Wednesday, 28 December 2016

The Doctor Who Treats Herself Has a Fool for a Patient...

About five weeks ago, I saw my family doctor about my headaches. I had basically had a headache nearly every day since July, with just occasional days off. I was having relatively frequent migraines on top of that, worse than when I'd been pregnant with my other kids. This isn't uncommon for migraine-prone individuals. Around a third get worse during pregnancy. There were no red flag signs and I didn't have pre-eclampsia, so it was almost certainly just down to hormones and I just had to cope and try to avoid overusing OTC meds (because you can get medication overuse headaches too, which is just cruel) while waiting for it to get better on its own. 

After the baby was born, my migraines really picked up and I was up to two a week - on top of the ever-present underlying headache - by the time I saw my doctor. She gave me an abortive therapy (a powdered NSAID) and put me on a medication commonly used to prevent migraines. 

Since the cold weather hit, I've had my usual uptick in asthma flares. This happens every year since my asthma is cold-triggered (well, it's everything-triggered. My lungs suck) but it's been extra sensitive this year. I commented to my husband recently that it seemed like I was using a lot of my rescue inhaler and it just wasn't relieving the tightness very well. 

Now, if you are not a medical person, it likely won't occur to you why my asthma and my migraines are related. They aren't. But the drugs are.  

The most common migraine prophylactics are beta blockers. That is, drugs that inactivate the beta adrenergic receptor by blocking the binding site. They're mostly used for blood pressure, so there are cardioselective ones (ones that work primarily on the types of beta receptors found in the heart.) I wasn't prescribed one of those. I was prescribed a first generation, non-selective one. 

This matters because the drug that is used as a rescue bronchodilator acts on... (I'm sure you can guess) BETA RECEPTORS!

It's a beta agonist - the exact opposite of a beta blocker. So is the long-acting drug (a LABA - long-acting beta agonist) in my maintenance medication.

This is why you don't give nonselective beta blockers to asthmatics (or patients with COPD.) I know this. I am entirely aware of this fact. If I saw these meds together on a patient's list I'd ask my staff about it because of this. It is something I know and would clue into in a clinical setting. 

But for weeks I've been lamenting my crappy lungs while taking a medication that blocks my lung medications. 

Now, my family doctor - who is aware of the severity of my asthma - should have clued into this too, obviously. Most patients wouldn't be aware of this and would probably be worrying quite a lot in my position given how much it sucks to not be able to breathe. But I really, really should have picked up on it earlier. 

I probably would not have realized this for a while longer until a med student friend asked me a question (a helpful learning activity) about beta blockers and asthmatics and I had a face palm moment. 

I feel like a complete idiot, really I do, because this is something I absolutely should know as both a severe asthmatic and a medical trainee. Guess I'm just so used to blaming my awful lungs for things that it didn't even occur to me that my worse-than-usual symptoms are essentially a drug interaction. 

So a phone call is in order, obviously. 

Hopefully I've bought enough time for the pregnancy hormones to peter out and my headaches and migraines don't come back. The beta blocker was actually quite effective for that in my case. 

This is why you don't treat yourself. It's possible to completely miss very obvious things. And obviously I can't be relied on to remember the most significant aspect of my medical history. 

Tuesday, 27 December 2016

Gratitude

Last week, I bought a lottery ticket. A simple, colourful scratch-off ticket covered in promises of vacations abroad and freedom from the drudgery of daily life.

It was the first time since I got into medical school that I bought one, whereas we used to buy one or two a month. I know the odds of actually winning anything of significant value are astronomical, but when you live as we do, a lottery ticket is a small price to pay to be able to dream for a short while about what if..?

What if I could finally pay all my bills on time every time? What if I could put my kids in the activities they've been asking for? What if we could buy nutritious, high quality food instead of whatever is on sale? What if I could buy my kids the presents I think they deserve?

What if my life changed completely overnight?

And then mine did. I got into medical school.

While we do still live on a budget, of course, my husband and I agreed that it would make sense to make it a modestly more generous 'income' than we had previously existed on. Part of that is just to account for the fact that we pay more than double the rent here than we did back home, but part of it is to allow us to have some fun together as a family, to allow our kids some extracurricular activities, to get the kids decent presents for birthdays and holidays.

Our children have to give up so much for me to go to school, it didn't seem fair to make them wait another 5-8 years before they could enjoy having some extracurricular activities or a birthday party. We certainly aren't living like I have a physician's income yet, but modestly better than we were.

But the generally modest lifestyle we have enjoyed has shaped who we are, and it has shaped our kids. On the solstice, as we opened gifts, I had a moment of absolute parental joy that was shadowed by the spectre of our difficult past.

We had purchased our son a little programmable, Lego-compatible robot as his major gift. My husband, being a silly sort, decided to wrap it in layers. He pulled a number of boxes from the pantry and the recycling and sequentially wrapped the little robot in 5 different boxes, plus its own. The largest one was a Rice Krispies box.

So my son, full of the excitement only a pile of gifts can bring to a child, tore into the paper. And his eyes lit up. "Rice Krispies! Thank you. You know I love cereal!" He smiled at us and there wasn't a trace of disappointment in it.

He was very grateful for a box of cereal.

He was even more excited when we prodded him to unwrap it (again and again and again...) and he found his little robot.

He's a good kid. For all the challenges he copes with, he's definitely a good kid.

It also reminds me that the important lessons that we're trying to teach are sinking in.

I hope that all my work enables me to give my kids the gift of a bright future; one where they don't need to buy a $3 scratch off ticket so that for a brief while they can have some small chance at a dream of better things. But I can see that they'll still find their happiness even in the smallest places. Like a box of rice cereal.

Sunday, 18 December 2016

On Son Schooling

My son basically hasn't done any meaningful amount of work at school since September. By the start of October, he was completely non-functional in the classroom, then he was in the hospital for a week, then excluded from the school for a week after that (because, to quote the principal, "staff are nervous.") We met and planned and instituted new approaches and the school accessed some additional resources before he started back.

He started by attending just over an hour a day, just to see if he could be in the classroom without escalating. That eventually increased to almost 4 hours a day and he's been at that point for about a month.

At school, he usually does one math question from the board. Sometimes he'll write a sentence. Otherwise, he plays on his school-provided iPad - which is supposed to be locked down to only certain educational apps but he still manages to watch YouTube on it - or he spends his time playing Lego on his own.

He didn't even get a report card for the first term because they didn't evaluate anything so had nothing to report. His teacher has no idea what he can do. Because of the behavioural challenges, his actual skills haven't been fully demonstrated in school. Ever.

His kindergarten teacher saw a bit of what he could do and she was amazing with him, but things sort of crashed and burned (literally - we had a house fire) in September of grade 1 and here we are three years later still trying to make up lost ground.

We're basically homeschooling him at this point. We bought some workbooks and we set him daily assignments. We expect him to be doing academic work during the hours he would be at school, with a recess.

We started with the grade 3 curriculum just to review. He started this year still officially on an adapted grade 2 curriculum according to his IEP (see my comment above about no one actually knowing what he can do) but I know that was ridiculous because he's been able to do that stuff since before he started kindergarten.

He usually only needs to be told how to do something once, and then he can globalize it across multiple applications.

He's pretty much flown through the grade 3 skills, as I expected he would. He's picked up all the grade 4 (and higher) skills I've demonstrated to him pretty much immediately. Because he is interested in computers, I introduced him to binary and compared that to our base ten system and he was doing all the multiplication in his head to figure out binary place values. I introduced him to scientific notation and how that plays into place value. He got it right away, and of course understood what exponents mean based on this.

We currently expect him to do at least 3 math worksheets (around 20 questions each) per day, and fill the remainder of time he would have been at school with reading. The math worksheets are pretty much a joke for him - usually less than 30 minutes to finish all of them - and since he reads at a rate around 200wpm he's able to cover quite a lot of ground in an afternoon. He doesn't like doing this, but he has to do it to get his screen time, so he just sits down, powers through, and then is off on his merry way.

But his teacher has never once heard him read out loud. She had no idea if he was even at grade level, let alone how far past it he is, until we told her.

He pretty clearly has some exceptionalities and that's what frustrates everyone - he just won't engage with them. Everyone at school is too afraid to push him to actually do work because they worry he'll escalate. He hates school.

No matter that I love university, I also hated school when I was a kid. Haaaated it. While I certainly don't want to sound like I'm bragging at all because I'm not and this has actually been a source of many challenges, I was identified as exceptionally gifted very young. I experienced the whole 'asynchronous development' issue that tends to be a problem with very gifted children, and I think we're seeing a bit of that with him. People tend to expect gifted kids to act mature, but it's really not fair to expect and some actually may have significant social/emotional/behavioural delays despite strong cognitive abilities. It means kids like I was tend to explode, opt out, or shut down. Highly gifted kids often also tend to have issues with authority as well and will often just choose to ignore whatever rules they disagree with.

I lost interest in school by grade 5 and pretty much gave up on doing anything but the absolute bare minimum after that. My son beat me by four years. He tried in kindergarten. He shut down in grade 1. Unfortunately he lacks that little tiny sliver of desire to comply that I had.

I'm trying to figure out how to help him have a better time at school. Right now, essentially homeschooling him and treating school hours as 'practice social skills time' is pretty much the best option we have so that's what we're doing. I just wish I could actually get him enjoying school, or if not actually enjoying, at least participating.

Tuesday, 13 December 2016

On Surgery and Sleep

I went to a minimal access surgery workshop this evening. Unfortunately, due to the fact that there was a fair bit of latex in the sim room, I wasn't able to participate in the sim activities, but I did get to use a da Vinci surgical robot. It wasn't for long, but it was very cool. I'm amazed they even let med students touch it let alone practice with it. 

Yeah, med school really does have its amazingly cool points. Props to the Technology in Medicine IG for that.

Speaking of surgery, my daughter is getting tubes in the morning. Her pre-op appointment was last week and it was pretty fantastic. The child life worker showed her the equipment they'll use and showed her what she'll experience. She gets a little passbook so she can get a stamp at each step of the way - checking in, getting gowned, waking up, etc. I get to go in with her for the induction phase. I'll need to have the baby with me at the hospital tomorrow (nowhere to pump privately when I'm supposed to be staying with my daughter, so I need to bring the baby) so I'm currently trying to find a classmate to hold M while I go in with C.

It's rather convenient to know a whole bunch of people who spend a ton of time in that building and people are often quick to volunteer to hold a baby, I find.


Wouldn't you want to snuggle her?
As it's nearing 1am I should probably get to sleep. I've been staying up late to work on my lit review because I've ended up doing so much during the day. It's really affecting my sleep. Tomorrow is going to be another such day. I'm going to be tied up at the hospital basically all day so I'll just have to work once I get home. I really want to have a draft writeup prepared by end of day Wednesday. I'm not required to have it done by then, I just want to.

And honestly, considering I'm three weeks from starting my OB/Gyn rotation, I really shouldn't be complaining about screwed up sleep right now because a month from now I will laugh at myself.


Monday, 5 December 2016

On Being Home

I lamented a great deal about my difficulty finding electives for this period because I had no idea what I'd be able to do physically so soon after giving birth.

I was extremely fortunate to be able to set up a reading elective and the research elective I'm currently on. I'm working on a literature review for a particular technique for a particular application. It's actually really interesting stuff.

But I'm finding working from home very difficult. For one, I have a super cute, snuggly, tiny baby upstairs and I want to spend time with her. There's also my other kids, who are both having a hard time and I want to try to help. I've been ending up with a lot of morning appointments and stuff, so I'm typically working from late morning or early afternoon into the evenings (with a break at suppertime) so I'm not getting to spend a ton of recreational time with my family, even though they're *right there.* That's hard.

While I know I'm learning and I'm contributing to my education, I'm still feeling a bit disconnected from being a clerk. My colleagues are on the wards, they're in contact with patients. I'm in contact with my keyboard. As immensely and extraordinarily grateful as I am for the opportunity to do research and for my reading elective, and for the wonderful supervisors I am lucky to work with, I am feeling like I would be able to do some clinical work right now.

Of course there was no way to know ahead of time that I'd be capable of doing clinical work so soon after having a baby. There was no way of knowing that I'd have a baby who has slept from 11pm until 7-8 am since five weeks old  (yes, really. My OB told me when I mentioned it "don't say that too loudly in this office.") There was no way of knowing any of this ahead of time which is a big part of why I booked the electives I did, in addition to also wanting some research elective time.

I'm grateful for the opportunity to be home, to have a very flexible schedule during this period. I very much do need this, and I expect I'd probably actually be having a rough time with clinical work particularly since I've been dealing with a pretty significant increase in the frequency of my migraines since delivery (I've seen my doctor, don't worry. I'm on a beta blocker as migraine prophylaxis now and I have an abortive therapy that works fairly well.)

I suppose I'm suffering from a bit of 'grass is greener' syndrome. If I were doing clinical work, I expect I'd be feeling a bit wistful at not being home. Even though I am in my office much of the day, I'm still able to go and nurse M. I still see my daughter get off the bus, and still eat supper every day with my family. And I don't have call.

My OB/Gyn core is only 4 weeks away. I'm certain once I get into the groove of that, working very long weeks walking the halls of the hospital where I was only just recently a patient, I'll probably look back on this time at home, in my office with my family just upstairs, and be rather sad about it being gone.

But for the moment, I'm finding it a bit of a challenge. I think tomorrow I'll make the time to get out for a long walk. I need it. 

These kids will never be mistaken for anything but siblings. 


Friday, 2 December 2016

The Imposter in my White Coat

In less than a month, I'll be able to say "I'll be a doctor next year."

I'm just letting that sink in for a minute, because typing the words out was enough to make my blood pressure increase.

This entire journey has been an exercise in how often I can freak myself out over how fast every phase of my training just zips by.

The other day, my daughter - who we strongly suspect has fairly mild asthma - was complaining of breathlessness at school and was in the office. So I shoved my stethoscope in my purse, drove over, and took a listen right there in the office. The school secretary said "I knew you'd know what to do."

And the thing is... I did know what to do. Not that assessing breathing is hard; I've been able to do it since long before I started medical school. Being taught how to use a stethoscope to listen to my own lungs when I was younger than my daughter is now is what set in motion the snowball of my interest in medicine. But I am much more confident in my skills now, though I don't show it well, and I am expected by others to have these skills. A few years ago, showing up to my kid's school with a stethoscope to assess their breathing would have sent some eyebrows skyward. Now, it invites relief.

The summer before I started med school, I was in a restaurant and a man in his late 20s passed out in front of me. He just dropped without warning and hit the floor pretty hard. As someone trained in first aid, something I needed for my volunteering, I took charge and followed my training (direct a specific person to call 9-1-1, ensure ABCs, etc.) A volunteer firefighter showed up after about 5 minutes and I handed off the situation to him because he has proper first responder training. That's the point of first aid - assist until you can hand off to someone with more training.

Very soon, I'm going to be one of those people with more training that receives someone from the first responders. I suppose I technically already am, given that I have over a year of medical school under my belt. But I'm not really expected to be able to do much on my own with a great deal of skill yet, the confidence of my kids, friends, and my daughter's school administrators notwithstanding. I'm still protected by the soft cotton wool of being just a student.

I am someone who has trouble believing in myself. It's probably rather apparent after four and a half years of writing this blog that my self-confidence is most generously described as absent (or more realistically as 'wandered off in the woods of northern Ontario twenty years ago and hasn't been seen since.') While I realize that I actually do have some knowledge and skills, I still feel very surprised any time I turn out to be good at something. I suffer from a terrible case of Imposter Syndrome and often feel like any day now, the administrators are going to realize I was only offered admission as a mistake.

This isn't uncommon, particularly in high-achieving women. Even writing that last sentence, I see "high-achieving women" and I take that to mean other people, not me.

But as I move into clinical activities next month, where I'll be involved in the care of women during one of the most significant phases of their lives, I feel like I need to seem at least somewhat confident, even if I don't quite feel it yet.

Monday, 28 November 2016

To Visit or Not

I've been trying to get OB/Gyn electives, but it's been proving difficult to get any in Hamilton. They're popular. I'd had a number that had been declined because of no availability, and since I was getting desperate for OB electives, I applied to visiting ones.

I have 10 weeks (well 8 plus 2 vacation) elective time next year, and my next elective block isn't until January 2018, after I've applied to CaRMS.

Currently, I have these booked:

February 13th to March 26th block
1. OB/Gyn in Ottawa (2 weeks)
2. OB/Gyn (RE) in another city (2 weeks, different subspecialty)
3. Diagnostic Imaging (2 weeks, home-school)

July 17th to August 13th block:
4. Family medicine (2 weeks, home-school)
5. Emergency (2 weeks, visiting, only informally booked. Will need to apply through the portal when it comes available)

I'll be honest, I really don't want to be away from my family for a month for those first two if I can avoid it. We went through having our family broken up for months at a time when my husband worked out west and it was incredibly hard on our kids. I'm already going to be away for my paeds rotation, and could end up away for more. My kids already deal with a lot and I don't want to make things harder on them.

During the Ottawa elective, my husband and kids will be there for almost half of it. He's going to bring the kids up for Winterlude over their Family Day long weekend plus a day either side, so I'm not actually going to be away from my family for more than a few days during that one. I really wanted to ensure I do a visiting elective in Ottawa because it's #2 on my preferred locations since we like the city. My husband grew up there and I lived there for ten years, so we know it well and wouldn't mind moving back temporarily.

To my surprise, I just had two OB/Gyn electives approved locally, for the second and third elective spots above. The one in the #3 spot is with a preceptor I would REALLY like to work with, and it's primarily surgical and I'd like more surgical exposure.

I'm not sure which to take, or whether to take either. Visiting electives are the major way we demonstrate interest to prospective programs, but we also need to keep things varied. Not sure if my preclerkship electives will be considered in looking at how broad my electives were.

I do think I should probably do 3 OB/Gyn electives pre-CaRMS, but doing two at Mac might be a bad idea.

Debating whether I should take the one in the #2 spot, and then try to book another down East - again, my family will be with me - instead of that Emerg elective in August.

Honestly, I've no idea. With just a few days left to decide, though, I have to figure it out soon. 

Super happy baby!



Thursday, 24 November 2016

Competing

After I'd done what I felt was a sufficient amount of reading on my elective topic yesterday, I ended up spending some time looking at CaRMS stats.

When I was in undergrad and working on my strategy for applying to med school, I spent a lot of time looking at the statistics that I was able to find. I'm a numbers person and I often find comfort in looking at numbers while I find anecdotes tend to be more intimidating. For a time, I would go look at the posts on premed forums to see what types of people got in and obsess a bit. It was often disheartening, because I knew there were many ways I'd never measure up. I just did not have the time or means to do as much in the way of ECs as they did. I didn't have access to the same sorts of opportunities because of where I lived, and even if I did, the fact that I had issues with childcare and so on made it hard to actually do anything.

Still, I did get into med school. On my very first try, at that. So it's not like all of my stressing about being inadequate actually meant anything in the long run.

However, with just a year to go until CaRMS (my classmates hate it when I point that out) I'm finding many of those old feelings of inadequacy returning. I am a good student, sure, but so is everyone else in med school so it's not like I stand out that way. As with my med school applications, I don't get gold stars for balancing a family while attending school. As with my med school applications, actually, having a family may hurt me in that it means I'm less involved outside of my mandatory activities. Extracurricular activities are still a thing when it comes to CaRMS applications.

OB/Gyn - which I am increasingly convinced I will be making my first choice - is competitive to get into. More than several other specialties often considered competitive, actually. On average, roughly 90% of applicants overall match to their first choice specialty. For OB/Gyn applicants who rank it as their first choice discipline, the percentage who match to it is much lower, and falling. There's very little change in the number of applicants to OB/Gyn year to year, but the number of spots for CMGs has fallen by 20% since 2010.

What bugs me a bit about CaRMS applications is how much of the selection process really seems non-quantifiable. Like I said, I'm a numbers person. But with med school there's no GPA, we don't have any sort of standardized testing score like the MCAT at this level in Canada. There's no way to compare myself to the successful applicants on a numbers basis, I can only look at overall trends in matching. That's something I find challenging.

Realistically, my chances of getting into OB/Gyn are way higher than were my chances of getting into med school. I just have to try. Agonizing about it isn't going to get me anywhere. It's a bit different in that I really only have one shot to make it work (unless I go unmatched, but let's ignore that possibility for the sake of my blood pressure.)

Keep focused on the goal and do my best. That's all I can do.

Four and a half years ago, I was talking about this very same thing - about how I psych myself out by comparing myself to others - and wrote something that I think I'm going to put on my wall.

To rework it a bit: I often feel thoroughly inadequate in the face of people who do things far better than I do. It's a bit discouraging, but I don't have to be the best, most impressive applicant ever to realize my goals. "You don't have to be the fastest gazelle to get away from a hungry lion, after all. You just can't be the slowest."

That said, I still went and made a few figures with CaRMS data, because I like visual representations of trends.
What happened in 2012 and 2013?!?


Tuesday, 22 November 2016

Other Pursuits

During the transition to clerkship rotations, we had a suturing station. I like suturing. A lot. It probably should not have surprised me as much as it did given my hobbies, but it did.

I'm an artsy sort. It's not that I have any particular natural talent in artistic pursuits because I do not, but I enjoy artistic expression in a general sort of way and have a lot of enthusiasm for it. Any ability I have is entirely acquired through a lot of practice but I'm not exceptionally good at any one thing since I've never felt the need to completely dedicate myself enough to any one field to develop significant skill.

When it comes to music, I am very out of practice with my instruments but used to be pretty good. I am an enthusiastic if not particularly talented singer. I do sing Broadway musicals constantly in the car when I'm driving my kids around, to the dismay of my son. Currently I'm on a Hamilton kick. It was Les Mis until recently, so I think my kids consider this an improvement.

I took up a number of my hands-on artsy hobbies partly as ways to increase my fine motor control. I've mentioned before that my finger coordination has always been pretty terrible as evidenced by my awful handwriting unless I write very slowly. I started sewing when I was ten, then eventually I took up calligraphy in my teens to discipline the muscles in my hands. Then I took up yarn arts - knitting and crochet.

How does this at all relate to my enjoyment of suturing?

Well, think about it.

My wall of British actors.
While I will never be steady enough to do microsurgery, I can make neat, evenly-spaced sutures relatively easily (in practice scenarios.)  Crochet taught me how to make smooth rotating and hooking motions, which helps drive the needle smoothly. Knitting taught me how to coordinate my finger movement timing without tangling a thread. Sewing taught me to be comfortable working with needle and thread without stabbing myself. Calligraphy reduced the tendency of my fingers to tremble when doing fine work.

I've spent many years working on steadying my hands and being able to exert fine control over them. I have sketchbooks full of pages where I have just written words out over and over, trying to neaten my writing into legibility, then some semblance of presentability. I've spent many days with inkstained fingertips after evenings of trying to eke some amount of beauty out of pigment and pen. I've spent hundreds of hours trying to train my eyes and hands to work together well enough to put recognizable images on paper.

And it worked. It proved possible to teach my stupid fingers something useful. 

Now, this may all fall apart completely when I am actually suturing a living human, but it is still incredibly satisfying to see something I put a lot of work into have practical applications.











Obligatory baby picture (unrelated to the rest of the post)
This shirt was a gift from my ProComp group (a lovely group of individuals.) Her initials are M.E.D., so the shirt is not entirely about my career choice!

Monday, 21 November 2016

Welcome to Clerkship

With the second year OSCE behind the class (except for me) and our tutorials wrapped up, procomp finished, MF5 done, today is the first official day of clerkship.

Last week, we did our two days of transition to clerkship, which was actually pretty fun. We did rotating stations (Mac seems to love rotating stations...) on O2 management, airway management, suturing, casting, IV insertion, EKG, foley insertion, and defibrillation. Basically a crash course in the hands-on part of important procedures that we've spent over a year learning about. We learned indications for things, we've learned interpretations, but we didn't really actually work with the equipment until now. I still really like suturing and IV insertion was fun too.

Then.. that was it. Preclerkship is done. We're clerks now. (*Hyperventilate*)

At the clerkship orientation session, we were given little "clerkship survival kits" from OMSA (the Ontario Medical Students Association.) The implied message: "Welcome to living out of a bag for the rest of your training!"



Earplugs, toothbrush and paste, and a phone charger. Very useful stuff, though, so I am grateful.

I am on reading elective this week, and I'm having fun with my topic - issues in access to maternal care in low and high resource settings. My supervisor is a perinatologist who does a lot of international work. He's also super nice, so I'm glad to be working with him.

Next week I start a three week research elective. I'll be conducting a literature review and preparing a paper on the topic (it's related to my interventional elective back in the summer.) Super excited for that as well. It's an interesting topic, and I may get a publication out of it which is just a perk.

Since I'm working from home and I'm not doing clinical work like my peers, I expect I'll feel a bit more 'clerkish' in January when I start OB/Gyn. While I'm enjoying this work, I know I'm going to get a kick out of that too.

Bring it on!

Thursday, 10 November 2016

Adapting to Challenges

Baby is three and a half weeks old now. The last week has been a bit rough. There was one day where I ended up needing to be away from home all day. Miss M is in the middle of a growth spurt and it's really important that during these early weeks I nurse as much as I can instead of pumping, when possible, since babies are more efficient than pumps. I have another full day next week, 8am - 5pm, which is going to be challenging to work out logistically.

I basically am nursing constantly while at home, and then even when I'm away my husband is bringing her to me as much as possible. It's involving a lot of running around for him, but he's such a trooper.

Growth spurt means she isn't sleeping well, which means I'm not sleeping well. I'm a bit concerned because of this.

Today we had our CAE on the Mental State Examination. I was literally so tired beforehand that I had difficulty putting sentences together, but we were allowed notes for this so I think I probably did okay. Monday is the CAE for the psych subunit. Tuesday is my class' year 2 OSCE, so it's on everything we've done so far in clinical and communication skills. 

When I met with the faculty about my leave, we'd actually agreed that I would delay this OSCE and do it with the 2019s next year. But I was feeling fine last week and so when I was asked as I was leaving the office if I'd be sitting the OSCE with my class, I decided to just go ahead and do it now to get it out of the way so I don't have to prepare for an OSCE while doing CaRMS apps. However, I am very, very tired, and I don't know if I can get through the entire OSCE - which is at the time of day that M basically nurses for 4 hours straight - without pumping. It's not really possible to just run off for 20-30 minutes in the middle of a station/circuit-based examination. So I've decided to go ahead with delaying it. I'll have to request leave from my family med rotation next fall to sit the OSCE with the 2019s, but that's better than completely tanking it right now because I have had no sleep and am in pain from engorgement. 

This aside, overall I'm actually doing really well for having a three week old baby, though a large part of it is down to my husband being amazing. I actually find it rather funny how often people express surprise or amazement that I'm back to school and stuff already - this happens multiple times almost every day and I'm never quite sure how to respond. The baby is not the most demanding thing on our plates right now, to be honest, and I was completely physically recovered by 10 days anyway. The lack of sleep has been significant the past few days but this is most likely temporary, once she's through this spurt. 

I knew these few weeks would suck. I expected this. I even wrote several times on this very blog that I knew I'd be stressed the hell out for this period. Honestly, it's not half as bad as I expected, but it is challenging in ways I wasn't anticipating, so there's that. At least I'm being accommodated so that it's still possible to graduate on time with my class while not having to put myself through anything too horribly taxing right now. I'm very appreciative.

Today my MF5 group had our farewell lunch. I'm going to miss these guys; they've been great. All my groups have been, but this one was particularly fun and friendly and I'm sad to see the end of it. But I can't think of a better group to have finished off preclerkship with. 


Definitely going to keep posting lots of baby pictures...



Sunday, 6 November 2016

Last of the Last

We're on the last few cases of the last subunit of the last foundation of preclerkship. In two weeks and one day, I'll officially be a clerk. I have eighteen months and four days to go until the very last day of my program. 

It's very hard to believe that it's almost over, and I'm essentially at the halfway point of med school - well, what would be the halfway point at a traditional program. I technically have longer until graduation than I have completed - I'm 14.5 months in - but the transition to clerkship is a big mile marker and for most med students is essentially 'halfway' so I'm choosing to consider it that way. 

Plus, the next year and a half is going to go very quickly. Six weeks just flies by and with my longest blocks being 6 weeks, it's going to feel like this whole period is gone in a flash. Well, maybe not internal or surgery. I hear they're pretty killer.

Since my initial elective period will be done essentially completely at home, I don't think I'll really feel like a clerk until January, when I start my obstetrics and gynaecology core. After that, I have a series of six different two week blocks (3 elective then 3 cores, one of which is a selective) which I'm sure is going to go by incredibly quickly. 

But nervous about working for fifty weeks straight - I start January 2ed next year and go straight through until December 18th of next year without a break. It's nothing I haven't done before, but it's still a bit daunting. Clerkship is a bit of a different level of intense.

It's odd to consider that as of January, I'll be doing what I'm going to do for the rest of my career, at least a pared-down version of it. There will be more in the way of educational components, obviously, but I'll be seeing patients, writing orders, dictating notes, and doing a whole lot of paperwork. While there are a few important milestones along the way - finishing med school, finishing residency, getting my first job - at which I'll gain even more responsibility, ultimately I'll be doing the same sort of stuff in my day to day life from January onward. Some differences (I'll still have tests and such to prepare for, at least for a while) but definitely in the same ballpark. It's different than going to classes and studying for tests.

So the transition to clerkship is, I think, going to be a really big one. It'll be interesting to look back on my reflection this evening in a year's time, when I'm preparing my CaRMS applications and residency is looming. 


Obligatory baby picture. :) She's three weeks old tomorrow!

Tuesday, 1 November 2016

Practicalities - On Breastfeeding (and doing so while med student-ing)

Yup, it's a post about breastfeeding. You had to know this was coming at some point. But I'm big on normalizing breastfeeding, and it's part of new baby life for me and lots of moms, so I'm going to talk about it and how I manage it during med school.

Miss M is two weeks old now. She's growing well - as of yesterday, she was almost half a pound up from her birthweight. Babies always lose a bit of weight - up to 10% is normal, M lost about 5% - but they should regain it by two weeks of age. She's done quite a bit more than that unlike my first two, possibly because she's combo fed which means she is both breast and formula fed.

I used to be very militantly anti-formula, to the point where I would argue that formula should be available by prescription only. I believed a lot of things that I now know aren't true and I had made breastfeeding a huge part of my identity in an attempt to prove that I was a good mom even though I was really young because I'd internalized the message that "good moms" breastfeed no matter what, unless they are completely physically unable to. I no loner think this way, obviously, but I did for a long time and I was a bit of a jerk about it, to be honest. I'm firmly in the "fed is best" camp these days.

Really, I hated the early weeks of breastfeeding my other two because my kids comfort nursed and cluster fed a lot but I steadfastly refused to allow any bottles of pumped milk or formula or any use of pacifiers because I believed that they would lead to damaging my supply and lead me onto the "downward spiral of supplementation" which I had been warned about repeatedly. I remember sobbing my way through many feeds in the early weeks. It really impacted my ability to enjoy the time with my newborns and do anything but nurse 'round the clock.

Didn't want to go through that again, and I'm much more flexible with infant feeding now and realize that formula is a perfectly reasonable alternative food for my infant, so we decided to combo feed from the start to ensure that she's comfortable going back and forth from breast to bottle and is familiar and comfortable with the taste of formula.

As well, it's way, waaaay easier for my husband to have a couple of ready-to-feed formula bottles in the diaper bag to use when he's on the go with the baby. But breastmilk is cheaper (not free - my pump was $300 and a box of storage bags, which is enough for ~4 full days worth of feedings, is $15) so we want to use that as much as possible.

So far, so good. She goes between breast and bottle (formula or expressed milk) easily and has no apparent taste preference. She also takes a soother which makes me very happy because 1) my husband can more easily calm her, 2) I don't have to deal with hours of acting as a pacifier, and 3)  pacifiers reduce SIDS risk.

To maintain my supply, I pump while I'm away from the baby. Currently, I can't go longer than 2.5-3 hours since that's how often she nurses. Most of my sessions are 3 hours long, but when you add in transit time, and the fact that she may have last nursed more than an hour before I leave, then I have to pump roughly in the middle of most sessions. I've had my husband bring the baby to me at school so that I can feed her directly, but she ended up being quite a distraction to my group (yes, I actually breastfed during a small group session) because she's cute, so we didn't do that again.

When I'm in our main building, finding space for pumping is not an issue. While I have absolutely zero issue nursing in public, pumping is different mentally for me and I want to be somewhere private. The lovely admin staff have been great about letting me use an empty office.  I do have these fantastic things called Freemie collection cups (I make no money from recommending them - I just think they're awesome) which mean I don't end up needing to be partially undressed to pump like I would without them but still, I'm not whipping out my pump in a session. The baby is cute, the pump is not. It's also loud. Whirr-hiss-whirr-hiss.

Finding space when I'm not in the main MD program building is a bit of a challenge. The hospital (where I have some sessions) does have a few locking single-user bathrooms, and they're perfect. Private, lock-able, have a sink for washing up, and they usually have an outlet. But there's only a few and they are not always available. Ran into that today. I was darting around for a good ten minutes trying to find an alternate place to pump before one of the bathrooms came free.

Making pumping arrangements is also coming up in a few other ways. For one, the places I'm staying at while on visiting electives. I needed to email the property owners to ensure I'd have access to enough freezer space to store the milk I'll be pumping (up to a week's worth at a time, which is actually quite a lot of milk.) I have to contact supervisors and admin staff ahead of time to ensure I'll have access to a private space with an outlet and a fridge. It's a bit awkward to have to ask, but it's best I ask well ahead of time so that it doesn't come as a surprise when I show up.

So far actually sorting out the breastfeeding while on the run thing has been interesting, but it's going more smoothly than expected. I keep a manual pump in my bag just in case I get stuck somewhere or forget my electric one. I have a cooler pack so I can store up to 24oz for up to 24h away from a fridge.

Overall, though, it's workable. I have no supply issues (we thought this might be a problem because I'd be away a lot from the start and I didn't historically do well with a pump, but I'm pumping more than she takes while we're separated) and she has no issues with being combo fed. It's gone more smoothly than I thought it would, and that's making life easier for all of us.

We'll see how this works out when I transition to clinical work in January, though. I'll write a post about how that works out.

Pumping with Freemies means I can be way more covered!

She got her own Halloween pumpkin. 

Sunday, 23 October 2016

Goodbye Mat Leave

So, today is my last day of maternity leave. Yup, I really only had one week off. 

Even though it's not a social smile at this point, little reflex smiles are still adorable. Even at 2am. 

I'm on accommodated attendance for the next two weeks. Basically I'm attending virtually but I may actually just go in person since I feel fine. My recovery this time has been great, aside from the late spinal headache I developed. Still waiting on that to resolve completely, but it's not as bad as some migraines I've had so it's manageable. Compared to how I felt after my other two, this is pretty fantastic. 

I'm nearly back in my prepregnancy clothes and expect I will be within the week. I'm down quite a bit from my prepregnancy weight as of this morning (the fact that I was below my prepregnancy weight the day I gave birth makes this somewhat less impressive) which is why this is the case. I expect I'll need new clothes once the postpartum tummy goes away, considering things are loose already, and I'm hoping to continue losing weight. 

What's surprising me most about my recovery so far is that I'm not having the massive emotional swings that I had after my others. I did not go through those horrible crying jags a few days after she was born. I'm not starting to feel depressed or anxious at all. My mood is completely normal. Moreso than it was during pregnancy. I feel like myself. While I know this might change, especially as stress mounts in the coming weeks (I have a tOSCE in two weeks and our second year OSCE on everything we've learned the week after that...) I'm considering it a very good sign that I'm feeling so good at this point. My OB starting me back on my medication during my third trimester seems to be doing as we'd hoped and helping prevent postpartum mood issues. 

Because I'll be away from baby/on Skype for several hours this week - 2 hours for clin skills, 3 hours each for tutorials and procomp - I've been pumping to get used to it. I've never been good at pumping milk but it's a necessity this time. Every ounce I pump is an ounce of formula we don't have to buy. She's actually my first kid to receive any formula at all, but we're using it as a placeholder while I build up a stash in the freezer and so that my husband can take over some feeds so I can study (since I'm not able to pump as much as she takes per feed.) The goal is to have her receiving only breastmilk since it's essentially free, aside from my time and the investment into the pump. I like free. 

The fact that I'm going back to school this week isn't making me feel anxious or sad or anything. I'm  quite okay with it; I've been missing the mental stimulation of tutorials and I feel like I'm getting behind and this is not a feeling I like. At the moment, I'm typing this while holding M, who is quite asleep, and I'm shortly going to go do my tutorial prep for tomorrow and go over the tutorials from last week. 

It's nice that Plan A is working out. While I know it was certainly a possibility it wouldn't, having things go exactly as hoped is a nice change. 

This kid makes the best faces while asleep. 

See how tiny she is?!






Monday, 17 October 2016

What I Did Today

When an anaesthesiologist is working on putting something into your spine and says "that's weird..." some anxiety is justifiable. 

But despite needing three attempts at an epi, plus a spinal (which all left my back looking rather like dog's meat) to actually get pain relief, things went great. I only had to push for five minutes and little miss M was born at 6:13pm. 

She's 6lbs3oz and so far quite calm. Nurses well. Sleeping decently so far. Got time for a nap and a shower and I'm feeling quite human now. Hopefully we'll have an okay night and the fact that she's had some formula on top of nursing will keep her bilirubin down so that we don't end up needing a prolonged stay. 

She looks very much like her siblings did. She's also my smallest but not by much. My son was only 6oz heavier at 40w. She's a dainty thing but strong and quite alert.

It will definitely be interesting to see how the days ahead go. Right now, I'm just enjoying seeing her sleep.

My kids are born fuzzy. 


Current view. Totally has the right idea here. Sleeeeeep. 



The Day

We're on our way to the hospital now. Miss M will hopefully be here later today (if it takes until tomorrow I'm going to be less than thrilled.)

I've decided that since she's the first baby for my class (I know she's not going to be the last - babies happen with a fair frequency in the age group of my peers) she gets to be called a Mac Mini. Wonder if I can get her a teeny maroon sweater...

Med school while pregnant has been a hell of a ride. I expect it's going to be quite a bit harder for the next little bit while I manage it with a newborn at home. 

But that's a bit distant. Right now, I need to get through today. That's the next big task. Today. And then all the days after. 

So far so good, anyway. Hopefully everything goes quickly and smoothly. That would be a nice change from the usual. 



Very last pregnant photo. 

Monday, 10 October 2016

Better Days Ahead

Yesterday I began my Thanksgiving preparation. This is the last big amount of baking and cooking I'm going to do before the baby. We got a big turkey so that there will be a ton of leftovers for me to portion and freeze - being able to grab some pre-cooked turkey out of the freezer to throw in with some vegetables and rice, or into a pot of soup, makes for a really quick and simple meal and I want to keep things as simple as possible for the next little while. 

It's just the four of us for thanksgiving, but I'm still going all out because why not? Well, hopefully it'll be the four of us. My son's still in the hospital but he is able to come home on day pass today. I think part of why I'm putting so much effort in is to keep me distracted, to be honest. If I'm not cooking, I'm cleaning everything. I'm not sure how much is nesting vs. coping mechanisms. 

Right now I have two pumpkin pies (one for the neighbours) in the oven, made using the last of my pumpkin purée from last year. I have two more pumpkins to process (roast/purée) for this year, but I'll do that later this week. I just do not like canned pumpkin anymore. Yesterday I made two dozen pumpkin apple muffins and a batch of bread which makes either five loaves or three pans of rolls and one loaf. Pan rolls are awesome. 

My house smells pretty awesome at the moment, really. 

Once the pies are done, the turkey is going in and I'll get started on the cranberry sauce, since it takes around 4 hours to cool (I make my own.) Once I'm done this post, actually, I'll be making the stuffing. Then starts the vegetable prep. Squash, sweet potato, mashed potato, turnip, carrots.

Should be enough that I won't really need to cook for several days, and I'll have lots of turkey meat to freeze. 

With one week left until the baby is here - assuming all is favourable, I'll be induced on the 17th - and with my son in the hospital, I'm just trying my best to keep life as normal as possible while things seem to spin wildly away from any sense of normalcy. All I can do is try, though, and get through the hard days while enjoying the happier ones. 

Happy Thanksgiving, everyone. 


Thursday, 6 October 2016

Life Continues, Interrupted

I am very, very tired. 

Had an early ultrasound yesterday, so I was up quite early after a whole night of tossing and turning and ultimately getting little sleep. Got a chance to lie down a bit in the afternoon and I got just a few minutes of light sleep before I left for clinical skills in the late evening but I was still exhausted. During clin skills I started having some irregular, but rather strong contractions. Left a bit early to go home and lie down to get them to stop (they usually will.) But when I got home, something else demanded my attention. 

My son is currently in the hospital. We got to the hospital around 10pm. Ended up in a room without a bed for several hours. My son got a mattress pad to lie on. I couldn't stay upright, so I just tried to sleep on the floor for a few hours, but didn't really manage it. Around 3am we were moved. My son got a proper bed, and I got a chair to sleep in. The contractions kept waking me so I didn't end up really getting any restorative sleep, though fortunately my son did. He was assessed in the morning, and admitted around noon. 

As soon as we (my husband called off from work for the day) got him settled and my husband was heading home to pack up some stuff for our son since he'll be there a while, I headed to tutorial. Fortunately, just the next building over. I actually arrived on time.

Unfortunately, I'd not had any time to prepare for tutorial and I was... more than a little fraught given the circumstances. My wonderful group members and incredibly kind tutor were very understanding which was very much appreciated. My group is very lighthearted so it was nice to actually just do something normal for a few hours, my inability to contribute to the tutorial aside. I hate being the teary pregnant woman, but I just couldn't control it today. Tired, stressed, dealing with contractions still... my coping abilities only go so far. 

For what it's worth, while I am now dealing with what I'd probably describe as 'practice' labour. I dealt with this for over two weeks with my (first) daughter so I think it's along the same lines and don't think it means anything is imminent. I get a stretch of quite painful contractions, not just Braxton hicks, but while they can cluster a bit, they don't really get regular and they may ease a bit if I lie down. It's not labour but it's enough to make sleeping difficult unless I take an antihistamine that works fairly well to encourage sleep. 

The next eleven days are going to be the biggest challenge of med school so far, so I'm breaking it up into pieces. Just get through a few days at a time. Get to the next milestone, the next tutorial, the next appointment. If I keep doing that, we'll get through it. We always do. 

Tomorrow, I'll meet with my son's care team and we'll plan things. That will make it easier to get through the next few days. 

But first step first. Sleep. Good, restorative sleep. 

Sunday, 2 October 2016

The Inevitable Onset of Nesting

Towards the end of pregnancy, women sometimes get a burst of energy and develop this almost frantic need to clean, organize, and otherwise prepare things. It's called nesting. I don't know if it's a social conditioning thing or actually has a physiological basis to it, but it certainly wouldn't be the oddest behaviour we've evolved as a species.

Anyway, this is basically me right now. This weekend, I desperately needed to clean and organize things. The hall closet, the bathroom cupboards, everything in the master bedroom. I am not the world's most enthusiastic housekeeper, but in late pregnancy, all bets are off.

So I'm nesting. Finding the energy to do my tutorial preparation was difficult, but there was no challenge in finding the energy to go through our medicine cabinet, reorganize all of our first aid supplies to make sure we have a well-stocked kit, or go through the general pile of cosmetics, lotions, and whatnot that seem to accumulate over the years.

With two weeks to go until I'm induced, it suddenly feels very pressing to do all of this. The car seat is now installed in the SUV. My hospital bag and the diaper bag are packed and ready to grab. While I have a scheduled delivery, there's always the possibility of going earlier, so I want to be ready.

I have also, in the last week or so, become incredibly prone to going "awwwww" about everything, which is rather unlike me. I am not normally the type to lose my head over tiny things, but hormones seem to have an effect on this aspect of my personality. Seriously, look at these little itty bitty teddy slippers.


That I have so little time left until the baby is here is making it very difficult to focus on school. With my son, I stopped working 4 weeks before he was born. With my daughter, I had stopped work at 26 weeks because I'd had preterm labour issues (it stopped, but my OB felt it best putting me off work until the end.) I have mandatory stuff at school until the 14th so this is the busiest that I've ever had to be immediately prior to having a baby.

While I currently have a bit more energy than I have had over the last few months, my ability to focus really is quite reduced at the moment, and that's making the necessary brain work of medical school quite challenging.

I can focus a great deal on organizing and cleaning, but neuroanatomy is proving a challenge.

Just a couple more weeks, though, then she'll be here, I can recover, and we can settle into the somewhat crazy first few months as a family of five. Hopefully the work I'm putting in now to get the house into a more organized state will make that initial transition a bit easier, anyway.

Thursday, 29 September 2016

Welcome to Cold and Flu Season

I am currently in bed, feeling sorry for myself because I've got a bad cold, for which I have my lovely and generous little children to thank. Do you have any idea how miserable it is to cough and sneeze constantly whilst 8 months pregnant? It's awful. I've been sicker than usual with this pregnancy and I'm very glad that it will be over with in 18 days. As a severe asthmatic, I'm already prone to getting sick more than most people so being worse than that has really sucked.

Everyone else in the house is sick too this time. At least the kids are old enough to be relatively self-sufficient. My husband and I were both feverish, achy, and slow to get started this morning so my son came into our room, told us that he got himself and his sister breakfast, and they went and watched Netflix for a while. This is why I prefer parenting school-aged children to babies. Babies have their charms and all, but they won't take care of themselves when you're sick.

The fact that I am curled up in bed feeling terrible today doesn't mean I've been unproductive, though. My brain may feel like it's immersed in molasses, but I've been able to get quite a few things done. Finalizing a few things around my November/December electives, sending out a number of emails, had a phone call about services for my son, and have been doing some reading in preparation for the neuro teaching session and test tomorrow. I actually feel pretty accomplished for the day.

And since it seems my fever has finally broken, I should be able to get some effective studying done this afternoon and evening, which will be good.

Like life, medical school marches on even when you're sick. Leaving the work to later just ends up making it all that much harder to get through so I'm glad I didn't take the day completely off, anyway.

I am taking the day off from cooking, though. I'd planned to make a roast in the slow cooker today. It'll keep for tomorrow. Tonight is whatever we feel like ordering in, and I'm not going to feel a moment's guilt about the almost undoubtedly unhealthy supper we're likely going to have.

Also, just because it's that time of year:

Get Your Flu Shot (as soon as this year's is available in your area.)

Wednesday, 28 September 2016

Getting Involved

I haven't really done much in the way of extracurricular stuff in medical school yet, but I'm starting to feel the pressure. I look at my CV and it's kind of thin. 

I have...
- No research (have a meeting about this today. Hope to change it! Especially because this looks like awesome research)
- One exec position 
- Planned/executed a successful networking event with my group (super fun)
- Volunteered with national organization's AGM 
- A Quality Improvement project
- Two POCUS certifications
- (Just agreed to this so haven't done it just yet) Organizing a skills night for students interested in a particular specialty

That's pretty much it. It's not really a whole lot. I've got some classmates who have CVs as long as my arm detailing all the advocacy and research they do, all the conferences they've attended/presented at, multiple committees they've run, events they've planned, changes they have helped implement in the community and our program. My classmates are super active, involved people who care about the world and our futures and I think it's awesome, but I'm feeling a bit lackluster by comparison. 

It's not that I want to do things to pad my CV, but I am starting to worry that I'm not really being as involved in my school and my community as a medical student should be. We are encouraged to use this time in our lives to become leaders and I'm not really doing that. I'm worried this will impact me come CaRMS time, but beyond that, I worry I'm not really fulfilling my role as much as I should. 

Although frankly right now I'm way too tired to do much more than worry about it. Fortunately I will no longer be pregnant soon enough, so I'll actually have some energy back and be able to get involved as much as I'd like to. (I realize people assume I won't be sleeping with a newborn in the house, but that period is relatively brief and I will not be the one primarily responsible for nighttime care.) 

There are things I want to do, events I want to get involved in. I passed on a lot of really cool stuff over the last year because I was really focused on trying to ease the transition into medical school for myself and my family, and then I was too tired with the pregnancy. But preclerkship is when the typical student would have the most time to get involved, to take charge with events and groups, to get involved in advocacy and research. I'm looking ahead at clerkship, with its standard 10+ hour days plus call, and realize that fitting more into my schedule is going to be a challenge. But I'm going to make it happen. 

I want to be more active in the community and in my program. I want to do research. I want to help host events, and get more comfortable with public speaking, with organizing people, with taking a leadership role. I want to use this time to work on these skills because it's part of the experience of medical school and so far I haven't really done that. 

Sunday, 25 September 2016

Falling Into Place

Things seem to be getting sorted out around my electives. I knew they would, but that didn't stop me from a considerable amount of panic over the last while, as has been abundantly apparent by my recent posts.

I have things booked for my four weeks in Nov/Dec. Well, one is agreed to but not fully booked in the system yet; just waiting on confirmation of one piece of information before I do that. 

In February and March, I have a six week elective block. I'll only have done my OB/Gyn core by that point, so it seemed as good a time as any to do some OB/Gyn electives. It'll be fresh in mind so I'll be able to put in a good effort and come in strong. Better than doing an elective before a core and not knowing much. 

Unfortunately, this being my largest elective block before CaRMS, it's also an important time for me to do visiting electives. While it's not optimal for me to be away for weeks at a time when M is so little, my husband and I agreed that it was probably a good idea to go ahead and just book electives in other cities for that time and cope with the inconvenience. It's not as bad as spending a core at a distant site, anyway, and it's necessary to keep my options open.

We decided that I'd stay within somewhat reasonable driving distance so if I get a stretch of days off I can come home, or they can come see me. So I applied at a couple schools in Ontario.

Just the other day I was offered a visiting OB/Gyn (L&D) elective for February and I'm pretty excited. I've booked a room in a house that's maintained specifically as a rental for visiting medical students. It's a 5 minute walk from the hospital so I won't have to worry about hospital parking, rather conveniently.

For now I've actually got most of my electives for this winter and for next year sorted out, which feels pretty good after all the stressing about it.

I have a total of 12 weeks elective time before CaRMS, 14 weeks if I include next summer's vacation time which I am planning to work through. I'm not going to do electives longer than two weeks, with one exception, so this is time for 7 electives. This is what I have so far:

1. Reading elective, OB/Gyn topic - 1 week
2. Psych - 3 weeks
3. Visiting L&D
4. Gen paediatrics
5. Diagnostic Imaging or MFM (I think it's likely I'll have MFM during this time, but I won't know for sure until next month.)
6. Family medicine
7. Visiting Emerg (back home - it's been penciled in, not confirmed, can't apply via portal for a while)

I am trying to find something else to replace the gen paeds elective. I don't think it's a very good idea to be caring for hospitalized sick kids during flu season when I have a baby at home who has only had one or two rounds of vaccines and is too young to get a flu shot. I am not sure I'll be able to get a flu shot before she's born either to give her some protection. I would like to do a paeds elective, but I'm not sure that's the best time to do it.

I also definitely want to do an elective back home during my two weeks vacation next summer, so I'm really hoping that they open up those sites again soon (the medical education coordinator is away and as far as I know no one has been hired to replace her temporarily.)

In Jan-Feb of 2018, I have another 6 week elective block before my last core (psych) but I'll be able to take two weeks of that off for CaRMS interviews. which is why I'm working through my vacation. I'll get stuff for that time booked later. At least I know I need to apply before June of next year to ensure that I'm not competing against visiting students for spots.

I think this is a good selection of electives which will expose me to some great skills that I'll be able to take with me into any specialty. My interests are well-represented, but I'm also exploring a broad range of options. I would like to do one more OB/Gyn elective at some point if I don't get that MFM one. This isn't what my final list will be since I do expect some changes, but even if it doesn't change much I think I'd be pretty happy with my choices.

For the first time in quite a while, I'm feeling like things are coming together nicely.

Now I just need to go finish reorganizing closets and scrubbing bird cages because it feels extremely important to get these things done before the baby. Nesting is such a weird phenomenon.


Friday, 23 September 2016

Crazy Week Takes a Tea Break

As might have become clear with my complaining over the past few weeks, things are rather at an intense pace at the moment.

I've had at least 3-4 things scheduled every day this week, from doctor's appointments to mandatory sessions. I've ended up with unscheduled things that have taken up way more time than they should in between the scheduled things. It's just been really hectic, and I'm having to let some things slide (like multiple messages and emails from other students I want to get to! Sorry if it seems like I'm ignoring your message, I'm just honestly really busy!)

Just by an odd collection of circumstances, I ended up with 4 medical appointments, a sick kid, a PA day for the kids, and a large event all in one week, on top of a CAE and a transition to a new unit and a four hour clinical skills session on Wednesday that left me totally fried.

It's times like this where I really feel the stress of being a student with a family. A paediatrician appointment for my son ended up taking most of the afternoon Tuesday. Dealing with the pain in the arse that is getting his medications covered ended up taking a lot of this morning on the phone with the government (everyone's favourite activity!) My husband ended up going to work late today so he could take our daughter to her appointment. He's taking the kids with him to work tomorrow and I am unendingly grateful to his bosses for allowing that in a pinch.

But, the week did end up productive. We got a new family doctor, who I really like. I'm participating in some non-school, but career-related networking activities. I did end up confirming an elective (woo! Finally!) Also have a new therapeutic approach to my son's challenges, so I'm hoping that maybe we'll start to see some progress there.

I haven't really had much time to spend with my family, or even to catch up on my own needs, though. I ended up taking a nap in the medical student lounge yesterday because I managed to arrive just over an hour early for clinical skills, after dropping off my daughter to my husband at his work, and it was the first chance I'd gotten to sleep.

Fortunately, the next three weeks look a bit quieter, so I'll have lots of time to study, get caught up, and work ahead a little. I've felt like I've had very little time for it this week, which is a bit distressing considering the rate at which the material is flying at us.

Yesterday did have one of those lovely little moments, though, where I got to leave everything at the door for a little bit and just enjoy myself for a short while.

We ended up keeping our daughter home from school yesterday because her cough - she's got a bit of a cold, nothing particularly bad - sounded horrible and she just did not feel well first thing. She actually ended up getting quiet a bit better rather quickly so after an appointment, I decided we'd stop at a lovely little tea shop for lunch. She was, as she often is, dressed up in one of her fancy dresses, and I was a bit more put together than usual myself. We had scones with devon cream and jam, finger sandwiches, small sweets, and lovely sweet rooibos tea from pretty china cups. She was so, so thrilled and chattered until I dropped her off about her 'fancy tea party.' I don't get time for many of these moments, but I absolutely love it when I do get to just connect with one of my kids for a while. 






Sunday, 18 September 2016

Wall

I've hit a bit of a wall. Well, more than a bit.

The last few weeks have been very, very stressful. I normally do fairly well with keeping all the balls in the air but right now I just am not. I am exhausted. Utterly physically, emotionally, mentally spent. And there's no recovery time on the horizon.

There's no point in the near future that I can look at and say "I'll definitely be able to take some time to put myself first for a bit." The baby will be tiny during my two weeks break this December, and we have someone coming to stay with us, so I'm not going to be able to have downtime then (although my friend will most likely watch the kids so I can go out which will be nice.) I have to work through my vacation next summer so that I'll have time off for CaRMS.

I suppose I can schedule some 'me' time in December 2017, when we have three weeks off.

I knew, going into this, that it would be hard. Medical school is hard. Having a baby is hard. Doing both at the same time is obviously going to be very hard. I'm still very committed to doing this and pushing through what I knew would be a rough few months, though. This is not an unexpected period of difficulty and I was bracing myself for it.

But right now I'm having a hard time, and I think it's perfectly reasonable to express that. I expect that a lot of med students hit a wall around this period; this last little bit before clerkship. We have a LOT of material to learn in a very short period of time, and we have the uncharted country of clerkship looming in the near future.

I know I need to make some time, somewhere, to take care of myself, but it's hard to find it. I've basically been spending no time with my kids lately just to have time to go over the material over and over because my ability to retain information is shot so my usual "look at it once, know it" method isn't working. I require more sleep than usual, but it's so broken up that it's not really particularly restorative sleep. My appetite is gone. I've averaged only about 1400 calories a day (I have tracked what I've eaten for years) in the last week and only really that much because I've been forcing myself to eat because I'm pregnant. Still losing weight, but at least it's slowed. Some people stress eat, I do the opposite. Food is just extremely unappealing when I'm stressed.

So I'm tired and overwhelmed. But like with every other time I have faced periods like this - there's plenty of times I've written similar posts over the years I've kept this blog - I will get through it, and things will get better because they always do, so I'm looking forward to that.

Just need to keep on.

Friday, 16 September 2016

Just The Facts: Specialty Selection

For those unfamiliar with how it works, here's a quick breakdown of how medical students become residents (as I understand it from the perspective of someone who hasn't done it yet.)
- In November of your last year, you submit your applications via CaRMS to residency programs.
- Late January to early February, you are interviewed by programs that are interested in you.
- Programs create a ranked list of residents that they are interested in.
- Applicants create a ranked list of programs they are interested in.
- The match algorithm is run which supposedly should optimize the number of applicants and programs receiving their highest possible choices.
- In March, you're told where you're going, and the programs are told who they are getting.

Factors that I know determine how programs rank you:

- If you've 'shown interest' in the specialty. This means having done at least one elective, or research, in that field. Being part of an interest group, being a student member of the professional college/assocation/society, being involved in advocacy related to the specialty. These are all ways of showing that you're interested.
- Good evaluations on cores. Often, it means *all* of your cores, not just the one most closely associated with that specialty since they're going to want to know that you don't become completely useless when you're doing something you don't enjoy as much.
- LORs (yup, premeds, you have to get these in med school too. More of them.) Programs have different requirements. Most require they be from currently registered physicians; some programs allow LORs from non-physicians. Sometimes they specify that they have to be from a certain specialty, or they may specifically request clinical or academic physicians.
- Whether or not you have done research (they all say they don't require it, but every single person involved in ranking applicants that I've talked to has said that they do consider it very strongly.)
- How well you fit into the team/culture/program. This is a hard one. It can be from having done an on-site elective - few programs seem to require on-site electives - or just from the interview and associated meet and greet activities.

Factors that will determine how I rank programs:

- Specialty. Obviously. But I'm not going to rank all programs in one specialty higher than all programs in another specialty, because there are other factors at play.
- The patient population I want to work with. This was something to consider recommended by a current resident when I requested input on how they had selected their specialty and what factors they did consider, and which ones they think they should have put more weight on.
- Lifestyle of said specialty (including during residency.) No, 2-5 years is not forever, but it's still years out of my life and the life of my family.
- The program itself; there seems to be a lot of variation in how programs actually teach and how they support their residents.
- Location.

This last one is the most critical for me, whereas it may not be as much of an issue for others. Just like with med school applications, the advice that comes from the top down is loud and clear: apply very broadly. But, just like with med school applications, I am ignoring that advice.

Especially because I am very seriously considering a specialty that requires a five year residency, the location matters a lot, particularly because my kids are older. My oldest will be either entering or in high school before I finish residency. My family would be absolutely miserable living in Toronto for five years, as an example, so I'm not even going to apply to programs there, just as I didn't for med school. Nothing against the school, it's just not a place I'm willing to live for five years. I'm also not going to apply to residencies based in Vancouver because we just won't be able to live well as a family of five on a resident's salary there (which, funny enough, is the second lowest resident salary in the country) considering the cost of living.

But, since I'm so much more strongly considering OB, and I'm excluding one of the 5 programs in Ontario right off, I'm expanding my geographic area to consider more westward. As much as I want to go home, applying to only 6 programs - 4 in Ontario plus the two Atlantic programs - in a rather competitive specialty is not really setting myself up for success matching to that specialty (I'll obviously also be applying to family med as well) so my husband and I are weighing options for western schools.

There's a lot that goes into this besides just deciding what sort of doctor I want to be. In that way, applying to medical school was far easier.