Canada

So I have had a lovely 3 hour lay over in Ottawa Canada. This is such a nice airport, they have given me free wifi, but I cannot streamline so no tv shows, no movies, reels or anything too dificult for my connection to handle. I was reading my book, but it feels like 10pm but it is really 4pm and this thought makes me want to go buy another cup of coffee. this is a long long day...
I forgot there is snow on the ground. and it is warm coat weather here. I was wondering around the last three weeks in light jackets or rain coats. Oh well at least I got to break up some monotony of winter.
My flight just got delayed another 20 minutes. They are missing one of the crew members. I hope its not the pilot, or the nice flight attendant. I feel like I always like one better than the others that have to put up with me for a flight. I have eaten four meals today already. It just does not seem right... I have watched 3 movies on the plane. I have been so productive in completely trivial pursuits.
oh they just called my flight.
see you all in the US!!!!

love to you all.

You Say Goodbye and I say Hello

Alright I have purposely stayed away from what I have been learning here because it was medical and sometimes dry, frustrating, or disgusting. So if any of these things sound not for you, please stop reading at this time.

My time on the John Warin Ward of Infectious Disease in the Churchill Hospital in Oxford was different everyday. It was often painfully disorganized and frustrating because some people did professional jobs, others did not. So it goes in medicine. I happen to be someone that prefers to do a complete job, and keep the patient care as my focus at all times. I am lax about professionalism I know this, and honestly my command of American English is pretty terrible so I did all kinds of foibles in British English.

For instance, when nurses are ignoring me, I informed my team, "they are blowing me off" this has a different meaning in British English and it was embarrisingly pointed out to me at that point. Other things, I just do not remember all the technical terms of things but I hope I learn them as I progress in my professional career. At this time I am woefully inept at using correct terminology and it tends to make me sound unproffesional and unknowledgable. I really see this as a self correcting problem and I cannot make myself learn it any faster if I put more pressure on myself to get it right. So I put up with lectures and try to figure out if I was true to my patient's issues they have with their health. That being said, I would feel like I had just inserted my foot into my big mouth frequently at the end of the day. Never with patients, with my professional colleagues and seniors.

When I was not being an outspoken "plain speaking" US American I was being harrassed for being a surgeon in a medical ward. However I did get to do some interventions here. I plucked larvae nesting in a patients skin and causing inflammation and unease as it moved around inside his skin. That was pretty intense and fulfilling when I pulled one out. I have taken care of AIDs patients at different levels of disease, HIV patients, TB patients, leishmaniasis, shistosomiasis, cystercercosis a lot of psychiatric patients that had questionable infections--(really medicine and surgical teams just dumped them on us b/c they did not know what to do with them) the nurses were always very good with patients, the abusive, the psychotic, the catatonic, the senile, the demented, the drug abusers and the prisoners.

what did I learn about the United Kingdom's health care system? Both the UK and the US system have their problems and fail their patients at some level. I cannot tell you which one is better or which one does the best job. I get very frustrated with both of them and feel there is a need for change but know that is as likely as me being out of a job because there is no need for medical care.

Sorry to disappoint but I did not walk away from this experience a convert to the UK health care system. I also continue to be disappointed by the US Health care system as well. I think it is inefficient, not cost effective, and not patient friendly. I am a product of this system so I continue to want to work on changing it for the better. However after experiencing another health care system and working in it for a very brief time as a student I have a little perspective on general problems all health care systems experience. For that I am grateful and will be learning from this experience for years to come.

Ward Rounds

My month here has been long, crazy ward rounds everyday. We did not finish until mid afternoon most days. To me, you spend an hour maybe two hours, but then you go to the OR. Not so with medicine doctors. All the same these have been extremely long ward rounds. We would consider every physical finding, every test, what test we should order next, and then what exactly is the diagnosis and how are we going to treat it? Most the time there is a muddle of things going on with patients and it is hard to pick out all the problems and what to focus on and such.

Yesterday we had our last patient to round on. Mr. E. He came into our ward with uremia encephalopathy. His urea was 40 for those that follow labs. He was a vascular path without legs, he was weak, quite confused, and aggressive. Last week he took regular swings at me on some days and then would invite me to sit down and talk nonsense for a while. He was entertaining. He had some problems with a urinary tract infection while with us, and still had all his medical problems. We walked into his room and he was laying there in bed dead.
It was not a shock, a surprise, or anything out of the ordinary really. He lifeless body layed there in bed. He had been alive only a few short hours before and was fighting with the nurse because he did not want his oxygen mask on. His swing was gone from his arms, his eyes fixed and dilated. We listened to his heart for a full minute, without any sounds, no pulses. His hopping around in bed with his leg stumps had ceased, his incomplete sentences, accusations, and loyal Britain singing was gone. I was no longer the dirty American trying to fool him. He was there helpless, alone, and lifeless.
His partner was an American, she could always calm him down, and introduced herself to me as, "the love of his life" I could not take to heart is anti US American names for me. He had three wonderful children and I am sure they will remember him as the fiesty man he was even at death. I really enjoyed him for the time that I had with him.
There was nothing to do but say a prayer over him quietly, cover his beautiful body up with a sheet, inform his wife and then we went to lunch. Life goes on, there continues to be another crazy patient that needs looking after and perhaps a place for him to die as well. He continues with me reminding me not every angry word or act of rage is directed directly at me. Most of the time it is just frustration reaching out for contact and needs my skills as a medical doctor if there is anything that can be done. And when there is not then it is to help him die peacefully.

The Irish Sinnott

So I flew to Ireland this weekend. My one flatmate was returning home and the other flatmates decided to make sure she got home. We stayed with her family in Galway for two nights. We saw the sights!!! It was quite good.
I was in Dublin for 1 1/2 days all together. Enough time to find the Sinnott Bar. I went in for lunch and ended up staying quite a while. I met some young Indian london bankers on a birthday weekend in Dublin. I helped them finish a keg of Guinness. I am not a huge fan of the taste normally but I think it tastes really good in Dublin and I think I would feel weird drinking anything else!!
Interesting fact about Sinnott Bar in Dublin: Each Table has two kegs installed in the center and a self pouring tap at the table. You have a choice of Guinness or Carlsberg- a lighter beer. There is an electronic tracker of how many pints you drink. This was just fascinating and the guys I was with and I had a great time tapping the keg!! I left them outside of McDonald's to finish my tour of dublin. They were going to go pass out! I love meeting fun people and having a few hours of good times. We each took responsibility for the worlds problems, the bankers- responsible for the economy, me- responsible for the Iraq and Aghan wars. We had several drinks to each respectively. It was a bit light hearted but we did find commone ground to discuss issues in a friendly way.
I stopped by the Celtic Whiskey shop, had some irish whiskey, went to Temple Bar area and listened to Authentic Live Irish Music, and then finished off the night with an Irish Coffee. It was over 4-6 hours just in case you thought me an alcoholic. I also had a maximum of 4 drinks with these events! I got on my train and never the less, took a nap and ended up in Galway.
The next day my flatmate and I went on a 7 hour bus tour of Ireland, including the cliffs of moher, the Burren-boggy area in Western Ireland. I had a fantastic time. Seeing the Cliffs of Moher made the long day worth it! and again my Anthropology bend on things was stimulated by the prehistoric findings, the English castles, and talk of the little people. There are Leprauchauns everywhere, you have to believe and you have to look for them...
My sunday was spent running in Galway to some sights and sounds. It is right on the coast and for me this was lovely!! I can count on my hands the amount of times I have run on a coastline. I am deprived in Iowa... We then did the Guiness Tour, it was fun to see how the process is made but not that much different from the Miller Brewing tour, which is free. But one overarching theme to my weekend was, "I am contributing as much as I can to the Irish Economy" everytime I looked at the price of trips/souvenirs/food. It is expensive but their economy has been devastated since the the economy failed. So again I felt socially responsible.
I did the city tour and say the K----- gaol (cant remember the name of the jail, but very historic like, alcatraz but involved with all the Irish independence events), the Jameson whiskey factory and some cool sights in Dublin, that are associated with Oscar Wilde, James Joyce, and Michael Collins.

If you get a chance-- I highly recommend it!
I am flying back next week on monday so I think I will make one more post and then catch up with most everyone from the States until I go traveling again...

take care, blessings, and love!
kristina