skool

i've been negligent in recaps of my rotations lately. I'm still in school, things are generally still good. I'm getting a bit anxious about the residency appliance that i am in the midst of, and feel like whatever i say now carries more weight since i've (mostly) decided to what and where i am applying.

Anyways, The past two were Emergency med and pediatric derm.

emerg, as usual, was amazing and fun. I got to work at the trauma centre, and see lots of cool stuff. pedestrian vs. car, pedestrian vs. bike, pedestrian vs. airplane.

and the little guy never won. (though nearly always survived what i saw)

The teaching was amazing, I got to suture a lot, and to have respect for the cost of alcohol. I'm sure that taxes on booze do not come close to covering the health care costs, even just in the emergency setting. I was on nights the long weekend after frosh week (so maybe i'm biased) but there'd be mornings when nearly every bed was occupied by somebody sleeping it off after a fall, an accident, or just forgetting to breathe after a night of revelry. Morning would come, the barfing would subside, and the nurses would send people home while the beer stench slowly faded. It was so different from my elective in emerg last year, which was at another hospital which didn't get trauma, and wasn't downtown. There was very little EtOH, and way more 'weak and dizzy'.

Peds derm was a pleasant surprise. It was far from a slack month. I was there early, and usually stayed till fairly late. I learned tons, and had great teaching once again.

But i'd make a terrible dermatologist for many reasons. I'm far more about function than form. I'm not very visual, and i tend to make my diagnoses mainly on history. But i really like the fast pace, the attention to nomenclature, and the precision of it all. I also got to see a lot of interesting psych stuff which i wasn't expecting. Having worked for years with kids with OCD, I've only ever met one person with trichotillomania (compulsive hair pulling). But I saw so many kids in that one month. And other self-injury masking as organic. But we just referred all that to psych once we'd diagnosed it. Which was not so satisfying.

I was expecting it to be mostly eczema and acne, and there was some of each (though not nearly enough acne that i'd feel comfortable having a treatment algorithm in my head yet.) But there was also tons of weird and interesting stuff too. I saw a lot of mast cell tumors, which i'd never heard of before. (Mast cells are a kind of immune cell with granules inside that get released during an allergic reaction.) And a tumor of mast cells can have degranulation caused by physical trauma. i.e. when scratched, becomes a hive. weird.

But I now know what to do about eczema. ho-lee! And i am glad that i was there for the full four weeks bacause i got to see how well keeping the baby wet worked to clear it up. Kids who were eczemateously covered head to toe, put in wet pyjamas for a couple of weeks, steroid cream, a bit of moisturizer and voila - recognisable child. It was something. Messy, labour-intensive, and stunningly effective.

I'm going to be relieved and sad when this is all over in just 3 more 'blocks'. It has been a really nice time in most ways.

That said, i know that the upcoming weeks of orthopedic surgery are going to involve holding on, clenching my jaw and trying not to scream like a kid coaxed onto a roller coaster. ugh. I hadn't really missed the CBC Overnight waking me up. But i guess i'll become re-acquainted with Radio Prague or whatever canned show they're playing at that hour these days.