Journey to Gestalt

Today I did my first ultrasound guided thyroid biopsy…make that first 3 thyroid biopsies. It was nice big step toward the ultimate goal of residency. The gestalt that is radiology. The big picture. I had this realization that everyday during residency I get a slightly closer to mastering radiology. Its like when you load a program on the computer and it tells you in a bar graphic what percent complete it is. And the bar creeps ever closer to the end as the percentage inches up. That is how I feel each day. Some days my bar edges over more than others. Some days it feels like it isn’t moving at all.

I would say that people make the most progress toward the 100% (which in my mind equals passing the oral boards) in the first year. I think the learning curve is the steepest and you learn 40-50% in the first year alone. Then the rest comes over the next 3 years. And as you learn more other pieces start to fit easier and progress is made with less struggle. At least I hope.

Tomorrow night is my first accompanied call. And it is St. Patrick’s day. I hope there aren’t crazy bar fights and drunk people losing consciousness left and right. There probably will be. I better review head CT’s. Tomorrow my green will be my scrubs.

Here is one  my favorite T-shirt designs of all time:

Kinda gross but funny nonetheless. Check it out at my web site.

Miley vs Thom

New update from one of the most bizarre musical feuds ever… In response to Miley’s vow to ruin Radiohead, Thom Yorke said “when Miley grows up, she’ll learn not to have such a sense of entitlement.” Well put, mate.

Apparently, Radiohead and Kanye also have some beef. Thom says that he doesn’t know how he offended Kanye. On his blog he says “wish us all (Radiohead) a safe journey if you still like us and you’re not one of those people i have managed to offend by doing nothing”.

It’s a little harder to choose sides on this one because they are both some of the top musical artists out there right now. When it comes down to it though, I think I will always go with Radiohead.

More rain today… trying to spend some time learning about renal findings on ultrasound. Column of Bertin, is that pronounced like Burton or Berteen? If anyone would like to enlighten me, please comment.

Fair Warning

Well it’s Friday and I have survived my first week of ultrasound. Today we had a patient come in for a biopsy of a lymph node in her neck. She had thyroid cancer in the past, so there was concern for recurrence. When we were explaining the procedure to her and getting her consent, she warned us that when she gets nervous she talks a alot and acts “stupid”.  We emphasized to her the importance of not talking, so that the soft tissues of her neck would not move while we had a needle in her. She seemed to understand. Once the procedure got going, the whole not talking thing went out the window. She must have been really nervous, because there was all kinds of chatter coming from her, even with the needle buried in her neck. We kept having to ask her to be quiet and keep her hands out of the sterile field. It caused us a little anxiety, but fortunately we were able to get the biopsy without puncturing any vessels or the trachea. Because that would have been not so good.

Next week I start taking “practice” call. Can’t wait…

Here is what I consider the most absurd product from the Pantalaine web site:

?

If anyone knows what is going here, please comment and tell me.

Dumb and Dumber

The worst part about being a first year radiology resident is constantly being the least knowledgable person in the reading room (except for the med student of course). And with the way rotations work, as soon as you get to know a little about what you are doing, you move on to something else you know nothing about. I am not only talking about anatomy and disease, but also how everything works; the computer systems, the biopsy needles,  the attendings individual likes and dislikes when it comes to wording a report, etc… This cycle is very hard on the ego. I suppose it is like a rite of passage tht every resident goes through. I can hardly wait for a few months from now when the new first years come in. Then, there will finally be some people that know less than I do.

This has been a tough first week on ultrasound, my last rotation before I start repeating. Tomorrow is Friday and I am overjoyed. My difficulties motivate me to read, and that is a good thing. But there will be no reading by the pool this weekend.

If you need a little comic relief, check out the “prank war” videos on this site. They are pretty funny and elaborate.

http://www.youtube.com/results?orig_query=prank+war&search_query=college+humor+prank+war&orig_query_src=4

Miley Cyrus, Ultrasound and the Couch Dress

Today’s post is brought to you by an even better product then the Snuggie (if that is even possible):

Comfy and Stylish!

If you have a spare second and are looking for a laugh check out the Pantalaine web site. It is hilarious!

So I had trouble going to sleep last night, as many of you probably did also, due to the time change. I had to play quite a few rounds of Sudoku on my iPod touch before I felt sleepy. And then when I woke up it was dark again like it used to be. Loving this time change… It was a beautiful day, however. And coming home with the sun still up made it all worth while.

I started ultrasound today. I didn’t know what I was doing so I watched my upper level all day. It was super boring. Every study was read out as could be this, could be that. It was quite unsatisfying. I kept thinking to myself, “just get a CT already!” And there’s a totally different computer system for ultrasound. It doesn’t run on our PACS. Why is that? With all the money that goes in to the PACS, you would think you that could look at ultrasound on it (and nuclear studies, even). Heavens to Merkatroid!

I had a random thought just now that Doogie Howser might have been the first blogger on TV…

We had a huge victory in our intramural basketball league yesterday. We beat the psychiatrists by one point. I hope it’s not a depressing a loss for them…

One last piece of news that I stumbled over yesterday, that is very upsetting. Apparently, Miley Cyrus is out to ruin Radiohead. Did I even just put Miley Cyrus and Radiohead in the same sentence? The story is that she wanted to meet them at the Grammy’s, and Thom and the boys did not want her coming into their dressing room. Can’t blame them. She’s, like, a little annoying when she talks. (I will give her credit musically, though. I do like some of her songs.) So she was offended and during an on-air interview on the radio she said she was going to “ruin” them. I would tell her to grow up and act her age, but she is only, what? 15? Anyway, Radiohead is untouchable, being one of the greatest bands of our time. And now I think I respect them just a little bit more.

Here is a link in case you want to read about it:

http://www.rollingstone.com/rockdaily/index.php/2009/03/05/miley-cyrus-snubbed-by-radiohead-vows-to-ruin-them/

March Madness approaches. Can’t wait.

Focal Fatty Infiltration by the Pool

This blog post is brought to you by Snuggie, one of the weirdest infomercial products I have ever seen…

Today is a glorious spring day with temperatures in the 70′s after a long stretch of bitter cold, and most importantly, it’s Saturday. I’ve caught up on some sleep, did some overdue chores around the house, hit the gym and then grabbed my ultrasound Requisites book and went to the the pool. Everybody was out exposing their ashen torsos except for those who have been obviously tanning throughout the winter. People were reading about medicine and law. There were a few business folks out as well, all thirstily soaking up the rays. I never felt so good reading about hepatocellular carcinoma.

Yesterday was supposed to be my last day on GI, but I was assigned to substitute in the chest room again. I came in the morning and started looking at one PA/Lat after another. There was music coming from attending’s computer on the other side (he was not there). At first it just sounded like opera, which was calming. Then, a familiar tune started playing and I began humming along, not really thinking about what it was. Then it hit me. It was “Noel”, the christmas carol. I had heard rumors that this particular attending listened to christmas music all year long, but I didn’t believe it. But here it is in March, and sure enough, one after the other, the carols played. It got really annoying, but I obviously couldn’t change the attending’s internet radio station. Fortunately, the other chest attending was equally as annoyed, and she ended up changing it. Hallelujah!

I watched Nacho Libre after several glasses of wine last night. Here is a picture of Nacho and his wrestling partner in their “stretchy pants”.

Sweet Stretchy Pants

Brehmstralung and Delirium

So, we had to be at the hospital at 7 am this morning for a lecture. We also had lectures at noon and 5 pm. Our 5-6 pm lecture was physics. While we were learning about the exciting world of filters and grids and everybody’s heads were bobbing up and down, intermittently dozing off, for some reason, a picture of a naked obese woman lying on an x-ray table popped up. She was lying with her legs spread apart and her genitals and breasts were covered with lead shields. One of my classmates started giggling. And then it spread like wildfire. Everybody was giggling and snorting and trying to hide it at the same time. The guy who started it kept it up for a good 15 minutes. It was pretty amazing. Just when I thought he had it under control, another snort came out. When I asked him at the end what was going on, he said, “the fat lady kept popping up in my head!”

Here is my interesting news story of the day:

http://www.starmagazine.com/jon_gosselin_kate_partying_volleyball_cheating/news/15304

Enough whining already…

So I came home from work today and my wife asked me what I did. I told her that I stuck a tube in a man’s penis, injected contrast and took some pictures. Then I stuck a tube in this guy’s rectum injected contrast and took some pictures. Then, I put a caulking gun in a woman’s anus, injected barium paste and watched her defecate. (And, of course, took some pictures.) She then said “ugh, I could never do it”. And that was the end of the conversation…

It was a great day at work, though. The schedule was light, we had some interesting cases and we finished nice and early. Tomorrow we have MSK conference. That’s a little nerve racking. The attending can make you feel really dumb. I am going to have to cram some fracture eponyms tonight.

After reading my last 2 posts, I realize that I am complaining a lot. I don’t want anyone to get the wrong impression.  I am absolutely grateful to have made it as far as I have and to be a radiology resident at a great program. There were many times along my path to this point that I thought I would never get here. But I do use this blog as therapy, so there is going to be some bitching now and then.

I think if I wasn’t a resident, I would want to be Andy Samberg. Him and his friends are hilarious:

Indecisive like Jason Mesnick

Ok, I admit it. I watched The Bachelor finale last night. Pretty much all 3 hours of it. Granted, I was going through the UVA High Res Chest CT tutorial while it was on, but I still witnessed the utterly dramatic flip flop that Jason pulled in front of all of America (all while Ty was taking a nap). You won’t remotely understand that last part unless you watched. Sorry.

So 3 hours in radiology resident free time is like an eternity. Just think of how many pages of Brant & Helms I could have read in that time. No wonder I didn’t know the answer to the question asked of me in conference today: What percentage of lung if contused is prognostic of requiring mechanical ventilation… 40%. People who read instead of watching The Bachelor know the answer to those kind of questions…

So I stepped away from my GI rotation today to substitute in the chest reading room. I read like 50 x-rays. Painful. And I couldn’t wear scrubs. At least I didn’t get peed on.

So as another outlet for my bottled up creative energy besides this blog, I am filming a documentary at work. I get footage in our 15 minutes of free time after conference before we are expected to return to the reading rooms. I do short interviews using the Flip my brother got me for being his Best Man. As you can imagine, with only 15 minutes a day to get footage, the project is progressing slowly. And people are anxious, but I keep telling them that these things take time. I am pretty sure that they all think I am crazy. I don’t really fit into the mold that all the others fall into. Instead of roaming the halls with an open book in my hand (one 4th year does this all the time) I am thinking about my next t-shirt design, the next footage for my documentary and making a beer pong table. (We are going to have a tournament next month, if I can get some plywood). Perhaps this is why I am feeling a little stifled by residency. Don’t get me wrong, I like interpreting images, but it can’t be the only thing in my life. I think this is why I will never be a truly great radiologist. This is hard to swallow. At least I don’t have a Schatzki ring.

Check out my t-shirts and mugs here.

Here is a sample design:

Irony is getting run over by an ambulance.

I had a realization over the weekend that radiology residency is just not cutting it for me. (Maybe I should consider surgery?…:) I am constantly having feelings of longing for something more in my life. And when I sit down to really think about what is missing, I come to the conclusion that I have no outlet for creativity other than deciding whether I will use the word “normal” or “unremarkable” in my reports. I need more, a lot more. So MedJester is back and starting fresh. God it feels good to refer to myself in the thrid person!

I started blogging a few months ago and ran out of steam after about 9 posts, but this time it’s going to be different. (I think the Buffalo Bills said that a few times in the 90′s.) But I’m serious this time. I need this. It gives me a platform for all of the items I put aside in my mind throughout the day that I think others might find amusing. Because the most valuable thing in the world is a good laugh. Laughter makes you happy, keeps you young, lowers your cholesterol, increases your sperm count, etc…

For example, I got peed on today. Totally sprayed, and not by a cute little clean smelling baby either. A full grown not so clean smelling adult. You got to laugh about that… The resident I was working with got a huge laugh out of it. I guess they don’t call it a voiding cystourethrogram for nothing. But you know what I say, “When it comes to imaging, VCUG’s always come out number one!”

So in noon conference today, our lecturer asks “What is the most common location for gastric lymphoma?” And then proceeds to tell us it’s the stomach…

As I used to, because I am a money grubbing whore, I will plug my medical T-shirt and mug site like I used to.

www.cafepress.com/medjester

And leave you with this brand new design in honor of my favorite album of the 10th grade The Chronic. (You can get it on a t-shirt or mug at the link above.)