Drinking from the fire hydrant

My facebook status this week:

Vitum is entering one of those hell weeks that usually end with his friends asking, "Why don't we see you anymore?" Trust me, my bed feels the same way.

I spent most of Christmas describing third year to my friends and family like this: it's like working full-time (a doctor's definition of full-time, which is often 50 or 60 hours a week), plus being on call for an overnight shift every fourth night, plus studying for a major exam every month. Wheeeee!

Like I've said many times before, though, I am careful not to whine too much. Not only were my first two years of med school two of the most fun-packed years of my life (as I was reminiscing with a classmate just this afternoon), but as hard as I am being worked right now I'm doing what I love, and worked hard to be able to do.

After all, it is indeed my signature at the bottom of the application to medical school from three years back.

Yet, sometimes I check just to make sure.

Read the rest of this entry »

Make sure you know what you are getting into... [part one]

One of the pieces of advice I was given as a pre-med, and that I frequently give to pre-med students (it's #7 on my Top 10 list of advice for pre-med students) is,

"Make sure you know what medicine is like before you sign up for it."

That was ringing quite loudly in my mind when I started my call shift the other night. I had had a busy week in surgery. There were some really long days of showing up on the ward at 7am then a full day of office then going straight to the hospital at 5pm and seeing emergency patients and eventually taking them to the operating room and getting home well into the wee hours of the morning... with a full day in the office after that.


Most of the surgeries were routine, but some came with the emotional stress of having to tell a patient and their family they had a 50% chance of dying on the operating table, and a 50% chance of us opening them up, finding that we could do nothing, and closing them up to face their death within the next few days. (One patient's response to that speech? "Bloody hell." Yeah, no kidding.)

I also had a long academic half-day full of lectures on things that I need to know but had no energy to learn, that also went late into what was going to be my evening relaxation time.

I had to try and fit in studying for my two upcoming exams in between all that, and then on top of that I tried hard to make time to get some exercise and spend some quality time, either on the phone, online or in person, with the people in my life who mean a lot to me. And no, there was no time for going to my buddy's poker game, watching the Leafs get their butts kicked (I haven't watched one game this season!), an afternoon round of golf, or any of the other things I would have enjoyed doing that resemble this "having a life" thing I've heard so much about.


As soon as I finished work in the surgeon's office for the last day of this tough week, I headed to the hospital to get my pager and start call - and within five minutes of my call shift starting, my resident and I had five patients to see, all of whom were pretty sick. Just as we were trying to figure out who to see first, the pager went off two more times. We didn't get a break longer than ten minutes until 2am, when I got a bit of sleep before the pager started going off again (getting a bit of sleep means it was a lucky call night).

I'll admit when all those pages were coming in right at the start of the shift, I was feeling the stress of the whole week on top of having a lot on my plate all at once, and I fell into a rut I find myself in once every year or so when all the negative thoughts come rushing to me. I find myself seriously asking if I am in the right place, if I made the right career decision, if I will ever be able to treat patients on my own, if I really knew that medicine was like this before I invested all that effort and money into pursuing it.


Fortunately, the five minutes the resident gave me before I had to meet up with him on the ward was just enough time to break down, almost re neg on my no-crying policy, and beg for some strength from heaven.

Fortunately, God was listening and obliged. And all in all it ended up being a really good call shift. For me, that means a night with some varied, useful cases that are important for me to learn how to manage, and with some good opportunities for me to see patients on my own, evaluate their situations, and develop a plan and present it to the resident for their approval and questioning. We triaged those first cases well, and got through them and all the other calls throughout the night, and put off studying for just a few more hours in order to do those therapeutic things like write this post and sleep in late for the first time in a while.

::: part two to come... :::

Read the rest of this entry »

Poking a screaming child? That'll put hair on your...

"Bet you feel the testosterone surging through your veins now, eh?" the ER doc supervising me said. "That'll put hair on your chest."

Then again, I'm sure everyone else in the ED (and all the other wards on that floor) also had a snappy comment for me, seeing as how each and every one of them could hear the screams of my patient.

A young girl had gotten a huge gash in her arm after falling through a plate-glass window, and the emerg doc took one look at her chart and handed it to the resident, who handed it straight to me. At that point I was still unsuspecting, super keen to sew up yet another wound. Boy, was I naive.

After looking at the wound I flattered her quite nicely about being such a trooper, such a large gash and all and so little crying.

Turns out that all my buttering up was for nothing, which I found out as soon as she asked if she would be needing a needle.

That's where I went wrong.

She sensed my instant of hesitation before my answer, and took that as her cue to start screaming at the top of her lungs.

The screaming didn't stop. We tried everything from distraction, to warm blankets, to massaging her temples, to topical anesthetic and intranasal fentanyl, all of which seemed to only fuel the screaming, which lasted well into the procedure, despite the gallon or so of lidocaine I used to freeze the wound.

Even though I have sewed many a wound with very little fanfare, this whole experience actually stressed me out a lot -- much more than I expected it to.

You see, I still have enough compassion left that it makes me feel REALLY bad when I know I'm hurting a patient, especially a child, and I get uncomfortable when I see a pouty look, let alone screams of bloody murder and "PLEASE STOP! NO MORE NEEDLES! OH FOR THE LOVE OF...' Yeah, I didn't know 11-year-olds knew that many swear words. Kids these days.

It was made even better with the parents shooting me the look of death the entire time for causing harm to their little angel. Fortunately, the father's claim that he wouldn't be bothered by the blood soon proved to be quite false, and the emerg doc saw him starting to reel and whisked him away, saying "OK, come with me, you are sitting down over here. Put your head between your legs."

As well, with all the the flying fists and limbs I was pretty scared of buring the syringe or suture needle in my own hand.

In fact, I was even more stressed that I'd be poking the care aide holding the child down. Keeping this saint happy had risen to a very high priority ever since she set aside one of the leftover hospital meals for me (which, despite being hospital food and looking like it had already been digested once, was still food).

The procedure finally ended, and she finally went home, and a strange calm fell over the emerg. In fact, with the young girl gone I could only really hear monitors beeping, ambulance sirens, nurses shouting, and other patients yelling, which was so much more quiet than when that girl was there.

Later on, one of the doctors told me that he used to feel bad poking children because they would cry so much. "Then," he said, "I had my own kids, and realized they cry all the time... even if you are not doing anything to hurt them."

That did make me feel a bit better. But I was still so worked up when it was all over that I considered going to the homeless gentleman and ask if he was gonna finish that bottle of rubbing alcohol he was using to get drunk (tuition is due soon, so I am trying to get all the free hospital food and free alcohol - of any form - I can get). I figured if dealing with the screaming child didn't put my hair on my chest, perhaps some isopropyl alcohol will.

Either way, any more shifts like this and I think I'll start losing hair rather than growing any more.

Read the rest of this entry »

Studying Scared

What does it take to get Vitum off his butt and into study mode?

Good intention? A desire to do well?

Try fear. Plain, simple fear of failure. That's all it takes.

Unlike last year, when around this time I was enjoying how slack I thought medical school was, this year is different. Not just for me - I've noticed that a lot of people who took it easy early in the semester for the last two terms are turning up at the hospital & university study rooms on the weekends / evenings. And I've got three things that are giving me enough fear to get me studying scared this early into the semester.

1. Life around finals time sucks.

First of all, now that I've been through a year of medical school, I'm more aware of what it involves. I know how hard I had to work when last year's finals were approaching. I spent entire days and entire weeks studying with few breaks. Seeing few friends outside of med - and even friends in med - was not an option, and how the only thing that kept me going was the thought that "if I don't work my butt off, I'm gonna fail." I don't want to be going through that again come finals at the end of this term, so I'm studying now. Hopefully, as a result, around finals I'll feel a bit more prepared and the stress level will be a bit lower.

2. Finals are gonna be brutally hard.

While that should be reason enough to get my nose in the books, there's another reason. If there's any truth to what the third-year students say, my finals this year are going to be tough... much harder than last year.

That could be because for some of our units, the course directors have decided that providing us with lecture notes and lectures that cover all the topics that will be on the final are ineffective strategies for teaching physicians, and so we're expected to do a lot of reading from a variety of sources outside our lecture material. That's intimidating... as is generally the case with medicine, there's not enough time to learn everything, which means I can only hope that which I've learned is enough to get me through.

3. I don't want to fail and have to repeat second year!

In addition to those first two reasons, there's something else. There are a few people in my class this year who are repeating second year. Their reasons for doing this span a wide range - personal reasons, lots of stuff going on in their lives, MD/PhD students who are doing bits of the program at different times as their classmates, and not doing well enough academically last year.

Despite the fact that I don't know the individual reasons that these people are in my class, every time I see them around I think of the last reason. Yeah, it's hard to fail out of med school, and if I do fail a few courses I'll be able to repeat the year, but the third reason I'm getting my study on is because the last thing I want to be doing next year is repeating second year. Med school is a long time and I'm excited for the clinical part of medicine, which doesn't happen until next year. I would hate to be stuck in another year of PBL and our physician and society course.


The funny thing is, I'm sure this year will be a lot like last year in that it seems 90% of the class is scared of failing, but 99% of the class ends up passing. I think it's because we former pre-meds are used to undergrad exams, which we would routinely go into feeling like we knew all the material. Med school exams are scary because there's no way you will know all the material... and getting your 60% for a pass is much harder and requires much more knowledge and understanding than getting a 95% in undergrad.

There's a few people I've talked to that are afraid of third year. Rightly so - from all accounts 80-hour work weeks, being on call all the time, and having the stress of working with attending physicians, seeing patients, and trying to figure out where all the equipment is - let alone knowing how to use it - will be stressful enough. But I'm not even thinking about that yet. I just want to get through second year.

====

By the way, Happy Thanksgiving, y'all. That's right, it's Thanksgiving weekend in Canada. (early holiday, our soaring currency, our pristine health care system...bet you want to move here now!) Seems like everybody is doing family stuff this weekend, but since school is so far from the family - and since the 'rents are coming out here in two weeks - I'll be going to a friend's house for the festive meal. He's a master in the kitchen and I'm looking forward to it.

Read the rest of this entry »

Well at least next year, it will be easier...right?

Oh wait... it won't.

During finals, a friend in my class told me that this was about the highest level of stress she has ever been through.

She wasn't the only one. I saw a few people crying in the halls before finals, and had to handle the odd late-night telephone call with a sobbing classmate on the other end of the line.

"I can't believe this," she told me, apparently asking for help finding the end of the tunnel. "The second-year students are done already, so second year can't be much harder, can it?"

"Actually," I replied, "I hear second year is a lot harder. At least we had one final out of ten where we had the feeling we had studied everything. Apparently, that feeling goes out the window for even the anatomy lab final next year."

"Well, once we get through that, it will be great to get to third year. We'll actually be doing medical stuff and won't be in classes any more."

"Uh, well, from what I've heard, third year does have lectures in it, in addition to being on the wards more than full-time. And, you have to write finals for each rotation that are standardized across North Amercia."

"Well, at least after several weeks working through, say, surgery, you'll know the information inside and out."

"Actually, I think that you can't be guaranteed to see everything in your rotation that will be on the test. So, for most of the stuff you need to know for finals, you need to study from books on your own, between seeing patients, between lectures, and between being at the hospital full-time."

"Huh... wow... well, at least.... at least you're only doing one final at a time.... just surgery, or just ob/gyn, none of this infectious diseases and cardio and renal and pulmonary all in just a few days."

"Yeah, I suppose, but what if you're in your emergency rotation and in comes a 76-year-old smoker with COPD (a chronic respiratory disease) who has a blood creatinine of 1800 (likely kidney failure), who is short of breath due to an acute exacerbation of congestive heart failure (uh, clearly a cardio problem)... and has S. aureus sepsis (you guessed it, infectious diseases)?"

"You're not helping."

---

Added 15 June: I was talking to a doctor the other day who described third year like this: "You get thrown into it and are just like 'WOAH - I've learned more in my first four weeks of third year, than in my entire last six years of university.'" Scary.

Read the rest of this entry »

Year 1...Done. Vitum Medicinus: 1/4 M.D.

"I don't know what to do with myself," my friend said over the phone the day after finals. "I don't have anything to go study."

He was serious. I felt the same way.

"Maybe I'll go read some second-year Anatomy," he offered.

Not an option, I told him. We met up, and proceeded to go to the beach and fall asleep on the sand. Then, when my parking ran out, we moved to another beach, and, well, fell asleep there, too.

That's right - I spent over an hour doing something other than studying, and was able to enjoy it. No thoughts of panic. No feeings of guilt.

My last couple of days have involved:

• going to the movie theatre for the first time in months (Knocked Up attempts to be a chick flick AND a comedy, and while it has a few good laughs, in the end it comes up short at both)
  
  
• attending the end-of-year party where everyone (except me, of course) partied hard and relaxed (I say not me because I was heeding the advice delivered to me in a text message from my mom: "Congrats on being done! Party easy." Love ya, mom.)
  
  
• saying goodbye to med friends who will be redistrubiting all around the world to do incredible things
  
  
• enjoying this beautiful city - driving around parks, laying on the beaches, wandering through forests
  
  
• and starting to re-establishing communication with my dear friends outside of medicine whom I have simply not seen for months, perhaps one of the worst aspects of this exam period. I saw my sister today for the first time in two months...and we live just a few blocks apart. Each time I try to explain what I've gone through (I'll detail it here in a bit). I hope they understand and don't simply think that I am avoiding them.

I start work on Monday, researching and writing Internet-based educational materials for a couple of emergency medicine docs. It will be nice to have evenings off, and to catch up on the countless posts and ideas that I've had for the blog. And July 17, well, let's just say I've got a bit of a surprise coming up. Stay tuned.

This summer should be fun. And relaxing.

Ahh, relaxing. Haven't done that in a while. Excuse me while I get back to it.

It's good to be done.

Read the rest of this entry »

Eaglestar's Dilemma: Study for finals, or see his child?

With this whole studying for finals thing going on, especially now that classes are over and I am leaving my study books at school because all I do at home is sleep (and I wonder why I go all the way home just to do that - why not sleep on the clinical skills practise beds!), I feel like I've been fairly disconnected from my family, my friends outside of med school, and heck, even a large number of my med school classmates that choose to hole up in a study room other than my own.

Turns out I'm not the only one that feels this way.

In a rare study break opportunity, when my attention-deficit was getting the better of me, I turned to a friend in my class that I was studying with... we'll call him Eaglestar (hey, again, as is my policy with classmate aliases - he chose his own), and asked him about his son, who was just born a couple months ago.

"Hey, Eaglestar, how's your son doing?"

He lifted his shoulders in the air.

"Who knows!"

We all had a good laugh about it, but we probably should have been crying. In fact, I've decided that anybody in my class that I see smiling is simply neurotic...there is no joy right now!

Yep, guess I'm not the only one who feels disconnected from anything not med school.

Read the rest of this entry »