Holidays, Day 1.

I am disappointed that I haven't been able to keep up the blog more regularly this semester. It's been such a wonderful and horrible few months. It makes me sad to know that a lot of it will be left undocumented. I was going back through old posts and was amazed at how much I've already forgotten. I am so pleased that I put the time in during those early days. Maybe I'll print the blog again when I am done medical school and read it on the beach somewhere before residency begins, to remind me of the twists and turns that got me there.

Seeing all those posts gave me the impetus to summarize what has been going on lately. I try to remain an upbeat person and I also try to keep my issues in perspective by reminding myself that I'm lucky to have first world problems. But.

That said.

I am so ready to kick 2012 to the curb. There were some major low-lights.

My mom's house was hit by lightening and burned down in August. She was physically unharmed, though understandably shaken up by the whole thing. She's handled it amazingly well though, and has demonstrated what a tough and philosophical woman she is. Go mom!

Mom's kitchen.

My aunt on my dad's side died of lung cancer (also in August). It was really tough seeing her this summer before I left. I knew that she'd probably die before I came home for Christmas, and I was really sad to miss the funeral. She was a very tough lady, remaining stubbornly independent right until the end. She became aphasic for the last couple of months due to brain metastasis, which was a cruel twist. I hated watching her struggle to find words after a lifetime of sharp wit and story telling. Plus, it was like saying goodbye to my dad again by losing that connection to his last living sibling.

Love the shirt, Auntie Rita!!

In October, some crazy junkies decided to try to light my house in Ireland on fire after attempting to break in. Nothing like waking up to police and firefighters on your front lawn. That was by far one of the most frightening nights of my life, to date. You just don't realise how much refuge and security you get from a house until you don't feel safe and relaxed in it!

Seriously?

And overall it has been the toughest semester of medical school. With the Canadian boards, the residency application process, my research projects, my Grand Rounds presentation, and student society work piled on top of the hospital rotations, I feel like I've been flying by the seat of my pants since arriving in July. I've been on a "take this one day at a time" regime as main method of survival.

But yes, I cannot ignore that it has also been a fantastic few months, with a smattering of high-lights too.

I was blessed with a great group on my hospital rotations. No sociopathic gunners, no drama queens, no gossip generators, just pleasant folks who were trying to learn and get through the challenges of being a medical student.

I was living in a beautiful house, with my dear friend and ideal flatmate, Margaret. She's the type of flatmate whose car you're happy to find in the driveway when you get home. The kind that doesn't borrow your clothes or blast trance music, leaves no dishes in the sink, likes her own space but is always up for a hospital debrief and cup of tea when needed. Win.

Yes we are wearing matching sweaters, thanks for asking.

My pediatric and obstetric rotations were fantastic. I am partial to tots and tums, so I had been looking forward to these electives for ages. I even had the great pleasure of being at the mall and running into one of my former patients whose labor I attended. She gave me a giant hug and kiss and proudly showed me her 7 week old daughter. Those are the nice treats in medicine that remind you why you're going $300 000 in debt and forsaking a normal life for years on end.

Though it has mostly been work there have been a few little adventures that have kept me sane. Three weeks ago myself and two Besties went on a trip to Belfast for a pediatric/obstetric review course (and some evening shenanigans).

For the record, Eileen (in the nerd glasses) was trying to look...sexy?

We did manage to get a lot of work done as well, despite the shenanigans. Though Eileen did nudge me halfway through the Saturday morning session to show me an addendum she'd made to the schedule...

The lightweight.

So yes, I suppose I cannot complain too much. But I am ready, oh sooooo ready for my Christmas holiday in Canada. Once again I plan to adopt full pajama wardrobe on most days. Yes I will be working on a literature review and writing up my 10 000 word reflective journal assignment...but...those can be done in aforementioned pajamas which makes it bearable (just). (And no, sadly I cannot just submit the blog as my assignment!)

Here we are, Dec. 1st and I am officially half way through final year. Bring on the eggnog, festive sweaters, and (hopefully!!) residency interviews.

Happy Holidays! From me and my Nerd Herd. xx

Welcome To the Jungle - 2012

Things are starting to pick up momentum here on the wild west coast of Ireland. Exams are exactly two short weeks away (eep, why I am I still typing this blog post instead of memorizing differentials for fatigue??)

A brief look at life for the next few months:

May
-exams
-pack up house
-move things / car into storage
-fly home

June
-start pediatric emergency elective in Alberta (4 weeks)

July
-have a week 'off' (see below for what will actually be happening during 'off' days)
-start gastroenterology elective in Nova Scotia
-start CaRMS application process (Canadian post-graduate application)
-have 10 days holiday to study for MCCEE (Canadian board exam)
-fly back to Ireland, find place to live / move in / start psyche rotation

August
-study for boards while doing psyche rotation while working on CaRMS

September
**Canadian Board Exam**

October
-CaRMS and obs/gyne rotation

November
-Submit CaRMS
-collapse from exhaustion

December
-hit 'refresh' on email inbox until residency programs start emailing
-possibly decide that I'll stay across the Atlantic for post-graduate training

Just typing all of that gave me a facial tic. I may have to start playing this song everyday when I get out of bed.


 

Racing: The Irish Way

 

A few weeks back I convinced my brotha-from-anotha-motha, Ryan, to run this 10 mile race. So he signed up. 

I balked. He trash-talked. I registered. I regretted.

It was actually pretty fun.

The drive there was an adventure, at one point the GPS (who I've named Dunce Cap or D.C for short) even got lost, telling us to turn left but mapping us to the right and then getting all hissy when I went left. I really want to throw that thing in the majestic river Shannon most days.  Though the road (pictured above) was scary and narrow, the directions were typically Irish ('after a long bend in the road take a left and follow that road') we somehow found the place. I had a moment of anxiety the night before when I realised that doing a race in the middle of February is actually a really bad idea. You see, it is too soon for there to be any resolutionists (as I like to call them). No one decides on Jan 1st to do a race 6 weeks later. Most would think it is not enough time to train for a medium distance run. And this race, in particular, is known as the 'most challenging 10 mile race in the country'. I'm not sure about this claim as it is possible that it is the only 10 mile race in the country. So, the folks running an ass-buster in Feb are likely going to be really in shape, doing it as a fun day out as they prepare for their next big race somewhere else. 

Oh I so called it. As we pulled up we could see a blur of lyrca stretching and light-jogging up the first hill.  Formidable specimens, they were. I could see the outline of their vastus mediali  from the parking lot (which, by the way, was a farmers driveway, complete with fowl and swingsets, pictured above).

This is what happens when you set a camera timer and try to look tough.

The weather was outstanding. It was indeed a challenging race with loads of hills. But both Ryan and I were happy with our times (Ryan had hoped to do it in 1:30 despite the elevation and he finished in 1:19)! I was hoping to finish under 2 hours since I haven't really been distance running since....oh....2008! But I managed to pull a 1:32 out which isn't exactly olympic qualifying time, but it got the job done. And I was pleased. And apparently haggard.

Hello, beauty.

After the race I drove home, grabbed some food, water, bathing suit, and towel, and headed to the icy Atlantic nearby. My car thermometer read 7 degrees yet somehow I managed to strip off my many layers and plunge in. I am a firm believer in the ice bath. It had to be done and I figured a sunset dip in the ocean would be better than the view from my bathtub.

Turns out, I was right. Shortly after my dip the clouds rolled into this amazing formation that nearly took my mind off the fact that every cell in my body was shivering. I sat in my car, cranked the heat on (sorry environment, it had to be done for a few minutes) and ate my picnic supper. I made a mental note regarding what a lovely date I'd taken myself on, and deciding that yes indeed I would go out with myself again. Once the beach was dark I drove to the gym and vegged out in the sauna and decided that life was pretty much all I ever hoped it'd be. Oh Ireland, I really (heart) you sometimes.

Life One Liner

(I know this is supposed to be a medically related blog but lately it is more like a this is what I am eating and doing in my free time blog. Apologies. The heart-wrenching and hilarious moments of my emergency nursing days are long gone and I am starting to feel like a broken record of worn-out anecdotes. Also, I'm working like a fiend to finish up my research project and special study module as I hope to do an elective in March. I want to be able to leave the country knowing all my little scholastic ducks are in a row and life is organized. A very non-ABB behavior pattern. Usually when I leave the country there is a dizzying storm of clothes, textbooks, toothbrushes, running shoes, papers, granola bars, open luggage, garbage bags, and USB cables around me for 2-3 days...and then *POOF* I disappear. I swear this time, that shall not be. As a result I fear Asystole is not getting the attention it deserves. Hence, blogger guilt. It's like mommy guilt without the cereal in the hair and spit-up on the shoulder.)

Dr. Joe is on annual leave this week so I sat in with one of the other GP's in the practice, I thought I should branch out in his absence. Everyone here is lovely, though I must admit that I miss Dr. Joe's Prairie Home Companion version of social histories. During one of the consults the patient was talking about the age ranges of her four children, aged 6 - 13.  I thought she summarized things so brilliantly, "Ah sure, in my house there is everything from Santa Claus to maxi-pads". What a perfect slice of life. That is one of the things I miss about bedside nursing, the little glimpses into people's lives, scenes I could collect in a shift.

It got me thinking, what would my one-liner of life be right now?

It's all...tupperware and textbooks?

...Band-aids and backpacks?


...practice tests and data tables?


...scones and stethoscopes?


...residency worries and vitamin D supplements?


...bad skype connections and emotional eating? 


Dunno. All of the above I suppose. What is your one-liner these days?

Running

So I signed up for a 10 mile race in February. Figured I needed something to train for and wanted to do a race before I go away for my elective in March. For the record, I haven't run 10 miles since I was living in Revelstoke approximately 4 years ago. And I haven't really been running much lately, just short interval sessions, but no distance. Then I realised the race was in 2 weeks, panicked and registered for a 1/2 marathon trail race at the end of the month. Seems I felt like registering for races = training for races. 

The other twisted logic I recall having at the time was well, if I am running 10 miles on the 12th I might as well run 13 miles on the 26th. Again, there are some major holes in that line of reasoning. Especially if you can't actually do the former.

But then I think the little voice that makes sense piped up and said, you did a 4h and 38 min adventure race in November, how bad could only running for a couple of hours be??

And that was when the true value of thrashing my body all around for the Sea to Summit finally came to light. For the rest of my life I will have to compare all acts of athleticism to that day, and pretty much nothing is going to be that much of a challenge--so why not go for it?? Sweet.  Why not, indeed.

So today I tested the waters (or rather, the pavement) and went for a 10.8 mile run just to see if I could do it. And I could! (At the pace of anvil-dragging snails mind you, but determined anvil-dragging snails.) So maybe I won't die in the Irish countryside this February from a cardiac catastrophe. Hell, maybe I'll even enjoy myself!

Last Day

Tomorrow is my last day in the hospital. I cannot believe that I am halfway done third year already.

Does life always move this fast? Everyone said it would, but I didn't believe them.

I am really going to miss the hospital. I've only just figured out the best shortcuts through the wards, the codes to all the change rooms, where the best coffee is served, the names of the nurses, the passwords for the diagnostic reports, lab results. Not to mention I'll miss some of the lovely working relationships I've made and friendships that have formed.

Now I will be in GP land until May. A new set of people, codes, computer systems. Another adventure.

I was hoping to go to Dalhousie for a 3 week elective in January, but unfortunately it fell through just recently. Now I am trying to figure out what I should do with that time. I need as many weeks of electives back in North America as I can get. So many schools don't even take international students, and the ones that do want you to apply 9 months in advance. I don't know where or what I am going to do now. (And no, a holiday isn't an option. With international medical graduates the competition is so fierce I am going to have to basically invent my own specialty and write a textbook on it by next fall if I want to study in Canada once I graduate!)

I shouldn't be thinking of all this now, it is so late, and I'll never sleep. Reflecting instead on the past 18 weeks...

Have you learned the lessons only of those who admired you, and were tender with you, and stood aside for you? Have you not learned great lessons from those who braced themselves against you, and disputed passage with you?
 

-Walt Whitman

Indeed, Mr. Whitman, some great lessons...

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.

I Have "Hapless Female" Qualities

I took my little blue beauty into the bike shop today after my cycle for a 'tune up'. It was embarrassing.

Me: Hi. I bought the yearly maintenance package for my bike and I wanted to bring it in...

Bike dude [in hurried manner]: Ok, what does it need?

Me [suddenly realising how ridiculously hapless I am at very basic bike maintenance]: Yeah, it pretty much needs...um...air in the tires, a little oil on the chain, and...I dunno, the pedals tightened? Er...maybe the shifters...[stares at ground, toeing invisible mark on floor] shifted...[trails off, mumbling incoherently]

Bike dude [expression softens as realises he's dealing with moron of epic proportions and takes pity on me]: Ok, that shouldn't take very long [chuckles to self] we should have it ready by Wednesday [enunciating well and speaking very slowly].

Ok, so I am a ridiculous damsel in distress when it comes to my darling road bike (and killing spiders). 

Today's event cancels out the fact that I wielded very heavy machinery last week in a very non-girly way (with a steady hand and...ok...the odd high pitched squeal of delight).

I hate those moments when I feel like a hapless female, but dammit I don't have time right now to learn about gear shifters and spider aversion therapy...I am in the thick of it with trying to piece together a smooth cardiac exam without being reduced to a blubbering mess in front of the ward sister, the reg, the SHO, and several medical students.

And so, for now, I pay the bike shop 25 Euro a year for unlimited bike maintenance. And I am ok with that. Usually. 

Good And Bad

This Saturday my interview on CBC's national radio show White Coat Black Art will be airing. I am a little nervous (ok, a lot nervous) about how it is going to turn out. The interview with Dr. Goldman was the day after my USMLE exam so there were a couple of reasons that I may not have been overly articulate. However, I still really enjoyed the whole experience and was flattered to be asked on the show (considering I've been a dedicated fan and listener since it's inception years ago).

My prediction is that my contribution will only be a tiny piece of the show, but I am still excited and pleased about the exposure that the blog will receive. Of course now any thinly veiled anonymity will be removed and I'll be having to keep Asystole on an even straighter and narrower course. 

The interesting outcome of increased traffic is usually increased trolls. I was really surprised (oh, how naive I am sometimes) at some of the troll-y comments when my "Advice to Interns" pieces were published on KevinMD during the summer. I suppose I just have to remember that some people really take themselves too seriously and do not understand 'tongue in cheek' nuances.

So we'll see, maybe trolls, maybe increased traffic, maybe nothing.

For now I am being kept quite busy putting together my research project (in surgery, of course!), training 6 days a week for the big race next month, compiling a report on the elective /residency woes of Canadians Studying Abroad (CSA's), and trying to keep a smile on my face.

That last part is sometimes proving to be the hardest of all tasks! But as Shakespeare rightly pointed out in Macbeth, 

"Come what come may

Time and the hour runs through the roughest day". 

Scenes from the Day

I (heart) fall.

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?!

And While I am on the Tiny Soapbox...

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

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



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

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

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

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

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

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

Read it. 

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

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

The Fear

It's really starting to set in.

Since we get our curriculum delivered via case-studies (PBL) and our exams are cumulative for years 1 and 2 that means I have to memorize/learn/understand/regurgitate 48 cases from the last year and a half for my exams. Which start in 8 days.

Each case has an anatomy component (these weekly mini-case studies we have to know around all the differentials, embryology, etc--usually about 20 slides), a histology component (usually about 30 slides), pharmacology, physiology, pathology, stats, and of course all the psycho-social stuff (which has yet to ever show up on an exam).

So I thought I'd get through all the cardiac cases today (as a treat to myself, since I like cardiac).

Yeah, I got through 2 cases. TWO. And I have cranked out a solid 10-11h of focused study. This is not good. I think I will have to abandon all plans for actually going through cases properly and go into a take-no-prisoners mode. I don't know what that last statement means but...first, I will have to start flying through the anatomy sheets...basically ignoring most of the details and skimming though the cases.

I really never thought I'd have to
know so much about the larynx...
next slide! 

Then I'll throw my eyes over each diagnosis in Medicine at a Glance (the book that every patient hopes their doctor never used in medical school). Burn through about 1300 histology slides. (Thank goodness that pink stain never starts to blur into one image after a while...)

Next I'll somehow read through the learning objectives from all a handful of the cases and hope to hell it's those ones that show up on the long answer. Not like last year where 10% of the written marks came from if you knew what a P-value was or not. Really glad I spent all that time memorizing, oh, everything but stats.

Wow. There were a lot of numbers in the preceding paragraphs. Am I perseverating on irrelevant details? Trying to somehow strategize how I can cram all of those numbers into the number "7" which is how many days I have left to study?


In other, more interesting, non-medical-school-meltdown news, I think I'm going to abandon my attempt to read 100 Years of Solitude unless someone from the blogoland can convince me that it's worth sticking with it. I am about 100 pages in now, and it just hasn't grabbed me. I thought I'd give Gabriel García Márquez another shot after Love in the Time of Cholera became an anvil in my backpack two years ago on my Himalayan trip (one of the few books I brought with me so I felt I had to keep reading it). 


The other reason I am feeling tempted is Freedom by Johnathan Franzen is sitting on my bedside table waiting to be read. Well, it was supposed to be for my Christmas break (but then, so was Into the Wild which I accidentally started reading and finished last week). I remember loving The Corrections so I have been wanting to get into Freedom ever since I saw it at the bookstore.

I just like staring at the cover and thinking "December 15th, late afternoon...sigh" I'll get my own little taste of freedom for a few sweet weeks.

Breaks over! Back to it...

Spinning

So Tobie and I attended our first spinning class today.

I do a lot of interval training on bikes, especially when my knee starts being an idiot. But I must admit, I've always been afraid of spin classes, figuring they are reserved for only the uber-fit.

But today we just went for it, the timing worked out and we were craving a good sweat (besides, I was thinking safety in numbers).

It was pretty fun actually and a hoooo-nanny of a cardio workout! But, I must say the music the instructor was playing was très horrible. 


At one point the instructor did a Phil Collins medley which gave Tobie and I such a giggle fit we almost had to leave. She retaliated by walking over to Tobie's bike and cranking up his resistance by about 740 degrees.

Both he and I had visions we were in a BAD rom com...we were the single 30-somethings meeting at a spin class, locking eyes during "In the Air Tonight" and then a cut to us later in matching white turtlenecks, drinking white wine in front of a fireplace. Pure comedy. Anyway we got a double abdominal workout this evening as a result.

Is is bad form to bring your shuffle to a spin class?

Sheesh.