Archive for the ‘Rants’ Category

Time Table for Ophthalmology Match (SF Match)

October 19th, 2010 No comments

Applying for Ophthalmology residency can often be very frustrating, because you need to start applying at the beginning of 4th year, but many schools preclude doing an ophthalmology rotation prior to the beginning of 4th year.  As a result, getting letters of recommendation can be rushed/tedious process, but don’t worry most candidates are in the same boat.  Since only a few of your classmates embark on this path each year, often there is little help from the facility and admin office, but fear not, the application process is no different than medical school/college and is easy with a bit of planning.

For an in-depth look at the match please see my sleep-deprived post-call rant and my mildly more coherent post on the interview process.

Time Line: Based on 2010 application
1st, 2nd, 3rd year: If you are fortunate enough to know you want to ophthalmology early, during your first or second year contact the ophtho program director and ask if there is a research project you can assist with.  You will likely be tacked onto a second year resident’s project.  Most projects are very easy, and allows you to get to know the attending and residents, and more importantly they get to know you.  This will put you in a very good position to get good letters of recommendation and a publication is great.
April – May of 3rd year: If you medical school permits, do your 1 month sub-internship (or elective) in ophtho.  This will give you good exposure to ophthalmology.  Let you get to know the staff when few people are doing aways.  The residents are well-seasoned, so the attendings will teach the medical students more.  Do a grandrounds (it actually easy).  Ask for at least 2 letters of recommendation.   And this will allow you to start applying to away rotations in July  (This is key because it will allow you to get letters of recommendation from 2 institutions)
April – June of 3rd year: Get your letter of recommendation from your non-ophthalmology person.  Remember for SF match you need to send the letter (not the admissions office).
May of 3rd Year: Start applying for your aways.  Please see my rant about where to apply.
June of 3rd year: SF Match application opens.  Download the application and start working on it.
July of 4th Year: If you have not already done so, do your Sub-I at your home school.  If you have already done one or cannot get a sub-I at home, do an away.  It is critical that at the end of this month you have at least two ophthalmology letters of recommendation in your possession by the end of the month.  Some programs (notably Tulane, require a 4th chairman’s letter, now is a good time to ask)
Last week of July, 4th Year: Have attendings (letter writers) review your application/personal statement.
August 1st, 4th Year: Target date for sending in application.  Yes, I know SF match’s target is Sept 1st.  But you want your application to go out on the first CD that SF sends.  This gives you time to guilt trip attendings to finish their letter of recommendation.  Early is always good.
August 14st, 4th Year: If SF Match has not sent an automated confirmation letter, call them to confirm they have the complete application.
September 10-14th, 4th Year:  The SF match is infamous for messing up distribution lists.  If a program is important to you, contact the program coordinator to ensure your application made it.  Now is opportune time to express your interest in the program and say that something extra that is not on your application.  Ignore this step at great peril.
October 26: Release date for Dean’s Letters is Nov 1st.  BUT they can be send it early, so the delivery date will be on Nov 1st.
October-December, 4th Year: Interview season
December, 4th Year: Rank List
January 6th, 4th Year: Rank list due – do not change at last minute, SF Match is infamous for being unable to confirm a new list at the last minute
January 14th, 4th Year: Match Day

See not so bad 😉

Restaurant Review: Copper Grill, Destin FL

May 26th, 2010 No comments

Copper Grill: is a restaurant I have wanted to try for several years.  When it opened in 2000, I heard many good things about the fabulous cuisine.  Due to the regions abundance of outstanding local restaurants,  I put off going for about a decade.

The Food: The food offers are your standard fair steak house with a couple local catches and a selection of Maine and African lobster.  Before going to the restaurant, the online menu differs from the in restaurant menu in terms of price and the weight of steaks; the online menu has 2 ounce heavier steaks for $4-$5 less.

The highs: During the appetizer course, the Jumbo Lump Crab Martini was the highlight of the evening.  It was light and perfectly balanced for the summer, in fact it was likely the best item we ordered all night.  For the main course, all the steaks were cooked to the proper temperature.

The Lows: The tuna steak appetizer fell flat; its surface was badly burnt and that depreciate an otherwise attractive dish.  The restaurant has an open kitchen in the center of the establishment, while I am normally a fan of a kitchen on display, this one was more dismay.  There was only one chef and as he completed a course he placed it under the  salamander.  Some of the main courses from our table of four sat there for 10 minutes before being served.  While this is not completely outrageous it does explain why my lobster tail was leathery. In a restaurant who’s logo is a lobster, a rubbery-tough to cut with a steak knife lobster tail should make own re-evaluate the quality control. My last bone to pick is presentation, if you ordered a steak without topping, it comes out simply in the middle of a cutting board.  Simply a small slab of meat, lost on a large board with no garnish or accompaniment.

Ambiance:  Dimly lit with modern American decor.  Large comfortable booths.  I found our server to be slightly over bearing with her gimmicks and pressuring members of our party to get drinks/desserts. 

Cost:  Appetizers averaged $14 and entrees $40-43 for average sized portions.

Overall: Copper Grill is an average want-to-be ‘upscale’ steak house whose high prices will ultimately put it out of business.    Personally, I see no reason to return with Destin’s abundance of locally owned upscale dining and Ruth Chris just right down HW 98.

The joys of clinic, . . .

December 18th, 2009 No comments

Last night was my first trip to the local Equal Opportunity Clinic, aka student run clinic.  The clinic went well, not too many pain seekers, and I must commend the students; they were second years who triage patients much better than many of the third years I have seen on the wards.  Someone told the attending erroneously that we were done with patients, so almost everyone in clinic went home.

So when I finished up on my last patient, there was only 2 students and myself left in the clinic.  I asked the students to give the patient his scripts and I left.  Naturally, the front door is quite literally chained shut with a novelty sized padlock, there is no security, and the parking lot is not lit.  I head to the side door and walk around to the dark parking lot.  There are only two cars left, my car and a truck that is parked, so that the cab door is next to the only entrance to the ramp to the clinic.  I’m not sure what caught my attention, but I stopped and watched the truck and noticed someone was moving around in the truck.  I got a very bad feeling and jumped over the railing of the walkway and ran towards my car.  At the same time, the door to the truck opened a large/thin man got out, never said a word, and started running towards me.  I got to my car, started the ignition, backed up (almost hitting him), and peeled out.  He continued to run after me for several hundred feet.  I called 911, but it sounded like he was long gone.  I just hope the students made it out safely.

I cannot imagine if I had not taken notice and continued down the ramp.  The path  has a railing on either side and ended next to his cab door.  All he would have had to do is wait until I walked to the end, open the door, pull a gun, and would have been completely trapped.

The thing that really pisses me off is, this is a free clinic.  Sure it is slow, the wait sucks, and we don’t prescribe narcotics, but we give out good care, we give out tons of free medications, we see everyone who comes in our door, and at least we are trying.  Everyone is a volunteer and could easily stop doing the clinic.  I did not see him in clinic, but that does not mean he was not seen by someone else.  I mean what type of piss poor protoplasm camps outside of a free clinic and waits to jump a doctor.  I mean really? Fuck you.

Windows 7: It stinks and I do not like it.

December 18th, 2009 No comments

I have used Windows 7 since it’s beta and subsequently purchased  a copy of the Ultimate edition.  While I mostly use my Mac,  I feel that I have used Windows 7  enough over the past 3 – 4 months to make a well rounded review that is not based upon a knee-jerk reaction that most blogs published after using it for less than 1 hour.

Windows 7 is simply a rewrite of Windows Vista, but induces customer feedback and a huge overhaul of the  user interface (UI).  The UI enchantments are the big selling point this new OS.  After a painless install and booting up, will you notice the striking changes to the desktop and taskbar; it is as if Vista mated with OS X and Ubuntu.  The new taskbar has a very strong linux feel to it, you can have multiple desktops, run in parallel, the program icons expand when a program is running, there is a new preview feature, and there is finally a go to desktop corner.   In fact I would not surprised if they simply stole the code from KDE.  This is not a bad thing: these features are time tested and proven on both Linux  and Mac, so it is about time windows embraced this basic technology.  My big complaint is the new Start Menu.  It is very difficult to navigate, it demonstrates very unintelligent suggestions for the most used applications, and offers almost no ability to customize.  To do something as simple as changing icons/folders in the start menu, you need to open two system folders.  This has been a constant source of frustration for me.  This is also the first build to remove the beloved Windows classic startbar.  A final criticism on the new desktop, is the  Windows widgets are still memory hogs and useless, turn them off ASAP.

The next thing that will be immediately apparent is that the UAC is now reasonable.  Windows did a good job at removing >90% of UAC and making it so the average user can tolerate to use their OS, and yet enough warnings to be effective.  Strong work.

Windows 7 mimics OS X control panel.  Microsoft has tried to slim the control panel down to several icons that offer a few different choices that will suffice to most users.  However in doing this, they have taken away much customization that was possible on XP and Vista.  For me this was the most powerful feature of windows, no matter how bad it was out of the box, you could tweak almost every aspect of the OS with ease.  Now only that they have taken simple tasks like sharing a folder, and made it a multi-step process.  It would seem they are making things much more complicated, rather than simpler for the average user.  For me Windows 7 lost a lot of points for the redesigned control panels.

In Brief:
The good
:  It’s new taskbar/desktop finally implements long awaited changes.  It is a good user experience.  Windows 7 is much faster and much less annoying than Vista.

The bad: The new Start Menu is definitely a  huge failure and I cannot wait for a patch bringing back the classic start menu.  Changing options via the control panel is plain cumbersome and simple tweaks are not possible without manually editing the registry or a system file.  I have also had major problems with internet connectivity on Windows 7.  For LAN connectivity, I had to disable the OS ability to regulate bandwidth as described here.  And to solve the problem with random disconnects on my wireless network, I had to change the settings on my router as described here.  I have never had similar issues before with another other OS.  I believe that there are still too many bugs for your average user to navigate around.

Thinking of upgrading: If you have Windows Vista, this is a mandatory upgrade.  If you have any other OS, I don’t see the need.  I would wait until the price falls or until you start having software compatibility issues.  Almost all software is XP compliant, so there is no motivating factor to change.

My thoughts on PC vs. Mac:  I think Mac has this one all tied up.  Mac is easy to use, great support, it just works, and it runs Windows software flawlessly (with VMware Fusion).  So while Macs do have a hefty price tag you get what you pay for.

Categories: Computers, Rants Tags: , , ,

Hell on Earth: The Medical Intensive Care Unit

December 12th, 2009 No comments

I have recently finished up my 6th week in the MICU and I am safely say that it has been among the hardest things I have ever done.  The MICU is a simply soul-sucking place where become come to die. This is  due to the fact that the clientele of a medical intensive care unit are people who can no longer breath on their own or their heart can no longer pump without aggressive intervention.  In the MICU death is omnipresent and simply part of your daily life.

No physician welcomes death; we spent a disproportionate amount of our time trying to stave of death another day, hour,  even minutes.  However, it is recognized that death is part of the profession and often a blessing for the patient and family.   However in the MICU, death is a part of your life,… just like brushing your teeth.   When you go in the morning, the first thing that you see is families crying in a waiting room that is tastelessly furnished with glass walls.  If you are lucky, you do not recognize the people and can assume your patients made it through the night.  You then check the board and see who has died, and follow up by talking with on of the few nurses you trust to find out who your sickest patient is.  The majority of the day is then devoted to trying your best to prolong the life of a patient.

However, when all of your patients are this sick it is usually just a matter of time before they pass.  Often the hardest part if telling families that their loved one has already passed, but we are mechanically keeping them “alive” with ventilators, constant dialysis, and pressors.  They see us doing so much that they cannot understand it is futile and the horrifying reality is that anything that can feel has to be agony.  It is gut wrenching to see a rare moment of lucidly in a patient’s face and the expression of pure pain, sorrow, and longing to die.  And yet I am there only to keep them a live hours longer.  And it is only 7 am and knowing if I am lucky I will leave in only 12 hours.  The worst is when your on call and knowing it will be a minimum of 30 hours before leaving these harrowing wards.

On a long call after everyone else has left, three things inevitably happen. 1) A patient codes/seizes/becomes hypotensive or maybe all three 2) The ED calls you with a patient they have intubated (and therefore cannot talk) for a reason you cannot quiet discern, no one has a history/contact info 3) Some other service calls you wanting to transfer a patient that they have has for 4 months and no longer want to talk care of.  Usually all the above happen at once.  You spend your night talking with families on patients you barely know, making life and decisions on these patients, nursing calling you every 15-20 minutes with a critical lab, admitting new patients, training patients on other services, and after 24 hours you cannot think, physically drained, emotionally drained/liable, the opportunity to sleep has never crossed your mind, and yet you still have 6-10 hours before hoping to go home.

Now rinse and repeat for weeks on end.  Night/day cycles completely erratic, never rested, no time to visit family/go out.  And this is only the pressures of work, what about a home life, the economy, etc?  By the end of the third week you notice that no one has shaved in a week.  What quality of physician do you think is taking care of you?  I have no qualms admitting that I failed to live up to my own expectations.

Excluding the patients that you know will die the moment you lay eyes on them there are three other types
– The first are patients that should have never come to the ICU.  Patients who had to come due to some silly hospital rule about administering a medication, a patient forced into the unit by an important physician wanting good care for a special patient, or a similar circumstance.
– The persistent patient: The person who the ED did that “one extra round of CPR” and brought back someone how has been without a pulse for >30 minutes.  I’m not saying they shouldn’t try, but there is a 90% mortality rate for CPR >10 minutes and horrible long-term morbidity for those very few who leave.  More often then not these patients only have cranial reflex, meaning they can gag/blink, but nothing else.  These patients can live on the ventalotor for years (like Terri Schiavo).  An MRI can confirm that their brain matter was atrophied away and they are not locked-in.  These patients often have been in the same room for 6 months or even a year.  Most of these patients do not have health insurance, so they stay in the MICU and we watch them gradually die over the years.  They persistently occupy a room that should be used to save another,  . . .
-The final type of patients are the few rays of hope.  These are people how by all accounts should have died, but recover.  There are  a few every month.  Diffuse alveolar hemorrhage, drug ODs, hypothermia.  Sadly, these saving graces, often mean more to the physicians than the families and the patients themselves.  These very few patients do not make life any easier, but they make the struggle worthwhile.

Moving, . . . always a wonderful experience.

May 12th, 2009 No comments

I just finished moving from NOLA to Florida.   It was a mostly smooth move, but with a few very large hiccups along the way.

After match, I began looking into U-Hauls and moving companies.  I was surprised to see a one-way U-Hail being very comparable to professional movers.  And I thought to myself (albeit very misguided), why move yourself when someone can take the hassle out of it?  So, I get a few quotes and decide to go with United Van Lines, since they seemed reputable and quoted a reasonable price.

Well that is when everything began to go wrong.  After not hearing anything from United for a couple weeks, I gave them a call to ask a few questions, such as confirming the reservation and when they typically come out.  When I spoke with the receptionist, they could not find my reservation or confirmation #.  They told me the person who normally looks into these things was out to lunch.  After living in New Orleans for 10 years, I expect these things.  So I wait 4-5 hours, and after no follow-up I call back and straighten things out.  I also found some of my paperwork was missing from my packet and had to have it emailed to me.

Six days before my move, I call again to confirm.  I find out that a truck has not yet been confirmed for my move, but they told me they would have one by Monday and they would call me then.  So, I wait till Monday.

By Monday afternoon (T minus 3 days till move), I had not received a call, so once again I call to the office.  And find out things appear to be finally on track.

Wednesday morning, I decided to sleep in before the move scheduled the next day, only to be rudely awakened by several people wearing United shirts.  I was quite confused, knowing the day was Wednesday and I was moving on Thursday.  When I informed the movers this, they asked me what day of the week it was, the date, if I was sure, and if they could just move then.  At this point, I was a bit more awake and was delighted to see track marks decorating both the arms of two of the so-called ‘movers.’  At this point, I turned them away and waited a couple minutes so the van crew could phone in and I called the United office.  They had no idea what transpired and could no explain what transpired.  At this point, I was left with very little recourse, I fired them.

At this point, I booked a U-Haul with a trailer for my car (several hundred dollars cheaper than the estimate a few weeks ago!).  I then scrambled and called/emailed everyone I knew in town and was very lucky to receive help moving by a few great friends.  With a fully packed 17′ U-Haul and the company of my best friend, I hit the road to Florida.

Everything was going swimmingly till mile marker 168 in Florida, when the rear wheel of my trailer blew out.  No damage was done, but I was even luckier to have a friend making the trip with me to preserve my sanity while waiting 90 minutes for the repairman to come to replace 2 wheels (another wheel was about 1 mile from blowing out)

So other than absolute incompetence, drugged out movers coming a day early, and losing a tire at 70 mph the move went fantastically!

Swine Flu: Much ado about nothing

May 1st, 2009 No comments

Every year “The Flu” rages across the world.  Leaving in it’s wake a trial of thousands dead.  Most of the casualties being the elderly, newborns, and immune impaired (AIDs, chemo, diabetes patients).  This happens every year, and it rarely makes a human interest piece on the news.

So why is swine flu different?  Why is is causing thousands of American public schools to close their doors even without infected students, causing riots in Mexico, and worldwide travel restrictions?  The simple truth is the media love fear.  Fear gets them ratings.  The so called swine flu is N1H1, these refer to surface proteins on the flu capsid, is mainly a zoonose (native to animals, not humans)  and when zoonoses leap into humans it can be a big concern.  Since the human immune system has never seen these viruses before they are often devastating.  The next pandemic killer will likely be a zoonose of pox virus.

So why shouldn’t we worry about swine flu?  Simple, the vast majority of people who contract the virus have very mild flu symptoms.  Most of the people who have died from the virus were elderly or very young.  Preliminary studies indicate that it has a very low virulence value (it is not well adapted to humans and does not easily spread).  So this means that the virus will only spread in heavily populated areas, causing mild illness, and can likely be curtailed with nothing more than hand-washing and other sanity rituals.

Fear is an easy emotion to capitalize upon and make ratings!   Yes the public needs to be informed about epidemics, but schools should not be shut down.  Yes 328 people have been diagnosed with swine flu and 18 have died.  That is 5% and that is a terrifying number.  But here’s what the media doesn’t want you to know.  There have only been 328 confirmed cases.  There have likely been >3000 total cases!  Suddenly 0.5% mortality doesn’t seem so news worthy.  This more realistic estimation makes swine flu about as harmful as the regular common flu.  And as swine flu gets better at infecting people, it will likely be less virulent…. as a good respiratory virus succeeds the most if the host feels good and coughs while at work/school.

The solution is simple.  Wash your hands.  If you feel sick, have the common courtesy to stay home a day or two (sick days are NOT for going to the beach!).  If you feel a little sick, stay home and chances are you will feel great in 48 hours; there is no point in going to a doctor’s office and being exposed to everyone else’s germs.  If you feel really sick, see a doctor.

Categories: Intern, Random, Rants Tags: , , ,

Delta sucks

April 16th, 2009 1 comment

Recently I made the huge mistake of flying Delta.  Usually I do not have a preference in carrier, as they as treat you the same,.. like dirt.   So when I go to the airport, I have pretty low expectations and sally have no complaints

However my latest experience was pretty pitiful.  On the first leg of my trip, my flight was delayed >3hrs.  This made me mad, but wasn’t such a big deal since they posted it earlier.  What made it ridiculous was that the plane had no problems, it sat in NOLA all night.  The flight was three hours late because delta could not find a flight crew (pilot was there, the flight attendants were not)!  How do you schedule a flight for months and not have a flight crew?  Maybe a preceding flight was delayed and they could not make it, but in this case how do you not have 2 people in a major city that can toss some peanuts?  I tried to get on earlier flights, but I guess others beat me to it,.. anyways I got to my destination 3 hrs late.

But this is nothing compared to the way back.  When I tried to check into the returning leg, the online check in gave me a seat voucher.  I found this disturbing since I bought a guaranteed ticket, so I called the Delta customer service.  And the outsourced Haitian or Puerto Rican explains that there is 1 seat left on the plane and she will reserve it for me.  No problem.  However, when I get to the airport the next day to check in, I no longer have the seat that was promised to me and I was assigned another voucher.  I go up to the desk and ask what the seat voucher means, and they tell me it is standby!  I politely inquired how I could have a standby ticket for a full priced guaranteed ticket?  They didn’t know.  I ask what happened to seat 22B, which I was assigned over the phone?  They didn’t know and someone else was assigned to it now!  So, I ask how many people have voucher and will we all get seats, and I was told no the plan was overbooked.  I proceed to ask how I can get a guaranteed ticket?  And I am told the only way to ensure a ticket is pay $50 to get on an earlier/later flight.  Needless to say I was flabbergasted that I was screwed out of my seat and now I am being told I have to pay more to get a seat.

Needing to get back to NOLA and being stuck with a lottery or being extorted to get a seat, I relented and paid the $50.  I am getting what little justice I can by bitching about it here and to report the incident to the BBB

*sigh*  Don’t fly Delta

Categories: Random, Rants Tags: , , ,