the needle. They'd draw blood on the patient I'd been operating on and let me know what kind of stuff I'd been exposed to. To make matters worse: the nurse who took my blood could have used a little extra practice because she gave me a big ol' hematoma in my antecubital fossa.

The good news out of all this? I found out 45 minutes ago that I don't have HIV. Cami will be so happy to hear this. Also, most of the swelling in my ear went down, so I don't look like one of those gnarled rugby players anymore. Cami will also be happy to hear this.

In conclusion, I was called back into the OR, given an auricular hematoma, a needle stick, exposed to who knows what kind of infectious disease, and got a big bruise on my arm. If only I had left on time...

Mystery Dinner

2010-12-19T08:17:00.006-05:00

Every year, Kristin, one of the residents in the ENT department, and her husband Cody host a Christmas party. This year they opted to go for a mystery dinner. This is one of those events where everybody is given a character role to play and over the course of the evening you are supposed to figure out who the murderer is. Everybody is given a fairly complex character history and some dirt on other characters and the goal of the dinner is to 1) have fun and 2) figure out whodunnit.

Cami and I have never done one of these dinners and always thought it would be pretty fun. It actually was. I was given the role of Ben de Toy, a successful lawyer by day and a successful lover by night. Cami was Mary Christmas, office receptionist and undercover FBI agent. Cami really got into the role of the "ditzy receptionist," we had to make a stop at Mega Thrift so she could get a fuzzy sweater, red belt, a pair of gold stilettos, and a clutch. Add all that to the skinny jeans and Bumpit she already owned and she looked as if she dressed like that every day... which she doesn't, of course.

I was pretty excited about my character, too. I spent a good portion of the evening looking up awesome pick-up lines. I tested them all on Cami before the dinner. Her favorite: "You must be a parking ticket, 'cause you got fine written all over you." Sadly, I didn't get to use most of them, because I was murdered shortly after the dinner began. Worse still, Cami was unable to avenge my death by properly identifying the perpetrator. I did get to come back from the grave as a police officer and arrest the actual perp, but it wasn't quite the same. Cami's failures as an FBI agent aside, we had a good time.

Christmas Music

2010-12-17T08:06:00.000-05:00

Seriously, does this song make everybody else cry too?

But If Not...

2010-12-15T16:44:00.004-05:00

We went to the Temple Saturday morning. We had set a goal at the beginning of this year to attend the Temple twelve times. A goal of twelve visits a year gave us a little more flexibility than the standard "once-a-month" Temple attendance goal. Attending the Temple with such regularity has been a blessing for me in ways that I hadn't imagined. I have had spiritual truths revealed to me as I sought to understand the Gospel principles the taught in the temple. I received comfort, respite, and guidance in the midst of some challenging circumstances. I also realized, that although every Temple visit is not a spiritual explosion of revelation, a certain percentage of them are. Therefore, the more frequently I go, the sooner I will experience those revelations. The realization of this simple truth was, in and of itself, just such a revelation.

Saturday's Temple visit was a special one for me. Throughout the ceremony, I felt as if the Lord were blessing me with His tender mercies. I won't go into a whole lot of detail, but I felt very strongly that they Lord was aware of me and our circumstances. It was a special experience and I felt it was a harbinger of good news to come. We were anticipating a call from the lab at the reproductive health office to let us know if Cami's frozen eggs had survived the thaw. Though we were bracing ourselves for the worst, deep down I had a feeling things were going to be good when we saw that there was a voice message from the doctor's office when we got back out to the car. We were happy to hear that of the four eggs we froze, three survived the thawing, and two had been successfully fertilized. It was as if the Lord was rewarding us for completing our Temple goal and enduring our struggles with infertility at the same time. In a way, we were finally parents!

Assuming everything went well, and the eggs kept dividing, we were to go ahead with the transfer the following Wednesday. We called friends and family to have them join us in the prayers and fasting. While still trying to temper our expectations, excitement started to overtake us as the thought of finally having children (twins even) seemed possible. We got a call from the doctor's office again on Monday to let us know that the eggs were still growing and dividing and that Wednesday's appointment would be at 11:30 am.

I made arrangements to be able to sneak out of the OR to be at the appointment. Cami requested the day off. We fasted. We prayed. On Tuesday night, I asked Sean and Ashley to come over and help me give Cami a blessing. It was very difficult for me not to simply give in to what I wanted to tell Cami, and I tried very sincerely to channel the Lord's desires to Cami. Through the power of the Priesthood, we blessed Cami that she'd have the opportunity to be a mother and that the Lord had accepted her sacrifices in enduring this particular trial.

The next morning, I had a hard time concentrating as I watched the clock tick away the hours until Cami's appointment. I feigned interest in whatever case my attending was performing and did my best not to appear distracted. It was not easy. As the hour was nearing for Cami's appointment, my phone buzzed. It was a text message from Cami: "Call me. Change of plans."

My heart sunk and I got one of those lumps in my throat that always seems to arise when bad news arrives. I excused myself from the OR and listened as my tearful wife explained that the eggs hadn't grown any since Monday. The transfer was canceled. We failed again. We weren't parents after all.

I ran through a host of emotions and arguments over the following several hours. I just could not understand how I could have been so wrong. I was convinced that all of the coincidences and "lucky breaks," coupled with the Spiritual promptings I'd had earlier that week in the Temple had been the Lord letting me know that we were finally going to receive the blessing we'd pleaded for. As the week went on without any setbacks, I became even more convinced that this was finally the time. I think this is what made this all the more devastating.

When I got home, Cami seemed more or less at peace with everything. She confessed that she had the feeling the night before that this wasn't the right time. I am ashamed to admit that this frustrated me even more. I was frustrated that, yet again, I bought into everything. I exercised "faith" as best I could and yet I found myself heartbroken and disappointed again. I felt abandoned and mislead. I was terribly confused.

Cami and I had a long talk that night. She taught me a lot. I realize that one of the errors I have been making throughout this whole process has been a simple misapplication of faith. Instead of focusing on the overall journey, I have been focusing on the individual steps. Instead of accepting the Lord's timetable, I am guilty of trying to make the Lord accommodate my own. Much of my frustration stems from the fact that Lord hasn't seen fit to meet the deadlines I have imposed on Him. I am working on trying to refocus my faith on the process as a whole: We will eventually reach our destination...

I have been thinking a lot about Elder Dennis E. Simmons' Conference talk from 2004 entitled "But If Not..." He tells the story of Shadrach, Meschach, and Abed-Nego, who refused to worship Nebuchadnezzar's golden images. Faced with the punishment of being cast into a fiery furnace they responded: "If it be so, our God whom we serve is able to deliver us from the burning fiery furnace, and he will deliver us out of thine hand. But if not, we will not serve thy gods, nor worship the golden image which thou hast set up."

Faith in the face of trials and tribulation certainly isn't easy. Especially when it appears to us that our faith may be misplaced because things don't work out the way we anticipate them to. That is why having faith in the "big picture" is so important. I have faith that the Lord loves Cami and me. I know that He wants us to be happy and experience the joys of parenthood. For some reason that I have yet to understand, we aren't ready for that experience yet. I trust in His wisdom and know that things will work out.

"Our God will see that we receive justice and fairness, but if not... He will make sure that we are loved and recognized, but if not... We will receive a perfect companion and righteous and obedient children, but if not... we will have faith in the Lord Jesus Christ, knowing that if we do all we can do, we will, in His time and in His way, be delivered and receive all that He has."

Up and Down

2010-12-10T16:25:00.004-05:00

What a morning! Cami had another ultrasound this morning. Prior to her last IUI, Cami had four little eggs harvested and frozen for this experimental IVF procedure. When the last IUI was unsuccessful, we moved ahead with our IVF. She's been on a number of medications to prepare her for everything.

Unfortunately at her last appointment they said her blood flow to her uterus was too poor. They put her on Trental, vitamin E, and aspirin to try and improve circulation to her uterus and delayed doing any implantation until they could assess whether or not this improved. So we went into the office today for a repeat ultrasound. Amazingly, I was able to steal away from work for a few minutes to go with her, something I usually am not able to do. Well, the news wasn't great. It appeared that Cami's uterus had improved, but not to the extent that they had hoped. Essentially, her uterus probably wasn't healthy enough to go ahead with the IVF, and the PA we were working with thought it would probably be best for us to consider this month a scratch and try again in January.

Obviously, we were a little disappointed, but figured it was the right decision. We didn't want to waste this opportunity if it wasn't going to have a good shot at being successful. Additionally, it helped us identify a possible reason why we'd been having so much trouble in the first place. The PA said she'd call us after she spoke with the supervising MD to let us know what if any meds Cami would have to take in the interim. So we stopped by the lab to give some blood and then made our way out to the car.

Just as we got in, my phone rang. My phone never rings and I must have sounded a little puzzled when I answered the phone. It was the PA we had just spoken with. After discussing the situation with the MD, they both felt that Cami had responded well enough to warrant a shot. They were going to begin thawing our eggs and would need to fertilize them today. Of course, that meant we had to turn the car around and let me trudge up to the office so I could make my "deposit." I was not particularly excited about that (I usually have to psych myself up about these things, but maybe the short notice was helpful).

Long story short, the waiting game begins today. There are a number of variables at play. Before we can implant those eggs, a number of things have to happen: 1) the eggs have to survive the thawing, 2) the eggs have to let themselves be fertilized, and 3) they have to grow a bit post-fertilization. If all these things occur, we'll proceed with the IVF on Wednesday. They are supposed to let us know over the next couple days how many (if any) of our 4 little eggs survive, and will give us an idea if we'll be clear for takeoff come Wednesday. We are trying to temper our expectations, as the chances of any of these handful of eggs surviving is small at best. Cami will be taking a bunch of shots this week and will have to continue a number of meds for awhile (even longer if she actually gets pregnant). We'll see how the weekend plays out.

Residency Is Hell (Sometimes)

2010-12-08T16:37:00.008-05:00

I used to take issue with the idea that hell was a flaming lake of anguish and torture. For me, a dark, frigid hell was a much more intimidating location. Well, I've learned something this past week: Hell is neither a fiery inferno nor a frozen abyss. Hell was last weekend on trauma call. After this past weekend I am a broken, shadow of a man. But most of all, I am just so very tired.

I was on call Monday and then again on Wednesday. Unfortunately, I spent all of Wednesday night in the operating room. So, going into the weekend, I was already pretty exhausted. Worst of all, my weekend of call happened to perfectly coincide with the first snowfall of the winter. Accordingly, all of Winston-Salem freaked out and somehow managed to smash their faces in all weekend on less than a half-inch of snow.

I sewed a ear back on, a face back on, a lip back together. I saw the girl who sledded into a brick wall and the guy who slipped on some ice and impaled his throat with a stick. I worked the whole weekend long. It was terrible. Every time I got close to being able to go home, my pager would go off. Then it would go off again. Since it was snowing, all the people who didn't want to brave the "frozen tundra," simply called in the Physician's Access Line. I got a dozen or so pages from patients who were concerned about their ENT related maladies.

I was tired. I was frustrated. The more tired and frustrated I got, the crankier I got. I'm usually a patient person, but with six hours of sleep over three days, my patience started to wear thin. I snapped at ED residents for calling me at 2:00 am... for the fourth time that night. I'd eventually have to go and apologize to whatever resident or nurse I was short with. It wasn't their fault that the cheerleader with the cheek abscess decided to show up in the middle of the night. I must have looked like pretty pathetic there, because they all forgave me pretty readily and even sympathized with me a bit.

Sunday afternoon, after a brief two hour respite, I was called back into the hospital. I dragged myself back into the car. On the way in, I got paged twice more with two more consults. I almost started crying. It literally felt like it was more than I could handle. I was powerless to make it stop and the only thing I could was suffer through it. I pulled into the ED parking lot and offered up a very sincere prayer. I sat in my car for fifteen minutes composing myself before I could muster the energy to drag myself through the hospital's double-doors. But I did it...

All things eventually come to an end. Last weekend was no different. Eventually, Monday morning arrived. I was no longer on call. I got to get some sleep and life always looks a bit better after a good night's sleep.

I keep hoping things will get easier soon, but we all know when that's going to happen. Fortunately for me (and for those poor ED residents I barked at), my responsibilities on primary trauma call will end in six months. Until then, I just have keep toughing it out. I'm not the first and I won't be the last one to have to go through this stuff... but I tell you, I'm not going to miss it when it's gone.

Shout Out to Dr. (Timothy A.)!!

2010-11-30T09:34:00.008-05:00

If having your name in a newspaper makes you famous, than my husband is famous. See here. Tim's response to the article: "I didn't sew up anything in her eye, I sewed up stuff above her eye. Just goes to show you, only a small percentage of what you say actually makes it through to the patient." And even if this doesn't mean fame, I'm pretty sure it means Dr. (Timothy A.) is good at what he does. But honestly, I'm not surprised, just grateful and proud.

Sweet Home Alabama

2010-11-28T20:40:00.008-05:00

We had four-and-a-half days off and a holiday to celebrate, so Cami and I decided to make the best of it by inviting ourselves over to my sister Cindy's house to spend Thanksgiving. Fortunately, Cindy obliged to our unsolicited request and we made the seven hour drive to Huntsville, Alabama.

Cindy and Mark and their four kids have been living in Huntsville for awhile, but this is the first time we've been able to visit their house. Correction: The first time we have visited them in their house. Cami and I overnighted in their house during our drive to NC last year. Unfortunately, Cindy and the family were on vacation at that time and we shared the house with Harry Pawter, a large ball of lard and gray fur they call a "cat."

Thanksgiving is a great holiday for many reasons. I think we all need a day dedicated to reminding us how good we've got stuff. A holiday which encourages us to eat ourselves silly is also a plus. Cindy did a great job with dinner. Her kids also did a great job entertaining us while we ate. My favorite act was Bryce "trying" some sweet potatoes. He certainly deserves the Oscar for "Best Performance while Eating a Gross Food Product." He was literally on the floor nearly dry heaving. Great job, buddy.

When we weren't gorging on food, we spent some time playing video games. And by "some," I mean A LOT. The boys needed a lot of help with some video games they had gotten stuck on. Whether I wanted to or not, I was going to help them. We also squeezed in a little Rock Band here and there. I had forgotten how fun that game was. When not playing games electronic, we took on the board game variety as well. Good times were had by all.

In addition to all of the above, we also had the chance to see the new Harry Potter movie with the kids. I would have rather watched the fat Harry Pawter roll around the floor for two hours. That movie was incredibly boring. I also suffered through the BYU/Utah game. I would have rather watched the Harry Potter movie again with Harry Pawter coughing up hairballs on my lap than see Utah come from behind to win the game. There's always next year...

Boring movies and football losses aside, it was a good Thanksgiving. We didn't enjoy the drive back home (much too long) and I think both Cami and I are a little depressed about starting work again tomorrow. The worst part about any vacation is coming back to regular life again. Especially when regular life requires you to be on call five of seven days the first week back.

Thanks, Cindy and Mark, for having us over. We'll have to return the favor some time.

Giving Thanks

2010-11-25T02:00:00.003-05:00

I have so much more to be thankful for than I'll ever have the capacity to express. Despite the challenges we face daily, and some of them are pretty rough, this life is a pretty beautiful thing.

Happy Thanksgiving, everybody.