Friday, 29 April 2016

Small Updates

Small person update: all is well. Definitely human looking now and wiggly. Was not very cooperative with the scan but eventually it was possible to get the NT measurement which was 1.2mm, so no increase in my risk. :)

Baby was measuring well. 68.5mm CRL which is average at 13+0 (I'm 12+4 today, so within range.) It's still difficult to believe that things are actually working out this time. 


Thursday, 28 April 2016

Specialty Considerations

Now that my clerkship stream is set, it's time to really start thinking about what I want to get out of it.

I came into medicine knowing that my primary interest was family medicine, with some interest in obstetrics and emerg.

Family is and always has been my central interest. The variety, the fact that you see patients at all stages of life, the long term relationships, the flexibility, mobility (at least initially), and ability to personalize my practice are all really appealing features. I can do +1s in other areas of interest, though some are terribly competitive. It's what I sort of see as my default choice, unless something else draws me more. There are no major drawbacks to family, really, besides the fact that it can become a bit monotonous according to some I've spoken to, but I think that rural FM and urban FM might vary considerably there.

Emerg is something that's fallen away a bit. The lack of follow-up would likely be something that would frustrate me a lot. I like to see things through. It certainly appeals to my enjoyment of thinking on my feet and making quick decisions, and the huge variation in stuff they might see and have to do in a day is appealing. The pace is something I think I might either love or hate, depending how much sleep I got. I don't have a history of liking shift work.

OB/Gyn is one I though I might originally drift away from but I'm actually leaning more strongly towards. I've been fascinated by childbearing since my teens and that's really intensified since getting into med school. It's never been something that only interested me when having my own babies. While I really don't anticipate loving surgery, OB/Gyn isn't, as far as I know, one of those specialties that usually ends up with day-long surgeries, though I could perhaps see that happening in gyn-onc. There is a lot of room to vary your practice. After talking to an OB/Gyn she explained how she transitioned from primarily delivering babies to eventually focusing on gynaecological oncology surgery and now does that almost exclusively. I could focus in fertility or high risk obstetrics or other areas. There is the ability to vary your focus and customize your practice. There's a bit less mobility with this than there would be for family or emerg, but the field is by far not saturated and, well, people are always going to be having babies. Apparently the reputation about the lifestyle isn't really that accurate nowadays, though it still is more intense than family or emerg would likely be. Especially during residency.

A five year residency (emerg or OB) would be a lot to ask of my family. I'd be a trainee until my son is 16. With my and my husband's combined income, we'll still have a very good family income during residency so it's not like we'll be bad off. I wouldn't be able to train at home - they only have FM residency on the Island - and it's entirely likely that we wouldn't even end up back in the Maritimes for residency. OB and emerg are both fairly difficult residencies to get into, the latter moreso than the former.

It's a difficult decision. I'm fortunate to have time to think about it all and thanks to the stream I'm in, I'll explore each of these areas quite a lot by the time CARMS apps come around. I'm fortunate there.

Plus, there's always the possibility I'll completely fall in love with something else. Who knows?

Time for bed, though. I have my NT scan in the morning.

Wednesday, 27 April 2016

Calm down, Kay

So my little freak out last week is a bit embarrassing now. I think I was getting swept up in the general panic of my classmates.

I got Dark Blue, my first choice. 

Problems solved. 

So this is my schedule for the last half of med school (number of weeks are in brackets.)

Starting November 21, 2016...

Electives (4)
Vacation (2)
OB/Gyn (6)
Electives (6)
Anaesthesia (2)
Selective (2)
Orthopaedics (2)
Medicine (6)
Emerg (4)
Elective (2)
Vacation (2)
Surgery (6)
Family (6)
Paeds (6) - CARMS apps are during this time
Vacation (3)
Electives (6)
Psych (6) Ends March 30, 2018.

That's followed by six weeks of CIR - Concept Integration and Review which is basically review for our licensing exams. Then we graduate in May. 

Six weeks of anything is a very brief time and passes quickly, so having those last sixteen months broken up into 2-6 week blocks is going to make the time go very quickly, I'm sure.

Besides that first four weeks of elective time, which for me is going to be academic electives instead of clinical since I'll still be recovering from delivery, my other elective blocks are spaced nicely. 

I am reconsidering whether I should do academic electives for that entire four week block. I may do a one week reading elective and then three weeks of some lower intensity, maybe laboratory-based clinical elective. Something with no call. If I deliver, say, October 24th (that's 38w for me. I delivered my second at 37+6 spontaneously so this isn't outside the realm of possibility for a scheduled delivery) I'll be a month postpartum once I'm done my reading elective and I think I'll probably be able to tolerate sitting and a bit of walking around a lab or office, so long as I'm not running around and standing all day. I'll likely ask around and try to figure out what I can do.

As it is right now, thanks to my advisor I've got some fantastic leads on post-MF4 electives (I may be doing radiology, which will come in handy no matter what specialty I end up doing, and possibly derm, which will also have some really useful skills) and I hope to have these sorted out soon so I know what I'm doing this summer. 

Things are starting to come together. Now I just need to get this PRIME QI Project done. 

Tuesday, 26 April 2016

Meltdown

My son hasn't been very prone to meltdowns for a long time. He still has them now and then, but the big blow-up, knock-down, clear-the-room meltdowns haven't been a regular occurrence since he went on antipsychotics. They still happen, just not daily like they used to. They started getting further apart once he went on medication. They went down to once a week, then once a month, and since about age 6 he's averaged about one per year until this year. He's had two since we moved.

Yesterday was one. 

Kicking, flailing, required restraint, screaming and hollering loud enough we worried the neighbours would call the police. We very seriously considered the psych emerg. 

He's big now. Largely due to the antipsychotics, he weighs nearly 100lbs. He's 4'9". I have adult friends barely bigger than him and he has the strength of a grown man when he gets worked up. A physically violent meltdown in a kid his size is a wildly different event than in a 35lb four year old. 

I'm only 12 weeks pregnant. It's not that dangerous for me to handle a meltdown right now, but soon enough it will be. When I was 25w pregnant with my daughter, he hurt me badly enough that it triggered regular contractions and I got put on bedrest. He wasn't even 4 yet.

He does so well a lot of the time that the autism is a sidenote, more or less. We are so used to the small adaptations to him being autistic that have just become part of our lives - advance warning of changes, being mindful of things like ambient noise, sticking to schedules as much as possible, not drawing attention to sensory-seeking, dealing with some ongoing self-care issues  - that it isn't really a front-and-centre part of our lives. He just is himself, he needs parenting a slightly different way, and that's that.

Then days like today happen, and we remember how different our lives really are.

Eventually he calmed down and went on to have a good day at school, but it did leave me thinking a lot. Hopefully it will be a very long time before we see another one. We have a referral in to see a paediatric neurologist to discuss his medication, and this is one of the things I'll mention.

It's left me rather pensive since yesterday. How we need to adjust our crisis planning as he gets older. Because while the meltdowns are definitely, and thankfully, much more rare an occurrence, they are much more dangerous when they do occur. 

Thursday, 21 April 2016

Swept Away - Stream Chaos

There are 8 major clerkship streams. For Hamilton campus students, each of these has two slightly different versions, but the order of pretty much all the cores is the same. We are required to rank all of the streams.

Now, I'm interested primarily in family, OB/Gyn (leaning more that way, to be honest), or emerg. Of the three, emerg is not as high a priority as the others.

Here's factors that all of us need to consider:
- Many programs require that you do your core before you do an elective in that discipline
- It's important to do electives in your specialty(ies) of choice before CARMS
- It's good to not be too much of an idiot in your cores if that's an area of interest (so try not to do it too early)
- You may need certain letters from certain cores to apply to certain programs

So, basically, when selecting my stream, I have to already decide what I want to do for residency.

Here's a breakdown of how the streams work out for me:

Grey: 
- Starts with 4w electives, then 6 family and then 4w electives. There are only 2 weeks of electives (total) before CARMS but after OB/Gyn and Emerg. But besides that, it's probably not too bad. This is my #2 choice from a career standpoint.
Orange: 
- Starts with 4W electives and then 6w psychiatry which wouldn't be too bad. But OB/Gyn core is after CARMS. Pre-CARMS electives are before all three fields that interest me. Family is dead last. This one is career suicide.
Dark Blue: 
- Starts with 4W electives then 6w OB/Gyn then a 6 week elective block. Emerg is followed by 2 weeks electives (pre-CARMS) and Family is the last before CARMS so I'd have the chance to have a strong showing and get a good letter. This is my #1 choice.
Green: 
Starts with 4W electives, then paediatrics. OB/Gyn and Family follow and, later on, there's 6 weeks of elective time pre-CARMS. Only problem is emerg is at the end, but that's the one I'm prioritizing least. From a career standpoint, this is #3.
Yellow: 
- Family and OB/Gyn are right before CARMS with no elective time after them until the very end. Elective time is all after Med/Paeds/Psych so really limits what I can do.
Pink: 
- No pre-CARMS elective time after any of my areas of interest. This is the surgery gunner stream.
Light blue: 
- Starts with 4 weeks of emerg. Has some elective time after emerg. OB/Gyn and Family are also pre-carms but no elective time after them until after CARMS. From a career standpoint, it's probably my #4.
Red: 
- All the elective time is up front except for 2-4 weeks after emerg. Family core is post-CARMS. No elective time after OB/Gyn. Has a reputation: "red is dead."

Basically, from a career standpoint, I need dark blue, light blue, grey, or green.

BUT I can't do light blue, green or grey. 

Light blue starts with 4 weeks of emerg. I'll be 2-4 weeks out from a c-section. I absolutely can't do emerg shifts at that point. It'd be dangerous for my health.

Green and Grey have the same problem: I'd be caring for sick (potentially very sick and infectious) children during the height of cold and flu season. I may encounter children with influenza, with RSV, with rotavirus, and I could potentially end up bringing those home to my too-small-to-be-vaccinated baby. While I will obviously encounter sick people in other streams, kids in particular are more likely to harbour and transmit the infections that would be most dangerous for me to bring home at that point.

Pink and yellow are suboptimal because I'd be 2 months postpartum and doing surgery or medicine, both very intense rotations where students don't get time to pee let alone go every 3-4 hours to pump, which I'll need time to do. Accommodating my needs during those rotations will likely seriously compromise my learning.

Orange is just not a good choice with my career plans at all; I would not be able to do any of my areas of interest before applying to CARMS.

Really, my only option that doesn't compromise my career or my infant's safety is dark blue. It also happens to be one of the most popular streams and so there's a pretty low chance I'll get it.

I have been trying to meet with the faculty to discuss this and see if they might possibly consider guaranteeing me a stream as an accommodation. I shouldn't have to commit career suicide to avoid compromising my own (or my child's) health and safety, but it looks like I may end up having to make some very difficult choices.

Unless I get dark blue, either my health, my infant's health, or my career are in jeopardy.

(rant about how frustrated I am with this and the fact that I hadn't been able to secure a meeting to discuss accommodations with the faculty.)

Of course immediately after I ranted, I got a meeting for Tuesday. So hopefully we can work things out.

Sure, universe, make a jerk out of me.

Sunday, 17 April 2016

Face-value criticism

I've twice had people in a position of evaluating me comment on something now so I'm paying a lot of attention to it.

When I am deep in thought, I scowl. My husband will often come across me in the middle of an assignment and ask what has pissed me off. It's not something I think about, it's just sort of an automatic thing. I frown and I start visualizing connections between topics. I have a little mental whiteboard so sometimes I'm reading off of it or using it to map out ideas. Probably not the best way to explain that, but oh well.

I guess it's a variant of that really stupid, but accurately named, "resting bitch-face." Thinking-cranky-face?

I'm sure you can see the problem with the fact that when someone says something that sparks off a whole train of thought, I look (apparently) angry. It's because I'm actually mentally writing a list of questions to research later (since a lot of the time I come up with a bunch of side questions that would totally take a session off track) or I'm trying to reevaluate an experience I had and figure out why it doesn't fit with what I've just learned. 

People evaluating me have thought that I was disagreeing with what they said, or being defensive of my own knowledge (I'm really not. I'll defend my opinion if I have a very good reason to disagree and it's an appropriate time to do so, which I think is reasonable, but I fully understand at this point that I have far less knowledge than the people teaching me.) Apparently because I've also somehow ended up with this reputation of having a lot of clinical skills knowledge, me looking think-y can throw off classmates if they think I'm indicating that they are doing something wrong or can shake their confidence. 

So going into MF4, I'm making it a big personal goal to tackle this cranky face issue, because it will really suck if patients think I'm scowling at them. 

At least my evaluators brought this up with me. I don't really think of it so having it called to my attention about the impact in a clinical setting is important. The only problem is that instead of focusing on my learning, I'm going to be focusing on my expression, at least until I get this handled. 

In the end, at the very least, my husband won't think that every time he sees me studying that I'm plotting the downfall of my textbooks.


Wednesday, 13 April 2016

Many Colours

MF3 is done as of tomorrow evening for me. Friday and this weekend are pure relaxation before we dive into MF4.

I'm now working on setting up the rest of my post-MF4 electives. I have three weeks set up back home so I need to find 4 weeks, preferably here, in things that I can do while 6 months pregnant.

Beyond that, I have to figure out clerkship pretty much now. Our stream lottery is in two weeks and we have to rank our stream choices (they're colour coded) now. After the lottery, we get one week to switch with other students but if we can't switch or don't choose to, our rotation is locked in and that's what we're stuck with for 16 months.

There are a few major considerations we all have:
- Many specialties require that you have demonstrated an interest (eg. done an elective) in that specialty to be considered for it.
- To do an elective in a particular specialty, you usually (but not always) need to have finished your core rotation in that specialty first.
- The way our program is structured, you can end up in a stream that has a core in a specialty you want after CARMS.  Traditional schools usually have most or all of their cores before CARMS. Eveyrone in my class will have at least one core rotation after we submit our residency applications.

I have three major interests: family, obstetrics, and emerg. Only three of the streams don't put one (or more) of these after residency applications. Only one of them has elective time that falls after all of them but before residency applications. Of course that moves it to very high up in my consideration.

But I have additional considerations:
- I'm starting clerkship with a newborn at home. I can't do anything intensive right away.
- I also can't start with paeds (or probably family, since same issue) because that'll be during cold/flu/RSV season and my baby will not have even his/her first course of vaccines yet. I don't want to bring anything home that could seriously harm my infant.
- I will be pumping so need a specialty that is going to be more adaptable to me having to take off every 3-4 hours.
- I can't end up hours away from home at one of the distant teaching sites when my baby is very young as I will be nursing. Pumping 24h a day Monday to Friday for 6 weeks is far, far inferior to actually nursing in the evenings/overnight while pumping during the day.

So this complicates things. If I can get grey or dark blue stream, I'll probably be okay. I'd be doing OB/Gyn while I have a two month old at home, but I'll be much less likely to be around infectious children than I would in paeds or family, and I'd imagine they'll probably be pretty supportive of pumping.

We'll see how this all plays out. It's certainly challenging. I may request from the faculty if it is possible to receive a set rotation as an accommodation for my situation (I'm requesting accommodations around pumping and site selection as well, though I don't know what they will allow yet. I never ask for accommodations for family stuff but I think it is reasonable in this case.)

Hard to believe we're at this point already. Setting our clerkship schedules. Planning out the rest of our training.

Hard to believe by the time all this comes to fruition, we'll be a family of five.

Wow.

Sunday, 10 April 2016

Interview Wrap

So the interviews have wrapped for another year, the premeds are off home to dream about receiving offers, and everything gets back to normal for us. 

This is our last week of MF3. CAE is on Wednesday and I do have quite a bit of prep I want to do for that. Monday and Tuesday are pretty full; we have our mandatory clerkship lottery info session tomorrow, then I have clerkship in the afternoon. mOSCE style. I don't think I'm sufficiently prepared for it, but I do have some review time tomorrow and Tuesday. 

The massive exhaustion I've dealt with for the last month and a bit is starting to lift. I'm not a complete zombie during the day anymore, and that's helpful. I might start being able to get through the day without a nap soon enough and I expect my productivity will shoot through the roof once I've reached that point. Maybe I'll actually be able to eat normally soon enough. While I'm on a drug that is helping with the morning sickness, it doesn't completely eliminate it. I'm still only able to eat a couple smaller meals per day without making myself sick and so I'm not eating enough (I've lost a total of 13lbs and I'm now losing at a rate of about a pound every 3-4 days.) While some weight loss isn't a big deal, particularly since I have plenty of extra to start with, it's probably not a great idea to let it continue accelerating so I should probably take some steps to minimize it. 

I would like to note my consternation with the fact that it seems like the only time I lose weight easily is when I'm not supposed to. Some days, I imagine the universe laughing heartily at me. 

All that aside, it's time to hit the books and then get to bed because I actually have to attend lecture tomorrow. Mandatory lectures. Ugh.

Thursday, 7 April 2016

Summer Progress

I got confirmation that I have an elective back home for three weeks in July! I'll follow that with my week off and my husband and kids will drive down to meet me and we'll rent a cottage for the week before heading back to Hamilton.

So I'll be spending almost a month back home and I'm super excited. It'll be hard to be away from my kids and husband for three weeks, though and I have to figure out some stuff around my prenatal care. I'll be away from 21w until 25w and apparently my OB won't see me until around 22w so I'm not sure if I'll see him before I leave or after I get back. I have to have my 20w scan before I leave, obviously. 

Quite honestly, at the moment I don't know who is following me officially. It seems to be my RE still (I'll be seeing him for my IPS results and whatnot) but I don't have regular appointments with him anymore. My family doctor hasn't indicated he wants regular appointments either. I should probably clarify this, really. I don't know who is starting the antenatal records for me either. 

Not really that big a deal. I can monitor my own BP, I have all my reqs for blood work and stuff. I will be seen in-office, just not every 4 weeks precisely. Besides the initial blood work (which I'm going to do tomorrow) and my IPS and anatomy scan, all of which are taken care of, there's not really that much to do until much later on anyway. If I have a concern that comes up, I can always drop in to my family doctor.

What I need to do now is schedule my other electives. I need to confirm for sure the dates of my elective back home then I'm going to request some others. Obviously I have to be careful what I'm going to be doing; I usually have some limitations in later pregnancy and I don't want to risk pushing myself too far. While it's pretty common for medical students to put their needs completely on the back burner, I simply don't have that option. During clinical electives, 14+ hour days are pretty common and I know I just will not be able to cope with that while 6 months pregnant. I have an appointment next week with Student Affairs so we'll see how this goes. 

Obviously I don't plan to turn this into a baby blog, but I do want to talk about the challenges of managing the demands of medical school and being pregnant (and, eventually, having a baby during med) because it's something other students may go through and I figure I may as well be honest about it. 

Also, had an ultrasound yesterday and all is well. I was measuring 9w1d which is in line with my known dates. My due date remains November 7th. Baby was fine, heart rate of 160, and looking decidedly human-shaped now. Next scan will be the NT (11+0 to 13+6 - usually done in week 13 here) and we'll tell the kids after that. 

Little wave.


Monday, 4 April 2016

Places, places!

I didn't end up hosting today (I suppose it was yesterday now since it's now almost 1am) but I did get to participate in the interviews anyway. I had trained as a standby actor and someone was unable to make it so I got pulled from hosting. 

Obviously I'm not allowed to talk about the performance of the candidates or the scenario at all and I fully intend to respect that confidentiality agreement to the letter. But what I can say of it is that my experience of it was super fun! It's been a long time since I acted and I had a lot of fun just being able to do something different for a bit. It was a great way to be involved in the process and I'd certainly suggest it to anyone who would like to participate in the future. 
 
There is a boatload of work that goes into preparing the MMIs and I cannot commend the wonderful people of the admissions office enough for their ability to keep things moving smoothly. A year out from my own interview and I remain awed at their nearly supernatural organizational ability. 

It takes immense work to interview 550 people, to keep the actors, assessors, hosts, tour guides, speakers, and so on in order, at the right place at the right time. Organizing food, allowing for all the different possible dietary restrictions, it's just a LOT of work. To have things go seamlessly, as my interview day did (and today, as far as I know, but I was on the other side so I can't tell) is amazing. 

I'm speaking next Sunday about my experience as a mature student and so I am looking forward to finally seeing the admissions video!

Such an exciting and nerve wracking time for all these applicants. I'm so excited for them, their futures ahead. They'll know in just a few weeks and hopefully next year they will see how much work went into getting them there.