Unfair

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?

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

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

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.