Brains to Brains

It's that time of the month again. That time when residents generally move from one service to another. Nothing less so for me. Onward from specialty surgery to general medicine...the antichrist, the polar opposite. I guess you have to fill those potential surgical hours with something. Might as well be hours and hours of rounds, discussion, and rounds again.

But this will be a good time to study for the next round of boards bound to be just around the corner, as they always are. Step 3 is the next "step" and the one "must do" before getting licensed in the U.S. as a physician. There are many 100's of folks in my same position, looking forward with great awe and nausea toward that next exam. I'm sure there is a tonic for that ailment.

If I learned anything on the brain service it is that there is a tonic for everything. And for everything that doesn't have a tonic, there's surgery. A chance to cut is a chance to cure.

Batteries Not Included

There are so many reason not to swallow batteries. Beyond the local irritation, they can get jammed and cause obstructions. The little watch size batteries can eat through the lining of the gut easily. All and all, it's just a plain nuisance.

But when you are schizophrenic, it's just plain fun I guess.

Hurricane Andrew

I can't believe that it's been 20 years since Hurricane Andrew hit South Florida. Has it really been that long ago? Incredible how time seems to be flying by and moving at the speed, well, of a hurricane.

That was a surreal time but one of those events that marks the passage of time and activity of life. One of those event where you know exactly what you did, where you were, how you reacted.

I hope Issac moves through this week with little damage or mayhem for Haiti, Cuba, West & Panhandle Florida and New Orleans.

Suprise!

Rarely are there real common things presenting in medicine. Although I've heard it said that common things present in common ways, when considered with the unique characteristics of the human sitting, standing or lying in front of you is rarely common. Ponder that.

Exception: If someone rolls in with a large metal object sticking out of his face. An uncommon thing in a common place (his face) perhaps, but uncommonly uncommon none the less. Now I've confused myself.

Neurosurgery is like that. The shock of the presentation wears off into the activity of the care taking, surgerying, ordering, x-raying, and a host of other ings. I think it's the proximity to the head that makes this stuff so unbelievable. Nothing should be that close to the head, unless you are making out with it, or eating it. Rebar belongs embedded in cement, not in a skull. Pretty uncommon.

Mistakes

Ever contemplate...wish I'd married a Virgin.

Now, let me get this straight!

It spilled from my mouth before I could even stop myself. It was one of those "trigger" after and long day of really sick folks. And I laughed all the way back to the truck.

My boss doc had me go down to interview a patient prior to admission to the hospital. I asked the usual questions about the who, what, where, when and how's of his complaint. I discussed the what were were going to do and the medications he was one, and those we would give him.

And he said, in a thick, Southern front-porch rocker drawl...
"Doctor, ain't there nothing I can take?"

And I heard myself say...
"Now let me git this straight"

And then started singing under my breath...
You put the lime in the coconut and stir them all together,
Put the lime in the coconut and you feel better,
Put the lime in the coconut...

All Knowing, I Surrender

ca·pri·cious (k -pr sh s, -pr sh s). adj. Characterized by or subject to whim; impulsive and unpredictable. Synonyms at arbitrary.

Any semblance of control in the process of medical education is purely accidental and largely a mirage. There is no control placed in the hands of the student. This is a great exercise in surrender, acceptance and releasing all vestiges of control.

Just wish it wasn't so arbitrary and carpricous bordering on abusive. Traditional medical education is as broken as the system itself. And that may be a whole chicken or egg first discussion all by itself.

I become more and more understanding of what Dr. Stead was fighting at Duke all along. It's an entrenched way of doing things that prevents any real progress without threats, rules, regulations and outside scrutiny. Medicine has brought this upon itself and I, along with my colleagues, are paying the price for 100's of years of bad habits.

I surrender, once again.

USA!

Nicely done ladies! Great redemption gold medal win v. Japan!

Adding Years to Life 2.0

Wish there was a way to just upload the basic information and skills people need to get healthy. It's so simple, but so hard:

Sleep more,
Less work,
Brain thinking activities,
Best air quality / Quit smoking,
Less caffeine,
Aspirin daily,
Less tanning/sunburning,
Floss/brush more (less heart dz),
Lose weight,
Less fast food (salt, sugar, fat),
Less iron supplement,
Physical activity

Ready, set, go!!

Evaluation

I really don't know why we waste our time and effort in medical education with summative evaluations on clinical rotations. What a crock of clostridial waste.

Let's review: Effective evaluation is both summative and formative with timely feedback based on established learning objectives with unbiased, objective and constructive educational correction.

With none of that present, the result is pure manure, wasted paper, time and effort with absolutely no ability to learn or improve.

That was fun.

Medical Types

I've become, in my old age, a consumer of watching people. I really listen now, really absorb who is right in front of me, and try to seek understanding of who they are. And in a teaching hospital, it is quite the array of personality types.

But I think I've distilled it down to it's basics at this point. It seems there are three "types" of people involved in the practice of medicine.

Dr. User
They seem to always want something from you to assist what they are doing, but rarely (if ever) offer something to you. They reach out when they identify your strong points, to augment their weaknesses. But they are the first to run for the hills if you need them or you demonstrate weaknesses yourself. If you are in trouble, these folks can't be relied upon or even trusted with your issues. They certainly aren't bad people or clinicians. But they are fearful, insecure, self-centered and driven to achieve little beyond what serves them best and first.

Dr. Standby
I'd say most of the people I encounter in medicine are "standby" folks. They wait in the wings. They don't come forward in hard or easy times. If you get into a jam, they wait silently close by and watch to learn from your mishaps, but are willing (although not excitedly) to assist if you ask. They aren't easily made friends of, but once they do accept you, they are all in. They are good people to know and have access to, but they aren't very committed to you or anyone else.

Dr. All-In
These folks are totally committed to everyone and everything around them. They don't hide in self serving practices and aren't shy about committing to you if you are open to it. They are accepting of everyone, every patient, every situation without a whimper. They are there for you when you need in hard and good times. They seem to approach more readily when they sense distress. They never appear burned out or disturbed by the people we live with or serve. They stand by you in good and bad times. They are likely the best friends to have in the long run and have the potential to be totally honest with you when you need it most.

I'm a Standby right now, a bit cautious. I strive to be an All-In. I think it's all about moment by moment focus, stress management, being there and approachable in good and bad times for colleagues and patients. It's about daily renewal and openness to the possibilities. Paging Dr. All-In, Paging Dr. All-In.

Cocaine

"Cocaine can constrict blood vessels in the brain, causing strokes. This can happen even in young people without other risk factors for strokes."

I've read that statement in countless books in school and journals studying the use of cocaine. I've always had a interest in the effect of drugs on the body growing up in South Florida where it's always been available. I've been interested in the effects since my days working in trauma and seeing the aftermath of use and abuse. I've seen people try to fly off balconies on LSD. drive into walls on alcohol and drive too fast for the curve on coke.

But nothing is more devastating than a deep brain bleed in a young person from a snort. It leaves the person alive but with greatly reduced function, with bills they can't pay, rehab that will never get them close to the way they were, and loved ones taking care of the rest. So sad.

Heros All Around

My new hero, Kayla Harrison ,78 kg of "kick ass". Great lesson; Don't get mad at the past, just GET GOLD! Awesome, amazing performance after years of total bullshit in her life. Way to go Kayla!! Absolutely inspirational.

First Month Done

Oh thank God it's August! I can finally sleep in my OWN bed... the simple pleasures of life.  The first month of residency is officially over and I've broken the ice on the "rest of my life". Beyond the cognitive decline of an aging clinician, I think I held up pretty well for an old guy.

Still the yungins are really, really sharp and I can tell already it's going to be a challenge to make the grade and keep up in some respects. We shall see. It's one day, one patient at a time. But for now, it's (I hope) a realy good nights' sleep in my own bed.