Todays Quote from the Classroom

In our clinical skills lab the instructor was talking about signs of respiratory distress in babies.

"Since they can't tell you anything...you're basically practicing vet medicine".

My Politically Incorrect Medical Education

Yesterday we had a lecture on EKG interpretation and the cardiologist giving the lecture was chatting about using the R-R interval to calculate heart rate. It went like this:

"Take 300 and divide it by the number of small squares between the R to R interval...that gives you the HR....so....if there are 2 squares between the R-R what is the HR...?"

-Everyone stares back in silence.

"150!!" he says exasperatedly.

"So look at this one...there are 3 squares between the R-R interval....what does that make the HR?"

-Silence again.

"JEAZUS! Are ye RETARDED? It's NOT that complicated!!"

I almost lost my sip of tea out the nose.

One of the many hilarious quirks of Ireland and Irish medical training. The consultants actually yell "JEAZUS", and call you "retarded" during lecture, and no one even blinks an eye.

Back to No-Life, Back to Reality

Tomorrow classes start again. Which is probably a good thing because I am spending waaaaaaay too much time in the highly entertaining blogosphere. I heart all you medbloggers.

Things will be busy, what with the resolutions and all.

Manfriend and I have decided that today will be a day of 'deep relaxation'. After pilates* we are donning  'relaxing pants' (a.k.a sweat pants).  Getting new mohair blanket out.

There will be tea drinking, book reading, movie watching. The last day of true indulgence.

Does it mean you are old when the above activities are considered 'true indulgence'???

--ABB suddenly flashes back to her reckless youth and shakes her head.--

Well my life expectancy got a little longer when I changed that definition I suppose.


*Update post pilates: the instructor actually taught the class to the entire Dirty Dancing soundtrack. It just doesn't seem right to be doing boat pose to "She's Like the Wind". I was giggling a lot. Couldn't help myself! And squats to "Yes!" I had to hold back from throwing some arms in. You just can't tease a girl with partial dance moves to that kind of music. I have a hard enough time not going into the side-step when I am running.

"She leads me to moonlight, only to burn me with the sun..."

What I Learned About Doctors in Nursing School

 MD Girl* and Liana both were curious as to what we were taught about doctors/med students in nursing school, it was shaping up to be an irritatingly long comment from me so here is a post instead. I used bold so that you could skim through a 3 minute version of my answer the question. For those who are drinking your morning coffee and want a long winded version...read between the bold.

I wish I could offer some very interesting, discussion promoting, insightful answer to that question but I honestly don't have one.

I really had to dig into the recesses of my mind to try and recall specific things that were said about physicians or medical students (formally) in any of my classes. There was a class that was a small group session with pharmacy, nursing, medical, O.T students, which Keet mentioned, but for some reason I had too many electives and they didn't make me take it. It was apparently supposed to highlight the different areas of expertise in the allied health fields, and teach everyone to play nice once they were in the professional sand box together. 

As Keet said in his response in the comments--it really depended on the instructor what was said and what was taught with regard to doctors and medical students. There wasn't what I would call a specific mantra in the curriculum that was repeatedly droned to us.

So instead I'll give you a brief sketch of the types of instructors and the lessons we were meant to learn from them...

Some instructors were from the days of yore when nurses stood up if a doctor entered the room. Those were the ones that implied that we never question anything, we perform our orders even if they seemed inappropriate, and never assume that we had gleaned any information in our extensive interactions with the patient which the doctor might have missed (and therefore not to bother HIM with such trivial matters). Med students also deserved a seat if we were in report together and they were standing. Oh, and we were meant to find all the doctors hilarious, charming, always appropriate, and a fountain of fascinating tales on everything from fly-fishing to changing the oil in their new Mercedes convertible. 

Other instructors were hellbent on providing ample examples of when they were right about something and the doctor/medstudent was wrong. These instructors anecdotes had the central theme of them saving the day with monotonous regularity and I usually mentally rolled my eyes when another health care homily started. These nurses had the clearly visible chip-on-shoulder approach to all physicians (and med students). They were also the ones that gave med students grief, just because they could.

The take home message that was drilled into my brain though was--do not develop a false sense of security just because you are not the one writing the orders. If a doc orders the wrong drug/dose and you give it--YOU are responsible. Ensure you always know what you are giving, the side effects, the intended therapeutic effects and your patients allergies. That nugget was a keeper and I still am very anal about medication administration--especially because so much of what we give in the ED is I.V push (i.e the fastest acting method to give a drug and quickest way to kill someone if you make a mistake).  I am still blown away when I am getting report and the patient is on a med I've never heard of and I ask--"Oh, what is that drug for?  What does it do?" and I get "Oh, I don't know" from the nurse who administered it.

Whaaaaat?

But I digress.

Another type of instructor (and when I say that I mean clinical and/or lecturer) is the type that sees MD's/med students basically as a colleague. They told us that nurses and doctors were each their own profession but that we were supposed to work as a team. They got along with docs/students on the floors and encouraged us to use the medical students/doctors as a resource if we didn't understand something. They encouraged us to ask questions, confirm orders we thought were shaky, and to bring our patient concerns to the PCP/med student as we were the patients advocates.

Which brings me to the final camp--the slightly out of touch academic nurses who were now onto their post-docs in nursing. They were teaching us only because they had to round out their esoteric academic indulgences with some actual student interaction--as per their contract. These nurses hadn't had any clinical experience in over 20 years. They had spent their careers doing things like developing nursing theory and nursing diagnoses. Now usually I get a rash when I think back to those lectures and the subsequent papers I had to write because I think a lot of it is actually *not* clinically relevant and is really self-indulgent navel gazing.  But before I get a flood of comments--especially from you Keet---(hee) I will say that some of the models and theories are very well developed and very applicable: the patient centered care model, Orem's self care model are a couple that immediately spring to mind. But I swear if I hear the words "health as enabling consciousness" or "contrasending with possibles" I still break out in a cold sweat.

A lot of these instructors seemed to forget that physicians and medical students existed (or maybe they wanted to forget). You could have entire courses with these people and never hear those words. Partly because these women (yes they were all women so I can say that) were so very very focused on promoting nursing as a profession. Period. Thus their main thrust was expanding nurse theory, nursing diagnosis, nurse practitioner roles and nurse autonomy, so all of this had very little to do with the interaction of nurses and doctors. I don't mean to sound overly glib on this matter--I actually agree that nurses are professionals and should be seen as such. I also agree that many nurses would be amazing in expanded roles with increased autonomy. But that is not what all nurses want. And if we're going to be working in a hospital or clinic (no matter what the scope) I think *some* attention should be paid to what the roles  (R.N, nurse practitioner, L.P.N, medical student, resident, attending) mean and how we can maximize efficiency, patient care, and patient safety by working in harmony.

I hope that answered your question.

I am always happy to be spurned to think about these things, so thank you for the comments and questions.

*I thought that was a better abbreviation than 'Old Girl' because yeah, that isn't an overly apt moniker.   :-)

Somedays I Feel Like A Mole or Why I Went to Medical School

I always wondered what doctors really thought of nurses, or how nurses were portrayed to medical students.  I could never really get an answer I truly believed because none of my doctor friends would ever make disparaging comments about nurses around me (or if they did they'd preface it with some disclaimer so that I wouldn't be offended).

I saw how some doctors listened to nurses, I noticed how some would always do the opposite of anything a nurse suggested or would ignore any information a nurse brought to the table.

The dynamics were always very different too, depending on the department and location.

The first ED I worked in the docs and nurses got on fairly well as a general rule. There was banter between the two, you could clarify an order without attitude, you could ask 'why?' if you didn't understand the rationale for something being given to a patient. It was expected with urgent patients that the blood work, x-rays, and I.V's would be initiated by the nurse before the doc saw the patient and you had better run for cover if they weren't. It was a pleasant place to work, although I must admit I was nauseated and insomniac with fear the first 6 months (I was a new grad).

In my second/third ED the nurses and doctors barely even spoke to each other, except out of necessity. The doctors wrote orders, put them in a slot, the nurses picked them up and carried them out. R.N's wouldn't initiate any sort of treatment (other than I.V's) without an order. And with certain M.D's you wouldn't even do that because then they'd make some passive aggressive remark to the patient like, "I wasn't going to order an I.V and make you get a needle for no reason but the nurse decided you needed one".

The two camps never socialized together. 

On the wall in the hallway to the department were a bunch of historical photos and documents from the hospital when it was established over 100 years ago. One of the documents was a framed timetable of nursing duties which started off with "0630h--clean and mop doctors lounge and locker room".

I am sure that some of those docs wondered why the nurses weren't still doing that before report.

Then I started working up North where the nearest doctor was hundreds of kilometers away (by plane ride only) and my sole interaction with them was by phone or teleconference. I generally had a great working relationship with all these colleagues who I strangely never met but spoke on the phone with many times. When I needed a medevac they'd arrange it and find me a bed in the south--no questions asked. There was a great deal of trust and respect (for the most part) because many of the physicians who worked in the receiving hospitals had been to these remote communities and knew what we were up against; we could do chest and limb x-rays, HgB, WBC (using a microscope, counter, and half an hour of spare time), HCG, fetal fibronectin, and RBS. With only 1 exception of the 11 stations I worked in there was no defibrillator, no monitors, no I.V pumps, no rapid troponin machine, and no blood.  The new residents were told in no uncertain terms--if an outpost nurse calls you for a medevac--you arrange it.

My only major head-bang-into-concrete-because-it-feels-better-than-this-conversation moment was once when I called to arrange a non emergent transfer of a patient who clearly needed a cardiology consult in the south. I told the ED consultant that the patient had been having unstable angina for over a week and due to his past history of heart attack and hypertension I felt that keeping him in the high arctic (i.e 8 hours by plane to a major hospital and cath lab) was unsafe. He told me not to "use the word 'angina' because that was a diagnosis. And nurses don't make diagnoses."

After that I worked in a very busy ED which happened to be at the bottom of two very large mountains that skiers, snowboarders, monoborders, and telemarkers enjoyed--sometimes to the tune of over 20 000 people on a busy day. This was like a fairy tale ED. 80% of the patients were pretty healthy but had some acute injury which we were really good at dealing with. People came in, we fixed them or stabilized them, and they went away satisfied (for the most part). This is not usually the case in most emergency departments. The morale between the nurses, docs, and paramedics was very good. They had Christmas dinner together, stood up for each other at their weddings, skied together, biked together, raced together. I loved it there and knew it was a place of trust when one day I saw the orders for a fx humerus that read: analgesic.

The paramedics, nurses, and docs were all very good at orthopedic trauma (to the extent of which I didn't appreciate until I had to witness ortho trauma handled in my subsequent ED's). With no doubt in my mind if any of those doctors were asked their opinion of nurses their deep respect and trust would shine through in any answer they gave. And the patients knew it too. Time and time again I had patients tell me--everyone here is just so nice and all of you seem to get along so well!

Fast forward to my last 4 months of nursing before moving to Ireland to become a medical student. I was working as a travel nurse in 2 different emergency departments--one was very rural and one was about 1 hour away from a tertiary center. Something changed, in a very palpable way, when my physician colleagues discovered I was going to medical school. Even though my knowledge base, education and experience hadn't changed--the way I was treated by the docs changed. One day a doc I barely knew and had hardly worked with turned around at the desk and said, "hey! aren't you the nurse that is going to medical school?" Um yes, and apparently word travels fast. He didn't know my name but he knew that fact about me.

Suddenly I was given more opportunities to suture (most of them knew that I sutured up North), I was invited to look at x-rays and shown what they were looking at, I was handed lab work and asked what the differentials were, I was doing small procedures under their direct observation. When I asked questions they really took the time to explain it to me, and then would often grill me about the answer at a later date. I was loving it. But it also left me feeling a little uncomfortable. I hadn't done anything special to deserve this treatment. There were many of my nurse colleagues that would have appreciated (and certainly deserved more than me) the interactions and opportunities I was getting.

If I had consistently had that degree of respect, that chance to discuss cases, and my opinion listened to I might not have gone into medical school. But every time I saw some medical student working through a list of differentials with a doctor or looking at an x-ray I thought "Hang on. I have a brain. I am curious. I want to know the rationale for these choices--not because I am being a bitchy-know-it-all-emerge-nurse-who-questions-your-every-move, but because I want to learn too".  But I was a nurse. And even though as a triage nurse I had to come up with differentials and acuity for every patient I saw I never had the reason or forum to bounce ideas off my physician colleagues. I did learn a great deal from the many fantastic, brilliant, hilarious nurses I've worked with along the way who've taken me under their scrub sleeve and shown me the way when I was walking around in circles (you know who you are...)

But it was that change in responsibility when I was seen as the 'nurse who is going to medical school' -and those extra opportunities started occurring--which solidified my decision. I was making the right choice to become a doctor. I couldn't live in the arctic permanently just so that I could have that autonomy and respect. At some point I'd have to live in the south where I was required to get an order to give a tylenol to a patient. It was too schizophrenic and too bizarre.

So now I am in medical school. And I feel a little schizophrenic again. Because I am still a nurse yet I am also a medical student.  Someday I will be a nurse and a doctor and I don't know what that is going to feel like or what that it going to look like in my practice. 

My first interface with the medical world as a medical student was very brief but gave me a glimpse of what is to come. We have this aspect of our education called the Early Patient Contact program which pairs us up with another medical student and we are given a chronically ill patient and a prenatal patient to follow for 2 years.

Our first meeting with the prenatal was at the doctors clinic, but we arrived before the doctor and the patient. The nurse greeted us and got us all set up in her office, let us use her computer to look at the charts, and went back to the main reception. During our entire interaction I wanted to tell her "hey! I am a nurse too!" but there was no need to and it would have seemed strange and artificial for me to just blurt it out. I guess a part of me wanted her to know that I knew where she was coming from, I wasn't some completely clueless 1st year medical student.

I have to chuckle at the irony of always wanting to come across to the medical students as a 'with-it' nurse yet now I wanted to come across to the nursing staff as a 'with-it' medical student.

I am pleased to see in my lectures from visiting consultants or during PBL sessions, nurses are mostly referenced with respect or used in anecdotes as the person who 'really knew what was going on'. Lecturers have made points to our class like "listen to the nurses", "respect the nurses and their knowledge", "nurses will save your ass" and "nurses will make your life hell if you come off as an arrogant medical student/doctor". All of which I, of course, agree with.

I almost never feel like a medical student, but some days I feel like a mole--sent by my nursing sisters and brothers to see what happens on the *inside* of medical school. What doctors really think about nurses, how nurses are portrayed in medical education. And of course I know, it comes down to the individual doctor and the individual nurse.

I am interested at the layers this metamorphosis will have for me. I like that the lines between nurse and doctor for me will forever be blurred because I know that I will always be a bit of both.   

In the meantime I'll be reporting back and keeping my fellow med students in line.

Desperately Seeking New Music

I need a serious injection of new music for my running mix.

Happily my knee has been feeling 100% (ok, maybe more like 97%) for the past 2 months, which means that I've been very slooooowwwlly and carefully getting back into my running regime.

YAY!

That only took a year of sports med docs, physios, orthos and massage therapists all giving me different advice (and telling me different diagnoses).

So the running is good but my music is stale and since it is January it means I will have more time to ponder the universe on the track while the 'resolutionists' take up the weight room. Like today at the gym I waited half an hour for the gang of 17 year old males (seriously people, who weight trains in a group larger than 2??) to free up a bench. Argh.

Anyway, this is the current mix in case any of you are in the same boat, any suggestions greatly appreciated! (No laughing at some of the songs).

Hotel Yorba--White Stripes
The Waker--Widespread Panic
Fidelity--Regina Spektor
I Gotta Feeling--Black Eyed Peas*
Stayin' Alive--N-Trance
Praise You--Fatboy Slim
Single Ladies--Beyoncé
SexyBack--Timberlake
Honey--Moby
Rich Girl--Gwen Stefani
Couch Surfer--Bran Van 3000
Black Sheep Mix--Z-Trip and Radar
A Punk--Vampire Weekend
Freedom '90--George Michael
Nothin' Better to Do--The Chordials
Time Bomb--Rancid
Know Your Enemy--Green Day
Pump It--Black Eyed Peas
Maneater--Nelly Furtado
Bug Powder Dust--Bomb the Bass
Where is the Love--Black Eyed Peas

Thanks to Ann Marie for the hand-me-down ipod and Cathy Lee for a great compilation that contributed to the set.

*If you need an intervals song--this is the best one evah.

Something A Little Lighter

As I mentioned, I'll be carrying over a few posts from my former blog...and I came across this one from last January. The time of year is right and I didn't want to do another downer post...just yet. Got plenty of those in the cabinet.

---

Normally I try and avoid yahoo "news" stories but I stumbled upon this random article today. I usually abhor the onslaught of  "Best Of"*, "End of the Year" lists and "Top Ten" type articles that surface in January...but I will admit...there were some real gems in this piece. It cracked everyone in my house up, so I figured it was 'blogworthy' (my own word for 2008).

My favorites on the list for "Word of the Year 2008" according to Macquarie Dictionary include:

bromance

(say 'brohmans) noun Colloquial a non-sexual but intense friendship between two males. [bro + (ro)mance¹]

fanta pants**

(say 'fantuh pants) noun Originally British Colloquial a person whose hair is naturally red. [from the orange-coloured soft drink Fanta + pants, with reference to pubic hair as the indicator of hair colour]

flashpacker

(say 'flashpakuh) noun Colloquial a backpacker who travels in relative luxury. [flash(y) + (back)packer] --flashpacking, noun

and

fur child

say 'fer chuyld) noun Colloquial a pet animal, as a cat or dog, treated as one would a child.

Oh and John, you are not allowed to make any comments which may draw parallels to my travel style and any of the above definitions. :)

*Exceptions being the 'Old Favorites' on IDDX, as well as Maha and OMDG's 10 year review.

**Incidentally, here in Ireland they call red-heads "Gingers" or "Ginger-balls". It is not exactly a term of endearment either.

I Wonder If I am Cut Out For This

I was putting off writing about him as every time he crossed my mind, my eyes would involuntarily well up and that lump in my throat would appear.

Now as I sit to write the kilometers are stretching out between us and it has been days since I held his tiny hand in mine. Or rather that he spun his misshapen fingers around mine, holding my index in his soft grasp. I could feel the tiny nodules that marred every joint on his underdeveloped body. I was afraid of putting too much pressure anywhere that would invoke pain. I handled his body like he were made of blown glass. Unlike his mother who dragged him in to my office, her arms encircled under his armpits, the rest of his body hanging awkwardly as she walked forward. Her body banged into him with every step.

He wasn't diagnosed with the congenital disease known as Farber's Syndrome until he was three years old, which was long past his life expectancy. Born to a mother who was 14 and looked like an emaciated 12 year old. It felt perverse imagining Paulassie's conception. Her expression shifted from vacant stare to passively disinterested. She was there, but not really. I wondered about fetal alcohol effects when I spoke to her. So instead I addressed Paulassie's grandmother, who seemed to be not only the primary care giver, but also the only wage earner in a house that supported six people.

His disease was essentially autoimmune, like asthma or arthritis. So few cases documented even the massive search engines online turned up only vague references to the disorder or obscure articles in foreign medical journals. Their bodies bent on destroying their own tissues so efficiently that the children rarely lived past 6 months. Their swallowing mechanisms were faulty resulting in many pneumonia's due to aspiration, their eyes were affected by severe astigmatism which made vision nearly impossible, and their joints would be covered in painful nodules which deformed them beyond function. Their larynx also suffered degeneration which caused these babies to have a distinctive hoarseness. The part that I wished I didn't know, was that when these children died and their brains were autopsied it showed that most had entirely normal brains. Thus many live with cognitive functioning that remains untouched. They are tiny creatures trapped inside a ramshackle body, minds intact.

And so there he was in my office that day. His eyes moving back and forth so quickly that it was obvious that he could not be focusing on anything, any attempt to do so was futile. He had a cough that shook his entire body but he lacked the ability to expel the phlegm which rattled his chest with each breath. He seemed listless but alert. A vulnerable little being on the stretcher. I examined him and shuddered at the sound produced by his lungs, causing me to reflexively clear my own throat.

At first it seemed to me to be a routine examination of a handicapped child who had a nasty lower respiratory tract infection. I spoke with his Grandmother about the importance of thickened fluids, his antibiotic regimen, antipyretics, etc. It was the end of the day and I was anxious to take my long overdue lunch break. What more could I do? I didn't know anything about this disorder except what was outlined in his care plan. I was hoping this visit was almost over. His Grandmother remained still. It became evident that she was not ready to leave.

Then she mentioned their last trip to the Sick Kids hospital to see a specialist, it became clear to me that there was a bigger question in front of us.

At age 4, Paulassie had long outlived other children suffering the same disease. At some point there would be a mark of deterioration, a place where the medical care would shift from multi faceted to palliative. But we didn't know when the point was going to be.
He had been ill for several weeks now, the last course of antibiotics seemed to only marginally improve his health. Yes, it could be viral, but it could be worse than that.

As his Grandmother spoke of their trip South, she told me she would never return Paulassie to a specialist again. "He never treated us like we were people, he never shut the door to his office when he looked at Paulassie, he started doing something on his computer and ignored us." By the end of her remarks she was crying. She was a proud Inuit woman, one of the leaders in this community. A respected Elder. She supported her children, husband, and handicapped grandson. I couldn't help but wonder what the eyes of the specialist saw when he looked at her, or her grandson. Perhaps he thought she didn't understand the situation, that she was simple. How could he explain to her the complicated nature of Paulassie's disease, the likely outcomes? So why bother? Her English wasn't impeccable but I was sure his Inuktitut would have been pathetic.

Maybe it was he that didn't understand. That when you raise a child that is in pain, deformed, and requiring care 24h a day you understand the situation on levels than can never be expressed in any language. Dissected by any specialty. You understand that your own heart aches with such heaviness you dare not even hint at it's weight, for if you did you would surely buckle under the burden.

And so it was there in my gray office, as the snow swirled outside and the wind howled, she asked me without saying a word--was this the beginning of the end? And without making a sound I replied--I don't know.

Paulassie smiled and stroked my finger with his own. He twisted his face toward the voice of his Grandmother while we spoke. I looked down at this sweet natured little being who knew not what was spoken, and what was being left unsaid.

Now the tears simply rolled down her face as she tried to convey her fears and her love for Paulassie. Struggling for words she dropped her hands in defeat,

"he is my heart".

Perhaps all that I learned that day has yet to be revealed to me. What I carry now is an attempt at understanding where people are 'coming from' when we see them out of context in Big Hospitals. Here to see The Specialist. For some it is a journey of 1000km, a language barrier, and a claustrophobic city full of strangers. Unfortunately we can never know where people are truly 'coming from'. Yet I think it is something to consider. Sometimes we can't know that when skimming over a respiratory illness in a small child, we may be holding someone's heart so delicately in our hands.

----


Since I have made my initial blog private I will be bringing over some of the medical posts from there . Sorry for the redundancy to those of you who've been reading since way back when I was an Arctic traveler. If you'd like to have access to ohtanninbound just drop me an email (address on my profile page). Cheers and Happy New Year!

TWINS!!!

This New Years day also brought with it a new niece and nephew for ABB! Indeed. On a blue moon, a full moon, and January 1st to boot.

For the medical peeps: my sister in law is a 40 y.o G2P3, had uncomplicated SVD at 38 wks, male child 6lbs 5oz and female child 5lbs 11oz.

For all the rest: Maxiums Alexander and Ella Jane and my S.I.L Karla are all happy and healthy.

This makes 7 nieces and nephews in total for me now, and certainly the last for all my sibs.

I am so pleased that everything went well...when you are a medical person you can't help but have every complication swirling in your head the entire time someone in your family is pregnant.

I had a moment of pout face yesterday at the thought that I missed their arrival on the planet (and that I wasn't there to give the nurses and docs a hard time hand). One of the frustrating things about living in lands far away from home. Sigh.

No pics of the babes yet...in other news (i.e my boring life) I bought a mohair/wool blanket today to get me through the cold damp winter months which remain here on the Emerald Isle. She's a real beaut.

Is it a bad sign when you get that excited about a wool/mohair blend??

New Years, Now and Then

tMy Manfriend's parents are here for the holidays, and we've been doing the tourist-thang with them in Dublin and now back in our neck of the woods. Yesterday we walked around some castle ruins and a small hobby farm. There was a damp chill in the air and the low branches on the trees made the afternoon feel like a scene from Sleepy Hollow. I like this photo because you can see the duck just starting to take flight.

Whether I like it or not, January 1st brings with it the mark in time, the reflection on the year and years passed. Where was I last year? What was I doing for New Years Eve? Well this year I was in my living room eating filet mignon. Tobie and I capped the evening with some very bizarre UK television specials, including performances by Boy George and George Michael (maybe it was part of their community service obligations...)

A street in Dublin on St. Stevens Day

In 2007 I brought in the New Year with John in Morocco. I cannot pretend that I loved every minute of that trip as there were many bumps along the way---lost luggage for 6 days, colder than expected temperatures for climbing, sketchy rooms in Casablanca, roach infested train rides...but John put up with me nonetheless and we had some great times despite the surprises. I thought the contrast in color, cities, food, climate and company from 2 years ago until now was worth posting.

The only day the sooks are closed up and silent. The Feast of Abraham which also happened to fall on New Years Day.

The locals simply referred to it as "le fête" while simultaneously dragging their index finger across the throat. This was usually done with a large grin on the face (making the throat cutting mime that much more disconcerting). They'd excitedly ask us, "What are you doing for the fete???" *slash, slash, slash*.

The fête is a great celebration which often involves the slaughtering a sheep (or goat, etc.) to commemorate the willingness of Abraham to kill his son as it was God's will. Instead--by God's command--he killed a ram. We didn't follow the 'when in Rome' rule on that one but we did enjoy the fireworks and festivities.

A street in Morocco on St. Stevens day.