Testes...testes...123.

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

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

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

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

TUBERCLE. Tubercle. Tubercle. Tubercle. Dammit. 

 Check.

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

Silence.

Maybe he hadn't heard me.

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

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

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

OH FUCK! 

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

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

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

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

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

Finito Mosquito

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

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

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

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

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

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

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

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

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

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

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

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

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

Phew.

We were set free.

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

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

And then it was over.

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

Oh Our Lives

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

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

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

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

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

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

Hmmm. Yeah. No.

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

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

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

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

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

**Cue peals of laughter**

[You had to be there.]

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

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

**Cue peals of laughter**

[You also had to be there].

Oh. 

Our. 

Lives. 

 

Where are the balloons?!

Yesterday was the last day of my surgery rotation, which also happened to be the last day I had to show up to the hospital as a lowly medical student. Of course it ended with me racing in for a 0730h ward round which didn't happen, giving me time to kill before surgical Grand Rounds. Afterwards our professor of surgery gave us a little pre-finals pep talk which included the well worn phrases:

-don't worry, these are the easiest exams you write in medical school
-know the basics
-you'll be fine
-try not to get too stressed
-know all the medical emergencies
-soon it will be over and you'll wonder what all the fuss was about

It was an uncharacteristically nice and reassuring discussion with him, though it did nothing for my chronic teeth grinding and constant gut-ache. After a few questions about exam specifics from the others I asked him if he was going to miss us. He said (sarcastically) yes, and I will especially miss your esoteric and obscure contributions to tutorial from the corner of the room.

WIN!

(If I leave a legacy of esoteric obscurity behind then I feel I have succeeded as a student in surgery. In much the same way I felt I succeeded in internal medicine when I received an email from one of consultants telling me about a banjo competition this week. Reassuring to know that my true personality somehow shone through my crusted, exhausted exterior.)

We were dismissed after that and a cluster of us emerged into the morning sunlight, blinking and saying goodbyes and good-luck to one another. It was surreal. I was FINISHED my medical school rotations! Where was the fanfare? Where was the receiving line of dancing nurses and interns patting me on the back, handing me pizza, and popping Champagne corks?

I remembered a conversation I had this summer while I was on my pediatric emergency elective. One of the docs was telling me about his last night as a resident, at the end of his 5 year program. He was walking down the dim corridors, leaving after a night shift, "This was MY hospital, I kept these wards humming through the night for five years. I spent my LIFE in these halls...and when I walked through the automatic doors at the end of that shift I didn't get a handshake or a thank you or a good luck. It was just over and I was standing in the parking lot, in the rain, and it wasn't MY hospital anymore". 

I got it when he told me this story but hadn't thought about it until I left the hospital yesterday. I had a very similar feeling as I drove out of the unbelievable chaos pit they call a parking lot. I cranked up the Mumford and Sons with a fitting song, and left a little mental trail of confetti, streamers, and balloons behind me...

Worth It

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

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

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

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

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

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

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

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

It makes all of this worth it.

Shifting

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

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

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

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

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

Roll. On. Residency.

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

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

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

It's 1723h and I am Still in My Pajamas

The main thing I am currently trying to do is decide if I should or should not have a hot chocolate right now. I am still in my pajamas, and unshowered. All I've done today is clear the dining room table of stacked medical books. And I've eaten some snacks. And stared at the wall, in the typical now what? post-exam flat lined brain.

The exam was, a marathon of concentration but not too bad (except that I accidentally brought a mint chocolate flavored nakd bar with me as a snack---ahh I HATE MINT CHOCOLATE!) I am sure the prometric center lady thought I was a loon when she saw me pulling out the reams of food I had to declare prior to the exam. I just never know what I am going to crave or need to eat during times of extreme panic/stress but what I do know is that if I get hangry then I might throw the computer through the window. Yogurt, coconut water, almonds, apples, nakd bars, granola bars, water, more yogurt...I had a little tower of food placed atop the filing cabinet. I ended up chucking the bar in the bin after one bite, drinking a yogurt at race pace, and slamming the coconut water. I used almost all my time, just finishing the last few questions at the 3h 54 minute mark. I blame this on being ridiculously fastidious for the first 80 questions and then realizing I had 100 questions left and just over 100 mins left. It's been a while since I ran an exam marathon, cut me some slack.

After finishing I sped back to the hotel to shower, and check out. Then I zoomed over to the Operation Smile Dublin office to meet some of the staff involved in organizing my upcoming mission. While sitting in my car outside of the office, about 1hr after leaving the exam, I felt my pulse and noted that it was still >100 bpm. I tried to tell my adrenals to cool it. The saber toothed tiger was gone, I no longer needed 180 degree vision. I probably looked like a feral insurance saleswoman when I clunked in, suddenly very hungry and slightly wild eyed with a twitch to the right side of my mouth.

It was a very relaxed meeting and after chatting for a while the two of them stated that due to my arctic experience they should send me on one of their "really remote missions". Yes!! Well maybe they also were thinking that based on how I presented myself to them: better to tuck me far far away from any promotional material photo opportunities.

After that I was able to kick off my heels and head for the hills. (Well, shortly after a trip to my favorite deli in Dublin to stock up on essentials like Chile Hot Chocolate, truffle oil, and nice cheeses!) Drove out to the wild west coast and spent the weekend by the sea eating fantastic food, drinking Champagne, climbing up mountains, sleeping in, strolling around manicured gardens, sipping coffee, and just generally remembering how it felt to be human.

So thanks a million for all the lovely comments and emails of encouragement. It really means a lot coming up to an event like that.

Of course there are things already tugging at my sleeve to get started, like CaRMS, writing up my Grand Rounds presentation, school work...but not today. Or at least, not until after that hot chocolate.

Study Daze

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

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

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

Gen: How about hypokalemic metabolic alkalosis?

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

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

Perfect. 

The Burden of Work

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

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

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

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

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

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

Heaven and Hell

Survived third year!! A brief montage and summary of the past week. 

Monday was the long answer written exam (3h, 10 questions) and the extended matching exam (150 questions). I know some people run marathons without food, and most people write exams without food. I could not imagine either. When my blood sugar gets low (i.e. below 6) I get hangry and my brain function ceases. I was certainly not taking chances with finals. Photo below was taken with my sweaty pre-exam hands before we were strip searched for electronics.

 

After the incredulous feelings of did they really have an immunization schedule long answer question? along with seriously? gynecology emergencies? dissipated, Margaret and I noted that the sun was shining outside and we had two days of studying still ahead of us. 

So we took something beautiful (her parent's backyard)...and made it ugly.

 

We spent Tuesday and Thursday hammering for the clinical exams. 

 It has been so long since I've had to use sunscreen I thought I ought to take a photo. 

One of the really stressful things about the clinical exams is that they were a different format than the previous 2 years, where we had OSCE's. This year our long case was a patient with real pathology who we had 30 mins to examine and take a history from (the cases ranged from things like a post-op orthopedics case to diabetes). Then the examiners questioned us for 20 mins. 

My patient was a good historian and had a very straightforward presentation which I had prepared well for. I am usually rubbish at presenting (you have to be detail oriented and well-organized) but somehow the planets aligned and I actually did my best case presentation ever! What are the odds? 

There were no questions that stumped me and the absolute best part was after the examiners walked out I turned to the patient and she said to me I hope I am never in the hospital again, but if I am I really hope you are my doctor! I was completely bowled over and honored. 

The short cases went quite well too. They were all very barn-door spot diagnoses and exams. Though I did manage to stutter out some random statements and completely forget basic things (which I would never forget in an actual hospital, i.e taking a blood pressure from a patient in atrial fibrillation). Yeesh. The highlight was one of my surgical case patients yelling to the examiners as they left the room GIVE HER AN A.  

Awesome and awkward. 

So there you have it. Third year, done and dusted. I also just received some rather big news. But that deserves its own post. Heh. A little suspense to keep all of you coming back. In the meantime, it is sleep time. Sweet, sweet sleep.

One...Week...Left...ughhhhh

Cottage Love

I have been commanded by my friend Ryan to update the blog (so he can get Guns and Roses out of his head). I figure I need to make the few people that still check in on me happy, so here's a quick post!

I am in the final stretch of 3rd year. I spent the last 4 days holed up in a classmate's cottage, attempting to cut myself off from the world and bury myself in the books. Amazing how much more productive I am when the only internet I have access to is an intermittent flickering of 3G on my burner when the planets align.

I had planned to go just for the night but the fireplace and views were too lovely to tear myself away from. So I burned home, picked up the rest of my books (oh, Toronto Notes, you monkey on my back...you) some tinned mackerel, instant coffee, and returned.

A week from today final exams will all be behind me. And two weeks from today I'll be on a plane back to Canada. I am mentally composing my ode to the Irish countryside already. Some questions that will remain...Year three, where did you go?? Did I squeeze every last drop out of my year on the wild west coast?

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!

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. 

Breathing to the Bases Again

For those of you just tuning in, on Monday I wrote the USMLE Step 1 exam.

The USMLE is an 8h mental marathon, designed to ruin free-time around the world and deprive second year medical students of sleep and robust immune systems.

My Summer 'Break' 2011

I will attempt to give an account of test day, though at this point most of it is just a collection of scenes which my stressed-to-the-max brain compiled.

I had my alarm set for 0600h as the testing centre was an hour away from my mothers place but I awoke at 0540h to a newsworthy thunder storm. Peering up from my basement-bedroom vantage point all I could see was a magenta sky--really, it was magenta and I figured either Armageddon or the Rapture had arrived. The thunder and lightening were happening at the exact same time, no pauses between each, just continuous crashes and flashes. I envisioned a darkened testing center, no power, or a flood of water rushing through the place. Didn't happen.

A bald-headed Buddhist Nun in full robes met me at the Prometric doors, told me in heavily accented English to remove my shoes and handed me slippers. I tried to ascertain when said slippers had last been washed as I had bare feet and a wart phobia. She was either perplexed or offended by my inquiry (or both) so I after a few minutes in the unsettling footwear I went to the car and found some socks.

The Buddhist Nun took my ID and information, another guy in line asked me what I was writing, I said, "USMLE Step 1", he coughed softly and replied in a bored tone, "oh yeah, I wrote that last year". I tried to make my smile convey the "please stop talking to me" vibe.

The Nun scoffed at my lunch size. It was ridiculous, I'll admit. I had no idea what I was going to feel like eating so I had everything: a thermos of my sister's borscht, cheese, one bite brownies, strawberries, apples, caffeinated beverages, nuts, fruit leather, turkey wraps, water, and granola bars. Oh and salty chocolate.

I started the exam. Had issues with the mouse and figuring out the 'strikethrough' and 'highlight' option (since I had been practicing on my mac and this was PC delivered). Got in the groove. For the first 60 questions thought, "this isn't so bad".

I took a break after block 2. Not long.

Block three the Nun walked over to me and handed me 2 orange earplugs wrapped in kleenex. I had no idea what was going on but I accepted them and popped them in my ears, under the sound cancelling headphones.

It was so quiet. I was pretty sure I could hear my own heartbeat. I started thinking about The Abyss, got claustrophobic and tore off the headphones and earplugs.

After block 4 my coffee rush and will to go on was starting to wane. I took a break.

The Nun informed me that my mother dropped off the earplugs. Wha??? I remembered saying at breakfast that I'd forgotten to buy earplugs but wasn't too concerned about the oversight. My mother had driven in to drop off some earplugs. I am guessing after the inspection, Nun felt they contained no crib notes, tiny microphones or recorders, and brought them in to me. I told Nun that my mother lived an hour away and it blew her mind. She informed me that she wished she had my mother. I felt Nun and I starting to bond. I think we'd gotten off on the wrong foot (pun intended).

The testing centre was connected to a Sylvan Learning Centre which meant that on my break little Timmy's and Johnny's were coming in and out of the main foyer en route to their reading lessons. The doors were open to the learning centre so naturally I heard the lessons.

Timmy can you draw me a big "D"? Can you draw me a little "d" now? OK, now I want you to tell me which words start with the sound, "duh". 

Oh how I wanted to be Timmy at that moment. I could easily have drawn a little AND big D!! I didn't have much of a handle on the Krebs cycle but I. Know. My. D's. 


Come on TIMMY!! Get your head out of your ass! You GOT this one!!!

Good thing I am not a Sylvan tutor.


Back in I started to really hit the wall. Seems that they put all the easy questions in blocks 1 and 2 and NOW I was getting hit from all directions. Self esteem dropped, dreams of practicing medicine faded, desire for throwing in the towel, peaked.

Break.

I din't feel eating. I felt like building a time machine and going back to study harder and longer.
Decided to have some 2-bite brownies. Chocolate always makes things better.  I parked my butt on the curb outside, in the parking lot, and wrestled with the packaging. The packaging gave, suddenly sending the brownies flying into the air and scattering on the pavement.

Noooooooooooooooo!!!!

I probably would have eaten them if a woman sitting in her parked car hadn't been watching the whole scene unfold. I just couldn't bring myself to pick up the brownies off the oil-stained tarmac. Especially considering how much microbiology I'd learned in the past 3 weeks.

Thankfully I still had a double espresso and taurine drink which kicked in and brought me to the finish line.

Afterwards I walked out into the shimmering heat I noticed a Vietnamese nail shop next door. Yep. Watching Dr. Phil and getting a mani/pedi for cheap was just what I needed.

Then there was catching up with some dear friends, dinner, drinks...some random drunk guys harassing us at the bar flashing their Peace Officer identification cards. One asked me where I'd been all his life and I couldn't resist saying, "University".  Most days that is where I feel I've spent my life.

It all made sense at the time.

And that concludes a romp through the days events. Thanks again for all the support friends and strangers.

Well That Was Surreal...

I need to start by saying a giant THANK YOU to everyone who tweeted, called, emailed, and commented "good luck!" wishes to me for the exam on Monday. I actually walked through the doors of the testing centre with a ridiculous grin on my face because of all the support that had been coming my way. 

On Friday I will give the whole shakedown of the day's events. But in the meantime I will give you a small sneak peak. Exam day involved (in no particular order):

-A thunderstorm of biblical proportions
-A Buddhist nun
-A random mid-test delivery
-A lesson on How to Write Big D's and Little d's.
-A few minutes of self-loathing
-A trip to a liquor store
-A Gypsy reunion
-A martini and a couple gin and tonics
-An encounter with some correctional officers
-A mani/pedi
-A very large bowl of seafood

The bottom line is that one of the bonuses of having a blog is when it feels like I'm in an episode of the twilight zone, I simply smile and think, "blog fodder".

It is over. I hate to guess how I did but I hope I did well...ok passed. I hope I passed because if I have to spend any more time thinking about bacterial pili I may go buy that banjo.

Until Friday.

Please Note

Please note the countdown that is on lower right sidebar.

Accepting all forms of incantations, wishes, prayers, vibes, energy beams, sacrificial offerings, blessings, final thoughts, advice, good-will, and major credit cards. 

That is all.

Feeling Important

Did anyone else get an email from 'North America' today??

Below is part of an email I received this evening, it was quite a long one (since it came from an entire continent so I won't bore you all with the rest of it...)

Yeah. North America is always so formal in our written communications, but I can read between the lines.

The Pit

Of USMLE despair.

Oh God, what have I gotten myself into??

I am getting those urges again to buy a banjo and tour the south-eastern US with a rag-tag bluegrass group.

It's ugly. It's really ugly. I feel nauseated just thinking about it. I spend all day at it, and at the end I feel like I've accomplished nothing, learned nothing, mastered nothing. I think this is what major mental burnout feels like.

I. Need. A. Break. From. Studying.

Like 2 weeks. That is all. Is that so much to ask for?

My Little Shout Out

Tobie...Master Violist!

In about 3 hours Tobie will be playing a concert which is the final exam for his Masters in Orchestral String Performance. I am, of course, bursting with pride and excitement on his behalf. I have seen his dedication and discipline with hours of solitary rehearsal, six days a week, for the past 2 years.  He's so amazing, I had to make a little shout-out post on his behalf.

My only little twinge of sadness is that this marks the end of his time in Ireland, with me staying on for two more years. I am also disappointed that I wont be there for this big performance. I'd love to be in the front row...with a giant smile on my face and tiny prayer in my heart.

I am sure he'll play beautifully. I did get to see his dress rehearsal performance. A link if you'd like a taster.

Good luck, Tobie! xo