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.