Monday, 15 March 2021

Denouement

Happy birthday to me 

I’m done RESIDENCY!



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. 

It’s a strange feeling to be done. I’m not a resident anymore. I’m an attending. My license for the Island will be issued in the next few days and next week I start working as an attending in emerg. 

Frankly, I’m nervous. Very. There is so much to know and be able to do and while I’ve spent residency seeking out skills, there is always more to learn. There are things I never did as a resident but will have to do as an attending. That’s the reality of medical training; sometimes you’re just taught how to do something but never actually have the opportunity to do it in vivo. 

All I can do is keep learning and pushing myself to be better. Do what I did during residency - read around cases. Continue listening to podcasts. Go to sims when available. Go to conferences. I just have to push myself to keep learning. 

I can’t know everything. But I can and do know how to figure it out. That’s what residency is for. We learn the foundations of how to be doctors, and that includes how to answer a clinical question. 

Doctor means teacher. 

But we’re the students too. 

That’s a big part of why I’m in this job; the lifelong learning. And the fact that it is not only expected but requires going forward is something that gives me comfort. I’m not expected to be a doctor who knows everything right now. And that’s okay. 

I’ll be okay. And so will my patients.

One foot ahead of the other. Treat the patient in front of me. Just get through the shift. 

I can do this. 

For the last nine years, I have accomplished one difficult thing after another and even though it has been hard it has been possible. This next challenge I will treat the exact same way. 

For today, though, I’ll celebrate. I made myself a cake and I’m sleeping in. Because have I ever earned it!

Friday, 1 January 2021

The Long, Long Dark

 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

Next Steps

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

CFPC ya later exam...

 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. 

Wow. 


Tuesday, 13 October 2020

Bummer... bummer... bummer... (keep going)

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

Days are dripping away

 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

The Gravestones

 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

You Are Ready

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. 

Do I?

Monday, 17 August 2020

Impostorism

 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

Blocks

It should be obvious after eight years of me writing a blog about my life that I enjoy writing and will find even the flimsiest of excuses to write a lot. 

Even when I am not posting here, I'm regularly churning out a thousand words per day minimum. Poems, opinion pieces I never send anywhere, stories, informative posts for groups I'm in, etc. Writing is only one of my hobbies but most definitely my most cherished one. 

But the moment the file is titled "Personal letter" my ability to write evaporates and I am left stumbling around the keyboard with as much talent as one of my birds, and just as likely to crap all over everything (figuratively, of course.)

The FM-EM CaRMS process opened today and my personal letters are still terrible. The ones I have finished are staggering under the weight of the cliched lines they contain. The ones that I haven't started are staring at me from the folder where I saved my documents. 

I need to get a move on.

Also, still need to talk to two people about letters of reference. Much harder to get in to talk to someone in person with COVID. 

Have I mentioned how much I despise asking for letters of reference? It is so awkward, even if a necessary evil. 

"Oh hey, person I admire who I worked with for a while, can I ask you to take time out of you incredibly busy life to write a letter that checks several boxes for my career prospects?"

I just... hate it. The process feels artificial. But I've got six weeks to get my stuff together and apply. 

And I am applying almost everywhere. We decided to cast a wide net this year; basically anywhere we can afford to live. That excludes Toronto, Vancouver, and all the programs in Quebec (salary is significantly less.) Pretty much everywhere else I'll be applying, though. We have friends or family almost everywhere, and I've lived in five provinces so I know roughly what to expect from coast to coast. 

Though I would in fact be happy to match anywhere, I have to admit I am definitely more enthusiastic about some programs, and have one top choice that is leagues ahead of the others in my estimation. But it's also much smaller than average and quite competitive so I know my chances aren't great. 

I am operating under the assumption that I will not match, and am creating a parallel plan to prepare for that eventuality. If I do match, all the better. 

For now, though, I need to get through these damned personal letters. 

I've made more progress on this blog in the last hour than I have in these documents in the last six weeks. 

Time to get to it. 

At least it'll save me from having to spend too long thinking about my husband's surgery tomorrow. I'm trying not to be nervous. I know it's safe. But my brain still goes places, so this is at least a semi decent distraction. 

Thursday, 16 July 2020

Life in a Jam

Title refers to my current hobby: I've made almost four dozen jars of jam in the last few weeks. My mulberry tree has been very productive as have my raspberry bushes and strawberry plants. Also picked a few flats of strawberries too.

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. 

Kay

Wednesday, 24 June 2020

Uuuuuuuuuuugh... personal letters

You would think that after writing a blog about my life and career for more than eight years, I would be able to punch out a handful of letters about that exact topic in the course of an evening.

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

Trifurcation

With nine months to go before I finish residency (holy crap) I have three options. 

Option 1 - go straight to work as an attending; either do some locuming or just find a grown up job to start.

Option 2a - A bit more training. Something like SEME or a bit more residency via one of the “choose your own” programs. Mac has one, there are options through ROMP as well. 

Option 2b - A bit more training but as Emerg mentorship. This means working as an attending in emerg as a second doc; managing lower acuity and being supported by the first doc with higher acuity patients. 

Option 3 - PGY-3 FM/EM

Option 1 is appealing because, well, money and schedule. I get to start working on my debt and save up a bit to relocate the family and buy a house and just... be done with training. I’ll have more control over what I work. Biggest problem with this route is that the hospitals near where we want to live require CCFP-EM to work in the emerg so if I go this route I’m going to need to work somewhere besides where we want to live, at least for four years while I accrue the hours to challenge the EM exam. Or I give up emerg.

Option 2a is appealing because I can do some work as an attending between when I finish and when I start the additional residency months. In fact, right now I’m applying for 3 blocks that would start in March so I’d actually just finish up in June. It would mean I’d have more control over the additional training time I do. I could choose the blocks I do and include some OB as well. Downside: not a path leading to CCFP-EM and potentially of limited use with getting a job but useful for skill-building. It’s also more time as a resident which is great because benefits but also crappy because I’d still be making resident salary. Although I could moonlight. 

Option 2b is great because I’d get paid as an attending, I’d have some flexibility with where I work (there are multiple options) and it’s not for a set length so I could potentially just do it for a while. It does tend to be more limited shifts since you can’t be solo doc. I also wouldn’t want to just show up somewhere and have them assume I’m staying forever when I really just want to be there to train for a while. Also hard to say whether it’d be reasonable to move the family so would I be away for a while? I don’t know. Lots of unknowns. Most of the places with these sorts of arrangements are in Ontario, so it’s likely it would keep us here longer. It’s also not a formal route to the CCFP-EM credential so while a couple years of this could help with getting an emerg job back in the Maritimes, it would still take me a while to get the credential which may limit my employability. 

Option 3 is looking like a probable route for me, if I get a match. It’s a year of an intense and crappy schedule - REALLY crappy during some blocks - and will probably require 1:4 call on several really intense blocks like CCU and ICU. It’s another year of being a resident, having no control over my schedule, getting paid as a resident (although I can moonlight.) It also may require moving the whole family for just one year which would suck. Or could mean me leaving for most of the year, which would also suck. But it’s the fastest and most direct route to the CCFP-EM which would then mean I could work in the ED at the hospitals near where we want to live instead of it taking another four years before I can manage that. 

So... things are undecided. I don’t know what I want to do. Have so many options and don’t know what to decide. I really don’t want to spend another year as a resident; I want to be an attending. I want to start paying down my debts and buy a house and just get on with living the life we’ve been waiting for for so long.

But I also really want to be able to do the sort of work I feel like I’m really good at and that will keep me interested and engaged for many years to come. 

It’s hard to decide these things. 

You’d think, eight years into this whole journey of uncertainty and indecision, I’d finally have a clear path forward and I’d know what I was doing next. 

But right now I feel about as certain as I did before I applied to med school. 

Who knew it’d still be like this almost a decade later?


I get to look all fancy and doctory in my new work headshot. 

Monday, 11 May 2020

Quaranteens

My oldest is a teenager now. Hard to believe that happened, considering he was five years old when I started this blog (eight years ago Sunday!)

He’s basically what you expect of a teenager. A bit surly. Very sarcastic. Enjoying his independence. Hides out in the basement playing video games and surfaces frequently to eat inexplicably large volumes of food. 

He is also hilarious, helpful, a wonderful big brother, and a solid and dependable kid. He’s 5’6” now and will probably hit 6’ easily within the next couple years. Three years ago, I would not have believed that he’d be the kid he is now. I hoped for half as much growth as we have gotten and I am so damned proud of this kid. 

My older daughter is 9 and nearly a teenager already. All about video games and meme culture and exploring new ways to dress and express herself. 

The last few months have seen her shed her babyishness. She’s shot up in height and is developing a maturity about how she thinks that I think exceeds her age. She’s clearly still very much a nine year old in some ways but then sometimes I can’t help but wonder where my tiny little girl went. 

She is my whirlwind child; all intemperate energy exhausted in a burst of enthusiasm, leaving behind the post-storm quiet afterwards. 

When in-person school was cancelled back in March, I wondered how this would go for these two kids. My husband and I had considered the option of online schooling for the both of them previously given the difficulty inherent in a traditional classroom environment for autistic kids and kids with ADHD. We figured an environment with fewer social pressures would be helpful. When the online schooling plan started, we hopped on. 

Slowly, they’re acclimatizing to this modality for doing school work, but more importantly they are thriving. 

These two kids have long had challenges socially in school and it has been reflected in basically a complete shutdown from both of them when it comes to academic work many times over the years. But being home, I am seeing the lights turn back on and I am seeing them both so very happy in ways I have not seen in a long time. 

C is talking so much about the future and about what she likes to do and she’s so much less shy and withdrawn. She’s trying new foods (this is a REALLY big deal!) and exploring new ways of expressing her individuality. She’s making arguments to support her points instead of just whining or stomping off to her room in frustration. 

And bit by gentle bit, she’s engaging academically too. Today we did some geometry work and it took maybe five minutes of me teaching before she understood the concept. We spent 45 minutes sitting on my bed talking about the topic. 

She would stand and sit and walk around the room, go look out the window, draw on the backs of the pages, play with a blanket, sing a song, and otherwise just ADHD’d the whole time, but she still finished the work on her own terms, and she did well. She learned the lesson she needed. 

My oldest is pretty independent with his work now. He sits down at the start of the week and makes a list of his lessons and assignments. He asks us if he has questions. But more importantly he talks about the topics and explores things with us. 

And he is happy. He’s smiling so often. He goes and plays with his siblings joyfully and is glad to help out. 

There has not been a single behavioural blowup with all of this going on. Two or three years ago, this level of upset to his routine would’ve caused weeks or months of difficulty for him but now he’s thriving and happy and he is doing so well. 

I’m so proud of these kids. While the world slowly tries to figure out a way forward, they haven’t just made the best of a bad situation, they have used it to grow even further. 

Now, as for the two toddlers... send help. 






Thursday, 30 April 2020

The Slightly Less Fat Lady Sings

Last spring I posted about my plan to have bariatric surgery.

My surgery was in late November. I am about 70lbs down now and while I do notice my clothes fit differently and I’m down several sizes, I am dealing with the fairly common issue after these surgeries where I do not perceive myself as any smaller. 

One of the things I was hoping for after surgery was for my RA to be better controlled, but unfortunately it’s not. Still really need the biologic and sulfasalazine to manage.

My asthma control has improved, though, and that’s awesome. Haven’t had to use my ventolin in the last week! My goal is thirty days, and then being able to make it through bike riding without it. I doubt that’ll ever happen, but I can hope. 

I don’t have much stamina yet but I’m working on it. I eat on average 800-1000 calories a day (supposed to be 1200-1400 at this point but I can’t tolerate that yet) so that’s just enough to keep me going through the day with my regular activity. After this surgery you have to prioritize protein based foods which I do, but it’s really hard when you can only eat small amounts of meat at a time. 

Most of my food right now is protein drinks, cheese, yogurt, hummus, and tuna. Veggies and I have a love-hate relationship. Much as I love them, they hate me. My tiny stomach can’t manage uncooked veggies yet. 

And it’s funny how many foods you become averse to after this surgery. One of my favourite meals forever has been apple oatmeal. I’m five months post-op now and can only just now manage little bits of apple, and the thought of the mixed texture oatmeal is just... bleh.

Overall the surgery was a really good idea. It’s nice to know I’m doing what is necessary to ensure I’m as healthy and functional as I can be for as long as possible. I feel like I’m setting a good example for my kids by prioritizing my health and following the evidence instead of fads. 

The recovery sucked. It was a rough few weeks. But I feel good now, and I know I’ll feel better as the next year and a bit (when it’s expected I’ll hit my nadir weight) roll by. 

The one downside is that I’m now one of those people with blood pressure that’s a wee bit low (as opposed to normal, which it always had been.) That combined with my tendency to drop my heart rate into the 40s if I eat more than a half a cup of food has combined to make me very prone to passing out. The other day at work I was just standing with my attending and dropped all of a sudden. It happened back in February too.

I need to load up on salt and caffeine before I do anything which involves longer periods of standing. Really. That’s in addition to compression socks, lots of fluids, leg exercises, and rising carefully. 

So there is a downside (gravity) but otherwise it was a very good decision and I am happy with how things have gone. I would just prefer to pass out at work less often.

Monday, 27 April 2020

I’m Bored

I have four consecutive days off. 

This doesn’t happen. I’m a resident; synonymous with “works a lot.” I triple checked my schedule and it’s true, I was actually scheduled off for Friday through Monday.

Thank you, person who makes the schedule. Not only has this elective been fun, it’s relaxing too. Probably not what people assume when it comes to emerg. 

My husband and I have been talking more about the plan to apply for PGY-3. The more I’ve done emerg, the more I’ve realized that when crap hits the fan, I want to run towards the chaos and help. That’s my reflex. I never would have thought this about myself years ago, even though I’ve always challenged myself to not be a bystander. It never occurred to me that this was something I’d enjoy doing, not just something that felt like an obligation. Part of being a good person. 

But I do actually enjoy being in the middle of things, much to my surprise.

Which is why it’s been a tiny bit frustrating lately. Obviously when booking this elective a year ago, I was not anticipating it would be during the peak of a pandemic. A big part of why I booked it where I did is because it’s where I could get more procedural skills in acute, majorly ill cases. But because of COVID, they are (reasonably!) being very protective of residents. Which is wise of them, and I am grateful that the attendings and the program are looking out for us. 

But damn is it frustrating that I basically am not allowed to do the things that I specifically came here to learn. 

This is three blocks of emerg as a resident (with 2.5 - CMS and elective - to go) and I just feel the need for more acute management skills.

Who’d have thought a pandemic would actually make it more difficult to get skills in managing acutely ill patients?

That’s part of why I think I need more training. Its all about volume. All I read cannot replace being hands on with patients. 

And I’m, perhaps somewhat selfishly, hoping that the pandemic may slightly decrease the number of applicants for emerg PGY-3 this year. 

Also, boredom led to this:



This is Jedi. We adopted her a few weeks ago. 

Wednesday, 15 April 2020

In the ED

I'm currently on elective in emerg at one of the main hospitals where I did clerkship, and I'm enjoying it so very much.

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

In The Deep of the Morning

Don’t know if anyone has noticed but I’m posting around 1am most days. 

It’s because I can’t sleep with all this rattling about in my head. 

I wouldn’t say I’m anxious, precisely, but I am... pensive. Weighed down by the mass of all the thoughts rumbling about in my brain. I honestly haven’t gotten to sleep before 4am in over a week.

In some of the Facebook physician groups I’m in, fellow physicians - it’s been a while now since I got over the hurdle of being unable to think of myself as a doctor - are talking about their plans. How they’ll isolate themselves from their families indefinitely. How they’re updating their wills. Ensuring they have signed medical powers of attorney in case they cannot make their own decisions. 

There is a weight to this talk and it settles in the soul and reminds us that this job, this vocation, this calling, it has a cost. And it may be everything. 

Even with PPE - if we don’t run out - and caution the risk of infection is there. 

My kids will almost assuredly be fine. They’re robust little people and the illness seems far milder in the young. But what of my husband, who had a heart attack less than a year ago, and has diabetes? Or me, with an autoimmune disease and bad lungs? And multiple admissions previously for severe pneumonia. 

I know of residents who have taken protective leaves of absence, because they, like me, have health conditions that put them at risk. My program would support me if I chose to. 

But something inside me shrinks at the thought. And it tells me I belong out there, and I have to work, and I have to help, and I need to put my fledgling skills to use.

Then I see an attending I’ll work with this summer tweet that she’s prepared her family for the possibility she might not be able to come home. 

And I see friends discussing their code status. 

And I feel the space where daily updates from someone I follow has turned into the lingering silence of a digital void.

And people like me - rational, sensible physicians - are preparing themselves for something we never thought we’d face. 

A gym at Yale is lined with beds, prepared to receive the ill, like a painfully modern recreation of the unimaginably bleak photos from 1918.  

I am not anxious. But I am aware. And I feel as though I have a healthy respect for the seriousness of the wildfire we are facing down, armed with little more than paper gowns, plastic masks, and saline flushes.

But like my colleagues, I am getting ready. And I will be there to help. Even when it’s hard to leave the safety of my home to facedown the microscopic threat. 




Saturday, 21 March 2020

Volley’d and thunder’d

Cannon to right of them,
Cannon to left of them,
Cannon in front of them
   Volleyed and thundered;
Stormed at with shot and shell,
Boldly they rode and well,
Into the jaws of Death,
Into the mouth of hell
   Rode the six hundred.

-Charge of the Light Brigade; Alfred, Lord Tennyson

Monday I’ll be back at work. 

It feels like I’m getting ready to deploy. As close as I can imagine it feeling like, anyway. 

Have I ever mentioned here that when I was 18, I tried to join the military? One day in late September 2005, I walked across downtown Ottawa to the recruiting office on Slater. I wanted more information on the Regular Officer Training Program. I felt it was a way for me to return to my studies and find my way into a good career. 

Having grown up in a military household, it seemed like a good career. And it is. If I could have joined the military, I would have. However, I learned that day that my medical conditions would keep me out and I’d have to give up my plan of joining the Canadian Forces; something I’d rolled around in my head for years at that point. 

It’s something I’ve revisited mentally a number of times. Sadly, I know it’s not an option open to me even now.

But the battle comparisons are flying thick these days. Family and emergency medicine are being described as the front lines. This is a battle we’re preparing to fight, and too many physicians are going in unarmoured and unarmed. 

PPE is stretched thin. There are too few ventilators for the wave that’s coming. Casualties among the ranks are starting to climb. 

It is reaching our shores, my friends.

It’s time for me to suit up and make my way to the front lines with my colleagues.

Is this my deployment?

I think it might be.

When can their glory fade?
O the wild charge they made!
   All the world wondered.
Honour the charge they made!
Honour the Light Brigade,
   Noble six hundred!

Tuesday, 17 March 2020

Standing on the Sand

Hello. 

I don’t know if anyone is still reading, but if you are, hi. I’m still here. 

It was necessary for a while to take a break from blogging publicly for a number of reasons, but I’ve missed it so here I am. To start with, my husband, children and I are all fine. Doing very well, in fact. I’ve been around, mostly on Facebook and Twitter, but not in my old haunts so much. 

This seemed like a time to focus on getting my thoughts out somewhere. This blog has been incredibly helpful for me in my reflections on my growth as a physician. It’s wonderful to be able to look back at what I thought at different stages of training and reflect on how my own responses have changed. 

As we are currently facing an unprecedented time in modern medicine, which is leading to many difficult thoughts, I needed to come back to this outlet which allows me to explore more complex thoughts than a few hundred characters will allow. 

At the moment, I’m off work pending a call back from public health with the results of my COVID swab which was taken on Friday. I had a cold and am fairly sure it’s not COVID but because I’ve been in emerg for the last two blocks, couldn’t rule it out. I assume they’d have called me before now if it were positive so I’m more or less just hanging out with my kids and watching movies all day, then spending the evenings preparing.

If you’ve read my older posts you may have gathered that I do have an interest in medical history. Major outbreaks have always been a particular theme, the result of having watched Outbreak when I was probably too young for it. I have found major epidemics through history to be fascinating in an academic sense, but I have never wanted to live through one. Especially as a physician. 

In the coming weeks, many doctors are expecting the worst, but we are hoping to avoid it. We’ve felt the trembling of the earthquake and heard the sirens. We see the waters pull back from the shore and are preparing ourselves for the tsunami to come. But we can also see so many who are still standing on the sand, crying out that everything will be fine. See how the water went away?

Once I’m given the all clear to return to work, I’ll be on my geriatrics rotation. Spending time in long term care and nursing homes. And then three weeks from today, right around the time the wave is cresting on Canadian shores, I’ll be in emerg in the ninth largest city in the country.

During a pandemic unparalleled in our lifetimes.

I worry about getting sick, naturally. I’m young, but have difficult lungs and autoimmune disease, so my risk is higher. I worry about harm coming to me and leaving behind my family. I worry about my husband’s heart; it will never be 100% again. Even though my children will almost certainly come out of it okay if they catch the illness, I wonder at the effect of all of this on their mental health. My dear Little Bird is anxious at the best of times. After a conversation about events, she hugged me so much tighter. She has been subdued, and helpful, and more affectionate than usual. More tearful than would be her norm. 

My oldest is growing into a wonderfully silly young man - almost as tall as me now! - who sobers and can be relied upon when necessary. He quips and jests much of the time, but his eyes have been shadowed when he’s seen me cough, and he’s come to ask me some serious questions in the evenings when his siblings are asleep. 

How will this time mark them?

I was just a few months older than my son is now when 9/11 happened, and that was an event which shaped the world I grew up in. It shaped who I became. 

Will the COVID pandemic be that for my older children?

My younger two are more or less functioning as usual. Slightly naughtier than they might otherwise be because of the unexpected shifts in their schedules, but essentially normal for a toddler and a preschooler. I hope when they get older they have no memory of the stresses of this time. 

I have so many things I need to figure out how to say. 

I’m glad to be coming back here, where I have the space it say it. Even if I am just shouting it into the aether. Better than it all rattling about in my head. It’s getting crowded up there. 


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.