How Much Is Enough

I feel like 2nd year really started like a bucket of cold water to the face. I was still reeling from almost 2 months of full-time plus in the hospital, jet lagged, bleary eyed...and BAM!

Hypertension!

CHF!

Rheumatic heart disease!

Acute astma exacerbation!

Lung cancer!

I feel like I am drowning this year*.

I made all sorts of vows to keep up a strong training regime, to play mandolin every day, to spend quality time with Tobie, to get a good nights sleep, to eat well...

It seems that I am constantly trying to patch together work for the weeks PBL, cram anatomy from last year, review all of our cases from last year, prep for the weeks "line of fire" anatomy session, and learn the new material being thrown at us.

I am tired of the 'drinking from a fire hose' analogy. Drinking would mean there might be some satiety involved, some resolution of thirst. But I honestly feel like the I am just running after the bus which is belching exhaust (and lung cancer causing hydrocarbons!) at me.

It is just hard knowing when enough is enough. When have I read something enough, when do I understand something enough, when have I gotten enough detail. It is impossible to know and it is that nagging uncertainty that I am sure is now fueling my insomnia. Oh, hey thanks for returning with a vengeance sleep thieves!

Sigh.

So blogosphere...how do you structure your time? How do you know when to stop? How do keep your sanity (relationships, hobbies, life) in medical school?

*Ok maybe there is something to that stupid fire hose analogy. Damn.

Nothing New To Report

Just a whole lotta this:

Fighting the urge to faff. 

Tobie 'relaxes' while I study. Our evening 'quality time' together. :(

Our 7am study group. The "Functionally Useless Nubbins". Yes we named it and yes the acronym is F.U.N. 

Ryan and I pretending to look studious. I was actually watching a youtube video I think. 

It is going to be a long, tough, year. 

Spinning

So Tobie and I attended our first spinning class today.

I do a lot of interval training on bikes, especially when my knee starts being an idiot. But I must admit, I've always been afraid of spin classes, figuring they are reserved for only the uber-fit.

But today we just went for it, the timing worked out and we were craving a good sweat (besides, I was thinking safety in numbers).

It was pretty fun actually and a hoooo-nanny of a cardio workout! But, I must say the music the instructor was playing was très horrible. 


At one point the instructor did a Phil Collins medley which gave Tobie and I such a giggle fit we almost had to leave. She retaliated by walking over to Tobie's bike and cranking up his resistance by about 740 degrees.

Both he and I had visions we were in a BAD rom com...we were the single 30-somethings meeting at a spin class, locking eyes during "In the Air Tonight" and then a cut to us later in matching white turtlenecks, drinking white wine in front of a fireplace. Pure comedy. Anyway we got a double abdominal workout this evening as a result.

Is is bad form to bring your shuffle to a spin class?

Sheesh.

Finally!

Ok--quick nerdy medicine post.

One of my pet peeves is how every time oxygen therapy comes up in class the prof will drone on and on about COPD'ers and their hypoxic drive and not overloading them with oxygen because it will "cut out their respiratory drive and they'll stop breathing".

ARgghhhhhhhh.

I get the theory behind this but I can say (with a hand on my heart) that in 10 years of nursing school/working in emergency departments and dealing with countless and I mean countless respiratory distressed patients (and *most* of them COPD'ers) I have never, evah, seen one of them lose their drive and stop breathing from being overly oxygentated.

Not one.

Now I am sure there will be some readers out there that will disagree or have a case example of when it has happened (which is fine) but teaching an academic theory that is very very very very unlikely clinically seems odd to me since most of my classmates now believe that you can't give more than 2L of O2 to someone with COPD.

I flash to the last severe respiratory distress patient I had with severe COPD (I was actually positive the guy was going to code but thank heavens he didn't). The man was a very unnatural shade of blue, very tachypnic, tachycardic, frightened out of his mind, and sucking so hard on that non-rebreather. Ummm I don't think the oxygen was coming close to knocking out his drive to breathe, the oxygen was keeping him alive.

ANYWAY.

Today we had a lecture from a visiting respirologist who stated in his lecture (and I quote):


...there is all this talk about C02 retainers and patients with COPD, about how you need to be very judicious with oxygen therapy because they will lose their respiratory drive...in my experience this is purely an academic concept and I can say that I have never, ever seen it demonstrated in the clinical setting, it's not really a concern...


I swear I almost jumped up and yelled "THANK YOU!!!"

But I didn't.

Yay! Now I have a respiratory specialist *ON TAPE* making that statement. I can sit back and feel vindicated. Even my study buddy looked over at me when he said it and gave me the thumbs up.

Huzzah!

Pacing Bunny Lost at Terry Fox Run

Yes.

I was supposed to be the pacing bunny that made sure the folks at the back of the run didn't get lost so every once and a while I'd stop...do ridiculous dance moves...jumping jacks...waving and cheering...and wait for the stragglers to be in sight so I could carry on.

Problem was I got lost because I ended up on a strip with no one behind me or ahead of me.

I ended up back on course ahead of most of the group (by accidental shortcut) and witnessed a dirty freckle-faced kid on a horse and chariot chase three of the runners off the sidewalk.

The running sweep Tyler ran into some 1st years that informed him that their "cheerleader had gotten lost" which he found amusing, knowing how much I'd love being called that.

I will have to try and track down a photo...due to time and money constraints all I was able to put together was bright green and white striped thigh-high socks and a fluorescent lime green headband.

It was fun though, all in all and I liked the chance to be a part of an event like that. I wore my friend Jody's necklace and spent some of the time just thinking about my dear ones that have died from cancer in the last couple of years. Thankful to be able to make a fool of myself, run, laugh, dance on the sidewalk, and support a good cause. And of course it was a privilege to carry on the memory of the amazing human legacy that is Terry Fox.

--Update: photo posted on FB this afternoon. Sadly, the socks are not visible and I am really not sure what the hell I was doing. I think I was trying to make "bloods" symbol, a pathetic attempt at double entendre regarding the event being put on/attended by med students.---

Pacing Bunny

So in a hypoglycemic state I agreed to be a pacing bunny on Friday for the Terry Fox run that the med school is putting on.

Any suggestions on how I can achieve 'maximum ridiculous' and still run 5km?

All I have so far is a running skirt and some long rugby socks (and possibly a viking helmet).

Heart Sounds Buzz Words

As promised, for NP Odyssey:

delayed rumble
machine-like murmur
opening snap
blowing
midsystolic click
crescendo-decrescendo
holosystolic
harsh-sounding
radiating
ejection click

My strategy is say them loud! Say them earnestly, and with confidence. If someone disagrees with you, point out the less than ideal conditions for auscultation (i.e emergency department or busy exam station). Then smile and hope to hell at least one of your buzz words was correct.

Or become a specialist. At one point this summer the radiologist was commenting on the fact he wasn't entirely sure if he was seeing a small effusion on a chest x-ray or not. He gave me a wicked grin as he dictated there was an effusion, clicked off the dictaphone and said, "Who is going to disagree with the radiologist's findings?"

Point.

When You Try to Simplify Something That Isn't Simple

A Long Hard Look at the Nephron

So I tried to make myself a nice simple diagram of the nephron complete with what diuretics act where.

Turns out that is not possible.

Partly because I am as thick as the ascending loop of Henle when it comes to renal knowledge so every note I make on my drawing requires an explanation for myself. During 'firing squad' anatomy this week I couldn't remember what "closer to the top of the head" was in medspeak (pretty sure I said "dorsal??" *facepalm*). Sigh.

Turns out the school is giving us grades this year which is a bit of a drag. It's been so freeing having this pass/fail system because I could let myself indulge in being a human (nearly) guilt free, plus it made it hard for the annoying people who insist on shouting their grades from the bell tower.  That really pleased me. While we are on the topic of grades, can I just say that people telling me their grades feels almost equal to slamming my hand in a car door, while the car is still moving. I *painfully loathe* it. Partly because I never know how to respond, from either perspective. When I did worse than the Boundary-Free-Human then I feel frustrated that they had the urge to impart their numbers on me (unsolicited), when I did better than them it makes me feel awkward. Gah.

Hence, my avoidance of the whole GRADE discussion. Full stop.

But now we are getting our grades and I wonder how I will be able to avoid the inevitable score-card of comparison conversations that will erupt around me.

[Ok before this turns into an ego driven rant about my level of medical experience I am just going to hit the big "delete" button on that last paragraph. It made me sound really bitchy and petty. There, you all were spared.]

In other news, I took the day off. We had friends over for dinner last night and it ended up becoming one of those evenings where someone suddenly goes "shit! it's 0230h!" and we all wonder where the time and the wine went. So this morning Tobie and I slept in and then moseyed around the farmers market in town. Came home and had tea with one of my lovely friends, Emma, from school (who incidentally is doing brilliantly and has a 21 month old). Afterwards there was napping, Tom Yam soup making, and calling home. And I was reminded that I get too worried about too many things. I really want to play my mandolin, cook food, go for runs, catch pilates classes, visit friends, and talk to my family, not worry about what my grades are. Or what the future holds for me in terms of residencies, the USMLE, etc.

Emma, Rosie, and Tobie. They aren't thinking about the nephron, and look how happy they are!

And a complete non sequitur. Tobie has a crumb problem. I thought I'd document it here. Please click to enlarge the fall-out from a baguette and a bit of cheese. He comes by it honestly though, I've noticed it is a familial trait. He thinks I must have suffered a mentally scarring event as a child which is why I am able to eat without a foot of food-bits surrounding me. He clearly has no issues getting down to business.

Tobie thinks he looks like a street person eating at a soup kitchen in this photo.
But he did not prohibit me publishing this photo. So. 

Nephron

I hate thee.

"But I know all about love already. I know precious little about kidneys."
                                                                            --Aldous Huxley, Antic Hay

Heart Sounds

I'm just going to put it out there. I probably wouldn't pick up a murmur in the clinical setting if it got off the bed and slapped me in the face.

Today we had a 2h clinical lab to 'go over' (read: learn for the first time, really) heart sounds and murmurs.

Yeah, the highlights included the one clinical instructor actually saying

"just learn some buzz words so that in the OCASE when you are thinking CH&*ST F*&K I can't remember ANYTHING you will be able to rattle off some key terms at least"

and another instructor saying

"well shore you'll say what it is then get an echo and find out it's somehting completely different so fock it".

Sigh. Ireland. You really do amuse me.

The lowlights included:

feeling like I don't know anything
feeling like my medical knowledge and cardiac knowledge is ZERO
feeling slightly deaf
not understanding what everyone else seemed to be grasping (awesome feeling)
being POSITIVE it was a systolic murmur when in fact it was not that at all
wishing I'd listened to heart sounds on every patient that ever stepped into the ED over the past, oh 6 years


The lowlights were punctuated by the fact that I was demonstrating my incompetent medical student persona in front of one of my favorite clinical instructors who is a totally badass ED doc. Pretty serious and intense guy and just someone you generally want to be on-the-ball around.

I was so not on the ball.

It is one of the things I love about medicine though, just when you think you understand something...you realise you have no bloody clue.

The New Domus

Tobie and I used to have Domus 1 and Domus 2 last year (our two separate living quarters). But now as we are living in sin, we have combined housing forces to create the New Domus.

We had our reservations about living on campus again, many of you have probably read my many rants on the frustrations with noise, broken glass/vomit on my walk to school, no privacy (my bedroom window faced into the very high traffic courtyard), and a refrigerator we'd call a "beer fridge" back home meant for four people.

But after looking at many places in town last summer, we decided we didn't need to look out our window and see a man in a jogging suit pissing in the alley, or a gang of Whiskey Tangos drinking a 40oz of vodka at 1030h while their 3 year old plays on the park bench. I remembered: cities are dirty there are no decent running trails, and I hate crowds.

So, we are back on campus. This time in a 2 bedroom "family unit". It's a definite step up in that it has a washer/dryer, a bathtub, and a meh sized fridge (good enough for two, by Irish standards), oh and a killer view. As evidenced by photo below.

View from the balcony off the kitchen. Yes please! Note castle ruins on horizon. 

Is a man ever sexier than when he is eliminating
a spider problem??

And so I present: the New Dormus. Note: we are still getting moved in so the walls are quite sparse. Tobie put the kibosh on me plastering all the walls with mountain scenes as he is "more of a hill or valley person". True story. Hahahha.

We have a bit of a spider issue which is mostly due to the fact that the Irish don't believe in screens* so if we want the windows open we usually wake up with Charlottes Web above our heads and in every corner of the living room. So far Tobie has been a STAR at removing the 8 legged fiends (and before everyone gets up in my grill about how spiders are good because they kill other bugs let me say this: I am an arachnophobe. You wouldn't tell someone who is afraid of heights that heights are no big deal and you should go and live high on a ledge).

So today after some internet research we went at the problem from with surgical precision and military strategy. We cleaned all the windows inside and out, wiped out all the ledges, swept the ceilings and eaves troughs, and wiped away all web infrastructures we could find.  This is apparently the best approach according to the Canadian pest control website (yes I know we are in Ireland but clearly the Irish don't believe in insect problems or they'd put bloody screens on their windows!!)

Our uselessly large entryway. We are still musing on what to do with this space...mini home gym? Yoga studio? Study center?

The entrance to the office/guest bedroom (complete with ensuite).

Above is a few of the reasons why moving back to Canada is going to be a serious nightmare (four more textbooks are also coming poste haste). The view, however, from the office makes it very hard to not stare listlessly out the window when one should be reviewing regulation of crossbridge formation in cardiac muscle.

I did not photoshop that little boat into the picture, I swear on my Robbins textbook.

Master bedroom and bathroom below (tub!!) And no, we did not choose that bedding. 

View from the head of the bed. 

No medical or "science-y" texts allowed in the master bedroom by decree of his Lordship, Tobie.

Yep, more view shots. This is from the master bedroom window. 

                

Tobie is seen above, relaxing with his new Mordecai Richler novel. Yes the furniture is practically plastic, we are trying to roll with it. View from the living room window, also pretty okay.

Our wee Irish kitchen.

Balcony off the kitchen.

In the shot above you can see a little strip of the great trail that runs along side the river. The break in the trees gives a glimpse of the little fishing huts as well, one yard contains a rooster which makes me laugh every time it crows (as an aside, when a crow makes noise is it called 'roostering'?)

Oh right, the dining area. 

I think that everyone has had about enough photos of the apartment now.

And finally, across the river is the another one of the residences. So, that is pretty much a complete tour of the place. Despite the drawbacks of residence living I think we've done quite well. Also, Tobie and I are smart enough to recognize the fact that this is probably the last time in our lives that we'll be able to wake up together, have lunch together, eat dinner together and spend the evening together. Okay maybe not the last time but it probably won't happen again until we are 65.

Exactly.

I had a great chuckle this morning while reading Abilene Rob's recent post. Actually his two most recent.

If you too like to chuckle, I recommend heading over for a boo.

We Meet Again

Starting to settle into my life back here in Ireland. In some ways, the summer was such a blur that it feels like I was only a way for a long weekend.

I found a receipt in my wallet last night.

It appears it must have been from right after the OCASE since I normally don't buy two bottles of wine before noon. Nor do I usually buy wines that aren't 2 for 1 Tesco specials.

I am certainly looking forward to the 2011 version of this receipt.

In many ways it is great to be back. I have a *much* better living situation this year. Turns out Tobie is a wonderful roommate, I have a spectacular view, a kitchen all to myself, two of my closest friends literally a stones throw from my balcony, and a bathtub.  Speaking of a kitchen all to myself--I discovered last night that if I put an apple crumble in the oven and then do yoga in the kitchen then I have my own home version of Hot Yoga! Sweeeeeet. So really, what more could a woman want in a domicile? (Ok, other than a sauna, numerous kitchen appliances, some art on the walls, a good stereo system, and some non-plastic furniture.) But I digress. 

I am finding it slightly hard to get into the groove again with PBL and the volume of reading that has already been put before me. This week is a hypertension case and I love cardiac physiology so I am enjoying the process but finding the wheels are turning a little slowly compared to June.

I have decided to think of medical school as two separate programs. Years 1 and 2 is the academic program and years 3 and 4 is the clinical program. If I think about it that way the road seems a little more bearable, in such that I am now more than halfway done the program. Ha! Hey, whatever gets me through 2 years of small group learning and not touching any patients.

I am still processing the summer and all the wild and wonderful experiences I had in the hospital. Hopefully some of that will help to pad the writing so I don't spiral into posts about stress levels, lack of sleep, and eating tuna out of the can. 

It's on year 2, it's on...