Fin

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

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

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

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

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

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

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

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

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

The intellect of man is forced to choose

perfection of the life, or of the work, 

And if it take the second must refuse

A heavenly mansion, raging in the dark. 

Weak Week

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

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

It didn't.

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

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

:(

:(

:(


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

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

Ok, that is enough whining for one post.

Scenes from the Day

I (heart) fall.

Another Charming Trend in Medicine

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

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

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

Hello, Ireland. Need a doctor?

Little Things, Like Spicy Pickled Eggplant

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

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

Adventure Racing

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

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

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

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

Did I mention I am scared?!

Last to Know

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

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

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

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

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

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

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

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

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

So I suppose time will tell.

The Blasket Blast

Last week I was whining to Paddy (our surgical SHO) about the fact that my bike needed a tune up, M.C overheard and kindly offered to get it road worthy for me. From this, the topic of the Blasket Blast road ride came up. It is an organized bike ride that goes around the Dingle Peninsula, along some of the most breath taking scenery that this country has to offer. So M.C asks Paddy and I if we want to enter the event with him as he's going to be participating. In true ABB form, I agree without asking any questions (you know, shoot first, ask questions later). I either didn't hear that it was 150 kms or figured that he was exaggerating.

I forgot all about the discussion until a few days later when M.C informed me that he'd paid my registration. Paddy was out because he was on call and couldn't get anyone to switch (how hard he tried is unknown!) Right, so at that point I started asking for details because the longest road ride I've  done is ~70 km in Prince Rupert TWO SUMMERS AGO. He tells me it is 150 km and 8 days away, that was when I started to get really, really worried. This was compounded the day my roommie met M.C and uttered immediately afterward: you are so screwed! He looks seriously fit. Great. Thanks.

Thus began my week of fretting and bike riding. I did ~80 kms last Sunday, then two 35 km rides during the week. I had no idea what was going to happen but I figured I better give it a lash. 

I did enjoy the carb loading part of the whole thing and took it to the next level...indulging for several days before the ride. You know--popcorn for dinner, hummus and crackers several times a day, granola by the handfuls...and chocolate mousse the night before (there are carbs in chocolate, right?)

A scene from the night before, all the food and water ready. And spare socks. Of course my riding shoes with clips were nowhere to be found so I busted out the sneaks. Awwww yeah.

First coffees, just after the summit of Connor Pass.

So there were two rides, one that was 110 kms and one that was 150 kms. We were doing the latter with about 40 other people, men in tights to be specific. Ok, there was one other woman doing the long ride...at least we think she was...a woman. If you note the biker in the background you'll get an idea of the one-piece spandex jumpsuits and waterproof clip booties that everyone else was wearing. All the long riders were SERIOUSLY decked out. We looked like we'd found our gear at a garage sale the night before, by comparison. Both M.C and I were also the only people wearing running shoes. We got some very disappointed and looks and clucks throughout the day due to our athletic faux pas of epic proportions!

And then there was the flat tire. The guy who stopped to radio the support car with a foot pump informed us that he hadn't gotten a flat in 4000 miles. We were undeterred though our place at the end of the line was definitely secured.

And then we got stuck behind some sheep. As you do, when you're riding the Tour De Irelande.

 

Some lovely scenes from the day. 

The Blasket Islands.

 

The above photo shows the Irish version of a 'highway', and how wide a bike rider can expect the shoulders to be. 

 

First lunches. And a latte from a road-side bus! This was my kind of race. 

 

 At the 95 km mark we decided it was time for ice-cream.

And a photo op of the old ABB and her bike.

Finally! Several hours, 150 kms, 2 pairs of socks, 2 lunches, 3 coffees, 1 ice cream, several rainstorms, and 3 pee breaks later we arrived back at the start. We had a really fun day, actually. I even managed to pull out my last bit of juice on the final summit and trash talked M.C all the way to the top.

And it was GREAT!!

I am so glad I did it. I love it when I surprise myself! Go Team Sneaks!!

Good News

The best part of my day, hands down, was getting to tell a patient that her CT scan was clear, and that no further cancer had appeared in her abdomen.

As a nurse in the emergency department I often saw the test results before the physicians did. Many patients would ask me directly what the results were but I always had to defer and say that the doctor would be in to speak to them shortly. It was one of the things about nursing that irked me on a regular basis.

Today the chart landed in my hands and I called a bubbly woman in to the office. I asked what her referral was regarding and she informed me that it was for the results of her recent CT scan. She had a history of cancer in her abdomen and as I flipped through the chart trying to find Diagnostics I said a silent prayer hoping things would be normal. Found the report and read it out to her...everything was normal. As I read I could see in my peripheral vision her shoulders relax slightly from a hunch, and heard a breath escape with the movement. The relief on her face was a delight to me.

So much of our practice deals with pathology and telling people bad news that these moments of relief and reassurance, are a treat. I am grateful that I was able to start my career of telling people results with some good news.

Tiny Holes and Testicles

So I knew, going in, that medicine wasn't glamorous. But sure, I love it anyway.

M.C has been giving me any opportunities he can to unleash me on patients and attempt my (now feeble after two years of atrophy) suturing skills. I learned a new tie last week and had a chance to suture up some trocar incisions. The piercing gazes of the O.R staff can be enough to make any steady hand tremble and I was kicking myself for not being smoother when he handed the needle driver over to me. It was only a few tiny knots in a couple minute incisions but I could feel the sweat starting to trickle while I worked it out.

Then yesterday he let me attempt hand-tying for the first time. Of course the anesthetist had to come out from behind the drapes to watch the show and the scrub nurse faintly jerked her head every time I made a mistake, but M.C let me persevere until I got it right. I just hoped that my damp scrub top at the end was from my nervousness and not from the hydrocoele fluid that I'd been sprayed with earlier in the procedure. I figured out quite quickly that practicing tying knots with a shoe string around a toilet paper roll is no substitute for scrotum and sutures. Go figure.

And speaking of testicles...I thought I saw plenty of man-bits when I was nursing...but oh no. Of course seeing testicles isn't anything new, but having to figure out what is wrong when someone comes in with a swollen one is something completely different. I find myself sometimes getting caught up in trying to visualize the structures under the skin while I am palpating the problem. I think the last thing you want as a male patient is a woman staring off into space, blank expression, ball in hand. Rolling.

So I am going to try and become a little faster and more methodical with that exam. Like everything else.

Only 2 weeks of surgery left, and then I am off to ponder sodium levels and sliding scales for the next 9 weeks start my general medicine rotation.

Theater tomorrow!

A Personality For Surgery?

I don't really know what people mean when they say, "oh you've got the personality for surgery". Is that like having a face for radio? Because to me, that is what it sounds like.

When I think of surgeons (apologies in advance to any who might be reading this) I usually envision an ego-maniac who likes to have hissy fits. Someone who is impatient, brusk, irritable, and cold. Granted, in the last while that stereotype has been opposed by many of the all-around-awesome surgeons I've met and worked with. Many of them well rounded, caring, hilarious, sensitive folks...really!

The other night myself and and handful of the junior attendings were out for supper and the registrar (a position equivalent to resident purgatory as far as I can tell) was going on about our astrology signs and when he found out I was a Leo he joked that I was the quintessential Leo. Now he's been around hospitals for a long, long time so I asked him if he thought there were specialties suited to certain Astrology signs (I am grasping at straws here people, I know that) and he laughed and said, "Do you mean, 'what should I go into because I am a Leo?'"

"Er. Yes." All eyes around the table fixed on me. Conversation stopped. Now I was feeling awkward.

"Well, surgery of course. Lots of Leo's gravitate to surgery."

"Why?"

"Because they are bossy and need to always be the center of attention!"

Ah, thank you. Yes. Well I suppose I did ask.