Introducing...

Dr. Albino Blackbear BSc. N., BM BS (Hons)

It actually happened!

Residency starts...er...in two days! 

I am a terrible blogger. Once the last box is unpacked and internet is hooked up, a proper post will follow. 

Finito Mosquito

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

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

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

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

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

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

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

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

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

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

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

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

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

Phew.

We were set free.

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

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

And then it was over.

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

Worth It

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

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

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

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

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

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

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

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

It makes all of this worth it.

Shifting

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

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

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

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

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

Roll. On. Residency.

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

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

I MATCHED!!!

Into what specialty do you match the girl who loves everything?

RURAL FAMILY MEDICINE!!!

I felt that this post needed to be written today. So despite the fact that I am running on 1.5 hrs of sleep and am still trying to grasp the outcome of yesterday's events, I wanted to update the blogosphere. 

The last few weeks seemed to drag on with painful anticipation. I spent many sleepless nights trying to sort out how to rank, and trying to decide what I truly wanted to be. After I submitted my list to CaRMS I started really doubting my list order. I mean, really started doubting. I had what can only be described as pseudo-panic attacks where I would go around and around in my head all the possible outcomes of the match. What would make me happy now? In 5 years? In 10 years? What was going to be able to give me the life that I wanted outside of work? What could provide me with the chance to write, maybe do some more work for CBC, travel, have flexibility, allow me to keep my athletic pursuits up, and also just enjoy big and small adventures with Duncan (I know, I know...I am introducing this character late in the game but he deserves his own post later). I've been wrestling with my first love (emergency medicine) and my new love (obstetrics) and trying to decide which of the two I wanted to do. Then I would be in clinic and see a few kids and think, "But...peds! I LOVE PEDS TOO!" or I'd meet the most fly 87 y.o lady who'd reinforce my hope for aging awesomely and I would mourn the loss of elderly patients. Also? It turns out I really enjoy continuity of care in my life. It just brings a whole other layer to job satisfaction for me.

I know, could the writing on the wall have been any more obvious?! I love getting off the beaten track, away from throbbing mega-hospitals and being somewhere that I know the radiographer's names as well as the name of the woman who serves the casseroles in the cafeteria. I don't want to live somewhere that people look at your handbag, not your face when they see you in the street. I don't want to take a subway to work or require reservations every time I go out. I am a country girl who loves country medicine. I don't know why it took me so long to come back to that, and accept it! 

So when I saw that I matched in rural family medicine, I thought..."Of course!!!" But I've forgiven myself for not knowing this a long time ago. I allowed myself to contemplate other areas of medical specialization to the furthest degree. When I said that I was going to just experience medical school and see what I liked, without preconceived ideas, I DID that. And this is where I ended up. It feels very full circle-ish to me. Now I get to do everything! Peds, obs, emerg, women's health, sports medicine, chronic disease management, surgical assist, palliative, hospitalist and down home family medicine. 

Some weird and wonderful things that have crossed my mind in the last day. 

I matched in the first program that I interviewed at. I adored the program, the people, the location. But I was guarded and wondered if part of my swoon was attributable to the fact that I was fresh and excited about interviews. I mean, initially I was so delighted with the place that I thought about not going to any other interviews. But then realised that would be a ridiculously bad idea for someone like me (a lowly IMG). I kept going back and comparing each subsequent program with that first one. Wondering.

When I was driving into the town (where I ended up matching) I came to a bridge and had a very strong sense that I would end up crossing this bridge a thousand times. I loved the look of it, I think partly because it reminded me of a bridge near my house where I grew up in Alberta. It was one of the few photos that I took during those two weeks of interviews, but it is my favorite. Looking at it, I can remember exactly that sense of predicted familiarity and how my heart had already started to feel tied to the place. It was strangely powerful and most unexpected.

Then last week, I had a dream that I matched to my program. In my dream I was shrieking and celebrating and telling myself that this was the perfect thing, and that I was so happy with the way things worked out. Of course when I woke up I felt the stress and worry creep back in as consciousness returned. The dream had been so vivid. That was where I wanted to go. What if I matched somewhere else?

I recently started on a new rotation with a congenial, fiercely intelligent, slightly quirky, banjo-playing dermatologist. When we met he asked what specialties I had interviewed for while I was in Canada. I told him, but I didn't say where in Canada any of these programs were. I told him about my previous life as a nurse in Nunavut and the NWT. A little while later he was introducing me to a patient and said, "This is ABB, she is going to be a family doctor in northern Saskatchewan". Now, again I will say that I hadn't told him where I was interviewing, and I have yet to find many Irish people who can even pronounce "Saskatchewan" let alone use it in a sentence. I mean, most Irish people know Ontario because their cousins always live in Toronto, and they've all been to Niagara Falls. Funny because it is true. So the comment from Dr. R threw me a little, but I didn't say anything to him about it, I just made a mental note. Innnterrrrresting. 

And now I am here. A little like a dog spinning around before he lies down. I still haven't fully grasped that the uncertainty, that has been hanging over me since I started on this journey over 5 years ago, has lifted.

I have a job as a doctor in Canada.

Let me just say that again on the off-chance that it sinks in.

I have a job as a doctor in Canada.

And it is a bloody good thing (as I am ~$250 000 in debt!) And an exciting thing. I am beyond grateful and excited to start on July 1st. I feel like I've been in the starting blocks for years. As a nurse I hoped some day I would become a doctor, and then as a medical student I had to deal with being slightly taken away from direct patient care. Mostly watching others do the nursing and doctoring. I've been striving, waiting, chomping at the bit for this responsibility.

This past week especially I've had a most distractible mind. My normal regime of night-before ironed work clothes, packed lunches and leisurely breakfasts has disintegrated to eating dry cereal and turning my underwear inside out instead of finding time for laundry...

But tonight I eased myself back into life. I cooked a delicious pot of veggie chilli, did loads of laundry, and sat down to write this post. The lack of sleep last night is catching up with me but I am happy.

It seems I've gradually started living my way into the answers. I cannot believe that I can actually say,

"I am going to be a rural GP!"

At the risk of extending this stream-of-ramblingness any more I just want to also say that over the years this blog has given me a great outlet and a wonderful connection to people all over the world. Even when I've felt like a tiny medical student, hidden away in a dark study room for weeks at a time, I felt connected to the people that read and commented, or took the time to write. I have made great friends and kept in touch with old ones through Asystole and I feel like it has given me many gifts on this wild ride.

And so writing this post for those of you that have been following along, gives me so much pleasure! Thank you all for the words of encouragement, advice, offer of cars, couches, lifts from the airport...for mailing forgotten bathing suits, buying me giant soup pots, sending mugs, meeting me at airports, buying me lunch and even the odd train ticket.

Expect the unexpected. Or maybe what was right in front of you the whole time.

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. 

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. 

My Recent Mid-Term Evaluation

Above is photographic evidence of why Dr. Joe is one of my favorite people on the planet. Yesterday we went through my mid-term evaluation. On the back of the score sheet they are invited to make comments on specific strengths and weaknesses (theoretically so we can improve by the final eval).

I pretty much spent the rest of the day chuckling when he handed it over to me to submit to the school.

Life One Liner

(I know this is supposed to be a medically related blog but lately it is more like a this is what I am eating and doing in my free time blog. Apologies. The heart-wrenching and hilarious moments of my emergency nursing days are long gone and I am starting to feel like a broken record of worn-out anecdotes. Also, I'm working like a fiend to finish up my research project and special study module as I hope to do an elective in March. I want to be able to leave the country knowing all my little scholastic ducks are in a row and life is organized. A very non-ABB behavior pattern. Usually when I leave the country there is a dizzying storm of clothes, textbooks, toothbrushes, running shoes, papers, granola bars, open luggage, garbage bags, and USB cables around me for 2-3 days...and then *POOF* I disappear. I swear this time, that shall not be. As a result I fear Asystole is not getting the attention it deserves. Hence, blogger guilt. It's like mommy guilt without the cereal in the hair and spit-up on the shoulder.)

Dr. Joe is on annual leave this week so I sat in with one of the other GP's in the practice, I thought I should branch out in his absence. Everyone here is lovely, though I must admit that I miss Dr. Joe's Prairie Home Companion version of social histories. During one of the consults the patient was talking about the age ranges of her four children, aged 6 - 13.  I thought she summarized things so brilliantly, "Ah sure, in my house there is everything from Santa Claus to maxi-pads". What a perfect slice of life. That is one of the things I miss about bedside nursing, the little glimpses into people's lives, scenes I could collect in a shift.

It got me thinking, what would my one-liner of life be right now?

It's all...tupperware and textbooks?

...Band-aids and backpacks?


...practice tests and data tables?


...scones and stethoscopes?


...residency worries and vitamin D supplements?


...bad skype connections and emotional eating? 


Dunno. All of the above I suppose. What is your one-liner these days?

When Alcohol Should Be Taken Before Exercise: a.k.a Zumba

I was lured into my first zumba class by my eternally optimistic and anti-weightlifting roommate last week. I used to snobbily chortle at the aerobics classes last year in the University gym and vowed never to attend such a fitness monstrosity. I figured zumba must be something completely different...

For those of you who haven't attended a class yet, I'll ruin the surprise: zumba is nothing more than an aerobics class to Latin dance music.

And it doesn't look anything like this:

No, it is more like this:

Which is awesome, actually, because I'd be way too scared an un-glam enough to go to the top class anyway. But the whole experience has been a bit of a disappointment, in myself. I like to think I have rhythm and maybe even some sweet dance moves. Turns out, I have neither. I took highland dancing as a kid which is a very regimented, precise type of choreography. Zumba requires hip gyrating, booty shaking, arm twirling, and general freedom of movement. Possibly some sexiness as well. I am incapable of shaking my money maker with abandon, especially when that money maker is in lycra and not in the gin and tonics. 

Dear Margaret (roommie) and I agreed that we'd probably crush the dance floor if only we arrived a litte tipsy one day. Then we felt like that agreement made us sound like alcoholics. Then we questioned if drink only made us think we were good dancers or if it truly loosened us up enough to display our Jennifer Grey type skills. Either way I think my Irish heritage shows itself well amongst my fellow wooden, self conscious, antitheses of sexy, arhythmic, fair sisters. 

The bottom line, however, is I am sweating and laughing at the end. And possibly expanding my (already killer, right?) repertoire for my next big night out. Which is more than I can say my nemesis The Treadmill can offer!

Zumba, I misjudged you and your aerobic-class self.

An Unexpected Test--Part II

I'd get to the girl, first I wanted to make sure Maggie was stable.

Maggie was well bundled up which made a quick primary survey almost impossible. I put my hands under her jacket and tried to feel along the bony aspect of the back of her neck. I pressed down on each vertebrae while asking if she was having any pain, numbness, or tingling. She said no.

I tried to move my fingers systematically around her skull feeling for any ridges, deformities, warm tangles of blood, boggy swelling. Nothing.

I quickly checked the pulse in her wrist—strong. That was a good sign, she had a decent blood pressure and wasn’t tachycardic, which meant she wasn’t going into shock (yet) from some hidden injury that was causing blood loss.

Maggie was alert and talking to me the whole time, she said one of the girls on the hike had lost control coming down too fast from the top. Maggie lunged after her, also losing her footing and going head first down the steep and rocky terrain. Now I was getting worried about this unknown girl and felt fairly certain that Maggie had no immediate threats to life or limb (despite my woefully brief and incomplete initial survey).  I asked the 3 young girls with her to try their best to keep each other warm, to continue talking to Maggie. I asked them to send someone over to me if she suddenly became confused, nauseated, or started complaining of numbness or tingling. 

I scurried over the slippery rocks to the second cluster of people, perched on the lateral aspect of the slope. A young girl was buried under a similar assortment of raingear and jackets, crying out in pain. Two of her teenaged friends were huddled against her, shivering in their thin hoodies and track pants. Her legs were splayed awkwardly but with no visible deformity, blood spattered the rocks near her feet. Under the hood of a green raincoat I could see that her hair was thickly matted to one side of her face with blood that appeared to have come from her scalp. Her cheek was also cut, just under the eye. She opened her eyes when I asked her to and told me she’d started coming down the mountain and couldn’t slow down, she didn’t know how she’d fallen or if she’d been knocked out.  Her pupils were of equal size, they constricted when she focused on my face, she knew where she was, and who she was there with.

Again I wrestled with the tangle of clothing trying to feel her neck and scalp. She said she had no neck pain but yelped whenever I touched her head, especially near her forehead. It seemed impossible to locate the cut as all the blood had dried in the lumpy nest of hair.  I looked in her ears and under her nose for blood or clear fluid that might indicate she had fractured her skull. Dry. She didn’t have the characteristic pattern of bruising associated with basal skull fractures, the bluish tinge behind the ear or black circles referred to as ‘raccoon eyes’.

I felt her wrist, trying to locate her pulse. As I measured her heart rate, which was fast but not worrisome, she complained of pain. I was reassured though, by the lack of a sickening crunch or odd angle to the joint, something I’d come across many times in the Whistler emergency department. I put my hands under her jacket, asking her to take deep breaths while I felt her chest rise and fall. Her rib cage felt stable and she said she had no troubles breathing. Good. She had a blood pressure and no breathing issues.  I felt her belly, tested the bones of her pelvis for pain or instability. She cried out in pain when I brought my hands down her left thigh and leg. I couldn’t feel any swelling or grinding under my pressure, the leg didn’t seem shortened but it was hard to tell and I didn’t want to move her limbs unnecessarily.

Somewhere in all of this I found out that the man with them was Father Henry, the priest who had been escorting a church group up the mountain, which is a famous pilgrimage for Catholics.  Maggie was the other leader of the group, which left him running back and forth between the two huddles, with one cell phone (and sometimes two) pressed to his face. 

It was during my assessment of Tina that I too started to shiver. Suddenly the combination of wind, fog, sweaty T-shirt, and stillness left me very cold and wishing I’d brought more clothes. I pulled on my damp wool shirt and windbreaker. Once I was crouched behind Tina with my hands along side her jaw and neck to stabilize her cervical spine, I realised that if I was that cold, the girls lying on the ground were in even bigger trouble.

At this point an athletic Swiss couple, each dressed in layers of hi-tech looking gear, arrived and offered extra coats to pile on the injured hikers. The woman pressed up against Tina’s legs, the man against her right side. Tina’s two friends took up positions on the left. A tall middle aged Scotsman came up and suggested we use his large backpack as something to put underneath Tina. 

I cringed with the realization that I should have thought of that ages ago.

CAcBCDE. Catastrophic bleed. Airway/c-spine. Breathing. Circulation. Disability. Environment. 

All of this had been drilled into me again only weeks ago at the Advanced Trauma in Community course I’d taken. Environment. As in, assess complications due to environment such as cold temperatures and adjust to protect against these dangers. 

And so there we were.  All of us freezing, worried, and wondering how long it would take for the mountain rescue crews to arrive, if they were sending a helicopter, and if the helicopter would even be able to land amidst the fog and wind.  I asked one of the girls to take over c-spine for me as I went back to check on Maggie. She was well bundled up and had a similar gathering surrounding her. The tall and quick thinking Scotsman and his wife were monitoring her. This gave me peace of mind over the nagging thought that I was ignoring one of the casualties. Maggie was still alert and oriented, nothing had changed since I had first assessed her. She said she was more worried about Tina than anything else. I tried to reassure her before running back to my post: holding on to Tina’s neck.

We heard ambulance sirens in the distance which gave us hope that help was soon to arrive, hopefully with blankets at least and and possibly stretchers.

“Wait!!!” I asked Matt, the teen to my left, to grab my nearby camelback.

“I had an emergency blanket in there this morning…did I leave it in or put it in my other pack?? Ohhh…” 

And then I remembered the brief conversation I had had with myself before heading off this morning. “I am only going on a road ride and a run, I am definitely not going to need my emergency blanket or my headlamp.”

Of course.  Dammit! We really could have used that emergency blanket now.  Tina was shivering uncontrollably to the point where her teeth chattered causing her to cry in frustration, “Get me OFF this mountain!!!! Where are they??”

We tried to calm her by talking about Justin Bieber, the hot blankets that awaited her, the exciting helicopter ride she was going to have…it distracted her for short periods of time. Father Henry would threaten to start singing if Tina went quiet for too long. This proved to be an effective technique for getting her to start talking again.

By now, over an hour had gone by since I arrived on the scene.  I thought about sending the teens down with one of the hikers who was offering to help. Were they going to get hypothermia while trying to keep their friend warm? Were we only creating more casualties by keeping them with us? What was the legality of sending minors down the mountain with strangers? What if we were up here until the middle of the night? I remembered only a couple of months ago a woman being stuck on Carrantuohill until 4am waiting to be stretchered off the mountain with a broken ankle.  At least now they could get down safely in the daylight. For the time being we decided to keep them with us. 

Surely mountain rescue was going to arrive any minute.

 

Clinical Exam Follies and Triumphs

This week I had the opportunity to invigilate a licensing exam for doctors here in Ireland. Though no one actually said anything to us about confidentiality I am very certain that I am not able to blab about any sort of details. However, I will say that it was a fantastic learning experience to see how different people perform under pressure, how examiners basically set out to shred you to pieces, and how little things can really affect one's rapport with the examiners.

One thing I will take with me for when it come to be my turn on the sharp end of the short-case examination:  if you are told "examine body part [x]" then EXAMINE BODY PART X!!!!!

I was stunned to see people being told specifically to examine one organ or anatomical location to find them faffing around with other systems, only to the irritation of the examiners. The examiners would sometimes have to repeat themselves several times, "stop, examine x!"

There was one candidate who was my hero. She (somehow) remained calm, did very methodical and well organized physical exams, could rattle off differential diagnosis like a champ, answered all the examiners questions clearly and precisely, and was really personable to the patients. I was mentally cheering her on the whole time and wishing I was her. I also felt devastated for the people who started floundering, crashing and burning, knowing all too well the negative spiral of

stressed

mind blank

higher stress

flustered

adrenaline injection

mind completely barren of thought

fear of failure

despair

quavering voice

certainty of failure 

despair

despair

despair.

It was somewhat reassuring (or depressing, not actually sure which) to see that even people who have been doctors for years still get stressed and fumble during clinical exams, it is not just we doclings. 

Jaws of Life Teaser Photo

I am writing a post about the brilliant trauma course...but in the meantime...allow me to present ABB wielding an actual jaws of life. This photo taken shorty after I cut a car door off (hence my demented appearance).

Does this jaws of life make my thighs look big??

The really hilarious part was that the firefighter handed it to me, showed me where the 'on' button was and then told me to 'work away'. 

Yeah, in Canada I would have had to take a 2 day safety course, sign release forms in triplicate, show proof of tetanus immunization, and demonstrate to a workplace hazard team my ability to handle the machine before being allowed to turn it on.

What could possibly be more enjoyable than handling a machine that crushes metal at 600lbs per square inch???

Oh 'twas a good day, so it was.

Sunday Riders

So today Pádraig (the surgical SHO) and I decided to do a reckie of the road biking portion of a race he's competing in next week. We started at the Gap of Dunloe (a.k.a Kate Kearney's Cottage) and ended at the Torc Mountain waterfalls. A fabulous ride in part due to the spectacular scenery the entire way, and a delicious visit to my favorite purveyor of fine Irish food: The Avoca Café.

I also learned a couple of things today. For instance, my tiny little sewing-machine of a car can fit two road bikes in the back and two people who love blood and guts in the front. GO TOYOTA YARIS!

Another lesson learned was that not only are directions from Irish people usually nonsensical and obscure, the road signs are equally unhelpful. Unless, of course, you are looking specifically for tea and scones or a farmhouse with ensuites. Have you reached a fork in the road on random back country lane? Are you searching for a particular town or road number? Sorry. Can't help you there. Tea and scones? Take a left.

I've been to the Moll's Gap Avoca a couple of times but have always approached it from a different direction. So after a particularly sustained uphill we decided to pull off and have snacks, figuring the Avoca was at least another 20kms or so away. After some Clif bars and trail mix we started up again on the bikes, only to come across the "AVOCA, 500 METERS" sign within about 3 mins of departing.

I did hear Pádraig scream "NOOOOooooooooooooo!" through the fog.

I think he made up for the disappointment in having already eaten lunch by putting himself into a pre-diabetic-coma with the most delicious banoffee dessert evah.

And it was all downhill from there, friends. An outstanding day, topped by my new routine of sauna / ice-cold shower / sauna / ice-cold shower at the gym.

Ain't life grand?

New purple Icebreaker, for the win.

Fin

Well my first official hospital rotation has come to a close.

Today was my last day on the surgical team and I found myself staring off into space more than once, feeling genuinely sad. It seems like the last 9 weeks screamed by at break-neck-running-behind-my-consultant-speed. The thought of starting on a new team is a little daunting. I feel as though I just figured out my true place with this team, and that I was starting to habituate to their rhythm.

The apple crumble made big waves, the pan licked clean before the end of 1st tea break. The nurses and porters seemed genuinely shocked that I baked for them and many approached me to say thanks, or "fair play to you" which is the Irish equivalent to something like, "well done" . The porters also pretended to have food poisoning all afternoon (yes, pretended) and one proposed marriage.

When the last stitch was thrown in the belly I didn't know if I should shake M.C's hand in a formal manner, or make some cheeky comment (more my style)...so I just had my chlorhexidine shower (as per MRSA case protocol) and went to the gym.

I was happy to hear nothing but silence when I arrived home. The alarm people had to come and tear everything apart because the thing was completely haywire. I think I am going to start calling the alarm system, Hal, from now on. I was able to un-tape my memory foam pillow and yoga blanket from the wall (dampers) and make dinner without earplugs in, which was a pleasure.

Tomorrow I am going to attempt to review some medicine-y things. Like the heart. And probably the lungs. Look up Na+ levels and try to remember what exactly this condition known as diabetes is, which has come to mean only really really bad leg ulcers in my mind.

And so, I begrudgingly shelved my Surgery at a Glance, Surgical Recall, and my Physical Signs for Clinical Surgery and ordered The Oxford Handbook of Clinical Medicine.

Speaking of clinical surgery...if you haven't watched this TEDtalk by Abraham Verghese, please go make yourself a cup of tea and spend the next 18 minutes watching an extraordinary author and surgeon discuss the lost art of physical assessment. It is another typically awe-inspiring TEDtalk.

It is late so I'll close with a quote by Yeats, cited in Verghese's book, Cutting for Stone, 

The intellect of man is forced to choose

perfection of the life, or of the work, 

And if it take the second must refuse

A heavenly mansion, raging in the dark. 

Adventure Racing

Today I registered for my first adventure race--and I am ridiculously excited (and scared!)

I am not exactly sure what I am getting into but it combines three sports that I am moderately un-terrible at (cycling, running, and hiking) set in an area of Ireland that I've always wanted to explore.

It is the Sea 2 Summit race in Westport, with part of the track going up Croagh Patrick (the Magic Mountain--apparently you can lessen your purgatory sentence if summit it barefoot). I suppose my main reason for possibly biting off more than I can chew is that my days are wonderfully full at the hospital but my evenings and weekends sometimes feel a little...well...empty.

Don't get me wrong, I've been enjoying hikes out and some of the new people I've met, but I find that these days, the only time I feel really good is when my heart is pounding and I'm trying to ignore the singing of my muscles. I thought it'd be ideal to have something to train for. The added bonus being that there is no water sport involved which means no one has to see me thrashing about in a bathing suit like a wounded walrus. WIN!

Did I mention I am scared?!

Trains

My sister informed me in a huffy way that it had been too many days since my last blog post. So, hello again, blog world, and hiya Dust!

The days just seem to be so long and groundhog-esque I start a post and think, "I am boring myself" and I close it. I've been doing that lately with emails as well, I'll spend half an hour writing someone an email and then I just delete it. It's mostly that I feel as though life has become quite one dimensional, it is a good dimension, don't get me wrong. I just fell uncomfortable rambling on to others about it.

It is also the pace of life these days unsettles me, like when you're on a train and think you're not really going that fast until another train passes going in the other direction. Suddenly the force, speed, and momentum is clear and almost frightening.

There have been a few trains going in the opposite direction lately.

I spent a good part of my morning with one of our palliative patients. She is a lovely woman and as she spoke about the impact of her recent diagnosis I made no attempt to hide the tears in my eyes. I used to be quite good at remaining buttoned-down with my reactions to patient's emotions (working in the emergency department gave me a lot of practice). She was just so open and honest with me, held my gaze, and for most of the interview gave me unflinching details of her ordeal. So when she cried, I did too. And I think it was appropriate. I have no idea though.

I also assisted with a below the knee amputation. That was my first limb amputation, having seen a great toe removed before. My normally jovial consultant (M.C) was thin lipped and quiet for most of the lengthy surgery. At one point he simply said, "God I hate doing these procedures." I suppose a surgeon simply cannot get the same satisfaction from amputating a limb, compared to cutting a cancer out, or removing a troublesome gallbladder.

But it wasn't the bone sawing or muscle slicing that I found unnerving. It was how quickly the patient reached for my hand and how tightly he gripped it before the anesthetic whisked him off to sleep. A couple of weeks ago I had met him, a broad burly man, who was gruff and a little abrasive. He wanted the procedure because it was going to improve his quality of life but I felt his reservations as soon as his giant hand engulfed mine.

So today, in an effort to slow things down a little I ventured out to the mountains and hiked in an area known as the Eastern Reeks. The ground involves a lot of bog walking and slippery rock negotiating. The forced concentration and good conversation gave me a much needed break from thoughts about the hospital and school.

An Irish Inukshuk?

I am definitely going to make an effort to get out at least once a week. Especially once my foot is completely healed. Yeah. It is possible that a 6h hike today may not have been what my ankle needed.

A long day outside was definitely what my head needed though. Also, the unwinding pace in a cottage with beer, a fireplace, and hot soup, was perfect.

A Perfect Day

The orthopod I shadowed last summer used to bellow quite frequently, "A day without blood is a day without happiness". He loved his job and approached each of his cases with the excitement and wonder of a 7 year old boy who has just received a new Lego set. I used to think the saying was funny, if not a little crass. But I have to admit, I am starting to get it.

The days that I get to scrub-in for procedures always seem a little surreal and sparkly. It's odd maybe, but I love the ritual of scrubbing, gowning and gloving. I like staring at the angular instruments all laid out in precise order, the hum of the anesthetists buzzing around the patient at the beginning of the ritual, the bleeps from the cardiac monitor. I like having only my eyes, voice, and hands free to convey a message...the rest of my body covered up by various layers of protection. It's strange that I enjoy this controlled, anal-retentive world, because I also love being swept up in the unpredictable and ever-changing currents of the emergency department. Maybe I need to accept the fact that I will forever be a woman who likes extremes in medicine.

So yesterday I had the chance to spend the morning in theater, being a 1st assist on several circumcisions. It probably sounds banal to most people but at this stage it is all a new, fun, and nearly vertical learning curve.

In the afternoon I did histories and physical exams on some of our patients, and then went to the A & E to see a surgical consult who was a query appendicitis. I am always amused by the similarities between emergency departments in completely different countries. The controlled chaos, harried staff, complaining waiting room patients, limited stretcher space, tiny nursing stations, paramedics waiting to unload newcomers...it feels like home, even on the other side of the Atlantic.

It felt like a good day. I had no idea how good it was going to get!

There is a rather large Rose of Tralee festival (in Tralee, obviously) every year. It is sort of like a beauty pageant without the really dumb contestants and bikini portion of the show. Anyway, one of our classmates has a friend who is visiting for a few days from Canadia so we decided to do the touristy thing and check the scene out.

And what a scene it was.

We ended up in this old pub called Sean Og's (or something similar) with a large table right near the front. The place was bursting at the seams, mostly filled with 50-70 year old Irishmen. A few of us youngsters (heh) were enjoying the scene as well. Shortly after we arrived, a middle aged man with gelled hair and velcro shoes walked in, plugged his guitar into a sound system on the tiny stage (which also sat a large table of retired Irish tourists from Dublin) and proceeded to rock the joint for the next 4 hours.

There were several times throughout the night when all I could do was stare in wonder around the pub, full of people with glasses raised, singing in unison to everything from party songs like Galway Girl and Whiskey in the Jar, to traditional folk numbers such as The Fields of Athenry, peppy tunes like Las Vegas (The Hills of Donegal) and classic sing-a-longs like The Gambler and The Boxer. It was gritty Guinness-swilling-liberation song-singing at its finest. The one man band was killer, barely pausing at all between songs. At one point I was pulled up on stage by a geriatric Irishman to jive. Hands-down one of the best pub nights I've had in Ireland. My facial muscles actually started getting sore by the end of the night from smiling and laughing so much.

Oh Ireland. Sometimes I really do love you.

Scenes from an Irish Surgical Ward

I went upstairs today to see if I could find my intern, Simon. There he was, filling out yet another cardex of medication orders. The poor guy does such a ridiculous amount of scut it boggles the mind, yet he always has a smile on his broad Burmese face. I am so happy that he's on my team.

We were discussing Mr. Smith's night time sedation as as his current meds aren't doing the trick. The Ward Sister warned that the night nurse would have a fit if he didn't settle again tonight. So as we hammered out some different strategies I leaned back from the nurses station to have a peak in Mr. Smith's room.

And there he is, sitting upright in a big blue padded chair, his tray table in front of him. An open bottle of Guinness is on the table and he's grasping a plastic cup almost empty of it's brown fizzy contents. He gives me a giant dentured grin and I remember how he looked last week, flat out in bed and sucking hard on the 10L non-rebreather mask. I thought he wasn't going to survive the weekend.

"Er.....is he getting...Guinness??"

"Yes, I think they prescribed it for him yesterday." 

So I'd heard that it used to be common practice to prescribe the stout because it was so high in iron and vitamins, but part of me just dismissed that along with so many other back in the olden days stories. Like how my cardiologist grandfather used to round on his patients with a cigarette in hand and the nurses used to smoke at the desk.

But I saw it with my own eyes, today, and hell if Mr. Smith didn't look a lot perkier.

Then while I was taking bloods from another patient a cell phone went off and the ring tone was an Irish jig being played on a fiddle. At that point I wouldn't have been surprised to pull down the bed sheet to see the patient wearing wellingtons and a tweet jacket. Seriously.

I hope when I am practicing in Canada that one day I'll see a patient pouring maple syrup over poutine while a Celine Dion ring tone goes off. Wait, scratch that...a Neil Young ring tone. Otherwise I'll have to give more points to the Irish for being so...(quaintly)...Irish.