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30 April 2012

Geek pics

Our "official' portraits from the Calgary Expo.  The first is Tavia and I with Wil Wheaton (Wesley Crusher).  The second is Jonathan Frakes (Will Riker), Marina Sirtis (Deanna Troi) and Micheal Dorn (Worf)

A Little Rant from the Bottom of the Totem Pole

Some people you will succeed because of, and other people in spite of.
I have had yet another encounter with a consultant who sees students a bothersome and burdensome or bug-like, not worthy of talking to. I started by introducing myself, and she stared coldly and snipped "we're not starting yet."  OOoookay. So the other student and I sat and waited half an hour until she called me in and assigned the other student to another Dr. She then proceeded to see several patients, not once explaining to me or the patient what she was doing, or why. No teaching moments happened in an hour and a half.  Since I have much more interesting ways of wasting my time, I left halfway through clinic.
This is not an isolated incident. Last year in Internal Med, I was assigned to a consultant for 8 weeks. After 3 weeks of daily scribing and ward jobs, he looked up and said, "Yes, can I help you?" with no remembrance of me. Way to make me feel like part of the team.  This same guy then YELLED at a patient for not knowing she had the atrial fibrillation which caused her stroke. The poor woman was aphasic from the stroke (lost her ability to speak), and could do nothing but shake her head as tears rolled down her cheeks. I spent most of the morning after rounds comforting her and explaining what was going on with her treatment.  I have seen registrars just not show up with no explanation, or not prepare anything to teach for sessions because they "don't like students" (yes, she said this. At least she's honest.) I have seen more senior staff rip strips off junior staff, or like my experience today, just ignore them.  Just about everyone I know has been reduced to tears at one point or another in their training.

Why does everyone think this acceptable behaviour??? I think there is no level of education at which being a jerk of a human is OK.  I understand that the consultants are not paid to take us on at teaching hospitals (Even though the school of med still thinks it's OK to charge us full tuition for the free service they're getting). I also realize that not everyone is Chatty Cathy or uber-teacher.  But why can't there be competence AND kindness, or at least civility? ARRRRRRGH!
OKAY, getting off the soapbox. I have to say in all honesty that I have had more GOOD teachers than bad ones. I just had to get the grump off my chest.

Thanks, Dr. Douche, for at least teaching me how I don't want to practice (WHICH INCLUDES TEACHING). I'll remember it. And thanks, Drs. Decent and Still-Cares: I'll remember your lessons too.

"Dr. D" at Ask An MD addresses the Jerk Factor:

Why are so many doctors jerks?
Excellent question! As any nurse will tell you, doctors are notoriously difficult to work with. We doctors have a much higher percentage of jerks among us than the general population. Even Doctor D (on very rare occasions) has been known to be downright ornery towards patients. There is a epidemic of condescending, difficult, foul-tempered doctors, and you the patient are the one who suffers!

Some doctors have been jerks their whole lives. Maybe they weren't hugged enough as babies. These docs just love having a position of power so they can make others feel small. Such natural-born jerks can be found in any profession, and just one of them (especially as a customer service representative) can make anyone's day miserable. Such doctors will never change. It is best to avoid them whenever possible (unless you need surgery).

But the relatively few natural-born jerks in the world just aren't enough to explain the over-abundance of jerk doctors. This only leaves one explanation: many doctors become jerks by becoming doctors.

The number one reason everyone says they want to go to medical school is "to help people." Believe it or not, we were all once innocent wide-eyed young medical students who really cared about you.

Then they fed us through the decade long meat-grinder of training involving sleep deprivation, endless memorization, calling patients by their diseases, and getting yelled at regularly by our jerk-doctor teachers. At first we hated those other jerk-doctors, then we felt sorry for them. We worked till we were dead tired, and then got told heathcare is cutting back so we had to do the same work twice as fast next time. Patients expect us to work miracles after watching too much TV, and don't see any reason for dieting or quitting smoking since our purpose in life is to cure everything. Despite our good intentions people keep destroying themselves with bad habits, and nice people keep dying, and everyone is angry we can't turn them back into twenty-year-olds. Add to that lawyers promising irritated patients that they can hit the jackpot, if they just sue jerk doctors--It is enough to turn even the nicest medical students into misanthropic bastards.

As a patient that just wants to get your check-up none of this is your fault, but you are going to bear the brunt of this. Your best bet is to look at your doctor, and try to imagine him/her as the kindly, altruistic, and terrified student that showed up on that first day of medical school. Somewhere in your doctor lurks that annoying humanitarian impulse that doesn't die easy.

28 April 2012

Getting my geek on.

For the first time in several days I have a decent Internet connection. I can now tell all you fine folk what I have been up to.
  Today was the first day of the Calgary Comic & Entertainment Expo. This wasn't the only reason for my trip to Canada, but it was the reason I am doing it now.
  My friend Tavia and I where able to meet several of the Star Trek The Next Generation actors. First was Wil Wheaton. He was at a convention last weekend in Gold Coast, so we were able to chat about Australia.  He loved the Koala Sanctuary and Morton Island. He's not such a big fan of the Gold Coast, but neither am I.
  We were also able to meet Marina Sirtis, Jonathan Frakes and Brent Spinner. Brent was very chatting.  We also got a photo taken with Wil Wheaton.
  Tomorrow is our big photo op day.  Hopefully we will also get to see a bit more of the expo.
  Most of this week was in Deadwood. I spent some time with Mom and was able to fix up her computer.  I was also able to scan a pile of my baby pictures which I'll post later. Wednesday night I spent with my sister Barb visiting and sorting REA contracts by land location.  The rural electrification area was having a big meeting the next day and she had taken some work home.
  Also visited Tavia where I got to bottle  feed a lamb and haul firewood.  The lamb was more fun.
  Last weekend was spent visiting my inlaws.  I helped Susan buy an new computer and set it up for her. (I'm seeing a computing theme).
  The mid week was spent in Martensville, Saskatchewan.  I went to visit my adorable 3 year old niece Hunter. My brother Rick happened to be there too. ;-)  It was a good chance to see Rick, Tracey, Jackson and Hunter. While in the area I got to visit the Krahns; Aunt Carol, Uncle Neil plus Christopher and Daniel.  My Brahma hat barely escaped Neil's clutches.
  The first weekend in Canada was spent visiting old friends.  We even had a Skype party at Barbra's so Barb could get in on the action.
  So far everything is going so fast.  I haven't been able to see everyone that I wanted to see, but it has been great to see so many.
  We are planning to both be coming back to Canada next June for my nephew Trevor's wedding to Amanda.  Hopefully we can see you all then.

(Photos and videos to follow as soon as I can)

25 April 2012

I think I found breakfast Nirvana....

I think I have found the most awesome pancakes in existence. Check out Recipe Girl's page for this and other yummy indulgences. I tried them on my housemates this morning, and three out of three people agree: we all agree. And for those interested, Polly seems to be doing ok....whew!
I made a few changes from her original: a little sugar and vanilla in the pancake batter, and upped the cinnamon in the swirl. I also make a different glaze.
Having toothpaste consistency in the swirl is really important, or else you get cinnamon splort. Which is not the worst thing that can happen. It's just not as pretty.

Cinnamon Roll Pancakes


4 tablespoons (1/2 stick) unsalted butter, baaaaaarely melted (not boiling)
1/4 cup packed brown sugar
1 tablespoon ground cinnamon
Mix and scoop the filling into a  zip baggie and set it aside. Squish the bag to remix before you start swirling.letting it cool will thicken it, warming will thin it. Isn't science fun??

2-ounces cream cheese, warmed
2 tsp milk
1/2-3/4 cup powdered sugar
1/2 teaspoon vanilla extract
use the microwave to warm (cautiously) and mix until it is viscous liquid, about honey consistency.

1 cup all-purpose flour
2 teaspoons baking powder
1/2 teaspoon salt
pinch of sugar
1 tsp vanilla
1 cup milk
1 large egg

1 tablespoon canola or vegetable oil or melted BUTTER!! (Thanks, Paula Deen!)

My (Barb's) rule of pancake batter is beat with a whisk/fork 100 strokes. Don't be lazy and use a mixer!


 Heat a large, nonstick skillet over medium-heat and butter that baby up. Use a 3/4 cup measuring cup to add the batter to the pan. Reduce the heat to medium low. Keep the heat low or your pancakes might cook up too quickly, and the sugar will burn and smoke. Snip the corner of your baggie of cinnamon filling and squeeze the filling into the open corner. When your pancake begins to form bubbles, start at the center of the pancake, and squeeze the filling in a swirl (see photo below). Cook the pancake 2 to 3 minutes, or until the bubbles begin popping on top of the pancake and it's golden brown on the bottom. Slide a thin, wide spatula (shout out to my buddy Barb D for the most awesome spatula EVER) underneath the pancake and gently but quickly flip it over. Cook an additional 2 to 3 minutes, until the other side is golden as well. When you flip the pancake onto a plate, you will see that the cinnamon filling has created a crater-swirl of crunchy cinnamon awesomeness. Wipe out the pan with a paper towel (or else you have that carbonizing sugar problem again), and repeat. Re-warm the glaze briefly, if needed. Serve pancakes topped with a drizzle of glaze.  After consuming, go directly to gym and start walking it off.


21 April 2012

Homemade Kitty Hospital OR Expensive cat is Expensive

Apollyon has unfortunately become unwell. It began two nights ago when we noticed she wasn't being social, just lying on my bed. Then she became hot, wasn't eating or drinking or going to the litterbox unless I picked her up and put her there. She wasn't grooming. Her eyes became rheumy and she looked miserable. She became uncoordinated and weak. And I became anxious about it, so off to the vet we went. The lovely vet did an examination, which included a rectal temperature (Polly was NOT cool with that). Apparently a normal cat runs at about 38 oC. Polly was at 40.1 oC. They admitted her, did some blood tests and rehydrated her with IV fluids. They also gave her an antipyretic to bring down the fever and some pain meds to ease her discomfort.
Poor baby! with IV fluids, feeling crummy.

$510.00 later, the picture was looking like "feline acute supperative choleangiohepatitis" Which is an impaired liver due to bacteria that have ascended her bile ducts, invading the ducts into the liver. the immune cells that are attacking the bacteria work somewhat like a landmine, and cause indiscriminate damage with inflammation- this kills the bacteria, but the healthy liver cells are collateral damage. This will cause her bilirubin to rise, and the skin of her ears was turning yellow (jaundice). This could possibly lead to liver failure, which can be fatal.   Because the local vet would not be open Sunday, and Polly needed more care and monitoring, they referred her to an 24 hr emergency vet, or Kitty ICU. That doesn't come cheap- $475 for the continued care plus $150 per day just to be there. They also recommended a $450 ultrasound to look at her liver to better understand the type of problem she was having. Being in medicine, the vets and  nurses and I could shop talk, and it was fascinating to see how processes I understand in people play out in cats.

Rob and I agree that vet care is something we budget for. But we have set the limit at $500 per episode, and the condition has to be reversible, not progressive. So I had to decline admission to the kitty ICU and the imaging. Instead, the emergency vet and I worked out a plan- I would give her subcutaneous fluids at home, as well as oral antibiotics twice daily (liquid, at least. Giving a cat a pill is a Herculean task!)And we would try and get her to eat.
Homemade Kitty ICU. Polly is getting fluids subcutaneously. After getting antibiotics down the hatch. She is definitely NOT a happy camper, but she is starting to perk up a bit.

 The debate about refusing pet treatment due to financial constraint can be a heated one. Some call it "economic euthanasia". The vet did give me a rather expectant look when she gave me her quote. I'm sorry, I won't be handing that kind of money over, but Polly is not ready for the Euthanol yet. We will give this a chance to work itself out with supportive therapy. I did some digging in the literature regarding feline cholangiohepatitis. Apparently even if correctly diagnosed and treated, there is a 50% mortality rate in the first year. The remainder will usually live from 1 to about 5 more years, and a fraction will have normal lifespans. So there we are. I will do what I can to help my kitty, whom I do love. But I will not spend a fortune diagnosing something just to know what it was that killed her or that we didn't need to know because we took care of the symptoms and it went away (granted, in people, I JUST WANNA KNOW!). I am also unwilling to fight an expensive losing battle in which she suffers for no good reason. Two excellent opinion articles at Salon called "What I wouldn't do for my cat"  and "How to say No to your vet" lays out the controversy and echoes my feelings pretty well. Except I don't think most vets are inspired by money. I think they are inspired by what is now possible to do in order to help an animal get better. And I admire that.  They deserve to be paid for their work, too.

So here's hoping Polly will pull through.

17 April 2012

15 April 2012

ICU- And now I don't

I have to say that my attention span is a little longer than the average ED doc. But it is a lot shorter than an ICU Critical Care doc.  I found my one week in ICU to be fairly boring as a student (I am not dissing the work or the unit's usefulness one bit). The patients tend to be comatose or close to it, so we can practice Glasgow Coma Scale reporting (Did you know you can be dead for days and still score 3?)  In addition, just about everyone has a endotracheal tube in their throat, so getting a history is pretty much impossible, even if they were awake.  I got a lady to squeeze my fingers when I asked her to, and I'll call that a win.  And that about sums up how much physical exam you can do on an ICU patient as a student.  I will say that every doctor and nurse and physio and pharmacist in the ward can recite their patients' story forwards and backwards. They know all these things because of how precarious the situation has become by the time you land in ICU, and often based on multi, Multi, MULTI factorial causes. They can keep it all straight, and have contingency plans with backups for every possible complication that could arise.  This is probably the most useful thing about being exposed to Critical Care- when discussing treatment we are always asked "what do you do if X fails?"

The first exposure I had to the ICU setting was when my cousin, Dwayne, was a patient after surgery for renal cancer. You can read his story HERE. He died a few days after admission to ICU- but was very compassionately and professionally cared for by the staff there.  I have also visited ICU as a student following burn patients. Now that I better understand the processes they were following, I have even greater admiration for the work the folks in ICU do.

In order to handle the slowness of the unit, I began to play a little game: How many tubes and wires can be attached to one person?  The week's winner was a transplant recipient at 32!  This included an indwelling bowel catheter AKA "poop chute" (they aren't going to take the poor guy to the bathroom, and bedpans only work if you can warn someone it's coming), urinary catheter, ventilation tubes down the throat, Nasogastric tube to get some much needed calories in,  Extra Corporeal Membrane Oxygenation (bypass machine), kidney dialysis, ECG (x12 leads), multiple chest drains, surgical wound drains and vascular access in a number of places.  The "loser" was on her way to improvement enough to move to a regular medical ward and had only 19.  And this one of the reasons that a stay in ICU is approximately $2000.00 per day. 

In OTHER NEWS, Rob has taken off from Oz's sunny shores for a visit back to Canada (and it was snowing when he arrived- he was very pleased).  Aside from forgetting to pack underwear, his flight was uneventful. I am a little jealous.

05 April 2012

Paska- a Mennonite Easter Tradition

I grew up in a Christian home, backed by a Mennonite heritage. It has definitely informed some of my world view, as well as my tastebuds.  There is food that can transport me back to my mom's and grandmas' (Klassen and Harms) kitchens, make me feel safe, social and happy (and full!)  Mennos do seem to be a bit obsessed with food: making it, stretching it to feed more mouths, enjoying  it, planning for the next meal or faspa (tea or late supper).  I knew my Grandma Klassen had accepted my husband to be when she asked at the dinner table, "Would you like some more, Robert?"
Easter is a special time of celebration for us, both spiritual and culinary.  One of the most constant food of Easter time was Paska, or Easter bread.  I have some in the oven as I write.  Here is the best recipe I know, and it comes from a site called Mennonite Girls Can Cook.
 The blender makes life so easy.  And I need to mention how enamoured I have become with BAKING PAPER.  It is fairly common in Australian bakeries for muffins, breads, etc. And it makes getting things out of the pan/off the cookie sheet a breeze. 
**NOTE: "Do it (add something, mix something, etc.) until it looks right" is a central tenet of Mennonite cooking and baking. Which usually means you watched someone else do it first or you have learned from the cruel mistress of experience (hmmmmm... remind me of medicine, much?)**

The aroma is just amazing from the time you blend the citrus until the last loaf has cooled.
You will need 4 or 5 loaf pans . .or you can free form little twists or use muffin tins. .. just adjust your baking time. the oven closely.
  • 2 tablespoons active dry yeast
  • 1 cup warm water
  • 1 teaspoon sugar
  1. In a large bowl, put your yeast, sugar and warm water. Let sit 10 minutes. If it hasn't poofed up, either your yeast is old, or dead. If that happens, start again. There is no point in going on without nice poofy yeast.
  • 1 medium lemon
  • 1 medium orange
  1. Take your citrus and peel it very thin. I use a vegetable peeler. You don't want to use any of the white part of the peel. Put the thinly sliced peel in the blender.
  2. Once you have removed and discarded the white pith of the citrus, chop your lemon and orange, removing all the seeds. Add the chopped lemon and orange to the blender.
  • 1 1/4 cup milk
  • 1/2 cup of real butter
  1. In a microwave safe bowl or in a pot on the stove, heat the butter and milk until the butter melts.
  2. Once it is melted, add it to the blender and begin to puree.
  • 2 large eggs
  • 3/4 cup sugar
  • 1 teaspoon salt
  1. Add the eggs, sugar and salt
  2. Start the blender on high and allow the citrus, peel and milk, butter mixture to run for about 2 or 3 minutes.
  3. Measure the milk/citrus and sugar mixture. It should be about 4 1/2 cups. If you have a bit more or less that is fine, you will just adjust the flour likewise.
  4. Pour the mixture, along with the yeast mixture into a large bowl. Add flour one cup at a time until you have a smooth, soft dough. It will be sticky.  7 cups of flour should be right,  but it will depend on the size of your eggs and lemon and orange. (At this point, I sometimes add raisins, or candied peel- Barb) With a plastic bowl it is easy to tell when the dough has enough flour because it will stop sticking to the side of the bowl. Do not add more than 7 1/2 cups flour. Allow it to remain sticky. The amount of flour is a guide. If your dough is still super sticky add a little more flour a dusting at a time. It should be able to hold its shape. Don’t despair if you think it is still too sticky. . .go slow. . .add a dusting more. .turn the dough on the counter and knead until you are out of flour again. .and then give it another dusting and continue....
  5. After kneading it for about 8 - 10 minutes.transfer to a large bowl, cover with plastic wrap, a tea towel and allow to rise until doubled. This should take about an hour. .to an hour and a half.
  6. At this point, give it a bit of a punch down and let rest at least 10 minutes or up to another hour.
  7. During this time prepare your pans. Either baking paper or butter.  Make loaves and let rise until doubled in bulk -  about an hour
  8. Preheat the oven to 350 F. Bake the loaves about 20 minutes. but again it totally depends on the size of your pans.
  9. Allow to cool on cooling racks
Paska Icing
  • 1 cup of soft real butter
  • 4 pasteurized egg whites (young children, pregnant women and people with compromised immune systems should avoid raw egg whites)  Or you can use egg white powder and water.
  • 2 teaspoons vanilla
  • enough icing sugar to make a soft icing. It will harden again in the fridge.
Beat all together until light and smooth....and spread on each slice and sprinkle with coloured sugar (Australians call them hundreds and thousands). 


03 April 2012

Anaesthetics= Safe passage through Surgery

This is my one week exploring the wonderful world of anaesthetics.  So far I have done cannulas and laryngeal mask insertions.  Most of the consultants and registrars have the same reasons for liking their fellowship:
1) results are always immediate; they can chemically speed up or slow down a patient's heart rate and blood pressure as needed. They can make them breathe and watch the oxygen saturation rise correspondingly.
2) The lifestyle is good
3) you only manage one patient at a time, and pretty much never have to deal with complication after surgery is completed.
If done properly, anaesthetics is a pretty laid back job.  Enough so that they catch a bit of flack:

I have sat in with the anaesthetist during orthopedic surgery, lithotripsy (breaking up kidney stones), and cardiac surgery.
During the lithotripsy session, the patient developed hiccups after administering the Propofol (a milky looking drug that makes you lose consciousness). Normally we wouldn't have to paralyze the patient, but his diaphragm wouldn't stop jumping around, some rocuronium was added, and that was the end of that. Start the ventilator!

I sat in on a coronary artery bypass, and I had to write it down before the amazingness of seeing someone's heart and lungs while they were still using them slipped away like a dream.  It was an awe inspiring thing. Standing next to the anaesthetist during the procedure is the best seat in the house to watch open heart surgery.  Cauterizing as they go, an incision is made down to the sternum.  Vapourized flesh curls up in small plumes like from your morning coffee; the surgical assistant suctions off the acrid smelling smoke.  Then out comes the electric bone saw.  The rib cage collapses slightly to one side once they finish sawing. The chest is winched open, and there is the heart, convulsing in its space. The lungs gently expand and recede over the heart like slow waves on the shore. It smells of salt and iron, and the scent reminds me a bit of fresh uncooked steak. The main artery and veins are placed on bypass, and a machine takes over the work of both heart and lungs. The lungs are allowed to collapse, they flatten and shrink away into the back of the chest.  The heart takes a dose of potassium salts, and slowly quivers to a halt- cardiac arrest.  Last week in emergency department, the same condition would have sent a small army of doctors and nurses into a flurry of activity. It looks shriveled and deflated and defeated, cowering in the bottom of the thoracic cavity. The surgeon dumps a cup of sterile ice on it, which will cool it and slow the muscle's metabolism. Now the surgeons can get to work, replacing clogged coronary arteries with cleaner ones donated by the adjacent internal mammary artery and more distant saphenous vein sites.

All the while, the head of the person having this done to them sticks out from under the drape with eyes taped shut. The patient is pink and peaceful, even though by some standards he/she is dead. They have no heartbeat and no pulse, only the steady whirsh of blood in the tubes of the bypass machine.  The temperature has dropped into hypothermic ranges. And the insides are outside, which only 300 years ago meant you were dead or heading there. No breathing. No movement or awareness. Hopefully the brain is in a quiet, nothing place while this is going on.  So surreal. The grafts are finished and tested. The heart is started again with what looks like electrified salad spoons on either side of it. The grafts hold as they take on the challenge of feeding oxygen to a hungry heart. The lungs are re inflated, and the chest is put back together with wires and sutures. They will let the anaesthetic wear off later tonight, and the patient will recover over the next weeks.  The sternotomy scar will remain, but I doubt the patient will ever comprehend what actually happened in that OR.

BBC produced a great history of surgery, and Episode 2 demonstrates how the ability to do heart surgery evolved: