6 years of school. Thats 4 of an undergraduate degree, and 2 in a professional program. Working through each and every summer. Blood, sweat and tears into exams, assignments, labs. Then my last and final year doing clinical placements throughout different areas of the hospital.

Some memorable moments

• The Australian medical resident who looked like Dr. House
• Icecream everyday at 4 pm for 2 weeks with a certain preceptor in internal medicine
• Being called “Anna” or Dr Anna, on every rotation despite introducing myself as “Anne, the PA Student”
• Being able to be first assist in every orthopedic surgery I attended
• Being mistaken for a medical student, or resident
• Overnight call at a hospital while I was doing my surgery rotation, and SM stayed with me at the hospital all night, even brought pho to the hospital, when I was hungry!
• Free sushi at a big city academic hospital for rounds!
• Being told I had the qualities and potential to become a physician by many of my preceptors
• Getting to know the patients and their families
• Being able to take the time to provide quality care, and receiving appreciation from patients
• Discovering things I never realized about myself:
• Emotionally and physically, I am a lot stronger than I thought I would be
• That I probably can’t do shift work
• I love team work (I’m usually shy)
• When receiving didactic-type lecturesthat the rotation I dreaded the most (internal medicine) ended up being the rotation I loved most!
• I’ve finally grown up.

After everything, I made it. Sorry if I sound cheesy, I’m simply overwhelmed. Glad to be done

Spring Cleaning - One thing I’ve noticed, is that somehow I have this unintentional propensity to accumulate so much stuff, which makes for miserable moving missions every time I move (which is once or twice a year for the past 6 years). I think a goal of mine, when living at home is too cut down a lot of the stuff. I know clutter has never ever made me feel good. Somehow I am able to manage through the “organized mess”, however, some days more than others I find it stressful to come home to so much stuffSort out things I need to throw out, clothes I can donate.

No place like home

This rotation, for orthopedics, I scrubbed in and assisted in every single surgery. I saw 20-30 patients at every clinic, with a review and feedback with the physician after EACH case I had seen. I worked on a weekly basis on my goals which my preceptor helped me set and achieve, and I received constructive feedback. By far the most structured learning environment and rewarding rotation (my second last one too!) I’ve had so far. Good teachers are hard to come by.

Upon conclusion of finishing my last week in orthopedic surgery, I feel like I’ve learned a tremendous amount. I love how fast-paced the environment was, the variety of work you get to do – whether it is clinic, the OR watching the surgeon performing cutting-edge techniques, teaching sessions and research – and this was something I didn’t anticipate going into the clinic, just how much I could learn. It was originally a placement I did because I wanted to supplement my knowledge in the context of Family Medicine and ER, but it seems I’ve broadened my horizons a bit and am now considering a possibility of a career in Orthopedics (of course this depends on job opportunities upon graduation).

I definitely got used to seeing a lot of “carpentry” tools in the OR. Things I used to see my dad take out of his tool box in his garage. Surgeon to scrub nurse:  ”Mallet, Spectrum, Screw, Anchors, Drill!”  The surgeries were quick too, 1.5 – 2 hours for most routine procedures. I enjoyed and got the hang of retracting, local, staples, stitching. It was a great experience!

The residents and staff were amazing to work with. It’s fantastic being able to work in a high-efficiency, high-yield environment – and this structural organization, attitude and leadership of all members of the team is something I want to take with me.  I knew that I enjoyed this rotation, simply because I just loved coming to the hospital/clinic everyday.

Last rotation is coming up next week before graduation. Can’t believe its so soon!

Synopsis: Picked as her best friend’s maid of honor, lovelorn and broke Annie looks to bluff her way through the expensive and bizarre rituals with an oddball group of bridesmaids. (IMDB)

Review: A movie that isn’t entirely boring, with its share of interesting characters and quirky funny moments. I realize that in a lot of movies recently, directors have been trying to portray protagonists that are ‘imperfect’. Perhaps it started with “Ante Vigils” in The Dark Knight. Perhaps its a way of  that movie makers feel that they can get audiences to relate to these ‘imperfect’ characters. Well, not so much with our heroine in this movie, I think they made her a bit too flawed that it seemed unrealistic (of course it is a movie).  Annie (played by Kristen Wiig) has had a lot of difficulty and struggles financially, romantically, and also as a best friend or bridesmaid. A good portion (too much) of the movie is spent with her in self-pity and spiraling down this path of self-destruction, where at no point is she really in control of her life.

Given the theme of this movie (friendship, bridesmaids), its relatively superficial comedy about responsibilities of a maid of honour, they try to go much deeper but I felt they failed to do so. Perhaps its because I’ve never been in “Annie’s” situation, but I found that rather than empathizing with the character, I found it difficult to relate to her, and to be honest, didn’t really have a lot of respect for the way she reacted in the movie (me asking for some situations, “Do people really do this in real life?”). Perhaps its just a me, I don’t like movies where women are portrayed as having low self-esteem and throwing themselves at any man that will take them (take for instance, the character Gigi from “He’s Not that Into You” (2009)).

Conclusion: A relatively good movie about friendship. Perhaps a good one to see with some girlfriends, but don’t goo too much out of your way.

Rating: 2+/4

Trailer:

SM enlightened me to the fact that I was only 2 months away from finishing, then 7 weeks, then now… it’s hard to believe I am only 6 weeks away from finishing my program, and possibly university – forever!!

That moment, seemed so far away a mere few weeks ago. I’ve started preparing my resume, my cover letters, gathering my references, and preparing what may be a permanent move back away from my university town and back to my home city.

I’ve had a long list of things I wanted to do once I finished.  Pay off my student loans first and foremost, move out, get my own place…

This seems strange, I’ve been used to being a student for so long, the idea of not having classes in the fall, purchasing binders, pens, organizing a class schedule. Life will definitely be different, but I have to say the thought of no more midterms or exams is exciting.

I had been practising my clinical skills all week with my friends. History taking and a focused cardiac, resp, abdominal and MSK exam. After completing the two hour OSCE, I drove immediately home. Found Lynne passed out looking feverish, her arms splayed, not being able to open her eyes.

Having done an entire OSCE this morning, I grabbed my stethoscope, and a light. I sat her down asked a few questions. So my history:

“20 year old female presents with sore throat. Onset of soreness began approximately yesterday. She describes no cough, no rhinorrhea or other coryza symptoms. No ear pain. A slight headache. She has fever and chills, as well as generalized weakness.”

Listened to her chest, palpated her cervical lymph nodes, which a few were tender. Look inside her throat, and bingo.

“Strep throat, you have strep throat.”

Also known as bacterial pharyngitis, or streptococcal pharyngitis. Here’s what I saw at the back of her throat:

A normal vs. strep throat. Notice the white exudates at the back, a key feature of strep.

I immediately took her to the doctor, who gave her some antibiotics, a 10 day course of Penicillin V. I suspected the symptoms were too severe for “just the flu”. Of course I had seen dozens of strep throat during my family medicine rotation.

I took her to Tim Hortons where she had some soup and hot chocolate (no milk). Now some R & R.

Well, I realized since the start of this morning that I had no idea where my handbag was. I knew it had to be somewhere in my house. I searched every conceivable place, even calling up SM to see if it was there with him.

As I became frantic, I realized my bag has my pager. So I called the hospital’s paging system, and explained that I lost my pager and required just a few “pings”.

I heard it, and to my relief I heard it somewhere in the house (that pager is LOUD). I ran upstairs to my mom’s room, called the hospital again to ping my pager and they did. I discovered it hidden behind a towel hanging behind the door. How embarassing T_T My mom started lecturing me and my dad came in laughing, since he witnessed my relentless search and then my victorious find almost an hour later.

My aunt then said to me, “Some things never change…” in reference to all the things I used to lose when I was little (my sweater, my lunch bag, my gloves, my socks, my toys, the list goes on). I guess I’m just more clever at finding it (versus the lost and found at daycare for the things I lost when I was little) – really is just a matter of time.

I’m on week 5 of 6 of my internal medicine rotation. We usually take on a max of 2 or 3 “active patients”, and however many patients who don’t have as many critical issues. Being as enthusiastic a learner as I wanted to be, I never said “no” to my attending. I took on as much as I could, worked as hard as I could, because I knew that I had to take advantage of every learning opportunity I could. As much as I impressed my attending, it seemed to come at a price. I showed up Thursday morning, sharp stabbing pains down my throat, dizziness, fatigue despite a full night’s sleep – and I just did not feel right. I spent 3 hours trying really hard to work through the day, but I had been assigned 11 patients, 8 were active and 3 were not – and I had only 4 hours to get through them all as opposed to 8 due to a half academic day. I kept telling myself “5 hours left, 5 hours left”. But when the NP I worked with came and asked how I was doing, my first response, “I don’t feel so hot“. My attending checked my throat, and temperature (so my supervisor apparently was a GP before becoming an internist) and told me to go home.

To be honest, a sore throat would be something I would have stayed at work at anyway. I was going the entire week 2-3 times harder than my usual norm, maybe it was burn out too. I felt so emotionally depleted, and I felt guilty about going home. As SM told me, “If you’re sick and continue working, this will impact your health, and the health of your patients!”. I was finally convinced.

I had hot teas, soups, plenty of rest. Unfortunately I had to cancel on a friend’s birthday on Saturday. I spent Friday completely away from work and with SM. Today, I slept, a LOT, I read leisurely, and I also spent some quality time with SM. The throat is still sore, but I am feeling much better emotionally, and feel as if I have the strength to take on as many responsibilities as I need to. I’m lucky to have someone as nice as SM to look out for me.

I’m week 4 into my internal medicine rotation, and was speaking with one of my patients. He’d told me a lot about his life, and his experiences. A retired corporate lawyer, now working on his deteriorating health. Since he was just waiting in hospital for placement in the community, he doesn’t have any acute issues, so he was one of the last patients I saw for the day. I usually sit with him for an hour or so because we have pretty unique conversations.

We were discussing some of his experiences in law school, and practise. He told me some of the reasons why he was averse to family-practice and divorce-law, and he replied “I never want to be in the middle of two people that hate each other immensely.” So I told him how I couldn’t believe that two people that vowed for undying love would turn to hatred. I asked him whether it had to do with communication or trust. “No, its about forgiveness. People hold on to the smallest things of lttle significance, and its like a spur under a saddle. It builds resentment over time. If you can’t let go of the little things, the resentment builds and turns to hate, and when something big happens – everything falls apart. It happens because people can’t forgive. Some are just incapable of it, and hold on to things simply because they don’t know how to let go.“

Forgiveness is a lot harder for me than trust. It means not bringing up someone’s past and using it against them. It means taking a step back and appreciating why someone may have betrayed your trust. To me, that is hard to fathom. But I realize that forgiving someone is acknowledging the fact that friends and loved ones are human, and make mistakes.  I think more importantly, without being able to forgive, we shut out people in our lives that could have made a world of difference, and we limit our ability to grow and expand.

However, if someone truly hurt us, in the most deepest, intimate and unimaginable of ways – is forgiveness appropriate in that situation? Because even if forgiveness takes place, betrayal changes a relationship (of any kind whether with family, friends, a partner – it changes trust. So how does true forgiveness occur in that circumstance?

78 year old male with history of hypertension, diabetes, renal transplant after 15 years of dialysis, severe peripheral vascular disease and gangrene of the toes, past coronary artery disease presented with 3 second periods of light-headedness which started this morning at 8:30 AM when he sat down to read the paper. This occurred six times. The paramedics found atrial fibrillation on ECG at 10:30 AM while on route to hospital. Pt has had no other symptoms other than the lightheadedness. Patient denies chest pain, shortness of breath, altered level of consciousness or mental state. Physical findings were unremarkable, however cardio exam revealed a 4th heart sound. All investigations came back normal (bloodwork, Troponin T, CK, glucose, etc.).

He told me, “this would be a good case for you, I have lots of clinical pearls to teach.”. I saw the patient on my own, wrote up my consultation note, and reviewed the case once I was ready. He listened to me as I listed what I gathered from the history and physical, investigations, as well as my assessment of the situation and plan.

“Talk me through the common causes of Atrial Fibrillation”

“What do we worry about for management of New-Onset Atrial Fibrillation?”

“What drugs would we use?”

After each point, he gave me feedback.  He wasn’t condescending towards me as I expressed that I didn’t know the answer to some of his questions. He even sat down and walked me through how to read this gentleman’s ECG. Afterwards, he thanked me and acknowledged my contributions for this patient’s care at the hospital under the Internal Medicine unit.

I walked away, feeling like I had learned so much. I appreciated his patience, his time, and acknowledged the fact that medicine is not something I can learn entirely on my own.

What an end to a great day.