My DC housing search

Well, I realized the other night that I hadn't been writing about my DC condo search, so I figured I should fill you in.

My parents and I arrived in DC on Tuesday night. Dad had his meetings with various people on Capitol Hill, and Mom and I had an appointment to meet with the realtor on Wednesday morning. So we hopped on the Metro and headed out to Bethesda and met with the realtor. On Wednesday, she took us to various places in Rockville, Bethesda, and Chevy Chase, all fairly close to National Naval Medical Center (Bethesda), the future site of Walter Reed National Medical Center at Bethesda (combination of Walter Reed Army Medical Center and National Naval Medical Center, scheduled to occur in 2011). There were a few that looked really good on the inside, but looked like old apartments on the outside, so I wasn't too thrilled with those. Then there were a couple of high-rises, which I liked a lot better.

Anyway, on day two, we saw some more places in Silver Spring (closer to Walter Reed), and while the units themselves were nice, they were all in the same community, which was a children-and-dog type area--not really what I'm looking for. So we made plans to go back to one of the highrises in Rockville (2 metro stops from NNMC and USUHS, where I'll be spending my second year of residency). Friday I made an offer and filled out all sorts of contracts, so hopefully we'll be finding out soon if the offer was accepted.

Yesterday we met up with Melanie and went on a tour of the new Visitor's Center at the Capitol, then went on to the Newseum and spent some time wandering around there. Quite an interesting place. I'd recommend it if you're in DC with a few hours that you can dedicate to museum walking.

Anyway, here's a picture of the building where I made an offer. Sorry, I don't have any pictures of the unit (which would probably be entertaining, considering the bright gold that is currently on the walls).

Last day of the ACPM conference

Today was the final day of ACPM 2009, which was a bit sad. It was fun hanging out with medical students and doctors who have the same feelings on medical careers as I do (even if they are all bleeding-heart liberals who think that Obama is the savior of the known universe). Anyway, here's a brief run-down of the day (and I'll try to explain acronyms and abbreviations better):

1) One last breakfast with the MSS (Medical Student Section)

2) Listening to the explanation of Healthy Americans 2020, which is a repackaging of Healthy Americans 2010. Nothing's really changed. Pretty boring session.

3) Argued with some administrators/test-writers of the USMLE (United States Medical Licensing Exam; the Board exams) about public health and preventive medicine questions in the multiple-choice and standardized-patient portions of the exam. LTC (Lieutenant Colonel) Cavicchia (one of the OSU alums in preventive medicine) was taking my side, so I guess I wasn't too far off.

4) Lunch (not that exciting)

5) Great careers in preventive medicine-public sector session. This is where the CDC, Army docs, and state/county public health directors talked about their careers. Some of them were pretty impressive. CPT (Captain) Ahluwalia and I were essentially planning out the timelines of our careers (when he would take over from the current Army director at the Global Emerging Infections System and when I would take over from him, etc). I hope it works out that way!

6) Preventive Medicine challenges in Iraq and Afghanistan session. Needless to say, this one was geared toward the Uniformed Services Academy of Preventive Medicine (of which I am the lowest ranked member!)

7) Wrote a speech at the last minute for the awards banquet, and then gave it in front of all these impressive preventive medicine physicians, including my future residency director. Well, they said I did a good job, so I guess that's all that matters. And no, I didn't win an award, I was giving them--I was announcing the winners of the Future Leaders in Preventive Medicine grant, which is what paid for the other medical students to come (I was paid for by being a med student section officer).

Anyway, tomorrow morning it's off to the airport to try to get on an earlier flight on standby. Either way, I'll be home tomorrow.

Update from the ACPM conference

So I was going to write about significant events for each day of the ACPM (American College of Preventive Medicine) conference, but I got too lazy. Here's significant events of the first two days:

1) Met my new residency director. LTC Cersovsky, the current WRAIR residency director, will be getting promoted (as happens in the Army) sometime this year, so MAJ Mancuso will be taking over. I got to meet him, and everyone who has worked with him says he's a really nice guy and very smart, so that'll be a good experience.

2) Met another OSU alum in Army preventive medicine. MAJ Schnabel is a 2002 OSU College of Medicine alum who is currently the director of the Global Emerging Infection Surveillance at the Army's research facility in Kenya. He has done some pretty exciting things with disease surveillance in Africa, which really makes me want to have his job someday. He now makes five OSU alums/future alums I know in preventive medicine in the Army (one resident at Madigan, one resident at WRAIR, a staff member at WRAIR, him, and me). Pretty impressive for a school that doesn't emphasize preventive medicine in the curriculum at all.

3) Impressed the MSS (Medical Student Section). We had our annual MSS meeting this morning, and the members who were there seemed rather impressed with stories from PNG. One of the girls had done some public health work in Tanzania and also sees herself doing a lot of international medicine in her career, so we had a very long talk about that while socializing tonight.

4) Discovered that I get to add another publication to my CV. The project I worked with at WRAIR during my preventive medicine month has been made into a poster (CPT Ahluwalia, the resident--and OSU alum--I worked with that month will be presenting).

5) Been invited to join in another research project. Another WRAIR resident (CPT Manos) invited me to join in a project that involved WRAMC interns (of which I will be next year). It'll probably lead to a publication in a few years.

6) Been welcomed to the RPS (Resident Physician Section). CPT Ahluwalia is the RPS president, and I think he's grooming me to follow in his footsteps (being as I'm a fellow WRAIR Buckeye and all), so he's been taking care of me during the conference and talked me into coming to the RPS meeting and is trying to get me to run for an officer position (as an intern!). He's also been trying to convince me to go to Johns Hopkins for my MPH, which is what he did.

7) Networking, networking, networking! I'm meeting so many interesting people with very interesting careers in the field, and I'm getting very excited about the possible things that I can do, both in the military and if I decide to leave when my commitment is up (in eight years).

So far, it's a really great conference, and I'm looking forward to learning more tomorrow. As for now, it's time for bed.

The never-ending day

Wednesday, February 11 began at 5:15am in Port Moresby, Papua New Guinea. After a quick shower and packing everything that didn't get packed the night before, I helped myself to breakfast and checked my email again before getting in the taxi at 7am, headed for the airport. Check-in went rather smoothly, although we discovered that my itinerary required me to get an Australian visa (which they were able to handle at the POM airport), and I found myself with some time to kill before my 9:40 flight (which left at 10). I occupied some of that time by buying a six-pack of South Pacific beer for the brothers as a souvenir at the duty-free. Unfortunately, they'll never get it—it was confiscated by customs in Sydney. I guess it's the thought that counts, right?

It was an uneventful (thankfully!) flight from POM to Brisbane, and then I grabbed my bag, went through customs, checked my bag in again for a domestic flight to Sydney, took the train to the domestic terminal, and had just enough time to buy a bottle of water before boarding the plane to Sydney. Then in Sydney it was another transfer from the domestic to international terminals before it was time to go through customs again (this time for departing Australia). This layover was a little longer, which gave me time to peruse the duty-free in Australia (I bought crocodile and kangaroo jerky to replace the confiscated beer) before hopping on a nine hour flight from Sydney to Honolulu, most of which I slept through (thankfully).

I was awake for the last two or three hours, which gave me time to start reading a book I bought at the Sydney airport called A Doctor's War, by Rowley Richards, a former Australian Regimental Medical Officer who was captured in Malaysia during the Second World War; the book is from his diaries of his time spent in the POW camp. I'm not done with it yet, but so far, it's an amazing book, right up there with A Surgeon In Combat by an American Army battalion surgeon in Europe during this same period. Many of the things Dr. Richards writes about I have experienced myself as a young, future medical officer in the Army in a time of war. One thing that really rang true to me is his descriptions about his excitement about seeing combat, which in the wisdom of his older years (after having been a POW) he scoffs at as youthful ignorance. I will admit, I have experienced the same anticipation about deployment, which I am sure will happen, it is just a matter of when and where. I know it is youthful ignorance, and I know that my preconceptions about what the life of a doctor is like in a combat zone are probably 90% false, but those feelings are still there, and I am sure that someday, like Dr. Richards, I will look back and wonder why I looked forward (if that is even the right term to describe it) to being deployed. Still, what I have read so far is very powerful, and I'm very impressed with what Dr. Richards went through and how he managed to continue working as a RMO during his time as a POW. And all of that was in the tropics, so he was dealing with things like malaria and dengue fever and tropical ulcers, most of the time without any medications (the Japanese confiscated their medicines); he wrote about applying good hygiene and preventive measures in a time when such ideas weren't popular at all. He's now a preventive and occupational medicine physician (well, he's now semi-retired, but he was a preventive/occupational medicine physician), so there's another reason for me to look up to him. I hope if I'm ever in conditions half as bad as he faced that I can show the same initiative and integrity that he writes about.

But anyway, back to the never-ending day. I ended up landing in Honolulu around 9am, still on Wed. Feb. 11—in other words, I landed before I left PNG, which made me laugh. I had to calculate time zones to determine if I should take my anti-malarials or not (I did, including my first dose of my terminal prophylaxis on primaquine), and then wasted time on the internet in the Honolulu airport (I would have rather been at the beach, but we don't always get what we want) until it was time to board for the last leg of today's flying, a five-hour flight from Honolulu to Los Angeles, where I will be for a few days for the American College of Preventive Medicine conference. I'm still on that flight as I'm writing this, to be posted later.

Overall, it's an exhausting 30 hours of travel time (not counting my flights from Kikori to POM “yesterday”)—all of which spans 11 hours on the clock (10am in PNG to 9pm in LA). I'm just hoping that my sleep won't be so disrupted that I'll miss out on important parts of the conference.

My blog for the next six weeks

After a very snowy week in Camas, I am again sitting in an aiport (PDX) for the nth (I'm too lazy to count) time this year, waiting to go off on my next adventure. For those of you who don't remember, I am going to be spending four weeks in Papua New Guinea on a Global Health elective, learning about tropical medicine and basically working on not getting dengue fever (I have medicine for malaria and am vaccinated against just about everything else, so that's what I'm going with).

As part of my rotation, I will be keeping a blog with INMED, the organization that is taking me to PNG. Obviously, as I will be in the bush of a strange foreign country, internet access will be patchy at best, and I will not be keeping two blogs. So, here's my link to where you can see what I'm up to until I return:

inmedblogs.us/elisabethhesse

Enjoy, and I'll talk to you soon!

Match results!

The military match results came in this morning at 0600 EST. I have, obviously, been looking forward to this moment for months, if not years. Here it is:

Walter Reed Army Institute of Research preventive and occupational medicine residency class of 2013

Yay! That was my first choice and I'm quite thrilled with the results. Tonight is our post-match Military Medicine Interest Group meeting, so I'll find out how my military classmates did and where they'll be going.

Anyway, here's my schedule for the next four years:

July 2009-June 2010: transition year internship at Walter Reed Army Medical Center
July 2010-June 2011: Master's of Tropical Medicine and Hygiene (or Master's of Public Health) at the Uniformed Services University of Health Sciences (or, if I get an MPH, at Johns Hopkins University)
July 2011-June 2012: Preventive Medicine practicum year at Walter Reed Army Institute of Research
July 2012-June 2013: Occupational Medicine practicum year at the USUHS

I don't know how they expect me to do work today. I'm too excited!

Pain medication contracts

One of the things about worker's comp patients is that most of them have chronic pain that has to be treated with narcotics (think Dr. House and his Vicodin addiction). Obviously, nobody likes to just give out narcotics (well, unless you're on House, in which case, everyone gives it out like candy). There are a lot of legal and ethical issues involved in prescribing narcotics, so the doctors try not to do it without thought.

So at the OSU Occupational Medicine clinics, the patients must sign pain medication contracts once a year before they can be prescribed narcotics. The contract is a couple of pages long, and I won't bore you with all the details, but some of the points they have are that the patient must agree that they will only get narcotics from the occupational medicine doctors (ie, they can't go to the ER for pain meds), that they will take them only as prescribed, that they will agree to random drug screens (both to make sure they are taking their medications and to make sure they aren't taking anything else), and that if they break any of the rules, they won't get any more narcotics.

Well, we had a patient yesterday (Friday) who Dr. Wynd is trying to wean off Percocet. She had been prescribed 1 pill four times a day, and a few months ago, Dr. Wynd decreased it to 1 pill three times a day. So, to make what was actually a really long and convoluted story short, she was still taking 1 pill four times a day, which Dr. Wynd confirmed by counting the remaining pills. So, she wasn't taking it as prescribed, and that means no more Percocet. Dr. Wynd prescribed Ultram instead (a non-narcotic pain med) and pretty much said, you knew the rules and you chose to break them.

I'm not saying the patient didn't have pain; she had quite a lot of pain, both leading to and resulting from a knee replacement surgery and three back surgeries. However, pain or not, rules are rules, and she knew them and broke them. If she was having as much pain as she said she was having (leading to the increased intake of her meds), she should have called for an earlier appointment to ask for another prescription, instead of just changing the dosage on her own. That way, she wouldn't have been in violation of her contract.

Unlike on TV, doctors are aware that narcotics can be addictive. They are also aware that they are sometimes necessary. The tricky part is getting things down so the pain can be treated without causing further harm to the patient.

OSUMC Clinical Epidemiology

Today I spent the day with the infection control team at OSU. The day started fairly early, as we had to review all the culture results for the entire hospital (it's a 1000 bed hospital; fortunately, not everyone gets cultures). These have to be monitored for a few reasons: 1) If anything wildly contagious/dangerous (TB, meningitis, etc) is cultured, the epidemiologists have to begin contract tracing and making sure everyone who has had contact with the sick patient gets proper treatment. 2) Infections, especially hospital-acquired infections, must be reported, according to the Joint Commission (the group that accredits hospitals). 3) Following bacteria and what they are resistant to allows for better antibiotic prescribing practices in the hospital.

After going through the culture results, I went on rounds with the infection control agent of the Ross Heart Hospital (one of the four hospitals that makes up OSUMC). It was rather interesting; many of the things we were looking out for were things I had never considered, such as the exact location of sinks and soap dispensers, making sure all procedure rooms have sterile areas, and checking for dust that housekeeping has missed. By the end of rounds, we had put in two work orders, one for a shelf in a procedure room and one for a sink. We also discussed how infection control personnel can be involved in hospital design, to make sure each room is properly set up for a given purpose.

This particular infection control nurse has been working with the cardiothoracic surgeons on reducing the infections associated with ventricular assist devices (VAD, or for any Grey's Anatomy fans, LVAD). Fortunately, one was being removed and replaced in one of the ORs today, so we went in so she could point out all the infection control changes that have been made, which have resulted in OSU having the lowest infection rates for VADs in the world.

After lunch was the Infection Control Committee meeting, which included reports on the hospital acquired infections and what is being done to reduce those numbers. After that, I went on rounds with the ICU infection control agent. We discussed infection rates and monitoring in the neonatal, medical, and surgical ICUs, and then went on rounds to those areas. All I have to say about that is NICU babies are scary. One pound is pretty small for a human being.

Anyway, at the end of the day, I feel that I learned a lot about epidemiology and how it applies in a hospital setting. It was more of a preventive medicine than occupational medicine day, but that's okay with me.

Dr. Wynd's Back Pain Clinic

No, there was no back pain clinic, just more occupational medicine, but for some reason, every since one of Dr. Wynd's patients this morning had complaints of back pain. It got a bit monotonous, but I've gotten a lot of practice doing back exams.

Occupational medicine hasn't been treating me too poorly. Most days, I start around 8, and head home around 3. Dr. Schaub, the doctor I'm mostly working with, has been getting me in various clinics and sites, including both occupational medicine clinics at OSU (neither of which are at OSU), employee health at OSU, hospital epidemiology, and the Big Lots warehouse (he's the Big Lots employee physician). Many large companies, especially large companies with warehouses or factories, have staff physicians, often certified in occupational medicine. That's pretty much where the money is in this specialty (and it's good money, from what I hear). Government agencies also employee occupational medicine physicians--of the OSU physicians I have worked with, Dr. Rodway is a DOT physician, and Dr. Kearns goes to the Defense Supply Center Columbus and is also a FAA flight surgeon.

Anyway, that's pretty much all I do every day--go to clinic, see people who have been hurt at work, see how they're doing, figure out what we can do for them, and try to get it done. There's a lot of government red tape to go through, which makes me very glad that I'll be doing this in the Army and not in a civilian setting. The Army actually makes things simpler.

Worker's Comp

This month, I'm doing an occupational medicine elective. I wasn't sure what all that entailed until I met with Dr. Schaub, my preceptor, yesterday morning, and I'm still not completely sure, but here's what I've gathered thus far: most of my days will be working in one of two occupational medicine clinics in Columbus, and I'll also being spending half days doing hospital epidemiology at OSU, work-site inspections at major corporations in Columbus, and working with FAA flight surgeons. Thus far, I've done half a day in the occupational medicine clinic.

Occupational medicine clinics aren't primary care offices, and occupational medicine docs aren't primary care physicians. The only reason for the visit, and the only concern of the physician, is what was injured while the patient was at work. People on worker's comp have to see occupational medicine specialists on a regular basis, for continued evaluation of their injuries, to determine if they are fit to return to work (and what duties they can do there), and to coordinate care with other specialists. That is all the doc is worried about--no lecturing the patient about not taking their blood pressure medicine or checking their blood sugar.

So before I began my shift yesterday, I was given the half-hour lecture about worker's comp and how it works. Dr. Schaub explained by explaining how things were before worker's comp: if you were injured at work, the only way you could get money for your medical bills and lost wages was to go through the tort system, and to do that you had a hire a lawyer (obviously), and had to prove you were injured at work (not so difficult if you came to work with ten fingers and left with nine, but more iffy if you developed lung disease after working in a coal mine for thirty years). There was also the assumption of risk, meaning that there were certain risks at every job, and if the employer told you about the risks, you accepted that you were okay with them when you started working there, and thus, any injury as a result was not the employer's fault.

Now, with worker's comp, it's completely non-tort--in fact, you can't sue your employer if you're injured at work. No lawyers are involved, and all that you have to indicate is that there is a "reasonable medical probability" that work contributed to the injury, so now that covers things like Black Lung Disease from coal mines, carpal tunnel syndrome in secretaries, etc. There is no assumption of risk; if the job-site isn't safe, it's now in the employer's best interest to make it so, in order to keep people from getting injured.

The biggest misconception about worker's comp is that it's permanent disability; it isn't. That's social security. Worker's comp only pays temporary total disability, and if you can't get back to a job before that expires, you're done. Notice I said a job, not your job--employers may have you come back doing something that won't aggravate the injury, and if you can't handle that, you may need to get a new job. One nice thing about this is if it becomes obvious that you can't go back to what you were doing, you could be enrolled in vocational rehabilitation, which helps you find/train for a new job that you can do with your injuries.

So yesterday we saw a variety of patients, from a legal aide with carpal tunnel (we had a laugh together about that one, as we both had our wrist braces on), to a TSA agent recovering from a broken knee after a fall while he was searching a passenger, to a woman who was going to have to enter vocational rehab, as she had been making no progress gaining strength in her arm after a fall on her shoulder a year ago. Many of these patients were eager to get back to work doing something; in fact, the legal aide was still doing a lot of typing on a daily basis.

I guess I never really considered how a relatively minor injury could sideline someone in certain positions. For example, we cleared the TSA agent for full-duty yesterday, but he still could not kneel on his right knee without pain, which means that while he's searching passengers, he'll have to remember to drop to his left knee, and while he's lifting luggage, he'll have to remember to support it with his left. We also had a correction's officer with a sprained thumb who couldn't go to work at all; even the most limited-duty jobs (ie, watching monitors) could conceivably require her to restrain a prisoner, and without grip strength of her hand, she couldn't grab someone and put them in handcuffs. Sometimes, it's all about putting the injury in perspective.