It's beginning to look a lot like...

At some point last week, the weather in Dublin turned. It has a certain bite to it. There's a frosty feeling (though, without the hazard/disaster snow of last year) and it has the smell of winter in it.

I'm over a short bout of gastro (I suspect it was thanks to back to back shifts in the A&E), and my man just got back from his trip home for Thanksgiving. You know what I did while he was gone? I cleaned and decorated. I've my Christmas decorations up in my flat, and now the baking is to begin. They'll be cookies and cake, and maybe a few extra specials on the side.

I have to start packing for home since I'm leaving on saturday, and I'm getting ready to do my Christmas cares as well. I love the holiday season. Now for some snow? If not in Dublin, I know there's some waiting for me at home in MN.

Must. Not. Bang. Head. Against. Wall.

Those of you residing in Ireland with me may understand where this is coming from. Those of you working in health care most likely understand exactly where this is coming from. And anyone who has ever been annoyed by an illogical loop of policy and stupidity will definitely know where this is coming from.

I just took a day off of work. (yeah... I know... Liz took a day off of work... Do both of her legs work?!). I worked 7 days straight, including 2 weekend shifts in the A&E spent dodging vomits and getting coughed on. Summed up, it sounds like this: bark bark bark bark cough whinge whaaaaaaah! sniff sniff wheeze bark bark wheeze PUKE! (yeah, that's a croup joke). I rolled home just after 11pm, ate a light snack, set my alarm so I'd get to work at 8.15am, tried to fall asleep... And the vomiting started around 12.30. I'm not going to be exceptionally graphic here, but I was miserably awake until 4am. Clearly when my alarm went off, I had to ring my co-worker and tell her that I wouldn't be able to come into work... And I felt guilty. With next to zero sleep, having been up sick all night long, probably dehydrated, definitely hypoglycaemic, and barely able to move, I felt guilty for not going into work.

I should take a moment to clarify that at present, I'm actually working for a neonatal service. I work with small babies. Small babies that are unvaccinated, because they are too young to have them yet... Prem babies, little babies, very sick babies... And I felt guilty not going into work. Why? According to my contract, if I have to miss more than 2 days due to illness, I need a doctor's note (yeah, I know, soak up the irony)... And I felt guilty taking one day.

Before further exploring this emotion, I need to discuss the last week and an email I've received. This past week, I have been at odds with one of my superiors. At odds is a nice way of putting that I completely disagree with the way they function at work. I have been pushed further and further out of my comfort zone as a doctor. It's been progressively worsening for the past month, and I feel as though I'm not learning, I'm just trying to keep my head above water as more and more work is poured onto my shoulders. Work that I'm neither competent to complete nor qualified to complete (nor am I paid to do)... I had to force my superior to do something they'd asked of me for "Medical-Legal" reasons. I have reached a breaking point when I have to throw down law to keep from doing work. (I won't get into the shifts I work... EU law be damned).

I also received an email from my medical union requesting I fill out a survey. The survey was focused on the working conditions and how to improve to keep the Irish trained doctors from leaving the country. (Spoiler alert: We leave because working conditions are shite and we are over worked, underpaid, and asked to do things that we've never been taught how to do. We aren't taught because all the seniors are overworked and filling the gaps of people that have left or been fired or are on maternity leave and the HSE can't be arsed to pay for cover.) Most of us work the jobs of two or three people, and yet we're expected to somehow take our annual leave, take our study leave, pass our exams, research and publish, and improve the system. You know what, feck off. SHOs burn out for a great many reasons... I've mentioned a few of them. And no, the other systems out there aren't perfect either, but I do know that if I were at home, I'd not have to move cities every 6 months for my jobs.

Now... with all of that, how could I ever, possibly, even minimally feel guilty taking a day off when I'm projectile vomiting for a night? Because I know that without me there, my co-worker will have to do her work AND my work. That anything I didn't do on Friday night will not only be waiting for me, but probably doubled in volume because there are things that can't be handed over to other people. Because there are patients that I've been seeing every day for a week and no one else knows them as well as I do. And because I am me... I've always felt guilty when my body isn't strong enough to do what I want it to do. For that last reason, I worry that I won't be able to remain in Irish medical system.

I will go back to work tomorrow. Just over 24hrs from the last time I vomited, I will go back to work. I have a 24hr rule, some places have a 48hr rule. There's nothing in writing right now that says whether or not I need to go back tomorrow or if I should take another day... Welcome to survival by the goodwill of your workers. But with the best and brightest leaving the country or burning out over the ridiculousness of demands, this system is on a road towards crash and burn. Maybe when I'm sick, I'm more cynical... Maybe I need more sleep... Maybe I'm just being bitchy. Who knows. But I needed a rant, and there it is.

Thanksgiving... Ex-pat styles

As an American, there is no holiday more universal than Thanksgiving. It is celebrated nationwide. It's a family holiday. It's a sports holiday. It's a shopping holiday. It's a 4-day weekend holiday that's notorious for travel (and delays). And in spite of the universality, it's celebrated uniquely in every home.

Many will describe a similar scaffold for the holiday:

• Wednesday: Travel, get stuck, dig out, get stuck again, travel more, arrive a little late...
• Thursday: Cook cook cook bake cook FOOTBALL! At some point, sit around a table, at multiple tables, at the adult table, at the kid's table, on the floor... wherever is comfortable, and EAT... 
• Friday: SHOP! It's black friday, you have to get going on those Christmas presents. Plus, there's more football on TV. And LEFTOVERS!
• Saturday: Uh... Football and Leftovers
• Sunday: More leftovers... more football... And it's time to pack up for travel back. Why does that always go smoother on the return trip?

Everyone has their own traditions. Their own habits. Their own recipes that make the holiday what it is. And it's something you cannot duplicate. And it's something I miss.

The holidays always leave me a little homesick. I haven't decided if knowing my family is together makes it easier or harder to be apart. But in my time away from home, I've learned a few things. Most importantly, you cannot do the exact same thing without the people. I once tried to replicate what my family does at home; that was a mistake that only left me feeling more miserable and further from home. I once had a group of ex-pats make a Thanksgiving dinner and take a small holiday... That too was a bit of a let-down. Sometimes the traditions from different families don't blend together very well.

For nearly a decade, a very generous donor (and member of the board of trustees) has hosted a Thanksgiving dinner for the Domers in Dublin. It's not the traditional Thanksgiving at home, it's not family style serving, it's not sweatpants or looser belts, it's not a beer and the game on TV. But I have to say, I enjoy the ND-Dublin Thanksgiving for all of those reasons. Rather than being in jeans and a sweatshirt, it's semi-formal attire. Instead of a giant bowl of mashed potatoes in the middle of the table, it's five-star fully catered dining. And while football is the normal background entertainment, a small talent show greased by the wheels of a champagne reception is a suitable replacement. I love the ND Thanksgiving because it isn't home. It is different enough not to try to be home. And the food... it's delicious. It's not exactly right, it's not what I'd be having at home, but it's close enough. And for five of the past six years in Ireland, I've been lucky enough to attend this Mass and Meal in celebration of Thanksgiving. And for that, I owe Mr. Martin Naughton a very large and heartfelt thank you. I do have to dash home from work, change clothes (put on something fancy), re-do my makeup and hair, then dash out to Mass. It's all very rushed. And I don't have Friday off work, so I can't make it too late of a night. But Dublin is my home (not that Minnesota is not home), and Mr. Naughton has helped me find a lovely way to have a comfort of home in a grand Irish way.

No offense to the Irish, Thanksgiving is a holiday that's very foreign. And I miss home. It's one of the most difficult holidays for an Ex-Pat... But I have so much to be thankful for. So much here, and so much back home.

Happy Thanksgiving.

Home sweet pasty legged fools :)

Just off the plane in Boston and I notice a few things in the first moments in the ol' US of A...

1) Americans = much more comfortable in shorts than the Irish. I was actually a tiny bit weirded out by the amount of leg I was seeing. Ps: Anyone not in shorts is in jeans. Maybe this is just Boston.

2) People I talk to when I travel often ask me if I'm heading home. I'm starting to find this a difficult question to answer. A few of my friends know that if I say "I'm going home." I mean my place in Dublin. But if I say "Home-home" I mean actually going to the States (which may not even be MN home, just State-side)... When did the definition of home become so complicated, and when does it start to make sense again?

3) American news stations... They have all lost the plot. I mean, really, all of them. Can someone please tell me what's going on in the world without completely covering with your taint (and yes, I mean that both ways). In addition, most of the politicians are also 8 shades of crazy.

4) If Amit thinks I'm loud and angry... He needs to visit the States more.

Effing Brilliant!

That was some AMAZING tennis!...

I absolutely love watching Rafa play. And I know people were gunning for a Novak v. Nadal final. But there's something about Federer and Rafa duke it out. Crap time for the rain delay... I think that really got into Rafa's head. The tie-breaks were brilliant. Rafa needs to stop picking his butt between points. I want to learn Federer's drop shot and Rafa's forehand. I need some bright tennis clothes! In fairness to Federer, the match was a lot closer than the score showed. Brilliant tennis! Congrats to them both! Vamos Rafa!!

How to make a present

So... I like a challenge. And sometimes, I look for a good reason for a challenge. And sometimes, I just make up a reason for a challenge. But every once in a while, things come together and I don't need to manipulate the situation.

Last Tuesday was Des' birthday (Happy Birthday!). Now, some of you may remember that I made some nifty cupcakes for Muireann's birthday. I wanted to do something different, but equally cool... Yeah, I'm a showoff. So here's my step-by-step guide to making a "present."

1. Make a plan. I know that's sideways, but that's what I up and did while sitting in Starbucks one day. I should have coloured my blueprints :)

2. Make sure you have all the necessary ingredients... There's nothing more annoying that getting started and finding out that you're actually missing something important. (and before you ask about the gloves... just wait...)

3. Wear an apron. Any apron will do, but if it's a fun one that you like (with a pocket for your mobile/timer) it makes everything just that much more fun!

4. Start the mixing!!! mmm... melted chocolate... There was actually a lot of mixing, because I made a lot of cake... And a lot of fondant wrap. All the fondant was white when I started, and I individually dyed the sections... Hence why I needed the gloves. I don't want to imagine the colour my hands would still be if I hadn't worn gloves!

5. Get to work... I tend to multi-task as I go. So as one was baking, I was washing dishes, or frosting, or cooling, or mixing more batter, or colouring the fondant... I couldn't tell you how long it took start to finish. I suspect about 4 hours. But that's only because I do multiple things at once. I'd dread doing something like this without that ability!

Top layer is made of chocolate cake with chocolate frosting and then lime green fondant wrapping. There were teal polka-dots added after I took this picture. The middle layer is made of red velvet cake with vanilla frosting and teal fondant wrapping, kept plain. The bottom layer is chocolate cake with chocolate frosting and then teal fondant wrapping with lime green stripes. As a final touch, I made navy ribbon...

6. Stack 'em up! Now, if you notice, the other presents are "similarly wrapped." There's a reason for the colour scheme... It's a long story, but it was on purpose. So it was all matchy-matchy :)

7. The last step is to put on candles and light them. I used "angel" candles that burn different colours, and I have a photo that somewhat shows the colours... But I think it makes it look a little like a Dr. Seuss cake? Don't get me wrong, I think it looks great!, but it does look a little Seussical, no?

You do of course need to throw in a birthday boy. Preferably a happy one. And enjoy the cake!!!

Ps: Yes, it did in fact taste really good too.

Lemony Fresh!

Well... I'm on a week long holiday. It's just about noon. And I'm already kinda bored... What is wrong with me?!

Ok, let's be fair. I'm not bored. I'm actually working on recovering from 4 calls in 6 days... and this strange mini-plague I picked up my last night on call. I got home Saturday morning, had a fry-up with Amit, then passed out from noon until 5. I think I finally woke up for some food... Slept all night anyway. And I slept most of yesterday. Apparently I needed sleep.

Once sleep is done, cleaning, paperwork, and baking comes next! Also on the schedule, re-insuring my car, finishing my SHO paperwork, boozy lunch with Bren, numerous coffees with Sinead (plus seeing her in her GRAD ROBES!!! WOOT!), chilling with Greer, Cake with Des ('cause it's his birthday, and I plan on making him fat). By the end of this week, I plan on having a fresh polish on everything (my house, my car, myself!)... Spring-cleaned and lemony fresh!

I had a chance to catch up (briefly and loudly) with Lianne when she was in town, which was great! I wish we'd had more time, but she was minding her boy (who was borderline insane with stress) and I was on call. But it's great to catch up with everyone, even if it is rare and quick. We get to compare notes and see where the careers are heading... I still think we're all pretty cool. (Though Lianne is super cool... It's true, she just is).

Then just for smiles, I was briefly minding Luke yesterday. He's gotten SO big! But he is just about the most chilled out baby I've ever met. Totally calm for mass and a bbq with about a dozen loud people... and even without a nap, clearly tired as heck, he was an absolute trooper. And he really liked the aglets on Des' hoodie... A little bit of baby drool never hurt anyone, and it's in the wash now!

PS: Can't wait to get back to paeds...

Springtime...

Everybody knows
It sucks to grow up
And everybody does
It's so weird to be back here.
Let me tell you what
The years go on and
We're still fighting it...

~ Ben Folds

I know we're now just mid-May, but I have the sneaking suspicion that the time between now and July is going to disappear faster than cocktail sausages at fat kid's picnic.

I have a pile of things to do on my desk, things that keep landing in via post. I have to re-register with the medical council, I have to fill out my employment papers for my next job, I have to sign a new lease agreement soon, I'm re-insuring my car, I've tried to re-NCT my car, my taxes are actually due back home.

It's almost harder to believe that intern year is nearly over. Well, it is and it isn't... The final meds have their results and a large portion of them are off in Portugal to celebrate (Have fun, Be safe, God speed!). Come July, more specifically, 57 days from now (yeah... that's the countdown working there) I'm no longer an intern; I'm an SHO... It's debatable how much that actually means when it comes to Paediatrics; it's not like I'll have an intern... Back to the bottom of the pile... But I know the expectations change. And I wonder if I'm ready for that. I know I've been whinging about the current situation I have at work (Liz, the first-year-qualified acting reg slash intern)... But at the end of the day, I am still an intern. I do still depend on the experience of those working above and around me. The only reason the current situation is working out is that me boss is very accessible and encouraging and the others on my team are extremely pleasant to work with.

From a long-term perspective, I see 2 more weeks being reg-less, one week of which is heavy with call... A week off... A bank holiday... A week on... A week with my baby bro in town :) ... A family reunion on the other side of the pond! ... A weekend on call... Two weeks... Then sayonara internship... Scary.

For those of you that don't know, I'll be kicking off the new job as a paeds SHO in the ED. 3 months of straight paeds emergency. I figure it'll be a great way to determine if it's where I want to end up eventually. Not gonna lie, I already have the books out. I do need to brush up on my paeds, and I want to hit the ground running. But I can't think of a better place to start. Colour me excited.

So for the next 57 days, I'm trying to balance my busyness with my exhaustion with my excitement. Some tennis to keep me sane, some running again to get the lads in shape, and yoga for myself. Time with friends, time to study, time to work, time for call, time with the family back home. Bit of cleaning, bit of purging, bit of re-arranging the flat. Welcome to the life of an intern.

Also, from facebook... I've discovered that my 6th graders are about to be high school seniors!!! Oh my word!!!

PS: Sinead, please come home... miss you! And Des, CAKE!

If Your Doctor Told the Truth at 3am...

"In the end, when Mr Foster started coughing up blood the on-call surgeon was stuck in traffic, the nursing staff was busy losing the lottery, his original doctor was thanking a garbage man, and the covering physician was incapacitated. And what was Mr Forster doing? He was dying in the hands of the Interns! Does that about sum it up?" ~ Kelso, Scrubs

First off, uber mega congrats to the final meds who are done with their exams! I know the results aren't out until Friday, but have an awesome week! Unwind! Be nice to yourselves! You all deserve it!

I've been keeping a bit of a countdown going (as some of you know) until this intern year ends... It's my own form of therapy. It's to keep my eye on the prize. But I think I'm just now realising that as soon as that timer ends, all those final meds just slip into the vacant intern posts. I'm not sure I even remember how that was. There's a small part of me that knows I've learned a helluva lot since I started, but that part of me still tends to be drown out by the sheer volume of the gaps in my knowledge.

I have often wished that I cared a little less, expected less of myself, had lower standards, could just "turn off" the worry and concern. I can't. And that's one of the reasons I have been chaffing under the yolk of the job I'm in. I know how dangerous things can get on call. I know how close to disaster I've been. I know how thin the cover is. And I know it's only a matter of time before I run out of fingers to keep plugging the holes. So... as a bit more therapy for myself, I'm going to try to be funny (and bitingly real) about a night on call, and how that sometimes goes... For those of you that don't work in medicine, keep in mind, sometimes, you work a full day shift before this. Sometimes, you have to work the next day... Sometimes, it's just the "12 hour" overnight shift.

7:55pm:
* Drop bag in res
* Get arrest bleep from intern going off-call
* Ask if there's anything important I should know about...

8pm:
* Paged to chart warfarin - don't know the patient, don't know why they're on warfarin, don't know what their INR is today... they had 4mg yesterday... so... yeah, let's go with that.
* Paged to chart IVF - normal, healthy, young patient, fasting from midnight for a scope tomorrow... fair enough. Just some saline... What do you mean they don't have a cannula? Fine. Insert green line.
* Paged to r/v CXR for NG siting - Can't even see the tip of the NG because the x-ray is off centre. But sure, it's clearly below the diaphragm, so that's fine. Pull the wire, start the feeds.
* Paged to r/v desaturation - Patient ++BMI (like maybe 39), known COPD, known OSA, on home O2... For some reason doesn't have oxygen mask on now... Put on mask, sir. Sats back to 94%. No, that's normal for him. No I'm not doing an ABG, you took off his O2, that's why it was low. What do you mean he needs a cannula? You paged the team ALL day? Who did you page? Yeah, that intern was post-call, they weren't here. Did you page the SHO at all? No? Seriously? ... Insert gray line, just because I can, and because anything shorter wouldn't make it through the fat.
* Paged for warfarin x3 - yeah... ok... done, done and... Wait no... Why is this one on hold? Is it still on hold? The patient is actively bleeding from an ulcer?! No, I'm not charting that tonight... No, I'm sure. No, I won't ring the reg! If they're bleeding, we're not giving warfarin.

9pm:
* Paged to re-chart paracetamol - ran outta room in the PRN section, fine, rewrite and leave.
* Paged to r/v patient with chest pain - patient has pain... in the ribs... pleuritic... and oh... in the hospital for rib fractures. Why aren't you giving her the oxynorm? ... Because of the pain?... Oxynorm is FOR the pain (PALM-FOREHEAD)... No, I'm not doing an ECG. No I'm not doing a TNI. Give her the pain meds! That's what they're for!
* Paged to r/v patient with low BP - BP 105/60, patient sleeping... uh, let her sleep.
* Paged to r/v patient post-fall - patient is confused normally, shockingly confused now. No obvious head trauma, seems to have slipped onto the floor and landed on their bum. No bruises. Oriented in person... and that's about it... well... keep an eye on her. What do I mean? I mean neuro obs... About every 2 hours... Yes all fucking night. No, I will not order a CT Brain right now.
* Paged for IVC - Patient on 3 abx for VRE... yeah, I'll put one in. Patient has zero veins. So... you're telling me that the intern on the team, the SHO on the team, and the reg on the team couldn't get this cannula in and you expect me to get it now? Why didn't they get anesthetics? Fine... I'll try. (15 minutes later) Yes... there is now a cannula in their GSV, right leg. What do you mean you wanted it in their arm? No, I don't care. They have one in now, deal with it.
* Paged to chart night sedation - Patient 3/7 post respiratory arrest, normal sats at 92%, COPD... brittle... hm... No. No night sedation.

10pm:
* Paged for tachycardia - Patient "tachy" at 90. Usual HR is 85, BP was up, now low, mild pyrexia ... just vomited? Oh... Do they have an antiemetic charted? Ok, well why don't you give them that. No, the tachy is probably from the vomiting.
* Paged to r/v low urine output - post-op, no urine in the bottle... Ok, BP normal, IVF show roughly 1L in... Sir, have you peed? Oh, you walked to the toilet and peed? Ok... awesome.
* Paged to r/v need for IVF - IVF charted in kardex by team... What do you want from me? If the team charted it, give it. You seriously expect me to take what the team wrote down at 5pm and change it? No.
* Paged to remove abdominal drain - uh... ok? I've never seen one of these before. I've not only never seen one before, I haven't seen one being put in or taken out. Ring reg. How do these work? "You just take it out." Ah, ok, thanks for clarifying... I'll take care of that now. Look at drain closely. Pull on sterile gloves, pull off adhesives, study base of drain for sutures, cut those off, study drain again... Pull out... Dodge the shot of ascitic fluid that shoots out too... ew. Apply pressure. Apply more pressure.... Pager goes off, pager goes off, keep applying pressure. Pager goes off, what the hell, that's this ward! Apply dressing. Throw away all the dirty bits. Wash hands.
* Return pages - run around like a scut monkey for an hour...

11pm:
* Paged to r/v patient that is deteriorating - deteriorating how? They're NFR... ok... But how are they deteriorating? They're dying... right... I'd assume if they're palliative. But what exactly is wrong? They're chesty and it's upsetting the relatives... Ah... That I can do something about. Review chart to make sure I know the allowed intervention for patient. Chart comfort measures. Discuss with night staff. Pop head into room and have brief but compassionate conversation with family. We will keep him as comfortable as possible. Leave note in chart.
* ... Regretting the crap I ate for dinner...
* Paged to r/v patient that is "off" - Patient is definitely off... in fact, kinda turning blue, diaphoretic, complaining of pain... Shit shit shit. Throw on oxygen, sit him upright, demand to know why he's in hospital. Give neb, ABG, fbc, ue, coag + ddimers (I hate ddimers), two IVCs, ecg, and cxr... Ring the reg... Spew rough background and the results I now have... I think it's a PE... Well, should I start therapeutic innohep? ... Any suggestions? ... Right, ok. I'll do what think is best and since YOU would have to get the radiologist in, I'm just gonna order the CTPA for tomorrow then, yeah? Thanks.

12am:
* Now to catch up on the 14 pages that came in while dealing with that other gentleman...
* Rewrite kardex - meh, rewrite 2 items into new kardex and label it II of II. They should have done that themselves today
* IVC for 2am ABX - yeah, I'm getting the tired blurry vision, throw in a pink line because I can't deal with a green right now.
* Run a BNP from CCU - fetch the HF clinic key from the A&E office, plate the sample, start it running, leave the office unlocked, return the key, return to the office, wait another 10 minutes, take the print out back to CCU... this in no way changes the management... 
* First dose ABX x2 - patients sent up to ward from A&E without first dose given... nice...
* Patient with SBG of 24 - give stat dose of actrapid... as per the sliding scale... thanks for letting me know...

1am:
* Paged for IVC - Wait, that's my patient. He's not on IV anything. Go to ward, flip through kardex, yeah, that paracetamol is iv OR po... give it orally!
* ... Really should have peed earlier...
* Paged to admit patient - Uh... it's 1am, what the hell? No you haven't paged me about this! What do you mean they came up from A&E without an admission or kardex?! I'll tell you what, have another look, because if I get there and the patient has been admitted and has a kardex, I am not answering another page from you again. Swing through the A&E on the way to the ward, grab the "non-existant" kardex from the trolley, go up to the ward... Here's the kardex, there's the admission note. Thanks for calling.
* Paged to r/v irregular heart beat - well, they're in afib. It's slow. It's been previously diagnosed. They're on all the proper meds for it. No I don't want to do an ecg or TNI. No I'm not giving meds. Do you even know what afib means?!

2am:
* Paged to chart night sedation - uh... that patient is asleep.
* Paged to r/v agitation - Patient in alcohol withdrawal... Can you draw up a dose of ativan? I'll be there in a minute to give it. Oh you can't? Why the hell not? Ok... fine, I'll be there shortly. Get to ward, drug press locked. Would you open this? You don't have keys? Where are the keys? Right... sit at table and twiddle thumbs for 5 minutes. Ok, press open, draw up the ativan, No, I don't need you to check it, where the fuck is the patient? Meet patient, have a quick chat, patient lying in bed seemingly calm. So... Why did you think he was agit- FUCK! (narrowly avoid getting punched in face) Patient starts thrashing and spitting... Riiight... Ok, 3 nurses help hold him down and I give a stat dose of ativan in his left arse cheek. Chart it in the kardex, chart PRN options, chart librium, write note in chart suggesting pabrinex tomorrow.
* Paged to r/v abnormal potassium - K+ = 3.4 (normal for lab 3.5)... resist urge to strangle someone... "But, doctor, don't you want to fix it?" Yeah, give the guy a banana for breakfast... walk back to res.
* Hi bed... take of sneakers, take off steth, pull pen out of hair, sit on bed, pager goes off... damn.

3am:
* Paged to pronounce - Palliative patient has passed away. Get out of bed, put on crocs, go to ward and priest is in room with family. Will come back in a few minutes.
* Paged to CCU - chart Mg for patient with tachy runs, chart pain meds for NSTEMI that has no analgesia charted, give first dose taz to intubated patient with temp spikes.
* Return to ward, pronounce patient, write note in chart, sign mortuary tf form, explain the next few hours to the family. Don't know the answer to most of their questions as patient isn't actually mine, tell them to discuss with the nursing staff, and offer my condolences.
* "Doctor, since you're up..." - yawn, rub eyes, probably should have washed my hands. Wash hands, wipe down steth, sign for bloods tomorrow, chart stat dose actrapid from before, sign off on 2x MSU and 6x swabs, rewrite one page of kardex, insert IVC for patient fasting and on IVF (went with a blue line because I was lazy), change another patient from IV lasix to PO (mostly because it has the same bioavailability, but also because I don't want to put in another cannula).
* Paged to r/v increased drowsiness - ... Wait a sec... This is the patient I just sedated... They're supposed to be drowsy! Unless you'd prefer he be bitey and punchy?! I'll come by and reverse his sedation. No? Awesome. Bye.
* Paged to chart glycerin suppositories - No bowel motion for 2/7, not eating, poor PO intake, team did not start laxatives during the day... Uh... No? Then no.
* Walk back to res... hello again bed.

4am:
* Paged to r/v abnormal LFTs - JESUS! his AST/ALT are >1000... Oh wait, he's in for hepatorenal failure. And you're telling me that the team is aware of these? And they're actually getting better? What the fuck is wrong with you? It's 4am!
* Paged b/c patient on telemetry was bradycardic for 10 seconds - well... how brady? 46? uh... what's his regular? 60? And he's sleeping, is he? Uh... ok...? What do you want me to do? You just have to tell me? Great. You've told me.
* Paged to rewrite kardex - Uh... no. The team can do that in the morning. PS: It's 4am, what the hell.
* Paged to chart glycerin suppositories - Patient is in "agony."... pager goes off again...
* Paged for transfer letter - patient for coronary angiogram tomorrow. What time? 1pm? Fuck off.
* Ring back ward re: glycerin suppositories - speak to different nurse. No, patient is asleep. Was already given the suppositories, they just need to be charted... Oh they do? Well, I didn't authorise their use, so I'm not charting them.
... Quarter to 5... Try to go back to sleep.

6am:
* Paged to chart glycerin suppositories - Please, doctor, before the day staff comes on. No. *click*
* Paged for early morning ABG due as per the request of the consultant. Uh, define early morning? "Don't know. I guess before nine?" Right... I'll be up before 9.
* Paged for repeat TNI in A&E for an admitted patient - *sigh* go down to A&E. Where are the TNI forms? You don't have any? Ok... spend 30 minutes finding a new TNI form. Fill it out. Find the patient. Hi sir, I'm just going to take a wee blood sample if that's ok. "NO! It's not ok! Fuck off!" *sigh* return to nurses station. That patient is very agitated and is refusing bloods. "Yes, we tried and he said no, that's why we paged you." Ugh... Well he's refusing me too, so the team can do it in a few hours.
* Paged by A&E... wait, I'm effing in the A&E! What?! "We think this patient was supposed to be on ABX, but they were never charted." ... (blink, blink) I don't understand. "Well, the consultant said they might need ABX, but like... they aren't in the kardex." ... (blink, blink)... Uh... What exactly do you want me to do about that? ... "Well, can you check?" ... (blink, blink) ... Uh... Check what? Check the chart? Because, I would hope that you can read too... "No, check with the consultant." ... (blink, blink)... (blink, blink)... What? Wait, you're serious? It's 6am. The consultant will be in soon. I am not ringing him on his mobile to ask that!
* Paged to r/v urinary retention - "Patient hasn't peed in like 4 hours." ... I'm guessing they're sleeping? Four Hours?! Oh my God! I haven't peed in 10 hours! Fuck! Tell you what, I'll come put a catheter in him if you put a catheter in me... hello? I think they hung up on me.

7am:
* Go to ward and do the "early morning" ABG. Manage to hit the artery on second try. Take sample to CCU... machine broken. Uh, fine, go to resus in A&E... machine broken. *Sigh* Go down to the lab... swipe in... machine broken. Wtf... shit... There's another machine somewhere... where was it... Oh yeah, in the SCBU... Run the sample. Return the print out to the chart. Get asked to put in 2 more IVCs on that ward... I consider it... One of them is my patients. Put in that IVC. The other one... I just put that in last night. Oh they pulled it out? Forget it.
* Paged to chart IVF - No. Leave that for the team.
* Paged to admit a patient to dayward - It's like... 7:55. No. By the time I hang up this phone, it'll be 8. There's a different intern on call. And the team can be called.

8am:
* Page incoming intern - no response.
* Consider turning off my bleep, but generally leave it on until I hand of the arrest bleep so people can find me if they don't have their mobiles.

8:15am:
* Ring fellow intern - where are you? You're supposed to be carrying the arrest bleep... I'm tired.
* Paged by team back in hospital - "Why did you give those suppositories?" Actually, I didn't. Because I didn't think the patient needed them, I didn't authorise them. I didn't ask them to be given. Talk to the nurses.
* Paged to r/v patient for CXR - "Doctor, patient is for repeat CXR today. Will you come order?" Uh... who's patient is it? PS: NO! The X-ray dept won't be open until half-eight. I'm not on call anymore. The team can do it when they're here in 45 minutes. Calm down.
* Ring other intern - Just a heads up, one of your patients passed away last night. Their family is still here. Let your boss know?
* Paged to rewrite kardex - would you please fuck off.

8:30am:
* Ring fellow intern - seriously dude... it's been a long night. I have an hour long drive in front of me and about half a day of errands to do before I can sleep... Where the fuck are you?

8:32am:
* CARDIAC ARREST BLEEP - CARDIAC ARREST A&E! CARDIAC ARREST A&E! - fml... Run to A&E. Reg looks at me funny, why are you still here? Well... someone has to carry this thing. Nurse looks at me, "Are you the anesthetist?" (insert crazy laugh) HAHA... No... ED SHO rocks in, looks at me, "Hey, are you the reg?" (look at reg with super confused look on my face) Uh... no... He is. (look around... something like 13 people in the room now), Hey reg, can I go... Too many cooks and all? I get the nod, I leave.

8:33am:
* Drink bad instant coffee in the canteen.
* Look up and see fellow intern walk past with his team... wtf... Hey assclown, please accept this arrest bleep and slap upside the head as my parting gift. Hand over the arrest bleep and officially go off-call.
* Finish drinking bad coffee.

8:40am:
* Collect bag from res and head toward exit

8:42am:
* Run into team... Hand over anything and everything from last night that had to do with our patients. Remind them of 5 super important jobs that need to be done today. No... I'm not here today... I'm going to go sleep... Uh... No, they're not paying us post-call, so I'm going home. In fact, I just attended an arrest that I won't be paid for. I'll see you tomorrow.

9am:
* Dump bag into boot of car, climb into the driver's seat, start car, stare blankly at the low petrol light... damn. Swipe card won't open the gate... honk... Wait for security to let me out. Bye hospital...

9:15am:
* Fill car with petrol. Purchase another bad cup of coffee.
* Sit in rushhour traffic for next hour and a half...

10:35am:
* Park outside my flat
* Stumble down stairs and into room
* Strip... these dirty scrubs aren't touching anything in my room.
* Put on clean shirt
* Pass out, face down in my bed.

2pm:
* Wake up... wonder how many of the patients I saw last night are well... wonder if I made a mistake... worry that I missed something important... What if that guy was actually in urinary retention? What if me ringing the consultant and starting antibiotics would have made a difference for the patient? What if those LFTs had been really off, and I should have seen them, I should have reviewed that patient... What if I'd been wrong about that ABG and it wasn't improved? What if it was getting worse? Or if that guy that needed the TNI was actually having a NSTEMI and I didn't take the bloods because he'd refused? Well, taking them when he'd refused would be assault, but like, it might have saved his life?...
* Get up, shower, put on civies, run errands, try to be a normal person for a few hours...

"It's never easy when someone accuses you of screwing up, especially when you know it's true. When that happens you can't shrug it off, because in a hospital the best way to learn from your mistakes is to carry them with you." ~ JD, Scrubs

So... to my fellow interns, let's be sure we're learning from our mistakes. To the incoming interns, be ready to make a few... and learn from the experience.

Counting... down...

We've discussed what happens when I'm bored... But I think this just needed to be done:

The Countdown.

On grief... and giving it

I am not the first, nor will I be the last intern to express their dislike for the weekend-day call at my current place of employment. But let me again say that trying to be a full time phlebotomist while covering all acute medical beds, plus admitted patients still in the A&E and the patients in ICU/CCU/HDU is virtually impossible. That isn't why this weekend was particularly brutal.

I don't particularly like losing patients. No one does. (not even palliative... that's an old joke). But I do understand when people are actively dying and beyond the reach of western medicine to save. It's a knack; some people can't tell, some people can. And when a patient is dying, it's important to make them as comfortable as possible. I do that. Whether by charting comfort measures myself, contacting a senior to do so, or ringing the palliative team for advice. But as an intern, if the reg or palliative consultant says the patient needs further active management, my job is to do as I'm told...

Also, death in an acute medical hospital is not, I repeat NOT, the same as dying in a hospice. The intern on call is not a palliative care nurse. They do not have just the one patient, in fact, they do not have just the one ward to cover, they have the entire fucking hospital. And it's almost a given that there is more than one acutely ill patient, if not more than one that is actively dying.

Now, let's combine the situation of weekend-day call with three patients actively dying with no palliative input, no comfort measures previously charted, and a reg that is difficult to get on the phone (let alone get up to the ward to see a patient). Disaster. But for the first time since I started practicing medicine, I had a family accuse me of being a bad human being. They tried to "soften the blow" by assuring me that I was probably a good doctor otherwise, but I completely lacked all compassion and empathy. It would have been easier to stomach if it'd been the other way around. I spent 20 minutes listening to them dress me down, accuse me of not caring, accuse me of not knowing what loss is. Then I apologised and had to move on.

Now with some distance, I can brush off the whole thing. Partly because they said some ridiculous things, including, "The most important thing for a doctor is to be with a family and patient at the time of death. Medical emergencies can wait." Maybe in a hospice, but not when you're the only doctor for roughly 130 patients. But that doesn't mean I didn't leave that awful day in tears. And you know what I learned... To stay further away from patients and families at the time of death. Because I can't afford to sit in the res and cry for 20 minutes when there are so many patients that are unwell. And I can't afford to spend 30 minutes with a family when they express displeasure. And I can't afford to lose any more of my self confidence dealing with things that are so far above my pay-grade and experience.

Deep breaths

Finally a bit of good news...

Ok, it's not a bit, it's a huge chunk, a meteor of good news. I have my jobs for the next 2 years. I accepted the offer nearly straight out. It's a training scheme job (so it's protected), I'll be in Dublin for 75% of the time (and commutable for the other 25% if I'd like), the order of my rotations is practically perfect (I couldn't have designed it better myself), I'll stay in my current flat for another year (so no moving at the moment, woo hoo), and I can get by without really needing my car for the first year (sorry, Timmy, you're going to be upgraded eventually).

This is such an immense relief for me. Sinead said she could see me visibly decompressing... I feel better. It doesn't change what's happened in the past few weeks, and it can't make everything better. But from the job front, that concern is gone now. I can plan for things again. I can keep nesting my flat. I stay in Dublin. Whew...

Can't this time thing go a little faster?!

I'm back to holding my breath. I'm holding my breath for Wednesday night when I get the final word on jobs... Oh wait... I'm on call... screw that. Let's hold out for Thursday. I'm holding my breath, waiting to see where I'm going to live. I'm holding my breath waiting for words from home. I'm holding my breath in hopes that I've been horribly horribly mistaken. And I'm holding my breath for the next break I get.

I want to again express my utmost condolences to the Cutlers. I want to thank my brother for letting me know. I want my dad to know I love him, and want to give him a hug. A friend like Robbie is an absolute blessing.

I want to thank my brothers for handling Zadie. She was the sweetest kitty. I'm sorry I wasn't there.

I've had friends come and go in my life before. I'm sure there will be more that leave. But this time, it feels so much more painful than ever before. Maybe it's the timing... It's been a difficult few weeks for me. Maybe it's the sudden disappearance with no word... Maybe it's because I feel like a total fool in this, believing that people are actually good. So much for restoring my faith in humanity. My faith in myself. Time heals all wounds... But scars can last a lifetime.

I'd appreciate if my friends would stop giving themselves head injuries that land them in hospital, and avoid car accidents that wreck their cars. You two are lucky that I didn't kill you myself... And Aido, you're lucky I wasn't on call.

I really want to clean my apartment. My fingers are itching to scrub everything from floor to ceiling. I've been in a purging mood. I've rid my room of a few bags of baggage that needed to go. But I can't really settle down to clean properly unless I know whether I'm staying or going... Ugh Wednesday... I'm trying to distract myself. I'm trying to find things to occupy my brain. There's not much I can find.

I did make myself some cake... In a mug... it was worth it. I should probably thank the lads for providing some boozy distraction. And Shinners for the everything.

Legend...

Robert J. Cutler Obituary: View Robert Cutler's Obituary by The Boston Globe

I've known Robbie most of my life (or rather, I should say that he has known me). Robbie and my father were friends since they were terrorizing the Boston neighbourhoods as kids. They survived college, they survived the Navy, they survived business, they survived marriage, they survived moves around the country. When my uncle passed away, Robbie flew last minute to Florida (I won't say how) to keep my father company. He made numerous trips to Ireland for the craic. He loved golf. He loved the Red Sox (and pretty much all things Boston). He loved life. He was wild in a great way. Absolutely full of life to the end in spite of everything. Robbie, you will be missed.

Stay of execution or more anticipation... either way, it's killing me

So, as some of you know, I was on a week long holiday this past week. It was very very much needed. I was exhausted, overworked, and stressed out. I didn't do anything in particular with this week off. I cleaned a bit (not enough), I baked a bit (not too much), I had a few tennis matches (getting back into the swing... ha), I slept a lot... I remained slightly stressed out. But I certainly don't really feel like going back to work tomorrow.

As slightly more of you know, last Wednesday RCPI announced their 1st round offers for SHO. The emails came out in the early evening, well after the close of normal business hours. I was expecting that. But it didn't make the wait any easier. I have 3 very brief things to say about the results. 1) I did get a job offer, and I've accepted provisionally depending on the 2nd round. 2) While it took a few hours (and maybe a few drinks) to get my head around it, no matter what happens in the 2nd round, I'm happy with the job I have (or with whatever I may get). 3) The number of people that did not get an offer in the 1st round was shocking. I have a few friends that didn't get any offers, which is insane. They are ridiculously qualified individuals. And I have more friends that didn't get anything near their higher picks, some of whom truly deserve it.

So now we wait again... I feel like the next two weeks will pass a bit faster than the past few, and some of that is anticipating the job change in April. I need a change of scenery (and my apologies to John, I wish you had the same impending relief). The heart-wrenching thing is that with everything that's been going on in the past three weeks, there's one person that I keep wanting to tell, wanting to talk to... And I can't. It's not even that I'm angry, I'm just disappointed... It makes me sad... It makes my heart hurt.

So I've been distracting myself as best I can. I'm starting to study again (so much for the one year of no study), I've been playing more tennis than usual with 3 matches or drill per week. We had team tennis finals just this Thursday (go The Who!... yeah, we won), and I made little tennis ball cupcakes for the after party (bit messier than my normal work, but people loved them anyway). And in my head, I'm preparing myself for a massive change in July... Massive. But I'm not sure it's coming. I will wait on April 13th before committing to it fully. But change is on the way...

Like a top

Day 1 into my week off... I've half cleaned my kitchen, done 2 loads of laundry, gotten a much needed haircut, had a fight with my scanner, coffee with Sinead, and baked my first trial of cinnamon rolls (not exactly cinnabon, but damn close). It was a labour of love, and the recipe had to be modified, because I don't really know what they meant by "bread flour" (... not to be confused with plain flour which was also called for), and they don't really "do" margarine here in Ireland. Also, I don't have a kitchen-aid mixer yet. YET. And they suggested that it was necessary for the frosting. As per the above picture, I strongly disagree. My frosting tastes fantastic, and it was hand mixed (as is everything else I make at the moment). All these recipes that require dough to rise for an hour, then to be rolled/cut and prove again... It's a trial for me. I don't like waiting. INSTANT GRATIFICATION!

Now comes the important question... I've only filled the first 24 hours of what will probably be a 36 hour wait. What the hell am I going to do tomorrow?! My flat is going to be glistening clean. I'm going to sort a bunch of bank stuff. I'm going to "sleep in" as much as that's possible for me. But then what do I do after 11am tomorrow?! Waiting kills me. I feel like I'm getting wound tighter and tighter. It's giving me ulcers. This needs to be over. ... So here's another shot of yummy warm cinnamon rolls. Distraction.

Special booby prize

The longer I've been in Ireland, the less I've celebrated Paddy's day. I don't know if that's a product of me needing to be more responsible, of the time of year it falls, or of me just being old.

Two years ago, I was in Cavan on Paeds and spent the day studying... Mary and I did catch the tail end of the town parade and grabbed a few pints before cashing in.

Last year, the impending doom of exams had me staying in... And watching the entire boxed set of Father Ted while studying.

This year, I was balled up on the couch, dreading the fact that I was on call last night and suffering from a bout of food-poisoning, or noro, or repulsion.

I can't decide if what I had was food-poisoning or a 24hr bug. I did eat lunch in the canteen in Drog on Wed and exactly 8 hours later I was returning said food to the toilet. One point in favour of food-poisoning. But then again, I've been exceptionally stressed out the past two weeks. It's possible my weakened little immune system... wait, no, my hardened, over worked, super exposed immune system just kinda gave up. The good news is that I survived call in spite of vomiting up to about 4 hours before going on call, I did manage a small bowl of cereal before leaving for work, and I rehydrated without needing an IV bolus (though, Ben, I really was seriously considering it).

And now, post-call, post-ickiness, post "grown-up" Paddy's day, I get to start my week off... The only advantage of being on call yesterday night, I have Friday day off. Let the recovery begin.

Now accepting suggestions for de-stressing activities next week...

And in parting, here's a picture of the random ferris wheel outside my house. Oh the stuff that happens on Paddy's day.

Unacceptable vs. Unforgivable

I had planned to put up a post last weekend. But then I'd gone and left it for Sunday, and I was on call all day. And for anyone who hasn't experienced being on call at the end of the weekend... it sucks. So when I managed to drag myself home late Sunday night, I was in no mood to put up a post. To be honest, I'm not sure I am now. This week was horrendous. I would easily say this was the worst week I've had since I started in July and Tuesday is the worst day I've had... possibly in my life.

I'm not one prone to massive exaggeration, so bear with me here. I'm going to try to give it some context. I work on a rather large, combined team, medical service that provides, in addition to general medical hospital take, cardiology admissions, in hospital day case admissions, and overnight interventional transfer service. At full service ("full" in these recessional times), we have 2 consultants, 4 SPRs, 3 SHOs, and 2 interns (plus currently one very involved sub-intern who has been slaving to keep me from losing the plot... she is a star). That leaves a consultant, 1 or 2 SPRs, 2 or 3 SHOs, and both interns on the wards for the in-patient service. This past week, at best, we've been ranging at 1 consultant, 1 SPR, 1 SHO, 1 intern. I spent two days on my own on the wards from about 9-4... No Reg, no SHO... Needless to say, I've been in a few hairy situations that I'd rather not revisit. I've been working overtime that I'm never going to get paid. And I've been unduly criticized for holes in the work. I hated this week.

Things that are "Unacceptable":

• Leaving an intern alone to run an in-patient service.
• Belittling an intern for not doing a job that they've not been asked to do and is not in their job description (And thus are completely unaware of).
• Allowing an intern to lose confidence in their ability to practice medicine when they cannot fill-in for multiple missing people at once.
  
• Yelling at an intern in front of patients/staff/colleagues.

Things that are "Unforgivable":

• Doing all of the above at the same time.

... Dearest of dear consultants, this type of behaviour is the reason half of the intern class is planning on leaving. You will be short NCHDs for years to come. You will be sadly disappointed if you continue to expect interns to make up for missing SHOs (PS: especially if the hospitals continue to refuse to pay us).

This was the first time since I moved here that I thought, seriously and 100% thought about moving home... I thought about calling in sick because I was dreading the idea of being in work. I thought about quitting. I thought about yelling at my boss. I thought about refusing to do work while in work. And I imbibed more alcohol in the past week than I have in about a year... My current post is dangerously close to giving me an ulcer, or a drinking problem, or both.

On Tuesday, arguably one of the worst days of my life, I had 2 other separate blows. First, it was the day I needed to submit my preference form for SHO. I got home, 100% crushed, balled my eyes out, drank, tried to eat without throwing up, and then tried to figure out where I wanted to be for the next 2 years of my life, all the while battling the voice in my head that was screaming to just go home. I have not experienced such an evening in the better part of a decade, and the last time I had one of those, was in fact the worst day of my life. Thank you job... Second, I was seriously let down by a friend; nearly as soul crushing as the day...

Needless to say, I'm happy to see this week gone. Fuck you second week of March. Please accept my foot up your arse as a parting gift.

My holidays cannot come soon enough.

On Call...

"This is the reason why your headache didn't go away: That's actually pronounced an-algesic, not anal-gesic. Sir, the pills go in your mouth"
~ Turk, Scrubs

I'm fresh out of another night on call, one in which I managed almost 5 straight hours of sleep. It's pretty much unheard of. In fact, I woke up at 4:30am and checked my bleep just to be sure it was still on. Now, that doesn't mean that it was a nice call. It was just a call that involved "sleep." I may have mentioned this before, but I never actually sleep while I'm on call. I'm a light sleeper and the res is never silent. Plus, I hear ever other bleep go off, and the sound of an ambulance backing up sounds shockingly similar to my bleep. As painful as it is to not actually sleep, I'd rather that be my problem than being too sound a sleeper and not hearing the pages (esp with the arrest bleep, or "bomb" as Ben likes to call it, sitting next to my normal pager).

Maybe I was due a gentler call after the last night I had... I don't know. But I've decided that as I'm well past the halfway mark of intern year, I'm going to try to take a learning point or two away from each call I do. Lesson from Friday night: Lots of people want to be leaders, few people actually are.

The arrest bleep went off and I ran to casualty. Some people say that the interns aren't required at the A&E resus, but when that pager goes off, I'd rather be an extra hand than leave them short-handed. We have 3 designated resus beds, and there's no saying that there isn't another in process at the time. On this occasion, there was an ambulance 5 minutes out with ongoing CPR/arrest. One would think the extra time to plan would help... It didn't. I then participated in a 20-minute resuscitation attempt on a person who was, and I know this sounds cold but it's 100% honest, DOA. Why?

Why did we spend 20 minutes (and I'm not going to consider the cost of equipment and drugs) of time on this? That's the lesson. 3 people sort-of, kind-of, maybe tried to run the resus. The person most qualified had stepped back with the feeling of too many cooks in the kitchen. The next most qualified didn't take command of the situation, allowing a lesser qualified person to change the plan from something that was pragmatic and, well, sound to straight algorithm. And the 3rd person that sort-of tried to steer the ship had no clue what the defib was saying, authoritative without the knowledge. I was twice mistaken for someone I wasn't. I had to tell people that 1) No, I am not the anesthetist and 2) No, I am not the medical reg. Now, I do have to say that no one panicked, no one did anything stupid or harmful. We just spent too much time on a no-win situation.

I want to reassure people of a few things. First, under different circumstances (ie: the patient were younger, fitter, hadn't collapsed at home, hadn't been under 10min CPR by the family, hadn't had 40min CPR by the paramedics... It's a distance from A&E problem) it would have been an efficient and probably successful resus. Second, I (as well as most of the interns I work with) am ACLS certified. I wouldn't necessarily be comfortable leading an arrest at the moment, but I could if necessary, and I would if I had to. Overall, mark it down under things I'll try to do better/not do at all.

I did have another great learning moment on call. By pure coincidence, I was in CCU to put an IVC into a patient that had (just moments before my arrival) been due for central line placement. I bumped into the anesthetist who let me stick around and see the central line go in. Now, I've ordered them before, I've dealt with them on a day to day basis, but I'd never seen a central line get sited. And now I have... cool.

A lovely day break.

So... What do you do on a Sunday night in Dublin?

I have a few suggestions:

1. Spring Cleaning. Maybe it was the sunlight and mild weather on Saturday, but I did a massive cleaning of the flat. And since the place looks and smells clean, I bought flowers. The place has a fresh look and feel... Which makes it much nicer to come home to.
   
   
2. Bake cupcakes. Much to the chagrin of my roommate, I'm working on certain baking skills, including what I'm going to call "Gourmet Cupcakes." I bake because it's cathartic, and relaxing, and you have a sharable happiness that comes out of it (as long as you don't burn it). Now, this time around I was making cupcakes for a friend's birthday... And I was putting a little extra on it. It was an experiment. I've never tried anything like it before. But I have to say, they turned out quite nicely, no? I think I'm going to be attempting a few more creative designs in the near future... In all this spare time that I don't actually have... Whatever. Watch this space. But I owe my roomie an apology for torturing her all day with the constant, "Hey, look at them now!" and then telling her we couldn't eat them yet... Sorry.
   
   
3. Catch a show. Saw a fantastic concert last night at the Olympia. First of all, they didn't lose power (sorry Coronas... I know it wasn't your fault, but that did make it a rough evening), though there was a moment with a bunk guitar... Fixed and show barely paused. The openers were a group called The Shoos - a Dublin based band, eclectic group of lads, but a great sound. I'm hoping to see them again in the future (and given that they're opening for a few more bands in the Dublin area, I'm sure I will). Good luck to them with the EP coming out in April! The Shoos were opening for Lifehouse... a band that I've been listening to for more than a decade, but have been around longer than that. Most people know them for their softer, ballad songs, but I will say this: Lifehouse ROCKED. Good job guys! Returning to Dublin for the first time in 9 years, they went through their whole catalog of music, which was brilliant... and a little bittersweet. It was almost like taking a tour through my past dating life... I've had a few of their songs intimately tied to a significant other, including songs being dedicated to me, sung to me, or being 'our song'. It would have been awkward had the songs still made me cry... seeing as the company I was in... But I do have to reiterate, Lifehouse was brilliant! They need to come back to Dublin more often. I'd see them again in a heartbeat.
   
4. Remember the closing time of the public ramp you park your car in... Yeah, that one is a little self-explanatory. Sorry for being a brat about the bill. Sorry for delaying that last 10 minutes. I'm glad we rescued your car!! It would have been fine if we couldn't, but I'm glad we did...

All these things served 2 main purposes... 1. Happy Birthday Muireann! (I hope you had fun!) 2. I'm avoiding thinking about how stressed I am for the impending SHO interview on Thursday...

New Year - New Job

Welcome to Drog, Welcome to Medicine, and Welcome to... well... I don't even know what to say about this.

The mental shift from surgery to medicine is taking me a bit of time. After 6 months of being decisive, cutting, stitching, and sending home, I've found myself with patients that on average are in hospital for months. The mean age has increased, the average amount of time with us has increased, but I have the distinct feeling that what I'm actually doing for the patients is bottoming out at less. The pace is slower, the ward rounds are longer, and the "let's see if this works" takes longer to see than in surgery.

While this is all going on, I've a few things on the front burner - like SHO applications. The most recent landmark of which was a 24hr delay in finding out about interviews. And in my mad panic, Bren reminded me that after 5 years here, I should be darn used to it... And I've come to expect it... But I'm a worrier. And not hearing anything had me sweating. Interviews are coming up soon... Ugh, I need a new suit.

On a similar vein, how the hell has it become February?! There's a part of me that can hardly believe that I'm a month into my new rotation, a month into medicine, and over halfway through my intern year... It's flying. I think in a good way, but in the back of my mind, I'm realising that I'm going to be an SHO soon. That's scary... That's really really scary.

The French are in town this weekend for the Six Nations Rugby... This does not please me. First of all, Rugby weekends make it nearly impossible to do the things you do every weekend just to keep the house running and yourself fed. Second, the French tend to make more of a mess of city centre (not rubbish mess, just walking/pedestrian rushhour mess) than the other blokes that come around. Third, some jerk knocked me clean off my feet yesterday. I've a bruise that covers the bulk of my left side (thigh to mid back) and my neck is killing me... Merde.

Monday is bringing my least favourite holiday, what I tend to call "Singles Awareness Day" or SAD for short. It's one of the worst days to be single... Having everyone remind you that you're single... At least there's a lot of good chocolate around. Mmn Chocolate!

And I think I'm going to leave it at that... Chocolate. Yum... Happy thought of the day.

About that letter...

"You see, I can't survive on my own. Even now, when I finally get to go home, in the back of my head, I'll know the hospital's still here, wide awake. But what the hell. The most important thing is that I got through my first three days without looking like a complete idiot... I'm the man."
~ J.D.
(and anyone intensely familiar with Scrubs knows that he promptly walks into a door)

Hi there 2011.

That's right, I do have a letter to myself. I did read it on NYE. And I did write a new one on Jan 1, 2011...

For those of you who don't know what I'm talking about, allow me to explain. A few years ago, I stopped making a list of resolutions and adopted a new plan. I write a letter to myself. I carry the letter around for a year (it's normally tucked away in a small pocket of my bag). Then I read it on NYE (or NYD). Last year, being a fresh decade, I wrote two letters to myself, but then I only get to read one this year.

I'm not comfortable publishing the entire letter online. It's too personal. But there are a few main points I made to myself last year; those I will share.

• Be Loveable - in the sense of embracing myself and loving me.
• Plans are... like peeing in the ocean - No, Joe, I didn't write that for you specifically, but think about it. You know I'm right.
• Life isn't fair, get on with it - don't take the important people for granted.
• Lose the baggage - it's not just that I'm a pack rat... I carry everything with me.
• Polish your halo - be good.

I asked for 3 main things for myself... I managed 2. And as Meatloaf says, two outta three ain't bad. Recurring phrase: Happy Bunny! (for those of you in the States, this is NOT the same as chubby bunny).

2010 was a good year. It was intense, it was full of change, it was scary, and it's over. To my friends: thank you, you are amazing.

To 2011... Bring it!