Well, let's just forget that "summer" ever happened. Those 5 precious weeks have come and gone with their hurdles and minimal pleasantry, save a lovely week with family and the delicious food eaten throughout and still now (smoked meat, lobster, french onion soup, etc...)
Ok, maybe I am being a little ingracious. Despite the restricted fun of the first few weeks amidst lots of studying (which doesn't always pay off in obvious, material, measurable ways, although one certainly does learn and re-learn a whole heck of a lot!), I did become quite engrossed in the FIFA World Cup and was extremely pleased to see my Spanish Roja win.
But one never expects or rejoices in heartache. It is more like a death all over again really, except it also leaves an abominable hole (I swear it feels very somatic -left parasternal border, 4th intercostal space... a physical hurt). As they say though, we're meant to learn from these things. And I did -I learned a whole heap about so many things (the vagueries are deliberate as a eulogy or shrine to the flitting beauty of affection and tenderness that imbued that tie). The longing remains, as does the love and memories (both wonderful and awful)... I'm basically counting on Lady Time to heal it all eventually.
So, anyways. This week is my second week of my Psychiatry rotation (my first official clerkship rotation) and it is awesome! The learning curve is pretty much vertical -I learned crazy amounts of stuff (no pun intended...) in just 6 days already (+1 call). Seen lots of schizophrenia, schizoaffective disorder, bipolar disorder, major depression and a few suicidal cases -emotionally tiring but very rewarding interactions and I very much enjoy the general demeanor / attitude of most of the psychiatrists and residents I have met so far. I follow 4 patients on a regular patients and basically spend more time with them than any of my superiors and it's amazing to observe and understand how they progress or deteriorate, followed by discussing potential management plans etc with the attending staff. So much fun, really... I am that much closer to becoming an almost-doctor! And the psych-social stuff is awesome, so you get to better understand the legal system (for example when you have a patient from the prison, who, in a state of acute psychosis nearly stabs someone to death...), the welfare system (a lot of psych patients are on welfare, though in some cases a third of it may go towards supporting a hefty drug habit or "self-medicating"... still they could not survive without it!), and social institutions that provide activities for people who otherwise could not work and would have nothing to occupy their days, which honestly would make anyone crazy out of boredom (so they can go to these centres and do wood-working, or plant-care, or computers or ceramics and get 'paid' for their work, a nominal $1.60 per day) and it's awesome, because a part from anti-psychotics, mood stabilizers and anti-depressants, or electro-convulsive therapy (hey, don't knock it! it's the most effective therapy for acute suicidality and mania, there's proper anaesthesia involved and all you see is a foot-twitch!), you can also prescribe these activities, like, on a prescription. It's pretty neat. The whole big picture I mean. It's not just brain drugs. It's a whole system of bio-psycho-social care and it is great (so far. from what I've seen.).
Anyways, I know. As fascinating as this part of my life is, everyone probably wants to know more about the heartache. You know, human beings are so fascinating in that way. It's like Elizabeth Gilbert wrote in Eat, Pray, Love (btw, I'm sure the book will be better than the movie, though I am so pumped to see the movie!): there are psychologists who have talked to people who have survived genocides when they were in refugee camps and all they could talk about was how that guy left me and took up with my best friend and that girl is in love with my brother, etc, etc. For all our grand achievements and terrible atrocities as a species, all we can think about is love.
Or at least I know that I certainly fall into that category. And, frankly, thank God I do. Love makes life worth living... even when it doesn't quite work out the way you thought it would (and believe me, my hurt is fresh enough, but this really is just the truth of the whole thing).
Monday, August 9, 2010
Saturday, June 19, 2010
Post-surgery & half-doctor: Yes, she still writes!
Surgery has come and gone, and look, I haven't even written to you! For shame. In short, surgery was a wonderful experience overall... hard work, no doubt, but also awesome. I had the best mentor surgeon of all time. She was not a 'typical surgeon' -lovely bedside manner, attentive, patient and caring, gentle, loved by her patients even when they had complications... and really, just a beautiful person. And she was the chief of general surgery at the hospital where I was placed.
Cool points of the rotation: I got to scrub in on a couple of surgeries -an open indirect inguinal hernia repair and a laparoscopic cholecystectomy (gall bladder removal), the latter in which I almost fainted while retracting (luckily I had the sense to mention that I was "feeling a little faint", so that the scrub nurse could quickly take over and make me sit on the floor before I totally blacked out!). I also watched 2 cataract surgeries and a corneal transplant (awesome to watch, but I never want to be an opthalmologist. I also never want to be a radiologist. Something about spending all your days in a dark room, I think...). The OR is kind of amazing though -thrilling (and hardcore, I'm not going to lie)!.
You know what else is thrilling and hardcore? The season finale of Grey's Anatomy (which of course I only finally had the chance to watch yesterday after my surgery exam and before the end of ICM BBQ at Beaver Lake). Stunning episode, amazing acting, and so intense. Not only did I tear up, I was actually sobbing -best outlet of life, I say!
And now I am half a doctor (well, you can't really be half a doctor... just like how you can't really be half pregnant, but it sounds cool doesn't it?). Start up again end of July and no holiday for the next 2 years (for real. like I have to choose whether I want to take Christmas Day or New Year's Day off). So my exciting summer plans include writing the USMLE Step 1, having my extended family come visit from out-west (first time in over 10 years for most of them, so that will be wonderful!), and then retreating up north for a few days to recharge before Clerkship officially begins.
However, before I get back to studying for this next exam, I am taking this weekend off. Le battery is dead, the tank is on empty, le brain is nearly dead, exhaustedly, I have nothing left to offer the world at this very moment. So today there was some self-pampering with an aromatherapy massage, a nice vegetarian lunch... also I have taken to drinking homemade matcha green tea-almond milk frappes... so delicious and energizing! I played the piano a bit (for the first time in a long time), I watched the end of a devastating FIFA World Cup match for Cameroon.
The best thing in life these days though is reading Three Cups of Tea and worshipping Greg Mortenson (hopefully I will finally finish this amazing book by the end of tomorrow!) Another best thing in life was going to my first wedding of an undergrad roommate. It's official. I will be going to weddings for the next 10 years, right? Then it will be time for, as Franc, in Father of the Bride II, would say, "the behbeh showa". Life is too crazy.
But overall, I think it's good. Just important to recharge those batteries. And to always take the time to write. Note to self: do as I say, not as I do!
Cool points of the rotation: I got to scrub in on a couple of surgeries -an open indirect inguinal hernia repair and a laparoscopic cholecystectomy (gall bladder removal), the latter in which I almost fainted while retracting (luckily I had the sense to mention that I was "feeling a little faint", so that the scrub nurse could quickly take over and make me sit on the floor before I totally blacked out!). I also watched 2 cataract surgeries and a corneal transplant (awesome to watch, but I never want to be an opthalmologist. I also never want to be a radiologist. Something about spending all your days in a dark room, I think...). The OR is kind of amazing though -thrilling (and hardcore, I'm not going to lie)!.
You know what else is thrilling and hardcore? The season finale of Grey's Anatomy (which of course I only finally had the chance to watch yesterday after my surgery exam and before the end of ICM BBQ at Beaver Lake). Stunning episode, amazing acting, and so intense. Not only did I tear up, I was actually sobbing -best outlet of life, I say!
And now I am half a doctor (well, you can't really be half a doctor... just like how you can't really be half pregnant, but it sounds cool doesn't it?). Start up again end of July and no holiday for the next 2 years (for real. like I have to choose whether I want to take Christmas Day or New Year's Day off). So my exciting summer plans include writing the USMLE Step 1, having my extended family come visit from out-west (first time in over 10 years for most of them, so that will be wonderful!), and then retreating up north for a few days to recharge before Clerkship officially begins.
However, before I get back to studying for this next exam, I am taking this weekend off. Le battery is dead, the tank is on empty, le brain is nearly dead, exhaustedly, I have nothing left to offer the world at this very moment. So today there was some self-pampering with an aromatherapy massage, a nice vegetarian lunch... also I have taken to drinking homemade matcha green tea-almond milk frappes... so delicious and energizing! I played the piano a bit (for the first time in a long time), I watched the end of a devastating FIFA World Cup match for Cameroon.
The best thing in life these days though is reading Three Cups of Tea and worshipping Greg Mortenson (hopefully I will finally finish this amazing book by the end of tomorrow!) Another best thing in life was going to my first wedding of an undergrad roommate. It's official. I will be going to weddings for the next 10 years, right? Then it will be time for, as Franc, in Father of the Bride II, would say, "the behbeh showa". Life is too crazy.
But overall, I think it's good. Just important to recharge those batteries. And to always take the time to write. Note to self: do as I say, not as I do!
Wednesday, April 7, 2010
Confronting the Internal Issue
So why have I not said a word about medicine lately. I am sure you are wondering this. Or maybe I flatter myself here. But well, let's confront the hard, cold truth here. Which is that I am not particularly enjoying it these days. In fact, sometimes I resent it. I am glad to be learning a whole lot of stuff, of course. It's the pressure-cooker I can't stand. That is what I am in right now, veritably. Believe me -Internal Medicine is no picnic. And I would know, because I actually did go for a lovely picnic this past summery long weekend in Montreal. We ate delicious avacado, havarti, sliced turkey, tomato, lettuce and dijon-mayo with salt and pepper sandwiches. And there was bocconcini, baby tomato and pesto salad. And later that weekend, my semi-salty chocolate chunk cookies. And Internal Medicine is galaxies away from that.
If I had to describe Internal in one word it would be this: a drag. But actually soul-sucking, opposite of joie-de-vivre, let's watch really sick, really old people who are too far gone to actually help -let's watch them get sicker, be in more pain, deal with more side effects, happily acquire C. difficile and VRE until their bodies and spirits and minds waste away, wrangle their friends and families haggard, give up with one last moan and at last, die. Now, you might be wondering how on Earth I could utter these words and yet be so infatuated with Palliative Care. That is because in Palliative, the goal is not "one last damn fight" to manage or control or cure the pathology. It is to manage pain, to make patients comfortable in their last days so that they can attend to more important material and spiritual concerns before leaving this world. The goal is the patient, not the collection of systems that happen to find themselves in a single human body. Bleak, you say? My friends, you ain't seen bleak until you've lived Internal.
And maybe that's life's ironic metaphor. That anything Internal is really an Inferno, which, if you're not careful, will burn you up and leave behind nothing but smoke and ash. Now really, this is not to say that the doctors in Internal Med are not good doctors. As a darling friend would say, "Au contraire mon frère!". They are some of the best doctors, hands-down. They are bright, compassionate, award-worthy, have one hell of a memory, boundless energy and the ones I have met really love what they do -really, exemplary physicians, no question. But it's the culture of Internal that is soul-sucking, the know-it-all, we're-so-busy-and-important and frankly reductionist 2D-attitude that rubs up so hard against me. I don't know. Perhaps I'm being unfair. Perhaps these guys have all read Kuhn's The Structure of Scientific Revolutions and Kleinman's What Really Matters and Andrea Tone's Medicating Modern America and enjoy reading fiction on occasion.
Just, well, my imagination feels so... stunted. Not because they don't think out of the box -believe me, if anyone has to think outside the box, it's these guys. But... there's... I just have a general feeling that there is a missing-the-forest-for-the-trees here. There ain't no space for no existential crisis. Nobody has the room to break themselves open and re-make themselves whole. And I can't quite touch the tangible problem here, except that I feel like my favourite part of me and what will make me the good kind of doctor that I want to be, kind of dies a little every day in there. Like someone rubbing margarine all over your windows... I mean, you can't see anymore! Really see. Because the science of the medicine is extremely important, absolutely 1000% necessary (and I plan on doing my 1000% best in learning it, I swear), but so wholly and fully insufficient. There is no way anyone is seeing the whole picture when the body is just an ammalgamation of systems. The whole is greater than the parts. And when it comes down to it, even Internal cannot explain the whole -they'll just call it 'autoimmune' instead. Sometimes they'll say 'idiopathic' (as in "we're idiots on this one"). They'll diagnose your COPD, your CAD, your CHF, your RA, your pancreatitis, your anemia... but when it comes to managing the whole picture and the person that actually manages to get them all (these poor patients, yes, they exist)... it's a sad deal. And it's suffering and wasting away and then a long (or short), painful death.
Yes, all areas of medicine deal with suffering and pain and death. But there's something about this baby that just saps my energy to negative 10,000. Really. I don't know what it is. But it makes me miss Anaesthesia like nobody's business. Okay. So there you have it. I think I'd most likely rather be a surgeon than an internist any day. But who knows -I have yet to do my ICM surgery rotation.
If I had to describe Internal in one word it would be this: a drag. But actually soul-sucking, opposite of joie-de-vivre, let's watch really sick, really old people who are too far gone to actually help -let's watch them get sicker, be in more pain, deal with more side effects, happily acquire C. difficile and VRE until their bodies and spirits and minds waste away, wrangle their friends and families haggard, give up with one last moan and at last, die. Now, you might be wondering how on Earth I could utter these words and yet be so infatuated with Palliative Care. That is because in Palliative, the goal is not "one last damn fight" to manage or control or cure the pathology. It is to manage pain, to make patients comfortable in their last days so that they can attend to more important material and spiritual concerns before leaving this world. The goal is the patient, not the collection of systems that happen to find themselves in a single human body. Bleak, you say? My friends, you ain't seen bleak until you've lived Internal.
And maybe that's life's ironic metaphor. That anything Internal is really an Inferno, which, if you're not careful, will burn you up and leave behind nothing but smoke and ash. Now really, this is not to say that the doctors in Internal Med are not good doctors. As a darling friend would say, "Au contraire mon frère!". They are some of the best doctors, hands-down. They are bright, compassionate, award-worthy, have one hell of a memory, boundless energy and the ones I have met really love what they do -really, exemplary physicians, no question. But it's the culture of Internal that is soul-sucking, the know-it-all, we're-so-busy-and-important and frankly reductionist 2D-attitude that rubs up so hard against me. I don't know. Perhaps I'm being unfair. Perhaps these guys have all read Kuhn's The Structure of Scientific Revolutions and Kleinman's What Really Matters and Andrea Tone's Medicating Modern America and enjoy reading fiction on occasion.
Just, well, my imagination feels so... stunted. Not because they don't think out of the box -believe me, if anyone has to think outside the box, it's these guys. But... there's... I just have a general feeling that there is a missing-the-forest-for-the-trees here. There ain't no space for no existential crisis. Nobody has the room to break themselves open and re-make themselves whole. And I can't quite touch the tangible problem here, except that I feel like my favourite part of me and what will make me the good kind of doctor that I want to be, kind of dies a little every day in there. Like someone rubbing margarine all over your windows... I mean, you can't see anymore! Really see. Because the science of the medicine is extremely important, absolutely 1000% necessary (and I plan on doing my 1000% best in learning it, I swear), but so wholly and fully insufficient. There is no way anyone is seeing the whole picture when the body is just an ammalgamation of systems. The whole is greater than the parts. And when it comes down to it, even Internal cannot explain the whole -they'll just call it 'autoimmune' instead. Sometimes they'll say 'idiopathic' (as in "we're idiots on this one"). They'll diagnose your COPD, your CAD, your CHF, your RA, your pancreatitis, your anemia... but when it comes to managing the whole picture and the person that actually manages to get them all (these poor patients, yes, they exist)... it's a sad deal. And it's suffering and wasting away and then a long (or short), painful death.
Yes, all areas of medicine deal with suffering and pain and death. But there's something about this baby that just saps my energy to negative 10,000. Really. I don't know what it is. But it makes me miss Anaesthesia like nobody's business. Okay. So there you have it. I think I'd most likely rather be a surgeon than an internist any day. But who knows -I have yet to do my ICM surgery rotation.
Sunday, March 28, 2010
Post-Baking...
So, yes. I did, in fact, actually bake. I didn't pull the "oh it would be nice to start baking in theory" stunt. Just pulled out my first batch of chocolate chunk/chip cookies, which are huge because how would i know those dollops would expand into massive, flat... things. The dough tasted a bit salty for some reason, even though i put everything in exactly like the recipe said to, except I cut the sugar quantity in half, just like my mum always does. Cookies are successful in being crispy on the outside, soft and gooey on the inside, but they crumble a bit -why is that? Anything to do with the changed sugar to everything else ratio? And although the cookies are not quite as salty as the raw dough, they taste just a tad on the saltier side... I don't know. I feel a bit discouraged to be honest. Like how am I going to one day bake the world's most fabulous red velvet cake if I can't even get a batch of standard, run-of-the-mill chocolate chip cookies done right? Sigh.
I have a headache now. True, I did eat a massive Sunday buffet brunch at this Indian restaurant in the West Island that I had never been to before... fried fish, tandoori chicken, another kind of barbecued chicken, pakoras and puri-chaat... those were just the appetizers (I went up twice for these). Then three naan slices with aloo gobi, butter chicken, lamb curry and spicy chicken curry (this was in 2 plate-fulls). Then dessert of kheer and gulab jammun... that was done thrice. And a cup of chai. Then in making my cookies, I ate some cookie dough. Then of course once the cookies were made, even though I felt like I was going to explode, I had to try 3/4 of one, having already downed 2 glasses of water to compensate for the salty dough. Now I really feel bloated, sick, tired... I even did yoga this morning (but apparently not enough to prepare for all these obnoxious assaults on my body...).
Really... I should just fast the rest of the day. Maybe a nap will help before trying to study... gotta get rid of this food overload, but I feel too tired to join my father for a walk. Ok... here's the plan: nap for half an hour, learn how to read ECGs better for 30-60 min, read some Blueprints afterwards. God give me strength. At least we know I won't get hungry in between...
I have a headache now. True, I did eat a massive Sunday buffet brunch at this Indian restaurant in the West Island that I had never been to before... fried fish, tandoori chicken, another kind of barbecued chicken, pakoras and puri-chaat... those were just the appetizers (I went up twice for these). Then three naan slices with aloo gobi, butter chicken, lamb curry and spicy chicken curry (this was in 2 plate-fulls). Then dessert of kheer and gulab jammun... that was done thrice. And a cup of chai. Then in making my cookies, I ate some cookie dough. Then of course once the cookies were made, even though I felt like I was going to explode, I had to try 3/4 of one, having already downed 2 glasses of water to compensate for the salty dough. Now I really feel bloated, sick, tired... I even did yoga this morning (but apparently not enough to prepare for all these obnoxious assaults on my body...).
Really... I should just fast the rest of the day. Maybe a nap will help before trying to study... gotta get rid of this food overload, but I feel too tired to join my father for a walk. Ok... here's the plan: nap for half an hour, learn how to read ECGs better for 30-60 min, read some Blueprints afterwards. God give me strength. At least we know I won't get hungry in between...
Wednesday, March 24, 2010
Spring Fever? More like "this season is on 'shrooms"...
It has been a long time since I have written. Really, it's just not healthy for a writer not to be writing more often... like an athlete who stops training -they get out of shape, they're not on their game, and most importantly, they probably also feel terrible (endorphins-withdrawal or something!). So forgive the off-beat style today.
The weather has gone nuts. Ya think it's spring, and then, BOOM! Hail, snow, rain... all at the same time. The trees that had just begun to bud were dipped in crystal and cold, along with that spring optimism. But take heart -we are stronger and tougher than that. And this morning, the sun shone bright as lamp posts cried puddles around us, and the glistening rainbows between the branches of the phantom-like trees dared another storm. It's so bizarre. And frankly, it's sickeningly exhausting sometimes (as in, I am actually sick because what ordinary human body can handle such temperature fluctuation without reeling just a little!).
Anyways. I think I want to learn how to bake some stuff. Mostly, because I realize I have become a cookie monster over the last month or so... it's great when the crispy-on-the-outside, soft-and-chewy-in-the-middle varities of chocolate chip heavenly morsels are free. (Aside: why does free stuff always taste better? look better? wear better? i mean seriously, isn't your favourite pen that free one you got at recruiting 2 years ago?) But you know, these days are not like those good ol' days... to purchase a gourmet cookie, will cost one roughly $3.99 -for one bloody cookie! It's insane. And multiply that number by 100 and you've got the calorie count for that same cookie -again, for one bloody cookie! And although these cookies do tend to be delicious, they are invariably too sweet. So like, I need to find a good cookie recipe and just cut that sugar in half. That way, I can eat 2 whole cookies for roughly 399 calories, savvy? Good recipe suggestions welcome. The other nice thing about baking is then sharing the goods with the people you adore -always a much enjoyed and heartily appreciated gesture to indulge a gourmande (and let's be serious, I do not befriend people who are not gourmandes ;).
Speaking of good food. I ate quite a delicious margherita pizza last weekend (yes, in Toronto of all places... i know, i know, incroyable, really! but good food in that city does in fact, exist... actually, since the last 3 months I have been visiting Toronto, I have yet to have an unpleasant culinary experience, which believe me, surprises both me and you... not to diss Toronto, but you know, I'm still a little sore about last weekend's hockey game -hopefully we beat the Sabres tonight though... then all will be well =) So anyway, this pizza. Hole in the wall place -Buddha Pie. Gourmet-pizza standard price. Thin crust (a bit too crispy, I will admit... yet not a deal-breaker by any stretch!), fresh crushed tomatoes as a base 'sauce', buffalo mozarella (slightly over-melted, but again, still fantastic), and freshly chopped basil. Really. Really. It was good. It was mmmmmm... good.
Well, nothing like writing - writing about the natural world, writing about food, to cheer one up amidst these seasonal upheavals!
The weather has gone nuts. Ya think it's spring, and then, BOOM! Hail, snow, rain... all at the same time. The trees that had just begun to bud were dipped in crystal and cold, along with that spring optimism. But take heart -we are stronger and tougher than that. And this morning, the sun shone bright as lamp posts cried puddles around us, and the glistening rainbows between the branches of the phantom-like trees dared another storm. It's so bizarre. And frankly, it's sickeningly exhausting sometimes (as in, I am actually sick because what ordinary human body can handle such temperature fluctuation without reeling just a little!).
Anyways. I think I want to learn how to bake some stuff. Mostly, because I realize I have become a cookie monster over the last month or so... it's great when the crispy-on-the-outside, soft-and-chewy-in-the-middle varities of chocolate chip heavenly morsels are free. (Aside: why does free stuff always taste better? look better? wear better? i mean seriously, isn't your favourite pen that free one you got at recruiting 2 years ago?) But you know, these days are not like those good ol' days... to purchase a gourmet cookie, will cost one roughly $3.99 -for one bloody cookie! It's insane. And multiply that number by 100 and you've got the calorie count for that same cookie -again, for one bloody cookie! And although these cookies do tend to be delicious, they are invariably too sweet. So like, I need to find a good cookie recipe and just cut that sugar in half. That way, I can eat 2 whole cookies for roughly 399 calories, savvy? Good recipe suggestions welcome. The other nice thing about baking is then sharing the goods with the people you adore -always a much enjoyed and heartily appreciated gesture to indulge a gourmande (and let's be serious, I do not befriend people who are not gourmandes ;).
Speaking of good food. I ate quite a delicious margherita pizza last weekend (yes, in Toronto of all places... i know, i know, incroyable, really! but good food in that city does in fact, exist... actually, since the last 3 months I have been visiting Toronto, I have yet to have an unpleasant culinary experience, which believe me, surprises both me and you... not to diss Toronto, but you know, I'm still a little sore about last weekend's hockey game -hopefully we beat the Sabres tonight though... then all will be well =) So anyway, this pizza. Hole in the wall place -Buddha Pie. Gourmet-pizza standard price. Thin crust (a bit too crispy, I will admit... yet not a deal-breaker by any stretch!), fresh crushed tomatoes as a base 'sauce', buffalo mozarella (slightly over-melted, but again, still fantastic), and freshly chopped basil. Really. Really. It was good. It was mmmmmm... good.
Well, nothing like writing - writing about the natural world, writing about food, to cheer one up amidst these seasonal upheavals!
Sunday, February 28, 2010
Anaesthesia: Intoxication and in His Head...
The Overview
I loved it. Best ICM rotation of life (so far, obviously). Kicks oncology's ass (let it be known -I have no interest whatsoever in oncology... BORING in all its forms). Nor do I care much for peds (kudos to those who have the patience for that... frankly, it just got on my nerves, at least in the family med setting... in fact, I may seriously reconsider my interest in family medicine based on the reality that I would have to deal with sick kids and their parents...).
But enough on what I don't like. Yes, it's true, I had to start everyday at 7:30 a.m. and anesthesiologists have to deal with arrogant surgeons (there is 1 respectful, kind, collegial surgeon for every 3 assholes), and if you're on the cystology/urology service, it is boring as all hell (urology: another shoot-me-in-the-face specialty).
Yet, overall I loved it -thoroughly enjoyable experience. I learned and got to practice intubations, mask-ventilations and putting in IV lines for patients... already, they actually let us DO stuff! I got to do some pre-operative assessments on my own (so much fun... doctor-patient interaction which is nice, but it's about a specific issue so naturally limits how long this lasts, and you provide them with all the information and reassurances that they need to feel a bit more comfortable about their surgeries and the anaesthesia they will undergo... and you get to assess their airways which is always fun =). There were 3 particular 'anaesthesia moments' which made quite an impression on me, which I will now share with you.
Day 1 Intoxication: On the brink of death in Obstetrical Anaesthesia
My very first day in anaesthesia was on the Obs service with one of the sweetest anaesthesiologists at the hospital. We started with a bunch of pre-op assessments for a bunch of women scheduled for C-sections, which was fun. And then we were called to the Obs OR to do the anaesthesia for a woman having a C-section for a breach. She was scared and vulnerable and her big blue eyes were like large watery wells as she looked at us with a desperate trust before we put her to sleep (general anaesthesia aka GA). Baby was delivered successfully. But. She had depressed respiratory drive and slow, irregular heart beat / weak pulse. They started to mask-ventilate. Then it was a code pink and a frantic search for a small enough endotracheal tube to intubate the baby, a flood of docs and supportive staff with crash cart and finally the adminstration of naloxone, which stabilized the baby.
It turned out the mother was being treated for chronic pain with opioids, resulting in opioid toxicity in the infant -naloxone was the antidote. They saved the baby's life but it was scary as hell. To be in there and to be utterly and completely useless as a second-year medical student. The best I did was stay out of the way. They don't count on us to do anything, but the uselessness was just overwhelming. I could not get the crash cart (like I knew where that was kept!), I could not call for help (who to call? what to say? what to ask for? you can't exactly run out into the hall screaming 'help!'), I could not even give the nurse a pair of gloves because I didn't know where they were kept. You know, we know we're not the most instrumental people as students when we go into these ICM rotations. But in that life-and-death situation, it makes you feel like you're trapped in a box and can't get out and can't scream and... helpless, helpless, helpless. And you look over and see the mother completely knocked out under GA -she cannot do anything for her baby, she cannot protect the baby or do anything for it as Nature had intended... and the baby, so small and helpless and breathless and vulnerable itself. We the doctors hold these 2 in our hands and the sense of responsibility is more powerful than anything you've ever felt in your life: they are helpless here, they have put their faith in us and trusted their lives in our hands -it is our duty to ensure they live through it.
Now you know, I am spiritual and I believe in God, and yes, I do believe that ultimately life is in God's hands -we mere mortals do not decide these things. But if anything worse would have happened to that baby or that mother and I was the physician in charge, how would I live with myself? There were so many little things I witnessed that could have affected the way things turned out -and they were all things that are in fact in our control. God helps those who help themselves. Life is ultimately in God's hands, but if you didn't really, really, really do your best, then death is your fault, not God's. I think that's the scary part. That in medicine, yes we do our best, given the circumstances, but there's always something that might have been done differently, that might have been prepared for better, that could have possibly been foreseen and prevented... essentially, there is a lot of human error that results in death. So how do you know when to take responsibility and when to surrender to the reality that you can't control everything? I'm not explaining this properly, but I think what often happens in real life, is that we don't do our best. We say we did our best. But we don't always do our best. We wish we could always be at our best, but we're human, so that's not always the case. So then we have to ask whether or not this is acceptable? That we try to do our best, that we don't always get there and sometimes not doing our best results in death, and sometimes, despite doing our best, death happens anyway. And are both of these situations acceptable? It's something to think about. And I love that I get to face these difficult situations and think about these philosophical and existential questions. And anaesthesia was the first specialty to give me that gift. So thank you.
On Call: The Cool and Complicated Cases
So I also did 1 night on-call during this 2-week rotation -loved it. It was a half-call, only until 10:30 pm, but still, so different from a regular day! All emergency cases -and the only time I got to see them stabilize an airway (intubation) using a fiber-optic instead of the normal laryngoscope way. For a retropharyngeal abscess in a woman with a super-tricky airway and severe enough anxiety combined with hypokalemia and too much local anaesthetic (lidocaine) that made the whole process crazier with sporadic tachycardias with arrhythmias (for the lay-person, in English: heart beating way too fast and abnormally). So again, a crash cart was needed, the anaesthesiologist in charge had to be called, etc. Except this time I was less useless -I was at least able to call the attending physician to come help. An improvement. An experience. Thrilling. And everything went well.
Anaesthesia for Neurosurgery: The live, pulsating Brain in his Head
Second-to-last day in anaesthesia, got to see the neuro side of things. The anaesthesia is the same(ish), but the surgeries -way, way cooler. Hands-down. I almost thought I wanted to become a neurosurgeon (and then I remembered, "Wait a minute, I still want to have a life"). I got to watch them do a focal resection of a tiny piece of scarred brain that had been causing epileptic seizures in the patient. So I asked the anaesthesiologists, "So basically this scar is causing seizures, so they're going to go in, remove the scar tissue and create another scar -how does this help the patient?" And they were like, "Huh. That's a good question. Never thought of it that way -I don't know, you should ask the neurosurgeon."
So during surgery, I'm allowed to go over to the surgeon-side of things, watch them using imaging technology as they are about to cut through the dura after performing the craniotomy, and the neurosurgeon (who is one of the very best neurosurgeons in the whole wide world! literally people fly here from all over to have him do their surgeries) himself, tells me to come close and explains what they've done and what they are about to do and I look inside where they've removed the skull and it is absolutely, freakin' gorgeous. The actual live human brain pulsates right below the thin layer of dura and it is a beauty. Fascinating. Amazing. That pulsating mass inside each one of us is what's responsible for all that humankind has ever accomplished, felt, thought, experienced in all of eternity. Ancient civilizations, poetry, art, Olympic records. It was all first just a mind-form. All just a ghost in that pulsating mass that only this privileged profession gets to see and touch in this state. What an honour indeed.
Afterwards I asked the neuro-guru my question. His response, "That is an excellent question" and proceeded to explain how in a natural scar, the inputs and outputs from and to other neurons remain intact and so abnormal activity can be transmitted to those neurons from the scar tissue, resulting in a seizure. However, the surgical scar severs these connections to other neurons (or at least, they really do their best to ensure this as much as possible) and so this transmission to other neurons is avoided. Later, to my anaesthesiologist attending, the neurosurgeon remarked "She asked such a good question -I wish more residents and doctors would ask questions like these" -made my day. After feeling useless at the beginning of this ICM rotation, it was so rewarding to feel appreciated, seen as intelligent, unique, worthwhile. By then, I also really knew my stuff in terms of all the different drugs, their mechanisms of action, when to give what, why you give what, etc and the residents with whom I was working also told my attending they were impressed that I 'knew my stuff' and was so interested in learning more, in more depth and detail. And it was genuine. Like I really, really loved it.
My final assessment?
But anyway, this doesn't mean I'm going to become an anaesthesiologist. Or that I'm not going to become a family doctor. But it is nice to have all this 'action', surprisingly enjoyed the kinds of doctor-patient interactions, because although they are short-term relationships, they are so intense because there is so much fear and trust and other issues to be managed and feeling like you're doing your job well and putting your patients at ease is rewarding enough without the on-going, long-term follow-up. And the good thing in anaesthesia is that once you leave work, work doesn't follow you home, and for the most part, it doesn't even carry over into the next day. They are paid well too. There is variety (pre-op / chronic pain service, gyn, obs, cystology (yuck), OR, etc, etc...). The kind of person who is an anaesthesiologist (at least the type of people I met) were very cool, energetic, down-to-earth people. But you do have to deal with surgeons and their egos (major downside). All that adrenaline, probably not good for balancing my already imbalanced 'feminine side'. So... lots to think about. But glad it was enjoyable. I learned so much and I loved the experience.
Neurology starts tomorrow -let's see how that goes...
I loved it. Best ICM rotation of life (so far, obviously). Kicks oncology's ass (let it be known -I have no interest whatsoever in oncology... BORING in all its forms). Nor do I care much for peds (kudos to those who have the patience for that... frankly, it just got on my nerves, at least in the family med setting... in fact, I may seriously reconsider my interest in family medicine based on the reality that I would have to deal with sick kids and their parents...).
But enough on what I don't like. Yes, it's true, I had to start everyday at 7:30 a.m. and anesthesiologists have to deal with arrogant surgeons (there is 1 respectful, kind, collegial surgeon for every 3 assholes), and if you're on the cystology/urology service, it is boring as all hell (urology: another shoot-me-in-the-face specialty).
Yet, overall I loved it -thoroughly enjoyable experience. I learned and got to practice intubations, mask-ventilations and putting in IV lines for patients... already, they actually let us DO stuff! I got to do some pre-operative assessments on my own (so much fun... doctor-patient interaction which is nice, but it's about a specific issue so naturally limits how long this lasts, and you provide them with all the information and reassurances that they need to feel a bit more comfortable about their surgeries and the anaesthesia they will undergo... and you get to assess their airways which is always fun =). There were 3 particular 'anaesthesia moments' which made quite an impression on me, which I will now share with you.
Day 1 Intoxication: On the brink of death in Obstetrical Anaesthesia
My very first day in anaesthesia was on the Obs service with one of the sweetest anaesthesiologists at the hospital. We started with a bunch of pre-op assessments for a bunch of women scheduled for C-sections, which was fun. And then we were called to the Obs OR to do the anaesthesia for a woman having a C-section for a breach. She was scared and vulnerable and her big blue eyes were like large watery wells as she looked at us with a desperate trust before we put her to sleep (general anaesthesia aka GA). Baby was delivered successfully. But. She had depressed respiratory drive and slow, irregular heart beat / weak pulse. They started to mask-ventilate. Then it was a code pink and a frantic search for a small enough endotracheal tube to intubate the baby, a flood of docs and supportive staff with crash cart and finally the adminstration of naloxone, which stabilized the baby.
It turned out the mother was being treated for chronic pain with opioids, resulting in opioid toxicity in the infant -naloxone was the antidote. They saved the baby's life but it was scary as hell. To be in there and to be utterly and completely useless as a second-year medical student. The best I did was stay out of the way. They don't count on us to do anything, but the uselessness was just overwhelming. I could not get the crash cart (like I knew where that was kept!), I could not call for help (who to call? what to say? what to ask for? you can't exactly run out into the hall screaming 'help!'), I could not even give the nurse a pair of gloves because I didn't know where they were kept. You know, we know we're not the most instrumental people as students when we go into these ICM rotations. But in that life-and-death situation, it makes you feel like you're trapped in a box and can't get out and can't scream and... helpless, helpless, helpless. And you look over and see the mother completely knocked out under GA -she cannot do anything for her baby, she cannot protect the baby or do anything for it as Nature had intended... and the baby, so small and helpless and breathless and vulnerable itself. We the doctors hold these 2 in our hands and the sense of responsibility is more powerful than anything you've ever felt in your life: they are helpless here, they have put their faith in us and trusted their lives in our hands -it is our duty to ensure they live through it.
Now you know, I am spiritual and I believe in God, and yes, I do believe that ultimately life is in God's hands -we mere mortals do not decide these things. But if anything worse would have happened to that baby or that mother and I was the physician in charge, how would I live with myself? There were so many little things I witnessed that could have affected the way things turned out -and they were all things that are in fact in our control. God helps those who help themselves. Life is ultimately in God's hands, but if you didn't really, really, really do your best, then death is your fault, not God's. I think that's the scary part. That in medicine, yes we do our best, given the circumstances, but there's always something that might have been done differently, that might have been prepared for better, that could have possibly been foreseen and prevented... essentially, there is a lot of human error that results in death. So how do you know when to take responsibility and when to surrender to the reality that you can't control everything? I'm not explaining this properly, but I think what often happens in real life, is that we don't do our best. We say we did our best. But we don't always do our best. We wish we could always be at our best, but we're human, so that's not always the case. So then we have to ask whether or not this is acceptable? That we try to do our best, that we don't always get there and sometimes not doing our best results in death, and sometimes, despite doing our best, death happens anyway. And are both of these situations acceptable? It's something to think about. And I love that I get to face these difficult situations and think about these philosophical and existential questions. And anaesthesia was the first specialty to give me that gift. So thank you.
On Call: The Cool and Complicated Cases
So I also did 1 night on-call during this 2-week rotation -loved it. It was a half-call, only until 10:30 pm, but still, so different from a regular day! All emergency cases -and the only time I got to see them stabilize an airway (intubation) using a fiber-optic instead of the normal laryngoscope way. For a retropharyngeal abscess in a woman with a super-tricky airway and severe enough anxiety combined with hypokalemia and too much local anaesthetic (lidocaine) that made the whole process crazier with sporadic tachycardias with arrhythmias (for the lay-person, in English: heart beating way too fast and abnormally). So again, a crash cart was needed, the anaesthesiologist in charge had to be called, etc. Except this time I was less useless -I was at least able to call the attending physician to come help. An improvement. An experience. Thrilling. And everything went well.
Anaesthesia for Neurosurgery: The live, pulsating Brain in his Head
Second-to-last day in anaesthesia, got to see the neuro side of things. The anaesthesia is the same(ish), but the surgeries -way, way cooler. Hands-down. I almost thought I wanted to become a neurosurgeon (and then I remembered, "Wait a minute, I still want to have a life"). I got to watch them do a focal resection of a tiny piece of scarred brain that had been causing epileptic seizures in the patient. So I asked the anaesthesiologists, "So basically this scar is causing seizures, so they're going to go in, remove the scar tissue and create another scar -how does this help the patient?" And they were like, "Huh. That's a good question. Never thought of it that way -I don't know, you should ask the neurosurgeon."
So during surgery, I'm allowed to go over to the surgeon-side of things, watch them using imaging technology as they are about to cut through the dura after performing the craniotomy, and the neurosurgeon (who is one of the very best neurosurgeons in the whole wide world! literally people fly here from all over to have him do their surgeries) himself, tells me to come close and explains what they've done and what they are about to do and I look inside where they've removed the skull and it is absolutely, freakin' gorgeous. The actual live human brain pulsates right below the thin layer of dura and it is a beauty. Fascinating. Amazing. That pulsating mass inside each one of us is what's responsible for all that humankind has ever accomplished, felt, thought, experienced in all of eternity. Ancient civilizations, poetry, art, Olympic records. It was all first just a mind-form. All just a ghost in that pulsating mass that only this privileged profession gets to see and touch in this state. What an honour indeed.
Afterwards I asked the neuro-guru my question. His response, "That is an excellent question" and proceeded to explain how in a natural scar, the inputs and outputs from and to other neurons remain intact and so abnormal activity can be transmitted to those neurons from the scar tissue, resulting in a seizure. However, the surgical scar severs these connections to other neurons (or at least, they really do their best to ensure this as much as possible) and so this transmission to other neurons is avoided. Later, to my anaesthesiologist attending, the neurosurgeon remarked "She asked such a good question -I wish more residents and doctors would ask questions like these" -made my day. After feeling useless at the beginning of this ICM rotation, it was so rewarding to feel appreciated, seen as intelligent, unique, worthwhile. By then, I also really knew my stuff in terms of all the different drugs, their mechanisms of action, when to give what, why you give what, etc and the residents with whom I was working also told my attending they were impressed that I 'knew my stuff' and was so interested in learning more, in more depth and detail. And it was genuine. Like I really, really loved it.
My final assessment?
But anyway, this doesn't mean I'm going to become an anaesthesiologist. Or that I'm not going to become a family doctor. But it is nice to have all this 'action', surprisingly enjoyed the kinds of doctor-patient interactions, because although they are short-term relationships, they are so intense because there is so much fear and trust and other issues to be managed and feeling like you're doing your job well and putting your patients at ease is rewarding enough without the on-going, long-term follow-up. And the good thing in anaesthesia is that once you leave work, work doesn't follow you home, and for the most part, it doesn't even carry over into the next day. They are paid well too. There is variety (pre-op / chronic pain service, gyn, obs, cystology (yuck), OR, etc, etc...). The kind of person who is an anaesthesiologist (at least the type of people I met) were very cool, energetic, down-to-earth people. But you do have to deal with surgeons and their egos (major downside). All that adrenaline, probably not good for balancing my already imbalanced 'feminine side'. So... lots to think about. But glad it was enjoyable. I learned so much and I loved the experience.
Neurology starts tomorrow -let's see how that goes...
Wednesday, February 10, 2010
A splendorous quarter-century celebration, Med-World musings and Love, Love, Love...
The sun that was stunningly bright and painting the library walls golden now only pokes out from behind the tall apartment building across the street. It has been a while since I've taken the time to write to you, to think at you. Almost mid-February now -my 25th birthday has come and gone (it was glorious in so many ways though -thank you to everyone who made it so very special... lots of dark chocolate, succulent lobster tail, tender, sweetly-glazed lamb, surprise roses, things that sparkle and shine, things that make the contours of my body sparkle and shine (garments, not under-garments people ;), lots of desserts, sparklers and candles... memorable indeed!) and I find myself very much caught up in the frenzy of trying to figure out the next critical years of my medical life.
What do I want to be? How do I optimize my opportunities so that I maximize all the possibilities of options of potential areas of specialization (this is exactly as complicated as I just made it sound, I swear, it makes one's head spin!)? Where do I do my clerkship rotations? Rural or urban? Quebec or Ontario? Canada or the U.S. (haha, that's a trick question, we know I'm in no rush to go back down south ;)? What order do I opt for? Pediatrics first since I've already decided I don't care much for kids or parents in the clinical setting? Or surgery first to get it out of the way? Where is the best OB/GYN and FamMed residency programs? Who should I talk to to find out? Who should I talk to to strategize? Plenty to think about.
I interviewed 3 applicants for Harvard College yesterday. Man, not easy to assess their 'qualifications'... like really, who am I to do it, and simultaneously, of course I am one to do it, but then, do I want the pressure of having to do it? Too late now, in any case.
But then I am also very much in the throes of love. Filling my heart with gladness, taking away all my sadness, easing my troubles... not that I had much sadness or troubles. Although, I definitely see the morning sun in all its glory, filling my days with hope and comfort, and my life with laughter... all made better because of my sweetheart. Kudos Rod (Stuart). You know who else was right? Lionel Richie. Good man. And I will now butcher "You Are" for my own purposes here... well, maybe I'll keep the butchering private -no need to make you all cringe and squirm. But really, honey, "all I want is to hold you"... (how about some wine with that CHEESE... and actually LR's a big liar for lovers because since when is holding ALL that is wanted... just sayin').
Anyway. Right. All that work and thinking and USMLE Step 1 studying awaits me.
What do I want to be? How do I optimize my opportunities so that I maximize all the possibilities of options of potential areas of specialization (this is exactly as complicated as I just made it sound, I swear, it makes one's head spin!)? Where do I do my clerkship rotations? Rural or urban? Quebec or Ontario? Canada or the U.S. (haha, that's a trick question, we know I'm in no rush to go back down south ;)? What order do I opt for? Pediatrics first since I've already decided I don't care much for kids or parents in the clinical setting? Or surgery first to get it out of the way? Where is the best OB/GYN and FamMed residency programs? Who should I talk to to find out? Who should I talk to to strategize? Plenty to think about.
I interviewed 3 applicants for Harvard College yesterday. Man, not easy to assess their 'qualifications'... like really, who am I to do it, and simultaneously, of course I am one to do it, but then, do I want the pressure of having to do it? Too late now, in any case.
But then I am also very much in the throes of love. Filling my heart with gladness, taking away all my sadness, easing my troubles... not that I had much sadness or troubles. Although, I definitely see the morning sun in all its glory, filling my days with hope and comfort, and my life with laughter... all made better because of my sweetheart. Kudos Rod (Stuart). You know who else was right? Lionel Richie. Good man. And I will now butcher "You Are" for my own purposes here... well, maybe I'll keep the butchering private -no need to make you all cringe and squirm. But really, honey, "all I want is to hold you"... (how about some wine with that CHEESE... and actually LR's a big liar for lovers because since when is holding ALL that is wanted... just sayin').
Anyway. Right. All that work and thinking and USMLE Step 1 studying awaits me.
Subscribe to:
Posts (Atom)