Dreaming

Last night I dreamt that I was skiing. It was one of those powdery-goodness days. I was flying, and landing.

More often than not I have nightmares, so this was a wonderful slumbering reprieve. This morning I remembered it so clearly, it left me giddy with the emotional imprint and a little sad with nostalgia.  I wanted to make a post about how much I miss certain parts of my former life. I found this post from my original blog, Feb 20th, 2008. And of course, a video which ought to make you laugh. Turns out transitioning from telemark to alpine bindings isn't that easy (i.e. 'fixing the heel does not necessarily fix the problem).

---

Anna and I had one of those perfect days at Rogers Pass yesterday. Bluebird skies, great snacks, good conversation, fluffy snow, warm sunshine. It rocked. We went to the "toe" of Pearly Rock and did two mellow loops and enjoyed a picnic lunch in the sun.

After I slid backwards, slow motion style, into the tree well Anna took over the trail making part of the excursion. The new bib pants paid for themselves already, kept me nice and dry despite the 'face shots' which were in fact, ass-over-tea-kettle-shots...though I did find pine needles in my underwear and bra at the end of the day...not sure how they made their way there...

Anna patiently letting me take her photo before dropping in...

I asked Anna if she wasn't afraid of losing her sunnies in the snow--only then realising that the former heli-ski and backcountry guide probably hasn't wiped out since 1995. I remembered: not everyone goes halfway down the fall line on their ass like I do.

These guys poached our line while we were snacking....which is what you get for making most of the sweet uptrack I suppose. No bother, there were still a few acres of freshies to be had. And plenty of space for me to drop and roll. And yard sale. Behold the video of humiliation. 

Woot! Some proof that I can stay upright after all!

Put Your Finger On It and Think

Yesterday, my histology prof (a.k.a Long Bones) was trying (in vain*) to have us identify an arteriole on a liver slide. Her way of describing it was a "fire hose".  Some of the students pointed at bile canaliculi or central veins, until she took the laser away and pointed to a tiny arteriole. Ok, maybe something that looked like a microscopic, tissue colored fire hose.

Many of us chuckled, so she told us not to underestimate the power of an arteriole, or an arterial bleed. I can definitely say that I have respect for the little fire hoses of blood when they are cut, but many of my classmates have never seen such a thing, except maybe on an episode of Scrubs. 

At this point, Long Bones uncharacteristically decided to tell us a story about her days as a junior doctor (I always find it entertaining to imagine these uber-talented-experienced-confident profs as bumbling-inexperienced-trembling interns). Her surgical prof in medical school used to always tell them: when you cut an artery and it starts to bleed, just put your finger on it and think. They used to laugh at the constant repetition of his seemingly trite advice.

Just put your finger on it and think.

One day, young Long Bones was in the ED and received a patient who had been bitten by a sheep. A nice deep bite to the upper thigh, complete with a large hematoma. She got to work scrubbing away, and figured she'd suture it. She saw this giant blob (yes, a clot) which she pulled off. The artery sprung to life and sprayed her face, her hair, and the wall behind her. Instantly she knew what to do, despite never having encountered an arterial bleed. She didn't panic.

She put her finger on it and thought. Then yelled at the nurses to call the surgeon.

I love those stories, the ones that tell you--hey, accept the fact that you will make ridiculous mistakes, and you will learn from them, and you will gain a new appreciation for those pearls which fell in your lap during your education.

Yes, it reminded me that I actually love being in medical school.


*Pun intended, of course. 

Histology Quotables

Today's lectures were rife with classroom quotables, I'll put them out tomorrow. But for tonight, I'll leave you with my favorite, from my histology prof:

"Every time you take a drink, God kills a hepatocyte".

Taken from http://www.apn-histopathology.unimelb.edu.au/gallery.html

And on that note, a cocktail I created tonight, which I named, "The Majestic River Shannon". It is a glass of cava (brut) with a splash of elderflower cordial, and a peeled quarter of orange. Deeeelicious.

And yes, I may have had one or two before making this post. Forgive grammar, punctuation, and spelling...

Classroom Quotables

Today the Associate Dean was addressing our class and said*, "the great thing that distinguishes man from beast is man's ability to take medication".

Nice one Dean-o.

*This was said in a very tongue-in-cheek manner, for the record, it was when the subject of polypharmacy came up.

Check. Reality.

If you want the whole story, go to Head Nurse's blog. Read about how a thank you letter to Roger Ebert turned into a tweet from him, which resulted in some very deserving people getting a little help from a lot of strangers.

It is a story of a young man, dying of cancer. He and his wife are trying to patch a living together for his final months on the planet. Because his insurance coverage is now non-existant, they are having to worry about how to pay rent, and how they will cover the cost of his palliative medications (oh, on top of coming to grips with being newlyweds that are now discussing his funeral and how he hopes to spend his remaining days). Inhumane. It is shocking to me, to read this, from citizens of one of the richest countries in the world. The advice they were given: move to Canada.

Well, they can't move to Canada.

But maybe Canada can still help out a little.

I am not an 'internet donation' person but this is legit, and these folks could certainly use a little help.

Father Ted - Road Block

Where did the weekend go and how is it that I got so laughably little done?

I've decided I have a nightmare problem. Well, I have known for a long time that nightmares seem to be my natural go-to in dreamland, but lately it's been getting ridiculous.

For example, last night I went to an Irish friend's house for a Father Ted marathon, and this was the final episode, "Speed 3". If you watch the clip you'll get an idea of the sheer ridiculousness of the show.

And yet, somehow my gray matter twisted the evenings entertainment into a nightmare that involved me having to drive a bomb-laden car to my epi prof's house to be disarmed. I awoke, very much afraid and then very much irritated at the realization that I can't even watch Father Ted without having to worry about my subconscious interpretation once I am asleep.

It is a drag. I mean, I'd really like to see Black Swan but I might actually have a heart attack in my sleep.

Slacker

Today I went to the Annual Research Day forum that the school puts on, which showcases relevant medically related studies that are being conducted by faculty and students.

I have already decided that I will likely be doing a lit review for my research project next year, so I was mostly going just out of interest to see what the kids are up to these days.

Turns out, I am a crazy slacker. I mean, I am a playing-videogames-in-my-mom's-basement-and surviving-on-delivery-pizza-and-cheetos level slacker in comparison to some of the other medical students in my program.

Yeah, like the 4th year who is on the National kickboxing team and also doing this extensive colon cancer gene marker study, looking at metastasis likelihood and risk/benefit of surgical intervention .

Oh and the 3rd year who is helping set the guidelines for radiation therapy in rectal cancer, thanks to his study. He's the class rep as well.

I could go on.

It could have been inspiring if it hadn't been such a 'kick up the hole' as they say here. What the hell people? I am barely holding on to regular exercise and a wee mandolin hobby here. You're out CURING friggin' CANCER! How??? They better have a pharmaceutical addiction or something.

Actual Fact

Ok, sorry, call me Beavis (again) but...

Yesterday, our GI lecturer's name was Manus.

All it takes is one apostrophe. One apostrophe people!

Now THAT is some good craic.

It's Not You, G.I.T, it's Me...

I swear, I am still on 1/2 speed since my return to school (I won't say Christmas 'holidays' because it really wasn't much of a holiday at all, and I don't feel like sullying the term).

I just can't seem to get my thoughts together and concentrate, AT ALL.

Things are slowly starting to ramp up, study group is starting to meet again this week, USMLE prep course starts again next week, anatomy group is back at it, my own USMLE prep is *cough* ongoing, I am supposed to be playing music for this fundraiser thingy but have to dust off my vocal chords before the event, etc. etc. But I don't feel like my brain has checked in, just yet.

Our case last week was a patient with Graves' disease, this week it is inflammatory bowel disease.

Thyroid. Yawn.

Bowels. Double yawn.

I guess I can cross endocrinologist and gastroenterologist off my list of 'possible careers'. Sweet. Now I am down to only 47 options.

Maybe it isn't the gastrointestinal tract I hate so much. Maybe I am just getting a little burnt out by this whole PBL process (hence the new countdown screen on right margin). Apparently this is a common finding among medical students around this point in their studies.

I know, this too shall pass!

On the upside--I am going to see both Ray LaMontagne and Iron and Wine in Dublin! Very stoked! And also excited that my good friend Cathy Lee will soon be here visiting (in time for the Iron and Wine concert). So some things to look forward to.

Wordpress vs Blogger

I am thinking of moving to Wordpress...has anyone else done the swap or have some thoughts on this?

I just like the layout on Wordpress better.

Do I really need to do that though, or am I just trying to find a way to kill a HUGE amount of time rather than study inflammatory bowel disease?

In other news, today I realized that my new haircut no longer allows me to look like a normal woman at the gym.

Note ridiculous hair nubbins poking out the side of my head.

Nope. Now I look like a woman who is trying to look like a 5 year old girl.

This completely destroys the months of attempts at gaining street cred in the gym here where 99.9% of the time I am the only woman lifting weights, surrounded by testosterone-crazed-bowling-ball-headed-whole-chicken-eating-febreeze-spraying rugby players.

Gone, in the snip (or two) of a scissor.

Heads Up

Based on descriptive cellular pathology terms...if you ever look through a microscope and see this:

Your patient has papillary thyroid cancer.

Go figure.

That representation of Annie has always creeped me out. Now I know why.

Saturday Morning Thought Invasion

Tobie has been in London for the week, and I have been missing his sweet face. Yesterday he and his parents returned (yes, they are still visiting). It is lovely to have him back. I never sleep well when he is away.

I woke up early this morning, just a little of the gray light starting to illuminate our bedroom. I looked over at Tobie, his face silhouetted against the window and thought,

"no signs of exopthalmous".

How romantic. 

Being in medical school seriously fecks up the way you look at the world.

Like yesterday also, I was sitting in my histology class and I noticed my prof had a long, surgical looking scar running along the lateral aspect of her leg. Her voice turned into a drone as I pondered, "did she need surgical repair of her fibula? I wonder how she broke it? Maybe she needed a fasciotomy for compartment syndrome? Wrong side for the usual vein harvest, maybe she had bad varicose veins?"

Then I realized, it was a run in her pantyhose.

I really need to get a new hobby.

Narrowing Down Future Career Paths

I was going though some old files on my computer today and came across a document named, "Things I Know". Naturally, I wanted to jog my memory and see what it was that I once thought I knew about something.

This is all that was written:

Things I know:

-I don’t want to do a job where volume is key, i.e. that I need to see 60-70 patients a day to meet a quota/keep the tofu on the table

-I like quality, not quantity

-I do like fast paced, hard work, unpredictable work

-I like doing, not thinking or watching or waiting

-I like skiing.

 

Well that about settles it then.

*Facepalm*.

Medical Jargon

When a health care worker becomes a patient, is it lame or appropriate for them to use medical terminology when talking to their care providers?

I am (as usual) on the fence with this one.

A part of me finds it borderline irritating sometimes when people present to triage and say things like, "I've had some discomfort beneath my xiphisternum for the past three days, not sure if it is from the NSAIDS that I've been taking or if it is a hiatal hernia, or what.." Or "my nephew has just fallen skiing, I am pretty sure he's torn or partially torn his ACL, his drawer test is positive and he's not weight bearing".

Naturally the thoughts running through my head will include; "are you telling me this as a secret hint that you are a HCW and therefore should be seen more quickly than the sicker people in the waiting room?", "are you using medical language because of it's precision and beauty, or as an attempt to make my assessment easier?", or "are you having a difficult time accepting that you are a patient and are trying to desperately hold on to your normal power position in this setting?"

And then I realise that I am probably over-thinking the whole thing. Yet the feeling of vague annoyance lingers.

Of course, when I went to the sports med clinic with my shin splints a few years ago I wrote, "bilateral anterior tibial pain" under the chief complaint box. Why didn't I write "shin splints"? Well partly because I didn't know for sure if that is what it was, "leg pain" seemed too vague and I could perfectly describe the area of discomfort using those words. I am pretty sure the MD who saw me thought it was douche-y (the only explanation for his terrible assessment and treatment).

Since then I try to just let go, accept that I am the patient and write things like "knee pain" in the chief complaint box when I go to see the orthopod. Even through it is "midline, subpatellar discomfort on palpation and with weight bearing exercise".

Thoughts?

New 'Do

Warning: Girly post regarding hair. Normal posting will resume again next time.

So I chopped my hair off. It is not the dramatic inch-long version that I did 11 years ago when I went to Asia the first time, but it feels pretty dramatic to me right now and I find myself waking up and touching the back of my head going, "really?"

Tundra tresses à la Canadian Arctic. 

After the Asia incident grew out I kept it pretty long. But I loathe having hair in my face so 98% of the time I wear it in a messy bun of some sort. Especially at work following a nasty catheterization experience wherein my hair fell from behind my shoulder into the dark, dank, yeasty thigh crease of a morbidly obese patient. I then had to sit in the ambulance transferring that patient for the rest of my shift and I can tell you I came pretty close to an ambulance hair cut on the way back from that drop-off!!

The permanent expression on my face in the hospital.

So the odd, odd time I'd wear it down, I didn't feel like it had any pizzaz to it. Mind you that might have had something to do with the fact that I spend about <1 minute getting myself ready to hit the town usually. 

To be fair, I was caught in an Irish rain storm that day. 

Ok let's be honest. I wore my hair like this. Almost. Every. Day. For probably the past 7 years. 

My, what a dazzling bun you've got there! 

 And once in a blue moon I'd mix it up with the Robert Palmer music video look. 

It was, in fact, a coincidence that we all wore stripes to the final exam in December.
I think we all felt an underlying 'imprisonment' vibe which we needed to express. 

So Tobie's sister is a killer hairstylist and she happened to be visiting over the holidays. Her take on style is that you should only keep one hairdo for 5 years and then you have to let go and mix it up or you'll end up looking dated. 

I let her at it. Still easing into it and deciding if I like it. I tried to take some nice photos to show y'all but every one makes me look like a complete tool. Ah well, here they are anyway! 

Tool: full frontal. Black and white unsuccessful at making me look
less "tool-ish". 

This is how it looks from the side when I am staring passively off in the distance. 

This is how it looks when I am self-consciously pawing at it and suspiciously staring to my right. 

This is how it looks when I've been doing CPR for 40 mins and can't
push it out of my face because there are questionable fluids on my gloves.  

So I did find the fatal flaw to the style a few days ago when, as mentioned, we had a very long code. It gets in my face when I lean over to try and do shit. This is annoying. I am going to have to figure out some pathetic way to bobby-pin it back or something at the hospital. And at the gym. But otherwise...meh. Change is good, so I've been told.

North West Passage

One of the enjoyable things about studying in a different country is learning the local twists and turns of culture, specifically medical culture and language.

To me, the Irish have a musical lilt to their speech which I adore. I find my own voice and accent sound harsh to me now, to the point where sometimes I catch myself wincing when I speak. The North American prosody seems halting, staccato, and brusk where the Irish manner of speaking is sing-song, soft, and rolling (with some exceptions, naturally).

To add to the charm, they have an immense vocabulary of slang (the particularly entertaining ones are usually some sort of insult--like wagon, spanner, minger, puck, tosser, dosser, knob, wanker, scobe). Hmpf. Might have to make up my own version of Santa's eight reindeer next year.

Anyway, one expression that slays me every time is the euphemism "the back passage" for rectum.  This is actually used even in our clinical labs, profs saying things like, "d'you know now, if someone has a low BP and has a history of ulcers, he may be bleeding out the back passage". To which I have to hide my snicker and "did anyone else find that hilarious" expression. Call me childish. Call me Beavis. But it is beyond my control.

So a few days ago we get a call for a woman who has elevated blood sugar and decreased consciousness. The two paramedics I am with go into the bedroom (which I have found is always up a narrow flight of stairs and/or the smallest room in the house). I physically couldn't have fit in there even if I had wanted so I stand outside and talk to her sister. The sister is a right proper older Irish lady who is shaped like a refrigerator box on sturdy legs with her hair in a bun, and a thick cable knit cardigan slung over her shoulders.

I was asking about medical history and specifically diabetes history to which she informs me the patient has none. She very sincerely started telling me about the patients meds, and about a 'bad turn' she had last year when they gave her some medication up the back passage which sorted her out immediately.

In my state of sleep deprivation and dangerously high levels of caffeine I was borderline giddy as it was, but she had just struck my professional Achilles. I bit down on my lip and looked at my gloved hands.

"Mmmmhmmm", I say, thinking, arrange face in serious, concerned manner.

"Yes, I am not sure what it was but they gave it up the back passage and it really seemed to work!"

"Okaaayyyy. Well I am not sure what that might have been but they'll have that info at the hospital I am sure." Please don't let her say that phrase again or I'll lose it. 


"Yes, now that I think about it, she'd never been given anything up the back passage before..."

I felt my face uncontrollably twist into a semi-grin and I tried to mask it by faking a twitch and then a cough. I mumbled something about needing to fetch some gloves out of the ambulance and bolted, pretty sure that I was the most horrible, unprofessional, medical student/nurse that had ever responded to an EMS call.


I just can't help myself. Especially after working in the Arctic. All I can see in my minds eye is Cabot or Amundsen with a fortified ship and compass trying to negotiate their way up the back passage. A journey no man had undertaken before, one they may never return from...heh.

Beavis. I know.

Chopped It

Took the plunge and chopped the 'do tonight!

Eek!

Still adjusting.

Oh right. Patients!

Just getting ready to crawl into bed after a long and harried day with the ALS crew. Oh and what a day it was. The glory of emergencies!

I mean, real ones...not the 'I saw an old guy going slowly down the street with his walker so I dialed 999' [true story that happened on my last shift].

I even managed to make myself useful and do a good thing. After a day of trailing with a kit bag it was nice to feel useful instead of useless for a moment. But that is a story for a day when I don't have to wake up again in 6 hours.

A nice reminder that I am learning applicable things! Information that is making my differentials more astute, my understanding deeper, and my realization that 'holy crap I don't actually know anything' crystal clear. It's always good to be reminded of the light at the end of the tunnel and what this is all truly about--patients! Not spotters, or papers, or OCASE's.

It is also good to realise that wow, I'd never want to work as a nurse in that hell hole of an emergency department. I thought the situation was dire in some of my previous Canadian haunts but, well, it was the Hilton in those places compared to what I saw today.

Sleep time.

EMS excitement!

Tomorrow I start my week of shifts with one of the ALS paramedic crews in town. I really enjoy spending time seeing things from another health care providers perspective. My experience is so limited to emergency departments, I find it fascinating to see what goes on in the pre-hospital setting before our worlds collide in the hospital.

Always thought I'd want to do trauma medicine (especially flight medicine when I was working up north). So this will be another exposure for future consideration. Most of the time I think my emergency stint is over, but...who knows?

Hopefully I will get some pinches to the old adrenals over the next few days to get me out of this holiday stupor!

Spicy-Boyfriend-Is-Away Burgers

Tobie is, a bit of a picky* and somewhat regimented eater. For example, he'd never cook burgers if we didn't have green lettuce to put on them.

Tobie's Law--all burgers must have one or two crisp slices of lettuce on them or they shall be deemed inedible.

He thinks chicken on pizza is an abomination, won't eat any meat unless it is cooked to hell (I told him what chefs think of people who order steak 'well done'), he hardly touches left overs, and is lukewarm toward Mexican food.

I, on the other hand; love things bloody/nearly raw, hate to throw out food, could happily survive on Mexican food alone, have fairly loose rules on what foods ought to be eaten together, and think chicken on pizza is a nice way of getting lean protein into a meal.

Yet, we somehow make it work. 

But ground turkey is a major point of contention between us. I LOVE cooking with ground turkey. I used to make shepherds pie, burgers, meatballs, lasagna, chile--all with ground turkey.

Tobie loathes it. To the point where he practically gags when he tries it.

So I am back at the homestead alone now for a week while Tobie and his family cavort in Dublin. I had to stock up on groceries (I have a car for another 2 weeks until Terrence gets back and reclaims it) so naturally I bought some ground turkey breast because Tobie wasn't there to stop me!

[Cue maniacal laughter.]

Anyway, I frittered around with it and came up with this killer (IMHO) recipe. Enjoy!

        Spicy-Boyfriend-Is-Away Burgers
-1 egg

-

-3 inch piece of dried chorizo sausage, peeled and finely diced
-handful of bread crumbs (if you are making your own dice them very small, or grate frozen bread)
-2 tbsp chipotle chile flakes (or one med. sized chipotle chile in adobo sauce)
-1 tbsp chile paste (or dried chile flakes/tsp cayenne)
-1 tbsp garlic powder
-1 tbsp chile powder
-salt and pepper
-2 green onions, diced

Mix everything up, form into patties, cook on heated/oiled pan or in the oven until salmonella/E.coli risk free!

I ate mine with pita bread, radicchio, salsa, purple onion and a bit of mayo. It was pretty damn delicious. Also, I wasn't really measuring things so all of that is a rough estimation. If you're worried about spice level then put in 1/2 the spices and fry up a spoonful to test it. I like a pretty strong kick.

--
*He is definitely going to disagree with me that he is a "picky eater" if he reads this post. Sorry Tob, I calls them as I sees them!

Fracking Insomnia!!!!

Why? Now of all times?

No exam stress. No noise. Adequate exercise. Normal meal times. Darkness. Early morning waking. Dim lights in evening.

AGHHHHH!!

I wish I was in my residency now. At least I could be putting lack of sleep to good use.

[Shakes tired yet wired fist at sky!!!]

What the hell, body??

Another Boring, Eye-Rolling Year in Review

I was getting excited about doing a year in review post until I read Michelle Au's blog this morning which said;

Don't worry, I'm not going to do an actual "Year in Review" post, because I do think that treads the line between boring and inviting people to kind of roll their eyes at you, because for God's sake, no one wants to hear your blow-by-blow of the year when you already keep a blog, for chrissake.

Which is probably a good point and should have steered me away from doing one (as I could probably take a tip or two from the superwoman-queen-blogger-extraordinaire-specialist-mother-of-two-sarcastic-hilarious-book-publishing-Asian-woman).

But screw it.

If you want to be bored and roll your eyes, please, read on! Or if you are new to the blog, consider this a mini-montage to bring you up to speed without having to sift through countless whiny posts about studying.

I actually don't see Jan 1st as the great big marker of time in the sky like many people do. But this year, I was by myself on New Years Eve (a first). This allowed some time to really reflect, and gave me the self indulgent space to read through the last year of posts to see what things I ought to keep a little more in the forefront of my mind when I think: 2010.

Because in a lot of ways, 2010 was a really exciting wild ride of a year (even though most of the time while I was in it, life seemed quite mundane). I don't want to look back and only remember one long study session.

The Highlights:

--Becoming an auntie to TWINS! On Jan 1st my brother and his wife had two lovely, healthy twins named Maximus (Max) and Ella. And though they are Gerber quality, they are not 'designer twins' despite the trend.

--Hearing Dr. Robert Gallo speak. Crazed Peta People and boundary-less audience members aside, it was a thrilling lecture. He's pretty much the equivalent to a medical deity, yet he comes across as a very humble, curious, sincere gentleman.

--Seeing one of my favorite artists, Hawksley Workman perform. It was a rush, amplified by the small venue size and cluster of Canadians (despite London location). Sometimes you just have to say, "screw the budget, let's fly to England to see one of our favorite musicians". Life is short, after all.

--Having my choice in medicine reaffirmed by seeing a woman with Parkinson's discuss deep-brain stimulation therapy. A big rescue lecture for me when I felt like I was drowning in self-doubt and frustration at deciding to come to medical school.

 --Getting to perform my first surgical assist! Ok that was a big one so it deserved a bigger font. And thus my choice in medicine was reaffirmed this summer again and again. I completely lucked out this summer, getting to work with some of my favorite nurses and docs one last time. It is such a joy to actually look forward to going to work.

--The other big one, catching my first baby! I know it is cliché to be all wide-eyed and full of enthusiasm as a medical student, but wow those were some hair raising moments of wonder. I know that with time all these firsts will fuse into the routine of day to day practice, so I am going to try very hard to remember and embrace some of the magic that practicing medicine can hold.

--Moving into a lovely apartment with my lovely Manfriend, Tobie.  So moving in together was a major event, especially since we hadn't even been dating a year--but the leap of faith for both of us has proven to be a wonderful choice. One of the things that isn't so much an event, but an unfolding, is getting to live with this stellar human and learn more about him and how we function as a unit. That is actually one of the most amazing parts of 2010. [Warning: sap alert.] Tobie is such a quality man and partner that every night (except the ones when I am fraught with pre-exam thoughts) before I fall asleep I give thanks for this relationship and all that it has brought me. It's true. I am so lucky in love. [Sappy portion of post over.]

--Going to a Canadian city I've always wanted to see--Montréal--and getting to eat (among other outta sight meals) my first, real Poutine. The other wonderful part of that trip to Tobie's homeland was spending a spectacular day at Le Nordik spa (I think music comes on with that link so be aware office cubicle readers). If you ever go to Québec you must visit at least those two locations. I will suggest that you do that in the opposite order, however.

--Spending some quality time with my BFF thanks to a last minute flight and aeroplan points. 

--Riding in my brothers newly built AC Cobra. I am so *not* a car person but WOW WAS THAT EVER FUN!!!!

The Lowlights

Naturally, the year had some low points. In fact, as I read through a lot of the winter/spring posts I see that I was somewhat unhappy (disillusioned? highly stressed? homesick?) for a few months there. I think a big reason for that was the gleam of adventure and starting a new life here had worn off somewhat right around the time when my dear friend and mentor, Nancy, died. What else can I say about this? Losing a loved one is hard, and it is only made harder when you are thousands of miles away from them while it is happening.

Course when I think of that time and those events all the other lowlights sort of pale, but I suppose that all things are relative and other difficult challenges presented themselves throughout the year. I lost more patients this summer in the ED than I am used to---some were stranger, sadder deaths for some reason. Most of them I didn't write about but sometime I will. There was my anatomy spotter debacle,  living in ant infested hospital lodgings, not getting to spend much time with my family this summer, and missing Tobie for our months apart.

Quality accommodation, courtesy of your local hospital. 

But how about not dwelling on the negative? Yes, I'd hate to end on a downer note. Taking stock of the year I see that 2010 was a year where I celebrated births and mourned death. I jumped in cold rivers and hiked on hot mountains trails. I kissed and cried, drank beer, sweated on a weight bench, celebrated and ruminated. Spent a night wearing a plunging neckline and more days than I'd like to remember in sweatpants. Cooked and walked, plucked the mandolin strings, and watched movies on airplanes. In a year, isn't that the most one can hope for? I'd say so.

2011? Bring it.

P.S Next January I promise not to do a Year in Review post!