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.

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. 

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.

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.