Getting a week's worth of errands ran in 3 days

In case you couldn't tell from the title, it's been a fairly hectic couple of days, but nothing all that blog-worthy. After dropping Mom off at the airport on Wednesday, it's been pretty much nothing but trying to get everything that needs to be done in person in Ohio (which is quite a lot) done before I leave for DC.

On Thursday, I had my meeting with Dr. Para, one of the Infectious Diseases specialists I worked with on that rotation, about the letter of recommendation he's writing for me. The meeting went fairly well, and he suggested I ask Dr. Schlesinger, the chair of the Infectious Disease division, for another letter, since I did research with him the summer between my first and second year. Unfortunately, Dr. Schlesinger wasn't in the office for these few days, so I handled all that via email (I think that's how Dr. Schlesinger prefers to work, anyway). So now that's taken care of, and I have four letter writers (which is the minimum), so I'm good in that regard.

So then I spent some time cleaning the apartment before my optometry appointment that afternoon (yay for new contacts), and then a mandatory med 4 meeting, which was mostly about reducing infection by washing our hands, and increasing patient satisfaction and stuff like that. The patient satisfaction stuff was based on survey results, which are the least reliable source of data, so I spent most of that meeting trying to distract myself from jumping up and telling them that those numbers mean nothing. But they did give us all-important business cards to give to our patients (which I will not do, in case you're wondering). Here's what it looks like:

After that meeting was the first Military Medicine Interest Group meeting, which got a lot more people than we were expecting (but we had enough food for everyone, so it was all good). I think we answered a lot of people's questions, and that's always the goal. It's strange to be a fourth year now and be the authority on all these things, instead of being the one asking the questions, like I was a couple of years ago.

Yesterday was more of the same. I went to Target to print pictures of MMIG members in uniform doing all sorts of military medicine-type stuff for our display case (it has to be updated every year at the beginning of the year; we just put up new pictures each time), then I had my travel appointment at the Health Center for my Papua New Guinea trip. I only had to educate the nurse practitioner on one thing, mostly because I didn't give her a chance to get it wrong on anything else--I told her what medications I would like and which vaccinations I need. The one thing she didn't get was terminal prophylaxis for maleria, which is when you take a treatment dose of a medicine that kills the liver form of the disease after returning from a long trip (defined by LTC as >4 weeks), to prevent relapse. She had never heard of it, and had to talk to the doctor, who agreed with me. Unfortunately, they don't carry that drug in the pharmacy, and I only get insurance in that pharmacy, so that's going to be expensive.

After that was more running around getting stuff taken care of, such as turning in receipts for reimbursements and taking some old study books to the "book closet" to be used in a book sale (it's a bit like selling books to a used book store). Then Jeff, Adrienne's fiancee, came into town and took us out to dinner, and fun was had by all.

Back in Ohio

This was our fourth day of driving (which was yesterday). It was a shorter day than some of the others, getting us into my apartment at about 5:30 Eastern time.

Being back in Columbus is quite the experience so far. It doesn't really feel like I've been gone for two months, and it's an interesting re-adjustment for Adrienne as well, who's had the apartment to herself for those two months. At any rate, she left early for work this morning (most of my classmates are on a rotation right now; I only have a vacation because I started last month early), and Mom and I wasted some time around Columbus before I took her to the airport at about three. Just our luck, though, it was raining today, which somewhat impeded our plans (going to the park and going for a walk; there's not much to do around Columbus), but it did let up enough for us to do that later in the morning.

Anyway, Mom is somewhere between here and Portland now, and I'm getting all sorts of stuff ready for the next few days and for my rotation at Walter Reed next month (I'm flying on Monday, assuming the government's travel agency gets me my travel documents). Tomorrow I have a meeting about a letter of recommendation in the morning and a Med 4 lecture about reducing infection through hand-washing (as if we didn't know that already) in the evening, followed by the first Military Medicine Interest Group meeting of the year, which I'm in charge of getting food for (guess it'll be pizza yet again). In other words, there's a lot going on in the next few days. I'm almost looking forward to my next rotation starting because it'll give me some more time to relax.

Heading back to Ohio: Days 2 and 3

Last night there was no free internet at the hotel, and tonight I'm tired from A LOT of driving, so this is a short post.

Day 2: Salt Lake City to Colorado Springs. This was originally supposed to be Salt Lake City to Denver, but the Democratic National Convention was in Denver, so that ruined that plan. Instead, we made it an even longer day of driving and headed down to Colorado Springs. We did some hiking in the Rockies on the way, which was nice.

Day 3: Colorado Springs to Fulton, MO. LONG DAY! It was probably 12 hours of driving, plus a time zone change, which makes for a long, boring, and very tiring day. Between the ever-exciting landscape of Kansas (that was a bit of sarcasm) and just being really tired of being in the car, it was not that thrilling of a day. However, we didn't have any scares with the gas, so it's all good.

Tomorrow: back to Columbus!

Heading back to Ohio: Day 1

This morning at around 7:30, Mom and I headed out for Day 1 of our return trip to Ohio. In the course of about 12 hours, we drove from Camas, WA to Sandy, UT (just outside Salt Lake City). It was a lot of driving, complete with worry about running out of gas. Near the border between Idaho and Utah, we passed a sign saying "Next gas 26 miles". Well, we figured we would have no problems going 26 miles with what we had, so we continued. Twenty-six miles later, about five miles or so after the gas light came on, we pulled into the station, grimacing about the price ($4.35) and the fact that we had to pre-pay inside. So, figuring we would get about seven gallons of gas, which would get us to our hotel, we tried to get into the convenience store, to discover that they were closed. To make it even more fun, right before the exit to this gas station, we passed a sign saying "Next gas 38 miles". Without any other options, we hopped back into the car, turned off the AC, and drove at about 60 mph (speed limit is 75) across the Utah border and to the next gas station, where fortunately gas was much cheaper. It was incredibly close; the gas tank holds 14.5 gallons, and we put 14.2 in. All sorts of fun.

Goodbye, Madigan

After crashing at Rachel and Jason's last night, I got up this morning and headed over to Madigan for the last time, for my out-processing, which is really just wandering around the hospital and getting signatures for doing things like turning in my white coat and badge.

This is a picture of Madigan I pulled off of Wikipedia. It's actually a fairly old pictures; the short buildings between the hospital and Mt. Rainer is the Annex (otherwise known as Old Madigan), which is where I was working. I know it's an old pictures because there are about half as many buildings there now. My building is near the middle of this group, which is now the edge of the group of buildings (there's a large field there now).

After a month at Madigan, I will have to admit that I am going to miss the place, especially things like always being able to find a parking place, hanging out with the interns, listening to LTC Wiesen talk about making President's Hundred on the rifle (he's one of the top 100 riflists in the country), trying not to laugh at the guys getting lost on their way to STD clinic, running on base in the morning when it's still cool, and enjoying the view of Mt. Rainer. However, there are also things I'm not going to miss, like that windowless box of an office I shared with the interns (windowless and without air conditioning), the strange animosity amongst the residents, documenting everything in AHLTA, and the like. Overall, it was a good month, and if it weren't for the fact that the residency program is focused on the things I find most boring about preventive medicine (public health department-type stuff), I would really enjoy doing my residency here. We'll see how things go at Walter Reed Army Institute of Research next month.

Anyway, after out-processing, I drove back down to Camas and proceeded to spend the entire afternoon stuffing my junk into suitcases so Mom and I can begin our cross-country trip back to Ohio tomorrow. And when I say stuffing my junk into suitcases, I'm not joking. I have three suitcases, three book bags, four boxes of wine bottles for Adrienne, and still more stuff that will just go into whatever crevice we can find in the car. That's a lot of junk.

See? A lot of junk. Hopefully it will all fit into the car tomorrow.

Interrupting my day with work

My days at Madigan are quickly dwindling down, as is my workload. Pretty much, I've finished everything that's on my list of things to do, with the exception of giving my scoliosis presentation (I've already finished the powerpoint slides), so I spend most of my time twiddling my thumbs and waiting for something to happen. Well, I occasionally do things out of extreme boredom to break up the boredom, like on-line training modules that aren't due for about a year or taking extra time for lunch to walk to Madigan (prev med is in the annex, not the actual hospital), buy lunch, walk over to the park, and eat and read my novel.

I did have to interrupt that nothingness with TB clinic this afternoon, which was fine by me. It's my favorite clinic of the three I do (TB, STDs, and travel), but travel is a close second, and I got to do that yesterday. I like TB clinic because there's some detective work (you have to decide if it truly was a positive TB skin test, and then what their exposure might have been), and a chance for patient education, and I feel like the patients leave with a better grasp of what is going on than they had coming in, and often feeling better about the situation. I can imagine it would be pretty scary to come back from deployment to be told that you have TB, and they don't really understand what a positive skin test means, and so we get to explain that to them and let them know it doesn't mean that they're dying or infecting their loved ones.

Tomorrow is my last full day of preventive medicine at Madigan, and then I'm out-processing on Friday. It's been a good month overall.

A weekend in Moses Lake

After arriving back in the great state of WA from New Mexico, I climbed (literally) into Kit's big red rental pick-up, crashed at his place for the night, and headed over the mountains for the heat and sagebrush of Moses Lake on Saturday. Not much happened on Saturday; Mom and I visited Stephanie, Madison, and Boe, and then we headed out to the Hochstatter's for a pinochle party (something that one doesn't really see in Ohio).

Sunday was Thea's baptism, followed by a family/church/whoever felt like showing up barbecue at Lou and Debbie's. Danelle and Nicholas were a bit wary of me at first (as Ben said, Nicholas must be able to sense the doctor), but they eventually realized I wasn't going to be poking or prodding, and that I wasn't too scary, and Danelle even went so far as to demonstrate several animal sounds and motions by the middle of the afternoon.

Then it was back over the mountains, at which point I remembered that I had stuff (namely, my suitcase with my uniforms and boots) still in Kit's apartment, with no Kit. Since they were jet skiing in one of several large pockets of no cell phone reception, I wasn't able to get a hold of him to figure out a way in. Fortunately, after we called just about everyone we knew in Moses Lake, Jon showed up, so we were able to get in and get my stuff, and then it was back down to Tacoma for me, to start my last week at Madigan.

On my way back home

I'm sitting at the Phoenix airport now, enjoying my three and a half hour layover on the way back from Albuquerque at the Military and Veteran's Hospitality Suite, which is like the USO rooms, only not sponsored by USO. It's all the same--free internet, free snacks, and Marines playing cards and video games. Not much else to do.

Anyway, the conference ended on a strange note. Throughout the week, I noticed a definite lack of cohesiveness among the Madigan PM residents, which is unusual. Most residency classes are rather close-knit, but not this group. We had one van for the group of us, and at any given time, about half of us knew where it was and when it was leaving either the hotel or conference center. One of the majors was left behind in the morning almost every day, because nobody made any effort to make sure that they communicated the day's plans to anyone. This morning, for example, the two interns and I assumed that we were leaving at 7:30, because the first session started at 8. Well, we were sitting around at the continental breakfast, and finally saw one of the residents at about 7:50, who then informed us that the van was leaving at 9. In other words, we could have gotten an extra hour and a half of sleep. Not only that, but we missed the one good session today, which was at 8:30. And then, by the time we arrived at the conference at 9:40 (the hotel is about ten minutes away... we were just that delayed in leaving), we were too late to walk into a 9:30 session, and 10:00 was a break session. In other words, we had nothing to do until 10:30. So, to recap--the interns and I did NOTHING but sit around not knowing what was going on for three hours. By this time, CPT Wilson and I were so annoyed that we decided to go for a walk around downtown Albuquerque (which is not all that exciting, in case you're wondering) instead of going to any of the sessions, which we weren't interested in anyway.

Tonight, Kit's picking me up from the airport, and then Kit, Alex, and I are headed over to Moses Lake tomorrow to see family and for Thea's baptism on Sunday.

USMLE Step 2 CK score

Yay! I passed Step 2 CK! I got an email this morning as I was getting ready to head out for the conference saying that my score was in. However, when I tried to click on the link, the settings on Internet Explorer were off or something, and it wouldn't open, and I didn't have time to fix it before I had to leave. So, I figured that I passed, because if I failed, it would say something along the lines of "click here to reschedule", and it didn't. I finally got to check when we returned to the hotel in the evening, and I did indeed pass, and beat the national average by 2 points (which was a closer margin than my Step 1 score).

Other than that, the most exciting event of my day was my "interviews" for residency positions with the two Preventive Medicine residency directors (Madigan and Walter Reed). I use that word lightly, because it was really just a conversation about why I'm interested in PM and how the two programs are different. That, and this was nothing scheduled--I showed up where I knew they were sitting between sessions in the conference (granted, LTC Wiesen told me where they were going to be and told me they would be there between 9 and 12, but that was it).

There were a few good sessions, a few boring ones, and when the day was over, we headed back to the hotel, ordered dinner, and watched the Olympics. All in all, a good day.

Aaron's ordination and visiting the cemetery

I guess I'm a little slow with the posting. On Sunday, Mom, Dad, and myself went down to Hillsboro to attend Aaron Putnam's ordination. It was a nice ceremony, and it was good to see family I hadn't seen in awhile (or ever, for some of them).

After that, we swung by the Lewis Pioneer Cemetery, because I still hadn't seen Grandma's headstone. We discovered that the cemetery had a new sign.

I thought it was pretty cool.

Grandma's headstone. I think it turned out rather nice.

We also saw Ted's headstone while we were there. If you notice, both of these have pennies on them. Those were the two newest graves (at least in the Hesse plot), so we thought it had something to do with marking them for something, but we weren't sure. Dad emailed Troy and asked, and he said that the pennies are signs from above, placed by our loved ones in places we wouldn't expect to get our attention. Well, it worked, because we noticed them.

I'm in Albuquerque right now, at the Army's Force Health Protection conference. Not much exciting so far, just listened to a few talks on malaria in Afghanistan and diarrheal diseases while deployed.

Shooting and such

After work yesterday, I headed up to Burien to hang out with Kit and meet up with Daniel Christian, who was in my class in high school (and I haven't seen him since). He's now a King County Sheriff's Deputy as well, so I got a good laugh at some of the stories he and Kit were telling over dinner last night.

We had no idea what to do this morning, however, and when I saw that I had no interest in watching whatever was on the Olympics this morning (I don't even remember what it was, that's how disinterested I was), we had to come up with a plan B, which was go to a shooting range Kit knew about but had never visited (as he has access to a free range and all). They had an Uzi to rent, so we decided that would be cool.
The Uzi

Kit firing the Uzi (note the Glock he has holstered...)

The target (whom we named "Bad Guy") after Kit destroyed him with the Uzi (note... I actually scored higher than Kit while firing the Uzi, but his shots were clustered tighter than mine. As my biostats book would point out, I'm more accurate, but he's more precise).

And I fired the Uzi as well. It wasn't easy, especially since I'm left-eye dominant (as you can see, I'm firing left-handed). The really bad thing about firing an assault rifle left-handed is that the brass is ejected on the right, so right in front of my face.

And of course, we both did our part to get rid of some of Kit's ammo on the Glock. Fun times.

"Actually, that's 'thanks for the cake, sir.'"

Okay, so nobody's ever said that, but that's how I feel sometimes when I forget that in the Army, you're supposed to attach "sir" and "ma'am" to the end of everything when you're talking to a superior officer. It's not as if I was familiar enough with my attendings at OSU to call them by their first name, but I didn't end a conversation by saying, "I'll keep that in mind, sir," either. Often I realize about two minutes after LTC Littell or LTC Wiesen walks away that I should have done that, at which point it's obviously too late. CPT Peik seems good about remembering that (which is probably why I keep realizing that I forget it; I keep hearing him say it), but CPT Wilson doesn't seem to say his sirs and ma'ams all that regularly, either, so maybe I'm not as insubordinate as I sometimes think I am.

Anyway, proper address of senior physicians aside, today was a fairly normal day around PM at Madigan. The morning was spent going through AR 600-110, which is the Army Regulation on HIV testing and surveillance. Quite a lot of legalese and government-speak in there without ever really saying anything, which by the end of the morning made me feel like my head was going to explode. Then we had an award-giving ceremony for COL Barraza, the PM department chief, who is going to be leaving Madigan for Germany in a couple of weeks. There was cake, which was where the title of this post came from.

The afternoon was one long education session for me. The residents take turns going over chapters of the epidemiology textbook with me, and today they caught me for two chapters (they had been slacking, and realized that the week was almost over, so they had to get caught up on their educating responsibilities). I also did some work on my scoliosis project, which is currently looking longer than anticipated. Well, it's always easier to remove slides than put them in, so I'm not too worried about that.

After work was another not-so-fun aspect to being on a very, very large Army post. Today the power went out on Ft. Lewis everywhere except the Madigan Annex (I don't know why; we don't have a generator). This meant that all the streetlights were out, which made driving around a post with a couple thousand other people quite the experience. I was headed up to Uniform and Supply to buy more tee-shirts for under my ACU's, which requiring driving across post, only to be told that they were closed due to the power outages. So what would have normally been a twenty minute diversion on the way home turned into an extra hour and a half--and I had nothing to show for it. Such is life, I guess.

Bad car! Bad med student!

Hmm... I don't know which story to start with. I guess I'll go chronologically.

I managed to wake up on time this morning, so I went running for about an hour, then showered and changed at the gym before going to work. The morning was pretty low-key, with a giant conference of all sorts of preventive med people (PM, public health nursing, occupational medicine, industrial hygiene, health physics, and others I'm probably forgetting). After that there wasn't much going on, so I finished the online smallpox vaccine course and did some work on my scoliosis project before latent TB clinic in the afternoon.

And here's where the "bad med student" part comes in. So I'm interviewing the patient, who had a skin test of 13 mm after returning from Iraq. Unlike most that we get, he's never had a completely negative skin test, so he wasn't quite sure why he was referred to the TB clinic this time. Well, after finishing the history, I present the case to the attending to determine whether or not he's in a risk category that would make 13 a positive test (low risk is only positive if it's over 15 mm; medium risk is 10-15). Then we went back in together to get more history to figure out his risk factors. Yeah. Apparently, in addition to being deployed in a country with TB (which we sometimes consider a risk factor), he used to work in a chiropractor's office (patient care is a risk factor), lived in large cities in Texas (where there was possible contact to Mexican immigrants with TB), and spent a weekend in jail (another risk factor). So if I had bothered to take a complete history, I would have realized without a doubt that he was medium risk and 13 was a positive result and he should get treated. Oh, well. I'll do better next time.

Now for the "bad car" part. After our day was over, I got in my car, and the key did not turn. At all. I tried jiggling the steering wheel, pressing the brake, arming and disarming the alarm... nothing. So I called Volkswagen roadside assistant, and they called for a tow truck (it was very interesting to try to describe where I was parked, but that's another story). Fortunately, Bubba the tow truck driver showed up fairly quickly. Yes, his name was Bubba. I couldn't make that up if I tried. Well, he couldn't get it to turn, either, so onto the tow truck the car goes. Then we got it to the Volkswagen dealership here in Tacoma, at which point it starts up on the first try. So now my brand-new car seems to like making me look like an idiot. Hopefully it's done playing games now.

Can we make this any more awkward?

Actually, to be fair, STD clinic wasn't nearly as awkward as I feared it would be. Most of the guys (and the vast majority are guys) have been through this before and know what to expect. Most also realize that them being there is their own fault.

I saw three patients today, and they were all pretty straightforward--one got a phone call last night saying someone he slept with tested positive for chlamydia and he should go in for treatment, so we ran some labs and gave him some medicine. The other two were a few days early for what we jokingly call "green light Friday". They don't have any symptoms, don't have any contacts with anyone with an STD that they know of, they just want to be screened to make sure everything is okay. So we draw blood and take a urine sample and give them a phone number to call if they don't hear from us first.

After that, the day was significantly less exciting. I went through the CDC's online TB course (which mostly consists of reading mind-numbingly boring powerpoint-type slides and answering questions) and then went over the first chapter in the epidemiology textbook with one of the residents. Then I went to the DA's online smallpox vaccine course (more powerpoint slides, more questions). Those were even more mind-numbingly boring than the CDC's TB stuff, and not even laughing at whatever the interns were talking about was helping me stay awake. It didn't help that our office was probably over eighty degrees even with the fans on.

Since I overslept this morning (my cell phone for some reason froze at 4:45 am, so there was no alarm), I didn't get to run before work, so I tried running after work, when it was almost ninety degrees outside. Needless to say, I didn't run far. Hopefully there will be no repeat performance from my cell phone, and I'll be able to run when it's still cool out tomorrow.

Travel clinic

After an uneventful weekend of shopping and hanging out in Camas, I was back up to Madigan this morning to do more prevention of diseases. The original plan was for me to be in STD clinic this morning, but that didn't happen--they were already lined up out the clinic door when I arrived at 7:20 (clinic starts at 7:30 and it's all walk-ins), plus there was a new resident running clinic (they switch every month, so this is the August resident), and it was just too hectic to try to see patients and train a med student at the same time. By the time the morning was over, they had seen 18 patients. The record for that clinic is 22. I did hear some stories though, which left me and Captain Wilson (the intern who wasn't in clinic this morning) shaking our heads in wonder.

So instead of working STD clinic, I spent the morning doing more of my research for the scoliosis project. I found a timeline of scoliosis screening in Washington, which I thought was interesting. It didn't take them much to make school screening a requirement after the first recommendations from the Scoliosis Research Society and the American College of Orthopedic Surgeons in the 70's, but then after the US Preventive Services Task Force made the recommendations against in 2004, they've been trying to repeal the law requiring it, which has taken quite some time. Apparently it's much easier to make a law than get rid of it.

There were three patients in the afternoon for travel clinic, all three of which are what are referred to in the travel medicine world as "VFRs"--Visiting Friends and Relatives. In other words, they were born in foreign countries (in this case, Asian countries), became Americans (one couple immigrated, the other woman married as serviceman), and are now traveling back to their home countries to visit. In other words, they are experienced travelers who know more about what is needed than I do. They were good patients to start with, though, because they were fairly straightforward. It just took me awhile to figure out how to document everything in AHLTA.

After work, I swung by Rachel and Jason's for some free food (thanks, Rachel :)) and just to hang out. Kit was there, too, so the four of us talked about all sorts of random things from gossip about who is dating whom and applying for police jobs and nuances of the Army and things to do in Hawaii. We did have a quote of the night (which is probably on Rachel's blog, too): someone knocked on the door, and Jason got up to see who it was. After looking in the peep hole, he said, "Oh, it's Mormons," and then opened the door, at which point, one of the missionaries said, "Yep, it's the Mormons, just like you announced. Would you like to hear about Jesus Christ?" We got a good laugh at that one (of course, after we politely told them we were in the middle of dinner and closed the door). Good times, good times.