At the end of this whole long road, here’s my piece of paper. No fanfare, I just quietly picked it up at the building where six years ago I had my Mac interview.
Monday, 15 March 2021
At the end of this whole long road, here’s my piece of paper. No fanfare, I just quietly picked it up at the building where six years ago I had my Mac interview.
Friday, 1 January 2021
On the other side of the long, long dark, when once again we meet,
We'll breathe an unmasked sigh of relief.
Welcome to 2021; hopefully a much brighter year than the last.
I personally have a lot of things to look forward to in the coming months. Firstly: COVID vaccination.
The rollout of vaccines has been especially slow here in Ontario. That little shot of hope hasn't made its way to me and honestly I'm starting to think I might not get it until I get home to the Island. They've at least vaccinated their health workers.
It's just a matter of weeks at this point. Weeks until I have some protection that doesn't rub my ears and make it harder to communicate with my patients.
Weeks until I have something within me but my wits and diligence to fight this virus.
Right around the time we leave this province, and head towards one that has a far, far lower disease burden.
As it stands we're getting the move preparations checked off the list. I'll be leaving ahead of the family by about 3 weeks. Bringing one dog, one cat, and two birds with me and will be isolating in my parents' basement. I can work while isolating, so I'm planning to arrive a couple days before my first shift.
Once my isolation period is done, I'll have a week or so to find us a place for the start of May and then will return to Ontario and help finalize the house preparations. We'll let the landlord use the last two weeks of April to repaint/replace/repair (there's some stuff that's just sort of worn out as it was old when we moved in 5.5 years ago) and then we'll isolate in a cottage on the Island before moving into a temporary place.
Plan is to rent a place for just a few months, even if it's just a vacation rental. We want to buy a house towards the end of the summer, and we want it to be our forever home. No more moving.
That is definitely something to look forward to. My last move.
A nice thought to start the year on.
Happy New Year, all. I hope you had safe celebrations.
Wednesday, 18 November 2020
There's been a lot of back and forth on my blog and social media about where I'll settle and what I'll be doing when I get back there.
My husband and I had a good, long talk and realized that everywhere we've considered going, we've been comparing it to the Island. We've been looking for PEI everywhere we've considered. And we realized that if we settled here even for a few years, we'd almost certainly end up stuck here, because our oldest would be almost at the end of high school, which is an awful time to move. But then our older daughter would be in high school, and we'd be stuck for longer. Then I would have a practice here and would feel I would have to stay.
If we stayed for two years, we'd be here for decades.
So because of that - and for a few reasons I don't really feel like sharing publicly - we are going home.
In March, I'll be starting to do some emerg locuming at a rural hospital with an emerg that is more urgent-care-ish with the occasional all-hands-on-deck situation. Closer to the summer, I'll be adding some shifts to cover absences at the provincial tertiary centre which has a great team.
The goal is to work towards my CCFP-EM credential. I need at least 400 hours a year at the larger hospitals in the province due to the new requirements for emerg time to count towards exam eligibility, but I'm confident I can get that.
I'm sort of accidentally becoming a full time emerg doc for at least most of next year. There are some things evolving (eg. with respect to group practices, reproductive health, etc.) which mean I should eventually be able to settle down into part time emerg/part time clinic, but the exact way that's going to work hasn't quite settled yet.
Overall I'm quite happy with this outcome. My kids are happy to be going home. If schools close, we'll be leaving in March, but otherwise I'm going to travel back and forth for a few months until we move the family.
We're going home.
Five years ago, when we left the Island, I had a hard time with it. I cried as we drove over the bridge. That place has been the only place I have ever considered my home and leaving it behind was very painful. As soon as we decided we would go home for good, a weight was off my chest.
With 17 weeks of residency left to go, I'm raring at the bit to get it over with and just get home. Even though it will be snowy and cold and more than a little dreary, I look forward to the crisp air and the rolling hills and the beautiful vistas that I have so dearly missed.
Monday, 19 October 2020
Wrote my CFPC exam on Thursday and honestly found it very easy which means I either did really well or completely bombed it. I'll know sometime in December.
A few hours before my exam, I got an email saying they've cancelled my sitting of the MCCQEII on October 25th. Because of the second wave of the pandemic that was *incredibly* predictable and a bunch of people told the MCC would likely be happening in October. But still they wanted to push ahead with trying to cram a bunch of people *at high risk of exposure to COVID* into one place for an unnecessary in-person exam. Everyone knew this would happen!
The exam was going to be modified such that we were not going to actually physically examine the patients. We were going to stand on one side of the room and describe what we would do.
Why this could not be done virtually, I have absolutely no clue.
Frankly, I do not think the MCCQEII adds anything that my competency-based residency program doesn't already evaluate me on constantly. I personally do not think this is an exceptionally necessary exam, particularly for family medicine - and other generalist - trainees.
But they've insisted, so I have to sit the exam. Only now I can't. The next sitting is in February and that's essentially full. I've emailed them to ask to be considered for the February sitting because I'd really prefer to ensure I have finished this before I am finished residency and I've now had two attempts to write this exam cancelled.
If you're sensing some frustration, I am indeed quite frustrated.
Most likely I'll be able to apply for provisional licensure with supervision until I've been able to take the exam. It's just a pain in the behind, and more paperwork, and potentially delays to getting started working.
I just want to work.
Tonight I worked my last ever shift as a resident at the Hamilton hospitals. I've been on paeds emerg and it has been such a fantastic place to work. It's really just been such a relaxing rotation, and I've really enjoyed the team. It's incredible to show up and have everyone be happy at work. Something only seen in paeds world.
It's also the same hospital where I did my first clinical rotation of clerkship, and it's attached to my former med school so it's been the site of a lot of the best parts of my training. The last five years have felt at times very slow but overall seem to have flown by in the blink of an eye. Five and a half years ago, I had my Mac interview in that building. It felt significant to work there tonight, and to be saying goodbye to it as a trainee.
To be fair, I'll be back there next week for blood work so it's not like I'm actually permanently leaving it, but I'll be there as a member of the public, not to work. It feels different.
I'm almost not a resident anymore.
There are so many lasts lately. My last shift at my home base hospital (and probably the last time I'll ever be there as a resident) was back in August.
From here until attendinghood, I'm only scheduled to work in my clinic. That's it. It's clinic from here until the end.
With frustrating things like this delayed exam and the paperwork I'm going to have to deal with for that, it's easy to get wrapped up in the things that drag on, but really this time has flown by. I'm almost a fully licensed doctor.
Tuesday, 13 October 2020
Results came out last week and I did not get any PGY-3 emerg interviews.
19 programs. Almost $1000 in application fees. Weeks of work. Getting up the guts to ask people for letters - not an easy thing for me - and then putting myself out there and agonizing over my letters.
All that and not even a single interview invite.
I'm sad. Rejection is hard. Perhaps it's been easy to get a bit complacent. I mean, I got into med school on my first try and I got my first choice residency program. I guess I was sort of expecting I'd at least get a couple interview invites.
But I didn't, so that's that.
It came as a bit of a kick to the confidence, coming less than a week before writing my CFPC.
That said, I'm glad at least that I was just flat out rejected everywhere and didn't get like one interview at a low-probability-of-matching school. That would have dragged things on for another two months before I knew what was happening next year. At least this way, I know right up that as of March, I'm an attending for good.
Well, that's mildly terrifying.
Attendinghood ahead. 5 months to go.
Yikes. Very yikes.
Assuming I pass my exam this week, and the other one at the end of the month, I'll be done.
My parallel plan to doing a PGY-3 EM was to see about some emerg mentorship in addition to clinic work. I've been in contact with one of my previous preceptors. His clinic is great, and I really enjoyed working there. It's well-resourced, well set up, and I like the area it's in.
So we're starting the process to plan our next steps, and much to my surprise it involves staying in Ontario longer than planned. This plan has evolved over the last year or so as I've realized that it makes sense to have a good, solid foundation in practice and some capital before we pick up and move our family a long way. It makes sense to spend my first couple years in practice near where I trained. I'm not moving too far from the nest as I spread my wings a bit.
Additionally, with this area there is at least one hospital (probably two) where I can do some supported/mentored emerg work and build my skills. Then I'll have a few years of experience which will be useful in getting emerg work when we head back to the Maritimes. The people who've known me as a trainee are more willing to nurture me as a new grad, and then I'll have a foundation and I can move on.
Even though I am sad about not meeting my PGY-3 goal, my parallel plan (not backup) is equally exciting. I'm going to be an attending in five months.
Five months until the cotton wool of residency falls away.
It's scary. But also exciting.
Monday, 28 September 2020
I'm writing my CFPC exam next month. Ten days later, my MCCQEII.
Each exam has a required COVID screening before we're allowed to write. Obviously if I'm sick, I'm not allowed to write. If anyone in my house is a confirmed case within 14 days of the exam, I'm not allowed to write. And if my children are awaiting results of a COVID test, I'm not allowed to write.
This presents a logistical issue.
If you're not aware of the situation in Ontario right now, basically kids are sent home for any even peripherally possible COVID symptoms. Two hour runny nose because of allergies? Mild cold because your classroom of 25 kindergarteners all have the autumn yuck and half the kids have already been tested negative for COVID? Sent home. Require 14 day self-isolation or a negative COVID swab and 24 hours symptom free.
Because few parents can manage a continuously rotating cycle of kids on 14 day self-isolation (keep in mind - CERB has ended so there's no financial backup here) they are flooding COVID assessment centres for swabs for tiny people with seasonally appropriate runny noses. And I'm doing a boatload of NPSes on little kids who really don't need them and who are leaving the hospital upset and scared. It's taking up to a week to GET an appointment and then up to a week for results to come back. So essentially you're stuck home with a kid for 10-14d because they had the sniffles for a few hours.
What working parent can afford this?
I've booked two weeks off in October and will probably just be pulling my kids from school for the month. My husband is going back to work and we REALLY need his income so that we can afford all my fees to apply for my independent license and stuff. Plus there's a long break in income once the resident salary stops and before I start getting my billings paid. It's going to be a very lean spring before I start getting attending money and so I'm not sure what we're going to do over this winter.
My older two kids can easily stay home by themselves if they are sick or quarantined, but M and R can't. And if they're on self-isolation I can't just bring them to work with me for the day and stick them in an office with an iPad while I see patients. Maybe I can toddlerproof my bedroom and do virtual visits from home so I'm not missing too much clinical time?
I don't know what to do.
The only thing I can think of is for my husband to try to find an evening or night job for the next few months so that there's always one of us home. We wouldn't see each other, but it would be something.
Maybe we'll do that.
This winter is going to suck.
Five and a half months until attendinghood.
The finish line is close.
I just feel like I'm going to be staggering once I get there.
Wednesday, 23 September 2020
Every doctor has a graveyard
Sometimes we stroll along the rows
and lay flowers at the feet of stones where lie our greatest teachers.
The patients we didn't help
or ones we did
but whose lessons stayed with us
long after the chart was closed.
The stones grow heavy as the years roll on
And the path grows long
But the grass grows best where it is watered
and sweet smelling flowers will bloom where seeds are planted
So mind your lessons
And tend the memory of those who taught you best.
Thursday, 20 August 2020
Due to a scheduling hiccup, today I ended up working with an attending who I last saw two years ago, just before I went off on maternity leave.
At the end of the day as he was giving me feedback, he told me that I'm ready to be done. "You are ready. You're good at this."
It was comforting to hear that when I still have over six months to go.
While thinking about the time remaining in my residency program, I realized this evening that my time at our home hospital is coming to a close.
My next two blocks are in emerg at other hospitals, and then I am in my home base clinic until I finish residency in March. I'm not scheduled to return to my hospital... ever.
Because we are currently doing our academic days virtually, I have no reason to return until or unless we return to in-person academic days.
It is making the end of residency feel so very close.
Today an email came out looking for MF2 clinical skills tutors, and the timelines work well for me since the first years start MF2 right after I finish my MCCQE2. I love to teach, but I'd rather teach MF3. Only I realized I might actually be an attending by the time they finish MF3, so I'm not sure I can.
I have my schedule that goes until 3 weeks before my CFPC exam, and will probably have my schedule for that period soon.
My exams are speeding towards me rapidly, and they're the last big hurdle. After that, it's just checking boxes on the rather lengthy list of things-residents-do to ensure my requirements for completion are met.
I'm already in talks with people about where I'll be working come March. I likely have at least a couple locums I'm going to be able to do, as well as some hospitalist work. Definitely won't have any shortage of work in the months leading up to fellowship, if I get one.
It's entirely likely that the next time I arrive at my hospital after Monday, I'll be an attending coming there to work.
That thought is staggering. How has residency gone this fast?
My attending thinks I'm ready.
Monday, 17 August 2020
Impostor syndrome is basically my natural setting.
Despite things working out for me well over the last eight years - with some hiccups along the way - I still always feel as though the rug is about to be pulled out from under me. As though at the next minute, someone is going to come along and tell me it was all a mistake and I was never really accepted to medical school and that I really don't belong.
Even though I know that I actually am pretty good at this job, I never really feel like I belong here. I don't feel like I'm any good, and I don't feel like I deserve any of the positive stuff that's been said about me.
I constantly feel like a fraud.
So going through the CaRMS process is unearthing every single one of my insecurities yet again. Because what I am doing is going and asking programs to rate me, to judge me, to decide if I belong. To decide if I'm good enough. Worth investing in.
Even my own parents didn't feel like I was a worthy investment, so why would anyone else?
I am having a hard time with this. Every day I go back and forth, thinking I should just cancel my application, that there's no way I am good enough.
Then I head into the ED on one of my admissionist shifts and spend time with the docs who know me, and they all have some new nugget of learning, and some are asking me when I'm going to joint their ranks, and for a few minutes I think, just maybe, that I might be able to make it work.
I'm still waiting to hear back from my PD about whether she will write me a letter. If she doesn't, I essentially won't succeed. Almost every program requires a PD letter. There are 3 programs I'm applying to that will accept a site director letter instead. My PD does not know me especially well. As I'm at a distributed site, the only time I've come to her attention is when there's been administrative stuff. Like me being sick, or needing disability accommodations, or having issues with hours around my mat leave.
I doubt my name has ever crossed my PD's desk in a positive way. How on earth could she write me a supportive letter? She's actually really nice and every time I've encountered her she's been reflective, wise, and caring. So I don't think she would ever do anything to intentionally mess up my future, but it's entirely possible that she may just not know me well enough to be able to say anything good about me as a doctor and trainee.
I think I might ask to have a call with her. My evaluations have always been exceedingly positive, and I've done a lot of teaching. I'd like to share those things with her so she can see that even when I do deal with limitations, I'm still a good resident. Still a good doctor. Still worth investing in.
But that email asking for a phone meeting is still sitting in my drafts. Because every day, I vacillate between whether or not I should even apply.
I struggle to believe in myself. Why would anyone else?
Tuesday, 4 August 2020
Thursday, 16 July 2020
So, naturally, I made a bunch of jam because I've been pretty relaxed the last little wild so why now?
This is my schedule for the rest of residency:
Block 1 (now): FM + FM-OB + Rural EM elective with a fantastic preceptor
Block 2: Admissionist (was supposed to be EM but there was a scheduling hiccup)
Block 3: Adult emerg
Block 4: Paeds emerg
Blocks 5-9: Family med, plus the academic portions of block 7.
I also have a few days of block 10 which will be family med as well. But then I'm done. March 15th - my 34th birthday - is my last day of residency.
Can you believe it? Nine years after starting this whole wild ride, I'm going to be done. An independently licensed family physician.
That's bloody terrifying, just to be clear.
On a related note, I'm also in a jam because my October is looking like a mess.
October is when I'll be writing my CFPC exam.
Also my MCCQE2.
Also the birthday month for both of my daughters.
Also when PGY-3 EM interviews are.
Oh, and I'm going to be on a paeds emerg elective at my #1 PGY-3 emerg site choice. So, you know, need to be working hard.
November 1 is going to be such a relief this year. I'll probably book the day off just to sleep to recover from the wild ride of October.
Oh wait, I ALSO NEED TO FINISH MY RESIDENCY PROJECT.
It's crunch time now with just a few months ticking down quickly. March feels both very far away and very close. It seems to depend on the day.
Right now, I'm going to go finish my presentation for MHBS. Because that's one more checkmark I need to graduate. I'm into checklist-completion months now.
Want some jam?
This is missing the multiple jars my kids have eaten and the ones I’ve given away. There is raspberry, strawberry, plain mulberry, mulberry/blackberry, mulberry/strawberry/blueberry, and mulberry syrup.
Naturally, taste tested on fresh biscuits.
Wednesday, 24 June 2020
You would be wrong.
I despise writing personal letters.
For one, there are all sorts of expectations. I'm writing for an audience that wants to see specific things. They probably don't want to see me nattering on about my children or my plans for my mobile reproductive health clinic (yes, I plan to do this. Stay tuned!)
I have to write about why they should consider me for an emergency medicine fellowship.
IMPOSTOR SYNDROME ALERT
It's hard to convince someone else that they should let me do a thing when my brain keeps telling me that I'm not good enough to do the thing.
These programs are exceedingly competitive to get into. Research is usually expected. About a third of residents applying to FM-EM at the English schools do not match. On paper, I am not that impressive a resident. I'm not a chief, I don't have research or presentations, I've only done one block of formal teaching and I haven't done any amazing superstar things.
I have my POCUS IP, I've taught preclerks, and that's kind of it.
Now, I am a good resident. I work hard, I'm smart, I get along with people, I'm honest, and I love to teach whenever I get the chance, though it happens less at my site. But my focus is and always has been on being the strongest clinician I can be. I'm not and never have wanted to be a big name academic physician so that's not the way I've planned my career. And honestly I only decided about two months ago to apply to the PGY-3 emerg so it's not as though I've been aiming for this for a particularly long time the way many have.
All I can really do is hope that what I do have to offer will be enough.
Thankfully, interviews will all be virtual this year so the only cost to me for this process is the ~$700 I'll be paying to apply broadly.
But I need to write all these blasted letters first.
Can I just submit a link to my blog?
Sunday, 31 May 2020
I get to look all fancy and doctory in my new work headshot.
Monday, 11 May 2020
Thursday, 30 April 2020
Monday, 27 April 2020
This is Jedi. We adopted her a few weeks ago.
Wednesday, 15 April 2020
The first couple of shifts were all about re-learning where forms are and what work processes have changed. Third shift was downright relaxing, though.
It feels like holding your breath before diving into cold water. You know the shock is coming, but not yet, not yet. Just a little longer.
The emerg is so quiet. We're seeing just a handful of patients a shift. Even the attendings. I was sent home three hours early the other day, because there were two attendings and almost no patients.
It's incredible. I've never seen any emerg like this. Many patients who are coming in are sicker, but overall there are fewer.
Everyone is a little on-edge, being extra careful about their PPE and hand-washing. We're being careful with mask use, though we're not at the point of severe limitations by any means, just caution.
THe effect of this all on patients is clear. Many are afraid to come in even when they really probably should. When they are there, they can't have a support person with them (with some exceptions; eg. minors, needing translation) and everyone they see is masked and likely gowned. It's just a different environment than they may be expecting.
Honestly, it's just downright strange to see empty beds in emerg. I am used to departments working over 100% capacity.
It's become very apparent that as much as emerg docs may enjoy the occasional less-wild-than-usual shift, quiet is definitely not the natural setting for this specialty. The poor emerg physicians don't know what to do with themselves when they're used to working flat out all the time.
The other thing that has become very apparent is that I'm starting to see myself as an emerg doc and that's been a weird thing to realize. My interest has always been in reproductive health and then halfway through clerkship I did that emerg rotation and loved it. It surprised me a lot how much I enjoyed it during clerkship and since then I've been sort of inching towards including emerg in my practice.
At this point, I'm pretty sure that I'm going to be applying for the PGY-3 in emerg, though only at a few places since we don't want to split up the family (I don't mind having a bit of a commute) as well as the 'build your own' enhanced skills training that Mac offers so that I could do an additional 6 months for extra skills plus some additional deliveries.
I'm not positive anymore that I'll do deliveries out in the community, as much as I love them. The practicalities of doing intrapartum obstetrics aren't great and unless I can find a good group to work with, it'll be nigh impossible.
But I still want to keep one foot in the community, so I still think I'm going to do a reproductive health focused part-time practice. Sexual health, pregnancy care, lactation medicine, etc. Lots of family medicine trained emerg physicians have part time outpatient practices; sometimes as FM, sometimes in things like sports med or pain clinics. No reason I can't do EM and repro.
Of course a lot will depend on what's feasible once I'm in the working world. It's a lot easier to plan things as a resident than an attending.
Right now, though, my plans involve getting through my next shift without getting sick. And then the shift after that, and the shift after that.
Attendinghood is still a year away. COVID is right now.
Sunday, 22 March 2020
Tuesday, 17 March 2020
We went for a walk to see some waterfalls. My oldest, naturally, has to play the sullen teenager.
Since you can’t see R’s face in the other one, here he is, enjoying a powdered timbit. He’s almost 18 months now.