Pigg-o-stat

Well folks, meet the Pigg-o-stat. Also known by its more PC name, the Pediatric Immobilizer and Positioner. Although it looks like some kind of Medevil torture device, it's actually used to "immobilize" squirmy, wiggly little ones while we attempt to get a chest x-ray of them.

It's interesting to note the look on the kid's face in the pictures. I assure you they don't often look like that in real life. Most of the time they are screaming their little lungs out (which, consequently makes for a better chest x-ray) with snot running down their face.


Luckily, the whole procedure takes about as much time as it takes you to tie your shoes, but that doesn't mean the first sight of the thing doesn't scare the hell out of the kid, or the parents for that matter. For obvious reasons it's only used as a last resort, after all attempts to manually immobilize the child have been exhausted. Also, the children it is used for are often so small/young, they wont remember the whole traumatic experience and soon after being liberated from the dreaded apparatus are back to happily sticking legos up their noses as toddlers have done for centuries.....well, decades anyway.

Usually, the parents are asked to don lead shield aprons and sit with the children for reassurance during the exam, but ultimately it rests on the radiographer to make the patient as comfortable and non-traumatized as possible. I am not looking forward to the first time I have to put an itty-bitty patient in one of these contraptions. Let the screaming commence.

VVMC

Verde Valley Medical Center. That's the name of the site for my first clinical rotation!!! VVMC is in Cottonwood, Arizona, a sleepy little desert town of about 10,000 people located in the high desert of central Arizona. Although the city itself is small, the hospital services much of the rural population of central Arizona.

View from Tuzigoot Monument near Cottonwood, AZ

I can't believe how everything played out. As I have explained before, the way the draw worked is that the names of everyone in my Outer Site group (i.e. sites not located in the Phoenix metro area) were put into a bowl and our instructor pulled the names one-by-one at random. As each name was pulled that person got to choose which clinical site they wanted from a predetermined list of hospitals and clinics that our instructors gave us. As luck would have it, I was the FIRST name pulled. Can you believe that!!! I never have that kind of luck.

Unfortunately, the day before I had found out that Flagstaff Medical Center was not accepting students this semester, so I had decided my second choice was Verde Valley Medical Center in Cottonwood. So of course I jumped on VVMC and am now officially assigned to that site. Cottonwood is about 65 miles or an hour's drive from my apartment in Flagstaff. So, althoug it means a lot of driving, I will be able to live at home in Flagstaff with Becky and Imara again. Yay!!!

In a few weeks, I will be contacted by my clinical instructor and will have to visit the hospital for an orientation meeting. I can't wait to get started. I wish I didnt have to wait until mid-August for clinicals to start. :-(

I apologize for keeping you all hanging regarding which site I got. Its just that I was sick for a few days after the draw and spent most of the time in bed, then we drove out to Santa Fe, NM this weekend for a friend's wedding, and I just got back last night. Santa Fe is a beautiful city and I hope to post some pics soon. Stay tuned. :-)

Clinical Site

Most people look forward to the end of the day. They long to flop into bed, ready to say hi to Mr. Sandman. I do too. Or at least I did until last week. I havent slept more than a few hours each night for the last several days. I lay my pretty little head down at night and sit and stew. I worry about where I will end up for my first clinical rotation.

I just found out today that Flagstaff is not accepting students this semester for clinicals, so that choice is off the board. My next choice is a hospital in the small town of Cottonwood, AZ, which is about 65 miles from Flagstaff, just close enough for me to live at home in Flagstaff again and drive each day to clinicals. Sure it means a lot of driving, but if it also means I get to live at home with my wife and cat, not pay two rents each month and have one food bill, then so be it.

Unfortunately, I am not assured this site. The way our system works is that everyone's name is put into a bowl and our instructor pulls the names from the hat one by one and that is the order in which we get to choose our site. A so-called "random" drawing. Not so random for me since I have just about the worst luck with this kind of thing as any human on earth living or dead.

Anyway, I'm in competition with at least 10 other people who want the same site as me. Granted I have 2nd, 3rd, 4th, 5th, and 6th choices, but I would rather not fall back onto those, as they would entail endless driving, double rents, and a prolonged absence from my family (family = Becky plus cat), who I have grown quite fawned of as of late.

For these reasons, I have found it difficult, if not impossible, to get to sleep and stay that way for the last week or so. I know its silly because there is nothing I can change until the day we draw, which is tomorrow by the way, but still my little brain gets to working, and worrying, and I run over all the scenarios in mind until I'm so worked up sleep is not even on my radar anymore.

At least by lunch time tomorrow it will all be over one way or another. I just hope my historically bad luck takes a turn for the better and I get the site I want. I really need some stability right now, and actually living at home again would really provide that for me.

So if you happen to see a falling star tonight, please keep me in mind when you do your wishing. I will probably be up all night anyway, and I plan to do a lot of wishing of my own.

Word of the Day

Defecography!!!

Defecography is a functional study of the distal colon, which includes fluoroscopic or radiographic imaging during defecation and is used to evaluate fecal incontinence and other functional problems of the lower GI.

If you can't tell, this chapter in positioning has to do with imaging the upper and lower GI (Gastrointestinal) system and there are several new procedures we have to learn, one of them being defecography.

Defecography is not an uncommon procedure and it can be performed at most hospitals and imaging clinics. However, in my opinion, the way they go about getting the images is a bit.....ummm odd.

In order to visualize soft tissue (e.g. parts of the digestive tract), a contrast material must be used. A contrast material, often just called contrast, is a substance that is radio-opaque, or does not allow x-rays to pass through it, and shows up as white on the radiograph (aka x-ray image). The contrast material most often used for contrast studies of the GI system is barium sulfate. Barium usually comes in liquid or semi-liquid form and generally has the consistency of pepto bismol, so that it coats the walls of your GI tract and also does not pass through too quickly. It's administered either orally or via a barium enema.

Defecographs are different in that they are a functional study and the actual movement of the colon is observed using fluoroscopy, a sort of live, moving x-ray. But for the colon to be able to act on the barium contrast in order for the radiologist to observe function, the contrast must have a thicker consistency than a pepto bismol-like liquid.

Here is where it gets interesting. A common practice among radiographers is to mix the regular barium liquid with freeze-dried instant potato flakes in order to obtain the proper consistency. Of course, other substances have been tried, but most don't offer the proper consistency, even dispersion of barium and "cost effectiveness" as simple, over-the-counter instant potatoes.

So if you ever have the need for a defecography study, just know that somewhere in Idaho a farmer worked very hard on his harvest just so the doctor could get a good look at your large intestine in action.

the average adult human's digestive tract, from the mouth to the.....err ah...other end, measures about 30 feet long. That's about the length of a school bus from bumper to bumper.

Update: Flagstaff Wildfire

Taking advantage of the cooler temps and higher humidities during the night, fire crews were able to get a handle on the Woody Fire buring southwest of Flagstaff. Below are two links to articles about the fire.

Wind-whipped wildfire forces evacuations

Fire Update 1:30pm Thursday - Arizona Daily Sun (Flagstaff newspaper)

I'll post more updates as I know more.

Wildfire in Flagstaff, AZ

Video of smoke from the Woody Wildfire 2 miles west of Flagstaff, AZ.

Wildfire in Flagstaff

Well, it finally happened, a wildfire started in Flagstaff. Its called the Woody Fire and it started yesterday morning right next to I-40 about 2 miles west of Flagstaff, which is about 1 mile west of OUR apt!! I wasnt up there but I've been able to get a lot of info thru the news and from Becky.

As of last night it had burned a 1 mile stretch of ponderosa pine forest from I-40 up to West Route 66, and was expected to jump across 66 as it moved northeast. Several areas were evacuated by police and fire crews north of the fire including 3 trailer parks and the Lowell Observatory.

They blocked off Route 66 and with all the gawkers, traffic in town was in chaos. Becky took some pictures and video of the smoke as it rose up over the city. Here are some of the pictures she took.

Smoke as seen from our apt parking lot.

View from intersection of Woodlands Village Blvd and West Route 66 in Flagstaff, AZ

Same view as previous picture after smoke has moved.

Helicopter works at dropping water on the fire as the sun begins to set.

Map I made in Google Earth showing the location of the fire in relation to where our apt is

Unfortunately the weather is prime for starting and encouraging fires right now. Flagstaff has sustained winds of 25 mph and the humitity is around 5% with a dew point of 2 degress (i.e. VERY dry!) The temps are starting to rise too and are expected to hit 85 degrees today, which doesnt help any.

They called in fire crews from around the state in a hurried attempt to control and beat back the fire and keep it from moving toward town. The latest news says that the fire is progressing at a surprisingly slow pace for the conditions which has allowed the crews to keep it from crowning, which is when the fire moves from the forest floor into the tops of the trees. As you can see in the pics the smoke is a light, white color which means the fire is on the forest floor. when the smoke turns black it means that the trees are starting to burn, which usually leads to an increase in the speed of progression.

Its pretty scarey. We arent directly threatened at our apt, but it isnt too far off. fires like this can really take off fast and get out of control in a very short amount of time, especially in these conditions. Luckily Flagstaff had instituted the practice of forest thinning and deadfall removal in the forested areas in and around the city, which helps control or at least slow down the spread of fire. The states fire commissioner says that is a major reason the fire has not grown much in the last 24 hours.

I will try to keep up on whats happening up there, although its hard from Phoenix.

Wish us luck.

Open mouth. Insert foot.

Open mouth. Insert foot.

Video of Bush making fun of a reporter for wearing sunglasses on a cloudy day. He later finds out the reporter is blind. oops.

¡Que idiota!

The 3-second rule does not apply in the operating room.

Culture Clash

Eve at RN2B1Day brought up a good topic recently on one of her posts. This is a quote from her site that sums up the main idea if the post:

“we were told that we had to be careful of how much eye contact we made with other people because it could be intrusive and/or a sign of disrespect. The explanation was that some cultures do not like eye contact and that we had to be weary of this. A couple of instructors said eye contact made them nervous or that they thought it was rude.“

She was confused by this, because she had been taught her whole life that making eye contact was a sign of trust and interest in the other person. Which I completely agree with.

However, it’s important to realize that not all cultures interpret certain behaviors the same way. This is very evident for me because I live in the city of Flagstaff, Arizona, which is right next to the Navajo and Hopi Reservations in northeastern Arizona. Understandably, there are sometimes “misunderstandings” when people from the Navajo or Hopi cultures interact with “white/Western” culture, and vice-a-versa when tourists travel through the reservations.

I've had some experience with cultural differences. When I worked at a museum in Flagstaff, I often worked very closely Navajo and Hopi volunteers. When I would first meet them they would be very reluctant to shake hands and if they did they almost never made eye contact. I later learned that (traditionally) in their culture making eye contact is often perceived as an aggressive or overly personal behavior. Once I found this out, I had a better understanding of my volunteers’ behavior and didn't take it personally.

Working in medicine can be an especially slippery slope. Often medical workers need to ask patients very personal and private questions and sometimes perform very invasive procedures on the patient’s bodies. This can be traumatic and off-putting for anyone, but especially those who have never had experience with Western medicine.

In my opinion the best thing one can do is realize that these differences do exist and to be sensitive to them. It is likely that if a person is being treated in an American or Canadian hospital they are at least somewhat familiar with our basic cultural norms and will have some idea of what to expect. At the same time, you should keep in mind that most patients (from this culture or any other), are sick and scared and wanting to be anywhere else at that moment than stuck in a hospital bed in your hospital. Try not to take it personally.

PS a great book to read on this topic is one called "The Spirit Catches You and You Fall Down" by Anne Fadiman. It is the story of an immigrant Hmong family with a very sick child and their experiences with Western culture and medicine.

Factoid #1769

How to Contract TB: Go to Milwaukee, Wisconsin. Ride public transport. Repeat.

Frickin' HOT!!

Well, the big news in Arizona right now (besides the first wildfires of the season) is the HEAT. They are issuing heat advisories for Phoenix, Tucson, Yuma and several other lower-elevation cities. Below are some screen captures I took from the Phoenix news today.

The temp at the time of broadcast (5:15 pm)

The high today. WOW, we matched the record, lucky us! (note the sarcasm).

The projected lows for tonight. Still frickin' hot. Notice Flagstaff though,
comfortable 45 degree, ahhhhhhh!

The projected highs for tomorrow. Thank god I'm in Flagstaff this weekend, a perfect 85 for us!

Look what I have to look forward to, yippee skippy. (again note the sarcasm).

I hope I survive the week and don't end up as a big, fleshy puddle on the classroom floor, ewwwwwwwww!

I suffer from Golf Balls

A man entered the bus with both of his front pockets full of golf balls, and sat down next to a beautiful - you guessed it - blonde. The blonde kept looking quizzically at him and his bulging pockets. Finally, after many such glances from her, he said, "It's golf balls". Nevertheless, the blonde continued to look at him thoughtfully and finally, not being able to contain her curiosity any longer, asked "Does it hurt as much as tennis elbow?"

Cheese

I've thought about it and, if it didnt involve massive weight gain and eventual death by malnurtition, I would subsist on a diet composed entirely of cheese and cheese related products.

Some day I hope to make it so.