Thursday, October 29, 2009

Quotables from the Classroom

In the past week during lecture:

1) The Dean of Medicine advised the females in the class to 'go out and get a toy boy'.


2)During an immunology lecture the prof began quoting the Simpsons--'the tot with the spots--the sister with the blisters!'

Nice to have people who don't take themselves too seriously in medicine. There are already enough of those in the student body.

Monday, October 26, 2009

CPR Refresher

On Thursday we had to take our CPR first responder training. I was trying not to be bored out of my mind as we sat through 8 hours of "one-and-two-and-three-and-four-and" chest compressions and how to perform the Heimlich maneuver.

Interestingly though, when we pulled out the baby models for the infant CPR I felt my heart rate pick up ever so slightly and a knot tie itself in my stomach. At first I tried to step back and figure out what was happening...and then realised that it was just a little too much of a reminder seeing a lifeless looking baby in front of me. I briefly touched on the neonatal code that I was involved in last summer when I was working as an ER nurse in Canada.

It had been a very very busy day in the emergency department and we were short staffed as the connected ICU had two very heavy patients which required 1:1 nursing. Earlier a woman had walked in holding her soccer sized belly and we had directed her upstairs to the maternity ward. We hadn't paid much attention and were just happy we could tell at least one patient that they could be seen somewhere else. Just before lunch we heard the announcement on the hospital PA, "CODE BLUE...NURSERY....CODE BLUE...NURSERY".

My colleague and I were both standing in the nursing station when this announcement was made. For a split second we just looked at each other, the main thought running through my head was that I was pitying the nurses who had to deal with that situation. On the heels of that thought was the realization that as an emergency nurse I was likely responsible to respond to that code. One of the points that no one mentioned during my 4h orientation. My colleague who was in charge stood rooted to her spot with wide eyes and said, "Go".

I turned and ran up the three flights of stairs to the maternity/medicine ward. Remembering that I have only ever run once before in the hospital...years ago when a patient I had escorted to CT crashed during the scan and there was no bagger in the CT area. I got to the top of the stairs and took a moment to catch my breath and collect myself. There is nothing worse than staff who BURST onto a scene. What was that saying about taking your own pulse first?

Walking onto the floor I saw a crowd of patients, family members, and staff had gathered around the periphery of the nurses station. When I rounded the desk two of the medicine nurses pointed me to the room I was destined for.

Going in the first thing I felt was the heat. The doors were closed and this was during a very unusual hot spell--in a hospital with no air-conditioning. The warmer was also on and no windows could be opened. With 9 or so bodies in the room the air was thick and sticky. Two anesthetists were at the head of the warmer finishing up the intubation, one was already peeling off her gloves and saying, 'well you've got things under control here...' An emergency physician was standing to the side of them finishing up with inserting the umbilical line. None of the family was present in the room. The maternity nurse was getting the buretrol and IV lines going and the charge nurse was on the phone with the lab and xray department. I grabbed a pen and started writing.

Sometimes I like recording, especially when it is a patient that I know nothing about. Being the recorder allows me to go through what needs to be done (in my head) and gives me an opportunty to keep other nurses organized. Some people get a little 'chicken with their head cut off' in code settings (and I am certainly not excluding myself from this group) but I find if you say, 'hey what size catheter are you inserting?' or 'where is a second IV line going to go?' then folks seem to get on task and off the circular merry-go-round-wheel-of-stress.

This code was being run by one of our most pleasant and experienced ER docs. Even during arrests he uses the words 'please' and 'thank you', never raises his voice, and never looks ruffled. I instantly calmed down and was grateful for him and his demeanor. In fact, it was almost comical how he raised his eyebrows to me when a clearly very flustered nurse came running into the room with the syringe of broad spectrum antibiotic in hand...the door banged against the wall causing everyone to jump. It was sort of a 'hey lady, we're all cool in here! What's with the Grey's Anatomy entrance??' kind of look.

The baby was not doing well. I had finally gotten report and learned that mum had arrived with no previous prenatal care, and no physician following her pregnancy. She had a vaginal delivery a few hours ago at 32 weeks gestation. The baby was just over 2900gms and had gone into respiratory distress and then cardiac arrest.

The code blurred into the various stages I was used to in adult situations...the arrival of the lab and attempting to work around them...the x-ray technicians and the portable machine forcing us out of the room for a momentary breather...then the hurry up and wait aspect until some reason for all of this happening presents itself.

The x-ray came back showing the 'ground glass' appearance to her lungs. My role in the code had shifted to providing ventilation with our neonatal bag valve mask. Along the side of the bed with the warmer heating my already sweaty neck I counted out respirations and watched the monitor for her wildly fluctuating oxygen levels.

Now my memory shows me only slices in time from the rest of the event. I can see the surfactant bubbling around the ET tube and I can hear the gurgling hiss. I can see the flushed cheeks of the maternity nurse and the two bowls of untouched tomato soup sitting on the bedside tray. I see the rise of that tiny chest with each squeeze of my hand on the bagger. It is strange to feel that tenuous line between life and death strung between yourself and another, another very helpless individual. Where else in the world does that exist? When in our lives do we feel that responsibility and connection to another human?

I remember feeling very in the moment and calm, detached and interested from a medical point of view but not sad or upset. I remember thinking that I found the differences between being in an adult code vs a pediatric one very interesting...and I wondered if I shouldn't dismiss pediatrics for my future.

A nurse from the floor came in saying the ED was a zoo and they had phoned up to see if things were under control so I could go back downstairs. The child was as stable as she'd been for the past couple of hours so the mat staff said they could take it from there. The infant transport team was due to arrive shortly anyway so I was relieved of my duties. I headed back though the doors of the ED and picked up the first chart with orders on it;

IV ancef 2gm

On I went into the room to find a cheerful man with a sailors lexicon who had traumatically amputated his right 2nd finger just past the knuckle while he was at work. And from there the rest of the shift swallowed me up in the usual more mundane presentations and chief complaints.

When I wrote about this event before I mentioned that I drove home and sat in my car parked in the driveway for quite some time after the shift. I looked at my feeling of detachment, I thought about how intriguing it was. Another example of professional self-preservation? I replayed in my mind how frustrating it was trying to use equipment I wasn't accustomed to and made a mental note to familiarize myself with the pumps and lines we had stashed away for peds cases.
It wasn't a good night. I talked about it at length with a friend via of the downsides of travel nursing is you don't necessarily have the people you need around you to informally debrief with.

Then the incident travelled to the back of my mind until this CPR exercise.

And so it goes, the recall. The questions that almost never get answered--the long term outcomes, if our interventions were effective, if we gave the best care possible? The images arrive in your mind and the present is abandoned for a few moments while someone talks about how many compressions per minute and someone else makes a joke about having babies in medical school. No one really wants to hear about the fact that your last code was a pediatric code so you tuck all of it away again and allow time to do its job. Moving right along..

Monday, October 19, 2009

Oh Ireland

I am feeling homesick tonight. So to attempt to cheer myself up I am making a post using the photos I took a couple of weeks ago. These are from the Cliffs of Moher. I love this one below because of the face that appears etched in the rock.

I'll go back hopefully some day when it is gray and misty...the cliffs are almost too pretty in the sunlight.

This fence was near a Good Samaritan sign, at first I thought it was a bit of a random place for a counseling poster...then...ohhhh....riggggghhhht.

How I feel sometimes about going back to school...

These are from an old Franciscan Monestary. I absolutely loved spending time could really sense the history of all the souls that had passed though those walls, their graves underfoot.

The courtyard that backed onto the large stone kitchen where they baked bread.

And finally a photo from a cave tour we did. I quite liked the waterfall inside.

It's a long weekend here now and I've opted to stick around in the hopes of catching up on some sleep, some reading, and normal living (i.e. a trip to the Farmers Market tomorrow). Hopefully this is just an extension of the 5 week bump that apparently everyone goes through.

The Great Irish Canadian Thanksgiving

The first matter of business was the stock for the gravy. One of the chefs staying with me roasted the giblets and two packages of wings as soon as we got up Saturday morning. Then the great pot of onions, garlic, celery, carrots, roasted meat, and wine simmered for hours. By 1100h the house already smelled like my mothers Thanksgiving dinner. We made a giant batch of stuffing, thanks to my mothers recipe. Simple and delicious. Having never made an all-out turkey dinner before I was definitely scared that things were going to go Pete Tong. Once the birds were stuffed we sent them out in a flock to the various surrogate ovens we had commissioned for the event. Specific instructions and fingers crossed we set to work getting the large common room ready.

One of my classmates taking a bird to her residence.
At around 1730h all the turkeys were cooked so we went around collecting them so that the drippings could be used to finish the gravy. Of course one of the people in charge of an oven was no where to be found, wasn't answering the door or his cell phone. We couldn't get a hold of his roommate either so we just hoped that our Village was not about to burn down due to a charbroiled bird. After 1800h we were finally able to get a hold of the final turkey and it was in fine form, not burned in the slightest. The moment of truth though was the carving. By that time there were already over 45 people at our gathering. Wine was flowing, music playing, people snacking.

The turkeys turned out absolutely perfect. I was stunned. I had always thought there was some mystical chant or great cooking wisdom involved in making a stuffed turkey. But apparently the only required charm is a phone call home to one's mother. When I closed my eyes I was back in the house I grew up in, sitting at our table with the extra leaf put in...steam on the windows and animated conversation all around. That first bite truly took me back and I thought about the legacy of food that is passed down in families. I made a mental note to learn how to make my mom's pastry next time I am home. I've got the stuffing down now. Baby steps.

The assembly line of carving.

Some very excited Canadian guests.

All in all, many of the Canadian guests told me at some point during the evening that they felt a little less homesick due to our replacement celebration. The Irish contingent definitely asked to be invited again next year and seemed impressed at our dedication to eat LOTS of food in the name of, harvest? Pilgrims? Just pass the cranberry sauce.

Monday, October 12, 2009

A Call for Good Online Resources

Just thought I would put this out there...while wading through the mire today online in the hopes of finding good pathology, embryology, histology, and all the other 'ology's' out there I decided that I am tired of shoddy internet hits and questionable sources.

If anyone can suggest some good sites for me as I endeavor to find supplemental info via the internet that would be great. Feel free to email me or put it in the comments section.

I am already dialed with and emedicine so preferably some other (free) sites would be greatly appreciated.

Thank you blogworld, in advance.

Sunday, October 11, 2009

Quick Post

Just a quick note to say that the Thanksgiving dinner (for yes 50 people) was an EPIC success.

Went to the Cliffs of Moher today and had a lovely time tramping around with my visiting friends.

Due to the major lack of embryology studying this weekend the real post and photos from yesterday are going to have to wait a couple of days. But in the meantime, I can say that I've successfully stuffed and cooked in 6 ovens enough turkey to feed 50 people (with ample help of course). They turned out beautifully.

Bucket list: check.

Friday, October 9, 2009

Asystole and Anatomy Enjoy Canadian Thanksgiving in Ireland

As many of you may or may not know, this weekend is Canadian Thanksgiving. My housemate decided that we were going to organize a massive turkey dinner in our residence common room. Somehow I was coerced convinced to make stuffing, stuff the turkeys, and organize the surrogate ovens around campus that we'll be using. It is going to turn into a gong show with Pieces of April proportion I am sure.

The residence manager has been a star with regards to the event, she even donated 100 Euro towards the food and wine. There are about 50 people on the guest list now and I can't help but wonder what the hell I was thinking when I figured it was a good idea. Well it'll be epic I am sure, either an epic failure or success...but I don't think anything in between.

In fun and random news...Anatomy on the Beach is coming up with another Canadian classmate for the weekend! We met last December when I went down to the Caribbean to check out his school. It was a great time and I couldn't help but have a chuckle over the fact that it was our blogs that caused our worlds to collide. Anyway, we've since kept in touch and decided that Thanksgiving was a perfect excuse to meet up again since now we're both strangers in a strange land (he's in the UK now).

I promise to take photos and give a play by play of how it all went.

For my Canadian brothers and sisters--Happy Thanksgiving!!

Monday, October 5, 2009


Whenever I had an eyelash on my cheek, my former boyfriend would always brush it away with his finger and hold it in front my lips for me to blow away while making a wish.

It never seemed hokey or contrived to me. Every time he did this I would indeed make a wish. For as long as I can remember every wish I ever made was to one day get into medical school. This was the candles on the cake, the money in the fountain, the shooting stars.

Two days ago I was on a bus trip with some classmates and one of them said, "oh, you've got an eyelash" and proceeded to brush it off, onto the ground. Of course my knee jerk response was "Hey! I didn't get to make a wish on it!"

It got me thinking...what would I wish for now? And nothing jumped to mind. I mean, nothing. I guess I've been putting so much of my psychic, emotional, mental, physical, financial effort into this goal for so long that it really pushed everything else out. With medical school like a looming building on my landscape, so many seedling goals died in the shadow.

Accomplishing a long term goal certainly has it's adjustment phase. Though I am here and very much living in the moment, enjoying what I am learning...I've been wondering, what do I wish for now?

Saturday, October 3, 2009

7 Things About the Albinoblackbear

So I was doing my daily read of Old MD Girl and her post was about 7 things that you wouldn't know about her. At the end, instead of 'passing it on' she suggested if you were reading the post you ought to write one of your own. I have been working on a couple of posts that are still...not ready so I thought this would be a good tweener...otherwise you'll be exposed to a lot of youtube videos. And that just seems unfair.

And now....*drum roll*

1. I was engaged once. Was a runaway bride in fact. That was 4 years ago and the slighted groom-to-be and I are still good friends. Whenever I go to the town we used to live in we have dinner and continue to be pleased about the fact that we never got hitched. He's married to someone else now and is ridiculously happy. I am happy for him.

2. I made it to the last round of selections for the Canadian Air Force to become a pilot. I got cut in Toronto after the final simulator flying and navigation tests. It was a process that took almost 2 years. I think it was one of those 'sliding doors' moments where my life would have taken a drastically different turn had I been accepted. Instead I took at year off school and traveled around South East and Central Asia.

3. I am terrible with plants. I kill any plant that has ever been given to me. I don't like to garden and hate the creepy crawly things that live in gardens. I know this is wrong and that I should embrace gardening and all it's bounty...but...gah...maybe someday.

4. Speaking of creepy crawly things, I am an arachnophobe. To an almost psychiatric inpatient level.

5. I would happily live somewhere that had maximum summer temperatures of 20 degrees celsius. I hate the heat. I hate being hot when I sleep, I hate direct sunlight, I hate that muggy humid heat, I don't even really like sunny days. I don't tan and have never been one of those people who hangs out at the beach. I like clouds and love the rain. Why am I starting to sound like an emo/goth/socially maladjusted woman? Hmmm....

6. I have a neuroses about my hands smelling like food. I can't eat wraps or things from places like Subway because I find that food smell just hangs on and it gives me the willies. I love to cook and from time to time after an epic meal I can still catch a whiff of garlic or onions on my hands and I need to go and SCRUB myself before I can enjoy the rest of the night.

7. I am a musician. I play piano, mandolin (badly), guitar (badly) and sing (pretty well I've been told). Had a pretty awesome band for a few years and we rocked some amazing shows and festivals in that time. My housemate here in Ireland found someone had uploaded our CD to youtube, which I thought was hilarious. Anyway, yeah...that's us. The George Bushes. And that is your homegirl, Albinoblackbear, on lead vocals. It's all original music...and I am still very proud of the music we made.

Anyway, if you are still reading...I urge the same to you blogosphere. Just because you drop random details about yourself it doesn't mean we'll figure out who you are. Or will we??