Rapid Interpretation of EKGs

Edit: I have heavily edited this post after learning that the author of this book is a convicted pedophile. I no longer think Dale Dubin is the greatest man on earth. But, it's still a good book so I've kept my post about it. My advice - get a used copy.

For anyone who ever tried to learn how to read EKG's the name Dale Dubin probably rings a bell. He is the author of the wildly popular "Rapid Interpretation of EKG's". This summer when I was working with an internist for a few days and he was doing stress tests I said I didn't know how to read an EKG so he gave me the book he learned EKGs from - a very tattered copy of Dr. Dubin's masterpiece (blanks not filled in so I'm not sure if he really got the maximum out of it). This book has stood the test of time and is now in a very glossy and colourful 6th edition.

Basically, this book is fill in the blanks and by being fill in the blanks prevents one from skimming the pages and tuning out and not learning anything. If only every book I've ever had to read was fill in the blanks I'd probably be a lot smarter. The only way I can fall asleep while studying EKGs is to put this book down, that's how much it captivates my attention. Not that I don't still fall asleep, I just have to put the book down first.

My only issue with Dr. Dubin's book is that he doesn't discuss the cardiac axis until chapter 7 on page 203, and it isn't until this chapter that he discusses the 12 lead ECG and the orientation of the QRS complex in each lead. Furthermore, I'm a little confused still about the correct orientation of the p-wave in all of the leads. Nevertheless, I'm not finished the book, so maybe these things will become clear with time.

This is the only book I've bought this semester so far, and I gotta say, it was totally worth it.

Urgency

Amongst my peers there's a sense of urgency. Travel now, have fun now, while you STILL CAN. (imagine maniacal laughter inserted here). We all have a fear that after this summer, our last summer off, we will never be able to have fun again because we will be working all hours god sends and we won't have any vacation time. Whether this is true or not is probably dependent on your specialty and how much you're willing to sacrifice to take time off and travel and do all of those other things, but it is true, this is probably the easiest time to do it. Unfortunately, this is also the time when we all have no money.

It is true, any bank here will give you a loan if you say you're a med student. Some of my friends have lines of credit that extend up to a quarter of a million dollars. A QUARTER OF A MILION!!!! But, do I want to pay later for the fun I'm having now? How long will I be working to pay off the fun I have now? Lots of people in my class are going travelling this summer on their loan money. I am lucky. I don't currently have any loans. My parents have worked hard to ensure that I can graduate without debt. But, now I'm heading into a summer where I'm not going to make any money and I want to do some fun things. I'm struggling with whether to take out a small loan or not. It sounds silly, but, what if my parents are disappointed that they did all that work to put me through med school just for me to go off and take out a loan to travel? Is it all worth it in the end for the life experience of one last summer of freedom?

Nobody Wants Me

I really want to do something clinical this summer in family medicine. It's turning out to be harder than expected. Nobody wants a second year med student and it's becoming VERY disheartening. I don't have the connections or my connections just aren't working out and I've come to so many dead ends now it feels like I'm banging my head against a wall. I can't sell myself any harder. I just want to practice practicing. I just want to get out there and experience what it's like to be a dctor in a small southern ontario community. I just want to figure out if this is what I want to do with my life. Is that too much to ask? Apparently so.

Sad

I just walked into the medical school main building at my university. On my way in I passed two first year medical students, recognizable from their bright blue backpacks. Both girls were smoking cigarettes outside the front door. How sad that the people who are supposed to be advising others on how to protect their precious health are ruining their own. They have no excuses; we grew up in a generation that fully knew what dangers cigarettes hold, and yet the smoke. We had the benefit of ads and publicity campaigns aimed at stamping out cigarette smoking. I don't even think smoking holds the "cool"ness factor that it once did. So then, why?

There was one smoker in my class when we started and he no longer smokes and I think that's great. There's no time like now to quit.

I know that medical students aren't gods or immune to the plights of normal human beings but I hope that we are well educated about the health effects of our actions. If you are a med student and you smoke, maybe you can enlighten me as to why.

Podcasts

My med school has recently started podcasting our lectures afterwards and I have to say, it's awsome. I missed one morning last week due to my inability to get out of bed, and I just listened to the lecture. I have to say, just sitting here listening instead of trying to write things down at an insane speed really added to my understanding. In lectures, I usually have to sit there and I'm trying to hard to write things down so that I understand the notes and get the insight when I go back to study that I don't remember what the lecture was about afterwards. Sitting in my living room just listening, I actually took something away from it. This podcasting thing is genius. Although I won't be able to re-listen to every lecture on podcast, I can put them on my ipod and use up the time on the train or at the gym to listen to a few key ones for understanding. Finally, something useful done by my medical school administration! Hoorah!

Icky Snotty Goo

I think I've lost 1/2 my body water in snot in the past 2 days. I am keeping the tissue industry alive! Who knows whether I picked this up observing in the ER or whether it's been brewing for a week or more (and is responsible for my headache) but I am most definitely ill. This really has ruined my plans for tomorrow's holiday. I was going to observe in labour and delivery and I was really looking forward to seeing babies!

I'm going to have to start studying this week. Ugh. Things always seem to get busier near the end of the year when I need more time to study.

Exhaustion

There's nothing like being somewhere that you don't know your way around and doing something you're not familiar with while trying to impress someone to tire you out. By the time that I got home from my shift I observed at on Tuesday I was pooped. It was only 11:00 and i was totally shattered. Clerkship is going to be even more exhausting I'm sure, I was only there for 6 hours! Granted, I had done a full day at school first.

It was fun though. I got to ultrasound one of the residents' belly, I saw lots of kids with sore ears/tummies/throats, I saw a man in anaphalactic shock and saw a woman who may have been having an MI but not really. The resident I followed around was great. He had no qualms about letting me go in there first and do my own physical before he went in. It's great to get that experience, although I must say, I need more practice looking in the ears. Ben is going to have his ears looked in a lot this weekend.

To add to my exhaustion, after I got home it started snowing and didn't stop until the next morning, leaving us with 10 cm of fresh fluffy not plowed snow. It was a bit of a biking nightmare. I got TO school but had to take the bus home due to the complete and utter ridiculous state of the roads.

Hopefully tonight I'll get to bed somewhat early (although it's trivia night and I'm going) and feel like I've started to recover tomorrow.

Valentines Day

For me, the best part about valentines day has got to be the abundance of cheap heart shaped chocolate. On the 15th of February I hit the sales and stock up for exam time. I love chocolate; some might say it's my kryptonite. Unfortunately, once I have the chocolate near me, i can't stop myself from eating it. This is demonstrated by the fact that I ate 12 chocolate hearts tonight. Oh, and yes, I'm pathetic and I bought them for myself because I was having a chocolate craving and my boyfriend doesn't believe in valentines day. He's morally opposed to someone telling him that he should tell me that he loves me extra super special much on this day because to quote him "he loves me every day".

I think it's an excuse not to buy me a present, but hey, maybe he'll buy me an out of the blue present some other day instead. I bought him a present because I fully believe in valentines day. Who doesn't like an excuse for presents? We also went out to dinner because I whined that everyone else was doing something for valentines and he could atleast throw me a bone.

It was a very nice dinner. Unfortunately I forgot to ask for my seafood pasta without tentacles (I just don't like the texture) and it was chocked full of squid arms! I picked them out and it was super yummy. (munching on chocolate heart #13 as I type this - please, someone, take them away from me). I've really been ODing on seafood lately, but it could be worse things... like more chocolate.

I have also been having mysterious headaches so today I broke down and bought pain killers. I usually don't take anything for my headaches because not much works except sleeping it off but when I woke up today with the same headache I had yesterday I said ENOUGH! a couple of 222s later I felt a bit better although not fully. I've been trying to modify lots of lifestyle factors such as drinking more water, eating more regularly, and wearing sunglasses all the time to alleviate the annoying pain but it just won't go away. Maybe tomorrow will be better.

Well, this post has certainly been random. Must be all that chocolate talking. Happy valentines day everyone! Look forward to a post soon about my observership in the ER tomorrow!

Like sand through the hourglass...

What do people really think of Canada? There is this satire TV show called "talking to Americans" where a Canadian "reporter" goes around and asks Americans questions about Canada or stating facts about Canada that are quite ridiculous. For Example:

1) Canada is a land-locked country and they are wondering if they can use a few US ports for launching their Navy, do you think the US military should let them?

2) Canada recently legalized the stapler, congratulate them!

3) Did you know that the capitol building of Canada is a big ass igloo?

And they get certain prominent americans such as the governor of Arkansas to give their two cents. (watch the clip, it's very funny)

Now, of course, this show is meant to be a satire so they don't pick the intelligent answers, but, let us take another example of the American perception of Canada: Days of Our Lives.

I don't personally watch days of our lives, but my roommate has recently become addicted and she tells me that Canada has been mentioned twice lately:
1) A man gets a face transplant in Canada and comes back totally healed with no scars
2) A couple abducts their stolen baby to Canada and hides out in a warehouse where the Canadian police cannot track them down until they can sail away on a cruise ship into the night with their baby with fake Canadian passports.

First off, since when is Canada the mecca of experimental plastic surgery and how come everything sketchy seems to happen here? Oh, and, by the way, they're in Toronto, how the hell do you get on a cruise ship in Toronto? Is it sailing around the great lakes?

In conclusion, what IS the perception of Canada in the US? Friendly igloo living, sled dog riding, aboot and eh saying, rednecks?

*ED: just for the record since someone might wonder, i myself am Canadian and I live in an igloo and say eh

Just when things were looking down

Just when you think you'll never like medical school again, some brilliant clinical teaching comes along and makes you fall in love all over again. Today we had some absolutely great cardiology teaching where one of the cardiologists had 5 of his patients come in and we went around and listened to their findings. I heard aortic stenosis, aortic regurgitation, mitral regurgitation, a mid-systolic click, carotid bruits and it was all great. I love it when you hear/see teaching in action. All of the people were super nice and willing to just lay back and relax while we listened until we heard what we were supposed to, no pressure. The doc who taught it was also really nice, he made jokes and asked questions and let us ask whatever we wanted without making us feel dumb. I think that for 1st and 2nd year medical students, it's important for us to be able to ask questions about dumb things without feeling chastised or ridiculed, save that for clerkship!

All in all, I felt like it wasn't a waste of time, unlike a lot of our didactic teaching time. Yay cardiologist. Although, I still don't want to do internal!

I'm a lump

Ever just lose that gold 'ol med student motivation? I sit in class and think "oh, that's interesting" but when I get home, all I want to do is sit and watch tv, take naps, eat chocolate, go to the gym. Cracking the books just doesn't seem a priority. I SHOULD be cracking the books though. I should be studying the kidney, I should be studying the heart, I should be working hard. Where did that good ol' work ethic go? Quick, someone, give me your work ethic so I don't get kicked out of medical school!

In good news, after the girl I was supposed to live with gave me the news that she has to stay in her current place with a girl that I don't think I could live with, I found another place to live! Unfortunately, it means paying double rent over the summer so I'm going to have to get a subletter. I have a lead on a person but I think I might have to get a few people for different months who are coming to do medical electives at the hospital here. Let's hope there are lots of people who want to come hang out here!

Be Kind to Cyclists

With the threat of global warming, many people are thinking about things that they can do to alleviate the burden we place on the earth. Hybrid cars, electric cars, biofuels, we are starting to hear these terms thrown around in everyday conversation; however, each of those cars still consumes the amount of fossil fuel it takes to build each individual part and to assemble them and produces the associated emissions. The fuel consumption and emissions that go into building a new hybrid car makes it less efficient and environmentally friendly than driving a used compact car that runs on petrol. Riding a bike does not consume fossil fuels or produce emissions. The costs to the environment of creating the bike are balanced out by their zero emissions and zero fossil fuels existence. And, if you buy a used bike, you don't even have to incur the environmental costs of manufacturing. This comes down to my main point: biking is best. Therefore, car drivers should respect cyclists' right to be on the road.

I cycle 5 days a week to school 12 months a year. Rain, snow, sunshine. Almost everyday that I ride my bike on the road I am scared for my life because cyclists are not respected by cars. I stop for stop signs, red lights, pedestrians, and in exchange for following the laws of the road, I demand the respect of others on the road. I have only been hit by a car once, which is quite enough, but I have been cut off, had people fling their doors open right infront of me, had pedestrians step out off the sidewalk right infront of me, been squeezed off the road, and have had quite a few side mirrors brush my sleeves. Here are some tips for motorists:

1) Slow down when you are passing a cyclist - not only is it better for the cyclist you are passing, but it also warns the cars behind you that there is a slow moving vehicle on the road

2) Change lanes if there is not enough room to pass with at least 2 feet between you and the cyclist. There is no prize for getting as close as you can to a cyclist and staying in your own lane. think of them like a scooter - you wouldn't try to pass a scooter in the same lane would you?

3) Respect our judgement on how far we ride into the center of the road and don't try to crowd us into the curb. Some roads have depressed road grates that can be dangerous for cyclists and we move out to avoid them or, if there are people parked by the side of the road we leave enough room for their doors to open so we don't get "doored" (see tip 4)

4) Look before you throw open your door. A cyclist is easy to miss if you're not looking for one, do you want to be responsible for injuring another human being? do you want to have your car door damaged?

5) Thank a cyclist for their zero consumption and zero emission mode of transportation while you drive around your personal contribution to global warming. We're doing it for you and your children as well as ourselves and our own.