Gene's Joint

back from greece!

Good to be back home!

Btw, www.millhouses.gr is like the best hotel I’ve stayed at

Food Santorini

Mythos Taverna – best place we ate in Greece
Pirgos – Santorini
+302286032444
open all year round
referred by Antonis from Art Space
best dishes: Eggplant dip, anything with Feta cheese, grilled fish, fried calamari, kebab

Going to Greece and maybe Mexico

Good news, Jane and I are going to Greece, Athens and Santorini in 2 weeks! whoo hoo

http://millhouses.gr/Photos.asp

Now arranging a Mexico trip with my parents

Gorham pics

Of course, a couple months late, pics of northern NH. Beautiful place . . . considering its in the boonies

So boonies here, they can’t even spell Hillbilly right

On the border with Maine at sunset, its not the ocean but ain’t it beautiful?

Mt Washington . . . I climbed that sucker . . . in my car :)

Gorham, not much there but at least its green and pretty.

Judgement

Just woke up from a fun night on Thursday my last call night on Surgery. Had a full day in the OR, still working on tying those knots under Dr. Liu’s watchful eye. Made it to Dr Z’s guest lecturer talk by Ross Jaffe, another one of those guys that one could perceive to “have it all”. He’s an MD/MBA, was an internist and founded Versant Ventures which now has $1B under management (with 11 other GPs, this means he probably pulls in $1mil a year in salary plus 2% carry so probably gets a payday of $50-70mil every 10 yrs). Dr. Jaffe said something that really resonated with me. He said that people ultimately get paid for 3 things 1) Skills 2) Analysis 3) Judgement of which judgement is the most important thing (and what he iterated to me that should be a reason for me to pursue residency instead of stopping at the intern year.

As I left with those words for my last call night at DHMC, I saw again how judgement makes a big difference in the ED. A 30yo guy who was partially ejected in an MVC came in with what turned out to be a really bad laceration in his spleen and was bleeding to death in his belly. We took him to the OR and as soon as we opened his fascia, he started gushing blood out of his abdomen. We ended up sucking 4L of blood out but fortunately found the lac in his splenic and short gastric arteries and tied them off (I hope he makes it). The other fortunate thing was that Dr. Burchard (one of the best teachers I’ve met here incidentally) was on call and was able to make the right judgement to take him to the OR immediately after the FAST scan (ultrasound) of his belly showed fluid for immediate exlap. In this age of testing and data overload, another physician may have wanted to waste precious minutes by taking him to CT scan risking the possibility that he would bleed out.

I guess the moral of the story is really that in an age where “evidence based medicine”, hard sciences and technology seem to rule the day, the truth is that the soft squishy qualities like good judgement, common sense and deciphering what is important and relevant are MORE not less important.

A great day in surgery

My last day on the trauma service has turned out to be what you could say is one of the best days any physician could ask for. It started with patient C (a kickboxer who got rhabdomyolysis – where his muscles broke down and put him into multiple organ failure including a failing heart) whose tests showed he was finally stabilizing after almost a week of acute resuscitative efforts, he’s a long way from “stable” but doing a lot better than when he came in.
Then the shocking highlight of my day when a woman came in literally having had her hair caught in a mail sorting machine and being scalped and me and my resident spent a good 20 mins washing clots from under a loose hanging scalp and wrapping up her head while she was fully conscious talking to us.
There was the 2AM trauma case of a guy whose tractor flipped over onto his leg followed by the highlight, a 16yo who killed a horse by ramming into it with his ATV with a intracranial bleed who we took into the OR and evacuated. I ACTUALLY GOT TO CLIP OFF PIECES OF HIS SKULL with a bone cutter. I think we saved his life, he went from appearing to be dead on a ventilator to breathing on his own after the surgery. I hope he does well.

Finally eating breakfast with my residents who all complimented me on the good job I did. Definitely a sense of satisfaction and even a little pride. In particular Josh, my chief resident and someone I really look up to as a physician told me “you are one of the best medical students I have worked with”. All in all, a great learning experience

On a brighter note . . .

I think if surgery/critical care were a lifestyle specialty where I could be in California and travel to Asia occasionally, I’d TOTALLY do it. Its exciting, challenging, multifaceted and you really do get to say to yourself at the end of the day that you saved lives (Not true in most specialties).

My fallback plans are Anesthesia (where I would definitely get to do critical care but its also a specialty that appreciates and values good lifestyle), Urology, where everyone seems happy and the surgeries are cool. Medicine is looking more and more miserable and kinda painfully esoteric compared to the practicalities of surgery.

Liking surgery . . . or do i?

Last day (and night) on trauma surgery. My highlight today was talking to my patient Mr. T and his wife B, he was in a motorcycle crash that very nearly killed him and he was basically comatose last week, this week he is really recovering except for some minimal depression from being in the hospital. I gave him a pep talk, they talked about how nice it was to have me and complimented me, it felt very good to have played the role of the good doctor with the excellent bed side manner.

But that’s just it, in the end I think I’m a relativist. Its not that I have a “passion” for medicine. Its more that I feel very comfortable playing the role of the caring doctor. Do I really care about the patients? I dunno. I check up on them a lot, I hope they get better. But I am also really really glad to be outside the hospital and I groan at the thought of sacrificing the hours of my youth away at the hospital as a “resident”. Nonetheless, I think I empathize with patients, and to some extent that must mean taht somewhere deep down, I really do know a little what its like to be alone in a strange place. But on the other hand, I really do enjoy the compliments I get from patients, the compliments I get from my residents or attendings (my teachers). Those things also make me feel smart and with it. The added benefit of surgery too is that its almost exclusively an old boys club where you get to feel like one of the guys. That too is a role that I like to play.

So the real question that I have been asking myself for the last 3 years is, do I like playing the role of the compassionate physician at the beside who sacrifices his time and energy for the good of his patients or would I rather play the role of the coldhearted business person who doesn’t really help people but has time and money to spend on the material things in life?

Either way, I think shakespeare was right, life really is just a stage.

Notes on surgery

The last three weeks have been like a roller coaster, downhill at a 100mph one minute, then crawling up to the top for another drop. In Trauma surgery, its an amazing thing to be able to say that I helped save someone’s life. But the sacrifice to one’s own life is equally profound. In the last three weeks, I’ve spent less time outside the hospital than inside, slept an average of 5 hrs a night for 14 days straight without a break and have felt at times completely exhausted, mentally and physically. I don’t think I’ve used my cell phone at all except to call my girlfriend to get dinner after leaving the hospital. I’ve even questioned at several instances whether or not I even want to do my intern year at all.

The bright spots are the days when I can really talk to families of my patients in the ICU, watch the kidney of a 22yo suicide victim being fused with the arteries of a 38yo diabetic recipient or the day that one of my patients who fell off a bike and had emergent surgery to repair a bleed into her neck finally left the hospital.

Sleeping for 15 hours after being up for 35. Man, I can believe I’m paying tuition for this!

Positive Override!

Malcolm Gladwell’s Blink talks about a couple of states of mind. Positive override vs negative override. Positive Override is where you are generally happy and anything negative is just a fluke that you roll with and Negative is the opposite where you are generally miserable and anything good that happens is just a temporary run of dumb luck that probably will go away.

Today I find myself DEFINITELY in positive override! I won’t overanalyze but I think its a combination of things most important of which is that I am REALLY loving it at Dartmouth these days especially after being back from my “away” rotation at Children’s Hospital of Orange County in California and seeing what it is like in the real world of medicine where interns are too busy to learn and told to spend LESS time with patients to be more efficient and doctors generally are rewarded for efficiency, not critical thought or patient care. The management and rewards system there is definitely messed up!

Contrast that with Dartmouth where we spent a whole day on talking and reflecting about Death and Dying with our Associate Dean who happens to be a practicing oncologist trained at MGH with 30+ years of experience talking with patients. And today got to watch Hillary Clinton come to DHMC and give an excellent talk on healthcare (btw, I think she won my confidence today for candidate most informed and capable on improving healthcare in this country). Then proceeded to interview a former drug user who has turned her life around as part of our substance abuse discussion today. Btw, I think I am going to be really good at psychiatry.

Anyway, besides that, I am really happy to be around my classmates and friends who love and support me. Just found out that one (and probably another one) of my classmates is sticking around for an extra year and will probably be graduating with Jane and I which will be great!

Today I feel like I am learning, growing as a person and feeling very happy with my life and relationships. Its a great feeling!

Hope everyone else is doing well too!