Amputations, Courtrooms, and Ultrasounds

What's better, studying or being a parent?

Yeah, it depends on the day.

You're talking to your daughter here, by the way. Hi everybody and welcome to the podcast. This is Generations MD. My name is Stephanie and I'm joined here by my colleague, Dr. Sarah Davis, who's also my mother. I'm on fall break.

Yay, that's fun.

Finished my surgery rotation and I was like, okay, I'm gonna have a full week of, you know, not having to study, not being in the hospital. So I was just like, oh my God, I am so excited to relax, see my friends, catch up on a bunch of stuff, book all my doctor's appointments. Uh, I decided to book 2 trips. Um, I, uh, decided, okay, I need to, you know, get my workout schedule back in order. I decided I needed to get rid of everything in my closet and subsequently buy an entire new closet. Um, to—

This is the definition of ADHD, but carry on.

Organize my— organize My closet, get some new things to organize. Then as organizing my closet, decided, well, there's a bunch of other things that need to be organized, as in bathroom and office and other things. And also said that I was gonna write an entire manuscript.

Um, manuscript?

Yes, yes. So I've done half of most of those things.

Well, that's pretty good because the week's like half over.

Well, yeah, but then I have my other— I did one trip and then I was only really— I realized I'm only in Houston for 2 days. I leave for my next trip tomorrow. So, hmm.

Okay.

Yeah.

So you got a lot of unfinished projects. Yeah.

And I, yeah. And I have to play in a soccer game tonight. I have to get my haircut tomorrow.

Hmm. I think some of that stuff's not going to get done.

Yeah, and then obviously in catching up on the podcast, you know, agreed to that, catch up on some stuff in regards to that. I had big plans, big plans.

I admire your, uh, you know, your enthusiasm. It's, it's good.

It is kind of like— I kind of forget that as, you know, not trying to be like, oh, being a med student is so hard, but like, it is A little bit, you know, just talking to my friends that just work normal jobs and it's like, it's like, oh yeah, for, you know, rotations, I, I have to— oh, for this next rotation, I only have to be there on the weekdays and like the weekends I have off. And it's like, wow. But then they're like, oh, well you have the weekends off. But then I kind of forget like, oh, well yeah, I have the weekends off to study. It's like, I—

Right.

Yeah. It's not like I should just—

yeah.

It's not. I realize I forget that other people have weekends off and they can actually just, you know, do the weekend.

Yep. Yep.

Is this what it's like, like being a parent, just having to do stuff?

Oh, it's far worse being a parent.

Well, obviously, but I just mean in the sense of like, you know, no freedom.

No freedom. I remember somebody saying that they're like, parenting is relentless, which is kind of a, Appropriate word. And, you know, people like, you know, this is when you have small children, but somebody's like home with their kids all weekend and then they're like, oh, it's Monday morning, yay, I'm going to work, it's going to be easy.

Yeah.

You can go to the bathroom whenever you want to, you can eat when you want to, like, that's just glorious. So, but, you know, anyway, but you don't have to, you know, when you don't have to Study, being a parent.

What's better, studying or being a parent?

Yeah, it's, it's, it depends on the day.

You're talking to your daughter here, by the way.

Well, I know there were, there were some days when being with you was way better than studying for a test. Wow. Wow.

All right, I'll take it, I guess.

Um, it's, it's all just different, right? It's a different thing. It's, um, Right. But this is the phase of your life that you're in now. And it's, you know, it's fun. Thank goodness you're young and you have lots of energy. I do. You know, one thing that is nicer in this day and age is because you can get various errands done and buy things online. Oh yeah, for sure. That is really helpful because that used to be stuff you'd finally have a little bit of time on a weekend and then you had to go to these places that are only open until whatever time and trying to get All your errands done. And that was, that was harder. A lot of stuff just didn't get done.

Yeah. I mean, I did go, I, I'm a big online shopper and, you know, people probably don't care about this, but I did go to The Container Store today. And I mean, just shout out Carla from The Container Store who just absolutely changed my world. I'm just like so grateful. I, sometimes you just got to go in person to a store because She just like opened my eyes to just the most incredible organization tactics and ideas that I will hold with me, um, for the rest of my life.

And, and what was the cost of this therapy? Everything was 30% off. Oh, so you saved money by going. I did. It was great.

It was honestly fantastic. I was looking for something very specific and she showed me how to do it. She was like, well, this might be a little complicated. And then she went into the whole thing. She was like, you gotta choose your width. You can do 20 by 2, and then you choose how many, and you can choose like, you gotta choose these numbers that have to add to 7. But I was following, I was with it, and I did what I needed to do.

That's like a complicated formula.

It was to get these drawers. But I wanted a very specific set of drawers and I could do it myself and I was so excited about it. Anyway, I'm thrilled to set those up.

That's great. I do get a— I go to Container Store sometimes when I just, I know I need to clean stuff up in my house, but I just want motivation and I just walk around in there and you just kind of get excited.

Yeah.

May have to come to Houston just to see Carla. Well, backing up, let's talk more about your surgery rotation. You are done with your surgery rotation. You guys do just 2 months of surgery. We used to do 3 months of surgery. Um, and it's now it's over, but you loved it, right?

I did. I feel like I talked about it before a lot, but yeah, no, I loved it. I threw myself into the rotation. I am really satisfied with the way that I did things. Um, I spent a lot of time There, but I was just like, I, I don't know, I just wanted to do it all and I wanted to learn as much as I could. And it just got me really excited about learning, honestly, which is really cool. I feel like the tests and everything, all of it, it just beats it out of you. It's like, you know, I've been worried about tests and grades since I was in middle school. Like, it's—

Mm-hmm.

It gets so exhausting and then you just, you're so focused on the, on the test taking, but third year medical school is the coolest thing ever. Like you just get to go do all these things, be in the operating room, learning, doing stuff. And like genuinely was just bit bopping around and just being like, what? Like, I'm just trying to learn. Um, and yeah, it definitely got me. It's like, I don't know very many experiences in life when you get to do When you get to do that.

Yeah. And you, you finally are thinking to yourself, oh, this is, this is why I did this.

For sure. For sure.

Like, it's so long before you get to do that.

Yeah. It's so long before you get to do that. But like, I just think anybody for any rotation, it's, it's, I mean, I don't know, especially for surgery rotation, there's so much that you can do. There's so much hands-on learning. That like you gotta just take advantage for it. Again, you're paying to be there, like you should take advantage of it, um, and just try to learn. Um, yeah, I mean, obviously it's just like, as we were just talking about balancing the studying and being in the hospital, but like, I think the value of being there and if you're actually like doing stuff and being in the operating room is.

Yeah.

Is a lot higher than a couple extra points on your exam. So as long as like you, you get done what you need to get done. But yeah.

Yeah, yeah. I mean, yeah, what a, what a waste if you were spending a lot less time in the hospital and then just sitting there in front of more books. You've already done enough of that.

Yeah, exactly, exactly. And that was— it's hard like for the first one when you're like— I, I am for my first rotation and I was Very stressed out about getting out of the hospital to then go and study, cuz I just didn't know how, I didn't know how much time I needed to be putting into it and stuff. But I think slowly I'm kind of starting to figure it out. I put, definitely put a lot less time into like out of the hospital studying surgery, but I mean, it all worked out. So yeah.

Good, good.

Mm-hmm.

And you did get some fantastic evaluations in surgery.

Yeah. I like the way that they did evaluations for surgery. They, you got to ask residents and the people that actually You actually worked with to kind of like write you a review. It felt like turning around an iPad and asking for a tip every time. But I mean, it's part of their job too. So it's an awkward thing, but it ends up getting— rather than just having one attending write your eval, and these evaluations end up on your residency application. So it's, you know, anyone—

A—

who is evaluating you for their residency program is going to read this. So it's, it's important that people who are actually working with you are writing these. And the way that they did it was you could kind of ask people that you worked with and they would write stuff down and then compile all of them into this one big thing. And, um, yeah, it was— I, I'm really proud of myself and happy with how that turned out.

Yay! And you decided you like doing procedures?

Yes, I do. I Um, my final toe count was 5. My final finger count was 2. I consider myself—

Can you explain what that is? Yes.

I consider myself the amputation service. Um, the, like, lots of people would come into the hospital with, uh, like dead fingers and toes, normally due to either like, um, like they had diabetes and they had some sort of wound on their foot. Uh, and then You know, you end up like kind of just either an infection source or you lose blood flow to that toe for some reason and the toe dies and you got to cut it off. So, um, that happens a lot.

Um, more than you'd think, I guess.

More than you would think.

Yes.

And I— people, surgeons don't like doing that, those procedures. They don't like cutting off the toes and stuff because, you know, they want to do the more intense stuff. Those are like very simple, boring procedures. I loved it. Um, I love the simple, easy, just cutting off the toe. Now if it was like a foot or like a leg, like that, that's sad. That's like not, you know, that's, that's not cool.

But you got 9 other toes.

Exactly, exactly. It's like if you're cutting off toe, like that's okay. Finger also, like if it's one finger, it's really like, I mean, you know, it's a bummer. It's more of a bummer than a toe, but, um, But I mean, it's not like I— well, I did cut off the end of a thumb, um, but it was on the other side of the—

it was on the distal side of the knuckle, right?

Yes.

So yeah, it could have been a lot worse.

Could have been.

For any hypochondriacs out there, like, while she says this is common, this doesn't mean that this is going to happen to you, right? Right, right. This is something—

these are people like, like One guy came in because he, it was a lot of work injuries for the hands. Like they'll come in and they had some sort of crush injury on their finger and then you gotta take it off. It's not like you, or people with chronic diabetes and it's not like, yeah, people are not just like, you know, oh my God, I was, I was fine earlier today and then my finger fell off. Well, somebody did have an aneurysm in their, uh, finger. Very random, like randomly just had an aneurysm in their finger and, and, uh, yeah.

Died. New fear unleashed.

Yeah, no, seriously. But I mean, I don't know, got probably predisposed— predisposition to have aneurysms or something. So maybe there's some noise above me. I'm gonna have an aneurysm somewhere. I don't know.

That it could be a lot worse. Could be in your brain. Again, hypochondriacs, just kind of skip over this because I have not too many of my patients are listening to this because all of a sudden they're going to come in, they're like, I got this pain in my finger, I think I got an aneurysm.

I will come cut it off. I will happily do it. I will have— if anyone, um, in the area has, you know, uh, any issues or needs to consult me for any amputation, just let me know and I will happily come and do a bedside amp.

And that's what you guys were doing these like at, at the bedside?

I only did one on the bedside. No, I was in surgery, so gotta take them to the OR.

Well, of course. Yeah. Yeah. Um, well, good. Now what's your next rotation?

I have emergency medicine ultrasound.

So which is it? Is it emergency medicine or ultrasound? It's, it's, it's just doing like point-of-care ultrasound in the emergency department?

Yeah, that's what I mean. They use ultrasound all the time. This is a new thing. Um, for people who don't know, every single specialty uses ultrasound really. Like, this is like, they have these ultrasound machines. It's a very quick and easy way to see Anything. Um, I mean, you can see the heart, you can see your kidneys, you can see muscle, you can see, um, you can see fractures actually. Like, you can, you can use it. It's not, um, I guess I don't know the technical term for it. Like, it's a very, uh, like, it's a good first-line thing. It's not very like specific.

Yeah, I mean, it's not like it's, it's not like a CT scan or an MRI, but it's an That's an improvement over physical exam.

Yes, yes. Physical exam, people are not doing those much.

Not doing those.

Yeah, yeah.

I mean— Physical examination is very important.

Yeah, I think a history is very, very important.

True.

Physical exam.

Focused physical exam.

Focused physical exam. There's some things for sure. Um, but I think that, yeah, I mean, if somebody is saying they're having right upper quadrant pain, just, you know, put an ultrasound on there and look at their gallbladder right away. Uh, I mean, they've always—

It is very handy.

Yeah. I mean, they've always done that, I guess. Right? Like, what was it?

Well, not at bedside.

I mean, I don't have one of those in my Somebody comes into the emergency department, they're having very upper quadrant pain. Back in the '90s, what do you mean you didn't do— like, where was the ultrasound?

You could order an ultrasound, but the ultrasound tech had to come from radiology with this big machine that they wheeled in, and they could only do one at a time. And so it was, you know, if you wanted to do that, I mean, the patient might be sitting there for several hours before the ultrasound tech could get there and do it. We actually used to use ultrasound a lot for diagnosing appendicitis. Now CT scan is a lot more preferred.

Which I think is so— that is, I think, physical exam. That made me so mad on my surgery shelf is that that was the next line was you had to put this person in the CT scanner when they're having— they had leukocytosis, fever, lower, like left lower quadrant pain and—

Right lower quadrant pain?

I mean, right, sorry, I said diverticulitis. Right lower quadrant pain and it was like, And then you still had to— like, you wouldn't— you couldn't just do an ultrasound, you had to put them in the CT. No one's going to the operating room without going in the CT scanner.

I know, but they used to. That— yeah, that— it used to be enough and be like, okay, yeah, you did. They didn't routinely do CT scans for— if you thought it was— if it seemed like appendicitis, then you went to the operating room. You might do an ultrasound. Sometimes you would admit them for serial abdominal examinations and see, like, They still do that. Do they? Okay. And, um, but, but being able to do point-of-care ultrasound, I do think is very exciting. I think it's just a funny thing to me though, because things usually get more and more precise. I would have predicted that nobody would be doing ultrasounds in this day and age, that because CT and MRI have gotten so much better than they were 30 years ago, I would have thought we would just have a lot more of that. And so to see a resurgence of Little, little itty-bitty ultrasound is kind of like the, you know, the mighty, like the mighty radiology technique, which I just think is kind of interesting.

Well, yeah. I mean, to get somebody into the CT scanner, it's also the most dangerous place in the hospital, CT scanner.

Oh.

You know that?

No.

Well, because yeah, somebody comes in, okay, they're having right lower quadrant pain and they have a fever. And then you're like, okay, well, they're in a ton of pain. And then you, you're like, okay, well, I guess we have to get a CT before we take them to the operating room. You put them in the CT scanner, all of a sudden they're septic. And like, so it's hard. Also somebody who came in like car accident and then they're like, okay, you know, you do like, you also do, did they do that like for trauma when you come in and do a FAST exam with ultrasound?

No.

Uh, okay. So that's like the— yeah. That's also like the first thing you do is somebody comes in. I mean, obviously if they're like, they have a gunshot wound or something like that, then they definitely need to go to the operating room. Then you take them there. But like if somebody comes in and, you know, they seems like they might have some internal bleeding, then you just like, do you like ultrasound their heart and like their lower abdomen and kind of their like left side and their right side. And then you just see if there's like any fluid in there. Mm-hmm. But sometimes there's not, but You can still have some bleeding. So then they're like, okay, we put them in the— their blood pressure's dropping, dropping, dropping. You put them in the CT scanner and then it's like, okay, then they're in hemorrhagic shock and then you have to get them out and it's, it's a pain. Um, and yeah, I don't— people die in CT scanner. It's a thing. But anyway, my—

More, more fears unleashed.

No, my point is, is that like the ultrasound is great because there's ultrasounds all around. Like there's been, On every, I mean, on IM and on surgery, I'm evaluating patients, somebody's saying they're having some chest pain, then they're just like, hey, go find the ultrasound. So you just go find it and you bring it in and then they'll just take a look.

Wow. So, I mean, it could be that not too far off, everybody will have their own little personal ultrasound in addition to your stethoscope.

Maybe, but also the machines that they have, the ultrasound, it is something you when you roll in.

Okay.

It's not like something that you're holding because—

Well, because sometimes they have the handheld and it goes to your phone. Yes.

Yeah, but those ones like aren't— I don't know, they're not—

They're probably not as good.

Yeah, they're not as good. I'm sure people do have those, but it's like if you have one right outside, then it's just like they're all over the emergency department. That's why like I'm doing this, um, this rotation, because it's like you just go evaluate somebody and then they're just kind of like You like— they, they bring the ultrasound with them when they're evaluating.

Okay. Yeah, I mean, that's going to be a great thing to learn. Honestly, I would love to have one of those in my practice. I think patients would like it.

Yeah, yeah. So anyway, I'll let you know what I learned. Hopefully I learned some stuff.

Yeah.

Um, yeah, we'll see. Um, well, I guess I don't wanna— I don't wanna get into all the nitty-gritty details of it. Um, but just the concept of the whole thing. And I don't know all the details either, but that trial that's going on—

Oh God. Yeah, I, I have purposefully stayed away from it, so I don't know very much about it.

I don't want to get into like the actual details of the case, but—

This is the Lindsay Clancy trial, by the way. Is that what we're talking about?

Yeah.

For our listeners.

And just like essentially they are bringing all of these doctors, specifically psychiatrists, onto the stand and like going through their notes. One by one and just being like, uh, like nitpicking all of it, which is just, you never think that that is gonna happen. And it is just so crazy when you're writing, you know, they write so many notes all day and it's like, you know, one comma versus not. Then, like, I, I saw something that they were going through the review systems, which is, you know, a section of your note that You write, you know, you're okay. You write like negative abdominal pain and, um, and tenderness. And it's like, okay, that means they don't have any abdominal pain. They're not having any tenderness on palpation, whatever. And they read it and it said like negative, it's like negative psychosis, pressured speech. And then they were saying like, well, does that mean that she did have pressured speech because you didn't write negative? psychosis, negative pressured speech. It was like negative psychosis, pressured speech, which is like, you know, you know that when you're reading and all of these little like acronyms and stuff of them just being like, well, what does this thing— what does this mean? It's like you think that you're writing a note in order to communicate to other physicians, but like you're reading— you're writing this note and it's, it's a legal document.

I mean, I think about that honestly a lot when I'm writing a note. I do think about, um, You know, especially if you're seeing a patient and like there's something serious going on with them, I do like— I kind of think in my head, okay, how would the lawyer read this?

Mm-hmm.

And I think about that a lot also when I communicate with patients in writing, which now they do lots of portal messages and that kind of thing. But I just— I read it back and as I put this into the chart and just think, hmm, how would this read to somebody who didn't know the situation? I don't know that that makes me, you know, that, that, that's so much better or worse, but I, it, it's, it's in my head all the time.

I do think that's a good way to be, but it's just like, I mean, you do have the luxury of being able to like take your time with your notes and just think about it a lot more rather than people who have to do a million a day. And it's like, it's just, I, I don't. I don't know. It's just hard.

No, it is hard, which is just so stupid. And it's stupid that the billing became the whole reason for the note. I mean, the note is supposed to be a communication. It's not supposed to be for whatever level of billing code, but that's a lot of the reason for the note now. So anyway, yeah.

It makes it very difficult to sort through what is actually important.

Yeah, it does. But yeah, I do. I feel terrible for those doctors who are Involved in just a, you know, it's just a horrible, horrible case. Yeah.

And like the one that's like 1 year out of residency.

Mm-hmm.

It's like, oh my God.

I know, I know. That's, yeah, that's your, that's nightmare. Um, I mean, getting sued in general, we talked about that when we talked with Dr.— or not Dr., Mr. Anderson. Um, just talking about it's just very, very stressful for doctors to get sued. It's Just so horrible going back through every single thing, and it's just like any Monday morning quarterback. It's very easy to say you should have done this, you should have done that, but with the information that you had at the time, it was the right decision. But if something has an 80% chance of being the right thing, there's still 20% chance that it's not the right thing. So—

For sure, for sure. Well, everyone, Thanks for listening. Uh, find us on TikTok @generations.md and @drdavispgy30, and on Instagram @generations.md. And if you have any questions or interested in being guests on the podcast, you can email us at askgenerations.md@gmail.com. And we'll talk to you guys soon.

Bye. Bye.