November 30, 2005

Minnesota Doctor Faces Sentencing

From Fox 9 news

Posted by calv0016 at 11:43 PM

November 29, 2005

Psychiatry at HCMC

So, I've now completed two out of six weeks of my psychiatry rotation at Hennepin County Medical Center. So what's it like? Well....

- The patients are much sicker than those found in the community. In general, the vast majority of psychiatry is handled by primary care doctors, with the more complicated patients seeing psychiatrists. And of those that require a psychiatrist, only a few require hospitalization. And of those that require hospitalization, it's the sickest that tend to end up at HCMC. Most psychiatrists tend to see way more depression than schizophrenia, with full-blown psychosis rare. Not at HCMC.

- Of the patients I've followed so far, the major problems have been pseudo-dementia (dementia secondary to severe depression, in this case secondary to bipolar disorder), poorly controlled paranoid schizophrenia, relatively newly diagnosed paranoid schizophrenia, residual-type schizophrenia and substance abuse (alcohol and crack), schizoaffective disorder, catatonic-type schizophrenia, aggression secondary to Huntington's Disease, dementia secondary to muscular dystrophy, suicide attempt secondary to schizoaffective disorder, suicide attempt secondary to major depressive disorder, and agitation secondary to multiple strokes. Of those patients, about 75% have a history of chemical dependency, and over 90% are in the psych unit on a 72 hour hold, a court hold, or have been committed.

- The doctors who work there are special. They all have a natural affinity for the practice environment of HCMC. Some people speculate that this trait is indicative of psychopathology, but at the least it indicates a desire to work with the sickest of the sick psychiatry patients, a great many of whom are poor, uninsured, and/or homeless.

- In addition to the doctors, I also work with nurses, nurse practitioners, occupational therapists, mental health workers, social workers, and psychologists on a regular basis. Throw in the occasional consult from another service (medicine, endocrinology, cardiology, neurology), the lawyers involved in the court hearings, and mental health and chemical dependency workers from the community, and it's a full house!

Posted by calv0016 at 3:53 PM

November 14, 2005

Ophtho

My Ophthalmology rotation ended last Friday. I gave my presentation on the science behind vitamins for treating age-related macular degeneration and took the short exam, then went down to the Adytum and began studying for my psych rotation (yes, I'm that much of a geek that I began studying for my next rotation immediately after finishing the previous one). Ophtho was interesting, and something I'm glad I did, but not something I would have liked doing any longer than the 3 week rotation.

Posted by calv0016 at 7:02 AM

October 29, 2005

Ophthalmology

This past week I began my Ophthalmology rotation at the U. It's almost entirely shadowing residents and seeing them work up patients. We're supposed to do the following:
* experience most types of ophthalmic practice settings (i.e., outpatient, inpatient, emergency room, operating room);
* obtain adequate knowledge in the areas of ophthalmology most commonly seen in family practice (i.e., red eye, glaucoma, trauma, strabismus, neuro-ophthalmology, and medical ophthalmology); and
* obtain skills in basic ophthalmic examination techniques (i.e., visual acuity measurement, strabismus, slit-lamp biomicroscopy, tonometry, ophthalmoscopy, visual field examination).

Posted by calv0016 at 11:26 PM

October 6, 2005

IMIG of the Month

My very own U of M Internal Medicine Interest Group was featured as an "IMIG of the Month" in ACP's IMpact newsletter.

Posted by calv0016 at 6:53 PM

September 30, 2005

Anesthesiology is over

My anesthesiology rotation ended today. I'm very sad, as I enjoyed this rotation tremendously. I now have a much better understanding of cardiopulmonary physiology, autonomic pharmacology, muscle relaxants, and airway management. I can now perform basic airway management, including tracheal intubation, and I'm decent at starting i.v.'s. Next up...my "radiholiday."

Posted by calv0016 at 4:34 PM

September 28, 2005

Katrina Relief

I received this email today. My understanding is that it is likely I'll be part of Team 4, set to be deployed between October 23 and November 11.

This is the U of M blog started by a Team 1 member and currently continued by a Team 2 member. The Mayo blog is here.


Dear MRC medical student volunteer,

We need the assistance of 3rd and 4th year medical students willing
and able to deploy to the Lafayette Louisiana area as part of an
ongoing University of Minnesota Medical Reserve Corps and Mayo Clinic
collaborative relief mission.

We are sending 4 teams of physicians, nurses and mental health
professionals to Lafayette over a 60 day period. Team 1 has just
returned and Team 2 is currently deployed in the area.
Team 3 will depart on October 9 and return October 25.
Team 4 will depart on October 23 and return November 11.

We are recruiting 4 medical students for Team 3 and an unspecified
number for Team 4. You must be able to participate for the entire
duration of team deployment. If you are interested and able to
volunteer for either team please contact me immediately via email.

I'll look forward to discussing the details with you.

Thank you very much,

Elizabeth McClure

Posted by calv0016 at 6:17 PM

CAGB Anesthesia

Today I basically had a single case - a 3-vessel Coronary Artery Bypass Graft (CABG). The monitoring in this case was pretty intense. First, we had the basic monitors that everybody under general anesthesia has:

pulse oxymeter - heart rate and oxygen saturation

ECG - for showing a continuous electrocardiogram, monitoring for cardiac ischemia, etc (oh, he came in with ST-depression, evidence of ischemia)

non-invasic blood pressure cuff - for blood pressure (duh)

Ventilatory monitors - to show us air flow, pressures End-titdal CO2, FiO2, inspired oxygen concentration, inspired anesthetic gas concentrations

Temperature probe - for looking at "shell temperature"

And since this case was a bit involved, we also had:

Arterial line - continuous blood pressure monitoring (when every 3-minutes is just not sufficient)

Central venous line with a pulmonary artery catheter - pulmonary pressures, core temperature, measurement of cardiac output and cardiac index, and right ventricular end-diastolic pressure

Transesophageal Echocardiography (TEE) with doppler - this uses an echocardiograph machine similar to what is used in regular echo, but the probe is placed in the esophagus rather than on the front of the chest. Amazing pictures, nice view of the heart valves, and we were able to see and estimate (using color dopler) the direction of blood flow and detect some blood regurgitation from a bad valve. This site shows some of what we could see.

And then there were the monitors on the bypass machine, which I mostly ignored and let the perfusionist worry about.

It was also pretty freaky to see the cardioplegia - I could look into the hole in his chest and see a non-beating heart, the ECG was flat (i.e.-"flatlining"), and his pulmonary artery pressure was zero (i.e.-no flow through the lungs). Yikes! And yes, he was brought back to life near the end.

Posted by calv0016 at 4:23 PM

September 21, 2005

Things overheard

It's interesting hanging around a busy OR area. Staff know that I'm not an attending physician nor resident so they sometimes fail to censor themselves. Overhead today from a nurse coming out of an OR:
"I hate surgeons." She turns towards me, realizes I'm there, and says "Let me rephrase that....I hate surgeons."

Posted by calv0016 at 3:53 PM

September 18, 2005

Sex grade

Medical School is tough - they even grade you on sex. I passed my sex class at the end of year 1 (old news), and now I've honored my sex rotation in year 3. I hope that clears up any confusion or ambiguity.

Posted by calv0016 at 1:41 PM

September 16, 2005

Passing Gas

On Monday I started my anesthesiology rotation at the newly renamed University of Minnesota Medical Center - Fairview. According to the director of medical student education, we should be able to handle ASA I cases (patient is otherwise free of disease; the simplest cases) by the end of our 3 weeks. We'll see.

We mostly just show up at 6:30 into our assigned OR room and spend the day with a CRNA, since the CA1s (first year clinical anesthesiology residents) are relatively young and not the best teachers right now. On day #1 I managed my first (human) intubation with a little assistance. That was sweet. Yesterday my room was an MRI suite, and do be in there requires special safety training which isn't worth going through, so I found another room. Got to do another intubation, this time on a 6-year old, which went well and with no assistance. Also got to mask a kid for his entire procedure (PICC line placement - they ran a large i.v. from a vein in his arm to just outside his heart for long-term antibiotic therapy). So we anesthetized the kid but then I had to hold a mask over him and watch his (spontaneous) breathing and help him breath if needed. It went well, but my hand ended up really tired after masking for 45 minutes. The good part was that I got to sit down for 30 of those minutes. Otherwise, I was standing for the other 8.25 hours straight - no bathroom break, no lunch break, no coffee break.

Posted by calv0016 at 5:30 AM

September 11, 2005

Sex in the City

My 3-week rotation with the Program in Human Sexuality has come and gone. It consisted of sitting in on individual therapy sessions, group therapy sessions, a some supervision meetings for the post-docs (PhDs or PsyDs getting trained in sex). The major groups I worked with were sex offenders and people with compusive sexual behavior. I didn't see much women's health or transgender medicine, which are the other two major areas. Getting into therapy sessions was difficult, leaving lots of down time. But I learned a few important things, and am glad to have had the experience.

Next up....Anesthesiology, AKA The Big A.

Posted by calv0016 at 2:10 AM

August 20, 2005

Ortho Surg

My ortho surg rotation has come and gone. It went about as well as I could have hoped for, considering that it gave me all my surgical subspecialty credits. After the third week I really got tired of surgery, and I'm once again thinking that surgery is not for me. Good to know.

Since I do seem what little emergency medicine I've seen, I thought it would be wise to try to do my EM rotation earlier rather than later. So I switched out my mid-fourth year HCMC EM rotation out for an EM rotation at Regions in my later third year.

I also dropped my renal rotation late in my fourth year and added a hospitalist and palliative care rotation at Abbot Northwestern in November of my fourth year.

My new schedule is posted.

Posted by calv0016 at 9:42 AM

Life Flight

While up in Duluth a kind soul overheard me mention that I love all things that fly, and offered to talk to the pilot of the Duluth Life Flight helicopter to see if I could fly along. The pilot agreed, and I got permission from the medical director. So on Saturday I took call with the Life Flight crew and got to go on a call in the BD117B2. I was up in the library causually reading when the overhead page announced "Life Flight Code 3" (translation: Life Flight is being scrambled for a case), and a moment later by pager told me the same thing. I sprinted to the helicopter area, changed into my nomex jumpsuit, and ran out to the pad and was escorted to the helicopter by the flight nurse. We flew to Hayward, WI, which took about 25 minutes. It's a very pretty area between Duluth and Hayward - few roads, almost no houses, only a few farms, and a guy fishing in a small lake from a canoe. I was riding in the back and facing backwards, so as we started to descend in Hayward I thought we must be crashing, as all I could see is wilderness. We burst intot he hospital, where people looked at us strange. They must have thought we were aliens, seeing as how we descended from the sky in a strange vehicle, were dressed in strange outfits, and spoke a weird language. In the ED we prepared the patient for transport, loaded her up, and fly back to Duluth and took her to the Duluth ED. Very fun, and very crowded.

Posted by calv0016 at 9:39 AM

July 30, 2005

Orthopaedic Surgery

This past Monday I started Orthopaedic Surgery in Duluth. This rotation gives you almost no responsibilities, so it's much different than my peds rotation. On one hand this makes the rotation a lot more boring, but it's nice not to be working my butt off. In general I'll be spending most of my time on the surgery side, which is about 1/2 clnic and 1/2 surgery. I'll occasionally be on the med-ortho side, which is a clnic of Family Practice docs who did a sports med fellowship. They tend to do the medical management of patients, and refer to the surgeons when appropriate. Thus, from the surgery perspective, most of the non-surgical cases get weeded out. Very efficient for all parties involved.

So far I've only spent two days in surgery, saw 4 surgeries, scrubbed in on 3, and got to close on one. While I'm not thrilled to be doing orthopaedics, I find surgery to be really cool once scrubbed in. Just watching from a distance is boring, but getting to be close to the action is cool. This is definitely making me consider general surgery as a career choice.

Posted by calv0016 at 4:09 PM

Peds has come and gone

I finished peds 2 weeks ago, but I was too lazy to update this. I liked the in-patient medical management side of things a lot, but was very bored during my 5 clinic days. While I enjoyed working with kids and parents, I'm not sure I would want to only work with kids and parents. So after finishing this rotation I'm again thinking that an Internal Medicine hospital-based sub-specialty might be a good choice for me, and that primary care is not for me.

The schedule on peds was a bit rough. Call was q4 (every 4th night), and on call nights I don't think I ever left before I had worked 30 hours. I usually would get 2-5 hours of sleep per call night. They also gave us a ton of autonomy. Depending on one's senior resident, one could function like a sub-i. I loved all the work and autonomy, and will really miss this rotation

Posted by calv0016 at 4:04 PM

May 31, 2005

Welcome to Peds

Today I started my first rotation - Pediatrics at St. Paul Children's Hospital. So far it looks like a pretty nice rotation.

Posted by calv0016 at 10:27 PM

May 29, 2005

Heart Failure

Found an interesting book online - "Heart Failure - Diary of a Third Year Medical Student" by Michael Greger. To give you a flavor of what it seems to be about, here are two quotes he starts his book with:

Besides medical school, there is probably no other four-year experience - unless it be four year's service in a war - that can so change the cognitive content of one's mind and the nature of one's relationships with others.
- F.D. Moorse, Harvard Medical School

This is the School of Babylon
And at its hand we learn
To walk into the furnaces
And whistle as we burn.
- Thomas Blackburn

Posted by calv0016 at 9:25 PM

May 27, 2005

Welcome to Pediatrics

Got a notice from the rotation coordinator for my pediatrics clerkship. To quote: "Teams have been assigned & call schedules are set; they are NOT alterable. Overnight call is Q4". So every 4th night, I get to admit patients starting from 2 pm 'till 7 am.

From the student-run Ward Guide:
For many students, this rates as one of the most enjoyable, yet demanding of the required rotations. Medical students are typically given a tremendous amount of responsibility, and manage multiple patients. Although the focus is on inpatient pediatrics, most sites provide opportunities to work in the clinic, ED, and/or the newborn nursery at some point. All sights have overnight call, usually Q4. The SHELF examination is fair and covers clinically relevant material that will be covered during daily didactic sessions. The residents and staff are among the nicest you will encounter in your rotations, and are also among the best teachers. So jump in and see what its like to be a pediatrician for six weeks, we think you will be pleasantly surprised!

Posted by calv0016 at 4:04 PM

The boards

Yesterday I drove down to Rochester to take Step 1 of the United States Medical Licensing Exam. It was 7 hours, 350 questions. Parts were easy, parts were challenging, and parts made no sense. But at least it's done. I should have my score in two months. Ug.

Posted by calv0016 at 3:57 PM

April 23, 2005

Nerd Scale

My friend forwarded me this medical school nerd scale. I'm not sharing my score.

Posted by calv0016 at 10:15 PM

One down...

Just took (and passed) my lab medicine exam. It was listed as a single credit, which doesn't seem like much, especially since I'm currently taking 26 credits. I have one more week of classes, then pathology on Monday, pathophys on Wednesday (heme/onc + ID), and pharmacology (period 6 exam and a cumulative exam) on Friday. Then I'm done with classes!

Posted by calv0016 at 3:12 PM

April 22, 2005

Rotation changes

Psychiatry became available in period 5 of 2006, so I dropped my sleep med rotation and I put psych in there (I'm still at HCMC). Into period 8, where I had psych, I put my neurology (also at the same location as before, North Memorial). Then I added back sleep med into period S2B of 2006 (still at HCMC). I lost a bit of vacation in year 3 and early year 4, but opened up 4 more weeks of elective time in September-October of year 4. I put in cardiology right before my medical ICU rotation, both of which I can drop if I want to do an away rotation. I also like having neurology before Med II
Here's my updated schedule.

Posted by calv0016 at 7:25 PM

April 16, 2005

San Francisco poster

My abstract submission was selected for a poster presentation at the Annual Session of the American College of Physicians in San Francisco (where I'm at now). Today I showed my poster, "Epidemiology of Sedation in the Intensive Care Unit," and it was judged as one of a couple of winners. So they're going to mail me a cash prize and a certificate. Yay!

Posted by calv0016 at 11:00 PM

April 8, 2005

Publication #3

My third journal publication has now been assigned to an issue - the May 1st issue of Biochemical Pharmacology. So look me up on page 1385 when you get yours delivered.

For those curious, here are my three, in chronological order. For fun, compare the publication dates and issue numbers of #1 and #2 (exact same issue of the exact same journal). These studies were done almost 4 years apart (I worked on #1 in the summer of 1998, and worked on #2 in March of 2002) and in different areas of research (different drug classes, different areas of the body, different model animals, different applications), and yet their ended up only 141 pages apart in the same issue of the same publication.

#1 Kinin-Induced Anion-Dependent Secretion in the Porcine Ileum: Characterization and Involvement of Opioid- and Cannabinoid-Sensitive Enteric Neural Circuits

#2 Maternal Vaccination Against Nicotine Reduces Nicotine Distribution to Fetal Brain in Rats

#3 Reduced Nicotine Distribution from Mother to Fetal Brain in Rats Vaccinated Against Nicotine: Time Course and Influence of Nicotine Dosing Regimen

Posted by calv0016 at 4:20 PM

Registration free for all

Tonight open registration started. While it's likely some things will change, here's my schedule as of now:

May 30 - July 10 Pediatrics at St. Paul Children's
July 11 - July 24 Vacation
July 25 - August 21 Orthopedic Surgery in Duluth
August 22 - September 11 Sexual Problems in Clinical Medicine at FUMC
September 12 - October 2 Anesthesiology at FUMC
October 3-October 23 Radiology at HCMC
October 24-November 13 Ophthalmology at the VAMC
November 14-November 27 Vacation
November 28 - December 11 Sleep Disorders at HCMC
January 2 - February 12 Medicine I at ANW
February 13 - March 26 Surgery at Methodist
March 27 - May 7 Psychiatry at HCMC
May 8 - May 28 Dermatology at FUMC
May 29 - July 9 Medicine II at the VAMC
July 10 - July 23 Vacation
July 24 - August 20 Primary Care - Family Practice (location TBD)
August 21 - November 17 Primary Care - Internal Medicine (location TBD)
September 18 - October 15 Neurology at North Memorial
October 16 - November 12 Medical ICU at FUMC
November 12 - December 10 Emergency Medicine at HCMC
December 11 - December 31 Vacation
January 1 - February 11 OB/GYN at Mercy Coon Rapids
February 12 - March 11 Cardiovascular Medicine at FUMC
March 12 - April 8 Nephrology at HCMC
April 9 - April 30 Vacation

July 1, 2007 - ??? Internship and Residency (location TBD!)

Here's my graphical schedule.

Posted by calv0016 at 1:40 AM

April 7, 2005

Elective Pick #4

Today I picked Sexual Problems in Clinical Practice. My schedule has been updated.

Posted by calv0016 at 3:37 PM

April 6, 2005

Rotation Pick #3

For my third pick I chose Radiology at HCMC in October of my third year. Here's my current schedule.

Posted by calv0016 at 11:58 AM

Elective Pick #2, etc

A few hours after drafting my radiology elective, an anesthesiology elective opened up in 3B (September) at FUMC that I grabbed. And then yesterday morning I drafted dermatology in period 9A (May) at FUMC. My schedule has been updated.

Posted by calv0016 at 6:54 AM

April 4, 2005

Elective Draft #1

For my first elective draft, I picked a radiology rotation at the VA, disappointed that all of the anesthesiology slots were filled. Then later tonight I noticed a slot opened up, and I grabbed it. Here's my current schedule. Tomorrow I have first pick (8:00 am), and I'm torn between opthalmology and radiology. Stay tuned for late breaking news.

Posted by calv0016 at 10:51 PM

April 1, 2005

Draft #10

And for my final draft of required rotations, I picked Emergency Medicine at HCMC in period F4 of my fourth year. My schedule has been updated.

Posted by calv0016 at 3:28 PM

Draft #9

For my ninth pick I chose neurology at North Memorial in period F2 of my fourth year.

Posted by calv0016 at 3:26 PM

March 29, 2005

Draft #7

For my 7th pick, I registered for the Primary Care Clerkship in periods S3 and F1 of my fourth year. First I do 4 weeks of Family Practice, then I do 4 weeks of Internal Medicine. My schedule has been updated.

Posted by calv0016 at 8:59 AM

March 28, 2005

Step 1

The testing center in Woodbury that administers the USMLE (United States Medical Licensing Exam) Step 1 is closing, so I had to re-schedule my exam. I'm now taking it on May 26, 2005 (same date as before) in Rochester.

Posted by calv0016 at 10:44 AM

Draft #6

For my sixth draft I choose Med II (Internal Medicine Sub-Internship) at the VA Medical Center for Period 1 of my fourth year. My schedule is now updated.

Posted by calv0016 at 10:43 AM

March 26, 2005

Schedule

A graphical view of my current MS3-4 schedule can now be found here.

Posted by calv0016 at 2:11 PM

March 25, 2005

The Draft, Day #5

For my fifth pick, I choose Psychiatry in period 8 at HCMC. Supposedly this is THE place to do psych if you have an interest in the field.

So far my schedule looks like this:
6 weeks at St. Paul Kids (May 30-July 10)
2 weeks off (July 11-25)
4 weeks of Ortho Surg in Duluth (July 25-Aug Aug 21)
[many many weeks that are unscheduled]
6 weeks of Med I at Abbott Northwestern (Jan 2-Feb 12)
6 weeks of Surgery at Methodist (Feb 13-March 26)
6 weeks of Psychiatry at HCMC (March 27-May 7)

Posted by calv0016 at 3:24 PM

March 24, 2005

Draft, Day #4

As promised by the tech people, the server was back alive and working well at 7 am this morning (well, it was more like 07:14:04, but who was counting?). I traded my orthosurg spot for a period 1 Peds spot at St. Paul Children's Hospital, and then at 8 am drafted back my period S3 Orthopedic Surgery spot in Duluth. Crazy, crazy 16 hours.

So far my schedule looks like this:
6 weeks at St. Paul Kids (May 30-July 10)
2 weeks off (July 11-25)
4 weeks of Ortho Surg in Duluth (July 25-Aug Aug 21)
[many many weeks that are unscheduled]
6 weeks of Med I at Abbott Northwestern (Jan 2-Feb 12)
6 weeks of Surgery at Methodist (Feb 13-March 26)

Posted by calv0016 at 8:07 AM

March 23, 2005

Draft, Day #3

It's only draft round #3 (out of 14!) and I'm already sick of this. Today I registered for Orthopedic Surgery in Duluth in period S3 (July 25-August 21). Then after that I think I broke the system. What did my Dad say..."I could break a brick." Hopefully it will be back up and running in time for my fourth round pick at 8 am tomorrow.

Posted by calv0016 at 6:26 PM

March 22, 2005

Because cutting others is frowned upon elsewhere

In my second draft choice, I selected Surgery at Methodist Hospital for period 7 (February 13-March 20).

Posted by calv0016 at 1:02 PM

March 21, 2005

The Draft, Day #1

Today I made my first draft for my MS3-4 years. I snagged Med I at Abbott Northwestern in Period 6 (Jan 2-Feb 6). I'm very happy about this. With me on this rotation (assuming nobody switches) are my friends Greg and Niti.

Posted by calv0016 at 4:39 PM

March 18, 2005

The Real March Madness

It's not basketball, but it does resemble the draft.

The U of M match list is here and the statistics can be found here.

Some national statistics can be found here.

Posted by calv0016 at 11:09 AM

October 19, 2004

Period 1...CHECK!

Period 1 (cardiovascular and respiratory) has come and gone. After four tough exams (pharmacology, pathology, cardio pathophys and pulmonary pathophys), I'm very happy to have made it through a period packed with so much information. Now on to Period 2, where we learn about all that goes on above the shoulders in psychiatry, neurology, ophthalmology, and otolaryngology . . . . I miss period 1 already . . .

Posted by calv0016 at 7:37 PM

September 2, 2004

Visit to Abbott - like working Lake Street

On Wednesday IMIG visited Abbott Northwestern, the last of the three Internal Medicine residency program visits of the summer.

In the morning I shadowed a cardiologist, and got to see (among other things) an angiogram. Very interesting. After that we rounded on some patients, and I was pimped like somebody working Lake Street. It was actually fun as I didn't expect myself to know anything and thus was pleasantly surprized when I was giving asnswers that were actually correct. For a full description on The Art of Pimping, I refer you to this reprint from JAMA.

Posted by calv0016 at 5:09 PM

August 19, 2004

Real Medicine Downtown

I spent today shadowing a very generous general internist in downtown Minneapolis and got to see and do some interesting things. The highlights/lowlights:
- we had to tell a patient that he/she probably had metastatic cancer
- I heard what a ball-type aortic valve replacement sounded like and correctly identified the patient as having systolic murmer.
- I took a history from a patient recovering from pneumonia, read the X-ray correctly (which is a big deal, since reading the simple chest X-ray is sort of like reading tea leaves), heard an expiratory wheeze, and nailed the diagnosis of bronchitis and suggested an appropriate treatment course.

What amazes me is how proficient the doctor was at moving from one patient to another, giving each his undivided attention as though that was the only patient he had to see that day, even if he just came from a very difficult case.

Posted by calv0016 at 5:44 PM