Learning to Talk

Med school is a fascinating thing. In the words of my preceptor, "medical schools accept people who are generally very good at talking, interacting with people and are naturally patient centred individuals, and we turn them into biomedical machines who get stuck in conversations."

I am actually afraid of interviewing patients. Before medical school, I loved talking to people and getting them to tell me about their lives. That is honestly one of the reasons I like to fly so much, you never know who will be sitting next to you for the next 4 hrs. But now, I am paranoid that I will forget to ask something, ask too many closed questions, ask too many vague questions, say something wrong, or make an inappropriate facial expression. Talking to people just became one of the most difficult and nerve racking things I have ever done.

It's not the workload that is overwhelming, it's learning how to talk, act and essentially be another person almost overnight. And being a former athlete and somebody who has not had to struggle much to do really well in school or other things I have taken up, so I'm not used to being awful at things. Somedays it makes me question whether or not I am cut out to be a doctor. Everybody has told me for such a long time that I would make  a "great doctor" but not being good at the actual doctoring bit is really hard. (Note: nobody has told me I am awful, I just feel awful because it is such a struggle to do such a simple thing.)

Med school isn't hard because of what you need to study, it is hard because of what you need to learn to become.

This is how I feel all the time in clinical skills.

The Floor

Today I spent a long time on the floor of an emergency room. You know those pictures you see of sub-par Canadian hospitals in American media propaganda about how bad universal healthcare is? Well, today I flat out was lying on the floor of the emergency room, creating one of those pictures

I have a spinal headache from the procedure that I talked about here. If you have ever had a spinal headache, you will know it to be one of the worst headaches of your life, when you are sitting or standing up that is. When you lie down though, it is gone completely - hence the floor.

You know what? I actually don't even mind that I had to lie on the floor. There was a chair I could have sat on, but it wasn't quite as horizontal as the floor. I am not unhappy with the care I received. I ended up being seen by my own doctor (a specialist) to set up a follow up appointment for Thursday and a team of anesthetists who offered me the choice of doing a blood patch today, or later in the week if my headaches cannot be managed with the pain meds they gave me. I am happy with that. They gave me choices. I chose the conservative route of trying pain medication and then going back directly to anesthesia for a blood patch (skipping the emerg line up) if I feel like I can't take the headache anymore. I think that is awesome. I am not above lying on the floor. I don't have a life threatening emergency, just a painful complication, other patients who are sicker need the bed more than I do.

Even though I am Canadian, and I believe I have the right to healthcare, I also believe in equitable healthcare. I think, despite the lying on the floor thing, that I received equitable and quality care today. I have the right to healthcare, but not the right to take it away from others.

Is this just the inbred Canadian niceness coming through, or do I have point here? I am willing to sacrifice my own comfort and not complain about it because I know that resources are being used to help the people who need it most.

Being in a hallway doesn't mean they aren't receiving the best care possible.

The first week of the end of my degree

I think title says it all, but this is the first week of classes of the last semester of my undergrad degree. Come June I will be happily not walking across the stage to receive my degree in Health Sciences because I will likely still be in Tanzania. (Who would want to sit in stuffy gymnasium for three hours when they could be deep in the Maasai region of Tanzania at a field camp with giraffes walking around?) Needless to say, I am pretty excited that this is the end of my first degree and that I get to finish off with a pretty awesome global health research studentship to Tanzania.

The unfortunate part is that I will be starting yet another semester with post-concussion syndrome. You may remember this post from October, well the saga continues. I still have daily headaches, yet they are mainly orthostatic (I get them when I sit up or stand up, but if I lie down they go away). This has led the concussion specialist physiatrist that I am seeing to suspect I may have a CSF leak (which is what I asked about a week after my concussion when I threw up every time I stood up and the ER doc told me it was impossible to occur unless there was a skull fracture). Soo... I have to do a radionucleotide cisternogram (say that thee times fast) in two weeks, which essentially involves a lumbar puncture, an injection of some radioactive nucleotides and me lying on a table in the angiogram suit for 6 hours. I'm not excited...and I think that if it shows I don't have a CSF leak, I likely will have one after this procedure (every time a needle goes into my epidural space I end up with a CSF leak that doesn't resolve its own). From what I am told, this the best test to check for a CSF leak, and apparently they can't do a blood patch (the procedure done to stop CSF leaks) unless there is indication of leak, which there will be no matter what after this procedure because I am 100% certain (based on past experience) that I will end up with one. Some rules and systems don't make any sense and in this case will likely cause unnecessary patient suffering. This procedure seems pointlessly expensive (to taxpayers of course, GO CANADA) and I am fairly certain I will end up needing a blood patch in the end regardless of the test outcome.

And for further updates, I got wait-listed at Wayne State SOM (which was better than I though based on the strangeness of my interview) and rejected pre-interview by UBC by 0.5 (they give you your application score and the cutoff score for interviews). The UBC thing really upset me because BC has a huge shortage of doctors in rural areas, yet they reject rural applicants at higher rates than those from urban areas (they publish these stats). It has to be recognized that opportunities to build up extracurricular activities in a small town are limited (like there are none), I made some of my own, but even that was a struggle. Anyway, if i don't get in anywhere this year, I know my GPA will be high enough to put me above the interview cutoff for next year for UBC.

On another note I spontaneously decided to apply for graduate school in Gottingen, Germany. But sadly if they like me I essentially have to repeat the a German version of the MCAT (in English thankfully) so now I have go back to studying plant ecology, physics and chemistry.

Who wouldn't want to get a MSc or PhD from here? 

Despite all of these emotional up and downs, and headaches caused by the physical ups and downs, I'm excited for what 2014 has in store. This year represents a void of the unknown and not knowing what is going to happen is always exciting. It also represents long hours in the lab trying to finish my honours thesis on time (so I can actually graduate) and the challenge of fulfilling these 10 goals. 

I hope your 2014 is filled with moments of joy but also full challenges that help you realize its okay to not be in control, and of course, many Medical Mondays (12 to be exact).

Thanks for stopping by!!

(I should also share that I get to snag link up spot 1 because I am in a different time zone,  so technically it is still Sunday here. There are some perks of living in mountain time, in addition to the mountains and -20°C weather.) 

The Wounded Healer

I am taking a class called "Psychosocial Oncology" and today's lecture was about palliative care. The two instructors giving the lecture were what most people would consider in medicine to have opposing jobs. One had a doctorate and was a member of the spiritual care team, the other was a physician and the director of the acute-intensive palliative care unit. Together, they helped me to redefine my notions of adult palliative care, and I was astounded by their abilities to interconnect their roles. Needless to say, I learned a lot about the process of dying, both from a medical perspective and spiritual one. 

5 things I learned today about dying:
1. 93% of palliative care patients ranked maintaining a sense of humour to the end as one of the most important things
2. 0.5% of people in Oregon choose physician assisted suicide despite it being a readily available option
3. Palliative Care physicians are often more influential and important in the life of a person who is dying than any of their "active treatment" physicians
4. Palliative Care medicine actually involves a lot of "real medicine," its not just about pain control
5. Most people who are dying have little desire to confess their sins or wrongdoings  at the end, people do not consider them to be important to them any more.


When we were discussing the importance of physicians and members of the palliative care team to let down their barriers, show their emotions and connect with patients, this quote was on the slide:

"The doctor is effective only when he himself is affected. Only the wounded physician heals." - Carl Jung

I'm not sure how I have made it almost 21 years now with out ever seeing this quote from Carl Jung. I have been beginning to doubt whether or not I can make other well if I am not entirely free of illness myself. But I now feel again that strong sense of purpose, and what I guess you could label as "my calling" to medicine. I don't believe that everything happens for a reason, but I am grateful that this quote was on the slide today, it was exactly what I needed. Perhaps me being in pain, will allow me to heal somebody that others cannot. 

I will someday be a Wounder Healer.

Shadowing

I had a pretty impressive morning of shadowing last Wednesday, followed by a somewhat less exciting afternoon of looking at mice in square boxes, cleaning up their excretions and testing their grip strength. But I am sure, you don't want to hear about what I do with mice...back to shadowing.

I shadowed my PI in the neuromuscular clinic, and it was needless to say a really great learning experience. I wasn't too sure how good of a teacher he would be, but he turned out to be pretty great. He explained all the cases to me, what each part of the neuro-exam looks for, the EMG results, and patient histories (some which were more complicated than mine). The first patient we saw was a younger women (early 40's) who had massive file and extensive history. I empathized with her because it seemed like she had been through a similar experience as me when I first got sick. She has seen pretty much every specialist in the city (a neuroimmunologist? I didn't even know that existed), has had extensive testing, has been "combative" towards doctors demanding tests/medications, and at one point wanted to go to the Mayo clinic. Her story seems kinda like mine (I was never combative though, but definitely frustrated). I almost wanted to just give her a hug, and I really wanted to tell her that I truly understood what she was going through, but alas, I was but a mere shadow.

The last patient we saw was a woman in her 50s who had an ethanol induced neuropathy. She doesn't take the vitamins that she needs (B1) which can reverse the neuropathy, she continues to consume alcohol, won't go to physiotherapy and doesn't have a family doctor. She had so much muscle wasting that she looked like a person with muscular dystrophy, and she can no longer straighten her legs so she is wheelchair bound. Non-compliance has committed her to a death sentence from a curable disease. Because of her, I witnessed for the first time what it is like to tell somebody that they will die, and soon, from a condition that is in fact reversible.

It is going to be interesting when I finally become a doctor, I think I am going to see myself reflected back to me in the experience of patients. In almost every patient we saw, I recognized something of my own story in the story of the patients. I empathized with the frustrations of one, the research tenacity of another, the ability of one patient to push through the pain, and realization of a grim future of another. I hope I never lose this empathy. At the same time though, I would give anything for my condition to just disappear by taking some vitamins, most people would, so I don't know how I am going to react when I encounter non-compliant patients. I see non-compliance as selfish, and I feel it makes the role of a doctor almost meaningless.


Needless to say, shadowing was an enlightening experience, which motivated me to submit my AMCAS application on Friday (even though I am still waiting for one transcript to arrive at AMCAS). I also started my application for UBC and the rest of the Canadian applications open up in a couple of weeks. The ball is rolling, and I have started to have nightmares since I submitted my AMCAS application. Looks like it is going to be a long wait until May 15, 2014....


PS Happy Canada Day!!!

The AMCAS Dilemma

On Wednesday, May 8th, just two days from now, I will be able to start my AMCAS application. This is the summer where I officially apply to donate the rest of my life to the practice of medicine, to the art of healing. I'm almost more scared of what will happen if I do get in than if I don't, and if I get into an American school, and not a Canadian one.

Most Canadian schools (or the ones I am applying to at least) drop your worst academic year. The University of Calgary drops your worst year if you have completed 3 full time years (yippee for me!), and UBC will drop your worst year if you have 120 credits (ie, you have completed 4 years). This is where the problem begins. I am in third year, so uCalgary will drop my worst year, but UBC will not. My best chances for admission are at UBC (if I had my worst year dropped, ie the year I spent in the hospital), which would only happen if I applied in the NEXT cycle, not this one.

So, if I complete my AMCAS application, and I apply to the 10-12 schools I have a chance at in the US, and I get into one of them, but not a Canadian school, do I go, or do I wait a year and reapply? If I wait a year, UBC will drop my first year and my GPA will increase (likely) to above admission averages, but my GPA alone won't guarantee me admission. But UBC has a large rural assessment component to the application (which is very much in my favour as I grew up in a town of less than 4000 people), and my extra curricular activities will only improve with the addition of one more year on my application. So, my application, if I were to apply in the 2014/2015 cycle would likely be much stronger, and my chances for admission are higher.

Back to the dilemma, do I submit an AMCAS application? If I get in only to an American school, do I go? My intentions for the past year was that I would apply to US schools, but that was on the thought that UBC would be dropping my worst year, and now that they won't be, I am second guessing. I want to cover all of my bases in Canada, and ensure I have the strongest application possible submitted to Canadian schools before I hop across our southern border.

I want the best chance possible at becoming a doctor and I don't want to miss an opportunity to fulfill my dream, but waiting one more year and getting in to a Canadian school would mean that I would be at least $200,000 less in debt and be able to get a residency spot in Canada. (Plus, I don't have to write step 1, or go through the silly basic science courses that US medical schools force you to go through.)

WHAT DO I DO??? I just want to be a doctor! (Preferably in Canada, and if not Canada, Washington or Oregon state because they are the most similar places to Canada other than of course Canada itself and New Zealand.)

Reflections of Explosions

I was 8 years old when the twin towers fell. I remember that day because up until that morning at school, I didn't even know what the twin towers were, and I pretty sure most of the adults in my town didn't either. I remember waiting in the classroom, practicing my times tables (I was nerd back then too) getting ready for our daily quiz because our teacher, Mr. Collins, was unusually late. When he walked in, he walked in somberly, and slowly. Somebody asked "Mr. Collins, why do you look so sad." Then he told us what had happened, and we were called to the gym for an assembly. I didn't understand why anybody could possibly do this, but what I didn't understand even more was why people were blaming Muslims...how could a religion hijack a plane and fly into office buildings in New York? When I got home from school that day, my parents reassured us that we were safe, and my dad made it a specific point to tell us that it was individuals that caused this attack, not a country, not a religion and that it was not a reflection of the world we live in.

Today, while I was studying for my GI physiology test, I had twitter up on my screen. The first tweet I saw was from CNN, "Explosions at Boston Marathon." When I read the word "explosion" I immediately thought of fireworks or firecrackers, because who would set off a bomb at the finish line of a marathon? Within seconds, new tweets came up that replaced the word "explosion" with "bomb" and then one "bomb" became two, injured became dead, pictures of debris in the streets became pictures of blood in the streets...I felt like an 8 year old again, watching in awe as the world exploded.

As the day passed, and as I continued to follow on twitter, I began to see pictures of people helping people, rather than pictures of carnage. Tweets and facebook posts from all over the world showing support for Boston steadily increased, offers for blood donations, restaurants opening their doors and people offering their couches and spare beds to complete strangers began to trend. This is a reflection of the world we live in. A really awful thing happened today because of the choices made by a few select individuals, these choices have changed people's lives and the world forever, much like 9/11. But I choose to see the world as a whole, because the number of good people will always outweigh the bad.

Bombings like this happen almost weekly in other countries, and I am not trying to belittle what has happened to day in Boston, but a bombing in Boston is no more tragic than a bombing in Baghdad. The people of Boston are as strong, generous and kind as the people in Baghdad. So as we mourn and try and reflect on this day, let us remember that people all over the world have felt the same confusion, sadness and loss as we do today and as we did on 9/11.

Let our prayers for Boston resonate throughout the world to all of those affected by senseless attacks on humanity.

"Do not let the pain make you hate"

I wish I had the strength to follow these simple rules.

"Do not let the pain make you hate." This is a really hard thing to do, for me, its more a physical pain that makes me hate, but I know that is not the case for everybody. I hate that I have to deal with things that everybody else deals with, and deal with the pain. My life would be so much easier if I could just sleep through the night, not spend most of the day feeling nauseous from the pain and not spend huge amounts of time faking to the world that nothing is wrong. I hate that I can't do anything about these things, and I hate that the pain makes me hate things.

I don't know why I have this idea in my head, but I feel like if I ever get into med school that my worries will just disappear. I have no idea why I think this will happen, because likely my worries will triple once in med school. Maybe its because my goal of trying to get into medical school has been the only thing that makes me keep on going despite the pain. What will happen if I don't get in? Well, I think my pain will make me hate the world even more than I already do.

I need to go see my family doctor about sleeping pills....I hate asking for drugs (and there we go again with my pain making me hate things).

Never the answer?

I always here people say to or about a friend, a loved one or somebody that they don't even know that "Suicide is never the answer." (Before you get your spandex shorts in a knot, this post isn't going to be about me contemplating suicide...in fact it is not about me at all.) When people say things like this I find that it makes me almost irate, not because I think suicide is a good option, but because people who say that is not an answer to your problem clearly have no idea what that person is going through.

Today's post is about how a boy, living in my city, thought it was the only option. This boy's story can be read here and his name is Dom. Dom had chronic pain that started when he was 14, and it progressed to the point where it was so badly controlled, that by the time he was 18 he decided that his only option to end the pain was suicide. And now I bet you are thinking that: "No, there must have been a better option, there must have been treatments....there must have been something other than suicide that would ease his pain!" Well, my friends, as somebody who has chronic pain, you are eventually told that there is nothing more that can be done to help you, other than physical and emotional therapy. See, Dom was a teenager, and chronic pain is something that people, let alone other teenagers, can rarely comprehend. They don't understand why you can't just get out of bed and go to that party on Friday night or why you can't go shopping after school. Unless you have chronic pain, you cannot understand what it is like (even if you are a doctor, or a medical student or a personally know somebody with the disease).

Dom made the decision to end the pain because our medical and social system failed him. The only thing that kept me out of the depths of isolation and depression when it all first started for me was that I had teachers who had chronic pain, the fact I was at a boarding school where I was constantly surrounded by people making isolation impossible, I had a doctor who tried absolutely everything to help me and I had my bike. I was lucky to be where I was at the time...luck, pure luck, and without it, I don't know where I would be. Dom was completely imprisoned by pain, without doctors to fight for him or friends to pull him out of the depths of blinding pain. If you where him, would you be okay with having your mom spoon feed you for the rest of your life? Would you be okay with asking you sister to help you put on your socks at 18 years old? I wouldn't.

So don't judge somebody when they decide that taking their own life is the only solution, because for them it just might be. For me, I had decided to find my own solution, to spend my life in the lab trying to fix this problem. I still have hope, Dom didn't. I can tell you that even if you believe people who commit suicide go to hell (which I absolutely don't), hell might just be better than having every inch of your body be on fire all the time.

Just think about it for a moment, what would you honestly do in Dom's situation?

Laughter

The best thing about volunteering at a Children's Hospital is laughter. Its my job, to make the kids, nurses, parents and doctors laugh. When you are volunteering in a respite/palliative setting and with children, the best thing that  I can do for them is to make them laugh. Today I played Uno Jenga with a patient, a nurse, a nursing aid and a doctor. We were having so much fun that we even drew a couple of parents and other patients out of their rooms to see what was going on. I left my shift today and walked out of the door with everybody laughing and smiling. I can only hope that when I am a doctor, I will be able to do the same, to go home everyday knowing that the last person I talked to was either laughing or smiling when I walk out the door. 

Life of a Kid

I had to attend a palliative care training course today, it was depressing, but also opened my eyes to how important the role of a volunteer can be for an individual at the end of life and for my volunteer situation, a family. I volunteer at a pediatric hospice, but its 80% respite care and 20% end of life. I haven't actually been there yet when there was a kid and family there for end of life care, I have just played games and done fun things with kids who have pretty severe and disabling conditions. Every kid that comes through the door (unless they are a sibling) are technically considered to be palliative meaning that they have shortened life spans, but are not necessarily actively dying.

Today also happens to be the anniversary of a pretty tragic death in my own hometown. On this day, 8 years ago, a boy named Chris, who was a year older than me, passed away from a quading accident. We used to play on the same soccer team every year and went to the same school. He was an amazing athlete and would have gone far in life. He was airlifted to Calgary, and stayed overnight in the ICU, and I can remember our principal the next morning going around to each classroom telling us what had happened. It was hard, at 11 years old, to wrap my head around somebody my own age dying from something that kids do everyday in my town, from something so simple as quading at the ski hill with some friends after school. Its hard not to think of who he would have become if the accident didn't happen.

I wish that these kids I play with on Friday mornings could have the chance to grow up to be something amazing, that they would be able to fulfill their dreams.Today was the kind of day that really makes you think about life, and instead of thinking about why bad things happen to people, I am thinking about why they didn't happen to me. Why am I so lucky to be celebrating my 20th birthday in a week when some kids don't even make it to their 5th, 10th, or 16th birthday?

I just need to focus on giving it 110% everyday on behalf of those who cannot.

Peace Like a River.

Training

I pretty much completely stopped training August and then September wasn't so great either, but now that I am part of the High Performance program at the Olympic Oval, I'm back into 100% full bore training plan. I can see what my coach is trying to do, build up the endurance side of things before it snows, then do some testing and then jump into a winter of interval training. But my legs hurt for real after riding 3.5hrs on Saturday and 3 hrs on Sunday. Today is a rest day, and then tomorrow we are back on the bike with another 3 hr ride.

I did actually manage to finish that health and society paper that I wrote about last Friday, and I did learn a few things about myself.  I am one of those people who don't employ any method of coping strategy to deal with the pain, which likely means that I have accepted that it will always be there and that there is no point fighting. I just live my life like I don't have pain, even though I'm pretty sure if somebody was actually using a scalpel to cut open my leg right I wouldn't be able to tell.

Wiriting About Pain

I had to chose a topic for my Health and Society unit research paper. I thought about the whole shabang of health related issues (okay, I didn't think about all of them because that would take FOREVER), and I ended up settling on what I know best, Chronic Pain. I started off wanting to focus on the young adult population, but there is far more research on the adolescent population. And lets face it people, there is no point making an assignment harder than it should be, sometimes you just have to start writing and go where the sea of journal articles takes you.

It is interesting writing on a topic focused on a population that only two short years ago I belonged to. I didn't have chronic pain until my last year of high school, and it was brutal. As I wind my way through the research articles, there is one idea that keeps on coming up, adaptation to pain. People who have lower perceived quality of life and higher scores on depression scales are focusing their lives around ending the pain, rather than living with it. I can attest that focusing completely on the pain and finding new ways to get rid of it consumes your every thought. The pain starts to literally rule your life, and that's how it was when it first started for me. For the first two months, I avoided wearing shoes (I wore flips flops in December and January, and yes, I live in Canada) I rarely went out for our team group rides and I was less involved with my school life. Then one day I woke up and decided that enough was enough, that no matter how much it hurt I wasn't going to stop doing something. Even though my pain levels increased, I was happier.

They call this adaptive behavior. Rather than avoiding the pain, you adapt your life and actions to include the pain. Its like your annoying little brother that follows you around all day, you can't get rid of him, so you have to do things that also include him.

I always wondered why the pain doesn't seem to get under my skin (that often), and it's because I somehow learned to adapt to the pain. I will probably never give up on new ways to try and get rid of the pain, but in the mean time, I know how to live with it.

I found this book conveniently on display in the library today, so naturally I signed it out. Its odd holding a textbook about yourself...

Things I miss

I'm really enjoying all of my classes here at uCalgary, and I am starting to make some friends (at least I think and hope). People in my program are a bit stuck up and a little bit clicky, so its not the easiest task. I feel like I made a dozen good friends in Guelph in a week back in first year.

Today it really hit me that I miss Guelph. As I was desperately running around and trying to complete my research award application before the 4pm deadline today, all I could think about were my friends back in Guelph.

So, here is a list of things that I miss about Guelph:
1. Friends, especially my twin KH
2. The abundance of Gluten Free food on campus
3. The Bullring (which is an extension of #2)
4. The Guelph Transit system and the bus drivers that were oh so nice
5. Proximity of grocery stores and grocery stores that had an abundance of Gluten Free products
6. The Bookshelf
7. Seeing familiar faces everywhere I go
8. UGC (University of Guelph Cycling Team)
9. The UOG campus in general, both the atmosphere and the people
10. The idea that I am missing out on sharing moments in lives of the people that I love, that I am missing out on those stairwell conversations with my room-mates and that we will all slowly grow apart.

Thing I like about Calgary:
1. Smaller class sizes
2. I feel like profs actually want to get to know me, and some of them already do
3. I am being presented with countless opportunities that I would have never gotten had I stayed in Guelph, such as research, research funding, amazing mentors and awesome volunteer opportunities
4. Being closer to home and especially my Grandmother who is still coping with the loss of my Grandpa
5. My condo's proximity to my classes

As you can see, so far there are more things that I miss about Guelph than things that I like about Calgary. I almost feel like I made the wrong decision to go to Guelph in the first place, not because it was a horrible experience or that I regret spending two years there, its that I didn't realize how much I would miss it and miss people. This move turned out to be harder than I thought...

The Swell

I haven't posted in a while because I have been super busy with that thing called work and that other thing called the MCAT, neither of which I fully enjoy. I have been spending a fair amount of time on my bike and the weather is beginning to look a bit more like summer...which is nice because I had clean my bike 4 times a week there for a while.

I bet you are wondering about my good ol' leg eh? Well, truth be told, so I am and so are my doctors. My whole leg below the knee is swollen and spongy like (yuck) with some nice vascular changes (aka my veins are popping out) and a heck of a lot of pain. Now, I know what you are thinking...I should probably stop riding my bike right? Wrong. Cycling doesn't make the pain any worse or any better, but it keeps the muscle spasms in check and keeps me from going insane, so really I don't see any good reason to stop riding.

I have another appointment with my family doc this week...I have pretty much seen him or his locum every week for the past month. There is something not right about what is going on, after the neuroma resection 2 years ago (almost exactly) I knew something wasn't right and everybody just kept telling me it was fine. Then I almost had a below the knee amputation...I don't want to repeat that, this time I am not settling for "don't worry."

On a completely different note, I almost had a heart attack today (not really, but my heart rate went to about 205). I was out for a ride on my usual 65km route, I was just starting up a bit of a hill when all of a sudden this giant thing ran out of the forest 20 feet in front of me, across the road and into the forest on the other side. That is the first time in a while that I have seen a bear whilst out on my bike. It scared me a lot because it wasn't very big, meaning that mama bear might be around waiting to pounce and I was going up hill with a head wind having only spandex for protection. I live in a rural area (obviously) and bears aren't exactly a new phenomena (I'm really not afraid of them) but today seeing that bear with nobody but lil' me around made me realize how vulnerable I really am on my bike.

Pro tip of the day: Bring bear spray when riding in the BC Rockies.

"The best is yet to come"

There were (and still are) thundershower warnings for the day, but they weren't supposed to start until about 5. So I figured a 1 hour 15min ride after my nutrition class would get me home in time, but I was a bit worried that I might get caught in the rain. I hummed and hawed for a bit, checked the weather network about 12 times to make sure nothing was changing, and then finally decided to pull my kit on.

BEST DECISION EVER! You are probably thinking something amazing happened during that 40km ride...well, you would be wrong. Nothing out of the ordinary happened, other than I had one of the best rides I have had since the summer. The wind wasn't too strong, it was 20 degrees Celsius out, but not too sunny and it was humid so the air just felt nice. I raced a bus for about 3 km, and won, I did a few hill repeats and it felt great. There wasn't too much traffic out, so I was able to avoid all the rough patches in pot holes in the road and take the smoothest routes across the train tracks.

What made this ride even better was that my ankle didn't hurt so much and my leg felt strong, allowing me to pedal at a higher cadence and a lot smoother than usual. I actually felt like I was flying, not riding a bike. It was just simply an amazing feeling.

I also just came back from an Athletes in Action seminar (an organization that helps your faith to growth through your sport) and the speaker was John Hood. He is a member of the Hamilton Tiger Cats CFL team. He shared with us his personal story and struggle to make it to the pros, and that not everything worked out the way he had planned. Despite having things get in the way of his dream, he just kept at and kept faith that everything was happening as part of a bigger plan. And that everything that happened to him, although it may have been perceived as a set back or negative when it was happening, actually made him a more determined person and changed his life for the better. 

His talk really helped me to see and begin to understand that maybe everything that is happening and happened to me, namely chronic pain, is actually what is shaping my future and may actually be providing me with a path to reach my dreams. Its not the path I mapped out, but its a path that was hidden and waiting for me, and all I need to is have faith and follow that path, taking each opportunity as it comes and making the most of it.

As John Hood said, "The best is yet to come," and I chose to believe that he is right, and I will not stop working towards my dream of becoming a doctor. Whatever gets in my way is only preparing for what has yet to come.

"I've Been Fighting Things I can't See"

I have been listening to a lot of Switchfoot lately, specifically their new album Vice Verses (if you haven't listened to it you should check it out because its wicked). Its helped me think things through a little bit, sometimes music does that.

I have come to the realization that I am depressed because I am tired of trying to pretend to the world and to my self that my pain doesn't exist. It does exist. If you are somebody who has chronic pain that is reading my blog then you are likely 100% familiar with this. See, for me, sometimes I think to myself that there is noway that this pain can be real, how can something that science can't explain, something that you can't see or understand hurt so much? It must not be real, if imagine that its not then it won't be, and if I hide the pain from people around me then they won't know that it exists, which will give me more reason to believe it isn't real right? Wrong.

Before Dec. 19th, before I saw the surgeon in Vancouver I thought I had CRPS II, which is essentially something that you can't every really get rid of, if you are lucky you might get 2 years where you go into remission.To me, this type of disease seems like something that cannot possibly exist. No origin, no defined treatment, not certainty of a cure...seems like something that shouldn't exist right (it is real thing, just nobody can really explain how it happens quite yet)? Well, it does, but now that I have been diagnosed with a "Persistent Neuroma Syndrome" it made it real. A neuroma is something that is tangible, it has an origin, therefore the pain has an origin, therefore I can't pretend like it doesn't exist anymore because my logic is no longer an escape route.

Basically I have been hit the face with the truth, that my pain is 110% real. (Please don't get the impression that CRPS pain is not real, it is, very, very, very much so, it is just hard to grasp where the pain comes from using logic, I guess that is why they call it Complex Region Pain Syndrome...cuz its too complex for the most intelligent among us.) The diagnosis of a persistent neuroma syndrome is very much a blessing because it means that surgery is a treatment option for me, it also means that I could wake up from surgery completely pain free (well, obviously surgery is painful, but I mean after all that heals). At the same time, I have been forced to admit that my pain is not a figment of my imagination.

I've been fighting things I can't see. Thrive, by Switchfoot.