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.