If you have been to the page, you may have noticed I have recently changed the avatar from dr zoidberg. The new one is pretty neat and zoidberg could use some time off. It looks almost like me…an almost, ALMOST dr j To give credit where credit is due, thanks be to carmen, who pointed me to maebemaebenot who actually found this hot new trend all the kids these days are doing. And in case you also want to jump off this bridge all the popular kids are leaping from, here is the link for yourself

faceyourmanga

Other than that, the rotation is going as well as can be expected. Managed to see a case of eye herpes on a 67 year old woman. You are wondering how she got it, perhaps? disturbed by the thought of a granny getting freaky? Well, set your minds at ease, because she had type 1, the oral variety. She had touched her lip during a recurrence, and then touched her eye without thinking about it.

Now that happens to be a far more severe case than what I saw. But do you notice the growth of blood vessels and advancement of the sclera (white part of the eye) onto the cornea? That is known as neovascularization. It is one of the common signs of a herpetic infection in the eye.

The lesson: Wash your hands. Also, dont get herpes, if you can help it.

I also got to see a couple of cataract lens removal patients, preoperatively all the way through to post op. In cataracts, the lens of your eye accquires opacities as you age, kind of like a window pane building up dirt over the years. Now some people it affects so severely that they can no longer see through the window. So that is when we go in, remove the old lens, and put in a new one. Like smashing the window open, taking out all the glass, and putting in a new window. But since I am using a retrospectively poor simile,

And without using a slit lamp to examine a dilated eye, you would never know the difference. Creepy, isn’t it?

Most of the remaining patients were rather routine…yearly vision exams, follow up diabetic and/or glaucoma appointments, an occasional red eye or contact lens fitting, nothing to write home (or the internet) about. I use these patients to learn more about common problem management, and improve my ability with direct fundoscopy…using the handheld I am now almost always able to find the optic disc and nerve, and am gradually improving in my ability to estimate cup/disc ratio, and some indirect fundoscopy, which is the same as direct, only not.

Have you ever been in a car and heard or used the phrase “pedestrian! 10 points!” or some equivalent thereof, and wondered where it comes from? Wonder no more…the concept of numerary reward for hit and runs dates back to a 1975 film titled “Death Race 2000″. Costarring a young sylvester stallone. In a postapocalyptic world, the united provences entertain the masses with a cross country death race. Racers are awarded points not only for winning, but also for number of pedestrians destroyed with the elderly and the pediatric given higher values and such.

Incidentally, a remake of that film will be released next friday simply entitled “death race” I am interested to see how the story is adapted. I advise you to watch the original and compare for yourself.

As for the weekend, I have been on a five mile hike at silver falls state park, which i will go into more detail about next post. I will also be heading up to Portland to check out the zoo, the remainder of the city and go to the indian festival being held that day…I dont know how i keep coming across these random ethnic festivals, but i am not complaining

in answer to the olympics post, the fake story was the one about lack of compelling human drama disqualifying an athlete. Below is another article from the same writer, andy borowitz

China’s Gold Medals Found to Have High Lead Content

China’s impressive haul of gold medals at the Beijing Olympics was
tarnished somewhat today when it was revealed that “abnormally high
levels of lead” were found in the first-place medallions.

The medals, which were supposed to be made entirely of gold, were
instead found to be composed of 99% lead alloy and coated with a
gold-colored lead-based paint.

The shocking revelations roiled the Olympic complex today and sent
officials looking for answers from the Chinese manufacturer of the
medals, the Wuhan One Hundred Percent Gold Medal Corporation.

“We are trying to determine how exactly so much lead got into those
gold medals,” said a spokesman for Wuhan, China’s largest exporter of
gold medals. “Until we do, we are urging all first-place athletes not
to lick, taste or suck on their medals.”

The news about the potentially toxic gold medals spread panic among
Olympic champions, especially U.S. swimming phenom Michael Phelps.

“I am very, very concerned about my extensive contact with gold
medals,” Mr. Phelps told reporters. “But what am I supposed to do? Stop
being so awesome?”

In other Olympic news, China’s hopes for winning more medals in
women’s gymnastics were dashed when one of their leading gymnasts
vanished down a bathtub drain on Tuesday.

Immediately after Jiang Qimin’s disappearance, Beijing authorities launched a search for the acclaimed seven-pound athlete.

Jiang had been the subject of speculation earlier this week as many
foreign observers doubted China’s claims that the two-foot-tall gymnast
was sixteen years old.

In an interview with NBC’s Bob Costas on Monday, Jiang sparked
controversy with this response to a question about her age: “I want my
sippy cup.

I have described in my earlier posts a little bit about oregon, but it has mostly been about the people-the outdoors and everything else is stuff you just sort of have to see for yourself. Or in a picture. taken by me. erm. yes.

the football stadium for the Oregon Ducks, across the street from the apartment i am staying in. And me here months too early for football season. dang.

Who doesnt love a robot?

All taken less than a mile from my apartment while on the bike trails through the park. Dont worry, its not my bike

Also on this bike ride I came across at what first looked like a random park picnic, but in fact ended up being a festival commemorating the deaths caused by the Abomb in Hiroshima and Nagasaki. Yes in a city full of white people, i still managed to stumble across the asians. How do I do it? I dont know, I just do it

Of course, this being a hippy town (as previously mentioned) there was generously provided a community potluck dinner

but no actual trash can. Just a mini sink, and two cans…


Yes, real raspberries growing wild. And yes, i have eaten them. and no, i have not gotten sick. yes, really.

In need of a haircut, I found a barber/chirugeon in the midst of a parking lot, selling a shave and a haircut for two bits! well actually 10 dollars, but still. I include the picture because the entire experience was ideal. I got this guy’s life story, how he went from one job to another and became a barber punctuated by joke after joke after joke, both clean and dirty, all done with different voices. And the fact that the haircut he gave me was pretty darn good too, that was just icing on the cake

A vendor at the saturday market actually spinning fleece into thread. I stuck around for half an hour waiting for rumplestiltskin to come by with straw to be turned to gold, but he never showed

Later that weekend it was off to junction city, 10 miles north for the annual Scandinavian Festival!

replete with pastries…

puppets…

and ponies…?


Viking Sal is a little old for rape, but he still is a pretty darn mean pillager. Staff hand carved, helmet bones from a real cow.

The danish are a clean and  industrious people

and those for no good reason

On to other matters. Since I came up here only for a month, i packed a bare minimum. This did not include most kitchen supplies (that it did include some should be no surprise to longtime readers). Nor did it include spices. So when my program coordinator dropped off some household supplies including a small table spice jar, i was quite happy. In the space of one day I went from eating canned tuna with mayo and chips too

Something that would be much more amazing were my food photography skills a bit better. Remind me to build a lightbox at some point.

Anyway, this incredibly cheap dinner consisted of green onions, spinach, garlic powder, red pepper, olive oil and a handful of cooked pasta. All tossed together in a pot, cooked on high for about 5 minutes and sprinkled with feta. You could probably purchase everything you would need to make this with what is in your wallet right now. Unless you are a resident, then you might have to just go hungry again ha ha oh

-Almost Dr J

News Version: Morgan Freeman crashed a car and had to pried out with the jaws of life.
True Version: Lucious Fox was testing a new TUMBLER for Bruce Wayne and had a problem merging

End of week one, and the expectation and reality of this elective are somewhat different. Not bad, just different.

I honestly had no idea what to expect coming to oregon, as earlier posts may have alluded too. This included what my rotation would be like. I assumed (and what have we learned about THAT?) I would be in a hospital, working with residents, other medical students, perhaps on a consult service.

Instead, I am in a private practice staffed by three attendings, working pretty much by myself, and essentially shadowing the doctors since all the grunt work, so to speak, is done by the technicians.

This means that i literally have nothing to do the majority of the day other than follow the doctor into a room, look at any interesting slit lamp findings, and perhaps ask a follow up question or two as they come to me.

If you know me, I am sure that reading that last sentence would indicate I am practically jumping out of my skin. The good news is that while the rotation is far from what I was expecting, I am still learning quite a lot. The opportunity to work exclusively with three attendings pretty much guarantees me a decent letter of recommendation, all three are eager and willing to teach so i am learning quite a bit, and boring as the day may seem, it is my lack of activity, NOT ophthalmology itself that I bemoan. Always nice to find out I have no need to second guess myself despite how often i seem to do it.

Additionally, one of the doctors offered me an opportunity to write a case report which has a good chance of being published in an upcoming ophthalmic journal, not too mention hinted at other chances this month to become involved in research that may or may not publish by the time of interview season. So while it will be patently obvious that I am doing research soley to enhance my application, the fact will remain that I will have published, thereby-you guessed it-enhancing my application regardless.

This week the patient base included not one, not two, but 5(!) patients with lupus who came to visit for visual screenings. Plaquenil, a drug often prescribed for those with this condition can become toxic to the eye and requires screening every 6 months to a year. Lupus is the pink elephant of medical school-it is harped on over and over again in multiple classes in didactic settings, then you get out into the real world and rarely encounter anyone who has it.

I also have seen multiple DSAEK pts. rather than spelling out a long technical surgery it boils down to this: Some people have a very thin corneal membrane, and this can occasionally result in edema (swelling) in the eye, distorting and destroying vision. The previous solution to this problem was a full thickness corneal transplant-i.e. your cornea is lopped off in its entirety and replaced with one from a dead guy, which is sewn in place and actually gives you pretty decent vision. It does however have some complications such as making you more prone to cataracts in the future, a long recovery time, and any and all complication associated with sutures

Well, along the way, some fellow comes along and says-hey, why replace the WHOLE cornea if most of it is still functional? So he goes and makes a tiny incision in the cornea, scrapes out the thin membrane behind it and sucks up the lens, then puts a new cornea and lens behind and underneath the old one. This partial thickness surgery heals much faster, does not cause cataracts since you are given an implantable artifical lens with the new cornea, and requires minimal to no sutures, which vastly decrease complications. Voila! The new hot surgery.

Oh and did I mention that to make sure the new graft adheres to the underside of your eye, they pressurize it by placing an air bubble in your cornea which sits there for several days?


     

    The cornea being prepared for
        a new type of transplant.

   
After the transplant, the cornea is
      held in place with an air bubble,

                  instead of stitches.

Pretty darn cool, eh? Oh and no worries, the bubble shrinks and dissipates within a week, leading to clear vision.

I also saw a guy get a gold plate sewn into his eyelid, not to bling out or add value but because he had a muscle problem that would not let him close his eye completely. Well not being able to close your eye means it can dry out and infections can get in, so a small weight is sewn into the eyelid, giving it that little extra push from gravity and allowing you not only to see better, but one up the rap stars.


I would show you a pic of someone with it, but the whole point is that it is undetectable.

My only other complaint is a mild case of the blues/boredom what with being up here all by myself. Friday night approaches and I can go see a movie by myself, go to a bar or club by myself, or wander around the mall…by myself. Which i will probably do regardless, but it is more fun to do in company, and I have no one i can just call up to hang out with in oregon.

However, I am still going to some scandinavian festival this weekend, possibly hiking at some nearby waterfall, or maybe hunting down a zipline tour. Just because I enjoy the company of others doesnt mean I cant find numerous things to keep my lonesome amused…and with luck, i will meet some people to hang out with at these events.

Thus ends week 1, wherein I learn that by the end of this month i will probably be in really good shape from the biking and daily gym visits I do in lieu of drinking with buddies. Hey, we all need a fresh start/recharge now and again, right?

Oh and a final postscript-I will be throwing up one more personal statement on here this month. Not another revision, as the optho one is as done as I care to make it, but my backup personal statement, as I will also be applying to internal medicine in the event things dont quite work out with matching into my chosen field. Feedback would be greatly appreciated, as you folks helped me to hammer out what my advisor was saying looks like a pretty decent statement for my gold medal choice.

Next week-photos, and cooking adventures!

First things first.

My month of GI in california is now completed, and I have pictures to post…later. Yes, Josh is pulling his usual “i took current photos but will not post them til they are no longer current” schtick.

however, after having driven cross country multiple times from LA to Chicago and back, the drive from LA to Eugene oregon was ridiculously easy. A day trip in fact. 12 hours exactly…leaving my house at 6:30am and arriving at my abode for the next month at 6:30pm.

As much as i may bitch about driving sometimes, I love road trips…the endless road ahead of you, the sheer number of possibilities, the blast of wind in your face at 90mph with the radio turned all the way up. There are few activities that bring such a smile to my face as traveling of any sort, no matter how mundane its purpose. And despite being surrounded by people on the road, your car becomes your own bastion of privacy…everyone is too busy driving their own cars to look around most of the time. Not me…i wave, i sing, i smell the air of each state i go through (oregon smells like christmas tree!), i puzzle out license plates and all in all have myself a grand old time.

Although thank goodness for those bluetooth earpieces-not because I am on the phone while driving, but anyone who looks in my car and sees me talking to myself or doing any other activity just assumes I am on the phone, so hey works out for me.

I saw a dragon sculpture somewhere between northern california and oregon. It was neat, but there was no one there for me to excitedly point it out to so they could not care at all. But a special internetland hello to rosie, who called me unexpectedly while driving just for the hell of it. Though she was unaware of this, long driving is the one time i actually ENJOY talking on the phone. All other times i prefer text messaging.

Oregon also has one of those mystery vortex houses with gravity where things roll uphill and shit. I need to check that out in a month on my way home.

Oregon does NOT let you pump your own gas. Apparently they still have full service stations throughout the state. I discovered this when i stepped out of my car to fill up, and some guy came up, took my money, unscrewed my gas cap, and started washing my windows. I was very confused, as he was wearing a gas station uniform and did not appear homeless at all. He took a look at my license plate, then at me, and said, Oregon and New Jersey still have full service gas stations…you wont be doing any of your own pumping here. So I thanked him, and continued on my way, and now i am wondering if I was supposed to tip him or not…what is the protocol? It felt like stepping back into the 50′s

In case any of you are wondering what I am doing here, you’re not the only ones! j/k I am doing a month of Ophthalmology starting monday, and when NYU rejected me from their slot, the date was so late that I was scrambling to find an open optho elective at ANY school for August. Oregon had one open, and I thought to myself, well, it is west coast, and they have bent over backwards to accomodate me, changing dates of elective, providing me free housing, and potentially research, so it seemed like a good idea at the time to pack up and head down the oregon trail

heres to hoping I do better in real life than that stupid computer game…i got so obsessed with buffalo hunting that most of my party would die of dysentery or i dont even remember what else. Not starvation though!

Oregon on first impression seems…rustic. More on that later. for now, i have located the grocery store, mall, and local bar. Tomorrow i have to find the hospital, which is supposedly biking distance from the apartment. Heres to saving on gas and parking for a month!

So, a month in Oregon. here we go.

Tomorrow marks my last day of GI consult service, and my last day in SoCal, at least for a while. If i remember, I will take and post some hospital pics so you can all see what I have seen. Well, architecturally speaking anyway, I doubt most of you would want to see all of what i saw this month. Unless you are GI aspirants.

But I digress. What have I gotten out of this month?

I have learned, perhaps most importantly, that while I still enjoy internal medicine and GI, it really is a silver medal for me compared to ophthalmology. I like it, I can do it, but I dont LOVE it. Prior to doing my ophtho rotation at cook, I was not aware of the difference.

However, i have become more competent in management and identification of most GI problems, and ideally, when the appropriate and inappropriate times to consult a GI service are…which will hopefully keep me ahead of the curve as a resident next year.

I have learned that I like LAC-USC hospital and I will doubtless apply here, but as things stand, I am still not sure if Southern California is my number one location to match at the moment. Sure, its nice being near family, and the weather is great, but LA is not a city like those i have become accustomed to, and while many residents seem to like the program and learn a lot, there were also many sub-voce mutterings about the malignancy of the program in how residents are treated

In what is a recurring theme in this blog (no not zombies or cannabalism, but hey thanks for following!) i have learned that I really did pick the right career path. I may not love every minute or every day of medicine, but I cant imagine myself doing anything else, and given some autonomy rahter than forced lecture attendance, the time really does seem to fly by, even when i dont get home til 8 or 9pm

So saturday morning bright and early I will be driving up to eugene oregon to do an optho rotation for the next month and see if anywhere else on the west coast is worth living.

Today I met a man with no esophagus. Instead, anything he swallowed would shortly pop out a whole about halfway down the side of his neck. I desperately wanted to give him some water to swallow. I guess medicine is all about learning restraint.

Why did he have no esophagus? Well a long long time ago, he got an incarcerated hernia- basically his organs shifted in a way they werent meant to, and got all tangled up cutting off the blood supply and leading to tissue death. This led to an operation where he had the top part of his esophagus turned into a blind pouch and exiting through a neck hole, the bottom part removed completely along with most of his stomach, so all his feeds are through a tiny little tube that goes directly into his intestine

Now in many cases, this can be a permanent situation, but for this particular gentlement he was scheduled to have his esophagus reconnected in a few months.

…

Are you ready for the best part?

….

When they took his esophagus out, they dont stick it in the fridge. No, to reconnect it, they need something else that is esophagus like…hollow fleshy tube shaped able to pass food. Something like, say, a section of his colon.

Yes, his new esophagus is going to come from his colon.

I wonder if everything he eats now will taste like ass?

Thanks for all the feedback thus far…looks like I am mostly fixing up grammatical errors now. Definetly dont want to make any of those, as one of the doctors i used to work with told me he actually mis-spelled ophthalmologist on his residency application. That would be…embarassing, to say the least

If you had to give up one of your senses, which would it be? What
single way of experiencing your environment would you cling to at all
cost?
For many, I suspect the desire to see would be retained at the expense
of the other senses. We are visual creatures, after all- isn’t it said
that seeing is believing, and beauty is in the eye of the beholder? One of my hobbies is photography,
an incredibly sight oriented art form. And the first and most important lesson
in photography is to focus, in order to best direct the attention of the
audience so they can see and experience the situation as you did.

My first view of medicine was panoramic, and I tried to take everything
in at once with a wide, unbiased view. I transported patients in an
emergency room, I performed research with a chiropractor, I worked as a
technician
assisting with LASIK, anything that would give me a  glimpse into the
world
of healthcare. While my exposure to each field was limited, the one
that
ultimately contributed the most to my development was the time I spent
interning for my ophthalmologist.

At first, it was just another healthcare-related job; Once I zoomed in however,
I noticed how happy everyone seemed to be. The elderly man having
cataract surgery so he can pick vegetables at the farmers market, the
father bringing in his daughter for her first contact lens fitting, the
woman overjoyed to find a botox injection would restore the sight previously hindered by her droopy lids. 
Even the doctors appeared as if there was nowhere they would rather be
than reassuring  a patient about dry eyes, or excitedly scheduling the
LASIK
appointment for a new patient. The entire atmosphere was friendly,
relaxed, and above all, personal. The doctors really knew their
patients, not just as a differential or problem list, but as people.

Just prior to leaving for medical school, I underwent LASIK myself, a
patient with an in depth knowledge of my condition but no less
concerned about someone cutting open my eye, regardless of the size of
the blade. The doctors, along with their staff, provided just as much
information and support as if I had walked into
their office devoid of any technical knowledge.  I left to begin my own
medical training with clearer vision in both body and spirit.

As I went through my
third year, I enjoyed the majority of my rotations, especially the ones in which I had more opportunity to interact and follow up with a patient
beyond the initial admission, learning more about them than just the
reason they came to the hospital. Despite that, I never seemed to feel that one “ah-ha!”
moment, that snapshot that we are all told will come to us when we have found
the right field.

Until, that is, I decided to revisit the field of ophthalmology, doing a rotation near the end
of my third year. All of a sudden, everything seemed to come into
focus; no matter how many patients I saw, or how complicated they were,
I felt confident and the days just seemed to fly by.

It is said that hindsight is always 20/20. While I didn’t know it at
the time, my early experiences in ophthalmology focused my interest
enough to try it again in medical school, only to find that both my
desire and enjoyment of the field has been magnified a hundredfold.
Everytime I use my digital camera to capture a random face, or set up
my tripod to shoot a landscape, it reminds me of how happy I am to have
“perfect” vision and how I would like to work toward giving others that
same opportunity. So I am taking my shot…all that remains is to see
what develops.

So there it is…I have read all your suggestions, and left onyl a few elements unchanged as a matter of personal preference. The hardest part of my optho app is now done. Not the most nerve wracking, just the hardest

Fewer corrections made this time around…are we nearing a finished product?

–

If you had to give up one of your senses, which would it be? What single way of experiencing your environment would you cling to at all cost?
For many, I suspect the desire to see would be retained at the expense
of the other senses. We are visual creatures-after all, isn’t it said
that seeing is believing, and beauty is in the eye of the beholder? One of my hobbies is photography,
an incredibly sight oriented art form. And the first and most important lesson
in photography is to focus, in order to best direct the attention of the
audience so they can see and experience the situation as you did.

My first view of medicine was panoramic, and I tried to take everything
in at once with a wide , unbiased view. I transported patients in an emergency room, I performed research with a chiropractor, I worked as a technician
assisting with LASIK, anything that would give me a  glimpse into the world
of healthcare. While my exposure to each field was limited, the one that
ultimately contributed the most to my development was the time I spent
interning for my ophthalmologist

At first, it was just another healthcare related job; Once I zoomed in however,
I noticed how happy  everyone seemed to be. The  elderly man having
cataract surgery so he can pick vegetables at the farmers market, the
father bringing in his daughter for her first contact lens fitting, the
woman overjoyed to find a botox injection would restore the sight previously hindered by her droopy lids.  Even the doctors appeared as if there was nowhere they would rather be than reassuring  a patient about dry eyes, or excitedly scheduling the LASIK
appointment for a new patient. The entire atmosphere was friendly, relaxed, and above all, personal. The doctors really knew their
patients, not just as a differential or problem list, but as people.

Just prior to leaving for medical school, I underwent LASIK myself, a
patient with an in depth knowledge of my condition but no less
concerned about someone cutting open my eye, regardless of the size of the blade. The doctors, along with their staff, provided just as much information and support as if I had walked into
their office devoid of any technical knowledge.  I left to begin my own
medical training with clearer vision in both body and spirit

As I went through my
third year, I enjoyed the majority of my rotations, especially the ones
wherein I had more opportunity to interact and follow up with a patient
beyond the initial admission, learning more about them than just the
reason they came to the hospital. Despite that, I never seemed to feel that one “ah-ha!”
moment, that snapshot that we are all told will come to us when we have found
the right field.

Until, that is, I decided revisit the field of ophthalmology, doing a rotation near the end
of my third year. All of a sudden, everything seemed to come into
focus; no matter how many patients I saw, or how complicated they were,
I felt confident and the days just seemed to fly by.

It is said that hindsight is always 20/20. While I didn’t know it at
the time, my early experiences in ophthalmology focused my interest
enough to try it again in medical school, only to find that both my
desire and enjoyment of the field has been magnified a hundredfold.
Everytime I use my digital camera to capture a random face, or set up
my tripod to shoot a landscape, it reminds me of how happy I am to have
“perfect” vision and I would like to work toward giving others that
same opportunity. So I am taking my shot…all that remains is to see
what develops

–

SO folks, do you think this is ready to submit to my advisor, or can you help me get to a round 4,5 or dare i say 6? Not to mention that I have to pound out another personal statement for internal medicine in the event i dont match (knock on wood)

33 year old prison patient complaining of rectal bleeding.

Why, are you wondering? Well, just before this gentleman got arrested, he stuck a straight edge razor blade up his behind to “protect himself in prison”

I will pause while you all let the implications of that sink in.

Contrary to the initial thought i am sure we all had…his plan was not to have a razor in his ass to prevent rape (scary thought that is) but to have a shank all ready for him for the everyday prison fights, not the shower, slippery soap related ones.

Except, when he withdrew the razorblade from his anus, it had sliced open the wrapping he had covered it with, and consequently also tore up his rear end on the way out. So he still ends up going to prison with a sore and bleeding ass.

Tragically amusing.

For the first time today, i came up with a plan all by myself.

Normally before we round, I will get a chance to at least run my history and physical by the fellow and discuss the plan i have come up with. This will be followed by a discussion of “yes thats good, or no do this and here is our justification for it” type of dialogue

But today our consult service was swamped with more patients than we could take care of before rounding, so when the time came for me to present to the attending, I was in the hot seat flying solo. And I made my way through it. I went over the H and P, the lab values, all the usual things with little to no commentary by the attending asking for more information, since i was providing all the necessary data.

Then when he asked me what i wanted to do, I had both a differential ready and a plan.

“Well, given his active bleed and previous history of gastric AV malformations, I would like to do both an EGD and a colonoscopy.”

Fairly simple, right? Well, at least in the context of most people being consulted to GI get one or the other. But that is beside the point. For the first time, I was the one who decided it should be done, and I justified it. And the attending agreed with me. given the symptoms i described, he said it was a reasonable plan. Then when rounds was over and we moved on to staffing the patients, the fellow was confirming with me that my patient was on the list for colonoscopy for tomorrow. I told her, EGD too unless she didnt think it was necessary…still nursing that bit of doubt, i guess.

All she had to reply was, well its your plan, just make sure you notify the primary team so he can be prepped.

No one argued, or corrected, or even made a teaching point out of it. I saw the patient, and based on my evaluation, and my evaluation alone, he is going to have these procedures done.

Now THATS validation.