Monday, October 19, 2009


Two weekends back I had the opportunity to participate in what I can only describe as an amazing event. Before I go any further I must put out the disclaimer that i do not have time to edit this much and thus I am sure errors will abound. please forgive me:)

anyhow, medwar. the short version is i participated in an all day adventure race with medical scenarios. and it rocked. for the longer version, read on.

after a 6+ hour car ride to central michigan and a night spent at sub-freezing temperatures in a tent (i know see why my tent is called a three season tent because i found the 4th season) we got up and assembled at the start line. being the midwest medwar there were over 30 teams of three from all over ohio, wisconsin, michigan, and more.

at the go command we all raced helter-skelter to the lake shore where the teams jumped in canoes and headed out onto the lake in the cold early morning light. or tried to. one team, close by our boat, capsized and almost took us out as well! we were then rammed by another boat which almost tipped both teams. clearly there were few skilled canoeists in the competition. the starting canoe portion took us over 2 miles through a series of lakes connected by small passages until we arrived in "asia." i say asia as the theme of this year's competition was "around the world."

we were handed a slip of paper explaining we had just arrived after a tsunami had hit and needed to help as many people as we could. before us were three dummies and an event coordinator who narrated to us/answered our questions as if he was a victim. we had to initiate CPR on a baby (plastic life size doll), splint the arm of an inflatable dummy and insert a tube (we used part of a pen we disassembled) in the throat of a third dummy to restore breathing after massize facial trauma. when we cut through into the "throat" (plastic tubing under fake skin) red goo went everywhere - they had inserted ketchup packets in the dummy! for failing to assess the scene for safety we were penalized by having to clean the babies diaper which had been fouled with chocolate goo.

From there we were told to navigate any way we saw fit to the next point on our map. heading off at a medium jog we started passing several teams who had gotten ahead of us by whipping through the medical scenario. Arriving at the top of a hill (mt. everest) one of our teammates was whisked (alex) and myself and Luke were handed a scenario detailing that he had become disorientated, wandered off, and fallen. assessing alex's condition we found a fractured femur and possible spinal cord injury. we had to immobilize his neck, splint his leg, and then construct a stretcher to carry him down a very steep hill covered in low trees and brush. this proved to be the most physically demanding of all the scenarios. we splinted his leg with the canoe paddle we were required to carry, immobilized his neck with card board and duct tape, put him on a tarp we had, and started to haul him down the hill. this sort of worked but the trees were so low and the slope so steep we went very slowly. if alex really had the injuries we was pretending i imagine we would have severely aggravated his condition. we eventually made it to the checkpoint and received no penalties - nice!

We ran on until the next point in which i had become "too cold to continue." my teammates had to warm me up and build a fire of adequate size. to pass each team had to burn through a pencil. alex had read about rubbing cotton balls with vaseline and those babies worked like a charm - we were through that pencil in no time!

at the point luke and i became "snow blind" and had to put on goggles with that essentially left us with no vision. alex led us through a mile of trail in this condition and with his careful guidance we had no falls.

after the blindness we arrived in south america and luke was instructed to split from us to go get water. i handed him my filter and we split ways. alex and i had been instructed to find the park headquarters to rest before luke would rejoin us but we could not find him. we headed to the other side of the parking lot and found a bunch of competitors with paper bags over their heads and a lady patrolling them with an airsoft gun - colombian hostage situation! i tried talking to her in spanish but i guess the scenario wasnt that realistic. we had to identify luke, and then escape with him without getting shot by the guard. running from the scene we came across several dummies. it turned out our interpreter had been injured in the flight and we had to take care of him. looking to dummy over we found a gun shot wound over his right lung and discovered it had caused his lung to collapse in. for this we had to create a one way valve for which we used the pen tube, tape and a piece of a latex glove. when i tested the device later at my house it really worked! you could blog through it but not suck much air back in. after rescuing Javier we had to describe how we would coordinate a helicopter extraction and alex's lucky guess of a 100 ft by 100 ft landing zone let us escape without a penalty.

after rocking through south america it was on to its northern counterpart. yes, things were going well. and then we got lost. badly. we thought we knew where we were on the map but this turned out to be incorrect and led us to run 2 miles down a county road outside the park. by the time we got back on track any hope of victory was pretty much gone but we were having fun so this wasnt too big a deal.

the north america challenge was three-fold: removing a giant fish hook from a chicken thigh (dead chicken) - we pushed it out through the flesh and then clipped the end with pliers that alex had somehow thought to bring, filtering water and then drinking it to prove it, and finally a gear check to make sure we had a change of clothes and water proof layers, a compass (should have been using it more:) etc.

We took off though the trails on the way to Europe and promptly got lost again. I blame it on our speed. we were running fast enough that we could get way off track before we thought "hey, maybe we shouldn't have been going south quite this long..." in the end we arrived at the first europe scenario from the opposite direction have run an extra 3 miles or so on a completely different trail. at least we were getting great exercise! the slow teams we had passed earlier all gave us funny looks as we passed them for the second time.

arriving in europe we were "exploring nazi caves on the coast of france" when alex screamed. we rushed to over to find him, according to the scenario, lying next to a broken bottle, pupils dilated, vomit and feces evident, and shallow breathing. we had to figure out what he had been exposed to and administer the proper medication. luke and i looked at each other. 6 weeks in and we certainly hadnt gotten to any like this yet. we both recognized signs that his parasympathetic "rest and digest" nervous system was out of wack and one of the meds from the pile (of which most i had never heard of) i knew had something to do with stimulating the heart (atropine). as we debated, the volunteer delivering the scenario got on us saying, "you gotta commit, he's gonna die, make a decision!" "ok, ok, um... we'll go with atropine" i replied

"you're right, he lives"

nice! turns out the substance was sarin nerve gas which is an irreversible cholinesterase inhibitor aka nasty.

At that point we had to get to the next point on the map without using any roads. this didnt turn out too bad as we found a good trail and didnt make any wrong turns. popping out from the forest we came upon... africa! the first challenge was a safari "hunting" expedition. each team member had to hit three separate targets using paintballs and a slingshot - super fun! from there we ran up the road a bit to find huge rubbery fake halloween feet that had a small hole with a cooked noodle sticking out. this was to simulate Guinea worm and we had to extract the noodle, er worm, without breaking it. in real life this process can take over a month!

another free for all navigation section led us back to the lake where we had to construct a shelter and have it tested by a guy with a squirtgun. at this point we could have canoed back or there was the optional orientering challenge. a number of questions had been scattered throughout the park and for each question found and answered correctly time would be subtracted from your total team time. losing so much time being lost we didnt have much of a chance on this portion but did manage to get 2/10 question zones.

from there it was back to base as fast as we could paddle. the pizza, chili and cidar feast that awaited us was heavenly after a hard 7+ hours on the move fueled by bagels and energy bars.

reflecting back on the event not only did i have a blast but i learned a fair amount too. we didnt finish very high (middle of the pack) but in the end none of us cared too much. i definitely plan to return next year.

Sunday, October 4, 2009

White Coat

Yesterday was our white coat ceremony in which we donned the traditional garb of our profession and recited the oath our class had created.

(Me with my friends L-R Phat and Steve before the white coat ceremony. Phat is from Vietnam and has become a study partner of mine; we've been meeting up to quiz each other and find areas we are weak in/explain them to the other person. We're planning to hang out and cook some time soon as I want to learn how to cook Vietnamese and Phat wants to learn something that is not Vietnamese!)

(The three neighbors, L-R Emily, myself, and Anst with our white coats and lake Mendota in the background. Neither Anst nor I had family that was able to make it so Emily's family took us on as surrogate children and even gave us a ride to the ceremony.)

I went in to the ceremony not too excited but ended up having a pretty good time. The two highlights were meeting several classmates' families and listening to Dr. Cynthia Haq, the main speaker for the event and also a UW professor of family medicine and head of the global health center. She talked of the excitement and challenges ahead as well as reminding us to take care of ourselves in the years to come so that we may continue to be of use to those we serve. Right on! As for the white coat, well, to be honest I hope to not wear it as much as possible. I tend to overheat with extra layers and in addition feel in some cases the coat can be a barrier between doctor and patient. We shall see; I know they want us in them when we are in the hospital but my preceptor physician told me right off the bat not to bring one and no tie either - fine with me!

Speaking of which, I've visited the family doctor I was assigned to twice twice now and just this last time (Friday) I was with the doctor for a kid's exploding abscess, frying off warts with liquid nitrogen, , general well exam, several substance abuse/depression cases (which are so tough - you can just see the potential in the person if only they could remove the yolk of their addiction), I felt a possible testicular cancer and, the highlight, I interviewed my first patient!

The patient was a young spanish speaking woman with a sore throat and got to ask her the questions we have been learning in our interview class: "where does it hurt, how long, fever?, tried any medications or home remedies?, etc." Then I reported bac to the doc before we both went in and he finished up the interview. Watching him I realized I missed some key questions but overall most of them! It may have been a pretty minor event/illness but for me it was pretty exciting - my first real patient interview - and it was in Spanish!

In other news we finished up our first round of exams last week and so far the 2/4 grades I have seen came out well. It's nice to know I haven't forgotten how to study after 2 years out! It's also getting colder - fast. My first month was a paradise like 70-80 degrees, sunny all but one day with low humidity. Then about two weeks ago it dropped an average of 30-40 degrees!

One final highlight. Right before exams I needed a study break and decided to head out for a short run. I was chugging along when all of a sudden I noticed apples at my feet! A quick scan of the tree above showed it loaded down but the tree was a big one (closest apples were a good 20 ft up) and it was smack in the middle of someone's yard. I decided to knock on the door and see if the owners were OK with my going for the apples. The man who answered seemed a bit perplexed - "they're pretty high up but go for it if you want." I returned home, grabbed my football and bag, ran back to the tree and began to chuck the football up into the branches. It worked great! The best times were when I would knock an apple down and then catch it and the football! After I was at this for a good half hour the wife came out, she had been watching me for some time, and commented she'd never seen anything quite like it but it sure looked like I was enjoying myself! I collected a good 30 of the most amazing tasting apples and proceeded to make a huge apple crisp which I just finished up yesterday. Awesome!

I hope you're all well.