Medicine Giveth and Taketh Away

My relationship with medicine has been a complicated affair. Depending on the day I can feel anything from anger and resentment to gratitude and love for it. It's been this big, ambling, shuffling entity in the background and foreground of my life for as long as I can remember. At times it is all encompassing, at times it disappears to a pin hole in the distance. Some days I find medicine grounds me, makes me feel like I have a better understanding of the world and what is truly important. Other days I feel that it warps my perceptions so much that I have no idea which direction is north.

I took two days off this week, leading up to an emergency medicine conference that I am attending (in Whistler - if any of you are also going to be there, come and say "hi!")

Having a couple of days to breathe (and by 'breathe' I mean 'finally catch up on paperwork, presentations, research assignments, leave requests, and emails') has given me some time to think about the last few months and my initiation into being a physician.

The weeks fan out behind me, some moments are vividly etched, the others already faded and gone.

Like finally being able to eat at the end of a 15 hour shift, with my only option being the last bowl of chile in Subway. I mean why did the guy have to tell me that it was the last bowl of chile? He could have just said, "Here is a delightful bowl of piping hot chile!" not "you got the very LAST bowl".

Or having to appear interested and awake during post-call re-enactments of Duck Dynasty episodes by an attending. Informing a patient that there is no such thing as a "butt cast" for her pain following a hard landing on her derrière. Holding a fibrillating heart between my fingers and squeezing, squeezing, squeezing until there was nothing left to do but wash off the blood that had managed to seep under my sterile gloves. There were unexpected flowers at the hospital on my birthday from Duncan. There were babies that came into the world, chubby and screaming while yellow-gowned, O.R capped men proudly stroked their wife's hair. And also the grey dishwater colored ooze and rotting flesh stench of necrotizing fasciitis, and countless miles spent walking the rotary trail with my puppy, Monty, while I tried to make sense of it all.

So many moments. Tumbling. Flashing before my eyes while I try to fall asleep. Those nights when the sweetest feeling ever is having your feet at the same level as your heart. That bone-tired exhaustion surpassed only by the relief that the day is over. On the especially bad days Monty is allowed up on the couch with me. His scruffy face and propensity to lick my socked feet are enough to make me laugh and take my mind off whatever transpired at the hospital that day.

 

Which is why I am never sure of how to answer the question, "How is residency going?" My mind floods with all of the images of these moments. Some hilarious, some disturbing, touching, rewarding, enlightening...humbling. So I suppose the best answer to that question is, "it's complicated".

Blog Readers, I Salute You

This is just an aside. A short note to say that I really appreciated the folks who took time to send comments and emails my way in response to my last post.

It pleases me greatly that people still read this blog (which is...ok maybe not in asystole but certainly a life threatening bradycardia - forgive me, I had to). It also is humbling and thought provoking and reality checking to hear the thoughts of people who have been reading this blog (or who know me / are related to me). I appreciate that I can be (somewhat) candid and honest. Which is what I would want if I was reading story of someone who was chasing a dream.

I think that too often we get to the goal and the story is over. Happily ever after. But really, everyone knows, deep down inside that this isn't true. My mother reminds me that what doesn't kill you makes you piss on your shoes and that the people who got their dream residencies in their dream specialties are pissing on their shoes for many reasons as well.

So thank you all, for your thoughts and notes and perspectives and wisdom. I had intended to end the blog after graduation but it seems there are still people out there who read it, and even enjoy it!  And I think I still have a lot to say about medicine and this journey which continues to unfold in strange and challenging ways.

In a completely unrelated note: today while the pediatrician was listening to the lungs of my 3 year old patient the kid gave his mum a thumbs up. I swear I am laughing as I type this. Even though I am looking forward to my next rotation (anesthetics) I will miss certain things about peds. Though, I will not miss the daily cough in my face routine that occurs.

Testes...testes...123.

My hand was shoved down, awkwardly positioned between the folds of trousers and half-pulled down underwear, in the man's groin crease, trying to palpate his testicles without pulling any of his pubic hair. Something didn't feel right, but it wasn't his testicles.

I was in my final surgical OSCE's and it was my first station, where the adrenalin was flowing and my mind was racing faster than my running commentary...

...and I would be checking to see if there were any hard lumps in the scrotum, or if I could not get above the swelling...

I had only just recovered from initially describing my landmarking for the deep inguinal ring as the "midpoint between the pubic trochanter and the anterior superior iliac spine" which caused my examiner to hover his pencil over the marking pad as I searched for the correct word that started with a "T".

TUBERCLE. Tubercle. Tubercle. Tubercle. Dammit. 

 Check.

Initially I hadn't been too flustered. It was a groin exam for a lump, which is pretty standard on a surgical final. But I didn't think that we'd be expected to actually tackle the tackle in the exam. I said the usual "Ideally I would like to expose the patient fully and perform a genital exam to complete my hernia assessment" and waited the beat for the examiner to butt in, rescuing the patient from a succession of 32 fumbling medical students.

Silence.

Maybe he hadn't heard me.

Ideally I would like to EXPOSE the patient fully and perform a genital exam...

Still nothing. So I went for it. Which is how I found myself rolling this 70 year old man's testicles around in my hand at 0905h on my last day of medical school, wondering WHAT it was that didn't seem right.

It wasn't until my rest station a few stops later that I saw, between a one inch crack in the curtain, a colleague pulling on a pair of gloves.

OH FUCK! 

That was what felt weird. I have been a nurse for 5 years and a medical student for 4. I put on gloves when I hear the ambulance bay doors open, even before I see the patient. So WHAT THE HELL WAS I THINKING DOING THE EXAM BARE HANDED?!?!? What felt weird was the fact that I didn't have a nice latex barrier between myself and that poor man's private parts.

I started wondering if maybe my mistake had been a red flag (i.e. cause for failure of my surgical OSCE's as a whole). When one of the emerg docs walked by and asked how I was doing during a later rest station I told her, "Well, pretty good for starting the day by ball handling without gloves, how's your day going? Do you think I red flagged???"

She said she couldn't be sure but told me not to worry as once during her emergency medicine exams she put in a chest tube without gloves (I'll point out that this involves sticking a FINGER INTO THE CHEST after you've made an incision in the rib cage). She did make me feel better.

Afterwards with some of my classmates during our postmortem on the exam I confessed to my ridiculous oversight. The color drained from one girl's face as she suddenly realized that she had done the same. Ohmygodohmygodohmygod. She seemed to be quite disturbed by this realization. It wasn't until much later in the evening when she had consumed a few celebratory pints that she approached me at the bar and confessed.

You know how freaked I got about not wearing gloves? Well...I couldn't tell you at the time because I was so mortified....but mostly the reason I was so upset was that when you said that I realised that right after that station I had EATEN A SCONE!!!!!

Finito Mosquito

It was a rush. It was not anticlimactic at all.

I had been warning myself not to build up in my mind the last moments of medical school and the thrill of being done. So many milestones have felt disappointingly bland once they were reached.

Well it turns out that finishing medical school is not one of those milestones.

After a week from absolute hell (which I will get into once my medical degree is firmly planted in my hand) I arrived on Thursday morning for the last set of OSCE's (clinical exams). It was 12 five minute stations of medical or surgical skills. My last station was giving discharge instructions to a patient and when the buzzer rang, the actor patient stood up and shook my hand to say, "Well done!! You're done!!" The examiner said "Congrats!" and I emerged from the cubicle to see my friend, JM standing there with a huge grin on his face.

JM was the very first person I met in our class. We met in Toronto while taking the elevator up to our interviews. He surmised that I was there for the same reason and asked me where I was from, what I did for a living etc. When I told him I was living in Whistler, working in the emergency department there he stopped me and said, "Wait, so you live in Whistler, you have a job you love, yet you're planning on giving it all up to move to a different country and become hundreds of thousands of dollars in debt to be a doctor? Why?"

Well, when you put it that way. I had thought about his comment many, many times during the last 4 years. Why, indeed.

So when I saw his face as I stepped out of my last station I had to chuckle at the perfect end to medical school. We gave each other a rib-crushing hug and he said in my ear, "You know why this is a perfect finish don't you?"

I laughed and cried a little and said "YES! You were the first person I met on this journey!"

Then I randomly hugged a few other bewildered, exhausted, adrenaline frazzled classmates...I may have pounced on a few invigilator bystanders as well. It is all a bit of a blur.

We were then put in a 'holding tank' room in the hotel for over an hour as the other groups of students hadn't gone in for their exams yet. We weren't allowed to use our phones so as not to text anyone what cases were in the OSCE. I came prepared though. One little bottle of Champagne in my handbag which was quietly popped and then poured into the coffee cups they had provided for tea. A "CHEERS!" and few gulps to my pals that were also in the group. Shortly after the Prof of Medicine arrived and was asking us how it went. We were gathered in little groups chatting away, so when he approached we had just finished our Champagne. He said, "Are you having drinks soon?"

"Er.....well yes! In fact we've already had a little Champagne!"

You could see him mulling over this fact...hmmm are they allowed to have alcohol? This is an exam...hmmm...it's only 1030h...

Then he said, "Of COURSE you've already had Champagne! You're DONE! Good thinking on packing some in advance!!"

Phew.

We were set free.

I went and had an Indian head massage (best idea ever) at the spa, and spent the afternoon in the steam rooms and saunas with my dear friend, Emma.

The evening contained all the predictable events. Champagne. Great dinner out. Drinks at pub. Eventually going to Nancy's (the bar I LOVE to HATE). Having a drunk Irishman spill an entire pint of Guinness on me. Heading home with soaking wet jeans and a blister from my high heels.

And then it was over.

But I know it isn't the end. As a friend of mine on FB said, it isn't even the beginning of the end! 

Oh Our Lives

The main comment going back and forth between my friend Gen and I these days is, "Our LIVES!" to basically summarize all the insanity going on. Finishing medical school and leaving Ireland continues to unravel in quirky and unexpected ways.

We are both trying to cope with all the aspects of tying up our lives here while suffering from brain asystole, attempting to cram more information into our grey matter which is already packed to the rafters with random facts.

Gen is trying to sell her car and found a potential buyer who is a physician at a hospital 90 mins from town. I offered to go with her to show it so we could study in the car. That way she wouldn't feel like the precious hours before exams start were wasted.

We pulled up to the ambulance bay and waited for the guy to come out. Finally he appeared as we talked our way through rheumatology questions. He wanted to take the car for a test drive so I hopped in the back seat, she sat up front. He took the wheel, told us he didn't have a drivers license, and proceeded to start pulling donuts. Then he began screeching around the ambulance bay, speeding up towards the cement dividers and slamming on the breaks. I hollered at him to stop the car and let me out--he apologized and then began whipping a second donut near the parked ambulance. I told him, "STOP THE CAR AND LET ME OUT!!! So he did.

He then proceeded to take Gen on a terrifying ride through nearby streets, not using the windshield wipers despite the rain, and accelerating towards the waiting cars at the traffic circles. Gen was convinced that she was saying goodbye to life over a 1000 Euro car.

Incidentally, I also posted my car online and so far have received random late-night texts from weird Irishmen and an offer from an "off shore worker" who wanted to pay by PayPal without coming to see the car.

Hmmm. Yeah. No.

So we retreated to the safe enclave of my kitchen where I then received emails of required documents and YET ANOTHER POLICE RECORD CHECK for my residency program. Both for Ireland and Canada. Really?? I am in medical school here. I wish I had the time to have enough fun to get arrested in Ireland. Today my mom asked me if I was going to quit medical school. I told her yeah, it was just one criminal record check too many.

Tomorrow exams start. Six hours of written papers. The books are now closed. Mostly because studying has taken a giddy and ridiculous turn.

Gen, tell me about the life cycle of malaria...

Well, it replicates in the mosquitoes liver...uhh....

Dude, I don't think mosquitoes have livers...

**Cue peals of laughter**

[You had to be there.]

Ok, next question...Pearl, an 89 year old nursing student suddenly develops intractable diarrhea....er...no...nursing HOME resident...

Wait...woah...GO PEARL! 89 year old nursing student!

**Cue peals of laughter**

[You also had to be there].

Oh. 

Our. 

Lives. 

 

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...

Worth It

Things are picking up speed here in the final push to the finish. Suddenly a hundred things are pulling for my attention and I'm remembering the nit-pickiness involved in extricating oneself from one country and moving to another. Annoying things like transferring electrical bills to a different name, showing people the apartment, answering questions about my car to prospective buyers, pawning possessions, cancelling bank accounts and returning internet modems.  Time feels warped in that it seems like an eternity until I am back in Canada, yet there's not enough time to complete all the extracting tasks, study for finals, feed / clothe / wash myself, put petrol in the car from time to time, sleep, and possibly exercise when a window of time and weather presents itself.

Yesterday I was studying with some friends when I realized that we had spent the last 20 minutes discussing which brand of under-eye concealer hides dark circles the best (this may seem like normal conversation to some women but these particular ladies are *not* the make-up discussing types).  This was shortly after we screened each other for depression upon discovering that 'generalized anxiety disorder', 'panic disorder' and 'depression' criteria were starting to hit a little too close to home. We stopped studying psychiatry at that point and moved quickly to cardiology where we all felt slightly safer territory existed.

I woke up a few days ago with a burst blood vessel in my left eye which has definitely hitched up the haggard appearance a couple of notches. I am told that REM sleep can cause blood vessels to burst. Fantastic. This on the heels of 3 straight days of waking up not to an alarm but to the sound of my own teeth, grinding. On the upside I suppose that my face is getting exercise while I am sleeping so...win?

But it's not all cereal for dinner and fitful sleeps.

Today I received a card in the mail from one of my maternity patients. She had been one of those women who labored in such a way that I was in complete awe. I am pretty sure that if (and that is a big IF) I ever have a child I will be the craziest, drug-seeking, wild-eyed, foul-mouthed, sweaty, crying mess. She was this calm, focused, sweet, gracious lady throughout her (analgesic-free!) labor until complications resulted in an emergency c-section. For the duration of our long night together she used hypno-birthing and relaxation techniques to stay calm and work through the contractions. It was an amazing thing to see.

In her card she included the hypno-birthing CD along with a photo of her and her now 5 month old daughter, on holiday in Paris. It was a lovely gesture and a beautiful sentiment. My favorite line from the card being, "I will always have the most amazing memories of my labour...remembering yourself so close in my heart when I think of the wonderful team we had together on that night".

During a week (month? year?) when I have often asked myself if all of this is worth it, I receive this card. What a privileged and beautiful place to occupy in a strangers heart: the place that holds the memory of their child's birth.

Knowing something like that makes up for every single stressful hour. It makes up for being the person who breaks bad news, or the person who has to scavenge for food in the day ward after being in the hospital for 20 hours without a meal break. It really does.

It makes all of this worth it.

Shifting

When I moved to Ireland I made a conscious decision to try and see it as my home for these four years. I did not want to be counting down the days until each trip back to Canada. It wasn't an easy transition and for the first year I was homesick a lot of the time.

Tobie got me through most of those rough patches. We used to go on Canadian fantasy dates where we would describe scenes to each other of where we'd like to go on a Friday night. Keep in mind that at the time we were both living in dorms with no vehicle, plastic furniture, and a varying caliber roommates (from 'good' to 'reality show awful').

Then last year I moved to Kerry and was living in country bliss, working in a fantastic hospital, surrounded by hilarious staff, beautiful beaches, and boggy mountains. Oh, and I finally became capable of understanding the Kerry accent (have a listen below).

Once I moved back to the city to start 4th year in July, things picked up to break-neck speed and I must admit that much of the last 8 months has been an absolute blur. Wasn't I just writing the MCCEE a few weeks ago? Wasn't I catching babies and listening to manic patients tell me about their new business deals just yesterday?

Now I have less than a month left in Ireland, a job in Canada, and a man who wants to get a dog with me. Now I am anxious to get home. The two weeks in surgery and the week of exams ahead seem like a cruel gauntlet to run through, especially because I feel more like crawling through. It is so hard to stay motivated to study, and to keep smiling and nodding enthusiastically during another clinic where I only get to watch other people doctoring.

Roll. On. Residency.

So I am starting to shift now between Ireland and Canada. It's strange, and very nostalgia inducing. When a bottle of fish sauce runs out I don't replace it because I doubt I'll get through another bottle in 6 weeks. My pantry is starting to look very bachelor-esque and barren. I've started using all my hotel shampoo's and soaps because I loathe the thought of buying more that I won't finish (why don't hotels also provide tiny laundry soaps?!) Friends are randomly given clothing, books, music when they come over as part of a pre-purge offloading. I look at all my belongings with a more discerning eye...hmm will I bring my yoga mat home or leave it with 'Enable Ireland'?

I'll tell you one thing, the silicone oven mitts and wine aerator are coming home with me!!!  Oh Ireland, it's been fun but I gotta make a move.

Well That Wasn't Easy

So I finally submitted my rank order list. Those of you who have gone through this whole process please skip the following couple paragraphs. Actually, just skip to the bottom of the post.

After interviewing for residency jobs the candidate has to rank the programs in order of preference. The programs do the same, they rank the candidates in order of preference. These lists are kept confidential so neither the candidates nor the programs ever find out who ranked what / where (theoretically). These lists go into an algorithm which "matches" the program the candidate wanted the most with the program that ranked him/her the highest. The algorithm favors the candidate. What that means is...(by the way, I am explaining this for the 117th time in the last 3 weeks so from now on I will be referring people to this post rather than reciting my little speech)...I will be matched to a program I really want over a program that really wants me. 

An example. I interviewed for several programs. Let's say every program I interviewed for had three IMG positions (this was not usually the case, most places only had one IMG position but this is my fairy tale blogland).

-If the program that I ranked first ranked me in their top three then I match there.

-If the program that I ranked first didn't rank me in their top three then the list goes to my number two choice.

-If my number two choice ranked me in their top three then I will match there.

And it goes down the list like that until I match (hopefully).

-Now, conversely, if I am ranked number four at my top choice, but their top three match somewhere else, then I get bumped up the list and would be their new first choice, thus I will match there. And so on.

So the programs have already submitted their rank order lists which is why I feel like I can be slightly more open about the process now. Well, a tiny little smidgen more open.

I spent the last 3 weeks in a career choice mulling daydream. I emailed former colleagues, texted friends, called my boyfriend, mother, and siblings to ponder out loud. I dropped in on past professors, lunched with career idols, and lay awake at night trying to figure out how I wanted to rank the programs. See the thing is, I interviewed in 3 different specialties...all of which I truly enjoy and all of which I see myself being happy in, ultimately.

These are examples of my considerations for some of the different programs (in no particular order...heh):

1. LOVED the residents, they sold the program very very well. The faculty were very upbeat and relaxed. They had really put a lot of effort into the call schedule and maximizing learning. Great access to outdoor adventures, training tailored to someone who wants to work in rural setting. Research project support as well as required classes on medical education that count towards a masters. Downsides were that the city is sketchy, the winters are brutal, and it is pretty far from the Rockies.

2. LOVED the program, very similar to one above. Brand new hospital, great call schedule, opportunity to engage with the community in interesting ways, very flexible and supportive of residents cultivating their interests within the program. Far from international airport, smaller population, lower volumes, loads of hands on training though as no competing fellows and fewer co-residents.

3. LOVED the institution and what it represents. State of the art training labs, simulators, anatomy sessions. My favorite location by far, bigger but not too big. A program that would definitely support any type of practice I might want to pursue down the road. Close to great recreation, international airport, major city.

4. LOVED the program director. Again, a lot of flexibility, support for master's training. BIG centers, huge volumes, massive exposure to EVERY POSSIBLE THING YOU COULD EVER WANT TO SEE. Big city, big rent prices, big drive to anywhere green and pretty. Very, very far from the Rockies.

And so it goes. Every place I interviewed had similar pros and cons. I tried to sit down and mathematically create an answer to my dilemma. I made categories like "recreation options" and "location" and "academic advantages" and I gave each place a rank for each category. But when I looked at it in the end, I was favorably ranking the programs I really hoped would come out on top, not necessarily objectively tallying the sums.

In the end, I ranked all of the programs I interviewed for. I suppose that my top four choices are all places that will make me jump up and down if I see them on my computer screen on March 5th (match day). My remaining choices will all be perfectly acceptable starting points that will get me where I need to go (and I suspect may be hidden gems).

I do believe that in 5 and 10 years I will look back at this time in my life (the rapidly approaching fork in the road) and laugh at where I thought I was going...and where I actually ended up.

3 is better than 2

Woke up this morning, still feeling hellish from the apparent TB* that I caught before coming home from Ireland.

It was my usual routine of

1. regain consciousness
2. realize where I am on the planet
3. worry about having a job on July 1st
4. hit 'refresh' on my phone to see if any emails have come through.

BAAAAAZIIIIIINNNNNNGGGGGGG!!!

Let me tell you, after all the rejection emails I received when applying to medical school in Canada, seeing the subject heading "Invitation for Interview" is a sweetness I can't even describe.

Without taming the Medusa-like mane, or smoothing out the red flannel pajamas, or brushing my teeth, I walked up the stairs into my sister's kitchen, phone held high in the air. My brother in law saw the rising iphone and said,

"Ooooooohhhhh!!!! I THINK WE'VE GOT ANOTHER INTERVIEW!!!!!!"

Cue familial happy dance.

--
UPDATE: Just received 2 rejection letters. Sigh. Keeping me honest, I suppose.

*I didn't actually catch TB. I just have a horrendous respiratory tract infection which I cannot seem to shake, though no night sweats, weight loss, or hemoptysis (for the record). 

Waiting

Time...goes...by...so....slowly! So...slowly!

Hey, so have I mentioned that 'tis the season of CaRMS, interview offers, interviews? Yes, OK, probably once or twice.

Whaaaaattttt? You are tired of seeing the word CaRMS?

Believe me, so am I. My apologies. It is just that right now, whenever the constant chatter in my brain stops to take a breath, the word CARMS appears and I descend into one of my thought spirals of:

what if I don't get any interviews?

what if I get loads of interviews for jobs I really want?

what if I have interviews during my surgery elective in Ontario?

what if I don't get a job next year in Canada or Ireland?

how am I going to start paying off my suffocating debt?

am I going to work as a nurse next year?

do these flannel Christmas pajamas make my bum look big?

and so on... 

Ack! Waiting!!! 

“...of all the hardships a person had to face none was more punishing than the simple act of waiting.” -Hosseini

File Review Starts Today!

Dearest Readers,

Today all of the programs start reviewing the mountain of applications for residency positions. That means that today is when the "Yes!" and "Hell NO!" piles are made. On average each IMG seat has >100 applicants vying for an interview. The programs typically give about 3-8 interviews per position. I'm no mathematician but those odds are not ideal, to say the least.

So, as of now I ask that you cross your fingers, and all other paired appendages for me (ok, well not all...I do want you to keep your gonads) . If you're a praying person, throw up a few prayers. If you're a wiccan / pagan / animalist scatter some ground up chewable aspirin into the wind while chanting "grant ABB an interview".  

It's exciting, and frightening, and nerve wracking all at the same time. Pretty sure that is why I woke up with a gut ache this morning. Or maybe that was secondary to the paroxysmal coughing fits I was suffering all night (upside to coughing fits--sore abs! See post below).

I do take small comfort in knowing that up to this point in my medical career I did absolutely everything that I could, with every fiber of my being, to succeed at this stage. If I don't get a residency in Canada, well...I've got plan B and C simmering away on the backburner.

Alea iacta est. The dye is cast.

I am trying to let go and know that wherever I end up is absolutely where I am meant to be, even though it may not be where I think I ought to go. But I am still allowed to hope for certain things. Right?

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

Forced Silence

It's weird not being able to write about the biggest and most important development in my medical education to date. Tonight I finished the final touches on my CaRMS application (for Canadian residency program). All my documents are uploaded, fees paid (ouch), letters in, and programs selected.

Now all I do is wait.

And attempt to get a good night's sleep.

I'd love to write about all the thoughts I've been having on my future career prospects, what I really hope to match in, where I really want to live and study. But I can't! The truth is, this blog is so easily linked to my name if anyone wanted to do a quick google search on their future resident it'd only take 2 seconds to find a treasure trove of ABB rambles on life and career choices.

So, as part of the game I can't really say where I applied or what I applied to. If you're reading this, dear Program Director, then rest assured yours is the ONLY program I want!

It has been a helluva few months. Between studying for the EE, hospital presentations, the Case Competition, my placenta study, school work, and CaRMS applications I truly have not had 2 days off in a row since I came back here in July. Even when I went for a little getaway weekend trip to Cromane I was working on personal letters most of the time. Now I have less than 2 weeks left in this rotation and then I am back to Canada for 8 weeks! Yep. I haven't been home for Christmas for NINE years. It's going to be unreal. Yes, I will be working on a lit review and doing an elective in general surgery but I will also be getting in some skiing, hot yoga-ing, novel reading, soup making, spinning, visiting, sleeping, studying, and full-on relaxing. And hopefully...residency interviews!!

Ahhh, it's going to be so good.

I will start finding out about possible residency interviews in roughly a month. Will keep the blogosphere posted, so to speak. And also, I hope to finally write about life for the last few months. There have been so many wild ups and downs. I feel like most days I am barely able to process what has happened before the next wave hits. Life moves so fast, in 1.5 weeks I am officially halfway through final year.

Thanks for coming along for the ride!

My current mantra.

Silent High Fives

So today I found out that I passed the MCCEE (the first of about 42 exams that I'll be writing as part of my Canadian licensure). 

Yes, it is great that I passed but I need to score >95th percentile if I actually hope to be invited for any residency interviews in Canada (I know that I am prone to exaggeration but this is one time when I am just stating a cold hard fact). My actual score will be released in the next few days. I've already decided there is NO WAY IN HELL I am checking my grade while at the hospital. 

Today I was in the library working on CaRMS between tutorials (and saving lives, and stamping out disease) when I received the email that I had a "communication from the medical council". Instant armpit stains. Several of my Canadian compatriots were also in the library and it didn't take long for the ripple of "Shit what is my password? What is my username? How did you log on? Was it your email? Was it the MCC site or the PCRC site" commentary to pass through the room. Followed by a second wave of "I passed", "Did you pass?" and then quiet high fives and quick hugs and stifled "Woohooo"'s. 

Joanna broke half her remaining MARS bar in two and we toasted our quarter pieces in victory, mini as it was. 

I've been putting the whole EE thing in the back of my head, categorizing it as "A Worry I Can Do Nothing About". Things in this category are strictly not allowed to keep me up at night or monopolize my waking thoughts. But now, now it has surfaced and the thought of opening that web page next week to see my score already turns my guts to water. 

Living the dream. Living the dream. Living the dream...

CaRMS Chest Pain

You know that feeling you get when you realize you may have made a major, life plan threatening mistake? When, in an instant you feel the blood drain from your face and limbs, and your stomach takes up residence in the back of your throat?

Yeah. I had one of those recently.

I was calmly working away at CaRMS, putting in all of my volunteer, work, clinical experience. Filling in dates, ticking boxes, clicking on drop-down menus. It was Saturday night at around 1am and I was starting to get very tired, losing my ability to focus. But I was buzzing from reading program descriptions and fantasizing about where I might be a year from now. So I kept on a little longer than I probably should have.

I wanted to finish this last section and then go to bed. I came to the program selection area and when I saw the big shiny "SUBMIT" button I figured it was just with regards to payment (my application far from being finished).

So I hit "SUBMIT" and then realised that I had, in fact, made a very large mistake. My body was instantly unsure of how to contain it's fluids. Sweat soaked my shirt, then I nearly vomited and peed myself at the same time.

In my mind I saw myself spending 2013-2014 with a micropipette in some dimly lit lab, tucked away under a hospital stairwell somewhere. Hiding from both the bank and my mother. I then remembered hearing stories of people who didn't match due to clerical errors, and those who missed a form here, a deadline there. I saw myself becoming a CaRMS urban legend.

I frantically sent a FB message to my friend Rob who went through this process last year, I think the word "crisis" may have been heavily overused.

Robert say, "nothing you can't fix". Grasshopper calm down.

He may look like a normal guy, but he's actually a little CaRMS Confucius. An Online Residency Application Oracle. Despite being on the drive home from a shift in Detroit he kindly messaged me back and called me as soon as he got in, talked me down from my window ledge and explained that all was not lost. I actually think I would have gone crazy if I'd had to wait until Monday at 0900h EST to call the helpdesk. By about 0300h my breathing had retured to my lung bases, gastro and urinary symptoms had disappeared and my tremor had resolved. It's nice to have 24h free support line!! So thaaaannnnnnnkkkkksssssss ROB!!!! (He is one of the 10 of you that hasn't given up on the blog!)

Oh I cannot wait to have this all finished and to start finding out about interviews.....eeeeeeeeeep!

Back to the land of tick boxes and drop down menu. Tedium, thy name is residency applications!!

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. 

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.

Study Daze

I was studying with my friend Gen today (I'm writing EE on 20th, she's on the 28th). The comedic highlight of the day for me was this.

Gen: So what are some other corticosteroid side effects...?

Me: Dunno, I think I've listed pretty much all of them.

Gen: How about hypokalemic metabolic alkalosis?

Me: Never heard of that one...wow! Ok, good to know.

Gen [deadpan]: You have that underlined and starred in your textbook.

Perfect. 

The Burden of Work

As I plod through drop down menus and hustle reference letters, I try to remind myself that I am thankful to have the burden of CaRMS. 5 years ago when I started the process of summer school organic chemistry courses I didn't even know if this day would ever arrive. But here I am, gathering all the little stones and jewels of experience from the last ten years, shining and presenting them for various selection committees, hoping to catch the eye and interest of some program director.

Obviously my thoughts are overrun with pre-exam stress (my Canadian board exam is a week from tomorrow) and the uncertainty of my future, but I am trying to stay positive and focus on one day at a time living.

And I reminded myself of what Kahlil Gibran writes about Work, and use that to keep it all in perspective.

Always you have been told that work is a curse and labor a misfortune.
But I say to you that when you work you fulfill a part of earth's furthest dream, assigned to you when that dream was born,
And in keeping yourself with labor you are in truth loving life,
And to love life through labor is to be intimate with life's inmost secret.

But if you in your pain call birth an affliction and the support of the flesh a curse written upon your brow, then I answer that naught but the sweat of your brow shall wash away that which is written...

...Work is love made visible.
And if you cannot work with love but only with distaste, it is better that you should leave your work and sit at the gate of the temple and take alms of those who work with joy.
For if you bake bread with indifference, you bake a bitter bread that feeds but half man's hunger.
And if you grudge the crushing of the grapes, your grudge distils a poison in the wine.
And if you sing though as angels, and love not the singing, you muffle man's ears to the voices of the day and the voices of the night.