Cleveland Clinic X 1 day

I arrived in Cleveland today without a hitch around 3pm via airplane. After getting my luggage I grabbed a taxi and started to head to my new home for the next 2 months. As I looked through the taxi window, I saw lots of industrial looking smoke stacks. It was not the most scenic but the taxi driver got me to my destination pretty quickly so I was grateful for that. After I got here, I picked up my key to my room and as I dug through other peoples envelopes in search for my name, I saw one of our classmates that will be here for 1month.

I got to my room and found this:


I unpacked the little that I packed and gave the classmate a call. I was lucky to learn I had no roomate to share my room with. Hurray!!! We later met up to go grocery shopping and I took a tour of the hospital.
and saw this in the lobby:


Its a sculpture made out of steel letters of a person sitting. On the wall there was a wall of letters like a waterfall....
Next on my to do list:

1. Where to do laundry
2. Find the gym
3. Find food.
3.

GI Rounds

Austin: Outside the hospital from 9th floor




Sorry loyal readers, I have sorely neglected this blog. However this entry should make up for the all the ones I have missed.

Its the last week of my Sub-I and it was throughly fun. I had an awesome team that was serious for about 2% of the time. The rest of the time was spent talking about my favorite subject "FOOD". Topics like where to find the best cupcakes in Austin, where the best restaurants are, what are the best food stalls you have been to, the best hole-in the walls dominated our talks over HTN, and DM and infections. Not to mention we talked about cooking too. Well you may say, hey this sounds like an all girl team. It wasn't we had 2 guys who frequently chimed in on they're fav eats.

After work I usually spend my time exploring Austin's eats. I've included some pictures




The first 2 pics are from Whole foods, yummy desserts. The second picture is candy shaped like fruit. Its a bit blurry but in person the candy is goregous.





Flip happy crepes as you see is a trailer that makes Crepes- out on Town Lake. It's really popular here and was featured on Food Network's best Eats. It such a popular place that the wait was 1hr :(. I didn't have the patience to wait and try them. My intern told me that Paris Crepes are better.

So my rotation ends on Friday right on the new Team's call day, but since I have to turn in my pager and ID by 4PM looks like I can't partake on Call on Friday...Hooray!

IM Sub x1.5weeks

IM med sub I this last week has been albeit a mixed bag. Let me list out the pros and cons that I have encountered.

Pros
-Clean, nice appearing facilites
-Efficient ancillary staff-social work & nurses
-Good resident who teaches
-alot of autonomy to make an A/P
-Free access to Dr.'s lounge for food
-Austin-lots of good eats

Cons
-Not enough volume of pts
-250 beds
-FMG residents
-IM resident who told me off b/c I made too much noise in the ER by printing a 100pg Uptodate Article on my pt.
-must wear dress clothes even though its a county hospital.

Goodbye Dallas Hello Austin!

I left Dallas early this AM at 6:45 and said goodbye to my Kenyan family. I will surely miss them they were such a lovely family. One thing I sure won't miss is sleeping in the heat. I don't what's with the people I and Melodie have been living with this last month. They sleep in 80deg and 82 deg set thermostats. I am roasting on my bed at night. Its just completely uncomfortable. Truly nothing is better than your own house. So as I drive down 35-S on my merry way to Austin, I pick up a hitch hiker aka Dina. She wanted to hitch a ride to Austin to check out craigslist cribs when she stays for her rotation next week. So Melodie became our chauffeur and drove us to around in the ghetto. At the first stop the owners left the light on in the house and we peered through the windows like thieves and took a look a Dina's housing option. It was a small house with 2 front doors. After that I stepped what felt like a ice cream cone but actually it was a dead bird..Ewww I was grossed out for the next 30 mins. It feeling was like a smush and crunch and then I saw some round thing protrude out.

Dina's next option was a 50's style house with a 50lb dog, Lola waiting to greet us. One thing I am freaked out about are big dogs and stepping on dead animals. (As a kid I accidentally stepped on lizards and frogs in the dark and I was bitten by my neighbor's dog when I was playing in their yard.)

So a popular thing people down in Austin do for recreation is Tube. Tubing is basically sitting in a rubber tire tube and floating down a river drinking beer along the entire 3mile river. It was overcast and drizzling, but we forged ahead and got there rented our tubes. First thing we were wondered how do you even get into the tube? After making a dive into the tube we drifted along a snails pace into river all separated. Then it started to pour and thunder and Dina and Melodie brought their phones and cameras. So we hurriedly left the water with a lot of effort and put up the cameras. It got a lot more interesting and fun starting here. So after starting out pretty well we were able to keep together for a long while before we hit a shoot which is a rapid rush of the springwater through a narrow tunnel. Basically you need the currents to carry you away further down the river. Howevere we were caught in eddie currents and would cycle around the stagnant water for several times until a nice 12 year old boy pulled me and Dina back into the center and away from the eddies.

So after some more tumbling and flipping over we ended our trip with some funny stories and I settled in the rest of my night in Austin.

the final stretch

I have 8 days left of my rotation non including weekends. Seeing that there is not much time left, I did my one night of call Ob Anesthesia with one attending I had spent the most time here. Ob-Anesthesia call is 24 hrs. I worked from 630 to 3pm in gen surgery ORs and at 3pm I started OB call. Call basically consists of 1 faculty 2 residents usually CA-1 (PGY-2 but 1st year in Anesthesia, b/c intern year is spent rotating through various specialities) and several CRNAs. I basically spent the night being the residents personal servant. I helped prepped pts in the OR for anesthesia, I did some more spinal blocks, and made sure the attending saw that I was working. The attending told me I didn't have to present for every case so at 12 pm I took a break until 445am. I saw a twin-Csection, a placenta previa, and suspected chorioamniotitis.

By the end of the of call, I asked my attending for a rec letter and got a yes. So after 2 weeks I am finally getting the hang of this place. I know it takes exactly 20 minutes leave home to make it exactly on time to Parkland, that it takes me 12 minutes to walk from the parking lot to the hospital, and how to find an OR to sit in on.

I learned that no matter what I do, some attending will still treat me as invisible, and that's okay, b/c the best thing to do is move on and find a better one. Some residents will still ignore me b/c but that's okay too, and I just hop into another OR. I really don't understand how I can be in the room and be helpful but the resident will not tell me what's going on or why such actions are taken for the anesthesia plan. I just hate the feeling that you are not part of the team and just excluded from what's going on. As I look back I think my time at JPS was really medical student friendly place. I always felt that I was part of the team no matter which service I was on.

Echoes from a Far

Despite my grr-hate last entry on Monday, I really really like Anesthesia. Its so much fun for me everyday minus the drama. This week I am in Parkland OB-Anesthesia and I find the residents and attendings in the Ob-Anesthesia dept are really enjoyable people to work with. But you may ask how so? Didn't you spend an entire blog entry griping? Well in contrary to its own location and entitiy, most of UTSW Anesthesia is made of up of of residents from other Tx med schools and out of state schools, very few actual UTSW grads are actually in the UTSW residency program. They are actually really personable. They work really hard but spend alot of time but our down time is really getting to know each other ie Residents with attendings and residents with med students, attendings with medstudents.

Today I got to do 2 successful spinal anesthesia blocks in women who were getting Bi-Tubal ligations. It was quite satisfying to do something successfully. What is a spinal anesthesia how is different from an epidural? Well spinal block is done at the L3-L4, level. Using iliac crests with landmarks find the space between spinous processes to mark and insert your needle. Once you find ur location, you numb the area with Lidocaine, insert a guide needle into the spinous process space ( ie gap), and then puncture the dura, thread a very fine wire into the dural space and watch the CSF flow out of the needle and then inject in your fentanyl and buvicane into the space. An epidural consists of the same general process of a spinal block except you have a continuous thin tube hanging out of your back and available to the Anesthesioloists when they need to inject more Fentanyl.

So after lectures, all the visiting med students go and eat lunch together down in the cafeteria. So as we were walking down a student from Tech mentioned how he was getting brushed off and can't really find residents or an attending to tag along with since all the UTSW kids get to all the attendings and best residents early. He was like man, UTSW kids know where the attendings are at all times. You may ask why do u need to stick to an attending? Well anes is a really procedure and hands on oriented type of work. If you are NOT able to find a patient, teaching oriented attending : A) you may never get to do any type of procedures ie Intubation and lines ect B) you will not learn good technique and form and C) lastly build a relationship with an attedning to obtain rec letters from. So as this Tx Tech student (guy) was telling me his brush off stories, it was basically the same experience I and another visiting med student had our first week. Might I say I heard my own echo?

So this place as far as the Med school goes is really not a lets be nice and help each other out type of environment (I have to point out the residents are the opposite of the students). Take for the example that some of the UTSW kids have already over 15 intubations and a multitude of procedures under their belt but US visiting students ( and more and more visiting students are realizing the discrepency in treatment between Us and UTSW kids) have barely gotten in 2 (me) They do not share nor do they offer help. They are neither nice nor or they outrightly mean. Its a medium of unspoken "your on my territory. "

However at least I have another UNT person with me, we do at least point out to eachother the nice attendings and take turns doing procedures since we are on the same OB-anesthesia schedule. What's the point of this craziness- in hogging every thing? My philosophy: I know i'm going to learn all the "stuff" ie intubation and crap during intern year why not just have a good time, joke, and find an attending to notice me and get a letter and finally say "Peace out, I outta here".

New Places New Faces

It has been 1.5 weeks since I started my Anesthesiology rotation at UTSW. I was very stressed out and wallowed in self doubt my first week here. Its not that I don't like Anesthesia. I have come to love and know without a doubt this is what I would like to do. However the environment here is ultracompetitive. The UTSW kids bring their A game every day. They to me from the view of an outsider exude intelligence, confidence, and a nature of competitiveness. What do I mean by their gunner-esque qualities. Well for one thing they "shot gun" attendings, like people call shot gun for the front seat of a car.. ie tell the other students that this is their attending for the day as to claim one attending to themselves and to have the other students back off. I find this a little to the extreme.

Mind you these are very successful students and they most likely can get into any residency program anywhere. They are the "package" ie...research since first year of medical school, extracurricular activities packed0 resume, and each have some interesting background whether they have either another degree ie masters, or have some former career. I would say a large percentage of them have been to prestigious colleges outside of Texas. Don't get me wrong not everyone is like this but the few that I have encountered in my rotation are crazy gunners.

My second issue after my inferiority complex is about illusions. Illusions of what might you say? Answer: People. The program coordinator here plays himself to be a people oriented, med student loving, teaching type of person. As I came to work this person this far from true. What I found is that this administrator plays favorites with UTSW kids and brushes other med students off, myself and and another visiting medical student can vouch for this. I spent the first week feeling like an unwelcomed guest very unsure myself. Being here has made me wonder what have I done the last 4 years?

The second illusion. People quickly lose their defenses after a few days. Another visiting medical student from Virginia Osteo school very amicable but soon learn this person is very much a kiss ass. He spends significant amount of time asking some questions that can be found in a textbook and attempts to talk to attendings about their interests ie boating, investments ect. These conversations are for the most part seem forced onto the attending. Most of the time it seems alot of questions are just ways to get attention. My question is do attendings see thorough this attempt of kissing-ass?

My first and last trauma at JPS

Throughout third year of med school, I have had a couple of memorable moments that I probably will remember the rest of my life, such as my first delivery of a baby, the bizarre delusions and hallucinations of some psychiatry patients that I interviewed, but nothing stands close to your first patient death. Last night was a rainy Tuesday night at JPS, relatively slow trauma night, until about 1:00 am my intern wakes me up for a level 1 trauma (the most serious trauma you can get at JPS) a 41 yo AAM with gunshot wound to the chest and was also involved in a MVC (motor vehicle accident). How do you top that..it was a 2 for 1.

Here was the story: Police found the man on the ground at scene of the accident with patient semiconscious laying face down near his car. Witnesses heard 10 gun shots and saw the man crash his car into a tree.

He arrives at about 1:10am Wed in JPS, he has a gun shot to his left lateral chest with no exit wounds. He also has a open abrasion ,you can see his patella (bone) on his right knee. BP is 130/80 pulse is 130. He gets intubated, a chest tube bilaterally-bloody effusions drain into the chest tube, a femoral line, and a foley that is empty, even after 4L of Lactate ringer's solution. All this time he also gets 2 chest x-rays and he is sent to the OR immediately.

In the OR, it was the biggest team I have worked with there was 1 anesthesiologist, and 4 CRNAs 3 scrub techs and 3 RNS running around gathering supplies and prepping. So my 2 residents begin cutting. This patient's body habitus quite big I would say 280lbs with a large belly and maybe 6'2. The attending rushes in and takes over the entire surgery, we open his entire belly, the attending takes over, and takes out bowel and cradles it in his gown and the table while the residents are frantically searching for a bleeding source. Meanwhile I was standing near the surgical tech getting instruments ready. I was then told to squeeze next to the head of the bed and retract with all my life this man's chest cavity while they continue to dig into the chest wall. Blood is filling his entire chest cavity, and neither my attending nor the residents can find the bleeding source. Six units of blood was tranfused and more LR was given. Suddenly the part of the electricity in the OR began to short fuse. My resident's head lamp went off, the Bone saw wasn't working because of an electrical fuse. More blood is spilling. More blood is ordered from the blood bank, but there isn't any more blood of this man's blood type, they ran out. So my attending yells and tells the anesthesiologist to get any F-ing blood you can. He also F-ing requests a special type of Epi-injection- cardiac epi. He injects it directly into the patients heart. This entire time I am retracting this guy with all my body weight leaned away. My attending now is manually squeezing the man's heart.

They finally see the source it was the aorta, vena cavae, and liver that was bleeding. This also find a approximately 5 mm bullet still intact in his liver. Everything became grim. There was no point of return, when my attending noticed the blood was getting thinner and thinner in consistency. He say's okay we're going to "call it". It was the end of the trauma at 3:42am. The bullet travelled from his left chest wall through his aorta into his vena cava and lodged into his liver, where it was very difficult to see and contain the bleeding. After my residents sewed up the belly, I stayed behind to help the scrub tech clean the body. Here is the story in FW Star Telegram:
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Man dies after being shot, crashing car in Arlington

ARLINGTON -- Arlington police are investigating the death of a man who crashed his car into a tree after being shot.

Police dispatchers said they received calls of shots being fired about 12:30 a.m. in the 1000 block of East Arkansas Lane.

About five minutes later they received a call that a car had crashed into a tree on eastbound East Arkansas Lane near Collins Street.

When police arrived they found the driver had been shot.

He was transported to John Peter Smith Hospital where he died about two hours later.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

That was the fastest 2 hours that passed by in my life. It all felt like it was 30mins. Who knew so much could happen in 2hrs. Here is what I found out later that morning. The man was a drug dealer. He was shot and was trying to get away by driving, he lost consciousness and crashed his car into a tree where police and paramedics found him.

This was my last call night at JPS for general and trauma surgery . It was memorable closing and reminder of how fragile life can be.

Methodist is Awesome

I'm at the end of my 1st week at Methodist and I love it. I owe my good time to my all male residents & attending. Male teams are so much more laid back. They joke all the time and just procrastinate and don't have a fit if something doesn't get done. Everything can always be done tomorrow. So my attending recently finished residency and is really young. He reminds me of a Erwin, and my upper level resident remind me of Ben. My attending is really cool, non intimidating and very willing to teach. Upper level resident, just like Ben, so nice I mean he words everything in the nicest way so that it doesn't feel like he is ever telling you do do something only that he is suggesting that you do something. I have learned more in 1 week that I would say me entire month at JPS. Seriously how did I get so lucky? Too bad my team changes this Sunday after call I'm going to miss all of them. Best part of Methodist are free lunches, snacks in the library, and good looking residents. :)

Medicine at JPS is stressful

After my intern talked with my attending, I am now less of a scut monkey and get actual real pts to follow. I got to do admission H&P's and write orders and follow through until discharge. However all of this does not come without a lot of stress. My extra duties came about after the intern pulled my attending aside at a pharm dinner and told him I wanted to do IM and I wanted more hands on experience without me knowing. The second day to my shock I was called out by my attending in front of the entire team telling them I wanted to do more. I knew these people less than a week and alot was already happening.
Over time my attending became less scary and I realized he just is really likes discipline among his residents and students. He wants them efficient, persistent, and just to follow through on all studies on each patient. Yes all attending are asking for the above qualities, its just that he asks that of each resident to the 10th degree. With two weeks into medicine, its definitely my most stressful and hardest rotation so far. I felt like I have never been so aggressive and anal than this medicine rotation. I have never been grilled so hard and questions are just way beyond what I can answer. JPS on top of it is just frustrating because orders are partially carried out or extremely slow. On top of that, my intern and I were bearing the grunt of things my upper level failed to do or orders he changed. I wanted to say so badly "looks your senior resident changed your orders" to my attending but, that would have just caused more trouble for me so I suck it up and say yes, I am sorry that order was not accomplished. Other than that medicine at JPS is quite cool, you see real pathology. I now realize what other med students are saying about my attending, he actually isn't bad, I just dont understand the bad rep. Nurses told me that she has witnessed him yelling at residents at one point. I think you have it made if you just go to his pharm rep dinners. Tell me what you think?

The Biggest Scut Monkey Roaming JPS

Last night was my first Medicine call night. Before I delve into how call night played out, I'm going to fill you in on the dynamics of my team. I am on team Medicine team C. I am paired with a notorious attending who is is from Eastern Europe and thinks women's place in society is barefoot and pregnant wearing an apron much less a doctor. So it doesn't sound like a good start. Well first of all I have a ob-gyn intern and psych intern and senior family resident on my team. Its quite a bunch. On the first day I was told to stay away and do not listen to the ob-gyn intern b/c he is known to be a slacker. The other two residents are nice and helpful. On my first day of rounds still in my nice business clothes, I listen to glimpses of my attending's bedside manner. This a conversation to a patient: " You have a arteriovenous malformation" you will need to see neurosurgery. The patients eyes just ballooned three times bigger and my attending walked out the door. So as you can see he doesn't have the best bedside manner.

Lets move on to call night. Ok call starts at 3:00pm at JPS and patients trickle in for admission. While all the other med students I talked to on Medicine already have their own patient load to follow, I have ZERO. I hoped and hoped that I would get a patient on call night so that I can follow, but my senior resident insisted that he and the other residents do everything themselves. So no patients for me, and I spent the rest of the night shadowing interns. This was such a bummer especially since I was so excited about doing medicine and hoping to really force me to think of good A/P. I am like excesses baggage that constantly runs around JPS hunting down VS, xrays, doppler, and echo reports. I'm on call again Sunday with new resident's on my team I hope they will let me have a patient.

Its also really disappointing to see how jaded JPS residents act. They are really pessimistic labeling all pts some name or another "drug seeking", "hispanic panic"-[chest pain in a hispanic woman who is not having an MI], and others. Another problem around JPS is getting help around here. Can you believe JPS does not weight pts as part of their intake vitals, it has to be specially ordered. On the bright side, my senior resident says my attending likes me so I should not have a problem on this rotation. Haha the irony , how could someone like me I haven't done a single thing that is worth evaluating.

About time for a New Entry!

Well I took a long blogging vacation. I think I should get back to this thing. Like any first day. It starts out with orientation:all the necessary information, phone numbers, books, preceptors. I like my assignment. Preceptors are laid back, teach alot, and I get a lot of time off---> what more can I ask for? I saw lot of colds, and good variety of stuff I have never seen before.

time to sleep: I 'll write a better entry next time.