Tuesday, 26 July 2016

Rays

So, radiology is proving fun. Students on elective with one service can basically head over to any of the others to see anything interesting, and I've been doing a bit of that. Two days in and I've seen quite a variety of procedures. 

Because I'm pregnant, no one wants me in the room particularly much when fluoroscopy is in use since they're all concerned M's health and safety. Honestly, I think I'm more comfortable with being around radiation than most would be. Pregnant interventional radiologists continue working and I'm going to have waaaay less exposure in two weeks of  mostly observing from a ways away than they would working throughout a pregnancy at the bedside. If I'm properly shielded and radiation use is being kept as low as reasonably achievable, which is a constant goal, I'm quite comfortable being in the room. I have participated in a short procedure and hope I'll have the chance to do so again.

Just observing is fun, though. At this point in my training, I'm not really able to contribute at all (besides the fact that I always carry pens which is handy) and I know very little procedure-wise so it's not like I'm actually useful to have around. I'm mostly a black hole of time, with the occasionally useful ability to go fetch something, and so I am immensely grateful for the techs, nurses, and physicians who take the time to explain things to me or direct me to the appropriate resources for learning. Everyone is fantastic so far and it's really lovely how welcoming to students they all are. Mostly I'm trying to observe as much as possible and retain as much as I can. I make lists of things to look up later and if I'm unsure what I saw so I need help figuring out where to start, then I ask.

Part of what I'm trying to do on this elective is learn how to be a good team member in the hospital and how to be a good, useful clerk. I'm paying attention to how equipment is handled, who does what, and who to call for which things, because things like this will pay off come clerkship. I may not be intending to pursue radiology, but there's plenty that I can learn from it to take with me through the rest of my training and inti practice. That's true of everything, of course, which is why I'm just trying to learn from all of it. 

At the moment though, I am so insanely exhausted its hard to describe. I haven't had time to recover from the trip yet - we got back Sunday morning and I started my elective Monday - and so my body is making sure I'm reminded of the need for downtime. Fortunately it's a long weekend coming up so I should have time to relax a bit. 

Saturday, 23 July 2016

Mainland

We're on our way to the bridge right now, car packed up and vacation week finished. My daughter was in tears this morning, I don't expect my son is too far behind.  

It's hard to leave the Island. It was hard last year. It will be hard next year. But it'll make our eventual return so much sweeter, I'm sure. 

I've spent a fair bit of this trip thinking about my specialty of choice, because that will essentially decide when or whether we can come home. 

Going into OB is guaranteeing we won't be home for good for at least 7 more years, probably more because OB jobs don't come up often here and you can't exactly just move into town and hang up a shingle as an OB. We could be away for the rest of my career. 

Going into family medicine means it's highly likely we can move home for residency in two years and almost certainly once I'm done residency. 

I enjoy family, I do. I can see myself being happy doing it, always have intended to go into it. But when I walk into a prenatal appointment, discuss gynaecological issues with patients, or assist with deliveries, THAT is definitely the part of medicine I most enjoy. I find pregnancy fascinating and have for a very long time. But as a family doctor on the Island... I'll actually only be allowed to do prenatal care until 32w (low risk only, of course) and with few exceptions the OBs do the deliveries so I won't really have the option of delivering my own patients' babies here like I might as a family doctor somewhere else. This was something new I learned on this trip. 

So I basically have the choice to either do what it is I most enjoy or the certainty that I can come home. 

There are so many factors at play - the longer, more intense residency is certainly a big drawback for OB/Gyn, the fact that I can sign onto the sponsorship agreement next year if I commit to FM, the loan forgiveness if I do rural FM - so I'm glad I have time to decide, and I'm keeping my options open with my electives. 

But as we pass the green and red fields that make up the patchwork landscape of our home and see the sun glinting off the water that has been nature's baptism for generations of my family, it is hard to imagine making any decision that would take us away from here. 



 



Monday, 18 July 2016

Over the Sea and Over the Land

I'm sitting at the small dining table in the cottage, in front of the open window. There's quite a wind blowing in over the water; enough that I'm not completely convinced my Surface is going to stay open throughout my typing this. There's the smell of rain on the air, and at sundown we saw some in the distance so it may hit us soon. My daughter and husband are on the porch, enjoying the breeze, and the bugs, a bit more directly.

The cottage we're at is right on the strait. During the day, we can see the thin smudge of New Brunswick across the way, and the bridge is visible in the distance at low tide. It's just gorgeous here, though. The kids have been enjoying wandering on the sand and splashing in tide pools as well as climbing the berm and getting filthy.

We plan to hit the beach tomorrow. Wednesday and Thursday are looking like they may be storm days, so they'll be spent in the cottage, relaxing, enjoying time together, maybe dancing in the rain a bit, celebrating the clean air and the broad freedom of the sea ahead of us.

I have desperately needed this time to recharge. I have lots of reading to do if we do end up holed up for a couple of days; I need to prepare for my next elective, which starts a week today. I have to call and get my computer access set up for the hospital back in Hamilton as well, and turn in my medical education access badge for here.

There's a lot to do, but I'm prioritizing my downtime. I've got a very long stretch ahead of me - 4 and a half months until my next time off, and then a year from that - and I need to take this time to be present with my family while I can. The next six months in particular are going to be incredibly exhausting because MF5 is intense, I'll be having a baby in that time, and then jumping right into clerkship. It's going to be hard, and I'm going to need to conserve what strength I can.

So for right now, I'm going to enjoy the free, clean, beautiful air that the sea is providing me, and I'm going to breathe deeply and hope it gets me through the trial of the year to come.

Six more days of beautiful rest until I'm back into the race. Best make the most of it.

Climbing because they can. 

Rain off in the distance this evening. 

Wednesday, 13 July 2016

Wrapping Up

Two more days of this elective to go.

I've been enjoying myself immensely, as I've mentioned in my previous notes. I've learned a lot, but I'm really starting to feel the need for a bit of downtime to integrate everything I've learned. Kind of at saturation point, really.

This week I'm also not feeling well which is impacting things. Yesterday I was so lightheaded that it continued even when I laid down. I woke up still feeling extremely fuzzy and rough. The NP at the clinic where I am took my BP and it was fine. I've been making sure I'm drinking a ton of fluids and I'm not doing anything strenuous really, just talking to people, but I feel so weak and my brain is super fuzzy. It's really annoying.

I can tell I'm not doing as well as I would like to on my elective. I'll study something and just not be able to recall as much as I would like. It's 'baby brain' - common phenomenon in pregnancy. You just lose the ability to focus as well as usual. I feel like an idiot a lot of days. While I know some of that is just to be expected when I'm seeing a lot of new stuff, I'm normally exceptionally good with recall so being dulled this way is really frustrating. Not to mention I just do not have time to study enough to get myself the necessary exposure and re-exposure to overcome the difficulty remembering.

Right now, I wake up at 7am. I'm ready and at the clinic for 8:30. Work until 5-ish. Then I usually need to lay down for an hour or two afterwards because I'm so freaking tired. So 7:30 or so I have supper, and then I'm ready for bed at 9:30-10. If I see my son that evening, the couple hours of possible study time are gone, and this isn't even allowing for the (very necessary) downtime.

Reading over and over to cement things in my mind is something I literally do not have enough hours in the day to do right now, and I feel like I'm just not doing as well as I want to because I just can't read enough, I can't recall things I've learned from my foundations well enough. I'm forgetting things that I've known for years when I need to know them most and I'm crossing things over in my mind.

I'm frustrated with myself, really. While I know this is very much a typical part of pregnancy and I did expect it, it's intensely frustrating to not be performing as well as I know I'm able to, but I don't feel able to catch up.

I know I'm going to have to study a ton during my vacation week to make sure Im ready for my next elective.

Just keep reminding myself: I signed up for this. I signed up for this. I wanted this. At least it's not during clerkship!

Wednesday, 6 July 2016

The Family Way

Clinical this week is much as it was last week. I'm learning a massive amount and my supervisor is really dedicated to teaching. She takes a few minutes here and there to actually give me short lessons on disorders we're seeing, normal clinical management of certain things, actual typical presentations vs. textbook presentations, regular monitoring blood work for those on certain meds, etc. The details that are super important but I may not have done in my MFs. A lot of it is stuff that you learn best from clinical exposure. 

I've seen lots of derm complaints and cardiovascular disease, kind of pillars of primary care. I've got lots to learn, still, but I'm finding that I'm getting faster at charting. I still don't write directly in charts; I write a rough draft and let my supervisor read over it and make any additions/subtractions before I write it into the chart. I'm doing a lot more writing by hand than I have done in a while. 

I've got some additional personal learning goals around psych and pharmacology that I am fortunately getting lots of time to pursue. Pharmacology just cross-pollinates with pretty much every encounter, whereas psych is common to many. I know I'll do some in MF5 but I really wanted to ensure that I'be got a working base in psych before clerkship. 

One thing I had thought about, and asked about, doing while I'm here is some horizontals in other services. Paeds, emerg, a couple others. However, I am just way, waaaay too tired. I get back to my friend's house at the end of the day and I am just wiped. I'm in bed by 10 most nights and sleeping until 7am and I am still just exhausted. It's all down to pregnancy, really, particularly since I'm up multiple times a night. 

I'm very glad that I won't be pregnant during clerkship itself because maaaaan I would not be able to cope if I was doing this AND taking call! At least after M is born my husband will take her if I really need sleep. I can't really pass off the baby so that I can get some good rest at the moment. 

Only ten days until my husband and daughter get here. I'm very excited to see them, since I'm really not used to us being apart anymore. This is the longest I've ever gone without seeing my daughter and it's been years since my husband worked away from home. We FaceTime at least every couple of days but it's just not the same. 

While I am enjoying my elective immensely... I don't think I'm going to do many away electives without my family. I just do not like being away, out of our home and routine so much. I know visiting electives are super important for matching, especially since I want to match away from my home school, so I'll have to do some, but I don't think I'll be running off to BC for a month down the line or anything like that. 

It's only 9:30pm but I think I'm for bed. It was a long day.