Run, Doc, Run!

Thank you.

2012-01-16T19:40:00.000+01:00

Things have been busy lately. I'm back at work, although not full time, and I'm working on emergencies.

One of the things that bothered me on the wards, is that you work really hard, and you rarely get a 'thanks'; meanwhile, the nurses get chocolates and cards. The patient sees you once a day during rounds (IF they're not too ill, that is) and they think you sit around looking pretty in your oversized white coat the rest of the afternoon or something like that. I don't know. It's not even that I want attention or something; it's just that I felt under-appreciated. The nurses and the consultants were more appreciated than I was; yet, I was the one making the long hours.

On Emergencies it's different. It's almost as if my patients have read this blog or something; because almost every single one thanked me. Actually, I doubt any of them read this; some were too blind, some were too old... and some were too unable to read English.

I know it's my job, I know I get paid to do it.

But still.

It feels good to be thanked.

Tips for Junior Doctors part 7: sometimes medicine is really, really easy.

2011-11-24T23:11:00.000+01:00

Sometimes medicine is really easy.

Exhibit 1:
60-year-old lady with ridiculously long medical history and a 3-page drug list (requiring 15 minutes to write prescriptions for upon admission) and UTI is somnolent; family is really worried. 'She's like this all the time now'.

A glass of lemonade fixed her hypoglycaemia.

Exhibit 2:
50-year-old male with chest pain, nausea, vomiting and a heart rate of down to 36/min.

Asking the family to keep talking to him persistently raised the heart rate to a safer 45-60/min, while I waited for my labs to return.

Explaining to him that he is most likely suffering from good old stress, but we need to do a stress test (har..har..har..) and repeat some bloods just to make sure, made him a lot better right before my eyes. He literally stopped sweating and put his (still empty) puke bowl away. Heart rate 60.

Such a clean fellow!

2011-11-20T00:02:00.000+01:00

Spent my Friday afternoon in Emergencies. I love Emergencies; have I mentioned that? Oh, yes, I have. A few times. My Patient Of The Day wasn't an Emergencies patient, due to a viral outbreak all 112-calls have been forwarded to another hospital and we had very few medical emergencies. I saw a guy with probably a large psychological component in his complaints on the surgical ward instead.

And I watched the hassle-bassle of the Emergency Department going on. There were a few interesting patients for the surgeons. One of them presented with a shampoo bottle up their bum. Bottom-side first, of course. Not only had he managed to insert a normal-sized shampoo bottle into his anus, he walked around with it inside of him for a few days before working up the nerve to go to Emergencies. It showed somewhere in the middle of his abdomen on X-ray. I always thought the colon propulsion went toward the exit... I don't know the end of the story though, I do know that he wound up in the OR.

Gentlemen, should the need arise to insert a bottle into your anus, please, attach a string first so you can pull it out if it 'slips in too far!'

The Return of the Blonde Doctor.

2011-11-14T18:13:00.000+01:00

Meanwhile I'm half getting somewhere when it comes to beating my black dog. I'm all drugged up and ready to go.

OK, not really, I'm on the lowest possible dose but I'm having a blast with the side effects.

And really, I feel like there's some sort of taboo on mental health issues in doctors. But really, we're people too, and anything that can happen to you can happen to us. The depression hit me hard, and the resulting relapse into anorexia hit me harder. I am fighting.

And right now, I'm struggling to regain my career, to return to work, to make it work. I've been given the green light to start seeing patients again, limited to one a day three days a week. I see them in the emergency department, the only place where I can do this.

And today was my first day. I was nervous. I went to work at around noon, after having some trouble collecting my medical gear. I was not as much nervous about seeing a patient, I was nervous about colleagues and consultants.

So I got to the hospital, and faced my first challenge: how to get hold of a white coat. I didn't know the autovallet doesn't work between 10AM and 1PM, there's no sign to enlighten me either. It was somewhere betwee 12:15 and 12:30, and I wasn't entirely hoping to sit there and wait, so I went around to the linen room. A very cross lady handed me a coat, in the same size I wore before, and I'm drowning in it now.

I don't know why hospitals always insist on letting us wear ugly coats.

Went to the emergency department. Welcomed by colleagues. Stared at by a medical student. Not-sure-what'ed by nurses. (But I brought them home-baked biscuits, we had too many). One colleague told me 'well, we have dyspnoea, dyspnoe and dyspnoe, which do you prefer?'
Eh, I'll see the one with dyspnoea...
New nurse handed chart to dr Olderguy, Dr Olderguy handed it to me 'It's dr Blondie's patient'.

Old-ish lady with heart failure. Gave her some lasix and sent her to CCU.
On my way out:
Patient: 'Dr HerGP said I have ladies' legs'
Daughter: 'Well, old ladies' legs then, because mine don't look like that'.

And then, actually, I was tired. Need to train that brain a bit.

I have discovered the use of podcasts though. As I'm (more or less compulsively) walking around, I can now study at the same time!

Sometimes, you do get credit...

2011-10-27T21:28:00.000+02:00

Nightshift, somewhere early AM. Busy night shift, I might add.
Patient on emergencies starts grumbling about how long it's taking and about my ringing phone.

Me: I'm sorry it's taking so long; I'm the only medic in the hospital at the moment.
Patient: You mean there's no other doctor on Emergencies?
Me: Well, not for medical emergencies, no.
Patient: Oh, you poor thing!

Tips for Junior Doctors part 6: How to let someone die.

2011-10-14T12:32:00.000+02:00

A few weeks ago, a lady came to my ward just to die. I've had that happen to me a couple of times, most of them go peacefully.

This lady was in her fourties, and died of breast cancer. Her parents were there. That was a first for me; usually young ones die too fast for the parents to watch them. She was on morphine, and not really conscious any more. The oncologist went in with me that morning during ward rounds, and talked to the family, and told me I'd be checking up on them. She did not leave me any other instructions.

I checked on them about three times that day, the last time being around 3:30PM, after which I was busy talking to patients and families and doing other doctor stuff. Pretty close to handover, I went to check up on them again. At 3:30 she seemed comfortable. At 5:15 or something, she was restless. Nurses have already upped the morphine. I phoned the oncologist, who told me to start midazolam. Nursing staff needed about two hours to get it.

She didn't actually make it. My shift ended at 6PM, but I was still rounding up at 7:15 when the nurse came to tell me she passed away. Normally I don't do any actual work after hours, but I felt I couldn't let the nurses call the on-call to pronounce her if I'd been involved in her dying all along. I went in, pronounced her and shared my condoleances.

Then, the family told me it was horrible to watch her go like that, all restless. They thought she were suffering. They were unhappy. They wanted her to go smoothly. I told them I would have liked to see things go in a different way too, but I wasn't sure how I could have acted differently. I did not know it would take 2h to get midazolam to a ward. I can only act on what I know, and I didn't know she was getting restless until it was too late. I didn't want to go in there all the time, I wanted to give them their time. I explained this to them.

These kind of situations make you really nervous as a doctor. These are the 'I am going to sue you' type of situations.

They accepted it. They said they were happy to be able to discuss it, and that maybe they should have called me. They were going to talk to the oncologist too.

I also mentioned this to the nurse who was working the morphine dose. Turns out it was her first abstination. Next time she'll fetch the doctor sooner.

But the thing is, none of this is part of medical school. Medical school teaches you to save lives, and, given that this is Holland, they teach you about euthanasia. Nobody teaches you how to act, how often to check, what to say when someone is on your ward with palliative sedation and slowly dying.

Blonde Confessions 2: Emely

2011-10-14T12:05:00.000+02:00

When I was little, we had a Domestic Worker, but back then they were still called ousies or maids. Her name is Emely, and she wore overall-dresses and headscarves. My mum provided her outfit, from Pick&Pay, and she wore her oldest shoes to work. She took care of us sometimes when my parents were working, she washed, cleaned, ironed, sliced up some veggies for us and cooked when Roger, the gardener came on Wednesdays.

Our dogs loved Roger, and one of them once followed him up a ladder onto the roof. Roger hadn't noticed, and Staffordshire Bullterriers can do lots, but they're not good at climbing down ladders. We couldn't find the dog. Until someone drove up the driveway and asked us why the dog was on the roof.

I loved Emely. She could read, and write. She had two children, both finished school. She was a Sepedi, her second husband was a Zulu if I remember correctly, and she also spoke Afrikaans and some English. Four languages for someone who never went to secondary school, how's that, Americans? I learned lots from watching her. I learned how to do many household tasks. I also learned to eat like an African, using your hands, much to the annoyance of my mum.

Emely had a hearty laugh. She laughed at the idea of my mum doing her own household in Europe. She laughed at stupid things we did, or things that were pretty alien to her, as a former countryside Sotho girl. Such as training bras. (But really, my school dresses rubbed me in a way that was really uncomfortable!). She laughed at the labrador who wouldn't eat unbuttered bread. She laughed at the Staffie who was, well, being a Staffie.

When I clean my house or do my laundry, I keep thinking of her. I can imagine she'd laugh really hard at the idea of me, at age 18, cleaning people's homes for money. I was a domestic care worker, the only difference is in the 'care': people needed to be sick or weak in order to get help.

When I iron my clothes, I can see her standing in the back kitchen with her ironing board. Doing a better job than I am doing now.

I cleaned my windows the lazy, European way, using a window wiper. It was all stripy. I cleaned them her way, using old newspapers, and voila, clean. Well, sort of. She'd probably laugh at my attempt.

I can still hear her laugh.

Grumpy Junior Doctors

2011-10-04T22:01:00.001+02:00

Somebody searched, and found my blog using 'Grumpy Junior Doctors'. ,

Brilliant.

my IT band, continued

2011-09-25T14:42:00.000+02:00

Since I'm on recovery time for other matters, I decided that I had time to visit a physio. Half a year onwards, and I still can't run properly.

His verdict: Yes, it probably was ruptured, yes, you probably were a bit stupid for not seeking help (but come on, everybody was looking at me as if I were whining), and now there probably are some adhesions causing my problems. He'll try to fix that.

And I got some pretty Kinesio tape, criss cross over my thigh.

My homework was to run 15mins and see what it does. So I did that today, and the lateral side of my right thigh feels oddly exhausted. Not painful, just nagging.

Nightmare

2011-09-25T14:34:00.000+02:00

I tried so hard to prevent this from happening. But it did. I had to call in sick from work, because you can't do much doctoring if you're barely capable of getting out of bed and have the attention span and memory of a goldfish.
I do actually feel like a goldfish.

I'm considering taking meds again. Considering my past history. Considering the fact that all my brilliant 'relapse prevention stuff' failed me, and I went down whilst trying my hardest.

But then again. I'm feeling ever so slighlty better after a week and a half at home. Maybe it's simply because I sometimes manage to sleep. But my current level of functioning is nowhere near what I need.
And then there's the relapse risk, which is statistically 90%.

Everything I do is a fight. Getting out of bed is a fight. Getting to sleep is a fight. Eating is a fight.

Black puppy

2011-09-07T00:48:00.000+02:00

I haven't been writing here much lately. To be quite honest, I haven't been reading much either. I just don't really have the mental energy for it.

My black dog seems to be back for a visit. I'm fighting really hard not to let it crush me. I'm not all the way down there yet. Today, I had a good day. I felt neutral during the evening. It's the best day I've had all month. It's not serious yet, I've been a lot worse in the past. I'm still working, I'm still sort of functioning, but it's there. Haunting me. I can't remember if I was fully depressed as a teen. I don't think I was. Regardless; if this thing follows through, it's my second depression if I don't count the BC pill-induced one I went through in 2009, the third if I do. I get agitated-depressed, so basically I remain more or less functional for a long time.

I'm not keen about the idea of anti-depressants, and I'm not entirely sure how to go from here; but I'm fighting.

Yes, I'm also on a new BC pill. But actually, this time I don't blame it. See; I was going down BEFORE I started the pill, and actually, I'm calmer when taking it than I was in the pill-free week. And I have a good enough explanation for what's happening, the pill-induced depression just seemed to happen out of the blue and lifted within 3 weeks after switching to another pill.

Yes, I know doctors and mental health issues are taboo. I also know that I'm not alone. Depression is a common ail amongst physicians. In fact, doctors commit suicide relatively more often than most other professions. (Ironically, female psychiatrists are most likely to take their own lives!). I know 2 GP's who went through depression.

And I'm fighting.

Blonde Confessions 1: I have a fur coat

2011-09-02T22:38:00.000+02:00

I need to write about something that has nothing to do with sick people. So I invented the 'Blonde Confessions'. That's just about it.

But this one is a big one, considering this is 2011, and fur has been faux pas for 20 years or so. I'm an animal lover. I eat half vegetarian, I eat organic meat if I eat meat, I keep pets, I only buy leather because it's durable and I use my leather products for years on end until it's really worn out. Seriously, my leather jacket had been sutured up five or six times before I finally threw it out; I'm still wearing (and loving) a pair of boots I bought in I think 2007; I've dyed them myself (using shoe polish!) after they got ruined by the snow and now they've got a glorious vintage look to them. And I'm all for cow or sheep's leather, because, get real, we eat the rest of the animal. At least, I really hope they use the skin of the animals we eat, else it would be a waste. I don't like the idea of the fur industry. I really don't.

But I own a fur coat. A real deal caracul fur coat. (And I hope they didn't waste those poor lambs' meat). It's a lovely coat. It's a late '60s style coat, maybe early '70s.

Because it's actually from the '60s or '70s. I inherited it from my grandmother. I've never worn it, and it's definitely not for everyday wear. I'm scared to wear it, scared someone would spraypaint it if I did. It's for a sort of special occasion that doesn't exist any more. It reminds me of a time when things could still be special. And it's valuable. If not in money, it's valuable because it belonged to one of the most important people in my life.

And look, dear PETA spray paint people, this is not your average fashion-diva fur coat. The lambs died about 40 years ago, that was before you were born. I shouldn't have to feel guilty or ashamed if I'm wearing something that old which belonged to someone that dear to me. The coat exists. If it were to be destroyed, or never worn, wouldn't it be even worse karma?

Tips for Junior Doctors part 5: DO wake your patients.

2011-08-17T18:01:00.000+02:00

My patients and I survived the first night shift. I'm apparently not the type who is extremely sharp in the middle of the night. My sharpness returned with the sunrise... and my, what wonderful sunrise it is if it promises the end of a night shift.

Typically, there are two doctors on call (SHO/residents), a surgical one and a medical one. I'm the medical one. It's just me, and the entire hospital. Me, the wards, and emergencies.

And it was busy. I work in a relatively small hospital, in international standards. My phone kept ringing, a few sick patients on the wards who required attention, a random transfer in the middle of the night from another hospital ending up on the wrong ward because I didn't know the patient was expected and 'admit through emergencies' was misinterpreted, and an emergencies department which never got empty. Until 7:45AM when I sent my last patient home, and the patient arriving had blood all over him, which means it's surgical.

Surgical doc had phoned me at 11:30pm to ask if he could use one of the on-call rooms. He slept most of the night, and his ED patient arrived at a decent time. I didn't even have time to go to the medics room to eat something.

But then again I forgot that I have no appetite at night.

Because it was busy on Emergencies, I didn't have time to go and admit the misplaced patient before he fell asleep. I phoned the lung doc (patient got admitted to pulmonology) to let him know that patient is there... because really I had no idea how to go about this. Basically, the problem itself was something that required no immediate attention. Lung doc normally is a very nice man, but not when sleeping. I got burned down. Because I didn't wake a completely stable patient to take a history.

Actually the main thing that went wrong is that Ghost Doc saw said patient earlier in the evening, and sent the patient to a PCI centre who sent them back to us (because it turned out to be a suspected pulmonary embolism and not a heart attack). Ghost Doc wanted to finish off the case herself, and didn't hand it over to me. She fell asleep in one of the on call rooms, with the patient's chart. Ghost Doc's shift ended at 11PM, but she always haunts the halls of the hospital when she's not supposed to be there. I got phoned by the other hospital, who wanted the patient on a pulmonary ward, not a cardiac one. I didn't know the patient was already expected on the CCU, in the end the message was 'fine, send them in through Emergencies'. And they told the ambulance to go straight to the pulmonology ward. Had I know the patient already had a bed, we wouldn't have a problem at all, because I know that CCU nurses are capable of administering Fragmin, and are capable of detecting respiratory distress, and that the doc on the CCU is capable of organising a CT scan for the patient and transferring the patient to another ward after the friggin sheeth had been removed!

Medicine drugged my creativity

2011-08-15T16:08:00.000+02:00

Or maybe just my inspiration.

See, I used to be a talented artsy kid. Part of this artsiness already went slumbering in my teens, I guess, maybe. But still, I've made some pretty nice things. But it wasn't all dead, I was known for my style in medical school.

I also used to be a talented writer. People liked reading what I wrote because I wrote it well, even if I only wrote about something rather uninteresting.

But nothing seems to work right any more. I don't even look as nice as I used to; in part because there's no point in looking pretty for dreary hospital work. I'm not happy about my writing, my painting for a friend failed and even the tray I'm pimping instead just doesn't have it ...

And I don't really know how to revive it. It's like I have forgotten how to create.

Something is missing from my life!

Adventure running

2011-08-08T11:56:00.000+02:00

I went for a little explore-run yesterday. Recently moved to a new place, and the weather was good. I never went fast, and I walked bits in between, and I discovered bits of trial and lots of water and green... and I was having fun in the sun and then in bits of rain and then in the sun again (all in a matter of less than an hour!). At some point I found myself eye to eye with a couple of bovine ladies.

At some point I failed to notice a bump in the road, and the result is a very sore knee. Guess that makes for the end of running again, for now.

Motivational Speech

2011-08-06T13:14:00.000+02:00

I used to be a child psych intern. I switched to medicine, because, well, psychiatry is not the right career for me. That doesn't mean I wasted my time with psych. I've learned skills which I use on a day to day basis still; sometimes managing things my consultants don't (or I like to think so).

Example number one: a more-or-less elderly lady is a notorious care-avoider; leading to her losing her mobility and her vision in one eye. She probably has OCD and some cluster C personality traits, maybe even obsessive compulsive or avoidant personality disorder, says my own quick psych screening. Now she's here with a diagnosis of double cancer, and she's tending to start avoiding it again. The oncologist worries about it, and after the bad-news convo orders me to go over it again with the patient and the family. I managed to get her to acknowledge her cancer and the prognosis, and a few days later she was able to tell me she wanted to fight for what she had left of her life.

Example number two: a depressed 80-something year old lady who just returned from ICU where her life had been saved a few times BUT she still has her chronic abdominal pain (possibly psychogenic) and I have to tell her -wearing this: that we have no answer for that, but the best for her is to enter revalidation and go home in the end. Her son wasn't impressed, they want her to go to an academic centre to find the cause of it all. The reason for my pretty yellow outfit is that she's got three super-opportunistic multi resistent bacteria on her, and if I get those on my ward the ward can be closed down. She started crying, she doesn't see the light, she sees no progress in it all and she's still in pain. So here I was, dressed as a duck, motivating an old lady and her son until they both started listing tiny progresses.

European 48h laws... and those damn interesting patients!

2011-07-27T22:25:00.000+02:00

I worked from 8AM till almost 9:30PM today. This is no rarity. I am tired, and I am beginning to regret certain choices in my life. I fought damn hard to get my life back from the claws of my past; and all I do is work. I don't feel like a hero, or 'special' because I'm the doctor. In reality many patients still can't comprehend the fact that women can be doctors too and call me 'nurse'. I have all respect for nurses, but if I wanted to be a nurse I would have gone to nursing school.

The best one?
Me: Goodmorning mrs Little old Lady, how are you doing today?
LOL: Morning Nurse, I'm fine, actually!
Me: Eh, Doctor...
LOL: Oh, sorry, Doctor. You know, I think it's so great that young women are doctors nowadays! Go Girls! But aren't you too young to be a doctor?
Me: Eh, thanks, and no, I'm the same age as most other graduates!
LOL: but you look so young!
Me: I suppose I'll appreciate that in ten years. Now, have you had any more black stool?
LOL: Not much, Nurse!

I spent the rest of the day talking drugs, infidelity and shit on the gastro/onco ward. Always fun!

Internist nr 1: So, if you were a little Clostridium spore, what would make you think 'Ah, this is great, I'm going to become a bacteria'?
Internist nr 2: Spores don't have brains.

Gastro doc: You have a colitis, but it's not bleeding anymore. We'll observe you for a bit, and if your stool is normal, we'll discharge you on Friday..
Old lady: Ok. So if I make a good poo, I can go home?
Me: Basically, yes...

But seriously. EU regulations state a 48h max work week for doctors, with good reason. I'm tired, and I'm regretting certain life choices, and working 65+h weeks isn't making me love medicine any more. Yesterday I was naughty and went home before 8PM. I paid the price, but I don't regret having time for a DVD. Today I spent the entire day running and talking, and I still had a lot of admin to do at 7:30PM. I went home when the system stopped responding.
Monday I left the hospital at 10:01PM. One of my patients died at 7:15PM. I came home close to tears, not because she died, because that's what cancer patients do. I came home close to tears because all I had time for was a shower and a quick cuddle with my rats... and then sleep and the whole thing would just start over again. I want to go pick up a new rat at the shelter, but I don't have the time for it.

The problem is, roughly, that there aren't enough doctors to take care of the patients in 48h a week. Mind you, I don't even have time for the discharge letters, and meanwhile specialists and secretaries are moaning about unfinished letters. I have no idea when I'm supposed to do them.

Tips for Junior Doctors part 4: do your wondering beforehand

2011-07-24T19:14:00.000+02:00

New patient got transferred to my ward with a hypo (insert every electrolyte here). And oh, yeah, something with his thumb. Now the hypokalaemia, hypocalcaemia, hypophosphataemia, hypomagnesaemia, hypoalbuminaemia, hypochloraemia and hyponatraemia and oh, the diarrhoea he had as a result of the phosphate suppletion were things I'm supposed to be able to deal with as a medical SHO. The resulting hyperkalaemia too.
Thumbs, however, are too difficult. The chart read 'consult plastics'.

I phoned my colleague who took care of said patient to find out if plastics have been consulted. No, they haven't.

So; I phoned Plastics, who, I might add, only have consultants. Said consultant was operating.

Me: 'Eh, I have a consult for you. Mr X has been admitted with about every possible electrolyte disturbance after quitting alcohol. Now I just got him on my ward, and I also discovered that you haven't been phoned yet for his *reads chart* eh... chronically grown in thumb nail'

Right. I just phoned an operating plastic surgeon to come and see a grown in nail.

Dr Silicone: 'Right, I'll come see him Monday on my round'

My return and my primary school; they're completely correlated.

2011-07-24T18:41:00.000+02:00

Oh, by the way, I'm returning to the Blogosphere. Just so you know.

Also, just so you know, I'm fascinated by the random search terms that lead to my blog.

I'm nearly done with my apartment, was just sorting out my jewellery. I found some stuff I haven't seen in years, including my very first pair of stud earrings. I had my ears done when I was 8. They're blue, to match my blue school uniform.

Speaking of which, my grade 3 teacher still teaches grade 3. I used to be scared of her, she was a notorious slapper. In hindsight, she was fair and only hit you when you actually did something wrong. For the record, in the 1990s South-Africa, physical punishment of children was the most normal thing in the world. The school as a whole has gotten smaller. It's not a private school. They have 3 classes per year now, we had 5 and we were already somewhere between 30 and 40 in a class.
In Africa we didn't get the whole pedagogic schooling European kids got. We went to school to learn; child rearing was our families' job. I got homework from grade 1 onward, and from grade 4 onward I was responsible for getting myself to class and making sure I got the right books with me AND that my homework was done. (At this point, we were past Mandela, and physical punishment was technically not allowed, but detention was allowed...) Imagine the shock I went through when I set foot in a primary school here! I was turning 12, and the kids didn't get homework, they didn't have to bring books to school... they just had to bring their food and drinks for breaktime... which was placed near the sink so they don't lose it. The result was that I dropped out of primary school, skipped a year and went to secondary school.

Many of the teachers still work there. A bunch of others look like they're my age. Ah, the joys of internet! All I wanted was a pic of my uniform, to demonstrate it's blue-ness.
Luckily this bloke used his daughter in one of his flicks, and coincidentally he also sent his children to my school (the school's in the background!)
http://www.youtube.com/watch?v=STIKcVFQ53w&feature=related

A Good Work Out

2011-07-24T18:08:00.000+02:00

I'm a runner turned gym bunny.

(And while typing this, I'm watching BBC's Robin Hood; and wondering how likely it is that his Merry Men had crucifixes tattooed on their arms in medieval times....)

Anyway. So I'm a runner turned gym bunny who also suffers from sub-clinical ADHD. Apparently.

I miss running. I miss being outside, but not as much as I would have if we had an actual summer this year. I was at the gym, doing the Fit and Fun Circuit and meanwhile watching the WC swimming in China something. (No sound, and I was too far away to read it). Then that made me miss swimming.

I did a BodyCombat class. Then, I did the 10 minute ab workout. Then, I did two rounds of the Fit and Fun circuit. Then, just for the sake of it, I did a 10-minute trot on a treadmill. I want to retrain those running legs; but the legs themselves seem to be the problem.

At least, being a gym bunny, I can work on my fitness without busting my still fragile IT-band again, and then, when the time is right, I'll be able to run again, and run fast.

In the meantime I suppose I'm wearing my running tights and running shorts to the gym; and while it's fun to run in the rain once in a while, it's been doing nothing but raining lately. Also, my gym shoes are in better condition than my running shoes (wonder why...) and my funds are slightly low these days... so it's good to know I'm making the running shoes last a bit longer!

Tips for Junior Doctors part 3: remember everything.

2011-07-17T15:19:00.000+02:00

I'm on a ward with mostly oncology and gastroenterology patients. (However, pretty few gastroenterological oncology patients, they tend to hang out at the Colon Cutters). It's not my favourite ward to work on; patients are complicated, time demanding and everything else is chaotic because I have 3 different supervisors. Apart from that, a certain nurse drives me nuts.

But that aside; I made the mistake of forgetting to fill out the paperwork to send a CD with a scan to another hospital. To err is human, but to be a doctor is to be superhuman, you see.
Ever since the oncologist who ordered me to fill out said paperwork keeps on telling me to write everything on my list.
To the point where simply prescribing the drug then and there would be easier than writing it down and then prescribing it.

And then I have to go find the nurses to do stuff; and they're always nowhere to be found.

New apartment!

2011-07-09T21:34:00.001+02:00

Yes, I've been MIA.
And yes, I have a very good reason: I just moved and I have no internet at home yet, and my phone sucks. I promise I'll be back! And a great July to you all!

Tips for Junior Doctors part 2: be not the bearer of good news.

2011-06-26T23:03:00.000+02:00

At least, well, just don't.

Mr Grumpy presented with a ridiculously yellow face, and after some tests and an ERCP he got told that it's likely pancreatic cancer.

Enter dr Blondie.

MRCP showed localized inflammation, and my task was to tell him and his family this glorious news: he was going to live.

Mr Grumpy was happy and relieved. 'Thanks for taking care of me, doc'.
Mrs Grumpy and the 4 junior Grumpies however, were mad. Really mad. Mrs Grumpy kept going on about how she's a nurse and how this is not how things are done. The 5 of them verbally attacked me, going on about how I'm unprofessional (because I memorized what I was going to say and did not have the file with me, simply because I was bringing GOOD news) and how this is horrible and then asking me impossible questions only to tell me that I know nothing. Mrs Grumpy had a grain of decency and used the words 'excuse me', while the mini-me's were simply harsh in their 'I'm right and you're wrong'. Then they demanded to see the internist RIGHT NOW. Not going to work, he has other patients too.

And they kept going on; the internist told me they called me a 'twit who knows nothing'.

All because I told them their father was going to be just fine.

On a lighter note:
Patient quote of the week: It feels like there's a marble rolling around in my head.
(good, that means you haven't lost all your marbles)

New House

2011-06-19T19:38:00.000+02:00

I have a new house. I have a demanding job. Moving house and medicine doesn't go well together...

Today I moved the first stuff. Paint, carpets, linoleum, some other stuff.

So, no, not much time to blog.

A day at IKEA.

2011-06-13T19:57:00.000+02:00

As you may or may not know, I've found an apartment. A 3 bedroom apartment (WITH walk in closet) and it's all for me.

That calls for some budgeting (as I need to pay a warranty) and a visit to IKEA.

Today was not the best day for that. I doubt any of the days I have available for such expeditions are the ideal day, but today must have been the worst idea. The entire Holland thought it was a good idea to go there today. I have no idea what they were doing there because I am VERY certain that not all of them were moving or redecorating. IKEA had a sale, and Dutchmen love sales, no matter how lousy they are.

Apparently, for some people, IKEA makes the perfect family day out. I don't get it. I don't find it inspiring. I find it cheap and practical and very unoriginal, but some people find it incredibly inspiring to walk around the IKEA and eat cheap meatballs. Maybe they're the same people who park their cars in the loading zone?

What I understand even less, is why they bring their children with them. I found a little boy complaining to his dad about how boring it is; and the dad said 'I know son, I don't like it either'.
So then why are you here?
And why are your children running around where I'm trying to push my heavy cart?

Another challenge was getting my stuff on a single cart. It's more than I thought it was going to be. Kitchenware takes a lot of space.
So does a full length mirror and the massive framed poster of a red London bus against a black-and-white background. The idea is an entirely black-and-white hall with just the red bus and maybe a red vase sticking out.
I went slightly over my IKEA budget (damn kitchenware, and I insisted on getting the exact rug I wanted, come on, I'm working as a doctor...)

but afterwards I went to CarpetRight and managed to get a really good deal on my carpetins and vinyl, spending 200 euros less than I bargained for, so all in all I'm playing quitte.

Now still needed: curtains for the living room and one of the extra rooms, blinds for the bedroom, a DVD-player, an iron and ironing board, a clothes rack, a stove and a broom. Oh, and the paint.

I'm poor.

Tips for Junior Doctors part 1: Make sure you have the right patient.

2011-06-12T20:08:00.000+02:00

Highly advisable: being efficient and seeing the patients in one room in one go.
Not-so-advisable: getting your patients mixed up.

Friday afternoon, cardio ward. Short-stay room. I have 2 grey-ish-but-not-yet-fossilised males, both returned from a coronary angiogram that morning. There also are slight differences:

Patient A has a wife who has been hanging around the room the entire day, boasting about how annoyingly rich she is. (Seriously, I don't care that you made a bid on a ridiculously famous estate in South-Africa, I care even less that you can compare the most expensive shopping streets in the country; and I'm not as flattered as you think by the fact that you're impressed with my medical school. The main reason I went there as opposed to my colleagues is that I had the guts to go there.). Patient A also had the worst outcome and needed a CABG.

Patient B is younger than patient A, and probably was a good man, your average Joe. His outcome was fine, and he was good to go ahead and get the planned valve surgery.

One of them had an angioseal, the other didn't; both had palpable masses over their femoral arteries.

I mixed them up, went ahead and told patient B that he had several options for his surgery. Then I phoned the cardiologist because I could not feel a femoral pulse, asked him if it was fine to let the patient go home. All this time, I thought I was talking about patient A.

Until at some point mrs A pointed out that that was not her husband.

Trust me, no matter how human such a mess-up is; the patients are not impressed. It's hard to get your stories straight afterwards.

In hindsight, I should not have ignored the fact that I thought that it was odd that such a high class citizen as 'mr A' pulled down both his pj bottoms and his underwear the minute I told him I needed to check the place where they stuck in the catheter.

I quit running. Or let's make it an intermezzo.

2011-06-05T22:43:00.000+02:00

It's not a conscious decision, it's not a permanent thing either. I have just completely lost my motivation to run. The reason? I'm not getting anywhere. I am getting extremely frustrated. I can't face another 5k lap which I can't even fully run. Ever since my IT-band drama (which also is my most-read post on here) I've been slowly, extremely slowly, increasing my running, every time I went a bit faster or ran a bit further, a dull ache in my right thigh reminded me to go slower. I haven't even finished a 10K run ever (the injury happened at 9.5k in the build-up to the 10k race). I'm not getting what I wanted out of running.

Apparently I don't have a body that takes too well to sudden increases in work-out load. Or maybe my body was in worse shape than I thought, years after the anorexia still... because come to think about it, prior to getting really thin I went through years of compulsive exercise. Looking at my body now, I wouldn't know where I lost those extra 10kg from, but well, it had to be muscle mass. I'm a doctor, and I want to understand what is happening now.

I never went up to the amount of exercise I did as a teen. (I had a resting heart rate of 54 at age 15, and I was about the strongest girl in my class). This winter, I still did not come close, but it's the most I've done since the anorexia. There probably was more strain on my muscles and joints than I thought, because I did not take that into consideration. I think my body just couldn't handle it, it was still too weak, and it was probably leaning towards overuse. Combine fatigued muscles, joints and ligaments with the way I cooled down on that fatal day, and the IT band just sort of tore. There is no other way I can explain the lumps on the thinnest part of the band.

In case you were wondering, such an injury takes long to recover.

And now, in prime running season, I've lost all motivation. I haven't run in a week. I can't make myself. I hate how slow I am, I hate how I can't run 5k in one go, I can't bear to face the same laps again and partly, the solitude is too much for me right now. And maybe, at this point in time and place, I was once again asking too much of a still weakened body.

So, I quit.

Here's the most interesting part: I don't quit. Not for good. Never for good. I'm just taking a break. I've been looking at gyms and I've been doing my Pilates (and I'm getting better at it, I'm ready for a new challenge) and actually, right now, my goal is where it should be: I need to get stronger first. I need to not be running ahead of myself; and if I want to be doing the things I want to be doing, I need to get physically stronger. I need to be doing something that does not require level 4 sports bras, as the sports bra level reflects the impact on the rest of your body too. And meanwhile, when the weather is good and so forth, I will sneak in a little jog and dream of long runs.

I'll call it Project Fitness. Maybe this is the last hurdle in my recovery, maybe it isn't. Maybe the last hurdle would be finding and keeping myself a man.

Perfection.

2011-05-29T21:15:00.000+02:00

So, life has been getting on, I've been busy and you can blame the hour and a half I need to get to and from work each day for my lack of posting.

I may have found a place to stay, but I'm shutting up about it till I actually have it. It's lovely, and large, and that's all I can say.

I am getting used to the hospital life, and I am absolutely shocked at how far I've come in just 3 weeks on the wards. I even managed an unstable patient while his family came rushing in (fair enough, we had an appointment) with tons of questions.

And then I got my first pay check... and I treated myself to a pair of sunglasses. I worked hard enough for it, and I needed something special. They're perfect, and they're the real deal:

Mirror-glassed silver Ray Ban aviators. They look really good on me, and the style suits my personality; the combination of light and slight and tough and masculine. It's a little dream come true; and I know it's maybe superficial; but I really enjoy owning and using things that are 'perfect'.

It's maybe my old strive for perfection in a non-lethal form. Not just stuff, but also time, people, activities and food: it has to be worth it. The older I get, and most certainly after my shopaholic phase, the better I get at only spending 'it' if it's really worth it.

And then, I enjoy it.

I still love and adore the green trench coat I bought in 2007. It makes me sad to think it's it's last season; but it's getting a bit too 'vintage'.. (and I still have no idea where those stains came from)

I bought a blouse too, and a gift for someone, new mascara, new shoes (my old ones sort of became seperated from their soles, good enough reason for new ones) which are basically what I've been looking for for 2 seasons now and this:

The powder was an impulse buy...

Looking back on new years projects..

2011-05-22T14:21:00.000+02:00

Remember these? My 11 projects for 2011? The 22th of May sounds like a perfect day to look back on them; simply because I thought of it today.

1) find and start my first job as a doctor

2) Get my driver's licence.
Eh, STILL working on that. I'm probably going to get an automatic gear licence rather than a manual one. I recently found out I have/had a mild form of some type of developmental dyspraxia, which has absolutely no significance in normal day-to-day life, but given that it's based on a brain development abnormality, it's not going to get any better than this and I'm struggling a bit with the driving.

3) Run 10k, and run a race.
Neither of these have worked out. I got injured at 9.5k and had to forfit my race. Running is on a low now, but it seems like my IT-band FINALLY healed, and I did go for a run yesterday. Might do a 5k race towards the end of summer, I think I should.

4) Get my diving licence

5) Join a club
I need to live somewhere first....

6) Improve eating habits and get back to set point weight
Working on that still, and am half way there weight-wise.

7) keep up cross- and strength training.
Considering I'm a bit sore from my pilates yesterday and this morning: doing so!

8) Learn to cook new dishes
Er, I collected some recipies to try, and then never had to cook again!

9) Make time for creativity

Basically, I'm working on a painting. Not just any painting, but a wedding-gift painting.

10) Be more organised.
Not entirely sure how and what, but in order to do my job I have to be somewhat organised. I do actually tidy up my room sometimes, if that counts.

11) Learn something new
I've been busy learning new things for my job, if that counts, and if it doesn't, well, I've learnt about Zulu culture, how to take care of a gerbil, what the different measurements on a bicycle tire means, how to put on new pedals on a bicycle, that Spanish is an easy language... just to name a few.

All in all, not doing to bad, I think.

Oh, hey, it looks like we survived!

2011-05-21T22:22:00.000+02:00

Dear mr Harold, I know it's only 10:20PM.... but I think we would have noticed something by now if the Rapture was going to happen today, don't you think?

Um.. Oops?

2011-05-21T11:40:00.000+02:00

Yesterday I was the only ward doc, again. It was OK, as the front-half's specialist did her ward rounds herself and I had a grand total of 7 patients to attend to. Or make that 8. It was a calm day.

I started out the week with 12 patients; and ended with 4. Mine all got discharged or turfed. My colleague had one 96-year-old lady who wasn't doing too well, and right from the moment I heard that I was going to be alone on Friday, I had this funny feeling that she was going to pass away on Friday.

She did.

When the nurse came in; I asked the specialist who was going to pronounce her formally. She went. And she left for her OP clinic. Half an hour later the ward administrator came in and asked for the paperwork. I told the med student to phone the specialist. The med student handed me the paperwork. I knew it, that's why I asked who was going to pronounce her. So I basically had to re-pronounce her... and go talk to the family again.

Turns out that once again, the patient's full names aren't registered in our system, and once again I had to ask for them.

'Mary Magdalena'

So I filled out a death certificate for a 96-year-old Mary Magdalena, and she went off to the morgue. And I went off to my free lunch.

At 4:45PM the family phoned. "I'm so sorry, we gave you the wrong names. Her full names are 'Mary Madeleine', not Magdalena."

When I phoned the morgue, she had already gone, together with the paperwork. No worries, the morgue-man (whose number is a fax number) said: he'll let the officials know when they come by on Monday.

No, I don't like my job

2011-05-16T22:43:00.000+02:00

right now.

Look, I know nothing, can do nothing, and yet, people are expecting everything of me.
Meanwhile, I'm running a ward, and I have anything between 6 and 12 patients to attend to; and they're MY responsibility.

I want to run very very far away; I'm nervous, I'm exhausted, and considering that I'm pretty high up on the hospital food chain, I work long hours without overtime pay.

Medicine is not ER or Grey's Anatomy, it's Scrubs. (Although I did enjoy the 'bronchial tree' patient on Grey's, loved the word play, but it's not high on my diff diagnosis in any patient).
Oh, and it's not House either.

It's Scrubs, and I'm pale and sweaty and I hope nobody dies.

So ask me again, maybe in a few months or longer, if I enjoy my job.

Well, that explains it!

2011-05-14T12:37:00.000+02:00

Mrs. Cushing-Addison: 'Well, since I started taking only 5mg of prednison a day I've been really poorly, I've lost my appetite, was nauseous, I was sleeping all the time and I'm hurting everywhere'
Dr Blondie: 'Wait, you're only taking 5mg? Since when?'
Mrs Cushing-Addison: 'Well, dr Lung said we were going to taper off the prednisone so I did it at home'
Dr Blondie: 'But... we were planning to do that here, in hospital'.

(The irony is: after her predisone booster for her respiratory problems I have tapered her down to 5mg now, and she's perfectly fine as far as I know)

Time...

2011-05-11T21:43:00.000+02:00

Day 3, early morning.
I'm heading back from handover when a nurse calls me into a patient's room, the sats have dropped. It's a gentleman who somehow landed on my ward the previous day without my knowing. I discovered him when I went looking for him, and gave him a quick look before heading home. Complicated case, and a DNR.

I did not resuscitate. I watched him slowly deteriorate; I informed the family; I talked to my supervisor; I started him on fluids when the tension dropped.

Then he refused to have his stats taken. I told the nurse to phone me if he got worse, thinking he was going to die somewhere in the afternoon. We had lunchtime presentations, and given that there's nothing more I could do for this patient, and all the others were set, I decided to go. (Besides, free lunch!)

I barely grabbed a sandwich when the nurse phoned me. He had died. I just had to pronounce him.

First day on the wards...

2011-05-10T22:56:00.000+02:00

Remember that very first episode of Scrubs?

Yesterday was that day.
I arrived later, I had the driving test in the morning. (The pulmonologist thought I was there yesterday morning... interesting.)

"Hi, welcome, the back half of the wards is yours."
Eh...

There's two of us on the ward; a final years med student and a regular med student. The final years is on my half, which I really appreciate as she does 4 of my 12 patients (and needs prescriptions for them quite often).

I didn't know how stuff worked. I didn't know my patients. I didn't know jack about medicine. (I still don't.... or at least it feels like that).

I barely ate yesterday, I was so nervous. It wasn't really warm, but I was sweating. I almost cried a couple of times (to be fair, I was really upset about my driving test still, but that's another matter)... I left at close to 9PM in the end. It was just a nightmare, really. One of the nurses offered me a cup of coffee at some point. At the end of the day I finally knew more or less why my patients were there (only to have them sent home today ,but that's another matter), I had clerked my first official patient (who of course is too complicated for the med students) and I had figured out how to prescribe stuff.

Then, today at the handover it turned out that there were problems with my patient. I think I froze, and wondered if I did something to almost kill her. But she's on the transplant list for a reason, and I wouldn't be surprised if the same thing happened tonight.

Of course, it's Grand Round day. I think I almost threw up, but luckily the specialists are very nice and everything went fine.

By the end of the day I felt like I was getting the hang of the ward work...

... now I just need to learn some medicine.

I love exercise!

2011-05-08T22:41:00.000+02:00

That's all I wanted to say for today. Went to Scheveningen and back on my bicycle with a friend, then went running and then did pilates and now I'm nice and tired.

I'm just not too happy about where I am with running. I want to be going fast and far, but I'm getting nowhere. I'm still doing run/walk intervals, the pace is still around 5'30/km... and I get this very tired feeling in that right IT-band after running. That means I can't push harder than I'm doing. I have resolved to do those lateral stability exercises every day.

Slowly but surely I'll get there... one day.

How appropriate...

2011-05-04T21:19:00.000+02:00

The 4th of May is 'Remembrance of the dead' in Holland. The 'dead' being those who died in war. (Because 5th May is Liberation day, you know, WW2?) I don't know what to do with today as a special day really, my 'dead' survived their wars and died of illness, and I remember them when I see fit.

However, through some random coincidence, I spent 'Remembrance day' doing Advanced Life Support and Paediatric Advanced Life Support courses. Roughly, the idea is to prevent dead people from further dying.

You know the scenes in ER when they yell 'clear' (and everybody is still touching the bed) and then shock patients with a flat line, who usually wake up after a few shocks?

Well, real life is nothing like that. Most of the patients who needed CPR I've seen actually died. The most dramatic was the 21-year-old. She had a pulmonary embolism; had been started on streptokinase, and then crashed. During the resuscitation she started bleeding from her old TB laesions; and there's no way to stop the bleeding. Her lungs filled up. She was younger than I was at the time.

I don't know how I've managed it; but I've seen more cardiac arrests than almost any other fresh graduate I've spoken to. (I'm not drop dead gorgeous, it's not me...) And now I'm the doctor. I'm the internal medicine 'resident' / 'SHO' (Dutch term doesn't translate); and I'm the one who leads. Today I learned just how much I learned during my 10-week Acute Medicine elective last year. We worked through a couple of acute scenarios, and I didn't do worse than the others, despite them having actually worked as a doctor already.

I have tomorrow off; and then Friday I'm going to do the ALS etc exams.

Had a lovely run today though. Last run at 4min/2min, next run 5min/1.5min... am slowly working towards 30mins straight. Again. But there's no pressure really.

First day at work

2011-05-02T21:17:00.000+02:00

Well, today was the Big Day. I got up at 6AM, got myself dressed and ready, took care of the rat's ear (he has an ear infection), made myself cucumber and philadelphia sarmies and got on my green bicycle to go to the train station. Now that bit was less than amusing: the wind came from the wrong direction.
15 minutes in the train and a few minutes' walk and I was at the hospital; but I couldn't find the building I was supposed to be at at 8AM.

After a walk around the hospital, I finally found it, hidden behind tall trees and what used to be the parking lot before they started building the hospital.

I'm starting with an intro course and the acute care courses. I sort of lost track of all the things and people I saw today.

But it involved a lot of walking and a lot of listening and getting my ID and trying on white coats. We have this very cool system where you scan your hospital ID card, and then your white coat (or nurses uniform) comes flying towards you.

But that's all for today.

And I must admit, I skipped my run yesterday.

Queen's Day!

2011-04-30T21:40:00.000+02:00

Since yesterday was all about the British Royals, today is all about the Dutch Royals. And I did fairly nothing about it.

Really, I should be doing this:

or this:

or maybe even this:

But No.

I spent my afternoon working on my sun tan. That did not even work; it's only April and I think my skin is as dark as April is going to get it. See, I'm not really such an un-fun girl; I just really wasn't in the mood and didn't have the right people with me. Plus, I'm broke. Plus, well... there will be a Queen's Day next year too.

We celebrate Queen Beatrix birthday every 30th of April, even though her actual birthday is on the 31st of January. Her mum's birthday was on the 30th of April and she wanted to keep the celebrations on that day in honour of her mum, and because, well, it's freezing cold on the 31st of January. It's a day of festivities, the colour orange (Because the Royal house is the house of Orange-Nassau), vrijmarkten where random Dutchies can sell their junk on the streets, and every year the royal family visits a different town or city in the Netherlands.

I did not entirely miss out on the 'fun' though. When I went to the shopping centre for bread and paracetamol I sort of innocently and involuntarily walked in on the local vrijmarkt where -mostly- kids sold their family's junk (mainly their old toys) and used their earned money to buy someone else's junk (because Dutch people like cheap things, even if it's completely useless). There even was a fanfare band (named the Pomme Toeters), followed, naturally, by a bulky, tall black man with cigarrette, bald head and staffie bull. Some people sold ugly cupcakes, one of the supermarkets had a stall with the unusual combination of candy floss and strawberries, a Hindustani woman sold traditional Dutch treats and this guy also earned an euro or two on his merry-go-round contraption:

Yes; it's a bicycle with a merry-go-round on it, and he provided the music himself too.

Bye bye life...

2011-04-28T22:18:00.000+02:00

Sooo, I'm starting work on Monday.

Sooo, I'll be starting with an introductory course.

Sooo, part of the course will be Advanced Life Support; Paediatric Basic Life Support, ABCDE (wasn't this covered in med school?), immediate care for the sick child and some other stuff I don't see as a separate item.

Sooo, I suppose I'll be studying this weekend.

House Hunt

2011-04-26T13:35:00.000+02:00

Along with finding a job (check!) comes finding a place to stay. While it's OK to spend your extended holiday at your parents place, it's NOT OK to be in your twenties, working, and still living with your mum and dad.

I can travel to work by train quite easily, but with a 48h work week, I think I want to live closer by. The city I'm going to be working in is a fairly small city in the (relative) countryside. The province of 'Zuid-Holland' has no proper countryside. It's close enough to the big cities anyway. So, I decided I'm going to move there.

Finding an apartment turns out to be a little more trying than I expected. I'm just me, and I don't want to be spending all my money on rent. Problem is, 'all my money' makes me ineligible for subsidised housing, which means either I pay up, or I rent from a potentially dodgy landlord.

Results so far:
- Apartments scheduled for demolition in 'medio 2012'. Cheap, and if they're still in good condition (built in 1960), well, might be an option. Only problem: 'medio 2012' could be anything from March to September, and I really need to be able to stay there until June.

- The PERFECT place, not too expensive, close to the city centre and the hospital, big enough, with a fireplace and a WALK-IN CLOSET and a balcony.... but someone else thought it was perfect too, before I found it.

- A cheap one-room apartment, rather small but with a complete kitchen and a balcony, but only one room and a bathroom (I'm dreaming of having a seperate bedroom, you know)...and it may already be taken. Near hospital and city centre.

- A mildly affordable place which might work, from a decent broker.... in a nice neighbourhood about 3k's from the hospital, only slight problem is that it's on or near the shopping centre where there have been some problems with youths hanging around causing trouble. (Look, if it's the same as here, I'd consider it)

-A nice-looking apartment in an adjacent small town (less tax), yet still only 3k away from the hospital. Not too expensive. Only problem is: 'only for rent to 2 people'.

So...

Easter Weekend

2011-04-25T13:41:00.000+02:00

My sisters gave me the little sheep above for my birthday, almost a week ago. I can't bear to eat it, just look at those eyes!

This morning we had Easter breakfast; (with a few Beacon marshmallow eggs, from the two boxes my dad imported this week... what the hell do you do with two boxes of Beacon eggs??) and yesterday was just mellow. Went for a run with my sister, watched some TV, went to church with my family (and had the entire church queue up to talk to me)...

So, that was Easter Weekend.

And I'm starting work in a week!

So, what did you do today?

2011-04-23T21:01:00.000+02:00

It's a chilled, relaxed, sunny Saturday somewhere between, well, Good Friday and Easter Sunday. Apart from chilling in our (kiddie) pool on one of those floaty beds (what, if you close your eyes it's almost like floating in a real pool!), I decided it was a good day to reveal the following picture of my belly:

Signed, sealed, delivered

2011-04-22T12:13:00.000+02:00

There. I signed my contract and am on my way to mail it. (Once the floor is dried up, Grandma did the floors). Along with it, I'll be mailing the MRSA kit. This means the job hunt is officially over... for this year.

If I'm MRSA positive, I might have to get treated and then find another job. Because I can't start work at this hospital if I'm MRSA positive.

I have a contract for 38h/week, plus 10h 'training and supervision', which comes down to 48h a week (EU norm). In the beginning it will probably take me longer to do the work I'm supposed to do in 48h; but essentially my work day is from 8:00 - 18:00/18:30; not taking into account shifts. When doing night shifts, I get to sleep during the day. When doing evening shifts, well, I forgot how this hospital did it, but either I work 'doubles' and get days off in return, or I just work evenings. I'll be earning enough to have to pay around 30% in taxes (we have a stepped tax system: the more you earn, the higher% you pay), and I'll be earning more than my friends who started work 2 years ago and who smilingly always had money when I had none. I also have 116.82 hours of vacation for 2011. If I worked a full year, I'd have 175.23 hours of vacation, which is just over 4 weeks. Mind you, that 0.23h is very important. I just don't know what I am going to do with 14 1/2 minutes of vacation.

That just to give you an idea, since my stats page says most of the people who actually read this are American.

At the dentist

2011-04-21T19:20:00.000+02:00

Me: No, sorry, I can't make appointments half a year in advance, I work in shifts. But can I get an e-mail reminder instead of the card you sent me like I requested last time? (Yes, we like to save the trees...but more importantly, I receive e-mail on my phone, which, coincidentally, I also use to phone them for the appointment)

Receptionist: Oh, sure, sorry, we must not have your e-mail address.
*checks my info*
Oh, right, something is wrong with your adress, please look at it.

Me (peeking at screen): Yes, there's no @.

Receptionist: Oh, right! No idea what egg did that!

(apart from the missing essential, I found it amusing that she called her colleague an egg!)

Work out details: tuesday run/walk workout 35min plus an hour cycling, yesterday none specifically, today 50min cycling and a zumba class. I need to work on my bicycle fitness, simply because I'm tired of struggling to get places!

500km of my running history.

2011-04-17T18:35:00.000+02:00

I've just logged my 501th km on my nike+ system. That's something, right? Despite 3 injuries in the last year, I've made it to 500k.

Total, that is.

I 'seriously' started running on September 12, 2009, apparently. There were a few runs on there from before that, which I deleted. (I also have an estimated 50km which I haven't logged.)

Then, just as I was getting somewhere, the winter happened. Three months of subzero temperatures and crazy snow... and I couldn't face that. I went to the gym instead, but I hate treadmills.

Then I injured my lateral collateral ligament during a street dance class...

Then I injured it sort of again late last year...probably doing nothing in particular.

Then I finally got going, and then I hurt my IT band.

Then we got to now, but 500k over and done with.

Let's just make the next 500k more productive?

Today I went out for about 35 mins, starting with 2 mins walking, then 3 mins running, then 2 mins walking etc. I tried to actually run during the running bits but my cardio fitness dropped so fast while I was out. Nonetheless, I've managed to keep a pace of well below 6'00/km during the running bits, even below 5'30 on the first four runs, then about 5'30 for two runs and then 6'00 on the last one. I don't know if I'm being particularly smart. I just know that I can do this.

Very long dead fellow countrymen

2011-04-16T01:30:00.000+02:00

Today another holiday tale.

We also went to visit the historical Stellenbosch in South-Africa. It's really a gorgeous town, idyllic almost, set in South-Africa's wine country.

I think maybe my memory of this part of the trip is slightly blurred by the fever I had, and the murderous sore throat, and maybe the horse-dosages of pain killers I took... but I do remember that it's a fascinating place to go and home to Stellenbosch University, one of the country's best uni's.

A few years ago, I was an elective student at Stellenbosch University's Tygerberg campus. Tygerberg is in Cape Town, technically, but it's Stellies' medical faculty. That's my teeny tiny history with the Cape; in reality I'm from Gauteng. Originally, that is, I've spent half my life abroad and the result is that I'm not really from anywhere in particular anymore.

At the Mother Church in Stellenbosch I found this:

Tombs of dead, well, fellow countrymen. They're dead Dutchmen from the 1700's; which makes me unsure if they're dead old or new fellow countrymen. As a white South-African, I have Dutch ancestors, probably not the ones buried here, but still. Some of these buried here would be first-generation South-Africans, from before the Afrikaans were the Afrikaans and before the English discovered how much fun South-Africa is. I'm an expat in Holland, but I'm a Dutch citizen since I think 2008. These tombs made me aware of an odd cycle I'm running (or cycling) around the Dutch: I'm not a 'real' Dutchwoman, but yet, these dead Dutchmen are double fellow countrymen.

Exercise: Pilates work out DVD.

My Legs

2011-04-15T00:46:00.000+02:00

Second work out of my 'getting back to running after IT band syndrome' plan.
Run-walk-run in 2min intervals for 30 minutes. I took my sisters with me. They're seasonal runners; and the weather is improving. The work out is by no means challenging, but I think my IT band begs to differ but doesn't say too much.
I'm faster than they are, but they are fitter than I am. They describe us as the soldiers and the floating alien, I'm the alien.

The only problem with my plan is that it's not really a plan. It's just something I came up with after my 2 runs in South-Africa, and the plan was to make a plan.
Part of the plan was to count Zumba as 'running' for now.
The plan might be to see if I can do part of the 'Nike Walk To Run schedule.

Maastrichts Mooiste is in 2 months. I'm considering doing the 5k run; well, mainly because it would be a good excuse to hang with a friend. All I need to be able to do is run for 30 minutes straight, right? I'll have to see what my work schedule is like first; I've decided that races are no priority for me now.

----------------------------------------------------------------------------------------------------------

In terms of not-so-recent weight gain I realised that I have one pair of black trousers to wear to work; that's it. Actually, come to think of it, this not-so-recent weight gain trouser problem goes a bit further back than the cardiology kilo's: I own two pairs of jeans and one pair of black trousers fitted to my post-recovery body. For the record: I went through weight restoration in 2008.

Don't ask me what I've been wearing for the past 2.5 years. I don't know.

I decided to find myself a pair of trousers suitable for work today, and preferably a light brown or beige pair. I did buy two pairs of jeans before going to South-Africa because I sort of just grew out of my old ones; a light grey pair and just blue jeans, forgot the latter in SA. Not relevant. Relevant maybe, is that I lost a minimal amount of weight in SA. I was sick for a few days.

I aimed for something less than 30 euro's. I'm low on cash. In the H&M it turned out that that minimal amount of weight was enough for me to need the same size I needed last year, before the whole cardiology-weight-gain thing. I'm pretty close to my set point weight. I found the size thing very amusing. Even more amusing was that I forgot that H&M trousers are too short for me, and only realised that after pair nr 4. I can't remember the last time I tried on trousers there. I had better luck in the Zara, where I found a pair for 26 euros.

The most amusing thing of all maybe, considering my past, was my legs. I'm pretty thin, and I think my legs are pretty thin too. Not too thin, just, well, like they should be. I don't look in the mirror thinking my thighs are fat or big. (I do look in the mirror thinking that running actually works for cellulite though! I have less of it now than I had at my lowest weight!) My thighs are right-sized in my humble opinion, and I love that I finally have calves. Thank you, running.
However, whoever sets the standards for confection clothing seems to disagree with me about my thighs. I either have too much thigh for my bum or too little bum for my thigh, either way: it doesn't fit right. And apart from having handed my sister a pair of annoying jeans (too loose at the top, meaning it got pulled down by the sheer force of my gigantic thighs...), I find this extremely amusing. My thighs don't even touch. Maybe the proportions are correct in the sample size. Maybe other women my size have booties but never exercise.

I don't care. I'm proud of my legs.

And I suppose the good news is that my new beige trousers (slightly tighter over the thighs than over the rest) will still fit at my personal, healthy set point.

And maybe the best part is that I have seemed to 'reset' my attitudes towards food, leading to something closer to my normal pattern of intuitive eating. It feels so much better.

Cheers to my legs.

Good night.

Today is not my day

2011-04-14T00:14:00.000+02:00

Allright, because I promised Africa stories:
One of the ironies of South-Africa is: new cars are programmed to automatically lock when you drive. I suppose too many people have been hijacked or robbed at traffic lights: South-Africans lock their car doors when driving, it's safer.
Yet, the back of a bakkie is considered a completely legit place to transport people and stuff. (I deliberately looked for a white-people shot, because foreigners seem to believe that only black people ride there)

Anyway. Woke up with a headache and a fight with my mum (at least, it feels like it, but I probably woke up with just the headache). Took two paracetamol and went to a big market with my grandma and sisters, paracetamol wasn't doing it's job. Yes, they sold cheap clothes there, but I didn't like it. I like cheap clothes if they don't look cheap, you know? I don't want to look cheap.
So really, not much more sensible to say.

Work out: apart from walking around the market, none.

HR interview

2011-04-12T23:21:00.000+02:00

I had my appointment with HR today. You know, the guys who do the paperwork and so forth when you get hired.

This morning, I woke up more or less fresh and fruity and ready to go. I had my day planned out, but it turned out to be one of those days that don't go entirely to plan.

I sorted out the remaining paperwork, signing all the forms and making photocopies of documents. Then I got dressed and put on some make up. Getting dressed turned out to be a bit of a challenge as I don't have much to wear, literally. I wore my floral blouse (very trendy) with a black waistbelt and a black lacy skirt and ballerina-pink ballerina pumps. I calculated that I'd need about 20 minutes to get to the train station, as I didn't have to buy a ticket because my public transport card had money on it.

Wrong.

I forgot to plan in idiot time, which I needed for the following:
- somehow between 11:30 last night and 11:30 this morning some family member had managed to move my bike in such a way that I can't get it out easily
- I have forgotten that getting said bike requires 5 whole minutes of locking and unlocking
- I could not find my watch between someone else's laundry, which was conveniently placed on top of my stuff
- Naturally, my public transport card would be blocked. Naturally, all my attempts to get rid of the student-free-travel tag were in vain, with the result that 'they' found out it's still on there post graduation and apparently blocked my card. 'They' were supposed to have it untagged on the 1st of March after I requested them to do so.

The result: I missed my train. Not in the acceptable way, where you'd be 5 whole minutes late, but in the frustrating way where the train is still standing there but you can't get the door to open any more. Then it stands there for another half a minute without letting you in, before leaving.

I planned to take a relatively early train, to make sure I was on time. I ended up being there at 1 precisely...
after which the lady at the reception (the correct reception) sent me to another building, where I found out, at 9 past 1, that I had to be in the first building and the man with whom I had the appointment was waiting for me. So I sort of missed out on the interview with him, and went straight to the formalities with another lady. Which I find frustrating, because apart from not leaving a sharp impression, I don't know exactly when and where I start.

Plus, I have to take time off almost immediately for the driving test (the medical one, not the one that will get me my licence, well, ok, that one too) because OF COURSE it could not be done in these last few weeks I'm off. I really don't want to take time off immediately.

Workout: total of 1,5h cycling just to get places, and a 55min zumba class. Legs still sore from my 15x2min work out alternating running and walking... or maybe it has something to do with the cycling. I'm not used to it anymore.

In the Land of the Zulu

2011-04-11T16:44:00.000+02:00

As we drove towards the luxurious Cathedral Peak Hotel, the scenery was breathtaking. We turned off the main road, and drove through a really rural area. The shrill contrast between the sheer beauty of the country and the harsh poverty of the people in the small towns didn't seem to make sense. There were hundreds of school children walking home at the time. Hundreds of school children in an area with no jobs. Children with goats; a few cattle, some thin. Most of the colourful houses were brick, that's a good thing.

The hotel itself was gorgeous; I've never been in such luxury. But then again, I've only been in a hotel maybe twice before. There was a small wedding party present; and a few other guests. We had buffet breakfasts and dinners, and while we were off to dinner the housekeeping staff would open our beds for us, and leave a story and a chocolate on our night tables.

The next day we went for a guided walk. Our guide was Wise Man; a local Zulu. He was a tall, skinny man with upside-down tear shaped scars all over one cheek. They didn't look like accidental scars.

Wise Man was in his early 30's and unmarried. He's unmarried because he can't pay the lobola (bride price) of 11 cows for his girlfriend of 7 years. He doesn't earn much but he tries to save up for the cows, but it's hard because his parents died and as the first born child it's his duty to take care of his younger siblings. There are six of them, and three have finished school but can't find jobs.

When my dad said he should marry a city girl because then he wouldn't need to pay lobola for her, he replied:
"No man, city girls are lazy. They don't want to carry firewood or 20litres of water on their heads"
and under his breath he valued them at 5 cows. (The irony is: these city girls are important for the development of the country!)
He didn't have any children because he's not married. Sadly, I doubt the girl would still be able to conceive when he saved up for those 11 cows.

Wise Man grew up in a small village with no electricity and no running water in a place with no future for the few thousand who live there.
I grew up in the suburbs in relative luxury and had the opportunity to study and had three jobs to choose from.

Underseas Adventures

2011-04-11T14:07:00.000+02:00

Right. Part one.

I've already half posted about this, but it was fun.

I spent my first week at the seaside in KwaZulu Natal, getting my diver's licence and enjoying family time. Apart from my right hand, I also managed to get my ears sunburnt. Human Anatomy 101: ears are covered with skin too, remember when applying sunscreen. Apart from that I only got a mild tan; wetsuits don't let through much UV light.

Diving is fun. The course is interesting, and I've learnt interesting things. Among other things: it's complicated to breathe through your mouth underwater without a mask on, water gets in your nose. This might be slightly terrifying when there's 12 metres of water above your head. I've also learned that, despite being a strong swimmer and not weighing that much, I don't float. You have to be able to swim 200m and keep yourself afloat for 10 minutes in order to do the course. The Swedes who did the course with me floated, I had to tread water.

We went for a total of 4 ocean dives; which included practising skills. Aliwal Shaw is a gorgeous place to dive, and apart from the already mentioned white tip reef shark I saw thousands of fish which I can't identify... and a giant potato bass, and two stingrays. One of the stingrays had take-away dinner in it's mouth. It was really gorgeous!

On the last morning I went for a run on the beach with my dad. OK, maybe I overdid it a tiny bit, but it was good. Nothing better than barefoot running on the beach... and it's good for my calves and feet too. I might do a bit more of that when the weather gets better here in the Underworld; after all, the beach is just a tram ride away.
It was incredibly humid though.

I am back

2011-04-10T21:21:00.000+02:00

Hello, I am back from South-Africa.
Right now I don't have time for blogging, but I'll catch up soon.

COMING UP ON RUN, DOC, RUN!:

Travel stories, all the way from Africa...
Running, yes, I started again!
and of course, I'll be starting work as a real doctor in less than 3 weeks!

Speaking of which... I had a bit of a fright on the plane last night when they called for a medical doctor. Fortunately there were 3 medical doctors and my services were not needed.....

Greetings from...

2011-03-23T14:16:00.000+01:00

...the bottom of the ocean!

And thanks for all the congratulation messages!

Ok, fair enough, I'm not exactly on the bottom of the ocean, but I was earlier. I'm doing a dive course and we had our first two open water dives today. Great fun! Even saw a white tipped reef shark!

I also somehow managed to burn my right hand in the sun. It's pretty funny. My right hand, and nothing else.

Graduation Day!

2011-03-17T23:46:00.000+01:00

And, an actual picture of me. See? I'm blonde. That's me, being congratulated by the president of the exam board of our medical faculty.

On the way to Maastricht I phoned the hospital and accepted job nr 3. Yes, I'll be working hard, but at this stage I need to learn a lot, and this seemed to be the best learning opportunity. Yes, I love cardiology, and I love psych, but I need more than either one. Plus, this job includes cardiology and pulmonology and A&E on top of just medical wards; I think any UK FY2 can be jealous of me.

We arrived early, parked our car and then went to the church. It was a bit weird at first, turns out there were only about 20 of us. Then time for the group picture, and also time to discover that one of my classmates is already working at the hospital where I'm going to start working in May.

For all those who wonder how such a ceremony works: I live in Holland. We don't do robes and hats. We do pretty dresses and high heels. Or not, in some cases.
The chairman opened the 'special meeting of the Exam Board'. After the short opening speech, he read the Oath, and then we had to reply with the last sentence (This I promise/ So help me God Almighty). My sister said I did my oath too quickly for her to take a picture! I went with the God Almighty one, stammered on the Almighty, because it was a church and because it seemed safer from my agnostic point of view.
After that we were handed our certificates after somebody gave a little speech for us. In my case it was my father. Some were funny, some embarrassing, some down to the point. Some fathers made a point out of saying that their children were now their colleagues, mine joked about always having to do the speech for his own students and now for his daughter. The Exam Board enjoyed the speeches; I suppose it's fun to learn about the anonymous students.
Then it was time for a final speech, and, an hour and a half after it began it was time to wrap it up again. Drinks were served, but no refreshments. A bit disappointing, really, but it doesn't matter. A friend of mine couldn't make it, but she came to the drinks bit to congratulate me.

We drove back, and then went out for dinner.

I sat up straight like a lady all day long. The dress was beautiful, but only comfortable when my spine was straight.

I'm flying to South-Africa this Saturday, so I'm not going to be writing much in the meantime.

Job Interviews nr 2 and 3

2011-03-17T23:03:00.000+01:00

*This post was intended to be posted 2 days ago, but due to lack of time did not happen*

Apparently it's not extremely hard, once you're through the bit of sending out applications, to get a job as a doctor. Not taking into account the ones that turned to be for non-existent jobs, I got invited to half of my applications; the others just didn't respond.

Interview nr 2 was at a psych institution. Yes, I like psych, and no, I do not wish to become a psychiatrist. I'm also a good one for this particular job: I know a lot of psych compared to most fresh graduates, and I also know a lot of somatics compared to most fresh graduates who aspire to go into psych. They offered me the job. It was tempting: 4 days work, and I wouldn't have to stay there when on call. The lady was very nice; the other doctors were enthusiastic, the psychiatrist was... well, a psychiatrist. But getting another job after a year of psych would be slightly challenging.

Interview nr 3 was at a general hospital not far from here. It felt a lot like Hospital to me; hard work... but also a good learning opportunity. It was very much down to business: this is our hospital, this is what we offer, and when can you start? Afterwards I got a grand tour of the hospital. Lots of young doctors, which is good.

Which left me with a very difficult decision, really.

A nice hospital
Good working hours
or
something where I could learn.

Job Interview nr 1

2011-03-11T17:09:00.000+01:00

...of 3.

I never applied to cardiology; I applied to internal medicine. My application got sent through to cardio, because they had no opening in internal medicine. I loved that about this hospital; others don't bother.

I got a job interview at cardio.
I love cardio, for the record, but when I applied at this particular hospital, I had to pick one, and I picked the most obvious one.

I had my sister drop me off (of course, I could have used the tram, but she was driving in more or less that direction anyway) and I found the OP clinic quite easily. The receptionist immediately asked me if I were here for the job interview, I said yes. She went off and told him I was here. (And, since I was 15mins early, the good impression started early)

Between my charm, my cultural background and apparently a more impressive resume than I thought I had, it took him less than 10 minutes to decide he wanted me. Having done cardio research, and being a BLS/AED instructor did help too.

I have a job, though I have 2 more interviews. He was happy for me to let him know Tuesday.

Staccato Update.

2011-03-06T21:52:00.000+01:00

As I once more remove Louis the Rat from underneath the shower curtain I use as a pee-guard for wherever they free-range. (My bed, in this case). And, it works better when they're on it, not under it. At least they have fresh breath. They've been bugging me for peppermints.

Yes, I'm still alive.

No, I haven't forgotten about this. I just am sick and tired of my boring life.

Yes, I'm still selling Hugo Boss, and no, I'm not selling much. I always thought I had high requirements for my clothing. These people make me look like I dress with no more discretion than those on www.peopleofwalmart.com.

I suppose the greatest news is that, yes, I've actually graduated in the meantime. With 367/360 ECT credits, and no, I have no clue what I did to earn the extra 7 credits. Ceremony is next week, but in the meantime I'm no longer enrolled, no longer a student.

I've sort of decided to do the traditional pledge if I pass for my driving test. That would be this Friday, and with a regional first pass chance of 33% and a driving school with a first pass rate of 50%... I'm not extremely confident.

Randomly.

I also have a job interview next week; the first one. Most of the applications turned out to be for non-existing jobs, which is quite interesting, as I did react to existing advertisements. The interview I did get was not for something I applied to. They had no available position in Internal Medicine, but they are looking for somebody on Cardiology. I like Cardio, and I've done cardio research. I liked the Cardio bit, but not the research bit. I'm trying to get into a place where I don't know anyone. I've borrowed a suit and I'll put in my best charm... and really, it might be a good idea to start there. Get my first experience with being a doctor in a familiar, less broad specialty. Besides, they have the option to switch to General Internal after 6months, if there is place.

I'm also not going to run the race. My leg is more busted than I initially thought.

That's it for now.

I want to run...

2011-02-24T21:24:00.000+01:00

but...
I can't.

I'm injured, once again, still... and it's frustrating.
Here I was, thinking I did everything right.

Here I am, with my overuse injury. This is a bitch. I was finally getting somewhere....

I tried to run today, it has been a week. I didn't get far, turned around and jogged back.

I think my race is screwed.

I'm looking at a MINIMUM recovery time of 2-4 weeks. 1 week done.

Frustration

2011-02-21T00:25:00.001+01:00

I just can't wait to get my life together. I am utterly frustrated. I'm sitting at home, sometimes doing the odd temp job. I am also volunteering once a week, btw. My social life is a mess, my body is a mess, and I'm broke.
I'm not getting anything done. This weekend, I was supposed to write two applications and send them. Not done. Also, the money-time balance is way off: loads of time, no money. In a year I'll have money, but no time.

Saterday's temp gig was slightly better than promoting toilet paper. I got to put on my 'suit' (10 pound Marks&Spencers trousers combined with a white longsleeve tee and my black blazer -Elle, so it's sort of designer- which I bought at a going-out-of-business sale) to sell Hugo Boss at De Bijenkorf, a posh warehouse which I absolutely love. It's odd, seeing teens wearing clothes that cost much more than I made in a month with my job at that age. I was fascinated by the people who bought the clothes. Maybe one day I'll marry rich? If required, I wouldn't mind learning to play tennis, but I sort of draw the line at hockey.

To add to my frustration, I haven't gotten very far with my 11 projects for '11.
Almost two months gone, and here's the status quo:
1) Find and start first job as a doctor: Well, 3 applications sent, one turned out for a job that doesn't exist. Another 2 will be sent out in due time. Tuesday?

2) Get a drivers' licence: Well, in all fairness, this one is going OK. Test on March 11.

3) Running: The first aim was to run a 10k race. Am still working on that, and I am at 9k, but I also have a bit of an ITband problem. After gait analysis by my physister I have learned that I am indeed a midfoot striker (much to her amusement) but I also use my right (affected) leg less and I need to work on my strength. The shoe is not the problem. Good, because I want to do other things with the little money I have.

4) Get my diving licence: The course is booked.

5) Join a club: is proving difficult: no money. Also, with no job I still can't guarantee I'll be near here for the rest. Stability is the biggest issue here!

6) The food and weight situation: is, if possible, even worse. Much to my frustration. Am working on it, but I'm going to look awful for a while. It's just fairly impossible to do it right while living here. Yes, it's almost march, and I'm heavier than I was with New Years. And even more uncomfortable. No, I am not going to buy fat jeans. The thing is, boredom leads to eating more than usual. Boredom plus hunger is catastrophic, but I don't have the resources to handle the hunger in a healthy way. Extremely frustrating!!!

7) Keep up cross- and strength training.I am still cross-training, but strength training isn't happening. I find it rather boring. And today I spent half an hour trying to get the pilates DVD to work, it didn't. I did a better job at uni: the gym was close by. I get bored, and I can't do it in front of the TV in my room. (Because there's a bed, and then some mess because there's nowhere to put my stuff, and then the rat's pen and that was my entire room)

8)Learn to cook new dishes: Well, I did one...does it count that I made mash for the first time?

9) Creativity time: Well, apart from writing, no and this is frustrating. I'd love to work on my ratbook project, but it's such a hassle to dig out my stuff in the garage... as I have nowhere to put it and nowhere to work.

10) Being organised: Well, I tried with the room. It doesn't work It's depressing. And I'm not getting anything else done... Literally, there's a bed, and part of a closet and a desk that is mine. I can't put anything anywhere. And it's driving me nuts.

11) Learn new things. Well?

IT's.......

2011-02-18T22:02:00.000+01:00

Yes, crap, it's true.... Remember my thigh pain?

Though not your typical IT band syndrome. The bit that's normally affected is remarkably unaffected in my leg. Also fairly atypical is the sudden onset. I have pain in mid-upper thigh, only sometimes radiating to my knee.

I also have a physiotherapist sister who didn't mind giving me a rub. A very painful rub, I might add. Turns out there band is a bit thickened/swollen with a lump in it. Even I felt the lump....

The frustrating bit? Never once have I been forcing myself.

Crap.

Rest for now, will do short runs now and go swimming just a bit more often. I still want to race. Not fair. What now???

The next planned run was 5k, after that I was going to be at 10K, with about 2-3 weeks to work on that.

And, for future reference, the IT band lies roughly in the L5 dermatome:

Ah. The Importance of Hydration.

2011-02-18T00:09:00.000+01:00

This was bound to happen.
I still haven't figured out exactly how I want to take my liquids with me on longer runs. I don't feel much for running with a bottle in my hands, and I'm not sure those belts actually work.

Meanwhile, I'm running close to 9km.

Up till now I've managed with pre and post run hydration. Drink half a litre slowly in the 45 mins before running. It worked.

But today (nice and sunny), I found myself thirsty after 15 mins. After 25 mins I was parched. and after 34 mins the Man with the Hammer hit... and I didn't get very far.

Interesting how, if you're really really thirsty, you start considering drinking the water from the pond.

I trespassed onto restaurant property trying to find a tap. No luck. I decided to drastically decrease my tempo and add more walking...

And finally, went to the MacDonalds to drink water from the tap in the loo. A manager greeted me, I said 'Hi' back. (Look, I have no money on me! Besides, what does MacDonalds possibly sell that won't interfere with my run?) Then I walked out. (They're pretty strict about the loos being for customers only.).

Unfortunately I started getting sharp pains in my right outer leg (but NOT in an iliotibial tract pattern) right after that so running didn't go so well afterwards either. In the meantime I've been having these weird pains on and off, especially when going downstairs. Almost like a nerve got a hit somewhere. I'm too young for this shit!

I suppose the good news is that I ran the first 5km of my 5mi which turned to 9.3km run in 29:something minutes.

Job Applications

2011-02-16T17:33:00.000+01:00

Yes, I'm writing them. I need to start working at some point, don't I?

Slight problem though. Apparently, I can't take my driving test, which means I'm a bit limited when it comes to job appliacations?
Don't believe me?

Found a nice psych job. Requirements: own transport, due to lack of sleep-in calls.
GP training: requirements: driver's licence.
Anything too far to cycle and too complicated to reach with public transport: idem ditto.

I'm pissed off about the whole driving test situation. It's not like I wasn't extremely clear about the situation.
Now it's overbooked.

Writing letters is complicated. I'm nervous.

Me and my GP

2011-02-15T23:46:00.002+01:00

Yes, another side-post on when the doctor gets ill. I also wrote about the vetinary dilemma. And now, I'd like to talk about my own doctors.

The thing is: I love my current GP. Not in the wrong kind of way... just in the way that she's really good. I don't want to be with her, I want to watch her and learn. (That, of course, won't work). In my time as a medical student I've witnessed and experienced enough GP's to know that you have bad ones, average ones, and good ones. A good GP is worth their weight in round brilliant cut diamonds. Patients often see their GP as 'their' doctor, and trust them, often more than they trust the specialists. (Statement may not apply in all countries) Specialists often complain about GP's, usually about 'daft' referrals. The thing is: on average, a GP refers 10% of their patients. Specialists forget that the GP handles the remaining 90% themselves. A reason for referral could be: I don't know what to do with this. Yes, that does sound daft on a referral letter.

(But, honestly, still, if you can't read an ECG, don't make one, dear GPs who refer to cardio unit)

Dr G1 was my GP when we first moved here. I had to switch GPs when I went to university, and registered with dr W. I never saw him/her. Then I moved out of their 'service area' (GP has to be able to get to you in 15mins in case of emergency), and registered with dr G2 and her colleague dr M. Recently I moved back, and was re-registered with dr G1. Because the rest of the family are registered with her.

Dr G2 is an older GP. She went to medical school in the days when it was a big deal for a woman to go to medical school, and trained before my university even existed. I liked her. She knew I was a med student. I think she probably had a few med students in her practice. She also was really good about my eating disorder; without judging me. I read my notes when I switched GP's recently, including a rather enthusiastic bit about me finally gaining weight. Dr M doesn't know about my status as a medical student, and she seemed to have a bit of an edge about her. One day, when the surgery was really quiet, I ended up chatting about shoes with her. Human after all. Quite a contrast with the time I ended up in a discussion with her about what's in Nexium. (Esomeprazole, for those who wondered, and for those who think it's the same as omeprazole, go review secondary school chemistry)

Dr G1 is probably slightly younger than my parents, although she looks ageless. She has a sort of energy around her. Interestingly enough, she still knew who I was, 7 years after I last saw her. It's in the little things, really. The way she takes into account individual things; such as my cultural background. The way she obviously loves her job. Her attention to detail, and the fact that she's on top of things. Or at least, the things I came to her with. She knew that the Nuvaring could cause the problems I had, for example, but maybe just because her patients are on average 20 years younger than Dr M's. She also quickly revisited the entire situation around my lactose intolerance and stomach problems, and did not just write me a prescription like the other 2 did. Suggested I see a nutritionist after my holiday.
She recently started training new GP's. Good thing. You want the good ones to teach.

None of my doctors were ever annoyed with me being a medical student, thus a notoriously difficult patient. I'm not a difficult patient, I respect their seniority. Also, I'm not one for medical student hypochondria. I've suffered enough real drama, don't need the pretend.

Gynaecologist (I wanted a mirena for period pain, ended up not getting one): Have you done your rotations yet?
Me: Yes
Gynae: So what do YOU think about this pain?
Me: Probably just primary dysmennorhoea...
Gynae: What about endometriosis?
Me: Well, I hope not....
Gynae: laughs.

Anyway. The only other doctor I've seen was my psychiatrist. I used to be a little nutty, remember? I was severely depressed a few years ago, and basically this man made a huge difference for me. I wouldn't know how he is with other patients. All I know is that he took me seriously when others didn't. He didn't get lost on labels like 'chronic'. I'm also forever grateful that he didn't admit me to the psych institution when I was at my lowest. He said that specific place would not be a good place for me. Later on, when I got to know that place, I had to agree. He really contributed to the fact that I am where I am today, against all odds. I owe him a picture of my graduation.

Look, mental illness can happen to anyone. Thinking that it might not happen to you, or that you are above such mushy mushy things, might only make you more susceptible and less treatable. That means those around you suffer too. I'm pretty honest about my past.

And I don't think having that past makes me less of a doctor. On the contrary; I have life experience which I can use to be a better doctor (than I would otherwise have been). Statistically I have a higher recurrence risk than somebody who never suffered from anything. (For instance, statistically, I have a 70% depression relapse risk. I also have a 30% chance of remaining healthy... I tend to focus more on that bit). On the other hand, having learned to take care of myself both mentally and physically is proving invaluable in a demanding career with a rather high suicide rate. I am not the only one. I personally know a few doctors who have dealt with depression and told me about it.

I do think the relationship between you and your own doctor changes when you're in medical school; particularly towards the end. It's neither good nor bad, it just is. It's such a marvellous profession though: everybody needs doctors at some point in their lives; even the doctors themselves.

Hippocratic oath

2011-02-12T18:05:00.000+01:00

Due to more or less popular demand I have decided to write something about the Hippocratic Oath.

As you may know or may not realise, I live and studied in the Netherlands. Compared to about any country I've ever been to, this is a fairly atheist country. If mention 'church', you almost say it softly because you don't know how people would react. (If you say 'mosque', run. Yet, a teacher at one of our colleges, refuses to shake hands with female students based on his new-found faith after a trip to Mecca. In Holland, you shake hands till you have no right hand left. If he tried that with me, I'd demand a different teacher and make a complaint against him for discrimination based on gender. If I'm too filthy for him to shake my hand, I can't trust that I'll get assessed for my work and not the fact that I happen to be born with a vagina.)

The Hippocratic Oath is a tradition. Technically, it's no longer a Hippocratic oath, but a Doctor's oath, since we don't really pray to Apollo any more, and it has been revised many many times. It holds, at least in this country, no legal value: my registration as a doctor is the legal bit. It is a sort of rite of passage into doctor-hood, if you want. It's a moral oath, and it is not the same as the various guidelines on ethics, good clinical practice and such.

The original Hippocratic oath may or may not have been written by Hippocrates of Kos (450-370 BC), but it's one of the most well known documents from that time. For the first time, it required physicians to submit to a moral code of conduct. Also, for the first time, the curer and the killer were not the same person. For those interested in the original version: http://en.wikipedia.org/wiki/Hippocratic_Oath; Actually, go see, it's pretty interesting. Even back then there was a problem with doctors sleeping with patients and others, apparently! Also weird: the oath is Greek. Yet, we all know the related 'primum non nocere'. Latin.

(^Aesculapius. I wonder what ancient physicians would say about modern medicine. At least we have one other thing in common: I like to wear dresses too.)

In the Middle Ages, the learnings of the pragmatic Galenus of Pergamum became crucial. He was less interested in the moral grounds of the Hippocratic teachings. However, during the middle ages, it was common for physician's oaths to be sworn. It wasn't until the 1500's that the Hippocratic Oath made it's way to European universities. It has been translated into Arabic in the 900's, and has played a role in the Islamic world since. During the Renaissance Galenus' popularity decreased, whilst that of Hippocrates increased. It was another way for the Renaissance man to attempt to become perfect. (Or wait, was the Homo Universalis after that?) Of course, the stance taken on euthanasia and abortion in the Oath matched that of the time, based on Christian, Jewish or Islamic religion. (You'd say that discussions on these topics would get old after 2500 years!) Ironically, the text on no killing may not even have had anything to do with euthanasia, but with a frequent request to ancient physicians to kill somebody. Swearing the oath was introduced in Europe in the 1500's, of course, adjusted to the Christian faith. The oath has remained fairly unchanged here since 1878, until 2003.

Nowadays, the main concept of the oath is still intact. Some aspects have changed: abortion, for example, and the fact that sometimes 'Do No Harm' and 'I will not take the life of another man' contradict each other. The Hippocratic ethic has reached it's limits in the late 1700's already. In 1948, after nazi abuse of medicine, the Declaration of Geneva was written:

D EC L A R AT I O N O F G ENE VA
(Wo r l d M e d i c a l A s s o c i at i o n , 1 9 4 8 ; l a at s t e h e r z i e n i n g 2 0 0 6 ) 4
At the time of being admitted as a member of the medical profession:
I solemnly pledge to consecrate my life to the service of humanity;
I will give to my teachers the respect and gratitude that is their due;
I will practise my profession with conscience and dignity;
The health of my patient will be my fi rst consideration;
I will respect the secrets that are confi ded in me, even after the patient has died;
I will maintain by all the means in my power, the honour and the noble traditions of the medical profession;
My colleagues will be my sisters and brothers;
I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affi liation, race, sexual
orientation, social standing or any other factor to intervene between my duty and my patient;
I will maintain the utmost respect for human life;
I will not use my medical knowledge to violate human rights and civil liberties, even under threat;
I make these promises solemnly, freely and upon my honour.

The oath is by no means a religious oath. It is a pledge to yourself, and to society. (Or, like the British like to say: The Public). It never was a religious oath; despite all the Greek deities. It was meant to make better physicians. You know, who have moral standards and don't sleep with patients. I think many patients think it means we become superhuman.

In 2003 a revised Dutch physician's oath was written, based on a conference in Kos, Greece. In this, you have the option to mention the Almighty, or not. and that is what I meant with the traditional, religious oath, or the atheist one.

Ne d e r l a n d s e a r t s en e e d ( 2 0 0 3 )
Ik zweer/beloof dat ik de geneeskunst zo goed als ik kan zal
uitoefenen ten dienste van mijn medemens. Ik zal zorgen voor
zieken, gezondheid bevorderen en lijden verlichten.
Ik stel het belang van de patiënt voorop en eerbiedig zijn
opvattingen. Ik zal aan de patiënt geen schade doen. Ik luister
en zal hem goed inlichten. Ik zal geheim houden wat mij is
toevertrouwd.
Ik zal de geneeskundige kennis van mijzelf en anderen bevorderen.
Ik erken de grenzen van mijn mogelijkheden. Ik zal mij open en
toetsbaar opstellen.
Ik ken mijn verantwoordelijkheid voor de samenleving en zal de
beschikbaarheid en toegankelijkheid van de gezondheidszorg
bevorderen. Ik maak geen misbruik van mijn medische kennis,
ook niet onder druk.
Ik zal zo het beroep van arts in ere houden.
Dat beloof ik.
of
Zo waarlijk helpe mij God* almachtig.

The above, translated by yours truly as that seemed easier than finding the actual (non existent?) translation:
Dutch Physican's Oath (2003)
I swear/promise that I will, to the best of my abilities, perform the art of medicine to the benefit of my fellow human beings.
I shall take care of the ill, promote health and alleviate suffering.
I shall put the interest of the patient first and shall respect their views.
I shall do no harm to the patient. I will listen and properly inform them. I shall keep secret that what has been confided to me.
I shall promote the medical knowledge of myself and others.
I admit the limits of my abilities. I shall be open and transparent, and I know my responsibilities towards society.
I shall promote the availability and accessibility of health care.
I shall not abuse my medical knowledge, not even under pressure.
I shall keep the profession in honour,
This I promise
or
So help me God Almighty.

And, for completion's sake: the UK version:
T HE D U T I E S O F A D O C TOR
R EGI S T ER ED W I TH T HE
G ENER A L M E D I C A L COU N C I L 1 4
( 2 0 0 6 )
Patients must be able to trust doctors with their lives and health.
To justify that trust you must show respect for human life and you
must:
• Make the care of your patient your fi rst concern
• Protect and promote the health of patients and the public
• Provide a good standard of practice and care
- Keep your professional knowledge and skills up to date
- Recognise and work within the limits of your competence
- Work with colleagues in the ways that best serve patients’
interests
• Treat patients as individuals and respect their dignity
- Treat patients politely and considerately
- Respect patients’ right to confi dentiality
• Work in partnership with patients
- Listen to patients and respond to their concerns and
preferences
- Give patients the information they want or need in a way they
can understand
- Respect patients’ right to reach decisions with you about
their treatment and care
- Support patients in caring for themselves to improve and
maintain their health

• Be honest and open and act with integrity

- Act without delay if you have good reason to believe that

you or a colleague may be putting patients at risk

- Never discriminate unfairly against patients or colleagues

- Never abuse your patients’ trust in you or the public’s

trust in the profession.

You are personally accountable for your professional practice

and must always be prepared to justify your decisions and

actions.

Resources:
* Nederlandse Artseneed, de Commissie Herziening Artseneed, 2009.
* Wikipedia, partly
*Ned Tijdschr Geneeskd 2005;149:1062-7

Ceremony: a yes?

2011-02-11T16:13:00.000+01:00

So, after some whining at the faculty I might be allowed to join the graduation ceremony, as an exception. Because my grandma is in the country and I want her to be there.

Fingers crossed.

(Yes, I do feel a bit ashamed of the drama. It's not like me, except that this really matters to me.)

Now. Traditional Hippocratic oath, or atheist pledge? I DON"T KNOW. Maybe I should flip a coin on the matter.

5k run today. My legs and my lungs refused all 5000m long. Tomorrow is rest day. My legs are heavy. I think I'm going to leave my work-out schedule for what it is now. 3 runs ,1 zumba class, 1 swimming session and some strengthening excercises a week.

The Hippocratic Oath(Modern Version)

I SWEAR in the presence of the Almighty and before my family, my teachers and my peers that according to my ability and judgment I will keep this Oath and Stipulation.

TO RECKON all who have taught me this art equally dear to me as my parents and in the same spirit and dedication to impart a knowledge of the art of medicine to others. I will continue with diligence to keep abreast of advances in medicine. I will treat without exception all who seek my ministrations, so long as the treatment of others is not compromised thereby, and I will seek the counsel of particularly skilled physicians where indicated for the benefit of my patient.

I WILL FOLLOW that method of treatment which according to my ability and judgment, I consider for the benefit of my patient and abstain from whatever is harmful or mischievous. I will neither prescribe nor administer a lethal dose of medicine to any patient even if asked nor counsel any such thing nor perform the utmost respect for every human life from fertilization to natural death and reject abortion that deliberately takes a unique human life.

WITH PURITY, HOLINESS AND BENEFICENCE I will pass my life and practice my art. Except for the prudent correction of an imminent danger, I will neither treat any patient nor carry out any research on any human being without the valid informed consent of the subject or the appropriate legal protector thereof, understanding that research must have as its purpose the furtherance of the health of that individual. Into whatever patient setting I enter, I will go for the benefit of the sick and will abstain from every voluntary act of mischief or corruption and further from the seduction of any patient.

WHATEVER IN CONNECTION with my professional practice or not in connection with it I may see or hear in the lives of my patients which ought not be spoken abroad, I will not divulge, reckoning that all such should be kept secret.

WHILE I CONTINUE to keep this Oath unviolated may it be granted to me to enjoy life and the practice of the art and science of medicine with the blessing of the Almighty and respected by my peers and society, but should I trespass and violate this Oath, may the reverse by my lot.

Progress?

2011-02-09T23:05:00.000+01:00

I tend to get frustrated with my running. It feels so slow. For instance, today I ran 5.4miles at a pace of 6'32/km (I do metric, but 5 mile is an official distance apparently, and equals to 8K, which means that on my iPod I can just select 5 miles rather than set 8k. That's all. I ran 8.7K today). It took me almost 57mins, which is still 3 mins faster than the last time. Still ridiculously slow, but I am beginning to feel like 10K in an hour might, just might, be possible. I've got another 4.5 weeks to go.

A month ago I was doing 4.4k at 7min/k. Look, that's twice the distance, and it's faster.

The second half of today's run was challenging. I could feel my legs. I saved those 3 mins in the first half; at 3miles (more or less 5k) I was at 30mins.

The route is pretty. I like this one. I'm going to do it 2 more times, then up the distance to 10k. Yes, finally. I've surpassed myself.

So if the theory is right, I should have some fitness for this distance right in time for the race.

There is progress, yes, but I'm a perfectionist who measures herself against her own ambition. I think that's really what's frustrating me.

Oh, thanks CPC site, for reminding me I've got another 31 days and 11h 41m 22s before the race.

Well, race... a time of 60 minutes would rank me at about 700th out of somewhere between 2000 and 2100. I guess that's still roughly in the fastest 1/3. It's my goal time. That's all. All I need to do is be little over 3 mins faster on what I do now, and add in another 1k. A month.

I want to be in the fastest 1/2. That sounds fair enough.

And mainly, it's to have fun. First race, first big event.

And right now, I walk for a short bit after every 3 songs in my playlist.

Oh. No.

2011-02-08T18:51:00.002+01:00

Oh. No.

Shit.

I just re-checked graduation info, and with a graduation date of 28-02 the ceremony is on the 16th of JULY. Ju-fucking-ly. I can't believe it. I was so certain it would be in March, apparently I must have misread something, because I was so certain about it when I half-deliberately posponed the date. It was only half-deliberate, it would have been very nearly impossible to have everything set to graduate in January. (That would have given me, the surgeons, and the faculty one week to have everything done. I can work that fast, but the surgeons don't neccesarily have time, and the faculty has never been fast).
It's just not fair. July would basically mean that I won't have a graduation ceremony at all. That would mean that I'd go and pick up my diploma and nothing else, I can't wait 5 months. I'll be working in July, who says I'm going to get time off?
And why would I want to go to a ceremony half a year after I actually graduated?

I'm completely shattered. 6.5 years of hell, and I can go and pick up my diploma at 9AM on the first Tuesday in March. Oh wait, that's the day AFTER. No glamour, no proud moments, no ceremony, no pretty old church building, no pretty dress, no grandma at the ceremony. No, I can go and sleep at Anne's place, and pick up my certificate at 9AM... like it's a renewed passport or a visa. I'm sitting here, crying my eyes out. It's just not fair.
I already sent a beg-email to the faculty, but I have no faith in them.

I guess that also means I don't have to worry about whether I make the traditional, religious oath, or the non-religious pledge. (Yes, that's an issue if you're agnostic)

I need some inspiration

2011-02-07T23:22:00.000+01:00

I am in a bit, ok, lot of a rut. No words, no actions, no nothing.

'Had' to skip 2 runs due to weather and 'ladies' circumstances, but I did do a strength work out today. Better than nothing, right?

My Fitness level (RW NL feb 2011)

2011-02-03T21:26:00.000+01:00

(This post is not an example of literary excellence. Scroll down for the test results!)

Right now, I feel awesome. Yes, including nasal American accent. (Completely irrelevant, but I love my own accent. Southern-English with a twist, so to speak. It's not Southern-English; but that's not the point either. Compared to many of my (white and coloured) countrymen I sound more rounded and classy. And come on, compared to most Americans too.)

I went for a 5 mile run today. It didn't go so extremely well in the beginning (asthma is a nuisance) and at a few points I had to use my phone to determine where I actually was. My LG android phone is too big to take out, but Google Maps saved my day. Even if I had to keep it in my hand all the time. (It started out in the back pocket of my leggings, but then it dragged down the leggings with it). My 5-mile run ended up at 5.5miles; because the trial seemed more fun than the road. Except then I missed a turn. But I feel fine now; and I think if I do that same run another 2-3 times (with 5k runs in between) I can simply move up to 10k after that. So close! It took me a full hour and 34 seconds to complete my run, but that's fine for now.

Another thing: when should I replace my shoes?? I'm wearing lightweight Mizunos (see all over the blog) and I've done 450k on them. Dutch version of Runners World says 800-1000k; but I'm actually not sure these will last another 450k. Most of the wear is on the front part with almost no wear on the heels. I'm sure they'll be perfectly fine till I start earning some money for new shoes. I just wonder if there are shoes that are more suitable for mid/forefoot strikers than these. I had them fitted at a running store, with a camera on a treadmill. The only problem is that I can't run on a treadmill.

I did the fitness level test in Runners World this month. I did better than I thought. I also intimidated another woman-runner when doing the 400m speed test. Maybe she should try it too. I'm only going to give the levels relevant for me, if you're interested go find the full test in RW. Runners World Find Out How Fit You Are

"Hoe Fit Ben Jij?" (How Fit Are You?) Dutch RW, feb 2011
1) Core:
The Test: How long can you hold a the Plank position?
Great: You can hold perfect form for 2 minutes
Good: You can hold perfect form for 90 seconds
Fair: You can hold perfect form for <90s

My results: 41 seconds. FAIR. Yes, I know. Pilates anyone?

2) Upper Body StrengthThe Test: do as many push-ups as you can. (results women aged 20-29)
Great: >23
Good: 12-22
Fair: 0-11.

My results: 11. FAIR. Actually, I'm impressed. I haven't been doing much about my upper body at all.

3) Lower body strengthThe test: Squat test. (Results women aged 20-29)
Great: >43
Good: 25-42
Fair: 24

My result: 50. I could have kept on going still, but decided to save my quads for my run as I already landed myself in the GREAT zone.

4) Flexibility
Test: reclining hand-to-big-toe test (results for women; left leg stretched)
Great: More than 90 degrees with straight leg
Good: More than 90 degrees with leg slightly bent
Fair: Less than 90 degrees

My result: Left leg more than 90 degrees with leg slightly bent; right leg more than 90 degrees with straight leg. GOOD. Interesting. Actually this is a pretty poor score for me, I'm quite flexible, but my hamstrings aren't doing too great in comparison to the rest. Stretching time!

5) BalanceTest: Standing Stork (or, what yogi know as the Tree); time average between both legs.
Great: >50s
Good: 26-49s
Fair: 25s or less

My result: 45s. GOOD. Actually, I'm impressed. My ankles are incredibly unstable. Need to work on them still, though, because the ligaments are basically shot.

6) Joint mobilityTest: bar squat


Great	If with feet flat on the floor, your torso is parallel to your lower leg throughout the test, your thighs are below parallel to the floor, and you're able to keep your knees aligned with your feet without knees caving inward.
Good	If you can meet the above parameters, but only with heels elevated on the board.
Fair	If you have trouble maintaining form in either heel position

My result: GREAT. Yes, I have plenty of joint mobility. I probably did the 'extra great' version of it, as my butt touched my heels.

7) Speed.Test: Run for 400m/0.25m
Ah now this is interesting. RW NL gives one time for women and one for men, while the website (RW US) gives an age-table.
Great: <70s in NL; <60s in US
Good: 70-80s in NL; 60-70s in US
Fair: >81s in NL; >71s in US.

My results: 70s. I'm going to leave it at GOOD. I'm not a sprinter, but in this case I was limited by my level of cardiovascular fitness: I can only keep up my current near max speed for 38s. But it felt good. Goal: run that stretch in less than 1 minute; (the actual stretch is 450m). That, I think I can do. I'm only really at the beginning of my running. If I can run that in 60 seconds, I can run 400m in around 54-55seconds. That would be pretty decent. Ambitious? I don't care. If I can run 400m in 70s after less than 2 months after starting from scratch and having done absolutely no speed work; I sure as hell can run well under 60s after some speed work. Who knows, I might actually compete some day. Like, within the next year.

I should have done athletics instead of swimming in secondary school.

8) EnduranceTest: a 45-min treadmill test. While normal people run faster on a treadmill, I run faster outside. I hate treadmills. But actually, reading the US version, it's a 30-minute test run... the Dutch version made it seem like you should measure the entire 45min.
Great: >7.4km
Good: 6.4-7.3km
Fair: <6.3 km

My results: Well, at first I thought, oh, terrific, I run 7k in 45 mins. But no; let's just leave it at FAIR as, just like I already knew, my endurance sucks at the moment. I'll be thrilled to get my 5k time back under 30 minutes, thanks. And what if I had a terrific endurance but absolutely no talent for running? My sister has a terrific endurance... but she won't get anywhere near 7.4k in 30 minutes. But my endurance still is horrible. I'm not running as slow as I am for no reason.

9) Cardiovascular strength
Test: step-ups + heart rate
Great: <93
Good: 94-110
Fair: >111

My results: 100/min. GOOD. Well, that's not too bad.

10) PostureThis one is NOT in the Dutch version, but is on the site. Stand against the wall-test.

Great	With your head level, your butt, upper back, and back of your head are in contact with the wall.
Fair	Either your head, butt, or upper back have to strain to make contact with the wall, or don't touch the wall at all. This is an indication that you have too much curve in your upper back, a forward head position or a combination of both.

My results: GREAT. I have good posture. (I stand tall. Heh.)

So, that's it.
And here's an overview of my iPod tracked best times since December. None of them are impressive, but I've started from scratch remember.
1k: 5'56"
3K: 18'28"
5K: 32'21"
1 mile: 9'16"
2 miles: 18'55"
5 miles: 55'09"

That's just for me, in a month time I'll see where I stand.

Einstein (13-07-2009 - 30-01-2011)

2011-01-30T11:55:00.000+01:00

My baby died this morning. Not sure what of; his infection seemed to be clearing up. Anyway, I'll miss my crazy boy, and he can trot off to the Rainbow Bridge where he'll never have trouble breathing again.

Not in the mood not in the mood...HEY I'm loving this

2011-01-28T20:08:00.000+01:00

Today's run was 7.32km at a pace of 6.28/k. I'm getting really good at running slowly. This is something I was never capable of, actually, and I was pushing myself too much on every run. I always had sore calves. Always. The thing is, my basic cardio fitness level isn't too great. I'm building it up as I am building up my running; and I simply can't run a full 5k at my 'usual' pace of 5'20. I will get there soon enough, and I will get even faster... safely.
For now I'm good with building endurance, even if that happens at a pace of 6'28.

I spent half the afternoon procrastinating my run. It was cold out, and I was not in the mood for it. And yes, it's wildly interesting to read some tips about buying a used car; the deal was that I was going for a long-ish run.

Once I started running with my 'run' playlist in my ears, I started getting in the mood. It was sunny but cold. I started out running against the wind, but had the wind in my back on the way back. At some point, the wintry sun started feeling warm in my face even, and I was far from cold. I was creating my own tiny little summer.

I'm right on schedule for my 10k run.

I also noticed that I'm a midfoot striker. I find this interesting. There is no 'pathological' reason for this, it's just what I do. Apparently it's very Chi or something...

I'm just wondering if this means my shoes need to be replaced sooner.

Dutch Driving

2011-01-28T00:11:00.000+01:00

I am in my mid-twenties and I do not have a driver's licence. I am not really ashamed of it: why would I get a licence if I have no foresight of having access to a car? I live in Holland; where public transport is fair and a bicycle gets you to city centres faster anyway. I even had a student travel card (like the one below), allowing me free travel on the entire public transport network in the country. At first during the weekends, later during the week.

Allright, fair enough, I cursed the fact that I had no car quite often. As a busy student I only went to the laundromat once every three weeks. It would have been a lot easier to do that by car. Same goes for weekly groceries. I have carried lots of random things on my bike, including a microwave oven. And a full month's worth of dirty (and then clean) laundry. Or the times where public transport took over an hour on a trip which would take me just as long by bike (20km), or about 20mins by car. The annoying bit was of course that I had to travel that route two times a day, five days a week.

Getting your licence is quite hard here. You're allowed to drive at 18; with a valid licence. Most people need at least 40 driving lessons before they can go for their test. Only about half of them will pass. One of my sisters only passed the 5th time. As did one of my supervisors in the past year. Driving in Holland also is harder than in many other countries. Narrow streets, cars parked everywhere, pedestrians, various public transport vehicles, cyclists, weird roundabouts and lots of traffic are a few aspects of Dutch traffic. This city apparently is notoriously complicated. (seriously, sometimes I don't even know where the bit where I'm supposed to drive is!) My instructor said that if I can get my licence in this city, I can drive anywhere. Manual, of course. An automatic transmission only licence is considered a licence for the handicapped.

I started taking driving lessons in December 2009. I was optimistic, and planned to have my licence by January 2010. The crash course (I had 6 weeks off) crashed and burned before I even got started. I passed the required written test in one go (average is 2 times). I found myself a driving school. I filled out the paperwork. And by truthfully crossing the YES when asked if I ever had eye surgery; I became 'medical'. It feels like almost handicapped.

I had to get a full medical evaluation. I had to find an independent GP to test my eyes, my urine (nope, still not pregnant and still not diabetic), my psych history... etc. That was after paying 23 euros for the single sheet on which she wrote her findings and 30 euros for the check up... 8 weeks later I got the good news that I am fully fit to drive (but still had to have a special examinor). Without the fit-to-drive paperwork I can't take a test. You do the math. The irony? There is absolutely nothing wrong with me. I don't even wear glasses or contacts.

Taking lessons once a week from a 21-year-old instructor didn't go so well. When Michael Jackson came on the radio, he would turn up the volume and tell me that he has liked Michael Jackson since he was a kid (in the 90s). Yes, I was a kid then too, only I was a slightly older kid. I quit, I couldn't take lessons more often while working in another city. I started again when I worked in Maastricht; but then my research project literally drove me to the edge of what I could handle in terms of work-stress... and driving didn't go so well. I did my practice test right after practically passing out from sheer exhaustion. Needless to say; that was a very bad idea.

So now I am back in The City and am taking lessons again. I'll probably get close to 70 lessons before my first test, and I really want it to be the first and only test. I feel like I deserve it. My written exam had expired, so I had to take it again, and passed it again this Monday. I had to get the 'fit to drive' paperwork again, but luckily this time it only took 2 weeks, and now I'm set to go. My instructor said it's possible to get there in the time I have left.

I'm an agnostic; but I might actually start praying if that will help me pass the test.

Not Alone.

2011-01-24T22:13:00.000+01:00

First things first: I passed my written drivers test. Whoot.

This evening I ran a lap around our neighbourhood. I am horrible at estimating distances, apparently, because what was intended to be a 6k run clocked in at 6.88km. I suppose I will just run 5.2 in my next run to AVERAGE at 6k a run for this week. I'm thrilled. I barely walked. Kept the pace low, but still this work out was a challenge. My nano is fairly accurate at the moment.

Apparently I'm not the only one who runs in this neighbourhood. I always run into other runners. Even in the middle of the day; though then it's typically women (SAHM's?) in a great range of running and non-running clothes. I went running at around 7PM and lapped around part of the neighbourhood. A great part of the route consists of the shell-path next to a canal between the older and newer part of the neighbourhood. The return bit is on a cycle path. On this simple route, in the dark, I ran into 11 other runners. 2 women, 8 men and 1 young boy who ran with his father. (Apparently, running is also a man's business). No kidding. After runner nr 5 I made a sport out of counting them.

As my mum put it:

"Looks like you're not the only nutcase around here then."

My run was also perfect to try out my new Puma 'winter hoodie'. I love my other running hoodie so much that I can't wait for it to come out of the laundry. (I also hate my very old Nike jacket, it's too pink and not as terrific and I can't put my hands anywhere)

Not always exceptionally easy

2011-01-23T13:54:00.000+01:00

I'm in a bit of a slump. I'm not OK with a few things; including my current diet. If your diet is causing you to gain weight, you should change it before you become obese. I know, I've been whining about this before... but that only goes to show that I'm actually struggling with it. And I am not happy about that at all. Note to self: just because you have a history doesn't mean you're immune to physiology. I need new jeans though. And I am really panicking about not fitting in my dress.... the thing is I'm not sure if I could find support for this. Because I'm not overweight and because I'm the doctor I should know what's best... Knowing doesn't make doing easier.
(That, for the record, is not my ass, it's merely an illustration of the problem.)

Another thing that may not be extremely difficult but rather boring: I have to re-take the written driving test tomorrow. I will probably have to devote an entire post to the driving subject... just let me pass the test first. Studying for it is tedious and making me cranky.

Also not smart: If you're known to get asthma attacks during exertion in low temperatures, do remember to use your inhaler BEFORE leaving. Else the supposedly easy 5k run becomes a lot harder and a lot wheezier. I always wonder if running during an asthma attack has the same effect as height training. Scheduled for tomorrow: 6k run WITH inhaler. Maybe I'm also a bit stupid.

Oh well. Back to 'What To Do In Case Of An Accident'. (Call 112?)

These Boots are made for....

2011-01-20T20:41:00.000+01:00

One thing I love about running is that I finally have a good pair of calves. I never had that. I always had thin, skinny calves. And I love shapely calves on a woman. I think mine are perfect now; not too much, but just enough to balance out the fact that I have thighs. The alternative is carrot-legs. But the 401km I ran on these running shoes are showing in my calves.

Having calves also means that I can finally wear boots. I'm not talking about the saggy type that I've been wearing; or ankle boots... I'm talking about the kind of boots I see loads of other women wear. And today I bought myself a pair of boots. See?

(Yes, that's my stethoscope. I used it to listen to Einstein's chest this morning. It sounded clear)

I know it sounds shallow, but to me being able to buy normal boots feels like an accomplishment.

Run Philosophy

2011-01-19T14:47:00.000+01:00

Just returned from my 5k run. I'm already 3.5 mins faster than last week; but I'm still not happy. But then again, it does take 4 weeks for your cardio fitness to improve and the best thing would just be to keep going. This was not a 'good' run. But that's OK. I feel good about going.

And the trail bit of my route is still flooded. The fact that it's raining every other day doesn't really help either, I suppose. It's raining now too, and not just a little bit. It does make me feel a bit smug to know that I beat the rain. It started raining just as I got home.

I skipped my run on Monday. Bad girl, I know. But not really. I was visiting somebody and having a good time and I haven't seen her in a year. I was doing something that was equally important to me. As it is, I am exercising 5 times a week. 4 times won't kill me. (I did go to Zumba last night; it may not be the ideal cross training method but I love it).

I don't live to run. I run for life. There is a difference. I run because I (usually) like it. I run because it makes the rest of my life just so much better. While it is completely true that I can get most of the effects of running from other sports, most of them don't allow me to live through the seasons, get fresh air and impulsively change the entire scenery of my work out. I can run any time, any day, and that appeals to somebody with a future demanding job. I can run alone, and I enjoy the semi-meditative solitude. I can run with friends, and enjoy their company, but usually they don't stick to it.

Running for life means running enhances my life, and doesn't stand in the way of it.

I am looking forward to summer rain runs, and to tanning my legs while getting a work out. I am looking forward to showing off my long, tanned and toned legs in summer. I am looking forward to the race, despite being apprehensive of it at times. I am looking forward to fun, hilly trail runs; but I am nowhere near the fitness level needed for those. I am also nowhere near hills, but that's another matter. (Turns out there are some 'man made hills' around here, which will have to make do).

The 10K. Then 15K. Then maybe half a marathon. I'm not aspiring a full marathon now; at least not for the next few years.

When your pet is sick.

2011-01-19T00:13:00.000+01:00

Einstein and I went to the vet today. Einstein has had difficulty breathing ever since I got him. When I was in England he showed some massive improvement in behaviour, but lost weight. In the past week or so his breathing seem to be worse, and he's had a near-suffocation episode caused by snot blocking his nose and drying up while he's asleep. It's not often that you can save a life by removing snot, but I suppose your ABCDE is your ABCDE whether it's a human or an animal. Now I also noticed that whatever is in his nose stinks. But he didn't seem that sick.

So I took him to a new vet today, because I wasn't certain about starting him on Baytril. I miss my old vet, but I moved. The old vet was perfectly fine with guiding me in treating my own pets, and we had mutual respect for each other. Actually, two of the three vets I saw there in the past years were like that; and I remember some interesting conversations with them about medicine. The third one didn't know me that well.

This one was talking down to me and seemed a bit annoyed with me for bringing him in so late. I'm not normally one to throw in the 'I'm a doctor' thing immediately. I am also fully aware of the differences between human and veterinary medicine; and I know that treating your own animals is technically illegal. Like I said; the vet was supportive of me doing what I did because they knew I wouldn't do something stupid. But I didn't have the same feeling with this new one; but maybe she just had poorer communication skills. But, like I suspected, Einstein has a bacterial upper respiratory tract infection of unknown duration and he is really underweight. She also immediately said Einstein's breathing problems are due to allergies and seemed a bit upset that I didn't have him on anything for it and mentioned vaguely considering antihistaminics as a trial.

I wanted to say:
"Look, lady, I'm aware of the fact that this animal should have been started on Baytril earlier. The thing is, to me he is actually acting healthier than he had been in a long time and I found it really hard to differentiate between his 'normal' breathing problem and this because he didn't show the symptoms they normally show. I also wasn't sure if he really was having more trouble breathing, or if it just looked like it because he was so thin. I don't know why he is so thin, I wasn't there. He has continuous access to good quality food. I don't know what his normal new pattern of behaviour is; he changed. It was a good change.
I am also not just some idiot considering antihistaminics. I went to medical school. I wouldn't have given it to him just like that. Your option of giving him dexamethason doesn't sound too lovely either, to be honest.
Einstein has been repeatedly seen by vets in his first year. Allergies are only in the differential diagnosis; we could not find a single factor that made his problems worse, apart form dry air in winter. He actually was doing better after he stopped growing; and I actually have a strong feeling that the problem might be anatomical. This animal isn't being neglected.
And stop calling steroids ´anti-inflammatories'. While Voreen isn't a human drug, dexamethason is."

But regardless: Einstein is going on, doing his thing. He skipped the bath this week and got a bit of cat food with baytril instead. He will be fine, for now, and if he doesn't improve in 3 days I should go back with him to get doxycyclin. I'm supposed to weigh him every week and he should gain 12-20% of his tiny body weight. If he doesn't, she wants to see him again.

The old Einstein wouldn't have had a problem with that; a few months ago he actually was too fat. The new Einstein might find it a bit harder, as the new Einstein actually engages in physical activity.

When the Doctor gets ill

2011-01-15T20:28:00.000+01:00

I remember a conversation with a primary school friend of mine who is living an amazing life that has absolutely nothing to do with medicine. I think I had the flu at the time; or it was when Public Health Services had me quarantined after I phoned them to ask whether or not I could get the repeat MMR jab if I were ill. They had me tested for mumps; it was negative, but I only got well enough to return to work the day before my quarantine was over.

She: "I always wondered what doctors do when they get sick. It seems though, as if you guys suffer just like the rest of us"

Me: "Well, yes, except nobody feels sorry for us."

Some medical students suffer from hypochondria during medical school. One of my yearmates actually saw a psychologist about it. The thing is; we learn about these horrible diseases, but we only learn to put it into perspective a lot later. Perspective is important (unless you work in the States, then you just test for everything or get sued). Medical student hypochondria tends to reach it's max during psych block; but let's not talk about that. I never was one for medical student hypochondria; I just tend to take things as they are.

Reminds me of something else.

In second year/third year I had a group of 'friends' who turned out to be weak and fake because they ditched me when I needed them. Regardless. At some point I had the flu. I actually went home for it, in those days I was still really hardass and refused to go home for anything.

Her: "So what do you think you have then?"

Me: "Meh, just a bit of influenza" (that was when big words made us feel smart)
Her: "No you don't. Why do you always want everything to be extra special? You just have the flu. Influenza is what kills people, you're not that sick. Stop trying to be special. You don't have influenza, you have the flu. You'll be fine".

Me: "Influenza IS the flu".

Her: "No, it's not, stop pretending you know more than me" (she had worked as a nursing assistant for a year).

While I never doubted that I would be perfectly fine, I surely hope that lady now knows that the flu is caused by one or another strain of the influenza virus. And that the ordinary flu kills people every year.

And about me 'trying to be extra special'? Life would have been a lot easier if I were 'just normal'. I am not 'just normal'. Almost nothing about me is not 'just normal'; and really most of it is in a good way. There were days I wished I were 'just normal'; because being labelled as 'unusual' is a bit lonely sometimes.

I just hope being 'unusual' would allow me to do some amazing things later on. You know, like really helping people.

So what does the doctor do when she gets 'ill'?

I've been noticing an intermittent really tired feeling in the lateral part of my left leg; which felt nothing really like my injury. But because of the experiences with that, I'm a bit freaked out because I do NOT want to have to forfeit my 10k race. Like I said; I have two future physiotherapist sisters who are a lot better with the locomotor system than I am. Or so I think; turns out I'm still the one who had the highest score for neuro in my group.

After some bickering over my leg and some cluttered physical examination; one of them decided to test my sensibility. Turns out I have diminished sensibility in the area innervated by the n. peroneus communis and the lateral sural nerve.

And then, I turn to 'UpToDate', only to discover nothing new.

And then, I sigh, relieved, that I can keep on running as long as my peroneal muscle keeps doing it's thing.

And the, I curse, because redefining tired as numb doesn't make it any less annoying.

The slow process of being fast.

2011-01-14T00:50:00.000+01:00

This is not as easy as I thought it was going to be. I am shocked at how fast I lost fitness. Today I ran 5k according to my schedule... or, well, tried. The plan is to now work with a 10%/week increase, which allows me to get to 10k with 2 weeks spare.
I'm not going to work with a flashy schedule; I am going to slowly increase and just run to finish during the race. I feel like once I've jumped THAT hurdle, I can work towards running awesomeness. Maybe join a club or a group or something; but I like the solitude of my runs sometimes. A once-a-week group would be cool. At the moment I can't afford the membership of a running club (and I'm nowhere near fast enough); and googling running groups in the area gives me the first hit 'trimclub'. No way I'm going to join a 'trimclub'. I don't 'trim'; I run.

Or at least I try to. I have officially set the record for the slowest 5k in my history. 36minutes and 47 seconds. That is, FYI, about 10 minutes SLOWER than the fastest I recorded. The worst part? My heart rate went up over 180 on several occasions. I wasn't even running. I was trotting. This is really frustrating. My former top swimmer and almost-physiotherapist sister kindly reminded me that it takes 2 weeks for you to lose fitness and 4-6 weeks for you to regain it. I suppose I will just have to simply suck it up, and think of the long..er...run. Interestingly enough, the area around my former injury felt tired after zumba, and felt tired after the tortoise-run... without it being painful in the least. I just need to watch what I'm doing. Sister said it's OK...

I am also pretty convinced that my heart is fine with 180bpm (especially in shorter bouts) and probably has a higher max rate than it should have according to the formula. It goes up quickly without me even noticing much in my breathing, and it drops even quicker. My current resting heart rate is in the high 60's I think (currently 72; yes, I just measured, but I'm obviously not fully resting); I've had it at 54 at some point, years ago, when I was a swimmer. I'm going to do a max heart rate test once I get a bit fitter. It's just too easy for me to push it over 180, and always has been even when I was a lot fitter. I'm not an exercise physiologist, but the quick drop is a good thing.

(I got a heart rate monitor watch for Christmas, and tried it out today. The strap is far too big, but thanks to sports bras I can just wear it tucked into my bra)

Then I did my ballet excercises, or, well, some of them. I'm actually considering, once I've got an actual job, to take up ballet as a counter-act for running. The only sport I actually have potential real talent for is dancing. Maybe if I weren't 5'10 tall. It's a sad story, really. As a kid I had trouble getting along in terms of motor skills. I had eye problems and the resulting glasses made it impossible for me to catch balls and do much of anything that required depth perception: everything shifted as soon as it entered a different part of my glasses' visual field. I also have hypermobile joints and normal muscle tone; kids like that often are a bit slower because it's simply harder to walk on instable legs. I got a lot of crap over me for this; and it really damaged my self esteem: I was in a very competitive school and felt so ashamed of myself. I simply didn't believe I could do it. My parents were rather harsh on me because I didn't do any sports (and once I took up swimming at age 12 they wouldn't let me quit or train less, not even to take free drama classes with my friends once a week. I started feeling left out in my group, and later lost the friends). I asked my mum if I could take dance lessons. You'd think she'd jump at the opportunity to get her 'lazy' daughter to do some exercise, but no. Her response? 'No, you can't dance because you don't have rhythm. You're not a black girl', or something in that line.
After I left home, I discovered that I can, in fact, dance. And I do, in fact, have rhythm. I've done salsa; I've done belly dancing and I've done a course of modern dance (which didn't work out so well because I was the only one with no experience in the group); oh and of course there was the notorious street dance lesson. I did a theatre class; and the teacher insisted on putting me on centre stage in the dancing scene because she said I looked so graceful. Black men on nights out usually approve of my dancing; white men just stand there moving their arms and sometimes their legs. (I'm not a racist; but there is a certain truth to some stereotypes). My friend told me I'm a good dancer after one Zumba class. Yes, I can dance.
But I'm too old to really go anywhere with it. Maybe one day I'll have a daughter, and maybe she will inherit my flexibility and rhythm, and maybe even she'll want to dance and if so maybe she'll be good at it and it will give her what it could have given me. Who knows.
That doesn't make it any less fun.
And I am really fascinated by how much those simple ballet exercises I did improved my leg-posture and with that my butt. But for now, I'm going to have to stick to my work out schedule.

Running is not the only thing that is going to be not as easy as I thought it would be. Getting my body back is going to -surprise surprise- require some hard work too. Luckily a great deal of the hard work overlaps with the running goal; but I am going to have to put in some effort on the nutrition side of the coin as well. I am not going to push my body to unnatural weights; I just want to fit my own jeans again. I just want to feel like my body is mine again (and yes, my poor fitness levels are making me feel worse). The thing is: I believe that the slimmer version (you know, the one who could run a 27min 5k) is my natural weight because that's what I maintained with natural eating. Yet, here I am, not there, and still struggling with the damage from something that happened half a year ago. The problem is that it seems to have influenced my eating habits in a negative way, and it's so hard to get that back to healthy again. The other problem is that living at home makes it really, really hard. There is a lot of food I can't eat (lactose) or won't eat (bread. I just really hate 'normal' bread, and it's been like that since I can remember. I've tried 'getting over it', didn't work). The foods I would like to eat have other purposes than my lunch. Yes, I'm actually 'not allowed' to take them. Breakfast is tolerable. I miss fibre-tasty all-bran; and the sugar-loaded but non-fat yoghurt my mum bought when I asked her to next time bring healthy yoghurt and explained that it's not about the fat, but about the sugar, doesn't really help me with feeling healthy. But I suppose, I'm the only one responsible for my health.

On a brighter note in this too long post: I handed in my last reports yesterday; and I really love the surgeon who is supposed to review its attitude. He just does things instead of moaning about it. I could learn from that, haha, see above.

Those Last Reports

2011-01-09T21:15:00.000+01:00

I am sitting here, being a bit unable to actually finish my elective report. I need a kick in the butt.

I've been going on like this for quite a while now, and yesterday my documents were open on my laptop without me actually typing a single word. Horrible, isn't it?

It's just the first one that is hard. The other one is easy and probably will not be procrastinated, as it makes me eligible for my 400 euro refund from the uni. Money IS a motivator.

So this is me, signing off for now, and I will try very hard to finish it tonight!

RUNNING!!!

2011-01-08T19:04:00.000+01:00

Yes, I am excited about it. Today, ladies and gentlemen, was the day of the first run that felt like a real run ever since that lateral collateral ligament decided it didn't like something I did for the second time in a year. I did a slow 4.5k and did short bits of walking in between because for some reason it seemed like the tuna sandwich I had 3 hours earlier had other ideas about where it should go than I did... but that's not the point. Or maybe it was the karma of yesterday's piggies (no, NPodyssey, you don't have to google it.... there was a picture of them right below where I mentioned them). I don't know.

The point is that I went far and long enough to feel like I actually went. These shorter recovery runs don't feel like real running, they feel like physiotherapy exercises. Next time probably with a little less walking. Heh. I didn't even run with music today, it was fairly windy (eh, I live quite near the coast) and listening to music while running in the wind just doesn't work.

So here's what my route was like: I started off from our home, crossed the water (large ditch, not quite a full sized canal) to the cycle path, then ran up the sound wall next to the high way where I do catch all the wind but also feel a bit adventurous, climbed down the sound wall to run on the cycle path next to the high way and followed it to the traffic light, crossed that and passed the kart centre and turned left down a small street, then turned left again to start the way back...passing the gym and the MacDonalds. Running past the MacDonalds made me feel a bit smug, but once the smell hit me smug went over in nausea. Then I headed home following the car road (running on the broad sidewalk) and finally through a bit of Suburbia where a woman smiled approvingly as I passed her. I saw one other runner, a small, slow person of unidentifiable sex. I'm going to assume it was a woman because she was wearing a rather thick white jacket. I noticed that I got closer to her despite going slow and stopping to tuck in a runaway shoelace. She continued on when I turned left.

I came home feeling I could still go for several km's, but I know it's better to build up slowly. Besides, I WAS going slow with my average pace of 7.01/k.

Another fun thing: My Nike+ sensor seems to be finally, and accidentally, perfectly calibrated. My run measured 4.48k on Google Maps, and 4.48k on Nike+.

10k here I come! I'll be happy if I can finish in less than an hour.

The weather was a nice 9 degrees Celcius, and windy but dry. It was just starting to dusk, and for some reason I love running in the sunset. It was cloudy.

The nice weather allowed me to run in my favourite running top for winter; a red one from one of the local home brands. Heh. So soft...and apparently not available any more. The local store brands usually are cheaper (same price as Nike in the UK; apparently Nike in the UK is a different distribution area than here, and colours are different, but Nike is more expensive here). Oh well. I hope they make them again next year.... I'd like to have two of them.

EDIT:

..........drumroll....................

I just signed up for my very first race. I signed up for the City Pier City run in The Hague.

Of course, I said I expect to finish somewhere between 0h55 and 1h20. I really hope it will be faster. But I am going to finish, and the idea is to get fit and start somewhere with racing.

Interesting fact: According to my Nike+ yearly overview, I ran an average of 6k a week in 2010. Not much! 2010 was a year in which I couldn't run for a great deal of the year, and spent a great deal of what was left doing those annoying short recovery runs. (Also, not ALL my runs are actually tracked on Nike+). It started out with really bad weather with snow and ice through the entire February; a bout of illness in March, LCL injury in late May, leading to me not being able to run the race and it only recovered in September.... only to take another (light) blow in November. It's all better now, I am taking it easy and have been completely pain-free for about 3-4 weeks now.

I'm Just A Girl..... but...

2011-01-07T18:53:00.000+01:00

...sometimes.

Look, I know I am actually, typically, deep down maybe a bit of a tomboy. I used to be a bit of a skater, I come from a country where your average girl is tougher than your average European man, I am fascinated by cars and never wear uncomfortable clothes just because they're pretty (unless it's an occasion). I can read maps but can't take directions and probably won't stop to ask for them either. I forget birthdays and names, but never stories and faces. I took upper level maths until I decided I wasn't going to go to Delft University of Technology. I spent my childhood climbing trees rather than playing with Barbies. I played Gran Turismo with my dad, and I'm pretty good at fixing things. If I had perfect stereopsis I would have become a pilot (though not a fighter pilot; for starters my dual nationality probably won't allow for that; I mean, what if the Old Country declares war on the New Country?).

...but sometimes, I'm just a girl like any other girl. Ok, to be fair, if you look at me, you wouldn't think I'm a tomboy. I look feminine, even if the only real reason I have long hair is because it's low-maintenance. (Yes, I admit, I sometimes leave the door without even brushing it, I've gotten good with elastic bands and a few pins at most). I love make up, even though this is a fairly new fetish of mine. I love wearing skirts and dresses, though never the doll-type. I'm not a particular fan of high heels, but I do own 3 pairs of high heels. (Ok, fair enough, they're at least 2 years old, but I have grown attached to my 80's style black ones even though they've got evidence on them that I do own small animals.).

It's just... some things are ooh-shiny-pretty. And they smell nice and make your skin soft. I love clothes, there's just so much creativity in it.

I now own I think 3 or 4 lip glosses, while I typically don't wear them.

And today, instead of going swimming, I've stayed in with a bag of piggies (Katja Biggetjes), one of Holland's coolest specialities. Why? Let's just say that's what girls need to do at certain times in their lives.

Now, let's talk about cars again.....

I have decided that, given the fact that I'm a city dweller and a smaller car would be ideal rather than big, strong one, this car would be my ideal one:

Yup, a Mini Cooper. It's got character, it gives you a fair output while still doing OK environment-wise (unless you're driving a Cooper S)... with fair, I mean compared to other cars typically driven by women such as the Ford Ka or Toyota Yaris. (I love the chocolate-toffee Mayfair edition above)

I'm the girl who stops to check out the car- without noticing the hopeful man inside it.
So here are a few more cars to drool over.

^Dodge Viper

^How can you not love a GOLDEN Beetle?

^Elvis, anyone?

^Space Age

^ I don't see how that one works, to be honest

^Extra Special Lambo. Do you REALLY need to Pimp Your Ride if you're driving a lambo?

Having Something To Do.

2011-01-06T00:21:00.000+01:00

I won't be working full time for the next 2-3 months. I'm happy about it, it's my break. That doesn't mean I tolerate doing nothing at all, just not my thing.

I'm taking driving lessons. Because driving lessons in Final Year was a decidedly bad idea, and didn't work out. Before you get all judgemental: I live in Europe, I use a bicycle and I have access to free public transport on weekdays. So there. I had my first driving lesson in one of Holland's largest cities. It was a bit more challenging than driving in the small historic city where I studied, but it went OK and the instructor is going to prep me for my test. It's long overdue, but still I'm a bit scared about the prospect of driving all by myself.

In terms of road rage randoms: a BP lorry managed to park at the BP petrol station in such a way that it blocked an entire lane of the road next to the petrol station. I'm quite impressed, actually.

I am also quite impressed by one of the Pets. He's a fully grown male, but managed to jump up over half a metre to land on the few-mm-thick wire panel I used to make a free range area for them.

Also, I signed up for a local Zumba class. I'm going with a friend, and it's really just people from the neighbourhood. Would be good to meet people from around here. Yes, I partly grew up here, but in my defence: when we moved here the neighbourhood consisted of 2 blocks and no paved streets. 50% of what stands now wasn't there when I left for uni. I went to a try-out today, it was fun.

I'm still planning to look for a part-time job for the time being. It's just not working so well, haha, I'm busy with all kinds of things!

Agency called me, they had an Emergency Care job in the 'region' for me. I asked them where it was. They said somewhere on the 'closest island'. Yes, but that's still a 2-hour commute, and I haven't had enough turn-downs yet to consider moving further than the big city south of this one.

On the bright side, the cardiologist agreed to be my referent, and I am considering asking that other psychiatrist as well because he really knows me.

There's a run due tomorrow morning. I'm so happy about the snow-free temperatures, but they've predicted rain for tomorrow morning and evening.

Referent

2011-01-04T21:47:00.000+01:00

I don't really know where to start with this whole job hunting thing.

So I started with updating my CV. And forgetting to return a phone call from an agency. Actually, the agency was my first, impulsive, step. But that was a long time ago.

So I e-mailed the cardiologist I worked with, and phoned the psychiatrist I worked with during final year. I really like the psychiatrist and I sort of miss working with/for him, but he's quite a character. I also worked with another psychiatrist at the same placement, wonder if I can ask him too? What do you think?

*insert sound of fingernails tapping*

I'm nervous about this whole process.

The Old City

2011-01-03T23:47:00.000+01:00

I talked to a minister today. I used to claim that I don't do religion; but recently I have to admit that I've become a bit of an agnostic. It was an interesting conversation with a really approachable, intelligent man. He reminded me of the 7th Heaven reverend a tiny bit, but then without actually having that many children.

So after that I went to the Old City, where I never actually lived but where I went to secondary school. So many memories of skipping class...haha. They've built a new shopping centre in the meantime, and it took me some time to figure out that the iCentre is actually on this new shopping-centre plain. I bought myself a pair of light pink slippers with pink flamingoes on them. Because they were cheap and my feet are cold. I hate light pink, but the other option was beige with camel flamingoes.... and flamingoes have to be pink.

It was weird walking through the Old City, seeing everything that changed, but especially remembering me as a teen walking there.

The iCentre helpdesk guy (who was cute, and who thought I was cute) managed to get my Nike+ sensor back to life, and I'm really happy about that. He flirted a bit, of course. And I flirted right back, because I'm like that.

Then I went for the same run as two days ago. Next plan is to build up with another 400-500m, but I am allowing for short walk breaks (just enough to get my breath back a bit) as I'm for some reason struggling with the temperature. Or maybe I just lost more running fitness than I thought I did. I'm happy to announce that, while I'm still careful about it, my knee hasn't complained in 2 weeks.

The Projects for 2011

2011-01-01T16:14:00.000+01:00

First of all: happy 2011.
1-1-11 is almost as cool as 11-11-11

^The lighting of the annual local bonfire. When the thing is actually fully on fire it's 5-6 storeys high and too bright for my camera to capture anything. At 3 in the morning I looked outside and thought it was getting light already, that's how much it lights up the neighbourhood. (Of course, no bonfire without having fireworks thrown into the crown, bunch of idiots).

Once upon a time, when I still was a neurotic wreck, I used to make resolutions and measure progress every month...and so forth. I even had a pretty notebook for it. Then, I changed and grew and learned that I'm quite capable of just living without all that... and in the end those resolutions never made me a better person. What DID make me a 'better person', or at least, what was more effective was to simply start whatever 'resolutions' the minute I thought of them. Even IF it's the 31st of December.

This year, everything changes right around New Years. That somewhat changes the matter. Or, maybe not, but still. This year, I have stuff to do, a new life to build if you like. New city, fresh graduate, and three months to do Things. This year, I still have no 'resolutions' because the word sounds dismal to me. It reminds me of smokers who start smoking again on the 3rd, 'gym bunnies' who turn into couch potatoes on the 7th, fat people who will weigh more on the 31st of December 2011 etc. Resolution isn't strong. Plans are. I have a few projects for 2011, and while I'm not going to bore you with the exact details, here they are:

1) Find and start my first job as a doctor. This includes: studying a bit, fixing my CV, applying, interviews, etc. etc. etc. Plan is to start working in internal medicine or paeds.

2) FINALLY get my driver's licence. I am enrolled at a driving school, am going to re-take the theory test halfway through January, and hopefully I'll be done with the whole shebang by March. I'm a bit ashamed of myself for not having it yet... buut there were 'circumstances' (among other things the fact that I'm 'medical' even though I am perfectly healthy with perfect eye sight).

3) Finally make my way up to at least a 10K and race. I might also continue on to a 15k race, and maybe a half marathon (depending on the time I have available). Have already sort of started on this goal, and am going for a run right after I've finished this (I want to see the aftermath of the bonfire). Immediate side project: get NikePlus thingy to work again. The sensor is NOT flight-proof.

4) Get my diving licence. Because diving is amazing, I love nature, I'm an ample swimmer, and I was a few m away from a tiger shark on my first ever diving experience. I might even train as a diving physician later on.

5) Join a club. A running club, a book club, a dancing thing? Don't know, something to research. Meet new people.

6) Improve my eating habits and lose the few pounds I gained, preferably by March. (that implies doing it slowly). It's about balance, not about weight. My 'goal weight' is my natural weight. My body is just not happy with my recent bad eating habits, and I'll feel a lot better if I fix it.

7) Keep up cross-training and strength-training. I love that swimming trains my upper body, and strength training is very important for me.

8) Learn to cook new dishes. I might as well do something useful with my dinner-chores. And no, I'm not really a kitchen princess.

9) Make time for creativity. I took art and art history in secondary school (sort of a minor, if you wish), I was a childhood artistic talent, but then came along medical school. It's all about balance, once again, and yes, I know it makes me sound like I'm 32. But creativity can be trained.

10) Oh, yeah, and put some more effort in being organised. Because chaos doesn't always help. It is possible to be flexibly organised. Starting with my room....and the mess my phone contact list became after I tried to organise it. (I was too vigorous, it deleted all my contacts and then when I re-synched it (viva Google), it was a mess)

11) Learn new things. I'm considering learning French, reading, and just basically keep on being naturally curious. Curiosity killed the cat, but I am not a cat.

some more H2O

2010-12-29T16:50:00.000+01:00

2.5k of which 400m crawl-kick with kicking board, this time in 1h10mins. Included 1min of jumping up from bottom of pool (2m deep): this works my bounce-muscles and my entire frontal thigh is feeling really fatigued now. Plyometrics for increased running performance, right? Runners World says so. I copied the moves from my competitive swimmer days when that type of explosive power was needed to get me off the starting blocks fast, and to get away from the side of the pool ASAP. It's great fun to shoot up above the water (well, the bit of me above my upper thighs at least) anyway. I've also added tumble turns again, with the aim to do them fast with a strong push-off. I think I'm going to try to get to the pool once a week (for more balanced training), and I might have to cycle there. That would add up to 'real' triathlon training,although this:
might not be the appropriate cycle. ('They' say the swimming and the running is the hardest bit of the triathlon anyway. I might consider doing triathlons in the future, when I'm earning enough for a race bike to not be a stupid purchase)

Also, when it has been uncovered from underneath the snow, the new playground with it's tartan-like 'floor' across the street will provide a lovely place to...well...jump.

Tomorrow I'm going for a run again. I'm a bit ambivalent about pushing myself to run at the moment, I'm only now reaching the stage where my knee has a chance of actually fully recovering and while short runs may benefit the healing, overdoing it (or even doing a normal amount of running) may set it off again.

Cuddles.

2010-12-28T20:00:00.000+01:00

I once read that pets have a positive effect on people and even prolong life. It allows for an improved quality of life for the elderly. Stroking your pet boosts your oxytocin/serotonin levels, making you feel better. I can't remember the exact resources, but it was all very scientific.

When I was in a rough spot, someone suggested I should get a pet. She saw me with a dog. Dogs require lots of time, which I don't have. Instead, I opted for something smaller. Walking them is easy: just open the cage door.

Through the years, they've given me more than I could imagine.

One of them is on my lap right now, warming a bit of my lap with his warm body.
They're almost always ready for cuddles.
They're excited when I come home.
They're a fuzzy bunch full of character and made me laugh more than once.
They're willing to clean your hands if they think you haven't done a good enough job (or if your hand lotion smells yummy)
They give lots of cuddles and some kisses.
They've amazed me with their intelligence.

I need no scientific proof: pets can make you happy.

Swimming

2010-12-27T22:55:00.000+01:00

Hope everyone had a very Merry Christmas. I sure did, and I even made it home for Christmas despite previous chaos at Schiphol Airport. I even managed to make it to the airport in time to sit there for an hour before I could check in.

So Christmas festivities have passed and I am staring at an impasse of about 3 months before I start working. Mainly because I have to wait 2 months for my diploma and my father has interesting plans concerning me, March, PADI diving school and South Africa. In the meantime I intend to actually find an actual job for when I return, and to find a part time short term job for the meantime. Preferably once a week, preferably something health-care related, preferably something that pays OK. Just to allow me to earn a little bit of money. Plan also includes finally getting my driver's licence. (I had access to mostly free public transport for the past 6.5 years).

The weather and the streets around here look like this:

I have a basic rule. If I can't walk on it, I can't run on it. (and I most definitely can't cycle on it, but that's a different story). I slipped several times on my way to the supermarket today, luckily manage to 'prevent' falling. One of those times I showed some pretty interesting cross-legged techniques. Now THIS would be about the only situation I'd really want to run on a treadmill.

Treadmill running is still better than NO running.

I have no access to a treadmill.

I do have two sisters who are swimmers and have driving licences. I do have access to a community pool and my sisters compulsive commitment to their swimming.

So this morning I dug up my old blue goggles, my old dark-blue-with-bright-pink-trimming Adidas bathing suit and an old swim cap... and joined my sister in her pool parade. It was fairly quiet, and this pool had one line put in to mark a separate lane for fast swimmers. Normally Dutch pools -at least the ones I've been to- don't put in lanes. Maybe because they believe people should be free to swim wherever they want. (This typically leads to me not being able to swim at all). A fast lane is a good development. Unfortunately it was occupied by a rather normal-average swimmer who was slower than I am.

Regardless, I swam for 1h20m and managed to do 2500m. I'm not extremely proud of this performance. While I don't like to compare myself to my sisters when it comes to swimming... she did do 4250m in 1h25m. (But I beat her in Gran Turismo on the PS3)

The thing is, I had no access to the gym for months now and was shocked at how weak my upper body had become. Last time I went for a swim, I managed 3000m. That was at least 6 months ago. My arms got so tired after only 250m. I could feel the muscles in my back. I used to be a competitive swimmer in secondary school, and I still am faster than most amateur swimmers. Probably just because I have the technique and maybe partly because I am 24 and not 54.

Cross training. And yes, swimming works your quads. I can feel them.

Flying Home For Christmas

2010-12-24T13:40:00.000+01:00

everyone!

Flying home this evening, I'm still a bit upset about my flight being rescheduled. But, according to airport flight info, the original home-for-Christmas-Eve-dinner flight does not exist any more. I'm thrilled to get out of my crappy accomodation, thrilled to go back and see my family and my pets, thrilled that this means that officially I'll never be a med student again... and

a bit sad to leave England behind. I sort of like the place, you know.

Right. So my plane seems to be leaving, my father is going to pick me up from the airport (as this seems to be more likely to succeed than me trying to ride the train home, as Dutch railways don't do well with European Winters. Now all I need is to get to the airport and keep my fingers crossed they don't weigh my hand luggage. (it's 13k, not 12 and not including my handbag). According to KLM I am allowed to take 23kg or 50lbs of check-in luggage (If they fuss, I'm going to fuss right back.) and I weighed my luggage at somewhere around 45lbs. I firmly believe they should not charge me for a few kg of overweight luggage because I myself am a bit of a lightweight and I don't think it's fair that the fat person next to me pays the same price for his ticket (and half of mine) as I pay for (the other half of) my seat.

Yes, I once spent an entire flight from Amsterdam to Johannesburg trying to squish a very fat arm and some side fat out of my seat. Not fair. For the record, that's 11+ hours.

Red Lipstick

2010-12-23T01:30:00.000+01:00

I'm Doctor Blondie. I'm a blonde. I am therefore permitted to be shallow sometimes. That, and I need something more airy to write about than the influence of education of girls on the Millennium Development Goals.

But, I am Doctor Blondie and I am in search of the perfect red lipstick. Red lipstick is classic. It does actually look good on blue-eyed blondes. (my eyes are dark blue, that in itself is a bit unusual, my hair is medium blonde and my skin is not as blindingly white as you might expect, I tan easily)

See?

and of course:

I think I've proven my point. Of course, we also have Scarlett Johansson

and the Olsen Twins (in this case Mary Kate)

Georgia May Jagger

Taylor Swift (just in here because I think she looks good, not because I'm American and know who she is)

Christina

Reese

And of course Charlize Theron

Anyway. The problem is, red lipstick is all fine and dandy if you're just taking a picture. But in real life we like to do things like sip coffee or elegant glasses of wine, kiss boys, and preferably still have our hot red lips at the end of the evening without hourly touch ups. (I'm not girly enough for that, I want my make up to stay where I put it). Then, there is also the issue of the Perfect Shade. Fire Truk Red simply doesn't suit anyone, not even if it's called Chili.

Not even long-lasting lipstick lasts as long as you might expect, and it decides to leave your lips in little chucks. Not sexy, but hopefully this only happens AFTER you've kissed the boy.

So what inspired this?
My discovery of MaxFactors lipfinity lip stain. Not so infinite, but definitely less chippy than the actual lipfinity.

As I mentioned, I'm working on reports and I'm bored with them.
Also, I am flying back on Christmas Eve, and with the European Winter in Holland I really hope I'll actually make it.

Running might be cancelled today. Running in virgin snow somewhere only dogs and the odd runner comes: sounds terrific. Running in half melted half refrozen snow in a city: not entirely worth the injury that may result.

That Magical 10K

2010-12-20T23:28:00.001+01:00

So, instead of working on my -seemingly- endless reports, I've been obsessing about this whole 10k thing. Not unusual for me; I tend to obsess over things till I have a plan, and then the skies in my head are clear as crystal again.

It seems like the weather will be picking up, as in, I'm confident I'll get through January with no snow-outs.

That means I should be able to run 10k on the 13th of March. Just to finish it, I can work towards weird and wondrous times later on. Right?

Problem is, I can't find a schedule to work on. I would love one. I'm doing 2miles now, increasing distance every other run as my knee allows and improves. Meanwhile doing my strengthening exercises.

Basically that means I'll be close to 4k again before I leave, and near 5k just after New Years. From there I can increase my distance with 10% a week. That would mean that I'll be able to do 7.25k around the beginning of February. Time is on my side. I just want to finish. If it's under the hour, I'll be really happy.
Runner's World has a beginners 10k schedule which I should be able to start early Feb, ready to race 6w later. Right?

Happy Haircuts and Freezy Running

2010-12-20T19:55:00.001+01:00

Over the last few days I had fun... and the uni network was having some unexpected downtime. I couldn't get online in 4 days.

I am happy to tell you that I passed both the OSCE and the computer exam.

In the past days I went to 2 dinner parties and 1 High Tea. I'm going to miss the people here!

And today I had my hair cut. Still naturally blonde, but really shiny now. 2 inches off. Haircut is a haircut, but the lady asked me if it was a lot different in Holland.

I'm sorry to disappoint her, but no.

I can run 2 miles now, without my knee bothering. I know I should be doing run/walks, but I can't. If I walk for too long, I get an asthma attack. I had my first sub-zero temp run the other day, and it wasn't so bad! It was cool to see the frosty bits on the ground.

Unprepared

2010-12-16T16:25:00.002+01:00

Today is OSCE day. And just for the record. Normally I am a serious student. More or less. But around here I've done less than I've actually done in my entire career as a medical student. Well, not counting first year because that was all about becoming a student. I agreed to do the end-of-block exams as a sort of motivator to do something, except that it didn't work so well. Hey, I'm on my elective. And I'm tired, I've worked 50hour weeks on my first job, followed by a 2-week break, followed by 70 hour weeks on my second job... followed by a move and my elective abroad. Brain malfunctioning. Brain not effectively capable of studying. Motivation absent.

So... those were 10 9-minute stations. The OSCE's I'm used to consist of your normal assessment, treatment etc, followed by an oral exam. Our finals were one massive OSCE. Now I had 9 minutes for something fairly superficial.

I just put in my worst suture in my entire suturing career. I've never had to suture wax before, the needle behaves differently. Your thread becomes all slippery and waxy. I've sutured heads, legs, fingers, vaginas... but no wax.

I've managed to mis-stab the radial pulse doing an ABG. It's a friggin plastic arm.

I forgot the name of a drug.

And about the asthma thing. Steroids. Ipatropium. Fuck, yes, I do actually know that.

Different policies in different countries mean different tests being ordered.

Question: What causes, other than DKA, cause metabolic acidosis.
Me, er, alcohol, renal failure, er
...blank....
Massive ingestion of vinegar.

What? They didn't ask for common causes, and I HAVE actually seen a patient with metabolic acidosis due to vinegar ingestion. She was anorexic and vinegar made her shit.

Of course, now I can come up with all kinds of brilliant answers. And later on I have a multiple choice question exam. Can't be that hard for this unprepared lady can it?

I suppose the important advice for today still remains:
Do not overindulge in vinegar.

Run!

2010-12-14T23:34:00.000+01:00

I am so happy about this. Really. I am.

Today I ran the 2.6K mini run without experiencing any pain. That means, next time, I can go a bit further, and maybe my dream of that first 10k race is achievable. I even went a bit faster today, but that may just be attributed to spending less time at the traffic light. I wasn't trying.

I'm not going to save the world of this.

2010-12-14T01:07:00.002+01:00

I'm one of those people. I want to see other people happy, and I believe in treating people the way you wanted to be treated. That means, sometimes, giving people what you desperately wanted for yourself.

But I think I am more or less done with this personal campaign of mine. Haters will hate and stupid people will be stupid. A high IQ apparently does not protect against stupidity. Sadly, western society is screwed, and too many women who could have been great throw away themselves for the sakes of men.

See, here's the deal. This will probably be the only time ever I am going to write about this on here because it is my past and I don't believe in lingering in the past... especially if said past can always come back and in fact kill you.

I have a 10-year history of anorexia and bulimia, and I am as close to being fully recovered as anyone can ever be. But that, my dear people, is almost my entire secondary school career and almost my entire university career down the drain. Many former ED suffers go into ED counselling or some other form of anti-eating disorder thing. When I was ill, I thought it was because they didn't want to let go. Now I know it's because they really don't want others to go through it.

The problem is, Western society (continental less than American, British or South-African society) glorifies disordered eating. I have already written about this. Entire magazines devoted to teaching people 'self control' and 'how to burn more calories'. I am fully aware of the paradoxical obesity epidemic (or maybe the paradox is the other way round). I also have real respect for those who attempt - and manage- to turn around their unhealthy lifestyles using patience, common sense and actual healthy eating. I also have sympathy for those who suffer from very real eating disorders. My sympathy ends -and my campaigning begun- at those who have the full potential to be truly healthy, but continue to obsess about food and use ridiculous methods to attain unhealthy weight goals. Some of them call themselves 'pro-ana'; others think this fasting thing of them is actually healthy. And they're stupid enough to think they won't have a problem or won't develop an eating disorder because they will never reach the weight limit for being anorexic. Newsflash: Most of the eating disordered people I know are not underweight. Eating Disorder Not Otherwise Specified is potentially lethal too.

I myself was not underweight for half of the time. That didn't mean that my metabolism didn't come to a screeching halt above my actual, natural set point weight when I was fasting. I didn't look the part, but I was very ill. Somehow I did manage to land myself in the 'really underweight' range. Now THAT was a shitload of fun. Nothing fit, I was too weak to carry my own groceries up the stairs, I passed out during dermatology operations.

I sometimes still miss the perceived 'good' things about my anorexia. I miss the kick, and I miss the false sense of safety it gave me. But I am going to have to deal with that. I did the whole thing in reverse order, starting with bulimia and finishing off with anorexia. The price was high:
- My growth stopped. Well before I ever became underweight. I had a catch-up growth spurt in the first set of treatment, but I never reached my full growth potential. I don't regret not being 5'11, but if I entered the first bout of recovery 2 years later, I would be standing a rather average 5'8 tall.
- I only started ovulating at age 19.
- Loneliness. I have few friends, I have no boyfriend or life partner and I have not had one whilst in my cocoon.
- I would have been earning nice money right now, instead of still trying to get that licence to practice
- I had one good year of secondary school, I missed out on all the fun in the rest.
- I missed out on almost my entire student life.
- Eating disorders are expensive
- and actually, I do not have to explain that 10 years of suffering is not worth it.
- I have no idea what the state of my skeleton is like. I don't know what long-term complications may still wait for me.
- Even to this day, I have stomach problems.

I am just very lucky I still managed to finish my studies. Most people don't get that far, especially those with a chronic (duration >7.5 years) eating disorder (of the anoretic type). A friend of mine died. Several others are still stuck in limbo. Living with pure bulimia or compulsive overeating may leave you, on average, in a more functional place, but it can't be much less of a hell. After my first bout of therapy, I went off to university. Around my second year, I re-entered therapy. In the end, I never got the help I needed. Simply because I had been given up. Was working towards learning to live with the anorexia, and restoring as much of a normal life as possible.

But I did get better. I essentially did it all by myself, without the support I really needed. That bit still hurts, and maybe that's why I want to help other people not go into the valley of hollow cheeks. I'm wildly jealous of those 16-year-old anorexics who get admitted, get the full work up and still bitch on about how hard it is. Oh, and then write stories in magazines about it. I did not have support, I was sent to group therapy for people with personality disorders where I was completely out of place due to lack of personality disorder. I had a GP who would request bloods for me if I asked her to. The few people around me were tired of my anorexia, and did not support my fight any more. I didn't have nutritional support.

And since I've been talking to some people about it, I've been telling this story because I know that so many people would be so much happier if they were normal around food and if they could accept that maybe, like the lovely Venus, they're real women with real curves. I tell the truth, because I really wished somebody would tell me the truth and help me back then. Preferably before the shit hit the fan... but nobody was bothered.

It's my past, and it was born in a very unhappy place. I was not just the girl who wanted to fit in. I was not one of these wannarexic girls, neither was I wan of those who really just have a personality disorder but want sympathy for their eating disorders. I was the real deal, and I had idiotic followers who wanted to be like me (as thin as me)... there are 170 of them who started following my old blog while I was desperately trying to get better.

But essentially, all I wanted was to be happy, ordinarily happy. This song still breaks my heart.

And yet, there are so many people, people around me who feed into this monster. A bunch of hypocrites, who will scrutinize me for every biscuit I turn down (because I don't want to eat biscuits right after dinner)... meanwhile they're going on and on about their crazy diets, their fasts, how fat they are... I hate 'you're so skinny' comments, by the way. 1) I'm naturally skinny, when I'm eating healthily my body ends up there and stays there and 2) you have no idea what it took to get up to my natural weight after being really underweight for years. Many of these people hold habits that are not extremely different from mine as an anorexic. The main difference is maybe somewhere between 5 and 20 BMI points, really. And maybe the fact that I never held the delusion that I was being particularly healthy in not eating. And maybe the thought pattern behind it.

So I have decided to choose the selfish, less mature stance on this over the mature one where I want everybody to be happy in themselves, since all my best efforts have simply been disregarded, and people just WANT to keep on to whatever false hope they're clinging on to. I mean, in the end, every day they spend fasting, or on some crazy diet, will only make them fatter in the end and it will only bring them further away from their crazy BMI 18,5 goal weights... because we all know the only way to lose a vast amount of weight is to preserve muscle mass... and fasting or crazy diets kill muscle mass. And kills your mind, your satiety mechanism, your metabolism... all those things you need to successfully lose a vast amount of weight.

My new stand on this will be: Whichever way you turn it; I win, so suck it up and enjoy being fat forever. I win in your terms, because I'm thin. I win in my terms because I get to have a healthy diet (yes, actually eat and remain thin) and a strong mind and body which have conquered the most lethal psychiatric disorder. Now if you don't mind, I'll go on and kick ass in real life.

Or attempt to go to sleep.

I thought up that entire piece over my very nutritious and fairly all right tasting pasta with tuna and nice veggies.

Pedometer

2010-12-13T20:14:00.000+01:00

My iPod nano has a pedometer. I find it rather amusing. Since my actual running is a bit stalled till my lateral collateral ligament is healed properly again, and I have no access to a gym (let alone one with a lovely pool)... I decided that I'm going to walk. It's not that cold, and I feel like I have time on my hands, and I can benefit from time outside in the daylight.

Now see, I know the UK health people like to advise us to aim for 10 000 steps a day, and as an overachiever I decided that that should be my bare minimum. I figured I'd get that easily, as they also recommend 30minutes of exercise a day and I normally get that without even trying, as I live in a country where this:

is my standard method of transportation. And apart from that, I do exercise.

I was slightly wrong in those assumptions. I decided to go for a walk and see how far 10 000 steps actually is.
It took me 2 hours to walk 10 790 steps (according to the iPod), and that's a total distance of about 8-9k, roughly estimated based on my runs in the city). Only stopping for a soya chai latte to go, and to take a few pics. In the process, iPod tells me, I have burned 411 calories. I'm a bit dissappointed. Sure, it's fine to look at all the pretty things (or ponder about how boring the city actually is), but I miss my kick. And I can burn about 400 calories in 40 minutes if I run. So this whole walking thing doesn't seem too efficient. Not that I'm all about the calories, but it does give you a rough overview of expenditure.

I would find it interesting to see how much you walk on a day, being a doctor. I know, technically it's a bit of a sedentary job, but not really. I only noticed the massive difference that those few steps and the getting up and sitting down and lifting obese peoples' legs or digging in their abdomen makes in terms of activity when I did my research-ship. That was a computer job most of the time. And it drove me crazy.

So Now What.

2010-12-12T23:28:00.001+01:00

I have an OSCE on Thursday. I have 5 days to study for it, including the scrap left of today. I've never had 5 days to study for anything. Wow. I don't even know how to go about having days to study. I mean, I took 1 day off to study for my finals. Everything else had to be crammed into a 50h work week.

I don't even know where to begin. Acute Medicine can be anything.

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We all love MMSE's. Date of examination: 10/12/2010
Me: What year is it?
Flapping Dentures: I dwunnow
Me: What's today's date?
Flapping Dentures (suddenly articulating really well): It's November 30th, that's right, it's my birthday today!
Me: Well, happy birthday Sir.
(checking notes: D.O.B. 30-11-19ancient.)
.........
Me: who's the Queen of England?
Flapping Dentures: ewiwiwew
(er. I'm going to take that as Elizabeth?)
.....
and then he suddenly recalled seeing me earlier. Took me a while to understand when: I was standing at the desk writing my notes when he was brought in.

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Christmas shopping time. The shopping centre was crazy busy. I managed to land my sister her gift in her size, then tried on a few blouses off the sale rack at H&M as I'm rocking professional attire these days. Came home with a very light dusty pink blouse with sleeves that are just a tiny bit too short. I don't mind that, hospital hygiene regulations require rolled up sleeves anyway. Then I decided to get myself a soy chai latte at the Muffin Break and go home to continue my gift hunt on a day on which all these people are working.

Muffin Break has the best soya chai lattes. And this particular one is franchised by the sweetest Indian couple.

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Then I did my toning/ballet work out. I'm getting better at it, and either my entire abductor section is getting stronger or I'm getting more flexible.
I need to strengthen and stabilise my ankles and feet. I have hypermobile joints, essentially it comes down to me having to take good care of my body and to stay in the habit of doing strengthening exercises. Having a naturally flat muscle type does not exactly help with the quick muscle and stability building, but I suppose they should be enough to support my own body. It's not like they have to support 100kg or something. If only I knew how to easily improve ankle stability.

Last day,

2010-12-12T00:29:00.000+01:00

Well this is a legendary day. Sort of. It is, unless in a flurry of keenness I decide to return to A&E right before Christmas, my last day in clinics as a medical student. Next time I lay my hands on a patient (an actual one), I will be the actual doctor.

Well, not counting the OSCE. Those are fake patients, and I am ever so much starting to regret agreeing to do it.

Of course, final day could not pass without a rectal. Patient claimed he had his prostate removed. Prostate was very much in situ.

Random visitor of random patient (not mine): 'You look too young to be a doctor, what are you? 26? 27?'
I am 24, thanks.

Running: same run as last time, this time with slightly less pain. Still stuck with those three laps though. The weather has picked up, and it was slightly warmer than the predicted 4 degrees. I took my jacket off, and it was a bit amusing to be running with my short sleeved T when some people were still wearing hats. I hate this knee injury, and I think I need to be focusing on strength training right now.