Pocatello, Idaho, a place that makes Curling seem exiciting

I am now in Pocatello Idaho for my pediatrics rotation. I am super excited about it because Pocatello is supposed to be one of the better rural areas to do your peds rotation. You get to see a wide variety of clinic patients, round on children in the hospital every day and also round on NICU patients. My old roommate, Melissa, did her Peds rotation here and had a very good experience (although she did warn me that they work you very hard here).

Despite being an ideal location for a pediatrics experience, Pocatello itself is perhaps not the most exciting town in the country. Many people have asked me how Pocatello is and what it is like. I have struggled with a way to describe it. Perhaps the best way to explain it is that Pocatello is a place that even makes the sport of curling seem exciting. Allow me to explain. The Olympics are now in full swing and there is a news channel that seems intent to play every minute of the curling competition despite it being perhaps one of the most boring sports played in the winter Olympics. In other locations I have been at during the winter Olympics, it seems to be a widely accepted fact that when curling comes on, the channel should be changed. Curling is perhaps even below commercials in interest-holding-ability.

However, in Pocatello it is a different story. In several patient rooms, parents sit holding their sick child watching curling in rapt attention. In the physician's lounge in the Pocatello hospital, curling has been playing on the big screen TV every day. It is even a item of discussion in the elevator (i.e. "Hey, Jim Bob [<-- made up name], How about Canada's Curling team? Aren't they something?"). Perhaps the scariest event of all occurred when I went home Friday evening after a very long week and found myself watching curling in a near mindless state. It was an almost out-of-body experience. How low had my life sunk? What had happened to me that I was actually exposing my brain to the neuron-atrophying affects of curling? Then I realized it could all be explained in one word: Pocatello. Indeed, Pocatello, Idaho is place so boring that it makes the sport of curling seem exciting. I have included a few pictures of the area of Pocatello, surrounding my apartment to aid in the illustration of what Pocatello is like.

This is the parking lot in front of the apartments the medical students life in. As you can see, it is jam-packed and parking spots are hard to come by (note sarcastic tone of this sentence). Did I mention I received an angry note after accidentally parking in another tenant's spot after coming come in the middle of the night after call. As you can see, he or she was right to be upset, as there was obviously no where else to park.

Here is the view out of my apartment window. Did I mention that the apartments are "in town."
Here is the prettiest picture I have of Pocatello. It did have its moments of beauty/charm.

Here is a picture of the road in front of my apartment after the snow had melted.
Now think back to the pictures posted above. Look at this picture of an Olympian throwing a curling stone (or whatever they are called). Doesn't it now put off an air of mystery and perhaps even excitement? Do you see how curling could captivate you if you lived in a place such as Pocatello for an extended period of time?

Peds in Pocatello, Idaho.

First let me apologize to my blog readers about being so bad about updating my blog. I was so happy to be back in Seattle with friends and family after being in Alaska for 6 weeks that I didn't publish any of my blog posts that I started during my psychiatry rotation. I have now made a few edits and back published some of my tardy blog Jan and Feb blog entries. Just as a heads up: The date at the top of the blog entry is the date when I save the first draft of that entry, not when it is finally published to the blog. Thanks to Aunt Bev for reminding me that people still read my blog and that she missed my updates!

Now, for an update. I have now finished my psychiatry rotation. I made the 12 hour drive from Seattle to Pocatello, Idaho where I starting off my 6 week pediatrics rotation. I am very excited about the rotation. I love kids and am considering pediatrics as one of my specialty choices. Pocatello is supposed to be one of the best places to do the pediatrics rotation because you see a wide variety of pediatric problems in clinic, in the hospital and in the NICU. There are 10 different physicians we will be working with during the 6 week rotation.

Opportunities for personal enrichment outside of the hospital/clinic may be a little less varied. I did some research prior to departing for Pocatello, I did some research on things to do in Pocatello and I found the following website:
http://www.tripadvisor.com/Attractions-g35572-Activities-Pocatello_Idaho.html
Apparently the top things to do in Pocatello are:
1) Visit a museum
2) Visit a Fort Hall Replica
3) Visit Old Town
4) Visit an old church
5) Visit a mansion

"I wanted to clean out my bowels, so I ate soap."

As part of the psychiatry rotation, you spend several weekend and weekday nights 'on call' with the resident until 11:00pm or so. You split your time between seeing patients in the psychiatric emergency room and answering questions about ward psychiatry patients from nurses. On one afternoon with the resident we got a question from a nurse about a patient on the wards who was complaining of "bowel distension" and some mild abdominal pain. I recognized the name of the patient as one of the patient's my team was following so I offered to go upstairs and talk to the patient first. The resident said he thought this was a great idea and said he would be arriving about 10 minutes after me. Here is a summary of our conversation (at least as good as I can remember):

Me: "Can you tell me about your abdominal issues?"
Patient: "Well, I know my abdomen is very distended, and I am really constipated."
Me: "Tell me more. When was your last bowel movement?"
Pt: "I have had two bowel movements today and they were both pretty loose and I had two bowel movements yesterday too, but I know I am constipated. Look how big my abdomen is."
Me: "Some people might think that if you have 4 loose bowel movements in the last 2 days, that you probably aren't constipated. Can you tell me if you have changed anything about your routine or what you have been eating recently?"
Pt: "Well, I really wanted to clean out my bowels, so I ate soap."
Me (confused, and trying to keep a straight face): "Uh, allow me to clarify. You ate soap?"
Pt: "Yeah, soap. You know, it comes in a bar."

Hmmm... I wonder what the source of her loose stools and abdominal distention/pain was?

When you think about on a very basic level, it sort-of makes sense. If you want to clean your hands, you use soap. If you want to clean your dishes, you use soap. If you want to clean out your bowels, wouldn't you also want to use soap?

Oh so good. Soap. Deliciousness in a bar. Maybe those food scented soap bars really have a market.

A couple people I have spoken to had their mouths washed out with soap when they were younger after saying some bad words. They say that it actually doesn't taste that bad. I wouldn't know.

Voices.

In psychiatry you learn that a surprising number of people hear voices. Many people can successfully go through day to day life hearing voices (aka auditory hallucinations) and frequently without other people finding out. When we talk to patients who have auditory hallucinations sometimes they like the voices. It may be the voice of their mother telling them comforting things. Sometimes it is their own voice which is telling them positive self talk saying things like, 'don't be sacred' or 'you can do it,' etc. However, perhaps even more frequently, the voices are degrading and cruel. They may say things to the patient over and over again such as, "You are worthless. You are worthless. You are ugly." One patient said the voices said to her, "Eat, eat, eat, and die." Others have voices that say, "Kill yourself." Over and over again. Perhaps the most horrific, are the voices are those that state that if the patient does not kill him or herself that something terrible will happen to the rest of the world (the world be destroyed, all the children in the world will die, etc). Usually the patient has some sort of understanding (however small) that voices do not indicate reality and that if the person does not kill him or herself that the world will not come to an end. However, this led me to the question: What if the patient actually believed that if he or she didn't kill him or herself that many other people will die?

In Biblical philosophy it is said that there is no greater love than to lay down one's life for one's friend. Likewise, it is also considered by many to sacrifice yourself in service to your country. In some religions it is considered a sin to commit suicide which may even result in the person committing suicide going to hell. But what if the patient truly believed that if they didn't kill him or herself then many other people would die? In that situation, although it is of course a terrible tragedy that the individual has tried to end his or her life, is it not also an incredibly selfless act? Although their reasoning is flawed as they have been given incorrect data, they are acting along one of the most noble of moral codes of our culture. Just food for thought.

Reading notes every morning - better than a best-selling mystery/adenture novel!

I am now in the depths of my psychiatry rotation in Seattle. It is a great and truly memorable experience! Medical students are divided into teams that round on patients in the hospital fr psychiatric reasons. For the most part, patients are being held against their will for their own safety (either for suicidal thoughts/plans or psychosis or something similar). The teams usually consist of an attending psychiatrist, either a psychiatry resident (psychiatrist in training) or a psychiatry physician's assistant, 1 or 2 medical students, a social worker, a pharmacist, and occasionally a pharmacy student. The teams are generally a lot of fun and are very dedicated to helping patients.

In the morning, the students get there a little before the other members of the team and look up labs, medications and read nursing and other notes from the team's patients from the team before. Then before rounding the medical students can update the team on what is going on with the patients before team interviews the patients each morning. This is a very similar pattern to what happens on other rotations in the third year of medical school. However, what is different about psych is WHAT is written in the notes. On other rotations, the notes usually have the patients blood pressure, heart rate, how much fluid they consumed and how much the urinated, how they slept, how much pain they are in, etc. In summary, overnight notes in other third year rotations are just a touch boring. Occasionally something exciting happens (your patient worsened and might have to be sent to the intensive care unit or something else sad or upsetting), but generally not the most exciting part of your day. Psych notes have a lot of this medical information too, but they also have descriptions of what the patient said or did the previous afternoon and night. By almost every definition, psych notes are almost never boring. In fact, opening up psych notes in the morning was one of the my favorite parts of the day. It was even better than opening up a best selling adventure or thriller book because you never knew what patient might have done over-night.


My pictorial version of psychiatry notes - they are better than an adventure/thriller book or movie. Even more exciting and unexpected.

I loved OB, now I am on my psych rotation!

I had a blast on my OB rotation in Anchorage. It was a lot of fun. I got to see lots of deliveries, numerous surgeries, and work with some very cool people. I had such a good time on ob, I actually started considering at a specialty choice. (We will see what the rest of third year has in store for me surrounding my life decision making plans). OB had some wonderful moments. Mom's and babies are lots of fun.

Despite our enjoyment of OB, at the end of our stay in Anchorage, the cold weather and the very short number of daylight hours made us pretty happy to get on the plane and come back to Washington State.



Here is a picture of the OB students I was with in Anchorage. From left to right they are Jonathan, Lindsey, Kristin, and me. This was taken after our final exam on the very few hours of day light. By the time we were about to leave a large portion of our conversations focused the fairly depressing topic of astounding lack of daylight hours. Here are just a few of our sample conversations:

Jonathan at 1:30pm, "Hey, guys look at the beautiful sunset outside." We looked outside, and indeed there was a brilliant red sunset behind the snow covered mountains. It was indeed beautiful, it perhaps would have been even more touching if it was occurring at 5 or 6pm instead of 1:30.

Lindsey, at around 11am a couple days later (just a couple days before the shortest day of the year), "Hey, guys, look! It is another beautiful sunset." Me, "That is beautiful, but it is before noon, so that would make it a sunrise." Lindsey, "Uh, that looks just like the sunset a couple days ago. Are you sure it is not a sunset?" Allow be to explain this conversation. Towards our last days in December, the days became so sort that the sun essentially rose as a sliver of light from behind the mountains in the south (around 10am), and set as sliver of light a few hours later as a sliver of light coming behind the mountains from the south. Thus, other than the time of day, the sunset would be difficult to differentiate from a sunrise.

After a brief, but well needed break for Christmas, I am now on my 6 week psychiatry rotation in Seattle. I am looking forward to some unique experiences and catching up with people in Washington.

Enough with spam comments on my blog!

I curse you internet junk-mail spammers!!!!!! (earthquakes, thunder and lightening sound). No more spam comments on my blog! No, I don't want comments trying to sell Viagra on my blog posts about learning Swahili in Tanzania. Anonymous comment posting has been eliminated due to abuse by spammers. You must now have a Google account to make a comment.

A quick Tour around the Alaska Native Medical Center

Although we don't actually get to do any OB/GYN work there, several people have strongly recommended that we take a tour around the Alaska Native Medical Center (where native Alaskans get their medical care). It was a really nice hospital with AMAZING artwork. If you are ever in Anchorage I strongly recommend visiting. Just a couple pictures here. It is an excellent reminder of the cultural heritage of the area/state. Lindsey took these pics because my memory card was full.

View from the top of the ANMC. The medical complex was pretty impressive and quite modern. I was very impressed.

Walrus Ivory carvings abounded. They were really good. There were several larger whale-bone carvings as well.
Lots of artwork adorned hallways and entryways into the hospital. The main entry is actually a sitting area in large circle to symbolize community and sharing between the different Native Alaskan people groups.
This was a basket display on the second floor. The plaque next to the basket says that sometimes seal gut is used assist with decorating the baskets.

The information sign beside this display said this traditional coat is made out of squirrel fur.

Hangin' with the other 3rd year med students in Anchorage

There are actually a bunch of 3rd year medical students here in Anchorage right now: 4 students on OB/GYN, 3 students on pediatrics, 2 students on psych, and 2 students on internal medicine.
Some of the students flew back to Seattle for Thanksgiving. Others had their husbands/significant others fly up here to meet them. Anyway, the medical students and partners that were here had a great time putting together a combined Thanksgiving meal.

Many concerned individuals have asked if I had to spend Thanksgiving by myself. Rest assured, that did not happen. Here we are with other med students having our Thanksgiving meal together. To my left is another third year named Erika and her husband, Mike, to their left is a 3rd year student named Chris, and to his left is third year student, Alison, with her boyfriend.

This is a picture Lindsey took of me. About 100feet behind me was a moose eating a bush. Lindsey joke that you couldn't see the moose at all, but you could see that was scared for my life (moose can trample people if they get too close).

Here is a family of moose that we ran into one night when Lindsey and I went to pick up the car. They look cute, but they are huge and dangerous.

For Erika's birthday we went out to Sushi. It was really good and a lot of fun. On the left we have Lida and Erika (on Pediatrics) and on the right it is Lindsey, me and Jonathan (all on OB/GYN).

Here is a picture of Lindsey hanging out at our kitchen table. We have a nice little apartment.

A drive around Anchorage

There have been a number of humerus things we have seen while driving around Anchorage. I thought I would share just a few of them with you here.

One of the dilemmas in the area seems to be: what to do with the snow? Seen here it was made a decorative part of a court. The bulldozed all the snow into a big pile in the center of the court and made a path to drive around the outside and built a snow man on the top. Thanksgiving cheer all around! Note that in this picture it looks pretty dark, but it was taken around 9:30-10am.

Typical driving on the main roads. You can see the mountains, etc in the background. Apparently, the mound of snow at the side of the road after snow ploughing has a name, but I can't remember it right now. I will have to get back to you on that.

I have never seen so many Hummers, Pickup trunks, and Subarus in my entire life. They are (very understandably) quite popular here.

The phone number for the local Anchorage cab company is 222-2222. I think they made it so that even if you are really drunk you can easily call a cab.

The "Community Minded" liquor store is one of our favorite signs. Our question is: how is a liquor store community minded? We decided a sub-slogan could be something like, "We keep our prices low to keep you drunk. Truly thinking of the community."
This is another one of the many liquor stores. It sort-of reminds me of how Seattle has lots of coffee stands, but here they sell alcohol. Alaska does have a very high rate of alcoholism compared to many other states, and it can be a pretty big problem, particularly out in the more rural areas.