FIRST INTERVIEW!!!

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

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

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

Et voila!! My first offer!!

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

Hark! A Child Cries in the Distance!

I love going into the maternity hospital for work.

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

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

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

What a place! What a privilege.

Need Not Apply

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

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

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

Is this some kind of sick joke??

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

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

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

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

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

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

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

over my head. 

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

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

I Guess I am a Final Med?!

Today was my first day in the Tiny People Only emergency department.

I arrived to town last night, still feeling jet lagged and disorientated from the packing and moving. The chaos of the last few days had me finding my toothbrush wrapped up in an ipod USB cable and a stethoscope stuffed into a running shoe.

Falling asleep last night I realised that I needed to be up at 0630h and had no alarm clock. I listened through different selections on my "Deep Sleep" app for my ipod and tried to choose the most annoying piece to set for an alarm in the morning. Word of advice: do not choose music from an app designed for sleep, if what you want is to be woken up.

So I picked one of the chanting/meditation ones, hoping the incessant gong ringing would rouse me. Instead I found myself in a deep sleep, dreaming that I was walking along a lake shore in Nepal.

Nepal. Something isn't right. Sighhhh. Listen to that nice chanting. Monks. Hmmm. Chanting. Wait. Ringing, why is ringing bad, why? Ohhhhhh nooooooo! 

So I didn't sleep in too much, but long enough to be in a panic. First squarely hitting my shin on the corner of the wooden bed frame while leaping into nylons at record speed. I believe the entire bowl of oatmeal fell down my throat with one gulp, followed by two gasps of lukewarm coffee.

This really was not how I wanted to start my first day as a final med.

I scurried down the streets trying to locate my bus stop. Lost and convinced I'd missed the bus, I felt my shoulders drop, realizing that things were going from bad to worse when the bus appeared and took me where I wanted to go.


It was a long and busy day. It felt strange to tell people I was a final year student. A little daunting to step into the role of Canadian medical student where you are expected to immediately hit the ground running, perform assessments, establish diagnoses, elucidate care plans, and order tests. Plus these aren't the patients I am used to dealing with, they are all so little. The little humans. Don't get me wrong, I like it! But it is very different to the medical student role in an Irish hospital, to be sure.

For now, I am not going to worry too much about all of it. I am just going to sleep. 

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.

I (Heart) Rural Medicine

In the last 48h have included having the opportunity to:

-catch a baby
-cut a piece of glass out of someone's face (and then stitch them up afterward)
-surgically assist with fusing toes, replacing hips, replacing knees
-perform a D&C
-assist with a hysterectomy
-sew up knife wounds
-assess / treat / discharge about 75 emergency patients
-learn how to insert an IUD

Despite the exceedingly damp climate my hands are cracking from so much handwashing, I'm surviving solely on t.v. dinners and instant soups, clean underwear is becoming a scarce commodity, and I've spent every day (except one) in the hospital since my arrival. And I couldn't be happier.

My days are so full and varied, with such fantastic teaching from the docs here. It's hard to sleep at night, completely wired and excited by each day's events. I feel so fortunate to be here. I'm starting to believe that saying about how "there are teaching hospitals and then there are learning hospitals". Say what you will about rural medicine...but my experience is that people working in remote areas have half the egos and double the desire to teach.

I've been spending a lot of my retractor-holding and trying-to-sleep time thinking about the (soon arriving) residency application process. Today I truly felt like a few things have started to crystallize in my mind about what I want to pursue...

As always it is a work in progress, but I think that will have to be a post for another day.

In the meantime, check out my new O.R clogs while I try to get some well deserved sleep.

Yes, yes I did.

Hard Mattress

After a somewhat lengthy orthopedic surgery where I had been holding a foot / leg up off the table, Dr. Boots handed over the suture material and told me to get to work.

Me:

Umm...should I come around to the other side of the table?

Dr. Boots:

No, sweetheart just get to work, this man's got a bloody tourniquet on! We don't have time for dancing around. Put in some mattress sutures. 

(Some of you might scoff at the fact that I haven't mastered the mattress suture. As a potentially aspiring surgeon I maybe should be able to do them in my sleep, however, I spent most of my time in general surgery trying to perfect my sub-cue stitches and hand-tying. Bad medical student, BAD!)

And now I have.

And they were a thing of beauty. All two of them. Damn you arthroscopy and your tiny wounds!

Dr. Boots:

There, that wasn't so bad now. No need for all the shivering and shaking. You know my 17 year old daughter can do mattress sutures, no problem. She taught herself.

(Surgical Drape) Curtain Falls. 

[For the record...my hands were shaking because my forearm muscles were maxed out from assisting...I swear! I should also add, Dr. Boots is amazing and kind of like the slightly-unimpressed-but-fantastic-teacher orthopedic-surgeon-father I never had. Above example illustrates the way we communicate. Me, hopeless rube in ortho...him ortho king. Get it?]

First Ultrasound!

Bet that got your attention!

Yes, last night I had the opportunity to do my first ultrasound on a pregnant woman. Can I just state for the record that there are many concepts in medicine that fascinate and perplex me, not to mention the endless list of interesting presentations and procedures. But apparently there is one thing that turns me into a giddy, effusive fool: prenatal ultrasound.

I trundled down to the emergency department last night after my flatmate (and ER nurse) called me in to see some good cases. The doc who was working knows me well so he was happy to have me seeing and working up patients. Early on in the shift a pregnant woman presented with some minor bleeding so he wheeled in the ultrasound machine, flicked off the lights and handed me the transducer.

At first all I could see was fuzzy blobs and fluid and then lo! A vertebral column appears in the darkness! And then I saw the heart, its tiny chambers pumping away. I practically jumped up and down, Look! Look at the heart! Hey, there is a femur, wow! The baby is moving his, ah...or her hands! That is amazing!! 

So maybe I should have played it slightly more cool, but I couldn't help myself. It is quite something to look at a nearly flat and unremarkable belly and then suddenly be given a glimpse into a hidden world that houses a kicking, twirling, fist-pumping little being.

I spent the next portion of the evening smiling to myself as I stitched up wounds and listened to heart sounds.

The little beating heart and those dancing legs were a delightful reminder that there are also joys in medicine, even in the emergency department on a Friday night. 

Thank you, little one. I needed that.

A little bigger but you get the idea, image from here.

FIRST CUT!!

Dear Diary,

Today I had the chance to make my first scalpel to skin incision. M.C was very nonchalant about the whole thing. I had set up the tray as per usual (thanks to years of nursing and having to set up many a tray for minor ops) and then he just casually said to me, "okay, so work away there...get a blade for yourself..."

Yeah, I tried to play it cool but I am fairly sure that the eyes-popping-out-of-my-head-with-questioning-stare gave it all away.

He smirked and pretended to have something to do away from the patient while I went about (excitedly) excising my first skin tag.

This was followed by a sebaceous cyst excision and another skin tag removal (of a patient I had seen 1 month ago and booked for the procedure). She said she hadn't felt a thing, and that I was worth every penny that he was paying me. HA! I shall never let M.C live that one down.

I was pleased to learn that I have a steady hand and do indeed get a rather large kick out of cutting people (in the socially acceptable cutting to cure sort of way). I am sure that such a milestone is something you never forget. Course I am happy that this happened in one of my favorite little hospitals, on Valentine's day nonetheless.

Today was a good day.

Sincerely,

ABB

Surgical Field Trip

Headed for the hills today for a surgical assist field trip. M.C took me with him to the wild and wooly west coast for an operating theater day in one of the remote hospitals.

I have Monday's off (from GP) but was more than happy to spring out of bed at 0545h, knowing that I'd have the chance to be first assist and 'camera woman' for all the cases today.

And indeed, it was well worth it. Worked a lot on my sub-cue suturing skills and scope handling. Lots of neck craning and nervous sweat. So. Much. Fun.

I really cannot pretend to be aloof about this whole surgery thing. Pretty soon I'll stop sheepishly mumbling and toeing the floor when people ask me what I want to be when I grow up. Not today, but pretty soon.

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?

No Pressure

"So the patient has been temporarily paralyzed by the drugs, and you're the one keeping them alive by squeezing air into their lungs...but...no pressure".

Gulp. 

I was holding the mask as tightly against her face as I could, sealing the rubber to her cheeks in the effort to keep highly oxygenated air from leaking out. Looking down at her from the head of the bed I saw the patient from a different vantage point, a place that made her look so vulnerable.

And she was vulnerable.

A few minutes prior to closing her eyes she had been nervously chatting and laughing away as we prepared her for surgery. The dose of propofol and the inhaled sedatives smoothed her face and left her body limp. Now we had injected medication into her intravenous line to paralyze her. Once her muscles were relaxed we could slide a tube down her throat and into the trachea, providing the means to ensure that her airway would remain open and her lungs could be well ventilated with oxygen during the surgery.

I removed the mask to prepare for the intubation. Her skin was pale, the freckles standing out now that the nervous blush had faded from her cheeks and neck. She was perfectly still and we were moving into action. 

It struck me then how explicitly patients trust their doctors and nurses. Of course I have always understood this as a general concept in healthcare but this was suddenly a much more concrete example. Patients literally put their lives in our hands on a daily basis.

Why have I never said to a patient, "Thank you for trusting me with your most precious possession"? Why has a patient never said to me, "Please do not be hurried, or harried, distracted or inattentive, because today you are responsible for my survival"?

I suppose these are silent agreements and understandings that we have in all of our patient interactions. Yet the fact that we don't outwardly acknowledge these understandings means that maybe we've forgotten that at the core, it is an honor to be in this role. I'm not so unrealistic to think that one is thankful when the bleep goes off for the 47th time on a Christmas eve night shift...but I hope that at the end of the day when I am bone tired and flopped-out on the couch in the call room I'll remember this, and take even just a tiny measure of satisfaction from the honor of responsibility. 

No pressure.

An Unexpected Test--Part 1

At 0800h I was standing in my room at the B & B, holding the silver emergency blanket in my hand.  I gauged its weight and worked at stuffing it into my already bursting camelback. The pack was full, mostly due to the 2L water bladder, but I had also managed to squeeze in 3 nutrigrain bars, a headscarf, my mobile, a few tissues, and a headlamp. My first adventure race was only 2 weeks away, so I had driven to Westport the night before to join the training group and suss out the upcoming racecourse. In a rush I’d ‘packed’ by basically throwing all my outdoor gear into the car, hoping I’d managed to toss in all the essential pieces of kit.

“I am only going on a road ride and a run, I am definitely not going to need my emergency blanket or my headlamp. The last thing I want is an overstuffed pack bouncing on my back while trying to run” I thought.

I pulled the blanket and headlamp out of the camelback and transferred them to the larger pack that I take on hikes. This pack always contains my mitts, 2 winter hats, spare socks, earmuffs, and rain pants. Just in case.

I couldn’t have predicted that 5h later I’d be pulling the camelback apart thinking,

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

So I finished getting dressed in my long biking pants, tank top, t-shirt, long-sleeved merino wool top, and windbreaker. I usually end up overheating and cursing every layer once my heart rate gets going, but it seemed windy enough to warrant the wool shirt. I kept it on and headed out the door for what I thought was going to be a morning consisting of a bike maintenance workshop, followed by a group road ride, and short run.

Due to a miscommunication with Paul, the trainer, regarding the schedule, I ended up cycling to the base of Croagh Patrick without my running shoes. He felt terrible and offered to head back to town and collect them for me.  I was embarrassed that I’d misunderstood the plan and contemplated going up in my clips, but he insisted, so I gave him my keys and waited.

By the time Paul returned most of the training group were trickling back into the parking lot after hiking to the shoulder. He handed the shoes over and suggested that I hike to the top (since that was how far I’d have to go on race day). He gave me his mobile number and said he’d go through the rest of the course with me on my own once I’d cycled back to town, later in the afternoon.  I was so mortified over being the most high maintenance participant of the day that I didn’t mention that I had no way of locking up my road bike while heading up the mountain.  I waited for everyone to leave and then negotiated with the elderly Irishman selling walking sticks from a stall in the parking lot. I told him I’d be 2 hours maximum and he agreed to keep an eye on my bike as long as I propped it within view of the stall.

It was noon, there were snatches of blue sky scattered amongst the clouds, but the top of Croagh Patrick was wrapped in a heavy grey fog. It was the best that one could hope for in terms of Irish weather so I struck off.  I started my GPS timer and (mostly cheesy) ipod running mix, trying to move as fast as I could up the mountain, partly to take advantage of the weather and partly because I didn’t want to keep Paul waiting once he was done with the training group.

An hour later I was nearing the top of the mountain, which is mostly a rocky scramble. Despite the cold wind and scattered rain, I had long ago shed all my top layers and was down to a sweaty t-shirt. I was hammering away with Daft Punk and Fat Boy Slim blaring, feeling good.

Then I saw a small cluster of people crouched down on the trail ahead.  I thought for a moment that it was just a group of melodramatic teenagers taking a breather from the sustained final push to the top. Then I noticed that one of them was lying on the trail with blood on her face.

I crouched down and she opened her eyes. I asked what had happened and if I could help. The person on the ground was a woman in her thirties with soft brown curls framing her bruised and swollen face. A cut across the bridge of her nose bled in a line down her cheek and along her neck. She was covered in a mix of raincoats and sweatshirts, visibly shaking. Her clear blue eyes opened when I asked her her name and she told me it was Maggie. A hover of teens surrounded her. They said she’d fallen and hit her head but she hadn’t been knocked out. A frantic looking middle aged man in a blue cableknit sweater and khaki pants spotted with blood approached me and said that mountain rescue had been called and that they were on their way.  I asked if there was anything I could do, he said “Uhhh…I don’t think so, mountain rescue will be here shortly…” 

In these situations I never know how to state my credentials, going into a ramble about being an ex-ER / arctic nurse, now 3^rd year medical student, with a smattering of trauma and backcountry courses, seems a little too long-winded and confusing. So I decided to distill it down to ‘student doctor’ even though it sounded vaguely ridiculous at the time. Especially since that part of my background was probably going to help me this least at this point.

“I just want to make sure she’s ok, I am a student doctor...can I quickly check her out?”

“Wait…what?”, the man said, “oh thank God! You’re a student doctor? Once you’ve looked at Maggie can you come and see the girl? I think she is in worse shape.”

The girl?

It was then that I saw a second huddle of teens away from the trail, on a steeper aspect of the scree, about 5 meters away.

Oh dear.

I Heard It!! I REALLY heard it.

Small miracles, tiny accomplishments, baby steps forward.

Some days in medical school it feels like the 'teaching' just boils down to constantly being told how many differential diagnoses you forgot, how many signs you failed to elicit, and how many questions you didn't ask the patient. The constant deluge of information and things you ought to know by this point can begin to feel suffocating.

Until a miniscule but measurable gain occurs and suddenly, it seems worth it.

Like today...I actually clearly heard my first heart murmur which I confidently and correctly identified after performing a decent cardiac exam!!!

Pretty sure that at the exact same moment a unicorn was born and a leprechaun discovered a pot of gold.

I honestly thought that heart murmurs would always be a mystery to me and that there would never come a day when I'd be able to do anything other than pretend I heard it. 

But, nay! I heard it. I really heard it. And strangely, that made me smile. All day.     

Small miracles.

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.

:)

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. 

Another Charming Trend in Medicine

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

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

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

Hello, Ireland. Need a doctor?

Good News

The best part of my day, hands down, was getting to tell a patient that her CT scan was clear, and that no further cancer had appeared in her abdomen.

As a nurse in the emergency department I often saw the test results before the physicians did. Many patients would ask me directly what the results were but I always had to defer and say that the doctor would be in to speak to them shortly. It was one of the things about nursing that irked me on a regular basis.

Today the chart landed in my hands and I called a bubbly woman in to the office. I asked what her referral was regarding and she informed me that it was for the results of her recent CT scan. She had a history of cancer in her abdomen and as I flipped through the chart trying to find Diagnostics I said a silent prayer hoping things would be normal. Found the report and read it out to her...everything was normal. As I read I could see in my peripheral vision her shoulders relax slightly from a hunch, and heard a breath escape with the movement. The relief on her face was a delight to me.

So much of our practice deals with pathology and telling people bad news that these moments of relief and reassurance, are a treat. I am grateful that I was able to start my career of telling people results with some good news.

A Personality For Surgery?

I don't really know what people mean when they say, "oh you've got the personality for surgery". Is that like having a face for radio? Because to me, that is what it sounds like.

When I think of surgeons (apologies in advance to any who might be reading this) I usually envision an ego-maniac who likes to have hissy fits. Someone who is impatient, brusk, irritable, and cold. Granted, in the last while that stereotype has been opposed by many of the all-around-awesome surgeons I've met and worked with. Many of them well rounded, caring, hilarious, sensitive folks...really!

The other night myself and and handful of the junior attendings were out for supper and the registrar (a position equivalent to resident purgatory as far as I can tell) was going on about our astrology signs and when he found out I was a Leo he joked that I was the quintessential Leo. Now he's been around hospitals for a long, long time so I asked him if he thought there were specialties suited to certain Astrology signs (I am grasping at straws here people, I know that) and he laughed and said, "Do you mean, 'what should I go into because I am a Leo?'"

"Er. Yes." All eyes around the table fixed on me. Conversation stopped. Now I was feeling awkward.

"Well, surgery of course. Lots of Leo's gravitate to surgery."

"Why?"

"Because they are bossy and need to always be the center of attention!"

Ah, thank you. Yes. Well I suppose I did ask.

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.