Tri-8 Wk14, Day 520 - Monday, 8/8

Over the weekend I received a letter from Logan stating I had AF'd Dx Imaging. AF stands for Attendance Failure and means I have to take the class over. I didn't make it in time for Rheumatology this morning so I also have AF'd that class as well. I love the trite, arrogant advice that gets tossed my way sometimes such as the brilliant Tx of "you need to get more sleep". No shit Sherlock, I think to myself. As Dr. Kuhn had pointed out in class one time, "it's not as simply as turning a page in a book" which, is pretty much my situation. If any of my unsolicited advisors had any clue what they were talking about they would know there's a bit more to the story and Tx then just "get more sleep".

Varieties of the "Walk in my Shoes" is a is a status post I've seen a lot on Facebook lately and that's kind of what I think when I hear such flippant advise. Try waking up with 30% less oxygen then you went to bed with, see how that feels and how well you can function. Try driving an average of over 650 miles per week for school and spending about as much time sitting in your car as you do in class and try doing all this when you're 45 as opposed to being in your 20s.

...insert a couple hour time gap here...

looks like this gets finished later...

Tri-8 Wk13, Day 519 - Friday, 8/5

I had this day off from clinic, for which I am extremely grateful.

I painted a picture the night before in honor of my new nephew. I called the painting The Wyatt Gibson. I'll toss up a picture of this and keep catching up with my blog entries. :) The painting is acrylic on canvas.

New Baby!

Tri-8 Wk13 Day 518, Thursday 8/4

My brother and his wife had a new baby boy this morning at 7:01 a.m. and named him Wyatt John Dukowitz!

I'll toss up a picture of the lil critter and move on to catch up on my Friday blog ;)

The vacation day that never was ....

Tri-8 Wk14, Day 517, Wed, 8/3

I was hoping to take off tonight so I could more adequatly study for my PT III practical tomorrow but, after a couple members of the "staff" expressed concerns over my vacation request I acquiesced and withdrew the request. Guess what? The patient never showed up anyway. It's sort of an every other type even with that person ...

grrrrrr .... is about all i can say.

so, i will end this tri with more than enough clinic hours and two unused vacation days.

Those vacation days have gone way down.

Based on once a week clinic duty and three days off and a 15 week semester - 3/15 = 0.20 or 20% vacation rate.

at three days a week for 15 weeks with 6 vacation days ... 6/(15x3) = 6/45 = 0.13 or 13%

at 5 days per week for 15 weeks with 6 vacation days... 6/(15x5) = 6/75 = 0.08 or 8%

and ..5 days per week for 15 weeks with 4 vacation days = 4/75 = 0.05 or 5%

so, we slaves have the vacation days cut from 20% to 13% to 8% to 5%

anyway - it was kind of bullshit for me to give in - guess it's my fault but WTF. just give us our f*cking vacation days without any hassle.

whatever.

Tri-8 Wk13, Days 515 & 516, Mon & Tue, 8/1 & 8/2

shit ....

I've got a PT III final practical on Thursday and tried taking tomorrow off so I could study for the class which I've scarcely been to but, after submitting my vacation request I found out I have a patient scheduled ...I didn't actually schedule them, it's something the front desk took care of which is fine ....

As is kind of customary these days, I fell asleep soon after I got home tonight which means, by 5:30 p.m. since I actually got off work at 3:30 today and got up about an hour ago (11:30 p.m.) but, not I'm not exactly sure when I'm going to be able to get enough study time in for this exam on Thursday. Since I just got up I could maybe stay up but once tomorrow starts it won't end until I get home at 8 p.m. which means it will be *really* hard to continue to stay up to study for that exam.

Hell, i could fall back asleep now. Maybe not. I'm just pissed off.

idk- i'm tired - going back to bed - looked over some PT stuff but not really sure exactly what to study ...hence the need for extra time to have any chance of getting through that final.

Tri-8 Wk12, Days 513 & 514, Thur & Fri, 7/28 & 7/29

I survived. Two solid months of mandatory 5 day per week clinic is FINALLY over. Like a lot of people I was saving the gist of my vacation days for finals but it looks like the start of the next semester is our first day of finals for the current semester. I'm not sure I quite understand that because you don't actually move on to the next semester until you've passed all your classes. oh well.

I put in vacation request for 8/5 and 8/12, two Fridays in a row and now that I'm back to a normal clinic schedule that means I'm already off on Thursday and now on Friday and Saturday and Sunday and Monday!!! - Five Days in a ROW! YeeHaw!

I'm not exactly sure what's going on in school.

I really had no solution for effectively dealing w/ the abhorrent schedule I was subjected to over the past couple months. About all I can say is that it's a good thing I don't own a shotgun. I have been learning quite a bit but, not necessarily anything specific to any current classes. This reminds me of the special class I was put in during grade school where us higher motivated types of students wrote out on a contract what we wanted to work on during the week.

One interesting thing I studies was the primary and secondary ossification centers in the metacarpals and the phalanges. Both metacarpals and phalanges have primary ossification centers centrally located along their shafts but the phalanges have secondary ossification centers proximally, at their bases while the metacarpals have their secondary ossification center distally located. BUT WAIT - only metacarpals 2, 3, 4 and 5 have secondary ossification distally and metacarpal #1 (the one attached to the thumb) has a PROXIMAL secondary ossification center which means in terms of ossification the first metacarpal is more like a phalanx. Makes me wonder if things were misnamed originally... this same phenomenon occurs in the foot.

with the carpal bones, ossification starts at the capitate and kind of spirals around in a counter-clockwise direction but, the age at which these carpals ossify isn't exactly one per year but more like 2-3 months for the first two then age 3,4 and 5 for the 3rd 4th and 5th but, also year five for the 6th and 7th. then the pisiform which is just a nifty little sesamoid bone finally ossifies between the ages of 9 to 12.

I've also been going over some of the neural pathways, specifically w/ the eyes and the various reflexes. Unilateral cranial nerve palsy has also become an interest mainly because it's now clinically relevant and we've got real people involved. Of course ...I'd say about 1/2 the people I'm working with and trying to learn things for aren't even official patients from my clinic but still people that come to me with issues so I do the best I can.

...got severely sidetracked here - oh well, that's it for now :)

Tri-8 Wk12, Days 511 & 512 - Tue & Wed, 7/26 & 7/27

I'M DRIVING LESS THAN 40 MILES TODAY! I'M DRIVING LESS THAN 40 MILES TODAY!

I'M DRIVING LESS THAN 40 MILES TODAY!

I'M DRIVING LESS THAN 40 MILES TODAY!

I'M DRIVING LESS THAN 40 MILES TODAY!

I'M DRIVING LESS THAN 40 MILES TODAY!

I'M DRIVING LESS THAN 40 MILES TODAY!

• I'M DRIVING LESS THAN 40 MILES TODAY!
• I'M DRIVING LESS THAN 40 MILES TODAY!
• I'M DRIVING LESS THAN 40 MILES TODAY!

That's 40 miles TOTAL. I've had enough - quite enough. I'm going to the St Patricks Center in downtown St Louis for my clinic shift today. there's only so many days the 5 a.m. alarm can go off with me waking up as if I've been run over by a truck.

Next week - week 13 will be my first opportunity to get out of this mandatory 5 day per week rat race. I think I summed it up best in an email I had to send one of the teachers whose class I'd already screwed up in when I said, "If everyone in Tri-8 has the same requirements then we should all have the same demands."

Amazingly enough, I got home at 5 p.m. yesterday! It was fantastic. I was also asleep by 5:30

I know Dr. Guebert has talked about his father and the pain that man has been going through. It makes me very sad. I know there has been reference to him maybe "checking out" voluntarily.

I know we've talked about the mortality rate with reflex sympathetic dystrophy and the number one cause of death with that disease being suicide.

I know my pains probably aren't as bad as others but, dropping a third of your O2 saturation levels over night doesn't feel very good either. I've read the mechanism behind it is equivalent to a severe stroke or dying.

I've come to believe that things like a person drinking soda or ingesting Splenda are probably far less detrimental to health then losing the will to live.

I've read about cultures in Africa where capital punishment consisted of ignoring the offending party until they eventually wandered off into the mountains and died.

I never was able to come up with a solution to my situation which would allow me to effectively continue to get up at 5 a.m. every day then go to all my classes then go to clinic every day as well as attend all of my weekend obligations such as Loomis, SOT or Irene Gold board reviews.

I no longer think sleep is the answer but maybe just a beginning of a solution. The weekends I did have off, especially the last weekend when I missed my final SOT classes I was in and out of bed constantly and never up for more than two hours at a time and that still didn't help the exhaustion.

Moving, being healthier and being younger were the only answers I could come up with. The idea of putting my home on the market and moving seemed too huge an endeavor to pull off with all the school demands. Healthier is an option. I know I started training for my St. Peters shift back in Tri-7 and was going to the gym quite often. Of course, at that time, I was only aware of the distance I'd have to be traveling and not the 5 day per week shifts. Younger ...nothing I can do about that and, quite frankly, .....yeah .....what is, is.

I am going back to sleep now. That's pretty much where I live if I'm not in a class or clinic.

Tri-8 Wk12 Day 510 - Monday, 7/25

5 months until Christmas -

maybe 2 weeks or so until I get a new niece or nephew - that will be pretty nice :)

not really much sure about anything else.

Got my last Case Report in today but wasnt able to listen to my 20th case report due to patient duties.

It does seem like week 12 will be my final week of mandatory 5 day per week clinic.

Dr. Hogarth, my clinician, is really pretty good at overseeing the case reports. I've never seen him in a classroom situation but he definitely seems to have a talent for teaching.

The case report I gave tonight didn't have a clear cut resolution due to non-compliance by the patient but, it did involve a pretty serious auto accident and I was really curious what Dr Hogarth had to say about it. He did not disappoint. A class might be good but that could be slow going. Hogarth would probably make a great teacher for that class but I have no idea if he'd want to leave clinic.

My favorite scenario is what a clinic pulled off last Friday by knocking out 16 case reports in a single evening. That's what a fellow intern told me anyway. All I can think is that represents 8 days I could have been off from clinic.

Dr. Guebert had a pretty good class today. We got to see a CT with contrast and it was a really nice picture showing the relationship between a vertebrae, the psoas muscles and the ureters. I think most everyone knew the roundish images on the CT were ureters but seeing the relationship to other structures was pretty cool.

That's about it.

Oh, my radiator went out and I got a letter from the IRS. Car is at the shop to get the radiator fixed and ....i guess the IRS really did want me to file last year even though I didn't work or sell any securities.