Surgical Pearl: Nutrition

Today the locum pediatric orthopod took me down to the x-ray department to look at some films, on our way out he stopped at their desk and poached some chocolate. He clearly saw my judging questioning gaze (I have firm beliefs that you ought to contribute to the trough you graze from).

"Look, when you're a surgical resident you learn to get calories from any source available. It's an old habit. You find every patient fridge that is stocked with ensure or crackers...this hospital is great because the recovery room fridge has cheese. Cheese will be where you get your fluids from."

Residency: when you begin to see cheese as hydrating nourishment.

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...

Histology Quotables

Today's lectures were rife with classroom quotables, I'll put them out tomorrow. But for tonight, I'll leave you with my favorite, from my histology prof:

"Every time you take a drink, God kills a hepatocyte".

Taken from http://www.apn-histopathology.unimelb.edu.au/gallery.html

And on that note, a cocktail I created tonight, which I named, "The Majestic River Shannon". It is a glass of cava (brut) with a splash of elderflower cordial, and a peeled quarter of orange. Deeeelicious.

And yes, I may have had one or two before making this post. Forgive grammar, punctuation, and spelling...

Classroom Quotables

Today the Associate Dean was addressing our class and said*, "the great thing that distinguishes man from beast is man's ability to take medication".

Nice one Dean-o.

*This was said in a very tongue-in-cheek manner, for the record, it was when the subject of polypharmacy came up.

Splinters and Successes

I am done (soooo done) studying for the day, but before I crash out for a fitful repose I wanted to quickly post about the USMLE course that I started last night.

Ok so the school didn't pick the best evening to start the class but I figured I'd go anyway, not like I had any other plans from 1900-2300h (ha!) This first session was basically a getting-to-know what we are up against and how to prepare for the exam. It was taught by Dr. Stephen Daugherty via web from Chicago, and moderated by a techie in London. Needless to say we had some technical difficulties and it resulted in him being mic'd through a cell phone for the presentation, but, it worked.

He's actually a very good presenter and I found 90% of his talk interesting and helpful (pretty hilarious in parts as well). His background is in psychology and he appears to have a special interest in watching medical students suffer exam psychology, in relation to medical students.

One thing that really resounded for me though was at the end of the lecture he was talking about successes and failures, mainly around the theme of success on the exam, of course. With that, he made an excellent point, he said that success in medicine (i.e. acing the USMLE) isn't something to be celebrated, it is a splinter that has been removed. It really isn't as pessimistic as it sounds, and I chuckled at the accuracy of the statement. Why didn't someone say that to me TEN YEARS AGO???

For a long long long loooooonnnnnnngggg time I thought that the MCAT was the pinnacle for me. It was like this really big, frightening, monster exam with teeth that dripped blood of recent pre-med wannabes. It seemed like such an obstacle that it took me several years of stalling, starting another career, and studying other things in university before I could muster up the nerve to even attempt the pre-requisites for medical school...then write the MCAT.

Once the denouement of that story was behind me things quickly shifted to the next false summit, getting IN.

Hell. That was a year from hell. The application process and the waiting is horrible. I'd already been rejected once before a few years ago by all the schools that didn't require an MCAT. But, now I felt I'd gotten over what once seemed a nearly impossible event--completing all the pre-requisites and the MCAT. That (massive victory for me) was pretty much lost in the chaos of submitting applications.

Then I got rejected at most schools and got accepted by a few. And I really thought that I'd achieved *the ultimate*. My life-long goal, right? MEDICAL SCHOOL.

Does this sound like I lacked even a shred of self awareness or insight to anyone but me? I honestly shake my head at how absurd it sounds while I write it out. But my profile rant alludes to the discovery that was on the horizon for me. Things don't become PERFECT when you realize a long-term goal. It just means that itch has finally been scratched. That sliver has been pulled out.

And there is another horizon, far far off that my eyes are fixed on now. And things are still frustrating, and upsetting, and annoying sometimes. Things didn't suddenly fall into place for me the day I started medical school. Life is wonderful and challenging and funny and stupid and unpredictable just like it was the entire time I was staring at that false summit of getting in. I'm not saying that I don't appreciate that I have achieved something to be where I am today. What I took a while to discover though is the truth behind the enjoying the journey mentality.

It's good now that I have a different perspective on this, because I catch myself falling back into the "can't wait until" fantasy world. These fantasies about acing the USMLE, or landing the ultimate residency and how things will be so much better then. But they won't be, necessarily. I say that because really, my life was great 5 years ago, my life is great today, and hopefully my life will be great 5 years.

And for now, I just have this sliver in my paw. A big one called "Christmas exams" and another one called "USMLE".

Rant done. Sleep required.

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. 

Classroom Quotables

Had one of those "Dead Poets Society" type lectures yesterday from a brilliant, hilarious, curmudgeon of a psychiatrist/scientist.

More on that later.

But his opening line to the talk was, "so I understand you're doing a problem based learning program, which really means, it's your problem, not mine."

Never heard it put that way but yeah. Pretty much.

Tobie Quote of the Day

I was struggling to explain to Tobie what an "internal medicine" doctor does. I just have a sense of their crazy jobs from dealing with them in the hospital but found it hard to convey it to someone who doesn't really know different specialties or how the hospital rhythm works. All I know is they have a hard job that requires the ability to understand pretty much everything about every system, what all lab values mean, and how to fix them.

When I was done my vague and pathetic explanation Tobie replied:

"Oh, so they are sort of like specialized GP's that work in the hospital, but with the really really sick people, who are pretty much never going home."

Oh dear. Don't ever say that to my friends who are doing internal med!!

In fairness, the ACP doesn't do much better of a job of explaining...

The Only Thing Worse Than Getting it Wrong...

We had a lecture today by a very peculiar prof. He fluctuated between funny, rude, interesting, irreverent, and sarcastic. He was asking a lot of questions during the lecture and people were being fairly silent (as he would hear an answer and say something like, "who said that?" and then find the person in the crowd and say "no, that's wrong").

Near the end he asked about ECT and if anyone had any opinions on it.

Another long dead silence.

I finally offered, "it can be a very useful treatment for certain patients".

Him: "What kind of patients"

Me: "Patients with depression"

Him: "What kind of depression"

Me: "Severe depression, like catatonic depression*"

Him: "You are completely right. You are going places."

Yeah, like the 7th circle of adult-learner-nerd-never-going-to-make-friends-hell.

I searched for a way to climb into my empty pop bottle.

Epilogue:

Tonight while walking to do laundry I saw a group of guys from my class (who I hardly know except in passing). They waved and then as I passed one yelled,

"HEY! YOU'RE GOING PLACES!"

Yeah,  thanks for that Mr. Prof Doctor Weird Man.

*I only said this not because I am a super-nerd-gunner but because I worked in acute psyche as a student nurse (and as a casual for a year after I graduated). I was amazed by the recovery that some of our most desperately ill patients made from ECT and was always dismayed by the bad rap that ECT got in the media/medical field. I was trying to give it a little plug while I had the opportunity. Now I basically have a 'kick me' sign on my back. Sigh, oh well!

Quotes from the Classroom

You may have noticed that it's been a while since my last "Quotes from the Classroom" post.

You also may have noticed that I have not really been 'feeling the love' in medical school these days so I've resorted to truancy. It's been helpful in that I have gotten a lot of work done on the essays (which have no application whatsoever to medical practice) done. But being stuck in the hovel all day and night is making me more and more curmudgeonly. I figured it was time to start going to class again.

Yesterday I ventured out into the light and attended three greatly interesting lectures; one was a GP/derm/sports med overachiever who lectured to us about the different types of arthritis and how they will present to you in clinic.

"The patient will come in and tell you they can't throw their leg over the seat of a bike...or whatever it is they like to throw their leg over."

Hello!

This was followed by an orthopod and then an anesthetist who is a pain specialist (have I mentioned yet this month that I want to attach myself to the leg of every anesthetist I see, begging them to take me to the hospital with them??)

By far the most entertaining part of the afternoon was the orthopedic surgeon who lectured to us about joint replacement surgery. There is just something a little jarring about the statement "so we saw the head of the femur off, it goes in the bin, and then we set about getting the prosthesis into the femur".

This of course was followed by, "the first rule of orthopedic prosthesis placement is 'when it stops movin', stop bangin'".  Remind me never to get my hip replaced!

And the pearl of wisdom bestowed upon us when one of the students asked about osteolysis (complete bone destruction around the prosthetic causing instability and pain for the patient), "there is no problem that metal can't solve".

It is safe to say that orthopedic surgeon has long been scratched off my list of "maybe that is what I will be when I grow up".

---

15% off men's scrubs with code "mens_save"

Quotables from Today's Classroom Adventures

In the mind-numbing 6 hours of lecture today on such topics as fulminant liver failure, biochem, narcotic abusing colleagues, and the kidney...a few snippets of lecture really stood out of the rest.

For example, the comparison of the kidney's microtubular cells and microvilli to the X Factors 'Jedward' twins. Also making note of their 'tight junctions' what with them being twins and all.

The discussion of the positive "doggy style" sign which is when a patients hepatic encephalopathy has gotten to at least a stage 3 causing them to get on all fours on the bed (and then rip out their central line and start waving it around like a lasso--OUCH)!

And how ionic bonds are basically like two desperate people speed dating. One ion is desperately needy and the other is desperately wanting to give. They form a strong bond due to their mutual dysfunction.

Wow.

A New Chapter

I wish there were more hours in the day so that I could read. Well, non-medical texts, that is. Although it'd be nice for some extra time to crank through those as well.

I miss the mountains, I miss my nieces and nephews, and I miss reading.

My reading time is now after Tobie falls asleep, headlamp on, buried under the covers. It's a bit like summer-camp or secret reading after your parents told you to go to sleep. But it's the only time that I don't feel guilty doing it.

I just started "Anatomy of an Illness" by Norman Cousins, and I am so excited about it. Almost as excited as I am about getting to "William Osler, A Life in Medicine" by Bliss, which is also burning a hole on my nightstand.

The intro to the Cousins book contained the famous quote by Francis Peabody, "The secret of the care of the patient is in caring for the patient".

A simple, and very true fact.

I sense many late(r) nights ahead.

Todays Quote from the Classroom

In our clinical skills lab the instructor was talking about signs of respiratory distress in babies.

"Since they can't tell you anything...you're basically practicing vet medicine".