Tuesday, 22 January 2019

Ending Up

It may come as a bit of a surprise to anyone who has read anything of this blog or spoken to me basically ever, but I’m no longer certain I’ll be going home to practice. I’m not certain I won’t be either. 

This lack of certainty is driving me just a little bit around the bend, but I think it’s good that I’m keeping my options open. 

My husband and I decided that in the interests of long-term planning, we’ll have one more year to decide but we want to be sure where we’ll go by the time I start my last year of residency (which is next February.) We are going to need to take time to prepare the kids for whatever we end up doing, we’ll have to make plans to transfer care of our son and apprise the school system, so it’ll be a long process which is why we’re trying to ensure as much lead time as possible. 

The fact of it all is that where we go when I finish residency is almost certainly where we will stay permanently. We want to settle somewhere so I can build a practice and we can raise our kids in a home we own. 

We know we want to go to the Maritimes. Ultimately we’d prefer to go back to our home province, but there are a bunch of things that worry us. Opportunities for our kids. Mental health care and support resources for our son. The ability for me to practice the way I wish to is a big one, as are things like practice remuneration models. 

Money has never been why I went into medicine, but I live in the real world and I have a family of six to support so yes, I freely admit that money is part of my decision process. I also have a boatload of student debt, and my oldest will be entering high school soon after I finish residency and so I’m very interested in incentive programs and they vary considerably. 

There’s a lot of stuff to think about. Deciding on my rank list was far easier because I was only trying to decide where to live for two years, not the rest of my life. 

I have a year to decide where to go. 

Why doesn’t that feel like enough time?


Sunday, 20 January 2019

This Year

Welcome to 2019. 

I’ve been enjoying my parental leave. It’s been fantastic to spend so much time with the kids, although I am very much looking forward to getting back to work. 

Fortunately I’m going to have a bit of a trial run: I’ve been selected as a clinical skills instructor for MF3 which is renal, reproduction, and genetics. It’s only a few hours a week, but it’ll be nice to get to doing something medical before I get back to work. MF3 ends about a week and a half after I return to work. 

My first rotation when I get back is a block of family med, so I’ll be able to ease back into things with a nice schedule and lower acuity patients. 

Then I have my OB rotation which is probably the worst one schedule-wise during my program. It’s our only rotation with 1:4 overnight call, and I’ll be doing that for two blocks. The call stipends will be nice anyway. Plus I love OB and can’t wait to get back into it. 

The one challenge will be managing pumping. It was a little easier as a med student; I wasn’t necessary to the work. As a resident, I have actual responsibilities and on OB there will be plenty of times I can’t leave. Figuring out how to keep my milk supply up during that rotation will be a tough one. Not the end of the world if I am a bit short - R will be 7 months old by then - but I still don’t want to end up with supply issues. 

With just eleven weeks of my leave left, I’m trying to cherish the time I do have home so that I can work on the goals I set for myself and my family. It’s probably the last time during my kids’ childhoods that I’ll be home for this length of time, so it’s precious and I need to make the most of it. 


Today is R’s third-day. He’s a third of a year old today. 



Saturday, 22 December 2018

Raining in December

I’ve been kind of quiet because I honestly don’t have a lot to say just yet. My life at the moment is incredibly normal and a bit boring. We spend the day taking care of the kids, relax in the evenings, cook a lot, exercise some, and plan last minute cross-country trips. 

We’ve been trying to plan to head back home since the summer, but things have never quite aligned. For it to work out. My pregnancy was pretty rough so we decided it was best not to travel far during it, then we couldn’t really have the kids miss school, when we tried to think about making it work over thanksgiving or their PA day long weekends. 

So about a week ago my husband and I decided we’d make it happen over their school break. Their last day of school was technically today, but we kept them home since today is the solstice and that’s when we have a family celebration. 

We started preparing for the trip, planning to leave Sunday night. Then we found out today that there’s a rainfall warning (oh Maritimes in the winter, how I miss your capriciousness) followed by an overnight freeze Sunday night, which just makes the road a mess for a few days. We decided it’s best to get ahead of that, so now we’re leaving tomorrow. 

I managed to get six people and a dog packed for an eight day trip in less than four hours. 

Skills, I have them. 

The pet sitter is arranged, the house is if not perfectly tidy, passable. All laundry is done, anything perishable is now frozen, coming with us, or will be eaten in the next 24 hours. 

I just pulled a family trip out of my back pocket, and I’m actually kind of proud of this. The kids really want to see their grandparents, whom they’ve not seen in almost a year and a half, and I’m wanting to touch base with some recruitment officers and doctors. ‘Tis the season of medical society socials. 

We won’t be hitting the beach, much to my sadness, but at least we’ll get to see my grandmother, who nearly died earlier this year and continues to be poorly, and my friend who is now rocking at medical school. 

Life is good. Today started with my kids excitedly tearing open presents, and ended with them sleeping soundly and happily in their beds, looking forward to a snowy road trip East. 


This book exists. 


I gave up trying to get nice pictures of all my children at once around Kid #2. 

Naturally, she thought the tree was hers. 



Sunday, 25 November 2018

Being Medical

I helped with the first year mOSCE this past week. 

It was fantastic to do something slightly clinical again, even if it was grading first years on their history-taking. I was pleased with them, anyway. They were where I’d expect them to be for first years just a few months in, and it helped me realize how much I’ve grown as a clinician since then. 

I miss work. I love being home with my kids and all... but I miss work. I miss medicine. I’m looking forward to getting back in April. My emerg rotation would have been in mid-January and I’m kind of bummed that I’m going to go almost a whole more year before I get to do it. 

But I do need the time to recover. While the initial few days after delivery weren’t bad, I’ve actually been having a really rough recovery this time. I had a spinal headache (post dural puncture headache) which I just kept waiting on to get better, since they typically do. It hadn’t gone away by my six week postpartum visit, so I finally got a blood patch at that time, which is the treatment for a spinal headache. It was only partially successful. I still have a spinal headache. It only gets better if I lie down flat on my back. It’s not as bad as it was before, so I haven’t opted for a second blood patch. I passed out completely during it and my heart rate went into the 40s. It was an interesting experience and I’m not keen to repeat it. 

But it’s still exhausting to have a constant headache that gets worse whenever you bend down. It’s about 60% of the strength of my migraines. Every day. 

It will probably get better eventually. They typically do. There have been cases of them lasting many months, but that’s rare. I’m just waiting. It’s refractory to pain medications so I don’t bother taking any. I just lie flat whenever I can. 

Honestly I’m not at my most functional state, so it’s a good thing I’m not working at the moment. I need more time to recover, and that’s what maternity leave is for. I’m glad I took the time off this time around. 

Even if I really do miss working and feeling like a doctor. 

Today I had a moment where I did have to use some skills and a bit of macguyvering. My dog hurt her leg at the park. She was running and went down with a yelp then wouldn’t get up or walk. I called the vet and splinted her as best I could using a stick, a pair of mittens, and my shoelace. I realized only afterwards it would’ve made more sense to splint the front of her leg instead of the back, given the normal ROM. But hey, I was in a field and working on the fly. 

Doggo is okay, but sore. Vet thinks she may have torn her ACL, but that it’s unlikely to impact her athleticism given she’s half border collie and it would take multiple amputations to slow her down. 




Wednesday, 31 October 2018

A Nice Pause

I decided to take a short break from my blog to avoid filling the place with baby stuff. That’s what Facebook is for. 

In summary, Smallest will be six weeks old on Thursday. He’s growing well after we had a rough start. He ended up in NICU for several days followed by several days of phototherapy. But now he’s a pretty standard young infant; meetings milestones. Has a bit of an old-man-going-bald look going on, like my oldest did, but I still find him cute. My co-residents were beyond sweet and got him an awesome shirt which I am looking forward to doing a photo shoot in when he’s big enough. 

Miss M is now two years old, and Miss C is eight. The years are moving on much faster than I ever thought they might.  

I’ve been starting to explore my options for after residency, in light of the accelerating sense of time. 

The plan has always been to go home. But I don’t know that I can practice at home the way I want to so I’m trying to ascertain how likely it is that I could. We’re looking at another Maritime province as a strong possibility as well, since we have friends and family there. 

Because of my time off, I’ll finish residency in February 2021, so I’ve got plenty of time to decide. And things can change over time, as the last few years have gone a long way to demonstrating. 

The time off is allowing me to get ahead in some of my tasks for residency. My QA project and leadership projects are the two things that I really want to get a head start on. I can probably finish my leadership project and at least lay out the structure and do the background reading and literature search for my QA. 

Im feeling a bit disconnected from the medical world so I really want to get back into it. I may start attending grand rounds and such for a variety of departments just to keep my brain going. I hate stagnation. 

It’s lovely to be home with the small people and my husband, but caring for an infant and toddler is not something I find mentally stimulating. Tiring, yes, but it doesn’t challenge me like a good clinical quandary. 

I’ve been listening to more podcasts and I’m going to try to catch up on my leisure reading now that R is into a bit better routine. 

So far, I’ve succeeded over the course of this leave in making a list of things I want to accomplish in the next five months. Hopefully I’m not creating more than five months worth of goals for myself. 

The plan is to get moving on some of these goals this week. I’ve scheduled time tomorrow to work on my leadership project outline, and I figure that is a good start. 

I’ve spent years working on ways to manage my busy life. Being decidedly less busy at the moment is leaving me feeling rather more directionless than I’m comfortable with.

Probably, I’d be well-served by learning to spend more time relaxing than I’m used to. Focus on some self-care. 

I’ll put that on my schedule and make sure I get to it. 



I had to include at least one photo. This is the awesome gift from my co-residents. R is the fourth baby born to residents of my site and they have all received this same shirt. Our site name is on the back. It’s a bit big for him at the moment. 

Friday, 21 September 2018

I Did a Thing

Yesterday, in the dead hours of the morning, I couldn’t get to sleep because I was contracting. 

And they picked up and up. So around 8:30am, we headed to the hospital and the sibling doula met up with us. After a couple hours of walking to see if the contractions picked up, I was admitted. 

Got an epidural right away which only took two tries this time. The epidural was fantastic.

The kids were basically bored to tears throughout most of the labour, and mostly just chilled out on electronics. Doesn’t surprise me at all. The doula was wonderful about making sure they got up and got their energy out and taking them for meals and washroom breaks and such. She was really fantastic to have; absolutely made a huge difference. It would not have been possible to have had the kids present without her. 

When the time came for pushing, my husband and both older kids were at my side. I tend to push fast, and despite the longer labour, that was true this time as well. After a couple good pushes he was out. His big brother and sister were sobbing with joy. There were many tears and happy shouts from them both. 

The resident who delivered him (who is probably one of my favourite residents ever and I’d consider a friend) was utterly amazing. She showed the kids the placenta and explained the physiology. It was really cool for them to be able to have that experience. 

Baby R was seven pounds even. Unfortunately he has needed some transitional support in the NICU and is currently there on CPAP. He was grunting quite a lot last night and having to work quite hard to breathe. I’m being discharged shortly and my husband and I will be trading off who is here with him. It’s fairly likely he won’t be here any longer than the weekend as he’s doing quite well. He’s just grunting a bit and slightly tachypnoeic without the CPAP. It’s likely because of the gestational diabetes; the risk of respiratory distress are much higher. He was 37+1 so a touch on the earlier side as well, which further increases the risk. He’s been slightly tachycardic in-utero and low movement was an issue within the last week so I do wonder whether he was a bit depressed prenatally as well, but I can’t know that for sure. 

Either way, he’s here now and besides needing a bit of a helping hand, he’s doing well and will hopefully be home soon. 






Monday, 10 September 2018

On Happiness

In the nearly six and a half years I've been writing this blog, there have been many ups and downs. I don't always post the downs because sometimes it's best not to ruminate, but overall I think I've given a fairly decent picture of what my life has been like. There have definitely been some periods of pretty intense stress, but overall things have been moving in the right direction this entire time, and I am extraordinarily fortunate.

Being off work at the moment has allowed me a bit more time for reflection than is my norm, and I was surprised the other day at how peaceful my life feels right now.

I hear no end of people telling me how stressful and busy and difficult my life must be, with nearly-four children while being a medical resident. It's something I hear constantly, and it never ceases to amuse me.

Yes, I am busy. Sometimes the days are very long.

But I love it. 

This year, in particular the last six months or so, probably represents the happiest period in my entire life, and things just get better every day.

Nothing has ever felt so very intrinsically right as practicing medicine. I'm good at this, and I enjoy it. If you have to be away from your kids all day, it may as well be something you love that occupies you.

Beyond just the work aspect, my personal life is going incredibly well too. The long, dark financial tunnel of training is coming to an end. I'm looking at an ROS that's going to pay off more than half my debt. I'll be free of student debt two years after I finish residency, and I'll be back practicing in the Maritimes.

My husband and I are looking at our long term plans, and we are watching our dreams start to unfold in front of us. Buying a house that really suits our wants and needs isn't a pie in the sky, wistful 'someday...' for us now. It's something we're seriously planning for, and we know how and when it's going to happen.

The kids are doing amazing. Our household now compared to our household two years ago is a different place. While we have the joyful chaos one expects of a larger family, it's a functional chaos. Aside from very age-typical behaviours, we're not dealing with anything more severe. For the first school year ever, we made it through the first week without hearing a peep from the school.

The older two have matured so much in the past six months in particular it's almost unbelievable. They've both really taken to heart our talks about the sort of people they want to be. Both of them are polite and helpful (generally; they are still kids after all!) They prefer to talk out their problems instead of act out. It's absolutely amazing how big of a change has come over them, and I am so proud of them for how hard they have worked and I have a lot of hope for this school year.

Miss M, of course, is a toddler with all the attendant naughtiness that comes with being nearly two, but she is still an easy, easy child. Sleeps well, eats well, listens relatively well (for a toddler) and is so enthusiastic about everything. She brings a smile to everyone's face, which helps make the 53rd "No, we don't drink the cat water" that day a little more bearable.

Perhaps its just my overly emotional nature when I'm pregnant, but I'm honestly just so very happy with how my life is going. I love seeing the kids grow and mature. I love the fact that my husband will soon be able to be home full time being the nurturing dad he has always enjoyed being. My work is wonderful, even though I'll be a bit sad to be away from it for the next few months.

I have spent so many years working towards a better future for this family. My husband and I have driven ourselves so far past our limits we've had to redraw the lines of possibility to be able to manage everything. But it feels like the world is opening up before us, and the future we thought was possible is starting to unfurl.

We're standing at the edge of the rest of our lives and the path ahead is bright and shining.

How fortunate we are to have made our way here.

Saturday, 8 September 2018

Sleep and Growth - It's a Pregnancy Post

I'm off work now. I did try to go to work this last week, but basically any time I did anything I started having contractions regularly, so I ended up needing to take last week off anyway.

Because having contractions every 10 minutes when you have a thirty minute commute and a history of precipitous delivery is the setting for a very crazy birth story, and I'd rather not have that happen, thanks much.

I am having contractions almost all night every night right now, but they never get closer than 8-10 minutes and fade away by morning every day, so it's all just prodromal/'false' labour (for those who don't know; 'false' labour does feel very much like the real thing with the exception of the fact that the contractions don't increase in frequency past 5 minutes. It does REALLY hurt, and it does cause some very slow, gradual changes, but it's not active labour.) 

So this necessitated that I stop working early and now I'm really bored.

We're ready for the baby, aside from the fact that he's still nameless. The bassinet is set up, the clothes are washed, hospital bags are packed, car seat base is installed. All the baby equipment that we'd put away after Miss M outgrew it has been washed and readied for use. The school has been advised that the kids may be pulled out randomly, the sitter has been given the information of the backup sitter who will watch Miss M.

Things are ready to go. My induction is still booked for October 5th, and I still strongly doubt I'll make it to 39+2. I had prodromal labour like this with my daughters and C was born spontaneously at 37w and while I was induced at 37w with M, the basically just needed to walk me past some Pitocin to get things started so I doubt I was far off delivering on my own anyway.

As it is, I just need to get to September 21st (37+2). That's the day that I will hit 600 insured hours and will be eligible for my full maternity + parental leave benefits. If I deliver before then, I lose the 17 weeks of maternity leave, but still have the parental leave. While I'm not working right now, I'm actually officially on vacation time (which still counts as insured hours) for this coming week and the following week. My official maternity leave starts on September 24th.

At this point, what it means is that my return to work date will change if I deliver early. If I deliver on or before September 20th, I will have to return to work December 15th. Otherwise I'm not returning to work until April 1st. Aside from the day this week I tried to go to work before I needed to go back home, I've actually been on either vacation or sick time since August 24th so I'm dreadfully bored.

I am a bit concerned about keeping up my knowledge and skills during my time off. I have some reading materials, my LMCC study stuff, lectures, etc. While I'm not *technically* supposed to attend any workplace activities, I have been told in the past residents on mat leave have elected to attend the monthly simulations, so I might do that for my own learning. I also plan to attend conferences and whatnot when the opportunity arises as I want to keep up.

But primarily, this time off is to get to know my new small human and learn to navigate being a family of six, which is somewhat terrifying to consider.

Tuesday, 28 August 2018

Practical Stuff: Loan Repayment Considerations

Here's something a little more practical to consider: loan repayment.

Between six years of student loans and my LOC, I've got a lot of debt, as is pretty typical of a freshly graduated doctor. I'm not planning to disclose actual amounts, just to say that it's a lot.

However, I have a few factors working in my favour:
- Big family
- Short residency (even with my leave, I'll finish in December 2020.)
- My home province's student loan rules

Because I moved from a province which does not do integrated Canada-Provincial Student Loans, I have three separate student loans plus my LOC:
- Home Province Student Loan [HPSL]
- Canada Student Loan (standalone)  [CSL]
- Canada-Ontario Integrated Student Loan [COSL]

My home province student loans have 0% interest throughout repayment. That's for everyone; it's not something I have to apply for, which is convenient. They also don't require medical residents to repay their loans until afterwards. I just have to apply for the residency deferral once, and then repayment will start a year after my (original) residency end date in June 2021.

The CSL/COSL is another matter, but this is where having a big family works in my favour. 

There's something called the RAP (repayment assistance program.) It bases your Canada Student Loan and/or combined Canada-Provincial Student Loan on your family size and income. For a single person, they don't start repaying until they have reached an income level of at least $25k. Doesn't matter much to most residents. 

But for a family of 5+ the income level below which repayment is zero is $67k. At least it was in 2016; I think it's higher now. It goes by income in months prior to application and you reapply every 6 months. The interest is paid for you during this period, it does not accrue.

My husband won't be working anymore after the leave (well, probably. That's a separate post.) so there won't be his income. It'll just be mine, which is below the zero-repayment level. Even with my call stipends, our income will only just edge over the zero-repayment level in late 2019 because of the fact that I'll have several months of reduced income during 2019 due to my maternity leave. 

Anyway, what this all means is: 
- HPSL: don't have to repay until 6 months after residency ends (amount will also be reduced under a debt reduction program)
- CSL/COSL: will start repaying at a veeeeery reduced rate in late 2019, won't have to start repayment in full until after residency. (Plus, I'll have almost all of this forgiven under the Forgiveness Program for rural family physicians.)
- LOC: interest-only repayment during residency and for 12 months after

And of course if I end up doing a PGY-3, these things can be continued. 

This sort of information isn't made easily available to residents because so little of it applies to the majority. Because I'm in a unique situation as a resident with a big family, I've been putting together information on these programs for myself for a long time, to make sure I have my financial bases covered.

I also share this information gladly with others because I think that it's entirely justifiable for us to use programs such as these which are intended to help us get our careers off to a good start. It's not exploiting a loophole or anything unethical; it's just strategic application of poorly-advertised programs for their intended use. 

Starting to wonder if I should put together a guide for parenting medical students. There's so little guidance for people who fall outside the norm. Might be useful. 

Friday, 24 August 2018

Vacation

I am utterly and completely exhausted. 

The last couple of weeks have been fantastic from a learning perspective, but physically I’m just worn out. All the running about during the day wouldn’t be a problem if I weren’t eight months pregnant, but I am and I’ve pretty much reached my limit. After today, I only have four more days of work left before I’m off, though, so that’s good. 

Starting off with my hospitalist block was a really good plan. For one, I got to learn who the specialists in the region are and where to send patients for outpatient stuff. I learned a lot about community supports and how to access them. This is stuff that will help me a lot in the next couple years in my clinic. 

It also gave me quite a lot of independence with managing my patients. It was really fantastic to see patients I admitted turn around and get better and go home. Some of them I’ll even be able to follow in my clinic because my FM supervisor is their family doctor. 

I really enjoyed the hospitalist work, to be honest, and I think it’ll be nice when I go home and get to do that occasionally. I wouldn’t want to do it exclusively, but it would be fun to do it as part of my practice. 

While at times it has been absolutely exhausting keeping up on my work, the learning has been incredible. The fact that my program is small so I work one on one with staff has meant quite a lot more autonomy than I think would be typical in a more hierarchical  program with multiple levels of residents. Once my staff got used to how I work and was comfortable with my level of skill, I had a lot of freedom. Appropriate freedom, of course. Staff were still following along and ensuring that I wasn’t screwing up, but I wasn’t expected to clear every single little thing with my staff. It’s a natural part of the graduated responsibility, but it was nice to have it so seamlessly granted. 

It was nice to be able to just put my brain to use. Clinical thinking is my strong suit, always has been, and I’ve really had the chance to demonstrate that on this rotation. The feedback I got from my staff docs has all been extremely positive and I’m so pleased that my anxiety over this transition appears to have been for nothing. 

Plus, this program was absolutely the best choice for me. The working culture at my site is incredible. People are very collegial and very pleasant to me. The staff are absolutely excited to teach and to help make me into the best doctor I can be. I never feel like a burden as a resident and it feels like all the professionals I’m working with are great at their jobs and that makes my job so much easier.

It is so cool that I actually get paid to do this. 

Residency is amazing. 

As tired as I am, as long as the days have been, this has been an immensely satisfying and worthwhile eight weeks. 

But I’m also really looking forward to my week off next week. 

Friday, 10 August 2018

Revisiting Plans

Currently, my maternity leave is scheduled to start on October 5th - my induction date - with everyone understanding that I'll probably deliver before then.

But I'm increasingly having difficulty with the physical demands, few as they are. It's not so much the walking about, it's the constant up and down throughout the day. The discomfort has become true pain and it's at the point where despite doing my physio exercises I'm spending my off days mostly recovering and basically unable to spend any sort of quality time with my kids.

I want to take a bit of time off before the baby is born so that I can rest and nest a little. I do still need to work my 600 hours before I can start maternity leave, though.

But.

Vacation hours count as worked hours too.

So I'm going to take two weeks of vacation starting September 10th, then start my official maternity leave on September 24th. I will hit 600 hours worked on September 14th (36 weeks and 2 days.)

If the baby is born before I reach 600 hours worked, I will have to use up my vacation and professional leave days to get me to 600 hours, and then I can take parental leave but I lose the maternity leave entitlement (yup, if he's born premature I actually will actually get less leave because of the hours requirement since maternity leave can't start later than the day the baby is born.)

In either case, so long as I don't give birth before September 7th, that will be my last day of work. I plan to return to work April 1st if I do end up with the full leave entitlement, December 15th if I don't. Regardless, I'll have some time off to recover and shouldn't need to return to work after giving birth.

I haven't yet heard back from the program about their feelings regarding my plan, but honestly I'm ready to push to get this if that becomes necessary since it's important to look out for myself. I'm entitled to a whole year and am taking much less, so I doubt they'll make any fuss anyway. My program admin are all very reasonable.

So yeah, I'm down in the final weeks before leave and feeling the need for that time off very much. Not that I don't enjoy work. Residency is absolutely fantastic; I highly recommend it. I'll get to that a bit more in my next post.


Monday, 30 July 2018

Transformative

The last week has been one of a lot of growth for me. 

I’m working with a different staff now and he’s much more hands-off than the one I was with for the three weeks prior. Different, not better or worse.

For the first weeks as I got my feet under me, I absolutely needed the hands-on, frequent checking-in my last staff was doing. By the end of my three weeks with him, I’d gotten quite a bit of reassurance that I was actually doing well. My current staff is a bit old school, and he’s an internist not an FM-hospitalist, so his approach is a bit different. He expects me to hold my own and while he does check in and he’s well aware of how his patients are doing, for the most part I’m expected to be fairly independent with my daily work (though always free to ask questions of course.)

It’s been very good for me from a confidence-building point of view. I’m making sure that I’m comfortable with and can defend my decisions. 

One thing I ran into a lot in med school was near-paralysis from uncertainty. I’d be so worried about doing something wrong that I would hem and haw and delay and double and triple check things I was still pretty sure about. Basically I was always certain I was doing something wrong even when I knew that wasn’t the case. 

I’ve been realizing that the people who’ve been telling me that I’m good at this might have been onto something, and I actually do have a pretty good sense for what to do a lot of the time. 

What I needed was a good run of tough cases that I did well with to kick me in the pants and show me that I do have some useful skills and I’m actually appropriately competent for where I’m at in my training. 

My staff I’ve been working with have been giving me very positive feedback, and it’s helping with the confidence element. Having been able to make a significant difference in management several times has also helped. 

I’m not getting a big head or anything, but I am feeling more sure that I can do this. 

This first month of residency has been an absolute roller coaster. Just scary enough to be incredibly fun, and at the end of that ride I’m sitting here, exhilarated, saying “that was fun! Let’s go around again!”

Monday, 23 July 2018

Haha, nope.

I was thinking my call schedule was pretty decent. And it is; I don’t work past 11pm (except when I do because I’m finishing stuff up) and it averages out to 1:4 in a four week period. 

But I’ve actually worked just a smidge under 200 hours in the last three weeks and my body has gone “hey Kay, you’re an idiot.”

My grand plan was to try to ensure that I have all my hours to be eligible for maternity leave pay (600) done as quickly as possible, earlier in pregnancy so that I could ensure if I deliver a bit early it wouldn’t be a problem.

Issue being, my body *really* disagrees with me working this much while very pregnant. Been run down the last few days but it hit me this evening. 

Only my fourth week into residency and I’m sick. I expect because I’ve exhausted every bit of my reserves of strength. I seem to have some sort of gastro thing going on. For most of today I though I was just really, really tired and that’s why I was a bit queasy and fuzzy-brained, but nope. Sick. 

Currently trying to figure out who to notify that I won’t be at work tomorrow because I am going to take an actual sick day. Since absolutely no one wants a doctor with gastro slowly waddling around the hospital. 

I pushed myself too hard, and I am paying for it. I feel so sore and weak that moving around my house this evening is a challenge. Despite wearing my compression socks and being careful to elevate my legs whenever I can, my legs are oedematous tree trunks and my kids thought it was cool to make dents in my shins by poking them. And they hurt. The hours of intractable cramping in my calves every night probably isn’t helping there. (No, I don’t have a DVT.)

My body isn’t playing by the right rules. I’m supposed to just be able to push through anything and keep going. I’m supposed to be able to just get done what needs to be done and catch up later. That’s why I booked a week of vacation at the end of August; to recover from pushing myself hard through my hospitalist rotation. (Vacation days still count as hours worked for calculating my hours, FYI.)

But dammit, nature, you win. 

I have my meeting on Wednesday about my maternity leave plans, and I’m going to bring up with the admin that I’m just not doing well with the call and I need to back off on my hours. Call is voluntary for me at this point so it’s entirely at my discretion if I choose to continue.

And I think I need to choose not to. 

It’s not like me to elect to do less, but at this point I have to do what I am always telling patients to do: listen to what my body is saying. 

And right now it’s screaming REST. 

Sunday, 15 July 2018

Resident Resident

Yesterday I was in the elevator on my way back to emerg and a lab tech stepped in. I said hi, since I’m trying to just get to know people. She smiled and said “you’re always here when I’m here! Do you ever go home?”

“Well,” I replied, “I am a resident, and the title fits.”

Last week was nearly seventy hours of work, and next week is even more with 3 call shifts, but then I have the following weekend (28/29) off which will be nice. 

This wouldn’t be too bad if I weren’t almost seven months pregnant. Plenty of services work much worse hours, and really I’m done by 5-5:30 most days, I just start pretty early. 

But being on my feet all day is pretty tiring. Even sitting down a lot is tiring because it makes my back and hips hurt. The only position that doesn’t cause me to ache right now is lying down, so I try to find time during the day to go take 15-20 minutes to just lie down in a call room and take the strain off. Not always possible, but the “I don’t even have time to pee” tales-from-the-trenches don’t seem to apply to my program. So long as I’m efficient with my use of time, I have time throughout the day (usually) when I can grab a bite to eat or a quick rest if I need it. 

I think I’m actually turning out to be pretty decently efficient for someone who is only a couple weeks into residency. Yesterday was pretty decent; I did consult after consult (IM consults at that. They used to take me three hours, heh.) and feel like I was pretty confident in my diagnoses and plans.

Yesterday was also a pretty big day for me just feeling like an actual doctor. 

I had my first “hey, you’re a doctor, come here” moment and I didn’t panic and I just went back to first principles to manage the situation. It was interesting to really feel like I knew what to do, and just go with it. 

I also felt strongly enough about something in my plan for another patient to push for it and it made a difference in the patient’s management. 

The experienced residents and staff all tell us that it does eventually come together and we won’t always feel like idiots. It’s nice to actually be seeing some of that come true. 

I actually have some doctor skills and can do real stuff now. Cool. 

Wednesday, 11 July 2018

Keeping Up Appearances

I am someone who prefers to wear casual clothes. Dressing up regularly isn't a preference of mine, but it's often necessary in medicine.

Because I currently have two pairs of pants I can wear besides my (well-loved) jeans, my outfit every day at work is black slacks plus one of my three nice maternity shirts. As I am currently well past the "is she just fat or also pregnant?" discriminatory level of bump, there are only so many things I can wear.

Most days I wear my pearls, and make sure I'm wearing earrings and that my hair is brushed - not that it stays looking halfway decent with the heat we've been having.

I'm trying to make sure I look put together, so that I can at least feel a little bit like I actually belong there and have some legitimacy to the "hello, I'm Dr. D..." introduction.

I've weirdly been complimented several times this week on my nails, of all things. I usually keep them painted unless I'm on a service where they can't be, but I change it every few days so it stays looking neat. For no particular reason, several people have noticed this week which was sweet... but now I'm worried that if I forget to fix a chip or something, they might think I'm looking unkempt and doubt my competence.

With all the anxiety a new resident can muster, I'm worried about, of all things, my nail polish reflecting poorly on me.

Guess that means I haven't had anything worse to worry about.

Honestly my program is pretty fantastic and everyone has been incredibly nice at every point. I do feel like a complete idiot most days, largely because I'm just getting back into the flow of things and I have awful baby brain, but I'm refusing to feel stressed about that because I know it's totally normal to feel that way at the start of residency.

I'd be worried if I felt super confident in everything. I'm supposed to be a bit of an idiot right now.

One thing I really need to work on is my presentation skills. I'm really out of practice and with how I'm feeling currently - baby brain, generally exhausted and run down - I'm just not at my best with presenting information in a concise, logical, and well-communicated manner.

I wish my mouth had an edit button.

This will improve. Like most other things in medicine, it's a skill, not an inborn trait, so I've just got to practice and keep practicing. I absolutely love that I'm not having to present patients at the bedside in front of CTU groups, though. Because that is something I'd definitely never get comfortable with.

This week, though only half done, is a definite improvement over last week. I do feel like I'm catching on to my work flows, and I feel like the efficiency piece is coming along. All the staff docs I'm working with are fantastic and really supportive, which is a huge perk.

Overall, residency is starting out way better than I thought it would, which I'm very happy to be able to say.

I just need to stop fixating on the little tiny things, like nail polish.

Saturday, 7 July 2018

Week One

First week of residency went well. I’m actually surprised by how okay I feel after those few days. 

It was very long and tiring, particularly as I’m dealing with insomnia, but overall it was manageable. It’s nice to be able to sign my own orders, not as terrifying as I thought it would be, and I feel like I’m being given a level of supervision that’s appropriate for where I’m at. My staff is available for questions and is overseeing what I do without micro-managing or breathing down my neck. He’s ensuring I don’t make mistakes, but also giving me freedom to make decisions and find my own way of doing things. 

Not to say the week was perfect. There were a few things that, in retrospect, I should have done differently, but I suspect that will be an occurrence throughout my career. They aren’t things I’d class as mistakes, just not optimal. Nothing I did hurt anyone, or would have, so I think they’re just very good learning opportunities. 

I’m very fortunate that I’ve been working with a really great staff doc. He’s really quite kind and very understanding of how overwhelming the first bit of residency can be. He’s been very encouraging. I’ll be working with him this coming week as well.

Probably the scariest moment of the week was when I showed up to a code (they’re run by emerg docs at this hospital, I went so I could observe) and the doc in charge said “hey, you should’ve jumped in. You’ve done ACLS. Time to put it to use!” This was day three of residency. He was really encouraging, though, and is apparently one of the emerg docs I’ll work with throughout residency. 

Quite honestly, I have yet to have any negative experiences at work. I’m sure they’ll happen, but I wasn’t dressed down or yelled at or chewed out at any point this week. I was respected and supported and treated like a valuable member of the care team. The other doctors I’ve dealt with haven’t spoken to me with the “ugh, a resident” tone, they’ve spoken to me like a colleague. Everyone has been very welcoming. 

I think this might be because I’m at a small site with very few residents, so everyone gets to know us as individuals instead of as a general group of walking headache-generators that shows up each July. 

I am beyond happy I chose the program that I did, and I hope I’m going to continue to have lots of positive experiences. Monday is my first “day back” at my family clinic, and then I have two calls next week so it will be around 66 hours total which is going to be hard for me. 

But I feel like I can do it. Maybe next week it’ll even start feeling less weird to introduce myself as a doctor. 



How I feel about my current level of competence. 


Tuesday, 3 July 2018

I Signed Orders!

Today was my first actual day working as a resident. Thanks to Canada Day falling on a Sunday and my program being eminently reasonable about things like having a life, I got the long weekend off before starting. 

I started the day with one goal: don't make any *big* screw-ups. 

Very happy to report I was successful on that front. I went all day without messing anything up.

It's helpful that all my patients are quite stable and straightforward, so it wasn't even a terribly complex day either. My staff is really wonderful to work with, too. He's very conscious of the fact that I'm brand new at this, and was very reassuring and not pushy about the time I am taking to get used to stuff. 

It did feel like it took me forever to review charts and get to know the patients, but that's partly because I'm still getting used to the EMR and the particular way things are noted at this hospital. That will get easier with time. Also, as I get to know the patients better over the coming weeks, I won't need to do a full review on every patient I see. The patients I saw today will be much faster to see when I next see them. 

Thankfully I didn't actually run up against any medical stuff that I didn't know today. I was comfortable with my patients' admitting and active issues and how their other illnesses might impact their current course of treatment. I thought I'd actually have a harder time with that stuff than I did since I haven't done any sort of inpatient medicine work since February, but it all came right back which was nice. I didn't actually have to break out my Resident Survival Guide (basically "How to be a Doctor 101" in pocket-sized format) for anything besides one thing that I wanted to look up for curiosity's sake. 

Needed to get used to my particular formatting for charting again, but that won't take long. 

Overall it was a very good and very productive first day. I feel like I can actually do this. 

Of course it was downright weird to be introduced and addressed as Dr. Lastname. I kept almost introducing myself as Kay, the medical student, and nearly tripped up several times. This will take quite a bit of getting used to. Minor issue, though.

I was really confused this morning when I went to park. There's a "Doctor Parking Only" lot at my hospital and I don't know if I'm allowed to use it. I mean, technically, I am a doctor. But not a staff doctor so I don't know if I'm eligible, and I'm kind of embarrassed to ask. 

I'll figure it out eventually. 

Also, I passed my MCCQE1 with a solid score that I'm pleased with, not that it means anything at all except that I don't have to write it again. 

Tomorrow is my first academic day - my program does whole days - which is mostly more orientation stuff, but it'll be a nice way to break up the week. 

Thursday, 21 June 2018

There Have Been Better Weeks

I learned this week that I will be conditionally licensed to practice. I'm required to undergo a thorough assessment by the Physician Health Program (PHP) and enroll in monitoring if they suggest it, which apparently they pretty much always do. This is essentially what I expected, but I admit to being frustrated. 

Admittedly, I'm hoping they will decide I don't need monitoring but I'm assuming they will. This process already feels invasive and stigmatizing enough. I don't much appreciate being under a microscope because of a bunch of people who know nothing about me thinking I'm some ticking time bomb who is going to run off and hurt patients the moment I have a bad day. I very much object to the assumption that a doctor with a history of easily treated depression is such a risk to patient safety that even in the absence of any evidence of conduct difficulties my privacy must be sacrificed. 

If I sound irritated, it's because I am, but there is absolutely nothing I can do about it at the moment so if they say jump, I jump. 

Regardless, I have other stuff to worry about. 

Pregnancy is going well (24 weeks now) but I've been having some issues this week that are prompting further workup. Serious stuff has already been ruled out, just have some more imaging and two appointments on Friday. 

I must say, accessing health care when you're (barely) a doctor is really different, even compared to how it was during med school. I suppose because I actually have some clinical know-how now, enough to realize when things are probably fine but need some looking into. It's much less anxiety-provoking when you know why things are being done, what tests say and don't say, and what's next. 

There's also the awkward added element of running into a bunch of people who know you really well. With one exception, every clinician - resident or staff - I've dealt with this week is someone I have worked with before or know well through school.

There's no way to avoid that, though, so I just need to get used to it. But I can't imagine it'll ever not be awkward, at least a little bit, to show up at your colleague's workplace and be like "hey, I'm sorry to make more work for you but..."

Thursday, 14 June 2018

Review Day, Reviewing Plans

Today was the day my case was scheduled to be reviewed by the college. I still don't know if it actually was; my online portal still just says it was tentatively scheduled to be reviewed today. Nice of them to keep me in the loop. It's only my future on the line.

If it was reviewed today, I won't know the outcome until late next week at the earliest, which is itself an absurdly long time to send an email.

There's nothing I can do about that at the moment, anyway so I just have to wait.

Residency is just over two weeks away. I don't have my schedule yet. We're supposed to have them no later than two weeks before they go into effect so I assume I'll receive it shortly. I do know I'll be on hospitalist for the first two blocks, followed by a block of core family.

I've decided to only take twelve weeks off once Smallest (he still has no name) is born. My plan is to work blocks 1-3, be off for 4-6 and return during block 7. For residents in my program, that's our Family Medicine Academic block, and all residents get at least a week off during it. There are no clinical activities during that time, as I understand it. I don't have a ton of details, but my understanding is that it's a relatively low-intensity period and I think it'll be a good time for me to return from maternity leave.

Taking only 12 weeks off means that I'll finish residency in late September 2020. This is preferable to finishing in December (my original plan) because it means I can send my husband and the kids home to the Island that August, then join them a few weeks later. If I were to finish in December, it'd be unreasonable to pull the kids out of school mid-year, so really we'd end up staying until summer 2021. This is much more convenient for us.

Plus I think a 12 week leave is sufficient for me. As I haven't actually found a job (long story) I've essentially been off for 6 weeks already and I am bored to tears.

I don't do well with idleness.

While I know that taking care of a newborn isn't idleness, I don't find it mentally challenging. Physically, yes, but not mentally. Especially after having gone through it several times already. New babies are cute and all, but I don't feel the desperate need to stay home that many of my friends have felt. My husband is an awesome dad and we're both much happier if I turn the domestic duties over to him while I go to work.

I am planning to preemptively book a couple of weeks off in late March (~6 months postpartum) just to ensure if I am starting to develop postpartum depression again I have a preplanned break to address it. Much easier to do in residency when we actually have vacation time to use.

Med schools really should think about having some sort of floating time off that students can take.

Still, I'm very much looking forward to starting residency next month, assuming my license was issued today. We'll see!

Thursday, 31 May 2018

Competence - A Story About Why Doctors Die

I wasn't sure about posting this before the issue was resolved, because this blog is not at all anonymous and I've never really intended it to be. I try to keep in mind that I'm personally - and professionally - accountable for the things I write here. And what I write here, once it's here, where the information goes is out of my hands.

I can't reign things in once I've put them on the internet.

Which is why I've been hesitant to talk about this. The fact is, though, that it is consuming so much of my consideration at the moment that I really need to, so I'm going to share the details here with the understanding that it's going to hurt.

In late May and June of last year, I was sick.

As was the case after having my older kids, I had developed postpartum depression and it was making it very hard to just get through things. Postpartum depression cranks every bad feeling up to 11. It didn't help that I was running around the hospital all day on an injured knee, and carrying the same workload as my peers who weren't losing an hour a day to pumping.

It wasn't a good time. I was unwell.

So I did what we should do; I took a medical leave to get some help, start a new medication, and catch up on my sleep. After the two week leave, I went back to work and finished my next rotation with flying colours, made up the missed time during an elective block, and haven't had an issue since. I recovered from my postpartum depression, just as I did with a little bit of time and medication changes after my other kids were born.

I figured that was the end of it.

When applying for registration as a physician, I was honest on the form and disclosed both my one week leave for giving birth and my two weeks off for postpartum depression. After talking to the credentials department, I had my psychiatrist write a note stating that I had recovered from the postpartum depression episode.

My psychiatrist also, however, included my other diagnoses that were not related to the leave, which I did not consent to being included. Things like my phobia of wasps (nature's black and yellow mistakes) and the PTSD I have from being assaulted.

My application has been sent for additional review. Because the college has "doubts on reasonable grounds" that I meet the registration requirements. Specifically, this regulation:

2.  (1)  It is a non-exemptible standard and qualification for a certificate of registration that the applicant’s past and present conduct afford reasonable grounds for belief that the applicant,
    (a)  is mentally competent to practise medicine    (b)  will practise medicine with decency, integrity and honesty and in accordance with the law;
   
(c)  has sufficient knowledge, skill and judgment to engage in the kind of medical practice authorized by the certificate; and
   
(d)  can communicate effectively and will display an appropriately professional attitude.  O. Reg. 865/93, s. 2 (1).
I had postpartum depression. My conduct has never at any point given any reason to believe I am not mentally competent to practice medicine, My conduct has never at any point given any reason to believe I will not practice with decency, integrity, honesty, or in accordance with the law. My conduct has never given cause to believe that I do not have sufficient knowledge, skill, or judgement to practice medicine. My conduct has never given cause to believe that I cannot communicate effectively or behave with a professional attitude. 
The college is doubting these things purely on the basis of my having treated mental health issues. 

I got help because I was sick, and now my ability to practice medicine is being called into question. 

I have a problem with that.

Currently, I do not know if I will be licensed. I will learn their decision about a week before I'm due to start residency. It is entirely possible that they will put monitoring requirements on me which may delay the start of residency.

I have learned while reaching out to others that this process is essentially guaranteed for anyone who discloses any sort of psychiatric diagnosis on their application. The presumption is that having a psychiatric diagnosis makes you unfit, and you must then prove your fitness. 
I find this to be an extraordinarily backwards way of doing things that does not take into account physician wellbeing, and makes assumptions about fitness to practice that has nothing to do with actual patient safety but is far more about maintaining for the public an image of physicians as unassailable superbeings.

This sort of nonsense is why doctors are dying. The stigma is real for doctors admitting to needing psychiatric help. The professional repercussions potentially faced for seeking help are real. The lack of confidentiality for physicians who do seek assistance for mental health concerns is real. 
I am not worried about the practice capability of physicians with treated mental illness who, in the opinion of their treating physician(s) are capable of practicing medicine. 
I am worried about the possibilities of a doctor who is afraid to get help for mental illness or addiction because they will face this sort of process. 

I had postpartum depression and my ability to practice medicine is being questioned. A doctor who takes time off to recover from a major depressive episode for any other reason will be subject to the same process; having to prove that having had depression doesn't make them unfit to be a doctor. 

It isn't okay to have to defend my ability to practice medicine because I had a common complication of childbirth. 

This is a problem. This is stigmatizing. It creates a barrier to accessing mental health care. It perpetuates the belief that asking for help is weakness. It is an additional reflection of the medical culture's refusal to acknowledge that doctors are human beings with physical and mental needs just like everyone else. 

This stigma is part of why physicians are consistently near or at the top of the professions most likely to die by suicide. It is so hard to get help, and the help can come at such a great cost, that doctors are suffering in silence. 

Which is why I decided to post this. Because this is wrong.