long overdue

it has been brought to my attention that it has been approximately 2 years since my last post here.

 

wow….  TWO YEARS….

seems like a few months.  so much has happened, and life has gone by so quickly.

and so here I am, sitting down to write my first post since June 2015.  since the week before I started my general surgery residency.

where to start

to pick up simply where I left off is hard.  but lets see if I can hit the highlights.

when I moved to Oklahoma it was on essentially a trial basis.  I had madly scrambled into a position as a “preliminary” intern in general surgery.  I had no real guarantees on my future, all I knew was that I had a job for precisely one year, and then would be doing the applying/interviewing/praying for a spot somewhere thing all over again.

I started off July 1 on a general surgery rotation.

I began to learn

differential diagnoses of common surgical problems

writing official H & Ps with semi-accurate physical exam findings

wading through patient charts for the important information in the sea of endless words

coping with the incessant noise of the pager that is permanently attached to the hip of all residents.

and I made some friends.

then I moved to vascular surgery

I learned

documenting proper vascular (pulse) exams

operating a hand held doppler

wound assessments, and the many words we use to describe them

dressing changes… and more dressing changes

I became more comfortable with my position, with myself and with the people around me.  I got to operate and reaffirm my choice of surgery.

Trauma rotation began

chest tubes.  central lines. arterial lines.  ICU evaluations and presentations.

I watched my seniors closely and tried to learn the evaluation and management of the patient who rolls into the trauma bay with holes in their body, bleeding on the table/floor/staff.  keeping cool and making decisions with a dying person in front of you. prioritizing.

NIGHT FLOAT

evaluation of patients on the floor.  work-up of the febrile/tachycardic/oliguric patient.  determination of just how sick someone really is, and what needs to be done to make them better

narcotic dosing (and overdosing)

a little bit of autonomy.  try to make the right decision.  don’t be afraid to ask for help.

make friends with the nurses.

answer your pager.  it may go off every three minutes. sometimes you drop it down the stairs and hope it breaks.  but it is part of you.  answer it.

always evaluate for yourself. don’t take anyone else’s word for how your patient is doing.

and make some more friends

and then it begins over again.  vascular and general and trauma surgery.  getting to operate some.  getting to know the attendings. learning medication dosing, decision making, patient assessments, note writing.  becoming a part of the resident family.

in the midst of it all, re-applying for intern level positions, in the constant battle of being a DO trying to get a spot with the MDs.  shouldn’t matter, and they always tell you in medical school that it doesn’t.  they are wrong.

being nervous about re-interviewing for residency.  feeling as though every single minute of every day is an audition for a spot at my current program.  trying my best to never screw up.

interviewing.

getting to do my first appendectomy.

dealing with life and death and sickness.

and then one day in February, mere weeks before submission of rank lists for residency spots – already resigned to repeating intern year at another program, leaving the life I have developed and the friends I have made –  being paged into the office of the department chair, who sits with the program director, both with serious expressions on their face.

being offered a permanent spot, promoted along with the rest of my class to a second year in July.

becoming slightly more confident in the job.  loving life.  learning a ton.  operating.  and being with great people who have become like family.

and then before you know it  —  June 30th 2016.

the end of intern year.

 

 

 

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the calm before the storm

…an apt title for this post, I think.

as I sit in my new living room in Oklahoma – the fourth state that I (and the pup!) have lived in over the past 3 years, thinking about what has happened, and what lies ahead.

those three months off were great.  I got the opportunity to spend a ton of time with the parents and little siblings, made a trip to Georgia to see the older sister and her offspring, then down to Orlando for brother/sister-in-law/DISNEY WORLD time.  it was tons of fun.

and then I graduated.  I was actually pretty cranky the week of graduation, for a variety of reasons.  I certainly had mixed emotions about traveling back to my school, especially after what had occurred during match week, and the communication (or lack thereof) that ensued during that rather difficult time.   I was excited to see a lot of my friends, with all of us together again for the last time in probably quite a while.  while I was excited to see friends and catch up with everyone, I ended up ditching most of the get-together activities in favor of a trip to St Louis with my three youngest siblings, doing the tourist-thing of the Gateway Arch, the City Museum, and the St Louis Zoo…

but let me back up a few days.  the main reason that I was somewhat out of sorts and not up for socialization?  on Wednesday we left for Missouri (myself and the three amigos),  the night before we left I learned that a friend of mine from the bygone days of grad school at the good ol’ University of Colorado (a friend whom I had worked closely with for two years), had died.  specifically, had, that week, set his house on fire and shot and killed both his wife and himself, leaving behind their two young children.  I was pretty shook up by this.  this friend was one of a small remnant of us former grad students that had made a habit over the past 4 years of getting together 1-2 times a year if possible to catch up.  in fact, I just saw him, twice, in January.  he seemed happy, loved his job, and as always adored his kids.  I don’t know if that makes it harder to learn what happened just a few months later?  certainly made me wonder what I missed.  was he acting strange and we just didn’t pick up on it?   regardless, it is sad. and I feel terrible for his boys.

so anyways, I was cranky.  but we made it back to town in time for the graduation awards banquet (the food was terrible but I won some money! woohoo!)

graduation was fine.  actually, I was super nervous and thought I might pass out.  but it happened and I didn’t make myself look like too huge of an idiot.  the school president did however knock over and break the university official staff of awesomeness… or whatever that thing is called.  which seemed like a bad sign.

on a funner note, my entire family came (all the siblings, their spouses, my parents, etc) and we stayed in cabins on the lake for the weekend, and had tons of fun hanging out, playing games, eating, etc.

and then back to colorado (after a quick house-hunt trip) – making the most of my last few weeks of freedom before the move, we took a mini-vacation to Breckenridge, climbed the Incline in Manitou Springs, saw Wicked in Denver, wandered the floors of ikea, had backyard fires with marshmallow roastings, and just enjoyed life.

and now, I am here in Oklahoma.  all moved into my house just a few blocks from the hospital, hoping I get the opportunity to stay for a while, and my stuff spends more than 12 months out of boxes.  Edison and I are getting the lay of the land, both the neighborhood and the nearby “mountain” that is really more of a hill with some neat hiking.  orientation is winding down, we have learned ATLS and the hospital EMR system, and picked out our desks in the resident lounge.  I’ve met more people than names I actually remember, and have a badge that says “doctor” on it.

and so I officially start Wednesday, July 1st at 5 am.  I think I’m ready?  as ready as I will be, I suppose.

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the end of (some) things

well, it’s official.  I am done with my final rotation of medical school.  officially.

towards the end of things there, I started to wonder if it was ever going to happen.  I finished off on a good rotation – general pediatrics with a pretty rock-awesome doc who let me do just about everything, from patient exams to note writing to e-prescribing.  I certainly enjoyed those four weeks, despite my two bouts of gastroenteritis thanks to those adorable little germ monsters.

this year has been insane, full of ups and down.  super tough rotations where nothing seemed to go right and I felt like a total imbecile interspersed between rotations where I met awesome people, got to do and see a ton, and received super nice evaluations.  I attended interview after interview (talk about a money hole) in both pediatrics and surgery, and at each I put on that totally phony smile and pretended that that program was awesome and my favorite and I-can’t-think-of-anything-I’d-rather-do-than-come-here.  ugh.  I don’t think I was very good at that.  and of course, considering the outcome of my Match experience, I may in fact be correct.  after all of this, the nice bits and the not-so-nice bits, my confidence has definitely taken a battering this year.  and so perhaps it was fitting that as I walked out of the  pediatric office on my last day and glanced at my eval form (yes I know poor form) the comments section read “competent, confident, ready for post-graduate education.”   I hope so.

I’m ready for graduation.  I may not be actually ready to jump into intern year, guess we’ll see when I get there.  but I’m ready to try.  I can’t think of anything I’d rather do, and after 5 years of this whole med school thingy, I’m ready for a whole new/different adventure.  I’m ready to start training in what I actually want to do with my life.

and so I face the oncoming months with much excitement and.. .yeah, a good portion of fear and trepidation.  I got the email today informing me that my contract to be a resident in the Surgery program at the University of Oklahoma is in the mail, I’m starting to think of all those fun things like house-hunting and moving and stuff, and I think, after 11 years of post-secondary education, that I am finally ready to move on.

onwards and upwards.

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the MATCH. or…. not.

last week was a crap week. I try not to make it a habit of turning the inter-web into my own personal whine fest.  but sometimes, honesty is required.  and it’s important to note the extreme level of suckiness experienced over the course of the preceding 168 hours in order to fully appreciate the better parts.

so I’m on this pediatrics rotation here in the springs.  it’s a great rotation.  it’s general peds on an army post south of the springs. only about 30 minutes from home, so I get to stay at my folks’ place (with my puppy dog.)  so that’s nice.  but sometimes on pediatrics when you’re seeing all the sick kiddos they like to share their germy-ness.   and get you sick.  and so I ended up with a somewhat impressive bout of gastroenteritis. just as I was getting over this yuckiness, monday March 16 rolled around.  this is known to medical students as “match day” —  the day that 4th years across the country find out whether they ‘matched’ into a residency program-  that is, whether their personal rank list of preferred residency spots were sympatico with the lists formed by said residency programs.

well….. as I learned on that day, sometimes these lists are not friends.  and you get a not so sympathetically-worded email from the national “program-in-charge-of-your-entire-future” entitled “Did I Match?” which then awkwardly informs you within the body of this email that no, in fact you did not match.  sorry.

eventually things worked out.  I had to spend a few days at home, by the phone, waiting for programs with open spots to call and phone interview me.  I went through the Supplementary Offers and Acceptance Program.  I was fortunate enough to receive an offer in the first round, and so by Wednesday at noon I had accepted a spot with the General Surgery program at the University of Oklahoma in Tulsa.  it’s what’s called a “preliminary” spot, meaning one year guaranteed, then I have to either find a different program with an open 2nd year slot, or try and slide into a spot with that program…. not completely ideal, but I consider myself blessed to have a place to go.  also, it’s really a great program,  a nice size, in a pretty decent city, and the program director is super nice.  she even called me right after I hit the ‘accept’ button to welcome me to the program.  I think I’m gonna like it there.  and we’ll just take it all one day at a time.

I was also super happy to be at home with my family while going through this, because it was definitely rough/emotionally exhausting, and thankful to have friends praying for and comforting me as I walked through the process.  also, I’m totally believing that it’s where I’m supposed to be… and what I’m supposed to be doing. and so, looks like I’m gonna be a surgeon.  and I don’t think I could be happier. (well…. a categorical spot might make things even better, but that’s ok.)

ok.  countdown time.

one more week of rotations

57 days until graduation

and 3 months + 11 days (ish) until the beginning of intern year.

‘For I know the plans I have for you’ says the Lord ‘plans to prosper and not to harm you; plans to give you a hope and a future’   ~ Jeremiah 29:11

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kids + surgery = AWESOME

really the title says it all

I just finished up a 4 week pediatric surgery rotation in Sioux Falls, SD.

10360411_10205443601745318_3999256934412468975_n 10404187_10205571965354328_4489181990229423232_nyup, I got to hang out in the castle for the month of February.  and it was pretty dang fun.

talk about a great opportunity. I got to combine two of my favorite things (pediatrics and surgery) and work in an awesome environment.  I was on this rotation with three pediatric surgeons, which meant plenty of procedures to experience, lots of clinic and rounding to fill in the empty spaces, and being on call every night, waiting for the next kid with appendicitis to roll into the ER.  it was also interesting to watch how my three attendings each approached a situation, and how they worked together on the more challenging cases.

during my rotation I got the chance to assist in a wide range of surgeries, including a tracheoesophageal fistula repair, several appendectomies, gastroschisis repair, umbilical/epigastric/inguinal hernia surgeries, G-tube placements, repair of a persistent omphalomesenteric duct, etc.   I really enjoyed being a part of the peds surgery team for the month, participating in team rounds, surgery, clinic, and educational conversations with the docs.

I will admit that I am kind of a wimp, and South Dakota is COLD.  I spent most of my off time snuggled under an electric blanket, warm beverage in hand, wondering why I didn’t sign up to do this rotation in like August.  haha.  but it was SO much fun, and totally worth it. I am very thankful that I was able to experience this rotation, and for the great mentoring relationships that I developed with a few of the surgeons while I was out there.

in other news, I submitted my final rank list.  match day is coming up shortly (March 20) and I am feeling… FINE (freaked out, insecure, neurotic, and emotional…)

but seriously. I’m terrified.

monday I start my very last rotation- 4 weeks of pediatrics back in my home town.  then I’ll be done. (well, mostly.  except for a 2 week pharmacology elective. bleh.)

y’know, figuring out the future is not very much fun.  or easy.

anyways, this is the point where I’m supposed to let go and let God take care of me, after all “thus far has the Lord helped me”.  it’s just my neurotic control-freak nature that likes to stand in the way of me doing that.  I’m a work in progress.

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January in the SICU

January was all about the ICU. I got the opportunity to do a surgical ICU rotation up in Denver, which meant a few things: I got to stay at home with the folks for the month (and the pup!), I had a 3 hourish round trip commute each day (longer on blizzard-y days), and I got to experience a pretty “intense” (hehe) intensive care rotation… so, lots of good learning and exposure to a variety of interesting topics, as well as interactions with a whole host of different providers/faculty members/residents.  the fact that I got to wear scrubs every day was just a bonus. in my SICU rotation, in addition to learning more about patient care, ICU procedures, note-writing, presentation-ing, etc, I learned about two broad/general types of surgical patients through personal experiences with the following: The series-of-unfortunate-patients:  my month in ICU saw it’s share of patients who, through no fault of their own, ended up severely unlucky in their medical situation.  we’re talking not just “short-changed” but like “robbed blind” sort of unlucky. there was the lady who came to us for post-op care after a total colectomy.  sure, lots of folks get those, but this lady could be the poster-child for the ‘antibiotics stewardship’ movement.  got a cold from those pesky grandkids who visited over thanksgiving and it just won’t go away?(it’s been two weeks for crying out loud!)  let’s go to our primary care doc for some advice!  doc thinks there’s maybe like a 1% chance that this might be bacterial?  let’s prescribe some antibiotics! (can’t hurt, right?… famous last words.)  and then the diarrhea starts…. and goes… for weeks.  ER says c. diff colitis, end up admitted to the hospital on triple antibiotic therapy.  which doesn’t work.   fast-forward through not qualifying for fecal transplant (ew), and straight into a total abdominal colectomy with end-ileostomy.  next year, let’s just face-time the grand-kids, hmm? or the lady who came to us two weeks after an elective laparoscopic hysterectomy for a family history of ovarian cancer?  in pretty bad condition, septic, severe peritonitis.  whoops, looks like they  poked a couple of holes in your small bowel with their ports, and apparently didn’t take a second look when they pulled those suckers out.  yep, you’ve been leaking poo into your belly for a few weeks. yikes.  sorry.  how about some anastomoses? then breakdown and repeat anastomoses?  actually, how about you just hang out in the hospital a few months while you form some enterocutaneous fistulas.. after all, draining poo out of your skin is better than into your belly, right?  at least then it’s “controlled” and then there’s the guy who just had an outpatient procedure – scoped to remove a duodenal polyp, only to realize 24 hours later that they didn’t just take the polyp, they took a large chunk from the bowel itself, and he’s got a perforation requiring an emergent laparotomy.  that scar’s a little bigger than you were planning, huh? but for all of these less-fortunate patients, it was cool to be involved in the helping them recover part of it – yeah, it was pretty cruddy that they ended up in that spot, but they were getting some pretty stellar care from the SICU teams, with a whole lot of surgeons/critical care docs/physical therapists/etc working hard to get them feeling better. and then there were the patients who, through natural progression of some illness or other, ended up in the SICU – the “I’m just happy there was a surgical option” patients-   the guy with ulcerative colitis and primary sclerosing cholangitis leading to liver failure who got a new liver and a total colectomy, the lady with a gi-normous pancreatic tumor who got a Whipple procedure that bought her maybe an extra few years to spend with her grandkids, the dude who was worried about the possibly malignant tumor in his pancreas that ended up being benign, the type one diabetic who got a new kidney and pancreas and started making insulin again, and on and on…. that’s the cool thing about the Surgical ICU, vs say the medical ICU — that is, for the most part your patients will stay for a few days.  optimally, they have just had the surgery to fix or at the very least ameliorate their problem, and you’re helping them recover in the short-term, but they are quite obviously getting better.  it’s not just another relapse of a chronic disease, this one worse than the time before, each one inching them a little closer to the end of it all. all that said, it was a great month, enlightening in the educational aspect to say the least.  also, I always love getting to be home with my family, doing things like having family movie night with plenty of homemade popcorn (and plenty of butter on that stuff!) coffee dates, family meals, actually going to church on sunday (novel…), and just loving Colorado. also, Keegan and I had a pretty awesome Disney/pixar movie marathon going for a few weeks.  we watched the classics – One Hundred and One Dalmatians, Robin Hood,  Toy Story, Peter Pan, Monster’s Inc, The Incredibles, Rescuers Down Under… to name a few.  and yes, some of those were on VHS and required dusting off the VCR and sitting through the agony of rewinding those videos when we got them out (curse our 12 year old selves that failed to do that when we put them away!) all in all, another good month.  and another month closer to the match, graduation, and residency.  funny how time flies.

Around here, however, we don’t look backwards for very long. We keep moving forward, opening up new doors and doing new things, because we’re curious… and curiosity keeps moving us down new paths.            ~ Walt Disney

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west coast adventures

I’ve been pretty quiet on here of late.   I think that is mostly due to the fact that I have been kind of busy doing stuff.  stuff like visiting rotations in different parts of the country.  stuff like interviewing for residency programs.  stuff like traveling 2000+ miles through rain, snow, ice, etc to get home for Christmas.  and stuff like taking a long hard look at the options for my future, and deciding what kind of future I would like to have.

that said, I figure the best way to update this is through some visuals, shared here:

I hit the road at the end of October.  headed west, through the Rocky mountains, in search of sunny California.

I hit the road at the end of October. headed west, through the Rocky mountains, in search of sunny California.

I was lucky enough to get a ER rotation in a small town in northern California, close by to some of my favorite cousins.  so I got to learn some good stuff, and spend time with great people.  I call that a win.

I was lucky enough to get a ER rotation in a small town in northern California, close by to some of my favorite cousins. so I got to learn some good stuff, and spend time with great people. I call that a win.

my residency interview in Kansas City just happened to coincide with game 6 of the world series.  the entire city was psyched up, and anything that could be turned blue was. including all the fountains downtown.  being a Giants fan, I would have preferred orange.

my residency interview in Kansas City just happened to coincide with game 6 of the world series. the entire city was psyched up, and anything that could be turned blue was. including all the fountains downtown. being a Giants fan, I would have preferred orange.

flew into San Francisco just hours after the Giants won the World Series.  it was pretty cool.

flew into San Francisco just hours after the Giants won the World Series. it was pretty cool.

spent Halloween with cousins - photo documented a couple of firsts for me here: first time dressing up for halloween, and first time ever trick-or-treating! verdict: I'm OK with not having done those things as a kiddo.  no permanent damage.

spent Halloween with cousins – photo documented a couple of firsts for me here: first time dressing up for halloween, and first time ever trick-or-treating! verdict: I’m OK with not having done those things as a kiddo. no permanent damage.

drove down to Monterrey to meet up with the little sister for the day.  it was a beautiful day on the California coast.

drove down to Monterrey to meet up with the little sister for the day. it was a beautiful day on the California coast.

Monterrey Bay Aquarium: definitely worth it.

Monterrey Bay Aquarium: definitely worth it.

One word: penguins.

One word: penguins.

Got the opportunity to do a 4-week visiting rotation in hepatobiliary surgery at Oregon Health & Sciences University (OHSU) in Portland, Oregon.  learned a ton and had an awesome time! plus, not a bad view from the OR!

Got the opportunity to do a 4-week visiting rotation in hepatobiliary surgery at Oregon Health & Sciences University (OHSU) in Portland, Oregon. learned a ton and had an awesome time! plus, not a bad view from the OR!

spent my first Thanksgiving away from family.  next best thing? how about a day at the hospital on a surgery rotation?!

spent my first Thanksgiving away from family. next best thing? how about a day at the hospital on a surgery rotation?!

Voodoo doughnuts and Stumptown coffee. because, when in Portland...

Voodoo doughnuts and Stumptown coffee. because, when in Portland…

a day on the Willamette river.  visiting the Portland downtown market, and enjoying life.

a day on the Willamette river. visiting the Portland downtown market, and enjoying life.

welcome to Portland, folks!

welcome to Portland, folks!

interviewed at THIS PLACE in South Dakota.  yes, it's a castle. yes, that may have been one reason I applied there.

interviewed at THIS PLACE in South Dakota. yes, it’s a castle. yes, that may have been one reason I applied there.

got visited by this kid while in Portland! hanging out downtown and enjoying Christmas stuff!

got visited by this kid while in Portland! hanging out downtown and enjoying Christmas stuff!

IMG_2415

yes, we climbed to the top.  and yes, the view is way better from the bottom. dang it.

yes, we climbed to the top. and yes, the view is way better from the bottom. dang it.

sisters! (at the bottom of the falls)

sisters! (at the bottom of the falls)

at the top!

at the top!

heading home from Oregon we drove through the Redwood forest.  and of course, we had to drive THROUGH the redwoods.

heading home from Oregon we drove through the Redwood forest. and of course, we had to drive THROUGH the redwoods.

on our way to see our grandmother in Modesto, CA.

on our way to see our grandmother in Modesto, CA.

stopped over in Salt Lake City for a day to interview at Primary Children's Hospital.  digging the decorations.

stopped over in Salt Lake City for a day to interview at Primary Children’s Hospital. digging the decorations.

finally on the road towards home.  headed into what amounted to a polar vortex.  after experiencing highway closures, 0 visibility conditions due to blowing snow, cold, fatigue, and hunger (apparently there is no food available in Laramie, WY after midnight), and a 9 hour drive turning into a 14ish hour drive, we made it home to Colorado Springs at 4:30 am on December 23rd.

finally on the road towards home. headed into what amounted to a polar vortex. after experiencing highway closures, 0 visibility conditions due to blowing snow, cold, fatigue, and hunger (apparently there is no food available in Laramie, WY after midnight), and a 9 hour drive turning into a 14ish hour drive, we made it home to Colorado Springs at 4:30 am on December 23rd.

made it home for Christmas with the family! happy ending.

made it home for Christmas with the family! happy ending.

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