Back From Vacation

So, I just got back from vacation this week and started my next rotation, Cardiothoracic Surgery. Vacation was nice but just oh so short. I drove home because I wanted to get some hunting in. Above is a couple of pictures of our cabin. The top one is of the wood burning stove and the bottom one is when we laid the stone foundation around the bottom. Well, to get to the story about hunting and the reason there are no pictures of a deer, is that I suck at hunting and missed the deer I shot at. End of story.

It was nice seeing all of my friends and family. I stayed with my parents the whole time and we all had dinner at my grandparents for "Thanksgiving." I wish I had time to hang out with everyone longer.

Well, needless to say, it had to come to an end and I had to drive home. On the drive to and from St. Louis, I read a couple of "Books on Tape."

1. Common Sense - Glenn Beck

-This was a great book. It was short and to the point. It did not speak about how bad democrats are, or how bad republicans are. It basically spoke about the lack of common sense that goes into many of the decision that are made, both in and out of politics. It is a book inspired by the Thomas Payne book. I have yet to read that one but hope to someday.

2. Christmas Sweater - Glenn Beck

-This is a book written based around a true story/true events in Glenn Beck's life. The moral of the story is that we are the only person who can decide if we are happy or not. Not our past, present or future events, but our attitudes. It basically states that everyone has terrible things happen to them at some point in their lives, but only we can make the decision to wake up happy.

3. The Shack - William P. Young

-Awesome book. A Christian book. I don't want to give details because it is worth

reading and I hope you do. It really makes you think.

Anyway, I have to go read. I haven't had time this week but have a couple of hours tonight.

Happy Holidays

First Visitors

Well,

I had a weekend off and my cousin, Kristin, and Yosh came in to town to run a half-marathon. I was going to run this, but I started out too quick and got shin splints. For some reason I tried running six miles my second week. I accomplished the six miles, but thereafter I could not even run 1/2 mile due to pain. They still ran the half. Unfortunately, it was a short weekend and we didn't get to do too much, but it was nice having visitors. Here is some pictures of us in Hyde Park by the Christmas tree.

Trauma

So, I am 3/4 finished with my trauma rotation. It is an interesting experience to say the least. Most of what we do is deal with social work issues because almost everyone who comes into the trauma bay is either homeless, drunk, or both. I have learned that the fastest way to get into an accident is to be intoxicated. Whether you are riding a bike, riding a motorcycle, driving a car, or just crossing a major highway on foot, being intoxicated seems to be the common denominator.

But, this has truly been an eye-opening experience. If you have a weak stomach, I suggest skipping this paragraph. People come in shot and we have to put tubes in their lungs while they are awake. These tubes are about the diameter of a nickel. Other people come in brain dead from an accident and have their brain hanging out of their skull. But, since it is a teaching hospital, we treat the patient as if they were going to make it. Just because they are brain dead, does not mean their heart isn't working and they aren't breathing on their own. So if they are, we go through the motions of trying to save their life to learn. So, one night, I was doing chest compressions on a patient as their brain was coming out of their nose. I almost vomited. I know this is a necessary part of a general surgeon's training. I am just glad it's not part of mine.

Unfortunately, being the bottom guy on the totem pole I do not get to do much of the cool stuff. I get to drain abscesses, admit patients and discharge patients. I wish I got more experience running traumas and learning about head and neck trauma but I try to just learn this on my own. Oh well.

I am just getting a little frustrated being a non-general surgery resident on general surgery rotations. We don't get treating differently, so I am not complaining about that. I am frustrated that I am learning about things that have nothing to do with Head and Neck Surgery. But, like I said, I try to read a bit every day or so to get ahead.

Otherwise things are going well. I got to go to the operating room and do 3 surgeries last Friday. 1. Lipoma resection: this is a benign lesion that was on someone's neck and I got to do the removal of it. 2. Benign tumor resection: this was on someone's chest and I got to help remove this. 3. Umbilical hernia repair: I didn't get to do much of the actual repair, but I got to open the skin with the scalpel and close the wound after it was fixed. None of these three cases have anything to do with my specialty, but at least I got some experience with the knife and suturing. The attending was very good about letting me do the operations and teaching me how to use the instruments.

All in all, this is an okay rotation that I wish I had more duties but am still trying to make the most of it.

Skyway Pier Fishing

Went fishing last week. We went off Rattlesnake Key off the South Skyway Pier. We couldn't decide if we wanted to take the Hobie Mirage Outback Kayak out to the Skyway and fish for some Spanish Mackerel or hit the flats and try the Trout. I got out there a bit before Mike so I decided to catch some bait. I was having no luck until about 30 minutes before he got there. I first tried using a Cast Net. Needless to say, this is not the best thing to do from a kayak. I fell in. Luckily I decided to take my phone and put it in the dry box just prior. So, all is safe and I climbed back in. At this point, bait was coming into the grass flats as the tide came in. So, I started using my Tsunami Fluorocarbon Sabiki Rig. This was slower, yet safer from a kayak. I caught a decent amount of bait, including greenbacks and lady fish. At that point, Mike finally showed up. It was about an hour before dark and we started catching some fish. We mainly used MirrOLure. We also used some of the bait I had caught. We did well and caught over 5 trout each. Unfortunately only a few were keepers. Those few tasted good.

Disregarded Common Sense

Vacation

Yes, I actually get 2 whole weeks of vacation this year. They are as follows:

1. 11/30/09-12/6/09

2. 3/22/10-3/27/10 (I have to be back by Saturday night because I am on call Sunday)

What is going on with this world?

Ok, so there are many things to talk about.

1. I am finished with Neurosurgery. I had a great time with the guys. We all had very similar personalities and got along well. They treated me well, too. But, it is nice to not be on call anymore for the next few weeks. In short, I am on anesthesia right now. Basically, I walk into the OR and put the tube in the patients' airway for the case. Not a bad gig considering I have no call or weekend responsibilities.

2. I am going to San Diego this coming weekend to present a paper I wrote on Head and Neck Cancer. I am going to try to go to the Zoo. Otherwise, any ideas for what there is to do?

3. Some bone-head Orlando, FL Representative (D) made a bone-head comment yesterday. He said that the Republican Party's health care reform plan is "Don't get sick." That's it. Oh, I cannot believe I almost forgot the other bone-head comment, [if you do get sick,] "Die quickly." I know that's how I feel as a Conservative in the health care field (sarcasm, of course). I mean, seriously? What jack ass would actually say that at the US House of Representatives? Only the Democratic Party could produce someone as intelligent as Alan Grayson to enlighten all of us on how we, the majority, feel about health care.

4. A couple of friends of mine, Neil and Jenna, are getting married in November. Unfortunately I have my week of vacation the week after, so I cannot make it. That sucks.

5. My cousin Kristin and her friend Yosh are coming to Tampa for a 1/2 marathon in November. I decided since they are going to come all the way here as my first visitors, the least I can do is attempt to run this with them since this is an easier month. I started training last week. I am embarrassing. I will give you updates shortly.

6. I am thinking of getting a mountain bike or kayak when funds are sufficient. Right now, I am saving for a kitchen table. Priorities. It will probably be after Christmas when I can afford this.

Ryan

Updates

Hello all,

I am now finished with my month of general surgery and am coming to the end of my first week of neurosurgery. I miss general surgery for a few reasons: 1. I actually had a clue what I was doing, 2. The other intern and I were actually good enough to get responsibility which resulted in learning how to take care of patients (isn't that what we are supposed to be doing every rotation?), and 3. I got to do a procedures.

Some procedures I got to do was place central venous lines which is basically a big IV but in one of the major veins, place arterial lines which are used to monitor respiratory status in really sick patients, and I even got to intubate someone which is where you put a tube in their airway to hook up to a ventilator to help the patient breath.

All in all, it was a good month. Now, I am on neurosurgery. I feel retarded to say the least. Honestly, the 4th year medical students that want to go into neurosurgery know more than I do. I think that they accept we don't know much, but I still don't like feeling like such an idiot every day. Oh well, it is only one month.

Next month I am on anesthesia where I get experience managing airways. The airway is a big part of ENT especially in emergencies. We are the ones that get the glory of cutting someone's neck when they cannot breath in an emergency situation. Plus, the first week of that rotation I am going to San Diego to present a paper that I accepted for publication on head and neck cancer. It will be a nice few day vacation plus a nice way to build up my Curriculum Vitae.

Other than that, the apartment is taking shape. We have a new chair and side table. We sold our coffee table and will get one that matches. All that is really left is to get a kitchen table and chairs. No new fishing stories since I have not had any time to go. Maybe this weekend since I get a day or two off!

On a political note, I hope that all of us can stand up to the coercive bullying that is going on in the White House and the media.

Keep in touch everyone!

The [Near] Future of Medical Schools

So, This health care bill that no one seems to be reading has some interesting facts in it. It is going to give funding preference to those medical schools that accept underrepresented minorities (Asian and Indian would not count). It would also give funding preference to those schools that produce a higher percentage of doctors in rural areas. 

First and foremost, what I am about to say has nothing to do with these fields as a whole, just pattern recognition over my short career in medicine. The smartest medical students go into subspecialties, whether it be medical (Gastrointestinal, Cardiology) or surgical (Plastic Surgery, Orthopedic Surgery, Otolaryngology). These students, in order to be competitive for such specialties, must have the highest grades in school, the highest board score ranks in the country, be AOA (Medical Honors Society), and do well in 3rd and 4th year clerkships (which translates into these students being both intelligent, hard working, and well liked). In addition, people that go into these specialties have difficulty practicing in rural areas because these areas do not have a large enough patient population to sustain a practice. Therefore, they practice in cities, typically with universities associated with them.

On the other hand, students that do not do as well on their board exams, do not do as well in school, etc. typically go into primary care (Family Medicine, Internal Medicine, Pediatrics). Again, I am not saying all of those in these specialties fit this bill, because I know many of them that know far more than I and many of my surgical subspecialty colleagues. But, this is a fact which has been proven year after year.

So, if this bill passes, funding will be preferentially given to those schools who produce students who typically may not work as hard or may not be as intelligent. Also, funding will be given to schools that base a portion of their acceptance criteria on race and ethnicity.

I am in favor of equality and equal rights. I think all man kind are created equal. But, this does not mean that I agree that a certain group of people get preference over another group who are at least, if not more, qualified for the same position. Despite background, we all have choices we make day in and day out. We choose whether to wake up in the morning. We choose whether we are going to work today or sleep in. We have a choice for every single action we make every day of our lives. This, I don't think, is the problem. I believe the problem is people do not want the responsibility of their choices. For example, if someone was breaking into my home and went into my children's room, I would use a firearm with deadly force. I would choose to take a man's life in order to protect my children who are in imminent danger. If I were to go to court, lose the case, and get sentenced to jail, I would be able to live with my choice. I know this is an extreme circumstance, but if people would say to themselves, "Am I satisfied with any possible result of the decision I am about to make?" then I think people would be more successful overall. 

So, for people to think they can be a medical or surgical physician because they are underrepresented in the fields, they should stay home and study in high school instead of going to a football game, or they should pass on this weeks episode of American Idol and read from their textbook instead. Medicine is not the time to give people positions based on race and ethnicity. Medical school, residency, and being a doctor is hard work. It is mentally grueling and takes an unexplainable amount of self-determination to succeed. It is supposed to be competitive between those most qualified, even if time and time again it is the non-underrepresented minorities. 

I don't know about any of you who actually read this, but I do not want my medical care, whether in life threatening situations or routine office visits, from someone who is a doctor because of race and ethnicity and not qualifications.

Check out this video that sums it up.

Carotid Endarterectomy

On Friday I got to help on a Carotid Endarterectomy:

It is a procedure where the surgeon makes an incision on the side of the patients neck, dissects out the carotid artery, makes an incision in the carotid artery, then pulls out the atherosclerotic plaque. After this, the surgeon sews a patch over the incision on the artery then closes the patient up. I got to help with the dissection as well as the graft. The attending let me suture one half of the graft on to the artery. When we unclamped the artery, it did not leak at all. Not too bad for my first go around!

This is a picture of the graft.

Health Care [Crisis?]

Our Commander in Chief did it once again. That's correct everyone, he had a conference at which he did not answer anything directly. I even have to agree that the reporters actually had a few good and pressing questions. For example, one lady asked the President if he believed he was standing up to his promise of transparency. Instead of just saying "Yes" or "No," he did what he is ever so famous for: dodged the bullet. He decided to answer the question by making a direct hit on the previous Administration. His answer was that the current administration is more transparent than the prior.

I have a few frustrations:

1) First of all, he did not answer the question. The reporter did not ask about anyone else but the President. She simply asked a yes or no question, and a valid one at that.

2) I am not sure how he measures these things. He claims that he is more transparent, but what does that mean?

What would I have done differently?

1) The only thing I would have done differently than her is stand up immediately and boldly state, "That was not my question, Mr. President. My question was a simple one that you cannot answer and will not answer, just as any other question you have been asked tonight and this entire presidency thus far."

Anyway, that was just one example of many from the entire conference yesterday afternoon. His entire argument on health care seems to be backed by nothing factual. He makes statements that spending money on health care is still leaving us with less of a deficit than the prior administration. Again, I am not sure how he makes these assumptions. Also, he assumes that his radical health care reform is best for the majority when it is the minority that desire such a reform.

Don't get me wrong, I agree there are issues with the current health care system. I think one of the biggest problems right now is Governments' meddling in the middle of it. Go to any VA and try to get care. I cannot imagine a health care system operated by the government. So, why would I desire years and years of our future health care, going from ground breaking research, some of the best care in the world, and a competitive platform for developing talented physicians, to a system in which there is no incentive to advance health care. In my opinion, that would make our system go from having problems, to a crisis.

Baby Toes

Well, I have completed two weeks and come to the half way point of Vascular Surgery at the VA. Things have been going great. We are not too busy, so when there are cases in the OR I get to watch or even scrub. My team is amazing. The chief resident has said good things about me both to the general surgery faculty and the ENT residents. I got to sew some wounds and tie off some vessels that were bleeding. But, yesterday I got to complete my main goal of vascular surgery: I chopped off some toes! The surgeon let me use the Bovie (basically an electric knife that helps decrease bleeding) to cut off the tarsal (part of the toe you see) and 2 metatarsals (the bridge of the foot) and then debride the infection out of the wound and finally sew the wound up.  I am on call this Saturday so I will work a 24 hour shift. I just hope that nothing comes in that I can not handle.

Then, when I got home Val just found out that her sister had her baby. She had a baby girl who was born at 33 weeks and is 5 lb 6 oz (I think). She was given prenatal steroids to help develop the baby's lungs, which must have done a great job because the baby has been in the neonatal ICU without any oxygen supplementation or any difficulty breathing. The baby should be able to come home in a couple of weeks. I will post a picture once I have one...Stay tuned.

Vascular Surgery

Hey all,

I started last week on Vascular Surgery here at the VA. It is a lot of fun. I have a great team that is not the "typical surgeon." They are very nice, helpful and patient. I had my first night of call on Friday. It went pretty well. I did not mess up too much!!! I actually did a decent job. But, I learned that I still have a lot to learn. Being a resident is much different than a medical student. In school, when we do not know something, it doesn't really matter because it's the resident's responsibility to take care of the patient. But now, I am the resident and have the responsibility. I don't know if this is something medical school can actually prepare someone for. I think it's one of those learn as you go and pray you don't screw up situations.

Anyway, I need to get reading a bit about fluids and electrolytes. This seems to be one of the things in inpatient care that affects all patients.

Hope all of you are doing well! Keep in touch.

Off-Shore Fishing

It actually happened. We went off-shore fishing in Brandon's boat. After waking up at 3 am, a many many many mile and few hour boat ride, we reached the fishin' hole. Actually, it is an old wrecked shrimp boat that created an artificial reef which means great habitat for gigantic fish. We could not have had a better day from the start. The water was calm, making for a more pleasant boat ride. The weather was beautiful. And, we had a cooler full of beer among good friends. Not sure what could have made the day better. Wait, yes I can: FISH. And fish is what we caught. The day started with me hooking what looked like a Barracuda, but the line got cut when it was about 10 feet from the boat. After that, Mike caught his Shark. Then I landed a Bonnita, which evidentially is not really good to eat, but great bait, so we kept it. From then on it was nothing but Amber Jack and they just got bigger as the day went on. About half way through the morning another boat showed up and decided to anchor right next to us. At first, I was a little annoyed until we caught about another 4 Amber Jack and they caught nothing. So, the look on their faces as we were having all the fun was worth it. After about noon, we had limited out on Amber Jack so we headed to another spot to try to catch some Grouper. We did just that, catching many off of the chopped bait we made out of the Bonnita I caught. But, Jen caught the only keeper. So, after a long day of drinking beer and catching fish, we headed home to clean them up. Unfortunately, this is where the day went sour for my thumb. The Grouper had not passed yet, and Brandon, being as funny as he is, told me to "Just lip it," to get it in the cooler. Not remembering Mike's only secret to ocean fishing: "Everything in the ocean wants to hurt you," I did just as Brandon advised and came up with less thumb than I started with.

Mike's shark.

The Bonnita, aka fish bait.

Steve's Amber Jack.

Mike's Amber Jack

Jen's Amber Jack

Me trying to hold the fish with the gaf. Brandon is equally excited in the background.

Back at the dock.

Here are the 5 Amber Jack and the solo Grouper on the top. Steve's hand is on the fish for size reference.

Here is the group holding up our 5 Amber Jack we caught.

Here is the remains of my thumb. From now on, don't "Just lip it."

The Place

Yes, our apartment is actually called, "The Place." We are on the 5th floor over-looking downtown Tampa. I will have some downtown shots soon (aka, once I remember). But, here is our place in The Place.

We'll start with the main entrance. The wooden door on the right slides back and forth to enter the library/guest room. Our library has some new bookshelves lining one of the walls with the desk in the middle. These shelves just barely hold all of our books; therefore, we purchased those with optional upward extensions we can add on later if needed. The white couch you can see in the guest room makes a bed, and a quite comfortable one at that. Unfortunately, not much more can fit in our library. There is also a door leading from the guest room to the guest bath.

The guest bath is a full bath with a stand up shower (no bath tub). There is a door leading to this bathroom from both the guest room and the dining area as you can see by the door on the left in the photo above.

Next, you would walk into the dining area. I do not have a picture of this area because we currently do not have a dining table and chairs. We are waiting for sufficient funds. So, lets head to the kitchen. Our kitchen has a neat lay out. As you walk in, the fridge, stove, and a small counter space is on the left. The island is free floating in the middle. Then, on the right side, there are two pantries separated by what is called an "Urban Fireplace," meaning, all you can burn are candles. Plus, you can check out our cool modern orange barstools (2 more to come, again when funds are sufficient).

Despite how great our kitchen is, my favorite part would have to the the wine fridge. It holds more bottles than I could ever afford or drink. But, it is pretty sweet to have wine at the correct temperature.

Now to the living room. Our entertainment center is awesome. Each shelf has a light underneath. Also, once we get a newer TV, we will mount it directly onto the wooden part in the middle. Our couches are awesome as well. They are from ScanDesign which is a Scandinavian furniture store. The white couch's arms move up and down. They are in the up position here and then flatten out to offer more seating. The backs move backward as well which creates a sitting place for tall people (obviously not Val and I). The black chair has white stitching and a chrome base that swivels.

The coffee table in the middle and the glass tables with lamps will be replaced as well. But, as I have mentioned, we need more cash dollars for that. I won't show anyone the master bedroom yet because it is not even close to being finished. But, you can see the sliding door that leads to it in the image above of the white couch. So, now we will go to the master bath. This is huge and has a double vanity sink, bath tub, and separate stand up shower.

Fishing in Florida So Far

Well, I have gone fishing 4 times thus far and have been successful in each trip. Two trips I went with my friend Mike Fister on his Kayaks and the other two times Mike and I went with our friend Brandon Hirons on his boat. Mike is wearing the blue hat and green shirt in the pics below.

The first trip was successful with many spanish mackrel. Unfortunately the last few we managed to hook were gobbled by dolphins before we could g

et them on the boat.  

A successful day, nonetheless.

Here is our second trip, on Brandon's boat. After we 

dropped the girls off because they were cold, we 

headed back out and starting catching some 

spotted trout and catfish.

The third trip began as Mike and I started at the Skyway Pier. This was our first mistake. Not only did we not catch any fish, Mike managed to let the ocean eat one of his fishing rigs. Well, all we can say is, another $80 or so down the drain. After that frustration, we headed to the flats on his kayaks and managed to catch quite a few fish, and 4 were keepers. Here are some trout. A mangrove snapper was also hooked but was under regulation size; therefore, released back to sea.

The fourth trip started out on Brandon's boat trying some Tarpon fishing. Let's just say the Tarpon were huge, surrounding us, but not biting on our live (well, at first) crab and 2 varieties of baitfish. Once all of our bait died, we headed to some flats. We were very successful, catching over 15 spotted trout each. Despite this good luck, only one was a keeper. Sorry, no pics of our solo keeper.

Just started...

To all who may read this, it has begun. I mean, life has begun. No more sitting in a library and calling what I do work. Work will actually begin here in a couple of weeks. Orientation starts this Sunday with BLS (basic life support) and ACLS (advanced cardiac life support). I also have an orientation for every hospital we rotate at (Tampa General Hospital, VA Hospital, Moffit Cancer Center, and All Children's Hospital). So, until then, I have just been trying to settle into the new place. I will have pictures up shortly.

I just wanted to get this started so that I can keep contact with the world even though I may be working while everyone else is awake.

Stay tuned and feel free to share the site...