Below are the 8 most recent journal entries recorded in skeetdawg's LiveJournal:

Friday, July 28th, 2006
1:00 pm	Story Time I love stories. I love hearing stories. I love telling stories. There's nothing better than a good story, well-told. I realized today how much of residency is stories. These past few weeks on Trauma I've been laughing about the stories I hear on service, remembered stories from services past and today, hearing stories from my Attending that remind me how great medicine and surgery can be. My favorite patient to present that we admitted recently is a 26-year-old guy that is legally blind who was riding his bike at night and crashed it. ER: I've got a guy down here who crashed his bike. We need a trauma eval. Me: What's the story? ER: He's 26 and he's legally blind. Me: Did you say he was riding a bike? ER: Yes. At night. Me: And he's legally blind. ER: Yes. Me: Okay. ER: Yeah. Me: I guess it didn't matter that he was riding at night. ER: Right. His one-liner on the list is almost as good as the "hoof versus face" for the last guy that got kicked by a horse and "MCC vs mailbox" for one of the motorcycle crashes. Our Attending today was telling stories about when he was a resident about a thousand years ago. It never ceases to amaze me how different things were for them as housestaff. He was telling us about how when he was a resident he used to pour the electrolytes into the TPN solution before running it in. There was a hood on the floor and they'd put it in themselves after they got the labs back. Our old chairman, who helped develop TPN, used to mix the whole bag himself when he was in Vietnam before giving it to injured soldiers. I can barely order the stuff for pharmacy without a nutrition consult and these guys were boiling the stuff in pots and sewing the bags they hung it in. My favorite story he told us today was about one the attendings here from long ago and the very first patient to get a vagotomy for ulcer disease. Dr. Dragstedt was a pioneer in definitive ulcer operations. He did a lot of procedures on dogs and figured out that vagotomy helped eliminate acid secretion which led to ulcers. He had this one patient who needed a gastrectomy for ulcers, which was the procedure of choice at the time until vagotomy became a widely accepted alternative. The gastrectomy was pretty morbid and people would be miserable afterwards. They'd be running to the bathroom after a bite of food and getting flushed all time from dumping syndrome. This patient had had a cousin that had the procedure and a neighbor that had the procedure. The resident went into his room to tell him the operative plan and the patient said, "No way. I'd rather die from ulcers and bleeding than have a gastrectomy." They told Dr. Dragstedt and he went in to talk to the guy. "If you don't have this done you'll probably end up dying from the ulcers." He didn't budge, "I don't care. I'm not going to have a gastrectomy." To this, Dr. Dragstedt pulled a chair up to his bedside, leaned in close to his patient and said, "Let me tell you about my dogs." Current Mood: contemplative Current Music: CNN (1 Comment |Comment on this)
Thursday, July 20th, 2006
3:22 am	My Pregnant Chief I'm on Trauma night call now. The overall theme on this watch is pretty similar to the operative approach to Trauma... get in and get out. From the time I come in at 6PM the overwhelming feeling is that I'm being chased by a wild animal - a big one - pretty much until I leave the next morning at around 8AM. This rotation is the one that really makes you hate the pager. My sister just started a year-long trip, biking through South America and Asia with her husband. I get the e-mails from them at night with all their pictures and two unfortunate realities sink their fangs mercilessly into my soul: 1) what she is doing is about fifteen thousand times cooler than what I'm doing right now... and 2) I brought this on myself. I made this decision. And now I'm in a smelly call room getting calls about people who aren't breathing and protecting people, with so little sense that they use lighters to assess how much fuel they have left in their gas tank, from themselves. This is the second year I'm playing this role on the Trauma Service. It's also the second year I'm doing this rotation as the junior resident for the first rotation of the academic year. I took call with the chief that I started on with last year. She's pregnant now, but you couldn't really tell by how fast she moves or talks. We were in the trauma bay last week waiting for a guy who shot himself in the chest with a shotgun. She was wearing her surgical gown and gloves and pulled herself up onto the stretcher to rest her feet. There she was, semi-reclined and breathing sort of heavy the way people do when they gain 20 some odd pounds in six months. The mound of her unborn son making the green gown billow out. Almost reminded me of pictures I saw of my mom when she was pregnant with me wearing maternity dresses. It occurred to me that with her due date coming up, there is a real possibility that she could break her water in the middle of one of our traumas. That would be something. "Skeeter, my water just broke... what did the FAST show?" "Really? You should probably go then. It's negative." She's one of my favorite chiefs and working with her that night reminded me a lot of how much fun I have working with her. She grows bigger by the day. Yesterday morning in the SICU both our teams were rounding in the same pod and someone was getting an X-ray. We all moved away and I instinctively headed towards the door to make sure she got outside before they shot the film. We sort of laughed about it and she said, "At this point I'll get radiated if it'll make this thing come out." Gotta love that kind of honesty. Current Mood: blah Current Music: Jack Johnson - Questions (Comment on this)
Wednesday, April 12th, 2006
8:12 pm	VA Spa HONDAs. Hypertensive Obese Noncompliant Diabetic Alcoholics. It's a stereotype sure, but that's what a lot of us call the typical VA patient. Interviewing a vet is a little different than your average H&P. For one thing, I've never worked with a population of patients less aware of what their doctors are doing to or for them. Countless vets have passed told me how they indeed have major abdominal surgery, but no clue what was done or for what reason. "Do you have your gallbladder? Your appendix? All of your colon?" "I don't know doc. They did something but I don't know what." They're great guys and you can't help but be frustrated with them and love to work with them at the same time. Being in this alien city and hospital with no one but my dog makes it interesting in that I find uncharacteristic comfort in CPRS and the pervasive inefficiency associated with any government run facility. A lot of things are different, I find, but many things stay the same. I'm going home by 5 PM every day which is different. There are no shortage of dirty jokes for vets to tell us about viagra or breasts just before we put them under which is the same. Some Attendings actually let me operate which is different. Others yell at me and dump work on me which is the same. At any rate, things are getting better here. The dog is barking less and listening to me more. My car will be fixed next week. There's a lung resection and a hernia on the schedule for tomorrow. Things could definitely be worse... Current Mood: content Current Music: The Best of What's Around - Dave Matthews (Comment on this)
Monday, April 10th, 2006
8:45 pm	Crunch, Drag, Sparks Currently doing the only off-site rotation we have in our program. It requires a four-hour drive to a beachside city. It's a pretty outstanding rotation apart from being totally isolated from people and a system you're very familiar with already. It's a sobering moment to realize you're taking solace in the uniformity of the VA system. I've only been here for one full week and made the drive back home to see familiar places and help my dog stop losing his mind wondering where the heck he is every minute of the day. I left here at about 4:30 which would put at home at around 8:30. I had a pretty good day in the OR, got out early and raced home to collect the dog, some laundry and start the trek home. There are a few times in my life where I've thought that perhaps I've seen signs foretelling the future, that I'm clairvoyant, or both. This was such an occasion. I drive a 1995 Toyota Corolla DX. It's a 5-speed stick that I drove in high school, college, med school and now residency. My parents gave it to me when I moved away to residency. I love this car as old and relatively beat up as it is getting. I drove it to a lot of interviews for different schools. I've taken to the beach and to ski resorts. I've made out with girls in it and taught countless people how to drive stick in it. It has probably been one of the few constants in my life apart from my family and a handful of friends. The first sign that tragedy was to strike was when I watched the odometer roll over to 160,000 miles. "Wow, I thought. That's a crapload of miles. What a great car." The second sign was that I saw about forty seven people pulled over on the side of the road with the hazards on waiting for tow trucks or good samaritans. "That has got to suck," I thought to myself. I wasn't even making fun of them in my head... I was honestly feeling bad for them and glad that I'd never had to deal with that. Sure enough, about 500 yards away from my home exit, in the final 10 minutes of my a four hour drive home the car makes the most horrendous crunching sound I've ever heard come from a inanimate object. The car immediately begins to slow down and I hear what sounds like a strut from the Empire State Building being dragged underneath my car. Luckily, few people were around me and I was able to ease her over to the shoulder and pull over. While crossing the major interstate highway I noticed a glow surrounding the sides and back of my car. The scent of melting plastic started to fill the car. All at once, every episode of the A-Team and that one car chase scene in the third Matrix movie flooded my mind. I grabbed my dog by the collar and literally rolled us out the passenger side door. I imagined that the explosion threw us onto a roadside embankment... but none came. The car sat there, innocuously and completely void of any open flames or dramatic explosion, until the tow truck driver came to carry us back to my house only 7 miles away. The following day I took the car to the dealership and learned later on that it would cost 2200 dollars to replace the engine that was now no more than a block of swiss cheese with Toyota stamped on it. That, as it happens is how much the car is worth so, essentially, I will be buying my own car. The moral of the story is always check your oil, listen to your instincts, and it's better to be safe than sorry when it comes to potentially explosive metal/plastic structures even if you look sort of stupid to the 3 people that may have seen you going by on the highway at 90. Current Mood: drained Current Music: Jack Johnson - Breakdown (1 Comment |Comment on this)
Saturday, January 28th, 2006
11:40 am	Guts, ABSITE and Peru It has been a week. I don't know if I'd call it interesting or boring. But, 7 days have most assuredly passed and I am still around to talk about it. The cases this week have been a little more out of the ordinary than usual. It causes one to take pause about what their job really entails. Two babies were diagnosed with congenital anomalies prenatally that require surgery. The first was a child with gastroschisis - her guts did not reenter her abdominal cavity the way ours did before we were born. The second had duodenal atresia - his guts decided that they didn't feel like playing by the rules and simply closed up after the stomach. We knew about these children and what we would have to do for them before they were even born. I find it simultaneously rather bizarre and humbling that nature should, for reasons surpassing understanding, afflict these children with such grossly abnormal development and that we should say, in the face of these afflictions, We'll just see about that. Fixed them both and they are recovering in the NICU with no apparent problems so far. One of the few times this year I felt pretty pumped about my job. Just finished the ABSITE exam. One of the few times this year I felt like I might actually get fired from my job. Few things are as painful for me as multiple choice tests. Medical school was when I started noticing that I'm horrible at them. It is a poor prognostic indicator to take a 5-hour exam in 2 and a half hours. I have another year to look forward to fraught with Attendings pulling me aside to ask me if I could really be as stupid as my test scores reflect. It's awesome. It's strange to see the entire program in the same room for such a long period of time. One wonders who is taking care of the people in the hospital. Attendings and designated interns, that's who. Interns who are afraid to call Attendings directly and Attendings who have forgotten what it is to be a resident, aka biatch. Makes for a great combo. With the ABSITE behind me I plan to play basketball and drink a variety of alcoholic beverages this afternoon. One more 12 and a half hour shift and I'm off to Peru. 7 days of pain free exploring in a different country, learning a new language and constantly battling the instinctual urge to skip coming home. The latter option being next to impossible as several residents in this program will certainly come to Peru, find me and kill me if they can't drag me back. First time in two years I'll be travelling abroad. Been too long. (Comment on this)
Monday, January 23rd, 2006
10:45 pm	Holiday Gut When I was gowning up for my first case on the Pediatric Surgery service I saw my attending looking at my gut. I called him out on it. You were just looking at my gut, weren't you? He kept prepping the child whose hernia we were going to fix and denied it. He then asked me how my holidays went and if my parents brought down lots of food from home. This doesn't count anyway. This is Holiday Gut. The challenge was then proposed. For my seven week stay on the service I would lose 2 lbs per week. I'd weigh myself at his clinic each week on the same scale to track my progress. The first week I dropped 3.7 lbs. One of my friends asked me what I get if I manage to lose the 2 lbs each week. My reply... I get to live past 45. The whole challenge has now spread around the residency program (it's not a very large program and we're all like family - dysfunctional and crazy - but family). My attending's advice to me (bear in mind this man runs twenty miles on weekends with his wife... like, all at once... in a row) is to get off my ass and do shit. He and his wife now call me on Saturdays, the one day I have off, to make sure I'm getting off my ass and doing shit. The chair of the division told me when we were operating together that the new department motto is, indeed, Get off your ass and do shit. So far so good then. Lost nearly twice the amount of weight I was supposed to lose for the first week. How did I do it you might ask. I'll tell you. 3 simple things: 1) If you drink Coke the way most people, say, breathe oxygen, don't do that anymore. Drink water instead. 2) Spend 3 out of 5 days of your work week wearing a garbage bag like a robe and turn up the heat in your house to 85 degrees. Stand in one place from about 8 am until 6 pm and have the most intimidating person you know watch you perform some skill that they're really good at, but you don't know squat about. That's operating as a resident in a pediatric surgery room. 3) Get off your ass and do shit. I started running, a horribly masochistic and time consuming activity, but effective. Weigh in is tomorrow. Hope to have dropped another couple of pounds or it's going to be an annoying week. Current Mood: amused Current Music: Jason Mraz - The Remedy (Comment on this)
Sunday, January 22nd, 2006
1:00 pm	Toilet Training Vacation is coming up next week. It's the second of my three 1 week escapes from pagers, consults, nurses and pain. I'm going to Peru. First trip abroad since I went to India a year and a half ago. It's been too long. I bought the ticket to go last week. People have asked me why I'm going to Peru. "Because I've never been there." I find that when I travel anywhere, particularly to less modern locales I am keenly aware of one thing above all... where the nearest bathroom is located. Never am I so attentive to my bowel habits as when I'm in a place where any one of several million bacteria thriving in the water or whatever questionable piece of meat I haphazardly decide to ingest can turn my typically regular visits to the throne totally haywire. In Guatemala, most of the places I visited when I strayed from the mountain city where I was staying had bathrooms as few and far between to the point where one wonders if people down there even took dumps. It was like a crusade for the holy grail looking for a decent place to do one's business... decent being a raised concrete cylinder surrounded by rotting 2 x 4's. Toilet paper was the only thing besides my passport that I kept with me everywhere I went. In Japan it was looking for Western style toilets because the last time I was able to crouch down that close to the ground without falling over, much less with my pants around my ankles and trying to pinch one out, was when I was ten years old. Even the Western style toilets had places to put your feet up on the seat so that if you wanted to crouch like that on a normal toilet you wouldn't lose traction. There's an image. In India I had to go in Eastern styles that flushed, Western styles that didn't flush, holes in the ground, holes in the sand. That was an interesting trip. I'm excited to be finally getting out of here for a vacation. Can't wait to see Machu Picchu. It's supposed to be a mystical place that was a retreat for Incan nobles. Bet they've got awesome toilets. Current Mood: tired Current Music: John Mayer - Your Body Is A Wonderland (Comment on this)
Tuesday, January 17th, 2006
1:55 am	Dog Party I've had my dog now for a year. Named him Isaac. Got him from one of those pet rescue places. He's half lab/boxer and the coolest dog I've ever met. One of those dogs that really smart, but plays dumb. It's interesting to have had him for a year now because I can't remember ever not having him. I've never been so aware of how long I'm away from home because of him. Work days being as long as they are he has a cadre of aunts and uncles that come to hang out with him when I know I'm not going to be back early enough to take care of him. I recently threw a birthday party for him. He turned one a couple of months ago. I invited all of his friends, that is to say, all of my friends who owned dogs, plus some other dogless friends who need little excuse to get together and drink. Few things in my life to this point have made me feel like a dad, but for this party. All the dogs were running around the house like lunatics. All of the humans were in the kitchen drinking, eating pizza, and talking about work. Each dog could have just as easily been a 5-year-old kid. My dog knew it was his birthday party and asserted his lordship over puppy and human alike throughout the evening. One of Darwin's dogs, Dexter, was the kid that's allergic to everything and has to be coaxed into playing with everyone. "Guys, be nice to Dexter." Rob's dog, a pug, ran around acting bigger than he was. They'd all run and run, and intermittently settle down only to run some more. Everyone else was pretty "normal." Jeannie brought doggy ice cream over. They all crowded around us to lick it out of the plastic containers. Dexter threw up. "Guys, be nice to Dexter." This was the first time the contrast between the dog party and a kid party became obvious. Kids know that they should not try to eat one of the guest's vomit. The other ones were that you don't have to tell your kids to stop humping each other and sniffing each other's genitalia... at least not when they're five. One of my friends was there with her significant other and the atmosphere was such that everyone else would look at them and ask, "So when are guys going to get a dog?" When I would leave the kitchen I figured they were whispering about me, "I can't believe Skeeter is taking care of Isaac all by himself... so brave." Everyone left after a couple of hours of running, humping, sniffing and barfing. I picked up all the trash and Isaac fell asleep with his pile of new toys and bones. Greatest dog ever. Current Mood: awake Current Music: Hospital Hum in Call Room (2 Comments |Comment on this)