7/11/2008

Family & Friends –

It has been a long time since my last letter, lots has happened and I can’t possibly remember everything to catch up on all of it. However, I have finally started clinical rotations (so much better than the book-work of 1st and 2nd year!) so I think my approach for this letter will be to recount a few choice experiences in as much detail as I can and then just give a brief overview of what the rest of my time is usually spent doing.
First, my disclaimer: I have given similar disclaimers before, but I’m about to do it again! I’ll try and euphemize things and keep terms as medical as possible, but I have spent up to 14 hours a day in a urology rotation for the last 2 weeks…I can’t exactly chronicle how I have spent my time without using some “grown up” words. Be warned!

Well, having said all that, I’m proud to announce that I am the best third year medical student rotating in urology right now in the same way Ring Starr was the best drummer on the Beatles…namely he was the only drummer on the Beatles! J
Because of a crazy lottery system used to determine which order we do our rotations in, I was one of only 3 students in my class to start the year with my elective. Among those 3 students I was the only student to choose urology as my elective, thus I am by far the best third year medical student in urology at the moment! Actually, things are going really well and I’m really enjoying the rotation! Urology is considered a surgical sub-specialty, so of the 5 days a week I’m expected to show up, 3 of those days are spent in the operating room (OR) and 2 are spent in clinic seeing patient who are awake and who can talk back! Because it is a surgical field, urology has pretty harsh hours (I wake up at 4:30am and go to bed at 11pm and usually work 12 to 14 hour shifts with no lunch breaks except to eat a PowerBar while typing my progress notes at a computer). Despite these forsaken hours, I’m learning a lot about myself which is kind of scary…I REALLY REALLY like surgery and the OR! Yikes! Clinic is fine. I think I’ll like it even better once I know more, but I can’t get enough of the OR! I’ve scrubbed in on lots of surgeries in the last two weeks including several really long cases (including a 6 hour job) and I just wish every day was an OR day!
My residents are great also…but I’ll get to that in a minute. First, let me start at my first day and try and be at least a little chronological.

I thought my first day was going to be just an orientation day, and that is all I had mentally prepared for. I hadn’t expected to mingle among real doctors, let alone real patients who have real medical issues! I was right about one thing, there was an orientation. However, it lasted for 10 minutes! At the end of that time, I was given a pager number and the name of a resident and told to present myself at the Milwaukee VA hospital and page the resident ASAP!

What Eric says: ”okay, no problem!”
What Eric thinks in his head: “uhh…how do I drive to the VA? Where do I park? Once I’m there, how do I page someone? Are they expecting me, because I sure wasn’t expecting to be sent to them today!”

Anyway, I drove in the general direction I knew the VA to be, found it, ambled around until I found what looked like a somewhat legal parking spot, walked in the first door I found and stood there…let me try and paint this scene a little better…
The Milwaukee VA hospital is a multi-building 10 story hospital with hundreds of workers and hundreds of patients all going different directions. Everyone else seems to know where they should be and what they should be doing. Also, it is a major teaching center for MCW and so there are lots of medical students that flux through, so one new medical student is not a site that will stop anyone in their tracks and cause them to ask me if they can help. So there I am, feeling like I’ve got an IQ just north of a bedroom slipper, wondering how to page this mystery doctor. I finally resolved on a fool-proof, tried and tested method that has served bewildered medical students for decades: I blindly followed the first person wearing a white coat I could see through winding hallways until I lost site of them, but by that point I had been deposited at a nurse’s station and I once again demonstrated my keen mental prowess (“uhh…how do I page somebody?”)
This began a series of “go to this place and ask for so and so” followed by “now go to this place and ask for so and so”. This human pinball game culminated in me wearing scrubs and being dressed in a full-body lead apron just before being escorted into an operating room. The last thing, almost as an afterthought, as I walked through the OR door was that a person handed me a pair of dark radiation-resistant glasses to put on. This did nothing to ease my disquiet, but I went in anyway and stood in a corner until the procedure was over and the surgeon could pay attention to stuff other than the kidney stones he was trying to break apart and remove though the patient’s urethra (the lead apron and glasses were because X-rays were being used to visualize the kidney stones and instruments during the operation).
Anyway, at this point I met the two residents I’ve been working with for the last 2 weeks. Both are super cool guys and I feel spoiled because I know that all residents aren’t this cool, and I’m just glad I got the cool guys on my first rotation while I’m still fragile. I think a few months from now I’ll be much better prepared to face less ideal residents that I may need to work with.
Back to the story however, the day’s excitement didn’t end there! With my residents I spent the day in the OR and got to see several neat operations. To add to the adrenaline of things, two of the patients tried to have bad reactions to the anesthesia and there were a few tense moments when we could easily have lost them. They were convulsing and I was trying to help hold them down so they didn’t fall off the operating table. Even the anesthesiologist attending was shocked to have 2 of these cases in the same day when usually things like this only happen once every few months (I must have bad mojo or something!). Anyway, I went from helping hold down the second convulsing guy who was turning blue and trying to die to a computer training with several of my classmates. Most of them had spent the day in dull orientations and then I run in 5 minutes late dressed in scrubs, surgical mask and cap, sweating and flushed from the adrenaline and they could immediately tell that my day had been a little bit different than theirs had been!
When I finally got home I was exhausted and didn’t really do much besides just brush my teeth and go to bed!

The days since that first one have been filled with the exciting, the mundane, the weary, the tense, the exasperating, the bewildering, the overwhelming, the thrilling! I feel I have learned a lot and yet still have so far to go just to know the rock bottom basics! I have gotten a lot of positive feedback from people so far though, so that is encouraging because I’m working my butt off! Here is a run-down of an average day in the life of Eric during a urology clerkship:

I usually have to be at the hospital by 6am, which means I have to wake up by 4:30 or 5am
I have to pre-round which means see all the patients on our service who spent the night in the hospital and see how their night went, then I have to write a progress note on how they are doing (I still suck at these notes and they are my least favorite part of what I have to do in a day)
Then I round with the resident and see all the same patients again while he teaches me about all the things I did wrong when I pre-rounded (hey, I'm still learning…everyone is expected to have no clue at my stage!)
Then I usually spend most of the day in the Operating Room. After that first day, the residents have been getting me to scrub in, which means I actually get to assist in surgery. Tuesday, for example, I got to remove a softball-sized fluid filled-sack (a hydrocele) from a guy's scrotom and then sew him back together. My resident let me do a lot of the actual sewing and cutting! He just supervised to make sure I didn't mess up! It was pretty neat. I've also helped on several other surgeries. We do a lot of prostate removal surgeries (usually a 3 or 4 hour surgery), so I spend a lot of time on my feet for these!
Like I said, lunch is usually just a quick power-bar and then back to the operating room or clinic to round again. When all is said and done I've been spending 12 -14 hours per day at the hospital only to come home and have 1-2 hours of elders quorum stuff to do and several hours of study I need to get done also! I'm not sleeping nearly enough, but oh well! It is amazing how well adrenaline keeps you going throughout the day!
Yesterday morning I had a big presentation which I had to give to the entire Urology department. A pretty intimidating thing considering most of the people there have been urologists for a minimum of 10 years, and some for much longer than that! I did my presentation on a disease called Tuberous Sclerosis and one of the tumors that is common to this disease which are called Angiomyolipomas. I got a really good response from people, so I guess that means it went good!
Today I helped surgically treat a guy with phimosis. I’m not going to describe what this condition is because that is probably a little too graphic despite my disclaimer (if you really want to know, look it up on Wikipedia). Lets just say that the treatment for the condition is circumcision, which is a whole lot more unpleasant for a 65 year old man than it is for a little baby boy…enough said! I’ve also been assisting in a lot of cystoscopies and prostate biopsies looking for bladder cancer and prostate cancer, respectively.

Well, I’m not helping my sleep right now and I need to get to bed! Love you all!
-Eric