Third Year of Residency

I guess it's time to post again - it's only been eight months! I am now a third year resident which means I should know all there is about family medicine, right?  Hah! What it really means is that I now realize that I will NEVER know it all and will spend the rest of my life learning and depending on God to help me help my patients!

Marion Historical Museum

Marion Hospital

Right now I am writing to you from Marion, Kansas, where I am "moonlighting" - working as a small town doc in the emergency room of a rural hospital. I'm here from 6 PM Friday to 6 AM Monday to take care of anything that walks (or rolls) in the door. So far I have seen three patients, none of them truly urgent - a sports concussion, a foot injury and poison ivy. I do have to be prepared to stabilize very sick or injured patients, so it's a lot of responsibility (and a bit scary still). Mostly, I enjoy meeting the folks in the community, putting my medical knowledge and skills to the test, and gaining confidence.

In June, my father and I took a group to Bolivia for our annual mission trip. We saw over 250 patients during the week, worked at the girls' orphanage and helped to build a special education and rehabilitation center that will also serve as a daycare center for health workers' children.  My patients were mostly adults with diabetes, but I did see some interesting - and sad -cases. One man had just had a heart attack and needed a cardiac catheterization. However, the cost is really prohibitive in Bolivia, and I am not sure about the outcome. He was on medical management, but I am sure even the recommended medications are very expensive for the average Bolivian.  Another patient was in remission for ovarian cancer. She had to travel to Santa Cruz every 6 months for tests - CT scans, bone scans, blood work. You can imagine how expensive all of that is. She had already spent all of her money and taken out loans to pay for her initial surgery and chemotherapy. I wish I could have helped them more, but I was able to pray for them. I did diagnose one woman with diabetes. She was very upset initially. However, I gave her a lot of education and encouragement regarding diet and exercise, and she attended a diabetes education class while I was there. Hopefully, it was caught early enough that she can make some lifestyle changes to avoid some of the long-term complications of diabetes. Unfortunately, there are limited medications available to treat the disease in Bolivia. Insulin is very expensive and somewhat dangerous to use without good glucose monitoring. And almost noone has a personal glucometer; test strips must be outrageously costly there. How could you know how much insulin to use without frequent testing?

On September 22, I will be heading to  the Middle East for a one-month rotation at a small hospital and residency program. It will be a unique opportunity to learn about Muslim culture, the health issues and medical system in this part of the world, in particular women's health.  I will also get a first-hand glimpse of what it's like to run a residency training program and teach residents. Please pray for safety, a great learning experience, and clear direction about whether or not this is something I want to do long-term. I'll be blogging while I'm there, so stay tuned....

Almost done with Medicine!

The adult medicine service at the hospital is our most challening rotation. The hours are long, the patients are really sick, and the cases are usually pretty complicated. But I guess that's what makes it fun - I get to use my brain to figure things out, and my best people skills. I didn't always think it was fun, but this year as my confidence has grown, so has my enjoyment of medicine. Of course, I won't be sorry for the month to be over. On to new things! The rest of the year should be a piece of cake since this is my last medicine month this year. I've gotten all the hard rotations out of the way.

I got to go home for a weekend too -that was fantastic! It was so great to just hang out with friends and family and to visit my church back home. I'll be home for Christmas too, but only for 4 days. Can't wait to see everyone again!

Aaahh. Family!

The highlight of this month was seeing my niece and nephews, especially my newest nephew. There's nothing like family to remind you what's important and eternal in life. I am blessed to have two sisters who share my faith in Jesus and want to raise their children to know God and follow him. My niece is especially sweet and has such a tender heart to please the Lord and love her brothers.


I enjoyed spoiling her by taking her for ice cream (it took her over half an hour to finish a cone!!) and buying her Halloween costume. Doesn't she make the cutest witch you've ever seen?



She got to meet Christopher Columbus at a special event, but she was a little shy. Apparently a man dressed in strange 15th century garb was a bit scary for her. So I took her for ice cream and we watched the people walking by. She's really into "I Spy" right now. I got to play for hours while she licked her cotton candy cone.


Here's the two older ones giving me a concert. The middle nephew is all boy. He doesn't sit still - likes to be on the move, making noise, running, jumping, going up and down stairs . . . and up and down . . . and up and down...


And here's the newest guy. You have to admit he's adorable! I couldn't put him down!


I don't know when I'll get a chance to visit again. Thankfully, I will see them all at Christmas. It will be rushed and crazy, and I'll be competing for their attention with Grandma and Grandpa. But I'll settle for whatever I can get. They grow up so fast!

Colorado Trip 2011

Every year, my residency program takes a trip to Colorado with the first and second-year residents. I posted photos about the trip last year. This year I was on the organizing committee, so it was a different experience. But it was lots of fun. Despite the fact that we call the trip "Bike Trip", I did not actually take a bike ride. I did get a massage (very nice) and take a hike to a lake and waterfall. The weather was fabulous and the aspens were just beginning to change color.

Here are some photos.

Toenail Removal

Yep, you read that right. That's what I've been doing this past 2 weeks - removing toenails. Sounds pretty gruesome, I know, and actually it is pretty gruesome to watch. Doing it is not too bad though. And it has to be done. Ever had an ingrown nail? They hurt; they get infected; they make life miserable. It's really pretty easy to fix. And I have now learned how to do it!

Podiatry is a pretty important thing for a family doc to know. Foot problems are so common! All diabetic patients reach a point when they need regular foot exams to trim nails and callouses and check for neuropathy. Athletes and regular people who work out have heel pain, pain in the ball of the foot, capsulitis. The foot is an amazing appendage - it bears all of our weight, allows us to walk, run, jump and gives stability and balance. So you can imagine how much of a beating the foot takes and how prone to injury it is! I've learned to recognize and treat plantar fasciitis, bunions, joint capsulitis, warts, ulcers, corns and callouses, fungal infections, arthritis, and lots of other conditions. I can inject steroids and anesthetics in the right spot to provide relief, take off all or part of a toenail without pain, and suggest exercises and inserts to relieve pressure on different parts of the foot. It has been a very practical two weeks.

September also included a trip to Colorado for our annual first and second year resident team building activity. Once again, the scenery and weather were spectacular. The aspens were just beginning to turn colors to yellow and orange. The air was fresh and cool. I enjoyed walking around Dillon Lake (reservoir actually) and up to Continental Falls. As one of the trip organizers, I had a bit more responsibility for all of the logistics. But even with that, I had time to enjoy the time away.

Well, all for now. My eyes are starting to close of their own accord. Miss you all!

Family Meeting

This past week I had the opportunity to conduct a family meeting regarding a patient whose prognosis was extremely poor. The patient was a 71 year old woman with advanced breast cancer who was in hospice at home doing fairly well. She comes from a large and very close family. One night she woke up, felt dizzy, vomited and passed out. When EMS arrived, she was in asystole - her heart had stopped beating. No one knows for how long. They shocked her, did chest compressions, put a tube down her throat and started mechanical ventilation. Generally speaking, the recovery rate from "coding" someone (doing all those things I just mentioned) is pretty poor. Technically the patient was dead, and the EMS team brought her back. Unfortunately, her brain suffered extensive damage during the time her heart wasn't beating. By the time she arrived at the hospital, it was evident that she was severely compromised. At first the family wanted to do everything possible for her in the hopes that she would recover.

The purpose of the family meeting was to help the family understand the patient's condition and make decisions about how aggressively to treat her. It was a pretty emotional meeting. There were about 10 family members present, mostly the patient's children. Most of them understood that the patient was not going to get better. They knew she did not want to be kept alive on a ventilator and they did not want her to suffer unnecessarily. After many tears, honest answers and prayers (on my part), the family decided they would take the patient off the ventilator. We stopped all of the medications and IV fluids and wrote orders to keep the patient comfortable (medications for pain and anxiety). The family all gathered at the patient's bedside and later, when they were ready, they had the patient extubated (pulled out the tube that was helping her breathe). She passed shortly after that. It was one of the hardest things I've ever done, but also beautiful in a way - helping a patient die with dignity surrounded by their loved ones and helping the family through a very difficult time.

New House

Here are some pics of my new house. I moved at the end of June and have gradually been settling in with my new roommate Alexis. I don't have any pictures of her yet but I'll try to update soon.

It's a townhouse/duplex - pretty cute and comfy. Trying to fit two people's stuff in is a challenge, but we're managing to downsize bit by bit and get organized.

Started a new year and had a great first month as a second year resident on adult medicine. I'm on pediatrics now, so totally the other end of the spectrum. Life is still ridiculously busy, but I guess that's just the way it's going to be for another two years.