Nuts!

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!

... 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!

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.

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. 

More from me... 

Enough about work! I haven't had much time to go out and explore but will definitely in the next coming months! 

July 4th weekend,sky-trammed to Roosevelt Island to have a look, and saw my dorm / hospital from the East River side, then walked along the promenade next to the FDR "highway" to watch the Macy's parade. Frankly, unless you're right at the spot, it's probably better on TV but I may be saying that cuz it was pissing rain and we were all getting wet. 

Then the first weekend of August, went back home for my 10 year high school reunion, which was a lot of fun! The bar in the beginning helped, but it was good fun catching up with everyone. No one's really changed that much even though so much in everyone's individual life has. But basically, those who wanted to be doctors in high school are, and so are those who wanted to be lawyers, teachers, etc. A few people are married with kids and stuff, but those just seem like details. 

Otherwise, I've been spending my free time watching the Olympics, going to the gym, catching up on sleep, arranging my room (I still need to arrange rug / carpets) and trying to get it roach-free which I think may finally be working after buying every product available, and lastly...studying. heh. I figure once the Olympics are over, I'll be doing more reading - that's what I tell myself anyway. Besides the rug(s), the last things I need to do are hang my pictures / photos, maybe wall mount my tv, and I'm dying to buy a bike once I find a place to lock it. 

Anyway, enough mickey mouse stuff. Hopefully I'll have more exciting things to post soon!

Hello from the peds ER! I'm doing my pediatric emergency month right now, and I'm really enjoying myself. I thought I'd hate it because kids aren't my thing, but surprisingly I've found it a joy to work with them. They can be really cute and I'm finding that I can build a good rapport with them and their parents...well, most of the time anyway. Such a change from my student days where I was distancing myself from babies at arms' length! And the people I'm working with (attendings, most students, the nurses) are great fun to be around.

The only thing I don't like is doing procedures (including bloods) on them because obviously they don't like it and kick and scream as soon as they see you coming, and it's hard for parents to watch. But c'est la vie, has to be done. The last day I got an IV in a 5 month old on my first try and nearly whooped with joy. I've done a few laceration repairs (always with shaky hands, those kids are so jumpy) and a couple foreign body removals (ie. beads stuck up noses).

Another thing that's really difficult is when something bad happens. Today, a child who was seen yesterday (on my day off) and admitted to the hospital took a turn for the worse and passed away. It really upset the staff because the child came into the ED communicating well and fairly stable on admission, but started deteriorating soon after. As always, there is reflection and discussion about appropriate management, as well as quite a few tears and empathy for those poor parents. It put a damper on things but then you have to focus on the kids currently in the ED and work resumes again. I've worked in MICU before where things are sad and serious, but there's just a lot more gravity when a child is affected.

Anyway, after I wrote last, we had 2 weeks of ER orientation which were great - I finally understand how to read ECGs better, a smidge about how to read ultrasounds (I still need a lot of practice) and refreshed some facts in the far depths of my memory. I'm always going to have to be studying, but still trying to settle in a bit which is a) very expensive and b) very time-consuming! I must have contributed to half of Bed Bath and Beyond's profit share this month!

The last two weeks of July we did shifts in the adult ED and a couple shifts in the peds ED. I was hoping it'd be smooth transition, but I think all of us got caught trying to get used to the system. The first week was frustrating, asking everyone how to order things on the computer which really slowed us down, forgetting to ask things in the history and having to go back to ask, forgetting answers to questions I knew way back when while getting pimped (lightly, there's no heavy pimping that goes on here that I've seen) but should definitely know (I totally forgot about anion gap / electrolyte stuff in hyperglycemia), etc. But I think we've gotten into the groove of things now and developed some rapport with the people we work with. 

I like our peds ED because you see a greater volume of  "easier" patients so I've gotten practice with getting histories quickly and doing examinations quickly, as well as multi-tasking because I'm also the most senior person there in the mornings so I take all the students' presentations and my work quadruples in like 20 minutes if it's busy. The peds ED can get really crowded and busy too, which is a useful experience to have when people are shouting all over the place to hear each other and everyone's hurrying everywhere and things are falling onto the floor and babies are screaming, etc. 

The only thing I wish we had more of us a little direct supervision. Not that I want hand holding, but sometimes...you're seriously thrown into things without a) having done it before or b) knowing the exact specifics of how to do it and c) without someone watching you. Talk about knowing some theory, trying to apply it practically and praying to God you don't F__ up. I can understand how it's useful to be thrown into it, and the situations I've dealt with aren't that serious, but talk about adrenaline pumping. And not only that, sometimes I find myself teaching / supervising people doing things when I haven't even done it myself. You seriously take the bull by the horns, grit your teeth and just do it. Everyone is very nice and offers help, but it comes more in verbal advice rather than direct supervision. This is how it works in a busy system that does not have as much staffing as other places might...and you know, it has worked for now and made me a lot more confident. But I'll keep praying! 

And it begins....!

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!!!

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!

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!!

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

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...

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)

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?

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

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!

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 :)

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...

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!

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

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!