There is a lot about which to write over the weekend, but let me start with this: remember a few blogs back when I explained why people get their gallbladder out? <CLICK HERE> Well, I included an abnormal cholangiogram to show a blockage in the common bile duct, but I didn't include a normal cholangiogram for comparison. So here's a normal film. Notice how the contrast goes all the way into the duodenum this time, instead of stopping blindly. So that's your anatomy lesson for today.

It's 5:34 AM. I think I'll take a cat nap.

Yesterday I was post-call, so I went home and walked straight into my pool. I've decided that pools and rafts are the coolest thing ever, as they afford you the opportunity to enjoy the UV rays of the sun while doing absolutely nothing. Then if you get hot, you just jump into the pool to cool off. Then I drove to Houston in preparation for all my meetings today. Upon arriving in Houston, I made some lovely hamburgers with Hatch peppers (smoked at Central Market: Plano) which were very good. Then the three Club 1948 boys headed to the world famous West Alabama Ice House for some beverages. I had $1.75 Pearl canned beers and $3.00 Fat Tire bottles. We were joined by the lovely Denise, Ruth, Jenn, TODD FOX, and April. TODD FOX doesn't get mentioned enough in this here Blog which will be explained later. It was a pleasure to see the lovely Ruth, who I got to answer all of my unanswered questions about her yoga-breathing, belly-dancing, non-vegetarian, Bowen Therapy, HP ways. She seems very cool, but I still wonder if my slight intoxication was annoying to her 100% sobriety. Then we were joined by a ton of medical school people named Eric Graham, Ann Hyslop, Tara Sullivan, and Dave Timm. It was delightful to see all of them. Then we went home.

The next morning I woke up at ten and discovered that TODD FOX e-mailed me. Isn't TODD FOX the ultimate porn name? Or maybe it should be a sexy spy name or something. Anyway, TODD FOX apparently isn't all to pleased with the amount of mentions he gets in this here blog and rightfully so. He is entitled to several mentions, because as we all know TODD FOX is good people. So the e-mail is a link to a web page that he wrote for me. What the web page does is scan through the index page of my blog and search for the name you enter to find out "does Tommy Roshek love you", which apparently I did not for TODD FOX. The code is very clever, and apparently TODD FOX wrote the thing in like 20 minutes. If you follow that link however, you're not seeing the original product. After a few back and forth e-mails, we decided (jokingly I thought), that his thing should search my entire blog including archives to find out "does Tommy Roshek love you". I think it's probably pretty complicated to do that sort of thing, but by the end of the day
TODD FOX had written the code, and now the World Wide Web can find out not only "does Tommy Roshek love you" but also how many times I've loved you and how long it's been since I last loved you. I will officially work this link into tommyroshek.com's index page over the weekend. So cheers TODD FOX. I have a man crush on you. Then I had Freebirds with Nick and got my car washed.

Then I met with Steve Jones, an employee in my school's student affairs office. I needed to see all of my test scores during the third year to finish the UT-Houston residency supplemental application. While I was doing that, I had the opportunity to read all of the comments my attendings on each rotation have left, which are stunningly good. I had no idea these people liked me so much, but it's comforting to know that they feel I'm going to be a really good doctor someday. Then I headed over to Dr. Safi's office to see if he would write me a letter of recommendation. He wasn't there, but his secretary told me it wouldn't be a problem and to leave all my supporting documents with her. I felt weird about that, because you like to hand the stuff to the letter-writer and meet with him or her. But she convinced me and I told her I'd be back after my meeting with the chairman of general surgery.

I had 30-minutes before my meeting, so I decided to meet with Kim Anderson to see how she was doing. Earlier in the day, Nick bumped into her and was told a story about how Craig Messick (our class president going into surgery) was in her office all the time to have his personal statement read and little paranoid stuff. So I announced to the secretary that Craig Messick was there to see Kim. When Kim heard the news she shouted "NOOOOOO!" to the secretary at which point I revealed myself and laughs were had by all. It was classic. Dr. Anderson then read some of my stuff, and we chatted. However, as luck might have it, Craig Messick showed up! Poor Kim just laughed and laughed. Of course, we then had to explain why Craig's presence made everyone laugh. The coincidence was striking and yet further proof that my life is based on the movie "The Truman Show" with Jim Carrey. Kim is such a wonderful person. She loves to laugh and cut up, which is right up my alley. She's really taken tons of time out of her schedule to help me get into a good residency program, and I can't thank her enough. Then I met with Dr. Andrassy. We had a splendid meeting. We discussed my career plans, golf, and whatnot then Dr. Red Duke walked in to shoot the shit. He found out that I was working at Baylor Dallas and passed his regards to Dr. Jones, who is the chairman. They were actually residents together at Parkland around the time JFK was assassinated. In fact, they were both working the Parkland ER when he arrived that fateful day. The meeting ended, and Dr. Andrassy sounded as if he'd write me a nice letter. Then I went back to Dr. Safi's office to see if he was back but no luck. The secretary said everything would be great, and I believed her. So I went home.

At home I discussed the content of the day's meetings with Nick when none other than Dr. Safi called my cell phone. We had a brief meeting on the phone, and he offered to write me a letter of recommendation. WOW! So now my letter-writers include Dr. Andrassy, Dr. Potts, Dr. Safi, and Dr. Estrera. I will ask Dr. Fischer to write for me on Monday, and I have one other person to ask possibly this Friday at Baylor. So today was a good day. It was totally worth it to do all that driving (now the second time in two weeks). Someday I will look back on this day and fully understand that it was probably the day that started my surgery career.

It's getting late here at the hospital. I just got back upstairs after a quick trauma. This is sort of depressing. A paraplegic crossing the street in a wheel chair was hit by a pickup truck who ran a red light. I don't know if the truck stopped or what, but the victim isn't in good shape. I'm not sure how she is going to come out of this, but the CT scan of her brain doesn't look all that good. I hope things turn out alright.

More Olympic greatness today...and more controversy. All-American Carly Patterson of Allen, Texas took home her third and final medal of the Olympics today. She won the silver in the balance beam. Also, Paul "my my what an unfortunate voice I have" Hamm took the silver amid more controversy about his competitor's score. Apparently there was about 10 minutes of booing and jeering before he could finaly do his thing on the high bar. Whatever. The Olympics are obviously set up in a subjective fashion for a reason--ratings. There will always be controversy. It's impossibly to objectively rate events like gymnastics or figure skating. And the Olympics don't want it like that anyway. They want controversy, they want ratings, and they want people talking about the night before at the water cooler the next morning. It will never change...and should it really? I love the drama, the stories behind the athletes, and the pagentry. I know all of it is completely commercial, but there is still competition involved. There is heart involved. And when you peel back all the bullshit, it's human against human. Who is the best in the world? Who trained the hardest 7 hours a day for 10 years? It's pure gold.

It's still early on Sunday morning. I can see the sun poking through the clouds intermittently, which is very nice. I'm supposed to be going to Lake Texoma this morning with Dave, Mary, and Charmaine, but Mary punked out (no surprise). So the three of us still might go, but Charmaine is post-call which increases the likelihood she will pass out on the boat. Plus, I probably should finish my residency applications and maybe get some rays before the week starts. So we'll see how this lake thing turns out, although I know Dave is going no matter what.

I already went to Baylor and saw my patients. How cool is it that we don't have a set rounding time with the attendings. I got there at 6:30, saw my patients and was gone by 8:00. It was absolutely fantastic. In addition, there appears to be some very nice cases on the schedule for tomorrow, so I'm looking forward to that.

Finally (for now), there is now an available preview to Wes Anderson's new movie The Life Aquatic starring Bill Murray, Owen Wilson, Willem Dafoe, Kate Blanchett, Anjelica Huston, and Jeff Goldblum. I'm sure everyone's favorite Deepak Pallana will be involved, and doesn't that look like Michael Caine in the preview?? I highly encourage you to check it out...as the first 25 seconds of the preview made me laugh out loud. The movie is due out this Christmas.

This morning was sort of frantic. I woke up at and noticed the sun shining. That's not a good sign, because I was supposed to be on my way to work before the sun came up. Then I looked at my alarm clock, which was blinking the dreaded 12:00. So there was a power flicker and my alarm didn't go off. So I called my residents to apologize and offered to come in Sunday morning, which I will do. Ugh, what terrible luck. I'm sure they'll understand, but it's never good to miss work for silly stuff like that. What a bummer. The rest of the day has been spent working on my residency application. I'll be pleased when this is all over, and I am moving very close to finishing this thing. Thank God the main stuff is out of the way--now I'm left with adding extra-curricular activities, hobbies, interests, blah blah blah. Plus, Nick called me to let me know that my USMLE Step II scores have arrived in Houston. I'll be opening that letter when I arrive in Houston on Tuesday. I have scheduled meetings with Dr. Andrassy (the Chairman of surgery), Dr. Fischer, and hopefully Dr. Safi (the Chairman of Cardiothoracic Surgery).

Yesterday I was post-call but still had a nice surgery. First off was a trauma that came in. Apparently a woman fell from 3-stories, and had a few internal injuries. We sent her to interventional radiology where she had a branch of her hepatic artery embolized to stop bleeding. Her right renal artery was avulsed, so she lost her right kidney. It's amazing to think that a guy came in a week earlier after jumping off a 10-story overpass with no injuries whatsoever, and this woman falls 3-stories and loses her right kidney. Then I did a procedure with Dr. Stratman, a younger general surgeon who is very nice and a good teacher. We did a laparoscopic cholecystectomy. Translation=we took out a gallbladder using a camera and robotic devices without opening her belly. People usually get their gallbladders taken out, because they have pain in the right upper quadrant of the belly, often while eating. The gallbladder stores a substance called bile, which is this goopy green stuff that helps you to digest fat. The pain could be because there are gall stones in the gallbladder, stones in the exit duct (cystic duct) of the gall bladder, or even in the common bile duct which empties into the first segment of the small intestine called the duodenum. To make sure there aren't any stones in the hepatic duct (which would not be helped by taking out the gallbladder), we do a procedure called a cholangiogram where radioactive contrast is injected into the cystic duct and an x-ray is taken to see if the contrast is emptying properly into the small intestine. Well, in this patient's case, the contrast mysteriously stops right before it reaches the small intestine. This is most likely due to a gallstone obstruction or a narrowing of the lumen of the duct. So she'll visit the GI doctors who will put a tiny camera into the bile duct and see what's causing this blockage. If it's a stone, they'll take it out. And if it's something else, they can usually fix that problem too. I've included the x-ray image of the blockage. The top two branches (called the left and right hepatic ducts) come from the liver (where bile is made) and combine to become the common hepatic duct. Then the cystic duct from the gallbladder hits the common hepatic to form the common bile duct. You'll notice that the gallbladder is missing from the x-ray, because the cystic duct was clamped off and the gallbladder already removed when we shot the film.
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Last night was spent with several people. We started at a place called Primos (means cousins), which is a Mexican/cafe place on McKinney in the Uptown area. I got there early and sat at the bar with my $1 off margarita. A gentleman named Galen Johnson sat down next to me which lead to the normal pleasantries. He found out that I go to school in Houston and work at Memorial Hermann Hospital. Well, he works for Trammell Crow, which is a huge real-estate/contractor company. It turns out that he's involved with Memorial Hermann to build a bunch of new hospitals. Before that, he was an executive with Baylor University Medical Center, which is where I'm currently doing my rotation in general surgery. Also, his father used to be the CEO of BUMC, which is pretty cool. He knows every surgeon I've worked with this month, and his kids when to high school in Lake Highlands with one of my favorite attendings, Dr. Derrick. So it was totally cool to chat with him for an hour or so. Then he paid for my drinks, wished me good luck, and left. It never ceases to amaze me how I tend to bump into these people. It's further evidence that my life is actually a version of the Truman Show, with these "random" beneficial events occurring every so often. I hope and everyone at home watching their television sets and enjoying my life thus far. Then Charmaine (of The University of Texas Medical School-Houston), Mary Mathieu (of the University of North Texas Graduate School), and Mary's two friends (Kaley mentioned previously and Nicky) arrived. We had a few drinks, then Charmaine and I left for an Irish Pub. The place is called The Tipperary Inn, and it's outstanding. I was totally amazed with the whole presentation. We were joined by Ryan Ricks (of Club 1948), Kristin Ohlenforst (of ohlenforst.net), Baseball Jim (working in Dallas), Katie Sternweis (of The University of Texas-Southwestern Medical Center Graduate School for Psychology), and two other friends of Kristen. I really enjoyed this place and plan to return at some point in my life. Then I went home and fell asleep.

Man, you just gotta love the Olympics! Somehow, I get sucked into this thing whenever it comes, and I'm so happy that I do. Today after four surgeries and a patient who died in a trauma, I got some dinner and joined the rest of the team in the resident lounge. We crowded around the 56 inch television for some good old fashioned Olympics watching. We watched Michael Phelps win Olympic gold. We watched women's all-around gymnastics, combined with tons of commercials. We watched Michael Phelps set a new Olympic record in the 200M breast-stroke. Then we watched as Carly Patterson of Allen, TX (a suburb of Dallas) accomplished what no American woman has ever accomplished in a non-boycotted Olympics...she won the all-around gold medal, one night after Paul Hamm became the first American man to accomplish the same feat. Don't you get goosebumps when our National Anthem echoes across the arena? Shit, my national pride is always front and center during the Olympics, and we certainly have tons to cheer about this summer. I love it.

It's 3:07 AM.

(From last night at Nathan's house after several drinks...)

I'm actually at nathanbeach.com's house. Let's be serious for a moment...Nathan is one of my best friends. He is probably the smartest person I know, on par with maybe Nick Hamilton. In high school, Nathan introduced me to creativity and correct grammar for that matter. He sort of made it possible for me to truly excel in college. Now we're cooking pasta and listening to Linkin Park on the Bose Wave Radio. Apparently he's moving to California as soon as he gets a job. I can't fault him for that, as So Cal is the greatest place on Earth. I hope he moves out there with Shelley. Anyway, I think it should be noted that he's my buddy and partly responsible for showing me the world ouside the cookie cutter. And German stuff.

(And now onto the present...)

Hmmm, that seems sort of gay, but we'll keep it there anyway. The thing above is sort of pure, as I had no inhibitions so I suppose it's nice to have that on this here blog. Let's talk about last night.

Work was kind of slow, but I had fun anyway. My only case was a left hernia repair with the greatness that is Dr. Derrick. Then I hung out with my Intern Dan and rounded on floor patients. I I&D'ed (incision and drainage) a guy's left arm abscess which is always fun. Then I went to clinic and saw a bunch of new patients being evaluated for upcoming surgery.

Then it was off to Gloria's. This was my second trip (lifetime) for happy hour to said Gloria's.

PHONE INTERRUPTION

Seema J. of KPFT Pacifica Radio in Houston, medical colleague, and close friend just called to say hello. She always seems to check in up on me to see how things are going, chitchat, or whatever. She also mentioned that she isn't getting enough exposure in this here blog, so therefore I am currently exposing her. Love you.

END PHONE INTERRUPTION

At this trip to Gloria's I was first joined by Dr. Meredith Hulsey of the Baylor University Medical Center pathology department. Meredith was my intern during the first month of the 3rd year of medical school. We of course became great friends along with her husband Kevin (or Kev-O as I call him). At that time, she was learning to be an obstetrician/gynecologist at St. Joseph Hospital in Houston. She decided that she didn't like that and switched to pathology. Next Kristin Ohlenforst of ohlenforst.net arrived straight from her clinical psychology PhD training at UT Southwestern Medical Center. She has been mentioned in this here blog previously, and we all know how much I love her. Then my good buddy Katie Grysen of UT Southwestern Medical Center arrived. She is currently in her 4th year of training to become a kids doctor. I met her the summer after my 1st year of school while doing a preceptorship with Dr. Bob Fine of Baylor University Medical Center. She became an instant friend due to her outstanding personality, intelligence, and overall sweetheartness. She also is the best softball player I've ever seen and formerly one of her high school's drum majors. Then we were joined by Dani, a lovely 31 year old from Kristen's psychology PhD program. I sat next to her for the better part of the evening and was very impressed with her personality and no-bullshit attitude. PLUS I GOT AN E-MAIL ADDRESS! Oh man, I'm rolling now. (Isn't weird that we're starting a new era of technology where people are exchanging e-mail addresses instead of phone numbers? Or maybe she just doesn't want me calling her. Maybe I'm just a horrible loser. Oh God, what am I doing? AHHHHHH, my life is a failure!) Then came Meredith's high school friend Leigh and her buddy Brian who is a Police Officer for the city of Dallas. They were at the other end of the table, so I didn't get to chat with them quite as much. But they seemed very nice. Arriving next was Nathan Beach of the world famous NathanBeach.com. You already know Nathan from above. Then arrived a very beautiful, tall, blonde girl friend of Kristen and Dani named Amanda. She got there a bit later, but I learned that she is from Lancing, Michigan. We didn't get to chat very much either, but she seemed very cool as well. So the evening progressed (and what a beautiful evening it was...cool temp, no clouds) and we ended up on the patio enjoying margaritas, excellent conversation, and the beautiful Dallas summer evening on Lower Greenville. I think I was psycho-analyzed several times, we discussed how everyone who went to college in Texas knows each other, talked about Katie's upbringing as a high school drum major, discovered a lot about 31 year-old Dani, and had a very nice overall time. This sort of thing is EXACTLY what I needed after two weeks of hard work at Baylor. Work hard, play hard right? Actually the outing at Volcano on Tuesday night(described in a previous blog) and last night are so refreshing for me, because everything has gotten sort of stagnant in Houston friend-wise. It really has been great to meet a few new people like Ruth and Dani along with seeing long-time friends of days past like Nathan, Meredith, Katie, and Kristen. Seriously, it's been a great week considering work and play. I really consider myself blessed for all the wonderful people I've met and the solid relationships I've forged over the years. I'm very lucky to know such intelligent, fun, quality people.

Saturday

Today has been spent floating in the pool and listening to Sportsradio 1310 The Ticket. I'm now totally bored with residency applications, so I've decided to add some random stuff to this here blog thingy. First of note is recent correspondence with my new friend Ruth in Houston. Apparently in addition to her work at Hewlett Packard, she also practices alternative medicine. She is a student of "Bowen Therapy" which is intended to increase blood flow to the tissues among other things. I highly encourage you to check out her webpage www.bowenmethod.com where you can read about what she does and even schedule an appointment should you live in Houston.

Next up is the posting of some random pictures. My mom was going through boxes of old photographs of various family stuff and came across an image of my house when we first purchased it in the spring of 1984. We have lived in the house for 20 years now, so I thought it would be cool to show you the before and after photos. The first set is of the front yard. Notice our cool cars, Myrtle the Jetta and my Dad's Buick.

The next image is of our backyard. Since we moved, we've added a few things (like a pool), so it's quite striking how much things have changed. The coolest part of these two sets is how much the trees have grown over the last 20 years. Enjoy!

Finally I'd like to include a picture my mom found of me as the Mayor of Enterprise City. This "city" was a fake city the Richardson Independent School District created for fourth graders (and other grades) to learn about the economics of private business and living in the real world. We learned about supply and demand, pricing, balancing a check book, and all sorts of civic things. Oh man, I was quite the politician back then. I even had to give a "state of the city" address at the beginning and end of the day. I remember my dad and I spent hours in the days before the event writing my keynote speech. I bet I still have the manuscript hidden away somewhere in a closet. Good times.

So where did I leave off? Wednesday's meeting with Dr. Potts went quite nicely. He reviewed my personal statement, resume, and my list of surgery programs to which I'm applying. We had a good chat, everything was in order, and I left in high spirits. Then I got in touch with Dr. Estrera, the cardiothoracic surgeon with whom I'm doing aortic research. I left him my resume and personal statement, and he's going to review everything like Dr. Potts did and write me a letter of recommendation. So the day was productive.

Then I drove back to Baylor to start my call night. I spent most of the evening seeing consults and reviewing CT scans and MRI's. The ER was quiet as well, so call was less busy than usual. Thursday morning I saw patients then scrubbed into a case where a guy had a mass near his kidney. We kept sending tissue samples to pathology for evaluation, and they couldn't figure out what it was. I had to leave the case for a meeting, but it turns out that the surgeons ended up taking the mass and the kidney, because they were so close together.

The rest of the day was spent floating in the pool. My next door neighbor's son Blake came over to join Carolyn and myself and finally Tiger made an appearance. He and Carolyn are leaving for New York today as David is competing in the United States Amateur golf tournament which starts Monday. I wish him all the best, and I'm confident he'll have a great time and do well.

Gosh I'm so behind, so I thought I'd get you caught up.

Last Saturday night was call evening #2. Here is what happened:

1. So the beginning of the day was spent writing my personal statement for residency applications. Once I got rolling, things really took off, and I ended up writing about 75% of the statement. Then the trauma thing began (pronounce trah-mah).

2. Gun Shot Wound (GSW) to right leg which severed the popliteal artery, so a prosthetic graft had to be placed because the artery could not be repaired. The 3rd year student Seth scrubbed in on this one, so I'm not sure what happened post-op.

3. 21 year old punched by boyfriend, pushed out of truck, rolled over (tire mark on back) fractured pelvis, head laceration, lots of vomiting. I ended up stapling this girl's scalp (yes, with a staple gun) to prevent further bleeding. I saw her the next morning in the ICQ with low blood pressure and tachycardia (which can mean anything but often means the patient is dehydrated), so I gave her a liter of ringers lactate (IV fluid), and she was discharged later in the day.

4. Abdominal knife wound, we opened him up, and 2 liters of blood gushed out (onto my shoe mind you...how dare he). When I talked to him the next day, it turns out that his wife has a mental illness and stabbed him with a small knife. Unfortunately the knife knicked his mesentary (the thing that holds the bowel together and gives it blood supply), and he'd been bleeding slowly into his abdominal cavity. He is now doing fine.

5. I was asked to evaluate a young guy with signs of appendicitis. So I examined him, and agreed. CT scan showed inflammation but no perforation into the bowel (really bad if that happens) so he was scheduled for surgery later that night. He eventually went to the OR the next morning, so I missed that case.

6. 13 year old kid decided he'd ride on the back of a trunk. Unfortunately the driver reached speeds of 50 and more, and the kid fell off back of trunk onto the street. Apparently he had a seizure-like episode and hit his head. His CT scan was normal, but we kept him that night just in case.

Then Sunday was here, the post call Sunday. Basically I fell asleep floating on the pool, slept a lot, and finished personal statement while watching "The Birdcage" with my mother (such a fantastic movie). Is this a bad sign that I wrote the last fourth of my personal statement while watching a bunch of gay people try to fit in with straight people?

Monday

I participated in what's called a Whipple Procedure (or pancreaticoduodenectomy) which takes at least 5 hours. I was the 3rd person in the room behind Dr. Derrick and Dr. Holden. It was the coolest thing I've ever seen...because I was standing at the top of the bed watching the entire procedure without obstruction of view. A Whipple is when someone has a tumor in the head of the pancreas. The problem with a tumor in that location is that there are several structures in the immediate vicinity which makes things difficult. Commonly a piece of the stomach is cut out along with the first part of the bowel (the duodenum), the head of the pancreas, the common bile duct, and sometimes the gall bladder. Then all of that stuff is connected back together. I'll try and find a picture for your edification. Our particular patient's cancer was confined to the pancreas only with no metastases or local spread, so his chances of survival are greatly improved. Unfortunately, most people's pancreatic cancers aren't found until it's way too late, and most will die within 18 months.


Tuesday

I participated in the harvest of two kidneys from live patients (to different patients, two different operations). There were two attending physicians and me. So THAT was awesome. The procedure was done laparoscopically, meaning they didn't need to cut the belly open. Instead they used a camera and instruments that act like the surgeon's hands. They really were two cool procedures. Then I hopped in the car and drove to Houston. Upon arriving in Houston, I met up with Nick, Ryan, Todd (from Boeing), Denise, Jenn, and Ruth at The Volcano. I probably had a few too many frozen screwdrivers, but it was well-deserved. We had a lot of great conversation including the insight Todd shared with me about dating. He was pretty much right on the money for his Tommy analysis, so I appreciate the advice. I also got to chat with Ruth a bit who is friends with Jenn. Ruth seems like a nice girl, so I'll have to hang out with her more often when I get back to Houston. Then I went to sleep in anticipation of the big meeting with Dr. Potts (our program director in surgery) the next morning.

Yesterday wasn't all to exciting. The highlight was playing pool with Dave at the Dallas Fox and Hound. We played 25-cent games, double or nothing. No one won any money. And that's about it. I also called Cory to wish Nikki a happy wedding and congratulations. I hopethings go well for her and her new husband.

Today has a nice pace to it so far. Call started at 0900. I saw all of my patients and then had some time to work on my personal statement. Right after lunch, a trauma case went up to the OR. Apparently a guy got into a fight with a few of his "friends" and had a beer bottle smashed into his right forearm. Some of the fragments became lodged in his arm, so we explored the wound. Dr. Foreman (the Chief of Trauma at Baylor) was the attending. He handed me the instruments and walked me through the procedure. So really, this was my first case from start to finish as a "surgeon". It was pretty awesome. I found the glass fragments (which were pretty big and deeply embedded into the muscle), irrigated the wound out, and made a nice closure. Dr. Foreman is pretty cool. I look forward to working with him again (probably tonight when it gets busy). The next case was a woman with a small bowel obstruction. We opened her up and found a 5 mm adhesion which we cut and relieved the obstruction. Then Dr. Westmoreland (who is also very cool) handed me the instruments and allowed me to close the fasical plane deep to the subcutaneous fat. Remember kids, the 3 most common causes of bowel obstruction are

1. Previous abdominal surgery causing adhesions of the bowel wall
2. Bowel cancer
3. Hernia

And the 4 most common clinical signs of obstruction are

1. Fever
2. Tachycardia
3. Abdominal pain
4. Leukocytosis

(can you tell I was asked a few questions during the surgery?) I think I'm going to add to this as the day goes on. (I brought my laptop, and the hospital has wireless internet, which is pretty sweet.)

Surgery #1

Yesterday was probably the best day I've had at Baylor so far. We started with the removal of a parathyroid adenoma. The parathyroid is a gland on the thyroid that controls the level of calcium in the blood. If you have too much parathyroid hormone (PTH), then your body will start stealing calcium from the bones to circulate it in the blood. Lots of stuff can happen including kidney stones and heart problems. The surgery is very cool, because the calcium returns to normal levels literally minutes after the hyperactive parathyroid is removed. The only thing you need to watch post-op is if the patient is speaking without difficulty and for a hematoma in the neck incision site. The reason for checking the voice is because the nerve that supplies the vocal cords runs in the thyroid gland (recurrent laryngeal nerve). If it is damaged, you can lose your voice. The other thing about hematoma is important, because if the buildup is great, the airway can become compromised (as the surgery is in the neck). I saw the patient yesterday, and all was well so we sent him home that day.

Surgery #2

Next was a laparoscopic resection of the pancreatic tail, spleen, and gallbladder. A laproscope is a camera that goes into the abdomen and then the surgeon uses tools outside the body to do inside surgery. It's very nice. I have pictures of the pancreatic tumor we took out which will be posted shortly. Since the tail of the pancreas is so close to the spleen, the spleen must be removed as well in case some of the cancer has migrated in that direction. We took the gallbladder out, because the patient had pancreatitis (inflammation) due to a gall stone that blocked the duct leaving the pancreas. The surgeon's name was Dr. Derrick from Georgia, who's a hoot. His anesthesia guy is Dr. Parks who is equally a hoot. I was very impressed with the amount of laughter during the case, which went remarkably well. Dr. Holden did an excellent job. I have since seen the patient, and she is doing well so far. Here is an image of the surgery. The big mass is the tumor growing from the tail of the pancreas. The purplish thing below the mass is the spleen, which was also removed.


Surgery #3

The final case was an incarcerated inguinal hernia. You all know about hernias (a loop of intestine that slips out of place). Well in a male, these hernias can slide in the scrotum and cause problems. One such problem is called strangulation where the bowel becomes twisted and looses its blood supply. If that happens the bowel can die or perforate causing spillage of bowel contents into the body (not good). This patient's bowel was caught in his scrotum and rather adhesed to the wall. So Dr. Derrick pulled the thing out and then we used a Doppler to make sure there was still blood flow to the bowel, which there was. This case was fun, because for the first half it was just Dr. Derrick and me. Eventually a resident popped in, but for a while I was pretty excited about being the 1st assistant in the procedure. I have seen this patient since the procedure, and he also is doing well.

I'm really amazed at how awesome the Baylor surgery residents have treated me this week. Dr. Holden, the chief, has been especially great. She is an excellent teacher and has made sure that I've participated with several of the doctors here and always the interesting cases. I've never had a chief go so far out of her way to help out a student. She's pretty cool if you ask me.

Finally, I got my 1st international hit to the website yesterday. It seems someone from Singapore found my site via google while looking for some medical stuff. I'm flattered this blog is even associated with medical stuff in the first place. I hope the visitor from Singapore found what he/she came to see.

I was of course, post-call today (meaning I was finishing a 30-hour shift). The morning was good. I saw my ICU patient, went to Chief's Conference (where the chairman of surgery asks the residents about their cases, procedures used, and any complications), then on to Grand Rounds. Then I scrubbed on two cases, the first a right inguinal hernia repair and the second a partial glossectomy. You all know what a hernia is. A partial glossectomy is the partial removal of someone's tongue. This guy had a small squamous cell carcinoma on his tongue, so we cut it out. Hopefully he doesn't have any metastases which would be bad.

I left the hospital at 1:30 to go have lunch with Dad at a NY style deli in Addison called Gilberts. I had the traditional Ruben sandwich, potato salad, and iced tea. Dad had the same, except his sandwich had pastrami while mine had corned beef. Then I went home to lay on a raft in the pool while listening to the Quincy Carter reports out of Oxnard. What a shock that was. He probably tested positive for drugs, so Jerry and The Tuna said see you later to old Q Car. Then I took a nap.

Then I read for a while and watched the Ranger's game with my folks. They won again, handedly over the Tigers. Then I did something that cannot be reported on this blog, because it will get people in trouble with other people who read this blog. However, it was a very nice event, and a good time was had by all. Then it was time for my softball game with the Dallas A&M Club people. I forgot all of my softball stuff in Houston, so I played in tennis shoes and used my sister's old first baseman's glove from high school. I played center field, right-center, and third base. In my two plate appearances I had a triple, double, RBI, and 2 runs scored. Not bad for someone who hasn't played softball in over a year. We were down early but fought back hard in the late innings to win. I was very impressed with the team effort. I was also very happy to see everyone and look forward to playing again in two weeks. Then I went home.

I'm sitting in the resident's lounge at Baylor University Medical Center in Dallas, experiencing my first night of call on general surgery in the month of August. I started yesterday. It was a typical first day. We did all of our orientation stuff, got parking, got ID badges (mine still isn't working on all the doors), and filled out lots of paperwork. Then the students met with Dr. Jones who is the chairman of the department. He lectured us over fluids and electrolyte replacement of the surgical patient. Then I went to clinic and saw a patient with a unilateral breast discharge and possible masses. That's always suspicious (even though this patient has a history of cysts in that particular breast), so we ordered a mammogram and an ultrasound to rule out cancer. Then we had trauma conference and went home. Dinner was pork tenderloin, Caesar salad, and hashed browns. It's good to be home with parents that can cook.

Today was nice. I got here at 6:30 for basic science lecture (which was over acute respiratory distress syndrome or ARDS). Then it was straight to the OR to observe a mass removed from a guy's parotid gland (in the cheek), and then I scrubbed in on a 5 hour case involving cancer of the esophagus. It was way interesting. Apparently this 80 year old patient went to the doctor for a routine colonoscopy but also complained of minor swallowing problems when asked about other symptoms. So the GI doc also did an endoscopy (where a camera looks down the throat into the stomach) and found an adenocarcinoma of the esophagus right at the junction of the stomach. This sort of tumor is usually from long standing reflux disease (same as the commercial that urges you to take the little purple pill). So the surgeon needs to cut the cancer out (along with parts of the stomach and esophagus to make sure all the cancer is gone) and then sew the esophagus back to the stomach. This procedure is called an esophagogastrectomy. Then I had dinner with the team. We have a chief resident in the fifth year, a 3rd year, a 2nd year, an Intern (1st year), a 4th year medical student (me), and a 3rd year medical student. Tonight I've been reading and watching television on the fabulous big screen TV in the lounge. I'll most likely be hanging out in the ER the entire evening taking trauma call. Baylor is cool that way, because whichever surgery team is on call also takes trauma that night. Plus Baylor is a level 1 trauma center, which means we get all the major cases (along with Parkland a few miles away). So I'm looking forward to call and not too worried that I probably won't be getting much sleep tonight. This month is really going to kick ass.

It's good to once again be back in Dallas. In the 4 hours since I've been home, there have been two highlights:

1) Dinner was superb. We had scallops drenched in a white wine sauce, cantaloupe wrapped in prosciutto on a bed of lettuce, and fried rice. I was pleasantly full after all that, which was complimented by my D'Albola Pino Grigio 2001.

2) The first e-mail I received today was from my friend Connie, alerting me to a softball game this Wednesday at 10:10 PM. I'll be playing every Wednesday this month for the Dallas A&M Club team which I started playing with back in 2000. These are some of my favorite people, playing one of my favorite sports, so I couldn't be happier with this arrangement.

Friday

Now I suppose I need to recap the weekend, which was a big bundle of fun in Austin, Texas (the Capitol). Friday afternoon was sort of frantic, because I didn't get done with my research stuff until 1:45. I missed the UT shuttle bus, so I decided to walk the 2.5 miles to my car in 100 degree heat, because the next shuttle wouldn't be there for probably an hour or so. While doing this, Ryan updated me on the schedule for departing Houston. He expected to leave work around 4:30 or so arriving in Houston by 5. I told him I'd be late (around 5ish), and he wondered if I meant like 6 or 6:30, to which I said would be impossible. I then drove my sweat-soaked ass to the oil change place, then to the hair-cutting place. While all this was going on, the vascular surgery fellow with whom I'm doing my research called and said all the files I copied from Hermann Hospital were missing, and I needed to straighten that out. Well, that was weird, because I put them back exactly where I found them which was in a cabinet marked "DR. SAFI/DR. VILLA". So I told him I'd do my best. By the time my errands were complete, it was pushing 4 o'clock. This meant that I had to shower, pack, and go back to school to find the files in an hour. Well, I packed and showered (all taking way too long), and upon leaving the shower I found 3 people in my living room. They were Denise, Brent, and Colleen. Denise is an Aggie and excellent person to be around. Brent is a Boeing colleague of Ryan's, and Colleen is his high school sweetheart from near Madison, Wisconsin. So I got dressed and took care of last-minute plant watering and such. Thinking there was no way I could get to school and take care of the file thing, I e-mailed Dr. Villa to tell him I couldn't do it. Of course, it turns out that Ryan had to stay at work late (he's in the middle of a big project with his Japanese colleagues and didn't get home until 6 or so) and I would have had time to take care of the school stuff. Actually I thought it was quite ironic that he jokingly asked if I would be ready by 6 or 6:30, when it turns out he was the one having to scramble. So for once I was actually early for something, which was nice. Plus Dr. Villa can handle the file thing, as I had most of the stuff ready to go and the data prepared. We plan to submit an abstract by the end of August, so I'm excited at that prospect. (What's an abstract? It's how scientists summarize their research project and pose their hypothesis, which is the scientific question the research aims to answer.)

Then Todd and April arrived. Let us discuss Todd and April. Todd is an upper-level supervisor at Boeing. He was Ryan's boss for a few years and now has switched departments. He's your typical mid 30's cool boss guy. He's totally grounded, very ambitious, but he certainly knows how to party. So he's on my cool list. April also works at Boeing, but in a different department. She is a SERIOUS partier. April is very cool and very sarcastic. She's very sweet most of the time, but she also has that mean streak which keeps things interesting. And did I mention that she likes to PARTY. Man does she like to party. So it seems April was promoted at Boeing, so Todd brought nice champagne, and we all drank to her success. Then we allowed Ryan to finish his packing and we headed to Austin. Upon arriving it was straight to Larry's to drop stuff off then off to the South Austin Trudy's. Shout out to Mary and Sarah who camped out for an hour and got our table for us. The funny thing was, by the time the whole group sat down, there weren't any chairs left for Mary and Sarah, because they were getting the check. So I sat with said hot ladies, and we drank Mexican martinis and ate fajitas. Then it was straight to 6th Street for a stop at Cheers, The Library (I think), and somewhere else. Fun was had by all. Then I went home with Mary and Sarah. I met Sarah's dog Lacy (who is very hyper), and we eventually fell asleep around 4 or 5ish.

Saturday

We got up around 9:30 and proceeded to Larry's. I popped a beer down the hatch and we all caravanned to New Braunfels for some toobing. There were a few little snafus getting there, as our car drove to the Comal first. And as it seems, the other cars got a bit lost as well. But we all ended up at "Rockin R" toob company where we hopped in the river and began our trek. The river was great. We had a large group of 17, so "the peleton" as I called it (after the large pack of bikes in the Tour de France), started down the river with three coolers full of ice cold beer and two bags of Franzia wine. We floated and drank, floated and drank, floated and drank (you get the idea). We met lots of people, used lots of sunscreen, and drank lots of beer and Franzia. The beer selection was superb this year including Red Dog, Milwaukee's Best, Budweiser, Miller Light, Coors, Coors Light, Schaffer Light, Steel Reserve (replacing the ever popular Sportz beer), Schlitz, Colt 45, and Pabst Blue Ribbon. Of course in addition is the "bladder of Franzia" which is the boxed wine you buy at the store, but we take away the box and leave the silver bladder. We had two of those lovelies. And so that was the toobing beverage service. On the river, this dude Josh was hitting on Sarah, and Sarah was sort of hitting on Josh. Todd and April seemed to be rather friendly and that was about it. There was a cool tree swing that we used to take a break and jump into the river. And I don't recall seeing any snakes which is always a plus. Upon completing the journey, one of our party (who will remain nameless) was a bit too tipsy, and the jerk New Braunfels cop sort of gave her a hard time (which she did not fail to remind us of the rest of the evening), but I offered to take control of the situation and everything was fine. We left New Braunfels and proceeded to the Cici's all you can eat pizza bonanza, where we ate several pizzas each. After that it was time to go home and shower.

Back at Sarah's house, it was decided by all that there would be no further partying that evening. So Sarah and I headed over to Randall's to pick up the essentials:

1. Non-fat Coffee-Mate
2. Already made cookie dough for baking
3. Berry-flavored Propel water by Gatorade

Then we headed back to the house for Propel water, cookies, and fresh-ground coffee with non-fat Coffee Mate. In addition we decided to watch the movie Along Came Polly with Ben Stiller and Jennifer Aniston. The film had its funny moments including some nice bathroom humor with Alec Baldwin which had me laughing out loud. It was a good rental, but not the greatest I've ever seen. The main event of the evening was Sarah's 35-year old boyfriend Justin. Apparently this guy works at the Horseshoe Bay resort. He was in Austin that night and the night before engaged in some drinking. The previous night he called while intoxicated and actually apologized to Mary for appearing like an ass. Little did he know how badly he would trump the previous night's performance. I think he probably called the house around 15 times during the movie. Then he actually showed up at Sarah's house after circling around in a cab, because he forgot where she lived. His visit caused Sarah to miss the last fourth of the movie while talking to him. To recap at 11:30 PM:

Drunk Dials to Sarah's cell phone: 10
Drunk Dials to Sarah's home phone: 5
Visits to Sarah's place: 1

So then we stayed up a bit more talking about whatever and enjoying conversation. A few hours past and then the calls started again. One after another. There would be a string on the cell phone, then a string on the home phone. I think there were text messages mixed in there too. Then things quieted down, and we fell asleep until we were awoken by a knock at the door. What time was it? It was 5 AM. He knocked, no answer. He knocked again, no answer. He knocked on Sarah's window, no answer. The dog started barking. Then Sarah finally got up to answer. Luckily Justin brought a Calvin Klein model standing through the sunroof of the car still out in the street. After that we all fell asleep, good times had by all. To recap at 5 AM:

Drunk dials to Sarah's cell phone: 20
Text messages to Sarah's cell phone: ??
Drunk Dials to Sarah's home phone: 10
Visits to Sarah's house: 2

Sunday

Sunday morning was rather uneventful. We slept in, got up, and headed over to a nice breakfast place called Kerbey Lane Café.. The three of us started with very spicy Bloody Mary's. I had eggs Benedict, Mary had a similar dish without the Béarnaise sauce, and Sarah had a spinach and ham omelet, along with blackberry pancakes. Everyone was very happy. I got in the car and drove to Dallas, without event.

As an aside, I need to comment about Sarah and Mary. Let's start with Sarah. I've known this girl for a pretty long time, but the extent of our visits are usually no more than 10 minutes when I'm meeting Mary for something. I think she has really grown up in the last few years, and she is now graduating from UT in a few weeks. She really reminds me of my sister in so many ways. I was very pleased to spend the weekend with her and sort of get to know her on a better level. As for Mary, we all know how I feel about Mary. She's perhaps the nicest girl I know in the world, besides perhaps my mother. I don't think I've ever had a bad time with her in 10 years. She parties hard and without fail. She's definitely top 3 girls to hang out with and probably my favorite girl friend of everyone from high school, or really from everyone I know.