Sunday, March 23, 2014

R&R 2014

Just wanted to say I am heading to Rural & Remote conference in Banff this coming weekend. Looks like it's going to be a fantabulous weekend of sessions for the birkenstock-and-jean-wearing-bearded-bougie-carrying-mad-skillz-canoeing-to-work-rural-physician!! I am also excited (and a little scared based on the pre-reading) for the AIME and EDE-1 courses that I am taking when the conference is over.

So if any of ye are knocking about come and say hi! I'll be the one eating ribs at the BBQ and loading up on as many pens as possible.

Thursday, March 20, 2014

Gallstones

"My doctor sent me in for an ultrasound - he thinks I have gallstones because I've had this pain..." points to right upper quadrant "...for about a week".

Well I had seen the ultrasound report and yes there was a gallstone but more worrisome than that there were many other findings that suggested stage IV cancer.

There are moments that change your life forever. The event that defines 'before' and 'after'. At times, working in healthcare means being a person who straddles that precise moment in someone's life. For better or for worse.

The nice thing about obstetrics is often this is a joyous time to share with patients. The before we knew we had a son who had ten fingers and ten toes and his father's nose to after. But more often I have had to share moments that I would rather excuse myself from, altogether.

I have developed a very irritating contact dermatitis on the backs of my hands, a constantly itchy, burning rash that never completely goes away thanks to all the handwashing and O.R scrubbing I have to do. Despite my efforts with creepy mitts, vasoline, and steroid cream at night, it remains a dull roar. I have never had a nervous tic or habit until this came along. I catch myself scratching my hands now as my anxiety level climbs at work and I have to wonder sometimes if it isn't just the weather and the washing that has brought this on. I am mulling, processing, worrying about patients I saw in a way that is different now.

Now I find myself at this woman's bedside and I feel myself scratching and will myself to stop. I am nervous because this is a tight rope walk of being alarmist for possibly no reason versus alerting her to the fact that she might have an advanced, and likely fatal, disease. She has always been healthy, on no medications, no surgeries, doesn't smoke or drink, having spent her days being a farmer's wife.

My attending comes in and explains the ultrasound findings. I see the husband's face start to change under the thick brim of his baseball cap. I see the information sinking in and that moment of before and after forming. He suddenly looks very agitated and I can tell the discussion is over, he wants to go. We excuse ourselves and I hang on to the hope that this lovely lady does not have a death sentence, that the ultrasound was wrong, everything benign.

While scrubbing in for a case a few days later the general surgeon tells me that the ultrasound was not wrong and that she has very advanced disease. I look down while he tells me this. I feel the rough end of the brush against the back of my hand while the chlorhexadine soap suds roll down my arms. I picture the conversation they must have had and inaudibly shudder. She came in thinking she had gallstones and walks out knowing she metastatic cancer. The water rinses the lather off and trails into the drain at the other end of the sink. I push the swinging O.R door open with my foot and take a green sterile towel to dry my dripping, raw hands. 

Monday, March 17, 2014

Move

Today I started my 3 month rural 'family medicine' rotation. It is in a northern community which has a hospital and clinic run by advanced scope GP-anesthetist and GP-surgeons. Needless to say I am both excited and intrigued to see how this all goes. It could potentially be a community I could see myself living in. If, I am capable of completely eschewing hot yoga, dining out, drinking coffee in quaint locals, retail therapy, exotic ingredients and mountain gazing. Hmmm. Being in the hospital and clinic I am in a little bubble of "this is SO great!" until I step outside. It's a big sacrifice at the end of the day. Kick ass job in Armpitville or the opposite alternative.

While I was packing for the move I had flashbacks to all those times I would go on northern nursing contracts. Packing bedding, knives, high-quality snacks, books, towels, candles, textbooks, stacks of Yogi tea and feeling the mix of anticipation and dread at leaving whatever cozy digs I had. Hoping that my roommate and apartment wouldn't be too nuts and too ghetto, respectively.

My roommate here is fantastic. Our eyes are definitely aligned but the digs...oh the digs. A former elementary school turned into an apartment building. It means the echos of feral children and their meltdowns infiltrate as obtrusively as the constant supply of cigarette smoke. And I have to think, before medical school I had a cute little house in the mountains and an RRSP in the bank...now I have...this. 

Well at least I am back in the work bubble in not too many hours.

Goodnight.

Saturday, March 15, 2014

Hello

A brief summary of things that have happened over the past few months, when I apparently stopped blogging on a regular basis.

Nov: Gen surg and ER rotation. Duncan's dear uncle in Scotland died and we had to make an emergency trip back to the UK for his funeral (which was why I was on an airplane catching a baby).

Dec: Ob/Gyn rotation. Christmas. Very little laundry or grocery shopping done. Very little sleep had.

Jan: More Ob/Gyn and then ICU. That was interesting. One of the attendings asked me if I had kids and when I said no replied with, "Ahhh, so you are alpha female on beta blockers". I mentioned this on FB which caused a very interesting little burst of outrage from my female physician friends. Incidentally I thought the comment was hilarious but then was embarrassed for NOT being offended.

Feb: More ICU then a 2 week elective in Major Trauma Centre in Alberta. My mind blown by the prospect that a) there is such thing as an interventional pulmonologist  b) they will come and do a thoracentesis on your patient in the ED if needed. Also, being in a centre that has an outpatient clinic for virtually every medical complaint known to man. Oh send them to the outpatient chest pain non cardiac clinic. Oh send them to the outpatient early pregnancy loss clinic. Oh send them to the depressed but not suicidal clinic. Oh send them to the outpatient intubation clinic. 

March: Elective in Ob/Gyn. Yep.

Now we're all caught up. Okay not really, not at all. Residency is rife with hilarious, heart warming, heart wrenching moments - many of which I would LOVE to write about. But there are a lot of things that are taking up my precious moments of free time (like watching Episodes, downloading Matt LeBlanc's ring tone and hoping that someone SOMEWHERE will recognize it). But also things like talking to my boyfriend, making soup, buying lottery tickets.

Plus, it's just been a tough year. I am questioning so many decisions on a regular basis and trying to decide which direction to go professionally. In Canada GP's can work in many different expanded scopes and I really want to pursue more training. Problem is I love bits about all the extended scopes and want to do it all (yet time marches on and the line of credit interest payments steadily rise up). So I spend a lot of time musing on GP-surgery? GP-Anesthesia? Extended obs skills? ER?

Sigh.

I would really like to get back into writing more and back to keeping a regular blog again. Not going to happen this month though as I have a licensing exam, an advanced airway course, and an ultrasound course looming. Oh and a dog who needs walking.

Maybe next month. 

Sunday, November 17, 2013

Is there a doctor on board?

So a few days ago I delivered a baby on board my KLM flight from Amsterdam to Calgary. It was one of the most surreal, frightening, exciting, unbelievable experiences in my life.

Full story to follow soon!! :))

Sunday, October 6, 2013

Life Goals = Check

So for the first time since June, I feel somewhat ready for the week ahead. For the past 10 days or so my main life goal has been to empty the dishwasher. I thought, if I could pull that off I might even lift my game and wash the sheets on my bed.

Well, done and done.

You might be thinking that this is THE most boring post you've ever come across but honestly, I feel this deserves to be put down in the history books. My food for the week is made (mulligatawny stew, curried cauliflower soup, and some slow-cooked peanut chicken), the sheets are fresh, the floors are vacuumed/washed, my bathroom is clean, laundry is done, bills are paid, dog food is stocked, and the fridge is sparkling. Oh it is sweet. This is what happens when I get two whole days off!! (Ok, I was post-call on Saturday so I slept until 1415h, thus making my achievements even more impressive, as far as I am concerned).

This week will be busy, I have volleyball tomorrow, am on call in the ED on Tuesday and on call for anesthetics on Wednesday but then on Friday I am flying home for Thanksgiving!! I can't even remember the last time I spent Thanksgiving with the family. It's been at least 10 years for sure. I am ridiculously excited...and prepping my elastic waistband pants in advance. Ah screw it, I'll just wear scrub bottoms the entire weekend.

In other GREAT news, Duncan finally gave his notice at work which means that the Manfriend will be joining me here shortly on the bald prairies. Yes, he is leaving his job and house on the ocean in BC to move here. It must be love.

Let's hope he's still smiling come February...

It's going to make such a difference having him here in the shoebox-sized rental. Residency has been a heavy go and a lonely road so far, and it's definitely been tough to keep the fires burning long-distance. Hopefully his tender British hide doesn't get frostbitten during his first REAL Canadian winter. Eep. Yeah, he's been in Canada for four years but Vancouver Island winters really don't count. We had a long discussion about vehicular modifications required for -40 degree winters, phrases like "block heater installation" and "winter tire purchases" were thrown around. I think he is still processing all of this. I get random questions like, "So...do people plug their cars in at work??" in the middle of a conversation about running shoes.

Yessssssss.

I am currently on my combined gen surg/ortho rotation. It is...meh. I really enjoy being in the O.R but my program has really changed up our rotation so that we spend most of our time in ambulatory care and surgical clinics. Which, I suppose, is nice for the people who hate being in theatre and who plan to have mainly GP clinic based practice. (In case it isn't already painfully obvious I don't plan on having a predominately clinic based practice). I recognize that this approach makes sense in terms of what family medicine residents need to know from a surgical rotation perspective - I just wish I had some more time getting to assist and do procedural things. Which is probably why I LOVED LOVED LOVED my anesthetics rotation (but that is a whole other post). Did I mention, I LOVED ANESTHETICS?!?! 

Well, that is enough rambling for one night. I just thought I should check in with the odd happy post from now on so that people don't think I am scouting highway accessible bridge abutments.  

Also. My dog rules.

Wake up and pet me dammit!!!
Roll on, Monday. 

Tuesday, September 24, 2013

Medicine Giveth and Taketh Away

My relationship with medicine has been a complicated affair. Depending on the day I can feel anything from anger and resentment to gratitude and love for it. It's been this big, ambling, shuffling entity in the background and foreground of my life for as long as I can remember. At times it is all encompassing, at times it disappears to a pin hole in the distance. Some days I find medicine grounds me, makes me feel like I have a better understanding of the world and what is truly important. Other days I feel that it warps my perceptions so much that I have no idea which direction is north.

I took two days off this week, leading up to an emergency medicine conference that I am attending (in Whistler - if any of you are also going to be there, come and say "hi!")

Having a couple of days to breathe (and by 'breathe' I mean 'finally catch up on paperwork, presentations, research assignments, leave requests, and emails') has given me some time to think about the last few months and my initiation into being a physician.

The weeks fan out behind me, some moments are vividly etched, the others already faded and gone.

Like finally being able to eat at the end of a 15 hour shift, with my only option being the last bowl of chile in Subway. I mean why did the guy have to tell me that it was the last bowl of chile? He could have just said, "Here is a delightful bowl of piping hot chile!" not "you got the very LAST bowl".

Or having to appear interested and awake during post-call re-enactments of Duck Dynasty episodes by an attending. Informing a patient that there is no such thing as a "butt cast" for her pain following a hard landing on her derrière. Holding a fibrillating heart between my fingers and squeezing, squeezing, squeezing until there was nothing left to do but wash off the blood that had managed to seep under my sterile gloves. There were unexpected flowers at the hospital on my birthday from Duncan. There were babies that came into the world, chubby and screaming while yellow-gowned, O.R capped men proudly stroked their wife's hair. And also the grey dishwater colored ooze and rotting flesh stench of necrotizing fasciitis, and countless miles spent walking the rotary trail with my puppy, Monty, while I tried to make sense of it all.

So many moments. Tumbling. Flashing before my eyes while I try to fall asleep. Those nights when the sweetest feeling ever is having your feet at the same level as your heart. That bone-tired exhaustion surpassed only by the relief that the day is over. On the especially bad days Monty is allowed up on the couch with me. His scruffy face and propensity to lick my socked feet are enough to make me laugh and take my mind off whatever transpired at the hospital that day.


Which is why I am never sure of how to answer the question, "How is residency going?" My mind floods with all of the images of these moments. Some hilarious, some disturbing, touching, rewarding, enlightening...humbling. So I suppose the best answer to that question is, "it's complicated".

Thursday, August 22, 2013

Easy Life

It can be a passing comment. Or the answer to a question.

But medicine can break your heart, or crack it just a little. And it isn't always the big, dramatic moments. Sometimes a patient says something to me that is such an unbelievably loaded statement, such a deep and unguarded truth about who they are, that I feel both weighed down by it's burden and lifted up by the privilege of hearing it.

---

"What does her name mean?"

"It means, easy". 

I chuckle a little and smile. The woman speaking to me has perfect, chocolate colored skin. Her hair is wrapped in a regal looking, multicolored scarf. Her cheekbones are high. Her eyes see that I don't understand.

"It means, easy life. My other three children were born in refugee camps in Kenya. She was born in a hospital in Canada. Compared to the rest of us, she will have an easy life." 

Now I understand, but really have no idea.

---

His right rotator cuff and surrounding musculature was so badly torn one day at work that the orthopedic surgeon stated in his letter that he "abandoned the procedure" when the first repair was attempted. As the patient spoke to me I saw dozens of deep, linear, pale scars on his left forearm, the kind of scars that you get when you cut yourself deep enough to draw blood but not deep enough to bleed to death.

The patient told me about the numbness in his fingertips and the ache in his arm. About the surgical waiting list. I asked if he was right or left handed.

"I am right handed. Well, actually, I was left handed. But I went to a residential school and they forced me to write with my right hand. They didn't use very nice techniques to do so. They wouldn't let anybody be different in any way. Same hair, same clothes. They wouldn't let me use my left hand. So now I am right handed...I have a granddaughter. She is left handed. She gets to stay that way."

Monday, August 19, 2013

Blog Readers, I Salute You

This is just an aside. A short note to say that I really appreciated the folks who took time to send comments and emails my way in response to my last post.

It pleases me greatly that people still read this blog (which is...ok maybe not in asystole but certainly a life threatening bradycardia - forgive me, I had to). It also is humbling and thought provoking and reality checking to hear the thoughts of people who have been reading this blog (or who know me / are related to me). I appreciate that I can be (somewhat) candid and honest. Which is what I would want if I was reading story of someone who was chasing a dream.

I think that too often we get to the goal and the story is over. Happily ever after. But really, everyone knows, deep down inside that this isn't true. My mother reminds me that what doesn't kill you makes you piss on your shoes and that the people who got their dream residencies in their dream specialties are pissing on their shoes for many reasons as well.

So thank you all, for your thoughts and notes and perspectives and wisdom. I had intended to end the blog after graduation but it seems there are still people out there who read it, and even enjoy it!  And I think I still have a lot to say about medicine and this journey which continues to unfold in strange and challenging ways.

In a completely unrelated note: today while the pediatrician was listening to the lungs of my 3 year old patient the kid gave his mum a thumbs up. I swear I am laughing as I type this. Even though I am looking forward to my next rotation (anesthetics) I will miss certain things about peds. Though, I will not miss the daily cough in my face routine that occurs.

Wednesday, July 31, 2013

Okay okay okay!

So today my friend Rob posted this on my FB page, "I feel like the blog is circling the drain.. like an end stage nephro patient. Write more stuff!!!" 

Which is fair enough. I've had a lot of posts or snippets of posts floating through my head since I started residency but for a number of reasons I feel like I can't write them. 

For one, I live in a pretty small town and I have an ever-increasing paranoia that I am violating patient confidentiality by writing about things that happen at work. Also, for some reason I feel slightly more duty-bound to pretend that everything is fantastic because SHAZAMMMM! I am done medical school and am actually a doctor now - i.e. life goal has been realized and therefore I should be rolling through a field of tulips with an ecstatic expression on my face. 

Truth is, I am actually not that happy. But I mean really, the cards are stacked a little against happiness right now. 

I just moved to a new town and have no friends. I just started a new job which is always stressful. The herniated disc in my back is unrelentingly painful and restricting my activity (thus quality of life). I am broke as a joke. My boyfriend still lives two time zones away because Canadian immigration moves slower than maple water in an ice storm and his permanent visa has yet to be granted. This town is ROUGH. I could go on and continue to list another dozen first world problems but I will stop myself there. 

I am a positive person, I really am. I always try to find the silver lining in things. I try to think that everything happens for a reason and that the universe puts me where I need to be. But I just can't seem to go there in my mind right now. I am not a person of regret usually but right now I regret so many things. I regret studying abroad and the financial repercussions as well as the professional ones. I don't want to be here. Am I allowed to say that? I can't wait for the end of the day (or night) when I can be home watching "Parks and Recreation" reruns in the quiet darkness of my curtain drawn living room. 

Transitions are hard, and I know that. I remember being nauseated and sleepless before every shift when I first became a nurse, and gradually that faded. I just suppose that I am frustrated too that I didn't anticipate these growing pains. I (erroneously) believed that I knew what I was getting into, coming into medicine from a nursing perspective. But I realize now, more than ever, that every stage of life brings with it some joys and some sorrows, some stimulation and some tedium. Becoming a doctor hasn't allowed me to transcend that reality. It's just given me more waking hours to experience all of it.