Day 2: Friday--First day of ATLS

Today started with reveille at 0500 and all of us in my hutmet reluctantly crawling out of our sleeping bags. Fortunately, it had cooled off significantly overnight, so it was a really nice morning—as nice as 0500 can be, of course. After a quick breakfast at the DFAC, it was back into formation to march over to the theater, singing cadences on our way to our lecture.

We had a couple hours of lectures about general military medical things—traumatic brain injury, followed by a preventive medicine lecture I could have given in my sleep—and then the nurses headed off to Trauma Nursing Care Course (I think that's what it stands for), the dentists to Pre-Hospital Trauma Life Support, and the doctors to Advanced Trauma Life Support, over at Ft. Sam Houston, which involved a bus ride by old school buses that have been painted white (and are therefore no longer school buses, I guess).

Waiting for formation

It was kinda nice being in air conditioning for the entire day, but six hours of straight lecture (they let us eat our MRE lunches at 1400), followed by three hours of practicing procedures (inserting central lines, intubating dummies, etc). And then it was back onto the buses to make our way back to Camp Bullis and the hutmets (eating the M&M's from my MRE on the way, of course).

After another squad leader meeting (we have them every night, to get the schedule for the next day), I decided the weather was mild enough for a run. We have to run in buddies (which I would want to anyway, as it was already dark by then), while carrying flashlight cones—the roads out here at camp don't have streetlights. I asked a few people, who were somewhat intimidated by my nine minute mile pace for a four mile run, and finally found a Navy family medicine intern willing to run with me (and in boots!). He's stationed at Bremerton, so we chatted about Washington and various intern complaints while we ran. And in the dark, with him wearing boots and me carrying a flashlight and both of us talking, we still managed to run faster than a nine minute mile pace.


Well, it's definitely time to go to bed (almost 2200), considering the 0445 reveille tomorrow, so we can get back to Ft. Sam to sit around and learn some more ATLS.

C4--Day 1:Thursday--Welcome to C4

Today started ridiculously early—my alarm went off at 0245 so I could shower and throw some last minute stuff in my bags before SuperShuttle arrived at 0330 so I could get to Reagan National Airport for my 0600 flight. Packing was actually pretty easy—it doesn't require much thought when you're not allowed to wear anything that isn't a uniform, so I just threw everything I had that said 'Army' into a bag. Anyway, it's a good thing they got me to the airport that early, because when I arrived at the airport and tried to print my boarding pass, I discovered that the Army didn't actually pay for my ticket. So, after almost an hour on the phone with the emergency line at Carlton-Wagonlit Travel, everything was taken care of and I got on my plane. And then promptly fell asleep for a good portion of my DC to Dallas leg of the trip. After a brief visit to the Dallas USO, it was onto another plane to San Antonio, and then another brief visit to the San Antonio USO before the shuttle came to take me to Camp Bullis, and C4 officially began.

They started with the standard briefs—this is C4, this is what will be going on in this week, etc—and then they issued us our gear. And what fun that was. Rucksacks, kevlar helmets, flak vests (and those things are heavy, in case you were ever wondering), canteens, ammo belts, fake M-16s (not just unloaded, but fake), sleeping bags, duffles, etc, etc. Lots of stuff. And then they stood us out in the sun and made us try everything on and told us at least twenty times to hydrate—but didn't let us go to the water buffalo (water tank on a trailer) to fill our canteens, which would have been nice, considering it was 90 degrees with 95% humidity—quite the change from the 50's-60's in DC.

The gear

We had our first formation a bit later, after most of the class had arrived, and then they marched us to the DFAC to pay for our MREs and feed us dinner. We were each issued a case of MREs, which is a bit intimidating, considering each MRE is probably about 3000 calories and could feed a small Ethiopian village. Needless to say, I'll be taking MREs back home. Christmas presents, perhaps?

What passes for food in these parts

Somehow in all of this, I ended up being made squad leader—yeah, bad idea on their parts. When nobody volunteered, the sergeant glanced at the list and called out a random name, which just happened to be Captain Hesse. Fun, fun. The other Walter Reed people all thought that was pretty funny (there are five of us here, but none of the others are in my squad).

Well, I am now finally clean(ish), which feels very, very good after sweating through my ACUs for half the day (I wore civvies while I traveled and changed at the San Antonio USO). Tomorrow we start with reveille at 0500, and then it's a day of Advanced Trauma Life Support (ATLS) at Ft. Sam Houston (yay for air conditioning!). That goes on for a couple of days before we get to the field portion of the course (which is when we have to start wearing the flak vests and kevlar and ammo belts and all that fun stuff). Should be interesting...

Pediatrics Clinic

I actually started in the peds clinic at NNMC (Bethesda) on Friday, after returning from C4 on Thursday (and I'll start posting entries from C4 as soon as I'm done with this one), but nothing really exciting happened then, and I didn't think anyone would want to read about the kid with the scraped nose or the other kid with the flu.

Anyway, the way peds clinic works for transition year interns is that we aren't assigned patients (as the pediatrics interns/residents are), but choose an attending and work with them. Today I tagged along with a pulmonologist, because the idea of doing well-baby checks was really boring to me. The morning was mostly asthma patients (not that exciting), but we did CF (cystic fibrosis) clinic in the afternoon.

Depending on the patient's age and how he or she is doing clinically, patients are seen either quarterly (every three months), semi-annually, or annually. Overall, it's a pretty simple appointment--ask them (or parents) how they're doing, if they get short of breath, energy level, any GI symptoms, and what kinds of medications they're taking.

The first two patients were siblings, a 22-month-old boy and his eight-month-old sister. Both of them were doing really well, so that was good. Like I said, pretty simple appointment, and we ended up just telling the father to keep doing what they're doing and come back in three months. The third patient, on the other hand, is not doing so well. She's seven and has been pretty sick (pneumonia, diarrhea, etc) for about five weeks. At some point in there, she had the flu (don't know if it was seasonal flu or H1N1) and had a course of Tamiflu, which definitely didn't help the nausea and such. Then her cultures came back as a bacteria in the Mycobacterium family (same family as TB), which automatically buys her at least a year of four more antibiotics, in addition to the other medications she was already taking.

All sorts of fun. Really.

The Army 10 Miler

On Sunday, the Metro opened a couple of hours early, a few streets in DC were completely closed, and about 20,000 people flocked to the Pentagon for the Army 10 Miler, which is one of the most popular races in the DC area (another being the Marine Corps Marathon; both races fill up within three days of registration opening).

I met up with a couple of other interns, as well as the husbands of a couple of interns, at the Forest Glen metro stop at 6am Sunday morning (when the Metro opened), to begin our journey to the Pentagon stop. We ended up arriving a little after 7, which was almost an hour before the race began (although closer to an hour and a half to when we actually crossed the start line). I ran with Beth and Emily, an orthopedic surgery intern and general surgery intern, respectively, for the first six or so miles, before I lost them at a water stop around the sixth mile marker.

With my dramatically bad performance at the half marathon a couple of weeks ago, I decided to take it fairly easy for the last four miles, which meant that I didn't get that great of a time (1:38 or so; a bit faster than 10 minutes/mile), but I was still standing at the finish line, which was the ultimate goal. Of the five of us, though, nobody ended up with that great of a time, so I didn't feel so bad (Beth and Emily ended up coming in only a few minutes ahead of me). After crossing the finish line, we got our coins (above), and then it was off to our meeting place, the Pentagon Metro sign, which worked out pretty well. While we were waiting for the menfolk to wander up(they must have been spending a lot of time in the food tents), I saw someone in an Ohio State shirt, so we chatted for a few minutes. Turns out, he's a sports medicine physician at Nationwide Children's Hospital, so that was pretty interesting.

Anyway, it was another long Metro ride back to our cars (by the way, cramming a bunch of sweaty, stinky people into Metro cars is not pleasant), and then we went our separate ways to go home and clean up before heading out to breakfast (which we ate at 1 pm...). Then I spent most of the afternoon taking a nap. All in all, a pretty good day. Emily decided that we should do it every year of residency. I agree.