Sunday, September 11, 2011


All day long, I've felt uneasy, unfocused, unsettled.  I suppose that it'd be terribly easy to blame it on being bombarded with images from that horrific day a decade ago.  In some ways, I thought I that I was a little further along, that the scab would hold.  I didn't lose anyone in the attacks, don't have any amazing story of survival, or any first-hand account from that day. My stories from NYC are apocryphal; they're the "friend of a friend" ilk.  Still, like most everyone, I remember exactly where I was, exactly what I was doing, and exactly how uprooted the world felt to me in the span of a few short hours.  As I climbed into a coworker's car and fled home, I remember the certainty that anything was possible, that maybe the bomb threat on our office building in Atlanta was another imminent attack.  That evening, I remember being struck by a news correspondent's grace and composure as she walked the ash and paper-filled streets of lower Manhattan.  I remember the haunting silence in the skies near Hartsfield International Airport.  I remember getting drunk and reading Hemingway, identifying more than ever with his lost generation.
The decade since has been kind to me.  Several weeks after 9/11, I met the woman that I'd later marry, the woman that now carries our child within her.  I've grown as a person, as a husband.  I've mourned the loss of dear family and friends and have celebrated the arrival friendships and family anew.  I've abandoned the corporate world in favor of chasing my dream to be a physician.  I've left family and friends on the other side of the country to strike out on this crazy endeavor with my wife and my dog.
In many ways, I feel courageous more often than not.  I feel humble, thankful.  I am luckier that I deserve to be.  Still, when file through the images from that day so many years ago, when I hear the sounds of the chaos, it still fills me with dread, with terror, with anguish.
Go hug someone you love; tell them what they mean to you.

Monday, August 15, 2011

Le Circ

I've performed (under close supervision) two circumcisions.  One was on an 8-day-old; another on a 16-day-old.  It's a crazy, crazy thing to do.  After administering anesthesia, removing adhesions, installing the correct Gomco clamp, you just do the damned thing.  Generally, the babies tolerate it pretty well without very much agitation.  One of them slept through it.

On another note, I'm giving up calamari for a while.

Saturday, August 13, 2011

On Being a Part of It, In Good Times and Bad

Another week has flown the coup.  I am having an amazing time in my Family Practice rotation.  Part of it stems from the fact that I'm working with preceptors who are near my age and who love to teach.  They're great at encouraging me to be a part of their day and to help them with patients.  It makes a huge difference, believe me. One of my docs does a lot of pediatrics and women's health care, which is pretty interesting.  In all, I've been seeing a lot of good cases, meeting interesting patients, and getting better at the art of being a physician.

The Bad
It's interesting to be in the room, to work with someone, and to be privy to such personal information.  I've heard things that spouses might not hear from their loved one.  I'm trusted to inspect areas of concern on a body that few will ever be given permission to examine.  There are few things better than to be there when you know the solution for a malady, when you're able to offer comfort, solace, a remedy.  Antithesis to the joy is being the bearer of bad news, the worst news.

I spoke with a preceptor about how he'd discovered what was likely lung cancer in a patient who'd had a non-remitting cough for some time.  The patient had to be begged to get a chest X-ray.  Being in the room while the doctor delivered the news was, to say the least, humbling and crushing.

Last week, I was helping with an OB exam.  We got the bedside ultrasound and doppler and were going to do a check for a patient complaining of bleeding and abdominal pain.  We saw the fetus but no heart flutter.  We couldn't find fetal heart tones with the doppler.  Standing there in the darkened room, watching the woman's face strain with the comprehension of the images on the monitor was absolutely crushing.  I can still see her bathed in the light of the LCD panel, eyes widened with fear, tears welling.  It was an awful, awful silence.  At times, I don't know if my heart is large enough for medicine.

The Good
Mostly, though, I get to deal with sick people that can be helped and who's understanding of their body is, let's say, unique.  A couple of days ago, I met with an obese gent who told the female nurse that he had an eye problem that wouldn't clear up.  (It's likely allergies.) When I met with him, he confessed that, although he was too embarrassed to tell her, he was here for a rash on his penis that wouldn't go away.

He'd been to see someone about it before and, when they recommended treatment and another circumcision, immediately considered them a quack.  He was convinced that a salty discharge from was drying the skin on his penis.  Also, he also was certain that his penis was shrinking.  I explained that his recent weight gain likely changed his perception of his penis but it was doubtful that it was going anywhere.  The physical exam showed that he had a infection that likely stemmed from a hygiene problem worsened by extra penile skin.  Another circumcision that completed the job would probably remove the bacterial breeding ground and prevent it from recurring.  As it stands though, treatment with topical and oral anti-fungal meds will likely do the trick for him.  Weight loss will do wonders for his ego ... and ruler.

Monday, August 01, 2011

On Free Lunch and Ethical Comprimise

On my last rotation, drug reps would provide lunch for the office in exchange for a little face time with the doc to discuss their products and garner feedback from the prescribing physicians.  As I was essentially glued to his hip, I attended these lunches also.  The more experienced reps seemed to have an easy-going relationship with the doc: they'd known one another for a long time, they'd talk about the drug, and, thankfully, would intersperse normal conversation.  For many of these, it was informative and beneficial.  Here's new information about a drug, here's a new combination with a synergistic drug, here's some news about pricing or insurance coverage that will help your patients, and ask for information about how the physician prescribes it.  Also, they'd stock the sample shelves.  So, it's a good way to get information.  As a student, it was a great way to learn a little more pharmacology involved in family practice and save some cash on lunch.

Occasionally, however, I'd meet a rep that really made me feel icky, that reminded me of a caricature of a used car salesman.  On one particular day, a slick dressed gent who wasn't particularly humble was pitching his wares and doing his best to sell his drug.  He was trying so damned hard that, at one point, he actually says "Boom!!!  Take that, high blood pressure!" about his drug's ability to lower pressure.

I sat there amazed but thankful for the best catchphrase I'd hear in quite some time.  Personally, I'd love to see it in some ad campaigns.

Sunday, July 31, 2011

Boom! Take That, First Rotation!

For most of July, I worked in a Family Practice clinic with a doc who uses OMM (osteopathic manipulative medicine) for some of his patients.  After two years of having my face in a book, it was exhilarating to actually be in a clinic and working with patients.  There were times when I felt like an actual doctor and, as expected, many times when I realized just how little I know.  It seems that most of the patients we saw had the problems you'd expect: diabetes, hypertension, hyperlipidemia.  My doc was a former flight doc and a great guy.  Literally, he'd bound down the hall and into a patient room.  Often, I'd have to run to remain hot on his heels. He taught me a ton and didn't make me feel like an idiot.  Occasionally, I'd do that on my own.

Valsalva and the Fluid in the Ear
One patient came in with a complain of fluid behind her ear.  After taking a brief history, I looked in her ear.  Sure enough, I was able to see a little fluid bubble behind her ear drum.  My doc asked me to have her perform a Valsalva maneuver and see if the tympanic membrane fluttered.  I thought it a little strange but, as I was looking in her ear, I asked her to "bear down" with her abdomen to increase pressure.  She looked at me a little funny.  "Bear down," I repeated.  "Sort of like when you're having a bowel movement."  Her face looked at me with the same confusion that I felt inside.  What the hell does a bowel movement have to do with an eardrum?  Why do a Valsalva for this?  I made eye contact with the doctor who was staring at me like I was a total moron.  As he walked over and took the scope from me, he said to the patient, "Just hold your nose and swallow."
"I didn't know that was also called a Valsalva," I whispered.

Saturday, July 30, 2011


Didn't want to jinx anything by writing.  I've passed my Step 1 boards.  The silence is over.  I'm back with stories from the field.

Thursday, June 09, 2011

T-Minus 14 Days

Boards in 14 days.  Heads down studying.  Doing very little else other than jamming so much shit into my brain that I am neglecting to grocery shop, see or talk to my wife, go outside, drive well, dress well, and so forth.

I feel like a penguin on an iceberg watching others jump into the water and feeling rapid cycles of fear, anticipation, terror, and exhaustion.

In other news, if "Music of the Night" from "The Phantom of the Opera" pops into your head at midnight while you're studying, DO NOT, under any circumstances, create a Pandora station to listen to it.  If you do, I promise you, your efforts will end like this:  three tunes later, a song will play - maybe it will be "Circle of Life" from "The Lion King," maybe it will be "One Day More" from "Les Miserables," maybe it'll be "Memory" from "Cats." Rest assured, a song will come on and it will grab you.  You'll be alone at nearly 1 o'clock in the morning, alone, singing aloud, tears streaming down your face, dripping onto your Pharmacology notes.

Grrrr, manly!

Friday, May 13, 2011

Out of the Forest

Second semester done.  Boards looming.  No longer walking into the forest.  Running terrified out of it.

Friday, April 15, 2011

That's Pure Hell

Another week in the record books; another system completed.  Today marked the final exam of the reproductive system.  I'm relieved and quite tired.  Sleep beckons but I've got a story to tell...

This Is Probably Going To Sting.  I Mean Really, Really Sting.  Badly.
This week, all the students did a male genital exam.  This consists of doing a physical inspection of the genitals, palpating the testicles for masses, feeling for hernias with the old "turn your head and cough" maneuver, and the prostate exam.  For these male and female genital exams, the school hires "patients" who are compensated for their time in helping further our education.  Let's just say that these folks come from various walks of life: some are dedicated to helping us learn, others are on tough times and need the money.  Regardless, it's a pretty unique thing and, for sure, is one hell of a tough way to make some money.

When it was my turn to go, I was grouped with two other students and a preceptor who would oversee the process.  We walked into the room and saw our patient: a young man in an exam gown, a little nervous looking. He was pretty fit and looked like he'd seen some scrapes in his life as evidenced by some visible scars and plenty of tattoos that covered his arms.  He reminded me a little of a down-on-his-luck Manny Pacquiao.  Behind us on the counter was a box of gloves, a few tubes of Surgi-Lube, and a paper towel with a huge mound of gel (similar to what you might see when you're preparing to insert a catheter).

After a little chat, the exams began.  The first student started out, asked the patient about his health history, did a fine job with the exam, and was cruising with no hiccups until it was time to do the digital rectal exam.  He grabbed a tube of lube from the counter and fumbled with it a little while trying to get it on his fingers.  To make matters worse, the patient wouldn't quite bend over far enough on the table to allow for a easy exam.  (Honestly, can't say I'd blame him.)  Undeterred, [student 1] continued and the patient did his best.  Prostate examined, hands washed, sighs of relief sighed.

The next student moves in to the repeat the exam and, as expected, sort of built on the what we've just seen by incorporating feedback in real time, if you will.  He was very precise in his exam and his technique.  When it came time for the prostate portion, he turned to the preceptor and asked if he should just use the lube on the paper towel.  The preceptor gave his approval and the student easily got his finger lubed up and ready for the exam.  He asked the patient to bend over and, confidently, began the exam.  As he conducted his exam, [student 2] asked the patient to relax and tried to reassure him.

As I stood there with the first student, I noticed that the patient's toes had curled under his feet, and that his hands had clenched the table, and that his arms were quivering.  Truly, his feel had curled up so damned much that I though [student 2] was going to be wearing Dorothy's ruby slippers.  We looked at each other for a split second and the first student asked the patient if he was uncomfortable or if he was doing okay.

"I think ... it's ... alcohol," the patient said through gritted teeth.

Everyone in the room gasped and blanched, including the second student who, by the way, immediately ended the exam.  We all leaned over the paper towel on the counter and smelled the mound of hand sanitizer on it.  It was never lube!  Someone had prepped a bunch of hand gel and left it by the lube ... while we were doing prostate exams.  Needless to say, we apologized profusely and asked if he needed some time to go wash up or if he was still in pain.  He said that he was fine and that we should continue.

"Holy crap, this dude is prison strong!" I said in my mind as I gloved up.

I will admit that it's a hell of a thing knowing that you're batting cleanup and having to do another exam on a patient who's just had a bolus of Purell introduced into his rectum.  During the genital exam and hernia check, I talked with the patient while explaining what I was doing on the exam.  When I asked him about the prior hernia that he mentioned, he pulled up his gown to show me the scars on his chest from the repair of a surgical hernia after he'd been shot.  "Shot," as in "with a gun."

"Damn," I thought, "[student 2] is gonna get his ass killed tonight."

When I got to the prostate check, I made sure to grab the tube of the lubricant and apply a liberal amount.  I did the exam, discarded my gloves, and, with the other students, thanked the gentleman profusely for his time and involvement in our education. We offered our most sincere apologies and left the room.  He mentioned that it was like something from SNL and told us his nickname as we were leaving.

After our debriefing session with the preceptor, the three of us students walked, shell-shocked, back to our study carrells.  [Student 2] remarked about how I charmed the guy and how we were best buddies by the end of the exam.

"It wasn't that hard, really.  All I had to do was not put a handful of Purell in his ass and we were buds."

It really is the simple things, isn't it?

Wednesday, March 30, 2011

Dr. D.R.E.

Class continues to progress.  Board exams relentlessly approach.  In a few months, I'll be in the hospital on rotations.  This journey seems so far from where it was when I quit work some years back and began this endeavor.  As I'm in the midst of what is the craziest bit of studying that I've experienced, I've not written very much lately.  Do, however, feel free to check out Scholarly Photos, a photo blog that I've created to provide some creative outlet in lieu of writing.  (See the links to the right; you'll know the one.)  I look forward to posting more regularly in the near future.  In the meantime, please accept the following yarn as a down payment on future posts.  
-- The Scholar

Yesterday, I shadowed a doc at an Urgent Care clinic.  In the past, I have been stunned at the variety of things that I've seen, amazed at her prowess in diagnosing and treating, and thrilled at what I've seen.  Late in the day, we saw a patient who presented with prostatitis.  We took a history, did a physical exam, and asked him for urine.  The doctor got a gown for him and asked him to change into it because we'd need to do a rectal exam.  Pretty cool, I thought, as I walked out of the room.

A few minutes passed and, during a break, she asked me if I'd done a rectal exam.  She asked if I wanted to do this one.  I let her know that I'd never done one but I'd love the opportunity as it would be a great learning experience.  As we went back into the room, I was pretty amped from the adrenalin and anxiety.  Like a hawk, I watched everything she was doing.  She asked the patient if he'd allow the student to do the procedure as a learning experience and he consented.  Immediately, I threw on some gloves and was overcome by a sudden urge to roll my freaking sleeves up as far as I could get them.  Seriously, if I was wearing a muscle shirt, the sleeves still wouldn't have been up high enough.  No worries, I was going in!

The doc gave me another quick demonstration which I pantomimed in the air.  I can only imagine the look on the patient's face as he overheard me repeating everything; poor guy must've been mortified.  Next, the doc and I tried to put a dollop of lubricant on my finger.  Turns out, the tube of KY was nearly empty.  Honestly, it was like fighting to get the last bit of toothpaste out of tube that should've been thrown out a week ago or, more specifically, exactly like someone nervously trying to get adequate lube on their finger before doing their first rectal exam on a patient.  Once successfully prepared, I approached the "entry zone," began the exam, and did my best to act out her instructions, being careful to try to listen with my fingers for any abnormalities.

After, I ditched my gloves, maintained my professionalism while I left the room, and, grinning, washed my hands as furiously as Lady MacBeth.

In addition to that patient, I helped suture a hand laceration, removed an embedded foreign body from someone's eye, did a few physicals, practiced OMM on two patients (a respiratory case and a shoulder rehab), and saw a bunch of sick kids.

My day was awesome.

I.  Love. Medicine.

Wednesday, February 23, 2011

New Neighbor, Same Old Crazy

So much to share, so much has happened. First, however, the most recent gem...

Several months ago, my crazy upstairs neighbor moved away.  Since then, things have been, frankly, far less crazy.  Don't get me wrong, it's a good thing.  In fact, it's a great thing.  The new tenant is a pretty nice guy.  He's an older gent who's renting the apartment while he's in town for some continuing education courses related to his job.  In start contrast to the previous tenant, Batshit McCrazy, he's a friendly, "with-it" kind of guy.  On numerous occasions, we had conversations outside.  He's got a knack for remembering who the hell I am and what it is that I do.  To top it off, he remembers Winning Run and a bit about her as well.  I suppose that he's just a nice guy who enjoys conversation.  Anyway, it's a nice change from the previous who, each time she met you, seemed happy to be meeting you for the first time.

Last week, on the eve of the President's Day weekend, I was packing my car to head to Seattle to see Winning Run.  As I'm putting the last bag inside, I see him walking across the parking lot toward his apartment and say "hello."  We begin to talk.  After a short while, the conversation drifts toward current events and to the upheaval in Egypt and other countries in the vicinity.

"It's pretty crazy what's going on over there, right?," I asked.

"Yeah," he said.  "It's a mess.  We need to watch out."

"Tell me about it.  Oil prices are going to go through the roof," I offered.

"Uh huh.  We need to be aware of what we're doing; they're watching," he explained.

"Yeah, we use too much oil.  I guess the government does need to watch out.  We need to wean ourselves off of it, don't we?," I offered.

He looked a little puzzled. "Government?  No, man, the UFOs are watching us."


"Huh?," I asked, unsure of how we moved so quickly from unrest in the Middle East to extraterrestrial monitoring of our affairs.

"Yeah, they're out there," he exclaimed while pointed toward the horizon.  "I seen 'em flying.  I know planes and what I've seen are not planes."

"Okaaayyyy," I said while trying to put on my best poker face.

"It's started back in World War II when we built the bomb and brought all the Nazis over to work on the space program.  We had the power of death, the bomb.  They started watching."

"Really," I said, moving toward my door.

"I've got friends who work for nuclear power plants.  Sometimes the guards will go outside and see their ships hovering outside.  Sometimes they shut the plants down, just turn 'em off, to let us know they're watching us."

"Guess we'd better behave, then," I told him.  I wished him and good evening and ducked into my living room.  "Well, that got effing crazy really, really fast," I said to the emptiness.
My favorite part of the conversation was how he looked at me like I was the crazy one for suggesting that the government, not aliens, were watching us.  Priceless.  And completely, utterly wacko. 

Long live Batshit Crazy McGillicutty..

Tuesday, January 04, 2011

Maybe It Isn't Really About The Baseball

A few weeks back, I commented to my classmate that I'd noticed a bunch of young guys in the town wearing Atlanta Braves apparel.  Being so far from home, when someone sports a hat or jacket from my hometown team, it's my first impulse to shout "Go Braves!" at them, or at the very least, to introduce myself and chat with them.  Hell, Winning Run and I did the same to some people in Seattle who were decked out in UGA gear one Saturday in the fall.  They were pretty friendly.  For some reason, however, I've been hesitant to do the same with the folks I've seen around town here.  "I'm pretty sure that these guys aren't baseball fans," I mentioned to my buddy.

Which brings me to today's lecture about gangs...
During what was an informative lecture about gangs that included several cringe-inducing security camera videos of homicides and assaults, I connected a few dots.  (Those dots, by the way, were not about why we were having this particular gang discussion as part of our medical school education. It was informative, engrossing, terrifying, and heartbreaking but lacked the ties to medicine that I would've preferred.) A local faction of major gang sometimes leaves graffiti tags using a three letter abbreviation or numerical equivalent. The officer giving the lecture mentioned these numbers. Immediately, I recognized them as an area code from the Atlanta area.  Then, I made the leap to Atlanta apparel.  When I asked the officer about this connection between the "area code" and MLB clothes and hats, he responded as if it were a novel idea to him.  "I guess they could be doing that.  It fits.  We'll look into it," he told me enthusiastically.  "Considering that I've seen more Braves gear out here than I did back in Atlanta, that might be a good idea," I said.  Then I returned to my seat and planned what I would say to the crowd when the mayor inevitably presents me with the key to the city.

In other news, I'm glad that when I saw the first of these cats, I didn't start yelling and doing the Braves chop ... or running through my pitch signs.  They might not be as nostalgic as I am for the Sid Bream slide.

Saturday, January 01, 2011