Where are the balloons?!

Yesterday was the last day of my surgery rotation, which also happened to be the last day I had to show up to the hospital as a lowly medical student. Of course it ended with me racing in for a 0730h ward round which didn't happen, giving me time to kill before surgical Grand Rounds. Afterwards our professor of surgery gave us a little pre-finals pep talk which included the well worn phrases:

-don't worry, these are the easiest exams you write in medical school
-know the basics
-you'll be fine
-try not to get too stressed
-know all the medical emergencies
-soon it will be over and you'll wonder what all the fuss was about

It was an uncharacteristically nice and reassuring discussion with him, though it did nothing for my chronic teeth grinding and constant gut-ache. After a few questions about exam specifics from the others I asked him if he was going to miss us. He said (sarcastically) yes, and I will especially miss your esoteric and obscure contributions to tutorial from the corner of the room.

WIN!

(If I leave a legacy of esoteric obscurity behind then I feel I have succeeded as a student in surgery. In much the same way I felt I succeeded in internal medicine when I received an email from one of consultants telling me about a banjo competition this week. Reassuring to know that my true personality somehow shone through my crusted, exhausted exterior.)

We were dismissed after that and a cluster of us emerged into the morning sunlight, blinking and saying goodbyes and good-luck to one another. It was surreal. I was FINISHED my medical school rotations! Where was the fanfare? Where was the receiving line of dancing nurses and interns patting me on the back, handing me pizza, and popping Champagne corks?

I remembered a conversation I had this summer while I was on my pediatric emergency elective. One of the docs was telling me about his last night as a resident, at the end of his 5 year program. He was walking down the dim corridors, leaving after a night shift, "This was MY hospital, I kept these wards humming through the night for five years. I spent my LIFE in these halls...and when I walked through the automatic doors at the end of that shift I didn't get a handshake or a thank you or a good luck. It was just over and I was standing in the parking lot, in the rain, and it wasn't MY hospital anymore". 

I got it when he told me this story but hadn't thought about it until I left the hospital yesterday. I had a very similar feeling as I drove out of the unbelievable chaos pit they call a parking lot. I cranked up the Mumford and Sons with a fitting song, and left a little mental trail of confetti, streamers, and balloons behind me...

Hark! A Child Cries in the Distance!

I love going into the maternity hospital for work.

Ireland was apparently the first country in the world to have one. Every day I have to dodge new dads in the parking lot trying to juggle car seats and flowers, handbags, suitcases, and "IT'S A BOY!!" helium balloons. Women (mostly waddle) around in various brightly colored bathrobes, either trying to break up the boredom of being admitted, or in the hopes of getting things going in the labor department. Giant bellies, little bumps, nervous nulltips, exasperated over-termers populate the antenatal clinics. It's quite the humming baby factory.

On the labor ward every couple of hours a new admission would walk casually up to the desk with a mix of fear, sometimes excitement, expressions of pain, or lines of fatigue on her face. While being checked in some would have to pause and lean heavily on the nursing station if a contraction took over. Others went shooting by in a wheelchair pushed by an admissions midwife, hair blowing back behind them with the "don't push yet!!!" instruction barked by a senior midwife...a few minutes later we'd hear some hollering followed by the gusty cry of a new arrival to the planet. I could just smile to myself because at that moment only infinite possibilities exist for that baby.

Of course, of course we've seen sad outcomes, unexpected premature deliveries, undiagnosed syndromes and malformations. But even those, which weigh heavily on the staff, give me inspiration from the grace and strength exhibited by the families of those babies.

What a place! What a privilege.

Hello, World

No, I haven't drowned in a giant puddle of amniotic fluid.

I am loving life here in OB/GYN but just absolutely wrecked and savaged by work right now. Did nights through the weekend so am currently on my 10th day in a row at the hospital, am working on a Grand Rounds presentation for Friday, applying to CaRMS, writing up assignments...oh and I started collecting data for a new study yesterday.

I have a mouth full of canker sores and an ever-expanding derrière due to stress and lack of exercise.

But I'm good. I'm gooooooood.

Stories to come. Once the dust (er....fluids?) have settled.

In the meantime: birthing babies = awesome. 

Hospital Fashion

This week has been comprised of mostly lectures and case-based learning for psyche. It's been a nice way to wade back into the hospital pool. My head would probably explode if I were doing 4h ward rounds and being pimped on things like the causes of ascites.

Also, our professor of psychiatry is a very dynamic, engaging lecturer who ensures we don't get bogged down in the language and the esoteric aspects of mental health. So that part has been entertaining and educational.

The other day I thought something he said was quite simple, but interesting. We were talking about the dress code on the psyche ward. He scanned the room to take in what we were all wearing (various degrees of LL Bean, basically).

Turtlenecks, they're so hip right now...turtlenecks.

He nodded and gave his approval, then said, "Just think, when you're getting dressed to come to the psyche ward, it is not about you, it is about the patients. If you're wearing provocative clothes, loud, dangly jewelery, etc., you might distress or distract some of the patients in ways that are uncomfortable for them. Bottom line: it is not about you."

I really liked that way of framing it. Because the school has given us detailed lists of 'acceptable' clothing options, though I have seen some...er...interesting outfits trotted out. I think looking at what you wear to work in that light is probably the best gauge for appropriateness. Who am I wearing this for? And I'd say it applies outside the realm of psyche too.

All this, of course, coming from a woman who hopes to spend her life in scrubs and outlandish clogs. 

Back in Eire

More airports, dragging my luggage behind me. More waiting at stuffy gates and cueing for dingy bathrooms. I was able to slightly balance my suitcase on my thigh while weighing in, which allowed me to avoid the $250 excess charge. I didn't feel guilty because last week they charged me $106 and then promptly lost my luggage for two days. I was worried my meeting with Brian was going to be in 3/4 length pajamas with hearts on them and a team-building exercise 1999 t-shirt.

The bright side was being met in Shannon by a friend who had packed an airport picnic lunch. Nothing like arriving to smoked salmon, Greek yogurt, and fresh berries, and a weak cup of Irish coffee.

Two days of mini-vaycay on the west coast, going to my treasured beach and drinking coffee at Moll's Gap was punctuated by having to wake up at 6am to drive to the hospital for my first day of placement.

Thankfully, I am doing a psyche rotation first which means a week of lectures before hitting the ward. It's been a nice way to ease back into school after a fairly frenetic summer, couch surfing from Squamish, BC to Charlottetown, PEI.

Right now life is a little hectic, 1/3 of my belongings in Kerry, 1/3 in the house I am moving into, and 1/3 in my current digs (a spare room at my friend Marg's parent's place) . I was going through bags finding camera battery chargers, hand blenders, lavender oil, textbooks, protein powder, pencil cases, and mittens, all thrown together. Needless to say I'm trying not to feel as scattered as my possessions.

For now, I have my notebook, two pens, clothes for work, and a travel mug. I'll survive the next few weeks until the dust settles. 

Final med: no excuses!

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...

I Heard It!! I REALLY heard it.

Small miracles, tiny accomplishments, baby steps forward.

Some days in medical school it feels like the 'teaching' just boils down to constantly being told how many differential diagnoses you forgot, how many signs you failed to elicit, and how many questions you didn't ask the patient. The constant deluge of information and things you ought to know by this point can begin to feel suffocating.

Until a miniscule but measurable gain occurs and suddenly, it seems worth it.

Like today...I actually clearly heard my first heart murmur which I confidently and correctly identified after performing a decent cardiac exam!!!

Pretty sure that at the exact same moment a unicorn was born and a leprechaun discovered a pot of gold.

I honestly thought that heart murmurs would always be a mystery to me and that there would never come a day when I'd be able to do anything other than pretend I heard it. 

But, nay! I heard it. I really heard it. And strangely, that made me smile. All day.     

Small miracles.

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. 

Fin

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

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

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

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

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

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

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

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

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

The intellect of man is forced to choose

perfection of the life, or of the work, 

And if it take the second must refuse

A heavenly mansion, raging in the dark. 

Last to Know

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

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

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

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

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

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

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

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

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

So I suppose time will tell.

The Blasket Blast

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

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

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

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

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

First coffees, just after the summit of Connor Pass.

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

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

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

 

Some lovely scenes from the day. 

The Blasket Islands.

 

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

 

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

 

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

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

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

And it was GREAT!!

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

Good News

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

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

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

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

Tiny Holes and Testicles

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

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

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

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

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

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

Theater tomorrow!

A Personality For Surgery?

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

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

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

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

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

"Why?"

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

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

Scenes from an Irish Surgical Ward

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

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

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

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

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

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

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

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

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

Me Med Student, Me Watch Things and Do Nothing

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

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

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

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

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

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

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

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

Week Two: Objectives

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

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

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

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

Conversation During Clinic: Pimping

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

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

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

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


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


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

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

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

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


Me: No, it's your job.


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

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

 

First Day of Surgery Rotation, Take 2

So the conversation yesterday went something like this:

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

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

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

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

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

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

And so it was.

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

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

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

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

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

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


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


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