Change of Pace

Its amazing. For the the past three days I have actually woken up without my three alarm clocks. Granted, it was not the usual 4am, but it was a welcome change. Today we wandered out to the pond. Kevin and Tyler did a couple fly-bys. It was also my first chance to see the huge wind farm that has been put up north east of town. I was keeping my eye open for rattle snakes, but didn't see any this time. The picture is actually from earlier in the year. Instead of worrying about getting shot like I would in Dallas, I had to watch out for rattle snakes. Kevin and I made it out the tennis courts for a set and then I played Jonathan a little one-on-one hoops. I can tell I have been in medical school for too long. Hopefully, tomorrow we'll get the chance to head out to the lake.

This evening Anthony and the kids were over for dinner at our place and somehow the conversation got around to hockey fights. I am not sure how. Anyway, Tyler made me aware of an interesting clip. If you are remotely interested in hockey, I would recommend checking it out.

Canada vs Russia in hockey

Spring Break

This post could actually be called free time, as I really don't have any pressing school obligations. The weekend was spent trying to catch up on all the activities that I haven't been able to to do for quite some time. I started a little early and got a bagpipe lesson in on Thursday night. After a weekend full of tennis, football, and frisbee, I am certainly feeling the deconditioning that has occuring over the past year. On Saturday, I also went to the third meeting of "Foundations of Faith" in Carrollton. It was good.

A couple of weeks ago, I decided to spend a few days of spring break shadowing different physicians around Dallas. Yesterday, I worked with an oral maxillofacial surgeon. It was certainly a change from the crazy pace of Parkland and Childrens. We had mostly healthy patients getting dental implants, tooth extraction, and wisdom teeth pulled. Today, I met up with an ophthalmologist in the Dallas area. I watched a few cataract surgeries, a trabeculotomy, a shunt/reservoir placement for glaucoma. I also some some lasik eye surgery. There were a couple of other procedures involving cutting lasers and burning lasers, but I can't remember the names. The surgeries really are something else. I think the patients are awake for sugeries. The shunt and reservoir surgery looked the most complicated. I could barely see the sutures with my naked eye. Watching the surgeon tie knots was impressive. Cataract surgery was interesting too. They make a few cuts around the cornea, go in, cut a hole in the one cell thick capsule layer surrounding the lens, mash up the lens, extract it, and then stick in a new lens. Never once did I see a tremor in the doctor's hands. I was planning on observing and ear, nose and throat doctor tomorrow, but it couldn't be worked out with the hospital where he was going to be working.

"Free Time"

Another week has passed. I think I am finally getting a little better at pediatrics. Maybe it has something to do with the fact that I have had half as many patients. It is much easier to keep up with 2 general peds patients a day than 3-4 cardiac patients. Instead of getting to the hospital between 5-5:30am, I can get there at 6am and still finish seeing my patients without too much difficulty. Our attending was so nice as to give us one day off this weekend too. We were originally scheduled to work 12 days in a row, but we agreed to double up and see the other med student's patients on one weekend day. I worked today so I should have the day off tomorrow. That means I will be able to go to breaking of bread in the morning and then have the afternoon "free." True free time in medical school is really a rarity. In addition to the hospital work, we are supposed to keep up with all our own studying, develop presentations, and do patient writeups. In other words, you are free from hospital work to study some more.

I did take a few minutes off this afternoon though to work on my bagpiping. I figured the afternoon was the time of day when my neighbors would be least disturbed by my practicing. With my earplugs in to protect my hearing, the volume is still loud. Hopefully when I go to outpatient pediatrics, I will be able to learn a few more new songs for my neighbors. A few weeks ago, someone was complaining that my blog did not have any Dallas pictures on it, so today I finally erased some pictures from off the camera and will try to put up some photos from around here.

Rocket Fuel

Its nice to finally have a day off after working two weeks in a row. Friday was the last day of my rotation in pediatric cardiology. It started out early, as have most days for the past two weeks. I was up at 4am and at the hospital by 5:10am. By 6:45am, I had seen all my patients, written my notes, and by 7am I was ready to observe a 5-6 hour surgery. One of my patients had a congenital atrioventricular septal defect which was going to require surgical repair. I have never seen so much work go into preparing an operating room, and I can only imagine the cost of the equipment and the surgery. I watched them set up the equipment for almost an hour before word came that the surgery had been cancelled. Over the past two weeks I have seen a good chunk of pediatric cardiology. In first and second year we studied all sorts of cardiac defects and now I finally had a chance to see them. I know I saw tetralogy of fallot, transposition of the great arteries, atrial and ventricular septal defects, coarctation of the aorta, and patent ductus arteriosis just to name a few. Some of these kids have to be fed "rocket fuel." With the various heart defects, their circulatory systems are incredible inefficient and they require a huge amount of calories. Some of them were on 140-160kcal/kg/day diets via feeding tubes. If I remember correctly, 1kcal=1Calorie used on regular food labels. If there is a dietician out there they can recheck my work, but I think that would come out to about 68 Calories/lbs/day. In other words, for every pound you weigh, you must consume 68 Calories a day. Plug in your weight and you can figure out how many calories total you would need a day. Granted, I think infants need more calories for their weight, but these kids are requiring huge amounts of calories. Even on these diets, we aren't always able to get them to grow as needed. On top of all this, some of these kids have congestive heart failure and require fluid restricted diets so their lungs don't get too congested. It is a real challenge to pack enough fuel into such a limited volume feed. Afternoons were always fun. We would usually meet up some time after lunch to do "murmur rounds." We would get a chance to go around and see patients with different kinds of heart murmurs. We would all get a chance to listen, describe what we heard, and the go through the process with our attending physician of figuring out what the possible causes might be. It was amazing to see how a well trained ear could get a pretty good idea of what wall, valve, or vessel had the problem. If I learned anything else, it was that kids are incredibly resilient. These kids would go in for open heart surgery. The surgeons would crack open the sternum, go in and do some major repair and these kids would be going home a few days later. Their pain tolerence was also pretty amazing. Who knows if I would ever end up in pediatric cardiology, but it certainly was an interesting two weeks.