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.

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 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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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."

The curriculum at this university, 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.

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.

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.

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.

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.