Friday, June 26, 2009

"...and that's when I broke the child's arm in my bare hands."

The surgery I was watching was getting into the tedious stages, fitting and re-fitting a bone chunk that cracked off when the elderly woman had slipped on a banana peel (yes, you read that right). They already had an assist, so I wasn't scrubbed in for this one. Just as I was looking for a new distraction the orthopedic surgeon's pager went off.

A five-year-old boy had fallen out of a tree, and landed on his arm, which was broken. The emerg doc was going to re-set the bone, but wanted the orthopedic surgeon to have a quick look at the x-ray first. They called it up on the computer screens in the OR, and the surgeon gave his blessing that the emerg doc could set the bone himself.

I asked the surgeon if I could go watch the reduction of the bone, and soon was on my way to the ER where I found the doctor. I knew him from working with him in the ER a few weeks prior.

"I heard you're doing a closed reduction - can I watch?" I asked.

"No," he replied.

I was a little surprised, but didn't have time to react before he said, "You're going to do it."

"Uh, I'll give it a shot, but just so you know, I haven't done one before," I admitted.

"That's fine, I hurt my wrist. Come look at the x-ray."

That's when things got exciting.

This wasn't just going to be a regular reduction.

The doc showed me on the x-ray where the wrist had broken through the smaller of the two arm bones, the ulna - but not quite all the way through the radius.

Turns out that for a break like this to heal correctly, rather than just pulling the bone into place, like is done with most reductions, it was important to make sure that the break went all the way through the radius.

And how would that happen?

You guessed it... breaking the radius would be my job.

Sure enough, after a quick briefing, under close supervision, and as soon as the child was COMPLETELY sedated (what, you thought we would do this with the poor kid awake?!), it was time to hold on to the arm just above the wrist, and see-saw it back and forth at 90 degrees until I heard a pop and crunch. And that moment was just as the doc had predicted: "That's when all the eyes of nurses and staff watching will bug out of their heads." Fortunately, the child's parents weren't there to see what was involved.

Once the bone was broken, we were able to tug it into position, and put a cast on while still applying traction with our hands, just long enough for the cast to harden. By then, the patient was just starting to wake up from the sedation.

And while the patient didn't remember a thing - thank goodness - I definitely won't forget doing this for the first time.

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Wednesday, June 24, 2009

Maybe I'm not cut out for this... maybe I should think about quitting...

This post was actually written around March, about 6 months into my third year.

I'll admit it. For a while there, in the middle of third year, I wasn't sure if this medicine thing was right for me. Just look at this line from a post I wrote back in January:

as hard as I am being worked right now, I'm doing what I love, and worked hard to be able to do.
Yeah, it sounds chipper and rosy, but in all honesty, I didn't actually say I enjoyed third year... I was really just trying to convince myself that I should enjoy what I'm doing.

At that point, third year was really starting to wear on me, and I was almost ready to throw in the towel. I try really hard not to complain, but I was ready to write a post similar to one of the many I have found on other medical blogs, featuring such depressing tidbits as: "Medicine has made me a shitty person" and "Times I muttered “kill me now” under my breath [during third year]: 84,239." (In fact, I found so many tidbits like this back in the day that I made a list).

There were a bunch of reasons I was feeling this way. A few: The shifts are so long. It's really hard to have a life while you're in med school. The finals are demoralizing, and you leave almost every one thinking you failed. It's embarassing when you feel like the custodian knows more about treating patients than you do. You have barely enough time to do your hospital work and call shifts, let alone study outside of them. You are in a huge amount of debt. You're on call whenever you want to be doing something fun with your friends. You keep making mistakes. The list goes on...and on.

But of all these, the biggest reason I wanted to quit:

I was sick and tired of feeling like I don't know anything at all.

Every day, I'd see patients and think I knew what was going on, and then realize I had no idea. Even if I knew what medical condition they had, I didn't know the basics on treatment - I mean the very basics - such as which IV fluid to run or if I should even start an IV, let alone how to treat the condition. Most of the doctors supervising me were nice about it, but I still felt like an idiot.

This is especially tough to handle when you have done two years of medical school, and worked your butt off to pass those exams, and feel like you have accomplished something by passing two years of medical school, completing a four-year degree before med school, and by even just making it into med school. But no. You show up on the wards, and then realize how very, very little you know.

Like I've said before, now I understand why some doctors are assholes.

I know I said I don't like to complain much, and actually, the only reason I am willing to vent about this is because I don't feel this way anymore. In fact, over the last month or two, I've come to a realization - I am actually enjoying what I'm doing.

Slowly but surely, the passion I had for all this - the same passion I felt back when I was a pre-med - is coming back.

I'm not sure exactly when it happened. It might have been when I did a full history and physical on a patient and then realized that I had learned a lot about those and could do a pretty decent one now. It might have been when I was chatting with an inquisitive nursing student who knew about as much as I did when I started third year, and realized that I've actually learned something this year. Most likely, though, it was when I thought I knew what was going on with a patient... and actually did get it right... and actually had an idea about what type of treatment they needed.

That's exactly it. After 4 years of high school, 4 years of undergrad, and 2.5 years of med school, I'm finally starting to be able to do what I've trained for for so long.

I'm finally starting to play doctor.

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PDA Update: Why I RETURNED the PDA I chose!

UPDATED Again June 24 - Now includes the phone I chose AND how I like it

In the summer I wrote a fairly comprehensive report on which PDA I chose for my clerkship, taking into account the pros and cons of the ones on the market.

In short, I ended up choosing the Samsung Jack (also known as the i616) from Rogers, known in the USA as the BlackJack II.

I LOVED this phone. So much. It was exactly what I wanted, and so much more.
I sent it back to Rogers today.

You see, Rogers came out with a new version of the Windows software - upgrading Windows Mobile 6.0 to 6.1. And that's when the problems began.

Why I returned it:

The old phone was fantastic. Quick to respond, looked great, worked amazingly well, good call quality, outstanding battery life, and ran all the medical software I used on a regular basis (post on this to come soon).

Then the new version of Windows Mobile came out, and it was horrible.

There were glitches that were merely minor annoyances, ie. waiting 7 seconds between songs in a playlist.

There were more severe annoyances, such as the phone randomly changing time zones, screwing up all your reminder and appointment times, or the battery life being significantly shorter with the new version of Windows.

There were major technological glitches, in that the phone would stop working - calls could connect incoming and outgoing, but would not have any audio. My internal medicine attending was not impressed when I missed his calls beacuse of that.

And then, to just drive me entirely up the wall, there were glitches that made me wonder if the people that designed it had ever used a phone before (switching the phone to "silent" silenced ONLY the ringers - but alarms, e-mails and texts would all cause the phone to ring loudly!)

Each one of these was a step backward - none of these problems occurred before I made the upgrade, which I downloaded from the cell service provider's website. And the improvements in the new version were minimal. So, I sent the phone back, and got a new one - which had the same new version of Windows - and ALL the same problems. And after a few months of not bening able to make calls, I finally threw in the towel and said "enough."

Which mobile phones I considered:

I looked at 3 phones:

  • the HTC Touch Diamond, which my provider was willing to exchange for free

  • Blackberry, which I would have had to pay for

  • the iPhone, which I would have had to pay for

I had some qualms about the Blackberry and iPhone from the last time I went through this choosing a phone process, and the HTC Touch Diamond was new to me, but I reconsidered all of these.

Which phone I exchanged it for:

I was really excited about the HTC Touch Diamond. It's a sleek phone, with a Windows operating system like my old phone, so I knew it would support all the exact same software I had used. So, I went to a Rogers store and tried one of these slick things out.

After five minutes, the phone had just about finished booting up.

After ten minutes, the phone was about halfway through its mandatory First Startup configuration.

After fifteen minutes, I was trying to figure out how to do basic things, like start the Internet explorer, add a new contact, and use the keyboard.

After twenty minutes, I was STILL trying to figure out how to do those basic things, and was starting to get annoyed with the touch screen which was a tad unresponsive.

After twenty-five minutes, I was STILL doing the above, and just about ready to throw the phone against the wall. Learning to use a new phone should not be that difficult...especially for someone who is fairly tech-minded like myself.

After thirty minutes, I gave up. Scratch the HTC Touch Diamond off the list.

My concerns about the Blackberry and the iPhone were that not a lot of medical applications were made for these platforms - most are made for Palm or Windows.

However the medical applications I found I used almost exclusively were:

  • Epocrates - a free drug lookup
  • UpToDate - subscription to the latest research on medical topics (wait until your med class does a group order for a massive discount, or better yet, arrange one yourself)

  • Archimedes - a free medical calculator

  • Diagnosaurus - a free differential diagnosis generator
Even though I paid for Merck Manual, I found that with UpToDate on my phone, I turned to UpToDate for most topics.

Turns out all of the above except UpToDate are available as iPhone applications, and UpToDate is available through the iPhone, you just have to use the Internet connection. As well, Rogers offered me a deal on the iPhone.

So, I decided to set my concerns about the touch screen keyboard aside, and went for the iPhone.

The Verdict...How do I like the iPhone?

Perhaps the best way to answer this is to ask, what do I miss about the BlackJack?

Frankly, almost nothing. While I thought I would miss the tactile keyboard, it turns out that I'm getting along on the iPhone just fine. My typing is slower, mind you, but not by much.

As well, until the iPhone 3G S came out, the iPhone didn't have video. But to be honest, I never used the video on my BlackJack.

The only thing the BlackJack had the upper hand on was battery life - the iPhone isn't that great (no word yet on how much better the 3G S will be). As well, loading UpToDate on the BlackJack was faster - I didn't have to type in a password, because it was downloaded to the device already, rather than accessed through the mobile web.

The iPhone is much better at browsing the internet, or surfing through a long page on UpToDate, for example. Rather than rolling a little scroll wheel over and over, you simply slide your finger - much easier.

And, the iPhone's GPS is much faster to lock a signal than the BlackJack (even though both are extremely accurate) - helpful for finding hospitals or doctors' offices on the first day of a new rotation, and for using RunKeeper - a FREE program MUCH better than Nike's run tracker - to track my exercise.

All in all, I don't miss the BlackJack. But to be honest, I was perfectly happy with my BlackJack...before the new version of Windows. I'll even go so far as to say that had the Microsoft update not been so full of glitches, and I stayed with my BlackJack, I would be just as happy as I am today, as far as a medical device is concerned.

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