Field trip to the power plant

I have officially started my studies for my master's in tropical medicine and hygiene (which is a master's in public health, plus extra courses in tropical medicine and international health). No, I am not doing things out of order with my education--the MTM&H is, in fact, only offered to physicians, because there's so much clinical stuff that requires a med school background.

Anyway, this is the pre-fall quarter, which is a half quarter (the year will end with another half quarter in the summer); it's only six weeks long, and it's pretty much just the basics. We have Intro to Public Health, Computer Systems in Public Health, Social and Behavioral Sciences, Selected Topics in Occupational Medicine, and Intro to Environmental Health. The fun thing about the environmental health class is that we have field trips every Tuesday and Thursday.

Yesterday was our first field trip, to Mirant power plant in Alexandria, VA. It's a coal plant (half of the nation's electricity still comes from coal; sadly, very few people have the fortune of living in the Pacific Northwest and getting hydroelectric power). Here's the basics of how electricity gets from coal to the home:

1) Coal is burned, which boils water to make steam. The steam then turns the turbines, which makes electricity.

2 and 3) The electricity is sold to Pepco (which I think is the only power distributer in the area), and transmission lines carry high-voltage electricity to load centers

4) Distribution centers lower the voltage

5) Power cables transmit lower voltage electricity to homes and businesses (and the Pentagon)

Since it is an environmental health class, we spent quite a lot of time discussing air and water pollution. One thing that I was very fascinated by is that the emissions are completely invisible--it looks like there's nothing coming from the stacks (the two active stacks are circled in black). The steam, which is the real driving force (it turns the turbines and makes power), doesn't really escape in visible quantities, either.

Here's a timeline of energy sources for our country (energy sources, not electricity sources... we use a lot of petroleum, but that's for driving, not turning on light switches). Like I said, most electricity comes from coal, which natural gas also playing a large role. Nuclear is next, renewables below that, and hydroelectric is rather low. And sadly, there's no room to increase that number (we don't have enough fast-flowing rivers like the Columbia)

And here's a picture of the power plant from the Potomac River. It's literally right on the river, and right across the street from the residential areas of Alexandria, sitting on about 23 acres (very small for a power plant)

Tomorrow we're going to Carderock, which is where the Navy makes model boats and plays with them. Or something.

Internship graduation

Last week, we had internship graduation, which is a little like kindergarten graduation--it doesn't really mean much, except they got to get us dressed up in uniform and line us up for yet another graduation ceremony (because clearly, by the time we become doctors, we haven't had enough graduation ceremonies). I took a few random pictures of us "lining up" so you can appreciate a bunch of interns and residents more dressed up than we would normally be (ie, not in scrubs or camo). People in white are in the Navy, those in dark blue are in the Army, and I don't think I have any pictures of the few people in the Air Force who were graduating.

So we got all lined up, proceeded into the concert hall (yes, fortunately, it was indoors... it was probably 95 degrees at 1000, when the ceremony began), and sat through yet another graduation ceremony. The host was the commander of NNMC (Bethesda), so a two-star admiral in the Navy, and the graduation speaker was LCDR Jardik, a Navy urologist who wrote a book (On Call in Hell) about his deployment to Iraq, back in the early days of Iraq. Then we marched across the stage to receive our certificates, which say "Please go to the GME office to pick up your diplomas". Yeah, completely useless.

Since then, I haven't really done much involving a hospital. I had a few more days of dermatology, but then Thursday NNMC was closed (there was a big ceremony opening the Intrepid Center, whatever that is, and the President was there, so they closed the outpatient clinics to keep security risks down) and I was supposed to help with the transitional year interns (next year's class) orientation on Friday, but that was cancelled at the last minute. Tomorrow, I'm going into WRAMC to outprocess (that should be a fun time...) and then on Thursday, I officially start my preventive medicine residency.

Marine Corps 17.75K

I got up ridiculously early this morning to drive down to Quantico (about 35 miles away), which took me about 1.5 hrs this morning thanks to Beltway construction, to run the Marine Corps 17.75K (about 11.1 miles). Yes, that is a random distance--1775 was the year the Marine Corps was established, so that's where that came from.

This was the inaugural race of the 17.75K (by the way, it's the only 17.75K race in the world), so nobody really knew what to expect. It's part of the Marine Corps Marathon training series, which is how I heard of it.

Anyway, here's the course map:

So as you can see from the elevation map, there were quite a few hills. Fortunately, probably nine of the eleven miles were in the park, so there was good shade cover, which was definitely necessary. By the time I got back to my car (about 10:30), it was 85 degrees and rather humid.

Overall, slower than I wanted to run (1:52ish, which is about a 10:07 minute/mile pace), but I survived, which makes it the longest run I've done in over a year, and a good way to kick off my training for the Marine Corps Marathon.

West Point, and onto Dermatology

My friend Yolanda is moving out to California to work at Travis Air Force Base next year (which means, in two weeks), and she decided that she wanted to see all the service academies at some point. She had done a rotation at Annapolis, so she wanted to see West Point before she moved. We would have taken my friend Jen, who went to West Point, but sadly, she was on vascular surgery and was working all day.

Here's a picture of the quad, which is right outside the barracks (dorms), and where the cadets have accountability formations 2-5 times a day. Obviously, in June, after graduation and before the new plebes (freshmen) arrive, there weren't many cadets to be seen.

Here's the roof of the field house. The other side says "SINK NAVY", but I just couldn't get a good picture of it.

And this is the West Point Chapel, which is an absolutely beautiful building. Overall, a very beautiful campus, although Jen informs me that it's bitterly cold in the winter, with the cold air coming in over the Hudson.

So that was my Saturday. Didn't really do much on Sunday, and then yesterday I started my dermatology rotation--last rotation of intern year! So far, I haven't really seen much, but we (as in, me and the dermatology residents) did get a lecture this morning on how to moonlight as an attending and make a lot of money in the outside world. The main point, which was repeated over and over, was "This isn't the time for interesting cases and expanding your education. This is for making money." Gotta love dermatologists.

Memorial Day

Well, there's never a shortage of things to do in DC, and that certainly applies to Memorial Day weekend as well. I was on-call Saturday night (as I said yesterday), but was recovered by yesterday evening, to go to the National Memorial Day Concert at the Capitol. It started at 8, so we got there at 5 so we could get a patch of grass to sit on. Anyway, to say that it was an amazing concert would be an understatement. In addition to the music, they had short scenes (I don't know what the correct drama term would be... not really scenes, not dialogs... more like interweaving monologs) of real stories, by famous actors (such as Gary Sinise, who was one of the hosts; the guy from The Unit who also does the All-State commercials; some people from Criminal Minds, etc)--and the real people of these stories (the ones who were still alive) were sitting in the audience, with the camera panning to them at the end. Very emotional stuff.

This was the view from where we sat:

And of course, the Capitol itself.

The U.S. Army Drum and Bugle Corps was there as well. I have some pictures of the buglers, too, but here are some drummers:

That was yesterday, and today, I met up with Melanie and her friends (who better to spend Memorial Day with than someone with a Master's in Military History?) at the WWII Memorial for the ceremony at 0900. There was a brass quintet from the Army Field Band, in addition to the color guard and wreath-laying ceremonies, and it ended with elementary school students around the memorial with pictures of service members who had died in the war, one from each state and territory, in front of the pillar for that state (I guess that sentence only makes sense if you have seen the memorial).

After that, we wandered around, killing time in the oppressive heat before the Vietnam Memorial ceremony at 1300, so we went through the Korean War memorial to read the wreaths. Here's one from the 25th Infantry Division:

For those of you who watch Criminal Minds, this guy should look familiar. Joe Mantegna hosted the concert last night with Gary Sinise (aka Det. Mac Taylor, aka Lt. Dan), then was one of the keynote speakers at the WWII ceremony this morning (his father and four uncles all served in WWII; he brought one of those uncles to the ceremony), he was at the Vietnam ceremony (and that's quite the ceremony, by the way), and he was in the parade. It's nice to see that kind of support for veterans and fallen service members.

A Sunday morning bike ride isn't leisurely...

... when it's a five mile ride up and down hills after a night on call on the labor deck to get home. Here's the route, which I do twice a day (coming and going), because I have to get to work before the Metro is running. Great fun.

My night on call actually wasn't too bad. We had a fairly consistent flow of patients through triage, which is pretty much my domain. The med student follows around the second year resident to help with deliveries, and comes help me in triage when nobody is close to delivering. She was actually a huge help through call, because she was so eager to help with everything, even after I told her she doesn't have to try to impress me with anything. I think she really likes OB, but isn't really sold on the lifestyle (ie, still having to spend the night in the hospital as an attending). Since it is almost the end of her third year of med school and she doesn't know yet what she wants to do, she's thinking of doing a transitional year internship (what I'm doing this year) and then being a general medical officer for a few years. She's also getting married in a few months, which complicates matters further (she's Air Force, her future husband is Army but might be leaving the Army next year, etc).

Anyway, we weren't terribly busy, which gave me time to cyber-stalk one of my patients. One of the questions on the admission form, for some reason, is "level of education". So I looked through her pre-partum questions, and found "doctorate", which isn't that unusual, except for the fact that she was a sergeant first class, and there aren't many SFCs with Ph.D.s. I went through her medical record, all the way back to her entry physical, which listed her occupation as "Special Bandmember", and then got on Google. Here she is below (the one in the maternity uniform):

Yes, she is a professional flautist in the United States Army Field Band (one of the specialty bands, like the Marine Corps' "President's Own"). I thought that was pretty neat. And at about two this morning, they had a little girl.

So now I have all sorts of Memorial Day plans (no work tomorrow--yay!), including the Memorial Day concert at the Mall tonight. Maybe I'll get some pictures from that to share.

Yes, I am still alive

Okay, I know it's been a ridiculously long time since my last post, so here's a quick update on what I've done since then:

-Finished up my allergy/immunology rotation. Good times, easy work, got an excellent evaluation for the rotation (it helps that my program director was the one writing the evaluation)

-ER rotation in Fairfax, VA, at a civilian hospital. I had forgotten in the course of this year that not everyone speaks English, and medications aren't really free. That was a bummer of a reminder.

-Now onto OB/GYN, at both Walter Reed and NNMC. The first two weeks were gynecology clinic at Walter Reed, which was a combination of what my attending called "bitch and itch clinic" (acute visits), and annual well-woman exams. For everyone who thinks that gynecology is preventive medicine... NO. It's not. Performing pap smears is not preventive medicine; reviewing the literature and making recommendations about who needs pap smears is preventive medicine. I was rather disappointed that nobody seemed to know the recommendation that after 3 normal pap smears, they can be spaced to every three years. If gynecology was preventive medicine, they would have explained this to their patients instead of continuing to perform unnecessary, expensive, and painful procedures.

-So now I'm into the second half of the rotation, which is obstetrics at NNMC. It's pretty much the definition of hell. When not on call, it's twelve hours (0500-1700) at the triage desk, trying to determine if women are in labor not. Great fun.

So in life outside of the hospital (what? There's life outside of the hospital?), I got a book published! No, I did not write it this year; I wrote the story a while ago, but I decided I might as well see if I could get anything to come of it. I went through a self-publishing company, which pretty much means that I pay them, and they do the marketing and distribution and whatnot after that, and hopefully I get some money back in royalty payments. It's on Amazon, even, which is really cool, but here's the website for the book: http://thenetworkconvergence.com/ This does mean that everyone should buy a copy (and recommend it to your friends...) I'll even sign them for you. Or you can buy a copy directly from me for a discount. Let me know. Whatever.

Anyway, that's what I've been up to for the last two months. Hopefully it won't be another two months before I update again.

Penicillin desensitization

I spent Friday morning in the ICU for a penicillin desensitization. Sounds exciting, being in the ICU, but it was actually a lot of sitting around, doing nothing but talking to the patient. It takes place in the ICU so everything is there in case the patient has an allergic reaction (which is kinda expected; the reason why he needs to be desensitized is because he had a reaction in the past). Fortunately, he didn't this time. Like most things in medicine, boring is good.

Penicillin desensitization isn't something that's done all that much anymore, because there are so many other antibiotics that can be used for infections; however, for some infections, such as syphilis, penicillin is by far the best choice, so if you have a patient with a penicillin allergy, you desensitize them in the ICU and give them penicillin.

The way desensitization works is that after everything is set up in the ICU (EpiPen in the room, etc), you start with a very, very small dose, and then if everything goes well, there are eight more injections with increasing doses, separated by twenty minutes. The whole thing takes almost three hours (160 minutes), and then you keep the patient in the ICU for another hour or two after the last dose (which is a full treatment-sized dose) to continue to monitor for allergic reactions. So there's something to do (which takes two minutes) every twenty minutes, and the rest of the time is spent waiting and watching and chatting with the patient (and watching ESPN, because that's what people do during March Madness).

We spent most of the time talking about careers, of all things. The patient is a lieutenant in Navy intelligence, working in MTAC (yes, the real MTAC... it is not a fictional creation of NCIS). His orders are up in January 2011, so we talked about what he wants to do next. Since he's going to be up for promotion to lieutenant commander by then, he wants to deploy to Iraq or Afghanistan (outside of the medical corps, there are boxes that need to be checked for promotions); the problem is, he's HIV positive and therefore not sea-worthy (we say 'non-deployable' in the Army). You can remain on active duty with HIV, and like all medical information, that status is classified medical information, but when it's time for promotion boards, the question does get raised about lack of overseas duty. Fortunately for the patient, he did deploy and have sea time before he became HIV positive, so that shouldn't be an issue for this promotion board, but he does know that he won't make commander, so he's planning on getting out at his twenty-year mark, which is in seven years.

In all, chatting with a patient while doing absolutely nothing isn't a bad way to have to spend a morning. And then I spent the afternoon being enrolled as a healthy control in an asthma study, so it was a very low-key Friday. The hardest part about the whole day was getting skin tested for allergies (I'm apparently allergic to birch and cottonwood pollen; who knew?). As my surgeon friends tell me, this shouldn't even be allowed to be considered an internship, because I hardly ever have to do any work.

And back to the grind

Well, after many hours of travel on Sunday, I arrived back home on Sunday night, only to have to go back to work at WRAMC on Monday morning, to begin my Allergy and Immunology rotation. Fortunately, it's a pretty easy rotation, so that helps ease the pain of being back somewhat. In fact, it's even easier than my Allergy and Immunology rotation at Tripler last year, because there are fellows here (completed their residency, now getting advanced training in Allergy and Immunology), so I essentially just follow them around.

The first patient I saw on Monday was a two-year-old girl who suffers from maternal hyper-vigilant syndrome--pretty much, there's nothing wrong with her, but her mother thinks that she gets sick more than two-year-olds are supposed to, so she's being worked up for an immuno-deficiency syndrome. I'm pretty sure everything will come back normal.

Nothing too exciting on Tuesday or Wednesday, just the standard allergic rhinitis and hives. Today, one of the allergists at WRAMC was giving a lecture on immunology and occupational asthma to the second-year preventive medicine residents at USUHS (working on their MPH), and she invited me along. Of course, by the time I got back to WRAMC, all of the fellows were done seeing their morning patients, so I didn't really have to do except work on my application for a Virginia medical license (we have to be licensed; it doesn't really matter which one, and Virginia is one of the easiest and cheapest) and took off early to take some of the paintings I bought in Peru to the framing shop, where I spent an arm and a leg to get them framed. They better look pretty good when they're done.

Done with the rotation!

Today was the last day of my research rotation (I'm still in Peru; not leaving until early Sunday morning, but all I have left to do is hang out in Lima and spend money I don't have at the Inka Market). It was a pretty low-key day; all I did was give my presentation. Here's the title slide:

Both LCDR Maves and Wes (the Georgetown student) chuckled at the little bugs at the bottom. So, in case you can't tell from the title, I focused my research and my presentation on entomology (the study of bugs, not the study of language--that etymology) and its role in preventive medicine, starting with the history of diseases carried by bugs in the military, with a healthy amount of information about MAJ Walter Reed, because no self-respecting Army preventive medicine resident can do a project that has anything to do with bugs without talking about MAJ Walter Reed.

So that was that. As I was filling out my evaluations and preparing to email the presentation to my program director, though, I realized I never turned in a research proposal to her (supposed to be done one week before the research rotation begins) because I never filled one out. So I did that this afternoon, too, and amazingly enough, I did everything from my proposal during this rotation. I'm just that good (filling things out retrospectively doesn't hurt, though...).

Now I just need to figure out what I'm going to do tomorrow that won't end up costing me another few hundred Soles... (BTW, Mom, I found a painting I think you'll really like. Happy birthday. You'll get it a week after our birthday, when you and Dad come visit).