As I do have a smartphone, the emails come right to my pocket. But sometimes I read them when I have a moment of downtime while standing in a hospital. I can’t tap out a reply at that very moment. So I put it away with every intention of replying when I get the chance.

However, sometimes things get busy. You get other emails that push the email down the pile. And when things finally settle down I simply forget.

And I apologize for that.

If you have emailed me through the Contact Me page and have not received a reply, please do re-send it.

I will continue to do my best to respond as soon as I can.

Over the course of this interview season, this is a question that I have been asked numerous times. The person asking me really doesn’t care whether or not I like the city of Loma Linda. The implied question is whether or not I like Loma Linda University School of Medicine. The question is one that has been asked by fellow interviewees. It’s not unusual. While waiting in a room full of interviewees, conversation usually starts out with asking each other what school one is from. This question is usually followed by a “how do you like it there?” question. Invariably, the answer is positive — or at least neutral.

I don’t think I’ve ever heard an applicant say they didn’t like the school they came from. And for some reason, I somehow doubt that anyone would admit to disliking their soon-to-be alma mater — at least not while on the interview trail.

So how do I like Loma Linda? I like it very much. I think medical schools are more similar than different. We learn the same material. We take the same national exams. Sure, each institution offers their twist on how the material is presented, but the material is the same.

One thing that is different here is Loma Linda’s emphasis on Whole-Person Care. The curriculum is designed to not only emphasize the physical pathophysiology, but to also highlight aspects of spiritual care as well. I feel like I have been encouraged to go beyond the diagnosis — to treat the patient and not just the disease.

I have accepted that I attend a medical school whose name does not carry the weight of an ivy league establishment. I have become accustomed to puzzled looks when I say that I go to Loma Linda University. Many people outside the area have never heard of this place. Saying I attend a medical school in Southern California usually gets guesses of UCLA or USC. But once in a while I do come across people who have heard about Loma Linda.

On a recent interview, a program director in another state noted my educational pedigree. Glendale Adventist Academy for high school. Walla Walla College (now Walla Walla University) for my bachelor’s degree. Loma Linda University for medical school. “You must be a Seventh-day Adventist,” he said to me. He continued, “we like students from Loma Linda. Do you realize that your ethics curriculum is more extensive than most other schools?”

On another interview a resident asked me what school I came from. When he heard I was from Loma Linda he said that it was plus for me since the program liked Loma Linda students — they’re usually a really nice group of people.

It was nice to go outside of the this insulated, geographical area where everyone knows of Loma Linda University and hear other opinions of my home institution from people who have no incentive to say anything nice about it. Or maybe it was just a little bit of validation that I appreciated hearing.

So how do I like Loma Linda? Evidently, I like it very much.

Since I started medical school, I get the occasional item in the mail that looks like this — a letter addressing me as Dr. W. The front of the envelop usually says Jeff W. M.D. above my address.

It always amused me. I suppose you could say it tickled me.

I felt the same way when I saw this today.

And then I realized that after labor day weekend next year, I will have earned those two initials.

I know I’ve made a similar statement a couple of times in recent months. But it’s only because the whole idea is still surreal to me. It hasn’t sunken in yet.

On Thursday I will be taking USMLE Step 2 CS, one of the many exams we need to take in order to get a medical license and DEA number (we need to pass USMLE Step 1, Step 2 CK, Step2 CS, and Step 3).

Sometimes I feel like I’m barreling towards the finish line. At other times I feel like I’m plodding along at a snail’s pace. Regardless of my perception, I’m moving steadily towards May 27 — scared and excited all at once.

Upon hearing about my schedule, many residents have sighed and said, “Oh, the life of a 4th year. Enjoy it while it lasts.”

It won’t be all fun and games, though. This first week I’ll be studying for Step 2 CS and taking the exam on Thursday. The following couple weeks I’ll be finishing up my interviews. But then I will have a few weeks off at the end. I’m still not sure what I’ll be doing. There has been some talk about the possibility of going to Korea. My sister is leaving for Korea in about 1 week. She’ll be teaching English there for 4 months. She would like me to come visit. Well, I’d like to go visit too.

But I’ve also considered other travel alternatives. The others are all cheaper than a trans-Pacific flight. One option would be a road trip. I considered just driving east and just going for a week without any planned agenda. I considered flying out to the east coast and just wandering around for a while. I also considered trying to talk my parents into letting me use a week of their time share somewhere — perhaps I’ll go to Hawaii again.

Obviously my mind is all over the place.

We’ll see, though.

Whatever I end up doing, you better believe I’ll be posting about it!

It’s kind of like a pediatrician or even a Pediatric ER physician. Little kids might not be able to complain. And when they do, they may be very vague, unable to give a good description of what they are feeling.

I recently worked a Pediatric ER shift where I saw a 4 year old patient who was transferred from another facility. The other hospital wanted us to rule out appendicitis because the patient had abdominal pain and a CT scan that was equivocal.

I went in to see this little patient who appeared to be lying comfortably in the gurney watching the TV hanging on the wall. The patient, who I’ll call Joe, didn’t seem to be in pain. So I asked his parents what the problem was. It turns out that Joe had been vomiting — up to 10 times over night — and that was why he was brought in to the ED. I asked if Joe was communicative at home. His parents told me he was.

Was Joe a child who would normally complain of pain like a stomach ache? Yes, they told me. Did Joe ever complain that his stomach was hurting? No, he didn’t.

At this point appendicitis was getting knocked down lower on my differential (list of possible diagnoses). I proceeded to sit down next to Joe and say hello. He stared back at me. I told him I was going to just take a look at his stomach and started to pull back the hospital sheet that was covering his belly.

Almost immediately he pulled it back. Apparently, this kid liked his stomach covered up. I pulled back a little and pressed on his stomach. He started crying. I tried to observe how he was crying — to see if he was just being fussy or if it was really painful. I started pressing on the left side and worked my way to the right lower area of his abdomen (where appendicitis typically presents with pain) and tried to see if his crying intensified as I neared that spot.

I finally gave up and let him cover up his stomach. But I tried one more time. This time, I pressed on his stomach through the sheet. This time Joe did not cry. I was able to press fairly deep all over his stomach without eliciting any cries of pain.

That pretty much did it for me. And, after more discussion with the parents about Joe’s symptoms at home prior to coming in to the hospital, I concluded that appendicitis was not likely in this little patient.

In the adult world, most patients are able to communicate. Sure, I’ve had adults who were unable to communicate with me, but the proportion of patients who can’t communicate is much, much less. I don’t plan on going into pediatrics or emergency medicine. But I can appreciate how difficult it can be at times. And I am thankful that there are people who choose to do it.

There are many great things about Emergency Medicine. For one, I love the shift work. It must be awesome to leave the office and never have to carry a pager or be on call. When you’re on, you’re on. And when you’re off, you’re off. The salary is also an overall plus for those considering it. I mention just a few of the positives of EM to make the point that there are things I do like about it.

But the reason I can’t go into EM is the system and how it is (poorly) designed. I realize that my impression of the system is based on my experiences while rotating as a medical student through local hospitals that include a level 1 trauma center and a county medical center. So the picture I have is probably not representative of all hospital EDs. But I hope to stay in the area. I would like to stay in academic medicine. So I think my sample size fits.

While rotating through medicine and surgery I would often be sent to the ED to admit a patient. While going looking for my patient, I’d have to walk through hallways and aisles lined by chairs and gurneys filled with patients watching my every move. They watched because they hoped that my eyes would meet thesis and that I would stop. I hated that feeling. I wanted to stop an help them. But I couldn’t. I had no idea what they were there for. And they weren’t someone I was asked to see.

Perhaps this is just a small thing. But to me it was huge.

The second reason I can’t see myself going into EM is that there are just so many non-emergencies. The system of healthcare we have leads to so many people coming into the emergency departments due to complaints that should be dealt with in the primary care setting — or even the urgent care setting. I can only imagine that I’d be frustrated dealing with this on a daily basis.

It may not be much. Some may see this and minimize my reasons saying that they are silly. But in the end, they are the reasons that pushed me away from emergency medicine. And it’s a personal process everyone must go through for themselves.

I’ll be happy when it’s over.

In the meantime, here’s a video I found and am sharing in honor of breast cancer awareness month — because early detection saves lives.

For a moment I felt the tears begin to swell. And I turned away, took a second, and kept my composure.

I have been in sad situations before. But this was the first time it (almost) got to me.

When I passed the gurney for the second time I realized that the patient was asleep. This time I paused at the bedside. I noticed her wrist was exposed. And on that wrist was her identification badge. The name confirmed my fears. This was the very patient our team had discharged one week earlier and showed up in the ED the very next day with discharge papers still in hand. This was the patient whose medical record would reveal multiple visits to the ED for the purpose of obtaining meds.

If you’ve read this far and are wondering why I was so fearful, it’s because I feared that the patient would be a “bounce-back.” A patient becomes a bounce-back when they return to the hospital within the same calendar month after their discharge. When this happens, should the patient need an admission, they go back to the team that originally took care of them. The theory is that it provides continuity of care as the team is already familiar with the patient and his or her issues.

As I continued on with my work, I knew I didn’t want this bounce-back. I didn’t want the patient back on our team. She had been hard to work with in the first place. She had terrorized the nursing staff. She had frustrated her sitter. She had tried our patience. She had refused treatments. She was a difficult patient.

Like I wrote earlier, she was a frequent flier. I am not sure her repeated admissions helped her. Sure, she had physical ailments. And we could help the occasional exacerbation. But they were chronic conditions that we wouldn’t cure. To me, it seemed that the most pressing issue was her mental health. I suspect, and I’m no psychiatrist, that much of her behavior would improve with more attention to her mental health. But sadly, the system we are in affords little help to who need it, and even less to those who don’t think they have a problem.

As I begin to wrap up this post, I admit I am struggling. I don’t know where I am going. I suppose it is borne out of a frustration that is without an avenue of release. There’s nothing that I can do to help patients like the one above. And as I go into Internal Medicine, I am sure I will encounter many more people who, though suffering from significant medical and mental illnesses, will try the patience of those taking care of them.

Perhaps, this is just my weekend, off-day rant.

But one article caught my attention and I couldn’t help but click on it. It told of the two pilots who were ordered to intercept Flight 93. Back in 2001, there were no fighter jets that were armed and ready to take off to intercept planes. It was a different time.

When the order came to intercept Flight 93, the two pilots, Lt. Heather Penney and Col. Marc Sasseville, could not wait for their planes to be armed. They took off with only 105 lead-nosed bullets and the knowledge that those bullets wouldn’t do the job.

From the article:

“It was decided that Sass and I would take off first, even though we knew we would end up having to take off before our aircraft were armed,” Penney, among the first generation of American female fighter pilots, said to C-SPAN.

Penney said each jet had 105 lead-nosed bullets on board, but little more.

“As we were putting on our flight gear … Sass looked at me and said, ‘I’ll ram the cockpit.’ And I had made the decision that I would take the tail off the aircraft,” Penney recalled.

Both pilots thought about whether they would have enough time to eject before impact.

“I was hoping to do both at the same time,” Sasseville told the Washington Post. “It probably wasn’t going to work, but that’s what I was hoping.”

Penney, a rookie fight pilot, worried about missing her target.

“You only got one chance. You don’t want to eject and then miss. You’ve got to be able to stick with it the whole way,” she said.

The pilots chose their impact spots in order to minimize the debris field on the ground. A plane with no nose and no tail would likely fall straight out of the sky, its forward momentum halted, Penney said.

I read the article and was just amazed and reminded about what our men and women in uniform are willing to do for us each day.

Source: MSNBC.com