Thursday, 30 June 2016

Week One

This week was fantastic. 

I'm still very, very tired from the trip since I haven't really had a chance to recover yet. I probably should have left Friday so that I could have Sunday to just recharge, but it's not the end of the world. My friend and her family are going to visit family for the long weekend so I'll actually have the house to myself this weekend which will be nice. I plan to sleep a lot. 

Tomorrow (well, today really since it's past midnight here) is Canada Day so I'll be taking my son to the festivities at the major park downtown, which is walking distance from where I'm staying. 

Learning-wise, this week was just amazing. My supervisor is really, really interested in teaching and she's very much up on evidence and remembers drug mechanisms off the top of her head. She's been in practice 3 years now and so she's still familiar enough with being a student that she knows where I'm at. She has a really profound knowledge base which is quite admirable. She makes a lot of opportunities for me to learn new things, including procedures and I'm extremely appreciative. Learning to write a good SOAP note is my big thing right now; as med students tend to do, I write way too much but still manage to miss some critical stuff so that's something I absolutely want to work on during my electives this summer. 

I also have a bit of a personal side project of working on primary care pharmacology and psychiatry because they are areas I do not feel well versed in and I want to develop better understanding. So she set me a project for the weekend: learning about the mechanisms of the various oral agents for diabetes and their applications. 

This is really proving to be a very interesting elective and I'm enjoying it a lot.

While I do feel a bit like an idiot considering how vast and detailed her knowledge base is - and it's stuff a LOT of practicing family doctors I've run into don't seem to know or consider, as in she actually just seems to have a relatively huge knowledge base - I do really enjoy being with patients, talking to them. It's why I can see myself in primary care so much, I really enjoy this aspect. But her practice also involves procedures and hospital work, so it's very varied. 

Very excited to see how the next weeks play out. I'm getting a fair bit of derm exposure so that will come in handy later this summer and throughout my education. I REALLY need to start brushing up on my vascular anatomy though. That's going to be a big one that I'll really need to know for later. 

The clinical stuff is definitely the best part of med school so far. 

Monday, 27 June 2016

Home

I've not taken any pictures since I got here because I've mostly been driving. 

I got sick yesterday. I think there may have been something wrong with the breakfast I had at the hotel because within a couple hours of leaving, I was really, really sick. It is impossible to communicate how much it sucks to need to drive 8.5 hours with gastro. We kept having to stop every 45 minutes or so. My son was getting so frustrated with the delays he was almost in tears, the poor thing. 

By the time we got to the Island I was so dehydrated I needed to go in for IV rehydration since I couldn't drink enough to replenish what I was losing without getting sick. Dehydration while pregnant is... extremely unpleasant and I do not tolerate it well. It can also be quite dangerous as it can trigger contractions. Normally I'd just rehydrate as much as possible at home and suffer through until the gastro blew over, but I didn't feel that was a safe option at 21 weeks pregnant. I felt considerably better after some fluids and IV antiemetic. Still feeling decidedly weak, but I think that's more from the trip than the illness. 

On the off chance I was contagious, I didn't want to stay at my friend's house last night because she has a baby and a four year old and stomach bugs are just horrible for anyone but even more for kids, so I made other arrangements. But because I was in the hospital until the arse end of morning, I couldn't go to where I'd been planning because I didn't want to wake anyone. I ended up sleeping in my car for a bit, which is actually really comfortable and I'll honestly probably do it again in the future if I need to just kip for a few hours while on a trip. 

At the moment, I'm at my favourite little diner having my first real meal since Friday. Saturday was all road snacks that I'd packed in the cooler. I ordered supper at the hotel but barely ate any because I was so tired. Yesterday I only managed a couple bites of beef jerky and some veggie straws. 

I'll be meeting my supervisor, in the building next door, in about a half hour. I met with the fantastic med education coordinator today, as well as a couple of M3s from another school who are here on cores. They seemed nice enough, though we didn't get much opportunity to chat. I'd forgotten that students from the Atlantic schools can do cores in things other than family here. That's fairly new, but I'm glad of it. I talked with the coordinator about doing an emerg elective during my vacation weeks next year, and she seemed to think it shouldn't be too challenging to set up. I'd much rather do an emerg elective here, anyway.

Going to go finish picking at my lunch and hope I stay feeling better. I could really use a proper, solid night's sleep right about now. Maybe tonight. 

Saturday, 25 June 2016

Middle of the Mont

We are currently in a small town in Quebec, resting for the night. We're about 100km past the halfway point of the drive. 

I'm very much looking forward to getting to the Island tomorrow. Unfortunately it won't be early enough in the day to actually do anything. I'll just drop off my son and dog at my parents' house and then head to my friend's house to sleep. I have to be up early Monday; I'm meeting with the medical education coordinator at 8am. I'm not meeting with my supervisor until noon, but I'm sure I'll be busy enough. 

Next week should be nice. Because of Canada Day, I get Friday off so I plan to just do some reading, cook for my friend's family (I need to repay their generosity!) and relax as much as possible. While none of my electives will be extremely physically taxing with call and little sleep or anything, I'm no longer actually used to working a set 40 hour schedule anymore. My weeks vary so much that I usually have time to nap every day at some point, or sleep late often. Preclerkship has spoiled me. That won't be the case this summer and that's going to take some getting used to.

To be honest, though, an 8 hour day in a clinic is so, so much better than an 11 hour day on the road. Ugh. 

I enjoy this trip far, far more as a passenger. 

Thursday, 23 June 2016

The Suboptimal Option

One bright light: Our dog is home. She got picked up by animal control, had a rough night, but is happily home now.

Our plan for now through July was this:
- I fly home for my elective. Stay with my friend. Take the bus back and forth.
- I fly back to Ontario after my elective is done, drive down with family (cheaper than my husband doing the trip over two days.)
- Enjoy a week's vacation.
- Drive back to Ontario together.

Well, things change.

I am now bringing my son with me. It would cost around $800 to fly him down with me. About that to send him down unaccompanied on a separate flight. I'd also need access to a vehicle regularly while there. Its possible I might be able to

Instead, here's the plan:
- I drive down in the SUV with my son (and the dog) over the weekend, splitting it into two days. Will cost about $100 for a motel for the night somewhere in Quebec (mid-way point of the drive.)
- My son (and dog) stays with my parents, along with going to a quieter childcare program most days.
- Husband and Daughter fly out to meet us to enjoy the vacation week (I use the credit from my airfare to buy these tickets.)
- We all drive back to Ontario together.

So I'm going to be driving 17 hours by myself with a kid and dog. While 5 months pregnant.

I'm going to do the drive over two days, booking a place somewhere in Quebec to stay along the way.

This way, I'll have a vehicle while I'm down there. My son will be cared for somewhere that's not going to kick him out (hopefully.) I lose a day's preparation for the trip, but I've asked my husband to take off work tomorrow to help with that.

Not looking forward to that drive. The longest I've driven on my own is 5-6 hours, so I'll be making sure to take frequent breaks, be highly aware of my status, and be ready to stop driving if need be.

Fate doesn't handle temptation well

Never utter the words "well, I think we might be past the worst of it."

We are currently in a logistical quagmire. We're waiting for multiple referrals. 

There are several facts at play:
- I am leaving Sunday for an elective that I cannot cancel or modify. 
- My husband needs to work.
- Our son no longer has after care for when he is done school.
- Son is not currently behaviourally stable enough to cope in a home care or in the summer program (they have fewer accommodations for him than either school-based one.)

Our possibilities, as much as we can manage to figure out are extremely limited and all suboptimal in the extreme. 

I don't know what to do. 

Honestly, there're no good options. We don't know what to do. We're up the creek, we've only got a couple days to figure things out, and I am so stressed out I'm seeing spots. 

People keep saying stuff like "I don't know how you do it!" 

Well right now, I don't know. I've run out of answers. I'm out of energy and time and backups. My house is a mess, I have so much laundry to do to get ready. My husband's incredibly kind and tolerant employers have been so amazing but they have their limits too; we can't abuse their generosity. 

There are no services for this sort of thing. There's nothing between 'admission to psych' and 'waiting weeks or months for services needed to stabilize the kid.' I'm so tired. I want to help him but I don't know how anymore. 

And to top it off, our dog ran away when my daughter left the gate open and we haven't found her.

Cherry on top. 

I can't fix anything these days. 


Tuesday, 21 June 2016

Wrenched

My son had a huge escalation yesterday requiring restraint because he was attempting to run (and I absolutely can't catch him.) I ended up hurt, partly because I overestimated my current capabilities which is a no-no. My back is wrecked right now. I am mostly okay standing, and somewhat okay lying down, but anything in between hurts like the dickens. The fact that my centre of mass has moved further away from my spine is exacerbating the issue. 

These are not good for balance. (20w scan from Monday. Hello alien face person!)

We had long lecture on medical legal issues (the required preparation was 'only' 139 pages) this morning and no real small group, just a bit at the end of the lecture, so I think my brain just hasn't quite turned on yet today. 

Tomorrow morning is the last CAE for MF4. My level of caring is... suboptimal. I think I can do reasonably well, but I don't feel like I have the primary concepts as well as I should so I'm reviewing now. 

I'm all ready to start my elective back home on Monday. It'll be a half day and then I have to do some training at the hospital to get my computer clearance on Tuesday, so it'll be about halfway through the week before I'm really into anything. Making plans for what to do for the downtime. I don't actually know if my supervisor will have call (she didn't mention it, but I plan to clarify) so as of now I'm expecting I'll likely have my evenings and weekends off, which will be nice. 

I'm looking forward to each of my electives for their own reasons. While derm and interventional are not specialties I intend to pursue, derm has applications everywhere and I'll need to learn things for interventional that will carry through in dealing with any patient that may cross over with them, which is a lot. No part of medicine is completely independent of all others so any specialty has things I will use in my future practice. 

But for now, time to study. I'm so tired so I'm just going to focus on major themes and then get to sleep. 

Thursday, 16 June 2016

Checked Out, On Our Way

I can't speak for my entire class, but it seems a fair number of us have just kind of checked out since the OSCE. Tutorials are... much more relaxed. Not that my group has been uptight at all. 

With our vacations mere weeks away (well, some have longer than others until their week off) and nearly ten months of med school behind us, I think most of us are just eager for something different. A change is as good as a rest, after all. Getting into clinical activities for a couple of months is something new and refreshing. We get to go apply that which we have learned on the wards and in clinics. Make use of the knowledge we've gained. 

We have the last CAE on Wednesday, but then immediately after that I'm going to start reviewing my highest yield topics. I'll only have five days until I start my family medicine elective, but I think that gives me enough time to at least cover some pharm (need to remember to pick up the clerk pharmacology handbook from the book store...) and major pathophys for common disorders. I'm going to flip through my psychiatry residency survival guide - all of us are given these booklets - so I have some familiarity with diagnostics for psych stuff even though we don't do that until MF5. I figure I'm going to be in family med, I should probably know more. 

Some people were kind enough to point me towards some interventional radiology resources, so I'm going to get to reading those over the next while, and I need to work on some derm since that's my other elective. I don't want to come in completely clueless, you know? But my knowledge of derm is limited to contact reactions, the ABCDEs of melanoma, a bit of knowledge around acne treatment, the major dangerous drug reactions involving the skin (DRESS, TEN, SJS) and that's pretty much it. Besides things like localized infections and sun protection, stuff anyone should know. 

I'm concerned a bit about my travelling elective, since I'll be in a clinic in an area well known to me. It's the same building my family doctor's office used to be. It houses a walk-in I've attended many times, as have members of my family. My son's old school is a five minute walk from it, and my kids' old daycare is about 1km down the road, and my husband's and my old job just a bit further. I will most likely see people I know. It's unavoidable in a small place like that, I suppose, but I'm curious how it'll work out. 

Monday is my 20 week ultrasound. I'm really, really bummed because my husband can't come - his boss needs him that day, and he's already had to take a lot of time off for family stuff. Ultrasounds make me nervous, because I'm always terrified things will go wrong. This time, I won't have my husband with me if there is bad news. I'm not expecting anything, but I'd still really rather he be there just in case. 

The anticipation of the ultrasound has meant the last few days have dragged a lot, but I know once it's over the next week is going to fly by and I'll be flying home without my family. 

I'm looking forward to that and dreading it in equal measure. 

Monday, 13 June 2016

Five Very Short Months Away

I think I'm mentally checking out because of all the planning I have to do. 

There's a series of learning events during the transition to clerkship week which cover certain clinical skills (potentially) needed during clerkship that we don't cover during the general clinical skills curriculum. Things like IV insertion, intubation, casting, suturing, and others I don't know about yet (I really need to remember to email.)

Being that I'll be a matter of a couple of weeks postpartum, I'm likely going to be excused from this skills rotation, but on the condition that I've previously covered these skills on my own. I've done some suturing (of pigs feet, not people) and I wasn't half bad at it. I've done a lot of sewing over the years, so I think that might contribute. That one's easy enough to pick up, anyway. Intubation, casting, and IV insertion are more challenging skills. 

I'm thinking I might buy a practice kit for IV insertion, which will at least solve one problem. If I can find a latex-free one, anyway. 

I've signed up for a skills workshop for Friday which will hopefully cover some of these, but there's a lottery so I may not get to attend. Plus there's the possibility that my son may need to be picked up after school this week (long story) so if that ends up being the case, I will have to pass even if I do get a space. I doubt they'd be thrilled with a 9 year old tagging along. 

Now, I've done lots of papier maché over the years, but I doubt that's going to translate to good casting skills. This is a hard one to figure out. Outside of an actual workshop, I don't think it's really possible to truly practice the skill on my own with a trainer or something. 

When it comes to learning these skills, an emerg horizontal is out as a possibility. I'm dealing with a pretty frustrating tendency to nearly pass out (or actually pass out) when I stand too long. A 12 hour emerg shift is going to leave me on the floor at some point, and I'm sure a supervisor would rather not have me end up there as a patient during a shift because I pushed myself too hard. 

Bit nervous about my clinical electives coming up because of this, to be honest. I didn't book anything terribly physically intensive because I knew this was a possibility (it was a problem both of the other times I made it to the second trimester, too) but there will still be a fair bit of standing and walking around that I'll need to cope with. 

I have no idea how I'm going to make sure I've covered all of these skills in time. I'll eventually figure it out, but the time has really come when I need to put energy into actually getting it figured out. 

That, plus my clerkship electives, and how I'll manage preclerkship in the immediate postpartum period, and what specialty I want to go into, and if I'll apply to the family med sponsorship program.

Oh, and I still need to study for my OSCE. Which is on Tuesday.

And write my RPP. 

Still less stress than undergrad, though. 

Friday, 10 June 2016

Upcoming OSCE

Tuesday is our first OSCE.

I should be panicking. I'm not, but I probably should be. Lots of my class seems to be pretty seriously studying for it. Personally, I'm considering a nap.

Somewhat conveniently, my Monday tutorial was cancelled and we're doubling up for Thursday, so I have more free time than anticipated to actually do some studying before Tuesday.

We do have one thing that we all have to do by Tuesday: our RPPs. This is the 'reflective physician portfolio.' It's a writing assignment, to reflect on our experiences as students so far and our shifting identities and whatnot. We have to do one per Foundation, and the MF4 one is due on Tuesday. I don't find these particularly taxing, considering they're shorter than my average blog posts, but it's another thing I can't forget to do. It's not like we really have much in the way of actual submitted work that we're required to do, though.

It feels like I am checking out a bit, the closer I get to post-MF4 electives, and I think a lot of my classmates are experiencing the same thing. It's exciting to be switching to something different for a couple of months (not to mention the vacation week...) after 10 months of classroom based education.

Of course, it also signals the end of the easy part of our training. It's not that preclerkship is ridiculously easy or anything, but compared to undergrad, I certainly found it a lot less stressful. Particularly since I'm not working. I have had more time to myself, more flexibility in my schedule, and less urgency around reading massive amounts of material than I did in undergrad or that I likely would have had at any other med school. I think this is something that varies widely school to school, but I can definitely say that Mac's preclerkship curriculum has been a high point of my education.

MF5, though, is apparently extremely busy and stressful, with a ton of material to learn, and I'm going to be doing it while heavily pregnant and then with a newborn. I'm going to be exhausted beyond reason, and then after that we move into clerkship. Sure, there's only 4 weeks of clerkship until we get a 2 week break, but again: I'm going to have a newborn at home during this period and I'll be recovering from childbirth (which has not historically been an easy time for me.)

So, really, I'm in the last couple of weeks of the longest laid-back period I've been able to enjoy during my adulthood, and I probably won't have another prolonged period in my life with so few demands on me until I retire. So it's a bit sad to realize that I'm saying goodbye to this wonderful part of my training.

With an OSCE ahead, another CAE to write in a couple of weeks, several more tutorials to go, and plenty of studying to do... I'm going to take a nap. Because I want to enjoy every possible chance for them while I can.

Monday, 6 June 2016

Homeward

I leave for the Island in less than three weeks and while I'm very excited about going home and seeing my friends - I'm staying with friends while I'm there - and enjoying the Island air, I am a bit nervous about being away from my family for three weeks, and about not having a car (the Island's public transit is... rudimentary.)

I've never been away that long before. My husband has been, since he worked out west and would be gone a couple months at a time, but my kids have never had me be away for several weeks at a time. It makes me a bit nervous that while this is the first, it may not be the last. Because of the possibility that I may end up at very distant sites for core rotations, which is something I have no control over, and because I'll be doing other electives away, I will spend more long weeks away from my kids and husband over the course of my education.

I'm not at all nervous about my husband handling things; I know he can without a problem. But it's going to be emotionally difficult for me, I know it. It's also going to be hard for the kids for me to be there while they're stuck here, considering how much they want to go home. Just last night my daughter was up until nearly 10, terribly upset, crying about how much she hates it here, how she hates her school and the city, and how she wants to go back home. Rips my heart out to see her so upset and to not be able to do anything about it. My son's counting down to when we leave for our trip home.

After my elective is over, I'm flying back to Ontario so that I can help my husband with the drive. It was only $250 more for me to get a two way ticket than a one-way and it ends up cost neutral because we'll have one less night on the Island and my husband won't have to get a motel overnight in Quebec to split the drive into two days (with both of us, we can do it in one shot by taking shifts.) Logistically, it'd be a HUGE pain for him to drive two kids and the dog 17 hours on his own. So we lose a night on the Island, but we save a lot of headaches.

My flight back is early morning the day after my elective is over. I'll get back to the house, spend the day packing, filling the cooler with food to eat on the way, doing last minute tidy-ups, meeting with the pet sitter [sluckettg - I took your recommendation and I've been in contact with them] all while my husband sleeps. Late evening, my husband will get up, we'll get the car loaded, and set off.

Starting the drive at night is done for a bunch of reasons. The deer in Ontario aren't too bad, but we don't want to be going through rural Quebec or New Brunswick at night or during the evening or early dawn. We'll hit Montreal around dawn, stop for breakfast, I'll take over so my husband can sleep a few hours, and it'll be well into the daylight hours before we hit the worst deer/moose areas. We expect to arrive on the Island around supper time.

I've done this drive, from different parts of Ontario, many times as either a passenger or a driver. It's a bit of a rite of passage for my kids; their first summer drive home. While it's intensely boring to be a kid stuck in the back of the car for that long, there are parts of the trip that I always came to look forward to. Seeing the patchwork tapestry that makes up rural Canada, learning the curves in the highway, the different types of forest you pass through. Those long, wide expanses in Quebec where the horizon is broken by distant hills. The most magical bit is those last few kilometres as you approach the bridge, which still feels new after almost twenty years, when you can smell the strait and the earth turns red, and the marshes are briny, there's nothing that compares to that feeling of homecoming. When you crest the bridge and can finally see that little strip of rusty earth coming closer, just barely above the caress of the Atlantic waves, it's home. It's a feeling I can't describe, but I hope to share it with my children this year.

Friday, 3 June 2016

Exhaustion setting in

This is going to be an incredibly long summer.

Today is essentially my day off, so I slept in. Until 10am. Lounged around, read a bit for tutorial, shopped online a bit since my son needs some new summer clothes. I planned to go grocery shopping and do a thorough clean of the kitchen. Hah, nope. Just after 2 I went upstairs to get my phone, laid down on my bed for a minute to read email and fell asleep until 5. It's now just after 11 and I am absolutely exhausted and getting ready for bed. 

I've only been awake for a total of 10 hours today and I haven't actually done anything even remotely strenuous.

My weekend plans mostly involve house stuff and review for the OSCE. My clin skills this last week was a mOSCE and I am not at all happy with my performance - I totally blanked on one thing - and so I'm planning to spend quite a bit of time reviewing. The OSCE is on the 14th. I'm a bit worried about it. To be honest. I've been having trouble standing for long periods (I start getting very dizzy) and I'll need to be standing for around 90 minutes for the OSCE. I don't want to make a fuss by emailing the faculty and asking for them to place chairs in my circuit for me, but I also don't want to pass out on them and cause an even bigger fuss. I really hate inconveniencing people but I feel like I'll have to. 

I'm actually having some issues with the pregnancy and was in emerg this week as a result, so my first appointment with my OB was just moved up by two and a half weeks. I'm seeing him Tuesday. He has great reviews and I've heard lovely stuff about him through the grapevine so I'm looking forward to it. It'll be interesting anyway. There's two issues at hand, really. One is relating to a possible pregnancy complication that's been causing some issues. One is the fact that my elective ultrasound last weekend saw something that needs some more looking into (not dangerous but definitely in need of clarification) but they couldn't do it since it was a non-medical place. 

Overall, it's been a tiring week so it's no surprise I'm so exhausted. I leave for the Island three weeks from tomorrow to start my first post-MF4 elective and I am really, really looking forward to it! Three weeks in family med. That's going to be awesome. Provided I can make it through the day without a nap by that point.