Goodbye Tuba City!

Just finished my family medicine rotation in Tuba City Arizona on the Navajo Rez . . . here’s some pics of the place and the peeps

Me, Mark, Dr. Guzman and Dr. Kandell

Me and Ernest – family med nurse extraordinaire

Me and Dr. G

Entrance to the hospital

Our good ole family med trailer

Family med clinic waiting room (at lunchtime)

Our last Friday Flea market (this is where we got the good roast mutton)

Gimme some mutton!

Last day at Dinebito (rural clinic 45 min outside of Tuba)

Couldn’t leave without a nice sandstorm to send us on our way

Me and Mabel

Me and Dr. Tang (lookit my hair!)

Allosaurus tracks in Tuba!

Raptor Ribs mmmmm

I guess I wasn’t the only one who thought that looked good . . . petrified dino dung

Goodbye Monument valley!

A stop in Arches National park (here’s Mark at window arch)

Delicate arch

Turret Rock – looks like a gun turret I guess

Good hotel in Ecuador

Hotel Bambu
www.hotelbambu.com in Canoa, Ecuador next to the ocean, a really nice backpacking beach town very nice, especially the hammock next to the hotel, best place to take a nap while listening to the waves

099263365
052616370

Good tour guide in Egypt

Mohamed
Mohamedguide2@yahoo.com
He took us to Abu Simbel, Nile tour and Luxor, Karnak, etc, really really great guide, very hard working. If you take Egypt Air domestically, don’t sit in the back near the latrine . . . yes, it smells there

Grass is greener . . .

I was just talking to my bro the other day about where we each are in our careers/lives and where we want to go. As an entrepreneur, he’s feelin’ the pains of the economic recession pretty hard on his business and thinking about going into the recession proof health care industry whereas I am three years into my health care “experiment” in which I would get a sense of whether I loved being a doctor enough to give up doing business. Its funny because both of us are looking at the greener grass and wanting to be there. Myself, missing the excitement of a big transaction or the “pie in the sky” while Uly wanting a simple non-stressful office based practice that pays a steady annuity with good health benefits down the road. The story is not quite so clear cut in the sense that both of us are ultimately want both. Some sense of stability punctuated by periods of excitement and risk taking. Ultimately, I think we will both have a little bit of both.

All of this does give me pause as to whether I am glorifying that other world of business too much in my mind and forgetting the downsides of uncertainty and frustration that come with risk taking. We’ll see what happens . . . Admitted Students Weekend at Tuck is next week!

Intro to ED

Worked a shift with Dr. L tonight at Tuba City ED. Not too many really sick people but that didn’t mean it was any less educational. My first patient, a 66yo diabetic with a 101.5 degree fever, sore throat, cough and body aches was pretty cut and dried . . . or so I thought. Body aches, cough, no red throat and her age made it VERY unlikely that she had anything other than a viral upper respiratory infection. And our Dartmouth teaching tells us that 90% of the diagnosis is in the history NOT in expensive, unnecessary and ultimately resource wasting lab tests and imaging. Yet we did a rapid strep swab, ordered a chest xray, drew blood from both her arms, made her pee in a cup all to rule out a possible life-threatening sepsis which my history told me she DID not have in the first 30 seconds.

So apparently the thinking goes in Emergency Medicine that to be right about the diagnosis is NOT as important as to be paranoid about the worst case scenario. In fact, forming a “differential” diagnosis in EM is upside down. Its more about looking at the worst possible 3 diagnoses for a patient’s chief complaint, ruling them out with tests and history rather than to gather data and based on that data, come up with the mostly likely diagnoses.

Toward the end of my shift, I also saw an aggravated patient with seizure disorder who was screaming profanities at the medics and staff trying to undress her and draw labs from her. Meanwhile I listened as Dr. L tinkered with the police dispatch radio testing it to make sure it was working in case they needed to contact us.

I guess the question after all this is: do I really want to be up at 4am in the morning dealing with all this stuff? Even if I do get to work 3 days a week and be off at predictable times, have a life outside medicine, etc.

Lately I’ve been thinking about the question “if you take away all the money, prestige, what is it that you would be excited about doing every day?” Would it be staying up all night in an ED?
It should be an interesting summer.