Addendum: how many cities can I fit in to two weeks...?

Okay, so when I published that post below just now I realised the title I started off with has nothing to do with what I ended up talking about! In my head the topic for the day was, "Update on elective planning!" LoL Thus, do allow me this addendum.

I spent more than a good few hours online this past weekend dreaming of where I want to go in those two weeks holiday I have on my way to The Gambia. Two weeks isn't a lot of time when you think about it and the possibilities are endless! How do I choose? One place I definitely want to go after my recent bout of web-surfing is Tunisia. I have to admit the Arab culture has always fascinated me and reading about the medina in Tunis, the ruins of Carthage, and exploring Saharan Africa... oh man, that really hits the spot. I thought of Morocco as well, but after doing the research and honestly thinking about it I think the main attraction would be being able to say to people, "Oh yeah, I went to Morocco. That Casablanca is pretty cool." Actually, no I lie, that would be reason #2 of 2. Number one would be to visit the Hassan II Mosque: the third largest mosque in the world, it looks out onto the Atlantic which can be seen through the gigantic glass floor for 25,000 worshippers, and one of the few mosques open to visitors. But I remain undecided as to whether that's worth the extra travel time and mu-lah associated with adding an extra city/country onto my two-week agenda. As it stands it looks like Seattle --> Boston/NY --> Tunis --> The Gambia. Now once I get to The Gambia that's a whole other chapter! I'm so excited! Which reminds me, I need to seriously start saving up some money cos all this travelling doesn't come cheap. Fo' sho.

how many cities can I fit in to two weeks...?

My Paeds run wrapped up on Friday, good riddance! LoL The oral exam with the Paediatrics Prof was tough and though I passed I have to say my dignity was shattered when I came out the other end. Thank you med school for yet another lesson in humility. But it's Paeds, my most difficult subject, so I accept my overall Pass with a grateful heart. It's crazy to think that unless I specialise in Paediatrics this is the last of any formal teaching on it... ever! Anyways it's over and that's all that counts.

Did some baking and Christmas shopping over the weekend (been doing bits and pieces whenever I can and am still not done!), then had a friend over Saturday night for which I cooked the most delicious elaborate dinner! At least, elaborate in my books: spinach, mushroom and feta stuffed chicken wrapped in bacon, served with galicky potatoes and salad, and leftover Christmas baking and coffee to finish. It was fun because I had a good afternoon to just go at my pace and really unwind doing it. I have to admit I find both cooking and baking quite cathartic when done under my circumstances with plenty of time and resources.

After that dinner I kind of went a bit downhill. During the month on Paeds I was on-call the first weekend, in Auckland the second, then on-call again the third weekend so I basically went through it with no breaks at all. I tend to do this to myself though -- push myself way too hard for a while and then something forces me to slow down (I wouldn't go so far as to call it "crash" but stand at the precipice of, you know?). So the past couple days I've been doing bare minimum, watching movies, catching up on rest. I still have this publication for my clinical trial from last summer to write up -- I hate having it hanging over my head still, urgh! yay the day it'll be done! -- as well as various tasks for NZMSA. Being productive has its downsides especially when you just need to take a break and feel you can't! Oh well, they're shelved for now, it'll all just have to wait.

Despite all this, I'm feeling much better, in-my-head-wise. All that internal drama with surgery and training programmes -- it's behind me now. I caught up with one of the Profs here who I did research with a few years ago (and who remains a sort of de facto mentor) and he really put my mind at ease. He reassured me that I'm on the right track and it was okay not wanting to get caught up in the "rat race" that can be a career in surgery (he too is a renown surgeon!). He really encouraged me to not be afraid to do my own thing on my own terms at my own pace like I'd always planned, but to do so strategically nonetheless. And that is exactly what I needed to hear. Teachers, mentors, they do so much for so little in return. I've had a couple truly incredible mentors throughout my life and I will forever be indebted to them, a heart filled with gratitude. :)

So yes, I'm definitely starting to plan ahead the next two, three years of my life, but with my usual brand of enthusiasm and excitement, not stress or worry. All in all, I'm revved up and ready! It's no longer, "...here... I go... again... *sigh*..." but, "HERE I GO AGAIN, YE-AH BABY!!!" Hehehe... Things are definitely looking up, kid!


On a completely different note, Christmas... man, already! I'm not sure if it's being in NZ (summer and all!), being older, being the family of four we've always been, or a combination of all of the above, but Christmas always feels so chilled out and anticlimactic (in a good way). I'm not very affected by the commercialism, shopping just feels like shopping, and the closest I get to the "Holiday Spirit" is wanting to watch Home Alone and make hot apple cider if only I knew how. LoL It's nice though, it being so chilled out. Kirsty's flying down tomorrow for an entire week (yay!) and our usual barbecue Christmas Day. Dad and I have decided to do a father-daughter day tramp up Mount Cargill on New Years Day which should be nice, so long as he doesn't lecture me the entire time!

This year has been so full of the highest of highs and so symbolic of the passing of one era of my life to the beginning of another that in comparison this holiday season feels so ordinary. A chance to catch my breath in the midst of all the crazy. And I gotta say, blogging from bed at nine in the morning and nothing but Anne of Green Gables: The Sequel on the agenda for the day? Catching my breath I most certainly am. :)

pet project!

A couple weeks ago Shuichi and I decided to take it upon ourselves to put together a wee booklet for the upcoming fifth years -- part informative, part encouraging -- as they head into the most intense year of medical school. Advice about the individuals run throughout the year and tips on how to prep for end-of-year finals. Not just what we did as individuals, but bringing together what our classmates did, what worked, what didn't... what we would have wanted to know in hindsight. And it's come together really well! Shuichi's girlfriend is gonna proof it tonight, final touches tomorrow, and then it'll be ready. It's taken more work than I originally thought, more hours than intended, but I can't believe how cool it's turned out... and in the end if it makes fifth year just that much easier or better or more manageable... if it encourages just one person, it would have been worth it. :)

a little too... Christina Yang?

Things have calmed down a bit this past week. Last weekend I was in Auckland for the final NZMSA Exec meeting of the year. Despite the fact that more than half the Exec are away overseas it was still good to recap what we've done and our plans for 2010. The meeting was relatively informal and not too content heavy which was nice (and so foreign) because normally by Saturday afternoon my brain is utterly fried and Sunday can become a mission. But like I said, lack of numbers and formality kept things pretty easy-going. A few of the Exec members who were there had just had their first week as doctors so it was good to hear how they were going and what I have to look forward to in less than a year's time. :) Also, due to a semi-late start Sunday morning, one of the Exec members and I had a chance to catch up over breakfast -- he's an Aucklander and, as I found out halfway through the year, a Christian. It's been really awesome getting to know him and he's quickly become a good friend. In particular it turned out that we were going through some similar stuff this year in our respective lives regarding relationships and being Christian and single and in our early twenties, etc., which is an area/topic largely untouched, unaddressed by most church communities, so it's been good sharing resources, insight and encouragement.

The other upside of the weekend was that I got to catch up with my sister! And what's more check out her new fancy apartment in Parnell. She was previously living in a tiny studio close to the med school/hospital, but now has "upgraded" with a friend of hers to a 2-bedroom, 2-bathroom apartment. Much, much roomier I have to say. On Friday night I shouted her and Anthony out to dinner which was nice. Then Saturday night after the usual Exec dinner I passed on going out to town with them and Kirsty and I did Movenpick icecream and videos instead -- awesome. And because the meeting finished a wee bit earlier than expected Sunday afternoon Kirsty and I had a chance to do some shopping in Newmarket before I had to head to the airport. So, all in all, a very fun weekend.

It's been a bit less hectic at the hospital too. I've been largely hanging out at PAU (the emergency Paediatric Assessment Unit) trying to admit kids as they come in. Plus we had like three different presentations to give, which on the whole all went alright. One more presentation and an oral test to do this week and then, IT'S OVER! First run of TI year... man, this year is gonna be over before I know it.


I have to admit, I've been in a funny head space lately. I think it's been ever since a few of us on the surgical interest club committee caught up with our "mentor" surgeon ("Mr A") to talk about our plans for the upcoming year. It was a really worthwhile meeting because Mr A ended up going on a huge tangent about the application process for surgical training. And despite working my butt off these past couple of years with research and extra-curricular stuff, it seems there has been a big hole in my approach. On retrospect, although I have no regrets for the research I've done (bioethics, surgical education, endocrinology) I can't help but think maybe I should have... been more... surgically-minded?? I dunno... and my overseas elective that I've been planning for the past year... it's not surgical at all. And although it wouldn't count against me in my future application, realistically I could do something that could count FOR me??

There's a part of me that's thinking, well, I told myself from the get-go that I wouldn't become this all-surgery, all-the-time, nothing-but-surgery kind of person, that I would still have other interests and not let it dictate my life... However, the potential downside to that (I've now realised upon looking into what it takes to successfully apply to the surgical training program) is that maybe I do need more of that "focused" mindset if I wanna get in... as I most certainly do. I also learnt from my conversation with Mr A that if you're accepted into the training program you can choose to defer for a year, so even if I apply as soon as possible (which I told myself I wouldn't do cos what's the rush? there are heaps of other stuff I wanna do in my life before making that huge commitment... but which now I am seriously contemplating doing... lol), there's the potential to get accepted, have that security and then spend a year travelling and volunteering overseas as per the original plan.

*Sigh*... I dunno... It's crazy though because things are getting a bit more serious now. Like it's not just about, "Oh yeah, I was thinking maybe surgery, but who knows what'll happen," to, if I want it I need to start knuckling down so to speak and plan out the next couple of years of my life... which... I know, sounds all a bit too hard-core... but... I've always been the kind of person who, if I know what I want, I go for it. Full stop. And, I know what I want. So... I guess... that means... here I go again.

today I got paid less than minimum wage... and you probably did too, lol

Despite an overwhelming desire to write, write and then write some more about what's been going on lately, I find myself unexpectedly (or not so unexpectedly?) pressed for time!! The Paeds department here was notorious for their assignments/presentations/etc during 5th year and TI year I'm afraid is little different. So in between working on one of four presentations I have to give during this four-week run, not to mention an oral test, AS WELL AS on-calls, I'm finding it a bit difficult to (a.) be sociable, and (b.) get some quality time to jot down my thoughts. A bit frustrating but to be honest, I'm too physically exhausted to care right now. After all weekend on-call, and then back in the hospital this morning to do a blood test before 8am handover, all I want to do is get into bed and sleep.

If the point of Intern year is to give us a taste of what life is like after graduation I believe I am starting to understand... and, well, I have a year to mentally prepare myself for a life of physical exhaustion. LoL But still, no regrets. There is joy in suffering... fo sho.

Okay... back to the literature search on carbohydrate counting. Oi vey.

whoa, what just happened?

I experienced my first cardiac arrest today... in the neonatal intensive care unit (NICU).

I experienced my first death in the hospital... the death of a tiny little baby.

Without saying too much, this newborn baby has been pretty sick and no one could figure out why. They (the consultants and registrars) had spent a while discussing this baby at the morning handover meeting, but I didn't think too much about it myself. Then, having been assigned to NICU for the week, I met this baby and the whole family an hour later on our ward round -- and indeed the baby was unwell but stable. It was pretty hard going for the family who knew things were getting serious and, in some ways to an outside looking in, it kind of felt like they were preparing themselves to say goodbye, like as if somehow they knew in their heart of hearts what was to come.

It was later that afternoon that all of a sudden there was an explosion of beeping from one of the NICU monitors, followed by hushed exclamations of "Where's the doctor??!?" Before I knew what was happening there were two registrars, one house surgeon, two nurses (with the consultant on the way)... and me, standing, just standing there, watching it all unfold in front of me like a scene from a TV show, but this time in slow motion and with hushed voices in an otherwise silent and frozen NICU. And in those next ten minutes it was like everyone else in the room was holding their breath, completely paralyzed, afraid that one wrong movement might somehow change the fate of this little baby, dusky blue, teetering on the edge of the precipice that is life... or death.

I was frozen. I just stood there. They didn't need me, and, frankly, I had nothing to offer. No skills, no understanding, no knowledge. My role, I quickly realised, was just to take it in.

You know in First Aid course when you practice CPR on those mannequins? And on "Annie" (the adult mannequin) you're supposed to use the force of your entire upper body to perform the compressions? (To quote one of the instructors, "You're not doing it right if you haven't fractured any ribs.") But then afterwards they bring out the infant mannequin and teach you to use two fingers? Two fingers. Two fingers of one hand for compressions. I always felt a little ridiculous doing that, like, honestly, would two fingers really be enough??

After my car rolled off the bank in Motueka the image that stayed with me (and remains with me still) is the blurred view of the green and brown forestry through the windshield as my car tumbled on it's side, like being inside a glass hamster wheel looking out. In the same way, the image that haunts me from this afternoon is of the registrar's two fingers pushing up and down on this tiny little baby's heart... and on this tiny, fragile, precious baby, two fingers really were more than enough.

After about fifteen minutes of resus, as the registrars continued to do compressions and bag ventilate, the consultant went over to the family to explain to them that they would now stop doing compressions and that it was time to say goodbye. And it was then, as they started to extubate the baby, that it was too much for me. I stepped outside, left NICU, and in an empty hallway at the back of the fifth floor, started to cry.

It sucks. Plain and simple. And it breaks your heart. I can't even begin to imagine what it's like for the family. I only met the little baby this morning and it was enough to break my heart; I can't even begin to fathom what it would be like had I spent every single moment of six, seven, eight months with a baby that was inside of me, then to watch it die before it even had a chance to live.

Needless to say, it was a pretty intense first day. And to be honest, I think I'm a little shell-shocked.

not just awesome but delightfully awesome

Hi! And hello again! The past few weeks have been such a whirlwind of events and emotions and I have no idea how I'll catch up on writing about it all, but I have decided I must and I will. Maybe not all at once, but there are just so many thoughts, memories and reflections flying around my head that I NEED to get it down on paper.

I start back up at the hospital tomorrow, for my sixth and FINAL year of medical school.

[pause]

My sixth and FINAL year of medical school.

[pause]

My sixth and FINAL year of medical school... yeaaaaah...

[pause]

Did I mention that tomorrow I start my sixth and FINAL year of medical school?

I just can't get over it. And no matter how many times I say it, it still sounds strange and completely surreal. I think once I'm in the thick of it, back on the wards, busy running around and doing work it won't feel quite so strange but for now I remain in the realm of utter disbelief.

The past couple months have been the most intense of my academic career, emotionally, mentally, physically, spiritually... and it just feels all too surreal that it's behind me now, that I actually did get through it. I did what I had to do (although I'm not quite sure exactly what that was -- have they become repressed memories already?? lol) and in the end I managed and I survived. I didn't burnout (although I came dangerously close a couple times this year), I didn't have a breakdown, I didn't give up... somehow I pressed through... through that final, most painful phase of the metamorphosis that is medical school. And here I stand, a Trainee Intern.

Weird.

But delightfully awesome. :)

So much has happened the past few weeks, from the cathartic release of finishing exams, the utter elation and jumping-up-and-down upon receiving the "You've passed" email, to the most epic, relaxing, brilliant road trip back up to Motueka this past week and all that was in between. And like I said, I'll most definitely be putting pen to paper this upcoming week, but for now suffice it to say: Goodnight dear world, I'll see you tomorrow. Yours faithfully, Anna, Trainee Intern Extraordinaire. :)