As I'm sure you know, it's difficult to find time as a medical student to make it to the gym on a regular basis.** Fortunately, youtube has supplied us with a variety of inspiring workout videos that we can do in the comfort of our own homes, never far from our textbooks...
Please take a few minutes out of your day to spend on yourself. Physical fitness is a key aspect of health and well-being.
Lena Rowat may be one of my new favourite people... I just read an article about her in the latest Explore magazine (Oct 2009).
Not only is she an outstanding skier, mountaineer, and explorer but she also comes from a medical family that found a balance between leading wilderness-centric lives and pursuing careers as doctors. In fact, Lena even found time to apply and get accepted to UBC medical school (although she later dropped out to further pursue skiing... and good on her for being able to make that decision cuz while we all might joke about how the debt after one year locks us in forever, we all secretly know that it really isn't a joke.)
Anyway, this is all to say that you should read the article because it's fantastic. To further prompt you, I've copied here the "Rules of Rowat" from pg. 62:
1. If you're going to dress at all, dress ironically. Always bring a party dress on your expeditions.
2. Do handstands whenever possible. Naked handstands are better.
3. Always eat the best food in your pack first. Because then tomorrow you'll also be eating the best food in your pack.
4. Old food is better than new food. It tastes better because you're doing the right thing while you eat. Dumpster food is best of all, because you feel like you're eating treasure.
5. Silliness is a very undervalued wilderness skill. Take yourself too seriously and not only won't you be having fun, you'll probably get a snowball in the face.
6. Swim in every puddle, pond, mountain tarn and raging flood-swollen river you can. A pack can float on a Therm-a-Rest.
7. Carry less and improvise. A grocery produce bag could work as a condom, but make sure you double bag it.
Ok, so I didn't say that I necessarily agreed with every golden word that Lena Rowat espouses but when it comes to being a unique individual, pursuing your dreams, and having a hell of a good time while facing some of the worst life has to throw at you - I think she makes a pretty good role model.
Now, it is definitely time for me to go to bed. Jeesh.
Today was a grey day and I felt lousy (really lousy) right from the moment I first woke up. I've had this pestering sore throat and cough for about a week now (no, it's not the oink oink that everyone is so worried about!) but it's still been keeping me on edge a little. Combine this with some serious soreness from yoga last night (I stretched in ways I didn't know where possible and I've almost perfected my head stand!) and you've got a recipe for a slow-moving, slow-thinking Saroja.
Thus, despite awaking at my regular 6:30am, I never made it to lecture... instead, I let the bunnies out and did the last of my on-line learning modules. I also wrote a good chunk of my CTP and made a good, wholesome breakfast before trundling off to my afternoon doing clinical with physio.
Post-physio, I was still feeling pretty swamped and rotten so instead of going straight home, I dropped by the shopping mall with the vague idea of "just looking" for a good dress to wear to the many weddings I've been invited to attend this year. Up until this point, I've been borrowing dresses, shoes, and jewelry from Penguin's little brother's girlfriend.
Sixty minutes later, I had successfully purchased a gorgeous little dress, necklace and earrings to match, sexy shoes (plus an extra pair for shoes (boots? shoe-boots?) for clinical that I just couldn't leave in the store), and groceries. At which point, I came home feeling very proud of myself for spending a shockingly small amount of money on all of it combined.
I then made myself Penguin's heart-winning chicken breast stuffed with roasted red pepper and leeks in white wine cream sauce with mashed potatoes and freshly cooked buns.
Then, while eating dinner, I received an e-mail saying that I had, indeed, won a spot at my super exciting elective placement for surgery - should I choose to take it.
---"The 'fight or flight' response does not apply equally to both sexes; rather, it most accurately characterizes the response of male animals under threat. The female response to non life-threatening stress has been characterized as 'tend-and-befriend'." B. McEwen
On the surface, this statement seems to state the men are inherently warriors while women are naturally gardeners. But, if you think about it, this author's argument is based on a comparison of apples and oranges not apples and apples. The threat that elicits a 'fight or flight' response from men is a life-threatening event whereas the McEwen clearly states that the 'tend-and-befriend' response only occurs when the threat is not life-threatening.
There is something seriously wrong with my furnace. Aside from the fact that it hasn't been producing anything but cold air since I turned the heat on and now my house is hovering around 10 degrees, it also makes this bizarre buzzing noise that fluctuates in volume, intensity, and duration. During the day - not a big deal. But at night... good grief!! The furnace itself is located in the bedroom and it definitely kept me up until 2am until I turned on the radio loudly (set to static) in order to drown out the noise.
Does anyone know how to fix something like this? I just can't find the loose part that's the culprit.
I think about strange things when I'm brushing my teeth. And I brush my teeth a lot, just ask Penguin. Toothbrushing time is the highlight of my day sometimes - and it's not pathetic! It's just that I get to think about whatever I want while brushing my teeth, whereas during the rest of my day, I have to concentrate on something else all the time. Free-thinking time is something I cherish.
Here are this afternoon's tooth-brushing thoughts:
A helpful mnemonic for medical crises (thanks Sara and WildMed!)...
In the backcountry, a group of climbers set off to ascend a series of peaks. The pace is brisk and the terrain is difficult below the treeline in the valley. One of the climbers falls behind by noon on the first day. That morning, the slow climber had struggled to keep up with the group. They would arrive at each rest point just as the rest of the group was packing up to leave. The group tried to reassure the slow climber by saying, "c'mon, c'mon this part is easy!" but it didn't seem that way at all to someone who was exhausted.
Eventually, the group left the slow climber behind. It was almost a relief to the tired mountaineer who had been filled with anxiety over holding the group back and trying to push themselves beyond their limits to keep up. Now, the tired climber could rest when they wanted to. They could climb at a pace that allowed them to enjoy the scenery, the warm work of their muscles, and the quick, full breaths of clean mountain air.
Looking up, the slower climber could see their friends' silhouettes high up on the ridgeline, in full sun, and moving toward the first peak. The tired climber was not yet out of the valley's shadows and could only imagine what the view must be like from so high up. The climber did not envy the main group - the lone mountaineer knew that they would make the summit eventually. In the meantime, they were content to walk the wilderness alone.
7 am. Raining. Woke up alone and tired. Had stayed up late the night before doing background research so that I wouldn't be swallowed by the ocean of neuroanatomy that we're supposedly born knowing. Laid in bed listening to the radio and the rain.
7:20am. Finally got up. Let the bunnies loose and gave them their papaya chips. Brushed teeth.
7:25 am. Made english muffin with fake peanut butter. Looked at the dishes on the counter and decided that I'd wash them later.
7:30 am. Hoping rain will stop so I can walk to school
7:40 am. It rains harder. Call Scarlet and ask for a ride.
8:00 am. Discover that Hoyle has peed on my pillow. He thinks this is marvelously amusing and shakes his ears at me while skipping away. I decide I'm going to eat him for dinner.
8:20 am. Desperately washing urine-soaked duvet in bathtub before Scarlet arrives. Duvet cover and sheets are already in the washing machine. Grab raincoat and laptop and run out the door.
8:30-10:30 am. More hopelessly overwhelming neuro lectures. Had a lukewarm orange pekoe tea.
10:30 am. Talk with Scarlet about how ridiculously stressful school is right now. Discover that the majority of my time sensitive errands cannot be accomplished without a car. Person in front of me at the bank machine manages to break it, thereby eliminating further errand opportunities. I walk home in the rain.
11:00 am. Standing under a tree trying to keep the laptop dry while it pours even harder outside. Reminisce about walking home from the grocery store in the North Land to our old apartment and smile.
11:15 am. Clouds are quickly blown away and I get to walk the last 35 feet home in vibrant, warm, and relatively dry sunlight.
11:20-2:00 pm. Do 3 loads of laundry, vacuum, clean oil stains out of carpet and off coffee table, wash dishes, make lunch, sterilize water purifier for winter storage, put away camping equipment, dance around living room to old mix tape by Melon, call insurance about the new car, think about how wonderful the weekend was (ostrich, cheese, and chocolate fondu and Penguin). Try not to think about all the work that needs to be accomplished this afternoon.
2:00 pm. Settle down in front of laptop to resume studying. Day is improving: looking forward to going to gym tonight to watch HIMYM, looking forward to getting done this neuro homework, looking forward to possibility of getting a car by the end of the week.... and looking forward to Thanksgiving in only 2 weeks.
Our C/S class was early this morning (8-10am), which left me the entirety of my Wednesday to get work done. And, believe you me, there was certainly plenty of work that demanded attention.
So, after a brief get-soaked-to-the-skin-because-of-a-freak-5-min-rainfall sojourn to the bank, I made myself a Chai latte and sat down to work. and work. and werk. and werkwerkwerkwerk.
In the end, this picture pretty much captures my day. And yes - maybe finding this picture indicates a teeny bit of procrastination but I think that I'm entitled to some sanity-saving moments every now and then. Aren't I?
Yeah, I know. I should be studying. But, I took a quick break and found these few unique design elements after some random web searching. Sorry, I can't remember which websites I pulled each of these from... the artists certainly deserve the credit.
Highlights from the latest Scrub-In (medical student magazine) "LOL Texts ;-)" box:
- "Hey, this very intoxicated girl just came into the ER puking. I'm pretty sure she had a salad for dinner but I don't think she remembered that since she kept yelling at her friends, 'WHY DID YOU LET ME EAT TREE LEAVES?'"
- "A random man in the hospital just asked me out. He looks a cross between the four horsemen of the apocalypse and a cat. I'm highly uncomfortable..."
You know how vineyards have those bird cannons that intermittently fire to keep the feathered ones from eating the crops? Well, I think I need one for my living room. It could be set to go off at odd intervals, with a sufficient variety of sounds, that it would randomly startle the rabbits and thereby prevent them from chewing all my stuff. That way, I might actually be able to get some work done without having to throw myself between my furniture, rug, and walls and their sharp little teeth every 5 seconds.
Almost a week ago, I discovered what specialty I want to pursue. This has been a overwhelming relief since I have spent most of my first year in medicine wondering if I had made the right choice. At last, I feel as though I can find my own footing and start really digging into things with enthusiasm instead of feeling lost and frustrated.
I'd like to be a surgeon. A general surgeon, who specialized in trauma.
Surprised? I thought not. Frankly, I was. Having barely survived a year of med school, I was a little shocked that I could look upon a 7 year residency with enthusiasm rather than utter horror. But, I'm getting ahead of myself... here's the back story:
I've spent the last 3 weeks doing a rotation in general surgery with the chief surgeon, whom we shall call Dr. M*A*S*H. The hours were long - 7am to 6pm every day and then home to read for 3-4hrs every night. But, my doc had a great sense of humor and the cases were interesting and exciting. I took to it like a duck to water and my learning curve was steep and profound.
Most of our surgeries were laparoscopic cholesysectomies and segmental resections of breast (cancer). We also did a few very bloody bowel resections including an APR, which is about the worst thing I think a human being has to go through - or at least, the worst thing I've seen medicine do to "help" someone so far.
I came home most nights tired but happy. I liked the work, I liked my preceptor, and surgery is just plain cool. For the most part, though, I didn't give surgery much more thought than "hey, this is pretty fun". And then we spent an afternoon repairing hernias...
We had 3 inguinal hernia surgeries in a row one Monday afternoon. The first one was completely overwhelming. While I'd read up on the anatomy the night before, everything down in the pelvis is so 3D and layered that it's pretty much impossible to picture it without having a body (or a living, breathing body) right in front of you. The second surgery went much better, I'd figured out that Hasselbach Triangle and the difference between direct and indirect hernias. After the third surgery, I walked out of the OR thinking to myself: "This is it. I want to be a surgeon." I could easily see myself being 55 and repairing my 400th hernia and still loving it.
I called Penguin as I walked out to my car to drive home that night and told him the exciting news. I could feel him smiling on the other side of the phone but we were both cautious: 7 years of residency is a big commitment and what about adventuring?
Over the next 1.5 weeks, Dr. M*A*S*H did everything he could to deter me from surgery, in the nicest way possible. He pointed out that surgery is still very much a Boys Club - you gotta be able to smoke cigars, drink whiskey, and drive stick. (I have 2 out of 3 there, at least!). He also pointed out that you have a responsibility to your patients, colleagues, and the hospital to do call and be around for follow up. You can't just slice off someone's breast, diagnose her with cancer, and then leave town for 6 months to go climbing thereby leaving all the follow up to someone else. In fact, as a surgeon, you spend 70% of your time at work. Everything else: family, food, sleep, play has to fit into that other 30%. Your work is your life.
I listened. I thought about it all. And on my last day, Dr. M*A*S*H and I got some coffee and sat down to talk. I said I was still interested. He said that he might have some ideas on how to solve my obstacles...
1) I'm about as much of a boy as a girl can get when it comes to playing rough and acting tough.
2) Wherever you go in medicine, you have to absolutely love it. It's too much of an investment to settle on a speciality that doesn't really float your boat just because you want a certain lifestyle. If I loved surgery, I should go for it. Nothing is impossible - difficult, yes, but not impossible.
3) If I want to go adventuring (and/or have a family), I don't have to take a staff job right away after graduation. Instead, I can do locums (which lets me travel in itself) and the contract work would give me the flexibility to take time off on my own schedule to jump on an expedition or pop out a bambino (yick!). Even if I were to take a staff job, it's still possible to go adventuring (Kenneth Kamler does it, afterall!), I just have to find the right colleagues and understanding hospital admin to let me.
4) With surgery comes specialization, something that I've been worried about avoiding. Dr. M*A*S*H specializes in breast cancer... but the plus side of Gen Surg is that you get to see everyone: 2 y/o, 97 y/o, and everything in between. Over coffee, we talked about what kind of Fellowship I might pursue after residency and he pointed out that I could do traumatology. I looked it up on CaRMS and only 3 universities in Canada offer this option: UBC, Toronto, and uOttawa. Clearly, this works out perfectly for me!
5) 70% of your time is a huge portion of your day to devout to work. After 3 weeks of surgery, I was hungry, tired, and excited. I thought about spending the rest of my career in this mixture of exhilaration and exhaustion and that's when I thought about Einstein's quotation: "Life is like riding a bicycle. You have to keep moving to stay balanced". I've always been a happier person when I'm stupidly busy (sorry Mom and Dad, but you know it's true!). And I was certainly the happiest that I've been all year while I was doing this rotation.
The best thing about surgery is that it's hands on: there's a problem, you fix it. You're always the last option: you only cut when medicine and time can't make things better. And if you can't fix it, then there's nothing else that can be done. It's that simple. It's this kind of perspective that totally feels right to me. Hopefully, I'm right for it.
On the Suffering of the World - Arthur Schopenhauer
Thus Spoke Zarathustra - Friedrich Nietzsche
The Human Condition - Hannah Arendt
Your Inner Fish - Neil Shubin (this one is mostly just for fun)
I know what you're thinking: Saroja, how on earth are you going to read all these books in just 2 months while still doing school full time? My answer: I don't have a freaking clue but I'm really determined. If I'm going to enter that contest, I need to start writing pronto. Alas, before writing comes research.
If anyone has any suggestions for good reads that relate to my thesis, please send them my way! My goal is to start putting pen to paper by Sept. 5... deadline for contest entries are Jan 15.
Two weeks ago, while on the highway heading to the coast town for class, Pinelope (my 20 y/o car) cracked her catalytic converter. The sound was unbelievable. At first, I didn't think it was my car because I was riding behind a giant dumptruck. However, as soon as I moved to pass, I realized that it was Pin and not him.
With nowhere to pull over on the highway and running late for tutorial, I roared my way into the quiet little town and parked at the hospital, red-faced and thoroughly distraught. At that time, I didn't even know what a catalytic converter was. All I knew was that my car was broken.
The Real Deal came out to the parking lot and helped me look it over during a break. We determined that it was part of the exhaust system and he called a friend of his who came swooping in to the rescue. This wonderful gentleman dropped everything he was doing and came to the parking lot to assess the damage. He then left his car for me to drive home later and drove Pinelope off to his friends to weld her back together, no charge.
You don't get much more awesome than that.
With Pin patched, I drove her to the NC the next day to celebrate a belated Easter with my family and have our trusted mechanic complete a thorough repair of my car. This, it turns out, was my great undoing. Upon receipt of the car after $600 of repairs - she sounded worse than when she had only been 3/4 welded together. In fact, the next day, she drove into the parking lot at school with smoke coming out from under her hood.
Needless to say, I was fuming a bit myself, too. Having lost faith in the car (and to some degree, my mechanic - although the jury is still out), I made the executive decision to retire Pinelope and go find a new set of wheels.
Now, there's a few things you need to know about this decision:
1. It's likely to break my grandmother's heart because Pinelope was originally her car and she gave it to me to use while I was in med school. She LOVES that car.
2. Despite Nana's accumulation of very little mileage, the car had to have several major repairs before she was road worthy again. Battery, alternator, thermostat, radiator, and now exhaust and catalytic converter. It just didn't make any sense to pour more money into a car that was already sucking my bank account dry with its cavernous gas tank and lousy fuel economy.
3. Buying a new car meant reliability and longevity. It also meant a little more safety (hello, airbags!) and a stereo for those 10 hr round-trip drives home.
4. Buying a car meant a big chunk out of my line of credit, which has caused no little amount of nausea when I consider the state of my financial situation.
So, as you can see, I had to select my criteria for a car carefully. It couldn't be too expensive but it also couldn't be a wreck and require any immanent repairs. I needed a car that will last me through residency (8 years, min) and I had about 10 hrs to look for one while I was home for the weekend.
And look, I did! With the help of the endlessly patient and supportive Penguin, we drove from the West end to the East end and just about everywhere in between. In total, we visited 10 dealerships and test drove 8 different cars. In the end, I settled on a 2007 Honda Fit, manual txn, 15 000km, and comprehensive warranty until 2012 or 120km.
I will admit that it was a little over budget (and by a little, I mean about $2k) but it was still less than a year of tuition and I really feel like I made the right choice. There are still a few strings to tie up to finalize the deal - my mechanic is giving the car a good check to make sure there aren't any hidden faults, the dealer is going to do some body work to touch up a few scratches, and I've got to finalize the payment through my bank and insurance companies. Other than that, though, I should be picking up the new car on Friday.
My very first car! EEE!
So thanks to everybody who helped me nurse Pinelope through her final illness, look and learn about new cars, and put up with my occasional panic attacks throughout the whole process. I'm very, very grateful.
These days, I find myself surrounded by science... both literally - I have been sitting in the middle of a circle of textbooks all afternoon working on tutorial - and figuratively, since the study of medicine at this point in my scholastic journey is pretty much entirely about scientific theory (read: the pathophysiology of disease an disease states). This has been a complete 180 from my undergrad, during which I studied (for the most part) religion, philosophy, history, literature, and the fine arts.
For the most part, I've found the transition from undergrad to med school to be pretty difficult. It's not to say that I'm incapable of the actual meat-and-potatoes comprehension but rather that I've been lacking motivation. In turn, this lack of motivation has blossomed into an ugly flower of discontent and self doubt.
I'm worried that I made the wrong choice in coming to medical school... that I don't really belong here and that I've made a mistake by taking this path. While this feeling is very strong at times... I also can't give you any really good, solid reasons as to why I feel this way. I just do.
So today, as I found myself to be more ADD than ever despite a good morning and warming pool of sunshine on my living room floor (nothing cheers me up more than sitting in the sun), I finally decided that I'd put my question of belonging to a higher authority.
Now, before I continue, I'll ask you to keep an open mind. After 5 years of studying theology, I find it difficult to actually find any sort of clear definition for my own belief system. This is what I can tell you - I believe in nature and an interconnectivity between all beings. I believe that there is something greater than the self. And I believe that with an appropriate amount of consciousness, one can connect with that 'greater force' directly to gain understanding and insight into oneself and the world.
Many traditions have many different ways of doing this - through prayer, the Kabbalah, music, runic stones, ecstatic dance, zen meditation, etc. For me, I like to use a Tarot deck - which, you will note, is entirely unscientific.
Thus, today, I put my textbooks away and pulled my deck instead. After a few minutes of clearing my mind, I asked it: Am I in the right place? Did I make the right decision in coming to medical school? Should I choose a different path?
Here's how the universe answered:
Historically, I have been fairly competitive and stubborn by nature. I attribute my successes to my determination to overcome life's difficulties through vitality, enthusiasm, and perseverance. In addition, I feel utterly blessed for the clarity and insight that my experiences (both successes and failures) have provided.
Right now, I'm busy tying myself up in knots about whether I've made the right decision to come to medical school. It has been difficult to remain engaged in my studies or nurture the relationships with my friends and family due to this stress. Today, I have been reminded that in order to be creative and productive, I need to look after myself (eat well, get enough sleep, and exercise). Since coming to medical school, I've found it very difficult to make the time to cook properly, get enough sleep, and find time to work out. Clearly, this is something that must be remedied immediately.
The deck also reminded me that it's possible to try too hard. Being so focused on one goal means that you don't experience the journey because you're too caught up in arriving at the 'right' destination. I cannot plan the future - I will never know exactly what's coming. For this reason, I need to open myself to experiencing the present and taking a more relaxed approach to life. In doing so, the circumstances that appear unappealing and difficult may actually become very rewarding.
Lastly, the final card that I drew from the deck was Losgann- the frog. Within the layout that I was using to read the cards, this figure was meant to inform me of what my actions may manifest in the future. Losgann is the symbol for medicine in Druidic lore.
I had my first code blue today. After years of training, I finally got to put my CPR skills to good use. I might be hopeless at other clinical skills like palpating for hepatomegaly or giving nerve block to dislocated fingers but when called upon to do CPR, I slide right into my role without a second thought or a moment's hesitation.
The action itself felt very satisfying. It wasn't an adrenalin rush, it wasn't a shock, it wasn't even exciting, per se. I've practiced doing CPR so many times that it was just second nature. I did what I was asked to do and I did it well and that made me pretty happy.
On the down side, our patient died. In my mind, it was a pretty good death - very much like my late grandfather's. This elderly gentleman had spent his morning grocery shopping with his wife before coming home to share lunch together. Prior to running some afternoon errands to the local Home Depot, he stepped outside to bring in the mail... and never came back in. He collapsed on the steps, where his wife found him moments later.
The EMT and ER staff worked for an hour to revive him but to no avail. I accompanied the primary physician to tell the wife. She sat alone in the pink consult room, confronted by a panel comprised of the physician, myself, a nurse, and a nursing student.
The now-widow said matter-of-factly, as soon as we walked in, "it's not good news, is it?". The physician shook her head sadly and delivered the bad news exactly as we'd just been trained to do last Tuesday in our Art of Medicine class.
After a shakey moment to digest the information, the widow looked lost. Her son was in Florida and could not be reached. There was no other family. After a few moments of silence, she said quite simply... "We were supposed to go to Home Depot this afternoon. What am I going to do now? We'd- we'd just finished lunch together. The dishes are still in the sink." How quickly plans can change.
While the technical aspects of delivering CPR had been, I'll admit, almost enjoyable (not because I wanted someone ever to be that hurt but because I was finally in the right place at the right time to provide the care I'm trained to)... delivering the bad news was heart breaking.
It bothered me that immediately after this, my shift ended and I walked out of the hospital and drove the grocery store to pick up chicken, chick peas, and tomatoes for dinner. This poor woman's world had just shattered and I simply walked away from this fracture in humanity to do a mundane chore.
I realize that I cannot relieve her of her grief or help to carry her burden. But, I can be thankful for the lessons I've learned from this experience and I am so grateful to have been privileged to share in both the widow's and her husband's story.
Today was decidedly not sunny. I tried to make the best of it - I caught up on my sleep from the Friday night episode, made a delicious breakfast (I finally got my frittata to rise!!), and then did some solid studying for the afternoon.
At 3 pm, I decided that I would not be intimidated by grey skies and pulled on my running shoes to do a 20km. I was actually excited to go - I'd eaten well that day, slept well the night before, and had new music on my ipod that I was anxious to listen to with my full attention.
Unfortunately, I discovered that 12 hours is not enough recovery time from an allergic reaction. I chalked the first painful 2 km up as mere 'warm up discomfort' but just I was in the shadow of the canal-spanning bridge and 5 km from home, my body went into full revolt. My gut contracted with an iron fist and my calves spasmed. My sides stitched together so that it was hard to breathe and I felt the colour and warmth drain from my face straight down to my toes.
I staggered to a nearby bench and sat down, gasping like a fish out of water. I kept my eyes glued to the pavement as tried to muffle the agony of my mutinous muscles as the couple I had just past running, strolled past with curious and somewhat concerned glances.
After 5 min, the pain wasn't getting better. I sucked hard on my camel pack hose with hopes that it was an electrolyte thing and my Gu2O would help. No luck. I got up to walk but felt dizzy and sat back down. I knew I wouldn't be going anywhere fast. It was time to swallow my pride and call for a rescue.
Scarlet arrived in her car, Bubbles, and scooped me up from my roadside crash zone. She delivered me safely home where I wolfed down an orange, drank some water, and slithered pitifully into a hot bath to put the sword to the last of my cramps. After swallowing a few advils and choking back tears of frustration, I once again returned to my couch... never so happy as to see Tortora and remain sedentary.
It's been awhile and there are 3 fantastic stories that I need to tell you. So, here goes...
My long-awaited ER placement got off to a rocky start. It began with me missing the first day, entirely. I had it in my head that I started on the Wednesday... so 2 hours before I'm scheduled to go in, I double check my e-mail to make sure that I have all the details straight. 5 pm, check. Bring stethoscope, check. Bring clinical skills book, check. Have ID, check. Start on Tuesday...
Tuesday was yesterday.
I don't have a phone number for my doc, so I send him an e-mail. It was the most humiliating and pathetically apologetic e-mail I've ever written. He bought it, told me not to worry about it, and I showed up half an hour early for our next scheduled meeting.
Thus, I walk-in on my new "first day" and meet my preceptor who is just wrapping up a patient in the PEOF (Push Em Out Faster) section of the ER. There's no time for any kind of introduction other than a handshake until we take care of one more patient, so my doc scoops me up and we meet the patient together.
This guy was on the job when he got a small 1 cm long wooden splinter lodged in his arm. My doc explains that it's too risky to pull it out with tweezers since some debris might be left behind in the skin. So, he numbs the guy and then makes a shallow laceration over top the splinter with a scalpel.
Suddenly, my face feels flushed while I simultaneously break out in a cold sweat. My ears start ringing and my vision becomes tunnel-like. I realize that I'm about to faint. My mind flails around inside my skulls like a spooked sparrow in a cage -- C'mon Saroja! You can do this. You've seen worse. Tough it out. Keep breathing. F-ck, you're such a wimp. Seriously.-- It's no good. I realize that either I've got to get out of there or I'm going to fall flat on my face. I excuse myself, in a muffled voice, and duck under the curtain. Luckily, the bed beside us is empty. I sit down. My doc calls across the curtain for me to lie down and get my feet up. I ignore him and sit with my head as far down between my legs as I can get it. I wish I were an ostrich and the slick hospital tiles were sand that I could bury myself in and never come up.
The rest of the shift goes by uneventfully. We see lots of good stuff but my confidence was completely deflated and I think that I come across as a shy, overwhelmed greenhorn. At the end of the first shift, I'm pretty sure my doc doesn't think I'd last one minute in the ER as a clerk, let alone a resident or as a career. I'm determined to change his mind, though. I ask when he's working next and he says tomorrow. I surprise him by asking if I can come in, to make up for our first missed session. He agrees.
The next day, I show up... again, half an hour early. I've vowed never to be less than early for any meeting with this doc. As luck would have it, our first patient is a guy who cut his thumb open sagittally. It's going to need cleaning and stitches. My doc helps me to irrigate the wound and investigates to make sure that the joints and tendons are still in tact. They are. With a sly look, he hands me a suture kit and tells my patient to yell if I faint on him.
I pull up a stool, explain to the relaxed patient what I'm going to do, and put in 7 stitches. I am as happy as a clam. I am redeemed.
The rest of the shift goes by like the first - lots of interesting stuff to see and I look on, wide-eyed. I talk my doc into letting me do a history on a patient with GI symptoms and nail the diagnosis. I think that he's mildly impressed with me. Not impressed enough to make up for my poor first impression, but I'm slowly regaining ground.
At least I've paid my dues now. It seems that every med student has to faint at least once and now that it's over with, I won't have to worry about it anymore. I hope.
Scarlet, Lao Tzu, their spouses, and I all went out to dinner last night. We went to a vietnamese restaurant that Scarlet and I have been to before and I was looking forward to the tasty meal. Unfortunately, the restaurant tried to kill me twice and nearly succeeded.
For dinner, I ordered a side of spring rolls, a main course of noodles and shredded pork, and a carrot milkshake. I had a brief chat with the waiter and told him that my meal must be prepared with "no fish and no nuts". He informed me that the spring roles had shrimp and offered to change the order to a veggie spring roll. I agreed.
A few moments later, the waitress came and put 2 spring rolls in front of me. It was already 8pm and I was starving, so I wolfed them down without hesitation. Moments later, our main courses arrived. There was some confusion over who got what and when the waiter put down th spring rolls that Lao Tzu had ordered, he pointed emphatically at them and said, "vegetarian". I gulped, if those were the veggie spring rolls, had I just eaten the shrimp ones?
When my bowl arrived, it was garnished with crushed peanuts. My stomach sank a little more. I sent the bowl back and glanced at my watch - if I had eaten the shrimp, how long did I have? Awhile. The shrimp wouldn't kill me but it wouldn't be a pleasant night, either.
My meal was finally returned - without peanuts and without shredded pork. It was one big bucket of plane-jane noodles. I didn't care. I was resigned to my fate and didn't want to make any more of a scene. I ate them quietly.
After a brief sojourn to Scarlet's after dinner to watch some Clone High, I went home to make dinner for the bunnies before retiring for a much needed sleep. Midway through shredding greens for their meal, I doubled over as my stomach clenched. It was like flicking a lightswitch, my GI had finally figured out what I'd done to it. I can never sneak anything past those pesky organs. I gulped down a gravol and hoped for the best.
I fed the rabbits and crawled into bed... tried to lie as still as possible as my stomach clenched tighter and tighter. I knew it was a losing battle. I spent the next few hours in the bathroom vomiting. It was black and viscous. I threw up in the toilet, in the sink, and - worst of all - out of my nose. I brushed my teeth at least 6 times and then threw out the toothbrush. I bleached down the whole bathroom at 4 am and then fell into bed and finally slept.
Today, I was supposed to run 25km but I woke up exhausted and still queasy. It was also pouring rain. I felt miserable and stayed in bed as long as I could by reading the book for the MedKid Book Club (MKBC).
I'm not really bitter about the whole evening. I really enjoyed the time I spent with my friends, chatting over dinner, and my first introduction to Clone High. The only thing I regret is actually paying $20 to be poisoned. Needless to say, I won't be going back to that restaurant for awhile.
Today had the potential to be an absolute waste. I was in a foul mood when I woke up - tired, still sick, worried about the work I needed to do for school, and depressed over the fact that I didn't feel up for running, yet again.
Fortunately, though, the day was saved by Scarlet and her husband (I will have a name for you soon - it's on the tip of my tongue but it just hasn't presented itself yet. Thanks for being so patient, if you're reading this!!).
We drove to a greenhouse that lay on the boundary of 3 towns and bought a lot of plants. The greenhouse advertised that it sold Lithops, for which I was ridiculously excited. Unfortunately, they were out of stock. But, I did get a goldfish plant, a spider plant, some purple heart alpine poppies, a gorgeous hanging plant that I haven't identified yet, and - best of all - a staghorn fern!!!
Afterwards, we had pizza and wings (not exactly what my stomach wanted after such a tumultuous night but still solid food) and we giggled over hybrid fist bumps/high fives that looked like glomerulus' and Bowman's capsules. Then, we went back to Scarlet's and re-potted our plants/sowed seeds before curling up on the couch to watch more Clone High while a thunder and lightening storm rolled through.
And that is how my day was saved. As an added bonus, the Real Deal called just to see how I was doing. While I haven't called him back yet, it felt good to be looked after by such kindly friends. Tomorrow promises to be sunny and I'm looking forward to it.
I am increasingly concerned that I'm in the wrong program. Last Friday, I was reading how Cartesian Dualism was reflected in French garden architecture (particularly at Versailles) and became ridiculously excited.
I cannot claim that any of my research into PTH, cholelithiasis, or splenomegaly have been nearly as fulfilling or thought-provoking.
I'm beginning to panic about the frequency of these intuitions. How can med school possibly be fulfilling if it's only a means to an end?
A human being should be able to change a diaper, plan an invasion, butcher a hog, conn a ship, design a building, write a sonnet, balance accounts, build a wall, set a bone, comfort the dying, take orders, give orders, cooperate, act alone, solve equations, analyze new problems, pitch manure, program a computer, cook a tasty meal, fight efficiently, die gallantly. Specialization is for insects.
This morning has been a series of misadventures. I got up extra early to go do a clinical placement at the local Diabetes/Endocrine Clinic... and I left extra early because I had to drop by the campus first to pick up my Clinical Skills notes, stethoscope, and coat. I also got a little lost on the way there because Gmaps got it wrong and told me to turn right when I should have turned left... but all in all, I made it there by 8:15 and the clinic was supposed to start at 8:30.
And there I waited, in a deserted hallway, for 45 min.
While I waited, I panicked about being in the wrong location and called poor Scarlet twice at a god-awful early morning hour while simultaneously musing to myself that how can there possibly be another Diabetes/Endocrine Clinic in a city of 130 000?!
It was then that I realized: it's Family Day. I had known that to begin with -- that's why I chose today to go to the Clinic! I had the day off and what better way to spend my holiday than work? Also, the sign up sheet clearly offered Feb 16th as an option and the academic coordinator definitely told me that she had e-mailed the Endo Doc to let her know that I was coming. In fact, she had told that the Endo Doc had also replied along the lines of "Don't be late or I will breathe fire all over you and feed you to my patients, roasted."
Needless to say, I was a little irked as I left the hospital to return home. On the bright side, however, I now have the WHOLE day to do chores, errands, and homework.
...an age that is anything but practical but believes itself to be more practical than any other age. ~Pablo Picasso
Electives are stressful creatures.
Revision: electives are fun and motivating and educational. That's if you survive the process in trying to set one up.
I've been trying to nail down my summer block elective for 2 months now. Eight rejection e-mails later and I've got 1 week to make the NOSM deadline. I am currently juggling 3 balls: NOSM, Greenland, and Tropical Tundra.
I have become a hermit because whenever I talk to anyone else about the elective process, they tell me their amazing stories of their summer plans. Jack, for instance, is doing fly-in's up north (read: far, remote north). The Real Deal is going to cottage country. Steel Wheels is going to the Philippines. Sweet+Splendid is going to Africa. And, as of this moment, I am going nowhere.
To recover from rejection and to maintain morale, I've been trying to set up some horizontal electives. Namely, ER or surgery... since that's what I think I want to go into. With the assistance of 2 administrative assistants and 2 solid weeks of effort, I still haven't managed to get an acknowledgement from any of the local docs.
On the bright side, I discovered that the gym has a change room with a hot tub and cable TV. I go there now not to work out so much as maintain my sanity. Good grief.
Today was our midterm evaluations and, while they didn't go badly, I feel like the good ol' balloon of self-esteem sprung another leak and continues to deflate. My clinical skills preceptor has this to say as a way of summarizing his feedback for me:
It's as if you are a car. Let's say you're a Honda. This means that you're a good car and certainly not deficient in any way. But, you're not a Mercedes.
Well, maybe I like Hondas! Not every doctor-to-be aspires to own a fancy, gas-guzzling car with leather seats and loud stereo, you know. Ok. Maybe I want my future vehicle to have a loud stereo... ideally, though, it would be an 80s ghetto-blaster strapped onto the back of my very classy European bicycle. Harumph.
In other news, I have acquired a new rabbit. Hoyle and I drove to the Center of the Universe to adopt her from Despair's cavern. She's a sweet, timid dutch cross and while it wasn't love at first sight, they certainly were snuggling by the time we made it back to the Tundra. This has been quite a relief since I had braced myself for months of bonding hell.
The new bunny's name is Jazz (really!) and she's still learning to come out of her shell. When you go to pet her, she'll pancake to the floor and pretend to be a turtle. It's awfully pitiful while still being very cute. Also, because she lived her whole life in a tiny cage, she hasn't developed the coordination to run, yet. Instead, when she wants Hoyle to play, she'll shake her head and hop around a bit, but sometimes she loses her balance and trips over her own feet. Hoyle stares at her like she's gone mad when this happens and, while it might mean that I'm a horrible person, this form of rabbit interlocution always makes me giggle.
Lastly, I would like to mention that I have discovered where the Herald of Spring winters. Today, I was confronted by a giant flock of them in the tree outside my building. It was a very odd feeling to be met with so many rosy breasts in the middle of January. I was also struck by the irony that this means that I conduct their migratory route once a month to go visit Penguin in the Far North. Who says that names don't define us, anyway?
Fruit-on-the-Bottom Yogurt Drought Persists, Day 3.
So, after months of silence, I have once again returned to blogging. I apologize for my prolonged literary absence, despite Penguin's significant effort to encourage me to put fingers to keyboard. To put things lightly, the first semester of medical school was an uphill battle. I've certainly learned many things during this time but, unfortunately, the lessons did not come easily and so there was little time (and honestly, little inclination) to start this blog off with 3 months of pessimistic prose. So, to sum it up for you, I have written this haiku:
Bunny!! But sick for
Three months; three funerals- God!
Homework never ends.
With the new year, however, come new enlightened intentions. Here are a few pieces of wisdom I have accrued since September and intend to implement from now on...
I didn't want to get into med school to learn about biochemical reactions, biomechanical physics, or other cutting edge scientific whatnot. I applied to med school because I find meaning and satisfaction in helping people who are in trouble. It's cliche but it's the truth. If I had wanted to learn the in's and out's of the most current health science, I would have gone into research. And we all know that I'd rather swallow a live mouse than do that.
Unfortunately, our education thus far has been strictly textbook. The result has been that my motivation went from 100% to nil as soon as the tough got going and my immune system packed up and went to Hawaii without me. Usually, I use school as an escape from the rest of my life- but for the last 3 months, I've been using the rest of my life as an escape from school.
Thank god for our class on the Art of Medicine, though, or I would probably have dropped out by now. After returning from Winter Break, we had a class that focused on the characteristics of a good medical student. Two phrases stuck with me from this class: 'competency is crucial' and 'striving for excellence'.
The competency statement reminded me that even if I'm not particularly interested in, let's say, the pancreas, I still need to know about it in order to provide my future patients with the standard of care that they deserve. It terrifies me to think that, one day, I might be treating a patient and have to step back and tell a colleague: "Do you know anything about the pancreas? I've got a patient and I think there is something wrong with their's but I skimmed that chapter back in first year and don't know jack about it." Gulp. Of course, I'd rather a doctor that owns up to the limits of their knowledge (after all, you can't know everything!) but I'd also like to have a doctor who has the fundamental knowledge required of them by their training and profession. Thus, whenever I'm up late on a Tuesday night trying to sort my way through the pentose phosphate pathway and its relevance to the metabolism of carbohydrates in diabetes mellitus, I remind myself that it's important to be a competent doctor.
Often, with that mental note in mind, I can squeeze out another 15 min of good studying before droopy eyelids and my fragile attention span once again tempt me to pack up the books and head to bed. At that point in time, I often find myself thinking - "I've done just enough to fake it through the next tutorial without anyone realizing that I actually don't have a clue about what's going on here. I'm sure I'll figure the rest out later." First of all, let me tell you, there is no "later" in med school. If you don't get it now, you're not going to have time go back and look it up later... the curriculum moves forward as inexorably as a glacier advancing on you, a tiny, insignificant ant, in its path. And just like the ant, you are expected to carry 10x your own weight in knowledge by the end of it all.
Thus, I now have a second mental note in my arsenal to keep the concentration juices flowing until the job gets done satisfactorily and that is: a good medical student strives for excellence. It's just not enough to say: that's good enough. Can you imagine a surgeon cutting a 6 hr surgery short and, as he's sewing up the patient, mutter to himself: "I'm sure that's good enough." (Btw, did you know the pun? smirks) This is exactly the scenario I think of when that second wave of sleepiness hits and usually it'll bolster me to hit the books for a little longer until I get the job is truly done.
Like I said at the beginning of this rant, though - I didn't strive to get into med school because I'm fascinated by the science. So what else is there to being a doctor than knowing the specific enzymes that your pancreas pumps out when you eat a delicious dinner? Answer: a lot. And it's more than just the doctor-patient, doctor-doctor, doctor-nurse, doctor-whomever relationships that we all keep harping about... it's about what is a doctor? Does that definition change if you move to a different part of the world? What does a doctor do that is unique to that profession and what does a doctor do that, despite the fact that they might pretend to have to monopoly on a particular service, they actually aren't the only one (or even the best ones) to approach about certain problems? Doctors don't save the world, social workers do. Doctors don't take care of you when you're sick, nurses do. Doctors don't just cure disease, sometimes they create them. Doctors don't just heal, sometimes they maime, or even kill. Why do the people who talk about this vital message feel the need to espouse it as such verbose pedagogy that the recipients of this vital knowledge are left retching from the forced feeding or simply comatose? And why, knowing all this, do I still want to be a doctor?
To be honest, I'm not as sure as when I first got into med school. I am confident, however, that this self-doubt is going to be beneficial in the end. I would be much more worried if I just cruised through this experience and didn't think twice about any of it.
For the last 3 months, I've been afraid of writing about this self doubt and lack of direction. Clearly, however, my aim now is to embrace it and learn from it. A good blog reflects both sides of the coin that is reality: on one side there are the fun, whimsical stories of daily life and on the other is the profound drama of struggle and hardship. Recording both sides, as I experience them, is my commitment to you, my dedicated reader, and to myself. So please look forward to many more posts in the upcoming weeks.