Testes...testes...123.

My hand was shoved down, awkwardly positioned between the folds of trousers and half-pulled down underwear, in the man's groin crease, trying to palpate his testicles without pulling any of his pubic hair. Something didn't feel right, but it wasn't his testicles.

I was in my final surgical OSCE's and it was my first station, where the adrenalin was flowing and my mind was racing faster than my running commentary...

...and I would be checking to see if there were any hard lumps in the scrotum, or if I could not get above the swelling...

I had only just recovered from initially describing my landmarking for the deep inguinal ring as the "midpoint between the pubic trochanter and the anterior superior iliac spine" which caused my examiner to hover his pencil over the marking pad as I searched for the correct word that started with a "T".

TUBERCLE. Tubercle. Tubercle. Tubercle. Dammit. 

 Check.

Initially I hadn't been too flustered. It was a groin exam for a lump, which is pretty standard on a surgical final. But I didn't think that we'd be expected to actually tackle the tackle in the exam. I said the usual "Ideally I would like to expose the patient fully and perform a genital exam to complete my hernia assessment" and waited the beat for the examiner to butt in, rescuing the patient from a succession of 32 fumbling medical students.

Silence.

Maybe he hadn't heard me.

Ideally I would like to EXPOSE the patient fully and perform a genital exam...

Still nothing. So I went for it. Which is how I found myself rolling this 70 year old man's testicles around in my hand at 0905h on my last day of medical school, wondering WHAT it was that didn't seem right.

It wasn't until my rest station a few stops later that I saw, between a one inch crack in the curtain, a colleague pulling on a pair of gloves.

OH FUCK! 

That was what felt weird. I have been a nurse for 5 years and a medical student for 4. I put on gloves when I hear the ambulance bay doors open, even before I see the patient. So WHAT THE HELL WAS I THINKING DOING THE EXAM BARE HANDED?!?!? What felt weird was the fact that I didn't have a nice latex barrier between myself and that poor man's private parts.

I started wondering if maybe my mistake had been a red flag (i.e. cause for failure of my surgical OSCE's as a whole). When one of the emerg docs walked by and asked how I was doing during a later rest station I told her, "Well, pretty good for starting the day by ball handling without gloves, how's your day going? Do you think I red flagged???"

She said she couldn't be sure but told me not to worry as once during her emergency medicine exams she put in a chest tube without gloves (I'll point out that this involves sticking a FINGER INTO THE CHEST after you've made an incision in the rib cage). She did make me feel better.

Afterwards with some of my classmates during our postmortem on the exam I confessed to my ridiculous oversight. The color drained from one girl's face as she suddenly realized that she had done the same. Ohmygodohmygodohmygod. She seemed to be quite disturbed by this realization. It wasn't until much later in the evening when she had consumed a few celebratory pints that she approached me at the bar and confessed.

You know how freaked I got about not wearing gloves? Well...I couldn't tell you at the time because I was so mortified....but mostly the reason I was so upset was that when you said that I realised that right after that station I had EATEN A SCONE!!!!!

Finito Mosquito

It was a rush. It was not anticlimactic at all.

I had been warning myself not to build up in my mind the last moments of medical school and the thrill of being done. So many milestones have felt disappointingly bland once they were reached.

Well it turns out that finishing medical school is not one of those milestones.

After a week from absolute hell (which I will get into once my medical degree is firmly planted in my hand) I arrived on Thursday morning for the last set of OSCE's (clinical exams). It was 12 five minute stations of medical or surgical skills. My last station was giving discharge instructions to a patient and when the buzzer rang, the actor patient stood up and shook my hand to say, "Well done!! You're done!!" The examiner said "Congrats!" and I emerged from the cubicle to see my friend, JM standing there with a huge grin on his face.

JM was the very first person I met in our class. We met in Toronto while taking the elevator up to our interviews. He surmised that I was there for the same reason and asked me where I was from, what I did for a living etc. When I told him I was living in Whistler, working in the emergency department there he stopped me and said, "Wait, so you live in Whistler, you have a job you love, yet you're planning on giving it all up to move to a different country and become hundreds of thousands of dollars in debt to be a doctor? Why?"

Well, when you put it that way. I had thought about his comment many, many times during the last 4 years. Why, indeed.

So when I saw his face as I stepped out of my last station I had to chuckle at the perfect end to medical school. We gave each other a rib-crushing hug and he said in my ear, "You know why this is a perfect finish don't you?"

I laughed and cried a little and said "YES! You were the first person I met on this journey!"

Then I randomly hugged a few other bewildered, exhausted, adrenaline frazzled classmates...I may have pounced on a few invigilator bystanders as well. It is all a bit of a blur.

We were then put in a 'holding tank' room in the hotel for over an hour as the other groups of students hadn't gone in for their exams yet. We weren't allowed to use our phones so as not to text anyone what cases were in the OSCE. I came prepared though. One little bottle of Champagne in my handbag which was quietly popped and then poured into the coffee cups they had provided for tea. A "CHEERS!" and few gulps to my pals that were also in the group. Shortly after the Prof of Medicine arrived and was asking us how it went. We were gathered in little groups chatting away, so when he approached we had just finished our Champagne. He said, "Are you having drinks soon?"

"Er.....well yes! In fact we've already had a little Champagne!"

You could see him mulling over this fact...hmmm are they allowed to have alcohol? This is an exam...hmmm...it's only 1030h...

Then he said, "Of COURSE you've already had Champagne! You're DONE! Good thinking on packing some in advance!!"

Phew.

We were set free.

I went and had an Indian head massage (best idea ever) at the spa, and spent the afternoon in the steam rooms and saunas with my dear friend, Emma.

The evening contained all the predictable events. Champagne. Great dinner out. Drinks at pub. Eventually going to Nancy's (the bar I LOVE to HATE). Having a drunk Irishman spill an entire pint of Guinness on me. Heading home with soaking wet jeans and a blister from my high heels.

And then it was over.

But I know it isn't the end. As a friend of mine on FB said, it isn't even the beginning of the end! 

Oh Our Lives

The main comment going back and forth between my friend Gen and I these days is, "Our LIVES!" to basically summarize all the insanity going on. Finishing medical school and leaving Ireland continues to unravel in quirky and unexpected ways.

We are both trying to cope with all the aspects of tying up our lives here while suffering from brain asystole, attempting to cram more information into our grey matter which is already packed to the rafters with random facts.

Gen is trying to sell her car and found a potential buyer who is a physician at a hospital 90 mins from town. I offered to go with her to show it so we could study in the car. That way she wouldn't feel like the precious hours before exams start were wasted.

We pulled up to the ambulance bay and waited for the guy to come out. Finally he appeared as we talked our way through rheumatology questions. He wanted to take the car for a test drive so I hopped in the back seat, she sat up front. He took the wheel, told us he didn't have a drivers license, and proceeded to start pulling donuts. Then he began screeching around the ambulance bay, speeding up towards the cement dividers and slamming on the breaks. I hollered at him to stop the car and let me out--he apologized and then began whipping a second donut near the parked ambulance. I told him, "STOP THE CAR AND LET ME OUT!!! So he did.

He then proceeded to take Gen on a terrifying ride through nearby streets, not using the windshield wipers despite the rain, and accelerating towards the waiting cars at the traffic circles. Gen was convinced that she was saying goodbye to life over a 1000 Euro car.

Incidentally, I also posted my car online and so far have received random late-night texts from weird Irishmen and an offer from an "off shore worker" who wanted to pay by PayPal without coming to see the car.

Hmmm. Yeah. No.

So we retreated to the safe enclave of my kitchen where I then received emails of required documents and YET ANOTHER POLICE RECORD CHECK for my residency program. Both for Ireland and Canada. Really?? I am in medical school here. I wish I had the time to have enough fun to get arrested in Ireland. Today my mom asked me if I was going to quit medical school. I told her yeah, it was just one criminal record check too many.

Tomorrow exams start. Six hours of written papers. The books are now closed. Mostly because studying has taken a giddy and ridiculous turn.

Gen, tell me about the life cycle of malaria...

Well, it replicates in the mosquitoes liver...uhh....

Dude, I don't think mosquitoes have livers...

**Cue peals of laughter**

[You had to be there.]

Ok, next question...Pearl, an 89 year old nursing student suddenly develops intractable diarrhea....er...no...nursing HOME resident...

Wait...woah...GO PEARL! 89 year old nursing student!

**Cue peals of laughter**

[You also had to be there].

Oh. 

Our. 

Lives. 

 

Where are the balloons?!

Yesterday was the last day of my surgery rotation, which also happened to be the last day I had to show up to the hospital as a lowly medical student. Of course it ended with me racing in for a 0730h ward round which didn't happen, giving me time to kill before surgical Grand Rounds. Afterwards our professor of surgery gave us a little pre-finals pep talk which included the well worn phrases:

-don't worry, these are the easiest exams you write in medical school
-know the basics
-you'll be fine
-try not to get too stressed
-know all the medical emergencies
-soon it will be over and you'll wonder what all the fuss was about

It was an uncharacteristically nice and reassuring discussion with him, though it did nothing for my chronic teeth grinding and constant gut-ache. After a few questions about exam specifics from the others I asked him if he was going to miss us. He said (sarcastically) yes, and I will especially miss your esoteric and obscure contributions to tutorial from the corner of the room.

WIN!

(If I leave a legacy of esoteric obscurity behind then I feel I have succeeded as a student in surgery. In much the same way I felt I succeeded in internal medicine when I received an email from one of consultants telling me about a banjo competition this week. Reassuring to know that my true personality somehow shone through my crusted, exhausted exterior.)

We were dismissed after that and a cluster of us emerged into the morning sunlight, blinking and saying goodbyes and good-luck to one another. It was surreal. I was FINISHED my medical school rotations! Where was the fanfare? Where was the receiving line of dancing nurses and interns patting me on the back, handing me pizza, and popping Champagne corks?

I remembered a conversation I had this summer while I was on my pediatric emergency elective. One of the docs was telling me about his last night as a resident, at the end of his 5 year program. He was walking down the dim corridors, leaving after a night shift, "This was MY hospital, I kept these wards humming through the night for five years. I spent my LIFE in these halls...and when I walked through the automatic doors at the end of that shift I didn't get a handshake or a thank you or a good luck. It was just over and I was standing in the parking lot, in the rain, and it wasn't MY hospital anymore". 

I got it when he told me this story but hadn't thought about it until I left the hospital yesterday. I had a very similar feeling as I drove out of the unbelievable chaos pit they call a parking lot. I cranked up the Mumford and Sons with a fitting song, and left a little mental trail of confetti, streamers, and balloons behind me...

Worth It

Things are picking up speed here in the final push to the finish. Suddenly a hundred things are pulling for my attention and I'm remembering the nit-pickiness involved in extricating oneself from one country and moving to another. Annoying things like transferring electrical bills to a different name, showing people the apartment, answering questions about my car to prospective buyers, pawning possessions, cancelling bank accounts and returning internet modems.  Time feels warped in that it seems like an eternity until I am back in Canada, yet there's not enough time to complete all the extracting tasks, study for finals, feed / clothe / wash myself, put petrol in the car from time to time, sleep, and possibly exercise when a window of time and weather presents itself.

Yesterday I was studying with some friends when I realized that we had spent the last 20 minutes discussing which brand of under-eye concealer hides dark circles the best (this may seem like normal conversation to some women but these particular ladies are *not* the make-up discussing types).  This was shortly after we screened each other for depression upon discovering that 'generalized anxiety disorder', 'panic disorder' and 'depression' criteria were starting to hit a little too close to home. We stopped studying psychiatry at that point and moved quickly to cardiology where we all felt slightly safer territory existed.

I woke up a few days ago with a burst blood vessel in my left eye which has definitely hitched up the haggard appearance a couple of notches. I am told that REM sleep can cause blood vessels to burst. Fantastic. This on the heels of 3 straight days of waking up not to an alarm but to the sound of my own teeth, grinding. On the upside I suppose that my face is getting exercise while I am sleeping so...win?

But it's not all cereal for dinner and fitful sleeps.

Today I received a card in the mail from one of my maternity patients. She had been one of those women who labored in such a way that I was in complete awe. I am pretty sure that if (and that is a big IF) I ever have a child I will be the craziest, drug-seeking, wild-eyed, foul-mouthed, sweaty, crying mess. She was this calm, focused, sweet, gracious lady throughout her (analgesic-free!) labor until complications resulted in an emergency c-section. For the duration of our long night together she used hypno-birthing and relaxation techniques to stay calm and work through the contractions. It was an amazing thing to see.

In her card she included the hypno-birthing CD along with a photo of her and her now 5 month old daughter, on holiday in Paris. It was a lovely gesture and a beautiful sentiment. My favorite line from the card being, "I will always have the most amazing memories of my labour...remembering yourself so close in my heart when I think of the wonderful team we had together on that night".

During a week (month? year?) when I have often asked myself if all of this is worth it, I receive this card. What a privileged and beautiful place to occupy in a strangers heart: the place that holds the memory of their child's birth.

Knowing something like that makes up for every single stressful hour. It makes up for being the person who breaks bad news, or the person who has to scavenge for food in the day ward after being in the hospital for 20 hours without a meal break. It really does.

It makes all of this worth it.

Shifting

When I moved to Ireland I made a conscious decision to try and see it as my home for these four years. I did not want to be counting down the days until each trip back to Canada. It wasn't an easy transition and for the first year I was homesick a lot of the time.

Tobie got me through most of those rough patches. We used to go on Canadian fantasy dates where we would describe scenes to each other of where we'd like to go on a Friday night. Keep in mind that at the time we were both living in dorms with no vehicle, plastic furniture, and a varying caliber roommates (from 'good' to 'reality show awful').

Then last year I moved to Kerry and was living in country bliss, working in a fantastic hospital, surrounded by hilarious staff, beautiful beaches, and boggy mountains. Oh, and I finally became capable of understanding the Kerry accent (have a listen below).

Once I moved back to the city to start 4th year in July, things picked up to break-neck speed and I must admit that much of the last 8 months has been an absolute blur. Wasn't I just writing the MCCEE a few weeks ago? Wasn't I catching babies and listening to manic patients tell me about their new business deals just yesterday?

Now I have less than a month left in Ireland, a job in Canada, and a man who wants to get a dog with me. Now I am anxious to get home. The two weeks in surgery and the week of exams ahead seem like a cruel gauntlet to run through, especially because I feel more like crawling through. It is so hard to stay motivated to study, and to keep smiling and nodding enthusiastically during another clinic where I only get to watch other people doctoring.

Roll. On. Residency.

So I am starting to shift now between Ireland and Canada. It's strange, and very nostalgia inducing. When a bottle of fish sauce runs out I don't replace it because I doubt I'll get through another bottle in 6 weeks. My pantry is starting to look very bachelor-esque and barren. I've started using all my hotel shampoo's and soaps because I loathe the thought of buying more that I won't finish (why don't hotels also provide tiny laundry soaps?!) Friends are randomly given clothing, books, music when they come over as part of a pre-purge offloading. I look at all my belongings with a more discerning eye...hmm will I bring my yoga mat home or leave it with 'Enable Ireland'?

I'll tell you one thing, the silicone oven mitts and wine aerator are coming home with me!!!  Oh Ireland, it's been fun but I gotta make a move.

Intimate Insight

I know that these images and this story are making the rounds on social media these days, so my apologies if you're feeling inundated. I felt that these images were too profound and raw and beautiful to pass over.

It is one of the most heart wrenching photo essays I've had the privilege of seeing. I think it shows so poignantly the suffering, strength, love, hope, fear, and anger that features in the struggle with such a devastating diagnosis. To me, these photos express very clearly the questions that we struggle to form when we ask about cancer, and I believe they show the answers to those questions. A few of Angelo Merendino's photos from the website are shown below. In my opinion he is a brilliant photographer, and she a powerful subject.

http://mywifesfightwithbreastcancer.com/

Insert Foot

I was in outpatient clinic recently when I called a patient in from the hall. He was awkwardly positioned in a wheelchair, looked to be in about his mid 50's, with thick brown hair neatly combed back, smartly dressed in a tie and sweater. An elderly woman wearing thick support stockings, polyester skirt and heavy woolen shawls pushed the man into my office.

I introduced myself and said hello to the man, then said to the elderly woman, "and you must be his mother?"

Now I can hear you all cringing and possibly yelling, "NOOOOooooooooooo" at the computer screen. Well as Mike Birbiglia would say,

I know....I am in the future too!!!!

See the thing is, I learned long ago never to assign relationship speculations during interactions with patients! In the emergency department I've often been surprised to discover that the young woman wearing the leather dress, knitting beside the stretcher of an elderly man isn't his daughter / girlfriend / caregiver / niece but is in fact his surrogate mother / Wiccan priestess / life coach / financial advisor.

So I don't know what was wrong with me when I said that, but the elderly woman quickly jumped in to correct me with,

I am NOT his mother, I am his WIFE. I know taking care of him has worn me down but COME ON!

Oh dear. So I apologized and attempted to carry on with the consultation. I was actually surprised that I didn't lose my composure completely. Suppose being berated for years as a basketball referee and then a triage nurse has helped me stay calm when the waters of communication get choppy.

But rather than let it go she kept bringing it up.

At one point she asked me about my "American accent" and I said, "Yeah, actually I am Canadian" to which she replied, "I know, I just said that to annoy you considering what you said to me earlier".  I was mortified. It was awful. Lesson, re-learned.

This is what medical school has done to me! All of my healthcare street smarts have been replaced with useless lists of things like the rare causes of secondary hyperparathyroidism! Thankfully I will be back in the real world soon.



 

6 Minutes

So in case you didn't know, it is World Kidney Day today! I was at our local shopping mall with a gang of retired nurses, fellow medical students, renal nurses, and the renal pharmacist, giving out information and checking blood pressures and blood sugars.

We were MAD busy all day with a steady queue of feisty Irish grannies (mostly) and the odd Irishman who had been dragged there by his wife. It was actually a really fun day but the highlight for me was when a woman standing there with a pram said as I went by, "Hey! I know you!" I looked at her and scanned my mental files for her face. "Er....." She said, "you were there in the maternity hospital when I had my son! Remember me?"

I felt terrible because I couldn't place her (and I am usually great with faces). She said, "Remember? Six minutes??" Then I remembered. YES! I had even written about her on the blog! She was the one that had gone shooting by in the wheelchair panting while the midwife yelled at her not to push yet.

Of course I remembered her. I told her if I'd seen a side profile with her hair blowing behind her I would have recognized her right away. We had a nice visit and I had a chance to see her gorgeous blue eyed chubby boy, grinning away at us. So delightful.

I love my job!

Have you hugged your kidneys yet today?

WOW!

I am totally blown away by how many people commented on my match post!

I have been soaking in the sweet sunshine of many lovely, kind, thoughtful, generous comments from so many readers (many of whom I didn't know existed!) I actually didn't want to make another post because I wanted that one to stay front and centre for a few more days.

Honestly, people. Thank you so much for taking the time to comment and send on such wonderful encouragement. I am truly humbled by this.

Note to self: have mega life accomplishment more often!