Sunday, 23 April 2017

I See You Little Bones

My husband made chili and homemade biscuits for supper. This has absolutely nothing to do with the rest of my post, but I just wanted to document somewhere that he actually made biscuits using my family recipe, and did an amazing job. He keeps saying he can't bake, but he keeps proving himself wrong.

Anyway, to medicine.

For my final assignment for my ICU rotation - which was a fantastically educational rotation to have done - I have to write a two page reflective paper.

This is not what I would call a challenge, given my tendency to reflect at length about absolutely everything (incidentally this is public post number 1060. I have 142 in draft.) The question was which topic to pick of the many I identified whilst there. Eventually I settled on something that might quirk a few eyebrows, but I think provides very strong material for reflection. Only problem is that I've written three pages and have to trim it down.

Damn my prolix nature.

Next up is ortho, which feels like it is going to be rather intimidating. Ortho is not my natural milieu, and I had a baby three days after the end of that unit so most of what we did has gone completely out of my head.

This is a bit of a problem with all these two week rotations. I just do not have enough time to learn and actually absorb information before I'm onto the next one, and I have no time in each of the rotations to really absorb and apply the information. My exam for ortho is ten days into the rotation.

I'd planned to spend this weekend studying intensely, but between my husband being at Cub camp with our son yesterday, spending the evening in emerg with the wee one for x-rays (she's fine! Just very sore after her big sister tried too enthusiastically to get her to roll over again and accidentally twisted her backwards onto her arm. She can't move it very well, but it's not broken) and feeling just awful today, I've not gotten as much studying done as I'd like and I feel like I'm going to show up and be a huge idiot tomorrow.

But then I feel like that for every rotation, and so far only one preceptor has actually thought I'm an idiot. Or has at least expressed as much.

As for now, I'm going to go listen to some Tragically Hip (I'm doing paediatric ortho...) and read about classifying fractures.

Tuesday, 18 April 2017

Finding Silence

After my current rotation - internal med selective - I have my ortho rotation and then I'm done with two week rotations until my electives this summer. Because I had a 6 week elective block followed by my anaes/selective/ortho block, I'm doing six 2 week rotations in a row.

It's nice to rotate through a bunch of services and all, but by the time I've learned how things are done on one unit, I'm moving onto another. I have three days left on this rotation - I've only done 6 because of the holiday weekend - and I'm just now getting to the point I feel like I'm able to comfortably do actual work that contributes to the team instead of primarily learning through observation or needing to be babysat through my work.

This is also just a really, really awful week for me right now. M is not sleeping at night and while I try to trade off with my husband so that at least one of us ends up well-rested, many nights neither of us is getting much sleep. I'm averaging probably 4-5 hours a night for the last 2-3 weeks, and that's really not an exaggeration. I can usually manage fine on that for a couple of weeks, but I am reaching the point of exhaustion saturation and I desperately need a reset.

I also have pretty much no downtime at all. I come home from work at 5-ish. Hang out with the kids, maybe catch up a bit on Facebook while my kids do their homework or use their screen time allowance, eat supper, play with the baby a bit while my husband gets the older kids to bed, and then I study until around 11pm, get ready for bed and lay out my stuff for the next day, then crawl into bed around midnight. Often the baby wakes up right around then, so I nurse her back to sleep (I'd have to pump if I didn't) and then get her settled right around then.

Then I get up around 5:30-6am, shower and dress and get to work for 7-ish.

Weekends are spent with my family, evenings once kids are in bed are spent studying.

I am almost never alone. Usually I'm nursing while I study, or I'm attempting to spend time with my husband - well, at least in proximity to my husband if not actually interacting with him - or I'm with the kids.

This weekend I took two hours - during the day when the kids were awake, at that - and went and played video games in the bedroom. All by myself for two hours straight. And I realized that was actually the longest stretch of time I had spent alone not doing something either for school or my family since I got back from Ottawa almost two months ago.

My exhaustion is coming across in my functioning at work (school, whatever.) I'm not performing at the level of which I am capable because I am so tired.

I think this weekend I'm going to just shut myself up in my office for one day and just do nothing.

Sunday, 16 April 2017

Will I in the Quiet Moments

I'm sitting here, nursing my baby who will be 6 months old tomorrow, and trying to figure out my plans.

I had my pre-CaRMS career counselling session last week and it went fairlywell. The counsellor said he's confident I could match to OB if I choose to go that route, but said he understands my concerns. My problem is pretty clear and I explained it to him: the career path I want is not really the best career path for me to take for my family's sake.

When I've asked some staff about it, I've gotten very encouraging and positive advice about pursuing what I love and the fact that residency is working as a doctor even though you're still a trainee. It's all reassuring and all but the fact of the matter is that most of them did not have school-aged children when they started residency. Several I spoke to did start their families during residency, but that's very different.

As much as it sucks to be super busy during your child's earliest years, the reality is that they probably won't remember it very much if at all. My kids are old enough that a long residency is going to happen during a very significant part of their most formative years. When they are adults they will remember me being in residency and I cant help but worry that they will look back on those years with sadness.

I realize an OB/gyn residency is 'only' five years compared to the 25-35 year career I'll have afterwards, but my kids have their entire adult lives to come and I don't want to negatively impact that.

My kids will be 16, 12, and 6 by the time I finish a 5 year residency. I've been in school since my oldest was 5, my second wasn't yet two, and my youngest was still an arrested primary oocyte.

It is extraordinarily tempting to choose the relatively easier path (no path in medicine is easy, but some are shorter) and go for family medicine, apply for a sponsorship so I graduate with less debt, move home next year when I graduate, and finish my training back on the Island. Then start in family practice, work a relatively normal working lifestyle, get to know my patients extremely well, be there through the trials and triumphs of their lives. See my youngest patients grow up and then care for their children. Leave clinic at 4:30 or 5 and spend every evening and weekend with my family.

But I would have to give up managing deliveries (family doctors don't really do deliveries back home,) and scrubs and my ugly-as-sin waterproof clogs - that I totally love because they're so comfortable - and surgery. I wouldn't be walking the halls, room to room, ushering babies into the world and women into motherhood. I wouldn't be in the operating room doing that somewhat ridiculous but eminently ritualistic dance to close my gown.

As much as it surprised me to learn it, I fell in love with surgery and the thought of spending the rest of my career without seeing the inside of an OR on a regular basis is more than a little disheartening. I think I could be happy in family med, in that it's a good job and it is medicine so I can be there to help people with their health. Family doctors are extremely important for tying everything together for patients, for being a first and major point of contact for the rest of the health system. If I match to family, I won't be depressed about it or anything.

But if I pursue family exclusively, I wonder if in those quiet moments after the patients are gone for the day, when I sit back in my office with a tea and a digital stack of lab results to review,  will I look back wistfully at the choice I didn't make, or will I be satisfied with the one I did?

I've given myself until the end of June to decide.

Sunday, 9 April 2017

Breathe In, Breathe Out

Anaesthesia is done, but I'm right off to ICU Medicine starting tomorrow.

I've been spending much of this weekend studying. Well, trying to. Also trying to find time for my family. My integration of concepts is simply not where I want it to be, and I really need to go back to basics in some areas. This means lots of reviewing to make sure I don't hesitate and doubt myself constantly when asked something. 

I did get feedback during my anaesthesia core that I need to work on my confidence. This is something  I really struggle with. Im always pretty sure that everyone around me is completely annoyed by my presence and that the best thing I can do is shut up and get out of the way. I feel the need to apologize for my presence, for the space I take up.  

While I realize this sounds irrational, this is what social anxiety does. It sucks. I realize it's not normal, but at the same time, I've spent most of my adult life trying to fix this and haven't managed to yet. It's quite frustrating. 

But the preceptor I had on Wednesday night was right; I need to find confidence. Or if I'm not able to actually have some, fake it. "You have to show confidence," she said. "You're the doctor now."

The lack of confidence is sometimes paralyzing. I have all this knowledge in my head but when a preceptor (or a peer) asks me a question to assess my knowledge, I stumble and doubt and sometimes end up saying the opposite of what I mean and I make an idiot of myself even when the question is something I know extremely well. It's not a problem with patients, funny enough, and I have no problem at least faking confidence when I'm with patients, but with preceptors and sometimes peers, I'm so self-conscious it's painful.

I'm also still very much finding my feet in clinical medicine. I find it very jarring to move from staff to staff, to never know how they want things done, to do something on Tuesday that I was told to do on Monday and have my knuckles rapped over it. I understand it's the nature of the training, but it's really aggravating to feel like you're constantly wrongfooted and useless.

It's a matter of getting comfortable with it all, I know. I'm doing stuff now that I simply do not know as well as OB/Gyn and I have to do better with accepting that I won't and can't be as strong in everything as I was in my favourite discipline. I need to be okay with 'okay.'

Might take me a while to get there.

In the meantime, here are my girls being cute. M is pretty much in a constant state of happy flailing so it's hard to get photos where her limbs aren't blurry. 


Monday, 3 April 2017

The Minutiae

Med school, like med life, comes with a lot of paperwork.

Fortunately, the school is nice and organized and reminds us with plenty of time.

Also fortunately, I can submit my prenatal blood work from last year which will cover a bunch of the new requirements. It's quite possibly the first time having had a baby during med school has saved me time.

I've ordered my vulnerable sector check (which can be done online, yay!) and so all I have to do is do my TB testing since I think I'm considered as having exposures now because I've had clinical placements in hospitals with more than 200 beds.

My current placement is going middling to well. I'm not at all a natural with anaesthesia and feel very wrong-footed a lot of the time because I'm not confident in my knowledge, but I need to develop that. The way the rotation goes is that we work one on one with a different staff anaesthesiologist every day. Unfortunately it doesn't give them long to get to know us, so if you have a bit of a weak day, which everyone does now and then, you don't have the opportunity to improve on your performance for that preceptor.

It also means you're in a constant state of unsteadiness because different staff want things done differently. Basically, no matter how you do something, there's a pretty good chance you're not doing it to the preference of your staff. Not that it's necessarily wrong, but that it's not how they want it done. It's a bit tedious to learn each person's preferences each day, but I can understand that everyone has their own way of doing things. It would be nice to have a single preceptor for this rotation, though, and I think that's likely the feedback I'll give at the end of it.

You just don't have enough time with any one staff physician to get to know how they do things, and they don't have enough time with you to get to really assess your abilities.

After this I'm off to ICU for two weeks, then orthopaedics. ICU feels more than a bit intimidating and I feel like I'd feel more comfortable with it if I were doing it after my medicine rotation. Ortho looks quite interesting - I've been on the other side of the drape for several ortho surgeries - and it'll be nice to have a better view for those cases.

Overall I'm still really getting to that point where I feel like it's okay for me to actually do things as opposed to just observing or being taught via discussion. It's quite the transitional period and I expect it'll be a while yet before I really feel like part of the care team as opposed to a somewhat annoying outsider who asks lots of questions.


Look how big she is now!

Saturday, 25 March 2017

Pink Fluff and Career Stuff

My bird is still alive. After my last post, he took a turn for the worst and we were pretty positive he was going to die. He couldn't hold himself up well. He was shaking. We kept him on a heating pad, under his basking lamp all night, on the couch with us. We figured the best we could do is ensure he wouldn't die alone, in a cage. 

He survived, and that morning I noticed something thanks to my experience with birds which lead to us getting a med that has turned things around. 

So thanks to a lot of intensive care - tube feeds, crop washouts, IM meds at home - he's still alive and is actually improving. He's on six different medications, but he's doing surprisingly well. A week ago he was so emaciated you could have cut paper with his keel bone, but in the last few days he's gained back over 15% of his lowest body weight and he's got his attitude back (which includes taking swipes at me.) Birds with this disease never live their normal lifespan, but a rare few have survived a few years with it, so there's some hope we may be able to manage this long term. 

There's my update on the fluffy roseate dinosaur. 

The aforementioned fluffy roseate dinosaur, at the vet's office. He climbed up onto my shoulder which just does NOT happen. 


Now, to medicine. 

I've now finished my last OB/Gyn elective and have wrapped up three straight months of OB/Gyn (which for the rest of this post I will shorten to just OB.) I figured this stretch would decide for me once and for all whether I want to apply to OB. 

Well, I definitely love OB. All of it. I think I can handle the lifestyle too. 

I am not positive I can handle assisting in vaginal surgery. Specifically assisting; I think I could handle being the primary just fine, because then you're seated or standing straight. But assisting in vaginal surgery means being stooped over, half under the patient's leg, twisted sideways, with your arms outstretched, retracting without moving for hours at a time.

Spending 7+ hours in one day in a position that seems especially designed to be excruciating for someone with pre-existing back issues is... not optimal. My back has been screwed up since a bad fall I had when I was 15. I manage just fine most of the time, even though I deal with pretty much constant pain from it, but sometimes have to be a little extra cautious with my movements. 

There is a LOT of assisting in vaginal surgery during an OB residency, as one would expect. I am honestly not entirely sure I could handle five years of doing that regularly and I worry that I might make the already chronic pain I cope with so much worse. 

That's my one big hang up. I have no worries about my ability to manage the other requirements of the job or training for it. The five year residency is certainly daunting, but I'm up for it. I just feel so at home in OB. It's the part of medicine that comes to me most naturally, that I have the most interest in, that feels like where I belong. I don't want this one thing to hold me back from it, but at that same time, I don't want my career to disable me. 

I've given myself a deadline for making a decision about what residency/ies I'll apply to. End of June. That gives me time to apply to the family medicine sponsorship if I do decide to do family med instead. 

Thankfully my school has us have a mandatory career counselling session and mine is scheduled for early April, so I'll be able to get some feedback on my thoughts, I hope.

It's hard to believe that in less than a year I'll know what kind of doctor I'm going to be. 

Sunday, 19 March 2017

Under the Lights

I've been baking this weekend. Probably not the best past time, but enjoyable nonetheless and quite honestly I'm baking to feel like I can do something useful. 

We have our cockatoo home now, but he's dying. We're basically doing palliative care and waiting for him to die. There is a small, vanishingly small, possibility his illness may remit for months to years, but it's highly unlikely with him as sick as he is currently. He does not seem in pain at all or we would have him euthanized. He's enjoying eating his favourite foods, and spending time under his heat lamp and snuggling up to us. He's very sick, but essentially on a slow downhill trajectory. If he goes downhill fast or seems to be in pain, we'll call our vet to come to the house to euthanize him. As it is now, we're just trying to let him enjoy the rest of his time with us. 

My kids are learning some important lessons through helping take care of Gallifrey. We're coping with some big emotions, as we'd expect. 

I wish I could make this better. If he were human, there would be options. The virus would be better understood. The treatment options would be better than "we think this might help, so that's what we're doing." 

This illness - formerly known as macaw wasting disease, then PDD, then ABV, and now avian bornavirus ganglioneuritis - has been around as long as I've had birds. The virus is everywhere. Almost every flock will have a bird or two who carries the virus asymptomatically. It's somewhere around 25-40% of pet birds who have the virus. Whether it will progress to a clinical syndrome, as it has done in my bird, is unpredictable. This is the most likely time of year for it, because they're entering breeding season and the hormonal activity is stressful. 

I've been poring through what little literature I can find to see if there's anything else we can do, but he's already on the generally accepted treatment regimen that, in some birds, helps them live for years longer. 

It's pretty obvious he's not going to live for years more at this point. He's hanging out under his heat lamp and eating a bit. We're feeding him some hand feeding formula as easily accessible calories and fluids. 

We've done our best by him, and that's all we can do. Now we just have to help keep him comfortable and let him pass in his own time, in his own space, where he is happiest. 

He needs a bath, but I'm hesitant to give him one because he's having trouble maintaining his temp already. :-/




Wednesday, 15 March 2017

Vale Viceni

And just like that, I'm thirty. 

It has not been the most festive of birthdays. For two reasons. The first is that a friend's husband died on Monday. It was one of those extremely sad cases of stage four cancer out of nowhere followed by a rapid decline over a handful of weeks. A group of friends are all trying to support her; I absolutely cannot imagine what she is going through. They'd just had a baby a few months ago and so it's just an absolute mess and I'm feeling very sad for her and can't help but spend some time having a bit of a deep think about life. 

Beyond that, my cockatoo is very ill and is probably going to die. He's been at the vet since Sunday. We went to see him this evening and he's very, very ill-looking. It was quite sad to see him so poorly. He perked up and said "hi!" when the tech brought him in to see us, and we spent some time with him. 

This is the hard part about pets. Even when you take very good care of them, things happen. With birds in particular, there is often very little you can do. Last year, when we tried to save our cat, there was at least an aggressive course of action we could have tried to see if we could save her. With a parrot, there's little research on treatments so you just kind of have to hope that what you try will work. I've kept birds for twenty years and I have often not had access to an avian vet so I've had to learn some avian medicine and I can comfortably manage some stuff, but I'm very glad to have an actual avian vet guiding us now. 

It's just very hard to see him so sick, and to know it's probably not going to get better. My son dearly loves this bird - as do we all, but he's very close to him and few other beings - and I know losing him will be hard. 

So this has not been the best week. The fact that it's only Wednesday is not very reassuring. 

This will be a good week to see the back of. 


Sunday, 5 March 2017

Catching Up

This is the longest I've gone between posts in a while. The reason why is that I honestly just got really sick because of my stubbornness.

It took me 14 hours to drive home from Ottawa - a five hour drive - because I kept having to stop to sleep.

I had strep throat (lab confirmed) which essentially knocked me off my arse. I ended up with a fever on and off for five days, though basically medicated myself into some semblance of functionality for the bulk of it and since then I've essentially been asleep any time I've not been at work. I come home at the end of the day, get my stuff ready for the next day, and go to sleep.

In the last week and a half, I've spent almost no time with my kids, have let the ball drop on several commitments, have let pretty much every single thing in my life fall apart, and I'm still outright bloody exhausted. Clearly, I need time to recover that I simply don't have. It is taking absolutely everything I have to be at my best while at work and I have nothing left by the end of the day. It's a damn good thing I don't have call right now because that would just be a mess.

My current elective isn't even that physically demanding. I'm walking around most of the day, but that's hardly taxing. I'm at a fabulous clinic with some absolutely amazing staff, and some really wonderful residents I'd already come across. It's honestly a really good experience and I am very much enjoying it and am learning a whole lot. I just wish I wasn't so tired.

This is honestly making me wonder if I have what it takes for a surgical residency. I am so exhausted from a stupid strep infection because I didn't have enough recovery time. How will I manage being sick during residency? What if I have an asthma exacerbation and end up in emerg because I can't breathe, or there's a flu outbreak? Maybe OB/Gyn is a better option because I'll mostly be working with otherwise healthy patients? I don't know. I'm too tired to think very rationally right now.

I am planning to see my doctor about my currently disproportionate level of exhaustion since I have a day off coming up. My schedule for my next elective just kind of worked out that way, so I'm cramming all of the errands I need to run into one day because time off on weekdays is rare. Probably not the best plan, but there's no real way around that since I have time-sensitive things that need to be done.

As for the moment, I'm going to go lay out my clothes for the morning and then get to sleep. Have to be up at 5:30.

Thursday, 23 February 2017

By the By in Bytown

I've really been enjoying my elective here. That is, until today.

I woke up feeling a little off - just that sort of half-sick, not quite awful feeling. My throat was a bit scratchy but that often happens in the winter. So I just got on with my day.

By noon, I'd spiked a fever (max temp I measured was 38.8) and was shaking and sore and my tonsils are scarlet and awful looking. Centor Score: 4. 53% probability of strep pharyngitis.

The residents I was with, understandably, had me leave. I'm holed up in my hotel room, under a pile of blankets, feeling pretty sorry for myself. I have bottles of water, acetaminophen, benzocaine lozenges, and my pajamas.

I only missed 4 hours of today, and my residents said I could return if I'm afebrile tomorrow so I'm just trying to will my body into health. There's sort of an unspoken "Thou Shall Not Take Sick Days" culture in medicine (I actually was told explicitly by a physician that doctors can't take sick days so I suppose it's not truly unspoken.) It's understandable, particularly for specialists who might have patients waiting months or years to see them. Cancelling your clinic or OR day may result in unacceptable waits for rescheduled patients.

But I'm just a student. The care I deliver is not so critical that my being absent for an afternoon will cause unacceptable issues for patients, and it's just plain irresponsible for me to stay there if I could make a newborn sick because they go downhill reaaaaally fast.

I'm hoping that my fever breaks overnight because I really, really want to work tomorrow. I had planned on returning to Hamilton tomorrow after work, so I didn't actually book my hotel for tomorrow night. I have to check out in the morning. But if I end up working a long day tomorrow to make up for today, I'm going to need to sleep before I make the 5 hour drive back. Honestly may just kip in my car for a few hours, or ask a friend if I can conk out on their couch for part of the day.

Right now I need to get my hotel room ready for the morning. Have to take my suitcase out to my car and lay out my clothes, make sure I've done my going-over of the room because I would hate to forget something.

It's been nice being back in Ottawa. I like this city a lot, and have missed living here more than I realized. I'll be a bit sad to leave, to be honest.

I just really hope that I'm feeling better in the morning so I can at least work on my last day here.

Wednesday, 15 February 2017

Happy Birthday!

Today is my husband's birthday. I'm rather sad that I can't be with him tonight. He's sick, and the baby is just getting over being sick herself, so he's also tired. But from here I couldn't do anything for him for his birthday and I'm sad.

I will be seeing the family tomorrow. My husband is driving up with the kids tomorrow evening. I'm switching hotels as well, since this one isn't really ideal for having the whole family here for 6 days, though it's been workable for me for the last few days. It doesn't cost much more, but I wanted to save money where possible. There's actually a program that reimburses clerks for travel for one elective per year within the province, so I'm going to be reimbursed for my travel and accommodations, but I still wanted to be reasonable with my costs (even though my nightly rate at both hotels is below the cost limit.)

I'm a bit tired at the moment but it's more because I'm not sleeping well rather than anything to do with my elective. I'm not doing any call or anything, so it's just a normal 7-5 schedule (which I find amusing. A 'standard' week is 50 hours. Plus whatever call shifts you are scheduled for.)

The residents and staff I've been working with are amazing. Not that anyone at Mac wasn't awesome, but I really like the atmosphere here. It's different. Not better, but from my first few days I think I've just gotten my feet under me a bit better. I also really like being back in a bilingual environment. It hadn't occurred to me until I got here how much I'd missed hearing French regularly. My expressive fluency has also taken quite a beating over the last couple of years since I've not had many opportunities to speak with adults in French, so it's nice to be where I can use it. I think my desire to come to Ottawa for residency is certainly increasing.

This is a good city. My husband grew up here and I did live here for ten years, so we both know it well. While we did move to my home province after some rather difficult events (I knew multiple people who were murdered in a very short period) I have always liked Ottawa. Plus I know my way around well enough.

I'm very excited for my husband to get here tomorrow and be able to revisit his old stomping grounds and see his old friends. I think he's been wanting to consider coming back here himself, so I have a feeling he'll agree with me that this'd be a good place to go.

Not that I have complete control over that.

Still, it's so-far been a good trip. I'm enjoying myself. I just wish I could be home with my husband. At least the kids insisted he buy a cake, so they had that for dessert.

Sunday, 12 February 2017

Canadian Warp Speed

Ever driven quickly through heavy snow? My husband and I jokingly refer to this as going warp speed, because the effect is similar to how they illustrate entering warp speed on Star Trek.

We're nerds and we make no apologies for that fact.

I'm just settling into my hotel in Ottawa right now, having washed off the road after a very long drive. According to Google, the drive should take almost exactly 5 hours from my house to this hotel. I left my house at 1pm. I got here at nearly 10pm.

The weather sucks.

At the moment, I'm just reviewing hospital policies and my orientation guide for the morning. I am very much looking forward to getting started on my first visiting elective, though I am quite nervous. This is definitely a program I'd rank very highly, given the opportunity, but I know sometimes Mac students have a bit of a reputation of being less prepared than other clerks. It's something I've only really heard rumoured, and seen on the Internet, but I can't help but worry. Not only am I only a year and a half into med school, instead of 3+ the way other clerks on visiting elective would be, I only have one core under my belt at this point. I'm still learning the ropes as a clerk.

But I just have to roll with it. I think I'm very strong material-wise for this specialty, but it's the ins and outs of being a clerk that I'm still navigating. Learning exactly what is acceptable for me to do on my own, what residents and staff expect me to take initiative on, how much I'm allowed to do paperwork-wise before having something checked or signed off ahead of the next step. I know some of this is going to vary service to service and place to place, but I don't even really have a range of what's normal at my home school yet.

I generally prefer to lean towards 'check more/don't assume too much' but I know that can annoy residents and/or staff. I don't ever want to overstep, but at the same time I don't want to create more work than a clerk should.

It's a bit of a balance, and one I'm still working hard to find.

Still, we'll see how things go tomorrow!

Monday, 6 February 2017

Delivering Futures

I finished my last OB/Gyn core clinical shift yesterday morning. While I'm glad to have a bit of a break from clinical activities for the week, I'm looking forward to getting back to it next week.

OB is definitely an incredible specialty. Mostly fun, but it's also sometimes very sad.

During my time there, I saw the alarm activated for obstetrical emergencies more than once. It was incredible to see the nurses all swarm together, the residents jump to action, everyone finding their way to a place of usefulness (while I stayed out of the way as much as possible, which is how a medical student can be useful in these moments.) I was not in the room for the emergencies, but just seeing how all of these experienced care providers reacted to hearing that sound was pretty amazing. Everyone drops what they are doing to leap in and help these patients.

That is medicine at its most raw; when everything else takes a back seat to preserving life and limb. Time is brain. Especially for those tiniest brains connected to life by a half inch rope of jelly.

As a final assignment for this rotation, we have to write up a paper on an ethical scenario we encountered. I'm not having trouble finding one - I'm having trouble deciding which one of the many to write about. It's due tomorrow and I am absolutely not at all feeling bad about the fact that I haven't done it yet since I have been thinking about it.

The case I think I'm going to write about is one that was one of my two personal test-cases. My "if I can handle this, I think I really will be able to handle becoming an OB/Gyn" cases. I thought about writing about one of them here - in a roundabout, many-details-changed-for-privacy sort of way - but I decided against that since I don't know that I could sufficiently anonymize the story.

My thought about how much I need to change something for privacy before I even consider talking about it here is that I want to change it so that if the patient themselves were reading it, they would not recognize that I am writing about them. Because I'm still so new to clinical activities, I don't think I'm reasonably able to do that yet, so I will always, always choose to just not talk about a case rather than risk even the slightest possibility of posting something I shouldn't.

The only detail about the case I think I'm comfortable sharing is that it involved one of those difficult decisions that is unique to OB/Gyn: how much do we risk this patient's outcome to improve the potential outcome for that patient?

I suppose other specialties might see that in roundabout ways when they're dealing with resource limitations or in something like a mass casualty situation, but I think it comes up far more often in obstetrics. Really, it's interlaced with everything in obstetrics. The risk/benefit balance goes four ways instead of two.

The case I saw that most challenged me wasn't the one that I'll be writing about for this assignment, but it has been on my mind a lot. It was a cruelty of nature, not a failure of people or of medicine. Mother Nature is not a benevolent matriarch. I'm comforted, though, by the fact that there are so many skilled hands, at the ready, prepared to dive into the action when that alarm blares, when nature fails, when the blood hits the floor and all else is forgotten, to guide tiny lives through troubled moments and into the arms of their mothers.

That is where I want to be.

Wednesday, 1 February 2017

Chalkdust

On the wall outside a theatre back home, there was a big, black chalkboard. I think it may be gone now.

Up top, it said "Before I die..." and the remainder was a blank field of possibility. A box of chalk was attached to the wall nearby, tempting passersby to share pieces of themselves.

A few years ago, I was walking by and I stopped and read some of them.

Before I die...

...I want to get married.
...I want to have children.
...I want to go to Disney World.
...I want to have tacos for supper every night for a year.
...I want to see my children grow into good people.
...I want to fall asleep beside my wife every night.

They ranged from the mundane to the absurd. Some were clearly there as jokes, and some were profound.

I found a scrap of space where the ghost of someone else's confession remained in the scattered dust and with the dry rasp of chalk on slate I added my own words in a vibrant yellow cursive.

Before I die... I want to become a doctor.

So here I am, fifteen months from doing just that. I wonder if other people read that and thought it sounded silly. Or if they saw it and imagined some hopeful youth, in high school perhaps. I doubt someone would see that and imagine an exhausted, poor, fat, overly anxious woman who runs herself ragged between school and work and family.

I don't think I'm anyone's first mental image of a medical trainee.

But here I am.

In the last weeks, I have had the immense privilege of helping care for people, and there is no part of it that I have not enjoyed. I love deliveries, I enjoy suturing. I like observing surgery. I like assisting with surgery (even though at my level of training 'assisting' means suctioning, cutting sutures, retracting, and sometimes helping close. Still cool, though.) I like talking to patients and their families. I like rounding.

I like all of this.

Even the paperwork. Once I figured out what needs to be done, I'm glad to do it. I know the residents and staff have less time for that part of things, so I'm glad to do it to get in the practice.

I've not yet encountered anything that makes me go "ugh, not again." I realize it's only a few weeks so everything is still fresh and new to me, but I can easily picture myself doing this all the time. Days in, days out.

I do not feel that way about every part of my other clinical exposures. I think it's telling that I'm at the end of my core and I am really, really happy that I have 6 more weeks of OB/Gyn ahead of me.

Before I die... I'm pretty sure I want to be an OB/Gyn.

Perhaps, when I'm home for my two week emerg elective this summer, I'll take a walk downtown and see if that chalkboard is still around.

Sunday, 29 January 2017

Sowing

I don't typically post about politics on here. Just reading my blog, one might think that I'm one of the many people who distances themselves from disagreements that happen because of political beliefs, but I'm not. I so am not. There's a video out there of a rally I attended where I'm up speaking - holding my baby daughter on my hip as I spoke to a nodding crowd through a megaphone. That is who I am.

My blog here has always been intended as a relatively neutral platform. I think I've commented on my political leanings only once, in passing, when encouraging people to vote.

But today, I am breaking with my nearly five years habit and I'm writing a very political post.

With about a quarter of my traffic being from the US, this is for you guys, but I'm reaching out to my Canadian readers too because I expect that like me, many of you have a lot of American friends and/or family.

Ahem.

RESIST, DAMMIT!

Last night, someone I know well - an incredibly sweet soul of a woman - posted that she cannot now legally enter the US because she holds a dual citizenship. Born and raised in Canada, but because she is a child of two countries, she is unable to cross the border. While last night's judicial stay means she could now, it is temporary. It's a bandaid on a bullet wound. There is so much more to do.

I have friends with complex medical needs who are terrified that they are going to die because they are going to lose their insurance and, with pre-existing conditions, be unable to get any more.

The reinstatement of the Mexico City Policy means that money that helps save the lives of women and babies will be withheld. It means that while paying lip service to protecting life, the US government is willing to withhold funds that go to prenatal care, emergency obstetric care, contraceptive care. They so disagree with abortion that they will let women bleed to death in childbirth, or suffer from labour so obstructed for days that they die of infection because they can't access a C-section.

Trump tells the media that the US should "take Iraq's oil." He said that maybe they'll "get another chance" to do so. A president, standing in front of the cameras of the world and telling people that national policy should be theft of resources. There is little else he could say or do that would more thoroughly damage the tenuous relationships between Americans working in Iraq and the people there. He has painted targets on the back of American servicepeople overseas.

People call him stupid.

He's not stupid.

He plays the fool to make people underestimate him, but it should be clear by now that he's good at playing the long game. He is a shrewd and calculating man, well practiced at pulling strings. His actions, I am almost positive, are intended to try to provoke actions that he can use to justify further violations of human rights. It's as though he's drumming up for war. I dearly hope I'm wrong about that, but as the days pass, as he insults more and more governments from the comfort of his office, as he authorizes rights abuses, my apprehension grows.

The US is a nation built on a base of protest. The most beloved stories of that nation are of people resisting unjust rule, of fighting against tyranny. Attend rallies. Support with your voice if you can't with your funds. Write emails. Sign petitions. Make phone calls. Talk to people. Show kindness in the face of hatred. Show inclusiveness in the face of exclusion. Sow love where hate grows.

The narrative of America is one of resistance from its birth, and the seeds that grew to revolution are still there. Water them.

Rise up.

Resist.

Some Resources:

The Council on American-Islamic Relations: https://www.cair.com/
- Helping to protect the rights of Muslims in America.

The American Civil Liberties Union: https://www.aclu.org/
- Has been helping detained persons access legal protection.

This page has summarized a number of resources and ways to get involved (primarily for Americans) on the immigration issues:
https://www.thenation.com/article/how-to-fight-trumps-racist-immigration-policies/

Donate to the Planned Parenthood Federation of America: https://www.plannedparenthood.org/ or
The International Women's Health Coalition: https://iwhc.org/

This is just a tiny sprinkling of resources. There is so much more that can be done to counteract the harm that is going to be done by this administration. Check out the Bill & Melinda Gates Foundation's projects, spread the word about the GAVI Alliance since even vaccination will be under fire.

While I'm aware this is drastically out of step with my usual posts, I can't not say something as I watch malignant nationalism metastasize in the very last place it should ever take hold.

Saturday, 28 January 2017

When Demand Outstrips Supply

I have all of today and all of tomorrow off. I'd only had one day off since the 9th of January, so I was getting pretty run down. I got 7 hours of sleep last night and then took a 4 hour nap this afternoon. For the first time in about two weeks, I actually feel pretty normal.

This schedule has meant a lot less time with my family. I'm leaving before most of them wake up in the morning and most days I'm not home until nearly 6 if I don't have call. The older kids go to bed at 8pm, so I'm barely seeing them at all. That's hard to get used to.

Fortunately M is such an easy baby we have no problems going back and forth from bottle to breast, but my milk supply has taken a beating. My opportunities to pump are irregular and it's often hard to get away when I need to so I often end up going longer than I should and so my supply is reducing. In the last two weeks, I've pumped less than she has taken 11 days.

I have no problem supplementing with formula and we have been since the beginning (though out of preference, not necessity. I was producing as much as she took and was just freezing the milk to have a freezer supply for longer separations.) While everyone is very supportive of me breastfeeding, the nature of OB/Gyn doesn't really make it easy to run off for 20 minutes every 3 hours.

It's messing with me a bit, to be honest. I had oversupply with my other kids. While my milk was delayed coming in all three times and we dealt with thrush and mastitis with my second, I have never really dealt with supply issues because I was home with my other two and fed on demand. I've never pumped much before. Quite honestly, I hate it. I will probably only pump during day shifts for the first six months or so and after that I'll only pump overnight when on call or when away from home. It'll take a while to adapt to no daytime pumping, I'm sure, but other mums do it successfully.

On Monday I'll be entering my last week of OB/Gyn clinical for the core, and then we're back into an academic week which should be nice. After that, I'm off to Ottawa for two weeks and am very much looking forward to it!

Tuesday, 24 January 2017

The Nighttime Hours are Shrinking

I am absolutely loving my OB/Gyn core. I am very, very tired, but it's worth it. I'm learning a great deal. As is evidenced by my near absence of posting, I'm spending most of my waking hours at the hospital.

My preceptor is amazing. She has high standards, and is fiercely protective of her patients, and I think that's incredible. Every time I meet patients with her, they tell me how lucky I am to be working with her, and they rave about her bedside manner. It's left me smiling many times.

She expects a lot from her learners, but she also gives a lot. It's clear she expects me to demonstrate interest and an ability to learn quickly. but she is ready to take the time to teach and ensure I have the opportunity to learn. She won't force the information down my throat, but makes it available for my consumption.

I am incredibly grateful to have someone who is so willing to offer guidance as a preceptor. I really lucked out. Perhaps it helps that I'm actually interested in the specialty and demonstrate a legitimate interest in what I'm learning. But I do try to be interested in everything, even stuff that isn't my favourite topic (I wouldn't say that anything qualifies as boring to me, at this point.)

While I may not be able to do many things well right now, I am a willing and enthusiastic learner so I suppose that counts for something. It may also help that I'm not all "yay babies!" I actually like the gynae half of the specialty too. Obstetrics is just a part of OB/Gyn, and I actually think I might like the gynae stuff a bit more.

I definitely like surgery and want to learn to do it, which is less of a surprise than it would have been before last summer but still bowls me a bit. It's definitely pushing me further away from family. I don't know if I'd be happy doing just the occasional punch biopsy, Paps, and nothing more procedural than that. I've got a surgery-heavy OB/Gyn elective coming up in March to explore that further. 

It hasn't all been happy moments, and I think I'm getting to see a very good cross-section of the specialty. My preceptor has really been helping with that; making sure I see a very wide variety and get to by as hands-on as is appropriate for my level of training.

The fact that I'm exhausted, have worked somewhere near 200 hours in 2 and a half weeks but am sad that I only have a week and a half left in the clinical part is rather telling, I think. I'm having a blast.

Given my current state of exhaustion (not helped by the fact that I actually have to wake up to pump in the night now because my supply was tanking from the irregular hours) this is perhaps not my most coherent post, but I hope I've at least communicated my enthusiasm.

When you really need to study, but also want to snuggle.

Saturday, 14 January 2017

The Calm and the Storm

As might be obvious from my lack of posting, my first week of call is kicking my butt.

To be fair, I actually have three 25 hour call shifts in a 7 day period - making it a nearly 100 hour week when you add my non-call shifts- so it's pretty brutal. Last night in particular was rather intense. My first call shift was pretty quiet, but last night most definitely was not.

Today, though, is my son's tenth birthday. It's absolutely incredible to me that he's already 10 years old. When did that happen?

It made me reflect a bit on the nature of delivering babies. I remember the name of the attendants at each of my childrens' births. I remember in detail how the days went; my birth stories, like those of every woman who has given birth, are a part of the fabric of my life and I will never forget them. The fact that I am part of those stories for other people now - not that I really expect most people necessarily remember the medical student - is pretty cool.

But I also really like gynae surgery. My supervisor typically does two OR days per week and I get to attend with her. I was post-call one of her OR days last week, but when I attended the other it was fantastic. The whole time, I was just thinking "I have to learn how to do this." It was nothing terribly complex, just routine stuff, and there were no complications, but I still very much want to learn it,

Six days and 2 call shifts in (I have another tomorrow) and I haven't actually found anything I don't like to do yet. I realize that I'm still at the point of everything being new and shiny and exciting, but I can very much see myself doing this as my career. I've been told by a few people that the specialty you should pursue is the one where the most 'boring' part (I think 'less stimulating' is probably a better term than 'boring' since I don't think anything in medicine is boring, but I realize that may change.) is something you still don't mind doing. For OB/Gyn that's largely low-risk prenatal appointments. I enjoy them. It's nice to talk to patients, to hear how they're feeling about their pregnancy, to alleviate concerns about what they're experiencing. It's probably the lowest-stress part of the specialty.

It's a very flexible specialty, and I like that. It's medical and surgical. You can focus more on obstetrics or more on gynae or do an equal amount of both. In some areas, they have labourists who just do deliveries and emergency gynae surgeries.

So far, I'm definitely enjoying it as much as I thought I would and that's promising. I seem to be getting on well with the team. I'm rather nervous when it comes to paperwork because I definitely don't want to risk screwing anything up, but I found my nerves were slowing me down quite a lot so I'm relaxing a bit and realizing that I do actually know how to do stuff decently well for the small amount of training I have, I just have to make sure I keep the most important information in mind and always, always double check something if I'm not sure. 

Today did mark a big first, though. For the first time ever, I didn't immediately greet my son on his birthday and I've not spent much of the day with him as I had to sleep. I know this won't be the last time that happens, and I may completely miss birthdays in the future.

But we're going out for supper soon, so there's that.

And tomorrow, back into the fray. Hopefully for a quieter shift, but even if not, it's not the end of the world. It's an awful lot of fun, even if the excitement is at 3am.


Saturday, 7 January 2017

Needs Must

Monday is my first day on the wards and in clinic. It is also my first call shift. I'm a bit nervous about that bit since it'll be my first night away from M since she was born. I've been careful to try to avoid getting in the habit of nursing to sleep since I knew I'd be away for a lot of nights so fortunately there shouldn't be any issue with getting her to bed.

Working out my pumping schedule should be interesting, particularly given that OB/Gyn doesn't really lend itself to having anything scheduled during a shift. My plan is that every 3 hours, I'll take the closest moment to go pump (Except between midnight and 6am.) So sometimes I might have 3 hours between sessions, sometimes it might be 4.5. I can't really go longer than that during the day or I'm in pain. I should need to pump about 5-6 times during 24 hours if I'm away from M the whole time.

I am really excited to get working. Especially because this is my favourite area. I know this material very, very well. Not just because it's been directly applicable to my life many times over, but because it's a major area of interest for me.

Must admit that I'm a bit nervous about how I'll manage when I'm on different rotations. Because I'm doing six weeks of OB/Gyn electives immediately after this core, I'm starting my clinical part of clerkship with 12 straight weeks of OB/Gyn. While it is a very comprehensive specialty - medical, surgical, across the lifespan, with patients of varying complexity - it's also very specialized in that in the obstetric part of it you're seeing primarily younger, mostly healthy women for a normal physiological process. I'll likely not be seeing many elderly patients (although some certainly come up in gynae, of course) and probably won't be seeing a whole lot of extremely sick individuals the way one might on ICU.

Every patient population has a different general approach; that's what we learn in preclerkship. There are some clinical skills I'm just not going to even consider over the next 11 weeks so I'm going to need to spend some time making sure I don't forget important things that will come up on my future cores. And, you know, my LMCCs.

As it is now, though, I'm just trying to focus on being a good clerk. Be helpful. Be cooperative. Be useful. Be ready and willing to learn. Support your resident. Be professional.

Let's see how well this works out at 3am, shall we?


Thursday, 5 January 2017

Tied Tongue

Most of the way through the first OB teaching week, and I'm having a blast. Today, breastfeeding, prenatal diagnosis, abnormal labour, and low risk OB. We've had suturing practice and great lectures on fantastic topics. 

I did some suturing practice at home too, using pig tongue. My daughter, who is easily grossed out and terrified of anything needle-like, enjoyed it a lot. She actually did a couple stitches. I was so proud of her for letting her curiosity overcome her fear. My son kept asking me to cook the other tongue for him. Can't say I've ever cooked tongue before. Not that I'm planning to; I need lots of practice. 

Aside from the fact that things are busy, I've been posting very little because I'm dealing with some pretty awful insomnia at the moment and it's taking me a lot just to get through the day and try to get done what I need to do. I'm only getting about 4 hours of sleep a night, on average, and so I'm feeling very run down.

Being very 'off' in January/February is rather normal for me - in fact I think I've made a post to this effect at some point every year - and so is postpartum insomnia for the first few months, so I'm just sort of riding it and hoping that it gets better soon. It may actually work in my favour a bit now because of this: 

So 90s. 

Call.

I start call shifts next week. There are four students in my stream together on the one unit, and so we made a call schedule (well, I made it because this sort of thing is fun for me, and they agreed with it) that meets our requirements and will hopefully not be too brutal. There are 28 shifts and we each get 7. I have two weekends fully off (we all do; I arranged it that way) and I've strategically positioned my post-call days to ensure I'm off for a few important things without needing to actually schedule time off.

Given that I'm still dealing with insomnia, I expect I'll probably do fine with call. Can't sleep anyway, might as well just care for mums and learn.

I am really, really excited to get started on the unit and with clinic. I feel like I'm actually going to be good at something. It'll be important, I think, to be careful to not come across as a total know-it-all in my enthusiasm. The goal is to be a good clerk. Be helpful. Be enthusiastic. Seek out learning opportunities. Be a good team member. Learn from everyone, including the patients. Especially the patients.