Success / Fail

Success:

When you correctly diagnose an appendicitis in a child who no one thought had appendicitis.

When you think you heard coarse lung sounds in the right middle lobe and (lo!) the x-ray shows a RML pneumonia.

When you finally get a kid who has clamped his teeth down on your tongue depressor to actually open his mouth wide enough to see tonsils. 

When part of your work day involves witnessing a 4 y.o perform a convincing and prolonged air-drum solo on his dinner tray with 2 brightly colored straws.

When you finally get a sample of liquid gold urine from a child with tummy pain and a fever.

Fail:

When you are taking a history and ask about immunization status and the parent states, "Immunizations are not based on science". 

When you ask a parent to keep their kid from eating any food until their nausea / vomiting / abdominal pain are sorted out and you go back in the room to find the child eating bright blue cotton candy (or is that a success because the child is clearly feeling better?)

Peds Say the Darndest Things....

I had a patient who came in with a very itchy rash over her entire body. It was a busy day and she waited with her dad for about 3 hours before being seen. She readily jumped up on the bed and pulled up her dress to show me the angry red bumps on her belly, then kicked off her black boots to show me the bottom of her feet, which had been spared.

Her little thighs were raw with scratching and I felt terrible for her long wait. I said to her, "I am so sorry that you had to wait so long to see a doctor, especially on this lovely day".

She shrugged and said, "It's okay, I know you have lots of other patients to see too!"

She was six years old.

In five years of emergency nursing and three years of medical school I've never had an adult respond with the same selfless and realistic view of the situation.

Adults of the world, take note. Children of the world, stay awesome.

Peds? Really?

First of all, I love pediatrics!

Children are such completely different animals. My experience so far with pediatrics has been fairly limited to the odd asthma, RSV, gastro, or rash that presents to general emergency. But working exclusively in a pediatric emergency department has been a completely different reality. I have really been enjoying the challenge of trying to connect with children, like figuring out ways to make clinical exams tolerable to them or jazzing up the neuro exam to make it like a game. I get to be kind of silly and fun, disguising the seriousness of it all. It's a treat, especially when you can get on the level with a kid. Most of them seem to lack the hang-ups that adults have around illness and disease. They are stoic but not in the look how stoic I am being, so stoic that I am actually not providing accurate information to my health care providers way that adults are. There is a different kind of job satisfaction that comes with helping to name a new teddy bear (Mr. Fall off the Wall) or getting an energetic high-five from a kid who was burying himself in his mother's skirt for most of the history. 

Plus, I always thought that (because I am really not that great with kids in the real world) I'd dislike pediatrics. And then there is the crazy parents, who also frighten me. But it seems that crazy parents are not as common as I'd imagined. Or maybe I am just not noticing them because my interaction time with parents is more limited, compared to when I was nursing.

The hospital is beautiful, brand new, and completely child-centered. T.V in every room, popsicle fridges at every corner. The staff seem to really love their work. I'm so impressed at how they are able to balance between the focused intensity of acute care while making it fun and minimally scary for the wee patients. Everyone is just so nice. Maybe it is harder to be a curmudgeonly pediatrician or crotchety nurse, I don't know.

It's been a great learning experience also, being put in with the residents for all of their teaching sessions and tutorials. Their simulation training has a dedicated faux trauma bay in the department, complete with all the drugs, pumps, and machines that go bing! We did a session on Thursday with mannequins that are very realistic (heart, breath, bowel sounds, as well as pulses, intubatable throats, seizure capability, etc.). All the mock codes were run in real time, that is, you wouldn't just say, "I would start an IV and give ceftriaxone", you actually assign the task of IV start to one of the team, they put in a line, someone draws up the actual drug and sets up the infusion. The enthusiasm to teach and job satisfaction of the attendings is contagious and I must admit I look forward to every shift.

It is strange though, being in a new city. I feel like I am regressing as an adult. No phone, no car, no idea how the city is laid out. I walked for over an hour in the hopes of buying a new burner only to  find they were sold out. The saleswoman kindly advised me to call ahead next time. I gently pointed out that I didn't have a phone, hence why I was trying to purchase one! Sigh.

And so, getting settled in. Trying to enjoy each day for what it offers. I have already managed to locate and join a yoga studio for the month, so at least some physical activity will take place. Did I mention there is also a very decent wine store down the street allowing me to finally taste my favorite American grapes again (in Ireland you're lucky to find Ernest & Julio). It's Friday night, I'm post hot-yoga and ready for a glass of red and my new book.

Back to work tomorrow, the adventure continues.

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. 

Back in the Fold

I believe when you're a 10 y.o girl shopping at "Claire's" = Nirvana

Touched down in Canada yesterday. Into the bosom of my family, greeted at the airport with hugs and a packed lunch of roasted vegetables and broiled salmon. Had been bumped to business class on the long haul part of the flight but still managed to catch no sleep. Leaving Kerry was punctuated by a pathetically slow packing effort on my part. But that is a whole other story.

Yesterday my niece Rachel and I found ourselves at the Farmer's Market, though it was late in the afternoon so only a skeleton of stalls remained. We dined on mini-doughnuts and then went to the mall where we were sucked into a vortex of hot pink or shiny made-in-China trinkets. I think maybe we enjoyed ourselves a little too much in the sunglasses section. The sugar high must have gone to my head because I did nearly buy a faux diamond tiara and rainbow leg warmers.

Justin Beiber said whaaaaaat?

Operation Smile

I walked out of my final short case exam on Friday with a cryptic text from an unknown number simply stating "please call S____". Still buzzing with adrenaline and excitement at being done I dialed the number, worried that something was wrong, perhaps with someone I knew.

"Hello, this is ABB, I received a message to call."


"Yes, hello ABB, are you finished your exams?"

The slight worry ratcheted up one degree.

"Yes..."

"Oh good. Well I can congratulate you on that and something else as well...you've been selected as the recipient of the Operation Smile medical student fellowship!"

[Cue exhilaration and dress wearing suppression of cartwheels on sidewalk].

I think I then said the words delighted and thank you about 17 times. She added that the competition was stiff but they thought that I'd had some amazing life experiences and that the organization wanted to add to that list for me. Which I thought was such a lovely thing to say.

Of course I am honored (and surprised nearly beyond belief) that I was chosen. Being unable to take on international electives or sign up for volunteer work since starting medical school has been difficult, especially after getting a taste for it on my Himalayan expedition in 2008. I've been having to bide my time and just look forward to future opportunities much further down the line. But now, I won't be waiting long at all!

This is such a gift for me, and I am fully aware of the fact that it is the chance of a lifetime. According to their website they receive thousands of inquiries a year from medical students, for only about 20 available positions. I. Can't. Wait.

Still don't know when or where, but will be keeping the blog updated as things unfold. I still can't believe that third year ended on such a high note, especially after the last few months. And so, back to packing boxes. Smiling.

Image from http://www.operationsmile.org/

[Incidentally, you can donate to Operation Smile any time!]

Heaven and Hell

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

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

 

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

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

 

We spent Tuesday and Thursday hammering for the clinical exams. 

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

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

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

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

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

Awesome and awkward. 

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

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

Cottage Love

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

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

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

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

Welcome To the Jungle - 2012

Things are starting to pick up momentum here on the wild west coast of Ireland. Exams are exactly two short weeks away (eep, why I am I still typing this blog post instead of memorizing differentials for fatigue??)

A brief look at life for the next few months:

May
-exams
-pack up house
-move things / car into storage
-fly home

June
-start pediatric emergency elective in Alberta (4 weeks)

July
-have a week 'off' (see below for what will actually be happening during 'off' days)
-start gastroenterology elective in Nova Scotia
-start CaRMS application process (Canadian post-graduate application)
-have 10 days holiday to study for MCCEE (Canadian board exam)
-fly back to Ireland, find place to live / move in / start psyche rotation

August
-study for boards while doing psyche rotation while working on CaRMS

September
**Canadian Board Exam**

October
-CaRMS and obs/gyne rotation

November
-Submit CaRMS
-collapse from exhaustion

December
-hit 'refresh' on email inbox until residency programs start emailing
-possibly decide that I'll stay across the Atlantic for post-graduate training

Just typing all of that gave me a facial tic. I may have to start playing this song everyday when I get out of bed.


 

Permission to Take Blood

A sprightly 72 year old came into the office for a prescription refill and blood pressure check. His tie was tightly knotted, thick hair combed into place, and shoes well polished.

We asked him once more if we could take blood to screen him for the routine things; high cholesterol, diabetes, prostate antigen. Once more he said, no doctor, I don't want to know if something is a brewin'. Not interested. 

Joe pressed him a little, sure come on now, are you sure you wont let us?

To which his eyes shone a little brighter and he answered, listen Joe...if I walk out into the street and collapse in front of the surgery, tell ya what, I give you permission to take as much blood as you want.

Fair enough!