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.

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

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.

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.

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.

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.

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?

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.

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

Here are some pictures of the actual wedding...

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.

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!

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.

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

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.

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.