Eli the intern

2010-05-22T13:18:00.003+01:00

Good morning, or whatever time it is while you read this. I've been home from Ireland for less than a week. The last month has been a whirlwind of exams, details of a new home and newer floors, packing, escaping from Ireland before the volcano could cause me any trouble... Once landed I've gotten various forms of insurance, registered my car, and done all of the other things necessary for a new house and life. The next week will be all about packing and moving to Northampton with Kate. We'll have a few weeks to paint and move in before I start the doctoring at Baystate. An exciting time to be sure.

It was strange to leave Ireland. My last exam was enormously exciting and relieving. I had the exam in Tralee, so we had a 2 hour drive back once the day was over. We had champagne and beer for the trip back, and the mood was quite different than on the way over that morning, as you can imagine. The following several days involved recovering from the night before, packing, seeing friends, and taking in my last days in the city where I spent the last 5 years.

I'm picking up this paragraph some weeks after writing the first two. Life has been good, and busy. More painting has been done (with more yet to do, probably today!) some artwork has been hung. We've had some people over so the house feels more alive. New cichlids have been added to the tank. And I started at the hospital. I have to say everyone at Baystate has been great. The other interns are an interesting, friendly bunch that I'm looking forward to working with for 3 years. Talk about a diverse group. Different ages, family status, countries of origin, countries of education... Fascinating. Plenty to learn both in and out of the hospital! After a week of various training and orientation we had our first few days in the hospital. They are taking it very easy on us to make the transition smoother. Four of us to one patient, no real responsibilities except learning the electronic charting and figuring out how to report back to the attending. I will be starting in outpatients tomorrow, where we will continue to have a day or two of orientation and shadowing, and then start getting our own patients. It's all very exciting, and still only mildly nerve-wracking. I hope the balance stays that way!

I'm not sure how this blog will continue. I know I don't want to be worrying about patient confidentiality issues, so I will stay far away from that. Hopefully I will have the time and energy to continue to write about my experience as a resident, and thoughts about medicine and life. Stay tuned. The blog title no longer makes much sense so don't be surprised if that is different soon too!

Thanks for reading these 5 years. Talk to you soon.

Eli

2010-03-31T20:03:00.002+01:00

You can tell it's exam time because the days are getting longer, warmer, and sunnier. How's that for a mixed blessing?!?!

2010-02-20T07:41:00.002Z

Hi all. I know I haven't posted in a while. Have been having trouble keeping up with my email as well. I wonder if the moods that allow both to happen are related. Anyway, where am I at? At where am I? That's the ticket. For the last two weeks, and for the next two, I'm in Limerick in the pediatric department. I'm learning a lot there. Lots of kids with CF, and a wide assortment of other problems. There's an outbreak of measles currently, due largely to the bozo Wakefield in England claiming the MMR vaccine causes autism. Another out break is in the Traveling community here; they're a group of gypsies, basically, though racially they're Irish. Because they move around so much it's hard to make sure they get all of their immunizations. This year has been bad for measles in Ireland. Luckily the vaccination rates are back up to nearly what they were before all the damage was done.

I suspect most of my readers (are there any any more?) know, but I do have exciting news. I will be starting as an intern at Baystate Medical Center in Springfield, being trained in internal medicine. This is great for a number of reasons. Being close to my family and being at a great hospital being two of the most important. Only 6 weeks left in the hospital here! Then 2 weeks of study time (or perhaps 1 week to travel in Italy and 1 to study) then a month of exams, then I'm done!! Hard to believe. This time feels to have gone both quickly and slowly here. I suspect I will have a more reflective blog entry in a few months once I've finished here.

That's it for now. I've got to apply for a Massachusetts medical license!

2010-01-10T16:50:00.003Z

I suppose I've not been great at sharing my experiences this year. Haven't felt particularly motivated for whatever reason. Trust that I've been keeping busy! I'm now only about 4 months from finishing my degree. Wowsers. That's mostly what's in my head these days. Perhaps once some of my school work and residency stuff slows down I'll find the muse to write some more. Until then, here a few pictures of the "extreme weather" we've been having in Cork. The flood picture is really quite mild compared to the destruction in caused the the center of town (though the stairs to a rehabilitation hospital is not really an ideal spot for a waterfall), and the winter shots are what happens when you get a hard frost in a country as humid as Ireland. It's snowing as I type, so perhaps I'll include some pictures from that soon.

2009-09-21T19:20:00.001+01:00

Oh yeah, some of you probably want to know what happens at the end of this year. I've applied for emergency medicine programs. Many of them. All over the country, pretty much all 4 corners. It's really a waiting game at this point. Perhaps I'll see some of you when I go for interviews (keep your fingers crossed). More news as event warrant.

2009-09-21T18:42:00.009+01:00

I still haven't taken pictures of my new place yet. A thousand pardons.

After a week of lectures, some of which were great, I started in the hospital. My first rotation is surgery, and the first 2 weeks were with a colorectal team. Interesting medicine, and interesting doctors. One an older, revered Professor of surgery, who has a very old-fashioned, and enormously educational teaching style. He really believes that teaching is as big a part of his job as practicing medicine. The other man has only been in Cork a couple of years, but is also a great teacher, and his patients love him. For the next 2 weeks (one past, one coming up) I'm in Mallow, apparently the ancestral homeland of Tip O'Neill. Things are a little quieter up there, so I'm getting to admit patients, take bloods, ECGs, etc. It's great, and reminds me that I learn much better from doing than reading or watching. Though it feels all too familiar from other times when I've been stationed out of the city, I'll include some pictures here for your enjoyment or what have you.

The top one is the view from the res. Pastoral, no? The other three are my room. It's en suite and everything. Not to shabby. Its only draw back is the view:

Not that it's an ugly hospital, but I generally don't like to live in sight of my work. Here's a picture of the hospital from the front:

One evening I took a walk into town looking for a cyber cafe. Though we have internet access, email is blocked.

The top picture is this old building with a forest inside. I thought it was cool the way the trees were coming out the roof, door and windows. The next is a restaurant I passed on my walk. Perhaps Kentucky has a meaning I'm unaware of? The last is just some pretty berries I saw. I didn't eat any of those, though I did stop to munch some blackberries growing beside the road.

That's enough for one evening. Thanks for stopping by.

2009-09-21T18:09:00.004+01:00

Well, here we are again. I'm a little later than usual with a summer update, but things have been busy since I got home in late May. To start with, I went to a reunion at Macalester with the Traditions, the men's a capella group I was in there. It was a blast. Josh and I stayed in a dorm room together, surrounded by other Traditions and reunionites.

It felt a lot like being in college again. It even smelled the same. Though now this dorm has an elevator, which would have made getting to and from storage in the attic a lot easier. Oh well. There was much frivolity, usually involving singing, liquor, or in true Trads fashion, the combination of the two.

It also proved to be a great time to catch up with many of my other friends who were in town for their 10th reunion. Hold on to your hats/seats, but my 10th is coming up. It's unlikely that I'll get to attend, but it's amazing to think about. By that time I will have lived in Cork for as long as I lived in Boston. And who knows what's next?!

That weekend was also host to a local street fair, Grand Old Day or something like that (it happens on Grand Ave.) I got to eat cheese curds, talk with an old friend, and see my friend Casey perform in his hip hop role, rather than as a goofy a capella singer. An excellent weekend all around.

The day after I returned from there I started at Baystate Hospital for my month-long elective in emergency medicine. If I was a better person I would have done more writing as I went through that experience, but I'm not, so I didn't. It was a great month though. From the staff at the parking lot through to the Chief of the department, everyone was friendly, helpful, and seemed happy to be doing what they were doing. It was eye opening, considering how cranky the nurses and porters tend to be in the Boston area. I got to examine and take histories from patients, help form treatment plans, learn (and utilize) new suturing skills, spend time in the sim lab, have tutorials, drink bad coffee, and spend an evening with some paramedics. I loved it. So many patients, so much pathology. My first shift epitomized what I love about emergency medicine. As I walked in, there was a patient crashing after a crack binge, someone who had had a stroke, and a child having an asthma attack. There are few, if any, situations outside of an emergency department where all of those people present at once.

A couple of patients stick in my mind. One was a 100 year old man from Kerry. He didn't seem at all surprised or interested that I greeted him in Irish, but his children were delighted. He was fine. 100 years old and didn't need a single pill. Another woman came in with benign positional vertigo, which anyone who has had it will tell you is far from benign. Anyway, in the course of investigating her illness we ran some bloods and it turned out she had a million platelets. The normal number would be somewhere between 150-400. I never did find out what that was all about.

As soon as that month ended, I was straight into studying for the USMLE Step 2, a continuation of the licensing exam I took last summer. Lots of studying. I did much better this year than last, which is a relief. The scores are an important part of my application for residency, especially coming from a school abroad. One of the exams (it was a 2-parter) brought me to Philadelphia where I got to catch up with some more old friends.

It wasn't all work, though. I had 2 wonderful weekends in Maine with Kate, and lots of visits in between, since it turns out Middle St. is closer to her job than her own apartment. She was also able to join us on the Cape for a few days which was excellent.

All in all it was an excellent summer. The work was rewarding, and my time with Kate and my family was marvelous. Or "grand, like" in the local vernacular. This brings us to the start of the school year, which we're all expecting to be my last. But that's for a different post.

So long, and thanks for all the fish.

2009-05-25T22:07:00.002+01:00

I was kind of dumbstruck when I saw this advertisement. I'd be interested to hear your reactions!

2009-05-09T07:36:00.002+01:00

I realize it's been a while since I've written, and between exams coming up and the busy June I've got lined up I don't know when I'll write again. I may as well put my early mornings to good use.

I spent the last month on the psychiatric inpatient ward, which also included some time in the outpatient department. Because of limited resources, the people who arrange to get themselves admitted in the unit are really quite ill. Schizophrenia that's not responding to treatment, bi-polar disorder that becomes destabilized... I'd say 80% of the inpatients I saw fit into one of those two categories. It was an interesting month, to say the least. Besides learning about the pharmaceutical options of treatment, which are mainstays here but a relatively small part of the job, I also got a peek into the multidisciplinary approach they take here to mental health. Again, only with the sickest of the sick. The MDT meeting I went to consisted of a few psychiatrists (one consultant, 2 trainees) a couple of community nurses, a social worker, an art therapist, and maybe a couple of others. They talked about all of their cases, and made sure that living arrangements, medications, home visits, and social/activity lives were all maximized.

Now that that's over I'm headed into 3 weeks of exams. 2 next week, 3 the following week, then one more right before I come home. I land in Boston on the 1st, and then head out to a Trads reunion in St. Paul for the weekend, before I start my month in the Baystate emergency department. Hopefully I won't see any of you there!

Not much of an update, I understand. Such is life.

2009-04-03T18:20:00.003+01:00

What may be difficult to discern is that there is a heron of some sort (Great Blue?) standing there. This shot was taken in the middle of town, maybe 100 yards from the fast food joint people go to at the end of a night of drinking. One of the benefits to having two rivers run through a city!

If anyone was curious as to the cause of the economic troubles currently affecting Ireland, I would propose that having signs like this probably isn't helping.

2009-04-03T18:04:00.003+01:00

I recently took some pictures of my walk to choir rehearsal. It's about as convenient as using sugar packets to bake a cake, but it's a lovely walk. I thought it would make more sense (read: easier for me) to just upload them to my picasa web album, for which there is a link on the right. Look for the album called Sunday's Well. Enjoy!

2009-02-15T14:22:00.002Z

A little something different... I have to write a "letter of intent" to the director of education in the Baystate emergency department as part of my application to do an elective there. I'm not totally sure what should be included in one of those, but here's what I've got. What do you think?

I first became truly aware of emergency medicine as a summer camp counsellor in rural Vermont. With so many children running around in the woods for so many hours each day, accidents were bound to happen. Coincidently I was around several of the worst ones, and felt horrible that I didn’t have any skills to deal with it. A friend steered me towards a wilderness emergency medical technician class, and it was exactly what I was looking for. It gave me a way to approach “the sick and injured”, as the text book says, and consequently how to take each emergency in stride.

From there I went on to use my skills in the more formal setting of an emergency ambulance service. In that environment I was introduced to the breadth of patient population, variety of medical, surgical, and social complaints that occur in a day, as well as the odd mixture of intense excitement and dreary routine that emergency medicine offers.

Several years later, I find myself in a position to advance my medical knowledge and practice, and am exhilarated by the chance to get to sample and learn so many different aspects of medicine as allowed by program in the fourth year of training here. I find it easy to get excited about each new subject -- cardiology, nephrology, neurology, ophthalmology, urology. But how could I possibly choose between them? There isn’t a single body part that is without wonder, a single organ system that doesn’t awe and intrigue me with its intricacies. Of course these thoughts take me to emergency medicine. What better place to be to see a wide variety of pathologies than an emergency department? The variety combined with the fact that so much of emergency medicine is based on problem solving is extremely appealing.

Though I sometimes wonder if I would miss the ongoing relationship that is found in a primary care setting or with other chronic conditions, I also have cause to remember all of the unusual relationships formed between emergency staff and the repeat customers to the emergency department. Perhaps they aren’t the archetypal physician-patient relationships of old, but they are just as important to the people in them. I also learned how to create rapport quickly with my patients in the ambulance, and I think that is a skill that will be quite useful to me in a career in emergency medicine.

It is hard for me to see too far past my immediate future; I have so much to learn in the remaining year and a half of school, and many years of education after graduation. Emergency medicine offers a lot of choices that suit me in that regard as well. I would like to get involved with prehospital care again, and I would like to expand that interest into disaster medicine. Though most specialties can be useful at a mass casualty incident, the aspect of emergency medicine that is making organization out of potential chaos is attractive to me.

I also believe I have a lot to offer Baystate. Since I grew up in Amherst I have the desire to care for the community that Baystate serves. My time at the Caring Health Center has introduced me to a part of the local population I was unaware of, and now have a good idea at some of the struggles the underserved population of western Massachusetts faces. My undergraduate degree was in Russian Studies, which I believe leaves me especially able to communicate with a large portion of the immigrant population of the Springfield area. My time as an EMT working in a busy city has shown that I can handle, and even thrive in the hectic atmosphere that can be emergency medicine, and my other life experiences have taught me both how to be a good team member as well as how to lead.

I look forward to the opportunity to work and learn at Baystate. I think we have a lot to offer each other. Please do not hesitate to contact me with any questions.

2009-02-15T14:02:00.002Z

Wowsers. Zounds. Gadzooks. It's been an exciting couple of weeks in the maternity hospital. A particular highlight was when I stayed until 2 in the morning with one of the SpRs while he was on call. In the course of the day I saw 3 forceps deliveries (including the rarely seen beast of a Kielland forceps assisted turn without an episiotomy), 2 ERPCs, and 4 c-sections. Two of those I scrubbed in on simply to stand closer to the action, but for the second 2 I was actually the obstetrician's assistant.

I was struck by a number of things that night:

C-sections smell funny. It is likely that all abdominal surgeries smell funny, but so many of the ones I have seen have been laparoscopic so they weren't as fragrant.

The first cry of a baby as it gets pulled out of the uterus is amazing.

I imagine c-sections might feel anti-climactic to the parents. After 10 months (where did this 9 month figure come from anyway?) of pregnancy, 10 minutes later they're holding their baby (shoot, only two forms of the word 'there'). I realize there are a lot of good reasons for having a c-section, but in my inexperienced mind labor is an important part of the entire process.

Those of you who are parents might be familiar with all this, but it has been exciting to experience for the first time.

I've also been to many clinics, both obstetrical and gynaecological, and so have seen consultations with woman with uterine and ovarian cancer, prolapsed wombs (a better sounding word than uteruses), amennorrhea, and other problems. The doctors are all wonderful, both to their patients and to their students. Encouraging us to stay late and get involved, and making sure we're getting exposed to as many different aspects of the specialty as possible. It's been a real treat not to feel like an after-thought.

Ciao.

2009-01-15T22:51:00.002Z

A few odds and ends (a great Dylan song, BTW) from the last couple of weeks. First of all I should say that my mood is the best it's been in probably years. Not sure what all that's about, but I have a few ideas. I don't necessarily care, either!

On the way back to Ireland after a wonderful vacation I had two exciting sitings. The first was Cornel West, who was on the plane from Logan to Newark. A tight, ill-fitting suit and an enormous afro made for a hard-to-miss event. I realized I don't know a think about his writing/thinking, so if any of you know something of his worth reading (and also accessible) let me know. The other was a ring necked pheasant along the side of the road in Shannon. Gorgeous. I had just gotten off a red-eye, so it's possible I was hallucinating, but probably not.

My time in Limerick was fine. I was staying with an obsessive compulsive, ultra Catholic woman and her husband, who were both slightly racist, and generally afraid of unfamiliar things. Very much enjoyed reading, watching, and talking about sad/scary things going on in the world, particularly medically related ones. The ENT was OK. They were all very nice, but not yet used to having students around. A lot of the job is looking in people's ears and clearing wax out, or telling parents that it's been a bad winter for ear infections, and no actually, your son or daughter does NOT need grommets thank you very much. I got to scrub in for one surgery so that I could stand closer and see more, but even then they're operating on such small areas that it's hard to see much. My last patient before I left early (to make it to a choir rehearsal) was a lady in the ICU who had bleeding varices. For some reason the blood that continued to ooze after she was fixed congealed in her oesophagus instead of going into her stomach, so she had a huge clot gumming up the works. Two different gastroenterologists had already tried their hands at solving the problem, to little avail (is that an acceptable phrase?) so the ENT consultant tried (his equipment was slightly different, which may have accounted for his success) and was able to vacuum out the rest of the clot.

I'm excited about choir for the moment. Some Tchaikovski, Schubert, Vittoria. Beautiful stuff.

Bedtime for Bonzo

2009-01-11T08:48:00.004Z

Now it's time to catch up a little bit.... Where we last left off I think I had just had a really interesting couple of weeks with neurology. The two weeks previous to that was spent with a nephrology (kidney) team, and it was fantastic. The doctor in charge is notorious in the hospital, as are his two brothers who are also doctors in CUH, each one taller than the next. The nephrologist is the most wacky, however. Imagine Groucho Marx as a brilliant doctor, and you're in the right ballpark. I learned a ton. We got regular little teaching sessions about medications or dialysis or other conditions, and rounds with the team were very informative because there were a lot of patients so it was easy to learn by repetition.

Your plumbing, on the left, and your kitchen's plumbing on the right. Are the shapes a coincidence? Well, yes. This part of the blog was inspired by coming home to make dinner one night only to find the sink plugged with rice. Similar to the problem kidneys can have with contrast media.

What I think is so fantastic, though, and may have already mentioned, is that it really made me feel like I was a medical student, and helped me to see the light at the end of the tunnel. I was treated as someone who needed to learn medicine for the purpose of being a doctor, not as a student who needed to be kept busy. My mood continues to be elevated, even more so after a restorative couple of weeks at home.

I don't expect to write too much about the next month. I'm spending two weeks in ENT (or otorhinolaryngology if you want to give your tongue and spellcheck a little practice) in Limerick. The teaching is pretty good, but I'm just not that interested. We spend most of our time in outpatients, clearing a lot of wax from people's ears. That whole thing about never putting anything in your ear smaller than your elbow is true, by the way. Cotton buds really foul things up. I'm staying with a kind woman who appears to be afraid of everything under the sun. God, MRSA, dirt, water getting on the floor of the bathroom. The place is right across from the hospital, though, which is convenient. There's a couple of pubs, restaurants, and a Tesco nearby, so even though we're on the edge of town it's convenient enough. After this is done, I'll be spending a week with vascular surgeons and a week with urologists, both at the Mercy Hospital in Cork. That trifecta has earned this month the moniker "the tubes rotation."

Hello, I must be going.

2008-12-06T08:16:00.002Z

I had an unbefuckinglievable day yesterday. I know I haven't written about the first half of the rotation yet, but I'll do that soon. I've got to get this down on paper first. The only background needed is that I'm with neurology these days...

The day started earlier than usual with rounds in A+E at 8. The first patient was a young German woman who was having some unilateral numbness, decrease in power, hyperreflexia, and some cerebellar signs. Unfortunately MS is high on the list of possibilities for her. She's going to need an MRI, and possibly a lumbar puncture to look for oligoclonal bands. It was interesting to see a possible diagnosis from the beginning. As for now her story is unfinished. Still waiting for the MRI.

Next we went on to see an young American woman with a crazy medical history. I'll have to remain vague in this forum as the details could theoretically reveal who she is to people who know her. She has a long history of a heart condition, and seizures are some of the effects of that. After her seizures she gets an atypical presentation of Todd's paralysis, which I had never seen before. It was interesting to get to talk to someone who is very familiar with her own medical condition, and I think she appreciated having another American to chat with. I think she's a republican, but I'm trying not to hold that against her! I also did a little research for her and for us as she used brand names for medications, and those are different from country to country. Another good reason to stick to generics. She had another seizure during the day, but was more or less OK. We don't know much more about her at this point either -- she'll need an EEG, though that's unlikely to show anything.

The third patient of the day was a young Polish man (are there any Irish in the hospital ?!!?!) also with a seizure history. He had had an attack, as he liked to call it, the day before, but was still quite confused. Though it's not unheard of for the postictal phase to last a few days, it's not particularly common either. His wife said this is normal for him, and that he was frequently confused, agitated, and slightly agressive. He, too, got an EEG, which luckily for him meant he didn't need a lumbar puncture. We got a phone call from the neurophysiologists while we were seeing some other patients -- the man in A+E was in a non-c0nvulsive status epilepticus! Never heard of that before, much less seen it. He was constantly seizing, though without motor involvement so it wasn't obvious. But it definitely explains his confusion and other neurological symptoms. Crazy.

After we got them squared away we went to do some consults that were requested by other doctors in the hospital. The first was a young woman who was brought in by the neurosurgeons because she was having headaches and spells during which she got "spacey". The MRI had signs that initially looked like a tumour to the surgeons, but is more likely to be a herpetic encephalitis. An unusually non-dramatic presentation of the illness, and also unusal because our patient had no other signs of a herpes infection. She should be well after two weeks of intravenous acyclovir.

The next man is another foreign natural who presented with a constant throbbing headache and a 6th cranial nerve palsy with very easily elicited eye-movement signs. His MRI showed a lesion of some sort in his frontal lobe with tons of oedema. As part of the work up he was diagnosed with advanced AIDS. As we were getting ready to leave the ward we got a call from radiology that his CT thorax showed what was likely to be a splenic lymphoma, so the lesion in his brain was likely to be lymphoma as well.

At the end of the day we went to visit another interesting, potentially exciting case. About a month ago a man fell and has been in hospital for the last three weeks with an enormous subdural haematoma, essentially in a coma. The night before last he started opening his eyes to command, squeezing our hands on command, and appears to be trying to speak. A most unexpected turn of events. It's still unlikely that he'll regain much function, but he also wasn't expected to do this well, so the neurosurgeons will reevaluate after the weekend. What was particuarly poignant was that at the same time as this man was making a recovery, a patient in a different bed in the same room was receiving his/her last rites. A perfect microcosm of the joy and sorrow present daily in a hospital.

I felt like I had had too many cups of coffee by the end of the day I was so revved up. I relize Ian may be the only person who finds this day as exciting as I did, but I feel quite lucky to have seen so many interesting patients and pathologies all in one day. I've been having a great time in the last month particularly, and I think it's a good sign that medicine is what is helping to break through the low mood I've been battling for the last few years.

More tales of my time with nephrologists to come....

2008-11-10T21:32:00.003Z

"I know why North American students are outspoken. Tell me if I'm talking through my hat on this one. It comes down to one factor really, show and tell." This was early on in our last lecture of the day, which was from a geriatrician, and purportedly to be about delirium. A topic he didn't actually get to for 45 minutes. He went on to explain that while at first glance show and tell seemed to function as a way to teach about the life-cycle of hamsters and other such pets, really it was to get us used to speaking in front of people.

And so the lectures continue. They range in topic from international paediatric care [as an aside, I'm listening to Leonard Cohen sing about being KY Jelly. WTF?] to blood-borne viral illnesses to the biochemical principles of blood lab tests. Ooh. and forensics. All sorts of pictures of dead bodies, taught by a woman who I believe is the model for every medical examiner you have ever seen on screen. All in all a pretty good deal. Most of the lecturers seem pretty glad to be there, and do a great job making the subjects interesting and make sense. I've found the lectures that are the best are when the lecturer clearly has respect for his/her profession, patients, and us. It really makes a difference.

For instance, this doctor who is in charge of the blood lab. We're all used to radiology as a specialty, but don't really think about the lab as anything but a place where you send icky stuff and get back useful numbers. But of course, it's actually the same as radiology, in that the doctor uses clinical information we provide him to help make sense of the information that the tests produce. Much of the time it's straightforward, but there can be times when results are equivocal or something, and it takes a specialist to make sense of it. He actually got me wanting to know more! The same thing has happened for me with obstetrics and neonatology. I'm feeling very fortunate to be in a position to be exposed to so many different things and excited by most of it. Helps me to see the light at the end of the tunnel.

Another interesting thing about this week has been the hospital's response to the election (pause for cheering). EVERYONE here is excited. Well, there are some American republicans around who aren't, but only two of them, and I like them anyway. But doctors all over the hospital were talking about it with excitement. Pretty cool.

I should probably head to bed. Another 7 hours of lecture tomorrow...

Good night, Gracie

2008-10-27T18:47:00.001Z

I'm nearly done with the World's Most Disjointed Attachment. As you know, I spent the first week in plastic surgery. The following week I spent in ophthalmology, which I have to admit I found far more interesting than I expected to. There's something about looking the wrong way through people's eyes that is amazing, and getting the visual information about various disease processes, both opthalmic and systemic, is fascinating. Though I dabbled briefly with the idea of going into ophthalmology (it encompasses some surgery too, which is amazing) ultimately I think it is too focused a specialty for this bouncy attention span of mine. Not to mention I don't like the idea of spending 5 years in medical school only to focus all of my further training on those 2 little globes in your face. Last week was spent in Dermatology. Quite dull. I know, it's important for a number of reasons, but still dull. Luckily we only had half days there, so I got to go to the gym and do lots of yummy cooking and baking as well.

We had a long weekend this week (some sort of bank holiday as they're called here.) It was also the Guinnes Jazz festival and the beer festival, so there was plenty going on in Cork this weekend. Had some Belgian beer (Pater, it was called) and chatted with a fellow named Barry who is heavily involved with the beer world in Ireland. He told me about a liquor store that carries beer with hops in it. How exciting! It was a great opportunity to have some beer that wasn't a stout or bland European lager.

On to two days of anaesthetics this week, where we'll learn about pre and post-op assesments, and probably some intensive care medicine as well. Then there are these academic half days at the end of the week, but I don't know what those will entail. They haven't bothered to tell us yet.

It's been appropriately cool and rainy here. Today there was a lone rain cloud (isn't there a chapter in winnie ther pooh that relates to this?) that rained on me for much of my walk to the grocery store, and then even gave a little hail once I got inside. Luckily it had cleared up for the walk home. Though there are some trees turning colors, particularly on campus, they don't compare to what I imagine I missed at home. Sigh. Soon I'll get to smell and hear the leaves crunching under my feet once again.

I'm feeling like this wasn't a particularly interesting post. Sorry. If I come up with anything more thrilling I'll let you know.

Ciao

2008-10-12T09:26:00.001+01:00

It's been a full week. I spent the last 5 days with a plastic surgery team. At the very least, it was good to see what non-cosmetic works they do in plastics. Lots of nerve and tendon damage in the hand and wrist. Breast reductions and reconstructions. Lacerations of various sorts, repairing fingers that have been crushed by hammers or gates. Removing skin cancer, cleaning wounds, making skin grafts for burns. Seeing such a wide variety was great. The team was fantastic -- friendly, and happy to teach.

One particular surgeon has left an impression. He is an Iraqi man, in Ireland now for a little less than a year. He has been a surgeon for over twenty years, but at some point recently a group of militants started killing cosmetic surgeons. So he's in Ireland, where he has to work for 2 years as someone much less qualified than he is, at which point he will be fully registered. Fortunately his previous experience will allow him to have a private practice. Otherwise, due to the politics and economics of the irish medical system, he wouldn't be able to advance very far in the hospital setting.

Next week I'll be doing ophthalmology. It used to be 2 weeks, and the doctors try to cram all of the same stuff in to less time. It sounds like the tutorials are interesting, but the ouutpatient clinics are fairly dull, as it's mostly watching doctors look at patients eyes. I'll actually have to study this week! They give us a written and a clinical exam.

Friday night an old friend of mine from Timberlake was in town with his brother, on a tour to support some work they do. You can check them out at www.foundmagazine.com. It was great to see him again, and get to show him around Cork. It was a helpful reminder that I do have a life, and personality, and experience that goes beyond my time in medical school, or even my time in Boston. It was a reminder I need more frequently than I'm getting. Since I'm having trouble finding extracurrculars here, it is easy to forget about all of the other things I enjoy doing in life. One of the good things about having this difficulty is that it is making me much more aware of the fact that I have to make some conscious decisions about my future in order to get some of my other interests back into my life again.

Good night, and good luck.

2008-09-21T13:01:00.002+01:00

My parents' last request before they went galavanting about Martha's Vineyard was that I should update them on the goings on of last week. I spent the last 2 weeks in the emergency department of the Mercy Hospital in Cork. It's a relatively small hospital in the middle of the city, and provides emergency care mostly for people in poorer sections of town. Not a ton of major medical or trauma cases, but very steady musculoskeletal injuries, asthma, COPD, abdominal pain, overdoses, and paediatric cases. It proved to be an interesting time. The two consultants in charge seem to enjoy their roles as teachers, and the registrars and SHOs did for the most part as well. The figures for the number of ER visits in America, Ireland, and the UK are all about the same, and end up with an average of 1 in 3 visiting and emergency department each year. That's astronomical. The Mercy is no different, though has fewer resources than many at it's disposal since most of its patients have public insurance which means inadequate resources. So the idea of the ER there was very much "first aid." Even if a patient had complicated or unknown medical problems, they wouldn't be sorted out in the emergency department. The role of the ER is to make sure the patient can breath, help a cut to heal, find the infected appendix, etc. While this is generally the idea of emergency departments in the States, the Mercy operates as an extreme example of it in order to stretch their resources as far as possible.

What did I get to do? During day shifts I was generally with one of the consultants, seeing patients or practicing reporting on patients to the doctor. The evening was when I generally got to do things like take venous and arterial blood sample, do ECGs, and suture wounds. It was educational and fun. Though lately I have been thinking more about intensive care as a future for myself, I appreciated the fast-pace nature of the emergency department. I got to work with doctors from all over the world, including Ireland, Malaysia, New Zealand, Austrailia, and Sudan. I got to see a little girl's hair used to hold togther a scalp laceration, and the finger of a sterile glove used as a tourniquet for a man who accidentally planed his finger instead of the door he was working on. I'm not sure I would have seen that if all of the doctors had been from fully industrialized nations with relatively adequate resources.

We also had a day of lectures about the fundamentals of emerency care, set up in the "ABCD" paradigm of medicine -- Airway Breathing Circulation Disability. The main speaker was the chief at the CUH, which is effectively the best ER in Ireland. A very cool man. He started the talk off with a picture of a man whose face had been shot off. A useful demonstration of the importance of a good airway, no?

I'm sorry to be moving on. Just as I was starting to get comfortable there and develop relationships with the nurses, doctors, medics, security guards, etc, it's time to move on to a dry couple of weeks discussing how and why to do research. I'll probably show up to the ER a couple more times to tie up looses ends, which will be nice.

In the mean time we're trying to have some fun when we can. Yesterday was beautiful (as is today, much defying the odds) so we lit up the grill. Almost felt like a normal person again.

TTFN

2008-09-06T11:18:00.002+01:00

Greetings and salutations. I have finished my whirlwind first two weeks of lectures. They were doozies (they were a doozy? hmmmm. apologies to grammerians reading this.) Generally 7 hours of lecture a day, covering reproductive physiology, embryology, birth, neonatal health, neonatal ill-health, parental ill-health, psychiatry, ENT, opthamology... probably some others I'm forgetting. For a complete rundown feel free to read my schedule which is linked to the side of the blog. Most of it was really interesting and well taught. The obstetricians were so enthusiastic and such good lecturers that a number of us started wondering if maybe we were interested in that after all. Not likely for me, but good stuff. I'm looking forward to my time in the maternal hospital.

Monday I start my 2 weeks in emergency. We are the first class to get a dedicated rotation in emergency (in Cork, I mean. It's quite normal in the States.) which is exciting. The schedule they've given us ahead of time doesn't make too much sense so I'm not sure exactly what I'll be doing, but at the very least will include some casting and wound management. From what I can gather the clinical teachers in the hospitals are prepared to make us work hard, which is great. It seems like rather than simply letting us loose unsupervised all the time we will have more tutorials and practical teaching along side the patients and house staff.

After emergency (or A&E as it's called here) I will have two weeks to work on my research project. This project was traditionally done in final med, but do to years of feedback and a new faculty member in charge, it is being split into two tears and actually assigned credit and dedicated time. I'm not sure what I'll be researching yet, let me know if you have any ideas! After that I'll have a mixed month of special surgery (neuro/plastic/orthopaedic),opthlamology, dermatology, and anaesthetics, with a week for each. Then another couple of weeks of classes and a month of renal medicine and neurology to take me through til Christmas. Should be a good, busy term.

Thanks for stopping by!

2008-08-24T19:42:00.003+01:00

Part two.... The Common Areas

The Kitchen
Our back yard
Our grill, kindly left to us by our friends who graduated

I have a picture of our living room too, but the blog seems to keep swallowing it.

2008-08-24T19:28:00.003+01:00

This will just be a quick post. Got into Cork Friday morning, to an empty house. No worries, the rest of the roomies are to show up soon. Thought you might like to see where I'm living now...

The entrance
My room
My room some more. It's not actually big enough to necessitate two shots, so that may be misleading.
Upstairs. My room is on the landing.

2008-04-04T13:52:00.004+01:00

The top two pictures were taken on the street next to my house a block away from each other. Despite my affection for both tofu and pax I am not responsible for either demonstration of anti-social behavior, or whatever it is people call graffiti.

I don't know that the bottom shot needs much color commentary. Surprisingly, the pay parking fills up quite quickly. That's at the South Tipperary General Hospital for an inquiring/nosey minds.

The 10 days after I returned from Clonmel were busy spent learning about chi squares, one-way anova tests, and other drool-inducingly boring statistics. I sort of learned some things about statistics, though they kind of skipped the beginner level stuff to get straight to the intermediate which is the stuff we'll actually need to know when we do our final med project (which may be done in 4th year, but probably won't change the name). So really I have no idea what those tests are, but I sure can make some cool looking graphs on the program SPSS.

2008-03-05T22:18:00.005Z

This is the view from South Tipperary General Hospital (I'm pretty sure it was the inspiration for the American soap), where I spent the month of February. It was always nice to leave the hospital after a long day and be greeted by that view, especially at sundown. I'm not sure how the rest of the populous feels about being able to see the hospital from every part of town, though.

All and all it was a great month. Of course, traveling back and forth between Cork and Clonmel had already worn itself thin, but in terms of teaching I couldn't have asked for anything more. One of the cool things is our main contact there is the first Irish woman to both summit Mt. Everest and hike to the South Pole. It's a small hospital, only 6 physicians in medicine (others in surgery, pediatrics, and obstetrics) and very few students. Because of this the consultants can take the extra time to actively teach us during rounds, and some of the other meetings for the entire staff were expanded to make them useful as well. I was with a geriatrician, and because of a general lack of specialists in the hospital, her patients had everything under the sun. Parkinsons, stroke, heart disease, kidney failure, and of course pneumonia. I was finally able to learn a little about disease and patient management, which was great. I got to interview and examine patients in Dr. Pillay's outpatient clinic, see how tilt-table tests are run, learn how to do an arterial blood-gas, do venesections, and spend more time with anaesthetists.

I won't lie, I was sick of the round trip every week. This is my first week in Cork since the middle of December. With my 3 week vacation coming up, I won't have spent very much time in this apartment, or getting to see my friends before the somewhat hellish build up to summer exams. To make it even more ridiculous, our first week up there coincided with something called coursing. Some activity where greyhounds chase bunnies through a field. In today's world the dogs are muzzled, so the rabbits are only subject to abject terror, but very little, if any physical harm. People come to this year after year, so all of the b+bs are booked well in advance. We stayed with Bernie, who is a pal of the woman who runs the place we were in for the bulk of the time. Bernie was very nice. Somewhat strange to be staying with just a random woman (she is not an inn keeper). She is also the aunt of one of our biochem lecturers, as it happens. So the beginning was a little crazy, returning from my trip to Boston, starting in a new hospital, and hanging my hat in so many places. But for these two weeks I'm sleeping in my own bed, cooking my own food in my kitchen, and generally having a slower time of it.

I'll leave you with some pictures of the place I made home for the month of February

2008-01-19T15:01:00.000Z

January 17, 2008

The second week here in Clonmel have flown by. Pretty much more of the same, as far as the medicine goes. A lot of sore throats and coughs, rashes, joint pain/injury, a well-baby check… I’m wondering if anxiety is as rampant every where as it is here. A lot of people very anxious about their health, or that of their children. Even in parents whose children are older, there are a lot of very nervous people around.

Once again we got to see very few of the female doctor’s patients, even fewer than last week. I understand why women might be uncomfortable having extra people in the room for a pelvic exam or Pap smear, but it brings to the foreground some of the frustrations of getting trained in a Catholic nation that is still very squeamish about gender relations. For our classroom based clinical teaching, they only want men to volunteer to be patients. I’m beginning to wonder if I’m ever going to really get to treat a woman. It turns out not just to be in training, either. Dr. Lynch almost always puts his stethoscope underneath a female patient’s clothes, rather than ask her to take her shirt off.

I’m noticing this week I’m frustrated about a few things. I think the pace of this experience isn’t agreeing with me, so I’m generally irked. It may be that most of my training at this level will feel slow to me; I’m pretty much just a fly on the wall, so my day is filled with standing around listening and watching. I’m learning, but I really prefer hands on stuff. I feel like I need to be learning practical skills and differential diagnoses, not just getting better at communicating with people. Perhaps because I don’t feel like I’m really learning all I could be, it’s easy to let the aggravating things about this rotation get to me. It’s a lot of travelling. 1.5-2 hours each way, every week. Having to buy lunch and dinner every day, while trying to maintain a somewhat healthy and affordable diet. Scarce internet and phone access, making keeping in touch with friends and family difficult and/or expensive, depending on which solution I choose. This week I bought a loaf of bread, and some cheese and mustard that I keep with the milk for coffee and some vaccinations or something at the office. I supplement that with a Pot of Noodles (which actually has tvp in it, so I’m getting some protein with the fat) or yogurt and fruit or something. Dinner continues to be a search around town. Last night I found a place to get a decent felafel for cheap. The guys who run that restaurant are from Bagdad.

Another thing that is beginning to grate on me is Dr. Lynch’s disdain for all treatment outside medicine. He continually disparages chiropractic, acupuncture, rehab, and all forms of mental health treatment that don’t involve medication. WTF? I have yet to tell him that both my parents are therapists. I’m just not interested in having that conversation.

I’m not really this cranky, actually. I’m enjoying meeting people, and having fun on our little sojourns into town. I’m already more used to the routine, and I imagine will continue to get more accustomed to it. It’s only a couple of months.

I was going to take some more pictures of my life here, but awoke to a nasty rain storm that involved a lot of wind, some thunder and lightning, and about 1 minute of ferocious hail. It mostly cleared up over the rest of the day, but my camera-phone isn’t exactly high tech, so I’m waiting for a little more sun. Stay tuned.

To quote Calvin, more news as events warrant.

2008-01-11T20:26:00.001Z

January 9, 2008

Last night the 4 of us (there’s two more at a B+B around the corner, and John has a car) went into town to find dinner. We’ve been a little spoiled living in Cork, I’d say. Not much open in Clonmel, even at 7:00. There were a few restaurants of varying quality and price, and we eventually settled on a chipper. Why, you ask? That’s an excellent question. If you come up with an answer, please let me know. It was fine. Not great, not terrible. It was dinner, and it had protein, which were about the only criteria I was aiming for that night. Tonight will be a similar scenario. Only The Nose knows what we will find.

Today was a little slower medically. There was a different doctor there in the morning, a younger woman. She was quite friendly, and had a really calming, competent air about her. Unfortunately most of her patients didn’t want us in the exam room. My hypothesis is that younger patients are generally shyer than older ones. I doubt I will collect the data necessary to prove or disprove that idea. I don’t have any striking memories from this morning, so I guess that I’ll skip the color commentary. The afternoon was interesting. More back pain, chest colds, and the like, but also a couple of more interesting things. One was a man with a likely haemorrhoid. The GP actually had a simple proctoscope that he used right there in the office, through which he was able to see some internal piles. I was once again struck by how comfortable Dr. Lynch is at doing a number of different procedures in different parts of the body. Injections into joints, a ring to support a prolapsed uterus, injections into piles, foetal ultrasounds… I’m not sure how much all of those skills get utilized by urban GPs, either here or in The States. The last patient was a young woman of 19, on what I believe is her second pregnancy. She was grinning the whole time, which I interpreted to mean she is quite excited to be having a baby. He did an ultrasound on her, which was really amazing to see. I think it is the first time I’ve been in the room for a foetal ultrasound. At 24 weeks, we could see its limbs, heart, liver (those things are giNORmous in foetuses, by the way) and head. There may have been some boy parts, but we weren’t sure. Very cool.

Since it was raining pretty hard the secretary (or Hub, as Dr. Lynch introduced her as) gave us a ride home, which was very sweet. Just chilling at “home” now, waiting to hear back from our friends about dinner plans. The three kiwis moved out today, but I suspect we’ll see them next month at the hospital. I think the Simpsons are on. I’m Eli McKenna-Weiss and you’re not.
Here's a behind-the-scenes view of a medical student's bedside table and dresser while he's on a placement in Clonmel.

2008-01-11T20:08:00.000Z

January 8, 2008

I’m writing to you now from my room at the B+B. There’s no internet here, so this posting is likely to be a compilation of several days’ ideas. Or I’ll separate them by day. still, though, perhaps too long and boring to anyone but my mother. It’s the end of my first day on location in Clonmel, only my second full day back in Ireland. How strange we can change locations and lives so quickly. One minute I was enjoying my vacation in Massachusetts, the next I’m learning to be a doctor in ruralish Ireland.

I hopped on a bus Monday evening, glad to have some quiet time to myself to try to get my brain and body less lagged behind the jet. Put some Josh Ritter on my headphones and… took a nap. Sean, one of the proprietors of the B+B picked me up at the train station (yes, you read correctly. Don’t ask me why I can’t take a train from Cork to Clonmel, but the bus stops at the train station. It sounds like something they would come up with in Russia.) I quickly got settled in. The other inhabitants of the inn: 3 women from New Zealand doing some of their medical training at South Tipperary General Hospital, where I’ll be next month, a GP from Capetown filling in for a few weeks, and 2 medical students from UCC. Arguably one of the safer places to be in the area. My room has a double bed, a little t.v., a closet, a dresser, and a sink. Both mirrors in the room were either designed for small people, or tall people who like to look at their torsos. There’s a shared toilet and shower (separate rooms, also a la Russia) with a comfortable sitting room downstairs. Breakfast was also a group affair, with people coming and going as their schedules necessitated and their breakfast arrived. Sean couldn’t stand for any of us to have to go to work in the wet weather, so he made a couple of trips with the various people to where they had to be. I feel like I am in one of those English comedies that have no apparent plot, barely move, and yet are utterly charming.

The G.P. we’re with, Paddy Lynch, is a great guy. Talks a mile a minute, and is a very patient teacher and doctor. Today was mostly about observing, but found little teachable moments. Today’s patients were varied, as they seem to be in a GP’s surgery outside the big city. A woman with symptoms that appear to be intermittent claudication, an infant in for some immunizations, some adolescents with ear aches and chest colds, some adults with chest colds, some routine blood tests, cryosurgery for a sebaceous keratosis, a prolapsed uterus (or womb, as the doctor said, which does have a friendlier ring to it), a woman with a as-yet undiagnosed nerve problem, a few folks with lower back/disk pain… You get the idea. We felt some pulses, listened to some chests, got to see how ESR is measured. Then off home, to change and relax. Somehow very tiring, despite the fact that we didn’t actually DO anything.

2007-12-20T12:39:00.000Z

Here I am, in the momentary lull between exams, a hectic day of travel, and Christmas. Various relatives have been coming, going, and returning, with more to come and go today. How wonderful to have a family that's willing and eager to travel great distances to be together. There's a beautiful lazy snow falling now, which I predict will make those of us traveling today less than thrilled.

It's been longer than I wanted it to be between posts; I'm afraid by now I won't be able to capture some of the excitement and import of the latter half of my term at school. Probably the most interesting was the two weeks I spent with the anaesthetists in the operating theaters of Cork University Hospital. I got to see a laparoscopic bowel surgery, some neurosurgery (where I got to see how the brain pulses!) and watch an anaesthetist put lidocaine underneath the sclera in preparation for cataract surgery. Wicked. Though I don't expect to go into anaesthetics, it was cool to see, and got me excited to continue to learn about surgery. I got to start some IVs, put in some airways, and learn about various anaesthetic agents. So all in all, a very educational couple of weeks. I finished off with a few weeks with some respiratory and cardiac patients. That included a few good tutorials, and I got to hear some heart murmurs and the like. The two or so weeks after that were devoted to exams. Few classes, too much studying.

The next term, starting in January, should be quite exciting. With the exception of 2 weeks spent learning more about epidemiology we won't have any classes whatsoever; all of our time will be in hospitals and clinics around Ireland. For the first 3 weeks I will be with a GP in Clonmel, the county seat of Tipperary. It turns out that it's not as far as the song would have you believe. I'll get a week of vacation, or I think they're actually calling it private study time. Then I'll be back in Clonmel for a month in the hospital there. It should be really interesting to get to see medicine in a more rural setting than Cork, since most of Ireland doesn't have all of the resources of the city. The doctor who organized this term is also hoping that there will be some continuity between the GP and the hospital so that I might be able to see the full course of some of my patients' care. The town is about and hour and a half north of Cork, and I don't really know what my living situation will be. The school will put me up somewhere, likely a bed and breakfast, but I probably won't know until I go back. Most of my friends will be in Cork the whole time, so it will be strange to be away from them for so long. I imagine I'll be back at my own place for the weekends. I'll probably have little to do but write while I'm up there, so hopefully I will be posting frequently.

I think that's it for now. Mom's up, and the heat's on in the other room. Later.

2007-11-12T21:49:00.000Z

Here's just a quick one. I took these pictures with my cell phone, and one of them was in the mirror. It felt much like that old riddle. What's the one part of your body you can't touch with your right hand? Do we have any suggestions for names for those guys?

2007-10-28T10:58:00.000Z

I have now spent two months in the hospitals. My first month I was on the team, or more accurately, loosely affiliated with a team that was lead by two gastroenterologists. One of them was a hepatic specialist, or which there are surprisingly few of in a country so full of alcohol. It definitely wouldn't count as efficient education, but I did get to see a fair amount. I took lots of histories of patents with conditions related to liver failure, anaemia, and Crohn's Disease. One man who was having mild anaemia and liver trouble talked to us for a while about addiction and told us where to find an open AA meeting to go to to learn more about what it's like to live with an addiction. He is underwhelmed by physicians' understanding of the psychological and social aspects of addiction. We also examined these patients, and got to see and feel on live people many of the signs and symptoms we've read about in our pathology and physiology texts. For the last three weeks I've been with a urologist at one of the private hospitals in the city. It has been a wonderful experience so far. We have spent several days in the operating theater with him, and he has been a really supportive and proactive tutor. Urology isn't necessarily a branch of medicine I'm expecting to go into, but it has gotten me excited to learn more about surgery. Another great aspect of this rotation has been an hour long tutorial given to our group every morning we're there. It's generally about how to conduct a focused history/exam on patients in different wards (cardiac, respiratory, endocrine...) On Tuesday I start my next rotation, which will be 2 weeks of anaesthesia and 2 weeks of cardio/respiratory medicine. A lot of people have really been enjoying this rotation because you get to see surgery, and generally practice a few procedures. In the mean time we're studying furiously for a pathology exam to take place next week.

In completely unrelated news, I finally got a tattoo at the beginning of the year. I've been percolating the idea around in my head for several years, and finally I got the inspiration to do it. I've included several photos of the scene. To help explain one of the pictures, you should know that the place I got it done (by a German man named Stefan) among other things bills itself as the only place to get pole dancing lessons in Cork city. Needless to say it was an interesting afternoon. I though I had a close-up of the tattoo itself, so check back here for more pictures.

2007-09-22T19:56:00.001+01:00

After some "gentle" urging from my Aunt Megan, here goes the first blog entry of my third medical year. The summer had a lot going for it. I got to spend a lot of time with my family, which is great considering how much those little nephews change in short periods of time. My work at the clinic was fun, educational, and I got to continue to develop some friendships and professional contacts there. There was some weird interpersonal stuff at one of the clinics, where a couple of the LPNs decided they didn't want me helping them. The other clinic, however, had plenty to keep me busy and were quite happy to have me. I also go mini tutorials from Dr. Sondhi throughout the summer, about some kind of medical condition that was relevant at the time. I also got to see a lot of my friends Carrie and Gabriel, and their spouses, which was really fantastic. I've been friends with Carrie since we were about 5 years old, and it's kind of amazing to have that kind of longevity to a friendship. Gabriel I met later, but it is great to renew that friendship after several years apart. I got to spend a full week on the Cape for the off-site session of Camp Tofu, which was too much fun. I don't have any of those pictures, so you'll have to harass my family for those. Because school started a month earlier than it has in the past I only got to spend a few days at family camp, but it was a great way to prepare myself for the coming year.

After getting an interview at Drexel over the summer, I was once again rejected. I was having a really hard time getting excited about coming back here. But, with the help of various professionals (including the McKenna/Crawford/Smith family doctor, Julian Jonas) I find myself quite happy. My mood is generally much higher than it has been in years, I'm feeling confident, more or less relaxed (how relaxed should I really be in medical school, you're wondering). I'm also noticing that I'm able to feel more at home and content here, and less like I'm divided across two continents. A whole bunch of us seem to be happier, so there could be some kind of adjustment period in effect as well. Something else that helps is that the school is much better organized this year than it has in the past, so with a few exceptions, things have been running quite smoothly. It's also the first semester I truly feel like I'm in medical school. We're finishing all of our class work (at least for this year) by Christmas, so it's going to make for a very busy fall. Or autumn as they insist on calling it here. Pathology is the biggest single class, and that's moving along at quite a clip. Who needs more than 3 hours to talk about disease processes of the lungs, anyway? Pharmacology, epidemiology, clinical practice, and an elective (I'm hoping mine is going to be a moot court with a lawyer who's on staff here). One of the other exciting things is that 3 mornings a week we're in the hospital. Our role is minimal, by which I actually mean non-existent. We're there to take histories and examine patients, since those are the skills that will provide about 90% of our diagnoses in the future. In the spring we will be full time in the hospital, I believe with a little more explicit teaching going on. In the mean time, I'm with a gastroenterologist who specializes in liver disease. Let me assure you there is no shortage of that in this country, naturally mostly due to alcohol. These patients make for interesting examinations and histories, which is great. Also learning some about ulcerative colitis and Crohn's disease. Lots to do!

The pictures in this post are a random sampling of recent months. The top is a picture from our tutorial on how to scrub in for theater. At the bottom is a picture of Camp Dad took from the ridge, and a picture of me and my cousin Molly from a hike we went on with Pam, Megan, and Mom. Fun times!

I suppose that's enough for now. Hopefully I'll post some fun/exciting/interesting stories from life in the hospital!

All my love,

Eli

2006-06-20T03:00:00.000+01:00

Here are some pictures of the actual wedding...

2006-06-18T13:39:00.000+01:00

At the end of March, I went down to Peru, ostensibly to go to my friends' wedding. Of course, I didn't travel all that way for a weekend of ceviche and pisco sours. I got to spend a couple of days in Cusco, Aguas Calientes, and of course the magestic Machu Picchu.

2006-05-21T13:16:00.000+01:00

St. Patrick's day in Cork was quite an event. We missed the parade, because we had an exam the following week and were attempting to study. But there's always time for a pint!

2006-03-19T21:08:00.000Z

Here's one picture to give you all a taste of my parents' visit to Ireland. It does show the lovely weather we had. Behind us you can see the Cliffs of Moher. We went that day because the weather was supposed to get worse. What a country. Come back soon for more updates.

2006-01-23T20:48:00.000Z

Here are several pictures of us at the annual Med Ball. The mutton chops were entertaining, but foolish-looking without the tux.

2005-11-24T17:16:00.000Z

Finally some new pictures, these showing my beard. I'm mostly growing it out of laziness. Don't expect to see it in real life. The top picture shows my team of scratchers, the next one is Brian, the other American in my class. I wish I could tell you what was going on in the picture. The bottom picture is at a dent student party. Two canadians, two kuwaitis, and me. A regular UN here in Cork.

2005-10-21T17:38:00.000+01:00

Here are two pictures of the Brookfield Science building. Brand new. The outdoor picture is taken by the entrance we use (when did Nick find a time when there was no one standing there? It's usually ridiculously busy there) and the indoor shot is from that entrance towards our main classroom, which is G10, if you must know.

2005-10-21T17:36:00.000+01:00

These are two pictures of the Main Quad, which seems to make Mom think she's at Hogwarts. Some trivia: it is made out of locally mined limestone, I believe actually mined from the spot where the Boole Library now stands, immediately opposing the Quad. Also, the lore on campus is if you walk on the grass in the Quad you will fail your exams.

2005-10-21T17:35:00.000+01:00

If you're standing where the last picture was taken, this is at 11 O'Clock. It's the student center.

2005-10-21T17:32:00.000+01:00

This is the main part of campus. At 12 O'clock is the chapel, which has beautiful stained glass and floor mosaics. To its right is the O'Rahilly building. I'm not sure what they do there. I don't go in there.

2005-10-21T17:29:00.000+01:00

These are just some pictures around the periphery of campus. Western Rd, and a couple pictures of the River Lee.

2005-10-21T17:25:00.000+01:00

These are some pictures from around town. St. Finbarr's Cathedral (UCC's slogan is "Where Finbarr taught let Munster Learn." He's an important guy around here. The courthouse, and a couple of pictures of the main shopping/strolling/people-watching part of town. The part shown I believe is called St. Patrick St.

2005-10-14T16:11:00.000+01:00

Here is a good group shot. From left to right: Mahta, Blair, Moi, Martin, Laura and Caroline. They're all Canadian. Beneath are a couple of pictures of Team Purple. Completely accidental of course. In real life the shirts are much more similar in color. The one in the pub is the place called Western Star that sponsors Medical Society (or MedSoc). I'm sick of going there. Too loud, crowded, and full of 18 year-olds.

2005-10-12T21:53:00.000+01:00

These are all pictures of my trip to Youghal (pronounced Yall) with Mahta. It was an appropriately rainy day for a trip to the Irish countryside. Had my first Irish fish and chips here.

2005-10-12T21:51:00.000+01:00

This is a thrilling picture of me at the main gate to UCC. A branch of the River Lee runs along one border of the campus.

2005-10-12T20:35:00.000+01:00

The upper (you may also use "superior" or "proximal" if you're in the mood) is a picture of Julie and Tim, both from Vancouver. I don't know who the lad on the far right is. The guy in the distal, lower, and inferior picture is Wyatt. He's a dent student from Medicine Hat/Edmunton.

2005-10-12T20:32:00.000+01:00

This was taken from inside a bus going to Kinsale. As you can see, I didn't make it on that trip. Instead Tony, Tim and I went for a cup of coffee (and a scone with cream and jam) in town.

2005-10-12T17:50:00.000+01:00

This is right towards the beginning of my time in Cork. I'm standing downtown with Mahta, who hails from Toronto.