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Happy Labor Day weekend to our faithful blog readers.  We are excited about getting to spend a couple of days at home all together with the family since my schedule has become much more palatable since starting my new rotation in toxicology.  We have been so blessed to have a lighter schedule this month so that I could have some time to decompress after an intense first two months of residency and so that I could have a few weeks to study before I take take the last of of my board certification exams (the Step III which is a two day exam that I have in about three weeks).

Even though my schedule has been better, Melissa has not been feeling the greatest with a recent illness all this week along with the pregnancy induced symptoms that she continues to struggle with even though we have started the second trimester.  Karuna started her homeschooling classes a couple of weeks ago and at the pace she is going through the material it appears that she will finish her pre-kindergarten curriculum in a couple more months.  She loves the literature based curriculum that Melissa is using with her because it seems to feed into her love for reading.  This year we are using a curriculum called Sonlight which was developed by missionaries to allow them to educate their children while abroad and then was adapted for use both in the US and abroad.  We wanted to give homeschooling a try this year since Karuna is not quite old enough to start kindergarten this year.  Since we are planning on being at a mission hospital when we finish residency we did not want to be in a position where our choice of a hospital was based primarily on access to good schools nearby.  Thus we figured that if homeschooling is a good fit for our family while in the U.S. then we can continue doing that while working abroad and not have to worry about picking up homeschooling if God calls us to work in a rural mission location.  We also thought that long-term homeschooling would be more adaptable to my schedule while I’m doing emergency medicine because of my odd schedules with night and weekend work and days off often falling during the typical work week and it will also make it much easier for us to travel because we would not be limited by the typical school schedule.  We’ll let you know how the whole process goes but so far it seems to fit Karuna’s learning style well and she seems to be learning a ton from Melissa.  Luke also seems to be enjoying homeschooling because most of the time when Karuna is reading a book with Melissa he likes to listen along and do the activities with them.  Otherwise he seems perfectly content running after the cat or playing with his toys while Karuna does her lessons.

Last week we got to enjoy spending some time with Melissa’s brother-in-law Ryan.  He was in town working with JP Morgan Chase training them to use some new software that his company, DSS, has developed to make electronic copies of checks.  He was in town for about four days and so we got to grab him away from work for a night to enjoy some great Spanish tapas food at Cafe Madrid.

I finished my month of emergency medicine at Parkland last week.  As an intern, we do about 18 twelve hour shifts every four weeks which doesn’t sound too bad except for the fact that you are often trying to transition from days to nights as your switch your shift times.  My month in emergency medicine at Parkland was a very eye opening, first hand experience with regard to many of the problems faced by the American medical system.  Most of the patients we serve in the Parkland ER do not have insurance and so we often get to see the consequences of people waiting far too long before they ever seek care.  Two patients come to mind when I think about how messed up our medical system is.  One was a man in his fifties who was the executive of a company before he lost his job about a year ago.  He lost his COBRA coverage a couple of months ago when he noticed that he was having some swelling on one side of his face that kept getting worse.  He was seen two times at a free-standing clinic for this swelling but they gave him antibiotics but didn’t pursue the root cause of his swelling any further.  Then during the past month he noticed that he was having multiple episodes of coughing up copious amount of blood and after a month of this not getting better he finally came to the Parkland ER because there was no where else he could go to get care since he did not have any insurance.  When I met him I immediately noticed a large swelling in his throat and neck and a CT scan confirmed our suspicion that he had cancer of his throat that had spread into his neck.  Thankfully I was able to get him into one of our ENT clinics quickly but perhaps if he had insurance he could have caught his cancer 3 months ago when it had not yet spread into his neck.  The second was a lady who works for a department store as a manager but who did not have any insurance through her work.  She had suffered from very severe diarrhea for the last three months but again because of no insurance she was not able to get access to good medical care and the clinics she went to just tried to put band aids on her problem.  By the time she showed up to the emergency room on my shift she had become so weak from her chronic diarrhea and had such bad irritation of her skin that she just didn’t know what else to do.  She was in tears as I talked with her because she kept apologizing for coming to the ER but she didn’t know what else to do to get better.  Perhaps if she had insurance or access to healthcare she could have been diagnosed with new onset ulcerative colitis much earlier and prevented three months of misery.

I’m really interested in finding out what the two major presidential candidates have to say regarding getting people access to basic healthcare because it is so unfortunate that in a country as wealthy as ours there is such a large disparity between the haves and have-nots.  What is ironic is that we spent almost twice the amount of money on healthcare than most other developed countries but yet we rank among the lowest in terms of basic healthcare outcomes like infant mortality or life expectancy.  In a lot of ways I wish both the presidential candidates would at least spend one day in one of our county emergency rooms to meet our patients face to face to see the enormity of this problem.  I’m thankful that Parkland is there for patients who fall through the cracks but an ER trying to provide all the basic care for a population or one hospital taking care of the indigent is just not a sustainable option.  It will be interesting to see the debates this fall and to hear the solutions that both parties propose because clearly a better solution needs to be there to provide basic healthcare.

I’ve also enjoyed my shifts in the ER more and more as I’m starting to learn more about how our hospital works and how best to help my patients navigate the medical system to get the care they need.  I’ve also enjoyed that over the last few weeks I’ve gotten more opportunities to pray with my patients especially with the patients who I’ve had to give some really bad news to like the discovery of a new tumor or in talking with a patient who had tried to commit suicide.  One man’s story comes to mind as I think about sharing the hope of Christ with my patients.  This was a man who was released from prison a few months ago on a drug trafficking charge and had come into the emergency room because he had made a very serious suicide attempt.  As I repaired his wounds I had lots of time to talk with him and to learn about him.  He was in prison for several years and during that time his family completely shunned him and did not make contact with him once even though they lived close by.  When he got out of prison he tried to find jobs for several months with no success because no one wants to hire an ex-convict.  After months of this he realized there was really nothing much left to live for since his life was in shambles and he couldn’t think of any way to put his life back together and there was no one there to help him fully re-enter society.  So when he reached that low point in his life he decided the best option was to end his life.  As I talked with him we talked about the issue of faith and how he had finally started to attend church again while he was in prison after he had walked way from God for many years.  As I shared with him some of my own struggles with depression and how when I thought life was unbearable the only person I could run to was Christ alone.  I shared with him a verse that God had used to speak to me many years ago when I contemplated ending my life.  Matthew 11:28 says, “Come to Me, all who are weary and heavy-laden, and I will give you rest.  Take My yoke upon you and learn from Me, for I am gentle and humble in heart, and you will find rest for your souls.  For My yoke is easy and My burden is light.”  I had an opportunity later to pray with him and I hope that God used me to share with him the hope in Christ, someone to turn to who will never reject him.  I was also wondering what resources there are available to help prisoners re-enter mainstream society, especially with regard to helping them find jobs again.  If any of you know of any organizations that specifically work with ex-convicts please pass along that information so that I can share that with some of my patients since I see a lot of prisoners in the ER.

This past Monday I started a new rotation in toxicology which has been a phenomenal rotation so far.  Most days I get in around 8 AM and other than Tuesday I’m usually about to be home by 1 PM!  I’ve enjoyed it a lot because I’ve been learning about the management of different toxins but I have not felt overwhelmed by the work like on other rotations.  The faculty at UT Southwestern staff the North Texas Poison Center where we receive all the poison center calls for the North Texas area.  It is an interesting place because we follow most of these patients from afar unless they end up being admitted at Parkland.  Usually the patient or the treating team gives us a call when they suspect a toxin exposure and the serious ones get triaged to the physicians to recommend treatment plans.  It has been interesting to get cases from other hospitals and to see how patients are managed so differently depending on which hospital you show up to.  This rotation has convinced me of several hospitals that I definitely don’t want to end up at if I get injured!  We’ve got some interesting cases so far with several serious Tylenol overdoses, Copperhead bites, organophosphate poisoning, tricyclic antidepressant overdoses and exposure to chlorine gas.  I’m hoping to use this rotation to learn as much as possible with regard to organophosphate poisoning since there are so many people in India who try to commit suicide with this agent.

This weekend was supposed to be a four day weekend because I have Monday off and I got done with work on Friday very early in the morning.  We took the kids for a repeat visit to Dallas Zoo with the focus being on the big cats, reptiles, birds and amphibians.  Luke and Karuna liked the artificial river the most since we brought along their bathing suits and they used the opportunity to play in the water to cool themselves off in the midday heat.  I ended up working a shift in the emergency room overnight on Friday because one of my classmates was ill and so I spent most of the morning catching up on sleep.  The rest of the weekend looks to be relaxing one with plenty of time with Appachan and Ammachi and cousins who are back in town.  We are also excited that next week Melissa’s parents will be coming into town from Nebraska to visit us for a couple of days.

Please keep the people of Louisiana and Texas in your prayers as the latest hurricane, Gustav, barrels towards the Gulf Coast.  This morning we started receiving patients from hospitals near the gulf who are evacuating all their inpatients to other hospitals in surrounding states.  If we end up receiving a large number of patients (in the 100s) then it appears they will activate the disaster plan which might mean that I’ll be working a couple more shifts this weeks since all the EM residents are on the disaster pager.  We’ll keep you updated on how everyone is doing over the next couple of days because right now the forecast is for the storm to be a tropical depression by the time it reaches the Dallas area and we are expecting quite a bit of rain.

We also wanted to post some new pictures from the last month.  The first set is pictures from David and Kris’ (Melissa’s brother and sister) visits to Dallas along with pictures from Ashish and Lydia’s first birthday party.  You can view that slideshow by clicking here:  Pictures from August.  The second set are some pictures I took while on trauma surgery and while I was doing my ambulance ride-along with Dallas EMS.  You can view the slideshow by clicking here:  Trauma Surgery & EMS.  As always you can also just click on individual pictures below.  Have a blessed Labor Day weekend!