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?