Sunday, 29 January 2017

Sowing

I don't typically post about politics on here. Just reading my blog, one might think that I'm one of the many people who distances themselves from disagreements that happen because of political beliefs, but I'm not. I so am not. There's a video out there of a rally I attended where I'm up speaking - holding my baby daughter on my hip as I spoke to a nodding crowd through a megaphone. That is who I am.

My blog here has always been intended as a relatively neutral platform. I think I've commented on my political leanings only once, in passing, when encouraging people to vote.

But today, I am breaking with my nearly five years habit and I'm writing a very political post.

With about a quarter of my traffic being from the US, this is for you guys, but I'm reaching out to my Canadian readers too because I expect that like me, many of you have a lot of American friends and/or family.

Ahem.

RESIST, DAMMIT!

Last night, someone I know well - an incredibly sweet soul of a woman - posted that she cannot now legally enter the US because she holds a dual citizenship. Born and raised in Canada, but because she is a child of two countries, she is unable to cross the border. While last night's judicial stay means she could now, it is temporary. It's a bandaid on a bullet wound. There is so much more to do.

I have friends with complex medical needs who are terrified that they are going to die because they are going to lose their insurance and, with pre-existing conditions, be unable to get any more.

The reinstatement of the Mexico City Policy means that money that helps save the lives of women and babies will be withheld. It means that while paying lip service to protecting life, the US government is willing to withhold funds that go to prenatal care, emergency obstetric care, contraceptive care. They so disagree with abortion that they will let women bleed to death in childbirth, or suffer from labour so obstructed for days that they die of infection because they can't access a C-section.

Trump tells the media that the US should "take Iraq's oil." He said that maybe they'll "get another chance" to do so. A president, standing in front of the cameras of the world and telling people that national policy should be theft of resources. There is little else he could say or do that would more thoroughly damage the tenuous relationships between Americans working in Iraq and the people there. He has painted targets on the back of American servicepeople overseas.

People call him stupid.

He's not stupid.

He plays the fool to make people underestimate him, but it should be clear by now that he's good at playing the long game. He is a shrewd and calculating man, well practiced at pulling strings. His actions, I am almost positive, are intended to try to provoke actions that he can use to justify further violations of human rights. It's as though he's drumming up for war. I dearly hope I'm wrong about that, but as the days pass, as he insults more and more governments from the comfort of his office, as he authorizes rights abuses, my apprehension grows.

The US is a nation built on a base of protest. The most beloved stories of that nation are of people resisting unjust rule, of fighting against tyranny. Attend rallies. Support with your voice if you can't with your funds. Write emails. Sign petitions. Make phone calls. Talk to people. Show kindness in the face of hatred. Show inclusiveness in the face of exclusion. Sow love where hate grows.

The narrative of America is one of resistance from its birth, and the seeds that grew to revolution are still there. Water them.

Rise up.

Resist.

Some Resources:

The Council on American-Islamic Relations: https://www.cair.com/
- Helping to protect the rights of Muslims in America.

The American Civil Liberties Union: https://www.aclu.org/
- Has been helping detained persons access legal protection.

This page has summarized a number of resources and ways to get involved (primarily for Americans) on the immigration issues:
https://www.thenation.com/article/how-to-fight-trumps-racist-immigration-policies/

Donate to the Planned Parenthood Federation of America: https://www.plannedparenthood.org/ or
The International Women's Health Coalition: https://iwhc.org/

This is just a tiny sprinkling of resources. There is so much more that can be done to counteract the harm that is going to be done by this administration. Check out the Bill & Melinda Gates Foundation's projects, spread the word about the GAVI Alliance since even vaccination will be under fire.

While I'm aware this is drastically out of step with my usual posts, I can't not say something as I watch malignant nationalism metastasize in the very last place it should ever take hold.

Saturday, 28 January 2017

When Demand Outstrips Supply

I have all of today and all of tomorrow off. I'd only had one day off since the 9th of January, so I was getting pretty run down. I got 7 hours of sleep last night and then took a 4 hour nap this afternoon. For the first time in about two weeks, I actually feel pretty normal.

This schedule has meant a lot less time with my family. I'm leaving before most of them wake up in the morning and most days I'm not home until nearly 6 if I don't have call. The older kids go to bed at 8pm, so I'm barely seeing them at all. That's hard to get used to.

Fortunately M is such an easy baby we have no problems going back and forth from bottle to breast, but my milk supply has taken a beating. My opportunities to pump are irregular and it's often hard to get away when I need to so I often end up going longer than I should and so my supply is reducing. In the last two weeks, I've pumped less than she has taken 11 days.

I have no problem supplementing with formula and we have been since the beginning (though out of preference, not necessity. I was producing as much as she took and was just freezing the milk to have a freezer supply for longer separations.) While everyone is very supportive of me breastfeeding, the nature of OB/Gyn doesn't really make it easy to run off for 20 minutes every 3 hours.

It's messing with me a bit, to be honest. I had oversupply with my other kids. While my milk was delayed coming in all three times and we dealt with thrush and mastitis with my second, I have never really dealt with supply issues because I was home with my other two and fed on demand. I've never pumped much before. Quite honestly, I hate it. I will probably only pump during day shifts for the first six months or so and after that I'll only pump overnight when on call or when away from home. It'll take a while to adapt to no daytime pumping, I'm sure, but other mums do it successfully.

On Monday I'll be entering my last week of OB/Gyn clinical for the core, and then we're back into an academic week which should be nice. After that, I'm off to Ottawa for two weeks and am very much looking forward to it!

Tuesday, 24 January 2017

The Nighttime Hours are Shrinking

I am absolutely loving my OB/Gyn core. I am very, very tired, but it's worth it. I'm learning a great deal. As is evidenced by my near absence of posting, I'm spending most of my waking hours at the hospital.

My preceptor is amazing. She has high standards, and is fiercely protective of her patients, and I think that's incredible. Every time I meet patients with her, they tell me how lucky I am to be working with her, and they rave about her bedside manner. It's left me smiling many times.

She expects a lot from her learners, but she also gives a lot. It's clear she expects me to demonstrate interest and an ability to learn quickly. but she is ready to take the time to teach and ensure I have the opportunity to learn. She won't force the information down my throat, but makes it available for my consumption.

I am incredibly grateful to have someone who is so willing to offer guidance as a preceptor. I really lucked out. Perhaps it helps that I'm actually interested in the specialty and demonstrate a legitimate interest in what I'm learning. But I do try to be interested in everything, even stuff that isn't my favourite topic (I wouldn't say that anything qualifies as boring to me, at this point.)

While I may not be able to do many things well right now, I am a willing and enthusiastic learner so I suppose that counts for something. It may also help that I'm not all "yay babies!" I actually like the gynae half of the specialty too. Obstetrics is just a part of OB/Gyn, and I actually think I might like the gynae stuff a bit more.

I definitely like surgery and want to learn to do it, which is less of a surprise than it would have been before last summer but still bowls me a bit. It's definitely pushing me further away from family. I don't know if I'd be happy doing just the occasional punch biopsy, Paps, and nothing more procedural than that. I've got a surgery-heavy OB/Gyn elective coming up in March to explore that further. 

It hasn't all been happy moments, and I think I'm getting to see a very good cross-section of the specialty. My preceptor has really been helping with that; making sure I see a very wide variety and get to by as hands-on as is appropriate for my level of training.

The fact that I'm exhausted, have worked somewhere near 200 hours in 2 and a half weeks but am sad that I only have a week and a half left in the clinical part is rather telling, I think. I'm having a blast.

Given my current state of exhaustion (not helped by the fact that I actually have to wake up to pump in the night now because my supply was tanking from the irregular hours) this is perhaps not my most coherent post, but I hope I've at least communicated my enthusiasm.

When you really need to study, but also want to snuggle.

Saturday, 14 January 2017

The Calm and the Storm

As might be obvious from my lack of posting, my first week of call is kicking my butt.

To be fair, I actually have three 25 hour call shifts in a 7 day period - making it a nearly 100 hour week when you add my non-call shifts- so it's pretty brutal. Last night in particular was rather intense. My first call shift was pretty quiet, but last night most definitely was not.

Today, though, is my son's tenth birthday. It's absolutely incredible to me that he's already 10 years old. When did that happen?

It made me reflect a bit on the nature of delivering babies. I remember the name of the attendants at each of my childrens' births. I remember in detail how the days went; my birth stories, like those of every woman who has given birth, are a part of the fabric of my life and I will never forget them. The fact that I am part of those stories for other people now - not that I really expect most people necessarily remember the medical student - is pretty cool.

But I also really like gynae surgery. My supervisor typically does two OR days per week and I get to attend with her. I was post-call one of her OR days last week, but when I attended the other it was fantastic. The whole time, I was just thinking "I have to learn how to do this." It was nothing terribly complex, just routine stuff, and there were no complications, but I still very much want to learn it,

Six days and 2 call shifts in (I have another tomorrow) and I haven't actually found anything I don't like to do yet. I realize that I'm still at the point of everything being new and shiny and exciting, but I can very much see myself doing this as my career. I've been told by a few people that the specialty you should pursue is the one where the most 'boring' part (I think 'less stimulating' is probably a better term than 'boring' since I don't think anything in medicine is boring, but I realize that may change.) is something you still don't mind doing. For OB/Gyn that's largely low-risk prenatal appointments. I enjoy them. It's nice to talk to patients, to hear how they're feeling about their pregnancy, to alleviate concerns about what they're experiencing. It's probably the lowest-stress part of the specialty.

It's a very flexible specialty, and I like that. It's medical and surgical. You can focus more on obstetrics or more on gynae or do an equal amount of both. In some areas, they have labourists who just do deliveries and emergency gynae surgeries.

So far, I'm definitely enjoying it as much as I thought I would and that's promising. I seem to be getting on well with the team. I'm rather nervous when it comes to paperwork because I definitely don't want to risk screwing anything up, but I found my nerves were slowing me down quite a lot so I'm relaxing a bit and realizing that I do actually know how to do stuff decently well for the small amount of training I have, I just have to make sure I keep the most important information in mind and always, always double check something if I'm not sure. 

Today did mark a big first, though. For the first time ever, I didn't immediately greet my son on his birthday and I've not spent much of the day with him as I had to sleep. I know this won't be the last time that happens, and I may completely miss birthdays in the future.

But we're going out for supper soon, so there's that.

And tomorrow, back into the fray. Hopefully for a quieter shift, but even if not, it's not the end of the world. It's an awful lot of fun, even if the excitement is at 3am.


Saturday, 7 January 2017

Needs Must

Monday is my first day on the wards and in clinic. It is also my first call shift. I'm a bit nervous about that bit since it'll be my first night away from M since she was born. I've been careful to try to avoid getting in the habit of nursing to sleep since I knew I'd be away for a lot of nights so fortunately there shouldn't be any issue with getting her to bed.

Working out my pumping schedule should be interesting, particularly given that OB/Gyn doesn't really lend itself to having anything scheduled during a shift. My plan is that every 3 hours, I'll take the closest moment to go pump (Except between midnight and 6am.) So sometimes I might have 3 hours between sessions, sometimes it might be 4.5. I can't really go longer than that during the day or I'm in pain. I should need to pump about 5-6 times during 24 hours if I'm away from M the whole time.

I am really excited to get working. Especially because this is my favourite area. I know this material very, very well. Not just because it's been directly applicable to my life many times over, but because it's a major area of interest for me.

Must admit that I'm a bit nervous about how I'll manage when I'm on different rotations. Because I'm doing six weeks of OB/Gyn electives immediately after this core, I'm starting my clinical part of clerkship with 12 straight weeks of OB/Gyn. While it is a very comprehensive specialty - medical, surgical, across the lifespan, with patients of varying complexity - it's also very specialized in that in the obstetric part of it you're seeing primarily younger, mostly healthy women for a normal physiological process. I'll likely not be seeing many elderly patients (although some certainly come up in gynae, of course) and probably won't be seeing a whole lot of extremely sick individuals the way one might on ICU.

Every patient population has a different general approach; that's what we learn in preclerkship. There are some clinical skills I'm just not going to even consider over the next 11 weeks so I'm going to need to spend some time making sure I don't forget important things that will come up on my future cores. And, you know, my LMCCs.

As it is now, though, I'm just trying to focus on being a good clerk. Be helpful. Be cooperative. Be useful. Be ready and willing to learn. Support your resident. Be professional.

Let's see how well this works out at 3am, shall we?


Thursday, 5 January 2017

Tied Tongue

Most of the way through the first OB teaching week, and I'm having a blast. Today, breastfeeding, prenatal diagnosis, abnormal labour, and low risk OB. We've had suturing practice and great lectures on fantastic topics. 

I did some suturing practice at home too, using pig tongue. My daughter, who is easily grossed out and terrified of anything needle-like, enjoyed it a lot. She actually did a couple stitches. I was so proud of her for letting her curiosity overcome her fear. My son kept asking me to cook the other tongue for him. Can't say I've ever cooked tongue before. Not that I'm planning to; I need lots of practice. 

Aside from the fact that things are busy, I've been posting very little because I'm dealing with some pretty awful insomnia at the moment and it's taking me a lot just to get through the day and try to get done what I need to do. I'm only getting about 4 hours of sleep a night, on average, and so I'm feeling very run down.

Being very 'off' in January/February is rather normal for me - in fact I think I've made a post to this effect at some point every year - and so is postpartum insomnia for the first few months, so I'm just sort of riding it and hoping that it gets better soon. It may actually work in my favour a bit now because of this: 

So 90s. 

Call.

I start call shifts next week. There are four students in my stream together on the one unit, and so we made a call schedule (well, I made it because this sort of thing is fun for me, and they agreed with it) that meets our requirements and will hopefully not be too brutal. There are 28 shifts and we each get 7. I have two weekends fully off (we all do; I arranged it that way) and I've strategically positioned my post-call days to ensure I'm off for a few important things without needing to actually schedule time off.

Given that I'm still dealing with insomnia, I expect I'll probably do fine with call. Can't sleep anyway, might as well just care for mums and learn.

I am really, really excited to get started on the unit and with clinic. I feel like I'm actually going to be good at something. It'll be important, I think, to be careful to not come across as a total know-it-all in my enthusiasm. The goal is to be a good clerk. Be helpful. Be enthusiastic. Seek out learning opportunities. Be a good team member. Learn from everyone, including the patients. Especially the patients.