Saturday, May 30, 2009

Transitions, Continued

We are packed. I've been reading Connecticut newspapers even though I haven't quite found one I like. There's a house waiting for us in New Haven, and my wife and I are debating the merits of being called Yalies or Yaliens. She prefers the latter. We're squeezing as much as we can out of the nascent Seattle summer. Two recent activities we recommend are hiking at Ingalls Creek (on US Highway 97 between Bluett Pass and Leavenworth) and an afternoon canoeing through the Washington State Arboretum on a boat rented from the UW WAC.

Today's looking like another beautiful day.

Urban Phantom

The Urban Phantom has been relocated.

The black bear that seen earlier this week in Seattle was found yesterday in Everett, WA, just 30 miles north of where is was first sited. The bear turned up in another urban area, so wildlife officials tranquilized him and transported him out of the urban area. Hopefully for him, the adolescent male was dropped off along Highway 2 in an area that is not already claimed by an older, stronger bear. In the end, I'm happy the animal did not meet the same demise that the poor creature found in the University District three years ago.

According to wildlife officials, at no point were humans at risk from the bear; they claim that the bear was more at risk from cars or from dumpster diving. Evidently, human food doesn't do much good for bears. It probably doesn't do best for humans either!

Friday, May 22, 2009

Final Day

Today's my last day in clinic or hospital. At least of medical school. How will my wife and I celebrate? By packing, of course. But school is not quite over. After two days off next week, we teach second years procedures for a few days and then have a week of a summary course called "Capstone." I think that consists of advanced procedure training and learning the basic stuff that may have slipped through the cracks the first time.

Anyway, I am so happy to be finished with one more task that I could yip with joy. Fortunately, I can save myself the embarrassment because the neighborhood coyotes are at this moment doing just that. Well, at least they are yipping for some reason.

If you would like to read more of my reflections, consider following this link to my column at The Differential.

Tuesday, May 19, 2009

Seattle Bears

No. We are not getting another sports team. (Though I hardly noticed the NBA SuperSonics' absence.) A few years ago, a bear was found in Seattle's University District. It met a grisly demise at the hands of untrained law enforcement officers. Hopefully, the city has learned its lesson. Because there's a bear in Ballard. It's been sited in Seattle's West Shore: Magnolia, Ballard and the area. According to the Seattle Times, wildlife officials are involved. This guy is reading the ingredients on a tranquilizer dart.

I hope this bear is not destroyed. I wonder how much cash has been spent on the bear thus far. Multiple squad car chases and a helicopter have been involved... Read the article. You're not going to believe it.

Update 5/20/09

The bear, now named "Urban Phantom" has made his way back north and east of the city. Hopefully, we will find a spot more to his liking in the Cascades. Here's a map detailing many of the animal's sightings.

Sunday, May 17, 2009


As I've been packing, I've begun to realize which "stuff" from medical school is important and which is not. Read about my ideas over at MedScape this week. As a bonus, I can offer you a glimpse into the social dynamic between my wife and me as we pack for the big move!

Need a hint? My wife is an awesome packer. I am not.

Saturday, May 16, 2009

Hearkening Back

When Susan and I move next month, we are planning to leave our televisions behind. Part of that decision is that they are older. Part of it is to reduce the volume of stuff to move. One of the things I am looking forward the most to is not having cable television. Lately I've been sucked in to programming (namely on the SciFi, Animal Planet, History and Comedy Central channels) when I should have been writing, studying or packing. So the move is something like a "practice what I preach" opportunity. (As an adult, I alternate between tolerating and railing against the boob tube.) Find stronger opinions than mine at the Kill your Television web site. Rather than release lead and mercury into whatever space I'd be weilding a sledgehammer, I've turned two old TVs into fish tanks...

So what will I do with my time? I'll try gardening, home improvement, internet ideas and reading... These things I already do and actually enjoy more than commercial programming. For example, I liked this piece in the New York Times by its editorial observer Verlyn Klinkenborg about reading aloud. Reading aloud is fun. I just need to find some people who agree with me. I bet there are a few in New Haven!

And what about other screen entertainment? Movies? Internet? We will still be able to do that, but on my desktop computer. I think the screen is bigger than our TV's anyway. And shows I really want to see? I guess I'll have to try out BitTorrent for size. In the mean time, I've got some packing to do!

Thursday, May 14, 2009

Rotation Schedule

This week, I assumed my place in the national online call reqistry known as (That's pronounced, "Am I on?") Like every other resident, my call schedule is available to anyone with the proper login. Since I'm not sure how protected said logins are, I'll relay for all those who are interested which rotations I've been assigned.

6/21 - 7/20 Yale ED & Orientation
7/21 - 8/17 Bridgeport Hospital ED
8/18 - 9/14 Bridgeport Hospital ED & EMS
9/15 - 10/12 Bridgeport Hospital ED
10/13 - 11/9 Pediatrics at Bridgeport Hospital
11/10 - 12/7 Medical ICU at Yale
12/8 - 1/4 Ultrasound & Anesthesia
1/5 - 2/1 Ob-Gyn at Bridgeport Hospital
2/2 - 3/1 Yale ED
3/2 - 3/29 Cardiac Care Unit at Yale
3/30 - 4/26 Orthopedics
4/27 - 5/24 Medicine at Yale
5/25 - 6/21 Yale ED

This is just one more step in my transition to residency!

Sunday, May 10, 2009


ED Shoes, click on the image for a Flickr interactive view.

There comes a time when all that's left to be said is, "Goodbye old friend." This week I used that phrase twice. Once to the Harborview emergency department and later in the same day to my clinic shoes. Over the past 2 years I've used a dedicated pair of shoes during ED shifts and overnight call. The day I stepped out of the Harborview ED was the same day I said goodbye to these old friends. The left toe bears the badge of ortho (plaster). The right foot has a spatter from irrigating my last wound in Seattle. Both bear marks from my away rotation at San Francisco General, as the heels and laces retained a tinge of the scrubs' cranberry pink dye. The real reason for discarding this pair was the torn apart left heel and loss of sole traction. Otherwise, with a splash of bleach they'd be ready for another shift!

An expanded version of this article was published at Medscape's student blog, The Differential.

Sunday, May 03, 2009

911 Blogs

There's a blog published by the now online-only Seattle Post-Intelligencer called Seattle 911: A Police Blog. Many cities have similar sites that act as 21st century police scanner bulletins. While surfing for news this morning, I happened to find that the top three stories on the site involved patients I saw at Harborview Medical Center during my last shift. There are also pictures to help understand the injury mechanism. Here's one:

The entries each indicate transport to the hospital where I was on call. My willing compliance with HIPAA and patient confidentiality rules prevents me from saying any more about the specifics of the cases, but I will comment briefly on a facet of patient care that could use improvement. Information is often lost in the transition from witnesses to emergency response personel to emergency physicians to their hospital consultants. (I was a student on the orthopedics team at the time.) We hope that the important information is maintained, but invariably, there is something that we wish we had known at the time.

Even with excellent sign-offs between providers, patients come in to the hospital with limited histories. Patients could be 'out of it' due to shock, pain or pain medicine. There could be a language barrier. Patients are sometimes intubated. Important features may have been observed but not documented on the scene, in transit or during an initial physical exam.

One of the important questions in the patient's history for emergency docs are: How did this occur? Among providers, this question becomes: What was the mechanism? Discovering or confirming this info with the patient is one way emergency providers evaluate patient alertness and orientation while they do their injury surveys, so patients sometimes get annoyed at having to tell the same story over and over again. But that's if the patient can tell the story. Sometimes they cannot.

It turns out that the Seattle 911 blog had information that may have been helpful for providers to understand these patients' injuries. In two of the cases from Friday, the entry was made while (or soon after) the patient was in the emergency department, further underscoring the potential utility of electronic documentation of pictures. One of the patients described the accident in a way that when I saw the image, I thought, "I saw the person involved in that accident." The other image generated a, "So that's how that happened" response in me. The importance of pictures (yes, worth a thousand words) is well known in emergency care; the soon to be history Polaroids of automobile accidents are often taped to critically injured patients' charts. The photo below is more a reminder of how beautiful it was on Friday that how the accident occured.

It wouldn't have changed how we treated these patients to know the specifics documented in the blog entries; the primary determinants of treatment are derived from the physical exam and what the x-rays and CT scans reveal. But one wonders if speedy documentation of accidents and injuries in the field could ever be incorporated into the electronic medical record. iPhone medicine is already being practiced in many emergency departments. The fellow on our service used his Blackberry to photograph one of our patients' wounds. He only partially joked with the radiology tech that he needed it to plan for a surgery. The image was later used to communicate with the attending surgeon and was reshown the next morning during a sign-out conference.

Reforming and universalizing the electronic medical record is central to the Obama plan to reduce health care costs. I hope the software programmers include a mechanism for documenting accident photos. In the mean time, maybe I should keep the local injury blogs open on one of the ER's computers.

Photos are from the Seattle 911 blog and were taken by Ben Otteson and Dana Vander Houwen.