Friday, December 23, 2011

The Real Reason, On CBC Today

When I am asked the reason I chose medicine, I almost never tell the truth. I feel a little protective of the real reason and how it might be perceived by others, so I usually reveal some of my less sentimental and more cerebral motivations for becoming a doctor.

But, when given the opportunity to create a small radio piece about my grandad and how he continues to medically inspire me, I happily got to work.

I know it is Christmas Eve, but if you need a half hour break from the chaos, have a listen to a story that is very close to my heart.  Tune into CBC's national radio show, White Coat, Black Art today, or go to the website and stream it at your leisure.

Hope everyone is having a wonderful start to their holiday!

Merry Christmas and happy holidays.  Stay safe, keep warm.



Thursday, December 15, 2011

Circular Conversations at Customs

There happened to be a good friend from school on my flight from Newark to Ottawa yesterday. We didn't plan it that way but we were pleased to have some catch-up time throughout the cab-rides and layovers. Naturally we were chatting while waiting in the customs line, until I approached the weedy French Canadian with a friendly, "good afternoon". His blonde hair was shaved to the nub, and he had an expression on his face that said I'd rather be wearing mirrored aviators...

He responded to my greeting with, "who is that you are traveling with?"

Uh, I am traveling alone.

Alone?

Yes, alone.

Who was that guy you were talking to then?

Um, a friend, but we aren't traveling together. [What are you, a jealous boyfriend??]

You are on a flight together but not traveling together, hey?

Yes, I bought my ticket separately, we live in different towns...er...I know him from some classes we took together.  [Confused and now flustered at this strange line of questioning, I think I probably sound like a drug smuggler].

Where do you live then?

I live in Small Town Ireland.

And where do you go to school?

At University in Ireland.

And what are these classes? [Smirking like I am about to say, 'nude sculpting']

Um...medicine classes? [Am I a complete imbecile? When have I ever described my education as 'medicine classes??'] 

What are you studying at University of Ireland?

Oh right, medicine, I am studying medicine. I am a medical student. [The lady doth say 'medicine' too much, methinks...]

And you are in Canada for just 25 days then?

Yes. [Hello, I am a Canadian citizen I can be in Canada for as MANY BLOODY DAYS AS I WANT!!!]

He tosses my passport onto the desk and motions to next person in line. I collect my luggage and walk through gate to see Tobie's smiling face. Until we reach the safe confines of his car my head continues to dart around waiting for customs to taser me or demand a bag / body search.

What is it with these uniformed misanthropists? Is it that their job is so bad that they feel the need to be acrimonious power-trippers? Are they actually not allowed to smile, or be polite, engage in socially acceptable forms of communication? I was so annoyed, wishing I could delete the whole welcome home to Canada experience.

The great part is I am home. Sorta. At least I am in the motherland, where the "hot" and "cold" tap are one, my 'accent' doesn't attract attention, and soy milk comes in more than one brand / flavor.

Oh, Canada...you complete me. [Sighs]



Monday, December 12, 2011

Palm Reading

I love looking at people’s hands.

My fascination with hands started when I learned how to I.V cannulate.  I found myself subconsciously evaluating the potential ease or difficulty an I.V start would be, even absentmindedly tapping along the length of a vein (usually creeping out the boyfriend or family member).

Now that I’ve been learning so much about how many clues the hands and nails can reveal regarding systemic pathology, I’m becoming borderline obsessive about looking at the hands of people around me…hoping to see some obscure clue to illness.

Last night I came across a quote in my favorite textbook, “Hamilton Bailey’s Demonstrations of Physical Signs in Clinical Surgery” which I thought encapsulated my rekindled curiosity,

“Regarding the hands, ‘one does not need the mysteries of palmistry to read in them something of the past, a great deal of the present, and even a little of the future. In them is written the record of age and sex; of occupation and habits; of skill or ineptitude; of hard work or indolence’ (Cutler)."

The Apples Do Not Fall...

In a complete blog non-sequitar I'd like to present a post by one of my good friends, Ryan. It's like cute overload if you're into children and skiing.

It made me laugh at least.

Oh how I miss Revelstoke, and the great people there (and killer skiing)!

Sunday, December 11, 2011

Where Am I Going Again?

As I mentioned on twitter this afternoon, when I pack I am sort of like a dog circling a spot before lying down. Only my ritual seems to involve spinning around for hours. Packing has the tendency to flare up an attention deficit problem and I find myself vacuuming, baking, cleaning my hard drive, flossing, and online shopping while stuffing random articles into my suitcases.

This trip home is exciting and a little unsettling at the same time. I haven't been back to Canada for Christmas since 2008 so naturally I am looking forward to watching some crisp moonlight snowfalls with the Nana Mouskouri Christmas album playing in the background. I can't wait to see my mom, Tobie, his family, my good friend Liz...the Arab grocery store in Montréal that I love.

The unsettling part is that I don't know how long I am going for, and where I'll be for January. It is a little difficult to pack when you don't know if you'll be spending a month in Arizona or Nunavut, a GP office or an O.R. We're talking a lot of variety here. Heels? Hikers? Nylons? Blouses? Scrubs? Sneaks? Not to mention which books I'd bring based on the place / rotation. I am still trying to arrange something but my most recent lead is looking unlikely now as well. I found out this week that I also didn't get any electives at the University of Ottawa for the summer. Have I mentioned that I am tired of feeling like a medical pariah an outcast? Is this blog post turning into a pity party? Maybe...

So now, instead of coming back to Ireland at the end of January it looks like I might be flying straight back after New Years. Sigh. I just want an opportunity to learn, and to get some hands-on experience.  It is really disheartening to constantly feel doors close in my face when I am working hard and putting myself out there. It is true that at every turn medicine asks, how badly do you want this??

OK. That is enough whining. 


On a happier note...the ginger cake that I made today turned out beautifully. I may be turning a corner in this whole baking thing. Yes, yesterday my kitchen did look like I'd had a seizure in it while holding a bag of baking soda and I probably ate 4000 calories of "broken" brownies oh I can't bring the broken ones to the Christmas party...but with each event the baking part gets a little easier and the results get a little more edible. Maybe I should try to get an elective at a pasty school...hmmm...

Wednesday, December 7, 2011

Luck Be A Placement

"I never come to work with a heavy heart, I am always whistling on my way in. Sometimes, at the end of the day I have a heavy heart, but never at the beginning". 

This was said to me today by my new preceptor, a man who has been a family physician since opening his clinic thirty five years ago. At that moment I said a silent prayer that I will someday be able to say the same thing about my career.

J. A is easy to laugh, and a very straight talker.  A shock of white hair rings his bald head yet he carries himself like a much younger man. I was fairly certain we'd get along well right from the beginning based on the fact that his expression seems to carry the right combination of mirth and sincerity. But he sealed the deal today on our way to a home visit when, as we walked out to his car dressed in our long winter coats, he suddenly turned to me and said, "Oh dear, I've just remembered...I've got a lot of game in the trunk of my car...er...I'm really sorry...I was hunting on the weekend and...well...the car smells quite bad!"

Yes, I think we're going to get along just fine. How could he have known he was dealing with an Alberta girl, raised in a family of hunters? One of my earliest memories is going to my Dad's shop, and opening the door to the horrifying sight of a moose head on the cement floor, then lifting my eyes to an even more gruesome view, the skinned body hanging from a large winch.  I just smiled and reassured him he didn't have to worry, the smell would not offend my delicate sensibilities.

To be paired with a physician who--still whistles on his way to work, is genuinely keen to learn about current best practices in medicine, and is quirky enough to have animal hides in his car makes me think I've probably hit the jackpot for the next 5 months. Woot!

Thursday, December 1, 2011

Last Day

Tomorrow is my last day in the hospital. I cannot believe that I am halfway done third year already.

Does life always move this fast? Everyone said it would, but I didn't believe them.

I am really going to miss the hospital. I've only just figured out the best shortcuts through the wards, the codes to all the change rooms, where the best coffee is served, the names of the nurses, the passwords for the diagnostic reports, lab results. Not to mention I'll miss some of the lovely working relationships I've made and friendships that have formed.

Now I will be in GP land until May. A new set of people, codes, computer systems. Another adventure.

I was hoping to go to Dalhousie for a 3 week elective in January, but unfortunately it fell through just recently. Now I am trying to figure out what I should do with that time. I need as many weeks of electives back in North America as I can get. So many schools don't even take international students, and the ones that do want you to apply 9 months in advance. I don't know where or what I am going to do now. (And no, a holiday isn't an option. With international medical graduates the competition is so fierce I am going to have to basically invent my own specialty and write a textbook on it by next fall if I want to study in Canada once I graduate!)

I shouldn't be thinking of all this now, it is so late, and I'll never sleep. Reflecting instead on the past 18 weeks...

Have you learned the lessons only of those who admired you, and were tender with you, and stood aside for you? Have you not learned great lessons from those who braced themselves against you, and disputed passage with you?
 
-Walt Whitman

Indeed, Mr. Whitman, some great lessons...

Sunday, November 27, 2011

No Pressure

"So the patient has been temporarily paralyzed by the drugs, and you're the one keeping them alive by squeezing air into their lungs...but...no pressure".

Gulp. 

I was holding the mask as tightly against her face as I could, sealing the rubber to her cheeks in the effort to keep highly oxygenated air from leaking out. Looking down at her from the head of the bed I saw the patient from a different vantage point, a place that made her look so vulnerable.

And she was vulnerable.

A few minutes prior to closing her eyes she had been nervously chatting and laughing away as we prepared her for surgery. The dose of propofol and the inhaled sedatives smoothed her face and left her body limp. Now we had injected medication into her intravenous line to paralyze her. Once her muscles were relaxed we could slide a tube down her throat and into the trachea, providing the means to ensure that her airway would remain open and her lungs could be well ventilated with oxygen during the surgery.

I removed the mask to prepare for the intubation. Her skin was pale, the freckles standing out now that the nervous blush had faded from her cheeks and neck. She was perfectly still and we were moving into action. 

It struck me then how explicitly patients trust their doctors and nurses. Of course I have always understood this as a general concept in healthcare but this was suddenly a much more concrete example. Patients literally put their lives in our hands on a daily basis.

Why have I never said to a patient, "Thank you for trusting me with your most precious possession"? Why has a patient never said to me, "Please do not be hurried, or harried, distracted or inattentive, because today you are responsible for my survival"?

I suppose these are silent agreements and understandings that we have in all of our patient interactions. Yet the fact that we don't outwardly acknowledge these understandings means that maybe we've forgotten that at the core, it is an honor to be in this role. I'm not so unrealistic to think that one is thankful when the bleep goes off for the 47th time on a Christmas eve night shift...but I hope that at the end of the day when I am bone tired and flopped-out on the couch in the call room I'll remember this, and take even just a tiny measure of satisfaction from the honor of responsibility. 

No pressure.

Tuesday, November 22, 2011

Tomorrow and Tomorrow...


It is moments like this that make me so happy that I am in medical school.

Thursday, November 17, 2011

Engrossed

I don't know where to begin talking about "And the Band Played On" by Schiltz.

I've been wanting to read it since I had the unique opportunity to hear Dr. Paul Gallo speak 2 years ago at the University. Of course, I am only now beginning to grasp his role in the discovery of HIV and how he stood at the epicenter of an extraordinary time in medical science.

At the risk of sounding laughably naive, I never thought of how powerfully the politics of the time and society's value judgements facilitated the development of the AIDS epidemic. I hadn't considered the blatant discrimination displayed against gays by the lack of alarm and media coverage. How one of the first news stories to appear about the epidemic was only when a woman had contracted the disease...suddenly it was a story only when someone other than a homosexual man was sick. As I write this I shake my head at how stupid I sound. Of course politics and conservative beliefs played a huge role in the pathetic response by agencies like the CDC and the NIH. Of course. I just hadn't considered all these angles to the issue before.

But still, it boggles my mind. And it saddens me so deeply to learn how many lives could have been spared if only things had been handled more efficiently and more aggressively by people in power--from government agencies to gay leaders. I temper this statement only by saying that I know how easy it is to judge through the lens of the retrospectoscope.

And yet it is also enthralling to read about a time in medical science when clinicians and researchers were scrambling to put together this puzzle with seemingly random pieces. Some patients had toxoplasmosis, others had PCP, some thrush, many Kaposi's sarcoma...no wonder if took time for people to figure out this was one disease with so many faces. Even the concept of determining that it was an infectious disease...when many thought it came from a bad batch of 'poppers', inhaled nitrites.

I am just over half way through the book and already it has made me frustrated, angry, inspired, impressed and very, very sad. What would it have been like to be a nurse or doctor in San Fransisco in 1982 when we didn't know how the disease was transmitted? Let alone, what it would have been like to be a gay man in the same place at the same time? It is chilling to go there in one's mind.

I grew up knowing AIDS only as something famous people did fundraisers for, then as a rare disease I might encounter as a nurse, to a collection of the faces of AIDS patients I did care for. Then it was a complex subject I needed to memorize for the USMLE, and now to this...something I really know nothing about at all.

This book has certainly opened my eyes and heavied my heart.

Sunday, November 13, 2011

Hurt So Good

Okay so I think it is safe to say I am officially hooked on adventure racing. 

I get by with a little help from my friends.
 Wow, that was a ridiculously good time! Where do I sign up for the next one?! Granted, the absolutely perfect weather yesterday has probably amplified my infatuation with the whole concept of thrashing my body for hours on end. I have to wait for official results but from the numbers last night it looks like I came in 9th for the women!! I was hoping to finish in 5h and so was really pleased with my time of 4:39.

Can't write a proper post right now as I am on a mission to buy some jam from a market I spotted yesterday after the race. I would have bought some at the time but I had no wallet on me...plus I probably looked like public health threat given the fact that I was leaving a trail of hay, seaweed, mud, and sweat in my wake.

Thanks much-ly for all the tweets, emails, and comments of support! I was having second thoughts about doing it all week so all those little nudges meant a lot.

For you data nerds: run, cycle, hike, evil cycle, ocean sprint/obs course*/run.

*And by 'obs course' I mean going over hay bales and running through tires, etc. not learning how to manage labor presentations. Whaaaaaaaaat...c'mon...medical people read this blog, someone might need clarification!!

Friday, November 11, 2011

Why My Roommate = Awesome

Today, while loading up my car with race gear, I found this stuck to the seat of my bike. If that isn't ridiculously sweet, I just don't know what is.

Wednesday, November 9, 2011

Last Ride


2 days ago was my last training ride before the Big Race this weekend. It was an absolutely beautiful evening, only marred by the screaming of my leg muscles. I think the photo does not do the steep climb justice so I am including a screen shot from my GPS so you can appreciate that it actually is a hill and not just a meandering, gentle walking path from the nursing home. 

Note the lack of 'flat bits'.
Tonight I went on a short run, and for the first time in a long time it felt good. I suppose that is the main bonus for me: having something to train for means I'll train. Because I have to admit, I am not really looking forward to the weekend. I'm doing this because I want to see if I can finish it, but I'd be much happier if it didn't involve 8h of driving and staying in a hotel alone for two days (oh and killing myself on a crazy multi-sport course that will probably take me about 5-6 hours!)

The biggest joy for me about the triathlon in June was the fact that most of my family was involved. It was so fantastic to come across the finish line to big hugs from my sister, sister-in-law, bro, bro-in-law, niece, and nephews! It just feels weird that I'll be finishing and high-fiving myself (before collapsing in a twitching mess).

And speaking of high fives...I would not like to high five my body for how has changed in the last 10 weeks. I found my measuring tape a few days ago and thought it'd be interesting to see if my measurements have changed since I kicked s*it into high gear. Granted, the last time I measured myself was about a week before I went on my Himalayan trip and I was in decent shape then but...

First disappointment: 4 inches gone from chest. Buh-bye.
Second disappointment: no inches gone from thighs or butt.

SERIOUSLY BODY? Seriously???

Great, so now I have the upper body of a 10 year old newspaper delivery boy, and the lower body of a middle-aged Greco-Roman wrestler. That is sub-awesome.

Um...do these vertical stripes make my thighs look big?

Tuesday, November 8, 2011

When One Eponym Suffers Another

The Oxford Handbook of Clinical Medicine is full of charming and hilarious little gems, usually tucked away in the depths of information overload. I would love to meet the authors of this sanity-saving handbook and shake all of their collective hands (while buying them beers).

Today I came across this entry which I felt the need to share:

In 1931, Buerger's* disease caused gangrene in the toes of Harvey Cushing**--the most cantankerous (and greatest) neurosurgeon ever. He had to be wheeled to the operating theatre to carry on his brilliant art (and to continue terrifying his assistants). He had to retire partially, whereupon his colleagues presented him with a magnificent silver cigarette box, containing 2000 cigarettes (to which he was addicted)--one for each brain tumor he had removed during his long career, so verifying the truth that although we owe everything to our teachers, we must eventually kill them to move out from under their shadow.
-Herman Hesse, Demain


And so there is your CME in obscure medical history for the day.  You're welcome. 
--

*Buerger's disease (thromboangitis obliterans) is smoking related inflammation of veins, nerves, and middle-sized arteries (which thrombose, causing gangerene). Cause is unknown. Stopping smoking is vital. Most patients are men. 

**Cushing's disease is bilateral adrenal hyperplasia from an ACTH-secreting pituitary adenoma. He also is known for Cushing's syndrome, and Cushing's triad...but I think we've learned enough for today.


Sunday, November 6, 2011

An Unexpected Test--Part III

And then I remembered…I was supposed to phone Paul when I got down. What if he heard about the rescue or saw the helicopter and thought it was me. He knew I was heading up alone…and my bike! (Now I know it might sound like a crass thought to have in an emergency but that bike is worth more than my car and heaven knows I’d never be able to afford a replacement.)

I asked one of Tina’s friends to take over c-spine for me while I called Paul and checked on Maggie again. Paul was stunned when I told him the situation, and said he had started to wonder what had happened to me. He offered to help in any way he could. I wasn’t sure how long the elderly Irishman was going to be selling walking sticks and watching my bike, so I asked Paul if he’d pick it up for me and then collect me later once the ordeal was over. He was happy to do so and I could breathe a little easier.

I resumed my post after a short jog on unsteady legs in an effort to get my body temperature up again. Tina was oscillating between drowsy silence and angry outbursts directed at the cold. We were all starting to shiver. I couldn’t remember a time when I’d been that cold. I’ve been outside during winter in the Arctic circle but I was always appropriately dressed for that. My cold sweat and thin jacket were a bad combination and at times my hands and body started shaking to the point where I wondered how effective my c-spine stabilization was.

Finally we heard the reassuring buzz of the approaching helicopter. The fog was so thick that only the sound alerted us to its descent nearby. Tina began to cry out with relief. Our huddle, which consisted of Father Henry, two teens, the Swiss couple, and myself, looked around at each other with relief on our faces. Relief that soon turned to concern as we heard the noise change and then grow quieter and quieter. Tina soon realized the helicopter was gone and started to cry.

Twice more our rescuers tried to land unsuccessfully. Each time our hopes rose with the crescendo of its approach and fell further as it drifted away again. I was getting genuinely worried now about hypothermia, for all of us. How cold did it have to get before the injured ones really started getting into trouble? Our little circle got tighter and tighter. After the helicopters 3rd failed attempt to land, another hiker coming down the mountain stopped to offer help. She immediately started pulling out extra pieces of clothing, hot coffee, and chocolate. She threw an extra coat over my shoulders and then sat behind me rubbing my back and arms in an effort to stop the shakes which were starting to take intermittent control of my body. As she pressed up against me she said, “I know I am getting into your personal space here, if I am annoying just tell me to go, but you really look like you need warming up…” I told her she was the farthest thing from annoying and that I was extremely grateful for the warmth she brought down with her.

Finally, the helicopter was able to drop a rescuer down nearby. Keith was a tall, stocky flight paramedic and he had with him two large bags filled with emergency medical supplies and outdoor protection gear. I gave him the best report I could from my initial surveys, and helped place a collar on Tina. We were able to wrap her in a thick, warm, bright orange emergency sack.  Soon many other rescuers were on the scene. I didn’t ever find out if they had arrived on foot or along with Keith when he was dropped off.  Someone, who I think was a doctor taking direction from Keith, took over c-spine. I asked the Swiss guy to pull my bent leg straight for me so I could stand.  My leg muscles had seized up and fallen asleep during the nearly three hours that I’d stayed almost motionless. It was a strange combination of sensations as I tried to negotiate the rocky terrain over to Maggie and the swarm of rescuers who surrounded her.  I knew the patients were in good hands and I suddenly felt like a supernumerary gawker. Where had all those bystanders come from? I approached Keith and told him I was planning to head down. He offered to give me a lift in the helicopter to the hospital. I thought for a moment how much I would love a spin down in the whirly bird but I felt like I needed to go sooner rather than later. He didn’t know how long the refueling would take and I didn’t know how much longer I could stay on the rocks. Not to mention that I’d long ago called Paul and told him ‘the helicopter is landing’ and then forgotten to update him with ‘and now it is gone’. He’d probably been waiting at the bottom for well over an hour.

I said goodbye to the rag-tag gang who I’d spent the afternoon with, wished the patients my best, and gave Keith my contact information.  Leaving the scene I took one last look at Maggie, getting rolled into the bright orange rescue blankets. The bruising on her face had started to look like raccoon eyes and I stiffened with the thought that maybe she did have a skull fracture after all…and that I hadn’t observed her close enough.  My next thought of course, was what could I have done differently if she was a skull fracture?

I started running down the mountain.

It felt so good to get moving again. My legs were rubbery and sore. Soon my body temperature started rising and the sweat started pouring. By the time I reached the bottom I was pulling off the extra layers and soaked again. I pulled open the door to the café at the bottom and spotted Paul reading at a table near the window. The teapot in front of him was empty. I sat down and began a litany of apologies for my lack of communication and keeping him waiting. He too apologized for the crazy afternoon of training that turned into a rescue off the mountain. He got up to buy me some tea and I went to the bathroom to wash my hands and face.

I looked like I’d been through the wars. Clothes damp from fog and perspiration, hair and eyes wild from the wind, lip cracked from nervous chewing. My attempts to make myself presentable to the café crowd were futile. I dried my face and hands with some toilet paper and went out to enjoy the hot tea and padded chair.

Epilogue

That evening, while I was driving home, Keith called to tell me they’d successfully airlifted one patient after the other, off Croagh Patrick. Maggie had gone second, and they’d left with her just after 1730h. He said both were stable and expected to do well. I thanked him for the call.

The next day Father Henry called me to say that Maggie had been released with a few stitches, and that Tina was expected to go home the next day. She had no broken bones, just a bad sprain, concussion, and a few head and facial cuts that required stitches. He thanked me profusely for my help. I felt somewhat sheepish because I didn’t really feel like I had done anything except stay with them. He told me that just being there and my reassurance that they weren’t doing anything to make the situation worse had been invaluable and extremely helpful.   

Two days ago I received a series of text messages from Tina, thanking me for my help, telling me how scared she was, and how she had been convinced that she was going to die.

I was very touched by the fact that all three people had endeavored to make contact with me and that they were so appreciative. It didn’t change the fact that I had felt helpless and useless during most of that afternoon on the mountain. But it was nice to think that in their eyes I’d made a difference.

I’d spent the 4h drive home going over the scenario in my head and thinking about all of the things that I should have done differently. I berated myself for things like not having thought of getting both of them off the cold ground right away, and not showing one of the people in Maggie’s group how to hold c-spine. All told, it was a very good learning experience. It showed me the power of reassurance, reminded me of my love for emergency situations, and reiterated the importance of never, ever, going out without a headlamp and an emergency blanket.

Tuesday, November 1, 2011

An Unexpected Test--Part II


I'd get to the girl, first I wanted to make sure Maggie was stable.

Maggie was well bundled up which made a quick primary survey almost impossible. I put my hands under her jacket and tried to feel along the bony aspect of the back of her neck. I pressed down on each vertebrae while asking if she was having any pain, numbness, or tingling. She said no.

I tried to move my fingers systematically around her skull feeling for any ridges, deformities, warm tangles of blood, boggy swelling. Nothing.

I quickly checked the pulse in her wrist—strong. That was a good sign, she had a decent blood pressure and wasn’t tachycardic, which meant she wasn’t going into shock (yet) from some hidden injury that was causing blood loss.

Maggie was alert and talking to me the whole time, she said one of the girls on the hike had lost control coming down too fast from the top. Maggie lunged after her, also losing her footing and going head first down the steep and rocky terrain. Now I was getting worried about this unknown girl and felt fairly certain that Maggie had no immediate threats to life or limb (despite my woefully brief and incomplete initial survey).  I asked the 3 young girls with her to try their best to keep each other warm, to continue talking to Maggie. I asked them to send someone over to me if she suddenly became confused, nauseated, or started complaining of numbness or tingling. 

I scurried over the slippery rocks to the second cluster of people, perched on the lateral aspect of the slope. A young girl was buried under a similar assortment of raingear and jackets, crying out in pain. Two of her teenaged friends were huddled against her, shivering in their thin hoodies and track pants. Her legs were splayed awkwardly but with no visible deformity, blood spattered the rocks near her feet. Under the hood of a green raincoat I could see that her hair was thickly matted to one side of her face with blood that appeared to have come from her scalp. Her cheek was also cut, just under the eye. She opened her eyes when I asked her to and told me she’d started coming down the mountain and couldn’t slow down, she didn’t know how she’d fallen or if she’d been knocked out.  Her pupils were of equal size, they constricted when she focused on my face, she knew where she was, and who she was there with.

Again I wrestled with the tangle of clothing trying to feel her neck and scalp. She said she had no neck pain but yelped whenever I touched her head, especially near her forehead. It seemed impossible to locate the cut as all the blood had dried in the lumpy nest of hair.  I looked in her ears and under her nose for blood or clear fluid that might indicate she had fractured her skull. Dry. She didn’t have the characteristic pattern of bruising associated with basal skull fractures, the bluish tinge behind the ear or black circles referred to as ‘raccoon eyes’.

I felt her wrist, trying to locate her pulse. As I measured her heart rate, which was fast but not worrisome, she complained of pain. I was reassured though, by the lack of a sickening crunch or odd angle to the joint, something I’d come across many times in the Whistler emergency department. I put my hands under her jacket, asking her to take deep breaths while I felt her chest rise and fall. Her rib cage felt stable and she said she had no troubles breathing. Good. She had a blood pressure and no breathing issues.  I felt her belly, tested the bones of her pelvis for pain or instability. She cried out in pain when I brought my hands down her left thigh and leg. I couldn’t feel any swelling or grinding under my pressure, the leg didn’t seem shortened but it was hard to tell and I didn’t want to move her limbs unnecessarily.

Somewhere in all of this I found out that the man with them was Father Henry, the priest who had been escorting a church group up the mountain, which is a famous pilgrimage for Catholics.  Maggie was the other leader of the group, which left him running back and forth between the two huddles, with one cell phone (and sometimes two) pressed to his face. 

It was during my assessment of Tina that I too started to shiver. Suddenly the combination of wind, fog, sweaty T-shirt, and stillness left me very cold and wishing I’d brought more clothes. I pulled on my damp wool shirt and windbreaker. Once I was crouched behind Tina with my hands along side her jaw and neck to stabilize her cervical spine, I realised that if I was that cold, the girls lying on the ground were in even bigger trouble.

At this point an athletic Swiss couple, each dressed in layers of hi-tech looking gear, arrived and offered extra coats to pile on the injured hikers. The woman pressed up against Tina’s legs, the man against her right side. Tina’s two friends took up positions on the left. A tall middle aged Scotsman came up and suggested we use his large backpack as something to put underneath Tina

I cringed with the realization that I should have thought of that ages ago.

CAcBCDE. Catastrophic bleed. Airway/c-spine. Breathing. Circulation. Disability. Environment. 

All of this had been drilled into me again only weeks ago at the Advanced Trauma in Community course I’d taken. Environment. As in, assess complications due to environment such as cold temperatures and adjust to protect against these dangers. 

And so there we were.  All of us freezing, worried, and wondering how long it would take for the mountain rescue crews to arrive, if they were sending a helicopter, and if the helicopter would even be able to land amidst the fog and wind.  I asked one of the girls to take over c-spine for me as I went back to check on Maggie. She was well bundled up and had a similar gathering surrounding her. The tall and quick thinking Scotsman and his wife were monitoring her. This gave me peace of mind over the nagging thought that I was ignoring one of the casualties. Maggie was still alert and oriented, nothing had changed since I had first assessed her. She said she was more worried about Tina than anything else. I tried to reassure her before running back to my post: holding on to Tina’s neck.

We heard ambulance sirens in the distance which gave us hope that help was soon to arrive, hopefully with blankets at least and and possibly stretchers.

“Wait!!!” I asked Matt, the teen to my left, to grab my nearby camelback.

“I had an emergency blanket in there this morning…did I leave it in or put it in my other pack?? Ohhh…” 

And then I remembered the brief conversation I had had with myself before heading off this morning. “I am only going on a road ride and a run, I am definitely not going to need my emergency blanket or my headlamp.”

Of course.  Dammit! We really could have used that emergency blanket now.  Tina was shivering uncontrollably to the point where her teeth chattered causing her to cry in frustration, “Get me OFF this mountain!!!! Where are they??”

We tried to calm her by talking about Justin Bieber, the hot blankets that awaited her, the exciting helicopter ride she was going to have…it distracted her for short periods of time. Father Henry would threaten to start singing if Tina went quiet for too long. This proved to be an effective technique for getting her to start talking again.

By now, over an hour had gone by since I arrived on the scene.  I thought about sending the teens down with one of the hikers who was offering to help. Were they going to get hypothermia while trying to keep their friend warm? Were we only creating more casualties by keeping them with us? What was the legality of sending minors down the mountain with strangers? What if we were up here until the middle of the night? I remembered only a couple of months ago a woman being stuck on Carrantuohill until 4am waiting to be stretchered off the mountain with a broken ankle.  At least now they could get down safely in the daylight. For the time being we decided to keep them with us. 

Surely mountain rescue was going to arrive any minute.
 


Monday, October 31, 2011

An Unexpected Test--Part 1

At 0800h I was standing in my room at the B & B, holding the silver emergency blanket in my hand.  I gauged its weight and worked at stuffing it into my already bursting camelback. The pack was full, mostly due to the 2L water bladder, but I had also managed to squeeze in 3 nutrigrain bars, a headscarf, my mobile, a few tissues, and a headlamp. My first adventure race was only 2 weeks away, so I had driven to Westport the night before to join the training group and suss out the upcoming racecourse. In a rush I’d ‘packed’ by basically throwing all my outdoor gear into the car, hoping I’d managed to toss in all the essential pieces of kit.
I am only going on a road ride and a run, I am definitely not going to need my emergency blanket or my headlamp. The last thing I want is an overstuffed pack bouncing on my back while trying to run” I thought.

I pulled the blanket and headlamp out of the camelback and transferred them to the larger pack that I take on hikes. This pack always contains my mitts, 2 winter hats, spare socks, earmuffs, and rain pants. Just in case.

I couldn’t have predicted that 5h later I’d be pulling the camelback apart thinking,

“Wait!!! I had an emergency blanket in there this morning…did I leave it in or put it in my other pack?? Ohhh…”

So I finished getting dressed in my long biking pants, tank top, t-shirt, long-sleeved merino wool top, and windbreaker. I usually end up overheating and cursing every layer once my heart rate gets going, but it seemed windy enough to warrant the wool shirt. I kept it on and headed out the door for what I thought was going to be a morning consisting of a bike maintenance workshop, followed by a group road ride, and short run.

Due to a miscommunication with Paul, the trainer, regarding the schedule, I ended up cycling to the base of Croagh Patrick without my running shoes. He felt terrible and offered to head back to town and collect them for me.  I was embarrassed that I’d misunderstood the plan and contemplated going up in my clips, but he insisted, so I gave him my keys and waited.

By the time Paul returned most of the training group were trickling back into the parking lot after hiking to the shoulder. He handed the shoes over and suggested that I hike to the top (since that was how far I’d have to go on race day). He gave me his mobile number and said he’d go through the rest of the course with me on my own once I’d cycled back to town, later in the afternoon.  I was so mortified over being the most high maintenance participant of the day that I didn’t mention that I had no way of locking up my road bike while heading up the mountain.  I waited for everyone to leave and then negotiated with the elderly Irishman selling walking sticks from a stall in the parking lot. I told him I’d be 2 hours maximum and he agreed to keep an eye on my bike as long as I propped it within view of the stall.

It was noon, there were snatches of blue sky scattered amongst the clouds, but the top of Croagh Patrick was wrapped in a heavy grey fog. It was the best that one could hope for in terms of Irish weather so I struck off.  I started my GPS timer and (mostly cheesy) ipod running mix, trying to move as fast as I could up the mountain, partly to take advantage of the weather and partly because I didn’t want to keep Paul waiting once he was done with the training group.

An hour later I was nearing the top of the mountain, which is mostly a rocky scramble. Despite the cold wind and scattered rain, I had long ago shed all my top layers and was down to a sweaty t-shirt. I was hammering away with Daft Punk and Fat Boy Slim blaring, feeling good.

Then I saw a small cluster of people crouched down on the trail ahead.  I thought for a moment that it was just a group of melodramatic teenagers taking a breather from the sustained final push to the top. Then I noticed that one of them was lying on the trail with blood on her face.

I crouched down and she opened her eyes. I asked what had happened and if I could help. The person on the ground was a woman in her thirties with soft brown curls framing her bruised and swollen face. A cut across the bridge of her nose bled in a line down her cheek and along her neck. She was covered in a mix of raincoats and sweatshirts, visibly shaking. Her clear blue eyes opened when I asked her her name and she told me it was Maggie. A hover of teens surrounded her. They said she’d fallen and hit her head but she hadn’t been knocked out. A frantic looking middle aged man in a blue cableknit sweater and khaki pants spotted with blood approached me and said that mountain rescue had been called and that they were on their way.  I asked if there was anything I could do, he said “Uhhh…I don’t think so, mountain rescue will be here shortly…” 

In these situations I never know how to state my credentials, going into a ramble about being an ex-ER / arctic nurse, now 3rd year medical student, with a smattering of trauma and backcountry courses, seems a little too long-winded and confusing. So I decided to distill it down to ‘student doctor’ even though it sounded vaguely ridiculous at the time. Especially since that part of my background was probably going to help me this least at this point.

“I just want to make sure she’s ok, I am a student doctor...can I quickly check her out?”

“Wait…what?”, the man said, “oh thank God! You’re a student doctor? Once you’ve looked at Maggie can you come and see the girl? I think she is in worse shape.”

The girl?

It was then that I saw a second huddle of teens away from the trail, on a steeper aspect of the scree, about 5 meters away.

Oh dear.

Monday, October 24, 2011

I Heard It!! I REALLY heard it.

Small miracles, tiny accomplishments, baby steps forward.

Some days in medical school it feels like the 'teaching' just boils down to constantly being told how many differential diagnoses you forgot, how many signs you failed to elicit, and how many questions you didn't ask the patient. The constant deluge of information and things you ought to know by this point can begin to feel suffocating.

Until a miniscule but measurable gain occurs and suddenly, it seems worth it.

Like today...I actually clearly heard my first heart murmur which I confidently and correctly identified after performing a decent cardiac exam!!!

Pretty sure that at the exact same moment a unicorn was born and a leprechaun discovered a pot of gold.

I honestly thought that heart murmurs would always be a mystery to me and that there would never come a day when I'd be able to do anything other than pretend I heard it. 

But, nay! I heard it. I really heard it. And strangely, that made me smile. All day.     

Small miracles.

Sunday, October 23, 2011

Mind Go Blanko

On Friday my new consultant (MNC) gathered together myself and the other doclings to do some bedside teaching. Normally I try to slink between the folds of curtain during these sessions as I really don't want to be pimped on differentials for pseudopseudohypoparathyroidism or some other disease dredged up from the Annals of Obscure Internal Medicine. But since MNC hasn't seen me examine / present yet he asked the handful of final meds to step away from the morbidly obese no-necked man who was sleeping with his feet at the head of the bed, and told me to conduct a complete cardiac exam and report my findings.

Yeah. It was sub-awesome.

First of all, I could hardly feel his radial pulse and my racing thoughts kept forgetting where I was in my count...was I at 14 or 24 when I had counted 15 seconds...wait...did I start counting when my seconds hand was at the 12 or the 1 position...where DID his radial pulse go--GAH!

Then I attempted to feel his carotid pulse which should have been located somewhere between his clavicle and angle of jaw (which were, in his case, resting comfortably on each other, heavily padded by folds of flesh). No luck, despite the patient kindly allowing me to dig around there for a while.

JVP? No. Bueno.

Ok, and on to the apex beat. Not so much. Heart sounds?? Is this stethoscope on?? Tap. Tap. Tap. I can't actually even hear his heart beating--hark?! Is that it?? No, that is the sound of my own blood rushing through my ears...

And now to my dazzling presentation. Sure, I'll just neglect to mention that he was hooked up to telemetry, and that he had cardiac meds at the bedside...even though MNC kept asking me, "is there anything else you'd like to comment on??"

"Er...he has a midline abdominal incision??"

"No, he's on telemetry."

"Oh, right." Yeah, the device you hooked cardiac patients up to everyday in the emergency department. The painfully obvious tangle of colorful wires stuck to his chest. Yes, those.

Surprisingly MNC did not shred me into tiny bite sized pieces. I suppose he just assumes that 3rd years are clueless. The major bummer was when he turned to the final meds and asked them how to manage the patient. I had to fight hard to not pull a "Summer" from School of Rock...

"Oooh! Ooooh!! ASK ME!! I know how to MANAGE a CCF patient!!! Really!!! YES!!"
But, no. My medical self had failed and my nursing self couldn't help me now.

Ah well, maybe my extremely low bar setting means I will appear to shine upon my next opportunity to examine and present.

Maybe.

:)

Thursday, October 20, 2011

Alright. Medicine, I misjudged you.

I am sure this will induce some smugness out there to you medicine-y people, so I will say it just this once: you were right.

Internal medicine isn't terrible. I have seen some really interesting cases and signs...water-hammer pulse, palpable heaves...murmurs, palsies, and masses oh my! DiGeorge syndrome, death, dementia, failure to cope, hyponatremia, acoustic neuroma. And that was just one patient!  (I'm kidding. Sort of.)

The other good thing about this rotation is it has definitely removed any lingering doubts that I want to go into surgery or acute care. Internal medicine is just not my cup of tea, which is a good thing know when you are someone like me who finds something of interest in everything I am exposed to.

In other news, training for my race is going...well, it is going. When I see what I am supposed to be able to do at this point (as per the schedule they gave us with registration) I get a little nervous. It is only three weeks away and I haven't been doing multi-sport training yet, mostly because I just don't have time to do a 3h cycle followed by a 1h run in one day. I've just been trying to get out at least 5x per week with one sport at a time. This is not really good enough but it is all I can do right now.

I have already given a heads up to my medical team that I may end up becoming one of our patient's on Nov 12th. I know the registrar will take good care of me, she's very smart.

And now I must return to my daily meditation on the kidney, the neuro exam, and all things cardiac.

Sunday, October 16, 2011

I Have "Hapless Female" Qualities

I took my little blue beauty into the bike shop today after my cycle for a 'tune up'. It was embarrassing.

Me: Hi. I bought the yearly maintenance package for my bike and I wanted to bring it in...

Bike dude [in hurried manner]: Ok, what does it need?

Me [suddenly realising how ridiculously hapless I am at very basic bike maintenance]: Yeah, it pretty much needs...um...air in the tires, a little oil on the chain, and...I dunno, the pedals tightened? Er...maybe the shifters...[stares at ground, toeing invisible mark on floor] shifted...[trails off, mumbling incoherently]

Bike dude [expression softens as realises he's dealing with moron of epic proportions and takes pity on me]: Ok, that shouldn't take very long [chuckles to self] we should have it ready by Wednesday [enunciating well and speaking very slowly].

Ok, so I am a ridiculous damsel in distress when it comes to my darling road bike (and killing spiders). 

Today's event cancels out the fact that I wielded very heavy machinery last week in a very non-girly way (with a steady hand and...ok...the odd high pitched squeal of delight).

I hate those moments when I feel like a hapless female, but dammit I don't have time right now to learn about gear shifters and spider aversion therapy...I am in the thick of it with trying to piece together a smooth cardiac exam without being reduced to a blubbering mess in front of the ward sister, the reg, the SHO, and several medical students.

And so, for now, I pay the bike shop 25 Euro a year for unlimited bike maintenance. And I am ok with that. Usually. 

Friday, October 14, 2011

Clinical Exam Follies and Triumphs

This week I had the opportunity to invigilate a licensing exam for doctors here in Ireland. Though no one actually said anything to us about confidentiality I am very certain that I am not able to blab about any sort of details. However, I will say that it was a fantastic learning experience to see how different people perform under pressure, how examiners basically set out to shred you to pieces, and how little things can really affect one's rapport with the examiners.

One thing I will take with me for when it come to be my turn on the sharp end of the short-case examination:  if you are told "examine body part [x]" then EXAMINE BODY PART X!!!!!

I was stunned to see people being told specifically to examine one organ or anatomical location to find them faffing around with other systems, only to the irritation of the examiners. The examiners would sometimes have to repeat themselves several times, "stop, examine x!"

There was one candidate who was my hero. She (somehow) remained calm, did very methodical and well organized physical exams, could rattle off differential diagnosis like a champ, answered all the examiners questions clearly and precisely, and was really personable to the patients. I was mentally cheering her on the whole time and wishing I was her. I also felt devastated for the people who started floundering, crashing and burning, knowing all too well the negative spiral of

stressed
mind blank
higher stress
flustered
adrenaline injection
mind completely barren of thought
fear of failure
despair
quavering voice
certainty of failure 
despair
despair
despair.

It was somewhat reassuring (or depressing, not actually sure which) to see that even people who have been doctors for years still get stressed and fumble during clinical exams, it is not just we doclings. 



Monday, October 10, 2011

Good And Bad

This Saturday my interview on CBC's national radio show White Coat Black Art will be airing. I am a little nervous (ok, a lot nervous) about how it is going to turn out. The interview with Dr. Goldman was the day after my USMLE exam so there were a couple of reasons that I may not have been overly articulate. However, I still really enjoyed the whole experience and was flattered to be asked on the show (considering I've been a dedicated fan and listener since it's inception years ago).

My prediction is that my contribution will only be a tiny piece of the show, but I am still excited and pleased about the exposure that the blog will receive. Of course now any thinly veiled anonymity will be removed and I'll be having to keep Asystole on an even straighter and narrower course. 

The interesting outcome of increased traffic is usually increased trolls. I was really surprised (oh, how naive I am sometimes) at some of the troll-y comments when my "Advice to Interns" pieces were published on KevinMD during the summer. I suppose I just have to remember that some people really take themselves too seriously and do not understand 'tongue in cheek' nuances.

So we'll see, maybe trolls, maybe increased traffic, maybe nothing.

For now I am being kept quite busy putting together my research project (in surgery, of course!), training 6 days a week for the big race next month, compiling a report on the elective /residency woes of Canadians Studying Abroad (CSA's), and trying to keep a smile on my face.

That last part is sometimes proving to be the hardest of all tasks! But as Shakespeare rightly pointed out in Macbeth, 

"Come what come may
Time and the hour runs through the roughest day". 

Sunday, October 9, 2011

Jaws of Life Teaser Photo

I am writing a post about the brilliant trauma course...but in the meantime...allow me to present ABB wielding an actual jaws of life. This photo taken shorty after I cut a car door off (hence my demented appearance).

Does this jaws of life make my thighs look big??


The really hilarious part was that the firefighter handed it to me, showed me where the 'on' button was and then told me to 'work away'. 

Yeah, in Canada I would have had to take a 2 day safety course, sign release forms in triplicate, show proof of tetanus immunization, and demonstrate to a workplace hazard team my ability to handle the machine before being allowed to turn it on.

What could possibly be more enjoyable than handling a machine that crushes metal at 600lbs per square inch???

Oh 'twas a good day, so it was.

Friday, October 7, 2011

Good Trauma

For the past 2 days I've been at an Advanced Trauma in the Community (ATC) course, and yes, I did get to smash a car window and use the jaws of life! There will be photos and yarns soon to follow. Oh, and a breakdown of how I cycled through wanting to be a firefighter, police officer, and paramedic throughout the day.

If I had been wearing Star Wars pajamas then I probably would have completely morphed into the 7 year old boy living inside of me.

Trauma, woot!!

Sunday, October 2, 2011

Sunday Riders

So today Pádraig (the surgical SHO) and I decided to do a reckie of the road biking portion of a race he's competing in next week. We started at the Gap of Dunloe (a.k.a Kate Kearney's Cottage) and ended at the Torc Mountain waterfalls. A fabulous ride in part due to the spectacular scenery the entire way, and a delicious visit to my favorite purveyor of fine Irish food: The Avoca Café.



I also learned a couple of things today. For instance, my tiny little sewing-machine of a car can fit two road bikes in the back and two people who love blood and guts in the front. GO TOYOTA YARIS!




Another lesson learned was that not only are directions from Irish people usually nonsensical and obscure, the road signs are equally unhelpful. Unless, of course, you are looking specifically for tea and scones or a farmhouse with ensuites. Have you reached a fork in the road on random back country lane? Are you searching for a particular town or road number? Sorry. Can't help you there. Tea and scones? Take a left.

I've been to the Moll's Gap Avoca a couple of times but have always approached it from a different direction. So after a particularly sustained uphill we decided to pull off and have snacks, figuring the Avoca was at least another 20kms or so away. After some Clif bars and trail mix we started up again on the bikes, only to come across the "AVOCA, 500 METERS" sign within about 3 mins of departing.

I did hear Pádraig scream "NOOOOooooooooooooo!" through the fog.

I think he made up for the disappointment in having already eaten lunch by putting himself into a pre-diabetic-coma with the most delicious banoffee dessert evah.


And it was all downhill from there, friends. An outstanding day, topped by my new routine of sauna / ice-cold shower / sauna / ice-cold shower at the gym.

Ain't life grand?

New purple Icebreaker, for the win.

Friday, September 30, 2011

Fin

Well my first official hospital rotation has come to a close.

Today was my last day on the surgical team and I found myself staring off into space more than once, feeling genuinely sad. It seems like the last 9 weeks screamed by at break-neck-running-behind-my-consultant-speed. The thought of starting on a new team is a little daunting. I feel as though I just figured out my true place with this team, and that I was starting to habituate to their rhythm.

The apple crumble made big waves, the pan licked clean before the end of 1st tea break. The nurses and porters seemed genuinely shocked that I baked for them and many approached me to say thanks, or "fair play to you" which is the Irish equivalent to something like, "well done" . The porters also pretended to have food poisoning all afternoon (yes, pretended) and one proposed marriage.

When the last stitch was thrown in the belly I didn't know if I should shake M.C's hand in a formal manner, or make some cheeky comment (more my style)...so I just had my chlorhexidine shower (as per MRSA case protocol) and went to the gym.

I was happy to hear nothing but silence when I arrived home. The alarm people had to come and tear everything apart because the thing was completely haywire. I think I am going to start calling the alarm system, Hal, from now on. I was able to un-tape my memory foam pillow and yoga blanket from the wall (dampers) and make dinner without earplugs in, which was a pleasure.

Tomorrow I am going to attempt to review some medicine-y things. Like the heart. And probably the lungs. Look up Na+ levels and try to remember what exactly this condition known as diabetes is, which has come to mean only really really bad leg ulcers in my mind.

And so, I begrudgingly shelved my Surgery at a Glance, Surgical Recall, and my Physical Signs for Clinical Surgery and ordered The Oxford Handbook of Clinical Medicine.

Speaking of clinical surgery...if you haven't watched this TEDtalk by Abraham Verghese, please go make yourself a cup of tea and spend the next 18 minutes watching an extraordinary author and surgeon discuss the lost art of physical assessment. It is another typically awe-inspiring TEDtalk.

It is late so I'll close with a quote by Yeats, cited in Verghese's book, Cutting for Stone, 

The intellect of man is forced to choose
perfection of the life, or of the work, 
And if it take the second must refuse
A heavenly mansion, raging in the dark. 


Thursday, September 29, 2011

Weak Week

Tomorrow is the last day of my surgery rotation (boo).

My house alarm has been going off for 2 days, unrelentingly. The alarm company wont shut it off because we are not the 'homeowners'. My landlord is away on holiday and unreachable. I spent last night trying to sleep with earplugs in, a pillow on my head, fan blowing in my face, "Tibetan Rain Song" blasting out of my ipad, and my dormer window wide open. All in the hopes that the combined white noise would drown out the loud BBBEEEEEEEEEEEPPPPPPP! that goes off every 3 seconds.

It didn't.

I am considering a B & B for the weekend if we can't disable the alarm by tomorrow. It is like Chinese House Alarm Torture. Believe me, we've tried everything. Including punching the key pad (which strangely didn't work).

Did I mention that I am also in a bad mood because tomorrow is my last day of surgery? Oh right. I did.

:(

:(

:(


The only nice thing is the scent of apple, strawberry, blueberry crumble wafting up the stairs. I am bringing a vat of it tomorrow as a thank you to the theater staff (who have, for the most part, been amazing).

Now I must get to my thank you note writing. And it's 2335h. And I am getting up at 6. Gah. (I use the term 'getting up' instead of 'waking up' because if tonight is anything like last night, I was woken every 40 mins or so BY THE BLEEP OF PROFOUND ANNOYANCE and was wide awake when my alarm went off.

Ok, that is enough whining for one post.

Sunday, September 25, 2011

Another Charming Trend in Medicine


"IMG" means "International Medical Graduate". As in, anyone who studied medicine outside of Canada and wants to do post-graduate studies in Canada.

Did I mention there are 45 Canadians in my medical class alone?

Dare I delve into how many of those 6.5% matched to something other than internal or family medicine?

Hello, Ireland. Need a doctor?

Little Things, Like Spicy Pickled Eggplant

"I'm Paul Kennedy, and this...is Ideas"

Because sometimes it really is a collection of little things that make me oh so happy.

Friday, September 23, 2011

Adventure Racing


Today I registered for my first adventure race--and I am ridiculously excited (and scared!)

I am not exactly sure what I am getting into but it combines three sports that I am moderately un-terrible at (cycling, running, and hiking) set in an area of Ireland that I've always wanted to explore.

It is the Sea 2 Summit race in Westport, with part of the track going up Croagh Patrick (the Magic Mountain--apparently you can lessen your purgatory sentence if summit it barefoot). I suppose my main reason for possibly biting off more than I can chew is that my days are wonderfully full at the hospital but my evenings and weekends sometimes feel a little...well...empty.

Don't get me wrong, I've been enjoying hikes out and some of the new people I've met, but I find that these days, the only time I feel really good is when my heart is pounding and I'm trying to ignore the singing of my muscles. I thought it'd be ideal to have something to train for. The added bonus being that there is no water sport involved which means no one has to see me thrashing about in a bathing suit like a wounded walrus. WIN!


Did I mention I am scared?!

Thursday, September 22, 2011

Last to Know

So, why is it that no one ever told me about surgical critical care as a specialty? It basically combines all the things that I love: really sick patients, emergency medicine, critical care, and...surgery...!

What? Why was this option never presented to me at career day in high school?

Off the cuff one day M.C told me I should consider trauma surgery (yeah yeah, OMDG I hear you snorting) and I brushed the suggestion aside because I would like to start my career sometime before the age of 45. But I've started looking at some of these different fellowship programs and (Trauma! Surgery! and Critical Care! Oh my!) they sound ahhhh-mazing.  

How seriously bad assed would that be? I can only imagine people who have that training must land in the department completely dressed in black, crashing through ceiling windows, and worming their way under laser sensors to get to their patients, because that is how medical ninjas roll.

I just hope I am married by then because LORD knows no man will have me if that is the career I choose.

Anyway, just reading the program descriptions makes me slightly wide eyed.

The problem is, I could also see myself running a vegetarian aromatherapy clinic where we sit and knit our own yogurt after telemarking to work.

And thus continues the fight within me on choosing a medical specialty. My complete love for living the simple life in the mountains, attending bake sales for the hockey team, and making soup is at odds with the part of me that could live in a crazy wild big city cracking chests in the ED by day and going to the symphony at night.

The only thing that really comforts me is that M.C also said, "I think you'd be good at anything you do". Which is no small thing, coming from someone who you have a great professional respect for.

So I suppose time will tell.