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...

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.

Pelvic Exams!

Today was a more than normally fun day at school. We spent the entire morning practicing speculum exams, bimanual exams, and prostate exams on plastic dummies! Woo hoo! The dummies were actually very realistic -- I think they cost around $600 a piece. They had replaceable uteruses and prostates so you could feel different pathologies. Good times!

After class Carla and I went for a run. We ended up running down the river bank and across the LRT (subway) bridge over the river, back up the river bank (~200 stairs), and back across the river on the high-level bridge. In this satelitte image you can see the two bridges we crossed, and the parliament buildings to the top right of the screen.

Other than that I've just been studying gynecology (gross/boring) and wasting time on my laptop. Time to go iron a shirt/tie for tomorrow!

Cardio Exam

Well I just had my cardiology final exam on Friday, and I think it went pretty well. Most of the questions were fair, and I got all of the hard questions right (because my friends and I study by quizzing each other with the hardest possible questions on the most obscure minutae we can read about). The best part of the test however, was that this test had more technical errors than any other test I've ever written. It was literally a "gong show". There were upwards of 30 corrections the profs had to make during the exam, and that involved interrupting us about 40 times. Lets see if I can remember exactly went wrong:

1. Some people were missing pages 3 and 4.
2. Questions 82-89 had the right answers written right beside the questions. We were told to put "A" for our answer to all of these questions, yet later you will see that we never got to questions 82-89 on the answer booklet.
3. The graph question printed out wrong, with the labels not lining up with the graph at all.
3. Questions 42-90 had 8 options for multiple choice (A through H), yet the answer sheets only had 5 options (A through E) per question. Because of this problem one of the profs ran to go get some proper ScanTron sheets and we were told we would be given an extra hour to transfer our answers to the new answer sheet. One student put up her hand and said, "What if my flight leaves at 11:30" (which should have been half an hour after the test ended). Meanwhile the other prof decided that we should just forget the ScanTron and fill in the answers in the question booklet. But then a different prof changed that decision to having us skip from question 41 to question 201 on the ScanTron (which had 15 letter responses). So now question 42 became question 201, and question 93 became question 252, etc.
4. Some minor typos - like "subclavian vein" instead of "subcardinal vein".
6. Late in the test writing period, one of the profs suddenly announced we only had 20 minutes left, while people started to freak out. He told us that the original hour we were promised was only if we had to transfer answer sheets, but as this was no longer the case the test ends at 11:00am. So people started to yell. We were given the full extra hour.


As you can see this was a disaster. Somebody will probably be fired. I thought it was a fair exam that tested our skills of recalling cardiology medicine while in a highly stressful dynamic situation (hehehe). Oh and by the way I know that the numbering of my example errors is all messed up, and that is a joke.... laugh....

Clinical Skillz, auscultation skillz, diagnostic skillz....

The cardiology course I'm currently taking introduces med students to Clinical Skills for the first time, which I have found very exciting. These are the things doctors do at the bedside during a physical exam. So specifically to cardiology this includes observing for the jugular venous pressure (something I had never heard of before this class), taking blood pressure, taking pulses, and what I find particularly fun: listening with the stethoscope. I think my musical skillz directly help my stethoscope skillz. When listening to a murmur its important to grade the intensity of the sound, the pitch, where on the chest its loudest, where it radiates to, where in the cardiac cycle the sound starts and where it ends, whether its regular, regularly irregular, irregularly irregular, etc. The hundreds of hours I've spent listening to piano solos over and over again has enabled me to hear a sound and be able to basically take a "picture" of it in my mind.

These clinical skills classes are fun because they show you how the "book-learnin" I'm doing actually helps in the real world -- as opposed to helping for nothing other than test scores.

Anatomy

Anatomy has finally started! On Friday we had our first anatomy lecture, which involved using pencil crayons to colour in most of the anatomy of the chest. It was insanely fast paced. Our anatomy prof is absolutely amazing -- definitely one of the funniest profs I've ever looked at / listened to.

After this introduction we were taken up to the cadaver labs and introduced to our cadavers. That day all we did is basically stand over the bodies and expose their chests. I was definitely more anxious than I thought I would be for the uncovering of our bodies. I think it was just the big work up to the event (i.e. all of the lectures on professionalism, death and dying, respecting the wishes of the donor, etc.). And also the fact that it stinks in the anatomy lab like formaldehyde and phenol.

All of the anxiety I felt on Friday was definitely gone by this afternoon however. Today was our first day of cutting. We cut through the skin along the sternum and the costal angles along the rib cage. Its crazy how easily a scalpel will cut through flesh! We then proceeded to cut "finger holes" in the chest wall so we could pull the skin off and cut away the underlying superficial fascia (fat). It was awesome! We continued to dissect the pec major muscles. Its amazing how tough nerves are! Blood vessles rip very easily, but the nerves are like tough threads. We had our hands deep inside the body, underneath the pec majors, feeling around for the lateral pectoral nerves. It was so cool!

Now I'm not so sure that surgery would be that horrible of a position. I would still like to have patient contact in whatever specialty I end up in, so up until this point I hadn't really been considering surgery.

New Semester

This semester I will finish off the endocrinology course I'm currently in, and start the CPR block (cardio, pulmonary, renal). I'm looking forward to CPR because thats when we start anatomy (this link will take you to some sweet dissection videos)! I will probably buy my own human dissection kit sometime this week. Nothing major like buzz-saws and corkscrews, just some forceps, scissors, and scaples.

Studying like mad

I've been studying lots lately, as my Immunology/Infection/Inflammation final exam is this Friday. I kind of like memorizing huge amounts of information, I'm just not sure if I'll remember this stuff years from now. After the exam on Friday, the parties will begin. I will be accompanying 39 friends for a limo ride with champagne to the Rum Jungle (a club at West Ed Mall), and from there we'll be heading off to the Globe for some more partying with relieved med students. Hopefully I'll have some pictures to post from that. Ok back to studying about rashes, malaise, and lymphadenopathy (swollen lymph nodes:)

I Love School Supplies!

Here I am wearing a $300 stethoscope that I WON the other day in a raffle! At this point all I know about it is that the little ends go in your ears.

Phlebotomy Lab 1

Why is my forehead so shiny? Because it is covered in sweat. I'm holding a vial of blood that Ryan sucked from my arm. My not passing out during this procedure (coming close doesn't count...) was a huge accomplishment for me.

Phlebotomy Lab 2

Here are some med students in the phlebotomy lab, learning how to take each other's blood. I have NO IDEA how i didn't pass out.

All my money is gone

Yesterday I spent all of the money I've saved in the past 5 years. That's my tuition check for first year at the UofA. Hopefully all that money will go to a good cause... I was actually surprized how easy it was for me to drop off that 10 grand check. I'm normally so cheap I have problems buying new pants.