My heart is still pounding

I had an experience last night that had my hands shaking for a good 10 minutes afterward. A little background is needed for this. I'm in a Family Medicine residency which means we do adult medicine, pediatrics, and OB/GYN stuff including delivering babies. Anytime patients come in to be evaluated I see them, come up with a plan, run it by an attending physician (teaching doctors) and then go ahead with the plan. When its close to delivery the doctors come in and stand next to me while I'm delivering the baby. I've had 15-20 deliveries this year and it's usually a very fun experience for everyone (once the baby is out, that is).
Last night I'm on the phone with one of the teaching doctors for a patient when I get interrupted by one of the nurses who takes the phone from me and says, "you need to get in that room right now!" The doctor of this other patient had just recently gone home because the patient wasn't really dilating that quickly. Well, she dilated in a hurry and as this was her 5th child, things moved pretty quickly from there. Before the other doctor even make it to the hospital, and before I even had time to get anything on but some gloves, I'm catching a baby. (Delivering a baby is pretty messy business and usually I have a splash gown for...splashes, and some booties on to cover my shoes). Talk about getting your heart pumping.
Part of the reason that this was so heart-pumping was that 2-3 weeks before residency started I had a dream that was similar to this. Some lady was having a baby right then, and the surrounding crowd asked if anyone was a doctor. I proudly raised my hand and they said I needed to delivery this baby. Then the panic set in because I didn't know what I was doing and this was stressful enough to wake me up out of sleep (for those of you who don't know how hard I sleep, that's sayin' something). I am pleased to say that I have learned much since then, and everything went smoothly with this delivery, but my hands were shaking for a good ten minutes afterwards.

Favorite story...so far

I'll give you a little background into Wisconsin in general and La Crosse specifically. Ready? They love to drink, and drink a lot. The graph to the right shows that Wisconsin and SC have 50% of their car accidents involving someone legally drunk (blood alcohol of 0.08%)

So here's my favorite story so far. Last night I was in the ER when a patient came in with some belly pain. He was a middle-aged guy who looked in pretty rough shape; broken shoulder in a sling, broken wrist in a cast, recently detected broken hip, and recently detected broken heel also in a cast (which is a ridiculously difficult bone to break). He also had a number of bruises all over his body and a nice stitched up laceration across his forehead. Like I said, pretty impressive.
Here's the gist of the story. He was drinking ("a couple of beers" yeah right) and was driving home after a get together. He was "only going 45mph" and there were "brake problems" with his car, all of this caused him to crash.

You know what he crashed into? A barn! And it was 50 yards off the road! That's right, he got half a football field away from the road and crashed into a big barn all with only "a couple of beers". I still find it hard to believe and I met the guy.

Barefoot Running

I read a fascinating book recently called "Born to Run". The storyline is about these native Mexican runners called the Tarahumara who run amazing distances (50, 80, 100 mile races for days at a time) well into their 70s and 80s without many of the problems/injuries runners in America experience. They do this without the "benefit" of modern running shoes or anything other than a sole of leather or tire rubber for shoes.

So I thought I'd give it a try (the running without modern running shoes, not the 100 mile races). I actually tried barefoot running first, and loved it. I could feel the ground, my stride changed and I didn't have the big impact from leading with my heel (very painful doing that barefoot), and I could actually feel the ground. Unfortunately I was abrading off the bottoms of my feet faster than my calluses were growing.

Enter www.invisibleshoe.com. I stumbled onto this website where they sell Vibram (sole material for shoes) and nylon with Do-It-Yourself videos on how to make modern running sandals. I figured I could make those myself and went ahead and did so. It has been awesome. Same feeling as going barefoot, without the abrasions that were such a problem.
I get a bunch of funny looks from people when I wear them, but honestly they are so much fun to run in and it feels really fun to run again.

Conversation Yesterday

Me: We are moving to a place called "La Crosse, Wisconsin." Can you say "La Crosse."
3 yr old: "La Crosse." (Pause) Mom, did you know that is the same place Jesus died?
Me: No, Jesus died "on the Cross" but we are moving to "La Crosse."
3 yr old: Yes, I know. Jesus died "on La Crosse."

I guess she thinks we are moving to Jerusalem.

Family Residency

So this is a post for those who I haven't told yet, but I've decided on Family Medicine for my profession.
There are many reasons that I've chosen it, but here is the short list
1 - I really like teaching people and helping them learn what they can do to live healthy
2 - I strongly believe that an ounce of prevention is better than a pound of cure.
3 - You can address the whole person and not have to pass them off to another specialist to deal with their problems (an Orthopedist doesn't do blood pressure, an Internal Medicine doesn't do much musculoskeletal, etc.)
4 - You can take care of a person, their mother, child, sister, grandmother, delivery babies, etc. all in the same practice
There are more, but like I said, this is the short list. I keep running into people who I haven't told about my decision, so I thought I'd better tell the 10 people who read this blog at least.

Making Good Choices

This Obesity Epidemic is getting way out of hand. I had a patient come in to the doctors office for a regular visit. She was about 5' 2" and was probably pushing close 300 lbs (that's just a little over what she should have been). I really wanted to help her because she didn't seem happy with her current health situation so I proceed to talk with her about her diet and exercise. Here is how our conversation went.

Me: Tell me a little bit about your diet and exercise?

Patient: Well, I know that I need to lose weight. I try to make good choices for what I eat, but it's really hard, ya know. I try to eat more vegetables so I went to a Chinese buffet for dinner because they have vegetables (!?!), but you need to be careful of those sauces, there are lots of calories in there.

Me: Uhhh (thinking: yeah, it's not the sauces that you need to worry about, it's the five helpings)

Patient: I had a really hard day last week and my daughters wanted to take me out to Carrabba's for dinner, but I said, 'No, I should be good.'

Me: Good for you

Patient: So we went to Golden Corral instead.

Me: Oh.

- I was dumbfounded. This lady is lugging around an extra 160 lbs (which is an entire extra person) everywhere she goes, and her "good choices" are going to a chinese buffet for vegetables and going to Golden Corral (another buffet) instead of Carrabba's Italian Restaurant!!

Me: Ummm...so...need any refills on your medications?

I do some push-ups.

Today a guy came in for his yearly check-up. Usually these are pretty uninteresting affairs with a series of questions about the person's health being answered with things like, "I feel fine", "No complaints". About half the time they answer my questions about exercise with, "yeah, I go running about 2-4 miles per day" and they look like it. Or they answer, "Yeah, I go walking sometimes" or "I'm pretty active."
Today I asked a guy if he exercises and he said, "I do some push-ups in the morning" "Me, too" I said. I thought this was code for I don't do much so I'll cover by saying that I do something menial. But when I scrolled down his chart a little more the nurse who checked him in had asked him how many, and he does 800 push-ups every morning. 800. Ridiculous? It gets better. When I asked him how long it takes him to do this punishing routine, as I think to my self I bet I'd be lucky to do 30 pushups, he told me that he pauses between each set of 100 for 30 seconds but could probably do the whole 800 in 8 minutes!! "Um, yeah. Me too." I replied.