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.




Friday, 5 May 2017

Kay's Tips for Being a Good Clerk

So from my accumulated wisdom from the last four months of clerkship, I've learned a handful of things I wish to share. 

1. Carry at least two (functioning!) pens  and a piece of scrap paper at all times. 

2. Watch what your staff does so you can learn how they do things - ESPECIALLY surgeons. You may get looked at like you have two heads for doing something the way you were taught by another staff. Don't take it personally. 

3. Don't take anything personally. 

4. If someone 'corrects' you, even though you are doing something exactly the way you were instructed to do it 24h before, just go with it. Don't argue. Related: if you're told you contaminated yourself and you're 100% positive you didn't, still don't argue. Get a sleeve/new glove/new gown anyway. 

5. Thank people for teaching you. Not everyone will try. 

6. If you need paperwork filled out, let your supervising staff/resident know early on in the day. 

7. Get to know the nurses and other allied health. They almost certainly know more than you do about what you should be doing especially if you're brand new on a service.  

8. Waterproof shoes. 

9. If you feel lightheaded in the OR - and it happens to lots of people! - let the surgeon/resident know, hand off your tools/retractor and step away and sit immediately. Don't try to fight it. Don't risk passing out in the field. For one, it's not good for the patient. Two, no one likes it if the med student creating a mess of paperwork. (I have not passed out, but I nearly did.)

10. If your staff or resident tells you to go eat, rest, or grab a coffee, do so. As in immediately. Don't wait around, don't ask if they're sure. Run for the call room/break room/washroom as fast as your little legs will carry you. 

11. If you're asked if you'd like to go home early, the answer is yes. 


Tuesday, 2 May 2017

Re-evaluating My Options

Five facts that are causing me some stress:
1. I love obstetrics and gynaecology. A lot.
2. I have concerns about the physical toll of an OB/Gyn residency on me and the stress it will place on my family.
3. I will likely not be able to return home for a long time if I do OB/Gyn.
4. I do not greatly enjoy the full scope of family med nearly as much as I like OB/Gyn, but do enjoy some parts that are not part of the OB/Gyn scope (well-baby care, breastfeeding concerns)
5. We all really want to go home.

So I'm looking into the possibility of being a women's health-focused family physician who does low-risk obstetrics including deliveries. As far as I'm aware, there's really only one family doctor on the Island who does deliveries routinely, but I know in Ontario there are multiple family doctor groups that do low-risk obstetrics and women's health.

There is at least one physician on the Island whose practice is primarily women's health, and there's another I'm aware of who receives referrals from other family physicians because she does things like IUD insertions and pessary management. They're also establishing a women's health centre out of one of the hospitals, and last I heard they've been looking for someone who will work there.

I think I'd be satisfied with not having gynae surgery as a part of my practice if I were still able to do obstetrics and women's health as the majority of my practice.

In Ontario, I know it's entirely possible to do that.

I don't know about how achievable that is back home, but if it can happen, I want to make it happen.

It would be the best of both worlds if I could manage pregnant patients through pregnancy, parturition, and postpartum, see their babies for well-baby checks at the same time as postpartum checks, see them for breastfeeding concerns, do contraceptive counselling and IUD insertions, STI screening and management, do initial nonsurgical management of gynae issues like endometriosis, prolapse, and PCOS. Do low-risk OB, primary care gynae, some paeds.

None of that is outside the scope of a family doctor. Most family doctors don't do deliveries nowadays, but it's more a practical consideration - you basically always have to be on call to manage your own patients' deliveries - but that's manageable if it's done as a call group, and I know for a fact that there are family doctors who do that.

I figure, if a family doctor can do primarily emerg, or hospitalist, or geriatrics, or palliative, why can't I do women's and infants health?

If I could go into a family medicine residency being sure that I could make that sort of thing into my future, I would do it in a heartbeat and I don't think I'd regret the fact that I wouldn't be doing surgery.

I love OB/Gyn, but if I could be something between a family doctor and an OB/Gyn, I'll dive in with both feet.

I think I'm going to call the offices of the doctors back home who I know do more women's health-oriented practice and see if I can speak with them, and I think I might try to change my family med elective this summer to be with a women's health focused family doc.

Thinking on this, it's actually feeling like this might be a workable solution, and might be a good way to shape my career the way I want it to be, combine all areas I enjoy, and provide a desperately needed service to my home province.

It would also mean we could go home, potentially as early as next year if I match to that family med program. That is incredibly tempting.

I'd have to leave for a year (possibly) to do a women's health fellowship, but there's also the possibility I could do that in the maritimes, so I could potentially just be gone during the week.

This seems workable, but I need more information so that's my next steps.


Sunday, 23 April 2017

I See You Little Bones

My husband made chili and homemade biscuits for supper. This has absolutely nothing to do with the rest of my post, but I just wanted to document somewhere that he actually made biscuits using my family recipe, and did an amazing job. He keeps saying he can't bake, but he keeps proving himself wrong.

Anyway, to medicine.

For my final assignment for my ICU rotation - which was a fantastically educational rotation to have done - I have to write a two page reflective paper.

This is not what I would call a challenge, given my tendency to reflect at length about absolutely everything (incidentally this is public post number 1060. I have 142 in draft.) The question was which topic to pick of the many I identified whilst there. Eventually I settled on something that might quirk a few eyebrows, but I think provides very strong material for reflection. Only problem is that I've written three pages and have to trim it down.

Damn my prolix nature.

Next up is ortho, which feels like it is going to be rather intimidating. Ortho is not my natural milieu, and I had a baby three days after the end of that unit so most of what we did has gone completely out of my head.

This is a bit of a problem with all these two week rotations. I just do not have enough time to learn and actually absorb information before I'm onto the next one, and I have no time in each of the rotations to really absorb and apply the information. My exam for ortho is ten days into the rotation.

I'd planned to spend this weekend studying intensely, but between my husband being at Cub camp with our son yesterday, spending the evening in emerg with the wee one for x-rays (she's fine! Just very sore after her big sister tried too enthusiastically to get her to roll over again and accidentally twisted her backwards onto her arm. She can't move it very well, but it's not broken) and feeling just awful today, I've not gotten as much studying done as I'd like and I feel like I'm going to show up and be a huge idiot tomorrow.

But then I feel like that for every rotation, and so far only one preceptor has actually thought I'm an idiot. Or has at least expressed as much.

As for now, I'm going to go listen to some Tragically Hip (I'm doing paediatric ortho...) and read about classifying fractures.

Tuesday, 18 April 2017

Finding Silence

After my current rotation - internal med selective - I have my ortho rotation and then I'm done with two week rotations until my electives this summer. Because I had a 6 week elective block followed by my anaes/selective/ortho block, I'm doing six 2 week rotations in a row.

It's nice to rotate through a bunch of services and all, but by the time I've learned how things are done on one unit, I'm moving onto another. I have three days left on this rotation - I've only done 6 because of the holiday weekend - and I'm just now getting to the point I feel like I'm able to comfortably do actual work that contributes to the team instead of primarily learning through observation or needing to be babysat through my work.

This is also just a really, really awful week for me right now. M is not sleeping at night and while I try to trade off with my husband so that at least one of us ends up well-rested, many nights neither of us is getting much sleep. I'm averaging probably 4-5 hours a night for the last 2-3 weeks, and that's really not an exaggeration. I can usually manage fine on that for a couple of weeks, but I am reaching the point of exhaustion saturation and I desperately need a reset.

I also have pretty much no downtime at all. I come home from work at 5-ish. Hang out with the kids, maybe catch up a bit on Facebook while my kids do their homework or use their screen time allowance, eat supper, play with the baby a bit while my husband gets the older kids to bed, and then I study until around 11pm, get ready for bed and lay out my stuff for the next day, then crawl into bed around midnight. Often the baby wakes up right around then, so I nurse her back to sleep (I'd have to pump if I didn't) and then get her settled right around then.

Then I get up around 5:30-6am, shower and dress and get to work for 7-ish.

Weekends are spent with my family, evenings once kids are in bed are spent studying.

I am almost never alone. Usually I'm nursing while I study, or I'm attempting to spend time with my husband - well, at least in proximity to my husband if not actually interacting with him - or I'm with the kids.

This weekend I took two hours - during the day when the kids were awake, at that - and went and played video games in the bedroom. All by myself for two hours straight. And I realized that was actually the longest stretch of time I had spent alone not doing something either for school or my family since I got back from Ottawa almost two months ago.

My exhaustion is coming across in my functioning at work (school, whatever.) I'm not performing at the level of which I am capable because I am so tired.

I think this weekend I'm going to just shut myself up in my office for one day and just do nothing.

Sunday, 16 April 2017

Will I in the Quiet Moments

I'm sitting here, nursing my baby who will be 6 months old tomorrow, and trying to figure out my plans.

I had my pre-CaRMS career counselling session last week and it went fairlywell. The counsellor said he's confident I could match to OB if I choose to go that route, but said he understands my concerns. My problem is pretty clear and I explained it to him: the career path I want is not really the best career path for me to take for my family's sake.

When I've asked some staff about it, I've gotten very encouraging and positive advice about pursuing what I love and the fact that residency is working as a doctor even though you're still a trainee. It's all reassuring and all but the fact of the matter is that most of them did not have school-aged children when they started residency. Several I spoke to did start their families during residency, but that's very different.

As much as it sucks to be super busy during your child's earliest years, the reality is that they probably won't remember it very much if at all. My kids are old enough that a long residency is going to happen during a very significant part of their most formative years. When they are adults they will remember me being in residency and I cant help but worry that they will look back on those years with sadness.

I realize an OB/gyn residency is 'only' five years compared to the 25-35 year career I'll have afterwards, but my kids have their entire adult lives to come and I don't want to negatively impact that.

My kids will be 16, 12, and 6 by the time I finish a 5 year residency. I've been in school since my oldest was 5, my second wasn't yet two, and my youngest was still an arrested primary oocyte.

It is extraordinarily tempting to choose the relatively easier path (no path in medicine is easy, but some are shorter) and go for family medicine, apply for a sponsorship so I graduate with less debt, move home next year when I graduate, and finish my training back on the Island. Then start in family practice, work a relatively normal working lifestyle, get to know my patients extremely well, be there through the trials and triumphs of their lives. See my youngest patients grow up and then care for their children. Leave clinic at 4:30 or 5 and spend every evening and weekend with my family.

But I would have to give up managing deliveries (family doctors don't really do deliveries back home,) and scrubs and my ugly-as-sin waterproof clogs - that I totally love because they're so comfortable - and surgery. I wouldn't be walking the halls, room to room, ushering babies into the world and women into motherhood. I wouldn't be in the operating room doing that somewhat ridiculous but eminently ritualistic dance to close my gown.

As much as it surprised me to learn it, I fell in love with surgery and the thought of spending the rest of my career without seeing the inside of an OR on a regular basis is more than a little disheartening. I think I could be happy in family med, in that it's a good job and it is medicine so I can be there to help people with their health. Family doctors are extremely important for tying everything together for patients, for being a first and major point of contact for the rest of the health system. If I match to family, I won't be depressed about it or anything.

But if I pursue family exclusively, I wonder if in those quiet moments after the patients are gone for the day, when I sit back in my office with a tea and a digital stack of lab results to review,  will I look back wistfully at the choice I didn't make, or will I be satisfied with the one I did?

I've given myself until the end of June to decide.

Sunday, 9 April 2017

Breathe In, Breathe Out

Anaesthesia is done, but I'm right off to ICU Medicine starting tomorrow.

I've been spending much of this weekend studying. Well, trying to. Also trying to find time for my family. My integration of concepts is simply not where I want it to be, and I really need to go back to basics in some areas. This means lots of reviewing to make sure I don't hesitate and doubt myself constantly when asked something. 

I did get feedback during my anaesthesia core that I need to work on my confidence. This is something  I really struggle with. Im always pretty sure that everyone around me is completely annoyed by my presence and that the best thing I can do is shut up and get out of the way. I feel the need to apologize for my presence, for the space I take up.  

While I realize this sounds irrational, this is what social anxiety does. It sucks. I realize it's not normal, but at the same time, I've spent most of my adult life trying to fix this and haven't managed to yet. It's quite frustrating. 

But the preceptor I had on Wednesday night was right; I need to find confidence. Or if I'm not able to actually have some, fake it. "You have to show confidence," she said. "You're the doctor now."

The lack of confidence is sometimes paralyzing. I have all this knowledge in my head but when a preceptor (or a peer) asks me a question to assess my knowledge, I stumble and doubt and sometimes end up saying the opposite of what I mean and I make an idiot of myself even when the question is something I know extremely well. It's not a problem with patients, funny enough, and I have no problem at least faking confidence when I'm with patients, but with preceptors and sometimes peers, I'm so self-conscious it's painful.

I'm also still very much finding my feet in clinical medicine. I find it very jarring to move from staff to staff, to never know how they want things done, to do something on Tuesday that I was told to do on Monday and have my knuckles rapped over it. I understand it's the nature of the training, but it's really aggravating to feel like you're constantly wrongfooted and useless.

It's a matter of getting comfortable with it all, I know. I'm doing stuff now that I simply do not know as well as OB/Gyn and I have to do better with accepting that I won't and can't be as strong in everything as I was in my favourite discipline. I need to be okay with 'okay.'

Might take me a while to get there.

In the meantime, here are my girls being cute. M is pretty much in a constant state of happy flailing so it's hard to get photos where her limbs aren't blurry. 


Monday, 3 April 2017

The Minutiae

Med school, like med life, comes with a lot of paperwork.

Fortunately, the school is nice and organized and reminds us with plenty of time.

Also fortunately, I can submit my prenatal blood work from last year which will cover a bunch of the new requirements. It's quite possibly the first time having had a baby during med school has saved me time.

I've ordered my vulnerable sector check (which can be done online, yay!) and so all I have to do is do my TB testing since I think I'm considered as having exposures now because I've had clinical placements in hospitals with more than 200 beds.

My current placement is going middling to well. I'm not at all a natural with anaesthesia and feel very wrong-footed a lot of the time because I'm not confident in my knowledge, but I need to develop that. The way the rotation goes is that we work one on one with a different staff anaesthesiologist every day. Unfortunately it doesn't give them long to get to know us, so if you have a bit of a weak day, which everyone does now and then, you don't have the opportunity to improve on your performance for that preceptor.

It also means you're in a constant state of unsteadiness because different staff want things done differently. Basically, no matter how you do something, there's a pretty good chance you're not doing it to the preference of your staff. Not that it's necessarily wrong, but that it's not how they want it done. It's a bit tedious to learn each person's preferences each day, but I can understand that everyone has their own way of doing things. It would be nice to have a single preceptor for this rotation, though, and I think that's likely the feedback I'll give at the end of it.

You just don't have enough time with any one staff physician to get to know how they do things, and they don't have enough time with you to get to really assess your abilities.

After this I'm off to ICU for two weeks, then orthopaedics. ICU feels more than a bit intimidating and I feel like I'd feel more comfortable with it if I were doing it after my medicine rotation. Ortho looks quite interesting - I've been on the other side of the drape for several ortho surgeries - and it'll be nice to have a better view for those cases.

Overall I'm still really getting to that point where I feel like it's okay for me to actually do things as opposed to just observing or being taught via discussion. It's quite the transitional period and I expect it'll be a while yet before I really feel like part of the care team as opposed to a somewhat annoying outsider who asks lots of questions.


Look how big she is now!

Saturday, 25 March 2017

Pink Fluff and Career Stuff

My bird is still alive. After my last post, he took a turn for the worst and we were pretty positive he was going to die. He couldn't hold himself up well. He was shaking. We kept him on a heating pad, under his basking lamp all night, on the couch with us. We figured the best we could do is ensure he wouldn't die alone, in a cage. 

He survived, and that morning I noticed something thanks to my experience with birds which lead to us getting a med that has turned things around. 

So thanks to a lot of intensive care - tube feeds, crop washouts, IM meds at home - he's still alive and is actually improving. He's on six different medications, but he's doing surprisingly well. A week ago he was so emaciated you could have cut paper with his keel bone, but in the last few days he's gained back over 15% of his lowest body weight and he's got his attitude back (which includes taking swipes at me.) Birds with this disease never live their normal lifespan, but a rare few have survived a few years with it, so there's some hope we may be able to manage this long term. 

There's my update on the fluffy roseate dinosaur. 

The aforementioned fluffy roseate dinosaur, at the vet's office. He climbed up onto my shoulder which just does NOT happen. 


Now, to medicine. 

I've now finished my last OB/Gyn elective and have wrapped up three straight months of OB/Gyn (which for the rest of this post I will shorten to just OB.) I figured this stretch would decide for me once and for all whether I want to apply to OB. 

Well, I definitely love OB. All of it. I think I can handle the lifestyle too. 

I am not positive I can handle assisting in vaginal surgery. Specifically assisting; I think I could handle being the primary just fine, because then you're seated or standing straight. But assisting in vaginal surgery means being stooped over, half under the patient's leg, twisted sideways, with your arms outstretched, retracting without moving for hours at a time.

Spending 7+ hours in one day in a position that seems especially designed to be excruciating for someone with pre-existing back issues is... not optimal. My back has been screwed up since a bad fall I had when I was 15. I manage just fine most of the time, even though I deal with pretty much constant pain from it, but sometimes have to be a little extra cautious with my movements. 

There is a LOT of assisting in vaginal surgery during an OB residency, as one would expect. I am honestly not entirely sure I could handle five years of doing that regularly and I worry that I might make the already chronic pain I cope with so much worse. 

That's my one big hang up. I have no worries about my ability to manage the other requirements of the job or training for it. The five year residency is certainly daunting, but I'm up for it. I just feel so at home in OB. It's the part of medicine that comes to me most naturally, that I have the most interest in, that feels like where I belong. I don't want this one thing to hold me back from it, but at that same time, I don't want my career to disable me. 

I've given myself a deadline for making a decision about what residency/ies I'll apply to. End of June. That gives me time to apply to the family medicine sponsorship if I do decide to do family med instead. 

Thankfully my school has us have a mandatory career counselling session and mine is scheduled for early April, so I'll be able to get some feedback on my thoughts, I hope.

It's hard to believe that in less than a year I'll know what kind of doctor I'm going to be. 

Sunday, 19 March 2017

Under the Lights

I've been baking this weekend. Probably not the best past time, but enjoyable nonetheless and quite honestly I'm baking to feel like I can do something useful. 

We have our cockatoo home now, but he's dying. We're basically doing palliative care and waiting for him to die. There is a small, vanishingly small, possibility his illness may remit for months to years, but it's highly unlikely with him as sick as he is currently. He does not seem in pain at all or we would have him euthanized. He's enjoying eating his favourite foods, and spending time under his heat lamp and snuggling up to us. He's very sick, but essentially on a slow downhill trajectory. If he goes downhill fast or seems to be in pain, we'll call our vet to come to the house to euthanize him. As it is now, we're just trying to let him enjoy the rest of his time with us. 

My kids are learning some important lessons through helping take care of Gallifrey. We're coping with some big emotions, as we'd expect. 

I wish I could make this better. If he were human, there would be options. The virus would be better understood. The treatment options would be better than "we think this might help, so that's what we're doing." 

This illness - formerly known as macaw wasting disease, then PDD, then ABV, and now avian bornavirus ganglioneuritis - has been around as long as I've had birds. The virus is everywhere. Almost every flock will have a bird or two who carries the virus asymptomatically. It's somewhere around 25-40% of pet birds who have the virus. Whether it will progress to a clinical syndrome, as it has done in my bird, is unpredictable. This is the most likely time of year for it, because they're entering breeding season and the hormonal activity is stressful. 

I've been poring through what little literature I can find to see if there's anything else we can do, but he's already on the generally accepted treatment regimen that, in some birds, helps them live for years longer. 

It's pretty obvious he's not going to live for years more at this point. He's hanging out under his heat lamp and eating a bit. We're feeding him some hand feeding formula as easily accessible calories and fluids. 

We've done our best by him, and that's all we can do. Now we just have to help keep him comfortable and let him pass in his own time, in his own space, where he is happiest. 

He needs a bath, but I'm hesitant to give him one because he's having trouble maintaining his temp already. :-/