Monday, 29 February 2016

Developments

I was planning to not post this until later, but I changed my mind.

Today, I had some blood work and I got the call around 1:30pm with the results.

As of 10am today, my βhCG is 24 and my progesterone (P4) is 37.

I am currently 4 weeks, give or take a day or two, pregnant. hCG is a touch lower than I'd like it to be (I'd be happier with 50+) but it's not outside the expected range for where I am. The fact that my progesterone is 37 is actually really good news as a P4 below 20 is strongly predictive of a non-viable pregnancy whereas a higher P4 is associated with (though not as strongly) with a viable pregnancy.

The thing about the hCG is that the exact number itself doesn't matter but the doubling time matters. Typically, serial betas are drawn around 2 days apart because 85% of viable pregnancies will have a beta level that doubles in 48 hours. If my beta on Wednesday is 48 or higher, that's good. If it's at least 40, that's okay but a bit worrisome. If it's below 40, it's much less likely to be viable.

This is a very, very early pregnancy. Women often do not disclose that they are pregnant this early on, but quite honestly whether the pregnancy progresses or ends poorly, I'm still going to post about it. So why not talk about it now, when I can still be excited and a bit hopeful?

This does mean I am due November 7th, so riiiight under the wire for avoiding having a baby during clerkship (which starts November 21st.) I am, obviously, REALLY hoping this pregnancy works out and not a small bit because I do not want to be pregnant during clerkship because that would suck. Starting clerkship with a newborn at home is far less daunting.

I am quite likely to be classified as high risk given the high possibility of abnormal placentation with a pregnancy in a woman with untreated Asherman's. Guess where the regional high risk centre is.

My school!

Which means I will literally have my kid at school. Now that is dedication to one's studies.

Still, I'm rather on tenterhooks until Wednesday afternoon when I get my next beta.

I really, really hope this is it for us and that we finally have a successful pregnancy. All I can really do is wait and see anyway. There's literally nothing else I can do besides just wait and hope. But it's nice to write about it.

Sunday, 28 February 2016

200,000

In the next hour or so, I will hit 200,000 views. I hit 100,000 views last year on March 27, so it's been eleven months and one day which is just incredible. 

The first 100,000 views took three years. The next, eleven months. That's just insane. My life is simply not that interesting, I just talk a lot, hah. 

It's really incredible how much the last year has changed our lives. I was only a few days done of my Mac interview on March 27 last year, and this year I'm going to be hosting for the interviewees on the 3rd of April. It's exciting! The next batch of future little Macs will be passing through the door in a matter of weeks and we will welcome them and try to put them at ease. 

I'm going to leave this post a bit short. A conure is currently trying to type on my iPad while I'm writing and it's getting a bit tedious. 

Still can't believe I've hit such a big milestone! 



 

Friday, 26 February 2016

Better Days and Encounters

I've long thought about how much of my life I share here. People I know in real life read this blog (hi, guys) as well as potential preceptors, potential supervisors, people who will impact my professional development. I post a lot of very personal stuff on here, stuff that most people don't talk about in public or with acquaintances, things like finances and my inner insecurities and fertility and pregnancy loss and family troubles. 

But that's part of the concept behind this blog; for it to be an honest recounting of my life throughout this journey. Some stuff IS too personal and I don't publish it, but anything I do talk about I consider to be fair game for discussion. 

I was reminded today of how many people I encounter who know more about me than I know about them. While I was waiting for tutorial, a very nice health sci student asked me if I'm the author of this blog. This student is applying to med school again this year and has an interview at Mac in April, so this paragraph is here purely to wish T luck. I don't post names unless I'm told to so I just wanted to give a shout out here and hope people will post some comments in support. :)

Today was, despite being a bit exhausting, a good day. I don't want to make a particularly long post (I'm beat and only had three hours of sleep last night) so I'll get to it later. But today was definitely a good day. 





Wednesday, 24 February 2016

I need a break.

I need a break badly. The few days we had 'off' between MF2 and MF3 just didn't end up being relaxing because they filled up with appointments and stuff. 

I'm feeling like I'm approaching burnout at the moment. I just can't work up the motivation to prepare for tutorials as well as I want to. I am not performing at my usual standard, and that's bothering me. 

With today's somewhat intense schedule - procomp from 9-12, tutorial from 2-5, then clinical skills from 5:30-8:30 - I am just more than a little fried. It's a lot for one day. With the clerkship stream lottery coming up too quickly and the pressure to get post-MF4s set up, and the more intense material of MF3, I really need some time off. I'm not getting time off, but I do need it. 

Tomorrow I just have a short clinical skills session, then I'm coming home to relax and do nothing for a few hours because that's the closest I get to time off. 

There are perks to this short program, but the lack of prolonged downtime to look forward to is a definite downside. 

Sunday, 21 February 2016

T Dot and Close Encounters

Living close to Toronto has the benefit of being able to go do fun stuff in the city while also benefitting from not living there. 

I like the stuff there is to do there, but I can't imagine the sheer number of headaches people must get from dealing with the constant crowds and traffic. I can deal with it for a day at a time or so but then that's it. The constant crushing presence of endless humanity is suffocating. Some people find that energizing, like my daughter, but definitely not my husband, myself, or our son. 

We went to the zoo again. It's a great way to get out and have fun and let the kids run around for the day. With our membership, we have unlimited visits for the year so we are definitely getting our money's worth. It's pretty quiet in the winter, with today the busiest we've seen it yet. Probably because you could see the lion cubs today. 


They were cute and playful as expected. So was Nneka, the baby gorilla. She is so sweet and we go see her pretty much every time we're there


But the cool thing about the zoo is that every time you go, you can discover new animals. Today, this guy was my favourite. 


Afterwards we went to the Eaton Centre. I hadn't been there in years and years. The four of us only managed about two hours before it just got a bit too much. Even my daughter, who is an extrovert to the extreme, was exhausted by all the noise and masses of people. 

One very cool thing though is that we saw a favourite actor of mine. At least I think so - he walked right by us and it definitely looked like him. My husband spotted him first and was all excited. Considering I've seen well over a dozen seasons of TV shows in which he acted as a main character, plus films, I'm fairly certain it was him but the possibility always exists that there's someone wandering around Toronto who just happens to look exactly like Anthony Head (Giles!)

All told, a fantastic day. We spent a total of 9 hours walking around, several more stuck in traffic (seriously, what kind of city has rush hour on a Sunday?!) and the kids went to bed early, without complaint and with hardly a peep once their heads hit their pillows. 

Saturday, 20 February 2016

U/S and Them

I did an emergency department echo (EDE) course today. It was super fun. We got to try generating images and figuring out what we were looking at. They taught us about certain positive findings. It was really, really cool. 

The day did illustrate, however, that I absolutely need to work on keeping my bloody trap shut. 

To start with, I barely slept last night. Now, my brain-to-mouth filter works fine (usually) if I am well rested. But last night, I woke up at 2am and didn't get back to sleep until 6:30 and I had to be up at 7:15. So I barely slept and I was in excited-walking-zombie mode. 

This is not a good mix. 

I saw something on one of the scans and asked the instructor if it was what I thought (a totally innocuous and very common finding, for what it's worth, if it was what I thought!) and the simulated patient, a med student, goes "WHAT?!" and the instructor practically chokes and I'm kicking myself and apologizing and saying I'm a first year med student, you can't take anything I say too seriously.... 

It was... not my best moment. By far. My mouth has gotten me into trouble before. I've been kicking myself about it since it happened. 

This is not the sort of mistake I can afford to make in a clinical setting. I'm better than this. I hold myself to a higher standard than this. I shouldn't be making stupid little gaffes like that. I also know I shouldn't be completely beating myself up all day to the point of near anxiety attack over it. I'm going through a bit of an "I obviously don't belong in med school" mental crisis, and I know this is ridiculous. 

The last couple weeks have been very rough and I'm not doing terribly well, to be honest. Im giving it another week to see if I even out but if not, I'm going back on my medication and calling this challenge a failure. I can see even in my posts and my personal journals how my mental health is deteriorating over the last couple weeks since I titrated down and then stopped my medication. I have been under performing at school and making stupid mistakes and forgetting important things and being very anxious about everything. 

Much as I'd rather not be on meds long term if I can avoid it, I think it's pretty clear I do still need medication. It's good to have it confirmed, at least. 

On the plus side of today, though, besides the fact that it illustrated how much I still need to be on my medication, I really enjoyed performing ultrasounds and I'm sure I'll seek higher certification in EDE in the future because I can see how useful that will be. 

In one of the med-students-only rooms, we have 'constant presence'. With the other campuses. That's a video feed to one of the lounges at Niagara Regional Campus. The inset image is what the camera can see of the mail room at Hamilton. This is what med students do with VC technology. 



Thursday, 18 February 2016

Restless

Today is one of those days I'm feeling rather restless. I want to just pack up and go somewhere. Obviously I'm not going to because that would be impractical and irresponsible (I have tutorial, after all) but damn do I want to.

My new tutorial group is nice. I know one of them because he's in my procomp group and I've spoken to two others at other times, but I hadn't met two of them before (at least long enough to know their names at first sight anyway.) Still, I expect I'll get to know them well enough. It's a small group and I expect we'll be able to get on well enough.

Tuesday was a bit nuts because we had procomp and then tutorial and then clinical skills so I was at school (well, school then the hospital) for almost 12 hours which gets a bit intensive. Our new clinical skills preceptors are... intense. They seem very nice but it's clear they have high expectations of us and I just hope I don't disappoint. They're going to do some additional stuff with us - reviewing EKGs and whatnot - which is appreciated. One is a PGY1 radiology and the other is PGY1 internal, so it's an interesting contrast. They both went to U of O so they're not as familiar with Mac's program as my other preceptors have been.

Last night, an interest group put on a fantastic event called Dinner and a Trauma. We had dinner (obviously...) and had a fantastic talk on trauma medicine from an emergency physician who is also the program director for the emergency medicine residency program here. He was a very engaging speaker and I really enjoyed the subject matter.  It was quite a fun evening. I'm really going to have to do this sort of thing more often.

I do have a bit of an interest in emerg, but I can't really see myself doing the five year program. Obviously I am not ruling it out but I don't think even more years of education is a good idea, especially when the 2+1 family med + emerg will be sufficient for the emergency department back home.

Given that the clerkship stream lottery is in two months (holy crap) I really do need to focus my areas of interest now to ensure that I do my cores and electives in those areas before CARMS applications.

It's weird to think about the fact that clerkship is only nine months away. I'm going to have responsibilities soon. Sheesh.

Tuesday, 16 February 2016

Bad Timing

So, MF3 is renal - that's what we're doing now - and then repro. The repro cases are going to be hard.

We have cases dealing with infertility, a patient with several miscarriages. Complicated labours. A teen pregnancy (and, of course, the pregnant teenager is portrayed as being all around rebellious and difficult. Because even in medical school the people who write our cases can't help but paint a teen who gets pregnant as a 'bad egg!' Do people not realize that 'good' teens end up pregnant sometimes too?) which experiences a complication I had with one of my own pregnancies (different outcome, though.)

Repro is going to be very difficult. Especially because we have three infertility cases the first week. Obviously I have to learn it (hah... I already do) and I have to take part in tutorial, but it's going to be really hard.

This is where I can't help but wonder how physicians cope when they are treating patients dealing with issues the physician is dealing with in their own life. Obviously you don't disclose your own challenges to your patient, but there's got to be a lot going on internally and I'm curious how doctors cope with that.

A bit of a think-y topic for this evening. I honestly don't know the answer, but I'm going to read a bit and see if I can learn how doctors have dealt with those feelings. I know I will have to deal with this many times over the course of my career and I need to learn now how to start dealing with it.

MF3 is going to be hard, I think,

Monday, 15 February 2016

An Experiment and Invulnerability

I've been on medications for my mental health for thirteen years off and on.

Occasionally, I like to challenge myself and see if I'm ready to go off of medication. I know I may never be able to go off them for good, and I'm okay with that, but all things being equal, I'd rather be on as few medications as possible. If I absolutely need it, I'll take it, but I like to know for sure that I do still need it. I'm never going to not need my asthma medications, so those are here to stay, but others? Variable.

When I started my current management medication, I was at a vastly different place in my life and I think I'm now at a place where I can try to go without it. I've been on a very, very low dose for a while now, so I've tapered myself off over the last couple of weeks by gradually extending the time between doses to four days and I'm going to see how I do during the start of MF3 before I decide whether or not I'm going to go back on.

A friend of mine posted this article about physician suicide recently. It seems everyone in the medical community I've talked to about the subject knows that doctors (particularly female physicians) are at a high risk of suicide, but it doesn't really seem like anyone's doing much about it besides vague promises to 'promote wellness.'

From reading through the registration application documents, it looks like I'm going to have to disclose my history of mental illness to my registering body when I seek permission to practice in a province because I have to disclose any illness, mental or physical, which might impact my practice. Is it possible I'll have a serious exacerbation of major depression and miss work? Yup. Unlikely, but possible.

Also might end up with an asthma exacerbation and miss work, but I somehow doubt that being an asthmatic might keep me out of a job. (Being fat might, but I knew that going into this.)

As much as we talk about eliminating the stigma around mental illness, it seems doctors are just as bad as the general population at perpetuating it. The culture of invulnerability that seems to permeate medicine makes it clear that those perceived as weak are lesser. It's the same sort of mentality that makes me feel very unwelcome in medicine as someone who has dealt with chronic illness and continues to deal with being fat.

But I can't hide the fact that I'm fat. I can't even really successfully hide the fact that I have severe asthma considering I usually need my inhaler after being out in very cold or very hot weather so my classmates occasionally see me take a couple puffs. I do, to a degree, hide that I have dealt with mental illness. While I have talked about my experiences with physical illness, I have not spoken about my experiences with mental illness at school because I worry about how this will change how my classmates treat me. Obviously I've talked about it here, and my blog is fairly well-known so it's hardly a secret, but I don't volunteer the information, even when the conversation might prompt such a disclosure.

Medicine, I think, has a ways to go in dealing with mental illness, both in patients and in its own community.

For now, I'm just going to give myself a little test. See if maybe, just maybe, my brain is ready to take a leap in a new direction.

Let's see, shall we?

Saturday, 13 February 2016

A Long Me-Medical Post

I have not posted in detail about my infertility assessments and stuff because it's, obviously, stuff of a rather sensitive nature. I'm not at all shy about talking about it, though, I just figured the internet (and my classmates who read this... hi guys!) probably don't want to know *that* much about me.

But today, I am making an exception and I'm going to give a little window into what this experience is like. My purpose in posting this is that I have heard from other women who deal with infertility who read my blog and I'm relating my experience as a patient. I also personally like reading patient stories so I'm writing one today. So stop here if you don't want to read that.

Since we started seeing the reproductive endocrinologist last month, I have finally felt like we are making progress. Thing is, I've had a number of chemical pregnancies; these are pregnancies that lasted only long enough to be detected by biochemical testing, but didn't progress. Basically, a very early miscarriage. Most people consider a loss before 5 weeks a chemical pregnancy. Most women who experience a chemical pregnancy won't know about it; it will just seem like their period is a couple days late (if they are regular) or may just seem like normal variation if they aren't clockwork regular. Typically it's mostly women who are trying to conceive (and thus test very early) who notice these early pregnancies. 

A lot of doctors don't 'count' chemical pregnancies. So whenever I'm giving my obstetric history and they ask how many pregnancies I've had, I have to give two numbers - one with and one without CPs. So my medical records actually show different numbers of pregnancies, depending who you ask.

It's frustrating to not have chemicals counted as losses. The fact that I lose so many pregnancies so early on is clinically relevant; they shouldn't be dismissed, but until now they largely have been. 

So for years, I have been trying to figure out why I have such difficulty maintaining pregnancies. When we saw the RE for the first time and I qualified my number of pregnancies by explaining how many of my losses were chemicals, he said "I need to know about the chemical pregnancies."

Finally, someone is listening. 

And then I immediately got a repeat pregnancy loss panel. I've had a total of 24 tubes of blood drawn now during assessment. I had an ultrasound in December, another one on my first visit to the RE, and another on Monday. And yet another on Wednesday, along with a sonohysterogram. 

The purpose of this test is to check things out. Because I had a confirmed ectopic pregnancy, and repeat losses (no way to know if most of them were ectopic as I'd not had ultrasounds with most) they needed to verify tubal patency. There's two ways to do this by imaging; sonohysterogram or hysterosalpingography (HSG.) The latter is more complex and so is done if sono doesn't give answers. 

The way this is done is by threading a small catheter into the uterus, inflating a balloon to seal the cervix, and injecting a saline solution which makes the uterine cavity and tubes easier to see on ultrasound (this is a bit simplified, but that's the basics of it.) 

Being who I am, I of course read all about it years ago. I focus on the literature, not anecdotes, so I read UpToDate and whatnot to refresh. They all said it was well tolerated, didn't hurt, quick and easy basically. 

They lied. It did hurt. A lot. I admit to being a bit of a wuss when it comes to this sort of thing, but for frig's sake. The balloon inflating is kind of 'meh, I can handle this.' Then the saline injection was 'holy hell I might kick someone but I can't move and I'm in stirrups and ARGH.'

Also, I have something going on in my uterine cavity - it didn't expand when they injected the fluid, and they tried several times (each quite uncomfortable.) RE said it might possibly explain the ectopic and booked me for a 3D for today. 

The 3D today went a long way towards confirming what I have thought for years: I have scar tissue and adhesions, most likely related to my losses and the placental issues I had with both deliveries. In fact, the RE seemed to suspect highly that the fairly significant complication I had following my first delivery had something to do with it. [I had a retained placental fragment for the better part of two months because the midwives missed it and dismissed my complaints of continued bleeding. I had surgery in March, after delivering my son in January.] I likely have Asherman's syndrome, which is something I've suspected for a long time. I also seem to have what may just be adhesions but may be a septum; it wasn't possible to tell on the 3D. 

The takeaway is this: once this cycle fails (and it probably will - things aren't looking good on that front. Even I could tell how abnormal my uterus looked and I'm only a first year med student) I'll be put on an anti-androgen drug and I'm immediately increasing my anti-hyperglycaemic agent (again, not diabetic, this is normal for women with PCOS) to try to get my PCOS under control to help lose more weight. I'm to avoid pregnancy for a few months since we don't want more losses. I'll have an HSG in March or April to be certain of the diagnosis and then in May I'm going to have a hysteroscopy with adhesiolysis and septoplasty. The chance of a successful pregnancy after this could be from 30-70%, I'm not finding consistent reports, but anyway, the chance is possibly good. But there's also the strong possibility we may just end up having to accept that we may never have a third child. 

If we are eventually successful, my next pregnancy will be considered high risk, it seems. There appears to be a risk of about 10% that a pregnancy following surgical treatment of adhesions will have placenta accreta, and the surgeon told me after I'd had the surgery for RPOC after my son was born that it may have been a case of 'mild' accreta. So I'm thinking that my original suspicion - that after two deliveries complicated by placental issues I'll automatically have a caesarean for my third - is probably correct.

It is vindicating to finally be getting some answers. I finally have some confirmation that not only am I not crazy, I was *right* and even though I wasn't even yet a medical student, I still had a better understanding of my clinical presentation than my doctors did. 

My RE was very surprised I had gone so long without being properly assessed, and he said the Island's health care sounded almost third world. And it kind of is, unfortunately. 

This is my longest post ever on here, I think, and this has a lot of detail, I know, but I think my medical history in this area is an interesting case study. And hopefully I'll have a positive outcome to share eventually. But that's most likely months down the road, if it ever happens. 

At least now I have answers. And a plan. And, finally, hope. 

Friday, 12 February 2016

800

This is my 800th published post. 

I have a number of posts (over 100) which are written but not posted, for a variety of reasons. Some because they're too personal, some because I felt they weren't going to add anything to the blog, some I just never finished and lost interest in. But the fact that I actually have 800 separate posts published online is really quite astounding. 

I started this blog 1,367 days ago, on May 17, 2012. That's nearly four years now. When I started, I'd only just decided to pursue medicine for sure. Since then, I have averaged one post every 41 hours, with my longest break being about ten days.

Four years ago, when I started this, I had no idea how I'd do in university. I did amazingly well.

I had no idea whether we'd be able to afford for me to stay in school. My husband busted his arse to make it happen. 

I didn't know if I would ever be able to get into a medical school. I got into one of the most competitive ones in the country. 

I did know that leaving the Island would be hard, and it was. And is. I did know that I would want to go back, and I do. I did know that I had fantastic kids and an amazing husband, and none of that has changed. 

My earliest posts were sillier, more lighthearted, and I suppose that reflects the more carefree life we lived then. While my husband worked out west and I was a stay at home mom, our lives were fairly simple. It was hard having him away, but that was the only major difficulty. My son had his therapies, which were fairly simply managed. My daughter was a toddler and had few opinions. We lived happily in our little house in the country and spent languid days at the beach and evenings dodging mosquitoes in the woods. 

Life has changed a lot since then. My career consumes an increasing amount of my time, energy, and mental faculties. My kids are so much more grown up and in school full time, and my husband is now the primary caretaker of the home and kids while I am absent so often. 

It's amazing how much has changed. 

At the same time, we are as close as ever. We are still a goofy, silly family that spends a lot of time together. We still love each other fiercely. We still prefer to flop down on the couch, piled together with bowls of popcorn, and watch a silly movie than go out to festivals full of people. Our kids still know they are cherished, but not put on a pedestal, and they are members, not leaders, of this family. 

Our family life is still, at its core, as loving as it ever was. That hasn't changed and I am glad for it. I have changed a lot over the years. While I worry less about where our next meal is coming from, I worry more about the future. 

But we have a bright future ahead, and that is finally a certainty after all the years I spent worrying and wondering and throwing my all into it. 

Eight hundred posts in, and look how far I've come. 

Life is good and getting better. 

Thursday, 11 February 2016

A Touch Overwhelmed

This week is really the first week since I started medical school that I've felt particularly overwhelmed by both life and school at the same time.

The week just started at full tilt and didn't get better. I had to be up really early basically every day and I didn't end up getting enough sleep. My mind just isn't working at its peak efficiency this week. I did horribly in my mOSCE (by my standards) and I didn't know the answer to two simple questions the physician I was shadowing asked me today. Simple, simple stuff that I should have known and I DO know, I just could not, for the life of me, recall at the time.

The shadowing this morning was really fun, though. The physician I was with is a gastroenterologist with a focus on hepatology so I got to see lots of liver pathology today. He was really fantastic about using the patients to teach me about the management of their illnesses; he'd explain things a little more than he might otherwise have done just to ensure that I got as much out of it as possible. He was really a fantastic teacher and it was clear the patients responded well to his demeanour. I'm going to send him a thank you note. Which reminds me, I need to write one to my family med supervisor too.

The purpose of the thank you notes is not to suck up. I am honestly grateful for physicians who take the time to teach me. I'm sure it's quite a drag to have a medical student with them - especially in such a busy clinic as the one I saw today where they're run off their feet.

Teaching the next generation of physicians is a core part of the medical profession, but that doesn't mean it's convenient, easy, or a desirable activity to many physicians and I understand that. So I try to be sufficiently grateful for the time of the physicians who are imparting their time.

That all aside, I'm still just... wiped for today. With all the appointments (stuff we don't have time to get done most days) and the fact that I need to get a whole bunch of stuff sorted out before my husband starts his new job (full time!) next week, I'm just really feeling the strain.

So I'm going to go have a glass of wine and colour in my new anatomy colouring book. Because these totally exist and they are awesome. I bought the Netter's Anatomy Colouring Book.

Haaaand craaaamp. 

Tuesday, 9 February 2016

Onward!

So MF2 is, for me, officially done. Had my final tutorials yesterday, did quite well on the CAE, had my clin skills mOSCE this evening (which I will admit was *not* my best but I'm going on several days of crap sleep so I can live with that) and now I'm done.

Several of my classmates are taking vacations since we're not back until Tuesday.

I am looking forward to reading and doing some writing. This is basically our reading week, more or less, so we're all making the most of it in our own ways.

My son ended up coming to school with me this morning. That was a bit awkward and it's a little ridiculous how that came about.

My husband really suddenly got a working job interview. As in, late yesterday afternoon he dropped off a resume and the place asked him to basically come in today for a trial run. It's an auto glass place, like the last place he worked, and he's been looking for that sort of job again since his current one isn't so great on hours.

Anyway, he had to be there for 9. Now, this is basically an interview so he absolutely couldn't be late. It's downtown so traffic can be difficult, so he figured he'd leave around 8 just to make absolutely sure that he was there on time (allowing for traffic, construction, and finding parking if necessary.)

Problem: while our daughter's bus leaves at 8, our son's doesn't leave until around 8:20-8:25. We can't drop him off at school until 8:30 because of monitoring.

Other problem: I needed to be in ProComp at 9am. If I dropped my son off at 8:30, there'd be no way I could get to ProComp on time when allowing for traffic and parking. We had SPs today so I REALLY didn't want to be late.

So, realizing there was no way we'd be able to get our son to school and my husband and I to where we needed to go, I just let my son attend school with me for a few hours this morning.

I had a monitoring appointment at the clinic at 7am which really needed to be done today, so I had to bring my son with me, which was a bit awkward. Fortunately, I handed him a tablet and he sat down and didn't bother anyone. He couldn't come in the exam room with me (if you don't know why, I'm not telling you) so he just sat peacefully out in the hall. And he was well behaved during procomp.

He got to school a few hours late, but he had a great rest of the day and he enjoyed being a temporary med student. I'm chalking it up to learning experience.

In other news, my appointment went well. Woo! No bad news today, and I have another appointment tomorrow for something that looks decidedly not fun, but it's important to the assessment.

Also, my husband got the job. He starts Tuesday, and our kids will be starting before and after school care then as well.

All told, a very, very good day. Now I'm going to go have a glass of wine and read.

Sunday, 7 February 2016

Endo To Go

Last CAE for Gi and Endo is tomorrow morning. I feel unprepared, but when I actually think about the topics, I'm able to pull reasonable explanations and pathways out of the depths of my brain so I'm pretty sure I'm actually more prepared than I think I am.

Strictly speaking, CAEs aren't supposed to be evaluations. They are supposed to identify areas where we need to flesh out our knowledge, and the take up of the CAE is supposed to be the most important part.

But, because we are medical students and have spent years obsessively stalking every possible mark on anything that could even be marginally considered evaluative, we pretty much all treat them like tests. Tutors usually do as well. Plus there's a spot on our transcripts for CAE performance (it's just one overall score on a 1-5 scale) which means we treat them fairly seriously.

So tomorrow I get to wake up at 6 because I need to be at school by 8. Yup, I need a 2 hour lead time to ensure I'm there on time.

After the CAE, there is a large group session to tie together all of MF2, and then there's a post-MF4 elective information session. Which is good, because I'm getting really worried about my post-MF4 electives. Particularly because I don't have any yet, though I'm on one wait list and two lotteries.

Once those are done, I've got an hour and a bit for lunch and then it's tutorial time!

And then after that, I've got about three hours to chill out and read then it's tutorial time again!

So I won't be seeing my kids tomorrow, since I'll be gone before they're up and home after they get to bed. But that's life as a med student.

Tuesday isn't really going to be much better. I have to go to the clinic for a scan at 7 am (ew) and then I have procomp and then a meeting then my last clinical skills with my current preceptors. And that's it for the week. Woo!

Saturday, 6 February 2016

I'm having a bawl

So.... this aromatase inhibitor I'm on isn't as bad as the ER modulator I took before, but I seem to be constantly on the edge of tears since yesterday. I actually just started crying over nothing. Seriously. I'm reading about calcium homeostasis and I got really, really sad all of a sudden.

To be fair, when I was on the SERM (I'm trying to avoid using specific drug names, even though I have in the past, I'm aware) I was a raging hellbeast for a few weeks. I would swing from irrationally angry to irrationally depressed to bawling my eyes out about chicken commercials. I'd cover that much ground in like five minutes. My husband seriously deserves a medal for putting up with that. He was REALLY relieved when the physician said this drug wouldn't be as bad.

That's true, this one still isn't as bad, but I'm a bit worried for Monday because I have my last CAE for MF2 and if I get frustrated, I can't exclude the possibility that I may end up crying at my desk and that would be really embarrassing.

I have a whole bunch going on this week. I'm taking part in a QI research thing and one of my teammates had an *incredible* idea for what to do and I'm looking forward to taking it on. We're meeting again on Tuesday to work on next steps and on Wednesday I'm doing a final MMI practice session with a med applicant who was fantastic enough to help me prep for my interviews but who unfortunately ended up reapplying this year (but she's totally going to kill her interview this time around!)

Thursday morning I'm shadowing a physician at a GI clinic and I'm really looking forward to that. I haven't done much shadowing or any horizontals so this will be a nice exposure.

Monday and Tuesday are basically full with tutorials and clin skills, and then the rest of the week is dotted with the sort of domestic stuff that tends to consume a lot of time but not a lot of mental power. Appointments, minor repairs, errands like mailing off letters and forms and whatnot. I also am planning to write a fair bit. I am working on a bit of a longer, more article-like piece about how motherhood affects my career trajectory and I want it nicely polished before I send it off.

Related to that, this past week I met with a group of fantastic young woman physicians-in-training and we're forming a Mac branch of the major national medical womens' group and I'm super excited about this. It's about time I really start getting involved.

Between that, the QI research project, and a side project another student and I are working on (which I'm not posting details about until it has solidified more but I'm REALLY EXCITED about it) I'm starting to build up my CV. I'm not, strictly speaking, doing this stuff FOR my CV, but because it's fun. It just happens to have the effect of looking good on my currently pitiful CV.

I am actually starting to worry about building up my CV at this point, though, for a variety of reasons, but that's something I will address in another post.

She is just sitting there, staring at me as I study. 

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Complete sidenote: This is my 796th published post. I've actually written 901, but 105 of them are unpublished since they're more journal-y than blog-y. Hard to believe in a few days I'll be up to eight hundred published posts. I knew I was chatty but that's just ridiculous.

Thursday, 4 February 2016

Checklists

I've been having a harder time keeping organized lately so I downloaded Wunderlist, an app a friend recommended. It's free, and it's exactly what I needed. I'm able to share lists with my husband so we now have a running 'groceries to buy' list, and a common list between the two of us for kid stuff.

Thanks to structuring my day well, I got so much done yesterday. It's incredible how much of the day can be taken up with making phone calls and setting appointments and stuff, but those are things that need to be done.

With MF2 now wrapping up, I have a bit of time for other stuff so next week has a bunch of appointments. Dentist, optometrist, vet... Planning to do some reading for fun as well. I basically have six days off next week because we moved our Thursday tutorial to Monday evening, which basically makes it my reading week. Some people are actually going on trips.

This is the thing with our program; we have to find time off to relax where we can get it, and the first two MF transitions are a good time for that. I don't think it will be the case for MF3 to MF4 or from MF4 to our elective time because the next two foundations are structured to be more intense and they have cases right to the end. And that's okay, it's med school, it's supposed to be intense.

On the note of post MF4 electives, I still have none. I'm on the waitlist for a two week clinical teaching unit elective, and I've put my name in to the emergency department lottery. There's actually very few emerg elective spaces available (6 for 205 students!) so I doubt I'll get it but I can hope.

I'm still waiting to hear back from the lovely woman who was going to try to help me set up an elective back home. Once that's settled, for good or ill, I can see about setting up a rural elective here. I'm actually starting to get a bit stressed because so many students have really interesting looking electives set up already and I don't have any.

Guess I'll put that in my check list...

Tuesday, 2 February 2016

Where I'm At

I did the suture event in the anatomy lab tonight and while I didn't think my sutures were terribly good, apparently they were for someone who hasn't done it before. I suppose having sewed, knitted, and crocheted for many years helps with the comfort level. 

Given that my interest is in rural family, it's likely I'll do emerg too, at least somewhat. That means I might need to do stitches occasionally so it's good that I'm at least getting some practice. I'm not sure if I'm permitted to post the photo of my pig foot, but I'll ask and if I am, I'll post it. It was enjoyable enough, though I certainly still don't see myself having a future as a surgeon. 

It's kind of funny how quickly the list of 'doctor skills' is increasing. I'm halfway decent at physical exam skills, and I like putting together information to come up with a differential - I find that a lot more fun than procedural type stuff (not that I've done much of that yet.) I still feel like I know nothing, but when I look back I can see how my knowledge base has increased. Supposedly that's just sort of the standard state from here out throughout my medical training.

We finally got our MF3 schedules. I'll have two tutors this time around, but an even smaller group; only students. I know one of them and met another at the suture workshop this evening. MF3 looks like it's going to go very quickly, especially with all the personal stuff I have going on to distract me. 

On that front, I'm finally, fiiiinally being seen by an RE. Only took seven years since we first started having issues for me to finally get a proper workup done! I've had a total of 21 tubes of blood taken (18 at one visit!) and I'll have regular blood work while I'm undergoing assessment and treatment. Also have to have frequent - as in up to several times a week - scans to monitor my response to meds. I know the infertility stuff isn't as relevant to the subject of my blog as the med school stuff, but it's part of my life - an important one - and I want to post about it. I think it's also something that doesn't get much exposure so it can't hurt to talk about it, eh? I'll spare the intimate detail though, haha. My RE does the infertility horizontal electives for Mac students so I made a point of asking for no med students. There's just some ways you don't want to get to know your classmates, and I don't want any of them having access to my medical history.

The RE is continuing investigations while we start treatment, so I get to be poked and prodded and scanned six ways from Sunday over the next few weeks while also taking a drug (aromatase inhibitor) which is likely to make me rather emotional. That's probably an understatement. And I get to start that lovely drug tomorrow. Yay. At least I'll be a week off it before MF3 starts. Small mercies. 

And here is a small, very happy, conure being snuggled. 



Monday, 1 February 2016

Adieu, MF2

Okay, not yet, but almost. I have two cases to prep for Thursday, then we set objectives for our last MF2 case which we'll take up Monday afternoon.

Because my tutor is being nice, he's let us move our last MF2 tutorial (CAE take up and final evals) to Monday night, which means we're actually done MF2 more or less after clinical skills on Tuesday.

Our clin skills preceptors are both away this week so we doubled up last week. Next week, Tuesday evening, we're doing a mock OSCE - Objective Structured Clinical Examination - and that's pretty much my last required bit of MF2. There's a large group session by my tutor (the MF3 director) on Friday and then that's all.

This week, though, is pretty busy, even though I don't have clinical skills.

Tomorrow night, I have the suture workshop. I'm super excited about it. As someone who sews, knits, and crochets, I'm used to working with thread and thread-like fibres in a crafting atmosphere, but I've not done suturing. I have no idea how any of those skills might translate, but I hope that some of the dexterity I've learned, and the various knots and casting methods, might come in handy. Hope so anyway; it'd be nice to not be completely incompetent the first time I do something, though I do very much expect I will be.

On that note, I have Point of Care Ultrasound training on the 20th and I am REALLY excited for that. We get to do such cool stuff in med school.

Wednesday night there's a meeting of the Hamilton Branch of the Federation of Medical Women of Canada and I'm looking forward to that. I'm starting to want to network a bit, which isn't something I've been terribly focused on doing yet but I really do need to start. I'm nearing the halfway point of first year, I don't get to use the 'I just started' excuse anymore.

The relentless search for letters is soon going to be on. I need three letters of reference from clinical preceptors and/or med school professors (I'd assume tutors would work) to apply for the family medicine sponsorship program, which I intend to do this fall. I hate the idea of begging letters off people but I do hope to sufficiently impress them so that those who supervise me will want to write me one. I just hate asking for letters; it seems like such an imposition and I don't want to be an annoyance.

But no one ever got anywhere in their career by just waiting meekly by, so I suppose I need to go for it when the time is right, but ugh...