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!