Tuesday, December 9, 2008

Day 6--The Day I Became "Shishue"

Nicknames. Usually either a sign that you are a complete loser or a sign that you are cool enough to warrant an alternate moniker. In this case, I am not sure which category I fall into. Wait. Yes I do.

Today I got up early and took dose 2 of the cholera/E.coli vaccine that I purchased in Canada. Since it has to be taken on an empty stomach it made me pretty nauseated. Especially when I stared thinking about what was contained in the cloudy liquid I had just poured down my gullet. The B-subunit of the cholera toxin I am ok with, but the whole inactivated V.cholerae count was rather unsettling.

After breakfast (of hopefully limited bacterial load) we piled into Jeeps for the long road drive to our first camp. I was in a Jeep with Cathy, James, and attending Liz.

The classic "do I have anything in my teeth?" photo...
We had an absolute blast in the jeep, entertaining ourselves with various car games like, "what is that lorry carrying?" Time flew by, surprisingly. At one point we stopped to stretch our legs and get some air. I took this photo as it was not an uncommon sight to see very small children wandering alone. This little one certainly seemed like she could hold her own.

After snapping the photo I walked around the side of the jeep, trying to negotiate my way around the deep mud and the standstill gutter which was full to the brim with black, murky, 'schmegma' as I like to call it. As I opened the door to the jeep and attempted to keep my telephoto lens from banging on the side I slipped and ended up calf-deep in the gutter. In the shit gutter. The black, liquid, toxic waste, oily, slime gutter.

I totally panicked. I didn't know what to do. I just stood there for a few seconds with my mouth hanging open, my heart racing, and my stomach churning. Liz sprung into action...dumped a large zip lock full of tylenol out and told me to drop my shoe in it, grabbed large bottles of water to rinse my leg and pants off, told James to find me some scrub pants, and asked Cathy for some spare footwear.

A few miles down the road we stopped at the side of the river so I could rinse off my clothes, leg, shoe, and orthotic. I would have taken a photo but I was still traumatized by the event.

Unfortunately there was a jeep of fellow volunteers parked behind us when it happened so it wasn't just my car that saw the incident. "Shit shoe" was my initial nickname, which was later shortened and softened to "Shishue". We decided that Shishue also sounded more Asian as well and was therefore more fitting. People have already started using expressions like "pulling an Erin" or "having an Erin moment". Great. As usual I make an impression in a group almost immediately for better or for worse...in this case the latter obviously.

The rest of the ride was uneventful except when one of the other cars in our caravan got stuck.

We arrived, set up camp, and then figured out our roles for the next day. I am working in the Triage tent which ought to be interesting.

Sunday, December 7, 2008

Day 5--And So It Begins

Liz offered me space on her bed since there had been a mix up with my booking and I was without a place to stay. We decided since we were basically carbon copy versions (only with 5 inches of height difference but otherwise similar in appearance), both Canadian, and both in love with Smoking Lily clothing that it wouldn’t be weird if we crashed together after only hanging out for a few hours. Besides, the next month was going to involve living in a tent with a complete stranger anyway.

Enjoyed my last warm shower. Oh yes I did. Made a mental note of its greatness knowing it would be a long while before I felt the sensation of an overhead spout drizzling warm water over me. I know it is a cliché but we really do take a lot for granted in our day to day lives.

The group met at some ungodly hour in the hotel lobby. There was some quiet confusion and chaos as we eyed each other up. Some people had come in groups or with friends, others were solo travelers like me. A lot of big hiking packs and newly minted outdoor wear appeared on our tired and un-caffeinated bodies. We loaded into several taxis and headed for the train station. I believe there were 21 of us total but I could be wrong. If you’ve heard the phrase “cat herding” then you can make a visual representation of what we looked like in the train station in Delhi. Most of us had a large pack on our backs and a little day pack on our fronts. Okay maybe less like cat herding and more like deformed turtle herding.

We were divided into groups of 6-10 and given our assignments for seating on the train. I was at a booth-like seating with a handful of the group and another cluster sat a few tables away.

We clamored to get our bags into place in on the metal rods that ran along the upper sides of the train. Every seat was full and every square inch of space in the luggage area was occupied. I pushed and stuffed and squeezed my heavy day-pack on top of my big pack, directly above our table with the hopes that I could easily access it for various means of entertainment when needed.

Turns out I was the entertainment that day.

After we had been served our thermoses of hot water for tea and coffee, Leba (one of the members of the group) handed over her hot water to me, not wanting it. I was, for some reason making two simultaneous cups of tea when the rocking of the train caused my day pack to slide off the top of my bag and land with a major crash right on the table causing both cups of tea, several opened packets of coffee mate, and sugar to fly up into the air in a magnificent arc and land directly on my head and lap.


At first I was stunned. It happened so fast. One minute I was about to enjoy some sickly sweet tea, the next, said tea was dripping off my nose, down my pant leg and onto the floor. A light dusting of dried creamer and sugar covered my face and hair. Everyone on the train burst into laughter. Even has I write this it makes me chuckle and wince. All I could hear was Napoleon Dynamite saying “IDIOT” in my head.

Thankfully I was wearing my arcteryx rain pants so the tea just beaded and rolled off, but my pink shirt was not so lucky. I grabbed as much newspaper as possible to clean up my mess but it was a disaster. Somehow in the tea-water-fall I was the only casualty. It was amazing.
I scuttled to the washroom and offered my trip-mates some soggy newspaper on my way by “current events anyone?” John radioed Liz in the other car “Erin has had an incident with some tea but I think everything is fine now, over”.

The rest of the day was thankfully uneventful. We took train after train after train and finally arrived in Shimla around 2000h. Hungry and tired we wandered into the hotel meeting room and did group introductions. I got a pretty good vibe off of the gang, mostly young 3rd and 4th year med students, a few residents, Deb (the NP), 2 dentists, John and Liz (attendings), and me. Deb and I switched things up so we could board together. I liked the fact that she was older and seemed totally chill. In a possible world of type-A-overachievers I wanted to secure a roommate that was going to be mellow.

Tonight I take my sore-from-sitting-for-the-last-three-days-self to bed and enjoy the last time a mattress is underneath me for the next three weeks.

Friday, December 5, 2008


We interrupt this journal of my recent volunteer trip to India to happily announce that I have been accepted to 2 medical schools!

So...now I just have to wait to hear back from the other 12 that I applied to...sadly the interview offers for the rest don't come out until February or later...

If there are still some of you out there...I promise I have emerged from the cave that I crawled into after India and will get back to posting again more regularly.

In some ways this knowledge that I am now for sure going to medical school is...almost hard to wrap my head around. I have spent so much time and money and made so many sacrifices to get to this point I almost thought that there would be fireworks and cartwheels when I found out.

But it was just a large envelope and at the time no one to jump up and down with. It did seem a little empty. Of course my family was over the moon but everything almost seemed bittersweet.

Anyway now there appears to be someone who is going to come along for the ride so...fingers crossed...

Day 4---The Taj

It is Oct 3rd by my watch and I am exhausted. Amazing how one can be exhausted from doing absolutely nothing.

This morning Liz, Sheele, and I met in the lobby sometime just after 6am. We had booked a taxi to take us all to the Taj Mahal. I hadn’t seen it my first time in India because I was on this holier-than-all-things-tourist trip and frankly, I just wasn’t interested in the detour. But here I was again, with no real excuse not to go.

As we stood in the foyer preparing to go a woman approached us and asked if we were with the HHE trip. Yes, yes we were. Turns out it was Deb, the nurse practitioner from the Bay area who was joining our expedition. With some finagling we were able to arrange another cab so that we could go two by two to the Taj.

It was a long, sweaty, day in the taxi. Deb and I quickly hit it off and were equally puzzled by our frequent and unexplained stops along the way. I was happy to be back in dahl, raita, and naan heaven. The thin pink napkins that I swiped from every restaurant table to keep as emergency tp in my money belt were still available. The only difference was now, I wasn’t the paranoid 20 year old. I didn’t bother with tucking my money belt into my pants anymore, I liked the ‘bandit look’ as I called it—slung over one shoulder.

At the Taj things were insanely busy. An Indian holiday meant a line up that stretched half the length of a football field. People approached us, trying to sell their guiding abilities, Taj key chains, and postcards. We stood in line in the sweltering head of the day. The sun seemed to push the humid air down upon us, through the smog and smells of the city. At security I was turned away, having to go lock up my power bars and my ipod. Electrical equipment and food is not allowed. The others ventured on in, I walked to the nearby locker and handed over my things. Got back into the line and was then turned away again, this time for my book, “Three Cups of Tea”. Apparently certain books are not allowed onto the grounds either. The frustration at my impotence in the situation seemed to be compounded by the heat and random nature of my ‘contraband’ items.

Finally we were all in. We put the booties on over our shoes and padded along the stone walkways. Ok, I’ll admit. The Taj is a beautiful structure. It is quite phenomenal in fact. But I was now drenched in sweat, hypertensive from my line-up experience, jet lagged, and hungry. And now I was staring down the barrel of a 4h taxi ride back to Delhi.

Back in the cab my shirt front dried from the air-conditioning, my back and legs remained sweat-soaked I shivered back to the hotel, fell on my bed, and fell asleep.

Despite the long, dusty day I was glad that I went on the excursion. Tomorrow we meet first thing and I will finally have a better idea of what the next month is going to look like!

Sunday, November 2, 2008

Day 3--Dehli...Why the hell not?

The hotel did not send a driver to pick me up (as prearranged and paid for online). I would have been more discombobulated if things had gone smoothly. I remember from my last trip to India is that things never go as planned, and one should always expect the unexpected.

I had been patting myself on the back for being so wise to pack my down booties in my carry-on (they really came in handy on the ultra-chilled flight) but as I rifled through my bag pulling out mitts, booties, and fleece to find my hotel information in the stifling Delhi heat, it bordered on comedic. My shirt sticking to me and sweat running between my shoulder blades while I made a pile of down articles on the floor.

The sun was coming up, though barely visible through the smog. It was just after 6am when I got a pre-paid taxi chit and settled into the back of a mini-van for the 45min commute through the city. It was how I remember all of the Indian cities I spent time in. Hot. Dusty. Chaotic. Loud. Polluted. The traffic was a mix of lorries, cattle, dogs, rickshaws, pedal bikes, cars, motorbikes...even a guy on inline skates! No real observation of lanes and the horn being the 'signal' of choice to maneuver from side to side. I was happy to dive back into this throbbing city.

Somewhat apprehensive about what the next adventure will entail.

It's now 1050h and I am exhausted. Exhausted from doing nothing. Sitting on planes, and in taxis but I haven't slept since I left Canada. Only a few dreamy head-bobs that woke me right up again on the plane. I need a good stretch or a walk but the thought of stepping out into the madness is unappealing. I'll sleep for a few hours only so avoid exacerbating the jet lag. Then I'll go exploring.

1830h--So much for a few hours sleep and avoiding jet lag.

2300h--Came back from an email attempt to have a short brunette come running out of a restaurant at me, "You're Erin aren't you???"


"I can tell by your 'Smoking Lilly' t-shirt and your lululemon headband!! You've got to be a Canadian from the West coast!"

And so it was how I came to meet Liz, the assistant attending.

After a chai with her and John, the attending, I felt somewhat more reassured about the group I'd be spending the next month with. Both young, adventurous, and entertaining. So far, so good. Except she did shatter my notion of originality. I am evidently a walking stereotype: West coast girl. Suppose it could be worse...

Last time I was in Delhi I had a few friends with me and we had all dreaded coming out of the quiet beauty of the desert and hitting the big city. In an attempt to amuse ourselves we imagined the jobs of the Delhi tourism board trying to come up with slogans to lure tourists...a couple we drummed up were, "10 billion cockroaches can't be wrong!" and my personal favorite, "Delhi--Why the hell not??"

We're going to rent cabs tomorrow and head for the Taj. They twisted my arm. I didn't see it last time and I figured I really can't justify coming to India twice without seeing the Taj...

Saturday, November 1, 2008

Day 2 (ish) Seoul Searching

It's dark . I just watched the last 1.5h of Sex and the City movie, again. My favorite scene is still the part on the bridge when Miranda and Steve meet up. I am such a sucker for romantic moves in a movie (cue strings and running toward one another--I'll eat it up).

Seoul airport is no longer the 1970 version of a Greyhound bus station that it was in 1999. All you could buy was 15 cent plastic cups of ginger tea and admire the brown and yellow stripes on the walls. Nope. Now it is huge, airy, bright, gorgeous, and non-smoking.

Jana and I had to overnight here when we came through last time. I remember the greyness and uniformity of the city, how grimy and stark it was. In our hotel we watched the American military station with commercials for quitting smoking and marriage counseling (and I saw my first cockroach).

I wonder why I always listen to depressing music on airplanes?

I remember having to take a flight once after falling in love, I still listened to the most depressing music (Gillian Welch's 'Time the Revelator') but with a giant grin on my face. I was so filled with joy and hope.

Hope is almost worse than love because hope isn't messy or complicated. Hope doesn't take away your appetite or make you distant, lost in your thoughts. Hope is pure and simple. It erases doubt and smooths over the corrosion's of the past. That is why it is so dangerous. It took me months to recover from that. Losing hope. Months.

Clearly I need to sleep.

Thursday, October 30, 2008

Day 1: Packing, Sleeping, Flying

Finally, after 2 am I started packing in earnest. Forgetting, of course, my raincoat. I looked at the pile and pared down a bit. (I'd come to regret the fact that I only brought 1 pair of climbing pants, one pair of sweats, and rain pants for a month of traveling).

Washed clothes, filled stuff sacks, charged batteries, jotted 'notes to self', sorted medical supplies by ailment (gastro, respiratory, blisters, rashes...), checked aamc website compulsively for mcat scores (not there). Finally after 4 am I fell into bed thinking about how it was going to be the last night sleeping with my pillow, my lavender and pine linen spray, and my bedside fan. I thought that due to the harried nature of the previous hours I'd toss and turn in a fitful slumber but instead I closed my eyes and within moments I was sleeping most soundly. Rare for this bear.

The next thing I am aware of is the phone ringing and it is 0730h.

I felt bone tired, my legs ached and stomach rolled from the lack of sleep. I know the ringing phone is my mother, the next thought is, "MCAT!!!"

Stumbled out of bed, stepped into the kitchen, flip open the lap top and logged on. No scores. Sigh. The morning proved to have other obstacles including uncooperative registrar people at my old Uni, some transcripts not yet received...picky paperwork ends that needed tying up.

Still has not sunk in yet that I'll soon be in India. Sure that as soon as I touch down it will come. Just hope the hotel people are there to pick me up so I don't have to deal with being hassled by taxi drivers. I remember how they descend on you like a pack of wolves in that place. Off to the airport. Here goes!

Thursday, October 23, 2008

21 Days and 1 Shower Later

Just a quick post to say that I am alive and clean for the first time in three weeks. Well I've been alive, just without running water, electricity, or phone access...

My internet time is up in 3 minutes and I will be heading out into the fray of Delhi streets to be assaulted by noise, odour, vendors, pollution, and dust.

Finally was able to check email to find out about my first MD school interview invite!!! Woot!

Gotta go. More soon.


Wednesday, October 1, 2008

"Take half the clothes and twice the money..."

The title was sage parting advice from a friend. Is there any luggage really worth having in sweltering heat and a suffocating crush of humans?

Almost 10 years later and here I was...back in line at the pre-pay taxi stand...well 'line' is a bit of a stretch...more like 'wedge shaped crowd of pushy people'...it was only 5 am but already the rivulets of sweat were running down my back and I felt like a 4 day old bandaid. Tired and grimey.

Got to my hotel finally.
Cockroach in room count: 1.
1 is in the 'acceptable/to be expected' range.

I'd been up for >36h with no sleep. (If I can't sleep in a bed why would I ever be able to sleep on a plane??)

Hello Delhi. You haven't changed at all since I last saw you! You are still a pulsating mass of people, bony animals, thick dust, brownish smog, vivid sari's, sleeping beggars, road side barbers, and government officials standing on road sides. You are horns and incense. You still have ineffective ceiling fans, dank internet cafe's, rickety scaffolding, and Hindi music blaring out of tinny speakers.

It's good to be back. It's great to see you. What do you have in store for me this time???

Saturday, September 27, 2008

How about some tact...and a side of discretion?

I knew that once I made my "this is the last post before I go to India" post that something would happen and I'd have the urge to make one...last...post...again.

I sent this story to a friend this evening and then knew I wanted to put it up here. I mean really...what is a humiliating public experience good for if you don't use it as blog fodder??


So I got my friend Dr. A to write me a script for all the things I might possibly need for any variety of illness or accident that could occur. He's been to India so I just put it into his hands. But I didn't look at everything he wrote down on the script...

I go, drop it off at busy drug store midday...hum de hum...just killing time...waiting for my Rx...

When I return to pick it up the pharmacist tech inquires in a very loud voice,

"are you waiting for a Rx?"
"what is the last name?"

There are several people milling about also waiting for their drugs. She says over their heads,

"Your doctor ordered something that is over the counter, do you want me to grab it for you?"


I get up thinking...what could that be? She walks through the line and grabs a tube of canesten (yeast infection cream) out of the aisle, holds it up and says in her not-so-sotto voice

"He ordered a waaaaay bigger amount than this...do you want me to grab you a few packs?"

"um...no...that is fine"

I assume the public humiliation is over but she's just getting started.

"So, this is an ANTI-FUNGAL cream and it is MEANT FOR THE VAG but you can put it anywhere"

I am torn between thinking, 'did she just yell out VAG?' and trying to form a response that might truncate this exchange.

As she steps behind the counter she turns the box over in her hands reading the side,

"Yep. For the VAG but if you have a FUNGAL INFECTION anywhere else it'll work there too"...

Thanks, I can read. Please don't trouble yourself by reading me the information off the box!!!

Also, please allow me to dig myself into the linoleum now as I note the fellow customers take a precautionary step backwards.

Its not like I can save face my announcing to the crowd,

"I don't actually have a VAG infection (really, I don't) it's just that I am going to be traveling in some remote areas and I wanted to bring some medications just in case...I mean, I don't even GET yeast infections but my friend ordered it for me because..." shit.

So I hold my head high and try to pay with some dignity.

I still can't believe she used the word VAG!!!!

Friday, September 26, 2008

Hello Himalaya!

The time is drawing near.

Right now the house has many Albinoblackbear-made piles around it. Clusters of electronic charging devices, stacks of medical supplies, collections of scrub tops and underwear, hordes of powerbars.

OK now it is starting to sink in! I am actually going to India!

Packing is a bit of a challenge as the weather will be changing drastically. I checked the temperature this morning and it is 31°C (about 88°F) in Delhi but in the first of the Himalayan cities we are going to the low is around 6°C (46°F) for today. So in go the flip flops and the down jacket I guess!

I finally realized one of the perks of working in health care when I showed up at my ER around midnight (knowing it'd be a bit quieter) and got one of my colleagues to give me a script for the little-old-lady-like shopping list of prophylactic meds I want to bring. Man I am going to have a tricked out first aid kit!

So I am not sure how much I will be blogging while I am gone (almost never) but I will be keeping a journal while on the road. I look forward to the emotional, physical, and mental shake up this trip is going to give me. It is most needed.

Until I post again!


Saturday, September 20, 2008


I've had this sinus cold for almost 2 weeks now. This is my first really bad one and now I see what all the fuss is about. I had a couple of days off between my sets of nights last week and spent most of it in bed, trying to sleep. I guess I did get out for an afternoon hike with Same Name which was great, but once the Advil Cold and Sinus wore off I turned back into a snotty troglodyte. I had a day off yesterday before starting this set of 12h shifts, and you guessed it...I was horizontal for most of that as well. Awesome. I am going to be in wicked shape for this trip. Maybe they will let my donkey carry O2 for me. (Yes there are going to be donkeys to carry the clinic supplies). Wait, maybe they will let the donkey carry me.

This morning I woke up and I swear the infection has moved into my right mandible and zygomatic arch. Either that or I was grinding my teeth last night something fierce.

I have a stash of moxifloxicin which one of the docs at work gave me for my trip...I am resisting the urge to start taking them. Step. Away. From. The. Moxi.

Speaking of my trip I just realized that I am leaving in 8 days. 8!!!

I am not finished any of my applications and am thinking I may pare the list down because at this point it is about quality applications not the quantity.

Thursday, September 18, 2008

Fine Motor Skills

I enjoyed myself immensely tonight at work.

Partly because it started off with a code. Yay! A real emergency!

Not just the usual "abdo-pain-NYD-and-bed-4-is-waiting-for-second-trop-then-they-can-go-give-this-guy-a-tetanus-shot-and-a-migraine-in-bed-5" start.

Then one of my favorite docs let me suture a stabbing victim's wounds up.

Double yay!

This is a unique opportunity for me because when I am suturing in the North there is no one around to look at my technique or results to give me feedback and suggestions. It's great to have someone else watch and tell me what I am doing right or wrong so the next time I am in the middle of nowhere Northern community suturing someone up at 2 am I'll feel slightly more confident.

The best part was the fact that the feedback was "You did a perfect job. Don't be so worried about your work, you're obviously a perfectionist. Very well done."


One of the other nurses said, "I suppose you don't wake the doctor up for sutures when you're up North hey?"

"Uhh...there are usually no doctors in the places I work...sometimes the nearest doctor is 4h away by plane..."

"Oh! Really?"


I guess when I say that I work in 'remote' places sometimes the logistics aren't totally conveyed.

Saturday, September 13, 2008

I Was There, In the Room

I was just having a conversation with a friend of mine a few days ago about when people cry out in true anguish, and how those cries remain carved into your memory.

I told her of the two cases which still make me shiver when I think of them.

The first was a 43 year old woman who miscarried 14 week old twins in the department. Her absolute desolation was heart wrenching as she sobbed and cried out for her babies, apologizing to her husband, and uttering, "this was my last chance..." It was enough to move several of the staff to tears that night. I can close my eyes, and I am standing in the hall between the patient bathroom and the gyne room. A small basin is in my hands, and there are two baby boys in it.

The second case which comes to me often, was a 13 year old girl who jumped out of her second story window to sneak out to a party. She landed on her back, crushing her lumbar spine. I knew it was bad when I looked in the report room where the MD's pull up imaging results. I saw the ER doc sitting with his head in his hands. He got up and walked into the patients room, and a few minutes later the scream of despair at her diagnosis of paralysis echoed through the department. For hours she screamed and screamed, "NOOOOOOOOOOO!"

I can still feel myself standing behind that nursing station desk, the desk lamp shining on the charts beneath it, the overhead lights dimmed. My heart pounding.

I know that last night will be one of those nights now too. One that will stay with me a long, long, while.

4 teens were in a car which lost control and rolled over down a rocky embankment. The front seat occupants were both killed and the two back seat occupants were brought into the department. Both were in mild shock but physically stable. While we waited for the urine test to come back on my patient I sat and talked with her. A gorgeous girl with long curly hair down to her waist, mascara lining the contours of her face. She kept telling me she was fine and wanted to know how her friends were doing. She'd start crying softly and apologize to me for doing so. She told me the driver was her best friend, that she tried to wake her up at the scene but couldn't. "Please try to find something out about her, why isn't she here? Can I see her?"

I'd been told that her friends were waiting outside and that they didn't want her to know until she was sent home. Her urine came back clear and she was discharged. I walked with her out to the parking lot just as the parents of one of the surviving friends showed up. The night air has a chill to it now and soon we were both shivering as we walked out to the cluster, she asked me, "is she out here?" Her friends put their arms around her. I walked back into the department to grab her a blanket. Just as the ambulance bay doors swooshed closed behind me I heard her cry out "NOOOOO!!! YOU HAVE GOT TO BE KIDDING! YOU'RE LYING!!!! LYINGGGGGG!!!"

I came back out and she was being supported but her friends, she was wretching, crying, knees buckling. Her white shorts and legs were spattered with blood and on her feet the blue OR booties I'd given her. We gathered around, tried our best to support her.

After some time myself and the other nurse returned inside. I went into the staff lounge and fell asleep. I know that sounds harsh but I was running on 4 hours of sleep and the high emotional intensity of the night had sucked the remaining drops of energy from my bones.

After my break I returned to a quiet department. When the shift was over I felt the beginnings of my cold getting worse and exhaustion seeping in. Stepping outside the sun and seeing the rising mist at the bases of the mountains, I was reminded that there were things to be celebrated, and things to be grateful for. I drove out of the city limits, pulled my bike out of the back of my car. I went for a long road ride to think about the evenings events, how the feelings were going to be shaped in my memory.

My job, which can be horrible (yesterday's post), can turn around on a dime and suddenly become a high honor. When Eve Ensler writes about birth she starts with a line, "I was there in the room..."

For birth, and death, and everything in between...we are there...in the room. And that is why, I love this work.

Friday, September 12, 2008

Code Brown

I was asked to come in early for my night shift yesterday and agreed---not for any altruistic reason---for the double overtime. I was supposed to start at 2330h but instead started at 1930h.

I arrived and my first task of the day proved to be helping a 75 year old woman out by disimpacting her. That's right, sticking my hand up inside her rectum and pulling out clumps of poo. (To my delight I only gagged once and didn't get the usual waterbrash and watery eyed reaction I get when dealing with #2. I also couldn't believe my luck that I had made it this far in my nursing career without doing a disimpaction. It is somewhat of a right of passage.) The best part was when I stepped out to grab some more gloves she decided to give it a go herself and when I re-entered the room grabbed my forearm with her poo-mitt to steady herself.

Um...can you say "clorahexadine shower"?

Unfortunately it appears that the baseball sized lump of badness was what was keeping in her G.I. bleed.

Yeah. If you've never smelled a G.I bleed you ought to crack a beer and toast the universe now because you've got something to celebrate.

My problem went from dealing with someone who couldn't let it out to someone who couldn't stop letting it out. Just as fast as we stripped her bed, changed her gown, rolled her back and forth about 7 times to put new sheets and pads down, the great tide of feces flowed forth. I resigned a couple of times within a half hour period but the site leader wouldn't accept said resignation. I started using the "I love my job" mantra to ensure I was mouth breathing.

After a few hours of this her repeat troponin came back elevated indicating that there was some cardiac cell death likely happening...oh and her lactate was high as well...oh and her WBC...shall I go on?

So she needed to be transferred from the sub-acute section of the department and into the cardiac monitoring area. I gave report to the other nurse, scrubbed every square section of exposed skin on my body until it was raw, and sat down for the first time since arrival to chart.

I looked at the time:


Which goes to show, you should never do anything for the money.

Wednesday, September 10, 2008

Blog Award

In the dead heat of LBMCAT (Life Before MCAT) Rogue Medic gave me a Blog Award.

I was flattered for a couple of reasons.

1) He writes well researched, thoughtful, interesting, funny posts on things medical. I respect the amount of time and leg work he puts into his blog (unlike myself who pretty much uses this forum to whine and/or tell the odd quirky story about ED work). I don't know how he stumbled upon my site but he seems to think I write well and has given me many props and readers in the short time that Asystole has been up and running...er...'flat-lining' I guess.

2) I assumed that no one really read my long, drawn-out, gratuitous postings from start to finish...but evidently he does! And it appears there may be others out there...to quote the famous Oscar acceptance speech, "you like me! you really, really like me!!"

Not sure about the real reasons I even have a blog. Blogs.

I used to keep a journal pretty religiously but when I started blogging I stopped because I thought that OTB would be an on-line journal that no one else ever looked at. But my only-child-like-attention-seeking attributes made me want to be a popular blogger. ME! ME! ME! ME! LOOK! AT! ME!

But my journal was mostly random notes of self deprecation, resolutions regarding discipline, really bad poetry about love gone wrong, mandolin tabs, recipes, and more whingeing about my love life. Really...who would want to read that? But secondly, why would I want to put it out there to the world? Do we all have a little Jerry Springer guest living inside of us? (Wait. Has any guest on Springer ever been 'little'?)


So now I have ohtanninbound for the "life" side of things and this blog for the "medical" side of things. But clearly the two overlap. And I find myself sugarcoating/downplaying/deleting a lot of my posts on OTB because now there are people who read it (careful what you wish for) and I don't know if I want folks knowing things are feeling pretty rough right now in many many ways. Okay. I guess I do.

Wait. I was talking about my blog award. And this is on Asystole. I am sleep deprived.

Back on track...this award thing has rules and they are as follows:

1.You have to pick five blogs that you consider deserve this award in terms of creativity, design, interesting material, and general contributions to the blogger community, no matter what language.

2. Each award has to have the name of the author and also a link to his or her blog to be visited by everyone.

3. Each winner has to show the award and give the name and link to the blog that has given him or her the award itself.

4. Each winner and each giver of the prize has to show the link of “Arte y pico” blog, so everyone will know the origin of this award.

5. To show these rules.

Well...I am not very good at following rules. Besides, there is no possible way I could pick 5 blogs to give this award to. I love all kinds of blogs for different reasons. And really, who am I to judge anyway?

My friends have brilliant blogs (L. Corn, Nature Nerd, JFS, Curmudgeon), but I have a context for them and it is a way for me to feel like I am 'in the loop'. They crack me up also. It's good to surround yourself with people who have razor wit...keeps one sharp.

I read a gaggle of medical related blogs. Some I find offensive yet hilarious, some just let me get my ER groove on while I have my cereal* (see Whitecoat and ERstories) but would likely leave non-medical people bored (or confused). Others have posts that chronicle the major and minor events in a med student's life which I enjoy, partly because they give me a constant reminder of what I am getting myself into. BINY, OMD, BB are my top three because I think they are all people I would enjoy working with based on their views of patient care, random pop culture references, dedication to athletics, and quirky humor. Really...what more could you wish for in a colleage? To add to that, I've recently started skulking around Dragonfly's site, her post on interpreting letters is nothing short of brilliant...check it.

To round out the "smile on your brother try and love one another" post I appear to be creating...I must confess to my guilty pleasure in the form of Cute Overload (seriously, don't knock it 'til you try it...I don't get my kicks out of the cuteness per se, but the banter attached is so unapologetically devoted to the cause and humourous I visit it almost daily).

Oh, and of course...Fail Blog. How I wish I'd had the comic genius to come up with that one.

Okay, that's enough for now. I started this post 12h ago before going to work....and now I've been up for >24h which means I am entitled to an eye mask and some shut-eye before I get back on the merry-go-round tonight.

*It really is the best cereal ever. The best. Try it. And no, I didn't get free samples for saying so.

Sunday, September 7, 2008

Space Shifting

My friend Nature Nerd was leaning on me pretty hard to go hiking last weekend. And though I had a million things to do (like pack my belongings and work on med school applications) I agreed. And it was good.
The decompression post-school and MCAT was very much needed.
Seems the best thing to do after a stressimus maximus year is hit the trail and enjoy the views.

We hiked in and set up camp the first day, which allowed some sweet rock scrambling with only day packs for the second day.

The snow stared to fly so we headed down and back to camp. It would have been a slippery descent. And since one member of our party was a little off balance due to her 24 week gestation state, it might have gotten ugly.

Check out the wicked avy paths on mountain in the distance.
Certainly helped to get me amped about my upcoming trip as well...and break in the new hiking boots.

Saturday, September 6, 2008

The List Continues

Northern Ontario School of Medicine

That brings the count up to 17 applications total so far. Not including the US and Australian schools.

If I don't get in to at least one I will have to re-evaluate my career choice...oh...and my self esteem...

Friday, September 5, 2008


When my father died 6 years ago I was given an amazing gift. This gift was seeing people in my life emerge from the mists of the past to stand behind me, around me. It was like a great circle of arms holding me up. From junior high social studies teachers, to former roommates I'd lost touch with, to nearly unknown classmates--I received food, mix tapes, wine, money, hugs, cards, laughter. My childhood friend arrived on the next available flight. And even though this time was difficult, disorienting, and sad...it was also joyful. Joyful because I was able to see how many people cared about me in a time when loneliness would have been treachery. I was stunned and humbled by the love that came my way. And though after it was over many retreated to the background again, I am comforted to know they are there. A silent army of support.

These last few weeks have shown me that network still remains rooted in the soil beneath me. On the days leading up to and after the MCAT* I received many phone calls, emails, and visits. I was contacted by friends, strangers, bloggers, and family members, stretching from the western Arctic to the eastern Arctic, through the US, down to Australia.

People have busy lives, worries, and children...dogs, jobs, and stressors of their own yet many contacted me to say things like, "oh, on the day of your mcat I shut the door to my office at 2 o'clock and just sent you thoughts of peace and clarity for 10 minutes".

Truly amazing. It worked.

The exam was long, and challenging. And if you know me, you know I have terrible test anxiety. I used to get nose bleeds during physics exams and once completely blanked on a chem midterm (forcing me to hand in an empty exam). But on the day of the most important exam of my life (to date) I was calm, cool, and collected. No PVC's, no diaphoresis, no memory blackouts. I answered the questions I could, guessed on the ones that I couldn't. Smoked the essay component. And stayed calm.

So again in a very difficult, stressful time in my life I have been astounded by the thoughtfulness of the people near and far from me, even ones who don't know my name sending me well wishes. My little nephews keep asking, "Auntie, when do you find out your GPO?"--not sure where they get the "O" from but it is still cute. If I heard "I am SO proud of you" once, I heard it a dozen times.

It will still be weeks until I find out my grades and how my shot at medicine is starting to shape up. But honestly...no really, honestly if I flopped it, that will be okay...I was given something separate from grades and admission offers. At the end of this long and arduous road I've been on I was given the opportunity to see that though often these days I feel alone...I am not. And blessings...I have many.

It has been a difficult time, most definitely. The day after the exam I was on the couch staring at the wall for hours wondering where the last year and a half had gone and what I had to show for it. Has this all been worth it? Is medicine really what I want? What are the things I value in my life?

It's a work in progress. Hoping some of that fine Himalayan air will give me some insight.

*(There is one very non-incriminating photo of the post MCAT celebrations on ohtanninbound. Yes there was a wee celebration that night.)

Thursday, August 28, 2008

A Whole New World

I've been holding off on making a post because there are so many wonderful things I want to speak to regarding the last 2 days of my life.

A quick note in the interim to all the amazing people (friends, bloggers, family members, professors, strangers) who have given me an unending supply of encouragement over the past year and a half:


It's over baby. I went in, did my best. A challenging exam to be sure.

I will be spending this weekend hiking in the Valhalla mountains to decompress and get ready for the upcomming chapter in my life.

More to follow. But in the meantime--don't worry that I've had a nervous breakdown, shaved my head and abandoned the med school goal for ashram living.

Monday, August 25, 2008

'Twas the Night Before MCAT

Dear Blog Readers (yes I believe that I can make 'reader' plural),

In case you haven't pieced the obvious together I am writing the MCAT tomorrow.

I am desperately trying to be zen about the whole thing, which is proving near futile.

I know that the score tomorrow isn't going to define the rest of my life, and that it will not dictate if I get into med school or where. It may throw a wrench into the "when" part of the equation if I bomb it as I will have to rewrite and reapply (oh JOY!) again next year.

Ahh, next year. I can't even think about that.

This will be the longest and most intense exam I have written to date. So if any of you out there have any vibrant words of encouragement, last minute strategies, personal anecdotes of how you were bombing practice exams and then shone like an Asian prodigy on test day, or tips for what/how much to eat/drink during the 3 alloted 10 minute breaks it would be much appreciated. You can email me at subtleanvil(at)gmail.com if you don't want the blogosphere to know that you soiled yourself on test day but still got into Stanford.

I will spend the rest of the day trying to fight the urge to curl into the fetal position and suck my thumb and/or watch reruns of 'The Office' on my laptop.

1200h MST tomorrow...please send God/Allah/Buddha/Confucius/Mother Earth/Pan/Universe--whatever you believe in--- a shout-out on on my behalf.

Studiously yours,


Saturday, August 23, 2008

"And There's a Fuc*#ng Ferrari"

I had my first ride in a Ferrari last night.

Which coincided with the first time I have ever felt cool getting out of a car or driving down a "strip". I feel very uncool and unhip 99.999% of the time, partially due to the fact that for the past year my pants almost always exhibit a drawstring waist, and my footwear--laces.

Yeah. Orthotics and sweat pants are really hot this season I hear.

I recently bought a new toyota matrix, which I love. It gets pretty good gas mileage, I can throw my bike/skis in the back no problem, and I can sleep quite comfortably in it with the seats down. These are all major bonus points which I appreciate on a regular basis...

But I can tell you it does not cause anyones jaw to drop, nor does it cause random strangers to hang out of their vehicles to compliment you on your 'ride'. People don't rev their engines when they are stopped next to me at a light. No. The matrix can do a lot of things, but it doesn't do any of those.

Riding in my friend Kate's 355 Ferrari last night (in pants with a zipper and shoes with heels) I saw what happens when you are sitting in a car that gives some men wet dreams. It was pretty hilarious. I may have to post some pictures...

The quote of the night goes to a 20-something guy who was sitting on a park bench near a set of lights that we were parked at. He was deep into some story of woe, it looked like he was listing off several things that had gone wrong for him that day, or month, or whatever...his friend was nodding sympathetically. When the guy looked up and saw the car he then added to the list as he threw up his hands,

"And there's a fucking ferrari..."

Oh yeah baby.

But like all things good and bad, it had to end. I woke up this morning to find my guise of coolness has once again vanished and I am back to being just a girl in sweatpants driving a matrix.

Thursday, August 21, 2008

Reality Check

I am embarrassed at what a whiny baby I have been lately.

"Poor me, I am writing the mcat next week!"


The news today has given me a reminder that I needed...of the fact that my life is so good I ought to be singing from the rooftops not wallowing in self pity.

Nothing like a good dose of reality to remind one of all the things I ought to be thankful for.

For starters, the fact that my brothers are alive.

I won't ramble on about it here as well, but another three Canadian soldiers died today in Afghanistan. They were all from my brother Russ' Battallion. No matter what your feelings are about the war in Iraq and Afghanistan, hearing about young men and women dying is saddening and frustrating, so I opted out of my usually non-political postings and made one today on ohtanninbound in their honor.

My heart and prayers go out to their families.

Private Colin William, a medic who was killed July 7th.

Wednesday, August 20, 2008

I Felt a Funeral in my Brain

I felt a funeral in my brain,
And mourners, to and fro,
Kept treading, treading, till it seemed
That sense was breaking through.

And when they all were seated,
A service like a drum
Kept beating, beating, till I thought
My mind was going numb.

And then I heard them lift a box,
And creak across my soul
With those same boots of lead,
Then space began to toll

As all the heavens were a bell,
And Being but an ear,
And I and silence some strange race,
Wrecked, solitary, here.

And then a plank in reason, broke,
And I dropped down and down--
And hit a world at every plunge,
And finished knowing--then--

Emily Dickenson

Monday, August 18, 2008


The first thing that popped into my mind this morning was the Gibbs free energy equation.

I literally opened my eyes and before I could think,

"ahh...it's a new day...I'm going to make myself a coffee..."

I thought:

"Shit! Is it spontaneous if the answer is negative or positive, and what is it if the S is negative and the H is positive?"

This is no way to start the day.

I haven't even cracked biology yet. Exam is a week away tomorrow. Oh. Crap. Make. It. Stop.

Is that a funeral march I hear??

Saturday, August 16, 2008

I am Leo Hear Me...er...Study?

Today is my birthday.

So to celebrate my last year as "someone in their twenties" I've decided to do a little comparing to the birthday that brought me into this decade.

Hmm...only a few subtle differences.

Well, at that stage in my life there was a core group of us that became somewhat recognized as a band of creative merrymakers. Ones that were skilled at throwing wildly successful and entertaining theme parties.

I can't really go into details because the last thing anyone needs is a ruined political career...Some of the themes included, "Cowgirl Divas" and "Rockstars and Girls in White Panties" (if you get the Mike Meyers reference you earn 10 points) . Only a handful of these print photos are now starting to show up on Facebook, which makes me thank the gods of modern technology that digital photography was NOT mainstream during my early twenties.

My birthday party's theme was "X-Women" because of the hype around the recently released summer blockbuster "X-Men". Ahem. Yes it was that long ago.

We rented a bar for the night that my friend Shelley owned, which soon became filled with scantily clad super-heroes and heroines. I had even rented a full costume and wig for my "Ice-Queen" portrayal (part of my homage to the Snow Queen, but with a more evil sounding twist).

Oh my oh my was it ever a blast. The bits I remember. I do recall that it was the only time in my life that I needed double sided tape to keep the sides of a white sequin dress from revealing the top half of my birthday suit.

By the end of the night there was a lot of smeared mascara, scattered glitter, sweat-stained Lycra, and beer-soaked feather boas in the bar, making it a birthday that will forever stand out in my mind. Well...excerpts from it will...at least.

Today I am alone. Studying for the exam-which-will-soon-be-dead-to-me. I drove out to hang with my family only to find that the twins are both out of town with their kids for a holiday. It's okay, I'll kick back here in this quiet (air-conditioned-thank-GOD) house and keep myself busy.

This evening I will treat myself to a road ride on MY NEW BIKE!!!!!!!!!! (aka birthday present to self).

And then study some more.

So let's see, 20th Birthday:

-private bar party
-surrounded by friends
-making music
-wearing wig and snazzy dress
-hot rockstar boyfriend
-mind suitably altered for evenings events
-sweaty Lycra
-stress free existance

29th Birthday:
-sweaty Lycra from road ride

Wheeeew! Glad there is at least one similarity!!

Tuesday, August 12, 2008

Two Weeks Left

At this exact time in 14 days I will be half way though my MCAT.

Excuse me while I go have a panic attack.

Sunday, August 10, 2008

Uncle Fester

I can't take credit for the name as it was my pal Craig who coined it on our hike last week, but here's "Uncle Fester" at about day 10.
Since when do blisters get blisters? It just ain't right!
I'm proud of him in a twisted way, he's kinda grown on me (pun intended). But I've had enough. I've been trying to train for my Himalayan trip (and possibly a race in September) but have had all kinds of issues; Fester, something weird happening with my Rt. patellar tendon, and Rt. lateral plantar pain radiating up behind my lateral malleolus (my guess is peroneus brevis tendon).

It's really frustrating. And it makes me feel like a wuss complaining about it, especially since my dear friend (and athletic hero) AMG just won the Calgary marathon with a completely torn ACL. But I've been eating NSAIDS like candy and icing...it'd just be great to get out there and feel strong instead of spending the runs trying to distract myself from a demon pitchfork jabbing at various areas....does this mean I am getting OLD??? *gasp* Is this what it is like???

Especially nagging, wussie ones. I think next week I am going to try and take it easy. I tacked on 94kms of running in the past 2 weeks and 20kms of hiking. It's just tough because right now the only thing that makes me feel good is exercise...sigh...

Saturday, August 9, 2008

Arctic Shopping

Bostonian in New York recently made a comment about obtaining fruit in the Arctic and I was reminded of a contract 2 summers ago working in Kugaaruk, Nunavut.
I had a three week contract there during a crazy RSV outbreak. It was just me and one other nurse manning the station in a community of about 800. It was pretty hectic and after a few days we got into the groove of trading off: I'd call the medevac, monitor the child while she went upstairs and slept, ate, brushed her teeth, and stared blankly at our one channel of CBC North. Then she'd come down a few hours later and we'd switch.

After two weeks of this we were sent a third nurse for relief who was a new NP grad lacking some basic assessment skills so we were forced to buddy her the entire time. Thus giving us no relief at all. It was a harrowing experience having 4 month olds come in with O2 sats of 76%, respiratory rates in the 70's and tracheal tugs you can see across the room. All this with the nearest medical facility hundreds of miles away by plane access only. By the end I could nearly do a respiratory assessment and peds I.V start in my sleep. I had also picked up my colleagues habit of yelling "cocksuck!" every time the on-call phone rang. Classy, I know. But it made us laugh.

I did get 2 days off in the three weeks there. One of those days I was able to get a paddle in with the mental health and addictions counselor. It was wonderful breathing fresh sea air and feeling the wind on our faces.

The locals were pretty cute.

But the "dairy section" left something to be desired.
(Note toilet paper roll in right corner).

And this was the fruit and produce section.

The local store had all but run out of any fresh food at all, there was no bread and no dairy that wasn't expired. That week the store manager did charter a flight however, bringing only the most essential item into town, Pepsi. No joke.

A week later some cottage cheese arrived, I bought several tubs and spent the rest of my time there surviving on cottage cheese and canned pineapple. It was to be the last time I traveled north without bringing my own food, despite the hassle and (occasional) heartache. Some trips my cooler would be left in an hot airport hangar for days and I'd get everything floating in 2 inches of thawed blueberries and their juice. Other times my food luggage would end up in -40 degrees outside, my soy milk frozen and exploded.

It's all part of the adventure I suppose.

Bostonian's comment brought me right back to the trials of healthy eating in the North. It's been almost a year since I was up there and had nearly forgotten that thorn-in-my-side to working there. And here I am, mindlessly enjoying all the local produce without a moments pause to really appreciate it.
Like strawberries that don't even need to be chewed, just pressed between your tongue and the roof of your mouth. I am reminded of the small blessings we take for granted every day here in southern Canada.

Friday, August 8, 2008

The Internet is Weird

So. Weird.

I am a stat junkie. A numbers girl. So I like seeing how people stumble onto my site. I get a kick out of finding out what searches or other blogs are linking me, which photos or definitions have lured people in.

I've noticed some very odd ways that the intertubes bring folks to my so-called-life blog, this blog, or my Flickr account.

I find it all very amusing that several times a day I get hits when car junkies search "AC cobra" they come up on a photo of my brother in his garage and then some ramblings about my family hanging out on the boat. I am sure they are less than impressed.

And although Raffi may no longer be a name on the lips of children across the nation, people still google him and apparently they come right into my clutches.

The "banana phone" lives on. Too bad the 'banana hammock' does as well.

And then there are the expected hits, like people finding me when they google "asystole" or "atrial fibrillation" and such, but there is one new, very odd, and somewhat unsettling net which is catching some folks surfing the web.

My friend Marnie's boot cast!

I tracked down the site but one needs some sort of profile to get in and I cannot be bothered to make up a bunch of bogus info and set up a fake email account just to get in...though I must say my curiosity is piqued. Evidentially there is some German fetish/forum for people with casts or on crutches. They like the looks of Marni and her one-crutch-wonder self and have linked to my site! These pics were from Nature Nerds staggette...and I figured they were pretty harmless. Apparently some folks find them hot...or should I say, heisse?

This photo has had over 350 views.

This one, over 750.


What kind of chafes me is that I am really pleased with many photos I have taken over the years, yet the nearly 2000 hit spike came from some photos of me and my friends leg wrestling and standing around watching each other do handstands!

Some of my favorite photos that I am actually proud of, like these ones below have only enjoyed a whiff of the attention the grainy blurred stag/crippled friend series have had!

Nunavut Day Celebrations
A Man Who Stole My Heart in the Arctic
The Underdog.
Glimpse into train station in Morocco.
The Market in Fez.

But no. It's the crutch that brings in the hits...this one

I am not so creeped out by it all to make my account private but it has certainly given me pause with regard to what gets some folks all hot and bothered. Medical conditions are sexy apparently and as my friends the Gillatrons have discovered, some people find them through searching "sexy woman wheelchair".
(Thanks for stealing my post idea E.C)

Is there a theme here?

Maybe I ought to start wearing a wrist brace or use a cane when I go to pick up groceries and see what happens...

Tuesday, August 5, 2008

Borderline Pleasant

Okay sometimes MCAT studying isn't sooooo bad...

Countdown is at 21 days.


Saturday, August 2, 2008

Running out of Brain Cells

Kara and I decided that we wanted to do a long run today.

We made sure everything was in order: drank plenty of H20 last night and in am, had a great protein/carb breakfast, coffees. Only one thing was getting in the way of some sweet oceanside pavement pounding--both of us are working on some pretty remarkable instep blisters right now. We didn't want that slowing us down so she pulled out the first aid kit, slapped on some blister pads, and we were off.

At around the 13km mark I couldn't help but notice that my blister was giving me serious pain and I decided that said blister pads were useless. After the run I mentioned that the pads didn't seem to work as I hobbled around 'Picnic' with my recovery coffee. Kara then realized that she may have made a mistake and given us wart pads.

Great. Wart pads, nice. Nice one.

Salicylic acid+heat+sweat+friction+mileage+skin breakdown=perfect.

I pulled off my sock and found the circumference of the blister had tripled and so had the amount of fluid.

When her husband came home I made some joke about how she'd left her wart pads on the counter near the salsa and it was less than appetizing. To which her husband said:

"Wart pads? Those are the felt floor protectors for the bottom of the chairs! Not wart pads!"

Me: "Nooooooooo..."

He: "Yes!" as he flips over island stools and shows me.

Yeah. We're brilliant.

Thursday, July 31, 2008

Gonna Shine Up My Boots

Well my hiking boots that is.

Sent off the deposit today for a month long volunteer trip to the Indian Himalayas. I have to be in Delhi to meet the group on Oct 2nd. I am pretty EXCITED! And a little scared.

I've been longing to go back to India and Nepal since I was there 9 years ago. Ack! 9 years ago? Really??? Oh my. Now I feel old. Or maybe now I realize how young I was....so that was why my mother was having a nervous breakdown for the entire 7 months that I was gone!

They are very clear on the application forms and waivers that one has to be in "top physical shape" as we must get to the villages/settlements on foot, it's not a cushy land-rover-to-destination-trip. One of the passes is almost 14 000ft! Somehow I think it'll be a little more rugged than the last time I was close to that elevation...

And I figure if I am going to be in that neck of the woods, and spend the money and carbon footprint getting there...well....heck maybe I should stick around and head up to Nepal for a few weeks for some more trekking...any takers??

Training starts tomorrow.

Finally Something Good

It has been a rough couple of weeks here on the homefront and medical pursuits front. But tonight as I checked my email before tucking my wee self into bed I found this little bright star. It's from an enrollment manager at QRS School of Medicine where I emailed some questions and info about myself wondering if I ought to bother with an application...here was the response--edited for brevity but key parts intact (allow me to bold my favorite parts of the message):

Dear Albinoblackbear,

Many thanks for your response and for your sharing your details about your unique situation.

In answer to your question, I do feel that you are a great candidate for future success with QRS. A good number of our graduates and current students are not the “traditional” student, but rather have majored in another field or are embarking on their second or even third careers just like you, so do know that you are not alone!

Your grades are solid.

Best of luck to you on your upcoming MCAT. Do keep in touch!

All the best,

Nice Lady at Registrar


And on a complete non medical topic...I totally spanked my run today. Finally feeling like I am getting my running mojo back. It's a terrible self-defeating cycle with running...I take time away, get frustrated at how fast my abilities wane, don't want to run, go for another bad run, take time away, don't want to run...but this past week I've just been forcing myself to go out the door and I think I am over the slump. My spiffy new running skirt helped a bit too I think.
I like to think my legs are more of a 'cloud white' than 'skim-milk-bluish-white' as pictured...

Monday, July 28, 2008

And Since Then I've Hated Myself Just a Little Bit

I am consistently in awe at the succinct beauty of C.S. Lewis' writings. Something I recently read by him raised this point,

"...we must hate the bad man's actions, but not hate the bad man. For a long time I used to think this a silly, straw-splitting distinction: how could you hate what a man did and not hate the man? But years later it occurred to me that there was one man to whom I had been doing this all my life--namely myself. However much I might dislike my own cowardice or conceit or greed, I went on loving myself. There had never been the slightest difficulty about it. In fact the very reason I hated these things was that I loved the man. Just because I loved myself, I was sorry to find that I was the sort of man who did those things..."

It has caused me to reflect on a recent incident from a few nights ago has been gnawing at me. I keep coming back to it in my mind, seeing myself react more quickly, with more confidence and ease, with strength. Like those times when you think of a really good comeback or joke but the moment is long past and you're just left to burn and smolder in your thoughts of inadequacy.

This 30 something woman in tight jeans, heels, and handbag has been coming in for her late night dose of IV therapy. She's suffering from a case of pyelonephritis. I am sure it is unpleasant and irritating to be sick to have to drag yourself to the hospital thrice daily, (two times to Ambulatory Care during the day, and once to the ED late at night) but I believe that this does not excuse her behavior in the slightest.

Each night when she comes in she harasses the nurse who must work at a slow jog to keep up with the IV therapies, the evening meds of the admitted patients, the call bells, the pukers, the criers, the poopers. It is the 'non-acute' side of the department which means you can forget a break all night and you can also forget getting to do anything fun (like assisting with reductions, sedations, intubations, chest tubes, etc). This woman will complain about the fact that she has to sit in a chair (a chair that just happens to go into full recline but I guess that is beside the point), because really she "deserves a bed". She demands blankets. No, HOT blankets. She needs juice. She needs a new IV site because this one is really bothering her.

One night the nurse actually accommodated the early site change and thus subjected the entire department to the womans wails, screams, and sobs while the new IV was put in. And I mean SOBS. There were tears rolling down her cheeks I-kid-you-not. I even went over to see what was going on and to see why one of my colleagues had clearly snapped and decided to shove bamboo slivers under someones nails that evening instead doing her job.

But no. It was just our little pyelo getting a #22G catheter in the arm.

So I am on the dreaded 'pit' side the other night. And I am dealing with the usual 10-pt-per-nurse ratio and I go to flush her IV with normal saline while we wait for her repeat blood work to come back to see what the plan for the next day will be. While I am hooking up the syringe she points to how badly her skin is doing, how the site is clearly not working and that it needed to be changed. Since 250mls of cipro had just gone into that supposedly "non working site" I was unconvinced but assessed the area anyway. Her skin was slightly puckered from the op-site but looked pink, healthy, and non-infiltrated underneath. I explained that it was the taping job and not the signs of a faulty site.

When I went to flush the line she almost knocked me over as she reached around to grab her hand in pain, screeching. The saline was going in with no resistance and again I noted no signs of infiltration or an interstitial loss. She demanded that it be taken out otherwise she wouldn't sleep that night.

Remembering back to the antics the night before I told her that since we'd been having such a hard time getting IV's in her I was less than willing to pull out a perfectly good site. I added that I was certain it would not go over well when she returned the next day without a saline lock in place (I was really trying to save this faceless RN unknown to me at the ADC program that kind of a start to her day...faceless RN if you ever read this blog you can thank me anytime).

I wrapped her hand up and went to tend to the patients in the department that were actually quite sick and in need of attention (in a non-pathological way). Like, for example, the woman in bed 6 with gross hematuria and the guy in 5 with hepatic encephalopathy.

As I am on the other side of a curtain nearby doing a quick EKG on a patient that had seemed to have vagaled but just wasn't coming around in a timely enough fashion for my liking, I had to listen to pyelo ranting at a just-below-yelling-decibel-level:

...yeah they have me in a hucking chair in the middle of the hucking department...no I am NOT in a hucking bed I am sitting here in a chair! Yeah I told her to take it out and she wouldn't...because it is so hard to start a hucking IV on me!! Yeah, they are so hucking brutal down here...they are waaay hucking better in ADC...I just cannot believe the hucking treatment I am getting....I don't even hucking know what the huck I am waiting for...this stupid hucking antibiotic isn't hucking working anyway!....

And on and on and on she went in a similar fashion. I could feel the anger rising in me. I felt my face beginning to flush and my heart rate starting to rise.

Why was she allowed to pollute our emergency department with her sense of entitlement, her anger and her foul language? Why was I feeling so incredibly offended by her mouth? I used to be a basketball referee for crying out loud! I've been called every name in the book in front of hundreds of people and I had never taken it this personally.

Why was the person who was the least in need of emergency care in the entire department allowed to rudely and inappropriately disturb patients and family members with dissatisfaction over her care?

Because I didn't do a thing about it.

Ugh. It makes my stomach turn a flip every time I think back to it.

Why didn't I walk over to her and say, "please turn off your cell phone, as you can see there are signs everywhere restricting their use. Also, please refrain from using such offensive language. If you are not happy with your care here please feel free to be seen at XYZ emergency which is about a 10 minute drive away. Thank you and good night".

I am so angry with myself for cowering away from the confrontation that would have spared my other patients, family members, and colleagues from her ridiculous (and totally unreasonable) ranting.

And I am also unhappy with myself for hating this woman who was sick and clearly has other issues than her pyelo or she wouldn't be acting out in the way that she did.

I have been thinking of ways I will deal with these things in the future, how I will handle them more pro-actively. How I will learn to "hate the bad man's actions but not hate the bad man". How I can try to see those poor qualities in myself and change them; the sense of entitlement, the impatience, the desire for attention.

And how I will let go of this, move on , regrow that thick skin I once had, and keep smiling.

Saturday, July 26, 2008

Ketamine Harshing My Mellow

I've given ketamine to several pint sized humans in my old ER with predictable results: the eyes get glassy and go in opposite directions, the doc performs whatever needs to be done, kid cries a little, parent freaks out because the child does not look sedated, procedure is over, kid starts coming around, and then kid freaks out.

Previously I gave little pause to this common chain of events but tonight seeing an adult go through the hellish journey of a bad ketamine dose I am starting to rethink our cavalier usage of it with the tots.

38 year old man comes in with anterior dislocation of his shoulder. He injured it last week and then tonight while asleep it popped out again. He was in excruciating pain and had to keep his elbow suspended above his head for comfort (something I have never seen). Anyway as we wait for the pre-reduction films to come back my colleague pops 50mg of ketamine into the man's IV and we wait for him to get all gooey so we can begin the reduction.

As simple as slowly lowering the arm allows the shoulder to slide back into position. Nice and smooth. And the reduction is complete.

Then he starts losing it.

The man is crying out in complete horror and fear, waking up our few sleeping inpatients. "What is happening to that guy?" is muttered throughout the department. He was shrieking like he was at hells gate, tears streaming down his face, a look of complete panic in his glassy eyes. Mostly nonsense peppered with "noooooo!" , "don't let me go under again!!!" and "what have you done to me?" were some of the phrases that began to ring through the hallways of our previously peaceful 5am ER department.

I took up full time occupancy at the bedside trying to calm him down and reassure him. He thought that each time the BP cuff inflated that I was putting him under again. Then he was sure that because I kept telling him where he was and that we had just fixed his shoulder that he was in some sort of loop of existence that he couldn't get out of.

Finally he started to come around a bit but was still very leery of his surroundings and my motivations with regard to his well being. I asked him simple and direct questions about his life and family to keep him on track, at his insistence "ask me more questions". I myself was having flashbacks to talking friends down from bad trips at rainy music festivals and loud dingy clubs, "no Kent, there are no worms in your tent and no they are not crawling through the ground and then through you..."

He was finally able to focus on my face and told me that he had seen horrible things and for a while had been reliving a frightening experience from high school when he was bullied for being gay because he was the smallest guy in his class. My heart really went out to the guy. He was visibly rattled.

His wife and daughter showed up and their presence seemed to solidify that things were once again as they seemed. I knew he was OK when I heard him singing, "what a long strange trip it's been" while I drew up his dimenhydrinate for the road.

After he left I couldn't help but think of the many babies and toddlers I've seen coming out of ketamine anesthesia. All of them did seem to have an air of panic about them and most were carried out of the department clinging to a parent, wailing. I always just chalked it up to being scared, post-procedure, and being in a strange place. But now I wonder what 'long strange trips' they'd been on. What had their little Sesame Street watching brains created for them to trip on?

The other thing that gave me pause was, back in my raver days I remember many kids taking ketamine for parties. I'm usually not one to judge about the poisons people pick to party on but, ketamine?? Seriously? How much more dangerous can you get than being surrounded by thousands of strangers on a dissociative anesthetic which can cause you to slip into a coma? Really. Nothing says "party girl" like being in a vegetative state at a rave. Strange indeed.

A fascinating drug nonetheless. The wiki is an an interesting link ,if you've got time to give it a read.

My medical directive may have to be expanded from "DNR----and if you have to restrain me please do it chemically and not physically" to also include "and if I need to be consciously sedated please do it with midazolam and fentanyl. Thank you."

Note 'ketone' and 'amine group' in structure, hence the name. Sorry, I love organic chemistry. I had to!