Monday, 28 March 2016

Optimistically Procrastinating

Despite the fact that I'm actually pregnant right now (I made it to 8 weeks! My latest loss was at 8 weeks 1 day so if I make it to Wednesday still pregnant, I'll be in "I've only made it this far with kids that ended up born" territory) I am finding it surprisingly difficult to study our obstetrics cases. This was unanticipated.

I actually find pregnancy and fertility stuff really fascinating. Have since I was a teenager, actually. That it has proven so applicable to my life has meant it's actually been a fairly high-yield topic when it comes to reading about it. 

But for some reason, my brain absolutely does NOT want to study for my case for tomorrow. 

I think largely because it's yet another stereotype case. While Mac actually goes to a lot of trouble to teach us about matters of privilege, social inequalities, oppression, etc. the teaching cases we get far too often rely on stereotypes. We've so far had teen mothers come up three times; twice in PBL cases, once as an optional scenario. The teen moms are always portrayed as ignorant, uninformed, or as rebellious. Basically, "bad kids" from bad family situations. 

And this bugs me. A lot. 

As a once-upon-a-time teen mom, this really gets to me, and I'm sure there are cases that are representative of stereotypes of other populations that bug other students. This one in particular gets to me personally, though. 

Not all of our cases are like this, but some of them, definitely. And this is a problem because doctors stereotyping people is how important things get missed. It's how Indigenous people get ignored to death in ED waiting rooms because people assume they're drunk instead of sick. It's how pregnant teens get scared off from appropriate care because they're treated like shit. It's how obese people end up with serious diagnoses delayed or missed entirely because no one investigates red flags, just brushes them off and tells the person to lose weight.
Doctors looking at a patient as a 'type' instead of an individual can kill.

I'm not ignorant of the fact that, for instance, lower educational attainment or financial challenges are more common amongst teen mothers. Or that certain marginalized populations are more likely to experience, for instance, incarceration or addictions. But do we really need 'representative' cases that only show negative stereotypes?  How about a 21 year old mom of a 5 year old who is now in university and working full time, or a high-functioning individual dealing with a hidden drug addiction? Or an eating disorder in a male patient that went unnoticed because of his sex. Give us cases that AREN'T stereotypes. 

Challenge our perceptions,  don't just reinforce the stereotypes the media forces down our throats. 

There's my rant for the evening. 

Thursday, 24 March 2016

Yay Visitors!

So we have two interviewees coming to stay with us in two weeks. We aren't having anyone stay for the first interview day and I think that's best because it's next weekend and I'm going to be hosting so I'm going to be tired. 

This long weekend is going to involve cleaning the house in excruciating detail. Basically it's the spring cleaning we really need to do anyway. It'll be interspersed with naps, of course, but it'll be nice to have it done. I need to cycle out the out of season clothes. I think we can get the snow pants and heavy coats and whatnot put away for the season now. 

We need to go over the kids' rooms and take outgrown clothes out of circulation as well. This takes a surprising amount of time, particularly for my daughter. I've found that the mis-sizing of clothing starts pretty young; a 5 in one brand is not equal to a 5 in another so I can't just go through and remove everything under a certain size. This has never really been the case for my son's clothes and it's really annoying. 

I'm basically not planning to do any school work this weekend. That's what Monday is for. Of course, the kids are home Monday (husband isn't) so I'll have to do my work while they're here but my son and I recently went to Michaels and got some new craft supplies so they have plenty to keep them entertained and I can get stuff done. 

Plus now that we're in Obs cases instead of renal, I don't need as much prep time since these are areas I spend a lot of time reading about anyway. 

Tuesday is looking pretty fun. For ProComp we got to select what our groups do. It's supposed to be a wellness experiential day, so my group decided that sleeping in is a great way to increase our wellness. So instead of starting at 9, we're starting at 10:30, and we're going out for brunch on the waterfront. I'm looking forward to it. The sleeping in especially. Sleep is a particular interest these days...

On that note, I'm going to go read for a bit and go to sleep. 

Saturday, 19 March 2016

Mild coma and Things to Look Forward To

I've basically been sleeping every spare moment the last week. School, study, sleep. The 6-10 week period is when I am basically comatose and so I'm just really glad my husband is so supportive and so ready to take on more of the household responsibilities while I sleep. It should be over with soon enough anyway. 

We're starting to very cautiously think about our plans for the fall. I'm due November 7th, two weeks to the day before clerkship starts, and our clerkship stream lottery is in just a few weeks. I plan to try to get a stream that has me on a 'lighter' rotation - call and schedule-wise - right out of the gate, and where I won't have elective time immediately after that. I plan to travel home for as much of my elective time as possible and I would rather not be doing that when Kid 3 is still so new. 

I'm planning to ask to meet with student affairs so that I can get their support in approaching the faculty, which I need to do soonish. 

This coming week is going to be pretty busy. I have a PIE - ProComp exam - on Tuesday morning at 8am. Then we have ProComp from 9-12, then I have clinical skills from 2-5 and tutorial from 5-8. Considering that I have to be up at 6am to ensure I'm at school for an 8am test, and I can currently barely stay awake for longer than 8 hours at a time, Tuesday is going to SUCK. I honestly don't know how I'm going to pull off a 15 hour day (from when I wake up to when I get home and go to sleep.)

We got our MF4 schedules. This is very early considering we only got our MF3 schedules with barely a week's notice. I have another small group, and I know two of my group members at least a bit. Both of my tutors are internists and both of my clinical skills preceptors are PGY2 family medicine so they're just a few months away from practice. That'll be a change from the PGY1 IM, PM&R, Rads, Neuro, and Emerg I've had. I like how we get such a broad exposure to residents and tutors from different fields. 

One thing I'm really looking forward to right now is the MMIs. I'm hosting on April 3rd and speaking as a mature student in the 10th. I really appreciated during my own MMI day that they had a mature student speak to their experience at Mac. It made me feel a lot more welcomed and it has proven true that Mac's flexibility has made my life a lot easier so I want to talk about that. Plus we've got a couple of interviewees coming to stay with us so I feel really involved in this year's MMI experience even though I didn't end up taking part in the video.

The fact that we'll be meeting the potential-2019s soon is really exciting. It's a big milestone, to welcome the class after us as we were welcomed by the one before. When these guys are just finishing up MF1, we'll be entering clerkship and we'll be the ones they come to with questions about what clerkship is like. It's exciting, this passing of the torch. 

I'm really pleased that they let us take such a huge part in the interviews process. I appreciated the 2017s doing it and I hope the 2019s will get as much out of our excitement as well. 

Tuesday, 15 March 2016

Last Prime

Happy Birthday to me!

It's my last prime birthday of my twenties. Also, my last birthday of my twenties. I'm now officially 29 years old.

I got a birthday present. 

That is a definite intrauterine pregnancy (the larger feature you see in the large dark space is the yolk sac. Embryo is the small, more oval structure closer to the 'wall.') Had a heart rate of 107bpm. I have another ultrasound in three weeks and then I transfer to OB care. Yay!

Things are actually going well this time. So I got good news for my birthday. The day actually started off really, really horribly and it was bad enough I missed ProComp but things seemed to settle later in the day. I was okay enough that I was able to go out with my group after our evening tutorial.

But now I am totally wiped and I need to go sleep. I didn't sleep last night and so I'm really, really tired.  

Sunday, 13 March 2016

Mac Life

I'm so glad that the closest thing we have to tests in pre-clerkship is the CAEs. I don't know if I've ever explained what they are.

The point of these is for us to take the information we've gone over in tutorials (and anatomy and LGS) and apply the concepts to a new scenario. We're usually given a few cases and asked questions about the pathophysiology, or the evaluation, anatomy of what's going on, stuff like that. We don't exactly get grades for these (though some tutors do give us actual marks) - we get rated on a 5 point scale of 'not meeting expectations' to 'exceptional.' 

I'm happy with 'meets expectations' because, well, that means I'm meeting their expectations for what a trainee doctor should know at this point. I am okay with being average. I don't expect to be exceptional at everything.

During O week, one of the presenters (I cannot remember her name) put up a bell curve and pointed to the upper tail. She said "To get into medical school, you've all been up here until now." Then she changed slides to where "meets expectations" was written large across the bottom and said "Welcome to the middle, folks! If you get 'meets expectations' that means you're meeting expectations. That's good."

I try to keep this in mind. If I am meeting expectations, that means I am learning what I need to learn. That does not mean I am screwing up my future the way getting a 3/5 would in undergrad. 

Doubtless my class has many students who have a hard time getting out of the premed mentality of achieve at all costs, but, frankly, I like sleeping. I like having a life outside of school. My training is going to demand immense sacrifice from me starting in November, so I'm going to enjoy the relative ease of preclerkship while I can. I study, absolutely I do, but I put limits on the time. I'm not going to spend 4-5 more hours to learn every single receptor in a particular system. It's low-yield information. I need to know major drug targets, yes, but do I actually need to know the name of every single little ion transporter in an organ? Absolutely not. It's not going to alter my understanding of disease processes or my treatment of patients. If I get a patient with some really rare defect in a particular ion channel in the kidney, I'm going to look it up.

You can't know everything in medicine. End of. I'm not going to kill myself trying.

Frankly, at the moment, my body won't allow prolonged periods of study. I actually fall asleep. Like, slump over my tablet, dead to the world asleep if I spend too long lost in the mire of detail. 

Thursday, 10 March 2016

Upcoming Plans

This has been a surprisingly busy week and I'm very much feeling it. I had to withdraw from a thing I was going to attend this evening because I am just totally wiped.

Our tutorial tomorrow has a lot of material to cover, but I'm really glad our next tutorial after that won't be until Tuesday. Our CAE for renal is on Monday and it's a LOT of material to review. I just find renal so difficult to absorb (Sorry. Really bad kidney joke) so it's a lot of going over things again and again. 

Next week is going to be pretty crazy. We have the CAE Monday morning (at 8) and then I have clinical skills that evening on campus so I have all day to kill, though I'll probably go home instead of studying at school. I like midday naps when I have the chance.

Tuesday is my birthday (29th) but unfortunately we're going to have to celebrate it the day after since I won't actually see my kids at all on that day since I won't get home until after they're in bed. Because I have a whole lot of evening stuff lately, this is happening a lot and I feel bad. 

The rest of the week is fairly normal. Repro sessions and whatnot. 

I do have host training, since I'm going to be a host on one of the MMI days. I'm super excited to see the interviewees. The potential class of 2019. It's a lovely milestone along the way towards clerkship. 

Speaking of that; we do our clerkship stream selection in about a month. We do get to pick, I think we rank the different streams in order of preference, but then there's a lottery to make the ultimate decision of what we'll do. Most of the streams start with an elective period, which is good, but I think I want one of the ones that start with an 'easier' (from a schedule point of view) rotations since I'll likely have a newborn at home and be recovering from surgery. 

I may soon have an elective set up at home which I'm really excited about. I may get to work with an actual Island doctor this summer and I'm beyond excited. Once I have this worked out, I'm planning to set up one in the Mac rural region and then hopefully another at the teaching hospitals here. While I'm excited to go home in August, it will mean I'll be there a few weeks without the kids and that'll be hard, but it won't be the last time that I have to go away for an extended period during my training. 

At least this one will have a vacation either at the start or end of it. 

Wednesday, 9 March 2016

Little Surprises

While it's still a little too early to be completely sure, to everyone's surprise, especially my own, it appears that this pregnancy isn't ectopic.

I have another scan next Tuesday, on my birthday, since we should be able to see more.

I'm actually having a bit of a weird time mentally now. I have been bracing for really hard news, and all signs seemed to point that way, but nope. It's not a completely certain thing but it looks entirely possible this may be a viable pregnancy.

It is surprisingly difficult to accept that things may actually work out this time. I think it'll be easier next week if we see the heartbeat; maybe then I can be excited.

It feels like some of the fog around my brain is lifting so I'm going to go study for a while.

Also I promise not all my posts will be pregnancy-related. It's still going to be mostly med school but the last week has been difficult, hence the focus.

Tuesday, 8 March 2016

When Medicine Gets Personal

I (should) find out tomorrow if this pregnancy is viable or not. It probably isn't, and I'm bracing myself for that probability. I am very distracted and having a very difficult time focusing in general and I'm sure my tutors and preceptors have noticed, which is why I have explained to them what is going on. While it's clearly not a secret, given that I've posted about it on my blog which some classmates read, not everyone knows and I haven't volunteered the information to many people who don't already know.

Problem: this Friday we have our first repro cases. Next week's clinical skills is taking an obstetric history. It is extremely likely that I will be recovering from the loss of this pregnancy when I have to cover this material and I'm honestly not sure how I'm going to do it. The end of a pregnancy tends to be a very emotional time (whether it ends via birth or otherwise) because of the wild hormonal fluctuations, so I know I will have an extremely difficult time dealing with these things. How do you dispassionately study the very topic that is causing you extreme distress at that very time?

Thing is, I guarantee that many, probably most, of my classmates have at least one topic that is going to be really hard for them. Whether it's someone who saw a close family member die slowly due to cancer, or someone whose promising sporting career was cut short by a MSK injury, or someone who deals with severe mental illness themselves or in a family member, everyone's going to have something that's hard to learn about objectively.

I'm not alone in that, at least.

I just don't know what I'm going to do if the news is bad tomorrow - and I fully expect it to be - and I have to show up on Friday to discuss reproduction, and then show up after losing a desperately wanted baby, and pretend to pleasantly and professionally take a history from a pregnant woman.

I can push aside a lot of my own thoughts, experiences, and feelings, which is something I need to do as a future doctor, but I think everyone has a breaking point and I'm pretty sure this will be mine.

Friday, 4 March 2016

Important Systems

The kidneys are really, really important.

Objectively, I know this. They are critical to health and when things go wrong with the kidneys, things go wrong everywhere else. Those little bitty beans are incredibly important if you want to keep on living and their activity needs to be considered any time anything else is wrong anywhere else because you need to consider renal function before prescribing pretty much anything.

But the one thing I have definitely learned from this unit is that I am not going into nephrology.

This is the first time I have had to really push myself to learn the material. My brain just does not want to absorb it and I have to go over it multiple times to retain it. It's not that it is particularly difficult compared to anything else we've done, but I just can't seem to focus on it long enough to learn it in the detail I need to.

It also does not help that I am very distracted by non-school stuff, but really, I've always got stuff going on outside of school so I can't really use that.

At the moment, though, I would definitely like a Matrix-style information upload to my brain. The kidneys are going to be the death of me.

Thursday, 3 March 2016

Where Things Shouldn't Be

I'm having a rough few days, honestly. There is a pretty strong chance this is another ectopic pregnancy. I won't know for sure for at least a week or so, though, so I get to live in this really horrible limbo until then. More bloodwork on Saturday but that can only confirm if the pregnancy has ended on its own; a doubling beta doesn't rule out ectopic (around 20% have low hCG that still doubles normally and this happened last time.) It's playing out exactly like the last one did, so I'm pretty much just trying to forget I'm pregnant because I probably won't be in two weeks.

It would be awfully nice if we could just hit a good streak where everything goes as it should for a while, though.

I suppose I can't be too selfish. We're fed and housed and the kids are healthy and happy. I got into medical school on my first try out of my third year of undergrad so good stuff does happen, but that was pretty much the first time things had gone in our favour in a long time. People who have read since before then may recall my "I better get into medical school because it just can't be possible for this much negative stuff to happen to one family" rant.

It's funny, really. Someone recently told me I'm 'strong' for dealing with what I do and I just don't get that. I'm stubborn, yes, but this isn't strength. I have mini-freakouts on a semi-regular basis; I just get it all out at once and then go on until I need to punch pillows again. My pillow is really, really flat. It's not like I can just up and quit school or stop taking care of my kids because life is hard (the house totally does get pushed down the priorities list when things are really rough, though.) Life is always going to be hard sometimes. It's going to be hard for everyone, for different reasons at different times. You get a reprieve now and then, and everyone has different sorts of difficulties, but we all have our demons and we all deal with them in our own ways.

Right now, I'm dealing with my current negative mood by whinging on the internet. If things go well, I'll celebrate, but in the likely event that they don't, well, I'll have preemptively released some of that stress and can just get on with it. After a good cry, a batch of cookies (that I may or may not actually bake - cookie dough is totally therapeutic,) and a few days of moping.