An Irish Toast (or two)

To ring in 2011 I thought I'd supply the blog world with something to say at midnight (other than happy new year--which is soooo 2010).

"That your patch of trouble may not cover the hole in a leprechauns breeches."

Or after a few drinks you could tackle this one:

"God spare you the years to smoke your dudeen, drink your cruiskeen, flourish your alpeen to wallop a spalpeen". 

Ok, I can't help myself...Happy New Year everyone!  

Was there ever a bad year for Guinness??

Ghost of Christmas Past

I was reading through posts about the holiday season on my old blog and I found this one from 3 years ago. It made me realise that it's been a long, long time since I've been home for Christmas. The theme of being away seems to keep coming up, which was a big part of why I started blogging. It was an easy/exhibitionist way of keeping a diary, an account of things.

I will post soon about my most recent Christmas, but in the meantime...a little trip down memory lane.

---

A marker in time. Christmas.

When I was a kid I was allowed to sleep in the living room, next to the tree. I always loved falling asleep to the blinking lights and the sounds of cards and laughter coming through the glass door that separated our living room from the kitchen. Even now, sometimes when I can't sleep I try and imagine myself back in time feeling that sense of anticipation and security as Christmas danced on the horizon and family were every where I turned.

Last Christmas John and I were in Morocco and it was less than ideal, though we did try to make the best of it. It was cold at night and the Riad we were staying at had no central heating (which was the norm) so at night the owners would bring a smoking stove with virtually no ventilation into the common room where we'd oscillate between freezing outside breathing fresh air and smoke inhalation in the warm-ish common room. I was homesick and calling home made it no better, listening to my families enjoyment of their rented cabin in Fernie and freshies on the mountain each day.

Photo booth near Todra Gorge where we were staying.

It reminded me of when I called my father on Boxing Day from the west coast of India in 1999. I felt a million miles away from everything and everyone standing there in the suffocating phone booth, sweating, rings of dirt around my neck. I was crying and he just said, "why the hell don't you come home then?". It makes me laugh now...you can't call your parents crying on the other side of the world and not expect them to say such a thing. But at the time it was as ludicrous a suggestion as "why the hell don't you join the Spice Girls and go on tour with them?"

I searched online for some way to get home from Morocco but of course it was Christmas and it would have been impossible to change flight and go home without losing my money on the return ticket and likely losing my boyfriend in the process. So I stayed and we spent a shivering, coughing, Christmas eating tagine and scrambled eggs with the chain smoking Czechs, the hilarious Germans, and the hospitable Moroccans.

So a year passed and it seems that life again had it's own plans for me this Christmas.

After successfully finishing a semester in Kelowna I was excited to return to Revelstoke to see friends and then be on my merry way to Red Deer to see my brothers, sister, nieces, nephews, brother-in-law, sisters-in-law, mother. It rarely happens that all four of us kids are in the same country at once.

I made smoky sweet potato soup, bought all kinds of organic veggies for a roasted winter vegetable pasta (with fresh pasta from the Italian deli in Kelowna). I had to make several trips to the car to pack the Petit Syrah, the Champagne, the food, the mandolin, clothes, ski gear, and camera.

Got about 50 km down the highway and after being tailgated by an asshole in an SUV on the black ice I decided to turn around.

Now I was trying to negotiate the black ice while sobbing and snotting all over my steering wheel. Okay enough with Christmas and crying I say!!! I unpacked all the food, the drinks, the instrument, the clothes, the books, etc. and put on my snow pants. Tobogganing in the alley with Carlos, Ruby, Polly, Nelson, and Sophie cheered me up.

And thus the Revy Christmas whirlwind began.

Surprisingly Wonderful

Last night I finished "The Elegance of the Hedgehog". 

It was not an easy read and many times I got frustrated with it and wanted to throw it against the wall. Ok, not that violently frustrated (I did want to do that to Bryce Courtenay's Tandia when I got to the end). But I did feel rather exasperated by Elegance on more than one occasion. I wanted to lose myself in a book, something non-medical and gripping. This book made me think about philosophy and sociology and frankly, I wanted a romp. 

But as the chapters wore on, it grew on me and the characters really came to life. And then the last 50 pages enthralled. Ohhhhh...and the end. The END! I couldn't sleep. I just lay there, head-lamp on, reading the last few pages again and again, crying. 

No sleep. More crying. 

It was a good book, in the end. I think I'll have to tackle it again from the beginning, less standoffishly. 

Biochem Anyone?

I had been out of university for about 6 years when I decided to go back and take the missing, magical pre-requisites that would be my ticket to passing the MCAT and getting into medical school.

It was a full year and a half of inorganic chem, organic chem, physics, microbiology, and health sciences. It sucked. For a lot of reasons.

Once I was done that I was able to apply to several schools in Canada/abroad and had enough of my bases covered to write the MCAT so I opted to not go back in the fall for another full year of calculus, stats, and biochem--doing that would have given me the pre-reqs to apply to U of Alberta and UBC. But I was getting close to 30 for crying out loud! How many more 1st year courses did I have to endure??

I was living in my friends' parents basement doing o-chem when my 10 year high school reunion rolled around--which I obviously skipped. What was I going to say? Yeah, things are going well...I am in the process of getting dumped, I am doing a second year chem course, unemployed, and keeping my fingers crossed on getting into med? Riiiiiiggghhhhhht.

I just couldn't face it. I'd drained my RRSP's and my relationship. I thought that if I couldn't get in somewhere with what I had then I'd figure out a plan B.

Turns out maybe a little biochem would have come in handy after all.

They barely touch on it in my program, yet the USMLE seems to care if you know what a g-coupled protein receptor is.

I took the kaplan diagnostic test last week and found that my (major) areas of weakness are medical genetics, biochem, and molecular biology. Shocker! I never have taken any classes in those areas!

When we did our little kaplan pep talk a couple weeks back the lecturer said that wherever we have weakness we should spend 30 mins a day from NOW until the exam chipping away at it, "If your weakest area today is your weakest area on exam day then you aren't studying correctly".

Taken at face value it's pretty basic/obvious, but I think it was absolutely sound advice.

I've plowed through the first few chapters in the review book of medical genetics. Tomorrow the autodidact begins biochem.

This is going to be an interesting little educational diversion.

Wish me luck.

Dublin

Merry Christmas Blogistan!

Someone please come save me from this very intermittent wifi and my sudden lack of gastronomic restraint.

It is 2000h and I need to go and brush my teeth because I've eaten so much sugar today that it feels like every tooth is covered in a mini blanket.

Missing my family large, numbing the pain with mulled wine. Ok, not overly adaptive but hey, whatever gets you though the day.

Failed at getting Tobie a present so will try to claw my way back to 'best girlfriend ever' status after my fall from grace today. What can I say? The man has expensive taste and I am a talentless pauper!

Hope everyone is well loved and well fed.

ABB

What Study Hath Wrought

Ok so that is a radial nerve injury. When was the last time I showered?

Ever wanted to know what medical school looks like? Well here at Asystole I am willing to show the ugly truth. It involves a lot of sitting. At a desk. And reading/memorizing/cramming/blogging/gnashing of teeth/flash card writing/ and questioning your decision/capabilities/intelligence/motivation for medicine. 

I've been wearing these pants for so many days I'm surprised they haven't
created their own blood supply from me. 

It also involves choosing outfits that are a combination of comfort and warmth, borrowing clean clothes from your boyfriend and not buttoning them up properly. Medicine makes you commit the biggest fashion faux pas of all (yes something worse than scrubs)--socks with flip-flops. When it gets down to the wire, one also goes around with self-made flash cards in hand so that the boyfriend can 'quiz' you while you make dinner. And by 'quiz' I mean 'fail to read your handwriting, comprehend your shorthand, or pronounce 'natriuretic' properly'. Proof that three of my loves cannot be combined: medicine, Tobie, and cooking. 

You will get up before the sun and go to bed after it. And most of the time there will not be a paycheck or excessive alcohol consumption involved (the two main reasons I'd be up early or in bed late when I was in my early twenties).

The garbage closest to you for the month approaching finals will look like that. Note *one* item from Canada's food guide. Seriously, I was so aghast when I saw this I had to take a photo. I have been a pseudo-health-freak for many many years and this image is but one more plot on the 'demise of healthy living' that is medicine.

And that is just the beginning.

Threes?

Today I left the lights on, draining the battery of my friends car.

Then I lost my favorite shirt at the gym.

And then flooded my kitchen/living room by leaving the hot water tap on while I meandered off to vacum.

Post-exam brain? Yep.

Stress level even registering on the Richter? Nope.

I love life.

All Quiet

I needed a couple of days away from my computer screen and away from the confines of my office. Now that I've read a few hundred pages of my book, slept in, gone for walks, talked to my family, prepared a turkey feast for 10 people (on one hours notice), and worn my housecoat for >5h straight...I feel like I can sit in here and stare at my computer screen again.

It's been wholly up-and-downish since my last exam (anatomy spotter of doom) on Wednesday afternoon. If you want a more detailed account of how those exams work I linked to my previous explanations in the last post. A quick and dirty version: there are 25 desks, 50 questions. 1 minute per question. When the buzzer goes, after two minutes, you get up and move to the next desk. Everyone starts at a different point on the exam, this time I started at question #15.

I was flying! Remember, these exams are designed to make grown men cry (and they do). This semester I opted for a different study tack, and I think I cracked the code. Our anatomy prof gives us about 15-25 images each week with our learning objectives for the case. That is what most people study on because often it is these images that turn up on the exams. Now that we've been in school for a year and a half this means the amount of slides that could be chosen from are >600. Instead of madly trying to go through all the slides from the past I picked the concepts that keep coming up and looked at as many images of those things, from different sources--especially imaging atlases (because I am really trying to train myself to visualize the 3D version of x-rays, CT, MRI). I spent time reading up on hernias, embryology of the face, cardiac circulation, head injuries, lung pathologies, etc. in general and avoided my notes all together.

It totally worked. The first 10 questions seemed almost laughably easy. I was trying not to grin at how well prepared I felt and how much I was ROCKING THIS EXAM!! Oh what a feeling.

Hang on. 

I am supposed to be at question 26. But I am at question 25 on my bubble sheet? BUZZZZZZZZZZ!!! (i.e. move to the next station)

NOOOOOOOOOOOOOOOooooooooooooooooooooooooooooooooooooooo. 

Yep. Somehow I got out of sync with the numbers, I missed filling in a bubble somewhere. Somewhere between the vagus nerve question and the head injury one.

Oh God. I am going to vomit. What question am I looking at now. Yes, ok fine common fibular nerve question...ok should I try and figure out where I made the mistake? Should I flag my prof down? I thought for sure that vagus question the answer was "D" but it looks like I put "E", maybe that is where I screwed up, maybe...BUZZZZZZZZZZZZZZ!!!

Ok I am going to be sick. No, don't be sick. Forget it. Move on. Finish this exam as well as possible. FINISH in STYLE. Don't have a meltdown now. Don't vomit now.

Head in the game. Game face. Bring it.

I finished the exam. Told my prof on the way out that I'd gotten out of sync somewhere between 15 (where I started) and 26. He just said "Oh, ABB!" with genuine empathy and disappointment for me. He said he'd look through my answers and try to rectify the situation if he could.

It was actually too much. He's a real hard ass, so getting his very kind response brought on wave of nausea number three--I bolted.

Home, called my mother. Cried. Composed myself and called my prof. I told him I didn't expect he could really fix anything but that I'd told him only because my ego/vanity couldn't handle the thought that he wouldn't see the mark that I had been on my way to getting. I know, I lost prob max 10-12% in the mistake (and maybe a smattering more due to the momentary panic), but that I passed overal. Thing is, I don't obsess about grades. I want to learn this stuff for the sake of being an excellent, safe, competent physician. I can't even tell you what I got last year because I looked at my marks and then forgot about them. But for once, and for the first time in medical school I felt like everything came together during an exam!

He told me not to worry, the exam was only worth 14% of my total marks for the year and that it would in no way compromise my academic standing overall. We wished each other a Merry Christmas and hung up.

I changed from my nervous-sweat-soaked t-shirt and headed to the pub. I suddenly missed my friends and classmates and I wanted nothing more than to be getting "yay we're done!" hugs and drinking a Guinness. It was over, I was past it, and I wanted to reclaim the celebratory feeling that I deserved.

I reclaimed it and it has been a sweet, sunny, quiet few days since.

Exam Time

Had two exams yesterday. One at 0900h and one at 1600h. Nothing like having a 5 hour break in between to feel nauseated, anxious, and exhausted while trying to decide if cramming if futile or beneficial. 

Turns out in this case it was beneficial. 

I knew I'd be too frazzled to concentrate on studying (and the nagging voice of 'should I even be doing this?') so I went for a run right after. A totally killer-hill-interval-one in a desperate attempt to flush my body of all the adrenaline of the morning (as well as some of the junk food I've been eating this past 2 weeks). 

I went back to my study pit and tried to focus, despite the workout I was having a pretty hard time looking over stuff and keeping it in. In the morning we'd had our EMQ exam--for those of you not cursed with this type of exam I'll give a quick example (my apologies to the non-med readers, you can skip the boring blah blah blah and head to the bottom):

For each clinical scenario below, give the most likely cause for the clinical findings. Each option can be used one, more than once, or not at all.  

A-Myeloma                 

B-Hodgkin's Lymphoma            

C-polycythaemia vera         

D-amyloidosis

E- chronic lymphocytic leukaemia           

F-Waldenstrom's macroglobulinaemia       

G-acute lymphoblastic leukaemia

H-Burkitt's lymphoma

I-paroxysmal nocturnal haemoblobinuria

J-essential thrombocythaemia

K-chronic myeloid leukaemia

L-antiphospholipid syndrome

1. A 25 year old man presents with enlarged painless lymph nodes in the neck. His peripheral blood film shows Reed-Sternberg cells.

2. A 45 year old man presents with fever, weight loss, tiredness and gout. On examination there is splenomegaly. WBC 112. The Philadelphia chromosome is detected. 

3. A 70 year old woman complains of weight loss, headache, blurry vision, lethargy and hematuria. Positive findings on exam include cervical lymphadenopathy, splenomegaly, and numerous retinal hemorrhages. Bone marrow biopsy shows lymphoplasmacytoid cell infiltrate. 

4. A 27 year old man presents with haemolytic anemia after surgery. He reports a history of recurrent abdominal pains. Ham's test is positive. 

5. 60 Year old man presents with headaches, blurred vision, and itching over the whole body (the last after a hot bath). Positive findings on examination include plethoric facies and moderate splenomegaly. Hct: 65%. *

Yeah, so that wasn't a question from our exam but it was a sample of the EVIL that is EMQ. The whole idea is that by giving many answers the 'posible right answer by guessing' amount is decreased to an insignificant amount. 

I usually feel pretty strong about my ability to perform on these, and don't get AS stressed as I do about the long answer exam or the anatomy spotter. The thing that scares me about the long answer is that if I get a question that I have no idea about then suddenly I see a barren desert in my mind. Tumble weeds blow by and the soundtrack to a western movie starts playing in the background. I'm sitting at the desk, in the middle of this desert and it a tumbleweed bumps into me on its way by.

[Cue scream of mortification at the thought of one of my profs marking my exam!!!]

Well yesterday was a little different. I felt like I got spanked by the EMQ compared to the long answer. Out of 100 questions on the morning exam it seemed like well over half were pure pharmacology questions. There was ONE, I repeat ONE thread on bone physiology and that was it for physiology. I have a pretty decent grasp of pharm but some of the questions were ridiculous--like knowing length of action verses T1/2, etc. It is simply not possible to memorize those things for every drug when you're expected to know a couple hundred meds. GAH!

In the in between as mentioned I was faffing a bit but just before leaving I picked up my USMLE book to look something up regarding estrogen (this school has proven to be OBSESSED with sex hormones). Just by chance I saw the summary of polycystic ovary disease. I looked at it, remembering vaguely having a case of PCOD last year in the fall.

YEP. It was one of the 6 long answer questions!! YIPPEEEE! I would have gotten ZERO on that question if at about 20 mins to exam time I hadn't chanced on that little box summary (bad pun intended).

So I don't know.  I am of two minds now on the whole last minute cramming thing? Thoughts? Experiences? Cited journal articles telling me I should or shouldn't do it?

Tomorrow is my last exam. Anatomy spotter.

We meet again!! (dun dun dunnnnnnnnnnnnnn) 

--

*Ok you nerds, the answers to the EMQ are in the comments.

Happy/Sad

Today I got a little care package from my sister in law (who is this beautiful, athletic, hilarious, thoughtful, supermom/superwife). She sends me these parcels from time to time, and they are always such a treat.

Everyone hates licorice so there is always plenty left for me. 

With the tea she also included a little card from my niece and nephews, which was both delightful and depressing. 

My favorite line is from Aidan, my 10 year old nephew: "hope you have a good Christmas, where ever you are". Totally got a lump in my throat as I read it. I really miss my family, and getting to see the little ones growing up. Everyone is going to be in Australia for Christmas but I am staying here to do a project for school (shadowing ALS paramedics) so that I won't have to do it in June (when I'll need to be studying for the USMLE). 

I know that my travels are abstract in their little worlds, and I've been away for the last eight Christmases (usually working), so this is nothing new to them. It's just that sometimes I hate being the wayward Auntie that is always away. 

Splinters and Successes

I am done (soooo done) studying for the day, but before I crash out for a fitful repose I wanted to quickly post about the USMLE course that I started last night.

Ok so the school didn't pick the best evening to start the class but I figured I'd go anyway, not like I had any other plans from 1900-2300h (ha!) This first session was basically a getting-to-know what we are up against and how to prepare for the exam. It was taught by Dr. Stephen Daugherty via web from Chicago, and moderated by a techie in London. Needless to say we had some technical difficulties and it resulted in him being mic'd through a cell phone for the presentation, but, it worked.

He's actually a very good presenter and I found 90% of his talk interesting and helpful (pretty hilarious in parts as well). His background is in psychology and he appears to have a special interest in watching medical students suffer exam psychology, in relation to medical students.

One thing that really resounded for me though was at the end of the lecture he was talking about successes and failures, mainly around the theme of success on the exam, of course. With that, he made an excellent point, he said that success in medicine (i.e. acing the USMLE) isn't something to be celebrated, it is a splinter that has been removed. It really isn't as pessimistic as it sounds, and I chuckled at the accuracy of the statement. Why didn't someone say that to me TEN YEARS AGO???

For a long long long loooooonnnnnnngggg time I thought that the MCAT was the pinnacle for me. It was like this really big, frightening, monster exam with teeth that dripped blood of recent pre-med wannabes. It seemed like such an obstacle that it took me several years of stalling, starting another career, and studying other things in university before I could muster up the nerve to even attempt the pre-requisites for medical school...then write the MCAT.

Once the denouement of that story was behind me things quickly shifted to the next false summit, getting IN.

Hell. That was a year from hell. The application process and the waiting is horrible. I'd already been rejected once before a few years ago by all the schools that didn't require an MCAT. But, now I felt I'd gotten over what once seemed a nearly impossible event--completing all the pre-requisites and the MCAT. That (massive victory for me) was pretty much lost in the chaos of submitting applications.

Then I got rejected at most schools and got accepted by a few. And I really thought that I'd achieved *the ultimate*. My life-long goal, right? MEDICAL SCHOOL.

Does this sound like I lacked even a shred of self awareness or insight to anyone but me? I honestly shake my head at how absurd it sounds while I write it out. But my profile rant alludes to the discovery that was on the horizon for me. Things don't become PERFECT when you realize a long-term goal. It just means that itch has finally been scratched. That sliver has been pulled out.

And there is another horizon, far far off that my eyes are fixed on now. And things are still frustrating, and upsetting, and annoying sometimes. Things didn't suddenly fall into place for me the day I started medical school. Life is wonderful and challenging and funny and stupid and unpredictable just like it was the entire time I was staring at that false summit of getting in. I'm not saying that I don't appreciate that I have achieved something to be where I am today. What I took a while to discover though is the truth behind the enjoying the journey mentality.

It's good now that I have a different perspective on this, because I catch myself falling back into the "can't wait until" fantasy world. These fantasies about acing the USMLE, or landing the ultimate residency and how things will be so much better then. But they won't be, necessarily. I say that because really, my life was great 5 years ago, my life is great today, and hopefully my life will be great 5 years.

And for now, I just have this sliver in my paw. A big one called "Christmas exams" and another one called "USMLE".

Rant done. Sleep required.

The Fear

It's really starting to set in.

Since we get our curriculum delivered via case-studies (PBL) and our exams are cumulative for years 1 and 2 that means I have to memorize/learn/understand/regurgitate 48 cases from the last year and a half for my exams. Which start in 8 days.

Each case has an anatomy component (these weekly mini-case studies we have to know around all the differentials, embryology, etc--usually about 20 slides), a histology component (usually about 30 slides), pharmacology, physiology, pathology, stats, and of course all the psycho-social stuff (which has yet to ever show up on an exam).

So I thought I'd get through all the cardiac cases today (as a treat to myself, since I like cardiac).

Yeah, I got through 2 cases. TWO. And I have cranked out a solid 10-11h of focused study. This is not good. I think I will have to abandon all plans for actually going through cases properly and go into a take-no-prisoners mode. I don't know what that last statement means but...first, I will have to start flying through the anatomy sheets...basically ignoring most of the details and skimming though the cases.

I really never thought I'd have to
know so much about the larynx...
next slide! 

Then I'll throw my eyes over each diagnosis in Medicine at a Glance (the book that every patient hopes their doctor never used in medical school). Burn through about 1300 histology slides. (Thank goodness that pink stain never starts to blur into one image after a while...)

Next I'll somehow read through the learning objectives from all a handful of the cases and hope to hell it's those ones that show up on the long answer. Not like last year where 10% of the written marks came from if you knew what a P-value was or not. Really glad I spent all that time memorizing, oh, everything but stats.

Wow. There were a lot of numbers in the preceding paragraphs. Am I perseverating on irrelevant details? Trying to somehow strategize how I can cram all of those numbers into the number "7" which is how many days I have left to study?


In other, more interesting, non-medical-school-meltdown news, I think I'm going to abandon my attempt to read 100 Years of Solitude unless someone from the blogoland can convince me that it's worth sticking with it. I am about 100 pages in now, and it just hasn't grabbed me. I thought I'd give Gabriel García Márquez another shot after Love in the Time of Cholera became an anvil in my backpack two years ago on my Himalayan trip (one of the few books I brought with me so I felt I had to keep reading it). 


The other reason I am feeling tempted is Freedom by Johnathan Franzen is sitting on my bedside table waiting to be read. Well, it was supposed to be for my Christmas break (but then, so was Into the Wild which I accidentally started reading and finished last week). I remember loving The Corrections so I have been wanting to get into Freedom ever since I saw it at the bookstore.

I just like staring at the cover and thinking "December 15th, late afternoon...sigh" I'll get my own little taste of freedom for a few sweet weeks.

Breaks over! Back to it...

Creepy

Look into my dead, soulless eyes...I beg of you...

Is it just me or does Jimmy Wales look really creepy in this photo? I know the photo is meant to capture him looking all earnest, friendly, and engaging. To me he just looks like a guy who has an eye twitch and a penchant for eating raw kittens.

I would not give this man money (even if I had any). I would walk slowly backwards from him, never losing eye contact until I got far enough to turn and sprint in the opposite direction.

Sorry Jimmy, not this time. Not with that photo.

B.M.

Oh the memories, the stories I could tell...Yes, I did call this post "BM".

Only because I've written this abbreviation so many many times in my life, yet recently it has taken on a new meaning: basement membrane.

I never thought those two letters would ever mean anything else in my world.

Safe to say, it will resume it's original meaning in August when I start my clerkships...

Taken from http://www.bu.edu/histology/p/22403lba.htm
a.k.a my favorite web site right now.

In Kicking Myself For Not Asking...

I always ask questions at the end of lecture. Barely anyone else ever does which I find weird and borderline irritating. I feel like saying "Really? No one has a question? This nephrologist just lectured to us for 2 hours and everything was crystal clear--you have never wanted to ask a nephrologist anything?"

Sometimes I bite my tongue, or just ask after class because even though a really big part of me doesn't care what the other students think of my question asking behaviour, sometimes I just don't want to be that girl. You know, the one who asks questions. Every. Lecture.

Anyway, yesterday I went to an evening presentation by the only peds neurosurgeon in Ireland. Yes, you read that last line correctly. I didn't ask my question because a few people (mostly doctors) in the audience were asking long blow-hard-like-listening-to-their-own-voice-pseudo-questions. Also, I was pretty sure that I must have missed a pivotal aspect of neural tube development/spina bifida/Arnold-Chiari malformations in school because NO ONE ELSE asked and it seemed like a really obvious question (why do repaired spina bifida patients who no longer have ACM's still need shunts, why do they still have hydrocephalus, like forever??)

I kicked myself afterwards because when I ran into my anatomy prof in the parking lot I asked him. He had been wondering the same thing. Anyway, when I was venting my frustration at not asking (and my reasons why) he said,

Everyone waits for someone else to ask the key question.  Evolution taught us to take risks vicariously.

So, anyway. That is my quote for the week. Nay, month.


I think I will get a coffee mug with that written on it. 

December already?

So apparently it is December.

November seemed to whiz by, our cases were pretty interesting (but sad) overal. We had a homeless man with schizophrenia, a girl with bulimia, and now two kidney cases back to back. I wanted to write about our bulimia case (don't worry, these are fictional 'cases') because we did 2 weeks worth of learning about eating disorders, which was really, really depressing. Hopefully I will get a chance to jot some thoughts down soon before it is all gone from my brain.

Kidney. We meet again. And again. Yet this time I am strangely attracted to your complex mystique. There is so much going on there, I love and hate you now, when before I just hated you. There is something almost mathematical, but artistic about that loop of Henle. I am determined to get inside the mind of the nephron this time around. YOU WILL BE MINE, KIDNEY!!!

Ok, I've not been sleeping much, it's giddy-tired today. I decided I am taking my camera out with me today to do a "day in the life" montage for the blog.

Running Path

Tobie and I went for a chilly* Sunday walk yesterday on the path I usually run on. Isn't she a beaut?

*Chilly by Irish standards.

The Only Accurate Thing About Grey's Anatomy

I used to watch Grey's about 3 years ago when I had gone back to do my pre-req courses for medical school. I'd spend a lot of time yelling at the screen when seriously inaccurate events were depicted (several times per episode) but yet I couldn't tear my eyes away. Yes, it was my television version of a train wreck.

The only thing they got right was the baking. Izzie used to bake when she was stressed and for me, that is bang on. Only I rarely bake, I cook.

action shot

Hence yesterday being rather therapeutic.

It was Ryan's birthday on Thursday so I offered him a birthday dinner as his present from me. I love cooking for people anyway, so it's like a double-edged gift sword of goodness (poor mixed metaphor? Whatever, I like it).

So out of the menu options he chose Hearty Wine and Beef Stew with Dumplings, I deviated slightly from the recipe because I loathe parsley, so the dumplings had green onion and basil in them instead. There was garlic bread and home made ceasar salad to start, and for dessert this berry custard and ginger cookie bowl of yumminess. And, naturally some mulled wine--hey, it is almost December. We have a farmers market here on campus I was able to get all organic veggies and even local organic meat (a.k.a happy meat) for a decent price.

Since I started making the stew at 1400h, it was great to study and breathe in the aromatherapy all afternoon. Somehow the different types of collagen and epithelial adhesion mechanisms just weren't that hard to bear.

By the time dinner was on the table I had been able to shake off the horrible feeling that had been churning my stomach all week. This was also in part due to the comments and emails of encouragement from the blogosphere---thank you! I definitely needed that pick-me-up.

School is hard, and most days yes, all encompassing. But somehow when there are people around that you love, delicious stew on the table, and mulled wine in your glass, life seems more than ok.

Caught with a mouthful of Ceasar. 

Medical School Makes You Haggard

I often end up turfing or just writing private posts about how much I loathe medical school somedays. I guess I don't want this blog to turn into a whiney drone about stress levels, lack of sleep, nil free time, and nostalgia for Canada. I am sure if I was back in my pre-med shoes again I and I came across posts like that I'd grind my teeth and think about how much I wanted to be in medical school while the world seemed full of undeserving, unappreciative little snots who did nothing but complain about being in medical school.

But let's be honest. I am not feeling the love right now.

I know that it is partly because finals are looming and that just brings my baseline cortisol levels up a notch, but it's also this sinking feeling that I made the wrong decision by quitting my life and coming here to do this.

I've been ruminating on the reasons I seem to have been hard-wired into pursuing medicine and wonder if there would have been any way I could have re-wired myself before I got tangled up in this.

I remember the exact moment that I decided I was going to be a doctor and after that, nothing else even seemed to be a possibility. The problem is that it was my complete awe and admiration for an astounding physician that made me want to pursue medicine. Where my reasoning may have been flawed is that it was the man (my grandfather) that was astounding, not the career. He would have touched hundreds of lives and made a positive impact on the plantet if he'd been a used book seller, or a languages professor, or a farmer, or a school janitor. When you are eight years old though you can't grasp that part of the equation. You just see a wonderful human and think the best way to somehow be like them is to do what they did with their life.

I should be feeling good, I did well on the anatomy spotter. But I just feel, obligated. Obligated to constantly study, review, test myself. Surely it is natural, when something seems to take up your entire existence, to feel resentful towards it from time to time?

I am actually grinding my teeth even when I am AWAKE these days. That is a new one. Can't sleep, can't eat, can't relax. Ugh.

So I apologize to the premeds that might stumble upon this post. But right now I'd rather be anywhere than here.

Engage with Grace

Things we are grateful for this year

For three years running now, many of us bloggers have participated in what we’ve called a “blog rally” to promote Engage With Grace – a movement aimed at making sure all of us understand, communicate, and have honored our end-of-life wishes.

The rally is timed to coincide with a weekend when most of us are with the very people with whom we should be having these unbelievably important conversations – our closest friends and family.

At the heart of Engage With Grace are five questions designed to get the conversation about end-of-life started. We’ve included them at the end of this post. They’re not easy questions, but they are important -- and believe it or not, most people find they actually enjoy discussing their answers with loved ones. The key is having the conversation before it’s too late.

This past year has done so much to support our mission to get more and more people talking about their end-of-life wishes. We’ve heard stories with happy endings … and stories with endings that could’ve (and should’ve) been better. We’ve stared down political opposition. We’ve supported each other’s efforts. And we’ve helped make this a topic of national importance.


So in the spirit of the upcoming Thanksgiving weekend, we’d like to highlight some things for which we’re grateful.


Thank you to Atul Gawande for writing such a fiercely intelligent and compelling piece on “letting go”– it is a work of art, and a must read.


Thank you to whomever perpetuated the myth of “death panels” for putting a fine point on all the things we don’t stand for, and in the process, shining a light on the right we all have to live our lives with intent – right through to the end.


Thank you to TEDMED for letting us share our story and our vision.


And of course, thank you to everyone who has taken this topic so seriously, and to all who have done so much to spread the word, including sharing The One Slide.

We share our thanks with you, and we ask that you share this slide with your family, friends, and followers. Know the answers for yourself, know the answers for your loved ones, and appoint an advocate who can make sure those wishes get honored – it’s something we think you’ll be thankful for when it matters most.


Here’s to a holiday filled with joy – and as we engage in conversation with the ones we love, we engage with grace.


To learn more please go to www.engagewithgrace.org. This post was written by Alexandra Drane and the Engage With Grace team.

IV Starts

Today in clinical we are learning the fine art of I.V cannulation. 

This oughtta be interesting. 

Last year I had to just about bite my tongue off when we were taught to aspirate before injecting in IM and SC injections. When I was in nursing school *cough* 11 years ago that had already been turfed thanks to evidence based medicine that demonstrates the only area where this is indicated is in dorsogluteal IM's (even there it is debatable but certainly NOT indicated with SC injections). 

Ok well initially I didn't bite my tongue and said it to another student but the bat-like hearing of our clinical skills prof exposed me and I was told in no uncertain terms I would fail the OCASE if I didn't aspirate. Sigh. I muttered something about doing it for the exam and never again. (BAD medical student!! BAD!!!)

Anyway, I am interested to see how the IV starts are going to be taught. I wonder how many I may have done in my career as a nurse? Hard to calculate but based on rough figures...7 years, 200 shifts per year (with great variation in # of starts per shifts) maybe averaging 6 starts per shift...that comes out to 8400 starts. Okay even if that is a gross over-estimation, I am well past the 5000 mark. Hey! That is kinda cool. I never actually figured that out before. 

Below is a comment that I left on Rob's blog ages ago when he wrote about learning how to start IV's. They are some of the little tips/tricks I've gleaned mostly from other nurses, much more experienced than I. 

--

I love IV starts. These are some of the rituals I go through when I am starting an I.V. 

First off, most people believe that there is a metal needle in their arm. When people are really anxious about it (esp PEDS) I show them how it works with a demo needle that I chuck. It seems to really calm a lot of folks down. I only usually show adults if they are going to have the IV in for a long time, it makes them more relaxed about moving the tethered limb around. 

Some tricks I use for tough starts (I am sure you know these already but in case you don't):

-In the elderly with the feathery skin and veins don’t use a tourniquet as you are more likely to have it roll or blow with the induction. Just anchor the vein above the site with the thumb of free hand and go at a very superficial angle. As soon as you get flashback take the needle out and gently advance the catheter. 

-For tough starts go for the radial vein near the wrist (usually very juicy as not many people use it).

-Warm people up with either warm blankets or (my personal favorite) 100cc saline bags that you put in the microwave for 10-30 sec. This is great with PEDS also, I warm the bags up then kling wrap the bags to their hands and feet–go off and do some other task and when you return–BAM! the veins are waiting for you. (Just make sure you hold the bag on your own skin for about 10 sec to make sure it is only warm not hot. I think that hot wet towels are a bad idea because as soon as you take them off it cools the limb down a lot and if you get caught up doing something else then you have a cold, wet limb to try and salvage a start out of. Dry heat is better.)

-Drop people’s hands so that their arm is hanging below the chair. 

-Don’t slap the veins as sometimes that causes them to flatten out.

-Take your time. 

Really. I spend as much time as I need just chatting with the patient while I palpate around for the best vein. The longer I take to find a good one, the greater the likelihood I’ll find one on the first poke.

-Don’t be afraid of small guage needles on hard starts. No matter what they tell you blood *will* run through a #20, even a #22 in a pinch. Not everyone needs a #16 in the pinky to prove your abilities.

-If you hit a valve going in, you can try to gently push through or just pull back a bit and if the line is good just secure it there. 

-Tape is our friend. Use paper tape on the elderly, especially if you don't feel like tearing their skin off when you d/c the I.V. 

-And finally, feet are sometimes better than you think. Esp in people who’ve had lots of chemo or alternative drugs (ahem) in specific veins.

So there you go blogworld. My free, unsolicited advice on I.V starts. Now I am off to learn how to do it! There may be some major tongue biting today as well, but must go and see what the gold-standard-medical-school-OCASE-way of doing it is. 

I won't mention my aversion to gloving with difficult starts!

5 Down, 3 To Go

So we had another mock spotter on Friday. Each term we have one mock (i.e. it counts for nothing grade-wise) and one final (real) spotter.

These exams are also known as "bell ringers" because you get 1 or 2 minutes per station where you have to determine what it is you are looking at and then answer questions on it--before the GONG goes off and you have to move to the next station.

I have to say, this was the best one so far, for me. I don't think I did wonderfully on it but I feel like I am finally figuring out how to ace these exams.

For one, I used to just about have a seizure whenever I saw this photo:

Human embryo at around 3 weeks. 

But now I am not as freaked out. It's just a teeney, weenie little embryo---and it can't hurt me! I know what the bits do, and what they become, and I am not as easily thrown off by our prof putting random genes in the answer (which I don't know) to trick us.  I just look for the part of the answer I know (like nucleus pulposus or skeletal muscle or whatever) and ignore the via Gli3R protein or in response to Fgf signaling part of the answer. I know, it sounds obvious, but when exam adrenalin is rushing I tend to see those words and BLANK on all the things I do actually understand. Freak out. Run out of time. Guess.

So. I try to breathe. When I get to the next station I force myself to let the last set of questions go. I used to ruminate. There is no time to ruminate.

Also, I am in two amazing study groups (mostly composed of the same people), and we've been preparing for exams since the second week of school. Every week we've made presentations for each other on the salient points from our cases last year. We make up quizzes for each other and handouts, etc. It works really well because you are forced to do the review every week and you want to do a good job (so that you don't look like a slacker for the group presentation). 

2 weeks ago we each made a mock spotter for the group from 7 randomly assigned cases spanning both last year and this year (thus covering all the cases). Making the damn thing was VERY time consuming and it took us 2 three hour sessions just to get through all of them, but we timed them like a real spotter and everything. 

I never realised that the BEST way to study is to try and make exam questions! You really have to think about the concept, how to trick people, how to word questions and make plausible fake answers. Each question took me at least 30-60mins to make. 

Hello. It paid off. There were several of our exact slides on the exam Friday!!

Huzzah!*

The real bonus though is that I only have THREE spotters left in the future of my earthly existence. This makes me very happy. Though I must say, since I've been thinking more and more about pursuing surgery, studying anatomy is less tedious than it was in the past. 

---

*I did have one of those post-exam-facepalms though in the shower yesterday. I was just washing my hair and like a lightening bolt one of the histology slides (that had confused me) popped into my head. I thought that it was liver with the arrow pointing to fibrosis. But the lightening bolt struck and I suddenly remembered doing it in one of our mock exams! Nooooooooooooooooooo! It was a fibrillary tangle in a sample of brain tissue! Ahhhhhhhhhhhhh. Facepalm. Facepalm. Facepalm. Sigh.

Can't win 'em all I guess. 

Spotter Today

In less than 2h.

Eeeek!

Doctors of Tomorrow

Today I noticed one of the first-years had as his FB status:

Whenever I see the facebook poke icon, all I can think about is a bimanual....gahhhh.


I would have loved to have commented:

Classy. 


Or

Whenever I see you all I can think about is that one day you'll be a doctor....gahhhh.


This is coming from the guy who wore a name-tag that said DOCTOR CANADA on it during the first week of school when we all went on a meet-and-greet-pub-crawl together.

Thing is, I know so many amazing, talented, intellectual, well-rounded, thoughtful, hilarious people that didn't get accepted into medicine.

Then there's that guy...who did.

(All that being said, my FB status today was that I want to drop out of school and become an Ottawa Valley Irish Dancer so...what does that make me? And yes, yes I did see the Chieftans last night in concert.)

Random (Hilarious) Acts of Kindness

The Irish are obsessed with high-visability reflective vests. I mean *obsessed* (at least in my neck of the woods). It is not uncommon to see people walking their dogs, running, DRIVING, with them on. Or, my personal favorite, having them fitted over the passenger/driver seats.

It seemed a little excessive to me though I am a fan of excessive personal protection use (i.e. after working in Whistler emerg I contemplated wearing a mouthguard/helmet to the grocery store).

Anyway, now that we have about 7 hours of daylight it is always dark when I run, whether I go in the morning or late afternoon/evening. I've been feeling a little, er...underexposed since I run in something akin to the "Invisible Pedestrian" costume from the old SNL skit with Dan Aykroyd.

So I've been on a quest to find arm warmers that are reflective. Impossible to get where I live (since evidently women don't exercise here unless it is in gold PUMA's). I thought about ordering some online but I hate buying things I've never tried before (not to mention the ones I found were black, thus furthering my ninja/running getup).

I ambled into the Universities book store yesterday to get some scribblers and saw a promo where if you buy a newspaper you get a free reflective armband (I said the Irish were obsessed with reflectors).  They were out of newspapers so I asked if I could just buy an armband. The woman told me to just take one. So I pushed my luck and asked if I coud have two.

Does anyone need two tickets to the gun show?

I mentioned my invisible pedestrian running attire and she pulled out a big (classically Irish) reflective vest from behind the counter and said, "you need to get one of these!"

I (inwardly) chuckled and appraised the vest---and said it was great and that yes I should get one but that I figured I'd be too hot in it. She showed me how thin it was and suggested it'd be perfect for running. I agreed. She then goes, "ah sure now, just g'wan and take it!"  WHAT?

Yep. She gave me the vest! Hilarious! She said someone gave it to her last week and she didn't need it.

That's what I am talkin' about!

So now you will be able to both read my blog and see me from space! How awesome is that??

Though I am cautiously aware of their subtle assimilation tactics. Pretty soon I am going to switch to drinking tea in the morning and become obsessed with hurling. 

Thanks random bookstore lady! 

Venue of Vultures

Sometimes when I feel myself only staring at the far-off horizon of being FINISHED medical school, I go back and read through old posts I wrote when I was trying so very damn hard to get INTO medical school. I try and use these reminders of the fact that there are always new hurdles, new accomplishments, new goals waiting after each stage is complete.

This is something I easily forget.

I came upon this old post from my former life this morning. It was exactly what I needed to read.

---

How is it that finish lines can feel so hollow? I was driving home from my exam, the last surge of adrenaline from writing was long gone and had been replaced by the anticipated nausea. I was expecting to feel jubilant. Relieved. Excited. It's strange how coming to the end of a long road can be so anticlimactic.

There have been times in my life where I have felt the pull of endless possibility in many directions so it is a sensation I am already familiar with.

In my minds eye I feel see myself running in a canyon, it's hot and rugged and my head is down to follow the rust colored contours. Running, running, running and then suddenly the ground opens up beneath my feet and I am flying through the air.

So far I have always landed on my feet, but at this juncture I have no idea where that might be. This next year is wide open for me.

So this chapter is closed.

The stage, predominately the basement of the central academic building. Often empty, save for a few random people (who also know where the electrical outlets are) playing video games or watching youtube. During the day the large picture windows let you see what you're missing. By night, there is no way to shift your weight to make those fixed plastic chairs comfortable. And generally, around this time the night cleaning crews arrive, and with them the cue to head home.

My last night studying in CAB. 

A major player and ultimate ally here at the university, Raj. This man met me almost every morning and every afternoon, for a total of 3-4h a day to tutor me through the wonderful world of organic chemistry. For the last 6 weeks I've robbed him of his opportunity to sleep in, and any opportunity to eat dinner outside the bowels of the chem building. Raj--you ROCK!

And now for the best part. The last act, the celebration! 

I was sitting in the students union building a few days ago when I looked up and saw Paul. A good friend and former partner in truancy, vandalism, and general adolescent skulduggery. I haven't seen him since we graduated from high school. It was strange looking at him and seeing a man's face superimposed on the image of my 17 year old version of him. As Friday was his last exam for his most recent degree and my last exam in year of pre req hell, we thought it fitting that we ring in the New Reality together. And as an added bonus, his roommate Jaison was also a friend from high school who I'd often hoped I would connect with again someday.

So we ate, drank, and were merry!

There really is a special connection that we carry with people who have been in our lives during the tumultuous and wondrous time which is our coming of age. I generally shudder at any thought of high school or the people that I was forced into spending it with, so it was amazing to spend an evening reacquainting a couple of dear friends who had been red balloons in a gray landscape.

So for now, I am free of the venue of med-hopeful vultures. Free to spend time with the important people in my life, time in my kitchen, and time on the trails. And for all of that, I am happy.

Remembrance Day

My Uncle Pat was 19 years old when he was killed in WWII. His plane was shot down just weeks before the war ended. I've heard the story of the telegram arriving and it gives me chills. Something so many of us cannot fathom, losing a family member to war.

My Grandfather fought in WWII. As a result of his Airforce navigator service he was given free tuition in the university and program of his choice. He chose biochemistry and medicine at McGill and went on to become a legendary rural family doctor who then became a polio expert. He was on the team of physicians that brought the first iron lung to Canada. He then studied internal medicine and eventually in his forties went back to specialize in cardiology. After further training at McGill he returned to set up the first Cardiac Care Unit in Alberta.

When he was dying of cancer he continued to work in cardiology, as well as with his long-surviving polio patients. He wrote a memoir about the polio epidemic, and was working on a cardiology textbook when he died. The cardiac ICU at the University of Alberta hospital is named the Russel F. Taylor ward in his honor. I remember that whenever we stayed with him he'd make me scrambled eggs before leaving on his 6:30 rounds, and listen with sincere interest to my seven year old ramblings.

Both of my brothers are also soldiers. 

The House of Children!

Russ is a NATO and Governor General award winning combat engineer who is a world expert in post-blast forensics. He's completed over 10 tours of duty everywhere from Rwanda to Yugoslavia to Afghanistan. He is an absolutely wonderful father and husband to his family which includes 11 month old twins, Max and Ella...and the current star of the family, Gionna.  

Shandy with his Cobra

Shandy is a retired infantry Lieutenant Colonel. He too has spent time serving all over the world, including UN peacekeeping in Nicaragua and aiding with the set up of the interm government in Afghanistan. He is also an amazing husband of 18 years and father to his three children, Taylor, Aidan, and Rachel (and his current baby, the AC Cobra that he built). 

All three of them smiling AND looking at the camera. An event in itself!

I will never forget the dread that would accompany the news broadcasts when my brothers were in Afghanistan.  Every time a soldier death was reported without releasing the name there was a flurry of phone calls between members of my family.  Are they alive? When did you last hear from them? And of course the guilt that comes with relief that it was someone else's family dealing with that horrible grief. 

Naturally, every Remembrance Day I contemplate the plight of soldiers and their families around the world. War, sadly, is not a thing of the past. Today we continue to have innocent civilians, aid-workers, soldiers, and journalists killed in conflicts around the world. 

My thoughts and prayers go out to those families today that are remembering with sadness instead of thankfulness. 

In Case You Were Wondering

How this weeks forecast is looking:

What it doesn't say is that there are also 50km/hr winds happening right now.

It is going to be a seriously harsh walk to school this morning. Yes, harsh, and that is coming from the girl that wrote this post* (below) 4 years ago. Ok I promise, soon the content will return to non-weather related topics.

*Taken from my pre-Asystole blog...

You Know You Are in the Arctic When...

So picture Saskatchewan. Now go straight up, through Nunavut. Over all the rocks and trees and tundra. Over the caribou, lichen, streams, and ravens. Drop off the top of Canada's mainland, cross the frigid waters that will turn you to ice in minutes, then stiffly climb onto the shores of Victoria Island. There you are. In Cambridge Bay.

Imagine a flat, white, landscape. Depending on the day that white will be cut in half on the horizon with blue-bird sky that surrounds you 180 degrees or with a matching shade of blowing white which makes you feel like you are in one of those snow globes someone is shaking vigorously.

Welcome to the North.

It has been cold up here. Not just "oh I think I'll wear a coat today" cold but more like "oh, I think I have to bring my blowdryer and an extension cord to work today so I can de-ice my lock when I get home" cold.

My walk to work is approximately 5 mins (or 1.5 Lucinda Williams songs I've discovered). And in that time all kinds of fun and interesting things can happen to you when it is -50 with the windchill.

Things like:
-your face freezing to the inside of your coat from the moisture in your breath. As if you licked the entire front of your face then stuck it to the side of a metal door.
-your eyelashes freezing shut
-a trail of snotcicles (icicles made of snot) clinging to your upper lip
-a pain, burning, immobility of movement in the fingers which leads you to believe that your fingers are actually freezing. It is not just an expression any more.
-your earphone cord seizing up to a taught, brittle, wire instead of the normally flexible plastic handing loosely by your side.
-tendrils of hair coated by breath moisture turning into wisps of ice hair framing your face, which then melts and plasters to your forehead imediately after stepping indoors.

It's fun. It's something different all the time.  Today it is only -37 with the windchill so people are outside snow kiting in the bay to celebrate the chinook like change in weather.

Got to love those hearty northeners, hey?