Thursday, 23 February 2017

By the By in Bytown

I've really been enjoying my elective here. That is, until today.

I woke up feeling a little off - just that sort of half-sick, not quite awful feeling. My throat was a bit scratchy but that often happens in the winter. So I just got on with my day.

By noon, I'd spiked a fever (max temp I measured was 38.8) and was shaking and sore and my tonsils are scarlet and awful looking. Centor Score: 4. 53% probability of strep pharyngitis.

The residents I was with, understandably, had me leave. I'm holed up in my hotel room, under a pile of blankets, feeling pretty sorry for myself. I have bottles of water, acetaminophen, benzocaine lozenges, and my pajamas.

I only missed 4 hours of today, and my residents said I could return if I'm afebrile tomorrow so I'm just trying to will my body into health. There's sort of an unspoken "Thou Shall Not Take Sick Days" culture in medicine (I actually was told explicitly by a physician that doctors can't take sick days so I suppose it's not truly unspoken.) It's understandable, particularly for specialists who might have patients waiting months or years to see them. Cancelling your clinic or OR day may result in unacceptable waits for rescheduled patients.

But I'm just a student. The care I deliver is not so critical that my being absent for an afternoon will cause unacceptable issues for patients, and it's just plain irresponsible for me to stay there if I could make a newborn sick because they go downhill reaaaaally fast.

I'm hoping that my fever breaks overnight because I really, really want to work tomorrow. I had planned on returning to Hamilton tomorrow after work, so I didn't actually book my hotel for tomorrow night. I have to check out in the morning. But if I end up working a long day tomorrow to make up for today, I'm going to need to sleep before I make the 5 hour drive back. Honestly may just kip in my car for a few hours, or ask a friend if I can conk out on their couch for part of the day.

Right now I need to get my hotel room ready for the morning. Have to take my suitcase out to my car and lay out my clothes, make sure I've done my going-over of the room because I would hate to forget something.

It's been nice being back in Ottawa. I like this city a lot, and have missed living here more than I realized. I'll be a bit sad to leave, to be honest.

I just really hope that I'm feeling better in the morning so I can at least work on my last day here.

Wednesday, 15 February 2017

Happy Birthday!

Today is my husband's birthday. I'm rather sad that I can't be with him tonight. He's sick, and the baby is just getting over being sick herself, so he's also tired. But from here I couldn't do anything for him for his birthday and I'm sad.

I will be seeing the family tomorrow. My husband is driving up with the kids tomorrow evening. I'm switching hotels as well, since this one isn't really ideal for having the whole family here for 6 days, though it's been workable for me for the last few days. It doesn't cost much more, but I wanted to save money where possible. There's actually a program that reimburses clerks for travel for one elective per year within the province, so I'm going to be reimbursed for my travel and accommodations, but I still wanted to be reasonable with my costs (even though my nightly rate at both hotels is below the cost limit.)

I'm a bit tired at the moment but it's more because I'm not sleeping well rather than anything to do with my elective. I'm not doing any call or anything, so it's just a normal 7-5 schedule (which I find amusing. A 'standard' week is 50 hours. Plus whatever call shifts you are scheduled for.)

The residents and staff I've been working with are amazing. Not that anyone at Mac wasn't awesome, but I really like the atmosphere here. It's different. Not better, but from my first few days I think I've just gotten my feet under me a bit better. I also really like being back in a bilingual environment. It hadn't occurred to me until I got here how much I'd missed hearing French regularly. My expressive fluency has also taken quite a beating over the last couple of years since I've not had many opportunities to speak with adults in French, so it's nice to be where I can use it. I think my desire to come to Ottawa for residency is certainly increasing.

This is a good city. My husband grew up here and I did live here for ten years, so we both know it well. While we did move to my home province after some rather difficult events (I knew multiple people who were murdered in a very short period) I have always liked Ottawa. Plus I know my way around well enough.

I'm very excited for my husband to get here tomorrow and be able to revisit his old stomping grounds and see his old friends. I think he's been wanting to consider coming back here himself, so I have a feeling he'll agree with me that this'd be a good place to go.

Not that I have complete control over that.

Still, it's so-far been a good trip. I'm enjoying myself. I just wish I could be home with my husband. At least the kids insisted he buy a cake, so they had that for dessert.

Sunday, 12 February 2017

Canadian Warp Speed

Ever driven quickly through heavy snow? My husband and I jokingly refer to this as going warp speed, because the effect is similar to how they illustrate entering warp speed on Star Trek.

We're nerds and we make no apologies for that fact.

I'm just settling into my hotel in Ottawa right now, having washed off the road after a very long drive. According to Google, the drive should take almost exactly 5 hours from my house to this hotel. I left my house at 1pm. I got here at nearly 10pm.

The weather sucks.

At the moment, I'm just reviewing hospital policies and my orientation guide for the morning. I am very much looking forward to getting started on my first visiting elective, though I am quite nervous. This is definitely a program I'd rank very highly, given the opportunity, but I know sometimes Mac students have a bit of a reputation of being less prepared than other clerks. It's something I've only really heard rumoured, and seen on the Internet, but I can't help but worry. Not only am I only a year and a half into med school, instead of 3+ the way other clerks on visiting elective would be, I only have one core under my belt at this point. I'm still learning the ropes as a clerk.

But I just have to roll with it. I think I'm very strong material-wise for this specialty, but it's the ins and outs of being a clerk that I'm still navigating. Learning exactly what is acceptable for me to do on my own, what residents and staff expect me to take initiative on, how much I'm allowed to do paperwork-wise before having something checked or signed off ahead of the next step. I know some of this is going to vary service to service and place to place, but I don't even really have a range of what's normal at my home school yet.

I generally prefer to lean towards 'check more/don't assume too much' but I know that can annoy residents and/or staff. I don't ever want to overstep, but at the same time I don't want to create more work than a clerk should.

It's a bit of a balance, and one I'm still working hard to find.

Still, we'll see how things go tomorrow!

Monday, 6 February 2017

Delivering Futures

I finished my last OB/Gyn core clinical shift yesterday morning. While I'm glad to have a bit of a break from clinical activities for the week, I'm looking forward to getting back to it next week.

OB is definitely an incredible specialty. Mostly fun, but it's also sometimes very sad.

During my time there, I saw the alarm activated for obstetrical emergencies more than once. It was incredible to see the nurses all swarm together, the residents jump to action, everyone finding their way to a place of usefulness (while I stayed out of the way as much as possible, which is how a medical student can be useful in these moments.) I was not in the room for the emergencies, but just seeing how all of these experienced care providers reacted to hearing that sound was pretty amazing. Everyone drops what they are doing to leap in and help these patients.

That is medicine at its most raw; when everything else takes a back seat to preserving life and limb. Time is brain. Especially for those tiniest brains connected to life by a half inch rope of jelly.

As a final assignment for this rotation, we have to write up a paper on an ethical scenario we encountered. I'm not having trouble finding one - I'm having trouble deciding which one of the many to write about. It's due tomorrow and I am absolutely not at all feeling bad about the fact that I haven't done it yet since I have been thinking about it.

The case I think I'm going to write about is one that was one of my two personal test-cases. My "if I can handle this, I think I really will be able to handle becoming an OB/Gyn" cases. I thought about writing about one of them here - in a roundabout, many-details-changed-for-privacy sort of way - but I decided against that since I don't know that I could sufficiently anonymize the story.

My thought about how much I need to change something for privacy before I even consider talking about it here is that I want to change it so that if the patient themselves were reading it, they would not recognize that I am writing about them. Because I'm still so new to clinical activities, I don't think I'm reasonably able to do that yet, so I will always, always choose to just not talk about a case rather than risk even the slightest possibility of posting something I shouldn't.

The only detail about the case I think I'm comfortable sharing is that it involved one of those difficult decisions that is unique to OB/Gyn: how much do we risk this patient's outcome to improve the potential outcome for that patient?

I suppose other specialties might see that in roundabout ways when they're dealing with resource limitations or in something like a mass casualty situation, but I think it comes up far more often in obstetrics. Really, it's interlaced with everything in obstetrics. The risk/benefit balance goes four ways instead of two.

The case I saw that most challenged me wasn't the one that I'll be writing about for this assignment, but it has been on my mind a lot. It was a cruelty of nature, not a failure of people or of medicine. Mother Nature is not a benevolent matriarch. I'm comforted, though, by the fact that there are so many skilled hands, at the ready, prepared to dive into the action when that alarm blares, when nature fails, when the blood hits the floor and all else is forgotten, to guide tiny lives through troubled moments and into the arms of their mothers.

That is where I want to be.

Wednesday, 1 February 2017

Chalkdust

On the wall outside a theatre back home, there was a big, black chalkboard. I think it may be gone now.

Up top, it said "Before I die..." and the remainder was a blank field of possibility. A box of chalk was attached to the wall nearby, tempting passersby to share pieces of themselves.

A few years ago, I was walking by and I stopped and read some of them.

Before I die...

...I want to get married.
...I want to have children.
...I want to go to Disney World.
...I want to have tacos for supper every night for a year.
...I want to see my children grow into good people.
...I want to fall asleep beside my wife every night.

They ranged from the mundane to the absurd. Some were clearly there as jokes, and some were profound.

I found a scrap of space where the ghost of someone else's confession remained in the scattered dust and with the dry rasp of chalk on slate I added my own words in a vibrant yellow cursive.

Before I die... I want to become a doctor.

So here I am, fifteen months from doing just that. I wonder if other people read that and thought it sounded silly. Or if they saw it and imagined some hopeful youth, in high school perhaps. I doubt someone would see that and imagine an exhausted, poor, fat, overly anxious woman who runs herself ragged between school and work and family.

I don't think I'm anyone's first mental image of a medical trainee.

But here I am.

In the last weeks, I have had the immense privilege of helping care for people, and there is no part of it that I have not enjoyed. I love deliveries, I enjoy suturing. I like observing surgery. I like assisting with surgery (even though at my level of training 'assisting' means suctioning, cutting sutures, retracting, and sometimes helping close. Still cool, though.) I like talking to patients and their families. I like rounding.

I like all of this.

Even the paperwork. Once I figured out what needs to be done, I'm glad to do it. I know the residents and staff have less time for that part of things, so I'm glad to do it to get in the practice.

I've not yet encountered anything that makes me go "ugh, not again." I realize it's only a few weeks so everything is still fresh and new to me, but I can easily picture myself doing this all the time. Days in, days out.

I do not feel that way about every part of my other clinical exposures. I think it's telling that I'm at the end of my core and I am really, really happy that I have 6 more weeks of OB/Gyn ahead of me.

Before I die... I'm pretty sure I want to be an OB/Gyn.

Perhaps, when I'm home for my two week emerg elective this summer, I'll take a walk downtown and see if that chalkboard is still around.