~ Christmas Morning Casserole from The Nebraska Cookbook

It has been a long time since I posted any recipes and sort of a long time since I really got back into blogging.  I really enjoy it and need to get back into the daily updates so that I can keep in touch with the world and those that are interested can kind of keep in touch with me and what I am doing.  I thought I would start this Wednesday off with a couple of recipes that we tried a long time ago.  The first is the Christmas Morning Casserole from The Nebraska Cookbook.  It was a pretty good dinner when it was fresh out of the oven.  However, this is not a casserole that can be utilized as left overs and really should be utilized when there are a lot of family members around to help eat it in one sitting.  For the initial taste and quality I would give it a 7/10 and for ease of preparation I would have to give it an 8/10.

Ingredients:  1 32 oz. package frozen hash brown patties, thawed; 4 eggs; 1 can (10.75 oz.) cream of mushroom soup [because of Jen’s distaste for mushrooms we used cream of celery]; 2/3 cup of milk; 2 cans (4 oz. each) mushrooms [we did not add this ingredient]; 2 tablespoons butter, melted; 2 cups cooked cubed ham; 2 cups shredded cheddar cheese.

Recipe:  In a 13 X 9 baking pan, layer hash brown patties.  In a bowl, beat together eggs, soup, and milk.  Stir in mushrooms, butter, and ham.  Pour mixture over hash browns and sprinkle top with cheddar cheese.  Bake at 375 degrees F for 45 minutes.

~ Santa Fe Turkey Stew from A Man, A Can, A Microwave

This recipe really did not look anything like the picture that they had in the book.  The picture really looks horrible, but I really encourage people to try this recipe especially with football season right around the corner.  This is an excellent dip for tortilla chips.  It does not look like it would be appetizing at all, but looks can be deceiving and this dish saves well and is easily reheated in the microwave.  Upon eating the left overs it tasted like it was just made that day even after 2-3 days in the fridge.  For taste I would give this dish a 9/10 and for ease of preparation I would give it a 10/10.

Ingredients:  1 lb. turkey breast tenderloins, chopped into bite-size pieces; 2 10 oz. cans enchilada sauce (we used both hot, but the book states 1 mild and 1 hot); 20 oz. can hominy, well rinsed and drained; 4 oz. jar chopped mild green chiles, drained; 1 green bell pepper, chopped; 1 tablespoon olive oil; 3 minced garlic cloves; 3 sliced scallions; 1/2 teaspoon dried oregano; 1/4 teaspoon ground cumin.

Recipe:  In a 2 quart microwave safe bowl, stir the turkey and bell pepper with the oil until good and greasy.  Cover tightly with plastic wrap.  Nuke for 4 to 6 minutes, stirring once, until the turkey is almost white in the middle.  Mix in the rest of the ingredients.  With the dish uncovered, nuke for 25 to 30 minutes (stirring a few times), until the sauce is bubbly and slightly thickened.

~ Creighton’s First Photo

Creighton is here.  He arrived on Sunday morning at 10:39 a.m.  He weighed in at 7 lbs. 8 ounces and was 19.5″ long.  He came out screaming and received Apgar scores of 8 and 9 out of 10.  He was so perfect.  I know almost any parent will say that about their own child, but he just looked so perfect.  His back was perfectly in line, no cleft lip or palate, no low-set ears, nothing.  He was perfect.  He owes all of that to his mom and the terrific care she took of herself while he was in there.

The birth was more eventful than I would have liked it to be and he was already proving to be very stubborn.  Jen did such an amazing job with all of it though.  I have to say thank God for the epidural though because it would have been a very long and painful process otherwise.  Jen’s water broke at about 11:15 p.m. on Saturday night, I got home to take her to the hospital at about 1 a.m., and she labored all the way until 10:39 a.m.  He continually got stuck in the pelvic canal and bless Jen’s heart she continued to push with all her might.  They finally made the call to go with the vacuum to help Jen out and once that was attached it was about three pushes and he was born.  I reached over to him after he was born and cut the cord.  As I did he grabbed my hand and we were bonded for life.  I know that it was just his grasp reflex taking over, but it still won my heart unlike anything else in this world ever has managed to do.

It is pretty amazing to think that he was born at the hospital that both Jen and I got our training for medical school.  It was such a great atmosphere because everyone knew us and treated us well.  We had tons of visitors and they gave us a room that we really should not have received considering our payment methods.  However, the staff treated us amazing and I will never forget or regret the day my son was born here in Oklahoma.  I am confident that there would have been no better place.  Because he was born here in Oklahoma he is an automatic American citizen.  It should really help with Jen’s applications and green card situation, but I do not ever want him to forget about that great country to the North where most of the great clothes and support has come from.  In his baby room right now we have both the American flag and Canadian flag hanging proudly to represent the wonderful combination of heritage that he is.

We have been home for one night thus far and it has been quite a challenge.  Jen has been amazing at getting up with him and feeding him.  I have tried to help but it is really tough because we are still waiting for the milk to come in and the ability to pump so that I can feed him.  He is slightly jaundiced and we are getting that looked at today at about 2 p.m.  He screams like a young kitty at the top of his lungs.  There is no sleeping through it, but he is perfect in his own little ways and I love him more than I ever could have imagined.  I am scared to death of screwing him up, but I know that between Jen and I plus our family’s help we can get through anything and he will grow into a wonderful man someday.

More pictures of the last three days….Enjoy!!

~ Jen in Outpatient on Sunday morning around 2 a.m.

~ Creighton’s First Fetal Heart Tracing

~ Jen in Inpatient around 5 a.m.

~ First Family Photo

~ Creighton’s First Footprints, Mom and Dad’s Thumbprint

~ Creighton’s First Day at Home around 5 p.m. Yesterday

~Jen and Creighton At Home Day 2, After a Long Night : )

~ Taken at the Capital Building over Christmas last year

I can finally talk about Internal Medicine as a whole because I received my grade yesterday through email from the Associate Dean of our school.  I received a B after all the hard work that I put in.  It was disappointing, but was exactly what I thought I got so at least it came as no surprise.  When MUA does our grade in clinical rotations there are three parts to it:  Clinical Cases Online, Clinical Clerkship Exam, and the Preceptor Evaluation.  I will go through all three so that prospective students and those of you that are just curious how it works can better understand.

• Clinical Cases Online:  These are cases that are supposed to be realistic representations of actual patients in scenarios that are similar to real life.  I found that they were very well done and enjoyed them.  I tended to spend between 1-2 hours on each one and there were two per week.  Additionally, we had to write reflections at the end of both of the cases talking about what we learned and describe the case a bit.  This aspect of our grade was worth 10% of our final grade.  I would always take this very seriously and try to get as much out of them as possible.  I think most people at our school though did not take them seriously and usually just clicked through them as fast as possible.  It is really too bad that the school does not take off for this behavior, but it is not shocking considering everything else that they allow students to skate by on.  All in all, this was a very valuable use of my time in terms of learning proper management of patients as well as proper ethical interaction.  For current and future clinical students I highly recommend taking them seriously because you can really learn a lot.

• Clinical Clerkship Exam:  The clinical clerkship exam is a very weird exam that we are required to take after each of our clinical rotations that are considered core rotations.  There is one after Internal Medicine, Surgery, Pediatrics, Psychiatry, and Obstetrics / Gynecology.  The Internal Medicine exam was long and tough and not really applicable to what was learned on my particular rotation.  Therefore, I found it to be an unfortunate exam with many questions that related back to the Step 1 style of exams.  I complained a lot about it with Jen and she stated that in order to pass that part of the rotation that one must do a ton of Exam Master questions.  Therefore, on my obstetrics and gynecology exam I will be doing a bunch of the questions.  However, for internal medicine I read First Aid for the Wards and did some questions, but it was not enough for this particular exam.  I got a 43/100 and failed the exam.  Be aware students that it is not the format you are used to and one must be prepared to work fast and hard throughout in order to get finished in time.  I will be better prepared for future exams at the AMI testing center because it can leave you with quite a pit in your stomach.  This is worth 25% of your overall clinical grade.

• Clinical Preceptor Evaluation:  I have always been very good at the hands on stuff in college and now in medical school.  My internal medicine preceptor gave me a very good evaluation and I was quite pleased with it.  I got a 92% by his evaluation and probably deserved more like a B.  It was nice to know that even though he was quite hard on us throughout the rotation that he was noticing our ability to interact with patients and our ability to give effort everyday.  I did not miss a single day of the 3 month rotation including some weekends and 2 holidays.  I gave it a very strong effort and by looking at my earlier posts you can see that I was exposed to tons of disorders and diseases that will enhance my knowledge.  I felt like I learned a ton on the rotation and that I really got a lot out of it.  I hope that future students will give the same effort so that we are able to continue to excel at our clinical site here in Oklahoma.  I know for sure that most of the students that are here now have given great effort, but it only takes one to spoil the whole thing for future MUA students.  This part is worth 65% of your overall grade.

Overall, it was an excellent experience that taught me that I could never be an oncologist, or any type of specialty or primary care that deals with death daily.  It was sad to see 9 people in 3 months pass on during my rotation.  Additionally, I learned more in 3 months than I ever imagined was possible.  The cases are very valuable and should be utilized to their full potential.  The exam at the end needed some work and I am going to do my best to improve that.  I am glad that I did the rotation here in Oklahoma City because I could not have learned from a better preceptor or better residents.  Key things learned and reviewed in this rotation:  Trade names of drugs, discharge summaries, how to write prescriptions, how to look up labs, how to write orders, the physical exam, how to interview a patient, what happens at a code blue, CPR, and how to properly write a SOAP note.

~ Taken in Antigua

I am on my last week of Internal Medicine currently.  I get done on Friday.  I will post an in-depth summary of Internal Medicine on Saturday, but for now here are the different things I have encountered on this service in only 11 out of the 12 weeks.  I have removed all duplicate cases because one would never believe the amount of people with hypertension, diabetes, and hyperlipidemia.  Enjoy…

Abdominal Aortic Aneurysm
Abdominal Migraines
Abscess
Achalasia
Acute Exacerbation of Chronic Obstructive Pulminary Disease
Acute Pancreatitis
Acute Renal Failure
Alcohol Intoxication
Amphetamine Abuse
Anemia
Anti-phospholipid Antibody Syndrome
Aortic Stenosis
Ascites
Aspiration Pneumonia
Assault
Asthma
Asthma Exacerbation
Atrial Fibrillation With Rapid Ventricular Rate
Auditory Hallucinations
Bacteremia
Biliary Colic
Bipolar Disorder
Bradycardia
Breast Cancer
C1 Avulsion Fracture
C5-C6 Fracture
Carotid Bruit
Cellulitis
Cerebral Vascular Accident
Choledocholithiasis
Cholelithiasis
Chronic Atrial Fibrillation
Chronic Obstructive Pulmonary Disease
Cirrhosis
Cocaine Abuse
Common Bile Duct Obstruction
Compromise Of Left Vertebral Artery
Congestive Heart Failure
Contusion To The Brain
Coronary Artery Disease
Crohn’s Disease
Decubitis Ulcer
Deep Vein Thrombosis
Depression
Diabetes Mellitus
Diabetic Ketoacidosis
Diabetic Retinopathy
Diabetic Ulcer
Dilated Ischemic Cardiomyopathy
Dizziness
Empyema
End Stage Alcoholic Cirrhosis
Epidural Hematoma
Gastric Ulcer
Gastroesophageal Reflux
Gastroparesis
Glioblastoma Multiforma
Hematemisis
Hepatic Encephalopathy
Hepatitis B Acute
Hepatitis C
Hepatomegally
Hyperchloremia
Hyperkalemia
Hyperlipidemia
Hypermagnesemia
Hypertension
Hypertensive Urgency
Hypocalcemia
Hypoglycemia
Hypokalemia
Hyponatremia
Hypotension
Hypothyroidism
Hypoxia
Ileus
Jaundice
Left Femoral Neck Fracture
Left Prepatellar Bursitis
Leukocytosis
Lewy Body Dementia
Liver Hematoma
Macrocytic Anemia
Melena
Metabolic Acidosis
Migraine Variant
Nausea
Normal Pressure Hydrocephalus
Opioid Addiction
Osteomyelitis
Overdose On Benzodiazapines
Palpatations
Paraplegic
Parathyroid Adenoma
Parietal Skull Fracture
Paroxysmal Nausea and Vomiting Syndrome
Peripheral Vascular Disease
Pleural Effusion
Prostate Cancer
Pulmonary Edema
Pulmonary Emboli
Pulmonary Fibrosis
Rectus Sheath Abscess
Recurrent Right Pneumothorax
Renal Cell Carcinoma
Respiratory Acidosis
Rhabdomyolysis
Rheumatoid Arthritis
Saddle Parathesias
Scleroderma
Septic Knee Joint
Shortness Of Breath
Sick Sinus Syndrome
Sickle Cell Pain Crisis
Small Bowel Obstruction
Spondylosis
Status Migrainosus
Subarachnoid Hemorrhage
Subdural Hematoma
Syncope
Syndrome Of Inappropriate Anti-diuretic Hormone Secretion
Systemic Lupus Erythematosis
Thrombocytopenia
Tobacco Abuse
Transient Ischemic Attack
Transverse Myelitis
Tylenol Overdose
Urinary Tract Infection
Vestibular Disturbance
Vomiting
Wet Gangrene

~ Image taken from google images for obvious reasons

A week ago yesterday, Jen and I went to a patient’s funeral that I took care of for 21 days while he was in the hospital.  It was really nice of Jen to go with me because it was a long service and it had really no significance to her what so ever.  However, it was very important to me considering I spent almost thirty minutes a time with this patient each day making sure that he was feeling alright and that everything was going alright.  I sort of made it my personal goal to get him out of the hospital.  I never met that goal and really had very little part in his care, but I still felt really horrible when I found out that he had passed away.

Mr. Scleroderma was quite the guy.  He came in with a pneumothorax and was treated with a chest tube right there in front of us in the emergency room.  I was hooked on this patient right after that moment.  We took a look at his x-ray and realized that he had some terrible lungs.  Mr. Scleroderma had smoked for a long time, but quit and was having a hard time breathing.  Come to find out after a CT, he had huge Bullous Emphysema and was going to have to use oxygen for the rest of his life.  It was a slow process and everyday that I would see him was another day that he was just waiting for the lungs to fill back up and get rid of the pneumothorax.  My attending thought that he noticed something about his skin and eventually a biopsy was taken and it was confirmed that he had scleroderma.  Scleroderma is a tough disease to deal with sometimes and actually can be fatal.  However, we had a dermatologist come and evaluate Mr. Scleroderma and he stated that he thought in this case it was more mild and would probably be a benign course.  After, two weeks it was decided to do a pleurodesis with talc powder and scar the lung to the chest wall in order to get rid of the pneumothorax.  He made it through the surgery and was showing pretty significant progress when the worst thing that could possibly happen occurred.  The other lung had a bleb from the Bullous Emphysema pop and of course another pneumothorax occurred on the left this time.  At one point and time he had three chest tubes altogether.

The whole time that Mr. Scleroderma was in he had a whole lot of phone calls and visitors and because of this I knew that it was going to be a huge funeral.  His wife was an amazing lady that was with him throughout and was always the most polite lady.  I really had to attend this funeral because believe it or not he really instilled what it means to have a human compassionate side to being a doctor.  There were times where he would squeeze my hand and I would tell him to keep fighting.  His wife always talked to me as though I was a real doctor.  I always made sure to tell them I am just a student, but they always came back with the fact that it was close enough.  I will never forget Mr. Scleroderma because he made such a huge impact on me.  No matter the day and no matter the pain he would always say good morning and would always be pleasant.  It was evident that I was not the only one that was touched by him throughout his walk through life, but it seemed like I was one of the last.  I only hope that someday people are saying the types of things at my funeral that they were saying at his.

He was an amazing man that found his way into my life to teach me a little something about death early on.  It is really valuable to learn while on these clinical rotations that you are not just treating the patient in the bed, but also the wonderful family that is around that patient and therefore should be as compassionate and helpful as possible.  While this may seem like a duh comment, you would  be surprised at the amount of physicians, especially residents, that try to treat death as no big deal.  In fact, my resident told me that Mr. Scleroderma died by saying, “Oh, by the way, Mr. Scleroderma died.  Anyway….”  It is really sad that physicians detach themselves in such a manner and I think it is better to give everyone that human element of respect.  It is not just a job for me, and it really should not be for anyone else.  As soon as it becomes just a paycheck, one should move on out of the health care field.  Mr. Scleroderma was a wonderful patient and taught me more about compassion and care of a patient than anyone to this point.  I hope his family and wife know how much being able to care for him really meant to me.  I have witnessed nine patients die, but this was the most significant of them all.

~ Image taken from http://www.willandbeyond.com/?tag=office-hours

Well, I am back from the time crunch that is my life as of right now.  I got up at 4 a.m. just so I could write this post.  I feel horrible that I have not had time to write on my blog, but everything has just been crazy since I started my medical school clinical training, along with a dog that demands A LOT of attention and exercise, a wife that deserves A LOT of attention, laundry, lawn mowing, garbage and recycling duties, cooking,  trimming, dog doodie pick-up, working 24 hours a week at the Halfway House, and last but not least Davenport MBA homework.  It has been tough to adjust to having all of this at once and still trying to study for clinical medicine once I get home.  I get super tired and eventually my body just gives up and I head to bed.  Something had to give and unfortunately it was my blog.  However, I have realized that it is really important to do this because it really gives me a release and enables me to put all the random thoughts that are in my head out there.

Posts that will be upcoming include my Internal Medicine summary, our Kansas City trip, many more recipes, our 1 year anniversary, death of a patient, and attending a funeral of a patient.  I am sure there will be many more to talk about as well, but those are a few that I have in mind.

I wish life was not such a rat race.  I feel like we go and go and go and yet we are never satisfied or at a point that we can slow down and just enjoy it.  This is the reason for the picture and title of this post.  Everything has felt beyond hectic and there is never enough time in the day.  I said last night to Jen that I wished there was about 36 hours in a day, and her reply was that I would just try to cram even more stuff in and that I would not be satisfied with the amount that I get done.  To be completely honest she is probably right.  I always attempt to get more done than is probably physically possible in a day.  But in my defense, I am just trying to aim high and without doing everything I can to get house duties, husband duties, student duties, friend duties, son duties, and father duties done each and every day I would feel like a failure.  In fact, the amount of things that are going on have caused me to continually take 2-3 minutes to pray that I am able to continue and that I am able to do my absolute best.  I think it is probably the one thing that helps me the most…. Praying for family and friends as well as myself.