Tuesday, 17 October 2017

Un

Miss M turned one today.

Birthdays aren't a huge thing in my family. Typically we go out for a meal (birthday person's choice - for some reason we've developed a bit of a tradition where it's always East Side Mario's) have cake and a few presents at home.

Even though we don't really do birthday parties or anything, something about the first birthday is special for me. It's the point of transition from infant to toddler and it means that this small person has been part of the family for one of every holiday.

M is definitely a toddler now. She walks, she talks, she has an attitude. She plays jokes and likes to help out and climbs on everything. She speaks in sentences occasionally. Right now one of her favourite words is "Guys!" When she's excited and trying to get everyone's attention to show us something, or when she's trying to find us.

She has probably twenty words already, plus a couple signs. Honestly, she's been the easiest baby and I hope will be an easy toddler. She's obviously going to be an energetic one, that's for sure.

It's really nice being on my family med rotation and having so much time with my kids. Given, I'm also in the midst of CaRMS applications so I do have less time than I would otherwise, but still, I'm finding balance.

I've actually really been enjoying that about this rotation. The family docs all seem so focused on lifestyle, wellbeing, and self-care. It's quite different from the "rest is for the weak" attitude of some specialties.

I went out for a walk over my (hour and a half) lunch today. On a glorious autumn day, I had time for a leisurely meal and a nice stroll. I could have had a nap.

This is awesome.

The resident I was working with today had the afternoon off because she's working an evening clinic.

It's just all so humane. I'm wondering if this is specific to the program or if this is a common family med residency thing. If so, sign me the hell up.

I'm home in the evenings to spend time with my family. I'm waking up at 7:30am, well-rested, and going into work during daytime hours, and I am leaving during daytime hours. At the practice where I am, I am getting to do procedures, and seeing a huge variety.

I've seen several examples now of really fantastic family practices, and I do think I will be able to find my own niche.

My husband is right; it's best for our family for me to do family med. But beyond that, I think it will be really good for me too.

I made an awesome cake. It was really, really good.

Want some cake?

Friday, 13 October 2017

This Ten

Last night, my son tearfully asked me if I can be done school sooner.

He expressed that he misses me and that he feels like he doesn't get any time with me anymore.

That's hard to hear. He's aware that my career is important for our family's future. He expressed that. But at the same time he's a ten year old boy with some pretty high needs, and he needs his parents.

He and I have always been close. My son is a smaller, slightly more autistic, male version of me personality-wise. We have lots of long, rambling conversations about the world and about interesting scientific concepts and anything else that crosses our minds. He approaches me with questions about world events and uses me as a sounding board for his opinions about important topics. He does not tend to shy away from being painfully honest with me.

While he clearly loves his dad and enjoys spending time with him too, and I dearly love and have special and unique relationships with my other children, I think my son and I have a certain type of bond just because we are so similar.

So hearing him tell me how hard my schedule is on him was a big deal.

I talked to him about how I planned to do family medicine now, partly because I want to make the choice that's best for the family and partly because I think it's the right choice for me. He asked if I'd be okay not doing surgery and I told him that I'd be fine because what matters to me most isn't my job, it's my family.

He was also very happy about the possibility we may go home next year.

I thanked him for being honest with me, as I try to do any time he has shared something with me that was difficult for him to say.

Really, I am very glad he told me about how he is feeling. We made some plans to spend some one-on-one time together in the coming days and weeks, and I'm going to keep him in the loop with what's going on with my residency applications.

Everything seems to be falling into place to support my decision to go for family. It's nice to feel a bit of the stress drop away.

Tuesday, 10 October 2017

My Island

Have you ever seen Braveheart?

There's a rather amusing character named Stephen, an Irishman (ironically played by one of the few actual Scottish actors involved in that movie, as most of the Scots were played by Irishmen) He refers repeatedly to Ireland as "my island."

I often refer to my home the same way. My peaceful Island. My beautiful Island. My little place in the world.

I want to go home. We all do. My children speak daily of when we go home. It is simply an accepted fact that we will never stay away for long. We have lived here over two years and still my children do not see this city as their home, only a short detour before we head back to where we really belong.

Life here is different. It is louder. There are so many more people. We are a family full of introverts who are all exhausted by spending large amounts of time in the company of large quantities of people. Living in heavily populated areas is simply not our natural milieu.

The city has some of the same spirit of the Island in that it has fallen on hard times and is working to pick itself up. It has a long history it is proud of, and there are many lovely historical locations. But the sense of community does not exist, not the way it does back home.

Soon after we moved here, my husband was in a drive through and someone knocked at his window. After slowing down his heart rate, my husband rolled down the window. The gentleman introduced himself as another Islander and had been moved to say hello after seeing our Island license plates.

That man had lived in Hamilton for fifty years, and he was still from the Island.

No matter how long I live elsewhere in this country, I'll still head to that little strip of red clay to go home. I'll still hang an Island flag in my home, and still keep that little glass vial of red sand on my desk. I am sitting here this evening attempting to write my personal statements and yet again am struggling to start with anything besides I want to go home.

I want to talk about how Dal's family medicine program emphasizes the flexibility required of a rural family doctor.

I want to talk about how the modifiability of a family medical practice is well-suited to my broad interests.

I want to talk about how I've had people asking me to be their family doctor since before I even started medical school because I understand what it is like to be a patient.

I want to talk about the man who thanked me at Walmart for treating he and his wife like people during her recent hospital visit.

I want to talk about how I have seen people rejected by family physicians who don't feel capable of taking them on, and how my curiousity about their complexity makes me a good fit for them.

I want to talk about how I was afraid of obstetricians and almost made a fatal choice when pregnant with my second. How having access to a family doctor who does deliveries might have made the experience so much less traumatic than it all was.

I want to talk about the young trans* patient who came out to me in between sobs when he asked about my rainbow watch band and I explained why I wear it.

But it all comes back to me wanting to go home. I want to help my community. I want to serve the people who share that Island. I want to be able to show up and help, and add another pair of shoulders to help support the burden of that ailing health system. I want to sit down in my office and hear my patients speak in the country lilt and the Scots-influenced burr that hides in the Island voice.



Saturday, 7 October 2017

Gowns

I had my graduation photos a week and a half ago.

It was hot and muggy. I had to park at the hospital and walk to the student centre, so while I had treated, dried, brushed, sprayed and otherwise negotiated with my hair to attempt to get it to listen to me, within the first ten steps out of the blissfully climate controlled building, my hair had gone rogue.

They photoshop the photos. That made me feel better. Those flyaways don't deserve the immortality of my grad photos.

They also did CaRMS headshots and those did not turn out terribly flattering, but I think I finally have to acknowledge that cameras do not have it in for me, and I probably really do look like that. Dammit.

It's a bit surreal that my grad photos are now done. I keep having moments where I realize how fast this is all going. I'm months away from finishing medical school.

It's freaking October. Thanksgiving is on Monday.

Match Day is less than five months away.

And I've finally decided what I'm going to be when I'm a grown-up-doctor.

For months I've been going back and forth and agonizing over what to do with my career. I love OB/Gyn and know that I'd be happy with going that direction career-wise, but I also know that it would mean five more years of trying to balance family life and intense medical training. Lots of OB/Gyn residents start their families during training, but it's different from having school-aged children with additional needs and lots of appointments.

Beyond that, I sat down and had a good long talk with my husband. He has never expressed a preference about what specialty I should choose. Everything has been "Whatever you want, it's your career, I'll support you in anything you choose." Because my husband is wonderful and supportive.

But I think after the 6 weeks of me being on surgery he got a taste of what the five years of an OB residency would be like. I don't think he really got it when I was on my OB rotation that an OB residency would be years of me being that tired, that checked out from family life.

I think he clued in while I was on surgery and coming home at the end of the day to study and sleep before going straight back to the hospital. He has now expressed that he would prefer that I go into family med.

Hearing him say it took a huge weight off my shoulders.

I've been essentially trying to decide on my own with incomplete information. Now that I have that piece - my husband's preference - that has helped tip the balance. This is a decision that affects the whole family, it should involve the whole family.



Tuesday, 3 October 2017

Unique

I'm trying to write my personal statements.

It isn't going well.

I'm supposed to sell myself. I'm supposed to tell the programs why they should choose me instead of other people. I need to tell them why I'm unique.

But I can't mention my kids. So says almost everyone.

On paper, I'm not that impressive.

I haven't been on a ton of committees, or contributed in a meaningful way to the program. I don't even have a bachelors.

People constantly tell me how impressed they are with what I'm doing and how hard I work. Barely a day goes by that I don't hear someone tell me how they have no idea how I'm doing all this. I've been told that people see me as "an inspiration" and that others admire my work ethic. I don't write this to brag because honestly, I just live my life and get on with things and I do not see it as a special thing, but it is literally the only thing about me as a medical student that makes me unique.

There's no way for me to communicate how hard a worker I am in my statements without mentioning my family. As well, having had kids is a huge reason for my interest in OB/Gyn. I've been there. I know what a huge difference having a good OB makes.

Having a son with additional needs and experiencing the frustration and helplessness that comes with wanting to make things better for him and the rest of our family is a big part of why I think I'd be an incredible family doctor if I go that route.

I can talk about loving my Island and wanting to go home to the beach and help serve my community. I can talk about wanting to have work-life balance while I improve my field through my efforts. But that doesn't make me a good candidate for a residency program.

I keep coming back to mentioning my kids; talking about how they push me to want me to be better, to work harder, to keep my priorities straight. I want to talk about how I already have had to learn strategies for work-family balance because this is my life. I am already there.

Do I really want to match to a program that would see my children as a huge liability, that has a culture that is not family friendly? How well received will it be when I need to ask for time off for appointments for my kids, or have to take a phone call during clinic?

I love medicine. I am so glad in so many ways that I have had the opportunity to study medicine and I am very excited about the next step in my career. But I don't want to have to hide this huge part of who I am to do so.

Tuesday, 26 September 2017

Messes

My son has had a very rough start to the school year and we are basically dealing with a cluster...fuss of epic proportions.

This happens every year. Every year. Then at holiday transition periods and before the summer break. He's in grade 5 now. You'd think we'd have figured out how to avoid these periods of trouble but so far no, and it seems that every year that passes these events get worse. I don't think he can handle a full time school schedule, but cutting down to part time isn't feasible at the moment. Pretty sure once I start residency next year my husband is going to need to drop down to part time at the most and partly homeschool him.

On the note of residency, I've made my long list of programs I'm seriously considering applying to. It contains over twenty programs, counting the different sites as individual programs, across eight schools. Seven are OB, two are emerg, one is family plus emerg, and the rest are family. I think I've got a good mix, and some really fantastic-looking programs on my list.

CaRMS is consuming a very large amount of my thinking right now. It's such a huge step in my career, but it's also a huge decision for my family life. I'm choosing the type of career I'll have, the type of life we'll live, the type of call my kids will have to put up with that pulls me away from their important events. I'm choosing how many holidays I'm going to work, how many days I'll return home exhausted. I'm choosing where we'll likely live and how long we'll be even further away from the Island and how many more years I'll have less control over my ability to schedule important meetings and things for these tiny people my husband and I created.

It's not just my specialty I'm choosing and so it's just not so easy as deciding what I like the most.

This process feels disturbingly like putting on the Sorting Hat.


Friday, 22 September 2017

Early Morning Wrap

The faculty, in the interests of mental wellness, randomly gave us a four day weekend. Being an idiot, I had traded my 'baby call' (off at 11pm) on the night before the oral exam for all night call for last night, so my wellness weekend didn't start until about 7:30 this morning. It was a PA day for the older kids, so my husband took one to work and the other curled up on the couch with me and watched movies while I had a short nap. Then we went out for lunch and did some window shopping.


My plan for this weekend involves mostly working on my personal statements and CV because I basically haven't before now and the weeks between now and when CaRMS closes are going to go very quickly.

The surgery rotation was just so damn tiring I couldn't get much done. It felt like I could never catch up on my sleep even on the (few) off days I had. I had great teams and learned a lot on this rotation, but maaaaaan I'm tired. I have no idea how the surgical residents do that for five years. I was waking up at 4:45-5:30 depending when we'd start rounding, and then I was usually at work until 6-ish. I'd come home and see the kids for maybe an hour if I was lucky, then study for a few hours and then go to sleep.

There was almost no time for actually living my life on this rotation. It was enjoyable subject matter, the staff I worked with were fantastic, and the senior residents very kind and helpful. There was none of that stereotypical toxic atmosphere of surgery; it was actually a really supportive, learning-focused environment. The one drawback was the hours.

I've really missed my kids. They have missed me too. This is the first time that I've really been hearing them complain about my working hours. Every other rotation they've managed just fine, but this time around I was just so tired and so busy with studying that they saw very little of me and it has clearly affected them.

For the next six weeks, I'm on family med in a clinic that goes from 9-5. I don't know what I'm going to do with myself for the three hours I'll be awake before work until I get used to not waking up automatically at 6am in a panic thinking I'm late to work.







Sunday, 17 September 2017

Eleventy Letters

Miss M is eleven months old today. She now walks, and has some rather forceful opinions. She's very much a small toddler these days. It's hard to believe we're only a month out from her birthday already. This has been one incredible year, in both bad and good ways.

The 2019s are about to start clerkship themselves, and I'm looking forward to seeing the junior clerks around the hospitals. I won't see them until January, though, since I'm going to be away for a month for paeds.

I've gotten approval to do an elective over the December holiday to make up some time, if I can secure an elective in a service that works normal hours over that period. Which is pretty much only emerg, not that I mind since I actually really enjoy emerg. I don't think I'm going to apply to the 5 year program, though I'm tempted to since I think I'd do well in that field. I've not really worked long enough with a single staff to really justify having one write me a letter, though, so the option is pretty much off the table anyway.

The whole business of asking for letters is just... ugh. I know I'm a strong student, most of the time, and most staff I've worked with have expressed very strongly positive feedback but I still hate asking. Some students ask staff on almost every rotation they do if they'll write them a letter. That's definitely not me.

I realize that writing letters is just part of the job for doctors who take on learners. But it still feels like I'm asking them to go above and beyond for me, asking them to give up some of their limited time to further my career, and I will generally go to pretty significant lengths to avoid bothering people to do something for me.

Funny enough, I have absolutely no problem advocating for my patients or asking the nurses to do things for them. I have zero anxiety around that sort of stuff. Or for my kids; totally no problem asking people to do things they need. But when it comes to asking someone to take time out of their day to write a letter for me, it feels so awful and awkward considering I'm basically asking them to sit down and write about how great I am.

Soon enough this part of it will be over with, though. We're already halfway through September, and the applications process closes in November.

Then I get to gleefully ignore CaRMS until mid-January when the interview circuit starts and I get to experience a whole different set of anxieties.

At least I'm not interested in Internal. Those poor people have to do this process twice.

Wednesday, 13 September 2017

Clerking

Clerkship is kicking my rear.

I just feel like I'm never fully on top of everything. There's always paperwork I need to do, that's on the brink of being overdue (or occasionally is overdue, which is very unlike me.) I'm often getting things done at the last minute which, again, I also do not like. I much prefer chipping away at things over time, but I'm just having a really hard time finding my stride with managing the administrative part of med school on top of the clinical learning. I'm usually so good at having a dozen balls in the air and keeping them all going; the fact that I'm not keeping on things as well as I like to is bothering me a lot and I plan to use my upcoming wellness weekend to revisit my organization methods and improve.

My current rotation, aside from the fact that the hours are awful, is actually going really well. I feel like I'm getting to the point where I'm a little more comfortable operating semi-independently with some safety buffering. Of course that's the whole point of medical education; gradual increase in responsibility, with oversight gradually pulled back until you're ready for independence.

A consult that used to take me a couple hours now takes me 30-45 minutes. I'm not needing to look things up as often because my knowledge base is definitely considerably broader than it was even a couple of months ago. It'll be really interesting to see what my next PPI score is.

This evening, as I study for my surgery oral exam, I'm reflecting on this journey overall so far, and feeling pensive about what's ahead.

As I sit here taking a break from studying - six and a half hours before I need to wake up for the day to get to work - I am wondering if I would recommend this career path to my kids if they asked.

Honestly, the answer is still yes. I wonder if that will change by the end of residency.

I'm only a few months out from the end of medical school. This whole match process is going to blow by and then we'll be preparing for our exams before we know it, but there's still a long road ahead and I'm cautiously looking forward to it.

Been listening to this tonight, thinking about where I want to end up.



Thursday, 7 September 2017

Opening Day

CaRMS opened yesterday. I registered as soon as possible.

Now I'm comparing programs and deciding where to actually finally apply.

I think I'm going to apply to both family and OB as well as the FM+EM integrated program. I love OB and gynae. I love the OR. But I also enjoy treating children, and I think seeing families through the transition to parenthood would be really fulfilling. I also think I'd enjoy having an element of emerg as an option, though I don't think I want to do the 5 year emerg.

Ultimately, I'm going to have to give up some things I enjoy no matter what I end up in. Family definitely keeps more doors open, which is why I'll likely rank it highest, but I also want to apply to OB because I already know that I love that field..

Location is probably going to be a bigger deciding factor for me than speciality.  I'd rather be in the Maritimes for family than in Ontario for OB, but it's a very small margin.

But, of course, I may change my mind on that in two weeks. I'll be driving myself up the wall with this right up to the moment I submit my rank order list.

Right now, I just have to get my application ready. I need to write my personal letters and I just have no idea where to even begin with that. I have a four day weekend coming up (the faculty randomly gave us four days off as a "wellness weekend") and plan to spend the bulk of it working on my CV and personal letters.

I've written probably half a million words in this blog about my journey to medicine, but writing a short piece about myself as a professional is going to be extremely difficult.

Two months to put this all together doesn't feel like enough. At least I'm on family med for the bulk of it, so I'll have pretty reasonable hours and evenings and weekends to work on my application.

Hard to believe CaRMS is here already. In less than six months, it'll all be decided one way or another.



Friday, 1 September 2017

Almost Downs

For the second time ever, I almost passed out in the OR last week.

It wasn't a great day, but it has really helped clarify something that's become undeniably obvious.

Much as I love surgery, I'm just not cut out for full days of being a primary responsible surgeon. I also don't think I can handle a five year residency where the bulk of it includes waking up at stupid o'clock. It's something I keep going around and around, but it's kind of reached the point where I am staring down the barrel of CaRMS and trying to decide what the rest of my life is going to look like.

For one, I do not want to be a resident for more years than I have to be. For many reasons. The inescapably crappy hours for many years is a big deal to me. I'm having a hard enough time coping with the lack of sleep and lack of family time in clerkship. I miss my kids. Three extra years of barely seeing me is a big deal. This is something that physicians who did not have kids prior to residency can't understand. It's one thing to have kids in residency and then be busy for a few years when your kids are little and won't remember it. It's something totally different when they're about to go through the hormonal nuclear war of puberty and adolescence, when they need their parents arguably more than infants and toddlers do.

There's also the fact that I have a deep hatred of being pimped. Being very socially anxious, there are few settings as uncomfortable to me. I have no problem with OSCEs or MMIs or oral exams, or patients asking me lots of questions, but specifically being pimped in a group is extremely uncomfortable for me and I just want to crawl out of my skin or be swallowed up by the ground or pull the fire alarm and Zoidberg my way out of the room going 'whoopwhoopwhoopwhooopwhooopwhoop.' I am entirely and completely comfortable being asked questions about my patients, about cases, about my thought process around my impressions and plans, and what I'd do if X happened, things like that. But I hate being asked what the 6th most common cancer in (oddly selected subpopulation) was in 2002.

I get that it's a common way of attempting to quickly assess students' knowledge, and I'm sure there are some students who find it helpful, but I do not. While I will always want to learn more, and will absolutely spend the rest of my career constantly expanding my knowledgebase, I definitely do not want to be a resident longer than I absolutely need to.

I'm finding as CaRMS approaches, a lot more of my classmates, like me, are leaning far more heavily towards family. I know several other students who, despite having been very strongly in favour of pursuing one particular specialty, are now saying family. We're looking around at all these specialties we've been interested in and admitting that as much as we may enjoy those particular fields, length of training, lifestyle, autonomy, and flexibility are not minor considerations (which is precisely what everyone has been telling all of us for years.)

I love reproductive health and intrapartum care. It will definitely be a big part of my practice no matter what I do. I'll also likely do some surgical assisting because I do enjoy the OR so much.

But I am tired. I have been a student for a long time, and I don't think I have the energy to run another marathon right now, and residency is a marathon. A five year long marathon.

I have a feeling that no matter which way I go, there are some things I'll miss having as part of my practice. There is no perfect solution that gives me absolutely everything I want out of a medical career, but at the same time I can maximize my career and family life and I can make it to the other end of residency not completely exhausted, so that's important too.

Monday, 21 August 2017

...are you sure?

We all went out for supper this evening since today is my husband's and my eleventh wedding anniversary.

At the restaurant, someone complimented us on our kids' behaviour. Said she was surprised by how well the baby was doing and that the other kids were so well behaved.

I was tempted to ask if she was sure she was referring to my kids....

We do actually try to teach our children restaurant manners, and if they misbehave in a restaurant we remove them. Part of parenting is reasonably preventing your child from annoying other people. Sometimes, this is unavoidable no matter how desperately hard you're trying. (Consider plane travel.) But it's terribly nice when you get feedback that things you're doing are working. If you see a family with kids who are behaving well, tell them. Seriously awesome compliment to get.

In unrelated, and panic-inducing, news, CaRMS opens in two weeks.

I'm so not ready for this. I still haven't decided for sure what I want to do. I may ultimately rank my programs based on location rather than family vs. OB/Gyn. I don't think I'll be applying to anything else, and honestly location of studies has been as major a consideration for me as which specialty.

I came back from the Island a week ago with a plan to do family med with a focus on women's health.

Then I started my current rotation (surgery) and realized all over again how much I love being in the
OR.

This keeps happening. I go home, and I realize how desperately I want to go home to finish my schooling and how much need there is for family doctors, so I decide I'll do that. Then I walk into an OR and realize I don't want to give that up.

I can't have both.

It's not that I fall in love with every specialty I do; I actually do have particular interests and it's not all 'this is awesome, I should do this.' I really liked emerg, briefly considered it, and think I'd probably really enjoy doing it, but I don't absolutely love it to the point that I'm willing to do the schedule gymnastics necessary to match to it at this point in my training.

Ultimately, it'll be out of my hands which specialty I match to since it comes down to the CaRMS algorithm, but I'll still have to decide which one I want *more* since I've got to rank them.

Six months is not enough time for this. I've spent the last two years being wishy-washy about what path to pursue and I've talked to tons of people and I'm no further ahead in my decision making. It changes week to week.

No matter what happens, though, I think my kids will be okay. They seem to be doing well, based on how supper tonight went.

I'll just need to remind myself of this the next time I'm breaking up the tenth bicker-fest in an hour.

Thursday, 10 August 2017

By the Sea

We're currently staying in a little home near the water on the south side of the Island.

I've been enjoying my emerg elective a lot, but having a bit more exposure to it, I've decided that while I like emerg well enough, and I enjoy the pace of it, I'm not sure I necessarily want to apply to the five year program.

I like dealing with undifferentiated patients and all, but I still find myself immediately gravitating towards patients coming in with lacerations I can suture, people for whom I can use bedside ultrasound in my evaluation, or obstetric or gynae complaints.

So basically, I really want my practice to focus on women's health, and I want to do procedures.

The question then becomes: OB/Gyn or family med with a focus? Basically, I'm back where I was a year ago.

I had a completely chance meeting here when I encountered one of the PGY1s in the Island family med program. She knows two FM PGY2s who are planning to manage their pregnant patients' deliveries as part of their practice here.

Bingo.

Seems like there might be a setting here for me to have a call group of family doctors who offer obstetric care. When I've spoken to people, it seems like there really is space for a doctor who has a focus on women's and infant's health but isn't an OB. It might be a bit challenging to get started (I'm sure there'd be a bit of "why send my patient to you when I could send them to an actual specialist?") but my intent would be mostly to focus on routine reproductive health, sexual health, initial management of things like POP and SUI/UI, and maybe take some of the burden off the OB/gynae group by managing some of the lower acuity stuff.

The beauty of this is that I could come home to do my residency next year.

Being home is very bittersweet. It's hard for me to look at that red sand just across the field from me and think about taking a career path that would prevent me from coming home. My kids love being here. Even my dog loves it here. The winters are, frankly, awful, but the summers make it all worth it.

Wouldn't the end of June next year be a lovely time to move home?


Monday, 31 July 2017

Pathways

CaRMS applications are a very short time away, and my decisions around my specialty choice are consuming a lot of my thinking power, as one might expect.

I'm pulled in a bunch of directions. My major considerations are:

- Women's health is my major area of interest
- I also like higher-acuity stuff
- Love procedures/working with my hands, bedside ultrasound, adore surgery
- Really enjoy working in the hospital;
- Would rather not be a resident until I'm nearing 40
- I also enjoy working with kids (surprised myself)
- My large joints (including shoulders) are getting bad fast and my small joint mobility is starting to be impacted
- Would like to be able to go home to work
- My family is getting tired of me being a student

So I've got three ways I am considering going:

1. OB/Gyn
- Love all of it. A lot. Love surgery, womens' health, tending women through the lifespan for reproductive concerns. Lots of procedural stuff, bedside ultrasound.
- Assisting in vaginal surgery will be extraordinarily difficult, bordering impossible for me. I simply can't be bent sideways for hours at a time. There is no way around having to do this, though.
- Very intense residency. Very intense practice lifestyle with regular call.
- Very rare for jobs to come up back home, but there's lots of OR time for OBs if they want it (supposedly)
- I most likely won't be doing much early pregnancy care since OBs usually don't (this is an area of interest) and will generally only do the 6 week postpartum visit; won't do much with breastfeeding concerns, won't take care of the infant(s) at all once born
- Very competitive residency to get into

2. Emerg
- High acuity. Lots of procedures, suturing, bedside ultrasound, interpreting imaging and applying to clinical findings (really enjoy this)
- Lots of variety, including some womens' health
- Incredibly challenging residency to get into and I'll have only two electives in it so chances are crap
- Good lifestyle once in practice; shift work, which I like. No call.
- It is physically intense. There are very few older emerg docs, I've noticed. My mobility is getting worse by the year - will I be able to do it in 15 years?
- Hard to know how likely it would be I could come home. Not many 5 year EM docs here.

3. Family
- Can focus on women's health if I want to. including doing deliveries.
- May not be able to do deliveries if I go home. There's just 1 family doctor on the whole Island who delivers their own patients
- Very minor procedures in-office. No surgery, unless I decide to do some assisting.
- To have even a chance of doing deliveries, either need to have no life, or need to find a call group of other FMs who do deliveries (again; hard to do here)
- Could do FM+EM as well. But probably can't do that plus FM+OB, since I'd spread myself too thin to keep my skills optimal
- Mostly outpatient, clinic setting, long-term followup. Low acuity. Definitely not my favourite.
- Can finish training back home.
- Can manage a better lifestyle. Can tailor my practice more as my mobility becomes increasingly worse

All things taken together, on paper FM looks like the best option, but I honestly really prefer practicing in-hospital and I found I really liked the more episodic nature of care for OB  and EM ('episodic' might be a stretch to describe a pregnancy, but it's a self-limited timeframe.) I'm not sure I really crave the longer term nature of family med the way I thought I would.

It'd be nice to be sort of a secondary FM, I suppose. Something between family doctors and OB/Gyns where patients can self-refer, not take years to get in for stuff, and can have one team follow them through pregnancy start to finish, and care for their baby too. I'm just not sure how feasible that is, or if I'd enter practice, end up with a full roster of routine FM patients and never get to tailor my practice as much as I would like.

It's hard to decide, and I only have so long to figure it all out. CaRMS opens in five weeks and the application process is going to fly by, I'm sure.




Sunday, 30 July 2017

Fantastic

You can tell my mood is improved because I used the word 'fantastic' four times in my last post alone.

I promise, I do have a generally good vocabulary, but it was just one of those days.

Miss M and I arrived on the Island early this morning - 1am - so I can start my emergency medicine elective here. The trip wasn't too bad, to be honest. I upgraded to business class (it wasn't that expensive after accounting for not needing to pay to check my bag) which made a huge difference. The extra space was really important for the baby. as was the fact that we could use the business class lounge before our flight. It was really nice to be somewhere quieter with really nice facilities. It made for a much more peaceful start to the journey.

People were very kind and helpful at the airport and on the flight. I had the baby, tiny folding stroller, my carry on bag, and the diaper bag so my hands were a little full, but many people jumped to our aid, holding doors, taking a bag, or even entertaining the baby. My seat neighbour took M for a while to play with her, as did the lady behind me, and the flight attendant. She was pretty happy throughout the flight so people enjoyed getting to play with a cute baby for a bit, and I enjoyed the break.

Yes, I do let strangers hold my baby. For one, we were on a plane, so it's not like they could run off with her. Two, most people are generally good, and just want to help, and I was grateful. She enjoyed it too, and it's important for her to socialize.

My parents had left my vehicle at the airport parking so after getting my luggage, we just hopped in and drove to my friend's place. Yesteday was the Pride parade and then my friend was out late anyway so it wasn't disrupting her to crash there for a few hours, but if I'd gone straight to where my kids are I'd have spooked the dogs and woken up everyone.

After being reunited with my kids, we went out and grabbed some essentials that I'd decided to buy here instead of travelling with, and then went out for ice cream. They're all comfortably in bed, and I'm just doing some paperwork and stuff before settling in.

It's wonderful to be back in the salt air and the bright sun of my Island. I never feel quite right unless I'm here.

We let Miss M have her first ever Cows ice cream (well, sorbet actually) which is a bit of a rite of passage for my kiddos.

Damn it's good to be home. It'll just be that much better when my husband gets here.

 

Monday, 24 July 2017

Priorities

I'm currently on a family medicine elective that I'd booked at the recommendation of my 'clerk 2 clerk' mentor. The clinic I'm at is really fantastic; there's a really close working relationship between the physicians and allied health. Everything flows together very smoothly. It's actually a really fantastic model of how a practice can run.

The physicians have really fantastic relationships with their patients. The patients rave about the care they get. It's really quite probably one of the best examples of a family med practice I've seen. It's what a former family doctor of mine back on the Island was trying to do, but didn't get enough support for. This is team-based health care as it should be done, and I'm really grateful for the recommendation to work here because it's really showing me a fantastic picture of what family med can be.

I'm doing well, and having a lot of fun. Learning a lot, definitely.

I was told when I started my internal med rotation that students usually find it one of their most developmental rotations; that it helps them grow extremely rapidly as clinicians. That was absolutely not my experience, but I feel like I've really rapidly grown my clinical skills - examination, interpretation, problem-solving, care planning - over the course of emerg and family, and I'm looking forward to coming in strongly during my emerg elective starting next week.

Lately I've also really been trying to focus on self-care. That's why I've been writing a lot less frequently on my blog. I'm trying to spend my evenings enjoying time with my husband and my baby daughter - the older two kids are with their grandparents - and spend as much time relaxing as I can. Right now, it's not optional. I'm still not optimized from a medication point of view so while I'm miles ahead of where I was, my overall state still requires a bit more nurturing than I tend to give it. This means taking things slow, asking for help, saying no, being more cautious than I am inclined to be.

Coming into CaRMS applications (oh man... that is not far enough in the future) I'm going to be stressed to the max in the coming months, so I can't afford to crash and burn now. I need to be at my best.

That's what I keep telling myself, anyway.

Thursday, 13 July 2017

Non-emergent

Today was my last emerg shift, and it was really incredibly busy and great learning.

I feel like my learning trajectory with this rotation was what my trajectory with internal should have been and probably would have been if not for the fact that I was doing so poorly at the time.

It has reminded me that I'm actually good at this whole medicine thing. I can do this. I am doing this. Despite everything, I'm still on track to graduate on time with my class, and I'm pretty proud of that.

On Monday I start a family med elective and I'm looking forward to it. Lower acuity, but less in the way of immediate access to imaging and labs so it'll require more logistical thinking, more resource awareness, and I'm looking forward to that. It'll also be a good way to get to know the local outpatient specialists and clinics better. Nerver hurts to improve your list.

Then after that, HOME! Two weeks back on the Island, working in emerg in a very different setting than I've just been in. It's a full-service emerg, but it's not a major trauma/cardiac/neuro centre like here. MIs, strokes, and traumas absolutely come in, but a lot of the most acute stuff goes elsewhere once stable. It'll be really interesting to get a very detailed understanding of who goes to the mainland and how those decisions are made. I really doubt I'd ever be an academic centre physician, so this hospital, which I know so well, is definitely more the sort where I'll end up.

It's nice to have had such a positive, successful rotation over the last few weeks. It's really helped me get back to myself and remember what it is I really love about medicine. The challenge of it. Getting messy. Working with my hands. Being on my feet with ten things in the air, and keeping those things in the back of my brain while I focus on the task ahead of me. I think I did really well with finding a balance.

There were a couple staff who were really fantastic teachers, and I think I may ask one or two if I can do some horizontal shifts with them on weekends or evenings, just so I can get some more experience with emerg and decide if I want to apply to it for sure. I'm thinking I may; I really, really enjoyed this rotation and I think working some more shifts in (without the need for meeting ECEs or having evals done) is going to help clarify things. It's ridiculously competitive so the possibility of matching to it with only one or two electives in it is pretty low, but stranger things have happened.

Come to think of it, I think I may pop my OB/Gyn preceptor an email and see if I could do a horizontal with her too. I want to keep my OB skills fresh.

Don't know why it didn't occur to me earlier that we can still do horizontals in our off hours.

That would really help with my decision-making around CaRMS.

I'm going to go finish my project and then send emails.

Thursday, 6 July 2017

Running About

I'm really, really enjoying my emerg rotation.

Quite honestly, I'm surprised by how much I like it. I came into med school thinking family, OB, and emerg would be my areas of interest, but emerg had kind of fallen away because I figured the lack of follow up would drive me mad. I do not actually mind it at all. The episodic nature of the care is really nice, as is being able to give suggestions for further follow up, and working with other specialties fairly closely.

My staff have all been pretty awesome. They've been giving me lots of fantastic opportunities for procedures, bedside ultrasound (I particularly enjoy this and have gotten really good feedback about my skills with ultrasound,) and seeing a very wide variety of presentations. The staff have all been really good about letting me make mini-objectives for my shifts. Like yesterday, I wanted to do more cardio/resp since I'd just incidentally not done a ton of it so far.

Plus, the hours are pretty awesome, I must admit. Shift work has its appeal. I find working the same hours every day more difficult. Well, I suppose the funny thing is that when I worked shift work, I wanted a 9-5 schedule, but once I had a 9-5 schedule, I actually missed the flexibility of shift work and the fact that the days didn't have the exact same pattern all day every day. For a few years I've been telling my husband how I plan to have an atypical working schedule because I don't like working the same times every single day.

Variety is nice.

I'm actually thinking I may also apply to emerg and the combined family plus emerg come this fall. Emerg is exceptionally competitive so the probability of actually matching to it is incredibly low, but I've been getting really stellar feedback from all of the staff I've worked with and I've had a couple suggest I consider emerg, so I think I will. Can't hurt to apply, anyway. This is where the three year program is a bit of a bummer. While I conveniently happen to have an emerg elective coming up in a few weeks, I had booked that because I felt good emergency assessment and management skills would be necessary to my future as an OB (which they are in any specialty) - I did not book it because of a plan to apply to emerg. Had I booked anything else, I would have no electives in emerg before carms and so would really not be able to reasonably apply to it at all.

On the note of residencies, I've been running into lots of brand new residents considering the year just started. They all seem slightly terrified, and I have a feeling that I will too. It's really quite a bit of a panic-inducing thought that I'll be a week into residency this time next year. After all of this, the full five years of blogging here since I started this crazy journey, I'm less than a year from being able to sign my first prescriptions - which I will almost certainly check over fifteen times before handing them to patients.


Saturday, 24 June 2017

On Being There

Today was not a good day.

Around 11am, my cockatoo basically crashed. He'd been looking a bit worse for wear the last few days so we'd made a vet appointment, but he became acutely worse. My husband rushed him to the vet, but I had to be at work so I couldn't go.

He died in the vet's hands while I was at work.

I was speaking with my very upset husband on the phone while he held our beloved pink fluffy cockatoo minutes after his last breath. Our pets are very dearly loved and we go to the ends of the earth for these creatures we choose to share our lives with, and we have fought so hard for so long to keep Gallifrey going, but his body finally couldn't hold out any longer. He went downhill so fast, there was no saving him.

When I have lost pets in the past, I've had an extremely hard time in the immediate aftermath. Hearing my big, strong husband that upset - he is as close to our pets as I am - is also really hard. Thinking about the devastation my kids would feel is hard.

But today, I shut it down. I shed a couple of tears and then told myself to shelve it, I had work to do. So I put it out of my mind and went back into the pit and kept going.

I smiled and laughed and joked with my patients, and chatted with my colleagues, and I learned and worked, and followed up and figured out where things go. I sutured and lanced and interpreted x-rays and labs and I think performed very strongly as a medical student today.

And now as I sit to write this, and I think about the fact that I'm not going to see that little beast trying to steal my supper anymore or sneaking up behind me to 'preen' (pull out) my hair, I'm finally letting the tears fall, because now I can. Now I'm me, not the doctor-in-training, and I have space to let myself feel the grief for the loss of my feathered friend.

Today I realized that I finally can pull down that barrier when I need to, far more effectively than I have in the past. I can shut it down and shelve my personal life and get the job done, and when I leave I can still feel, I can still process. I can hit pause on the processing I need to do, and I think that's a very important skill to have developed.

But now it's time for bed, and then in the morning I'll wake up to a slightly quieter and less colourful house.

Wednesday, 14 June 2017

Away and Being Away

I have been unwell lately. Sufficiently so that I've been on medical leave for almost two weeks and won't be back at school until next week.

I've been away from my blog too because I'm just trying to focus on feeling better. It's not been a great time, honestly. On the plus side, the knee I injured early in my last rotation is actually feeling better since it has actually had time to heal and I've had lots of time to read. I've also had time to actually see my doctor about some ongoing issues and stuff is actually getting addressed, which is good.

Needing to be off on medical leave unexpectedly is certainly never a good thing, but it has allowed me time to recover that I did very much need, so there's that.

I'll be starting back right at the start of my emergency medicine elective and I'm quite looking forward to it. While I don't think it's the field for me, it does have incredibly important skills (this is true of all rotations, I suppose) that I'm looking forward to learning. Emergency management is part of what OBs do so that's pretty important to get to know.

Plus I'll be rotating with some absolutely awesome classmates, so there's that.

In three weeks, my older two kids are going to be heading off to the Island for the month of July and half of August. I'll be heading down to join them in late July for an elective. We've worked out a fairly decent approach to the trip this time. My parents are going to be flying here, picking up our SUV and the kids (+/- the dog) and driving back. They get to use the SUV the whole month of July, and it's much, much better to drive for 17 hours in a comfortable Highlander than in their little Nissan.

This means that when I go home for my elective, I can fly which saves me doing the drive by myself again. My husband will be flying down to join us during the second week of my elective, and then we'll all drive back together.

Works out.

It's a working "vacation" for me, essentially, but I think it's very important to have as much interaction with the Island medical system as I can. It's important for deciding whether I can reasonably go back. While I'm there, I plan to ask to meet with the OB department to discuss the possibility of being a family doctor who does deliveries vs the likelihood of being able to return home to practice if I pursue OB.

We'll see, anyway.

I'm just looking forward to getting home at all. The Island in the summer is a magical place and I miss it desperately.

Monday, 29 May 2017

Sound and Fury Signifying Nothing

I forgot I was at home earlier, and went to reach for my call room key in my purse.

It's been a long few days and I'm really tired.

Right now Im trying to get a ton of paperwork stuff done because that's life.

My husband is going to be returning to work part time next month when his parental leave is up, and then full time in July. Our older two kids are going to be going to spend much of the summer with their grandparents, so conveniently we'll actually be down to just one kid for all of July, then we're back home for two weeks (vacation for my family, elective for me.)

We've decided to do this as a means of limiting our overall debt. Our original projections took into account that I'd be applying to the sponsorship program and while it was obviously never a guarantee that I would be accepted for it, I'm pretty sure at this point I won't be applying to it because I still very much want to go for OB/Gyn.

Well, usually.

I find on post-call days, particularly when I haven't had any sleep, I lean pretty heavily towards just going for family med because it's a specialty that allows for much more sleep and a better lifestyle, and at the moment, that is incredibly appealing.

But it's kind of like that whole "don't shop hungry" idea. Don't make career-modifying decisions whilst exhausted.

Family med has a lot of customization, it really does. You can tailor your practice in many ways, but it is still primarily a medical specialty with some occasional procedures and maybe, maaaaybe some surgical assisting.

I want more than that, and I know that if I'm going to have the stronger emphasis on procedures and surgery, I need to go for OB.

But ugh, sleep. Sleep is nice. Being home for supper with my family is also nice.

Yet... surgery.

There's the rub, and that's why I've been going around and around and around.

Which is making me even more tired, so I'm going to go to bed now and stop thinking about it until tomorrow.

Unrelated to anything: my cat looks like he has a side quest for me. 

Tuesday, 23 May 2017

Sundowning


The title of this post is a medical phenomenon. Patients with dementia or delirium sometimes go through something called "sundowning." Towards the end of the day, they begin to get more confused, more agitated. Sometimes combattive. It's quite the challenging phenomenon to deal with, and it is hard for the patients.


I wrote most of this post late yesterday, when I had retreated back to my call room after a consult. The anticipation of the pager's shrill beep was keeping me awake during that precious potential sleeping time, and my mind would not shut off. I was agitated. I was frustrated. And I was so tired.

Usually, I find sundown to bring a lot of peace. The transition times of day - as I watch the sun fall off the edge of the horizon and as the earth rotates to reveal it once again - have always been my favourites. I'm someone who finds strength in quiet.

Years ago, I started making a habit of going outside at the break of dawn with a cup of tea, sometimes a cat, and breathing in the fresh, clean morning air.

I don't think that's likely in this city, but as I wrote the bulk of this post last night, I made plans to find a quiet corner high in the hospital to enjoy a coffee and watch the sun rise over the city. That didn't happen, as I slept through my alarm and was late to handover, but I intended to find my way to the hall outside the teaching room, where large windows look east. That meant first getting through the night.


Overnight, the hospital halls are hushed and still in a way that is so at odds with how people usually see them. I remember from the parts of my childhood spent in the hospital that it reminded me of an empty church. It still does. My father is a minister and so growing up I spent a lot of time in empty chapels; walking between the pews, hearing my footsteps echo off the angled ceiling. I was allowed places parishioners often were not. After the service, I'd get to drink the leftover communion grape juice from tiny glasses. I'd play with the organ. Knowing the church in emptiness felt like being in on a grand secret.



Most churchgoers only ever see the chapel at its height, teeming with life or celebration or clouded by tears and grief. Most patients experience much the same of the hospital; they have visited sick family members, they have grieved in the halls, they have perhaps celebrated new life in the one ward for functioning organs. But they have not known it in the stillness, even when they have stayed. Like the chapels of my youth, walking quiet corridors deep in the night feels like a privilege; a trip down the fairy way into a different world.


There is a certain smell and a particular acoustic quality to many churches. These are branded in my memory as markers of peace. While I left the faith in my teens, I do have pleasant memories of hours spent sitting on the carpeted dais and hiding in the secret places parishioners don't go.

The difference, of course, is that the hospital at night is far more populated than those chapels I explored. There are nurses walking as quietly as possible to and fro, people paging, monitors beeping, nighttime medications to give or vitals to take. The hospital is never still. It is never fully at rest. But like the churches I knew, is a place where families change and death and new life are both addressed plainly. It is a place of transition.

The room I spent last night in smells like an old church, which is what brought this all to mind. As I walked the corridor towards my nominally locked door, the soft thump of my footsteps echoed in just that right way to remind me of my father's steps down the annexe hall. I lay in bed in my call room, unable to sleep, but listening to the creak and grumble of unwilling pipes that were old when I was born. Like evenings spent in the sanctuary as my father fixed something or set up some new system, or as the women toiled at some project intended to help the world or the community, I rested without sleeping. As I child I would sleep anywhere, but my curiosity often kept me awake. That's still a problem. But as with then, I seek out the quiet places where my mind can settle.

I watched the sunset from the eighth floor windows yesterday. As I looked east, the sun behind me, I saw the broad brush of orange light paint this industrial city vibrant for a short time as houses nestled in the shadow of the hospital stared back at me with undressed windows.

For a short time, I found some peace, and I stopped to enjoy it. The hospital is both a cage and an endless world of new experiences for us. Life under the microscope of constant evaluation, constant assessment and reassessment of how well you are adhering to the plan for how things should go; whether as a learner or staff, it is challenging. But I found a moment yesterday, I stopped and for a time felt peaceful, and I thought about how hard I have worked to get to that eighth floor hallway, in my scrubs, my stethoscope heavy around my neck, the weight of responsibility in between the pages of the chart in my hand.




The sound of a siren in the distance reminded me I had a job to do. The papers in my hand, a dictation waiting. It came easier this time. It will keep getting easier, they all tell me.


When that was done, I made the pilgrimage back to my room, and listened to the silence, in search of peace, awaiting sunrise.



The juniors residence is visible in this photo. As is Miss M, who made my morning much brighter. 
.

Sunday, 21 May 2017

Unwell

I'm not doing terribly well right now. I can't focus on a damn thing. I'm reading sentences multiple times and still not retaining sufficiently so I'm spending hours and hours and hours pounding away at my study materials and I'm getting nowhere and I can't recall things which I absolutely do know. It's very frustrating.

There's actually a physical reason for this - going through workup, but basically right now I'd be a great OSCE station and the labs and imaging are more to confirm what's already pretty obvious - so I know I'll be doing a whole lot better once I get that side of things worked out. It's actually probably why I've been so flat out exhausted for months. But that doesn't make it any easier to cope with the fatigue and brain fog in the meantime.

This is all very difficult because I normally have extremely high retention for what I study and I've never had to brute force study like this, but my mind is so foggy right now that I'm actually having a hard time with basic day to day tasks. This is much worse than the third trimester 'baby brain' and I felt like an idiot with that.

It also doesn't help that while I'm dealing with absolutely soul-crushing fatigue, I'm about to start a 26 day stretch of work (three weekends in a row) with 7 call shifts in there, so I kind of want to curl up and cry. Post-call days are still work days. I don't leave until 10am post-call, which means I've worked ten hours on that day. So yeah, I still count post-call days as work days. My next day off is June 17th - the second last day of this rotation - and I've spent this entire weekend studying so I basically haven't had it 'off.'

Honestly I'm having a hard time finding any time for self-care. Okay, I'm not just having a hard time, I have had precisely no self-care time at all. I've barely seen my kids this rotation so I feel like if I'm not studying I should be with them, or taking some of the load off my husband, but I'm minimally functional right now right now and am saving all the energy I can for work.

I'm sure it's pretty evident by my posts lately that my mood is in my boots. I've basically spent all of today holed up in my office trying to study and failing miserably because I can't remember anything, so I've spent the last two hours starting at this stupid SIMPLE (online training) case feeling like the biggest idiot in the world because I just can't remember anything. And I'll feel like more of an idiot when I can't answer at the drop of a hat what the mechanism is for whatever drug that I read about six months ago and have never seen used clinically.

I've tried to write a post about this a few times, and have failed. I'm not even sure I'm going to post this one because I've been doing a lot of complaining lately, and this is what I signed up for so I really shouldn't.

I'd be lying if I said the thought of just leaving med school hasn't crossed my mind. I wouldn't, I never will, but damn it's tempting right now to just say 'screw it' and walk away from this and not feel stupid anymore and have to work 10-16 hours a day for a almost a month straight.

I'm trying to be positive. It's only four more weeks. It's only four more weeks. I will come out the other side of this with much better essential skills and knowledge. This is a critically important formative experience for my future as a physician.

This will make me stronger. I know it will. I just have to get through it. A month is nothing in the long run.

But it's a long month, looking at it from this end.

Sunday, 14 May 2017

Blows

I am a very anxious person, always have been. I tend to get stuck on seeing the worst that can happen and occasionally I'm paralyzed by that anxiety - this has been particularly bad during my current rotation where, during my day-to-day clinical activities, I'm freezing on what to do.

The funny thing is, though, that in an emergency I'm actually very calm, collected, and I'm comfortable taking control of a situation if it is appropriate for me to do so.

I've gone through first aid training a number of times, and I think that helps, since I've been this way well before I started medical school.

Today my youngest - she'll be 7 months on Tuesday, which is incredibly hard to believe - was having some eggs and started to gag. Then she stopped gagging and just moved her mouth a few times while looking at me. I whipped her out of the high chair, cleared her mouth, inclined her downward over my arm with her mouth open and delivered five hard back blows. She started crying, but it was soft, so I did it again since I felt she might be partially obstructed. She brought something up in her mouth and was none too happy but seemed okay. I took a listen to her lungs, and all fields seem clear and I don't think we need to take her to emerg. I'm studying (well, I'm on a scheduled 10 minute study break right now) so my husband is watching her carefully and if she seems off at all, we'll bring her in.

Thing is, I didn't even think about it. Even with relatively little experience - I've only had to do this once before and it was nearly ten years ago - I still just shifted into the problem-solving algorithms I was taught. I didn't panic, I just got to work.

It's funny how I can be someone who panics at the sight of a bee but when faced with a scary situation, I'm fine. I'm so anxious about my kids getting hurt but when it comes down to the line, I don't feel a second's guilt about hitting my infant hard on the back to clear her airway.

At my stage of training, within the hospital the vast majority of the time my role during a code is "stay the hell out of the way until told to do something" and then probably doing compressions because apparently med students are the muscle during codes at this site.

But outside of learning situatons, I have had to manage emergencies/urgencies - babies choking, person passing out in front of me, witnessing an assault, kid having a seizure, amongst others - and I've been totally fine. Assess the situation. Call for help. Give individual people single instructions. Get to work.

This Mother's Day, I'm grateful for the fact that I have skills which help me keep my kids safe. I'm grateful for the fact that my husband does too; that in an emergency, I know he will be equally quick to put his first aid training to use.

I'm reminded that my job as a mother - like my job as a soon to be physician - is one not only of guidance but of protection, and sometimes you've got to hurt to help and anxiety be damned, I've got a job to do.




If you are someone who cares for young children, please make sure you have first aid training and ensure you have taken infant CPR so that if you are faced with something like today, you will also be comfortable knowing what to do.

Friday, 12 May 2017

Within Doors

First week of internal was... probably my worst week of clerkship so far.

Well, there's no 'probably' about it.

Basically, my anxiety got the best of me and I froze up at every possible opportunity to demonstrate any sort of skill. I stammered a lot. My presentations were awful.

I just, overall, completely sucked as a clerk and basically made more work for everyone.

The way the CTU schedule is, we really have about 3-5 hours a day of clinical time. The rest is spent in teaching or meeting with our team (new patient rounds in the morning, running the list throughout the day, or handover.)

I lose about an hour of that because I need to pump. My pumping room (a call room) is in the juniors residence which is on the first floor in a different wing, far away from where I'm usually working. I'm down to two pumping sessions a day, but still, adding in time to get there and back, plus pumping time, plus time to wash my stuff, and I lose over an hour of that clinical time, and I can't run off during other activities.

So between my absurd level of sleep deprivation, my sky-high anxiety about doing poorly on this rotation, and the fact that the issue I've been trying to see my doctor for since February is getting worse, I'm basically a stressball at the moment. I'm that harried, slightly crazed-looking med student who is muttering to herself and stumbling over words while presenting.

In short, an absolute mess.

This is burnout. I'm actually a very strong student with a very solid knowledgebase. There is absolutely no reason my reflex should be to say "I don't know" about things I'm 95% sure of, but I still do that because my anxiety gets the best of me.

I'm also in too much pain to bother putting in the effort some days. Looking up the ridiculous name of an obscure trial so that I know the answer to some trivia question the next morning is really not high on my priority list. Absolutely I need to keep up on medical research and I need to be critical of evidence and stay on top of guidelines and why they are the way they are... but that's supplementary to, not in place of, what I need to work on right now. Preclerkship helped me build the foundations of my medical knowledge. Clerkship is building the walls. Residency is deciding on all the fiddly bits and doing the decorating.

I'm coming out of my first week of internal feeling very defeated and exceedingly stupid. No one was unkind to me at all; in fact all the staff and other learners have been very kind so far.

The very last day of my program is less than a year away, and honestly I've never felt less prepared than I do today.

Logically I know this feeling will pass. I know I will get through this, I will learn, and I will be fine because I always am and I tend to 'anxious' myself into a far bigger mess than I have any right to be.

But anxiety isn't logical, so despite logically understanding that like all things, this too shall pass, it's still hard until it does.

I'll get there. Just not soon enough.

Tuesday, 9 May 2017

Eep

So day one of CTU and I'm basically deer-in-headlights level terrified, feel completely out of my depth, and feel like all of my classmates - many of whom have done CTU electives and so actually have some idea of what we're supposed to be doing - are way, way better off than I am right now.

I need a ton of study time because I basically need to review the entirety of the last nearly two years because I feel like nothing at all has stuck in my mind.

Study time is one thing I don't have.

We got our tutorial topics for tomorrow at nearly 8pm. I've been studying, but just do not feel like I've even begun to appropriately cover anything adequately for tomorrow, and I'm on call tomorrow.

Time management has always been my forte. I'm good at getting stuff done, at prioritizing, but I have no idea how I'm going to make enough study time on this rotation.

When I'm there during the day, I don't have time for anything. I've already cut down my pumping to 2 sessions a day, but that still means I'm losing about 45 minutes in that 9 hour day where I could be doing clinical stuff, so I have to get the same amount of work done in less time (3-4 hours of that 9 is meeting/running the list/teaching) which means I need to be even more efficient than my peers.

I'm finding it rather hard to be optimistic about the next six weeks.  This is an absolutely critical rotation to my development as a future physician. Much of the information I already know, I just have to work on my confidence in putting together a plan. It's not that I have massive knowledge deficits - not as huge as I feel like they are anyway - but it's just a matter of putting things together in a coherent and structured manner, and learning the ins and outs of how this unit works.

Today, I'm feeling very, very student-y. Unprepared, unknowledgeable, and almost paralyzed with anxiety about screwing up.

I know I'll get over that feeling, and I'll figure out how to make my studying time work because I always do, but in the meantime, I'm going to just have to remember to breathe.

At least I'm usually able to do that.

Sunday, 7 May 2017

I'm Not Very Good at Plans

So a few days ago I got really excited, thinking I had it all figured out, that I'd do family med and focus on women's health and low-risk obstetrics and just be done in two years and be happy with that and I'd go on my merry way inserting IUDs, doing endometrial biopsies, delivering babies, and giving everyone HPV vaccines.

Then on Friday I was in the OR all day and realized one very important thing: I really like the OR. I got my first inkling of this last year with my IR elective when I learned I like procedures a lot more than I thought I would and my enjoyment has been confirmed repeatedly since.

Friday was my last OR day until late August and that made me very sad. My next rotation is internal medicine, then emerg, then I have family and emerg electives before my surgery core (4 weeks general, 2 weeks gynae onc.)

For my next core, I have to dress up every day. No scrubs. No sneakers. No silly hats and victory laps down the OR racetrack towards PACU.

May eleventh is exactly 1 year from the final day of our program. Graduation will be a couple weeks later, but I really finish med school 1 year from Thursday.

In that final year, I have 3 weeks off for CaRMS interviews, 2 weeks winter break, and six weeks of concept integration. It doesn't feel like very much at all, but it's even less when I consider that I've really got six months to decide what I'm going to do for sure because CaRMS is rushing towards us at lightning speed. This year's somewhat depressing match statistics - 77 OB spots for 113 applicants listing it as first choice - have been released and that's it. Next year, one of those data points will be me.

The 2017s are done clerkship; we're not seeing them around the hospital anymore because they're doing concept integration. Well, they were. I think they are done now, and just finishing their preparation to write their LMCCs.

They graduate on the 25th and then we're the senior medical students.

I really need to have my future figured out pretty soon. The end of medical school is approaching rapidly (I'm sure I'll feel differently around 2am on Wednesday when I still have 6 hours to go before I can leave) and I just feel like I can't decide.

When you compare the first two years of, as an example, Mac's OB residency and the first two years of the family med program back home around half of the rotations are the same. The big difference is that 9 blocks (36 weeks) of the FM residency is community FM, so you're working generally better hours than OB residents for 8 months.

Realistically, a family med residency isn't going to be *that* much easier over the course of those two years. And the last half of an OB/Gyn residency is less school than it is practice with eventually irrelevant training wheels and lower CMPA premiums.

It would be lovely if the answer to my indecision would just fall out of the sky.