what a boring saturday

Today, I spent a large portion of the day completely deleting and then rebuilding my iPhoto library. For a while, iPhoto has not been working well for me, but it's probably my fault. Before I got a new hard drive in my old computer, I went back and forth debating whether I'd keep my pics on my computer HD or on an external HD. Since I kept changing my mind, pictures were randomly stored in both places, or one or the other. I moved things around a lot and also did some digging through the iPhoto library file (which you're not supposed to do). Somewhere along the way, things got very screwed up, to the point that I could no longer import photos from Lightroom. So, instead of fooling around with the library any longer, a job which had already wasted too much of my time, I just deleted the whole thing and started over. Fortunately, since I never really decided where to put things, I had copies of everything stored in a separate file. And, now that my computer has a much larger HD, I had it all stored on my computer.

Long story short...my iPhoto is working perfectly again and everything is where it should be. I still have to import some more pictures to iPhoto, but I'll get to that later. In short time, all of the pics will be properly organized in iPhoto (like iTunes, it automagically organizes everything for you, and you never have to see how it does it), and deleted from the random places that they were before.

After screwing around with iPhoto for way too long, I've gotten some decent peds studying in, both from First Aid and Blueprints. I think I'm going to go find some food, since I've hardly eaten today, and then come back to study some more. For the first time since I've been here, I've taken my Ritalin. I really need to start taking that stuff every day, because it sure does make me productive!

NOOOOOOO!!!!

I'm going to miss my opportunity to get a Free Chipotle Burrito! Chipotle is one of the best foods I've ever put in my mouth, and in this whole country, there's not a single location! English people really have no idea how to eat! For those of you fortunate enough to be in the US, dress like a giant foil wrapped burrito (or anything else on their menu), and get a free burrito!

Edwards Syndrome...something you don't see everyday

Today, I saw a baby with Trisomy 18, otherwise known as Edwards Syndrome. As the name implies, it occurs when a baby has three copies of the 18th chromosome, instead of the usual 2. As with most chromosomal abnormalities, it's a particularly tragic disease. It usually causes a large number of problems, including serious kidney and heart defects, and multiple dysmorphic features such as rocker bottom feet, a short sternum, and micrognathia. The babies often die before 3 months of age and almost always die before 1 year old. Unfortunately, the baby that I saw to day is extremely sick and will most likely fall into the first category. He is probably the smallest baby currently in the NICU, and makes absolutely no respiratory effort. It's hard not to feel bad for the parents, who will probably be making a very difficult decision shortly.

Seeing conditions like this really help to learn the disease. It's one thing to read about a rare disease in a pathology book. But, it's entirely different to actually see someone with the disease in front of you. It associates a person with the disease, and makes you really want to go learn about it. In the future, I will be remembering a person, when I think of Edwards syndrome, instead of just trying to remember facts from a text book. The same is true of the many other childhood diseases I've dealt with in the last few weeks. Although peds is not my favorite rotation, I really do enjoy clinicals! It's easy to forget why you want to be a doctor in basic sciences, but clinicals brings it all back!

Moving right along

As of today, I'm half way through with my peds rotation. Time in clinicals is flying nearly as fast as time in basic sciences. Of course, my next two rotations are twice as long as my current and previous rotation (12 weeks, instead of 6), but things are still coming along pretty quickly. It's amazing how much of a difference one week can make in my outlook of things. Last week, I was thinking how long I had left, since I had only completed 2 weeks, with 4 still to go. Today, I'm happy that I'm almost halfway done!

I'm also pretty happy that I'm nearly finished the two rotations that I was least looking forward to. Although, I have to admit, I did like psych a lot more than I had expected to, and I actually miss the rotation. Looking back, I really did like my attending, and I even enjoyed most of the patients on the unit. Unfortunately, I like peds a little less than I expected to, but I think that has something to do with the fact that I'm doing it in the UK.

Mostly, I'm looking forward to IM and surgery; IM because it should actually feel like practicing real medicine, and surgery because that's what I think I want to do. It really won't be long now before I have to start preparing for step 2, and that scares me a little. But, that means I'm getting closer to finishing the 4 years I wasn't sure I'd ever start, more or less finish!

sorry for the neglect, blog

Sometimes, I just stop blogging. I'm not sure why I do it. But, I'm sorry anyway, and I'll try to keep it up again!

Anyways...where to start?

I'm now just about done my first week at Queen's hospital, and I am liking it a lot better than KGH! Largely because I can now easily walk to work, but also because I like the rotation better at Queens. I feel like I've learned more in the past week than I learned in two weeks at KGH. Queens has more patients and sicker patients. And, I haven't even started clinics or been to the NICU yet! People doing clinics seem to like that, so I'll see how it goes next week. I'm really hoping that the attending will let me stay at Queens for the rest of my time here.

Last weekend, i visited Bath, Stonehenge, and Windsor Castle. I took the tour with Evan Evans Tours, and it was a very good experience. Wound up being another beautiful day for sightseeing, with sunny skies and cool (but not cold) temps. Windsor Castle was as impressive as I would have imagined (for a royal castle, still regularly in use), Stonehenge was larger than I pictured it, and Bath was just a beautiful city. I wish we had more time to walk around Bath, but it was a long day and we had to get going after about an hour and a half. You can't get very close to stonehenge, but it actually makes for better pictures, since there aren't tourists trying to hug the rocks. There is only one night per year (I think the summer solstice), that they actually let people go up to the rocks. But, you're plenty close for pictures. Unfortunately, internet here largely sucks. For some reason unbeknownst to me, the companies seem to consider 3GB per month fair "unlimited" internet use. Well, it's not, at all. Because of the insane cost of bandwidth, I can't upload all of my pics to Flickr. So, unfortunately, my blog will have to remain uncharacteristically black and white until I return home. However, have uploaded many of the pictures to facebook, since that uses up less bandwidth.

This weekend, I don't have any plans yet. But, I have planned a trip to Paris for next weekend. Although I knew it was a bad idea, I tried to be nice and wait for another person to get their schedule before making plans. Because of that, by the time I knew what was going on, the prices had jumped up for this weekend, as I knew they would! But, I guess it's not awful to save a little money and sleep in for one weekend. Maybe I'll head to cambridge or oxford for a day trip.

As an aside, I'm REALLY missing good sushi, good mexican, and good meat (for reasonable prices). I can't wait to get back to US food and internet!

Last day at King George!!! Woohoo!!

As the title implies, today was my last day of peds at King George! Starting Monday, I'll finally be at queens, which means a 5-10 minute walk every day, instead of a 10 minute walk and then 20 minute bus ride. Also, since all of the sicker kids are at Queens, should be more to learn.

So far, here's what I like and dislike about the UK rotations:
Like:
1. Good teaching, and it's frequent. They usually start late, which is annoying, but most of it is very relevant and very good. Almost every day, at least once a day, we sit down for 45 minutes to an hour and discuss a particular topic. So far, they've included diabetes, cystic fibrosis, evaluation of headache, seizures, fever, rash, etc., all of course related to pediatric presentations.
2. It's easy. Our regular hours are 9-5, but I've never actually stayed until 5. Every wednesday is half day, and I was out by 1pm for the last 3 days. If you need to be somewhere, just go. The UK students are usually out even before I leave!
3. You can see as much or as little as you want, as long as you ask. Want to draw blood or start an IV? Just ask. If you want to spend all day on the ward and interview all the patients, you can. If you want to go to the A&E (ER), just go, ask for a registrar (resident), and see patients. Need to spend more time studying? Go home or to the library and study.
4. Travel wherever you want around Europe on the weekends
5. No call, nights, or weekends (at least not in my rotation)

Dislike:
1. Typical stuff that goes along with not being in the US - it's more expensive, food is not as good, internet kind of sucks, no iPhone access, etc. etc.
2. I would like more of a schedule and more direction on where to go and what I'm supposed to be doing. Things seem very haphazard. If they feel like teaching (which they often do), they'll just randomly announce in the morning to be in the conference room whenever they think they want to teach
3. All of their drug names are different, so it takes a while to have any idea what drugs they're giving. They also use different units for many of their labs, so it takes a while to figure that out too. A glucose of 11 is VERY low for us, pretty high for them (multiply by 18 to get our equivalent unit). Finally, they use drugs that we don't use, and don't use drugs that we do. For example, they still regularly use chloramphenicol for peds and they don't use sulphamethoxazole. Is it any wonder that they have like a 75% resistance rate to trimethroprim?
4. They do things a bit differently here and I kind of like things the way I'm used to. Doctors here regularly have to run around looking for x-rays or labs (nothing is computerized and they don't seem to have techs). One doctor told me he spends 30% of his time treating patients and 70% running around looking for things. Nurses also usually can't start cannulas (IV's) or draw blood.
5. Things are SLOW! Patients are regularly held overnight (or longer) while they wait for blood results, scans, dietary, EEGs, etc.
6. Did I mention it's expensive? The dollar kind of sucks.

WTF, Romford?

There is not a single Taco Bell or Chipotle anywhere near me. In fact, I don't know that there's one anywhere in London! Why would they do this to me? How am I supposed to get my fix? This is crap...i'm not happy.

A bit of a slow down

Unfortunately, I have not really seen anything exciting in peds since the last week. Part of this is likely due to the fact that for some reason unbeknownst to me, we have to rotate at King George's hospital for part of the time. Unlike Queen's, King Georges doesn't have any peds or neonatal intensive care, so all the really sick kids are elsewhere. There is nothing at King George that isn't at Queens, but lots at Queens that isn't at King Georges, so I really can't wait until this week ends and we switch hospitals. Not to mention the fact that you need to get up about 45 minutes earlier to commute to King Georges.

Today, we had three teaching sessions. They were all pretty good, but the doctors really like to start late. Kind of inconsiderate in my opinion, especially when we have other things scheduled to do, but maybe that's just the status quo. Since this is only my second rotation, and only rotation in the UK, I really don't know what's normal. So, I just keep quiet and do what they say. This strategy worked well in my last rotation and got me a great eval, so hopefully it will work again. I know...me keeping quiet...hard to believe. But, at the moment, my grades, and very possibly my future residency placement, depends on it.

Over the weekend, I went to Madrid, with Josh and Song. It's a beautiful city, but I was pretty sick on Saturday, which made it much more difficult to really enjoy. I tried some paella and sangria, but could hardly eat any of it. However, it was definitely the best sangria I've had in my life! When I get back to the US, I'm going to be in search of somewhere that can come close. At some point, I'll upload all the pictures I took. Hopefully, even though I was pretty miserable walking around, the pictures will make me remember it in a better light. At least if I was going to be sick, it turned out to be an absolutely perfect day for walking around, with temps around 65-70 and not a cloud in the sky. The only problem with Madrid is that either no one speaks English, or no one will admit to speaking English (I suspect the latter). This made it more difficult to get around and impossible to argue with the thief of a taxi driver we wound up with.

At the moment, I'm slowly trying to recover from whatever virus is currently attacking me. Good news - it appears my immune system is starting to kick some ass. I now am pretty hoarse and cough a lot, but I'm feeling much better than I did Saturday. I bought some dextromethorphan for the cough, so hopefully that will help.

Peds in the UK

Today, I finished my 3rd day of paeds (as the spell it in the UK). Not much of a milestone, but it's progress. The biggest shock has been how different the UK medical education system is than ours!! First, they do not go to college; they go straight from high school to med school. Then, med school is either 5 or 6 years, depending on if they get a degree or not. In either case, unless you come with a degree, med school is considered undergraduate. Then, after graduating, they begin residency as a FY1 and then FY2. During these two years, they rotate through a little of everything, and don't specialize at least until they reach their third year. In their third year (which they have to apply for, again), they're considered house officers and usually start their specialization (although not always). After a couple years of that, they apply again to become a registrar. At this point, they're in specialty training and are pretty senior. They can spend a pretty long time here...basically, until the consultant (their word for attending) thinks they're ready. If they're good, it can be just a couple years. Otherwise, can be longer. It's not unusual to take 10 years to complete surgical training (compared to 5 in the US).

However, there is a trade off, which is that they work MUCH fewer hours than US students and residents. I believe that their maximum workweek is 48 hours, which is not exactly strenuous. And medical students have it pretty darn easy! My schedule is technically 9-5 (which is already easy), but most of the students are gone by 2 or 3, since the consultants really don't care what you do. Basically, you get as much or as little as you want out of it. Even in surgery rotations, you get out in the early evening or late afternoon and have weekends off. All students also have wednesday afternoon off, to go play a sport (or just go home). And, my attending said he knows that we probably had a hard week, so we should just take Fridays easy and leave early! If you want to go to the ER or OR, you're pretty free to do so. Or not, if you just want to go home. If you don't like surgery and don't want an insane schedule, this is definitely the place to come!

However, you can also learn a lot, if you want to. Most of the registrars like to teach and do it pretty often. We usually have 1 or 2 teaching sessions per day. Today, I saw a baby with CHARGE syndrome and Down syndrome, as well as learned how to do a baby check. We also had a lecture on Down syndrome. Tomorrow, we have a lecture on childhood asthma and another on cystic fibrosis. For the rest of the night, I'll probably spend a little time reading up on the, so I can appear smarter than I really am ;)

3rd year financial aid

I was reminded that I never posted on how financial aid works for the third year. I guess that's because I found that it works basically the same the previous two years...same paperwork, same process. The only difference is that once the loan checks arrive at MEAS, they send them to you to be signed, you send them back, they deduct their part, then they send you a new check. Similar to what they do at AUC, but obviously takes longer, since they have to mail everything instead of just having it waiting for you at registration. MEAS will mail you a packet once you leave the island, which has all the forms you need in it for your first clinical semester.

Fortunately, the financial aid office is also very helpful and returns e-mails quickly. If you do have any questions, you can just e-mail them and they'll usually send an answer within the day.

no iphone!! :(

I have figured out three things so far, since I've been in London.

1. A "subway" in London is not the same thing as in the US, at all. Here, a subway is just a walking path under a road, so you don't have to cross a very busy roundabout. I crossed quite a few very busy roads before I figured this out. What I was thinking of is just called the underground.

2. I do not like pounds. They're too big and they're all different sizes! Who came up with the idea of money that does not fit in a wallet. And coins? I don't much care for them either!

3. I really miss my unlimited data iPhone service! I am absolutely lost, both literally and figuratively, without it. I'm going to try to figure something out with O2 (the local cell company), but I'm not holding onto much hope.


I have conveniently provided this stick figure drawing, so you can see approximately how large their money is!

I'm in London!

I guess I have a bit of catching up to do on here! I finished my psych rotation yesterday at 1pm and was on a plane here later last night. Unfortunately, it was an overnight flight, so I'm pretty exhausted. I've gotta say...I'm a big fan of British Airways, but I still cannot sleep on a plane. I was in coach, but the seats were more comfortable than usual, reclined about twice as far, had video on demand at every seat, and they actually served 2 meals! For free! And free alcohol!

I arrived in london at about 5am eastern time, 10am London time. It was a little over an hour cab ride to get to my hotel for the next few days, but he went through the city and showed me the sights. Although I still have to go back (probably tomorrow) to really explore and take pictures, I've already seen Westminster Abbey, London Bridge, London Tower, Big Ben, Buckingham Palace, the London Eye, and a few other things. I also walked to Queens hospital, so I could get an idea of where I'd be working for the next few weeks.

The hospital is brand new, and looks it on the outside. The inside does not look quite as nice as a US hospital would, but I haven't seen the patient care areas yet either. I also saw a few ambulances, which were very different than what we have in the US! For one, they've got lifts on the back!! They NEVER have to lift a stretcher, which must be very nice. But, they're quite a bit smaller than what I'm used to at home.

I've gotten a few pictures of the hospital and Romford, but I forgot my memory card reader. So, getting a cheap one tomorrow is definitely on my list of things to do. Once I go into London, I can't imagine it will take too long to fill up the card. At the moment, I've got pretty decent internet in the hotel. So, I'm hoping it's at least this good in my apartment on Monday!

Speaking of hotels, this place barely qualifies as such. The staff is very friendly and I suppose it's got everything you need, but geez these rooms are small!! We're talking basically a double size cot, shower right behind it, and a tiny bathroom that you can hardly turn around in. Compared to this, a typical comfort inn looks absolutely luxury. I guess you could call it cozy though. I think it's time for me to go to bed! It's only about 6PM here, but I'm trying to get rid of jet lag!

DO NOT MOVE EMERGENCY VEHICLES!!!

Today, I'm going to share with you one of my greatest pet-peeves in the world. Occasionally when I'm driving the medic unit or some other emergency vehicle, some dim wit will walk up to me and ask me to move the emergency vehicle because it's blocking their car, road, or whatever. If you're one of these people, please allow me to save you some time...NO, I will not move the emergency vehicle for your convenience.

The thing is, I probably parked it there for a reason. If I'm driving the ambulance, I probably parked it in a place where I will have best access to the side compartments and the back for loading the patient. It's also very possible that I intentionally blocked traffic to protect myself, the rest of the crew, and the patient from cars passing us. If you haven't noticed, people tend to not do their best driving when they're trying to simultaneously view an accident scene; pretty flashing lights are just sometimes distracting.

If you see my ambulance somewhere with the lights on, and I'm blocking your way, please consider that someone has called 911 and needs help! Your ability to get out of a parking space, or continue on that road, is at the very bottom of my list of priorities. In fact, it's not even on my list of priorities. But one day, when you inevitably call 911, you'll appreciate that the paramedic is more worried about you than the people who want to get out of their parking spots.

One last thing...whatever you do, don't get in the emergency vehicle and move it yourself!! This is called "unauthorized use" and will buy you a ticket. Someone at UMBC is about to find that out.

Spring Grove Museum

If you ever get the chance, i'd recommend heading over to the Spring Grove museum. It's only open on Thursdays from 9am - 12pm, which is why it's taken me so long to make it over. It's run by a bunch of retired Spring Grove employees, who now volunteer to keep up the museum. It's not very large, but pretty interesting to walk through. Spring Grove was actually the second psychiatric hospital in the country, started back in the 1700's, so there's quite a bit of history to see there! Here's a couple pics. Sorry for the poor quality, but i only had my iPhone with me today. Check out my flickr site for many more. Clicking on any of the pictures should take you there.


This is the Foster Wade building, which is easily the creepiest building on campus. It's been locked up and condemned for many years, and I will not divulge if I've ever been in the building. If I had though, I'd tell you that it's far worse inside than out, especially at night, on Halloween! The dedication stone by the entrance reads, "Psychopathic Building," so that ought to give you an idea how old it is. This is only one part of it...it's a huge building.


If you weren't psychotic before you arrived at Spring Grove, this would certainly help to get you there!


The heavy restrain chair....this is what they used to get control of you before the days of chemical restraints


...or this


Some very interesting old articles...check out the titles!


Old electroconvulsive therapy (ECT) machine

My psych unit

I wasn't going to post any pictures of my unit, to avoid HIPPA violations, but then decided that posting a picture of the signs outside doesn't violate anything. Although, I did have to be careful not to get pictures of anyone in the yard! So now you've seen a small part of the outside of my unit, and the medication book. My fellow med student got a picture of the two of us inside today, so that will come later.

I'm on a unit which has a lot of forensic patients (people with legal issues), most of whom are not allowed to leave the building, hence the fenced in courtyard. At every entrance, there are two doors, and you only unlock one at a time. That way, there's never an unlocked path out.

My new favorite thing...

Yeah, I know it's a bad picture. But, the green tab which is pulled out reads, "Doctors Orders, Routine." This is the medication book on my unit, and it's where we write all of the medication orders. Anytime I, or the attending, write an order, we pull this tab up to let the nurses know there's something new to do. Since I've become a big fan of writing medication orders, I've also become a big fan of pulling up this tab...seems very doctor-like. Yup...it's the simple things in life that make me happy. Why is writing orders my favorite thing? Mostly because it's the only thing I've done so far that I couldn't have done before this year of med school. Psych is not exactly packed full of procedures to do.