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.