Spinal Model

Occassionally something really cool comes down the pipeline at work. In this case, it's a bit of work for an orthopedic surgeon who is doing a very difficult spinal reconstruction around the new year. I think it is a corrective surgery for a congenital defect, but don't quote me on that. In any event, he wants a life-sized model of the patient's spinal column, based on pre-surgical CT data, so that he can plan things out better. I asked for this one, because it's such hot stuff. We use a special program to segment different tissues from CT and MRI data (in this case, bone). That same program can output a 3D model that can be understood by our CAD programs. A little processing later, and we can output that 3D model to our rapid prototyper, which is a sort of 3D printer that creates plastic models by extruding plastic layer-on-layer, like building a topographic map.


This picture is of a test piece I did last week, based off an image set we have from a different project. This is the first cervical vertebra, which connects to the underside of the skull. Unfortunately, the flat white plastic (and lighting) saturates most of the texture detail, but you get the idea. This is a very accurate rendering of a person's bone. We'll be doing the same for this orthopedic patient, except I'll probably end up doing most of the spinal column.

Jasper's Romp

I borrowed the video camcorder from my office this past weekend. We decided it was time to get some video of Jasper doing his thing, so that all of you out there could see it. It is difficult to believe, even for us, that this bounding and romping creature is the same wretch that we brought home from Mason City. It took him weeks just to stop leaving his tail between his legs. Now, a few months later, he is having a blast getting chased around and dipping into the river. So here, for his internet debut, is Jasper:



He still freaks, however, if you throw anything in his direction - so fetch is right out. That is why you see H running around as though the plains were alive with the sound of music.

Videographer I am not - both in terms of equipment and editing. Plus, we were doing this towards dusk on a cloudy day - so the colors are a bit muted and everything is dim. Ah well. It's a start.

On call!

I didn't think I should post yet again with no photo, so here is what I look like when I'm on call. Except tonight I'm lugging a reflex hammer and a tuning fork in addition to a stethoscope. I'm taking call with the neurology ER resident: she is a senior (4th year) resident who is responsible for seeing all the neuro cases that come through the ER and deciding how to treat them and whether they warrant admission to one of the inpatient services (general neurology, stroke, or neuro ICU).

Since her shift started at 6 PM (I've been here since 7 AM for my regular service as well), I have:
-studied for a couple of hours
-cleaned out two email inboxes and sent some emails (still not totally caught up, sorry...)
-read about human research subject protection and taken an online quiz so that I can access the Institutional Review Board site and do some work on my upcoming research project (my classmate Beth is doing all the heavy lifting on our project right now, so I can't complain a bit).
-scavenged a brownie from the on-call kitchen and realized that I'd much prefer Rachel's chocolate mousse
-reviewed the comments on a journal article critique I wrote for my OB-GYN rotation
-updated my PalmPilot
-posted twice to this blog!

I should've brought my gym clothes and gotten in a workout after leaving the stroke team around 4:30. You may ask why I can't just wear my scrubs and sneakers to the gym...Well, Mayo has a strict dress code, not just for clinic (business formal) but for the gym as well. Scrubs are strictly not allowed. Though, the gym dress code has recently been liberalized from forbidding sleeveless things altogether, to allowing sleeveless shirts if they were designed sleeveless (no cutoffs) and if the shoulders themselves are completely covered (no skinny straps). Shocking! They're still chasing down naked people in the new sauna, so clearly some folks aren't getting the modesty message.

Pretty soon I think I may try to take a nap. This shift lasts till 6 AM, then I need to go and "preround" (check labs and test results and do a physical exam) on the patient I picked up today. Also hoping to get a minute to dash across the street to Caribou and get some caffeine. Then lecture from 7-8, rounds (discussing the patients with the supervising consultant...known as an attending at most other hospitals) from 8:30 to whenever. I should be done by noon or 1:00 and headed home for a drowsy afternoon.

This is Spinal Tap

So, one of the things that I was too tired to post about last week was my morning with the spinal tap nurse. Spinal taps (also known as lumbar punctures) occur all over the hospital in a bunch of different situations, but this particular clinic is for pre-scheduled patients. Their taps are an important part of their diagnostic workup (for lymphoma, multiple sclerosis, and so on) but are not a very acute need (like someone in the emergency room with possible meningitis would be).

There were two patients on the schedule, so in the spirit of "see one, do one" (thank goodness I didn't have to "teach one," which is the last part of the medical school triad), the nurse demonstrated on the first patient and then I did the tap on the second. I was quite alarmed at the prospect of sticking a giant needle into someone's back, no matter how many times I reminded myself that it was well below the end of the spinal cord, but just like that first cut in the anatomy lab, I had to take a deep breath and do it. The worst part was probably fumbling around with the setup tray, drawing up the anesthetic and getting the different needles on and off the syringes, feeling thoroughly incompetent and slippery-fingered.

I needed to give some extra anesthetic partway through (this happens, different people have different responses to the stuff), but as soon as I did that and repositioned the patient ("tuck your head down more! Bring your knees up farther!"), I got the spinal needle right into the desired space. The patient did screech once (apparently one moment of pain is pretty common at the moment of pushing through the covering of the cord), and luckily the nurse, anticipating my alarm, motioned frantically that everything was fine and not to pull the needle back out! Then we just waited for the appropriate amount of cerebrospinal fluid to drip out, and that was that.

There's a small chance I will get to do this again, either in the emergency room or on the inpatient floor, during the rest of my rotation. It's certainly something I'll need to be competent at as a resident...luckily, it turns out not to be difficult at all!

ps - I was reminded by A to explain the "This is Spinal Tap" reference. The best part of the movie is learning that amplifiers that go to 11 are, by definition, better. Now, that's my kind of math.

Too Much Time, followup

Not long ago I posted about a group of people, with too much time on their hands, who made a 21-foot X-Wing replica, complete with RC-controls and moveable S-foils. Well, they loaded it up with four M-size rocket motors and launched this weekend. As one might expect, the thing disintegrated during liftoff - it just couldn't handle the stress. A flood of star wars related humor is to follow, no doubt. Check here for the video.

Neuro Week 2

No posts from me this week because I have been at the hospital a LOT. I was on the general neurology inpatient service (there's a separate stroke service that I will be working on next week). In five days, I was there for 68 hours, including 34 hour overnight call (got a few hours of sleep then, so it could've been much more exhausting). This is similar to the hours I was doing on the internal medicine service earlier in the year, but I'd been told that neuro was much mellower, so it was a bit of a surprise! I do have this whole weekend off, though.

I saw some very interesting patients, learned more about doing the neurologic physical exam, and had some good lectures to prepare for the exam next Friday. Other than that, mostly sleeping!

Neuro week 2 leaves me not quite as excited about neuro as week one...on the other hand, that could just be the exhaustion talking. One of the neuro residents on my service this week did his whole internal medicine residency before coming back to start again in neurology, which is an extension I hope to avoid! I'd much prefer to make the right choice first time around, so that at some point I can actually have a salary and some control over my schedule. The advantage of neuro as a career would be a significantly higher salary and a nice steady schedule, especially if I saw outpatients rather than acute care things. Also the chance to be really expert at one narrow field. But it's hard for me to imagine giving up all the things I love about family medicine, like delivering babies (even in the middle of the night), taking care of kids as well as adults, and doing the coordination-of-care things that I really enjoy.

The doctors I'm working with certainly don't hold back with the career advice, so you, dear reader, should feel free to chip in as well!

Quick Post for 10/5

I've got nothing, so here's a picture of Hilary and Jasper

Too Much Time

There is much to be said for making something really freakin' cool, just because you can. Basing your opus on Star Wars gets you geek cred, too. However, there are sometimes when you really have to wonder - do these guys have too much time? A team built a 21-foot long X-Wing fighter, complete with movable s-foils and a little R2-D2 in the back. However, they went so far as to add SOLID ROCKETS to the thing, and RC controls for the wings. It actually flies; or, at least, they hope it will fly when it takes off later this week.