Orthopedics

Orthopedics is back on my short list. For the first two years of medical school I was all about the orthopedics surgery option for residency. However, I really came to enjoy family medicine. I continued to like it the more I did and it became the top thing I was interested in. Part of this reason was because of the horror stories I heard about surgery from my classmates.
This attitude was only encouraged when I started my Surgery rotation. The surgical residents and some of the full-fledged physicians are demeaning to the medical students, they can be verbally abusive, and seem like very bitter people. The hours are also really long (you get up at 4:20 or earlier, get to the hospital by 5AM, and don’t leave until 7PM, you also have to be on call at the hospital every 3rd night and you don’t get much sleep) and the residency is 5 years long of this. Unfortunately, most of the general surgeons I have talked to LOVED their surgery rotation. I really hate my general surgery rotation and I thought this was a death knell for any plans for surgery that were still floating around in my head.
Thankfully my father was persistent in encouraging me to not dismiss surgery too quickly. He sat next to his cousin who is an orthopedic surgeon on a recent trip and when he got back he told me give him a call and chat with him. One of the most encouraging conversations I’ve had recently. He HATED his general surgery rotation. When he went into orthopedic residency he had to do a year of general surgery before he got going on his orthopedics training and he said that that year was probably the worst year of his life.
Although that may sound less than stellar, it’s actually the best news I’ve heard in a long time. I have hated my surgical rotation and the thought of doing it for 5 years is intolerable, but if I only have to put up with it for 1 year before getting into a cool residency with cool surgeries and nicer people…well it’s back on the list. The hours are still going to be very very long as an orthopod resident, but I think it’s something that I can like as much as my family medicine dreams.

Why surgeons are the way they are

I’m finding out on my surgery rotation that surgeons and family medicine (FM) doctors are worlds apart (as are many different types of doctors, but let’s compare these two). Surgeons don’t really spend a lot of time talking with their patients. They don’t really connect with them as readily as FM doctors. With this in mind, here are some thoughts on surgery and surgeons.
Surgery is a very interesting process. One minute I’m introducing myself to a 30-something year old lady who is worried about her upcoming surgery, answering her questions, and reassuring her I will have absolutely no part in the actual surgery, and the next she’s under anesthesia. We take off her flimsy hospital gown, put a Foley catheter in her so she doesn’t pee on herself during the surgery, start marking on her body where we’re going to cut, cover everything that we’re not operating on and suddenly…viola…she’s just a torso of meat that we’re going to cut on.
For the next 8 hours I’m fascinated with what the surgeons are doing, identifying which parts of her insides I can from anatomy, managing the laparoscopic camera and things like that. I totally forgot who she was as a person.
In a similar story, there was a lady who needed a really big catheter inserted into her femoral vein (big vein in the thigh). She was very nervous, jumpy, and the process took over an hour for what should have taken 15 minutes because she kept yelling that it was painful and jumping making the needle come out. She quickly became an annoying leg that needed a catheter inserted.
Overall, I think it’s good that surgeons view patients as warm living pieces of meat. They are going to do very uncomfortable and frankly extremely painful things to them. They are doing this to help the patient but things are going to get a lot worse before they get better.
Some surgeons are better than others at connecting with their patients, but surgeons don’t have a lot of time to talk because they are in surgery all day in addition to following up with patients after and before the surgery. If I were to break this article down, I would say that I respect surgeons for what they do and I don’t know where we would be without them, but I really like talking with people too much to be a surgeon.

Some of my favorite things

I just finished my Psych rotation and while I don't have any interest in doing it as a profession it was definitely one of my favorite rotations so far. Part of it was because of the awesome hours (show up at 8am-ish, write up our notes and see patients until about 12 or 1pm and head home), the really relaxed attending physician I worked with and the interesting cases we saw. But by far the best part has been overhearing bizarre conversations I overheard that caused almost no reaction from the doctors.
Pt: "I see dead people coming out of my chest telling me to kill myself."
Doctor: "we don't really deal with dead people..."

Pt: "the black government implanted a chip in my head to monitor my thoughts and prove that God exists"

31 year old black Pt: "I'm 98 years old and used to be white, but the handicapped kids I taught kidnapped me and beat me up so badly that I turned black"
"I used to be a pink alien with pink hair down to my feet"

And many more that I just can't remember. I think this would keep things interesting and would be something that I could enjoy, but ultimately I still don't think it's for me. The reason being that I like talking with patients about their health, coming up with a plan together, and teaching them things they need to live a long and healthy life. This doesn't really work too well when the patients' brains are the problem and they can't really understand that what they are thinking is totally askew.

Once in a blue moon

If any of you have ever watched the TV series House M.D. you will know that he believes all patients lie. If you haven't seen the show then here's the low down...he thinks patients lie.
We had a guy that we took care of this week because he came in with a self-inflicted gunshot wound to his lung. Yeah, he shot himself but not with the intent to kill himself, just to get attention; a "cry for help" as he put it. There have got to be better ways for getting help, but nevertheless he was admitted to the hospital for depression, got some pain medications, and got his hydrocele surgically repaired so I guess it worked (A Hydrocele is a very uncomfortable disease of certain man parts). As with all patients that a doctor sees, we have to ask them a whole bunch of questions, and especially in the Psych Ward we see a lot of drug abuse so we ask a lot of questions about drugs. When we asked this guy if he did drugs he told us that he only did marijuana "once in a blue moon". When pressed further on that he admitted that he smoked a bowl of marijuana (not a joint, but a bowl) once a week and it helped with his vision (which it doesn't).
So in case you're wondering, "once in a blue moon" for this guy means once a week. (In case you're still wondering, a blue moon means either having 13 full moons in a given calendar year or having 2 full moons in the same calendar month. The 13 full moons one is much rarer than the 2 ful moons one).

My nightmare

I recently met a guy who is living my nightmare…he has celiac sprue. This is a disease where the person becomes allergic to wheat!!! If there is one thing that I love it is baking bread. If I had celiac sprue I would probably lose some of this weight I’ve gained the last 2 years but I would be miserable...miserable. But I digress; this is really a post about bread, not about being allergic to bread. We have two bread cookbooks, one pastry cookbook, two pie cookbooks, and one cake cookbook. Our first bread book was The Bread Bible by Ruth Levy Beranbaum and with some reservations we really love her book. It has many fantastic breads in it and it is a great book to start with for someone wanting to make their own bread. However, she is first and foremost a dessert expert (her cake book is amazing, as is her pie & pastry book. Nothing we’ve tried has turned out anything less than amazing) and the difference between her book and our recent purchase The Bread Baker’s Assistant is evident. Peter Reinhart is a bread instructor at Johnson & Wales University and he knows bread. This book doesn’t have quite as many recipes (or formulas as he calls them) and the ones that he does have are mostly hearth breads (also called rustic breads, or artisan breads) and taste absolutely amazing. Hearth breads are breads made from flour, water, yeast, and salt and that’s essentially it, but can be manipulated to produce a wide variety of different textures, shapes, and tastes. In case you’ve never had these breads, or more likely have never made these, I would highly recommend it. They are simple to make and absolutely delicious.

Residency Decisions - Not Psych

I recently started my Psychiatry rotation, and even though I've only been doing it for a week I can pretty much say that Psych is not something I see in my future. That being said, it is very interesting. Many of these people are prisoners of their own minds. One lady on the psych ward illustrates this point. She worked for many years as a postal worker (in the back rooms somewhere, not with customers). It's unclear exactly what happened, but somehow something pushed her over the proverbial edge. She started acting funny (-ier than usual) and it got so bad that she was commited to the psych ward. So far that wasn't the interesting part, what was interesting was that she thinks that she is completely normal. She hasn't washed her hair in over 2 months (until eventually had to put doctor's orders in her chart for a deep shampoo) and this hair was something else. It almost formed a 3 inch halo perpendicular to her head and the rest just fell back after. She has the devil's own hair product because it's been exactly the same for 2 1/2 months! It's very intersting talking with her though because she doesn't think she should be there, nothing is wrong with her, she needs to get out to go back to work, they have replaced her at work with an imposter, the women that visited her aren't her real daughters because her daughters are still little, etc. I just feel badly for her, but there isn't any reasoning with her. These messages are coming from her own brain without and of the normal filters that you or I have so she has no reason to disbelieve them, they are ABSOLUTELY true to her.
I guess ultimately I don't think that Psychiatry is for me because 1) i'm not patient enough for it and 2) I like interacting with people too much and even normal conversations here are analyzed for clues into the patients' brains, you can't just sit back and have a conversation with them.

...and we're back

It's been a while since I've blogged, partly because we've been busy, but also partly because we haven't made anything brand new. All that has changed with a couple of really delicious recipes we tried and the start of my Psychiatry rotation at school providing both a new and most likely crazy source or medical stories and ample time to try new recipes as it is one of the easiest and least time intensive rotations in 3rd year.
On to the recipes that I was particularly impressed with was the Cranberry-Walnut Galette. I'd never heard of a Galette, but essentially it is a pie with out the pie pan. You roll out the dough (which in this case was a soft cream cheese crust), put the filling on it, fold over the edges and bake it. This, for me, was one of those recipes that guests will Ooh and Aah over but is deceptively simple. The filling consisted of cutting almost an entire package of cranberries in half, letting them macerate in sugar for a couple of hours, combine them with walnuts and some other stuff and then put it all together and bake the galette.
As somewhat of a post-script, one of our friends commented the other day that it takes a special talent to make pie crusts. I don't really believe that, I personally think that most people when they do make a pie crust it's only one and they make another single pie a year later and then don't get any better at making pie crusts. I think it only takes 2-3 pies in a months time or so and you'll have learned how to ride the bicycle so to speak and don't readily forget.