I Am Not a Surgeon

February 16, 2011

As I start my second month of general surgery, it’s more clear than ever that my career is not in the operating room. I found anatomy lab during my first year interesting, and my decades of video game experience may have given me the hand-eye coordination of a master surgeon, but cutting and suturing just isn’t my thing. It’s messy. One slip and your patient (and probably the rest of the surgical team) are screwed.

That’s not to say that the surgeons I’ve been with haven’t been great. I had a preconception going in that they’d be arrogant and not very talkative, but the doctors teaching me have been some of the best physicians I’ve ever seen in regards to how they treat their patients both in and out of the OR.

A couple of weeks into my first month, Dr. E and I were consulted on a very sweet elderly lady who’d been having some recent episodes of vomiting. She had no previous medical history and was admitted to our service for what the ER physician thought was a small bowel obstruction. She had a little crush on Dr. E and asked my resident if she looked presentable before we came in to see her. She was very cute.

Unfortunately, when we took her to the OR for an exploratory laparotomy, we found extensive carcinomatosis throughout her entire abdomen. Not one centimeter was left untouched by the seeding. Dr. E decided that nothing we would do in the OR would be of any real help to our patient, so we closed less than 20 minutes after starting the procedure.

When you have to tell a family member that they likely only have a few weeks left with their loved one, especially when the news is unexpected, it becomes very emotional very quickly. I never uttered a word during the entire exchange between the surgeon and our patient’s son, and yet I found it difficult not to tear up. And no matter how many times I leave a procedure to tell the family that everything went fine and they should expect a speedy recovery, it doesn’t quite make up for the rare occasions when you have to deliver the worst news to someone expecting a clean bill of health.

So there we go. Decision made. Career choices narrowed down. Next option, please.

Leave a Comment » | Medicine, Surgery | Permalink
Posted by brianfishman

Match Game

January 19, 2011

When I started this blog a few years ago, I had no idea what I was doing. At the time, I was deciding between careers in medicine and video game journalism. Two fields that couldn’t possibly have less to do with each other, but ones that (as you can see from the layout of this page) share my affection fairly evenly.

So you can imagine my surprise when a lovely woman from Medscape contacted me through this site and asked if I’d like to write for a new blog she was starting. Match Game is a student blog focusing on choosing a residency program and the match process. Admittedly, I know very little about the match. My wife went through it a few years ago when she was choosing her pediatrics residency, but that experience is the extent of my knowledge on the subject. I do, however, have quite a bit to say about choosing a specialty. So we’ll see where that goes.

My first post is available here. I tried making the introductory post light and humorous. Here’s an excerpt:

It’s a scary prospect. The whole match process is a cloudy mess that you really don’t know much about until you start thinking about what residency program you’d like to apply to. If you’re anything like me, you spend your third year just trying to stay afloat on rotations, figuring out what you want to do with the rest of your life, and desperately trying not to screw up the rest of anyone else’s in the process.

Medscape is a sister site to WebMD that is particularly useful for medical students. Along with eMedicine, the trio of sites provide droves of information, medical references, and student perspectives that I’ve valued for some time now. It’s an honor to be asked to contribute to Medscape, and I’m really looking forward to hearing what people have to say about Match Game. If you have any feedback or suggestions for topics, please let me know.

2 Comments | Medicine, Personal | Tagged: , , | Permalink
Posted by brianfishman

My Favorite Games of 2010

January 12, 2011

When I transitioned from my second to third year of medical school this summer, I expected to have much more time to play video games than I had when most of my day was monopolized by lecture and rote memorization. While my time was taken up by much more enjoyable clinical experience, it still didn’t leave much left for games. Other than the occasional meaty console title, most of my video game time this year was spent on portable platforms right before bed. In no particular order, here is the list of my favorite titles from 2010.

Assassin’s Creed: Brotherhood (Xbox 360)

By far, my favorite new franchise of this generation of consoles is Assassin’s Creed. I lose roughly 40 hours with each new entry in the series, and Brotherhood is no exception. While I was initially disappointed with the return to Ezio and Renaissance Italy, by the time I was a few minutes into the game I knew I’d be happy to lose another few days to Ubisoft’s revisionist history. Very few games pull off the scope, atmosphere, and storytelling that Assassin’s Creed does. I don’t even care if Assassin’s Creed 3 isn’t set in 2012. With the talent that Ubisoft Montreal has for recreating defining moments in history, I’d play anything that bears the Assassin’s Creed name. (Except the PSP version. That thing was terrible.)

Alan Wake (Xbox 360)

Alan Wake did a lot of things right. The mood and atmosphere that game created was unlike anything I’ve seen this console generation. The plot is intense and addicting, and the storytelling mechanics are innovative. Each chapter ends at the perfect point to make you want to play the next one, and the extra bits of background information you get from finding radio shows and Twilight Zone parodies help round out the experience. Unfortunately, while the shine-and-shoot combat mechanic originally feels fresh, it quickly grows stale. The same enemies are thrown at you throughout the entire game, and challenge comes not from enemy strategy but merely from increasing numbers. Still, the combat filler wasn’t enough to turn me away from Alan Wake. An improved sequel would make it to my must-play list.

3D Dot Game Heroes (PS3)

It’s difficult to talk about 3D Dot Game Heroes without first mentioning The Legend of Zelda, but when you build your game on a framework as classic as Nintendo’s masterpiece, it’s tough to go wrong. Game Heroes has a charming retro aesthetic, an epic score, and a sense of exploration and wonder seldom seen since the early 8-bit days. It’s a great way to introduce new players to the style of game most of us grew up with.

Dragon Quest IX: Sentinels of the Starry Skies (DS)

I don’t think I’ve ever completely finished a traditional Japanese-style role playing game. I get engrossed for the entire game, and then always peter out when I get to the final boss. This is because I’ve found that final boss battles in RPGs tend to come down to luck. I go in to each one prepared with the proper items and usually over-leveled characters, but for some reason my characters always manage to die unexpectedly with a random attack about 3/4 of the way through the fight. Dragon Quest IX is no exception. I’m stuck at the final boss, but I keep going back and completing unfinished quests, leveling, and just exploring the world. A ton of fun.

Jeanne d’Arc (PSP)

Jeanne d’Arc is the only game on this list that was not released in 2010. It was one of the first games I downloaded when Sony started releasing full retail UMD titles on PSN, but I never got into it until last year. Before Jeanne d’Arc, I’d never played a strategy RPG. The art style was charming, the voice acting was superb, and the story was engaging in a way that made me want to keep playing through just one more stage. The combat mechanics were easy to understand and complex enough to keep me interested throughout the entire game. I loved the game so much that I tried a lot of other titles in the genre, but none hooked me quite like Jeanne d’Arc.

Picross 3D (DS)

The original Picross was the best $20 I’ve ever spent on a portable game. Picross 3D isn’t quite as good, but when you’re only slightly worse than one of the most addicting puzzle games I’ve ever played, you’re still doing pretty well.

God of War: Ghost of Sparta (PSP), God of War 3 (PS3)

Despite the widespread critical acclaim for the first 2 titles in the God of War franchise, I missed out on the PlayStation 2 titles. When Sony announced that they’d be bringing both games to the PS3 with improved HD visuals, I took that as my opportunity to catch up before God of War 3 came out. I played through the first two games in a matter of days, and GoW3 is one of the prettiest games I’ve ever played. Likewise, Ghost of Sparta is possibly the best looking PSP game I’ve come across in a long time. Although some might complain that the combat mechanics have become a bit repetitive, as someone who experience the entire God of War series over the course of only a few weeks, I loved almost every minute.

2010 games I haven’t had enough time to play yet:

Super Mario Galaxy 2 (Wii)

Kirby’s Epic Yarn (Wii)

Donkey Kong Country Returns (Wii)

Red Dead Redemption (Xbox 360)

Limbo (Xbox 360)

2 Comments | Video Games | Permalink
Posted by brianfishman

Gamers Giving Back

December 11, 2010

Gamers Give Back

Child’s Play is an international charity effort established by the hilarious people behind Penny Arcade, a webcomic about video games. I’m never really sure who I’m reaching with this blog, but I’ve written about the fund before. If you’re at all interested in my ramblings here, then you must have at least a passing interest in video games and/or medicine. If that’s the case, Child’s Play is the ideal cause for someone like you. Unlike so many charities where you’re unsure of exactly how your donation will be spent, Child’s Play uses your money exactly how you want. The map on their home page will show you the closest participating hospital in your area. You’ll be taken to that hospital’s Amazon wish  list, where you can choose which item(s) you want to buy for the children who are receiving their care at your chosen hospital. Possible donations include toys, games, books, or anything else the hospital requests through Amazon.

The last time I donated, I bought a copy of Lego Star Wars for Akron Children’s Hospital. It was a game that I had a great time with when I played it, and it’s perfect for family fun. This year, if money is tight, you can simply text GAMERS to 50555 to make a $5 donation through your cell phone bill. That’s what I did. I encourage anyone who appreciates reading my site to please consider a small donation. Child’s Play is one of the rare occasions where video games and medicine mesh perfectly together and gamers can have a positive influence during the course of a child’s hospital care.

Leave a Comment » | Charity, Medicine, Pediatrics | Tagged: , , | Permalink
Posted by brianfishman

It Gets Better

November 13, 2010

Many students find it difficult to decide what specialty they’d like to go into after graduating medical school. Unless you applied to school with a choice in mind, the first two years of lecture don’t offer much help deciding how you’d like to spend your professional years. It isn’t until your third and fourth years of medical school, when you’re out on rotations and getting a feel for your different options that it becomes easier to pick a specialty. I’ve had the benefit of being about 99.9% sure I want to go into pediatrics since long before starting medical school. Early in my pediatrics clerkship, that decision was made all the more clear.

I was working with a pediatric neurologist who specializes in Attention Deficit Hyperactivity Disorder (ADHD). In the morning, a young boy of about 11 years (let’s call him Johnny) came in with his mother. Her son was previously diagnosed with ADHD, and she wanted to discuss a number of behavioral issues he had been having both at home and in school. Johnny was a bully. He shoved his classmates, got into screaming matches with his mother, and was openly defiant toward authority figures at school. He threatened his classmates with physical violence and told his mother on repeated occasions that he wished she were dead. During this conversation with the doctor, Johnny appeared annoyed. He refused to verify any of his mother’s claims and would not answer direct questions with anything other than a shrug or “It doesn’t matter. I don’t care.”

Upon further questioning, Johnny’s mother revealed that her true reason for bringing her son to see the neurologist that day was a recent sleepover at her home. She had noticed the boys being more quiet than usual, so she went down to her basement to check up on them. His mother had inadvertently stumbled upon a mock wedding ceremony between Johnny and his male friend (let’s call him Matt). She promised not to tell the boy’s mother if they stopped what they were doing and went to bed.

It should be noted that at this point in the conversation, Johnny’s demeanor changed from annoyance to shame. He would not make eye contact with anyone in the room and remained silent when asked any questions. The neurologist pressed Johnny’s mother for more information, but she was quick to deflect the conversation toward accusations of Matt’s mother’s promiscuity. She believed Johnny was tricked into the pretend wedding because, although she and her husband have a documented history of verbal abuse toward one another and repeated screaming matches in front of their children, she claims that they are rather “prudish” parents. Matt must have learned his behavior from his morally questionable mother.

It was clear that Johnny’s mother was extremely uncomfortable discussing homosexuality. She had difficulty even saying the word aloud during our conversation. She seemed disappointed when the doctor told her that these behaviors would likely not go away and that there was no pill he could give Johnny to cure his other discipline issues. The neurologist recommended resuming regular therapy sessions with a psychologist to determine what was causing both his sexual and anti-authoritarian behaviors.

As a medical student on rotations, you often feel like your influence on patient care is limited. Depending on the location of your clerkship, the doctors you’re working with, your personal comfort level, and any number of other factors, your role runs the spectrum from simple observer to (if you’re lucky) integral member of the medical team. On pediatrics rotations, your job leans more toward the former due to the sensitive nature of the relationship between nervous, timid, or frightened children and the doctors they’ve grown accustomed to as they reach adolescence. This was the first time that, as a student, I felt as though there was nothing I could do to help my patient. Not only was it clear that Johnny’s mother disapproved of her son’s behavior, but it was also likely that she would not follow up with a counselor as the doctor recommended.

If anything positive came of the office visit, it was the certainty of my choice of specialty. With the continuity of care that comes from a primary care setting, the relationships I form with my LGBT patients will allow me to be a positive influence, guiding them toward important resources like the It Gets Better Project and the Trevor Project. There is nothing more rewarding in medicine than the potential for life-saving interventions, whether that intervention is a delicate surgery or a simple referral to the right resource.

2 Comments | Medicine, Pediatrics | Tagged: , , | Permalink
Posted by brianfishman

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