Shimmy on outta here

Sunday, Rebecca asked me how much longer I'd be around for, then Pastor Jose came up to me and asked the same thing. They get me for one more Sunday and then I take off. It was definitely a blessing to have PRC so close by and be such an awesome church. It's comforting and exciting to know that such a passionate congregation exists in Miami.

In between studying for the shelf exam, I Skyped with my dad who told me that he ran into an old high school friend at Trinity Baptist. Turns out their old commerce teacher is an usher there too. It was neat to hear that on the Sunday my parents decide to try out my church, they see familiar faces. They went to the 9:30 service which tends to be smaller than the 11am service I attend. I think they'll try out the 11am service next. But based off what my dad said about their experience, they see a lot of the same things I see which is encouraging.

In other news, my middle older brother, Justin, completed his medical lab technician program at SAIT and then got a job at Lifelabs in Burnaby. Looks like the BC boy gets to come back home, which is very exciting. Here's hoping I get to do the same in two years. I haven't seen Justin in almost a year. He was away for Christmas and then I took off to Saginaw days before he visited home for the holidays. To his credit, he wasn't planning on visiting home last summer, but mom encouraged him to come out because I would be in town. It wasn't until he was home that he found out why I was in town. Good guy, that one. Proud of him for finishing his program so well, experiencing the independent life, and scoring a job back home.

I scheduled out the rest of my core rotations and some electives. Didn't work out how I wanted, but I wasn't expecting it to. After Internal Med in Brooklyn, I have Family Med in Youngstown, Ohio. So while I get to escape a New York winter, I have the pleasure of experiencing an Ohioan winter, which is typically worse. The plus side is that I get to check out a new place. Never been to Ohio before, whereas I've been to Michigan, New York, and Florida well before med school. I'll have to ask Genny what I have to look forward to. The major plus side is that my rotation ends Dec 19th which allows me to come home for Christmas. I was worried that this would be my first year away, but God's good. In the new year, I head back to Brooklyn for Pediatrics, then I go to Pontiac, Michigan for Surgery. Plenty of flying. 

My doctor gave me Monday and Tuesday off to study for my shelf on Wednesday. On Wednesday, I went to my school rep to pick up my PALS certificate. Unfortunately, my name was "Kristen" on the card which is problematic. Definitely reaffirmed my stance on never naming a child Kristen or Kirsten. After the name fiasco, I headed to the testing centre to tackle the shelf. It felt like it went better than the Psych shelf (I got an A for my Psych rotation), so here's hoping for another A. To be fair, Psych and OB aren't known for having terribly difficult shelf exams. Internal and Family on the other hand are a bit notorious for being tough.

Thursday, my first day back at the office and my second to last day of the rotation. It was a full day of morning procedures starting at 8:30. Three tubal ligations in a row, then a quick drive over to the hospital for another delivery. This little tyke sure liked to take his time and even though mom had done this before, it was a tough labour. Had to do an episiotomy, but within an hour, Caleb had entered the world, and we were out of there. Another one of our pregnant patients was in the ER presenting with appendicitis-like symptoms. We checked on her and found imaging results negative for appendicitis which is comforting. While the doctor was working on her documenting, she sent me back to the office to get started on the backlog of patients at the office. We were running an hour behind. I arrived at the office just before 3pm, quickly scarfed down my PB & J, then I played doctor. It was chaotic, but also very exciting being on my own with the staff and patients happy to see me because I can legitimately get some things done without the doctor present. That's how the rest of the day went, I got the grunt work out of the way, then the doctor finished up. Oddly enough, after such a productive day and eating dinner, I wanted to hit up the gym. So I spent a quick 45 minutes on the treadmill.

Friday was full of procedures as well: hysteroscopies with myomectomies, and an endometrial ablation. Took some quick pics of the staff, said goodbye, then took off to the hospital where another patient was in labour. She was hanging out at 4cm for hours, so we grabbed a late lunch at 3pm, performed a circumcision on Caleb which seemed cruel at the moment but hygienically it'll be better in the long run, then we returned ruptured the membranes and put in a foley cath to see if that would speed labour along. We waited in the doctors lounge until 7:30pm periodically watching the monitor feed to see how labour was progressing. You see the baby's heart rate, the mom's, and the size and frequency of the contractions on the monitor. By 8pm, I was getting antsy. This wasn't how I envisioned my last day going. Finally, my doctor said that I might as well go home, which was music to my ears. I forgot to get a picture with her, but I got a good hug out of her instead. Fair trade.

Heidi at the front desk

Shakila, Liz, and Abby

Saturday, I slept in and it was glorious. I ran some errands for the July weddings - gifts, rounding out my bridesmaid get-up, getting a dress for Danielle's wedding. Then I returned the rental, walked over to Subina and Jim's apartment to wait for the new tenants to hand the keys over to them. Then walked home to eat dinner and work on Deen's dance playlist, and you know, this blog.

Psych done. Ob-Gyn done. Miami done. Well almost. I leave in two days. It was fun, but I'm ready to leave. New York - here I come and then home!!!!

Shall we continue

I may have noticed a few weeks ago that all my posts for this rotation have started with "S". And yes, I'm a bit disappointed that I sabotaged myself by having a post start with "Show" instead of "So". So I figured I'd name this one starting with "Sh". I over think a lot of things.

Sunday, Subina dropped off the keys to their apartment so I can give them to the students taking over their lease. A quick goodbye hug, a hello to her mother, and then they drove off. That's the last of my friends to leave Miami. They're all gone. Studying for the shelf, and preparing to move should keep me plenty busy. Add in the fact that I'm on call for the last two weeks and time should go by quickly. I finally had to rent a car in case I get a 3am call which my doctor says is quite likely because babies like to enter the world at ungodly hours. Thus my days of public transit in Miami have come to an end. I'll miss saving all that money. Thank God New York doesn't need cars.

Monday, I assisted in the removal of subcutaneous contraceptive implants in two patients' arms. It's been two years since I've handled scalpels, hemostats, and forceps. It's the first time, I've cut into a living human being. Thank God for lidocaine and patients that look away while you dig and pry open fascia to get at this little rod in their arm. Another interesting patient we had was an expectant mother requesting to keep her placenta post-delivery so she can grind it up and get it capsulized at a compound pharmacy. I suppose that's less off-putting than straight up eating it. Slightly less. On the plus side, compound pharmacies are being used. We finished off the day with a marsupialization of a bartholin cyst. It was quite large and well capsulized. We had to give the patient a bunch of lidocaine as I tentatively sliced away at this giant mass on her vulva. The best part is that you forget that you're working on a vagina. It's mini surgery and you're just focused on the cuts and what needs to come out and be sutured back up. The thing about cysts is that they're under a lot of pressure. So once I finally broke through that last remaining layer of the capsule, it was like a geyser. It's possible that reading this paragraph has already maxed out your "gross" quota for the day or week. So I won't go into the colour, consistency, or smell of what came spewing out. You're welcome.

Tuesday, I presented my case study at didactics. It's a requirement for this rotation. I presented a patient who within a week's time was told she was 10 weeks pregnant at the ER, but turned out to have a cervical ectopic pregnancy (very rare, very deadly) after an ultrasound through my doctor's office, then had a dilatation and evacuation at the hospital which became complicated due to massive hemorrhage and resulted in an emergency total abdominal hysterectomy. It was a tough case to work through as I read all these reports from the different people involved. So many hands in the pot and unfortunately we ended up with a woman who lost her only pregnancy and can't bear children ever again. It's been the most personal (most involved) case I've had in this entire rotation. So because of that and just plain missing my doses of hugs and love, I got a bit choked up near the end of the presentation when I recounted our follow-up call with the patient who broke down over the phone. Surrogacy and adoption are options, but for now it's all about giving time to acknowledge and mourn her multiple losses. Drove home to eat a quick lunch, then ran on the treadmill, showered, and Skyped with Yan for a couple hours. It was nice to catch up and just hang out.

Wednesday & Thursday were MOTS at work. Deen and I Skyped on Thursday which was wonderful. We talked about life and the upcoming wedding. Later that night, Ali and I Skyped too. We're both studying for shelf exams and provided each other a nice break. She's always great for conversation. It doesn't have to be about anything particularly important, but with every talk you get that growing feeling that it's comforting knowing she's in your corner. She's a special one.

Just as I was about to go to sleep, my doctor texted me that one of our patients had gone into early labour and to "sleep in scrubs". Well, let me say that if you really want to mess with my dreams, you'll tell me that at any moment I could be wakened and expected to show up at the hospital within 20 minutes. It was like Inception and Groundhog's Day in my subconscious; cyclical dreams of waking up to a text or waking up to a bunch of missed texts and rushing to the hospital in endless search of the delivery room. I must have been producing some major stress hormones because I woke up in a sweat and with a huge stomach ache at 2am. I made sure my phone was on max volume on the night stand, then endured MOTS dreams, when finally at 5:55am I got a text from my doctor that said "Maneb" followed by another text that said "Amen". I kid you not, I googled "Maneb" then "Maneb obstetrics" and I couldn't figure it out. What does this mean? Is this code for "roll out" or "false alarm" or "keep you posted"? Finally, I caved and texted back "Good morning. What does Maneb mean?"

Dr - "Me typing in my sleep"

I'll admit there's some solace in knowing that my preceptor, who's been practicing medicine for over a quarter century, is just as clueless as I am at 5:55am. On the other hand, did my doctor really just wake me up by sleep texting? That's a thing?

Our patient was taking her dear sweet time dilating, but either way, I lost sleep over it. She delivered at 1pm. It was the quickest, least gruesome vaginal delivery I've ever seen. A baby girl sitting perfectly in the pelvis, and a mom whose body has done this before, done and done. Out pops the head, suction, suction, suction, out pops the arms and torso, baby cries, out comes the rest, skin-to-skin, cut the cord, clean baby off and assess, take sample of umbilical blood, apply light traction on cord, more skin-to-skin, deliver placenta, assess placenta, and then leave. In and out in 10 minutes. No poop.

Then we were off to do a hysterectomy. You'd be living in a dream world if that took 10 minutes. 2 hours straight of standing and leaning over and I was just observing. The anesthetist who gets to sit for most of the procedure switched out, as did the sterile nurse, halfway through. Lucky. The procedure is methodical and succinct, but it's also just plain butchery too. The cuts aren't particularly smooth, the sutures seem a bit haphazard as you work your way down from the fundus ligating arteries, and when you finally get down to the cervix, you take scissors and cut the whole thing out. It made me feel a little better about some of my dissections in anatomy lab. Don't get me wrong, it's still an art. Just less Da Vinci and more Pollock.

Today, I got to catch up on sleep. The sun was shining, but there was no time to bask in it. Studying gets to take up my time. Shortly after noon, the weather did what it's been doing for the past week. It clouded over and then a thunder storm ensued. The lightning strikes were close as it illuminated the apartment and announced itself with a large "CRACK" immediately followed by roaring thunder. Definitely makes studying easier. Then by 4:30, shortly after the Ghana vs Germany match, the clouds cleared. I live with a Columbian man who's a freelance worker, meaning ever since the World Cup started, he's been home watching soccer all day, every day. It hasn't been terribly distracting because he's watching the Spanish channel and Spanish commentators tend to be over the top. So I tune it out until I hear "Gooaaaalllll!" for 10 seconds. That's my signal to look at the tv. 

Just after noon

A few hours later

So long, So long

Oh man, my Saturday night/Sunday morning was probably one of the most tiring nights of my life. As a final hurrah before the track people take off, we headed to the Hard Rock Casino. We all pre-gamed at Jim and Subina's where I had the sinking suspicion I'd be the DD. By 10:30pm, the 6 of us loaded up into two cars as my DD status started. It was a 45 minute drive to the casino. The place is huge complete with restaurants, high end stores to shop at, numerous bars, pubs, and clubs. Upon arrival, we headed to the bar in the middle of the casino where girls dressed in Miami Heat cheerleader outfits stood atop platforms to dance while 90's music played. One was dancing in a cage elevated above the circular bar. It was depressing. Couldn't help but feel like an asshole just for being there.

After the crew got their drinks, we headed to the penny slots, which reminded me of my grandma spending her days at the River Rock Casino. I hear she's been playing mahjong lately which is great. It encourages more interaction and keeps the mind sharper. Subina wanted to play a machine with a functional arm, because most slot machines are mainly button operated now. She lost her $2 pretty quickly. Jana (a classmate who's not from our rotations but in Miami) on the other hand, played once and won $100. She cashed out as per our encouragement. Then we played some blackjack where Paul and Subina cashed out with a profit. I spent a total of $25 that night, so don't you worry.

Our next stop at the casino was a rooftop club where more drinks were consumed. Then we went to an indoor club where things got sloppy including the other DD. Subina took note early on and ceased her drinking anticipating she'd need to be the substitute DD. The only thing the two of us were checking out that night was the time, watching hours pass by and no slowing down in our friends. We endured a very long night of turning away multiple drunk men who seemed insistent on determining "what kind of Asian" we are, eventually yelling at our friends to get their crap together after meeting (I kid you not) the 3rd and 4th guys together guessing "Japan, Korea, Vietnam, Thailand, Philippines, China, Tibet, Serbia?" (men can be such pigs), then a stop at one of the 24 hour restaurants so people could fill their stomachs with something other than alcohol. I got home after 5:30am, woke up a few hours later, and went to church. The rest of the week was spent trying to make ground on the sleep deprivation, but to no avail.

This week in my rotation, my attending let me take the lead in her obstetric appointments. I started the interview and physical exam and then she'd join us later. I appreciate that because it's always fun to use the Doppler to listen to the baby's heartbeat. The patients tend to be more comfortable and enjoy the extra chat time. It seems that everyone's finally warmed up to me which is nice because I was worried that it wasn't going to happen. The staff enjoy my humour and my doctor has really taken a liking to me. She's a Christian and very open about it. On her desk she has the same devotional book I was working through in my first year on Dominica. It's a nice thing to know you have in common, but as a med student, I resisted bringing it up. It may sound absurd, but if she was going to find out I was a Christian, she'd have to ask me directly or assume based off what I do and say.

Wednesday night, Jim, Subina, Paul, and I met up with a resident from Larkin (psych rotation) to see The Naked and Famous in concert. It was $20 for the show which featured some great opening acts. In Miami, the popular music is mainly house and dance music. The indie scene isn't big at all. So it was a real bargain to see such a prominent indie band for such a small price. They are great performers and musicians. And when you have such a small indie scene, it means that the attendees are there because they love the music. Sometimes (unfortunate as it may be) concert goers in Vancouver attend a show without knowing much about the band, but go because there's some sort of prestige factor involved (because the prices are so high and the music scene is so diverse and warmly accepted). For a moment there, we all forgot we were in Miami in the small venue. I think we felt like we were at a similar place from home.

After the show with Subina, Jim, Dr. Thai, and Paul

Thursday night, the same crew minus the resident saw 22 Jump Street. Not the greatest piece of cinema, but good for a few laughs. Friday, I headed to Jim and Subina's after work to help them pack. We had plans to meet up with other residents from Larkin for happy hour at Buffalo Wild Wings, but Jim was taking a bit longer and was leaving the next day, so she opted not to join us.

Paul, Dr. Singh, Subina, and I

After we spent a couple hours at B-dubs, we headed back home to check up on Jim. She finished packing and even loaded up her car. We thought we'd stay in to watch a movie Jim had rented a few days ago, but when Paul and I joked about going to Hooters across the street to watch the hockey game, she chimed in and said "I'm in!". So we headed over and had to request a TV be changed to the game. Hockey's not a big deal here. I'll admit I was cheering for LA because they represent the west and I don't hate them. Though it would have been nice for AV to win the Cup in his first year coaching a new team since being let go from the Canucks. Alas, as the old adage goes - West is best. Congrats to the Kings.

After the game, we headed back home and ended up watching the movie. Since it was Jim's last night, we wanted to do whatever she wanted and we knew she had been wanting to watch this movie for a while. Now Jim's a horror movie junkie. She's seen all of them. We've humoured her in the past and watched The Conjuring which was decently scary. So this night we watched Devil's Due. By any movie's standards, it was awful. Just awful. It dragged on and on to a point where we really just wanted someone to die already. The last 20 minutes were probably the most entertaining parts of the film. When the movie ended, it was midnight and there was really nothing left to do but say goodbye and we all knew it. I barely had time to get my shoes on before Jim enveloped me in her arms. A surprise hug if you will, especially since she's not an affectionate person and doesn't like being touched. Even though Miami culture is quite affectionate, the hugs are half hugs and last 1 second. So this surprise champions hug from Jim felt real good. Good thing I'm visiting Vancouver in 3 weeks 'cause all kinds of great hugs and cuddles await me there. I wished the three of them all the best in Chicago where they'll meet up with my island hubby Janos, and Diane my sneak hug competitor. Now to just get through these 2 weeks alone in Miami before I am reunited with my island family sisters, Malini and hopefully Kat in New York.

So summer's finally arrived for the rest of you

My sweet Bailey has graduated from high school! I feel so old. Super proud of you kiddo :) Since we're 10 years apart, that also means that my grad class just had their 10 year reunion. Of course I couldn't make it, but I'm certainly enjoying the pictures up on Facebook. Some people have not changed a bit, but maybe we just need another 10 years to see the difference.

Sunday at PRC again where plenty more people warmly greeted me. Because the week before was Memorial Day weekend, the majority of the congregation was away. So this Sunday there were loads more people with size comparable to ND. There's a girl who sits up front that could pass as Deen's twin. I had to do a double take last week, forgot about her, then did a double take again this week. The way she dresses, the colour of her hair, the way it sits up in a pony tail, it's almost comforting to see her even though she's not Deen. There's also a young female violinist who has the long locks of Jocelyn and the playing style of Kerry. What's better is that the sound engineer has the perfect mix to really hear that violin. Man, I love strings. Anyways, after the opening song, they give a good minute or two to greet those around you. It's a massive hug and kiss fest, very few handshakes. Lots of people said "Good to see you again" which was kind of neat because I sure didn't remember their faces or names. After the service, I chatted with a few people and then a woman named Rebecca introduced herself. We went over the usual stuff - I'm here for med rotations, I'm leaving at the end of the month, I live a quick walk away, I'm from Vancouver. She jumped onto every thing I said like a girl on a mission. Asking how often I work and when I'm free to hang out, saying people at the church live in my apartment, she lives just a couple blocks away from me, she hosts a small group, and of course remarking that I don't have an accent to which I threw out a "sorry" to satisfy her. She took my # and texted me immediately so I could store her in my phone. I tell ya, she's efficient.

This week in OB, I finally encountered my first miscarriage patients. I say "finally" because they're so common and I expected to see at least one in my first week. Despite the fact that first trimester miscarriages are likely occurrences, people can take it pretty hard. For instance, I had one patient with a great support system but needed to hear it from medical professionals that it happens, she didn't do anything wrong, she couldn't have done anything differently, and that it doesn't mean she'll never be a mom. On the other hand, I had a patient whose mother blamed her for the pregnancy loss and really tore her down. It's in those times when you have to be jerk and just bad mouth someone's mother, and you can't hesitate. It's not an eggshell moment. It's a confidently stomp and trample over all the lies her mother smothered her with moment. Sometimes you have to use strong words and raise you voice for the betterment of people. It's not a gentle approach, but it may be exactly what the person needs. Interestingly enough, I learned that lesson a decade ago with Courtenay. I had a lot of lingering guilt for the way I spoke to her when we disagreed on things, but she was quick to encourage me and show me that that's what was needed in those moments. Because of that, I tend not to second guess my gut approach to conversations, not because I'm confident that I'm in the right, but because I'm confident in the accountability I have through her, Deen, the holy spirit, and others to keep me in line.

Wednesday night PRC had a night of worship and prayer. We'd sing a couple songs, then spend time praying over different things, couple more songs, then we'd get into groups to pray more, and it kept repeating as such. I prayed with a Cuban woman, Aida, who came to Miami with her family when she was 12 and has raised her own family here and now has 3 grandchildren here as well. Very nice lady. We were joined by Lela and her husband Oscar. She came from Venezuela and he from Columbia. They recently celebrated their 4 year anniversary. She is a nurse currently taking courses to study to become a nurse practitioner. Coincidentally, she has cousins who live in Burnaby (which she thought was a suburb of Vancouver. I quickly corrected her). Those cousins go to Tenth Avenue which is where Naomi, Deen, and Jeff go (different campuses though). Apparently Tenth was looking to hire a new pastor a couple years ago who ended up taking a job in Nebraska at the sister church of PRC. Small world. It was a pleasure being there and spending some dedicated and focused time praying on your own and with others. 

Subina and I spoke a bit about church after getting our regular unnecessary dose of boobs and gore via Game of Thrones (only 2 more episodes left to endure). She considers herself agnostic. She went to a private Catholic school in Nepal but raised with Buddhist upbringings, which makes for an interesting mix that allows her to appreciate the tradition, conservatism, and meditation involved in them. In talking about my faith and the Baptist church I'm currently attending, she recounted a time she went to a service and was taken aback by the contemporary music and charismatic congregation. She was expecting a choir accompanied by an organ, and certainly no people raising their hands or periodically saying "Halleluiah!" or "Yes Lord!". I laughed because to a person used to a different style of worship, that would definitely be a bit jarring.

Friday was just a half day so I got to go home early and test the ankle out on the treadmill. We're making progress and at least I've learned that if necessary, I can run through pain for a good chunk of time.

Today, Subina, Jimena and I checked out the Fairchild Tropical Botanic Garden which happened to also have a farmers market. I love farmers markets. We definitely have plenty of them in BC. Great way to enjoy local delicious food. The girls stocked up on some produce, pasta, honey, and soaps. I bought myself a cilantro peanut chutney that will go well with some chicken and peppers. I know I just lost Caroline at "cilantro". In the time it takes for her to recover, just make a mental note that if you're going to prepare any dish for her, you better leave that leafy green out of it. Just like you better leave raisins out of everything you feed me. Ok, I think we're safe to come back now. After making our way through the market, we went on a tram tour of the gardens. Who knew there were so many different kinds of palm trees? After the tour, we went venturing on our own and checked out the exotic butterfly conservatory. They're so cautious with exotic species invading the natural habitat that you have to go through a series of three locked doors before entering and exiting the conservatory with a staff member escorting you along the way to ensure that no butterflies escape. Further to that, they insisted that you not touch the butterflies and that if one lands on you, an employee will safely remove it. You should have seen this family with two toddlers being followed by an entourage of staff. The kids would run at the butterflies sticking out their fingers saying "Land on me!". All in all, it was a beautiful place but the heat wore us out after a few hours.

A popular wedding ceremony location in the garden

A room in the lab with different species of plants

Inside the exotic butterfly conservatory

We headed home where Subina took a nap and Jim and I enjoyed the pool at my apartment and to give me an opportunity to even out those tan lines. On that note, I was a snake this past week, shedding a good layer of skin. I have just over a month 'til the wedding. So hopefully I'll get those lines evened out or else Deen's gonna have a maid of honour with some strategically placed tanning cream. 

Still just as ridiculous looking as before