Mind Go Blanko

On Friday my new consultant (MNC) gathered together myself and the other doclings to do some bedside teaching. Normally I try to slink between the folds of curtain during these sessions as I really don't want to be pimped on differentials for pseudopseudohypoparathyroidism or some other disease dredged up from the Annals of Obscure Internal Medicine. But since MNC hasn't seen me examine / present yet he asked the handful of final meds to step away from the morbidly obese no-necked man who was sleeping with his feet at the head of the bed, and told me to conduct a complete cardiac exam and report my findings.

Yeah. It was sub-awesome.

First of all, I could hardly feel his radial pulse and my racing thoughts kept forgetting where I was in my count...was I at 14 or 24 when I had counted 15 seconds...wait...did I start counting when my seconds hand was at the 12 or the 1 position...where DID his radial pulse go--GAH!

Then I attempted to feel his carotid pulse which should have been located somewhere between his clavicle and angle of jaw (which were, in his case, resting comfortably on each other, heavily padded by folds of flesh). No luck, despite the patient kindly allowing me to dig around there for a while.

JVP? No. Bueno.

Ok, and on to the apex beat. Not so much. Heart sounds?? Is this stethoscope on?? Tap. Tap. Tap. I can't actually even hear his heart beating--hark?! Is that it?? No, that is the sound of my own blood rushing through my ears...

And now to my dazzling presentation. Sure, I'll just neglect to mention that he was hooked up to telemetry, and that he had cardiac meds at the bedside...even though MNC kept asking me, "is there anything else you'd like to comment on??"

"Er...he has a midline abdominal incision??"

"No, he's on telemetry."

"Oh, right." Yeah, the device you hooked cardiac patients up to everyday in the emergency department. The painfully obvious tangle of colorful wires stuck to his chest. Yes, those.

Surprisingly MNC did not shred me into tiny bite sized pieces. I suppose he just assumes that 3rd years are clueless. The major bummer was when he turned to the final meds and asked them how to manage the patient. I had to fight hard to not pull a "Summer" from School of Rock...

"Oooh! Ooooh!! ASK ME!! I know how to MANAGE a CCF patient!!! Really!!! YES!!"

But, no. My medical self had failed and my nursing self couldn't help me now.

Ah well, maybe my extremely low bar setting means I will appear to shine upon my next opportunity to examine and present.

Maybe.

:)

Nostalgia Revisted: Promised Patty's Day Pics

Remember how my good friend, Cathy and her hubby, Nate, recently came to visit from Amar-ica and happened to be here for St. Patrick's Day? Well, at the time I didn't post the photos, but clearly some needed to see the blog light of day.

Prior to St. Patty's we also got up to all kinds of shenanigans which might be featured in future posts: eating-in-the-car picnics, visiting abandoned Work Houses, seeing the Cliffs of Moher, and some near-death experiences too.  For example, when I was almost hit by a giant tour bus while taking Cathy and Nate's photo. Note the looks of trepidation mixed with excitement. Also note they are in no way alerting me to the oncoming bus as I step farther back to take a photo of them holding their first official "Burdock's Fish and Chips" meal.  

"Er...Nate? Is that bus going to hit us as well?"

Crisis averted, both the smoked cod and I remained in one piece (ahem) and we were able to carry on with our touristy photo shoot. It was around this time that we started noticing people in Dublin getting pretty excited for St. P's day even though it was several days away. Lots of hats were already being sported, fake beards (did you know Leprechauns have beards??) and green sequins. We thought we should get some costumes in order.

 

But not until we saw Iron and Wine in concert. Oh, and the lead singer walking down the street before the show. You just can't be walking down the street with a balding pompadour and a crushed red velvet jacket and not expect someone to notice you. Of course, by the time I was confident it was definitely him, he was well up the street and I realised I didn't know his actual name. What was I going to yell:   

"Hey! IRON AND WINE GUY!!! Er...WICKED!!!"???

Iron and Wine Guy

The thought did cross my mind, I will admit. The concert was great and his new record is very much a departure from anything he's released in the past--big sound and very peppy.

But we had hats to find.

Two that didn't make the cut. I am referring to the hats, people.

After haunting every authentic "Made in China" Irish goods store we could find, and trying on a multitude of ridiculous items we settled on our St. Patty's day outfits. And they were grand indeed. Cathy almost bought a giant, solid silver skull at one point in a strange goth-Irish-souvenir store. I blame jet lag on her momentary loss of shopping reason.

The Cowgirl, Abe, and Jaunty Cap head to Killaloe.

We met up with Ryan and then were easily spotted by our Irish friends, despite the parade crowds...why you may ask?? Mostly because we were the Only. People. Dressed. Up.

Yeah, except for a few 5 year old's wearing green GAP sweatshirts and people who clearly had gone off their meds for the holiday weekend, we were the only ones that really took the days theme to the next level. Turns out, only people in the big cities really get gung ho about the dressing up thing. Yeah, people were taking pictures of us at the parade. Including a reporter from an English newspaper. Oi.

I have no idea what is happening here.

My only regret: not buying a jaunty hat like Cathy's...

Walking to the pub after the parade, along with the rest of the town.

Ok something needs to be said about the fact that Nate looked freakishly like both an unemployed Leprechaun in a tuxedo-t-shirt AND Abe Lincoln. That has got to be the most dichotomous costume combo to ever be successfully pulled off, yet pull it off he DID (the theoretical combo not his costume).

Lucky charms or a house divided against itself? You decide.

Rosie rocking my cowboy hat so much harder than I ever could.

After the parade and pubbing we retired to my friend Emma's house for a wee gathering. The noisy bustle of child minding, feasting, cooking, and beer-drinking went into the night, and it was a heck of a swell night. And now ye have seen what becomes of Canadians and Americans who find themselves dressed in green in a small town in Ireland, on St. Patrick's Day.

FIN (not quite)

May Day, May Day...We've Only Got 5 Weeks Left Until Finals!

So I realised that it is now, um, May. Which is a frightening thought for many reasons:

1) exams are fast approaching
2) our exams are cumulative and cover the past 2 years of curriculum
3) did I mention exams are fast approaching
4) Tobie and I will soon be sentenced to 2 years of living on separate continents
5) USMLE is also fast approaching (I just felt an ulcer form when I typed that)
6) I have to figure out where and with whom I am going to live next year as my placement is a good 2 hours from here...and frankly dorm living is starting to get old, just like me. I mean, don't get me wrong, finding vomit in the stairwell from time to time is a nice reminder of what I am missing in the hospital, but in the hospital vomit gets cleaned up...you know, right away.

So, since I am feeling a little nostalgic about my first 2 years of medical school drawing to a close [insert cartwheel and pulled hamstring here] I figured I would start doing some posts about the highlights or day-to-day-lights of the past few months. With photos! Doesn't everyone love seeing other people's photos? Heh. Pictured above is my office desk where I start every day, either with coffee and blog reading, biochemistry videos, yoga, or last minute PBL homework. Granted, that photo was taken during finals last semester, it is usually much cleaner in the old office.

Above is a photo of what greets me when I step out my front door each morning: smiling Ryan (and sometimes Mike but his is the opposite schedule to ours so this photo isn't exactly representative of most mornings). From here we trundle off to school. It should be noted that I took these pics in December, the dead of Irish winter, I know that seems untrue but you can tell because it was one of only a handful of days when Ryan wasn't in shorts.

Above shows the commencement of our daily river crossing.  It is one of my favorite parts to the walk as we often see all forms of animal kingdom from the bridge, including swans, blue herons, salmon jumping, and the odd old Irishman taking a dip.

I'll pause to acknowledge that this could possibly be the most boring collection of photos on a blog  (I get it, knitting patterns are more interesting to look at) but what has fueled this self-indulgent display is that I recently had my blog printed in book format. It was incredible to see the past three years actually bound and tangibly in front of me. But it also made me realise that I have quite a few gaps which I want to fill before I print the next one (my mother wants another 5 copies, of course, heheh). So, for the record I am going to try and flesh out what Year 2 was all about. After all, come June I will no longer be on campus and life is going to change drastically. Goodbye pre-clinical years, hello (theoretical) short white coat. The theoretical white coats aren't vectors for disease like the real ones, so that is what we will be wearing instead.

Approaching the foundation building. Another nice little bridge to cross. Oh you and your bridges, Ireland. 

This is the building where most of our lectures occur. In the basement, in a windowless room with a PC from circa 1997. Better than last year though, the air intake was right outside the front doors resulting in the classroom always reeking like a blues bar. Mmmm, second hand smoke, just what you want to be inhaling as you learn about bronchial carcinoma.

We still have to look both ways (twice) before we cross the street as we're still not exactly sure which direction the cars are coming from. Almost cashed in on my life insurance policy a couple of times here for that reason.

 Mike and Ryan acting 'natural' for my photo essay.

Photo below shows where some of the learning magic happens (suppose I'll need to get a photo from my PBL room before the end too). You'll note the war-bunker design and power-point-of-death on the screen. Doesn't that combo just make you want to sit up and LEARN? Of course the school is in the process of constructing a new medical building that will be all sweetness and light, however, since the construction workers walked off the job a few months ago the actual opening date has been pushed back to...who knows when? Well, long after we're off campus at least. For now we can stare at the concrete outline and feel a twinge of jealousy for those coming after us.

And the après class trip to the cafeteria. This was back in the day when all Canadians didn't immediately scuttle off to dark hovels to work on USMLE review. And naturally when I told Christine this photo was going on the blog she spilled water on herself. Smooth, girl. 

So you've gotten to the end of the first installment of 'ABB gets prematurely nostalgic for her pre-clincal years which so far she has mostly only complained about'. Happy May Day!

It's A Bird...

It's a plane...it's SUPERSHEEP!! The little rascal started running towards me so quickly that I was only able to catch a fleeting image of his rocket-candy-colored-coat.

Computer is back. Posting will resume again shortly. I was about to write one now but I am yawning with every second breath and daylight savings just happened. I looked at my clock and it was 0059h and then when I looked up again it was 0201h. So I really need to call it a night.

Off to count sheep.
(Couldn't resist.)

Take THAT, All Work and No Play

I am getting oh so very excited. Cathy and her husband Nate are arriving from Wisconsin tomorrow!!!

Cathy and I met on our Himalayan Health Exchange volunteer trip in 2008. You know when you meet someone and instantly know they will always be a part of your life from that point on? I have to say I was lucky enough to have that feeling about several of the folks on that trip, Cathy was no exception. There is also something about seeing your colleague's underwear drying on the line day after day, for a month, that really causes all pretense to fall.  It is pretty hard to put-on-airs and be aloof when no one has had access to running water for 3 weeks. Ok, one girl was aloof but we won't go there (who brings a white felt pea-coat as their jacket on a backpacking trip??) Bottom line, you bond with people when you are living and working together in the midst of controlled chaos and pit toilets.

Just chillin' (literally) at 14 000ft.

On the trip, Cathy was a 4th year medical student waiting to find out about residencies, and I was a nurse waiting to find out about medical school interviews.

Needless to say our lives have changed a little since then! She's now an old married woman and 2nd year peds resident.

I haven't actually seen her since our goodbye in Delhi, but we've kept in touch via email and random gift packages.

I've worked like a mad-woman all week in the hopes of taking next week off. I even managed to finish my paper early, and most of my homework for the next case is done. Now it is time to enjoy some Irish adventures and shenanigans. I don't feel a lick of guilt for my planned truancy. Besides, Cathy is like some kind of brilliantly-hilarious-Asian-American-Halley's-Comet that only comes around a few times in one's lifetime. I've got to enjoy the downtime when I can get it, after all, the hospital will be making me it's bi*ch soon enough.

Speaking of which, I GOT MED/SURG for the summer! STOKED!! Too many people wanted to do med/surg as their first placement (instead of GP) so the school had to do a lottery. The big issue is many of my Canadian classmates (myself included) are trying to arrange electives in North America in the hopes of getting some residency connections and local letters of recommendation. As you can imagine, the hoops to get back into a North American residency are many--but one step that many people have advised is DO AS MUCH IN CANADA AND THE US AS POSSIBLE* when you are a medical student. Many of these electives require that you have completed your 3rd year med/surg rotation. Needless to say there are quite a few unhappy Canadians right now in my class. I am hoping it will work out for them, the school has said they will try very hard to give them the preparation and skills required. Still, it's a gamble. Anyway, I am so excited as I cannot wait to get back into the O.R and back in the hospital in general. The small flickering light at the end of the basic science years is starting to show itself!

But now I must get cracking and get ready for the arrival of my esteemed guests. It's going to be so great to re-connect with this formidable woman!

*Any of you want to provide the ultimate clerkship experience for me in years 3 and 4? G'head and email me!

Currently Reading: In Stitches

Some days I think I am probably doing myself (and my GPA) a disservice by keeping this blog going. I've watched 90% of my hobbies and pastimes fall away, so I figure the blog is probably next on the chopping block. But then something really cool happens and I think, "NEVER!! They will have to pull this blog from my cold, dead, permanent-student fingers!!!!!"

Allow me to explain.

It appears that putting near-daily efforts into maintaining a blog does indeed have some benefits.  This week I received a galley copy* of In Stitches by Anthony Youn and was told that I could do a contest for a book giveaway on Asystole. I started reading it 2 nights ago and am already halfway through it. This, to me, is a genuine sign that I am enjoying it. The only commodity I have right now is time and I give that away very selectively.

It is a book about a gawky Korean-American who grows up in a 99% white community in Michigan. On top of a wildly controlling father and constant nerd-herd constellation keeping him from ever being cool, he also develops a disorder in his jaw, resulting in a lot of headgear wearing and eventual plastic surgery. He is forced by his father decides to study medicine and eventually becomes a plastic surgeon (I am not that far in yet, he is still in first year med right now).

So far I've found the book to be an easy and enjoyable read. There are some absolutely hilarious parts in it as well, and some definite parallels to my life in medical school. It is hip and self-deprecating, and honest**. It is also an interesting perspective for me to see; he was a very intelligent, driven, hardworking kid who did everything right and got into medicine. I was a rambling, traveling, musician, wanderlust ER nurse, who did everything wrong and got into medicine.

Anyway, details of the contest will be up soon, but in the meantime you can check out excerpts from the book here. Or you can go to the website for the book, here.  Heck, you can even pre-order the book here. Now back to my regularly scheduled program of pulling out my hair and typing a paper on central line infection rates in Ireland. Hooray!

--

*I am pretty sure that just means an advance copy in cool-publisher-jargon-speak.

**No I am not getting paid to say this, reading is a serious matter to me and if I didn't truly enjoy it I wouldn't tarnish my good-hobbie's-name by promoting something I thought was shite.

The Dreaded Mini Mental State Exam

For the uninitiated, the Mini Mental State Exam (or MMSE) is a fairly quick way of assessing a patient's cognition.

Academic side: Though it has reasonably high sensitivity and specificity (i.e. low false positives and false negatives) it can be somewhat biased in favor of younger patients with higher levels of education.

Reality side: It is a horrible, annoying, frustrating test for many elderly people. Either they are sharp as a razor and the test is insulting, i.e "tell me where you are, the month, name this object, write me a sentence", or they are mildly demented and get quite upset and befuddled when you ask them to do things like count backwards from 100 in increments of 7.

I thought that there was no way that administering a MMSE could get any more heartbreaking and painful than having to conduct it on someone who had Alzheimer's.

Well today I found out that there is one more thing which is worse: having to watch it conducted by a train of medical students, in front of about 20 people, on a mildly demented patient. Oh, yeah.

It was sad. And I felt so awkward and uncomfortable watching this burly, checkered-shirt-wearing retired farmer trying to scrawl a sentence on his knee.

The session was conducted professionally, I must say, but it still made me think that if it had been my Grandad up there I'd have probably swooped to the front of the class (created a scene) and escorted him out for an afternoon of fishing.

Pre Op Checklist

Dear Cowboy Classmate, 

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

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

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

Yours truly,

Someone Who Has Actually Worked in a Hospital

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

Saturday Morning Thought Invasion

Tobie has been in London for the week, and I have been missing his sweet face. Yesterday he and his parents returned (yes, they are still visiting). It is lovely to have him back. I never sleep well when he is away.

I woke up early this morning, just a little of the gray light starting to illuminate our bedroom. I looked over at Tobie, his face silhouetted against the window and thought,

"no signs of exopthalmous".

How romantic. 

Being in medical school seriously fecks up the way you look at the world.

Like yesterday also, I was sitting in my histology class and I noticed my prof had a long, surgical looking scar running along the lateral aspect of her leg. Her voice turned into a drone as I pondered, "did she need surgical repair of her fibula? I wonder how she broke it? Maybe she needed a fasciotomy for compartment syndrome? Wrong side for the usual vein harvest, maybe she had bad varicose veins?"

Then I realized, it was a run in her pantyhose.

I really need to get a new hobby.

When You Try to Simplify Something That Isn't Simple

A Long Hard Look at the Nephron

So I tried to make myself a nice simple diagram of the nephron complete with what diuretics act where.

Turns out that is not possible.

Partly because I am as thick as the ascending loop of Henle when it comes to renal knowledge so every note I make on my drawing requires an explanation for myself. During 'firing squad' anatomy this week I couldn't remember what "closer to the top of the head" was in medspeak (pretty sure I said "dorsal??" *facepalm*). Sigh.

Turns out the school is giving us grades this year which is a bit of a drag. It's been so freeing having this pass/fail system because I could let myself indulge in being a human (nearly) guilt free, plus it made it hard for the annoying people who insist on shouting their grades from the bell tower.  That really pleased me. While we are on the topic of grades, can I just say that people telling me their grades feels almost equal to slamming my hand in a car door, while the car is still moving. I *painfully loathe* it. Partly because I never know how to respond, from either perspective. When I did worse than the Boundary-Free-Human then I feel frustrated that they had the urge to impart their numbers on me (unsolicited), when I did better than them it makes me feel awkward. Gah.

Hence, my avoidance of the whole GRADE discussion. Full stop.

But now we are getting our grades and I wonder how I will be able to avoid the inevitable score-card of comparison conversations that will erupt around me.

[Ok before this turns into an ego driven rant about my level of medical experience I am just going to hit the big "delete" button on that last paragraph. It made me sound really bitchy and petty. There, you all were spared.]

In other news, I took the day off. We had friends over for dinner last night and it ended up becoming one of those evenings where someone suddenly goes "shit! it's 0230h!" and we all wonder where the time and the wine went. So this morning Tobie and I slept in and then moseyed around the farmers market in town. Came home and had tea with one of my lovely friends, Emma, from school (who incidentally is doing brilliantly and has a 21 month old). Afterwards there was napping, Tom Yam soup making, and calling home. And I was reminded that I get too worried about too many things. I really want to play my mandolin, cook food, go for runs, catch pilates classes, visit friends, and talk to my family, not worry about what my grades are. Or what the future holds for me in terms of residencies, the USMLE, etc.

Emma, Rosie, and Tobie. They aren't thinking about the nephron, and look how happy they are!

And a complete non sequitur. Tobie has a crumb problem. I thought I'd document it here. Please click to enlarge the fall-out from a baguette and a bit of cheese. He comes by it honestly though, I've noticed it is a familial trait. He thinks I must have suffered a mentally scarring event as a child which is why I am able to eat without a foot of food-bits surrounding me. He clearly has no issues getting down to business.

Tobie thinks he looks like a street person eating at a soup kitchen in this photo.
But he did not prohibit me publishing this photo. So. 

The Stethoscope is NOT an Accessory!

Let me say it again in case anyone missed it:

The stethoscope is NOT an Accessory!

Though I applaud your excitement at becoming a doctor and understand that you have oh-such-strong-urges to let the world know that you are on the path to enlightenment practicing medicine, if you are walking from your home to your clinical exam DO NOT WEAR YOUR STETHOSCOPE AROUND YOUR NECK. You have hands. Carry it in your hands. Or purses. Just don't wear it like a necklace.

*Facepalm*

If I hadn't just witnessed several of you doing it I wouldn't have felt obligated to rant about it.

Example of when it is okay to wear it: when you are seeing patients.