Golf...not just a car but a way of life... and oh how fragile that life can be

I believe it was a warm and sunny Saturday afternoon when the dynamic duo that is Shawn 'the bagger' Carter and Mike 'the mojo' Stewart stepped upon the not-so-green and overgrown grass that makes up a not-quite-so-famous par 3 course. After a few schalackings of the puny balls at the driving range and proving to everyone present that no ball [or tree] stood a chance in their wake they proceeded to attempt the formidable fairways of 'four'play. Yet, it was 'the bagger' who came through and sacrificed his lot in the game for his comrad 'the mojo', that 'the mojo' would play a better game with 'the bagger' at his side. So, that is how they left the tee at the first hole... and nine greuling par 3 holes later, they emerged victorious? Not quite. Nonetheless, they emerged, with a high-stepping pride in their step and a questioning look on their face coming home, walking down the fairway of that last hole. It was a monumentously memorable occasion, knowing that it would take but two of these guys to equal that of one who is to be reconed with, Ken 'the possum' Iverson. You see, it is the possum that plays dead at the first attack, a plan which Ken 'the possum' followed to a tee [no pun intended]. Then, as his sight was set and he smelled his enemies weaken, he emerged strong in the last, to bring home his glorious Bogey, and emerge from his fight with the golfing gods, not victorious, but emerge he did to live and golf another day.

Twas a beautiful day indeed.

Other stuff:
Sunday and Monday were relatively relaxing and I just hung out most of the day. However, it came to my attention that a dear family friend passed away on Sunday. I wish that I could have been there and could be there now for the funeral and services. He was not just any guy and he was not my Grandpa, but he might as well have been. It was in such a fashion that April, my sister, dubbed him our Grandfriend. He had a difficult course in the end, but he is in a better place right now. I mourn his passing and reflect with admired thanks the memories, gifts and time that he imparted on my life and to our family. He truly was a part of our family and we always loved him as such. Thank you Lloyd Ringquest on all that you have done, for it truly goes beyond all that we probably ever had the chance to express to you. RIP.

interlude

I think that I didn't get to describe Thursday... interesting case of a sternal wound closure problem. Basically it was a surgery that kept getting pushed back [supposed to start at noon... and didn't start until 14:30] because the room was tied up. The operation was performed in a room with pump access... the CT surgeon performed the sternal debridement which basically meant removing the irradiated crummy manubrium and a few rib heads. Then after this, a pectoral flap with a skin island was used to close the wound. The poor guy wound up going into V tach after the surgery and got some amiodarone and lidocaine. He is doing much better now and hopefully he will stay the course.

Then, on Friday work was not too bad and that night I just wound up passing out as I had to round on Saturday morning... freakin sweet!

I feel that all I have done is talk about work this week, but that feels like all I have done sometimes as this week was busy and hectic in many of its own rights.

On a lighter side, I found out that I got my first Plastics interview!!! Yeah! I hope that everything there will go smoothly as the interview is set for Nov 17th, 18th at Georgetown. So, it is time to start looking for plane tickets up towards that direction. Luckily, as it turns out that is a switch weekend of sorts between the fourth year rotations, so it should be free for that, which is convenient. Gotta start somewhere, right?

BTW... Congrats to Shawn Carter... ladies and gentleman... on making the wall at the Flying Saucer with his plate of glory. #164 I do believe. For those of you who are unaware, this plate represents that he has had at least one pint of all the various beer that are on tap/available. 210? Correct me if I am wrong, Shawn... but it is impressive [or sad] nonetheless. Attached are a few pics of the 'man' being 'the man'

-G

weekly woah

What a week, what a week.

As it turns out, this could have been one easy non-hectic week, lots of time to read and exercise and enjoy the outside. There were not may difficult cases this week which would have left for ample time for other various activities. So, after a time-consuming week full of little things to do, complications galore and various tie-ups, I am a bit fatigued to say the least.

Monday was a fun day in the OR. One of the cases that we did was an ischial decubitus ulcer repair using a gluteal cutaneous rotation flap. As it turns out, Dr. Friedman [attending] let the resident [intern Gene] and I do the entire case without scrubbing in. We both thought that was pretty cool and thought that we, in fact, did a pretty good job of it. It seems that patient happens to be in the best shape at this point on the service [or close to it].

Tuesday, Gene and I operated with Dr. Lagrasso doing some STSGs [split-thickness skin grafts] on a couple of patients, in fact, one of them can be seen on a prior blog entry. It was then that I got the chance to do the graft harvest utilizing the almight Zimmer. It is like a really good apple peeler, only the apple peeler is 7 cm wide and cuts at 0.012 inches thick. I am sure that April could appreciate that bit of goodness... mmm April's Apple Pie, yuuuummmmm! [I kind of have a craving right now!]. After that, we had a good little afternoon at the VA clinic before going back to round.... blah blah blah, that was the day

Wednesday was basically time consuming and full of consults. We have not had many consults in the past four weeks that I have been on this rotation, at least not during the day. Well, as luck would have it, we had 4 within 2 hours! It was kind of fun running around to see these patients and what was going on, but between those consults, doing evening rounds and then myself [with Gene supervising] repairing a dehisced wound, we wound up staying until about 8 [I definately don't mind the 14 hour days as long as you stay busy... if there is down time, it sure can drag on!]. The consults were interesting. We had one guy who hit one of those South Carolina trees as he was driving. They just happen to jump out into the middle of the road, much like northern deer. Well, of course he had an EtOH of 0.28 and was + for cocaine. The reason we saw him is that he had a pretty bad nasal fracture. On physical exam, there was not much edema in the area and he had NO pain at all! Crazy... well, not really since it was most likely an old fracture just picked up in this acute setting. Another trauma patient that we got to see had her facial trauma not directly from her car accident [she was trying to mimic the SC trees and jumped out into the road in front of a car and lost] but as a result of blowing her nose. She came into the ED from her trauma scene and after being stabilized she blew her nose and her eye blew up as a result. She probably had a nondisplaced orbital fracture that displaced or something upon the pressure of blowing her nose. Nonetheless, it was not bad enough to do anything about since all sensation [infraorbital, etc] and EOMs were intact, so we left be. But it was ineresting to see nonetheless. Then, there was a consult for another sacral decubitus ulcer that needed debridement... kind of a run of the mill problem for in patient plastics, so it seems. Anywho, this guy's story is intersting... HOD #95 s/p cervical spinal subluxation leading to incomplete quad. C-spine subluxation secondary to seizure d/o with an episode that landed the patient's head into a table. Anyway, after all that time in the hospital, it was finally noticed that he had a stage II/III ulcer. The last patient was seen based on hospital protocol. He got die injected into an external jugular, but IR must have missed or something and extravisated 100 cc of contrast into his neck. Plastics is consulted on such a case in order to make sure that blood and contrast die has not caused any overlying tissue breakdown or damage that can be taken care of. As it turns out, you could not even tell which side it was on, his external jugular appeared intact and there was no skin breakdown from the contrast. End of day... except for going to fix the sacral wound dehiscence... then end of day... Whew! I was also on call, but because I wanted to go to a case Thursday afternoon, I decided to take home call, just in case nothing too exciting happened, I would be able to go to Thursday's case.

I will get to thursday and today later... right now, it is eaty eaty time... that and the fact that I am contemplating the prior thought of the ol' AAP if you will [April's Apple Pie] and feel the need to William Shatnerize sweets into my evening... a mission to seek out new sweets and goodness, to boldy eat junk food like I never have before!!!

WTYL,
G

Mike the inebriated one...

Not all to long ago there was a birthday boy [Robeson] of whom I did not get to post a pic. He was rather GQ-esque that night at the ol' Grilled Teriyaki, so I figured I would just put a blurb about him up since I did not get to before.

Also, I have been informed that Mike is NOT an alcoholic as previously thought. This mysterious turn of events occured yesterday when someone who looks like Mike [but may in fact not be] informed me that Mike definatley is not a drunkard. Sitting at Panera doing radiology-type things this blond Mike-a-like was very convincing in his scheme to debate that Mike was infact a solid, upstanding student of the USC School of Medicine. I was one to go along with this story until later, this gumshoe came upon some evidence supporting the couter-argument that indeed Mike is a Perpetually Plastered Perfect Product of Partying; a P5 if you will. This P5 [mind you not P4, nor P6, but P5... a distinct designation indeed] is shown enjoying what he loves most... the drinky-drinky leading to his alterity.

WIth that said, I shall try to find more important things to do than pick on Mike on my blog... perhaps some actual studying might do [which does tend to be overrated BTW].

-G

MolASSes

So, in finishing up the up what has happened this week...

As it turns out, on Wednesday there was yet another birthday. The birthday boy's name = Robeson. Happy quarter century man!.! I suppose that I should put up one of the pics that I took of you that night during the goodness that was Grilled Teriyaki! Yum... the white sauce saturating each greased soaked morsel of meat and rice. How can one go wrong? As Mike put it "I think this is my first time here before midnight". Well, enough from the alcoholic. Oh, wait, there is another thing that the alcoholic stated [ok, maybe not really alcoholic, but sometimes you wonder where he comes up with what comes out of his mouth - haha], which was "ohhhh, thaynk-a-ewe"... which is my best attempt at phonetically spelling out the chinese/japanese-ish accent that he put on for our asian waitress. Not so much socially sound, politically correct, or alliterated with a filter. But, what can you do other than emberASS him.

So, after that lovely ordeal we went out to Delaney's for the dynamic duo of pint night and McFly. It was good times, listening to the 80's cover, but I had to call it an early night since work duties were pressing from the wee hours of the morn to come. During the evening, I was weraing my new volcom-stone shirt, green and long sleeved, which seemed to be a big hit. I suppose that I can thank April and mom for that. But only so much in that they helped pick out the size!!

There was one more thing about Monday that I did not mention... one of the cases that we did in the OR was a bilateral breast reduction. This went really well, and was the second one that I have helped to do. Basiclly it was Dr. Friedman take one breast and Garry take another. Of course I was given the smaller one, but it was plenty big if you ask me. [duh... otherwise she probably wouldn't be getting the durn reduction now would she... think mcfly... think!]. So, this time I was able to complete the deepitheliazation all on my own and did some scoring and resecting of the tissue. Although still very much a novice... or below novice; like subnovice or something, I feel that my skill with the blade and suturing are improving and spedding up... and when I say speeding up, I mean going from molASSes in January to maybe sometime a little later in the year... you know, a good late February MolASSes or something, possibley an early to mid-March MolASSes, but definatly not a May or June MolASSes. To reach that level of molASSes fluidity [unviscosity] would be a glorious day indeed. In fact, Dr. Friedman is probably somewhere around August MolASSES found on the hot side of the planet Mercury during its summer solstice in the middle of a big solar flare. Well, beating that to death, it went well and I am enjoying this plastics rotations quite a bit... which leaves me at the age old question... 'what next?'

As far as school goes in other areas, such as application stuff... so far I ahve just had interview offers with Orlando and Temple... which reminds me I have to confirm those and start setting up dates. We'll see. Those are for ER and I really have not heard back from plastics programs other than secondary applications... yuck!
So, the city of Disney love vs. the city of Brotherly Love.... touch choice... but hopefully there will be, as yet otherwise stated, 'more to come'...

And a bid adeau for the time being and try to get to the necessities of the day... oh what a day, this FRIDAY the THIRTEENTH of OCTOBER, 2006.

wtyl
-G

more to do... more to come...

Well, it feels like it has been a while since I have typed a few words to find their place upon the information superhighway. Since I last cared to elaborate on my daily happenings, I believe that my mom and sister had just gotten done visiting me... again, such good times.

Sunday [10/8] was a day of relaxation... well, fresh aire at least. It was relaxing to go and prance around the trails out at Harbison. It was a beautifully splendid morning when my roomie and I went to go and stretch our ever-aging legs out and see what we could do.... not for time or anything, just to see if we couls still run the trails at a decent clip, without sprained ankles, bruised feet or some other travesty that has hindered our runing in the past. Well, it was a good run... abut 10K worth, which definately woke me up for the day. Other than that, I just wound up doing some studying and playing in the intramural football game that night [our last regular season game... and we wound up with a record of 4-0 since we won that one as well; on to the playoffs!!!]. I wish that I would have some pics from Harbison that I could throw up here or some pics from the game... yet, alas, I am shortchanging my site and the eyes that are layed upon it as I do not hold such a valued commodity. However, I did see a mercedes that was painted taxi-yellow... intreaguing choice of colors to say the least [since the car spoke volumes for itself!!!]

Moving on...

Monday... oh what a day and how I thoroughly enjoyed it... on call. The only trauma that I was aware of was a guy who wound up getting in a car accident, going back to surgery and dying on the OR table because he bled out from a ruptured/lacerated IVC. Not too cool.

Tuesday... took this day to go and work out a bit, doing what I shall dub "CONSUELA"... because afterwards, you really felt like your muscles Can Swell A with pain... ok, totally less heterosexual now than I was about two sentences ago, but anywho.
Consuela - 3 sets for time of:
400 m
25 box jumps
15 med ball reverse overhead throws
25 situps
25 supermans
... then after this, do 3 sets of 20 pullups supersetted with 10 military presses
Talk about a burn... Oh Consuela, how I love thee!!! and how she takes my every loving muscle and cranks the pain intensity higher and higher as I succumb to my masochostic ways... at least with working out.
So, Yocum and I did this in the bubble and we ran into rusty and I figured that I would take a pic of some pole vault poles... if fact this is what all this training seems to be lending itself too... the hope to get my back strong and get in shape to do some good pole vaulting next spring and summer before residency comes and those things may get stomped to bits [poor dreams... must hold... on... to... ahhhhh].
Also, I got caught up with Grey's Anatomy... I know, I should not have to 'catch-up' however for some reason I did not get a chance to see it last week. Nonetheless, I am ready and rearing to go for this week's episode.

As far as the rest of the week goes up until this point, I will redeem myself later and return when the clock is later than it is presently.

Have a wonderfully splendid day... it is gorgeous outside here today!!!

-G

fam visit

This weekend, I had the pleasure of a visit from my mom and sister. We had a good little visit with a couple hour conversation at Atlanta Bread Company [gotta know and go w/ the ABC's], which really had nothing to offer. My mom enjoyed a steamy hot cup-o-hot-water, flavored w/ chocolate flavored cardboard shavings that was meant to represent hot chocolate. They also were 'out of french bread' but managed to find a stale-crusted slice for april to endulge palate with. At least the mushroom bisque was well mixed and had a sense of homogenaity... oh wait, that's right, there was a layer of olive oil existing ontop of that which was the bisque. It was like a protective layer of greasy goodness, holding the bisque firmly down in the bowl so as not to be disturbed by the flies and insects flying around. It was that oil that trapped such atrosities from entering the 'meat' of the soup, the edible part if you may. After delving through this layer, the actual soup was tasty. However, when we were done, there was no layer left, menaing either one of two things... oil suddenly has developed the ability to apply new physical laws of chistry and is able to evaporate into the air in a matter of minutes; or we ate it as we went. Hmmmm, not such a plasant thought. Anywho, afterwards, we ventured on over to Harbison blvd where we went to Columbiana mall and shopped for various things. If Rory reads this, please skip the next few lines after the following: April bought nothing and did not go over budget. SKIP... So, after April shatttered her budged by getting a green blouse and a grey skirt from Arden B, we went to grab some Starbucks coffee [where April and I got our favorite... Nonfat Pumpkin Spice Latte [half caf vs. full caf {April is a champ}], we proceeded to sit and talk to another good bit out in the middle of the mall. Then, I proceeded to carry April's torch of budget breaking with a little monetary mashing mastery of my own. I wound up getting a few shirts and hat [PacSun] which should bode well for the up and coming chillier times. After the mall experience, and being a Manger for April [Manly Mobile Hanger] we got some dinner/dessert and Marble Slab Creamery. This was my mom's wonderful idea. Mom and April got Rocky Road [and April got her version of it which included pecans instead of almonds] and I got the good ol' birthday cake w/ reeces pieces... goodness wrapped in happiness [as my roommate would say]. Well, we sat and talk there for a while before heading back to my place where we talked some more and I released Aprils tension by torquing her spine in various directions. The pleasure was written all over her face as you can see by the pic. She is totally ON DRUGS... well, at least adjusts them for others.
I thank my mom and sister for spending the day with me this weekend as the family time was wholesome, filling, and much needed. It was actually the 1 year anniversary of my mom's MI [heart attack] and I think she needed the time with her kids as well, since, when she went through the MI, she felt separated from her family [or so I think]. All-in-all, it was probably a good day for all of us to get to spend together. Unfortunatly my dad and little-little sister were unable to make it down. They were dearly missed and hopefully sometime soon this can be changed.
Arynn wound up having a dance yesterday [and I, as yet, am not sure how it went]. I was informed about some-THING with some-GUY... After all the stories that I have heard recently about Arynn, it sounds like she is going to break a lot of hearts... which may mean I will be breaking a lot of faces [I guess then I would be giving myself buisness -haha]!
Well, I am off to go and do something more productive like read or something... or not... who knows. What next?

-G

nec fasc...

Well, it seems that I am catching up on some blogging that has been missed thus far this week. For those that are interested in what I see on a regular daily basis during the course of this plastic surgery rotation...
Here is a case of a lady who fell at home off the steps of her back porch. She scratched her leg in the process and developed necrotizing fasciitis. She underwent radical debridement of her wound and then got a medial gastroc flap and STSG [split thickness skin graft]. Two days later, the rest of her wound was covered with a synthetic skin-like substance: Integra. A wound VAC was placed and the wound was dressed. She is to undergo dressings changes of the wound every 7 days. As it turns out, I snagged a pic or two of the wound at 14 days out, and the attached pic is waht it looked like. The integra looks like it has taken well [distal portion] but the STSG looks like it is struggling to take onto the medial gastrocnemous flap. EIther way, it is amazing what is done these days in wound care for people that really need it. The poor lady is in a great deal of pain and the meds that she is getting for this issue really don't seem to have much of ain impact on her... and after looking at the wound, I can only imagine. Hopefully her healing process will progress rapidly and her pain will soon diminish... but I can only watchfully wait and pray.

-Garry

some good things...

This Wednesday of this week, I had one of the better days that I have had in a while. As it turns out, I got my step two board scores back and did fairly well [enough to be well over a standard deviation above the national mean]. This was rather encouraging, but was not all fo the news that I would recieve on that day. I also was informed that I was elected into the USC SoM chapter of AOA. For those of you that don't know, that is you can check out the following web site:
http://www.alphaomegaalpha.org/AOAmain.htm
Also, on this day, I had the pleasure of eating at some of my favorite type of food... Japanese sushimi. It was so delicious and wonderful to endulge on such a delectable treat! I can't wait to do it again. Saki Saki!

-G

US Secretary of HHS

I forgot to mention that on Thursday we had an 'emergent' meeting for the SCMA [South Carolina Medical Association] BOT [board of trustees] that entailed a meeting with the US Secretary of Health and Human Services. It was just a small round table discussion with only 9 physicians [including myself] in the room. It was very informatinve to hear him speak on where he is trying to head the fedral physician reimbursement issues. If anyone is curious to know what we talked about, the just ask [comment or email]. Nonetheless, Mr. Mike Leavitt was a very political speaker and tended to direct all of his answers toward a preordained agenda... I guess that he is in his position for a reason. When he asked me what I wanted to do or what my ambitions were, I answered with 'Emergency Medicine'. I don't knwo what that means, but that has been on the forefront of my mind, even during this plastics AI. I love this plastics rotation and find the procedures mentally geometrically intreaguing and challenging. I think that it combines a love of spacial symmetry with handy-work and thought. Alas, we shall see... oh, we shall see...

-Garry

Weekend Update with Garry Martin

Well, it has been a realtively busy weekend this past weekend. Unfortunatly, it has not been too busy... I have just been trying to photographically document things more. I figure that since a picture speaks a thousand words [sometimes more if recollections of sentiment are brought forth and sometimes less if either speechless wonder or nieve ignorance are met] I would save myself some typing and just post some pictures of the things that have been going on.

I enjoyed going to the football game on Thursday against Auburn... although I left just before half-time. The reason that I left was multi [poly?] fold. First, there was intermittent rain throughout the evening [not always fun to be in when you know you have a long walk back to the car]. Second, we were losing by a good bit, but as it turns out if I would have stayed to the end it was an exciting fourth quarter and finish [although we still lost to the #2 team in the nation]. Third... I have 2 words for you "Grey's Anatomy". That's right, since it has been moved to Thursday nights this threw a wrench in the chain and I had to get back for at least some of it, which was good, BTW. Fourth and finally, I had to get up early Friday for rounds at the hospital, gotta love work!

Speaking of work... on Friday one of the procedures that we did was a facial fat injection. Fat was harvested [that is a harsh word for it... but it is not a delicate procedure!] from the abdomen and then placed in the buccal/maxillozygomatic area of a 15 year old boy. He was born with a hemifacial hypoplasia and has undergone various distractions and surgeries, and this procedure was meant to fill out part of his face in attempt to bring more symmetry.

At some point friday, I went to the gym and did a little light lifting. By gym, I mean the infamous 'Bubble'. Yep, I did a crossfitesque workout, which 'hit the spot' so to speak. Definatly much neded, much missed and much to be done again. I love that stuff!!!

Friday night was Mike's birthday [friend and classmate of mine]. So, I figured that I would show a pic of the kid enjoying his 25th with the ever-so-popular Everclear Smoothie at Dr. Rocco's. Happy Birthday MIKE!!! We had a pretty durn good ol' time. We went out to dinner at Yo Burrito [enjoyed the steak poquito burrito] and then went back to my place and had a bottle of Ben Yocum vintage Gewurztraminer circa March 2006. It went down well and then we headed down town. Unfortunatly, I called it an early night because... what is the theme for calling early nights... yep, that's right, I had to go and round in the morning. But, Mike, thanks... it was fun and I hope to do it again sometime.

Saturday, after rounds, I went out to Blaire's [another classmate of mine] Miles for Melanoma fun run. It was a 5K out at Lake Carolina, which is a cute little community about 20 miles out of town. It was an absolutely gorgeous community to run around and I was glad that I went after rounds for the brisk morning jog. I am not sure of the turn out, but there were about 30 people that ran and it was all for a good cause. As it turns out, I came across the line first with a time of 18:55. Not to bad, I felt.

On my way back, I spotted some youths [more than just two youts] raising money for their LaCrosse team by giving car washes. So, I figured it was for a good cause and Driver needed a bath anyway... and went ahead and donated the money to have my Driver bathed.

Sunday has been a much more relaxed day... spendin some time studying, throwing some javelin at the track and playing some flag football [won 39-0... yours truly had 3 interceptions [2 for TDs], 4 TDs total... and did a little QBing... good times]. Between those things I got a chance to donate funds from my bank account toward the wonderful cause that is 'food for my belly'. It was a donation that was well worth it. I was also happy to finally finish cleaning up my house [our house... since Ben lives here to... oh to have a famous winemaker present is every guy's dream!]. You know, things like sweeping, swiffering, laundry, dishes, bathroom stuff, et cetera. So, it was pretty relaxing listening to some Coldplay and 311 and yet productive at the same time. Who knew that you could hit two beautifully wonderful birds with the same cushion [not stone, since that would be mean to the fowl, which is not fair... hence; yes fowl not fair].

Alas, off to bed this evening hoping for some good shuteye. I probably was not supposed to have shut-eye this eveing as I found out this afternoon I was supposed to be on call [since Dr. Friedman is on call], but what can I do when I find this out the day of at 3-4 in the afternoon? I guess that means I will be taking call some time early this week. We'll see. I definatly will be taking call on October 9th, and should be taking call at least one more day BEFORE that. Anywho, enough rambling with the fingers and time to get REMbling with the brain.