Falling Apart Part 2

I went to my family doctor Monday with mixed results. I knew the spot on my thumb wouldn't be gone after Monday's appointment, but I was kind of hoping she would be more confident with her approach. She kind of had a "we can try and see what happens" approach, which I know is being realistic, but I was hoping for a more optimistic outlook. She has a freezing machine that is more powerful than what you can buy at the pharmacy, but isn't as powerful as what dermatologists use (liquid nitrogen). I decided to give her a chance and use her freeze. I will try a few rounds and see how it goes, otherwise I am going to ask to be referred to a dermatologist to try to get rid of this thing. She also put me on a healthy dose of vitamin C to help boost my immune system. This is obviously going to be a multi-week process so I am hoping to show some progress each week. I am hoping that if I follow up properly we can get rid of this over time.

As far as the toe goes, she didn't have much to say about it. She said it can take a year or so for the nail to grow completely out (already knew that) and that most of the nail looks dead (already knew that). She said she would look at it again at my next appointment and maybe put me on an antifungal because I might have an infection preventing the nail from growing properly. Who knows? The fungal medication takes several months to completely remove the infection, so it's going to be winter maybe before this thing is gone.

The spot on my thumb is my number one priority as people can see it - I usually have my feet pretty well covered. If I end up going to the dermatologist I will probably have them look at my feet too, though I might have to go to a podiatrist. Luckily we have a lot of them at the hospital I work at so I shouldn't have a problem finding one.

Screensaver Content Update Finished

It always amazes me how 100 pictures from an event will pop up within a week of the event, then the thread will go dormant for several years and then out of nowhere 4 or 5 very high quality photos will appear. This was the case this time around for the update as most of the "new" pictures added were actually pictures from older events that I had never seen before. Unfortunately this played havoc with my update process as most of these pictures were in a thread titled "Rare HQ Pictures" instead of being in their own thread with the title of the event. To make a long story short, lumping photos from multiple events into one giant thread makes it much more difficult to avoid repeat pictures in the screensaver. I could create my own folders with generic titles (I don't know the names of most of these events) but that would be taking a step backwards in my opinion as that is how I used to manage things. Adding pictures from new events was no problem, there were just more older pictures than newer pictures.

Making matters worse was the fact that Picasa is still acting up. It is not wanting to shut down properly, and when you force it to stop it only saves your work sometimes. I had to repeat work several times during this update process. I have been using Picasa for several years and this is the first time I have ever had problems with it. This version is quite buggy and I can't wait for a new version to be released. It is so unstable I can't use it sometimes. And it is really frustrating because I use it to geotag and name tag my own personal photos in addition to managing this screensaver. Very upsetting.

At any rate, I did get this little update project finished. There are some repeat pictures in there so it is a little more sloppy than usual. I will try to clean it up sometime in the future but it really begins to be a question of time and desire, and at this point I have little of either. I might shut the door on pictures from old events and only use newer pictures. That would help a lot I think. Also having an image organizing program that was reliable would help too.

Below is a screen shot to get a behind the scenes look on how this is all put together.

The Ballad Of Gay Tony

System: PS3
IGN Score: 9.2
Release Year: 2010

For political reasons The Ballad Of Gay Tony (TBOGT) was released over a year on the PS3 after it was released on the XBox 360. Ordinarily this would annoy me but it really worked to my benefit this time around as I didn't even have a PS3 a year ago and I had some time in between games to fill. There are two ways to buy this game. You can buy the disc "Episodes From Liberty City" which includes both TBOGT and "The Lost and Damned". This disc costs $40. I really have no interest in The Lost and Damned, so I opted to download TBOGT for $20 off the PSN. This requires that you have the GTA IV disc, which I do, so that wasn't a big deal.

TBOGT places you right back in Liberty City. You play Louis Lopez, the right hand man of club owner Tony Prince, aka Gay Tony. The events of this game take place at the same time as the events of GTA IV, and the game opens up with Louis at the Bank of Liberty which is being held up by Niko and his gang from GTA IV. Right away Louis establishes himself as a strong character with a level head. He is very likable from the get go and reminds me a lot of Tommy Vercetti from Vice City. Obviously from the opening scene Louis and Tony are involved with the bank heist from GTA IV, and later you learn about their involvement with the diamond theft from GTA IV (along with the fate of these diamonds). Tony's clubs are failing and you are sent on a number of over the top missions involving over the top characters. Tony gets involved with Russian and local gangsters and you spend the entire game saving Tony's tail and meeting people of your own. Probably the most memorable character is Yusuf Amir, a rich middle eastern property developer who is interested in all kinds of crazy ideas. Another character is Ray Bulgarin who is interested in buying the Liberty City Rampage hockey team at any cost. See the wiki article for the complete plot.

Perhaps the best part of the game is the BASE jumping. There are a number of missions that involve flying and jumping out of airplanes (or buildings) to get to safety. There are even various spots around Liberty City where you can base jump either onto moving vehicles or targets on the ground. One of the more memorable stages is where you kidnap a gossip blogger saying negative things about Tony, push him out of a flying helicopter, then you jump out of the chopper and catch him in mid air to save him. Like most of the characters in this game, the stages too are quite over the top but mostly a lot of fun.

As mentioned, this game takes place in GTA IV Liberty City so the confusing streets and traffic jams are back. Thank heavens for the GPS feature.

This game is a steal at $20. It takes around 10 hours to complete, and the entire game is quite enjoyable. There are a lot of memorable characters, Louis and Tony are both likeable, the BASE jumping is fun, and the stages are fun. There is also plenty of good dirty humor to go along too in typical GTA fashion. I would definitely recommend this game to anyone who is a GTA fan. It really is a lot of fun.

Falling Apart

I've never spent too much time in a doctor's office as a patient. This is partly because my dad would treat us when we were younger and had minor problems like sinus infections. It's also partly because I am young and pretty healthy and just haven't had a need to go to the doctor. With that being said, I have noticed a general decline in my overall health over the past few years. Nothing major has happened, just small things here and there. I think I have been spending too much time reading and learning how to take care of other people that I have forgotten to take care of myself. Now that I am going to be stationary at least for the next few years, I thought it was time to finally take care of some stuff.

When I woke up this morning, everything was fine. I put in my left contact, and before I was able to put in the right contact my left eye became severely irritated. This is the second time in about six weeks that this has happened to my left eye, and third time overall. Last time Sarah could see something trapped under my eye lid, but she couldn't see anything this time. Sarah drove me down to the hospital where I work but unfortunately the one doctor I was going to see was in a meeting. As we were waiting, I was talking with another doctor about it and he suggest that I go see an ophthalmologist since this has happened twice in the past couple of months. I thought that sounded like a good idea so I scheduled an appointment for this afternoon. In the meantime, my eye now feels much better, although it is still a little irritated. I am really hoping he says I have a corneal abrasion and that it is just coincidence that it happened twice so close together. I hope it isn't something wrong with my contacts. It just seems weird to me that I would have such severe reactions to an eye lash being in my eye. Most people just blink their eyes a couple of times and the lash falls out.

Secondly, I have had a wart on my right thumb for nearly two years. I have never in my life had a wart and I really think I picked this thing up from a patient while on rotations. Anyway, I have tried everything imaginable to get rid of this thing. I have tried compound W and over the counter freezing stuff from the pharmacy. I have tried duck tape and covering it in Aspirin. I have tried freezing stuff at doctor's offices. I have even had it surgically cut out and it returned. This thing is really challenging modern medicine. For whatever reason, my body is refusing to mount a immunologic response on the distal part of my thumb. I keep on thinking it will eventually go away, but it won't! It doesn't bother me much other than it is an eye sore so I am prepared to get really aggressive with it now. I have an appointment next Monday with a family doctor to try to get rid of it. I am also using this as an excuse to establish a family doctor that way whenever random stuff like this goes wrong I will have someone to turn to.

Once the wart is gone, I have a subungual hematoma on my right great toe that has been there since last August. I keep thinking that the nail will grow out and take the dried blood with it, but that doesn't seem to be happening. I can't notice any change in it since it first appeared. It didn't bother me much during the winter months, and it never hurt, but now that summer is approaching I wouldn't mind wearing sandals occasionally and this thing is hideous looking. So I need to get that taken care of too.

Here in a few months, when my dental insurance kicks in, I need to make an appointment with a dentist too. See what I mean about random things going wrong? I didn't have these problems while in college, and they are so random too. I probably need to start exercising too as my cardiovascular stamina is as low as it has ever been in my life, but that is a whole different topic.

Perfect May Day

Spring is my favorite time of the year. The days get longer, the temperature warms but it isn't too hot to be uncomfortable, and I love the spring time showers we get (not the thunderstorms so much, though). It is the best time of the year for sports too as racing starts, you get the NCAA tournament, and the NHL playoffs. In particular, May is a great time to be in Indianapolis with the 500 and all of its festivities. Unfortunately I will not be able to attend the race this year as I will be out of town for graduation. Carb day and pole day are out too as I have work and a wedding to attend next Saturday. So I decided to head down to the track yesterday to see and hear the cars for opening day of practice. It was a lot of fun to see (and hear) the cars going around the historic track. I think Sarah enjoyed it too as she has never seen the Indy Cars go around the track, just F1. It is nice to go on a day other than race day as it only cost $5 per ticket and the crowds are much, much less of a hassle. We stayed for a few hours until it started to sprinkle then we decided to take off.

Next we went to Broad Ripple with plans of attending the Broad Ripple Art Fair. It was quite overcast at this point and trying to rain so we decided to grab something to eat first. At this point I want to introduce a new section on my site about restaurants. There are a ton of good restaurants in the Indy area and Sarah and I like to go out and try new ones when we can. Broad Ripple has a lot of cool local restaurants and since we were already down there we had the opportunity to try a new restaurant. We decided to go to the Broad Ripple Brew Pub. It's a restaurant I have heard of before and it was mentioned in the most recent Indianapolis Monthly "Best Restaurants" issue.

Broad Ripple Brew Pub
Cost: $ (with $ = average price around $10 or less, $$ = $10-$20, $$$ = $20-$30, and $$$$ = $30 or more)

If you are going to go to the BRBP, I'd suggest going during a nice day when it is light out still and sitting outside. Sarah generally hates sitting outside and we elected to sit inside because there was no wait but the inside is quite dark. I think it would be better to sit out on the porch on a nice day, plus you get to do some people watching on the Monon trail. I decided to get the bison burger and Sarah got the Drunken Tortelloni. We were both satisfied with our food. My bison burger was cooked perfectly and was quite tasty. Being a brew pub, I decided to get a locally made beer. I ordered the Lawn Mower Pale Ale, which I was told was their Miller Lite equivalent. It was just OK. It tasted kind of like dish water honestly. The service was decent. The waiter was really nice but kind of slow. He apologized once about being slow. I think we was getting hammered at another table. I wasn't in any hurry and it really wasn't that big of a deal.

I am going to give the BRBP 3 out of 5 cheeseburgers. Let me explain my ranking system here since it is the first time I've reviewed a restaurant. One cheeseburger means it is awful and I would never go there on my own and would refuse to go there if I were in a group and they wanted to go there. Two cheeseburgers means it was pretty bad but I would probably be willing to return if I were with someone who wanted to go. Three cheeseburgers means that everything was fine and I would probably return if I were in the neighborhood but wouldn't necessarily go out of my way. Four cheeseburgers means everything was really good and would definitely return in the future. Five cheeseburgers means it is one of my favorite restaurants and would be a place I would take guests or families it is so good.

Putting Me To Sleep

One of the great things about being in the medical field is the great diversity of jobs. Not only is there great diversity among the different specialties, there really is a surprising amount of diversity within each individual specialty. Location, patient population, and personal interest are just some of the things that dictate what you will do on a daily basis. With all of these choices, it is obvious to think that there are some specialties in medicine that I am interested in and other specialties that do not interest me as much.

With that being said, I decided to do anesthesia for my final rotation before graduation. I have done several rotations where I am on the operating side of the table but honestly know very little about what goes on on the other side of the drapes. I figured this would be a good opportunity to get introduced to an aspect of medicine that I have not been around much.

Anesthesia has been simultaneously fun, interesting, boring, and frustrating. First off, the attending that I work with and all of the CRNAs at the hospital have been great. My attending actually sits down with me everyday to go over lectures on reading assignments one on one, something you would never get at a bigger program and one of the advantages of working and learning at a smaller hospital. Plus he is super laid back and easy to work with.

Obviously I won't be doing epidurals and spinals and all of the fancy things that anesthesiologists do in the future because I am not going into anesthesia. With that being said, there are certain aspects of their job that apply to all doctors, regardless of specialty. In anesthesia, if all things are going well (i.e. the patient isn't trying to die during the procedure), all of the excitement occurs at the beginning of the surgery. This is when you are pushing all of the medicines and preparing the patient for sedation, amnesia, and analgesia. Part of this involves securing an airway. Even if you aren't going into anesthesia, any health care provider should be able to secure an airway in order to handle patients who are crashing.

When taking care of a crashing patient, we are taught to take care of the ABCs - airway, breathing, and circulation - in that order. Obviously an airway is of utmost importance. There are a few ways to achieve this, but the best way to get an airway is with endotracheal intubation. Now you would think it wouldn't be that difficult to shove a tube down someone's throat in order to oxygenate them, but you would be wrong. I blame 80% of this on lack of experience and 20% on the fact that so many people are fat and have poor dental care. It can be surprisingly difficult to establish an airway and it is one of those things where since I have graduated medical school one might think I would be able to do this with no problem. In reality, it takes very little medical knowledge to intubate someone - it just takes hands on practice. This is one of the most frustrating parts of medical school in general. I have a pretty good foundation for a variety of medical diseases (most of them rare that I will probably never see), but come in with something simple like a sprained ankle and I will have trouble knowing exactly how to handle the situation. You feel useless and dumb despite a pretty significant knowledge.

However, I have a back-up plan! If someone is crashing and needs an airway and I am struggling with the ET tube, I can always mask them! Once again, you wouldn't think putting a mask on a person's face and squeezing a bag full of air to force feed O2 down their throat would be hard, but even doing that can be challenging. It seems like no matter how you position the mask air escapes out the side somewhere. Then I am stuck there like a schmuck thinking about how I have spent >$200,000 and I can't do the A or B of the ABCs to keep a person alive. This lack of applicable skill is really one of the most frustrating parts of being a medical student. Obviously residency is designed for you to acquire such skills.

Oh yeah, I mentioned this stuff being fun. Despite the frustrations, it is fun to get in their and try. And don't think I can never get this stuff to work. I can sometimes, just not often enough for me to be satisfied and not frustrated.

Pearl Jam

The 2010 concert season opened up for me Friday at Verizon. The weather started out questionable as little showers popped up here and there. There were storm warnings in the area and the gates didn't open until 30 minutes after the opening act was set to begin. It was all very strange and I don't know if that was because of the weather or for some other reason. Once in, the opening act started immediately and played only about 5 songs before they went off stage. This was followed by about an hour of silence. Like I said, the whole beginning of the evening was quite odd.

Pearl Jam took stage right as it was getting completely dark, and put on a good show. They played all of their big songs and sounded good. The weather cooperated as well as the rain and storms stayed away.

Thanks to SC for picking us up afterwords and to BoilerPip for coming along.