I remember having a Canadian flag on the outside of my house that would be unveiled at some ungodly early morning hour on July 1st, in celebration of Canada Day. My Dad would climb to the roof where the flag post was and precariously balance himself several stories up while attaching the flag. Surprisingly, in the many years this tradition has taken place there have been no injuries.
Happy Birthday Canada!
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I’m back…exams finished yesterday and today I find myself ready to study but with nothing to study for. I should go back to bed but I’m wired and I don’t know what to do with myself. So here I am – writing to the blog-o-sphere. I’m going to have to keep it short though ’cause my social skills, which were low to begin with, are next to nothing right now. This happens when you lock yourself in a room for vast periods without human contact…I think I’ve talked about this before, but I find post-finals I am not only brain dead but also incapable of carrying on small talk.
Imagine running into an acquaintance on the street and trying to carry on a conversation. I’m talking about someone you know well enough to say hi to but that isn’t a good friend. Normally there is a little awkwardness in the conversation because you don’t know this person well enough to ask about the interesting details in their life. Instead, in a normal scenario, you would rely on small talk – how’s the weather, sports team, work, etc. Now – post finals, remove any knowledge of the world around you because you have been living in a vacuum for the past month (or two). Causal conversation suddenly becomes infinitely harder.
I also find that the small visual cues that are present in normal conversation, the ones that clue you into whether the person is interested or not in what you’re saying are gone. It takes me a week before I feel re-adjusted to the world outside of my office and able to respond in a normal way to these subtle cues. It’s laughable – it really is.
Now imagine you gather a large group of individuals suffering from the same social awkwardness (“re-entry” syndrome) together, you add some alcohol and a nightclub…and you’ll have a pretty good idea of what the post-exam party was like.
It feels good to back to the world of the living.
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Dx requires 7 of the following 11 criteria:
1. Change in bowel habits
2. Lid Lag
3. Decrease in fluid intelligence
4. Fine tremors
5. Day/Night reversal
6. Oligo unilateral phalangeal ink stains
7. Lassitude
8. Functional kyphosis
9. Alternating periods of delusional ideation/depression/euphoria/sense of impending doom/irritability
10. Serum cortisol > 550mmol/L11. Refusal to perfrom Instrumental Activities of Daily Living (IADLs)
L CC, M KL. Diagnostic Criteria for Pre-Exam Trauma Stress Disorder. J. Procrast. 1(1) p.1. 2008
Bonus- This an example of:
a) Primary Literature
b) Secondary Literature
c) Grey Literature
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It’s the time of the year that I have come to hate. It’s sunny outside, summer is just around the corner and I’m stuck inside with my anatomy texts trying to make sense of some obscure plexus or muscle group. Medical school has become even more intrusive into my spare time as I find myself in the full marathon training for finals….and because of this I think I am going to take a little time off until the exams are over. I’ll be back on June 1st, once the dust has settled and life once again has some normalcy. I want to thank those who took the time to read the ramblings of me as I went through second year. Next year is when the fun truly starts and I can’t wait for that experience to begin, or to share it with you. I’ll talk to you again soon. – DocWalk
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Today I met a 23 year old today who is dying of metastatic cancer. I’ve met terminal patients before and had the opportunity to work with a doctor delivering palliative care in one of the city’s hospices, but today was different. Today it was hard to dissociate myself from the patient, it was hard to separate myself from her situation. She was young with a family and under other circumstances could have been a friend and this was different than what I was expecting.
I arrived early today for my patient assignment. Today the goal was simple – I would have an hour to complete a history and physical for an unknown patient. After I had done this I would have to present my findings to the attending doctor who would then discuss the case in further detail. After the case presentation we would then head back to the patient where the doctor, myself and another student would go over the findings once again and review aspects of the exam that I had missed. I was nervous but excited – this is the closest I have come to actually practicing medicine after 2 years of study!
Things went smoothly this afternoon. I was primped and pressed, wearing a tie and a little white coat. My stethoscope and id badge in clear view, a small satchel containing some clinical exam books and other paraphernalia I thought I might need or use (an otoscope, tendon hammer, measuring tape, marker, etc). I arrived 5 minutes early, presented myself to the secretary. The secretary passed over a little sticky note that had the patient’s name as well as a chart number written upon it, promptly paged the attending to tell him I was there and ushered me up to the 4th floor. On the 4th floor I made a bee line to the nurses station where I introduced myself (always, always be nice to the nurses) and asked to see the patient’s chart.
…….hmmm, ok – age (23), id, latest vitals by the nurses (thank-you…I’ll make a note of this in case the attending asks), chief complaint – the big C. Cancer. Worse yet. Metastatic cancer. The medications tell me that this patient is on a second line of chemo – this is confusing because this is a young adult and not one that I would expect to have cancer advanced to stage where it is essentially incurable.
“Excuse me”, I ask the closest nurse, “Is this patient on palliative treatment?” Thinking that perhaps I have made a mistake and that the cycle of chemo is not really meant to be palliative.
The nurse looks through the chart for a moment, leaves and comes back with different file. “Yes – it looks like this patient is receiving palliative care.” I finish my notes and hurry to the patient’s room as I am already behind on my allotted hour.
Like I say I don’t know what I was expecting. I had read 23 years but I think I was still looking for someone older. I am standing in the doorway looking into a room with a number of different people – mother, husband, small child, and friends. Amongst these people there is one that is sick and dying. For a moment it is the worst game of “Where’s Waldo” that I have ever played. I mean it could be anyone here – or it could be the slight, thin woman on the chair in one corner of this too small room.
I start into my dialog – this is the part I’m good at – the introductions, the making of people feel at ease, lightening the mood at little. I can be personable, and in this scenario I am in some ways auditioning to not only gain the trust of the patient but also all the family and friends present. One wrong move and it won’t be the patient that I will have to worry about, it will be her mom – chasing me down the hallway battering me with her handbag. But today I prevail, and manage to weasel my way close enough to the patient to begin the interview.
Even though I have made a good first impression, I am still not out of the woods. The patient is guarded, her mother present and her husband watches from close by. It’s hard enough to gain the trust of one person in a short period of time to a point where they will talk about about intimate details, but it is exponentially harder to gain the trust of multiple people in the room and yet (somehow) I am able to do it. This means that after 30 minutes or so I can finally begin to talk to the patient in earnest and hope to get a smidgen of the physical done as is expected of me by the attending doctor.
The details of the interview are of course private. The only thing I can say is that it occurred to me that my impression of this person’s disease and her impression of her disease were completely different. In some ways the sheer idea of a terminal disease, especially someone younger than me, is terrifying. For the patient, the disease was a challenge and a cure was the hope. I knew from her chart that she will die soon, but I couldn’t say if she had been told by her doctor as to how bad the cancer in her body really was…and honestly who really could sit her down and take away the little hope she has with such a brutal discussion. I have a respect for those who do this, who work with the dying. I have seen how they have frank discussions with patients still not ready to accept and I could see one such talk happening in this persons future and it made me sad.
For the moment, I take comfort in that the person I met today is surrounded by friends and has a beautiful family. For her, she will have love and support until the end. And for me, I have her to thank for time that she gave to help with my learning despite it being the most limited thing she has left.
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Week 2 of MSK covers normal joint function, cartilage and osteoarthritis. In some ways it would almost be better to cover the cartilage before learning about bone because of the fact that bone originally forms from cartilage (to put it simply) and also that cartilage formation is an aspect of bone healing. Regardless, this week is better organized than last week (which isn’t saying much).
My impressions of the MSK block aren’t the best. It covers a lot of material and seems to be poorly organized overall. Key concepts are either unintentionally missed (“oops – we meant to cover that but didn’t”) or outright ignored (“Go look it up yourself”). I feel as though the material is not coming together as well as it has for the previous 2 blocks, GI and Blood & Lymphatics. My stress levels are climbing because of this and I know I am not the the only one. The others that I talk to in the class admit that they are feeling overwhelmed and a little frustrated. I haven’t reached the point of being overwhelmed … yet, but I will definitely have to put in some good book time over the weekend to make sure I am happy with where I’m at.
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Or so it would seem from the large numbers of empty seats, the constant snuffling from the back row and the sea of green faces at lunch time. It would appear as though flu season has arrived earlier than expected. Some in the class may lay the blame at the feet at one or two individuals that were sick at the start of the year and, either knowingly or unknowingly, infected several others on a class trip. Others think they picked up something from the various clinics they have to visit each week. Regardless of the cause I spend a portion of my day worried that some twit classmate will cough on me and start the cycle for me and my family. I’ll do my best to avoid it. I’ll no doubt arm myself with the latest in the cold fighting drugs, as well as overdosing on daily regiments of vitamin C and Echinacea. I may even try that “Cold Fx” that Don Cherry endorses (I mean if he says it works it must be good – right?). Maybe if I believe strongly enough that I won’t get sick I can stave off whatever germs come my way. There has to be a solution ’cause I feel kind of feverish and I think my nose is beginning to run…
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I sent this to a friend of mine who has short listed anesthesiology…
I found this in one of my favorite blogs “the underwear drawer” which is penned by an anesthesiology resident.
Check it out at : theunderweardrawer.blogspot.com/.
Believe me it’s well worth the wasted time!
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