Rural Rounds

Saturday, March 24th, 2007 We leave for Cancun today, and since Thursday I have felt rushed from one place to the next. MUlation was Thursday, then I picked up some of the medical equipment that John told me was available. Friday morning I received a vision exam by a retinal specialist, and now have visual field testing scheduled for just after Step 1 to absolutely rule out the possibility of a nerve cell tumor or impingement of my optic nerve from drusen deposited around the cup. Friday night I packed, and my tension continued. Packing and laundry interspersed with phoning family engrossed my evening until 11 p.m., at which point I felt I might truly rest. I was in bed by 1 a.m. I awoke at 6:45 a.m., none too rested. With two hours to spare I still felt stressed and rushed...My general lack of control of the trip leaves me feeling inadequate... Sunday, March 25th, 2007 The night passed harshly, as the sound of the air conditioner kept me up much of the night. Our morning meeting was a...

Perhaps the biggest event in all of medical education outside of graduation itself is match day. Match day is the day during fourth year when medical students across the country find out where they have been accepted for residency. In many ways, it is like a professional sports draft; students file past a large table of envelops to receive theirs, not knowing what residency program they've matched to until they open that powerful letter. A little background on the match process... Students initially register for the match process in their fourth years with the Electronic Residency Application Service (ERAP), and through the fall and early winter of fourth year interview with the residency programs in the specialty field of their choice/interest. By early January, students begin to submit a rank list of the programs they are interested in, in order of interest. The programs that they interviewed with then submit a rank list of students they wish to accept as new medical interns. A c...

Monday evening this week my lab was required to do our GTA teaching session. GTA stands for Gynecologic Teaching Associate, which is the title of the women who are paid to be teaching assistants for students learning how to do the breast and pelvic exam. The role of the GTA is not just to teach how to do the breast and pelvic exam, but to allow the students to learn the exam by performing it on them while they teach. Now, it's one thing to do a prostate exam (a requirement to fulfill before entering our third year, for whatever reason), but the awkwardness of inserting your first digit in a man's rectum pales in comparison to the awkwardness of performing your first pelvic exam. One thing's certain; you never forget your first time. I was one of two guys in a group of four students, with two GTAs who work as nurses in the OB/Gyn department at Columbia Regional. The nurses gratefully understood the nervousness of performing a pelvic exam, especially for us guys who don't...

On Tuesday I had my third day in the pediatrics pulmonary clinic. I am grateful for the experience I have had there. I have been given a lot of practice in interviewing and examining patients that I would not normally have in my APD class. The first time there, I was nervous and avoidant of seeing any patients by myself. This Tuesday, however, I saw several alone before they were seen by the doctor, and prior to being seen by the doctor would return and give him the rundown, a.k.a. presenting the patient. I was getting better even as the morning wore on. One thing challenging about pediatrics is that your patient is often only a third your size with a will and defiance five times your own, making for a formidable adversary. When you ask an adult patient to comply with a request, generally they will without much hesitation. When you ask a child, you are first faced with putting the request in a manner they will understand. Second, you must ask it in a way that they will comply with. Tha...

Yesterday in Advanced Physical Diagnosis my classmate Blair and I met a man who was nearing end-stage liver disease. In the book The House of God, there is a patient with hepatitis who is named the Yellow Man, and the description fit well for this patient. My Yellow Man was a lanky gentleman with short messy brown-black hair, with a complexion that could be considered olive under normal circumstances, but was now a sickly yellow tint. All of the waste products from broken down red blood cells that couldn't be cleared through his diseased liver were built up in his blood to the point of making him yellow. Yellow Man said that he had been having nosebleeds for the past two months without relief. In interviewing him it became apparent that he had hepatitis C, a liver infection that eventually leads to scarring and liver failure. It was difficult to determine how he had gotten hepatitis, but he was under the impression it was from a blood transfusion. As his liver became more and more...

Yesterday I had APD and was with my classmate/partner and our instructor Dr. Phillips. He introduced us to a woman in the VA who had severe right lower abdominal pain who was admitted Thursday. She was on a morphine drip, and reported that the pain was so terrible she was passing out when she was admitted. Since APD is essentially a class on doing patient histories and physical exams, this was "practice" for us. We spent a good hour asking every question we could, exhausting our minds for medically relevant topics, and only then did a complete physical exam (almost a complete physical). By the time we reached the physical exam, Dr. Phillips had left to go to the swamp (the residents' workstation room) and said he'd wait for us. As my classmate and I moved through the physical, we reached the abdomen. I gently examined the lady's abdomen, noting that she flinched and guarded when I began to press firmly. I moved back and Blair repeated, with questions in between. ...

It's the third week of class for me now (all those undergrads who started today have it way too easy), and the year is out of the gates and running. It's incredible that a half month has already flown by. Time is so short when you stop to think about it. Maybe it's no wonder why so many people these days get so busy; they've learned that there's only so much time they have on this earth to accomplish something, and they're working hard to get what it is they're trying to do, done. It seems though that the ability to stop and smell the roses is still eluding most of us. As the wise philosopher Bueller once said, "Life moves pretty fast. If you don't stop and look around once in a while, you could miss it." All too true. I missed a lot of the last six months because in trying so hard to get from A to Z, I missed B - Y. Worse yet, getting to point Z results in a new point A altogether. Now that I've lost everyone... In the...

The year began wonderfully and quietly, and I believed it would turn to be an excellent year. Then on January 10th, or 11th, Pam Miller committed suicide. I received a phone call from John Drage informing me of what had happened. We hadn't been very close for quite some time, but Pam Miller is possibly the person most responsible for who I am now today. I believe there are God-ordained moments in time that influence our entire lives, and for me one of those moments came in the winter of 2002, the second semester of my freshman year at MU. I had grown apart from the friends on my floor I had initially made when their desire to go party and drink and my desire to stay sober led to our no longer hanging out quite so often. On a Saturday night I sat in the 4th floor lounge of Hatch Hall playing old school Nintendo alone, and most of the floor was gone doing other things. Pam Miller suddenly appeared passing through, and having met before she saw me and came and said hello. She invited ...

Last weekend I was able to attend the Global Missions Health Conference in Louisville, Kentucky. The conference is on Christian missions-field medical and health care work, both nationally and internationally (although international medical missions is overwhelmingly represented). I attended the conference with one other person, Halley, a nursing student I am friends with who heard of the conference through the Nursing Christian Fellowship group. We left town together on Thursday night last week to be able to attend the whole day's sessions on Friday. Being a six-and-a-half hour drive from Columbia (seven and a half when factoring in the time I drove in the wrong direction), we arrived in Louisville at 3 a.m. central time. Louisville unfortunately is on eastern time. After a two hour nap on Friday morning I awoke shortly after six to get over to the conference. The church that it is held at is so big you could fit my entire hometown's population inside the building (West Plains...

I apologize in advance for the length of this post, but it will likely be a week before writing again due to a busy schedule at the moment. So sit back and digest this in pieces if you like (although, if you want to know when you can see Dr. Peppers in action, scroll down to the last heading). I've provided some headings for breaking it up a little bit. Today was the second time my APD (read: advanced physical diagnosis) group met over at the VA hospital. This time however we were actually able to see patients, thanks to Dr. K, who is the resident paired with the attending in charge of our APD group. Dr. K had a talk with us about how she understood we needed to see patients in order for this to be a learning experience at all, and we proceeded to the second floor wards. Today we saw three cases. This week's cases: VA Hospital Mr. H was an elderly man who had developed pneumonia and a pleural effusion in his left lung. He was cooperative with allowing student doctors to exami...

Today was the Rock Equippers retreat. Basically, the equippers retreat is a day long getaway out of town somewhere where the small group leaders can gather together, be encouraged, share stories, and have John Drage remind us of what we have committed to as leaders and renew our commitments to ministry. One of the verses John shared in his introduction of our time together was 1 Peter 2:9. It says: But you are a chosen people, a royal priesthood, a holy nation, a people belonging to God, that you may declare the praises of him who called you out of darkness into his wonderful light. - 1 Peter 2:9 The verse is exceptionally powerful. I was reminded of the following quote: "It is a serious thing to live in a society of possible gods and goddesses, to remember that the dullest and most uninteresting person you talk to may one day be a creature which, if you saw it now, you would be strongly tempted to worship....There are no ordinary people. You have never talked to a mere mortal....

***Note, some of this material may not be suitable for those sensitive to squeemish topics. Those sections will be starred for your own warning*** Last night was my first day of ACE (Ambulatory Care Experience, basically a glorified shadowing patient-seeing experience before your clinical years) and this block I am doing my ACE in the Emergency Department. I was apprehensive at first, not because of what I might see, but because having volunteered there as an undergrad I was not given much to do in terms of volunteer service. In fact, they acted like they didn't know what to do with me. I called the ER to get the passcode for entry shortly before 4 p.m., and then, donning my white coat, proceeded down the hallway leading towards the west elevators and turned the corner towards the ER door. I let myself in, walked confidently up to the first person manning a desk station, and asked for the attending. There were two that night, and I was recommended to go to Dr. D. Introducing myself...

In psychiatry, there's a set of three patterns of thought that are observed in depression known as the cognitive triad. The cognitive triad consists of the following: A negative view of oneself A negative interpretation of experience A negative view of the future Outside of clinical depression syndromes, I feel it adequately describes the pattern of thinking in any episode of depressed mood. Having tried to think through my own periods of moodiness and depression, I've found that the mood often exists and persists only when all three patterns of thought are present. More on this later, but first a breakdown of how the triad has occured in my own thought process. To start, I've had a decent amount of difficulty with self-esteem, and with large groups of people social anxiety as well. When I begin to start feeling depressed, it will often start with "a negative interpretation of experience". Usually with people this manifests as an anxiety that the person or people ...

Last week was the end of block test week, and at the very end of the week, on Friday, I left for Mexico, Missouri for my church's annual 22-hour retreat. For the last two years it has been perfectly scheduled to coincide with the very end of test week and the beginning of break week, and both times so far has been an incredibly refreshing way to escape the world of academic medicine and the bustle of the city. "Cell phones don't work out here," I mused on the drive out to the camp. The camp where we hold our retreat is several small buildings owned by a Baptist church group out that way that allows us to use it each year. The property is the size of several football fields, with a creative array of fields, wooded hollows, remnants of a creek and some runoff lanes between rises in the ground. There's a lake with a dock that is the perennial wilderness baptismal. There's also a barn-like building that now serves as a chapel. A firepit next to an outdoor ampithea...

The summer research jump from last year to this year has been quite a step. I did a small research project, not too terribly important, last summer, that was published in a free online-only journal (in other words, not a real big deal, but worth being proud of). This past summer, I worked on infectious disease research in the pediatric department at the University's Children's hospital. My mentor, Dr. Mato, gave me and my classmate Amanda assurance that we would most definately see our work published. Yesterday, when I dropped by Dr. Mato's office while up on the pediatrics floor, she spoke of submitting my research for the Pediatric Academic Societys' annual meeting in Toronto for presentation. If my work is accepted, it would mean the chance to present my poster and research in front of doctors and researchers from across the country. Being only a medical student at best, I was humbled to find out she sees us presenting research amists other researchers who have done ...

Today I attended my fifth (yes 5th) wedding of this year. No one else that I know of is getting married before the end of the year, and that's good, because one season of giving wedding gifts is enough to break the bank. I easily spent an undisclosed large sum of money altogether on wedding gifts. Sheesh! Weddings can be incredibly wonderful, and sometimes difficult. Incredibly wonderful predominates however, as I am usually very excited to be able to participate in a lovely couple's special day and celebrate with them. Difficult sometimes in that if I'm not careful I can either 1.) start to feel the wedding-fever creep up and make me feel like I need to start looking for my own wife-to-be, or 2.) remind me that I haven't gotten to that point of finding someone to marry yet. I'm glad that for today's wedding, I was able to avoid falling into both traps. Now, about the wedding. Aaron Ferguson and Stevi Davis had known each other since I can remember. I had always...

Four weeks of school have gone by faster than should be allowed, and I'm already looking downhill towards my first test week of the second year. I'm thankful that Labor Day weekend falls right at this point; the three day long weekend will give me some chance to catch up. I have unfortunately been spending too much time in the evenings to socialize with those who come to visit (which, in the last two nights, has been a lot of people over). But I also think, maybe that's fortunate, because I know how easy it can be for me to fall into a sense of loneliness if I don't get enough contact with people, especially the kind that leaves me feeling as though I've been able to connect with others. I was asked today by my friend Davey if school has started to be stressful yet. I find it unfortunate that I usually feel stressed in general about school. Having a perfectionist attitude combined with school not being exactly the easiest thing in the world causes me to stress. What...

Lately, I've been thinking about Tyler. His desk chair and his electric razor are two things of his that I kept (many people who knew him took items that belonged to him, to put them to use instead of going to trash and to remember him by). Sitting in what was once his chair, I can "visit" with him, in a sense. I know others who knew him are doing the same when they look at pictures, or what they kept of his. "You are the salt of the earth. Buf if the salt loses its saltiness, how can it be made salty again? It is no longer good for anything, except to be thrown out and trampled by men. You are the light of the world. A city on a hill cannot be hidden. Neither do people light a lamp and put it under a bowl. Instead they put it on its stand, and it gives light to everyone in the house. In the same way, let your light shine before men, that they may see your good deeds and praise your Father in heaven." --- Jesus, Matthew 5:13-16 This was the foundation for my fri...

It's been all about the S the last few days. On Saturday (ironic, it starts with an 'S' day), my battery in my Jeep completely died a sudden death. There was a plastic sleeve attached to the battery that contained the purchase receipt. Purchased in 2002, well that explains it. It took about 10 - 15 phone calls to actually find someone available to take me to O'Reily's (I was trying to work out in concentric circles from my house), but I finally got a new battery. The guy testing the old one simply said, "Yup, it's dead," with a total resignation telling me that there was no hope in rejuvenating it. New battery, check. Now I'm mobile again... Fast forward to where I'm headed west on Stadium. A loud thunk followed by an instantaneous loss of power steering control, coupled with a drop in battery voltage from 14 V to barely 10 V, and a slowly rising engine thermometer told me something was wrong with the Jeep. I drove to HyVee's parking lot, p...

Originally Aug, 3rd In the last week and a half, I think that I have been asked "How are you doing/feeling?" more times than I can ever recall in such a short period. I had talked with someone about how reflexive it is for me to simply say 'pretty good' and push off the question. The truth is, I have not been good, and I don't know how to answer that question. The truth is, I want to talk about how I am doing, but often don't see so simple and common a greeting as a gateway to really opening up about how I feel. The truth is, I have probably still withheld a lot of feelings and problems I have dealt with in the last twelve days than most people are even aware of, and not because I don't want to share them. I haven't shared everything that has been going on because I don't know how to share it. I don't know if I should share it. I don't know how honest I can be about how I feel. I love my church community. I can't stand my church communi...