July Effect

July 1 each year is the start of residency for several thousand medical school graduates. That is the where the term "July Effect" arises. I am, starting July 1, part of that effect.

My colleagues in law, and business get so excited when they speak of internships. Companies with big names and even bigger reputations are discussed freely. Visions of suits, handshakes, networking breakfasts, long hours and potential job offers to follow usually accompany those discussions.

But for those of us in medicine, internship is more akin to a form of indentured (or edentulous) servitude. It is that first year when you have no sleep, no very little, have high amounts of activity, and no opinion (at least none that matters to anyone). On the food chain, even medical students are treated better (they go home early usually). It is a very different look and feel.

So now it's my turn to become part of the productive, or dangerous, time called internship. For the next year, beginning on July 1, I will become part of the 1000's of first year, PGY (Post Graduate Year)-1, residents... aka Interns. I'm scared, excited, worried, elated and I'm hopeful to be at least able to find my way around this massive medical center.

I am also going to become part of the "July Phenomenon", that time when experts have said to stay healthy and avoid the hospital due to up to a 10% rise in medical error. That is the first month that "we" are there, doing our doctor thing, in the very first month of our training practice. There have been arguments over the years if the effect actually exists, but from the looks of the PGY-1 class around me, I think the world is safe... as long as they are continually hovered over and supervised.

And so it begins. The years of medical school have led to this point in time. You really can't do much with a medical school diploma so this is where the rubber meets the road so to speak and we translate our knowledge into real, tangible patient care.

I'm scheduled for a opening schedule of 160 hours over the next two weeks with only one day off in the next 14 (not a violation of the new GME hours rules).

Ready or not hospital, patients and staff,

HERE WE COME!

Longevity: 4 Years and 1/2 way

It's really been a long gestation, but I birthed the credentials that I've been working toward for the past 4+ (depending on how you count the years) . In no particular order:

1. M.D. diploma
2. ECFMG certification of education
3. Residency match offer/acceptance
4. State M.D. resident license

It's a slow, slow delivery with much frenzy in the last year, but the "quads" have been birthed. And as I start my unpaid orientation for residency, I'm excited to be at the 1/2 way point "finish" of my education and training as a physician.

Throw on top of that a new hospital I.D. card, some new embroidered coats, and it becomes an "ahhhh" (like right after the baby delivers) moment

This point in time was a distant dream when I first got accepted to medical school and began this trek. And I say 1/2 way because given a 4 year (maybe 5) residency/fellowship course of study to follow, I've literally only completed 1/2 of the necessary hurdles to full medical practice licensure and board certification.

The process to get to this point is truly amazing, on so many levels.  It's been a cascade of emotions, effort, trials, schedules, deadlines and processes. It's hard to believe sometimes that anyone actually completes this process, but with one day at a time, enjoying every single moment, it is possible and feels great.

Literal Bible in Practice

I’ve read this several times in the past. It’s not new and it’s not mine, but it still tickles me. Sometimes we just have to step back and really assess what we believe, why we believe it, and the mass effect on the community and culture around us as we strive for cooperation, peace and a world we can proudly leave our kids.

Dear Dr. Laura;

Thank you for doing so much to educate people regarding God's Law. I
have learned a great deal from your show, and try to share that
knowledge with as many people as I can. When someone tries to defend the homosexual lifestyle, for example, I simply remind them that Leviticus 18:22 clearly states it to be an abomination. End of debate. I do need some advice from you, however, regarding some of the other specific laws and how to follow them.

1. When I burn a bull on the altar as a sacrifice, I know it creates a
pleasing odor for the Lord - Lev.1:9. The problem is my neighbors.
They claim the odor is not pleasing to them. Should I smite them?

2. I would like to sell my daughter into slavery, as sanctioned in
Exodus 21:7. In this day and age, what do you think would be a fair
price for her?

3. I know that I am allowed no contact with a woman while she is in
her period of menstrual cleanliness - Lev.15:19-24. The problem is,
how do I tell? I have tried asking, but most women take offence.

4. Lev. 25:44 states that I may indeed possess slaves, both male and
female, provided they are purchased from neighboring nations. A friend of mine claims that this applies to Mexicans, but not Canadians. Can you clarify? Why can't I own Canadians?

5. I have a neighbor who insists on working on the Sabbath. Exodus
35:2 clearly states he should be put to death. Am I morally obligated
to kill him myself?

6. A friend of mine feels that even though eating shellfish is an
abomination - Lev. 11:10, it is a lesser abomination than
homosexuality. I don.t agree. Can you settle this?

7. Lev. 21:20 states that I may not approach the altar of God if I
have a defect in my sight. I have to admit that I wear reading
glasses. Does my vision have to be 20/20, or is there some wiggle room here?

8. Most of my male friends get their hair trimmed, including the hair
around their temples, even though this is expressly forbidden by Lev.
19:27. How should they die?

9. I know from Lev. 11:6-8 that touching the skin of a dead pig makes me unclean, but may I still play football if I wear gloves?

10. My uncle has a farm. He violates Lev. 19:19 by planting two
different crops in the same field, as does his wife by wearing
garments made of two different kinds of thread (cotton/polyester
blend). He also tends to curse and blaspheme a lot. Is it really
necessary that we go to all the trouble of getting the whole town
together to stone them? - Lev.24:10-16. Couldn't we just burn them to death at a private family affair like we do with people who sleep with their in-laws? (Lev.20:14)

I know you have studied these things extensively, so I am confident
you can help. Thank you again for reminding us that God's word is
eternal and unchanging. Your devoted disciple and adoring fan,

Jack