Learning To Speak

Today’s prompt from the Daily Post is called “Take That, Rosetta!”  It asks the question: “If you could wake up tomorrow and be fluent in any language you don’t currently speak, which would it be? Why? What’s the first thing you do with your new linguistic skills?”

Tricky question.

I mean, I speak French.  I am not perfectly fluent in French.  I was doing pretty well when I was in high school doing higher level French courses and speaking in French with my Grandfather.  But, I haven’t had a French class since the 11th grade and rarely use my French at all now.  In fact, I am embarrassed to speak French because I fear I will look that ridiculous, unless of course the person speaks less English than I speak French, which happens from time to time at work.

So, if I could pick any language, I would pick French.  Because it would be the most useful.  And because given where I grew up and my heritage, I really should speak better French.

But, there is that whole stipulation about it being a languge I don’t currently speak.

This is more challenging.

I feel like I would pick Mandarin because it is probably the next most common language.

With either, I would be thrilled to finally speak to native speakers in  their own language and finally get the depth and wholeness of conversation that comes from talking with someone in their mother tongue.

Segueway…

Tonight, I had a conversation with some friends about language.  One of them teaches from time to time as a substitute in a language school for adults.  Today, she told us about teaching in a class that was for people who had no concept of the English language whatsoever.  As in they didn’t necessarily even know what way to hold the written page in some cases.  It is a lot of pointing and repeating.

Learning a language from the start is tough, especially when the teacher and all of the students speak different languages than you.  It is all about immersion and repetition.

It made me think about how crazy it is to learn language.

Medicine contains a lot of its own language.  In fact, each specialty has its own dialect.  Many words are the same, but there are some different ones or special meanings.  I am still trying to piece together some of the dialect that is Neurology and I have been doing that full time for a month.

I learned to speak French.  But, I had French words in my vocabulary my entire speaking life.  Even then, it was hard. I remember how tough it was when I started Immersion.  And again, my background was better than that of many other kids my age.  Even then, I was still sorting out the finer nuances of the English language and sorting out the intermediate-basics of French.

I did a summer program in the Netherlands and although Dutch does have some English or French appearing words, I was grateful that most people spoke English.  Being in a place where you don’t speak the language can be scary.

I can’t imagine being in a place where I don’t speak the language and nobody else speaks my language either.  Plus, factor in things like being in a new culture and country.

It must be so overwhelming.

When I was in med school, our school had this really awesome program where they would send in first and second year medical students with interpreters to get the medical histories from refugees new to Canada to help facilitate getting them family doctors (because with an interpreter, the visit is twice as long and often these people have complex histories and issues that would be too time consuming without screening and a starting plan).  It was a really eye opening experience for me and I do feel like it made a difference for some of the people.

I remember in one instance, I found out a woman was quite upset and concerned because she was due of her yearly pap smear two months before and nobody had offered one to her yet and she didn’t know where to go.  As it turns out, she had an abnormal pap in the past and had a sister die of cervical cancer and wanted to avoid that.  I got to red flag this issue and she was seen earlier because her concerns (which she was to embarrassed to tell to her case worker) were put out there.

Another time, we saw a whole family with sickle cell who hadn’t seen a specialist and were managing things like painful crises at home with no medications.  They were referred to hematology for assistance with management.

Sometimes, it was as simple as saying everyone was well and that they would just need maintance and preventative care.  Other times, we helped point people to dentists, emergency departments and urgent GP visits, so they could be referred to a specialist.

I feel like it made a difference.

It all wouldn’t have been possible without interpreters.

Language is so important.  We share so much in the human experience, but much of that is communicated with speech.  We take it for granted sometimes.

In the Middle of the Night

Last night’s home call, as I alluded to last night, was sub-optimally home.

I had an admission coming from another hospital scheduled to arrive at 9, then 10.  I called the nursing floor around 11:45 after forcing myself (foolishly) to stay awake until I had to go back in to find out that the flight was, in fact, delayed and that they had found this out a half hour ago and didn’t think to tell me.

I decided to go to bed.  Try to get some sleep.

I just dozed off and the pager went off.  A question from the junior covering the floors on my admission from earlier in the evening. Easy enough.

Back to sleep.

Slept for an hour and the pager goes off again.

After the mild freak out that comes with begin awoken from a dead sleep, I call the number back, ever so slowly processing that the number I was calling was not the nursing unit, but the emergency department.

Cue low level frustration.

A stroke to be admitted.  Fair enough.

I grumble, drag myself out of bed, put clothes on and stagger out the door.  By the time I park and navigate my way to the hospital from the parking garage, I am awake  again.  I am really  awake by the time I cut through the waiting room of the emergency department and have someone get mad at me for clearly being a doctor and just strolling in at 1:30 in the morning.  In my head I argued back.  But really, I just ignored them and kept walking.

I saw this consult.  I wasn’t sold on it needing admission, so I held them overnight for tests.  They could have just waited until morning to be seen by neurology.  It would be the exact same outcome.  That made me a bit cranky.  But, it was still a perfectly reasonable call.  Just one that had I known the symptoms were resolving, I might have asked if they could hang on to the person and I would see them later, when I was in to see the admission (whenever that was going to be).

I finished my consult at around 3:30 in the morning.  I called the floor.  Still no word on my admission.

Cue internal rage.

I didn’t want to go all the way home, so I went to pick up a call room key and decided camping out in the hospital would be better.  And safer.

I started singing this song to myself and it made me feel better.

As life works, as soon as I signed out the call room key, my pager went off.  My person had finally appeared.

I got home at 5:45 this morning.

As much as I whine, I feel badly for the poor people who were up all night because of travel, sickness and me making them do crazy things like finger to nose testing at all hours in the morning. Plus, it is my job.

I found this comic from doccartoon.blogspot.com (check out her page) that kind of parallels what it is like getting called in at all hours in the morning.

Last Call… Neuro (not EtOH) Edition

Tonight is my last night of Neurology call.

I am a happy girl.

I am going to be a sleepy girl.

I was already in to admit a stroke.  I know I have a direct admission coming at some point later tonight.  And odds are something else will go down in the next 10 hours.

Exciting parts of tonight were plentiful thus far, though.

I correctly identified a giant brainstem stroke based on exam findings and confirmed it with finding the lesion on the MRI.

Not all strokes are obvious like this. Image from neurology.org.

In correctly identifying the giant brainstem stroke, I managed to actually elicit a few findings on neurologic exam I don’t often get to see like  clonus, unilateral hyperreflexia (complete with 4+reflexes) and an up going babinski reflex (translation: signs of upper motor neuron lesions aka something higher level than peripheral nerves).

Image from meded.ucsd.edu.

Patrick kept supper for me in the microwave.  I got to garnish it with the deliciousness that is Siracha sauce that has become my favourite grocery purchase this week.

*Kind of Spoiler Alert*: Sheldon and Amy on The Big Bang Theory tonight.  So awkward (to the point that they make me feel better about my own level of awkward).  So cute (in a way that I don’t find nauseating).

This was not the episode I am talking about, but I do love these dance moves. Image from fanpop.com.

As much as it sucks that I know I am guaranteed to have to go back in sometime in the next couple hours, I also know that this call is much better than in-house call.  Also, I will likely be in hospital doing this next admission that I will get to be post-call tomorrow and possibly get paid for a full night of work.    The issue is that I will probably also be too sleepy to enjoy most of the day because of my post-call-ish-ness.  I can always hope otherwise, though.  I am getting better at being post-call.  If there is such a thing.

I feel like I could do better than this… Some days. Image from doccartoon.blogspot.com.

Plus, I am looking forward to tomorrow night when I finally get to redeem my Christmas present from Patrick by going to a dinner theatre that is a parody called “The Big Twang Theory.”

Good things.  Good things.

I will need this reminder a bit later tonight when I am sleepier and crankier.

Leave Your Shoes At The Door: Memory Clinic

This week’s writing challenge with the Daily Post and Rarasaur is kind of a take on one of my favourite quotes from one of my favourite books:

If you can learn a simple trick, Scout, you’ll get along a lot better with all kinds of folks. You never really understand a person until you consider things from his point of view…until you climb into his skin and walk around in it. –Atticus Finch in Harper Lee’s To Kill A Mockingbird.

The challenge is to consider things from a different point of view. 

I spent my morning in a memory clinic.  I have some choices in the current Neurology rotation I am doing, so I can pick from clinics being offered (that aren’t already occupied by other learners) to try to tailor my learning.

I chose to go to this clinic because memory issues are something that can be caused by cancer treatments I will in my future life administer.  I chose to go to this clinic because memory issues are common.  I chose to go to this clinic because memory issues are very personal for me.  I almost went to a different clinic for the same reason.

I can walk into this clinic wearing many different pairs of shoes in my mind.  These three are the most predominant.

I walk into the clinic as a part of the team. 

I don’t know these people.  I don’t know their past.  I can’t say for sure what their future holds.

I introduce myself.  He has that blank stare.  The lost look that dementia brings.  He is polite and shakes my hand.  Smiles back at me with a big grin.  I can see a stain on his shirt from breakfast.  He glances around uncomfortably as I meet his wife and daughter.  The daughter has a list of questions and a notepad in hand.

They sit down.

I ask what brings them in today.

He says, “a checkup.”

His daughter interjects, “He has been having trouble with his memory.  His family doctor thinks he has Alzheimer’s.  He repeats himself.  He doesn’t remember how to get home from his walks.  Mom isn’t coping well with him at home.  It isn’t safe.”

His wife looks tearful and ashamed.  She just nods along.

He then looks at me and asks, “Why am I here?  When can I go?”

I go on to ask questions.  How long has this been happening.  Talk about when things started, how the progressed, about safety issues, medicatons and family history.  I get to hear intimate details of their lives.  I listen to their fears and hopes, their belifs and misconceptions.  I listen to them bicker and laugh and cry.

I want so much to fix their hurt.  All I can do is offer the help that is available, a listening ear and a friendly smile.

I supported my family members as they have gone into a clinic like this. 

Unfortunately, I am aware that there is a good chance that one day I will sit on the other side of these figurative and real tables. 

I will be the daughter or daughter-in-law of the person being seen in the memory clinic.

I shake the resident’s hand and sit down with my Mom and Dad.

She explains the procedure and we laugh because we know the drill.

Mom tells her, “We’ve been here before. Plus, my baby here is a doctor.”

I am embarrassed.  “It never gets old,” I say and laugh.

The resident is puzzled, “You’ve been here before?”

“Oh yes, our Mothers were both through this clinic.  Alzheimer’s.  I guess its our turn now.”

My father sits silently, but smirks and shakes his head.

The resident looks confused at how casual we are about this.

“We have been expecting this.  It is kind of our way of coping.  Either way, we decided to come early.  Get on medication.  Plan ahead.  We have done this before.” I explain.

Later in the conversation, they are doing the testing.  I have given these tests more than I would have liked, but there is something different sitting behind your mother as they go through the questions.

She stumbles through serial 7s.  She can’t spell world backwards, but my Dad chimes in that she is “half dyslexic,” so that is probably why.  It isn’t.  She knows the season because we are wearing sandals and the date because she memorized it on the way in.

She draws the clock as I cringe when she almost mixes up the hands.  Almost.  I sigh with relief when she gets them right.

She can’t remember the name of my youngest child.  And my grandmother is still alive in a nursing home (we laugh because we joked that she would outlive us all, but in the end she didn’t).  She knows they downsized and moved to an apartment near my husband and I, but can’t recall their new address.

She glances back at us for confirmation.

The resident then asks for our help in sorting out the correct information.

I take a deep breath and give the correct information.  She smiles and nods alongs.  Agrees and laughs at her misinformation.  It is good that she is so good natured.

We smile and encourage her to continue but give eachother looks from the corner of our eyes.

We know.

Even more frightening is that one day, it might be me.

I’m sitting in an unfamiliar clinic room.  Something tells me I have been there before, but I just can’t place it.

Posters all around the room show pictures of human brains and nervous systems and drug advertisements.  This is my world.  This is what I know.

They come back in the room.  Patrick, my son, my daughter, two strangers one with a stethoscope around their neck.  I don’t know these people but they seem to know me.

Image from phenxtoolkit.org.

They pull out a test.  They say it was mine.

I recognize it.  An MoCA (Montreal Cognitive Assessment) test.  It is completed.  I must have done it earlier.

I don’t remember.

That is the frightening part.  I feel like I miss more and more with each coming month and I don’t even realize it all the time any more.

The resident is explaining the meaning of the results.

I know these things.  I used to do these things.

“Her level of education helps her get along.  Her scores have been fairly stable. When she first presented she got a 27, then a 25 six months later.   Since we switched her meds and started her on the trial drug, her score has  been hovering around 23.  But today, she got a 17.”

I stare at her. There has been some sort of mistake.  I have Alzheimer’s, but I am medicated.  I am a competent adult.  I am a physician and a mother and a wife.

She continues, “After all we talked about today, it seems your wife’s condition is progressing.  It is clear that she is having more difficulties with her short term memory and judgement, especially after the time she wandered out the other evening.  And that fact that she is no longer able to hide things very well any more.  Have you thought about what you are going to do when things get worse?”

I have.  I want to be put in a nursing home.  That much I know.   But, things aren’t that much worse, are they?  I try to remember getting lost.  I try to remember what clinic we are in.

Then I realize they are all staring at me.  How much time has passed?

I forgot to make my notes.  I always keep notes.  It is how I get by.  Memory cues.  I don’t know where we are in the conversation.  I feel overwhelmed.  I feel afraid.

My daughter takes my notebook from me and repeats what the doctor said about medication dosing and changes to my timing.  She says she will make sure the blister packs get replaced.

Someone from home care is coming by tomorrow to meet with us about getting some help at home.  She takes my calendar and marks that down.

Patrick is staying back to talk to the doctor.  I hate it when he stays behind.  I know what that means.  At least, I think I do, but I can’t be sure of anything anymore.

I want to stay.  I ask to stay.  I demand to stay.  It is my health and my body.  Back when I was first diagnosed, I could manage these issues.  Nobody figured it out until I was ready for them to know.  Medications are better now.  I am not my grandparents.  I just need to take better notes or add more pills or maybe take away more pills…

They tell me it will only be a minute.  I can’t understand why.  I just don’t like being apart from him.  He is one of the few people I know.  He helps me.

My daughter tells me we will go to the Starbucks across the street for lattes while we wait.

I tell her, “That sounds great, I haven’t had one of those for years and years.”

Blurred

This week, I thought my studying brought on some weird hypochondriasis.

I was being the cool cat that I am studying neuroanatomy and neurology stuff and feeling like I am finally starting to make some progress in my figuring out where certain presentations originate in the central nervous system, when this image of the brain seemed out of focus.

So did some of the side margin boxes.  And the next picture of a brain.

I stared at it confused.

Then I looked around the room.

I have complex migraines, that can  include a slight diplopia (double vision) and other symptoms (unilateral facial paresthesias, scotoma) so getting a slight amount of altered vision from time to time isn’t the most crazy thing to happen.  The issue is that it didn’t feel like my usual aura and when I looked up, the vision change went away.

I looked back down and it was still weird looking.

It isn’t like I was studying for a long time (this particular episode… If you factor in my million years of schooling, then it is obvious I have ben studying for a long time).

Then, it hit me.

I was having a stroke.

No.  That was definitely not it, although strangely enough that was the topic of this particular chapter – cerebral bloodflow and stroke presentations.

There was some sort of printing error in my book.  As a result, a few images were blurred.  Not enough to make them useless, but enough to make the reader crazy.

This doesn't quite give justice to the blurred sensation the pictures give when looking at them in person.  From "Neuroanatomy through Clinical Cases by Blumenfeld (2002).

This doesn’t quite give justice to the blurred sensation the pictures give when looking at them in person.
From “Neuroanatomy through Clinical Cases by Blumenfeld (2002).

I showed Patrick to confirm and he has the same confused reaction.

From "Neuroanatomy through Clinical Cases by Blumenfeld (2002).

From “Neuroanatomy through Clinical Cases by Blumenfeld (2002).

It makes me wonder how people can exist with the changes in function due to a stroke and not report to medical attention.  I mean, if you can’t see right, something must be wrong?

My mind has been blown on this service by the number of people with acute stroke who chill at home waiting for things to get better. Even when it isn’t their first stroke.  Time=brain, people!

And yet, I get it.  Because in this case, there was something else to blame.  We look for that something.  Anything that is less scary even if, at times, it is less plausible.  We hope the problem just goes away.  Sometimes we make it worse when we wait on things like that.

The scary part is that I used this same textbook to study neuro in med school and I only very vaguely remember this problem.  I think I realized the pages were blurry because of printing, but it isn’t a clear memory.

The highlights are proof that I did read these pages before.  Again, the picture takes away from the blurriness that is experienced in person. From "Neuroanatomy through Clinical Cases by Blumenfeld (2002).

The highlights are proof that I did read these pages before. Again, the picture takes away from the blurriness that is experienced in person.
From “Neuroanatomy through Clinical Cases by Blumenfeld (2002).

In retrospect, that was before my migraines were controlled, so it wasn’t unusual for me to have an aura in which I couldn’t see proprerly, so maybe I just chaulked it up to my weird brain.  Or maybe I blamed it on too much reading.  Or maybe I just wasn’t paying that much attention (although the highlighting on the page tells me otherwise).

Clearly, I need to learn my own lesson and pay attention both to my body and my books.

This also brings to mind a song that was popular this summer that I quite disliked, except for this version by Jimmy Fallon and The Roots…

Mama said there’d be calls like this…

Just a warning: I whine in this post.  A lot.

Today was just one of those call days where I was being pulled in 10 different directions at once.

This, after being stuck over two hours (until almost 11)  after my call shift was done Saturday morning when I should have been done at 8:30 because of a 7am consult that took longer than it should have.

I guess it was one of those call weekends.  And such seems to be my luck whenever I have Friday/Sunday call.  Although, theoretically I like the Friday/Sunday better or at least as much as Saturday.

My “home call” adventure had me stuck in the hospital from 8:30 until 6:30.  I didn’t eat, didn’t pee and didn’t even get to finish my morning coffee.  Yuck.

The day’s adventures included being physically threatened by a patient, helping to gather someone off the floor and being barraged repeatedly by a demanding family, plus the usual rounding, emerg consulting and phone answering.

But, at least the home call came to fruition when I got to leave at that point and Patrick got me McDonald’s and flowers as a consolation prize.  And now I am home.  And I am glad that I am not on in-house call where I would be stuck at the hospital and likely even busier than I was today.

I have mixed feelings about this.

Part of me just wants to stay home.   That is the reasonable part of me that is grateful that home call is awesome. But, then I know that means I have to work all week like normal people and that I will be tired tomorrow after the weekend and that isn’t so awesome.

Another part of me wants to get called in, so that I can be in hospital after midnight and potentially be one of those people who capitalize on post-call days.  But then, I will be tired and sleep most of the post-call day (which is what they were for, but I still always dream of being productive or useful on those days).

Either way, I am still glad that it is home call because that means it is theoretically a less busy call with potential sleep in my own bed.  I prefer that over up all night, in-hospital stuff any day.  I just want to whine a little because my weekend was yucky because I was too post call sleepy to enjoy a Saturday off, worked all day today and will be back at it tomorrow sleepy again from a busy weekend.

I also need to remember that busy days aren’t that unusual.  They just seem more nasty when you are on your own and when it is the weekend.

Such is life, though.  And that is how you learn.

I am just glad my time management and medical knowledge is a bit better this year than it was last year or I still wouldn’t be done.

I chose this career.  I need to take the good with the bad, just like everyone else.  It is just sometimes, I look at the bad and wonder why I just don’t quit and pick up a nice regular hours day job (Patrick reminded me that I can’t do that because we would never be able to pay back all my loans or make rent if I quit now).

I’m just glad there is generally more good than bad.

I also wish I could clone myself.  That would simplify things.

 

Last-day-of-rotation-Tuesday Tuesday

It is Top Ten Tuesday day, but given that I can’t even keep up with the books released years ago and the list is the top ten 2014 releases I am looking forward to, I feel that it is pointless to try to do it.

So, I present to you last-day-of-rotation-Tuesday Tuesday.

Yes, I feel like the two Tuesdays in the title are necessary.

What that means, I don’t know.

I will, however say that these past four weeks, I have learned that I can learn about Infectious Diseases.  The learning curve is huge and that is pretty cool.

Also, I realized this week that it wasn’t me lecturing my husband about the importance of the flu shot, me telling him that we have a few people I was following on ID with the flu or even the TV reports of deaths from the flu in another province to convince him to get a flu shot.  It was… Drumroll please… His barber.  True story.  There is a man chopping hair who is doing his part to promote public health.  That is awesome.

Seriously, he went to get a haircut and got a flu shot that I have been semi-nagging about for months on the way home.  Pretty awesome.  Now if only I can get him to make an appointment with our doctor to get his TDaP and MMR updated.  If only.

I also learned last week that (disgusting fact) tampons cause toxic shock syndrome by acting as a physiologic abscess.  ICK.  Thank goodness they sorted out which materials promoted bacterial growth and that high absorbency tampons were the main culprits back in the 80s before I really considered this an important issue.

Oh, and that toxic shock syndrome can occur not in women and not in tampon use.  Okay, I did know that, but I never really thought about it that much or considered it as a high level differential until this rotation.

On to Neurology tomorrow.  Yet another rotation that makes me nervous due to my sheer ignorance.  I can do brain tumours.  Everything else is going to be a bit sketchy until I can read and see a few cases.  Thank goodness for lots of references, good staff and basic medical knowledge.

I had a friend in med school who was awesome at neuro… So awesome that she plans to do it for a living one day. I wish she was here to tell me what to do.

I sense another giant learning curve about to start.

Only 6 off-service rotations to go…