I’ve been in Memphis for two weeks now finishing my last rotation at UT. It is a strange but odd feeling. One might expect it to generally be filled with joy and excitement but in my case it is somewhat anti-climatic. Similar to a made field-goal in football. Filled with relief and satisfaction after a long and tense expectation of failure.
So, I’ve only two weeks left. What am I doing with myself. I will be studying radiology next week and then palliative care the following week. I’ve settled on a specialty – Emergency Medicine. It shouldn’t come as much of a surprise to those who have been following my blog for the past year. After immersing myself in wilderness medicine and then finishing up an Emergency Medicine rotation two weeks ago I finally figured out that it fits me – or I fit it. Either way, I had a blast in the Emergency Department and learned a bunch. It fits best in my future career plans and allows for the greatest flexibility.
So, how is the finger? It is great. Today is exactly 1 and 1/2 months after the accident. I really think healing has been greatly accelerated by a new product I’ve been taking that help reduce inflammation and overall health. It is distributed by a company called Max International. I started taking it about 2 weeks before the accident and then after thought – well, I’ll learn a lot about it. It is a glutathione supplement and after taking it and seeing the results – my anecdotal evidence matches their scientific findings (warning it is a pdf).
So, only ten days after the accident, I had up to 50% mobility and by 14 days I was up to 75%. As soon as I removed the bandage I was able to type and at 14 days I was able to play the piano and do most everything including pull-ups. Only thing I haven’t tried is guitar again. Because of the scar tissue I cannot flex much beyond 80% but I’m continuing to work at it. I’ve included pictures chronicling the healing of my precious pinky and then some of the last few weeks.
Sometimes things happen that are best left to the imagination, food poisoning, C. Diff infections, major trama to an extremity. Well, 12 days ago at 3:15pm my pinky, yes the smallest of my phalanges, was rendered useless to me for the next week and 1/2. Yep, my pinky got smooshed. It was a random collection of events (bad judgment, big part of lake, unseen wake) that ended with my pinky between two boats. All things considered, however, I was very fortunate to sustain only soft tissue injury. No broken bones, no loss of motion or sensation just a really nasty wound (more graphic pictures of my finger after the break). As you can imagine – typing and other activities requiring a pinky have been rather difficult the past week or so.
Otherwise, I’ve been hanging out with friends playing games, biking Cades Cove and doing a lot of working and reading. I learned a new game, a group version of the classic battleship game. Everyone is given a sheet of paper where you mark your ships and after everyone has placed their ships turns are taken lobbing bombs. It is somewhat a bingo/battleship collage. It was fun watching and learning.
As to school, recently I did surgical subspecialties (last month) and am currently on Emergency Medicine. Surgical subs consisted of ENT, Urology, Ortho and Ophthalmology (hence the pic). I have to say I had expereinces in doctor’s offices I’ve never seen before or probably will never see again. It was fun and I learned alot. I’ve really been enjoying the ED or emergency department. For the longest time I’ve considered doing Family Medicine and then doing a fellowship in Emergency Medicine, however, all the doctors I’ve spoken to have highly suggested I just do the Emergency Medicine residency if that is my interest.
Well, count this as your warning – graphic pictures after the break – and this time they are real.
It has been a while since I’ve been able to spend time with missionary friends and this past week enjoy spending time with them. We did some tubing, hiking and then after the left I was able to ride Cades Cove. Learned a bunch about Zambia and life across the pond. Hearing about medical problems overseas really gives life to what we learn in school. Hearing from individuals who have had malaria multiple times and the descriptions makes me really understand why it is such an important global health issue. Below are some pictures from the hike.
So, I’ve continued to work on Android and believe I’ve figured out how to enable the wireless in it. I’ve built a case for it (hat-tip to borglabs). Once I get time to test the instructions I’ve found for the WiFi under android it will be much more useful and then I’ll post instructions on the build process and everything I compiled to make the process a piece of cake. Currently I’m running donut but would like to get eclair running once I figure out WiFi. I’d like to post some pictures but right now my PivotX install isn’t working for uploading the pictures from last weeks trip to PA and the case later.
Well, got PivotX working again by updating to the latest dev branch. Image insertion works again. Wierd things is I never upgrade and it stopped working by it self. Hum . . . Enjoy the pics
Well, it took rebuilding my HTPC, countless forum post readings and finally just trying something to figure out installing Android on the board was quite easy. I don’t have any pictures or anything, just search Google for a video of the IGEPv2 booting. Mine doesn’t look much different. I’ll have to say it isn’t worth much right now since the current kernel doesn’t have wifi enabled – my next project after Step 2 CS next Monday.
The process of installing it was quite simple. I just used Ubuntu 9.10 64-bit by following the instructions on the Andoid dev page for compiling on a 64-bit machine. Once that was all setup, I went to Project Rowboat, downloaded donut and compiled it. Used the same tool-chain from the Rowboat project to compile the kernel for it and prepared the card as suggested on the Ubuntu Wiki page at http://wiki.myigep.com/. Inserted the MicroSD card and waited for about 5-10 seconds before the Android logo appeared it booted. Very simple, yet very obtuse finding the instructions.
Along those lines, I also built and installed Ubuntu 9.10 on it. The performance was a bit sluggish compared to android which just flew. I’ll have to play around to figure out what OS I’ll end up with but given I want it in the car and I’m ultra familiar with Java, I’m leaning to Android. When I get a chance I’ll post pictures.
Tired and sad. Two words to describe how I feel right now. What a wonderful month of learning and adventure. So many amazing things and people. How cool it was to discover so many individual with similar interests. I’ll be posting more tomorrow from the hike, but I’ll post a few photos from the hikes right now.
Day 19 —
Everyone split-up today and went different directions enjoying the beautiful weather. Some went bordering, others hung-out at camp and enjoyed the sunshine while others went for a hike on Rainbow Trail almost getting to Mt. LeConte. The snow became knee deep and thus they had to turn around but they really enjoyed the beautiful views.
I on the other-hand went home to do laundry and rested for most of the day.
Day 20 –
Today we went to The Lost Sea and did the wild cave tour. It was great fun. Our guide, Shane, was really enjoyable and really tailored the tour for our group. It was funny to hear him really enjoy having a tour of adults rather then children. The lake in the cave is huge. In the 70’s they went diving with sonar and couldn’t identify any walls or floor. Thus the floor is deeper then 3500 ft and the back wall is farther then 3500 ft. That is a huge cavern.
After finishing we went to a place call Joe’s for the best burgers in Sweatwater, TN. The burgers were really good. They were really good.
Well that’s all for now, enjoy the pics.
All good things must come to an end and certainly the lectures went out with a bang. We had 3 lectures spanning from 8am to 4:30 pm with 3 breaks (one for lunch). It was a marathon session but very interesting. The lectures were over Space Medicine, Toxicology (i.e. venomous and poisonous animals) and making a Wilderness Medical Kit. It became one of our first beautifully sunny days and during our few breaks we made sure to enjoy it. All the pictures of us today were on the front porch of Tipton Lodge where we had all our lectures and was the headquarters of all our scenarios.
All in all it was an interesting day. All we have left for the remainder of the elective is the 4-day hike. Unfortunately, one mentor had to drop out. Because of this one group had to disband and join the other groups. Fortunately everyone found a hike they were interested in hiking so everything worked out. Now to rest and relax until Monday. Here’s hoping for more good weather.
As to the weekend, tomorrow some of us are going to the Lost Sea http://www.thelostsea.com/ for a Wild Cave Tour. It should be fun.
Here are some interesting facts from yesterday –
- Politics in NASA really hinders science
- Medicine in space requires a completely different thought process.
- CPR in space is worthless due to taking to long to initiate
- The most dangerous venomous animal is the Bee
- Most use the term poisonous and venomous interchangeably but that is incorrect. A Bee or a Rattlesnake is venomous but not poisonous (i.e. they will make you sick if they inject the venom but will not make you sick if you eat them). Poisonous animals are like the Puffer fish.
- Superglue, duck-tape, trash bags and safety pins are essential in a wilderness medical kit
Day 16 was a day full of lectures as will be day 18. Day 17 was our final day of scenarios. The posts are a day late and a bit short in content because as a camp we exceeded the daily bandwidth allotment and I didn’t take time yesterday to write. Yep, no internet yesterday so I couldn’t post anything about Day 16 or 17. It made me lazy :).
On day 16 we had lectures for a bunch of different topics. We learned about Dive Medicine, a recent medical trip to Haiti, preparing to lead a wilderness expedition, making a medical kit and lots of random facts. Some of the most intriguing were from the dive medicine lectures. Did you know:
- 1 clo – the amount of insulation created by a Summer business suit in England during the 50s and 60s.
- You can increase your total lung capacity via Lung Packing.
- Record for a man holding his breath is 17:19 on pure Oxygen. On room air it is 11:35.
- Record depth for free diving (diving while holding breath without breathing apparatus) is 702 ft for men and 525 ft for women (http://en.wikipedia.org/wiki/Free-ping).
- When adjusting to a new timezone allow 1 day for the first 3 time-zones and 1 additional day for every additional time-zone.
- FAST – Fatigue Avoidance Scheduling Tool. It was used to determine the hours limits of medical residents and show the equivalent blood alcohol level to the fatigue level. So someone with only 2 hours of sleep one night and works 18 hours the next day would have an equivalent blood alcohol level of ~1.8. Yep, basically drunk.
- The abbreviation SHAG, Social Hand Grenade, is someone who has trouble making all social interactions cease when they appear.
Day 17 was all about our final two scenarios. The first one was all about two very difficult extractions. The victims situated beneath a 50 ft waterfall (i.e in it) and since it was below freezing there was lots of ice. I was on the medic team and was stationed at base camp. Everything I hear was how great the teams did in their extractions. I didn’t see anything until the victims were brought back when we re-evaluated them and repackaged them for transport to the hospital (i.e. once we were done let our classmates free to get changed).
The second scenario was two male four-wheelers accident victims. They were both on a really steep slope demonstrated by the photos (rotate your laptop until the people are upright to see the angle of the slope). The packaging and transport went really fast and we were off the slope and ready for dinner in about 1.5 hours.
Between the two scenarios we had a wilderness improvisation demonstration. Each of us was required to demonstrate two improvisations using supplies we would have while in the wilderness. These ranged from making air splints from bedding pads to snow goggles made of aluminum foil. It was a great experience and many great ideas were shown.
The day ended at the Heritage Planetarium learning navigation through the night sky. It was an incredible experience and one I would like repeating.
Well, today we have a day of lectures starting with space medicine.
Gonna be a good day.
Please note all the injuries are simulated (i.e. no real blood).
After a long weekend we are starting our final week of lectures and scenarios. The month has flown by and it is starting to sink in that we are finishing up. Only 3 more days after today and so far the course has been great and I’m sad to see it ending. I’ve met a bunch of great individuals and have learned a tremendous amount about wilderness medicine.
Enough reminiscing though, yesterday was a great day of learning with several new lecturers and two more scenarios. We learned about lighting strikes, burn injuries and planning for an expedition from the medical perspective. We saw videos and pictures from Haiti from a Doc who had been there treating patients. The pictures and stories were heartbreaking and sobering in terms of our training and what some of us are shooting for as a career.
As to the scenarios, we had two in the afternoon and evening. The first scenario of the afternoon started around 2:30 and didn’t end until after 5:30pm. Of all the scenarios this was by far the most difficult. We didn’t rise to the occasion and struggled with the difficult extractions and triage.
Adding to the difficulty of the extractions we learned a new rescue structure and roles. The confusion about the new structure really increased the time to extraction and treatment. We learned a lot from our trials and struggles. In the end everyone was extracted successfully and no one got injured.
Our dinner consisted of MREs around a campfire waiting on our next scenario. The MREs from today are much better then the old ones. They are still not the greatest but are nourishment. After finishing our dinner, it was dark and we were notified there was a group of Boy Scouts missing but we were not given a point last seen. After about half an hour we were provided a point last seen and preceded to start searching for them.
I was on the transport team and since we had an unknown number of inpiduals we positioned ourselves in strategic positions to quickly transport them out. It turned out that only two inpiduals need transport and 3 of the 5 could walk out. We completed the entire scenario by about 9:30pm. It was great and we set a new record for speed of extraction.
In total, we were outside for about 9 hours by the end of our second scenario and slept really well. We finished up about 10:30 and were able to get in bed by 11:30.