Monday, December 28, 2009

Damn You Embryology...Damn You

Today I woke up and took a good long look at my embryology text book. I thought, "gee, wouldn't the holidays be a great time to really cozy up to that chapter on formation of the gut tube"?

No. No it wouldn't.

Am I going insane?

Well, yes and no. My anatomy prof is obsessed with embryology in a major way. He also loves lymph drainage, to an almost unnatural degree. He likes to constantly point out the fact that if you know your embryology inside and out then you will also automatically understand all the drainages for lymph, the visceral vs somatic innervation of things, and blood supply.

From my very cursory knowledge in the matter, he does seem to be on to something. It's just a matter of learning all this somehow on top of everything else that I have the difficulty. I spent mucho time on embryo studying and there were absolutely ZERO questions on the multiple choice and long answer exams. Only a smatter of questions on the spotter. I do not want to get into that irritating mentality of "am I going to need to know this for the exam" but when the volume of info is massive you can't help but let your mind wander there. I try and think of it in the practical way, "how is this going to present itself clinically and how will that matter?" None of my patients are ever going to ask me how I did on my anatomy spotter in 1st year, but they may want to know why a drug works, or what the complications of a procedure might be, or what causes an auto-immune disease.

I know, I know. I have already had my rant on this recently. I'll stop.

I wonder sometimes what the massive nerd-go-getters do over the holidays. Am I lazy for having taken the last 10 days off to cook, read, sleep in, watch movies?

One last tangent...a classmate of mine recently got me hooked on a BBC television series called "Bodies". If "ER" had been realistic, set on an obs/gyne ward in the UK, and everyone had had Irish/Scottish/English accents it would have been this show. (Oh, and if the sex scenes/O.R scenes had been a little more graphic.) It's a cringingly realistic med-drama. Quite good. And I usually stay away from that kind of 'entertainment'.

Friday, December 25, 2009

Fake Snow and Do-Wop

Yes, it was certainly another non-traditional Christmas in the land of Albinoblackbear. Last night we opened--well we didn't even open--we handed over our pressies.

I think I came out on top with an amazing CBC t-shirt (for my American friends, CBC is the Canadian equivalent of NPR--without the fundraising drives). I have an obsession with CBC. To the point where I even write fan letters to people like Eleanor Wachtel (for the record both her producer and the best interviewer of all time herself--Ms. Wachtel--wrote me back). Needless to say I haven't removed the shirt since it arrived in my hot little hands. Tobie (Manfriend) also gave me some great CD's, Rosanne Cash, the List and Chip Taylor and Carrie Rodriguez's Live Album. Double score. And to round it out, some beautiful jewelry from Tobie's mom and this insane piece of art that she bought for me because she saw it and thought that the woman looked like a 'lady doctor'. His mom is an artist so she finds these quirky things in the strangest places. Anyway, I love it and it's total uniqueness.

We went out to the pub last night to meet up with some of Tobie's friends from the orchestral music scene. I couldn't believe how wildly busy the downtown area and pubs were. People were crammed into doorways, reaching their pints high in the air to walk to a table of friends. Young, old and everyone in between was having a good dose of Christmas cheer. The packs of smokers huddled confined by rickety barriers on the outskirts of the pubs. We had some cider and hit the road back to the apartment. On our way by Arnotts they were pumping fake snow out of vents above the doors. Shoppers were streaming out speckled in large flakes on their peacoats and handbags. I had to laugh, being the to-the-core Canadian at the novelty that is snow at Christmas.

Got home and enjoyed a Christmas Eve feast.

Dessert was the best.

Behold the profiterole. Thanks to Marks and Spencer.

One of the major advantages of being with a Frenchman (well, a Quebecois to be exact). They appreciate (and endorse) the traditionally French dessert. Yum. Must admit that I enjoy it much more than my family's pumpkin pie finish to our Christmas and Easter dinners.

I was thinking about my last two holiday seasons which also were far from my family. Last Christmas I was working my yorkshire puddings off in a string of long shifts in an emergency department on the west coast. The Christmas before I was stranded in the BC interior mountains due to a large pass of black ice stretching between me and my relatives 9 hours away. Had a cozy celebration enveloped in the warm living rooms of my friends in Revelstoke.

My first time away over the holidays was in India when I was 20. I was staying in a rented room on a pig farm on the west coast of Goa. The toilet was an outhouse which had a small hole along side the squat toilet. When the door to the outhouse would open the pigs would squeal and fight their way to have it be their snout in the hole in time for the next delivery. No one believed me so I did manage to get a photo one night, the snout clearly visible between my feet. One of the other people renting a room at the farm knew I was a bit homesick and painted me a Christmas tree, the size of my palm, and stuck it on my door as a piece of cheer. I felt far far away from home.

Again I am far away from home and will be for some time.

But as Tobie always reminds me when I get down about being away--it's not where you are, it's who you are with. And I am loving our chance to enjoy some downtime in this magical city together.

Tuesday, December 22, 2009

Un Fait Accompli

Finals are done and I am enjoying my book, the streets of Dublin, and present company.

At night, the city is this beautiful crush of lights hanging above in different designs and colors. The crowds of people move one step behind their breath streaming out in front of them, big bags and winter coats. Christmas carols spill out into the cobblestone street.

Life is impossible to predict. I would have never guessed--last Christmas during my 16h shift in the ED--that I would be here in Dublin a year later.

Had my breath taken away today at the old library in Trinity College.

And of course I am nursing the beginnings of a post-finals upper respiratory infection. Hoping the megadosing of vitamin C isn't rendered ineffective by all the mulled wine.

Thursday, December 10, 2009

It's 1am...Do You Know Where Your Extensor Pollicis Brevis Is?

I have been trying to adhere to a humane study schedule this week, i.e:
0730h--arrive at gym, start work out
0900h--get home, have breakfast, shower, start work
1300h--anatomy study partner arrives and we go through 2 of our 14 cases
2200-2300h-read book, spend QT with Manfriend, watch reruns of Extras, yoga.
2300-0700h--sleep like a wee baby

Yeah, not so much.

More like

0700h--rise and drink espresso while trying to pry lids open
0745h--arrive at gym, wish I was in bed...send evil thoughts to person who nicked my sweet SIGG waterbottle on Tuesday
0900-0930h--faff on FB
1000-1100h--read my favorite blogs
1100h-realise that study buddy is due to arrive in 2h and need to get cracking
1800h-break for dinner and decide that I'll make a roast dinner for all my housemates and Mandfriend (why is it that studying brings out the BEST gravy in me??)
2030h-2230h--study, feel behind, wonder how I will get thought all the material
2230h-0100h--feel too tired to read textbooks but not too tired to read my current novel
0100-0700h-toss and turn all night whilst have repeating nightmares where I am trying to draw the formation of fetal heart on a white board and I can't even remember what that big vessel thingy is that is coming out the top is called...or I am trying to point out the intrinsic muscles of the hand on a model and suddenly I can't speak...or any variation of this study-mare.


My friend Shane has stated that the night of finals we are going to 'see the health care system from the other side' and 'get in a fistfight with a lamppost'. This is what keeps me going.

Pathetic isn't it?

Crap it's 1128h. I am behind schedule even on my procrastination....


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Tuesday, December 8, 2009

You Know You are Studying for Finals When...

Your dinner is a can of tuna in a coffee mug.

You know you are stressed and studying for finals when you feel guilty for having taken the time out of your studies to prepare aforementioned dinner.

Monday, December 7, 2009

For Whom the Bell Tolls

My life (and therefore my blog) is going to be at another all-time low of excitement and variation for the next week.

Classes are done and I am studying for finals which start next Monday. We have our new-age multiple choice extended matching question exam in the morning then our goodluck bluffing your way through this long answer exam in the evening. Wednesday is the death by firing squad anatomy spotter.

Until then I will be developing decubitous ulcers on my derrière from sitting all day long and attempting to focus my mind long enough to memorize, nay, understand all this information that has been tossed my way over the past few months.

Stay tuned for hypointeresting posts while I use my blog as a procrastination tool.

Or maybe I'll jazz things up with a montage of things I'd rather be doing...only time will tell.

Monday, November 30, 2009

Mock Anatomy Spotter: About as Hip as a Mock Turtleneck Sweater

(mock turtleneck)

When I was 20 I dated a guy who was in medical school. I remember him telling me about the anatomy spotter exam (they called it a 'bell ringer'). It sounded ugly to me. I envisioned all these really nerdy science freaks staring at bits of bone and looking into microscopes with a loud gong going off every minute or so. People would get so stressed that they'd vomit or get nosebleeds, fainting also wasn't totally uncommon.

I remember thinking...someday I'm going to have to do one of those and I know that I am not going to like it. For those of you who have not had the pleasure of having your cerebellum slapped with a hockey stick (which is what I equate the experience to) this is how it goes.

You sit down, there are 10 people or so in your circuit. In front of you is a laminated 8x10 of something, either a CT image, a dissection image, an xray, an MRI, a photo of a bone, a electron micrograph of an embryo or a photo of a histology slide. You have 2 minutes to answer the two questions, a bell rings and you get up and move to the next set of images/questions.

In the case of my evil anatomy prof the questions were not, "what is a" or "what is b" they were things like "if 'a' is damaged which structures will be affected and how?" or "what is the metabolic process occurring at 'a'?" or "what genes are expressed to ensure differentiation at 'b'?" Of course it wasn't only 4 options, but 8 to choose from as well. Thanks so much for that.

Yeah. It was ugly. And the thing that irritated me was the complete lack of clinical relevance to most of the exercise. Yes I do believe that you have to know your anatomy so well that you can answer questions under pressure in a rapid fire way....but in the 'real' world I am never going to have an unlabeled histology slide sitting in front of me with a patients life hanging in the balance while I figure out if it is from his spleen or his seminiferous tubule. Come to think of it, I am NEVER going to have a histology slide in front of me clinically...ever. That is what lab reports are for. Nor am I going to be staring at the saggital section of a fox jaw trying to decide if the cleft would be in between the canines or the incisors if "a" doesn't fuse with "b".


Ok my rant is done. I suppose that the exam had the desired effect: it scared the rubber boots right off me. Hence my 7 hours of dedicated examination of all-things-laryngeal on Sunday rather than reading my fantastic book (Shantaram by Gregory Roberts) or watching the flood waters rise outside the medical sciences building.

(mock spotter)

Courtesy of here.

Monday, November 23, 2009

Email Quote of the Day

Today was our mock anatomy spotter (post regarding that to come so I shan't go into too much detail right now). Suffice to say, admit your shortcomings and others will suddenly do the same to you...

My email:

Yup. I just ate my weight in pepperoni pizza in the hopes that it'd drown the pain of trying to figure out if it was a female or male pelvis on the MRI....and was that a beak? Or a feather? Or canines on the embryo question?? I swear Giles threw in some vet medicine just to test our mettle.

The response from one of my study partners:

OMG I totally know which question you mean!!!!! I def answered it thinking that it was female and then about 2 seconds before the bell went realized that this female had a dick...damn!

We are the doctors of the future people. Stay healthy. :)

Saturday, November 21, 2009

Bright Lights, Big Residency

This week the program director for the family medicine residency program in Newfoundland came to speak to the Canadians in our group about working and/or doing a residency in the Maritimes.

I am not going to make a secret about the fact that if I HAD to choose a residency at this exact moment in time it would likely be a 2+1 program in emergency med or anesthesiology. In Canada we have these residencies where you do 2 years of family medicine and then a year training in a specialty like emergency, anesthetics, surgery, oncology, womens health, etc.

This allows one to practice in only a slightly limited scope in that specialty. For example, you can work as an ED doc in any non-tertiary emergency department, you are not an ERP...but you can perform the same procedures as an ERP in a clinical setting. To be honest, I'd love to do a 2+1+1 in emergency and anesthetics.

This is why.

Last summer I worked with several South African anesthetists who also worked in the ED as emergency docs. When things got hectic, they had just that little additional skill edge of being uber comfortable with paralytics and hypnotics--and were also very proficient with procedures like lumbar punctures, intubations, nerve blocks, central lines, etc.

I thought--schizzammm! This is the perfect combination of backgrounds to be a very badass and on-top-of-things ED doc. (I know that this may have also been partly because they were Saffas and just used to doing 100 intubations a day and sewing people's arms back on in the ED when they worked in SA.) Regardless, it really got me thinking. It is so useful to have the two skill sets plus a great way to be prepared to work in rural emergency and international medicine situations.

Back to the Newfoundland presentation.

The program director was talked a lot about how they specifically orient the program toward eventual rural practice, they in fact have a 2+1 program for emergency medicine, and they choose their large hospital attendings very carefully--i.e they choose surgeons, internal med, obs specialists who actually believe in the importance of a very well trained family medicine physician. They don't want you to be the lowest rung on the ladder when it comes to procedures or input. Apparently the school feels so strongly about this they will actually put you in a different rotation if that starts occurring. Pretty amazing if you ask me.

So I asked him what his thoughts were on training in a large urban setting, like Toronto or Vancouver in ED's where you are going to see a lot more trauma, many MI's, septics, etc. and perform dozens of procedures a day...vs...doing a program that is rural focused and set in rural hospitals where you may have a lower volume of the high acuity presentations. Which is better for someone who wishes to set up practice in the Back 40?

He told me as a 2+1 resident in a major center I'd be the bottom rung and even though the high acuity presentations are more plentiful there will be 4 specialist residents and a fellow ahead of me in line to even peek at these presentations. Many specialists will feel I am a waste of their time because I 'only' want to do family medicine (which is kinda funny because I don't actually...I want to work in an ED but I don't feel like doing a 5 year ERP specialty is really necessary for my career aspirations). I know that in the hospital the ED docs are crapped on by the specialists anyway so I am used to that...but I digress. He also said since in the rural hospitals I'd be 'it' in terms of residents I'd get to do as much work and as many procedures as I wanted. Be on call as often as I wanted. This definitely appeals to me. And I can certainly relate to working with the docs who trained in an urban setting and then were clinically very useless when they first got to rural settings where there was no neonatal team, no stroke team, no respiratory therapist, no 24h lab...madly tapping into their Blackberry's 'does NOT compute!!!'

Anyway, the presentation certainly gave me food for thought regarding residencies. I am still unsure of the best way forward. A part of me also is intrigued by the 3 year emergency medicine residencies in the US. So we shall see. I know that as an international applicant I need to blow the USMLE out of the Time will tell what my options will be. It is a long way off but these days I need to see that there is an exciting light at the end of this tunnel.

Thursday, November 12, 2009

The Many (Inside) Faces of a Triage Nurse

So you've had this sore throat for 3 hours you say?

If your child was VOMITING why did you feed him CHICKEN NUGGETS?

You stare at me with your arms folded standing outside the curtain of your room for one more minute and I swear...I swear...buddy...

The 'nurses help line' told

you to

come in for your blister???


Some days I just want to let it out.

My sister in law used to be a flight attendant and when people asked her what her job was like she'd say "Smile! Now hold that for the next 14 hours".

That is how I feel sometimes when I am sitting at the triage desk.

Friday, November 6, 2009

Relationship Morbidity and Mortality During Medical School

A friend in my program recently got dumped by her boyfriend of two years. It was one of those horrible 'out-of-the-blue' dumps too, which is the worst I think. I've had one of those as well (on my answering machine, I might add) and it really was profoundly hurtful and difficult to process--dealing with the shock and the pain at the same time.

Without getting into too much detail, they were suffering through the beginning stages of a long distance relationship. Many of my classmates are in the same boat, studying medicine here and trying to maintain a relationship with someone back in Canada (or in another Irish locale). From completely anecdotal examples I can say that relationships seem to be on the chopping block when it comes to medical school. Then add the distance. I think it takes a very special combination of people to survive long distance alone, without one party being in the all-encompassing-entity which is our program. A remark that was made was "one by one we watch the relationships fail in our group of friends". And it's true, so far.

My aforementioned friend and I bumped into each other in the stairwell the day after it happened and we hashed out the hazards of being a 30-something-female in medicine. In a word, it's treacherous. Suddenly the reality of age is upon us. Don't get me wrong, I know we're not old by most standards...but basically take the fears that some single 30 year olds have and multiply that by a factor of, many.

Issues include:

The 30's are supposed to be our most productive/lucrative/peak-of-existence times in our lives. We are enfolded in the tight embrace of heavy workload, high expectations, competitive surroundings..and we're paying for it (partly in actual cash dollars).

"I'm in medical school" or "I am a medical resident" is instant man-deflector line in most social situations. I think that combination of words is actually heard as "I am an intimidating, career driven, over-achieving, heartless woman who puts her man last" by males of the species.

Our eggs are shriveling. The two cases we had last month involving fertility and abnormal pregnancies/birth defects were definitely stressful to the older women in my program who wish to breed. One of the comments my recently single classmate said was "should I freeze my eggs?" You just DON'T have to think about that when you are a 22 year old medical student. I don't think I want to have babies yet I found myself feeling very constricted by the time line ahead of me if I were to change my mind. I actually had a moment, starting at yet another photo of a birth defect, where I thought--"should I freeze MY eggs??" It was a scary moment. I was pleased when it passed.

On not much of a different note from above--the super-women who do have babies in medical school have an incredibly tough chore balancing the mother/student/wife/self...yet there seems to be this expectation that it ought to be possible and you are not (super)womanly enough if you take a year off to focus on one of the above things. I am already thinking I'll need a year holiday after medical school to re-water my soul by doing things like learning Portuguese and becoming dazzling at finger-picking on the mandolin...but I digress.

It has just caused me to pause once again on the choices I've made to get to this place (an inevitable choice I believe in becoming a doctor). I go on and on about how I value all the things I did in my life pre-medical-school (like nursing, traveling, playing music) but sometimes I think that the advantage truly does lie in pursuing these types of studies earlier in life. Already some specialties are off the list for me because I simply don't want to put so many more years into the schooling part of things. I hate that feeling of a time limit. Especially when 30 doesn't feel like an age where one ought to have those concerns.

So much living to do, so little time.

(Last fall in the in my happy place).

Wednesday, November 4, 2009

More Words of Wisdom from an Immunology Lecture

Recently I mentioned the excellent sense of humor my immunology prof has, today two of his gems were:

"Next time you write orders for some blood test [involving antibodies] know that a little mouse died for that test."


"If you're packing in a hurry and you only have time to pack one immunoglobulin, pack IgG".

Umm, awesome.

Image taken from here:


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Monday, November 2, 2009

Med School Blahs, or Things I've Been A-Missin'

I realize that posting has been thin lately, my apologies. I just feel so damn guilty whenever I am on the computer doing anything other than reading an ebook about osteoporosis or anemia.

I am still happy to be here overall, but the blush of September has certainly faded. The realities of being a student again and the small to large sacrifices that entails have really started presenting themselves.

One of the things I forgot about was the feeling of 'being done'. You know, when you've mailed your thank you cards, filled up the car, and marinated the chicken and you sit down with a glass of wine and you sigh...ahh..done. Nothing left to do now but relax. That feeling is gone, officially. And I know will be gone for a very very long time. Now when that sensation begins to wash over me the studious devil that sits on my shoulder reminds me that I really don't know all the ligaments in the upper limb...and I really don't know all the differentials that would cause elevated alk phos levels. I guess I ought to drag myself back to my desk for another wrestling match with one of my very expensive textbooks.

Having money was nice too. And a car. Ohhh...a car. I know, I is so much more environmentally friendly to walk and bus everywhere. But the bottom line: it sucks when you don't live in a major city with good public transit. Every time you need to get milk or laundry soap it is this 2 hour epic combination of bus riding, walking, taxi taking, ride coaxing, waiting, more walking. I knew we had arrived at a new low as I observed my housemates on the 2.6km walk home carrying their new printers on their heads.


Ok, I am aware that the rest of the world has it much harder than I do and that my whine is likely falling on deaf ears. It is simply that the reality of my old life continues to fade. And while it fades I see so many things I took for granted go with it.

Even just having a comfortable living room to entertain in. They provided us with a small couch (i.e. so small you can't do anything other than lie in the fetal position on it--which is the position I most often feel like reverting into anyway I guess) and two chairs. There are FOUR people living in this house, this means if we have ONE guest someone has to sit on a computer chair. Lovely. How homey and welcoming.

I miss being able to walk to a nice coffee shop and study. There are none around here (well there might be but that introduces the same logistics as grocery shopping) so it is either the my dorm 'cell' or the library. I miss the beautiful Clinical Sciences library at the U of A (Keith, know what I am talking about). A multi-story open concept, sky lit, plant friendly, quiet-as-a-tomb, study spot that was open really really late...and again really really early. The library here has the charm of a bomb shelter, is tiny, and has flickering fluro's overhead. If the asbestos doesn't get me the status epilepticus will.

Walking today I again tried to tell myself that I had to stop comparing everything to my old life and start accepting the fact that I am here and this is my reality for the next 4 years. I have heard many of my physician friends say if they had known what they were getting into they might not have chosen medicine--this is when we talked about the lifestyle/career aspect of it AFTER becoming MD's. I had always sort of felt really reassured that I'd never question my choice because I have a pretty good idea of what I am getting into when everything is said and done and I have a nice 6 figure debt attached to the piece of paper which says "MD".

But there are certainly some days that I have to ask myself, if I knew how much life would change during medical school--would I have chosen it? At this age? Right answer is a really solid "Um...I think so".

Thursday, October 29, 2009

Quotables from the Classroom

In the past week during lecture:

1) The Dean of Medicine advised the females in the class to 'go out and get a toy boy'.


2)During an immunology lecture the prof began quoting the Simpsons--'the tot with the spots--the sister with the blisters!'

Nice to have people who don't take themselves too seriously in medicine. There are already enough of those in the student body.

Monday, October 26, 2009

CPR Refresher

On Thursday we had to take our CPR first responder training. I was trying not to be bored out of my mind as we sat through 8 hours of "one-and-two-and-three-and-four-and" chest compressions and how to perform the Heimlich maneuver.

Interestingly though, when we pulled out the baby models for the infant CPR I felt my heart rate pick up ever so slightly and a knot tie itself in my stomach. At first I tried to step back and figure out what was happening...and then realised that it was just a little too much of a reminder seeing a lifeless looking baby in front of me. I briefly touched on the neonatal code that I was involved in last summer when I was working as an ER nurse in Canada.

It had been a very very busy day in the emergency department and we were short staffed as the connected ICU had two very heavy patients which required 1:1 nursing. Earlier a woman had walked in holding her soccer sized belly and we had directed her upstairs to the maternity ward. We hadn't paid much attention and were just happy we could tell at least one patient that they could be seen somewhere else. Just before lunch we heard the announcement on the hospital PA, "CODE BLUE...NURSERY....CODE BLUE...NURSERY".

My colleague and I were both standing in the nursing station when this announcement was made. For a split second we just looked at each other, the main thought running through my head was that I was pitying the nurses who had to deal with that situation. On the heels of that thought was the realization that as an emergency nurse I was likely responsible to respond to that code. One of the points that no one mentioned during my 4h orientation. My colleague who was in charge stood rooted to her spot with wide eyes and said, "Go".

I turned and ran up the three flights of stairs to the maternity/medicine ward. Remembering that I have only ever run once before in the hospital...years ago when a patient I had escorted to CT crashed during the scan and there was no bagger in the CT area. I got to the top of the stairs and took a moment to catch my breath and collect myself. There is nothing worse than staff who BURST onto a scene. What was that saying about taking your own pulse first?

Walking onto the floor I saw a crowd of patients, family members, and staff had gathered around the periphery of the nurses station. When I rounded the desk two of the medicine nurses pointed me to the room I was destined for.

Going in the first thing I felt was the heat. The doors were closed and this was during a very unusual hot spell--in a hospital with no air-conditioning. The warmer was also on and no windows could be opened. With 9 or so bodies in the room the air was thick and sticky. Two anesthetists were at the head of the warmer finishing up the intubation, one was already peeling off her gloves and saying, 'well you've got things under control here...' An emergency physician was standing to the side of them finishing up with inserting the umbilical line. None of the family was present in the room. The maternity nurse was getting the buretrol and IV lines going and the charge nurse was on the phone with the lab and xray department. I grabbed a pen and started writing.

Sometimes I like recording, especially when it is a patient that I know nothing about. Being the recorder allows me to go through what needs to be done (in my head) and gives me an opportunty to keep other nurses organized. Some people get a little 'chicken with their head cut off' in code settings (and I am certainly not excluding myself from this group) but I find if you say, 'hey what size catheter are you inserting?' or 'where is a second IV line going to go?' then folks seem to get on task and off the circular merry-go-round-wheel-of-stress.

This code was being run by one of our most pleasant and experienced ER docs. Even during arrests he uses the words 'please' and 'thank you', never raises his voice, and never looks ruffled. I instantly calmed down and was grateful for him and his demeanor. In fact, it was almost comical how he raised his eyebrows to me when a clearly very flustered nurse came running into the room with the syringe of broad spectrum antibiotic in hand...the door banged against the wall causing everyone to jump. It was sort of a 'hey lady, we're all cool in here! What's with the Grey's Anatomy entrance??' kind of look.

The baby was not doing well. I had finally gotten report and learned that mum had arrived with no previous prenatal care, and no physician following her pregnancy. She had a vaginal delivery a few hours ago at 32 weeks gestation. The baby was just over 2900gms and had gone into respiratory distress and then cardiac arrest.

The code blurred into the various stages I was used to in adult situations...the arrival of the lab and attempting to work around them...the x-ray technicians and the portable machine forcing us out of the room for a momentary breather...then the hurry up and wait aspect until some reason for all of this happening presents itself.

The x-ray came back showing the 'ground glass' appearance to her lungs. My role in the code had shifted to providing ventilation with our neonatal bag valve mask. Along the side of the bed with the warmer heating my already sweaty neck I counted out respirations and watched the monitor for her wildly fluctuating oxygen levels.

Now my memory shows me only slices in time from the rest of the event. I can see the surfactant bubbling around the ET tube and I can hear the gurgling hiss. I can see the flushed cheeks of the maternity nurse and the two bowls of untouched tomato soup sitting on the bedside tray. I see the rise of that tiny chest with each squeeze of my hand on the bagger. It is strange to feel that tenuous line between life and death strung between yourself and another, another very helpless individual. Where else in the world does that exist? When in our lives do we feel that responsibility and connection to another human?

I remember feeling very in the moment and calm, detached and interested from a medical point of view but not sad or upset. I remember thinking that I found the differences between being in an adult code vs a pediatric one very interesting...and I wondered if I shouldn't dismiss pediatrics for my future.

A nurse from the floor came in saying the ED was a zoo and they had phoned up to see if things were under control so I could go back downstairs. The child was as stable as she'd been for the past couple of hours so the mat staff said they could take it from there. The infant transport team was due to arrive shortly anyway so I was relieved of my duties. I headed back though the doors of the ED and picked up the first chart with orders on it;

IV ancef 2gm

On I went into the room to find a cheerful man with a sailors lexicon who had traumatically amputated his right 2nd finger just past the knuckle while he was at work. And from there the rest of the shift swallowed me up in the usual more mundane presentations and chief complaints.

When I wrote about this event before I mentioned that I drove home and sat in my car parked in the driveway for quite some time after the shift. I looked at my feeling of detachment, I thought about how intriguing it was. Another example of professional self-preservation? I replayed in my mind how frustrating it was trying to use equipment I wasn't accustomed to and made a mental note to familiarize myself with the pumps and lines we had stashed away for peds cases.
It wasn't a good night. I talked about it at length with a friend via of the downsides of travel nursing is you don't necessarily have the people you need around you to informally debrief with.

Then the incident travelled to the back of my mind until this CPR exercise.

And so it goes, the recall. The questions that almost never get answered--the long term outcomes, if our interventions were effective, if we gave the best care possible? The images arrive in your mind and the present is abandoned for a few moments while someone talks about how many compressions per minute and someone else makes a joke about having babies in medical school. No one really wants to hear about the fact that your last code was a pediatric code so you tuck all of it away again and allow time to do its job. Moving right along..

Monday, October 19, 2009

Oh Ireland

I am feeling homesick tonight. So to attempt to cheer myself up I am making a post using the photos I took a couple of weeks ago. These are from the Cliffs of Moher. I love this one below because of the face that appears etched in the rock.

I'll go back hopefully some day when it is gray and misty...the cliffs are almost too pretty in the sunlight.

This fence was near a Good Samaritan sign, at first I thought it was a bit of a random place for a counseling poster...then...ohhhh....riggggghhhht.

How I feel sometimes about going back to school...

These are from an old Franciscan Monestary. I absolutely loved spending time could really sense the history of all the souls that had passed though those walls, their graves underfoot.

The courtyard that backed onto the large stone kitchen where they baked bread.

And finally a photo from a cave tour we did. I quite liked the waterfall inside.

It's a long weekend here now and I've opted to stick around in the hopes of catching up on some sleep, some reading, and normal living (i.e. a trip to the Farmers Market tomorrow). Hopefully this is just an extension of the 5 week bump that apparently everyone goes through.

The Great Irish Canadian Thanksgiving

The first matter of business was the stock for the gravy. One of the chefs staying with me roasted the giblets and two packages of wings as soon as we got up Saturday morning. Then the great pot of onions, garlic, celery, carrots, roasted meat, and wine simmered for hours. By 1100h the house already smelled like my mothers Thanksgiving dinner. We made a giant batch of stuffing, thanks to my mothers recipe. Simple and delicious. Having never made an all-out turkey dinner before I was definitely scared that things were going to go Pete Tong. Once the birds were stuffed we sent them out in a flock to the various surrogate ovens we had commissioned for the event. Specific instructions and fingers crossed we set to work getting the large common room ready.

One of my classmates taking a bird to her residence.
At around 1730h all the turkeys were cooked so we went around collecting them so that the drippings could be used to finish the gravy. Of course one of the people in charge of an oven was no where to be found, wasn't answering the door or his cell phone. We couldn't get a hold of his roommate either so we just hoped that our Village was not about to burn down due to a charbroiled bird. After 1800h we were finally able to get a hold of the final turkey and it was in fine form, not burned in the slightest. The moment of truth though was the carving. By that time there were already over 45 people at our gathering. Wine was flowing, music playing, people snacking.

The turkeys turned out absolutely perfect. I was stunned. I had always thought there was some mystical chant or great cooking wisdom involved in making a stuffed turkey. But apparently the only required charm is a phone call home to one's mother. When I closed my eyes I was back in the house I grew up in, sitting at our table with the extra leaf put in...steam on the windows and animated conversation all around. That first bite truly took me back and I thought about the legacy of food that is passed down in families. I made a mental note to learn how to make my mom's pastry next time I am home. I've got the stuffing down now. Baby steps.

The assembly line of carving.

Some very excited Canadian guests.

All in all, many of the Canadian guests told me at some point during the evening that they felt a little less homesick due to our replacement celebration. The Irish contingent definitely asked to be invited again next year and seemed impressed at our dedication to eat LOTS of food in the name of, harvest? Pilgrims? Just pass the cranberry sauce.

Monday, October 12, 2009

A Call for Good Online Resources

Just thought I would put this out there...while wading through the mire today online in the hopes of finding good pathology, embryology, histology, and all the other 'ology's' out there I decided that I am tired of shoddy internet hits and questionable sources.

If anyone can suggest some good sites for me as I endeavor to find supplemental info via the internet that would be great. Feel free to email me or put it in the comments section.

I am already dialed with and emedicine so preferably some other (free) sites would be greatly appreciated.

Thank you blogworld, in advance.

Sunday, October 11, 2009

Quick Post

Just a quick note to say that the Thanksgiving dinner (for yes 50 people) was an EPIC success.

Went to the Cliffs of Moher today and had a lovely time tramping around with my visiting friends.

Due to the major lack of embryology studying this weekend the real post and photos from yesterday are going to have to wait a couple of days. But in the meantime, I can say that I've successfully stuffed and cooked in 6 ovens enough turkey to feed 50 people (with ample help of course). They turned out beautifully.

Bucket list: check.

Friday, October 9, 2009

Asystole and Anatomy Enjoy Canadian Thanksgiving in Ireland

As many of you may or may not know, this weekend is Canadian Thanksgiving. My housemate decided that we were going to organize a massive turkey dinner in our residence common room. Somehow I was coerced convinced to make stuffing, stuff the turkeys, and organize the surrogate ovens around campus that we'll be using. It is going to turn into a gong show with Pieces of April proportion I am sure.

The residence manager has been a star with regards to the event, she even donated 100 Euro towards the food and wine. There are about 50 people on the guest list now and I can't help but wonder what the hell I was thinking when I figured it was a good idea. Well it'll be epic I am sure, either an epic failure or success...but I don't think anything in between.

In fun and random news...Anatomy on the Beach is coming up with another Canadian classmate for the weekend! We met last December when I went down to the Caribbean to check out his school. It was a great time and I couldn't help but have a chuckle over the fact that it was our blogs that caused our worlds to collide. Anyway, we've since kept in touch and decided that Thanksgiving was a perfect excuse to meet up again since now we're both strangers in a strange land (he's in the UK now).

I promise to take photos and give a play by play of how it all went.

For my Canadian brothers and sisters--Happy Thanksgiving!!

Monday, October 5, 2009


Whenever I had an eyelash on my cheek, my former boyfriend would always brush it away with his finger and hold it in front my lips for me to blow away while making a wish.

It never seemed hokey or contrived to me. Every time he did this I would indeed make a wish. For as long as I can remember every wish I ever made was to one day get into medical school. This was the candles on the cake, the money in the fountain, the shooting stars.

Two days ago I was on a bus trip with some classmates and one of them said, "oh, you've got an eyelash" and proceeded to brush it off, onto the ground. Of course my knee jerk response was "Hey! I didn't get to make a wish on it!"

It got me thinking...what would I wish for now? And nothing jumped to mind. I mean, nothing. I guess I've been putting so much of my psychic, emotional, mental, physical, financial effort into this goal for so long that it really pushed everything else out. With medical school like a looming building on my landscape, so many seedling goals died in the shadow.

Accomplishing a long term goal certainly has it's adjustment phase. Though I am here and very much living in the moment, enjoying what I am learning...I've been wondering, what do I wish for now?

Saturday, October 3, 2009

7 Things About the Albinoblackbear

So I was doing my daily read of Old MD Girl and her post was about 7 things that you wouldn't know about her. At the end, instead of 'passing it on' she suggested if you were reading the post you ought to write one of your own. I have been working on a couple of posts that are still...not ready so I thought this would be a good tweener...otherwise you'll be exposed to a lot of youtube videos. And that just seems unfair.

And now....*drum roll*

1. I was engaged once. Was a runaway bride in fact. That was 4 years ago and the slighted groom-to-be and I are still good friends. Whenever I go to the town we used to live in we have dinner and continue to be pleased about the fact that we never got hitched. He's married to someone else now and is ridiculously happy. I am happy for him.

2. I made it to the last round of selections for the Canadian Air Force to become a pilot. I got cut in Toronto after the final simulator flying and navigation tests. It was a process that took almost 2 years. I think it was one of those 'sliding doors' moments where my life would have taken a drastically different turn had I been accepted. Instead I took at year off school and traveled around South East and Central Asia.

3. I am terrible with plants. I kill any plant that has ever been given to me. I don't like to garden and hate the creepy crawly things that live in gardens. I know this is wrong and that I should embrace gardening and all it's bounty...but...gah...maybe someday.

4. Speaking of creepy crawly things, I am an arachnophobe. To an almost psychiatric inpatient level.

5. I would happily live somewhere that had maximum summer temperatures of 20 degrees celsius. I hate the heat. I hate being hot when I sleep, I hate direct sunlight, I hate that muggy humid heat, I don't even really like sunny days. I don't tan and have never been one of those people who hangs out at the beach. I like clouds and love the rain. Why am I starting to sound like an emo/goth/socially maladjusted woman? Hmmm....

6. I have a neuroses about my hands smelling like food. I can't eat wraps or things from places like Subway because I find that food smell just hangs on and it gives me the willies. I love to cook and from time to time after an epic meal I can still catch a whiff of garlic or onions on my hands and I need to go and SCRUB myself before I can enjoy the rest of the night.

7. I am a musician. I play piano, mandolin (badly), guitar (badly) and sing (pretty well I've been told). Had a pretty awesome band for a few years and we rocked some amazing shows and festivals in that time. My housemate here in Ireland found someone had uploaded our CD to youtube, which I thought was hilarious. Anyway, yeah...that's us. The George Bushes. And that is your homegirl, Albinoblackbear, on lead vocals. It's all original music...and I am still very proud of the music we made.

Anyway, if you are still reading...I urge the same to you blogosphere. Just because you drop random details about yourself it doesn't mean we'll figure out who you are. Or will we??

Monday, September 28, 2009

The Heart of the Matter

Suddenly I was in the back of that rocking ambulance again. This time with Howard Thorpe. His pallor revealed what his silent lips did not. The wail of the siren bounced around us and the lights of the city streaked past.

He knew what was happening behind the layers of tissue, cartilage and bone. He knew what had occurred deep within his very core. The aorta is the body's largest vessel. A firefighter’s hose of blood which runs the length of the spine where it bifurcates into smaller but also high-pressured arteries at the neck and thighs. A tear in the aorta can cause a man to bleed to death in minutes.

Howard had come in with mild chest pain and leg pain while he was skiing. A neurosurgeon from Montana, he knew that chest pain wasn't to be trifled with, figuring it was nothing but wanting to be sure he came into the clinic to get checked out.

At that time the pain was in the middle of his chest, maybe a 5 or 6 out of 10. His initial exam rang no great alarms. The electrocardiogram was overtly normal, his blood pressure not too low or too high, heart rate was skipping along maybe a bit quickly, but nothing worrisome.

Howard was very personable, kind, unassuming. The clinic was busy that day but he was my primary concern. The broken wrists and dislocated shoulders could wait with ice packs and slings in various positions.

Howard’s family was still skiing on the mountain, unaware of his mid-morning check-in. I administered nitro spray under his tongue, feeling somewhat sheepish as I warned him about the possibility of a headache… like he didn't know! But then, one can’t be sure what medical people forget or fixate on when they are the patient. When suddenly they are on the them side of the ledger. Anonymous in their underwear and open backed gowns status…shuffling with their IV poles to the “patient" washrooms.

Howard said his pain had gone from a 4 to about a 1. I told Bob, the physician, and he advised me to keep his pain down with nitro and continue to monitor him. We nodded knowingly, the new onset of angina now under control. A cardiac foreshadowing. It was minor in the grand scheme of things. Thorpe was in good shape. He'd go home, and with his connections in Montana he would have the best cardiologist who would fast track him in to the cath lab where they would isolate those pesky narrowing arteries and do the things they do to them.

Howard would probably never even have to be an inpatient. He'd be tickety-boo and back operating himself in no time. All of this Bob and I were comfortable with. A nice guy with a not-too-bad diagnosis.

I went to get bed 3 ready for the next fractured wrist reduction. I heard my name from bed 1. "Erin? I just can't seem to get comfortable. Could you give me a hand?"

I walked quickly to his bedside. The head of the bed was raised and he was fidgeting in a strange way, fussing with the pillows. "I just can't seem to get comfortable. Can you lower the bed please?"

There was something about his movements that struck me as odd. Even bordering on alarming. "Where is the pain, Dr. Thorpe?"
"Right here, between my shoulder blades". He reached awkwardly around and pointed to that area on the back that immediately caused the hairs on my neck to stand. A classic sign of an aortic dissection. The tearing-of-the-lumen, pain referred to that area.

Trying to mask my reaction in my face or demeanor I helped him settle and quickly found Bob.
"His pain is mid-scapular,'ve got to get in there now".

Bob and I exchanged looks which confirmed that we shared the same thought. Our initial apple-pie assessment of his prognosis had just soured. This was not good.

We moved Howard to the trauma room. Bilateral blood pressures on his arms and legs showed a marked discrepancy in pressure. On top of that, the pulse in his left foot had disappeared. His major blood supply was compromised somehow… his circulation wasn't going where it was supposed to. Now the leg pain made sense. Clinically it was clear that he was dissecting. If he was lucky it would be contained, with the more delicate vessel tearing inside while the thick outer lumen remained intact.

We were arranging the med-evac to the tertiary center which housed the vascular surgeon. At this point it looked like ground transport would be faster than landing the chopper. Someone had to go with him, and that someone was going to be me. Bob explained to Howard what was happening. Strange… or was it… that Howard hadn't come up with that differential on his own. Emergency staff are so versed in the tell-tale red flags of triage that Howards’s textbook discomfort immediately drew the two of us to the same conclusion. Maybe it was Howards denial and his own rosy hope that it was angina that blocked out his objective analysis of the situation. Can a man indeed be objective when he’s subjected to such an experience. …

We loaded up in the ambulance. His son-in-law had arrived but was unable to locate Howard’s wife and daughter on the hill. They had planned to meet in about an hour. His son-in-law was planning to bring them to the hospital as soon as he could but now Howard would have to go without seeing his family.

Dusk and damp misty rain greeted us when we rolled Howard out of the clinic. The fresh evening air did nothing to untie the knot in my stomach as I carried the bulky cardiac monitor behind the stretcher, a cell phone and Doppler to amplify pulse sounds. Two large-bore IVs were running into his arms and I had a pocketful of morphine and Gravol to keep him comfortable during the ride. I had no other drugs or equipment to rely on.

Shaun pulled the ambulance out of the bay… the sirens came then. It’s an altogether different matter when you are riding inside their wail.
As we accelerated down the dewy road toward the highway Howard was asking me questions… almost talkative.
"What are my blood pressures?"
"They are dropping, Dr. Thorpe. The left side is only 70 now."
"Why are you using the Doppler?"
"I can't feel your femoral pulse on the left side. It’s gone." A place where normally the bounding heart rate kicks at your fingertips now gave me only a swoosh-swoosh-swoosh when I pressed the Doppler to his groin.
"These things are so sinister in my mind,” he said. “The only time I see them is when I am trying to repair spinal damage from them".
"I suppose it must be worse to have the medical knowledge, to know all the worst case scenarios. Worse than being blissfully unaware."
He nodded.

I have a strict pact with myself to never reassure patients when I don't know what an outcome might be. "It'll be okay" or "You'll be fine" are phrases that never escape my lips unless I am putting a bandage on a skinned knee.

Thorpe arched his back grimacing with pain, said, “It feels like it’s more in my throat now.”

I thought that he was going to bleed out right in front of me. Unsure as to the best thing to do as I watched his pressure plummet, I grabbed the EHS cell phone and called the clinic to update Bob and figure out what the hell I could do in the back of this ambulance if this man suddenly blew on me.

As Bob answered the ambulance lurched to the side, passing an unaccommodating commuter. The phone slipped from my hands and fell into several pieces on the metal floor.

I flipped open my own cell, so thankful that I had thought to bring it. Bob came on the phone again.

"His pressure is dropping. I've lost his femoral and he's getting pain higher up the sternum".
"Nothing you can do, Erin. Keep him comfortable, pain meds, fluids, that is all you can do in the back of an ambulance. It is out of your hands."

What I already knew but couldn't swallow.

Howard refused any morphine. Looking back I think he wanted to be as clear as possible for what could be his last moments. He knew he was a time bomb ticking.

He was silent and I forced myself to respect the desire he had to be alone in his thoughts.

Was he happy with the way his life had turned out? Satisfied? What haunting thoughts came to the surface now? Was it fear… resolve… peace?

His face revealed nothing.

He turned to me.

"Erin. My wife's name is Pauline. My daughter is Isabella. This is my wife's cell phone number. If I don't make it please call them for me. Promise me you'll call them and tell them I loved them." With a shaky hand he scrawled a number on a scrap of paper from his wallet.

I took the number and folded it into my scrubs.

"I promise". Was all I could say. My own heart was thumping in my throat.

He nodded, closed his eyes and seemed to go deep within himself. I bit hard at the inside of my cheeks. I felt myself go cold. I was going to watch this man die. The tinny interior of the ambulance his last vessel, a stranger at his side. My eyes remained locked on the cardiac monitor with its reassuring blips every second.

We arrived at the hospital in record time despite the rush hour traffic and the bridge. Shaun smoothly rounding corners, passing lanes and lanes of hassled motorists.

Howard is whisked into the ER, a trauma bay and team waiting for him. I pass on my report to a disinterested male nurse who is only half listening until I get to the part about the vanished femoral pulse. He glances up at Howard, several feet away being hooked up to monitors, oxygen, new IV bags.

I squeeze Howard’s hand as I leave.
"My name, Howard. Please remember my name, so you’ll know who to leave the message for at the clinic when you call to let us know how you are doing after surgery."

He repeated my name.

“I won't forget. You all did an amazing job. It may be a small clinic, but you all know what you are doing. Had me on my way as soon as possible. Other places might have missed the diagnosis. Shaun's driving was superb. I know how bad that bridge can be. Thank you for everything."

It was weeks before I heard the end of the story. A physician friend of his came to our ER department with gifts, wine, and a letter for the staff.

I still have a photocopy of it in my strong box at home. His handwriting is terrible so there are many words I cannot make out. He had dissected, from iliac crest to aortic arch. 7 hours of surgery and full recovery expected. In the letter he graciously thanked all of the staff. I smiled when I saw my name underlined—I am sure as a reference to my insistence that he remember my name and update me regarding his recovery.

But in it he says, “You all saved my life that day. You saved my life. There is no greater gift we can give each other. So I feel strange presenting you with these small gifts and a card. What can I say to the people who are responsible for me being alive today? Thank you really doesn’t cover it.”

In a strange way I am still haunted by that day. It simply comes at me from nowhere sometimes. As nurses we are placed in situations where a profound intimacy with strangers can be thrust upon us. We bear witness to the most pivotal times in our patients’ lives. In crisis we share moments with patients that is normally reserved for their most treasured loved ones.

“Promise me you’ll call them…”

I can hear his voice. I am in that ambulance. And I am scared. But more than that I am grateful for the precious burden of this work. Work that pains me, pushes me, frustrates me and scares me, but also honors me. Work that takes much from me, but gives moments in return that are profound in a life where superficiality often reigns.

I’m grateful just the same to come back to the present, to be running on the treadmill wondering what I need pick up from the grocery store for dinner.

(This is a re-post so my apologies for those who have already seen this. Working on a few posts right now but they are taking longer than usual as I feel guilty sitting in front of a computer when I should be memorizing the innervation of the pelvis...)

Monday, September 21, 2009

If I Had to Be A Cell...

Well, being a killer T would probably be more badass...but behold the beauty of the red blood cell...
© 2008 Kenneth Todar, PhD

Sunday, September 20, 2009


The #1 search term that has brought people to my blog in the past month?



Saturday, September 19, 2009

Why Medical School Equals Awesome

Two weeks ago I couldn't have described to you the structure of the inner ear, let alone the physics behind what happens when sound waves strike the tympanic membrane or how movement of the hair cells in the cochlea are translated into neurotransmitters. I didn't know that there are members in the Deaf community against the use of cochlear implants or that we have muscular mechanisms in place which dampen the sound of our own voices to ourselves.

Already I can look back over the past three weeks of school with some astonishment at the volume of information that has been thrown in our direction. The information we have gathered and disseminated amongst each other, the flash cards, the youtube videos, online dissections...I am sure part of this cooperative process has something to do with the fact that we only receive pass/fail grades for the first 2 years of our program, thus decreasing the competition factor by a notch or two.

Our program is structured using problem based learning. We are in groups of 8-10 and each week we are presented with a case study. We work through the various differentials as a group and come up with the likely diagnosis. Then we decide what learning objectives we need to tackle and are left to our own devices to gather that material, learn it, then return 4 days later to discuss it. Present in our groups is a physician who acts as a facilitator but not a resource, they are basically there to make sure we are meeting the curriculum goals and staying on track (and not teaching each other a bunch of misinformation). My group consists of 4 biochemists, one PhD microbiologist, a geologist, a biologist and a biomedical engineer.

2 weeks ago our case study was regarding a patient with sensorineural and conductive hearing loss. The case is revealed in stages during the two sessions on Tues/Fri...then the following Tuesday we have a 1 hr wrap-up and begin the next case. Since G.M had hearing difficulties our anatomy, physiology, histology, and clinical skills lectures were all based on the ear and examining it. Our guest lectures were from an ENT specialist, a patients rights advocate/medical legal advisor, a community physician, a speech/language pathologist, and a sociologist. All the discussions were focused mainly on the impact of hearing loss from the biochemical level to the community level. I found the amount of information that I retained MUCH greater than I would have anticipated. I am certain that the 'learning in context' aspect of the delivery had much to do with that.

What is astonishing to me is the truth behind, the more you know...the more you realise you don't know. This has been glaringly evident since day one of medical school. As an ER/community nurse I have to know a little about everything regarding primary care. Apparently--very little about everything.

How did I spend so many years in nursing school and 6 years as a nurse yet understand so little about the organism I was dealing with?

The other amazing thing is how each and every day I see a large gap in my knowledge filled-in ever so slightly. Something I've never understood before or always wondered about becomes crystal clear...from major to minor 'AHA!' moments. I am fascinated by the material we are learning, from the work of the smallest muscle in the body (the stapedius) to the social impact of 'fixing' an 'impairment' (cochlear implants).

It almost feels like a scam sometimes--I have the privilege of getting to learn full time about something that enthralls me--and at the end of it, I get to be a doctor!! What? How cool is that?!

And this weeks case has a blood disorder...I must return to the pages of my physiology text and attempt to wrap my head around the structure of the hemoglobin molecule.


Wednesday, September 9, 2009

Saturday, September 5, 2009

Curse of the Day

So today I picked up an amazing book called "Irish Blessings, Toasts, and Curses" from this cool little Celtic bookshop downtown.

It is going to be really hard not to turn this blog into a daily blessing/curse fest now...but I will try to control myself.

Except for from time to time...

Like today...

'May you marry in haste and repent at leisure.'

Thursday, September 3, 2009


Oh and last night at the pub a drunk Irishman spilled beer on me. I figure that's Gaelic for "Welcome to Ireland".

Wednesday, September 2, 2009

And So it Begins...

I can't believe I am actually here.

The goal of getting to this place seemed so very very far off that for a long time I hardly lifted my head to look up and see how many more stairs there were to the top. I would just focus on the two or three ones directly in my line of vision...keep my head down, and push on.

I remember very clearly talking to Vern about it one day on a walk in Revelstoke. It was the summer I first moved there and I could feel the contemplation stage of change slowly working it's way into action. I told her that at some time I'd have to give up work completely, move somewhere with a university, take 8 or so prerequisites, write the MCAT, apply to schools, then wait almost a year to find out if I was accepted or not.
She was also looking into a long application process at the same time, applying to school in Scotland to undertake her masters. We both sorta shook our heads at how daunting it all was.

Today I got to sit in a lecture room and look at my fellow classmates for the next 4 years. I've been so lucky since my arrival (save for the baggage incident) to have connected with some very amazing folks in my class. Musicians, chefs, dancers, researchers, engineers...we're all meshing into these interesting combinations. Our res unit of 4 has basically become the meeting point for our group of friends from res. We've already had late night jams, "Flight of the Conchords" showings, big group meals, and kitchen partying--and it's only been 5 days. My roommates are first years as well, and though they are a few years younger than me, it hasn't seemed weird. Just funny more than anything watching my one roommate figure out how to make a sandwich after coming home from the bar.

It was a long day of orientation today, and though I had ants in my pants after sitting for so many hours (8!) I must admit I was on the edge of my seat as they talked about clinical skills, labs, textbooks, the PBL groups, and our eventual hospital rotations. Next week we will be assigned our patients from the 'early patient contact program' which involves us following a prenatal woman from now through to 3rd year as she goes through the pregnancy and eventual birth/growth and development of the child. We're also being assigned a patient with a chronic disease who we will also be paired with until 3rd year. We'll be expected to attend hospital visits/doctor appointments/home visits with these patients...and be another resource for them as they work their way through the system. I am very excited to meet these people who will be a big part of my learning for the next 2 years.

After orientation we had a quick snack and headed out to the pub for a medical society social event. This was an event for 1-3rd years which included a life sized (timed) game of 'operation' as well as the normal mini version. I was terrible at the life sized one and wouldn't have come close to the top time even if I hadn't been buzzed out after 16 seconds. Instead of claiming fame and status with a win, I ate two free hotdogs (apparently my 'mystery meat' rule doesn't apply in Ireland) and drank some Guinness. The hot dog guy said that evidently I wasn't going to be a surgeon (I told him maybe I'd just be a slow one...) Came back to our place and had another jam session with my two new music-playing pals, drank some tea, and then called it a night.

It's strange to be in place finally. In the place that has been so far off on the horizon for so long. It is also lovely to be able to embrace the now--feel that my life has truly gone to the place it was meant to go, at the time it was meant to happen, and with the people I was meant to be surrounded by.


Tuesday, September 1, 2009

It's 0158h And I Have the First Day of Medical School Tomorrow

Yeah. The title kinda says it all. I will attempt a cogent post tomorrow (I promise). But for now let me say that I am so unbelievably happy I can hardly stand myself right now! My roommates are awesome...the friends I have already made are a talented bunch of uber quirky Canadians, and I love my life. We jammed until the wee hours yesterday then today explored, drank coffee, and bought school supplies.

Tomorrow is our first day as a whole group together. So far I've only met the Canucks...sorry for the rambly post but we hosted dinner, drinks, and an episode of "Flight of the Conchords" tonight and I may or may not have had a couple of stout.


Saturday, August 29, 2009

They Appreciated My Patronage By Slashing My Luggage to Bitsies

I have arrived safe and sound. The journey from Canada to Ireland was not without some of the expected twists and turns..and a couple of unexpected twists thanks to some awesome American Airlines baggage destroyers handlers and theiving thorough customs inspectors.

BUT! Overall life is good. I will post more tomorrow once I meet my roommates...eek!

Tuesday, August 25, 2009

Who Knew?

Who knew moving to a new country and starting school there was going to be such a tedious process? I have to keep taking a breath and reminding myself that I wouldn't be going through all this stress if I hadn't gotten into medical school. I guess I ought to be down on my knees thanking the admission GODS that I am spending my final days in Canada standing in line at the car registration place instead of drinking wine spritzers on a deck somewhere surrounded by the adoring faces of my friends and family. Yes. That is how it ought to be....

It is weird, I feel like I am jumping into a black hole. No idea what to expect from school or life in Ireland. My apologies for the dearth of posts lately but I have been staying in my mothers basement (which looks like it has been occupied by a schizophrenic who is conducting a garage sale there...) and she has DIAL UP (horror of horrors) and her phone was recently on the fritz. Frustrating? Yes. Life threatening? Almost. Speaking of mothers, I believe there is a direct relationship to the distance one is moving in relation to the degree of smothering that occurs.

More packing and unpacking to do. Two days until D-day.

Monday, August 17, 2009

My Last Shift as an Educationally Unadulterated Nurse

I finished my final contract up North on Thursday. Suffice to say it has been quite an interesting summer up there. The majority of the docs were very supportive and excited about the fact that I was going to medical school, and thus gave me as many teaching opportunities and hands on experiences as they could.

Last week I did my first subcuticular sutures with a facial laceration (under the direct observation of one of the MD's). I was brought back to one of my first shifts as a nurse in the ED when this patient came in who had been hit in the face with a broken beer bottle. His cheek was basically hanging in a flap about the size of a coffee-table coaster, off to one side. He came in from the bar hollering some story about how he had just been breaking up a fight between a man and a woman, how he'd been minding his own business, etc. etc. Amazing how he didn't work a burning bus and saving a poodle into the whole chain of events...regardless, his face was a mess.

I tried to watch the ED doc fix up this man's face. It involved many many subcuticular sutures and the whole laceration was very large and seemingly complicated. I had to keep leaving the room for fresh gulps of air because looking at this guy's cheek-hamburger was just a little much for my young nursing eyes. I was fascinated and totally impressed at this physicians ability to restore this man's face, but the 'everything-going-red-in-the-corner-of-my-vision-is-that-the-spins-now?' part was forcing me to step outside from time to time. When it was all finished, he had one line of sutures falling along his laugh line, from just beneath his eye crease to the corner of his mouth. It looked fantastic. I recall thinking--I really wish I had the skill and stomach to do a repair like that.

Fast forward 6 years--HEY! I did it!

It was by no means as beautiful and artistic as Dr. S's repair many moons ago. But I suddenly realized that I was doing a procedure that I could hardly watch in the past*. It was an exciting night for me and I was very pleased with how the final product turned out**.

These confirmations that I am doing the right thing by choosing to go into medicine are coming faster and with greater frequency than before.

During my last shift as an unadulterated-by-medical-school-nurse one of my colleagues commented on the fact that I was entering a different phase in my career which had no turning back.

It is true. I've thought about how from now on I will have one foot on the lily pad of nursing and one on the lily pad of medicine. I think there will be times where this divide is going to make for some interesting interpretations of my role with patients and co-workers. I wonder how I'll feel the first time I ask someone to do a task that I am normally expected to do. Why would I ask a nurse to put in a cath when I can do it myself? Or put a dressing on when I can do it to my liking in less than one minute?

I know these issues are a long way off as when I return to Canada to work in the summer I will be working with the constraints of my nursing license during the day, and trotting around behind docs as a med student by night. Still, I wonder how others have made that transition.

I was in the shower the morning of my last shift. I could feel a small lump in my throat as I thought about all the wonderful colleagues and friends I would be saying goodbye to. Life, so far has been nothing if unpredictable and though I do plan on returning to the ED I once haunted, who knows when and how that will happen.

Nursing has done me well and I have learned many many valuable lessons about standards of care, the focus of the different professions within health care, the opportunity for nurses to develop unique bonds with patients and family members, and the importance of having strong and super-smart nurses on the floor with you.

I have had the chance to visit remote parts of Canada and India because of nursing...I was able to work 6 months a year and travel, ski, cook, and climb the other 6. Overall it's been a sweet gig and I cannot pretend that I will not miss many aspects of it.

And so, in less than 2 weeks now, a new chapter begins. I hope that I will be able to continue with some interesting content on this blog...but if past performance is any indicator...the postings will start rolling out as soon as the studying is supposed to start (note last summers daily blog postings as I was meant to be studying for the MCAT).

Thanks for coming along for the ride.

*This bodes well for when I get into the OR, but that is another story altogether.
**Photo taken and used with patients permission.

Friday, August 7, 2009

Just When I Thought I HAD Seen It All...turns out I hadn't...

Yes indeed dear blog readers.

Blister guy came BACK to the ED today.

His chief complaint: "infected blister?"

I call him to triage.

"So...what brings you in today?? Since we saw you here yesterday for your blisters..."

"I wanted to come in 'cuz my blister popped, thought I should get it looked at."

*She walks into med room and hits head as hard as possible against narc cupboard in an effort to wake herself up from the reoccurring nightmare of 'worst abuses of emergency departments which I pay for with my hard earned tax dollars'. Yet she doesn't wake up. And then she hears screaming and soon realises the screaming is coming from her own mouth.*

I wish I was making this up. :)

Thursday, August 6, 2009

I Can Now Retire as an Emergency Nurse--I Have Officially Seen It All

I've learned not to roll my eyes at a chief complaint when I pick up a chart in the ED. Whenever I have done this it always comes back to bite me in the ass.

Like the time I rolled my eyes when I saw the cc was "sliver". When I called the patient in I could not hide the 'are you kidding me?' in my voice when I asked him about the 'sliver' that brought him to the department.

He calmly rolled up his sleeve to reveal a piece of wood thicker than my thumb just under his skin from his wrist to elbow. Yeah, he worked in a lumber mill and a piece had gone flying off a piece of machinery and into his arm.


Lesson learned.

So today I picked up a chart and see "blisters on both feet" as the chief complaint.

I am starting my mental diatribe but then caught myself--assess the patient, he probably slipped and fell into some hot oil and has full thickness burns to his feet or something...

But no.

He had a blister on each foot from walking. Right on the heels.

I had to ask why it was an emergency.

"Because it hurts to walk on them so I called the nurse line and they told me to see a doctor".

*She throws in the towel and walks away, shaking her head*.