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.

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.)

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.