The Secrets of Barista Nick

What better way to relax after a brutally long first week, than sleeping in Sunday morning and making yourself a Iced Grande Creme Brulee Latte to wake up to.

Ingredients

• 2 scoops of freshly ground dark roast espresso beans
• 1 ounce of Torani Creme Brulee flavour syrup
• 2 ounces of filtered water
  
• 2 cups of cold skim milk
• handfull of crushed ice
• (espresso machine)
• (martini shaker)
• (sexy looking mug)

Directions (followed by my expert advice)

1. Press ground espresso into handle of espresso machine (The key is to compact the espresso both hard and evenly)
2. Fill the espresso machine with 2 ounces of water and pull two shots of espresso (Use the best quality filtered water you have available)
3. Immediately after the shots are pulled, mix espresso with 1 ounce of flavour syrup (Mixing the syrup at this step ensures even flavour distribution)
4. Add 2 cups of cold skim milk to a martini shaker filled with crushed ice (Shaking in ice versus pouring over ice cubes has a number of advantages, quicker and more thorough cooling, and less dilution from the melting ice)
   
5. Add the 2 shots of flavoured espresso to the martini shaker (If you add the espresso before the milk, you would melt too much of the ice!)
   
6. Cap and shake vigorously (Until your hand is cold)
   
7. Decant your tasty beverage into a sexy mug (If shaking was vigorous enough, there will be a nice layer of foam on top, rarely seen in store bought iced lattes! As for the sexy mug, appearance/presentation is key. It just tastes better.)
   

First Week on the Wards

Look at me. Do I not look tired? That's because I had just finished my very first shift at the Royal Alex Hospital in Internal Medicine. Just as my luck would have it, I was the poor sucker who was on-call on my very first day! This means that we started the day at around 7:00am, and then I didn't get home until 4:30pm. THE NEXT DAY!!

You heard me right. I was conscious for at least 35 hours during my first day in the hospital. And while I'm complaining about working too much on my first day, I should mention that I was also on call on the Friday of the first week, bringing me to a grand total of 78.5 hours of hospital time during just my first week. Is that not double a full time job? Needless to say the time during which I wasn't in hospital I was either:

a) asleep

or

b) studying

OK now that I've got the whining and complaining out of the way, here is how it went. Actually my first week was much better than I had expected. It was definately frustrating not knowing ANYTHING, but I'm beginning to get a feel for how the hospital works. At first I didn't know who to call for what, which forms to fill out and when, where to find those forms, where to put those forms, etc etc. So my knowledge of medicine (or lack thereof!) has not really come into play yet. At this point its still just learning how to do the paperwork and how to deal with the simple things.

Here I will run through my schedule for tomorrow to give you a sense of what a day is like for me:

0745 to 0830: Morning Sign-In Rounds
- arrive with coffee in hand to get a short lecture on some random clinical subject

0830 to 0835: Prepare for Rounds
- head up to the on-call suites to print out my patient list for the day, meet my junior resident, and page my staff doctor so we can meet up

0840 to 1030: Round with Staff Doc
- go and visit every patient along side my junior and staff doc, check out what happened to them during the night, see how they are progressing, order new labs/tests and change managment if required

1030 to 1200: On My Own
- after the staff doc takes off, I am on my own usually doing paper work for our patients, arranging for Consults with other physicians on my patients, following lab values the come in throughout the day, grabbing lunch if possible

1200 to 1300: Rheumatology Teaching
- find my way down to a lecture hall in the basement to receive an hour of teaching on some random rheumatology topic with all my fellow students (rheumatoid arthritis, lupus, osteoarthritis, etc.)

1300 to 1400: Clinical Skills Teaching
- meet up with one of the senior residents along with all of my classmates, to go visit a patient and go over some clinical skills teaching (pulmonary exam, liver exam, cardiac exam, etc.)

1400 to 1800: On My Own
- again follow-up on random things ongoing with my patients, see what my junior resident is up to, if nothing to do: study, do assignments for the week

1800 to 2359: On ER Call
- consult patients in the ER who are requesting admission to General Internal Medicine, do full history/physical on the patient, write up full admission orders and admit the patient under the care of my staff doc (to become a patient I will follow throughout the next couple of weeks)

0000 to 0700: Still on ER Call
- sleep when I can, study when I can't sleep, and just hope my pager doesn't go off for another consult, in which case I would be wandering back down to the ER to admit another patient (we will probably admit 5-10 new patients throughout the night)

0745 to 0830: Morning Sign-In Rounds
- receive another short lecture on a clinical topic, except this time my eyes will barely be open, and the thought of coffee will make me sick

0835 to 1000: Round with Staff Doc (again)
- once again go through and visit all of my patients with my junior and staff doc, update their current progress, order new tests/labs, arrange for followup/placement, check new lab results as they come in, ask the nurse what happened throughout the night, etc.

1000: Go Home (hopefully)
- at this point I will not be punished for going home (after 26 hours of work) but if there are any issues ongoing with my patients, or if there are any other lectures throughout the day, I will be pressured into staying longer




So that's what my schedule is like for tomorrow! Craziness. I suppose I am coping well considering the magnitude of this change to my life. This next week will definately run smoother than the last, and hopefully that trend will continue. On top of that, this is supposed to be the greatest amount of work in any of my courses this year, so if it is all down hill from here, that's perfect for me. Should make for a relaxing year.

Year Three Begins

Year three of medicine has began. My first year in the hospitals. Just as lectures were becoming comfortable... (maybe too comfortable: sharing junk food, watching video clips on palm pilots, playing Text Twist on my palm with everybody that sat close enough to see the screen, running for coffee after the first lecture of everyday, spilling that coffee on myself almost everyday in a rush to get back to class on time, playing countless hours of Sudoku and Solitare, passing notes, beaming notes through Bluetooth/Wifi, running commentaries making fun of profs accents/mannerisms, fixing peoples Palm Pilots, sleeping, taking pictures of people sleeping, drawing on people sleeping, gossiping, throwing things at people, studying for upcoming exams, copying notes from previous lectures, finishing homework, applying for scholarships, playing Bike or Die on Zak's Palm during every single pathology lecture...

Proof that I lack human emotions

This pic was from one of the rollercoasters at the Calgary Stampede this year. A "kiddie rollercoaster" to be exact. One of the rollercoasters where you are the tallest person in line by like 3 feet.

Compare the emotions in my face (calm, cool, collected, double-guns to the camera), to that of Nicole's sitting directly to my left (pure terror). This death defying drop, the grand finale of the ride, was a grand total of 9 vertical feet. This was the one ride I could convince ALL of the girls to go on.

Fitness Craze

Lately I've found myself in a bit of a fitness craze. This is unusual for me. During school I hardly have any free time at all, and when I do I usually tell myself I should be using that free time to study. On top of that, my usual fitness routine for the summer is to go for a run every once and a while. I can usually keep that up for a week or two, but running is boring and overall completely unenjoyable for me. I have found a much more enjoyable way to burn many more calories. My new routine involves the following activities:

• Working out (8 times in the past 2 weeks)
  
• Playing Squash (5 times in the past 2 weeks)
  
• Swimming (7 times in the past 3 weeks)
  

How am I able to keep this up? I just bought myself a membership to the doctor's gym in the hospital. Not only does it have the allure of being a high-society exclusive fitness club, but it's less than 5 minutes from my place if I left now. On top of the excellent location, it is open 24 hours a day. I've been there for workouts and squash games past midnight a couple of times already, which is perfect for when I can't sleep. At this rate I should be able to undo a years worth of laziness in no time!

Calgary Stampede

These blog posts aren't in chronological order anymore... oh well. A couple of weekends ago I was invited down to the Calgary Stampede with my friend Nicole. It was an absolutely blast! I won't say much, because its more fun just to look at some of the pictures and read the captions.


Click here for pictures!!
More to come...


But I will fill in some of the gaps of the story, not told by the pictures. I had the sense that the Stampede was a big fair grounds with all sorts of random

eat carnival food, go touch baby farm animals, people watch...

cowboy-like sporting events. This was not exactly the case. You have to buy tickets for the rodeo shows, and these tickets sell out weeks in advance. So I was unable to watch any of the torturing of various pigs and cattle. So in reality, the Calgary Stampede is not much more than a giant carnival. The thing that sets it apart from the giant carnivals in every other city, is how much the city of Calgary gets into it! It's bizarre. The whole town goes crazy for 2 weeks. Everybody wears a cowboy hat and dresses like a cowboy or a stripper-with-a-cowboy-hat. People even dress like this to work. Even at banks! It was funny, I went into an RBC to get some money, and all the staff were dressed like bank robbers. With handkerchiefs over their mouths and everything! But I digress...

So once you are actually on the fair grounds, you can do the following things: ride carnival rides, play carnival games (no thanks...), eat carnival food, go touch baby farm animals, people watch, or go to some of the free shows. I partook in all of the above, except for the dirty carny games. You know the ones where you always lose.

I hadn't had carnival food in sooooo long. It was fantastic. Beef in a bun, corn dogs, cotton candy, ice cold root beer. Once a year, everybody should eat some carny food.

I didn't go on a lot of the roller coasters, 3 perhaps. But we did go one one which took your picture as you drop down the tallest drop. And the picture is FANTASTIC. I can't wait until I scan it into the computer and post it. You'll see...

The free shows at the Stampede are impressive. For example I went to a Nelly Furtado concert for free. She only played for about an hour, but still. She played tunes from 3 or 4 of her albums. We got pretty close to the stage, but I couldn't really see much other than a see of cowboy hats in front of me. I took some shoddy video clips on my cell phone, but Nelly is only 3 white pixels :)

Well that gives you a sense of the Calgary Stampede. I'll post again when I have more pics up!

A Taste of Edmonton

Last night Carla and I (and two of Carla's friends from work) went downtown to get some yummy food at the "A Taste of Edmonton" festival. This is sort the equivalent of the "Folk Fest" held in Victoria each summer. Instead of having stands with various international foods however, they have stands from 40 different restaurants in Edmonton. Each one offers a "savory" dish and a "sweet" dish. Admission is free (unlike the Folk Fest in the past couple of years), and all you have to do is buy some tickets which you trade in for food!

The festival grounds were packed, pretty much shoulder to shoulder in

Ginger beef, Cappucino Chocolate Shooter, Green Onion Cakes...

the main strip. A number of stages were set up with musicians playing various cover tunes (I think one guy was a Johnny Cash impersonator). Carla and I made a bee-line for the stand selling Ginger Beef -- our favourite Americanized asian dish ever. We quickly followed that up with a Cappucino Chocolate Shooter (some sort of giant truffle). Wandering around we cooled off, dipping our feet in the fountain and sat around listening to the second-rate folk music acts (what can I say? I'm a music snob...).

At the Folk Fest in Vic, the most popular item is the Hungarian Langos. Here, however, the longest line is for the Green Onion Cakes from some random chinese place. So we had to line up for those. They were amazing -- much better than you would think. Served with sour cream and super hot sauce.... mmmmmmmm...

Our last dish was a Tropical Gelati from some Italian restaurant. It was cold, but nothing special as far as Gelati goes. We'll be heading back for more food later in the week, because we still have a bunch of tickets left!!

Firing Up This Blog Again

It has been a while since I last posted anything! Wow. I suppose school was getting pretty monotonous towards the end of the year, and I really didn't have anything interesting to blog about. My days were pretty much like:

1. Wake up go to school
2. Sit in class forever
3. Go home and study and surf the net

But now its the summer and I've been up to all sorts of wild and crazy things. So not only should I have much more to blog about, I'll soon be starting my medical internship (actually I'll start a 3 week rotation at the ER in August!). So no doubt there will be lots of crazy things I can write on (omitting patient names of course)!

How to Make a Beat

Syncope Jazz Band

For the past semester I have been the leader of the Medical student Jazz Band. We adopted the namesake of a previous med school jazz bands from a couple of years back: the Syncope Jazz Band, which is sort of a bad pun on the words "syncope" (medical term for fainting) vs "syncopation" (a style of accenting musical notes off of the beats).

This is my band. And these guys make me proud. We just played our second gig of the year, at the Med Formal dinner/dance this past weekend -- and it was a hit! We played three tunes during the dinner portion (Stolen Moments, Summertime, and Chameleon), and played our "A-material" for the performance portion of the night (Mercy Mercy Mercy, and A Night in Tunisia). Those are links to clips from the original recordings to give you an idea (it takes a while, but the music will eventually start).

It was kind of funny because we played as

This is my band. And these guys make me proud...

background music during the dinner, everybody was busy eating and talking, the odd person listening. As would be expected. Then the performances started. Everyone was dead quiet for these. There was a girl singing opera, a girl belly dancing, a girl hula dancing, and then when the jazz band came on to perform: everybody stood up and wandered around talking!! People must of thought: 'oh the background music is back on.'

At least the table sitting directly infront of the bell of my saxophone wasn't talking. That would have been impossible. They would have had to scream at each other. Hehehhe.

Yummy Sushi

This is a pic of the nummy dinner Carla made for me on Valentine's Day. It was a total surprize too, I came home and it was all ready with candles lit and everything! Here's what was on the menu:

Drink: Silver Jade Green Tea
Appetizer: 6 piece California Roll
Main Course: Thai Peanut Spring Rolls

And here is a video of me with the recipe for the spring rolls!!!

Valentine's Day Card

You know that I've been studying way too much anatomy when the Valentine's Day card I make for Carla ends up looking like this. I think she liked it even though. I decided to portray the heart from the lesser known "back-side" for an interesting perspective. To finish the masterpiece off I coloured it in with both markers AND pencil crayons! Now that's fancy. I even used Carla's crafty-scissors to cut a lower border into the card -- that is true love and dedication my friends.

Medicine Cup Charity Tourney

This past weekend was the Stollery Children's Hospital Medicine Cup (Charity) Hockey Tourneyment (more photos here). I graciously donated my skills as a hockey player to help raise money for sick kids. Oh yeah. Girls did this kind of stuff.

I'm pretty good at skating. I just can't turn right. Or skate backwards. Or stop. And my stick handling isn't very good (it didn't help that I played left-handed with a right-handed stick without even realizing it....). Combine this with the fact that I bought myself skates that were one size too small. This way I

I just can't turn right. Or skate backwards... Or stop...

still fit into Junior skates, and save like $150!! Woot!! Needless to say I played on the "Boys Who Can't Skate" team, and we were entered in the girls league. Sadly though (for the girls), we beat every single team. When it came to the semi-finals, we played the 2008 med girls again but ended up tossing the game -- because we were tired and didn't want to play the next day. Oh and because we suck. The score was actually 11-11 and we lost on the fourth shot in the shoot-out.

It was hugely fun though. I'm really looking forward to the next inter-med hockey tourneyment, this April. And the girls had better watch out, because I might even find a left-handed stick I can borrow...

Interesting Medical Thingys

For the past 3 months I have been mainly studying. I would have just finished the Reproductive Block since the last time I posted about school. And since then I have finished (as of this past Friday!!) the Musculo-skeletal Cutaneous Block, which included Rheumatology, Dermatology, Orthopedics, and the anatomy of the skin/muscles/bones. Quite the overwhelming block. To get a sense of the block imagine having to know every single muscle in the arm and leg (take my word for it, there are a lot). And then for each of those, you have to know its arterial blood supply, its venous drainage, its innervation, its origin, its insertion, its function, clinical syndromes associated with pathologies of that muscle, if it is involved in any motor or reflex tests for the spinal level that innervates it, the location of the muscle as it courses through the arm/leg, etc, etc. Out of these 100s of hours of mainly boring material, I'll try to find some bits of information that would/might be interesting to a non-medical student:


1. Girls on the birthcontrol pill do not get PMS.

The pill keeps hormone levels fairly constant throughout the menstrual cycle, so the dip in hormones that causes fertile women to get "PMS" does not occur in women on the pill. This can only be attributable to regular grumpy/bitchyness. I can understand a "PMS-like-syndrome" occuring during the 1 week off the pill, but a "PRE-menstrual-syndrome" doesn't not physiologically occur.

2. When you flex your bicep, the big buldge in your arm is not caused by the biceps. It is a different muscle underneath the biceps that causes it to bulge.

I suppose this is more of a technicality. When you flex your arm, it is the "brachialis muscle" that does most of the work. This muscle lies underneath the biceps, originating from the humerus in your arm, and inserting into the ulna in your forearm. Your biceps isn't actually the main muscle involved in flexing the arm. The main function of the biceps is supination of the forearm (i.e. turning your hand from palm-side down to palm-side up).

3. The testicles are never biopsied to test for testicular cancer.

I just watched the mockumentary Fubar the other night. In this movie the main character gets his testicles biopsied to test for cancer. In real life you would just cut out any suspicious lump. The act of taking a biopsy from the scotum would rupture a rich lymphatic supply and would cause any cancer present to spread all over the place. Interestingly they do biopsy the lymph nodes for cancer staging, but the lymph nodes that drain the testicles are located quite high up in your abdomen towards your back. This is because the testicles originally form much higher up in your body, and then descend downwards as you develop embryologically, eventually switching places with your kidneys.

4. The medical term for the "pinky finger" is an even funnier word: "digiti minimi".

And that's pronouced "Digi-tee Mini-Me". And when you say that you have to stick your pinky in your mouth just like Dr. Evil.

5. The name for the ligament that secures the testicles to the bottom of the scrotum is the "gubernaculum". That word is just fun to say.

New Years '06

You might think this picture was from New Years 1972, but it was in fact from New Years 2006.

I ended up going to this laid back party/jam-session at a friend's of Mark's. It was good times. Apart from the purple cloud of smoke. I thought it was funny how we lost track of time around midnight, and then suddenly people were yelling for everyone to come upstairs for the countdown. When we got upstairs, somebody asked what time it was. Someone else said "12:03". So everybody just started yelling: "10!!! 9!!!! 8!!!!...". Laid back indeed ;)

X-mas Photography

This is a really cool picture of Carla I took this past December. This is the Corona LRT (Subway) Station in downtown Edmonton. That was a fun night too. Carla and I had decided to walk down to see the Christmas light display they had put up at the Legislature. Only problem was that it was -22 degrees celcius!! After walking through the light display, it was so cold that we decided instead of walking all the way home, we would just go catch the sub. Only problem being neither I nor Carla knew where the closest station was. We ended up walking further and further downtown for about 20 minutes until we came across a subway station. Turns out we had walked past 2 closer stations. Oh well, it made for a good picture. Just before taking this picture I had cleaned a tear off of Carla's glasses. A single tear drop was frozen solid to her lens. Crazy Edmonton.

Here is the best pic from the Christmas light display:

Three Month Blackout

Holy crap!! It's been 3 months exactly and I haven't posted anything. I apologize to my semi-regular readers. Life has become increasing busy as of late. Let me see if I can find some good pictures and any interesting stories that go along with them, so I can fill you guys in on what you missed...