APFT and Preparing for Yet Another Exam

Even though the rest of the Army does the APFT (Army Physical Fitness Test) in April and October, we just got around to doing ours on Wednesday (November 6). Better late than never. Now, this brings up a fun fact about coastal Georgia: it gets cold in the mornings in November. Not the kind of bone-piercing, dry cold that I grew up with. No, this is wet cold that you breathe into your lungs and it just kinda stays there, all cold. So even though the thermometer said 42, I was bundled up like it was far below freezing (or maybe the South has just made me weak).

Despite the cold (and a fair amount of whining by yours truly), I managed to do this on the APFT:

That's a 308/300, or better than what the Army considers to be prime fitness (it'll be recorded as a 300 in my records; just like there's no such thing as an A+, there's no such thing as better than the maximum score). Since our brigade command sergeant major (highest enlisted Soldier in the brigade) was here from Ft. Hood, my perfect score got me one of these:

This is our brigade coin, which I was supposed to be awarded during morning formation yesterday. Unfortunately, when they called my name, I wasn't there, because I was at the hospital seeing one of our Soldiers. He had an ACL repair last week and ended up developing a clot (DVT, or deep vein thrombosis) in his leg, which traveled to his lung (forming a pulmonary embolus, or PE). He's doing fine now, but he's been in and out of the ER since the day after his surgery. He first went in with shortness of breath and a CT (cat scan) was negative for PE. So he was sent home; four days later, he was again short of breath, and this time, they did find a clot in his lungs. It wasn't large, but they did admit him for observation and to teach him how to take the medications to treat it (one week of a blood-thinner shot and six months of a blood-thinner pill). Unfortunately, the day after he was discharged from the hospital, he was back in the ER. He followed up with the orthopedic surgeon who did his ACL repair and ended up coughing up a little blood, which freaked out the surgeon and he called for an ambulance. Again, he's fine. I explained to him that while he's on these blood thinners, he might cough up a little blood every once in a while, or he might get nosebleeds, or might bruise easily, and unless he's actively bleeding, there's no need for alarm.

The biggest learning experience of this (for me) was learning how to be an intermediate between the doctors at the hospital and the Soldiers and officers of my battalion. I obviously speak 'doctor', but this Soldier doesn't, and neither does his company commander or first sergeant. They're understandably protective of their Soldier and were very upset about all of this back-and-forth to the ER, thinking that it meant that he wasn't getting adequate care from the hospital. So I talked to his doctors, found out the whole story, and explained things to the Soldier, his commander, and his first sergeant in a way that (I hope) calmed everyone down.

Of course, after all of this, I hopped on a plane for Atlanta (okay, there was some time between; I finished up the workday yesterday, went home, studied, got up this morning, went running, gave blood, and then hopped on a plane for Atlanta), because I have my Certification of Knowledge in Tropical Medicine exam tomorrow, the first activity of American Society of Tropical Medicine and Hygiene. Since arriving at the hotel, all I've done is sit and go through my flashcards (I'll put up a picture of the stack of flashcards tomorrow, if I remember). I did have a nice view, though:

I'm on the 23rd floor of the Atlanta Marriott Marquis, which is downtown (and only a couple of blocks from a MARTA station, so I didn't have to spring for a cab from the airport). After my exam tomorrow (if I have any energy) and all day Sunday, I'm going to explore Atlanta, since I haven't been here (airport doesn't count) since my summer at Emory in college (2004... Man, time flies). And then I'll be spending my time conferencing and preparing for my presentation. More about that later.

End of Ward 75, beginning of psych, and a new coin

I was on call in Ward 75 on Sunday, for the last time in block 2 (I'll be back there in block 6). It was a really, really quiet call (which is a very good thing), and I actually got sleep, but we did have a bit of excitement. Right after the med student returned with dinner (we one out to grab us food every time we're on call), we were all sitting around eating and checking things on the computer, and suddenly he jumped out of his chair and said, "Hello, sir!" Just my luck--I had just taken a rather large bite of food. I turned to see who he was talking to (thinking it was our attending), and saw Lieutenant General Schoomaker, the Surgeon General of the United States Army (ie, my boss, after the President and Chief of Staff), standing in our team room. He was walking around the hospital on a Sunday evening, just getting a feel for the place and a reminder of what really happens in Army medicine, at the very bottom of all the decisions he makes. So he stayed and talked for a bit, joked about college football (he went to Michigan; I was wearing an OSU tee-shirt), and traded internship stories. He was an intern before the 80 hour work week (obviously), but still recorded his hours, just out of curiosity. There was one week that he worked 158 hours. He still doesn't know how he did it. Then he gave us coins (above), and resumed his wandering of the hospital.

And just to put things into perspective about how nice we have it now, in Block 2, I worked a total of 260.17 hours, which is 65.04 hours per week.

Well, I was supposed to start on PCLS (Psychiatry Consult Liaison Service) at National Naval Medical Center (better known as Bethesda) on Monday, but as I was post-call in Ward 75, I didn't start until today. It's going to be a really laid-back rotation, especially after MICU and Ward 75. We currently have three patients and three interns. I showed up at 0730 and left at 1600, and maybe worked two hours. The rest of the time, I sat around and twiddled my thumbs. Tomorrow, I'm bringing some fun reading, and after work, I'm going to Barnes and Noble and seeing if they have a USMLE Step 3 study book so I can pretend to study while I'm at work. It's going to be a good month.

4 star coins and the light at the end of the tunnel

For those of you who read my Facebook status update, you know that I now have coin from a four star general. Here it is:

And now story time. There is a lieutenant colonel in the room across from the MICU workstation. He was hit by an IED in Afghanistan (I believe... he's a SICU patient, so I don't know much about him). It's pretty rare that someone that highly ranked gets himself blown up (he was a Ranger or Special Forces or something), so he's gotten quite a lot of attention. I have now seen the Secretary of the Army and more stars than I can count. Anyway, on Monday morning, I was writing down lab values on my patients, and when I looked up from my computer, I saw stars. A line of four of them, right down the front of this man's uniform. He thanked us for all that we're doing to care for all of our patients, and then gave us coins.

As far as the light at the end of the tunnel, I had lunch yesterday with my future residency director, just to check in and see how my first month of internship is going and give me more information about the residency. Let's just say that I was really excited about what is to come. It really was a nice reminder that all of this being on call every third night and rounding for six hours thing doesn't go on forever.

I can't wait for next year.

More stories about coins

Last night, I went out for drinks with my friend Sunil, who is now a surgical intern at Bethesda (note: never go out for drinks with a sailor when you have to get up the next morning to listen to a briefing... ugh). Anyway, he's on a urology rotation right now, and had a fairly entertaining story about commander's coins (see my post on June 25), so I thought I'd share it.

The other day, one of his last patients for the day was a Vice Admiral (equivalent to a Lt. General; 3 stars). So he takes the history and does the general physical exam, and then because he's on urology, did a prostate check (digital rectal exam, or DRE), and then sent the patient out the waiting room while he finished his note or something. A couple of minutes later, he goes out to retrieve the patient, and the waiting room is empty. The receptionist said she thought he was done with the patient, so she sent him on his way. So Sunil had to go up to Executive Health and figure out how to track down this three-star admiral and finally gets a hold of him on his cell phone (he was still on base at the commissary or something), and asks him to come back to the clinic so they can finish the appointment. So the admiral comes back, they finish the appointment, and then they shake hands at the end. Sunil said he felt something round and hard in his hand; sure enough, he had gotten a coin, which he described as "very shiny, with three stars prominently displayed." At this, I had to laugh--that must have been a really good DRE to get a coin out of it!

Other than that, it's been a pretty boring since my last post. I went up to Baltimore this morning for the last part of the Deployment Health Surveillance workshop and then came back to the hotel to do a literature search related to the epidemiological investigation I've been assigned to work on this month.

Playing Army

Today I took a brief break from practicing procedures on cadavers and played Army for a couple of hours. After putting a chest tube and interosseous line (like an IV, but directly into the bone) into someone who really isn't going to benefit from either, I changed out of my scrubs and into dress clothes to meet with Major General Bostick, the Commanding General of the US Army Recruiting Command, and his entire entourage. I, along with Dr. Hitchcock, the Military Medicine Interest Group advisor and retired Air Force major, showed them around the medical center and all the cool things we have there. In the process, I got coins.

The one on the left is from MG Bostick, the one on the right is from LTC Rice, the commanding officer of the 3rd Medical Recruiting Battalion. And the backs:

After the tour, I ran home to change into my class B uniform (green skirt, green short sleeved shirt with 2LT bars on the shoulders) and headed for the restaurant to socialize with people with much higher ranks than my own. Fortunately, there were a couple of dental students there, too, so I wasn't alone in my second lieutenant-ness. After that, it was running home again, changing back into my scrubs, and heading back to school to do a kidney biopsy on someone with much larger issues than that (another cadaver). All of the running around made me a bit tired, but they're paying for my education, so it's the least I could do. Besides, it got me coins :)