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.

Mind Go Blanko

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

Yeah. It was sub-awesome.

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

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

JVP? No. Bueno.

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

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

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

"No, he's on telemetry."

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

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

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

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

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

Maybe.

:)

Alright. Medicine, I misjudged you.

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

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

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

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

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

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