Quick update

T-minus 14 months and counting.

I signed a contract to return to our hometown in Farmington, NM. I'll be doing general surgery/trauma.

We now have 4 kids (Zeke 7, Hallie 5, Rock 2, Bo 4 months). Time sure flies.

If anyone is going to the AOA this year, let me know and we'll hook up. Also, I'm planning a road trip to watch BYU play Ole Miss in football on Sept 3rd.

Hope everyone is doing well. I wish that I did a better job of staying in touch.

where you all going for jobs

i know at least all you doing anesthesia are in the process of finding a job. where are you interviewing or where have you accepted jobs. no offers yet here. curious about what the rest of you are up to.

Yearbooks

So did anyone else just get a yearbook from AZCOM? Seems a little late, but I just got mine yesterday. It was fun looking at all the people I have forgotten already. I couldn't remember real names, just "Black Widow," "Tarmac," "Pseudotarmac" etc. Now I know their names. I am a little jealous of those of you who are nearing completion of residency, I still have at least two years if I don't do fellowship. That stinks. Anyone going to end up back in AZ? We are thinking about it.

Going to Idaho

Hey guys. I know I have never posted on here, but we're wrapping up residency here in Omaha and I have my next Air Force base assignment to Mountain Home air force base about 40 minutes south of Boise. I thought about a few of you who went to residency in Idaho and wondered if you are going to be practicing in Idaho after you are done. Anybody else have any future news.

Austin

Prayers for Kevin and Leslie

Kevin and Leslie have two beautiful boys Isaac and Austin. Recently Austin suffered a seizure and the exact cause is still pending some testing that is being done. I spoke with Kevin today and asked him if it would be OK if I posted this on the blog. He and Leslie said that would be great.

I also told him that all those Mormon guys he hung out with know how important family is and that we would be more than happy to remember him and his family in our prayers. And if needed rent an RV and drive out to help.

Acutally Kevin and Leslie were able to come to our home on memorial day weekend for what you ask, a Bar-b-que. We grilled steaks and played with Austin, looks and acts just like Kevin. But I blabber on. So Kevin and Leslie please know that you will be in all of our prayers and we will be ready to help if and when needed. Thanks to all.

Housekeeping

A few quick thoughts:

1. Priceless 360 degree post by Dr. Glover.

2. Looks like I'm going to pursue Vascular Surgery. Love them diabetic feet.

3. I have a lead on a urology spot for any interested individuals. Especially those serving our country in the dangerous battlegrounds of North Dakota.

4. Detroit is a rotting carcass of a city, but pretty fun to train in.

5. Hope Jeremy's hernia is OK. Must be tough falling apart, old man.

6. Ann and I were talking about heading to Hawaii some time next winter (got to moonlight and make some $$$ first). Anyone interested?

7. Also still thinking about going to New Orleans for the BYU/Tulane game this fall.

"360 Evaluations"

Don't know if anybody is still reading but I noticed last week not much traffic. Anyway you all here would appreciate this story the most.

Just finished our 6 month evalutions. Called 360, meaning you get evaluated from all sides. You know the nursing staff, PACU nurses, Cafeteria workers, cleaning staff, and your attendings. So I am reading through my reviews which I must say were all pretty good. My program director and I are laughing about a few things but no problems. I notice she is holding one last evaluation, she said she wanted to save the best for last. It is from a PACU nurse. Apparently I wronged her a few months ago, when I did not comments on her new pattern for her scub top, or forgot to tell her that her new "crocks" were the bomb. I have a sneaking suspicion that the comments relate to the fact that I do not just give her dilaudid at her request and occasionaly ask such silly things as what the urine output is, what the last hemoglobin was, what is the BP, how much dilaudid has the patient recieved?? You know silly, stupid things like that.

Anyway in her evaluation of me it stated that Dr. Glover is "arrogant" and "belitteling". Her spelling. My program director was laughing and asked if I had a response. I told her to tell the nurse she has'nt seen anything yet. And come June 30, 2011 she would be wise to not be in the PACU because I will proceed to open a can of arrogant, the likes of which she has not seen before.

So you Family Practice guys get to open that can a year earlier. Would you please yell at some old overinflated ego of nurse for me. You know kind of like a shout out to all of us still in the treches. If any others have had the sublime opportunity of 360 evaluations please share. Especially Dr. Caywood and Koth.

Case Presentation

The setting: MS-2 year, Sahuaro Hall.
Present: MS-2 class, Dr. Finch in a sweet blue Hawaiian button-up shirt and his wavy blonde hair that needed to be cut about six months ago.
Dr. Finch: Ok guys, it's time to do another ICM case. This was submitted to me from a Dr. Jensen in Wray, Colorado. I'll start out by giving you guys some pertinent information, and I want you guys to come up with a differential diagnosis.
CC: "I can't poop"
HPI: 32 year old Mexican male with no past medical history is brought into the ED by his wife and family in moderate distress. He states that he awoke this morning around 2 AM with abdominal pain in his LLQ. It comes and goes, he is unable to describe the character of the pain. It's worse with standing upright, relieved by lying down. He notes that the pain has moved from his LLQ to his RLQ over time. He admits to some rectal bleeding this morning when attempting a bowel movement. He also admits to some nausea, but no vomiting.
PMH: None
PSH: None
Meds: None
Allergies: None
Social: No tobacco, had some drinks at a friend's home last evening.
ROS: No fever, chills, otherwise as above.

Dr. Finch: Okay guys, what is your differential?
Number 2: GI Bleed
Finch: Ok, good
Damon: (says to Jeremy, "That number 2 is a real prude. It's clearly appendicitis.") Appendicitis
Finch: Good Damon, what else can we come up with?
Caywood: How about a butt tumor?
Finch: You mean like an adenocarcinoma?
Caywood: Sure.
Kevin: Tapeworm
Finch: How do you figure a tapeworm into your differential?
Kevin: When I was a cop up in the Northwest I saw a guy with this same presentation who we did a drug bust on and we ended up hauling him in to the ED and he had a tapeworm.
Finch: Okay, if you say so.
(Kevin shakes his head in disgust)
Slice and Dice: What about a diverticulosis or diverticulitis? See, I spent nine years in the OR and I saw this kind of thing all the time. We cut guys open all the time for abdominal pain; maybe he needs surgery.
Jeremy: How about an abnormal skin lesion?
Brizzee: Psoriasis?
Finch: All right, you guys are getting way out in left field here, let's redirect. LLQ pain moving to the RLQ, nausea, comes and goes, what else do you guys want to know?
Trent: It could be a kidney stone or even a testicular torsion.
Finch: True.
Fake Tarmac: How about a Suave deodorant bottle stuck in this guy's rectum?
Finch: How in the crap did you guess that?
Fake Tarmac: Just a feeling I've got.
Finch: Yup, that's right. And here's the x-ray to prove it.

So what's the rest of the story? I went through a 15 minute HPI with this freaking guy on the interpreter phone and finally at the end of it he said, "Last night I went over to a gay friend's house and we had some drinks. I passed out and I think he put something up there."
Ok, so if only he had come into the ED and said, "I think I have a deodorant bottle shoved up my butt" it would have made things a lot easier. Needless to say, the rectal exam revealed a round plastic object high up in the rectum. I tried like the dickens to get the sucker removed, but ended up needing to transfer him so that GI could do the dirty deed.

If anyone really wants to see the x-ray, just email me, not sure if I should post it on the web.

Have you ever met a proctologist? Well, they usually have a very good sense of humor. You meet a proctologist at a party, don't walk away. Plant yourself there, because you will hear the funniest stories you've ever heard. See, no one wants to admit to them that they stuck something up there. Never! It's always an accident. Every proctologist story ends in the same way: "It was a million to one shot, Doc. Million to one."

passes step 3...barely

i was going to take step 3 a while ago but then i wasn't able to schedule it until recently. i got my score today and could tell by looking at the score that i must have barely passed but didn't realize by how narrow a margin until i read the score report that the minimum passing 2 digit score is a 75 and i got a 78. i would say how glad i am that i can finally forget all my omm but apparently i all ready forgot it. congrats to all of you who seem to be multiplying like crazy. hope residency is going well for you all especially my fellow gas passers. everyday in the OR i am so greatful to not be on the other side of the drapes. are you still out there shane? i think you and i are the only ones left that can go to a restaurant and fit our whole family in one booth.

It's Another Boy

Rock Thomas Kalcich

Born 10/15/08
20.5 inches
8 lb 8 oz

Delivered via C-section (no OMM required)

Mom and baby at home and doing well.

It's a Boy

Finally, we will be having a boy to end our family. The only question left is can he swing a golf club?? Early March we are expecting.

Hope everybody is having a tremendous learning experience, and keeping up on the OMM skills. There will be an exam at the end of residency. I will not be using CV4 from now on.

Anyone up for fantasy football?

Can we get enough people (8-10)?

ED Thoracotomy #2 this week

So I'm driving in to round on Sunday morning, and I'm about two minutes from the hospital hen my pager lights up: "Code 1 GSW abdomen"

I get to the hospital, cruise down to the trauma bay, and the on call resident is opening the chest. I throw a gown on and help out. We get a weak, thready pulse back. Off to to OR.

On the way, we pass the family in the hallway. They are (understandably) going nuts. We get to the OR, can't identify any bleeding in the thoracic cavity, and decide to open the belly. Blood gushes out (despite our clamped aorta). We lose our pulse. Quickly mobilize the left colon/kidney/spleen, and find a huge aortic injury.

We try and resuscitate/repair, but to no avail. Patient expires.

When my attending tells the mom, she runs out of the hospital and has a seizure. Luckily, she is caught by another family member, or she would have been a trauma consult too, and thus on our service. I feel a little guilty that instead of feeling bad for her, I was happy that she was caught so that I wouldn't have to admit and round on her.

Sometimes, cleaning up the list seems to matter a little too much to me. I'm not sure what that means, but there it is. Anyways, we're 1 for 2 in lifesaving thoracotomies this week.

Things I only saw on bad TV shows

I used to watch the TV show "ER", and "Trauma: Life in the ER". Nowadays, I really wonder why I wanted to watch a show about work.

Anyways, I got to participate in an ED thoracotomy today (The 3rd one in 6 weeks here). A guy took a sawed off chotgun blast to the leg and back. He had an obviously catastrophic leg injury, but he coded twice during the resuscitation. We had yet to even roll him over to look at his back because we had airway issues and needed a Cordis. Right when we flipped him and noticed holes in his back/neck, he lost vitals, so we cracked his chest.

It was awesome. Did internal compression until his heart started beating again. He had a pulmonary laceration that was bleeding pretty good, so we whip stitched it and ran to the OR. Gave him a wedge resection, tons of blood, and cut off his leg. (And you thought you had a bad day.). First pH in the OR was 6.6.

Good news is, he awake and alert in the SICU. He'll probably get ARDS, but he's alive for now. Pretty freaking awesome day. Then I had to go to stinking clinic, and be the king of Vicodinland for the afternoon. All in all, a good day.

A new title for the blog.

Because The BackRight was a lame name that came to me when nothing else would, this blog was so titled.

But no longer.

Let it be dedicated to the veterans (and brothers in spirit) of the Conshohocken Convoy, many of whom suffered (and still suffer) from Hotpocket Fever. Symptoms include an irresistible desire to drive over rumblestrips and a craving for red beans and sausage.

It is rumored that brother Jason Caywood still has loose stool from said disease, and brother Shane Taufer might be dead.

Paging "the guy called" Dr. Lohman

Rhett, I don't know what kind of internet "scheme" you have going, but my wife just got this post on her blog a few days ago:

"Hi Anne, you don't know me, my name is David, I live In Spain where the guy called Rhett Lohman was serving a mission. I have tried to find him for more than 10 years! He was serving in the Santa Cruz branch. I don't know if he remembers me but please, give him my email if you can, I would be eternally grateful.
bubuni08@gmail.com "

Can you please ask "BUBUNIO" to stop emailing my wife!

Thoughts from the ICU, and why Detroit is a scary place

I've been meaning to type up some stuff about the transition to 2nd year, being at a new program, etc. I'll get to all that stuff in a few days. But today I'm post call, and I had to tell you guys about the amazing volume of trauma I get to see.

Now a lot of people talk about trauma, but they're talking mainly about blunt trauma. Blunt trauma is boring. For a resident, it means chasing labs all night, cajoling radiologists for stat reads on imaging, and waiting for a drunk guy's EtOH to get back to double digits so I can send him home. If blunt trauma goes to the OR it'll be the Ortho or Neurosurgery guys taking them. (You're welcome for the babysitting.) So when people talk about trauma, they usually aren't describing anything cool, but rather just a bunch of tedious (albeit nessecary) work. Nothing for a surgery resident to get excited about.

Penetrating trauma is different, although at most places much more rare. Nothing quite like the rush of going to the OR with an unstable GSW. Don't get me wrong, I'm still a junior resident and don't do much to actually fix the guys. I'm just a small cog in the machine. As an intern, I did the H+P thing, acted as the scribe, did all the erannds and followed up everything. If I did go to the OR, it was as a third set of hands. A few times I did get to break scrub and eyeball a new trauma code while the attending and chief operated. It was a whirlwind of activity, and I was in the middle of it all, even if I was as important as trash blowing in the breeze.

Fastforward to 2nd year. Now I'm in the SICU. I'm barely out of second year, and I'm expected to manage critically ill patients by myself. I usually want to pull a Caywood's dad in my own shorts. But the cool thing is, I'm finding I can handle most stuff. I do have to call the intensivist with big stuff, but 90% of the time I'm running the show. Mananging vents, starting drips, doing procedures, the whole thing.

My first call I had a textbook case of severe hemorrhagic shock, and I was all alone. 18 yo male with GSW to right eye, belly x2, scrotum, and both lower extremities. Systolic out of the OR was in the 70s, refractory to fluids. I admit the patient, start some basic orders and call the attending with the admit, and give him exactly what I've typed here. He says "Sounds good. Get him a subclavian and a CVP at 8 or higher. Good luck."

I was almost constantly at his bedside for 18 hours. He was in shock, sedated, ventilated, the whole deal. But the guy lived. I can honestly say that my post op management saved that guy's life. Not that I'm anything special, any resident could have done it. But I did it. Even though he'll look like a pirate, that kid is alive because I helped him. (Two day later, we were able to extubate him, and amazingly he did really well. He even remembered me from that long night. So I guess he wasn't that sedated. Rarer still, he thanked me!)

This guy was the first of 5 GSWs that I would admit and manage that day. The crazy thing is that this number was not unusual. Being in Detroit provides us with an amazing volume of penetrating trauma (we still get plenty of blunt). The gangs here taunt each other on the streeet by touching their throat and belly simultaneously, as if to say "You're going to need a trach and PEG after we get to you." (We have medically savvy gangs here in Detroit.) We get a lot of patients purposely shot in the neck, and these are celebrated as "wheelchair shots".

I used to think Maryvale was a tough hospital (one time James Matthews and I watched his car get stolen from the 7th floor). But here last night there was a double homicide directly across the street from the hospital. Last week someone attempted to abduct a hospital employee standing outside in broad daylight. Three months ago a guy walked right through security into the ED with a loaded semiautomatic shotgun. He was upset that his grandma died in the ED earlier that week. He raised the gun to fire and it jammed. People started diving out of the way, and security caught up to him and shot him in the ED. A vascular surgeon got carjacked while driving up to the hospital for a case late one night. Crazy, crazy stuff. And it doesn't shock people here at all.

It's definately scary. But I love it. Despite the violence, a lot of the patients are good people. I really like my co-residents. (It's interesting how green we all are, under the same pressures, working together constantly. Sometimes it feels like it's us against the world. You bond with these people in a way that reminds me a lot of being on the mission.)

I am amazed and inspired by the two surgical intensivists I'm working under. Some days I even feel like a doctor, instead of usually feeling like I'm just a poser. I'm absolutely drinking from the firehose and learning tons every day. And then I come home every day to a big party with happy kids and a great wife. Who, despite being pregnant in the humid summertime, still has a pretty great attitude.

(And I'm dang glad I'm not an intern anymore.)

email addresses

Everyone survive intern year? Glad that is over. I'm sure mine and Jon's wasn't as bad as some of yours. Just glad to be moving on. Hoping everyone can post their current e-mail address. Or if you are afraid of spammers just e-mail at jeremykbingham@gmail.com. I'll put them all together and send them out.

Enjoyed the nursing horror stories. The "look it up yourself" comment was classic Damon. Would have paid to be there.

Be planning ahead for the Backright reunion in Hawaii 2014 (or recreating a 6 day roadtrip to Conshohocken, we'll jury rule it). There will be plenty of advanced notice so everyone can make it.

Jeremy

Small world

Damon,
I worked with this nurse all year and I just found out that she is from Farmington NM. I asked her if she knew any Kalcich's and she said she knew of them. And then I asked if she knew any Fishburns. She says, I know Ann Fishburn she use to babysit me. Her name is Gentry, I don't know her maiden name. I thought that was pretty cool.

Moving Day is Over

Just moved us into a home. (We rented for a year while we tried to figure out the Detroit real estate scene).

I am so sore this morning. That's what eleven months of lifting nothing heavier than a Bovie will do for you. But we're in, gotten most of the big stuff put away. The first 48 hours stink, but it's pretty nice now that we're a little more settled. Watching the Lakers/Celtics game was pretty cool.

I am still amazed that half of our stuff is children's toys and clothes. Even my unborn son has more stuff than I do.