Tuesday, May 18, 2010

Done with 1!

So, I was on the phone two weeks back with someone from AT&T to trouble shoot my internet (it had decided to tweak out during finals week and I didn't have time to deal with it then). At the end of our conversation she asked me if I was interested in bundling services, putting TV with phone and internet (as I only get internet right now). She went on about U-verse TV for a bit. When I replied I don't watch TV she was blown away. A brief pause was followed by, "then, what do you do?" The incredulity in her voice made me smile. Then I told her I ride bikes and climb trees.

Which is true, but what has been the real time consumer this past year was med school. And I am officially done with my first year!

The year finished out well. On reflection it was overall very enjoyable but there were definitely challenging sections. I think we (or maybe just me) often tend to review events in the past more kindly than they might have actually occurred so I reread some of my journal entries from throughout the year. There were indeed times when I was bummed out and frustrated but most entries ended on a hopeful note or at least attempted to find the positive. And being on the finished end sure does feel good!

I don't think I ever blogged about why I came out here to WI versus other options but it was based in large part that I felt this was the community I felt would best support and nurture me in becoming a compassionate and well-rounded physician. In other words, a gut feeling led to me taking a leap of faith. I thought and hoped it would be a good fit but wasn't 100% sure. Looking back though I think I made the right call. I have made new friends I hope to have for life, met and befriended mentors I admire greatly, become involved in more exciting service opportunities than I probably should have:), become even more fascinated and in awe regarding the inner workings of the human body, taken up a new fav sport (XC skiing!), and more.

What follows are some pics and stories from the past few weeks.

(My friend Tramanh and I in lab for the next to last time - the very last time was the test! As you can see we are both wearing our "nuerobiology" t-shirts, gifted to the entire class by our beloved nuero professor Big John. he really had us call him that too! the man is amazing. The blob on our shirts is a cross section through the brainstem - one of 10 levels we had to learn!)

After finals week I headed 5 hours north to the small town (approx. 2000 people) of Grantsburg where I did an "externship" for one week. To be honest I do not know the real difference between an internship and an externship but I do know I had an incredible experience and learned/reviewed loads of material. I also got to see how far I have to go in my training:) I was mainly working with Dr. Blaise Vitale who arrived in Grantsburg 20 years back through the National health service corps and has been there ever since. I got to stay in a very nice guest house right next to their lake-side home. I enjoyed several dinners with Dr. Vitale and his wife and two kids, got beat up in ping pong by his youngest child Teddy, and overall was made to feel extremely welcome.

(First morning before clinic looking out at the lake in front of where I was staying.)

On Monday (first day in clinic) I got to stitch up a patient that Dr. Vitale had removed a mole from (my first stitching on a live human ever!), learned to start an IV, was part of an emotional patient visit concerning a man who was struggling with his recent terminal cancer diagnosis, and then stayed the night on call. The last item is because G-burg is so small the family docs and PAs cover the ER (there are no dedicated ER physicians) and Dr. Vitale gets "call" once a week. Essentially he has to be at the hospital the whole night in case anyone comes in. I was informed as we started that if lots of patients came in I would have a "black cloud" and if it was light I had a "white cloud." We saw patients up till about 11pm and then went to bed. Everytime I heard a noise in the call room I woke up expecting the phone to ring but it never did. Not a single call the whole night! I was a termed a big white clouder which I wasn't too happy about but I guess for most people this is a good thing.

The following day I got to scrub in to surgery to see an endoscopy (where they stick a tube with a camera down someone's mouth and you see the image on a TV - it was awesome!). The second procedure I observed was a hemorrhoidectomy or removal of someone's hemorrhoids. I'll spare you the details but if possible I would suggest you avoid getting bad hemorrhoids. Over the lunch hour I had some free time and decided to go run around outside. I didn't have running shoes but there seemed to be lots of grass, the sun was shining, so I went for it. Turns out the hospital is surrounded by a golf course and I found a nice green to do some yoga and handstands on. This also happened to be in front of the pro-shop and after awhile a manager came out. He informed me I couldn't keep doing yoga on his green which I kinda figured but was nice enough to help me find some grass that I could use in the future. We chatted for awhile and by the end of the conversation he offered me a free round of golf with free clubs rental. I never got to take him up on it but man, the people up there were very nice.

That evening I accompanied Dr. Vitale to the local softball field for a team work night getting everything ready for the season. Dr. V has become very involved outside just medicine and it was neat to see how he had integrated into the community. I think I would like to do something similar in the future. That night, as I had the first night I arrived as well, I did a P90X workout with Dr. V in his basement. For those that haven't heard of P90X it's a series of workouts on DVD that range from "chest and back" to "kenpo" (martial arts cardio basically) to the "ab-ripper" to "power yoga". I've always been skeptical of workout DVDs but these kicked my butt! It was also a fun bonding time and even Teddy got in on a few of the workouts.

Wednesday was a long one. At the hospital at 8am to see the admitted patients, clinic 9-5, then sports physicals for local kids from 5-8pm. Two cool things that came from doing the physicals is I now feel much more comfortable with hernia checks and also learned the real reason you get asked to turn your head and cough. It's not to elicit a special cough or anything but merely so you don't cough in the person who is checking's face! Earlier in the day I had the chance to feel an actual inguinal hernia so I had the comparison to go on. Dr. V also found me a few heart murmurs to listen to. I've still got a long way to go on auscultation.

Thursday was a normal clinic day but after clinic I helped put in Dr. V's dock with him and Teddy. After the installation I took their kayak around some islands out on the lake as the sun faded into a sorbet spread of orange pink and purple above the lake. Sadly no pics.

My final day in clinic included learning several new procedures. I was able to inject over an abscess we tried to drain and froze off precancerous facial growths from a patient with a liquid nitrogen "gun" of sorts. During one patient visit a knock sounded on the door. Dr. Vitaled opened it and a concerned looking nurse from the operating room informed him she needed a moment. I went out as well.

"Dr. Vitale... we have a very rare surgery we want Michael to see."

It wasn't an emergency after all!

This brings me to one of the coolest parts about being in Grantsburg. I was the "new person." In a big teaching hospital med students are a dime a dozen but up in G-burg they don't get too many and thus everyone wanted to meet the new student, other providers frequently came by to show me interesting cases, people wanted to know all about me and there was a even a sign above my little student desk on the first day welcoming me! I felt like a rock-star to be honest. The fact that everyone there loved to teach made for a truly ideal learning environment.

Anyhow, back to the story. What they wanted me to see was called a gallstone ileus. Basically what happened was the person's gallbladder stuck to their small intestine, a hole wore through both the gallbladder and small intestine, then several gallstones popped through the hole and traveled down the small intestine a ways before getting stuck. The surgeon had to go in and find what he termed a spot where, "a sausage meets up with a noodle" or the spot where the block has caused a build up behind it so one section is enlarged while the small intestine following the blockage is much smaller. He found it alright, twice in fact! (as there ended up being two stones he had to remove). The picture below is of the larger of the two stones.

(The larger of the two gallstones. Crazy looking huh? This one, as you can measure by the scalpel next to it, was over 3 cm across!)

My time on Grantsburg in a clinical environment with such great teachers was just what I needed after a year largely buried in the books.

After my externship I had the weekend open. My plan was to camp and bike for two days before heading back to Madison. I found some sweet trails up past Cable in Northern Wisconsin. Pics below:

("The Wall" basically the entire side of a ravine that had been covered with slabs of rock. Great fun to ride!)

(A post ride self pic)

Next day I headed towards Madison but rode some trails half way back with my friend Tom.

(At an overlook from one of the mounds.)

(The so called "plumber's crack" trail feature.)

Since Sunday I've been back in Madison doing things like laundry and cleaning my apartment that got pushed aside during finals. I've also been preparing to go to Mexico and Guatemala this summer and thus have in the past few days eaten cactus and learned about other traditional foods of Jalisco for the nutrition/cooking classes we will run in Mexico, been instructed in how to make soap, and learned how to build/focus a telescope (all pertain to projects we will be doing in Jalisco). Concerning the telescope session (last night) as we were being taught by an astronomy grad student we also were able to use the main university telescope to look at venus, saturn, and the moon! My favorite image was either the rings of saturn (you could really see them!) or the craters on the moon.

Well, that's all now. I get back to WA May 30th and if you're in the area give me a call!

Warm regards to all.