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

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

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

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

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

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

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

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

Tomorrow At This Time

MCCEE? Bring it.

Study Daze

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

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

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

Gen: How about hypokalemic metabolic alkalosis?

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

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

Perfect. 

The Burden of Work

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

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

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

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

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

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

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.   

Lust in Translation

I was told last week by my attending that having a medical student sit in on consultations all day was "a bit like having a hitch hiker in the car". That it made him feel slightly self conscious and ill at ease. I thought this was a rather hilarious analogy and so I repeated it to my new attending this week.

He too found it amusing. 

At the end of the day I was saying thank you and going on my merry way and down the hall I called out, "thanks for giving me a ride all afternoon" in reference to the hitch hiker statement. He was smiling and waving and then abruptly stopped with a strange and slightly embarrassed look on his face. 

Yeah. Then it clicked. I've made this mistake before. 

Ride in Ireland = Sex. 

Smooth, ABB. Really, smooth. 

Oh COME on!!

Last Monday I started my placement at yet another hospital. It is the frustrating thing about this rotation: in an effort to expose us to various communities and outpatient clinics we have to travel to a new attachment for each of the six weeks. So, after the debacle in Hospital, Ireland two Mondays ago, I once again gave myself plenty of time, looked at two maps, and plugged my destination into the sat nav. 

I should have known that things were taking a turn for the worst again when the road began getting smaller and smaller, the crumbling castle ruins and petrol stations fading into the distance. Two old Irishman standing at a gate completely stopped talking to watch me roll by. Clearly I wasn't a local and clearly I didn't know where the eff I was going. 

And here, pictured below, was where my trusty sat nav directed me to. You may be able to read the "empty" status of my gas tank and appreciate that I had to back out  down the road because it was too small to turn around on. Yes, back out past the Irish farmers whose expressions may or may not have displayed a smirk at guessing my displacement. 

Of course I had to bail, once again and call the facility and request directions from "somewhere near the castle*". When I arrived, late, everyone made such a fuss over how often people get lost and how sorry they were that I had started my Monday that way. I was told to take a break and tea was made, scones were proffered and I figured, "Hmm, I could really get on board with this whole psychiatry thing!"

---


*Reason #342 that I love Ireland. 

Understandably Lost

Tuesday was the first day of my new attachment in psychiatry. I had google mapped how to get there and saw that it took 39 mins, so I gave myself an hour. My prof had also passed on the typical vague Irish direction set, "Take the road, it kinda veers, follow that for a while, eventually turn right before the motorway, near the hill, you can't miss it..."

I figured, "a hospital in the midlands, how hard can it be?"

In Europe it isn't uncommon for many little towns to be on top of each other. You don't realize you've arrived in a new place because all you've done is cross the river, or cross the street. So when I was quite sure that I was getting close to the town my hospital was in I saw this sign:

So I followed the sign to the hospital, naturally. I was, in fact, delighted that someone had been clued in enough to provide direction to the hospital! I drove and drove, but seemed to be getting farther away from any town, with no hospital in sight. I was getting nervous now too as it was getting close to the hour I was supposed to start. 

Then I see the big sign, "Hospital". Perfect. Except I cannot see an actual hospital-y looking building anywhere. I see the "Hospital Traffic Calming Area" signs so I know I am in the area...but then I start to think that maybe I am having a mini-stroke or something because there is no hospital to be seen. 

Finally, I get out of my car to inspect an old, yet stately looking building which could certainly be a dilapidated Irish community hospital, only to discover it is in fact a town hall. 

I am now 10 minutes late. I give in and call the number given to me during orientation week, having no idea if it is the consultants mobile or the hospital administrator's emergency line . A woman answers and I say, 

"Hello, my name is ABB...I was supposed to start my psychiatry rotation today...but I appear to be lost. I followed the signs to the hospital but I can't seem to find it....anywhere!"

She chuckles. I am now acutely mortified by the fact that I am late and lost on my first day. 

"You're in the town of Hospital. Like how Kilmallock is the name of the town, you're in the town named Hospital...take the road back to Kilmallock and ring me when you get there. I'll give you directions from town."

Of course the town of Hospital had to be spitting distance from the town I was doing my placement in. 

Of course the town of Hospital has no hospital. 

Of course. 

Hospital Fashion

This week has been comprised of mostly lectures and case-based learning for psyche. It's been a nice way to wade back into the hospital pool. My head would probably explode if I were doing 4h ward rounds and being pimped on things like the causes of ascites.

Also, our professor of psychiatry is a very dynamic, engaging lecturer who ensures we don't get bogged down in the language and the esoteric aspects of mental health. So that part has been entertaining and educational.

The other day I thought something he said was quite simple, but interesting. We were talking about the dress code on the psyche ward. He scanned the room to take in what we were all wearing (various degrees of LL Bean, basically).

Turtlenecks, they're so hip right now...turtlenecks.

He nodded and gave his approval, then said, "Just think, when you're getting dressed to come to the psyche ward, it is not about you, it is about the patients. If you're wearing provocative clothes, loud, dangly jewelery, etc., you might distress or distract some of the patients in ways that are uncomfortable for them. Bottom line: it is not about you."

I really liked that way of framing it. Because the school has given us detailed lists of 'acceptable' clothing options, though I have seen some...er...interesting outfits trotted out. I think looking at what you wear to work in that light is probably the best gauge for appropriateness. Who am I wearing this for? And I'd say it applies outside the realm of psyche too.

All this, of course, coming from a woman who hopes to spend her life in scrubs and outlandish clogs. 

Back in Eire

More airports, dragging my luggage behind me. More waiting at stuffy gates and cueing for dingy bathrooms. I was able to slightly balance my suitcase on my thigh while weighing in, which allowed me to avoid the $250 excess charge. I didn't feel guilty because last week they charged me $106 and then promptly lost my luggage for two days. I was worried my meeting with Brian was going to be in 3/4 length pajamas with hearts on them and a team-building exercise 1999 t-shirt.

The bright side was being met in Shannon by a friend who had packed an airport picnic lunch. Nothing like arriving to smoked salmon, Greek yogurt, and fresh berries, and a weak cup of Irish coffee.

Two days of mini-vaycay on the west coast, going to my treasured beach and drinking coffee at Moll's Gap was punctuated by having to wake up at 6am to drive to the hospital for my first day of placement.

Thankfully, I am doing a psyche rotation first which means a week of lectures before hitting the ward. It's been a nice way to ease back into school after a fairly frenetic summer, couch surfing from Squamish, BC to Charlottetown, PEI.

Right now life is a little hectic, 1/3 of my belongings in Kerry, 1/3 in the house I am moving into, and 1/3 in my current digs (a spare room at my friend Marg's parent's place) . I was going through bags finding camera battery chargers, hand blenders, lavender oil, textbooks, protein powder, pencil cases, and mittens, all thrown together. Needless to say I'm trying not to feel as scattered as my possessions.

For now, I have my notebook, two pens, clothes for work, and a travel mug. I'll survive the next few weeks until the dust settles. 

Final med: no excuses!