Pictures from Utah Christmas

Sandi and I went to Utah for Christmas. After a 17 hour drive with Lucy we were back in the promised land. Unfortunately it was not a white christmas, but it was a lot of fun to visit family. We split Christmas morning at Christy and Yoni's house in Taylorsville.
Then in the afternoon we spent it Orem at my parents home.
Then another 17 hour drive back to Iowa. We did stop and visit some family in Laramie, Wyoming and North Platte, Nebraska along the way and climbed the tallest "mountain" in Nebraska.
Wikipedia states: Panorama Point is the highest natural point in Nebraska, at an elevation of 5,424 feet (1,653 m) above sea level. It is located in southwestern Kimball County, near the point where Nebraska and Wyoming meet on Colorado's northern boundary. Despite its name and elevation, Panorama Point is not a mountain or a hill; it is merely a low rise on the High Plains. A stone marker commemorating the 5,424 feet elevation and a guest register are located at the summit of the drive.

Year in Review

Christmas Letter 2011:

On the first day of Christmas my true love gave to me:

1. One new dog. Lucy is a four year old rescue weimaraner whose favorite past time is devouring tennis balls.
2. Two summer camps. Sandi spent a week at Girls camp, while Ben spent a week at Boy Scout Camp.
3. Three day weekends. A family favorite, our last one was hiking in Loess Hills.
   
4. Four jobs a working. Ben spent the first half of the year working part time as a teaching assistant and still plays soldier in the Iowa National Guard. Sandi continues her job as a medical admin and moonlights as a waitress several nights a week.
5. Five half marathons. Ben completed his fifth half marathon and Sandi ran an 8k.
6. Six volleyball players. Sandi and Ben continue to stay active playing on intramural volleyball teams and playing lots of tennis and racquetball.
7. Seven days in Washington. Sandi spent a week in August with the Schlosser family hiking along the beach, at Mt. Rainier and camping at La Wis Wis.
8. Eight letters in Colorado. For Thanksgiving we visited Sandi’s brother in Colorado Springs, hiked the incline and drove to the top of a Colorado fourteener, Pike’s Peak.
9. Nine days a cruising. Sandi and a couple girlfriends had a nine day cruise to the east Caribbean visiting Antigua, Dominican Republic, Barbados, St. Kitts, and the British Virgin Islands. She left Ben at school.
10. Ten cesarean sections. Ben is a third year medical student. His year is spent rotating in different specialties at many hospitals. One month was obstetrics in Portland and he assisted in 10 c-sections.
11. Eleven motorcycles. Ben’s parents, brothers, and sisters all gathered for a week at Grandma’s cabin near Yellowstone National Park seeing buffalo, geysers and riding the 11 motorcycles we brought with us.
12. Twelve months of 2011. This year we are filled with gratitude for the many blessings the Lord has bestowed upon us. We are especially grateful for our family and loved ones and hope you have a wonderful holiday!
    

Love Sandi and Ben Rhoades

Introducing Lucy and Colorado Springs

The last couple months have breezed on by. Quite a few things have happened. I would like to introduce you to Lucy. Lucy is a weimaraner and joined us around the beginning of September.
The Weimaraner is a dog that was originally bred for hunting in the early 19th century. Early Weimaraners were used by royalty for hunting large game such as boar, bear, and deer. The name comes from the Grand Duke of Saxe-Weimar-Eisenach, Karl August, whose court, based in the city of Weimar (now in modern day Germany), enjoyed hunting.
Time for a flashback. Funny enough, I have been to Weimar. Way back in 2002, I was living in Berlin doing an internship for an aerospace engineering firm. I took off a week of vacation and was driving to Austria to spend a week at a JAE conference near Salzburg. I took a train to Potsdam, was picked up by this guy I had only talked to on the phone. I told him in my broken German that I'd meet him outside the train station and be wearing a yellow hat. We met and couple of hours into our drive to Austria we stopped in Weimar and picked up two girls. As we continued we drove as fast as the VW Golf would take us and reached 200 kmh (125mph) on the autobahn. The radio was blaring and this weird Fred vom Jupiter song came on and the girls in the back started to karaoke at the top of the lungs. Good times........

......where was I? Back to the present, Sandi and my dog's name is Lucy. Lucy is a 4 year old rescue dog. We don't know much about her past, whether she was abused or not, but she does have some interesting behaviors. Lucy stands a little over two feet tall at the withers. Vocabulary lesson: The withers is the ridge between the shoulder blades of a four-legged animal. If you add head and neck she's just short of three feet. She weighs about 60lbs. Loves to run and be outside and will tug you anywhere.

About the tugging, I learned the hard way. I took her rollerblading one day and in the period of 30min I had turfed it three times. First was I bailed because we were going to fast toward an intersection. The second was squirrel and she took off the other direction from me. Third was when she cut right in front of me and I fell over to avoid running her over. Sandi thought it was very entertaining to watch me fall as she watched while following Lucy and I on a bike. My wrists haven't been the same since.

Other than the dog, Sandi is still working for the National Guard doing medical paperwork during the day and waitressing nights. I have been doing rotations. I actually just got back from Portland. I did an obstetrics and gynecology rotation there and Mike and Kathleen generously allowed me to sleep in the dungeon of their chateau.

It was my busiest rotation yet. Dr. Dyson is the hardest working doctor I have and will most likely ever meet. We worked every single day I was there including Saturdays and Sundays. In fact Saturday mornings were just another surgery morning. I participated in deliveries of more than fifteen babies and scrubbed for numerous surgeries. We split our time between Providence Portland and Portland Adventist. In the clinic we saw around 40 patients if it was a full day. You could split the patients roughly into thirds. 1/3 for annual exams and pap smears. 1/3 for ob checks. 1/3 for some other gyn problem. Needless to say I saw a lot and got a lot of practice.
Outside of working, I only had time to visit a few people from my list. I didn't really have a lot of time off. Nor could I predict when I would get a page to come into the hospital for a delivery. I ended up hiking Dog Mountain one afternoon spent a night with some friends on Mt Hood and drove back Sunday morning to the hospital for an induction. Another day we had a late start so I drove to the beach at 6am and was back to Portland for hospital duty by 10am.
After four short weeks in Portland I drove the 1900 miles back to Iowa just in time for Thanksgiving. For Thanksgiving, Sandi and I decided to spend some time with her brother Greg. Greg is in the United States Air Force and is currently stationed in Colorado Springs. Sandi fell in love with Colorado Springs. She is really encouraging me to find a residency program in Colorado now. I think she just really missed the mountains.
Anyhow, our first day there Greg took us to the incline. Completed in 1907 the Manitou Incline was a 1 mile cable tram built to support the construction of a hydroelectric plant and waterline. After performing this service the railway was turned into a tourist attraction. It was operated until 1990 when a rockslide damaged the tracks and was closed. Some locals started using it for a tough workout. A portion of it is private property and it’s illegal to hike up the ties of the old cable car. That hasn’t stopped it from becoming the most popular hike in the Colorado Springs area.
The incline is 1 mile long and gains 2000 ft of elevation. It takes you from 6500 ft to 8500 ft. The average grade is 41% and steepest grade is 68%. It is star stepper to the max! The incline was great. Sandi thought it very gruelling and Lucy just ran straight up it. We spent the rest of the day touring Garden of the Gods and then had dinner at Edelweiss.
On Friday, we drove to the top of Pike's Peak. At 14,115 feet (4,302 m), it is one of Colorado's 54 fourteeners. Pikes Peak rises over 8,000 feet above the city of Colorado Springs.
It is famous for a couple things. First is the Pikes Peak Highway that curves and carves its way to the top of the mountain over 19 miles. It is home to an annual Hill Climb Race. Secondly in July 1893, Katharine Lee Bates wrote the song "America the Beautiful", after having admired the view from the top of Pikes Peak.
We later headed to Cave of the Winds and did a 90 minute tour and heard about all sorts of Cave legends about mummies and other ghost stories. The tour was pretty cool in that we were all given kerosense laterns and gave the tour an old school feel.
Next to see in Colorado Springs was the U.S. Olympic Complex in Colorado Springs is the headquarters for the U.S. Olympic Committee administration and the Olympic Training Center programs. Between 300-500 athletes train here for both summer and winter olympic events. We even got to compare our wingspan with that of Michael Phelps. Being only an inch shorter than Phelps my wing span was actually fairly comparable. I couldn't say the same for Greg or Sandi.
It was really fun to see Greg and get away for a bit. We had a wonderful Thanksgiving and have so much to be grateful for!

Rotations and Labor Day

After two years of classwork, the second two years of medical school are rotations. During the rotations you follow along with residents, interns and attendings in hopes of learning the art of medicine. My first rotation was at Broadlawns Medical Center in Des Moines.
Broadlawns is a community based hospital. The vast majority of the patients I saw had no insurance, or are on medicaid/medicare or the state medical insurance. Practicing medicine is quite a bit different than my last career of engineering. Two big differences I noticed where.

1. I was the only male on the floor I was working my first week of rotations. The resident and attending I was working with were both female and all the nurses were female. At Intel, the floor I worked on had a couple hundred engineers with probably around 10 females.
2. The computer work. At Intel I would try to be at my computer as much as possible to get work done and I would dread meetings because they would stop my forward progress. At the hospital I try to spend most of the time with the patients or discussing treatment plans with the other residents and attendings. The dreaded part is going back to the computer to complete the documentation. Quite the change.
   

I'll try to explain the day in the life of a medical student at Broadlawns. First some vocabulary:

• Student - third or fourth year medical student
• Intern - first year resident
• Resident - Graduate of medical school who is in a 3-5 year board certification program
• Attending - board certified staff doctor at the hospital
  

Typical day working at Broadlawns

• 5:30 Wakeup
• 6:30 Arrive at Hospital for morning handoff from the nightshift
• 6:30-7:30 Quickly visit the 3-4 patients on the floor from last night, review labs and other tests and come up with a treatment plan
• 7:30-8:00 Morning Lecture on some disease and *FREE* breakfast
• 8:00-9:30 Discuss all the patients on the service and visit them one by one with the attending, have the attending ask all sorts of questions about the patient you didn't think of and make you feel a little under studied
• 9:30-12:00 Write the progress notes, discharge patients, admit any new patients from the ER that need hospital treatment
• 12:00-1:00 Noon Lecture on some disease with *FREE* lunch
• 1:00-4:30 See patients in the family health clinic. Basically just being a family doctor. With occasional interruption when the ER calls to transfer patient to hospital.
• 4:30-5:30 Write/Dictate notes of family patients and then check labs to handoff any patients in hospital to night team
• 5:30-11:00 Go Home and study all those things you should have known, eat, workout
• 11:00-5:30 Sleep and then start it all over again
  

The patients in hospital were often acute and had many comorbidities. Diabetes, obesity, congestive heart failure, coronary artery disease, dyslipidemia, hypertension, cirrhosis, pneumonia, chest pain hold overnight to rule out heart attack. I got to see a wide variety of diseases. Dr. Ghali tells me that patients are my educators and the attendings merely facilitate that education. I couldn't agree more. When you see it in person and have to treat it. It is much easier to remember than reading from a textbook. I have many great learning experiences, many sad stories, and a few peculiar patients.
On my second day of rotations I did my first punch biopsy of a patient to test a skin growth on their forehead for cancer. I numbed the area, cut out a piece of tissue, and then put in a couple stitches. Needless to say, my hand was quite shaky with it being my first stitch on a patient and with the attending watching over my shoulder. But it was a good experience, I was much more smooth the next time.

If you are not on birth control, not using condoms, had five sexual partners recently, last period was 6 weeks ago. You should probably not be shocked to find out you might be pregnant and that you likely have a sexually transmitted disease. Risky behavior!

After four weeks at Broadlawns. I moved to the larger Mercy Hospital in Des Moines. My second rotation was interventional cardiology with Dr. Ghali. I have spent the past two weeks observing and helping with cardiac catheterization and pacemaker checks and insertion. I am really amazed at the technology and skill that the physicians have.
FYI: Cardiac Catheterization is a procedure where the physician inserts a tube into an artery in your leg or arm. The doctor gently runs the tube up into your heart. Through the tube the doctor inserts a special die while watching an x-ray machine. The physician can visualize how blood is flowing from the heart and how blood is also flowing back to the heart to keep it pumping. If there are problems with the flow or blockages the doctor can blow up balloons (angioplasty) or place stents (metal mesh tubing) to open the vessels. Search for cardiac cath on youtube to watch some videos if you are interested.
Anyhow the more time I spend in the hospital the more I realize three important things that would solve MANY of our patients problems. Here is some free advice that everyone has probably heard before:

1. Stop smoking
2. Don't eat so much
3. Exercise more
   

Enough about medicine. What else has been going on with Sandi and myself. Well for Labor Day, Sandi and I traveled to the Loess Hills in western Iowa.From the USGS website: Many Americans think of Iowa as having little topographic variation. However, in westernmost Iowa the Loess Hills rise 200 feet above the flat plains forming a narrow band running north-south 200 miles along the Missouri River. The steep angles and sharp bluffs on the western side of the Loess Hills are in sharp contrast to the flat rectangular cropfields of the Missouri River flood plain. From the east, gently rolling hills blend into steep ridges.

Loess (pronounced "luss"), is German for loose or crumbly. It is a gritty, lightweight, porous material composed of tightly packed grains of quartz, feldspar, mica, and other minerals. Loess is the source of most of our Nation's rich agricultural soils and is common in the U.S. and around the world.
However, Iowa's Loess Hills are unusual because the layers of loess are extraordinarily thick, as much as 200 feet in some places. The extreme thickness of the loess layers and the intricately carved terrain of the Loess Hills make them a rare geologic feature. Shaanxi, China, is the only other location where loess layers are as deep and extensive.
Sandi and I backpacked in and spent a night and did some hiking through the mix of grassland and forest. It was quite diverse for the small area it represented.
After some hiking we took a drove through North West Iowa and made two stops. The first was to the highest point in Iowa. It is called Hawkeye point. It is 1670 ft (510m) above sea level. It lies in the middle of a farm on a rolling plain a few feet from an old silo. You just drive up and take a picture.
The other place we stopped was Okoboji. It is a series of lakes near the border of Iowa and Minnesota. It is a recreational play place with many houses dotting the coast line of the three lakes and hundreds of people motorboating, skiing, fishing, wakeboarding, or sailing.

Island Park and Yellowstone

The second to last week of July Sandi and I traveled to Utah for a "Rhoades" vacation. It was just like being a kid again for me. The whole family went to my Grandma's cabin is Island Park, Idaho. It was the first time we've all taken a vacation together in probably seven years. It was a blast.
The first thing you need to know about Rhoades vacation's is outdoor toys. We had 14 people and we brought along 11 motorcycles, 2 four wheelers, a rhino, and 2 motorboats. And just so you know how much we love motorcycles, we didn't have room to bring them all so we had to leave a few behind.
We all spent a lot of time riding and everyone pretty much went down at least once and ended up with some bruises or road burn. Along with the bikes, we had two boats. One was for fishing and another for skiing, wakeboarding, or tubing. I don't have a lot of pictures from the boating since water and cameras don't mix too well. We did catch quite a few fish and the boys were pretty excited about that.
With everyone together it was also time to play some card games. My brothers, sisters, and their spouses all sat around the first night and played some penny poker. Joe won the pot.
Aspen also happened to have her second birthday the week we were there and we had a big party and Grandma McKay showed up to celebrate with us.
Island Park also happens to be a short drive from Yellowstone so one day we loaded up and headed over. We saw buffalo

and elk
and geysers and stink pots
and waterfalls
and of course who could forget old faithful
wait for it
boom!
On top of all that fun, Sandi and I had been missing the mountains so much since coming from Iowa that we decided to go on a hike. We first drove up to Sawtell Peak and then hiked across to Mount Jefferson. In the picture below Mt Jefferson is on the left and Sawtell on the right.

Sawtell Peak has a FAA radar staiton and road, so we rode a motorcycle to the top. In the left corner of the picture you can just make out the Grand Tetons. It was an amazing view.
One to the North of Henry's Lake
One to the South looking at Island Park. Grandma's cabin is hidden in the trees somewhere in the picture. The hike over to Mt Jefferson is about a 4.5 miles and around 1200 feet of elevation gain. We followed the ridgeline in the picture below.
The ridgeline represents the border between Idaho and Montana and we saw many of these boundary markers along the ridge. It was a great hike and nice to be back in the mountains. Here is our picture on top the 10,203 ft peak. We really had a good time on the vacation. I really look forward to doing it again. So, to Mom, I owe a big THANK YOU! for organizing, planning, and just plain being amazing!