Monday, November 30, 2009

Mock Anatomy Spotter: About as Hip as a Mock Turtleneck Sweater

(mock turtleneck)

When I was 20 I dated a guy who was in medical school. I remember him telling me about the anatomy spotter exam (they called it a 'bell ringer'). It sounded ugly to me. I envisioned all these really nerdy science freaks staring at bits of bone and looking into microscopes with a loud gong going off every minute or so. People would get so stressed that they'd vomit or get nosebleeds, fainting also wasn't totally uncommon.

I remember thinking...someday I'm going to have to do one of those and I know that I am not going to like it. For those of you who have not had the pleasure of having your cerebellum slapped with a hockey stick (which is what I equate the experience to) this is how it goes.

You sit down, there are 10 people or so in your circuit. In front of you is a laminated 8x10 of something, either a CT image, a dissection image, an xray, an MRI, a photo of a bone, a electron micrograph of an embryo or a photo of a histology slide. You have 2 minutes to answer the two questions, a bell rings and you get up and move to the next set of images/questions.

In the case of my evil anatomy prof the questions were not, "what is a" or "what is b" they were things like "if 'a' is damaged which structures will be affected and how?" or "what is the metabolic process occurring at 'a'?" or "what genes are expressed to ensure differentiation at 'b'?" Of course it wasn't only 4 options, but 8 to choose from as well. Thanks so much for that.

Yeah. It was ugly. And the thing that irritated me was the complete lack of clinical relevance to most of the exercise. Yes I do believe that you have to know your anatomy so well that you can answer questions under pressure in a rapid fire way....but in the 'real' world I am never going to have an unlabeled histology slide sitting in front of me with a patients life hanging in the balance while I figure out if it is from his spleen or his seminiferous tubule. Come to think of it, I am NEVER going to have a histology slide in front of me clinically...ever. That is what lab reports are for. Nor am I going to be staring at the saggital section of a fox jaw trying to decide if the cleft would be in between the canines or the incisors if "a" doesn't fuse with "b".


Ok my rant is done. I suppose that the exam had the desired effect: it scared the rubber boots right off me. Hence my 7 hours of dedicated examination of all-things-laryngeal on Sunday rather than reading my fantastic book (Shantaram by Gregory Roberts) or watching the flood waters rise outside the medical sciences building.

(mock spotter)

Courtesy of here.

Monday, November 23, 2009

Email Quote of the Day

Today was our mock anatomy spotter (post regarding that to come so I shan't go into too much detail right now). Suffice to say, admit your shortcomings and others will suddenly do the same to you...

My email:

Yup. I just ate my weight in pepperoni pizza in the hopes that it'd drown the pain of trying to figure out if it was a female or male pelvis on the MRI....and was that a beak? Or a feather? Or canines on the embryo question?? I swear Giles threw in some vet medicine just to test our mettle.

The response from one of my study partners:

OMG I totally know which question you mean!!!!! I def answered it thinking that it was female and then about 2 seconds before the bell went realized that this female had a dick...damn!

We are the doctors of the future people. Stay healthy. :)

Saturday, November 21, 2009

Bright Lights, Big Residency

This week the program director for the family medicine residency program in Newfoundland came to speak to the Canadians in our group about working and/or doing a residency in the Maritimes.

I am not going to make a secret about the fact that if I HAD to choose a residency at this exact moment in time it would likely be a 2+1 program in emergency med or anesthesiology. In Canada we have these residencies where you do 2 years of family medicine and then a year training in a specialty like emergency, anesthetics, surgery, oncology, womens health, etc.

This allows one to practice in only a slightly limited scope in that specialty. For example, you can work as an ED doc in any non-tertiary emergency department, you are not an ERP...but you can perform the same procedures as an ERP in a clinical setting. To be honest, I'd love to do a 2+1+1 in emergency and anesthetics.

This is why.

Last summer I worked with several South African anesthetists who also worked in the ED as emergency docs. When things got hectic, they had just that little additional skill edge of being uber comfortable with paralytics and hypnotics--and were also very proficient with procedures like lumbar punctures, intubations, nerve blocks, central lines, etc.

I thought--schizzammm! This is the perfect combination of backgrounds to be a very badass and on-top-of-things ED doc. (I know that this may have also been partly because they were Saffas and just used to doing 100 intubations a day and sewing people's arms back on in the ED when they worked in SA.) Regardless, it really got me thinking. It is so useful to have the two skill sets plus a great way to be prepared to work in rural emergency and international medicine situations.

Back to the Newfoundland presentation.

The program director was talked a lot about how they specifically orient the program toward eventual rural practice, they in fact have a 2+1 program for emergency medicine, and they choose their large hospital attendings very carefully--i.e they choose surgeons, internal med, obs specialists who actually believe in the importance of a very well trained family medicine physician. They don't want you to be the lowest rung on the ladder when it comes to procedures or input. Apparently the school feels so strongly about this they will actually put you in a different rotation if that starts occurring. Pretty amazing if you ask me.

So I asked him what his thoughts were on training in a large urban setting, like Toronto or Vancouver in ED's where you are going to see a lot more trauma, many MI's, septics, etc. and perform dozens of procedures a day...vs...doing a program that is rural focused and set in rural hospitals where you may have a lower volume of the high acuity presentations. Which is better for someone who wishes to set up practice in the Back 40?

He told me as a 2+1 resident in a major center I'd be the bottom rung and even though the high acuity presentations are more plentiful there will be 4 specialist residents and a fellow ahead of me in line to even peek at these presentations. Many specialists will feel I am a waste of their time because I 'only' want to do family medicine (which is kinda funny because I don't actually...I want to work in an ED but I don't feel like doing a 5 year ERP specialty is really necessary for my career aspirations). I know that in the hospital the ED docs are crapped on by the specialists anyway so I am used to that...but I digress. He also said since in the rural hospitals I'd be 'it' in terms of residents I'd get to do as much work and as many procedures as I wanted. Be on call as often as I wanted. This definitely appeals to me. And I can certainly relate to working with the docs who trained in an urban setting and then were clinically very useless when they first got to rural settings where there was no neonatal team, no stroke team, no respiratory therapist, no 24h lab...madly tapping into their Blackberry's 'does NOT compute!!!'

Anyway, the presentation certainly gave me food for thought regarding residencies. I am still unsure of the best way forward. A part of me also is intrigued by the 3 year emergency medicine residencies in the US. So we shall see. I know that as an international applicant I need to blow the USMLE out of the Time will tell what my options will be. It is a long way off but these days I need to see that there is an exciting light at the end of this tunnel.

Thursday, November 12, 2009

The Many (Inside) Faces of a Triage Nurse

So you've had this sore throat for 3 hours you say?

If your child was VOMITING why did you feed him CHICKEN NUGGETS?

You stare at me with your arms folded standing outside the curtain of your room for one more minute and I swear...I swear...buddy...

The 'nurses help line' told

you to

come in for your blister???


Some days I just want to let it out.

My sister in law used to be a flight attendant and when people asked her what her job was like she'd say "Smile! Now hold that for the next 14 hours".

That is how I feel sometimes when I am sitting at the triage desk.

Friday, November 6, 2009

Relationship Morbidity and Mortality During Medical School

A friend in my program recently got dumped by her boyfriend of two years. It was one of those horrible 'out-of-the-blue' dumps too, which is the worst I think. I've had one of those as well (on my answering machine, I might add) and it really was profoundly hurtful and difficult to process--dealing with the shock and the pain at the same time.

Without getting into too much detail, they were suffering through the beginning stages of a long distance relationship. Many of my classmates are in the same boat, studying medicine here and trying to maintain a relationship with someone back in Canada (or in another Irish locale). From completely anecdotal examples I can say that relationships seem to be on the chopping block when it comes to medical school. Then add the distance. I think it takes a very special combination of people to survive long distance alone, without one party being in the all-encompassing-entity which is our program. A remark that was made was "one by one we watch the relationships fail in our group of friends". And it's true, so far.

My aforementioned friend and I bumped into each other in the stairwell the day after it happened and we hashed out the hazards of being a 30-something-female in medicine. In a word, it's treacherous. Suddenly the reality of age is upon us. Don't get me wrong, I know we're not old by most standards...but basically take the fears that some single 30 year olds have and multiply that by a factor of, many.

Issues include:

The 30's are supposed to be our most productive/lucrative/peak-of-existence times in our lives. We are enfolded in the tight embrace of heavy workload, high expectations, competitive surroundings..and we're paying for it (partly in actual cash dollars).

"I'm in medical school" or "I am a medical resident" is instant man-deflector line in most social situations. I think that combination of words is actually heard as "I am an intimidating, career driven, over-achieving, heartless woman who puts her man last" by males of the species.

Our eggs are shriveling. The two cases we had last month involving fertility and abnormal pregnancies/birth defects were definitely stressful to the older women in my program who wish to breed. One of the comments my recently single classmate said was "should I freeze my eggs?" You just DON'T have to think about that when you are a 22 year old medical student. I don't think I want to have babies yet I found myself feeling very constricted by the time line ahead of me if I were to change my mind. I actually had a moment, starting at yet another photo of a birth defect, where I thought--"should I freeze MY eggs??" It was a scary moment. I was pleased when it passed.

On not much of a different note from above--the super-women who do have babies in medical school have an incredibly tough chore balancing the mother/student/wife/self...yet there seems to be this expectation that it ought to be possible and you are not (super)womanly enough if you take a year off to focus on one of the above things. I am already thinking I'll need a year holiday after medical school to re-water my soul by doing things like learning Portuguese and becoming dazzling at finger-picking on the mandolin...but I digress.

It has just caused me to pause once again on the choices I've made to get to this place (an inevitable choice I believe in becoming a doctor). I go on and on about how I value all the things I did in my life pre-medical-school (like nursing, traveling, playing music) but sometimes I think that the advantage truly does lie in pursuing these types of studies earlier in life. Already some specialties are off the list for me because I simply don't want to put so many more years into the schooling part of things. I hate that feeling of a time limit. Especially when 30 doesn't feel like an age where one ought to have those concerns.

So much living to do, so little time.

(Last fall in the in my happy place).

Wednesday, November 4, 2009

More Words of Wisdom from an Immunology Lecture

Recently I mentioned the excellent sense of humor my immunology prof has, today two of his gems were:

"Next time you write orders for some blood test [involving antibodies] know that a little mouse died for that test."


"If you're packing in a hurry and you only have time to pack one immunoglobulin, pack IgG".

Umm, awesome.

Image taken from here:


15% off scrub tops with coupon "asystole15" until November 15th.

Monday, November 2, 2009

Med School Blahs, or Things I've Been A-Missin'

I realize that posting has been thin lately, my apologies. I just feel so damn guilty whenever I am on the computer doing anything other than reading an ebook about osteoporosis or anemia.

I am still happy to be here overall, but the blush of September has certainly faded. The realities of being a student again and the small to large sacrifices that entails have really started presenting themselves.

One of the things I forgot about was the feeling of 'being done'. You know, when you've mailed your thank you cards, filled up the car, and marinated the chicken and you sit down with a glass of wine and you sigh...ahh..done. Nothing left to do now but relax. That feeling is gone, officially. And I know will be gone for a very very long time. Now when that sensation begins to wash over me the studious devil that sits on my shoulder reminds me that I really don't know all the ligaments in the upper limb...and I really don't know all the differentials that would cause elevated alk phos levels. I guess I ought to drag myself back to my desk for another wrestling match with one of my very expensive textbooks.

Having money was nice too. And a car. Ohhh...a car. I know, I is so much more environmentally friendly to walk and bus everywhere. But the bottom line: it sucks when you don't live in a major city with good public transit. Every time you need to get milk or laundry soap it is this 2 hour epic combination of bus riding, walking, taxi taking, ride coaxing, waiting, more walking. I knew we had arrived at a new low as I observed my housemates on the 2.6km walk home carrying their new printers on their heads.


Ok, I am aware that the rest of the world has it much harder than I do and that my whine is likely falling on deaf ears. It is simply that the reality of my old life continues to fade. And while it fades I see so many things I took for granted go with it.

Even just having a comfortable living room to entertain in. They provided us with a small couch (i.e. so small you can't do anything other than lie in the fetal position on it--which is the position I most often feel like reverting into anyway I guess) and two chairs. There are FOUR people living in this house, this means if we have ONE guest someone has to sit on a computer chair. Lovely. How homey and welcoming.

I miss being able to walk to a nice coffee shop and study. There are none around here (well there might be but that introduces the same logistics as grocery shopping) so it is either the my dorm 'cell' or the library. I miss the beautiful Clinical Sciences library at the U of A (Keith, know what I am talking about). A multi-story open concept, sky lit, plant friendly, quiet-as-a-tomb, study spot that was open really really late...and again really really early. The library here has the charm of a bomb shelter, is tiny, and has flickering fluro's overhead. If the asbestos doesn't get me the status epilepticus will.

Walking today I again tried to tell myself that I had to stop comparing everything to my old life and start accepting the fact that I am here and this is my reality for the next 4 years. I have heard many of my physician friends say if they had known what they were getting into they might not have chosen medicine--this is when we talked about the lifestyle/career aspect of it AFTER becoming MD's. I had always sort of felt really reassured that I'd never question my choice because I have a pretty good idea of what I am getting into when everything is said and done and I have a nice 6 figure debt attached to the piece of paper which says "MD".

But there are certainly some days that I have to ask myself, if I knew how much life would change during medical school--would I have chosen it? At this age? Right answer is a really solid "Um...I think so".