Random Bits

Some random bits of my week without any rhyme or reason (no apologies for disjointedness)…

Hockey is back.  And I believe it now that I see it.  I am not one of those fans who was so ticked off I refuse to watch.  I really did miss it when it was gone.   Last night, I watched the first period of the Habs game in broken-up slow motion thanks to poor streaming from a sketchy website.  I thought now that we have cable and a nice TV things would be better this year… The problem is we still don’t have every game televised.  And we can’t afford the NHL channels.  The Habs won, though.  Very good news to wake up to in the morning.

I am on Hepatology right now.  It is a learning curve.  My attending is awesome and loves to grill with questions.  I see it as a personal challenge; even though this is the most stunned I have felt since starting Cardiology last month.  Livers are interesting, I must say.  It has been slow clinically, but I have been making up for that with all sorts of required reading assignments.  I am such a geek.

Yesterday, I decided to fix our vacuum cleaner.  If you don’t know, I am the handy one in the family.  I just have some mad scientist in me.  Also, I am terrified of the vacuum cleaner.  So is the cat.  But, Patrick has been noting for the past number of weeks that the actual vacuum has no suck, even though the hose still works, despite him emptying the bin.  Turns out the rubber belt thingie (technical term) is broken. I disassembled the whole thing to figure that out.  He was going to go buy the part today and tomorrow I will put it all back together again (hopefully).  The poor cat nearly had a stroke with the vacuum being out long enough for me to mangle it.

Patrick gave me a cold.  Who says I work in a germy place?  I am pretty sure  kids are sicker than most of my liver patients, at least from an airborne contagious perspective.

On a related note, my tonsils hate me.  They are huge and whenever I get sick they get huger (not a word, but fitting in this case).  Swallowing is a challenge.  I really should consider getting them resected.  But, they will only do that multiple documented episodes of tonsillitis in a year.  And I will only get them documented if my own documentation counts.    I don’t think it does.  So, like my wisdom teeth, I will procrastinate until I develop a real problem.

Secondary to the whole tonsil issue… Soup and tea are wonderful inventions.

I finally finished reading The Circle by Ted Dekker last night.  It took me over a month.  It was awesome.  I recommend it.  I am also excited to start reading a book that fits in my purse and doesn’t weigh more than some of my textbooks again.

Sometimes, when I am on call and have down time, I start to read my fun book and then I get angry inside when someone pages and “rudely” interrupts my fun reading.  I do not quite have the same reaction if I am studying.

I met a random lady on the hospital shuttle.  She told me her entire life story and all about books she has written and how she decided to go back to university after retiring to get her B.A. and how she intends to travel across Canada after she graduates, just because.  She didn’t tell me her name.  She looked to be at least in her mid 60s.  Good for her.

I have a single white hair in my bangs.  I keep trying to pull it out even though some people say you shouldn’t do that.  I can’t seem to get to it because whenever I notice it, I am in a rush to do something else.

We have friends from the Rock visiting this weekend.  And friends from home moving to town.  Yay.

What randomness is occurring during your week?

From Hearts To Holes

It is yet another new rotation time.

Ah, the life of an intern.

Variety is the spice of life.

Some days I could use a little less.

As I have mentioned (here and here and here, for instance), I dislike change.  Starting new rotations never fails to stress me out, at least a little.  New expectations, new preceptors, new nursing units.  All of it can lead to pretty significant change.

I have been told on countless times that I am very adaptable.

Adaptable, yes.  But, I am a sad chameleon, the change isn’t fun to me.  I quite like consistency.

Although, I must admit, I am excited to be going into a less busy rotation.  And learning is good.  I like learning.  And relevant learning.

Jumping around like this will make me a good doctor.

Today, I went from the world of Cardiology to the world of Gastroenterology.

Thankfully, this isn’t as epic as the change from Surgery to Peds Emerg or Peds Emerg to Cardiology.  At least the two fall under the same Royal College specialty.  Big win.

Image from theunderwearer.blogspot.com.

So, as goes with the start of a new rotation, I have reading to do.  More than I do after I am a week in and more comfortable with the subject matter.  Tonight’s mission… Learn about the management of decompensated liver failure.  This, after a month of managing decompensated heart failure.  It is a pleasant change, to be honest.

On a completely unrelated note… My husband forgot me at work today.  In his defense, I walk home most days, but opted not do compliments of some snow.  In my defense, we did discuss that he would pick me up on the way to work this morning.  I thought it was funny.  Possibly because I frolicked out into the snow to met the car only to realize that it was not our car and our car was nowhere to be seen.  Better me than our unborn children.

This is kind of what I looked like when I realized he wasn’t outside and that it was snowing and I didn’t wear boots. Image from 123rf.com.

On a more related note, I listened to this song  while getting ready for work this morning.  Today marks my PGY-1 half done day. 

Nuclear Cardiology

Some processed images of a MIBI scan… Shows a heart with a fixed perfusion defect. Image from http://journals.tums.ac.ir.

Today, we were rounding, we decided to do a particular nuclear medicine test on a patient.  I internally got a bit excited.  And then the med student asked what it was and I gleefully explained.

It brought me back to my real Nuc Med days when I had a delightful teacher named Debbie who was extremely smart, but not always quite so aware of how ridiculous some of what she was saying is.  She is up there in my favourite teachers count.

You see, the patient was female and I pointed out the high false positive rate (especially when we were using this as a test to rule out a problem).  The reason for false positives… Breasts.

Hmmm… Ya know, my breasts could attenuate 80keV.  You just have to flop those dog ears of the way. –Nuc Med wisdom said while holding one’s chest.

Breast tissue attenuates (decreases) the radiation from the tracer that is deposited in the heart.  The center I worked at used a different tracer than the one here.  Where I trained, it was only 80keV as opposed to the 140 keV.  Still there could be some decreased detection and a possible false appearance of cardiac ischemia.

Of course we are still doing the test.  But I apparently even taught the cardiologist that new fun fact.

In those days of Nuc Med we had a secret quote board.  There, we kept track of all kinds of ridiculousness that came out of our faces those three years together.  And there was a lot of it.

We are such a nerd full of vans. –A

The trip in which we were a nerd full of vans... A Molecular Imaging conference in San Diego.  This is my class with the class from the year ahead of us and my favourite physicist ever.

The trip in which we were a nerd full of vans… A Molecular Imaging conference in San Diego. This is my class with the class from the year ahead of us and my favourite physicist ever.

Truth be told, I wish I had kept a copy.  I only remember a few gems.  Like the fact our patient care instructor couldn’t pronounce technetium, that Debbie asked us one day if she had an S on her head and that the condition cardiac tamponade will always make me chuckle more than the average person because one of the guys thought it was a tampon to the heart (and we all got assigned an extra reading assignment).

Our styling "star trek" lead vests.

Our styling “star trek” lead vests.

But, despite not remembering all of the ridiculousness, I still conveniently have a strange knowledge of bone metabolism, cardiac perfusion imaging, thyroid function and conditions and a variety of small niche type imaging techniques.  The stuff comes in handy from time to time, strangely enough.  Plus, the whole radiation safety and physics training is pretty handy now that the whole rad onc thing has started.

Our full lot at our hospital graduation celebration.

Our full lot at our hospital graduation celebration.

It made med school seem easier.  It helped me appreciate the health care team more.  It increased my laughter to schooling ratio.

If I ever catch you wearing scrubs outside the hospital, I will cut your fingers off… Using appropriate sterile technique. –Patient care instructor.

And the friends that I have are pretty awesome too.  Even if we only get to have approximately semi-annual outings together due to our spread across the country.  Very few people share fond memories of hanging an inflatable santa out a window with a noose, blowing bubbles out the same window, just to see people’s reactions and the joy of playing catch in any season, in any location.

All dressed up for our last day of clinical... With a stand-in.

All dressed up for our last day of clinical… With a stand-in.

It hit me… Right in the thyroid cartilage! -Me during a rowdy frisbee match… Indoors…  During the lunch break between the two halves of our licensing exam.

Hooray for Cardiology.  It brought me back to my good old days in my bizarre little radioactive niche.

Medicine Guilt

Medicine guilt.

You may be a victim of it.

It comes from being one trapped in the world of medicine for so long one feels guilty for being in it and out of it… All at the same time.

I had a brutal 1 in 2 cardio call week after Christmas, followed by a normal week of work.  And then, the light at the end of the tunnel… A whole weekend off.

We had high hopes for this weekend.  As any medicine person or family knows, this is a big deal, the weekend off.  Especially one that is off without impending exams or presentations. 

I had been feeling guilty… The house was neglected.   The husband was neglected.  The cat was crazy (okay, that is his baseline).

And honestly, I was exhausted and felt like I just needed some time to myself.

We made plans… Hockey game Friday night after work (okay, note to self, scheduling rambunctious activity after a draining 1.5 weeks is suboptimal), dinner and a movie date Saturday, church on Sunday and somewhere in there I was also going to clean the house watch the Community marathon on the Comedy channel, read my fun book and also finally do some of that reading around cardiology I had been procrastinating.  Nothing too big.

I loved the hockey game, despite being drowsy through most of it.  I slept in more than planned on Saturday, then got in a fight with Patrick over bacon.  On the bright side we had a delicious brunch with a more reasonable portion of bacon than I wanted to make (way to go Maple Leaf for making portioned packs… good for my cardiovascular health, sad for my tummy).  I failed to clean at all on Saturday but instead opted to catch up on blog reading, emails and all around laziness.  We went to see Parental Guidance where I laughed and cried like a fool (you NEED to see it) and then out for a delicious dinner (thanks to Christmas… Yay free stuff).  I was sleepy  by the time we got home again, but managed to snuggle in bed with the spouse for some reading of my fun book.  Church Sunday morning was followed by coffee with a friend from my childhood and finally house cleaning and a bit of that Community marathon.  I even called home.

Sounds productive, right?

And yet, despite doing all of that, I still felt dismayed.  I could have cleaned more.  Yes, I fixed our broken drawer (thank you Jeter for thinking it was his personal bed on the hunt for cat nip), but I haven’t managed to gather up our tax stuff or sort out the adventure that is my mail heap.  I did spend some good quality time with my husband, but was it really enough?  I saw that one random friend, but I haven’t talked to others in weeks.  And I definitely got nothing work related done.  I haven’t tried to get my call schedule rearranged for next month or read any cardio or touched physics in a dog’s age. 

Medicine eats your life. 

I priortize having a life just to spite it.

And yet, I have medicine guilt. 

I feel badly for the gaps in my personal life no matter how real or imagined they are.  I feel badly for the gaps in my professional life no matter how crazy my expectations are of myself.

I think the first step in fixing the problem is admitting I have a problem.

Patrick continues to reassure me that I would be unhappy if I wasn’t in medicine, even if I were better rested, spending more time with him and our apartment was perfect.

He is right.

I also know I would be unhappy if I did nothing but medicine.

Such is life as a resident, I suppose.

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Eep… ECGs

Image via healthtap.com.

ECGs terrify me.

Not the getting them part, although the the prospect of exposing my bosom to a stranger is not overwhelmingly thrilling.

I hate reading them.

Although things are getting better.

I learned to take ECGs when I was in Nuc Med, as we need to do both 3 lead and 12 lead ECGs for some of the tests.  That was fine.  I just knew what looked super abnormal to correct lead arrangements.

In first year medicine, we did a cardiology block that was rather intense.  Again, basics of ECGs were covered, but beyond that, not so much.

Then, I kind of forgot about ECGs until clerkship…

Where I went to med school, Friday mornings on Internal Medicine consisted of a kind of torture that begets old school stereotypical medicine… ECG rounds.  Yes, the cardiologists somewhat ironically always provided Tim Hortons coffee, muffins and donuts, so free food was a win.  But, that was countered by the humiliation that came with ECG rounds.

Image from ems12lead.com.

Basically, the residents covering the CCU would hoard ECGs from the week that seemed “interesting” (some of them, depending on who the people choosing the ECG, were moreso cruel).    Then, on Friday morning, they would be displayed one by one on a projector and the clinical clerks would be picked one by one to interpret the ECG and answer questions.  Sometimes the junior residents would get picked too, especially if things were difficult.

This is somewhat relevant to the adventures in ECG rounds… I wish I had referred to the diagram. I would probably be folding jeans at the Gap. But much more well rested. Image from doctorcartoon.blogspot.com.

It was horrific as a med student.  Because you would know it was coming all week.

Some people were nice about it.  They taught around your mistakes and gave some awesome tips.  Others picked and picked.

I think that colored my perspective of ECGs.

But I did learn, yet I doubted what I did learn.

By the time I started Cardiology this time around, I feel as if I could identify obvious ST elevation MIs and a few arrhythmias.

Image from leadsbank.co.uk.

I feel like the last week of call, minus the endurance sleep deprivation test has taught me a bunch about the management of cardiac patients by osmosis and by fire.

But, when I walked into teaching rounds this morning and a cardiologist was sitting there was an ECG up on the screen, I nearly pooped myself.

I know, that sounds dramatic.  But I had horrific memories of the torture of ECG rounds.

So, we, the three off-service residents and two med students, sat down across from this cardiologist and the ECG.  Nobody else looked as uneasy as I felt.  He chatted and got us to introduce ourselves (in my mind, clearly to belittle us by name).

He asked who would like to take the first one.

I had an out of body experience in which I volunteered.

I think it was a defense mechanism. I remembered that people who went first usually go the easier ECGs and sometimes were treated a bit better.  It was worth a shot.

I totally knew what was going on in the ECG… First degree AV block.

Image from gem.fi.

No face eating.

But, it was early.

And yet everyone had a turn.  And sometimes it took a while to get through an ECG and sometimes people made mistakes, but the cardiologist was helpful and pleasant.

We all started helping each other after we all had a turn.

It was quite possibly the most useful session on ECGs ever.  And not the first one where the instructor was nice, but one of the few I have been in (and those aren’t the ones I have generally remembered).

ECGs are such a bizarre thing to get the hang of (this from someone who did Nuclear Medicine sometimes called “Unclear” Medicine).  Little electrical tracings can say so much and make such a difference in management.

Maybe they aren’t quite as scary as I originally thought.

New Years On-Call… A Sort-of Pictoral Documentary

Well, Happy New Year!

I spent my New Years eve and the first part of the day in the hospital doing the delightful duty of Cardiology call.  While most people show pictures of parties… I will show pictures of my version of a party.

Yay... Start of yet another call shift.Goal... Look awake so I don't cry.

Yay… Start of yet another call shift.
Goal… Look awake so I don’t cry.

The day started off like any other day.  Rounding with the team and writing notes.  Oh, and some betting with one of our patients that we would find some sort of disease in his heart despite the patient swearing up and down we wouldn’t.   Later in the day, the cath was done and the patient was right.  Good thing we didn’t put down actual money.

I actually got to eat lunch at a decent hour despite having to run to a code blue that turned out to be nothing (thankfully!).  On the bright side, despite not going to the gym for months, I still fit in a bit of cardio.  My lunch  was left over spaghetti with chili-garlic thai sauce with a side of my ECG book.

Love the spork.  Not the ECGs.

Love the spork. Not the ECGs.

Post-lunch was more note writing and consulting and even a 30 minute cat-nap in my luxurious call room (again, luxurious is a relative term, but this room is decent except for its lack of window and proximity to a few loud fire doors that sound as if people are coming in to join you).

The best part is that they left an extra flannel blanket on the foot of the bed today!

The best part is that they left an extra flannel blanket on the foot of the bed today!

When official call-time started I grabbed a quick supper.  Instant “spicy noodles.”  They were surprisingly good.  I treated myself to my “fun” book The Circle series by Ted Dekker (which is also turning out to be surprisingly good).

First supper.

First supper.

But, as life on-call goes… Starting supper meant my pager went off and it was off to save lives, people (like on Grey’s Anatomy).  Realistically, people would be okay most of the time without my intervention.  Nurses are superstars.  And 1 in every 2 or 3 calls are legitimately urgent.  At least that is how it feels in my head sometimes.

While seeing someone on one unit, I was fortunate enough to catch some early evening fireworks with one of my favourite patients (yes, I am a terrible person and have favourites… Some people you just click better with) and a couple of the nurses.  They were pretty awesome fireworks.  We oohed and ahhed like stereotypical firework viewers.  So cliché.  So delightful.

Some of the lovely nurses on my main unit were ordering Chinese food for the festivity.  I joined in.  Who doesn’t like second supper on a potentially long night of call?

Second supper.

Second supper.

I was even more lucky to sneak my husband in (okay, not really sneak… The hospital is a public building) to share my Chinese food with me.  Kind of like fancy New Years eve dinner.  Except in the hospital cafeteria… With the mice.

The happy couple.

The happy couple.

I didn’t change into my evening attire until later in the evening.

Showing off the evening attire... Awkwardly.

Showing off the evening attire… Awkwardly.

By 11:30, I was feeling ready for bed and decided to attempt to call it a night.  Either that or I considered using my pager as a ball to drop at midnight… Preferably from a high, pager damaging height.

Pager... Hanging by the end of it's bungee cord safety string.

Pager… Hanging by the end of it’s bungee cord safety string.

But, at 11:45, I got called to deal with an emergency and rang in the new year sorting out vital signs and assessing someone.  On the bright side, they were okay and the staff on the unit were all wearing festive hats.

Amazingly, I got about 2.5 hours of sleep.

And then all heck broke loose.

Unrelenting chest pain, vomiting blood, agitated people and low blood pressure were all adventures on my list.

And thus, more cardio.

I realized at one point that sometimes I sing songs to myself when I do stuff… Like theme songs.  I was singing “The Final Countdown” while powerwalking to see someone acutely unwell and unstable.

I was thrilled to finally get to go home in the morning and crawl into my nice warm bed.  Kind of similarly to people who partied all night.

Okay... This picture is from when I crawled back out of bed.  I was too sleepy on the way in.

Okay… This picture is from when I crawled back out of bed. I was too sleepy on the way in.

Patrick made me a New Years eve traditional treat for lunch… Cheese sticks.  He ate his traditional one and I ate the rest.

Post-call lunch of champions.

Post-call lunch of champions… In bed.

So, there you go… New Years Eve in the hospital.

Tonight, we go to supper with some friends (okay, a friend and some people we have never met).  I hope I don’t fall asleep on them.

Whoo being festive.

Our Fake Family

Today is post-call day 2/3 in 6 days. I am glad I don’t stem from the day and age that everyone did regular 1 in 2 or 3 call. It is painful. Even the cardiologist I am on service with thinks it is crazy.

Last night was a bit rough. Not Gen Surg rough, but 2h of sleep rough.

But then, I get to come home to my lovely family. Patrick, the cat dog and our apartment house in the middle of a snowstorm. We are dog sitting for one of the other residents in our program and tonight because we like the dog and because the weather is suboptimal for three trips to the dog’s house, we are having a sleep over.

20121230-162658.jpg
I kind of feel like the song “Let It Snow” is relevant.

20121230-162641.jpg
I had a nice post-call nap and we are settled in for an evening of books, movies and Scrabble. I am even wearing my sweet new PJs from Patrick’s sister. All in our pretend house with our pretend dog. All we need is a pretend baby (although baby may hamper my sleep).

20121230-162730.jpg

20121230-162750.jpg
Also, we found this gem… A snowman either building, kissing, or as I prefer beheadding another snowman.

20121230-162846.jpg20121230-162857.jpg
Simple days like this make life great (I only hope it rains a bunch again to take the snow all way before we have to leave in the morning).

Labyrinthitis

I am on my first Cardiology call.

As a result, I have self-diagnosed with labyrinthitis. But not the real medical kind (the type with swelling in the middle ear resulting in dizziness and vertigo). The fake kind I made up.

This form of labyrinthitis comes from the confusion that arises when you are sorting out a new body system, new rotation and new hospital in one go.

I just had a big flare up down in emerg when I wandered forever to find my patient in a hall on a stretcher, then wandered even more to get him admitted (why does every place have to have a different system!?).

My most recent and tiring flare of my made-up labyrinthitis was just now when I finally decided I have some time to lay down and opted to go find my call room. Easy enough. Nope. It was in a hall, down a hall and away from anything remotely civilized looking. On the bright side, it is quite possibly the nicest call room I have been in less the one for obs-gyn in clerkship ( it was nice and had a window, but it failed with the whole being sandwiched between a lounge and a clinical associate who snored like a dragon… This makes it a draw). I wandered and wandered and when I finally got in… My pager went off. Classic!

Wandering isn’t all bad. And I was saved a lot of wandering thanks to Dr. Bond’s tour of awesomeness.

The best part of today is someone realized how bad it would be to leave me unattended all week, so I have a random senior to work with. Much safer. More efficient.

I am remembering why I enjoyed Cardio as a clerk. And also why it scares me.

Sifting through ECGs and complicated charts is just part of the adventure. Plus, I got to feel a pulsatile liver, hear a bunch of murmurs and start to re-learn ECGs in one fell swoop, all the while diagnosing a random TIA and explaining why pacemakers in radiation fields aren’t cool.

I hope the rest of my day is less labyrinthitis-esque. In fact, sleep is awesome, but learning isn’t so bad.

My made-up maze inflammation will improve as I settle more.

Merry Christmas Vacation

Christmas vacation is officially here!

It even started a bit early for me.

You see, yesterday was academic half day (aka physics time).  It was also my second (but, when you factor in that the first day doesn’t start until 2pm, it was really more my first) day of cardiology.  So, of course I was running late trying to tie up loose ends and failing at not looking like a total idiot.

By the time I had signed over to the on call person on my team, it was time for physics.  Problem: I was at another hospital.  Solution: I ran.

Okay, reality check… I actually ran for all of 30 seconds, maybe a minute, then remembered I am still a bit weak from the whole gastro thing, rather out of shape secondary to this whole residency taking away my gym time and it is winter and my asthma was not having it (not to mention I can’t run on the best of days).  I then powerwalked the rest of the way to the hospital.  Only to get a text from my junior physics counterpart (because, of course there are only two of us in the class) that there was no class today.

So, there I was sweaty, hungry and a touch woozy at the physics department.  I ate lunch and then came to an amazing epiphany… I was in protected time until 5.  That meant that I was actually off kind of early for my 6 days of glorious vacation.

I mentally frolicked home… In my head, I kind of looked like this (but vacation was the only source of my bliss… Not Viagra).

I cleaned the house (Jeter supervised).  I cooked for the potluck we were going to that night (Jeter also supervised).  I packed for home (he supervised that too).

So now, as we hide our tree from the cat so as to avoid him causing further destruction while we are away (on an aside, we had a mini fake bet last night that he would take the tree out last night despite us having gifts around it… Well, I thought he would, Patrick was more trusting.  The tree was still standing.  Shocking.  It, however was missing bits this morning), I continue to rejoice.  There is just something delightful about going home for the holidays.  And about having holidays.   Oh, and the fact that my parents have a fabulous white tree.IMG_0009

Even if I do need to start reading about cardiology, so as to avoid looking like an idiot when I get back (especially because I will be the ONLY housestaff on for a week), this shall be a Merry Christmas and a Merry Vacation!