Time for a Break

As you might have gathered from the frequency of posts on this site, internship kept me pretty busy. You would think that as the year went on, I would become more efficient and there might be more free time, but that didn't seem to be the case. It also seems like the most complicated patients from a medical, social, and ethical standpoint also came at the end of the year. This week I wrapped up most of the loose ends from my internship. I don't know if I will have a lot more discharge summaries to do in my career, but I can't imagine any of them being as long as some of the ones I dictated in my internship. My parking sticker was returned along with my ID badge. I think the best part was turning in my pager. I can still remember the first few times that it went off this year and there seemed to be some kind of excitement. As the year wore on though, it turned more into dread. A cross cover page or code blue at 4am is never fun. Overall it was a good experience and one that has given me many memories.

With most of my internship wrapped up, I headed up to Canada for a few days before starting my ophthalmology residency. Given that it is the end of June, I figured I would get some good weather. Today, I think the high was about 60F and there was a light breeze and drizzle. Tomorrow is supposed to be a little better. I can't complain though as it as nearing 100F the last few days before I left Dallas. With the weather, I used today to try to make some headway into the pile of online training that is required before I start ophthalmology in couple weeks and managed to knock out the training for two of the four hospitals.

What Lays Over the Fence?

It wasn't too long ago that I purchased my house in Irving. I can still remember the night of closing, not more than an hour after I signed the papers, that I drove over to my place to just take a look around. I stepped out into the small backyard. There is a pretty tall fence there and I had never really had a good look at what was on the other side so this time I took a jump and looked over. Much to my surprise, there was a funny looking animal on the other side. I had to just chuckle. You never really know what you are getting into. That said, I have certainly enjoyed living at my place and have good neighbors. Over the past few months, when I tell my friends that there is a pony living in my neighbors backyard, they rarely believe me. So today I had an extra few minutes and decided to take a picture of what I see almost every time I look out my back windows.

Life as an Intern

I thought these were two neat shots of the West Texas sky.

I was glancing back over some of my old posts and I realized that I have never really talked that much about what life is like as an intern in internal medicine. I just realized I need to change the blurb on my blog to read, "Life as an INTERN. "Run with patience the race that is set before us, looking unto Jesus the author and finisher of our faith." Internship has really cut back on my free time and that has certainly meant less time to post on this blog. The blog isn't the only thing in my life that has been neglected though.

I started off internship on CCU. The call is Q4 which means every fourth night you are working a 30 hour shift and you only get the day off if it is a weekend and it isn't days 1 or 2 of your four day cycle. Needless to say, it was a busy month. You have to learn quickly when you are on call by yourself and at 3am in the morning, someone starts complaining of chest pain or their heart rate jumps to the 180s and they start complaining of shortness of breath. I can't remember as a medical student having to interpret EKGs, but it is a little different when you are the only one looking at it and the person with chest pain and possibly have a heart attack is in the next room. It was a fun month though and some of the attending physicians at my training program were excellent instructors.

The next month was spent on the "wards" which means inpatient internal medicine. We were on call Q5. There is a greater variety of patients. They tend to stay in the hospital longer and there are more social issues. It was also my first time to have medical students working with me. As an intern, it is really a struggle to take care of your patients, do all the paperwork, keep in touch with the attendings and consults, and then do a good job of teaching the medical students.

The next months was an elective in ophthalmology. This is the are of medicine that I am going into starting next year so it was fun to get some early exposure. It was a change of pace from inpatient medicine. The month made me realize just how much I have to learn before I start next fall.

The past two and half months have again been back on "wards." There are certainly times when I would like to go back to being a fourth year medical student. The other day at noon lunch/lecture, I was talking to an old medical student friend of mine who took a year off from medical school to study at Bible college in Canada. I did three years of medical school with her, but now is is one year behind. It was funny. I think it was a Friday and she we were discussing what we were up to next. I had the next two days, the weekend, off and was thrilled. She had the next two months off.

The hours for internship are tough. I know that it used to be harder back in the day, but it certainly is no walk in the park these days. Four days off a month is not much. Most days start for me at 5am. I try to get there at 6am or soon thereafter. We average one day off a week and every fifth day is a 30 hour shift. I have certainly come to have a great appreciation for my time off. A weekend off is something to be treasured. Friends that you used to see everyday at school, you might see every month or two if you are lucky. Trying to coordinate the schedules of people who are working 80 hours a week is tough.

Last spring when I was enjoying my fourth year, I managed to get bumped off two flights and picked up two vouchers. Both have to used within one year. I guess starting in July, it didn't really dawn on me that it might be April before I would get more than two days off in a row. Last night I drove the airport and I now I think I have something worked out where I can still get some use out of the vouchers.

Making it out the assembly is also another challenge. You are working about 50% of you Sundays. And going to the weeknight meeting is tough because you are often either on call or have to be at work early the next morning. I am very grateful that several people from the local assemblies live nearby and I can meet up with them outside the regular meetings.

The first two months of internship I was living with an older Indian couple here in the Dallas area. They were kind enough to take me in for a bit after my lease ran out on my apartment and before I found a more permanent place. I ended up buying a home not too far from where I will be doing my residency next year. Being a first time homebuyer was a learning experience. There is a lot of work that has to be done to keep up a place too. Three months later, I still have boxes spread out around my place. There is still quite a few things I can't find. I am sure they will show up eventually. Two days ago I went to put on a pair of boots and realized there was a dry erase eraser in there so who knows were everything is going to show up.

Well, I have a little free time tonight and going to try to catch a racquetball game before it gets too late. You have to eat, sleep, and exercise when you can in internship.

Israel (Day 10)

4/12/08 We left Tiberias on the Sea of Galilee and headed for the Jordan River baptism site at Yardenit. The water was very dirty looking and contained many unclean fish. The verses of Jesus’ baptism were posted in multiple languages at the site. After four people from the group were baptized, we drove to Beit-Shean/Scyhthopolis. The told us it would be an impressive archeological site, but I was more than impressed with what has been excavated so far. Its location is at the juncture of the Jordan and Jezreel valleys and it has been occupied for much of human history. Most of the buildings were well preserved but many pillars were damaged in an earthquake. From the site, we were able to see Gilead. We continued to drive south past Mt. Gilboa and Jericho. We were less than one mile from the Jordan River, the border between Israel and Jordan. We stopped at Qumran and saw the caves were the dead sea scrolls were discovered. They were spread out through many caves in the rugged hillside. We kept going down to the Dead Sea where we would spend the night. I believe this is the lowest place on earth, at several hundred feet below sea level. That evening, I went down to the Dead Sea and went for a float. I was surprised at how easy it was to float. I had been assuming I would need to use a little bit of effort. I used a rock to help with balance. The water was warm and I could see crystallized salt everywhere. There was a boat attached to some steel poles. The poles had about six inches of sold salt surrounding them. The salt water certainly made any wounds or sores uncomfortable. I was able to pick some rocks up off the bottom of the sea. They were covered with crystallized salt. I brought them back to the US, but many of the larger crystals were knocked off.

The baptism site at Yardenit on the Jordan River. They had these verses posted in thirty to forty different languages. This one kind of caught my eye.


I think they actually dam up the river so there is enough water for baptisms. The pastor on our bus was only willing to baptize believers who had not be baptized before. As you can tell, the water doesn't look so clean. I can understand why Naman wasn't so keen on dipping in here.



An early Roman bathroom at Beit-Shean/Scyhthopolis. You can see the drain where the water flowed. It was probably cleaner than most of the gas stations we stop at these days.


Standing on the Tel overlooking Beit-Shean/Scyhthopolis. According to 1 Samuel 31, this where the Philistines fastened the bodies of Saul and his three sons after defeating them at the battle on Mt. Gilboa. Some remains of the walls of a fortress of the time of King David and Solomon is seen here too. Gideon also went to a brook nearby here for people to drink. This place has many impressive structures including bathhouses, a larger public theater, and public latrines. I can only imagine what it looked like back then.


I have some more pictures of Qumran and the Dead Sea. They will be in my next post.

Additional Pictures from Day 9 in Israel

Looking along the security fence between Israel and Lebanon. There were several signs warning of uncleared mines. This is where Israel and Hezbollah fought a year or two ago. I am not sure if those are bunkers in the left side of the photo.

The two thousand year old boat at the Kibbutz.

Riding on the bow of the boat on Sea of Galilee.

You can see how the wind can be strong on the surface of the sea. Apparently the air rushes out across the water after coming down from the Golan Heights which you see in the background.

I tried to walk on the Sea of Galilee but started to sink immediately. Sorry for the blurry photo.

Israel (Day 9)

4/11/08 We left Tiberias and drove to Capernaum where we saw the ancient synagogue. There were two sets of remains, the originals from the time of Christ and then those that were built on top in about 400AD. In the same area we also saw the remains of what is thought to be Peters house. Over top the remains is a large Catholic church. After that we drove up a hill behind the city to the Mt of Beatitudes, which included a natural theater on the hillside. On the hill, we visited the Church of Beatitudes, a Roman Catholic Church built relatively recently. If I remember correctly, it was built with some financial support from Mussolini. From there, we drove north to Dan. We saw many streams from springs which feed the Jordan River flowing to the south. Driving from Dan to Caesarea Philippi we went along the Lebanon-Israel border, site of recent conflict with Hezbollah. Looking out from the bus we could easily see the Lebanese towns, Israeli patrol roads, and large fences. Beside the road were signs warning people not to go there because of land mines. We were certainly within range of gunfire or rockets as we were less than one mile from the border. We had lunch in Caesarea Philippi. There we saw the remains of multiple temples, city ruins, and a deep cave with a spring that also fed the Jordan River. We drove back south to Galilee and saw an ancient boat, estimated to be 200 years old, in Kibbutz Ginosar. From Ginosar we took a boat ride across the Sea of Galilee to Tiberias. During the trip there were several short messages and songs (Hebrew and English). I managed to get a seat on the bow with a great view. It was neat to think who would have been sailing around on this lake about 2000 years ago. From the boat we could see the Golan Heights on the Northeastern shore. That evening after dinner, I took a walk along the Sea of Galilee. I walked in the water, not on it.

The excavations and synagogue at Capernaum.

Mount of Beatitudes overlooking the Sea of Galilee where Jesus multiplied the loaves and fishes.

The springs of Caesarea Philippi. It was here at the site of much pagan worship that Peter confessed "Thou art the Christ, the Son of the living God."

Israel (Day 8)

4/10/08 We drove up the coast to Caesarea and saw the ancient remains. There was Herod’s palace, the hippodrome, theater, and quite a bit of other stuff. I think the hippodrome is where they held the horse or chariot races and later where Christians were put to fight animals. From there we drove up and saw the aqueduct that brought water from Mt. Carmel to the city. We went up to the top of Mt. Carmel where we had a commanding view of the Jezreel Valley. While looking out, we saw several F16’s fly overhead. We also were able to see Nazareth and Mt. Tabor. We drove down to Megiddo and saw the ruins of many civilizations. From here you could see Jenin, the site or much conflict only a few years ago. We saw the Valley of Megiddo, the site of many battles in the past and one to come. Leaving there we drove to Nazareth, a Jewish and Arab city. In Nazareth Village, a 1st century recreation, our guide, an Arab believer, explained to us many of the parables that Jesus would have shared. They had many recreations of what He referred to in the parables. There was a wild little donkey tied to a tree that made me think of that children’s song, “there once was a wild little donkey, who had to be tied to a tree.” We drove past Cana on the way to Tiberias where we would spend the night. It was interesting to drive 200 meters below sea level. That evening, I was able to walk along the Sea of Galilee. I also had the chance to visit with a fellow tourist about Christianity, faith, logic, the reliability of the Bible. It was also that night that we figured out our guide was a Jewish believer, when she prayed in Jesus name.

Caesarea along the Mediterranean Sea, where the Gentiles first heard the gospel from Peter. This is the hippodrome beside the amphitheatre and aqueduct.

Looking out across the Jezreel Valley from Mt. Carmel, where Elijah hid from King Ahab. Notice the runways where the F-16s flew out and then over our heads.

Looking from Megiddo, across the valley to Nazareth on the left and Mount Tabor on the right.

An ancient olive press at Nazareth Village.

A little ship on the Sea of Galilee.