such is.

Sometimes when you take a step back from you life and think about it, you laugh. Or at least sometimes I do that, and I laugh.

Last Saturday morning after my call shift I sleepily got in the insanely slow elevator to meet my teams for rounds. In an effort to expediate the ride I pressed the 'close door' button, or so I thought, until a voice (I am fairly certain actually existed) asked, "Is there someone stuck in the elevator?" They place that emergency call button dangerously close to the one that closes the door.

On Monday afternoon I was suffering some whole body muscle soreness - legs, arms, back. One would have thought I had worked out intensely the day before in an effort to improve my cardiovascular fitness, overall health, or sculpt my body into a muscle machine. Nope. Just made a few snowmen on my day off.

Another day last week when I got around to eating lunch it was about 7pm, about 7 hours after the 6 hours I had anticipated my lunch being out of refrigeration. I thought about not eating it, but then I thought two other thoughts. 1) I was too hungry not to, and 2) maybe if I started vomiting from food poisoning I would get to go home early. Definitely worth it.

fourth first day

I have made it through my first day and my first call of general surgery at St.Paul's Hospital. That always makes me feel like I've accomplished something. Technically, I am half way through my surgery rotation, the first two weeks I was doing radiation oncology (which isn't really surgery at all) and then I did pediatric surgery at Children's Hospital. Now I will be at St. Paul's until Christmas.

Some observations:

It is very festive downtown these days. In other circumstances, I might find such holiday propaganda obnoxious, but it just makes it so much cheerier at 6:30 in the morning. St. Paul's has this huge, crazy light display as a part of their fund-raising campaign, and every morning, I walk through a tunnel of lighted stars to enter the hospital. It is quite magical really, and then I get to the other side, and instead of Narnia or a Secret Garden, there is a hospital full of colons that have cancer, or are blocked, or bleeding, or dying, or non-existent.

I quite like surgery, but am pretty clear that I don't want to be a surgeon.

I got new work shoes last week. Clark's unstructured - I don't know what the other 9/10 medical students say, but this one highly recommends them. I only wished I had known sooner about these wonder shoes. Wow.

Surgery as a medical student requires physical and mental stamina, in roughly equal parts. Pediatric surgery (which is my only other comparison) is small, and clean, and the retractors are just tiny little things. Open abdominal surgery in an adult on the other hand, is big, and messy, and the retractors are huge, and require a considerable amount of force. And, it is our job to hold them, strongly, and blindly, for sometimes hours. In between trying to mentally direct more oxygen to my burning muscles, pumping my calves to prevent blood pooling, and trying to decide whether it was my breath or the inside of my mask that smelled so funny, I took small trips to my happy place (which is where I think of crochet projects I would work on if I had time, or my bed - mostly those two things). The surgeon thanked me for my hard work and acknowledged that I couldn't see anything, and I really appreciated that. It's nice to get thanked.

another cinderella.

You know when you have been waking up at 5:00am each morning in order to take a very precisely coordinated schedule of two skytrains and then a bus, which in total takes about an hour, delivering you at the hospital at which you are working at 6:37am, and then one morning you wake up and look at the clock and it is 6:34am. Then, once you confirm that this is indeed the correct time you run around the house like a crazy person, and then just before you are supposed to be meeting at 7:00, you call the resident, and wake him up from his comfortable sleep at home, because you are uninformed of the fact that he just happens to be taking the day off for his daughter’s birthday. So then you try and page the other resident, which you don’t know how to do from outside the hospital building, so you have to call the switchboard and get them to help you, and then eventually you show up at work an hour late. I hate it when that happens.

But then sometimes, the next day, the very same resident that you woke up the day before tells you at 9pm that you should just go home for the rest of your call shift and he will call you in for anything interesting. And then the bus driver lets you on the bus even though you can’t pay him (rather than making you go to the Safeway and get the right change and then wait in the cold for the next bus).

And life is good. And it almost doesn’t matter anymore that your new professional pants are kind of itchy.

weed wacked

So my nostrils, and the rest of my head did indeed emerge from the waters of internal medicine if not triumphantly, at least intact. Then they filled up with snot. The point of sharing this information is not to whine, just to make an excuse for not posting before today.

I have wonderful family and friends. That's mostly the point of this post. So much of my energy this year has gone to working and studying and thinking about those two activities; and not much as gone towards relationships with the people who are really important to me. I have been a really bad friend in many instances - taking weeks to return phone calls at times. I have been an absent grandaughter, a lazy girlfriend, and a boring sister - and yet everyone has been patient with me. Friends just keep calling back, grandparents remain grateful for any contact, sisters persist, Kyle understands, and parents fly across the continent to freeze 19 single servings of homemade soup.

Thanks guys.

escalation

Contentment has been replaced by fear. Constant and unrelenting anxiety with a splash of tired. Heck, if my whole head was above water I would have a party - for now I am excited if both nostrils are out there. But, if I survive to the end of next week of work, and my internal medicine exams, I get two whole weeks of no call. Oh yeah. Happy dance time.

juice berry free days

Every day for the first weeks - month of my internal medicine rotation I packed myself a little container of fruit juice gummy berries from our Costco stash in my lunch. Often, those sweet little berries got me through the day. I would think about them sitting there in my locker, and wait for the moment I got to taste them, or sometimes I would forget that I had them, and then, oh the joy when I remembered that I did! No matter how it went, they were a pick-me-up, and I needed to pick myself up quite a bit.

On Friday afternoon, I was walking through the hospital basement, I realized that I had gone at least a week without the berries! And, I didn't even miss them! More importantly I realized that I had enjoyed my week at the hospital. Yup. I enjoyed working on the cases we had, and the teaching sessions that we were having (even the daily 7am ones we just decided to add), and really getting involved in patient-care. But what changed?

I think I am finally able to concentrate a little less on my own actual survival, and a little more on everything else. I am moving up Maslow's hierarchy of needs it seems. I feel confident that I am able to breathe, eat, maintain homeostasis with less conscious effort. I also feel a little safer, and a little more belonging, and might even be able to muster the beginnings of esteem. This last week I was able to get more involved in patient management and care, which turns out to be a bit more fulfilling than just surviving. Although still might not be contributing to many conversations, at least I am understanding a few more of them - one step at a time I guess.

like a tiger

I hadn't seen Nannie and Grandad for at least a few weeks, despite the fact that they actually live on my route home from the hospital, so, today, on the way home from a very quiet day at the hospital I stopped to visit. It was the third time that I had visited the lodge by bike, and each time I wonder about how appropriate my bike shorts are for the resident population. It's not like I am going to stop wearing them, but for a group of lads and lasses who went to elementary school in a time when it was unusual for girls to wear pants, I understand how the little spandex might raise a few eyebrows. The three of us visited until it was time for dinner, and as I dropped Nannie off at her table on my way out, the fact that I was riding a bike home seemed to be quite interesting and impressive to the ladies. After much encouragement and many well wishes for a safe ride I turned to leave, just as the little lady in the corner remarked, "nice tooshie." Apparently the bike shorts raised at least one set of eyebrows.

the midst of it

written 09.24.07

"She asked me what it had been like, and although I tried to tell her, I realized that it had not been like anything, and I could not."
- Roy in The House of God by Samuel Shem

So I haven't posted in a while, but I've thought about it a lot. I've thought about what to call my next post, or what the topic should be or whether I should write about my day, or my time so far as a medical student intern, or what I am feeling, or what I have learned, or whatever. Each time one or more of the following things happened, preventing me from putting fingers to keyboard:

1. I got too sleepy
2. I got too apathetic
3. I couldn't articulate the thoughts in my head
4. The idea that I had in the morning somehow became irrelevant during the course of the day.

Right now I am on call, and after reading everyone else's blog (it makes me feel less lonely), I decided it was time to buckle down and add to my own.

I don't think that I can sum up the last three weeks - less because so much has happened, and more because I don't know how to. I started my 3rd year of medicine (a.k.a. clinical clerkship, a.k.a. medical student internship) in internal medicine at Royal Columbian Hospital in New West - handy as I am living in Burnaby right now. My first day seems like a million years ago, and it felt horrible, even though nothing bad happened. I was on call, and 28 hours seemed like an eternity to survive. My pager didn't actually go off all night, but I woke up every 45 minutes because I was so anxious about missing it/what I would do if I heard it. Three weeks, six call shifts, 3 days off, a bunch of ups and downs and a million thoughts since then - I don't hate it, but I don't love it.

I spend lots of time thinking about whether my negative feelings are actually because I don't like medicine, because I don't like internal medicine, or I don't like things that are really hard, and promise to be that way for a long time. I am leaning mostly towards that last option today. It appears that after 20 years of being a student, in a classroom, taking the classroom out of the equation can be rather daunting. Figures.

My weekend was fantastic! I had two days off in a row for the first time since we started, and I filled my time doing enjoyable, comfortable things. Visiting friends, snuggling, studying, eating, and Bard on the Beach!

the ants go marching two by two

Preparing to start third year while not knowing much about it other than the fact that it is really busy, kind of feels like you are preparing for the end of your life. Over-dramatic? Perhaps. But seriously, it kind of feels that way...except not as sad. While I realize that I am preparing for a temporary (I hope) life-end - a life-pause - over the last few days I have found myself wondering if I would prepare for a permanent life-end any differently. I don't suppose that I would. I imagine that I would spend my time close to home, with people that I love, doing peaceful activities that I enjoy. No seven world wonders tour for this girl.

My long-weekend was fantastic. Friday night we had friends Aaron and Jieppe and their new little baby Peter over for dinner. I got to rock 18-day old Peter to sleep, which tickled me pink! Saturday Kyle and I packed up drove to Joffre Lakes Provincial Park where we hiked to the base of the glacier and camped overnight. Our timing was perfect, as it stayed dry for us the whole time we were at camp, and then started raining about half an hour into our two hour hike back to the car. Today I got to have lunch with Britt (my sister) and Leisha, ironed all of my professional clothing (which didn't take long because I don't have very much) and cleared off my desk for the start of another year. We even got the fire-place in the family room going for a while this afternoon. All good things. So, although I am really nervous, at least I am feeling content about hitting pause tomorrow morning.

bring it

(written August 27, 2007)

"Becoming a child again is what is impossible. That's what you have legitimate reason to be upset over. Childhood is the most valuable thing that's taken away from you in life, if you think about it."
- character "Baby" in Lullabies for Little Criminals by Heather O'Neill

So, it started. I have finished my first day of third year medicine…well not really, I finished the first 12 hours of orientation week. The day consisted of about ten different people telling us how, “we have reached an exciting stage of our medical training as we transition from classroom to clinical learning,” and “to be humble and hard-working” and “ to make sure we take care of ourselves, and sleep and talk to our loved ones etc.” I found myself being quite cynical about the whole thing, which in turn made me frustrated with myself for failing to be more easy-going. And then I started thinking about whether or not being “easy-going” was actually a good thing, or whether it was naïve or unrealistic or something less mature than cynical. Hmmmmm. In the end I vowed not to let myself enjoy cynicism too much more than whimsicality, but to enjoy both in moderation. Eventually I resigned myself to trying to pay more attention to lecture. I think I am just grumpy that my sweet, sweet vacation is over.

On my bus ride home I resolved to make a conscious plan about how I am going to approach this, “exciting, but harrowing year.” I toyed with making this the last post in which I whine – but I just don’t think that I am ready to make that kind of commitment before I have had a couple of call shifts. I am still working on my year-plan, but in the meantime, I will be more laid back about orientation week – I think I will have enough to think about in the coming months, I don’t need to worry my little head about hanging out in lecture one last time. Bring it on orientators.

the year that shall not be named

Since the last time I posted, I have returned home from a trip, puttered around between Burnaby and Vancouver for a few days, and am now getting ready to pack up and leave town for about a week (again). This is the sixth time that this pattern has repeated itself for me this summer, and, whether it is good or bad, it will be the last, as this time I will be back with just enough days to get ready for school starting on August 27th.

The end of my New York/Boston trip was great. The Friday in Boston, we toured in the scorching heat (our respective tour guides/friends might have/probably hated us for that, but were gracious enough not to tell us so). And, the next day, Leisha and Mike took us to the beach - it was fantastic. The night we returned to New York, my mom made me an early birthday dinner! The last few days and nights were filled with more touristing (Empire State Building, Guggenheim, Grennich Village etc.). I arrived back in Vancouver on time, with all the luggage. Whew. It really was a wonderful trip, but I have to say, I was happy to return to Vancouver's fresh air, cool breeze and space.

This afternoon, friends from school are getting married - yes both of them are in our class, but they have been together for much longer than they have been medical students. I am crossing my fingers for a lengthy sunny break in these suspiciously autumn-like cloudy periods we have been having.

Tomorrow Kyle and I will be heading eastward to the Kootneys again, for some last rest and relaxation before you-know-what.

more new york

Monday:

• stroll in Central Park – our tour guide on Tuesday told us that there is 529 billion dollars of real estate potential in this land
• American Museum of Natural History – really cool dinosaurs. We were kind of rushed and I ended up missing the Squid and the Whale diorama that was one of my only NY sightseeing goals. Oh geez.
• pizza on the rooftop of Mom and Alex’s Chelsea apartment
• Transformers movie in HUGE Time Square Cinema

Tuesday

• Metropolitan Museum of Art – we liked the Arms and Armor exhibit
• 2 hour Circle Line sightseeing cruise of East River/Statue of Liberty
• RENT! on Broadway – so fun.

Wednesday

• shopping – I really don’t like it…neither does Kyle, so why exactly we decided to go without Alex (fashion consultant and lover of shopping) we are still trying to figure out. We ended up riding the escalators up to the top of the block long, nine storey Macy’s store and then back down for sightseeing purposes. I eventually bought some pajamas so that we felt that we were accomplishing something. Finally, Mom and Alex came to our rescue and I ended up with some new, very needed professional pants, and Kyle got some equally needed shoes.
• Rockerfeller Centre: celebrity sighting – Michael Buble
• Radio City Music Hall (the outside)
• famous Brooklyn pizza joint for dinner, and a walk back home across the Brooklyn Bridge – both were very cool.

Thursday

• took the train to Boston to visit Leisha!
• Leisha made dinner for her boyfriend and us, which we enjoyed in his air-conditioned apartment
  

sister city

I really have to start posting more frequently.

I got back from camp last Friday. It was awesome and crazy, and exhausting, and exhilarating and emotional. Trying to articulate everything that the week was and meant is going to take more reflection than my current pace of life here in New York will allow. I hope to have the time and the brainpower to revisit my experience when I am back in Vancouver next week. This much I do know: it was good for my soul, and once more, Camp Winfield provided more for me than I could ever return.

Kyle arrived back in Vancouver about 7 hours after I did on Friday night, and proceeded to experience the effects of a certain gastrointestinal virus in full force throughout the night. This resulted in a very tired, and fairly dysfunctional day for both of us on Saturday, but we did manage to get ourselves ready for the big apple for which we were to depart the next morning.

We were both flying on points, and Kyle was added onto the trip later, so we were flying separately. I was to arrive at JFK a couple hours before him, so we planned that I would take all of our luggage in an effort to expedite our airport exit. I ended up arriving at JFK after Kyle with none of our luggage. The only thing that made me feel a little better about the situation was that in fact no one on my entire flight had their luggage. Due in small part to weather and in large part to a miscommunication between pilots and fuel guys that resulted in 1200kg of extra fuel being loaded onto the plane, and all the luggage was left in Calgary. Another example of why travel plans should really be considered travel notions.

It was great to see Mom and Alex again, and to see their Manhattan pad. We have had a great time so far visiting this busy and interesting city. Will post the sights we have seen tomorrow.

bet your bottom dollar

Well, just after I finished whining about the persistent gloom of the sky in Port McNeill, it got sunny. And, I got to go for a helicopter ride in the clear skies to boot.

I have been away from blogging longer than I wanted to, in part due another internet activity that rhymes with, "blogging," but is not nearly as much fun. Logging my patient experiences and finishing off the paper work that I needed to do to officially finish my second year of medicine and start my third has taken up a fair amount of my screen time lately. There is not much screen time in my future either, as I am heading to Camp Winfield for nine days in about five and a half hours.

In brief: My last week in Port McNeill was fairly uneventful, and I returned to the big city on Saturday afternoon. I have spent the last few days doing various life maintenance activities, and visiting before I take off for camp, as I am only going to be back in Vancouver for one day in between camp and New York/Boston where I will be visiting my mom and Alex in New York, and Leisha in Boston. It seems when I was planning my summer the fear of not ever being able to take a vacation again surpassed my fear of wearing myself out before the start of my clinical clerkship. I will be able to re-assess which I should have been more afraid of at the end of August.

Below is a picture of me with Ahmad and Nicole, on our hike of the (very) Beautiful Bay Trail, on Malcolm Island.

the weather fovercast

Today was a 5/10 on the grey-scale. 10/10 being, "as grey as you could imagine" and 1/10 being "just barely grey." I know I shouldn't make a general statement about the place after living here for only three weeks, so I'm not, I am simply saying that in the 21 days I have been here, we have had the following weather breakdown: 9 days of overcast, 4 days of overcast with rain, 3 days of overcast with wind and rain, 2 days of overcast with wind, 1.5 days of overcast with sunny periods, and 1.5 days of sun (with periods of overcast).

Anyway, that isn't really why I am posting tonight. I wanted to write the first of possibly many, "Nuggets that I have Learned/Confirmed for Myself in the Recent Past."

1. I really don't like television. I still watch it sometimes, but I am never in a better mood after watching t.v., than I was before I started. Usually I end up feeling cranky because it has been too loud, or stupid, or full of commercials, or some combination. If I ask myself, "what will I be missing if I stop watching this right now" I can stop watching 99.9% of the time. Even if it is Trading Spaces.

2. It is really great to be outdoors. I usually feel better when I am/have been outside. Especially if my jaunt has included some sort of exercise. I am lucky that lately my outdoors has always included minimal pollution, and a magnificent view of the pacific ocean, the b.c. coastal mountains, and beautiful west coast forests. It makes me happy (even when it is overcast).

two green shirts

It turns you inward. It makes you introspective. And there's something very cozy and romantic about it, I find. People all around me in the middle of winter are threatening suicide because the rain falls day after day after day and I just get happier and happier.

-Tom Robbins commenting on rain

I am pretty sure it doesn't make me happier and happier, and living on the West Coast, sometimes I get pretty tired of it, but I have to agree that rain can be cozy and romantic, and it certainly does make me introspective. On a day like today, when I don't have any real plans it is kind of nice to sit inside and watch the storm. I even talked myself into going out for a refreshing run in it.

Only four days of medicine for me this past week - nothing too exciting. I am not too excited with medicine in general these days, which is slightly concerning considering what I have invested in it, and the intensity of my training yet to come. I'm not going to go running away from med school or anything (right now anyway), but I do have some serious thinking about what is important to me on my thinking-agenda.

Kyle was here for Friday and Saturday, which was nice. He was able to come with me to the big pig roast hosted by one of the doctors in town Saturday night - excited carnivores were all about. Lucky for me there was also delicious salmon. I spent Canada Day on a whale watching boat with some of the other students here. Saw a couple of humpback whales, some pacific white-sided dolphins, tons of eagles, and some sea lions. Alas, we did not manage to spot the elusive orca.

planet earth

The origins of the word, "potlatch" come from the Chinook trade jargon formerly used along the coast. It means, "to give".

After finishing exams, going to Sasquatch music festival, moving, and visiting Castlegar/Christina Lake, I have been in Port McNeill for exactly one week now, and it is beginning to feel more familiar. I will be here for 3 more weeks doing my rural family practice rotation. I am also a part of the Interprofessional Rural Program of BC, and accordingly, am living with a physiotherapy student (Nicole) and a nursing student (Corby). The idea is that we learn about the different training programs and professions so that we can work more effectively together when treating patients...and it is working - we are learning lots from each other.

I was pretty busy working with the local doctors at the little local hospital and medical clinic during the week, but managed to get out and explore the magnificent North Vancouver Island scenery this weekend. Yesterday Nicole and I headed onto the ferry with our bikes to explore the Finnish settlement of Sointula, but ended up arriving in Alert Bay instead (next time we will cross-reference our ferry schedule with the one that the ferry actually runs on). Since we were there, we toured around the little town of Alert Bay for a while, and visited the U'mista Cultural Centre, and the world's tallest totem pole made from a single tree.

Today we went ocean kayaking outside of Port Hardy. It was raining when we started, but then the sun came out for the first time since I arrived and made the morning tour even more enjoyable. Aside from spectacular scenery we spotted several seals and even more bald eagles. No orcas, but they had been sighted in the same place yesterday - apparently whale season is just starting. We enjoyed fish and chips in Port Hardy before sighting a couple of black bears on the way home. I will post a picture or two when I can get my camera cooperating.

This week I will be heading down to Campbell River for a couple days to shadow/work at the methadone clinic there, and Kyle is coming on Thursday for a couple of days on his way to Fraser Lake, so there is lots to look forward to!