The Messy Medic

Happy New Year! I'm gonna celebrate with a Dragon Roll...

2012-01-23T04:31:00.002Z

Since I was late with my Happy Regular New Year, here's to Chinese New Year! New Year's resolutions: 1) blog/journal more 2) gym more 3) eat healthier (noticing some similar trends here!) 4) be more productive and stop wasting my weekends.

I'm typing this on my ipad with the bluetooth keyboard in the Kensington Pro 2 case. Pretty awesome, I have to say but of course I'll have to buy everything all over again when they upgrade to a new model.

So now that I haven't blogged in forever, I'll catch up. This week has been an EPIC WEEK! Someone rightly pointed out that I need to buy a lottery ticket to make my luck in 3's. I passed my EM written boards, I got a job offer at a prestigious place where I really want to be and where I will continue learning an incredible amount, so things have really started well so far. I can't believe how lucky I am sometimes (stable job, employment with good benefits, little debt, etc.)

Fellowship so far has gone well. I don't think I'm making as much of it as I could, but there definitely doesn't seem to be too much time! I'm much more comfortable in ultrasound use than I was when graduating, and although I still have nervous energy going into critical care shifts, I've had some great days as an attending and watched some great days that my friends have had too. I don't think (I hope) I've made major mistakes yet, and I've definitely learned things I could do better but my management has not resulted in disastrous consequences. I feel my confidence growing but am fortunate to be in a specialty where you can never get complacent. I still have some growing to do, but it will come. It's great to be in a very laid back but intellectual environment. Time to put the burners on!

Having more free time is great too. I've gotten to go to NYC a couple times for shows. Friends of mine visited and got a glorious few days on Fire Island this summer before we got kicked off for the hurricane. Went to London / Dublin just before Christmas and felt I never wanted to leave. Worked my ass off (9 shifts in 8 days) over Christmas and survived and also made some good moonlighting money. And now is now - we're going to Puerto Rico, Phoenix, Chicago and maybe I'll be able to swing another Dublin trip for a conference. Maybe Florida? and Australia in December? So far so good :).

Happy Independence Day!

2011-07-06T03:43:00.002+01:00

Reasons to feel independent:

1) Graduated out of residency!!! Woohooo!

2) Starting new life as an attending while having a nice transition by doing a fellowship

3) LIFE OUT OF MY NYC SHOEBOX and into my brand new apt which isn't large, but feels luxurious in comparison with my brand new furniture, awesome 46" tv, and a real bed!

4) I don't have to be chief anymore!

I'm going to miss the life of NYC and being able to get anything / do anything whenever I want, but I won't miss the traffic, the paradoxical culture-less population, the people congestion, the dirtiness, etc. Already in my apartment I love the fact that I can't hear much street traffic, I've got a great view of the long island sound, I'm surrounded by unique boutiques / bookstores / art shops, and the people seem naturally happier. I definitely won't miss the drama of my old hospital (and there was tons of it in June, even up to my last week which I had to sort out as the out-going chief, even though I was on vacation) :).

So I spent most of the weekend with a quiet one in, gradually sorting out my piles of clutter, building my new ikea furniture (my whole apt is best buy, ikea or bed bath and beyond) and finally making what feels like a home. My family left, which is a shame but I don't think there was much excitement on this family vacation this time. Hopefully there will be more exciting trips planned because that makes two dud vacations this year (Shanghai which we did not like, and this one where most of it was spent with graduation and me moving out of my apt, although we did have a very enjoyable massive shopping day where we all stimulated the economy)

Today was my official first day of fellowship, but there's nothing clinical yet so I still have a little downtime. Met some nice folks in my apt. complex, a couple people who are ED like me and who I'll be working closely with so I now have some potential company.

Things to check out: outdoor trails, and THE POOL!

Happy New Year 2011!

2011-01-15T04:05:00.003Z

First off, some resolutions (okay, 15 days late...but still... ) for the rest of the year

1) I will not let others get to me and I will be more patient with the stupidity of others (yeah yeah I know that sounds condescending, but it's what I need to tell myself before I explode at them). Try to be more patient because patience is not my strong suit
2) Go to the gym more - already making progress on that one!
3) Eat better - ok, not making so much progress there but because of all my night shifts lately, I'm nearly down to my high school weight!
4) Explore and enjoy NYC more before I leave - this will have to wait until after the exams
5) Go snowboarding!! - haven't made it yet this season!
6) Study Study Study - congrats to me for getting an Ivy League fellowship, but I better make it stick and not look foolish up there
7) Find that old optimism I used to have and start each day with a clean slate and look at each relationship I have through clean glasses
8) Find time for creative activities so that I can feel more balanced

I've got a lot of positive things to look forward to, especially in the first half of this year. First off, I'm going to my US fellowship at an Ivy League place full of history and tradition (I love that kind of stuff!) so already I feel I'm finally kick-starting my career.

After 2.5 years of residency, I really do feel like I'm ready to be an attending. There's some knowledge-based things that I really need to hone up before I get there, but in terms of spirit and attitude, I'm ready to handle anything thrown at me. It's nice when your attendings tell you as well, "You looking forward to this yet? You're ready and you'll be great!" Positive feedback is always so endearing. I've just finished two weeks at Harlem. Got a great thoracotomy case (my 2nd) and this one I saw up close and personal. I have the pictures to prove it, which I can't post unfortunately for legal reasons. Got a pure inhalational smoke injury which was a fantastic case, and between Harlem and Monte, I've gotten a lot of tubes on the first attempt. Although many codes come into the ER already DOA, I feel like I know how to handle them.

I feel like my residency has been a success, although I haven't achieved as much on the research end as I have wanted to. I'm comfortable with most cases, sick or FP-like. I'm comfortable with procedures. I'm happy with my patient through-put. I wish I had more time for reading or my elective or research, but we can't have everything. I'll get more of that during my fellowship, so c'est la vie! I definitely wish I had more time for creative venues, but that might change in the future, who knows?

My last Christmas in NYC for a little while...

2010-12-23T16:01:00.005Z

HAPPY HOLIDAYS!!!

This year, it's really chilly in NYC... and we finally got our massive blizzard / snow dump on Stephen's Day. Now all you European romanticizers know what I'm talking about! I do like NYC at Christmastime with the decorations and the constant store music blaring. But I definitely will not miss all the cursing. I'm no prude and I can be sailor-ish, but every time you hear someone on their cell phones it's always F-in this or s*** that. It'll nice to be in a place where everything is a little bit calmer and people aren't so angry.

Last week I went to see Bloody Bloody Andrew Jackson ... could have done without seeing that particular musical. Nice set, but not a whole lot of substance to the actual plot and no real wit in the lyrics. Then I subwayed to Macy's - another exercise in patience re: shopping in a big city at Christmas! Every time it's a big reminder of why I should just stick to online shopping :), which I've become quite good at! (and I get to collect boxes for my move out of here!)

I also saw Women on the Verge of a Nervous Breakdown which is based on a famous movie and also had one of my favorite broadway actresses in it (Laura Benanti). Unfortunately, the show is closing early and didn't get very good reviews but honestly, I thought it was fantastic! I was up in the mezzanine so maybe it looks less chaotic from up there, but I thought the way they put together scenes and used the set was pretty awesome. Fantastic singing and Benanti's character (the funny one) was just great. I'm going to have to buy the cast album just for that one song!

Oh, and another thing I'm going to have to see again is the Radio City Rockettes Christmas Spectacular... I thought it was going to be mainly for the kids, and in some respects it is but great choreography and sets. I'd love to take mom! Only next time I'll shell out for the expensive seats in front cos all the coughing snotty loud kids are in the back...

The rest of Christmas was pretty uneventful and all my off days were spent recuperating from work. Worked short staffed but we survived, it's snowed more this year than in any of my other years here and still you'll come up to waist-high piles of snow and all the cars are still boxed in. But it's kind of nice to see NYC blanketed in snow in the early mornings before people are trying to bustle in the streets.

Chiefs have it rough!

2010-10-07T12:01:00.002+01:00

I haven't posted on here in awhile! I thought being in final year of residency with a decreased number of shifts would give me more time. It has to some degree, but all my free time is monopolized by my Chief duties! So yes yes, I'm one of my program's Chiefs this year. Technically, I'm the Chief Resident of Acadaemia, but I dabble in everything that needs to get done. What does it mean? Respect, yes. Self-pride, yes. More money, not really. A HELL OF A LOT MORE WORK! And it also means no one likes me anymore, except when they want something...

But really, I do enjoy it. I'm not opposed to administrative stuff and it's interesting to try to plan our lectures and engage my program in useful activities. I'm not really a fan of being the end point for the whining or having to be connected to my email 24/7 though. But facilitating new ideas (whether mine or someone else's) is always good for change!

Currently I'm applying for my fellowship in Ultrasound EM. I think it's a field that is becoming increasingly more important (quickly) and I want to make sure I'm "expert" in it before starting my career when I have no time to go back and do it. I could potentially see myself doing a couple fellowships actually, but of all the ones offered in EM, this one is the most important right now. I have my first interview tomorrow and one next week as well, so we'll see how it goes.

We also just came back from Las Vegas ACEP, which was absolutely fantastic! Our program tries to send all the 3rd years and we lucked out that it was in LV this year. SO much fun, there was one night that there was a sponsored party in one of the hottest nightclubs on the strip, and we didn't get back to our rooms til 6 am! I've never seen so many docs on the floor (literally) before! Our program director took us out to a lovely dinner in the Venetian, and we went for a buffet in Paris as well. Walked the strip and saw the sites... LV would not be a bad place to live, I think. Can't wait for future ACEP's!

Big Bad Chief Rant

2010-07-08T03:35:00.004+01:00

Welcome to my last year in residency (now 1/2 year!) and to Chiefdom as well. Being Chief is about as fun as sticking a needle in your eye. I'd say since June, most of my free time has been spent poring over just one month's schedule. And I still have to do the conference schedule, arrange lecturers and assign text reading. Yikes.

Then there are the day-to-day problems . X person calling in sick and spending hours on the phone trying to reach people to cover. (This sick call business is getting really old and we've had multiple issues over the Christmas period). Y and Z people didn't show up to their outside rotations and there goes more hours speaking with administration. Once I was called during one of my fellowship interviews to handle this stuff so I had to keep apologizing for answering my phone. Went on until 10:30 at night! Sometimes I think for a bunch of doctors who are supposed to be logical and be able to handle problems by themselves, they can be worse than the general population.

Now it's interview season and we're short one program director, we're short attendings and so for the last month my time has been sucked into giving interviews or tours. Good thing I like meeting new people, but it means I can't really plan on things or do anything else like mini ski trips or whatever. Cramping my style, man!!!

It's not so bad, I do enjoy being able to effect "policy" and being an "authority" (DOWN WITH AUTHORITY MAN!), and we do get paid a small stipend. But it's definitely no holiday and I've lost a lot of my free time.

Fortunately I got through all my fellowship interviews in October / November (which was really hectic!). These days last forever, some of them from 9-5! I think I did about 7 interviews which was less than other people, and it was exhausting. I subsequently got URI sick for a month! They're pretty laid back just like regular ER interviews for residency but wow, I'd forgotten how tiring it all is. I don't think being chief really has that much bearing on your competitiveness for fellowship. It helps, but it's not going to seal a deal. I have a pretty good CV in terms of "extracurriculars" which is definitely not as extensive now as it was in medical school. Still, every little bit counts I guess. All my work has paid off, though ... I'm going to Yale for my Ultrasound Fellowship! Time to celebrate!!!

One last run...

2010-03-29T16:59:00.002+01:00

Too bad snowboarding season is over, just when I started getting a little control of my board! I went back for one last run and since last week was so warm and it suddenly turned cold over the weekend, all the groomed snow was like ICE so people were catching edges all over the place. Definitely was able to control turns and start linking them without falling, and the last two runs I did there were no falls which was awesome. But before those, my knees did take a beating. I'm definitely going to have to invest in some protective gear for next season. I can't wait!

Today I'm just cleaning stuff up, trying to pack up winter stuff and get everything clean. I'll go to OBGYN later and see if there's any evening deliveries. I need to start studying for next year since it's the big bag third year where I'm actually expected to know stuff. I also need to start saving. I need a new computer (yet again) cuz my laptop is fritzing out on me, and using this netbook is slightly annoying since I lost bluetooth when I upgraded to Win 7. DAMN WINDOWS 7 I DISLIKE YOU.

Goodbye winter, happy spring!

2010-03-27T17:06:00.004Z

Now the winter months are nearly over and usually I'm happy about this, but now I've found a new love - snowboarding! Too bad I didn't discover this sport sooner, I'm addicted...can't get enough. I've only been out about 3 times, but I'm already purchasing two boards (that I got on massive sale of course). One is the Burton Feel Good with Escapade EST bindings, which is just way too advanced for me right now (didn't quite realize this before I bought it). Can't wait til the day I'm good enough to handle it! And then I got the Atomic Vantage board which is more a beginner-intermediate board. Yeah, it's a men's board but with my height and large feet, there we go. I just love its design. Will have to tell you more about how they ride next year. Hell, I might even just start my own snowboarding blog!

Anyway, in Jan I went on vacation to Australia / NZ which was awesome awesome awesome. I'm seriously thinking of moving there to practice after residency and fellowship. Definitely a sorely needed va-cay, as my residency was getting extremely puerile and tempers were exploding all over the place. Visited my friend (another doc) in the Coromandel part of the North Island, which is very pretty. Unfortunately it rained the whole time but we did some sea kayaking and Zorbed (they stick you in a ball with warm water and roll you down a hill) in Rotorua. We also drove through Tauranga, which seems absolutely lovely and has a mountain and a beachside resort. Sounds like the kind of place I'd like to live! We stayed a few days in Auckland too, seems like a happenin place but more expensive than elsewhere.

Visited a friend in Brisbane and it was nice to see them after about 10 years (omg it's been 10 years since I saw them last), got to hug some koalas and managed for once to take some gorgeous not-quite-photogenic-photos-but-better-than-I-usually-take ones. We also got some beach time in, but this trip actually wasn't beach-heavy. Finally made it to Melbourne, with some good shopping and hanging out with my sis's friends done, and found a new favorite wine - Moscato! MMMMM. And always a highlight, the Aussie Open! It was a scorcher this year because we were sitting right under the sun, and saw roddick beaten by cilic :[. Also caught a great show with Geoffrey Rush called The Drunken Chaperone, very funny, we kept repeating lines for days afterwards!

Then back to work, exams, study (meh) and now I'm coming to the close of a rather useless OBGYN rotation. Ah, at least I've got snowboarding to distract me for at least one more weekend! That's the great thing about NYC. You have beaches an hour away and mountains 2 hours away. Seems like a great blend, thinking about staying here for a good while!

A Belated Thanksgiving!

2009-12-09T06:52:00.002Z

I'd set my 2 week holidays for the end of November, in prepping for a dinner I help organize over in Ireland for my alma mater rowing club. Unfortunately, the dinner fell through due to lack of interest this year (and funds), so we decided to cancel the dinner and I cancelled my trip to Ireland. A shame because I was looking forward to catching up with people, but c'est la vie!

So instead of using my time productively, I went in nearly every day to help my program out with interviews and to talk to the interviewees. I like doing it so I didn't mind, but there went my plans of trying to catch up on some work! Hopefully I can try to put my head down this month and do some study / reading, but it hasn't started out well :).

Then I had a few days at home with the folks for Thanksgiving. I have now realized that Banana Republic, Ann Taylor Loft, and BCBG Maxaria are my ultimate favorite stores and my credit card statements are skewed in those directions :). I figure I deserve it...somehow... ? Although I spent a significant amount of time at home attempting the unsurmountable task of cleaning the house for my parents, we had a nice dinner out at the Cincinnati Marriot hotel for turkey day. Why anyone would choose to cook and clean when they could have an inexpensive fantastic Thanksgiving dinner is beyond me :). So now that I'm nearly done with my 20's, I have a few things to be Thankful for.

1) Of course, the good health and not too many problems in life so far, knock on wood.
2) A stable career which isn't an office job, a career where I can actually help people and feel some satisfaction with on a daily basis (to combat the daily abuses), and a career where it seems I can be successful to the point of recognition in. And of course it helps that it is a financially fulfilling career when compared to most people.
3) I am much happier now than I was this time last year. There's much I can gripe about, but I think I'm used to culture here again and I have a bit more creative time.
4) I passed Step 3 comfortably and never have to do any of those again!!!

Starting December 1st, I'm back in the ER and it didn't take me too long to pick it up again after being on off-service rotations for awhile. There's some times when it's painful, but I'm happy I'm able to truck along quite quickly and so far have been able to clear out the rack, even if I'm the only resident on my side. If I could only do that with my personal projects and my studying ... :).

It's play time!

2009-11-20T03:49:00.002Z

So after the Step 3, the first thing I did was rent a lot of books from the library and see a ton of shows. This is why I can't move out of my 500 euro / month hole in the wall that is my room, because I keep spending money on other things!

Here's my brief synopses of the ones I saw:
1) After Miss Julie with Sienna Miller - interesting play, not my type of thing but interesting nonetheless. She's this young aristocrat who seduces one of her servants and the ensuing emotional turmoil begins between them as the dynamic between them shifts. Fairly good acting on her part, it must be difficult doing such an emotionally exhaustive role.

2) Oleanna with Julia Stiles and Bill Pullman - again, very good acting, and the concepts discussed throughout the play are provocative, but not really my thing. A little bit wordy and far-reaching. She plays this student who goes to her professor (Bill Pullman) for help, but as he tries to help her she misconstrues his words into sexual harrassment and ends up ruining his life. Her character is quite annoying, but that's the emotion this play is trying to provoke.

3) The Understudy - Julie White, Justin Kirk, Mark Paul-Gosselaar (hottie!) . This play was really funny, and very witty. Not as creative as 33 Variations but very cool anyway. This was about two actors (one understudy to an understudy essentially) and a stage manager trying to produce of kafka play, so there's all these Kafka references which are pretty amusing. I like "intelligent" plays that are funnier if you know what the jokes elude to. Very good acting as well, a little overdone on the cursing but cest la vie.

4) A Steady Rain - Hugh Jackman and Daniel Craig (both hotties!) . Interesting play, again not quite my thing but good acting. Very verbal play, not much action. It was a sort of "human" play too as both actors messed up lines or tripped over their tongue occasionally, but hey, they were forced to do American accents for 90 minutes. What was hilarious though was that after the show, they were trying to promote donations for Broadway cares, so they ended up unbuttoning their shirts and displaying their wifebeaters. Daniel Craig had marked his right and left breasts on his wifebeater, and then they auctioned their wifebeaters off for the crowd - an actual auction in the theater. And both wifebeaters went for $7000! They raised $14000 for broadway cares (damn!) and watching this was really funny / exciting. Then they invited people to come backstage to take pictures with them for a mere donation of $2000. Damn...some day I might have that kind of money to throw around...jeez.

5) In the Next Room or The vibrator Play - Laura Benanti (always one of my favorites), Michael Cerveris. This was a really creative play, and the character Benanti plays is brilliant. She's this really enthusiastic, curious young wife with tons of personality. Her husband is a doctor who basically ends up inventing these vibrators to help people overcome "hysteria" / depression / etc. in an age when no one even had a notion of orgasms. So he treats all these patients who obviously love this treatment and she's very curious but he won't really discuss it with her because she's not sick. It ends up delving into the fabric of their relationship . At the end for some rather funny reason it ends up with this make out scene and him ending up completely butt naked. Anyway, it was good.

Oh, and I also went with one of my friends to see the Rob Thomas concert, which was pretty good of course, he's got a great voice. And he pulled John McEnroe (yes the tennis player) on stage to play one of his riffs!! And he was really good, who knew John McEnroe could play guitar well!

So I guess seeing all these makes up for no travel for vacation. I'm going home for Thanskgiving next week. And I get to catch up with some things around here (woo) although I'm not doing a very good job of it!

I've also blown a crapload of moolah on toys for myself, got an awesome dslr to start playing with so hopefully I can have fantastic photos of NZ / Oz when I go in January and shoot happily around central park. Also got some of those fancy noise-cancelling headphones that I wish I'd had during Step 3 study in Barnes and Noble. Wooo.

FREE FROM THE USMLE!! (I hope?!)

2009-11-12T05:37:00.003Z

The last couple months have been a whirlwind. I just finished sitting Step 3, and honestly, those USMLE people need some help. I take objection to being the subject of some sexually-repressed exam writers who felt it necessary to shove very graphic displays of every penile or vaginal wart possible on my screen with some chancres thrown in for good measure. Obviously 1-2 questions are inevitable, but come on, 15+ ? I really really really do not need to see 15 nasty members of genitalia on my exam, with the new technologically advanced screens they have in the Prometric centers. Nor did I really need to see that xray of a very Sex-and-the-City-ish object shoved some place where it just did not belong, and which I'm sure had a very disturbing story behind how it got there. Nor did I need to be placed right by the door so that every single person entering or exiting the room could glance at my screen. Yes, I did hear an "OH THAT'S SO GROSS" at one point. I'm thinking of writing in to those people and filing a complaint against my excessively obscene exam. I can't believe this is what passes as a medical licensing exam these days!

Anyway, I'm on Ortho rotation now, which I'm finding very disappointing. It's like med school again where you're watching the consultant do history and physical and some very boring pathological findings. And this is coming from me, who absolutely loves Ortho. So needless to say, my attendance has waned.

In October, I did PICU (peds ICU) at one of our peripheral hospitals. Before going into that rotation I was apprehensive because I wasn't that comfortably handling very sick kids. The exposure was good, treating kids with diseases I've never even heard of before. But I found their way of running the PICU and "teaching" residents management of kids was a bit odd - a lot of times it was like trial by fire. My fellow residents were pretty cool and I did not in any way feel like my knowledge was sub-par, and there was one particular resident who annoyed the hell out of me (and her hair really really really reeked too). I hear she's book smart but wow, clinically that really did not come out. The q4 long call was pretty exhausting and there were times I didn't sleep because of coding kids (that was pretty awful). Definitely glad to have my call rotations out of the way and no more WCMC! I really enjoyed my time at WCMC and the pathology is great, but not having to commute and live up there for months at a time is awesome.

In September, part of my month was Ultrasound. I covered night shift sick call frequently so therefore missed most of it. So I really am not comfortably with my level of ultrasound knowledge at this stage. This is something I'm going to have to work on.

Anyway, am now on vacation and free for a little bit. I was all set to go back to Dublin for yet another DULBC dinner, and I was realy looking forward to it. But unfortunately not enough alumni replied, we couldn't get the funds and after a stressful weekend of phone calls and emails, we had to cancel the even to avoid a 1000 euro loss. So after we made this decision, I cancelled my flights to Dublin... there's no point going and spending the money for catching up with one or two people. Such a shame. So now I'm spending my vacation time helping out my program for interview season. And of course, seeing a ton of shows!

I'm a PGY-2!

2009-08-01T04:29:00.003+01:00

I finished MICU in June with no further difficulties. Had a relatively laid-back time and found after the Dublin ordeal, I was able to have much more collected thoughts and I'm glad I went for that sense of closure. Unfortunately, I had a case that I'll remember for the rest of my life where one of my patients, a young lady, died from the dreaded Swine Flu (she was immunocompromised as she had just delivered a baby). She developed ARDS, pneumomediastinum requiring bilateral chest tube placement, we placed her on a rotaprone bed with nitrous oxide therapy and at one point were considering ECMO. But it became more and more futile, which was of course very hard for the family to accept. And one of my nights on call, she became very bradycardic which we managed to resus for a few hours, before she coded. I had to call all the family to tell them to rush in, and try to get it into their heads that there was not going to be a miracle, and ask them to let her go peacefully. It was absolutely heart-wrenching, but interesting from a personal standpoint how to think of ways to get them to understand that we had done everything and have the mother sign the DNR. I think eventually what made them understand was that I explained we were not treating her, but treating numbers. I nearly cried at several points, but people seemed to think I was being very strong. But I was also really angry that I was the INTERN who should NOT have the responsibility of doing this. It should have been the senior residents. But, c'est la vie.

This last month was my trauma month in Harlem. I think it was a pretty good month for me, I don't know what I've missed because I didn't get any TICU exposure, but I got a couple chest tubes and some intubations, so I'm happy. Hopefully I'll get more when I go back for my regular ER month in April. I enjoyed it, which I'm pleased about because it's been awhile since I've really enjoyed my ER job. I was worried (and still am) that I have made the wrong career choice, and I still do feel to some degree that I've reached this goal and now I'm bored of it and want something else. But I think maybe as an attending, perhaps I'll be able to do my clinical shifts and who knows, make some money doing something completely different (ie. more creative)? We'll see. I don't think I want to do more than 14-16 shifts a month, but what made it better was that people seemed to value my work at Harlem (patients and attendings alike) and that sense of reward is satisfying. I'm just wary that I fell into this job because I happen to be good at it, not because I have a passion for it.

Summer has really not been summer yet, there have been a couple hot days but many more cold very thundery drizzly days. But I managed to catch a great warm weekend and spent it learning how to sail. The doing is not as difficult as figuring out where your point of sail is, and in that I need much more practice. If it wasn't so expensive I'd be continuing it a bit more this summer, but I need to save more and maybe I'll sign up for the dinghy class later. It was liberating though, although I probably enjoy rowing more. Cycling there gave me a chance to explore a new bike path adjacent to the hudson river though, which was pretty awesome.

I also recently went on my first "date" via match.com, which finally paired me with an attractive intelligent guy instead of a definitely-not-my-type 60 year old....we went the Coffee shop in union square and it was absolutely downpouring. He seems quite interesting, so we'll see where it goes !

Argh.

2009-08-01T04:20:00.002+01:00

Well, I typed out a description of the rest of the services and my impromptu trip to Ireland, but something in blogspot messed up and I lost the post. I don't have the energy to retype it. Maybe I will later. Suffice it to say that two months after the incident, words still fail to describe all the emotions and details.

Continued

2009-08-01T04:09:00.003+01:00

Oh, here it is.

I don't really feel like writing down every last detail, but I'll remember June 1st 2009 for the rest of my life.

The Butler's reception afterwards was simply amazing, and extremely detailed to dot what would have been Aisling's last I's. The next day in Dublin, it was the Trinity service. Many of us in the class met in the Pav together so we could go en masse to the Chapel, and again it was nice to have strength in numbers. The music I thought was quite somber, so it was very emotional. But Gra and Fergal gave fantastic speeches about the girls, there were professors there that we had not seen for awhile, and representatives of Air France, Brazil and France, and the President of Ireland were there. There was a nice reception in the Dining Hall afterwards, then headed to the Bailey for a commemorative drink for the girls, then the Deasy's had an absolutely lovely reception at their house afterwards as well. I mean, this was just so heartening to see people pulled together. At the Deasy's, a lot of the professors were there and it was nice catching up as well.

Had a couple days respite and just got to hang out with my rowing friends for a few days, which was really nice. I'm really glad I have friends outside of medicine to connect me to my second home. But being back made me really wish I had never left, and although I will never want to work for the HSE again, I loved living in Europe.

That Sunday was Eithne's service in Belfast, and at the reception afterwards there was a really lovely slideshow of photos.

That's all I'll say about that now. It's been two months since it happened, and words still fail to describe all the emotions and details. I'm not a very good descriptive writer, though. The only good thing to come out of this trip besides being with everyone again was a terrific amount of drinking. Peter and I went to a lovely tapas bar on the Friday night (very late as he got out of work late) and drank a hell of a lot of wine and cocktails. Then saturday night, I took him to this really fancy extraordinarily expensive dinner at Shanahans on Stephens Green where the decor is absolutely amazing.

A difficult month...

2009-06-16T00:59:00.005+01:00

In Pace Requiescat - Dr. Aisling Butler, Dr. Jane Deasy, Dr. Eithne Walls - June 1, 2009.

The passing of these three beloved friends and classmates is still a shock to us, and the last two weeks have been very trying, exhausting and emotional. If we felt this way, I cannot imagine what their families are going through. Especially as there's still no clear idea what happened to the Air France plane, all the hurt and anger about the airline knowing about faulty parts, and there's no clear idea where their bodies / belongings are. All we can do is draw strength from continuing to remembering their bright, lively and fun-loving personalities, their ambition and optimism.

I was told about this by one of my best Irish friends / classmates before it broke in the news, and I immediately told the rest of the Americans in our class. The girls were on their way to Paris, where Et's boyfriend (someone I'd known casually before they started being a couple) was waiting at the airport. No names were released or confirmed until June 2nd, and waking up to find their photos plastered all over the papers, internet, CNN was difficult. But as soon as it was confirmed, we knew we had to be in Dublin to support others in our class, mourn with each other and pay respects to their families. And in remembering them, it would let us gain strength and have some closure regarding this terrible loss.

I'm doing MICU at one of our peripheral hospitals, and fortunately not on a very busy service. My program director was very understanding and likened this situation to 911, not at the scale of it, but because of all the uncertainty and suddenness of the situation. She immediately put in a call to the program director at the other hospital, who was very good about granting me time off to go back. I tried not to be too emotional at work, but I was not able to focus and what's worse, did not care at all about my patients (that has never happened to me before). I was on the phone 24/7 to friends overseas (phone bill is going to be exorbitant), not eating and definitely not sleeping. We tried, but it was impossible to avoid - thinking of what their final moments must have been like as a plane literally breaks apart in front of you. Although knowing the girls, they probably took some zopiclone and had a few drinks so were probably sleeping. And it was comforting to know that they were seated together.

The rest of the residents on my rotation sympathized, but I don't think some of them understood at all (although they hardly knew me). They were more concerned that my leaving increased their call time and their work load. To which I say, whatever. In times like those, work is completely trivial, but medicine is one of the most unforgiving professions. Doctors are never "allowed" to be sick, doctors are never treated like normal humans, doctors are not "allowed" to have outside issues (kids sick, housing closures, even doctor's appointments, etc etc etc). But another thing that may be difficult for them to understand, and something that I loved about my training overseas which seems to be missing in the US, is that as a class we grow up together. As a class, we are very close. Medical school is demanding everywhere, but in the UK system the oral examinations are much more intense and the classes are together for longer. It's like a family and although you have your injurious spats and there's hurt and betrayal, what's done to one spurs emotion in all. Even though we're thousands of miles apart now, we still need and draw strength from each other, and will probably continue to do so for the rest of our lives.

So the few of us Americans who were able booked rush flights to make it to Dublin for services which were held for the girls. I think all of us were a little bit wary of flying as we were still empathizing, but a beer (some ambien would have been nice) calmed me down. One of my best rowing friends (not in my class but also now a doctor and a world-class athlete) picked me up, and after a nap we went into town to meet another of my rowing friends (the three musketeers reunited) for lunch in Avoca and it was fantastic catching up. Then went into College (Trinity) to meet a sports admin friend for coffee, back to Kilmainham for a rowing meeting (!) which lasted for ages. Finally, I got to meet up with one of my best friends from my class (Peter), and he and I proceeded to have a fantastic French dinner by Dublin castle (where they wouldn't give us a second bottle of wine) and proceeded to get very very drunk at The Bank bar in town. Had a fantastic night, I don't think I've ever had such a cathartic drinking session!

The next day, we Three Musketeers had brunch in the tea rooms in Phoenix Park, then legged it over to Peter's with my stuff, changed into my dress (amazed I remembered to bring everything to look presentable) and then met two others in my class so we could drive down to Roscrea in Co. Tipperary for Aisling's service. Beforehand, we met up with the others in my class at a hotel near to the church, and seeing them all for the first time in a long time was brilliant. Obviously everyone was quite sad and emotional, but the one good thing is that it reunited us all and allowed us to feel that connection with each other again. We walked over to the church and it was very moving to see it completely fill, spilling out the sides with her friends and communities. The newspaper the next day said about a thousand people were there. The service was beautiful. what touches me most about services is the music, and the music was absolutely gorgeous, not too somber but very tasteful, and the soloist(s) were fantastic.

Spring!

2009-04-13T03:02:00.002+01:00

I'm really happy it's starting to get a bit warmer and the days are longer. Have been really good about getting to the gym and doing some weights / running, even though I'm half-commuting to Westchester for my ER rotation (which is fantastic). The teaching is great, procedures are great...too bad we can't have an environment like this at my home hospital. I'd love working at a place like that. In the last two weeks I've gotten to do a very clean lumbar puncture (brilliant, took me all of 5 minutes, they never go like that for me!), a shoulder reduction with arthrocentesis, seen two chest tube placements. That's pretty awesome.

Have continued my theater splurge and since seen 33 Variations (with Jane Fonda), which is absolutely brilliant. So ingenious, it amazes me how Kaufman can have the clarity to think like that, make connections between a speculation on why Beethoven wrote his 33 Variations and the modern-day life of his musicologist, and life in general. I might have to see it again, or get the script for it. I love really intelligent plays like that. I've also seen the new musical "Next to Normal," which is creative but I can't really understand why everyone is raving about it. I don't really like the music in these new musicals. Bar one, "Invisible Girl and Super boy," I don't really like the music although some of the lyrics are kind of funny. Same as in Wicked, I don't really like the music except "Defying Gravity." Maybe I'm old-fashioned, but bring back the Gershwin / Hammerstein music. At least Sondheim's music makes sense, he's probably the only contemporary composer who makes good musical music.

This Wednesday I'm going on my first eharmony match date. Still a little wary of meeting someone off a dating website, but seeing as how it's nearly impossible to meet anyone when you're working, and that people don't approach each other in gyms and whatnot like they do in movies (never mind the fact that I still tower over all the boys in the gym) that's the only way to go. So dinner and then seeing Waiting for Godot with Nathan Lane...that alone should guarantee a good night!

I'm glad I'm in WMC ER right now with such a good experience so far. It reaffirms my part-desire to be a doctor and help people, and when I'm at work I enjoy it. I still know that being a doctor isn't the only thing that I want to have happen in my life and I'm still going to explore other options, but now I'm not as depressed as I was a couple weeks ago and it's a good job to be a "baseline" job. I still need to work a lot and study, but still having time for a theatre habit so that's not too bad! And I'm starting to work at creative endeavors with writing ideas and buying a guitar off amazon ;). We'll see if it can get me more content!

More fun in the big city!

2009-03-25T04:49:00.004Z

Man, my vacation was hectic and went way too fast :)!

Spent the first week of it in our condo in Vegas, where we had a family reunion with my grandmother and my sis (wooo!). Didn't really do much except eat, took a load of silly photos at the Valley of Fire park and flower shows in Bellagio. Only walked 1/2 of the strip once, because a day got wasted by sis getting sick >:(. And of course, buffet in Paris where I managed not to eat the whole dessert area like I did last time.

After leaving Vegas (having to get up at 3 am for the flight) and landing in NYC many hours later, saw an Ionesco play called Exit the King on Broadway (with Susan Sarandon, Geoffrey Rush, Lauren Ambrose) which was possibly not the best choice to end a long day. Not only was it dark and slightly depressing although there were a few funny bits in the first half, the second half was full of dragging monologues and esoteric dialogue which put everyone to sleep. We were in the 4th row from stage and in front of us this lady started snoring, and her friend with her gave her a huge elbow nudge, to which the sleeping lady jumped a foot in her chair and everyone behind her started snickering right in the middle of this death epiphany by Geoffrey Rush. Man, that was a head-banger.

Then Saturday we saw Blithe Spirit (Rupert everett, Angela Lansbury) and it was fantastic. The whole play is so witty and funny and Lansbury yet again is great at playing eccentric characters. Ate at Sardi's which was lovely and atmosphere is fantastic with all those actors' caricatures. Then we saw the Ibsen play, Hedda Gabler (Mary Louise Parker), and I wish we'd reversed the order of seeing these two because while well-performed, it was quite dark and bleek. I'll also try to avoid the American Airlines theater (roundtree) in the future because if you sit on the right side, it's adjacent to some alleyway in times square and you can hear all the immature teenage passerbys and lorries honking horns.

Sunday, we spent basically the whole day shopping at Woodbury Commons. Obviously spent loads of money and were wrecked by the end of it! We'd been up til 4 am the night before as we couldn't sleep, but somehow we managed to plod through the piles of clothes and Coach bags!

Monday, my friend from Ireland came and so we had a nice easy day of it, met up with a couple friends at my local bar and we managed to seriously bore my sis and my friend with all the medicine talk. I really need to find more non-medical friends!

Tuesday was the museum day and we raced through the Guggenheim, Metropolitan and Natural History museums. Man, that was a whirlwind and I won't be back to those for awhile! Think i might buy membership to the Met museum and just sit in the conservatory to read. Then Bubba Gumps for dinner in Times Square, which was a lot of fun and loads of silly pictures ;).

Wednesday we saw West Side Story on Broadway, which was good. This production is different because they've sung some of the songs in Spanish. I think that concept is interesting, but at the same time, I didn't like spending 120 dollars on tickets to not understand what they were saying. The lead guy of the jets started the opening song off key though he corrected himself. And the men weren't quite macho enough, in my opinion - i mean, i know west side story has some ballet style dance in it, but perhaps a little too effeminate casting. Good singing from the leads though.

That night, we went to the Knicks game, which was really exciting in the end even though now I can't remember who won...I think the Knicks did. They came out really strongly, but then let it go in the 2nd quarter and had to play catch up. My friend caught one of those tshirts that they shoot into the crowd, heh!

Thursday we drove to the Bronx Botanical Gardens which was nice (my Irish mate is into botany and all) and took silly photos of cacti and orchids. Had a nice chat before driving her to the airport. And then on the way back from JFK, got completely lost (in the dark) with my sis needing to pee really badly. Finally got the GPS working (woo for GPS!) and made it back before she had an "accident" in the car.

Friday we got TKTS to see 39 steps, which was hilarious. Very creative as 4 people play multiple parts. I love the theater!

Saturday, woke up early to stand in the TKTS line again hoping to see In the Heights (but it wasn't out yet) and then we met up with a couple high school friends (awesome!) for brunch in Greenwich. It's always nice catching up. Saw Reasons to be Pretty (Piper Perabo, Steven Pasquale even though neither of those two are the lead characters) which was interesting as you watched how a minor comment spirals into a huge life event, and was mildly amusing. A little too much cursing for me though. Then, my sis was curious about August: Osage county so we went back to the TKTS line and got tickets, and it was brilliant. Very funny watching this dysfunctional but normal ? family with most social taboos worked in! we were way up in the mezzanine though, so some parts were a little hard to hear. I'm just making notes for myself for other performances i try to see in the same theaters. I definitely have become a very avid theater-goer!

Then after getting very little sleep, Viv left for LaGuardia at like 5 am . :( . Damn, I wish we were at the stage in our lives where we could get the big house / apartment together like we always planned. We've been apart for nearly 8 years now after spending every single day together and I thought I'd welcome the change (and I have to some degree), but now I at least want her around to do stuff with, since my social network is still in Ireland .

Then this past Tuesday, I took myself to see the new Durang play (Why torture is wrong) mainly because I wanted to see Laura Benanti act again (I saw her in Gypsy). It was definitely interesting, made a few funny jabs, and the actress who plays the mother is hilarious! I think some roles had a little overacting going on, but I just find there's something very engaging about Ms. Benanti that's captivating. I spent the rest of the vacation downloading and watching episodes of True Blood, I'm not really certain why!

I've been feeling pretty down lately, which is something new for me. I've never felt this way before, and it's not pleasant, especially when I'm supposed to be on vacation relaxing! Maybe it's because my twin left. I just feel like there's something really missing in my life, I'm not enjoying my work and it's not exciting me to go into work. I like the idea of being a doctor, and I like acquiring the skills. But it's not a culmination for me, I don't feel like I have achieved anything. It's funny how people measure success as they grow older. Some would think I've done a lot and am a very successful individual at this age, and I thought I would feel that way too. But I don't...I want something more and I'm not sure what that something is.

Maybe it's the fact that to get to this point, I was involved in so many things and now those have just been cut out due to work committments, and I don't like my life just being medicine. I'd love to get into more creative endeavors, I think at the very least I'll start a little writing again (even though my thoughts are so jumbled I feel I don't know where to begin). But right now I'm questioning my life / career choice, and if I had to opt differently, I wonder what it would have been like to pursue one of the possibilities I was thinking of when I was 18 to be a musician / performing artist, although that would have been the less stable route. Although if I didn't do medicine, I never would have gone overseas to Trinity and met my wonderful friends there. Maybe I have too many unrealistic ambitions, but I still feel like a young kid who wants to get out there and do everything and make a mark in the world!

Vegas!!

2009-03-20T03:42:00.002Z

Have done quite a bit of nothing (besides work) these last couple weeks, and now am just finishing a couple days in Vegas, where we're having a family reunion at the condo. It's been really nice, gorgeous weather in the 80s and I love the sun! I'd love moving here except for the lack of water. We spent several hours at the Valley of Fire state park which had gorgeous red rock and stone formations. We missed seeing petroglyphs because my parents/grandmother weren't keen on hiking to those spots, but we amused ourselves by taking silly photos anyway! Who else can I take silly photos with except my twin :) :) ?

Then Wednesday we took some photos in a lovely flower exhibit at the Bellagio (more silly photos), they're always very creative in making their displays. We wandered around the strip more but only got halfway. Did some fake sword-fighting in Excalibur and rode the hideously expensive New York New York roller coaster where we had to wait for front row seats, of course. Fun enough and scenery is cool, but the pictures they take are kinda crappy and don't even include the taxi-cab-looking cars. Then spent hours in M&M world and coke world so Viv could find gifts for friends. Coke world have made these cool shirts which smell like their products, but they're too sweet-smelling and would definitely attract all sorts of interesting bugs in the summer. Good thing we think practically cuz otherwise I'd buy everything under the sun! Then had dinner at Rainforest cafe which is always a blast. I think Viv ate something bad though cuz she spent all last night and today running for the porcelain god....

...which sucked because we were hoping to go back to the Strip and finish off the rest of the half (I love Caesars Palace), but it wasn't to be. She's feeling a little bit better now, but my family ignored my doctory advice and tried pushing some herbal medications which I've never heard of before.

Anyway, to Manhattan tomorrow so I can show my sis and friends the dazzle of NYC!

I think I'm becoming more financially educated, having done my taxes (and paid HR Block an enormous sum to do it for me and fix my errors), and looking up all these Roth IRA companies online, and trying to come to grips with the funds in my 403(b) / TDA. I should take a class one day. But I think anyone who is or will be a resident should try to max out their Roth IRA each year of their residency before we become ineligible when earning an attending salary. I only have 3 years to do that unless I do a fellowship. So word to those who know nothing like me: INVEST IN A ROTH IRA NOW! The market is falling so your money will buy you more shares which will compound more interest when they start rising again.

2009-03-02T07:04:00.004Z

Well, last month was busy! Everyone was just so tired. You have to cram nearly the same amount of shifts (one shift less) into a short month. A bit insane, even though you can get more coverage during a day. I came in on a week of nights and was hit with a thoracotomy (I came too late so couldn't get into the action) and we spent the whole night trying to recover from it although it was cool seeing it. A GSW that transected the descending aorta unfortunately. The third year resident was too busy doing paperwork for the police so I ended up taking all the sign outs. I don't really know if a first year has done that before at my program. It was tough following everything and trying to deal with incomplete signouts, and meanwhile the chart rack remains overflowing. But no matter how bad a shift seems, I've learned it doesn't kill you and you survive.

Then we had our inservice. Have to say didn't study for it as much as I wanted to, but we'll see. .. 1st years generally don't pass, but the questions seemed manageable. Had a nice post inservice party! It's so nice when nearly all the residents and some attendings can be together. And we learned our ER chief of service has a fantastic apartment ;).

Now trying to figure out how to do my taxes. I don't think I'm doing something right cuz I keep getting it saying I'm making a negative operating loss. I think I may need to get a financial advisor, sigh.

Snow Snow Snow!

2009-01-19T20:07:00.002Z

On the eve of our seemingly savior President's inauguration, I've never seen so much snow coming down as now. I'm not from a snow-shy state either, but walking home last night, so much snow caked on my head that it actually weighed me down!

Right now doing my medicine floors month in Valhalla at one of our sister hospitals. I will be so glad when it's done. Just not my cup of tea, and I never thought I'd say this, but I like the way the St. James's (Dublin) medicine teams run a lot more. I'd forgotten how on floors you never ever get out on time, doesn't matter whether you're in surgery or medicine, you can't possibly enjoy your life like that. At least with ER you know you end at such-and-such time and get definite days off. I've talked to many disgruntled people over the last few weeks, including the superstar residents, high-ranked surgeons...they definitely don't tell you this crap when you're a young doctor hopeful.

Although residency is tough on everyone and so many 12 hr. shifts in first year really kills your spirit, I'm so glad I'm in ER. There's fewer arrogant assholes. I wish patients in hospital could see what their residents have to go through and how what seems like a small simple task is actually the result of someone scurrying high and low, begging, yelling, crying to accomplish it. Then on top of that everything is complicated by the state of health care in this country, medicaid and medicare limiting doctor's options, etc. Makes me more tempted to become an ex-patriate again!

But aside from all that, I think I'm disgruntled because I'm lacking a creative outlet . You spend time doing all these extracurriculars and excelling in all these activities to make you a well-rounded person because that's what med schools and residency programs want (well you do too but you know what I mean). Then when you get into residency, all of a sudden all those extra things are taken away from you and your whole life is just medicine when you've gotten used to being able to do and balance everything. can't wait for more time to just enjoy other things.

I'm starting to realize that medicine is just a job like everything else, and although for me it's a more preferable, safe stable job than others, it's just acquiring a set of skills like a mechanic or electrician. I always thought that loving your job was to love your life, and that medicine was the only job that I could like, but now I want to spend all my free time not doing medicine! It could be worse, but am definitely longing for the day when I can feel balanced again.

We'll see what changes our new president can instigate. I'd definitely love the pressure to be relieved from the ERs.

Apart from all this medicine mumbo jumbo, have checked out a couple restaurants for NYC's winter restaurant week. Went to a quite nice cozy French place last night, and checking out a Scandanavian restaurant tonight! Woo! I don't know how but somehow have lost like 6 pounds ... by eating!

heh.

2008-12-29T03:14:00.003Z

I treated a patient today who got bitten by a squirrel. X saw a squirrel outside the house looking "in distress," and decided to take some vital signs on it. How on earth you take vital signs on a squirrel I have no idea, but it obviously didn't really work so well for X because all X got for it was a good CHOMP on the hand. While I was struggling very hard not to laugh at the image of near CPR on a squirrel, X supplied that X got far enough to determine that the poor squirrel was indeed in respiratory distress. Now, how high a squirrel's blood pressure should be or how fast a squirrel breathes is beyond my depth of knowledge. But I rewarded X with a Good Samaritan award from our hospital on the discharge paper!

You definitely see some strange things in this line of work!

Oh, I also learned today that "toast" means "gun." Y was mugged and reported that there was some toast involved on the assailant's part. Here I was thinking "Oh sure, ok there was a scuffle at the shop and some food fight was involved and somehow he got some toast." My attending even asked specifically if there was a gun involved and I was like "Oh not at all, only fists." Didn't I feel like an idiot when my attending questioned Y and came back to me and was like, "Um...did you know that "toast / belt / heater" means "gun?" I mean seriously come on, like that's intuitive. How am I supposed to know that?! Everyone's laughter (including my Y's and Y's family) followed me to the phone while I called NYPD.

2008-11-30T23:37:00.004Z

This holiday makes me wonder when I got the medicine bug and why couldn't I have chosen something simpler where I don't have to study and I can schedule more time off? :) . I know every doctor thinks about that multiple times in their careers, and it's gonna take me a little while to get the "yeah, this is the only thing for me" feeling back.

The first week of my holiday I spent in Dublin, visiting friends and attending an alumni dinner for my old rowing club. I stayed in the Hilton Hotel for the weekend which I'd recommend to anybody, and then for a few days after, stayed in some friends' apts. It was nice, was like I never left and I was free to do whatever I wanted (ie. some training, even sculled for a trip!) like the times before I started working. I ran and cycled around phoenix park which was just like old times, and phoenix park is much bigger than central park so it was nice to get back to that.

I really miss sports and being able to train as much as I used to. Definitely have a few squishier spots now that I want to get rid of, but doing 2-4 hours training a day is now not possible!

Then for the second week of holidays, one of my Irish friends and another good Norwegian friend (both through rowing!) came over to visit. The first night, went to a Knicks vs. Wizards game which was boring for the first half but much more exciting the second half, so I'm glad they got to experience the atmosphere of Madison Sq. Garden even though they were both horribly jetlagged.

The next day, did the NY Movie and Tv tour, which was interesting and informative, took us through most parts of NY, but I don't think any of us were that into it and it took a good 3.5 hours. Our finishing point was the Palace hotel, which we went into to look at the christmas decorations, and a guy there gave us free tickets to see this year's Gypsy reprisal! Great seats, was an interesting musical (not my favorite sondheim even though everyone raved about it) a little funny on the plot (but i'd never really seen/heard about it before), but I thought the acting was amazing, especially by Laura Benanti who transforms from a tomboy into this gorgeous burlesque dancer / stripper. Well she's won herself a new fan anyway!

Unfortunately, one of my friends became ill and we came back early after wandering Times Square a little (I love Times Square, all the lights! I wouldn't even want to see their electricity bills!). Two of us went to this lovely euro-caribbean restaurant near me and then slept off more jet lag. Up early the next morning to the Statue of Liberty which we felt we had to go to just to satisfy the tourist requirement, so now we've done it and we didn't bother with Ellis Island. Then shopping up 5th avenue! After playing in FAO Schwartz, we were starving so had a great burger at Mickey Mantle's. I don't think my friends had been in that kind of sports restaurant before!

Took my friends to see the Guggenheim (interesting exhibits), and one of them became museum'ed out fairly early so she took off for some shopping while the rest of us went to the Metropolitan museum. I'm not an art connoiseur but I definitely am not really a fan of the Dutch style painting. Perked up a bit when we got to the more modern sections, and then came across a fabulous exhibit of modern British prints (including rowing!) which we loved. Made a hasty bee-line for the exit, then wandered around Soho for a bit and the outskirts of chinatown, chilled in a nice Soho bar then walked in search of food to the west end where we found some dodgy steak outfit where the waitress couldn't describe the food to us. I found this hilarious, but then again I was drunk off two glasses of wine in the soho bar, so I couldn't talk.

After a lie in on wednesday, we returned to the theatre district to see Wicked, which is a fantastic production. Not a huge fan of the music (I must have an "older" musical music taste), but the story line, setting / props and dance were terrific! It made funny allusions to the wizard of oz and the plot / dialogue was quite clever. I'm sure it was amazingly fun to write the play and see it pan out on stage! I'd love to know how to do that! Then went up to the top of the Rockefeller center, which is a terrific view, a little more shopping and then to the Hudson Hotel for dinner (they do lovely steaks, and the dessert portions are enormous!). The rest of the night was a little dodgy, as we went to two bars on different sides of town but they weren't very club-y. A friend of mine joined us, as well as one of the more laid back attendings and some lads also on vacation who my Irish friend knew.

Thursday - Thanksgiving, hurrah! We stayed in bed the whole morning, didn't even watch any of the Macy's parade, had a bit of brunch and I went back to sleep while the two girls trudged through central park. Had Thanksgiving dinner at Tavern on the Green, which I was glad to go to as the decor was interesting / funky / a little tawdry?, but don't think I'll be going back there again. The queue for those who had reservations was 45 minutes! On the way out, i got waylaid by a lady who said I had terrific karma (what does that mean exactly?!) and gave me her business card, for some tarot / psychic thing. But perhaps it was true because the Chase 1 in 500 free worked to my advantage that night!

We chilled for a little, and then I thought it'd be a great idea to go to woodbury commons for some black friday midnight shopping. Well apparently, so did a million other people because traffic to there was nearly standstill for about 3 hours. It took us 4.5 hours in the car to get to this place and there's no where to turn around to go back! On a normal day would take 1 hour. So after getting there at 3:30 am, at least my friends got tons of shopping done and everyone came back wrecked, but happy. That is definitely something i will avoid in the future, I will pay higher prices like everyone else :).

After coming home at 9 am, we slept for a couple hours and back to 5th ave / madison ave for some further shopping (notice a theme here?). New York is absolutely amazing for shopping, you can basically find everything here! since being here, I have definitely contributed to the profit margins of Bed Bath and Beyond and well as Banana republic (I must like B's) I've spent so much it's ridiculous! and I still don't have all the christmas presents ready! From what I saw and the amount my friends got, america is not going into recession this Christmas at least! Then we had dinner at this absolutely fabulous westernized asian/fusion place called Phillipe's, which I am definitely going back to.

Unfortunately, the holiday came to a close and after some last minute shopping, my friends returned home with very full bags and emptier wallets. But we fit in some tourist attractions, sight-seeing, good restaurants, Broadway shows and a lot of shopping, so all-in-all a very productive trip! I wish I didn't have to work so I could just spend all my days going to see all the Broadway (and off-Broadway) shows, museums, wandering around central park and doing some training for once, but 'tis not to be. At least I'm in the city where everything happens, so maybe eventually!

Back to it tomorrow...dun dun dun....

Nuts!

2008-11-30T23:24:00.003Z

I spent the first two weeks of November at in Harlem for my first rotation there. That place gets nuts! The first day wasn't actually too bad, as it was the day of the NYC Marathon and surprisingly, we didn't get that many patients.

However, that was the only quiet day. But even though it got hectic, most attendings took everything in stride and handled the patient load well. They've got some people who can run an ED well, and it makes such a difference. They have a sicker population, which was interesting. Did a few NG lavages which became a funny situation, as they recently got a supply of new equipment and it took ages to try to figure out how to get suction, so we're running through all different scenarios while this guy has a tube hanging out his nose.

I had an interesting patient who was perfectly lovely except for seeing demons / creatures on the walls. I actually became irritated at the attendant who kept repeating "the pt's crazy, everyone knows it, the family knows it, just crazy!" But the patient was very with it except for the seeing "evil," poor person. I hope they found a cause.

My last shift was absolutely pressing panic buttons. All was grand until about mid-morning when all of a sudden, sick patients were coming in at the same time. I was looking after a patient who I realized could be very pausibly having a brain bleed as I was interviewing him/her, and the attending at the time (who I get along well with and said some nice things about me) also had a couple sickies and as we were making plans, the CT machine went down. So then I spent about 3 hours trying to transfer them to another facility to have a CT, meanwhile checking every 5 minutes to see whether my possible brain bleed was still stable and the attending and I debating on whether we should do the LP or not without a confirmed bleed. We ended up doing the lumbar puncture with no complications, to our great relief.

And then I dashed home to hop on a plane to Dublin for the beginning of my holiday!

I don't want to do medicine anymore!

2008-11-30T22:53:00.002Z

... just kidding, but I'm just finished two weeks of holidays and the thoughts of going back to work are depressing!

In October, I was doing ER at my home hospital, which can be not-so-pleasant for a number of reasons. First, I need to do a lot more reading and studying because there are some areas I don't feel very comfortable in, but having time to do said studying is proving impossible since first years are assigned 20 shifts a month. A lot of your "days off" are actually spent trying to recover from night shift before you have to switch schedules again. I don't mind shiftwork, but it can make it difficult to plan things and use your time as effectively as if you had a patterned week.

Also, I'm finding myself beginning to get cynical, especially with regards to my home hospital and society in general. I think it's a bit scary, especially as I'm only 5 months into residency. The patient population here I find can be a little irritating. Probably a lot of things I write are going to be quite un-PC, but c'est la vie. I am constantly amazed by the number of people who do nothing to help themselves. This varies from refusal to learn English even after being in this country for a number of years (then wondering why doctors have no clue what they're trying to say, even with those damn interpreter phones which I am startin to hate) to coming in with severe asthma exacerbations because they ran out of medications 2 weeks ago (why they hell didn't you see your doctor 2 weeks ago and save yourself this mess?!) to foul-smelling nearly gangrenous cellulitic legs which are going to need amputation but could have been saved had they presented when it first started. When asked why, all you get is a shrug of the shoulders and a non-committal "I dunno." I feel we should make billboards telling the general public that medicine is not a magic wand, there are no quick fixes and we can't make their serious conditions disappear without any consequences.

Also, a hell of a lot of people flood the EDs for no reason. What part of "emergency" do people not understand? The cold that started yesterday does not warrant a visit! No, we do not give medicine to everybody! Your papercut is not a fucking emergency! Then they start complaining about the long waits or the fact that we aren't "doing" anything because they were expecting some pill. Wish we could hand out placebo pills. Wish we could turn people away at the door for things that do not need to be seen. And to top it off, the hospital gives free subway cards to patients on request, so some even make up conditions just to get the card! I just really can't stand it that these people are getting free healthcare and are the most ungrateful people I have seen, looking for the next free thing they can get from the hospital and complaining while they do so.

My friends know that one of the things I value most in people is if they treat others well, have a bit of ambition and put a little effort in to achieve their goals. The exact opposite is what I see on a daily basis and it's grating to constantly see that society and have words fall on deaf ears. Some of it is miscommunication between doctors and patients, but at the same time, we cannot make people look after their own health / life.

Anyway, when the free emergency healthcare system works for patients who actually need it, it is very rewarding. I estimate that happens about 60% of the time and 40% was probably preventable

Things are better and brighter!

2008-10-01T02:48:00.002+01:00

Mainly because I think I rid myself mostly of the roach problem :). I still see a couple sometimes, but I figure I just have to fog every once in awhile and it'll be ok.

So I'm now two rotations down, but I fear they were my easiest ones!

August was Peds ER which I surprisingly found myself enjoying, since as a student I held kids out at arms length and didn't want them near me! But I had fun for the most part, except when asked to stay 1.5 hours overtime to "supervise" the other peds residents doing lacs (how f-in ridiculous! just because I'm 2 months into ER does not mean I'm expert at lacs, and why the hell can't the more senior residents or the attending supervise?!). And also when playing mind games with some of the peds residents who get lazy and try not to see any patients and shove it on you, or when they don't manage ER cases properly. Once, I actually shouted at one of the residents, took 3 of his cases from him and told him which case to take, then took another 2 at the same time and cleared the ED in an hour after that. The attending loved it, but I was like "That is NOT my job, that's YOURS." Of course I didn't say that :). I was lucky with nurses too cuz one of them would shout publically, "You're not to take that case, there are other people SUPPOSEDLY working here too!" hehehehe!

But I'm just venting. Most of my frustrating with peds was working with my co-workers, not the actual cases coming in. It's nice and chilled in our peds ED although it can get really hectic at times. Still, it's got a more uplifting feel than our adult ED, and I don't know why that is. Maybe because you can have a quicker flow and faster dispositions in peds. I really enjoyed playing with the kids and using little tricks to get them to respond to you. It's especially rewarding when they wrap their cute little arms around your legs to give you a hug afterwards.

Then in September, I had CCU at one of our peripheral hospitals. That was pretty chill too with downtime during the day (most days). The only problem is that it's a long commute. At least 40 minutes in the car, about 2 hours by public transport. Fortunately I was able to grab a lift from a friend of mine (who was late more often than not, heh!) but I was getting up at 5:30 to be there for 7, and when I had to get public transport, I got up at 4:30 and wouldn't get home til 9. The first couple weeks were tough because I didn't really know my job description and didn't seem to be having any responsibility, plus learning an outdated computer system. But definitely the last two weeks I could see my input into the team and pre-empt orders, etc. I learned a bit, but I'm not sure how much was relevant to my own training. Some on pressure support, swan-ganz which i still need to read on, but what was really cool was learning how to do a bedside Echo.

Anyway, back to ER at my home city hospital and I've got a fairly good schedule - mix of nights, peds, etc. And no getting up ass early and leaving really late! Hopefully I'll now have more time for gym and study. I just bought a new bike too so I can't wait to have a go in central park!

This is getting ridiculous.

2008-08-29T03:37:00.003+01:00

Ok, call me naive. I had no idea NYC and roaches were synonymous. This is probably the worst place I have ever lived, but having said that, it's still liveable - except for the F_IN ROACHES! Oh, we've laughed, we've cried about them but now i'm starting to get really irritated.

So my hospital provides housing, which is great - a dorm style building (individual rooms are only 9' x 13' though) that's right across the hospital, and the location itself is convenient to the subway station and bus lines. Laundry machines on each floor, NO BILLS (except internet / cable which is contracted out) which is very useful for those of us keeping the AC and lights on 24/7 trying to deter the roaches, and hospital police for the front-doormen. Gym downstairs too, although it's very bare. We're hoping to build it up. And, "rent" is only like 300 a month, which is subsidized by my program / hospital.

However, the roaches. It's an old building and believe it or not, some people either through laziness, tolerance or religious opposition, DON'T KILL THEM! SO then they infest other people's rooms, they're in the walls, when I walk into the communal "kitchen" sometimes there's like 5-6 scurrying away from me and sometimes when I open the communal microwave, they scuttle out too!! I mean, GROSS!

I have become completely roach-obsessed. I spent all of today cleaning every single item I own, taking out the drawers and spraying, buying two tubes of caulk and caulking every crack I can find, I have roach bait everywhere. And I thought I was getting control of them until I saw one pregnant one yesterday and one large pregnant one today. The little ones I don't mind. The big ones I really do mind. My neighbor must not be killing them.

It's becoming a serious problem, I can't study cuz I look up, see one then spend 1 second killing it and 9 minutes cleaning the area. I can't sleep cuz I keep imagining them crawling on me when I sleep (although that has never happened, they actually don't go near my bed but one of my friends said he woke up to find 3 of them staring at him and he subsequently screamed like a girl). You can actually hear people screaming in the hallway if they find a particularly gross looking one.

I wish the administration would exterminate the whole building, but as far as I know, they only spray individual rooms. I hope all these fumes and stuff build up my immune system and not weaken it. I've already gotten 2 bad colds in the last two months.

I was getting so mad the other day because in my spoiled mindset, I was like "I paid for 9 years of high quality education, I worked damn hard to become a doctor, so why am I now living in a shithole that is the smallest hole I have ever lived in?" I was considering moving out...until I realized that unless you rent those really expensive apts in manhattan, it's a problem everywhere in the city. And some apts get like dead rats and crap too.

Sigh. I was considering staying here after residency. Maybe if I could afford one of those luxury apts, I will. Who knows. sheesh. I'm bombing / fogging my room tomorrow. I hope to god it works.

2008-08-20T03:09:00.003+01:00

And it begins....!

2008-07-01T03:54:00.003+01:00

Today is June 30th, the last day of rest before the nervously anticipated universal first day of a physician's year. That sounds a bit too dramatic for how I actually feel, which is fairly calm. Definitely just completing a year of clinical work gives me some degree of confidence, as well as the fact that we're not really working our first two weeks (we have ER orientation). I think a couple of the others are nervous though. There's a few things I'm going to have to adjust to, but they're small - drug names, American units vs. metric, etc. But all in all, I'm mainly excited about embarking on the ER journey. Let's hope it's the right one!

The last two weeks have been quite busy. I landed on June 15th and stayed in cheap hotel, which was decent but a pain in the ass to lug all the luggage to. Organization with my program is a bit lacking, but hey, what's new? Anyway, I had a bit of a scare with the living situation, which got sorted. We live in heavily subsidized dorm accomodation directly across the hospital. It's convenient, but the rooms are quite small and you share a bathroom/kitchen. That's not great, but honestly...how much time do I really spend in either?

June 16th, a week of general orientation began, which was really boring. Signing all these papers to get registered with human resources, not understanding a single thing about tax papers, not understanding a single thing about signing up for benefits like retirement packages and insurance, etc. I mean, way to make doctors feel stupid. I should have gotten like an MBA or something before coming here! Anyway, it was really funny cuz all of us ER people are alike. We all skipped multiple things, and would find the whole ER table in the hospital doing other things. On the last day, there was this cultural competency session on for hours and I was like "are you actually serious?!" and skipped. Maybe that's what doing a clinical year did for me - made me better at not sitting through crap!

Last week, everyone was doing their courses (ACLS, PALS, etc.) but i've already done them so I got to go home and see the parents and pick up some of the stuff I'd shipped home. Caught up on movies and got to see the human bodies exhibit at the museum which has been globally popular and somewhat controversial. It was interesting, but since we've done anatomy, it was like "been there, done that" but I could see how "lay" people would find it really cool. The dissections were very clean and neat, must have taken months to get them that good. had a small nightmare trying to fly back to new york with my flight plan diverted like 3 times. Ended up landing in laguardia, which was awesome because we flew over central park (nice view!) and I think I spotted my hospital and apt. tower!

Have spent ooodles of money trying to make my room space-efficient. When I got here, the room was a dump. Dirty floor, crap in the sink...the first place I headed was to buy cleaning equipment. The furniture sucked - old metal rusting bed frame and desk, with a really cracked plastic mattress. Anyway, now I've bought this awesome futon bunk bed which is brilliant, a nice 22 inch flat screen tv, and rugs so I don't have to look at the floor. Of course, I swiffer wetjetted the floor a million times before putting the rugs down. I'm going to have the desk removed and just put in some nice shelves, and perhaps a laptop stand so I can work from my futon. Cable guy came and installed internet, so I've made the room wireless - no long cables. And I still have to install my fridge and microwave, bought a dvd recorder and going to get a printer! So glad I still have euro paychecks coming in!! I figure an investment is in order if I'm going to be here 3 years, and why not, if I've got the money?

Anyway, I can't wait for visitors, so if you're in the area, give me a shout!

Watch this space and I'll hopefully update the ER journey frequently...beginning tomorrow!

NO MORE SCUT!!!

2008-07-01T02:55:00.004+01:00

Whether you're just beginning or internship or thanking god you've finished internship and moving on to senior positions, Good Luck! DOWN WITH SCUT! is all I have to say.

The last several weeks have been a whirlwind. It's weird to think that just two weekends ago, I was in Dublin, having some very boozy going-away celebrations. My very last call was June 3rd and for some funny reason, the American interns were all on together. Cheesy, but i took photos on call, just to remember what it was like. It's great not ever having to do call ever again, I absolutely hate all the inefficiency and incompentency shenanigans you have to deal with, and not to mention that call hours there are uncapped and admissions are uncapped. Can you tell I'm very happy not to have to repeat internship?!

Anyway, weather was lovely and I spent my last couple weekends in Dublin at rowing things and bbq's. Had a great time at Metro regatta in the sun, talking to loads of people I haven't seen in awhile and won't see in awhile. Then went out and had a fantastic rowing night out, that's something I'll really miss. Unluckily for me, met a hot boy, which is the typical leaving story, but cest la vie! Had a hungover bbq the next day, I love those spontaneous things, and Paulie did the typical man job of trying those disposable bbq's which didn't work. I had leftover burgers for 2 weeks! The next weekend, went up to Queens for the Queens vs. Trinity race, and was in the launch watching the races and had a fabulous time - it's great to enjoy the social rowing scene. Last bastion of British aristocracy and all.

My last weekend was a DULBC alumni reception (small) that was pleasant, bought way too much wine and cheese but who's complaining! And then dashed off to the SJH hospital ball for a last drunken medic night. Had a great time, but was definitely sad at the end and ended up bawling for a little while. Then dashed home, slept for 1.5 hours and then off to the airport to whisk away to NYC!

I had mixed feelings about coming. On one hand, I really wanted to get out of SJH, even though I really like that hospital. Enough was enough though. On the other hand, I really like european life and the way friendships are formed there, and I really didn't want to leave my close friends. Coming to NYC was the best thing for my career, but I was afraid that I wouldn't adjust well or like having to come back to US thinking and corniness. But now that I have, my wariness was unjustified and I'm having a great time. I really like it here and the people in my program seem great, and... NO MORE SCUT!!!! well...not as much anyway!

2008-05-04T22:52:00.003+01:00

My last rotation of formal intern year is awesome. General Medicine with a super team that's really efficient. It's great - I'm busier than my last rotation and I get to leave earlier. We're usually always out by 5 and when we're not busy, we take turns who goes for half days. Have gotten a couple interesting cases (the most recent one of an infected fluid-filled emphysematous bulla in a crack cocaine user) and have a decent level of autonomy. I'm really glad I'm ending with a good one.

Call can be really brutal though so I'm soooo counting them down. There was a saturday in April that was absolutely horrendous, o2 desats all over the place with neither myself or my partner going to bed and staying late on sunday while the intern coming on was waiting for his locum partner. Yesterday was ok, got to bed at 3:30 after an aspiration pneumonia with bad desat and a DKA that wasn't picked up in the A&E. I then wasted the rest of this gorgeous day sleeping. I'm so glad I'm going into a 3 year program and don't have to repeat intern year!

I actually found myself at a loss for words last night when a nurse asked me, "Would it not be better for both of you to be carrying your own bleeps instead of switching?" I was like "No, because then both people would be up for 24+ hours with no break since we only take like 30 min for lunch and dinner instead of us swapping so that we can each get 4 hours of sleep." She really didn't understand it. I was like "Would YOU like to be working for 24-30 hours? would YOU like to work 2 of your mere 12 hour shifts back-to-back?" Maybe this is why doctors and nurses don't get along because some really lack logic or the ability to think critically. I'm going to get shot for saying that but I'm generally nice to everyone and this inability of people to think logically or outside their own box really annoys me. There are fantastic nurses out there who I really like but for every one of them, there's like 5 dumbass/lazy ones who boil your blood on a daily basis.

Anyway, the day job is great and the free time has let me get all my stuff ready for going to NY. The number of forms you have to fill out is unbelievable. And then you have to do all the stuff for NY medical licensing and when you're reading through one form then you figure out you have to apply for something else and it costs like a grand! And you have to keep going back to the medical school office for your diplomas/transcripts/deans letters/etc. Anyway, I think it's mainly all sorted now. Hopefully everything's all set!

So I leave June 15th and I've already had to say good bye to one of my best friends, which was sad and weird. She just fininshed medical school and is now galavanting through south america. It is strange moving away from people I see virtually every single day and I'm sure I'll be making a lot of long-distance phone calls. Hopefully coming back once or twice next year (obviously around rowing events!).

I matched!!

2008-03-23T21:06:00.002Z

So around this time of year, messy medics go mad with fears / anticipation re: job security! But last week was Match week and 15000 US med students + several thousand foreign grads (US IMGs and FMGS alike) found out on St. Paddy's Day whether they matched into residency or not. Fortunately for me, I came out on the happy side, no worries about having to scramble! Heading to Metropolitan Hospital / NYMC in June to start my life as an Emergency Medicine doc. I was overjoyed, but I have to say the climax was taken away a little as I'd gotten clues and really positive emails from the program so I sort of knew in advance. It was the only EM program I interviewed at so I'm really thankful they gave me the chance - EM is fairly competitive at the moment with roughly 50% of non-US applicants matching.

So on Thursday when people found out which program we matched to, we went out for dinner at a gorgeous Indian restaurant (Jaipur, St. George's street) and met up with one of our friends/classmates who's interning in Australia (perth). Went to a pub afterwards to try to celebrate with the RCSI people who matched, but all of us except 1 faded really early.

It'll be really exciting moving to Manhattan, I think Metropolitan give us subsidized housing. I'm a little nervous cuz it'll be a big change and I won't know many people there, but it's only a short hop over the pond to visit my Irish mates. We're already planning visits. The ED department there is a lot different from the ones I did electives in as it's smaller and a bit more cramped, but we rotate through 4 hospitals so should see a really diverse patient pool. I haven't heard much about this program and the chief residents were quite positive about it, but of course they sort of have to be...it seems like a program which has opportunities for growth, and I like that it could be a place someone like me could have a positive impact on and vice versa. Plus, it's manhattan!!! Haven't heard from them yet but it's a holiday weekend ...can't wait to find out my schedules, etc.

I applied to A&E jobs here in Dublin too and got great feedback. I applied for the AE scheme in SJH, and while I didn't get it, I think I was the only intern who got an interview. I realized I was really junior to be even applying. I did however, get one of the two 6 month posts and the other guy is one who is two years my senior, so I was chuffed about it. They thought my experience was really advanced for my level of training (electives, ACLS and ATLS + PALS certs this year). I got interviews for the other 4 Dublin AE hospitals, but I turned two of them down and went to the St. Vincents scheme interview for the practice. And, i really love my suit! (hehe) . So it'll be awkward rejecting my job offer here as I already told HR I was going to accept, but c'est la vie.

It comes at a great time because all of us are starting to get really really tired of being interns. I don't know of a single one of us who's really enjoying the job right now, we want our lives to start and call just sucks.

Right now I'm nearly finished with my Medicine for the Elderly (geriatrics) rotation and I've really not liked it. I'm more a surgery person anyway, but this job been absolutely mind-rotting. I'm redundant...there's no real reason why my team needs me, there's really no individual thought as there was on surgery, no independence and NO TEACHING! I've learned absolutely ZILCH on this rotation, although I have gotten a little more familiar with some drugs.

Med El call is so irritating because it's more frequent than usual and although it's more relaxed work-wise, I don't find myself getting any more sleep. Your sleep is so disturbed by the nurses calling you for every stupid little thing because except for the acute ward, the nurses in the rehab/long stay wards aren't accustomed to handling any even minor medical issue or prioritizing. You know, i really don't give a damn that someone's bp is 150/90 at 3 am. They are completely inflexible and get so nervous every time they think their protocol isn't going to be followed. You end up getting bleeped hourly and get very disturbed sleep, and I then am kept awake because I'm fuming. And then on weekends, you carry the cardiac arrest bleep and each time I'm on the weekend, I get a cardiac arrest at like 4 am and then can't go back to sleep cuz you can hear everything in the shithole that's our doctor's res. And to top it off, these acute old people have poor access and are really difficult to cannulate or get bloods off. Anyway, call turns the sweetest people into bitches on wheels and everyone spends the whole time so angry. It's exhausting and no one likes feeling that way on a regular basis. Anyway, rant over.

I'm starting in general medicine 1st week of April, which will be busier but I'm looking forward to it and hoping I'll learn something. I'm going to start studying again for USMLE Step 3, but it won't be really serious studying yet - I just want to refresh the info that i've lost. But as I'm "in recovery" today, perhaps I'll start tomorrow :).

Summary of the rest of 2007

2008-01-20T11:55:00.000Z

Haven't posted in a long time - that's what being an intern does to you...sucks up your time and your life. But hey, the money's alright!!

So since the last post, I completed my surgical rotations of my intern year. Orthopaedics in St. James's and General Surgery in Ballinasloe, Co. Galway (Portiuncula Hospital) . I am definitely a surgery person. I like the independence and responsibility given to junior staff, and the no-nonsense direct approach to stuff.

But anyway, Orthopaedics was a bit mad. Ortho wards are like human zoos ... half of the patients are old folks who go nuts on the analgesia and anaesthetic meds. Another quarter are the drunks and druggies who demand a lot of attention. And the other quarter are those suffering from MOLS (miserable old lady syndrome) who block beds while you wait for suitable nursing homes for them. I came to work one day and found a whole ward dancing in each other's arms to some imaginary music which one of the patients had dreamed up. We were like..."what the hell?!?!" but hey, they were happy and weren't screaming like usual so we let them.

I loved Ortho. My consultants and registrars were awesome. The only thing I hate dealing with are the social issues, but other than that...i like tools, I like the in-and-out of patients, and I like the gratification you get from getting them back on their feet. A couple patients gave me presents...which was really nice and touching. Sure, there were a couple awful days when I questioned my sanity in choosing to become a doctor, but on the whole, I loved it. The worst day for me was in my first week, when there was a difficult case we had post-bilateral calcaneal fractures. Part of a vac dressing had adhered to a portion of the posterior tibial artery which sheared when his dressing was changed. Blood and screaming everywhere, which then set off all the other patients screaming, then the mother came in and started screaming at everyone about lawsuits and shit like that, and meanwhile the patient was taken to theatre like 3 times and had maxed out on pain meds because the tolerance was quite high (a nurse actually found some unprescribed "medications" in his drawer, if you get what i mean...) . and then right after the operation this patient goes for a smoke. GD it. That was a hairy day. And other awful day was only awful (regarding the same patient) because I was post-call and a miscommunication between the nursing staff, plastics and myself meant that I was there til 8 pm post-call. That was the closest I came to losing my temper at a nurse.

The thing that made SJH surgery hell was call. I hate call with a passion. Here, there are still no capped call hours. I've been working for 38 hours with no sleep before. My avg # of hours during Ortho was 85 hrs. per week...one week, I reached 102. Call is so irritating and you get called for all this stupid shit. I was absolutely furious at one of the most stupid ones I've gotten. I got urgently serial bleeped to review a patient for thyrotoxic crisis. So I rush up from A&E thinking "oh crap, what dose of beta blocker, which one, etc." and find the patient sitting in bed, reading a magazine. His only complaint was swollen hands (note: it was warm in the room, as it was summer). No tremors, no jitteriness, no feeling unwell whatsover. So I asked the nurse, "why did you call me to review this patient?" Her reply: "well, I thought swollen hands were part of a thyroid problem. Me: "Um... no." Her: "Well, could it be a paracetamol overdose or something?" Me: "Um...he's on 1g qds, which is normal. Also, you must have been a nurse for 20 years. In those 20 years, have you ever seen swollen hands from paracetamol." Her: "Umm..." Me: "Don't call me again." (and I was also thinking, "Go back to nursing school.") which is very mean of me, but come on.

Anyway, then moved to Portiuncula Hospital for General Surgery. At first I really didn't like it because it's quite remote, and lonely. But I made fast friends with the two UCD interns that were there, and we managed to have some fun. The best thing about it was that call was so easy compared to the big Dublin hospitals. the whole surgical population equaled one ward of SJH. Our bleeps worked from home so we could watch tv or clean up the house while doing rounds, and only got called maybe 3 or 4 times to do stuff. The nurses were fun too, but it's quite different there in that the nurses really run the hospitals since the doctors change every 6 months or so. My Consultant was lovely, and I got along with my team. I didn't ever go into theatre because I wasn't too interested in gen surg (not an abdomen person), and had other stuff to do (applying to ERAS, etc.) but it was interesting to go to a peripheral hospital.

In the first two weeks of December, I went back home to do interviews. I applied mainly for EM so had an interview in NY, then a prelim interview in NY as well, then a TY interview in Georgia. My number of interviews isn't great statistically, so I'm skeptical about Matching. But we shall see I guess. I interviewed at Metropolitan for EM, and I really liked it. But they treat interviews like informal chats sometimes, and everyone gets along well so it's hard to gauge where you stand.

I ended the year by being on call Christmas and stephen's days. Christmas day was grand (I was invited over to the main gynecologist's house for dinner because I knew his daughter, who's a physio there) and it was lovely. It only got really busy at like 11:30 pm and I didn't leave til 1 am, and then Stephen's day was busy but that's ok. Then I got like 6 days off afterwards because the teams treat the Christmas season as every day on call.

so for New Years, I went up to Letterkenny (Northwest Ireland) to visit a good friend of mine for a couple days, and it was absolutely lovely. She's an Olympic hopeful so spent a couple hours in the gym to kickstart my year off well (after a night of getting absolutely hammered), and her parents are lovely too. They treated us to this massive carvery for dinner one day and stuffed ourselves, and then went for a really nice drive to see some scenery. We didn't go out New Years Eve because we wanted to start this year off right, this being a big year for her, and I thought that we could go get smashed any night, but there are very few times we can actually just spend the night relaxing by a fire. It was a brilliant New Years :)

The world's a more disturbing place...

2007-06-04T04:23:00.000+01:00

I'm getting more scared by some of the young patients I'm seeing, who at 10 years old are like 88 kilos. Young girls. That's like 20 kilos more than I weigh. What the hell? I wonder what it's going to take to make kids (and their parents) change. It's sort of analogous the increasing interest in hybrid cars. It took petrol prices to shoot through the roof before people started considering them. Yeah, environmental concern was part of it...but not the primary concern. What's going to make measures to be put in place in schools/families to decrease the chances of being squashed by someone decades younger than you?

And, I had a patient the other day who required me to write on her school note that she was allowed to drink a bottle of water at school. I was like...what?! Apparently, the school won't let any of them carry bottled water because they're afraid kids will bring and drink alcohol in school! That's nuts! I mean, I'm sure they could...but wouldn't it be obvious picking out the complete smashed kid? and smell it? And wouldn't it be really dangerous for kids not to have adequate hydration? Man, things have really changed from when I was in high school...and that wasn't that long ago!

Finally! I'm nearly done!! (with med school)

2007-06-04T01:20:00.000+01:00

The last time I posted, I'd just finished Step 2 CK. It didn't go as well as I wanted, but passed anyway. So that's my ECFMG certification stuff done. I'm not that happy with how I've done academically during med school, but considering all the stuff I've been able to do apart from medicine, I'm fairly happy with the life experiences I've gotten from studying abroad in Ireland. I'll go more into specific pros and cons later.

The exams were nerve-wracking as we expected. The medicine and surgery papers were fair (except the surgery MCQ was a bit all over the place and definitely not very well organized). The day between the med and surg papers, I found out about a job opening in the US and given the uncertainty of getting a job in Ireland this year, I spent the whole day getting ready and faxing application materials, so didn't start cramming surg until 6 pm ! Definitely not good preparation, but I figured I had to take a shot at this opening, even if it was a long shot.

Then the day after the surgery paper, I was cycling a friend's racer to meet a couple friends for lunch near the hospital. My front wheel clipped and got stuck in the tram tracks, and I went flying. Must have landed under an out-stretched shoulder cuz I dislocated my left shoulder. Being in front of the hospital, I walked to the Emergency Department and was seen fairly quickly (it was quiet). It hurt like hell...I knew dislocated shoulders were supposed to be really painful, but I was really surprised at how much it actually did hurt (when the meds wore off). So then I had to be in a sling for the next 3 weeks - didn't take pain meds cuz they made me really sleepy, and then the diclofenac they prescribed made me quite ill, so stopped taking that. My friends took care of me that weekend though ;). Healing is really slow...nearly 6 weeks on, and I still can't extend my arm to its full range of movement. Abduction's back though!

The following Monday I had a psych paper, which was ok... I wish I'd done more studying for it because I could have done quite well on it. Studying was basically non-existant because the pain meds knocked me out or I was sick from meds. I learned my lesson! Then had a week off before the clinicals. The orals were strange given I only had one arm and couldn't do some of the physical exams....so I got asked some very weird questions instead. Can't say I'm the most loquacious... I wasn't really happy with the long cases, but the shorts in medicine went well. Managed to get through them fairly un-traumatically, one hand and all, and then had an agonizing wait to see if we got Dublin internships or not. After the school playing us around a bit, the postings finally came out 5 days late and fortunately I got a job! Unfortunately, 16 of my class didn't...I hope they've all found suitable alternatives that they're happy with. This whole situation is absolutely ridiculous.

Went straight from finding out about job postings to Kerry to spend with two of my best friends (both rowers, both in medicine) and it was absolutely beautiful. 3 days of doing nothing except enjoy the gorgeous sun on the beach. Anna took us to places she grew up with during childhood, with some stunning spots that have and will remain untouched. Some of the area is very mountainous so can't really be habitable, and the water lying between the mountains is therefore pure. The views were amazing and it made me fall in love with Ireland again (the past couple years have seriously tried my enthusiasm for the place). But I think it's back :).

Then the 2nd week of May was a hectic one, spent searching apartments in the Islandbridge area for something suitable. As all my classmates were away on holiday and I wasn't really keen on sharing (8-9 years in dorms is quite enough, thank you!), landed myself a sweet little place right next to the boathouse (my 2nd home!) in a lovely complex. Quiet, young area and professional area, with a little fountain and garden...expensive but worth it. Especially after some of the infested ones I visited during my search!

That weekend, I was off to London - sent by the IARU (rowing union) to attend a FISA classification workshop for adaptive (disabled) rowers and it was really useful. Once my documentation's turned in, I'll be the first and only medical and technical rowing classifier in Ireland for awhile, until they send more to be classified. Basically, I'll be officially classifying the athletes into boat categories to optimize their rowing abilities. It's a great project to be involved with helping the IARU to set up a Paralympic team, now that rowing is part of the Paralympic games. And from a medical point of view, the neurological conditions the athletes present with can be very interesting...complete or partial transections, amputations, polio, etc.

A few days later, I was back home to do an elective in Pediatric Emergency Medicine in the Cincinnati Children's Hospital. After a flight back from hell (I had to spend a night on the airport floor and it was Newark, for god's sake) I had a couple days to become unjetlagged and catch up on movies. I've completed 2 weeks of the elective and now have my last 4 days (yay!). To be honest, I haven't enjoyed this rotation as much as my November one at CCF - I liked CCF's structure a bit better, as it can be over-staffed and over-structured here. Also, I think I'm more of a fan of adult medicine versus pediatric medicine. I've found it hard to get to know the attendings because there's not as much contact with them as I had at CCF, so trying to ask for a letter might be awkward. And this whole precepting to fellows who then precept to the attending thing gets kind of annoying. Plus, there's no computer charting at our level anyway, which I don't really like. On the flip side, the kids can be really cute! This elective hasn't deterred my interest in EM any, and overall it's a good experience - I've rediscovered my weak points and have learned not to make assumptions (even though my assumptions are usually right. Better to be completely thorough!). I just feeling "meh" about this rotation has partly to do with me being at the end of my med ed tether and just wanting a break for awhile.

I go back on Friday, and when I land I go straight to Belfast to try to catch my gals' race (Lomac Tiles against Queens University is always very fun!), back down to a 21st, and then to Castleconnell for an adaptive rowing meeting the next day. A couple days to fix up my apartment and set up utilities, then mom's coming for graduation (June 15th, yay!). Busy busy busy! I'll be with my friends again! YAYAY!

The future...mall walking?

2007-06-04T01:15:00.000+01:00

I just wanted to say that I had no idea mall walking was that big in this country. I mean, I knew people did it...mainly old folks who were told by their docs to get some exercise...but I went to the mall early today trying to beat the rush and ended up having to wait around til they opened at noon. I must have been the only person there not walking...I was lapped by at least 150 walkers in the span of 45 minutes. On one hand I feel it's a bit sad...what happened to walks outside and enjoying the fresh air? But on the other hand, at least they're getting some exercise...and can spend some money afterwords. If I mall walked, I'd reward myself with at least some iTunes afterwords.

Ho hum

2007-03-26T19:26:00.000+01:00

2 more weeks til my last exams start, and 5 more weeks of study until I'm done with my formal medical education. On Friday, I had my last lecture of 24 years of schooling. You would think we'd be a bit nostalgic about it, but no...all of us are just ready to get out. Our class has seen some rough times and it's only going to get rougher with this politics nonsense regarding jobs. I hope to god I get an intern job...otherwise I will be very very depressed and basically have no clue what to do.

Anyway, what's happened since the last blog... I took Step 2 CK, and while I didn't think I did brilliantly, I thought it was ok. I was a little unhappy that I wasn't completely confident in flying it, but c'est la vie...that rarely happens with these kinds of 8 hour exams. I could always narrow it down to 2 answers and then was trying to choose between them. Hopefully I chose right! Not as difficult as Step 1, but given limited time to study for it, think I may have been able to do better. A few of my classmates are taking it in May, and that gives them more time...but I'm happy to have it out of the way and not doing them after finals. I honestly don't think at this point in time that I would do better now than I would have 4 weeks ago.

A big plus for me was that my girls won their novice colours race :). That was brilliant, and they stuck to the race plan exactly, and they rowed better than I thought they would. That was fantastic. And nice validation for myself and Anthony that we are doing something right in the coaching area, as the coach we were up against has been coaching for awhile. Everyone had a good night out but I wasn't drinking and left early. Ironically, I was hammered later in the week when we had Commons dinner for final meds. The malaysians weren't drinking so we took all their guinnesses and wine, then went to the Pav and Gingerman afterwards...all of us were fairly smashed after like 2 pints. hhehe.

So two weeks til the finals. They always say things will come together and consolidate. Maybe it's happening a little...but I'm still waiting to feel solidified!

2007-02-12T15:26:00.000Z

2 more weeks til Step 2 CK! AAAAAAAGH! At least it's slightly easier than Step 1, but still...AAAAAAGH!! I think I've planned my study a bit better than Step 1 though, so that's good. but there's always something to not know. I'm pretty much skipping the next 2 weeks of hospital to study for this exam, and a bit worried that that's going to bite me in the butt. I'll just have to work really hard to make up what I've missed and go see some patients! But I really want to nail step 2 cuz I recently received a couple fantastic recommendation letters from attendings at my last rotation which should carry me a good way during interviews as they come from a prominent hospital. That's always a confidence booster ;). But now I need the rest of my application to be solid, as I already have a blip in it from step 1. Sometimes I think I should have waited til May to take Step 2, but seriously...I do not want to take another exam after my finals!

Other than that, have mainly just been coaching. I'm really annoyed at the fact that I'm missing all the rowing parties (yargh!) but just have to have a willpower of steel to get through the end of med school. The girls have had a couple of races and I think they're starting to understand how to move together. If we can just find a way to solidify it (and quickly), regatta season should be a blast !

There've been a couple med parties - one was after the end of the biosoc inaugural and I stayed later than I should have, but it was a lot of fun. One of my Irish friends was really cute and telling me how much she'd miss me and kept hugging & kissing my cheeks. We were really starting to look gay, but ah well. And for med ball ...that was just messy. Another of my friends was hammered, puked on the carpet and left quite early cuz he was so drunk. I called him the next day and he wasn't hungover one bit, the bastard!

Anyway, speaking of drink, I want one. So I better stop before the temptation becomes too great and I end up drinking by myself at 4 pm.

The end's in sight :)

2007-01-15T23:10:00.000Z

So one of my mates found this site which reminded me I should update it :). So let's see...after the last blog, that was two months of hell studying for the paediatrics and obstetrics/gynecology exams. The written exams were ok but the orals are so subjective, it's really luck of the draw as to what case you get assigned and they're hell! But it all worked out ok.

After the exams, I went back to the Cleveland Clinic to do an elective in ER. It was awesome, maybe not as much fun as MICU in the summer because it's more individual and less team-based, but I loved it. For the last while I've been considering ER for my career and this elective just confirmed it, and of course the great staff made it more appealing. Just my personality seems to fit in - active, hate waiting around, want stuff done with some intensity but like having fun too. Anyway, I think I performed well during the elective and I enjoyed being there so hopefully will get an elective in a Level I trauma center for May after my last set of exams.

I came back to Dublin for Christmas and had a very lovely Irish Christmas as my friend's house (I love real fires. I don't care how much work it takes to clean a chimney, I'm definitely having a real fireplace when I grow up). And probably ate a whole hog in ham :)! It wasn't just all lazing around though, went sculling with friends on Christmas and Stephen's Day - water was lovely, would have been a shame to miss it. I do miss not being able to do as much rowing this year, but am definitely enjoying coaching novices. They're such a fantastic enthusiastic bunch, they make me smile :).

Then for New Years, myself and 2 other friends (from rowing) went to Oslo for 5 days in Norway to visit one of our Norwegian friends. That was really really nice. Her house is really cozy and modern, and it was fantastic getting to catch up with her again since she's really busy at her new job and all of us are busy with life in general. Didn't get to go skiing, but went ice skating instead, and visited a proper ski jump place so we could see what it was like looking down. Only it was very foggy, but you got the idea anyway. Visited her boathouse and stood on some frozen water, walked around Oslo city (it's lovely! big streets, clean). For New Years, we got dressed up and had a fantastic dinner (for 22 at hers), got quite drunk of course and toasted the New Year at a hotel. It might have been the drink or my lack of contacts but when we got home and into our comfy pj's I nearly got into a fight with a guy I thought was a burgler (we still aren't quite sure how he got into the house), but fortunately it didn't come to that. Haven't gotten that agro in awhile!

Now back and straight into hospital work for the last 3 months before our finals in Medicine and Surgery. It's been really tough. Sometimes in from 7:30 (meaning catching the tram at 6:30) and sometimes not done til 7, with no lunch break. Everyone's now stressing cuz we have no time to study and they keep telling us they want us to see patients and we're like...when exactly do we have time for that? And I have to take USMLE 2 Ck at the end of Feb so I'm being antisocial and studying / doing questions in any spare moment I have (now doesn't count). made more difficult by coaching (which I'm not giving up) so I don't get home til really late sometimes. Anyway, where there's a will there's a way! So hopefully everything will work out. There's still so much I need to refine and revise!

It has all begun again...

2006-10-06T20:39:00.000+01:00

Well, London (last weekend of August) was awesome. Went over for the World Rowing Championships to cheer on some friends, and it was fantastic. A lot of Irish people there cheering for the crews, and during the lightweight men's 4- race (with the Irish being up for the gold medal), the buzz was electrifying...it was so exciting! They ended up with the bronze, which is a good result coming into Olympic years. And my friend in the lightweight women's double won the B final and was so cute afterwards, just beaming. Lot of late messy nights, took me like a week to recover!

So then in the beginning of September I started my last official rotation of my med school career - General Practice (same as Family Medicine). It's like a merge between medicine and psychiatry. They do more "medical" stuff but are into all the touchy feely social and emotional stuff too, you don't know whether to be happy it's a more relaxed version of practicing or whether to gag with the corniness and groan at lectures about common-sense crap. We were placed for two weeks in an "inner" Dublin ring and one week in an "outer" ring. My inner was Leixlip (1 hour from Dublin) and my outer was in Kilmuckridge, Wexford (about 2 hours from Dublin). 3 weeks observing was quite enough, I found it very boring. The first clinic treated those who were on methadone, so I just sat watching paperwork being signed. The second clinic was quiet because apparently business was taken away by the National Ploughing Championships (I kid you not). I didn't see anything terribly interesting...but I definitely heard some weird stuff...what goes on in the country....geez.... Anyway, I would definitely Not do GP outright...it would be something I would retire to. At least no ward rounds.

At least this rotation is quite relaxed with a lot of time (not that I have been using it wisely), which is very helpful coming up to my first set of final exams. Irish universities are different in that your grades in previous years don't really count towards your final marks that go towards your graduation mark. That's why final year exams are so pressurized...and it's gotten to us from the first day. We now have 4 weeks to go to the day, 4 weeks to learn all of pediatrics (eeps! it's like all of medicine but for small people) and hopefully get in Obs and Gyne along the way. There are two parts to the exams...a written paper and a clinical one where you're assigned a long and short case. You could be given anything under the sun and asked even more. Scary stuff!

So time to hermit! At least I'm living in a single room on campus which is great for hermitting!

Finally!! SUMMER!

2006-08-19T00:59:00.000+01:00

Woooo hooo! Finally finished my MICU elective at Cleveland Clinic, and as fantastic as it was, it was loooong. I'll miss the environment & my team, but I won't miss the 30 hr. shifts and the 3-4 hr. long ward rounds. I enjoyed the work in MICU, but man, those ward rounds...seriously, it's nearly the biggest thing keeping me from going into medicine. I definitely need an active medicine where ward rounds and conferences are minimal. I'd be more of a surgery person, but I can't stand the thought of such repetition, doing the same procedures day in and day out, or those really long 7-hr. ones. I think I'll be able to do an elective in ER at CCF in November, so they won't get rid of me for too long! It'll be great to see what ER is like here, I loved A&E (accident & emergency) in Ireland. I'm glad I learned loads, saw a lot of interesting cases, got over acting like a med student idiot and got an idea of what working in the US is like. Also met some really fun people, med students and residents alike, got a good eval and hopefully an LOR (if he doesn't forget).

I might have said before...I can completely see how doctors get so absorbed into their work and become married to medicine (which doesn't bode very well for social life/relationships!) and I can conceivably see myself being sucked in in the future. That thought is a little depressing, but at least I know now that I love medicine and I'm definitely going into something that's right for me, which I suppose is good! And I also got to see the crazy work that'll have to be put in to advance or direct your career in the way you want it to go. Scary, but who doesn't like a good challenge?

But now I'm ready for my few days of summer next weekend when I go to London for a 3 day pissup!

Before that, have to take the Step 2 CS. I haven't prepared much for it, but I don't feel I really need to. It's mainly English proficiency, H&P and physical exams. I'm not the best with HEENT and Neuro exams, but we'll see how it goes. Will post about it. Anything would be better than my Step 1 anyway! So driving to Atlanta on Sunday to take the damn thing on Tuesday. I hope I don't crash and burn in London!

Life in the Cleveland Clinic

2006-08-09T04:11:00.000+01:00

So I'm post-call yet again, seeing how coherently I can ramble on before I fall asleep at the keyboard. I'm not sure whether napping during call actually helps or not. Cokes definitely don't keep me awake, just make me crash further plus have to pee. I'm still enjoying it and learning a lot, but things are a little slower now than my first week - for some reason, my team isn't getting slammed with codes and new admits like other teams are. Which I suppose is lucky and good, but we're just feeling a bit bored and slacker-ish :). I got a new patient yesterday, but then she was floored and out of our service so the most I did was the admit note. Doing less doesn't make you any less tired though, you're probably more awake when you're up and running around. I still enjoy calls, but they're starting to wear me down a little. Only 2 more left!

The living quarters here are pretty basic, and you can hear everything! When someone goes to the toilet or has a shower, when someone's typing, etc. So can't get a lie in past 6 am! Most of us have long days, and most everyone tries to do a little reading if we can and aren't too tired, but it's hard cuz all we want to do is have fun and watch tv. I've met a few fun and awesome fellow students here, which is a relief. And the residents/fellows/attendings themselves are nice and not averse to some fun, so that's a relief too. This would be a really nice place to do a rotation, I think, although I imagine it'd be hard to get in. Maybe it helps that I know the city too.

Taking the Step 2 CS in 1.5 weeks. I haven't "studied" as much as I've wanted to, but I'm not too worried. All I need to do is review some exams, maybe practice with people (it hasn't really helped that my patients aren't conscious, although I could possibly get in some practicing without feeling like I'm intruding! sounds bad, I know). Seems like my whole life for the past year has been just studying and reading, and it'll definitely be like that next year too if not worse. I hope some of it's going in!

medicine! wooooo!

2006-07-26T02:21:00.000+01:00

Well, it's been awhile, so much has happened!

Finished my OB/GYN rotation in June in the Rotunda doing Labour Ward nights (ie. the 10 pm to 8 am shift). I thought I'd hate it, but I really enjoyed it. I delivered my first baby on June 19th @ 4:51 am, and he was the cuuuutest little baby boy I've ever seen. The parents were fantastic, and let me give him his first bottle and play with him for awhile, took a picture of me feeding him and brought me the picture the next day! That was really sweet. It was a good rotation but I don't think I'd want to do it for my life. Delivering babies and everything involved with that region...it's just kinda gross.

Spent the month of July finishing off the rowing season. This month is my "holiday" month, which wasn't much of a holiday between moving to different places, catching up on errands, and the rollercoaster that is rowing. The national championships were on the 14th and 15th, and in our 8's race, we came 2nd. We rowed decently, but we were pretty disappointed with that. The team which came 1st beat us by a long way, but at least we'd gained some back on them from our last race in June. Anyway, that's team rowing done for me - will probably scull next year since I can't commit to team training while doing finals. It's been enjoyable, and Captaining this year has also been enjoyable, but I think it would have been even more so if I didn't have so many things going on (ie. stupid group projects and the TSMJ (student med journal) which became the bane of my existence for 2 months). Definitely glad to have a break!

Now doing an elective in MICU (medical intensive care) at the Cleveland Clinic. This is only my 2nd day, and it's awesome. I love it, and I love being here. And I love that I know this job will be the right one for me. So my first day yesterday was eventful enough with consults. Today was a little harder because my team were on codes (as in "code blue code blue!"). Since Cleveland Clinic is so large, you actually have to run from floor to floor and building to building every time a code is called. It's like ER or Scrubs. But what made today hard was not the fact that we were dealing with patients nearly on their death beds, but talking to their families afterwards, and they're crying and appreciative of your work but obviously very sad, and it's really touching. You try to remove yourself a little without being cold-hearted, and it's hard to do. I nearly cried, my junior resident actully did cry. And several codes happened within the space of like 2 hours so you couldn't get a break from the depression. So that bit obviously no one likes, but it was really good to see how the jr. and sr. residents handled it. Then after work, we went to a happy hour/dinner that was being held for the residents (I think I was the only med student there) and it was just my team + fellow there, and we just had the best time making fun of each other. My team is awesome, everyone is really nice, and I actually got a speech from the fellow yesterday about how we're all one big family and if I'm unhappy, they're unhappy, etc. This is the most organized rotation I have ever had with orientation, accommodation, pagers, nearly everything for free, and they're so keen on teaching.

The work hours are long but time passes by without you realizing. So I usually start at 9 am, which means 8 if I have to pre-round (everyone else is there at 7), and then you're done by 6 or 6:30 pm. Unless you're on call, which I am tomorrow...then you don't finish til noon the following day. So unfortunately, haven't had time to visit the gym any, but maybe I will my post call day or tomorrow morning before pre-rounding. And, I love that this rotation I can stay in scrubs and sneakers. So much more comfortable! And, hopefully by the end of the week I'll have put in a central line, several IV and arterial lines, ABGs, Corpaks (PEG system), etc. AWESOME.

I'm really impressed by this rotation so far, I'm considering internal medicine now as well (ie route to EM and ICU). ICU wouldn't be a bad field to be in. It's definitely an active medicine (although ward rounds do take 3 hours, which I don't like), and it's chaotic enough without being too chaotic. I loved A&E (ER) in St. James's, but that emergency dept is a lot smaller than the ones in the US. I visited the ED in Cleveland Clinic, and that seemed a bit insane - unhappy chaotic, not a good kind of chaotic. And in MICU, we're probably doing all the same procedures they're doing in ER anyway.

Oh, and I passed the USMLEs. Not a great score, but I always knew that'd be my downfall. I don't study enough, so it'll be cool to see what happens next yr when i actually do study!

2006-05-26T20:41:00.000+01:00

Man, I have GOT to start studying! Two weeks to the day until boards and not much to show for it. I've done a few practice Q's here and there, made some notes in the USMLE Bible that is First Aid, but I seriously have to step it up! I'm taking all of next week off, today's the last dossing day.

But it was a good one ;). Went to the gym early to release all the pent-up energy from the last few days - we're on a little lighter schedule of rowing training to accomodate the exam period. Didn't work too well cuz I'm still wanting to go for a run now. Then spent this morning running errands and splurging a bit before a few of the rowing gals came over for lunch. We're really close - I suppose a few of us have been together a few years now and seeing someone every day for like 2-3 years tends to bring you together :). It gets a bit bitchy sometimes, but we're each other's psychologists too. So myself and Anna decided to give people an exam pick-me-up, especially since one of the girls has had a tough time of it lately, and made a gorgeous lunch, I love lunches like that. Anna brought over a warm loaf of multigrain brown bread from Avoca that seriously could have been like a cake, and some salad leaves/tomatoes. I had corn for the salad and ham/cheese for the bread and ice cream to top it all off! I'll miss those lunches when I leave - they started about 3 years ago when Dor was Captain - a really good salad +/- potatoes with mayonnaise and bread in Rowing Rooms. And of course something sweet to top it off afterwards with a cup of Barry's Gold or coffee. Simple but perfect.

Continuing on my reflection... I love Trinity. And I love that all students of Trinity love Trinity. It gives us a really unique sense of community and pride, moreso than any of the other Irish colleges. It could have something to do with the fact that it's a closed campus...literally...it's walled all the way around and all open space is contained within the college campus itself. But I feel like I'm catchin up on that sense of school pride that I missed while attending CWRU, since I really didn't like being there, everyone was apathetic and that place really didn't suit me socially. Apart from a few friends, I wish I never wasted my time going there not from an academic point of view (the educational opportunities are endless)but for my own personal happiness and sanity. Ultimately it's what led to me and Viv coming to Trinity in the first place on junior year abroad...we just had to escape from the confines of that soul-sucking place. I hear it's better there now with the new renovations. Good for them, but I'm so happy that I came here. I'll be an IMG (international med graduate) but it's been worth it!

2006-05-24T11:35:00.000+01:00

On some down-time waiting for lecture to begin. So I'll continue updating my life :). It's a nervous time right now because although we're not in final med yet, all the rotations/study/tutorials are being geared towards doing the obs/gyne and paeds finals in November, then the medicine/surgery finals in April. Lecturers are going through what they're looking for when you present, how to make yourself shine, and all the stuff they expect you to know...and some of the things they want as basic knowledge seem like honors questions! That plus trying to figure out what you want to do and narrow down your field choices.

I'm definitely more a surgery person than medicine. Medicine's too boring for me, can't stand the 4+ hour ward rounds and 2+ hour conferences. Guess it won't be a life of free pens for me :). So I'm considering more active medicines like Emergency Med (which I really enjoyed) and am also interested in musculoskeletal medicine (PM&R), following on my natural inclination to fields like anatomy and exercise physiology. Problem being that physiatry doesn't really exist anywhere other than the US, so I haven't had any real exposure to it yet except for 2 days shadowing I did at Christmas. I also would consider general surgery, but I haven't heard anything good about surgery in the US in terms of lifestyle and colleagues. Lifestyle I wouldn't have a problem with. People being dicks to each other for absolutely no reason, or trying to one-up each other all the time, I would have a big problem with. I always think people work best when each person tries to be cooperative with everyone else, and I would not deal well in a situation where everyone keeps to themselves and hoardes info/ambitions. I'd really like orthopedic surgery (more an jocks/boys club than anal surgery) or even ophthalmology, but those are impossible fields to get into especially for IMGs like me.

Right now, planning on returning to the US for internship/residency. That's where the best post-graduate training and resources are, even though primary med ed is pretty standardized universally. And a life of large space, luxury and efficiency is appealing. To be honest, I like the european lifestyle (and dare I say people) better but it would be nearly impossible to advance career-wise over here, since I'm non-EU and non-Irish. If I could stay in Europe with an equal chance for career advancement I would, though probably would explore somewhere other than Ireland. Wouldn't mind doing a bit in Australia either, and I think eventually I would like to join one of those groups like Doctors-without-Borders to explore a different side of medicine and expose myself to problems/issues that I would never encounter otherwise.

But first things first, I've got to pass this damn USMLE first. It's an annoyingly difficult exam, and my studying hasn't been the best for it. I can't seem to concentrate very well, and it's a bloody 7+ hour exam! Each subject you study in medicine is huge as it is, and this exam combines them all! Whoever devised this exam must've been a big time nerd with a chip on his shoulder who's getting payback on those docs who've managed not to have social problems. Well it's working, it's KICKING MY ASS.

Summary of the year so far

2006-05-22T17:37:00.001+01:00

Well, after nearly a year I've decided to rekindle my blogging efforts. I've joined the bebo and myspace craze (great inventions!), and as awesome as they are, ya don't want to read a lot on them...makes them crammed. I like my internet aesthetically pleasing. So I've recently gotten in touch with a few mates who I haven't talked to in literally years, and since I'm cutting myself off from AIM cuz I get a bloop everytime I try to study, I figured this blog would be a great way of staying in touch!

I'm still in Dublin at Trinity College (I love this place!), one year away from becoming a full-fleged doctor. Right now I'm doing a rotation in Obstetrics and Gynecology, which to be honest, I'm not a huge fan of. Today in my group was me and 3 guys - we went to see a C-section of a woman with placenta accreta (a complication of pregnancy). Because it's relatively rare, there were like 20 people crammed at the foot of the bed trying to get a view. So the placenta dislodges spontaneously, and there was huge gushing of blood...like seriously, waterfall coming out of this tiny woman. And the surgeons are in there tugging away trying to get the baby out but one of them was rather rattled from all the blood spewing forth and her hands were shaking badly. When they got the baby out, it was blue and not breathing and was the most awful shade of pale grey imaginable. If anyone had looked at us 4 med students they would have seen 4 people who couldn't have gotten out of there faster! None of us were particularly keen on seeing a baby die. So they whisk the baby away and are slapping it to get it to respond and eventually have to intubate the baby (the instruments are kind of cute actually cuz they're like mini versions of the adult tools) , which they had trouble doing so there was a bit of panic. But after what seemed like ages, they got the baby tubed and she turned a nice normal color, and they controlled the mother's bleeding too (after a Lynch suture which makes the uterus look kind of like a pork round...) . So all was good. I'll give it more time, but not really falling in love with obs/gyne right now.

My last rotation was Ophthalmology, which was really cool. I enjoyed it, found more doctors to add to my list of people I want to be when I grow up, and learned loads. I thought it was going to be incredibly boring when I first came into it, and I don't like things poking eyes and whatnot, but it was cool watching the cataract surgeries and finally learning how to use the fundoscope. The only thing I didn't like was watching the unblocking of a lacrimal duct in a kid - that is viscious! They take this wire and literally jam it down the inner side of the eye...EW. I'd consider Ophtho if it wasn't so bloody hard to get into.

Before that was ENT. Which I pretty much skipped because of all the work that had to be done for the Trinity Student Medical Journal (which I directed this year). This year ended up being a hell of a lot more work than it should have been for various reasons - laziness on the part of some people and type A personalities of medics. Seems sort of ironic that the two happened simultaneously. Fortunatelly for me, the ENT rotation is a bit of a joke and as with some other things, it's "teach yourself medicine" time. I went in for two hours the whole rotation, and learned how to use an otoscope. Not well.

Before that, I was doing Anesthesiology which was an AWESOME rotation simply because the anesthetists were so keen on teaching. I really wish I could have spent more time there, but because of the feckin TSMJ, I had to skip a bit. I don't think I'd do anesthesiology, but it was way better than I thought it would be and not too boring because in theatre when anesthetists are just basically monitoring, you'd get a tutorial so you're not just sitting there staring into space. This rotation was split with radiology, which was also quite interesting. I liked viewing the MRI interpretations. For some reason, I just like MRIs in general. Not any specific body part, but MRIs of anything.

In January, I did Paediatrics. That was hell on wheels. A whole load of bitchiness came out of everyone. All I'll say for now is that MEDICAL STUDENTS AND GROUP PROJECTS DO NOT GET ALONG. DO NOT ASSIGN MEDICAL STUDENTS GROUP PROJECTS! I mean, it's pretty self-explanatory isn't it? What happens when you put 10 type-A personalities in together? And add to that a couple people who rank 10/10 on the laziness and stupidness scale? (trust me...there are some really stupid people doing medicine. I know that's not reassuring to the general public). That just really ruined the rotation for me. Plus I've never seen such flagrant examples of subjective grading in my life, with examiners hiding behind the excuse that "life isn't fair." Why the hell does that give them license to ignore the universal best practice of standardized examinations? The kids were the actual fun part. And I'm so glad I didn't drop any of them.

In December, I did Hepatology. That sucked because the team sucked. I learned nothing and felt it was a waste of time so essentially skipped it.

For October/November, I was doing Psychiatry. It wasn't as bad as I thought it would be. But that's probably because I started off interviewing a bipolar patient, who are mad fun people (I don't mean "mad" to be a pun). When they come into hospital, they're in their manic phase and delusional, but really fun to hang out with and interview. My patient even sang for me! So I got a good introduction to psych :). The rotation was enlightening and not too difficult. Some people in my class are now enamoured with it...but not for me. I find it still a bit waffly and psychiatrists are a different breed - sorry to the psychiatrists out there, but man...they say in 45 minutes what they could have said in 10, and what makes it worse is that you can anticipate what they're going to say about 3 minutes before they get around to saying it :).

Anyway, that's just a long brief recap of my rotations so far. All this + studying for USMLEs and Captaining my rowing team + TSMJ + SDN! I'll be glad when I can look back at this year and laugh.

The Messy Medic

2005-07-19T23:07:00.000+01:00

Hi,

First off, I'd like to say that I'm not really messy. Well, maybe a little, but I will actually clean my room when I can't open my closet door due to the piles of crap stacked in front of it. At the moment, my crap consists of un-ironed clothes, training kit and books strewn across the disarray that is my floor. Fortunately for me and everyone else, *most* of it's clean. To be honest, I really don't understand the concept of blogging. Who really wants to know what someone did at 3:07 pm on July 19th, 2005? But I'm creating this mainly for myself, since I don't keep a diary and I type faster than I write. I would some day like to be able to look back and ask myself "what the hell I was thinking?!" as life progresses to a point that eventually will make no sense :). Also, currently studying for the U-Smellies (USMLE), blogging as a procrastination device is self-explanatory. But I won't be one of those who posts every day, or even every week.