Adventures with the Army!

Greetings!

This month, for four wonderful weeks, I am spending some quality ArmyStrong time with a few hundred of my newest friends at the Army's Basic Officer Leadership Course in San Antonio, TX. This course is for HPSP students like myself from medical, dental, nursing, and vet school as well as for medical service corps officers (think PT's, OT's, etc) and doctors and dentists (and nurses and vets) who are now officers in the Army and for whatever reason haven't gone through a basic training course yet.

I'm not entirely sure what the next four weeks will look like, but it is a combination of death by powerpoint and a few weeks "out in the field" where we do land navigation, medical evac exercises, "warrior tasks" (guns!), and probably generally eat bad food and get really unattractive and smelly.

I flew out of BWI this morning after taking the light rail down at 6am with the crack fiends. A true Baltimore sendoff. I was wearing my full ACU's for the first time ever (whoa)....looked something like this. But I think we all know that in a "who wear it best" spread in a trashy magazine, I totally have that guy beat. I got to skip the long Monday morning bag check and security lines (sorry taxpayers of America, taking that perk shamelessly) which was cool because I ended up in the priority line behind Bruce Boudreau's family. Yes, I was in line behind the wife and son of a man whose bobblehead is displayed prominently in my apartment. One middle-aged gentleman grabbed my shoulder (in a kind way) and said "thank you for your sacrifice," which, although I've done circa little to nothing to deserve any thanks, I appreciated as a sentiment and (I'm not sure why) as preferable to the unfortunately now trite-sounding "thank you for your service."

Got in to San Antonio without a hitch and spent the day checking in, doing a lot of waiting in lines, figuring out my Kevlar helmet size (WHAT.UP), turning in duplicate copies of every possible form ever, and generally trying not to look like an total idiot. Thanks to Civil Air Patrol (google that ish) and my year of ROTC though, I'm definitely way ahead of the game. Hopefully some prior service bros will help me figure out how to put all my MOLLE gear when I get that later this week....(sup bro)

Have met a lot of cool people, which is reassuring because I went into military medicine partly because of the high quality folks. And I haven't been disappointed. Have met a bunch of USUHS kids too, so hopefully I"ll have some friendly faces around when I rotate through (and maybe eventually do residency at?) Walter Reed.

Luckily, it was not that hot today (low 90's) and is projected to stay that way for the rest of the week, so the weather shouldn't be as bad (at least this week) as I was fearing.

Worst news: as of 1600 today, BOLC is now dry. Even on the weekends when we're not on duty, or if we get leave to go to Austin for the weekend, or EVEN ON THE FOURTH OF JULY, we can't drink for the next month. It seems impossibly un-American that soldiers can't drink on Independence Day. Just saying.

We report at 0430 tomorrow morning for some physical fitness fun. Can't wait!

A couple of notable points in our way too long and rambling briefings:
-recognition of the problem the Army has with sexual harassment/assault as well as mental health. MORE importantly, a call to arms that this was something that we, as officers, needed to help the Army get better at. There is certainly a HUGE amount of room to grow in both of these areas, but they are problems that the Army is taking seriously and encouraging its officers (its leaders) to take seriously AND to take ownership for. Important steps in the right direction of what is sure to be a long road.
-some great points on professionalism that I wish medical school would prioritize more. They made it clear that we are professional soldiers, that we are officers, we are leaders, and that carries a responsibility both to ourselves, to the Army, and to our subordinates to hold ourselves to a higher standard. No excuses. Are there inconveniences to that? Yes. But that's not a reason to avoid meeting that higher standard.
-I think the most "we're in the Army now" moment wasn't talking about customs and courtesies (saluting, saying yes sir, etc), or uniforms, but rather that people and places can be made off limits to us. There are various bars and other establishments in downtown San Antonio that we are forbidden to go to, we cannot eat at the food court the enlisted guys hang out at, we cannot hang out with or be friendly with the enlisted guys (and not "be friendly" in a wink wink euphemistic way, which is obviously forbidden, but literally -- don't talk to them, don't be around them, don't go where they go way).
-Adultery is a crime under UCMJ (military law). They made all the married people stand up. Then all the single people stand up. And were like -- look around and take notes: stay away from each other. That was....weird. 

Psych patients say the darndest things

Homeless man with schizophrenia: You don't smoke do you? I could tell you didn't. Smokers usually have darker skin. And look at you -- white as a ghost!

Manic patient, as she shakes my hand and sees my claddagh ring: Are you married? Engaged? Hoping to be engaged? A fan of the Society of the Sacred Heart? Do you love Jesus? Are you Catholic?

Attending: tell me, do you still feel special?
Other manic patient: Yes
Attending: how so?
Manic patient: I'm a genie. I'm God. I'm Bo Derek.
[this same conversation takes place on rounds every. single. morning]

Me: We can't let you go until we're convinced you're going to be safe.
Suicidal patient: why do you think I'm unsafe?
Me: You drank 15 shots of vodka and then swallowed fifty pills.
Patient: oh that was an accident. I got my pill bottles mixed up.
Me: You swallowed fifty pills...accidentally?
Patient: Yes.
Me: That seems tough.
Patient: It's not.

Patient: when can I go home?
Me: We need to find a place for you to live first.
Patient: what about my house?
Me: the walls are falling in, it's covered in trash and it's been condemned by the city.
Patient: so?

Schizophrenic patient: You can't keep me here against my will!
Me: actually, we can if you're a danger to yourself or others
Patient: but I'm not an American citizen! I'm not subject to your laws!
Me: .....untrue

Don't Google this

Patient: What's the name of what I have?
Me: It's a Bartholin's gland cyst
Patient: what?
Me: I wrote it down here on your discharge worksheet. Important to know if you see another doctor for similar complaints, but I'm going to have to recommend you don't google image that.
Patient: Really?
Me: Trust me on this one. 

Kids say the darndest things

3 year old patient as I leave the room: I like her shoes, Mommy!

It's the little things that keep you going when you spent an hour of your morning with a 12 year old who has a history of crack cocaine use, suicide attempts, homicidal ideation, getting caught having sex in the school bathroom and who's mother died of a drug overdose, father is in jail, the great aunt who used to take care of him died recently, cousin's husband raped him when he moved in with them, and is now living in foster care. But don't worry, the state hasn't deemed it a priority to get him some psychiatric help.

Also, this conversation:

Me: How many girls have you had sex with?
Him: Just the one! It's true love!

[15 minutes later, at the end of the visit]
Him: So....am I allowed to have...you know....
Me: ......
Him: s......e......
Me: Sex?
Him: yeah.
Me: That's not for me to say. That's a personal decision. You need to understand the risks though. You could get an infection, like syphilis, chlamydia, or even an incurable infection like herpes or HIV. You absolutely have to use protection. You also have to be ready to become a father, because you could get a girl pregnant. You also can't have sex in school; I'm pretty sure that's a rule.
Him: So you're saying if I use protection and am ready to be a baby daddy, I can have sex?
Me: If that's the right decision for you and the person you're having sex with is okay with it, then yes. But you can't force anyone to have sex with you.
Him: I know. Can you tell my social worker to drive me to my girl's house then?
Me: ......no.
Me: What makes you think you're ready to be a father anyways?
Him: I am ready!
Me: you think you can take care of a baby? Another person? You just don't me you can't even take care of yourself.
Him: I can do it -- I've been waiting for a baby forever!
Me. How would you buy your child food and clothes?
Him: I'd get a job.
Me: You're 12.
Him: I'd lie about my age.
Me: Pretty sure they're going to require some documentation.
Him: I'd sweep up hair at a barber shop for like...$13 an hour
Me: Pretty sure it doesn't pay that much.
Him: Well, also. I get an allowance. Duh.

What's that?

**Warning: graphic content. not approved for all viewers**

"What?" my 16 year old patient in the emergency department asked.

"Huh? I asked if you were having vaginal, oral or anal sex...." I repeated, a little confused. She'd already revealed she was sexually active.

"Yeah. What's that....vaginal sex?" she said quietly.

"As opposed to oral or anal sex....?" I started.

Blank stare. Guess that approach wasn't going to work.

"It's when a penis goes into a vagina" I said, not breaking a sweat.

"Ew." she groaned. "you didn't have to say it like that."

Yeah, I think it's pretty clear I did.

And if you don't know what it's called, maybe you shouldn't be doing it, girl. Also, use protection, you're in the syphilis capital of the country, for goodness sake.

Just another afternoon in the wide-reaching and sometimes surprising world that is pediatrics. 

Rule number three

Baltimore, charming as it may be, can be a lot like a war zone. They (where they = M*A*S*H) say there are two rules of war. Rule number 1: young men die. Rule number two is that doctors can't change rule number one.

And I think rule number three is don't look back......


"This is not the right fucking suture" the trauma surgeon muttered as he threw it back on the tray. "How can we not have the right sutures in the fucking trauma bay" he said, impressively calmly, and to no one in particular.

The patient, a delta trauma, had come into the emergency department with his t-shirt soaked in blood, his face already pretty lifeless. Multiple gun shot wounds to the chest.

I ran to the next trauma bay and returned with every suture I could find, handing them to the nurse closest to the surgeon as he called out for them.

"So did this guy have vital signs in the field or not? Does anyone know?"

Silence. The question was a critical one. A gunshot wound to the chest, or any other penetrating wound, can sever a major blood vessel or the heart itself. If the victim is gotten to early enough, if he hasn't lost too much blood, an ED thoracotomy -- cutting into his chest wall in the emergency department -- might save his life if the surgeon can find the injury and sew it up. If a patient comes in with blunt trauma to the chest, or never had vital signs in the field (a sign he'd been down for a while), the process is invariably futile.

No one responds.

"Hold compressions," the surgeon says calmly and the tech performing chest compressions stops.

Before I can fully register what is happening, the patient's left chest has been flailed open. We just opened a man's chest in the emergency department trauma bay. Some injuries are found and stitched close. Vital signs do not return.

"Sharon, get in here," the surgeon says, gesturing with his head. "See what I'm doing? Do that."

What he was doing is internal cardiac massage.....CPR inside the chest. Rather than compressing someone's chest wall from the outside in an effort to pump blood from their heart, you simply squeeze the heart itself.

Let me repeat. I stuck my hands through an incision on a man's chest and squeezed his heart with my bare gloved hands to circulate his blood through his body.

Then the patient was declared dead.

The room cleared out.

I removed my hands from his chest and looked down at my blood soaked gloves and gown. My visor had flecks of blood on it and I'm sure the pattern extended to my mask as well. I'd just held a man's heart in my hands. His blood was covering me, almost from head to toe. And now he was laying in front of me, dead. Everyone else had left and the nurses and techs were already starting to clean up.

I tore my gown, gloves and mask off in one swift motion, threw them near the trash bin, and walked out of the trauma bay.

I didn't look back. 

Looking good

"So...Sharon....did you say yet what the anatomical segments of the right upper lobe are?"

Ugh. I was hoping he'd forgotten he'd asked me. I'd gotten how many segments there were correct (three), but I'd be damned if I remembered the names (remembered? shoot, I'd be damned if I ever knew to begin with). I stood next to the attending, my cheeks burning with embarrassment, though thankfully covered by a surgical mask and goggles. It had been a few minutes since the question was first put to me, as there was the entire matter of the patient on the operating table in front of us who needed her right upper lobe removed. I wished I was the one under anesthesia. The intern across from me locked eyes with me and I could tell she was trying to send me the answer. Telepathically.

"I just said one of them," the attending continued. "were you not listening?"

"Posterior" I said, way less than confidently. I hadn't been listening. 6 hours of standing here doing basically nothing will drive you to weird mind games to keep yourself awake. And it rarely includes being fully tuned in to what is happening.

"And then....?"

He really wasn't letting this go. I shifted my feet uncomfortably and tried to look competent with the suction.

"Anterior" I blurted out, more guessing than anything.

"Yes. And the last one...?"

I had no idea. Time to say words I did know..... "Superior?"

"Now you're just guessing. You've been on this service how long? You've been on this service a week and you don't know the anatomy of the lung? Really? A week? Really?"

Well that just seemed unnecessary. I could tell the intern was incredibly uncomfortable. The fellow didn't even look at me. Anesthesia was poking his head over the drapes at this point, staring at me, probably remembering why he didn't go into surgery. The scrub nurse fiddled with her instruments. "Yeah," I thought, "looks like I don't know."

"Interesting," the attending mumbled to himself and he continued the procedure, "don't even know your lung anatomy."

He turned to the intern -- "well?"

"Apical," she said. More than a little bit apologetically.

Surgery 1, Sharon 0