Thursday, 31 December 2015

The Year That Everything Changed

It's only natural to think about the last year on New Year's Eve. I don't make resolutions, but I do reflect. 

This time last year, I was still worrying a great deal about whether I would ever get into medical school. I had only had my MUN interview and didn't yet know if I'd be interviewed at any of the Ontario schools. 

And here I am, purple backpack in my room, two years and five months away from adding an M.D. to my name. 

This time last year, I was happily, if somewhat anxiously, pregnant. It would be only two days later that we'd get the bad news. A year later, we're no closer to expanding our family, but we have hope. We've got an appointment with a reproductive endocrinologist next month. I can finally get the assessment that I've needed for years but haven't been able to access. 

A year ago, we were living happily on the Island, with fantastic, if exhausting, jobs and a generally stable, but modest life. We're now in Hamilton, with far more neighbours than we're used to, in a city far larger than we're accustomed to, and which we were very hesitant about living in, but which has surprised us with its nicer side. 

This year has seen me grow as a person in many ways, partly as a result of accepting my role as a student physician and the position that will place me in my community, partly as a result of breaking away from some unhealthy relationships. It has been an experience, for sure. 

I don't know what next year holds, besides the start of clerkship, a trip home, and possibly our first ever international vacation, but I do hope it will top this year. Hopefully without any of the tragedy that touched the start of 2015. 

That said, I will always remember 2015 as the year that changed everything. What an extraordinary thing to be able to say. 

Happy New Year everyone. If you are out, be safe in your enjoyment. If you are home like we are, have a fantastic night. 


Friday, 25 December 2015

Quiet

We don't celebrate Christmas, but I do like the quiet of the day. Took the dog out for a walk (didn't even need gloves!) and it was quiet even along the busy road. I've taken a bit of a break from blogging for the last week and a bit just to spend a bit less time online. 

Simply by coincidence my husband has six days off in a row, starting yesterday, so he's got a little mini vacation. We're enjoying the time together as a family. Friend of mine stayed with us over the Solstice and it was really lovely to have someone come stay for a bit. We didn't get out to do much, but she got some time to relax after the strain of her second last semester of undergrad. 

I made an amazing meal on the day of the solstice, if I can pat myself on the back a bit. Roast and vegetables - potatoes, sweet potato, carrots, beans - and fresh bread and chocolates and pumpkin pie. Oh man was it wonderful. Literally the best gravy I've ever made and I make pretty good gravy if I do say so myself. 

My kids are going slightly insane with the deviation from their usual schedules, but that's to be expected over breaks. We're currently looking into what to do with them during the March break and then over the summer. My son wants to go to computer camp to develop his coding skills. Yup, he's an eight year old programmer. Or at least he's trying to be. He's been able to write a few simple programs that request and read back input. 

For his birthday, which is in three weeks, we've gotten him a book about using Python (that's the language he's chosen to learn) to modify Minecraft.

My daughter has been running around with her stuffed Dalek, using her sonic screwdriver (the Eleventh Doctor's) on everything. Scared the crap out of the cockatoo when she pretended to open his cage with it. 


Watching Doctor Who, naturally. In Superman pyjamas. Because that's how we roll in this house. 


Of course we got him a cool, light-up keyboard. That's the best part! He's totally in love with his computer. 
And yeah, he had to assemble it. 

As much as I love medical school, I am incredibly glad to have this time off. I needed it desperately and I feel so much more like myself. 

Or at least I will once we get a proper night's sleep at the right time. Last night was a chorus of vomiting thanks to a stomach bug, so it'll be good when that is all gone. Everyone seems to feel okay today, at least. 

I wish those of you who celebrate it a merry Christmas and hope all of you have a lovely day. 



Tuesday, 15 December 2015

Nice Spring We're Having This Winter

The weather has been confusing me. It's awfully warm for December, though back home they are having their usual snowstorms. Exams at my old school were cancelled today.

The early nightfall is certainly starting to get to me. I'm looking forward to the days starting to get a bit longer because right now I'm having a bit of a rough time focusing. Fortunately I only have two more things to do this week in addition to the CAE tomorrow morning. I just have clinical skills 'super Wednesday' and then tutorial.

The purpose of our triweekly 'super Wednesdays' - where we are taught clinical skills by a more experienced instructor - is to ensure we are all progressing at the same rate. I like that we do it this way because it helps eliminate any possibility of falling behind, though so far I've had really lovely preceptors who have been very concerned with ensuring our clinical skills progress as they should.

We aren't going to have our normal weekly clinical skills this week and it's partly my fault. Our residents weren't available on the days that worked for most of the group, and the days they were available had at least one student who couldn't make it, so we decided to just do a double session the week we come back. This is something Mac allows occasionally, at the discretion of preceptors.

So we're told anyway.

It was rather nice of them, especially considering that the reason I'd rather not go on Friday evening (and I'm the only person who doesn't want to do Friday) is because we're taking the kids to see the new Star Wars movie. We bought the tickets months ago. It's opening night and we've all been looking forward to this film for years. I am extremely grateful that my team didn't ask me to miss it. If we'd had clinical skills, 'I'm going to see a movie with my family' isn't really a good excuse for not going, so I'd have probably had to flake on my family.

I'm still unsure a lot of the time about planning stuff a way out because of this. Because we only get our MF schedules a couple weeks before the MF starts, I can't really plan things more than a couple months out at most and sometimes it's necessary to have more lead time to book things. Right now, I don't know my schedule past February 12th. Makes some things hard.



Sunday, 13 December 2015

I've been scooped

Haha, this popped up in my Facebook newsfeed today and I'm very amused.

It's an article about a just-published paper (last week) about an association between mothers with PCOS and children diagnosed with autism. The hypothesis is that prenatal exposure to increased androgens may alter neural development in such a way as to contribute to ASD. The paper is in Nature, you can find it online.

The reason I'm so amused is that back in 2014 I had this exact same hypothesis. I was thinking I'd have liked to make an honours project out of it.

Can I say "called it?"

I realize that this establishes only an association, there's no causation determined here, but it's still really cool to see that real researchers who shared my hypothesis actually found that the evidence supports it.

Had I actually been in the process of doing actual research on this, I'm sure I'd have been annoyed by the fact that this was just published, but I'm actually a bit giddy about seeing it to be honest, because it makes me realize that yes, I do actually have an okay grasp of this stuff.

Saturday, 12 December 2015

Not A Good Day

Today was not a good day. 

My daughter is using some of my son's attention-seeking behaviours and it is intensely frustrating. She's seeking attention because I'm so caught up trying to deal with my son. 

Usually, I am able to balance this. But today, I'm trying to get the house into order because my friend is going to be here in a week to celebrate the solstice with us. I'm excited that she's coming to stay for a bit but my slightly obsessive need for the house to be perfect before her arrival means I'm rather anxious at the moment. My husband is working this weekend so I don't have any backup which makes it hard to get anything done. 

I need to do my tutorial prep for Monday because I have a doctor's appointment in the morning so I can't do any fine tuning that day. I also have a CAE on Wednesday which I'm not terribly nervous about but still would like to do well on. 

I'm basically busy until Thursday evening, and then I only have part of the day Friday since we're taking the kids to see Star Wars: The Force Awakens that night. My friend arrives the next morning and I'll be driving to Pearson to get her, so I basically need to be done by Friday at lunch time. 

At least this is my last week before the break. And at the end of next month we have a bit of a mini holiday when we head to Winterlude for a few days.

Hopefully the week doesn't prove as stressful as it seems it will turn out to be. I am desperately in need of a proper break. 


Thursday, 10 December 2015

Let's get clinical

I hesitate whether to post this because it may come across as a touch negative, but really only inasmuch as it reflects on me, so I think it's okay to post.

Tutorials, while very important for building the foundations on which our medical knowledge rests, are not my favourite part of school. Particularly coming into MF2, where we have all been in different groups and all done things differently prior to now. We're still working out how to work together and I can see some areas where I'm having a bit of a harder time fitting in.

I use clinically-oriented resources (like Merck and UpToDate) instead of weighty texts that spend chapters expounding physiology at a level much deeper than our needs. One, because I don't have as much time to spend reading bulky work, and two because I actually have learned a lot of that before (thanks to having taken two physiology courses, human anatomy, endocrinology, immunology, and neurobiology all within the last two years) so often I really only need a refresher. We absolutely do need to know body systems in depth, because that's sort of what being a doctor is, but there's a limit to that depth.

Pretty much every single lecturer has said something along the lines of "I could go on for days about ____ but here's what you really need to know." I have used their information as the general guide to my learning. That and questions from licensing exams. Not that I'm trying to teach myself to a test, but because that gives me a ballpark for what I'll actually need to know as a doctor.  I make sure I'm meeting my learning objectives, and I am satisfied with that. Medical school is like 'drinking from the firehose' to borrow an expression from a book about information overload, and we need to be selective about what we learn because we simply can't know it all. Part of Mac's program is us learning for ourselves what we need to know.

But the fact that I have prepared in less detail than others (even though I have met the learning goals which means I am doing enough preparation) means I feel more than a little... inadequate contributing in tutorial. I think tomorrow I'm probably going to be pretty quiet (the fact that I have laryngitis at the moment will probably ensure that, actually) because last session I managed to stumble over myself because I was feeling so very not confident that I'm pretty sure I came across as an idiot even though I actually did know what I meant to say. I'd lost half my preparation time and notes because of having to completely reinstall my OS on my computer and I was completely ruffled so I misspoke several times and I hate doing that.

MF2 isn't getting off to a great start, really. Not that there's anything wrong with my group members, they're lovely, really. I just feel very unsettled and I'm really, really looking forward to the two weeks off I've got coming up.

Tuesday, 8 December 2015

Narrative

Procomp today was about narrative medicine.

I think we can say I have some experience with this.

So we had an exercise where we were supposed to respond to a prompt by writing whatever we thought for eight minutes. We read them to our groups and received feedback. No editing, no pre-amble, and no commentary (from ourselves) afterwards. Just let the work stand on its own.

The prompt was  "write about the rules for being a medical student."

So I did that. We get to keep the works and don't have to submit them. I'm going to post mine here, only very slightly edited for flow, and with one sentence inserted (I've italicised it), because I enjoyed the exercise, even if I don't think it's my best writing ever (or even terribly good, but it's not horrible.)

--------------
Be extraordinary, it seems, is the overriding theme of this whole experience. Most of my peers are successful and experienced academics, but I have only ever been ordinary. I am happy with ordinary. With tea on the deck at sunrise, evenings out walking the dog. I'm happy to see my children every evening, to share their days with them. I don't need to reach higher, to make a name for myself with my career, to find what will fulfill me. I've found it.

Be humble. Listen to your elders. Do as you are told. But learn so you can question, question so you can learn. But see where you are, know what you don't. Find your feet below you and reach out to meet the path but, extraordinary though you may be, acknowledge and respect the feet that trod the path before you.

Be aware. Of yourself, your patients, their knowledge. You don't know everything. You can't know everything. Let them teach you. Let yourself be taught.

Be yourself. But not too much. Know where and when you can let yourself free of the white coat with its Sisyphean demand for perfection. You may need to be more than you think you are. But listen. Learn. Be led by your inner learning creature who speaks to you in the quiet places where your doctor self breaks.
------------

I took rules in a more figurative sense. The rules we internalise, not the rules that are posted on the wall.

It was definitely fun to do. I had to have a bunch of ventolin this morning so my hands were shaking really badly as I wrote and it's barely legible, but I somehow can still manage to read it.

We should do more exercises like this. Though I expect my classmates may disagree.

Sunday, 6 December 2015

Trip!

Even though we'd thought about making the trip here our first real family vacation, we sort of didn't end up doing that. We spent the first few weeks getting to know the city and the area, but ultimately we didn't end up actually having a vacation the way we'd hoped.

So we still haven't had a proper vacation of any sort.

Next month, that changes.

It's basically a long weekend away since my Fridays are flexible. The kids have school but I think for a once-a-year sort of treat, it's not a huge deal to miss a day of school. We've actually had only one absence between the two kids this year so far, anyway.

We'll be leaving the Thursday night and coming back Sunday night and we're staying at a hotel to make it special. Got a really wonderful deal on a little suite.

Just have to arrange to have someone come in to check on the cats and birds, and we'll board the dog.

I'm really, really excited. This'll be our first vacation of any sort as a family. We'll be going home for a week in the summer and, if I am selected for the family med sponsorship next fall, my husband and I plan to head to the UK for ten days or so at the end of the year. The sponsorship is enough that I won't need to accrue much if any new debt for the remainder of my education and I'll be able to start paying off the LOC in residency (and I project I'll finish by the end of my first practice year.)

I figure a fun international trip at that point is entirely justifiable, eh? Most of my peers take trips. It's just that trips for us are more expensive because there's more of us which is why the one we're taking next month will be our first.

Life is pretty good these days, I must admit. Really need to get around to doing my tutorial prep for tomorrow. Coeliac disease. Woo.

Thursday, 3 December 2015

Lab Results

I posted before that my family was being investigated for genes associated with a certain type of inherited cancer due to the fact that we've had three (at the time it was thought four but one turned out to be a misdiagnosis) cases of a rather uncommon cancer down one side.

The genetic study took a very long time to get back but apparently was completed sometime in the last little while.

By choice, my husband and I generally have no contact with my family of origin anymore. Sometimes, it's the healthiest decision you can make. However, if our kids request to speak with my parents, we let them. Otherwise, we don't initiate contact and neither do they.

A couple weeks ago, my son asked to speak with them so we let him FaceTime. During that call, I was told that the genetic testing indicated we do not have the inherited kidney cancer genes, but that we're supposed to start getting mammograms in our thirties, so there is some cancer-associated marker, but I don't know what it is specifically.

On the plus side, if I'm going to have a gene predisposing me to cancer, whatever this is is probably preferable to the rather scary ones that were high on the suspicion list.

I'm rather glad I don't have a crazy high chance of ending up with kidney cancer. I can live without both breasts, not so much with the kidneys.

For once, I'm not in the weird subpopulation. Woot!

I've just had a pretty thorough evaluation as baseline stuff for my new family doctor, and to accompany the referral to the fertility specialist (I didn't act on the original referral I had; we decided to wait until we had OHIP, which will cover some assessments.) I have had a ton of blood work done, an EKG, and I have an ultrasound on Monday just to make sure everything is okay. 

The cool part about the lab I went to here is that they post your results online as soon as they are done. I just had the draw at noon and already have several results back, which is pretty cool. My doctor checked off the 'prenatal' lab section which lead to a lot of confusion today when I had to explain repeatedly that it's for preconception, not prenatal, testing. 

Back home, no one really does preconception testing like this - it was certainly never offered to me. Rather nice to have it done now so that I have a good baseline. 

Wednesday, 2 December 2015

Off To a Good Start

Had my first tutorial with the new group on Monday. The group has pretty diverse backgrounds, but everyone seems pretty nice. 

We're still at that point in med school where mostly everyone is still being almost artificially nice. I expect this'll start wearing off soon enough. 

With this new group, I am less nervous than I was with my first. I don't chatter as much so hopefully I will make a better impression this time around. Not that my last group actively disliked me or anything, but I do think I got off on the wrong foot and did not make the best impression of myself and I hate making a bad first impression. 

Guess we'll see how things go. 

Had first clinical skills for MF2 last night and I actually surprised myself by how much I remembered of the abdominal exam. The residents we have seem really nice. One is a PGY1 emerg and the other is a neuro resident (I think PGY1 as well.) They definitely seem more laid back than the original email exchange seemed, so I guess that just proves how important it is not to assume. 

I'm looking forward to getting to know this group and hopefully setting up some electives soon. I haven't heard back from the emerg physician I emailed but I've been told he can take a while to get back to students so I'm just going to leave it for a bit. If I don't hear back from him, I'll email one of the other contacts. 

Time to finish preparing for tomorrow's tutorial. I like that my new schedule (1-4pm instead of 5-8) means I'm home in the evenings, but I don't like that it means I don't have all of Thursday to do my prep. I have to go have blood work done in the morning so I can't even anticipate having that time. 

Still not too bad. Preparation averages about 4-5 hours per case. Sometimes we have two cases per tutorial but this week's is only one. Can't really complain, considering how intensive some of the other schools' schedules are. Mine is pretty laid back, really. Gotta love Mac.