A little classier but just as fun

In case you think you might have the wrong blog, this is still Happy Heather's Hullaballoo! I just decided it was time for a more mature, classy format. I'm not sure what the effect will be on the content of my blog entries.
You may also have noticed the poll on the side bar. I will be posting new questions about once a week. Make your voice heard..... your vote may be included in a new book I may write (haha, wait and see).
As for current stories of my tragic life....
I was getting on the skytrain this week when I saw a woman that looked very familiar. I contemplated going over and saying hello, but I honestly couldn't remember where I knew her from. I puzzled over it for several minutes and then it came to me. I had seen her at the doctor's office. I was half-way over to talk to her when I stopped. What was I going to say?
"Oh, hello, do you remember me? I gave you a physical exam the other day. You sure look a heck of a lot better with your clothes on."
I sat down by myself, feeling rather glum. Of course I couldn't go talk to her, she would be so embarrassed. In fact, maybe that's what it would be like for the rest of my life. No being silly, no doing crazy things, no joking around, cause people would look at me and say, "She's a doctor?" and they would be thinking, "You'd couldn't pay me enough to go see her. She's immature and untrustworthy."
I reluctantly decided to be more mature, more reserved, more sedate, and more serious.
I did pretty well, at least for a few days. It all kind of fell apart when I was shopping in Old Navy the other day. I bought a very mature, reserved-looking red sweater to wear to work. As I was about to go out, I suddenly saw a flash of colour that caught my eye. It was the only one left, a bright, bright yellow sundress with a frill around the bottom and wooden beads on the straps that clinked as you walked. I tried it on and I felt like a cloud of yellow sunshine.
I couldn't resist! It was half-price, and I bought it. I wore it yesterday when I walked to the bank. Halfway there I was waiting at a light and a man stopped and stared at me. He looked from the dress to my flip-flops to the six inches of snow I was wading through, and then he started to laugh and laugh.
And then last night I was making margaritas for my sister and her friends. I made the last one for myself, and we had unfortunately run out of soda to put in them, so I thought, well, if I can't top it up with soda, I'll just put in extra vodka to make up the volume. It looks the same either way.
It may have looked the same, but a couple of hours later when Alpha's friends were sitting around talking and having a good time, I was sliding down the wall and crawling to my bed. Who ever heard of replacing soda with vodka? Certainly not someone who was mature, reserved, sedate and serious.
But I suppose there are some positive benefits to not being able to squish into the new role I've constructed for myself. I worked a night shift on thursday night and one of my patients was this crazy, crazy lunatic. At 2 in the morning I was trying to convince him that it wasn't a good time to put on his clothes and go out into the snow. He started to laugh.
"Oh, you're a funny girl!"
I laughed with him. "Yes, now weren't we heading back to your room?"
Back in his room he picked up his hat.
"Look at this hat." He said, his voice slurred. "The way I got this hat is a very strange story".... he rambled on and on.
After a while I decided it was time to disengage myself from the conversation.
"Well, you have a good sleep." I said.
"How old are you?" He asked me. (Why do they always want to know how old I am?)
"Too young for you." I said cheerily.
"Did I tell you the story of how I got this hat?" He asked.
"Hmmm..... I think so. Now, do you want me to turn the bathroom light out?"
I left his room and later that night when I was joking with some other crazy lunatic and trying to convince him that 3:00 was too early to call his daughter and threaten to sue the hospital, I thought, I bet if I was a serious, reserved, mature and sedate person I wouldn't see the humor in this. And everyone knows that the nurses without a sense of humor are the worst ones.
Well, I haven't given up yet. I'd still like to be classier and more mature and reserved. But I also really love my new yellow dress. Maybe somewhere in the middle is a happier medium.

Merry Christmas eve eve

This week I was working a night shift nursing on christmas eve eve. (yes, that's the night before christmas eve).
Sometime in the week hours of the morning I was making rounds and happened to be in a patient's room bringing him some medication.
Being almost christmas, there was a certain buzz in the air. The nurses had hung up some decorations and in the nursing station there were stacks of boxes of chocolates from patients. (and you wonder why there are so many fat nurses.....what else do you think there is to do on a night shift except eat chocolates?) Most of the patients had told me about family members who were coming to visit them the next day, or what plans they'd made for christmas. Some of them had decorations up in their rooms and the odd poinsetta in the window.
I turned on the light in my patient's room and helped him sit up in bed so he could swallow the pills. He was a quiet man and I could tell he hated to put the nurses out, he never asked for anything. Since I had rudely awoken him at such an early hour I thought the least I could do was to make cheery conversation.
"So do you have family coming to visit you today or tomorrow?" I asked him.
In the pale shadows I could see he didn't meet my eyes.
"No."
I honestly didn't know what to say except "Oh." He didn't explain himself, he didn't jump in to say "They live far away" or some excuse like that. There was an awkward silence, in which I felt his embarrassment at his aloneness. There was nothing comforting to say like "I'm sure they're thinking about you" or some harmless lie like that. I could see by the look at his face that it would have been a lie anyway.
I met his eyes and said, very tenderly, "Well...."
I took my time in his room. I talked to him about the snow that was falling outside and how icy it was. We made quiet conversation for a few minutes and then I made him comfortable in bed and turned out the light when I left.
I still haven't stopped thinking about him. I can't remember his name, but it doesn't really matter. He is one of many. Our world is chock full of lonely, sad people. People without families, or people whose families aren't the kind that will cuddle on a couch and watch a movie on christmas night or sit in the hot tub squirting each other with rubber ducks until midnight or laugh at the dinner table together.
Loneliness is the most terrible feeling in the entire world. We should be very gentle with each other, because we are protecting that vulnerable place inside each other that feels aloneness. It is true that there is a God-shaped hole in each of us, and that God is gracious and compassionate and fills us completely. He is all we need and he is entirely sufficient.
But he also created us to need each other. We were designed to live in community and to learn to share and compromise and protect and love.

5 random things I just learned that may or may not be important

So I learned these random facts and honestly thought they didn't matter:

1. The left kidney sits higher than the right one
2. The entrance to the right lung is more vertical than the entrance to the left
3. The appendix is 3-5 inches long
4. The skin of the abdomen develops in horizontal lines
5. The left testicle hangs lower than the right one

And then I found out that sometimes seemingly random facts actually are important and even if they don't make sense at the time, it is worth knowing them. Here's why:

1. Because the left kidney is higher, the ureter (tube leading to bladder) is longer. In kidney transplants, the left kidney is always used because the longer ureter gives more length for stitching it in.
2. When small objects are inhaled, they tend to follow a vertical path and almost always end up in the right lung.
3. A 5-inch appendix that is very swollen from appendicitis can look like part of the small intestine on an X-ray or ultrasound
4. If the abdomen is cut vertically, it will leave a fatter scar than if cut horizontally, along the natural lines of cleavage.
5. I have no idea why this last tidbit is important, but I'm willing to believe that it might be. And that someone somewhere cares.

the long journey home

I don't really have any reason to tell this story: no great moral lesson or spiritual meaning. It isn't even exciting or that funny. The only reason I'm telling it is that it seems to be a common theme in my life. Irony.
I got a cheap airplane ticket and went up to Kelowna for four days. The plane ticket was $10.00 and I had a fantastic time. I was refreshed, rested and ready for anything. Anything except the journey home, it turns out.
I arrived at the bus depot in Kelowna a few minutes early only to be told the bus was late. I sat there for about an hour and a half, having a good chat with my future sister-in-law Yvonne. When the bus finally rolled in I got on and settled myself in a comfortable seat. The bus was only 1/4 full, so I was looking forward to stretching out a bit.
A middle-aged man who looked a little crazy sat down next to me. His face was slender, but his jacket was bulging out over his stomach as if he was hiding something under it. (An oversized fanny-pack? A gun?) I stared out the window and turned on my sister's ipod.
We hadn't even left Kelowna when the ipod died. Oh great. Nothing to do. I had some new motion-sickness medicine my doctor had given me, so I took it, and tried to lean against the filthy window and review some flashcards for school.
My eyes started to swim. I suddenly realized my jaw was hanging open and I snapped it closed. What was wrong with me? I decided I was sleepy. I put away the cards and tried to curl up enough to fall asleep. I drifted in and out. The bus lurched down the highway.
The man next to me tried to talk to me.
"Yeah, I'm a tree-planter. Tree-planting isn't just a job. It's peace work. All the people into tree-planting are part of this movement. They have their own culture, their own style. They're all athletes and wilderness people. We work like marathoners everyday. I was also part of the rave scene when it first started. Yeah, I used to go to these huge raves and everyone was having a good time."
Man, I was starting to feel sick. So much mud had sprayed up on the windows that I could hardly see out them.
"I used to have this house in kitsilano. There were always people staying there. We had these volkswagon buses in the backyard, and tents in the front yard. It was peaceful. We were all tree-planters."
I could feel my arms and legs going numb. Was I hallucinating? In and out of his strange rantings about raves, I swam in a sea of motion sickness. What was that stupid medicine, anyway? I breathed in, and out. I tried to eat a mandarin orange. I sipped water from my water bottle, but it tasted strangely sweet. I talked to my neighbor for a bit, and fell asleep, then woke up. God, I think I'm going to throw up....
There was too much snow on the road and we inched along. On Chilliwack we were late and some people missed their connection and had to keep on. When the bus started again they were arguing in loud voices with the bus driver. Everything was a blur to me. Three or four people were talking on their cell-phones at the same time in loud angry voices. The man next to me started talking on his.
"Yeah, then we got stuck on this mountain." I heard him saying. "We had this epic hike back out, through this epic river and we finally got rescued."
Maybe I'm dreaming? No, dreams don't smell like organic garlic and old pot like the guy sitting next to me.
The bus pulled into the station in Coquitlam after 7 torturous hours. I stood up as fast as I could.
"Nice to meet you." I said to my neighbor.
I ran outside. Someone had taken my bag out already for me. I grabbed the handle and staggered away from the bus. Something weird about that medication, everything was spinning. I dragged my suitcase into the building and ran into the bathroom. In the stall I knelt down in front of the porcelain goddess and paid homage for several long moments. And then several more long moments. And several more.
When I emerged from the bathroom I realized it was dark outside and I had better find the skytrain before it was too late. I wandered outside of the station and it was pouring rain. No, not rain, sleet. I knew where the skytrain station was, but there was no direct road. I pulled my suitcase behind me and staggered the 2 kilometers through the seediest area of Coquitlam that I could possibly have imagined, and prayed that God would keep me safe.
By the time I reached the station my fingers and my face were numb with cold. I sat on the skytrain and felt sick again. I concentrated on breathing deeply and tried to close my eyes and block out the noise around me.
I got off near my parent's house and walked the kilometer in the rain. I didn't have a quarter to call them to pick me up.... there were no stores close by to get change...
I walked in the house finally, put down my bag, hugged my sister.
"How was your trip?" My mom asked.
Wonderful. Just wonderful.
The good thing, I thought during my journey, was that every unpleasant experience I go through gives me that much more empathy and grace for others. And it could have been worse. That lump under my bus neighbor's coat could have been a gun after all.
Ahhhhh, life. Ironic. Tragic. But still so worth living.

Some things a lollipop won't fix

Well, I had a pretty humbling experience today.
I was working in the doctor's office and a young girl came in for a vaccination. She was about ten years old and was sitting in the examining room with her mom and older sister.
"I don't want a needle." She said in a whiny voice. "They hurt."
She started clutching at her mother and as I drew up the syringe I attempted to reassure her.
"You know what, I give needles all the time, and I'm really good at it. It doesn't hurt at all! And after we're done, you can have a lollipop."
"Look at your sister." I suggested as I reached for her arm, her cringing and whimpering.
In my experience, the best way to inject kids is to do it quickly, before they even know what's happening to them. And I would have done it, too, except something went wrong.
I poked the needle in and as I went to push the plunger down, the barrel was not connected properly and it popped off, shooting the medicine all over out the barrel.
I think I must have said 'oops' or something, because she looked over and there was a needle hanging out of her arm. I quickly pulled it out and tried to redeem the situation.
"Uh oh, I'm going to have to do that again. That syringe was not a good one."
The mother was staring at me, as if wondering what kind of a medical student I was and what I was doing to her child.
I quickly grabbed the vial and drew up another dose, hiding it behind my hand so she wouldn't see the needle.
Well, you try telling a kid that you're going to have to poke them a second time because you screwed up the first time.
I thought, what if going in fast is not the best technique? I advanced the needle a little more slowly towards her deltoid muscle, but i must have held it at a bad angle, because the needle bounced right off. I was sweating bullets by now. The third time I jabbed, I held it there and squirted it in, withdrawing it quickly and scrambling to find a bandaid.
"There you go, all done!" I said cheerily. "You were so brave!"
If looks could kill, I would've been dead.
The mother made some comment about getting three times her money's worth. I ushered them out of the room, wondering if there was a way I could redeem the situation.
"Here, would you like a lollipop?" I asked the little girl, offering her the bucket of candies.
She gave me a very insulted look, as if to say, do I look like a little child to you who can be easily pacified by a lollipop? You just stabbed me three times in one arm!
"They're delicious." I said encouragingly. "I always get one when I can." (Actually that was a lie, I just realized that now. I don't really care for lollipops.)
She looked at me evenly and said, "I'm not allowed to have them."
As they walked out of the office I waved goodbye and thought, no wonder there is such a thing as malpractice insurance. How can a ten-year-old make me feel so defeated? If only I hadn't said all that about being so good at giving injections....
"Oh, did the needle pop off the syringe?" the doctor asked me casually, his back turned to me.
"Uh, yes." I admitted in a small voice.
"That happened to me the other day." He said matter-of-factly. "Funny things, those."
Funny things indeed.

TIA

Today I was working at an extended care facility and I had an interesting experience. One of my patients, a chipper old man with a nice smile, was missing from the dining room around lunch time. Normally I would've waited a while for him to appear, but I thought, why not, I'll go look for him. I took his lunch pills and walked down the long hallway to his room. As I entered I saw him sitting sleeping in his wheelchair, hunched over a little. I came up and called his name, touching his shoulder.
No response. Suddenly I noticed that his skin was pale white and he had the sheen of sweat on his entire head, neck and arms. I put down my things and called his name louder, squatting down in front of him to see in his face. He opened his eyes halfway and barely acknowledged me. I knew he was diabetic, and running through my mind was the possible diagnosis of low blood sugar.
"How do you feel?" I asked him, hands on his knees.
"Not..... good." He barely got out.
"I'll be right back." I told him.
We were at the end of a long hallway and I knew all the other nurses and aides were busy in the dining room and no one would hear me call. I ran down to the nursing station, grabbed the glucose testing kit, a cup of apple juice, and on the spur of the moment, a thermometer, stethoscope and blood pressure machine. I briefly told another nurse what I was doing and I ran back to his room. He was almost slipping out of his chair. I whipped out the glucometer and checked his blood sugar. Normal.
A care aide came in and I said to her, "We have to get him lying down right now."
He was barely breathing. I felt for a pulse but couldn't find one. We pivoted him into bed, laying him down on the mattress.
"He already had a mini TIA last week." The care aide told me. "I'll go get oxygen."
TIA, or transient ischemic attack, is a mini stroke in the brain. I took his temperature, it was way too low. His blood pressure was slipping and I still couldn't find a pulse. His breathing was shallow and for a second I thought he'd stopped all together. The other nurse came in, she'd called 911 and the ambulance was on their way.
"He's had 6 heart attacks," she said, "and several TIA's."
We didn't have the equipment for a cardiac arrest on that ward, so he would need to be transported. We got the oxygen on, assessed him, and I found a pulse, but it was too thready to count, even with my stethoscope.
"I'll go grab his chart for the paramedics." The nurse said. "Someone needs to stay with him."
And suddenly I found myself alone with this semi-comatose man. I was leaning over him, one hand on his wrist and talking softly to him. What if he arrested right then and there? I know I've been a nurse for a while and seen lots of stuff, but I've never done CPR on anyone before. What if he was a DNR (do not resuscitate)? Should I start CPR on him anyway, because I wasn't sure?
I looked down and around his neck was a golden crucifix.
"Are you Catholic?" I answered, and his mouth moved in the shape of yes under the oxygen mask. "Would you like me to pray with you?" I asked.
"Oh, please!" He said.
So I held his hand and recited the Lord's prayer. I wished I knew more catholic prayers, but I didn't, so then I just prayed the words that came from my heart.
The paramedics came and I stayed with them awhile and they took him away on a stretcher.
Afterwards as I was sitting in the nursing station charting, the nursing supervisor stopped by to ask me about him. I explained what had happened, feeling rather good about my complete assessment, and she asked if it was another TIA.
"I think it was cardiac." I explained. "You know he has a history of heart attacks."
She didn't say much and after she left I thought a bit more about it. What was I thinking? Of course it was a TIA, not a heart problem. He may have been showing signs and symptoms of an impending heart attack, but he was missing the one glaringly obvious one: pain.
His complicated history of anemia, diabetes and congestive heart failure made it difficult to determine what was causing what symptoms, but he hadn't complained of any pain or tightness in his chest when I'd asked him.
I had to call his family and explain what had happened. They were upset, understandably, and asked me questions about what had happened. I explained about TIA's and assured them he was getting the best care possible. I got off the phone and thought, it's a good thing you weren't the doctor here today Heather, because you would have screwed up.
Sometimes I forget myself. I forget that I'm just a beginner. While I do know quite a bit because I'm already a nurse, there is so much that I don't know. I haven't been trained to diagnose yet, and I'm obviously not an authority on heart disease OR stroke. It's a good reminder that I need to be humble..... as humble as I can, because when I open my mouth, someone's life may be on the line.

Please tell me I'm normal

Yesterday should have been mental health day. I saw probably 5 or 6 different patients with 5 or 6 different types of psychological problems. Pretty varied, and pretty interesting.
I'm starting to feel really bad, though. I have a friend with severe ADHD, and when he'd told me about it, I hadn't exactly laughed, but I hadn't really believed him and I'd thought, yeah right, everyone can claim they have it and use it as an excuse for all sorts of bad behavior.
But actually I was totally wrong. Apparently ADHD is one of the most understood psychological conditions. It's true that it can be used as a label to slap on a kid who is 'behaviorally challenged' (i.e. naughty), but if one looks at the countless scientific studies showing decreased brain activity in particular areas, metabolic imbalances, documented symptoms, it emerges as a condition that not only actually exists, but is very treatable. That's the good news.
The bad news is that learning about mental illness is pretty much convincing me that I am mentally ill. Yesterday I was reading through my list of different conditions. Dreams/flashbacks and hyper-arousal? Yep, that's me- I have PTSD (Post-traumatic stress disorder). Increased activity, goal-directed/high-risk, decreased judgement, irritability, elevated mood and speedy talking? Apparently I am a classic Manic. Low energy, trouble concentrating and weight changes? Um, I have clinical depression. Or maybe my symptoms fit better with phobias, body dysmorphic disorder, OCD, psychosis or panic attacks.
As I was reading through the lists I had to keep saying to myself, Heather, you're normal. Heather, you're normal. Heather, you're normal. And apparently it's normal for students studying about these conditions to be convinced they have them all.
At least until I met my patient Susan this week. (*Name changed of course).
She was heading down the hallway of the hospital and I stopped her to say hi.
"Hi Susan, how are you?"
"Oh, I'm fine!" Big smile
"Where are you going?" I asked nicely.
"Oh, I'm just going upstairs to my room."
"That's nice." I said, thinking, her room isn't upstairs, it's right behind her.
"Yes, my room is inside the refrigerator. I'm going there right now."
"Oh, that's nice." I said again, thinking, what do you say to someone who thinks they're living in a refrigerator?
She walked past me, humming good-naturedly and pushed the button on the elevator. Later that day when I wrote on her chart I wrote "patient disoriented."
Heather, you're normal.
And then yesterday I met Gloria. Gloria is a ten-year-old girl who started having severe abdominal pain and persistent anxiety. A lot of it centered around school, and there was investigation to see if she was being bullied. She saw child psychologists who ruled out any abuse, and while a precise cause was not found for her abdominal pain and anxiety, the addition of some appropriate anti-anxiety medication and lots of loving support from her parents had gone a long way. She had come in to see the doctor for a check-up and looked at me out of the corner of her eye from under long bangs that hid most of her face. The stress of her mental illness had caused her immune system to be depleted and she had broken out in warts all over her body and extremities. We discussed what to do about the warts and how she was finding school.
Heather, you're normal, I told myself.
Later in the afternoon I was suddenly surprised to hear my name being called from the waiting room. I turned to see my good friends Penny and Patrick (* names unchanged) sitting there. We hugged and chatted and when I was sitting in the examining room with them I suddenly thought, aren't they normal people just like me? What are they doing here for?
Actually they had a pretty normal problem (no detail here, cause they ARE my friends), but as I said goodbye to them I thought, isn't it true that the only normal people are the ones I don't know? they could just as easily have been coming in to see the doctor about their borderline personality or schizophrenic disorders. The funny thing is, mental illness is not some rare and strange phenomenon that only people you don't know have. It touches most of us. In a sense we're all normal, and while there are, for sure, some pretty crazy people out there, a lot of it is just our diversity. We may all be genetically human but we're all so different in the way we respond to things.
But I still think I might have a mania. After all, how else can I explain my speedy talking?

Physician, heal thyself

Well, I may be learning lots about medicine and doing pretty well at it, but it seems I can't even keep myself healthy.
I came down with a bad cold/cough/sore throat this weekend and it's been three days and it still isn't gone. Since I'm working in the hospital tomorrow I'm desperately trying to get over it so that I'm not contagious anymore. I'm not sure exactly how it started: sleeping in the same bed as my sister who was hacking and sneezing and snotting for a week? Drinking way way too much coke? Staying up late and then getting up really early?
At any rate, armed with all my new-found knowledge about drugs and diseases, I decided to treat myself. The night before last I thought, clever Heather, I'll show everyone and I'll get rid of this thing in one night. I swallowed triple the dosage of vitamin C to boost my immune system. I took a Sudafed (nasal decongestant) and I sprayed double the dosage of this nasal corticosteroid into my nostrils. (I didn't really intend to use double the dosage but I don't have a lot of experience spraying things in my nose).
Well, I slept like a baby, but I woke up the next morning feeling like a truck had run over me. Yesterday I sneezed my way through the whole day and decided to boost my immune system by going for a brisk walk. I bundled up (except for my flipflops, of course) and marched around for a while in the freezing fog. Oh my, what a silly idea. Today I feel even worse.
The one thing about an infection is that it can't be rushed. Sure, you can take medications to manage the symptoms or try to kill the bacteria, but all of it is really just encouraging your own body to mobilize it's defenses and kick that bug out. You can't rush it, it takes its own sweet time and goes away when it wants.
I'm not a patient person by nature. I admit to being very intrigued by some of the concepts in the movie 'The Matrix'. What if I could just get a little chip implanted into my brain that would give me four years worth of medical knowledge or a new foreign language or a perfect understanding of car engines? What if I could swallow a pill that would instantly make me a superb volleyball player or talented cook or be able to do my own taxes with a swipe of a pencil? Would I go for the chip? I've always said yes, of course.
But the more I think about it, the more I realize it might be a really bad idea. You see, it's not so much the body of knowledge specific to that one thing that we need. It's all the peripheral knowledge/wisdom that is acquired along the journey. For example, if I just had 'Advanced French' implanted into my brain I would have missed all the wonderfully fun times of trying to speak with native French speakers and making entertaining mistakes and laughing at it together. I would have missed the discipline it built in me as I persevered by studying every day until I'd mastered a certain level.
If I just had four years of medical school implanted in my brain, I might save a lot of money and effort, but I would miss out on the other important lessons I have to learn along the way. For example, I already would have missed the most important thing I learned when I was in Antigua: I cannot survive as a Christian on my own; God has always intended to reveal himself through the church, and I am only a powerful witness to the world to the extent that I am a part of the body of Christ. Lone rangers are dead rangers.
You see, I learned that because I was desperately alone and in need of encouragement, accountability and support. I didn't miss it until I didn't have it. Some things you just can't rush, you just can't take a pill for, you just can't force them.
Which is why I decided today not to rush this silly cold. I'm just going to relax. Perhaps God has something important he wants me to learn along the way. I will let this cold take it's own sweet time, even if it kills me.

Real people

I've been working on some interesting assignments for medical school recently. We're looking at the histology of different organs in the body, what happens in disease, what are the typical symptoms you will see in a patient, etc. Some of the case studies are challenging, but there is a right answer that we pursue and all the pieces fit together in the end.
I'm learning more and more that this is not so in real life. Over the last week as I've worked in the hospital and in the doctor's office I've seen all sorts of patients, and not one single one of them was like my assignment case studies. Take for example Mr. Buttercup (name changed of course!) from work today. Poor Mr. Buttercup is a palliative patient, meaning he is dying slowly, and it seems like every system in his body is failing. I went into his room to change a dressing on a wound on his heel and I had to wake him up as he was nearly comatose. The sore on his heel is a pressure sore, caused by constant pressure on that one spot as he lies in bed all the time. The flesh had turned black and necrotic.
With ulcers of this type there isn't usually a lot of pain, even though they look horrendous, because the tissue is well and truly dead. I wasn't expecting Mr. Buttercup to cry out in pain when I unwrapped the bandage, but he did.
"I'm so sorry." I kept saying to him.
The ulcer was necrotic and had yellowish drainage coming out of it. I felt around the perimeter of it and the skin was hot and swollen, which is unusual for that kind of ulcer. It was probably infected. I cleaned and dressed it and tried to make him comfortable before leaving.
I sat down later with the doctor and discussed the patient. He had pressure ulcers, but they were infected. He wasn't drinking a lot of fluids so he was dehydrated. He couldn't swallow properly so he wasn't able to take his medications very well. He wasn't moving much so his circulation was poor. The doctor ordered a medicated cream for the wound and I called the occupational therapist to order a special mattress. We talked on the phone for a while and discussed different options.
"Honestly," she said to me, "I don't think it will make much of a difference."
"Well, what's being done now is not helping at all." I said.
"Perhaps we can try it then." She agreed. "There's nothing to lose with trying."
The sad reality of nursing dying people is that there is no hope of recovery. But I would like to see Mr. Buttercup pain free, if I can, and comfortable.
He's not a textbook patient or one like my assignment case studies. He's a real person, and when I'm having to clean his wound and he is wincing and when I leave and he thanks me with such a gentle smile, I feel tears in my eyes. I know I get too emotionally involved sometimes, but he is a real person after all. I have no connection to the fascinating cases I'm writing about on paper. They are 2-dimensional people with organized symptoms and signs that fit together like puzzle pieces with a diagnosis that I can say "aha! that's it!" to.
Mr. Buttercup is a real person, like me, and we share humanity and we share smiles and a handclasp and an intimate connection as I help him die gracefully, knowing that someday I'll be in his shoes.

A baby is born

Have I mentioned how much I love what I’m doing? Today was the best day ever. I got to my practicum and the doctor said “today we’re doing a C-section”. I could barely wait until 11:00. We walked onto the ward and the nurses were standing there, and one of the surgeons and the anesthetist. The surgeon shook hands with me, and I could see a smile under his half-tied surgical mask.
“Well, we can always use another assistant.” He said.
I went into the change room with my doctor and we stripped out of our clothes and put on green scrubs. I was too embarrassed to let her see me taking my own pulse, but I’m sure it was racing with excitement. We went into the hallway and shook hands with the Mom and Dad and talked with them for a minute. When the anesthetist called them into the operating room, we went to the big stainless steel sinks and scrubbed up to our elbows with chlorhexidine. I put on a hair cover, shoe covers and a mask and then we went into the operating room, opening the door with our shoulders. The OR nurses were waiting and I stood there arms outstretched while they put a gown on me and tied it, then slipped sterile gloves onto my hands.
“Don’t touch anything.” The doctor warned me, “Now that you’re sterile.”
We stood to the side and watched while a nurse swabbed the mother’s back as she sat on the operating table. The anesthetist was chatty and he had a student with him as well and he explained the procedure as he injected a local anesthetic and then prepared to give her an epidural. I watched the needle go in. I have a strong stomach for bloody things, but there’s something a little funny about seeing a 5 inch needle go into someone’s spine.
Then she was being laid down, a drape put up, the anesthetist testing her level of paresthesia, and the nurses catheterizing her and setting up the sterile field. They wiped the mother’s whole abdomen with dark orange iodine and then draped her with a large blue plastic with a whole in the middle that neatly exposed the surgical area.
“Stand there.” The nurse ordered me and I took my place next to the woman’s abdomen.
“Scalpel.” The surgeon said and the nurse passed him a shiny blade.
“Pick-ups.” She passed him a pair of tweezers. (I’ve been told that if I ever call them tweezers in surgery, they’ll ask me to leave.) In the background I could hear the anesthetist student being pimped by her supervisor, and I held my breath in anticipation of the dreaded questions.
But the surgeon was funny and engaging and my doctor next to me explained everything as we went along.
“This scar here is from her previous caesarean section.”
I used a sponge to soak up blood and the surgeon used a cauterizing gun to touch the ends of nicked blood vessels. Through my mask I could smell the unmistakable odor of burnt flesh and in the background I could hear the nurses counting off the instruments that went in and came out of the woman’s abdomen.
The surgeon cut through layers of flesh, carefully peeling back the layers of skin, fat and muscle.
“Put your hand here.” He ordered me and I put my hand into the woman’s abdomen.
“You can feel the baby’s head through the uterus.”
I felt the head, small and firm beneath my hand.
He cut into uterus, my doctor holding it away from the baby with pickups while amniotic fluid gushed out and poured down the sides of the drape into a waiting pouch. When the incision was big enough he reached his hand inside and began to deliver the baby out. I was holding my breath and the father was staring over the drape as the baby emerged, cradled in the surgeon’s hands. The baby was gray and covered in slime but suddenly he opened his mouth and began to squall loudly, and his skin gradually turned pink.
“Look at him!” the surgeon held the baby high so the mom could see.
“Scissors.” My doctor asked and she clamped the umbilical cord, cutting it off before handing the baby to the nurses and a pediatrician standing by. I could feel tears in the corners of my eyes. It was a magical, special moment.
“Now we deliver the placenta.” The surgeon said to me. “The nurse just gave her some oxytocin to cause the uterus to contract”…..
My attention was snapped back to the bloody mess in front of us. He talked to me and asked the odd question while he delivered the placenta and I sopped up blood and used clamps to hold her flesh back.
“Sutures.”
The nurse passed pick-ups holding a slender curved needle and long black thread and he began to stitch together the layers of her uterus, one by one, pulling the thread up in between while I dabbed with sponges and slid a retractor along her bladder to keep it out of the way. It took longer to stitch the woman up than it did to cut her open, and in the process I got splattered in blood. (Which is a whole lot better than being splattered with any kind of fluid from Nellie, if you care to know.)
When she was stitched up neatly, the doctor used a stapler to close the final layer of skin and then we swabbed up most of the blood and stepped back. The Dad was cradling his son in his arms near the mom’s head and we shrugged out of our splattered gowns and gloves and went to her. My doctor leaned over to hug the mom and I told her thank you for letting me be there and touched the little baby while he looked up at me with blinking black eyes.
“The baby is tongue-tied.” The pediatrician explained in a low voice to the doctor. “I’ll leave that in your hands.”
“Yes, it’s no problem.” The doctor assured him. (Tongue-tied is when the tongue is attached to the base of the mouth, and it is a simple procedure to loosen it that can be done in the doctor’s office.)
I was still breathless with excitement when we went out of the OR and stripped off our clothes and washed our hands. We dressed and the doctor and I went out of the hospital to rush back to her office to see an afternoon full of patients. Outside it had just stopped raining and the air was sharp and cool.
“Isn’t that wonderful?” The doctor said to me. “God made it stop raining just for the two of us today.”
She laughed and I couldn’t keep the happy smile off my face. And even giving injections to screaming babies and watching rectal exams all afternoon didn’t take away that good feeling.

The gift of trust

I feel compelled to caution any discriminating readers that my blogs may take more of a medical twist, and as such, may seem a little more unsavory. When one deals with certain topics all day, one things about such topics all night, and one necessarily blogs about such topics.
With that out of the way.... today I had a pretty interesting day at the doctor's office. I gave lots of injections (not too interesting!), and I also gave my first vaginal exam and pap smear. It was entirely unexpected. I found myself at the foot of this lovely lady's bed and being asked, "Would you like to try, Heather?"
I suddenly remembered the stellar advice Dr. Rust gave me in Antigua: If you're asked if you want to try a procedure, your answer is always "yes", and then you do it. And do it well.
"Yes." I said.
As I sat down and prepared for the procedure I had a rush of thoughts coursing through my mind: What if I hurt her? What if I don't know what to do? What if.... It was too late. I was holding the speculum in my hand and talking in a soothing voice to the patient, and the doctor was leaning over my shoulder and guiding me through it.
Well, without going into all the details, I did it, and I did it well, or at least I think I did because the patient said it didn't hurt at all and I'd make a good doctor. I just about floated out of the room. It's amazing what a piece of metal equipment and someone's privates can do for one's self esteem.
Speaking of private, my self esteem took a nose dive with the next patient. She was about 18 years old, and when the doctor introduced me as the medical student who was helping out, the girl looked darkly at the doctor and said flatly, "It's private."
The doctor gave me one of those 'sorry, can't do anything about it' looks and I went out of the room during the consultation. Unfortunately that girl wasn't the only one that day that didn't want me there. Later in the afternoon I sat down with a middle-aged man and the doctor, and the man said, "excuse me, doctor, but I feel really uncomfortable with her here."
I went out and sat with my textbooks until they were done. The doctor waited until the man had left and then turned to me, barely able to conceal his laugh. "You know why he didn't want you there? He wanted to talk about his problem with 'sticky poo'".
We laughed, and I thought grimly, if only he knew of my extensive experience as a nurse with sticky poo. But that didn't really matter, did it?
On the bus home I thought about it in great detail. From my perspective, I wasn't about to be put off by an embarrassing topic. For goodness sakes, I'd successfully done a pap smear that day. And although it made things a little different with someone of the opposite gender, even if I did feel a little embarrassed I never would dream of showing it.
But from his perspective, of course, it was worlds different. There I was, a 5-foot-3 23-year-old girl who didn't possibly look old enough to be a doctor. How could he possibly trust me with the intimate details of his bowel habits? I looked in the mirror in the bathroom and for the first time, wished for wrinkles. If only I looked older and more mature, then people would feel they could trust me.
It is such a privilege to be studying medicine. Today I sat in the consultation room with a beautiful middle-aged woman as the doctor explained to her that she had MS, a progressive, debilitating disease. The woman was a nurse. She looked at me and I looked at her and we both knew what it meant and why it was so devastating. There is no cure for MS, and it cripples and affects every part of a person's life before it finally takes it. Some people manage to have many years of quality life, but in the end MS will win. "Everyone dies." The doctor had said to me that morning. "Sooner or later, from something or other. What matters is the quality of life while they live."
She was fighting back tears and as she got up to go out of the room she said to me in a pitiful, quiet voice, "I have a young daughter."
"How old is she?" I asked. "12 years old." She said.
I thought about her symptoms and wondered if she would still be able to function at her daughter's graduation. I put a comforting hand on her shoulder and said "I'm so sorry."
We talked for a few minutes and then she went out, giving me a brave smile, and I thought, how blessed I am to be with her in this vulnerable time. How privileged that she would trust me, not because I look old and mature and tall, not because I'm the same gender, not because I'm a clever doctor with years of experience. She simply chose to trust me, as another human being, and because of that I'm so grateful.

So much to know, so little time.

Today I had my first day of an 'observational' practicum. I forget how many patients I saw with the two doctors; it is all a blur now. 20 or 30? I am left with one very distinct feeling: there is much too much to know and I'm not sure I'll ever be able to pack it into my little head. My head hurts.
The doctor I was with in the morning is classy; she looks like she stepped out of an upscale older ladies' fashion magazine. She is gracious, very intelligent and very eloquent. I didn't say much all morning, there seemed to be no point. I learned millions of little tidbits that I scrambled to write in my notebook while peering over her shoulder watching pap smears and breast exams and flu shots and hordes of other things.
Do you know that migraines can be helped by the caffeine in coffee, but chocolate, on the other hand, which contains caffeine, also contains histamine which can worsen migraines? Do you know that the nose produces 2 liters of fluid a day just to warm and humidify the air going into your lungs? Do you know that the antidepressant drug Wellbutrin is useful for helping with Nicotine withdrawal because it has essentially no side effects? And that was just the first patient.
By the afternoon my brain was full, but that was just the beginning. The next doctor walked into the office to see me sitting there and said, "Who's she?"
I stood up with a smile and an outstretched hand and the female doctor explained, "Oh, don't you remember Heather, she's here with us every thursday for the next 9 weeks."
He shook my hand and then turned and walked away without saying anything. I thought, oh brother, what have i got myself into. The female doctor gave me a signal to go after him and I ran down the hall to catch up with him and squeezed into the examining room with him. Look confident, Heather, I told myself.
"This is Heather, she's a medical student tagging along today." The doctor explained to the patient. I wondered if it would be simpler if I just wore a shirt that said "I'm really dumb, so don't ask me any questions."
Actually, the patients were awesome. Something about having a student there, but they loved to tell me ALL their complex medical problems as if I was a journalist writing an article about the weirdest health problems in history. In fact, one of the male patients even gave me a pen that said it was stolen from a real estate office. You never know what's going to come your way.
The doctor I was with all afternoon was pretty cool, though. He went over every chart with me and discussed his differential diagnoses and let me help out with a few things. The only super challenging question he asked me was whether or not I could recognize atrial fibrillation (a kind of heart murmur) from the ECG. I said yes, of course, and then was hugely relieved when he said, "You're right, you can see the absence of the p-wave here."
Of course. The absent p-wave. That was exactly what I had been meaning to say, he just beat me to it.
I felt bad for some of the older patients in for physical exams, one lady seemed a little embarrassed to have me in the room. I wanted to say to her, relax, honey, I'm a nurse, and you ain't got nothing I haven't seen before; but coming from someone barely old enough to be her granddaughter, it probably wouldn't have been that comforting. So to all of you who someday might have a medical student in attendance, thank you so much! You are offering a great service to the education of future doctors! Your willingness to be vulnerable and talkative and pleasant is no small thing.
At any rate, I better keep studying. I have about 10 million things to learn this winter, and I've barely started. Hopefully a good night's sleep will clear a little more free space in my brain.

Psalm 145

The Lord is near to all who call on him,
to all who call on him in truth.
He fulfills the desires of those who fear him;
he hears their cry and saves them.

I suppose I've staked my life on these verses. If it isn't true, then none of Christianity makes the least bit of sense.
About a year and a half ago I asked God for two things. I told him what they were, I told him they were the only two things I needed. I felt like I was talking to a brick wall, there was not even a whisper of an answer.
And then I had this deep sense inside me, that the two things I was asking for were not what I really needed. What I really needed was God, himself. Not what he could give me but who he is as a person.
I asked God to give me himself.
It's been a journey of faith. Those two things, one of them I am still waiting for. The other one has begun to fall into place. But really, I learned how little that mattered. What matters is that I've come to know a person.
In Antigua one day while I was jogging in the heat of the day, Brendan asked me, Heather, why do you read the bible? Do you just read the stories for interest sake or do you try to follow the rules?
I thought about for a second and I said to him, I read it because it reveals a person. All those pages, they can be taken as a good rule book or an interesting historical collection, and honestly, it's a bit boring if you read if like that. But what the bible was really designed to do is to reveal the person of Jesus. And that's why I read it, because I am in love with him.
Love is complicated. I should know since I've been in love so many times. Confusing, up and down, ridiculous, but totally worth it.

Zaza breezes through the airport

I have officially discovered why it is better to have a man check your bags at the airport. (If you're a girl, that is.)
You see, when I left Antigua, my suitcase was 14.7 kilograms overweight. Normally that would mean a $50 charge. When I checked in at the airport, groggy and tired as it was about 6:00 in the morning, I chatted with the guy behind the counter for a minute. He looked at my tickets and asked if I'd like him to reroute my 4 flights at no extra charge so that I arrived in Seattle 4 hours earlier. Well, of course, I said. Then he proceeded to tell me my bag was overweight but that he would waive the charge this time. He carried it for me to the conveyor belt and wished me a pleasant journey.
I got to Puerto Rico hours later and lugged my suitcase to the security check. I waited nervously while the man behind the counter looked at my ticket and weighed my bag. He gave me a charming smile and told me he wouldn't charge me for the extra weight and would I like it checked all the way to Seattle? Did I need help with directions to my gate?
I got off the plane in Dallas and waited a couple of hours, then flew to Seattle. I spent the night with a friend and then early the next morning went to the airport again. As I lined up to check in, I scanned the people at the desk for someone of the male gender. Not one.... I knew it was coming. The lady who ended up serving me looked at me with one of those don't-mess-with-me looks.
"Your bag is 14.7 kilograms overweight." She said blankly.
"I know." I put on my sweetest smile. "It's because of all the textbooks I have in there."
"Well, that will be $47."
I clasped my heart and tried to look horrified.
"Is there anyway you could waive that?" I asked hopefully.
"Sorry, no." She didn't sound sorry at all.
I handed her my visa card reluctantly.
After I'd paid for my bag, I went to line up to go through security. It was a long line to the first check, and by the time I got to the end of it, I realized suddenly that I couldn't find my passport anywhere.
"I can't find my passport." I said to the uniformed man in a bit of a panic.
"Don't worry, honey, it's around here somewhere."
He led me back to the counter I'd been at and I asked the lady there if she still had my passport.
"I gave it back to you." She said coldly. "And you won't be able to get on the plane without it."
"I know." I said sheepishly. Seriously, how dumb is it to lose your passport in another country?
I looked for ages, and then finally found it in an obscure pocket of my purse, although I have no clue which idiot put it there. I went back to the security line-up, but the man saw me and waved me to come to the front.
"You're going to have to go through a special security check." He explained to me. "The name on your ticket was spelled wrong and the woman who checked you in made a note that you have to go through it. But don't worry, it shouldn't take to long."
He led me down a long hallway, passed the line-ups of hundreds of people waiting to go through. Past all the security machines to a little roped-off area where three officers were waiting, smiling. They put my carry-on luggage through the machine, asked me to take off my shoes, and then searched me efficiently and quickly. They swabbed down all my belongings with some kind of tester device (It's a specialized chemical weapons detector, if you are interested I can explain more) and then handed everything back to me.
"You're good to go!"
Later while I was waiting for my flight a strange woman stopped me in the restrooms.
"Why did you get to skip all the lines and go straight through security?" She demanded, washing her hands in the sink next to me.
"Oh, there was a little misunderstanding." I explained to her about the ticket.
Afterwards I thought about it. One person can make your life very difficult, or one person can make your life very easy. It doesn't cost a lot to give an extra smile or waive a silly fee or help someone find something that's lost, but it can sure be a tremendous blessing.
When I got to Canadian customs in Vancouver, the immigration officer was very friendly and didn't give me any trouble despite the large pieces of coral and bottle of rum I had in my bag. (The fact that he wanted my phone number was totally coincidental.)
I got home safely and am enjoying about three days off before I start studying and working again. I'll be doing a practicum one day a week, and doing assignments to send in the rest of the time, before going back to Antigua in January. I'm not sure what the next two months will hold, but I'm sure they will be full of surprises and adventures, so keep reading Happy Heather's Hullaballoo!

leaving home, going home

Last night I was in a pensive mood and I wrote this crazy blog entry, full of emotional descriptions of what it feels like to say goodbye to a place I’ve come to love.
I wrote, “When I come home late at night after being out, there are a row of lights all the way down the mile-long driveway, and I can make out the palm trees swaying in the breeze overhead. The moon is always shimmery and ringed with a golden halo, and the scent of the flowers is overpowering.
The first of my classmates left today. We know we’ll be back together in January, but there was still this strange sense of incompleteness after he’d gone. We’ve all shared everything this last month and we’ve become so close.”
The best line was near the end and it said “But eternity is in our hearts, we are told, and that is why there is that ache there that doesn’t go away. It just waxes and wanes as we journey through life, drawing us inexorably towards something more, something deeper that will draw together the strands of reality and make sense of our lives.”
Pretty deep, huh?
I went to bed last night and it was raining softly. I awoke sometime in the night to the sound of claps of thunder and then the unmistakable roar as a hurricane-force gust of rain hammered on our tin roof. Shomaila and I both sat up in bed and looked at each other in the dim light. Another sleepless night. We tossed and turned for hours and then at 5:30 there was the sound of a truck outside and voices and we got up and stood on the porch. Nikki was leaving and we waved goodbye before climbing back into bed.
At 6:30 I was woken again by another truck honking. I climbed out of bed and it had finally stopped raining and there was a taxi driver outside who had come to pick up Nikki. I explained to him groggily that they must have made a mistake, Nikki was already gone.
What about Dr. Rust? He asked. She was gone, too, I said. As I watched him pull away I thought, oh dear, I’d better check on that. I wrapped myself in a sweater and stumbled across the campus to Dr. Rust’s house. I knocked on the door twice, and there was no answer. As I turned to go back to bed, I looked up and the sky was streaked with pale pink and the soft light of the morning. I got back into bed and struggled to fall asleep.
My dreams were twisted and crazy. I dreamt of past relationships that hadn’t worked out and there was a lot of saying goodbye, but there was also a lot of hellos and new, changed things.
Yanira woke us up again past nine and I lay in bed, thinking about it all. I feel ready to come home now. I know that I’m going to step off the plane wearing a sundress and flip-flops, and it’s going to be rainy and cold. Things will have changed at home, they always do when I go away. And when I come back here in January, things will have changed in this home. It won’t be the same. I won’t be living in the same bungalow with my class of 7 and catching rides to the beach and having to hang my laundry up inside because it’s always raining. Some things will stay the same, but some things will have changed. I don’t like change, I never have. It takes courage to face it.
But it’s an adventure. Living a life that God directs is not always fun, and it’s not always simple, but it’s always an adventure. Days like today when I haven’t slept much because of storms and noisy trucks, I’d rather do without the adventure. But if I look at the big picture, I know it’s worth it all.

Living in two worlds

Yesterday I experienced such a diverse set of circumstances. I lay in bed at night trying to figure out which one was real and which one I preferred.
We had an exam in the morning and for some reason had agreed to start it at 7 am so we could get out of class early. We stumbled out of our rooms at 6:58 and into the dark classroom. We’ve nicknamed this one hallway ‘mosquito alley’ because of the clouds of blood suckers that await around each door. We sat in the flickering light, hoping the electricity wouldn’t go out, swatting mosquitoes and trying to pay attention to our exam. After the exam and a long exhausting class, we went back to our rooms. It was hot out and because of all the recent rain, butterflies had hatched and they were swarming all through the gardens. One of my classmates and I decided to go for a run and we jogged along the potholed road for a couple of miles, dodging goats and spiny cacti and the occasional pothole that was bigger than a car.
When we got back I lay on the floor of my room trying to cool down, and wishing that the air conditioner would work.
Our professor, Dr. Gilbert, is the only person on campus who has a car, and we’d arranged to catch a ride to the beach with him instead of having to walk the 8 kilometers in the heat. Brendan and I had studied furiously all week so that we could go on Friday afternoon.
The closest beach to the university is a public beach, but it is surrounded by an exclusive resort called ‘St. James club.’ In all my life, even in pictures, I don’t think I’ve ever seen a place quite so exotically beautiful. Dr. Rust had given us some towel cards that allowed us privilege to trade in for free towels and sit on the beach chairs under thatched umbrellas. The sand is white and the water greeny-blue and the palm trees sway overhead in the breeze. There are hot pink hibiscus and bougainvillea everywhere and you can smell the scent of the flowers mingled with the salt of the ocean.
We lay in the sun with our histology textbooks and took breaks to jump in the waves or pick up pink shells along the beach. Later in the afternoon, the club served a free tea, and Brendan and I sat on a balcony overlooking the whole bay and ate little sandwiches and scones and drank tea. It was ridiculously luxuriant. We hadn’t had anything that tasted that good in about a month. We watched the sun go down across the water, the sky streaked with pink and purple, and when it was too dark to see our textbooks anymore we packed up to go. (I know it sounds impossible, but we did actually get lots of quality studying done.)
When we drove out of the club we entered a different world again. We were hungry and stopped to eat at a little restaurant run by some local people. It is an open-walled shack and in the light of propane lanterns we could barely make out the chicken sizzling over coals. The people were friendly and warm and we talked to some other customers and they poured us their homemade rum punch. (Don’t worry, I’ve learned my lesson and I got the girl version.) On the two walls that were still standing there were faded photographs of years past and advertisements for cheap taxis. Every now and again a bat would fly in and then out again, and although I couldn’t see them I’m positive that there were cockroaches scuttling underfoot. The food was amazingly good and we sat in the cracked plastic chairs, swatting mosquitoes and talking to the owners and laughing together.
We drove home and studied until far too early in the morning, and then woke up this morning to find another torrential downpour soaking all my laundry on the line. When I ran out to get it I got soaked just opening the door.
It is two different worlds. It is hard to reconcile the two together. One of the most unfortunate parts of it is the sharp delineation between the lives of the black people who live here, and the lives of the white people who live here. This is one of my first experiences with racism, and I find it uncomfortable to deal with. Sure, there are wealthy black people here. But for the majority of the island’s residents, they live in poverty while the rich white tourists enjoy the fruits of the land. I hate the fact that I am different, not because I’m wealthy (I’m not!), not because I’m Canadian, not because I’m a Christian, but simply because I’m white.
But I feel blessed that I have been able to experience both worlds here. Lying on the beach and watching the sun go down was heaven on earth. But sitting in a dingy hole-in-the-wall and laughing about the market’s best fish prices with a happy couple was also wonderful. And staying up late studying with my roommate and taking breaks to talk and laugh is also pretty special. Running in the hot sun, dodging potholes and goat crap and that feeling at the end of finally being able to stop, well, that’s pretty good too.
I’m looking forward to coming home in a few days and seeing everyone I missed and eating donuts and pizza and sleeping in a comfy bed and feeling cold for a change, but I think I’m really going to miss this place.

Zaza gets pimped

Today I had my first experience with pimping. In case you’re unsure of my meaning, I will explain. Pimping is what doctors do to medical students or residents working with them: While doing a procedure or examining a patient, or even just while they happen to be walking by a random medical student, they will ask obscure questions on just about anything slightly related to the case and expect you to immediately give the right answer, and if you don’t, they will either yell at you or haul you in front of the other doctors to chew you out and laugh at you, and then proceed to ask you more questions about things you couldn’t possibly know.
The only way to stop pimping is to answer back with a better and more detailed answer than they were expecting, and after a while they’ll hopefully stop badgering you. Pimping exists to make sure that medical students go home from the hospital and spend the evening frantically looking up things in their textbooks so the next day they can answer intelligently and not make fools of themselves. It ensures that we learn our stuff well.
Anyway, for one of our classes today, we were split up into groups and sent to clinics in St. Johns where we would be assisting a physician and observing. Brendan and I were assigned to a very pleasant doctor in a dingy little examining room. We sat down after introductions and our first patient came in.
She was a 7-year-old girl with chickenpox, and the doctor started writing a prescription. He was talking to the mother of the child and I was kind of zoning out and suddenly I realized the doctor was talking to me.
“Would you prescribe Acyclovir for this patient or not?”
Oh my goodness, he was actually expecting me to respond. What the heck was Acyclovir? I suddenly remembered it was an anti-viral drug used for Shingles but as far as I could remember, it wasn’t usually indicated for a simple case of children’s chickenpox.
“Probably not.” I said hesitantly.
He turned back to his prescription. I looked at Brendan across the desk and he nodded, letting me know I had been right.
“So what’s the incubation period for chickenpox?” The doctor asked me again.
I took a deep breath and looking pleadingly at Brendan. Come on, help me out.
“Well….” I started to say slowly.
“14 days.” Brendan jumped in.
“Yes, about 14 days.” The doctor responded. “And how long before it’s contagious again?”
“About a week.” Brendan answered.
“It may be a week, but actually it’s no longer contagious when the lesions scab over and stop itching.”
The doctor then went into a long explanation about the stages of chickenpox and talked to the patient for a moment, and then asked,
“Can you get chickenpox more than once?”
“No.” Brendan said at the same time I said “Yes.”
The doctor swiveled in his chair to look at me.
“Why would you say that?”
“You can get Shingles as an adult.” I said, “Even if you’ve had chickenpox as a child. It’s caused by the herpes…”
“And where does it show up?” He demanded.
“Along your nerve tracts.” I answered, thinking, I sure hope I'm right.
Brendan jumped in. “And it mostly manifests on the trunk- the back and chest area.”
The doctor grunted in affirmation and turned back to the patient. Phew. Passed that round. Across the table Brendan and I gave each other panicked looks and supportive nods.
The next patient had a bad cough.
“Listen to his chest.” The doctor ordered.
“Ummm….”
“You didn’t bring stethoscopes?” The doctor looked from the two of us incredulously. “I can’t believe you didn’t bring stethoscopes. Always bring them with you so you’re prepared.”
Prepared? I thought, I’ll never be prepared for this. There’s way too much to know.
Our next patient had a complex set of symptoms and we struggled to try to understand his vague replies, the doctor’s thick accent, and the jumble of notes and tests that he’d had done.
“What do you think about these hematocrit levels?” The doctor demanded.
I wondered what normal hematocrit levels were and if I could bluff my way out of having to answer.
“Well….”
“They look fairly normal.” Brendan said, and then I noticed next to the column of numbers, anything that was abnormal was labeled as ‘low’ or ‘high’.
I would have to remember that for next time.
Man, oh man. There were more questions over the next couple of hours, and we sat on the edge of our seats desperately hoping to get them right. I learned a lot today, and one of the things I learned was, when it comes to pimping, it’s all about survival. It’s about answering the doctor’s questions and then getting home and searching through my books and hoping that next time I know what the doctor is asking and can give the right answer. We met up with the rest of our class and all of us had been grilled the same way, and on the ride home we laughed about it and filled in the blanks of what we hadn't known. Next time. Good thing there's always a second chance to get it right.

Another lesson in humility

The other day I did particularly well on an exam and was feeling good about myself. Heather, I thought, you’re becoming quite clever and quite mature. I settled down to a focused, disciplined afternoon and evening studying anatomy. We have a big test coming up in a few days, and all of us were a little stressed about learning the huge volume of information in the little time we had left.
Well, I must have sat at my computer for about 5 or 6 hours, cramming my mature little brain full of the geography of the body, and by the end of it, I was feeling a little shattered.
We have a pleasant evening ritual, Vem, Brendan and I. After we’ve finished our evening studying, we sit together and have a drink and watch an episode of a very funny tv show. Sometimes two episodes. And then we all go to bed.
I could tell we’d been studying too long because of the spaced-out looks on everyone’s faces. Vem had been wearing his purple contact lenses and his eyes were bloodshot from staring at the computer and he looked like he’d walked out of a horror movie. Shomaila had collapsed on her bed and was comatose. Rebecca and Yanira were asleep. Brendan hadn’t shaved in I don’t know how many days and was looking like a truck had run over him. I sat down on the edge of the bed and tried to focus on the computer screen with the tv show but my eyes closed while I was sitting up and I just about fell over.
“Let’s play cards.” Someone suggested. (Okay, it might have been me.) “We always watch tv. We should do something else instead.”
I pulled out my deck of cards and we started a game of blackjack.
“What shall we bet?”
Not money, we decided, cause none of us had much of it. Not clothes, either, because the last time we’d played cards I’d lost 6 rounds in a row. We finally decided on push-ups.
The first round, the ante was 5 pushups and Vem raised it to 10 and Brendan folded and I turned up 20 to Vem’s 21. No prob. I did 10 push-ups.
The second round, I was dealt 21 and Vem raised to 15, and I called. Brendan folded at the ante and did his 5 pushups. I turned over my ace and ten and Vem had an ace and a jack. Fifteen pushups.
We poured rum and coke and dealt the third round.
“Are you allowed to bet if you’re already over 21?” Brendan asked.
“Of course!” I answered. “That’s called bluffing. It’s a really good strategy to flush out another player. You just have to keep a poker face.”
Vem was an exceptional card player; he had a poker face like nothing else and he was cool and collected. He’d been bragging about how many pushups he could do and I was itching to make him lose.
I was dealt 14. Brendan asked for another card and I could tell by the look on his face that he was over. Vem raised the bets to ten, and I called and raised it to 20. I asked for another card. He dealt me an eight. I looked at it in my hand and looked up at Brendan’s flushed face and then Vem’s cool and collected one. Well, if they could bluff, so could I.
“Raise to 35.” Vem said confidently.
No way he could win three hands in a row. Brendan threw down his cards. Drat. Now I’d have to bluff against Vem.
“Raise to 50.” I said coolly.
Vem had a funny smile on his face. “Raise to 75.” He said.
I suddenly was overcome with this panicky feeling. What if he wasn’t bluffing after all?
“Call.” I said in a small voice.
We laid down our cards. My 22 and Vem’s 21.
Well, they laughed long and hard.
I got down on the termite infested floor and cranked off 15 pushups. They laughed and laughed. Then another 35. They kept laughing.
I didn’t make it to 75, they agreed to let me finish my pushups the next night. We put away the cards and sat in front of the computer screen, exhausted, and watched tv until some ridiculous hour of the morning.
But I couldn’t get it out of my head, all night.
It wasn’t really about the 75 pushups and my aching pectoralis muscles. It was about my attitude towards life.
I’ve always had an overdeveloped sense of self-confidence and the ability to talk my way in and out of things. If someone asks me a question that I have no idea about, it’s not that I make up an answer, but I just find the best one that I can possibly think of and I deliver it as if it was the 100% guaranteed truth. It’s not lying; it’s being assertive, creative and responding to challenges with a positive attitude. Or so I’ve always thought.
I realized last night what it really is. It’s bluffing, or more accurately, another word that isn’t quite polite to print here but starts with the same letter.
My worst fear is that someday I’ll be at a patient’s bedside and I’ll make a call with their life in the balance and my b.s. answer will cost them their life. I know I’ll make mistakes, I know I’ll have patients die, but I don’t want it to be because I am so overconfident in my abilities to gamble that I can’t say “I don’t know.”
I’m learning to say “I don’t know.” It’s not easy, but it’s important. And I have the feeling that it’s one of the most important lessons I can learn here.
That and how foolish it is to keep betting when I’m over the limit in blackjack. So if you’ll excuse me, I have 25 pushups to go do….

Searching for profundity in the commonplace

These last few days have been so jam-packed with information that my brain feels like it's about to crash. Kind of. I still have found time to go running every second day with two other classmates (I think we're getting faster, and we go farther every run). We need to run. Brendan said two weeks ago about everything going wrong, if we don't laugh, we'll cry. And that's why we go running.
The most frustrating thing lately is that our water supply is on and off. We never know if it's going to be on in the morning or in the evening- about half the time there is no water and then we find the maintenance guy (if he's around) and if he's not we fill up buckets of rain water from the spigot behind the house. I've learned to keep buckets of water in the shower and fridge in case we need them. But that puts a cramp on our running a bit, because the guys won't run if they can't shower immediately after. So we finish class, check the water, and if it's still on, we run.
Yesterday we said goodbye to Nellie. The last week we've spent several hours a day with her in order to finish our dissection as fast as possible before she completely disappeared. We had our final lab test yesterday, and then we put her in her coffin. Another sorry corpse named John that had been waiting in a body bag for the coffin to be built was laid to rest with her. We lifted them in, put the lid on and nailed it shut. Then we stacked the coffin on top of another one. There are four coffins stacked in the lab, they've been there for a long time and probably will be for longer. Dr. Rust explained that it takes forever and a lot of money to get a burial permit in Antigua, so the cadavers get to hang around for a while more.
We put on face shields and used bleach to scrub the lab, cleaning our instruments and taking the garbage out. Earlier that day we'd put a bag of lab garbage out to be disposed of, and watched as some of the workers came to take it away. We all stood there looking out the window laughing, because if they had of known where the garbage came from they wouldn't have come near it in 1000 years. It wasn't as if a petrified leg would suddenly pop out of the bag, but that sure would've been funny. (Well, until we had to pay them off with more rum.)
So we laid Nellie to rest. We threw our clothes in the garbage and scrubbed. Nikki mentioned something about saying a prayer for Nellie, but we were tired and glad to be getting out of lab and just left her in her box.
Then last night I was taking my laundry off the line and there was that one shirt I'd worn and got stained in the lab, and there isn't anything that will take human fat out of a t-shirt. Dr. Rust told me that even de-greaser won't work. I'd washed it so many times, but still the smell of Nellie remained.
Nikki came out of her room this morning with a funny look on her face. "I dreamt about Nellie last night." She said. "And I said a prayer for her."
I'd expected my experience with my first cadaver to be profound. I'd thought we would have a solemn goodbye for her and reflect on the gift of life she gave. But it was not so. We'd stripped off our clothes and went for dinner, discussing the upcoming exam and laughing over silly jokes. It was so unemotional.
Sometimes I'm not sure what to write about in my blog. It's not that I don't have plenty of adventures. But some of them are so raw, and some of them are so commonplace. Saying goodbye to Nellie was so devoid of any emotion or profundity that I was left wondering if I'd missed something somehow. Shomaila leaping out of the bathroom shouting because a lizard decided to join her in the shower, so commonplace and every day now. Accidentally slipping on a pool of body fluids in the lab and almost wiping out on top of a cadaver? Commonplace. (Unfortunately). Trying to look through a microscope at a blood smear and having to take a break to kill 17 mosquitoes that were hovering around us? Cold showers with a bucket and a cup? Food poisoning with all its not-so-wonderful symptoms that I've experienced all week? These are just external challenges and they enter a familiar place in my heart and mind and I can deal with them. I've done it before, I'll do it again.
But other things are not so easy to deal with. Talking with Brendan about losing someone you love and how it feels to be helpless to save them? Raw. Dr. Rust teaching about how to identify signs of child abuse and finding myself up until midnight not being able to get it out of my mind? Raw, still raw, and I hope to God that it never becomes commonplace. I emailed my dear friend and mentor Dr. Jan White last week, asking for advice on how to deal with my strong and very emotional reaction to what I was having to learn.
"...the answer you probably don't want to hear", she told me, "keep on letting God break your heart, and keep a daily supply of Holy Spirit super glue on hand."
I've been thinking about it for a long while. It's okay that I react the way I do to some things. God made me this way for a reason, and someday maybe I'll understand. It's not easy to feel my heart being broken over things, but everyone falls apart over something and everyone needs putting back together again. It's okay, and it's normal. Commonplace, even.
And speaking of very upsetting but very common place things, there is the haircut that Nikki just gave me. It is unfortunately upsetting me more than I would like. Let's just say that most of my natural beauty was removed with a pair of scissors. There will be no pictures forthcoming.

More life lessons from sunny Antigua

I suppose you all are wondering how things are over here, after that last depressing blog entry. Our storm kept going for a couple of more days, but the good news is that because the flood damage to our rooms was so severe, we were all evacuated to a new building. My new room has a bigger bathroom and is a bit newer than the last one (although it doesn’t have internet connection, so I am in one of the classrooms right now pretending to study.)
It’s finally stopped raining and my clothes dried out and I even went running again yesterday and almost passed out in the heat. Today is our one day off and I got up pretty early and Nikki and I used an old electric skillet we had found and made pancakes and French toast for the whole class. (Yes, all 7 of us.)
This afternoon some of us are going to walk to the beach, so expect some pictures of a very sunburnt Heather very soon.
I appreciate your encouraging comments on my blog, it reminds me that even though I’m far away from home, we’re all still connected and we can share our lives with each other.
So far, academically, things are great. I’ve aced every exam so far and am enjoying the classes, especially Gross Anatomy. (I don’t know why they don’t call it Disgusting Anatomy, cause that would be way more appropriate.) I’ve also learned a lot of life lessons this last week.
My roommate is a cool girl, but we’re pretty different. I want the air conditioner off, she wants it on. I never lock my door or close the curtains, she’s locked me out like 5 times already. I never call my parents, she calls her parents about 3 or 4 times a day. (Sorry Mom!) I don’t mind creepy crawlies in the slightest, she uses bug spray like it’s going out of style and a massive “Hello Kitty” mosquito net. I’m a Christian, she’s Muslim. When we had to move rooms this week I wanted to be in the room on the end of the building with 6 windows and a brand new shower and no ac. She wanted to be in the room in the middle with 2 windows, ac and a hole in the shower wall that I can look out of and see the yard.
She wasn’t going to budge on the ac, even though it was highly inconveniencing everyone. Anyway, I’m older and had been there longer and was the one making the decisions. We argued. I admit, I was pretty upset. I went into someone else’s room and sat on the bed and sulked. (Wow, how embarrassing can it get?)
After a while I thought, I may be right about which room we should have, but is it a big deal? Here I have this absolutely stellar opportunity, when all my classmates know that Shomaila is being a jerk about the room, and are watching me to see what I’m going to do. I could push for my own way, which was clearly the right way, or I could choose to turn the other cheek and let her have the room she wanted, and be gracious and forgiving about it. I’m embarrassed to say that it took me about 30 minutes to change my attitude, but I finally did. I packed my clothes and moved into our new room.
And you know what? It’s absolutely fine. And you know what else? There were a few people who were blown away by my humble attitude. (One of them was me! I thought, hey, where did that come from? Cause I’m not normally this nice!) The good news is that Shomaila and I get along great, she’s a really nice girl. And I had the opportunity to demonstrate forgiveness and grace and I did.
Another life lesson I learned this week was to never drink three shots of rum on an empty stomach. Without going into any details that might incriminate me, I woke up the next morning and thought, what on earth happened last night? (Don’t worry Mom and Dad, NOTHING happened, WHATSOEVER). But I was given a serious lecture by Brendan about responsible, safe drinking, and I had an even more serious talk with God about it. (A really serious talk involving the words “I’m sorry”, “Please forgive me” and “I’ll never do that again”.) I thought about not telling anyone, keeping the secret between me and my two classmates who had been up with me the night before. (Obviously that was a bad idea of course. Perhaps I err on the side of indiscretion, but I’d rather be transparent about my faults than cover them up so no one knows I have them.)
The truth is that getting drunk is not only stupid, it is dishonoring to God. When I talk to Shomaila and my other classmates about grace and walking in the light and following Jesus, if they don’t see me living the walk I’m preaching, it means nothing.
I don’t have to preach with words. I can show them what grace is by forgiving them for their faults. I can show them love by giving up my time to cook them breakfast. I can show them self-control by having one drink and then calling it a night before I have to be scraped off the floor. I can show them truth by not cheating on my exams and having the integrity to not look at the answer key for assignments. I can show joy by refusing to join in complaining about flooded buildings and lousy cafeteria food.
And I suppose I could also show self-discipline by actually studying right now instead of writing on my blog.
Cheers! Have a great week, everyone.

p.s. The rum was actually mixed with coke and the coke here isn’t carbonated and it kind of tastes like rum anyway, so if I was making excuses I’d probably use that one.

That's life

I suppose I should have guessed that a ‘down’ would come after that ‘up’ the other day. And it came today. I started off the day without enough sleep, feeling groggy and having to drink a cup of Nikki’s coffee before feeling awake. We had an exam, but I finished early and had time to study. Too much studying. My eyes began to hurt from using the computer too much, making me feel a little sick, so I didn’t eat lunch. Instead I drank some coke and went to lab.
No one was in a particular happy mood with Nellie today. Rebecca was feeling a little unwell and the air conditioner was working too well, so everyone was cold and sniffling underneath our surgical masks. We were working on the thorax and it was back-breaking work, leaning over her for hours with scalpel and forceps, delicately prying apart veins and muscles and nerves and all sorts of things. I’d left my shorts outside when I changed into my lab costume, and halfway through the afternoon it began to rain. I was too covered in slime to go out and get them, anyway, we were running out of gloves and I didn’t want to waste another pair. Vem complained about having to pee, and I suggested he just go and stand in the rain and pee, no one would know. It seemed like a good suggestion to me, but he didn’t find it funny.

We moved onto Nellie’s head. It had to be skinned, and I gritted my teeth and started helping Dr. Rust with the unsavory task. Due to the decomposition, we decided to take off all the skin and cartilage and only study the structures beneath. I began to cut off her right ear. Not many things bother me, but I looked up at Dr. Rust and said, “This is really hard.”
I can’t really explain very well, but there is something very very psychologically difficult about cutting off parts of a person’s body, especially on their face, even if they are very dead. I had to remove part of her nose, and cut around her lips, and it was one of those hours that is very sober and you try not to crack too many jokes but you have to crack a few because you know you’ll spazz out if you don’t.
All of us were exhausted, physically and emotionally, before the end of lab, and I asked Dr. Rust if we could end early. It was pouring rain outside by this time and we de-gowned and scrubbed and stood in the entrance-way, looking out at the rain and not wanting to go into it. My shorts were in a sopping heap outside the door and I struggled into them. We had planned on going shopping as I was out of food, but the man who was supposed to pick us up decided it was raining too hard, so we’d have to wait for another day. Brendan and Vem and I had planned to go running after class, too, but Vem was getting over a cold so they decided not to go. All of this had put me in a foul mood.
I started walking back towards our house, and the rain was pouring down harder now. The road was covered in water and by the time we made it back, we were soaking wet. You know those times when you feel like yelling swear words or hitting something? I decided that I would go run it off, forget about the rain since I was already wet. I put on my running shoes and headed out into the downpour. At first it felt amazing. Within a few minutes I was soaked to the bone and I splashed through the puddles and sprinted down the road. It began to rain harder and for the first time in two weeks, I felt wonderfully cool. Every few minutes the sky would light up and then crash with thunder. I ran and ran and ran, a long way. I ran down to the main road and down it for a mile or so, and finally stopped at the top of a big hill overlooking the ocean. There was no one in sight and I stood there, looking at the bleak grayness.

I had to pee. Of course there were no bathrooms in sight. You probably know what’s coming. My mind flashed back to what I had said to Vem and I thought, hey, that’s not a bad idea. So yes, dear reader, I stood at the side of a deserted road in the sprinkling rain and peed. And it was then that I heard a car engine start beside me. I turned with a gasp to see that the empty car next to me was really full. The couple in the front seat looked at me very coldly, and then they reversed and pulled out onto the road, driving away. I thought I could just die right then and there. I wondered if Antiguans get arrested for public urination, and if they would report me. I wondered if they had turned to each other and said, “Is that girl really peeing right in front of our car?”

Well, I turned around and started running home. I ran and ran. The rain grew harder. The wind picked up. Suddenly the road in front of me seemed to disappear. There was nothing but rushing water. I was up to my ankles, no, I was up to my knees. I tried to keep running, but had to slow to a walk. After a while the rain began to pour so hard that it was stinging my body everywhere it hit. I couldn’t see a thing. I turned my back to it and huddled over, praying that it would stop so I could keep going. I still had over a kilometer to go. The wind was so strong I thought it would blow me over. Finally the gust let up a bit and I turned and kept going. The water was rising fast, and it was flowing across the road carrying rocks and mud and roaring down the side of the hill in turbulent rivers.

A few times I wondered if I would make it. I struggled to stay upright in the river churning around my legs, mud splashing up on me. The university campus is up on a hill a bit, so when I finally got there I managed to climb out of the water. I knew that everyone else would be huddled up in their rooms, so I stopped by the cafeteria, looking like a drowned rat, and picked up the food they had ordered for dinner. I hadn’t ordered any because I’d thought we would go shopping.
When I got back to our bungalow the doors were open and everyone was talking. My roommate came out.
“Everyone’s rooms are flooding!” I ran to our doorway and the water had just stopped coursing in the back wall and was puddling everywhere, half of the room was covered. Shomaila had frantically thrown towels and bathmats all over but the brown mud was everywhere. Outside, the rain was still pouring.
“My clothes!” I shouted to Shomaila. “Can you get my clothes out of the closet!” Shomaila had unplugged our computers and had tried to get things off the floor, but she hadn’t known that I kept my clothes folded on the floor in the closet. She ran to get them while I went outside and behind our house to see what I could do.

The workmen who had been repairing our broken pipes had left the earth open and there was mud everywhere, with rivers rushing through it. I got right down in the dirt and wrestled rocks and chunks of grass out of the way to divert the water away from the back of the house and down the side of the house instead. The ground was soft and suddenly I sank up to my knees in the mud. It was like quicksand. I managed to get out and Shomaila was standing under the porch watching.

“Heather, all your clothes are soaked through!” She called. “I’m really sorry!”
I finished throwing mud and rocks around. The rain seemed to be letting up a bit. Apparently the water had stopped coming in through the walls.
I walked a few steps and looked down at my mud-spattered legs and now-brown shoes. I sat down on the stairs of the house, and after Shomaila had gone inside I put my head in my hands and I cried, the rain coursing down my face.
I had no dry clothes. I had no food. I was exhausted and filthy and the skies had opened up and were dumping everything on me. I felt very low.
What can you do? I was shivering with the cold and after a while I thought about how I didn’t want to be a quitter and give up, I wanted to be a finisher and a winner in life. If I let this get me down, what kind of an example would I be setting for everyone else? There was always hope. Hope is not about outside circumstances. Hope is about who God is, and that he never changes. He is always good. He is always there.
I took my clothes off on the porch and went into our room, wrapping up in a sarong. Shomaila and I used our wash basin and mopped up the floor. I rinsed out my clothes and Nikki found something that would work for another clothesline and I hung up all my clothes to dry. I showered all the mud off and found one dry pair of underwear and a sundress and Vem gave me a shirt. I heated up some cold pasta and sat on my bed underneath the hanging clothes. My room looks like a Laundromat, there are clothes and towels everywhere. The roof was leaking down the wall, too, so we moved the furniture away from it and stacked our books on the beds and tried to dry everything off with paper towels.
You know what? It’s okay. This is real life. It’s not always easy, and it’s not always fun. But God is still good. And I’m still hanging on, even though I don’t have anything to wear or eat tomorrow. I know that it will work out, somehow.

Falling in love with Nellie

Well, for starters, Uncle Chris was the only one who got the completely right answer about the plural of Mongoose, so I owe him coffee (sometime in November?)
Now if you could just tell me the plural of giant tarantulas, because that's what we have over here. And not just a plurality of tarantulas, but lizards (I finally caught one today but he left me his wriggling tail and ran off), frogs, purple jellyfish (apparently they don't sting), mosquitos, termites, ants and one cute black kitty that I glimpsed today.
And then there are the maggots on Nellie. One mustn't forget Nellie. Yesterday I leaned to close to her and some of her body fluid soaked through my paper gown and through my tank top and onto my stomach. When I de-gowned after the lab I was horrified. I scrubbed the shirt with plenty of soap and hung it to dry, but the next day the stain was still there, not to mention the smell. Today we spent another several hours with her and while Brendan and I were peeling the skin off her arm, a chunk of flesh flew up and landed right on the spot between my gloved hand and my sleeve, right on my skin.
The whole dissection stopped. Brendan took his forceps and gently lifted it off of my arm. I considered going to wash right away, but then remembered that the water all across campus was shut off that day because of a burst pipe.
"I'll just suck it up." I told Dr. Rust.
She laughed. "I hope you'all don't do that."
Way to ellicit the gag reflex.
"You really like Nellie, don't you?" Vem joked with me.
"No, Nellie really likes me." I answered, thinking about my stained shirt and how I was going to get it clean.
Hours later we were working on the thorax (chest area) and I helped Dr. Rust cut the ribs so we could lift the chest off. Funnily enough, I think I've done the same thing a number of times with ducks, so I was familiar with where to cut. I wondered if all that duck cleaning would ever come in handy, and it certainly has.
There, underneath the rib cage, was the heart inside its pericardial sac, a glistening fat blob that was just waiting to be opened up. I could feel myself getting excited and after a long time of listening to Dr. Rust explain things about the chest I could hold it in no longer.
"Please, please, please can I open it up?"
"All right, Heather." She laughed, "Go on ahead."
I felt like a heart surgeon operating on a patient. I took my forceps and scissors and gently cut through the pericardial membrane, explaining in a calm voice about the different layers to my classmates. We lifted out the heart carefully and poked and prodded and examined the enlarged blood vessels leading to it and other signs that poor Nellie had been a very sick woman indeed. She even had a pacemaker implanted in her chest, and so we carefully worked on extracting it so we could follow the leads into her heart.
By the time we finished for the day the only word to describe it was carnage. We wrapped Nellie up and de-gowned and went outside into the hot sunshine. Behind one of the bungalows I found a water resevoir with a tap on the side of it, so we scrubbed ourselves there before going for dinner.
I know it might seem morbid to some of you, but seeing inside Nellie's chest today and touching her collapsed lung and cutting her heart out gave me the most wonderful feeling in the world. I haven't felt it for a long time, but I remember it well. Four years ago when I was taking my first biology class at TWU I snuck into the lab after it was closed, and I took a pin and poked a hole in my finger. I made my own blood smear and slid the slide under the microscope before focusing the lens. There before my eyes were my own red blood cells, swimming around like little flat donuts. I remember crying.
Over the last few years I've wondered again and again if this is what I was meant to do, to be a doctor. I tried to explain to people why it was different than being a nurse, and inside myself I wondered if it really was, and if I'd really like it.
I have to tell you, despite some lousy moments, I absolutely love it so far. I'm probably just crying because I'm overtired now, but this is one of the most fulfilling things I've ever done in my life. I know it's not everyone's cup of tea, and I'm glad about that, because someone has to fall in love with fixing cars and cooking and working with computers and teaching school and managing businesses. We all have something to do, and thank God it's different for each of us.

Mongoose

I forgot to add..... here's a trivia for you: WITHOUT looking it up in the dictionary, internet or any kind of book, the first person to tell me what the plural of Mongoose is, I'll buy you coffee next time I'm in town. Remember, no looking it up. This is something you have to come up with out of your own gray cells. I can't for the life of me figure it out... Mongeese? Mongooses? Mongi? At any rate, there's a lot of them over here, they live under my house and apparently occasionally get in through the hole under the bathroom sink.