Some Dayton Updates...

So I'm nearing the end of my time in Dayton, it went by crazy fast. Probably because I was so busy and always trying to normalize my sleep schedule...such is the life of an ER doc I suppose. All the docs here say that's the worst part, the continuous changing of sleep cycle. It really hasn't been too bad though, I actually went running at 3am one night on base, it was pretty awesome.

I have my last shift on Tuesday and I'm doing our "final presentation" that we're required to do. We also have to take a "final exam" or something on the last day. This pretty much sucks because I've heard it's random and impossible to study for. Also, my test taking track record always haunts me. After that last shift I still have like 5 days in Dayton until my flight to San Antonio, so I'm hopefully going to climb and explore a bit more.

I had my interview last week and overall, I think it went great! (but who really knows, they could've thought i was the weirdest person ever lol) I consider myself personable but when it comes to the "official dog and pony show interview" i tend to get nervous. I just am not a fan of putting on a show for people and selling myself with all of this "i'm going to tell you what you want to hear BS". And there are A LOT of applicants that I've met, not just here, but everywhere, that seem to be great at this. Maybe it's a negative thing that I somewhat struggle with the specific formalities of the things you're "supposed" to say in an interview. But, that's just not me. Sure I can interview well, but the second I try to pretend to be somebody I'm not, it goes down hill and I lose my train of thought and end up sounding like a tard. So, as I was preparing for this interview, which by the way was the biggest interview that I'll have since it's my #1 choice, I tried to not over rehearse or have any "canned" answers.  I had main points that I wanted to touch on, but I mainly tried to focus on staying calm, being myself.

My first interview was with the Chief resident. It was pretty laid back but certainly covered all the main questions, i.e  Why ER, Why AF, What are you good at, what do you suck at, etc. It was cool, but to be totally honest, the interview seemed really formal for what I was expecting from a resident. The other students confirmed that he was sort of too "by the book".  He was really nice and everything, I just felt like he was rushing through questions he "had" to ask and that made it seem somewhat impersonal.

The second interview was with the program director, and the session I was the MOST nervous for. So after all of the build up, this session turned out to be my favorite one so far. This doc (who was the same guy with the situs invrsus kid i wrote about in my previous post) is absolutely, without a doubt, one of, if not, my most favorite AF doc. We hadn't had anytime together on any shifts so I was worried he wouldn't know me that well. But as soon as we started talking it was crazy because it was so casual and informal. I honestly felt like I was talking to one of my best ROTC friends, and that made me feel really good. He didn't ask me any of the typical questions. He flat out told me he was really happy to see how much we had in common (he did ROTC also) and he wanted to hear about how I've gotten to this point. This interview was more like I was talking to a friend, it was really crazy. He wanted to hear about my ROTC life, my maintenance experiences, and how the heck I managed to get out of that to go to med school...apparently he understood how difficult that is. So i talked about that and how it started out as something I hated, but turned into one of the best experiences of my life, how it made me who I am today. I mentioned how I sort of feel like "fit in" better with my air force friends and what it means to me. Towards the end of the talk, he said some things that make me feel like the interview was a success. He told me that I'm a really unique applicant for a few reasons. The prior service thing, being in charge of more than 50 people, which in the med group, you only do when you're Lt. Col or above (aka i have more leadership experience already than him and most of the residents and practicing docs lol). But the thing that he said that made me really happy was that he told me I reminded him of himself and he could tell by my enthusiasm that I was being real. Going back to my whole thing of hating the formality of an interview, this was awesome to hear. Not only did I feel like I could be totally myself with him, he picked up on the fact that this conversation was different than the usual fake interview. That's an overall success for me, no matter what happens.

So i guess it's out of my hands now, I did my absolute best, and left it all on the field, so to speak. I know there are LOTS of people interviewing and competing against me, I just hope I'm different enough to stand out when the board meets. But if not, if I have to fight my way through again and do a general medicine year, that;s ok too. It's not like I haven't been in that position before, except that was worse lol. I'll be fine because even when it doesn't work out, it actually does, just in a different way. ;-)

Right where I belong...

Last week's conference, although it was an incredibly stressful day, was one of my favorite days of this rotation. It was stressful because we just got the numbers from the AF for how many ER docs they needed and it sort of hit me that this whole match process is finally here. That plus seeing other students interview and hearing how competitive it is really freaked me out for a bit. The thing that brought me back down to my baseline level of insanity was a presentation by the program director. He was lecturing on thoracic emergencies and did a separate presentation about a case he has while deployed to Bagram Air base, Afghanistan.  I'm going to try to tell the story the way it was presented...

The case was about a 7yr old Afghan boy he took care of immediately after an IED (improved explosive device, basically a makeshift bomb insurgent's plant all over town) went off in village market in the middle of the day. There was a large number of women and children hit and he happened to see this boy. This sort of thing happens unfortunately, pretty frequently. Kids are brought to Bagram all the time and taken care of. This boy, however, was not like any child routinely seen anywhere. On initial exam, before delving into his blast wounds, the doc noticed something strange about his fingers and toes.  They looked something like this:

For non-medical people, it's called "clubbing" and the exact physiology of it isn't really known but it's hypothesized that it's caused by a process that allows for right to left shunting of blood in the heart and leading to the mixing of oxygenated and deoxygenated blood in the body. It has been seen in people with long standing COPD, lung cancer, TB, cystic fibrosis, etc, something basically affecting oxygen content in the blood. Anyway, so as the primary survey goes on they notice this clubbing, puncture wounds to his chest and abdomen, and some other minor cuts. So just from the clubbing alone, doc new something was not totally right. As things progress and they start the trauma series of xrays, labs, etc they quickly realize this child  is incredibly unique. His chest x-ray looks something like this:

Notice anything wrong?? (I thought of scrubs at first and how they hang the xray backwards at the beginning of the show lol) But no technical error here...his "stuff" is on the wrong side! Heart and stomach, both on the right! This kid had what is called, Situs Inversus, basically where his organs are transposed to the opposite side of his body. He also had transposition of the great vessels of his heart, aka  the main vessels of his heart were also reversed. Crazy right? How is this kid even alive?? It's crazy because transposition of the great vessels is a condition incompatible with life in 100 % of cases UNLESS, unless, unless, there is small hole in just the right spot in his heart. In other words, his heart is totally backwards and this small hole, a ventricular septal defect, is allowing this crazy rearrangement of blood vessels to adequately oxygenate his body. Holy crap right?? Mind you, this kid is 7yrs old!! Which means, for his entire life, from the day he was born, his little body has been working sooooo hard to compensate for this congenital heart abnormality. AMAZING. 

So back to his resuscitation. After docs quickly figure out sort of what they're dealing with, they get some labs back.  The only 2 real labs of importance to explaining this case are Oxygen saturation and Hematocrit. Oxygen saturation is around 81%, which is low, but not as low as expected for somebody who probably has a huge hole in their lung, normal is greater than 92. His hematocrit, just a measure of the actual red cells in a blood sample, was also 81%, normal is anywhere from 40-50%. So this kid's ox saturation and his hematocrit are the same!!! This basically means this kid's blood is incredibly thick, to the point where this level of Hct is never seen, like ever! It's another way that his body has coped with this heart disease that he has, that's one of the ways he gets more oxygen, is to make lots and lots of red blood cells to carry more oxygen. Again...amazing. 

So now the docs realize that their previous knowledge of "normal" physiology has gone totally out the window. How can you even begin to try to treat/correct/maintain his physiology when you have no freaking idea what is his "normal" in the first place? All they really know is that he needs surgery to remove metal that is in his lung and abdomen making him bleed into his belly. 

*Side note: My favorite part of this presentation was when the doc was telling how $hit was hitting the fan and he had to run back and forth between this kid and a few others. He described what I can only picture to be the extremes of emergency medicine, badass docs and nurses running around making things happen in mass chaos. (doesn't that sound incredible?) My next favorite part of the story is when the doc, after getting the kid somewhat stable, tries to get a pediatrician (since he is 7yrs old) to take over. The poor peds guy practically craps his pants at the thought and refuses! I'm sure he didn't refuse because he was a jerk, I just think he was too scared to take on the case. :-) Sorry to all my peds friends, but I had to throw this in there.

Anyway, to make a crazy awesome, but long story short, the doc ends up putting a chest tube in the kid and taking him to surgery to remove the shrapnel left in his chest and abdomen. He survived the surgery but sadly died from complications of pneumonia several days post-op :*(

It is really really sad that he didn't make it. My first thought was, poor guy, so unlucky, just caught in the wrong place. But after really thinking about it, turns out that he was actually incredibly lucky to even be in that market in the first place. He basically overcame all odds to even be breathing, let alone live for 7 years. He wasn't just lucky, he was a walking miracle. We'll never know how long he would've really lived had he not been hit with that IED, but it surely wasn't going to be very long. It's even more amazing that he survived surgery. There's so much that has to go right in his physiology to sustain him, his body has been perfecting this for years. Surgery is highly risky in "normal" people, let alone him. So all in all, the fact that he died in the end while really heartbreaking, it's just a testament to how big of a miracle his life was to begin with. 

After/during this presentation I pretty much had chills. One of my dreams is to travel the world and practice medicine in places that doesn't have doctors really. To treat people, like this little kid, who have never seen a doctor in their lives. It's a huge reason i joined the Air Force. So although I sometimes have my doubts about how the AF will impact my life, hearing stories like this puts everything back in perspective for me. Stories like that are the exact reason why I'm here. Nothing pumps me up more than to know that I will be (hopefully!!) able to go around the world and have my own stories similar to this. Of course being a doctor alone is sweet, but being one of the few people who can handle crazy cases like this one, and help people that would otherwise NEVER see a doctor is incredibly exciting. 

There's a lot to worry about right now in this stage of the game. Residency applications, board scores, what happens if I don't match, where will I live, what if I'm still single at age 50 (lol, jk), it's A LOT to think about.  I do my best NOT to think about it too much and reassure myself that things will work out, they ALWAYS do.  But that day, sitting there listening to the story about that miracle boy made me REALLY realize something. The feeling I got from it made me see that although i am unsure of LOTS of things, like where on earth I'll be next year, or what I'll be doing. One thing I DO know is that right now, pursuing this dream, (totally stressed and confused and scared) no matter what happens, I'm exactly where I belong and wouldn't have it any other way.   

Just a few more months....

So there's a lot I have to write about, but it's late, and i just got off a long shift. But I just wanted to comment on the 2 things about my shift tonight that stood out more than anything:

1. "are you a real medical doctor? As in, you went to medical school? Because you don't really look like someone who would become a doctor."

I don't take personal offense to really anything a rude patient or even more rude family member says to me. This isn't because I have no emotion and am an "ice queen" as most would say. But mainly, it's because 99% of the time, the people being rude jerks in the ED are just not smart, at all, but they somehow think they have this wealth of knowledge because they have a 4th cousin who is married to a guy who knows a doctor, or something retarded like that. Anyway, tonight I went into a patient room to see a kid with a rash. No big deal, he has a rash. My first thought was (as I'm seeing this 5yr old kid, with no apparent rash, jump up and down through the door screaming along to the cartoon on the tv)..."wow, this kid couldn't be farther from having a life emergency, dandy." This also give me the first clue that his mom probably is not the brightest crayon in the box. So I go in, start talking to the little guy and mom. Before I can really start asking questions, mom flat out asks me if I'm a real medical doctor and proceeds to clarify that she's asking if I went to actual medical school. It was funnier than insulting actually lol. I had to stop myself from laughing almost. "did she really just ask me if i'm a medical doctor that went to real medical school?"

I explained I was in fact not a doctor yet, but am almost finished with ACTUAL medical school (the kind where you learn medicine and stuff). She was shocked because apparently, "you don't look like you would become a doctor."  WTF? I'm still not sure if that's a good or bad thing, i'm still sort of laughing at the whole encounter. But i assured her that despite my looks or whatever, I am qualified to be asking her questions about her son's non-existant medical emergency that she calls a rash. I basically told her some benadryl would clear up the miniscule red spot and "itching" her boy was having. 5 mins later, the attending comes in (only to appease her because I could tell she didn't believe me), and says the SAME EXACT WORDS, almost verbatim. I wish I could've had a camera to video her reaction that was SO appreciative and relieved and made it seem like the attending had just told her how to win a trillion dollars and I had told her nothing. SO...what did I learn from all of this and this crazy lady, other than the fact that apparently I don't look like a doctor and 95% of the people I see in the ED are very very unsmart. I learned that i CANNOT wait until somebody asks me that question and I can answer, YES DAMMIT I'M YOUR FREAKING DOCTOR! :-)

2. So tonight seemed to be "vaginal bleeding in pregnancy" night in the ED. We had about 5 women in a row come in for vag bleeding all less than 15 weeks or so. I got lucky enough to work all of them up and by the 3rd one, the doc was letting me pretty much solo the patients, meaning, I'd do everything, orders, exams, and they would just say a quick hello at the end, when OB/gyn came down.  My 5th lady that came in though, she was the one that gave me an experience that I don't think I'll soon forget.  She was bleeding pretty badly, hadn't felt the baby move in a couple days. When I told the attending about her he sort of grimaced and said in not so may words, he was pretty sure the baby was not viable anymore. So, with this in mind, I go in and do the pelvic to work her up just like everyone else. Mind you, this poor girl had been crying from the second she put the gown on, she had 2 previous miscarriages at around this same time. I set up the ultrasound, trying to console her without giving her false hope, but also without being unrealistic, she had lost a ton of blood. So as I'm getting the probe on her belly, doc walks in and stands there waiting to help me give her the bad news that her baby's heart isn't beating. So I look around for a few seconds and seriously, it was the craziest, one of the most emotional moments I've had in med school for some reason. Not sure if it was because you could feel the fear in the room from this girl at the thought she lost another baby. Maybe it was because it was my first time or so really being the one to find or not find a heartbeat. So after looking for about 2 seconds, I found it...it was beating strong and baby was moving. Right at that moment lots of things happened...i'm pretty sure my own heart stopped for a quick second, the patient screamed/sobbed louder than crap, and even the attending let out a "wow."  It was amazing and i was so happy that I let the probe slip and I lost the heart lol...but I found it again fast! So everyone was happy, not totally out of danger, but the baby was alive, unlike we all expected. I guess I never really grasped/felt how surreal it is to see your baby's heart beat on a screen. I've seen tons of them, but tonight it really hit me. I've never seen my own baby's heart beat (obviously!), but if this is even an indication of what that is like, all I can say is life is really a miracle. So yea, I'm pretty confident that I won't forget those couple of seconds for a long time. I should also not forget to not drop the probe during such crucial moments lol.

More updates to follow :)

Day off :-)

So today, other than a 2 hr lecture, was a day off! I have tomorrow off as well so I used today to really work on my personal statement for the residency application.  I really struggle with writing formally so it's taking me FOREVER.  I want to include things about my previous military time and past struggles I've had to get where I am. It's just really hard to articulate it the way I want it to come out. ALso, it's difficult for me to write about myself and somewhat "sell" myself to program directors. I'm a MUCH better speaker/interviewer than writer :-/  Nonetheless, it's coming along. I have my interview on July 23rd so I hope to be done with the personal statement by the beginning of next week.  As far as the interview, i'm nervous about it. I know all I can do is be myself, be honest, and hope for the best. I'm just hoping I don't say something stupid lol, i have been known to do that from time to time.

Overall though, being here, on a base again, surrounded by people in the same "boat" as me has really calmed a lot of worries I was having in the months before I came. Being disconnected from AF people and things, while still having to make plans with the AF in mind was stressing me out. It's sometimes difficult for my peers, and even my closest family and friends, to really grasp the concept of why I would even want to be in the military. They certainly support me and are behind me no matter what I do, good or bad, but that's different than somebody who just understands and gets it. I love my supporters and don't know what I would do without them. But sometimes, it's refreshing and super reassuring to be around people who I don't have to explain anything to...they just know and feel/understand where my driving force comes from, nor do they see it as a nuisance. I think I was just getting the feeling that I was alone the past couple of months. Alone in the sense that I was constantly defending and sometimes even doubting all of this Air Force thing. Now that I'm here though, I remember exactly why I make and have made certain choices for myself that could potentially make my life very difficult and non-traditional.  I guess you could say I like I belong to a "team" (wow cheesy!!!) again.  So I know it's silly to feel like I'm alone in this, because I know I'm not. Maybe I just needed to see other people doing this, and not only doing it, but being incredibly happy doing it. So being here has been great on more than one level, I needed it.

A month and a half until I'm back in AZ! With my little abbey girl and in my own bed! I still have a bit to go, but I am getting excited :-)

 It has been a good day off, and this song always makes me relax :-)  

Long day...

So I'm on my second week of my ED rotation. So far I have had a great time. Today, however, was by far my favorite day of all! We had a procedure lab where we were assigned to a live pig (about 100lbs) and got to do a bunch of procedures on them. We practiced getting intra-osseous access (basically sticking a large bore needle into a long bone when you can't get a peripheral IV), chest tubes, cricothyrotomy (hole in neck for airway),  thoracotomy (cracking open a chest), diagnostic peritoneal lavage ( flushing fluid in the abdomen looking for blood), and cardiac massage!! A couple of attendings and the program director were in my group so I either made an ass of myself of did a good job to impress them, who knows lol. But it was really awesome to be exposed to the setting where we can actually learn those types of procedures on live animals. I love that they put that much effort into teaching us on this rotation, it really makes up for the slow ED :-)

Everyday I'm here, and the more I talk to the residents, I love this program more. It's not as in your face military as San Antonio is, you get close to 5 civilian hospitals in your rotation, rather than just 1 big hospital, but most of all, the people are amazing. The people/personalities are what matter the most to me and if I can see myself happy working with these people. Granted, it IS the AF and people move around sooo much, but I feel like I can really fit in here. Also, I do want civilian hospital experience, and you get that for your entire 3 years here.  I do love the AF, but i think I will really like the civ/military mix of residency life they have here.  Sometimes they are the bane of my existence, but the homeless drunk does have his/her role in teaching students on how to be a good ED doc lol.

In other news, i've been running a good amount here. The base is pretty, pics coming soon! There's a sweet rock gym not far from here and I think i'm going to head there in the next couple of days. I've been sooo busy lately and they sneak lectures/labs in on my days off so I haven't had time to explore it yet. This week though!!

Ok more updates later!

Something I wish I didn't learn today...

It is still possible for people to fart during a rectal exam. 

Lesson learned...unfortunately. 

My first 2 shifts!

So I've been in Ohio at Wright-Pat AFB for 3 days now and I've had 2 ED shifts. Overall, they're been pretty good. The base hospital where I'm rotating is not a big place like I thought it was. There's no real trauma or real emergencies for that matter. The people that come to the base medical center are either retired military or active or they're dependents. Also, there are very few actual emergencies that come to the ER here. Most of the complaints are things that can be handled by a family med doc as an outpatient. That's just how this small hospital is set up :-/

That being said, the residency program here is actually quite awesome. As an intern/resident you actually don't spend anytime on this base hospital and you're out in the civ world at the big trauma hospitals around the Dayton area, so that's cool.

I have met some crazy awesome docs though. Although the actual flow of real emergencies is relatively low, I'm learning LOTS and getting to basically make the decisions for my patients, write the orders, and much more! So it's been great so far.

The other thing I'm learning is how different the medical side of the Air Force is from the operational side. I would NEVER think of calling a Col by his first name, much less a nick name, and here it's expected...crazy. I guess because of the team dynamics of the ED with nurses, techs, and docs, the relationship is closer and more laid back. I like that it's laid back and informal, I never really liked the whole "power hungry salute me because i'm higher ranking than you" thing that goes on.  Some people might argue that its a bad thing for the enlisted and officers to be on a first name basis when the rest of the AF is not, but trust me, everyone still knows who is the doctor and who is really in charge...regardless of the rank.  So it all works out.

Things I have learned so far:
- Don't assume that military members/dependents are less crazy than the average population...the crazy is still there, it just hides better in the military.
- I despise decisions based on pure politics, well this i already knew
- I hate being called ma'am
- How to remove a foreign body from an eye with a TB needle
- still not a fan of the pelvic exam despite my female-ness


It's 2am, and i'm falling asleep so better and more well put togther posts are coming soon!

Leaving on a Jet Plane...

So my week of post-boards relaxation has finally come to an end. I've spent the week mostly relaxing, packing slowly, watching soccer, and enjoying my free time. It was a great week, but I'm definitely ready to get back in the hospital and get back to work. I'm leaving on Monday morning at 6am for my 2 month adventure back in to the active duty Air Force. I'll be going to Wright-Patt AFB in Dayton, OH for 4 weeks and then Wilford Hall Med Center in San Antonio, TX for another month. The only difference this time is that I'll be working in the ED, not on the flight line :) .  I have sort of mixed emotions about how these next couple of months are going to go. I'm extremely excited to finally rotate at places I may actually end up and get a glimpse into what could quite possibly be my life for the next 3 years. With excitement comes the nervousness of "holy crap, I've been off active duty for 3 years, I'm gonna look like an idiot!" On top of this, there's the anxiety that I MUST impress these programs so they actually pick me from the hundreds of applicants. One good thing though, is that I feel ready to finally see what it's like to combine my Air Force life with my medical life. I've done them separately and I hope I realize and get that feeling that the combination of the two is exactly what I'm supposed to be doing. So, i'm excited/nervous/anxious/ready for the next 2 months!

Things I plan to do/keep up with while I'm gone:
- RUNNING!!
- SWIMMING!!!
- RIDING (i plan to participate in the SOMA 70.3 triathlon again this year in October so I gotta get my butt in gear!)
- CLIMBING
- TAKING PICTURES (of everything of course!)
- oh yea and reading and learning lots of Emergency medicine things :)

So that's what I'm up to for the next couple of months. It comes at a great time too...it's crazy HOT right now so it'll be nice to get out of AZ. Not to mention I've been wanting to get out of town lately. I love AZ but something has been making me antsy, like I need a slight change of perspective as of late. Not really sure why that is really. But hopefully I'll get a much needed change of perspective on the many things I purposely place on my already full plate. Maybe I'll just want to add more? :)

I will miss my abbey though :(  She'll be hanging out with Xiomi and they're going to keep each other from getting lonely, abbey was put on this earth for that, I'm convinced of that.

Well stay tuned for funny ER stories, angry rants of frustration, crazy ER times, and funny Sasha stories...we all know I can get myself into the craziest situations.