Wednesday, April 28, 2010

Sleep Thieves

I went through a really nice period over the last couple of months where I was sleeping pretty well (without pharmacological assistance) and my brain was happy.

The last couple of weeks I've been feeling that buzz in the background of my thoughts getting louder as more and more chatter rolls around in my brain:

"What if I bomb the USMLE?"

"Why the hell are my knees giving me so much grief again despite all the TLC I've been giving THEM?"

"I should write a letter to my sister in law whose dad just died"

"I should recert my ACLS soon"

"How am I going to fit in studying for finals with all the workload on top?"

"I should email Nancy's family and thank them for the lovely letter they sent me"

"How am I going to get in better shape when I feel I have no spare time?"

"Where am I going to do electives?"

"What specialty am I going to do my electives in?"

"Should I shoot for a province I *want* to do a residency in or one that I'll have a *chance* at getting a residency in?"

And so on. And so on. And so on.

Haven't slept much in the past couple weeks. In particular not at all the past three days. I am in a daze and we've started the neurophysiology unit this week. And the more days I go like this the harder it is to get it right because now I am stressed that I can't sleep!

Ugh. I can't memorize, concentrate, think, learn when I feel totally exhausted.

And believe me I do ALL the right things to facilitate sleep. I exercise every day (but not too late). I hardly drink coffee/caffeine at all but if I do it is only one cup in the morning. I do yoga on a regular basis. I don't study in the room I sleep in (most of the time). I get up 1/2 an hour earlier than I need to. I don't eat too late. I stop working at 2130h-2200h and do something else for an hour. I have a cool room, with white noise in it.


Any other suggestions most welcome.

And yes I have 4 sleeping pills but I am saving them for finals when the sleep thieves inevitably come and snatch everything they can from me.

Sunday, April 25, 2010

The Road

The road is long and some days it seems to stretch to infinity. Today was probably the first day that Ireland felt like home to me instead of a sentence. I noticed that the ache of homesickness was completely gone.

When your heart is broken people tell you that slowly but surely the pain will ebb away until one day you will wake up and realize that it is gone. I feel like missing Canada has been similar. After the initial rush of novelty and excitement wore off from the move I was left with a knot in my stomach. A knot that was a constant reminder that I was a stranger. I was no longer surrounded by the landscape of people and places I loved.

I took this photo last summer while I was driving back to BC. It is one of my favorites because it shows two of my geographical allegiances; the prairies of Alberta where I grew up and the mountains of British Columbia where I now call home.   It seems that Ireland too will resonate within a part of me when my journey takes me back home.

Thursday, April 22, 2010

Different Type of "Crack"

In Irish, "craic" is pronounced "crack" and it means "fun".

It's also a standard greeting, as in, "Hiya ABB, how's the crack?"

It's a gauge of enjoyment, "Ahh, it was a night of savage* crack!"

And a compliment, "Oh, yah she's good crack!"

It takes a little getting used to when people ask if you want to come over for some "good crack" but I feel it slipping into my lexicon and I fear for my return to Canada and inevitable slip when I ask a colleague if they had any crack over the weekend!

* "Savage" means great. 

Monday, April 19, 2010

The Easiest Way?

Anatomy prof: "The easiest way to remember which is which---genu valgum (knock-knees) versus genu varum (bowlegged) is to remember hallux valgus, you know, bunions".

Me (in my head): "Actually the easiest way to remember is that "gum" sticks your knees together. As in valgum."

Me (out loud): "Oh yeah, of course...hallux valgus...I'll never get the two mixed up again!"

Sunday, April 18, 2010

The Edible Woman*

This post could also be called, "I Get By With a Little Help From My Friends". 

It's been a tough couple of weeks. I am feeling rather disconnected from the world, living in a pseudo-reality of essay-writing-cramming-reading-sleeping-feeling-sorry-for-myself.

It is part of the challenges of living in a foreign country; not having the people, things, and rituals you normally revert to when things get tough. Granted I am blessed here with a slowly growing net of people willing to help hold me up, namely my boyfriend and some of my close classmates. A few days ago my good buds, Ryan and Mike showed up at the door with quite a surprise (you may remember Mike from his astounding artwork advertising my arctic nursing presentation in March).

It was the edible woman. If there is one fool proof way to impress me and make me laugh it is with chocolate (and simulated bowels made of glossetts and saran wrap, apparently).

I thought I should include a closer image to highlight the black lungs, heart, kidneys, gallbladder (green jellybean), bladder, thyroid, and 'corn' in small intestine. I think it was a most impressive artistic/comedic endeavor. And if this doesn't give some comfort to the general population that these are the doctors of tomorrow, I don't know what would.

It definitely made my week. Gnom, gnom, gnom...

I am lucky to have such a wonderful budding community of friends here, at home, and the virtual one of the blogosphere. Thank you for all the kind comments, emails, and edible presents lately! It means a lot.

She smilingly begins her Health Law and Ethics paper...


*With a nod to my first and maybe favorite Margaret Atwood novel, The Edible Woman.

Friday, April 16, 2010

Happy National Health Care Decisions Day!

I have harped on this matter before so I won't ramble on too much about it today.

I just think it is very important for us to give some thought and discussion to how we would want to be cared for in the case of a medical emergency, and what are wishes might be for resuscitation, organ donation, and life support.

Working in the emergency department I have had the unfortunate opportunity to witness families struggling with these decisions on behalf of their loved one who has suddenly become incapable of making their own choices regarding heath care interventions.

Even if you are a young person you ought to let your family know your end of life wishes, like organ donation or not, and what measures you'd like taken to keep you alive.

It is an uncomfortable topic but will give some relief to your loved ones if they at least have an idea of what you'd want, should an unfortunate circumstance befall you.

Take a moment and look at these websites for some guidance in making your wishes known. and

And if you want a worst case scenario of what really can happen, wander over to Dr. Grumpy's blog and see how it impacts not only the family of those involved, but also the health care workers. This is an important post on the matter.

Thursday, April 15, 2010

Today's Textbook Quotable

"The knee joint is relatively weak mechanically because of the incongruence of its articular surfaces, which has been compared to two balls sitting on a warped table top". 

Come again Clinically Oriented Anatomy (6th ed.)?? Can you unpack that analogy a little for me please??

Quotes from the Classroom

You may have noticed that it's been a while since my last "Quotes from the Classroom" post.

You also may have noticed that I have not really been 'feeling the love' in medical school these days so I've resorted to truancy. It's been helpful in that I have gotten a lot of work done on the essays (which have no application whatsoever to medical practice) done. But being stuck in the hovel all day and night is making me more and more curmudgeonly. I figured it was time to start going to class again.

Yesterday I ventured out into the light and attended three greatly interesting lectures; one was a GP/derm/sports med overachiever who lectured to us about the different types of arthritis and how they will present to you in clinic.

"The patient will come in and tell you they can't throw their leg over the seat of a bike...or whatever it is they like to throw their leg over."


This was followed by an orthopod and then an anesthetist who is a pain specialist (have I mentioned yet this month that I want to attach myself to the leg of every anesthetist I see, begging them to take me to the hospital with them??)

By far the most entertaining part of the afternoon was the orthopedic surgeon who lectured to us about joint replacement surgery. There is just something a little jarring about the statement "so we saw the head of the femur off, it goes in the bin, and then we set about getting the prosthesis into the femur".

This of course was followed by, "the first rule of orthopedic prosthesis placement is 'when it stops movin', stop bangin'".  Remind me never to get my hip replaced!

And the pearl of wisdom bestowed upon us when one of the students asked about osteolysis (complete bone destruction around the prosthetic causing instability and pain for the patient), "there is no problem that metal can't solve".

It is safe to say that orthopedic surgeon has long been scratched off my list of "maybe that is what I will be when I grow up".


15% off men's scrubs with code "mens_save"

Monday, April 12, 2010

Death Be Not Proud

Enough of trying to pretend that I am coping well. I am not.

There are a few workplaces in this world where you might have the wonderful advantage of a colleague who is always willing to help you out. This is the person you can call in the middle of the night, when you are alone in the clinic and suddenly overwhelmed with a septic child and casualties from an ATV accident. This amazing colleague does not ask questions or complain that she's exhausted, she just gets down to it. Her experienced and gentle hands start the IV while her stern voice gets a room full of hysterical teenagers under control.

I was lucky enough to have this colleague become my friend. She taught me how to make blue cheese bread twists out of the limited groceries we had access to in the Arctic. She rented a boat with me so we could see the icebergs up close, feel the gravel of a glacier under our feet, and bob alongside seals for the afternoon. She taught me to fish and she taught me how to do a proper head-to-toe assessment on a neonate.

Fortune continued to smile upon me.  This woman generously invited me to her home in New Zealand, letting me use her place as a base while I travelled around exploring the beautiful landscape of the South Island. She introduced me to her friends and colleagues and they embraced me as an honored guest.

Eventually she became one of my wisest confidantes, and I was truly blessed for this. She listened to my dreams, and encouraged me relentlessly to pursue them. She would write to me, telling me to push on when she knew that my determination was faltering. She sent me gifts when she was far away reminding me of how proud she was. She was one of the few people on this earth truly in my corner, championing my successes and lamenting my failures. When the first round of medical school rejections came, she pushed me back into the ring to keep trying.

She never married or had children. Her spouse was adventure and her children were the thousands of sick babies she held in her arms. Her entire career as a nurse was devoted to the vulnerable and weak, the poor and the forgotten. She spent years volunteering in Zimbabwe , Vietnam, Cambodia and Myanmar. In New Zealand she worked in a special care babies unit and in Canada she took care of First Nations and Inuit communities.

She took me under her wing during my first contract as an outpost nurse in the Arctic and tirelessly answered my endless barrage of questions those first months. If it hadn't been for her I am sure I'd have left the North with my tail between my legs, succumbing to the crushing weight of inexperience and fear.

Mentors and kindred spirits do not come along very many times in ones life.

In Nancy I had both.

She died from cancer on Thursday April 8th, 2010. 

Now that she is gone there is an empty void left in this world and in my heart.

Death be not proud. You have taken a shining star, a selfless healer, a wise woman, a sister, a daughter, and a friend.

Nancy I pray that you may now see all of the hearts you've touched, the lives you've saved, and minds you've inspired. Rest in peace my dear friend. 

Thursday, April 8, 2010

Reassuring Comments from Rang and Dale

With regards to drug treatment options for rheumatoid arthritis:

"The antirheumatoid action of most of these agents was usually discovered through a mixture of serendipity and clinical intuition. When the drugs were introduced, nothing was known about their mechanism of action in these conditions, and decades of in vitro experiments have generally resulted in further bewilderment rather than understanding."
                                   -Rang and Dale's Pharmacology, 6th ed. (2009)

I like the honesty in the statement, though it isn't overly reassuring considering the amount these drugs are prescribed. I guess that a lot of medicine is just knowing that it works, not necessarily knowing how it works...but no ones seems to want to admit that.

Wednesday, April 7, 2010

A Break From Gory Stories For the Non-Medical People

This model of car (truck? van? el camino hybrid?) is a big hit here in Ireland. At first I thought they were ridiculous, now I think I kinda want one for next year.

Tobie says they are a sign of a person who has truly given up.

I am unconvinced. All I know is I want to drive something hilarious, and I think this fits the bill for both comedy and practicality. Ok maybe not practicality.

What's the Craziest Thing?

My last post was getting a little long so I thought I'd break it up into two, on a similar theme. 

Often when I am out with non-medical people, after a few glasses of wine someone will ask,  "What is the craziest thing you've ever seen in the emergency department?"

This is a tough question to answer because there are many different kinds of crazy.

There is crazy-sad, crazy-funny, crazy-weird, crazy-annoying, crazy-smelly, crazy-gross, crazy-bloody, crazy-interesting, get the point.

Of course I love telling stories and talking about my work but the point is to entertain, not to bog a captive audience down in all the depressing things that haunt you.

For now, these are two of my crazy-wow stories from the ED. 

When you are a health care worker you have to really work at an impassive expression when you see things that disturb you. Mostly because patients are acutely aware of even the slightest muscle tic on your face when you greet them and their problem. The last thing you want to do is make them feel more embarrassed, upset, exposed, or vulnerable. You really want them to feel like you've seen, smelled, heard, felt, their problem 1000 times before and they can just relax and not worry about it.

There are very few sights that freak me out. But two patients in the past 6 years have actually caused me to take a quick polka step backwards before collecting myself (and my professional behavior) again.

The chief complaint on the emergency form said "bit tongue".  It was busy in the department and I was annoyed that someone would actually come in for such a trivial complaint. (This is where I think--do people in this world have absolutely *no* coping skills for minor injury??)

The couple was a calm middle-aged duo, a little wobbly from the drink, in matching leather jackets and riding boots. The patients husband smiled when I approached, almost giggling as he told me the story---she'd slipped in the bathroom and bit her tongue when her head hit the sink on the way down.

I was now doubly annoyed because it is a major pet peeve of mine when husbands speak for their wives (or parents for their children and vice versa with the elderly). I asked her to open her mouth and out dropped 95% of her tongue, sagging down to her jaw line, hanging by a thin ragged edge.

Yep. I actually jumped back in surprise. She then jerked her head to throw the thing back in her mouth. They both found my reaction hysterical. Ok world, I get it...preconceived judgments are a bad idea.

I kindly warned the plastic surgeon before he examined her that this was no small injury. Even he came out of the room with his eyes widened.

The other time I did a dance step away was when one of our more colorful frequent flyers developed a severe cellulitis, with a twist.  He was coming in four times a day-ish for IV antibiotics and every three or four days for a massive dressing change. The weeping, festering wound stretched from just below the knee to the ankle. He told me one day that there were maggots in his wound and he wanted them cleaned out and the dressing changed. He wasn't due for a dressing change for another couple of days and the department was swamped so I tried to talk him out of it. When I worked in adult psyche probably every third person complained of 'bugs crawling out of their skin' when they were going through withdrawal so I was nonplussed by his description. But, truth be told, I felt bad for the guy and life afforded him no luxuries, so if a dressing change was going to make him happy, I'd do it.

I peeled off the dressing and much to my shock and "egad!" I jerked back at the sight of dozens of tiny white wiggling maggots diving back into the flesh from the bright disruption to their darkened world.

"Seeeeee! I TOLD you there were maggots* in there but no one believed me!!!"

The timing for these types of encounters seem to always coincide with getting too cocky developing a false sense of confidence in your powers of prediction and assessment. 

*And yes I know that maggots are grand for wound healing and debriding necrotic tissue...but it was shocking nonetheless to see it unexpectedly.

Monday, April 5, 2010

What Gets You?

Everyone (and I mean everyone) who works in healthcare has an Achilles heel. Of course anatomically speaking we all have a tendo calcaneus but that is not what I am talking about.

Nope. What I am referring to is the bodily fluid, odor, sight, sound, sensation, taste, texture, illness, task, procedure, or person that you just can't stomach. That 'thing' that 'gets you'. It makes you weak in the knees (in a bad way), causes your vision to go a little red and fuzzy around the edges, your blood pressure to drop, your gag reflex to fire, sweat to bead, and hands to become clammy.

From geriatric lab techs to weather-worn nurses, crusty old doctors to gritty respiratory therapists--they have at least one 'thing'. And if they say they don't, they're lying.

I was having this discussion with a newbie medical student a couple of weeks ago saying how it'll be interesting to watch everyone in our class discover what their medical Achilles heel is. I know what mine is. Well, if I am completely honest I have quite a few Achilles heels. I always thought that over time they would disappear, but even several years of working in emergency departments hasn't numbed me to a few shudder inducing 'things' that still 'get me'.

1) Nails. I mean finger or toe nails. When they are severely deformed or overrun with fungus, shattered, or split I feel a shiver go through me. The last time I almost fainted in the ED was from attempting to overcome this issue by pulling out the shattered bits of finger nail from a crush injury.  My feeble attempt at medical aversion therapy. I'm getting better with them but still don't think I could watch an ingrown toe nail surgery.

2) Crepitus. That is the crunchiness you feel when there is broken bone under the skin (you can also have crepitus for other reasons which do not creep me out so I am not discussing those types). I am talking about bone crepitus.

My 2006 almost-faint-during-procedure was in Whistler where we dealt with countless fractures that required skill at removing ski-boots/snowboard boots/bib-pants/long-underwear etc. Contrary to media portrayal we *do not* cut clothes off people most of the time, especially there when a pair of good ski pants can run you over $500! So you've got to hold on to the crunchy, floppy, limb while a colleague pulls the fabric or boot off. This I am borderline ok with most of the time but sometimes during reductions or casting it makes me get all sweaty and pale. The worst one occurred was while I was holding traction on a 4 year old boy who had broken his leg. I still remember that purple cast and the wave of nausea taking over me as I felt those little bones shift under my fingers."Don't faint! DO NOT FAINT" was my mantra for the entire task.

Bones in general freak me out actually. The feeling of ribs cracking when doing CPR is really unsettling, seeing ribs cut during autopsy also makes me almost hit the floor. Though strangely, compound fractures (i.e the bone sticking out of the skin) don't bother me. There is no rhyme or reason to these aversions.  But I suppose this eliminates 'orthopod' from future residency options.

3) Pseudomonas. Once you smell it you'll remember it for life. The best way that I can describe it is a putrefied, sickly-sweet, heavy, rotten smell. And I swear---with no scientific evidence whatsoever to back this statement---that the odor molecules from this microbe are larger and stickier than any other. Once you breathe it in it seems like the odor attaches itself to your nasal passages for days. Days, people! I am not exaggerating. You're riding your bike or eating dinner or watching a movie, you inhale and BAM!! it's there again, like you're face is right in a giant petri dish of the stuff. When a patient has an infection of this flavor I need to put a little clove oil under my nose to make it through the shift, or a dab of friars balsam on the neck of my scrub top. Trust me, it's bad.

Those are probably my top three shudder-inducers. I always find it interesting to poll my medical colleagues as to what theirs are, and often it is not what you'd think. It's almost never the big things that jump to mind as the offensive bodily fluids. It's almost always bizarre and random phobias. I have co-workers whose 'achilles' is a thing like: knees (they don't want to touch them, especially if there is something wrong with them), or suctioning sputum (spit), touching feet, seeing greasy hair, assessing rashes, etc. Some of them I can understand but others (knees?) are beyond me.

To work in places like the emergency department or an operating theater I suppose it is adaptive that we aren't disturbed by the usual suspects, otherwise we couldn't do our jobs. But it is funny how certain aversions (or phobias) still manage to leak out and remind us that we are not bullet proof to the bodily aspect of the human condition.

What gets you?

Sunday, April 4, 2010


This Easter things were a little non-traditional.

Tobie and I were getting over our colds and were a little sad at how our holiday didn't pan out as we'd hoped. To cheer myself up I went to the Farmers Market on Saturday and decided to make a fun non-traditional Easter feast.  The market here makes me happy and definitely feeds my soul in a landscape which mostly consists of the uninspiring confines of my study bunker.  If you are not a foodie this post is bound to be boring drivel. My apologies!

I call this one: 
Yummy market and Tesco Bounty
or Life is Better When You Have a Car

First is the pizza dough thanks to Jaime Oliver's Recipe.

If I can make it, anyone can. This is my fun fig pizza which I haven't made since Nature Nerd's wedding! You have to start by making the dough and letting it rise. While the dough is rising...

Slice several onions into slim rings and throw into a heavy pot with a slab of butter and a drizzle of olive oil.

Then add a few heaping tablespoons of brown sugar and several gluggs of balsamic vinegar. Stir and let the onions reduce into a pulpy mess of deliciousness. The longer they cook the better. I usually set aside at least an hour. Tweak the balsamic and sugar to taste.

While the onions are cooking...Trim the heads off a few bulbs of garlic, drizzle with olive oil and pop in the oven. They usually take about 25-30 mins at approximately 300-350 degrees F.

After the garlic is roasted (yes I did *slightly* overdo mine above) then mix into the onion jam of goodness and stir about. Roll out your pizza and spread the mix onto the dough.
I then cut up a few handfuls of figs and put them on top. Tear a few large strips of prosciutto and add to the mix. Finally put some nice big slices of Cambozola cheese (hey, I never said it was a *healthy* pizza) and a dusting of Parmesan. Bake until it looks golden and delicious.

I like to throw a handful of arugula on top at the end.

Then I made a nice salad with fresh greens and beautiful cherry tomatoes, arugula, walnuts, and a tangy balsamic reduction sauce. Balsamic reduction is cheap to buy and tastes exactly the same as what you will slave over for ages to produce. I am no purist when it comes to some store bought condiments which make my life easier.
For dessert there was a rhubarb, walnut, prune and apple crumble. I wish there was some way to bottle up all the lovely aromas in the kitchen. And it worked! All that cooking made me forget that we were far away from our friends and families for the holidays.

Happy Easter everyone!

Thursday, April 1, 2010

Stranger in a Strange Land

So we came back early from Killarney because Tobie has a man cold.

Since I had a car at my disposal I figured I'd use my time wisely and go to the welfare office and apply for a PPS number (the equivalent of a social security number). Yes. I'd rather spend my afternoon languidly, doing something vacation-y like read my book...or worst case scenario...productive like writing one of my [insert plethora of cuss words here] papers. But no, I will be a responsible adult and get the PPS.

First of all I had the wrong address, parked in some random alley because I was so shooken up from a near fender bender, and then was given classic Irish directions*, "go tru the alley, turn at de cathedral, past the old hotel and it's there on de left".


There appears to be both a cathedral and old hotel on every corner in this country. 

Ok, so that is 2.5 hours of my life I will never get back. No PPS**.

I thought I'd cheer myself up by getting some groceries to make a delicious soup. Cooking always clears my head...forgetting of course that this is the day before Good Friday (i.e. the only day of the year that the 24h Dunnes is closed--actually). After getting rammed by a shopping cart and almost pushed over by a lady with a determined look in her eye and pickled beets in her hand, I settled into the shortest line I could find.

Yes. Things were looking up. Soup. As I was about to place my items on the counter the lady in front of me knocked over a giant jar of mayonnaise thus closing the til.

I should have stayed at home and chosen languid and vacation-y.

*There is a fairly strong anti-immigration sentiment here in Ireland. Especially because many Irish (wrongly) believe that the immigrants arrive and then go on welfare. So I was a little hesitant to ask that many passing pedestrians where the "welfare office" was with my foreign accent. Especially if you saw the part of town I was searching in. Let's just say lots of neck tattoos and broken bottles.

**Which once again makes me have the ultimate respect for immigrants that do not speak the language in their new country. Ok. I am fluent in English and have, oh 7 years of university under my belt and was almost having a crying fit on the street corner today in frustration. Here is to wanting to shake hands and congratulate every person I ever see who has started a new life in a different country.