Yesterday was my first day of PM&R (Physical Medicine and Rehabilitation; or Plenty of Money and Relaxation :) ), which is a nice change after four weeks on the medicine wards.
Every Tuesday morning in the PM&R clinic is TBI clinic--traumatic brain injury. When I did PM&R as a med student last March, I was on the TBI service and did a 1/2 day a week in TBI clinic, but today was completely different than that, because TBI in the military is completely different from TBI in the civilian world. Most of the patients I saw back at OSU were there as a result of drunken stupidity, which is most definitely not the case with the patients I saw today.
The first patient was an infantry specialist (gunner on an MRAP) who literally just got in from Afghanistan (he was on the Friday MEDEVAC). On Sept. 11 of this year, his MRAP was hit by an IED, and he ended up with a concussion that left him with persistent migraine headaches (nausea, vomiting, sensitivity to light, the whole bit). He ended up going to one of the field hospitals and got a CT, which didn't really show anything. He kept telling everyone that he felt better so he could go back to his unit, despite the fact that he was still having the headaches. After a few more concussions, it got to the point that his unit's medic realized that he wasn't fine, despite his insistence otherwise. It took the medic pointing out that a gunner who couldn't concentrate on his job was putting his unit at risk to get him to agree to be evacuated from theater for further evaluation.
It really puts things in perspective--here was a guy who was being fired at on a regular basis, who felt terrible on a daily basis, and didn't want to leave his job.
While the PM&R resident I was working with went to fetch the social worker, I chatted with him about his military history. His contract is up in a year and a half, and after that, he wants to go to OCS (Officer Candidate School) to become an infantry officer. Right now, he's still having headaches, and is having difficulty concentrating and sleeping. I really hope he gets back to where he was before these IED blasts.
The other two patients I saw had been established with the TBI clinic for awhile--one had a gunshot wound to the head and is almost back to where he was before he was shot, and the other was another IED blast, who now has some personality changes, problems with his memory, and pretty severe depression.
So like I said, traumatic brain injury in the Army is completely different than traumatic brain injury in the civilian world.
And tomorrow... amputation clinic.
Tuesday, December 15, 2009
Sunday, December 13, 2009
No more medicine wards!
Today was my last day on medicine wards--ever! It was definitely a good feeling to be walking away, knowing I wasn't returning. No more long internal medicine rounds, no more cross-cover call... If I had any doubts about wanting to do preventive medicine instead of internal medicine (which I didn't), that would have cinched it.
I told my resident and fellow intern when I came in for rounds today that my goal was to get out before 11am, and even with following and having to present four patients, I left the ward at 10:55. Of course, I had to sign out to the on-call intern before the other intern on my team to do so, but I did it.
I did, of course, have an ulterior motive for leaving the ward, other than just wanting to get away from Ward 75 as quickly as possible. I realized the other day that I have worked every single Sunday this block, and thus hadn't been to church at all during Advent, which is my favorite season at church. So, I checked the Walter Reed website, and found out that the Protestant services at the chapel are at 11am (hence the goal leave time). After switching out my white coat for my winter jacket in my locker, I had to practically run across base to get to the chapel (and still came in late), but I did get to enjoy a nice Advent service, so that made me happy.
The afternoon was spent doing as little as possible, which included a nap on the futon (I have a very comfortable futon) before heading out to dinner with one my friends, who was celebrating the end of her month on urology, going into a month of ER, which for a surgery intern is practically a vacation--predictable hours, no call, no residents to make life miserable.
Tomorrow I begin PM&R, and will get one of my four weeks on that rotation over before heading for the airport on Saturday to fly home for Christmas. I can't believe it's almost the end of the year already, but I'm definitely not going to complain about how quickly it's going--the sooner I can be done with internship, the better.
I told my resident and fellow intern when I came in for rounds today that my goal was to get out before 11am, and even with following and having to present four patients, I left the ward at 10:55. Of course, I had to sign out to the on-call intern before the other intern on my team to do so, but I did it.
I did, of course, have an ulterior motive for leaving the ward, other than just wanting to get away from Ward 75 as quickly as possible. I realized the other day that I have worked every single Sunday this block, and thus hadn't been to church at all during Advent, which is my favorite season at church. So, I checked the Walter Reed website, and found out that the Protestant services at the chapel are at 11am (hence the goal leave time). After switching out my white coat for my winter jacket in my locker, I had to practically run across base to get to the chapel (and still came in late), but I did get to enjoy a nice Advent service, so that made me happy.
The afternoon was spent doing as little as possible, which included a nap on the futon (I have a very comfortable futon) before heading out to dinner with one my friends, who was celebrating the end of her month on urology, going into a month of ER, which for a surgery intern is practically a vacation--predictable hours, no call, no residents to make life miserable.
Tomorrow I begin PM&R, and will get one of my four weeks on that rotation over before heading for the airport on Saturday to fly home for Christmas. I can't believe it's almost the end of the year already, but I'm definitely not going to complain about how quickly it's going--the sooner I can be done with internship, the better.
Wednesday, December 9, 2009
Update
Okay, so I now I'm doing an absolutely horrible job of keeping my blog up-to-date, which kinda defeats the purpose of having one in the first place. Here's what I've been doing the last month or so:
I'm back on Ward 75, the general medicine ward, this time on Medicine Green Team instead of Blue Team. There's absolutely no difference between the teams, except which team room (office) is used. We, and the other medicine services, actually (there are five: gold, green, blue, white, and red), have been taking quite a hit every time we're on call. Being on call means that if someone comes into the hospital who needs to be admitted to a medicine, they go to the on-call team. The cap for admitting patients to one team is ten, and after that, the senior night float admits them to other teams. Everyone has been hitting the cap, which is a lot of patients, and we can't seem to get them out of the hospital. We're on call again tomorrow night, and still have nine patients on the board. That means if they can't discharge people today (it's my day off today), we could potentially have nineteen patients on Friday, which is far too many.
I have had a few interesting patients, though. There was one the last time we were on call, a nurse with a thigh mass who we essentially admitted so she could get an MRI overnight ("expedited work-up"). Well, the MRI read wasn't as good as anyone hoped, and we called ortho (whom she had already been seeing for this thigh mass, as she had had it for two months), and today they're taking her to the operating room to do a biopsy. In other words, after looking at the MRI, they're concerned in might be a bone or muscle cancer of some sort.
There was another, a ninety-year-old man who really liked to talk (and was very sharp, for any age, especially ninety; a former Special Forces captain during WWII and clinical psychologist during the Korean War, retired at major), and during one of our longer-than-necessary conversations, he asked if I had gone to USUHS. When I informed him that I recently graduated from Ohio State, he got an incredulous look on his face.
He graduated with a Ph.D. in clinical psychology from Ohio State in 1951. Apparently, Buckeyes really know how find each other.
For the most part, unfortunately, the patients aren't interesting, just frustrating, and I'll be very glad when I'm walking out of the hospital Sunday, because that will be my last day on Ward 75--forever.
As far as other aspects of my life, well, it's difficult to have a social life while working eighty hours a week, spending every fifth night in the hospital, and only getting one day in seven off. The one date I went on (blind date, set up by a friend), was a complete disaster. He asked how long I "have" to be in the Army and then started talking about how things will be different once I get out. At one point, I made some joking comment about something about my uniform, and he said, "Well, at least you don't have to wear it at work."
???
Just what does he think being an Army doctor is? When I told him that I do, in fact, wear my uniform almost every day to work, he thought that was the stupidest thing ever. So overall, he seemed to think being a doctor in the Army was the worst thing ever, and I must be counting down my days until I can hang up my uniform and be done with it for good. I don't know if I'll be hanging up my uniform in eight years--it all depends on the opportunities presented to me at that point. For what I want to do in my career, I may be staying in forever, and I don't appreciate some guy I just met assuming he knows otherwise.
In other words, no second date.
So, in the meantime, I've been pretty much doing all that I can to keep my head above water as I finish up this rotation, and spending time with my fellow intern friends whenever I can, which isn't all that easy, when it always comes down to getting schedules to line up. On Monday, I start on PM&R (Physical Medicine & Rehabilitation), so that will be a nice change of pace.
I'm back on Ward 75, the general medicine ward, this time on Medicine Green Team instead of Blue Team. There's absolutely no difference between the teams, except which team room (office) is used. We, and the other medicine services, actually (there are five: gold, green, blue, white, and red), have been taking quite a hit every time we're on call. Being on call means that if someone comes into the hospital who needs to be admitted to a medicine, they go to the on-call team. The cap for admitting patients to one team is ten, and after that, the senior night float admits them to other teams. Everyone has been hitting the cap, which is a lot of patients, and we can't seem to get them out of the hospital. We're on call again tomorrow night, and still have nine patients on the board. That means if they can't discharge people today (it's my day off today), we could potentially have nineteen patients on Friday, which is far too many.
I have had a few interesting patients, though. There was one the last time we were on call, a nurse with a thigh mass who we essentially admitted so she could get an MRI overnight ("expedited work-up"). Well, the MRI read wasn't as good as anyone hoped, and we called ortho (whom she had already been seeing for this thigh mass, as she had had it for two months), and today they're taking her to the operating room to do a biopsy. In other words, after looking at the MRI, they're concerned in might be a bone or muscle cancer of some sort.
There was another, a ninety-year-old man who really liked to talk (and was very sharp, for any age, especially ninety; a former Special Forces captain during WWII and clinical psychologist during the Korean War, retired at major), and during one of our longer-than-necessary conversations, he asked if I had gone to USUHS. When I informed him that I recently graduated from Ohio State, he got an incredulous look on his face.
He graduated with a Ph.D. in clinical psychology from Ohio State in 1951. Apparently, Buckeyes really know how find each other.
For the most part, unfortunately, the patients aren't interesting, just frustrating, and I'll be very glad when I'm walking out of the hospital Sunday, because that will be my last day on Ward 75--forever.
As far as other aspects of my life, well, it's difficult to have a social life while working eighty hours a week, spending every fifth night in the hospital, and only getting one day in seven off. The one date I went on (blind date, set up by a friend), was a complete disaster. He asked how long I "have" to be in the Army and then started talking about how things will be different once I get out. At one point, I made some joking comment about something about my uniform, and he said, "Well, at least you don't have to wear it at work."
???
Just what does he think being an Army doctor is? When I told him that I do, in fact, wear my uniform almost every day to work, he thought that was the stupidest thing ever. So overall, he seemed to think being a doctor in the Army was the worst thing ever, and I must be counting down my days until I can hang up my uniform and be done with it for good. I don't know if I'll be hanging up my uniform in eight years--it all depends on the opportunities presented to me at that point. For what I want to do in my career, I may be staying in forever, and I don't appreciate some guy I just met assuming he knows otherwise.
In other words, no second date.
So, in the meantime, I've been pretty much doing all that I can to keep my head above water as I finish up this rotation, and spending time with my fellow intern friends whenever I can, which isn't all that easy, when it always comes down to getting schedules to line up. On Monday, I start on PM&R (Physical Medicine & Rehabilitation), so that will be a nice change of pace.
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