One Week At County

A musical interpretation.

Currently, this is my personal soundtrack whilst jumping from room to room during the morning sessions at Cook County.

By the end, I hope it sounds more like this

We shall see.....

The GPR Experience I

OK. So I’ve been slowly scrapping this post together over the last few weeks..but now I find myself with a four day weekend, so I really have no excuses.

Two months in and things are going well. I will briefly outline the program here at Masonic with an obvious disclaimer: NO TWO PROGRAMS ARE ALIKE – especially in regards to GPRs. Masonic is probably the best option in Chicago if for no other reason than pure stability. It has been around for a long time and most of the attendings were residents themselves. It also boasts the largest number of resident positions. Some may be turned off by this, but you’d be surprised how much you learn from your co-residents either through their own experiences. Collectively it ends up being quite positive.

So a GPR generally lasts one year, at Masonic, there is an optional second year. The squad we have this year consists of eight first years and one second. Most of the year is spent in our dental clinic which is literally across the street from the hospital.

However, we are sent on various rotations:

Anesthesia – One month: in the hospital, the goal is to get adept at placing IVs and learning as much about anesthesia as possible. I’m on this rotation in January.

Oral Surgery – One Month: at Cook County, working the OS clinic with all of the OMFS residents. I literally just started here, will be spending September shucking teeth.

Emergency Room – 2 weeks: Literally hang out in the ER

Dental Van – 7 weeks total (whenever I’m on second call, I spend that week doing dentistry in a van)

There used to be a 2 week block for the oral medicine clinic at UIC, but that is currently defunct as that department is seemingly being dismantled. We may actually end up in the OS clinic at UIC as well, but that is still up in the air.

OK, so those are the big block rotations, we do take call and this can be light or insane depending on the week. The crappy part is that when we are on call it is for an entire week, so if you get slammed one night, there is no recovery period. However, the calls we take generally are fairly basic and if it isn’t, we punt the case to OS or ENT. By basic I mean simple dental traumas and intraoral drainage.

I take first call 6 weeks the entire year, second call is 7 weeks. The first few weeks of call we would go in as pairs, but after the initial fear of stepping into an ER and making decisions on your own subsided, we generally go in alone.

Now aside from actual clinic, we attend various lectures ranging in all kinds of dental topics. One of the best is anesthesia which is taught by a dental anesthesiologist who generally is around on Thursdays for all of our SPC IV cases. He will also come in on the occasional Tuesday for normal patient IV cases. I have yet to do an IV case yet but have been assured, my time will come. Two residents see two cases (sometimes three) apiece on Thursdays.

Now bear in mind, the majority of our IV cases are on special needs patients. IV placement can be pretty damn hard if the appendage is flailing about, but it gets done. Sometimes, just getting the patient into the chair is challenging which makes me appreciate the effectiveness of ketamine. Generally use midazolam and propofol once the IV is set, and it is pretty dramatic how well this stuff works. I will talk more about this when I start working through some cases.

Here is the basic schedule:

M: 9-6

T: 8-4

W: 9-6

TH: 9-4

F: 9-4

I listed our clinic hours, we generally show up anwhere from 1-2 hours early depending on what the lecture schedule is like. We may also stay 1-3 hours after, again variant on the lecture schedule.

Thursdays is special needs day, elsewise we are seeing standard patients. However, a few AM/PM sessions out of every month we will have a specialist in as an attending. This is when we do procedures most dentists stay away from (Impacted thirds, Implants, Crown Lengthening, Osseous surg/bone graft, etc.) We end up with a pretty nice amount of variety.

So what have I done so far? The biggest exposure for me 2 months in is definitely endo. I have done more RCTs in 8 weeks here then I did in four years of dental school (including pre-clinical extracted teeth practice). I also never did any molars in DS, and have already completed four here. I still don’t see myself jumping into molar endo in private practice, but I’m no longer really scared to try either. Regardless, every general dentist should feel comfortable accessing any tooth in the mouth, if for no other reason than to perform an emergency pulpotomy.

Perhaps the next most significant gain for me is in my OS skills. I felt UIC prepared me pretty well for basic exodontias, but I definitely love to get more efficient. I’ve also gotten to try my hand and full bony impacted thirds (well at least #32 and #17 were). It may have taken me 2.5 hours and I may have sweated like a pig because I’ve never extracted a tooth that I could not SEE prior to the procedure. But hey, it worked out and the patient did fine, no lingering parathesia (woohoo!)

The coolest part is that I did exactly what the textbook said to do, and it WORKED. The key is ACCESS. If you think your flap is big enough, it probably isn’t.

Speaking of OS, I began my month rotation at Cook County for the month of September. Pretty much a revolving door tooth extracting machine is what I must become. I felt like I did ok on my first day, the hardest part is actually just figuring out how documentation is handled because I’m already used to the system in my home clinic. We have to ‘dictate’ all of our notes here as well which is new for me.

But as an aside, there is an amazing blog crossover going down here that I just have to mention. It seems I will be a henchmen/minion/lackey to Ben from DMDstudent.com for the next month. He’s a second year at cook and is the chief resident of the general clinic this month.

So I will shamelessly plug his site again because it actually has tons of good info, where as my site is really more for the cheap thrills..it’s ok to admit it. DMDSTUDENT.COM. Pre-dents, dental students, aspiring oral surgeons – Go there. Hell, there’s even a link over to the right if you are too lazy to type it in.

So I expect my dental extraction prowess to increase dramatically over the next four weeks.

I think I have sufficiently outlined the deal here.

I am starting to put my resume together for the dreaded job hunt. Planning to work in a few offices, but need to feel it out first.

Sigh. At least I’m not going into more debt at the moment.

Cheerio!

Let Me Count The Ways

Three full weeks into a GPR and I can already definitively say that this was a great idea. The amount of pure learning going on at this place is absolutely staggering. I probably learn more in one day here than I was doing in a month during my final year of d-school.

Unfortunately, the scheduled is pretty damn intense so I get home exhausted on a daily basis.

Real quick:

On call: got called in on a trauma case, replanted/splinted #9 and sutured facial lacerations. Scarring turned out pretty damn nice considering I'm not in plastics and had never sutured skin before.

OR case: Oral Squamous cell carcinoma , full mouth EXT prior to radiation therapy. Surreal experience to say the least.

Special Needs Thursdays: A brand of dentistry that many dentists never experience or are simply to frightened to try (with good reason). Exhausting and satisfying all at once.

IV sedations: Coming soon! One resident per week at the moment, eventually more. 20+ cases by the time I'm done (not including my month in anesthesia).

Implant dentistry: Free CE all year from nobel biocare once a month, new system at the office, will definitely be placing some soon.

Plenty of stuff I forgot. The attendings and co-residents are all great.

Sorry for the brevity, but time is not my friend anymore.

OFF!

End of The Trilogy

It was bound to happen eventually. I have graduated for the last time. This was my ‘Return of the Jedi,’ my ‘Last Crusade,’ my ‘Die Hard: with a Vengeance,’ my…well I think you get the point.

Now in this brief window of opportunity prior to continued graduation festivities, I can take a second to capture the moment within this dusty old blog that I have managed to stay at least somewhat active with over the last 4+ years. I don’t know what is more amazing to me, the fact that I am finally done with school or the fact that I have had a ‘blog’ for this long.

Yes indeed, I have graduated. The big fat DDS can now be plastered at the end of my name. Much like all graduations, the experience is surreal. However, this one is particularly strange to me. It has not sunk in yet, but I will probably not see many of these people ever again. These people who I have endured with, stressed with, laughed with, shook my fists in the air with, I could go on forever. I spent four years with the same 60some faces. We all went through the same experiences, the same classes, the same everything. This is what defers Dental School from college, or from high school. A small group of people are in it together for four straight years.

It really is a bittersweet moment. The faces I never really was friends or talked with much, I will miss them all. Even the people that would annoy the ever living crap out of me nine times out of then, I will miss them as well. We all go down different paths now. I hope to keep in touch with my closest friends but am realistic that even those relationships will no longer be the same.

Life goes on, as it always does. And I’m sure some of you may be wondering - where does this blog go from here? I have done my best to maintain it and I know my initial intentions got muddled along the way. However, I hope that I have provided inspiration, insight, along with an edge of light-heartedness that we all need every once and while. I know I haven’t always kept up with email queries, but I have tried!

So does this blog end? I really haven’t decided yet. I can’t imagine myself throwing in the towel yet, but I can’t make promises of regular posts either (not like I do that now anyways).

I’m off to a one year general practice residency that starts July 1^st, but before that, I plan to take some vacation, relax and just appreciate life for what it is.

I would like to do one final post on dental school in the near future, a final D-4 experience of course, but with a kind of summary of everything.

I’m sure it won’t end, but it will be different. I mean, I can no longer be the whiney bitching student I have been for the last three years can I?

As an aside, I have to say, despite all that bitching, I am genuinely satisfied with the education I received here at UIC, ESPECIALLY from a clinical standpoint. I feel extremely competent with meat and potatoes dentistry and hope one more year of essentially free CE, will push me into a great realm of practical confidence regarding what kind of general practioner I plan to be.

I appreciate all the positive feedback (and even some of the negative) I have gotten over the years. It has really kept this blog alive.

Good luck to everyone applying to school, in school, graduating, or just living life in a world unrelated to dentistry.

Adieu

21 Days Left, Again

What are the odds. I just randomly was thinking about this post I did approximately four years ago when I had 21 days left prior to graduation. As the blog gods would have it, I am in exactly the same position today. This was NOT pre-planned which is what makes it awesome. Twenty-one days stand between me and doctor-hood. So in the spirit of that original post, here are 21 things I will absolutely NOT miss about dental school. In no particular order:

1. Only learning dentistry for about 1 hour a day, the rest is spent cleaning up chairs, gopher running lab scripts, calling patients and checking out instruments.

2. Going into debt more and more each and every month

3. The pre-clinic

4. Studying power point presentations for hours on end

5. Cockroaches

6. Dental students, good lord we are an annoying bunch

7. Being treated like a 12 year old despite being 26

8. Calling my own patients and setting up appointments

9. Setting up my chair

10. Breaking down my chair and returning instruments

11. Having 1 out of every 3 units present with some malfunction (leaky water spray, broken hose, etc.)

12. Having 1 out of every 3 hand pieces not work, requiring me to go back to the window for seconds

13. Having to suck-up to pretty much everyone from the janitor on up

14. Being constantly hounded about collections as if I can actually get any of these patients to actually pay. What do you want me to do? Break their thumbs?

15. pre-clinic students leaving rotten smelly endo teeth in open jars all over the school. Pick that crap up please.

16. Having to coordinate with program directors that have NO cooridination in terms of what I have and have not done or when I'm on and when I'm not on rotation.

17. Having to mount every case as if the world would explode should I not

18. Having a crappy lab do all the work

19. Having to get everything swiped or signed (approved)...and I do mean everything

20. Attendance taking (again, I'm 26 years old here)

21. Being a student!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

I AM DONE!! and just like that original post... GO BULLS!

Exit Interview - Loans

Hilarious and disturbing at the same time!

"You are generally obligated to repay your student loan(s), even if you do not complete your program of study, do not complete the program within the normal timeframe for completing it, are unable to obtain employment after you complete your program, or are otherwise dissatisfied with or do not receive the educational or other services that you purchased from the school. However, there are a few situations in which your loan may be discharged and your repayment obligation canceled or forgiven.

- You die

...

...

...

Well at least they aren't beating around the bush.

CRDTS?

Perio: 100.00
Restorative: 96.21

I'm going to be a dentist.