old men with broken teeth stranded without love

(Odds are Dylan wasn't intending to describe the patient population that comprises the vascular surgery service at the VA, but he did a pretty good job of it nonetheless.)

So, I'm back! Surgery clerkship is over and done with, and I have been a Very Bad Blogger for the duration of it, but frankly, there's enough whining on the internet, and I didn't have anything really positive to say. In summary, now I know how to: do a guillotine amputation, dress a lot of really nasty wounds, distinguish a mono- from bi- from tri-phasic arterial Doppler signal, recognize gangrene at twenty paces and keep my head down while angry people in nicotine withdrawal shout and cuss a lot. Valuable lessons indeed.

General surgery was far, far better, but still not what I want to do with the rest of my life (seriously, if I ever see another *^#%# hernia repair it will be too soon), and I'm happy to leave the OR behind for now. I'll have at least two months of gen surg during residency, but we'll cross that bridge when we come to it.

Speaking of residency, a decision has been made! I'm (99.9% sure that I will be) applying for family medicine residencies, and I am going to be spending June and November in Manhattan, checking out Beth Israel and Columbia-Presbyterian, respectively. The away electives are still pending some paperwork, but I think family med is going to be my eventual destination. As such, I am completely delighted to be on my family med clerkship, which has been really fascinating so far.

I start my outpatient clinic next week, and so this week I've been working downtown at Care Alliance, a clinic for the underserved. I don't know the exact specifics regarding who qualifies for care, but a number of the patients are homeless and most are uninsured. It's been a pleasure to be back in a primary care setting, and I've been really enjoying working with this population. I understand how chasing an obscure diagnosis can be really intellectually exciting, and there's the thrill of stabilizing and managing the acutely ill patient, but... seriously? A free bottle of hydrochlorothiazide (a super-cheap diuretic, used to treat high blood pressure and heart failure) can make an incredible difference in somebody's life, and hopefully prevent that somebody from landing in the ED retaining 40 kilos of water and unable to breathe.

So I'm still getting excited about preventative medicine, which bodes well for the whole family med thing. I'm going back to Care Alliance tomorrow, but today my big adventure was tagging along with one of the staff at 2100 Lakeside, a men's shelter downtown. The day included: a discussion with Cleveland PD regarding this hostage situation, a board meeting for another shelter in town, an hour-long intake interview with a new client, and a tour of five of the area's homeless shelters. It was a pretty busy six hours. (Generally, on this day of the rotation, us medical students shadow a nurse who drives a van around town providing mobile medical care for the homeless, but she was off today, so I saw the more administrative side of things, which was probably more of a unique opportunity.)

All and all, it's been a great week, with more professionally interesting and satisfying patient encounters than I had over all five weeks of surgery, so... three cheers for primary care! I've also had the opportunity to get my life back in order, and have gone to the gym, done some knitting, started a non-medically-oriented book, and even cooked dinner a couple times. And blogged! Which will hopefully be a more frequent occurrence from here on out.

title from "Shelter from the Storm," Bob Dylan