True Stories From Podiatric Residency

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krabmas, are you at inova? If not, where are you? How happy are you so far?

Originally Posted by biocmp

krabmas, are you at inova? If not, where are you? How happy are you so far?

yes I am. I could not ask for a better program.

I know everyone thinks that their residency is the best, but mine really is. I have great co-residents and too many attendings that like teaching. There is always an oppurtunity to learn.

I'm on medicine now and they could not care less that I am going to be a podiatrist. I have the same responsibilities as any other intern.

PM me if you have more specific questions.

I'm sick (literally) from the ED. ppl love to cough on the asian guy....

I was walking down the hall last week and happened to glance in a room. I noticed that a patient didn't look like she was doing too well. I went in and examined her. I ended up calling a "Code Blue"!

I enter the OR, and the patient is being prepped for a circumcision (non-infant)...

The one of the surgeons asks the anesthesiologist, "you have an apprentice today?"
I respond and tell them I'm a 3rd year podiatry student doing the anesthesia rotation. The surgeon responds, "podiatry? Hmmm, I know they are doing more and more, but you guys don't operate on dicks, do ya?"

The other surgeon chimes in, "well, it depends. What if the dick is 12 inches long? That's a foot."

Originally Posted by Feli

I enter the OR, and the patient is being prepped for a circumcision (non-infant)...

The one of the surgeons asks the anesthesiologist, "you have an apprentice today?"
I respond and tell them I'm a 3rd year podiatry student doing the anesthesia rotation. The surgeon responds, "podiatry? Hmmm, I know they are doing more and more, but you guys don't operate on dicks, do ya?"

The other surgeon chimes in, "well, it depends. What if the dick is 12 inches long? That's a foot."

Now that's funny!

Only 8 more days of General Surgery!!! (Not that I'm counting) These 30 hour shifts are getting old

JW,
What kind of procedures are doing on your general surgery rotation?

Originally Posted by biocmp

JW,
What kind of procedures are doing on your general surgery rotation?

Anything and everything that goes with the territory. Colectomies, gastrectomies, hernias, lap chol, appendectomies, etc. And then there are the floor things like central lines. It is quite intense and very long hours. It has been a good experience and I've learned a ton but I'm ready to be done.

wow that sounds pretty cool! how long was that rotation for JW?

Most of the residency programs will have residents doing 1 month of general surgery. Some programs may require 2 months. During my general surgery rotation, I got to assist in a Whipple Procedure.

Originally Posted by meats

wow that sounds pretty cool! how long was that rotation for JW?

One month rotation (February). I don't know if it is cool as much as it is painful! No, I have learned a lot but this isn't for me.

Originally Posted by jonwill

One month rotation (February). I don't know if it is cool as much as it is painful! No, I have learned a lot but this isn't for me.

I am just finishing up Vascular surgery and thinking the same thing that q3 and q4 30 hour shifts are just not fun or exciting anymore. The first night it was sort of exciting but that was 2 months ago on Medicine. Next is Gen surg. I think I want another month of vascular. The stuff in the abdomen is pretty gross - and people ask why feet?

I was just thinking about this 30 hour thing. I keep telling people that we take home call for podiatry but for at least 6 months of the 3 years we are doing q3 or q4 30 hour shifts. Still better than doing it for 5 years though.

As for exciting stories - I was sewing a dehissence of a fem-pop bypass bedside w/ a subcutanious reverse GSV graft. And the patient decided to become nauseous and drop his O2 sats and gasp for air - real fun times.
You probably thought I was gonna say that I pierced the graft and the patient exsanguanated.

Originally Posted by Feli

I enter the OR, and the patient is being prepped for a circumcision (non-infant)...

The one of the surgeons asks the anesthesiologist, "you have an apprentice today?"
I respond and tell them I'm a 3rd year podiatry student doing the anesthesia rotation. The surgeon responds, "podiatry? Hmmm, I know they are doing more and more, but you guys don't operate on dicks, do ya?"

The other surgeon chimes in, "well, it depends. What if the dick is 12 inches long? That's a foot."

lol, wow... that's hilarious. mind if i steal that?

Internal med......i think i have wrist cramp (no dirty posts, please, haha) from the endless notes

Originally Posted by krabmas

I am just finishing up Vascular surgery and thinking the same thing that q3 and q4 30 hour shifts are just not fun or exciting anymore. The first night it was sort of exciting but that was 2 months ago on Medicine. Next is Gen surg. I think I want another month of vascular. The stuff in the abdomen is pretty gross - and people ask why feet?

I was just thinking about this 30 hour thing. I keep telling people that we take home call for podiatry but for at least 6 months of the 3 years we are doing q3 or q4 30 hour shifts. Still better than doing it for 5 years though.

As for exciting stories - I was sewing a dehissence of a fem-pop bypass bedside w/ a subcutanious reverse GSV graft. And the patient decided to become nauseous and drop his O2 sats and gasp for air - real fun times.
You probably thought I was gonna say that I pierced the graft and the patient exsanguanated.

I'm on vascular next and looking forward to it. As for today, I began another 30 hour marathon at 5AM!

When you guys are on rotations like gen/vascular/ortho surgery/anesthesia, are the attendings aware you are PM and S residents? Just curious if you guys are treated any differently than non-pod residents....meaning if you doing everything they are allowed to do.

Originally Posted by JEWmongous

When you guys are on rotations like gen/vascular/ortho surgery/anesthesia, are the attendings aware you are PM and S residents? Just curious if you guys are treated any differently than non-pod residents....meaning if you doing everything they are allowed to do.

Yea, they are aware but it doesn't matter. At least where I am, I am treated as a regular intern. I take care of my own patients and see my own consults. On floor call, I'm often called to manage blood sugar, blood pressure, electrolyte imbalances, nausea, isomnia, pain, etc. And of course, if I'm not sure what to do, there is always a chief to bounce ideas off of. It is a great learning experience but sometimes doesn't make for much sleep! It was the same on medicine. On ID, I was actually the only resident on service that month so I ran the service and worked directly with the attendings.

All of these off rotations are great for general knowledge but really make me thankful for the profession that I have chosen.

Originally Posted by jonwill

Yea, they are aware but it doesn't matter. At least where I am, I am treated as a regular intern. I take care of my own patients and see my own consults. On floor call, I'm often called to manage blood sugar, blood pressure, electrolyte imbalances, nausea, isomnia, pain, etc. And of course, if I'm not sure what to do, there is always a chief to bounce ideas off of. It is a great learning experience but sometimes doesn't make for much sleep! It was the same on medicine. On ID, I was actually the only resident on service that month so I ran the service and worked directly with the attendings.

All of these off rotations are great for general knowledge but really make me thankful for the profession that I have chosen.

Yes, it does make you appreciate podiatry that much more, but I enjoyed those months that I was on other services. It allows me to relate to my patients about the procedures/surgeries that they've had or about to have or talk to them about their medical issues.

Originally Posted by JEWmongous

When you guys are on rotations like gen/vascular/ortho surgery/anesthesia, are the attendings aware you are PM and S residents? Just curious if you guys are treated any differently than non-pod residents....meaning if you doing everything they are allowed to do.

Just like Jonwill, I to am just another intern. Our surgery residency is set up with 5 teams: Trauma, Vascular, Colorectal, Gen surg run by resident, gen surg kaiser. Each team has an intern and some other residents including a team chief. Vascular this month has me as the intern and the chief resident as our team chief. That is the team. The Chief went away this weekend. So the team is me. There is no "I" in "team" but there is a "me".

And just like jonwill, as the intern on the team, the floor is my responsibility. We are expected to know all of the patients on the team (meds, labs, results, plan...)
Tomorrow I get to scrub on an open AAA! It was supposed to go today but it got posponed until tomorrow. It is not dissected yet.


To answer the question - are we treated differently? The expectations are the same. We are asked the same questions as any other intern. And there is always someone else to call if something happens but we don't know what to do.

Words of wisdom for when you become a resident.

1. better to risk looking like an idiot and ask for advice than to do the wrong thing.

2. no one will think you are an idiot. the junior and senior residents are there for a reason and they know that.

Originally Posted by JEWmongous

When you guys are on rotations like gen/vascular/ortho surgery/anesthesia, are the attendings aware you are PM and S residents? Just curious if you guys are treated any differently than non-pod residents....meaning if you doing everything they are allowed to do.

When the attendings meet you they can read on our white coats and badges "podiatry" or "podiatric surgery".

There are times that we talk to the attendings on the phone before we meet them. In those cases they do not know. If you introduce yourself on the phone as "so and so the podiatry resident" and not just "so and so team intern" it is sort of saying that you are different.

Originally Posted by SportPOD

Yes, it does make you appreciate podiatry that much more, but I enjoyed those months that I was on other services. It allows me to relate to my patients about the procedures/surgeries that they've had or about to have or talk to them about their medical issues.

I agree with that.

Some of our patients are really sick but have you seen what the vascular surgeons see. The AAA patients are some of the sickest most non-compliant patients that get one of the biggest operations available.

I've had a number of attendings and other residents ask why we need to do these other rotations and if they will make me a better podiatrist. I always say that it will definitely make me a better podiatrist and that if nothing else it teaches me when to say no to surgery. I think it is very important to know when to not opperate.

Originally Posted by krabmas

Just like Jonwill, I to am just another intern. Our surgery residency is set up with 5 teams: Trauma, Vascular, Colorectal, Gen surg run by resident, gen surg kaiser. Each team has an intern and some other residents including a team chief. Vascular this month has me as the intern and the chief resident as our team chief. That is the team. The Chief went away this weekend. So the team is me. There is no "I" in "team" but there is a "me".

And just like jonwill, as the intern on the team, the floor is my responsibility. We are expected to know all of the patients on the team (meds, labs, results, plan...)
Tomorrow I get to scrub on an open AAA! It was supposed to go today but it got posponed until tomorrow. It is not dissected yet.


To answer the question - are we treated differently? The expectations are the same. We are asked the same questions as any other intern. And there is always someone else to call if something happens but we don't know what to do.

Words of wisdom for when you become a resident.

1. better to risk looking like an idiot and ask for advice than to do the wrong thing.

2. no one will think you are an idiot. the junior and senior residents are there for a reason and they know that.

diddo (sp?)

it's really amazing how nice ppl are. Yeah, you get the occasionally a-hole, but that's a rarity. Most junior/senior residents are really good at what they do and know a lot more than any sane person should. I'm not doing surgery this month (medicine), but even this is a great rewarding experience. (FYI: FDA alert released on "bisphosphonates" use just this past month) Probably the only negative experience I had with non-DPM's was at Cook County, Chicago, IL when I was a student, but that was with a Cardiothoracic Attending and yeah, he thought I was an idiot after that (... i really am an idiot, but i've done a good job keeping that a secret).

Really, the toughest residents are other DPM's you meet, especially during externships. haha, good luck, and just read as much as possible, foot & ankle stuff, but about everything else too!

I'm covering for my co-resident this weekend, so i am scrubbing in for a displaced femor fracture (really ugly), that should have been today, but her K was too low. "The joy of sx" on Sunday, haha, I feel yeah krabmas.

Originally Posted by JEWmongous

When you guys are on rotations like gen/vascular/ortho surgery/anesthesia, are the attendings aware you are PM and S residents? Just curious if you guys are treated any differently than non-pod residents....meaning if you doing everything they are allowed to do.

the biggest problem i have after doing one of these rotations is I forget what a foot looks like. If it wasn't for our weekly radiology rounds, cadaver/wetlabs, and AOFAS lecture series (ankle instability this week, ), i'd forget everything Pod related. I get so entrenched in the rotation as "their" resident, I have to read up on tube-feeding, endocarditis, hyponatremia, etc and lose track of what i'm actually here in Pittsburgh for.

Ha, i do love it though, and definitely agree with SportPod. These guys are good and have to be good or ALL of us will suffer in the end, especially if one of us was in the hospital for something.

Originally Posted by krabmas

I always say that it will definitely make me a better podiatrist and that if nothing else it teaches me when to say no to surgery. I think it is very important to know when to not opperate.

I got to scrub in on an open AAA repair today.

What a better way to learn anatomy than a cadaver!

And vascular surgeons use self retaining retractors for almost all of their surgeries. So great to not have to retract!

Later while rounding we hear a "code vascular in the ED" over head. I call the ED and it is a dissecting thoracic aortic aneurysm w/ hemodynamic instability. Tha cardiothoracic surgeon was already paged and calling back so that is the end of that story. We finished rounds and I went home.

Originally Posted by krabmas

When the attendings meet you they can read on our white coats and badges "podiatry" or "podiatric surgery".

There are times that we talk to the attendings on the phone before we meet them. In those cases they do not know. If you introduce yourself on the phone as "so and so the podiatry resident" and not just "so and so team intern" it is sort of saying that you are different.

Yea, I think it is important that when you do off rotations, you make sure they know that you are a podiatric surgery resident. It helps others better understand our training.

Personally, as a first year student I think it is great to read about all of the experiences throughout residency. Makes it much easier to keep working through Micro when you know there are great things a head!

It has got to be pretty neat as a podiatry resident to get the opportunity to rotate with different specialties. I can imagine that the rotations with specialties such as plastics, vascular, etc are very important when it comes to podiatry and the things podiatric surgeons are doing today and into the future.

Thanks again for all the great tidbits and keep them coming!

Originally Posted by GoldenGustie

Personally, as a first year student I think it is great to read about all of the experiences throughout residency. Makes it much easier to keep working through Micro when you know there are great things a head!

It has got to be pretty neat as a podiatry resident to get the opportunity to rotate with different specialties. I can imagine that the rotations with specialties such as plastics, vascular, etc are very important when it comes to podiatry and the things podiatric surgeons are doing today and into the future.

Thanks again for all the great tidbits and keep them coming!

Awe come on. You took your undergrad prereqs at Gustavus in the infamous Nobel hall. Micro should be a piece of cake for you now.

today I got to do an extravisation of a hematoma from the popliteal fossa.

The patient had a ruptured SFA/pop pseudoaneurysm that was stented endovascularly. Then the patient had a neuropraxia of the common peroneal nerve/possibly entire sciatic nerve at the level of the bifurcation.

So tonight we removed the hematoma. After the surgery the patient said he could feel his foot but he could not move it yet.

We will see how he does tomorrow.

Originally Posted by jonwill

...All of these off rotations are great for general knowledge but really make me thankful for the profession that I have chosen.

Exactly^ This is even how I feel about some of my 3rd year clinic rotations. There are many days and experiences that make me very glad that my future specialty is foot and ankle.

I also agree with your and others' statements about how pod residents need to make sure the attendings and other residents know they are DPMs in order to increase the awareness of our level of training and competence.

Originally Posted by Feli

Exactly^ This is even how I feel about some of my 3rd year clinic rotations. There are many days and experiences that make me very glad that my future specialty is foot and ankle.

I also agree with your and others' statements about how pod residents need to make sure the attendings and other residents know they are DPMs in order to increase the awareness of our level of training and competence.

I do not go out of my way to tell others that I am a podiatry resident. On surgery we have Family practice also rotating. They don't say oh by the way I am not really a surgery resident.

If a patient asks where I went to medical school, I go thru the whole story of podiatry resident on vascular surgery rotation and went to podiatry school at NY.

Sometimes I think that by saying that I am a podiatry resident some of the attendings and residents will teach less or think that I just need to get thru the rotation but it is not necessary for me to learn what the gen surg residents need to know. I want the full experience so I try to blend in as just another surgery intern. But the white coat says podiatry so it is out there for anyone to see.

Originally Posted by krabmas

today I got to do an extravisation of a hematoma from the popliteal fossa.

The patient had a ruptured SFA/pop pseudoaneurysm that was stented endovascularly. Then the patient had a neuropraxia of the common peroneal nerve/possibly entire sciatic nerve at the level of the bifurcation.

So tonight we removed the hematoma. After the surgery the patient said he could feel his foot but he could not move it yet.

We will see how he does tomorrow.

still can't move it. but he definitely has better sensation.

I was on trauma call last night. We had 3 GSW's and one assault. We had a guy "minding his own business" get shot twice in the face who is now in ICU. He just happened to have 3K in fifties and twenties on him. The sad one was the 17 year old who sustained a GSW to the head and ended up dying.

Anyway, didn't sleep at all and can't figure out why ANYONE would want to do this for a living

On the other hand, I'm sure glad that there are people who are!

Got to scrub a DRIL procedure today in Vasc Sx. Then we did a AV graft for dialysis access in the groin.

Last night one of my patients had an angio of the R leg. She then had belly pain. We followed the H/H for a few hours - it dropped. She became hypo tensive. The attending was called - she went back to the OR w/ a retroperoteneal bleed. SFA was ligated and drains placed. She woke up in the ICU and was extubated in the AM.

To Feelgood: I know you want to do lots of surgeries and get real good at being a surgeon, but with out inpatient care it is hard to learn what is normal post-op and what needs to either go back to the OR or the ER.

When you are out in provate practice and the patient calls you the night of surgery with a complication or that they cannot pee - what are you going to do if you've never seen a post-op patient before.

For my first few months of residency I wondered why we needed to round all the time. After medicine and vascular surgery I understand - we know our patients and what we are looking for as complications. we know what happened in the OR (good and bad). The nurses just know in general to call with outlying limits of vitals. Sometimes things happen during the day that the nurses wait to tell you until later when they see you for rounds. If you do not round again you won't find out. Better to find out before it is an emergency.

I agree - Feelgood - that when we are attendings we will not round 2-3 times a day. But for now we are residents (you will be) and this is what we do.

Originally Posted by krabmas

Got to scrub a DRIL procedure today in Vasc Sx. Then we did a AV graft for dialysis access in the groin.

Last night one of my patients had an angio of the R leg. She then had belly pain. We followed the H/H for a few hours - it dropped. She became hypo tensive. The attending was called - she went back to the OR w/ a retroperoteneal bleed. SFA was ligated and drains placed. She woke up in the ICU and was extubated in the AM.

To Feelgood: I know you want to do lots of surgeries and get real good at being a surgeon, but with out inpatient care it is hard to learn what is normal post-op and what needs to either go back to the OR or the ER.

When you are out in provate practice and the patient calls you the night of surgery with a complication or that they cannot pee - what are you going to do if you've never seen a post-op patient before.

For my first few months of residency I wondered why we needed to round all the time. After medicine and vascular surgery I understand - we know our patients and what we are looking for as complications. we know what happened in the OR (good and bad). The nurses just know in general to call with outlying limits of vitals. Sometimes things happen during the day that the nurses wait to tell you until later when they see you for rounds. If you do not round again you won't find out. Better to find out before it is an emergency.

I agree - Feelgood - that when we are attendings we will not round 2-3 times a day. But for now we are residents (you will be) and this is what we do.

I've got vascular next month. It should be interesting.

Rehab Med... (to self: "at least it's a top 10 program")... ugh.... rehab

Originally Posted by jonwill

I've got vascular next month. It should be interesting.

Best rotation so far. The attendings that we work with are amazing. Great people and great surgeons. The month made me want to be a vascular surgeon.

I think I might start putting AV fistulas between the DP and the venous arch.

Jon - do you have loops? Try to find some or borrow some for V.surg. They will be so helpful.

Originally Posted by Stafocker

Rehab Med... (to self: "at least it's a top 10 program")... ugh.... rehab

i need a massage after all this Rehab

So what kind of moonlighting options do podiatric residents have? Are you able to cover the ER or anything when you aren't on duty to make a little cash on the side? How about working with nursing homes or something of that sort? I know that none of us could ever become rich while being a resident (minus winning the Powerball or World Series of Poker) but I am just curious what you all do to make a little on the side?

Originally Posted by GoldenGustie

So what kind of moonlighting options do podiatric residents have? Are you able to cover the ER or anything when you aren't on duty to make a little cash on the side? How about working with nursing homes or something of that sort? I know that none of us could ever become rich while being a resident (minus winning the Powerball or World Series of Poker) but I am just curious what you all do to make a little on the side?

There is not a lot of time on the side for moonlighting.

Many programs prohibit it.

I've only really seen higher level MD residents moonlight.

Originally Posted by krabmas

There is not a lot of time on the side for moonlighting.

Many programs prohibit it.

I've only really seen higher level MD residents moonlight.

We actually do some moonlighting for ortho and some other pods as well. We don't have time to do a lot of it though.

OK, cool cases: I did a PT tendon repair with pegasus graft last Friday. That's only the 2nd one I've personally done and think it is a pretty cool procedure (I also tubulated the tendon of course).

Originally Posted by jonwill

We actually do some moonlighting for ortho and some other pods as well. We don't have time to do a lot of it though.

Don't you need to get your own malpractice in order to moonlight?

300+ pound middle aged man comes into the ER around 3am huffing and puffing after falling in the shower. BP is nearly 300 systolic.
"Any meds?" Nope. "Allergies?" Nope. "Major medical problems in the past?" He states that he gets SOB like this sometimes, but usually it's not so bad.

I decide it might be ACS, so I start him on O2 and notify my attending that he needs to see the patient and get him a BP med right away. With obvious fluid in the lungs on physical exam, my attending knows right away that it's acute CHF but tells me with a smile "at least you realized it was a pretty serious problem."

Labs come back with blood glucose of almost 300, and CXR shows and the most worst cardiomegaly I'd seen so far. My attending tells him he's diabetic with acute CHF and asks him if he has a primary doc who would like to admit him. The patient replies that he doesn't have a primary and doesn't really like going to hospitals or doctors. "Nope.... can't imagine you do."

I wonder if he will start going to doctors in the future?

Originally Posted by Feli

300+ pound middle aged man comes into the ER around 3am huffing and puffing after falling in the shower. BP is nearly 300 systolic.
"Any meds?" Nope. "Allergies?" Nope. "Major medical problems in the past?" He states that he gets SOB like this sometimes, but usually it's not so bad.

I decide it might be ACS, so I start him on O2 and notify my attending that he needs to see the patient and get him a BP med right away. With obvious fluid in the lungs on physical exam, my attending knows right away that it's acute CHF but tells me with a smile "at least you realized it was a pretty serious problem."

Labs come back with blood glucose of almost 300, and CXR shows and the most worst cardiomegaly I'd seen so far. My attending tells him he's diabetic with acute CHF and asks him if he has a primary doc who would like to admit him. The patient replies that he doesn't have a primary and doesn't really like going to hospitals or doctors. "Nope.... can't imagine you do."

I wonder if he will start going to doctors in the future?

feelgood wants to take care of his htn and dm

Originally Posted by krabmas

feelgood wants to take care of his htn and dm

I'll debride his nails!

Ahh, the life of a DMC first year resident. I just recieved the call schedule for my first year of residency and it looks like I will be spending the week of Thanksgiving and the week of Christmas taking first call at the hospital. This is going to be a long year.

Originally Posted by gustydoc

Ahh, the life of a DMC first year resident. I just recieved the call schedule for my first year of residency and it looks like I will be spending the week of Thanksgiving and the week of Christmas taking first call at the hospital. This is going to be a long year.

Yea, it's a long and busy year...

THAT I'M FINISHING!!!

When are you coming up?

Originally Posted by gustydoc

Ahh, the life of a DMC first year resident. I just recieved the call schedule for my first year of residency and it looks like I will be spending the week of Thanksgiving and the week of Christmas taking first call at the hospital. This is going to be a long year.

Ask for a good tote bag loaded up with toothpaste, deodorant, eye drops, and a razor as a graduation present...

...always good to avoid lookin like a derilict on morning rounds after a night of in-house call

Originally Posted by Feli

Ask for a good tote bag loaded up with toothpaste, deodorant, eye drops, and a razor as a graduation present...

...always good to avoid lookin like a derilict on morning rounds after a night of in-house call

you can find all of that in clean holding!