Giggity giggity!

Today marks the last day of my rotation in General Surgery's vascular department. Come Monday, I will be rotating through the trauma service just like one of those TV doctors on House or ER; that's when I will be clocking in 80+ hours a week in the hospital with many many sleepless nights! Oh joy!

Vascular surgery wasn't all that rough. I think I actually had one of the easier rotations compared to all the other students rotating through General Surgery. I did not have to deal with taking calls. That was a HUGE plus! Being the cunning linguist (*ahem*) that I am, I capitalized on my resident's foible and convinced about 10 people that I did not have to take call. She mentioned that she "thought" that I did not have to take calls, and from that, I told the attending and all the other residents and students that I did not have to take calls. Thanks to my witty prowess, I avoided spending on average 2 nights a week in the hospital. My hours were not too bad either. Initially, I was going to the hospital at around 4:30am to only leave at 6pm. As the month progressed, somehow we had less and less patients and I was able to shorten that down from 6am to 4pm. Over the last few days however, we have not been getting any OR cases - I would stroll in at 6am and leave at 10am.

Most of the patients I saw had symptoms of lower or upper extremity pain due generalized poor blood circulations. A lot of times I would be involved in cases where they would places stents into the arteries/veins so that adequate blood flow is established. I tend to think of vascular surgeons as plumbers. If there's a clot in the blood vessel, they unclog it. If the clog is too big to unclog, they add new pipes (blood vessels or shunts) to bypass the clogs. A lot of patients I saw had such inadequate blood supplies to their limbs that some fingers and toes were turning black. There were also a lot of patients with necrosed limbs that were also infected.....that was not a very good sight nor did it smell too nice either.....imagine morning breath mixed with rotting flesh and feces ........appetizing ain't it? Sometimes, the odor was so bad that I literally had to step out of the rooms to catch my breath.

One patient in particular had osteomyelitis (bone infection) of the left heel that was relatively intractable to non-invasive treatments. It got to the point where we had to perform mandatory amputation to thwart further spread of the infection. So there I was in the OR with a gigli saw in both hands. The "saw" was really nothing more than a serrated wire with handles at both free ends. Starting with the gigli saw at the under-surface of the left leg, around the lower portion of the calf muscles, I began rocking the contraption back and forth as if I was playing a game of tug of war between my left and right hand. 2 seconds in, blood began to trickle down the saw only to continue into an unrelenting stream. 10 seconds in, I begin feeling more resistance as the saw contacts the bone. 20 seconds in, I feel my deltoids cramp. By now, there was enough blood on the floor and surgical table that would put any slaughter house to shame. By 3o seconds, I had in my hands, the patient's severed foot. Who would have thought that dentists could perform amputations as well?

I recanted this experience moments later with an old general surgeon who had been in practice for 55 years. He replies, "Yeah, sometimes we perform operations like that to save the patients' lives. In your case, you saved him a foot at a time." Giggidy giggity!

Anybody with a sweet tooth?

I currently "live" in a private hospital doing my 2nd month of Internal Medicine rotation. Life here is pretty good. Being that this hospital is private, they hook up every resident and medical student with goodies. We have a giant 50" widescreen TV, pool table, and ping-pong table in our call rooms. During lunch, pharmaceutical companies would pass out free textbooks and free food. On top of that, medical students get $50 in credit to buy Starbucks coffee and what appeared to be gourmet food, considering it's in a hospital setting. Life is good for now.

My Internal Medicine team takes calls (stay in the hospital for 24 hours) and codes (in charge of performing CPR's) every 5 nights......not too bad..........actually, too relaxing almost. This afternoon while we were eating pizza and discussing patient issues, we all recieve a page for Code Blue. There are many code colors, pretty much any color of the rainbow stands for something. A Code Blue is when someone's heart shuts down for whatever reason, be it a heart attack or being stabbed in the heart.

It was a mad frenzy for 3 hospital residents and 2 medical students to rush to the code blue. It was a fast blur of 5 white coats zipping through the hospital corridors. As we arrive, we see a lifeless, half-naked lady in her hospital bed surrounded by a group of more than 8 nurses and doctors trying to resuscitate her. One of my team members grabs a trachea tube and rushes to establish a patent airway. One of my team members grabs a device and monitors her femoral pusle. Our team leader orders for the nurse to grab emergency medicine. I assume the role of performing chest compressions.

"Give epinephrine now!!!" screamed one of my teammates.

I continue compression on her rib cage at a rate of > 100 beats per minute. I didnt want to press too hard as to fracture her ribs, but that was the least of anyone's worries at this point. Her EKG showed electrical activity coming from the heart, but she was still not establishing any pulses. Her lifeless body continued to quiver with each compression from my now sweaty palms. Fatigue quickly set in as my lower back start to fail on me. Now's not a time to quit. I continued pounding her chest despite my whole body now starting to ache.

"Give amiodorone and epinephrine now!!"

Another 10 minutes passed before her pulse would be re-established. Everyone was tired. We looked at each other with a sense of pride and relief as we congratulated each other. It was a job well done.

One step closer.....

I got the results back from my USMLE (Unites States Medical Licensure Exam) Step 1. I passed!!!!!! What's surprising is that I actually did better than the national average! WOOHOO!! Yeah.........I'm gonna get trashed tonight......hehe. Tequila, anyone?

Dental (S)Care....

I arrive at the nursing home yet again to see more patients who are in need of dental treatments. Mrs. F had been inflicted with severe senile dementia - she would not have tolerated any strangers, let alone recieve any dental care. I told the nursing home staff to give her some medicine to relieve anxiety and also partially sedate her.

Time passes as Mrs. F begin to calm down. I attach a device called Pulse Oximeter. It's function is basically what it's called.......measures your oxygen concentration in your blood via a little clip on the fingers or toes. On a healthy smoke-free person, 100% is expected. Mrs. F's oxygen saturation started off at 93%, probably due to previous years of smoking, lung infection, or some other pulmonary ailments.

And all this time, Mrs. F screams out, "I hate you.........I hate you."

Mrs. F was to have all her teeth removed so a full denture can be fabricated. I proceed to numb her mouth, but she was flailing her arms and legs, making it almost impossible to work on her. I had to get Mrs. F's two daughters to pin her down while I proceeded. When her mouth became numb, I started to one by one, extract her teeth. The first tooth came out without a hitch except for some "gurgling" in the back of her throat, probably a combination of her saliva and blood from the tooth extraction. Her oxygen saturation dipped into the high 80's and gradually returned to the low 90's. I think to myself, "Hmmm.....she probably momentarily choked on her own fluids. I should take extra caution to dry her mouth."

"I hate you!"

I continued on to the 2nd tooth, and again, I began hearing the gurgles in the back her throat. Her oxygen saturation this time dips to the mid 80's and even tually stays in the high 80's.

"I hate you!"

I proceed with the 3rd tooth. Without missing a beat, I hear the gurgles again. Mrs F became very quiet and not fighting me as much. This time the oxygen saturtion dropps to low 80's and continued to drop to the high 70's. It then continued to drop to the low 70's. Fuck, she is suffocating on her own secretions!!!

I removed all my instruments and pushed everyone off of Mrs. F and tilted her head forward with her mouth open. Fluids consisting of mucus and blood began flowing out of her mouth and onto her bed sheets. I stick a suction tube down her throat and clearled the last bit of fluids. The oxygen saturation pleateaus at high 70's for a while, then mid 80's, and finally low 90's.

Mrs. F was not moving or responding for the next several minutes, then finally shouted, "I hate you!" That was the best thing I could hear her say at that moment.

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GEEK ALERT!! (dont read unless if you are a geek like me)
Those of you who have taken any kind of physiology class in high school or college may remember a little concept called "oxygen saturation curve."



Basically, at 100% oxygen saturation, the amount of oxygen available to your tissues is 100. At 95% oxygen saturation, your tissues only see 90. At 70%, your tissues only see 40 available oxygen. Mrs. F was basically not breathing for that brief moment.

Neverending journey...

I just recently finished possibly the hardest test I will ever take in my life. For the past year, I assumed the role of a student. This month, I am back in the hospital as a reaident.

Here is a breakdown of my daily schedule:

5:00 AM - snooze my alarm clock
5:09 AM - snooze my alarm clock
5:18 AM - snooze my alarm clock
5:26 AM - turn off my fucking alarm clock
6:30 AM - arrive at the hospital to see admitted patients
8:30 AM - see walk-in patients/go to operating room
12:00 PM - lunch
1:00 PM - see walk-in patients/go to operating room
6:00 PM - drive home
7:00 PM - eat dinner/fall asleep watching TV/goof off
10:00 PM - shower
11:00 PM - sleep

Arent you all just so jealous of my easy schedule?

You are fucked, Charlie Brown!

Whew......it's been a while since I've been on this site. With all the stuff going in my life right now, it surprising that I even have time to breathe.

Since I've got "friends" who think I write too much, I will try to cut to the chase and give you guys the short rundown. Now, I could have omitted this paragraph entirely, but I figure I will put it in just to piss them off. :-D

There are several big things going on in my life now. I just recently purchased a house with the aide of my parents. I never realized the effort and money involved in upkeeping a house. I just spent $6000 in furnishings, and it looks like that would only furnish 1/5 of my place. I'm pretty much a fulltime student; the only way I can make money is to work on weekends and to ditch classes on weekdays so I can go work. Grades are suffering because of the lackof attendence, but fortunately, grades dont really matter at this point anymore. It's not rare that between school and work, I only get sundays off to relax.

My next big hurdle is the USMLE Step 1, which is coming up in end of May. This test encompasses several subjects including embryology, human pathology, pharmacology, neuroanatomy, human behavior, microbiology, immunology, and epidemiology. In short, it's basically 2 years of hardcore curriculum condensed into a 7 hour exam that's designed to be taken in one day. Some of you may (or maybe not) remember me bitching about my 8 hour dental licensure exam which I had to endure in the summer of 2003. Well........that's like comparing the fundamentals of additon and subtraction to Calculus. My life is full of these never-ending exams....and I've only got 3 more progressively harder ones to go within the next 5 years.

Sigh.......

Faggot, anyone?

I'm currently taking a class dealing with the many facets of human behavior.

The first two sessions focused on childhood emotions and social behaviors. As part of the learning process, we had to visit a K-8 school and a nursery/pre-school. I observed how in each different age group, the social interactions amongst the children changed. There's a term that child psychiatrists like to call the two-year-olds........"the terrible two's." These kids for some reason scream and yell at each other - not really over toys either.

The next session focused on how alcholism and drug dependence modifies the human behavior. As part of this learning objective, we had to sit in a session of Alcoholics Anonymous. In the meeting that I attended, there were about 10 alcoholics present. The meeting began with an "AA prayer," mainly with the recovering alcoholics recognizing their wrongdoing and that they will surrender their will to their God. The AA members were not all street bums with no families - there were bankers, computer engineers (watch out, Benny), housewives - most of them just look like normal people that no one would suspect of being alcoholics.

The next session focused on the social mis/conception of HIV patients. The professor managed to secure some volunteers with HIV to come and share their experiences with the class....(I wonder how much they got paid. Speaking of which, the school also paid people to have us practice gynecological exams....i wonder how much these gals get paid. ) I have always wondered why gay people turn gay. Some say it's genetics while some say it's more to do with their upbringings. The volunteer that came to my discussion group was a rather interesting character.

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Richard is a 30 something year old male with HIV. He was diagnosed with HIV in 1990 when he went to his physician complaining of an unrelenting fever. He found out that he contracted HIV from his partner because he did not believe in using condoms - he prefers "barebacking" as he liked to call it. He never really went into details on how he became gay. I had to go visit his website to learn of his childhood history. He was born and raised in Texas. First of all.......it's Texas!!! Who in the world would think that a rustic place like texas would harbor the makings of a gay man.....but then again, there's that movie, Brokeback Mountain. He had 3 siblings - I believe they are all sisters, or maybe he has a brother also.... His dad was in the military and constantly drank. His father and mother constantly argued throughout his childhood, continuing to argue until their divorce when he was around 10. At times when he visited his grandfather (mother's side). He hated his grandfather.

"My grandfather, Ted or as we called him, Papa, which was my mother’s father, started playing a “game” called “uncle” with me. Papa, would wrestle me down to the floor, grab and squeeze my private parts and tell me to say “uncle”. It was implied that if I said “uncle” that he would let go, however, he would just tell me to say it louder, the whole time rubbing, grabbing and squeezing my privates. No matter how loud I would say “uncle”, it didn’t seem to matter, he would let go when he wanted to. Once, I started yelling for my mother, while he had me pinned down, she walked and stood at the door. He did stop, but, I was mad at her for not getting in his face like she did Miss Yarbrough, and tell him not to touch me EVER again. "

At 11 years of age, "A neighborhood boy and I went into a old shed behind an abandoned house and played “you show me your I will show you mine”. I tried to put my dick in his butt, but it wouldn’t fit. "

He also mentioned that after the divorce, his mother sort of went crazy. She would always beat him for reasons that he did not know. It got to the point where his grandmother had to call for social services to intervene, at which point, he was sent to Children's Home, where he was also sexually molested.

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Reading shit like this makes me sad. I didnt realize there were kids out there being treated like this - being sexually molested and beaten upon. And then you have spoiled brats like me who complains how it's not fair that I dont have an M3 like everyone else in my high school......

Disclaimer: Why do I have a picture of cigarettes, you ask? For you ingots out there, "faggot" is british for cigarette or a bundle of sticks. One can smoke a pack of faggots. One can also throw some faggots in the fireplace if it gets too cold.

Being a smart ass.......

Trying to procrastinate from my studies, I decided to venture into the mysterious domains of the digital internet world.

The thought of surfing porno sites crossed my mind, but it would just put me in a more depressed state. Talk about adding insult to injury, it will only remind me that I am not getting any sinful carnal pleasures. I eventually came across several websites that deals with IQ's. I have taken these online tests before - I never know if they are accurate. My typical IQ score ranges from 126-133. On my most recent IQ test, I managed to score 129. Here's how i fare against society:

40 - 54	Severely challenged (Less than 1% of test takers)
55 - 69	Challenged (2.3% of test takers)
70 - 84	Below average
85 - 114	Average (68% of test takers)
115 - 129	Above average
130 - 144	Gifted (2.3% of test takers)
145 - 159	Genius (Less than 1% of test takers)
160 - 175	Extraordinary genius

Above average.........eh, I guess I can accept that.