It's 1723h and I am Still in My Pajamas

The main thing I am currently trying to do is decide if I should or should not have a hot chocolate right now. I am still in my pajamas, and unshowered. All I've done today is clear the dining room table of stacked medical books. And I've eaten some snacks. And stared at the wall, in the typical now what? post-exam flat lined brain.

The exam was, a marathon of concentration but not too bad (except that I accidentally brought a mint chocolate flavored nakd bar with me as a snack---ahh I HATE MINT CHOCOLATE!) I am sure the prometric center lady thought I was a loon when she saw me pulling out the reams of food I had to declare prior to the exam. I just never know what I am going to crave or need to eat during times of extreme panic/stress but what I do know is that if I get hangry then I might throw the computer through the window. Yogurt, coconut water, almonds, apples, nakd bars, granola bars, water, more yogurt...I had a little tower of food placed atop the filing cabinet. I ended up chucking the bar in the bin after one bite, drinking a yogurt at race pace, and slamming the coconut water. I used almost all my time, just finishing the last few questions at the 3h 54 minute mark. I blame this on being ridiculously fastidious for the first 80 questions and then realizing I had 100 questions left and just over 100 mins left. It's been a while since I ran an exam marathon, cut me some slack.

After finishing I sped back to the hotel to shower, and check out. Then I zoomed over to the Operation Smile Dublin office to meet some of the staff involved in organizing my upcoming mission. While sitting in my car outside of the office, about 1hr after leaving the exam, I felt my pulse and noted that it was still >100 bpm. I tried to tell my adrenals to cool it. The saber toothed tiger was gone, I no longer needed 180 degree vision. I probably looked like a feral insurance saleswoman when I clunked in, suddenly very hungry and slightly wild eyed with a twitch to the right side of my mouth.

It was a very relaxed meeting and after chatting for a while the two of them stated that due to my arctic experience they should send me on one of their "really remote missions". Yes!! Well maybe they also were thinking that based on how I presented myself to them: better to tuck me far far away from any promotional material photo opportunities.

After that I was able to kick off my heels and head for the hills. (Well, shortly after a trip to my favorite deli in Dublin to stock up on essentials like Chile Hot Chocolate, truffle oil, and nice cheeses!) Drove out to the wild west coast and spent the weekend by the sea eating fantastic food, drinking Champagne, climbing up mountains, sleeping in, strolling around manicured gardens, sipping coffee, and just generally remembering how it felt to be human.

So thanks a million for all the lovely comments and emails of encouragement. It really means a lot coming up to an event like that.

Of course there are things already tugging at my sleeve to get started, like CaRMS, writing up my Grand Rounds presentation, school work...but not today. Or at least, not until after that hot chocolate.

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.)

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 Ride

 

2 days ago was my last training ride before the Big Race this weekend. It was an absolutely beautiful evening, only marred by the screaming of my leg muscles. I think the photo does not do the steep climb justice so I am including a screen shot from my GPS so you can appreciate that it actually is a hill and not just a meandering, gentle walking path from the nursing home. 

Note the lack of 'flat bits'.

Tonight I went on a short run, and for the first time in a long time it felt good. I suppose that is the main bonus for me: having something to train for means I'll train. Because I have to admit, I am not really looking forward to the weekend. I'm doing this because I want to see if I can finish it, but I'd be much happier if it didn't involve 8h of driving and staying in a hotel alone for two days (oh and killing myself on a crazy multi-sport course that will probably take me about 5-6 hours!)

The biggest joy for me about the triathlon in June was the fact that most of my family was involved. It was so fantastic to come across the finish line to big hugs from my sister, sister-in-law, bro, bro-in-law, niece, and nephews! It just feels weird that I'll be finishing and high-fiving myself (before collapsing in a twitching mess).

And speaking of high fives...I would not like to high five my body for how has changed in the last 10 weeks. I found my measuring tape a few days ago and thought it'd be interesting to see if my measurements have changed since I kicked s*it into high gear. Granted, the last time I measured myself was about a week before I went on my Himalayan trip and I was in decent shape then but...

First disappointment: 4 inches gone from chest. Buh-bye.
Second disappointment: no inches gone from thighs or butt.

SERIOUSLY BODY? Seriously???

Great, so now I have the upper body of a 10 year old newspaper delivery boy, and the lower body of a middle-aged Greco-Roman wrestler. That is sub-awesome.

Um...do these vertical stripes make my thighs look big?

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.

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.]

I Can't Pronounce The Tallest Mountain in Ireland...

But I can climb it!

It's called Carrauntoohil and it is just over 1000m/3400ft tall. A small herd* of us took Sunday off and drove to Killarney, near where the mountain is located.

The hobbits have "second breakfast" before departure. 

The beginning was a boggy adventure of slew dodging. My runners were dry up to about 1ms after these photos were taken.

"Crouching bank loan, hidden med student".  Camera 1.

Camera 2.

So we waded through the marsh with high spirits and soggy footwear. Not exactly rain, more like an Irish mist covered us initially.

Dry and happy!

My impersonation of an Irish explorer. 

As we ascended we got more and more into the clouds.

Well at least we knew which way was up!

Wet and hungry. 

We eventually got to the top...and enjoyed a nice leisurely lunch while admiring the views. *cough*

And then the rain and wind really decided to remind us that at all times,  Mother Nature is boss. 

But as we descended the clouds began to lift and our efforts paid off. 

Beautiful vista's opened up and the hammering on my knees became a little quieter. 

Despite walking like a pirate with two wooden legs afterwards, and completely bog-destroying my sneaks it was well worth it to get a little air in my bones. I miss the mountains so much, it was a nice little re-acquaintance weekend.

---

*What is a gang of medical students called? A "mensa of med students"? A "herd of nerds"? A "gaggle of geeks"? A"swoop of stress-balls"?