Finished Year 2

Whelp, that’s that.

Finished the Pharm exam, headed to Charter for a slide show and champagne. Then a jump off the cliff behind the library.

Now my mom and brother are coming to visit, landing in just a few hours! Frond’s parents are coming in too – on the same flight. Yowzas.

Leah and I went up to visit another roommate from first year before heading home, and as we exited the elevator, on the other side was the Pathophys prof and a tutor! The tutor with the bump on his head, the tutor who i felt was giving me such a hard time, and at the time it shook my confidence up. I thought it was because I was the only girl in my small group. It was the start of a term that wasn’t as academically challenging as last term, but somehow it was one of the more challenging, emotionally, mentally. I had moments where I felt so full of anxiety and stretched-too-thin, that I felt something in my chest was going to burst. There were moments I felt so jaded about this career path, asking: why do I care?

Now it’s finished and there’s a new feeling settling in. Something about reaching the end. Days can seem so similar, and trudging along, it’s hard to see where things are going. But moments like these are a chance to breathe and soak it in. It’s a turning point, people!

When I saw the tutor during Pathophys quizzes, he always gave me a smile, which I thought at first was a smirk. But the more sessions I had with him, the more I saw he was really teaching me something new I hadn’t learned yet in school. Out to get me? I think he was out to push me to be a better student, clinician, and better me. He lit up when he saw us leaving the elevator and asked us how the last exam went. Good! we told him. Best of luck on the step and in your careers! he told us, genuinely.

 

Psych! week

It’s Psychiatry week in Pathophysiology.

In honour of this week of self-analysis and labeling everyone you know with a psychiatric condition, here is nice gem from my prof:

It’s SPEAK.  It’s what he counsels his patients with depression to do.

S – Schedule daily (this is important)

P – Pleasant activities (we really don’t get enough)

E – Exercise (get that blood flowin’!)

A – Assertiveness (express those emotions and feelings!)

K – Kind thoughts (kindness starts with being kind to yourself).

He said that med students especially need to look after themselves.  I’m not sure about especially, but looking around at students, there is a definite tend to letting yourself go – physically, emotionally, creatively, and socially (myself included).  On the one hand I feel one-dimensional if I spend my days only studying.  On the other hand if I don’t spend all my time studying I feel behind and like I am not living up to my potential.

In the end, it’s this: we are living now, not just working and preparing for the future – future career, future location, future life.  We keep ourselves going by focusing on our goals but it’s still worth living a good life now.  Besides, it’s only going to get harder to figure this balance out; may as well figure it out now.

 

P.S.  I’m cyclothymic.

Gems from First Aid

There’s a study book to use for the Step 1 called First Aid, and you’ll see pretty much every med student on campus (and on any campus) carrying it around wherever they go.

Here are some of the gems it has:

How to remember that the nipple is at the level of the T4 dermatome?  T4 for the teat pore.

How to remember that Gardnerella vaginalis is one of the bacteria causing bacterial vaginosis, which produces discharge with a fishy smell and white blood cells covered in bacteria (clue cells)?  I have no clue why there’s a fishy smell in my vagina garden.

Hospital Dress Code

This term we’re heading in to the General Hospital and for the first time, interacting with real patients (who aren’t being paid for us to poke them).  Our school sent us an email outlining our dress code for the hospital trips.  Here are a few of them:

• Skirts must be no shorter than 2″ above the knee.

I was happy about that one.  It’s reasonable!  The usual at or below the knee is only good if you’re wearing a towel.

• Trousers or pants must be loose fitting

At my Catholic high school it was a big deal when girls were allowed to wear grey pants instead of the usual kilt.  But the admin didn’t expect people to start wearing grey yoga pants with their blouses.  I guess the Pope would not have been cool with that.

• No sleeveless clothing allowed

Not even under our white coats.  Someone told me that most of the hospital isn’t air conditioned and that last term someone fainted every week.

• No see-through clothing
• No topless

I wish I knew the story behind the making of that last rule.

 

Interdisciplinary: Who dat?

I met up with a couple friends from undergrad two nights ago.  One of them, BM, is in Physio school.  It was pretty cool to compare how our respective programs have been similar or different.  Mostly different so far.

She said that she was surprised how much writing is involved in PT school.  She had to write 3 papers so far.  I forget what the first paper was on, the second was on an experience with someone with a disability (this paper was done in partnership with a student from Osteopathic school), and a third paper on a topic of her choosing, which she wrote on Physio clinics under the public payment system.

It was really cool, how right off the bat her training is integrated into the training of other health professionals.  She recently finished a rotation in the neuro oncology ward, where she sat in on case reviews with med students.  She also completed some assignments where cases were reviewed by a team of students: a nursing student, a physiotherapy student, a medical student, and so on.  Each student reviewed the case and discussed their treatment plans from their discipline’s perspectives.  It must have been so interesting to see how each member approaches a patient, and to see how the treatment plans can compliment (or maybe even contradict) each other.

I told her how my mom recently hurt her shoulder when she fell on her elbow, and has a partial tear of rotator cuff muscles.  The orthopedic surgeon can’t do anything for her, so she was told to just let it heal on it’s own.  She had lost quite a bit of her arm’s range of motion (i.e. couldn’t put on her seat belt without help or a lot of pain) so she booked an appointment with a physiotherapist and has been really happy with the help she has had from there.  My friend BM was happy to hear this.  She said, “See?  We aren’t just support staff!” — I got the feeling this was more so directed at the world (Them!) than me.

One of the assignments BM had was for a group of the physiotherapy students to find out the different roles of various members of the health care team.  Her group did pretty well but in the end couldn’t figure out the difference in role between a licensed nurse practitioner and a registered nurse.  Her tutor asked them, “If you don’t know the difference between a licensed nurse practitioner and a registered nurse, how do you expect them to know the difference between a physiotherapist and an occupational therapist?”.   More than support staff for sure, but still trained to be a part of a team.  Definitely more than my training has been so far.  For sure these discussions haven’t come up in medical school, and yet I’m sure doctors will always be a part of the health professional team.  From my perspective, it’s too bad.

I thought back to when I learned about some kind of wrist-related pathology in first year Anatomy.  Was it carpal tunnel?  I don’t remember.  But I remember being told that the treatment for it was surgery.  Perhaps to cut open the flexor retinaculum, if it was carpal tunnel.  Frond was sitting beside me, and during break after lecture he told me he was so surprised that we were being told the treatment was surgery, rather than the much less invasive manual therapies he had learned and treated clients with in his previous life as a body worker.

Maybe it’s just my med school.  After all BM goes to a university that has made it’s name on “innovative” (unconventional) teaching styles.  It seems to work.  But regardless, more interdisciplinary training from the start of med school is something every med student (and patient!) will benefit from.

When you don’t like your patient

I’m still on the way home, on the second leg of my trip.  I am eavesdropping on the conversation going on in the row in front of me.  13C is coming home from Guyana where he’s been working in mining exploration.  He looks like a young guy, maybe around my age, with a kind of Western or Southern drawl.  He’s describing what he does to 13D and I’m trying to listen for any indication of gross injustices against the environment or local communities.  He’s an outgoing guy and seems really friendly.  He leans over the empty seat beside him and is now chatting with 13A, whose contribution to the largely one-sided conversation is the occasional “ah” or “huh”, “yea…”.  He’s talking about his life working overseas.  He proudly mentions having 4 girlfriends, who don’t know about each other “no, they don’t know about each other”.  He sounds jovial, like someone talking about how fresh the fruits are at the local market or maybe how a dad would talk about his son’s little league team.  I wondered how I would approach this if he were my patient.  Would he tell me about his 4 girlfriends?  How would I respond?  Impassionate, matter-of-fact: “Oh, well do you use protection? Have you been tested for any STDs?  Alright, well we have the facilities here to do that”.  I pictured the movie effect where you have a map with a pin-point on it that just spreads like a black wave, sludgy and oozing across the continent.

I remember one time my mom came home from the office upset.  One of her patients was cheating on his wife who was terminally ill.  His mistress wanted him to promise to be with her.  He was stressed and depressed but didn’t know why.  When my mom asked if he thought perhaps it had to do with his relationship situation, he was surprised and hadn’t considered it.  My mom was boiling the whole hour of therapy, as she was reminded of being cheated on herself so publically by my dad.

As much as Western medicine is about micromanagement and control of biology (at least we like to think that), we’ll eventually end up with patients who we will feel crappy listening to.  I’m thinking of the simulated patient we had who was abused by her husband but didn’t want to admit it.  Doctors are legally mandated to report child abuse and elder abuse but not spousal abuse, and I can’t imagine what it will be like to have to see some women walk back out into trouble despite all the counselling you give.

I guess part of becoming a health professional is always keeping a professional front.  Obviously my mom couldn’t bring her own baggage into the care of her patient.  The trick will be finding the balance between being jaded and being human.

Go home

One of the most frustrating things about my school are the other students and the things some of them say.

On my way home to Toronto via Trinidad, the first leg of the flight was in a Turboprop with about half the plane full of students.  In this small plane, some are talking about how desperate they are to get off the island and never return.  You couldn’t pay me to come back, one said.  When the cabin was sprayed for mosquitos, one joked about the next thing waking up in a strange place, Hostel-style.  Reply was that even being drugged and abducted and tortured would be better than staying in Grenada.  And so on.

It’s embarrassing to be in the same group as these people, so harshly ripping into an amazing, beautiful country in front of people who have grown up there and live there now.  Totally without a clue, these guys are.  I feel pretty certain that they’ve hardly ventured out from campus except the usual trips to the IGA or beach, and doubtful that they’ve had a conversation with a Grenadian outside placing an order for food.  Because that’s the only way I can explain how anyone can live here for 1-2 years and still talk like that.

As seen on Facebook

Things I won’t have to deal with anymore… at least for awhile… hopefully:

Accidentally wearing short-shorts on a Clinical Skills day and then being nominated to be examined in all manner of undignified ways.

Giving a daily presentation on a disease (as though I’m an authority on the matter) having only just discovered what it was 4 hours ago.

Studying the night before a Clinical Skills / Standardized Patient quiz not because I give a damn about my grade, but purely to avoid emotional damage secondary to being shamed… which usually happened anyways.

I won’t miss you, Term 4.

There’s a lot to thank Term 4 for: learning professionalism, patience, flexibility and a bit more maturity.  Snarky, ya — but the truth in this post was just too funny to not share.

An ode to the last exam

[8:50:01 AM] Shane:

“Twas the night before finals, and all through the college, The students were praying for last minute knowledge. Most were quite sleepy, but none touched their beds, While visions of essays danced in their heads. Out in the taverns, a few were still drinking, And hoping that liquor would loosen up their thinking. In my own apartment, I had been pacing, And dreading exams I soon would be facing. My roommate was speechless, his nose in his books, And my comments to him drew unfriendly looks. I drained all the coffee, and brewed a new pot, No longer caring that my nerves were shot. I stared at my notes, but my thoughts were muddy, My eyes went a blur, I just couldn’t study. “Some pizza might help,” I said with a shiver, But each place I called refused to deliver. I’d nearly concluded that life was too cruel, With futures depending on grades had in school. When all of a sudden, our door opened wide, And Patron Saint Put-It-Off ambled inside. His spirit was careless, his manner was mellow, When all of a sudden, he started to bellow: “On Cliff Notes! On Crib Notes! On last year’s exams! On Wingit and Slingit, and last minute crams!” His message delivered, he vanished from sight, But we heard him laughing outside in the night. “Your teachers have pegged you, so just do your best. Happy Finals to all, and to all, a Good Test!”

Iron-man for jerks

I know it hasn’t been that long since i was there, and that there isn’t really all that much different between us except that i started school a year before them, but lately everything term 1s do seems extremely annoying. Including studying at the same table as me, quietly doing anatomy questions together.

On a related note, exam time is a great time to reflect on how irritable and cranky of a person you can be. It’s like competing an iron-man and realizing you had it in you all along, but for downers. On the upside, it’s good practice for trying to stay aware of feeling annoyed, and keeping perspective. Emphasis on the practice. Having appropriate reactions to situations can be hard!

Tomorrow’s my Clinical Skills practical exam. We dress “professionally” in white coats and see our standardized patients. 6 days until the Path exam. 13 days until home and Christmas break. Whew.