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). 

And then there were TWO!!

Today while walking through West Edmonton Mall, trying to replace my burned in housefire ski pants, I checked my email .

ANOTHER INVITATION TO INTERVIEW!!!

I nearly cried in the mall. Then I nearly jumped up and down. Then I nearly hugged a random elderly couple who were eating ice cream. Then I tried to send 7 texts all at once.

It's big people. Big. I am over the moon.

These are some exciting times!

FIRST INTERVIEW!!!

Nope! I am not afraid to use the oldest meme on the internet to display exactly how I feel!

Yes, I do believe I have the right to put that title in all caps.

Of course, I've been compulsively hitting 'refresh' on my emails since Thursday which is when some of the IMG programs were rumored to start sending offers/rejection letters out. Last night my mom and I were babysitting my brother's three little ones so I was distracted with the chaos until after their swimming lesson. As soon as they all fell into an "Ice Age" induced trance and I was able to check my email again.

Et voila!! My first offer!!

I screeched, jumped up and down, did some clapping, fist pumping, and then ran into the living room to 4 stunned sets of eyes. Of course my mom was over the moon, but the little-ies just looked up at me from their warm milk like I had completely lost the plot. My niece asking me, "are you a doctor yet?" Um, no....but it looks like I might actually get to be one soon!!

Little Breakthroughs

Today was a big day for me in an area completely outside of medicine. Yay! There are other things in life besides stressing out about my future career.

Indulge me in a little post about yoga.

My sister has a great workout studio in her basement so today we decided to spend some time playing down there and attempting on some challenging yoga poses. She has become a serious yogi in the past couple of years who can now wipe the mat with me. Yes...the student has become the teacher. 

So we both had some fun breakthroughs today resulting in loads of whoops and high fives sounding up the basement floorboards.

To start.

We finally nailed Bird of Paradise. It is a beautiful pose and one that I've often admired others doing in hot yoga classes. But usually the flow is so fast and I am so afraid of falling on my tuchas that I haven't attempted it before. (I took a very hard and embarrassing fall from a bind once in Whistler which has made me one-leg-bind-shy). My sister went from not being able to bind to pulling off the pose five minutes later. We were both pretty giddy.

Bird of Paradise

Side Crow

Then we tackled Side Crow. Which isn't as pretty as Bird of Paradise but it is another one that I've been too afraid to try in class. Probably a good idea since my first dozen attempts involved me flopping all over the place like a dying killer whale, then face planting with my arms stuck behind my back.
Sis had it on her second try while I was still getting mat-burn on my face but then...VOILA! It happened!

Finally we went for the headstand.

My mom had been warming up with us and now she took on full cheerleader and coach mode. Your hands are too close! You need to make more of a triangle!! Straighten your back!

"Head stand" photo by Richard Seagraves

Oh headstand. How beautiful you are to behold. 

I can't remember the last time I tried to slowly extend into a head stand (as opposed to kicking up with a wall very nearby) but something just clicked today. It was unreal. It felt so easy I couldn't help but think...why didn't I try this ages ago?? I just never thought I was one of those people with enough strength and balance. And really, these days I don't feel like I have much of that physically or mentally.

Gotta love it when you surprise yourself!!

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?

6 Pack

Me: Yeah, ugh he said he "met someone else". From his running club, his running club. I mean, how cheesy is that?!

Ryan: Sooo cheesy. 

Me: I am pretty sure I know which one, the one with the six pack. I can't compete with that! I don't have time to get a six pack right now!

Ryan: Oh ppffffffttt! Who cares dude, you've got a six pack right here! [taps side of my head]

This is why we always need close friends around to keep things in perspective. 

I also love to write equations on windows.

Passive Agressive Notes

I am packing to go home, and preparing for another move which means going through all belongings with a scrutinizing eye. Used book stores, second hand clothing stores, and recycling plants--brace yourselves! I love a good purge, being the anti-pack-rat that I am.

So in this process I stumbled upon a little book of quotes that I kept during first year (yes, cue the nostalgic montage). One quote is from a weekend when Keith came to visit. For those of you who don't know Keith, he's one of my oldest friends. We met when we were 14 at a volleyball camp in Jasper, Alberta. We were both going through a "skid" phase and wanted to become doctors some day. Hence, fast friends. 

About 8 years later I managed to convince him, over a Boston Brute, to become a nurse with me. We also got our first nursing jobs together, as employed students on Unit 62 (the acute psychiatric unit at the Royal Alexandra Hospital). 

He's now living in London, England and has a masters in nursing (my attempts to get him to join me in medical school were ill-timed due to his masters!) He's this total kick ass, published, saving the world one abandoned patient demographic at a time nurse now. He's currently specializing in schizophrenics suffering with HIV. He also specializes in being awesome. 

London 2012. Almost at the 20 year mark!

Anyway (longest pre-amble ever) he came to visit at the very beginning of medical school. I was living with three classmates at the time. A few necessary points required to understand the passive aggressive note Keith left George (one of my roommates). 

We had a MASSIVE whiteboard in our kitchen. 
George had recently been published for some melanoma research he'd assisted with.
I had complained to Keith about how George always drinks from the Britta and never fills it up. 
Keith gets belligerent when he drinks beer. 

Georgey-Boy. 
No. You cannot leave the Britta with 1cm of H20 in the bottom. 
Unacceptable.  I think you're slipping. You're never going to get published again unless you refill the Britta. 
I'm just sayin'. 
Fer realz, Bro-ski. 
Love Keith. 
P.S Best note ever. 
P.P.S Yer momma.  

Stumbling sleepy eyed into the kitchen on Saturday morning George discovered this note written on the white board. We had been sitting there having our morning coffee and had completely forgotten about the note until George stopped talking and was clearly reading it. It was like one of those slow motion

Noooooooooooooooooooooooooooo! [dive roll attepting to grab paper towel to erase it before he actually read it.] But it was too late.  

George, ahem...failed to see the humor in the note, I believe. Being a rather serious chap. Things were a little chilly for the next two days but I sniggered to myself over it for ages. And Georges still brings it up when I mention Keith. Coming across these little gems is the one and ONLY upside to packing / sorting / moving hell. It still makes me laugh. Nothing like a dear old friend leaving passive aggressive / yer mom notes for your new roommate to really make things awkward. 

Love ya, Keith! xx

 

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

Friends, Formulas, and Finding Out

It's weird competing for residency spots with all of your friends. When I applied to medical school I didn't know a single person who was going through the same process. Now most of my Canadian friends here are scrambling for the same (extremely limited number of) residency spots.

Ugh.

Gah.

I hate that thought. I don't want to be sitting next to one of my good buds, on one of those uncomfortable steel framed chairs with the stuffing falling out of the cushion, waiting in line to be interviewed. How awkward will that conversation be?

"Residency, hey? One position at this school...*cough*...so....what is your rank list? How was Christmas?...Cold out there, hey?"

"Yep."

Also, at least one of the schools I applied to uses the following formula for interviews:

EE score: 20%
Personal letter: 20%
School marks/ranking: 20%
Research/publications: 20%

Then they interview the top "x" number and the interview is worth 20%. The schools rank list is based on that overall score.

So this is my worry...my true attributes and qualities don't necessarily shine when traditional formulas are applied. My complete lack of Canadian medical school interviews speaks to this. I mean, sorry, I haven't managed to crank out any major publications this year. Does that mean I am not going to be the most competent and safe and fun-loving resident you've ever had?! Hell no!

Maybe if the formula was:

Relevant health care experience: 20%
Culinary skills: 10%
Class ranking: 20%
Personal statement: 10%
EE score: 5%
Interview: 30%
Dentition: 5% 

Then I could rest assured that I'd have a job next year...!

Sigh.

Tick tock. Still a month of nail-biting to go...

How I currently feel...

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...

Life style.

Because I have been working on my residency applications and trying to sort out my future career, I have spent a lot of time thinking about what the concept of "life style" means. Whenever I mention the areas of medicine that I am interested in people always comment on life style. Somewhere fitting in the statement, "You should go into family medicine, it's the best life style."

At which point I want to put 6 inches of duct tape on their mouths.

If I go into family medicine it will be because I want to do primary care and live in the hills, be involved in community and do some extra training in EM, OB/GYN, or sports medicine. It will not be for the life style. Please do not try to sell a career to me based on the merits of how good things will be when I'm not at my job.  I want to choose my career based on how much I will enjoy being at work. Tell me to go into family medicine because you love your work, the fact that you enjoy the variety in your patient population, the continuity of care, the portability, whathaveyou. Not because of the life style.

[Because I plan to take most of this post down before submitting my CaRMS application I am going to be totally honest here.]

I am applying to emergency medicine, obstetrics/gynecology, and family med. I thought long and hard about general surgery as well, but realized that I actually LOVE the surgical component of OB/GYN more than the heavy scope and gastrointestinal component of gen surg. So, at this moment I am not applying to surgery. When people ask, and I tell them my choices, I am constantly told that I shouldn't do OB because of the life style.

Instead of a verbal reply to that from now on I want to hand over the following quote by a pediatric cardiac surgeon, from the book Walk on Water by Ruhlman:

You go through med school and they say, 'Oh, don't be a surgeon--lousy life style'. It's a mantra in med school: 'Life style, life style, life style.' Do you go into emergency medicine or do you go into...life style? I see people doing things that are really hard and uncomfortable, but they do them anyway because they're passionate about their work. I want to do that. I see someone turn off his beeper because it's one minute after five o'clock--is that being a doctor? This is why surgery is the wrong choice for someone like that: no life style. That is what it comes down to, either you go with what you're passionate about, or you go with life style. 

I basically want to stand up and do a slow clap every time I read that passage.

It really is amazing, the responses I get when I discuss my future career aspirations. People will nearly always respond with a disparaging comment. It's reminiscent of when I was in the application process for medical school, actually. I would often get, "Why would you want to do medicine?" or "I almost did medicine but then decided I wanted a life and family instead", "Medicine is so hard to get into", I could go on.

I said to one of the OB's at work a few weeks ago that I was applying to obstetrics. His response, "So, you don't enjoy sleeping through the night then?"

What is the matter with these people? Hellllooooooooo?!

My career will be a big part of my life. If I love my work I will consider myself to be blessed with an amazing life style.

That is, of course, if someone will give me a residency first!! :)

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!!

My Achilles is Actually My Heel

I have problems with my feet.

If you are a long-time reader you may recall "Uncle Fester" from my Himalayan trip training days...or my Summer of Cellulitis last year thanks to a hike in the eastern Reeks..Well it appears that the hills of Ireland have once again bitten me (okay, it was actually my new fell running shoes...)

Ahh, nice views, nice spot for lunch...say, I love my new shoes!

La la la ridge running so fun, these shoes are so great! Mud claw's forevveeerrrrrrrr!!!

I may vomit if I have to put a shoe on ever again. 

Consultant Crushes and Medical Miracles

I'm not going to get too sentimental about all this. Just hear me out.

There are a lot of things we get wrong in medicine, a lot of things we can't treat, cure, or figure out. But today in clinic I had the opportunity to meet some children who are living (playing, giggling, bright eyed, rose-cheeked) proof that modern medicine can be amazing. Similar sort of feeling to a day I blogged about 2 years ago.

I met a child who had a catastrophic birth with many complications, but because of the swift and expert interventions provided (including total body cooling) has managed to develop with no deficits in any area (physically or cognitively). Today she is an adorable, intelligent, able bodied little bean who seriously rocks pink UGG boots.

Another child who was born with a fatal cardiac anomaly, had surgical treatment, and also is now a happy-go-lucky perfectly healthy little man. I couldn't help but send mental props to the cardiac surgeons like Lillehei* who trialed, and failed, and failed, and developed and perfected surgeries like the repair of Tetralogy of Fallot or the Norwood procedures. If those men hadn't risked their careers and their emotional fortitude 50 years ago, today these children would have died at birth or after short and difficult lives.

My awestruck gaze was only sharpened by the fact that I was working with a seriously butt-kicking-ridiculously-intelligent-biochemistry-genetics-pediatric-metabolic-disorder-expert-ball-of-awesomeness consultant who loves to teach! I hoped some of her brain power might waft over in my direction if I sat close enough to her in clinic (without being too creepy and really invading her personal space).

And so, I return to my reading and eventually the newest episode of "New Girl".  Oh and yes, I am working like mad on my CaRMS application and my new research project. I have a whole post on recent CaRMS trauma in the works...but for now...I'll just say that today was a good day. A perfectly timed reminder of why I am putting myself through all of this.

*Read "Walk on Water" by Ruhlman and "King of Hearts" by Cooley if you really want to know what I am talking about. Both fascinating and unreal stories of larger than life pediatric cardiac surgeons.

Hark! A Child Cries in the Distance!

I love going into the maternity hospital for work.

Ireland was apparently the first country in the world to have one. Every day I have to dodge new dads in the parking lot trying to juggle car seats and flowers, handbags, suitcases, and "IT'S A BOY!!" helium balloons. Women (mostly waddle) around in various brightly colored bathrobes, either trying to break up the boredom of being admitted, or in the hopes of getting things going in the labor department. Giant bellies, little bumps, nervous nulltips, exasperated over-termers populate the antenatal clinics. It's quite the humming baby factory.

On the labor ward every couple of hours a new admission would walk casually up to the desk with a mix of fear, sometimes excitement, expressions of pain, or lines of fatigue on her face. While being checked in some would have to pause and lean heavily on the nursing station if a contraction took over. Others went shooting by in a wheelchair pushed by an admissions midwife, hair blowing back behind them with the "don't push yet!!!" instruction barked by a senior midwife...a few minutes later we'd hear some hollering followed by the gusty cry of a new arrival to the planet. I could just smile to myself because at that moment only infinite possibilities exist for that baby.

Of course, of course we've seen sad outcomes, unexpected premature deliveries, undiagnosed syndromes and malformations. But even those, which weigh heavily on the staff, give me inspiration from the grace and strength exhibited by the families of those babies.

What a place! What a privilege.

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. 

Well Put....

After examining the tummy of a very pregnant lady we were ushered out into the hall to be pimped by our Registrar. He asked my friend what his findings were and to describe the fetal position.

Friend: Well....When I was feeling her abdomen I couldn't really tell if I was feeling the head at the top or if I was feeling the back and feet. So...at the fundus I palpated either the head or the feet.

[You really can't fault that logic.]

[This was just before I got the fetal lie completely wrong.]

[Figuring out fetal lie, position, and presentation is harder than it looks.]

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.

Tomorrow At This Time

MCCEE? Bring it.

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.

Need Not Apply

This is what it feels like to be an IMG in the medical community:

MAN
WOMAN
HORSE
DOG
CAT
RAT
COCKROACH
LIVER FLUKE
Clostridium difficile 
IMG

I found out this weekend that I am inelegible to apply to the UK for internship.

Is this some kind of sick joke??

Yes, if you are not a UK, Irish or EU citizen then you need to write the PLAB (Professional and Linguistic Assessment Board exam) which ensures you have a basic grasp of the English language and basic clinical medicine. The downer is that I can't write it while still in medical school which means I am not eligible to meet the criteria to apply for internship. Annoying because Irish students don't have to write it, yet...I am going to graduate from an Irish medical school.

I was really getting excited about the prospect of possibly going to the UK if Canada didn't work out, so having another post-graduate door tightly closed in my face really is starting to get to me.

I feel like standing on top of something large and yelling,

"HEY! Will someone just GIVE me a CHANCE?!? 

I am competent and eager and ridiculously excited about medicine!!!"

It is so hard to stay positive and upbeat about things. I am working really, really hard studying for the Canadian exams, working on CaRMS, doing my current school work, applying for more electives...and sometimes I just feel like it is for nothing. It feels like no one will even consider me as a legitimate applicant because I have a big NEON sign that says, 

****WARNING---IMG---WARNING***

over my head. 

Ok. I am done ranting for now. I am letting it go. No sense regretting things from the past and no point worrying about the future. 

My only request is that if you happen to see an IMG walking around your neighborhood you should give them a hug. And tell them not to let The Man get them down.   

Lust in Translation

I was told last week by my attending that having a medical student sit in on consultations all day was "a bit like having a hitch hiker in the car". That it made him feel slightly self conscious and ill at ease. I thought this was a rather hilarious analogy and so I repeated it to my new attending this week.

He too found it amusing. 

At the end of the day I was saying thank you and going on my merry way and down the hall I called out, "thanks for giving me a ride all afternoon" in reference to the hitch hiker statement. He was smiling and waving and then abruptly stopped with a strange and slightly embarrassed look on his face. 

Yeah. Then it clicked. I've made this mistake before. 

Ride in Ireland = Sex. 

Smooth, ABB. Really, smooth. 

Oh COME on!!

Last Monday I started my placement at yet another hospital. It is the frustrating thing about this rotation: in an effort to expose us to various communities and outpatient clinics we have to travel to a new attachment for each of the six weeks. So, after the debacle in Hospital, Ireland two Mondays ago, I once again gave myself plenty of time, looked at two maps, and plugged my destination into the sat nav. 

I should have known that things were taking a turn for the worst again when the road began getting smaller and smaller, the crumbling castle ruins and petrol stations fading into the distance. Two old Irishman standing at a gate completely stopped talking to watch me roll by. Clearly I wasn't a local and clearly I didn't know where the eff I was going. 

And here, pictured below, was where my trusty sat nav directed me to. You may be able to read the "empty" status of my gas tank and appreciate that I had to back out  down the road because it was too small to turn around on. Yes, back out past the Irish farmers whose expressions may or may not have displayed a smirk at guessing my displacement. 

Of course I had to bail, once again and call the facility and request directions from "somewhere near the castle*". When I arrived, late, everyone made such a fuss over how often people get lost and how sorry they were that I had started my Monday that way. I was told to take a break and tea was made, scones were proffered and I figured, "Hmm, I could really get on board with this whole psychiatry thing!"

---


*Reason #342 that I love Ireland. 

Understandably Lost

Tuesday was the first day of my new attachment in psychiatry. I had google mapped how to get there and saw that it took 39 mins, so I gave myself an hour. My prof had also passed on the typical vague Irish direction set, "Take the road, it kinda veers, follow that for a while, eventually turn right before the motorway, near the hill, you can't miss it..."

I figured, "a hospital in the midlands, how hard can it be?"

In Europe it isn't uncommon for many little towns to be on top of each other. You don't realize you've arrived in a new place because all you've done is cross the river, or cross the street. So when I was quite sure that I was getting close to the town my hospital was in I saw this sign:

So I followed the sign to the hospital, naturally. I was, in fact, delighted that someone had been clued in enough to provide direction to the hospital! I drove and drove, but seemed to be getting farther away from any town, with no hospital in sight. I was getting nervous now too as it was getting close to the hour I was supposed to start. 

Then I see the big sign, "Hospital". Perfect. Except I cannot see an actual hospital-y looking building anywhere. I see the "Hospital Traffic Calming Area" signs so I know I am in the area...but then I start to think that maybe I am having a mini-stroke or something because there is no hospital to be seen. 

Finally, I get out of my car to inspect an old, yet stately looking building which could certainly be a dilapidated Irish community hospital, only to discover it is in fact a town hall. 

I am now 10 minutes late. I give in and call the number given to me during orientation week, having no idea if it is the consultants mobile or the hospital administrator's emergency line . A woman answers and I say, 

"Hello, my name is ABB...I was supposed to start my psychiatry rotation today...but I appear to be lost. I followed the signs to the hospital but I can't seem to find it....anywhere!"

She chuckles. I am now acutely mortified by the fact that I am late and lost on my first day. 

"You're in the town of Hospital. Like how Kilmallock is the name of the town, you're in the town named Hospital...take the road back to Kilmallock and ring me when you get there. I'll give you directions from town."

Of course the town of Hospital had to be spitting distance from the town I was doing my placement in. 

Of course the town of Hospital has no hospital. 

Of course. 

Hospital Fashion

This week has been comprised of mostly lectures and case-based learning for psyche. It's been a nice way to wade back into the hospital pool. My head would probably explode if I were doing 4h ward rounds and being pimped on things like the causes of ascites.

Also, our professor of psychiatry is a very dynamic, engaging lecturer who ensures we don't get bogged down in the language and the esoteric aspects of mental health. So that part has been entertaining and educational.

The other day I thought something he said was quite simple, but interesting. We were talking about the dress code on the psyche ward. He scanned the room to take in what we were all wearing (various degrees of LL Bean, basically).

Turtlenecks, they're so hip right now...turtlenecks.

He nodded and gave his approval, then said, "Just think, when you're getting dressed to come to the psyche ward, it is not about you, it is about the patients. If you're wearing provocative clothes, loud, dangly jewelery, etc., you might distress or distract some of the patients in ways that are uncomfortable for them. Bottom line: it is not about you."

I really liked that way of framing it. Because the school has given us detailed lists of 'acceptable' clothing options, though I have seen some...er...interesting outfits trotted out. I think looking at what you wear to work in that light is probably the best gauge for appropriateness. Who am I wearing this for? And I'd say it applies outside the realm of psyche too.

All this, of course, coming from a woman who hopes to spend her life in scrubs and outlandish clogs. 

Back in Eire

More airports, dragging my luggage behind me. More waiting at stuffy gates and cueing for dingy bathrooms. I was able to slightly balance my suitcase on my thigh while weighing in, which allowed me to avoid the $250 excess charge. I didn't feel guilty because last week they charged me $106 and then promptly lost my luggage for two days. I was worried my meeting with Brian was going to be in 3/4 length pajamas with hearts on them and a team-building exercise 1999 t-shirt.

The bright side was being met in Shannon by a friend who had packed an airport picnic lunch. Nothing like arriving to smoked salmon, Greek yogurt, and fresh berries, and a weak cup of Irish coffee.

Two days of mini-vaycay on the west coast, going to my treasured beach and drinking coffee at Moll's Gap was punctuated by having to wake up at 6am to drive to the hospital for my first day of placement.

Thankfully, I am doing a psyche rotation first which means a week of lectures before hitting the ward. It's been a nice way to ease back into school after a fairly frenetic summer, couch surfing from Squamish, BC to Charlottetown, PEI.

Right now life is a little hectic, 1/3 of my belongings in Kerry, 1/3 in the house I am moving into, and 1/3 in my current digs (a spare room at my friend Marg's parent's place) . I was going through bags finding camera battery chargers, hand blenders, lavender oil, textbooks, protein powder, pencil cases, and mittens, all thrown together. Needless to say I'm trying not to feel as scattered as my possessions.

For now, I have my notebook, two pens, clothes for work, and a travel mug. I'll survive the next few weeks until the dust settles. 

Final med: no excuses!

Inside Job

Yesterday I had the chance to finally meet Dr. Brian Goldman. It was quite the adventure, getting there and away. But, how many times do you get to to eat seared tuna with one of your medical heroes?

And how many times do you get to be inside CBC Toronto??

The answer to both is: not very many.

It was starting to unfold like a 1993 comedy. Of course, there was the tornado warning west of Ottawa just a few hours before my flight. Then the flight was delayed. Then just as we were about to taxi for takeoff they grounded the plane on the tarmac for an hour because of a major thunderstorm warning in Toronto. Followed by my arrival in a 31 degree city and a broken down shuttle bus.

Eventually I arrived at the hotel, which happened to be hosting a massive Make-Up-Sold-in-Houses convention. The scene was of drunk middle aged women smoking out front, in completely over the top prom dresses with sashes, proclaiming their yearly sales. Yes, yes I did also see a tiara.

The next morning I arrived at the CBC building in downtown Toronto and had to keep my credit card far far away from the schwag store (I'll take two coffee mugs, one aviator bag, an old-school CBC logo t-shirt and a scarf, thanks). By the way, CBC, if you're reading this I wear medium and I will shamelessly promote you forever on this blog...CBC.....CBC.......CBC.....!

Brian and I did manage to get a lot of work done despite my urges to photograph everything from the security guards to the Anna Maria Tremonti elevator. What do I need to do from this moment forward to someday have an elevator with my face on it?! Seriously. CBC radio is the soundtrack of my life. My earliest memories often involve long car rides with Peter Gzowski's gravelly voice or the As It Happens theme song. 

I was in my Mecca. But I think I behaved. I didn't leave any little Jian Ghomeshi action figures lying around, collect cigarette butts that could have been touched by Peter Mansbridge, or steal pencils off Elanor Wachtels desk. 

I did, however, manage to miss my flight back to Ottawa and ended up having to take the train. All well worth it. Brian and I have worked together on pieces for WCBA before but it was great to finally meet him. Bottom line, if you miss a plane because you're having lunch with a CBC radio host, there really is nothing to complain about.

I was pleased though, to arrive back at Dan and Lisa's for an arctic char feast, and relieved that the final leg of my journey did not involve riding in the back of a pick up truck with migrant workers and hillbillies. 

Though, it would have made a good story, I suppose...

RBC Revisited

12 years ago Keith took the train from Montréal to Halifax to meet me for a mini holiday while I was doing a French immersion program in Pointe D'Eglise, NS. We had very little money and very little idea about local geography, apparently.

After getting halfway to Charlottetown by hitching rides, we somehow found ourselves on the wrong side of the highway with our sign labelled "Bridge". It was only after a couple of long hours that some kind passerby pulled over, manually rolled down the window of her Mercury, and shouted at us that we were on the wrong side of the road if we wanted to get to the bridge.

I should also mention that during that time the sun was hot and we had one line of "Hold me closer, tiny dancer" in our heads. Singing it over and over and over again without knowing any more of the words but being equally incapable of thinking of new songs to replace it with.

We finally arrived in Charlottetown and blew our last $32 on a lobster meal. Somehow we had made a miscalculation of our finances which caused us to discover (too late) that indeed neither of us had any more cash. This was before the days when banks let us have visas or lines of credit. We called Keith's sister (collect) in a panic to have some money wired to us but it was going to take another day to arrive. I knew I had $15 dollars in my bank account so we went on a mission to find a bank machine that doled out cash in $5 bills.

Cue Hallelujah chorus from Handel's Messiah

Eventually we found one and were able to extract my final $15 to make it to the next day. We stayed at a barn shaped hostel run by a tyrant who wouldn't allow any lights on after 2200h. But life was good.

I had completely forgotten about this adventure until I went to visit a fellow blogger / friend this weekend. When I saw the RBC a faint halo appeared around it in my mind and I felt I ought to make a pilgrimage to the automated teller that saved us.

Funny, I thought I was poor then! Oh I had no idea how poor I could go. Sure, I can get wads of cash these days if I want, but I am also six figures in debt with no tangible thing to show for it yet.

Basically, I have the equivalent of a mortgage on the contents of my brain.

Excuse me while I go and put on a bicycle helmet. Always.

And Now for Something Completely Different...

I am waiting to fly across the country (from Pacific to Atlantic) to get ready for my next elective.

Spent my week between gigs trying to cram in as many visits as possible with family, friends, fine dining establishments, and watering holes. More often seeing many people for too few minutes. Soaking up cuddles and Champagne wherever I could. Though I am looking forward to this next experience I am tired from living out of two very heavy suitcases and sleeping in a different spare room every night. (Don't get me wrong, I LOVE that all my friends are grown ups now and actually have spare rooms...)

Two weeks of elective, a week of limbo in Ontario, lunch with my CBC BFF* and then it is back to Ireland for the last round of doctor school. The major downside to my relocation is no internet or mobile phone at my billet...I repeat no internet or mobile phone at my billet. 

It is going to feel a lot like when I was in Asia, circa 1999...walking the streets hoping to find an internet cafe that doesn't smell like body odor. In other words, I am apologizing in advance for not replying to emails, sending tweets, blog posting, or being on skype. I am sure I'll have plenty of time to catch up as I doddle around Ottawa for a week waiting to fly back to Ireland on the 27th.
  
Enjoy the sun (but not too much).

Yours in interweb withdrawal...

ABB

*My designation, not his.

Rolling Stone

Feels like I am back to my nomadic travel nursing days. Once again living out of suitcases and buying tinned fish and microwave meals to avoid over-using kitchen spaces. I had to chuckle when in one day I received emails from several different people all with the same subject heading "Where Are You??". My friend Kara says she has a separate page in her address book just for me. The phone numbers and addresses have changed so many times that she's erased through the paper in some places. I think I have "Z"  all to myself.

I've been planning to spend a few days on the west coast but hadn't quite nailed down when I'd be in specific towns. Kara knew when to expect me (roughly) so I called her yesterday to firm up when I'd be arriving at her house. I had forgotten that I was calling from my friend Erin's American cell phone.

"Hi Kar, how are you?!"

"Hey! Where are you?"

"Sorry I haven't been in touch this week. It's been really crazy and my phone doesn't work outside of the major cities because I am on a crap network--".

[she cuts in]"--Where are you??"

"I am in Squamish! I was thinking of coming to your place....tomorrow?"

"You are in Squamish? Really? Because your phone number says Idaho and if there is one person in the world who could plan on being in the lower mainland but end up in Idaho, it is you."

I think I am going to take that as a high compliment, a reflection of my fly-by-the-seat-of-my-pants-wanderlust tendencies which I often think have long faded away. 

Pearls

He had a little turban of gauze wrapped around his shaggy blonde head. Perfect rows of white teeth and blue eyes. I imagined that when Jack Johnson was 4 years old he probably looked like him; brightly colored board shorts, a mini ROXY hoodie, and lime green flip flops.  Despite the bloody gash (thanks to a fall on his grandparents fireplace) he was chatty and informed me he loved visiting Canada because he could play in the snow, his middle name meant "wave" in Hawaiian, and that he'd rather have an apple juice than a spider man sticker thankyouverymuch. 

After I unwound the gauze and inspected his scalp, I had to irrigate the wound with some saline to clean up the bloody tangle of hair before stapling it. He brought his hand up just above his head and hunched his shoulders down while I cleaned it, but didn't cry or pull away.

I was dropping the used bandages and gauze into the bin and untangling the situation when he cocked his head in my direction, studying my face while I scrubbed.

I really like your earrings.

Aw, that is so sweet of you, thank you!

You're welcome.  

Can't think of the last time an adult complimented my jewelery while I was repairing their head wound. Mind you, adults in that situation are usually fallen down drunk and mildly abusive.

I almost feel like most of my patients in the ED have been part of an elaborate ruse to woo me into pediatrics. It's working people, it is working!!

My Face Is My Fortune...

...that's why I'm totally broke!

I had a feisty 8 y.o girl come in tonight. Her long blonde hair was pulled back in a messy pony tail, an oversized black Karate hoodie hung low over her leggings. I saw she had the beginnings of two black eyes, a bit of a swollen nose, and a bump sitting on the bridge. She excitedly told me about how she got accidentally head-butted yesterday in karate just before winning her competition. She then mock-kissed her biceps.


So what brings you in today? Are you worried your nose is broken?

Yeah, we need to check it out....this [said while circling her face with her index finger] is my money maker.

And that was when an 8 y.o girl became my hero. I mean, she had me at the bicep kissing, but that line cinched it.

Paging Doctor Blackbear

So the last week at work involved a couple of milestones. I am so sleep deprived right now that I can only think of one (thanks to two 6am shifts starts, Ryan's recent surprise 40th birthday keg party, and 11h of driving in the last 4 days).

My attending asked me to page the neuro team for one of our patients and I mentally froze. Lowly medical students do not consult with other teams in Ireland. What amount of detail should I go into? How much history do they want? Is it like a geriatric consult where you have to mention how many pets they have and if they can still drive themselves to get groceries? Or is it like a surgical consult where you say there is a fracture, please fix it?

I told the unit clerk my name (Albino) and asked her to page the neuro team for me. 

A few minutes later I was assessing another patient when "Dr. Blackbear please pick up line 70770 for neurology, Doctor Blackbear" came over the PA . At first I was reflexively tuning out the sound of the announcement as it crackled into the room. Then I realized the call was for me! Yes, the title wasn't accurate but I have to admit it briefly made my stomach flutter with excitement. I know it sounds cheesy but I've been ignoring that interruption while in hospital for the last 12 years. It hit me that sooner rather than later I would actually be Doctor Blackbear! It is quite an exciting (and frightening) prospect.

Most days this journey feels so long that I almost forget that at some point the tuition payments end, the paychecks and different responsibilities begin, and new goals appear on the horizon. Hearing my name paged overhead was a jolt of reality: in a year from now I won't be able to ignore those calls and the next chapter will be beginning.

Excited!!!

Success / Fail

Success:

When you correctly diagnose an appendicitis in a child who no one thought had appendicitis.

When you think you heard coarse lung sounds in the right middle lobe and (lo!) the x-ray shows a RML pneumonia.

When you finally get a kid who has clamped his teeth down on your tongue depressor to actually open his mouth wide enough to see tonsils. 

When part of your work day involves witnessing a 4 y.o perform a convincing and prolonged air-drum solo on his dinner tray with 2 brightly colored straws.

When you finally get a sample of liquid gold urine from a child with tummy pain and a fever.

Fail:

When you are taking a history and ask about immunization status and the parent states, "Immunizations are not based on science". 

When you ask a parent to keep their kid from eating any food until their nausea / vomiting / abdominal pain are sorted out and you go back in the room to find the child eating bright blue cotton candy (or is that a success because the child is clearly feeling better?)