Giggles

Giggles.

I have had many responses to doing a rectal exam, but this one took the cake.

OK, I know I have tried to stay away from describing in graphic detail those fun little invasive exams I have to do on a regular basis, but I’ll make an exception here. This was an older gent with a history of, um, a little constipation. So I ask him all kinds of questions that would get me into trouble at my mum’s dinner table, do an exam, and decide I need to do a rectal exam. He seemed ok (‘Whatever you think you need to do, doc’), so I gloved up, lubed up, and started to spread his cheeks.

At this point he starts to giggle. He then tells me he is ticklish.

Have you *ever* heard of a guy who is ticklish when he is about to get a finger up his rump??

And it gets worse! I start to, uh, check his prostate and he raises both hands with an ‘Aw Lawdy’, a bunch of giggling, and asks if I am almost done. Now, I have had a lot of reactions to this kind of exam; from patients deferring to one accusing me of trying to touch their tonsils with a log. But I have *never* had someone giggle.

Maybe my technique is getting better….

Anyway, it’s the end of my term and I have learned a lot in the emergency room at the WORLD FAMOUS CLEVELAND CLINIC. Some things are different in emergency medicine in the States, but one thing is the same: a lot of patients come in for no good reason. OK: Chest pain – come in. Sudden, excruciating headache? Hurry in; maybe even run a few red lights. Sudden loss of vision? Have someone *else* run a few red lights. But a boil on your buttocks? Run out of your regular medications? An ingrown toenail? A sore ankle for 3 months that is worse after you are on your feet all day at work? Somehow, I don’t think the word ‘Emergency’ applies. (A certain medical student – who shall remain nameless – didn’t run into the ER when he used the ‘loo after chopping a hot pepper. He ended up very, um, warm and fidgety for about 4 hours. Not that he didn’t think about it, mind you. But can you imagine the fight between all the nurses and doctors on who would have to put the burn cream on? But I digress.) Sometimes, you wonder what folks are thinking when they come into the emergency room.

Not that I turned the cheerleader with the sore ankle away, mind you…

OK, everyone get out your playbill; there is a change in the second act of this little performance. The part of ‘Bryan in Orthopedic Surgery’ has been changed to ‘Bryan in Emergency Research’. This is my way of letting all of you know that instead of doing Ortho Surg for the next 4 weeks, I have changed and doing a research project in the ED here at the WORLD FAMOUS CLEVELAND CLINIC for the next four weeks. And while I would like to say things about the opportunity for research and expanding the knowledge base, it really comes down to one thing:

I’m tired of washing my hands for surgery.

And with that, it’s the weekend. I’m working on some Brown’s tickets, and trying to get to OSU for a game while I am in the state, and in general having some fun. I have this huge binder of research papers I need to read through. Not to mention trying to get the burning to stop…

As always, Love to All and keep working on your 101 List!
Bryan

Cleveland Rocks!

Boy, was I confused.

Not that Bryan being confused is anything new or unusual. In fact, it seems – most days, anyway – to be typical. But this was different. This was in the emergency room of the WORLD FAMOUS CLEVELAND CLINIC, and I had just finished talking to a patient with chest pain. The attending physician, who is my boss, walked in and introduced herself to the patient, gestured in my direction and said she was working with Dr. Canterbury.

I turned around to see if this mythical ‘Dr. Canterbury’ was standing behind me…

It may be a bit late, but welcome to Cleveland, home of the WORLD FAMOUS CLEVELAND CLINIC. (I am required by contract to capitalize that whenever I type it. Something to do with trademarks and reputation. But I figure if the reputation is so great, they never would have let me through the front door as a patient – never mind as a student. But I digress.) Even though I am about 40 minutes form Mom and Dad, it seems really weird to be ‘home’. I still can’t get used to Ohio State hats and the Cleveland Indians on TV – not to mention the Browns! Of course, after 3.5 years in Australia the parental units, are happy to have me so close.

I’m sure that’ll wear off with all the dirty laundry I’m bringing home this weekend…

But I am back in the emergency room and having a blast. The doctors are a lot of fun, and the patient mix is pretty interesting. I saw as many traumas in the first two days in Cleveland as I saw in my whole month at Harlem. I had one patient drive from two hours away with chest pain because he wanted to be seen at the WORLD FAMOUS CLEVELAND CLINIC in case he had heart problems (he didn’t – it was only gas). This has been in addition to the usual stuff of sore backs, weird skin rashes, patients hearing voices and a slew of sore tummies, the last of which was a kid who swallowed something that showed up on x-ray. We weren’t sure what it was, so we started a betting pool on what it might be. We had to return everyone’s money in the end, though:

No one wanted to dig through the, uh, ‘collection’ he left us to find out what it was…

And with that, it’s the weekend. I’ll be at home with the family this weekend doing laundry and celebrating my sister’s 40th, er, 37th, um, 33rd birthday. Not to mention trying to track down this mysterious Dr. Canterbury…

As always, Love to All and keep working on your 101 List!
Bryan

18 Weeks

Man, is New York *great*!

OK, the rotation has turned out a bit disappointing, more on that later. But all the bargains you can find – and people literally chasing you down the street to give you a better deal! Just the other day I saw some great designer bags for something like 90% off the store price – and the guy said he could afford to sell it so cheaply because he didn’t have any expenses. I mean, how expensive could the trashbag he was carrying stuff around in cost? I even managed to get a great deal on a watch; I had to really negotiate with the guy. I was cautious at first, until he reassured me it was genuine and that Rolex is really spelled ‘Ro!ex’ like the ones he had. He seemed nice, and he was selling it out of a classy leather briefcase on a corner in Times Square. But can anyone tell me:

Is my wrist supposed to be turning green?

Anyway, things have picked up a little on the patient front. I have had a range of patients in the ICU over the past month; most have made it, some haven’t. Many of the stories from the patients about why they came into hospital started out with ‘Well, I had been drinking with my friends for a few days…’ (Ya know, now that I think about it, I have a bunch of stories from my second year at Ohio State that start the same way. But I digress.): a couple of guys who were guests of the State of New York and were handcuffed to the hospital bed; a guy who came into the emergency room with a complaint of ‘it hurts’ – and could give us no other information; a guy who fell off a ladder and fractured his leg trying to break into *his* house; a guy who was playing ‘young boy games’ and jumped out of a second-story window on a dare (he broke *both* legs), and a guy who was sitting out front of his apartment building when - and I am not making this up – an air conditioner fell on his head.

I just realized that all the patients in this ward with dumb injuries were guys…

But my time here in Harlem is up (a couple of pix are up of me in Harlem Hospital at the blog: www.dowunderdoc.blogspot.com ) and while the folks I work with are great and I have managed to learn a few things, I am glad to be done. Next up, I head to Ohio on Sunday for 4 weeks of emergency medicine followed by 4 weeks of orthopedic surgery, both at the Cleveland Clinic. After that, it’s 6 weeks of radiology in Richmond, VA; I finish that November 4, and if all goes well, that’s the end of my clinical rotations with 4 weeks of vacation from November 4 until December 4. For those playing along with the home version, I am *18* weeks from being a doctor.

Hey! I saw that cold chill run up your spine!

And with that, it’s the weekend. Time to finish packing and get on a plane outta here. I’ll spend the weekend in DC packing for Cleveland and getting ready to deal with emergency medicine and my family (no, the two are not related). Not to mention showing off my new ‘Guccy’ bag…

As always, Love to All and keep working on your 101 List!
Bryan

What will it take to put you into some new medical equipment today...?

Trust Me: I'm a Medical Student

Harlem Hospital Center

At the Met

Harlem

Harlem

Boy, was I excited.

I had managed to not only get a rotation at Columbia University for July (they only accept the top 10 Flinders students who apply), but I also was going to get to do Trauma Surgery! In Harlem, no less! What more could a medical student wish for?

Well, as Mom is always happy to remind: Careful what you wish for – you just might get it.

Oh, don’t get me wrong – things started out well. I was walking to the hospital on my first day, all decked out in a set of scrubs with my snazzy little med student lab coat (With lots of pockets. Which is a bit of a hazard. In a very short time I have managed to accumulate about 20 pounds of stuff in those pockets; enough so that I now walk with a hunch. Stethoscope, reference books, needles, syringes, snacks, water bottle, band-aids, blood tubes and – this being New York City and all – Jimmy Hoffa was hidden in the inside left pocket for a few days. But I digress). It felt good to be finally getting back to ‘work’, closer to being done and to be honest, it was neat to be a medical student in the US.

That feeling, however, didn’t last long.

Where do I begin? The 6:30am starts; the on-call every third day (which means 24+ hours in the hospital with very little opportunity for sleep); the senior doctor who likes to grill the residents and students and hear himself talk, leading to looooong ward rounds; getting most questions wrong due to differences between here and Oz; no one really telling me what I was to be doing or what was expected of me; the surly-and-not-too-cute nursing staff; or the fact that, after two weeks of trauma surgery, I have seen one trauma and no surgeries.

Not that I am *wishing* for either more trauma or surgery – Mom, I think I have learned my lesson…

When I am not actively doing a trauma – which is most of the time – I help take care of patients in the Surgical ICU. These are patients who are either very sick and going to surgery, or very sick after being in surgery. You get to see all kinds of things and it really tests you; you need to know a lot about a lot of things, and you really have to keep close tabs on the patients – they can go south very quickly. Which means regular checks, lots of monitoring and drawing blood at least twice a day to see how the patients are doing. And some things are still the same here as back in Oz: All three times I have been on-call, we have had a patient ‘code’, and two of them didn’t make it. And before you ask, yes:

I drew blood from all three of them.

And with that, it’s the weekend. Being NYC and all, there is always something to do and see. I’m going to go exploring and tr a few pizza places that have been suggested to me, plus getting ready for yet another week of fun-and-games. Not to mention finding someplace new for Jimmy…

As always, Love to All and keep working on your 101 List!
Bryan

Vodka

Again, I couldn’t sleep.

Not that anyone in steerage class ever sleeps on those long international flights. (Not well, anyway – I mean, how can you sleep when you’re herded into seats barely wide enough to fit your rump, along with the rest of humanity, and the guy in front of you decides he wants to recline his seat into your lap, all the while –just on the other side of that fabled curtain – you can see the folks in Business Class, whose seats transform into huge beds with 600-count Egyptian cotton sheets and feather-down comforters and fluffy pillows, lounging around in their jammies. Makes you wonder what happens up in the First Class area. Maybe some kinda deal where the cute stewardesses give massages or something. But I digress.) So I shifted and paced and ate and drank and watched a movie and listened to music and stared at the ceiling. I finally decided I had enough and I took a sleeping pill.

An hour later, I was still awake.

Wide awake. With bad movies on, no one to talk to, and hours until the next meal. Now, I’d like to point out here that one of the weak areas of the education at Flinders is Pharmacology. That said, I still should know better than to do what I did next. And it wasn’t just that I took a second sleeping pill.

It’s that I washed it down with one of those little airline bottles of vodka.

The rest of the trip is a bit of a blur; I *think* I changed planes in San Francisco; coulda been Tierra del Fuego for all I knew. Somehow, I made it home to Washington, DC, where I got to enjoy our nations’ capital for about 20 hours before I boarded a train to Philadelphia to take another one of those joyous USMLE tests, this one a practical exam. At least I think I took a practical exam.

Either that or 12 innocent people had some rather invasive exams they didn’t expect…

On Monday, I head off to New York City to start my first US rotation; Trauma Surgery at Harlem Hospital. I found housing via the internet; thanks to everyone who made suggestions and phone calls to help me out. And following years of Mom complaining about me being so far away, and wishing I could be closer to the ol’ homestead, after New York I head to Cleveland for 8 weeks – 4 in emergency medicine and 4 in orthopedic surgery.

As you always taught us, Mom: Careful what you wish for; you just might get it!

And with that, it’s the weekend. I need to head off to West Virginia for a wedding - I figure since Dad is from West Virginia and so is the bride, that I am related to her somehow. I’ll also be packing for a month in New York – not to mention trying to get the cap off this little bottle of vodka…

As always, Love to All and keep working on your 101 List!
Bryan

Aussie Odyssey

Wow.

Three-and-a-half years ago, I sent an email home to a handful of folks to let them know I had made it safely to Australia; it had the same title as this week’s installment. Now, I’m sending an email to a couple hundred people to let them know that my Aussie Odyssey is coming to an end.

Boy, where do I even begin?

How does one find words to describe this adventure? Since January 2002, I have lived 10,000 miles from home in the Land Down Under. Not only did I start a new career and move to a new city, I moved to a different *country* about as far away as you can get. It takes a 30 hour day, three planes and several sleeping tablets to get home. Somehow I muddled through; cobbling something together from scratch that resembles a normal life: new friends, new routines, even a new language (If any Aussie ever tells you they speak English, don’t believe them. Provided you can understand what they say in the first place. But I digress.). But in the background of all this has been that tug of *home*. Of friends I’ve known longer than a few years and of family I only get to see once a year. I have missed far too many important birthday parties and my nieces, nephews and friends’ children are growing up very quickly.

In other words, I really, really miss home.

With that said, I’m also not entirely looking forward to leaving: Oz is a pretty neat place to live. I have made some wonderful friends here in Australia; people who mean a lot to me and whom I will miss terribly when I don’t see them every day. I’ve gotten very used to asking for toMAHto sauce to go on my chips, and I have become practically addicted to meat pies. And rugby is a pretty cool sport. And the Aussies have their priorities right: they work to live, instead of living to work (admit it: how many of you worked more than 40 hours last week?). From 9-5, they will give you an honest day’s work for an honest day’s pay. Heaven help you if you need someone at 5:01pm, though – at that point, they’re all at the pub having a pint.

And I think it’s my turn to buy a round.

The biggest question asked of me lately – other than when I am coming back here – is if I am excited about going home. My response is, well, mixed. I’m happy to be going *home*, but sad to be leaving Australia. As you would expect, I have become attached to this place.

Kinda like gum stuck on the bottom of your shoe…

I’ll be back with everyone in 2 weeks – just before I head off to NYC to do Trauma Surgery at Harlem Hospital. (If anyone knows anyone in New York who might have a spare room, couch or closet they would like to rent out to me for the month of July, please let me know soonest!) I’m going to start sending these updates out every other week from now on; I expect to be a lot busier in the States doing my rotations. Plus, without the Aussie’s to pick on, the emails will only be about me.

And that would be rather boring.

And with that, it’s the weekend. I’ll relax in Sydney and repack my bags about three times before I fly out Monday afternoon to Washington, DC. Not to mention scraping the bottom of my shoes…

As always, Love to All and keep working on your 101 List!
Bryan