Falling

There seems to have been some scepticism regarding my earlier post about the guy who survived a three-story jump unscathed. However, it was quite true -- I was part of the trauma team that evaluated him. Admittedly, he was complaining of some moderate knee pain, but otherwise we couldn't find any serious problems. (Physically, anyway; his next stop was the inpatient psychiatric unit.)

Falls are unpredictable things. People have survived falls from airplanes without parachutes, while just a few days ago I saw someone who was in the ER because of a fall from a chair. The traditional rule of thumb is that a three-story fall is usually survivable, while a four-story fall usually isn't.

Re-connections

This past weekend Lady M and I went to a wedding here in central Iowa. The bride was a dear friend from long-ago Boston days, and there were numerous other friends there from all over the country, some of whom I've seen within the past few months and some of whom I hadn't seen in almost 15 years. It was quite moving to have a chance to make so many re-connections.

So congratulations and best wishes to Julie! It was wonderful to see everybody, and I'm hoping I'll get to see more of everyone in the next few months as I start to head out on the residency interview trail.

One more story

True story: Guy jumps from the third floor of a parking ramp downtown. Lands on concrete in front of a police car, miraculously unharmed. He gets up and starts walking back to the ramp. One of the police officers shouts after him "hey, where are you going?" He answers "up to the fourth floor to try again."

Room Service? No, Emergency Room Service!

This evening around dinnertime someone from the hospital cafeteria came to the nurses' station in the ER carrying a tray loaded with food. She said that D___ had called down, since he wouldn't have time to eat. But there was no one by that name working today. Then somebody said, "Hey, isn't the patient in Room A named D___?" Yup, turns out the guy used to work in the cafeteria and he ordered his dinner delivered -- during his emergency room evaluation and treatment.

One of the attendings was pretty mad, but you've gotta give the guy points for initiative.

The horror

Today I swung by a Chick-fil-A for a quick bite, where many examples of their ads were on display: plaintive-looking cows with crudely-lettered signs imploring the customer to eat more chicken. Eat more chicken, they begged with their haunted bovine eyes, or else we'll be slaughtered and ground into hamburger. It was a horrific view of fast food supply chain Darwinism. If the chickens had paintbrushes, would they be scrawling out desperate pleas for humans to turn their carnivorous attentions to seafood? Seriously, the more I thought about it the more I wanted to become a vegan.

But I must admit that it was a very tasty chicken sandwich.

Bracelets

Last night a young man came to the ER in police custody. He had been found down, was arrested for public intoxication, and was here for medical clearance before being taken off to jail.

I examined him, finding him to be minimally responsive and complaining of pain in his wrist. He was handcuffed to the bed rail, and the cuff was pinching him, causing his hand to swell. I asked the officer to remove the cuff, after which the pain subsided. Otherwise he was less conscious than might be expected given his blood alcohol level (about half again the legal limit), but the police, who knew him, said that this was a typical event for him and I found no other evidence of injury.

Outside the room I spoke with the staff physician, who asked me whether I thought we should perform a CT scan of the man's head. On the one hand, he was found down and there was no way to know whether he had hit his head or sustained internal injuries. Perhaps he was semi-conscious because of an intracranial bleed. On the other hand, he had been found in this state many times by the police, who usually took him home to sleep it off. It was a busy night, and we had lengthening wait times for all of our patients needing CT imaging. What to do?

Hydrophobia

The last patient I saw yesterday was getting rabies shots following an animal bite. After my shift, walking out of the hospital at 4:30 a.m. I came face-to-face with a raccoon sitting on the fence by the entrance eating goodies out of a trash can. "Hello, little furry rabies virus reservoir," I thought. "I'm going to stay well away from you." Admittedly, it looked less like a slavering, crazy-eyed beast ready to sink its virus-laden teeth into my flesh and more like an overfed, slightly lazy garbage mooch, but you can't be too careful, eh?

So lame I'm cool

Melinda June has tagged me with this task:

TO DO: List 5 things you do, did or like that some may consider “totally lame,” but that you are totally proud of.

1. Trivial quotes from famous people. Sometimes you encounter someone famous who has no idea who you are, but who will say something completely incidental to you. I collect these comments. For example, I once had to get Stephen Jay Gould's signature on a Drop/Add Class form for school, and he said to me "Looks like you're taking a lot of classes." I got a backstage "excuse me" from David Copperfield. And here's one for newly self-identified Fanilow Melinda June: I once met Barry Manilow. The quote? "Hey kid, get me an ashtray." (For his driver, not Barry.) Hmm, as I think about it my quotes are all from the 80s and 90s. For some reason I run into a lot fewer famous people since I switched from the music business to being a medical student.

2. End credits. I usually stay to watch the end credits of movies. I've had people ask whether I read them, but that's not it (unless I'm looking for the name of someone I know who worked on the film). No, I stay to listen to the end titles music, especially when it's an orchestral score. After all, a symphonic soundtrack represents a major artistic effort, and all of that work by composers, arrangers, copyists, conductors, players, recording engineers, etc. gets stuck at the end, largely unheard. At the end of the film the context is fresh, and you get to listen to it loud on a big sound system, sitting in a comfy chair. If it's a good score, that's worth the price of the ticket right there. Then I go out and meet my annoyed date in the lobby.

3. I'm a weather geek.

4. When I'm out on the road and I pass one of those "Historical Site" markers, I pull over and read it.

5. I can juggle two balls. I'm still working on the third.

I tag Tom.

Hello from Des Moines

Yes, that's right -- Des Moines. Yesterday I started a four-week rotation here in the Emergency Department of Broadlawns Medical Center. So far it's everything I could have hoped for. Yesterday I saw a large, bearded patient wearing Harley-Davidson paraphernalia who was speaking in tongues. We went on bypass today after receiving three motor vehicle accident victims at the same time. Two of my attending physicians are identical twins. And that's only the first two days: we're just getting started!

Hanging by a thread

The newly-resurgent and skein-besotted Madame L describes her latest yarn find as "Wicked stuff the color of some really potent girly drink guzzled by some slightly older tall brunette with great eyebrows who will tell you the best joke you've ever heard, finish her drink, and will take you home and wreck your life." Brava, Madame L!

Which got me thinking about my own recent thready experiences. I'm just finishing eight weeks of rotations on various surgical specialties, and when it comes time to plunge a needle loaded with suture into living human flesh, a great deal of consideration goes into choosing the right suture material for each of many surgical tasks. Sadly, even the most technologically-advanced suture lacks the romance of Madame L's vivid yarns. Prolene, for example, might best be described as being the color of the pen in the pocket of the slightly-built systems engineer who solves your Ethernet problem, drinks half a Diet Pepsi from the break room fridge, and then goes back to his cubicle.

On the other hand, if it's a question of holding together your surgical incision, that's the guy you'd probably rather hang out with....

Riddle me this

Today I gave a presentation that featured both Samuel Pepys and William Shatner. What was the topic of the presentation?

Ow! Ow! I'll talk!

I know that nobody'll believe this, but I wasn't trying to be coy regarding the location of my upcoming interview -- I've just been super-busy with school. However, I've obviously enraged the mob, and I don't need that kinda trouble.

So, in a bid to forestall the threatened physical and emotional violence, I can reveal that the aforementioned interview is relatively nearby in the Midwest. Indulge me for the moment if I'm a little scanty on the details; I'm just getting started with the process.

However, I can offer two guarantees to my loyal and demanding readers: 1) if I interview anywhere near any of you I'll be certain to let you know; and 2) fear not, in four months you will be tired of the constant yakking about residency-seeking on this blog and begging me to write about something else.

Scientific writing

This is a sample sentence from the journal article I need to be ready to discuss in conference tomorrow:

"Treatment comparisons will be adjusted for any detected confounding and effect-modifying covariates with the logistic model for dichotomous endpoints and proportional hazards models for time-to-failure analyses."

Um, okay.

It begins

Today I received -- and accepted -- my first invitation to a residency program interview. Here we go!

Ghosts

Today, coincidentally on the first day of my Urology clerkship, the department opened its temporary clinics and offices in the former OB/Gyn space in the oldest part of the hospital complex. This will be the Urology department's home for one year while their more modern space is undergoing a year-long refurbishment.

Oddly enough, this means that today I entered a men's room that, for years, was used by the men who were accompanying -- and waiting for -- the women in labor & delivery. There, on marble dividing panels, are decades of etched graffiti. A quick glance reveals the usual crude defacements, but on closer inspection these panels display something much rarer. I realized that many of the graffiti consisted of a name and a date -- a birthdate! Some of them even included a birth weight. Dozens of births were commemorated here. The first dates I saw were recent, but soon I found 2003, 2001, 1998, 1993, eventually finding dates back to the mid 80s -- over 20 years of births recorded here. And as I kept scanning, I found names followed by short ranges of dates, spanning days or weeks. I could hardly believe it, but there were multiple memorials to infants who had died. Some even included brief messages of love or remembrance.

When and how did it become a tradition to record the births -- and deaths -- of newborns on the men's room stall dividers? Once or twice seems somehow inappropriate, tawdry even, but there was a strange strength to the layers of names and years carved into the cheap marble. Even the intermingled crudities of traditional men's room scrawls seemed neutralized and made transparent against the background of all those babies' names. How many men were overcome by joy or loss or fear of the future and expressed it by adding to the list here? This afternoon I was searching for the earliest date I could find, but now, thinking back, I realize that since the OB department has permanently moved to another part of the hospital there is also a last name and date scrawled there, somewhere.

If any part of an old hospital is described as being haunted, it's usually labor and delivery. Today I found the ghosts.