Amazing Neurology

After reading “The Man Who Mistook His Wife for a Hat” this summer I decided I was locked. I cannot get enough information about the way the human mind works. This topic is incredibly fascinating. Dr. Oliver Sacks is an amazing author and physician. After following a neurologist for a week this summer, it became obvious to me that most of Dr. Sacks cases mentioned in his book are ones that are pretty rare, especially the associative cortex pathologies. In his book, Dr. Sacks shows his amazing gift of observation and curiosity as he documents each of these remarkable case-studies. The patients in this book really pulled me in and sparked my curiosity as it never has been before. I was just amazed at the things that can be learned about the human mind through careful observation.

So, I brought another book recommended through Amazon’s recommendation list (which is actually pretty good), called “Phantoms in the Brain” by V.S. Ramachandran. I am only part way through the book, and it’s phenomenal. To get an idea of what his work is about see these videos:

Dr. Ramachandran is another brilliant neurologist who through careful observation is discovering amazing thinks about how the human mind processes it’s body-image, pain, and sights. These are truly interesting topics and I get excited just reading about them. If someday I am able to research these things and become a neurologist, it’s going to be partly due to these two gifted physicians.

My $10.60 Bathroom Break

Normally I don’t get charged for using the bathroom, but today was a different story.

Today I was trying to finish up some hours for my pilot’s license. I wanted to go to an airport I hadn’t been before, so I decided to fly to Huron, SD. About 3/4ths of the way to Huron, nature was calling. So, instead of just landing and taking off right away, I thought I’d take a bathroom break.

After landing in Huron, someone from the FBO came out and directed me towards a parking spot. I shut down, got out of the plane, and was asked if I needed fuel.

“Nope, nope, I just really need to use the bathroom. Could you show me where it is?”

“So you don’t need fuel or anything?”


“Ok, that will be a $10 landing fee.”

“Excuse me?”

“$10 landing fee.”

“Where’s the bathroom?”

“Inside that building and second door on the left.”

So I ran in and used the restroom. After I came out I explained that I was just a student flying up to get some hours. I was not aware of the landing fee, or even how to look up if an airport charged a landing fee, and I only needed to use the restroom.

The FBO attendant said, “Well actually there isn’t really a place to look up whether an airport charges a landing fee. But we’ve been charging a landing fee for three or four years now. That’ll be $10.60.”

I say shame on Huron FBO for nickel and diming students. That is just ridiculous.

Avera Clinical First Steps – Final Impression

So that’s it. The six weeks of the Avera Clinical First Steps has flown by. Was it worth it?

Yeah I’d say so. I highly recommend it to any student next year, but especially those who have no hospital experience. Sure the free food and the stipend are nice, but they aren’t the main reason to do this. If you don’t have any hospital experience this is a great intro. While it does seem like Avera is trying to strut their stuff during the entire six weeks of rotations, they really do have a lot to offer and many students from our group were surprised at the size and range of specialties and services that Avera offers.

It is really interesting to see what the outpatient OT, inpatient PT, RNs (of every variety), patient care supervisors, patients, radiology technicians, pharmacists, food service, respiratory therapists, wound ostomy, lab technicians, and medical technicians are doing on a day to day basis and how these all work together. Although I knew what a lot of these people did daily due to my prior clinical experience, I did learn a quite a few things.

But the clinical shadowing isn’t the only interesting thing the First Steps has to offer. Almost every noon during lunch a physician from a different specialty is brought in to talk about his/her specialty. I found these to be very beneficial. Every physician speaker was great and candidly answered questions students had about the specialty. Besides trying to expose students to different specialties, the First Steps also does a great job introducing us to the business side of medicine. While at times a bunch of this seems boring and useless, other things seemed very applicable and extremely interesting such as coding and physician recruitment.

Although there are many options for the summer between the first and second year of medical school, the Clinical First Steps is a solid choice and one I highly recommend.

Pediatrics: Another Look

As I struggle to figure out what my true calling is in the field of medicine, I find that my rotation at the Children’s Specialty Clinic at Avera has thrown my perception of the Pediatrics field.

The truth is, I never really considered Peds. I mean, I like kids and all. But I don’t love them, you know what I mean? Not long ago, during a family practice preceptorship, I was following the FP and he had a baby with a fever come into the clinic. For some reason this case woke me up from my shadow sleep walk that I was doing all that afternoon. But I couldn’t put my finger on why. It wasn’t the interesting-ness of the pathology, or the baby. Something was just slightly more engaging about that doctor-patient interaction than any of the others I had seen that afternoon.

Fast forward to the Children’s Specialty Clinic a few days ago. I was again more fascinated with the clinical cases I saw, and I think I have put my finger on why. The parents. Dealing with parents is one of the main reason why many upon many kid loving medical students decide that pediatrics is just not for them. But I found parents to be interesting, and their questions challenging.

At the risk of sounding like a moron/too inexperienced/whatever, my short time with adult services has left me with a taste of apathy. When asking an adult patient when their last surgery or clinic visit was mostly an answer of, “oh a few months ago” or “maybe like 2 years ago.” Whereas when a parent of a peds patient would answer a similar question they would surely pull out some list and say, “the middle of March 2008.”

But parents weren’t just better and more precise at the history, they were more engaging and seemed to take advice more seriously. When suggesting an adult to maybe tip the head of the bed up at bed-time for GERD and avoid pizza or other fatty foods, an adult may nod and agree. But I feel as though an adult patient is always thinking in the back of their mind, “yeah yeah, I know how to eat and sleep just give me the pill I need, and I’ll be on my way.” It was my impression that parents took this little advice more seriously. Parents also asked more specific questions, which in my opinion demands that the clinician knows what he/she is talking about and will keep him/her sharp.

Obviously I haven’t logged a lot of hours on the pediatric or medical floors. This is all based on an impression I got after a very short period of time. So at the risk of sounding naive and inexperienced, that’s my current opinion about peds.

*I will try to remember to bring this post back up during my third year pediatric rotation.

Intro To Private Pilot

Are you curious how much it costs to start working on your private pilots license? Here’s my personal numbers.

Discovery Flight (Is this something you actually want to do? Or is flying over-rated?) = $92.56
Book Kit (Includes classroom CDs with video lectures, pilot tools, textbook, and bag) = $344.75
Third Class Medical Physical (Are you physically fit enough in the eyes of the FAA?) = $148.00
Grand Total: $585.31

So there it is all out in the open. What it cost me to start working on my private pilot’s is just under $600. Quest Aviation in Tea estimates my final cost will be in the neighborhood of $6200. Stay tuned to find out how close that approximation actually is.

Finally, fun update – currently logged 18.5 hours of overall flight-time. Currently 2.8 of those hours are solo, and 1.6 hours are simulated instrument flight. I’ll be keeping you posted on how my cross-country flights go!

Third Year Advice

Thanks to a very nice MS3, we know-nothing MS1/MS2 students received a little advice during a mentoring session in the First Steps Program.

He wants us to know that Step 1 is a bad one, but he did have a few tips. Although he didn’t feel comfortable telling people how they should study, he did mention that it was a good idea to get one of the ‘First Aid’ books and really use that as a resource during our 2nd year classes. When we review the book during our classes it may seem elementary and only cover basic things. The 2nd year classes will seem exponentially more detailed than the ‘First Aid’ review book. These basic things are the concepts used for the Step 1 and will be as easily forgotten as the extreme details learned in class if not reviewed on a regular basis.

The Step 1 is also mostly Pharm and Path based (this student estimates 60% or more). While some basic biochem, microbio, embryology, or et cetera may be a question, it will probably be tied to a disease or drug treatment. This is why some students think it’s a good idea to schedule the Step 1 earlier than June. Some students have taken it right after finals, with the thought that Pharm and Path are fresh in their head and then they’ll have the entire summer off. This option isn’t for most students.

Another piece of advice, get exposed to specialties early (aka: this summer). As a medical student you will not have time to be exposed to a lot of specialties that you may be interested in. If you are thinking about ENT, or radiology, or anything else that isn’t a core rotation during the 3rd year, get out there and do some shadowing. Students pretty much have to have their mind made up by the beginning of the fourth year to start with the match application, interviews, getting LORs and all of the other things that go with applying for residency. So, if you are even remotely interested in a specialty not required in the 3rd year, do some shadowing this summer. This is the only chance you’ll probably get.

Lastly, when you get to those magical clinical years, be aggressive in you’re learning. Get out there and ‘do’ stop ‘shadowing.’ It’s easy in the beginning to be a wallflower and just exist early in the 3rd year. But if you take initiative and get hands on early, you’ll get much more out of your education. Do physical exams, learn to be concise and pertinent when giving patient reports, and use the Bates text-book since it really is a great resource.

Avera Clinical First Steps

The Avera healthcare system offers a nice 6-week summer course to the Sanford School of Medicine medical students between their first and second year called the “Clinical First Steps.” The program setup for two primary purposes.

The first is to give the early medical student a glimpse into what clinical medicine is really all about. To do this, the program tries to educate the medical students about what the supporting staff do in the hospital setting. The creators of this program had some stories as based on physicians who sometimes wondered, ‘why didn’t I learn that in medical school?’ They have also heard their fair share of, ‘how come that doctor didn’t learn that in medical school?’ types of comments. So six years ago they decided to create this program to give us the type of experience that generally isn’t taught to medical students.

Today during our orientation, the leaders of this program really wanted us to take home this first goal of the program. The example was one of a young 3rd year student. The ER physicians during this trainee’s time let the student ‘lead’ on a some-what critical case. The student started barking orders and requesting tests (an ABG to be exact). Getting carried away in the moment, the student demanded to see the results of the ABG ordered only 5 minutes prior. (NOTE: I have no idea how long it takes to get results from an ABG, this is just the story we were told.) Moral of the story was that medical students need to learn how long tests take to order, how long rooms take to clean, what a social worker, PT, OT, case manager, administrator, et cetera does all day. Knowing these things will makes us more effective and understanding physicians, and is the first goal of the Clinical First Steps program.

The second goal of the program has a little different spin. According to the opinion of one of our leaders, there are some doctors out there that were not meant to be doctors. Of course these doctors were smart and dedicated individuals, but they just don’t have the compassion (or whatever) to be good physicians and just work pay-check to pay-check not ever really caring about the patients. Luckily these people are a small minority. Our leader continues on to say he feels that unfortunately a larger portion of doctors end up in specialties where they are not truly happy. He feels that many physicians do not work in a specialty where they are truly engaged in what the specialty offers and the types of patients that doctor encounters. These doctors careers quickly become just jobs. When this happens these doctors also start to live from pay-check to pay-check looking forward to the day that they retire. This man’s opinion scares me, as I (and I’m sure my colleagues as well) want to work in a specialty where we are happy and fully engaged in it throughout our careers.

Finding this calling, is the second goal of the Clinical First Steps program. Throughout the next six weeks program leaders hope to expose us to as many different specialties as possible to help us get a feel for what we may someday want to do.

I am excited to go through this program and I have high hopes that it will help me narrow down my calling. I also can’t wait to start interacting with patients again, I really miss the hospital environment and it really brought back good memories being on the floors again.

Primary Care Preceptorship

Today, I had my preceptorship with a Family Medicine doctor at the McGreevy clinic on west 41st street in Sioux Falls. It was a good day, we saw a well rounded sample of patients from psych to a red toe.

First of all, during my day today, I really felt like I was connecting with the little kids. Something about the pediatric cases really seemed like it was up my alley. I was not expecting to ever go into any kinds of pediatric specialty, but now I might have to give it some consideration.

The other thing that I really noticed today was the door dance. The equivalent of the middle school dance in the exam rooms. During our after-clinic medical student dinner get-together, we brought up how weird it was to stand in a little exam room and try to get out the door. Other medical students went in to see a patient with an attending and a resident or another student. So a medical student, an attending, a second student (or resident) and a patient crammed into a tiny exam room.

As you can probably imagine the patient and attending would be the farthest into the room, while the first year medical student would be closest to the door (ie: farthest from the patient). When the clinic visit wraps up, as a first year trying to make a good impression, you want to open the door for the patient and higher up medical people to go out the door ahead of you. But due to the tremendously small amount of room you have to work with, you just throw open the door and walk out first like you’re dying to get out of there.

This probably doesn’t leave a good impression on the attending, but what can you do?

University of Nebraska Medical Center (UNMC) Neurosurgery Shadow

So I skipped school today.  

Yesterday I went down to Omaha, NE to spend the night with Bryan Krajeski – one of my good friends from my fraternity.  I would like to thank him for his hospitality.  

This morning at 3:30 am (because I was too excited to sleep), I got out of bed at Krajeski’s house and took a shower.  I left his house at 4:30 am for UNMC and arrived in the Neurosurgery residents’ office at 5 am.  Soon after I arrived, a third-year medical student from UNMC (actually his 7th year because of the MD/PhD) came in.  Then the intern arrived who was an ENT intern rotating on the neurosurgery service.  Then the chief and another resident.  Everyone was extremely welcoming and nice.  I felt like a part of the team from the very beginning (albeit a stupid, inexperienced, and useless part of the team – the point is I felt welcome and not a burden).  

The intern and the other student went to start rounding at one floor and the chief and I started rounding on all the patients in the random parts of the hospital.  Lady with really bad seizures, a girl who attempted a flip and broke her noggin, guy in car accident before christmas and still in coma, gigantic aneurysm in the basilar artery, another aneurysm in the carotid artery, headache guy who ended up having a pituitary adenoma were seen all before 7 am.  Then off to Tumor Board, which was at another hospital.  Interesting, but when you dim the lights to look at films its really hard to keep your eyes open.  

Back to UNMC, angiogram, clinic, aneurysm clipping, rounding.  Done at the hospital at 7 pm.  Made it home at 9 pm. I am physically exhausted, but still feel so excited.  

 I learned tons.  I met a lot of friendly residents and attendings.  I think I may have setup my research for the summer.  And I’m so glad I skipped class today.  

Sanford School of Medicine Review [Part 2]

Please visit Part 1 of the series here.  


Please visit the Sanford School of Medicine MD Program site for a better breakdown.  This year tuition and fees came out to about $22,000 for South Dakota residents.  We are one of the most inexpensive medical schools in the nation.  Also, we have a dedicated Financial Aid Advisor for medical students, and she works with you to get you on a budget and find the money you need to go to school.  


I have to admit, Vermillion isn’t the most stimulating place on the planet.  It is small, cold, and there is not a lot to do.  But there are some perks that go with living in any small town.  No problems parking, no traffic, cost of living is low, and you always know someone (or know someone that knows someone – only one or two degrees of separation) that is connected to anything in town.  


While the reputation is low among pre-meds, I believe/hear that the Sanford School of Medicine is actually very popular among high-profile residency programs.  The administration and upper class-men have told us time and time again that the clinical training at this school is second-to-none.  Medical students work directly with attendings and we gain a lot of experience!  Residency programs look for our students because they know we have that mid-western work ethic and we have a lot of clinic experience.  It has been said that our fourth years are allowed to do a lot more as a student here then they are allowed to as an intern in many residency programs.  The class of 2008 had 3/50 students match into a dermatology residency.  Dermatology is the most competitive residency in the nation and 6% of last year’s class matched into it.  To give you an idea, if only US seniors (approximately 15,000) matched into dermatology (approximately 400 spots) then on average 2.5% of medical students nation-wide match into it.  So, our class of 2008 over doubled that.  That’s pretty impressive.