Floods and the Niagara of the South!

A few weeks ago, it rained 4.5" over Saturday/Sunday. (For reference, 1" of rain is the equivalent of ~12" of snow.) It rains a lot here, but this was more than usual. It caused lots of flooding, and many of my students were trapped and couldn't get out of their areas to get to school; in our area, one of the two ways out to the highway from our house was flooded over. In the pictures with the green cones (taken Monday afternoon), the road where you see water is normally a bridge over a medium-sized creek that is usually 5 feet or more below the bottom of the bridge. A friend had been over for dinner the night before this picture was taken (when it was still raining). Fortunately she had a big truck, but she said the water hit the tops of her wheel wells! The blocked road is the first two pictures; the third picture shows the field alongside the road on the other way out from our house that was not blocked. It's normally a grazing area for cattle, with this little creek off in the distance. The water comes clear up to the edge of the road!

This lake/swamp you can see is normally a cornfield.

This is the view along the road from the second way out from our house. The line of trees in the back is where the creek normally is.

The week after all this rain, we decided to go visit Cumberland Falls waterfall in Kentucky (it's only about 90 minutes away and claims to be the Niagara of the South, so how could we not visit?! Especially with all that rain - extra water is a bonus in waterfalls!!). The falls are 68 feet tall and 125 feet wide.

Henry absolutely loved it. He spent the entire time at the falls excitedly yelling, "Wattafall! Watta!! WATTAFALL!!!!! Play water?? Oh, is dirty! Watta!!" on repeat. He loved the noise, the dirty water, the rainbows in the mist (which don't show up in the pictures, sadly), all the climbing on rocks, and the huge waterfall. I hadn't expected him to like it that much, but I think if he could tell us his top 3 favorite experiences of his life, this would be up there, right behind the first time he tried fruit snacks and jumping on his friend's indoor kid trampoline.

This excursion was last weekend (one week after the flooding), and every day for this past week Henry has asked me this question when we get in the car in the morning: "Have fun waterfall today?" We may have to plan a return visit.







Here's a little video of the falls. They don't look that big on this tiny screen, but they were actually pretty impressive!

3rd year...in our experience

Every time we say, "Hey, we need to write for the blog," we then end that conversation with, "But what would we say? Nothing is happening!" Well, here's what's not happening this year of medical school for us.

• James has done a lot of rotations. After radiology, he did internal medicine, cardiology, pediatrics, urology, family medicine, and he just finished one in the ER.
• James has officially decided that he wants to become a family medicine doctor. He says he likes not knowing what's behind the door, he likes the variety, and he likes using all of what he's learned at med school instead of mainly just one subject of it. He also is the type of person (as I'm sure you know if you know him) to appreciate a long-term doctor/patient friendship where he can get to know people and help them over time instead of only when they have one specific problem or emergency.
• I got another job doing some medical writing that keeps me busy in the afternoons during Henry's nap. Consequently, the dishes (which honestly weren't terribly up to date on an average week) have entered a sort of "let's play chicken" mode where James and I unofficially see which one of us will crack first and do them and clean the kitchen. But then the other one feels guilty and grateful, so it evens out!
• We found out we're expecting another baby! I'm due August 12, but since it'll be a repeat cesarean, it'll be a week earlier, so you can expect updates on that about August 5th. This will put it right between my birthday and James's birthday.

• My semesters this year have been the best I've ever had here. I don't know if it's that my students are getting brighter and more lively or that I'm just getting more comfortable as we go along, but I'm really enjoying teaching!
• Third year of med school is my favorite by far (so far!). James does rotations now, and while he's still gone from home more than if he had a regular 8-5 job, it's SO much better than the last couple of years. Obviously it greatly depends on what rotation he's on and what doctor he's with, but credit where it's due: rural doctors are great to rotate with! Many of the local doctors only do half days on Fridays, or work in another town that's too far away for James once a week and will give him that day off, or will let him set broken bones/clean out abscesses/do CPR/intubate patients. It was rough to be assigned to stay here in our rural area for these years of school also, but it's worked out for us.
• Henry is doing and learning lots of new things, but I think I'll do another post about some of those soon. He's almost two years old. TWO. My curly toddler baby is getting big!
• We're gearing up for the fall. That is the busy time (inconveniently close to this baby's due date!) when James will be doing audition rotations (spending 2 to 4 weeks at a time doing a rotation at a place we hope to do residency at, which in this case is almost exclusively out west and not with me! Oh no!) and interviewing at residency spots. We will find out next March(ish) where we will be going for residency. That will be an adventure of a season for us, I think, with him gone and me alone with the toddler and the newborn, but we'll make it through!
• Our 4 year wedding anniversary is almoskt upon us. My phone reminded me other day of a moment about a month before our wedding when James sent me a message on Facebook. He said that marriage was going to be like this scene from The Hobbit when Bilbo dashes off to join the quest and says, "I'm going on an adventure!" How true that was, and how fun the adventure has been so far. I have to remind myself sometimes in this school journey that Bilbo's adventure wasn't all fun (camping in mud, almost eaten by trolls, talking to sneaky dragons, etc) and that's all part of the adventure. In fact, you could say the hardships are the best part of the story.
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Black and White: the Radiology Days

I've started a new life as a rotating medical student. I can honestly say that it's way better than sitting in lectures and studying for never-ending tests. I've gotten a taste of radiology and internal medicine so far. Here is a sample of my experience with a radiologist.

Imagine an office big enough for two people, but not much bigger. The lights are never on and the only light you see is from the black-and-white computer screens and a little crack under the door. You may be wondering, why black and white? The answer is simple: to help get better contrast in the black and white images. The whole set up of darkness is designed to get better contrast on the images. If this isn't helping you, see my handy, dandy visual aid of an emergency dispatcher's room.

Now imagine more black and white and you got it.

What did I do all day? I watched the doctor read X-ray after X-ray, CT after CT, and MRI after MRI. I was constantly amazed at how incompetent I was (something that has become a recurring theme throughout rotations). For example, he had me read a book about chest imaging. After reading, I thought I could read any chest X-ray with the best of them. I would go in the next day only to be humbled by what I would think was a normal image, only to find out that that person likely had walking pneumonia. The other thing that I was constantly amazed by was how he would catch the tiniest, most subtle finding on an imaging study. I'm talking a minuscule fleck here, a microscopic scratch there, things that I would never have seen in a million years. And he managed to notice them right away. 

Mixed in with all the sitting and watching were fluoroscopic studies where the doctor would have a patient drink some oral contrast solution and then image their esophagus, stomach, and small intestine. I got to put on a lead shield gown complete with neck protector to watch these. They were fairly interesting studies, but not my favorite thing in the world. In fact, the only time that I've been puked on by a patient was during one of these. You see, the contrast solution doesn't taste terribly great. It's not the worst thing in the world, but it tastes like you're drinking liquefied chalk (I asked to try some after the incident). Anyway, a lady was drinking some and started feeling nauseated. I was quick on my feet and grabbed a nearby trashcan for her to hurl in. In my haste to prevent chalky vomit from being spewed forth everywhere, I didn't foresee that the swivel lid would be a problem. The lady did her thing and some of it splattered off the lid and all over my hands. It was a lovely experience. The doctor later told me that I had finally been christened a health care worker by getting someone else's bodily fluids on me. Given all the gray scale I saw all day, it was only fitting that her vomit was white and some of it got on my black watch. 

Next time, I'll write about internal medicine. There will be much more color and much less vomit.

A Little Bit of Henry

Henry's getting older. He's almost a year and a half old! When he was newer, people would tell me how fun it was to watch a baby's personality develop. I wasn't entirely sure I understood that; I'm still not sure that I do, in fact. Since he's our first, I can't tell what is his personality and what is normal baby behavior. I think I'm going to take all the negative aspects (crying, clinging, dislike of long car trips, etc.) and put them in the "just a baby" category, and so that means all the positive aspects are clearly his personality and make him unique among babies...right? Unique or not, there are a few funny things about him I want to share.

At a family reunion, summer 2016

• Henry flaps his arms like a little bird when he gets excited. This happens when he sees us bringing him applesauce or when he sees me come back after having been babysat all morning. He flaps very excitedly and squeals.
• Henry has a little Buddha belly (see picture above). It's getting a little less pronounced as he gets older, but his little shape toddling around the house makes me smile. I love his shape: his big head, his pudgy wide-set legs, the curly hair, and that belly!
• He knows the words "no!" and "yeah!" but isn't quite sure what they mean, so he almost always uses them backwards. "Do you want a snack, Henry?" "Nooooo!" (reaching for the snack).
• He loves to say "Dad." Lately, he's been sticking "a" in front of his words (so it's "a ball" or "a puppy," rather than just "ball" or "puppy") and now James is "a Dad." (The best part of his new "a" fascination is that he uses it everywhere.I'll say, "Henry, let's go!" He'll say, "A go! A go!!")
• Henry is (on a small level) exploding with words. Granted, he knows only a handful, but he's picking up more all the time as we use them. He has recently mastered "button" (for belly button) but for a while he didn't get the second syllable. I remember him playing with James on the floor one evening, when he turns around, pulls up James's shirt, and sticks his finger in James's belly button, proudly calling it, "A butt!"
• Henry is pretty good at identifying his own body parts. James particularly likes it when Henry will point out his hair by lifting a single strand when we ask where his hair is, and how Henry smacks his right hip when we ask where his bum is. The belly button is especially funny, because if Henry is wearing a t-shirt, it's easy to pull up the shirt and peer down to try and find it. If he's not wearing a t-shirt, he gets quite distressed. "A but-ton! A BUT-TON!!" and frantically tries to pull his shirt up to find it. 
• He still loves to taste everything he can touch, and he loves drinking anything he can find. He's not great at normal cups or water bottles, but he is great and finding them when we hide them.
• Speaking of hiding, he will hide pacifiers, spoons, etc. when he's done with them because he knows we'll put them away if we see them around. Then when he wants one, he'll pull it out from under the couch or behind some blocks so he can have it.
• Henry is very friendly with new people. He might make a few squeaks of protest when I leave him with others, but he recovers very quickly (if he notices I've left, that is. He often doesn't) and he's happy to hang out with pretty much anybody.
• He loves babies. "A baby!" he'll say when he sees one, then grin at me and cackle. Babies are very funny to him. Sometimes he'll steal my phone and somehow turn the camera on so it's taking pictures of him. He'll stare at the screen, which is showing him, and say, "Baby!" and laugh and laugh.
• He does not love shoes, he does not love sitting still, he does not love table food (one of the daily struggles he and I fight over), and he does not love cuddling at all. He's far too busy for that, thank you very much.
• He is all about puppies. His first word was "puppy" (he says it "pup-mm") and I think he actually thinks the word means "animal," because that's how he uses it. He does love dogs, though. If we see one on a walk, he'll spend several minutes happily remembering the encounter, saying, "A pup-mm! A pup! Pup-mm!" to himself. 
• He loves James so very much. His joy when "a Dad!! DAAAAD!!" comes home is heart-melting.
• Sometimes he has so much emotion that he doesn't really know what to do with it, and so his whole body will shake a little. This happens if he's very angry (usually if we take him away from exciting but forbidden things like the toilet or trash can) or if he's very happy. This week he was by the door when James came home, and he stood there, shaking a little, yelling, "Dad! A Dad! Dad Dad Dad Daaaaad!" for quite some time, flapping his arms. He got so excited he fell over. 

Rotation's Eve

It's the night before I start my third year in which I will rotate through a bunch of different specialties, shadowing and seeing the practice of medicine as opposed to only the theory. This has been the part of school that I've always been the most excited for, but also the most nervous. It's a great big unknown; I really have no clue what to expect tomorrow. How big of a fool will I make of myself? How will I annoy the attending due to my lack of knowledge and experience? What kind of cool stuff am I going to see?

When we were visiting family during our break, Sariah and I talked to my mom about what kind of things she would like to see on the blog. One of her questions has stood out to me more than the others: what are your fears about school? As the day of my first rotation has approached, I've thought more and more about that. What am I afraid of? Maybe this won't be relatable at all, but here's a small glimpse (in bullet point form) into my anxiety.

• What if I get into my first rotation and realize that I absolutely hate practicing medicine? I can't really change careers at this point because of the insane (and I mean insane) amount of debt that I've taken.
• I'm not going to be able to handle it when I lose a patient. I don't mean in the literal sense (although that would be kind of funny, trying to find a patient that's hiding in the hospital), but I mean in the sense of I screwed up and someone died as a result. How does one cope with that?
• I'm never going to see my family again. This is a big one for me. I want to be there for my family and I don't want to miss anything (a la Aerosmith's "I don't want to miss a thing"). However, I've chosen a career that will most likely make this fear a slight reality.
• I'm going to make such a big mistake that I'll get kicked out of the hospital and subsequently fail the rotation and get kicked out of school. 
• I'll misunderstand instructions and get chewed out because I didn't hear well enough or the doctor doesn't really know how to communicate his thoughts or he assumes that I can read his mind.
• I'm worried about the unexpected expenses like car repairs. I'm going to have to do a lot of driving over the next two years. Hopefully nothing majorly bad happens to my car, but you never know.

Although only 6 bullet points, I think that that about sums up my biggest worries. Whenever I get nervous before big things like this, I remind myself that things are never as bad as you imagine. They might be close, but for the most part, this has held true for me. May the pattern continue tomorrow as I face my fears.

Oh Boards. How I Hate You So

For those that don't know, after the first two years of medical school, every student takes the first step in becoming a licensed physician. Although technically not really a board exam, that's what it's called colloquially. I just took it. It wasn't a pleasant experience.

The way to imagine this test is to think of everything that you learned throughout college. And I mean everything, even down to the smallest little details from your freshman biology class about mitosis and meiosis. Then add on top of that, two years of med school, which is roughly the equivalent of four years of undergrad in terms of credits. After studying that impossibly large amount of information, you get to take a 280 (USMLE) or 400 question (COMLEX)* test that makes sure your basic medical knowledge is there. A few weeks afterward, you get a 3 digit score that residency directors will use to judge you when applying for residency. Fun stuff.

At any rate, boards are a big deal. They're kind of like the BAR exam, but for doctors. It's a super stressful time filled with much anxiety, lots of memorizing, tons of late nights, and more anxiety thrown on top of it for good measure. So how do you tackle the beast? Honestly, that depends on how you study, but this is how I did it. I still don't know my scores yet, but I feel like I did well enough that it could work for others too.

First off, I accepted the fact that there was no way that I was going to remember everything that could be on this test. It's frankly impossible. After accepting this, I was a little relieved, but not enough to stop studying entirely.

The second thing that I did was planned out how I wanted to go about studying. I'm an active learner, which means that reading textbooks without doing something active doesn't help me a whole lot. My typical day during my dedicated study time consisted of 4 hours of "book work" in the morning, roughly 4 hours practice test questions in the afternoon, and then a couple hours of videos at the end of the day covering the information that I went over in the morning. You're probably thinking, "Wait a second. He just said that reading doesn't do it for him, yet here he is saying book work. He must not know what that means." By book work I mean that I read out of a lovely book called First Aid for an hour, then I would "test" myself by standing up at a white board and writing down everything that I remembered from my reading. I would skim through the pages to see the different topics and then write down. If I didn't remember something, I would re-read that section. Thus, it was more active and my reading time had to be focused reading. Otherwise I wouldn't remember anything when I went to write down.

As I said earlier, my afternoons were filled with practice questions. I used a couple question banks (Combank and UWorld) to test what I had learned in the morning. Both of these banks allow you to choose the topic to be tested on. For example, if I read the cardiovascular section in the morning, I would get my cardio for the day by doing cardiology questions. Doing these questions was probably the most beneficial part of my day. The benefit basically comes down to this: you don't know what you don't know. By focusing on the questions and the explanations provided by the question bank about the question, I was able to hone in on my weaknesses. It's kind of a brutal and somewhat discouraging way to learn things, but very effective. Getting your rear handed to you via questions about something you thought you knew well serves as good motivation to keep studying, but it is a little depressing. That being said, I (and all my friends) found practice questions to be extremely useful.

The last thing that I did was set aside a day to relax every week. In my case, that day was Sunday. I would go to church with my lovely wife and son, and then relax with them the rest of the day. Having that day off made the biggest difference for me. It doesn't make much sense, but having one day off every week helped recharge me and was something to look forward to at the end of the week. It was so nice not having to think about the different gene mutations in cancers or what specific diseases look like under a microscope. I even started to notice that Mondays tended to be my most effective study day. Go figure.

Anyway, this is what the last two months of my life have looked like: lots of sitting in a chair, writing on a white board, and practice questions, followed by a nice respite on Sunday.

* There are two different licensing exams based on the type of medical degree that you're pursuing. If you're an MD student, you must take the USMLE (United States Medical Licensing Exam). If you're a DO student (like me), then you must take the COMLEX (College of Osteopathic Medicine Licensing Exam) and you can choose to take the USMLE if you want to or if you're slightly masochistic like me.

Another Semester's End

I gave my finals this week. I always ask each class for their favorite and least favorite topics we studied in class and why they liked/hated it. Here are some of my favorite answers.

Least favorite and why:
-The atoms because they involve chemistry.
-Fungus. Mold because it's not a good thing.

-Learning about the human reproductive systems. I have a very weak stomach when it comes to that topic.

-Duh...male reproduction! Who cares about them? But really it was okay.
-Ions! Ugh! Just thinking about it makes me want to cringe. Seriously though, it's awful. Protons, neutrons, electrons, cations, anions...it's terrible.
-Nothing because you teached it.
-The skeletal system. There's a large amount of terms to learn and to be frank, it sucks.


Favorite topic and why:
- I loved the bones. Specifically that my whole life I had lived a lie not knowing my true ankle.
-Muscular system: because I'm familiar with the names of muscles since I have deeply studied the science of bodybuilding for the past three years.
-All of it. Please pass me.