Second Opinion

I keep on fallin'

2009-12-29T20:57:00.004-05:00

Alas, another Jonah day for yours truly today. It was more than that. It was mortifying, embarrassing, humiliating, *insert adjective of choice* because you get the picture sort of day.

I'm on Pediatrics right now. This is my second week of Peds Critical Care (aka ICU for kiddies). And thus far, I've really adored it. It totally appeals to the ICU-loving Med Student in me - what with all the cool acronyms like ARDS, RDS, TTN, PPHN, HFOV, etc, etc. Plus all the Attendings here? Love! Yay for 2 hours of one-on-one Chest X-Ray teaching today! So you will understand why it would be doubly horrible that this happened to me during this rotation, in front of these attendings.

The story from the beginning? Well I was a bit sleepy going in to work today. But no big deal I thought. I'm pretty much tired every day in clerkship. As we were doing hand-over this morning (essentially where the resident on call over night talks about all patient issues they encountered), I felt sort of hot. Strange considering as how the unit (and hospital) are normally freezing, ice-cold. Anyhow, we start doing our bed-side rounds and I continue feeling a bit sleepy. Not any more different from any other day though. As we get to the third patient, the Senior resident randomly assigns the patient to me and starts asking me how I would manage them. Again, not really an issue. I felt a bit put on the spot, but it's not like it was the first time I was pimped. I had been in much, much worse.

But then all of a sudden it started getting really, really hot. And then I started having cold sweats. Then things started to turn black and the resident's voice became all muffled and distant. And I thought to myself 'Oh crap, fight it, fight it, deep breath, deep breath!' Then the next thing I knew everything turned blurry and voices around me were saying

'Are you okay, are you okay? Help her down. Lie down. Get a wet towel!'

Yup. I had passed out. I had fainted on rounds and was now lying supine on the floor of MY PATIENT'S ROOM!

I heard people around me saying:

'Should we do a blood sugar? (no poking me please)'
'Did you eat breakfast today? (I did) '
'Get her some orange juice (they did).'

I came around pretty quickly after that (I was never actually fully out, more of an out-of-body experience).

So yes. I reverse face-planted (trendelenburg!) in front of the whole unit. It was like my first year nightmare come true. How mortifying. They probably thought it was because I couldn't take the pimpage. Sigh.

I always thought that if or when I passed out it would be under more romantic circumstances. For example, I would be standing and operating oh so heroically for a long marathon 14 hour surgery. And then I would finally collapse out of exhaustion as a hot resident (hot senior would fit the bill nicely) or attending (Dr. Vascular would do) would rescue me and carry me out as others around cheered & clapped at my bravery (and birds would sing, and little animals would join in 'tra-la-la-la-la'... hmm, probably have been watching too many Disney movies). Alas, reality is so much more mundane. I would never have guessed it would be during rounds. Much less in the ICU. Even much less on Peds.

Oh, the humiliation

Don't make me angry. You won't like me when I'm angry

2009-12-14T21:06:00.005-05:00

12 weeks of surgery can really change a person. Like I said, spending all that time with the surgery residents had me slowing morphing into them. I began developing that surgeon attitude. You know the one. The swagger, the confidence, the cockiness. It's all about getting to the problem and fixing it (usually with a scalpel). Take no prisoners! So when I started to talk and act like them it became a bit weird. Because let's face it, all the people you're hanging out with are 1) guy and 2) guys who were surgeons. So there was a bit too much slapping me on the back (hard may I add), and making inappropriate comments. But there were times, when my new-found surgeon-esque confidence really came in handy.

I just came off of my General Surgery rotation 2 weeks ago. General Surgery is THE rotation during our surgery block. It's 4 weeks long, and you do a ton of stuff, and actually have a lot of responsibilities. One of the roles is to go down to the Emergency Department to consult and admit patients. It's fun. It's unpredictable. You never know who or what is waiting for you down there.

One night on call, I was paged to go see a patient with possible acute appendicitis. Easy-peasy I thought. By that point I had seen a ton of 'appys' so I was pretty comfortable with 'working one up.' Just had to ask the patient some questions, examine his belly and we would be good to go. Ah, if only every patient was so simple. You see, this patient - who we shall refer to as Mr. Stubborn, decided to make it a bit 'interesting' for me.

Stuff
Hi Sir, I'm Stuff the medical student on the Gen Surg team. They've ask us to come see you because they tell me you've been having some stomach pain?
Mr. Stubborn
Yes, the emerg docs tell me I have appendicitis and that I need an operation. They said SURGERY [stressing the word surgery] was coming down
Stuff
They told you that huh? Well I'm from the surgery team. But I do need to talk to you for a bit and do an exam before we know what exactly we're dealing with
Mr. Stubborn
[rolling his eyes]
Why? They told me I have appendicitis.
Stuff
[getting slightly irritated - it's way too late in the day for this]
I don't know what they told you exactly. But I really need to ask you some questions before we can do anything else.
Mr. Stubborn
[Like he's doing me a big favour]
Okay FINE. Just do it fast.
Stuff
[Trying to be nice]
Thank you

So I ask my questions. It's pretty clear at this point the guy has appendicitis, but I needed to do the physical exam in order to confirm.

Stuff
Okay Sir, now I need to have a feel of your stomach
Mr. Stubborn
[raising his voice]
What?! Why??! I already TOLD you that I have appendicitis. And that I need SURGERY.
Stuff
[getting very annoyed now]
Sir, I need to feel your ABDOMEN before we decide on anything. I have to confirm that this is appendicitis before we operate.
Mr. Stubborn
[starting to whine]
No! The other DOCTORS have already poked me enough. Plus it hurts too much. I want to see the SURGEONS already.
Stuff
Like I said I'm from the GENERAL SURGERY team, Sir.
Mr. Stubborn
You're not even a REAL doctor.
Stuff
[Oh no he didn't]
Look man, I'm the closest thing you've got right now to a surgeon. You want to get this treated? Well, turn around, stop whining and let me feel your stomach. The faster we do this, the faster you and I go to the OR. Got it?!
Mr. Stubborn
[meekly]
Yes ma'am

And that my friends is what 12 weeks of surgery does to nice girls.

Monkey See, Monkey Do

2009-12-13T22:59:00.006-05:00

In clerkship, you rotate through lots of different services and specialties. You spend an insane amount of time with the residents on that service. It can be a stressful situation, and you really do need to work as a team in order for things to work well and efficiently. So I guess, it’s not a surprise and sort of expected that residents on the same service will share certain idiosyncrasies.

For example, during my 12 weeks on surgery, I noticed that many of the residents loved to use the word ‘perfect.’ No matter what the situation, they always used ‘perfect’:

Gen Surg Senior
Mr. X, have you pooped yet today?
Patient X
Oh yes, doctor
Gen Surg senior
Perfect

Hot Senior
[during morning rounds]
I’m going to take off the dressing now. It’s gonna hurt
[rips off bandages]
Patient
[Screams in pain]
Hot senior
Perfect

Hot senior
[in OR]
Stuff you’re going to suture up that wound okay?
Stuff
[After 20 extremely long minutes of suturing up a 5 cm wound, says triumphantly]
Finished!
Hot senior
Perfect!

Another observation? Surgeons walk fast. Really fast. And they always seem to be walking like they need to get somewhere very important. And when and if they actually go somewhere important, they seem to storm into a place like they own it. On one of my first days on Vascular, when I was basically being my other senior’s second shadow, we were going down somewhere – I don’t even remember it being that important, perhaps for a coffee run? Anyway, we were trying to get out of the elevator but it was super packed with people. I had to push my way out while he had already forged ahead. Partly owing to the fact that the guy had an unfair advantage in the leg length department (6 ft tall versus 5ft 4) it was not a surprise that he was quite a bit ahead of me. So I started to run after him, not wanting to be left behind. I guess he noticed me not glued to his side, so he turns to wait and sees my clumsy running. When I finally catch up, he gives me my first piece of surgery advice:

"Stuff, we always walk fast and we walk with purpose. We NEVER run, but we always walk fast. No matter what, got it?"

So what has happened to me after 12 weeks of surgery? I find myself now saying perfect in every possible situation no matter how irrelevant. And I walk fast. Really fast. Surgeon fast. And I do sort of storm into places (with purpose of course). And people always ask, 'Surgery?’ To which I answer confidently, 'Yup!' (except that doesn't quite work anymore seeing as I am on pediatrics).

I hope my pediatrics rotation cures me of these, because at his rate I'll be drinking my coffee black, and making inappropriate comments about everything and everyone, having somehow morphed into a male surgeon.

Good-bye Tonsils!

2009-11-14T17:52:00.005-05:00

One of the most distinct memories I have growing up was when I was 6-years old. I was in Grade 1 then and we were just starting to read books. At my school, we would have afternoon sessions every week with the 'older' kids (older being 9-yrs old or so - which at that time was OLD) who were assigned as our "reading buddies." Our reading buddy would then come and read to us a book of our choice. There were tons of books to choose from. Fairy-tales, adventures, cars, animals. I remember there seemed like shelves filled with different books.

Unlike all my classmates though, I would always, every single time without fail, choose the exact same book.

The book? It was called 'Good-bye Tonsils.' Basically, it was about a little girl who had to have a tonsillectomy. It was a simple story, but I remember it vividly: the little girl meeting the doctor, going to the hospital (with her stuffed toys of course), having the surgery, and then afterward having only Jello and ice-cream to eat (a 6-year old kid's dream come true).

I was absolutely fascinated by this story and I still remember how enthralled I was by it to this day. [Thinking back, I was a strange kid because NO ONE else chose this book - I remember frantically looking for it one time because I thought someone else took MY book - but of course, no one did. It was just hidden].

Now in present day, I just finished my ENT (ears-nose-throat) rotation a couple weeks ago. It was here that I witnessed a real-life tonsillectomy for the first time. As I was assisting in the surgery, I immediately remembered the book and my 6-year old self. At that moment, it all felt so apropos. Like full circle, you know what I mean? That I was here - finally - reaching one of my goals/dreams. I guess that 6-year old girl was onto something huh?

Unfair

2009-10-14T23:35:00.003-04:00

I'm on pediatric neurosurgery right now. It's my second and last week which is now quickly coming to an end (such is clerkship - time absolutely flies!). I've been missing vascular and the team very much but this has been another eye-opening learning experience.

Peds neurosurgery. How do I describe it. Fascinating. And tragic. Very tragic. Seeing kids sick is not fun. That's not to say there aren't miracles and kids don't get better. They do! And when this happens it's a truly wonderful thing. But when they're sick, and I mean some of these kids are very, very sick, it's so hard to watch. It's hard to separate yourself from the situation and so very hard to not just sit and cry.

Last week on my second day on service, one of my consultants invited me to attend an emergency operation that night for a child with a brain tumour. It was some sort of rare metastatic brain tumour which was very large. But she got it out. And when we went to see him the next day, he was doing really well. He was still a very sick little boy but he was doing better, watching his cartoons and asking for Oreo cookies. The plan was to discharge him home and then continue with chemotherapy.

But then things took a turn for the worse. A recent MRI was pulled up. The tumour my consultant took out was gone, but now a second tumour had grown at an alarming rate. It had almost doubled in size since the last week. And what was worse was the appearance of a new third lesion. We had to tell the family.

As we approached them the mom already had tears in her eyes. She knew things weren't right. I guess parents just have that sixth sense. Going into the private room, I asked my resident if I should be in there too for this meeting. It felt so awkward, so wrong, so uneasy. I didn't think I belonged and that I was intruding on such a tragic and private moment. Once in there, the doctor started to speak... about the options, goals, expectations. It was a lot to take in. The mother started to cry again. They said that they had always known this was a possibility. That they knew the tumour was an aggressive one. They wanted to give their child a fighting chance. But at the same time at what cost. They wouldn't put their son through something that was futile. How much more could one little boy take. Was it worth it? They wanted answers. We could not say anything for certain. All they wanted was for their son to be okay. We couldn't even tell that. It was so hard to watch. So hard to be there. I wanted to cry. Wanted to comfort them, tell them it would be okay. That there son would get better. But it was not my place. I did not know them. They did not know me. So I prayed inside for them, for him, for all of us. And I hoped that it would be enough.

They decided to operate that night. There would be no Oreos for our little patient that day. So I had to fight back more tears as I heard him cry because all he wanted was that one cookie.

Peds has been tough in this sense. It seems so unfair. Life seems so unfair for our little patients. We shouldn't have to see little boys on our operating table waiting to have their brain tumour removed. Little girls shouldn't face an unknown future because they were 'accidently' dropped or shaken. We shouldn't have to fix them. They shouldn't be broken in the first place. It's too tragic, all too tragic.

I truly, truly admire all those who work with children. But for me, it's been a tough two weeks indeed.

Don't you hate pants?

2009-10-14T22:55:00.007-04:00

Midway through clerkship and I've survived! I've finished my anesthesia rotation (which I loved - yay for IVs and intubations!) as well as my vascular surgery rotation which I absolutely adored ever so much.

I was so nervous right before I started vascular. 1) It was my first ever surgical rotation 2) It had the reputation of being very intense and very busy 3) Did I mention that hot cardio resident was the senior resident on the team? Hence, I thought it'd be horrible. That I'd hate it. I mean what do I know about aortas and blood vessels? Um, they carry blood. Blood is good.

Luckily, it turned out to be an incredible experience. I mean I had my hand on a patient's beating aorta - not something one experiences everyday. Surreal and amazing at the same time. There certainly was never a dully moment on this rotation. And it sure was full of some very "interesting" experiences.

One day, I was sent to help out at Vascular Clinic. Normally this is a relatively easy and relaxed time. You go in, introduce yourself to patient. Ask them about their problem (usually it's a AAA or peripheral vascular disease) and then do a focused physical exam. So you palpate their abdomen for masses, and feel for pulses from femoral down. Patients are usually told to remove their pants for this and to put on a gown so we can look at their legs and feet more closely. Easy-peasy. Routine. OR so I thought.

I had seen many a patient by this time and that I had the 'act' down pat. I spoke too soon. I should have guessed that something was not quite right when the clinic nurse warned me the next patient was looking rather 'unkempt.' But again, I'm supposed to be all professional and stuff right? No judgments here.

Stuff
[knocks on door]
Hello sir, I'm St...
[stops short when she sees patient has gown on backwards and is not wearing ANYTHING waist down. I.e. The man is naked as a jaybird]
No Pants Man
Is this gown on backwards?
Stuff
Yes, yes it is. Now how about I put this blanket on you.
[Proceeds to cover man up while hurrying to finish the interview as fast as humanly possible]

So let's just say our patient population in vascular was never predictable.

Another day I was following around hot senior for the day (in clerkship thus far, I have latched myself onto whoever tells me to follow them and then don't let go. You learn pretty quickly that if you don't, your resident/team will forget about you and go their separate ways, leaving you lost. Oh so very lost. I was lucky in that my vascular seniors would usually tell me to follow one of them).

We get called down to the ER to see a consult for an "ischemic toe." As we're going down the lift, he pre-warns me that the patient has some "psychiatric issues." He mentions something about OCD and possibly schizotypal personality disorder. Apparently the patient had been in the night before but left AMA. Okay, we had our psych lectures last year. I could deal with this. I'm a patient-centred medical student. Boy was I wrong:

Crazy toe man
[sitting in bed looking rather wild-eyed and agitated]
Hot senior
Sir that toe is going to have to come off
Stuff to self
Crap. This guy looks scary
Crazy toe man
Oh I know. It's dead. That's why I cut off the dead part yesterday myself. Doesn't it look better now?
Stuff to self
[slowly moves closer to senior. Senior looks like he could defend us if necessary This is somewhat reassuring to me]
What?! He did what??!
Hot senior
Yeah, well that's just the top part. The whole toe is going to need to come off. Plus we're going to need to admit you to hospital. You have an infection in your leg.
Crazy toe man
I can't stay in hospital. I need to take my heart pills.
Hot senior
Sir this is a hospital. We have all the pills you need.
Crazy toe man
Yes but I need MY pills. Plus I don't have an infection. Look it's so pink. It's got to be healthy.
Stuff to self
[inching even closer to senior]
Yeah pink because you have a rip-roaring cellulitis. Man look at that massive pitting edema.
Hot senior
[pokes leg to demonstrate pitting edema]
Actually your legs are very swollen and that pink is actually your infection. We're going to need to give you antibiotics. And then take off your toe.
Crazy toe man
[Getting more agitated]
It's NOT infected. I can still feel it and move it. See. SEE!
[Moves foot with dramatic flair]
Stuff to self
[Is now right next to senior. Really wanting to grab his arm at this point and hold on for dear life]
Oh man. This is not going well. Can we get out of here now?
Hot senior
Yes it IS infected.
Crazy toe man
[getting VERY agitated]
NO it's not! I DON'T have an infection. And you're not putting me to sleep to take off my toe.
Stuff to self
[Has now completely glued her entire body to senior's side, cowering behind him ready to hide behind him should anything come flying at her]
This is not good. Please stop antagonizing him.
Hot senior
Okay fine then we'll just take it off here. You can stay awake. Then you can come stay with us for a few day. We'll get you your meds.
Crazy toe man
[Apparently appeased by this proposal]
Okay
Stuff to self
What? What just happened here?

And so hot senior amputates crazy toe man's toe in the ER using only local anesthetic! Apparently, the patients in the next beds were none too please with the sound of saw on bone. Go figure.

Ah Vascular. I miss you.

And so it begins

2009-10-12T23:02:00.012-04:00

Again intended to post this earlier, but here it is. Better late than never:

So here we are. Summer ended way too early and before we knew it, third year aka 'clerkship' aka 'the start of real medicine' aka 'the rest of our lives' had begun. So many people had said that clerkship would be the best part of med school. It would be the year where we finally learned real medicine and how to be doctors. It would be exciting! It would be fun! It would be amazing! All the superlatives on what we should expect and how we should feel.

Everyone around me seemed so excited and so ready to begin. But me? I was absolutely terrified. Don’t get me wrong, I wanted so much to feel like a ‘real doctor’ and be in the hospital treating real patients. But I was not excited. I was scared. I had no idea what to expect, what was expected of me. I mean, let’s face it, my clinical knowledge was so limited to theoretical what-ifs and standardized patients. I’d never treated anyone for real before. And what about the residents? And the consultants? Would they be mean? Would I get yelled at? What if I get paged when I’m on call and have no idea what to do? There were so many what-ifs. So no sir, I was not excited. I was frightened, petrified, spooked. And I felt like the hugest idiot in the world. And we had not even started.

The start of school came so quickly. One moment we were finished exams and summer had started. But then as fast as you can say “vacation” third year had started. We were off to a jam-packed start with intro to clerkship lecture week. Basically it was a week of reviews, and how-to seminars for different procedures (IVs, suturing, intubations, casting, etc). It was actually quite fun and helpful (and at times bloody – hello IVs!) but again it flew by. Soon we were at the Labour Day weekend. And that entire weekend I was so nervous.

You see, the way clerkship works at our institution is that our class is divided up into different groups. Each group will rotate through the core specialties (surgery, medicine, psychiatry, family medicine, obstetrics/gynecology, paediatrics) but in different orders. My clerkship group (and my first choice) started with surgery first. I figured I’d start clerkship with a bang and jump with both feet first. But surgery was also the most notoriously intense rotation. Thus explained my nervous anxiety.

First day of the rotation was actually okay. It was held at big academic hospital on campus and we were sent to the big fancy robotics department. The day was actually super fun and not nerve wracking (except for the lecture in the morning from the senior general surgery resident on what the ‘expectations’ for clinical clerks were – aka being scut monkeys). It was pretty much a hands-on session for learning how to do IVs, suture, tie knots, intubate again. Good practice.

And it would have been an excellent day had I been able to figure out how to tie a surgical knot.

Let's just say I was not the brightest bulb when it came to tying knots. In the one hour session we had, the first 30-40 minutes of it were spent by me trying how to figure out to do this one stupid one-hand square knot tie while everyone else had moved onto the more complex surgeon’s knot. The good news was that the attending physician supervising us was very nice and patient with me. But eventually even he gave up and got the – ahem – hot cardiac surgery resident to come help me. Let's just say that did not help the situation at all:

Hot cardio resident
So let's teach you how to tie some knots
Stuff to self
Good grief this guy is hot. How am I supposed to concentrate?
Hot cardio resident
[takes Stuff's hands in his while making a knot]
Make a figure four...loop the string around... finger under, over...
Stuff
Uh-huh
To self
I have no clue what this guy's doing or saying. Hmm, don't think this holding hands business is really doing anything to help my knot tying. Is it me or it really hot in here?

Now in the midst of the small talk the group was making (I was too busy trying to get that darn knot), I hear hot cardio resident mention that he’s actually the chief resident on vascular surgery this month and if anyone was doing vascular as a selective. And I don’t know why but someone’s voice which sounded a whole lot like mine said loudly in an overly enthusiastic tone “I am!” (needless to say I was shocked by said boldness). He turns and says ‘Oh great! I should spend more time with you to make sure your knots are awesome.’ To which I think to myself 'Oh crap, now he'll remember me as the girl who cannot tie knots.'

Good thing I was a great deal better at suturing (hot cardio resident said they looked good - at least I am not COMPLETELY without hope). But I was more than slightly intimidated and nervous by the fact that when I was leaving for the day, he patted me on the shoulder and said 'Hey see you in 2 week!'. Aww you would say, how sweet. But to me that scared me. Because that meant the remembered me. He remembered me at the end of the day and he would remember me in 2 weeks as the girl who absolutely sucked at tying knots. What a way to begin clerkship. Needless to say I have been practicing knot tying relentlessly ever since.

End of an Era

2009-10-12T22:43:00.004-04:00

Wow we have not updated in a long time. Apologies, but things have been in a word - crazy. I intended to post these things awhile back (i.e. in June) but one thing led to another and here are are now. So here it is:

So school is finally finished. It's been a hectic year. Super packed, filled with exams, tests, OSCEs (horrors!), volunteering, research projects! GAH! IT's no wonder we haven't updated in the longest time. While I'm glad that school is finished, I am still shocked and slightly alarmed at how fast it's all gone. I think about it and it feels like it wasn't that long ago that I had just started working with Dr. BossMan. I blinked and I got into med school. I blinked again and first year was all over. Now I've blinked a third time, and here I am, all finished second year and working with Dr. BossMan (and a certain infamous Dr. C) again. 50% doctors. Crazy, exciting, scary. It’s hard to know how to feel, especially with clerkship looming. What does that mean? Well, it means they’re going to let us loose onto real patients?! Like the non-acting /standardized type!? I find it highly alarming that today on the subway a person was choking on their gum and I froze. What in the world is it going to be like next year when emergencies happen every day?! Double yikes. (Note: the guy was okay). Anyways, let’s get through the summer first before we open that can of worms.

Rite of passage

2008-12-09T19:12:00.006-05:00

There are a lot of important milestones during the medical student's career. The White Coat Ceremony, clerkship, getting our first pagers, being on-call, receiving our MD degrees. All things we experience as we journey on our path to full-fledged doctory-ness. But there are also those other things... other not so pleasant tasks that as medical students we must experience as well. Being pimped by an attending? Accidently oversleeping when being paged? DREs?

Well as luck would have it, I may now cross off the latter from my list.

DRE's fyi, is the fancy medical term for when a doctor inserts his/her finger into a patient's rectal canal. This way you're suppose to be able to feel the prostate, masses, cancers, etc. etc [I say 'suppose to', because let's face it, I didn't really know what I was feeling for and I think neither I nor the standardized patient wanted to prolong the procedure].

This week for clinical skills was our male reproductive health session. That meant having the SPs (I really hope they got reimbursed very well for this session) teach us how to examine the male patient's .. how do you say it nicely... 'tenders' (as said very apropos by Po in Kung Fu Panda) along with the DRE (Po, incidently has a very nice DRE face going on here).

We watched a video on basic how-to's, then were paired off (guy + girl) with a tutor and SP to practice what we learned.

Yeah, initially it was sort of awkward. But whatever, I man-ed up, put on my serious/professional look and just did it. To be honest, my guy colleague seemed much more nervous than I. The only thing was that I kept asking the SP "are you sure this is okay?", "this isn't painful is it?" because honestly, some of these things didn't look too comfortable (uh, inguinal hernia exam? 'Nuff said). Fortunately, the SP and tutor reassured the female half of the group that it wasn't.

All in all it went better than I thought. At least I remembered to use lubricant. Unlike poor 3rd yr med student Deb Chen (watch at 2:30 especially):

Countdown to X-mas Break: 1.25 weeks!

A Chicken a Day

2008-12-03T17:19:00.003-05:00

...keeps the med students' stomachs happy. So on Monday evening, after the Nephro exam, our honourary class president, Dr. Kidney, held a dinner for all 100+ of us. As you might have guessed from my oh-so-subtle title, it involved chicken. Roasted chicken to be exact. It was very nice and yummy and VERY thoughtful of Dr. Kidney to sponsor this for us. This leads me to conclude that : a) he is awesome b) he is generous c) he also must have a lot of "disposable" income. (Actually, he was also nice enough to pay for our course manuals and course notes for this block, which is way more thoughtful than expected since I probably spend like 5 hours a week just printing those stupid powerpoint slides... grrr...sorry I digress).

Anyways, yesterday was our annual gingerbread house contest. It's held to raise money for our various class charities. This year Truffles, cramberry, Doodles and I went with a pink and blue theme (okay fine so this isn't a real theme... we admit that we went to buy candy 30 minutes prior... and this is what came out).

In honour of our nephrology block (and maybe to sway Dr. Kidney's opinion, seeing as he is the judge), I also created our very own gingerbread nephrologist! With glasses, kidneys and bladder! Yay! Notice the anatomically correct bladder, with trigone included! (some people have mentioned that it looks like he has ambiguous genitalia ... I beg to difer.. they're kidneys, ureters and bladder! Bladder!!)

Fun times all around. Almost makes you forget that finals are in 2 weeks. Almost...

Countdown to X-mas Break: 2 weeks!

CODE BLUE

2008-11-25T19:16:00.009-05:00

It's going to be a very post happy day! After some nudging and hinting on Stuff's part, I've decided to get my act together and post (after a long hiatus - see Stuff's most recent entry for excuse) about the Code Blue event Cramberry and I just attended in the ICU department.

We walked into the ICU conference room to see 1.5 plastic dummies and 2 cookies on the table. The cookies were left over from another meeting earlier in the day and have no relevance here, I mention them only because I was near starvation at the time and couldn't stop looking at them as my blood sugars dipped into hypoglycemic territory. I say 1.5 dummies because one was only half a dummy: torso and head with no legs or arms. The other one (with all appendages intact) was lying next to a crash cart (defibrillator + pharmacy + medical supplies on wheels). There were 10 medical students in attendance, all there to learn how to 'run' a code blue from an ICU doctor.

Dr. B started by walking us through all the components of the crash cart: how to turn the defibrillator on, adjust the voltage, slap gel pads on the dummy, apply the paddles, yell "CLEAR!", press the orange buttons, check rhythm, etc etc etc. (You know, exactly like how they do it on TV). She also went through all the components of the drug box: atropine, epinephrine, amioderone, lidocaine... basically the entire pharmacology section of our cardiology block in a little metal box (Stuff would have loved this part. Me, not so much). There are also two little bright orange pylons on the crash cart to put outside the doorway of the patient's room - just in case the hordes of people within weren't enough indication of a code blue situation.

We then split into two groups of 5. Each group had a leader, a drugs person, the electricity person, a chest compressions person, and the airways person. We took turned running codes on the dummy (popular codes include... "patient is awake and talking with slow heart rate!", "patient has pulseless electrical activity!", and "patient has arrested and is in ventricular fibrillation!") for about an hour. I got to be chest compressions person and electricity person for 2 separate cases. Unfortunately I didn't get to do the "CHARGE UP TO 200V! EVERYONE CLEAR!" spiel all us baby-doctors dream of yelling out - the case in question was of a bradycardic (slow heart rate) patient who needed pacing... so all I got to do was unplug the paddles and plug in the pacing pads. Boourns.

On the plus side, I did get to practice intubating on the 0.5 dummy at the other end of the table - the trick with intubating is to slide the metal laryngoscope into the mouth and stop just in front of the epiglottis (flappy thing over tongue), then push out HARD without chipping teeth or breaking any laryngeal cartilages to expose the arytenoid cartilages, then slide the tube into the trachea without going into the esophagus. I did it! It was glorious. Hurray for me! Hurray for 0.5 dummy!

Oh, and in case anyone was worried about my hypoglycemic state, Dr. B ordered us pizza for dinner. It was good. And that my friends, is how a fake code blue is run.

Countdown to X-mas break: Still 3.5 weeks!

Everyone poops ... and pees too

2008-11-25T16:13:00.004-05:00

...unless they have some obstruction or neurogenic condition, but then I guess it'd be more of a dribble, constant flow or... uh.. too much info?

So, as you can sort of guess, these past few months have been our bodily function blocks, otherwise known as Gastrointestinal and Genitourinary. Intestines and kidneys! Diarrhea and constipation! Poop, pee, poop, pee... and more poop! Hurray!

Okay, so I know there's more to it than that. Obviously... it's part of the reason why we've been MIA for so long. Sorry! We're okay, we've been here, just stressed and overwhelmed with lectures and assignments and exams and research projects, and life... but surviving though. The courses have been intensely detail-oriented, and GU especially has been particularly cerebral. Take today's lecture on proteinuria, or protein in the pee, as an example: there are two types, micro and macro, which may be transient, orthostatic or persistent. Now, persistent proteinuria can have 4 different kinds of proteins excreted, one of which is glomerular proteinuria, which can have primary or secondary causes which in turn have their own bazillion possibilites, etc, etc... You get the point. And that was only HALF the lecture! We still had to go through hematuria (blood in your pee) which had its own long, convuluted flow chart... kinda like glomeruli and nephrons! (Oh gosh, I'm nerdy). I felt like I was in a real-life choose-your-own adventure story, except every story seemed to end in glomerulonephritis. I guess it is as the docs love to say, "Clear as mud, no?"

Along with all these brain-frying lectures have been our clinical skills sessions. They've mostly been really helpful and help us consoldidate what we've learned (or were supposed to have learned last year... *cough* MSK *cough* anatomy) thus far. And all the docs (specialists in whatever speciality we're learning that week) have been really good... at least when we've had them (let's just say our pediatric sessions were spent mostly playing with the cute babies, and when asked by the parents whether we wanted to examine anything, it was replied with a prompt 'Uh no, that's okay.')

One thing about the ever-prepared medical student in clinical skills is that I get asked a lot for supplies. Paper, gum, pens, highlighters, and hand-cream. Yeah, hand-cream, because all that hand-washing and MRSA prevention does make one's hand get kinda rough. I shouldn't be surprised, but I just didn't anticipate from my guy colleagues (boo...how sexist of me!). At today's cardio session:

S
Hey Stuff, do you have hand-cream I can borrow?
Stuff
Sure... uh, but it's scented. Is that okay?
S [hesitating slightly]
Scented?... like girly scented?
Stuff
Um... yes, yes it is
S
Uh..... it's some fancy pefumey stuff isn't it? Okay, well thanks anyway.
[30 seconds later]
S [looking at his hands]
Actually, can I get some of that?
Stuff [handing over the lotion]
Sure!
Dr. Cardio
Okay guys, let's go examine the patient
[S walks out first, a scent cloud of Vera Wang by Vera Wang trailing]
S
Oh man
Stuff
Hey at least you've got supple skin now

So if you ever smell a bunch of med students smelling like Vera Wang, well you know where they go it from.

P.S. New skill I have perfected this year.... sleeping in lecture... I am awesome at it... Truffles, what with your grunting yourself awake and dreaming about clapping in class, have some practicing to do. =P

Countdown to X-Mas Break: 3.5 weeks!

Back to basics

2008-09-11T19:17:00.004-04:00

Time flies when you're having fun... or are over-worked and stressed. Work was great, the research (though overwhelming at times) was interesting, the docs were awesome, etc, etc... But faster than you can say 'medicine' here we are back at school again. Summer sure flew by quickly and bam, before you know it, we're in second year. As in we've passed first year. As in WE'RE the senior pre-clinical med students. As in we're one year away from actually having to take care of REAL patients. Gah! So, so, so scary.

Second year has really started off like first year never ended. No intros, no 'hi, how are you's', just straight into endocrinology and all them hormones. I guess learning about stress hormones by getting the students to release their own endogenous cortisol is one way for us to learn.

Classes this year are now in the afternoons. Good news? More sleep time. Bad news? Less time and therefore inclination to study... ugh...

Yesterday, I had a little accident that lead to a huge query on stuff we learn in school. Let's just say it involved the kitchen knife, my index finger and lotsa blood. Needless to say, after my botched attempts at first aid I was left with the question on whether I required stitches or not [luckily I think not]. This left me with my question... When do we learn about these 'practical' issues in medicine. Sure, we've learned that Cushing's Syndrome is due to cortisol excess, and that there are two types of calcium channel blockers, dihydropyridines and non-dihydropyridines. But how do you set up an IV drip, or give a person a needle, and most importantly, when, WHEN does a cut require stitches?!

I know, I know. We're supposed to learn this all in clerkship. I guess it's true what they say, third year's going to be straight into the deep end, head first and all. Trial by fire, eh?

Ouch!

2008-08-26T19:57:00.012-04:00

Bad news? I hurt my back yesterday. It was so bad that to bend, change positions, basically MOVE was excruciatingly horrible. I was going around like a 102-yr old man who needs a cane. Ugh.. so yucky.

Good news? I work in an office filled with docs who are very willing to give you an opinion/diagnosis/treatment all wrapped into one.

Yesterday when I went into talk with Dr. BossMan, I had to gingerly lower myself onto the chair. But even small movements like this caused me to yelp out in pain, which led to him asking what the matter was. When I said I hurt my back, he (so like a doc) did a quick HPI, then went on to tell me about HIS back problems last year where he had a herniated disc which led to an L5 radiculopathy and foot drop. Uh, not very comforting. Good for me was that I didn't have any neuropathic symptoms. So he gave me two ibuprofens and told me to take them (I'm a good patient so I did as I was told).

Unfortunately, this did nothing and the pain progressively got worse! Ugh! So I was hobbling around the place (trying to compensate for my weirded out back) when Dr. C, I guess noticed my strange gait:

Dr. C (in a super nice voice)
Did you hurt your ankle Stuff?
Stuff
No, I threw my back out.
Dr. C (again, super sweetly)
Oh... that's horrible. Do you want some ibuprofen? I have some right now I can give you?
Stuff (internally dying from the whole swoon-worthy conversation)
Oh no that's alright. Dr. BossMan just gave me two.

Okay, altogether now.... AWWWW... Gosh darn it...

Now brace yourself. It only gets better. Today, as I stormed into the office, being in a huff because I was slightly late, I rushed past Dr. C who was standing at the shiny, new espresso machine (daily ritual for all the attendings):

Dr. C (calling out to Stuff)
How's your back?
Stuff to self
Gah! He's talking to me again! Okay, no facial vasodilation allowed.
(gives pained look to Dr. C)
Dr. C
Oh no! Did you take ibuprofen? I can give you some if you want.
Stuff(swoons)
No that's okay, it didn't really work yesterday.

After said swoonage, and as I was coming out of the bathroom, I noticed Dr. C, the research coordinator standing outside Dr. Nice's office. Guess what they were discussing?..... Yep... my back

The RC & Dr. C seemed to think that I needed naproxen, or maybe try some more ibuprofen +/- acetaminophen (Dr. C, aka the human pharmacy it seems, tells me he has both). He also asked me to show him where the pain was & if it extended down the legs (see! see! so doctory). Dr. Nice, however, thought I should just try to rest & sleep it off. In the end, the consensus was to give ibuprofen another try...which I did.. and lo & behold... it worked!

So I've been (relatively) pain-free for the rest of today, and am crossing my fingers this whole business is not due to placebo.

I've said it before, and I'll say it again... I love me MY docs!

P.S. Truffles, I have one week to get over this 'sine curve' that is Dr. C =P
Please remind me next week.

Perks...

2008-08-13T20:31:00.003-04:00

...of being a research scutmonkey? Free medical advice!

I kid, I kid. But really? It's that you do get (relatively) easy access to world experts on different medical areas. Want to know about ventilators? Last door down the hall. Subarachnoid hemorrhages? Right next to that. It's pretty cool, come to think of it. Just wish that I more time & ballsy to ask sometimes.

Today was what you call a two-for-oner. You see I'm currently doing work on a study on ARDS. Dr. BossMan is supposed to be a world-expert on this. I am not. This is why today I had an appointment with him to go over tons of patients chest x-rays (CXRs) to determine whether or not they actually had ARDS, so that I could start & finish data collection. As we were going through the first couple, he asks me 'if I want to learn CXRs or not.' Um... do you even have to ask? If you can't tell by now, I, Stuff, am a huge nerd. So given the chance to learn about reading CXRs with an expert? Of course! I was just waiting for him to offer.

It was good. He talked about air bronchograms, looking at the heart borders, lung volumes, atelectasis. Showed me what he was looking at (because honestly, those air bronchograms are tough to spot... Sometimes you have to squint really hard... I wasn't sure if I was imagining things or not at times... Kind of like the JVP huh?), quizzed me a bit, asked me what my diagnosis was before he gave me the answer (which was really scary at first, but it's actually quite helpful). Put up with my inevitable stupid questions. You know, all that fun stuff.

I was a lucky girl today.

P.S. Apparently doctors here hate getting their picture taken. I'm trying to update the research board and NO ONE at hospital número 1 is replying me

You know it's bad, when my admiration for Dr. C is going down because of this. Not replying to my email? Grrr...I'm offended. I think he's avoiding me because he doesn't want his picture taken. And Dr. BossMan has a million excuses for not giving us one. Double grrr...

Unluckily lucky

2008-08-11T20:05:00.003-04:00

I must be a magnet for bad luck. Walking into doors, getting splashed by cars, gum on the shoe, that's me.

Today was out to lunch with Dr. BossMan again and us research assistants. It was a nice day so naturally we took a patio seat, under the sunshine, trees AND (duh duh duh - ominous music) the birds. Birds, or pigeons to be more specific, don't like me. They like to block my path along sidewalks, come up to me for food and fly over my head, dangerously close. So I should have known, or expected that together with my luckiness with the unlucky, something like this would happen.

Happily eating my sushi (comfortably this time, because Dr. C is on call this week and thus could not come) I did not realize that somewhere an evil, evil pigeon decided to have a BM right onto my chair, where in that exact spot my jacket was lying. And of course, being me, I did not notice said leftovers of that evil bird's dinner and touched my sleeve to it! All together now... EWWWW

Yup, I was pooped on. And as luck would have it, the ENTIRE TABLE saw it. Dr. BossMan, two of the fellows who'd come along, the research coordinator, ugh.

They say that getting pooped on by a bird is actually lucky. Tell that to my jacket, and my pride. I'm gonna go now to wash this 'luck' off. Hopefully, something better will fall on me tomorrow.

[Do you think I should buy a lotto ticket just in case? ]

P.S. Truffles, my dislike of birds does not extend to your bird. He and I like each other just fine. It's okay by me if he still flies on my head (so long as he doesn't BM me).

P.P.S Overheard one day while in office:

Dr. Nice [huddled around ultra-new 'espresso' machine (which apparently grinds, froths, steams, brews... I'm surprised it doesn't make a cake too!) with residents before 'teaching.']
So if you want to have an espresso, you add 30 cc's of water

Ah, sign of career melding into life.

A Jonah Day

2008-08-05T19:11:00.005-04:00

Anne, by what somebody has called "a Herculaneum effort," kept back her tears until she got home that night. Then she shut herself in the east gable room and wept all her shame and remorse and disappointment into her pillows. . .wept so long that Marilla grew alarmed, invaded the room, and insisted on knowing what the trouble was.

"The trouble is, I've got things the matter with my conscience," sobbed Anne. "Oh, this has been such a Jonah Day, Marilla. I'm so ashamed of myself. I lost my temper and whipped Anthony Pye." - From Anne of Avonlea

Haven't we all had one before? A day like today, when nothing seems to go right. I should have known. I woke up with a weird nagging feeling that made me NOT want to go to work. Ahh! That never happens, eager beaver that I am! But the feeling was there, and I seriously didn't really feel like going in today [see Truffles! I told you I had ESP....we seriously need to do a case report on this instead of our ethics project]. But in I went anyway, and I was still excited and pumped to get some interviews today.

Alas, good plans are often laid to waste. Why? One condition of the study I'm doing is that we have to talk to the clinical team first before talking to the families. Fair enough, as 99.99% of the time they know a lot more than me and can offer a lot of insight into how the families are feeling at the moment. But sometimes (especially now, aka beginning of the 'school' year for residents when some residents are very new, and some have never been in this type of unit before, much less know or care about the study I'm doing b/c I'm sure they have much more important things to think about, like maybe saving lives?) it can be real pain to do this. Because like I said before, a lot of the residents are really new, some fresh out of med school, so they can't really answer my questions. Actually, some are really confused as to why we're asking (bugging) them with these questions in the first place. Another thing which is annoying is that when I want to talk to them, I can never find them. They're either (1) at teaching (2) eating lunch or and this is the big one (3) rounding. Yup, at the new place, it seems like rounds go on and on and on for the whole day. So much so that... get ready for this... I'm beginning to ... really... dislike them! Ahh! What's happening? But honestly, it's really frustrating when you want to talk to the family who's standing right in front of you, but can't because you haven't spoken to the docs who have been rounding since midnight or something. Okay rant done.

Yeah, so no interviews, who cares right? But if you're like me, when it rains, it pours. Our 'office' in the other hospital is actually a floor up from the unit. So when you want to go to the unit, you have to walk down some stairs and then unlock a door which will lead you right smack into the middle of the unit. Normally, very convenient right? So today (being the enthusiastic research assistant that I am) in my excitement, I ran down the stairs and flung open the door HARD... to find 6 heads turned in my direction, and on them, 6 pairs of M.D. eyes staring at me. Yup, I had walked right into the middle of rounds. What made it worse was that I had to walk into the middle of their little huddled circle, move in front of the attending, while muttering sorry, sorry, excuse me, excuse me, in order to get out. Oh the humiliation.

But I'm not quite done yet. Later on in the day, I had to go retrieve a poster from one of the attendings, let's call her Dr. NEJM. So I went to her office, knocked loudly. I peered into the window and to my horror saw that she was talking on the phone. At the moment, I thought of 3 options A) This was a nightmare B) Run away C) Hope that she hadn't heard me. But of course, she did, and she opened the door. Groveling began. Worse yet, she told me she was talking on long distance! But thank goodness Dr. NEJM is as nice as she is smart. Poster in hand, I walked/ran away quickly to my desk.

So pheww what a day. Of course you know what the only cure for a day like today is right?

A bowl of ice cream and window shopping on the net for Louboutin shoes

Dressed to Impress

2008-07-22T21:33:00.008-04:00

Working in a hospital, or I guess any city urban-ish type building, in the summer is horribly confusing for one's central nervous system. I mean the axons from the spinothalamic tracts going to the temperature/somatosensory cortex part of the brain must be horribly confused.

Why you ask? What is the source of such confusion? Ah, well during this time of the year when the outside weather is sometimes ... how do you say... clothing optional, well the temperatures indoors are often hypothermic (is this a word?).

So the dilemma for me and almost all other office workers in the city is how to dress in something that won't give me heatstroke when I'm out and about, but at the same time will protect me from the sometimes Arctic-like temperatures at work. Temperature control is definitely not this hospital's best suit. Take our old offices from last year as an example. Since Dr. C's & our (research scut-monkeys) offices were joined and only separated by a temporary wall, you'd think they'd be the same temp no? Alas, this was not the case. While ours was often mind-numbingly cold, his was feeling hot, hot, hot, ole, ole, ole, ole. I guess that's why he found it weird that I was always wearing a scarf around the place.

I guess you could say that the new offices are an improvement. At least they're all uniformly cold now. So what's the solution? This is now where I, ladies & gents, introduce the concept of layering. Yup, winter sweaters are necessary work-wear at this office. Unfortunately, my sad hoodie does not exactly convey professional research assistant, no matter what I'm wearing underneath. That's why I've been looking to no avail for a solution to this problemo for awhile ...until now...

Introducing our official department fleece/sweater/saviour from the office AC that has a mind of its own. It's kinda like the one below, except it has our department logo and is therefore cooler, because you know we're the best and all.

The nurses and attending docs all have one. Dr. C has a red one that looked kinda like this, which I particularly wanted but I sadly couldn't get because I'm not part of their special club or something, something (so what if I'm not technically an MD. I'm 25% of the way there)...

But long story short, my problem has been solved! I'll be warm & toasty while at the same time looking like I actually work here and am not some random kid who just came from basketball practice or something. Woot!

P.S. Dr. C moment of the day:

Dr. C [with new swoon-worthy haircut]
So what are you up to these days? Entering data?
Stuff
Uh, well I'm doing some interviews with families, and yea I'm finishing up some charts.
Dr. C [with look of pity and empathy]
Ah [pause] good luck with that
Stuff to self
A doc who understands the toils of the underlings? [double swoons]

Inspired

2008-07-18T19:16:00.008-04:00

Every once in awhile, something comes along that really wows you. A moment that you play witness too that truly, truly inspires you.

Where I work in the hospital is a place that's filled with the sickest of the sick. Incredibly tragic cases where sometimes there's almost no glimmer of hope left. Young, old, men, women, large families, or no one at all. I've seen so many. Heartbreaking. At times it makes you question, what's the point? It's hard feeling so helpless, when even the doctors don't know what to do.

So it's a wonderfully incredible surprise to see that sometimes there is a chance. Yesterday following rounds, a lady stopped one of my co-workers in the hallway, telling him that she knew his face. Apparently, her husband had been in the unit some time ago, and we had interviewed her for one our studies. He had been one of those cases. Where all hope seemed to have gone. Survival? Unlikely. A 'normal' life where he could live independently? Almost unthinkable.

But here she was, introducing this smiling, jolly and healthy looking man as her husband, the same person who 6 months ago had maybe a 10% chance to live. He had some residual problems from his illness, but here they were together, alive, happy and well.

The wife asked us to lead them back to our unit so that she could see the people who had taken care of her husband again, to introduce them to him, to show them that he was okay now, to thank them. They held hands as we walked there, and she especially was beaming from ear to ear. We asked them to wait as we went to tell the nurses they were here. She wanted to see one in particular. When he came out, it seemed all the emotions within herself poured out, not wanting or willing to be contained. The tears flowed from both, but they were obviously tears of joy, happiness and gratitude. They hugged each other for a long time. Other nurses gathered around and congratulated the husband, telling him he looked so well, telling him that his wife never gave up on him. Dr. C & Dr. Nice were around too. They were seemingly shocked by the situation as well. "You see," said Dr. Nice, "everyday we deal with survival, if they'll live, not necessarily how their lives will be after." So it's hard for these doctors, nurses or even I to picture how these patients do once or if they leave the unit. I was transfixed by the entire situation. Wowed and humbled by the fact that even with the knowledge we have today, things can still truly amaze you.

Being there that day, even though I didn't know the patient or his wife, made me feel very honoured. As an undergrad who was interested in medicine, and even now as a medical student, I was & still am often asked why. Why do I want to be a doctor? Why do you want to practice medicine? It's a hard question. I'm often at a lost for words when I get asked this. It's hard for me to really define or put into words what drew me to this profession. What I do know though is it has a lot to do with moments like this. The way the patient made it despite all odds. The way I felt then & there when I heard their story. And if I'm lucky, the bond the lady and nurse had as they hugged each other and cried because they had made it through together.

As Dr. C put it "it's not too often we have them, but sometimes there truly are miracles."

Breath of fresh air

2008-07-15T20:26:00.005-04:00

Week 2 of being at the new hospital. Good news it that I found the microwave. Even better news is that there are TWO microwaves. Hah, beat that old hospital!

Okay I admit, I caved and went back today. But only because I forgot stuff there! Okay, so maybe I was a little lonely. Maybe a lot. It's ironic that at the new place I'm surrounded by people in cubicles but you feel so lonely. And the unit? It's not as cozy. Totally fish out of water feeling.

But going back today was not all wasted. Along our travels to track down a patient, we happened upon one of the RTs (respiratory techs) who invited us to observe them 'decannulate' the patient's trach tube (basically taking out a tube that they put into a patient's trachea - windpipe - to help them breath). Again, awesome because 1) I had never seen this before & 2) I had contact with people! Hallelujah!

So they take this tube out pretty easily (it just slides out) and apparently the hole that's left behind will close on its own, sometimes literally in minutes. Skin, cartilage...everything closes. Cool huh? What wasn't so nice was when the patient coughed during the procedure, shooting out some projectile solids, I'd say maybe 5 feet away. That's one strong cough reflex! Glad I was standing on the side for that one.

Another really young attending is on-call this week. Apparently he attended the same med school Truffles, Cramberry and I are at; went through the residency program & fellowship I want, where I want; and is now doing his PhD at some fancy-schmansy world-renowed American Hospital. AND apparently, we really want him back too! So basically, he's living the life I want. Gosh, I love this guy! I hate this guy! So jealous. Do you think I can be like him in 10 years?? He's exactly 10 years ahead of us in training. It's a lofty goal, huh?

The doctors are out...to lunch

2008-07-11T18:53:00.005-04:00

Seriously!

Okay, so it looked more like this:

What's the occasions you say? Well, Dr. BossMan took us (research scut monkeys), plus research coordinators and some of the attending docs out for lunch because one of the RCs was leaving.

It was in this cute little café type place where I had some yummy, yummy pasta. Anyhow, Dr. BossMan was there (of course, since he was footing the bill). The RCs, us three little scut monkeys, Dr. Charming, Dr. Nice and two other docs from my new hospital site. Yup, 5 docs in this tiny little restaurant. Good time for any of the other patrons to have a medical problem... maybe not so good for residents left at work or the patients at the hospital

So, it was a lovely meal with lovely food but at the same time it was so awkward. Is it an oxymoron to say that it was uncomfortably good? Does that even make sense?

Like I'm sitting around here with FIVE doctors, one of which is my boss, another of whom I could not even turn my head in their direction, much less look at because they made the blood vessels in my face perpetually vasodilated and erythematous (think about it), who were all discussing I dunno what. It was so very awkward. Should I laugh? Should I nod my head? Should I make small talk? Am I talking too much?! Too little?!?! Am I eating too fast? Too slow?? Too much? GAH!!!

Basically, in the end I spent the time talking to one of my fellow scut-monkeys [who also agreed on the awkwardness of the whole situation] and trying to avoid looking at Dr. C because of the subsequent increased core temperature & all.

But I still enjoyed it. I'm never one to turn down food right?

So, thanks Boss!

P.S. Docs on call having beer? How shocking.

Ears, nose & throat

2008-07-10T20:19:00.005-04:00

[N.B. Again people I did not steal this CT from work, tsktsk...what do you think of me?]

Another week, another round of.... you guessed it... ROUNDS (with sushi I might add)

Today was an interesting case - sore throat leading to (not very sure because I was too fascinated & confused by the CT images) a retropharyngeal abscess that somehow got infected and went into the mediastinum. It was complicated..so in basic terms the infection spread from his throat (they believe) down the prevertebral space into the chest and lungs. [Sorry I know there's tons of medical terms but I'm finding it hard to 'translate' them into everyday language]. Anyhow, what was cool about this was that - remember Truffles? - we had this discussion during the ENT block?? Danger zones, prevertebral space, hyoid bone, etc,etc. From Dr. Thyroid aka McSteamy??

Dr. WalkingEncyclopedia then started discussing how this could Lemierre's Syndrome - which to me soundly oddly familiar, because I thought Dr. Bacteria may have talked about this Truffles? - which he said was common in the 1920s. However, none of the (much younger) docs had ever heard of it so Dr. Charming looked it up on... shock upon shock...WIKIPEDIA! Wow. How much satisfaction do I find in this fact? Let's just say I was pretty chuffed.

So basically what I'm saying is that Thursday rounds never disappoint (and no, it has nothing to do with the fact that I can ogle at Dr. C for an hour - please I'm not that shallow). For example, next week, apparently we're having Mexican (okay so I'm not shallow, but I do enjoy free food).

In other news, I am now officially at the other hospital. This makes me sad. I feel very discombobulated with the new environment/people. I can't find my pen! I don't know where the bathroom is! Or how to work the photocopy machine! And worse yet, where the microwave (if there even is one) is! Oh no! It's like the first day of school all over again, except you're like the new foreign exchange student, who doesn't speak the language, and has no friends. Sigh... how lonely... Oh don't cry for me Argentina, hopefully I will pull through

...maybe?

Good to be back

2008-07-03T20:42:00.002-04:00

(Last week on Stuff's first day back to work)

Nurse
"Hey"
Stuff
"Hey"
Nurse
"So what the?"
Stuff
"Whaddya mean?
Nurse
"I mean you disappear for a year and now you're back all of sudden?"
Stuff
"Uh, yeah I just finished school"
Nurse
"Oh, so you graduated?"
Stuff
"Uh no. I'm just done first year"
Nurse (looking confused - I don't look that old do I?)
Stuff
"Uh...I'm in med school."
Nurse
"Oh okay, that's okay then."
Stuff (jokingly)
"That's okay? Is it a legitimate enough reason?"
Nurse (thinks for a moment, clearly toying with me now)
"Yeah, yes that's okay."
Stuff
"Does it meet your approval?"
Nurse
"Yes it does. You can come back."
(pats Stuff on back)
Stuff
"It's good to be back"

It's a mystery!

2008-07-03T19:29:00.009-04:00

N.B. This CXR of ARDS is from Wikipedia - so no I did not steal the film from work. Have more faith than that people!

Wow. Attending rounds today were...wow.

One of the cases today was of a patient who had sudden unexplained seizures, was subsequently brought to hospital where they developed aspiration pneumonitis. Now they are in our hospital where they have:

1) ARDS
2) Kidney/liver problems
3) Major thrombocytopenia (i.e. platelets - the stuff that helps clot your blood - was in the 20s to 30s, normal is ~140)
4) what they think is SIRS.
5) Is on so much vasopressors (meds that constrict your blood vessels so that your blood pressure doesn't fall to low, & blood to vital organs, e.g. heart, brain, is maintained) that their fingers & toes are actually blue, to the point they look black (I know because the nurse showed us)

In other words, they're pretty darn sick. And to top it all off, they have NO IDEA what is going on with this patient. What is the underlying cause? Could it be sepsis, suggested Dr. Charming? Unlikely, said Dr. WalkingEncyclopedia. They've been on broad-spectrum antibiotics for too long. Maybe TTP, said Dr. Nice (who btw is the only female attending, why are there so few of us??). No, because there were no RBC fragments on the blood smear. Hypertension?? Ischemic hepatitis?? Alveolar hemorrhage?? No clear answers.

This all led to a heated "discussion" between Dr. Charming & Dr. WalkingEncyclopedia (again?!?! I tell you this is a weekly thing) which was highly entertaining (imagine your head going back and forth like Pong but 100x faster, as they fire "constructive criticisms" at each other) but got sort of confusing because they started using all these terms & abbreviations that I recognize but need more time to be able to register in my head. I can't think that fast guys!

So unfortunately everything is just a mystery right now. Fascinating stuff, but tragic at the same time. But at the same time, these "discussions" between the two docs definitely add to the entertainment value. It's pretty funny because you'll know when Dr. WalkingEncyclopedia is really...uh...peeved by Dr.C. It's when he starts calling Dr. C by his full first name. Like Charmingson, not just the nickname Charms. Almost like he's a kid who's in trouble with his dad (probably doesn't help that Dr. C says 'dude' a lot, even during rounds, and sits on TOP of the chair back, tipping it back & forth). But honestly I think that most of these 'talks' are in good fun, and that they actually really like/respect each other. They just have a hard time expressing it. Like a real family!

My thoughts on the whole thing? The only thing I can say is that I hope in 12 years time, those same words and sentences that were coming out of their mouths will be able to flow out of mine as easily.

P.S:

Dr. Charming to Stuff
(who was wearing a particularly colourful pair of rainboots today - Truffles you know the ones)
"Nice boots"
Stuff
[swoons]

Round & round we go

2008-06-26T18:51:00.005-04:00

I love rounds. You know on Grey's Anatomy where all the docs hundle in a group & migrate from patient to patient to discuss the case? I love that. In our unit at the hospital, the cases are really complex and you often encounter some exceedingly rare conditions. Like right now, there is are cases of Moyamoya and Lubag. I know right? What in the world are those?? I had to wikipedia them!! (Shhh... wikipedia is the ultimate reference for med students... just don't tell our profs) And it's pretty nice to just stand back and listen to the 'experts' talk. And not be grilled, as in how I was grilled while on a surgery observership:

Surgeon
"Stuff, tell me what muscles I am cutting through right now?"
Stuff to self
Crud, I don't remember any anatomy of the lower limbs.. oh no, he's glaring! Better say something quick..
"Uh, gluteus?"
Surgeon
Gluteus what?
Stuff
"Gluteus..uh.. gluteus maximus?" (aka J-Lo's most famous asset)
Surgeon (who clearly has a 6th sense for this)
"Is that a guess or an answer?"
Stuff
[hangs head in shame]
"It's a guess"
Surgeon
"I thought so"

But the best rounds, as in I have to go to or will be disappointed if I miss them even if when I'm on vacation, are the attending rounds. This is where ALL the all-powerful attending docs come in to discuss the more difficult cases. I love how they bounce ideas off one another, and sometimes even argue (which frequently occurs between the youngest, our very own Dr. Charming, & the most senior doc, Dr. WalkingEncyclopedia - whom we must always call "Doctor" because he's just that sort of guy). It's like House but with real doctors who know what they're talking about! Plus there's free lunch to boot! It's definitely my favourite perk for this job. Today was no different, with some strange cases & sweet Indian food [courtesy of a drug company... I know... but I will not be swayed to use their drug just because the samosas were finger-licking good. Actually, food is usually either provided by drug companies (that's when the food's the best, to be honest) or the attending who's on call for the week].
These are days that make me love my job.

P.S. Our 1st Dr. Charming encounter for the summer. He's dreamy [Stuff's eyes glaze over]. Sigh. a girl can dream can't she? He reminds me of the Sleeping Beauty Prince minus the fact he looks nothing like that, and is not actually a prince, & doesn't wear tights or wield a sword. But he DOES have glasses, & he IS a doctor. [Nor does he resemble David Beckham (who is dreamy in his own right)]

Learning for life

2008-06-25T18:02:00.003-04:00

I think that working at the hospital this summer will be an experience. On the one hand, it's a really intimidating place where you're scared all the time if what you're doing is hurting or hindering the docs & nurses working there. But it's also an amazing opportunity to learn. And I mean really learn, and not just the usual textbook reading & memorizing of random facts like Pseudomonas smells like grapes in culture (yea, that's actually true apparently). You get to see the things you heard about in lectures in REAL-LIFE (again not on a power point slide or a pretend actor) and try to maybe just put it all together. Like today I witnessed the use of adenosine for a SVT, which is probably not the most exciting thing in the world but hey, I'm a girl that's easily satisfied.

But a lot of the things you learn at the hospital just can't be found in books or taught in the classroom. Take yesterday. One of my projects for the summer is to talk to the family of patients. It's an interview that's supposed to take 20 minutes max. But at the interview yesterday, talking to the aunt of the patient took much, much longer. At first she just answered the questions, but as she went on, she began to talk a lot more about her own feelings and what his illness was doing to her. The stress of the situation was evident on her face, and although she talked of keeping a positive attitude, it was clear that she too was suffering. She told us things she hadn't told anyone else. Not even her own family. But in a way, I felt that talking about it was therapeutic for her. And for that, I'm glad that I was there.

Today was also an, I don't know how else to describe it, but I guess 'interesting' experience. I witnessed my first brain-death declaration. The doc went through the entire process including pupil reflexes, caloric reflex test (which involved irrigating the patient's ear with 120cc of water), and apnea testing, etc, etc. I found it fascinating but at the same time difficult to witness. Because there was the patient, lying there, seemingly still alive. You could actually even SEE the heart still beating. Yet they weren't. There was no brain function left. The doctors proceeded with the testing, almost cheerfully it seemed. But I guess they were used to it?? It was a heartbreaking and confusing situation. I had no idea how to feel. I still don't.

But this is what I mean though. Learning this summer is going to take on a completely different meaning.

School's out for summer

2008-06-24T21:05:00.003-04:00

25% MD!! And one-quarter done, not counting the small, miniscule issue of licensing exams or something. Ce-le-bra-tion time, c'mon...

We've actually been finished classes and exams awhile (May 30th to be exact) but between our rural community observerships, starting summer jobs and European getaways, there hasn't been as much time (or inclination sorry to say) to update.

Exams were, well...exams. Which really means they weren't all rainbows and sunshine, but more like 7 consecutive days of dreary, depressing rain. But at least they're finished with and if my school account is correct, then it actually looks like we survived them and passed! Meaning no summer school for Stuff!!

Right after exams our class was split into small groups and placed around rural communities for a week of clinical observerships and "wining & dining." Whether said wining & dining was not as good as expected because a certain group did not get to go to a promised excursion of theatre, well that's another story to tell (sorry Truffles, I really can't get over it, haha). On the 'medicine' side of things, my week was quite interesting with a fair number of weird & wonderful cases (an undiagnosed case of Raynaud's in an infant anyone or how about some IPF?), as well as some not so rare but nonetheless cool because maybe someone (I dunno who - looking around innocently) knew the diagnosis was pinworm? But I digress. In the end I didn't get to do as much as I expected (i.e. not monkey see, monkey do but monkey see, monkey see & don't touch anything especially anything green or blue) but I had a good time altogether. Some things surprised me, like the fact that I actually liked family med & peds more than I thought I would. Other thoughts on the otherhand were more or less confirmed, like I hate standing in one spot for 3 hours because I am afraid of unsterilizing myself or others who come within 3 feet of my vicinity.

So after this week came my long awaited trip where Stuff became La Stuffé. Get it?? Sigh.. I went to France okay??

And that brings us to today where reality finally sets in and work began with Dr. BossMan at l'hôpital. Apparently I'm going to be banished to work at our other hospital site for the summer meaning (un)fortunately I'll be a shuttle bus ride away from Dr. Charming! Oh no! Where will I get my weekly/daily giggles re his cuteness from?? Ah, c'est la vie... Can't win them all, n'est pas?

[please forgive the French, I am still jet-lagged]

P.S. I find it slightly disturbing that Dr. BossMan and I share the same taste in music. Highly weird feeling to discover that you & him are bopping your heads to a song playing on his CD player at the EXACT SAME TIME. Gah!

Examinating...

2008-05-26T12:16:00.005-04:00

2 down, 4 to go!

Question on the Infection & Immunity exam a couple days ago:

Mr. X presents to you with eggs in his feces and segmented flatworms crawling out of his anus. He is otherwise well. Mr. X is infected with

a) Taenia saginata
b) Taeniasis soliem
c) Diphyllobothrium latum
d) Hymenolepis nana

Now, if like Mr. X you too have segmented flatworms crawling out of your back end, today is your lucky day. The organism in question is (a) and you get it from eating undercooked or raw beef.

Answer key:
Taenia saginata - found in undercooked beef. characterized by it's motility: since cows don't eat the grass around their poo, the organisms need to be able to move onto clean grass (after being pooped out) in order to complete their life cycle. hence, it has been known to crawl out of people's ... ahem... bottoms.
Taeniasis soliem - found in undercooked pork. don't need to be motile because apparently pigs eat *everything*.
Diphyllobothrium latum - found in undercooked fish.
Hymenolepis nana - transmitted through fecal oral contact... kids get this a lot.

Medicine is such a grand, noble profession. Apparently, finding cysts of parasitic organisms in stool samples is a lot like digging for a needle in haystack. And for some species, you need up to 5 negative samples before you can conclusively rule out an infection... so it's like looking for a needle in... 5 haystacks so to speak.

Everything comes down to poo.

A Real-y 'un-Real' Experience

2008-05-23T17:11:00.003-04:00

The immunology exam is tomorrow. It makes me want to cry. Very much. Right now I’m banking on the fact that it’s pass/fail. Sigh…

On the more exciting side of things, we un-quarantined ourselves again today! Why at the 11^th hour did I decide to go out? You see, a couple weeks ago, we were given the opportunity to sign up for these ‘patient simulation’ experiences. Basically, it was a chance for us to practice our “clinical-decision making skills” on a robot – or SimMan as he is called.

I was scheduled to go into the robotics department at the hospital at 8:15 in the morning with three other people in my class. So I went up to this really swanky, modern office to sign in (clearly there’s some bucks going into this area). One of my group members was just behind me, so we went up together to the next floor where the simulation was to occur. Right away, it was very strange. Lots of computers, lots of medical equipment…essentially lots of expensive looking stuff with buttons that made me afraid to touch them for fear of breaking something. Stuff & computers don’t exactly mix. Anyhow, one of the admin people came to talk to us about the ‘case’ we were being given, as well as the introduction to SimMan. After watching a video, we were told we were going to be dealing with a trauma case, and were handed trauma/isolation gowns and gloves (ooo, how Grey’s Anatomy – I felt very Christina Yang-ish). Gloves! I didn’t know it would be that realistic. Then we were led to the ‘simulation’ area where the ‘patient’ was lying. Our facilitator, who was a doctor in real-life, was acting as nurse in this case. So first impressions? Extreme confusion. I had no idea what to do. And yea it was pretty dang realistic. Blood? Check. Patient talking? Check. Breath sounds, pulse? Check, check.

The ‘nurse’ right away asks us what we want to do. Uh….I gots no idea man! Luckily, some people in the group asked for IV lines, some EKG leads. And we were underway.

Throughout the experience, I had this weird urge to laugh. It was pretty realistic but at the same time, kinda artificial. I think this really was because I was completely LOST, and if this was truly real-life, we’d have killed the guy 5 minutes in. For example, the ‘patient’ was bleeding, and really tachycardic (fast, fast heart rate). When prompted how to deal with this, one guy answered – “um atropine.” Atropine? Guys, atropine actually has the exact opposite effect. We tried it out. The ‘patient’s’ heart began to beat faster and his blood pressure went down even more. So, atropine not such a good thing in this case. Another thing? I have no idea how to give meds. The ‘nurse’ got this syringe for morphine and told me to ‘administer’ it. I thought, yea, I can do this. So I happily started pushing down on the needle, giving the patient the FULL dose. Again, not the best idea. Basically, the whole thing was a lot of trial and error. And lots and lots of time outs.

But we weren’t complete dolts. When we were giving the blood transfusion, I noticed that two of the units had different names and ID numbers than our patient’s. Ah-ha! Can’t fool Stuff! Caught it in time so that we didn’t give SimMan a major haemolytic reaction. Hehehe…no, no. Truffles, wouldn’t Dr. RBC-transfusion be proud?

In the end we didn’t kill the patient. We actually managed to save him, I think. I thought it was a cool experience. I’ve never ever done anything like that, so it was sort of good to have done this before we actually try it out on a real-live person. A lot safer for the patient too I guess (uh, atropine?). It was sort of like throwing us to the sharks, considering I had NO IDEA what to do 99.999% of the time, but it’s part of the learning curve. I only wish it was longer…and not right smack in the middle of exam time. Anyhow, wish us luck for tomorrow! The bacteria are calling out to me.

A simpler time

2008-05-21T12:50:00.004-04:00

Sorry for the lack of updates, but we’re currently in our “exam-study period” or for me, self-imposed quarantine. 6 exams upcoming within the next week, so it’s pretty much crunch time right now. It’s a bit disconcerting when you open your notes and realize that you don’t remember ANYTHING from the past semester. Sigh…so much for learning for life huh? I guess we know who the questionable admission is.

So studying has been going slow…very slow. I had set up a schedule for myself, but as always, things don’t always go as planned. The respiration section was much too long and I haven’t even gotten to ENT. And Cardio? Well good ole cardio is once again painfully slow. The only saving grace in the whole matter is that it’s pass/fail so at least it will (hopefully) not be so miserable.

Anyhow, you know me and studying. I can’t help but…ahem…distract myself while I read. So what is the choice of amusement for this week? Other than caffeine? Okay, this is super, super, majorly off-topic but I’ve been watching Road to Avonlea and Anne of Green Gables on DVD and YouTube. Because, hello, these were/are my favourite shows when I was younger (or maybe even now).

The idyllic settings are sooo pretty, so much so that I wish I was studying somewhere in PEI rather than looking out at the car park of my building (which is so depressingly annoying).

And don’t get me started on the romance factor. Anne and Gilbert? Felicity and Gus Pike? Sigh....

Okay, fine that had nothing whatsoever to do with medicine. But then again, I’m the best at finding odd connections between random things in life and medicine. So here goes:

- Gilbert was a doctor (haha!)

- Felicity went to medical school!

- Last but not least, the whole series was set in a rural location…and guess what our class is doing in ~1 week? We’re being sent off to rural communities around the province to do clinical observerships for a week. So Ha!

There you have it. My usual exam post on procrastination. Till next time! Until then, it’s angina drugs for Stuff… There’s nothing more sleep-inducing than a lecture on calcium channel blockers.

Pick me, pick me, pick me!!!

2008-05-14T17:17:00.002-04:00

Whoa. I feel old. I’ve always felt that even though it’s been more than 10 years since I’ve left elementary school, it seems just like yesterday. In fact, most days I don’t feel like an ‘adult’ even though I’ve long since passed that age where I can be called a teenager. Most days (and especially when we’re talking to “real doctors”) I feel like a fraud…like I’m acting that I’m all grown up when in fact I’m just a kid playing dress up in their parent’s clothes. So it was a strange feeling to be back in an school today where the ‘real kids’ are (aka not the 20-somethings who still watch cartoons, drink juice boxes and wear colourful rain boots).

You see we are currently in our last week of lectures for 1st year med (Woot!! And wow did time fly by), which is on skin. Or if you want to be more professional, “dermatology.” It’s one week of intensive, and I mean intensive lectures on rashes, bumps and weird skin disorders that make me feel really itchy and eww. I think I’m more grossed out by most of this stuff than say watching a cardiac surgery where they have to saw open a person’s chest. Yeah, I’m weird that way. Anyways, so this week has been extremely condensed and INTENSE! As a guy in our class said, it’s been like:

Doctor-Lecturer
[slide with random rash] Absorb. [30 seconds…next slide with a million different diseases] Absorb. [30 seconds…next slide with another random rash] Absorb [rinse, recycle, repeat]
Class
[EVERYONE'S eyes are glazed over, mouths hanging open]

Hey docs! We’re med students, not sponges or miracle workers. Too many rashes! Gah!! They all look the same!!!

Anyways…I’m totally digressing...so our block assignment for this section was to go to elementary schools around the city and talk to kids about sun safety. You know, sun = bad, sunscreen = good. High SPF?? Even better! My group had four people. Me, Doodles, and two other guys. So today we went to the school where we were supposed to talk to these grade 4 kids in the afternoon. First impressions on being back in an elementary school? Weird…very weird because as I said, if felt just like yesterday when I was 10.

After setting up, their teacher brings the kids in. Boy were the small! I wasn’t that small was I? At 9?? Then again I was a giant (I just stopped growing when I was 11. So in other words, I am currently short). We start the presentation and the kids are pretty excited. Oooo pick me!! Hands up everywhere. Ahh, if only WE were so enthusiastic during lectures. All in all I think we did a pretty good job. The kids answered lots of questions. Most of them were repeated but hey they’re not rocket scientists right? Although there was this one kid who seemed quite bright. He answered with some unexpected stuff. Like why is the sun bad – Heat stroke. And what does it do for your eyes – glaucoma! GLAUCOMA!! I think he was also one of the ones who said he wanted to be a doctor [actually, only 2 or 3 kids put up their hands when asked if they wanted to be a doctor when they grew up. Isn’t this a cool profession anymore or has our secret identities as nerds been discovered?]. And at the end when their teacher asked if they had any questions, he actually asked one where we couldn’t really answer – can burning yourself from the stove give you skin cancer like a sunburn? Really I had never thought about this. Note to self, good research question for future, hahaha. Most of the kids were more, um, simple. Like one boy put up his hand just to tell one of the guys that his cousin was too named *John*. Another one went up to the other guy in our group to tell him that he had the same name, and that he wanted to be a travel agent so that he could travel places for free. Very cute. Their teacher then asked us what kind of doctors we wanted to be. I didn’t want to scare them by saying ICU doc (like how was I supposed to explain that? Where all the REALLY sick people go and sometimes uh, die? They're 9 people, 9!), so I said a cardiologist. Then one kid asked if that meant I was going to cut people open and take out their hearts. Um, yes…

So all in all a good session. We had a good group. Lots of different personalities, which is useful in this case. One guy used to be a teacher so he worked really well with the kids. Also, another lesson learned is that if you tell kids that you’re going to show something scary or gross, they’re going to want to see it more. We had this picture of a basal cell carcinoma which was pretty disgusting so we pre-warned them, but the kids got super excited and ‘eww, eww, what’s that, oh eww!’ when they saw it, while jumping around to get a better look. Although there was this one boy who was scared and closed his eyes, and thank goodness *John* recognized this and went to comfort/shield him. Yup, so fun day. I hope they actually learned stuff and weren’t only excited because we gave them candy. Yay for bribing!! And yea I feel old. Now excuse me because I have to go feed my 15 cats then rub some ointment on my corns & bunions, while watching me shows....kidding!

A Grand Ole Time

2008-05-09T10:16:00.004-04:00

Last night was our class’ last formal event of the year. It was held at this swanky little club downtown, which was pretty nice. It wasn’t a sit-down dinner, which was a tad disappointing at first (because c’mon food = number 1) but they did serve some yummy hors d’oeuvres and…wait for it… CHOCOLATE FOUNTAIN!!! In the end I think that’s what convinced most of us (I’m looking at you Truffles) to go.

The event was scheduled to start at 8, with food coming out at 8:30. I had the afternoon off so I technically had plenty of time to get ready. Um, wrong. Lesson learned, when you’ve managed to live the last year everyday in sweats and tees, getting ready for a fancy night out will take you an exponentially longer than it did before. I started getting dressed at 5:30, but didn’t finish until two hours later. TWO HOURS!! Talk about reinforcing stereotypes. Part of the problem was that I couldn’t decide what to wear – safe old LBD, which had been worn multiple times before or my new white flowery one, which was pretty but sort of daytimeish and short. In the end I decided to bite the bullet and go with the new dress. What boldness! With some creativity (involving a belt, some jewellery and heels) I got it looking appropriately clubby. The only thing was that I felt very, uh, uncovered. These legs have not seen the light of day in a while. After finally finishing, I headed over to Truffle’s to help her get ready (aka makeup…and yay for success because one, I did not poke her in the eye with mascara or eyeline, and two, it looked nice if I do say so myself…maybe I should be a surgeon with that hand precision, hehe).

So we leave (T, cramberry, Doodles, Doodles’ bf, and I) for the place and get there on time. So in other words, early. Getting out of the car, I was again concerned with my hem length, and it didn’t help with the random guys hooting at us from their car. Uh, eww. But onwards we went. When we got there, we realized we were the first ones there. No fashionably late for these girls.

Wow, this is getting long. Okay, long story short (shorter): It was a fun time. Good food, although I’m slightly upset that I only managed to get ½ of the mushroom tart. Boo. Some dancing, lotsa pictures, and chocolate fountain!!

General observations from the night:
1. EtOH makes people do funny things. We saw everything from interesting dance moves, to yelling in people’s ears (ugh, my ears are still ringing…not impressed), to incoherent babbling/laughing while wandering around bumping into people. Yes, a few of those future doctors definitely killed some brain cells last night.
2. Our class has some weird affinity for Journey. Man, those people really perked up when “Don’t Stop Believing” came on. I don't get it…

3. Insulting a girl is not the way to get into her good books. I’m looking at you ‘Socially awkward boy’ (hereby known as SAB). Can you not touch Truffles’ head anymore?? Girls don’t like that. Nor do they enjoy negative comments on their outfits. ‘Controversial question guy’ was also there, looking creepy as always. But these people are for future posts (Truffles your turn, haha).

So all in all it was a fun night. And I planned on going to class today but alas my alarm clock didn’t go off! I did, I did! I’m sorry for abandoning you T!! I’m sure the “baked goods crew” who live in my building went though. They always go. Darn them for being so well-rounded (can you detect my jealousy?). Anyhow, must prepare for small groups this afternoon because as much as I would like to, I can’t skip the entire day.

The Call of the Wild

2008-05-05T19:58:00.003-04:00

Wow, only Truffles, cramberry and I could entertain ourselves so much with such everyday things. Some background knowledge is required in this situation. Our medical school is attached (literally, physically connected) to one of the citiy's main hospitals. Walking to school everyday, we take this route that takes us through the hospital to go to class because we are vampires, and hate the sunlight & also because we are lazy and don’t like stairs. Anyhow, next to said hospital is this river with a whole bunch of trees, and nature-stuff. It’s a strange dichotomy to see this beautiful, organic living scene next to the concrete jungle that is the hospital building and two, yes TWO car parks. So as we trek along to school, we always pass by this interesting little piece of nature.

Recently, we started noticing that there were these GINORMOUS fish swimming in this little river. I’d probably say they were 12 inches in length. HUGE! So we started looking at them as they tried to swim up the river, and I have no idea why, stay put once they get to the other side (these aren’t the smartest fish in the world, clearly). Now, this is something we (T, C and I) find inexplicably entertaining. Everyday we’ll stop by the bridge (with cars rushing past us no less) to look at the dim-witted fish floating around, and these extremely adorable Canadian Geese & goslings. Today, for example we spent half an hour looking at the fish trying to cross this pylon thing. We were very amused. Then after ethics class in the afternoon, Truffles and I spent another 30 minutes looking (and taking pictures) at the fish and ducks and its 12 DUCKLINGS! Incessant giggling over the cuteness ensued. Then we spotted a bunny. And took a pic of that. Clearly no one does procrastination better than these med students.

Countdown: 2 more weeks of class!

The other side of the hill

2008-05-02T17:54:00.003-04:00

Throughout the year, we’ve had a couple discussions on alternative/ complementary medicine, role of culture, traditions in a person’s health. There were a few lectures on acupuncture, one presentation on aboriginal health, some discussions on herbal meds, and even a session on hot yoga (and yes, it was VERY HOT, i.e. lakes of sweat, not pretty). But we’ve never actually seen first hand what this meant. I mean it’s one thing for someone to give a PowerPoint presentation or for us to do some research off the net. But it’s a totally different thing to actually see for yourself how important these factors are in people’s health.

For our small group session today, our facilitator took us to the city’s aboriginal health centre. Basically, it was a place for First Nations people to seek medical care, counselling, dieticians, social workers, etc. What was most interesting about this place was that they also provided their patients access to a traditional healer.

After giving us a tour of the centre, one of their traditional healers came into speak with us about his role in patient care, as well as what their traditional medicines entailed. He spoke about and showed us some of the natural herbs and medicines he used, as well as some of the prayers, rituals performed. He then explained how they were concerned with the person as a holistic being, and that healing meant fixing the spirit, the mind, all the while telling us some amazing stories from his own experiences. It was incredibly enlightening because I had never thought of some of these things from the perspective he gave. How experiences in a person’s life can lead to disease, and by treating their mind, you can heal their whole body and person was very interesting. A lot of what he had to say related to the belief that people were all inherently good and kind, and that by giving them hope, many things could be treated. Wow. It was a wonderful experience, and it really helped that he had one of those stereotypical story-time voices. I swear I could have listened to him all day, he was that mesmerizing.

So I think today really demonstrated the importance of a person’s culture and traditions in their health and healing. Clearly, there are many things that modern medicine cannot explain. Not that I’m saying I don’t believe in Western medicine (of course I do, I’m studying to become a doctor right? And evidenced based med, woot!) but at the same time I feel that as humans our complexity is sometimes utterly mysterious. I sincerely believe that the two can and should work together. Even the ‘healer’ shared this opinion. But I guess that’s what makes ‘healing’ and treating patients so interesting. And in the end we all have a common goal, that of giving our patients the best care possible.

[N.B. When asked the question how a person can become a healer in the traditional sense (Ojibway in his case) he said that a person is chosen, picked. They do not pick themselves. It comes to them, whether through their own dreams or from the elders. It is, inherently I suppose, a calling. Again, wow. Could it be that as medical students training to be doctors, we were chosen, called? Things happen for a reason right? Darn, I really should pay attention to my dreams more often – (although, somehow I don’t think that last one about Orlando Bloom counts =S)]

ZZzzzzzzzz

2008-04-30T16:44:00.003-04:00

2 hour nap... sign of no upcoming assignments/midterms/presentations, etc, etc for 3.5 weeks

Ah the life of an unstressed med student... Alll right...

5 more weeks to go till 25% (unlicensed) MD! Woot!

That swagger

2008-04-29T17:42:00.003-04:00

Our last clinical interviewing session was today. For the last two sessions, we asked both of our facilitators to act as interviewer, so we could get a sense of how “real” doctors approach them. Of course, as was the case with all the previous scenarios, these were not easy. Not surprisingly though (well surprising with Dr. N - remember him??) they did really well. They were sympathetic, they got to the issues at hand, they knew what to say and most importantly – they were in control of the conversation the entire time. Yes, they allowed the patient to speak and were very calm & empathetic with them but there was always the feeling that doctor was in charge. No cowering, no timidity. Just straightforward and confident in themselves and where they wanted the interview to go. It was just this sense of, I don’t know how exactly to word this, but that “doctory” feeling. Not cockiness, but definitely a demeanour that conveys authority, know-how, knowledge and just someone you could trust. Sigh…something I aspire to....

Which brings me to my other point, as today we also got our evaluations. As I went in, I knew that I had done my best but that not all my interviews had gone so well. Uh, HIV test guy? Talk about flustered. Anyhow, the facilitators said that I had done fairly reasonably. They said that my first interview had gone very well, but that the second was, well, “problematic” (no duh, I timed out 7 times!!). Oh don’t cry for me Argentina! They did give me some sage advice though. Dr. E espically said that she knew it was a difficult interview for me, but that she was glad that I got that interview because I probably learned/gained the most out of all my colleagues. She told me to not let my timidness/shyness get in the way of whatever I want to do, because I already had “the tools,” as she put it. So just go and be confident in my own abilities because I was capable of doing it. They then remarked that I should learn to be more dispassionate, and learn to distance myself more. I think this was because I was taking these situations too much to heart so I was trying to fix too many things all at once. They reminded that “the patient is the one with the disease” (thank you House of God!) I took this as, yes, it is our job as physicians to provide the best care possible to our patients, and give them all the information they need to make an informed decision. However, in the end it is the patient’s decision, even if this goes against our own beliefs & wishes. Sometimes, despite our best efforts, there’s nothing more that can be done. Doctors are human too.

TV, a med student's BFF

2008-04-25T17:23:00.006-04:00

First off, yay for blood midterm being done!! Boo for half the questions being about lymphomas. I don’t like lymphomas. They don't like me either. But yay again for this being the last midterm of 1st year med! Woohoo, two more months till 25% (unlicensed) MD!!!

As to how I actually studied for this midterm, well the last two posts are a testament to what actually happened. Let’s take yesterday (aka night before exam) for example.

11 AM: Eat brunch, hmm what’s on? Ooo Martha Stewart. Oh cool, it’s take your kids to work day! And they’re making zucchini fritters? I wonder if zucchini has folate in it? Wouldn’t want those kids getting megaloblastic anemia and all…

12 PM – 3PM: Trying to review notes on coagulation cascade. Note to self, Food Network and studying do not mix. Wow, is that guy making a mash potato/meatloaf cake? Mmmm beef, tasty plus a good source of iron. Prevention of microcytic anemia! BONUS!

3PM: General Hospital time. Hey look, those guys are using the same stethoscope that I have! Dang, that Dr. Drake is hot.

4 PM – 7PM: More attempted studying. TTP, HUS, ITP, HIT, TRALI, TACO!!! Abbreviation overload!!! Oooo TACOs! Dinner time…

7PM: Wow, ER’s on at a special time! Hey that patient has lymphadenopathy of his posterior cervical chain. No Abby, it’s not just a cyst. Posterior lymph nodes = bad (cue ominous music). Omigod, he just found out he had cancer! What’s that? Lymphoma?? Leukemia (argh stupid new doctor, can’t understand his accent)? I knew it! Overinflated sense of my own diagnostic skills! What's that?? Brachial plexus injury? Yea! I know what this is! We’re on a roll here, and we didn’t even have to turn the page!

8 PM: Raptors b-ball! Break time for Stuff!

9PM: Grey’s Anatomy’s back!! Oh thank goodness Izzie and George are no longer together. Wow, that guy got bitten by a bear. Eww…intestines…glad I ate already. Hmm, would they be using frozen plasma here or RBCs? I’m going with RBC transfusions, that guy’s gonna need a whole lotta blood.

10:30 PM: More basketball. Hey T-Mac’s got this thing on that looks like the cath lab leads! (silly giggling ensues)

1 AM: Sleep time!!

So there you have it. Stuff’s guide to studying in med school. Now excuse me now, I gotta go catch my shows.

How can you mend a broken heart?

2008-04-22T22:12:00.007-04:00

GAH!!! Lost again! 103-104...

Bosh is sad. I'm sad. I'm also mad. And now I'm more sad & mad because studying must resume.

[Note: The coagulation pathway is not too happy with me right now. I think they felt betrayed and cheated on in this whole process. Oh RBCs, if only you had more oxygen-carrying capacity. Maybe Bosh's last shot would have went in with his increased ATP production]

Kryptonite

2008-04-22T21:31:00.005-04:00

What's the one weakness that can get a Type-A, normally super paranoid and otherwise good little medical student stop her cramming for a hematology exam that's this, yes that's right, this Friday ??!?!

NBA Playoffs BABY!!

Let's Go RAPTORS!!!

We can de-plane Superman!

C'mon Bosh.... Be aggressive, be, be aggressive!!!!!!

Note: The coagulation cascade may have been injured in the making of this post.. it's not the medical student's fault that the Raps are not listening to her, and are NOT DRIVING THE BALL!!!! Oh snap

Career choices

2008-04-19T14:44:00.004-04:00

Tuesday was career night. Yes, yes I know this is a few days after the fact. But I didn’t have time to post. Blood and onc is slowly and painfully destroying me. One more week to go. Pray that I’ll survive till then.

Anywayz, back to what I was saying. Tuesday was career night at the hospital. It was a talk with the post-graduate director about the whole CARMs-residency matching process. Then some fourth year students and 1st year residents came in to talk about their experiences as well as electives that they did. Lotsa info, lotsa stuff I didn’t know. Sort of freaked me out. For example, apparently in order to become a doctor, it’s not as simple as graduating from med school. Firstly, you must get into a residency training program. Then before you go, you need to write not one but two licensing exams. Then you need to finish residency, write another set of exams to get I guess your ‘real’ license. Then you need to apply for malpractice insurance and go into ‘independent’ practice. Pfeww. Who knew it was so complicated. Who ever said getting in was the hardest part must not have gone to this talk.

After this we were let loose to visit various booths with all the different programs that had first year residency programs – internal med, opthamology, emergency med, general surgery, and many more… Cramberry, another friend of ours and I walked around together and visited some of the booths we were interested in. Well what they were interested in, because I was just the tag-along, who didn’t really have any questions, and just nodded my head using my “serious” face (i.e. slight furrowing of brow while nodding fervently up & down) to make people think I know what they’re talking about when in fact I have no clue, and am probably thinking about dinner.

It was interesting to see the different characters in the different specialities:

- Pathology was very nice but nobody was visiting their booth. I felt sorry for them, so I took one of their pamphlets.

- Neurosurgery guy was slickly dressed but seemed really cocky. Every time I saw him, he was on his cell.

- Nuclear medicine was a very odd collection of characters. One guy was HUGE! Like 6 feet cubed, literally. Another one looked extremely eccentric. He had these round spectacles, and white hair that came halfway down his back. Modern day Dumbledore?? The last guy was the most “normal” looking but even then he had a major unibrow. I couldn’t look him in the eye, for fear of laughing.

- Emergency medicine guys were good-looking and young but seemed like pranksters. At the end of the night, when general surgery had left, I saw them taping stuff on the gen surg poster and then taking a pic with it. Suspicious…

- Cardiothoracic surgery guy was hot. Like super hot. I didn’t talk to him. I just ogled at his hotness.

- Internal med girl was most normal. But she seemed tired. Very tired.

There were a lot more booths, but we couldn’t visit them all. All in all a good night. Overwhelming but informative. And for me at least, very entertaining. Alas, I regret not talking to cardio guy. (fans herself over his hotness)

Princess for a day

2008-04-18T17:08:00.004-04:00

There are some days when I’m honestly blown away by my class, and feel proud & extremely honoured to be part of it.

In our school, each medical school class has its own charity/charities that they choose to support for the year or for all four years. During the beginning of this year, our class voted that our class charities would be the ‘Make a Wish Foundation’ and ‘Sleeping Children Around the World’ for the next four years. Throughout the year we’ve been holding various fundraisers like bake sales, dances, night outs, etc, etc to raise money for them. And about a month or two ago we learned that for the ‘Make a wish foundation’ we would be ‘adopting’ a little girl who had cancer. Her wish was to go to Disney World, and it was our job to help her get there.

I guess both as a way for us to meet her, and for her to have a nice, special day for her & her family, a princess party for was planned for today. The whole class was told to dress up in costumes as princesses/princes or whatever Disney character we wanted to be. So yesterday one of our friends (I’ll call her Doodles) and I went shopping to get/make ourselves some costumes. In the end, after some major dollar-store shopping and some craftiness & engineering (that I’m ridiculously proud of) on my part we came up with some sweet costumes. I was Minnie Mouse. Truffles was a fobtastic princess. Cramberry was a bunny (stemming from the fact she LOVES them). And Doodles was Lilo from Lilo & Stitch. It was cute. And very fun. So today I wasn’t really sure what to expect. I didn’t know how this party would turn out. But as I walked into the class, I was amazed. Our whole classroom was decked out with balloons, streamers, an amazing magical castle complete with magical “burning” fire, and even a cool ‘river’ running across the floor. And the costumes! Wow. Many people had some incredible costumes on. From wizards, princesses, princes, and fairies to a ladybug, a bumble bee and even a unicorn with shades, they were all there. Of course, Mickey and Minnie were there too. It was awesome.

We had our 2 lectures for the day, and luckily the prof let us end early (actually I think the 1st prof thought he was in the wrong place). The people who were running the party told us that “Rosie” and here family were here, and that they were excited but nervous. They brought her in, and what followed was pretty amazing. Basically our class created a whole princess adventure for Rosie and her sister to go on, where they had various tasks to complete so that they could save the princesses from the ladybug and bumble bee. It was a fairytale come to life, and of course it ended with a happily ever after. The two little girls had so much fun.

After that Rosie’s mother spoke to us about their family, and what Rosie’s been through. She spoke about her treatments and how strong she is, despite the fact she’s still undergoing chemo. She then thanked us and reminded us to always think of our patients and who they were as people.

Today was an incredible day. I was so proud of our class to have been able to put this all together. To be able to sit in that classroom today so out of the “medical” realm, but all the while knowing that this too was so important, so relevant. As doctors, we often forget what it’s like to be a patient. We see the disease, the symptoms and signs. But we often forget that our patients are people too. They have emotions, and feelings and families that go beyond their condition. And as corny as it sounds, and I know we all laugh at how much we hate FIFEing, it’s actually important. That’s something I hope we never forget. But looking around today, with everyone in their crowns/ears/tiaras/hats, and knowing that these will be the future doctors of tomorrow, I think our class won’t have a problem.

Leap of faith

2008-04-15T21:38:00.004-04:00

Today was my fourth and final interview for the clnical interviewing sessions. I was nervous (in case you haven't noticed yet, but I’m often nervous – try always) and worried about what they would throw at us today. I know these are standardized patients, but in some ways that’s worse. Because they have this weird script/scenario they’ll go through depending on what you say and how you say it. So it can go REALLY well or REALLY bad. I wasn’t sure what to expect, but I knew to expect something difficult. For the past couple weeks, we’ve had to deal with angry patients, breaking bad news, the patient who comes onto you, the crying patient, etc, etc. I was wracking my brain to see what other scenario they would give me. I knew I didn’t want the angry patient [because I am a pushover and I will cower if you yell at me] but then again, any of the scenarios would probably be equally as hard. So I was nervous…very nervous going into it. And let me tell you, boy did I have right to be. They really threw a whopper at me:

Truffles if you’re reading this, STOP… SPOILERS for your interview onThursday! Don’t be tempted!!!!

Stuff
“Hi Mr. X. So what brings you in today”
Mr. X
"I want an HIV test"
Stuff to self
Oh crap
Stuff
“Okaay…Time out"

During our interview sessions we’re allowed to ‘time-out’ or basically stop the interview and regroup or get advice from the rest of the group. It sort of allows you to gather your thoughts, or to take a pause when you’re really stuck. They’re usually not used that often, maybe once or max twice per interview. As for me today, let’s just say I think I’ve maxed out on my ‘time-out’ quota for the next two years. Anywho, the interview’s going along and I’m getting by I guess, struggling along with the conversation, and desperately running out of questions to ask the guy:

Stuff
"So, you said that you need this test because you had an affair…can you tell me a little more about that?"
Mr. X
"Yeah, well I met this man at Mcdonalds [WTF?!?!] and yeah I was attracted to him, and so we had an affair."
Stuff
"Uh-huh. And have you had an affair with anyone since then."
Mr. X
"No"
Stuff
"Okaay… Ummmmm….. [long pause] So tell me a little about your living arrangement."
Mr. X
"Well, I live with my wife"
Stuff
[very hesistant now]
"Okaay"
Mr. X
"And we’re trying to have a baby"
Stuff
Oh crap [long pause] "Uhh-huuuh..."
Mr. X
"And she’s Catholic so we can’t use protection"
Stuff
I'm dreaming right?
[huge pause]
"I see."

So somehow I managed to get through the interview, extremely awkwardly and again, making the most of my ‘time-out’ usage. At one point, he asked me if he had to tell his wife if the test came back positive, and I said time out so fast I don’t think the guy even had time to finish his sentence. Poor man. At least I tried my best to sound caring and non-judgemental. That was my saving point. Because otherwise he would not have told me anything, and the SP actually said he would have left! Yikes! So yay for finishing clinical interviewing. And I totally agree with our facilitator that this was a good experience. She said, which I think is very wise that “it’s really easy to stay back and let someone else do something that you’re really uncomfortable with, but if you do it yourself, you’ll get more out of it than you can imagine.” So there you go people, face your fears! Pet that spider! Go skydiving! Or if you’re like me, go and volunteer to do that interview with that patient about their private business, because in the end…you’ll be the better for it.

When it rains, it pours

2008-04-10T22:11:00.006-04:00

I went home yesterday because I had a doctor’s appointment today at the hospital. Anyways, another revelation is that being a medical student has its perks. Basically, I got to do a mini-observership while I was there. The attending doc showed me this fancy high-tech ultrasound thing that tests for liver damage. It was pretty amazing because it’s the only one in the entire country! Yeesh, I might be the only med student to have seen this thing thus far. Craziness. He also gave me a mini-lecture on some other stuff which was pretty cool, and he showed me some nice percussing techniques (essentially knocking on patient’s chest/stomach to listen for differences in sound quality – it’s pretty much an art to determine what’s normal or not). Pretty sweet, considering I went in as a patient, but came out learning some new stuff. Yay for day not wasted!

Anyhow, my appointment was actually at the hospital I work at in the summer. So I was slightly weary about seeing my boss or any of the attendings from the unit. I didn’t want to explain why I was there, or introduce them to my mom, or have them see me because maybe someone had a tiny crush on one of the docs there (yea, yea story of my life) etc, etc. So my mother and I were waiting for the shuttle bus to take us back, and well, let’s just say life likes to play tricks with you:

Stuff’s Mom
“So how come you’re not hiding your face anymore? Aren’t you scared you’ll see Dr. BossMan?”
Stuff
“No, no… Dr. BossMan never takes the shuttle. He always drives to the other hospital.”
Stuff’s Mom
“Drive? Weird.”
Stuff
“Yeah, I dunno.
[bus arrives so Stuff & Mom get on bus]
Stuff
[happily sitting when suddenly spots Dr. Charming]
“Gah!”
Stuff’s Mom
“What?”
Stuff
“It’s Dr. Charming. OMG, he’s getting onto the bus. Hide me, hide me.”
Stuff’s Mom
“Uh, oookaaaay. Which one is he?”
Stuff
[hiding face in shame]
“Don’t look!”
Dr. Charming
[sits directly BEHIND Stuff ]
Stuff to self
[teeth clenched in terror]

Awkward…

Yes, so I managed to not make eye contact or have him notice me. Or maybe could it be, that he's already forgotten me?? (puppy eyes start watering, and slight whimpering sound can be heard)

So after all this I had to catch my train back to school. Problem, I was late. Very late. Like the train was actually going to pull away from the platform when I just managed to make it. I was running. No, correction I was sprinting like I was in the 100-m dash. That’s one way to become tachycardic.

On the plus side, I managed to get myself a new pair of running shoes today to replace my sad dilapidated ones. They lived a good life.

Stand up, speak out

2008-04-09T20:59:00.005-04:00

Sorry about the lack of updates lately. Nothing really exciting has been happening, other than blood & onc lectures, and we all know how riveting those are.

We came to our half-way point for our clinical interviewing sessions yesterday. I was slightly nervous going into it because the previous week we had emailed the course coordinator about one of our facilitators. You see, we were having some "issues" with this one person. That person (who shall be now be known as Dr. N) had this problem of speaking much too often and too long about...well...nothing. Like literally, he would have these 20 minute soliloquies on a subject that had nothing to do with anything anyone was talking about. And to make things worse, it made no sense whatsoever seeing as he used giganto words nobody has ever heard of.

Dr. N

"...blah, blah, blah...consequently, the corollary of aforementioned haematuria manifests itself as intolerance directed towards...blah, blah, blah..."

Stuff to self

[doodling ECG axis]

What is going on here? I didn't know Shakespeare was still alive.

Rest of Stuff's group

[looking dazed and lost]

Wha?

Another thing was that he was always talking about how he counsels patients on dialysis, etc, etc. I mean, that's fine, tell us about your job. But don't tell the same story every week man! Especially when we're talking about, I don't know, birth control? Blood Tranfusions? Common cold? Like, seriously? But the worse thing was that he often said some very offensive and discriminatory statements. So as a group, we went to the course coordinator to give some constructive criticism. She said she would speak to him. So you can see why I would be a little apprehensive going in yesterday. How would Dr. N react? Did we just commit academic suicide? Luckily, it seemed to go over well. Dr. N asked us if there were any changes we wanted to make, and we basically said we wanted it to be interactive, and for there to be more opportunities for us to speak. Lo and behold, it worked! It was the best session we had so far. Another example that speaking up when you think something is wrong or should be changed is really important.

On another note, Truffles has gone on a trip for a research conference far, far away. It's all very grown-up. If you're reading this Truffles, we missed you in class today! Good luck with your presentation, you'll do great. And don't worry, I didn't fall asleep in class today! Woohoo! I took some very extensive notes for you. And cramberry tried to tape the lecture but the doc was speaking very softly, so I'm not sure it'll record very well (it was AAA guy). See you next week. You better come back tanned, haha.

Blast from the past

2008-04-07T15:49:00.005-04:00

Today was side-ponytail/side parts and socks & sandals day at school. It was for our class fundraising. I had my little demure low ponytail slightly pulled to the side in the morning. But lo and behold, I walk out into my building lobby and there were some of my classmates dressed head to toe with quirky high ponytails straight out of the 80s, and guys with their hair gelled and perfectly parted down the side. They looked like they were out of some weird forties/fifties movie. Oh, and don’t forget the knee high socks and Birkenstocks.

Okay, so maybe it was more ‘Revenge of the Nerds’ but who’s keeping track? Of course I had to fix mine and make it more…ahem…dramatic. I think we scared some of the non-meddies at the bus stop. Like who are all these weirdos with the green backpacks and crazy outfits. HAHA, good times.

I think we should make this a tradition. Like literally I think we should still do it even when we’re all attendings and ALL-POWERFUL. We’ll all show up in whatever hospital/clinic we’re working at with these hairdos and outfits, and scare our residents and students. Yeah, they’ll think what the heck is going on, and then we’ll casually mention didn’t they get the memo on the new dress-code? And of course they’ll run away in circles and scurry around to try to please us. And then we’ll stand back and laugh at them. Because did I mention, attendings OWN you?? Oh, future residents and underlings of Dr. Stuff, I feel sorry for you. I’m an evil, evil girl… [devious cackling in the background]

Stupid quote of the day:
Stuff
[Talking about suturing and doing anything remotely involving the hands]
“Yeah, so I’m not too good with this medicine stuff”

Truffles
[look of shock and slight terror]
“Okkkaaay…”

What not to wear

2008-04-06T16:47:00.010-04:00

Last day of interview weekend. Phew…it’s been a long week. I’m pretty exhausted with welcoming people. I feel that I’ve given the same schpeel 100 times over and over again while grinning like the Cheshire cat. I hope I didn’t scare the interviewees with my slightly deranged look. Don’t mind my over-enthusiasm, I’m just trying to sell my school. Cuz you know, we rock and all. But now my mouth kind of hurts. You know you’re not a real people-person when socializing wears you out. Anywho, good luck to all and we’ll be seeing a lot of you next year!

So at the end of the day, cramberry and I were getting ready to go home, because it is nap-time for us (you see what I mean when I say I’m 5 years old?) and I had changed into my Ugg boots as my feet were killing me (flats are deceivingly uncomfortable after 5 hours… and save me the lecture on Uggs. They’re for practical purposes here people, not fashion. I live in a snow belt area and these are seriously the most comfortable pairs of shoes you’ll ever own especially in 10 feet of snow!). So we’re on our way out, but we saw one of our classmates from undergrad. Being friendly and nice, we stopped to talk with her for awhile. Anyway, there were some parents of an interviewee sitting close to us there, and this one lady kept staring at me and my boots. Like literally, she did the whole once-over and had this disgusted look on her face like she smelled rotting fish. Whoa it was bad. She then proceeded to turn to her husband and whispered something to him, making him stare at me while they muttered who knows what unflattering things. Gosh, I didn’t know my outfit was so offensive. Yeah, okay I was wearing a work-type skirt with Uggs, but that’s not what I had on throughout the day people! I had cute flats! But, yeesh, my feet wuz hurting bad. Cut me some slack. You can’t be a slave to fashion 24/7. Being a fashion-plate is hard work man. At least I was in black and white…not like this poor girl who sort of resembles a watermelon.

Jealousy and ambition

2008-04-05T22:59:00.005-04:00

Ambition is like love, impatient both of delays and rivals. ~ Buddha

Today was interview weekend again. Lots of interviewees, some more confident than others. I also saw some students from my old undergrad program. Yay for reprezentin…

Yeah, so a couple of us were having a conversation about what we wanted to get into for residency (i.e. when we become real MDs). Some weren’t too sure, and pretty open to anything. Others on the other hand were super-keeners and knew exactly what residency program they wanted and how they were going to get there. They have their 10-year plans all laid out. There’s this one person, for example, who has made it so far as to identify all the higher-ups/important persons for their desired program at our school, introduced themselves to said big cheeses, and has even lined up a research position with the residency director of the program. They also know who their competition is, and will be very happy to tell any new persons who are considering their program why they shouldn’t even think about it. Wow. This person scares me, puts me to shame, makes me hate them and be impressed & admire them all at the same time. Granted these are super competitive programs, with maybe less than 10 spots in the entire country so it’s kind of understandable that they have these strategies in place. But at the same time, it makes me wonder whether they’re putting all their eggs in one basket. I mean, how can you be sure, really, really sure that this is what you want when you haven’t really done it right?

I on the other hand have a general idea on my residency goals. I like a lot of things, but I’m really intrigued by critical care medicine and cardiology. But who knows? Things can change a lot in four years. Maybe I’ll hate it once I really get into it. I asked my facilitator about this once, and he said not to worry too much about it. It’s too early, and you won’t really get your feet wet until clerkship (3rd year). Ah, how wise he is.

At the same time, this kind of talk also makes me wonder at my own abilities. Honestly, I think I’m an okay student. Well actually, I'm pretty sure I’m a pretty good student. Not the TOP but certainly above average, in spite of the impression I give off. I mean when it comes down to it, I do know my stuff (hmmm... this may be debatable but work with me here). But these super ambitious classmates of mine make me wonder if I had worked harder, not watched that TV show or slept in for those extra 15 minutes, how much difference would it make? Life is strange. One day, you’re on top of the world, full of confidence and belief in yourself and your abilities. The next, you’re full of self-doubt and uncertainty in everything you do. I don’t know. GAH! Then again:

“No TV and no beer make Homer something, something”
“Go Crazy?”
“Don’t mind if I do!”

[See how serious & introspective blood & onc makes you? Yeesh...I feel like I should be wearing a beret and discussing Proust somewhere in a Parisian café]

Dressed To Impress

2008-04-04T20:38:00.009-04:00

In honour of our class' clothing sale, I thought I'd give some ideas for future logos/designs:

Because I am a nerd.

Robbed!

2008-04-02T22:26:00.003-04:00

The clock started early!

TJ you wuz robbed!

We wuz robbed!

[Sorry, but right now b-ball >>>> blood & onc]

Blood is thicker

2008-03-31T20:39:00.004-04:00

Day 1 of blood and oncology block. One word = Ugh… I know the professor/course coordinator is trying really hard, but omigod, this subject is DULL. Yeah, yeah, complain, complain Stuff, always complaining but believe me when I say it’s not exactly edge-of-my-seat riveting stuff here. And it didn't help that the prof’s notes didn't follow the presentation at all. This ultimately led to the inevitable frantic page-flipping by 147 students simultaneously. Not fun. Advice to future profs, please can your notes follow the presentation? At least some general semblance would really be appreciated. C’mon, it helps both you and us.

I know blood is a hugely important topic but I just can’t really get into it. But if theory holds true, I will end up becoming some kind of haemo-neuro-orthopaedic surgeon seeing as how these are areas I, uh, how do I word this nicely, have significant aversions to at the present moment. I guess it’s just serendipity. Let’s just hope that it’ll get better tomorrow, although I’m doubtful considering it’s biochemistry! Specifically iron biochemistry. I’m quivering with anticipation.

So what do you all think about saying hi to professors or facilitators. Today at the hospital one of our profs was standing next to me in line at Timmies. I wasn’t sure whether I should say hi to him or not, considering he only taught us for 2 lectures only. I don’t know, for me it’s sort of awkward. I mean if I had known him somewhat well, I probably would have but I just thought it was slightly strange. Plus it’s weird seeing the docs in their natural habitat, i.e. outside the lecture room. During undergrad, I’d often see profs in the subway. And it was WEIRD. Sort of like seeing celebrities in real-life. Like they weren’t really what you expected. Usually older and not so glossy up close. (Note: I went to a huge school in undergrad so our lectures normally had hundreds of people, meaning from my vantage, the lecturer looked 2 feet tall MAX). Maybe I’m just anti-social. Thoughts?

A little R&R

2008-03-30T13:29:00.005-04:00

Th-th-that that don't kill me. Can only make me stronger…

At least until we get the results of our cardio exam. Then I may have to go into hiding, forever. Planning on doing nothing today, which is pretty sweet. Some rest and relaxation before we start our blood and oncology block. Not really looking forward to this. I’ve heard from the second-years that it’s all biochemistry pathways (No, no pathways, no!! I’m having undergrad biochem nightmares as we speak… N- glycosaminoglycane…GAH!!) and cancer. Yeesh. So today will be a day of doing nothing. Zip, zero, nada, nilch.

Yesterday was the first day of interview weekend. I was one of the “floaters” meaning I was in charge of escorting the interviewees around to the info session, welcome room, etc, etc. It was super busy. Lots of people interviewing, so lots and lots of walking. Lesson learned for next week, wear comfortable shoes, aka not ballet flats which although look very cute, do not provide any arch support whatsoever. I think I developed some plantar fasciitis midway through.

So the interviewees seemed very confident from first impressions. Not what I remember from last year. Then again I don’t really remember much from last year. It was all a blur, and all I DO remember is getting locked into the hallway (the building is locked during weekends and you need card access to open doors – ooo, how CIA) and being extremely, extremely nervous. So I was very impressed with the confidence the way the newbies presented themselves. And what a range of applicants. Some from Toronto, others Montreal and Alberta, and a couple of Ivy Leaguers from the States who made me feel slightly inadequate. They all seemed very nice, and I have no idea who will get in (although a few rubbed me the wrong way…seemingly WAY to cocky… I mean c’mon man, okay you go here for undergrad but please, doesn’t mean you need to tell ME how to open to the freaking door. Sit down! Med students should have SOME degree of humility. Please refer to fact 1st years know NOTHING in eyes of the REAL doctors. But I digress). I hope that I presented a good impression of our school. I tried to be genuine, without putting down other schools because honestly even if I think my school rocks and is the BEST, I can’t really comment on other schools seeing as I don’t go there. I was honest with what I liked, and I think many of the students appreciated that. So to all those out there who interviewed yesterday and all those who have yet to interview, good luck. I’m glad it’s not me picking who gets in because you guys were pretty awesome from what I could tell.

Another thing about yesterday was that it reaffirmed how grateful and excited I am to be at med school. Seeing the nerves of the students, and remembering exactly what it was like for me last year, I was sooo thankful that it was not me that was interviewing. It’s SO different on the other side. I mean I know we moan and groan about how much we hate exams and mock-OSCEs and assignments and it can seem that we hate school at times, but I can safely say that Truffles and I are VERY happy we’re here. Truffles even saw one of her interviewers from last year. I suggested she hug him. Little did she know I wasn’t joking. I didn’t see my doctor (I can’t even really remember what he looks like) but if I did recognize him, I may have been overcome by a fit of gratitude that I could have kissed his feet. Literally… that’s how grateful I was yesterday guys. Seriously.

So yesterday was very interesting but also BUSY!! At the end of our shift, I was kind of sick of welcoming people to the welcome room. Which doesn’t bode well for clerkship, if I can’t even last 6 hours walking around. Anyhow, I was glad to be done for the day. Until next week then! I’m going to a welcomer in the welcome room so people can come to me, not vice versa. Plus VIP access to food. Mmmmm… And don’t tell because even though we’re not supposed to, but I’d totally fight the interviewee for the sandwich. I mean I’m nice, but not that nice! At least when it comes to food. (evil laughter in background)

2012

2008-03-28T17:16:00.003-04:00

Cardio exam is finito! Yay!! Career in cardiology for Stuff?? Uh, not so yay. Not unless you’d be comfortable with having a cardiologist who failed her cardio exam.

Future Patient of Stuff
“Dr. Stuff I have this pain in my chest, I think it might be a problem with my heart?"
Stuff

[serious look on face]
"What’s a heart?"

Anywho…tomorrow is interview weekend for next year’s batch of newbies, aka 1st year med students. Good luck guys! I know it’s nerve-wracking but it’ll be over soon. Things seem much worse than they actually are. Well unless you’re me, and you start rambling on and on for 10 minutes about how math is SOOOO important in medicine, and how much you LOOOOOVE it even though you have not actually taken math since first year undergrad. Oh memories. How young and naïve we were Truffles (FYI: above took place 12 months ago…yes, 1 year of medical school ages you THAT much…or not, I may have regressed to my 10 year old self during my time here. Case in point, I go to school with a small juice box in the morning and giggle inappropriately). Which brings up a good point, don’t ramble on and on when you don’t know the answer. It’s hard, I know because I’m a rambler but less is more sometimes, seriously.

So, don’t worry, it’ll be fine. If I could, I’d give you a pat on the shoulder as expertly demonstrated by Truffle’s observership doc. And as cheesy as it sounds, but take it from me (person who waited a LONG time to get in), things will work out the way they’re supposed to. See you all tomorrow!

[Note: above picture does not reflect abilities of 1st year med student. I did not look so confident, nor was I so well-versed in the usage of a stethoscope. Psst...Truffles had hers on backwards too. Sorry, Truffles, your secret is out.]

Heartbreaker

2008-03-27T20:42:00.004-04:00

Cardio exam tomorrow

Ready? No

Scared? Yes

Help!!!!

That is all...

Vogue, vogue...strike a pose

2008-03-25T17:14:00.002-04:00

Remember our small group session with the, ahem, chief resident? Well, it was held in a conference room on the cardiology floor. Not the wards, CCU or cath lab but the floor with all the doc’s offices. So, none of the noise and chaos, but instead leather chairs and lots of nice carpeted floors. Very ritzy.

Okay, but what’s so interesting about this you ask? Well, along the hallway coming into the department is a row of framed photos of ALL the cardiologists. But here’s the thing, these aren’t just regular pictures. They’re all posed, with some major photoshopping. Like glamour shots for docs. You know, the hazy romantic lighting, the serious half-smiles, and the dreamy gaze looking out at you in all their prettiness (at least more so than real life) and smartness. All this packaged into a knowing expression that calls at you saying:

"You can trust me with your heart. I’m a doctor, and I am THAT good.”

Real-life McDreamys? At our school? Who knew?

CABG soup

2008-03-24T16:41:00.005-04:00

We had a really cool lecture today on CABGs (pronounced “cabbage”). No, not the edible, flatulence-producing variety, but the heart variety. (Yes, I know the majority of my posts have been on cardiology, but bear with me because this is our last week of the cardio block. It’s been a long one). CABG stands for coronary artery bypass graft, or I guess more commonly known as open heart surgery.

So the cardiac surgeon today showed a lot of cool videos on some real surgeries. Like the real gory ones that they show on TLC or Discovery network except it was in our classroom. A nice change from the usual routine (aka not sleep inducing). There were videos of the ‘usual’ CABGs, with the vein/artery harvesting and then the actual graft procedure where they open up your chest, stop the heart, put it on the bypass machine and sew in the new vessel. The doc also said that sometimes the med student is the one to suture the vein to the heart. Uh…slightly concerning, but okay. If he’s cool with it.

He also showed some of the new fangled technology, with some new ‘tools’ called the ‘octopus’ and ‘starfish.’ There were also some examples of robotic surgery shown, including this thing called “da Vinci” which looked like it came out of a Star Wars movie. Anyways, the controller on this thing is crazy. The surgeon sits behind this, I guess you can call it console, and starts manoeuvring the machine through these joystick things. Almost like a video game. Actually, exactly like a video game. Haha…I knew my Wii skills would come in handy one day. Woohoo, Trauma Center champ! So the advantage of this is that you don’t have to open the patient’s chest, and everything is done through tiny incisions through their skin. The doc can even be in another country and still do the surgery. Wow, modern technology. Sometimes it just amazes me.

There's something about Stuff

2008-03-21T14:48:00.005-04:00

Okay, I have something to admit… Ready?

I, Stuff, have an unhealthy obsession with scrubs. You know those green pyjama things that you see docs wear? Yeah, I love them. More importantly, I am obsessed with scrub pants. Not to wear per se, but with the way they fit.

Every time a doc comes into our class wearing scrubs, I look at his scrubs (HIM because 99% of our classes are taught by males, sad considering that despite how much emphasis we are putting into equal opportunities, most leadership roles are still male-dominated. In fact all the cardiologists at our school are guys. But there’s neither here nor there). I look at how the pants fit, how long they are, etc, etc. It’s weird, I know, but it’s almost an automatic analysis as soon as they come in. And then I’ll give my report to Truffles, ASAP. Like literally in 5 seconds. I have a serious scrubs-radar. For example, we have this really tall doc whose scrubs that are too short, they end up looking like capris (I secretly hate him, damn you squat Asian legs!). And then there’s the opposite spectrum where a much shorter (vertically challenged, if you prefer to be PC) doc has scrub pants that trail an extra 6 inches past his shoes (It’s okay sir, I feel your pain). And then there’s my facilitator…his are perfectly proportioned. Yea, yea I’m biased.

But I think my obsession with scrubs stems from the fact that mine don’t fit so nice. Why doesn’t the hospital have smaller ones for us or at least with pants that actually fit? I’m not a picky girl. I just don’t want to look like I’ve stepped out of the next 50-cent music video when I’m at the hospital. Way to endorse confidence from patients. I mean, this is a diverse country right? We’re not all 6 foot tall giants, with freakishly long supermodel legs. So, if any hospital/scrubs manufacturer is reading this, can you please make scrubs for smallish-Asian girls with short legs? Pretty please? Many people will thank you.

P.S. Salmon scrubs, anyone? Just an idea. Pink does wonders for skin tone.

Pay no attention to that man behind the curtain

2008-03-20T19:38:00.003-04:00

Observerships are funny things. You contact a physician in the field you're interested in. They write back. You set up a mutually convenient time, and essentially become his/her shadow for a couple hours. It's not very complicated, except for the fact that patients sometimes tell their doctors very personal stories. And the poor medical student trying so desperately to blend in with the upholstery is privy to it all.

Case in point: I was scheduled to do an observership with a pediatric specialist one afternoon. Due to a snowstorm, I got to his clinic a little late, and he was already about to see his patient and her mom in the examination room. He told me to drop my stuff off and go in with him. Feeling guilty (for my tardiness - how unprofessional!) and rushed, I threw my backpack and jacket in a corner, clipped my nametag on, grabbed my stethoscope, and ran to the room. The door was open, so I put on my best "I-have-no-idea-what-I'm-doing-I'm-not-a-doctor-but-trust-me-anyways" face and slipped in. The exam room was TINY. Like, the size of my closet at home. The patient, a little girl, was sitting on the examination table, swinging her legs happily. Her mother was sitting on a chair against the other wall, her knees practically touching the edge of the exam table. The doctor was sitting at a tiny desk that his long legs didn't even fit under, and the 3rd year clerk was standing behind the door. Literally. The first thing I saw of him was his head, peeking out from around the door. The room was THAT small. There was nowhere for me to inconspicuously stand except the middle of the room, or the corner farthest from the exit, between a chair and a counter. I crossed the room and squeezed myself into the corner, feeling about three feet too tall and a couple inches too wide.

The doctor started off by taking a focused history, made a few jokes, and then asked the mom if there was anything she wanted to ask before he did the physical.

Doctor
Was there anything else you wanted to talk about?

Mom
Um... Yes... yes, there was something else.

Doctor
[compassionately]
And what might that be?

Mom
She- she's been in going through some grief lately, and I don't know if that might affect her condition.

Doctor
Why, what happened?

Mom
[Bursting into tears]
My husband just died.

Doctor
[Leaning forward]
Oh my goodness, I am so sorry!
[Pats her on the knee twice, leans back]

Me to self
[Staring up at ceiling, humming tunelessly]
Pretending I'm not here...

Doctor
May I ask how it happened?

Mom
[sobbing]
He had a heart attack in August.

Doctor
[Nodding, oozing wordless sympathy]

Clerk
[Nodding in a credible impression of the doctor]

Me
[Pressing into the corner, hoping to be swallowed by the white white walls into sweet oblivion]

It was awkward. So very very awkward. As I was standing there in my ridiculously tight corner, the stethoscope I don't know how to use clutched in my hand, I was forcibly reminded of a quote from a clinical skills study guide:

" If the patient becomes teary... gently gaze at the patient with a compassionate expression in your eyes. It is permissible to convey supportiveness by resting your hand for one second gently on the patient's shoulder or upper arm (not the leg or hand, and do not pat)."

Ah yes. Like so many things in life, it's so simple in theory. It's the practice that's the problem.

How to NOT become a cardiologist

2008-03-20T15:30:00.007-04:00

Ever wondered how to put the brakes on a career in cardiology or [insert medical specialty of choice]? Well, you’re in luck! Here’s a foolproof plan to help you on your way to early career ruination.

Step 1: Go on observership with cardiologist. Make sure resident happens to stop by for ‘chat’ with attending (and when I mean chat, I mean sucking up). [Note: For maximal effectiveness, resident should also be Chief Resident]

Step 2: Write and talk about such ‘chat’ with friends and have good laughs all around.
Step 3: Attend small group session led by said Chief Resident.

Step 4: At end of session walk out of class and be sure NOT to check if Chief Resident is walking behind you.

Step 5: Proceed talking about Chief Resident. Be sure to mention their Chiefiness multiple times.

Step 6: Turn around and realize they were behind you the entire time.

Step 7: Run away quickly.

So there you have it, 7 easy steps to a sure-fire one-way trip to a career in something other than cardiology. But in the off-chance this does not work, I suggest running around the Chief Resident shouting ‘yo mama jokes.’

If, however, you do want to become a cardiologist, then please disregard above plan (and may I ask why are you reading this?). In fact, you probably should do the opposite and start some major butt kissing. Also, if you want to be a heart doc but you have followed this plan accidentally (WTF?), then congratulations because:

A) You have exceedingly bad luck and may I suggest that you never gamble
OR
B) You are the hugest idiot in the world and may I also ask how you ever got into medical school in the first place?

If you selected A AND B, then congratulations again, your name must be Stuff.

This has been a public service announcement from Second Opinion.

Now if you’ll excuse me, I’ll be curled up in fetal position in a closet somewhere, crying myself to sleep.

Okay Truffles, please post something so we can never speak of this again. And if you are said Resident reading this, please understand this is all in good fun. Please don't hurt me... I like your hair and glasses, and you are smart??

Please, no questions

2008-03-19T14:45:00.008-04:00

So we’ve had another riveting set of lectures today on arrhythmias (when your heart goes whack, and decides to beat crazily). I’ve seriously hit a road block. This is sad, considering how excited I was for cardio at the beginning (Truffles can attest to this). I think it’s because we’re on week 5 of 6. And now things are beginning to look the same. Anyway, two more months and it’s summer!!

In my boredom, and generalized lack of motivation these days, I find that I’ve been searching the internet a lot lately. I came across this blog awhile back, but we just realized how much his description of his med class actually applies to ours. For instance, Truffles, cramberry and I likely belong to the “Anonymous Asian Female Section.” We actually sit roughly in this area too. Except we DO NOT use Hello Kitty notepads, and we love to make a lot of snarky remarks in class (okay that’s just me, haha). We too have a ‘question girl.’ What’s uncanny is that she sits in the exact same spot as his pic. Every lecture, guaranteed she’ll have her hand up. Okay, given I don’t mind her. She’s very nice, but sometimes…yeesh…please put hand down. Some of her questions are good and interesting, but others are so dang obvious. They make me want to scream, or at least run around in circles in my frustration. As an example:

Week 1 of cardio block
Doctor/Lecturer
“…so increased heart rate can actually have negative effects because it decreases the time for diastolic filling (the time where the heart fills with blood)…”
Week 3
Doctor/Lecturer
“…compensatory tachycardia (fast heart rate) can be decompensatory over time because of decreased diastolic filling time…”
Week 4
Doctor/Lecturer
“…diastolic filling of the ventricles may be shortened with tachycardia…”

So clearly we all had it drilled into our head that increasing your heart rate gives you less time for your heart to fill with blood. Okay, we got it. It’s been repeated for the umpteenth time.

Today after four hours of sitting in class on arrhythmias, wanting to kill self due to combo of tiredness, hunger and generalized boredom
Doctor/lecturer
“…so arrhythmias may cause tachycardia, and that may ultimately may lead to decreased cardiac output (how much blood the heart pumps per minute).”
Question Girl
[hand shoots up]
“Why does tachycardia cause decreased cardiac output?”
Me to self
Decreased diastolic filling time, decreased diastolic filling time, decreased diastolic filling time!!!
Doctor/lecturer
Well, you see, if the heart pumps too fast, there’s not enough time for it to fill with blood.
Question Girl
Oh
Me
GAH!!!

Power in numbers

2008-03-18T18:44:00.005-04:00

Yay! So there will be NO lab exam next week. The anatomy course coordinator sent around an email today:

“Due to a lack of communication the date for the CVS/RESP lab exam was not posted on [schedule website]. My sincerest apologies.

Since the class was only informed about it this week, we feel it would be unfair to ask you to write the lab exam on the scheduled date of Mar25th…

I hope you have still gained some knowledge from the lab and will carry this forward into other areas of your studying, but under the circumstances you will not be directly tested on the lab material.”

How lovely of her. I think we can attribute this to a number of our classmates who kindly mentioned our ‘concerns’ to the Associate Dean. Thanks D! We heart you!

On another note, has any one read this article from Maclean’s regarding the doctor shortage? If not, it basically makes the assertion that the doctor shortage we are having in Canada right now can be directly attributed to the increasing number of female doctors and medical students. When I read this, I was horrified, shocked and exceedingly angered on how such a sexist, and ignorant statement could be made. To say that my fellow female colleagues and I do not work as hard as our male counterparts or that the reason Canadians cannot find doctors is because there are more females, is beyond wrong.

It is true that this generation is working much less than the older generation. However, I think this actually a good thing when doctors balance both their personal and professional lives. Plus this phenomenon applies to both males AND females. I mean happier doctor means better doctor right? I certainly would not want a depressed, burned out physician taking care of me or my family. A good doctor is a good doctor, regardless of their gender.

This scapegoating of females is shocking, and it was certainly an awakening for me to realize that such sexist sentiments are still rampant in our society. The fact of the matter is the doctor shortage is a complex problem we are facing in this country today. Many factors are involved including our aging population, as well as earlier policies made in the early 90s to limit medical school enrolment. It DOES NOT, and I repeat, DOES NOT relate to the increasing number of females in the profession.

I am happy, though, that we have many health care leaders supporting us in this case. The Deans of two of Canada’s largest medical schools (University of Toronto & University of Western Ontario) have written editorials in recent publications of the CMAJ and The Toronto Star to denounce these statements. To quote from them:

“To suggest that a physician workforce that more equitably represents women in the workplace is the barrier to access is frankly a sexist excuse for logic. To disparage in any way the intelligent, dedicated women from Canada and elsewhere who have chosen to devote their lives to medical practice is shameful. The blame game gets us no closer to achieving what Canadians expect from us — a health care system that provides quality and timely access to well-trained, well-equipped, compassionate health care providers.”

You tell them ladies!

And so it begins...

2008-03-17T15:10:00.006-04:00

Happy St. Patty's Day!! Sorry for the long hiatus. We were on March Break, so forgive us for the absence. Trust me, it was a break we REALLY needed. Anyways, we’re back, for better or worse

So it’s that time again. The inevitable has happened. You know, that time when all the assignments, tests, exams, obligations, LIFE just comes at you. It’s started for us. We have our cardiology block midterm next week, and as luck would have it, they casually announced yesterday that our lab bell-ringer (organs/dead human parts placed in interesting positions for us to guess what they are) would also be next week. And just for kicks, it’ll include both cardio & ENT. ENT!! I haven’t looked at that in 2 months. And did I mention it’s NEXT WEEK!! Hold me, save me!!

On a lighter note, today our prof said this in lecture: “…remodelling means the myocardium is remodelled.” Uh yeah, and a horse is a horse, and apples aren’t oranges.

P.S.I read this comment from a reader of theunderweardrawer (awesome med blog, I live vicariously through her life):

“A new-ish med student on a surgery rotation was told by the intern before his first case case that whenever he farted in the OR, he had to announce it, so the attending wouldn't think they had nicked the bowel.Unfortunately, he had also had made some not-so-good dietary choices, so he felt the need, was unable to hold it in, and passed gas. "Uh, I, uh, passed gas," he announced. No one said anything. After a little while, it happened again. "Sorry, I farted again." A little grunt of acknowledgment from the attending. Toward the end of the case, it happened again: "I passed gas again."The attending stopped what he was doing, looked up at him, and said, "Boy, what is WRONG with you? This is a KNEE!”

HAHAHAHA…oh sweet procrastination, I love you.

That lovey dovey, that kiss kiss

2008-03-07T22:26:00.006-05:00

Sucking up. Fact of life??

When I was on my observership on Wednesday, one of the cardiology residents just happened to step by to have a “chat” with my facilitator. When the doc came in, the following convo ensued:

Doctor
Hey, what’s up?
Resident
Hey Dr. __, so I was wondering if you have plans tomorrow night?
Me to self
Oh boy…
Doctor
Hmm, well nothing really. Why?
Resident
Well it just happens that I have these tickets for tomorrow but I TOTALLY FORGOT that I have a meeting that night. So I just randomly thought of you, and wondered whether you’d be interested in going…
Me
[Eyes beginning to widen]
Doctor
Yeah that’s really nice of you. Thanks. How much are they?
Resident
Oh no, no don’t worry about it.
Doctor
No, seriously. I’ll pay you back. How much are they?
Resident
No, no, it’s nothing, it’s nothing.
Me
[Rolling eyes]
Doctor
C’mon. I’ll pay you
Resident
Okay fine, they’re $___ each. But honestly, it’s nothing.
Me

[Making kissy faces behind their backs]

The doctor then leaves to do another procedure, leaving the resident and me in the room by ourselves. They don't say anything to me at all, considering I’m just the lowly medical student in the room. They stay, I'm guessing they were hoping the doc comes back, but he doesn't. So they up and leave.

I have no idea how the doc felt about this. He knew right? Like c’mon I could see it a mile away. But maybe it’s just part of the culture. Thoughts??

Note: This post was edited to protect the identity of those involved. AKA Stuff does not want the off-chance that fellow reads this and recognizes themselves and then DESTROYS her (Please refer to March 20th) ....

And they called it puppy love

2008-03-05T20:39:00.005-05:00

Okay, fair warning. This is going to be a LONG post. I think it’s more for myself, to remember in the future what it was like. I went on my first observership today with my clinical skills facilitator.

So I got to the cath lab this morning (after the perilous trek through the snowstorm) nice and early at around 7:50 AM. The nurses showed me into the room where he would be, but warned me that hadn’t arrived yet, so perhaps I should go get some coffee. Of course, as nervous & excited (in other words, paranoid) as I was, I did not want to leave. What if he came and I was gone? And then he’d leave without me? So I decided to stay and wait. And I waited, and waited, and waited…

I thought a lot while I was there by myself. The cath lab is a cold and large, metallic room. It looked really unfriendly. I wondered what it would be like to a patient. I would have been really scared. I WAS really scared, intimidated and overwhelmed by the whole situation. I prayed that I would not cry… so I waited, and waited some more.

Finally, 9AM, and the doc walks in, sounding super-happy & energized: HI Stuff!!! How are you? Me to self - I’m cold, and scared, and I want my mom…

But he didn’t realize that because I’m a good actress, haha. After all the pleasantries, he began explaining what the first procedure would be – a diagnostic angiogram (where they thread up a catheter into a person’s heart, and inject dye to see if there are any blockages). He told me to stay behind the glass, and the tech nurse could explain stuff to me. I was slightly relieved.

For the next procedure, the doc suggested I get a pair of scrubs so that I could actually BE in the lab. EXCITEMENT ensued!! I was going to tell him that I already had said scrubs but before I could, they gave me a pair. In MEDIUM. Needless to say, the pants came down to my knees, and I had to roll them up three times. They were still too long. I digress…on top of the scrubs we had to wear these lead shields. They weighed at least 40 pounds. The one my facilitator had on made him look like a superhero. It was tight, black and had one sleeve. (Okay I admit it, I thought he looked hot, but don’t tell). Mine had flowers. He looked like Batman. I looked like Mrs. Doubtfire.

So we went in, and he showed me what he was doing. The femoral artery at the femoral head was located by aspirating and looking for pulsatile flow. He thread the catheter up, and he explained how they were looking for blockages within the RCA, LAD, etc, and testing for LV function. It was fascinating. I mean, they had a tube right in this guy’s heart! An image of the vessels came up on screen. It was strangely beautiful, like rivers cascading down.

I observed another 4 cases throughout the day. One case was particularly interesting. The patient had multiple lesions, in addition to a huge thrombus (clot) occluding one artery. They had to suction the clot out, and balloon the vessel multiple times. This patient needed 3 stents (wires that keep the vessels open)! They even performed a technique called “kissing-balloons.” How romantic!

The doc taught me a lot today. He was very patient with my questions (even the stupid ones), and he took a lot of time to explain the little details of everything. I admit, I am in a little awe of him. Okay, fine I have a huge crush on him.

So the day was really great. The only thing was that it lasted until 5 PM. I just didn’t know how to leave. Every time I was working my way to tell him, he’d start explaining the next case. So I sort of felt obligated to stay. But I don’t regret it, because he went over a lot of stuff at the very end.

The other thing was that the whole day, I had at the back of mind: Do not be the overly eager med student. Give him his space!! But I was following him around so much, I felt like a lost puppy. He’d go out, I’d go out. He’d sit down, I’d sit down next to him. I hung on every word he said. I was his shadow. But I think I got better at the end, but only because I was pretty exhausted at the end of the day.

Yeah, so I learned A LOT today. I’m very happy that I went. My facilitator is awesome. He is my new idol…but enough with that, I’ve written too much already. Now time for cardio assignment, boo…

P.S. Oh I forgot to mention, I had to skip out on class today to go on this observership. And as luck would have it, I met the doctor who was giving our lecture today. He discovered my delinquency! I apologized, but he was cool with it…

[N.B: Advice for other students – be careful not to be TOO eager that you step into the sterile field. Consequences maybe severe. Proceed at own risk.]

My cat's breath smells like cat food

2008-03-04T17:29:00.006-05:00

Today was one of those days where I really question my own intelligence. This afternoon, I had my advanced interviewing session. It was my turn, and even though it wasn't the easiest case, I think I did pretty well. I fleshed out a lot of the issues that the standardized patient (actor pretending to be sick) had.

So during the break, I was feeling pretty chuffed with myself. While everyone was getting them some Timmies, I decided to visit the little girls' room. Now, smart little me somehow decided to take a DIFFERENT route to said bathroom:

Me to self

Hey, let's go around back and save some time!...Oh no, there's another group in there...Okay, let's try this other door. Oh crud, it's locked. Man this is getting embarassing. Okay, better go back from where I came from.

[turns around and tries to go back]

What the flip...oh no, it's locked!!! OMIGOD, I've locked myself into a box.

I finally managed to open a third door, which led to the parking lot. Ah, what cleverness. What's ironic is that in 3 years, I could be YOUR future doctor. Be afraid, be very afraid.

Warning: May cause excessive daytime sleepiness

2008-03-03T17:51:00.004-05:00

What is up with me and pathology? We’re now right in the middle of our Cardiology block, so for the past couple of weeks we’ve had a few lectures in cardiovascular pathology from this one doctor. Now don’t get me wrong, I find pathology pretty interesting (considering I had a specialist DEGREE in pathobiology), but every time this guy lectures, I fall asleep. And no, it’s not the subtle head-nodding or even brief eye-resting. I have a full-on snoring (if I snored), limb paralyzing, REM sleep.

So today I was fully ready for this. I propped myself up, I had a snack of cookies ready for a good jolt of sugar. But I couldn’t fight the inevitable loss of consciousness.

Doctor
“…ischemia in the epicardial coronary arteries… blah, blah, blah…”

Me to self
[eyes closing] Fight it! Fight it! NOOO! Cannot help it, eyes will not open…cannot fight it…okay give up…nap time for me

Yes, so I fell asleep. Completely unconscious, body horizontal onto the next seat, drooling from side of mouth (no I kid…at LEAST I didn’t drool). I think I even had a dream. I finally woke up when my pen fell from my hands.

I feel very embarrassed about my obvious narcolepsy. I don’t do it on purpose. But it’s almost like my body knows it has to sleep as soon as he opens his mouth. What’s worse, I saw him in the halls today. We made EYE CONTACT! And I knew, I just knew that he recognizes me as the girl who never stays awake. I guess cardio-pathology won’t be in my future anytime soon.

I think I have a pulmonary embolism...

2008-03-03T17:15:00.005-05:00

Funny characteristics about the odd, pale, sleep mazed creatures that are your average medical student: (if you see one on the street, offer the poor thing the coffee sludge at the bottom of your cup... s/he needs it)

1) They immediately think the worst.
Doc: "56 y.o. male came in with history gradually increasing left hip pain starting 6 months ago and trouble sleeping at night because of the pain. Give me a differential."
Student: "Must be cancer metastasizing to the bone."
Doc: "You don't think it might be osteoarthritis?
Student: "Nope, it's gotta be cancer."

2) They go straight to the most aggressive (usually completely unnecessary and expensive) investigations.
Doc: "So what would you do to confirm the diagnosis of osteoarthritis?"
Student: "Full body MRI, stat. We don't want to miss any potential TUMOURS."

3) They're convinced that they have whatever disease/condition they're currently studying.
The entire lecture about soft tissue tumours, I was convinced I could feel a lump growing in my abdomen. During our week on back pain, I had shooting sciatica pain down my leg every morning. When we were studying the brachial plexus, I felt some mild tingling in my 4th and 5th fingers and was sure that my ulnar nerve was somehow pinched. No one ever told me that medical school was a risk factor for hypochondriasis. I'm sure Stuff can go into this in much more detail.

Let them eat cake

2008-03-01T20:40:00.004-05:00

On Thursday night a couple of us went to a dinner sponsored by the Rheumatology department. It was basically a night to introduce medical students to the field of rheumatology. There were some talks by the rheumatologists and residents in the program and by the end of the night I think a lot of us were pretty pleasantly surprised by what we heard.

Rheumatology seems to involve a lot of interesting cases, patients and a great lifestyle. Love House? Then Rheumatology is for you (lupus anyone? vasculitis? how about sarcoidosis??). So it was an informative night, and a lot of people I think are now seriously considering going into rheum.

The only thing that sort of bugged me about this whole thing was the fact the night was paid for by a drug company. It was on my mind the whole night. I mean, what was their ulterior motive? I saw one lady from the company talking earnestly with a couple of my classmates, and wondered what were they discussing?

I don’t know if it’s just me, but I felt sort of strange and sheepish about the whole situation. Almost like Julia Roberts in Pretty Woman minus Richard Gere, and lemony cheesecake goodness in the place of money and clothes (mmm…cheesecake)…And what’s worse, there were no free pens or post-its!! (joking, but those would have been nice, haha).

I know this is the nature of the beast but I just hope that these sorts of things don’t sway or influence my judgment in the future. I would not want it to compromise my patients’ care, just because I got some fancy chicken for dinner. I don’t know…how do others feel about this?

All I want to be when I grow up is a doctor

2008-02-29T16:58:00.010-05:00

Yesterday I attempted to acquire myself a pair of scrubs. I’m supposed to go on a scheduled observership with a cardiologist who does angioplasties (basically blowing up a balloon into your arteries to get rid of the dirty, dirty plaques from all them Mickey Ds).

So we (T & I) decided it would be a good idea to get a pair. Just in case he let me actually be in the room, as opposed to sit behind the glass like a two year old in time out. The thing is I both fear and hope that I get to go into the cath lab (where they do the balloony-stuff). I’m afraid that they’ll ask me questions…and as I said before, I don’t know much. Actually I know nothing. What's more, this doctor was one of my facilitators for clinical skills. And basically we/he doesn’t need to be reminded of my incompetence in this area:

Doctor
“…blah, blah, blah (whole bunch of complicated medical stuff related to the brain or something) cranial nerve…blah, blah, blah, blah…muscles of the eye? "
Me to self
[blank look on face]
There are muscles in the eye??

So anywho…I’ve decided that I want to see what he does for a living, considering he’s all smart and accomplished and stuff (and maybe because a certain someone had a little tiny crush on him in the beginning)…

I'm kinda nervous. It doesn't help that it’s supposed to be 8 in the morning (much too early to be doing medicine, in my opinion), and if it turns out to be boring (I mean looking at a black and white screen of wormy looking blood vessels for an hour might not be everyone’s idea of entertainment) I may fall asleep. And in my fit of losing consciousness, fall on the patient… what a lady huh?

Back to my scrubs story…so I got the “greens” from the linen lady (whose office is like in the dungeony area of the hospital), and tried them on at home. By the way, they were supposedly “small.” But on me… I think the pants reached halfway up my stomach… Who am I Steve Urkel? I look like I’m five again playing dress up…all I need is my Fisher Price doctor’s bag. What’s worse, I don’t trust that they’ll stay on…can you imagine? Face planting on the patient, AND losing your pants? How graceful…

The Beginning of a Lifetime of Humiliation

2008-02-29T13:14:00.004-05:00

It takes a lot of work to get into medical school. The application process has been compared to anything from a meat grinder to a cut throat rat race. There's nothing more (a) relieving, or (b) exciting than finally getting that acceptance letter. I jumped up and down like a crazy woman (well, I was at work when I got the news, so I didn't actually. But DEEP DOWN INSIDE I was doing the Riverdance). I couldn't stop smiling. Someone actually stopped and asked me if anything was wrong (I guess I must have looked a little off). But after the initial euphoria wore off, my first thought was "I wonder how long it'll take for the admissions committee to realize they've made a mistake". Ah, pessimism. My friend.

I had this concept that since med schools are so hard to get into, that medical students must be incredibly intelligent, capable people. And don't get me wrong, most of my classmates would fall into that category. What surprised me was that most doctors didn't expect much from us at all. Case in point: the following is a slide from our respiration block.

AIRWAY ASSESSMENT: FIRST DETERMINE...

1) Is the patient dead?
2) Is the patient dying?

If the patient is not dead or dying, take a history.

Yes. The attending felt it was necessary to instruct us NOT to attempt a history on a deceased patient. Perhaps they have run into problems in the past regarding that particular concept...

Picture the earnest medical student clutching a patient chart in sweaty palms, standing at the head of a body bag.

"MR SMITH??? MR SMITH, CAN YOU HEAR ME? CAN YOU TELL ME IF YOU'RE ON ANY MEDICATIONS? WHEN DID THIS PROBLEM START??? ARE YOU IN ANY PAIN? WHAT PRECIPITATES THIS PAIN? TELL ME ABOUT THE QUALITY OF THE PAIN. DOES IT RADIATE? MR SMITH?? HELLO??? WHAT DO YOU HOPE TO GET OUT OF THIS INTERACTION?"

Anyways. Bottom line. Most doctors' opinions on the intelligence level of the average medical student: low to very low.

Anatomy Lab: Day 1

2008-02-28T23:15:00.005-05:00

We met our cadavers today. The hospital chaplains held a memorial service in the anatomy lab before we started, and we were encouraged to think about who these people had been, what their lives had been like, who they had loved.

At our table, the six of us stared at the white bodybag lying in front of us. We could tell from the lumps beneath that our cadaver was short- probably a woman, someone said to break the heavy silence. One of the braver souls reached out and felt the leg through the plastic. "Rigour mortis," he blurted out with a nervous laugh. Body juices were pooling through the zipper of the bag. We decided not to unzip the bodybag just yet, and busied ourselves with our bone box. Bones were less personal. Carpals, metacarpals, phalanges. We pored over each groove and bump of the skeleton.

Our anatomy professor came over to watch our discussion. He leaned his elbows against our cadaver's head as if it were just another piece of furniture as he answered our volley of questions. After he left we looked at each other. We had all noticed his disregard for our cadaver. Somehow, that realization gave us the courage to open the bodybag. We all donned gloves and watched in silent anticipation as the zipper slowly pulled open.

First, the feet came into view. The cadaver was lying facedown. Then the legs, and then more came into view, until we were looking at the back of her head. It was a her. She couldn't have been more than five feet tall, an older woman with bluntly chopped grey hair. She probably had been a grandmother. She looked like she would have looked right at home sitting in a rocking chair in front of a big picture window, knitting booties for the newest grandchild. "Wonder how she died," someone mumbled. Stomach cancer and heart failure. She had been 66.

We decided to name her Nora. Partly because she looked like a Nora, but mostly because none of us knew anyone called Nora. We wanted her to be special. As we were leaving the room, we saw half a cadaver's head, sawed through the middle and sliced off at the shoulder, skinless and grey, discarded on a side counter in a little tray. I barely blinked. The desensitization has begun.

A Whole New World

2008-02-28T22:30:00.015-05:00

I think the first thing one needs to admit when you're in med school is that us 1st year kiddies are kinda dumb. Yeah, yeah all you type-A's out there. This is how you got in the first place right, from our nerdy brilliance. But once you’re here, it’s incompetence city.

Case in point – clinical skills. For those of you who don’t know what this means, in first year we have ‘clinical methods,’ which basically teaches us how to do physical exams. Except half the time we don’t know what we’re doing. And that right now what’s supposed to be normal could just as easily be abnormal. 90% of the time, this is how the sessions go down:

Doctor-facilitator
“Okay so today we’re going to practice taking blood pressures…you there…you’re first”
Me to self
Okay [takes deep breath] ... I can do this…I’ve watched ER…
[Trying to look confident while struggling to put cuff on patient and stethoscope on arm]
Doctor-facilitator
"So do you hear the korotkoff sounds?"
Me
[Confused look on face…the wha sounds?]
"Uh, no…actually I hear nothing"
Doctor

[looking clearly confused]
"What? Are you sure? How is that possible?...

[Looks at my stethoscope]
… uh yeah you’ve got it turned the wrong way."
Me
Oops…

Worse yet, don’t pretend to hear or feel something if you don’t. It won’t end well. Your facilitator will know, and you’ll just end up looking like a complete ass.

Doctor-facilitator
“So you there med student, listen to this patient’s chest”
Me to self
Oh no, he’s talking to me…okay, calm down…listen to the patient’s chest
[Puts on stethoscope…do I even have this on right? Procedes to ‘auscultate’ chest]
I hear nothing…oh god, this patient has no heart beat! Oh my god, he’s dead!!
[starting to panic]
Doctor-facilitator
“So do you hear that…?”
Me
“Um….[looking around at others in groups desperately for help]… yes, yes I do… "
Doctor
“What does it sound like?”
Me
Oh crap…make something up…
“Yes…I heard S1, S2" (normal heart beat sounds – basically lub-dup)
Doctor
“Yeah…well…[trying not to laugh or sigh out of frustration in my ineptitude]…no…try again…"
Me
[Laughs nervously] Okay…try again… “Um, breath sounds?
Doctor
[Sighs to self]…”uh, no…clearly this patient has a pansystolic mitral valve murmur”
Me to self
Kill me now…

So there you have it. Be comfortable with feeling like you know nothing. It’s going to last for a while…

5 Ws & How?

2008-02-28T22:27:00.006-05:00

Hello, welcome to second opinion. As a first post, we thought we’d do a quick introduction.

Basically we’re two 1st year medical students who wanted to create a way to record our experiences in this crazy journey that is medical school. It’s a way to let each other, as well as friends & family, keep updated on what are the goings-on in our lives. It’s our journal that’ll help us remember all those funny little stories 10-15 years from now when we’re “real” doctors with all the plaques, scalpels and real-life patients, not just those paid actors who pretend to be sick…

Okay, let’s be honest, it’s because we love procrastination & (let’s face it) this seems a lot more productive than watching ER, House or Scrubs on TV all day long…

So thanks for reading, and we’ll try to be as entertaining & interesting as we can. Enjoy!

Health Information Privacy Code

2008-02-28T17:08:00.004-05:00

Due to patient confidentiality, all medical school-related stories we tell involving patients, family members, health care workers, students, etc. have been changed in some way for privacy reasons. We will usually alter one of the following: name, gender, age, diagnosis, or the order in which certain events took place.

On a lighter note, look forward to our introduction post!