A hobby from the past.

I finally did it. I knew some parts had to be replaced so I made an order on Amazon after doing a little research. I ordered the parts that I knew were long overdue for replacing and had worn out. That evening when they arrived, I spent 30 minutes adjusting and replacing. And then, I just did it. After 7 years of not formally touching the thing, I played the violin. It felt amazing. I forgot how good it could feel to make music. I never felt myself to be very good, so you can imagine after 7 years it was a little rough around the edges, but as I played a few Christmas tunes for Jordan, I felt more and more come back to me. I think I am going to spend some more time playing in the near future. Ultimately, I would like to get some lessons, but in the mean time, I will keep doing a little research and work on re-learning some basics on my own. I don't anticipate playing the thing more than once or twice a month with my schedule, but someday, I want to make music again!

Here is a sample of what I want to sound like someday:

Ok, so if I sound a quarter as good I'll be happy.

~vaya con dios

I haven't had much to blog about lately. I think that is because I am already tired of writing about work. No matter how hard I try to put my experiences into words, the fact remains I am just not a good enough writer to convey what I have been experiencing. That is a little frustrating to me because the experiences themselves have been life altering to me, and yet, when I go back and read what I have to say it all seems a little...saccharin.  Really, I think what it comes down to is a combination of things.  Writing has never been a strength of mine, first of all. Second of all, it is really easy to complain about how hard life as a resident is. It is easy to fall into the same "my life is so hard" trap every time I sit down to write because, well frankly, this process is hard! There is a reason there are so many books, TV shows, and just anecdotal stories about what life is like in residency. In fact, just before I started writing this I was reading the blog of a really good friend of Jordan and I. She was talking about pushing the limits and working while sick. We all do this and I am pretty sure a lot of people outside of medicine do too. But that raises an interesting question, how sick is too sick? If I were, say, a barista, how sick is too sick to pour coffee? One could argue that perhaps being sick at all should preclude that person from working since they could spread whatever illness they may be experiencing to their unknowing customers. Of course, if we eliminated the contagious argument, then we start to get to the point I am trying to make. I would be fairly comfortable with my barista pouring me coffee if they felt ill, perhaps to the point of feeling, say, 50% of normal (again, assuming they were not contagious). Now let's carry this noncontagious individual over to the medical world. How sick is too sick to be a doctor? Would you want a physician caring for your loved one if he or she felt any less than a 100%? Is it okay for the doctor to be caring for your mother if that doctor were only feeling about 80% of his or her potential? What about 50%? Would the hospital even be able to function if everyone that worked there only worked when they were 100%? I suppose it probably wouldn't.

I don't really have the answers to this, we as health care providers are human and just doing the best we can, but I just wonder if the best we can is good enough. All of this gets me thinking about another strange set of feelings that are pulled out of me as a result of my training.  As a resident in training, a lot of my time is still spent dedicated to learning and education (I suppose that will be true of my entire career in medicine, but that just helps drive this point home, I think).  Never before has my learning and education had a direct impact on the lives of others. If I make a mistake in my learning it doesn't just count towards my grade, instead it directly affects others' lives.  There are times this really scares me, but that is not the point I am trying to make. What I am so poorly conveying is sometimes it is easy to lose site of reality. It seems strange to me how often I have to remind myself that I am working with patients, their families, and their lives. When I tell a patient the results of her echocardiogram show she now has a diagnosis of heart failure on top of the cancer she already knew she had, I am completely altering the course of her life as she knows it. What I am not doing is winning the game of discovering the correct medical problem and then getting bonus points for conveying that information to a patient in a caring way in which they can understand the diagnosis. And yet, I continue to fall into that trap daily. Maybe that's my way of separating myself a little bit emotionally, but at the same time, I really need to be careful to not lose sight that this not a game.

Well, I honestly thought this was going to be a short little blog saying I had nothing really to say, because I don't know how to say it or even what I want to say, but I guess not. If you are reading this, please know that while I have disappeared some, I am thinking about all of my friends and family all of the time. I am working really hard, but I am making a lot of progress. I feel more and more like a doctor every day, and I think this sacrifice will definitely be worth it. I will do my best to try to bring more to this blog in an interesting way so as to keep you up to date on my life, my training, and whatever random thoughts pop into my head on any given day. Thanks for reading, thanks for supporting Jord and I, and most importantly, thanks for loving us!

~vaya con dios

Crossroads

As Jordan and I wrap up our much needed vacation together I find myself reflecting. I decided to jot down a few thoughts to help myself process and the result is this blog entry...

Vacation is a strange thing. I think it is especially strange for the resident physician.  There has to be some sort impact on a person that is used to being occupied the majority of their time working and learning, going to a speed of 0.  For both Jordan and I, this vacation has brought a myriad of emotion. We both have done a ton of reflecting this week and I think that is a byproduct of having time. It is absolutely amazing to me that we are more than 3 months into our training as physicians. It's so amazing to me because I feel overwhelmed by the amount I've learned, overwhelmed by the fact that it feels like I have been doing this a lifetime, and overwhelmed by the fact that I am actually capable of doing this! It's such a crazy feeling!

I have also realized how lucky we are. We had the chance to spend time with some family and friends we hadn't seen in a while. We have been blessed to have such unique support by our families and by our friends in such unique ways that I am sure neither of us would have ever made it this far without them. I miss them like crazy but it is also because of them I am not only doing this, but I am doing this the best way I know how. 

We have also spent some time working on our house a little during this vacation. Can I just say, we love our house! We managed to do some much needed deep cleaning, hung a TV upstairs, worked on organizing our basement some, did laundry (funny how that has become a luxury in our house), and Jordan did some baking!

Jordan was asking why the heck I was pointing my computer at her while she was baking.

So I tried to catch her in the action...

 And here she told me to get some pictures of the house including the whole kitchen little did she know it would end up including her in the picture too of course (Oh and yes that is a spaghetti squash in the picture above in case you were wondering. I know you were!)

 Our living room...

And from a different angle...

 

Well that was a random detour. Don't really know what that was about. Once I find our camera, I will take some real pictures of our house and post them, we have only lived here for 3 and a half months after all!

Anyway, I hope you are well if you are reading this, and if you don't read this then I don't hope wellness on you (ok maybe I do anyway).  I think it is time for me to go to bed, I am goofy! I hope this blog is at least semi funny when I read this tomorrow and not totally embarrassing! 

~vaya con dios

Complications

I know I just finished a blog a couple of days ago but something happened that shook me to the core.  I had a patient my first month as an intern that was incredibly difficult to work with. He was a guy in his 30's who abused IV drugs, was HIV positive, and didn't care if he spread it. His entire persona screamed psychiatric problems to me. One night when he didn't get his way, he threatened suicide. The next morning, he said if I called psych in to see him, he'd leave AMA (against medical advice) and throw water on whoever came into his room. He said he had no plans of hurting himself and he wanted to live. We treated his abscess, talked about staying clean, and acted like we had made a difference. Then last night happened. He came back to the hospital really sick.  He was being treated when he suddenly started getting more and more sick.  The initial thought was that he had a complication of diabetes. They were treating him appropriately and he initially got better.  Then he got sick.  When things didn't add up, people started asking questions. He told the team who admitted him that he had binged on meth for days and missed all of his medications. He didn't want to get sick so he took all his medications at once after the binge.  He wasn't sure what he took but he said he took 60 pills. As he continued to get worse, they moved him to the ICU where he later refused all care and he died.

Now what's so strange to me is how guilty I feel. I had so much animosity towards him before. He had done all of this to himself. He would complain about everything, he abused drugs to the point of nearly killing himself, and worst of all, he knowingly spread HIV. But now, in hindsight...Now...I feel somehow, somewhat responsible. Why didn't I insist on a more thorough psychiatric eval? I know that he would have likely died from full blown AIDS a short time later anyway, but what if all of this was not him doing to himself? Rather, what if this was a psychiatric disease doing this TO him? I know this guilt isn't a burden I have to carry, I am trying my best to take it more as a reminder. I can't ever be too busy. I can't overlook these details that seem too minuscule as compared to their whole medical picture. Psych was a worry I had, but with how sick he was before, it just didn't seem like that big of an issue. His reassurances sufficed for me at the time. But in hindsight? Man, in hindsight I just can't help but wonder...

~vaya con dios

"I have been favored by God, and by those who have a say in what happens to me."

As I am winding down in the last rotation of the first quarter of intern year, I find myself looking forward to my first weekend off since starting. This process has been amazing, hard, exhausting, educational, and life defining. In other words, it's been crazy!

This rotation was a general inpatient month for patients with Kaiser insurance. I went into the rotation not really knowing what to expect. Honestly, I was nervous about the variety of patients I would see. I think I was expecting nothing but privileged individuals that could afford health care and would have the elements of disease seen later in life with well-treated chronic disease previously that reached a point where all the treatments we had would fail. Instead I saw a spectrum of patients ranging from a young woman with severe alcoholic disease to a patient with terribly controlled diabetes who had her life completely changed by a SCRATCH she suffered on her leg that will likely take her life in the next year, and all the way to an old man in his 90's with pneumonia who would transition to hospice (I am beginning to learn why they call it "old man's best friend"). This rotation was actually a really good one for me (even if I am so tired) and I really did see a wide variety of patients and illnesses.

My expectations of those favored enough to have a decent health insurance went out the window almost immediately.  Illness is a horrendously great equalizer.  The uninsured patients get the same diseases that the insured patients get.  I saw beautiful relationships carrying people through their times of illness on all ends of the socioeconomic spectrum.  I saw individuals nearing the end of life alone (and really what does it matter at that point if they had Kaiser insurance or Medicaid).  On a large scale I know how detrimental to a patient it can be to go through a disease process without insurance, but really when it comes down to the day to day, as a physician, I don't want to have to care how they will pay for their treatment. I want to be a hand to hold when they are scared, I want to be a teacher about an illness or treatment, I want to be a bright spot in an otherwise dark time.

Thanks for reading!
~vaya con dios

Fall!

With the unofficial beginning of fall coming tomorrow, the dorkiness that is completing my fantasy football draft yesterday, and the start of college football season, I figured I would change gears from my usual whining and complaining about being tired and think about my favorite time of year; fall! Baseball is winding down and the playoffs are getting ready to start! I still am clinging to the slimmest of slim hopes that the Rockies can hold on and grab a playoff berth (sadly, it's doubtful though). Ubaldo Jimenez had a dream start to the season, but sadly, he had 0 run support. Carlos Gonzales is having an MVP type season, but no one (nationally, anyway) pays any attention to sports in Denver. I am afraid this team was built for success but hit too many speed bumps along the way to make the run I am hoping for. All in all though, tt's been a really fun baseball season.

The Broncos season scares me. I want SO bad to think they are going to be good. I want SO bad to have hopes that they have an awesome season. But honestly, I am the most pessimistic I've been since...ever. Kyle Orton is average at best WITH a huge receiving threat (read: Brandon Marshall). The Denver defense is scary against the pass with the league leader in sacks (read: Elvis Dumerville). The team is being talked about only for having a backup (read: Tim Tebow).  Two of those three guys are gone, and the third is going to sit on the bench. This is why I am so down on their chances. To all this, I still don't care. I am so pumped for football to start, I can hardly stand it!
Anyway, I thought I'd take my shot at writing about something different and I think I failed miserably, just rambling about something most care about one-tenth as much as I do. Sorry about that!

~vaya con dios

A critical point in my intern year

The ICU. If you talk to or read about any new doctor or medical student, you will invariably hear the stories about the fear of that first night on call in the ICU. I too experienced that fear, the patient's are sick and the nerves are endless. Well here I am, 3 call nights shy of finishing my first experience as a doctor in the intensive care unit. This month has been challenging for a number of reasons, but it has also been good for me I think.

The first challenge for me has been a recurring theme; lack of sleep. I have been on call overnight every third night. It makes for long days and a lot of fatigue. I have managed to get anywhere from zero to 2 hours of sleep on those nights. Honestly though, it hasn't completely messed with me the way I was sure it would.

The real challenge has been the emotional aspect. It is tough to feel like I am constantly trying to learn and constantly being pushed to know more than I do, but that isn't the source of the emotional exhaustion for me. I have two stories that come to mind. A word of warning though, they are emotionally exhausting for a reason. Here goes:

The first is my most proud and yet is quite disturbing to me. A lady in her 70's came in for what we call a CHF exacerbation. Her heart was pumping as well as it should. Now, typically when this happens, we look for what set off the event. Sometimes we find a reason and sometimes we don't. That day I got lucky, and the patient got incredibly unlucky. When I went to the emergency room to start the paperwork to get her admitted, I pulled up her EKG. Now keep in mind, reading these things takes years of experience and training and I am by no means good at this, I miss a lot of stuff. But for some reason, I noticed an abnormality. I mentioned it to the cardiologist, but he wasn't convinced. He said he was willing to watch her closely from that standpoint, follow a few lab tests, and repeat an EKG later. Well, lo and behold, 8 hours later my concern for this abnormality being a heart attack held up. Now, in hindsight, the cardiologist told me I was probably right. Huge moral victory, right? Well it turns out it wouldn't have changed anything we did, but the hard thing was she got sick. She was on the brink of death that night. I had to tell her husband that I thought he needed to call family in from out of town because I wasn't sure she would make it. This story ended happy and she got better, but it really left me thinking. I was really happy that I found this abnormality when even the cardiologist hadn't. But how could I have been so excited about something that was so bad for this patient? Perspective can be a funny thing.

And the story that is already haunting me a little. A patient in her 20's came to the ICU one night when I was not on call. She was initially being seen at a rural hospital for abdominal pain. A CT scan at that hospital showed some really strange abnormalities, so she was told they wanted to send her to Denver for better workup. She arrived and looked ok. The CT scan was weird, but she seemed stable. That scan showed a bunch of lesions in her abdomen, the most prominent of which being in her liver. There was an onslaught of discussion about what might be causing all this, ranging from strange infections all the way to cancer. The picture wasn't making sense though. She had a diagnosis of lupus for many years, but was otherwise previously healthy. She was followed closely by her doctor. The mystery was, how could someone with such close medical follow up end up with such widespread abnormalities on her CT scan? Well the answer came in the coming days after a biopsy revealed that dreaded word: it was cancer. Based on the type of cancer, she was going to start aggressive chemo while in the hospital. One afternoon while I was on call (strangely enough it was the same call day as the previous story), I was approached by a nurse asking that I keep a close on the patient because she was worried. Now this request was somewhat strange that day because it was still during the day. The team taking care of her was still there, so typically the nurses would call one of those doctors. It just so happened that the resident on that team was in clinic, the intern responded really poorly (not important for this story), and the medical student taking care of the patient didn't seem to grasp how sick she was (a skill I am still developing). As I was working on our other patient, I decided to check in on this lady. She looked SICK. Her breathing was labored and she looked like she was heading towards respiratory failure. I decided there was no time to contact her regular team, I just acted. I called in the pulmonologist, the attending, and my resident. We decided it was time to put her on a ventilator. She had lots of family around and we gave them a chance to tell her they loved her and then intubated her (thank God we let them do that). Over the next few days she seemed to get more and more sick. Then came the point where we started to turn off the sedation and see if we could get her off the ventilator. She wasn't waking up. It later turned out she had massive bleeding in her brain and it became obvious that we had already lost her. Her primary doctors had to tell this family that never left the hospital, that stayed with her day and night, that 1 week ago didn't have any clue that anything was wrong, that this patient, this 20 something year old woman with two young children, that she would not get better. She died later that day. I keep thinking about her and her family. It is weighing on me a little, but appropriately so I think. If this story didn't bother me, didn't make me incredibly sad, I think I would have to reevaluate my career choice. I thank God that I feel sad about this, that it affects me.
One thing that struck me about this whole situation was how things carried on. The day after she died, I walked past her room. It was cleaned and still empty. The bed was made, the family was gone, but the buzz of the unit carried on just the same. The nurses, therapists, doctors all running around trying to help patients, trying to heal others. The medical world is such a strange place.

I have other stories, but this post is getting really long. I don't intend on being depressing in every post I make, but this last story is an overwhelming microcosm of the roller coaster of emotion I have been experiencing this past month.  Please do not misinterpret, I realized as I was speaking with her family throughout this disastrous time that I am called to do this, and I will continue to answer that call every way I know how.

~vaya con dios

One down...

One rotation down, 11 to go in my intern year. Well as you can probably tell from my disappearance from everything, it has been a crazy first month. I think the biggest transition has been spending so much time away from Jordan. I really miss her.

My first month of intern year was on a general hospital medicine service that took care of the patient's that don't have Kaiser (mostly uninsured or Medicaid patients). We took care of patients on general medicine floors and in the ICU. I only had a few patients that were in the ICU so it doesn't make me any less nervous to be starting my official ICU month now. Oh well, it is going to happen either way tomorrow.

I have enjoyed my time so far (I think). I mean the interactions with the patients has been great almost universally, I really like the staff, and I love the residents and attendings at Joes. I just miss the heck out of Jordan. When I am there, busy, and not thinking constantly about being home, it has totally rocked. When things are slow, or we would have a late admission that was gonna keep me from home, I got grumpy. My days off almost universally have ended with some sort of sad feeling ranging from just feeling down, to straight up losing it. It's weird, I want to be rested and recharged but it's almost like I am reminded of what I am missing. I am hoping that feeling will pass some but I am not holding my breath.

I am trying to think of some good stories that would be far less boring than just reading my complaining. I have seen a variety of things from IV drug users with infections in their arms, to major heart attacks,  to newly diagnosed advanced cancer. I have had some wonderful interactions with patients and I have had a schizophrenic patient threaten me if I didn't leave his room. I had another bipolar patient tell me he is the antichrist, nonchalant of course. I treated a patient that has been in the hospital since April and will continue to be there for a while. I saw a patient gain 30 lbs in water weight from his heart failure. I treated pancreatitis in a guy my age that was from drinking alcohol and was so severe it has made him abstinent. I treated a recovering alcoholic mother who developed postpartum depression and fell off the rocker, only to end up in withdrawal, in the hospital, holding her toddler. In all the hurt and and sadness in that mom, I also saw the miracle of having a husband stand by her, be there to pick her up, and love her enough to carry her through recovery- again. I treated an older lady from New Mexico that was hard of hearing (sound familiar?). She had a heart attack with a strange presentation. She reminded me so much of my grandma that we ended up chatting about making tortillas, her son's restaurant, and even what cities in New Mexico we have family in. I guess when I think about all this and how it has all happened in just my first month as a physician, I am able to somewhat grasp the reality of this all. I am able to grasp how blessed I am to be doing this.

ICU tomorrow. I guess I should stop writing and go to sleep. I am SO nervous for my first overnight covering the unit. Thoughts and prayers are certainly appreciated! As I said a month ago...Well, here goes nothing!

~vaya con dios

I know the pieces fit

Pay no attention to the title, I am listening to music in bed and am kinda amped up from a crazy busy day. My plan was to share a few pearls from what I've done/learned in residency so far, but I don't really know what to say! Oh well, here goes nothing, random thoughts from 3 weeks of residency:

1. Being a new doctor is hard!
2. Sleep is a commodity
3. Patients think it's funny to see a doctor that looks young (seriously, I mean they literally laugh)- it's a great compliment!
4. I have a lot to learn. Every day I am learning SO much and being taught so much. It really makes me wonder what I did in med school. I had to have learned something, right?
5. I literally had to write an order that stated, "ok to give patient a pickle."
6. I had a nurse tell me today, "I've only been doing this for 10 years, but what do I know." when I wouldn't let a patient eat while on a special breathing machine. Honestly though, I was right on this one and I wasn't even trying to argue the point!
7. I have a lot to learn
8. Being sick is scary. I admitted a patient in her 30's for a heart attack today. I can't imagine how that must feel for her and her husband. It's really sad. Her whole life is different now.
9. I will probably be uncomfortable for the next 6 months, maybe even 2 years. That is the nature of changing what you are doing every month. Every time I fell comfortable even a little, it will be time to switch.
10. I have a lot to learn.

Ok, like I said sleep is a commodity, and well, I have less than 8 hours before I have to be up to do it again!

~vaya con dios

Bad Feeling

Today sucked. Today was that day that I knew would happen, it just felt worse than I expected. Today was my resident's day off so I had more responsibility than usual. Now, I have already done this 3 other times (just the way the schedule worked out) and it actually went well those other times. What was different? Well our team had a higher number of sicker patients today. We actually only had half of the maximum number we can have (My team can have 14 patients and I can follow 10), but I was still 3 away from my maximum. What was hard was how ill the patients were. One in particular got so ill at the end of the day, I had to transfer him to the ICU. By this time of the day, my attending was gone and I was all alone. I had other residents I can ask for help, but the truth is they are busy and focused on their own things. If something went really south they'd be there, but boy it sure did feel scary. I am exhausted, I have no desire to do this again tomorrow, and frankly I am just defeated.  I will try to get on to blog some good experiences soon, but I felt like whining and figured blogging it to the internet abyss sounded most therapeutic. All is well, I will feel better after some sleep. Hope to give some good stories soon!

~vaya con dios

Heal thy self

Words I have a feeling I may need to remember frequently in the next 3 years. I am TIRED. So here's the scoop: Being an intern is hard. We have a team that has a "light load," meaning we have fewer patients than normal. This is great for me as a new intern. The catch is, I am terribly inefficient, slow, and my medical knowledge is best described as "rusty." There are several things I know I know, but my brain just isn't clicking. What's really hard is how difficult it is to picture that knowledge growing. I cannot possibly see how my brain is going to retain so much in so little time. I know it will happen, it has to happen, right?

The other really hard part is missing and worrying about Jordan. As busy and tired as I've been, I am pretty sure it is amplified about 7 times for her. I am sure she is doing great and I have come home both days so excited to hear how her day has gone (someone was a primary surgeon on a C-section today!!!!!!! I have to brag about my wife!)

I think I have to end this entry here because I am not really sure what I just said and I am practically falling asleep at the keyboard. Early morning tomorrow.

~vaya con dios

Here we go

Tomorrow. I can do nothing but stare at that word: "Tomorrow." I don't particularly have much to say, other than to ask for your thoughts and prayers as Jordan and I officially begin our careers as physicians tomorrow. Here goes nothing...

Crossroads

It's here. I am a resident physician. Those words keep resonating in my head. How is this possible?! Tomorrow will conclude my first week of my first full time, salaried job. The week has been a little more tough than I anticipated in some ways and better in other ways. I am having to get up early again and this is just reaffirming my fears about sleep (or lack thereof). Starting orientation so early has been tough for me. I have just come to terms with the fact that I like my sleep. That has been one of the tough parts. The other tough part really happened today. We had a day-long series of lectures and group sessions on critical care. During the lectures, we were all realizing the magnitude of our responsibility. We are expected to know more, to do more, to take responsibility. We will be pushed in a way we have never experienced. The fear of the unknown has been consuming this week. I think I just need to start already! Anyway, the whole point of this little rant is really for myself. I am curious what I will think next year when I am looking back. Will I laugh and think, "It wasn't that bad," will I think to myself, "I had no clue what I was getting myself into?," or more likely it will be some other response I can't even imagine?

My last thought is a verse an old friend from high school had posted on her facebook today. The verse really spoke to me and I think it is something I will use a lot in the coming year: 

Trust in the LORD with all your heart and lean not on your own understanding; in all your ways acknowledge Him, and He will direct your paths. -Proverbs 3:5-6

 ~vaya con dios

"Life doesn't end on June 23rd, son"

Thanks Mom, you are completely right! The other day I was talking with her about all Jordan and I have been doing getting prepared for residency. I was telling her the things we were doing around the (new!) house, the shopping that needed to be done, and the hours of fun and entertainment we have been having, all as a part of "getting ready to start residency." When she so astutely told me that I was acting like I thought I was dying on June 23rd or something, I realized, she was right! I had been taking the approach that I needed to get it all done. I was trying to have fun while I still could. I was getting matters in order. Once I realized she was right, it seemed a lot easier to just change my attitude and enjoy. So here is a list of all the "things we need to do before the apocalypse" :

Stock up! We decided it was appropriate to stock up on groceries and household items since we are unsure of how often we can go. We recently became members of Costco, so a large shopping trip was easy.  Boy did we ever shop. After all, who can possibly make it in this world without 6 tubes of toothpaste? 

This picture was one I took at Costco to send to my mom showing her that Kudos do in fact still exist, in bulk!

Seeing my grandparents for graduation. Do I even need to say more? It was so wonderful to see them, I love them so much! This picture is actually from a long time ago, but it always makes me smile!

Flea Market?! I hadn't been to a flea market since I was a little kid when my mom and grandparents would take me. It was actually pretty fun. I think the highlight for me was watching some guys stack about 10 mattresses in the back of a tiny little truck and try to tie them down. Classic.

 
Time with friends and family. Earlier this year, we had decided to buy tickets to a show at Red Rocks with Kathleen and Chris as sort of a last hooray in case we matched in a different city. Since we ended up staying, it was more of just a super awesome show with super awesome friends. We saw John Butler Trio for my first ever concert at Red Rocks, and they were fantastic

R

Rockies. What's a summer in Denver without going to Rockies games? Jordan and I went last night to see Ubaldo pitch and it was a blast! The game was delayed about 2 hours for rain. They managed to start the game and then it poured! We had so much fun, even though Jord was freezing.

The rain ponchos are so dorky, but they worked great.

I suppose that is all for now, but I definitely wanted to share what we've been up.

~vaya con dios

"School's out for Summer, School's out FOREVER!"

It was so awesome to hear Alice Cooper singing it on the drive home tonight. Jordan and I blared "School's Out" and loved it! Since we have finished, I have done a bit of reminiscing and looking forward as well. It was actually pretty interesting to talk with Jordan about our specific fears of residency. The thing that shocked me was that by far the scariest thing for me is not what I would have expected. So here you go, the top 5 things I am afraid of regarding residency:

5. Mean attendings/residents- This is lower on my list since I am going to Joes. If it were any other hospital the unknown aspect would probably make this jump to number one. Since I know a good chunk of the residents and attendings I am much less worried about this, but there is still the possibility.

4. Gaps in knowledge- Medicine is such a cerebral specialty with lots of tests and data and things to think through. I often find myself wondering if I have what it takes to do this. I want to be good at it, and I hope interpersonal skills are what will define me as a doctor, but there is still a fundamental base of knowledge that is so important. I am coming to realize medical school is less about teaching you the material you need to know to be a doctor and more about teaching how to think like one. Granted, it created a pretty good foundation of medical knowledge, but residency is when the real learning begins.

3. Missing Jordan- This one is pretty self explanatory. We have been talking about how we think we made such a good choice by getting married in December rather than waiting until this spring. We feel like we have created such an awesome foundation and have cherished all the time we have been able to spend together. Now we are trying to see residency as an opportunity to develop our separate lives and careers in a healthy way.  We know that spending 80 hours a week apart at work is not the healthy way, but we think it will help us appreciate each other all that much more when we do get time together.

2. Killing/harming a patient - Again, pretty self explanatory. I think if you are any new resident and you aren't afraid of this, then you are dangerous. This career path is high stakes. All of the sudden we have responsibility that can drastically affect an entire family and their lives. This is scary stuff. Medical training hierarchy will help alleviate some of this, but with each passing month and year we will have more responsibility and the stakes will be higher. Really scary stuff.

The last one seems really silly after spelling this all out, but bear with me. Trust me, it is by far what I think about the most and makes me the most scared:
1. Being tired- In addition to just enjoying sleep and feeling like my whole world is better when I'm rested, I am just plain terrified about this. I have functioned on little sleep during medical school, but I still managed to get more rest than most (especially more than the interns). I am afraid of feeling tired all the time. I am afraid of making judgment errors because I am fatigued. I am afraid of feeling down or sick just because I haven't had a good night's sleep. I am afraid of being the resident that gets in a car accident because I fell asleep at the wheel (happens all too often). I have sleep issues as it is, so to have sleep deprivation added to that, yikes! I am hoping that it ends up not nearly as bad as I'm building it up to be, but my goodness I'm scared.

Anyway, this post ended up being pretty long, but I was excited to write it down after my conversation with Jord earlier.

~vaya con dios

39 days!

39 days and counting. WOW! In just 39 short days I will be standing in a hospital with my first job as a physician with real responsibility and a signature that ends in MD (actually my signature will end in MD in less than 2 weeks!) I am pretty sure I have never experienced the level of anxiety, nervousness, and anticipation I am currently experiencing. I think the reason it is all hitting me right now is because it is so real. I have filled out the hours of paperwork that come with a real job. I now know which service I will be starting with (I will be covering a medicine team that takes care of under served patients both on a general medicine floor and in the ICU, I think). And most of all, it is only 39 days away! With residency fast approaching, Jordan and I have been trying really hard to cherish our time and just enjoying life together.

Looking forward to residency isn't the only thing keeping my mind preoccupied these days. As this next chapter of life is getting ready to begin, I have found myself reflecting on the chapter that is now ending. Med school has brought so much change to my life, I hardly recognize it anymore. The personal growth I have experienced is more than I ever could have imagined at the beginning. One story I want to share that I think sums up a lot of struggle I have experienced so far (and I know I will continue to experience). The following is taken from my personal statement that I had to write for residency applications:

     
  "Identifying a patient as a unique individual is an easy concept in theory, but is exquisitely difficult in practice.  It is far too easy to think of a patient as a diagnosis rather than as an individual. Take for instance, Mr. N., a severely ill patient with AML. Instead of a father, a brother, and a veteran, he became “AML guy,” a title that overlooked his individuality. Every day while I tried to convey treatment plans to “AML guy,” he would tell stories of friends, families, relationships, losses, and personal struggles. I became invested in his story, and through our conversations, I realized that what was important for Mr. N was not necessarily a cure. What he valued was to see his granddaughter graduate from high school. After long discussions with this patient, his treatment plans changed, and his demeanor and outlook immediately improved. I am grateful for Mr. N. He reminded me that I must maintain my focus on compassion, patient autonomy and strong communication in order to become a good physician and maintain patient-centered care."

Whether it's looking back at my medical school, or looking forward to starting life as a physician, I feel pretty blessed and lucky to have such wonderful support. You all mean the world to me, thanks for reading!

~vaya con dios

It's been a while

Jordan inspired me tonight. In reading her blog, I realized I haven't gotten to mine in too long. I will just quickly update for now, but hopefully I will remember to jot down some more soon. I actually really want to get some of the feelings I am experiencing in anticipation of graduating and starting residency while I am experiencing them. But for tonight, I figure I won't steal Jordan's thunder.

I was thinking about posting a few Jamaica pics, but I think that would be beating a dead horse since I posted so many on facebook (but if you haven't had the chance to see, you can go here). 

So I guess that doesn't leave me with much for tonight. So I will just tell you about our house! We are under contract on an awesome town home at a really sweet, central location. The funny part is, one of our classmates is selling the place and we had no idea until we saw his picture in the house. If you would like to see a virtual tour, you can go to http://www.visualtour.com/applets/flashviewer2/viewer.asp?t=2147902&sk=13. 


That's all for now, but let me know how you are doing!

~vaya con dios
 

Happy Easter!

Jordan and I have been incredibly busy since match day. We decided to look at buying a house. We have found a lender who is working to see if it is even possible for us to do without pay stubs and only a contract saying we are going to be employed. To be continued on that one.

After match, we hung around town for a few days, spending time with friends and family, and then headed out to Round Rock TX to visit my dad and step-mom. It was really fun! We mostly hung out, just spending quality time together, enjoying the beautiful weather! We went to Lake Travis to have dinner and watch the sunset, saw a comedy show downtown, and even sat on a dock drinking micheladas! It was really refreshing and nice to spend time with them.

When we got back we started a class focusing on substance abuse. I will try to remember to blog more about that later, but I will say it is incredibly interesting. I think Jordan and I will be continually faced by many different patients with dependencies ranging across the spectrum. So far we have learned about physicians and their struggles with substance abuse, some about adult problems, adolescents with drug problems, even pregnant mothers with substance abuse problems. I must say that I believed this was a disease before this class, but I am now even more convinced of the chronic, relapsing nature. People with drug or alcohol problems should not be judged as criminals. Rather, we as physicians have an obligation to recognize their disease and help them through the challenges it brings to their lives.

Lastly, a few words about today. I mostly wanted to post a link to another blog that was referenced in church today. http://peterrollins.net/blog/?p=136 is a link to Peter Rollins blog post. I found it to be a fascinating description on his beliefs of the resurrection. I hope the words strike you as much as they did for me, but if not, that's ok. Hopefully anyone reading this knows I try very hard to not have a "holier than thou" attitude. I try to be nonjudgemental, and as loving and accepting as I can. Mostly, I just wanted to say how blessed I am to have such amazing friends and family. I hope everyone had the chance to spend time with loved ones today!

~vaya con Dios

Media coverage

The media coverage at match day was actually pretty cool. There were people from news stations, The Denver Post, even Colorado public radio! Here are some links to stories where Jordan and I snuck in some appearances:

http://www.ucdenver.edu/academics/colleges/medicalschool/administration/Pages/MatchDay2010.aspx

http://www.9news.com/news/education/article.aspx?storyid=134894&catid=129

http://www.cpr.org/ has a scrolling thing of stories today with my picture, and this link has the story where Carl and some of our other classmates talk about match and health care reform.

What an exciting time! Jordan and I are doing well. We have gotten over the shock of match day and are both really happy to start trying to figure out life in Denver. We have been getting paperwork from our programs asking for vacation schedules and contracts. We are looking at maybe even going to Nicaragua with Josie and Zack during one of our vacations next year! It is very tentative right now and we don't even know if we can make the dates work, but if they do, we will be heading off as doctors on a medical mission trip next year!

Anyway, we are on vacation for the rest of the week. We are going to visit my dad in Austin on Wednesday. Then when we get back on Monday we start a class on substance abuse. It should be really interesting. It is kinda scary because it is also our last real class as medical students. Yikes!

Anyway, just a quick update for now.

~vaya con dios

Rocky Mountain High

 

Jordan and I, along with 150 of our classmates and the thousands of medical students across the country, found out this morning where we will be going for our residencies. This entire process has been so amazing for us. We have seen new places, visited with residents at all walks of life, and learned so much about ourselves. And after it all, we have learned we are lucky enough to stay home! I will be joining Exempla St. Joseph's for their internal medicine residency program and Jordan will be going to the University of Colorado's OB/GYN program. WOW. This has been a really wild ride and it is so hard to believe we are at this point. Anyway, just wanted to give a quick update, more to come soon.

~vaya con dios

"Great" family

I experienced something tonight that has been pretty rare in my life, but has always been cherished. With my grandma leaving for California this week, my extended family decided to come visit her. My great-aunt said she was worried she would never see my grandma again, so she decided to come. Since she did, all my great-uncles decided they would come too. Jordan and I went to dinner with them all and we had a blast. I always treasure those get togethers because they happen so few and far between. It was a really bittersweet, impromptu reunion. My uncle Alfonso (my grandmother's brother) passed away a few months ago (his wife and my grandmother are extremely close) and so there was an empty seat at the table. My aunt is still having a hard time but she was happy to see everyone; especially my grandma. For me, it was also bittersweet for many reasons. The last time I had seen most of this family was 7 years ago, for my grandma's 80th birthday. Every time they come, she lights up so much that I think she really reverse ages by 10 or 20 years. It really makes me happy. Sadly though, I was struck by the gravity of my grandparents leaving. They mean a lot to me and it is really hard to see them move away. Wow, this is going to be harder than I thought.

The other reason I wanted to post something was a story about one of my uncles. He was telling us how 4 of the brothers were in the military during world war 2. One was in the Air Force, one in the Navy, and 2 in the Army (although my uncle Eddie, the one telling the story, was originally in the New Mexico National Guard when they made them enter the Army). My uncle Eddie was in the Army in the Philippines when he was captured. He was a POW in the infamous Bataan Death March. The experience was so horrendous that he rarely talks about it, often cannot remember many details, and to this day he won't eat fish or rice. He was interviewed for a paper in Kansas once and all I have been able to find about it is this snippit:

 "Eddie Graham, 90, of Wichita, was among those who survived the Bataan Death March in World War II. He plans to attend the discussion tonight. 
He was part of a starving and exhausted U.S. force at Bataan in the Philippines who surrendered to the Japanese. Thousands of these soldiers were marched on a 90-mile trail that included deprivation, brutality and torture.
Those who survived faced years of brutal captivity; one-third died before the war's end.
"As long as I kept walking and didn't get out of line, I was all right," he said. "I had malaria at the time. Of the 2,700 men in my unit, about half came back alive. They died of mistreatment, malnutrition and sickness."
He was beaten when he took a drink of cold water. He has no memory of it.
"I survived by faith," Graham said. "I made up my mind I was going to come back."

                                                                                                                          -Map of Bataan Death March


Anyway, this is getting way longer than I wanted, I just felt compelled to share my experience tonight and a little about my great-uncle Eddie.


~vaya con dios

2 weeks and counting...

Match day is fast approaching! Just 2 weeks from tomorrow we will receive the envelopes bearing the name of a hospital and a city, the place in which Jordan and I will spend the next four years of our life. I think it hit me today while in class when we were talking about obtaining consent.  One of the doctors said something about how we will be doing this in just a couple of months, stating offhandedly that we would know where that is in just 2 weeks. Whoa.

Anyway, I don't have much to say/report. Jordan and I have been trying to make the most of the extra free time, spending time with friends and family. We have spent most Tuesday nights with Josie, Zack, and the kids which has been really nice. I managed to get down to Pueblo while Jord spent time with her mom and sisters last weekend. We are just trying to live up the free time! In fact, we have joked that sometimes we are trying to "live life like we are dying."

Finally, I had one last thing to share. About 6 or 7 months ago, my grandma fell and broke her hip. I have thought of this as the "fall heard 'round the family."  That fall was directly responsible for a series of changes that has affected so many of us. It is really incredible what it can do. After a series of huge changes, my grandfather has left for California to live with my aunt and my grandmother will be leaving next week. This is a really bittersweet change for me. Anyway, I don't really have a lot to say about it right now, just more of an update.

~vaya con dios

I have nothing to say

I really don't. Our pharm class is boring, rank list turned in, and nothing really happening. I really don't even know why I am writing this! It probably has something to do with the fact that I am in said boring pharmacology class. So, you get randomness:

-Jordan and I have started watching Dexter. The show is so smart. I won't get into the premise, but if you don't mind gore and you don't mind a dark, twisted type of show (you are rooting for a serial killer), check it out.
-RSV sucks. HIV sucks more.
-Go Nuggets, Avs, and Rockies! (heck I'll even through in Broncos since the combine is coming!)
-Less than one month to match day (actually it's 22 days, but really, who's counting?)
-Going to see John Butler Trio in June at Red Rocks, can't believe I've never been.
-I can't wait to be a doctor!
-I highly recommend Netflix
-This is pretty lame actually, sorry.
-Frogs are funny

Disclaimer: This last one is no fun. Actually, you probably shouldn't even read it. It's stupid politics:
-I told myself I shouldn't get into politics on this thing, but there is one thing that is too important: health care. Regardless of where you stand on the issues, the fact remains that most agree reform is necessary. The point I want to make about it is this: I think everyone needs to learn more about this debate and contribute to the debate through real, informed opinions. I for one am tired of hearing the words lobbyists, pundits, filibuster, liberals, conservatives, blah, blah, blah. There are things I hope to see change: No more pre-existing conditions; fair, equal access to poor, working poor, and middle class; caps to increases on premiums; fair, equal access to poor, working poor, and middle class; no more bankrupt families from some medical condition, and did I mention fair, equal access to poor, working poor, and middle class? Ok, I'll get off my soapbox. I am willing to talk about this anytime, but this is not the place for that (sorry!)

~Vaya con Dios

It's amazing to me how true the proverbial "grass is always greener" cliche seems to be appropriate for so many circumstances. Now before I make my case, please understand this, I have never been happier. What I am referring to is how school has finally slowed dramatically. Class time is minimal, no overwhelming responsibility, rank list submitted, and time spent with family is wonderful. All this time has been truly amazing. So where does the grass and it's green-ness fit in? Well even with all the abundant time and lack of real responsibility I feel like it isn't enough! I mean here we are with the most free time we have had in years and I still want more! I am pretty sure the reason for this is from the possibility that leaving home brings.  I know if we leave it is because it is where we are called to go. Here's the catch though, I don't know if staying is the right answer either. So where do all these conflicted feelings come from? Now this is something I have just finally come to terms with...Fear. I am terrified of starting residency, so of course I am not comfortable with going or staying. This is real responsibility! Anyway, I know that my first two real blogs comment on the fear of starting residency and the changes that will accompany that, but it is just the overriding emotion related to medicine that I seem to be experiencing these days.

There are other topics I can foresee myself talking about in the blog, sports likely will be one of them I mention often. With the Olympics and NBA all-star weekend there is somewhat of a mainstream sports lag. The olympics have been super fun to watch but I am excited to see how the NBA and NHL pan out and I am REALLY excited for baseball season. Here is something that drives me nuts though. Being a Denver sports fan, rarely am I in what is considered a "big market."  So I understand that ESPN and SI don't spend as much time covering sports here as they do teams on the East coast and in LA. BUT they are over the top. An ESPN poll today asks, "Which team will win the 2009-2010 NBA finals, Caveliers, Lakers, or Other?" This just says to me "Which is a name we should drop more often, Kobe or Lebron"  I just hope the Nuggs continue to play well and maybe actually do something to shut this stuff up! Anyway, that is enough of that.

Hope you enjoyed today, let me know if this is working, or if there is something else you want to hear.

Vaya con Dios

Rank List?!

Wow, I can't believe we are at this point. It seems like just yesterday we were sitting in the baking sun, watching our dean with his funny bow-tie, talking about the traditions of our school, waiting to walk up to the front to be garnished by white coats and stethoscopes (I was so excited to receive both and now don't really love either!) We quickly went from bright eyed premeds to droopy eyed med students who reeked of anatomy. We spent countless nights stressing about the genetics of lysosomal storage diseases, clathrin coated cells, and other lame-o random physiologic and pathophysiologic nothings for the next 2 years. We got down with our clinical side learning to speak the language of medicine, feeling like we were starting from scratch, becoming "young doctors," realizing we didn't know the definition of tired. Now we have once again become bright eyed as our fourth year has yielded some much needed rest. Bright eyed med students, and now we are submitting rank lists?!? Well here we are, list submitted, waiting for the NRMP computer to give us our sentence for the crime we committed by choosing to go to med school, just as excited as ever, waiting to see where we end up for our next droopy-eyed journey. Unbelievable.

Calling it our "sentence" is only in jest, but it does have a certain amount of doom that seems to be accompanying this next step. We think we know tired every step of the way, but this time, oh man, this time we have know idea what is coming for us! The real responsibility makes me excited and terrified at the same time. Thank God I am going through this process with Jordan. I think I would be a mess without her... Well that's enough ramblings for now, thanks for reading this nonsense :)

Starting a Blog

Well, I've never really done a blog before, but I decided to give it a try. I was thinking about how dramatically life has changed from one year to the next for as long as I can remember and I decided it would be fun to share that journey. I also figured that since I am about to embark on one of my craziest journeys yet with residency, now is a good time. I have no idea how this will work or what this will mean, but it should be fun! I am sure this will take some getting used to but hopefully I will have done this a bit by the time I start intern year.

Oh and I forgot, the picture at the top of the page is from our wedding. It is one of our favorites of the wedding party, and it really seems to catch how much fun the entire day was with so many awesome people.