Sunday, 23 April 2017
Anyway, to medicine.
For my final assignment for my ICU rotation - which was a fantastically educational rotation to have done - I have to write a two page reflective paper.
This is not what I would call a challenge, given my tendency to reflect at length about absolutely everything (incidentally this is public post number 1060. I have 142 in draft.) The question was which topic to pick of the many I identified whilst there. Eventually I settled on something that might quirk a few eyebrows, but I think provides very strong material for reflection. Only problem is that I've written three pages and have to trim it down.
Damn my prolix nature.
Next up is ortho, which feels like it is going to be rather intimidating. Ortho is not my natural milieu, and I had a baby three days after the end of that unit so most of what we did has gone completely out of my head.
This is a bit of a problem with all these two week rotations. I just do not have enough time to learn and actually absorb information before I'm onto the next one, and I have no time in each of the rotations to really absorb and apply the information. My exam for ortho is ten days into the rotation.
I'd planned to spend this weekend studying intensely, but between my husband being at Cub camp with our son yesterday, spending the evening in emerg with the wee one for x-rays (she's fine! Just very sore after her big sister tried too enthusiastically to get her to roll over again and accidentally twisted her backwards onto her arm. She can't move it very well, but it's not broken) and feeling just awful today, I've not gotten as much studying done as I'd like and I feel like I'm going to show up and be a huge idiot tomorrow.
But then I feel like that for every rotation, and so far only one preceptor has actually thought I'm an idiot. Or has at least expressed as much.
As for now, I'm going to go listen to some Tragically Hip (I'm doing paediatric ortho...) and read about classifying fractures.
Tuesday, 18 April 2017
It's nice to rotate through a bunch of services and all, but by the time I've learned how things are done on one unit, I'm moving onto another. I have three days left on this rotation - I've only done 6 because of the holiday weekend - and I'm just now getting to the point I feel like I'm able to comfortably do actual work that contributes to the team instead of primarily learning through observation or needing to be babysat through my work.
This is also just a really, really awful week for me right now. M is not sleeping at night and while I try to trade off with my husband so that at least one of us ends up well-rested, many nights neither of us is getting much sleep. I'm averaging probably 4-5 hours a night for the last 2-3 weeks, and that's really not an exaggeration. I can usually manage fine on that for a couple of weeks, but I am reaching the point of exhaustion saturation and I desperately need a reset.
I also have pretty much no downtime at all. I come home from work at 5-ish. Hang out with the kids, maybe catch up a bit on Facebook while my kids do their homework or use their screen time allowance, eat supper, play with the baby a bit while my husband gets the older kids to bed, and then I study until around 11pm, get ready for bed and lay out my stuff for the next day, then crawl into bed around midnight. Often the baby wakes up right around then, so I nurse her back to sleep (I'd have to pump if I didn't) and then get her settled right around then.
Then I get up around 5:30-6am, shower and dress and get to work for 7-ish.
Weekends are spent with my family, evenings once kids are in bed are spent studying.
I am almost never alone. Usually I'm nursing while I study, or I'm attempting to spend time with my husband - well, at least in proximity to my husband if not actually interacting with him - or I'm with the kids.
This weekend I took two hours - during the day when the kids were awake, at that - and went and played video games in the bedroom. All by myself for two hours straight. And I realized that was actually the longest stretch of time I had spent alone not doing something either for school or my family since I got back from Ottawa almost two months ago.
Sunday, 16 April 2017
I had my pre-CaRMS career counselling session last week and it went fairlywell. The counsellor said he's confident I could match to OB if I choose to go that route, but said he understands my concerns. My problem is pretty clear and I explained it to him: the career path I want is not really the best career path for me to take for my family's sake.
I've given myself until the end of June to decide.
Sunday, 9 April 2017
Monday, 3 April 2017
Med school, like med life, comes with a lot of paperwork.
Fortunately, the school is nice and organized and reminds us with plenty of time.
Also fortunately, I can submit my prenatal blood work from last year which will cover a bunch of the new requirements. It's quite possibly the first time having had a baby during med school has saved me time.
I've ordered my vulnerable sector check (which can be done online, yay!) and so all I have to do is do my TB testing since I think I'm considered as having exposures now because I've had clinical placements in hospitals with more than 200 beds.
My current placement is going middling to well. I'm not at all a natural with anaesthesia and feel very wrong-footed a lot of the time because I'm not confident in my knowledge, but I need to develop that. The way the rotation goes is that we work one on one with a different staff anaesthesiologist every day. Unfortunately it doesn't give them long to get to know us, so if you have a bit of a weak day, which everyone does now and then, you don't have the opportunity to improve on your performance for that preceptor.
It also means you're in a constant state of unsteadiness because different staff want things done differently. Basically, no matter how you do something, there's a pretty good chance you're not doing it to the preference of your staff. Not that it's necessarily wrong, but that it's not how they want it done. It's a bit tedious to learn each person's preferences each day, but I can understand that everyone has their own way of doing things. It would be nice to have a single preceptor for this rotation, though, and I think that's likely the feedback I'll give at the end of it.
You just don't have enough time with any one staff physician to get to know how they do things, and they don't have enough time with you to get to really assess your abilities.
After this I'm off to ICU for two weeks, then orthopaedics. ICU feels more than a bit intimidating and I feel like I'd feel more comfortable with it if I were doing it after my medicine rotation. Ortho looks quite interesting - I've been on the other side of the drape for several ortho surgeries - and it'll be nice to have a better view for those cases.
Overall I'm still really getting to that point where I feel like it's okay for me to actually do things as opposed to just observing or being taught via discussion. It's quite the transitional period and I expect it'll be a while yet before I really feel like part of the care team as opposed to a somewhat annoying outsider who asks lots of questions.
Look how big she is now!
Saturday, 25 March 2017
Sunday, 19 March 2017
Wednesday, 15 March 2017
Sunday, 5 March 2017
Thursday, 23 February 2017
I woke up feeling a little off - just that sort of half-sick, not quite awful feeling. My throat was a bit scratchy but that often happens in the winter. So I just got on with my day.
By noon, I'd spiked a fever (max temp I measured was 38.8) and was shaking and sore and my tonsils are scarlet and awful looking. Centor Score: 4. 53% probability of strep pharyngitis.
The residents I was with, understandably, had me leave. I'm holed up in my hotel room, under a pile of blankets, feeling pretty sorry for myself. I have bottles of water, acetaminophen, benzocaine lozenges, and my pajamas.
I only missed 4 hours of today, and my residents said I could return if I'm afebrile tomorrow so I'm just trying to will my body into health. There's sort of an unspoken "Thou Shall Not Take Sick Days" culture in medicine (I actually was told explicitly by a physician that doctors can't take sick days so I suppose it's not truly unspoken.) It's understandable, particularly for specialists who might have patients waiting months or years to see them. Cancelling your clinic or OR day may result in unacceptable waits for rescheduled patients.
But I'm just a student. The care I deliver is not so critical that my being absent for an afternoon will cause unacceptable issues for patients, and it's just plain irresponsible for me to stay there if I could make a newborn sick because they go downhill reaaaaally fast.
I'm hoping that my fever breaks overnight because I really, really want to work tomorrow. I had planned on returning to Hamilton tomorrow after work, so I didn't actually book my hotel for tomorrow night. I have to check out in the morning. But if I end up working a long day tomorrow to make up for today, I'm going to need to sleep before I make the 5 hour drive back. Honestly may just kip in my car for a few hours, or ask a friend if I can conk out on their couch for part of the day.
Right now I need to get my hotel room ready for the morning. Have to take my suitcase out to my car and lay out my clothes, make sure I've done my going-over of the room because I would hate to forget something.
It's been nice being back in Ottawa. I like this city a lot, and have missed living here more than I realized. I'll be a bit sad to leave, to be honest.
I just really hope that I'm feeling better in the morning so I can at least work on my last day here.
Wednesday, 15 February 2017
I will be seeing the family tomorrow. My husband is driving up with the kids tomorrow evening. I'm switching hotels as well, since this one isn't really ideal for having the whole family here for 6 days, though it's been workable for me for the last few days. It doesn't cost much more, but I wanted to save money where possible. There's actually a program that reimburses clerks for travel for one elective per year within the province, so I'm going to be reimbursed for my travel and accommodations, but I still wanted to be reasonable with my costs (even though my nightly rate at both hotels is below the cost limit.)
I'm a bit tired at the moment but it's more because I'm not sleeping well rather than anything to do with my elective. I'm not doing any call or anything, so it's just a normal 7-5 schedule (which I find amusing. A 'standard' week is 50 hours. Plus whatever call shifts you are scheduled for.)
The residents and staff I've been working with are amazing. Not that anyone at Mac wasn't awesome, but I really like the atmosphere here. It's different. Not better, but from my first few days I think I've just gotten my feet under me a bit better. I also really like being back in a bilingual environment. It hadn't occurred to me until I got here how much I'd missed hearing French regularly. My expressive fluency has also taken quite a beating over the last couple of years since I've not had many opportunities to speak with adults in French, so it's nice to be where I can use it. I think my desire to come to Ottawa for residency is certainly increasing.
This is a good city. My husband grew up here and I did live here for ten years, so we both know it well. While we did move to my home province after some rather difficult events (I knew multiple people who were murdered in a very short period) I have always liked Ottawa. Plus I know my way around well enough.
I'm very excited for my husband to get here tomorrow and be able to revisit his old stomping grounds and see his old friends. I think he's been wanting to consider coming back here himself, so I have a feeling he'll agree with me that this'd be a good place to go.
Not that I have complete control over that.
Still, it's so-far been a good trip. I'm enjoying myself. I just wish I could be home with my husband. At least the kids insisted he buy a cake, so they had that for dessert.
Sunday, 12 February 2017
We're nerds and we make no apologies for that fact.
I'm just settling into my hotel in Ottawa right now, having washed off the road after a very long drive. According to Google, the drive should take almost exactly 5 hours from my house to this hotel. I left my house at 1pm. I got here at nearly 10pm.
The weather sucks.
At the moment, I'm just reviewing hospital policies and my orientation guide for the morning. I am very much looking forward to getting started on my first visiting elective, though I am quite nervous. This is definitely a program I'd rank very highly, given the opportunity, but I know sometimes Mac students have a bit of a reputation of being less prepared than other clerks. It's something I've only really heard rumoured, and seen on the Internet, but I can't help but worry. Not only am I only a year and a half into med school, instead of 3+ the way other clerks on visiting elective would be, I only have one core under my belt at this point. I'm still learning the ropes as a clerk.
But I just have to roll with it. I think I'm very strong material-wise for this specialty, but it's the ins and outs of being a clerk that I'm still navigating. Learning exactly what is acceptable for me to do on my own, what residents and staff expect me to take initiative on, how much I'm allowed to do paperwork-wise before having something checked or signed off ahead of the next step. I know some of this is going to vary service to service and place to place, but I don't even really have a range of what's normal at my home school yet.
I generally prefer to lean towards 'check more/don't assume too much' but I know that can annoy residents and/or staff. I don't ever want to overstep, but at the same time I don't want to create more work than a clerk should.
It's a bit of a balance, and one I'm still working hard to find.
Still, we'll see how things go tomorrow!
Monday, 6 February 2017
OB is definitely an incredible specialty. Mostly fun, but it's also sometimes very sad.
During my time there, I saw the alarm activated for obstetrical emergencies more than once. It was incredible to see the nurses all swarm together, the residents jump to action, everyone finding their way to a place of usefulness (while I stayed out of the way as much as possible, which is how a medical student can be useful in these moments.) I was not in the room for the emergencies, but just seeing how all of these experienced care providers reacted to hearing that sound was pretty amazing. Everyone drops what they are doing to leap in and help these patients.
As a final assignment for this rotation, we have to write up a paper on an ethical scenario we encountered. I'm not having trouble finding one - I'm having trouble deciding which one of the many to write about. It's due tomorrow and I am absolutely not at all feeling bad about the fact that I haven't done it yet since I have been thinking about it.
The case I think I'm going to write about is one that was one of my two personal test-cases. My "if I can handle this, I think I really will be able to handle becoming an OB/Gyn" cases. I thought about writing about one of them here - in a roundabout, many-details-changed-for-privacy sort of way - but I decided against that since I don't know that I could sufficiently anonymize the story.
My thought about how much I need to change something for privacy before I even consider talking about it here is that I want to change it so that if the patient themselves were reading it, they would not recognize that I am writing about them. Because I'm still so new to clinical activities, I don't think I'm reasonably able to do that yet, so I will always, always choose to just not talk about a case rather than risk even the slightest possibility of posting something I shouldn't.
The only detail about the case I think I'm comfortable sharing is that it involved one of those difficult decisions that is unique to OB/Gyn: how much do we risk this patient's outcome to improve the potential outcome for that patient?
I suppose other specialties might see that in roundabout ways when they're dealing with resource limitations or in something like a mass casualty situation, but I think it comes up far more often in obstetrics. Really, it's interlaced with everything in obstetrics. The risk/benefit balance goes four ways instead of two.
The case I saw that most challenged me wasn't the one that I'll be writing about for this assignment, but it has been on my mind a lot. It was a cruelty of nature, not a failure of people or of medicine. Mother Nature is not a benevolent matriarch. I'm comforted, though, by the fact that there are so many skilled hands, at the ready, prepared to dive into the action when that alarm blares, when nature fails, when the blood hits the floor and all else is forgotten, to guide tiny lives through troubled moments and into the arms of their mothers.
That is where I want to be.
Wednesday, 1 February 2017
Up top, it said "Before I die..." and the remainder was a blank field of possibility. A box of chalk was attached to the wall nearby, tempting passersby to share pieces of themselves.
A few years ago, I was walking by and I stopped and read some of them.
Before I die...
...I want to get married.
...I want to have children.
...I want to go to Disney World.
...I want to have tacos for supper every night for a year.
...I want to see my children grow into good people.
...I want to fall asleep beside my wife every night.
They ranged from the mundane to the absurd. Some were clearly there as jokes, and some were profound.
I found a scrap of space where the ghost of someone else's confession remained in the scattered dust and with the dry rasp of chalk on slate I added my own words in a vibrant yellow cursive.
Before I die... I want to become a doctor.
So here I am, fifteen months from doing just that. I wonder if other people read that and thought it sounded silly. Or if they saw it and imagined some hopeful youth, in high school perhaps. I doubt someone would see that and imagine an exhausted, poor, fat, overly anxious woman who runs herself ragged between school and work and family.
I don't think I'm anyone's first mental image of a medical trainee.
But here I am.
Sunday, 29 January 2017
My blog here has always been intended as a relatively neutral platform. I think I've commented on my political leanings only once, in passing, when encouraging people to vote.
But today, I am breaking with my nearly five years habit and I'm writing a very political post.
With about a quarter of my traffic being from the US, this is for you guys, but I'm reaching out to my Canadian readers too because I expect that like me, many of you have a lot of American friends and/or family.
The reinstatement of the Mexico City Policy means that money that helps save the lives of women and babies will be withheld. It means that while paying lip service to protecting life, the US government is willing to withhold funds that go to prenatal care, emergency obstetric care, contraceptive care. They so disagree with abortion that they will let women bleed to death in childbirth, or suffer from labour so obstructed for days that they die of infection because they can't access a C-section.
The narrative of America is one of resistance from its birth, and the seeds that grew to revolution are still there. Water them.
The Council on American-Islamic Relations: https://www.cair.com/
- Helping to protect the rights of Muslims in America.
The American Civil Liberties Union: https://www.aclu.org/
- Has been helping detained persons access legal protection.
This page has summarized a number of resources and ways to get involved (primarily for Americans) on the immigration issues:
Donate to the Planned Parenthood Federation of America: https://www.plannedparenthood.org/ or
The International Women's Health Coalition: https://iwhc.org/
This is just a tiny sprinkling of resources. There is so much more that can be done to counteract the harm that is going to be done by this administration. Check out the Bill & Melinda Gates Foundation's projects, spread the word about the GAVI Alliance since even vaccination will be under fire.
While I'm aware this is drastically out of step with my usual posts, I can't not say something as I watch malignant nationalism metastasize in the very last place it should ever take hold.
Saturday, 28 January 2017
This schedule has meant a lot less time with my family. I'm leaving before most of them wake up in the morning and most days I'm not home until nearly 6 if I don't have call. The older kids go to bed at 8pm, so I'm barely seeing them at all. That's hard to get used to.
Fortunately M is such an easy baby we have no problems going back and forth from bottle to breast, but my milk supply has taken a beating. My opportunities to pump are irregular and it's often hard to get away when I need to so I often end up going longer than I should and so my supply is reducing. In the last two weeks, I've pumped less than she has taken 11 days.
I have no problem supplementing with formula and we have been since the beginning (though out of preference, not necessity. I was producing as much as she took and was just freezing the milk to have a freezer supply for longer separations.) While everyone is very supportive of me breastfeeding, the nature of OB/Gyn doesn't really make it easy to run off for 20 minutes every 3 hours.
It's messing with me a bit, to be honest. I had oversupply with my other kids. While my milk was delayed coming in all three times and we dealt with thrush and mastitis with my second, I have never really dealt with supply issues because I was home with my other two and fed on demand. I've never pumped much before. Quite honestly, I hate it. I will probably only pump during day shifts for the first six months or so and after that I'll only pump overnight when on call or when away from home. It'll take a while to adapt to no daytime pumping, I'm sure, but other mums do it successfully.
Tuesday, 24 January 2017
My preceptor is amazing. She has high standards, and is fiercely protective of her patients, and I think that's incredible. Every time I meet patients with her, they tell me how lucky I am to be working with her, and they rave about her bedside manner. It's left me smiling many times.
She expects a lot from her learners, but she also gives a lot. It's clear she expects me to demonstrate interest and an ability to learn quickly. but she is ready to take the time to teach and ensure I have the opportunity to learn. She won't force the information down my throat, but makes it available for my consumption.
I am incredibly grateful to have someone who is so willing to offer guidance as a preceptor. I really lucked out. Perhaps it helps that I'm actually interested in the specialty and demonstrate a legitimate interest in what I'm learning. But I do try to be interested in everything, even stuff that isn't my favourite topic (I wouldn't say that anything qualifies as boring to me, at this point.)
While I may not be able to do many things well right now, I am a willing and enthusiastic learner so I suppose that counts for something. It may also help that I'm not all "yay babies!" I actually like the gynae half of the specialty too. Obstetrics is just a part of OB/Gyn, and I actually think I might like the gynae stuff a bit more.
I definitely like surgery and want to learn to do it, which is less of a surprise than it would have been before last summer but still bowls me a bit. It's definitely pushing me further away from family. I don't know if I'd be happy doing just the occasional punch biopsy, Paps, and nothing more procedural than that. I've got a surgery-heavy OB/Gyn elective coming up in March to explore that further.
|When you really need to study, but also want to snuggle.|
Saturday, 14 January 2017
To be fair, I actually have three 25 hour call shifts in a 7 day period - making it a nearly 100 hour week when you add my non-call shifts- so it's pretty brutal. Last night in particular was rather intense. My first call shift was pretty quiet, but last night most definitely was not.
Today, though, is my son's tenth birthday. It's absolutely incredible to me that he's already 10 years old. When did that happen?
Saturday, 7 January 2017
Working out my pumping schedule should be interesting, particularly given that OB/Gyn doesn't really lend itself to having anything scheduled during a shift. My plan is that every 3 hours, I'll take the closest moment to go pump (Except between midnight and 6am.) So sometimes I might have 3 hours between sessions, sometimes it might be 4.5. I can't really go longer than that during the day or I'm in pain. I should need to pump about 5-6 times during 24 hours if I'm away from M the whole time.
I am really excited to get working. Especially because this is my favourite area. I know this material very, very well. Not just because it's been directly applicable to my life many times over, but because it's a major area of interest for me.
Must admit that I'm a bit nervous about how I'll manage when I'm on different rotations. Because I'm doing six weeks of OB/Gyn electives immediately after this core, I'm starting my clinical part of clerkship with 12 straight weeks of OB/Gyn. While it is a very comprehensive specialty - medical, surgical, across the lifespan, with patients of varying complexity - it's also very specialized in that in the obstetric part of it you're seeing primarily younger, mostly healthy women for a normal physiological process. I'll likely not be seeing many elderly patients (although some certainly come up in gynae, of course) and probably won't be seeing a whole lot of extremely sick individuals the way one might on ICU.
Every patient population has a different general approach; that's what we learn in preclerkship. There are some clinical skills I'm just not going to even consider over the next 11 weeks so I'm going to need to spend some time making sure I don't forget important things that will come up on my future cores. And, you know, my LMCCs.
As it is now, though, I'm just trying to focus on being a good clerk. Be helpful. Be cooperative. Be useful. Be ready and willing to learn. Support your resident. Be professional.
Let's see how well this works out at 3am, shall we?
Thursday, 5 January 2017
Aside from the fact that things are busy, I've been posting very little because I'm dealing with some pretty awful insomnia at the moment and it's taking me a lot just to get through the day and try to get done what I need to do. I'm only getting about 4 hours of sleep a night, on average, and so I'm feeling very run down.
Being very 'off' in January/February is rather normal for me - in fact I think I've made a post to this effect at some point every year - and so is postpartum insomnia for the first few months, so I'm just sort of riding it and hoping that it gets better soon. It may actually work in my favour a bit now because of this:
I start call shifts next week. There are four students in my stream together on the one unit, and so we made a call schedule (well, I made it because this sort of thing is fun for me, and they agreed with it) that meets our requirements and will hopefully not be too brutal. There are 28 shifts and we each get 7. I have two weekends fully off (we all do; I arranged it that way) and I've strategically positioned my post-call days to ensure I'm off for a few important things without needing to actually schedule time off.
Given that I'm still dealing with insomnia, I expect I'll probably do fine with call. Can't sleep anyway, might as well just care for mums and learn.
I am really, really excited to get started on the unit and with clinic. I feel like I'm actually going to be good at something. It'll be important, I think, to be careful to not come across as a total know-it-all in my enthusiasm. The goal is to be a good clerk. Be helpful. Be enthusiastic. Seek out learning opportunities. Be a good team member. Learn from everyone, including the patients. Especially the patients.