Nitrous is cool stuff

I had my first experience intubating a kid yesterday. He was only 3 years old and way too cute. I wasn't quite sure I had heard right when the anesthesiologist handed me the laryngoscope and said go ahead. I was seriously worried I might break the poor kid. Turns out everything is exactly the same, just smaller. I had no trouble and all went well. I think that set the tone for the rest of the day as I went 9/9 for the entire day.

Usually when we induce anesthesia we inject a couple of drugs into an IV. A narcotic pain med, a medicine to numb the vein, and medication to send them off to sleep - this medication burns a bit, hence the numbing, and finally a med to paralyze them. We do it slightly different for kids and young adults. For the 12 year old we induced we used nitrous oxide, commonly known as laughing gas. I had never experienced an induction with this gas before, so I wasn't exactly prepared for what happened. I was holding the mask and he had been breathing the nitrous for about 30 seconds or so. All of a sudden he began laughing uncontrollably. From what I could discern, there was no appropriate stimulus for this attack of hysteria. All I can say is wow. It was a good thing that everyone in the room was also laughing at the fact this kid was laughing, I'm not sure I would have succeeded in keeping it together.

I also attempted to work on my IV skills today. I did learn how to start an IV during the second year of medical school, but hadn't done another until last week when I learned again. I worked with two amazing nurses who helped me with my technique. I was on a roll, I had successfully started 5 out of the last 5. Today I got my first three and then I choked on the last one of the day. Damn, what a way to finish. There is always tomorrow to attempt to redeem myself.

This has been an amazing rotation in so many ways. It's too bad it has to end tomorrow.

My failed good Samaritan moment

I had an interesting experience this evening. I have next to nothing to eat in my house at the moment that can be made quickly and easily. I didn't want to cook so I ran to Cub Foods instead to buy something easy to make. Just as I was getting into my car after buying my food I was approached by a man on a bike. He yelled, "Hey sir". I hadn't started my car yet so I just opened my door. He showed me his security guard uniform underneath his coat and said he was looking for some help for inside the store. He started telling me that he had just moved here from Indianapolis 3 weeks ago and was living with his family in a nearby motel. His wife was trying to find a job but was running into difficulty. His car had just been towed for a reason I cannot remember so he had to get around on the bike he was currently on. He even had supporting documentation, Indiana drivers license, a paper showing his car had been towed and ID for his security job. I told him that I'm sorry but I don't carry much if any cash in my wallet - a lie on my part which I immediately felt bad about. He responded with a sad look and said he wasn't looking for cash. He then rode away on his bike while I shut my door.

I drove home and began to think about the book I had just read about the working class and how hard it was to make ends meet. I was thinking about how well off I really am and how lucky I am to even consider just running to Cub to buy some random food when I decide I don't want to spend time cooking. I almost never give cash to people out of fear that I am feeding some habit. In this case though I couldn't help but think I should have actually done something. I had just finished this book which spoke about this guy's exact situation, low paying job, living in an expensive motel because of a lack of funds for an apartment, one member of the family without a job even though she had been searching. I couldn't help but think that I had read that book just at this point in time because I was going to meet this poor guy and maybe now I would actually have the insight to consider helping.

I actually got back into my car and drove back to the grocery store. Only five minutes passed from the time I left until the time I returned. I drove around the parking lot for a few minutes but couldn't find the guy. I eventually saw his bike, or what I think was his bike, tied to a sign. I went inside to see if I could find him. I wasn't sure if he found someone else to help or if he was going to spend the few dollars he might have had buying whatever he could possibly afford. I walked through the entire store and was unable to find the guy. I hope he found someone to help him. I feel terrible that I didn't help him when I could. It would have been so easy to say, "Let's go inside and get you a few things to take to your family". Instead I just drove away.

Hopefully next time I will be able to make a better decision.

Identity crisis

For the most part, I've enjoyed every rotation that I've done. I haven't been able to see myself doing every one for the rest of my life, but I enjoyed the time I spent learning that specialty. The one exception was psychiatry. I thought it was interesting at times, especially when an undiagnosed bipolar patient came to the office in a manic phase. The poor guy had just bought an $80,000 boat in addition to the $40,000 boat he already possessed. He had recently started a new business and was working like crazy. In our 1 hour intake session he spoke more words than I say in entire week. Anyway, my point is that I enjoy almost everything about medicine.

Next year I will begin a residency in internal medicine. It's a great general residency as it is a gateway to many of the sub-specialties. I had originally intended on family medicine. I grew up in a small town and wanted to be a family doc in small rural town. That changed during the second year of medical school when I loved the renal system and began thinking about nephrology. I later did a renal rotation and couldn't see myself in the field. I did however absolutely love my GI rotation. As a gastroenterologist I would have the perfect mix of procedures, hospital and clinic. I couldn't do something that was void of procedures. I do understand that colonoscopies are part of the GI schedule but it really isn't as bad as you would think.

Now I have done a rotation in anesthesia. I can't believe how much I enjoy it after only 5 days. I think back to my second year of medical school where I thought it would actually be cool to be an anesthesiologist and wonder why I let that thought lapse from my options. I could honestly see myself doing this for the rest of my life.

The fact that I am considering either of these specialties is serendipitous. I did GI because I thought that it might be good information to have for family medicine. I never thought I could possibly enjoy it enough to consider it as a specialty. I am doing an anesthesia rotation because a good friend of mine is applying for anesthesia residency and talks about how great it is all the time. It has been almost by chance that my future has been decided.

The good thing about internal medicine is that I could do either GI or anesthesia. Anesthesia requires one year of either internal medicine or general surgery, followed by 3 years of anesthesia residency. GI requires a full three year internal medicine residency followed by a 3 year GI fellowship. Either way, I will be well positioned for the future. Now all I have to do is decide which future.

This is a random post

One more week of anesthesia and then I’m off for Christmas. I will actually be sad to see this rotation end because I enjoy it immensely and am learning a great deal of information. Depending on what I am able to set up for January I may see if I can come back for another two weeks. I’ll have to see what happens this week in respect to potential endocrine and radiology rotations I have cooking for next year.

I had a great weekend. I went to visit my friends again. I sure hope they are not getting sick of me since I’ve been to their house all weekend, every weekend for the past 3 weeks. I had a craving for salad and breadsticks from Olive Garden, so we braved the parking lot on one of the freeways to venture to the restaurant. The food was pretty good, but I was a bit amazed at the bill. It is now next to impossible to get out of Olive Garden for less than $20 per person. I remember when I was younger and my entire family could eat at Red Lobster for less than $50. We talked about that a bit on the ride home. We all just feel fortunate that we can afford to do things like that and not worry about paying the bills at the end of the month.

Part of this is because of a book I just finished reading. It is called Nickel and Dimed by Barbara Ehrenreich. My pseudo-girlfriend had read it and mentioned how good it was. It is about a writer how works in three different cities in entry level jobs and tries to make ends meet. She writes how affordable housing is nearly impossible to find, how working two jobs is almost a requirement to get by. It has really been an interesting and eye opening look into the working class. I have never been one to think, “If they were only motivated to find a job”, but I still never realized how difficult it could possibly be even attempt to find a job if you don’t have a permanent address, no money for a deposit or the first month’s rent. It’s a vicious cycle. I still haven’t had time to process it all.

I’ve never felt bad about my situation growing up. I never had any reason to. I lived in a small town and we looked basically like any other family there. I was pretty sheltered. I was never really exposed to either end of the wealth spectrum. Everyone looked middle class whether they truly were or not. Then I went to undergrad and saw what true wealth was out there. I was appalled at how many people at a Christian university flaunted what they had. I guess I really shouldn’t have been that surprised as the vast majority came from what would be considered middle to upper middle class families. It just seems wrong when compared to the struggles that so many of the working class families must go through just to survive day to day.

I’m not totally innocent. My friends and I rip on Wal-Mart constantly. We even joke about going to pick up a few things right away in the morning, sans shower, in our pajama pants, sweatshirt and bed head. The joke is that it is okay to do that since we would fit in without any trouble. I know, it is insensitive and wrong. We also mock many, many other things as well. I just will fail to share them all.

Anyway, minimum survival wage for a family of 3 (parent and 2 kids) is apparently $14 an hour and most jobs pay $7-8. As you can see, it is nearly impossible with only one job in the working class. These people are really amazing in how hard they work to make ends meet.

I’m not certain I have really made a point. The book was interesting though, I would definitely recommend it.

I enjoy passing gas

I started a new rotation this week where I get to pass gas. Yep, I'm working in anesthesiology. It's pretty dang amazing. I was able to intubate 6 people on my first day. Right after we give them a couple drugs to induce anesthesia, they completely stop breathing. I had to make sure the mask was on correctly and then give breaths for them while we hyper-oxygenate them prior to intubation. I was so concerned with doing everything I needed to do that I hadn't really realized what I was doing. I was solely responsible for keeping the patient alive. Had I stopped squeezing the bag the patient would have died. It hit me later how amazing a responsibility that was. After a few breaths on 100% O2, we stopped and I was able to put a tube down my patient's trachea. It's basically the same way they show on TV. You put a laryngyscope down the tongue and lift up the epiglottis. You then watch the tube go through the vocal cords. It's a damn good feeling to see the tube in the right place and see the patient's chest rise when you start ventilation again.

Yesterday I was able to see a couple of CABGs. That stands for coronary artery bypass graft, what we affectionately call a "cabbage". It's amazing to see how they harvest veins and arteries so they can bypass bad vessels in the heart. It's even more amazing when the cut open the pericardium - the sac around the heart - and you see the beating heart for the first time. I was thinking, damn, here is the man with his chest wide open and his beating heart right in front of me. It doesn't get much better than that. It was also the first time I had seen a patient go on bypass. That was a bit freaky from my new perspective as his vitals - blood pressure, heart rate, respiratory rate and sats - were essentially zero for quite a while. He came off bypass without too much difficulty and we were able to defibrillate his heart to a normal rhythm. They actually have an electrode that puts the heart into ventricular fibrillation which just keeps the heart quivering. They closed his chest up with steel wire and he was as good as new.

I honestly never cease to be amazed at what we can do with medicine. I feel exceedingly lucky that I am able to be a part of this profession.

Brrr

It's negative 2 degrees right now with a windchill of negative 19. It's a good thing I only have to walk 2 blocks from the parking lot into the hospital. It would be a good day to call in sick and lay on the couch under a couple blankets. It's too bad I would never actually do it.

All is well

I had my residency interview at the University today. It went extremely well. It was a pretty comparable to my last interview day. I had one half hour interview with a facutly member and then a short 5-7 minute interview with the program director. More or less just a hey how's it going type of thing. There were 15 of us interviewing today and only an hour to get through us all. The longer interview went well. We talked about my application a bit, what aspect of medicine I was interested in, and then a few other random things. He thought that I was very easy to talk to, thought that I would feel comfortable in most any situation and thought I would fit in well with the culture of the program. The program director also thought that I would fit in very well. Before I left he said that he would really like to see me come to the program and hoped that I would seriously consider them. He said that if after going to all my other interviews I decided I wanted to be at the U, I should let them know. Finally he said that he hoped he would be able to call me on March 15 and congratulate me on matching to their program.

Who knows, maybe he said this to all 15 of us. I would like to think that he didn't. This is considered a very good program and always ranks near the top in the nation, so it's not like they have to beg people to come. Maybe the number of applicants is down this year. Either way, it's nice to know that you are wanted. It's hard for me to decide which of the two programs I've been at so far is the better. I would have to say that I am leaning toward the U program right now. I'm going to have to consider it carefully and I am fairly confident that whichever I rank as my number 1 will be the one that I match to.

It's been a good week. I'm just excited that I will be able to stick around. Have I mentioned lately that I love this place?

New week

I had a great weekend. I spent the entire weekend away with friends, I mostly ended up being a bum. It's now Sunday night and time for bed. I'm too tired and am probably going to bed early. I had a great conversation with the girl today. I can't believe how much I like and respect this girl. I really wish something could come of it. We didn't have the conversation I thought I might start, but sometime soon. I like this girl too much to drag it on and risk that we can't remain friends in the future. Who knows, it may have gone too far already. I have another interview on Tuesday at the University. More ID tomorrow. There is the potential for interesting drama in my life on the home front. I'm not sure exactly how that will pan out. I'll have to post more about that in the future. I don't have the time or the energy at the moment, I'm too drained. I'll leave it at I had discovered that someone close to me had been posting nasty, hurtful things about me on a blog. I thought this was done with, but discovered that another had been posted yesterday. Just one more thing to let slide off my shoulders.

Beauty

I just finished watching Gray's anatomy. Yes, a guilty pleasure. Damn, Sara Ramirez is hot. If I were to ever fall for a women she would definitely be the one. She looks ever better in surgical scrubs.

First one down

I had my interview today. It went very well. We spent the morning getting an overview of the program, touring the hospital, going to working and attending rounds, attending morning report and the noon conference. The afternoon consisted of 2 half hour interviews. Both went well. The first was more or less to get a feel for what I was looking for in a program and how I would fit into the culture of the hospital. The second was more focused on my application, but we ended up talking about random things like running and boating. I loved the program and I'm pretty sure that they liked me. I still can't say exactly where I will rank them since I haven't gone anywhere else yet, but I'm fairly certain that they will rank me high enough so that if I rank them #1 or #2 I should get in there.

I was originally concerned about the fact that this is a community hospital rather than a university based hospital. I am planning on doing a fellowship in gastroenterology after residency. This is increasingly becoming a very competitive fellowship. From what I've heard, if you want a competitive fellowship like GI or cards, you need to attend a university based program. This program has actually placed their residents very well into both GI and cards and are great about allowing their interns to start research which is almost unheard of at community hospitals. I really can't rule out this program at all, and after learning about the program and talking to the residents, it may actually be the program to beat.

Tangentially, I left for my interview this morning at 6:55. I never know about traffic in this city, it can be great one day and then horrible the next. I was expecting a 45 minute drive and ended up with a 25 minute drive. Anyway, as I was leaving the apartment, I saw a guy out running in the cold. Usually not something I would notice, except that it was only 6 degrees and the wind was bitter. Windchill was -11. Despite that I actually love living here. Without the wind it is actually very refreshing to step outside into the cold. It could be 0 degrees and still be very nice as long as there is no wind. When it comes down to it, I really love living here.

The big day approaches

Tomorrow is my first residency interview. It is at a hospital here in town, one of the three possible programs. It's surprising, but I'm not nervous at all right now. I'm sure something will kick in about 6:30 tomorrow morning as I am contemplating leaving. I haven't really prepared at all, I'm not sure there is anything to prepare for. I start at 8:00 and the interview runs until about 3:00 or so. I'm not sure exactly what to expect, but lots of tours and presentations I would guess. They want to try and convince us to come to their program.

I was able to get my mind off of everything for awhile tonight which was great. A couple friends were coming to my end of town for a show and wanted to go out for supper beforehand. We went to a restaurant called Cosetta's. I'm not sure if it is a chain or just a local place. If it is local, the rest of the world is missing out. This place has amazing pizza and pasta, I can't think of a time I've had better. Parking was a disaster though, I got off the freeway only to find that the street was parking lot. 10 minutes later after going about 1/2 mile I realized that there was a hockey game downtown tonight. I ended up parking 6 blocks away and walking in the 17 degree weather (2 with the windchill). There was no way I was going to pay $20 to park for a $10 meal. My ears and cheeks were nice and red when I finally made it into the restaurant.

The whole thing was worth it though. 2 of my friends went to their show and I hung out and talked with the other for a good 2 hours or so. Nothing better to forget about the fact that you have an important interview coming up the next day. I think tomorrow will go well. I'll get to see if the nazi diet/exercise plan I went on will allow me to wear my suit pants for 8 hours. It should be a good day.

I hate wearing pants

So my first residency interview is on Thursday. I decided to bust out my suit this evening, something I should have done quite a bit earlier. I bought this suit for a college prom type of thing when I was a freshman back in the day. I'm talking about 7 years here. I tried it on tonight and the results are not good. The pants fit but are too tight. I'm going to have permanent lines around my waist after wearing that damn thing for 8 hours. Apparently I should have tried it on about 4 weeks ago when I could have had a fighting chance at losing a little weight. I went back on my health kick yesterday, I have been rather lax over the past 2 months or so. I'm sure that was a large part of the problem. I have a new goal, my pants will fit better by my second interview one week from tomorrow.

It's supposed to snow this week. Thank God for treadmills.

Thinking

I hung out with a few friends last evening decorating for Christmas. Well, I basically just sat around and talked with 2 others and the 3 of us watched the 4th decorate for Christmas, but close enough. One of my good friends from high school apparently is really into the Christmas spirit. His wife basically tolerates it and stays out of the way while everything is going up. I did help with the tree a bit, but that was only to help straighten the dang thing out. It was leaning about 30 degrees to one side making it look quite sad.

This is the same group that I have spent a fair amount of time with in the past few months, so my sort of pseudo girl friend was there as well. She and I went out for Chinese while the other two went out with the family for a birthday. Then we all reconvened at the house to finish putting up the tree. I am conflicted at the moment about what I should do. I love doing things like this with this group of friends but I feel like I'm lying to them every time we get together. Part of me does not want to tell this girl what is going on because I am worried that I am going to lose this. A much larger part of me realizes that this is incredibly selfish and is a totally inappropriate way to think. Sure, they all might be hurt when they find out, this girl especially, but I don't think that they will cut me out of their lives completely. I might have to endure spending quite a bit less time with them for awhile, but that is the price I have to pay for doing what I've done.

Am I overreacting? Are people really going to freak out and be pissed at me as much as I am expecting? I almost feel as though my fears are irrational, yet I can't seem to get rid of them.

I am contemplating telling her this weekend. Just writing that has almost doubled my heart rate. I'm not sure I am actually ready yet, but if I think too much about it I doubt I will every feel truly ready. I've been thinking some about the timing. A couple weeks ago it was her birthday, this past week was thanksgiving. We now have 4 weeks until Christmas. I feel as though I need to do this before Christmas and I really can't wait too much longer otherwise I'll have to worry about another holiday. I'm not sure exactly what to do. Anyone?

Man, the things I get myself into.

Frozen!

I woke up this morning and the lake we live on is completely frozen over! It's weird to look out the window and not see waves. I was just admiring the water yesterday. It was perfectly calm so you could see an amazing reflection of the clouds and trees. It was even more beautiful with the orange and red sunset reflecting off the water later in the day.


I love the water. In the past couple years I have realized how lucky and spoiled I was growing up. We've lived on a lake for almost as long as I can remember. I love sitting in my favorite chair in the sun room, just staring out the window at the lake. The waves are mesmerizing. It's also spectacular on calm days to see the reflections and then watch how they are disrupted when a duck swims by and creates a small wake behind it.

We also had a cabin about half an hour away where we would go to actually play on the water. That was a bigger lake and once in awhile we would actually see white caps. My family has a lot of great memories at the cabin. It's where we went to unwind and spend time together as a family. We never brought a TV out there so it was either be in or on the water or play games together. We could spend hours swimming, tubing, water skiing and jet skiing.

Living in the city, in an apartment, the water is what I miss most. It's always a treat for me to come home and enjoy the lake again. I'm certain that no matter where I end up it will have to be within view of water of some sort. Whether it will be river, lake or ocean I'm not certain - though probably not ocean since I'm quite attached to this state and we are about as far away from ocean as is possible in this country. I just love the water too much to not have it nearby.

Relaxing and productive

It's been a pretty good day after Thanksgiving.

I've managed to catch up on some sleep, relax and actually get a fair amount accomplished. I woke up this morning at 8:15, which is sleeping in for me. I turned on the tv to start a day of football. Yes it was the high school prep bowl (state championship), which means something like 14 hours of football. I had it on in the background the entire day and saw a fair number of pretty amazing plays, including one of my cousins who returned an interception 55 yards for a touchdown.

I reformatted my old computer so I can give it to my pastor's family. It will be nice to get the beast out of the house, at least for my mom's sake. I stuffed a bunch of envelopes for my mom. She helps with a group for her church that sends out a mailing every once in awhile. I washed a few loads of laundry, cleaned up my old room a bit and managed to read a few pages in a book I'm slowly getting through.

It's nice to be a bum once in awhile.

Tomorrow I will head back toward home. I'm stopping off at a friends house for the afternoon/evening but then back to the apartment. I really do enjoy being at home, but I can only hang around without going crazy for so long. The next time I come home it will be for an entire week at Christmas. Both of my sisters will be home at the same time though, which will make the entire week fantastic. The have both moved recently to another state, luckily the same one, so we don't spend as much time together anymore as we would like. That makes the little time we do get that much better.

I feel like I should be heading back to the hospital tomorrow, but the weekend is just beginning. It doesn't get much better!

Happy Thanksgiving

I'm heading home for Thanksgiving. The traffic has officially cleared from the road so the trip shouldn't be too bad (1.5 hours). We are having company tomorrow so I figure I should head home tonight and help my mom clean up and get things ready.

I hope that everyone has a wonderful holiday.