Home Based

After much traveling, I am finally done - at least for the time being. My ten ophthalmology interviews are done with. I now have the just as, if not more, difficult task of figuring out how to rank these programs. They all will make the cut since it is too ballsy for me to simply not put a program on the list. Some people do it, but I won't after having spent a decent amount of money an all my travels.

Unfortunately for the couple (maybe four) of readers I have, I shan't post publicly any rank list until perhaps immediately prior to January 15th, the date on which I will find out where I matched. It may be nothing more than paranoia keeping from posting such a list, but I know there are people out there who search for this kind of stuff. My list is due on January 8th, just one week before. That means I have less than a month to figure it all out. You wouldn't think it would be hard, but with as many variables as I am trying to consider, the decision seems impossible. I know what ranks 1st, 9th, and 10th on the list, but 2 through 8 remain undecided.

What do I like about the program?

What don't I like about the program?

How's the city it's in?

What's the cost of living there?

And of course within these questions lie many sub questions, if you will. And with the way this matching process works, there is just as good a chance I will get my second or third choice as it is I will get my first. Must choose wisely.

Outside of this, I have the rest of the month to think about it and to do my Christmas shopping. What does everyone want? I think I want a beer. . . . . . . . . . . . .Well, after that I have not much left to say. I would simply refer you to Rachel's Blog for baby info.

Giving the People What They Want ;)

Before I say much else, I have to just congratulate the Razorbacks for their closing win of the season against LSU. What a thrilling game it was. For the second year in a row, AR has beat LSU for the boot and the glory of bringing it home. Not to mention, they did it with a new coaching staff, no McFadden, and with a crap defensive line. Go hogs!

I'm not just a huge football fan, but I have come to like college football at least if not more than professional ball. Less politics, and just generally more entertaining. Since I am more of a casual fan, surely there are more exciting things in my life, right? Right.

With six interviews down, and four to go, it's hard to believe I started on this trail over a month ago. A month? Really? All of my hours and miles on the road over the last month really haven't made it drag by overall. But while on the road, what a drag! I have many miles on the car, and despite an oil change just two weeks ago, I would technically be due for another here in about 500 miles if I went by the 3000 mile rule. The trail has been fun, though. I have the same people in several places. It's nice to know that at each site, I am up against the same group of people, not a whole different 50 applicants. It makes me feel more confident that most of us have a good chance of matching somewhere. Here's the difficult part: every program has rocked my world in some way. SLU has a bunch of cool stuff to do, but the program seems almost too laid back. UTSW puts up excellent surgical numbers, but Dallas is probably just a little too flashy for me and I am sure the program is more malignant than the residents were leading us to believe. UMKC also put up great surgical numbers, but perhaps were a little too much into research requirements. UAB is a very solid program in a neat town, but the first year is in-house hospital call. OU puts up the best surgical numbers I've seen, is in a great city, and I can't find any true downfalls. MU is a solid, hidden program in a good town, but does very little trauma and so I might not get much orbital exposure. I will critique the remaining four programs in a later blog (as much for myself as anyone) and finally announce my rank list. I may not announce my rank list until after all lists are submitted. I can't see any reason why announcing it publicly would effect or hurt me in any way, but better safe than sorry.

Of course, every time I leave and go 300+ miles from home, Rachel gets some reason to be panicked about little Mia. They have all been good reasons, but at bad timing. I leave for Memphis tomorrow, so there better not be any scares Monday morning, Missy.

I put Christmas lights up this weekend since we can't put up a tree this year. We have acquired additional dining room furniture since the last holiday season and thus have no room. Maybe we'll get a little one footer and put in on top of said furniture. I would supply photos of the lights, but anyone who has tried knows they don't photograph well. But new baby furniture does!

The Mona Lisa will probably find a new home when the baby comes, or the trash can as was the initial plan. We decided to hang it in the room because it matched the green, but it doesn't match a baby. Never mind the stacks of diapers piling up, they will get used quick enough.

My room at the
Crowne Plaza Hotel
in Dallas, Texas.


Hello to all from Dallas! Why am I in Dallas? I am currently on my second of ten scheduled interviews. In order:

SLU in St. Louis, MO
UTSW in Dallas, TX
UMKC in Kansas City, MO
UAB in Birmingham, AL
OUHSC in Oklahoma City, OK
MU in Columbia, MO
UT Memphis in Memphis, TN
UAMS in Little Rock, AR
UK in Lexington, KY
U of Cincinnati in Cincinnati, OH

I was in St. Louis earlier this week and am spending today and tomorrow in Dallas. The first interview went pretty well I think. Before you ask, "Do you think they will offer you a spot?" let me just say that them offering me an interview was offering me a spot already. As noted in a previous blog, a rank list is submitted by the program and all the applicants. So now it's just a matter of how applicants rank that particular program and how the program ranks all the interviewees. Of note, St. Louis has a great program, with hospital-paid benefits. The residents were all nice people, and the faculty seemed nice as well. I wasn't sure what to expect at first since many of the residents at UAMS seemed to dislike SLU. I can't figure why since the program seems as good or better than UAMS - perhaps a few less cataract cases. This is not likely to be too important to me since I plan on being fellowship trained one day.

I would really like to add an interview at Duke to this list, but I haven't heard from them yet. I have been denied by three places, two in Boston and the other being John's Hopkins; I have turned down four programs now. That leaves about 13 programs I haven't heard from just yet. Some of them might not ever respond, including Duke. We shall see.

We're having a girl in case you haven't heard! Mia Kathryn Thuro.

I am off from school from now until we return in January. This isn't the case for all of my class, it's just how I have scheduled it. Many of my peers took July or August off. I couldn't do that for obvious reasons - rotations I needed to get done early. Two months off to travel and celebrate the holidays isn't too bad if you ask me. I'll be plenty busy.

I'm not sure what else to talk about right now, so see you next time!

So What's Going On?

You're probably wondering why I haven't posted anything in awhile. Why, Bradley, your wife has announced her pregnancy - have you nothing to say? Don't you have interviews by now? Has your cat grown a brain yet? Well, the answers to these questions and more may be ahead.

First, and perhaps most importantly, the baby. Rachel has already announced the news, so that's why I haven't had much to say about it here. Don't worry, it doesn't make me any less excited, happy, scared - you name it. Any time someone asks, "Do you know what you're gonna have?" I wanna say "A heat attack." Of course I'm kidding, and then I say we don't know just yet, but I want a girl. This draws up many looks and comments of surprise - "Really?" Maybe it's because I grew up with four brothers and only one sister. We'll find out in about three weeks. Right now we're just in the pahse of buying diapers every week while we shop for groceries, and trying to figure out what baby furniture we want. Adding a family member and needing new furniture means needing to completely rearrange some things around the house. Closets have to be reorganized multiple times, furniture must be relocated or sold, and clothes must be donated or boxed up. This is all happening, but at a slow pace since we have several months to go.

Interviews. It's interesting. Even though ophthalmology matches its applicants two months sooner than the other programs, the interviews aren't much earlier. I know someone going into pediatrics who is interviewing, like, yesterday while I continue to wait for my first one. I have so far booked five interviews, I'm trying to decide on a sixth offer, and UAMS has yet to contact me (which, barring some unforeseen earth-shattering catastrophe, will happen eventually). I am going to Dallas and St. Louis the last week of October, Oklahoma City sometime in November, and Lexington and Memphis in December. Cincinnati is the one I am trying to decide whether I want to go to or not. My goal is to get around 10 - 12 interviews, and since most programs haven't even begun informing applicants of interview selection, I don't think I have anything to worry about. Here's hoping. I have finally begun working on my application materials for the transitional year - yep, a separate application process meaning twice the money and time.


And no, the cat still has no brain. Any unanswered questions can be posed here at your leisure.

Return to Near-Normalcy

Many people asked if I was a Kentucky fan; I told them I was from Arkansas and that promptly ended the conversation.



A week back from Kentucky, and still no blog? Shame on me. Well, my punishment is to sit here and write one. That's right, I'm foregoing studying, foregoing filling out paper work for the eye bank, foregoing cleaning up the weather's havoc on our driveway and porch, to sit down and blog about recent events. I'm so hard on myself (no comments, please, RCT, GMA, and KGW!).

Kentucky was nice. Lexington is a nice area with lots to do within a two hour radius. I can't find any reason in my mind, though, to pick Lexington over Little Rock, or the other way around. Oh, aside from the fact that this is where we already live and live closer to both families than if we moved over to KY. As far as the residency program, it's par with UAMS - not as good for some reasons, better for other reasons - the kind of program that attracts me. If I were to decide to be retina surgeon, Lexington would be the place to go. If I were to decide to do oculoplastics, UAMS would be the place to go.

Let's not get too far ahead, though. I am FAR from a legitimate decision. Assuming I am invited, I will definitely return there for an interview and ultimately rank UK somewhere on my match list. But now that my application is in, and already redistributed to the various programs, it will be a matter of waiting for interview invitations and special requested additions to already submitted application material. I have to get an eye exam for the program down in San Antonio, TX - but this isn't uncommon for ophtho programs. I've gotten confirmation also from SLU. The 28 other programs I have yet to hear from. Time to hurry up and wait.

And study for Step 2, the written part. Yep, another eight hour test to be taken on the 26th of this month, which I am not taking off for study time. Many folks don't take time off to study for this exam, but that doesn't make it any less big or important than Step 1 from last summer. All I can do is come home from school everyday and jump right into my studies. Sorry, babe.

Don't have much else to say right now other than I am happier than ever to be back home and I must get back to studying. Peace.

New Yorkers

Top 10 reasons not to live in New York City, associate with New Yorkers, or even look at them:

10. They're certainly not any better looking, even though they think so.

9. They probably coined the phrase "metrosexual."

8. They believe that forgoing botox means not caring about how you look.

7. They believe that having money means you should buy more stuff (crap), not provide for your future or your family. The concept of old money doesn't exist to them, and never will.

6. They think watching ballets makes them more cultured. Nevermind that doing labor on a farm with people from all over provoides plenty of culture.

5. While David Letterman is fairly comical, most of them just plain aren't.

4. They don't have cars. They can't even say "car" correctly.

3. They also believe if you don't spend a small fortune on your clothes, you don't care about how you look.

2. They have long forgotten what trees and grass look like, and certainly can't appreciate it when they see it.

1. Have you ever met one, for cryin' out loud?

Optho Update

This is how we roll.





So I am finished with my first ophtho (sorry, I am not going to type out ophthalmology every time) rotation which lasted four weeks. I actually started this blog well over a week ago, but now that I am in Kentucky with time to spare and nothing to do, it is time I finish this piece. So ophtho was great - good hours, great people, cool surgeries, fast-paced clinic - all that one could ask for. There were some types of surgeries I didn't get to see that I would've liked to, like glaucoma shunt surgery, but four weeks is only a very brief window of time. I didn't get to see a whole lot of oculoplastic work either, making me further question whether or not that's really what I want to do. I know my lovely wife has been telling everyone that my plan was to do that, but in reality, it's simply a possibility my inexperienced mind has considered. I may in fact find that I want to do retinal surgery or cornea/external disease stuff or even pediatrics, although in peds I think I would quickly grow tired from all the prisms and strabismus surgeries. Let's just wait a while and see what happens. Pre-residency is far too early to start thinking about post-residency fellowships.

As previously mentioned, I am now in Lexington, Kentucky, doing basically the same thing I was doing in Little Rock. I am staying in a ladies basement (dungeon) for only $350 for the month. There is a big tree park, the Arboretum, near by where I can jog around a 2 mile trail a few times. I have been walking too the hospital, about a 1 to 2 mile walk each way, every day. I may grow tired of this soon. I can't say much about the program just yet as yesterday was merely an orientation to the hospital and department day. I am curious to see what the next four weeks bring me. I miss my wife terribly, but I am sure we'll both manage.

I did a grand rounds presentation at UAMS in ophtho, but now I must decide about what to do here in KY. I could do the same case presentation again, or take a completely different approach. My thoughts are that I could do a presentation on corneal tissue donation and baking since hardly any resident knows anything about it. The case presentation I did was nothing spectacular or unusual, just a typical case seen in a slightly younger than usual patient.

My application is essentially done, sans one letter of recommendation. This letter comes from the guy who called me a procrastinator. ME! He has taken longer than the other two letter writers. He keeps saying, "Oh I will have it done in a couple days," only to tell me a couple days later that, "Oh it's been busy this week. I just haven't gotten it done." Like this is different than any other week at the VA eye clinic? Was me signing up for the match the first day it opened procrastinating? Was me wanting to turn in the application by the beginning of this week, several weeks before the target date, procrastinating? Was me moving my CS exam up from November to last week procrastinating? Was me. . .OK, enough of this. Just a sore spot, I guess. I'm still waiting on his letter, which he now has to mail to me out here in Kentucky so that I can make the target date. If I wait to pick it up until I come back, the target date will only be a couple days away. I still feel strongly that the match's target date of September 3 is a little late considering some programs have deadlines in early September and the match claims it will take 3 weeks to process the application before they send it to any program. If I could get it in before the match experiences a surge of near-deadline submissions, there's less of a chance of them losing my paperwork, which they have a history of doing.

Well, that's all for now. I'm posting in the morning since there isn't anyone for me to work with this morning. Better luck this afternoon.

Fin

"Oh my dear treats, how I dream of you always."

The third year of medical school has finally come to an end. First, a little bit about the most recent rotation: neurology/neurosurgery. You may recall from my belated blog about geriatrics that life did, in fact, get worse after geriatrics. As if it wasn't bad enough, neurology was so much worse. Why, you ask? I had an attending who, while nice and with a good sense of humor, hardly acknowledged us for the whole two weeks. Nearly everyone in the department is from the Middle East and speak amongst themselves in tongues in the presence of others as if others didn't even exist. I'm not sure why, but I find that kind of rude. I know that in most other countries there are people from several different backgrounds all speaking different languages at the same time. The thing is, if you don't want the lame American sitting nearby to know what you're talking about, just go have the conversation elsewhere. For two weeks, I did practically nothing, and yet I had to stay in sights of the residents (who had a hundred better things to do than watch us) until four, five, or even close to six in the afternoon sometimes. The last two weeks were spent in neurosurgery. Again, we did next to nothing and were only rarely acknowledged, but at least we could go home early. At least then the resident recognized that we really didn't care to see yet another ventriculoperitoneal shunt placement or revision in a kid with a big head, and would instead let us go for the day. He was a cool resident. Overall, it was probably the worst rotation I've done all year. Thank the Lord it was a pass/fail rotation and I didn't have to study hard after going home.

Now, on to more exciting stuff. Third year is over, and after my one week of vacation, the fourth year kicks off. Not to mention it kicks off after what is likely to be an awesome weekend of camping near the White River. My new schedule will be off to the side here soon. I start in July with a month of ophthalmology - FINALLY! I have waited years (literally) to get at least to this point. In August, it's off to do the same in Lexington, KY. What's special about Lexington? Nothing, really - it's just that their program at least sounds really good and it's in beautiful Kentucky. I was about to give up on doing the rotation there after I found out that the graduate housing options were all filled up. I called the visiting student coordinator and she gave me a list of locals who rented out space in their homes or had attached apartments for short-term living. I called all the folks and one of them has offered me an excellent lodging deal. She has a house where her and her husband live upstairs, and the basement has three bedrooms, each rented out to separate people, with a shared kitchen and living room. It's only a mile or two from the university hospital.

Things with residency are shaping up nicely. The application is well under way. I have a rough personal statement written. I have finished selecting the 30 programs to which I will apply. I have already requested one letter of recommendation, but need to request two more. I have submitted my paper for publication which should be happening before too long. I'm also about to start studying for the USMLE Step 2 exams. That's right, plural - two exams. One is a written test much like the one I complained about when I started this blog. The other is a huge waste of money clinic on-your-feet exam that must be taken in one of five cities, and serves little more than to be sure you can speak English correctly. This part was originally designed for foreign medical graduates wishing to pursue an American residency, which is all fine and dandy. When the board decided to add American students to the test, it was for nothing more than to make money. 25,000 students per year x $1,000 per test / 5 testing centers = 5 million dollars per center per year. Do they really need that much money?

Well, I best be off for now. I have a lot to do and a lot to look forward to in the next year or so.

Residency

I love my wife; but, I saw this comic in the AMA newsletter and couldn't help but think of her fretting turning 27 years old - HAPPY BIRTHDAY!!





As you can see, Rachel's birthday is upon us; so, happy birthday to her. My birthday was excellent, as already stated. It was made more excellent with more birthday gifts from my own parents consisting of more camping supplies. I believe we are all set to visit the woods on 4th of July weekend.

So, I said previously that I would explain the matching process. Here it goes. Let's take the disposition of ten applicants applying for eight positions between four programs. For illustration purposes, the applicants are numbered 1 to 10, and the programs are A, B, C, and D. Program A will have four positions, B will have one, C will have two, and D will have one position. The process works according to how each applicant ranks the programs to which they applied, and also how each program ranks the applicants they interviewed. Each of the ten applicants ranks the four programs as follows:

1. A C D B
2. A B D C
3. B D A C
4. B A C D
5. C D A B
6. C B D A
7. D A C B
8. D C B A
9. A D B C
10. A C D B

Notice applicants 1 and 10 had the same rank list. Now, the programs submitted the following rank lists:

A. 5 2 3 1 10 6 9 8

B. 10 2 7 6 5

C. 8 1 10 4

D. 9 2 7 10 4

Since applicants 1, 2, 9, and 10 all ranked program A as their top choice, this is where they are initially placed in the first round. Applicants 3 and 4 ranked program B as their top choice, but B didn't want 3 or 4, so B matches no one in this round. Program C was ranked first by applicants 5 and 6, so neither is placed here as C didn't rank applicants 5 or 6 at all. Program D gets 7 as he ranked it first; as did 8, but D didn't want 8. So, thus far, applicants 3, 4, 5, 6, and 8 are unmatched after the first round. But, they have second choices to consider.

In the second round, applicant 3 chose D as its second choice, but D doesn't want 3 either. Too bad for 3. Applicant 4 chose A second, but A didn't want this applicant. Applicant 5 ranked D second, but didn't want 5 either. Applicant 6 ranked B second, so B acquires 6. Applicant 8 chose C as its second choice. Program C now acquires 8. Now, applicants 3 4, and 5 remain unmatched.

In the third round, applicant 3 has A as its third choice, which A considers better than 1, 9 , or 10. So now program A has 2, 3, 1, and 10 knocking 9 into an unmatched position for now. Applicant 4 has C as its third choice, so C no acquires 4. Applicant 5 has A as its third choice, which A considers better than 10. Program A gets 5 and loses 10. As this is the third round, one must consider the second and third picks for applicant 9 which are D and B, respectively. Program D just loves 9, so 7 gets ousted. Applicant 10 has C and D as second and third choices. Program C considers 10 better than 4, so it acquires 10 and loses 4. Applicant 7 has programs A and C as choices two and three, but neither A nor C want applicant 7. So, applicants 4 and 7 are now unmatched.

In the final round, applicants 4 and 7 hope to gain a spot. Applicant 4 ranked D fourth, but D didn't like 4 compared to its recent gain of applicant 9. Applicant 4 thus remains unmatched. Applicant 7 ranked B fourth, and B considers its 7 better than 6. B acquires 7 and loses 6. The third and fourth choices of applicant six are now considered, which are D and A. Program D likes its 9 better than 6, and 6 just missed program A since applicants 1, 2, 3, and 5 are ranked above 6.

Alas, the final result is here:

Program A got applicants 1, 2, 3, and 5; Program B got applicant 7; Program C go applicants 8 and 10; and Program D got applicant 9. Applicants 1 and 2 got their first choice, while everyone else got their second, third, or fourth choice. Two applicants, 4 and 6, finished unmatched, which is to be expected when 10 people apply for 8 positions. Although it didn't happen in this example, it is possible that a program will have a position to which no one matches. Suppose of all the people program C ranked highly, none of them ranked C quite so high and matched elsewhere; additionally, those who didn't match higher up on their rank lists didn't rank program C. This scenario would lead to no one matching in one or both of C's positions. These open spots are then vied for by unmatched applicants in what is known as the scramble - where unmatched applicants contact via phone program directors whose programs have open spots. This is a very stressful time as these applicants already failed to match, and now must be more aggressive than ever.

I don't know if any of this blog helps people to understand how the residency match works - but I felt the need to explain it to people. It me the longest time to figure out it worked until I found something that diagrammed it out for me. Only time will tell what shall happen.

The Misery That is Neurology

No, Daddy, I don't think I can quite reach the pedals.



First, let me tell you about geriatrics. A couple folks out there were hoping I would turn around and decide that I like geriatrics. Well, sorry to disappoint, but no, it didn't happen. Now, it wasn't the older patients that bothered me. It was the sitting around for two weeks with little to do, then sitting around in a clinic room boring myself to death with a whole two to four patients a day, and getting very little to nothing from it all. On the wards, we saw three or four patients in the morning, rounded, and then sat around the rest of the day since we weren't allowed to leave until after 4:30 every day. The clinic was everything but educational. See the hospice patient and nursing home patients weekly was a near waste of time. Worst of all, it's a graded rotation. It ought to be a pass/fail rotation considering no other medical school in the entire country dedicates (read: wastes) a month of their students' time on seeing patients who are no different from any other patient. What if I end up with a B, ultimately screwing up my GPA over a rotation incomparable to any rotation taken by another student at another school The things they harp on being extra careful about in the elderly are true all right, but these same things are just as important in nearly every patient on the medicine service at the VA, which I worked for two months.

As the rotation neared its end, I saw a light at the end of the tunnel. But that light quickly went out when neurology started. My discussion about this will be at some other time.

I have my paper undergoing its last revision by a transplant surgeon. After this, I will submit if for publication. I have registered for the ophthalmology matching site, and I am almost finished coming up with a list of the programs to which I will apply. It's an exciting time, so exciting in fact that I totally lost site of the fact that yesterday was my birthday. It came up on me so fast that the only reminder of the day was the wonderful pie my wonderful wife made for me. Oh, and a few b-day cards, text messages, and a million phone calls.

I don't have much else to say tonight. Guess I just have a lot else on my mind. Goodnight.

Spring Awakening

Below is a listing of pictures taken to commemorate the colors to spring blooming. These are the reasons we couldn't live in a city like, say, Chicago.

Welcome to our road. Yes, it's a gravel road.

So the mail person doesn't have to drive way out to all our neighbors - and they still screw it up.

The center of our "driveway." The stump, and the iron pot.

I planted these around the stump and iron pot. Hopefully, they will grow to be much bigger.

Our land, and iron pot, are infested with this bulbous plant. I was unsure of the type until. . .

A bloom! Which eventually became. . .

A flower: An iris, to be specific.

Another one, beside the house.

I'm telling you, these babies are everywhere!

Other types of purple flowers can be seen in the area.

And more.








The flowering bushes on the side of our house.









A closeup.

A different kind of flowering bush.








Same as previous, different color. Notice these are in front of our front porch.






In fact, the view from the porch.

In our back "yard," one can find many of these numbers.







Also in our back yard - WILD STRAWBERRIES!!!

Just outside the yard, the path from which Bailey's friend, Rosie, comes.

Venturing away from the house, it's amazing what can be found - a scary shed.

What appears to be an ancient torture device.

Chicks in a mailbox that hasn't received the Post in years.

Not sure how this one got here. It's about seventy years old.







A field of little, yellow flowers.

Now this field would be perfect for a game of ultimate!

As a result of all the storms in Arkansas, a babbling brook.

Also from the storms, a very wind-blown tree.







And finally, we look to the heavens to thank God for all this beauty.

As a side note, I can't begin to tell you how long it took to get all this formatted the way my anal-retentive self wanted it done. I hope you enjoy. If you haven't looked, below is also a new blog about my most recent rotation.

Family Medicine

I guess my kids actually love me.



So the rotation known as family medicine has ended. Let me preface any further comments by saying that I initially dreaded this rotation. This, in my mind, was to be the second worst rotation of the year, the first being geriatrics starting in two days. Despite my preconceived notions, I actually enjoyed the rotation. Don't worry folks, I didn't like it so much that I am changing my mind about ophthalmology - that is unlikely to change. I still hold that geriatrics will likely suck.

So what made family medicine somewhat enjoyable? A few things. The first was my fellow student. His name is Jon Chung, a 40-year old Korean-American who, after working as a psychologist for awhile, decided to reenter school and become a psychiatrist. With his age and former experience, he has a story to tell about every situation. You would think he was more like 60 years old, but looks thirty. He's just a very eccentric person and fun to work with. Since we were working down in Pine Bluff, we carpooled about three days a week. The 45-minute car ride provided ample opportunity to talk about our past lives as less productive members of society.

Secondly, we had autonomy down in the Bluff. From the very first day, we were seeing patients on our own, presenting them to the residents, and then working with the residents on a treatment plan. It actually made us feel like we were a more useful cog in the line of medicine. We were able to tell patients how stupid they were for coming to the ER for a two-year rash that was itching and required a work excuse (which we didn't give, pointed to the door, and said, "Get the f**k out!"). We never worked with the same resident two days in a row, which was great since no group of residents is perfect. There were those we chose to avoid for one or another reason, but this isn't the point of the discussion. The attendings were nice; they felt the need to actually teach us a thing or two.

Thirdly, we didn't have to do a lot of OB/Gyn. Let me explain. I worked at an AHEC, the so-called Area Health Education Center. There are several of these in different regions of the state, and other states have a similar program. Our family practice rotation distributes its students to the different centers. The only real disadvantage is that every site is a little different. At some sites, the students do a lot of OB, or a lot of inpatient internal medicine, or whatever. At Pine Bluff, it's all clinic, no OB/Gyn, and some ER. I liked the OB/Gyn rotation OK, but I didn't want to keep doing it elsewhere for four more weeks. I think I only had to do a couple pelvic exams.

The one unpleasant thing about the rotation was the last day, yesterday, and all the busy work leading up to it. After most classes/rotations, we take what is known as an NBME exam, the National Board of Medical Examiners exam. These are standardized, nationalized exams which take over two hours to go through and over three weeks to get scores. OK, so I am used to that, whatever. But after a break for lunch, we had to come back to take a lame 16-question quiz. How cruel is that? After the exam, we all had to give our presentations over an article to show that we still know how to analyze research data appropriately. Everyone's presentation was way too long. I've never had a last day of the rotation last so long.

Coming soon: a post of pictures.

त्रेअतिंग थे फमिली

इ ऍम होपिंग माय रेअदेर्स कैन रीड थिस। अप्परेंत्ली, आईटी'स इन अ हिंदू लंगुअगे ऑफ़ सोर्ट्स। वही? इ दोन'टी क्नो। थिस इस मी, बोर्ड अत क्लिनिक, वोंदेरिंग वहत टू दो नेक्स्ट.सो इ हवे स्तार्तेद फमिली मेडीसिन। आईटी'स अल अबाउट त्रेअतिंग पीपुल'स पूर्ली कोन्त्रोल्लेद डायबिटीज़ और ह्य्पेर्तेंसिओं। आईटी'स फार तू कोम्मों। पीपुल एइठेर कैन'टी अफ्फोर्ड ठिर मेड्स और जुस्त वों'टी गेट थेम फिल्लेद। एंड आईटी'स नोट ठाट थे मेदिकाशन्स अरे तू एक्स्पेंसिवे, इन मोस्ट केसेस। सी, वे वर्क वैरी हार्ड टू स्टिक टू थेफौर डॉलर लिस्ट पुट आउट माय वाल-मार्ट, एंड रेस्पेक्टेद बी मोस्टओथेर दृग स्टोर्स। ठेस अरे पीपुल व्हो वौल्ड रठेर स्पेंद मनी ओं सिगारेत्तेस एंड अल्कोहोल थान मेदिकाशन्स। इ उन्देर्स्तंद ठिर लिवेस अरे दिफ्फिकुल्ट, ठाट थे लिकेली हवे फमिलिएस टू फीड। गैस प्रिसस अरे थ्रौघ थे रूफ़, इ क्नो थिस। बुत थे काम इन रीकिंग ऑफ़ स्मोके एंड गोद क्नोव्स वहत एल्स। ठाट मनी स्पेंट ओं सिगारेत्तेसऑउघ्त टू बे स्वेद एंड स्पेंट ओं मेदिकाशन्स.इफ सोमोने दोएसं'टी वांट टू टेक करे ऑफ़ ठेम्सेल्वेस, ठाट'स ठिर पेरोगातिवे। बुत दोन'टी कीप किंग बेक टू माय क्लिनिक, इल अगं, बेकाउसे यू वों'टी टेक यौर दमन मेड्स। बरबर> थे ड्राइव टू पीने ब्लुफ्फ़ एवेर्य्दय हस गोत्तें ओल्ड। होवेवर, इ लुक फोरवर्ड टू थे देस व्हें जोन, माय फेल्लो स्तुदेंत इन थे ब्लुफ्फ़, एंड इ कार्पूल थिस इस अल इ'म गोंना टाइप सीन्स यू कैनरीड आईटी.

Time for Birth

One of our local resident lizards surfacing from the stump of a tree after the rain.





Hello again, folks. I have returned again with more to say about this and that. Read on if you wish.

Last week, I finished my OB/Gyn rotation. Stop me if you've heard this all before, but I started out with three weeks on the gynecology oncology (GONC) service. I actually enjoyed those three weeks. Though the days started early, some as early as 4AM, it was in effect much like my passed surgery rotation. We basically took care of women either the day before or in the days after a major surgery to decrease tumor burden. These were women who, while they may not have known it, were quite ill. Few will come around eventually with excellent outcomes; others, perhaps most, will not. Some had benign diseases that were more a nuisance than an actual health problem, but others had horribly malignant disease. Our jobs were to treat these ladies surgically. The chemotherapy and/or radiation therapies would be undertaken with another team of physicians. Well, Brad, if it sounds so bleak, then why the hell did you enjoy it? I enjoyed the surgical aspect. Perhaps I didn't mention it before, but I loved the surgery rotation - and this was much like that. Early morning rounds, followed by a day in the OR. I am a man who wishes to gain surgical talent rather than medical - the main reason I want to be an ophthalmologist. Sure those crazy eye guys must be cognizant of medical conditions which afflict the eyes as innocent bystanders, but I can't wait to cut and repair.

The next three weeks were the obstetrics portion of the rotation. The first week was spent in the outpatient OB clinic - the home of prenatal care. More specifically, I worked in the the community women's clinic - the home of prenatal care for Mexicans and others without insurance. I'm not racist, just saying it as it is. I told Rachel that if and when the day comes that she is a Medicaid patient up there, she will be loved. She speaks English, she isn't a morbidly obese patient on whom some poor medical student must perform a pelvic exam, she won't simply be knocked up for the third time before the age of eighteen by God only knows who, and she will actually give a damn about her baby's health (won't you?)! She and her husband will know how to take a shower - and that's another thing, her husband will probably actually be there, rotation permitting. That about sums up that first week. The next week was spent working 5AM to 5PM on the L&D ward delivering babies. I saw four or five c-sections, and three or four vaginal deliveries. One of the c-sections was a set of healthy, screaming, twin boys - it was heart-warming. Seriously. The following week was to be a week of nights on L&D from 5PM to 5AM. Since I was one of the lucky ones scheduled to do nights on the last week of the rotation, and since the clinic/ward duty technically ended Tuesday afternoon at 5, I only had to work one night. That was fun to rub in the face of disgruntled classmates. I also rather enjoyed my time in the hospital - aside from the many stereotypical L&D nurses who seemed to think their way was the only way, and by God, if they didn't have a say in how something in the hospital was to be run, then it was being run wrong. If the mop bucket (of all things) wasn't working to L&D standards, then somebody REALLY screwed every one's life to hell.

In other medical news, I have been on a search. I am making my way through each ophthalmology residency program, one by one, to decide to which ones I will apply. Ideally, I will apply to 20 to 30, but only interview at about ten or less. So far, I have only investigated programs amongst which some I will apply to, but at none will I interview. I have so far looked at programs in MI, WI, IL, NY, NJ, PA, MS, KY, TN, AL, OH, and IN. Know your states? The one exception to the above statement is Tennessee - I will likely interview in Memphis. Of the 45 programs I have searched, I have selected 11 to whom I will apply. I have MANY more programs yet to look at - roughly 70, so no worry.

Also in working towards residency, I have decided to try to publish another paper before applications are due, only this time I will be the primary author. Seems like an impossible time line, but it's not. The Jones Eye Institute at UAMS publishes the Journal of Ophthalmic Medical Technologists. Not exactly a prestigious publication, nor is it written for ophthalmologists as it's for OMT's, but it will do. I am going to write about the process of corneal transplant, from the time of the donor's death to the time of transplant. The technical aspects the actual transplant surgery will not be discussed. So I have some researching and writing to do. Wish me luck!

Soon, I will post a picturesque blog detailing the mass blooming of greenery out here in the woods. I look forward to that, as I am sure you do.

After the Marathon

The comparatively small medal from last year's relay race.

This is going to be one of those posts that has little to do with medicine. I think I am allowed to do that once in a while, despite the intention of this blog. Most life events are better commented on by my wife since we experience many of them together, so she often beats me to the punch with such things. Surprisingly, there are a few things more privy to just my experience.

To get the medicine aspect out of the way, I am currently on the OB/Gyn rotation. The first three weeks, of which I am about to enter the third, I am on the gynecology oncology service - essentially revisiting three weeks of the surgery rotation complete with early mornings and standing in the OR. The excellent thing about this rotation so far is there are five of us students on the service. On any given day, one of us has to attend the clinic, one student needs to be in each OR (of which there only one or two a day), and the rest, assuming they're not in private practice that day, go home after rounds. On Wednesdays, we have lecture and all that jazz after which we are free to go home on this service - which is usually by eleven ("This day goes to eleven"). Fridays entail a noon pre-op conference over catered (i.e. drug rep) lunch after which, again, we go home. Days are thus either long (5A to 5P), or laughingly short. Following will be three weeks of OB, one in the clinic and one on the L&D ward. I look forward to it, surprisingly.

On to other things. So today was the marathon. All 26.2 miles of it. I have been working up to this point since September or October, steadily increasing the length of my longer runs until I hit 20 miles, and then tapered down to rest the week or two before the race. It was all good and well - I was able to work up to and do 20 miles without much trouble. Most people could do it; it's just a matter of going through the motions of training. Granted, some have the misfortune of having joints that just don't agree with running that far/long, and that's a valid reason for some folks not doing it, but not for as as many folks who use it as an excuse. Sure, if you were going to run today after not having done it in a while, your knees will hurt. But there were plenty of people out there today far older than I running like champs.

Anyways, off my soapbox of sorts, today was the first day I ran over 20 miles. I started the race superbly. I was with or slightly ahead of the 3:30 pacer (which is an eight minute mile on the dot) until mile 13 or 14, during a long, two to three mile uphill stint. Suddenly, shortly after passing the 20 mile marker, my right calf muscle started spasming, hard. It was a bizarre feeling, powerful contractions that hurt like no other. I don't know if you've ever tried to run with a spasming calf muscle, but it can't be done. I had to walk for about half a mile. I passed the 21\2 mile marker and soon my left calf almost started doing the same thing, so again I walked a little bit. This time up to two miles. When I passed mile marker 24, I promised myself I would run the last 2.2 miles. I did, but they were a slow two miles. I finished in 3:58, which if I may say, ain't to shabby for my first race and considering I did over two miles worth of walking. I don't yet know where I placed amongst the thousands of runners involved in the event, but I know it was within the first two hundred marathoners, and I even finished before some of the half marathoners. An extremely large marathon medal (the world's largest marathon medal, seriously) and my always beautiful and wonderful wife awaited at the finish line to congratulate me on a job mediocrely done.

The environment of the race was wonderful. The comradery of the local Little Rock folk is awesome - people along almost the entire course cheering you on, calling you out by your first name (as it's on the race bib), and volunteering to hand out water and fruit along the way. (You can't run 26 miles and not eat and drink along the way!) The scenes and sights were great. We passed the Clinton Presidential Library, the river numerous times, Central High School (recall the Little Rock Nine), the capitol building, the governor's mansion, the beautiful Rebsamen golf course, and of course all around downtown LR.

Of note, one less fortunate individual passed away shortly after crossing the finish line today. He collapsed in the finishing area and EMS tried to resuscitate him, but were unable to do so. I don't yet know how old the gentleman was, but the details are less important. I am sure he had no intention of seeing this race as his life-ending event. Our thoughts and prayers go out to his family and friends for their loss.

I suppose that is all for now. I will go mend to my wounded feet and dehydration.

On Mental Illness

I have once again risen from the the ashes to create another post. Only read on if you wish to know about the crazies.

So I have started my psychiatry rotation. Once again, I am at the veteran's hospital, only now I am in North Little Rock, a nice half hour drive twice a day. Granted, I know some make much long commutes daily to and from their jobs, but I think they too fall in the crazy category. Starting on January 7th, I did three weeks of outpatient clinic where I saw patients who mainly suffered from depression and/or PTSD. I saw a patient who was at least manic, if not bipolar, who denied his condition despite a recent episode of wandering neighborhoods all night and hiding in peoples' bushes. I saw a schizophrenic in clinic who, while currently well controlled on antipsychotic medication, continued to report the voices of demons telling him he was the son of Perdition and the Antichrist. Those two together are a might heavy charge, if you ask me. Now, and for the next two and a half weeks, I will be working with the patients who are committed because they are super crazy, are super depressed, or have super PTSD symptoms. So I currently have a schizophrenic patient who is NOT well controlled on his medications. His retard Christian Evangelist born-again psychologist, likely from the hills of Deliverance, told him to stop taking the meds as they were causing his diabetes. While this may be true, it's better to have easily controlled diabetes than psychotic symptoms requiring hospitalization. He came in, self admitted, with grandiose delusions about how God worked through him in such a way that he was to communicate with high religious figures to spread information about the Antichrist. Again, a crazy claiming connection to the bringer of everything evil. Is there really a connection? He also thinks the police and millions of others are constantly surveilling him, just waiting for him to slip up and say the name and whereabouts of the Antichrist. It's him and "his people" versus the rest. I haven't yet asked what side I am on for fear of my life. He also sweats blood, much like Jesus and the apostle John, and doesn't want meat even though he knows animals are God's gift of meat to us. More medications, I say.

I would also like to bring up something educational. I saw to patients receive ECT, or electroconvulsive therapy, this morning. Let's dispel some Hollywood misconceptions, shall we? ECT does deserve its criticism, IF YOU LIVE IN THE PAST! It used to be a very barbaric procedure, and overused, such as we have seen as follows:

Jack Nicholson in One Flew Over the Cuckoo's Nest

Or, more recently, this one:

Ellen Burstyn in Requiem for a Dream



Notice, these people are awake and either strapped down or several people are holding them down. This is so far removed from the case of today, it's hard to imagine a time like this. Now, people are under full anesthesia, intubated so that they may breathe, and have been given a paralytic agent so that the induced seizure doesn't cause physical harm or kidney damage. The seizure lasts between thirty seconds and two minutes, ideally, and the only indication of its presence is an EEG (a machine which monitors electrical activity of the brain) and a seizing foot. The physician puts a blood pressure cuff around ankle to keep the paralytic agent out of the muscles of the foot to give the team a physical indicator of seizure activity. There may be some facial grimacing as preventing this would require far more paralytic agent. When the procedure is done, the paralytic agent is reversed with another drug, the patient is woken up and extubated. Simple (and boring) as that.

To be fair, here is a link to a pamphlet opposing ECT: http://www.antipsychiatry.org/ect.htm

There are MANY things wrong with this pamphlet. First, the website itself. I at first thought this was by a Cruise-lovin' scientologist based on that alone. Nope - it's a blood sucking lawyer, perhaps even worse. Second, he quotes books and articles dating as far back as the 30's up to the nineties, with a few updates at the bottom. Outdated information is a sign of poor research. Thirdly, amongst all his listed sources and recommended readings, ALL are opposing pieces. A well-written stance provides information from both sides. Now, there are some M.D.'s out there who also oppose ECT - psychiatrists in fact. Fair enough. But since when does any psychiatrist know an inkling about how their treatments really work? Fourthly, the "author" uses more quotation marks than Lisa Ramsey on a crack "binge" - simply "annoying." Sure there is some short term memory loss - as in they might forget the morning of the treatment, maybe the day before hand. Any more than that is exceedingly rare. Sure they may be in a trance for a bit after the procedure, but so are most seizure patients. It's called being in a post-ictal state, and it always passes without harm. There is no good evidence for permanent brain damage, especially since chronically depressed patients, the only patients in whom it is used, likely have brain damage anyway. It is NOT used as a scare tactic for patients - that's just crap. All the patients I have seen involved in it chose to do it on their own accord, and it's a rare enough procedure that the possibility of them being scared into it by others is highly unlikely, if not impossible. Here's what ECT IS:

1. More effective than taking a pill every day.

2. A VERY good option for those who have recurrent, severe depression unresponsive to other medications.

3. A last resort.

4. It can, and does very well, turn this:

In to this:

So there you have it, my standing on ECT. Just thought I would dispel some common myths about it. Soon, I will give my standing on the presidential candidates based on their standings on health care issues. Our good friend connection in Chicago, Carrie, hasn't yet reported on individual health care opinions, and I need to be informed. I fear for the future of medicine.

Belated

Fireworks from God only knows where, or to celebrate what year; but New Year's fireworks just the same.



So I'm about two months behind on blogging. I have little to blame except for myself, the surgery rotation, board exams, Christmas, New Years, family, the Wii, Rachel's need for attention, Cali's need for attention, etc., but nothing else. It really has been a busy time aside from the past week and a half. So, what's been going on?

Let's begin with surgery. It's over, long over in fact. I had fun, liked it a lot, didn't really mind the long hours, and met people in whom I instill trust to one day write for me a letter of recommendation used to land an awesome ophthalmology residency. Don't want to get ahead of myself, though. Plastic surgery taught me more about wound care than I cared to know - I saw some deep, nasty looking wounds. Vascular surgery was less than exciting, but this lies merely in the fact that the attending was gone for most of the first week, and the second week was in alignment with Thanksgiving. These all added up to not much to do for two weeks but sit around and wait for evening rounds. My four weeks of "general" surgery at Children's was fun, although I didn't want to do any clinic. I guess I just hoped to go for eight weeks without any clinic, it being surgery and all. I did see some impressive childhood tumors, ones that required two adult hands to hold and looked like big balls of pulsating goo. They had dedicated blood vessels larger than the ones that supplied their little arms. It's amazing to think that many of these childhood cancers have a better prognosis than many of the smaller adult cancers. I asked one of my surgery attendings there if he could write me a letter when the time came; he was glad to oblige.

The holidays came and went, much as they do every other year. Families were seen, gifts were exchanged, as were household common colds, and Cali was left home alone yet again for what seemed to her like years. We came back to critter who wanted us to believe she was a gray old hag. Hag maybe, lazy for sure, but not gray or old. I got a Wii for Christmas. I have played it ALOT, as has the Mrs. But she spends more time toying with the Sims and finding a new job than she does with the Wii. I, on the other hand, just wish to sit on the couch and try my hand at another (totally scientifically inaccurate) surgery. Good one, Mon. I've also been reading Life of Pi, another gift I got from Monica, even if it was given last year. Oh, and she also got us all tickets to the Trans-Siberian Orchestra. It was a show as much about lights, lasers, and fire as it was about music. What's in store for next year? Does she perhaps have something in store for the next holiday, MLKJ day? Only time will tell.

I am on call starting today for my job. That's right, the job I acquired back in AUGUST, I am finally going to make some money with. Oh, and help save some peoples' sight. Maybe I will get some sleep, maybe I won't. The great thing is, if I don't get much sleep, I am still off from school until Monday, and I'm not on call from 8AM to 4PM, so plenty of nap time.

Well, I really don't have much else to say. You've heard all about Rachel from her blog, I'm sure. Anything else I might have to say is not rated for this public blog.