Making moves

A little over a week ago, I finished up my general surgery subI at school. It was an incredible month, I had an incredible team, and I got to take out THREE gallbladders, SEW ON THE STOMACH, and cut open a bunch of people. Overall, it was a phenomenal month and made me a little sad I'm going to have to leave.

Two days later, exactly a week ago, I packed my bags (literally I packed on the day I left) and returned to San Antonio to start a month here doing yet another general surgery rotation. They call these "interview rotations," because it's basically a month-long interview with the residents and attendings in the surgery department to see if they like you. Kill me. I didn't realize how much the subI had worn me out until I turned up last week, trying to kill it and impress people and just did not have the energy to play any of those kinds of games.

After a rocky start to the week, I think I did well in clinic and in the OR later in the week. My interns were super nice in not making me come in this weekend, so I've been sleeping like a champ to try to get my energy back up to speed. It doesn't hurt that I'm staying in a luxurious hotel a block from the hospital with a very comfortable king size bed and free breakfast that includes a TEXAS-SHAPED WAFFLE IRON (okay, it's probably not at all luxurious by normal people's standards, but I'm a simple lady).

Yesterday, I decided to get out and about and scope out the San Antonio Missions Trail. Because the only thing that makes sense when you're in Texas by yourself is to do a 16 mile round trip walk in 102 degree heat. Obviously.

The San Antonio Missions are a group of.....missions....that lie along the San Antonio River. Established in the 18th century by Spanish Franciscans, they were meant as places of worship (and conversion) as well as marketplaces, and educational institutions (teaching the native Indians how to farm, ranching, blacksmithing, loom weaving, spinning, and masonry. And Spanish. And Catholicism). 

The first mission is the smallest, Mission San Francisco de la Espada. Apparently it was originally established in East Texas in 1690, but after the missionaries had dealt with one too many fevers, floods, fires, enemies, and limited supplies, they were like "bump this noise," and relocated to the San Antonio River site in 1731.  

Church at Mission Espada

Church at Mission Espada

Church at Mission Espada

At the Franciscan convent at Mission Espada. My mom isn't the only one who insists on doing this every year!

From there, I tried to start my 16 mile round trip trek, but I was foiled by trails that were closed to renovation. So I had to use my car and cheat myself out of the exercise (aka out of getting to have fries at dinner.) I parked in some sketchy park because the Missions close at 5pm and I was worried I wouldn't be back in time. Don't tell my mother.

Next on the agenda was Mission San Juan Capistrano. In what seemed to be a bit of a recurring theme, this mission was originally established in East Texas in 1716 to serve the Nazonis Indians. However, that didn't work out so well and they bounced on over to the east bank of the San Antonio River in 1731. Unfortunately, they suffered from some bouts with smallpox and measles, as well as onslaughts from the Apache Indians and later the Comanche. Lots of drama ensued. Political onrest. But then they figured out irrigation in Texas might be a swell idea, mastered that, and became a regional crop supplier. #America.

A cross. Among cactus. Very Texas. 

The church at San Juan. Very much a different feel than Mission Espada. 

Old school stations of the cross

From there, there was an excruciating long 3.5 mile walk to Mission San Jose. It was HOT. Damn hot. Real hot.  [sidenote: now I really want to watch that movie]

There is a bike share along the way. But that's cheating. I did not partake. 

 Near this bike share, there was a glorious sighting of people selling what could only be cold items. Unfortunately, I had only about $2 in change and no cash, but I was hopeful. Surely that would buy me a nice cold coke? NO. They were only selling Italian ice and the cheapest size (= dixie cup size) was THREE DOLLARS. That's three American dollars. Silly.

Lovely sights along the San Antonio River....not so much water in there these days. 

Must be getting close!

Oh why, thanks for the welcome, Jose.

 Mission San Jose is really Mission San Jose y San Miguel de Aguayo. Founded in 1720, it was named for St Joseph (Jose) and the governor of the Spanish province at the time. It quickly became known as the "Queen of the Missions" and was the largest of the missions in the area. It was viewed as a major cultural and social center, which obvi made it a target for the Apache and Comanche to attack con frecuencia.

Church and convent at San Jose

I was into this one and took a bunch of pictures.

HOLD THE PHONE. Mariachi Mass?!? I think this may have to happen #GodBlessTexas

Front side of the church at San Jose

Are we at the outskirts of San Antonio? I have no idea. 

After finding an oasis of a gas station and purchasing a delightfully cold but also gone-too-quickly DCoke (but unable to get any foods because they don't take credit cards #notAmerica), I headed off for the final mission of the day -- Mission Nuestra Senora de la Purisima Concepcion de Acuna. Or simply, Mission Concepcion. It was another 3.5 miles away, and I was seriously starting to lose my will at this point, but I figured I needed to finish what I started. I know these distances aren't terribly long, but, in my defense, it was 102 DEGREES OUT. Onwards, Christian soldiers.

Arrived! Mission Concepcion!

Love that Our Lady of Guadalupe made an appearance

I'm seeing a pattern. One that I'm extremely okay with.

Then I trekked the 8-ish miles back to my car. This is when I decided that not bringing any food or beverage nourishment was a horrible, potentially fatal mistake. I didn't feel.....great. But I made it! And celebrated with some delicious brisket.

Nice little oasis along the otherwise pretty barren San Antonio River 

SubI life

This week marks my second week since returning from BOLC and as much time on my general surgery sub-internship. A sub-internship, or subI, is an advanced clerkship with additional responsibility and expectations beyond those expected of a medical student on a regular rotation. Typically, one does a subI in the specialty in which they are interested. I'm doing my subI on one of the notoriously busiest services in the hospital, a group that specialized in pancreatic cancer (hint: pancreatic cancer is not good. Don't get it. But if you have to have it, come here. We're the best at it).

Last week I GOT TO TAKE OUT A GALLBLADDER. It was incredible. And short of closing skin incisions and doing random bits and pieces of surgeries -- a snip here, a stable there -- it was my first real surgical experience. Taking out a gallbladder can be an entire surgery unto itself, but the one I took out was in the context of a much larger procedure for pancreatic cancer, called a Whipple procedure. Anyways, it was incredible. Everyone is super jealous because medical students typically don't get to do such things. To put into context, one of my interns (granted, he's only a month into his internship) did his first gallbladder two days before I did mine and the other intern has never done one. Count it.

Today, when I was helping with a couple of cases, the attending said he'd like me open (aka CUT OPEN SOMEONE'S SKIN and cut down to the abdominal cavity) in the Whipple he has tomorrow.

I may be working 75 hours a week and the days start at 3:45am, but I HAVE THE BEST LIFE. 

Brief reflection

Not sure if you can view this video if you're not on facebook, but a friend of mine (dentist battle buddy) from BOLC recently posted it with the following message:

"I definitely have a new level of respect and appreciation for the service men and women of America. As a future Army dentist I most certainly will not be an integral part in the survival of our troops like these medics, nurses, and surgeons are. But I just had the incredible privilege of spending the month of July training with fellow AMEDD Army Healthcare team members and couldn't be more impressed with the caliber of professionals that I met during my time there. After spending a month with these amazing people I am confident that our military sons and daughters, mothers and fathers, spouses, and siblings are in the best hands possible. In the words of 2LT Charlie Maxwell "This game is serious! Don't ever forget that we are here to save lives." Thank you for your hard work and service [lists some of our names] and many many more. To the memory of those who gave their lives so we could sleep in peace at night...."

I think this video really encapsulates why I joined Army Medicine and what BOLC was able to affirm for me. 2LT Maxwell was our student commander and a former Special Forces medic. I think becoming an Army doctor was, for him, extremely personal. He's a guy who had to watch his battle buddies die out there on the battlefield. Having him as our commander was an incredible and constant reminder of our mission. I had a phenomenal time at BOLC; I enjoyed the training I did and the people I met. I had a serious serious amount of fun. I had a blast. But I like to think that I always had in mind an understanding and appreciation of the incredible honor and responsibility that my future job entails. Can't wait to be out there. 

What we need is a montage

Nothing sums up a month like a good photo montage

https://www.youtube.com/watch?v=QgNIDJCBfPs&feature=youtube_gdata_player

Graduation Day!

Officially an Army Medical Department Officer!

Last day at BOLC and I take an early flight tomorrow morning back to Baltimore. So many weird and conflicting emotions, but I'm definitely sad to leave. I've made some phenomenal friends here with whom I think I will stay in touch for life. And I don't say that lightly. Everyone keeps telling us that Army medicine is a small small world and that we will see our classmates from BOLC time and time again over the course of our careers. I sure hope so.

Last night, we had a final family dinner with delicious and cheap Mexican food. And margaritas. Obvs.

Afterwards we went to a country western dance hall...and I learned to two step! Was incredibly fun. A great way to send everyone off before our last official day today. 

Less than exciting

A week of legal briefs (5 straight hours), cultural sensitivity training, hospital tours, sexual harassment and assault prevention training, suicide prevention training, more suicide prevention training, surveys, outbriefs, surveys. Nothing too exciting to report.

Last week in the field

Last week we spent in the field again, at our glorious TTB (tactical training base) up at Camp Bollis.

Monday: due to some unfortunate scheduling of buses, we had to leave at 2AM Monday morning to head back out to the field. That's....two hours into the day. It was a very very long day as a result. Last week was focused on the tactical levels of care in combat medicine, so we rotated through the three "roles of care" in our platoon and ran through scenarios of taking on casualties. Super fun. On Monday we did "Role 3" which is the CSH, or combat support hospital. I was...the hospital commander. Not scary at all. The platoon did really well and honestly I didn't really have to make any tough decisions. I did get to have basically a one-on-one training session with a previous second in command at a CSH in Iraq, so it was incredible to get to hear her experiences and pick her brain.

I may look aloof, but that's just my calming command presence

Triaging patients

Tuesday: Our platoon did "Role 1", which is the most forward level of medical care aside from buddy care. This is a place very close to the battlefield where patients are stabilized and evacuated to higher levels of care. I was the doctor in this scenario, so had to make a lot of treatment decisions. They also had simulated gunfire that we had to react to and return fire (with rifle blanks). This was a little more stressful as a lot of casualties (members of other platoons who were employed as actors for our scenario) were coming in and fast. We also got to evacuate people via helicopter which was pretty awesome.

Our rides for the week 

Evacuating patients by air!

M16 at work

establishing a security perimeter

Wednesday: Our platoon did "Role 2," which is an intermediate level of care. I got to be on the Forward Surgical Team (FST), so we triaged patients to go or not go to the operating room. The head of the FST was an actual trauma surgeon in my platoon, so it was a great experience in that he led us through what a surgery on each of our patients would actually look like. I was the recorder for the FST, so in addition to providing treatment, I took notes on the patient's condition and what treatments we gave them, writing it on a piece of tape and sticking it to the patients' chest when we evacuated them.

Responsibilities of the FST

Trauma bag for the FST

Earlier in the day, I got to be a patient (multiple facial fractures because of a blast injury) for another platoon's scenario, which was another great way to see how the scenarios play out. It was actually extremely educational because you got to see the patient flow through the various roles of care. The different levels are all being played out simultaneously each day by different platoons, so although I was injured at a Role 2 facility, I got evacuated (by truck, unfortunately, didn't get to ride the helo) to the platoon at another end of the TTB who was acting through the Role 3 care.




Thursday: We packed up and went home on Thursday, but not before we had testing of our "warrior tasks." We had to assemble and disassemble a radio, call in a nine-line medevac order, and clear/assemble/disassemble and do a functions test on our M16. Not gonna lie, I kinda killed it. I was the first one done with the medevac order out of our testing group of about 40 people and the person to disassemble the M16 the fastest. A far cry from a week ago when I was struggling A TON with the steps of rifle disassembly. When we got back to Ft Sam Houston, we got to turn in our M16's. Although I really enjoyed learning to shoot and being a "real soldier," I couldn't be happier to turn that thing in. Having to carry it around at all times (and always at "the low ready" position), was not the most fun part of the last two weeks.

Disassembled M16

Friday: we were back at Ft Sam and we split into our different tracks for the day (e.g. vets vs dentists vs med corps vs HPSP). The HPSP among us did physical training with our company commander, a former special forces guy. Needless to say I was quite sore the next day. However, we only had one more talk to go to, so we had the rest of the day off. The family went to lunch at a brewery, then walked the Riverwalk, and met up with a bunch of other students at San Antonio's Howl at the Moon. Good times were had by all.

Some of the fam!

Battle buddy!

Battle buddies lookin fly

Saturday: we had a charity golf tournament for the Center for the Intrepid. Four person teams, best ball play, 9 holes. We had a great time golfing, driving around in carts and potentially enjoying some beverages. Being out in the sun really wiped us out, so we took it easy last night and just hit up some delicious Mexican food and a movie ("This is the End" -- funny, but strange. Very strange).

Golfing + beers = too aggressive for my blood, so I volunteered to photograph

One more week until I head back to Baltimore! A little conflicted about leaving: I've really enjoyed my time here and am definitely going to miss all the great friends I've made. They keep telling us that the Army is a small small place and that Army medicine is even smaller; we are virtually guaranteed to run into each other again. I hope that's true!