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.

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.

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.

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

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.

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.

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!

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.

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.

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

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.

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....

"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

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 

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.

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

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!

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.

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.

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.