Episode 5: The ABCs

A story of my first day as the second-year surgery resident in our emergency room, where we coordinate the care of all the trauma patients and act as a regional resource for a farflung network of hospitals. On my first day, a doctor called in with what seemed like a question far outside the realm of my meagre experience. On second thought, it turned out to be pretty easy. The full story, complete with my proving my first-grade teacher wrong by correctly reciting the first five letters of the alphabet before turning 30, can be found here. Or, as always, here's the button to subscribe:



Remember, since this podcast is anonymous, I can't do any shameless self-promotion of my own, except to those of you who have already found the show. So please, whether you love to listen to the podcast, or can't wait to show your friends the kind of crud that finds its way onto the Internet these days, pass the word! Thanks!

Episode 4: Speaking from the Heart

Welcome to Episode 4. In this episode, I review some mail from listeners and talk a little bit about the trials of medical school and how they compare - or don't - to the trials of doctoring. Jarrad, whose letter I read, blogs at www.veritography.com...check it out.

Get the podcast here, or better yet subscribe by clicking here:

Episode Three: Sometimes Things Go Right

The highs of medicine are as high as you can go.

In Episode Three, I talk about the most affirming moment of my medical career, such as it is thusfar. I hope you enjoy it.

The podcast has been growing in popularity, even at it's young, young age. Thanks to all of you for listening, but special thanks to those of you who've taken the time to write with your thoughts. I want to tell your stories and share your comments, so please keep them coming!

In the meantime, enjoy Episode Three!

Episode Two - When I Chose to be A Doctor

I've known since I can remember that I wanted to be in medicine. There were times, though, when that choice was muddied by my other interests. And there were even a few dark months when I was pretty sure I wanted to be a lawyer, instead. One night, volunteering as an EMT in the local ER, I met a patient who made my choice clear. That story here, as Episode Two.

Look forward to hearing what you think. Thanks for listening.

P.S. The podcast is now available on iTunes. Or just click here:

Dashing MD, The PodCast: Episode One.

Welcome one and all! Or at least one! I'm excited to announce the start of the Dashing MD podcast, another way to tell my stories and, if I'm lucky, yours as well. This is a new venture, and I have no experience in doing this, but I've been granted a full weekend off from work and have enjoyed spending part of it putting this first podcast together. I was suprised at how easy it was, in the end. Whether it's easy on the ears as well I look to you to tell me. Enjoy.

Better yet, subscribe to the feed and join the adventure automatically:

A new year

Time passed. And passed. And passed. And those of you who might have been reading would have noticed there wasn't much new to read. Those of you just starting to read will notice that there's a large gap since my last post. To summarize: I finished my intern year. Barely. I almost gave it up more than once. In fact, just after my last post, within a day or two, I actually picked up the phone to call my program director and tell her I was quitting. But in the end, reason (or perhaps inertia) prevailed, and I stuck around.

So I'm back now, a second-year resident, and things are a little bit better. The differences are subtle, but real. I'm more likely to be be referred to by name, rather than as "the intern." I'm a little bit more a member of the club. And almost overnight I find myself looking at the interns and thinking to myself, "I can't possibly have been that naive or incompetent or just plain _young_ a year ago." But perhaps I was, and probably I still am.

The Color of Nerves

This is a letter I received from N., whose national identity clearly weighs heavily, asking a great question that reminded me that there are lots of people who do NOT see parts of the human body exposed all day long.


My name is N. and I come from Austria not Australia! I would like to learn what colour nerves are.I am studying the nervous system and I know that we have trillions and trillions of nerves in our body.I hope you have an answer to my question.


So I told her:

Thanks for clarifying where you're from. People must get that confused a lot, and expect you to know a lot about kangaroos and things. How bothersome.

We certainly do have a lot of nerves in our bodies. Far too many for anyone to count. Most of them are so tiny that you can't see them at all, but the ones that you can see are a very pale yellow, almost white! I wish that things in the body were as clear in the operating room as they are in the books, but in reality it can be really hard to tell what's what, since most things are sort of pink/red and they are all stuck together. We have to be very careful to make sure that we don't cut things we're not supposed to, obviously, so we dissect very carefully to find all the nerves, arteries, and veins. The nerves look and feel a lot like rubber bands, while the arteries feel like little garden hoses, and the veins feel like floppy tubes.

Sometimes we have to cut nerves in order to be able to do the surgery properly and make the patient better. What do you suppose patients with cut nerves feel when they wake up? Actually, most of the time, they never even notice! There are so many nerves that even if you cut some of them, the skin is still covered with plenty of others. But sometimes, people have a little bit of numbness over the skin where we cut the nerve. Even then, other nerves will sometimes grow into that area and the numb feeling will go away with time. Pretty amazing, huh?

I hope that helps to answer your question. Please let me know if you have any more questions, and I'll do my best to answer them too!

Pulmonary Circulation

This is a letter I received from a fourth-grader named C. , asking a question that has plagued legions of scholars through the years and was only recently made clear:

My name is Carmella.I would like to ask you if you could tell me why the pulmonary artery is blue and the pulmonary veins are red . When the veins are blue they take the blood back to the heart and the red arterys take the blood to all the parts of the body.

And my response:

Dear Carmella,

This is a great question! To understand the answer, it is important to know that when you see real arteries and veins, they don't look red and blue like they do in books. The actually all look sort of purple, and it can be hard to tell which ones are arteries and which ones are veins. The way we tell in the operating room is by putting our finger on them...the arteries are firmer, and you can feel a pulse in them, while the veins are softer and don't pulse. Why do you suppose that is? I'll give you a hint: it's because of all the capillaries.

Anyway, you're totally right that arteries take blood away from the heart, and veins take blood back to the heart. What the red and blue colors on your picture tell you is not whether something is an artery or a vein, but whether that blood is carrying oxygen or not. When the blood goes from the heart to the rest of the body through the arteries, it carries oxygen to the tissues, so those arteries are colored red. And when it comes back to the heart from the body, the tissues have taken the oxygen, so the blood doesn't have oxygen in it and we color them blue. So how does the blood get oxygen again, to take back to the tissues? I bet you know the answer...it goes to the lungs.

So when the blood leaves the heart to go to the lungs, it is going away from the heart, which means it is going in an artery - the pulmonary artery - but it doesn't have oxygen in it - so the pulmonary artery is colored blue in diagrams. Then, when it returns from the lungs through the pulmonary veins, it DOES have oxygen in it, so it is colored red. It's exactly the opposite of the way the blood flows in the rest of the body, which is why we talk about there being two different circulations, the pulmonary and the systemic, and why there are two different pumps within the heart, the right side pump that pumps blood from the body to the lungs, and the left side pump that pumps blood from the lungs to the body.

It's complicated, isn't it! I think the best way to understand it is to draw a picture or make a model, and trace the route of a blood cell from the time it gets oxygen, through the tissues where it delivers its oxygen, to when it returns to the lungs to get more oxygen. That's how I figured it out!

Heart-lung Machines

This is an excellent question from G., in Germany:

I have a question if you would have the time to answer it I would
really appreciate it.If you take out your heart in a operation how are
you going to live ? Are they putting a fake heart inside your body?
When they are changing it how does your blood get oxygen?


To which I say:

Dear G.,

What an excellent question! We take hearts out when we transplant them, which means that we put another one back in to replace the heart that isn't working. That happens pretty fast, so people don't go without a heart for very long. But for the short time (usually about three hours) that their heart is disconnected from their veins and arteries, and isn't pumping blood around their bodies anymore, we have a machine called a heart-lung machine that does the work of the heart for them. It's really cool.

The machine connects to the biggest artery that comes out of the heart, which is called the aorta, and to the veins that come back to the heart, which are called the vena cavas. It takes the blood from the veins, puts oxygen into it, just like the lungs do, and then puts the blood with the oxygen in it back into the aorta, where it gets pumped back to the rest of the body. So it does the same job as the heart and the lungs while the patient's heart is being operated on.

You couldn't have the machine on when you're awake and walking around, though, because it is very big and would hard to move around with. Here's a picture of what it looks like in the operating room:



Can you imagine having to have that whole machine and the guy to run it following you around when you went out to the grocery store?! So for the moment, you still need to have a heart in your body most of the time. We are working on making artificial hearts for people whose hearts don't work and who can't get a transplanted heart from another person, but so far they don't work nearly as well as the real thing!

I hope that helps to answer your question! Let me know if you have more questions. It would be a pleasure to do my best to answer them.

Rennovation

I'm returned from a long vacation, much enjoyed, and, to my mind, much deserved. And so I resume my trumpeting into this great silence-with-promise.

Being away from this place, in a place where there were no great demands on my time, only reinforced the madness of my daily life as a surgical resident. Why is it that this job seems to feel it appropriate to maintain a tradition of indentured servitude? How is it that one of the most modern, advanced professions in the world still holds to the feudal premise of serfdom. The truth, I think, is pathetically pecuniary: this is the way that attending doctors insure a high income...if there were enough residents to make a resident's life easy, or even reasonable, there would be too many doctors. This is changing, slowly, as mid-level practioners -- nurse practioners and physician assistants -- who can write prescriptions and handle basic problems, but won't threaten to dilute the patient base, are made more common. Now that we are, in principle (though very rarely in fact) limited to 80 hours per week of work, these folks are much more common. But only enough to keep us right at, or over, the line.

Welcome back.