Back to the rural

It's kind of odd being back in Hinton where I finished my rural rotation about a year and a half ago. The reason I say so is because it's like this place was frozen in time when I left, and it's almost exactly the same since I came back. Granted, it wasn't that long ago but it's still kind of a bizarre feeling. The most dramatic change I noticed was one of the doctor's hair is a bit more salt than pepper and one of the hospital's walls are a slightly darker grey colour.
It also makes me hope that it seems that I've improved in my clinical training, judgment and management skillz. I may not know prenatals like the back of my hand as I did before but I'm hoping everything else has gained at least +1 EXP.
The one new thing I have enjoyed is the teaching role I've taken with the medical students. It's something I've already noticed I enjoy doing, and it adds something unique to my day. I'm finding myself looking to incorporate that into my future career.

Each day I'm also trying to look for what I would like to do in at least my more immediate career... both major and minor factors. It's difficult to evaluate because I still give the usual "Iiiiii... dunno" shrug whenever someone asks me, but small pieces are coming in here and there. It doesn't seem that full-time rural life is in the cards... at least for now. In many ways I still like the academic life, exploring cities, and while the schizoid side of me enjoys the remoteness, being in a hub city makes travel much more accessible. These may seem like minor factors in the end, but they're something for now.

(less than) two more weeks

Hard to believe it's been eight months already. Really really hard to believe actually.

I still feel like the same guy who got here back in September except maybe a bit more comfortable, a bit more able to put pieces and clues together, a bit more able to pick up on nuances, a bit more able to ask the important questions, a bit more able to figure out what's actually going on... maybe just a bit more competent.

It's an odd feeling. All along the way outside of rare occurences where I scream to myself "I just studied that!", I don't actually feel like I'm actively learning. When I see patients though, it doesn't feel as much like a giant question mark anymore. I now recognize more medications than I have to double-check on my iPhone. I'm getting some pimping questions... correct?

The days don't seem as long anymore. A 12-hour shift in the ER, a full day of surgery or a long clinic day don't seem as daunting. Don't get as much sleep as I'd like in one night? Meh! As I just told Brad, it feels like when you're training. At first when you begin to run (or swim or play that sport), you want to die. You don't feel like you'll ever get used to the rigors only to catch yourself breezing through spending more time than not at work and with less sleep than I usually get to boot.

Even more, I'm astounded as to how fortunate I am to have gone through my third year here in Hinton. The patients rave about the physicians I work with, it has an excellent setup for a town of ~10,000 people, and the medicine that passes through those hospital and clinic doors have not disappointed. I have a hard time thinking of what I have missed out on in the city minus the "weird and wonderful" that is not really what is important in third year when I'm trying to establish my foundation in medicine. I have seen the pediatrics, the obstetrics, the internal medicine, the surgery, the psychiatry, and of course what family medicine should really be like. What's more, my preceptors are more genuine friends than bosses, and outside of James have been my main outlets for support AND social out here...  and I know will be people I keep in touch with in the future, and not for the purpose of reference letters. I honestly could not think of a better learning environment.

As to the golden question: what do I want to do next? A lot of doors still seem to be open, and I don't feel particularly rushed to say I'm drawn by any of them. In fact, there could be some opening in the corner of my eye too. There is a "big three" that has always been around, and the winner of the race probably won't be revealed until very close to the end barring an exceptional experience somewhere, or the lack of one. In descending order...

3. Emergency Medicine - It made a strong push maybe about halfway through the year as I was starting to feel a lot more comfortable with assessing and making decisions regarding patients and has always been the vehicle through which I have learned the most in the approach to the sick patient. I liked its versatility - you never know what's coming through the door and that satisfies my very short attention span. The fact that I can also do things with my hands is a dimension the other two don't have much of in either quantity or variety. With that said, doing things with my hands is not what I want my career to be centered around which is why I have essentially knocked any of the surgery specialties off my list. The three letters "NYD" (not yet diagnosed) is also troublesome - I don't deal well with unsolved problems, and continuous care and building relationships with patients are both important to me. Finally, the biggest knock against it, at least from my point-of-view is the shift work. I know a lot of people don't really mind it, but growing up with two parents who both did shift work, I generate a slight personal bias against it.

2. (Rural?) Family Medicine - I can't picture a better working environment, should I decide to go down the Family Medicine path, than the Hinton Medical Clinic. Everything including the support staff, the set-up, the other physicians was almost as good as I could imagine a family medicine clinic being. The HMC played a massive part in a late push by Family Medicine. Building relationships and the variety of problems are both positives, but I do remember that if I ever had more than 5 days in a row of just straight clinic, I started to get incredibly bored. I do enjoy the versatility and the fact that literally any type of medicine can walk through the door (similar to EM above), and as a result, one's practice can be moulded as they see fit (also similar to EM above). A significant part of me though does want to be a relative "expert" in a field I work - where I can be looked to by colleagues for consultations or answers to questions. It may come off as egotistical, but I see it more as a challenge because if I am relied on in that way, it forces me to stay diligent.

1. Internal Medicine - the incumbent leader that never really had been unseated outside of feeling great after one Emergency shift back in January. I love the complexity of its cases, and at least a few of the subspecialties I feel can overcome my ADD-ish tendencies... maybe. Continued care is also a real possibility with a number of the specialties. Interestingly enough though, throughout this year I have further realized two major concerns exist:

(a) the patient demographics are relatively narrow, I'm sure people over the age of 60 make up over 80% of the people treated by internists. Comorbidities abound - many of the solutions for people on 30+ meds... is to put them on more medication. Sure, some may live longer, but what about their quality of life? Diseases may be diagnosed, and that can be rewarding, but a lot of patients they deal with are sick... and stay sick, or feel worse in the name of maybe living slightly longer. It can be argued though that yes, internists do see patients when they are at their worst. When they've hit rock bottom... and many of them don't make it out of that, but I'm sure it is incredibly rewarding to see them come out of it (eventually) much better. No pain, no gain, right?

(b) my hands will either be in my pockets or writing orders. Outside of physical exams, the two main exceptions are interventional cardiologists and gastroenterologists, but even they do a relatively limited number of procedures which are incredibly competitive to get training for and land a job. Sure, I'm sure my brain will be tickled and puzzled a lot of my time, but I fear my hands will grow to resent me... I guess that's what art and hobbies are for, hey?

So that's where I stand. It's almost 00:30 and I'm too tired to make a dramatic or insightful conclusion from this rambly essay. Somewhere in Edmonton, Ms. Tuba is cringing.

sunny boy: just can't get enough!

The other day while shopping at IGA for Cream of Wheat (yes, I have weird cravings), one of the grocers recommended I get this "Sunny Boy" cereal instead. He said it just plain tasted better. So I went for it! And now I just can't get enough!

[youtube="http://www.youtube.com/watch?v=_6FBfAQ-NDE"]

Thanks, Depeche Mode. And he REALLY does look like Shia LaBoeuf hahahahah

life charts update: a mess

Charts? More like soup at this point. Chicken soup with rice comes to mind. Maybe I'm just hungry. Seems like things are changing on a daily basis. IM remains stagnant. 5-year EM is falling, and family medicine is slowly rising. Now what?

I feel like I'm really hitting my stride with ICC, but I'm also ready to head back to the city. In the end though, no complaints.

sick = FTL

I hate calling in sick. Not only does being sick suck, but I find the guilt is just as bad. Why does it seem like no one except for me gets sick? Yeah yeah, I'm just being paranoid...

STARS simulator

So the STARS mobile simulator rolled into town today and I was scheduled for a 1.5 hour session inside this modded out RV. Instead, I spent 6 hours inside! It was a great experience! I wish I took a picture but it's fully equipped with an interactive mannequin that talks, blinks, breathes, has vitals... and even has responsive pupils.

Since I was the only person there at 9 AM this morning, they basically threw me off into the deep end with a simulation of me (and only me) managing an acute inferior myocardial infarction. Major fail, hahahahaha. We also ran simulations on septic shock, a fractured pelvis and a difficult airway. My brain is totally saturated now and I need to debrief myself on the information overload I received. With that said though, I probably won't forget any of the information I learned today any time soon.

Candied pecans

Amazing how much adding candied pecans to a salad really livens things up. I'll give credit to the goat cheese which is turning out to be the unsung hero of the kitchen thus far.
The spinach salad I made was pretty standard - grilled chicken (salt, pepper, cayenne, splash of maple syrup), spinach, strawberries and goat cheese. In hindsight I guess I could've thrown on some diced purple onion.
"Candy"-ing the pecans was simple enough. I just mixed in a tablespoon or so each of olive oil and balsamic vinegar with 1/4 cup (ish) of brown sugar into the frying pan on medium heat. Constantly stirred until the sugar had melted, and it was bubbling assertively. Threw in a cup of pecans and tossed it around to really let the mixture coat 'em up. Maybe 4 minutes for the initial mixture and another four to sweeten the pecans. Gotta make sure it's evenly coated. I then spread it out on some wax/parchment paper and let them dry for about half an hour. Make sure to separate the pecans individually because by the time they're done cooking they're already sticking together.

vegetarian lasagna

Had Q and Court visit this past weekend so I thought I'd whip up something special for them. Unfortunately, I've never made lasagna before so it was quite the process. We were all famished after a hike down Happy Creek Trail, so I'm amazed they didn't put up more of a fuss when I was taking so long to make the whole thing. It's a good thing they picked up some triscuits and hummus to munch on while they waited.

Anyways, the lasagna turned out great. About 98.2% of the effort goes into the prep, 1% goes into deciding how to layer it, 0.2% goes into the layering process and the final 1% in waiting. I used a recipe from my allrecipes.com iPhone app as a guideline, and improvised a lot from there. (Will update the post later when I upload photos from the making of)

First off, I decided to go with a from-scratch pasta sauce. Turns out it's really not hard - just sliced about five tomatoes into (rough) cubes, threw them into the frying pan with olive oil under medium heat for maybe about 6 minutes and let the tomatoes just fall apart. Added basil, salt, pepper, cayenne and brown sugar to taste. A bit too much cayenne pepper fell in, but I enjoyed the extra bite of the sauce.

Chopped up the mushrooms (less than the recipe), green pepper, onions and garlic. Decided to throw in some grated carrots in there too. Let that mixture grill in olive oil for a couple minutes (in the proper order too) before adding the sauce to the mixture.

Lastly, the cheese. Lots of open contemplation on how to deal with this layer. I had goat cheese (~350 g) and spinach (1 bunch) which I was excited about, but wasn't quite sure how to put the two of them together. James brought up the great idea of blanching the spinach and then using his hand blender to make into a paste. We then spread the paste on top of each (WHOLE WHEAT) lasagna pasta layer. It worked great.

In the end, the layers went as follows from bottom to top: Drizzled olive oil, thin layer of pasta sauce (maybe 1.5 cups?), pasta/spinach+cheese paste, then sliced zucchini. Repeat the sauce, pasta/paste and zucchini layers until the top where it was topped with a healthy layer of mozarella. It was baked in the oven at 350 degrees for 40 minutes, with the last 2-3 minutes on broil to help brown the cheese.

Seems a lot simpler writing it down, but I guess the disorganized array of vegetables around me and indecision slowed down the process quite a bit. I was super happy with the from-scratch tomato sauce. I honestly don't know what I'd change for next time except maybe try it with different types of cheese (feta? ricotta?) and maybe some parmesan on the top.

Bonsai ginseng ficus

If I were a Sim, this would add +3 to my Room category :D

Cod fail

Tried to grill some cod today. Should have remembered I suck at frying whitefish. I was trying a pineapple marinade that included some brown sugar and soy sauce, but I think the soy sauce overpowered the sweet flavour.
Potatoes were also an awful side. Should have gone with rice, but I guess I panicked because a few of my spuds began to sprout. Should know better than storing them in the cabinet between the oven and the fridge.

Believe me, the picture looks better than it tasted. Can't win them all I guess.

Impromptu penne with spinach and asparagus alfredo

Remembered that I had some extra asparagus and spinach from last week. Mixed it in with Alfredo sauce and it turned out surprisingly well. Grilled the asparagus briefly before pouring in the sauce. For the most part spinach cooks fast so I just mixed it into the sauce near the end. Very quick to make.

Steak

Made it last week. Quite the adventure with a frying pan and olive oil (low boiling point). It turned out all right though, and was as rare as I wanted for the most part.

Asparagus was my favourite part. Oven-roasted it actually - 10 minutes at 425•C I believe? Tossed it in balsamic vinegar, olive oil, salt and pepper. I do enjoy the flavor that was preserved in the oven vs. the conventional steaming.

First week: cooking

A brief overview of my culinary excursions this week (since I didn't so much "excursing" outside of the condo) --

Monday: Mung bean soup
A simple dish that was one of my favourites from Taiwan last year. It's a meal and a dessert! I added some coconut milk for flavour which turned out pretty good. Definitely feels like it's missing something though and if I ever learn how to conjure up those bubble tea tapioca pearls, those are going in next time.

Tuesday: Thai green curry chicken with coconut jasmine rice
Sounds exotic, but not too difficult if you're cooking from a curry paste. Cop out, I know but I gotta start with the training wheels on this one. Stir fried the chicken, onions and peppers with soy sauce, fish sauce, ginger, garlic, olive oil and sesame oil first. Added the paste and coconut milk later. Sort of wish I had a bit more coconut milk because that paste was REALLY spicy. Very tasty, but room for improvement.

Wednesday: arugula and spinach chicken salad
Nothing special here although I did try a honey/garlic concoction to flavor the chicken. I was especially excited since the honey came fresh from a classmate's parents who are beekeepers! Topped with feta, balsamic vinegar and olive oil. Next time I'll take James's advice and try to mix in goat cheese to add something special to that vinaigrette.

ah told you ah'll be back

Did I actually say that? Who knows. Maybe this (the 18th? 350th?) time it'll stick. I was thinking about it before, but Alim said I couldn't consistently cook. I primarily respond/react to challenges and competition, so we'll see about that! Now to dig out the photos...