I have problems with my feet.

If you are a long-time reader you may recall "Uncle Fester" from my Himalayan trip training days...or my Summer of Cellulitis last year thanks to a hike in the eastern Reeks..Well it appears that the hills of Ireland have once again bitten me (okay, it was actually my new fell running shoes...)

I'm not going to get too sentimental about all this. Just hear me out.

There are a lot of things we get wrong in medicine, a lot of things we can't treat, cure, or figure out. But today in clinic I had the opportunity to meet some children who are living (playing, giggling, bright eyed, rose-cheeked) proof that modern medicine can be amazing. Similar sort of feeling to a day I blogged about 2 years ago.

I met a child who had a catastrophic birth with many complications, but because of the swift and expert interventions provided (including total body cooling) has managed to develop with no deficits in any area (physically or cognitively). Today she is an adorable, intelligent, able bodied little bean who seriously rocks pink UGG boots.

Another child who was born with a fatal cardiac anomaly, had surgical treatment, and also is now a happy-go-lucky perfectly healthy little man. I couldn't help but send mental props to the cardiac surgeons like Lillehei* who trialed, and failed, and failed, and developed and perfected surgeries like the repair of Tetralogy of Fallot or the Norwood procedures. If those men hadn't risked their careers and their emotional fortitude 50 years ago, today these children would have died at birth or after short and difficult lives.

My awestruck gaze was only sharpened by the fact that I was working with a seriously butt-kicking-ridiculously-intelligent-biochemistry-genetics-pediatric-metabolic-disorder-expert-ball-of-awesomeness consultant who loves to teach! I hoped some of her brain power might waft over in my direction if I sat close enough to her in clinic (without being too creepy and really invading her personal space).

And so, I return to my reading and eventually the newest episode of "New Girl".  Oh and yes, I am working like mad on my CaRMS application and my new research project. I have a whole post on recent CaRMS trauma in the works...but for now...I'll just say that today was a good day. A perfectly timed reminder of why I am putting myself through all of this.

*Read "Walk on Water" by Ruhlman and "King of Hearts" by Cooley if you really want to know what I am talking about. Both fascinating and unreal stories of larger than life pediatric cardiac surgeons.

I love going into the maternity hospital for work.

Ireland was apparently the first country in the world to have one. Every day I have to dodge new dads in the parking lot trying to juggle car seats and flowers, handbags, suitcases, and "IT'S A BOY!!" helium balloons. Women (mostly waddle) around in various brightly colored bathrobes, either trying to break up the boredom of being admitted, or in the hopes of getting things going in the labor department. Giant bellies, little bumps, nervous nulltips, exasperated over-termers populate the antenatal clinics. It's quite the humming baby factory.

On the labor ward every couple of hours a new admission would walk casually up to the desk with a mix of fear, sometimes excitement, expressions of pain, or lines of fatigue on their faces. Some would have to lean over the nurses desk if a contraction came while being checked in. Others went shooting by in a wheelchair pushed by an admissions midwife, hair blowing back behind them with the "don't push yet!!!" instruction barked by a senior midwife...a few minutes later we'd hear some hollering followed by the gusty cry of a new arrival to the planet. I could just smile to myself because at that moment only infinite possibilities exist for that baby.

Of course, of course we've seen sad outcomes, unexpected premature deliveries, undiagnosed syndromes and malformations. But even those, which weigh heavily on the staff, give me inspiration from the grace and strength exhibited by the families of those babies.

What a place! What a privilege.

No, I haven't drowned in a giant puddle of amniotic fluid.

I am loving life here in OB/GYN but just absolutely wrecked and savaged by work right now. Did nights through the weekend so am currently on my 10th day in a row at the hospital, am working on a Grand Rounds presentation for Friday, applying to CaRMS, writing up assignments...oh and I started collecting data for a new study yesterday.

I have a mouth full of canker sores and an ever-expanding derrière due to stress and lack of exercise.

But I'm good. I'm gooooooood.

Stories to come. Once the dust (er....fluids?) have settled.

In the meantime: birthing babies = awesome. 

After examining the tummy of a very pregnant lady we were ushered out into the hall to be pimped by our Registrar. He asked my friend what his findings were and to describe the fetal position.

Friend: Well....When I was feeling her abdomen I couldn't really tell if I was feeling the head at the top or if I was feeling the back and feet. So...at the fundus I palpated either the head or the feet.

[You really can't fault that logic.]

[This was just before I got the fetal lie completely wrong.]

[Figuring out fetal lie, position, and presentation is harder than it looks.]

The main thing I am currently trying to do is decide if I should or should not have a hot chocolate right now. I am still in my pajamas, and unshowered. All I've done today is clear the dining room table of stacked medical books. And I've eaten some snacks. And stared at the wall, in the typical now what? post-exam flat lined brain.

The exam was, a marathon of concentration but not too bad (except that I accidentally brought a mint chocolate flavored nakd bar with me as a snack---ahh I HATE MINT CHOCOLATE!) I am sure the prometric center lady thought I was a loon when she saw me pulling out the reams of food I had to declare prior to the exam. I just never know what I am going to crave or need to eat during times of extreme panic/stress but what I do know is that if I get hangry then I might throw the computer through the window. Yogurt, coconut water, almonds, apples, nakd bars, granola bars, water, more yogurt...I had a little tower of food placed atop the filing cabinet. I ended up chucking the bar in the bin after one bite, drinking a yogurt at race pace, and slamming the coconut water. I used almost all my time, just finishing the last few questions at the 3h 54 minute mark. I blame this on being ridiculously fastidious for the first 80 questions and then realizing I had 100 questions left and just over 100 mins left. It's been a while since I ran an exam marathon, cut me some slack.

After finishing I sped back to the hotel to shower, and check out. Then I zoomed over to the Operation Smile Dublin office to meet some of the staff involved in organizing my upcoming mission. While sitting in my car outside of the office, about 1hr after leaving the exam, I felt my pulse and noted that it was still >100 bpm. I tried to tell my adrenals to cool it. The saber toothed tiger was gone, I no longer needed 180 degree vision. I probably looked like a feral insurance saleswoman when I clunked in, suddenly very hungry and slightly wild eyed with a twitch to the right side of my mouth.

It was a very relaxed meeting and after chatting for a while the two of them stated that due to my arctic experience they should send me on one of their "really remote missions". Yes!! Well maybe they also were thinking that based on how I presented myself to them: better to tuck me far far away from any promotional material photo opportunities.

After that I was able to kick off my heels and head for the hills. (Well, shortly after a trip to my favorite deli in Dublin to stock up on essentials like Chile Hot Chocolate, truffle oil, and nice cheeses!) Drove out to the wild west coast and spent the weekend by the sea eating fantastic food, drinking Champagne, climbing up mountains, sleeping in, strolling around manicured gardens, sipping coffee, and just generally remembering how it felt to be human.

So thanks a million for all the lovely comments and emails of encouragement. It really means a lot coming up to an event like that.

Of course there are things already tugging at my sleeve to get started, like CaRMS, writing up my Grand Rounds presentation, school work...but not today. Or at least, not until after that hot chocolate.

So my MCCEE exam is in 2 days (basically, it's like the Step 2 USMLE).

I just found out that the cut off score for IMG residency interviews include:

-100 percentile Obs/Gyne at U of Ottawa
-99.5 percentile Emergency Medicine at U of Toronto
-86 percentile for Manitoba Obs/Gyne and Emergency Med

etc. etc.

This is probably information I didn't need at this time.

I will attempt to keep the building nervous breakdown in check for another 40h.

I was studying with my friend Gen today (I'm writing EE on 20th, she's on the 28th). The comedic highlight of the day for me was this.

Gen: So what are some other corticosteroid side effects...?

Me: Dunno, I think I've listed pretty much all of them.

Gen: How about hypokalemic metabolic alkalosis?

Me: Never heard of that one...wow! Ok, good to know.

Gen [deadpan]: You have that underlined and starred in your textbook.

Perfect. 

I was studying with my friend Gen today (I'm writing EE on 20th, she's on the 28th). The comedic highlight of the day for me was this.

Gen: So what are some other corticosteroid side effects...?

Me: Dunno, I think I've listed pretty much all of them.

Gen: How about hypokalemic metabolic alkalosis?

Me: Never heard of that one...wow! Ok, good to know.

Gen [deadpan]: You have that underlined and starred in your textbook.

Perfect. 

As I plod through drop down menus and hustle reference letters, I try to remind myself that I am thankful to have the burden of CaRMS. 5 years ago when I started the process of summer school organic chemistry courses I didn't even know if this day would ever arrive. But here I am, gathering all the little stones and jewels of experience from the last ten years, shining and presenting them for various selection committees, hoping to catch the eye and interest of some program director.

Obviously my thoughts are overrun with pre-exam stress (my Canadian board exam is a week from tomorrow) and the uncertainty of my future, but I am trying to stay positive and focus on one day at a time living.

And I reminded myself of what Kahlil Gibran writes about Work, and use that to keep it all in perspective.

Always you have been told that work is a curse and labor a misfortune.
But I say to you that when you work you fulfill a part of earth's furthest dream, assigned to you when that dream was born,
And in keeping yourself with labor you are in truth loving life,
And to love life through labor is to be intimate with life's inmost secret.

But if you in your pain call birth an affliction and the support of the flesh a curse written upon your brow, then I answer that naught but the sweat of your brow shall wash away that which is written...

...Work is love made visible.
And if you cannot work with love but only with distaste, it is better that you should leave your work and sit at the gate of the temple and take alms of those who work with joy.
For if you bake bread with indifference, you bake a bitter bread that feeds but half man's hunger.
And if you grudge the crushing of the grapes, your grudge distils a poison in the wine.
And if you sing though as angels, and love not the singing, you muffle man's ears to the voices of the day and the voices of the night.

As I plod through drop down menus and hustle reference letters, I try to remind myself that I am thankful to have the burden of CaRMS. 5 years ago when I started the process of summer school organic chemistry courses I didn't even know if this day would ever arrive. But here I am, gathering all the little stones and jewels of experience from the last ten years, shining and presenting them for various selection committees, hoping to catch the eye and interest of some program director.

Obviously my thoughts are overrun with pre-exam stress (my Canadian board exam is a week from tomorrow) and the uncertainty of my future, but I am trying to stay positive and focus on one day at a time living.

And I reminded myself of what Kahlil Gibran writes about Work, and use that to keep it all in perspective.

Always you have been told that work is a curse and labor a misfortune.
But I say to you that when you work you fulfill a part of earth's furthest dream, assigned to you when that dream was born,
And in keeping yourself with labor you are in truth loving life,
And to love life through labor is to be intimate with life's inmost secret.

But if you in your pain call birth an affliction and the support of the flesh a curse written upon your brow, then I answer that naught but the sweat of your brow shall wash away that which is written...

...Work is love made visible.
And if you cannot work with love but only with distaste, it is better that you should leave your work and sit at the gate of the temple and take alms of those who work with joy.
For if you bake bread with indifference, you bake a bitter bread that feeds but half man's hunger.
And if you grudge the crushing of the grapes, your grudge distils a poison in the wine.
And if you sing though as angels, and love not the singing, you muffle man's ears to the voices of the day and the voices of the night.

Tomorrow I start my 6 week obstetric/gynecology rotation!

I am ridiculously excited because I do really have a crush on Obs/Gyne. I mean, I've always loved attending births (how could you not, unless you were dead inside?!) but now that I have realized how much I enjoy surgical procedures in some ways it seems like an ideal specialty for me*. Another reason I am looking forward to this rotation is our Prof is someone who is at the top of her game in both academic and clinical medicine. Plus, she loves her job to the point of infectious enthusiasm. I admire her on so many levels. I hope someday (no matter where I end up) to receive the same joy from my career.

It is okay. I still have about 20 mins until I have to chose my future specialty. Tick. Tock.

Also, if you feel like making any of the following statements in the comment section:

-oh you're always on call
-obs/gyne attendings/residents are evil
-the hours are terrible
-vaginas are gross
-you will get sued everyday
-terrible lifestyle
-fluids. Enough said. 
-you will get sued everyday
-prepare yourself for lawsuits
-did you know gynecologists pay the highest malpractice premiums
-you will hate your job/life

Just save your typing fingers. I've heard it all a thousand times before. Really. I get it. Just let me have my crush and enjoy my little rotation happiness bubble for a few more moments. I am sure that I will be ranting and raving about all the challenges soon enough.  

--

*Well it would be if I didn't have some weird first-love hangup for emergency medicine, which I just can't seem to shake.

Tomorrow I start my 6 week obstetric/gynecology rotation!

I am ridiculously excited because I do really have a crush on Obs/Gyne. I mean, I've always loved attending births (how could you not, unless you were dead inside?!) but now that I have realized how much I enjoy surgical procedures in some ways it seems like an ideal specialty for me*. Another reason I am looking forward to this rotation is our Prof is someone who is at the top of her game in both academic and clinical medicine. Plus, she loves her job to the point of infectious enthusiasm. I admire her on so many levels. I hope someday (no matter where I end up) to receive the same joy from my career.

It is okay. I still have about 20 mins until I have to chose my future specialty. Tick. Tock.

Also, if you feel like making any of the following statements in the comment section:

-oh you're always on call
-obs/gyne attendings/residents are evil
-the hours are terrible
-vaginas are gross
-you will get sued everyday
-terrible lifestyle
-fluids. Enough said. 
-you will get sued everyday
-prepare yourself for lawsuits
-did you know gynecologists pay the highest malpractice premiums
-you will hate your job/life

Just save your typing fingers. I've heard it all a thousand times before. Really. I get it. Just let me have my crush and enjoy my little rotation happiness bubble for a few more moments. I am sure that I will be ranting and raving about all the challenges soon enough.  

--

*Well it would be if I didn't have some weird first-love hangup for emergency medicine, which I just can't seem to shake.

This is what it feels like to be an IMG in the medical community:

MAN
WOMAN
HORSE
DOG
CAT
RAT
COCKROACH
LIVER FLUKE
Clostridium difficile 
IMG

I found out this weekend that I am inelegible to apply to the UK for internship.

Is this some kind of sick joke??

Yes, if you are not a UK, Irish or EU citizen then you need to write the PLAB (Professional and Linguistic Assessment Board exam) which ensures you have a basic grasp of the English language and basic clinical medicine. The downer is that I can't write it while still in medical school which means I am not eligible to meet the criteria to apply for internship. Annoying because Irish students don't have to write it, yet...I am going to graduate from an Irish medical school.

I was really getting excited about the prospect of possibly going to the UK if Canada didn't work out, so having another post-graduate door tightly closed in my face really is starting to get to me.

I feel like standing on top of something large and yelling,

This is what it feels like to be an IMG in the medical community:

MAN
WOMAN
HORSE
DOG
CAT
RAT
COCKROACH
LIVER FLUKE
Clostridium difficile 
IMG

I found out this weekend that I am inelegible to apply to the UK for internship.

Is this some kind of sick joke??

Yes, if you are not a UK, Irish or EU citizen then you need to write the PLAB (Professional and Linguistic Assessment Board exam) which ensures you have a basic grasp of the English language and basic clinical medicine. The downer is that I can't write it while still in medical school which means I am not eligible to meet the criteria to apply for internship. Annoying because Irish students don't have to write it, yet...I am going to graduate from an Irish medical school.

I was really getting excited about the prospect of possibly going to the UK if Canada didn't work out, so having another post-graduate door tightly closed in my face really is starting to get to me.

I feel like standing on top of something large and yelling,

I was told last week by my attending that having a medical student sit in on consultations all day was "a bit like having a hitch hiker in the car". That it made him feel slightly self conscious and ill at ease. I thought this was a rather hilarious analogy and so I repeated it to my new attending this week.

I was told last week by my attending that "having a medical student sit in on consultations all day was a bit like having a hitch hiker in the car". That it made him feel slightly self conscious and ill at ease. I thought this was a rather hilarious analogy and so I repeated it to my new attending this week. 

Of course I had to bail, once again and call the facility and request directions from "somewhere near the castle*". When I arrived, late, everyone made such a fuss over how often people get lost and how sorry they were that I had started my Monday that way. I was told to take a break and tea was made, scones were proffered and I figured, "Hmm, I could really get on board with this whole psychiatry thing!"

---


*Reason #342 that I love Ireland. 

Of course I had to bail, once again and call the facility and request directions from "somewhere near the castle*". When I arrived, late, everyone made such a fuss over how often people get lost and how sorry they were that I had started my Monday that way. I was told to take a break and tea was made, scones were proffered and I figured, "Hmm, I could really get on board with this whole psychiatry thing!"

---


*Reason #342 that I love Ireland. 

Of course I had to bail, once again and call the facility and request directions from "somewhere near the castle*". When I arrived, late, everyone made such a fuss over how often people get lost and how sorry they were that I had started my Monday that way. I was told to take a break and tea was made, scones were proffered and I figured, "Hmm, I could really get on board with this whole psychiatry thing!"

---


*Reason #342 that I love Ireland. 

Ok people. 

Ok people.

Ok people. 

Tuesday was the first day of my new attachment in psychiatry. I had google mapped how to get there and saw that it took 39 mins, so I gave myself an hour. My prof had also passed on the typical vague Irish direction set, "Take the road, it kinda veers, follow that for a while, eventually turn right before the motorway, near the hill, you can't miss it..."

Tuesday was the first day of my new attachment in psychiatry. I had google mapped how to get there and saw that it took 39 mins, so I gave myself an hour. My prof had also passed on the typical vague Irish direction set, "Take the road, it kinda veers, follow that for a while, eventually turn right before the motorway, near the hill, you can't miss it..."

Tuesday was the first day of my new attachment in psychiatry. I had google mapped how to get there and saw that it took 39 mins, so I gave myself an hour. My prof had also passed on the typical vague Irish direction set, "Take the road, it kinda veers, follow that for a while, eventually turn right before the motorway, near the hill, you can't miss it..."

This week has been comprised of mostly lectures and case-based learning for psyche. It's been a nice way to wade back into the hospital pool. My head would probably explode if I were doing 4h ward rounds and being pimped on things like the causes of ascites.

Also, our professor of psychiatry is a very dynamic, engaging lecturer who ensures we don't get bogged down in the language and the esoteric aspects of mental health. So that part has been entertaining and educational.

The other day I thought something he said was quite simple, but interesting. We were talking about the dress code on the psyche ward. He scanned the room to take in what we were all wearing (various degrees of LL Bean, basically).

Turtlenecks, they're so hip right now...turtlenecks.

He nodded and gave his approval, then said, "Just think, when you're getting dressed to come to the psyche ward, it is not about you, it is about the patients. If you're wearing provocative clothes, loud, dangly jewelery, etc., you might distress or distract some of the patients in ways that are uncomfortable for them. Bottom line: it is not about you."

I really liked that way of framing it. Because the school has given us detailed lists of 'acceptable' clothing options, though I have seen some...er...interesting outfits trotted out. I think looking at what you wear to work in that light is probably the best gauge for appropriateness. Who am I wearing this for? And I'd say it applies outside the realm of psyche too.

All this, of course, coming from a woman who hopes to spend her life in scrubs and outlandish clogs. 

This week has been comprised of mostly lectures and case-based learning for psyche. It's been a nice way to wade back into the hospital pool. My head would probably explode if I were doing 4h ward rounds and being pimped on things like the causes of ascites.

Also, our professor of psychiatry is a very dynamic, engaging lecturer who ensures we don't get bogged down in the language and the esoteric aspects of mental health. So that part has been entertaining and educational.

The other day I thought something he said was quite simple, but interesting. We were talking about the dress code on the psyche ward. He scanned the room to take in what we were all wearing (various degrees of LL Bean, basically).

Turtlenecks, they're so hip right now...turtlenecks.

He nodded and gave his approval, then said, "Just think, when you're getting dressed to come to the psyche ward, it is not about you, it is about the patients. If you're wearing provocative clothes, loud, dangly jewelery, etc., you might distress or distract some of the patients in ways that are uncomfortable for them. Bottom line: it is not about you."

I really liked that way of framing it. Because the school has given us detailed lists of 'acceptable' clothing options, though I have seen some...er...interesting outfits trotted out. I think looking at what you wear to work in that light is probably the best gauge for appropriateness. Who am I wearing this for? And I'd say it applies outside the realm of psyche too.

All this, of course, coming from a woman who hopes to spend her life in scrubs and outlandish clogs. 

This week has been comprised of mostly lectures and case-based learning for psyche. It's been a nice way to wade back into the hospital pool. My head would probably explode if I were doing 4h ward rounds and being pimped on things like the causes of ascites.

Also, our professor of psychiatry is a very dynamic, engaging lecturer who ensures we don't get bogged down in the language and the esoteric aspects of mental health. So that part has been entertaining and educational.

The other day I thought something he said was quite simple, but interesting. We were talking about the dress code on the psyche ward. He scanned the room to take in what we were all wearing (various degrees of LL Bean, basically).

Turtlenecks, they're so hip right now...turtlenecks.

He nodded and gave his approval, then said, "Just think, when you're getting dressed to come to the psyche ward, it is not about you, it is about the patients. If you're wearing provocative clothes, loud, dangly jewelery, etc., you might distress or distract some of the patients in ways that are uncomfortable for them. Bottom line: it is not about you."

I really liked that way of framing it. Because the school has given us detailed lists of 'acceptable' clothing options, though I have seen some...er...interesting outfits trotted out. I think looking at what you wear to work in that light is probably the best gauge for appropriateness. Who am I wearing this for? And I'd say it applies outside the realm of psyche too.

All this, of course, coming from a woman who hopes to spend her life in scrubs and outlandish clogs.