Tuesday, March 24, 2009

Where do fruit flies come from?

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.

How's that for an answer?!!!

Friday, March 13, 2009

Where is Waldo?

Since Sept. I have known
Eight people who have died...
In just 6 months!!

Wednesday, March 11, 2009

Specters move like pilot flames...

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.

Sunday, March 8, 2009

pH of various substances: orange juice (3.5), tomato juice (4.2), vaginal juice (3.5-4.5)...

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.

Better luck tomorrow, I guess.

Saturday, March 7, 2009

How to mount a staghorn fern...


It's been awhile and there are 3 fantastic stories that I need to tell you. So, here goes...

Story #1:

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.

Story #2

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. 

Story #3

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.

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