On Bended Knee

I've really been loving the push, the post race endorphins, the crazy sense of "did I really just do that?"

Until recently, I would never have considered myself an athlete. My friends are athletes, my family members are athletes. But since November, when I did my first adventure race, I've come to think...maybe I am one too?

Three weeks ago I did my first trail race. It was a 1/2 marathon with a nice sprinkling of 3500ft elevation for good measure. It was much, much harder than I anticipated. Waaaaaaaaay more difficult than the 10 mile road race the weekend before, and hella more mentally challenging than the Sea2Summit (which was 2h longer). I got crazy calf-cramp-of-doom followed by inhumane-hamstring-tetany-of-death which stuck with me steady for the last 2 miles. Yeah, I was 'running' as if I had a wooden leg, whimpering, and generally feeling miserable and frustrated. But dammed if I wasn't going to finish it...and then chug a large glass of orange squash concentrate by mistake at the finish line (who has bottles of concentrate and no water at a finish line???)

So I've been kettlebell-ing and running a little and cycling, feeling pretty pleased with my fitness and shiny new upper-body strength.  Ok, maybe the odd twinge to my knee and feeling of fullness in the back of my leg. Then 3 days ago I squatted down in the emergency department and saw stars...um...why can I not squat? Oh, because my knee is blown up like a balloon. Awesome.

So ice, ibuprofen, ice, elevation...more ice...did I mention I bought this sweet gel sleeve that doesn't freeze solid and can cuff right around my knee?

No improvement. No acute injury...hell, I hadn't biked/run/kettled in a week.

Today I had a steroid / lidocaine injection into it just before heading into theater for the day. Ooooooooh maybe standing on it for 8h after wasn't super brilliant. And now I am here. Not allowed to run or squat, my knee hurts like a fecker and looks like it belongs to Rita McNeil.

So frustrating to finally feel like I'm getting into the shape I've always wanted to be in...with an adventure race coming up in 4 weeks, a 1/2 marathon in May, and a triathlon in June...GAHHHHH!

[Pouts]

[Reaches for bag of peanut butter cups.]

[Recalls how tight work pants already are, puts aforementioned cups down.]

[Steps away from cups.]

Signs off.

(Photo credit: pic of the race trail taken by my good friend Stephen Bennett.)

Why You Don't Want to be an IMG*

Here is a little taste of how you are treated by Canadian universities--below is a timeline of correspondences that started last August when I was offered an elective (by the head of the department) for four weeks this summer. 

Anytime I'd email the hospital staff I'd get prompt, professional replies. When I'd email a question to the university in charge of overseeing this elective every reply started like this (I am the one who put things in bold):

The &*& Visiting Elective Office will not accept any email registrations until after February 1st, 2012 for April 2012 onwards.  I will not be keeping  a copy of this email so please email again on or after Feb 1, 2012 to officially register for this elective. 

(This in reply to a question regarding police record checks--i.e. do I need one from Ireland or from Canada or from both?)

Visiting student applications for the clerkship year April 09, 2012 – February 28, 2013 can only be considered after February 1, 2012. (There are no visiting electives between Feb 27 - April 08, 2012.) Please get in touch with me again at that time and I will provide you with department contact information. Thank you for your understanding.

  

That was a little annoying. But I rolled with it.

When the hospital coordinator emailed my offer and dates to the university a few days before Feb 1st the reply came to me:

 I will not be keeping  a copy of this email so please email again on or after Feb 1, 2012 with the department confirmation (email below from *&* is fine) to officially register for this elective.

So that was a little frustrating. But I just chalked it up to normal university proceedings and waited for the magical day that I could send my offer of elective email....again. 

Feb 1st rolls around. I send in my offer letter. Hear nothing for two days and then get...

Visiting student applications for the clerkship year April 09, 2012 – February 28, 2013 could only be considered after February 1, 2012. Once the mandatory rotation schedules for the next class had been distributed to the departments. As such applications for visiting electives opened Feb 1, 2012.

Thank you for your message requesting elective time at the University of &*&.  Unfortunately, with the increase in the number of our own students we are no longer in a position to accommodate all of the requests we get from visiting students. On Jan 30, 2012 UMEC has just passed a motion that is effective immediately that at the present time we accept applications (medical students) from LCME accredited international medical schools. With the increase in the number of U of &*& and Canadian medical students, it is felt that we can no longer accommodate students other than those from LCME Accredited schools. LCME Accredited schools are only in Canada and the US. Please go to the LCME website for a list of LCME accredited medical schools - http://www.lcme.org/directry.htm

Therefore your elective has been cancelled.  

Repeat.

I would suggest that you try one of the larger medical schools in Eastern Canada to see if they would be able to assist you.

 

I suspect s/he is referring to those Eastern Canadian schools which rejected my applications in the FALL because all the electives were already full there. Thanks, tips, for the help! 

And thanks for the apology for pulling the rug out this late in the game. Oh wait, there was no apology. 

Here are some simple equations for the uninitiated: IMG + electives in Canada = possible shot at Canadian residency

IMG + no Canadian electives = Would You Like Fries With That? + MD + $300 000 Debt. 

It does not make me feel all warm and fuzzy inside when I think about how hard I am trying to get back to a country that doesn't want me. 

Oh, Canada. 


---

*International Medical Graduate

Circular Conversations at Customs

There happened to be a good friend from school on my flight from Newark to Ottawa yesterday. We didn't plan it that way but we were pleased to have some catch-up time throughout the cab-rides and layovers. Naturally we were chatting while waiting in the customs line, until I approached the weedy French Canadian with a friendly, "good afternoon". His blonde hair was shaved to the nub, and he had an expression on his face that said I'd rather be wearing mirrored aviators...

He responded to my greeting with, "who is that you are traveling with?"

Uh, I am traveling alone.

Alone?

Yes, alone.

Who was that guy you were talking to then?

Um, a friend, but we aren't traveling together. [What are you, a jealous boyfriend??]

You are on a flight together but not traveling together, hey?

Yes, I bought my ticket separately, we live in different towns...er...I know him from some classes we took together.  [Confused and now flustered at this strange line of questioning, I think I probably sound like a drug smuggler].

Where do you live then?

I live in Small Town Ireland.

And where do you go to school?

At University in Ireland.

And what are these classes? [Smirking like I am about to say, 'nude sculpting']

Um...medicine classes? [Am I a complete imbecile? When have I ever described my education as 'medicine classes??'] 

What are you studying at University of Ireland?

Oh right, medicine, I am studying medicine. I am a medical student. [The lady doth say 'medicine' too much, methinks...]

And you are in Canada for just 25 days then?

Yes. [Hello, I am a Canadian citizen I can be in Canada for as MANY BLOODY DAYS AS I WANT!!!]

He tosses my passport onto the desk and motions to next person in line. I collect my luggage and walk through gate to see Tobie's smiling face. Until we reach the safe confines of his car my head continues to dart around waiting for customs to taser me or demand a bag / body search.

What is it with these uniformed misanthropists? Is it that their job is so bad that they feel the need to be acrimonious power-trippers? Are they actually not allowed to smile, or be polite, engage in socially acceptable forms of communication? I was so annoyed, wishing I could delete the whole welcome home to Canada experience.

The great part is I am home. Sorta. At least I am in the motherland, where the "hot" and "cold" tap are one, my 'accent' doesn't attract attention, and soy milk comes in more than one brand / flavor.

Oh, Canada...you complete me. [Sighs]

Where Am I Going Again?

As I mentioned on twitter this afternoon, when I pack I am sort of like a dog circling a spot before lying down. Only my ritual seems to involve spinning around for hours. Packing has the tendency to flare up an attention deficit problem and I find myself vacuuming, baking, cleaning my hard drive, flossing, and online shopping while stuffing random articles into my suitcases.

This trip home is exciting and a little unsettling at the same time. I haven't been back to Canada for Christmas since 2008 so naturally I am looking forward to watching some crisp moonlight snowfalls with the Nana Mouskouri Christmas album playing in the background. I can't wait to see my mom, Tobie, his family, my good friend Liz...the Arab grocery store in Montréal that I love.

The unsettling part is that I don't know how long I am going for, and where I'll be for January. It is a little difficult to pack when you don't know if you'll be spending a month in Arizona or Nunavut, a GP office or an O.R. We're talking a lot of variety here. Heels? Hikers? Nylons? Blouses? Scrubs? Sneaks? Not to mention which books I'd bring based on the place / rotation. I am still trying to arrange something but my most recent lead is looking unlikely now as well. I found out this week that I also didn't get any electives at the University of Ottawa for the summer. Have I mentioned that I am tired of feeling like a medical pariah an outcast? Is this blog post turning into a pity party? Maybe...

So now, instead of coming back to Ireland at the end of January it looks like I might be flying straight back after New Years. Sigh. I just want an opportunity to learn, and to get some hands-on experience.  It is really disheartening to constantly feel doors close in my face when I am working hard and putting myself out there. It is true that at every turn medicine asks, how badly do you want this??

OK. That is enough whining. 


On a happier note...the ginger cake that I made today turned out beautifully. I may be turning a corner in this whole baking thing. Yes, yesterday my kitchen did look like I'd had a seizure in it while holding a bag of baking soda and I probably ate 4000 calories of "broken" brownies oh I can't bring the broken ones to the Christmas party...but with each event the baking part gets a little easier and the results get a little more edible. Maybe I should try to get an elective at a pasty school...hmmm...

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.

:)

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?

How to NOT Make Friends

If you send me a FB request and I don't "friend" you it isn't because I got busy, forgot my password, accidentally deleted the request, or had a mini-stroke and forgot how to add people as friends.

No, it is because I don't want you to be my FB friend.

Here's how to ensure I will never never never never ever add you to that list:

hack into your family members account (who is my friend), go into her inbox, find an email exchange between the two of us and reply to me saying that I should add you as a friend.

Wow. That crosses so many computer etiquette / privacy / creep lines I do not know where to begin. 

*Shudder!!!*

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.

In Kicking Myself For Not Asking...

I always ask questions at the end of lecture. Barely anyone else ever does which I find weird and borderline irritating. I feel like saying "Really? No one has a question? This nephrologist just lectured to us for 2 hours and everything was crystal clear--you have never wanted to ask a nephrologist anything?"

Sometimes I bite my tongue, or just ask after class because even though a really big part of me doesn't care what the other students think of my question asking behaviour, sometimes I just don't want to be that girl. You know, the one who asks questions. Every. Lecture.

Anyway, yesterday I went to an evening presentation by the only peds neurosurgeon in Ireland. Yes, you read that last line correctly. I didn't ask my question because a few people (mostly doctors) in the audience were asking long blow-hard-like-listening-to-their-own-voice-pseudo-questions. Also, I was pretty sure that I must have missed a pivotal aspect of neural tube development/spina bifida/Arnold-Chiari malformations in school because NO ONE ELSE asked and it seemed like a really obvious question (why do repaired spina bifida patients who no longer have ACM's still need shunts, why do they still have hydrocephalus, like forever??)

I kicked myself afterwards because when I ran into my anatomy prof in the parking lot I asked him. He had been wondering the same thing. Anyway, when I was venting my frustration at not asking (and my reasons why) he said,

Everyone waits for someone else to ask the key question.  Evolution taught us to take risks vicariously.

So, anyway. That is my quote for the week. Nay, month.


I think I will get a coffee mug with that written on it. 

So Unbelievably Lame

So remember how I was all exited about the USMLE course that the school was going to provide?

Well I found out today that now it will likely be cancelled and I am seriously pissed.

The school was offering the course to Canadians who have the obstacle of being International Medical Graduates* upon completion, and it was going to be free for us. If Irish students wanted to take it, it would cost them 1000 Euro.

There was a meeting last night and apparently the Irish complained so bitterly that we were getting it for free while they were having to pay, that now the school is thinking of cancelling it altogether.

(Did I mention that we pay the equivalent to $36 000 per year more than they do?)

I would happily pay the cost of the course if they offered it, I am already in a bottomless pit of debt and if the course brings up my mark by even a handful of points it'll be worth it in the long run.

Classic case of a few people ruining it for everyone. Buhhhhhhhhhhhhhhhhhh.

---

*The deal is, when you leave Canada to study medicine you become an IMG in the eyes of our residency matching system. Not a Canadian-Who-Studied-Abroad-And-Now-Wants-To-Come-Home-And-Provide-Services.

This limits your opportunities for residency, especially in competitive ones because you are part of the IMG pool and IMG's rarely match in the 1st iteration--unless you go into a return of service pool. Fine if you want to spend 7 years in Saskatchewan POST-training (not that there is anything wrong with SK, just that neither Tobie or I have any bonds/family there so having to spend possibly 13 years there if I specialize seems a bit harsh).

The Irish students who study abroad have a sweet deal: they are given priority over foreign grads (like me) for post-grad training when they return home. That means, even if I was the number 1 ranked student in my class then I'd have to wait until the lowest Irish applicant matched before I could get a position in Ireland, if I wanted to stay.

In a nutshell, we get screwed in Ireland and Canada.

So, I planned to write the USMLE as it gives me some more options, and both Tobie and I are keen on living in the States for a few years. The bummer part is that our curriculum is not at all geared toward the exam so we are at a bit of a disadvantage compared to students who studied in places like the Caribbean.

Bloggers Block

I realize that there has been a dearth of meaty content lately on the blog. Mostly photos of my surroundings and anecdotes showcasing me losing my grip on rational thought.

I have to say though that lately all I feel like writing about is how bogged down I feel with school and how completely overwhelmed I feel most days.

So I start to write. Then read it. Stop. Throw it into the trash.

*She drums fingertips on keyboard.*

Things that are currently annoying me:

-mouth ulcer (the inevitable red flag of rising stress levels)

-the fact that the International office ticked the wrong box and said that I was in a "correspondance program" on my loan application for Canada, thus resulting in me not qualifying for the $15000 loan I received last year...a fact that only came to my attention when I noticed that it was about the time when my disbursement notice should be showing up (6 weeks after submitting forms) and it still hadn't arrived. I called the loans people in Canada to find this out: cue more paperwork, more waiting, re-processing, re-mailing, re-faxing. Hopefully I will still a) qualify for the loan and b) receive said loan before Spring....Inshallah

-neuro knowledge from last year is apparently no longer in lodged in my CNS

-zero motivation for weights/gym x1 week, not aided by the fact that my shuffle ear-buds died resulting in me having to listen to a smattering of Glenn Gould, David Grey, Brian Eno, Bill Frisell, and the Baraka soundtrack during my last workout. Granted, all brilliant songs/artists/albums, but not so brilliant when you are trying to crank a hill on a treadmill!!!

-boyfriend? Who is that? You mean the person I never get to spend any time with that lives in my home with me?

Things that are currently pleasing me:

-my squirrel-like behaviour last week resulted in many frozen meals ranging from beef and Guinness stew, to seafood paella à la-student-who-is-missing-most-vital-ingredients-including-saffron-and-rabbit, to red lentil curry. This means easy-happy-healthy meals all around. Yay for procrastination cooking!

-the school is paying for 2 of our consultant lecturers to teach a kaplan USMLE prep course. It starts in November and will be one three hour session every week, as well as free access to the q-banks, two full length mock exams, videos, prep books, a diagnostic exam, etc. This pleases me greatly as I was just about to invest in a bunch of study materials which I will now get FREEEEEEEE. Well, possibly "included" in my 38500 Euro/year tuition. Ahem.

look into my eyes...you WILL learn
about ligand-gated channels

-which brings me to this guy...Dr. Conrad Fisher. I've spent the last few days watching the kaplan videos for physiology and he's the instructor. Ok I will admit he is completely over the top but HEY! he's the first person to make action potentials make sense in my pea-brain...and he quotes poets like Walt Whitman and Rumi randomly throughout the lectures. You can't fault a guy who fits in poetry between shouting about calcium channels, you just can't.

-Tobie and I celebrated our anniversary on Saturday. We met on Thanksgiving (CDN) last year, but our first big official date was on the Saturday after. Our first date was epic and grand in every way. He picked me up at 10am and we spent the day in town, checking out the bookstore, some shoe shops, Irish pub...then we went to a great Indian restaurant which we closed down around 2300h, and tea at my house after.

All told, it was a 14h first date of loveliness. So naturally we decided to retrace some of our steps for the one year later version. This year Tobie actually walked about 4kms to the nearest florist to bring me a bouquet of white flowers. Lovely, and cute that he dressed up to give them to me when I got home from school Friday afternoon.

Greens and herbs from "the Herbman" as we like to call him.
I know, not overly original or lacking in euphemistic overtones.

Saturday afternoon was the usual farmers market adventure. 

Sigh. The farmers market. Really, the best part of my week, every week. 

We returned to the scene of the original date and had a most delightful meal--our first night out in fact since I returned to Ireland in August! (Is that pathetic or admirable, can't tell). 

-This weekend I am doing a shadowing shift with the EMS crew out of the big hospital in the Mid-West. I am going back and forth between being intrigued about how the night might unfold and being annoyed that I signed up. I am doing it more for archeological/sociological purposes than medical ones really. 

I just pray to the emergency medicine gods that it is not a slow night otherwise it is going to be a hella long 12h shift with two Irish dudes I've never met before. 

Thanks for the Memories, thanks for the MRSA

So I got a couple of (let's use normal-person language) red bumps just below my right knee last week. They were itchy and looked like mosquito bites. I really thought nothing of it. I figured since I've been doing a fair bit of trail running lately that it was bugs or some fern that I brushed into.

Nagging thought--"don't remember getting bitten, don't remember brushing into any ferns". 

Then I was sure it was spider bites since we're still at war with a hefty arachnid population that enjoys our windowpanes for web-related activities. But know in my heart of hearts that most spiders cannot actually bite enough to leave a mark on human skin. 

Then a few more of these mystery bumps arrived on the scene, along the side of my right lower leg. Ok, that is weird. Didn't look like bed bugs (washed everything and flipped the mattress just in case) and Tobie does not have a single mark on him. 

Itchy. Annoying. Spreading. 

Then 2 nights ago as I was falling asleep I had a sudden flash of me starting an IV on a patient with MRSA this summer, the lesions on her arms looked pretty much EXACTLY the same. 

Image. Out of mind. Enter state of denial. 

Finally last night I dove into my textbooks and emedicine to look at the beginning stages of cutaneous MRSA and behold it looks like a folliculitis and often is mistaken for a "spider bite". 

Cue litany of curse words. 

Ok, I have worked in some seriously filthy disease-riddled-inner-city emergency departments, as well as some rural places where so many of the patients had the MRSA warning on their chart we started joking that it'd make more sense to start flagging the ones who didn't have MRSA instead. Eleven years since my first hospital placement in nursing school---how many thousand exposures have I had to the whole gamut of infectious bacterial options? 

So I have enjoyed being blissfully unaware of my bacterial flora and fauna--while subconsciously knowing that I likely added MRSA to the list of "bacteria that live on me" a long long time ago. 

But I am pissed, more than a little freaked out, and slightly grossed out. Upset. I don't think I am blowing this out of proportion. One of the nurses I worked with 2 summers ago had to go on NINE WEEKS of IV vancomycin for a cutaneous MRSA infection. 

So I started myself on Bactrim DS---I know, I know...I should have had the wound cultured before starting ABX but I couldn't get an appointment today at the school and I have no car/no money/no time/no idea where to go in the city. Hopefully will be able to see a doc tomorrow as I only have 3 days worth of Bactrim. So bloody frustrating!

Ugh. 

And that is my Monday morning.

-----

The 1642h update:

Couldn't get an appointment until tomorrow. On advice of a friend I popped over to one of my former profs (who is awesome) to get some advice. Pretty much as soon as I opened my mouth I started getting all teary and emotional which made me annoyed and embarrassed which only made the situation worse.

She was really nice about it but I felt like an IDIOT. Now I feel like an IDIOT with a staph infection (that is probably not MRSA) who had a nervous breakdown in front of a prof that I like/respect.

*FACEPALMFACEPALMFACEPALM*

Ok I'll admit. Stress levels are running at an all time high.

I work in the ED and see patients with this all the time. So I think the combo of stress, proximity, panic, irrational thoughts lead to a  massive  slight overreaction. Worst thing is, I've always laughed at the whole 'studentitis' phenomenon where you believe you have most of the diagnoses you are studying in school.

Gahhhhhhhhhh! I need a holiday.  

Seriously

That was one helluva strange night. It was like the ED axis was spinning just slightly off kilter. Whatever the chief complaint was,  it had nothing to do with what was actually bothering them.

Chief complaint: shoulder pain
Actual problem: Baker cyst x 3 months causing leg stiffness which resulted in a fall which resulted in the shoulder pain which resulted in exasperation over Baker cyst, which resulted in ED visit despite impending surgical consult for removal of cyst very soon.

Chief complaint: shoulder dislocation (2 weeks ago)
Actual problem: scabies (and alcohol abuse)

Chief complaint: dizziness
Actual problem: desire for expedited nursing home placement

And it went on like that.

I had the husband of an IV ABX dental abscess refuse to look at me and just kept repeating over and over again, "I want to speak to the doctor". He wasn't quite getting the concept that there was NO doctor in the department at the time and at 0100h NO doctor is going to come in from a warm bed or give orders on a patient unless the NURSE makes it happen.


Then there was the completely obtunded teen that drank himself into a bedwetting stupor.  He awoke from the depths of a Silent Sam induced coma to drag himself to the ED patient washroom. He then pissed all over the floor, wall, sink and escaped out the other entrance to the bathroom. When mom arrived to pick him up a few minutes later I went to get him out of the bathroom only to find a trail of urine footprints out the other side. I did some frantic searching through the few unlocked doors on the main floor and into the basement, worried that I might find him head first down a stairwell or something. Then saw that the pissy-prints went out the front door. I offered to call the police to help find him but mom was fairly certain that he'd just wander to a friends house and pass out there for the night.

Needless to say I was more than relieved when she called to say that he'd stumbled home. Heart attack by me averted.

There was more, but I think I'll give those ones some time and space. It is a small town after all.

Found Buried in BBC News

Too bad only 1/100000th of the people who have heard there is a "link between autism and MMR vaccine" will actually hear Wakefield conducted unethical studies on only 12 subjects and published false information. Oh well, I guess if Jenny McCarthy says its true it must be (apparently to pose for Playboy you have to have a PhD in Immunology).

On Friday the verdict came out about his conduct and the General Medical Council is now considering "whether Dr Wakefield's behaviour, and that of his colleagues, amounts to serious professional misconduct and then if any sanctions should be imposed, such as striking them off the medical register."

Photo Andrew Zuckerman and Wired Article

Awkward...and Inappropriate

So last week we had a large research forum at school where local scientists came to discuss their work and the applications it would have to medicine.

For the most part it was a 'how to get yourself published in 8 weeks if you apply for this research funding and work with one of these dudes/dudettes'. So for the Canadians who are going home over the summer and don't qualify for the grants/opportunities it was just a chance to hear some of the exciting things going on in Irish research.

The keynote of the day came late, an address by Dr. Robert Gallo, a world famous MD/researcher who is (arguably) credited for co-discovering the HIV virus and it's link to AIDS. The man is also the most cited living researcher and has been published in over 1500 scientific journals. He gave a very funny, insightful, informative, and humble presentation on his work and where HIV research is heading in the 21st century.

I was so pleased to have the opportunity to hear him speak.

Then they opened up the floor to questions.

I noticed in the crowd many of the researchers from the day, fellow med students, medical school faculty. Actually was looking forward to hearing what some folks might put to him for questions...I mean he is one of the great living minds in the area of medical research.

Question 1 (clean-cut dude with GAP sweater and jeans stands up):

"WITH NO ADVANCEMENTS TOWARD A CURE FOR AIDS AND NO OTHER PROVEN MEDICAL ADVANCEMENTS WHY ARE YOU PEOPLE STILL DOING TESTING ON ANIMALS??? HOW MANY ANIMALS HAVE TO DIE AND HOW MANY BILLIONS OF DOLLARS HAVE TO BE SPENT BEFORE YOU REALIZE THAT IT IS FUTILE AND ONLY HARMFUL TO ANIMALS WITH NO GAIN TO HUMANS OR MEDICAL SCIENCE???"

It is in caps for a reason. He wasn't yelling at the TOP of his lungs but he was speaking so loudly and forcefully that his JVP was measurable from across the lecture theater.


(Heads in crowd shaking...looks of disbelief...I see blood drain from Dean of Medicine's face).

Now if I wasn't completely won over by Dr. Gallo before this part, he got me with his answer. His response was gracious, and even incorporated some light humor into the tense setting that overtook the room. He talked about the restrictions of human drug testing, the FDA, the expense of using animal subjects...etc. And how, if dood knew any ways around it and could present him with a feasible alternative, he'd gladly and willingly give up animal testing. Class act.

Pale and shaken Dean takes mic and asks for another question...

Question 2 (Older dude, with long skull and crossbone headband, heavy peri-orbital edema, white t-shirt):

"So I have this friend who has a CD4 count of 700 and an undetectable viral load....and he's having unprotected sex...with a woman...and he hasn't told her that he's HIV positive...what do you think about that? Is she at risk for getting AIDS?......oh and I should probably mention that she is pregnant with his child...is the baby at risk of catching AIDS? And should she breastfeed? Did I mention, his CD4 count is 700 and viral load is undetectable? What would be your advice?"

Just when you thought question period couldn't get any worse. It clearly had.

Dean of Medicine now looks like he's on verge of collapse as all blood has completely left the upper half of his body. Eyes are darting for burning fireplace or woodchipper to toss microphone into.

Again Dr. Gallo took the time to respond thoroughly to the question, as if he had been the guys doctor for the past 10 years. Oh sorry, the guys "friends'" doctor.  Riiiiiighhhhhhhht.

Listen up people.

If you're having some questions to do with your HIV status, your lowly moral reasoning at not informing your partner that you *may* be exposing him/her to a deadly disease, and your unborn childs'  future----please talk to your GP, call the nurses line, go to a STI clinic, but don't come and ask Dr. Gallo if your 'friend' should tell his girlfriend/mother-of-his-unborn-child that he's HIV positive.

Not appropriate.

It's like asking Marie Curie if you should have a follow-up x-ray on your scaphoid fracture or James Shapiro how many units of NPH you should take if your blood glucose is running a little higher than usual. 

Which brings me to another thing that gives me a rash...medical people are many things, but one thing that we are not--is naive.

If you start citing your "friends" lab values the gig is up. We know who you are talking about.

If you tell the triage nurse that you were walking down the street, minding your own business and a shotgun went off on your kneecap--oh and that it was not a gang related incident---we are still going to have to notify police.

If you say you slipped in the shower and your hand landed against the wall (which happened to be cement) clenched in a fist to "catch yourself" we are going to know you got in a fight. That's why it's called a "boxers fracture".

We know that the reason your tox screen came back positive for cocaine wasn't because the taxi driver sprinkled cocaine in the cigarette he gave you, even though you're *sure* that is the only way it could have gotten in your bloodstream.

Don't treat us like naive fools, because most of us aren't.

Thank you. (Steps off soapbox).

Suddenly I feel Old

Why is the question, "how many years of school do you have to go back for?" always followed by "and how old are you?"

Irritating.

Irrelevant.