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Trains

My sister informed me in a huffy way that it had been too many days since my last blog post. So, hello again, blog world, and hiya Dust!

The days just seem to be so long and groundhog-esque I start a post and think, "I am boring myself" and I close it. I've been doing that lately with emails as well, I'll spend half an hour writing someone an email and then I just delete it. It's mostly that I feel as though life has become quite one dimensional, it is a good dimension, don't get me wrong. I just fell uncomfortable rambling on to others about it.

It is also the pace of life these days unsettles me, like when you're on a train and think you're not really going that fast until another train passes going in the other direction. Suddenly the force, speed, and momentum is clear and almost frightening.

There have been a few trains going in the opposite direction lately.

I spent a good part of my morning with one of our palliative patients. She is a lovely woman and as she spoke about the impact of her recent diagnosis I made no attempt to hide the tears in my eyes. I used to be quite good at remaining buttoned-down with my reactions to patient's emotions (working in the emergency department gave me a lot of practice). She was just so open and honest with me, held my gaze, and for most of the interview gave me unflinching details of her ordeal. So when she cried, I did too. And I think it was appropriate. I have no idea though.

I also assisted with a below the knee amputation. That was my first limb amputation, having seen a great toe removed before. My normally jovial consultant (M.C) was thin lipped and quiet for most of the lengthy surgery. At one point he simply said, "God I hate doing these procedures." I suppose a surgeon simply cannot get the same satisfaction from amputating a limb, compared to cutting a cancer out, or removing a troublesome gallbladder.

But it wasn't the bone sawing or muscle slicing that I found unnerving. It was how quickly the patient reached for my hand and how tightly he gripped it before the anesthetic whisked him off to sleep. A couple of weeks ago I had met him, a broad burly man, who was gruff and a little abrasive. He wanted the procedure because it was going to improve his quality of life but I felt his reservations as soon as his giant hand engulfed mine.

So today, in an effort to slow things down a little I ventured out to the mountains and hiked in an area known as the Eastern Reeks. The ground involves a lot of bog walking and slippery rock negotiating. The forced concentration and good conversation gave me a much needed break from thoughts about the hospital and school.

An Irish Inukshuk?

I am definitely going to make an effort to get out at least once a week. Especially once my foot is completely healed. Yeah. It is possible that a 6h hike today may not have been what my ankle needed.

A long day outside was definitely what my head needed though. Also, the unwinding pace in a cottage with beer, a fireplace, and hot soup, was perfect.

A Perfect Day

The orthopod I shadowed last summer used to bellow quite frequently, "A day without blood is a day without happiness". He loved his job and approached each of his cases with the excitement and wonder of a 7 year old boy who has just received a new Lego set. I used to think the saying was funny, if not a little crass. But I have to admit, I am starting to get it.

The days that I get to scrub-in for procedures always seem a little surreal and sparkly. It's odd maybe, but I love the ritual of scrubbing, gowning and gloving. I like staring at the angular instruments all laid out in precise order, the hum of the anesthetists buzzing around the patient at the beginning of the ritual, the bleeps from the cardiac monitor. I like having only my eyes, voice, and hands free to convey a message...the rest of my body covered up by various layers of protection. It's strange that I enjoy this controlled, anal-retentive world, because I also love being swept up in the unpredictable and ever-changing currents of the emergency department. Maybe I need to accept the fact that I will forever be a woman who likes extremes in medicine.

So yesterday I had the chance to spend the morning in theater, being a 1st assist on several circumcisions. It probably sounds banal to most people but at this stage it is all a new, fun, and nearly vertical learning curve.

In the afternoon I did histories and physical exams on some of our patients, and then went to the A & E to see a surgical consult who was a query appendicitis. I am always amused by the similarities between emergency departments in completely different countries. The controlled chaos, harried staff, complaining waiting room patients, limited stretcher space, tiny nursing stations, paramedics waiting to unload newcomers...it feels like home, even on the other side of the Atlantic.

It felt like a good day. I had no idea how good it was going to get!

There is a rather large Rose of Tralee festival (in Tralee, obviously) every year. It is sort of like a beauty pageant without the really dumb contestants and bikini portion of the show. Anyway, one of our classmates has a friend who is visiting for a few days from Canadia so we decided to do the touristy thing and check the scene out.

And what a scene it was.

We ended up in this old pub called Sean Og's (or something similar) with a large table right near the front. The place was bursting at the seams, mostly filled with 50-70 year old Irishmen. A few of us youngsters (heh) were enjoying the scene as well. Shortly after we arrived, a middle aged man with gelled hair and velcro shoes walked in, plugged his guitar into a sound system on the tiny stage (which also sat a large table of retired Irish tourists from Dublin) and proceeded to rock the joint for the next 4 hours.

There were several times throughout the night when all I could do was stare in wonder around the pub, full of people with glasses raised, singing in unison to everything from party songs like Galway Girl and Whiskey in the Jar, to traditional folk numbers such as The Fields of Athenry, peppy tunes like Las Vegas (The Hills of Donegal) and classic sing-a-longs like The Gambler and The Boxer. It was gritty Guinness-swilling-liberation song-singing at its finest. The one man band was killer, barely pausing at all between songs. At one point I was pulled up on stage by a geriatric Irishman to jive. Hands-down one of the best pub nights I've had in Ireland. My facial muscles actually started getting sore by the end of the night from smiling and laughing so much.

Oh Ireland. Sometimes I really do love you.

Scenes from an Irish Surgical Ward

I went upstairs today to see if I could find my intern, Simon. There he was, filling out yet another cardex of medication orders. The poor guy does such a ridiculous amount of scut it boggles the mind, yet he always has a smile on his broad Burmese face. I am so happy that he's on my team.

We were discussing Mr. Smith's night time sedation as as his current meds aren't doing the trick. The Ward Sister warned that the night nurse would have a fit if he didn't settle again tonight. So as we hammered out some different strategies I leaned back from the nurses station to have a peak in Mr. Smith's room.

And there he is, sitting upright in a big blue padded chair, his tray table in front of him. An open bottle of Guinness is on the table and he's grasping a plastic cup almost empty of it's brown fizzy contents. He gives me a giant dentured grin and I remember how he looked last week, flat out in bed and sucking hard on the 10L non-rebreather mask. I thought he wasn't going to survive the weekend.

"Er.....is he getting...Guinness??"

"Yes, I think they prescribed it for him yesterday." 

So I'd heard that it used to be common practice to prescribe the stout because it was so high in iron and vitamins, but part of me just dismissed that along with so many other back in the olden days stories. Like how my cardiologist grandfather used to round on his patients with a cigarette in hand and the nurses used to smoke at the desk.

But I saw it with my own eyes, today, and hell if Mr. Smith didn't look a lot perkier.

Then while I was taking bloods from another patient a cell phone went off and the ring tone was an Irish jig being played on a fiddle. At that point I wouldn't have been surprised to pull down the bed sheet to see the patient wearing wellingtons and a tweet jacket. Seriously.

I hope when I am practicing in Canada that one day I'll see a patient pouring maple syrup over poutine while a Celine Dion ring tone goes off. Wait, scratch that...a Neil Young ring tone. Otherwise I'll have to give more points to the Irish for being so...(quaintly)...Irish.

It's My Party and I'll get Cellulitis if I Want To

If you've been reading this blog for more than 2 months then you probably know that I am usually a very casual dresser. In fact I have almost zero fashion sense and if left to my own devices I'd probably live in the sweat pants I bought in 2003, the zip hoodie from approximately the same year, and clogs.

The hospital has forced me to significantly lift my game in the wardrobe department and it has actually been enjoyable dressing like a demi-lady-doc (yes, I am implying that I am only a demi-lady and a demi-doc). The major downside has been footwear. Oh the footwear.

I wore heels the first week which caused some small blisters (I might add that these were well made and not cheap Campers that have rubber soles which means I don't have the annoying clickity-clack of heels in the long hospital corridors). The second week I thought I'd try flats (again, not the 20 Euro ones you can basically buy at a petrol station). These completely excoriated my feet into 'heel hamburgers' so I switched back to the heels. Yes, there is a reason I have devoted an entire paragraph to what shoes I have been wearing this month. 

On Sunday, Kris and I went on a hike and I went prepared with moleskin and band-aids since my heels were still recovering and I was breaking in new boots. Only a tiny new hotspot appeared.

Until yesterday.

I was sitting in a videoconference and feeling these shooting pains up my leg. Ok, not exactly a new sensation in the past two weeks so I ignored it. The pain seemed to be intensifying though as the conference dragged on so during the break I decided to inspect my ankle which felt that it had been both assaulted with a baseball bat and sunburned.

Well that explains it.

 

So I showed it to my fellow med student who is also on a surgery elective and asked if he thought I had med-student-itis (wherein you think you have every disease you read about). He told me I should see a doctor and get on antibiotics right away. We brainstormed and web-searched the efficacy of me taking expired cephalexin (thank you India, 2008) and came to the conclusion that I should probably  acquire some fresh flucillin. I did manage to have a quick review by one of the docs and started my antibiotics last night. Glad I didn't wait any longer though, by the time I got home at 1800h I could hardly weight bear on it.

For several reasons it had been a bit of a challenging day but the cellulitis was the icing on the 32nd birthday cake. I was feeling right sorry for myself. I probably would have driven to the airport and bought a one-way ticket back to Canada if it hadn't been for a 'chin up' chat with my mother, surprise cake / pressies from my roommate, and Tobie getting me to sign on to his FB account to look at some ridiculously awkward and lewd pregnancy photos that one of his friends posted. The man really knows exactly how to cheer me up.

Contrary to appearances I do actually have bones in my left leg and foot.

Today it is feeling a little better. Unfortunately Wednesday is one of our theater days so I had to sit out knowing I could not possibly stand still for 5h. My reg told me I could do minor ops instead.

Now I just have to find a pair of shoes that I can fit my 'cankle' into.

Randoms of the Day

Today at lunch in the cafeteria I was reviewing the different types of physical diagnoses that can be made based on 'inspection of the faeces' (complete with photographs). Didn't seem odd to me until the Senior House Officer (SHO) joined me for lunch. He peered over my shoulder and shuddered when he saw what I was reading while slurping back my soup-of-unknown-components. I actually find the lost art of physical diagnosis riveting. I do.

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I saw an SHO in the emergency department today wearing a scrub top (fine) with loose athletic pants that were 2 inches too long, dragging on the ground, with bare feet and flip flops (the opposite of fine). I am not the Emily Post of medical uniforms by any means but that was horrendous on so many levels.

On the subject of ridiculously unsafe and disgusting footwear I also saw a phlebotomist wearing open toed sandals on the wards today. WHAT?

That would never fly in North America. The infection-control-worksafe-auditing-psychos would be snapping their clipboards in half if they saw such a thing. I remember being told by an old manager of mine that I wouldn't be covered by WCB if I had a work related injury because my clogs had too low of a heel. Oh Ireland, sometimes your "it'll be grand" attitude goes a little too far.

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I am getting my vertigo et al issues finally checked out tomorrow. Freaked that I'll hit the ground while holding a retractor in theater so I figured it was time to actually see a doctor instead of reading UpToDate. Here's to hoping I'll be able to rule out acoustic neuroma or other space occupying lesions, soon.

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There is the most adorable little old lady on our ward having an abdominal mass and bowel resection done this evening. Initially she didn't consent to surgery (she is in her late 80's, after all, and not in the greatest health to begin with). She had fears that she would not make it through. It must be a terrifying decision to make. My registrar went and discussed things with her on evening rounds. She stuck out her wrinkled chin and said, "That is FINE. Do whatever it is you need to do. If I make it through I make it through, if not...well...so be it." But her voice did quaver a little. Her hair and skin were so thin but her eyes were bright and sharp. When the SHO poked his head around the curtain she saw him and pointed his direction, "Whatever that young man was trying to talk me into this afternoon, I'll do. Where do I have to sign?" It was funny and sad, and we all sort of chuckled awkwardly.

I don't know what it was but at that moment I wished I was her nurse who'd be there to talk to her once the doctors left,  rather than the mute medical student who didn't even know her name. And I decided, I didn't want to watch her surgery. Even though normally I'd be itching to scrub in on a new pathology and procedure.  I walked out to my car in the rain and was glad to shut the door to all of it.

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Thanks to everyone who sent emails or wrote thoughtful and positive comments on the last post. I had the chance to make a great meal for friends on Saturday, then scamper in the mountains on Sunday. Both activities were much needed and much was gained in terms of perspective. As always, will keep everyone posted on how things are unfolding.

Me Med Student, Me Watch Things and Do Nothing

Today I went to Middle of Nowhere (MON) Ireland for a rural lumps and bumps clinic. I really enjoy the outings to the country, hanging around the little hospitals, and seeing the old farmers who drive in on their tractors (true story). I had the chance to see a nice variety of patients: from swallowing difficulties to sebaceous cysts, urinary retention to infected toe nails. For me the real fun is with the procedures so I had to sit on my hands all day. Naturally I jumped at doing dressings or applying pressure to the odd excised mole lesion. Hey, that is how I need to get my kicks these days. Sigh. MC actually told me last week to stop making the beds between patients. Old habits die hard, I guess.

My registrar (I.S) and the locum consultant are both Muslims so they are currently fasting for Ramadan. This means that I.S gets up at 0315h to eat and cannot have any food or water until after 2100h. So today when he offered to buy me lunch I had to decline--I was definitely not about to scarf down a giant lunch in front of him after hearing his rumbling stomach all morning. I guiltily ate an orange in the hour long ride back to the hospital instead. It was 1430h after all, and despite the fact that most days it feels like I am fasting at the hospital...I am not obliged to.

Today's clinic reinforced that being a medical student in Ireland is way different than being a medical student in Canada. I suppose the main reason is over here, when one graduates one is allowed to test the waters for a bit longer, in Canada one is thrown into the pool at the deep end.

For example, I was chatting to the surgical intern yesterday at lunch and I asked him what clinical skills he can perform here at the hospital: IV cannulation (though mostly Senior House Officers [SHO's] do that), catheterization, and blood draws. He has never scrubbed in for a single surgery and likely will not have the chance to this year as he is on call for the wards and spends his days doing scut (writing discharge orders, medication charts, ultrasound requisitions, etc.). After an intern year, one becomes an SHO and does a little more, like admit patients, start IV's, mix and administer meds, maybe hold the odd retractor in surgery.

When I told him that medical students do all those things, plus skills like intubation, arterial lines, and suturing he almost choked on his egg roll.

Needless to say medical students here are to be seen and not...well...heard, unless they are being pimped, in which case the responses should be quick and confident sounding.

I know that I chose to sign up for this training but frankly I am a little worried I'll lose the skills I learned as a nurse such as cannulation, catheterization, blood draws, arterial blood gases, and suturing. Never mind the fact that I'll be hopeless at case management, creating care plans, admitting and discharging patients. Hopefully I can cram as much of that type of learning into my Canadian electives over the next two years...

Tomorrow brings a couple of long theater (O.R) cases so I must hit the books and Acland videos. Here's to hoping for light pimping, kind scrub nurses, and no lead aprons.

Week Two: Objectives

It's now Sunday afternoon and I'm quite smug about the fact that there is a ridiculously tasty pot of chorizo, chickpea, chicken, barley, and veg soup simmering on my stove. It is part of my objectives for the upcoming week which include:

-eating proper food as opposed to scarfing down (in the washroom) warm string cheese that has been sitting in my purse all day
-fruit (yes, that is an objective)
-exercising (ok that might be a bit of a hoop dream)
-keeping a log of what patients and presentations I saw (oh right, that one is a course requirement)
-going to bed earlier (and not watching Parks and Recreation reruns until I am almost comatose)
-actually looking up the answers to one of the 1000 questions I have lingering at the end of the day

I do love surgery. I wish I didn't. Even the tedium of holding a VERY large and awkwardly positioned retractor for hours on end doesn't deter me. I got to see how a stoma is made and how to reconnect loops of bowel following a resection. These are important life skills as far as I am concerned.

I just wish it was the days of olde when surgeons were trained as apprentices because I have lucked out with some great master barbers! Mind you, if I were living back then I'd probably be a serving wench, wet nurse, or prostitute...so...maybe I should count my blessings. 

Conversation During Clinic: Pimping

My consultant (MC) and I saw around 80 patients today in clinic. And I was in heels. Wow, when I was nursing I really took for granted the privilege of wearing scrubs and runners to work!

Needless to say there wasn't very much talking between patients, but one brief exchange did occur which cracked me up...

MC was trying to describe one of his colleagues to me, when I figured out who it was the conversation went like this...

Me: Oh right, I know the guy you mean. He's the one that pimped me on my first day and I had NO idea who he was!


MC: What did you just say? He what you? 


Me: "Pimped", wait, er...you don't know what pimping is? Didn't you go to Hopkins? Surely they talked about "pimping" there!?

MC: Isn't that like, a pimp, someone who has...you know...

Me: No no no...'getting pimped' means 'getting grilled' in front of patients or other medical students. Like when you ask me what the collateral blood supply is to the rectum. That is pimping. I can't believe you haven't heard that term--especially at Hopkins. Hang on, you were a Fellow so you'd have been the 'pimper' not the 'pimpee'.

MC [grinning madly]: So I was pimping people at Hopkins and didn't know? Wait, is that bad then that I pimp you?


Me: No, it's your job.


MC: Oh, ok, good to know. Pimping. Huh! 

And thus concluded a conversation I never thought I'd have with a consultant surgeon. 

 

First Day of Surgery Rotation, Take 2

So the conversation yesterday went something like this:

My Consultant (MC): So, why did you choose this part of Ireland?

Me: Because I miss the great outdoors and as far as I can reckon this is the best part of Ireland for hiking, biking, swimming, surfing, walking, climbing...

MC: My wife is part of this walking group that meets every Tuesday, you should go with them sometime. It'd be a great way to explore the area and find walks* that would never be on a tourist map.

Me: Yeah, that'd be great. I'd definitely like to do that... [In my head adding...in a few weeks when I am settled].

--Fast forward several hours. I am sitting in our video conference on anesthetic assessments and my mobile rings, I am not going to take it and then I see that it is MC calling. YIKES! So I grab it and run out of the conference.--

MC: Ok so my wife is going to be wearing a pink NIKE hat, driving a silver VW. She'll meet you at the Windmill parking lot at 1820h, do you have a pen? here is her number...

And so it was.

I know, I know. It sounds like a ridiculously gunner move but honestly, I thought it was really nice of him to set it up for me and I didn't want to seem like some outdoorsy blowhard who is all talk and no action. Also, was it a test?? I really don't think so, but I thought on my first day I did not want to seem like a flake. So I went.

And it was wonderful. Aside from the ring of geriatrico-hiking-psychos that cornered me at the beginning and created a chorus of 'tut tut's' over my footwear (runners). There were about 10 of them that surrounded me and started chastising me for my poor ankle support, lack of foresight, poor decisions...I offered to hitch a ride back to town when MC's wife piped up in my defense, "But she climbed Carrauntoohill last year in them and was fine!!" They finally dispersed with a collective head-shake and we were off!
 

We went to the peak on hikers right, just above the head of the lady in the foreground

Possibly the clearest night I've seen in Ireland. About 1/2 way up.

All retracting and no play...? NO WAY!

I couldn't take any photos from the top because it was almost dark so we were busy trying to get down as fast as possible. Yes, the sneaks held up and I made it out in one piece despite my "complete lack of ankle support!"


And thus concluded my first day of clinical rotations. Hope I didn't peak too soon!! Heh.


 *When people use the word "walking" here they often mean, "hiking". Turns out.

First Day of Surgery Rotation, Take 1

It is 2355h and I walked in the door about 20 mins ago. I've only just finished scrubbing the layers of peat moss and bog water off me (long story) but I thought I ought to give a quick update.

Surgery=AWESOME

I have the privilege of being with a surgeon who is not only talented but nice. He's got a great team and I think I am really going to have a fabulous experience.

Really excited. And happy. And relieved.

Until tomorrow...good night!

Into the Fray

So tonight is the eve of starting clinical placements and my 3rd year of medical school. Just found out I have the wrong shoes for theater (no sneaks or crocs, only clogs with a heel). So I'll be starting off with an inappropriate-footwear-bang!

I've gone through my entire wardrobe trying to find something that is summery-yet-appropriate-and-comfortable-yet-stylish. I do not own anything that fits all of those categories.

I am someone who is always to hot (which is why it is a good thing I came to Ireland over the Caribbean, tomorrow's high: 9 degrees Celsius. No joke). I don't want to be the medical student who looks like she's having a hot-flash tomorrow. Yet somehow the best outfit I could come up with were wool-blend pants and a wool-blend sweater. Nothing else seems right because I want to be as understated as possible tomorrow when I meet my team and Mr. Surgeon. Yes, in Ireland (and the UK, I think) the surgeons are Mr.'s not Dr's. Another odd quirk, like the hot and cold taps.

So, I am nervous and excited. My appetite has been gone for the past few days (which is probably a good thing after fat-camp all summer (a.k.a "studying for the USMLE").

On the upside, the blog fodder will hopefully improve as reading a blog about someone who does nothing but study isn't exactly gripping literature.

Fingers crossed things will go well tomorrow. I've been looking forward to being back in the hospital for so long--I just hope this part of the course will live up to my expectations. I remember so clearly when I was back in pre-req hell and typing up a physics lab, stumbling on Old MD Girl's blog while she was in her clinical rotations. I wished there was some way I could teleport myself to that place in medical school. And now I am here! In my wool suit. Look out world.