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Showing posts with label The Unnamed Institution. Show all posts
Showing posts with label The Unnamed Institution. Show all posts

Friday, September 12, 2008

It's so much better down here....

As luck would have it, my fiancee matched at Wake Forest for her residency. And I mean, pure luck as in someone suggested it to her and she thought, sure, why not? And boom! It ended up being her favorite place. And apparently they liked her, too. So naturally, it's imperative that I also match at Wake, as the nearest program is an hour away in Charlotte or an hour away in Durham. Crap. Commuting from Burlington every day = no. So as medical students are wont to do, I decided to do a clerkship at my desired residency, so to get my foot in the door and make with the face-time. You know, a sort of audition-before-the-audition. Like spring camps. I'm walking-on and hoping for a scholarship.

To be perfectly honest, I didn't know much about the pediatrics department before I got here. I knew, sure, it's a great hospital, and hey, they sure treat my girl well. And being that it's Wake Forest, I felt pretty certain that my level of pediatric training would be stellar. But I didn't really know what to expect upon arriving. But imagine my happiness - and this should come as no surprise to many of you - to find out that the South is, quite simply, better than the northern locales I've haunted the last few years.

When I was about shoulder-high, we lived in a small rural community outside Atlanta. Those three years were the golden years of my childhood. My neighbor's lawn was a gridiron every fall day, football in the biting-tackle five-mississippi rush two-completions-a-first and one-blitz-or-sneak-every-four style, watch for fire ants and don't land in Josh's Mom's azaleas. Every self-respecting male would line up for a long afternoon of man coverage and touchdowns in the driveway. We knew each other's college teams and no one gave a crap about the falcons and it was glorious. What I wouldn't give to be eight years old again, sweating stripes in my tee shirt and dragging two unlucky kids down to the concrete for seven.

But halfway through fifth grade, we moved to Richmond, where I would spend most of my childhood. Everything was different. Most poignantly, the other neighborhood whelps had little-to-no interest in the glory of a day ended in a cloud of dust. When we did play, it was three of us playing touch ball in the street and one guy QB'ing both ways. It ended up being a matter of attitude... a sort of Northern attitude.

See, Richmond's got Southern credentials. How can it not? It was the capital of the Confederacy. We've even got a statue of ol' Jefferson Davis on our Monument Avenue.* But the shadow of Maryland is cast long, like a deep blue cloak over the heart of Virginia. And like the Northerners I've come to know - and even enjoy - Richmonders are a closed lot. It takes 365 days of constant residence in Richmond to be accepted into society to the point that you are safe to address cautiously in public. This is no exaggeration or hyperbolic detail - my mother endured a full year to the day of grocery-store isolation before the Richmond switch was flipped and someone said hi to her. Heaven forbid you speak to a stranger in the elevator, and if you must enunciate the number of your floor, be courteous but curt. The Northerners just aren't friendly like the Southerners are.

Contrast this to the South where (God bless it) you go down to the Piggly-Wiggly and leave with three new best friends. My fiancee was not prepared for such openness and it honestly freaked her out. She and her mother left the Harris Teeter frankly astonished at a women who divulged her entire life story and the history of her progeny right there in the aisles. Here in - dare I say it - the pleasanter part of America, this is common practice.

Honestly I don't blame Richmond. Being that the confederates located their capital practically on Lincoln's beard, they were and remain the front line of a war that smolders on in the culture. Fairfax - spittin' distance from Maryland - long ago succumbed to the ravages of creeping Northernism and are flat-out Yankee in speech and decorum. Richmond, really, isn't too far down the road (commutable by morning train, believe it or not.) It's sad but only expectable that Richmond would become the Southern capital whose mannerisms divest her citizens of their twangs and drawls until they sound... shudder... like Marylanders.**

But North Carolina is safe, protected by Tennessee to the west and the broad band of unpopulated Piedmont north of Lake Gaston that my mother terms "the South Hill dead zone." Seventy miles of deeply forested and seldom-exited highway buffer the inevitable bleed-through of Yankee blueblood from Carolina's rolling hills. And it is just so much better down here.

Why? Lots of reasons. Part the first:


no one takes my cup

Life as a medical student is frequently boring. There are long periods on rounds in which an attending is fitfully adjusting some line, or pimping another student, or explaining something which you've already looked up, or just sitting around on the phone or writing orders or - you get the picture. But professionalism dictates that we refrain from doodling, whistling, or otherwise occupying ourselves - we are a team, and we are working together. Two things will help you out of this predicament. The first is, crackers. I've developed a sophisticated palate that delights in the subtle flavor and textural detail of saltines and graham crackers, inevitably free and mercifully crunchy. But what's even better is the cup of ice. Ever ready to quench your thirst or occupy your mind with crisp ice, it is your silent and faithful companion. And as my friends know, I'm usually thirsty. Every unit has an ice machine and an unquenchable stack of styrofoam cups. So I always have my cup of ice.

But you can't just take it anywhere - it would be rude to sip and sup while you're, say, listening to your patient's breath sounds. That just isn't done. So, the cup must be relinquished to enter the room. And that's when the nurses strike. Now, I try to do my part. The cup is clearly labeled with my name in attractive and legible print. But for some reason unknown to me, the northern unit nurses don't abide a cup bein' left about, whether some medical student's got his name written right there on it or not. The moment your cup is unattended, it's free game and that means it grows legs. Right into the trash.

Here in the hospitable South, no one takes my cup. I have left a cup for hours all on its lonesome, and returned to see it happily awaiting fresh ice and refreshment to the brim.


biscuits

Just as the nurses are swift and silent in their banishment of empty cups, the cafeterias in the North are insidious in their erosion of the highest ideals of breakfast cuisine. For a while, I didn't even realize what was amiss, though I always sensed that something was dreadfully, horribly wrong. And then it dawned on me: I say to you there are no biscuits.

Southerners, I know you, you're laughing. No biscuits, you fool? you may be thinking. Did you look oh I don't know in the cafeteria? It didn't register with me, either. Sure, I don't choose biscuits every single time I eat before 11:00. I'm not above the occasional croissant. I'll eat butter just on my grits. But for pity's sake, biscuits at least have to be an option. For three years, I bought my breakfast, blithely accepting the croissant, the English muffin, the bagel every day with no thought to what had been eradicated from my morning as I knew it.

I don't ask for much. I just want a servicable biscuit with my breakfast. It don't gotta be Bojangles, but we all know what a biscuit is; well, all we sensible folks. Don't even get me started on the pale-brown lumps of hardtack that the Yankees expect me to glom down slathered in salt-salt-and-burnt-bits gravy of identical, pasty complexion. It had been so long without edible biscuits that I was pleasantly surprised to find them at the caf here at Wake Forest. And damn, that's a good biscuit. Got that buttery, crispy lid that leaves a dust of salt onto your fingertips, and a soft flaky interior that puffs a little steam as you bite down. And it does that biscuit thing... I can't explain how a biscuit can be delectably moist and tender, and yet cleave to the top of your mouth like peanut butter. But you know what I mean. Them's a real biscuit, and what pleasure after so long. I was only able to contain myself because my fiancee and I ate Bojangles at the Charlotte airport on the most recent trip up to Pittsburgh - I had at least tasted a biscuit within the last week.

Now imagine my satisfaction upon realizing that these same biscuits are served every day with fried chicken. I'll be! It's good to be home, folks. Home where they make 'em some biscuits.


Also, grits - funny story in and of itself to be blogged out later. I'm looking at you, Dad.


* I don't know if you follow Richmond news. Ok, actually, I know that you don't. Monument Avenue is named for the monuments to Southern generals placed along its oak-lined streets at major intersections. There was a big stink in the mid 1990's when the city decided to add to the pantheon for the first time in 67 years and who do you think they chose? Humanitarian, athlete, and Richmonder: Arthur Ashe. Regardless of the arguments pro and con (both of which had their merits) for a black 20th century tennis player chillin' with J.E.B. and Stonewall, the statue's placement ended hilariously: Who's got the books now, children? MWAHAHAHA!

** Depressingly true. If I had a nickel for every time I've been told I have no Southern accent... well, I'd be ashamed to tell you how rich I'd be. And I won't reveal here how shamefully I embarassed myself in front of my father one awful fall day. T'weren't pretty, friends.

Saturday, August 30, 2008

I Get the Game!


Lo and behold, my medical school internet connection bestows upon me the glory of ESPN360.com, which on this day will broadcast the Auburn-LaMo game. I'm not the best at the play-by-play but I'll try to make it worth someone's while. War Damn Eagle!

I'm watching the Appy State - LSU game first because, hey, that's all we've got here.

1140: LSU just came out in a pistol set? Has the world lost its mind?

1146: Tonight's menu: NY strip, grilled mushrooms, grilled vidalia. Whether it will be the talented upstart Weber grill or the oven who, despite being less athletic, has been running this system for years? Game day decision. Clearly, everyone wants to see the grill in action, but if the weather is too stiff, we'll have to fall back on the less flashy oven as the starter.

11:47: LSU just ran the option from inside the five. Appy State stayed home and blew up the play. Goes to show that what works, works. Also, Hatch didn't pitch the ball ahead of Williams, who was then forced to stop and catch instead of running through the ball. All these option teams ought to play some rugby.

1153: Two balls overthrown to wide open receivers, and Appy State punts.

1154: Also, "Appy State" is an unfortunate moniker to me, the med student. I keep thinking "Appendectomy State." You be the judge of how appropriate that is, on this day when a pesky, vestigial (and rarely, lethal) football team is in serious danger of being annihilated by a well-trained squad who isn't going to let it sneak up on them.

1206: Someone get Armani Edwards a new chinstrap. He's lost his helmet twice already. And he's gonna be done by the second quarter if they keep calling his number.

1209: Jaret Lee in for LSU. Commentator's saying that they're gonna run more formations with Lee than with Hatch, but holy hell what else can they run? I've seen the option from under center, the pistol, the gun, ace... what else is left? Will their true frosh QB come in and run the A11?

1215: Huge blown coverage and Brandon Lafell catches a TD on the out 'n up. 24-0, five minutes to go in the half, and the mountaineers are already leaning heavily on the QB's legs. I think Appy State might be broken.

1220: Geez. Armani Edwards is getting hit over and over. He's throwing OK, but he's putting on a clinic in why the NFL doesn't run the spread.

1223: Again, an option pitch that doesn't work because the RB isn't allowed to run through the pitch. Appy State coughs it up again. Give 'em credit for going for it on 4th, though. They've got nothing to lose and at worst, this is great mental toughness training.

1225: Appy State's got quickness but they're overpursuing.

1227: Two poor throws off the back foot by Lee and two first down threats go unrealized. Tighten it up, man.

1229: I look away for, like, two seconds and Charles Scott blows right through a ten-man box on 4th and 2 for a long TD run. The only safety's ankles are completely broken. I'm glad to see LSU isn't patronizing Appy State, but this is just humiliating. 31-0 bayou bengals.

1239: Halftime. Charles Scott got the easiest 144 first-half yards of his entire life.

1240: Sideline reporter: Coach Miles, what have you done to limit Armani Edwards? Les Miles: We made him run all over the damn field and then beat the livin' hell out of him.

1245: This looks like it's gonna be a hell of a season. I can't even begin to say what stirs in me hearing the drumlines, seeing the players on the field. This is the best time of year. War Damn Eagle!

1250: Switched to the Florida game. The gators just ran a pro-style I form offset strong, weak twins, motioned the slot inside and ran off tackle for like 15 yards. That's 11 men in the box for the offense. God I love this game.

1255: Also, the Georgia game. They're comparing Moreno to Cadillac Williams. LSU's every-offense-simultaneously offense scares me. So does Knowshon Moreno.

1256: Also, the Virgina Tech game. The hokies just ran a nice zone read for a score from five yards out. What sprung the back was two offensive linemen zone-blocking at the second level. Pretty cool.

1259: VT gives up a first down on a well-run jet sweep to the near side. Good show ECU.

- Alright, I have to clean and pack at some point. Unless something climactic happens, we'll be back on the intertubes around time for kickoff. WDE. -

1325: I was just informed that Florida scored a TD out of the wishbone. The WISHBONE. This is why college football is so great. I've been watching for one morning and I've seen everything from the option under center to the wishbone to the gun to the pistol to the I.

1344: It's a damn good thing that Chic-Fil-A makes the manna-like sandwiches they do, else I'd never forgive them for renaming the Peach Bowl. Those tasty bastards.

1600: I just came back and saw that ECU beat the hokies on a busted special teams play. Damn! I picked the wrong game to miss.

Saturday, March 1, 2008

In like a lion

So surgery is coming to a close soon. I have only one day of actual work left. How's that? Literally, I needn't ever step into an OR ever again unless I decide I want to. And I don't think I'm going to miss it. Don't get me wrong - it's a tremendous privilege afforded to few, and yes, one that I've earned - but I just ain't no surgeon.

The interns (who rotate between surgical services every month) switched out this past Friday. What's nice about the interns rotating is that the resident previously on night float is going to be on the peds service. Sweeet. He's already let me do pretty much as I please, and I've gotten to see a couple of surgeries, help out on the wards, see some patients and (heh) blog a little. Tomorrow should be good. I'll see some procedures, I'll help out on the floor, and I'll get my time in. And then I'll be done.

Call on Friday was busy, else I would have probably given the weekly on-call update. Got to see a nice couple of cases. My favorite was the poor guy who came in real messed up after a bar fight. I feel bad for the guy, but he was the classic drunk trauma case. Bloody, beaten up, loudly proclaiming his sobriety, and puking his guts out. He was pretty pitiful, especially when the cops came into the trauma bay to take pictures of his injuries (more than a little smugly, I might add.) I had planned to study and sleep (as I've had the time previously) but we got the right number of cases at appropriate intervals, and I got about two good hours in.

Seeing as it's almost the end, highlights of the surgery rotation:
  • I walk into the neuro ICU on the first day of the rotation eating an energy bar. A resident sees me and says "Are you eating chocolate already? Where did you get that? Did you get that from the resident room? You shouldn't eat that!"

    My clerkship director says "You'd have to be a damn fool to want to be a surgeon, and you look smarter than that." Yes I do.

    Seeing an one of the neurosurgery attendings I&D a staggering head trauma.

    The chief of neurosurgery instructed me to make the initial incision on my first day.

    The classic drunk guy shows up to trauma, loudly proclaiming himself sober as he pukes into a basin that (being the good medical student) I am holding.

    Operating with the head of surgery, who let me sew because I answered a question about Top Gun without hesitation.

    My Auburn grad resident - war damn eagle!

    My little girl on total peripheral nutrition, who got used to me coming in early and would give me a little smile and open her mouth so I could check her mucous membranes (sounds worse than it is.)

    An Amish girl with tuberous sclerosis, who arrived in her Amish garb and a pair of delightfully tacky sunglasses (for her photophobia.)

    In ENT Peds clinic, we have what are essentially dentist's chairs for the patients to sit in, so they can be examined more closely. When he pushed the button to raise the chair, one of my residents would tell the kids that if they didn't tell him to stop, they'd go right through the ceiling. One kid looked absolutely terrified.

    The NP told me a story about how they'll take sick residents in the back of clinic and hook them up to IV's so they can keep working. She said she gave one resident three liters before she sent him home, and one of the attendings still thought he should tough it out.

    I'm whistling on the wards. My cool resident (a big gamer) looks up and says "Sounds like the chocobo song..."

    Diagnosing and forming a correct plan for an umbilical hernia in an asymptomatic one year old. I'm (almost like) a doctor now!

Friday, February 15, 2008

Adenovirus.

It's high flu season. And I've gotten some foreboding reports.

First of all, I caught a wicked good flu last weekend. And not just a rhinovirus, a real honest-to-God hates-your-guts influenza. Rocked me right in the face. For folks who don't know, most people who say they have the flu don't actually have the flu. They've got a rhino, a corona, or some other virus that makes you feel crappy, and you might go home or you might soldier through work after all. The flu ain't like that. Influenza gives you body aches and intense malaise - you just can't do anything. You sit around hurting for at least a couple days with a brain that feels like marshmallow fluff. You'll probably get pretty dehydrated, what with the fevers. Lord knows I did. My girlfriend said my lips were the color of my even-paler-than-normal face. And then she went and got me a pile of Gatorade and made me some soup - she's pretty awesome like that.

But it was also good on her account because (surprise!) she came down with the exact same thing while I was convalescing. We chowed down on some good wonton soup and lo mein that night (surprisingly good sick food...)

Long story short: you remember the flu. It does not play around.

Now, even though we got knocked flat on our butts with the flu, it wasn't anywhere close to killing us. But there are some people whom it does kill, chiefly the very young, the elderly, and people with weak immune systems - 36,000 a year in America alone. To make the obligatory bizarre comparison: HIV kills around 20,000 people every year in the USA (according to the CDC.) Eh?

Perhaps the plural of "anecdote" isn't "evidence"... but everyone I know seems to have gotten laid out by the flu. And now I hear that my girlfriend's old alma mater is closing up for a little while because too many students and faculty have gotten too sick. Keep in mind that the flu shot didn't work this year*, another nasty thing about adenovirus - sometimes it moves too fast genetically for our vaccines to keep up.

Maybe my concern also has something to do with having watched "Children of Men" recently, a premise of which is that the world went to hell after the flu pandemic of 2008.

Wash your hands and cough into your elbows. The fertility of the human race is depending on you.



*Makes me feel like less of a dumbass for being the asthmatic on steroids who "just didn't get" a flu shot. Only a little less.

Tuesday, November 20, 2007

It's virus season

[Written sometime in the fall, remembered just the other day.]

As third-year medical students, we spend our fall and spring semesters rotating through various medical specialties - surgery, medicine, pediatrics, OB/GYN, psychiatry, family medicine, etc. - so we can have some small clue as to what we want to practice. Currently, I'm on pediatrics, and I love it for the most part. I was small-talking with the NP I'm working with this week, and we got to wondering why Thanksgiving is so close to Christmas. I'm beginning to think it's because of this little booger:

I hate viruses and rhinovirus tops my list. It's rhino and RSV season here, and if Thanksgiving and Christmas were farther apart it would be depressing. I picked up a little somethin' somethin' from the kiddies last week and it's really rocking my world. That's the joy of pediatrics - getting innoculated with the latest respiratory viruses. Then, you're immune for the rest of the year. I guess that's one of the joys of pediatrics. Long story short, I've been pretty miserable. It started Sunday night, and has only gathered speed since then. Maybe the fact that I got up at 0400 Monday morning to come back to my rotation didn't help, but that wasn't entirely my fault what with the first slush/snow hitting us on Sunday night and 70-something miles of highway separating my home apartment and the hospital where I'm rotating. Monday was bad, but not so bad until the evening when the fever started. I slept ten hours into Tuesday and felt worse, and only made it through the morning thanks to a fellow med student's gift of cough medicine - and even still, I just couldn't focus. Brain was all fuzzy. In the afternoon I slugged some cough syrup to no avail. My NP looked at me and said "Go home - we won't tattle on you."

Any other med school, and I don't think that simple reassurance would have meant so much. But at my institution (which shall remain unnamed) it means something. If my course directors got word of my skipping out this afternoon, I'd have associate deans leaping down my throat in a heartbeat. It's just not the sort of thing that is tolerated, even if I'm febrile and have my hands full just not infecting my patients with whatever lovely bug I've contracted.

Mind you, this is the same institution that sent not one, not two, but four emails in two weeks to the students - CC'd to the course directors - explaining that the day after Thanksgiving is not a holiday. And scheduled lectures for that Friday afternoon. And, scheduled them at 1400 so that we could return to our clerkship site the day after Thanksgiving, work the morning, then drive back to our home institution for those aforementioned lectures. Thankfully, my clerkship site told us that we have no clinical responsibilities for the day after Thanksgiving and put it in writing. I just have the misfortune of having lectures that Friday. But for my unluckier classmates, it means they're stuck here for that day, and if the folks aren't close by, they don't get to see their families until Christmas. Better figure out how to make a turkey on your own.

I know that I'm a fortunate son with a silver spoon in my mouth, and I'm extremely fortunate to be in med school at all. But in all reality, physicians get sick, physicians visit their families on Thanksgiving, and physicians are able to plan this all in advance. And, while I'm not a physician yet, I'm paying out the nose for all this. I graduated from college with a degree in biomedical engineering, and gave up the promise of a career in that field to enter medical school. Here's a comparison of my financial status now to what it could have been:


For $50,000 into the red every year, I'd like a little more input into my holiday schedule. What's more: while physicians are handsomely paid, the average doctor's salary isn't enough to compensate for the lost investment time in which they're A. accruing a towering pile of debt, or B. paying off their loans. If you go to college, get a good job once you get out, and manage your money well, you actually do better than the average doctor in the long run. Don't even get me started on plumbers. You could say that people who go into medicine just for the money either don't understand finance, or are brilliant and will do interventional radio or plastics and will be millionaires some day. Neither of which is me. So why shouldn't I be an engineer? The money's better, the hours are great.


Or hell, why not be a Marine? Boot camp only lasts three months, and you certainly don't pay for it. I've taken to wondering what that would be like, since so much of med school seems like mental retraining.


The second stage of boot camp includes an exercise called "the crucible."

The crucible is the culmination of everything a basic rifleman Marine should know. It is three days of constant strenuous testing, humping, hardship, punishment, and starvation. The recruit is given two field stripped MRE's (Meaning all thats left is the main meal and side meals, taking away any candy, condiments, and such), and this is meant to supply them for the next three days. Worthy of note, is that while some recruits have food to spare at the end of this ordeal, others consume their rations quickly, and when they become hungry, other recruits aid their fellows, some even giving their last bit of food to another. This is one of the goals of the crucible: to train marines to look out for one another. This also distinguishes leaders among the recruits, something the Drill Instructors look for in their platoons. The crucible consists of certain challenges for the recruits, broken into platoons, to accomplish as a whole, or failed as a whole. One single recruit completing an obstacle means almost nothing. If anyone fails, it means that those that completed it failed to aid their fellow recruit in the accomplishment of their given mission.
source

Maybe we don't have MRE's, but we do have acetaminophen and guiafenesin.