Insert Foot

I was in outpatient clinic recently when I called a patient in from the hall. He was awkwardly positioned in a wheelchair, looked to be in about his mid 50's, with thick brown hair neatly combed back, smartly dressed in a tie and sweater. An elderly woman wearing thick support stockings, polyester skirt and heavy woolen shawls pushed the man into my office.

I introduced myself and said hello to the man, then said to the elderly woman, "and you must be his mother?"

Now I can hear you all cringing and possibly yelling, "NOOOOooooooooooo" at the computer screen. Well as Mike Birbiglia would say,

I know....I am in the future too!!!!

See the thing is, I learned long ago never to assign relationship speculations during interactions with patients! In the emergency department I've often been surprised to discover that the young woman wearing the leather dress, knitting beside the stretcher of an elderly man isn't his daughter / girlfriend / caregiver / niece but is in fact his surrogate mother / Wiccan priestess / life coach / financial advisor.

So I don't know what was wrong with me when I said that, but the elderly woman quickly jumped in to correct me with,

I am NOT his mother, I am his WIFE. I know taking care of him has worn me down but COME ON!

Oh dear. So I apologized and attempted to carry on with the consultation. I was actually surprised that I didn't lose my composure completely. Suppose being berated for years as a basketball referee and then a triage nurse has helped me stay calm when the waters of communication get choppy.

But rather than let it go she kept bringing it up.

At one point she asked me about my "American accent" and I said, "Yeah, actually I am Canadian" to which she replied, "I know, I just said that to annoy you considering what you said to me earlier".  I was mortified. It was awful. Lesson, re-learned.

This is what medical school has done to me! All of my healthcare street smarts have been replaced with useless lists of things like the rare causes of secondary hyperparathyroidism! Thankfully I will be back in the real world soon.



 

The Griswolds Meet Pieces of April

Somehow the post I wrote about our family Christmas was lost to the binary blinkings of blogger. This displeases me greatly as of course I am quite sure that it was the most delightful post I've ever written (probably not). So now, in its place I will make a quick summary the first (of two) family Christmas dinners.

It started with (what I refer to as) The Griswolds meet Pieces of April Christmas.

We had a major power outage the night before and day of our planned family Christmas feast. In fact, not just our house, but the entire neighborhood. This resulted in my mother and sister kicking into full food preparation RED ALERT. Driving across town to several surrogate ovens and bringing back cooked dishes wrapped in tea towels and hoisted into coolers. Meanwhile my brother in law bought dozens of electronic tea lights, large candles, and industrial flashlights to illuminate the house. We tried to strategically place the various beams (including one shining directly on the darkened Christmas tree).

"Yes, the tree is...er..lovely!"

Buffet by flashlight.

A romantic family Christmas...?!

Gift opening in the dark.

And then there was light!!!

Regardless of the electricity situation, the food was fabulous thanks to the industrious problem solving skills of my sister and the fact that she has a gas stove (no Christmas feast would be right without steaming sour cherry sauce for the pork and hot gravy for everything else). Despite being in the dark things maintained a degree of normalcy, the adults ate too much and the teenagers texted too much. We drank wine, opened presents, and enjoyed having (almost the entire) family together for the first time in ages. I have to admit, being home for Christmas for the first time in 9 years has made me very excited at the prospect of being back in Canada. As much as I love Ireland and all the adventures I've had, there is something to be said about being home, in the dark, with my crazy family.

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.

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. 

911 Call of the Night

We got the call from the ambulance, just before 2 am informing us that they were bringing in a man who'd called 911 for scabies.

Yes, that was his chief complaint. Which may win the "are you kidding me that you called an ambulance for that?" award.

The two night nurses debated on who would be the one to put the scabies cream on his back. The matter was settled by the ER doc putting a paper clip in one hand and letting the more senior RN choose which hand. She chose poorly.

We all itched and scratched for the rest of the night.

Downside...it cost taxpayers approximately $1000. Upside...the guy had a place to sleep and a change of clothing in the morning.

*Shudder* Image from here.

Why You Don't Want to be an IMG*

Here is a little taste of how you are treated by Canadian universities--below is a timeline of correspondences that started last August when I was offered an elective (by the head of the department) for four weeks this summer. 

Anytime I'd email the hospital staff I'd get prompt, professional replies. When I'd email a question to the university in charge of overseeing this elective every reply started like this (I am the one who put things in bold):

The &*& Visiting Elective Office will not accept any email registrations until after February 1st, 2012 for April 2012 onwards.  I will not be keeping  a copy of this email so please email again on or after Feb 1, 2012 to officially register for this elective. 

(This in reply to a question regarding police record checks--i.e. do I need one from Ireland or from Canada or from both?)

Visiting student applications for the clerkship year April 09, 2012 – February 28, 2013 can only be considered after February 1, 2012. (There are no visiting electives between Feb 27 - April 08, 2012.) Please get in touch with me again at that time and I will provide you with department contact information. Thank you for your understanding.

  

That was a little annoying. But I rolled with it.

When the hospital coordinator emailed my offer and dates to the university a few days before Feb 1st the reply came to me:

 I will not be keeping  a copy of this email so please email again on or after Feb 1, 2012 with the department confirmation (email below from *&* is fine) to officially register for this elective.

So that was a little frustrating. But I just chalked it up to normal university proceedings and waited for the magical day that I could send my offer of elective email....again. 

Feb 1st rolls around. I send in my offer letter. Hear nothing for two days and then get...

Visiting student applications for the clerkship year April 09, 2012 – February 28, 2013 could only be considered after February 1, 2012. Once the mandatory rotation schedules for the next class had been distributed to the departments. As such applications for visiting electives opened Feb 1, 2012.

Thank you for your message requesting elective time at the University of &*&.  Unfortunately, with the increase in the number of our own students we are no longer in a position to accommodate all of the requests we get from visiting students. On Jan 30, 2012 UMEC has just passed a motion that is effective immediately that at the present time we accept applications (medical students) from LCME accredited international medical schools. With the increase in the number of U of &*& and Canadian medical students, it is felt that we can no longer accommodate students other than those from LCME Accredited schools. LCME Accredited schools are only in Canada and the US. Please go to the LCME website for a list of LCME accredited medical schools - http://www.lcme.org/directry.htm

Therefore your elective has been cancelled.  

Repeat.

I would suggest that you try one of the larger medical schools in Eastern Canada to see if they would be able to assist you.

 

I suspect s/he is referring to those Eastern Canadian schools which rejected my applications in the FALL because all the electives were already full there. Thanks, tips, for the help! 

And thanks for the apology for pulling the rug out this late in the game. Oh wait, there was no apology. 

Here are some simple equations for the uninitiated: IMG + electives in Canada = possible shot at Canadian residency

IMG + no Canadian electives = Would You Like Fries With That? + MD + $300 000 Debt. 

It does not make me feel all warm and fuzzy inside when I think about how hard I am trying to get back to a country that doesn't want me. 

Oh, Canada. 


---

*International Medical Graduate

Ding! Ding! Round Two.

Today I bought:

-Toronto Notes, 2011. Yes. All 1400 pages. I think it's officially in the lead as most expensive (135 Euro) and heaviest textbook of my collection. Yet it is light compared to the weight of worry which is post graduate training....dun....dun....dunnnnnn. It is basically the study guide for our Canadian boards, known as the "EE"'s because there are too many letters ahead of that, so even the acronym gets shortened.

I've held off until now because I thought it was a bit much in every sense of the word.  But, I've realised that if I don't get 99% on the EE's I'll either be staying in Ireland to train or working as an RN in Canada, with M.D. after my name. And almost half a mil of debt. Sub-awesome. So the Toronto Notes are now becoming my new BFF.

It's true though. The fourth years in my program have just found out their Canadian interview offers and two (of 13 Canadians applying to get back) didn't even get an interview. Nada. The shopping spree continues...

I also bought the kindle version of First Aid Cases for Step 2. Mostly just as a way to structure some of my studying using cases instead of just reams of multiple choice questions. Which brings me to my next purchase...

Access to the Canadian MCCEE's Question bank for the next 9 months.

And then I accidentally bought USMLE Secrets For Step 1 for my ipad kindle. Yeah. I already have written step one. I meant to buy step 2. [Hits head on self-assembled desk.]

After reading dozens of reviews on step 2 study guides I opted for Step Up to Step 2.  It will also be arriving shortly via the postman.

Then I bought some pens. You know the ones. Because there is a lot of writing looming on the horizon, and that writing is going to be done nicely in blue-black 0.3mm point style, dammit. We have the technology, people.

It's only a short matter of time until I also cave on a USMLE q-bank but I just can't decide on USMLE-World or Kaplan. Kaplan is cheaper (wow, I can't believe I just typed that phrase!) but everyone seems to say U-World is tougher and prepares you better. In the same way getting hit repeatedly with a hammer makes getting hit with a hockey stick almost seem gentle.

I need to give my visa some time to stop shaking before I use it again. It was an expensive day. I am not even allowing myself a mental tally at this stage.

As always, any thoughts, experiences, frustrations, or treasured methods of study for the EE's or step 2 welcome.

And so, round two of studying for a life-and-career-path-altering exam begins!! Ding! Ding!

Another Charming Trend in Medicine

"IMG" means "International Medical Graduate". As in, anyone who studied medicine outside of Canada and wants to do post-graduate studies in Canada.

Did I mention there are 45 Canadians in my medical class alone?

Dare I delve into how many of those 6.5% matched to something other than internal or family medicine?

Hello, Ireland. Need a doctor?

Trisomy X Facepalm

Last week's case was a baby with ambiguous genitalia (not that uncommon, turns out). So last night I was finishing up the homework for today's class and reading about different sex chromosome related syndromes.

I blame it on the jet lag because it wasn't until after I hit the 'search' button that I realized my folly in the google image search for "XXX".

Yeah, lets just say the first 10 billion hits were not trisomy X phenotypes.

Facepalm.

Lost In Irish Translation

The phrase, "to get a ride" in Ireland does not equate to "getting into someone's car and having them drop you off at a specified location", it means something quite different (I will allow you to use your imagination on that one).

Today I was in the hallway at school and one of the profs bumped into me and asked if I'd found and purchased a car yet.

Several of the 1st years began filing out of their clinical skills, walking in between us.

I replied enthusiastically, "Oh yes! And the best thing is now I don't feel like such a teenager having to bum rides all the time!"

She turned her head to one side, squinting out of the eye closest to me.  A few of the students exchanged glances.

Aaaaaaaaaannnnnnnnnndddddddddd.....awkward.

"Er...I mean, ask for lifts all the time!"

When. Will. I. Learn??

Clinical Skills?

Today was a review session for clinical skills, where the lab is full of various plastic body parts for students to practice various invasive procedures on.

I was letting Eileen have a go at cannulating my arm (ha! everyone knows that nurses are the worst patients!!) and couldn't help but observe a couple of students practicing IM injections nearby.

Student A was wearing a thick rubber arm cover, student B* was holding the needle.

Student A: Ok, so draw up your fluids and give it a go.

Student B draws up saline for injection, pinches the rubber arm section, and angles the needle almost parallel to the skin, at about 10 degrees.

Student A: Um, are you sure you are doing that right? You are supposed to do it at an angle.

Student B: Well, not a 90 degree angle.

Student A: Yah, but not like that dude.

Student B: I am pinching the skin, this is how you are supposed to do it. (As he injects 3mls into plastic arm, still with needle at approx 10 degrees from skin surface). Whatever, I don't care, I am sure that is right.

5 months people, 5 months until we hit the wards. Good times. Oh medical students, sometimes the perfect combo of arrogance and inexperience!

---

*Student B is one of the top students in our anatomy class.

Pre Op Checklist

Dear Cowboy Classmate, 

I listened respectfully to you describe all the pharmacokinetics of bisphosphonates, which was super. Can I make a suggestion though for next class? Maybe you can put your arrogant ego aside for one minute and think: hey, my classmate might have some important insights to offer the group too, especially if the topic is...pre-op checklists...since that classmate has probably done a thousand pre-op checklists, on real patients in a real hospital. Maybe you'd listen, because you see, pre-op checklists have to be done right. This isn't some hypothetical situation that will never arise once they unleash you from the PBL room and onto the wards in 6 months.

If it was me, I'd be happy to have a nurse mention that height, weight, and last-meal time are actually crucial pieces of information to gather as well as 'abc's and maybe an echo' . Oh and that forgetting to ascertain said information might result in a pissy post-op encounter with an anesthetist, or surgeon. Just trying to save you from the mistakes I've made, pal.

Go ahead and roll your eyes. Enjoy the new asshole you'll be given come ward-time.

Yours truly,

Someone Who Has Actually Worked in a Hospital

P.S The sooner you make friends with the nurses, the better your life will be.