Professional Facebook Page

February 17, 2018 by DoctaJay

So I have started to think a lot about how to combine this blog which spans my life from 18 years old to my very old and ripe age of 32 years. I’ve decided to keep this blog as an archive of course of my journey through medicine and orthopaedic surgery training; just a brief review of my first posts reminded me of how immature I was :-). Concurrently I have also started a professional Facebook page where I interact with my patients and post success stories (with the permission the patient and their parents of course). Please check out the page: DoctaJayMD aka Jaysson T. Brooks, MD and like the page (shameless plug I know 🙂 ). 

New posts in this blog will be focused on the balance of medicine and family and how faith plays into my every day practice of medicine. Hopefully running these two social media formats will allow my readers to get the full breadth of what it takes to be a family man, orthopaedic surgeon, and child of God. 

Attending Life 1 Month In

September 19, 2017 by DoctaJay

So quick catch up. After spending an entire year living separate from my wife and kids while finishing my fellowship I have finally been reunited. While I know many couples have done it and have triumphed, I would never recommend doing a long distance marriage. At the onset, all I could think about was how good this would be for my career, and the fellowship was, but how it affected me emotionally and psychologically, I would never want to repeat again. Nevertheless, fellowship is over…I graduated with a great group of future pediatric orthopaedic surgeons. Below is a picture of me accepting my diploma from Peter Newton, one of the best pediatric spine surgeons in the world:

I remember wondering how I would feel when I started this medical training process in August of 2007. Getting my white coat was like a dream come true.


I thought I had truly made it…lol. But becoming a physician and then a surgeon and then a sub specialized surgeon is a process that can potentially suck that joy right out of you. Now that I am through it, and looking back, there are times I wish the training and been different, that I hadn’t dipped to such a low in my spiritual walk with Christ, that I had spent more time with my family, that I had taken better care of my health, but there are only so many things one man or woman can juggle at a time. I feel incredibly grateful to be done with training, finally getting a real paycheck (after uncle Sam takes almost 40% of it) and finally able to practice my craft on my own. 

Before I started my first job as an attending at the University of Mississippi Children’s Hospital I took a much needed vacation with my wife and kids. That break between the end of residency/fellowship and the start of your first job is vital and I would absolutely implore all newly minted attendings to go on that vacation that you always wanted to. For my family we spent a ridiculous amount of money on a Disney Cruise, but what that cruise meant for my kids was priceless. Every day they got to hang out with the Disney characters and visit various caribbean islands. My cofellows went on other amazing trips like backpacking in the Gallapos Islands or touring Europe. Whatever you decide to do, make sure it doesn’t involve work, because that will encompass your life until retirement. 

There is a lot I want to talk about as an east coaster moving down to the deep south of Jackson, MS. I will definitely be blogging about my experiences both in patient care, personal interactions, and raising my family while starting a practice. What I will leave you with is that the job here in Jackson is a true gem. Just 3 weeks in my clinics are almost packed and I’m already getting close to doing real scoliosis cases. This rapid of a transition in practice would not have been possible in a more metropolitan city. Some previous commenters asked if I had given up my desire to do missionary work since I took my first job in the states. Already 1 month in, I can say that the need her in many parts of Mississippi is as bad as many mission fields I have been on. More to come on that. Until then, I will be working on growing my practice at my new job. Why don’t you come and visit?!



I’m 31 and I finally have a real job!

April 3, 2017 by DoctaJay

Its been a very long time since I have blogged, and for that I apologize.  Thanks to the shaming by some avid readers and mentees, I’m back at it. A lot has transpired since my last post of graduating from residency. I am finally at the point that every medical student dreams about when they first start this arduous journey; I have a signed contract for my first job as an attending. I’m happy to say that I will be joining the pediatric orthopaedic surgery division at the University of Mississippi. If you had told me at the beginning of medical school, residency, or fellowship that I would be living anywhere more south than Virginia I would have said you were crazy; but here I am, and trust me, this period of life feels good.


So to somewhat pickup where I left off, I am currently a pediatric orthopaedic surgery fellow at the children’s hospital here in San Diego. This program is hands down one of the best training programs in the country. In hindsight I am still very happy that I matched here, the reasons why being:


  • Autonomy- When it comes to doing trauma cases, you are an attending, so you book your own cases that come in when you are on call and you do them. The autonomy also includes clinic where you run your own clinic seeing the many post-ops that get scheduled after you have a couple of busy calls. The opportunity to have this autonomy while still have the back-up of your attendings who can always be called in is so important to building the confidence needed to being a good surgeon.
  • Teaching- Many of the attendings here are truly amazing teachers, and it is the breadth of teaching that really has amazed me. Dr. Mubarak will mention principles he learned from Dr. Blount himself as we talk about various deformity cases, then Dr. Newton will discuss a patient who is getting spinal tethering, a procedure only done at a handful of centers in the country. In addition to having our own clinics, we are also in clinic with our attendings, which is an invaluable experience. So much of pediatric orthopaedics is decided in clinic, so being able to see how these attendings work-up and schedule or choose not to schedule cases has been golden. If I had to give one piece of advice to a resident considering various peds ortho fellowships, I would say that clinic is very very important and that you should go to a program that gives you the opportunity to do it and learn from the masters.
  • Research- This place is a true factory when it comes to research. They have a legion of research assistants and statisticians and graphic designers who make drafting a manuscript truly stress free. Seeing their model has shown me how successful a program can be (even more so than some pure University programs) when you have people doing much of the research grunt work for you. I think it certainly helps that they are in such a desirable city like San Diego, so its not hard to recruit people, but even in Mississippi (I’m just learning how to spell it J ) the opportunity to build a machine is there as long as you have the right people.
  • Volume- If you have ever taken a night of call as an orthopaedic resident, then you know that the peds call volume is always much higher in the summer than in the other seasons. Monkey bars, trampolines, etc keep us in business. Well in San Diego, its always summer so that equates to an unbelievable amount of trauma volume in addition to the large elective volume that they have. This volume equates to me doing and/or assisting in many of the cases I will see throughout my career as an attending.
  • Location- In addition it doesn’t hurt that when I’m not in the hospital or when I want to find a quiet place to write a paper or read a book chapter, I have miles of beach front desk space to choose from 


So with all of that goodness do I have any regrets? Yes I do. I think I truly underestimated how hard it would be to spend this amazing year of fellowship 2,300 miles away from my wife and kids back on the east coast. My initial thoughts were that I’ve already been married for 8+ years so my marriage is fortified enough to withstand the distance. I initially thought that I barely spent a huge amount of time with the kids as a resident, many times getting home after they already went to sleep, so this 1 year would just be a continuation of that. I initially thought that the environment of 75 degree weather every day and after work beach expeditions would make any associated stress of the distance melt away. I was wrong on all counts. The truth is that long distance marriages suck no matter how long you have been married. My wife and I have done our best to make it work, spending many thousands of dollars buying plane tickets to make a trip to see each other at least every 2 weeks since the fellowship year started but even that is sometimes not enough. And my kids who I see even less (its much more expensive to fly all 3 of them out then just the wife) initially seemed to be tolerating the distance well, but recently have shown signs of sadness even in school, which is affecting some of their school performance. This improved somewhat after I switched to an iPhone and made sure the kids always had an iPad nearby so they could FaceTime me whenever they needed to, but nothing is as effective as daddy being there in the flesh. Then there is the spiritual component; Satan knows which sins I’m more susceptible to and so do I, and as a man, being away from your wife for days on end, without any ability to relieve the stress that undoubtedly rises in the busy life as a surgeon is not good. Personally, I try to be extremely proactive with this issue by basically not ever even getting close to being in a situation where I would compromise everything God has allowed me to build in my family. What that equates to is that besides my co-fellows I haven’t attempted to make any friends, especially of the opposite sex. At times that can make things quite isolating and lonely especially when my co-fellows are out of town or on call or with their own families.


So, in hindsight would I recommend a resident who is considering multiple fellowships to choose a fellowship that would put him or her into a long distance marriage or parenthood? No. I do not think it is healthy. The downsides of being so far away have been buffered by the amazing training and surgical experience I have obtained here, but if you are not man or woman of deep resolve and temperance, the year apart has the potential to destroy you also. I am just truly counting down the days until I can be a full time dad and husband again.


Now how in the world did I decide to sign a contract in Mississippi? I have no family there and not even close family friends which is the primary reason many end up choosing their first attending job. Choosing your first job is a complicated process and I would encourage every resident or fellow going through this process to seek the wise counsel of many before signing anything. I interviewed at children’s hospitals all over the country including Orlando, Detroit, Long Island, California, and Maryland. After evaluating all of the options and seeking the advice of numerous mentors, a couple of key points rang true for me:

  1. Where ever you choose, make sure your spouse is happy with the choice. Or in a more man centric phrase, “Happy wife, happy life”. Even if you have the most amazing job in the world with amazing partners and it pays a crap ton of money, if your spouse is unhappy with the location, your happiness in those other arenas will not last.
  2. Academic pedigree is important, but operative experience is more important. Especially in pediatric orthopaedics, this is a push to box new surgeons into subspecialities, such as the deformity guy, or the cerebral palsy person, or the sports person, etc. Especially when it comes to spine, which is a coveted and protected subspecialty at many hospitals, if you even hint that you are interested in spine, many won’t hire you. For me, I actually have very broad interests, which include both spine and hip. To be honest in the future, I do not know which subspecialty within peds ortho I will be most known for, but I wanted that freedom to pursue ALL of my clinical interests without being limited by others in my division.
  3. I did not come from money, and my wife especially did not come from money. We hope to really change the narrative of our future generations and the only way to do that is to build wealth. Being an orthopaedic surgeon does help in that your salary often puts you in the top 5% in the U.S., but salary alone does not equate to a long-term ability to build wealth. It’s not just what you bring home, it’s how much of what you bring home that you save that helps to build wealth. I was amazed, as I interviewed at various programs across the country for my first job just how many places were in desirable locations but had cost of livings that were astronomical, especially for the lower salary that many of them offered. In the end, I realized that the best places to build wealth from cost of living or salary ratio standpoint were programs in the south, like parts of Florida, Texas, Mississippi, Tennessee, etc.
  4. You must like and trust your partners. That is something hard to figure out in that first job interview. Some people have a knack for figuring people out… I think I have that knack, but also I ask a lot of questions… a lot of questions. These questions are not just directed to partners in the group, but also my mentors who tend to know other folks in this small peds ortho world. Use these mentors to verify whether your future partners will be supportive of you, before you sign the contract.
  5. Work-Life Balance? When I interviewed for fellowship at TSRH, Dr. Herring who helped to build that program from the ground up told me an interesting anecdotal story about how he purposefully lived within biking distance of the hospital so that he could make sure that he was close enough to have dinner with his kids and still run to the hospital to do cases if needed. I took this to heart and decided that wherever I chose to work, I would make sure that the choice of location of the hospital and where we decided to live made the commute so short that I could be home for everything important in my kid’s lives. As amazing as many job opportunities were, many were set up in a way that would have made that work-life balance impossible with me traveling to multiple satellite hospitals, stuck in traffic here and there, etc. You can either hope that the work-life balance will somehow materialize once you are well established in practice, or you can be proactive from the beginning and try to build your entire life around it. I aim to try the later.


I am excited about the future. I am excited about finally being close to hanging up my own shingle and starting my practice. It is my goal to continue to blog and chronicle my journey to becoming an attending but I am unsure of what form the blog will take after that. What will I speak about? I can’t talk about individual cases I do at the hospital. How about you all leave comments about what you would like to hear from my when I become an attending. I don’t know how this all will work, but I hope you will continue reading along with me as I continue this journey.


From Graduation to Fellowship

October 6, 2016 by DoctaJay

Wow so much has happened since I last blogged. I had all intentions of writing an individual post about each experience of life got in the way, so I will summarize to catch everyone up. I graduated residency from The Johns Hopkins University Department of Orthopaedic Surgery!!!


5 years ago when I started on this journey I was humbled to even have the opportunity to train at such an amazing place. As you have seen from my posts throughout the last 5 years, the training was not easy. Surgical training is tough and when I started out my skin was paper thin; I had never been cursed at, never been told I sucked by a medical student or resident above me, never had to question whether I was resilient or smart enough for the task at hand, etc etc. But again, surgical training is like none other; every surgical resident has his or her share of stories of feeling like a total failure after a case or patient experience in the ER, every resident also has days where everything went perfectly and they actually received positive feedback. Every resident has that experience where they were left to do a case in the OR by themselves with the associated glee and terror that is often associated with that. Also every resident has the experience where they were left to alone to do a case, and unfortunately they had to call the attending in because they reached the limit of their abilities. It was not an easy task but by God’s grace, many sleepless nights, incredible stress, intermittent depression, family stresses, etc I made it through. Would I do it again? Yes I would; Hopkins is tough, but as I look back on the training I received, the mentors I gained, the patients both rich and poor I was able to treat, it was an unparalleled experience which has set me on a career trajectory the heights of which I have yet to see.


About two weeks after I graduated from residency I boarded a plane for the state of Maine to take part in the Maine Board Review course. It was hosted at Colby College which for me is truly in the middle of nowhere. The benefit however is that for 2 weeks I was away from my wife and kids, had 3 meals/day already prepared for me by the college and my sole job was to study for the boards. I continued my trend started in medical school and skipped all of the lectures. Instead I got access to the 8,000+ questions The Maine Board Review course offered and jumped feet first into studying. The questions they provided were SAE test questions, where were twice as long and hard as the OITE questions I was used to taking. This resulted in many days feeling completely deflated at the scores I was getting especially so close to the test time. I had a goal of doing 400 questions a day which was admirable, but by the end of the first week my brain was so tired I was barely doing 200 questions a day. I worked on week areas which were Hand, Shoulder and Elbow, Adult Spine, and Sports. When these subjects demoralized me and stripped me of my self-confidence, I would jump back into Pediatrics and Trauma and Tumor to start getting better scores. By the end of the 2 weeks I think I completed about 3,200 questions and I had extensive notes and stuff I did not know…WHICH WAS A LOT. After I flew home to Maryland, the days leading up to the test for anxiety filled. I wasn’t doing any more questions; instead I was just reviewing the notes I took while doing the questions in Maine. I had taken so many notes that it often took me 5 hours to review notes for each subject. The night before the test I prayed with everything I had in me. I tried to remember all of the other tests I thought I was going to fail in the past..the MCAT, STEP I, my epidemiology final in med school, my pathophysiology final in medschool, Step II, Step III. I even went back in a private written journal I had and read the testimony of how I pasted some of those tests almost 7 years ago. God gives us testimonies to solidify our faith when the future trials come, as they always will. Reading these testimonies got me through the night and then I woke up and took the behemouth of ABOS Part 1 Board Examination.




I can describe it in no other way. There were 8 blocks, with about 52 questions for the first 7 blocks. Where there was about 10 minutes left in the first block I looked at my screen and I had 17 questions left!!! After expelling my bowel and bladder contents into my pants, I raced through the remaining questions going with my gut feeling and choosing the first answer that seemed right. For the remaining 7 blocks each question stem was so long and took so much thought I barely had time to answer each question and I definitely had no time to go back and check the questions I flagged, which is what I have done for all previous standardized tests. When I walked out of that room I felt terrible, more terrible that I had felt after any test in my life. I knew I prayed, I knew I did my best, but I know also that prayer does = the answer I want always. I didn’t know what to think.


I spent about 2 weeks with my family, playing daddy and husband, devoid of any clinical responsibilities and then I boarded the plane to San Diego to start my pediatric orthopaedic fellowship. So far San Diego has far surpassed all of my expectations. This program is fellow focused and the attendings are so dedicated to teaching you nonstop that you barely have time to read all of the material that is suggested. But that is a good problem to have. In addition I have my own clinic, seeing patients with trauma that I operated on. The first day I had clinic, saw my patient, and realized there was no attending to present to I became giddy with delight. Of course I could always walk to a pod close by to ask a random attending a question if I was concerned but the autonomy and push to “grow up” as a surgeon and doctor is exactly what I needed. Only 2 months in I have learned so much and have also started the process of looking for jobs and even interviewing at a couple of institutions. I ask that you stay tuned to hear where I eventually decide to work!


Two weeks ago I received this letter in my email:




There are many graduated orthopaedic resident that did not pass this test, and while I worked hard, I’m certain I didn’t work harder than some that failed. I don’t know why God continues to bless me like this, but I am eternally gratefully and I hope I can use all that He has given me not for myself but for whatever task He gives me in the future.


With all that said, I write this blog post on the plane, flying back from the Scoliosis Research Society meeting in Prague, Czech Republic. If you are interested in deformity surgery of the spine, there is no other meeting to attending. Hearing the latest and greatest research regarding peds spine, and meeting so many leaders in the field was priceless. I still struggle with understanding how God intends for me to navigate the academic world such as this and the missionary field. I don’t know if its possible without giving up something else important like family, but I’m open to Him showing me which steps to take as he orders my path.



Finding Balance with Residency Your Spouse and Kids

March 1, 2016 by DoctaJay

I’m graduating in June of 2016, never again to traverse the halls of Johns Hopkins as an orthopaedic resident. When I entered medical school at Loma Linda University I never imagined that I would be in my current position. As you have read, much has occurred in the interim but over the years I observed how difficult it is to progress up the academic surgical ladder, while maintaining your Christianity and your marriage; adding kids to the mix only complicates matters. Because of all that I have seen and experienced, I have sought the advice of many who have gone before me within orthopaedic surgery and I have also sought God’s word. Here is what I have learned:

Finding balance between being a husband, husband+dad while being a resident has been a topic at almost every national orthopaedic meeting I have been too. Everyone always starts out their presentation on balance by saying that they don’t think they are the right person to give this talk, since they work all the time. But an important point to note first, is that balancing surgical residency, marriage, and parenthood is akin to balancing a basketball on your finger:


In order to keep the ball perfectly aligned on your finger, you have to stay active, constantly spinning it with your opposite hand. This is the first thing that I learned about balance in residency…its an ACTIVE PROCESS, requiring constant adjustments sometimes on a monthly basis sometimes on a daily basis. After each adjustment you find a new steady state. I have seen this personally in my own life and initially it frustrated me. At times I felt like a model dad when I would come home from work early, read to the kids, give them a bath, and put them to sleep, giving my wife a hand to do other things. Then I would start studying and reviewing my surgical cases around 11pm, only to fall asleep on my desk after 20 minutes. I would then wake up 5 minutes before I’m supposed to leave (even though my alarm was set for an hour before that), and then rush out of the house, without praying and barely brushing my teeth. Then there were nights where I knew I had tough cases coming up the next day, so rather than come home after I got off at 7:30pm and study for the cases at home, I would stay at the hospital until 9pm studying , and then come home. As a surgeon, I felt more prepared then than ever, but my wife, unbeknown to me ,had been hoping to spend time with me or had wanted to tell me about how terrible her day at work was. But by the time I got home at 11pm, she was half asleep; keeping all of the issues at work that she wanted to let out inside until I “had time”. This equals Good surgeon + Bad husband.

So what do you do? Like I said, small adjustments do need to be constantly made, however I sought further council in God’s word. 1 Corinthians 7:5 in the NIV version says:

5 Do not deprive each other except perhaps by mutual consent and for a time, so that you may devote yourselves to prayer. Then come together again so that Satan will not tempt you because of your lack of self-control.

To rephrase it in even more modern tongue, the Message translations says:

2-6 Certainly—but only within a certain context. It’s good for a man to have a wife, and for a woman to have a husband. Sexual drives are strong, but marriage is strong enough to contain them and provide for a balanced and fulfilling sexual life in a world of sexual disorder. The marriage bed must be a place of mutuality—the husband seeking to satisfy his wife, the wife seeking to satisfy her husband. Marriage is not a place to “stand up for your rights.” Marriage is a decision to serve the other, whether in bed or out. Abstaining from sex is permissible for a period of time if you both agree to it, and if it’s for the purposes of prayer and fasting—but only for such times. Then come back together again. Satan has an ingenious way of tempting us when we least expect it. I’m not, understand, commanding these periods of abstinence—only providing my best counsel if you should choose them.

If you are in a surgical residency and are married you will know exactly what I’m talking about, but if you aren’t you will soon find that the daily stress you are placed under as a resident can truly drain you empty of every last drop of emotional and physical energy, both of which are key components when being intimate with your spouse. Many nights you will get home at 11:30pm to a spouse who has been waiting to be with you, only be realize that you have nothing to give them at that time. Or maybe you try but you are so tired that the experience is so-so for both parties. Hopefully these experiences are few and far between, and hopefully they are overshadowed by those periods of time when you have a weekend off or are on vacation, or your research block when you can really get rest and spend quality time. But if you are in the midst of one of those periods where you are working your tail off and there is no break time on the horizon, how do you comply with what the word of God says?

First and foremost it is very important that you and your spouse have a real conversation about this issue. She or he needs to know exactly what happened to you that day; they need to know exactly what made you so stressed, and how that made you feel…even if they can do nothing to make it better. Then you need to listen to them, because even though they are likely working a job that is 98% less stressful than what you do, or even worse in some husband’s minds…they don’t work at all out of the home, their stress is their stress. And if you belittle their stress because yours is so much more, then eventually that may open an avenue for Satan to split you apart perhaps by sending someone who is willing to listen to your spouse. So after you have done all the listening you can and you have expressed yourself about your day, then its important to either muster up the energy to give your spouse what he/she needs, or be honest with them and say, “Honey, whether I want to or not, I will be asleep in 3 minutes because I’m so exhausted, but I know you have needs and I want to be there for. Can we reschedule for 2 days from now or tomorrow night? I will make sure to get home as soon as possible. Does this work for you?” Now hopefully you are true to your word and you don’t post-pone 5 or 6 more times, but you get the point. These conversations are part of the mini-adjustments that need to occur sometimes daily in order for you to find balance in your life.

What about if you have children? How do you give both your spouse and your kids the time they need while preparing for the 5 cases that are scheduled, knowing that rounds are at 5:15 am the next day? I have gone through so many different plans trying to get this right, but John Flynn, who is a pediatric orthopaedic surgeon at CHOP and who is also well known for his work-life balance finally gave me a break through during one of his talks and hearken to the message in Proverbs 15:22, where it says, “Plans fail for lack of counsel, but with many advisers they succeed”. Dr. Flynn’s concepts include:

1. Give your family the best of your time…first. Meaning that when I get home, for the first hour I am not on my phone discussing patient care, I am not on my computer checking Facebook, I am not watching the latest Netflix House of Cards episode, I don’t plop on the couch and turn on ESPN to clear my mind, etc. For that first hour, every ounce of my attention is focused on my kids and my wife. This is truly quality time, uninterrupted. Dr. Flynn even goes so far as to turn off his phone for that first hour when he gets home. After this hour is done, then you go to your office or Starbucks and study/prepare for the next day work wise. Even though it was only an hour, the amount of quality time you spend was so concentrated that I have found that my family is more than willing to let me get to work with few interruptions.

2. Sleep less (“Do not love sleep or you will grow poor; stay awake and you will have food to spare, Proverbs 20:13). Honestly, if you are a surgical resident, you are already genetically programmed to run on less than 5-6 hours of sleep per night. Some nights I can go to 3 hours of sleep or 1.5 hours of sleep. Use this gift wisely when needed. If I have a big project or case coming up. Rather than staying at the hospital for 4 hours to finish it, coming home super late and not seeing your wife and kids awake for the 3 night in a row you could come home, spend your hour, then go to bed early, like a couple hours before midnight. Then wake up super early, like around 2 am when your mind is rested and knock all the work out. Or you could just stay up throughout the night. I find the sleep more satisfying when I get a couple hours in before midnight and wake up crazy early, even if its like 1:30am.

3. Remember that your kids, especially when they are super young (less than 8 years old) will love you always. You almost can’t make them unlove you. Your spouse however has a higher capability of being fed up with your job, your attitude, your chronic tardiness, etc. If you have to err on the side of who the spend time with..your spouse or your kids, spend the time with your spouse. Residency truly is harder on them than your kids, so allocate your resources accordingly

4. Try to include your spouse on your educational trips. I’ve been to a lot of states throughout the country to present research projects, but its only recently that I made a point of letting my wife know months in advance when these trips would be to see if she could come even for a couple of days. These little get aways, even though it includes work for you, keep spontaneity and excitement in your marriage

5. Always try to be home for dinner. As a resident, this is often impossible, but as an attending with more control, this is very doable

6. While it is important to be open with your spouse and what exactly happened at work, so they can understand your stress, you can bring EVERYTHING home, or else you may just depress them deeply. (Again, you know your relationship better than anyone, so feel it out). Dr. Flynn made a point of when he comes home, he spends a couple minutes clearing his mind of the anger, the stress, and the frustrations for the day. And he puts a big smile on his face in preparation for walking into his home. This is something I’m personally still working on.

And finally, i leave you with this powerful text from the word of God:

And I saw that all toil and achievement spring from one person’s envy of another. This too is meaningless, a chasing after the wind (Ecclesiastes 4:4).

I am by not means a pastor, but when I read the text above it points my mind to the general rat race that is surgical residency. Everyone is going to the OR, reading for cases, seeing patients in clinic or on the inpatient side. But the additional things that really get your name out in the open such as writing and publishing articles, joining hospital committees, writing book chapters, traveling to one course after another, doing podium presentations at regional or national meetings, etc. All of these additional things while usually not required generally elevate your name nationally and within your your attendings’ eyes. There is nothing wrong with research; I have done quite a bit of it. But one mistake I think I made was looking at some of the residents in my class or even some below me who had 20+ publications and 10+ book chapters and doing my best to compete on their level. But these folks don’t have a wife who is also a resident; these folks don’t have 2 small kids; these folks have their job and maybe a girlfriend or “right now” friend. If I do research or write a book chapter it should be because I’M interested in the topic, not because I’m chasing after “The Joneses” in surgical residency. Doing all this work with that type of skewed motivation drains you at baseline, and even worse, takes much needed time away from your wife and kids. So at a certain point, I started saw no a bit more and I started choosing projects that really fit with my future goals and that I was actually excited to work on. I also started to do more of this research at work or after my wife and kids went to work so that when I was awake and could spend quality time I was actually available.

I hope that this post will help current residents early on in their training not repeat the same mistakes I made. Remember that residency is only for the next 3 to 7 years. And even your career at best will last for another 40 to 50 years after that. Your family is FOREVER. When its time to bury you, it won’t be the surgical nurse or your intern who are there for you, but this family that God has made you a steward of. Be careful to be a trustworthy and faithful steward.




December 27, 2015 by DoctaJay

The horse is made ready for the day of battle, but victory rests with the Lord. (Psalms 21:31)

These words spoken by King Solomon truly sum up what the last several months have been for me. I had trials in every aspect of my life; some attendings were attempting to ruin my hopes for a fellowship match, and everything else was on the rocks…my marriage, my health, and my relationship with God. I could not understand why all of this was happening; I thought I had done everything as right as I possibly could. Like Job, I was challenging God to show my why I deserved all of this and you know what He told me…nothing.

Sometimes it is just your time to be tested; you may never get an answer as to why.

With that said, God has revealed his character to me more in the last several months than I have seen in my whole life. I have grown in every facet of my life, and while the process was oh SO PAINFUL, I am a better man today, and I am continuing to grow daily. There is so much I want to share, over the next several posts, but for now I will report the following testimonies:

  1. Despite other’s best efforts, I did match at the top pediatric orthopaedic fellowship in the country, UC-San Diego/ Rady’s Children’s Hospital! I’m still on cloud 9 and can’t wait to spend my year in a place that has produced so many leaders in the field, and that also happens to have 85 deg weather year round :-).
  2. My marriage was great before, but it is even better now. There is so much I have learned about what it means to be a surgery resident and a husband that I wish I had known before i started back in 2011. I will share these nuggets in ensuing posts.
  3. My health is better than ever. I lost 24 lbs and my BMI is finally normal lol.
  4. God has blessed my research efforts.

I can truly say that God has given me the victory over almost all of the trials i was dealing with. But as the text above says, I first had to make my horse ready for battle; meaning I had to put in the work and preparation in order to get to a place that God could truly give me that victory. For those trying to get into medical school, or drinking from a fire hydrant of information in medical school, and walking around like a over worked zombie in residency, remember that the victory truly does rest with the Lord; simply do your best, put in the required preparation, and God will take care of the rest.

In my next post I will talk about how to be a husband who “loves his wife as Christ loved the church (Ephesians 5)” and be a competent orthopaedic surgery resident.


P.S.- Thank you to all who left comments of encouragement in my last post. While I did not respond to all of them, I read all of them at least 4 times over. They certainly helped me to weather the storm.

Comfort from the Word

March 31, 2015 by DoctaJay

I’m going through a pretty big test in regards to my faith and my career. I can’t really disclose why or what but I seem to have more enemies than I naively thought, who are really trying to hurt me. With that said, the Word of God always has a comforting message and for the past 2-3 weeks this chapter  (Psalm 25) has truly comforted me, and bolstered my faith in the deliverance I hope God will bring:

In you, Lord my God,
    I put my trust.

2 I trust in you;
    do not let me be put to shame,
    nor let my enemies triumph over me.
3 No one who hopes in you
    will ever be put to shame,
but shame will come on those
    who are treacherous without cause.

4 Show me your ways, Lord,
    teach me your paths.
5 Guide me in your truth and teach me,
    for you are God my Savior,
    and my hope is in you all day long.
6 Remember, Lord, your great mercy and love,
    for they are from of old.
7 Do not remember the sins of my youth
    and my rebellious ways;
according to your love remember me,
    for you, Lord, are good.

8 Good and upright is the Lord;
    therefore he instructs sinners in his ways.
9 He guides the humble in what is right
    and teaches them his way.
10 All the ways of the Lord are loving and faithful
    toward those who keep the demands of his covenant.
11 For the sake of your name, Lord,
    forgive my iniquity, though it is great.

12 Who, then, are those who fear the Lord?
    He will instruct them in the ways they should choose.
13 They will spend their days in prosperity,
    and their descendants will inherit the land.
14 The Lord confides in those who fear him;
    he makes his covenant known to them.
15 My eyes are ever on the Lord,
    for only he will release my feet from the snare.

16 Turn to me and be gracious to me,
    for I am lonely and afflicted.
17 Relieve the troubles of my heart
    and free me from my anguish.
18 Look on my affliction and my distress
    and take away all my sins.
19 See how numerous are my enemies
    and how fiercely they hate me!

20 Guard my life and rescue me;
    do not let me be put to shame,
    for I take refuge in you.
21 May integrity and uprightness protect me,
    because my hope, Lord is in you.

22 Deliver Israel, O God,
    from all their troubles!


I truly believe that tests come in our life so that we can share the testimony afterwards with others. I’m looking forward to having a testimony to share!

Monumentous Event!

January 23, 2015 by DoctaJay

Let it be known that on this day, Friday January 23rd, I have taken my very last in house call as a resident!!!!! Never again will I have to sleep at the hospital or be at the hospital and not sleep because I’m busy reducing fractures in the ER at 3 am. Never again will I have 5 pagers for every different orthopaedic service on my hip while also being harrassed by the ER about seeing a consult. Never again will I have to be the first person a nurse pages at 3am for a new tylenol order or because a drug seeking patient wants more dilaudid. Never again will I have to stand up front of my attendings in the morning boards and present all of my consults with the hope of not getting reamed for my chosen plan of care.

Now I’m not totally out of the woods. I won’t be taking in house call anymore, but I will be taking chief call, which means that i will the person junior residents call if they need help figuring out what to do with a patient when they are doing their in house call and I will be the person they call if a case has to go to the OR in the middle of the night. The the plus is that I will be home when they call me, and there is nothing likely sleeping in your own bed. But that is fun stuff, (or at least I say that now); most of the strain from now on will be the mental strain of thinking about the various treatment plans needed. It’s an exciting time for sure.

Fellowship interviews are going great. A recent article was published in JBJS talking about the orthopaedic fellowship match ( Its a good read, but what it shows is that almost all ortho residents are pursuring fellowships, of which Hand and Joint Arthroplasty seem to be the most competitive. Peds is one of the least competitive fellowships (you either love kids or you don’t) but its likely one of the strongest subspecialties at my residency, so that combination is making for a really nice interview experience. I have 4 interviews left at the Children’s Hospital of LA, Rady’s Childrens Hospital in San Diego, Hospital for Sick Kids in Toronto, and Children’s National Hospital in DC. After that the choice of how I should rank these various programs is going to be really really tough. Thankfully I know that God hasn’t led me wrong yet from high school up to now, so I’m confident He will make it clear where I should go.


January 4, 2015 by DoctaJay

It’s a new year and what looms on the horizon for my family is my 2 year old son starting pre-K in August. Now that may seem very far off for you, but when you have a stubborn 2 year old who doesn’t want to be potty trained, and being potty trained is a requirement for starting school, you are forced to start brainstorming early. It took my daughter probably 1 month to actually potty train; for my son its like pulling teeth. Finally we started to make some headway when we basically put a 40 minute timer on our iPhones. For Sunday, when we were both home, we basically made him sit down to pee every 40 minutes and you would have thought we were abusing him with all the crying and whining that occurred. We coupled this with basically keeping his pull-up diapers off for the entire day. After a couple of episodes of cleaning up poop and piss from the floor I had just about given up. I turned on the TV and sat down with him, sulking in my defeat. Then 10 minutes later, out of no where, he said the magical words every new parent wants to hear, “Daddy I think I need to pee pee.” I picked his body up and raced to the bathroom and started to sit him down on the toilet so he could start, but he protested saying, “Daddy, I want to stand up like you when I pee.” Now his manhood doesn’t quite reach over the toilet given that he’s 2, so I had him stand on the rim, and he peed like a champ!!!!!!!!

Its experiences like this that make you so happy to be a parent; to see your child progress and learn despite of how good or bad of a parent you can be at times. I look forward to all the things my son will continue to do now that he has started off right with standing up and peeing like a man grown.


December 29, 2014 by DoctaJay


All my life I have attended small, Seventh-day Adventist schools which gave me an excellent education but were otherwise never well known on a national scale. Coming to Hopkins for residency was my first time being in a place where people assume you are good simply because of where you work. It’s the pedigree of the institution that often goes before you, and its an interesting thing. Even if you enter the gates of a place like this somewhat mediocre, the environment encourages you to perform above and beyond, in order to keep up the standard.

I’ve seen first hand what the effects of pedigree are as I have been applying to fellowship. As you know I am applying for a fellowship in pediatric orthopaedics, and when I set out on this endeavor I organized my application in a similar way to how I organized my residency application…apply to as many institutions as possible with the hope of getting enough interviews to match. I received sound counsel however that this would be a waste of money and time. This person told me that based upon my application and where I was coming from, I should apply to places I’m truly interested in attending…GASP, lol. So I did apply; I applied to 10 hospitals and got 10 interviews and all I can say is thank you God! I still feel quite uncomfortable with the notion that people will think I’m good simply because of where I came from and who wrote my letters of recommendation. It goes against every fiber of my humility and my inclination to trust in God to lead me in the right direction. But if coming from an institution with a certain pedigree helps, I’m not going reject the offers.

I’ve been on 2 of the 10 interviews so far and unfortunately I really love both of them and could see myself going to both. I truly hope that I really dislike some of the others or else making my rank list is going to be tough. For medical students considering what residency to attend for orthopaedics, I think its important to look at the strengths of the institution you are interested in, before you decide. I actually had no idea that I wanted to do Peds Ortho when I started residency, but Hopkins turns out to be very strong in that sub-speciality. If you are interested in Hand however, and the program you want to rank #1 doesn’t have any hand attending and instead farms you out to do Hand with some local private attendings, then that program won’t help you to get a good fellowship. Evaluate each program individually and decide if that hospital is for you. 

The Balance of it All

October 4, 2014 by DoctaJay

Being a PGY4 orthopedic resident is so much better than the previous years. As a PGY4 you are considered a “senior resident”, which is an odd feeling because you really don’t feel like one for a good while. I was so used to the mindset of, “My chief will take care of this complicated case” or “My chief will know exactly what to do with this surgically complex patient”. Somehow overnight, I am supposed to have all of the answers and know what to do with the most complicated orthopedic patients. Oddly enough, many times I do, and its a fun feeling finally realizing that you learned something over the last 3 years.

I started my PGY4 year on research which was awesome because 1) I didn’t have to deal with all of the interns just starting having no idea what to do (like I felt way back when) 2) Allowed me to be home more with my wife starting her new residency 3)Allowed me to get all of my fellowship application items completed before it was due on 9/4/14. It was great also being home during the summer months with my kids. We went to the zoo and the park multiple times, and just plain had fun. As a surgical resident, your time is very precious, and when you can, its better to spend your time with what lasts…your family.

On the research front I’ve been quite busy. I have submitted around 5 papers for publication, completed 4 book chapters, and have 2 podium presentations lined up. I don’t say this to brag as I know for sure that there are serious ortho rockstars out there who published more papers than that just in medical school alone. But for me, having 2 small kids and a wife who is a resident, with all of the associated lack of studying that comes with a life like that, I’m pretty happy with that progress. I’ve truly realized how much I enjoy writing papers. I can’t totally deny that some of my interest in research is just based on the cool feeling you get when you search or your name in PubMed and an entry pops up. But there is much more to it than that; doing research constantly forces you to question if what you are doing can be done better or it forces to you really study why you practice the way you practice. I think it keeps you at the bleeding edge of your field. It also has its dangers as I’ve seen here at Hopkins. You can often be dragged into the rat race of publishing simply to get promoted, meaning that you are churning out projects that may not really matter to the field of orthopedic surgery. Also one has to ask when is enough enough? As a resident, do you really need to publish 10 papers, or even 5? I know of some residents who published over 40 papers during their training and that is great, however it really starts to count when you are an attending. Those papers really matter when it comes to academic promotion. So with all of that said, I have slowly learned to say no to attendings who have asked me to do projects; partly because I’m drawing to a close in my residency and don’t want to leave projects unfinished and also partly because I don’t need 20 papers to match into a good peds fellowship. Learning to say no has probably been the most important lesson I have learned so far in residency.

On the fellowship front I received my first interview invitation!!! I’m so excited to finally start this process. It has so far been much cheaper to apply to fellowship than residency. Applying to 10 programs costs only $60. After dealing with plane tickets the totally process may cost around $2,000 at its worst. The fellowship world is very small, and while your research and performance in residency is important, it is much more helpful to have a strong attending advocate who is willing to call his/her buddy at Harvard or Minnesota regarding your application. While its great that I have many well known peds attendings at my program, I am doing my best to remember that God is still directing my path; nothing is truly a done deal, and it matters more where He wants me to go.

Fellowship Application Submitt

September 7, 2014 by DoctaJay

So after much deliberation and advice from numerous residents and fellowships I have finally submitted my application for a fellowship in Pediatric Orthopaedics. It cost $100 to apply and $60 for up to 10 programs. Initially I was going to go all “Residency Applicant Mode” and apply to all of the programs, but sound advice from a choice few steered me away from this path. Fellowship is just a different beast from applying for residency and there is often no need to go crazy like that, especially for residents coming from U.S. programs.

I will keep you all posted on how the process goes overall. Last week I also turned 29 years old and while a part of me feels a bit old, I can’t say that I have wasted too much time since I left for college so many years ago. I praise God for bringing my wife and I so far from two high school kids in “love/like” to two MDs with two cute kids. I can’t understand why God is so good to His children, but I won’t ask Him to take any of it back.

Also my research block is over starting tomorrow and I will be thrown back into hospital fray. Gone is the bliss of waking up at 8 am, and writing papers and book chapters in my underwear. Oddly I am happy to be operating again even though that means less sleep. Probably most surgical residents coming off research would say the same. Either way I’m counting down to 2016 when this will all be over.

Mission Trip to CURE Hospital Dominican Republic

July 13, 2014 by DoctaJay

I am currently on the plane back to the U.S after an amazing mission trip to the Dominican Republic. We were working out of the CURE International hospital there which is dedicated to providing free pediatric orthopaedic care to poor children in the country (awesome right?). I first found out about this hospital from one of my mentors Scott Nelson who is currently a pediatric orthopod at LLU (my previous medical school for new readers). He spent over 5 years at the CURE Hospital in the DR and turned the hospital into a truly top rate facility where they were not just providing some care for poor kids, but the same type of care they would get in America. It’s this model that I am now convinced needs to be applied to all mission hospitals, but I will talk about that later. Another pediatric orthopod (Dan Ruggles) flew down with one of his residents to provide surgical care for patients that had complex orthopaedic disorders.

My first day was last Sunday, and we basically held a special pre-op clinic where all of the patients who had conditions or deformities that were overly severe were evaluated to decide if they were a candidate for surgery that week or would be better served non-operative management. Not that it is related to their care, but I have to pause and mention that Dominican children are some of the cutest kids I have seen; the combination of African and Hispanic heritage is amazing. So to continue, I saw a host of pelvic and limb deformities that were often times and unfortunately a result of the poor care that kids received from hopefully well intentioned but incapable local surgeons in the DR. I am certainly not talking about all surgeons here, but more than I would like to admit. Many children with previous osteomyelitis were missing large segments (10+ cm) of their femur or tibia after having it removed by the local orthopod instead of the surgeon first trying a course of antibiotics to identify the involucrum such as is seen below.


Many of the surgeons here simply open of the site of infection and start chopping away leaving the child with such significant bone defects as seen below). There was also a host of children who simply had congenital limb deformities such as tibial hemimelia or congenital femoral deficiency as seen below:


I also saw numerous examples of what happens to kids with Blount’s disease who either go untreated or were treated inappropriately given there combined femoral and tibial deformities or who were treated appropriately with an 8-plate but for various reasons did not return for normal follow up until years later as seen below:


Clinic also consisted of observations of numerous types of gait in kids with limb deformities to see how their bony alignment affected their functional ability. Below is the xray and associated video of a little girl with untreated hip dysplasia and her associated gait: DSC_0021

Below is a video of a little boy with untreated club feet and some other unknown lower extremity MSK disorder. You can see here how he ambulates pretty well given his considerable bony malalignment:

I could go on and on with the disorders that I saw, but the much cooler part of the mission trip was getting to operate on these children and see them get better. We started operating this past Monday basically non-stop until Friday. Operating overseas, even in a hospital as amazing the CURE hospital is definitely an eye-opening experience and showed me what is in store for my wife and I when we finally go overseas. Unlike the cush U.S. there are no Synthes, Stryker, or Depuy reps on hand to organize and replenish the instrument trays before and after surgery, so it was the task of the the residents and surgeons to rumage through the storage room seen below:


Once the instruments are pulled and sterilized we go downstairs to the inpatient ward to see how the patients were doing that we operated on the previous day. The inpatient ward is painted wall to wall with beautiful murals of nature and really provides a peaceful setting for these kids who are often in more pain than we would like…not because they don’t have pain medication but because the nursing often doesn’t give the medication as prescribed.

After rounds we head to the OR. Below is a video of what the OR suite looks like. And again, as I have seen mission hospitals in other countries, I was very impressed with the facilities. If you were blind folded and brought in you might not be able to tell that you weren’t in America..except for the fact that everyone only spoke in Spanish.

The highlight of my time again was working with the pediatric orthopods that flew down to take care of these big deformity cases. We performed big cases from Dega osteotomies w/ VDROs, medial plateau elevation osteotomies and application of taylor spatial frames, bilateral tibial and femoral osteotomies of severe blount’s disease, and the highlight was a rotationplasty performed for an iatrogenic short femoral (more handwork of a local orthopod). The xray below is of a 10 yo F who had a really short femur after a local orthopod removed a ridiculously large segment of her femur to treat her osteomyelitis:

IMG_0157 IMG_0114 IMG_0112

The defect was too large to perform a bone transport procedure so it was decided that the best way to treat her and get her walking again was to perform a rotationplasty. A rotationplasty in layman’s terms is where you turn the leg (from the knee to the foot) 180 degrees so that its facing backwards. This effectively makes the ankle joint into a knee joint and then they are able to walking with a prosthesis that is specially fashioned for them. This Mayo clinic video better explains it:

So we finally started the case and while tense at times, it was a great refresher on anatomy as we basically had to isolate all of the structures that cross the knee or attach at the knee. Afterwards, the relevant muscles are detached and tagged for later repair. The most difficult part of the case is dissecting out the femoral artery and nerve and its many branches. It makes it more difficult when these structures are covered with fibrous tissue as was the case in this girl. Nevertheless, with careful dissection and attention to detail and some praying, it all went well, as you can see below:

DSC_0052 DSC_0892 DSC_0887 DSC_0085


There were a whole host other cool cases, like the opportunity I got to do a SIGN nail ( which is the defacto intramedullary nail for cash strapped mission hospitals. Below is a cheesy picture of me with Scott Nelson putting one in:

photo 1


I also saw the amazing ingenuity that goes into many processes that we take for granted in the U.S. Like putting on a spica cast after perform a pelvic osteotomy for developmental hip dysplasia. I’m so used to seeing this and performing this on a true spica table, but they dont’ have one of those, or they had it and it broke. So they use a long stick, lot’s of plasty, and a thin layer of fiberglass and the results are pretty much the same as seen below:



I have numerous more pictures, but that would make this post longer than it really needs to be. To summarize, I had an amazing experience operating on these kids and they will forever be in my mind and heart. I am more sure than ever that peds ortho is the field for me and I’m excited about the prospect of spending a more long term mission period overseas once I’m done with my training in the U.S.

Santo Domingo

July 5, 2014 by DoctaJay

Once again I am writing this post in an airport. I’m currently on my way to Santo Domingo, in the Dominican Republic for a 10 day mission trip. There is a hospital there dedicated primarily to pediatric orthopaedics, and my mentor from Loma Linda as well as a great peds orthopod from Ohio will be there to show me what missionary life overseas can be like. Of course I’ve gone on multiple missions before, but never from a true medical/orthopaedic standpoint. I’m really excited to meet the patients, I’m excited to see their lives changed after their limbs are fixed, and I hopeful that I might make good contacts so that I can return when I am done with my training.

Otherwise, I am now a PGY-4 resident and that technically makers me a senior resident, which is crazy to even hear the words coming out of my mouth. I still remember seriously questioning my decision to go into orthopaedics after multiple crazy nights of call and stress during my PGY2 year. At that time, it seemed like the end of the tunnel was so far away and that I would never get close to achieving my goal. Now that goal is closer than ever and I’m even about to start applying for fellowship this upcoming September. All I can say is that God is good, and faithful, and He sustains you through any and all trials…truly. I will post more, once I get back from the trip.

Pediatric Orthopaedic Society of North America (POSNA)

April 29, 2014 by DoctaJay

So it would seem that I only decide to blog when I’m flying to a conference…perhaps that is true. Right now I am on the plane (courtesy of Southwests $8 WIFI) on my way to the POSNA meeting in Hollywood, CA. This will be the the first POSNA meeting I have been to and the last POSNA meeting I will be able to attend before I attempt to match into a Pediatric Orthopaedic fellowship position in April 2015. By this time next year I would have already known where I will be spending year of fellowship at. This is why I really wanted to attend this year in order to meet some of the giants in the field and hopefully get my name out there and just learn what new and exciting things are being researched in the peds ortho world. It doesn’t help that I get to do this in the sunny 80 degree California weather.

I have spoken in the past about my fears of doing academic medicine and trying to find that balance of advancing my career and maintaining the bond with my wife and kids that I love so much. Since then I have sought much counsel (Proverbs 12:15) and my views of academics have certainly changed. Just like anything in life, you can make academics what you want it to be. You can be the guy who is at the hospital at 4 am everyday who publishes 10 papers a year and becomes a full professor in 8 years. Or you can be the guy who publishes similarly relevant data but prioritizes his family and the time he/she spends with them and eventually will contribute enough to the field to be advanced academically. Being advanced also is probably the wrong goal to have. After talking with a couple of full professors we have here at Hopkins, they stressed that the goal should be to take care of your patient, first. After that comes research, and if you do good research (not necessarily a bunch of research), then you will be progressed. This is comforting to me as choosing to do Peds Ortho mostly directs me towards an academic career.

What has been more pressing on my mind is the apparent conflict between doing academic medicine and going overseas to do missionary work as part of the Deferred Mission Appointee program that my wife and I joined while in medical school at Loma Linda University. It takes time to build a successful orthopedic practice in the U.S. (probably about 4 years), and leaving during or right after those 4 years will basically destroy the practice you built, especially if you are gone for 1 year +. But I also have to ask myself, when God comes again take us back to heaven with Him, what will he put more emphasis on, my academic productivity or my productivity in things spiritual and altruistic. I have to believe it is the latter. But I want to do both equally well; I want to be an academic surgeon who teachers and writes, and I also want to help overseas. I don’t know how set I am in doing a full 3-5 overseas stay. I will have to get more guidance from God on how to proceed when the time comes.

Switching gears (as I don’t know when I will be blogging next), I tend to be incredibly neurotic when it comes to applying for the next academic position in life. So to go along with that, I’ve already chosen a handful of programs that I will likely apply to for my peds ortho fellowship. I may add more, but here is the tentative list:


Pediatric Orthopaedic Fellowship Program
Children’s Hospital Los Angeles
Director: David L Skaggs, MD
# of Positions: 2
ACGME Accredited: No

Rady Children’s Hospital San Diego/University of California San Diego Pediatric Orthopedic and Scoliosis Fellowship
Director: Dennis R Wenger, MD
# of Positions: 4
ACGME Accredited: No


TJU/ A.I. duPont Hospital for Children-Pediatric Fellowship Program
Director: Suken A Shah, MD
# of Positions: 3
ACGME Accredited: Yes


Children’s Healthcare Of Atlanta at Scottish Rite Hospital
Director: Michael T Busch, MD
# of Positions: 2
ACGME Accredited: Yes


Johns Hopkins Bloomberg Childrens’ Hospital Fellowship in Orthopaedic
Director: Paul D Sponseller, MD
# of Positions: 1
ACGME Accredited: No


Pediatric Orthopaedic Fellowship
Boston Children’s Hospital/Harvard Medical School
Director: Young-Jo Kim, MD
# of Positions: 3
ACGME Accredited: Yes


Pediatric Orthopaedic, University of Minnesota Program, University of Minnesota Medical School/Gillette Children’s Specialty Healthcare
Director: Kevin Walker, MD
# of Positions: 1
ACGME Accredited: Yes


Children’s Hospital of Philadelphia Orthopaedic Clinical Fellowship
Director: John P Dormans, MD
# of Positions: 4
ACGME Accredited: Yes


Dorothy & Bryant Edwards Fellowship in Pediatric Orthopaedics and Scoliosis
Director: Daniel J Sucato, MD, MS
# of Positions: 5
ACGME Accredited: Yes


Paediatric Orthopaedic Fellowship The Hospital for Sick Children

Director: Unni Narayanan, MD
# of Positions: 2
ACGME Accredited: No


The application season opens up in September 2014 and interview time is usually from November to March. I will keep you posted on how the process is going.


March 14, 2014 by DoctaJay

I’m currently sitting in the airport in New Orleans after the 2014 AAOS Annual Meeting and I must admit that I’m entering a better stage of clarity in regards to what I want to do and be when I grow up. One of the main questions that need to be answered  as a resident first is what sub-specialty are you interested in and next and equally important is whether you want to go into private or academics. I’m currently on my Foot and Ankle rotation at Union Memorial Hospital and its very cool. I can honestly say that I’m finally understanding the biomechanics of the foot and ankle and the various tendons that run through it. A significant amount of our residents have decided to pursue Foot & Ankle for fellowship due to the combination of the great teachers we have in residency, the nice lifestyle, and the great compensation. I could possibly see myself doing Foot & Ankle, but I don’t like the idea of being limited to one area of the body, and I also don’t like diabetic feet. So I have basically been between Spine and Peds, and I’m pretty comfortable now with the concept of doing Peds Ortho with a emphasis on Peds Spine. When I consider taking care of kids it just plain make me more happy, and thats what matters it the end. And if I do Peds I still get to do Foot and Ankle procedures, I still get to work on the hip, I still get to work on the pelvis, I still get to do trauma, I still get a little long term follow-up, etc. Its just seems perfect. I’m happy to know what I will hopefully be when I grow up and now efforts need to be focused on applying for fellowship and successfully matching. The madness never stops!

AO Trauma Course- San Diego

October 25, 2013 by DoctaJay

I am typing this on the plane to San Diego for the AO Basic Fracture course. This is a course hosted by the AO Foundation to teach residents the fundamentals of fracture fixation. Most orthopaedic residents go to this course during this PGY-2 year, but at Hopkins we have very little free time to do anything but work, piss, and sleep during our second year, so my whole class is going during our PGY-3 year. Its actually kind of cool this way because I have already done a significant amount of trauma, so most of what I go over in this course will hopefully be tips and tricks to tighten up my skills and knowledge. Or I could be totally wrong and end up learning all new stuff.

In terms of work, I am currently at the Bayview Hospital which is comprised of mostly Joints and Trauma. My joints attending runs two rooms and once he is confident that you know what you are doing, he lets you do much of the case. He likes doing the anterior approach for his total hips which has pretty cool anatomy. After about 5 weeks now on the Joints service I can confidently say that I do not want to be a Joints guy. Here are my pros and cons:




Very regimented and predictable Not enough variety. Every day I know that I either going to do a knee or a hip and I’m going to do it the same way I did it yesterday and the day before
Patients do extremely well often postop Reimbursement not rising, meaning you have to do more cases to maintain salary
Growing patient base as babyboomers retire When joints get infected that really sucks
Pretty good lifestyle as often times you can be done with 5-6 cases by 5pm (good for family) You don’t get to operate on kids usually. Everyone is old


What I can say that I have taken away from my time on joints is really solidifying my approaches to the hip. I’ve become quite comfortable with the anterior and posterior approach and I am starting to cozy up to the lateral approach. Knowing this approach and anatomy well will aid in a variety of cases that I might do in the future, even if I’m not putting in a total joint.


My next block is my first research block and I am so freaking pumped!!!! At Hopkins, Orthopaedics is the only surgical department that doesn’t require 1-2 years of research as part of residency. This is great in that I can go right into practice or fellowship after 5 years, but it is not great in that they still expect you to be productive academically. So in reality, much of our research is actually done when we get home on any normal night and then we really hit it hard during our research block. I really like the academic environment in that it keeps you on your toes as you are constantly challenged with tough cases or by questions from your residents or medical students. Like I have said before, I have had so many amazing mentors who have brought me to my current position, that I feel an obligation to follow the same path, particularly for minorities who may not have any attendings who look like them and understand their world view.


I have about 4 projects that I’m actively working on. My hope is that by the time I graduate I would have about 6-7 publications, with about 4 being first author. Some residents in my class are much more diligent with research and will likely graduate with 20 publications. Initially I was really perplexed by this and felt inadequate, but just recently actually I came to realize that for what I want to do I can’t look to others or else I will always come up short. I have 2 young kids and a wife who is also a resident. When I come home there is no silence; I am constantly pulled in multiple directions whether it be pillow talk with my wife (which I want to do), reading to my kids, playing with my kids, studying for cases the next day, reading articles for journal club, working on research projects, taking out the trash, etc. Which one of these activities do I do first when I get home? I really  envy the single guys who can come home to relative silence and just read or knock out another paper. I suppose the grass is always greener and some single residents would prefer to come home to a full house, but there is no question that from a residency standpoint you have the capability to be extremely productive academically if you are single. Us married guys do our best to keep up, and folks with kids have to try even harder. My hope is that whatever I get done will be enough to give me a strong CV by the time I apply during my PGY-4 to fellowships.


The fact that I’m even mentioning fellowship is crazy to me, but by this time next year I would have already submitted my applications for whatever subspecialty I decide on. It was just yesterday that I was jazzed about having a long white coat for the first time, lol. When people ask what I want to specialize in I still say that I’m between spine and peds. I’m hoping that by the end of this year, when I have done a little Hand and a little Foot and Ankle and a little bread and butter Spine I will have a good Idea of what I want to be when I grow up.

The Tea Party can Destroy the best of them

October 13, 2013 by DoctaJay

Gifted hands with an unbelievably ungifted mouth. I don’t even think Palin could have made a statement so unintelligent. One day he is going to wake up and realize that the tea party and Fox news really don’t speak for most of moderate Americans. My respect is gone.

Steinman Pins…SMH

October 6, 2013 by DoctaJay

Note to self, Steinman pins shouldn’t impale your hand.

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To make a long story short. While helping a junior resident put in a femoral traction pin, it ended up going through my 2nd web space through and through. Thank goodness he didn’t have Hep C or HIV, and thank God it didn’t get one of my digital nerves or fracture my proximal phalanx. Ortho can be rough some times, lol.

Destroyed by Call

August 16, 2013 by DoctaJay

There are not many ways to describe what getting killed on call feels like, but if you are a resident at Hopkins long enough you will find out. On this past Sunday I truly learned the definition when I received 20…yes I mean 20 NEW CONSULTS. It got so bad that the pediatric ER physicians who kept consulting me started to offer me food and caffeine because they realized that it was just me and there were like 15 kids alone waiting to be seen. This actually is not a very common occurrence at Hopkins; usually a good call night is about 10 consults which still keeps you busy because you are also attending to the other patients who are actually on the floor. We used to have a physician’s assistant helping to handle the floor stuff, but now we don’t…and being alone just plain sucks. But the call is over, and the only said part of it all is that I didn’t even beat the record which was 23 consults. Once you hit the 20s, 3 more doesn’t feel as painful.

Every time I log onto my computer I feel guilty at not blogging. There is just so much that occurs each day, and so little time to discuss it. From what I can tell, I may be the only blogger out there who is in orthopaedics residency that blogs with some consistency, besides my old classmate from Loma Linda who has a blog which is much more entertaining than mine: So because of that I feel some responsibility to keep it going, but with two kids, a wife, the orthopaedic intraining examination (OITE), research projects, etc. going on, its hard to find the right balance.  

I am currently on my Pediatric Orthopaedic rotation, which is by far our busiest service primarily because of Dr. Sponseller who doesn’t receive his sustenance from food or sleep by operating. He is a machine and has been unbelievable successful in his career. Every time I operate with him I want to be more like him, but know that I likely never will, but being at least close will be better than most everyone else. The only reason why I have time to blog today is because he is on vacation this week; next week when he returns we will get very busy again so I will likely be a bit silent.

So far, I have really been enjoying my pediatric orthopaedic rotation. One day we could be pinning a supracondylar humerus fracture, the next case we could be performing a pelvic osteotomy for hip dysplasia, and the next day we could be doing a 15 level posterior spinal fusion down to the pelvis. Its the mix of trauma cases and spine that really draw me in; as well as the patients (kids) are pretty fun once you get past some of the neurotic kids. For instance, 2 weeks ago, I was on call and I got a consult for a hand laceration in a in a little girl after she dropped a glass bowel which shattered. The Pediatric ER wanted me to rule out a flexor tendon laceration, but in truth they are just afraid of stitching lacerations. So I saw the little girl, and to make her feel more calm I honed in on her Dr. McStuffins sticker and asked her whether she had seen the show. We talked about Dr. McStuffins for like 2 minutes and then she let me examine her hand. I looked at her  hand with my loupes and found that she just had a laceration to her skin and subcutaneous tissue. Under conscious sedation I washed her hand out, stitched it up and placed her in a bulky mit with a volar slab splint. Well one week later when, they returned to my hand attending for a wound check, apparently they were so pleased with the interaction that they left me a card, which I will cherish forever. You can see it below:

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I still have 4 more weeks on Peds to make my decision between this sub-specialty and spine so we will see what happens. On other news, my son turned 1 years old 2 weeks ago. He is walking, running, climbing on top of the table, etc. It is such a blessing from God to see him grow up like this. Every time I get discouraged with residency and feel inadequate as a doctor or a surgeon I think of them and realize what its all for. I praise God for my wife too. As smart as she is, and despite what her actions might mean for her “career” as a physician, she has made it her priority to make sure that our kids and our household are where God would have it to be. If I was married to someone more like myself, my kids would likely suffer because there would be no one smart enough to realize what their work ethic was doing to their family. Finding a spouse that fills in your weaknesses is an amazing thing.

Well I have to wake up tomorrow morning to round. I will hopefully blog a bit later.

I demand proceeds

July 14, 2013 by DoctaJay




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I was notified by one of the nurses at Johns Hopkins Bayview that I was on their website. I don’t ever remember a picture being taken of me so I joked and said that she needs to stop getting all of us black people mixed up. Well low and behold, she emailed me to URL and I am on their website, doing what I always do, working on my iPad mini. I don’t even remember a camera man being on the floor. Hopefully I will be receiving a cut of the profits that this picture is sure to bring lol.

Now that I am a PGY 3, I have more time to actually breath. I hope to blog much more than last year and hopefully in my next post I will be able to talk a bit about the hell of my just finished PGY2 year.

My Last Call as a PGY-2

April 18, 2013 by DoctaJay

Today marks my last in-house call as a PGY-2 at the downtown hospital!!! Only a PGY-2 would understand what it is like to be done with in house calls at your main hospital. I know many will think, “But wait, it’s still April, how can he be done with in-house call?” You would be correct in saying that I can’t truly be done with ALL in-house call yet, but I’m done with the really stressful part. Like most academic ortho programs you have your main hospital like Johns Hopkins, Emory University Hospital, UCLA Hospital, etc which is where you do most of your call as a PGY-2. But all of these academic programs also have their residents usually rotating at surrounding hospitals where you get to operate with a lot more autonomy, the attendings are happier, and it’s not a Level 1 trauma center so that call is more manageable. At my program that “other” hospital is called Johns Hopkins Bayview, and it’s about 15 minutes away from Johns Hopkins Downtown (the historic hospital where Halsted and Osler practiced). The atmosphere between the two hospitals is like night and day; when you walk into the downtown hospital everything and everyone is high stress, darting to and fro, not smiling much. At Bayview, the security guard always greets you with a smile and a good morning, the cafe food is actually edible, the OR runs more smoothly, the Boards in the morning after you are on call is not a reenactment of the Spanish Inquisition, etc. So yes, today I am done with my last Johns Hopkins Downtown call as a PGY-2, and next month I move on Johns Hopkins Bayview…I can’t wait!!!

As an aside, I was talking with one of my old LLU SOM classmates who I respect a lot who matched into Ortho at an amazing program. We were both talking about how crazy this year is and what a toll it is talking our our families and more importantly, our spiritual lives. Now generally my friend’s spiritual life makes mine look like a total farse but he was relaying how difficult it was for him because not only was he dealing with the general stress of residency, but he had a wife and kid and no family around to help. As I look back, that is one thing that I am truly grateful God for, and that is living at least 40 min away from our parents on both sides. When you are a resident and you have a spouse and kids, you will not see them, much. You will also run into multiple situations where you thought you would be home at 7pm, but another consult came in and now you are coming home at 9 pm. Having a regular nanny would be impossible because you are usually at the hospital by 5am and you get home when ever the hospital prison guard decides to release you. My wife and I are blessed to have family who agreed to live with us and watch our children. With my wife being an OBGYN resident we have even less time for our kids and everything else. But after a rough week it is so wonderful to go to my arents house on the Sabbath, chill on the couch, and eat food that I nor my wife cooked, while my cousins play with our kids.

For those that are looking at future residency positions in ortho, don’t discount how important location can be. Matching into any ortho program is a huge achievement, but at the end of the day when you are super stressed you want to have those who you love and care about close by.


P.S.- that is of course not me jumping in the photo above as I have not exercised in 2 years due to residency. Hopefully PGY-3 yr is better.

My last 3 days

April 1, 2013 by DoctaJay

The last 3 days gives you an idea of what it’s like to try to balance Orthopaedics and fatherhood and your spouse.

On Wednesday I got up and into work by about 6:30am. Which is great because as an intern i was was getting in much earlier. I printed out our patient list to see if any new people were admitted to our service overnight. I also started going through our EMR to make sure folks didn’t have any new PT notes or event notes written. Then I went down to “The Boards”.

The Boards is the official name for the presentation of all the inpatient and ER consults that came in overnight. It is held in our conference room in front of our orthopaedic trauma, pediatric, and hand attendings. At many institutions this is done more privately in front of a computer with the on call attending and the on call resident but at Hopkins we believe in pizazz, lol. No really, while it is more stressful to present in front of all of your attendings and fellow residents, I believe this process better prepares you for what you will experience during your oral boards. So what is a boards presentation like? Well I was taught that a boards presentation should be done all in one breath, and provide enough information to satisfy most attendings questions but not provide so much information that you portray that you know it all making you a target for very difficult questions. For example( this is made up and does not reflect a real patient I saw):

This is a 35 yo female who twisted her ankle while walking in snow and sustained this closed, neurovascularly intact L Weber B ankle fracture. Stress views were negative. She was closed reduced and placed in short leg Bulky Jones splint.

And of course while you are saying all of this you are showing your pre and post-reduction films to the audience. If you are lucky and presented clearly and your reduction looks good you won’t get further questions and you can present your next consult.

As an aside the board presentation should include all the aspects of a regular Orthopaedic presentation:
1. Age and pertinent PMH
2. HPI including mechanism of injury
3. Physical exam
4. X-rays
5. Procedure
6. Assessment/ Plan

Okay so back to my original post, I went to the board and heard all the consults that came in overnight. Since I was on call that day I grabbed the call pager from the previous on call resident and went to clinic. We had about 40 patients in clinic and so we got to work quickly. Of course I’m still holding the call pager so I would have to leave intermittently when a pressing consult came through. By 5 PM we were done with clinic and so I went to the floor to get sign out from the trauma, peds, spine, and hand teams so that they could go home. By 6.30 pm myself and the overnight PA had the pagers and we set out to take care of patients that were post op.

The consults started rolling in around 8 pm the most concerning of which was a compartment syndrome of the hand with multiple phalanx fractures after a crush injury. This case had to be rushed to the OR immediately and so I was operating from 11pm to 3:30am with my hand attending. After I got out of the OR I saw a couple of other ER consults and them from 4:30am to 6 am I was writing consult notes based on what I had seen overnight. Then I rushed to get my board presentation with accompanying X-rays together for 6:45am. Boards went well and I then joined my normal trauma team for rounds from about 7:30 to 8 am. Afterwards I had to see more consults that had come in before the pager hand off time which was 7am. Afterwards we had grand rounds and teaching which went from 7am to 12 noon. You have no idea how hard it is to stay up for 4 hours of lecture while post call and not getting an ounce of sleep the whole night. So yeah my head was definitely bobbing through out lectures.

After lectures I went home and and my beautiful daughter and handsome son were playing in the living room. Honestly seeing them really makes everything worth it. I played with my kids for about 1 hr and ate some Jamaican bun and cheese that my grandma made for Easter. Then I went upstairs and collapsed in my bed, sleeping until 8pm. I woke up at 8 pm and talked with my wife about her day and helped her pack for our trip to Huntsville, AL for our college alumni weekend. She was leaving earlier with the kids because I had to work the next day until at least 5pm. So I helped her pack the suitcases and put the kids sleep. The next morning was our trauma team post-op conference which involves the PGY-2(me). In this conference the PGY2 gathers together the X-rays for every patient we operated on from last Friday to the next Thursday and presents them to the attendings in the standard format. We look at the preoperative films and the post operative films and discuss a variety of things including indications for surgery, nonop reduction techniques, approaches for getting down to the fracture in question, relevant anatomy, the various types of implants that were used, and what their post op plan is like weight bearing status, etc. As you can imagine this takes hours to get together and often times you end up reading about more than what the attendings pimp you about but it’s great to learn from.

After post op conference I went to the OR and we had a couple of cool cases like two weber B ankle fractures, a retrograde femoral IMN, one modification of a Taylor Spatial Frame, etc. They let me leave at 6 pm so I could get home earlier to pack for my trip to Huntsville. I jumped on the plane to Huntsville and arrived by midnight. The next day I went to church and enjoyed the alumni weekend festivities. On Sunday I went to the board meeting for a missionary group called NAPs ( and then I hopped on the plane back to Baltimore, again arriving back in Bmore at midnight.

I slept for 3 hours and got into work by 5 am because I was on call that day… Another 25+ hour shift.

Reminiscing about Medical School

March 23, 2013 by DoctaJay

I think I mentioned it before but my wife and I were part of a video series produced by the Loma Linda University School of Medicine on what it is like to go through 4 years of medical school there. This video is a snippet of the what the full video series entailed:

Everything Up to Yesterday

March 23, 2013 by DoctaJay

Wow it has really been a long time since I have had a second to post anything. When I was a college student I used to get really annoyed at reading the blogs of residents because they never seemed to update it enough. I just couldn’t understand why they would be so unreliable with their posts; of course now that I’ve become one of those residents I have a new found respect for folks that can keep up a steady blog, ready their material for their cases, take care of their family, do research, sleep, etc.

Pediatric Orthopaedics

The last time I blogged, I was about to start my Pediatric Ortho rotation and I was pretty excited; well the rotation came and went and I really had a good time. Peds Ortho was the specialty I was automatically placed on when I was a Sub-I, so it was interesting returning again as a PGY-2 with new found responsibilities. Our Peds rotation is extremely well organized but also very busy. My day usually consisted of me getting to the hospital by 5 am and getting our patient list together. Some programs are lax with the list, but not Hopkins. The patient list is the holy grail of tediousness, and if there is a period missing then you have officially failed in your chief’s mind. After the list is done, then you go to lectures, where one of the attendings goes through a pertinent topic like slipped capital femoral epiphyses (SCFE) or idiopathic scoliosis or skeletal dysplasias. After about an hour of lecture, then you run to the OR, and  the variety of cases is what always amazed me. In one day I might do 2 posterior spinal fusions on kids with adolescent idiopathic scoliosis (AIS) or neuromuscular scoliosis, etc. Or in that same day I could do a posterior spinal fusion, a surgical hip dislocation, a pediatric physeal sparing ACL reconstruction, and a polydactyly removal. And the best part is that the kids usually do really well; even if they are pretty sick they usually leave the hospital in their parents car, not via the morgue. I also really enjoyed clinic days also as you always saw such a variety of cases. Sometimes it would be just a kid with a fracture that was treated with a cast that you are checking up on, or a kid who is post-op from pelvic and femoral osteotomies to fix hip dysplasia, or a 15 yo girl who noticed that her back is slightly curved and wants to know if she needs surgery, or a kid with cerebral palsy and multiple extremity contractures who either needs a Botox injection or tendon lengthenings, etc. I really enjoyed also how much you are in the OR on this rotation. We have 4 attendings in peds ortho, and usually there are 3-4 OR rooms going with cases, so usually you are in the room with just you and the attending or you and the fellow, or sometimes just you with the attending talking you through the case. And the spines they do are sometimes ridiculous and are cases that most other peds ortho docs would turn away because of the complexity of the curve and their multiple comorbidities.


Now of course everything wasn’t pleasant during my peds rotation, as nothing in residency can be. This rotation particularly required you to read a lot, and finding time to do that while your wife is a resident and you have a 3 month old boy and a 1.5 year old girl at home just isn’t easy. Then of course you are taking in house call (6 am to about 12 noon the next day..aka 30 hours) so on those days you are either slammed down in the ER with consults, or you are being yelled at by your attendings because you are scrubbed in to a case and they don’t want you even thinking about the call pager which is ringing every 30 minutes while you are in the case. Then there is of course the self confidence issue; I realized this the most on this rotation how low my self confidence was when it came to being a resident. Through out most of my academic career, I have been positively affirmed that I was doing a good job; but that RARELY happens in residency. Usually, especially when you are a junior resident, you are only spoken to when you mess up, and it is usually in a tone to sear the message into your psyche so that you don’t do it again. Then of course that starts me down the road (inside my head) of me beating myself up for making a mistake or for not remembering something to the point where I am thinking of it days after the incident. You just cant do that to yourself in a surgical residency, or else you will drive yourself crazy. While I am still learning; I have started to realize that my self confidence can not depend on what I am told by others…I have to have my own internal barometer. While I don’t like the cocky surgeon attitude I need to have some semblence of that in order survive, especially at a place like Hopkins.

So to get back to my original topic, pediatric orthopaedics is now really high on my list of fellowships to pursue. I love doing spine surgery, especially on kids since they usually aren’t chronic pain seekers like many adult spine patients; I love the variety of cases;  I like how much the cases and problems make me think and want to go back and read, and while it may sound corny, I really enjoy the kids, even when their parents get a little crazy.

Bayview (Joints and Trauma)

After spending 2.5 months on my peds ortho rotation I went over to the Johns Hopkins Bayview Hospital where we primarily get our joint replacement experience. Bayview is a great hospital to be at, because even though it is still Johns Hopkins, the atmosphere is 100% more laid back than the main Hopkins hospital, and you get to have a lot more autonomy. While at Bayview I learned how to do my first total knee arthroplasty and my first total hip arthroplasty which is kind of the bread and butter of orthopaedics. Joints is an interesting beast because while peds ortho is all about variety, you get really good at replacing joints being doing the exact same procedure, the exact same way, every single time, 2-3 times a day. One of our senior joints faculty handed me  a 100 step paper on how to do  a total knee and told me to know it in a week. It almost seems impossible, but after you do a couple you realize how you become a well oiled machine once you learn the steps and can bang out like 5 joints in a day when you get good. And the best part is that the patients usually love their knee or hip afterwards because they have been suffering from their arthritic pain for so long. I really started to get interested in ortho after my father had a unicompartmental knee replacement, and when I saw how much it changed his quality of life, I knew I wanted to be part of a specialty like that. Bayview is also where I cut my teeth on doing some of my first ER procedures for trauma patients like reducing a distal radius fracture or placing a tibial traction pin. Even though it is a pretty straight forward procedure for most ortho residents, its hard not to look like a bad ass when you walk into a patient’s room in the ER, take a drill with a humongous Steinman pin attached to it, and drill it directly through their  bone while they are awake. Every time I do it, the ER docs and nurses either stare in amazement or cringe in pain while watching. For those who haven’t seen one, below is an example of one that I did for a segmental femur fracture:




Overall, while I enjoyed Bayview I did not fall in love with doing joints. Even though each case was unique in its own way, you are still pretty much doing the same procedure, the same way, in a different patient, 3-5 times a day. I really like more variety than that, which is why I don’t think it is very high on my list. Also, when joints get infected…that really sucks.  And you are stuck with multiple revisions and washouts and the patient really is never the same.

Interestingly it was at Bayview that I was rebuked the most about a spiritual issue. When you get to your surgical residency you will understand that you are always running the around the hospital, whether it is seeing consults, running to the OR to do a case, running back to the floor to take care of a crashing patient, running to the cafe to grab something unhealthy to eat before running back to the OR, etc. Especially as a junior resident when you haven’t exactly become entirely efficient with your time, you are running around even more. I had one particular attending at Bayview who seemed to really like to tear into me for this or for that to the point where I was confident that I never wanted to emulate any aspect of what he/she was like as an attending. But one day, as I was rushing back from the ER just seeing a consult and was taking out the sponge to scrub for the case, that same attending was  scrubbing also. We were both silent while we scrubbed and the only thing running through my mind was what the steps for the upcoming case were going to be, what neurovascular structures I needed to be concerned about, what questions the attending might pimp me with, etc. But my attending broke the silence and out of the blue (and most likely because he knew I was a Seventh-day Adventist Christian) asked me what I think about when I  scrub. I told him the truth; that I was thinking about the case, trying to run through the steps in my head. I thought he would be pleased with this answer and cut me a break throughout the case. But he instead responded by saying that when he is scrubbing, he is praying to God to guide his hands. He is praying that the patient does well, that he as a surgeon makes the right decisions throughout the case to help the patient; that the he helps and does not hurt the patient, etc. Needless to say, I was thoroughly rebuked. First I was a extremely surprised that my attending prayed at all, seeing as how he usually ripped me a new hole every day for one reason or the other. But the fact that he was telling me; who was supposed to be an example of relying on God for everything about praying before a case was humbling. I realized that in all the haste to get ready for cases, I rarely if ever prayed to God. That this rebuke came through this attending made it even more clear that God was telling me that I was slipping and that I needed to come back to Him. It is so easy to get caught up in the “doing” of medicine and surgery that you forget WHY you are doing…you forget what the driving force behind your compassion is. But thank God that when He rebukes it is to build you up, and not tear your down. Since then I have made it a point to pray when I am scrubbing and I truly feel that I have noticed a difference in how I operate and the peace I feel as I do various portions of the procedure.

Orthopaedic Trauma

Currently I am on ortho trauma which besides being on the peds service is one of the busiest rotations. Ortho trauma entails everything that you would think; we take care of all of the crazy adult “bone” trauma that comes into the ER like shattered pelvises, femur fractures, tibia fractures, patellar tendon or quadriceps tendon ruptures, etc. This rotation really teaches you the bread and butter of orthopedics because when you are out in the community, you may not only be taking care of routine sports injuries, but you will likely be taking call somewhere and will need to know how to handle any trauma that comes in. The operations that we do on this service are very cool, but similar to adult spine, the patients often don’t leave you with the satisfaction that you would expect. In big cities like Baltimore, its not the unassuming, pleasant 30 yo teacher who gets into a car accident and breaks her femur. Instead it is the 40 yo chronic heroin user, with hepatitis C, who was walking across the street while drunk, got hit by a car and presents to the ER with multiple fractures. These people are not inherently bad by any means, but they tend to not understand the herculean effort that went into keeping them alive and fixing them, and instead treat you and the nurses poorly while you try to take care of them. On top of that because of their pre-injury social status, they often don’t have the transportion or the desire to make it to their follow-up appointments, and will instead be lost to followup for months, only returning when their wound is draining or when they have a non-union.

But again that is quite a generalization and you do have a nice subset of patients (of all socioeconomic levels) that you enjoy waking up to take care of. I don’t necessarily think my time on this rotation so far has convinced me if I want to pursue ortho trauma for fellowship, but who knows what the future will entail.


Posts coming

March 2, 2013 by DoctaJay

Okay so I figure after 4 months I should probably start blogging again. Life has been crazy. Stay tuned for more posts.


October 13, 2012 by DoctaJay

So right now I’m on my Sports rotation and when you subtract the craziness of balancing family life, Sports is pretty awesome. I basically work with two attendings, one is a big time shoulder guy and the other a big time knee guy. With the shoulder attending I’ve been learning how to arthroscopically evalute the shoulder in the OR, performing debridements, labral repairs, biceps tenodesis, assisting in reverse shoulder arthroplasties, and total shoulder arthroplasties, etc. With the knee attending I’ve been learning how to scope the knee, perform ACL reconstructions both with patellar allografts and hamstring autografts, perform meniscus debridements and repairs, etc.

Our attendings are also the team doctors for the Baltimore Oriole’s (who are actually doing well this year) so that’s cool. They are also the team docs for the Johns Hopkins University athletes, so every Monday we go to their training room and see the injured players and manage their care there.

I now really understand why so many residents go into Sports after residency. You can have a pretty good life, with mostly outpatients, make good money, and still see your family. The one downer I see is that not my folks in 3rd world countries need their ACL reconstructed. So the skillset I would get wouldn’t really help me with my oversea’s mission. But I know I won’t be overseas forever, so its stil something to consider.

In about 2 weeks I switch to my Pediatrics rotation which is what Hopkins is really know for. Peds is actualy at the top of my list of possible specialties to go into so I’m excited to start. Its also an incredibly busy service so don’t expect to hear from me again until Dec. when I switch again.


October 6, 2012 by DoctaJay

So, as you probably guessed from my last post, I’m now a proud father of two kids. My wife gave birth to a healthy boy for which I truly praise God for. When he was born I was truly reminded of the awesome gift that God has given us to create; its a gift that the angels and even Satan were not allowed to have. Almost every day I have to remind myself of the happiness of his birth, because the tightrope balancing act that comprises my everyday currently is almost maddening.

My wife was given 5 weeks after she gave birth to stay with my son. Afterwards she started back on her residency training which wasn’t too bad. We would wake up in the morning, me around 3 am, and her around 4 am. By that time my daughter would have already waken up, walked from her room to our bed, climbed into our bed, and promptly fallen right back to sleep. I would shower, log onto our computer, check labs on my patients, prep their progress notes, etc. If I had an extra 5 minutes I would read a devotional out of the Great Controversey or the NIV Bible. At the same time my wife would be getting ready, pumping milk for our son to drink for the day, packing her lunch, etc. We would have a quick morning prayer together and go on our seperate ways. When we would get home that night, I would normally take my daughter for a walk, then put her to bed,while my wife would take our son, feed him, and put him to bed. This system actually wasn’t too bad, especially with an understanding and loving family member/nanny at home to watch our children during the day.

When my wife started on night float (6pm to 6am shifts), the whole plan went to hell. My day would usually start with me waking up around 3 am with my daughter right beside me after her usual routine of waking up at 2 am and walking from her room to our room. I would bath, log onto the computer to check patient labs, etc, then go to work. At around 7 am, my wife (after being up all night delivering other women’s babies and taking care of them post-partum) would arrive home to #1 a daughter who had gotten a good night of sleep and was now ready to play, #2 to a son who was ready for some good ole milk from the breast instead of the bottle, #3 a nanny who had not gotten any sleep overnight because our son was crying from 8pm to 3 am straight. So my wife fights to get a couple hours of sleep with the baby on the breast and a daughter who is just at the beginning of her terrible 2’s. At the same time, our nanny who did not get any sleep really takes our daughter so that my wife can get a couple of hours of sleep for work which will begin again at 6pm that night. Now I’ve been lucky to be on a light rotation, Sports, so I’m actually home by 5 p.m. usually. If something occurs and I’m home at 5:45 pm, I don’t get to see my wife because she is off to work already. When I get home, I immediately take my daughter while our nanny takes our son. I give my daughter my iPad so that she can be occupied while I try to get a little reading in. But often times she gets bored and wants Daddy’s undivided attention. So I abort studying, play with her, read to her, take her on a walk. Then I try to put her to bed, often only suceeding in putting us both to bed and waking up frantically at 11pm because I haven’t ordered labs for the next day or read for cases. So I stay up until 2 am, wake up again at 4 am, leave for work, again not seeing my wife who gets home around 7 am.

As you can see from my short spiel, it is like walking a tightrope when you have two doctors, both with busy residencies and two young kids. There are many nights that I ask God why He would allow us to have kids if I wouldn’t even have the time to raise them adequately. Then I realize how stupid the question is, as there are thousands of parents who want children but aren’t able to conceive. But my wife and I sure picked the perfect storm when it came to professions and kids. The only way this is even manageable is that we have a family member who is willing to stay and help and we have our parents who can take the kids on the weekends.

When are we supposed to study? As an orthopaedic resident at a program where the residents run the service, the only time to study is at work. I’ve tried to whole studying at home thing and its just not possible when you have a daughter who is intent on being the center of your attention 24×7. So I stay at work for an hour later to read and do questions for the upcoming OITE. What does this mean of course? It means that my nanny and my wife are taking the heat while I study. It means that I can’t do this consistently or my wife won’t get much time to study. It means that we are just screwed for now while my wife is on night float. This is the reality of the two resident physician home. If either of us were doing a peds, internal medicine, PM&R, etc residency, life would be better. But we aren’t.

I am not at all dissuading other couples from going the same route; just know that you will have to be okay with either 1 of 2 things, #1 excelling at parenting while not excelling at work, #2 excelling at work while not excelling at parenting, i.e.-someone else is raising your kids. We are lucky in that our nanny loves our kids as we love our kids  so we are confident our kids will be taught the right way, but its hard to let someone else do your God given job. Also when you are in a surgical residency, you really can’t be content with not excelling because if you suck at work consistently, then you get on the attending’s radar, if you stay on the attending’s radar for too long, then you could get fired. And then you really won’t be able to provide for your family.

And let’s not even mention the other things like #1 when do you cook dinner #2 when do you exercise #3 when do you go grocery shopping #4 when do you have time to be intimate with your spouse #5 when do you have time to deeply study your Bible…and the list goes on.

So in summary, life is pretty tough right now. But God would not give me anything that I couldn’t handle…its just hard to realize that while you are in the midst of it. I find solace in that my kids are too young to remember how much their parents are gone, but its still tough. Anyways, thats whats going on on the family front.


July 31, 2012 by DoctaJay

Its unbelievable that I haven’t posted in 4 months, but such life when you are balancing a surgical residency and a family. So much has happened since April:

1. May 2012: This was my last general surgery rotation and it was pediatric surgery. It was actually a breath of fresh air finally getting a chance to take care of kids instead of adults, but this is Hopkins so the kids tended to be medically more complicated than you would think, but it was cool regardless. I actually got to operate a good amount on this rotation but in general this rotation confirmed that I chose Ortho well because none of the procedures really got me excited. Case in point, my rotation culminated in that the very last general surgery operation I took part of was a manual disimpaction (of stool for the uninitiated) in the OR which took ~ 2 hours!!! Needless to say I was happy to move on to Ortho.

2. June 2012: This was the best month of residency because I was on Anesthesia, and those guys generally have better hours than us surgeons. I actually had a chance to hang out with my daughter and bond more with her while my wife started her orientation for OBGYN residency. Since I hadn’t had a vacation since the first 2 weeks of residency, it was nice to have this rotation before the hell of PGY-2 started.

Now I am 1 month into my second year of residency and they were not lying when they said it was the hardest and most painful year. Intern year was actually a cake walk in comparison because when I was an intern on my Ortho rotations, they knew I didn’t know much so their expectations were low and the residency work hours limited me to about 16 hours a day. When I was an intern on General Surgery they knew that I didn’t plan on being a general surgeon so their expectations were low and of course our hours were great because of the ACGME rules. Now that I’m a PGY-2 I have taken my first bevy of 30 hour calls and it literally saps the life from you. The adrenaline of seeing patient’s in the ER and reducing fracture after fracture keeps you going but then when you sit down to write a note your eyes start to get very heavy.

Don’t get me wrong, I am so happy that for now on I will only be seeing patient’s with orthopaedic issues, but the biggest problem I’ve had being a PGY-2 and taking call is that its almost impossible to get through the 30 hours without pissing off someone, whether that be your attending, chief, an attending in the ED, one of your co-residents who wanted things done a certain way overnight while they slept, etc. It also sucks because each consult takes you forever to complete because you have to look up everything in the Handbook of Fractures and then figure out how to put it into practice. Then there is the dance of trying to figure out whether you should call and wake up your chief to ask for help. You don’t want to be a maverick and possibly do the wrong thing for the patient, but you also don’t want to call your chief for every consult you see.

Honestly I’ve lost like 10 lbs this month just from stress and lack of time to eat. But I’m not complaining; this is what second year is about..its a steep learning curve and by the end of this year there won’t be many fractures that I will have trouble dealing with, and I will also be used to the general level of sleep deprivation that surgical residents live under.

I’ve still struggled to balance all of this with maintaining my spiritual and family life. I usually don’t have any time to sit down and have a long, in-depth devotion, but having apps like the Tecarta NIV Bible on my phone the E.G. White app has allowed me to get quick devotions in between surgical cases or during brief down times through out the day. As for the family part, I try to at least get home before my daughter goes to sleep. If I do then I put her to sleep to at least spend that time with her. And of course on my post call days I try to spend as much time with her and my wife as possible. But its difficult, and it will always be difficult; all one can really do in a 2 physician family like this is always strive to spend time with each other. Eventually it will happen.

When I’m not on call, I’m on my spine rotation and I actually really like it. Again, I’m at Hopkins, and so the spine cases are often crazy 12 hour cases. Meaning that the cases I’m scrubbing into, like a T1  to sacrum  posterior spinal fusion with a vertebral column resection of T10 and multiple osteotomies, with 6 L of blood loss, etc just isn’t the type of stuff most spine surgeons would do in their practice. I really like seeing a patient come in with terrible degenerative scoliosis and after a marathon surgery leave the room with a virtually straight spine (in the coronal plane of course). If I became a spine surgeon I don’t think I would do cases that are as long and as complex as my attendings here, which is fine. My only reservation is again keeping my future mission plans in mind, I’m not sure that spine surgery would make much sense as it requires a high level of hospital care (anesthesia and ICU) which will likely not be available in rural environments. But I won’t be overseas forever and so whatever I do when I come back to the states, I need to be able to enjoy.

In other news my son will be born tomorrow (planned induction) so I’m super excited. Keep us in your prayers that the delivery is uneventful.

Resident Stuff

April 13, 2012 by DoctaJay

So I noticed that over the past couple of months I haven’t commented on what I’ve actually been doing as a resident. Starting in late December I began my general surgery rotations that are required as part of my orthopaedic surgery residency. It is kind of the luck of the draw in terms of which particular rotations you get but mine worked out to be 1.5 months of Vascular Surgery, 1 month of ICU, 1 month of Plastic Surgery, 1 month of Surgical Oncology and Endocrine Surgery, 1 month of Trauma Surgery, and 1 month of Pediatric Surgery. The last rotation of my intern year is actually anesthesia which is wonderful because its a low stress rotation and will allow me to rest up before the infamously terrible ortho PGY-2 year arrives.

Plastic Surgery

I already commented on my time on Vascular Surgery and ICU. Plastic Surgery was truly a pleasant surprise. I must admit that I had no true concept of the scope of operations that plastic surgeons performed, but my month plastics opened my eyes. They were doing masseter nerve transfers for kids who lost function of their facial nerve after a tumor was resected to breast reconstructions, to repair of carpal and phalangeal fractures to closure of complicated spinal wounds, to in utero repair of spina bifida defects, etc. They did so much more than just the characteristic comestic surgery and they truly do work everywhere on the body. I loved the variety of sutures and the realitive healthiness of the patient’s which is what also drew me to ortho. During one of my last days on plastics one of the attendings liked my closure so much that she said I should consider switching to plastics, lol. I must admit, there really weren’t many other fields I liked besides ortho but after this month I could definitely have seen myself doing it. I don’t think I had the medical school grades to get into plastics, but I found out that you can actually do a plastics fellowship out of any surgical residency, including ortho, ENT, general surgery, etc. Doing another 3 years of plastics after my 5 years of ortho really isn’t palatable to me, but it was nice to fancy the thought for a bit.

Surgical Oncology/Endocrine Surgery

If you lined me up beside 1000 other ortho and non-general surgery surgical residents I would likely be ranked close to number one in terms of my disinterest in bowel surgery. So clearly I was dreading have to go through all day Whipple cases. However I was somewhat pleasantly surprised that most of the cases I scrubbed in on during surgical oncology were related to liver resections and I had no idea how cool liver surgery was. Our attendings here both preferred open approaches so I got to look directly at the biliary system, hepatic veins, and portal venous system. One time we were resecting a tumor that had incorporated itself into both the liver and the IVC that ran through it. When we got the last piece of tumor out a small hole appeared in the IVC and boy…DAT MOFO CAN BLEED, lol. I definitely have to give it up to general surgeons who on a day to day basis deal with life and death situations and barely break a sweat. Coming into medical school I thought I wanted to be that guy, but I’m too much of a softey to have my patients die on a somewhat consistent basis. Ortho is definitely for me, but again I was pleasantly surprised by the Hepatobiliary Surgeons here.

As for Endocrine Surgery, I must admit that the thyroid is by far the least exciting structure in the body. I guess what really made me not like the cases was that the field was too small. Every tool was itsy bitsy tiny, and you had to constantly worry about retracting too much. This is probably the reason why hand surgery so far hasn’t appealed to me. Who knows, that could all change.

Trauma Surgery

This is the rotation that I am currently on and its amazing how variable my night could go (I’m currently doing 5pm to 5 am shifts). One night this past week, we had like 3 gun shot wounds come into the ER; they all came in as trauma arrests so the room is just full of people doing compressions, placing lines, putting in chest tubes etc. They all ended up passing away which was terrible…more dead black Baltimore 20 year olds. I can see how people who do this stuff for a career can get jaded. Moving on, last night, when I was on, there was not 1 trauma and the nurses decided not to page me for anything on the floor patients. So I stayed up and watched documenteries on Netflix and slept a couple of hours. You truly never know what the night will bring on trauma surgery. So far though I like it because again it teaches me how to take care of pretty sick surgical patients and it also gets me back to interacting with my ortho brethern since we consult them often.

Yesterday, Johns Hopkins dedicated its new, 1.1 billion dollar hospital:

We move into the hospital on the 29th of this month and guess who the administration has volunteered will wheel the patients from the old hospital to the new? Of course the interns; we have expertise in this sort of thing lol. Honestly though the process is supposed to be pretty straight forward in terms of when we are to transport a patient to the new hospital but I just forsee huge mishaps along the way. Its my hope that no patients get lost or misplaced :-).

The hospital has 6 trauma bays decked out with all sorts of technology. The ER is huge and should hopefully alleviate me having to see patients in the waiting room as I have often had to do. What this means for me also is that after spending all intern year learning how the Hopkins system works and where to find everything, I will have to relearn it again 2 months before the new interns arrive. But you can’t impede progress and quite honestly it will be cool working with stuff that is finally brand new.

There there ya go, that has been my general surgery experience so far. In other aspects of my life, my wife matched into an OBGYN residency in Baltimore City so I am still praising God for that. We also are moving out of downtown baltimore and into the suburbs of the city which are much nicer than anything you have seen on TV about Baltimore. Anyways, I will report back on any new events that occur in my residency.

Trayvon Martin..My Son?

April 5, 2012 by DoctaJay

Above is an ultrasound of my next child, a boy! The excitement I have felt about this new addition to my family is somewhat hampered by the knowledge that I am “unfortunately” having a black boy. When I first saw the story about Trayvon Martin, the very first thing that entered my mind was that that easily could have been me. I know it sounds cliche, but when I take off my white coat and my scrubs at the end of the day, and walk out of the hospital in my hoodie and jeans, I look like any other black Baltimore man. And for many people that means I am more likely to try to rob to or attack them than give them fix their fracture. I’ve seen their eyes as I walk through the parking garage without my hospital garb. They clutch their purses tighter or the walk faster to the crosswalk that takes them to the hospital in hopes that they can get there before I “might” do something to them. It doesn’t matter that I have a terminal doctorate degree, that the last time I got in a fight was in 4th grade, that I’m more concerned about getting home to my family than going after their purse.

This event reminded me that still in 2012, another black child dead is less important than if it happened to someone of a fairer complexion. It reminded me that the world I am bringing my son into isn’t much different than the one world that Emmett Till grew up in. There are still many details to be discovered and it may very well be that Trayvon, after being approached (a fact which is not in dispute) went on the offensive. But even if he did, the fact that he didn’t have to be approached in the first place makes the loss for his mother even more difficult.

I’ve only been able to come this far secondary to all those who sacrificed their lives before me. If we don’t make a stand now and make sure that people know that they can’t get off easy by killing our sons then we have truly disgraced those who have sacrificed all before us.