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Internship 2

The month of May, I spent assigned to the pediatric surgery service at Kaiser Permanente Hospital in San Diego.  The staff pediatric surgeon, Dr JD, a former pediatric surgeon at the Naval Hospital, accepted surgery residents and interns to mentor.  This month gave me the opportunity to get to know Dr CY, the senior resident also assigned to the service.

As an unlicensed physician, as most interns are, I had a very limited role in actual patient care at This hospital for liability reasons.   I primarily observed, not being allowed to write notes and orders in patient charts, cover inpatient call, not even allowed to “scrub in” on surgeries.  The relaxed pace was sometimes boring but a welcome reprieve from the frenetic pace of the rest of the year.   

Preoccupation over my upcoming MRI towards the end of the month blurred my memory of that rotation.   One event does, however, stand out.  I was informed by CY of a little boy that had had a percutaneous endoscopic gastrostomy (PEG) tube for feeding because of a congenital abnormality.  He was having difficulty breathing due to indigestion and bloating.  Later that evening, the father called me with the same complaints.  As instructed, I told him to “burp” the tube and go to the emergency room if his difficulties continue.  I went to bed.  Early the next morning, around three am, the father called me back to inform me his son was dead.  I froze in panic.  “My God, what do I say?  What do I do?” I thought.  I had never been in a situation like this.  Previously I had been a part of a team in these kind of situations.  The more experienced attending physicians handled this stuff and I stayed in the background with the rest of the surgical entourage.  This time I was alone having to talk with an acutely grieving parent. I expressed my condolences for his loss.  I hung up the phone with the unsettling feeling that I handled it all terribly wrong.  Eight months later I would learn that there was nothing I could have said to ease his pain, but to have said nothing would have been deplorable.

The morning of Thursday, May 26 I went to the radiology clinic for my MRI.  The machine looked like all the other CT scanners and MRI scanners I had seen previously.  A nut  and bolt assembly with the bolt being the patient lying in a narrow trough-like table, and the nut being the large square machine that housed the rotating magnets.  But this time, I was the patient lying on the table whose head the unseen magnets would rotate around.  I lay supine on the table.  A cage was placed over my head.  I imagined I looked like a hockey goalie or baseball catcher.  The table slid into the scanner,  automatically positioning my head in the narrow opening.  “!-!-!” went the scanner, then silence.  Suddenly a loud “gnweuew”, followed by “dupt-dupt-dupt-dupt-dupt-dupt-dupt-dupt, blop-blop-blop-blop-blop-blop-blop-blop, doof-doof-doof-doof-doof-doof-doof-doof, rat-tat-tat-tat tat-tat-tat-tat.  The cacophony would have been deafening had it not been for the headphones placed over my ears.  Then silence.  A few seconds later the second cacophonic movement began just like the first.

The following afternoon I called the radiology department to get the results.  I spoke to the neuroradiology resident who was reluctant to discuss the preliminary results.  Radiologists generally don’t discuss results with patients, only doctors.  Dilemma, I was both.  He nervously stressed the results were only preliminary, not yet reviewed by his attending radiologist, not yet finalized.  With a shaky voice, he then delivered his preliminary findings which were word for word of the eventual finalized report, not out of nervousness and insecurity in his interpretation, but out of concern for what his interpretation meant to the person on the other end of the phone line, me.  I listened, hung up the phone, and steadily, with heart pounding, throat closing, and eyes welling, walked to the men’s room.  Once the latch clicked behind me, I collapsed to the floor against the corner, in a heap of wails and sobs.  I wept like I never wept before, and only twice since.

Internship

“Lieutenant, tomorrow at O-800 you WILL report to staff sick call.  You WILL obtain your medical record and you WILL report to the ophthalmology clinic.  You have an O-830 appointment with Commander Edwards, the neuro-ophthalmologist.  You WILL receive an MRI.” Captain S, Chief of the Department of Urology, sternly ordered me.  Immediately, I stiffened in fear and thought “Oh shit”.  I wasn’t concerned about the ophthalmology appointment.  I had been evaluated by CDR E two months previously as part of my flight surgery application.  I had been selected and would not have had the orders in hand to report for flight surgery training that summer had I had not passed the eye exam.  It was the MRI I feared.  That test had the potential to discover, uncover, reveal, ruin… and save me.  During my surgery Internship at the San Diego Naval Hospital, I was generally referred to as doctor.  So when a captain referred to me as lieutenant, I knew the only reply was “Yes Sir”.

From July 1, 1993 to July 1, 1994 I did a basic surgery internship, the toughest year of my life and the one of which I am most proud, at the Naval Hospital in San Diego, preparing me to repay the Navy four years of active duty service for the four year scholarship to medical school they had given me.  Early in July 1993 on my trauma service rotation, I began having some difficulties with touch sensation.  Feeling femoral artery pulses in order to phlebotomize the vessel to obtain an arterial blood gas measurement was difficult for me, sometimes impossible.  It became the running joke of Dr. G, one of the staff surgeons.  At times I felt the tears wanting to erupt but I refused to show my true emotions, laughing along with him.

As the year progressed, I started noticing other difficulties.  I had more trouble than most with fine motor tasks.  As the rest of my team would glide rapidly down the staircases, their feet seemingly not even making contact, I would be left slogging behind.  On call nights when I stayed overnight in the hospital and was awakened and summoned to assess a patient, I found it difficult to begin the long trek from my call room to the patient wards, spending the first 20 yards or so bouncing of the walls for balance.  One day I asked Dr. P, a fellow surgery intern if he was tired.  He emphatically replied “SHIT YEAH I’M TIRED!  I’VE BEEN UP FOR THE LAST 36 HOURS!”  So I tried to convince myself that it was just a hazard of the job.  But deep down I knew there was something more.

I had been a surgical intern on the urology service for the month of April 1994.  The interns rotated Fridays,  performing vasectomies and circumcisions with Captain Sands, the department chairman.  The previous Friday was my turn.  Apparently he had noticed something in my surgical technique that caused him enough concern to lead to our Monday morning meeting in his office, and warrant a mandatory ophthalmologic evaluation.  The reasons for his concern would not be made clear to me until a few months later.

At the appointment,  CDR E performed essentially the same exam he had performed two months previously.  This time he asked more directed questions focusing on my peripheral vision.  He was looking for signs of bitemporal hemianopsia, the classic symptoms of a pituitary adenoma, a growth in the pituitary gland at the central base of the brain that compresses the optic nerves affecting peripheral vision.    Untreated it could cause blindness, endocrine disturbances, and potentially death.  My responses to all of his questions where “No”.  “Your exam is unchanged from the last time I examined you.  I don’t see a justification for an MRI.”  “Whew.” I thought, finally releasing the breath I was holding.  “Well”, he said, “actually I do. If the captain wants an MRI, the captain will get an MRI.”

“Fuck!”                                                                       

Introduction

My name is Rudy Yanuck.  I am a 47-year-old retired physician, a US navy veteran, father of six, and a 20 year survivor of multiple sclerosis.  Through this blog, I hope to share my journey walking hand-in-hand with MS by sharing my trials and triumphs, tragedies and victories.  Hopefully my story will inspire and give hope not only to those suffering with multiple sclerosis, but also those suffering any chronic disease, such as Lupus, Parkinson's, Alzheimer's, mental illness, even those suffering from chronic health.  I know personally that reading other people’s accounts of their difficulties and how they were able to cope with their illness and continue living life fully have been very inspirational to me- Michael J Fox and Richard Cohen quickly come to mind.  Maybe you will find comfort and support in the words I write and the community I hope to build.