Med Neophyte

2009-07-12T20:43:00.003-06:00

And other cliches
This past week my husband took Harold out of town to visit the extended family. They were gone for three days making the rounds to various grand-aunts and uncles, second cousins and a great-grandmother. They were gone for 5 days.

While they were away I realized how all my classmates actually found time to study during clerkship. I did all the housework, went for walks to get coffee, did a bunch of reading for my rotation and even some pre-reading for half day. I wouldn't ever give up the support and love of my family, but it was a short glimpse into how, without them, there would be a lot more room in my day to devote to medicine.

By the time they came back Harold had learned how to wave bye bye, can sit back down from standing without a crash landing (he learned to pull to stand a couple of weeks ago), and started shrieking when he wants something. Well that last one is not so charming... but it is just like "they" say. They grow up so fast (sniff) and every moment I miss is something that I can't get back.

2009-07-10T16:39:00.004-06:00

Infection Control
This week there has been an outbreak of H1N1 in one of the wards of the hospital I work at. They quarantined the ward (no new patients, only staff that we necessary for patient care and only close family visitors). While H1N1 has been largely a mild disease this outbreak is where the kidney transplant kids (among others) stay.

I have always been pretty good about washing my hands at the hospital. I was quite proud of myself for going through all of clerkship without picking up any nasty bugs. But this outbreak has given me (and I think a lot of the other staff as well) considerable pause. While many of us might have previously been inclined to work through illnesses or gripe about how long it takes to "gown up", everyone is reaching for the hand sanitizer after and before every patient now. It is great that everyone is taking infection control more seriously now, and it will definitely decrease passing infection between patients.

There are already 5 residents off on sick leave. They will all be gone for at least 5 days to prevent spreading infection to any other patients (so far there are only two confirmed infected patients). This is creating havoc with the call schedules. I think the chief residents have doubled their grey hairs in the past week.

It also makes me think of Harold. I am now responsible to stay healthy to take care of him as well as to prevent passing a bug along to my patients.

But H1N1 is now a community acquired infection. Many of the kids I see in emergency (my present placement) most likely have it. We don't even considering testing for it unless the patient has to come into hospital. Most people with the infection aren't even being seen by doctors.

Now that Harold is in daycare he has a good chance of picking it up regardless of what I do. And if he does, I am probably not far behind. The only up side would be that I no longer have to feel bad about staying home when I am sick.

2009-07-06T13:55:00.003-06:00

What do you think?

I haven't posted in awhile for all the regular reasons (too much in the to-do list and the regular cadre of everyday stuff getting in the way). But I have also been struggling over what I should be concentrating on in this blog.

Now that I am a doctor and all official like, I am somewhat reluctant to post about medical stories. Pediatric neurology is a very small specialty and there is no way to make these stories completely anonymous. To protect myself and the little ones that I am lucky enough to take care of, I don't want to expose them to the whims and harsh stares of the internet.

Then there is being a mother. Harold is a huge part of my life and is continually surprising me, mostly with normal progression of babydom. I could use this blog to tell little stories about how pleased, but also scared I am now that he is standing and able to reach a whole new world of mischief. While all of that gives me endless pleasure, I don't really think it is worth your or my time to dwell on so much navel gazing.

I could use this blog to broadcast all my ranks, displeasures and pet peeves. But usually, by the time I have a spare moment to write something I have either forgotten or no longer have the rage fueled energy to post about the jerk in traffic or how stupid the government's latest move to "improve" healthcare is.

So what do you think? What would you like to read about?

2009-06-03T20:30:00.002-06:00

Long time coming

A lot has happened since I last posted. Not surprising since it has been such a long time.

I am now two days away from being done medical school.

I anticipated that these past 8 weeks (my make-up time for the "maternity leave" I took in the fall) would feel long, and they certainly haven't disappointed in that regard. I had my obstetrics and gynecology rotation first. It had been shortened from 6 weeks to 4 for the new class (or which I am temporarily a member). Unfortunately the director had been quite disappointed that the rotation had been shortened and wanted to make sure that we had as much experience in the 4 weeks that clerks had previously spread over the 6. This made for a particularly grueling rotation with lots of long hours and no time for studying. Bad enough if all you are trying to study for is the rotation test but even more frustrating for me trying to study for my licensing exam. At least they were kind enough to let me take the day off to write the test. (I still don't know my results, the dread of which still haunts me.)

I am not usually a huge complainer. I (at least in my own conception of myself) usually just go about getting done what needs to be done and don't whine. But there was a point in April while all of my classmates were sleeping in, sitting on their asses studying and complaining on facebook about being bored and I was doing crazy busy call, taking care of Harold whenever I was home and trying to sneak the odd cramming in that I was about ready to start my own pirate radio station just to bitch. "You think you're tired !?! Let me tell you"

Well I got through that. Then the next rotation was cardiology, busy but no call and I was usually home at a reasonable hour. But then there was graduation. I had fun at the graduation dinner but the whole thing was a bit depressing. Everyone was referring to themselves as "Dr". Aside from just finishing another day of my medical student rotation, I was reminded in a bunch of ways that I was not really a member of the group. No gown or hat for me. I didn't get fancy graduation pen with my name on it. My actual convocation will be small, with people I don't know - I might not even bother to go if I have to take time off of work.

Right now I am on an elective in my chosen field. It is kind of nice to get a bit of a relaxed intro to residency. I am still a medical student with no real responsibility but I am getting to know people in the program better and sort some of the paperwork and details out. The only problem is that I am completely burnt out and just counting the days and hours until vacation. I would like to be all keen and engaged but I can barely focus during a conversation. Not the best impression to start with.

In other news, Harold is doing really well. But that update will wait for another post.

2009-03-23T19:53:00.003-06:00

Settling In and Strained Peas

I am starting to get used to the idea of residency and the idea that I will be a doctor with little munchkins under my care. And I am also getting really excited about it. Clerkship has been great but there have definitely been parts that were greater than others. Moving to more and more experience that is relevant to my chosen vocation is welcome.

In the meantime I have 11 weeks of clerkship to finish. The rest of my class has 3. 8 weeks is not very long for a maternity leave but right now, with the rest of my class making plans for their 2 months off and having abundant time to study for their licensing exam, it seems interminably long. Not to mention that spring keeps threatening to emerge (not this weekend, this weekend it snowed 10cm) and mock me as I am trapped in the hospital.

I am just going to have to swear off facebook, put my head down and plow through. And ask for the evening off to go to my graduation dinner.

In other news we have started the little guy on food. So far he has tried rice cereal, butternut squash, carrots, yams and honeydew melon. The melon is by far his favorite but most things go down pretty good. Each weekend I have cooked and froze (as directed here) vegetables to eat through the week. I was thinking again today how having a kid changes your life in a million little ways you don't think of. I never would have thought "strain peas" would be on my to-do list.

2009-03-09T20:26:00.003-06:00

Pediatric Neurology

Today was match day.....

And I got my first choice. I will be staying here to do pediatric neurology...

Which mostly has me scared out of my mind. I had been weighing the choice between neurology and pediatric neurology. I had been considering neurology pretty much from the beginning of med school but when I did my pediatric rotation I did 3 weeks of subspecialty neurology and loved it. I loved working with the kids, I loved the clinical problems, I loved the physicians I was working with and I even loved working with the parents; the part I was most dreading. But the thought of being responsible for such fragile and innocent patients scared me off committing to it right away. Somehow the prospect of messing up in adult neuro (with an old stroke patient etc) just seemed more manageable.

But when it came to ranking I had to go with my heart. I am still scared out of my mind but I have 4 months to get used to the idea.

And we will be staying put, close to friends and families and our favourite restaurants. A small part of me is sorry that we will not be heading out somewhere new, somewhere adventurous, but I am confident that this is was the best decision for us. Anything to avoid a move :)

2009-02-26T20:55:00.003-07:00

Decision Making

Today was the day that our rank lists were due. I had arrived at a list I was fairly confident in about a week ago. Yesterday I started having doubts but, after gazing at it, I made only minor changes and went to bed happy.

This morning I had more doubts. Basically I have been deciding between two specialties. One that is more narrow and I have less experience in. The experience I did have was some of my favorite parts of clerkship but it is hard to know how representative those three weeks were. The other is more broad and I have done enough time to know that I would be happy there.

Then there is location. All the programs I interviewed at are reasonable so it comes down to where we want to live.

The deadline is passed and now I just have to wait and live with the result. I know that I would be happy in any of the programs and either specialty. So why I am stressed now? I have always been happy with the gut decisions I have made in the past and I have no reason to think this will be different. I think what is bothering me is the uncertainty. Once it is over, whatever the result is, I will be happier. Just a week and a half before this theory is tested.

2009-02-16T19:32:00.005-07:00

Touring

Bad Blogger, bad blogger.

I really have meant to stay more in touch. And I can't say that I have had nothing to talk about.

I have recently completed the CaRMS tour, a whirl wind trip around the country to interview for residency spots for those not familiar with this particular circus. I traveled from St John's Newfoundland to Vancouver BC and many spots in between; including 10 flights, a car trip, many random bed and breakfasts, hostels and couches. It was hard being away from Harold for such long periods but my mother-in-law came to help take the strain off the Hubby and everything went really well.

It was a surreal experience seeing so much of this gigantic country in such a short period, often spending less than a day in many new places. I hope to go back to many of them, but I don't think I would pick January/February. We heard "it usually isn't this cold" at almost every stop (not Vancouver of course, there were bike riders wearing t-shirts). I remain incredulous.

Now the task of trying to decide our futures. I have to rank the different programs. I applied to more than one discipline; neurology and pediatric neurology. Not really that different I know but it adds another level to the decision making. I think I have mostly arrived at a decision but I will share more about that after match day (March 9th). I don't want to upset the matching gods and inadvertently jinx myself.

In the meantime I finished surgery (though not the exam, I was in Toronto that day). The next two weeks will be Emergency and then Family. I am starting to feel a little left behind with my classmates already on the home stretch. Many of them will be on their last rotation and are focusing on the liscencing exam or vacation planning. I know the 8 weeks that I have to make up is not really very long, but I think it will feel pretty long when all my classmates have already flown the coop.*Don't worry, he is well within arms reach of my husband.

2009-01-05T19:32:00.004-07:00

Adventures in boob land

With a whole month between posts you might think I would have more to talk about (Christmas, school, momming) but things are pretty routine. Desperately trying to keep my head above water, but routine.

This post from a newly discovered blog has inspired me to post again. My little guy is now approaching 4 months and has been exclusively breast fed so far. This is the ideal that is promoted at every pre-natal, post-natal, vaccination, lecture, bus stop ad and match book cover (or at least that is the way it seems). Despite it being the natural option it is certainly not as easy as it might look. Child birth is "natural" too and that was no walk in the park either so I am not really surprised.

Things have been going pretty well for me and the little guy. I have friends who have not been able to keep it up nearly as long for a variety of reasons. While on leave I managed a modest stock of frozen baggies and have pumped (usually) twice a day now that I have returned to the hospital. Being a medical student with absolutely no control over my time, pumping usually means stealing 15 minutes away crouched on a toilet eating with one hand and trying to hold two pumping funnels on with the other. If this doesn't evoke a mental picture I will just tell you, it is not fun.

Sometimes I find an unoccupied call room where my pump and I can have a little more comfortable alone time. Which has probably led most of the cleaning staff to think I am having some kind of elicit midday affair ala "Grey's Anatomy".

After a few weeks of this my supply started to drop off. Combined with a growth spurt this made for a couple frustrating days for the boy and ate up all of our frozen reserve. My doctor put me on Domperidone - a gut motility agent that has raised prolactin as a side effect; or a prolactin raiser with diarrhea and gut cramps as a side effect. Holding a scope for a lap chole while your small intestine spams is also... not fun. But it worked and we are back to pumping enough to fatten the little guy up.

These problems are minor but med school and mothering are already pretty challenging undertakings and I am starting to resent the extra effort. For now I will keep at it but I can sympathize with all the other mothers out there that have sped the transition to formula or solids.

Happy New Year

2008-12-07T17:17:00.005-07:00

Taking it up a notch

The first month (has it already been a month?) back at school has been going well so far. I made it through two weeks of neurology and two weeks of surgery seminars and anesthesia. Anesthesia was really fun with lots of teaching, opportunities to do IVs and intubations, and talk to patients. Next week I start neurosurgery, a rotation that is notorious for being particularly harsh; a brutal combination of long hours, little responsibility and brutal bedside grilling.

I have been doing well when I am actually doing things, but when I am idle for more than a couple of minutes I fall asleep. In one particularly embarrassing instance I dozed off right next to an anesthetist that was giving me and two other students a talk about chronic pain. I am just thankful I didn't start snoring. With 6:30 starts and lots of standing around doing nothing, I am a little nervous about neurosurgery.

The little guys has been smiling for quite awhile and will chuckle occasionally now, but whenever we pull out the camera he gets more interested in staring at the lens. This is the best I can capture so far.

2008-11-23T22:34:00.003-07:00

Consult Rage
I had my first bout of consult rage last week. It is sort of like road rage but instead of wanting to tap on the window of some horrible or overly aggressive driver and ask them what they could possibly be thinking, it makes you want to call up a doctor and ask them where they went to medical school. It probably didn't help that I was called to see they particular patient just before I should have been sent home.

I was on call for neurology and was asked to see a guy in his mid-60's (details have, of course been changed to protect anonymity). He had been in a car collision a couple of days previous after blacking out (most likely syncope from 3 different hypertension medications) and running a red light. He had come to emerg and check out fine. The next day he saw his family doctor and promptly sent back to emergency for left sided "weakness". He was seen by neurosurg, had a head CT and C-spine x-rays and had been signed off.

And yet they still consulted neurology. I can only presume that they thought this left sided "weakness" was due to a stroke. Except he did not have weakness and never did. English was his second language and when he said weakness he just meant he couldn't use that side properly due to pain. This took me all of 30 seconds of extra questions to figure out. On motor testing the strength was fine, just limited by all the bruising from the collision. So neurology was consulted on a patient already deemed healthy by neurosurg that had no neurologic symptoms.

I might not have been so upset except for the extra hour (mostly spent waiting to review first with the resident and then with the attending) it kept me away from home.

On the up side that patient thanked me for being the nicest doctor he had seen in the 26 hours he had been in emergency.

2008-11-17T21:31:00.002-07:00

One week down, 25 to go
I am now into my second week back at clerkship. Things are as well as can be expected. Most people seem to be a mix of impressed and horrified when they hear I have returned with a two month old at home. Most relax noticably when they hear that I left my little guy in the care of his father. (I am not sure what terrifying alternative they were imagining.)

After some initial getting-to-know-each-other-and-the-bottle adjustments the guys are doing well. The little man learned smiling a couple of weeks ago and is making great strides in his laughing, which is probably the best way possible to come home. It also isn't so bad to come home to a hungry baby I can spend a little time comforting either. Right now I am writing in the doctor's lounge, 4 hours past my longest time away from him. He will probably be in bed by the time I get home so I am actually looking forward to tonight's 2am feeding.

I can't say that I was an all-star clerk last week, I tend to be much more of a go-getter. But no-one died or was neglected and things are more on track this week. I have been more on the ball at the bedside grill sessions and am trying to work my way into presenting at grand rounds on Friday.

New pictures will have to wait until I am on my own computer.

2008-11-05T20:52:00.003-07:00

Returning to the grind

I am in the middle of my last week of leave. In 4 short days I return to clerkship.

Just about everyone asks me if I am looking forward to it or dreading it. Of course I am dreading leaving my son for 8-12 hours per day. It is not like I am leaving him on a doorstep or sending him down the river in a reed basket. He will be at home with his very capable dad. But I won't be there to see him learn every new thing or check his stool.

I am also dreading trying to pump 3 times a day while at the hospital. I am not sure if there is anywhere half decent in the hospital to do this. And, as a clerk, I have no control over my time. It will be an interesting challenge.

But I am looking forward to getting back to medicine. To having adult conversations. To learning new things myself.

Of course another pic of the little lad; in a onesie from his aunt.

2008-10-07T13:35:00.004-06:00

3 weeks as a mom

I knew that having a baby would change my life. I knew that it would change what I do in the day, how I manage my time, and a million other little things.

I wasn't entirely prepared to have mommy-hood change me. I think I underestimated the change in priorities, the change in how I view my family, how I view myself. Everything for my body to my dreams (both the night time and prospective variety) has changed since I gave birth. Looking back now this completely makes sense, but I don't think it is something that you can quite prepare yourself for ahead of time.

Right now it is storming outside - for the first time ever I am appreciating the wisdom of an attached garage. Unfortunately I don't have one, so I am going to postpone taking my three week old, fragile to the elements, infant outside until it is over; or maybe until tomorrow depending on how he feels.

During our late night feedings/conversations the baby and I have made a deal. I will feed him whenever he wants, make sure he is clean, comfortable, warm, let him pee on me, spit on me and do everything I can to make sure he stays healthy and happy and has everything he needs. His part of the deal is to keep breathing on a consistent basis.

And of course another picture. These are already a couple of weeks old and he has changed a bunch. I will have to get some new ones to show how chubby his cheeks are getting.

2008-09-30T18:57:00.003-06:00

Mommy - hood

Thanks to Dragonfly for the link. She has noticed the medical baby boom taking place in the blogosphere. The same thing has been happening in my medical class - three babies in the past month; I think we are up to 5 this year. Because DF requested - and because I just can't resist - here is another look at our bundle of joy, taken by a good friend of ours that has a knack of capturing baby personality.

2008-09-21T07:00:00.002-06:00

The baby arrives

I gave birth to my first baby - a boy of 4115g - on September 17th. I got a little more exposure to different obs/gyne techniques than I would have liked (it ended up being a forceps delivery) but everything turned out well in the end.

Here is the stinker with my husband on day two.

2008-09-05T19:49:00.002-06:00

The World's Most Pregnant Med Student

I am now 38 and a half weeks pregnant. I have had a near dream pregnancy but I am now starting to feel the affects of hauling an extra 35 lbs around the hospital. Fortunately I am on a much less demanding rotation than my last one (neuro consult vs ICU). Unfortunately I am now in a much busier, more crowded hospital. I have had more strangers come up and touch my belly in the last week than all the rest of the my pregnancy.

Aside from the regular excitement over a new life, people, especially other health professionals, are fascinated by my reproductive state while in medical school. I will never get used to people I have never met asking me what my future career plans are while riding in the elevator.
"How can you manage?" "Are you going to take time off?"

I can understand why people are curious. I am a bit of a curiosity. (Step behind the curtain to see the World's Most Pregnant Med Student. Watch while she writes consults on her shelf of an abdomen. Beware the massive swinging belly.) But I am starting to wonder why they all ask me about it. It is interesting how introducing a baby into the picture gives people permission to cross regular lines of privacy.

2008-08-31T08:39:00.002-06:00

Addendum
I guess my fears were unwarranted because my evaluation actually went really well.

Next week Neurology; a rotation where I would really like to make a good impression. I don't think the neurotic self doubt is going to end anytime soon.

2008-08-28T19:41:00.002-06:00

(~) 3 weeks to go

I just passed the 37 week mark until my due date. At least from my one of my due dates. It depends on if you go by my ultrasound (at 18 weeks; not very accurate), my last menstrual period, or my ovulation date by body temperature. Either way my baby is pretty much considered fully incubated at this point, but could still chill in the womb for up to a month yet. I will post another belly picture when/if I have time for a mirror photo shoot.

On the med school front, today was my second to last day on ICU. I picked ICU as a selective during my internal med rotation so that I could get a little more comfortable with really sick patients and some more complicated problems. I also heard that it was a good place to get a few procedures under your belt, that the days were long and tiring but that, generally, people don't do call.

I haven't done as well as I would have liked on this rotation. 4 weeks later and I have only done a few central lines and attempted one intubation. I have stayed late a bunch of days (I drew the line at over night call at 33 weeks) and I did some weekend call. Despite what I think has been my best efforts, I haven't learned as much as I would have liked or done as much as I think I should be able to do. It doesn't help that one of my most recent patients has plateaued, refusing to get any better for the past four days no matter what we do, and the other failed her extubation yesterday even though I was sure she was doing better.

Today I rushed off to my doctor's appointment (they fit me in extra at the end of the day) and only realized on my way home that I had forgot to finish the note on one of my patients. Not the best way to finish off the rotation. I went back to the hospital to finish it but the attending had already been there to do it for me. I feel like a total schmuck. I guess I will find out at my evaluation if my staff thinks I am as big a failure as I feel.

2008-07-19T01:49:00.002-06:00

I am on call for internal medicine teams. I should be sleeping right now, between pages informing me of random numbers (sats, oxygen requirements, blood sugars) about patients I haven't met. But I seem to be too keyed up and there is a computer in the on call room, convenient for those people that can actually use it to enter orders etc (as a clerk I need someone to verify everything me so it is not so useful).

For those non-medical types out there let me explain briefly:

Internal teams is in house call. Which means I am in a room in the basement of the hospital that looks a little like a rather nice room at a hostel, or a really crappy hotel, or a sparsely stocked bunker. Aside from the computer, there is a lamp that doesn't work and a phone - the other implement they give us to make sure that we can respond to any page within minutes. I still have to search out some blankets so the single bed only has a small pillow on it.

I am on with a junior resident from my team (go gold! I was told they switched numbers to colours to distinguish the teams because team one would get all the patients) and a senior that is over seeing us and the resident from green team. I or the junior get messages from the units about patients that our admitted under our team (at last that is the theory, about 1/3 of the calls I get are actually about the other team). Sometimes it is just a phone number to call back, other times it is a very short text about some concern. Other times it seems like random numbers and letters. Like "Pt DW c/s 13 sat89 ventolin?" (*Not an actual page, just representative*). Believe me when I say this doesn't make sense even if you know what the short hand is.

At least I am not the junior resident. They can enter orders so they also get all the "can we get a gravol prn order for so and so" calls as well. All very necessary but not what you want to be woken up with 5 minutes after laying your head down.

Our other duty is admits. The senior residents takes consults from emergency and, if they think they should be admitted to internal medicine, we go and take a full history, do a physical exam and take a guess at what we should do with them. In the best case it is 9pm and we are the third medical person (after the ER doc and senior resident) to talk to them. More likely it is midnight or later and we could be the 5th or 6th (after a ER resident, the ER staff, the senior, another specialist or two). I was 5th in line today. So the very nice lady with shortness of breath was being rather patient answering my questions 2-3 words at a time in between her gasping inspirations.

And I get to do it all again the day after tomorrow... no I mean tomorrow because it is already tomorrow today... you know what I mean.

2008-06-26T01:26:00.004-06:00

Hhmmm...

Here are some of the comments I have gotten over the past few days:

- Boy, you're getting big
- Are you sure your not having twins?
- I thought you said you were due in September
- I didn't realize you were getting so big in profile
- It looks like you are about ready to burst
- Your bigger than all the other pregnant women (They were in the hospital for their prenatal class and I had a hard time convincing the cafeteria lady that I was working there, even though I was wearing an ID badge)

But my favorite came today:

- Are you sure you are going to make it through tonight?

12 more weeks to go.

2008-06-23T18:40:00.004-06:00

No Place Like Home

I usually think that, were I to win a couple million dollars, I would stay in school. I really enjoy what I do and I want to leave my time on this earth having contributed something. I don't think being a physician is a higher calling or anything, but I do think it will give me opportunities to make a really differences in people's lives.

But if you had given me the option of staying at home and only worrying about the people and concerns within those 4 walls, I would have ditched every higher ambition and be happy for it.

2008-06-10T21:17:00.003-06:00

Adventures in Gestating

25.5 weeks

I have started to wonder if people are treating me differently as a med student because of my expanding abdomen. Being new to clerkship, I don't know what it is like to be on these rotations without a fetus brewing, so I really can't really judge. But I think it is coming up in more ways than I expected.

In some ways I am think I am pretty fortunate. The nurses seem to be nicer to me. And, while I am in pediatrics, I seem to have a pretty easy time getting a history from some of the mom's. There is that "you're a mom, you know where I am coming from" feeling of sorority. Especially the new moms that are freaked out and worried about their kid but also freaked out and worried that they are freaked out and worried about nothing and wasting your time and you are going to think they are neurotic fools. Or maybe I am projecting a bit.

But there is also the other side. I am not sure if I am getting all the work or opportunities that I might if I wasn't lugging around an extra 30lbs. Are people "going easy on me" at the expense of my education and reducing my chances to make a good impression? To compensate I have become much more of a brown nosing pain in the ass than I would normally be inclined. You know the type - following around the resident and the attending like a bad stench and jumping on any possible case.

I was pretty happy to get out of my teaching half-day early today. Maybe I am back to my old self. :)

2008-05-31T22:51:00.003-06:00

Steady as she goes
You might think that I would have lots to blog about. I am now 24 weeks pregnant and into my pediatrics rotation for clerkship. But, things have been pretty uneventful lately. Being at the Children's hospital around some really sick kids for most of the day has caused me to have some pretty reactive emotions, but that was expected. I doubt there is anyone with a heart that could witness a newborn having seizures everyday or a 2 year old that hasn't progressed past the development of a 1-month old and not feel it. But I am sure, with all the hopes and expectations I have for the little one kicking away at my ribs (not to mention the hormones), that I am a little more susceptible to this particular heart break. So I will tell one quick story.

I am on pediatric neurology and last week we diagnosed a 3 week old with tuberous sclerosis. On the scale of things, this wasn't nearly the worst case I saw but the discussion with the parents during which we told them the diagnosis will stay with me for a long time. TS is a disease where you could live your life not even knowing you have it. Or, on the other end of the spectrum, you could be developmentally delayed with behavioural problems and have to struggle your entire life. Given that this child was already having seizures he is probably going to have a harder road than many others. All these parents want, like probably any parent hopes for, is to know that their son is going to be okay. They would like him to be "normal" but, as time went on and they understood the diagnosis better, I think they just wanted to know that they would still have their child, the little boy that they had gotten to know over the past 20+ days.

2008-05-15T21:35:00.002-06:00

One more week
My psych rotation ends a week from tomorrow. Most clerkship psychiatry rotations are largely inpatient following a specific staff psychiatrist, but mine has been almost exclusively outpatient. I do assessments on people referred either through their family doc or emergency. We make medication recommendations and then I see them a few more times to do a clumsy attempt at therapy.

This might be appropriate for some people that have short-term crisis-induced problems. But many of the people that come to our service have long standing interpersonal, personality and mental health problems. I feel bad that some of these people wait a month or more to see a psychiatrist, hoping that they will find a way to dig themselves out of an existence that has become painful and hopeless.

And then they end up with me. For a few weeks.

2008-05-12T20:50:00.003-06:00

Like baby beluga's mom

I am feeling particularly pregnant today. For the past month or so I have been feeling very good. I had a few rather unpleasant weeks in my first trimester but that passed. Aside from a nearly insatiable thirst and having to buy all new stretchy clothing, all of my pregnancy "symptoms" have been more of a fascination than an annoyance. Today I noticed that I have really slowed down. It took me nearly an hour to pick up groceries this afternoon, waddling down all the aisles and stopping to take my 5 hundredth pee break of the day.

There is an upside to being the size of a marine mammal. I actually had a guy offer me a seat in a crowded downtown coffee shop. A courtesy I thought had passed with cassette tapes. He was done his drink and just sitting there reading, but I was still surprised.

I am just over 21 weeks into my pregnancy, which means I am just over halfway through being an incubator to my peanut. This recent gearing down makes me a little nervous about clerkship for the next four months. I am not sure how four weeks in the ICU will go when I can't stand for more than 20 minutes and I am headed to the washroom at least once an hour. Thankfully my school is being very flexible. The peanut and I will take it as it comes.

2008-05-08T23:38:00.005-06:00

Hi from the Peanut

As almost everyone who reads this blog probably already knows, I am expecting my first child in just over 4 months. My husband and I are thrilled and excited but, like most first time parents-to-be I suppose, we are also freaked out, worried and afraid.

I am on my psych rotation presently. This week is my week to be at the Children's Hospital for the children and adolescent psych portion of my rotation. There is nothing like hanging out at the Children's hospital to make you acutely aware of how vulnerable children are to all the chemicals, germs, accidents and whims of fate or genes. There just seems to be too many things out there to protect my little peanut from. And plenty that I don't even have a chance against.

I have tried to be a good mother to my parasite so far but, as evidenced by my posting at nearly midnight on a weekday, I haven't been perfect. I feel guilty every time I have pop instead of water or give in to my desire for a bath instead of a shower. I know feeling guilty isn't particularly helpful and I know no parent is perfect. But I also know that, even if I am perfect, there are all sorts of horrible things that could befall my peanut. So isn't my responsibility to make sure he/she has the best chance possible?

My next rotation is pediatrics; three weeks of neurology and then three weeks of general inpatient. I have already warned my husband that there might be a lot of tears coming up.

2008-04-11T12:49:00.003-06:00

Night in Emerg
Yesterday I had my busiest night in emergency so far. The department I am doing my elective in is divided into two parts, each with its own staff physician, usually a resident and, lately, me. One part is more ambulatory cases: things like lacerations, minor muscular skeletal, minor abdominal complaints (at least as far as can be determined at triage). The other side gets the more major cases: resuscitation, possible cardiac or stroke, older more complicated patients, people who are likely to be admitted or at least need a consult. I was on the later last night.

So far I have preferred the ambulatory cases. They may be more minor, and sometimes there is nothing that can be done. [Three days of sore throat in a 27 year old without a fever or other sign of systemic disease is going to get a throat swab (at most) and a push out the door.] The only skill needed in those cases is the ability to explain that the need for antibiotics is not proportional to the time spent waiting. But stitching someone up, solving a defined problem in a single shift is satisfying. At least there is resolution.

I have been unlucky on the major side. The cases I have been getting are ill defined, inconclusive and, in many cases, not real (the overdose vs seizure later admitted that they faked the whole thing for a love interest). Last night was busy and I had the real feeling like I was working through medical problems to the benefit of the patient. This is what drew me to emergency in the first place. History - physical exam - differential diagnosis - thoughtful use of tests - diagnosis and plan.

Don't get me wrong. I am not one of those students that prays for a major accident or the acute onset of a dramatic deadly condition just for the sake of my learning, or the adrenalin rush. I would just as soon have your chest pain be some minor angina rather than a dissecting aorta. I don't wish for more sick people in emergency (at least I try not to). But I was starting to get a little sick of the people that were showing up at emergency because they felt that their family physician was not listening to them about the arthritis they have had in their knees for the past 5 years. Especially when it takes 20 or 30 minutes, and three stories about their grandchildren, before they tell me that.

2008-04-06T15:28:00.002-06:00

Homeward bound - one more week
(This will have to be a short one because I am running out of battery.)

One week down, one more to go. If it sounds like I am in count down mode that is not a coincidence. After 5 weeks from home I am ready to sleep in my own bed, cook on my own stove (I never realized how much I hate electric), see my cats, walk my neighborhood, go to my favorite restaurants... well you get the idea.

This elective has been fun. The great thing about emergency is that it is always busy and things pass quickly. But between the new place, living in a dorm, and doing shift work I am starting to feel disconnected from my regular life. Some people like the quote that goes something like "you should do something new everyday". I am tired of doing new things. All I do is new things. I want to return to some routine. I need to refind myself in all the familiar comfortable things that I surround myself with at home. Not the least of which being my husband.

2008-03-29T13:51:00.002-06:00

Two Down, One to go
Despite my original good intentions I have fallen into my usual negligent pattern of blog posting. In the meantime I have completed two of the three electives I am kicking off clerkship with.

The first was internal medicine in Kingston. For the first week I did emergency consults for the medical teams because my preceptor was away on vacation. You may ask why, for a two week elective, they would place me with a preceptor that was going to be away for a week. That would be a good question, for which I have no good answer. When she returned I was in "general medicine" clinic with my preceptor for the rest of the time. My preceptor is actually an endocrinologist so almost all of her patients have endocrinology issues. I am horrible at endocrinology; I am taking the experience as a learning opportunity that I would normally avoid at all costs. I also got practice at dictation. A skill that has already served me well and is something that I wouldn't have done unless forced.

All things considered, it wasn't the elective I was hoping for but it turned out to be good preparation for my next elective. I practiced a lot of skills: history, consult notes, orders, dictations, clinic notes, presentations.

My next elective was neurology in Toronto. I had a great experience doing my pre-clerkship elective in neurology in Calgary so I was really looking forward to it. I was apprehensive as well. Neurology became my first choice of specialty after the great experience I had in Calgary (and my psych experience was less than ideal, but we won't talk about that). Between desperately wanting to impress, I was also a little nervous that this elective live up to my expectations. I didn't want a really disappointing experience to cast me into a sea of self doubt and indecision.

I had a good time. It wasn't as much fun as my previous elective in neurology, mostly because I didn't get to see as many patients as I would like. This is a perennial problem in Toronto, which has a reputation for being overrun with trainees at all levels. Despite not being as hands-on as I would have liked, it was a good elective. I enjoyed clinic and inpatient, and I found all the cases really interesting.

Tomorrow I am off to Winnipeg for two weeks in emergency. I am also really looking forward to this elective. But I a have to opposite problem of my last elective. Emergency has been on my list of possible preferred specialties for awhile, but has dropped down to a distant third behind neurology and medicine. My goal is to learn lots, get a good reference letter and have some fun in emergency. But, if I have a really good time, I will be back to not knowing what I should really be putting my effort towards. I can't be really competitive for both neurology and emergency and I really have to make a final-like decision.

Ahh, the self absorbed second guessing and self doubt of a med student. Where would we be without it?

2008-03-03T15:44:00.003-07:00

Clerkship day one
I can't say that I was any kind of rising star today; but all in all I am counting it a success. No one died, no one cried. Aside from a brain freeze here or there (what do you call that area that you tap to look for kidney tenderness??) I think I even managed to look slightly less like an idiot by the end of the day than I did at the beginning. I even had a patient compliment me in front of an attending. I can't remember the name of the attending right now, but regardless. Most importantly, I have a couple things to look up to try to look smart tomorrow. Right now though, I think I have earned a nap.

2008-03-02T20:02:00.002-07:00

New place, new challenges
I made it to Kingston (Ontario, not the sunshine and rum one). I start my first clerkship elective tomorrow. Aside from being generally assigned to Internal Medicine and a mission to the Undergrad medical office to finish paperwork tomorrow morning, I have no idea what I am doing. I don't just mean that there is so much to know that I am assured to look like an idiot, though that is true too. I mean I don't know where I am going, or who I am working with, or what I am doing. In-patient, out-patient, what clinics. It's a huge mystery. Hopefully it is not too much of a disaster and I will have some time to let you know how it is going.

On another note, it is always interesting to see what differences you notice when you travel. I went on a short hike to the grocery store this evening to get some supplies for tomorrow. Two things that struck me right off the bat:

1. the roads here are completely bare of snow and the sidewalks are a mess. It is obvious that it has snowed here a fair amount and, without friendly Alberta chinooks, it has stuck around. While the streets seem to have been plowed by a magic truck that even scoops out the potholes, there is slush and ice and treachery on every side walk. Maybe there are no old ladies to break their hips here, or may be the students that live in the houses just don't care.

2. milk costs twice as much. I am sure there is some fascinating history about farm legislation and price control but geeze, x 2 seems a bit steep.

There is lots of cool things here too, cute old houses, good restaurants, blah, blah; but that is what I have noticed in my 3 hours stay so far.

2008-02-24T14:31:00.002-07:00

No Big News
It is not that there is nothing significant going on, there is lots, but I am not ready to talk about any of the important things things happening in my life. So I will post about blather instead.

My husband went away on a business course this week. I used to think that I was a capable independent woman. I can handle stuff. You stick me in a clinic I have never been in before and put a patient in front of me I can do (in most cases) a decent interview and physical exam, even have a good idea of what might be going on. In a week I am going away to a city I barely know, to a hospital I have never been in to do my first clerkship elective and I will handle it. I am the queen of handling it. At least that is what I thought.

I don't think I take my husband for granted. I thank him all the time for all the stuff he does around the house and tell him how much I appreciate when he listens to me rant about school or traffic or politics.

But he has been away for two days and I am already struggling under no longer being part of a couple. Maybe I am not suppose to say this as someone who thinks of themselves as a feminist, but I really depend on my hubby. After all, does anyone really enjoy doing their own laundry. Now I have to wash the dishes myself after making dinner, and there is no one but me to feed the crying cats at 6 in the morning (don't they realize it is Sunday and I was out till one last night). Division of duties is not just an efficient way to set up an automobile factory, it makes my life a lot easier.

I sure hope he deals better when I am away on electives. I can't actually remember the last time he cooked. I just hope he doesn't starve to death, or give himself liver failure from too much space cheese at Tubby Dog.

2008-01-08T15:10:00.000-07:00

Final course
As a second year student (in a three year program) I am in my final course before starting clerkship. Yay!

About 4 more weeks of lecture and small group, and then another few weeks of integrative (a vague, small group, problem based entity) and we will be thrust into pretending to be competent almost-physicians full time.

On another note, I have become unnaturally interested in the American presidential race. I guess I can partially justify all the time I spend checking polls, primary results and pundits overstated opinions with the whole what-happens-in-the-giant-empire-affects-the-mouse argument, or that I am a victim of trends in mass media. That all maybe true, but I tend to view the whole thing as entertainment. The soap opera story lines are riveting, I get the updates in easy to manage 2-3 minute increments and the characters are way more outrageous than anything on Canadian tv or writerless network shows. Or maybe I am just giddy that Bush will eventually, finally be replaced.

2007-12-24T13:58:00.000-07:00

Merry Christmas Everyone
Here's hoping everyone has a wonderful and safe holiday season; that you get to enjoy time with people you care about and share joy with all of humanity.

2007-12-06T09:37:00.000-07:00

Christmas is coming
We have our tree up and decorated and my husband has pulled out his impressive collection of Christmas carol CDs. So the holiday season is well upon us, irrespective of the fact that we have not yet started the gift hunting or made a card list. As with most things in my life, this is waiting for the completion of our present course and the latest round of exams.

I am having mixed feelings about this holiday. I am very much looking forward to the break. It will be the only one we have until X-mas 2008 and (so far) our social schedule is under control. There will, or course, be the frantic effort to catch up with friends and all the chores we have been all but ignoring but I should still have a little extra time.

So what is the problem? right?

Extra time is a med student's (at least this med student's) greatest enemy. As soon as there is a space in my schedule I think of all sorts of things to fill it with, re-over-commit myself and end up feeling like a failure when I can't get everything crossed off my to-do list. So far, in my 5 days free I have already scheduled 2 days of shadowing, promised to start cleaning out the basement and resolved to get ahead on a research project; this on top of Christmas catchup and chores I mentioned above. I will also, inevitably, spend a morning or two sleeping in, because I have earned it gosh darn it!

So I am setting myself up for regret. My Christmas hang over probably won't have anything to do with eggnog, too many trips to the goodies table or my VISA bill, but instead will live on as a list of unachieved goals that will hang around for a couple months until I finally give up.

2007-11-30T19:07:00.000-07:00

What's my pathology
Any time I do a personality test, whether it is that introverted/extroverted/feeling/reasoning test (what is it called?) or a "Are you a bitch or a pushover?" test from a magazine, I always end up somewhere really near the middle. Right in the middle of the square or under the "you know how to make your feelings know without pissing off your coworkers" category. I used to think that it was because I was balanced and mature. Now I am not too sure.

I am starting to think that I fall in the middle because it is the average of a bimodal distribution. I am pulled by two extremes of my personality. Sometimes I wish I was reading the complete works of Shakespeare aloud on the bus. But at the same time I wish I was sensible enough to drink 8 glasses of water and go to the gym for an hour every day. In the end I am neither as eccentric or as practical as I would like to be. I am somewhere right in the middle.

2007-11-25T22:02:00.001-07:00

One of our second year courses requires that we do 40 hours of clinical experience and write about some of the cases we see. I chose to do one of my clinical experiences in rural emergency
so I spent this last weekend in a rural emergency. It was great experience. I hesitate to call it fun, but it really was. The town is pretty small but they have a pretty big catchment area so everything from croup to motor vehicle accidents come in on the weekend.

I arrived at the hospital on Friday evening to pick up a key to the student housing. The emergency was pretty quiet at that time so I went to get settled in and find some dinner. When I arrived at the hospital the next morning the big talk was all about a case that came in at about 11pm. Patient came in GCS4, blown pupil, aspirating vomit; with no known cause. And I guess things got worse from there. They had 4 doctors, a resident, a med student, 3 ambulance teams and 4 nurses involved.

I was really jealous. If only I had been there a few hours later.

Usually I can honestly say that I would never wish anything bad to happen just for my own learning sake. But I do really wish I had been there. I think the reason is that the patient has died in every real code I have been involved in. I am about 0 for 5 now. This guy was about as bad as they come and last I heard he was stabilized in ICU in the big city. I guess I want the rush of feeling like I really helped save a life. It may be horrible and selfish but I want someone on the brink to come back for me.

2007-10-25T10:01:00.000-06:00

The arrival of Halloween (and Christmas)

I started noticing this week that I am waking up, stepping on the train, walking into the medical faculty, leaving the faculty and coming home, all in near or complete darkness. I am a child of my environment, and this annual inevitability always gets me down. To counter my drop in sunlight induced serotonin I have increased my caffeine intake and returned to yoga. The sum of these factors leaves me tired, jittery and stiff this morning.

Yoga was at our new and shiny fitness facility at the health centre last night. As I left through the large atrium that connects the old and new buildings, I noticed a fluttering, flying animal swooping through the atrium. Sparrows are pretty common self-imposed indoor aviators, but this was larger and creepier. It was a rather angry bat. I thought it was fitting for the season.

This morning I woke again feeling like I had just returned from a trans-oceanic flight and should be asleep for another three hours. After dragging myself through the regular morning routine and checking the temperature (1 degree Celsius; not bad) I stepped outside. Everything was covered in crusty white snow. Merry winter!

2007-10-19T10:09:00.000-06:00

I managed to get though Course 5. Course 5 is largely neuro and I have completed a Masters in neuroscience. You might think that this would put me at an advantage, and it probably did. Unfortunately it also gave me a false sense of security. My thesis was on learning and memory, which has almost nothing to do with the neurological diseases we learn about. Three days of studying after skipping most of the lectures, was not enough to feel comfortable with the final exam. Apparently I picked up more than I thought hanging around neuro labs for two years. I passed with no problem.

Now we are in Course 6 - Child and Women's health. A very different course from Neuro and aging. The course is run different, the patients are different, the health care workers are different, the attitude is different. But the most interesting difference to me is how much more opinions, and I would even say politics, play into this course.

All medicine has some aspect of "art" and we can't base everything on evidence, partly because we just don't know enough and partly because we are dealing with individual human beings and each one is unique. But I find it intriguing how often people (everyone from parents, to prenatal course instructors to doctors) argue their medical points about pregnancy and babies based on feelings or their own personal expectations. Maybe it is because everyone seems to have some. You rarely find someone who will tell you "I think you should have a stroke like this", but just about everyone will tell you how they think you should have a baby. And how you are suppose to feel about it.

Of course being pregnant (or being a baby for that matter) isn't a disease. A pregnant lady isn't sick or injured, but she isn't "normal" either. It is an extraordinary thing that happens everyday. It's a cliche but it is a common place miracle; not something you can say about a lot of other areas of medicine.

2007-09-24T09:32:00.000-06:00

I am well into the new year. In fact our first big test is bearing down on me with a vengeance. But if that was all I had to worry about I would be happy. We recently received the form to choose our schedules for clerkship. I was pretty proud of myself for narrowing down my prospective specialties to just three (emergency, neurology and internal), until I started to contemplate the possible streams for clerkship.

With only 7 months of clerkship before they cut off our academic records for CARMs applications, strategies to get time in chosen fields but also look good during that time, are high on our minds. And, as they like to remind us as often as possible, our class is much larger than the class ahead of us. This is expected to limit our choices and inevitably lead to disappointment for many. (I am in the combined MD/graduate program so my place in the medical class was held for a year. This refrain of constrained resources particularly raises my ire. If they were going to raise the class size why didn't they make sure they had the capabilities to train everyone first. Instead we get 'your class is much bigger', as if this would explain our compromised education. Gahh!)

I am considering letting emergency slip to a distant third just to dial down the stress intensity. I think I am already well placed for either internal or neuro. I feel very behind for making myself competitive for an emerg spot even though I have done some shadowing, a summer elective (in Nepal) and started a research project in emergency.

There is much to consider and only a week to weigh it. I probably shouldn't devote too much energy to it, though. Since my 'class is much bigger than the class ahead' I probably won't get my choices anyways. I should leave it to fate.

2007-07-21T08:56:00.000-06:00

I have finished my medical elective in Nepal. Two more days and I will back on Canadian terra firma. Four weeks went by fast but it has definitely been long enough. I spent three of my four weeks in the emergency department.

Though it is not currently a suggestion that comes up very often, small service charges have previously been proposed in Canada to help solve the problem of our stretched-to-the-limit health services. The theory being that a nominal fee will keep people from going to the doctor unnecessarily and will prompt them to seek out the most appropriate type of healthcare, for example not go to the emergency room when it could wait for a visit to the GP the next day. I have always been opposed, almost reflexively, to this idea. The idea of reaching for your wallet when you get to the doctor's office feels wrong and unCanadian. My experience in Nepal, where people do just that, has demonstrated for me why, even small payments for access to healthcare, are unjustifiable on every level.

The hospital I in which I was located is a not-for-profit hospital in the Kathmandu valley. Because it is a well-respected hospital and the fees are less than many other places, they see many of the poorer people in the area. However, it is in the Kathmandu valley so even the poor people here are better off than others in the remote areas. In the emergency department I saw largely three types of people. The first category were people who had some dramatic acute condition; traffic collisions, workplace accidents, MIs. These people come in and are treated because it is a matter of life and death. If they, or their families, can't pay, they are referred to social work and their fees are waived.

The second group is people that have the money. The fees are low enough that they will make little or no difference in their lifestyle. A chest x-ray is about $3, the price of a nice lunch in a restaurant, so it is no big deal. These are the people that come in when their 2 year old has a low-grade fever and the sniffles for a day; the teenage girl who comes in with menstrual cramps for the past hour. I am not saying that these people do not deserve healthcare, but the emergency room is not the place for it (I believe I mentioned it is cholera season here and the same number of staff has to take care of an extra 20 beds.) However, most of these people seem to have the opinion that they are entitled to complete and immediate attention. It is unusual for someone to wait longer than 30 minutes to see a doctor and if they do there is angry complaining and threats (which I was told are sometimes carried out). In Canada people often wait much longer and, while they are far from happy about it, they accept that the doctors are working away with patients that may be sicker than they are. This type of explanation carries no weight in the hospital I was at. I don't think this difference is due to Canadian politeness or some defect in the Nepali character. I think a big thing that contributes to the outrage from Nepali patients is the cash they handed over to get in the door. The fact that they paid for service means they want to be served and served now. Moreover, they have no compunction in demanding tests or particular treatments. Why not? They are paying for them. It doesn't matter that the chest x-ray for their 2 year old is exposing them to unnecessary radiation or the antibiotics will do them no good, not to mention that they are taking up more of the doctor’s time.

The third category of patients is those that come in because they really really have to. That $3 could be three (or more) days of income for their entire family and they may have to travel a large (i.e. expensive) distance to even get to the hospital. There is an increase in morbidity and mortality from this delay in treatment that only increases the burden on underprivileged families. They have now lost earning potential, especially in the case of long-term disability. But another consequence that I found particularly discouraging is how this emphasizes all other inequalities in society as well. Gender is a big one. Kids too. The sickest cholera patients I saw, the ones that looked like dried up skeletons in renal failure needing an extra dose of luck along with an IV, were young girls from poor families. It seemed to me that people would wait longer to bring in their sick daughters than their sick sons. In economic terms sons are worth more and so it makes sense, on a certain level, that they would be more willing to make the investment. I don't mean to imply that these families are callous or calculating. They are faced with impossible decisions and it is the girls that suffer the most. And don't forget, the people I saw were the ones that made it to the hospital. There are many more that aren't even able to make the choice because they live too far or have too few resources.

It is true that Nepali society is much more stratified than Canadian. The difference between poor and 'middle class' is astronomical. But with wait times and the centralization of services, there are already a number of obstacles to access in Canada as well. There are plenty of families where it is a challenge to make the paycheck stretch across a month of groceries and any extra expenses required sacrifices somewhere else. Putting up any more obstacles for those people disadvantages the most vulnerable and that would as reprehensible in Canada as it is here in Nepal.

2007-07-06T09:49:00.000-06:00

Another week of elective has passed. Well really half week if you take out the two and a half days that my husband and I spent learning about GI complaints from the patient's perspective. With a little time, a lot of water and some help from azythromycin we are back on track.

Last "weekend" (I have been taking Friday and Saturday off though Saturday is the only actual holiday day here) we set out on an excursion through the country side. I have developed a bit of a reputation with my husband for leading him on, what he refers to as "death marches", when we are vacationing. I thought I was prepared with my lonely planet map and description but we still ended up on an uncertain path with a mini-scramble up a steep hill to a nearly un-named town. Eventually we made it to the appropriate destination. He had said he wanted to venture off the beaten track.

While I am a bit of a blonde-haired, blue-eyed anomaly in the urban Patan, I am a near alien walking through the more rural towns a short 45 minute walk away, especially those with no real road to them. People are pretty friendly after a moment of open-mouthed staring. But a person can get used to just about anything, even being a two person parade. I thought I was doing pretty good getting used to the staring, the noise, the crowds, the garbage, the pollution and the lack of order here until Monday afternoon when my husband and I both came down with diarrhea, fever with chills (really bad for him; not too bad for me) and vomiting (just me). The result of some unidentified gastric transgression we had committed the Saturday before no doubt. Nothing makes you homesick like actually being sick.

But I was back at work by Thursday and, feeling a little bit of med student guilt, took today (Friday) off for another excursion). Hopefully this one won't make us pay the same physical price. We had a really good day visiting the Swayabhunath stupa (also called Monkey temple), the National Museum (interesting art, creepy taxidermy and lots of weapons) and then walking into Thamel in Kathmandu. My husband booked a trip out to Chitwan National Park to hopefully see some nature (other than stray dogs and crows).

2007-06-28T06:33:00.000-06:00

I just finished my first week in the Emergency department. I am not really sure how I feel about my day today... I don't know if I was prepared to see so many people die in one morning.

Maybe this is an odd thing to say, coming from a medical student. Death is probably as much a part of medicine as the living, but I must have been expecting this death to come in smaller doses. It was really hot today; combined with it being 'cholera season' and a few chronic illnesses in some susceptible people it was a rough one.

My husband is coming tomorrow so I am taking tomorrow and Saturday (the regular holiday day) off.

2007-06-24T07:09:00.000-06:00

I started at the hospital today. It was wholely overwhelming, but strangely not as much as I anticipated. Since I still find all my clinical encounters overwhelming this wasn't too much different. So far I would say the biggest difference from the emergency expereince I have had so far is that everyone gets less space. As in the beds are really close together. Everything is done in english (orders, charts, etc) except the talking, which, at this point is probably shielding me somewhat. I have been studying the phrase book but I still haven't made it much past namaste and hajur. I attached myself to a first year resident (I can't tell how pleased she was about that) and she was great. All of the residents there were very helpful, if a little suspitious that I was just finished first year, or that there was such thing as a three year medicine program. I learned how to take my own ECG and do a pelvic exam. I saw some regular stuff like cystitis, COPD and pneumonia but also mumps, a partial miscarriage, rat poisoning and cholera. (That is probably the part where I wish I hadn't given my mother this address. It is all good mom, I am being careful.)

2007-06-22T21:33:00.000-06:00

I am now a week into my vacation/medical elective in Asia. It has been a whirl wind up to now. I have started to settle in the Guesthouse that I will be staying at for the next month in Nepal, but I don't think the whirl wind is about to stop anytime soon.

So far my husband and I landed in Bangkok for the vacation part of my time. We went to the grand palace and a couple Wats, got Thai massages (I think this was my husband's favorite part), took a train (and bus and long boat) to Railay beach in Krabi, enjoyed some sun, explored some caves, and flew back to Bankok. We then parted ways and I flew to Nepal.

I am not sure how to describe Nepal so far. I landed at the airport and, after a bit of confusion about my name, found the driver to the guest house. The drive to the guest house was more than chaotic. There seem to be no rules, which seems to be a bit like Nepal in general. Everyone is really nice and seems to be getting where they are going, but with no apparent order. the guide book is not wrong when they say things (sights, sounds, smells) are a bit overwhelming at first.

But my room at the guesthouse is great. Surrounded by trees with a roof top patio and a school on one side. Fairly quiet except for the kids playing during the day and a wedding brass band that played last evening. I am starting to find my way around and really starting to enjoy it here (all 24hrs that I have been here so far). I am going to go exploring a little today and find my way to Patan Hospital where I start my elective tomorrow. All the best.

2007-05-29T12:10:00.000-06:00

It has been awhile.

Not that I haven't had plenty of things to rant about but it is just that time of year. Fatigue and impatience is running high and I am certainly not immune. We are down to less than three weeks until we are released to electives. There is, of course, all the year end projects and deadlines along with the regular course and preparing for the 'summer'. To illustrate some of the frustration: Last week, after having Monday off for Victoria day, we had 8hrs of lecture on both Wednesday and Thursday and then, at an extra lecture scheduled for lunch time on Friday we got notice of a deadline that had past a week before. I can't think of a better way to stress out a bunch of tired med students than to tell them that they are already behind before they even started.

We received another reminder of the deadlines this morning. So, aside from my other work, I have added 'invent time machine' to my to do list.

2007-05-08T16:55:00.000-06:00

It is only Tuesday but I am already sick of this week. Aside from my rapidly decreasing patience, I think I am actually sick; one of those slow irritating colds that make you tired and achey and last for ages. That or my med-student hypochondria has started to manifest in actual symptoms now.

Yesterday was a more eventful than average Monday. It was well summed up with my bike ride home. If you haven't been on the bike paths near downtown at rush hour, you might be surprised at the level of traffic that can be achieved with purely human-powered transport. The path is quite wide but with the walkers, joggers, bikers and roller bladers it turns into a exercise highway. There is even a yellow line down the middle for lanes. I was just west of downtown when I was coming up on a walker. I ran my bell and swerved to go around when I came across another walker coming right at me IN THE WRONG LANE. I swerved around her, just barely, but as I passed she shouted "Bitch" and tried to spit on me. I will assume that she was British, or perhaps from another island country where they drive on the left. But I was still a little upset with the whole encounter. This led me to wonder why it bothered me so much. Nothing really bad happened, there was no crash and I didn't even catch the loogie. So what if she was angry? She was totally in the wrong and there was nothing else I could have done. I guess it bothers me that you can be doing everything right and still get hated and spat on. This is probably a lesson that I should have learned by now. But, like I said, nothing really bad happened so I will just count my blessings and go on thinking that there is some meaning in following the rules and doing what you think is right.

2007-05-04T22:38:00.000-06:00

We finished our first OSCE-style exams today. I wasn't even out of the room (sometimes even as the words were leaving my mouth) before I was mentally kicking myself in the rear for my own stupidity. Needless to say I wasn't very happy with my performance. I think I at least came off as a kind, caring, reasonable human being, if entirely clueless. I blame the endless training to perform well on multiple choice tests. If you give me the option of the right answer I can almost always pick it. I just can't pull it out of the nether reaches of my stress-addled brain when it is actually important.

2007-04-25T13:53:00.000-06:00

Most of the unergraduate students at my school are now finishing up their final exams and moving on to their summer activities. Having worked and then done graduate school, I am used to year long schooling. (Our medical school has class until mid-June and we start up again at the beginning of August.) But it is still hard to concentrate with the weather (finally) getting nicer and the sun shining. To make it worse, all the year long classes are coming to an end. So we have exams without the knowledge that we will be free to enjoy the patios soon.

2007-04-11T16:33:00.000-06:00

All of the things that sit at the top of my to-do list are things that I really don't have any motivation to do. I have found myself reading physiology just to procrastinate stuff I find even more distasteful. So I have started setting things up so that I am forced into deadlines. Like scheduling meetings I need to complete things for or setting up equipment to make myself do experiments in the lab. This has just led to another problem. After even a short time doing only things that I really have to do, I am starting to get resentful and even more unmotivated. In an attempt to prop up my waning enthusiasm for medical school I have made another push to schedule some shadowing. I always feel more hopeful about my new career in medicine after spending a few hours actually talking to patients. While a good idea in theory, scheduling all these extra things is just going to lead to a huge pressure on what little time I have left to finish all those other things I need to do.

So should I buckle down and put real effort into the things I need to do at the expense of my good mood? Or should I do the things I really like to do at the expense of my academics?

When I put it that way it really isn't even a question. I am going to go and call a couple more doctors right now.

2007-03-30T11:04:00.000-06:00

Another systems course down; four more to go. The cardio/resp exam has come and gone and I actually did remarkably well. (The preceding sentence is meant to portray shock, not pride.) I am not sure where the last course got away from me but, with about 3 weeks left in the course, I started feeling like the heart and lungs were some sort of alien forces outside my understanding, outside my control, outside this world. Beta-blockers and agonists are my version of Jedi knights.

We have now started renal. So far I have the tubes and ions in hand, but I don't know how long that will last. I have planned my summer elective in Nepal over our exam rewrites (unavoidable given our schedule) so I have to pass this next course. Hopefully that will keep me motivated. My husband has managed to get 4 weeks off during his busiest time so he can join me. So if I fail and wreck all my plans I am also wrecking his plans for the only major vacation we will be able to have together for the next many years.

Seems hard to believe that we will be off to clerkship in less than a year. The fact that I may be responsible for patients' care is not causing me as much stress as the fact that I have made no progress towards choosing a specialty. Just about everything we have taken so far has interested me. I try to count this a positive because I think I could be happy in many different areas. But it is not helping to narrow things down.

2007-03-20T21:40:00.000-06:00

Two days away from the next big test so, of course, I was looking for something to distract me. It was sunny for a few minutes this afternoon between the hail and the rain so I went for a walk. Springtime (which always comes with a few false starts around here) smells like wet clay and melting dog sh*t in my neighborhood. There is construction on just about every block so I zigzagged my way downtown past all the blockades. I guess I am getting a little nostalgic. The chances are good that we will have to move soon (most likely right around when I am going on elective to Nepal; great timing). After living here for 8 years I am going to miss the park and the restaurants and the people that I am used to seeing. It is funny that, as a teenager, I was so excited to move away from my small hometown to 'the big city' so that I wouldn't be constantly surrounded by the same people. After more than an decade in the 'big city' I find it comforting that I keep running into all the same people. I see the the people that I know from folk fest volunteering at concerts, neighbors at the coffee shop and people from school downtown. I even know who the regular panhandlers and prostitutes are and who is new to town. I guess it is home.

2007-03-08T12:31:00.000-07:00

I spent the morning looking at hearts in the anatomy lab. I was again struck by the paradoxes of the human body. It is so beautiful and intricate and at the same time so crude and mechanical. It is the same thing with disease. I have seen patients with metastatic cancer throughout their body. All the organs invaded, slowly shutting down but still hanging on, sustaining life. And then the next person will have a clot travel to one particular sensitive spot or have a plaque in their heart rupture and they die suddenly, without any warning. I guess that explains why medicine can be so fascinating and gross at the same time.

2007-02-25T23:29:00.000-07:00

This are some of the things I learned this weekend:

If you are interviewing for something:
- do not wear cologne or perfume. As much as you might think that this finishes your look, noone appreciates your chosen fragrance as much as you do.
- do not lie. This seems obvious but you might be suprised how many people say things that aren't even believable.
- if you don't have something worthwhile to say, don't say anything at all. Even if your instinct is to fill up the space, don't.
- don not swear or use racial slurs. Duh.
- do not start making assumptions about the interviewer. Even if you are right, you look judgmental and narrow minded.
- do not cry. As much as the interviewer might be nice about it, they still don't want to console you.
- do not start talking about how badly you are doing at the interview.
- answer the question that is asked.

Even if you are four weeks behind, it still isn't motivation to study for a test four weeks away.

As long as you put enough chocolate in a cake, everything else can go wrong and it will still taste good. Especially if you eat it with friends.

2007-02-10T00:31:00.000-07:00

I don't expect every opening band to be worth the price of admission but I also don't think that they should be punishment for coming unfashionably on time. My advice to you, if Matt Allen (I believe he is from Lethbridge) is the opening act come late and stand at the back if you have to. Your sore feet are small price to pay for saving yourself the pain of having to listen to his set.

Ooops, that sounds bitter and judgemental.
I am sure he is a perfectly nice person if you take his guitar away from him.

2007-02-06T14:01:00.000-07:00

I have not posted lately because I am attempting to be be less cynical and judgemental as I speed my way to the big 30 milestone. Everything I consider posting just sounds bitter and judgemental lately (for example why is it that medical students, a group of people that all profess to be concerned with helping mankind, can only do generous things that will be put on a resume or CARMs application or used for class credit?) so I have been practicing the Thumper 'if you can't say something nice don't say anything at all' philosophy.

One thing that has come up for my consideration this week is what it is to be a Standardized Patient.

We learn physical exam in groups of 5 with a clinician preceptor (we are assigned 2 that we alternate between) and a SP in the medical skills area that is set up like a clinic. Both of our preceptors are rheumatologists and excellent teachers, but that is where the similarities end. On Monday we had a session with preceptor one. She is a pediatric rheumatologist; warm, exuberant and eternally sensitive. We had a great session, if a little superficial in content, with a youngish female SP where we spent a great deal of time doing respiratory exam. Thoughout the session preceptor one talked directly to the SP, made sure she was draped properly and at the end asked how the session was for her, if she had been comfortable. It was a comfortable experience for everyone.

On Wednesday we had a cardiac session with preceptor two. It started out badly; two of the people in my group and the SP were late because the roads were terrible. It went downhill after that. The SP turned out to be a rather larger young woman. The preceptor had requested a male but the med skills, for good reason, do not honor these requests. We are just as likely to get a female on our exams and need to learn how to do cardiac exam under all circumstances in practice as well. The preceptor was at all times respectful, but far from sensitive. Because of her extra girth we could not see a JVP, feel a PMI and hearing heart sounds was even difficult. It was an uneasy experience for everyone. I, and all the other members of my group, tried to make her feel as comfortable as possible, but our preceptor was evidently disappointed that we didn't have a better subject.

One of the people in my group later commented that he couldn't understand why she would subject herself to the experience knowing that she would be exposed and examined given her extra weight and that she was so obviously uncomfortable. I think that a great deal of the situation would have been diffused if the preceptor had shown sensitivity to the degree that preceptor one had demonstrated. On the other hand we practice on SPs for a reason. They are not in the vulnerable place that real patients are; they are not sick, they are not depending on us to fix them or give them answers. They are being paid to be there so that we can use them as living models. However, we are also learning to be physicians and demonstrating respect for the people that are in our care is a really big part of our training. We can't start thinking of our SPs as meat puppets rather than as people or we might be tempted to think of or patients as a collection of symptoms or diseases instead of people as well.

2007-01-23T22:24:00.000-07:00

I just got back from seeing "Pan's Labyrinth". It was quite good (with some fairly gruesome minor surgery scenes) but I am writing about about the people who sat in front of us. The group was, by our guess, a pair of middle age parents, a daughter and her boyfriend. I initially thought that the reek of booze was spillage on my husband's jacket from his last trip to the bar. But it was soon apparent that they were accompanying their movie with a beverage or two. The boyfriend left, sometime around the boogey man scene, and the rest of the group managed to drink themselves into an incoherent, but loud, mess by the end of the movie. While I enjoy a drink now and again, I don't really understand going to a subtitled historical fantasy/war movie to get hammered. They could barely make their way out of the theatre. It seems like an odd thing to do while at a movie with mom. I spent Monday morning shadowing in the inpatient psych ward at the hospital. Maybe it says more about me, but some of the psychotics actually make more sense to me than the 'normal' people I see all the time. I can understand that, if you honestly believe it is your job to receive signals for the armed forces or spirits are coming through the walls to get you, you could get paranoid or violent. I don't understand people who risk their life acting like an idiot in traffic just to wait two cars ahead at the light. Or spending $50 to sit in a movie, drink out of a flask and talk about your dog.

2007-01-16T22:10:00.000-07:00

Some times I feel like I am propelling myself through my day. All my strides are long and purposeful, like I know where I am going and how to get there. I can accomplish what I am setting out for. I am the powerful, confident overachiever that I would like to be.

Other days I feel like I am being dragged from place to place, from task to task. Anything I accomplish is drawn out and painful. More the petulant three year-old that would rather sit at home and watch cartoons than follow their parent around the supermarket.

I am definately in the toddler stage this week. I haven't done anything except the very minimum. I should be reading and learning and staying on top of things but, knowing that I still have months before I am going to be tested, I just don't wanna.

2007-01-14T22:38:00.000-07:00

I think my life might be a little off kilter. I had dinner at 4pm tonight and happened to be talking to an old friend of mine who wondered when I had turned 70 and started having dinner in the middle of the day.

Well, the reason I was having dinner so early was so that I would have time to go grocery shopping with my husband and then drive me up to the North East to pick up my car and still get to curling on time. My car was up in Hawkwood because I went to a Ukrainian New Years Eve party and ended up having too many martinis to drive home. My friend makes them with peach schnaps, vodka and cranberry juice so they taste like candy but knock you on your ass. I had to drive to the party because my husband was in Olds to attend a memorial service for an old instructor of his. I would have taken transit instead but I had to go out to the North East before the party to pick up my father-in-law's drycleaning that he needed because he was going to drive to Omaha. My sister-in-law had been in another car accident and her parents thought that she would need their help. Turns out she is fine and noone is going to Omaha in the near future.

To me this sounds like a bad idea sit-com episode. I guess random is better than boring.

2007-01-10T23:24:00.000-07:00

I went to a symposium tonight where 4 women doctor's gave talks about their career experiences. What I learned is that everything (stress, pressure on our time, demands from other people) gets harder from here, and then it gets even worse, and then it gets a little bit better. So, if I want to have kids before I am 40 I better do it now. From the stories I heard, I would be lucky to write a licensing exam while 9 months pregnant. It gets much worse.
I came home and told my husband this. He is 9 years older than me, so if I wait until I am 40 to have kids he will be almost 50, and that scares the crap out of him. Don't tell me men don't have biological clocks.

2007-01-03T11:26:00.000-07:00

I keep meaning to write something lengthy, significant and well thoughtout for the new year. But either something more important eats up my time or my mind is tired or empty. So I write with nothing more important to say than I am back at school.

I am still sitting on a mountainous list of things that I meant to do over the holidays so I have been thinking a lot about resolutions. I tend to make resolutions on a daily basis, which tend to run along the lines of "Tommorrow I will do better. Tommorrow I will have more energy and be more focused. I will get done more things on my list, especially a couple of those things I really don't want to do. I will be more clever, less bitter and nicer. Tomorrow I will listen to more music and exercise. I will do my makeup, eat breakfast and wear clothes with no wrinkles. Tommorrow I will be prepared for class and will really listen. Tommorrow I will be do better."

Being a new year and the traditional time for reflection, I have been thinking that I should make a resolution I can actually keep. Something that won't leave me with that feeling of guilty failure by mid February. I first considered some specific things, like I will go to the gym in the morning (there was a time in my life that I exercised every day between 6:00 and 8:00am) at least three times a week or bring my lunch from home at least four times a week. Luckily a little self realization shone through and I have cast this aside. Then I was thinking of making more of a general 'change in outlook' resolution; something like trying to judge people less, or not doubt myself so much. This would at least be vague enough that I can't exactly break the resolution, but I don't think trying to change my personality is setting myself up for success.

So I am taking my husband's advice and my resolution for the new year is to eat poutine once a month. I love poutine but I never allow it to pass my lips because of nagging considerations of my underexercised waist line. I guess you could say I am making the anti-resolution but at least I will avoid that episode of February self loathing.

I hope everyone has a very happy New Year.

2006-12-13T07:53:00.000-07:00

Just a few words.

The focus of my life for the past couple of weeks has pretty much narrowed to studying, so I have not had anything interesting to say recently. With three days left until finishing my tests and starting holidays I certainly don't have anything more interesting to say now (I have spent the past three hours in the anatomy lab, poking through pro-sections while listening to the Stephen Lewis Massey Lectures and it has left me in a strange sort of mood) but I thought I would at least let the faceless masses know I am still here. So I face another day of trying to cram my head with knowledge; armed with TIm Horton's coffee and hope that in some small way I might be able to make the world suck just a tiny bit less, if only I can pass this next set of exams.

But right now I think it is time for a nap.

2006-11-28T16:19:00.000-07:00

It is day four of sub -25 degrees. You might think that I am harping on this weather thing a bit too much, but then you aren't here. It was -30C with a windchill of -41C when I left the house this morning. So, if you haven't been in this kind of weather before; this is what happens when it is -30.

The furnace runs all night even though you turned down the thermostat to save fuel and you are sleeping under three comforters to keep your feet warm which are so heavy that you can barely turn over.
There is nothing for breakfast because you haven't been to the grocery store even though it is only 5 blocks away because your car is buried under a foot and a half of snow and needs to be plugged in but walking that far with groceries means the fruit and vegetables and milk will freeze.
You shower in the hottest water you can stand because you don't know when you will be that warm again and dress in three layers with the extra fuzzy socks even though it feels stiff when you sit down (and feel grateful that you don't have to see patients today because then you would have to try to hide long johns under dress pants).
There is no point in making coffee because, even in a thermal travel mug, the coffee will be cold by the time the train comes.
The trains are late because people don't want to drive on the icy roads or their cars won't start and some of the doors won't open because they are frozen shut so everyone in the overly-crowded car has to file out of the end doors.
The busses are late and the shelters are full so you are standing in the wind pacing back and forth so your feet won't freeze which they do anyway despite the winter boots.
The snot freezes your nose to your scarf and your eyes are streaming with frozen tears and your rings feel tight on your hand and you feel horrible for the teenage girl who doesn't have a toque and is turning from red to blue.
The battery on your iPod dies in 20 minutes and you watch dies and your cell phone makes a funny noise when you dial and you realize that maybe you should have left your laptop at home today.
You get to school in double the time it normally takes and half the group isn't there and everything starts late but you still have the same amount of material to cover.
It is dark when you go home where you fight through the same crowds and you see the lock is broken and won't open and you go to the mediocre restaurant nearby for dinner and their furnace is broken so you eat your mediocre dinner in your coat.
You are exhausted and you still haven't done any studying today.

2006-11-25T11:19:00.000-07:00

I have bad circulation. As much as I would like to think that I am a tough Canadian that can brave the cold, if I am outside for more than a few minutes my fingers go from burning to numb.

Maybe I should fill in some details for those lucky enough not to be living in a deep freeze (actually my deep freeze sits in our badly insulated back room so it is probably warmer in my deep freeze). CBC is reporting a temp of minus twenty one with a windchill of minus thirty. That is celsius if anyone is reading from the States, not that it matters when it gets this cold. Usually when it is cold in Calgary you can count on it changing before you get cabin fever but they keep pushing any sort of reasonable temperture to the end of the five day forecast.

The good news is that now I don't have anything else to do but study.

2006-11-19T18:01:00.000-07:00

My non-medical friends have now decided that I am definately weird. I spent 4 hours shadowing at an urgent care facility downtown; not a place any of them would chose to spend a Saturday afternoon. It was the best time. I have so much fun. And great motivation to get back to the books and fill in some of those knowledge gaps. It was not really busy, being a weekend and fairly early in the day, but the range of cases and patients was still amazing. It also helped that the doctor I was shadowing was awesome! Definately what I want to be when (if) I grow up. He is a family doctor that has done quite a bit of emergency and is now moving to doing exclusively urgent care. I am trying not to jump too quickly to a decision. I still have lots of time to decide a specialty and there is still lots of things I haven't learned or seen. However, based on my short experience yesterday I would sign up to do that everyday.

2006-11-15T17:18:00.000-07:00

I think I might be over volunteering myself. I am double booked at 8 in the morning. Perhaps this is not that early for clerks or residents or surgeons, but for someone who is still recovering from a grad student's schedule having anything more strenuous than sleeping on the bus or drinking coffee is pretty jarring at 8am. Committing myself for meetings this early must be a clear sign that I should restraining my right arm, the one that seems to keep popping up everytime someone asks for help with this project or attendance at that event.

2006-11-14T09:06:00.001-07:00

It is Monday morning after a long weekend. I dragged myself out of bed, across the snow to the train, and actually made it to school in good time for my first class. But, having shown up (half the battle I am told), I couldn't actually stomach sitting in lecture. So I grabbed a coffee and vowed to go through the lecture notes on my own. Instead I am blogging.

My husband registered his illustration business name this weekend. It is Expeditus Illustrating. Expeditus, by my husband's telling, is the patron saint of procrastination. Moreover there was probably never a real Expeditus, but rather the remains of a nameless saint that were marked for quick delivery. I am not sure what he is trying to say having a fake procrastinator as the name of his business but it is still an impressive sounding name.

I have 8 hours of lecture today. The first 2 hours have been designated for occupational safety and how it relates to MSK health. I spent the last three days with family, friends and heaps of food, so part of my justification for skipping class is that it would be more useful for me to review the anatomy that I was suppose to have learned last week. My older brother was married on Sunday so there were people in town and all those little errands to run that go along with large family events. As much as I resolve to get work done my will power is no match for a dinner or coffee or drink out with pretty much anyone. As a result I managed to get almost nothing done in a full three days. I have the next hour to make up for it.

2006-11-06T16:17:00.000-07:00

Two AV guys and blank blue screens. Never a good sign at the beginning of lecture.

We reached our last full day of dermatology lectures today. After working through most of the rashes and blisters it was scarring and burns. These were our first lectures given by plastic surgeons rather than dermatologists. We don't get many lectures from surgeons, which is a shame because they tend to have the best photos. Which brings me back to my fascination with gory pictures. I know it sounds insensitive but the grosser pictures definitely keep my attention. Perhaps I should take up some extreme sport to get my kicks instead.

The most extreme sport I am presently doing is curling. I know most people think of curling as more of a senior's past time than an extreme sport but those people have not seen me on a pebbled sheet of ice. With my level of grace and balance stepping on to frozen water with teflon shoes is definitely enough to get the heart pumping. One of the best things my parents ever did for me was judo lessons. In judo they spend a long time teaching you how to fall without hurting yourself. It is probably the only reason I have, as yet, not received any sort of traumatic brain injury.

2006-10-31T09:25:00.000-07:00

With 6 hours in I am enjoying derm lectures considerable more than I expected. I guess my claim that I am a visual learner might actually be true. Definately gross; I have been scratching my head constantly since yesterday afternoon. It could also be that the faculty has recruited more entertaining lecturers, at least for the first few lectures, because they realize that the vast majority of us are not clammoring to learn derm. Regardless of the reason, so far so good.

I am not sure if this honeymoon period will last. There is much less small group or interactive learning in this course compared to the last. I can see that being a problem for me. Hint - I am writing this in lecture right now. Even with a tonne of pictures I don't think that I can maintain attention sitting still for hours on end without even getting up to walk to another room. Apparently they are blaming 8 hour lecture days once or twice a week on our Christmas vacation. I feel like I am back in the corporate world, where people don't take vacations because they know that they are going to have to make up every moment of time they take off. I think it is time to skip out and get a coffee.

2006-10-29T22:42:00.000-07:00

With our first class finished it is about time that I got back to blogging. However, I don't have very much to say now that I am between classes. We start skin, muscular skeletal, and sensory tomorrow. I doubt that any of these will end up being subjects that I can get really passionate about but it is nice to have the chance for a fresh start. Like any fresh start I am making all the extravagent resolutions thus associated. I will stay on top of the reading, I will make summary notes every day, I will do extra shadowing in the area, then I will solve world hunger and write an opera. Oh well. Hopefully I will at least learn from the mistakes I made in the last course and improve on them. Time to move on.

2006-10-17T17:06:00.000-06:00

I should be journaling for my culture, health and wellness class. Tomorrow we have a session on immigrant and refugee health and wellness and we are suppose to journal our feelings and reflections before and after the class.

I generally have mixed feelings about our 'softer' courses. While I think the purpose of them is entirely useful, practical, admirable... the application is almost always annoying. Maybe it is because these classes tend to be haphazard and unorganized. The 'message' is usually lost in the mayhem.

I think the most annoying thing is that, unlike our other classes, there seems to be little acknowledgement of the variety in the class. They assume all of us are at square one, which I find odd since one of the criteria that they use to choose students is past expereince volunteering in a variety of things. They know that most of us have travelled and had experience with people in different settings but then treat us like we haven't left the city before. The result of this underestimation is that all of the discussions are pretty superficial. There is always a 'message'. Instead of a complex discussion the classes resemble fairy tales where we are suppose to get the moral. The result is tiresome; exactly the waste of time that proponents of the all hard science and practical skills curriculum claim.
Or maybe I am just starting to freak out about our first certifying exam and am mad at any distraction. 8 days and counting.

2006-10-10T20:11:00.000-06:00

I have been pretty negligent in my posting so thank you to miette at Running with Scissors for tagging me and thus prompting me to write again. So here we go - 20 random things about me.

1) When I was a kid my favorite place was a big old poplar in the middle of a field about two blocks from my parent's house. The town I grew up in was pretty small and we lived near the edge. There were cows half a block to the west and a wheat field two blocks to the south. The tree grew along a branch of the irrigation canal and was great for climbing. During the summer I would crawl up onto the thick branches; read, hide and stare through the leaves. Occasionally I would nap, probably not the best idea 10 feet up.

2) I am in the middle of reading about 4 books. Two I started during my honeymoon last December, one I started about 3 years ago shortly after I quit my job and went back to school. The other one was cracked somewhere in between.

3) My favorite colour used to be blue. If I was forced to pick a favorite now it would probably be green.

4) I hate picking favorites. I think my mood is too changeable to pick a favorite anything that would suit all occasions.

5) I was married one year and 2 days ago. We celebrated our first anniversary in Lake Louise.

6) We have two cats. My husband named the first one Mattisse because she likes to play with paper. I named the second one Findley after Timothy Findley because he is a dignified older gentleman. He is sleek but a little over weight.

7) I have lived with my husband for 7 years, 3 years longer than we have been a couple. We managed to stay roommates across the hall for that long before fate, in the guise of an open bar, brought us together.

8) I don’t believe in fate.

9) One reason I quit my job was because I kept picturing myself trying to explain to my future grandchildren why I worked for an oil company, something that I hope will be considered reprehensible and archaic by the time they ask me what I did with my life; like anchormen smoking during newscasts or child labor (if only there wasn’t still child labor).

10) I always jump at the cheap scares in horror movies.

11) I love the podcasts Wait, Wait Don’t Tell Me by NPR and This Week in Science.

12) I really don’t like Facebook. I know that I risk the cold shoulder by slamming such a massive and popular web 2.0 phenom, but everything about it just drives me nuts; the design, the function, the useless chatter. I also don’t like MySpace.

13) I am a pretty good cook. At least that is what my husband tells me. My specialties are anything with lamb, a 20 min meal from whatever is left in the fridge and BBQ ribs.

14) I am way more attached to my laptop than I thought I could be to any material object. It is probably the only thing that I would be truly devastated to lose. Which is bad considering it will probably self-destruct in less than three years, or at least be horribly outdated by then.

15) I drink way too much coffee, but I think that is hereditary. My parents both measure their daily intake in pots, not cups.

16) My optimistic naïve side thinks that most of the problems of the world could be resolved (or at least made a lot more manageable) if people spent more time thinking about the consequences of their actions on other people.

17) The worst job I ever had was house painting during the summer between highschool and first year university. For some reason, I was always sent up the ladder to do the highest parts. I think the manager thought that, since I was the smallest, I wouldn’t fall as hard. His math was faulty in general. He always underbudgeted the jobs so we usually made about 3 dollars an hour.

18) A friend of mine made up a 'punch list’. The punch list is three people who you would want to punch if you ever met them. Once they are on the list you are obligated to punch them if you do meet them (which led to an awkward situation between Alan Rock for one of our friends). Ralph Klein, Dick Cheney and Jeff Collins (the CBC afternoon guy) are on my punch list.

19) The farthest from home I have ever been is Thailand.

20) I jumped into medicine with both feet not knowing if I would like where I landed. I can't say that I knew enough about being a doctor to really be prepared for all of this. Thankfully I am enjoying med school even more than I thought I would. I am particularly enjoying communications and anytime we get to go talk to real patients. I am hoping that is a good sign.

Now to pass along the tag. I pick Anna, Tall Medstudent and sparkydoom.
Have fun.

2006-09-21T22:27:00.000-06:00

I hate housework. I am not sure if it a cause or an effect of my hatred, but I am also very bad at it. Don't think that I live in pig sty or anything. I still pick up the broom or windex when it is called for but it makes me angry every time. In fact, I think cleaning is the only thing that I do regularly that I am truely horrible at. But there are still month-old scuff marks on the limoleum that I can't get off with any amount of scrubbing and that tub ring mocks me every morning.

Of course everything else must be going pretty well in my life if this is the only thing I can think of to complain about. Have a great, cleaning-product-free, day.

2006-09-18T08:30:00.000-06:00

On Friday we had our first 'formative' exam (monitored by an invigilator no less). It you don't know what they mean by formative you’re not alone. My favorite definition of formative is - forming or capable of forming or molding or fashioning. I could use some fashioning. Or at least some new shoes.

Anyway, it was a test that was formatted just like our final (or summative) exam with representative questions but doesn't contribute to our mark. It was a good judge of how we are doing so far. Except I already knew that I was very far behind because I have been working on some papers for my lab that have held over from my Masters, so for me it was mostly just a kick in the teeth. Probably a kick in the teeth that will be good for me in the long run but I am still a little bruised right now.

We also had clinical correlation on Friday. As always, it was the best learning experience of the week and provoked issues that I wasn't expecting. Specifically the issue of consent and the doctor - patient - student relationship. We have examined one patient that was alone and had ascites and encephalopathy from chronic liver disease. We practiced shifting dullness, fluid thrill and palpitation. Though we repeatedly asked permission, she was obviously in some pain and was having difficulty talking. I doubt she understood all that was going on even if she did know what she was agreeing to.

Another patient we visited (on a different occasion, with a different preceptor) was an older gentleman that was being visited by his wife. Though there was no issue of reduced capacity, it was clear from the interview that they did not know how the many tests were going and were hoping for some answers, even from us. The wife thanked me for coming and helping. I had to explain that we were students and not in any position to give her information. That we were there to learn. This took me aback because I thought our preceptor had explained this to them. All I could hear coming out of my mouth was 'No, we aren't here to help you. We are here to take from you and give you nothing in return." I know this isn't entirely true; that we have to gain experience and knowledge so that we can help other people later. It just feels a little too easy justifying our actions in the name of education. Maybe I am a too prone to obsessive self reflection but I feel like part of learning to be a doctor is examining how our actions have an effect on the people we are lucky enough to call our patients. The reason that clinical corre. is such a good learning experience is because we get to see actual people, not just study cases. If we can't see them as people and think about how we are affecting them then we are losing out.

2006-09-06T20:16:00.000-06:00

It is always a good idea to count to ten and take a deep breath before blogging. If I had written this yesterday it would have been a much different post.

Yesterday we were had our first liver lecture. 8 hours of liver lecture. Aside from the very questionable practice of trying to cram info into malleable brains for 4 hour stretches, many of the lectures were of questionable value. I am not an expert but in my mind it makes sense to talk about the anatomy and function first, then the problems, next how to diagnose and measure the problems and then treat it.
Our agenda: First there was a lecture on physical exam to determine liver disease, then there was a lecture on laboratory tests for liver disease, then a lecture on all the different problems of the liver. A one-hour lecture (with 159 slides) on all the different liver problems. I think it was a record. After there were other lectures on individual diseases. It was mostly incomprehensible. By the end of the day I wasn't just exhausted, I was angry.

Last week were told that 70% of medical students were offered only one spot at a school. The implication being that most students do not have a choice. I don't mean to brag, but I did have a choice and yesterday I was regretting it.
Today was a different story. We again had 8 hours of scheduled time today but it included everything from small group discussion of cases, lectures and practicing of communication skills on standardized patients (actors). Predictably, my interviewing skills are very rudimentary but our preceptor (a family doctor from the community) was great and the patients were really helpful. Even on a fake patient playing doctor was exhilarating. I definitely didn't regret my choice today.

2006-09-01T23:48:00.000-06:00

I have never been so tired after an 18 hour day before. I don't know if it is the continuing chaos of our ever changing schedule, waking up early for a full 5 days in a row, two late nights of studying earlier in the week, the last two twelve hour days at school, running all over the school and then the city today or the incredibly exciting/stressful experience of talking to actual patients this afternoon. We had our first clinical correlation today and saw two people with different blood diseases. It was great to actually see people and not just cases for a change. I am going to bed now.

2006-08-28T16:30:00.000-06:00

Not your garden variety infected anal gland...
Claimed and proven today - gastroenterologists are very desensitized. Uninhibited in the words of our lecturer. I have certainly never seen so many pictures of diseased anal orifices; and all before lunch.
One of my classmates found this concluding the entry about Gas / Eructation, Flatulance on the online version of the Merck Manual at merck.com

"The following piece appeared in the Gastrointestinal section of past editions of The Merck Manual, and is being reprinted here because of reader demand.

Flatulence, which can cause great psychosocial distress, is unofficially described according to its salient characteristics: (1) the "slider" (crowded elevator type), which is released slowly and noiselessly, sometimes with devastating effect; (2) the open sphincter, or "pooh" type, which is said to be of higher temperature and more aromatic; (3) the staccato or drumbeat type, pleasantly passed in privacy; and (4) the "bark" type (described in a personal communication) is characterized by a sharp exclamatory eruption that effectively interrupts (and often concludes) conversation. Aromaticity is not a prominent feature. Rarely, this usually distressing symptom has been turned to advantage, as with a Frenchman referred to as "Le Petomane," who became affluent as an effluent performer who played tunes with the gas from his rectum on the Moulin Rouge stage."

2006-08-27T20:08:00.000-06:00

The curriculum at the University of Calgary, if you don't know, is systems based. After a breeze through fever, sore throat and otitis media we are well into the new combined blood and gastrointestinal unit. This is the result of a reshuffling of the curriculum that took a couple smaller individual systems and combined them into bigger courses. Which means right now we, the first year class, is taking GI before the second years have. This is the only explanation I can find for a couple of incomprehensible lectures last week. There must be a couple of lecturers that are used to giving their spiel to students already 16 months into med school, not three weeks. Whatever the reason, the result was a lecture that might as well have been in Spanish for all I understood. It was probably a good thing because, for the first time, I am honestly scared, always a good motivator for getting your butt in gear for studying well ahead of the tests. With the longer courses we don't have one that counts for anything until well into October. I have a feeling my usual cramming won't be appropriate.

2006-08-15T20:30:00.000-06:00

Most of our lectures so far have been pretty interesting but today we had an introduction to pharmacology. Despite the fact that it was 4 hours long (I think I now have a suggestion if George W was looking for a different method of torture to get around all those pesky rules and laws; something involving 130 people overcrowded in a overheated room with only really bad coffee available), I stayed awake and even alert. It helped that the lecturer is a researcher with an office right across the hallway from my lab so I had the added motivation of personal embarrassment if I dozed off. But it was also very interesting, not nearly as dry as I was expecting. I think the thing I liked the best was that it provides a whole different view of the functioning of the body. It has always fascinated me that a lot of what we know about the physiology of depression came from figuring out how the drugs that relieve it work. The lecturer also gave a little talk about the advertising and drugs. I had given some thought to the good and evil of advertising before but I think I was underestimating the patients. The argument in my mind was mostly whether the patient asking the doctor for these drugs was good because it is an opening for discussion or bad because it might pressure the doctors perhaps leading to over or inappropriate prescribing. Another potential problem is that an over-exposed, over-cynical patient population might become skeptical of drugs that had been advertised and even spread this skepticism to all prescription drugs. The thinking being that the prescription has more to do with profits and free golf trips then their well-being. I should have thought of this as well. I have a friend that believes all of the concern about avian flu is a political manufacture perpetrated by the Bush government to maintain hysteria while deflecting attention from the war(s) in the Middle East.

2006-08-10T09:20:00.000-06:00

It is now the beginning of day three and I was just about to edit my previous post. But in the interests of being accurate I will just admit I was wrong. The school stuff is already drowning me.

I am still attributing the majority of my confusion to the fact that my schedule is chaos. I am never entirely sure where I am going or what I am doing or how that is going to change an hour from now or if there is anything I should do to be prepared for the next hour or the next day. However, this I share with the rest of my class. We end up searching through the many different printed schedules we have so far received and then following each other around like sheep. We have been promised that this will all be sorted out when we receive our palms and the schedule is on the internet information system. Which will happen sometime in the next 1-3 weeks.

It is somewhat comforting that we are all in this confusion together. The case is not the same with the lecture material. I was right in there with the first lecture. Delivered by one of the neuroscience faculty about thermoregulation in regards to fever, I knew almost all the terms and could follow the flow well. The next lecture was basically on immunology, my understanding of which was (or should I say is) at about a junior highschool level. It was an excellent REVIEW lecture for most of my class. Not so for me. I am off to do some reading.

2006-08-08T19:56:00.000-06:00

My first day of classes came to a close a few hours ago. It was quite a relief after three days of orientation last week. I would be the first admit that I am not one to go for large shows of group devotion but it wasn't too bad. The get-to-know-you events were fun and some of the sessions were informative. By the end, however, the whole thing got a little too tribal for my tastes. Most of the people in my class seem like really interesting, smart people but I can' t buy the repeated assertion that we are all so 'special'. There are lots of great smart creative caring people out there that aren't medical students. Some of them, god forbid, aren't even in healthcare. And I understand that bonding with our classmates is important so that we can help each other out during the intense workload ahead but I resent the implication that we all have to be 'pals' to do it. Often it is easier to work effectively with someone you aren't sharing drinks with every other night. All in all I think that I can adapt to the social aspect of med school. At the moment I am more than a little overwhelmed with the actual school part of medical school. But I am sure that will pass with a little time as well.

2006-08-01T12:35:00.000-06:00

I am now a day away from being a medical student (barring some confusion over my registration). I am surprised to find that I am actually nervous. Despite the gruelling first day orientation schedule including nothing more daunting than meet-and-greet, lunch, a tour and a sophisticated version of a pep rally, I have butterflies in my stomach.

Oh yeah, there is also a pub crawl. Aside from the fact that it has been many years since a pub crawl actually sounded like a good time to me, I spent three days this weekend partying until 3 in the morning at the Folk Fest. I don't think I am up to a night of drinking with a bunch of type As a good 5 years my junior. At my (slightly) advanced age a pub crawl translates to a good chance to people watch at best, and a long night of babysitting at worst. I think I will drag my husband out to the evening of learning what life as a medical is like. We can be the jokers making wise cracks at the back of the class. Just because I am 'mature' doesn't mean we always have to act like it. That practically sums up why I married him.

2006-07-25T09:00:00.000-06:00

My lovely husband has lent me his anatomy colouring book, a souveneir from past days in art school, to help in my medical school preparation. I am not sure that I am learning anything but it makes for a good relaxation tool.

Speaking of my lovely husband I have been getting a strange reaction as a new married female medical student. I guess it has always been around but it seems to be more prevalent now that orientation is looming. It seems like the general feeling is a profound sympathy for my husband for being hitched to someone who has decided to leap back into school for another 3 years of overeducation, combined with suspicion that the act of hitching was motivated by the handy financial obligations that come along with the 'in sickness and in health'. I was told yesterday that my husband must be a very understanding man. In this case I am not sure that the 'understanding' extends to 'letting' me go to school or by letting me aspire to have a career at all. I know that I am awfully insulated but I thought people would think that my husband would be lucky to be married to a smart ambitious person that is choosing to use her talents to help people. This is definately not a universally help opinion.

I am not usually privy to these discussions but my husband has been regaled by a number of stories of opportunistic women who have dumped their husbands shortly after finishing the medical training these hapless men helped pay for. I keep telling him that he is the best husband I could have, but if I was going to marry purely for money I could probably do better. I live in one (possible the) fastest growing cities in North America; real estate here is going up hundreds of dollars a day; millionaires are being made every quarter thanks to the high oil and gas prices. Frankly I am a little insulted that these story tellers think I couldn't find a fatter wallet; if that was what I was seeking. I really think a better husband couldn't be found but I could probably enslave a better benefactor if that was my marriage goal. I am insulted that these people think my motives are so unpure and I am further insulted that they think I am not better able to fullfill these base goals.

2006-07-19T17:09:00.000-06:00

To help in my efforts to become at least somewhat qualified to be a medical student, one of my labmates lent me his medical physiology textbook that he has as a result of his zoology undergraduate degree. I am only a couple of chapters in but I am dismayed at the lack of pictures. Not since my class on partial differential equations have I had a text with less figures. I don't remember anything from that class. I have always been what one would call a visual learner. Maybe I should get on that anatomy thing first to make myself feel better.

2006-07-13T12:55:00.000-06:00

I was hoping to keep the frequency of this blog to every few days, twice a week at least. I have obviously not kept up to this, but I was on vacation. A good excuse if you ask me. I went on a roadtrip to the West Coast for a little more than a week, after finishing my corrections and turning in my thesis. There are still a couple of papers hanging over my head, but I am determined to get those out of the way before orientation starts the first week of August. Between that and the stuff I want to sort out here at home I will be busy for the next couple of weeks.

I am also thinking that I should start looking into doing some extra anatomy ond other studying in some of my weak areas, which is all of them. I am not really sure where to start but my artist husband does have the anatomy and physiology colouring books. Probably as good as any. Given that my understanding is at a kindergarten level a colouring book is probably appropriate. Besides, it gives me a reason to get new pencil crayons. New crayons and markers were always my favourite back-to-school supplies.

2006-07-03T13:17:00.000-06:00

As a joke in my defence presentation, at which no one laughed, I put a data slide rating some of the inner city Calgary coffee shops that I have frequented during my Masters. As a service to the rest of you lap top wandering caffiene addicts, I thought I would add the jist of it here. A couple of tea shops are included for diversity. Yay Canada.

Cafe Beano: 17th ave, 9th St SW; Best Mocha; comfortable; café food; no wireless; no plug ins

Koi Cafe: 1st St, between 10th and 11th ave SW; uses locally roasted Big Mountain beans; awkward chairs; full menu; has wireless; no plug ins

Purple Perk: 4th St, between 22nd and 23rd ave SW; Comfortable; mediocre coffee; very fast wireless; many plugs ins

Weeds: 20th ave, 18th St NW; Decent coffee; student-type décor; smoking room; café food; has wireless; one plug in near front door

Higher Ground: Kensington road; Often busy; good coffee; café food; has wireless; no plug ins

The Bean Stop: Eau Claire Mall; Broad selection of coffee and tea; mall seating; has wireless

The Roasterie: 10th St in Kensington; Allows smoking

Grounds for Reading: 7th Ave, about 1st St SW; Good specials; also new and used book store

Bumpy’s: 8th St, between 10th and 11th ave SW; cheesy country decor; uses Big Mountain beans; expensive

Steeps: Mount Royal Village, 17th ave SW; Tea only; good selection; has wireless; one plug in

Oolong Tea House: 10th St in Kensington; Good selection; also has coffee

2006-06-29T09:39:00.000-06:00

Now that I have finished my Masters (except for the corrections, which I have promised myself I will finish by the end of the week) I have gone back to seriously considering what the heck I am doing in medical school. Aside from the fear and dismay that they would actually let me into medical school when I am obviously underskilled and underprepared, what am I going to make of all of it anyway? My specialty shortlist is: neurology, psychiatry, family, emergency and pathology. A little bit of a mixed bag. I am torn between what I might be good at, what might be the most interesting and what might be the most useful to society. I know I have some time to decide but, with the University of Calgary program being only three years, I should have a good idea soon so that I can line up good experience for matching. Maybe, like a friend of mine suggested, I am experiencing a stress withdrawal and am just substituting worrying about the future in the absence of anything substantial to stress about. I need a vacation.

On another note, I went to Wilco at Mac Hall last night. It was the first night of their Canadian tour and you could say 'it totally rocked!' Lots of energy, good sound, a really good feel from the band and in the crowd. Everything you could ask for in a show.

2006-06-25T19:24:00.000-06:00

I passed! My defence was not the worst experience of my life; a report I have heard from a few other graduate students. There were a few things I would have liked to have done better, but my committee allowed them to go, so I probably should as well. I guess going over and over in my mind the questions I missed means I am a perfectionist. Now I just have to make some corrections and finish the paperwork. My mother is already asking when the graduation ceremony will be. Lucky for me I am in the combined graduate/MD program so I only have one when I am done both. I good way to put off that boredom.

2006-06-22T00:14:00.000-06:00

I am now about 12 hours away from either having passed or failed my Masters defence. Being that it is about learning and memory, I should know better than most that going to sleep now would be my best chance at remembering any of the stuff I have been cramming for the past 12 hours. For some reason the loss of consciousness scares me right now. I have this dread that all of the acronyms will get jumbled up and mismatched. Acronyms scare me like little spiders.

2006-06-20T16:06:00.000-06:00

And now.
I am close enough to my exam date to actually be looking past it. Something that I haven't managed to do until now. I have been putting off plans past my defence date in an attempt to not jinx the outcome. All of a sudden however, all I can think of is what I will do when I am free of this particular millstone. In best cases I will still have corrections and a couple of journal articles to contend with when I have gotten past the exam hurdle, but I keep imagining spending an entire day actually organizing my house, going to the gym, reading a novel. I think I am delerious.

2006-06-18T20:25:00.000-06:00

Three (and a half) days left.
I am just days away from my defence. The fact that I am writing this is indication of how my studying is going. I still have to complete (and start in fact) my defence presentation and I have a stack of reading to complete yet. Panic would not be far from the truth. There were periods there that I was sure I would never get my thesis done either. Hopefully this is the same situation. Hopefully I am not nearly as far behind as I think I am. Hopefully I can pull this off so I haven't wasted the last two years of my life.
Here's to hoping!

2006-06-16T09:18:00.000-06:00

But Friday never hesistate.
I am starting to get down to the wire for my defence. I have 6 days left. I am debating between working on a journal article that my supervisor want to submit and pushing that off to the back burner in favour of reading and studying. Theoretically knowing more would be the best call for my thesis defence but I somehow think keeping my supervisor happy is a better way to ensure passing. So it comes down to the age old question; What will ultimately get me further ahead, merit or mercy? When I put it that way it's obvious... I am off to please my supervisor.

2006-06-14T14:01:00.000-06:00

This is what our society is based on?
My husband an I spent a couple fo hours helping his parents pack up in anticipation of their move to a smaller home. They are leaving the split level, 4 bedroom that they have been in for the past 28 years to move to a one bedroom 'cabin on the lake'. This would be a big undertaking at the best of times, but the combination of my mother-in-law being a bit of a pack-rat and my father-in-law being the eternal boy Scout (always ready for anything) this is a move like none I have been a part of. Though, this could be more of a refection of my limited moving experience than the scope of the actual event. I was first in charge of cleaning out the lower bathroom. There was no less than 5 nail clippers and 2 nail scissors, 3 night lights, 2 toilet bowl cleaners. I was thinking this outrageous. How does someone accumulate all this stuff? And I started ruminating on the evils of consumerism in our age, encouraging people to buy more than they could every really require. When I got home, however, I remembered the two toilet bowl brushes under my own toilet. I can't even remember why we would have two. The only explanation would be that my in-laws are sneaking things into our house when we are gone. Or we had one that was perfectly good and then bought another that 'goes better' with the shower curtain. Of course the cat scratched up that shower curtain. Nothing matches now.

2006-06-13T08:58:00.000-06:00

Back at work.
I am now reading; studying for my Masters defence. My enthusiasm is waning and my resolve is next to non-existant. I find myself stacking distractions on top of each other just to avoid my text books. Right now I have the World Cup on the tv, my computer in front of me, a novel in my lap and a podcast playing. I know that medical school won't be any less work than graduate school, I am anticipating quite a bit more, but I am really looking forward to a change. I need something I can get excited about.

2006-06-12T11:03:00.000-06:00

Weekend adventure.
Dispite my lack of grace, I must be getting old. The first indication this weekend cam because it is my mother's birthday today. An aquainatnce of mine was surprised to hear that she is only in her mid-fifties and commented that she must have had all her kids in her teens. A quick bit of math would indicate that he thought I was at least 35. I am not 35 (not that there is anything wrong with that!). But the fact that I am bothered by an overestimation is a clear indication of my advancing age. As a teenager I always thought that it was only old biddies who are unhappy with what they have accomplished with their lives that get hung up on the number attached to their chronology. I am now that old biddy.
I am not quite as embarassed by the second indication of my age. I am starting to show a heightened frustration with the lack of respect people show to other people. I am more and more amazed at the complete absence of consideration of what someones actions might have on the other people around them, to the point that I actually yelled at an absolute stranger this weekend; an act completely out of my character.

2006-06-09T10:28:00.000-06:00

The weekend starts
Yesterday I broke my toe. Really, this isn't such a big deal but I keep hoping that I had finally outgrown awkwardness. And yet, here I am limping because I stubbed my toe on the coffee table. I continue to wait for that period where I am comfortable with myself, where I have at least a resemblance of grace.