Missionary Orthopod in the Making

I don’t know what happened or why I wasn’t warned by my classmates, but now that I am nearing the end of my 3rd year, pediatrics seems to be the most difficult rotation that I have been on. Truly it is internal medicine for kids, but its even more. I feel like when I was on Internal Medicine and I was on call and in the ED admitting patients, the admit would only take about 30 min tops. But each and every pediatrics admit takes 1 hr plus. I think the majority of my time is actually spent writing the admission notes because they want me to be more detailed than I have been on any other rotation…even psych! In addition to that, the majority of folks that I have talked to said that the pediatrics shelf exam is by far the most difficult, even more so than medicine and surgery. It just shouldn’t be this hard, but it is. I am so looking forward to being done with this rotation and getting on to family medicine and 4th year.

Today I had the chance to meet with an ortho attending who just recently stopped being the chair of the ortho dept. here at LLU. I had rotated with him for a week during my junior elective and he said that it was enough time for him to know me enough to write a LOR. So I set up a meeting with him so that he could get to know me a little bit more before he writes the letter, and also to give him my CV and PS. We had a really good conversation about a variety of things including the reason why they let go the last black resident. This attending was the first person that was able to give me a clear answer, and afterward I truly felt more comfortable about the whole situation. I now have less concern that there was anything racial about the decision, and I now have increased confidence that that resident’s performance will not affect how they look at me as a future resident. So yeah, I should be getting a good letter out of him.

I am still increasingly anxious about this upcoming application cycle for residency, and I am sure that alot of that anxiety comes from my lack of faith in God that He can, and always has guided me exactly to where I needed to be. I don’t know why I go through these periods of doubt whenever another big application or test comes…but whatever. All that I can do myself to to work hard, show diligence in my school work and in the hospital, apply on the first day possible, show them my character on away rotations, and leave the rest to God. It’s so hard to say that, but truly I have to leave the rest to God and TRUST, that he will come through for me.

Rather than close down my whole blog during this app process I’ve decided to password protect the posts where I am talking about the app process directly. You can get the password from me if you know me well enough to send me a text message or email. Otherwise, just wait until March 2011 for Match Day and I will unlock all of the protected posts.

Yesterday I was walking outside the hospital (in my dress up clothes and short white coat ) and a little girl was sitting on a bench with her grandma. As I got closer to their bench the little girl jumped up air ran towards me. She then presented me a beautiful rose that I suppose she picked from a garden around the hospital. She said, “this is for you doctor “, with a huge smile. The grandma smiled also and told me that she really loves doctors. I accepted the flower and continued to my destination but overall my day was really made already. Sometimes it’s so easy to get caught up in all the things that make medicine suck but when these things happen it reminds me of why I made this sacrifice. So yeah, I was definitely happy for the rest of the day.

So today marks the end of my first 2 weeks on pediatrics and I honestly think its pretty cool. It really is internal medicine for kids, but I think that the pediatricians are truly the smartest and most amazing diagnosticians in the world. They really do have to be able to take amazing histories, and when the histories are spotty, they are still able to observe and discover so much with their thorough physical exam. I have so much more respect for their entire profession. With that being said, these guys make me feel so stupid, because there are like 1,000 different things to remember when it comes to a kid and I always miss like 400 of them. I think the main problem is that I am honestly not good enough yet to do a complete history from my head. I’ve realized that I need to carry around a paper with all the titles of the sections in the history so that I won’t forget to ask about them. Maybe once I look at the paper enough times it will stick. But yeah, a pediatrican can take care of me any day :-).

Other than peds, I am still working on different orthopaedic projects and trying to make sure that I’m visible, but not annoying to the residents and attendings. I had an interesting conversation with the ortho PD here about why they hadn’t had a female or black resident in so many years and he really cleared up alot of misconceptions that I had. Now, I’m pretty sure that there are some programs that really don’t care to have diversity, but from what the PD told me, they had been ranking women in the top 4 and some black residents high enough to match for the past 10 years, but the medical students who were applying didn’t rank LLU high enough so they didn’t match there. And to be honest, its probably a viscious circle, because the women and black medstudents who were applying probably rank LLU lower because they didn’t see any women or black folk there, and so they didn’t match there. And then it repeats the next year. But now that we have 2 female residents at LLU, I think there will be alot more female applicants ranking LLU higher. In terms of black residents, I may be the 3rd that they have ever had…we will just have to see. But the conversation at least made me feel better that they weren’t trying to keep women and minorities out of their program.

In other ortho news I have officially secured all 3 of my away rotations for ortho. I will do 2 weeks here at LLU, then I will spend 4 weeks at Atlanta Medical Center, then I will spend 4 weeks at Johns Hopkins, then I will spend 2 weeks at Howard. I really feel like my choices give me the largest variety and open of areas that I wouldn’t mind living in for the next 5 years of my life. Its always suggested that you do your first rotation at your home institution because they know you and you know them, so you will be more comfortable and you may not be judged as harshly if you don’t walk on water. I am only doing 2 weeks here at LLU during my 4th year because I spent 2 weeks during my junior year and the attendings got to know me well enough then to write a letter for me. Normally it would be advised to spend 4 weeks at your home institution. My next rotation at Atlanta Medical Center (AMC) was chosen because next to being back home in MD, I definitely wouldn’t mind being in Atlanta. Also, AMC is a community program, so its a little bit less academic, more laid back, and they put you into the OR sooner. In terms of difficulty to match there, it doesn’t seem like its on the insane level as HSS or Pitt, so that is good. Also, since you are in the OR so much and there are no fellows I should get alot of orthopaedic experience here to prepare me for my next rotation at Hopkins. My 4 weeks at Hopkins of course is going to be a big one for me because its home. This program is at the top in terms of competitiveness, so it is definitely a reach for me. And then my last 2 weeks at Howard should be great too since there is already a LLU grad there as a resident and its back home too. Also, Howard is at the lower end of the spectrum (like AMC) in competitiveness, so if I do well on the rotation, and they like me, then I will hopefully have a higher chance of matching there.

So I’m ready to get this thing going. And I pray to God that I match!

So yesterday marked the end of my 2 weeks on my Junior elective that I of course decided to do in Orthopedics.  I had so much fun during these 2 weeks that I am absolutely sure now that I want to be an orthopedic surgeon.  Here is how my week went:

3/29- It was my first day with the program director here at LLU and I of course was a tad bit nervous since I didn’t do too well when I worked with him for one day during my actual surgery rotation. I can’t remember if I blogged about this or not but when I worked with him for that one day it was a day of clinic and basically he said that I was going too slow. I also didn’t know where any of the forms were, how to order xrays, how to perform hand exams, or really anything, lol, so yeah I was crawling and he is notorious for really flying through his clinics. So of course I made sure that I got a lot of advice from 4^th years on how to make sure that I excelled with the PD and they were definitely spot on. So yeah, my first day with the PD was in his clinic, and since he is a Hand surgeon we basically saw patients with issues from the elbow down to their finger tips. I was definitely more confident about seeing patients, making a diagnosis, getting xrays, writing a plan, etc. Now I had heard that the PD like to exercise during the 2 hours he takes for lunch between his morning and afternoon clinics, and I heard that particularly he enjoyed swimming. Now I am not an amazing an swimmer but besides playing basketball that is something I really enjoy doing so I asked him if he was going to swim again during lunch and he said yes. I told him that I learned how to swim from YouTube and whether he would mind me coming along. He smirked and said sure. Lol, now I know that this could be considered brown nosing, and to be honest it probably was, but I do like swimming, and whats the harm in swimming with the PD? So yeah we went swimming and I actually somewhat kept up with him although he has a lot better endurance than I do.  I know now why he exercises during lunch, because I felt so energized during the last half of the day.

Unfortunately, I didn’t really do a good job of keeping up with what I did each day, so I will just summarize it. The first week with the PD was pretty good. I felt like I got increasingly better at seeing a patient, evaluating his or her xrays, and figuring out a management plan. It was really odd though, because the PD didn’t pimp me at all, not one question. He did ask me questions like how long had I been married, what I thought of such and such professor, whether I had started my CV yet, etc. He also asked me basically if I was still planning on going back home for residency which is kind of a hard question for a potential applicant to answer, but I was truthful. I let him know that while I would prefer being home with my family, I would certainly be happy if I matched here, which I thought was important to stress. Even more so than how high you will rank them, a program wants to ensure that you will be happy if you match there. Overall I felt like the PD didnt mind me being around because on the last day, when he went out to lunch with the residency secretary and another resident, he invited me along…so I hope that’s a good sign.

I took call at the LLU medcenter during the first week and it was a really light call…kind of disappointing. Nothing came in at all so the resident sent me home at around midnight. Even though I really wanted to be busy, and learn how to splint and cast under pressure I just didn’t luck out that night. But I”m sure my resident was praising God that he didn’t have another crazy night of being up all night with different ortho cases that came into the ER.

I ended up taking call again over the weekend and the night started out really slow like my first call. Than at around 9:40 p.m. I commented to the resident how I had had really light calls before and that I really wanted some action so that I could get some experience. He looked at me with a somewhat evil eye, and sure enough 10 minutes later his pager went off. We ended up not getting to bed until like 5 a.m. due to multiple supracondylar fractures that came in…all of them in 4 year old boys. So yeah, I was happy for the experience, but I will try to voice my desires internally next time, because that night was crazy!

So yesterday I took my Surgery Mock Board, marking the end of my 12 weeks of surgery. I am actually quite sad to see it over because now that means I won’t get to be in the OR for quite some time. But overall I really appreciated my time there. During the 12 weeks I was able to adequately determine that I didn’t want to do general surgery, and I was also able to see that the fields of neurosurgery and urology didn’t fit my style either. I am so happy that I actually enjoy orthopaedics, including the clinic or I would be quite confused as to what field I want to go into now.

Next week we start are 2 week junior elective and of course I chose to do it in orthopaedics. The first week I will be with Dr. WWW, who is the program director and the second week I will be with Dr. J who is the past-chair. This could possibly be the only time that they could really get to know me so I really want to impress them and work hard. I basically plan to read up on everything possible dealing with the hand and arm this weekend. The arsenal of books I have are:

1. Hoppenfields Surgical Approaches which basically walks you through step by step what you will see during an operation
2. Koval’s Handbook of Fractures- tells you what type of fracture you are dealing with and now to fix it. Absolutely priceless when it comes to being on call in ortho
3. Ortho Secrets- Question and answer book that should hopefully help me to beef up my ortho knowledge
4. Netters for Ortho- essential anatomy book that focuses on orthopaedics.

So that’s what I will be preparing to read this weekend in addition to spending time with the wife.

If there is anything more exciting than the field of ophthamology then it has to be watching paint dry, because I would have gladly spent the whole day with my eyes to the wall rather than be in ophtho clinic or surgery. Truly this was the most boring week of my life, and the worst part was that the attendings and residents really wanted me to get into it. In my mind I was like…”I’m going into ortho, I won’t even know what an eye is by the time I’m a PGY-5″, but that didn’t matter to them. The attendings though were incredibly nice as well as the residents, and they really seemed to love what they did, but it was just a terror to actually sit a watch 30 cataract surgeries.

But that week is over, praise God.

Today was match day and I am so stoked for the 4th year students at LLU this year who were applying for ortho! There were 6 students applying for ortho this year from LLU, and all 6 of them matched! So 3 of the students matched here at LLU, and they are so great that I would really want to do my residency here just to work under them. Of the other 3, one matched at UW (which is a crazy nice program), another matched at Case Western (another amazing program), and the other one matched at Banner in Arizona. Overall they did really well this year and really raised the bar.

Its crazy to think that in exactly one year I will be opening a letter to see where I matched (hopefully, lol). Time really goes by fast in this process of becoming a doctor and Ican’t believe that I was just blogging about my first day of medical school, and now its almost done! So yeah, alot of the 4th years here that were applying for ortho gave me a ton of advice, and now I know that I can really trust the advice since they matched, lol.

I’m really ready to get started with this process too. I’ve already been accepted for an away rotation at Hopkins! And my application to do an away rotation at Howard should be mailed out on Monday. The VSAS application doesn’t open until April 1st, and I’m basically prepared to submit it on April 1st. Personally I am treating everything this app season like I treated applying to medical school…apply on the first day, and you can wipe all your worries away. If you have the capability to, I just can’t understand why you wouldn’t apply on the first day possible, especially if programs are evaulating the applications on a rolling basis. So yeah, judging on how everything works out I should have all of my aways lined up by at least April 15 which aint bad.

I’m not sure where all of my other classmates who want to do ortho are thinking of rotating but I like them all and would be cool with rotating with all of them. There are about 7 of us want to do ortho this year so we will see how everything plays out. So yeah, match day 2011 here I come!

So for the past 2 days I have been at the American Academy of Orthopaedic Surgeons (AAOS) conference in New Orleans, LA. The reason for me being there was because on this past Thursday the J. R. Gladden Society (JRGOS) had their annual luncheon, which always takes place on the Thursday of the AAOS meeting. The JRGOS got its name from Dr. J.R. Gladden who was the first black board certified orthopaedic surgeon in the United States. Dr. Gladden actually just recently passed away, showing that unfortunately blacks only recently have been able to break into the field of orthopaedic surgery. So yeah, that’s the background, now back to my trip.

So I left Cali this past Wednesday and didn’t arrive into New Orleans until midnight of Thursday. Because I couldn’t check into my hotel yet I called my orthopaedic mentor who is based in Riverside, CA and he said I could stay with him for the night. He happened to be staying at the Ritz Carlton downtown and I was absolutely blown away by how nice the hotel was. Everything looked vintage and expensive. My mentor was actually staying in the clubhouse of the hotel which is a segregated part of the hotel with extra amenities. The clubhouse section was like a lush living area with 2 living rooms, a dining room with a long dining table that was always filled with gourmet food and wine, and a business office with high bookshelves and lush leather couches. I was only sleeping on a cot in my mentors room, but it was the most comfortable cot I have ever slept on. Overall, when I make it, I would love to frequent the Ritz Carlton wherever I go if its anything like the one in New Orleans.

So the first event was the Annual Luncheon which took place at the Hilton Riverside hotel. The place was packed with minority orthpaedic surgeons from all over the country and the 60 minority medical students who attended. There were a lot of speakers and presentations of various programs but one presentation in particular stuck with me…it was from the President of the Caribbean Orthopaedic Society. The doctor told us a lot of things about what its like to practice in the Caribbean, the common and rare conditions that they treat, their access to medical supplies, and to me, most importantly the ratio of the orthopaedic surgeons to the population in each island. The ratios were quite terrible with some islands only have 1 orthopedic surgeon! The presentation really made me realize that there are so many missions fields out there and that I don’t need to go to India or Africa to serve God. I mean I still want to go to India or Africa, but many islands in the Caribbean need just as much help. Another highlight of the meeting was Dr. Zuckerman who was the current AAOS president, and a big shot attending at NYU. He gave a really nice speech to us about how committed the AAOS was to diversity in orthopaedics. He made some jokes about how when he was a 4^thyear medical student doing is Sub-I, the residents told him that if he matched at their program he would be their token Jew, lol. He told us the story to highlight the fact that orthopaedic surgery has a lot of “token” people, with minorities and women still struggling to get a good foothold into the field. He also mentioned how he gave the Charles Epps lecture at Howard University, and that he was so impressed and honored to give the lecture that he’s has made sure that every AAOS president after him will make it a point to give a lecture at Howard University each year. I thought that was a pretty big deal and a good indicator that the AAOS sees that something needs to be done.

After the luncheon it was mingle and greet time and I got a chance to talk with a bunch of attendings from across the country. Most importantly I got to hook up with a couple of attendings at Howard and Johns Hopkins and get their contact info. During this mingling session I really noticed how most of the minority orthopaedic attendings there had done their residency at Howard University or Drew/MLK Hospital in Cali. And now that the program at MLK has been shut down, truly Howard University was and  is the main place a minority can go to get trained in orthopaedics. This blew my mind because it almost harkened back to the days where the only place that black college students could go for medical school was Howard University, Meharry, or Drew. Of course there were certainly attendings who blazed the trail and were the first blacks to do their residency at various programs across the country, but for the most part most of the docs came from Howard.

Once the mingle and greet time was over they had mock interview sessions using residents and attendings as the interviewers. I didn’t really prepare for this and I realized how much I really need to start working on my interview answers. They asked me pretty standard stuff like whats my greatest strength/weakness, what would others say is my weakness, what is my greatest challenge, etc. And I truly had a hard time thinking of answers to these on the fly. But I will definitely work on it. After the mock interviews an attending from Hopkins gave us a lecture on how to excel during our Sub-I’s and as a resident. Overall I learned a lot of good stuff and I hope I can really hit the ground running when I start my away rotations.

After that session, there was a little meet and greet time where we got to spend a lot more individual time with residents and attendings and my eyes were truly opened to how vigilant I need to be on my sub-I’s and as a resident. I learned that I will be constantly getting evalulated by people who think that I’m probably not smart enough to actually get into ortho and if I do get in, actually do ortho. Because of that many might be looking for a reason to let me go as a resident. I heard plenty of stories of minority residents being let go anywhere from their chief year to their intern year. Now no one knows if minorities are let go at a higher rate than non-minorities, but according to the residents, it sure does feel that way. I also learned that I will really need to be vigilant on my away rotations and not let gunner students that are also rotating get an upper hand. One resident told me of an instance where one of the minority students on an away rotation was told by another student rotating that the resident said they could go home. And of course the minority student went home, while the other student stayed back and scrubbed in on more cases with the residents and attendings. Gunner medical students will do crafty stuff like that. So basically I learned to not go home until I hear it from my resident’s lips themselves, and then even then I’m going to offer to help out with anything else if possible. I refuse to play the game and do that to someone else, and I sure as heck refuse to let it be done to me.

Later that night all the medstudents went down to Bourbon St.  I have never seen such a crazy, sinful place like that. Lol, I can’t go back there again unless I am not married and I have renounced God. I think only then could I enjoy Bourbon St. for what its there for. It was basically like a 2-mile bar with gentlemen’s clubs mixed in between. And the gentlemen’s clubs were quite different because here, the dancers would actually come into the door and start dancing, enticing men to enter. I didn’t go in, but I must confess that I couldn’t avert my eyes, lol.

The next morning was the Triology Breakfast where basically the JRGOS, Ruth Jackson Society (ortho women’s group), and the AAOS diversity board met to encourage the students even more. I got a lot of good info from everything that was said. Like I said before there were about 60 medical students there thanks to a travel grant from Nth Dimensions, and I kind of felt like the odd one there since like 85% of the students were either from Howard, Morehouse, or Meharry, and the rest were from east coast medical schools.  So a lot of these students already knew a lot of the attendings and for the most part knew each other. But I didn’t let that fact keep me from networking as well as I could, especially with the other medical students because they will be my colleagues in the future. But once again I think it highlights that truly its hard to get into orthopaedics as a minority unless you are from a minority school.

So overall I had an amazing time, and I would definitely encourage any students who might even be remotely interested in orthopaedics to make it to this meeting because it is so informative and inspiring. I left with emails of people who are genuinely interested in me succeeding, and I truly believe that with a lot of hard work, the help of these attendings and residents, and God, I can match into orthopaedic surgery next year.

So I am currently in the Las Vegas airport waiting to board the plane to New Orleans for the AAOS/J.R. Gladden Society Luncheon. I am really excited about this trip because it will allow me to connect with alot of the top minority orthopods from programs across the U.S. By God’s grace I don’t need to pay for my housing because of a housing grant from Nth Dimensions, but I did have to pay for my plane ticket. There are about 60 minority medical students from across the country that will be there, and someone I’m the only person that they put in a hotel by themselves. I was actually looking forward to getting to know someone else by being roommates, but whatever, I should still be able to make some friends.

Below is the basic intinerary for the JR Gladden Society Meeting:

Annual Luncheon: Enjoy lunch with JRGOS members, fellow students, residents and industry sponsors. Former Philadelphia Mayor, Reverend Dr Wilson Goode will present the keynote address.

Mentoring Workshop: Join your fellow students & residents for an informational afternoon on how to succeed in orthopaedics.

Mentoring Reception: Relax in an informal setting and interact with friends and with established orthopaedists involved in the practice of clinical and academic medicine.

Triology Breakfast: Mentees of three groups, the J. Robert Gladden Orthopaedic Society (JRGOS), the Ruth Jackson Orthopaedic Society (RJOS) and the AAOS Diversity Advisory Board, collectively known as the Trilogy Group will enjoy breakfast and learn about each group’s individual mentoring program and how you as students can become involved. Emphasis will be on how valuable these programs can be to your professional development.

So as you know I am done with my 6 weeks of general surgery and now I am on my 6 weeks of surgical subspecialties. I spent the first 2 weeks of my surgical subspecialties on neurosurgery and the coolness of seeing the brain definitely wore off after the first week. But this past week I was on my 1 week of orthopaedics and it was truly the most fun that I have had since I started medical school, which I truly praise God for. I praise God because although I knew I was somewhat interested in orthopaedics, I hadn’t done an official rotation in it yet so I couldn’t truly say that I wanted to do ortho for the next 60 years of my life, but I enjoyed this week so much that I have no doubts that I can do it for the rest of my life.

So my week of ortho started out on Monday with spine clinic which was actually quite familiar since I just finished 2 weeks of neurosurgery. In the ortho spine clinic we saw a lot of the same types of conditions that I saw in the neurosurgery spine clinic like spinal stenosis, spondylothesis, degenerative disc disease, etc. But for some reason, I enjoyed the orthopaedic side of it more…maybe it was the attending and the residents, but I wasn’t looking at my watch the whole time in clinic for the first time of my 3^rd year. I knew that I was really interested in orthopaedics this week because it was the first time that I was writing down all the new things I was learning in my little notebook, lol. I had started strong writing down stuff during my first month of 3^rd year but I fell off simply because I didn’t care that much, but this week I started up again.

On Tuesday, I had my only OR day of the week, and it was with one of the sports attending here LLU.  It was actually a pretty short day of operating but still everything I saw was really interesting. That day we had shoulder arthoscopy to repair a rotator cuff repair and a knee scope on a young athlete to clean out her all the fibrosis that had formed from a previous ACL repair. It might be sad to say, but I’ll admit that Tuesday was the first time in my medical school career that I truly understood the rotator cuff. In the past 3 years I had answered many questions about the rotation cuff but without a firm understanding of exactly how it was structured, but seeing it through the camera just switched on a light in my head.

On Wednesday I had clinic with one of the hand attending who also happened to be the program director for the ortho program here at LLU and I much say that it didn’t go very well. First off I was only able to spend 4 hours in his clinic because I had an ortho lecture during the morning hours, so when I went to clinic he immediately told me to go in and see patients. But I had no idea where the progress notes were, how to access the patient’s xrays, how to really do a good hand exam, or really anything helpful at all. After about an hour he told me that I was going to slow, lol, and yeah…the day just didn’t go well. I went home feeling really deflated because I jacked up with ortho program director. But I talked with some 4^th years trying to match into ortho and the reassured me that all was not lost and that he didn’t hate me…at least I don’t think so……

Wednesday night I was on call and I was super excited. I came in at 5 p.m and I actually walked by the pgy-2 on call as I was walking in, as he headed towards his car. This should have been a sign that it was a slow night because the PGY-2 had time to leave and grab something to eat, lol. But as he was walking out he told me to page the intern who was on call and help them out, so I did. When I went upstairs where the interns were they were both people that I had met before which made it easier. It was a really slow night thus far so we just talked for a little bit about ortho and then they sent me to go and get dinner. I waited around for a couple more hours, and nothing came in at all. At about 11 p.m. the PGY-2 came in and told me to go home. I was a little hesitant because I really want to do ortho so I don’t want to leave early on call, but he told me that he already knew that I wanted to do ortho so going home wasn’t going to affect his view of me, lol, so I listened and went home.

On Thursday, I had foot and ankle/ pediatrics clinic which I really enjoyed. Every patient that we saw the diagnosis was quite clear and the fix for it was even more straight forward which I really enjoy. There was this little 7 year old girl that was in the room with her mother. We asked the girl what happened to her foot and she said, “I had a weight in my hand…and it dropped and fwaktured my fwoot”. Lol, she was so cute.

Overall I really enjoyed  my week and I am quite sure now that orthopaedics is the field for me. I was also happy to see that the ortho residents are finally starting to acknowledge my existence and I hope that eventually they  will actually like me. Next week I start my week of anesthesia, but I will only be there until  Wednesday, because on Thursday and Friday I will be at the J.R. Gladden Orthopaedic Society meeting at the AAOS meeting in New Orleans, LA. This should be a really amazing opportunity to meet the big minority ortho guys in the field before I start my application process this year. I will make sure to blog all about my experiences there.

So yeah, I kinda dropped the ball on blogging about the end of my general surgery service, but to sum it all up, I am glad it is over, and I hope to never have to do it again. It wasn’t the hours or the people, I just truly did not enjoy what they operated on, and I especially hated being woken up while I was on call to deal with patient A with abdominal pain, or patient B with a rectal abscess, or patient C with cholecystitis.

For the past 2 weeks I have actually been on my neurosurgery rotation. The way that our 12 week surgery rotation goes, is that we do 6 weeks of general surgery, then we do 2 weeks of our choice of either neurosurgery, plastics, vascular surgery, ENT, or pediatric surgery. Then we do 4 weeks comprised of 1 week of ortho, 1 week of anesthesia, 1 week of urology, and 1 week of ophthomology. A couple months back when I had chosen my surgery track, I had picked pediatric surgery for my 2 weeks because I really do love kids. But by the time that I had gotten through my general surgery rotation, and I was surgery that gsurg wasn’t for me, I decided that there was no need to see pediatric surgery since it was the same subject matter as adult but in kids (so appys in kids, hernias, etc.). Instead I decided that I wanted to see something that I would probably never be exposed to again…neurosurgery.

So I just finished my 2 weeks of neurosurgery and I must say that those guys really really really work hard. Much harder than I want to work in life. But to be honest that is not even what turned me off from neurosurgery, it was mostly their patients that turned me off. I have never been on a service that had so many people in a vegetative state. The majority of their patients were in the ICU, and during rounds, the majority of our patient interaction was us screaming into the ear of our unconscious patient “Mr so and so, can you hear me?”…..”Can you hold up 2 fingers?”…..”Can you squeeze my fingers?”. After its clear that the patient isn’t responding, once again, they move on to the next patient who usually is no different. Now of course I did see patients that were pretty sick, and then we discharged home after a full recovery, but it didn’t seem like that was the norm in neurosurgery. But they get to operate on the brain which is awesome, but to me not awesome enough.

Next week I start my 1 week orthopaedics rotation and I am totally stoked (yes I said it, stoked), about it. I really hope to learn alot of orthopaedic physical exam techniques during this week and hopefully I can get to know more of the attendings during this time. Also, this past week I had the opportunity to chat with an ortho resident at Hopkins and it was very informative. I had asked him a bunch of questions regarding their reputation of being malignant, their reputation of being all name and no real experience, their reputation of low operative volume, etc, etc. This resident replied back with the most detailed synopsis of his program I have ever seen, really laying out the pros and cons of hopkins’ program. After reading his reply, I am much more confident that I at least want to check out Hopkins on an away rotation for myself, to see if the rumors are true or not. So that is basically what I’m working on these days, VSAS applications and 3rd year course work.

So its currently like 5:30 in the morning and I’m up on call, didn’t go to sleep. Its been a crazy time with plenty of trauma. This dude who was hyped up on meth put his hand through a glass window  completely transecting his radial artery and many of his flexor muscles. If it was an orthpaedic service solely, they would have just left the bloody radial artery alone, fixed the muscles, and closed up because the ulnar artery provides the majority of the blood supply. However since I was on general surgery the surgeon decided to reanastomose the radial artery at 2:30 in the morning. And the worst part is that this surgeon is that classic cursing, rude, inpatient surgeon that you usually only see on TV. I just don’t see any reason to be rude to the anesthesiologiests, surgical techs, residents, or medstudents. But whatever, I’ve only got 1 more week on general surgery. After we reanastomosed the radial artery, then the orthopaedic service scrubed in to reconnect the flexor muscles and the superficial radial nerve (to prevent the formation of a neuroma). I got to stay scrubbed in for both cases and I definitely enjoyed the muscle reattachment more :-).

So since I’m on the topics of orthopaedics….I had basically narrowed down the schools that I wanted to do away rotations at to UMD, Georgetown, and Hopkins. I crossed out Union, despite it being a pretty great program because it was 6 years for no real reason. And I crossed out GW because of the serious trend of negative reviews about the program online. Finding out information about different orthopaedic programs is really tough because most of it is by word of mouth from 4th year students at your school or from reviews on Orthogate or SDN.

I was able to find out alot about UMD’s program from when I shadowed that UMD sports attending during my X-mas break. Finding out more about Hopkins took a little more work, but thankfully I was able to talk to an ortho attending at Hopkins. I had heard alot of bad things about Hopkins but the ortho attending basically gave me good info refuting most of that. My convo with an attending affiliated with a one of the other schools I was interested in (we will call it school X) was actually the most informative. The attending flat out told me to not waste an away rotation on school X. He told me that school X is the most undiverse…white male. program that he has ever seen, and they have no desire to make it any different. I’ve heard from other minority applicants on the interview trail that said that they got discouraged from ranking school X high because when they were at their interview, they looked at the wall of the graduating classes all the way back to the 60s and didn’t see one dark face. I know that someone has to be the first, but there is probably a reason why no one has been the first yet especially in an area as black as MD and DC. The attending also told me that they are quite proud of themselves and that all the other ortho residents (from school Y and school Z) can’t stand their guts because they are so cocky, for really no reason. The attending honestly couldn’t understand why school X had such a high view of their program when almost every ortho program is steller and they aren’t even in the top 1o programs, but none the less their pride is palpable. He had a hand in interviewing applicants to school X’s program, and he told me that even when very qualified minority applicants would interview, they would always find some small reason to rank a non-minority over that applicant. He told me that I have alot of options in the MD/DC area and that I should probably do an away rotation at a place who has a history of accepting minority applicants..at least one…and who won’t try to find some reason to accept a non-minority over me. I really appreciated the advice, although you can never fully trust opinions, but I appreciate it none the less. So after all of that I’ve decided to try to do away rotations at UMD or Hopkins. However, this weekend I plan on speaking with another attending about Hopkins to see if its more worth it to rotate there or at UVA. Both programs have a history of accepting minority applicants, but of course Hopkins is closer to home. Both are academic powerhouses. I guess I”ll just have to wait and see.

So if you had asked me last year how much I would be blogging during my 3rd year surgery rotation I would have told you, “About every 10 minutes, because its going to be so bloody awesome”. Now that I have finished week 5 of my 6 weeks of general surgery I realize how different the reality of my general surgery experience is. Below are some of the things I liked and disliked about doing general surgery:

LIKED
1. I get to wear scrubs for the majority of the day, which is great because I hate dressing up.
2. I get to go to the OR and if I’m lucky, scrub in, and if I’m lucking actually do something like throw in some sutures
3. I like the fact that when I go to evaluate a patient in the ER it is for a very specific surgical problem. Unlike medicine where my differential had to be expansive.
4. I like the clear cut problem solving of general surgeons…if appendix is inflamed we take it right out of the body. If gall bladder is inflamed, we take it right of the patient’s body.
5. Rounding on patients in the morning is pretty short. Is the wound looking good? Is the patient pooping, eating, walking? Good, then send them home.
6. Save lives. Hands down general surgeons save lives in most of the patients they deal with. If they don’t operate the patient often has a higher chance of dying. Its kind of cool in a sense to save lives everyday

DISLIKES
1. Subject matter. I absolutely…absolutely…absolutely hate a huge portion of what general surgeons operate on, which is the bowel and the rectum. I just can’t think of anywhere in the body that I detest the most. Hernias and gall bladders aren’t bad, but I loathe the bowel and it’s fecal treats and I hope to have nothing to do with it..ever.
2. Personalities. The general surgeons at the hospital I am at tend to be pretty wound up. Maybe its because if they aren’t absolutely wound up all the time then patients could die. Maybe its the stress of saving lives everyday, coupled with decreasing salaries. Or maybe they hate the bowel too…either way, they are often way too intense for me. Which is totally odd because before med school all the general surgeons I met seemed to be quite the opposite. Not intense at all, laid back, prone to smiling, etc.
3. Colotomies. I suppose that I could have lumped this together with subject matter, but I couldn’t because in particular I HATE HATE HATE colostomies. Sure they help save lives, but the nastiness they hold is detestable and seems like a cruel punishment to give a patient. I don’t like managing patients with colostomies and I don’t like even looking at the belly of patients with colostomies.
4. Call. for just about every trauma that comes into the ED, the general surgeons have to be there. Seems like a crazy life.
5. Variety. Maybe this is particular to the hospital I am at. But 95% of what I have seen they doing int he OR are laparoscopic cholecystecomies, laparoscopic appendectomies, thyroidectomies, and mastectomies. Pretty much it. I would like to work on a more wide variety of places on the body.

I am sure there are more dislikes that I just can’t think of now but they have been strong enough to make me completely cross out general surgery. So I have one more week of general surgery and then I switch to my specialty surgery weeks. I start off with 2 weeks of neurosurgery, and then I do 1 week of ortho, then 1 week of anesthesia, and then 1 week of urology, and end with 1 week of ophthomology. Pretty excited..weekends off…not poop or bowel…really happy.

The Lord is truly too good to me. When I was interested in General Surgery or Urology I had started a research project on pediatric kidney transplants so that I could hopefully get a research publication out of it. The attending that I hooked up with was super nice and basically let me run full steam with the project, allowing me to be first author on it. I was a little scared because previously I had really never taken research seriously, and therefore I had never truly known how meticulous you had to be to get through a project, but I basically did everything by myself including the data collection, the database creation, meeting with the statistician, telling him what I think we needed, taking the results, and writing a good abstract with associated graphs. I had submitted this abstract to the American Journal of Transplant and yesterday I got this letter:

The attending I worked with on the project told me that how the process works is that my abstract is published in a supplement to the journal and that I should make a poster for my project and present it at the meeting. But he also said to have the full completed paper ready for submission by the time that the meeting starts because once I present my poster, the journal has a greater chance of accepting the full paper once I’ve actually presented it. So my hope is that I get a full journal article publication out of this. I have to admit that I am really not a research guy, but there is something very special about seeing your name on a published article, and I can see how that thrill from seeing your name there can drive you to try to pump out more and more papers….of course in addition to the drive of just contributing to the field of medicine :-). I wish that this paper was an ortho paper but it isn’t, so I am currently working on 3 other projects, one of which I hope will get published before I start the application cycle, but you never know how things like that will work out.

So I’ve been practicing some one handed suture ties on a very willing can of sierra mist and its going pretty well. I hope that the next time I am asked to suture in the OR that I can break out the one handed tie with confidence.

Sometimes the amount of suffering the a people can go through, while we sit here in America complaining about dropped calls on our iPhones is overwhelming. Seeing the pictures and hearing the reports makes me wish that I finished my training 7 years ago. I heard on NPR last week that they desperately need doctors who specialize in amputations and crush injuries. While general surgeons certainly fall into that categories I think the orthopaedic surgeons are greatly needed too. I was just reading the blog of an missionary orthopaedic surgeon who is a graduate of LLU and who is returning to be a faculty member at LLU soon on his efforts in Haiti…check it out:http://curecaribe.blogspot.com/. Being in medical school, studying and going throughout my day seems so meaningless while so many out there are suffering, but I suppose that I am much more useful trained than untrained, so I will continue the process.

I’m am halfway through my 6 weeks of general surgery and its not terrible. I have come to realize that I really don’t like operations that deal with the bowel or with the anus.While the operations are certainly techinically challenging, I don’t find them overally interesting and the smell of feces makes me want to leave the OR. Its funny because I was so gung-ho about becoming a general surgeon before medical school and during my first 2 years of medical school because of all that I had been exposed to. In hindsight though I realized that in all of my exposure to the general surgery operations, I somehow managed to not see one single bowel surgery. All the surgeries I saw were traumas to the thoracic cavity, or to the neck, or to the extremities. So once I got on my general surgery service and I saw colostomies being placed and rectal abscesses being drained I realized that I truly am not cut out to be operating on that part of the body. Those operations are vital and certainly they need to be done by skilled surgeons, but it just doesn’t suite my tastes. So due to my new rules of not wanting to deal with bowel or rectums, I have truly officially crossed off general surgery and urology from my list (even though I think the other parts of urology are really cool). This leaves the other surgical specialties to consider which are ophthalmology, ENT, neurosurgery, vascular surgery, plastic surgery. I haven’t really been exposed to these other fields and on first thought, none of them really quite excite me. However I will be spending 2 weeks on neurosurgery when I am done with my 6 weeks of general surgery so I should get to see what their field is like. The more and more I observe and scrub into orthopaedic cases, the more excited I get about the field. So while I don’t mind checking out the other surgical fields left to observe, all of my current moves are towards ortho.

Tomorrow I meet with the program director for ortho to get advice, based on my current stats, CV, projected research, etc. which programs I should choose for my away rotations during my 4th year. Some have said that you have an 85% chance of matching where you rotated so I wanted to make the decision carefully.

So I think that somehow God heard that I didn’t feel that I was getting my full, hard, general surgery experience because last night on call I got 1 hour of sleep due to the insane amount of traumas that just kept pouring in. We had like 5 stabbings, a head on collision that brought in a couple of people that were near death, and bunch of consults on regular general surgery stuff like hernias, appys, acute choles, etc. After being awake for that long on my post call day, I started to feel that crankyness that I’ve have sometimes experienced from the residents when they are tired. I really want to learn how to not let my tiredness cause me to snap at my fellow residents or medical students. Anyways, I will keep my mouth shut for now on about how little I am doing because I don’t want another night like that.

So I had my first week of my surgery rotation and I am completely exhausted. My day starts at 4am and I am home by 7 p.m. usually. And then it starts all over again. My wife has it worse too; usually I wake up at 4 am, but she is usually gone by 4am since she is on the hardest working team at LLU. Because of the crazy hours we have been keeping this week we both felt like we hadn’t seen each other at all, which made the transition even rougher. With all that said though, I still prefer surgery to all the other rotations so far.

On Monday when I first arrived at the county hospital we went through orientation, got our badges and reported to our team. I was assigned 4 patients that had already been seen that day so I spent the rest of the day going through their charts so I could learn more about them. The next day I arrived early (4:45 am), saw my patients, wrote my progress notes, and was prepared to present them. However there were a lot of traumas that had just arrived so the resident that was supposed to round with us was in the OR. And the way it works here is that when the attending we are assigned to for the 6 weeks is operating or in clinic, we go where ever they are regardless of whether rounds are done or not so I left and went to clinic at 7:45 am since that was where my attending was. I found clinic to be pretty okay; you didn’t really have to do an exhaustive internal medicine-like physical exam. The patient came in because of a hernia, or a painful thyroid, or a mass, or for follow-up after their surgery. Once I got the hang of seeing the patient’s then they let me start dictating the H&P’s (basically you speak the H&P into a phone and someone types them up). I am sure that my first couple of ones were terrible, but it was fun to learn how to do it. The attendings speak so fast into the phone it is a miracle that anything gets put into writing. I guess I will be like that one day.

The operations have been pretty interesting to see, although I am starting to see why General Surgeons tend to be categorized as mean and unhappy. Almost every time they are called to see a patient, if they miss something or if they don’t take immediate action the patient has the possibility of dying. For example, a patient came in with acute onset right upper quadrant pain (probably an inflamed gall bladder). If they misdiagnose it or if they don’t take out in time, then the patient can die. The same thing goes for their traumas; when a patient comes in after a car accident they have to evaluate them for all sorts of injuries that could possibly kill the patient. Being under all that life and death stress can truly wear away at someone if they don’t know how to handle it, and I can see how they can get snappy after dealing with these problems for 30 hours straight every 3 days. Compare that to orthopedics or urology where there may be traumas, but they can deal with the patient a couple of days later and the patient won’t die from their injuries (for the most part). Instantly I could see job satisfaction increasing in an environment like that. I do really appreciate the surgical skills that I am learning, but I just don’t know if I could deal with the life and death thing day in day out.

Who knows…I have 5 more weeks of general surgery to figure it out.

So yesterday I got to the hospital at 5 am and saw my patients. I then went to the OR at 7:45am and didn’t finish until. 7 pm. I drove home, studied for a bit on today’s cases and then fell asleep. I woke up again this morning at 4 am and got to the hospital at 5 am. Today I am on call and from what I have heard I won’t get much sleep overnight so I will probably do the full 30 hour shift. My wife is getting it worse at LLU. While I wake up at 4 am she is already at the hospital by 4 am. We aren’t seeing each other really at all which is kinda rough. So yeah we are well into the Surgery grind. My wife already hates it. Personally I am not happy with the lack of time I have with your ( less than any rotation thus far) but I am enjoying the OR.

Yesterday while I was in the OR I got called a pussy by the attending because I wasn’t retracting like he wanted. Fun stuff…fun stuff.

So on Thursday night the deans of my medical school sat all the Junior down to talk about our Senior schedules. From all that they said, truly my 4th year of medical school will be the most flexible year yet and probably the most fun. I will kind of break it down for those who are wondering what 4th year is like. Basically there are 14 weeks of stuff that we are absolutely required to do, and then 20 weeks of stuff that we need to do something but they don’t tell us what, and then the rest of the 12 weeks are used for vacation! So the 16 weeks of required stuff includes:

Preventative and Community Medicine- 4 weeks
Emergency Medicine- 2 weeks
Intensive Care Medicine (MICU, SICU, or PICU): 2 weeks
Sub-Internship in either Family Medicine, Medicine, Pediatrics, or Surgery- 4 weeks
Neurology- 2 weeks

So starting this upcoming Monday an online calendar will open up that will all us Juniors to schedule exactly where we would like to put the required rotations. Then once the signing up process occurs then we are allowed to start applying for the 20 weeks of elective stuff which is really flexible. I can do an elective in “Film and Medicine” or I can do an away orthopedic rotation in Boston if I wanted to. I could also spend up to 8 weeks overseas on a mission elective! So over course, being the neurotic person that I am, I have already planned out my year, granted that I get my required rotations in the spot that I want it, everything else will hopefully fall into place. So here is my tentative schedule for my 4th year:

2 weeks (July 8-18)- Vacation/Studying for USMLE Step 2

2 weeks (July 19, 26)- Neurology Elective/Take USMLE Step 2

2 weeks (Aug 2,9)- Musculoskeletal Radiology: Hopefully I will learn how to read these images better in time for my ortho rotations

4 weeks (Aug 16, 23, 30, Sept. 6)- Ortho Elective at LLU: Very hard to get so I will probably camp outside of their door, lol

4 weeks (Sept. 13, 21, 27, Oct 4)- Ortho Away Elective at either Univ. of Maryland, Union Memorial, Georgetown, Howard, or GW

4 weeks (Oct 11, 18, 25, Nov. 1)- Ortho Away Elective at either Univ. of Maryland, Union Memorial, Georgetown, Howard, or GW

4 weeks (Nov 8, 15, 22, 29)- Preventative and Community Medicine

8 weeks (Dec. 6, 13, 20, 27, Jan 3, 10, 17, 24)- Vacation in the MD/DC area in addition to going on my Ortho interviews. Since 90% of the interviews for Ortho are during the months of Dec. and Jan. and since the majority of my interviews will be in in the MD/DC area it makes more sense for me to be on that coast rather than flying back and forth from CA to MD. So this will hopefully allow me to get some good rest and also save a good bit of money in plane tickets as I could probably drive to most of these interviews.

4 weeks (Jan. 31, Feb 7,14, 21)- Sub -Internship in hopefully Family Medicine because it will be more chill than doing it in General Surgery

2 weeks (Feb 28, March 7)- Anatomy Elective where I get to spend time in the cadaver lab dissecting and strengthening my knowledge of anatomy

2 weeks (March 14, 21)- Vacation/ MATCH DAY time!!!!

4 weeks (March 28,April 4,11,18)- Overseas Mission Elective to India or Africa

2 weeks (April 25, May 2)- Emergency Medicine

2 weeks (May 9, 16)- Surgery Intensive Care Unit

1 weeks (May 23)- Bonus weeks

Graduation- May 29, 2011

So as you can see that is quite the schedule and I look forward to being done with 3rd and entering the Oasis of 4th year. I probably still need to scour through it to make sure that I have my 14 required weeks and 20 elective weeks all in there but overall I think it is a solid schedule. Let’s see how it works out.

So here at LLU every Tuesday the orthopedics dept. has a basic science meeting where they go over different topics. Tonight they went over spine surgery and the different procedures you can do to correct kyphosis (think humpback of Notre Dame) and lordosis. The procedure entailed cutting wedges out of the spine and putting screws through the pedicles. As I was listening to all of it I nodded my head but I really didn’t understand what the attending was saying. Then he told us that there were 4 big rigs parked outside with full operating rooms ready for us to put what we learned into practice. It was crazy!!! Inside these big rigs were a bunch of operating tables complete with overhead lights, bovies, and a fresh (almost too fresh) body with its spine exposed. The residents were really nice and I got to place some thoracic screws while the residents worked on the lumbar spine. Making the correct path for the screw was technically challenging; if you went too medially then you were going directly into the spinal cord. If you went too lateral then you would be outside of the bone. It was nice that if I messed up I could unscrew it and try again but it was crazy to think that in a real case you only get to make the path for the screw once, and you better hope you don’t paralyze the patient! This experience further solidified orthopedics for me…the procedures are just so cool. And honestly, I think that at the end of the day that is what needs to be important for a surgeon because the types of procedures I do will be an important part of my practice. I want to wake up every morning excited to do this cool procedure and excited to teach other residents how to do these procedures. The hardest part is just matching into ortho…

But just as I saw the hand of God working to my wife and I into the same medical school, I know he will work miracles to get us into or respective residencies together. I just need to have faith.

So I have been on my psych rotation for about 3 weeks now and I must say that it is quite a different experience. The first two weeks I was on the general psych ward at the VA hospital and I overall hated it. The majority of the patients there knew the system and basically came in for their monthly psychiatric tune-up whether that be for depression, bipolar disorder, schizophrenia, suicidiality, or a combination of all of those. I mean I did see some patients improve but not many. Also I realized that I really do like talking to patients but not as much as you have to on psych.

On my 3rd week of psych I switched from general psych to addictions and I must admit that I really admire their programs. These are guys whose lives have been destroyed by drugs, alcohol, gambling and have decided that they didn’t want to sink any lower than where they were. I really liked how they were completely accountable to each other even for little things like going to the social security office to sign some papers. As I was sitting in their meetings listening to them describe the intense struggle they have resisting the temptation to drink or use I couldn’t help but feel like I experienced similar problems with gadgets, particularly cell phones. When a new iphone, blackberry, or windows mobile phone comes out I have an almost insatiable desire to purchase it. This has resulted in me owning 8 different phones in the last 3 years. Now luckily I can sell stuff very well on ebay so I have rarely lost money but none the less its an addiction. I consider myself a high functioning addict though :-).

Right now I am on child psych and it is frustrating primarily because their parents are often the source of the problem and we can’t really treat the parents. But overall interacting with the kids has been great. We have kids with depression, with bipolar mood disorder, with psychosis, etc. Its definitely gratifying to see them go home “normal” again. I have been trying my best to look excited while on psych and I am not sure of the job I am doing.

So on Wednesday I took my oral exams and my OSCE for OBGYN and on Friday I took the national shelf exam for OBGYN. The orals and OSCE that took place on Friday went relatively well. They gave us a list of 35 cases that we could be tested over for our oral exams and we wouldn’t find out which one we had until we arrived at the testing site. They also told us what our 3 OSCE exams would be over so technically it shouldn’t have been very stressful, but I was doing alot during this rotation between being a 3rd year med student on OBGYN and working on my research project that it was hard for me to study as well as I wanted to for these tests. On the actual testing day I found out that my oral exams would be over 1) postpartum bleeding 2) infertility 3) adnexal masses 4) rh isoimmunization. When I saw that I had adnexal masses my sympathetic system kicked up because that was the one case that I knew the least and it definitely showed when the attendings running the oral exams were questioning me. I think I did well on the other cases. For the OSCEs (where we had to interview paid actors about their Obgyn complaints) I actually wasn’t ranked very high as compared to my other classmates. But their comments were positive so I don’t really know what do say; here is what they said:

* Birth Control OSCE: DoctaJay has a very nice, friendly type of personality. As his patient I felt very comfortable and at ease talking with him. He seems knowledgeable and informed and knows how to relate information to his patient. Nice level of self-confidence. Needs to ask more history of his patient, but otherwise a nice interview.

* Painful Menstrual Period OSCE: The student did an excellent job of easily explaining the medical terms he was using in his description-also very easy to talk to/very conversational.

* Menopause OSCE: He gave me alot of information which was good but at times I felt a little unsure about some of the things he was talking about…he ran some of the things he was talking about together. Plus their was a lot of construction noise going on while he was talking

So the general gist I got from the comments was that I was easy to talk to and friendly but I needed to take their history a little better. I really do hope to get better in this respect. The national OBGYN shelf exam I took on Friday wasn’t terribly hard but I was just honestly tired of studying at the time so I didn’t cover everything I needed to as my times as I needed to cover it. I finished on time (praise God) but I am really not sure how I did. At LLU, the shelf exam makes up 40% of our OBGYN grade and the rest is made up of our OSCE, oral exams, attending evals, and resident evals. I won’t know whether I got honors or not until the whole school year is done and they look at all the people in my class and how I ranked against them.

I also decided to go on call with the ortho residents on Friday and I feel like I got a very good feel of what it was like to be a 2nd year resident, even the amount of hours they work. So after being up since 4 a.m. on Friday morning studying for the shelf exam and not taking a nap after since I don’t know how to take naps when it is bright outside, I went into the hospital around 6:30 p.m. at night. The PGY-2 that was on call was really cool and he taught me how to monitor the ER board (so that we could know about the patients that they would page us about before they paged us), write up a consult note, evaluate the patient, write ortho admit orders, write ortho discharge orders, etc. I also was able to appreciate a little more how the orthopedic service worked. I had always been told that I would never get any sleep as an ortho resident because you get slammed all night, even as an attending but what I found was not the case. As a PGY-2 you definitely do most of the grunt work by getting all the pages from the ED, seeing them, and admitting them if necessary. However if you are a PGY-3, PGY-4, or PGY-5 you take home call, and you only come in if the PGY-2 admits a patient that needs to be operated on immediately. And technically there aren’t very many trauma cases that need to be operated on immediately. Some do like pelvic fractures (risk of bleeding out is high), some spine fractures, septic knees and septic hips (risk of the joint getting destroyed by the infection). And if you have a good senior resident the attending barely has to do much either which is pretty cool.

The types of cases that came in too were pretty cool because they were basically all pediatric cases. We had one kid that had a septic hip, another kid who broke his femur when he took a jump on his motorbike that he couldn’t handle, we had a little girl with a supracondylar fracture from falling off a chair and some other cool cases. Overall I realized from the experience that you shouldn’t look at the life of the resident to see whether the lifestyle is what you want because residency sucks for everyone. Instead you should look at the lifestyle of the attending and take into consideration whether the attending specializes in trauma or not because that could skew your view a little. I am honestly getting more and more excited about orthopedcs because the treatments are often extremely definitive and the patients are often better off after you help them.

As excited however as I am getting about orthopedics I am a little concerned about the fact that many of the programs have their interviews on the Sabbath, particularly the programs in the MD/VA/DC area. In my heart I honestly do not feel comfortable with going to a residency interview on the Sabbath, but another side of me is saying that what is the difference because as a resident I will definitely be working on the Sabbath. But I feel that interviewing on the Sabbath is more so to help myself, while working as a resident on the Sabbath is to help someone else in need. I know its early to be thinking about this but maybe not, because it may not make sense to even apply somewhere if I know that they won’t interview me on any other day but Saturday. I just need to trust God more that He can open doors for me that don’t require me to break the Sabbath.

It is truly amazing how patients can be such liars. I had a patient who we had operated on for one of her gynecologic cancers. She was recovering well and at least in our view she was ready to go home. When I went to pre-round on her though she asked if she could be sent home tomorrow because she has a terrible headache (onset of 10 min. ago) and her brother and fiance are moving her to another apartment today so she doesn’t want to g home while they are in transition. The requests were reasonable enough but if she doesn’t have a medical reason to be there anymore then she has to go home, which my senior resident told her. So when we rounded on her with the attending an hour later she all of a sudden had some cough and she told the attending she had been coughing all night (which she hadn’t). He asked her if she had any nausea or vomiting and she said yes emphatically (which she didn’t just an hour ago). He asked her if she had abdominal pain and she said yes. So the attending decided to keep her one more day. The resident was looking and me the whole time just shaking his head. We couldn’t believe the acting job that just occurred; it was all I could do to not jump up on her bed and point, “YOU LIAR”!!!!, lol. But hey what can you do.

So today is the Sabbath and I am on call on L&D. In fact this is the last possible call that students on my current rotation can take and somehow I am the only student here. Our school has said that we have the right to go to church as medical students and that our residents and attendings can’t keep us here but I think that rules like that are harder in practice. If I am on a team, and I have a duty on that team, and I pass of my duties to someone else who already has their own tasks to go to church which is great for my spiritual life but not an emergency, then I put more stress on the team. Some of my classmates have had no problems requesting the time off but it just doesn’t feel right to me. But to be honest, even when I have had time to go to church there are times where I am so tired that I just sleep in and watch the sermon online. For me my relationship with Christ is not very much dependent on my attending church but getting into the Word (Bible), reading some inspired works (E.G. White), and showing Christ’s love to others in service in the local projects surrounding Loma Linda. Not that my way is better in any way, but so far it has seemed to work, although I do wish that I could be more in depth with my Bible study. If anyone knows where I can find the SDA Bible Comentary for cheap let me know.

I had an intersesting talk with a student about whether God had a speciality in mind for us. Its an interesting question because it inherently implies that there are specialties that we can go into that may not be what God wants for us. I’ve thought about this alot and I don’t think it is cut and dry. I do think that God certainly has a plan for each one of our lives and that the knows us well enough to know what we would really excel doing, but He also gave us the power of choice. We can chose our destiny and our path, whether that be a good path or a bad path, but in terms of the speciality that I pursue, I think there are multiple good paths. Sure some may be better than others but I don’t think you will necessarily be going against God’s will (unless He specifically told you to go a certain way) by chosing one specialty over another. I usually hate talking about spiritual things and saying “I think” because our theology should come from the Bible but I haven’t really found much to back my thoughts up. What I do know is that I really need to evaluate my motives for chosing a specialty, because if my desire to pursue one or another is based upon greed, money, prestige (i.e.-the praise of man), and power then that is not God’s will. But if a specialty is chosen truly because I enjoy it, and I can serve God by doing it, nothing is wrong with that, but motives are certainly the key.

Personally I don’t feel particular motives are pushing me towards general surgery, urology, or orthopedics. All of those specialities are amazing for  different reasons. I just need to figure out which field has patients and procedures that I would love waking up every day performing. And particularly I love kids, so I would be interested in which pediatric subdivision in each field would be worth pursuing in terms of types of cases and years it takes to get there. For example, to do pediatric surgeon through general surgery, I would need to do a 5 year residency, 2 years of research, then apply to a highly competitive fellowship that will take me 2 years to complete. To be a pediatric orthopedic surgeon I will need to do a 5 years residency and then 1 year of fellowship training without required research. To do pediatric urology I need to do a 5-6 year residency, then a 3 year pediatric fellowship. With my goal being missionary work, I don’t want to be training forever just to do it.

But besides that life isn’t terrible. I have the OBGYN shelf exam coming and I am certainly not ready, but such is life. I hope I can honor at least my surgery rotation this year. But right now I just need to buckle down and study. Happy Sabbath everyone!

So every Tuesday the orthopedics residents and attendings meet for their basic science conference where they go over new journal articles or practice drilling into composite bone or other cool stuff. Normally when I go to these meetings its usually the same 3rd /4th year med students that I see, but this past Tuesday I saw some that I had no idea were interested in orthopedics. I started to get a little scared because all of those people are so smart but in the end if we all play our cards right we will match somewhere that will make us happy. I just wish that ortho was like urology is for LLU right now where no 4th years are even applying to LLU this year.

The more and more that I read about pediatric orthopedics the more I get excited about it. I recently found the blogs of 2 peds ortho guys and they are really inspiring. Truly any doctor can be used by the Lord as a missionary. You can view the blogs below:

http://curecaribe.blogspot.com/

http://orthopaedic-residency.blogspot.com/2007_01_01_archive.html

So I went on call with a Urology resident last night although it was a tad bit different because urology residents take home call. So the resident texted e and told me that she of course is on home call and she will text me if she actually has to go in. At about 11 p.m. I texted her to see if she had forgotten me because I just couldn’t believe that she hadn’t needed to to into the hospital yet. She messaged me back and said that nothing is going on and that she is actually out pumpkin carving, lol. I’m sure that life as a urology resident isn’t always that good but it seems a heck of alot better than in house call that ortho and gsurg takes. But I don’t know…I feel like I would enjoy being busy but I’m still trying to figure out what type of life I want to live. And interesting article was just published in the JBJS about Orthopedic residents and the stress that they go through: CLICK HERE TO GO TO THE PAPER. It certainly seems like orthopedics will put more a strain on my marriage than urology would and gsurg is probably smack dab in the middle.

I have my OBGYN shelf exam coming soon and I feel like I am running out of time. Hopefully I can catch up on all of my studying today.