Thanksgiving on the Beach

This year we had Thanksgiving a little differently than in the past. The McMillans, who are really good friends of our family, invited us down to have dinner with them in Houston and then to come with them to their new beach house in Matagorda Bay for the weekend. My parents took this opportunity to drive down from St. Louis.

Dinner of course was wonderful at their house. Their two girls, Amie and Carrie, did all of the work cooking and preparing the meal for us to enjoy which included all the fixings. Turkey, mashed potatoes, rolls, an outstanding pecan stuffing, and an authentic Hungarian macaroni and cheese were all present. Kristi and I also made a pumpkin cheesecake the night before to bring as well which turned out to be a very successful hit for all present. The dinner was very delicious and before too long we were all happily stuffed. It was just in time to watch the Cowboys play too! We left for the beach house before the game was over, but we listened to it on the radio to hear that they beat the undefeated Indianapolis Colts in a really well played game by them! It was exciting to hear them playing so well again, with a new quarterback that is receiving lots of attention as well. It took us about 2 hours to get to the beach house, which is really nice and very well decorated by Carol already (which of course was no surprise to any of us). We drove out to the beach that night and walked down the jetty. The weather was amazing and the skies were crystal clear, perfect for star gazing. I was able to give K some lessons about the constellations as well.

The next day brought breakfast and the annual big football game with the Aggies against the Longhorns, for which we all gathered anxiously around the TV to watch. This football season has been filled with so many heartbreaking losses already, that I think none of us were expecting much of anything. However, the Ags proved us wrong and took down the Longhorns for the first time in Austin in 1994 with a score of 12-7. We were all screaming and really excited we couldn't really believe it.

Les has a boat attached to his pier and after the game we all took a ride down the Colorado river to the beach. On the way we even saw a friendly dolphin in the river as well who came up several times near out boat. They let us out on a beach that doesn't allow road traffic and we walked up and down for about 2 hours. The girls were mainly interested in the many many seashells that littered the beach, I saw a good opportunity to take some photos.

Matagorda 2006

After sunset, wet got cleaned up and had some outstanding seafood at a local restaurant before heading back to the beach again for a nice campfire, hot chocolate and s'mores. It was really nice with the fire crackling, and the shooting stars coming down from up above. Made it really easy to forget the wards on Ob-Gyn. It made for a really nice holiday as well. We all had to pack up and leave on Saturday morning. It was goodbye to the McMillans and my parents as well. It was a really nice excursion, but also a very fast one, and before we knew it, it was back to the busy work week at hand.

On the Interview Trail once again...

Part of being a 4th Year Medical student includes the inevitable transition from being a student, to being a doctor. A big step in this process is choosing a specialty in which you want to practice in, and where you would like to learn this trade. For medicine, this process is called the residency. After graduating from medical school, the new doctors enter into a residency where they continue their training specific to their career goals, such as in orthopedic surgery, or cardiology. Most of the time as a 4th year medical student is spent in applications and interviewing for the different residency programs that are available.

My application for a residency in Emergency Medicine is now complete and I have started on the interview trail. I'm already lucky enough to have one interview behind me. When I did my away rotation at UT Houston (which is practically right across the street) they went ahead and interviewed us there on the spot to save us from having to travel back once again--again not much of a deal for those of us that already live in Houston, but a great deal for those who do not. So for me, my first real "away" interview was a week ago at Scott and White Memorial Hospital in Temple, Texas. Again, not very far away, but it did involve some traveling. Scott and White was the program that I spent a month at in August and was really impressed with on many levels. I loved the small town nature of the area, yet the business of their emergency center and the quality of the training available. The staff and residents were extraordinarily friendly and easy to get along with. In January, they also have a brand new, very large emergency center opening to brag about as well. Temple is also where Kristi will be doing her clinical years for her medical school as well. So I definitely have a lot of reasons to have S&W as my first choice.

The night before the interview, the residents hosted us for dinner at a local restaurant as kind of a meet and greet ordeal. Kristi was able to make it and I think we all enjoyed ourselves. I was familiar with all the residents who were there that night, so it was more of just catching up than meeting. There was one other student from Baylor there that night, but I've never shared any activities with him, so I really didn't know him that well. This was our opportunity to "get the dirt" on the program, or in other words, the information that we wouldn't really feel comfortable getting from people at the hospital on the day of our interview. It was very comfortable and laid back, and I think everyone enjoyed it.

Kristi's parents were gracious enough to let me stay at their house again overnight for this weekend stay, even though S&W offered to pay for an overnight stay in one of the local hotels. It was really nice of them considering most programs do not offer as much. The interview day started bright and early with a tour of their brand new Emergency Department. It's so new that it's not even open yet. We had to wear hard hats and safety goggles and dodge the construction crews. It was very impressive however, and much larger than their current space. If I did happen to come to Temple, it would be a very nice place to work and learn, state of the art as well. Dr. Stallard then gave a presentation of the program which was very thorough and informative and interviews quickly followed. I interviewed with Drs. Stallard, Stone, Greenberg, and Tobleman, all of which I knew, and were familiar with me from my stay in August. I definitely learned of the importance of visiting a program you were interested in and getting to know people beforehand. All of the interviews were very laid back and comfortable. Most simply wanted to know what I had been up to since my visit. They also all gave me a very good impression that I would very likely have my first choice in a spot for residency. That much was very encouraging.

After the interviews, they took us out to eat in downtown Temple at a very nice restaurant called Cheeve's, which they provided for again. Overall, it was a very positive and laid back experience which only solidified my reasons for wanting to go there. Now I just have to wait for March for match day to see if that's where I will be going come summer.

The rest of the weekend was filled with helping the Kreneks at the lake and enjoying a Sunday early Thanksgiving dinner with them at their house. It was the perfect way to end the weekend.

Catchin' babies..

Well, my month of surgery is finally over, and I move into two months of Obstetrics and Gynecology. It officially wraps up my last clinical core rotation for my graduation requirements. I guess it would have been nice to finish up with something easy, but it'll all be over with soon enough. I've started out the two months on Labor and Delivery, at Ben Taub Hospital which delivers over 70,000 babies a year. Yeah.. that number I just quoted was correct. That's a lot of babies ladies and gentlemen. Hopefully, I'll be able to deliver a handful of those that come my way. It's a pretty amazing experience, bringing a new life into the world. A birthday is something that most people celebrate across the world, it kind of means something to be there at the time that will be so important to that person for the rest of their life. Also, what would a post about labor and delivery be about without pictures?




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The Real Grey's Anatomy...

I don't know how many of you out there watch the show.  I attempted to watch it for about all of two episodes, and it just so happens that the first two episodes coicided with my first month of General Surgery, as a 3rd year medical student.  For those of you who watch it, you might have an inkling to how a surgery service is run in a academic hospital.  At the top of the ladder, you have the Attending surgeons.  These are they guys who are finished with their education, and this is now their full time job.  Below them are the residents, or the surgeons in training.  It's about a 5 year long residency of training, with the chiefs being the 5th years, and the lowly interns at the bottom in their 1st year.  But yet, even below them reside us, the always enthusiastic med students who unlike those mentioned above, pay to be there.  The 4th and 5th year residents pretty much run the show, with the interns doing all the dirty work, all the attendings really ever do is stick their heads in from time to time.  And unlike the television show Grey's Anatomy... no one is sleeping with eachother.  In fact, the bantering and ridiculousness of it all made the show pretty much unwatchable after only 2 episodes for me.  It's by far the least realistic medical show on TV currently. 

 

Which brings me to the topic of this posting.  This was all about a year and a half ago, and although I would have been perfectly happy only having 1 month of General Surgery, I now find myself going through it all over again as a part of my required Sub Internship for graduation.   Granted, we did have a choice between Surgery, Medicine, and Pediatrics, however, everything I heard from those that matched into Emergency Medicine said that I should do my Sub-I in surgery.  So here I am...again...getting Tmaxs and running around in a hospital at 5am everymorning until about 8 at night. 

 

However, today was an interesting day.  A day we probably couldn't have scripted even if we were working for a major television network and had even tried to burn it onto celluloid.  You see, in medicine, and in a hospital more specifically, we have a term called a "rock".  The general idea is that patients come into the hospital with a problem, we help them with that problem, they move on and go home.   This is not true for a "rock".  "Rocks" are patients who come into the hospital, wind up on your service, and end up staying there.  They stay...and stay... and stay, and they never leave, and there's very little  you can do about it.   The largest "rocks" can stay on your hospital service for months until what usually happens is they die.  Even though there's nothing much you can do for them day by day, they still eat up a considerable amount of your time because it is required that you see each and everyone of your patients everyday.  This is the bane and the anguish of the "rocks". 

 

We've had a "rock" on our service for the past 2 months now, one that deserves special mention.  You see, he came to us with a very interesting background.   From what we were able to gather, he grew very sick suddenly in a hospital in Arizona, where he underwent a "unknown pancreatic surgery."  His recovery didn't go very well and he sought out an alternative therapy or something in Mexico.  In Mexico he underweant another surgery that ended up giving him a massive raging infection that nearly killed him.  Instead he languished in this Mexican hospital with his insides open to the world for about a month.  Unable to take it anymore, he actually taped up his stomach by himself, caught a bus to the border and went to the emergency center in a Brownsville hospital.  His abdominal wound was so severe that they wouldn't even touch him, they sent him direct to Houston via an ambulance transport. 

 

He pretty walked into our emergency center with his abdominal tape falling off and his insides hanging out of his belly.  You can imagine what the interns down there thought when they first saw him.  During his two month stay with us, he went to the OR repeatedly to get his abdomen pretty much sprayed out with a water hose the way you power wash two story windows.   On one occasion, they put a scope down his esophagus and into his stomach to get an inside view, but once they passed the scope into the intestines, the first thing they saw was not tissue of bowel, it was the ceiling of the OR with the surgeons looking right down into the camera.  He had a massive hole (fistula) going from his bowels straight through his abdominal hole and to the outside world.  

You can't imagine the pain this guy is in.  Our everyday visits with him were always secondary to his pain control.  He was always on massive amounts of pain medicine and none of them every really scratched the surface.   We had every assurance that this man would unfortunately die on our service.  His insides were pretty much mush at this point. 

 

However... we had a plan:  Operation Flying Rock was conceived.  The patient had often expressed a wish to go back to Arizona, where he still had family, and a hospital that had his records and was familiar with him.   The thing though is, you just can't put a person who is one breath away from the SICU on a bus or a plane and ship them to another hospital, or can you?  Technically, you're supposed to treat or cure a person before you discharge them from a hospital, sometimes though you just can't follow the rules.   The plan was to get this pt. back to looking like a normal human being as much as possible.  He was given a good shower, new hair cut and a shave and new clothes that a nurse picked up from Target the day before.  The hospital provided for a one way ticket on Southwestern Airlines to Phoenix, AZ.  (A plane ticket is much cheaper than one night's stay in a hospital).  Up until this point, the patient was getting all of his nutrution through an IV and was getting a constant morphine drip for pain.   Overnight, he was loaded up with a IV solution with a very high concentration of sugars.  His open abdomen was packed completely full with gauze and four layers of plastic wrap was adhered to his belly to prevent any openings.   A taxi was then called this morning with specific instructions (including a big hefty tip) to pick him up at the hospital, take him to the airport, and get  him in a wheelchair with a personal escort upon arrival to the terminal.  Before the taxi arrived, he got shot up with IM morphine, and was given several tabs of darvocet for him to keep in his pockets. His part was to act as much like a normal healthy person on the airplane just long enough for them to get him to Arizona.  Once in AZ, his mom would pick him up and drive him directly to the general hospital there.  All this happened at lightning fast speed this morning to make sure above all else he made it there. 

 

Just so you know, this isn't how things usually happen, but stranger things have been scripted, that's for sure. 

Pass the scalpel.

Well Vacation certainly ended very quickly and now it's back to the daily grind.  I certainly didn't pick an easy rotation to get back to either.  We're all required a "sub-internship" here at Baylor before we graduate.  It's basically a rotation in a major area of medicine such as surgery, internal medicine, pediatrics, or family medicine, in which we're given more responsibility and pretty much act like interns.  We're allowed to pick one in any of the areas I mentioned above, just as long as we do one before we graduate.  I picked surgery--not because I'm going into surgery--but because people I know who have gone into Emergency Medicine have all recommended it very highly as far as helping me get the residency I would like. 

For anyone who doesn't know, surgery hours are long hours.  I usually get to the hospital at 5 in the morning and frequently don't leave until after 7pm in the evening, which doesn't include call  nights when I have to stay all night.  I often also have to work 6 days a week.  It's all a part of being a medical student though, and usually the days are pretty fun and go by quickly.  Some of it is a lot of paperwork, but as a sub-I, I actually get to scrub in and help out with a lot of the surgical cases as well.  So despite the long  hours, the month should go by pretty quickly, and maybe actually be a little fun as well. 

Off to St. Louis.

St. Louis 2006

Sep. 24, 2006 - 53 Photos

200 years ago, the great explorers Louis and Clark set out from the Mississippi river on a 3 year expedition to explore the Western territories in President Jefferson's great plan for westward expansion. In the past couple of days, I traveled to within 100 yards of their exact step off point on their great journey. Coincidentally, this weekend also marks the 200th anniversary of their safe return back to the St. Louis area.

For those of you who may not know. My dad recently took a job promotion with ConocoPhillips which has moved my parents from Houston to the St. Louis area. They are enjoying the change in scenery and the new job. It is a job that keeps my dad from flying all over the place which is much to his liking. They're also enjoying a new home in the country compared to the hectic day to day life in a city of 6 million people. This past week offered me the opportunity to fly to St. Louis and spend a good 4-5 days with them and experience the life and times of St. Louis and the surrounding areas as it is a part of the country I have not traveled to yet. I flew to St. Louis this past Tuesday with my parents picking me up at Lambert International airport. They don't actually live in St. Louis, they live in the outskirts of the Mississippi river town of Alton, Illinois. Incidentally, Alton has often been cited as being one of the most haunted small towns in America. Pretty interesting especially approaching Fall and Halloween. Over the course of the week, I was shown around the new house, and met some of the neighboors who all seem really nice. The property that my parents bought is surrounded by woods on all sides of the house except for the back, where the backyard gently slopes down into a private pond. There's a small pier out there with two row boats for anyone to use at all times as well. You can tell fall is in the air as well, as many of the trees are starting to change in color already. It's a very secluded area, and I can tell that it's much better for my mom than being in the city. She's a very earthy, woodsy, type person and I can tell she's really enjoying it. I also really like their house. It's a two story building with lots of windows facing the backyard and the lake. Mom is currently busy texturing the walls and trying to figure out which colors to paint it. There's all kinds of little projects in it to keep them both busy for quite some time.

On Wednesday, we ventured up the Mississippi river to a ferryboat town called Grafton. The town is surrounded by very high sandstone bluffs that the American bald Eagles will soon be migrating to to roost in winter. It's a prime eagle viewing location as well as other river sports and sightseeing. We ate some really good Mississippi catfish in a 100 year old Victorian Home that used to be the home of a Civil War colonel.

It wouldn't be a trip to St. Louis without a trek downtown to see the Arch. There were all sorts of festivities going on in the Gateway Arch celebrating the 200th anniversary of Louis and Clark's return as previously mentioned. Everywhere you looked was Louis and Clark stuff. Unfortunately we were also dodging bad weather as storms and tornado warning were in the area. However, we did get to spend around an hour in near the arch taking pictures and seeing the sights. Hopefully, on my next trip we'll actually be able to take the tram up inside to the very top of the arch for the great view. I wasn't able to do that on this trip, but there will be others.

And of course that wasn't the last I heard of the inclement weather either. Traveling back to Houston, I ran into a detour in Dallas as all incoming flights into Houston Hobby airport were cancelled. Not wanting to spend a night in the airport or a local hotel, I just decided to rent a car and drive the distance from Dallas to Houston. It's only a 4 hour drive and I much preferred the idea of sleeping in my own bed. The drive went without problems and I made it back into Houston and my apartment at 2am last night. I have also since gone to the Houston airport to get my checked luggage from the flight that finally made it in as well as get my car. It was a rough ending to an otherwise great trip. I'm sure Louis and Clark had many detours along their journey as well.

Back in Houston.

So I finished up my two months of away rotations in Emergency Medicine and now am back In Houston once more. The weather is turning more towards Fall everyday so it's not nearly as bad as it has been this past summer. My big thing to do was schedule my sub internship which is required for all graduates from Baylor. It turned out to be not so troublesome as I got the rotation that I wanted. Now I'm just kind of kicking back on a mini vacation waiting for that to begin. It's given me some time to get some things done around here at my apartment. I've also been able to attend the first two Aggie Football games, against the Citadel and Univ. of LA Lafayette. Next week, since I have the time, I'm going to fly up to St. Louis to spend 5 days with my parents and see their new place. Should be fun, as I've never been up there before. We also have the big football game against Texas Tech coming up soon again. That's always at least a little interesting.

In Temple

Things are going well in Temple, I've been away for about 8 days now and have worked 5 shifts in the emergency center. It's a very different experience so far from Houston, but I would say that I'm still enjoying it alot. It's much busier than I thought it would be, and in some circumstances I'm having busier shifts than I ever had at Hermann. Part of the reason is the e.d. here at Scott and White isn't separated into different areas like the center at Hermann. There they had a pediatric section, a medicine section, and a trauma section. At S&W, they all go to one central emergency center with 25 exam beds. I was also slightly worried about the variety or lack of that I might experience here, but that hasn't been a problem at all either. I'm also enjoying working with many of the residents as well. I haven't had a lot of time with the attendings just yet, but I'm hoping to work on that in the coming days.

Living with the Kreneks is also going well. I don't see much of them during the days as I'm either on a shift or they're at work, but I usually help out around the house in the evenings with the many chores, and it's also fun to have a dog around for a change. It's been so dry up here and it was finally nice to get some rain last night, hopefully the storms will continue tonight as well as the area really needs it. My internet connectivity is somewhat limited up here, but I get access everyonce in awhile when my hours at the education center overlap with some business hours, so I can generally read my email every other day or so.

I'm also starting to work on my actual residency application up here as well. Hopefully I can knock some of that out while I have the extra free time before coming back to Houston for my sub-internship.