Saturday, 17 August 2019

Abled

I got to the point where I needed to ask for help because I'm struggling physically.

My hands are getting worse and worse. It's getting harder to keep up with tasks like typing and writing notes by hand. At home, as often as I can, I'm using dictation software. If I write a lot, my hands get so stiff it's hard to do other things.

Considering how much of my life has been centered around expressing myself by writing, having so much trouble writing is hard. The fact that my work requires so much of it is even harder. Documenting everything in medicine is so essential and I can't just not do that. But I need to save my hands for the really critical stuff.

I can write without using my hands, but I can't do physical exams without them. I need my hands to work and so I can be a mom and take care of my kids. So I need to reduce the amount of demands on my poor, unhappy fingers.

After a lot of struggling with myself, I asked my program for disability accommodations.

The main areas where my RA is being problematic are extended fine motor tasks like writing and typing, managing my fatigue (especially as relates to call shifts,) and getting sick a lot. So I've asked for access to dictation software, flexibility with scheduling (eg. not doing Friday/Sunday call, but straight 1:4 call so I don't have shifts too close together,) and masks for when I'm examining patients with respiratory symptoms.

Thankfully, my program was super responsive. They just jumped on it when I said 'hey, I need some support here.'

Pretty frequently, I am pleasantly surprised by how good my program is. No residency is perfect, but I think I'm in the best possible place for me to become the sort of doctor I want to be.

Even if that means I'm going to be spending a lot of time talking to computers.

Sunday, 14 July 2019

Opening Up

A couple weeks ago I wrote a Twitter thread that sort of blew up. Very much to my surprise it was shared fairly widely and I heard from a number of people with media contacts who are interested in telling my story.

I was kind of surprised by how interested people were in hearing about what happened and the strength of the emotions people have had in response to my story. I've been invited to speak in several settings, including one that you might know well.

A lot of people have been talking about the problem of depression and other mental illness in physicians, and the fact that doctors don't get help. But nobody is talking about why doctors are so hesitant to reach out for help. That's what I've decided to talk about.

I think my experience really demonstrates why it is that doctors are hesitant to speak up and get the help they need. They're worried about professional consequences, about the loss of privacy, about stigma.

 As a profession we have a bit of a love affair with this image of the doctor all powerful superhuman  who swoops in to save the day and leaves without making a fuss. The reality is that physicians are people too, with all the beautiful, messy, and sometimes painful experience that goes along with real life.

Doctors are often patients too, and I feel as though I should not have to fear being a patient because I am also a physician. We should feel supported and cared for when we need the help of our colleagues. Physicians should feel free to get the help they need, not fear for their ability to work the job they have sacrificed so hard to be able to do.

I've been honoured with the opportunity to speak and it is somewhat daunting to consider. But I feel like the time is right to start this conversation.

So let's talk, shall we?

Monday, 1 July 2019

Welcome to the New

Welcome to the new academic year. I hope those of you who are at a new level of your training are enjoying it and aren’t too terrified.

I had a post I was going to put up today, but it was a bummer and I decided against it. Instead, I was reflecting on the somewhat complex feelings I have around the fact that I enjoy my identity as a Canadian, but I also have a deep and personal awareness of how Canada’s crimes against Indigenous people continue to impact Indigenous families.

It made me think about an experience I’d had in med school, and I remembered I’d written a poem about it because it was one of those experiences that just stuck with me.

So, I apologize in advance, but I’m going to post one of my poems. Because I feel like it, and I like this one.


In her eyes I saw my daughter.

The blue and green, so like the sea in October.

October, when she was born.

The tinkling bells of her laughter rang with the song of a thousand summer winds,
a murmuration of happiness,
swirling between yellow-painted walls.

The straight, dark hair that someday she would
learn to hate, just a little bit, because it won’t behave, won’t accept the styles she tries to force on it,
styles that work better with caucasian hair.

She was described first as one of her People, as if that told me what I needed to know. He didn’t tell me that she loves green
and fishing
and hates bugs.
She was more a Native to him, than a child.

My daughter, my willow girl, so much like the tree;
bending and twisting with the winds, growing thin and wild. 
My Little Bird, a song always on her lips,
is to some first a Native,
and not a girl.

I wonder how she will feel about the white skin
that she got from me
when it camouflages the wide nose
and high cheekbones
her father blessed her with.

This little child who clutched at her devoted Kookum in the clinic, 
who danced in sunlit meadows and swam in rain-swelled streams, 
had rich and golden skin,
kissed by the fading summer.

She coloured happily, and waited, patient and quiet,
so unlike the ebullience of my Little Bird, who chatters like so many starlings.
All is well, dear child, said I to her. No shots today,
no worries.

Have a sticker.

Enjoy the school year, child, be yourself.

I turned back to my staff,
he said a job well done,
while he adjusted his Breitling. 

‘Those Native families,’ said he, 
‘the kids have such a hard time. ‘They never have enough.’

I went home to my family,
My husband, dear and wise,
my tall and dark-haired son, who has the best conversations, my Little Bird,
who climbs and sings and laughs so well,
and the tiny one
who screeches with joy as the cat tickles her, and tries so hard to share soggy crackers, with anyone who sits still long enough. 

While looking at my children
I recall the doctor’s words and think how poor he is.

2017
Following an interaction where my patient was described to me by my staff as “A Native kid.”

Thursday, 27 June 2019

Not Yet 2

The new academic year starts July 1st, but I don’t start PGY-2 until February. Next up is my paeds rotation; I start with two weeks of developmental paediatrics which is a unique part of my program in that it’s a core exposure for us. 

It’s also apparently a very positive experience for the residents in my program so I’m looking forward to it. 

After that, I’m on to emerg and I’m very excited to get there. The emerg teaching at my site is fantastic and the EDPs are all ridiculously nice. Emerg as a resident should be a good experience, and I’m thankful that it’s not my first rotation back. This gives me some time to rebuild my clinical confidence. 

Like many docs, I struggle with imposter syndrome. I doubt myself all the time. I worry about making the wrong call to the point that I hesitate even when I’m fairly sure I’m making the right decision. And honestly, that’s probably always going to be a thing to a degree. But as time passes and I spend more time actually doing my job, it’s easier to be more comfortable with my clinical judgement. Obviously as a resident it’s important to be appropriately mindful of the limits of my knowledge and seek guidance, but I’m going to be a staff doc in a year and a half. Independence is a necessary growth area. 

I love this job. I do. It is not without its frustrations and its major systemic issues (more on that later,) but the privilege of being able to do this work is incredible. 



Look who is nine months old!

Monday, 10 June 2019

Entrusted

I've had a string of really positive patient encounters recently that have been going a long way to reminding me why I'm in this job.

I'm also on OB/Gyn right now which helps, considering this is one of my favourite areas of medicine.

Sadly, the volume during my L&D shifts has been fairly low so I'm going to need to do quite a bit of extra time in higher volume settings during the rest of residency to gain the confidence I'd like. I may also see about doing a few extra months as an informal obstetric skills +1 at the end of residency just to ensure I'm as comfortable as I'd like to be with managing a delivery independently. That's something that can only come with practice and as a resident it's my job to seek out the skills if I don't have sufficient opportunity to do it on my scheduled rotation.

That's one thing about residency that I really like. My learning is completely in my hands. No one is handing me information. There are no rotation-specific checkpoints like end-unit exams. I'm the one who is going to be writing the $3500 exam at the end of this to prove I know my stuff; it's on me to make sure I learn it.

There is no handholding; it's on you.

So is caring for the patients.

As a resident, I have the benefit of backup. There is always someone more senior than I am to whom I can turn, but one of the 'Entrusted Professional Acts' right from day 1 of residency is to be able to provide initial management then seek help. It's something I keep in the forefront of my mind. In my first month of residency last summer, one of my patients was suddenly unstable and I was paged to the bedside. The RN had called my staff who said I was to manage it (Just to be clear: he was not far away, don't think he abandoned a baby resident with a very sick patient!) And I did manage it. I knew what to do immediately and as the situation wound down. That was one of the first moments when I felt like a real doctor.

There have been other moments like that, but while they have been just as profound, they have not been so dramatic or tachycardia-inducing. They have been the moments that people don't tend to entrust to medical students. It's the moments where I'm giving bad news and explaining what will happen next, or being able to explain something confusing and scary to a patient or their family member and put them at ease with the care they are receiving.

When patients ask if I can be their doctor, I feel there is no greater compliment as a professional. They are saying they would be willing to trust me with their health, and that is an incredible thing. I've been asked several times lately and it has left me very humbled and grateful for the opportunity to do this work.

To be trusted is the greatest privilege of the practice of medicine. It is a privilege I work each day to earn.

Thursday, 6 June 2019

Stabby Stabby

The title is in reference to my starting a biologic (a TNF inhibitor) for my RA. I inject myself with the medication. Too early in the therapy at this point to say whether it’s helping, but I’m hopeful. 

Things are going well with residency, though. I’ve been enjoying OB even if I am totally exhausted. As much as I am just loving doing this work, it is definitely cementing that I made the better choice for my own needs by pursuing family med. I can still do some of the stuff I love to do, but I can do other stuff too if my disease becomes too difficult to manage with certain parts of my care. 

This actually came up fairly recently. My job, among other things, involves a lot of taking care of sick people. I am now on medication which makes it more likely for me to get sick. Like... really sick. I have to be very cautious to avoid getting sick from my patients. 

There was a patient in clinic who had symptoms that I felt required some additional caution on my part. I didn’t think the more severe illness was likely, but it was on the radar so in my opinion I felt it was reasonably cautious for me to wear an N95 before going to see the patient, given that the disease I was concerned about is extremely contagious via droplet inhalation. It became a bit of a to-do trying to get appropriate masks and stuff. I’m going to keep some by my desk for the future. 

I know it’s going to make me stand out, being a doctor who wears masks in a family med clinic. But I’ve been hospitalized with complicated infections even before being on immune suppressing medications. It’s just good sense for me to be extra cautious. I just feel very conspicuous because I think people expect residents to be very self-effacing and to suppress their needs.

But as much as I love this job, it’s my job. I’m not going to risk letting it harm me. So that means I’m going to be careful, even if it is a bit inconvenient. 


Tuesday, 28 May 2019

Early Morning Wonderful

OB rotation is going very well. I’m glad it’s the only rotation where I routinely need to be at work for 7am because I am just not a morning person. This morning I got to teach med students and it was a fantastic start to the day; it’s really wonderful seeing their developing understanding and growing confidence. It’s very hard to believe I was where they are two years ago. 

Much as I absolutely love the medicine, in revisiting this field it’s clear that I would be struggling a lot if I were in an OB residency right now. The last four weeks or so are the first time that I’ve felt particularly disabled by a medical issue. Typing, walking around, doing up buttons, even holding R while he’s nursing, and other such ADLs are honestly really hard right now. 

So it’s a good thing I’m not running the gauntlet of a first year surgical residency or I would probably need to take a medical leave until the RA is under control. Because right now I’m having an absolute hell of a time. 

But, this is where the good news comes in. 

My super expensive biologic has been approved for 100% coverage. It’s a TNFα inhibitor and it costs a few grand a month so it’s pretty cool I won’t have to pay out of pocket for it, but I’m thinking I might need to stay a resident forever to keep these awesome benefits. 

The process to getting this approved was actually pretty straightforward which was fairly lucky. Preauthorizations for expensive drugs aren’t always (or often) so easy. Hopefully I’ll be starting on it next week and I’ll be on prednisone for a few weeks until the biologic has time to kick in. 

I’m not on prednisone right now because I’m doing patch testing. If you’re unfamiliar, it’s testing to assess for delayed hypersensitivity reactions. It’s an allergy test. I have 71 little patches on my back each with a different substance to determine which ones cause me to react. Have to wear the patches for two days then have them removed and then assess the reaction at removal and 24 hours later. I did skin prick testing for immediate hypersensitivity on Monday and that sucked way less. 

Suffice to say I am itchy. Very, very itchy. Not only because I have half my back covered in tape. But also because I’m having a fantastic array of allergic reactions which is the whole point. 

Being itchy and being unable to fix it bugs me more than being in pain. I have no idea if that’s a universal experience but holy cow it’s driving me to distraction right now! 

So while I completely understand the necessity of this testing, it sucks. A lot. I feel bad for recommending it to patients but at least I can commiserate with them afterwards. 

Yet another experience of my own to add to the “things that help me empathize with patients” pile. 

I think at this point, I’m good on the empathy front. Thanks, universe. 

Saturday, 18 May 2019

The Crunch

People always tell me how busy I must be and usually I can just brush it off because despite having a generally busy life, I do fine. 

But when something gives way, stuff piles up very quickly. I need to stay organized to stay on top of things, and right now that’s proving difficult. 

At the moment there’s more riding on me than usual and I also happen to be in one of the most intensely scheduled rotations in my program. As much as I love the work, I’ve got a lot going on and I’m feeling the stress, which I usually don’t. 

My husband is having a rough time with his recovery. Things aren’t great on that front. 

My RA is completely uncontrolled right now which is why I’m awake and complaining at almost 3:30 in the morning. 

Miss M is going through what’s probably the most challenging phase of toddlerhood and while it’s expected and developmentally normal, it requires a lot of emotional resources to help her grow through this phase. 

Plus I’m a resident and I’m not feeling as prepared as I would for my shifts, and I have to do my QI project. 

I’m also still dealing with this monitoring contract nonsense so that’s just one more thing on the pile. 

So things are just rough right now. I’m coping, because I have to and it’s my job to keep my stuff together so that I can support everyone else, but I’m feeling the strain more than I usually would. 

Thing is we all have these moments in our lives where everything just drops on us all at once and unexpected stuff occurs and life goes on despite the added demands. My ability to cope when this kind of stress hits has been what has gotten me through this whole wild ride to this point, and it is what will carry me through to when things get a little easier again. 

I’ve got several things going for me which help.

- I have some really amazing friends who are supportive and also able to remind me to take care of myself. 
- my incredibly sweet co-residents sent us a very thoughtful gift that gave me something less to worry about. 
- my oldest has really come into his own and is growing up into a reliable and responsible young man. 
- I’ve gotten back into swimming which helps with pain management. 
- discovered recently that Costco sells Diclofenac gel in large tubes so I have a constant supply nowadays 

And lots of snuggles from kids and pets and words of encouragement from wonderful people all make it easier. 

Things are a bit rough right now, but they’ll get better. They always do. 

Friday, 10 May 2019

Taking On Life Stages In Order

I start my OB/Gyn rotation on Monday and I’m pretty excited. After that is paeds, then EM, then several blocks of FM, then care of the elderly. They scheduled me to learn about the life stages in order. 

Because I had a week of vacation and a week of professional leave to use up by the end of June, plus a floating holiday, I actually have a bunch of days off during my next rotation and despite the fact that it means I have fewer weeks with 24 hour call, I’m actually a bit bummed. This is one of my favourite areas of medicine and my eight week rotation has become six. 

This also isn’t a great time to be doing 24 hour call. As I mentioned in my last post, my husband had a heart attack. He’s recovering well but still feeling fairly weak and a bit anxious. Obviously this isn’t a great time for him to be caring for a baby and toddler on his own all day so we have started the youngest two kids at a sitter’s house during the day. Conveniently the sitter lives just across the street so they’re close by anyway. We are trying to ensure there’s always someone home to help my husband with the younger two kids so he’s never on his own managing them. So me being on call means that the older kids need to help out most of the evening (M and R go to bed at 7) plus I’m going to just be exhausted all the time. I know I get tired even on normal days when doing overnight call and it’s going to be worse because my RA is really not well controlled at the moment.

So I’m a bit worried about how tired I’m going to be and how much that may impact how good a support I can be to my husband, but I’ll be okay. Recently I’ve managed to get back into swimming regularly and it’s helping with my energy level and pain control so that’s a really good positive change. It’ll probably be something I’ll do on post-call days. 

It’s actually interesting to me how much exercise helps my pain level. I do not routinely take any oral pain medication, although I use a topical NSAID gel most days. While I do get a bit of pain relief from the gel for my smaller joints (it doesn’t penetrate deep enough to make much difference for my elbows or ankles) the thing that makes the biggest difference is going for a swim or a walk. Getting moving is really hard when you hurt so much. I absolutely do not feel like I have the energy to go do it. Fatigue is a major symptom with autoimmune disease and it’s probably one of my biggest hurdles personally. But once I get over that inertia, I feel so much better. 

It always makes me think of how many patients I’ve talked to about movement as therapy. It only seems reasonable to take my own advice and I’m constantly telling patients that bodies do better when they move. So keep moving. 

Even though I’m a bit concerned about how rough this upcoming rotation is going to be, both from a physical perspective as well as managing things at home, I’m just going to keep that thought in mind as I go through my 24 hour shifts. Keep moving. 


Also I started a new hobby, because I needed more of those. Doing some metal stamping. It’s actually a lot harder than you’d think!

Saturday, 20 April 2019

Back In Back Out

I started back at work on April 9th and aside from the fact that I felt like an absolute idiot my first week back, it was super enjoyable to dive back into medicine. Seeing patients again was fantastic.

Then on Wednesday as I was getting out of my car at the hospital for academic day, my phone rang. It was my husband. 

“Hon, I’m going to need you to come home. I’m having severe chest pains.”
“Okay, I’m getting back in my car.” 

I hung up, got back in and started driving back home. I hit the button to call him on the car’s Bluetooth. 

“So tell me about this chest pain.”
“It’s right in the middle and it’s in my neck and my arm hurts. I feel like I’m going to pass out.”
“That sounds like it could be cardiac. What I want you to do right now is go wake up (Oldest) and tell him what’s going on and that he needs to help with the others. Then call 911.”

So he did. The ambulance was pulling away right as I pulled up. I got the older kids ready for school and then tried (and failed) to find somewhere I could take the other kids. 

Turns out EMS thought they might have seen ST elevations so he was protocol’d in as a STEMI and went right to the cath lab, bypassing the ED. By the time he arrived at hospital the pain was starting to subside, and the angio supported there was no ongoing occlusion, fortunately. 

But he had a clinically significant trop rise as well so he had an NSTEMI. They found a small PFO on echo as well. And someone has *finally* addressed his baseline tachycardia (he’s had a resting heart rate over 100bpm as long as I’ve known him.)

He’s home now and aside from feeling very tired, he’s doing okay. 

This whole episode has been a bit of a mind mess. My husband is my rock. He’s the strong foundation our family is built on, and having him go through something like this has shaken all of us. The kids were definitely freaked out and have been clingy. 

Right now, we’re working on logistics. He’s been referred to cardiac rehab and will be followed by cardiology. Obviously he’s going to need some time to start feeling better before he should be chasing after the littles, so we need to find daycare for the younger kids for a few months and figure out some way to pay for it (we just transitioned to only my income since he’d elected not to return to work after his parental leave.) 

Thankfully my program is being incredibly understanding. While he was in the hospital my husband was wracking himself with guilt thinking I was going to get in trouble for missing work because of this. It was nice to be able to put his mind at ease and remind him that part of why I made the career decisions I did was because I never wanted my job to come before my family’s needs. 

I’m beyond grateful he’s okay. That phone call is one I won’t forget for a long time. I’m glad that my program understands that I’m needed more at home right now and is willing to advocate for me to have some time to get things together. 

The logistics of responding to a medical event like this are something we don’t often think about in medicine. But getting child care arranged and ensuring my husband can get to all of his appointments and worrying about income and getting the bills paid and all of that is the stuff that piles on the stress after an event like this. We’re independent people; we can get stuff managed and we’ll be fine. But it does make me think of patients who don’t have the sorts of resources we do when faced with something like this. 

We’re lucky. I’m so glad my husband is okay and I hope he never has to make a call like that again. 

Friday, 29 March 2019

Let each man exercise the art he knows

(Title from Aristophanes)

I’ve been doing some teaching and I’m really enjoying it. I had not originally intended to do much teaching in my eventual practice but I think I might reconsider my feelings on the topic. 

We’re halfway through MF3 clinical skills now and I had the opportunity yesterday to teach the newborn exam with young mister R as my assistant. He was varyingly cooperative, and definitely both louder and more drooly than the baby models, but I think the students got a kick out of his presence. I also suspect it may help them remember a bit more now that they’ve felt a fontanelle and femoral pulses on a real baby. 

Plus R (mostly) enjoyed being the centre of attention. He’s a pretty social baby. 

That said, while I’ve definitely breastfed in the sim lab as a medical student before, it’s definitely a new experience to nurse a baby while simultaneously using him as a model for how to assess for dysmorphic features. And I guess I sort of gave the students a bit of a crash course on how not to be awkward with someone breastfeeding while talking to them. Welcome to medicine. I’m not the last person who’ll do that. Just wait for your OB rotation. 

Last couple of days we had the opportunity to see my husband’s family. His sisters and mother live in Manitoba and have been on a road trip for the past couple weeks. They stopped over here for a few days and had an opportunity to see the kiddos. None of them had met the youngest two kids and they’d not seen our older kids for four years so it was nice to meet up. My oldest is now a couple inches taller than his grandmother and almost as tall as one of his aunts. 

My sisters-in-law were kind enough to drum and sing for the kids, and included my older daughter as well. Miss M danced and R was entranced. It’s fantastic for them to get to experience such a welcoming. SIL invited Oldest to come spend part of the summer with them on the Reserve and we’re considering it. He wants to learn his culture and learn to fish and hunt. It could be quite the experience for him. He’s not had much time with that side of the family but he’s old enough to kind of hold his own in a new environment so it might be an amazing chance for him, especially as he’s lately been really developing his identity as an Indigenous person and I want to help him with that as much as possible. 

Identity is such a funny thing. It morphs and shifts throughout our lives in so many ways, but there are always some key pieces that never change. Watching my kids build those solid centres of who they will be is probably one of the most fulfilling things about parenting. My suspicion is that if I do it long enough, I’ll get to observe something similar with teaching. Watch students grow into clinicians. What fun that could be.  




Unrelated photo of Sakura ‘Too being fluffy. 


Sunday, 24 March 2019

Chewing the Fat - The Fat Lady Sings

I’ve made no secret here of the fact that I’m fat. It has been a fact of my life since I was a very young child and is kind of pointless to hide the fact. The last time I was at what is considered a normal weight for my height, I was a toddler. 

I have two normal-weight siblings and we were all raised with the same approaches to food. I’ll spare you the long story about how I ended up fat but the fact is it happened for a lot of reasons and remains so for a lot of reasons. Anyone who knows anything about the medicine of obesity knows that there’s a lot of factors at play in why people end up my size and why sustained weight loss is not simply a matter of just not being lazy.  

Considering the immense effort I went through to make my dreams a reality, I’m certain if you’re reading this you’ll understand that I am not by nature a lazy or unmotivated person. I’m actually really good at setting goals, changing habits, and working hard. 

So if that’s the case, why am I still fat? Did I just not want to change it hard enough? Maybe I just need *one more person* to make fun of me, or one more internet commenter to make some concern-trolling comment about how fat people are undeserving of human dignity (“...but really I’m just worried about their health!”) I’m sure that’ll fix it! 

Nah. 

What I need is another tool in my toolkit. Because the tools I do have kind of suck and for me and millions of people like me, they’re not enough. 

I am not uneducated about diet. In fact, if you’ve ever been in my kitchen you’ll know I keep my measuring cups and my little digital scale right beside where I prepare food because I’m particular about knowing exactly what I’m eating and I can rattle off the nutritional content of most foods without even checking my notes. I’ve tracked my intake in detail for around six years, with the exception of during my last two pregnancies because I would tend to restrict too much.

I am well aware of the scientific research out there on long term weight loss, and so I decided a long time ago that I’d follow the evidence once I was done having babies. 

So this fall I’m having bariatric surgery. 

My referral was sent in November and I had my first two appointments this month. I have another one in April and three in May and there are at least five more to be scheduled. It’s quite a process. 

Why am I going this route? Because almost everyone who loses weight by lifestyle management alone gains it back, plus more. I have lost up to eighty pounds before. I know HOW to lose weight. The basic approach is a simple one; the execution is not. This is not a matter of simple willpower. Willpower I have in spades. The issue is that cutting my caloric intake enough to lose significant weight and keep it off means feeling so hungry all the time that I can’t focus on basic tasks. It means food becomes a constant fight every second you’re awake. It meant I took up smoking when I was 18 to suppress my appetite so that I could actually get things done (I quit years ago, just to be clear. Smoking = bad.) It meant that I could not enjoy food socially without profound mood effects because of the need to starve myself to ‘make up for it’ afterwards. 

Yes, the basic premise is to eat less than you spend calorically but if you have never been very overweight and lost a significant amount of weight with your body fighting you every step of the way, you have absolutely no idea whatsoever what it is like when your body is developing whole new ways to be energy efficient when you need it not to be. 

Bariatric surgery helps remove that element of the process. It lets you restrict without your brain screaming that you are dying. It lets you re-train your body. It’s not a magic bullet, but it absolutely is the best tool out there for long term success with weight management. 

This isn’t a vanity thing. I’ve never been conventionally attractive and it’s not the goal.

I’m doing this because I have been at odds with my body my entire life and I’m fed up with it winning. 

I can’t fix my lungs. I can’t fix the crappy collagen in my joints. I can’t make my immune system stop being an idiot. I couldn’t stop all the miscarriages. I can’t make my chronic pain go away. 

But this, this I can fix. I can reduce my risks. I just need a new tool, because the ones I’ve got already aren’t enough. 

I am only 32. My future isn’t written yet, but I know I don’t want it to include early heart disease and diabetes if I can help it. I know what obesity costs patients as they age and I’m not letting that happen to me if I can do anything about it. 

This is not an easy process. I have to be run through a full gamut of assessments and then be on a liquid fast for a month ahead of surgery. Then after my insides have been cut apart and stapled back together I’ll spend months sipping and nibbling my way back to being able to consume real food again, all in the hopes that my newly abbreviated stomach will finally tell my brain to shut up and let me get on with my life. 

I have to give up NSAIDs - not an easy thing to do as someone who has RA and gets migraines - for life. Can’t have pop ever again (I don’t drink sugary pops, but I do love carbonation like Diet Coke and sparkling fruit waters.) I have to go 5-6 months with absolutely no caffeine. 

This is not, regardless of how people from the outside may view it, an ‘easy way out.’

I really waffled about whether to talk about this at all. I wasn’t sure if I wanted people to know about the surgery because of what they’d think. My decision to share has to do with the fact that I want people to understand that my being fat has never been because I’m lazy, stupid, uneducated, or undisciplined. It is a complex state that is not easily changed. When I do finally change for good, it will be because my body itself has been significantly altered, not that all of a sudden the approaches that’ve been failing people for decades finally worked. 

Nature has not been kind to me, but fortunately there are many talented surgeons who will help me flip the proverbial bird to the hand I’ve been dealt and change what my future health looks like. 

Tuesday, 12 March 2019

À musée

We’ve been trying to give the kids more educational and cultural experiences in general, and with the kids being on March break it’s a good time to get in some. Much as I’m not a fan of huge cities, living within spitting distance of Toronto has its perks. Lots of museums. 

Today we hit up the Royal Ontario Museum. I’m surprised it took us so long to go. We’ve lived here three and a half years and hadn’t gone until today and the ROM has exhibits that appeal to basically everyone in my family. 

There is one thing about me that becomes very obvious to people very quickly: I am a nerd about many things. As a kid, I was obsessed with dinosaurs for a long time. I was six when Jurassic Park came out and to six year old me, that was one of the best things ever. Loving dinosaurs as a kid is why I love birds - which *are* modern dinosaurs - even now. 

Both of my daughters love dinosaurs too. The ROM has a huge collection of fossil specimens as well as incredible cast reproductions, so of course we hit that gallery first. 

My son really wanted to explore the First Peoples’ gallery and that was a fantastic one as well. It’s a bit hidden off to the side it feels like. We had a tough time finding it. But the specimens are beautiful and the stories fantastic. It was amazing for my kids to see traditional artwork, clothing, tools, weapons, and ornaments from their own nations. My son is really developing his identity as an indigenous person, so he’s been asking for more exposure to First Nations history and culture and I love to make it possible for him. 

My husband and I love to do these sorts of daily outings with the kids. Even when it gets a little loud and wild, it’s the best sort of experience to share our love of learning with our kids. It is incredible to see their eyes come alive with surprise and wonder. Watching them discover new things is one of my greatest joys. 

We won’t have as much time for our adventures when I get back to work next month, but we have a few more planned at least. Next one will be to the Aquarium!



My oldest was smiling all day... except when I took photos, and that was intentional. M was yelling “Di-o-saur!”



R was less than impressed at the exhibits. 

(I blacked out other people’s’ kids.)

Thursday, 28 February 2019

Unexpectedly Difficult Directions

Back in December, I was hit by a wave of absolutely staggering fatigue.

This has happened a few times before, in fact I've mentioned it here before; a few months after Miss M was born I started dealing with it and it lasted several months. It had happened before that too, before we moved to Ontario. I'd had all the lab work you'd run for fatigue run several times but there was never anything particularly remarkable except for a mildly elevated CRP which was attributed to my size.

The last time this happened, my hands hurt a lot, but that was when I was doing my OB core and all those electives so I was in the OR a lot and just figured it was all the retracting and assumed the fatigue was clerkship exhaustion and PPD.

Well, this time, I'm obviously not in the OR and did not have a clear explanation for why a bunch of my finger joints were red, swollen, and so stiff in the morning I had to do physio exercises for the first couple hours after I woke. I just kept waiting for it to go away, but it kept getting worse.

A few weeks ago, I started to put it together and realized it all makes sense in the context of an autoimmune condition, particularly rheumatoid arthritis.

So I saw my family doctor who agreed and she referred me to see a rheumatologist. It was the fastest outpatient referral in my life: it took four days from my appointment with my family doc until I saw the rheum. I did the blood work on Friday and saw the rheumatologist on Monday and I do indeed have a seropositive inflammatory arthritis.

One of my first thoughts was actual surprise, even though this is a pretty classic presentation and obviously I knew it was likely as I'd seen my own labs beforehand. I'd been hoping I was just imagining things and that the soreness and fatigue were just a different presentation of postpartum depression than I usually have. Nope.

See, even when assessing myself, I'm not free of the biases that run rampant in my profession. I knew enough to suspect RA was on the differential, but very much felt that I'd be brushed off again and told it's just my weight or my mood; things I've experienced many times. So I was doing it myself.

Big women with psych histories get used to having everything blamed on their weight or mood.

It was nice to see a specialist who didn't immediately do that and actually assessed me.

We got a treatment plan in order. Because I'm breastfeeding R, I can't take the usual first line medication but I'm taking two others that are usual for RA management which are safe for breastfeeding. Having a doctor who knew off the top of her head which medications have good lactation safety profiles was actually a very pleasant surprise because this is not common and gave me an idea for my QI project.

I'm also on a bit of prednisone this week just to see how things respond. I started it Monday night and by Wednesday morning I woke up with very little stiffness, the swelling in my joints is visibly reduced, and the pain is very minimal. That supports the diagnosis quite strongly, I think. I'm ridiculously hungry and my sleep is awful - pretty typical side effects of prednisone - but it's nice to actually be able to nurse R without being in a lot of pain. 

This diagnosis does reinforce that I made the right decision going into family medicine instead of OB/Gyn. I'm not sure RA and a surgical career are necessarily the best mix. Also, the fatigue and brain fog is very intense and 24 hour calls would be extraordinarily draining, particularly as a staff who doesn't get post-call days. I love my job, but I want the energy to enjoy life outside of work too.

I'm hoping the DMARDs work quickly and that I'm not symptomatic when I return to work. Fortunately I'm in my clinic for my first block back so I'll have a very reasonable schedule to ease into things. For one block, anyway, then I'm on OB so all bets are off.


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.