Brain Changes

I've written before about how medical school changes your thought process. I've noticed lately that those rapid associations which we are supposed to make have started to infiltrate my thoughts more and more reflexively. And of course at the strangest times.

Last night while relaxing with a gin and tonic, in the company of my friend Emma and her daughter Rosie, I was talking about how a burned-milk-during-rice-pudding smell had instantly reminded me of cooking marshmallows. That association planted me back in my 7 year old self at summer camp and the wonder of staring into a fire while telling ghost stories. Emma remarked on the power of smells and memory associations, then laughed as she added "amygdala" and I, "hippocampus". We shook our heads and took a healthy slug of gin.  It all happened so fast. This strange wiring.

I absolutely love the escape of admiring photojournalism and portrait photography, but even that hobby has been terrorized by the medical mindset lately. Admiring the NY Times Pictures of the Year I came across this one below.

Before I could react to the gore (in all senses of the word), the disturbing nature of the image, and the brilliant composition and colors, I was mentally ticking through the blood supply and nerves in the submental region. I was thinking about how an airway could be secured, and wondering about the patient's prognosis. Then I went "oh GOD! LOOK at THAT AMAZING PHOTO!"

Warped I tell you, warped.

Ask...

Last night we had some friends over for dinner. The subject of food came up and Kevin there were foods that I missed from Canada which were hard to find here. 

I didn't have to ponder that question at all.  I started describing this type of chili garlic sauce which I have an addiction to. Seriously, I put it on (and in) everything from eggs, sandwiches, soups, salad dressings, stir-frys...oh it is divine. In the past year and a half I have combed through deli's, farmer's markets, grocery stores, Asian corner shops, giant Tesco's...all to no avail.

So today my doorbell rings and Lise, Ryan's girlfriend who arrived on Saturday from Montreal, presents me with...wait for it...

My precious.

Awwwww yeahhhhhhhhhhh.

She also came with real Montreal bagels for Tobie, but no smoked meat sandwich (his other request). Thanks Lise!!!

Life is good.

Now if someone would just turn up with a crate of GoLean Kashi cereal I'd be sorted.

Everything Has to Give? A Little?

I feel like I am doing a half-assed job at everything these days. It seems that there is nothing in my life that I am working really hard at, getting good results, and feeling proud about.

There seem to be two opposing forces: medical education vs everything else. Medical education seems to win most of the time, but not even in a really-impressive-colon-cancer-study-head-of-the-class-and-rocking-exams sort of way. Just in a holding-on-by-the-seat-of-my-pants kind of way.

I am trying to figure out how to juggle reviewing old and current curriculum, as well as maintaining some sort of USMLE study regime,  and keeping up clinical skills review.

My program is pass/fail so do I shoot for the 'just pass' (i.e do the bare minimum of school curriculum to get by) and study-til-my-eyes-bleed for the USMLE? Because ultimately the USMLE has more of a direct impact on my future than what I am doing right now.

[Sorry, I know that the above statement may strike fear in the hearts of the general population: you don't want to think your doctor ever uttered the statement, "so do I shoot for the 'just pass'" but the reality is, there are only so many hours in the day and I can only study so much.]

The thing is, in an ideal world every day, or at least every second day I'd like to:

-run/walk/weights
-do at least a smidge yoga
-play mandolin
-read (something that is not a textbook)
-sit down to eat
-read 10 pages from first-aid book
-watch a Kaplan review video or two
-make some flashcards
-plug away at current information for PBL sessions
-flick through histology slides, anatomy images
-work on presentation for review group
-blog
-read other blogs
-listen to some Goljan
-spend QT with Tobie
-do about 10-40 review questions
-sleep at least 7 hours.

But instead I usually:

-work on PBL but do a skimpy overview of everything
-sleep 7 hours
-make a handful of flashcards
-scramble something together for review group
-feel like I am a horrible student
-have lots of feelings of self-doubt and fear towards USMLE
-blog

This is not good.

Don't get me wrong, after working in the ED for five years I am pretty comfortable with only knowing a tiny bit about a wide range of things.  But at some point during my studies here it'd be nice to feel that I am doing something really well. Even if that thing is playing mandolin or running. Better yet, have it be biochem so I can stop waking up in a cold sweat in the middle of the night.

And While I am on the Tiny Soapbox...

I suppose I could have also titled this post, "Voice of Reason, Part II".  Maybe this will turn into a series of posts dedicated to people in this wild world of 'healing' whom I consider to be voices of reason.  Allow me to add Ben Goldacre to that list of voices. 

Just so happened that today Life in the Fast Lane (one of the best EM blogs in the history of mankind) posted this video about placebos. Which I enjoyed and thought you might as well.



It is based on parts of Ben Goldacre's book, Bad Science. As far as I am concerned, that book ought to be required reading for all nursing, medical, journalism, and pharmacy students. Or people that want to procreate. Or people who just generally want to understand how the media, health food stores, nutritionists, medical establishments, and pharmaceutical companies can toy with your mind (and your wallet).

One of my favorite aspects of the book is how it highlights the use of certain magical / flawed thought processes to arrive at unrelated conclusions. Example: pharmaceutical companies are bad and are only trying to make a buck so therefore I am going to turn to homeopathy (or shady sellers of snake oil and macrobiotic diet products) and refuse to immunize my children. This is faulty reasoning and doesn't make sense.

What does make sense is questioning the medical establishment as well as the alternative health business.  And, for your own critical thinking skills, attempting to understand how statistics can be manipulated to financially benefit people across the entire spectrum of 'health' related services--from the ear candlers to the radiation oncologists. One should be skeptical of pharmaceutical claims as well as alternative health claims. 

--I suppose I should clarify that I am not lumping things like acupuncture into the same category as caramel high colonics. We all have our 'too wacky to even consider' cut-offs in terms of treatments and I am not about to say where yours ought to be (as long as it falls somewhere after immunizing your children). Yes. This is my blog/soapbox and I will bring that issue up as much as I want.--

For the record, I think the placebo effect is a wonderful thing and if taking a sugar pill from a homeopathy jar makes you feel better--then be my guest. I am not pretending that the people who sell healing crystals are the only ones who benefit from this phenomenon. I realized very quickly as a nurse the power of the placebo even in emergency medicine. Lets face it, a big part of the successes in evidence-based western medicine can probably be attributed to the placebo effect as well.  I just think that alternative practices (i.e. industries that are not governed by evidence-based research and professional standards) can exploit the power of the placebo a little more, at greater costs.

Bottom line: Goldacre's book* is a hilarious eye-opener of an exploration into wrong-doings and exploitations from all sides of the health-care field. It gave me a better understanding of statistics, a thousand more reasons to seethe when I hear the name 'Wakefield' and the ability to see that I was being seriously duped on high-end skin care products. Ok, I may have just made his book sound like the most disorganized jangle of chapters ever written but trust me when I say he ties it all together nicely (and amusingly, especially if you read it with an English-accent in your head).

Read it. 

*No I do not have any personal/professional ties to Goldacre and I do not stand to make any profit from this endorsement.

[Oh, and please continue to vote for my friend Richard's stamp design here. He's climbed into the top finalist position! You can vote once a day until the competition closes in March.]

Voice of Reason

Watch the full episode. See more Need To Know.

Every time I read or see a well thought out piece on end-of-life decisions, it makes me want to go into palliative care medicine. Yes, I am a trauma/critical care junkie--but I also love the holistic approach and paradigm shift that palliative care provides. They are my yin/yang areas of love and interest in medicine. The ability to reach out and pull someone back from the brink---or the skill and wisdom to let go and let be when that is what a patient wants.

I think that Atul Gawande is an excellent writer and though he is a surgeon (i.e. from the specialty that probably gets slammed the most in the media with regard to these issues) he has an amazing grasp of these dichotomies.

I have droned on about end-of-life issues on this blog before, I know, but his article on the matter is a work of art as far as I am concerned. If you haven't already read it, you should. And then you should make your friends read it. And your parents. And your siblings.

I will now step off my well worn tiny soapbox. 

Better Late

I sort of dropped the ball on Valentine's Day this year. Tobie had planned to get me a massage as a gift (wicked!) but then I fell in love with this scarf in Galway. And I was given the option to choose.

Chose scarf.

I couldn't find anything for him and I didn't want to buy something just for the sake of buying it.

So I cooked him a Valentine's Day dinner. But like most important meals I make, it was chaos on wheels. I had to go to four different stores to find everything. Buckwheat flour? Ceramic ramekins? What? Oh, and about 2 hours to do the shopping and cooking. I almost always try new things when I am under the gun. No idea why.

Thankfully I had some of the more exotic things on hand (well, exotic by some Irish standards). See I knew those vanilla pods, dried mustard, and bakers chocolate from AVOCA would come in handy some day! Mwahahahahahah!

Initial chaos. Bad idea to try 3 new recipes at once? Um. Yeah. And yes that is a washing machine in my kitchen. Welcome to Ireland.

So these were the appetizers--buckwheat and cheddar blinis with smoked salmon. The recipe is here. Possibly the finest achievement of the night was that MY version actually looked BETTER than the Food and Wine magazine photo! That was definitely a first. Seriously, go look at their recipe. The below photo is mine. Also, I used mascarpone cream mixed with lemon juice, lemon zest, and snipped chives instead of sour cream (as the recipe called for).

The main course was supposed to be this scallops with brussel sprouts dish. But for the life of me I couldn't get my hands on fresh scallops. Of course, the one day I am looking for them, nary a scallop is to be found.

So after much angst and gnashing of teeth, I decided to substitute smoked coley for the scallops in the recipe. And HELLO NURSE! It was actually quite nice, the smoked flavor went well with the pancetta. Not to mention the starving student budget points for saving money on le cheap fish instead of les scallope!

  Oh I should mention, Food and Wine kindy offers wine pairing suggestions. Conveniently I was doing a creamy, fishy appy and main (which probably goes against all the laws of 'treating your arteries right') so one wine cut it. I bought a mid-ranged Cabernet Sauvingon Blanc. I grabbed blind though because my white wine knowledge is even more limited than my red.  It was probably something that had a 'hand selected by SuperQuinn' sticker and '10% off' label on it. But, I have to say, the magazine's grape suggestion was bang on. The crispiness cut the cream and didn't bring out the fishiness.  So good work there Food and Wine magazine on the wine pairings! Do not quit your day jobs.

Dessert was a bit of an adventure as well.  I managed to find these ridiculously cute ramekins on sale. They even came with little lids. God I am a sucker for little lids, it must be a throwback from my early Easy Bake Oven days or something. 

I am a terrible/hopeless/pathetic baker so it is always a gamble when I get on the other end of a measuring spoon. But! My desserts turned out looking like some kinda fancy-schmancy little pots of heaven when I took them out of the oven! (Pictured above). And then I covered them with dessert-wine-soaked cherries and vanilla mascarpone cream--and made them wickedly evil.

A little HDL never killed anyone, right?

So despite the fact that the molten cakes weren't quite as molten as I'd like, and that my timing was a bit off (was whipping the cream while serving the main course, as evidenced by the flecks of mascarpone all over my microwave and backsplash). Tobie was a happy man. And I think I have regained both my sanity and my title as 'best girlfriend evah'.

Tobie was happy. I was happy. Lesson learned. 

Even though I should have been memorizing what antibodies are specific to systemic lupus erythematosus and drawing out the pathways of auto-immunity...I made buckwheat blini.

Don't get me wrong, I appreciate the gravity of SLE and the importance of keeping up with school work. But you know, sometimes you just gotta make buckwheat blini.

Mozart for Lunch

Today Tobie played a lunchtime concert with his piano quartet. It is so lovely to get to listen to live music and allow the neurons in other parts of my brain to fire. I took this photo of him just before the show and I adore it (as I do, him).

Viola. Not violin.

I also included a short clip the concert for your listening pleasure, it is from the first movement of Mozart's Piano Quartet in G minor. Apologies for my consistently bad camera operating skills and poor vantage point.



Oh and yes, he is for hire!

"Aha!" Moment

I went for a run this afternoon with Prof. Goljan and listened to the part 1 of the cardiac lectures. 
He was talking about aortic aneurysms and aortic dissections and so of course my mind wandered off, recalling the most traumatic ambulance nurse escort I've ever done (outcome aside).

Dr. Goljan mentioned one of the salient features of aortic dissection: the midscapular back pain. This was the complaint which alerted me to the aortic dissection pathology in my 'mild chest pain' patient that day in the emergency department.

In passing Goljan said, "of course the pain is different than cardiac pain because the aorta is retro-peritoneal so it radiates into the back not down the arm".

OF COURSE!

In anatomy we have had to go through cardiac pain, and referred pain a million times, and the dermatomes, the arm, the jaw, blah, blah blah...and then other times we've talked about abdominal structures, retro-peritoneal verses intra-peritoneal, etc. etc. and the aorta being a retro-peritoneal structure.

But I never really thought about the connection with aortic dissection and the pain pattern!

(I know this has probably been dead obvious to all of you nursing/medical people reading this, but it just clicked in for me today).

AHA!

I have known for so long: mid-scapular back pain =  red flag = do bilat leg/arm BP's = ?dissection.

But it wasn't until today that I understood why that was the case.

Ok medical school, we've officially kissed and made up this week. I (heart) you again.

ABB Phone Home

 

Above is a scene from the chaos which is my weekly skype chat to my brother Russ. Now that the twins are walking, getting all three of them in front of the computer is quite a feat (notice my mother trying to corral Max who is always just pleased to be a part of the excitement). 

It's crazy, when the babies see me on the screen they actually reach out to hug me! Their virtual auntie. Man, I can't wait to get home in April. 

 

Request

One of my oldest, nearest, and dearests asked me to make a post on his behalf. How could I refuse?

Canada Post is currently running a design competition for a mental health related stamp. Richard is in the finalists with one of the top five designs. His life (like many of ours) has been touched by mental illness and he's used those experiences to create his submission.

Please follow the link and give him your vote. It would mean a lot, to a lot of people if he won. His design is called Beautiful Hope.

Overwhelmed

I am really not feeling the love right now in school.

I'd like to buy and banjo and do a road trip through the Appalachians.

Is that so wrong?

Below is the reason for my inspiration....

It's a long set, but if you listen to the first song you'll understand.

Galway Getaway

So young Tobington and I decided to use our new found access to vehicular transport and hit the road for a mini-adventure yesterday. It really is an amazing novelty to be able to step out the door and drive to another town, solely in the name of exploration. Our only true plan was to find the Farmers Market in Galway. And we did indeed find it. We also managed to gorge ourselves on delicious food, drink (a little wine--what? It was early in the afternoon and I only had 1.5 glasses!), and shop (I needed a new umbrella...I live in Ireland, ok?) Apparently being poor makes me defensive about every single purchase I make. 

If you don't know exactly where I live in Ireland, look up where the cultural epicenter of the nation is---then go as far away from that as possible. I am sure that many of you do know but for the sake of the few remaining strands of anonymity, let's just say that our home town here is known for gang violence, abject poverty, and closed-down-industrial parks. So a chance to breathe in the sweet air of Galway for the day was truly divine. Even getting snubbed by the wine snob that runs the wine and cheese shop was fun (almost as fun as trash-talking him in French and later figuring out that he probably spoke French).

Tobie endeavors to eat an entire wheel of cheese.

I was pretty excited about the fact that this coffee shop served soy latte's. Really. I can count on one hand the amount of places you can get a soy latte in this country. Yes, I know that sounds unbelievably uppity and bourgeoisie but I LIKE SOY LATTE'S DAMMIT AND YOU CAN'T GET THEM HERE!!

I also enjoyed how similar my hair looked to a hockey helmet.

I love the street scene below mostly because when I uploaded the photos at home I saw that the dude front and center is walking with a case of beer in one hand and a bottle of Buckie in the other.  He is definitely going to have a stellar afternoon. For those that have never had the pleasure of Buckfast, just imagine the sweetest wine you've ever tasted, mixed with Buckley's cough syrup, fortified with more alcohol and then injected with an unnatural amount of caffeine. Voila. Irish night out.

We snuck in from the evening wind and rain and enjoyed a lovely meal in a little Italian bistro before hitting the road back home. Tobie, as you can see, is a connoisseur of fine soda pop, and after a brief tasting, settled on a 2010 7-Up to round out his lamb ragout. (Not that I am one to tease, I paired my grilled salmon with crab and potato mash with a spicy, yet fruity, glass of ice water.)

Home sweet-sunset-from-my-office-window home.  

It was a fabulous day. I am still mentally adjusting to having a car again. After a year and a half here without one it is amazing how much life changes when you don't have to depend on a shite bus system or lifts from friends to do the things you want to do.

Even groceries are a dream now. The closest decent grocery store is a 4km walk which feels MUCH farther when you have 50lbs of groceries on your back. It is just so unbelievably annoying when you are standing in the aisle trying to decide between yogurt or canned tomatoes based on weight instead of what you'd like to cook that night for dinner.

Now I can make a nice butternut squash soup or buy a whole chicken for roasting without sacrificing toilet paper or milk for the week.

Oh the little things make me so happy sometimes.

 

You Know You Live In Ireland When...

Hitting the magazine racks this week, hot off the presses: Your Child's First Communion Magazine!

Holy crap!

(It was scary inside; little girls looking like Texan tween beauty contestants, mothers in swooping necklines, and fathers in pants that were tight in all the right places.)

Clinical Skills?

Today was a review session for clinical skills, where the lab is full of various plastic body parts for students to practice various invasive procedures on.

I was letting Eileen have a go at cannulating my arm (ha! everyone knows that nurses are the worst patients!!) and couldn't help but observe a couple of students practicing IM injections nearby.

Student A was wearing a thick rubber arm cover, student B* was holding the needle.

Student A: Ok, so draw up your fluids and give it a go.

Student B draws up saline for injection, pinches the rubber arm section, and angles the needle almost parallel to the skin, at about 10 degrees.

Student A: Um, are you sure you are doing that right? You are supposed to do it at an angle.

Student B: Well, not a 90 degree angle.

Student A: Yah, but not like that dude.

Student B: I am pinching the skin, this is how you are supposed to do it. (As he injects 3mls into plastic arm, still with needle at approx 10 degrees from skin surface). Whatever, I don't care, I am sure that is right.

5 months people, 5 months until we hit the wards. Good times. Oh medical students, sometimes the perfect combo of arrogance and inexperience!

---

*Student B is one of the top students in our anatomy class.

Decisions, Decisions

So my plan for the summer was to head home after exams (June 12th). Study like crazy for the USMLE for a month, write it mid July, take the last two weeks of July off, return to Ireland to start placements Aug 1st.

Life has offered up a bit of a curve ball and I am unsure as to what I should do.

I have been given the chance to be involved in a very cool clinical trial here in Ireland during the summer break (where I'll actually get to have some hands-on contact with patients). Problem is, the project will be full time for most of my holiday.

Everyone is always droning on about research and how important it is to have some papers on your CV, especially if I want to specialize or study in the US (I'd like to do both). So I am definitely keen on getting started on a project.

Flip-side is, when will I write the USMLE then? Remembering that our curriculum isn't based on preparing us for the exam, we have a MOUNTAIN of extra-learning to do on material that isn't part of my program. Yes, there is a long Christmas break, I could potentially study for it then, and write in January. But if I do my surgery rotation in the fall it'll leave me very little time to do any continous prep: it'll be one giant cram-fest over Christmas. Yeah, the Christmas break that I was planning to do nothing but drink egg nog and skate on the canal (not necessarily in that order).

Scales: USMLE vs. Research

Thoughts?

(Keep in mind that I am no pro-star when it comes to GIANT EVIL EXAMS OF DOOM.)

See the problem is, none of our faculty are Canadians who have studied in Ireland, written the USMLE, done research, organized international electives, or gone through residency applications for returning to North America. This means there is no one here that I can go to and say, "based on your experiences and your understanding of all these processes, what is your advice?"

We are left a little in the dark here in terms of guidance for our future careers.

Retail Therapy

So I bought a car today!!!

Cue "Walkin' on Sunshine". It actually feels like my 16th birthday. My parents bought me a 1976 Grand Marquis Mercury as a gift, and surprised me with it at the licensing office. There are photos of me jumping up and down and my dad grinning from ear to ear. I wish I had a copy of that photo here.

The sweet ride of yesteryear...

Yes, I could fit my entire volleyball team in the car, including 6'5" coach and obese water boy.

Today's purchase was a wild adventure which I will dish on soon. Let's just say, when you answer a private ad for a car sale, you never know what you are getting into. Don't worry, it's nothing bad, in fact it was better than I could have ever anticipated. Just very, very, surreal.

Sadly, I have PBL in 12h and a metric tonne of work that needs to be done regarding the spine before that, so we'll have to save the post for tomorrow. Until then, I leave you with a photo of her beauty. I think I'm going to call her, Belle Bleu.

Little. Blue. Better. 

I can fit my lip gloss and macbook in this one.

No Mets!

Just received an email from Elaine.

No mets! Wonder of wonder, miracle of miracles!!

Her surgeon is confidant that the two tumors are new, low grade, and contained.

She still gets to have her holiday before starting chemo, surgery, and possibly radiation. I can tell by her email that she is is great spirits (she is a great spirit) and I am smiling as I write this. So yes. It is going to be another tough road for her, but she is standing with her fist in the air.

Thank you for letting me worry on this blog, and thank you again for all your virtual support. I am sending her this screen shot to show how most of these dots constitute a thought, hope, prayer, or positive vibe, that was sent up into the universe today for her.

No News Yet

Thank you so much, wonderful people in Blogville, for your kind wishes, prayers, and thoughts.

Today Elaine is hoping to get the results of her additional biopsies. Of course the big fear is what the lymph nodes will reveal.

She told me last night on the phone, how after her routine mammogram screen they noticed some irregularities. She had an MRI and an x-ray. Her surgeon felt something just wasn't right and did core biopsies deep to the scar tissue from her previous lumpectomy.

Her radiologist told her everything was normal, the MRI and ultrasound had showed nothing. She called her husband, her daughter, her son, and told them she was in the clear. Then she saw her surgeon and he told her the cancer was back. His hunch had proved correct.

And we say thank God for medical hunches.

It is strange and wonderful that sometimes a hunch can unearth what no amount of radiation and resonance can.

We are all hoping that the chemo will shrink the tumor and it will be removed later this spring. Sadly, they've had to cancel their upcoming trip to Europe, but they promise to be in the front row for my graduation ceremony in 2013.

Elaine has told me, with a measure of joy in her voice that is mixed with fear and frustration: that she is held up by love and prayers. And this makes me feel a little joyful too.

No Words

I can't even write coherently right now.

There is more to this story which will come soon but for now, please...whoever it/she/he is that you turn to dear readers in your time of asking, please turn to them now and ask for things to go well for Elaine.

Someone I love very much has just found out that her breast cancer has returned. Tomorrow she finds out if it has spread to her lymph system.

The rain is hitting hard against my window and I would give anything to be on a plane back to Canada right now. I am stuck here, halfway across the world, always! It makes me shudder in frustration.

Please put her and her family in your prayers.

Words of The Day

I had never experienced a "night terror" before traveling to Asia. Well, I thought that was what they were called. I'd wake up in the middle of the night and be: completely paralyzed, seeing someone standing in the door to my room, hearing someone saying my name loudly, or all three.

Then I'd really wake up.

It was extremely frightening, especially since I was mostly traveling alone and staying in, er, less than reputable places. Some of my accommodations were literally mud huts with bamboo doors on them.

Today as I was bumbling through practice USMLE questions I came upon this answer to a question:

So THAT is what they were!!

Hypnopompic and hypnagogic hallucinations.

Ok, so aside from the fact that they are seriously cool words to add to one's vocabulary, I was intrigued by the transient nature of my former "classic symptoms of narcolepsy".

I stopped taking chloroquine about 5 months into my trip and the symptoms stopped. Of course I have heard that 'vivid dreams' are a common side effect of the prophylaxis...but now I can't help but think they should add hypnopompic and hypnagogic hallucinations to the list!
 

Flash Cards

My brother Russ gave me an iPad for Christmas (thanks Bro!!) which I have hardly had a chance to use/play with, but this week I finally did a little shopping trip to the app store.

I bought a flash cards app, I know, I know...."why buy an app for something you can do on paper for free?"

See the thing is, I have hundreds of handmade flashcards lying around in these crazy disorganized piles, written in my chicken scratch/shorthand which makes ME the only person that can decipher them.

The beauty of this app is:

-I can put images with the cards, which is the BEST thing about them, because it means I don't have to try and describe the histological differences between an osteoblast and an osteoclast--I can just upload an image from Wheater's on the card
-I can organize them into sets
-it keeps them in one place, not randomly strewn throughout my school bags, gym bag, purse, desk, couch crevasses 
-it keeps stats on which ones I get right, wrong, and sorta-right-but-want-to-go-back-to
-I can select to just go through my 'wrong' piles or my 'review again maybe' piles
-they are typed, not in ABB hieroglyphics, making it easier for another person to quiz me (well, slightly easier).

Anyway, I've only just started making cards but if any of you nerds out there have an iPad/iPhone/iTouch you can download my sets for your learning pleasure. I'll be adding to them every week. I know they are kind of specific to my course, and that making flashcards is a big part of the learning, but hey...you just might LOVE them and become more brilliant for having them (please excuse my occasional mnemonic or loose association technique in the answers).

My page is here. If the link doesn't work let me know and I'll fiddle with it.

Happy studies!

Sample:

Obviously, the images are larger and look way cooler on the iPad.

Pre Op Checklist

Dear Cowboy Classmate, 

I listened respectfully to you describe all the pharmacokinetics of bisphosphonates, which was super. Can I make a suggestion though for next class? Maybe you can put your arrogant ego aside for one minute and think: hey, my classmate might have some important insights to offer the group too, especially if the topic is...pre-op checklists...since that classmate has probably done a thousand pre-op checklists, on real patients in a real hospital. Maybe you'd listen, because you see, pre-op checklists have to be done right. This isn't some hypothetical situation that will never arise once they unleash you from the PBL room and onto the wards in 6 months.

If it was me, I'd be happy to have a nurse mention that height, weight, and last-meal time are actually crucial pieces of information to gather as well as 'abc's and maybe an echo' . Oh and that forgetting to ascertain said information might result in a pissy post-op encounter with an anesthetist, or surgeon. Just trying to save you from the mistakes I've made, pal.

Go ahead and roll your eyes. Enjoy the new asshole you'll be given come ward-time.

Yours truly,

Someone Who Has Actually Worked in a Hospital

P.S The sooner you make friends with the nurses, the better your life will be.

Oh Hello Something to Dream About

Wait, is that two of my favorite things in one sentence? With the word "course" at the end? Um. Yes please. 

Where do I sign up?

(Oh and come up with $5000, and permission to take a three week holiday right in the middle of my surgical rotation!)

I just have to tell myself: it is good to know that these things are out there and remind myself of that when the going gets tough here in textbook-land. 

Medical Art

Is it just me or does this image of a bone biopsy stain, showing low turnover osteomalacia, look like a lovely piece of modern art?

Image taken from Up to Date.

I would totally hang that in my living room. Well, a greatly enlarged version of it, otherwise I suppose it wouldn't be much of a conversation piece.

Experimenting

In an effort to wean myself off music (no earphones allowed during relay race in June) I have decided to try running to the not-so-dulcet tones of Edward Goljan's pathology lectures.

I think it is safe to say that most medical students know about Lord Goljan or G Pac as he is lovingly referred to on his FB fan site. You could say he wrote the book on pathology, because he did. THE BEST book on it IMHO: Rapid Review Pathology.

I usually need some heavy beats to get me up the hill outside campus gates but tonight I had [insert hard American G.I accent here]:

"look at that...what IS that...NUTMEG...does that look anything like a NUTMEG LIVER?? NO!! I don't know who decided that NUTMEG liver looked like NUTMEG. Must have been someone with CATARACTS...someone with corticosteroid use induced CATARACTS...did you know that corticosteroids can cause CATARACTS?? Not glaucoma. Anyway..."

But, it worked! Ok my pace was slower than usual, because he's good but he's no black eyed pea. I was surprised though at how having my brain engaged actually let me forget my usual, "I hate running, ow, ow, ow, remember to smile" mantra. I have been feeling guilty lately about taking time out to exercise what with my study and review for school plus study and review for USMLE schedule. But now--huzzah! I can cram and run at the same time! I do realise that maybe it is a bad thing to combine recreation with studying so I am still keeping up my yoga in a Goljan-free zone.

Path domination here I come!!