6 Minutes

So in case you didn't know, it is World Kidney Day today! I was at our local shopping mall with a gang of retired nurses, fellow medical students, renal nurses, and the renal pharmacist, giving out information and checking blood pressures and blood sugars.

We were MAD busy all day with a steady queue of feisty Irish grannies (mostly) and the odd Irishman who had been dragged there by his wife. It was actually a really fun day but the highlight for me was when a woman standing there with a pram said as I went by, "Hey! I know you!" I looked at her and scanned my mental files for her face. "Er....." She said, "you were there in the maternity hospital when I had my son! Remember me?"

I felt terrible because I couldn't place her (and I am usually great with faces). She said, "Remember? Six minutes??" Then I remembered. YES! I had even written about her on the blog! She was the one that had gone shooting by in the wheelchair panting while the midwife yelled at her not to push yet.

Of course I remembered her. I told her if I'd seen a side profile with her hair blowing behind her I would have recognized her right away. We had a nice visit and I had a chance to see her gorgeous blue eyed chubby boy, grinning away at us. So delightful.

I love my job!

Have you hugged your kidneys yet today?

Peds? Really?

First of all, I love pediatrics!

Children are such completely different animals. My experience so far with pediatrics has been fairly limited to the odd asthma, RSV, gastro, or rash that presents to general emergency. But working exclusively in a pediatric emergency department has been a completely different reality. I have really been enjoying the challenge of trying to connect with children, like figuring out ways to make clinical exams tolerable to them or jazzing up the neuro exam to make it like a game. I get to be kind of silly and fun, disguising the seriousness of it all. It's a treat, especially when you can get on the level with a kid. Most of them seem to lack the hang-ups that adults have around illness and disease. They are stoic but not in the look how stoic I am being, so stoic that I am actually not providing accurate information to my health care providers way that adults are. There is a different kind of job satisfaction that comes with helping to name a new teddy bear (Mr. Fall off the Wall) or getting an energetic high-five from a kid who was burying himself in his mother's skirt for most of the history. 

Plus, I always thought that (because I am really not that great with kids in the real world) I'd dislike pediatrics. And then there is the crazy parents, who also frighten me. But it seems that crazy parents are not as common as I'd imagined. Or maybe I am just not noticing them because my interaction time with parents is more limited, compared to when I was nursing.

The hospital is beautiful, brand new, and completely child-centered. T.V in every room, popsicle fridges at every corner. The staff seem to really love their work. I'm so impressed at how they are able to balance between the focused intensity of acute care while making it fun and minimally scary for the wee patients. Everyone is just so nice. Maybe it is harder to be a curmudgeonly pediatrician or crotchety nurse, I don't know.

It's been a great learning experience also, being put in with the residents for all of their teaching sessions and tutorials. Their simulation training has a dedicated faux trauma bay in the department, complete with all the drugs, pumps, and machines that go bing! We did a session on Thursday with mannequins that are very realistic (heart, breath, bowel sounds, as well as pulses, intubatable throats, seizure capability, etc.). All the mock codes were run in real time, that is, you wouldn't just say, "I would start an IV and give ceftriaxone", you actually assign the task of IV start to one of the team, they put in a line, someone draws up the actual drug and sets up the infusion. The enthusiasm to teach and job satisfaction of the attendings is contagious and I must admit I look forward to every shift.

It is strange though, being in a new city. I feel like I am regressing as an adult. No phone, no car, no idea how the city is laid out. I walked for over an hour in the hopes of buying a new burner only to  find they were sold out. The saleswoman kindly advised me to call ahead next time. I gently pointed out that I didn't have a phone, hence why I was trying to purchase one! Sigh.

And so, getting settled in. Trying to enjoy each day for what it offers. I have already managed to locate and join a yoga studio for the month, so at least some physical activity will take place. Did I mention there is also a very decent wine store down the street allowing me to finally taste my favorite American grapes again (in Ireland you're lucky to find Ernest & Julio). It's Friday night, I'm post hot-yoga and ready for a glass of red and my new book.

Back to work tomorrow, the adventure continues.

I (Heart) Rural Medicine

In the last 48h have included having the opportunity to:

-catch a baby
-cut a piece of glass out of someone's face (and then stitch them up afterward)
-surgically assist with fusing toes, replacing hips, replacing knees
-perform a D&C
-assist with a hysterectomy
-sew up knife wounds
-assess / treat / discharge about 75 emergency patients
-learn how to insert an IUD

Despite the exceedingly damp climate my hands are cracking from so much handwashing, I'm surviving solely on t.v. dinners and instant soups, clean underwear is becoming a scarce commodity, and I've spent every day (except one) in the hospital since my arrival. And I couldn't be happier.

My days are so full and varied, with such fantastic teaching from the docs here. It's hard to sleep at night, completely wired and excited by each day's events. I feel so fortunate to be here. I'm starting to believe that saying about how "there are teaching hospitals and then there are learning hospitals". Say what you will about rural medicine...but my experience is that people working in remote areas have half the egos and double the desire to teach.

I've been spending a lot of my retractor-holding and trying-to-sleep time thinking about the (soon arriving) residency application process. Today I truly felt like a few things have started to crystallize in my mind about what I want to pursue...

As always it is a work in progress, but I think that will have to be a post for another day.

In the meantime, check out my new O.R clogs while I try to get some well deserved sleep.

Yes, yes I did.

First Ultrasound!

Bet that got your attention!

Yes, last night I had the opportunity to do my first ultrasound on a pregnant woman. Can I just state for the record that there are many concepts in medicine that fascinate and perplex me, not to mention the endless list of interesting presentations and procedures. But apparently there is one thing that turns me into a giddy, effusive fool: prenatal ultrasound.

I trundled down to the emergency department last night after my flatmate (and ER nurse) called me in to see some good cases. The doc who was working knows me well so he was happy to have me seeing and working up patients. Early on in the shift a pregnant woman presented with some minor bleeding so he wheeled in the ultrasound machine, flicked off the lights and handed me the transducer.

At first all I could see was fuzzy blobs and fluid and then lo! A vertebral column appears in the darkness! And then I saw the heart, its tiny chambers pumping away. I practically jumped up and down, Look! Look at the heart! Hey, there is a femur, wow! The baby is moving his, ah...or her hands! That is amazing!! 

So maybe I should have played it slightly more cool, but I couldn't help myself. It is quite something to look at a nearly flat and unremarkable belly and then suddenly be given a glimpse into a hidden world that houses a kicking, twirling, fist-pumping little being.

I spent the next portion of the evening smiling to myself as I stitched up wounds and listened to heart sounds.

The little beating heart and those dancing legs were a delightful reminder that there are also joys in medicine, even in the emergency department on a Friday night. 

Thank you, little one. I needed that.

A little bigger but you get the idea, image from here.

Mind Go Blanko

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

Yeah. It was sub-awesome.

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

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

JVP? No. Bueno.

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

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

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

"No, he's on telemetry."

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

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

"Oooh! Ooooh!! ASK ME!! I know how to MANAGE a CCF patient!!! Really!!! YES!!"

But, no. My medical self had failed and my nursing self couldn't help me now.

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

Maybe.

:)

Alright. Medicine, I misjudged you.

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

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

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

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

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

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

Clinical Exam Follies and Triumphs

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

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

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

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

stressed

mind blank

higher stress

flustered

adrenaline injection

mind completely barren of thought

fear of failure

despair

quavering voice

certainty of failure 

despair

despair

despair.

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

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?

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.

Unsolicited Advice to Interns From a Former RN Who has Gone to the Dark Side: Part 3

This is the third installment of Unsolicited Advice.
 

Not House astutely pointed out in the comments section of my blog that "nurses will make your life a living hell" if you treat them badly. Some will make your life a living hell, no matter what. As in every profession, there are nurses with a chip on the shoulder, as well as those who are simply counting down to retirement. But for the most part, nurses want to work with you not eat you. Some of my suggestions probably appear ridiculously obvious, but I wouldn’t have been prompted to write these pieces if I hadn’t observed the examples below.

So aside from being proactive in the ways I’ve already mentioned (contributing food, introducing yourself) here are some things to avoid:

1) That is not my job or I'll get the nurse to do it are two phrases that can be heard by a nurse ears even if she were standing next to a jet plane at take off. The people who utter these statements send most nurses into a silent rage. If a patient is asking something simple and easy (like for a warm blanket and you are leaning on say, the blanket warmer) do not say "I'll get the nurse to do it" and walk away. At that point, you might as well have relived yourself on those brownies you brought in.

Nurses know that interns, attendings, and students are run off their feet--but so are they! Don't think that there are jobs more or less important than yours, and that you and your skills are at the peak of the 'importance triangle'. It's not beneath you to do non-doctorly things. Just imagine for a second how the hospital would run within hours of not having a laundry service, housekeepers, lab techs, office administrators, filing clerks...you get the picture. Until you've worked a few nights in small hospitals, you may not appreciate all the behind-the-scenes supportive work that many people do to keep the hospital afloat.

So if you have 2 seconds pitch in and help out. I'm not saying anyone expects you to change bedding, start all the IV's, walk Ms Jones down to x-ray, but small gestures are noticed and appreciated. There is nothing more annoying than having an intern say to you "get Ms Jones some water" while you are whizzing by pushing an ECG machine and primed IV pole and they are sitting down to check their Facebook updates.

2) If a nurse is asking you a question about something, don't blow her off with a patronizing answer or assume that they are questioning your care (this is different from Nurse Speak).

When I was nursing and I asked an MD a question, like "why did you use marcaine instead of lidocaine?" or "why did you chose heparin IV instead of sub cue lovenox?" it wasn't because I was trying to be inflammatory it was because I was curious and genuinely wanted to know. Were there guideline changes, or new evidence based medicine protocols? Don't forget that even though you're writing the order, the RN's are the one administering it, and many of them want to be right up on the why.

3) Messy handwriting is dangerous. Stop it. Many places are switching to computerized orders which definitely have advantages, one being that RN's no longer will have to add 'expert handwriting decipherer' to their list of skills. As a new nurse I almost gave a patient with lung cancer percocet (narcotic) instead of senna (stool softener) because of illegible handwriting and a missing-in-action MD. Thankfully, as the patient was about to tip them back I said, "do you normally take percocet at this time of the day?" to which his wife responded, "No, he's allergic to percocet!"

If you have bad handwriting, try and at least write medication orders clearly. It is also doubly sweet and handy if you alert the nurse who is taking care of the patient, "I wrote some new orders for Mr Jones and I added another antibiotic to his regimen". It is bad for everyone when the nurse checking the charts during night shift sees that no one noticed an entirely new set of orders after the blood cultures came back.

And thus concludes today's installment of Unsolicited Advice. I grudgingly redirect my efforts to understanding why I should care about the pentose-phosphate shunt.

Unsolicited Advice to Interns From a Former RN Who has Gone to the Dark Side: Part 2

After putting up yesterday's post I realized that I missed some sage Julie Andrews advice: start at the very beginning. It's a very good place to start. [Ha! Enjoy having that song in your head all day!] So I am going to back track a little.

This is the second installment on how to ingratiate yourself with your new colleagues as a freshly minted MD intern (or medical student, for that matter). These are just observations on behavior that nurses tend to notice, which can really make a difference on how you'll be received.  I hope some of my suggestions are helpful in making you appear like the Star Intern that you know you are.

Introduce yourself. There is nothing more annoying than having a new batch of people pulling charts off the desk or using the staff washroom without staff having a lick of an idea who they are. Half the time your name tag is either not visible or in such small print that we can't tell if you're here to deliver the wound-vac machine, take bloods, or admit the patient. Make yourself known to the staff. Introduce yourself to people in a polite, humanoid way, and be clear about your role. Say what year you are in, how long you'll be in the department, who your attending is, whether or not you still watch The Bachelor...whatever, just let people know your story. Do this especially with people like the charge nurse or the nurse who is taking care of your patient. They deserve to know who is doing that rectal exam on Ms Jones (as, by the way, does Ms Jones!)

Never assume that anyone knows you're the new intern / medical student / attending. They probably never got the memo, or if they did, it is tacked on the same board with staff party photos from 1997, the ACLS guidelines that advise a precordial thump, and the Thanksgiving pot luck sign up sheet. Talking about food brings me to my next point...

"There is no love sincerer than the love of food” according to G.B. Shaw. A special amount of love will be reserved for you if you contribute sustenance to the insatiable, gaping maw of the staff appetite.

The culture of food is central to the communal harmony (and sometimes survival) of the unit.  And blood sugar levels are directly correlate to measures of civility. We are well aware that you are run off your feet, working 30hr+ shifts, living on a line-of-credit, and sleep deprived but hey--if you are regularly feeding at the trough then consider making the odd contribution!

This sounds obvious, but I can count on one hand the number of interns / residents who actually brought food for the staff. Something as simple as a bag of oranges, crackers and hummus, money for the coffee fund...anything is highly appreciated. We're happy to keep you going when you haven't had a meal for countless hours, just show a little appreciation and return the favor once in a while.

Oh, and if you're in Canada never bring in Timbits. Once you've worked in healthcare for about 20 mins your lifetime Timbit capacity has maxed out. And try not to bring things that people put their hands in like giant bags of chips or other MRSA receptacles [shudder]. Germaphobes delight in individually wrapped morsels of chocolate or hands-free access, like fruit on toothpicks.

Remember, at the hospital food = friends. I can safely predict the staff will be dazzled with your thoughtfulness.

Hope today's installment was helpful and informative. Back to the pit of study hell for me (I may have a snack first).

Unsolicited Advice to Interns From a Former RN Who has Gone to the Dark Side: Part 1

If you’re a new intern you are advisedly a little afraid of the new found responsibility in your life. I say ‘advisedly’ because there is nothing more frightening in healthcare than someone who is  ‘unconsciously incompetent’, i.e someone who doesn’t even realize he has no idea what he is doing.

In an effort to be helpful I thought I’d write a series of little posts from my former vantage point as an emergency nurse. (I say series because I am in the throes of USMLE cramming but as July marks the infusion of new interns in hospitals, this is the best time to write these. It'll be my 'study break' activity.)

When I was nursing I had the opportunity to see many medical students, interns, and residents flit in and out of the department, noting the differences between the ones who sail and the ones who sink. Here are some tips for those that want to sail. 

You Are Book Rich, Experience Poor. You may know all the cytokines involved in septic shock, but the RN knows what it looks like from 30 ft. Guess which of the two abilities is going to save your patient’s life? You'll get there, but in the mean time, pay attention to the patients about whom the RN’s are concerned. Which brings me to my next point.

Spidey Sense is not learned it is developed. Many nurses have been in health care since you were wearing short pants and they have pattern recognition down to a science (or some might say, a freakishly intuitive level). Good nurses know the ‘sick look’ so when they feel something ain’t right with a patient…it’s probably true. Do yourself a favor and check the patient out. Also, this is a good way to show your nurse colleagues that you respect their opinions.  You hate them because they paged you at 3 a.m when Ms Smith wasn’t looking right, but now they’ll love you because you took their concern seriously. And let me tell you newbies: Nurse love is the BEST love when you're the new kid on the team. Now you won’t get another phone call at 0345h to find out if you wanted that ‘diet as tolerated’ order ‘by mouth’. Not that that has ever happened…

Nurse speak. Nurses learn very quickly how to speak in code to 

a) forestall disaster, 

b) make you think something was your idea, 

c) point out a mistake without being unprofessional, 

d) make a suggestion without appearing to offer advice.   

Here are some translations for Nurse Speak. 

“Are you sure you want to [fill in procedure, medication, etc.] Mrs. Jones?” 

means “If you do that you’ll probably kill the patient”.

“Did you say you wanted a CXR on Mrs. Jones?” 

means “Yo! You forgot to order a chest x-ray, I am going to go ahead and order one now to save you time and not make you look like an idiot when you page medicine and then have to tell them you haven’t done a chest x-ray yet”.

“Oh, I haven’t seen it done that way before, I always thought you had to…” 

means “Dude, you are seriously doing that wrong, please let me show you a better/safer/faster way of doing that”. 

And finally, 

“Did you want me to go ahead and dip that urine for pregnancy?” 

means, “It appears you’ve left out a major differential, I’m going to make sure it has crossed your mind”. 

And that concludes today's installment of Unsolicited Advice. Hope some of that is helpful!  

New Irish Digs

So, life as I know it back in Ireland is about to change quite a bit. If you've been reading for a while you will know that I am (not officially) done with pre-clinical medicine. Provided I passed the recent exam gauntlet, I'll be starting my hospital rotations on Aug 2nd in a new city (and not a moment too soon, honestly I think I am about to get 'office chair' sores from sitting and staring at textbooks all day long for the past two years.)

Pretty sure that for every month of pre-clinical medicine in the world an angel loses it's wings.

Anyway, I know very little about my new city except that there is a decent coffee shop, a giant Tesco, and no yoga studio. Well, 2 out of 3 ain't bad I suppose. My casa novo is about 7kms out of town on some crazy Irish road (and by 'road' I mean 'ruts wide enough for a carriage') and I love it.

It's so CUTE! Don't you just want to pinch it's cheek?

Front 'mud' room. Plenty of room for all my raincoats.

Front hall. Riveting isn't it?

Yes, yes I will be drinking cosmos* in my scrubs after a long day of holding retractors!

This is the view from the chair where I will be drinking said cosmos.

Oh hello, furniture that isn't made of flame retardant pleather! It's about time!!

Two words: gas stove. BAZIIIIIINNGG!!

Laundry room off the kitchen, complete with toaster. There is also a small bathroom attached. I think the drying rack really ties it all together. 

Guest room with ensuite. Never thought I'd have a giant felt flower in my home.

Guest room bathroom. Can't you just hear the Zamfir pan flute music that I will be pipping into the room when there are visitors?

My room. I like to sleep in bedside tables.

View from my room.

Kristina's room. She prefers a bed to sleep on, that is why we are so well matched as roommates.

Upstairs bathroom.

Kristina realizing she is tiny enough to live on the landing.

Across the street. Awwwww yeah!!! No annoying kids shooting hoops while I am trying to sleep off a nightshift!

View from the 'road'.

Needless to say, now that I am out of student accommodation people are actually considering coming for a visit! Kristina is only staying for a semester so not sure what will happen after Christmas. Maybe I'll turn it into a B & BYO Breakfast or something and charge 200 Euro a night. We'll see.

The part that I am trying not to think about is that young Tobington will not be living there with me. Because I mean really, what could be more romantic than living in a beautiful new house in the Irish countryside together?

Apparently living in separate countries. Le sigh.

---

*I don't actually drink cosmopolitans usually, I am more a dirty martini kind of girl, but I think the pink livingroom is going to drastically increase my consumption of beverages topped with tiny umbrellas or large pieces of fruit.

I'm doing the right thing, right?

[Warning: there are some dissection pics in this post which may be unpleasant / revolting for some of you to look at. Or they may pique your interest at what lies beneath our largest organ...]

Exam week was probably the most mentally exhausting 4 days I've lived through, to date.

I'll just break it down. 

Day one, morning--2h long answer section. Questions ranging from anterograde and retrograde amnesia and why they occur following head injuries, to different types and causes of pleural effusions, to describing the association between tissue transglutaminase and celiac disease. Good times, oh, good times.

That afternoon--100 extended matching questions. I've already ranted about that so I'll just say, wow it felt like an anatomy spotter without the pictures. Weird. 

Day two: off. Which meant 'studying ass off for remaining two exams'. 

Day three: take 2 years of clinical sessions ranging from skills like 'taking an alcohol history' to 'abdominal examinations' to 'suturing' to 'IV cannulation' to 'breaking bad news' and create an OSCE of HELL involving 19 six minute stations complete with actor patients and physician examiners. You have one minute to prepare before each station where you are given a one-liner like, "Mrs. McDowell is here with her 20 month old to discuss developmental milestones" or "you are at the GP surgery and suddenly a man in the waiting room collapses".  

Overall I'd say the OSCE went well, aside from some major facepalms...like forgetting to take the respiratory rate in the respiratory exam, saying the phrase, 'do you have any more questions for me?' about 25 times during the double (12 minute) motivational interview for smoking cessation station!!!

Day four: Take 900 histology slides and approx 4000 anatomy slides and choose 50 spotter questions. 

Some examples:

If "A" was damaged during a surgical procedure which of the following  might occur?

a) Horner's Syndrome

b) paralysis of cricothyroid

c) paralysis of cricoaretynoid

d) paralysis of pharyngeal constrictor muscles

e) inability to adduct glottis

f) inability to abduct glottis

g) chylothorax

[Buzz!!! NEXT STATION]

 [Buzz!!!! Next STATION!!!]

And so on...you get the picture! 

By the time the spotter was over all I wanted to do was crawl into a sensory deprivation chamber and stay there for about a week. 

Instead, Tobie and I went and had Ayurvedic head and foot massages in this beautiful clinic outside of town. It was lovely, though I wish I could have afforded a head-to-toe treatment. While I was sitting there sipping dandelion tea in the dimly lit and beautifully scented room, listening to classical Indian music, I couldn't help but wonder why I chose to throw myself into a career where I will most likely be under the glare of bright lights, with the clamor of overhead pages and monitor alarms as my soundtrack.

My prayer for the day: please God, let all of this be worth it.

--

Answers (to anatomy related questions, not existential life ones) can be found in comments. 

Still Alive, With Questions

I am still alive, have not thrown myself into the Majestic River Shannon or anything. Just been packing, sorting, moving, driving, packing, driving, flying, unpacking, sleeping.

And I have some burning questions that need to be answered:

1) Why is there always ONE guy in every airport departure lounge with a bluetooth talking 'business' in the loudest voice possible? Why is someone named 'Roger' always 'cc'd on the email' and 'crunching numbers'?

2) Why is it that whenever I wear a white shirt I suddenly lose motor control of my lower lip when eating?

3) Why is it impossible to fall asleep after being awake 24h?

4) Why is it, despite my best intentions to be more organized, every time I move there is always a few boxes at the end which contain a smattering of cleaning products, textbooks, underwear, spatulas, highlighters, hair products, face cloths, and organic quinoa?

5) Why are yoga instructors always ridiculously gorgeous and in perfect shape?

6) How am I going to survive two years living in Ireland without Tobie?

7) Why do airplane movies always make me cry?

8) Why did I think doing a triathlon this summer was a good idea?

I am actually working on a for realz post right now about the HELL week that was exams. But for now, I leave you with the questions I have been pondering for the last couple of days.

A (Not So) Beautiful Mind

Tobie came in my office recently and commented that one of the other residents in our complex might call campus security as my office window was looking a little too much like an unfolding psychotic break.

I figured, until I started drawing lines between the scraps of paper or taping up magazine clippings I was safe.

Ok, I'll concede. It is slightly creepy looking...

1/2 Way to being 1/2 Way

Ahhhhhhmmmmnnnnnn. [Loud exhale].
So the extended matching exam and long answer are behind me. I feel, meh about them. I felt like it didn't test our breadth of knowledge, but instead had very bizarrely chosen depth of knowledge questions. Like how much you knew about otosclerosis treatments or the theories behind why anti-depressants work (no, not mechanism of action, theories).

And other random things like, for example, on a 100 question exam there were 5 questions on different terms for heavy / irregular menstrual bleeding. Seriously? Seriously. It was that important for the school to assess if I knew the difference between menorrhagia, menometrorrhagia, and metrorrhagia??

During the year we had several cases involving lady-bits including pregnancy, infertility, PCOS, premature delivery, pregnancy induced hypertension, gestational diabetes, dysfunctional uterine bleeding...and then, 5 whole questions on bloody nomenclature? Nothing else? That was how they tested our knowledge of the ever-so-complex-involving-too-many-hormones-and-bits-diseases-childbirth-richly-innervated-many-muscled aspects obstetrics and gyne? Le sigh.

And while I am venting...

What was with the 10 questions on which muscles were eccentrically, concentrically, or isometrically contracted during each phase of the gait cycle? I thought the anatomy spotter was on Friday? Grrr...

Nothing on diabetes, heart disease, endocrinology...nothing. Ah well. It is over now! I just hate it when it feels like the test wasn't that applicable to the things the course really focused on. Like an entire long answer question on otosclerosis!? And another on the anti-gliadin antibodies in Coeliac!? Annoying.

Ok enough prattling on--all that is left is OSCE and spotter. Then...FIN!

Must Be Finals...

Yesterday on the way to practice OSCE* crap, I started driving in the opposite direction of my study buddy's house (a drive that I could literally do with my eyes closed, I've done it so many times).

I picked up my deodorant and toothbrush and was 1 inch away from putting the former on the latter to brush my teeth before I realized what I was doing.

And in new grandiose feats of procrastination: I did a tray of home made pita chips, vacuumed the ceiling**, and read up on the Moken Sea Gypsies of Thailand.

Must be finals
Must be finals
Must be fiiii--iiii--nnn--aalllssssss
[Sung to the tune of "Must be Santa".]

*OSCE's are "Objective Structured Clinical Exams" pffft. Too bad they are the farthest thing from it.
**I wish that was an exaggeration. 

Medical Gods Give Me Strength (and a photographic memory, please)

When I get really whiny about how hard it is to try and remember 2 years worth of curriculum I try to remind myself of the fact that it is a priveledge to study medicine. Really, it is. I know that there are hundreds (thousands?) of people that would gladly trade places with me this instant if it were possible.

This normally gets me re-motivated to try and remember things like the stages of herpes infections.

Not today. Partly because my exams for school start in 3 days and partially because I still have forty three more groundhog days of picking my clothes up off the floor and padding into an office at 0630h, only to emerge for feedings and the odd burst of exercise, then collapsing back into bed at midnight. Wicked pisser summer, hey??! Yep.

I chose this. I chose this! I chose this?!?

---UPDATE---

Just as I was writing the last sentence, Tobie returned from the Farmer's Market with gifts for me!! Ok, before you all start going "awwwww" I will point out that as he was leaving I asked him to please get me some presents because I was losing the will and that I would reimburse him for any expenses said presents would incur. And so, I am now the proud owner of the Joseph Joseph Chop2Pot Plus cutting board!! Yippeeeeee!

The way to this girl's heart is through kitchen gadgets.

He also got me my favorite (though normally banned from consumption due to the fact that it is pretty much PURE BUTTER AND ALMOND) croissant from the bakery, and some organic kale from our favorite local Herb Man*. So that got me through the evening. He's pretty sweet alright and wouldn't let me pay him for the gifts after all. I think I must be getting hard to live with these days because last night I was tormenting him about something to which he said, "don't you have to go and memorize a bacteria or something??"

Yes, yes I do.

Back to it!!

*No the end of that sentence is not a euphemism for other green leafy substances...I need every brain cell I've got at this stage of the game.  

Our Own Little Strange Acoustic Flash Mob Bette Midler Style

Okay so maybe the title was a little long and self-indulgent, and maybe I should be studying for my mock full length USMLE exam tomorrow morning, but...meh...the canker sores in my mouth and recent surge in nocturnal teeth grinding tells me I could probably use a night off.

Besides, how can I study for the USMLE when I am still buzzing with school-girl-giddiness from our little strange home grown acoustic flash mob (if that is what you'd call it) performance we pulled off today?!? 

To set the stage, it was our last anatomy class*, designed as mostly a review session. Prior to class we rehearsed about 5 times with a handful of people who agreed to be a part of it. All of us were absolutely vibrating in our seats for the whole session, anxious for the cue to start. We told the other faculty and Dean that it was going to happen at noon and they gathered outside in the hall. We had already distributed little flags with a picture of his face on them (see photo below) and sheet music.

Anyway, I'll let you watch for yourself...it starts a bit rough but I figure we pulled it together nicely by the end.

He was definitely surprised, and even a little teary, I think. I've probably watched the video about 30 times and just can't get the grin off my face. It was an absolute blast and I think an appropriate send off. He's a tough Prof, but very good. He has worked hard to design a very clinically relevant anatomy program, and it shows. I am actually going to miss anatomy. Little bit.

The photo we mounted on little sticks.

Now I am going to have to start brainstorming. Grad is only two years away! We put that together with one 30 min rehearsal---we could have a three ring bloody circus by 2013 if we get cracking!!

--

*Usually the class consists of our prof lining us up and drilling us for half an hour, in small groups of about 20. We've had this class every week for the past two years. Yeah, two years of anatomy. He's a very, shall we say, intimidating, gruff man, with an impressive CV about as thick as your arm (if you have thick arms) and a very short fuse for wrong answers. He's the one that tells us to die or hang yourself or jump off a bridge if you say that the facial nerve is the sensory nerve of the face (it's the trigeminal) or something along those lines.