tag:blogger.com,1999:blog-31386251630396377692024-03-17T21:03:37.412-06:00Asystole is the Most Stable RhythmAlbinoblackbearhttp://www.blogger.com/profile/15222730484450544498noreply@blogger.comBlogger623125tag:blogger.com,1999:blog-3138625163039637769.post-85007857657254204432020-10-02T00:38:00.001-06:002020-10-02T00:38:19.174-06:00<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://1.bp.blogspot.com/-N09Amon4NeE/X3a-g_YVDvI/AAAAAAAAD7g/XqTGCWwppMA1qGhAAlN5AFOvVrZGmf04wCLcBGAsYHQ/s2534/4A41508B-2BBD-4AB7-BC88-E3BEC0B1203C_1_201_a.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="2534" data-original-width="1241" height="320" src="https://1.bp.blogspot.com/-N09Amon4NeE/X3a-g_YVDvI/AAAAAAAAD7g/XqTGCWwppMA1qGhAAlN5AFOvVrZGmf04wCLcBGAsYHQ/s320/4A41508B-2BBD-4AB7-BC88-E3BEC0B1203C_1_201_a.jpeg" /></a></div><br />"Angels can fly because they can take themselves lightly" - GK Chesterton. <p></p><p>When I started this blog, I always thought I would someday achieve a balance between my loves and my hobbies and my work. I realize now that is too abstract and nonsensical. What does "balance" even mean? That I spend 4 hours a day working, 4 hours a day cooking, 4 hours a day playing music, 4 hours a day playing in the mountains, and 8 hours a day sleeping? </p><p>Every time I "escape" to the mountains the realities of life simply come into sharper focus...work and worries continue to accumulate, and I am inundated with endless mind chatter the second I touch my foot to the gas pedal heading home. </p><p>I took this photo on Sunday, climbing Castle Mountain in Alberta. On the approach I talked about this blog and I realized how much I miss the writing. I like the platform of IG for entertainment and quick hits for photo sharing, but it just doesn't lend itself to more thoughtful work. I want to come back, I really do. But in many ways, I feel like my story (if I ever had one) has been told. So I don't know how much is here to circle back to, if the interest would still be here, and what I might say. </p><p>Maybe I will say this for now. Yesterday I had a moment of bliss. I was standing several pitches up on Mt Cory. The sky above was bluebird. The evergreen forest below was contrasted with bright yellow larches, and divided by the snaking aquamarine Bow River. I was fizzling out mentally and physically from four long days of hiking and climbing. But there I was on this ledge, feeling a slight breeze and the sun on my face. I had been admiring the grooved contours of the gray limestone in front of me, ridges and runnels, like abstract art carved into the rock. My mind drifted away, the thoughts of "past past past future future future!" dissolved and I was just....there. I felt the rope tighten which cued my mind to being on belay and thus safe to climb. I unclipped the clove hitch that was securing me while leaning back on the anchor. I moved to climb and heard "ON BELAY!" The call made by your climbing partner when you're safe to unclip and start climbing. </p><p>My mind went from the blurry water-colour bliss to the shock realization that I had just made a potentially fatal error. I had drifted off, feeling so alive and so calm, that when I drifted back with complacency I skipped a step and removed my own safety, thinking that I must have heard the "ON BELAY" without registering it. </p><p>Of course I didn't fall. My climbing partner knew I was tired and knew I was probably being lulled by the tranquility and beauty. He had arranged the transfer to only allow a few seconds of a potentially dangerous window between me taking myself off the safety of the anchor and onto the safety of his belay from above. He knew what had happened as he saw me appear up the pitch too quickly. </p><p>I climbed to the top of the pitch and we carried on to finish the route. I oscillated between awe at the strange liminal space that I had dipped into momentarily, and panic at how carelessly I had made a mistake that could have ended in disaster. He was calm but pointed out that he saw the mistake coming and thus minimized the risk ahead of time. These moments are lessons, vitally important ones. </p><p>I suppose that is the danger of <i>drinking life to the lees</i>, there is always a chance you will reach the last drop sooner than planned. </p><p><br /></p>Albinoblackbearhttp://www.blogger.com/profile/15222730484450544498noreply@blogger.com0tag:blogger.com,1999:blog-3138625163039637769.post-25082275806261198312019-01-30T11:36:00.004-06:002019-01-30T23:57:45.262-06:00Sobering Sadness<div dir="ltr" style="text-align: left;" trbidi="on">
I have been circling around writing this post for the past week or so, afraid I will not give it what it deserves.<br />
<br />
I was deeply saddened last week to learn that one of my GP-Surgeon colleagues took her own life. This news was so devastating. She was 37 years old. She was a few years ahead of me in the same residency program so I knew her through alumni events and conferences, then last year we were in the same lap salpingectomy course. We spent a couple of nights catching up, telling rural doc war stories over $18 cocktails in our hotel lobby.<br />
<br />
I found out the news while at a dinner party with friends. From the confines of a bright pink toddler's bedroom I called my co-resident and we tried to wrap our heads around so many questions. Why did she feel this was her only option, did her colleagues see any signs, did her family and loved ones know what was going on? Was any of this work related? How could this have been prevented? Where did we go wrong? How had 'the system' failed?<br />
<br />
My co-resident, A.B knew her well as they have been locuming in some of the same places over the past year. She had recently had dinner with her and so A.B was trying to retrace every word and gesture and nuance from that night. She was left holding guilt and regret for not knowing V was so close to unravelling, and not realizing the desperate situation she was in.<br />
<br />
I have to admit, this whole situation has caused me to take a hard look at my decision to leave my rural surgery job last year. I don't have to go through mental gymnastics to see how the sleep deprivation, stress of the job, interpersonal conflict at work, having to make high stakes decisions, clinical unpredictability, and isolation could take down even someone whose mental health was robust. We have to be perfect. Our paperwork must be pristine, we cannot make any mistakes, our sleep and personal lives are not protected, and we have to be nice 100% of the time. Every medical advisory counsel meeting was a parade of other departments admonishing the physicians for not filling out the forms right or for calling techs in during the night, or having the resident make requisitions when only the attendings should, or ordering too many liver enzymes, or forgetting to put an impression on our radiographs. We take this quietly most of the time because we are sitting there in our rumpled scrubs, our socks damp from being worn for 14hrs in rubber boots and we've just lost the desire to defend anything or attempt to justify <i>why</i> we order those enzymes.<br />
<br />
I have gone through bouts of depression in my life, thankfully not last year. Even so, I visited some dark places in my mind. I often feel ashamed for leaving that role behind because I fabricate in my mind the judgements that others must be assigning me: that I wasn't tough enough, brave enough. I built this image of myself - the hard core ER nurse working in the arctic who would then become a hard core rural GP-surgeon. I could go to the rural conferences and snub my nose like everyone else at those city docs who have it so easy and who would never survive a day in <i>my</i> job. And yet, the image I created of myself wasn't actually me. I tell myself that it would have <i>probably</i> gotten easier and I <i>probably</i> would have started enjoying it. I <i>probably </i>would have laughed at the fact that I would wake up with a heart rate of 130 some mornings because I was so stressed out about being on call.<br />
<br />
I was at a conference last year and a board member of our medical association, who worked with me as a resident, came up to me while we were milling around at an appetizer social. He asked my how it was going and I just started crying. Not the gulping, ugly crying. The tears streaming into furtive dabs with a tiny drink napkin before dripping off chin kind of crying. I was mortified. He was mortified. I attempted to regain my composure as fast as I could. He reassured me that the first year of practice is hard for everyone and told me about some challenging cases he'd recently dealt with and then moved on to a different conversation. I felt embarrassed and angry with myself. I thought about that interaction for weeks afterward. He didn't get in touch. He didn't check in or pass on any information about physician support. It was just another conversation in a long history of similar conversations that didn't seem to ring alarm bells to anyone.<br />
<br />
But now, after all this with V, I see that maybe it <i>wouldn't</i> have gotten better. Maybe it would have gotten much, much worse.<br />
<br />
V's death brought the statistics around physician suicide, particularly female physician suicide, into painful focus. We do not talk about these realities and about the people behind these numbers. We do not admit to needing help, we do not reach out to those that might need it.<br />
<br />
---<br />
<br />
Late entry.<br />
<br />
I wrote the beginning of this post several months ago. I think I was scared to make it public. Or maybe I was just wanting to marinate on it a little longer. Either way, I think there continues to be more and more evidence that we need to be vocal about the fact that people are afraid to ask for help. That feeling weak and on top of that <i>feeling guilty</i> about feeling weak does not spurn one into wanting to reach out. It makes one want to curl into a ball at the far end of a cave with the hope that everything will just go away if you pretend it isn't there. But this is not the way to improve ourselves or this broken system.<br />
<br />
For those who are struggling: please, please know that it is quite possible that no one knows you are hurting or if they do, do not know how to approach you about it. Know that there is increasing awareness about mental health as well as support for those who need it. If you fear being judged, recognize that those casting judgement are probably hurting too and not addressing it in a healthy way. Know that sometimes things get better and sometimes it takes a major life shake up like a relocation and retraining to get to a place that will work for you. We've only got one precious life. No career or degree of recognition or fear of embarrassment is worth sacrificing that precious life for.<br />
<br />
<i>Courage. </i><br />
<br />
<br />
<br />
<br />
<br /></div>
Albinoblackbearhttp://www.blogger.com/profile/15222730484450544498noreply@blogger.com21tag:blogger.com,1999:blog-3138625163039637769.post-24063476941167115712018-01-15T09:16:00.002-06:002018-01-15T09:16:54.613-06:00Just Wow<div dir="ltr" style="text-align: left;" trbidi="on">
I hesitated on hitting "publish" on my last post, but am so so glad I did.<br />
<br />
There is an owl, somewhere nearby, hoo-hooing hoo-hooing hoo-hooing. The dogs are snoozing on their beds and a tiny silver sliver of light is starting to outline the ridge of the mountains. It's early morning and I am doing some school-work before work-work.<br />
<br />
But what I was actually doing was reading through the comments on my last post and feeling so grateful that people still read this blog and still leave me such wonderful, uplifting, affirming, supportive comments. Strangers (mostly) who know me extremely well whom I don't know at all. Some who have been on this journey with me since 2008 - my word - almost 10 years. It's a strange and beautiful conversation.<br />
<br />
Thank you.<br />
<br />
Hooo-hooo. Hoo-hoo. Hoo. </div>
Albinoblackbearhttp://www.blogger.com/profile/15222730484450544498noreply@blogger.com80tag:blogger.com,1999:blog-3138625163039637769.post-9749051710734756142017-10-08T16:30:00.004-06:002017-10-11T19:39:50.158-06:00On Endings and Beginnings<div dir="ltr" style="text-align: left;" trbidi="on">
Hello..<span style="font-size: x-small;">..hello.</span>..<span style="font-size: xx-small;">.hello. </span><br />
<span style="font-size: xx-small;"><br /></span>
Wow. Um. Not really sure where to start.<br />
<br />
I quit my job. I am no longer a rural GP-Surgeon. So, there's that. I moved. Enrolled in a Dermatology Diploma through Cardiff University, got a new full time job, a part-time locum. Oh and a full time LIFE again.<br />
<br />
I bought a new house, adopted a second dog, moved. Is that everything? I guess that is the big stuff.<br />
<br />
It's awkward as I have so much back tracking and so many half written half cocked stories and posts and its overwhelming. And were does one pick up the thread?<br />
<br />
I will start by saying that physician burnout is a real thing. I read somewhere recently that around 80% of physicians in their first year of practice report feelings of burnout. It made me feel reassured. I haven't really sat down and dissected the past 15 months since finishing to see if the diagnosis would be burnout but I can certainly see that there were moments, really long moments that lasted weeks or months at a time where the over arching theme could be described as "burnout". Sure.<br />
<br />
And I cycled through the emotions of feeling guilty for being overwhelmed when I should have actually felt good that I was acknowledging that too much was being asked of me. Feeling I was weak instead of seeing that the load was too heavy, and all of that.<br />
<br />
So now I'm staring at all these books in my basement. Do I get rid of the stacks of emergency medicine books? ECG guides, Operative Obstetrics, Mastery of Surgery, Palliative Medicine? I have Care of the Newborn and PALS guides strewn beside Colorectal Disease atlases and AIME study manuals. It's nearly comical. I am letting go of some of my skills, some of my training but I am weirdly clinging onto these books. I am not a nostalgic person. Ever since I Marie Kondo'ed the shit out of my house 2 moves ago I have paired down and donated, sold, and dumped a lot of my belongings. These books feel like haunting reminders of the person I thought I wanted to be or the person I thought I'd become.<br />
<br />
When people would ask me, "How are you?" at work my response was always "living the dream!" And this was an intentional response (for me) even though it may have sounded flippant. I said that because if you go back, all the way back to even before this blog started, I wanted to be a rural physician. A rural emerg or rural gp-surgeon or full scope rural GP. I turned my life upside down. I left my house in the mountains, all my friends, all my family. I left my financial security and traded it for crushing debt. I left the freedom to chose where I got to live. I left my hobbies, my boyfriend, my favourite recreation. I left my country! I traded all of that in to become a doctor. I came back to Canada and was lucky enough to land a residency in a fantastic rural program. Then landed another residency in enhanced surgical skills. Then I was offered a full time job in a full scope GP service practice in a place that I had spent 6 months as a resident. And everything was just finally lining up perfectly and I was reaching the end goal of 8 years of moving, studying, exam writing, wondering, hoping, and guessing.<br />
<br />
And my "dream" finally came true.<br />
<br />
And then it all went to shit.<br />
<br />
So I purposefully reminded myself every single time someone asked me how I was doing, that I was in fact, living my dream. It's so easy to remain in this goal oriented, delayed gratification, head down, <i>life will be great when....</i>mentality. "At the coal face" as my husband describes it. You are in survival mode, you don't look up you just grind grind grind. You will one day live your dream, you tell yourself.<br />
<br />
Then you arrive and the unicorns aren't sliding down rainbows to greet you. I can't even go back and read the post I wrote when I finished medical school because I may actually punch myself if I do. I <i>was taught </i>this lesson before but I suppose I never <i>learned </i>it.<br />
<br />
I wanted to remind myself so I could stay in the moment. So I could find<i> that thing </i>and see the beauty in where I was even when it felt like it was crushing me. Something had drawn me to this exact place in the world so I had find those rewards and acknowledge them. Even when it felt <i>really really hard</i>.<br />
<br />
I'm sure there are many, many people who chase certain goals in medicine, and achieve those goals and the rainbows and unicorns are there to greet them when they do. And to those I say, "you're so lucky". But to anyone reading this who felt weird and sad and stressed and unfulfilled when you finally got to live your dream I say, "you are not alone, dude".<br />
<br />
So I finally gathered up the courage to admit all these things to myself and those around me. And here I am. Trying to focus on how I am going to make this whole medicine thing work for me, instead of the other way around.<br />
<br />
To be continued.<br />
<br />
<br />
<br />
<br />
<br />
<br />
<br /></div>
Albinoblackbearhttp://www.blogger.com/profile/15222730484450544498noreply@blogger.com29tag:blogger.com,1999:blog-3138625163039637769.post-40543802616546169942017-09-12T20:01:00.002-06:002017-09-12T20:01:57.926-06:00Only in the Prairies<div dir="ltr" style="text-align: left;" trbidi="on">
My patient, sitting there heavy with pregnancy is looking dismayed at the thought of having to be induced now that she is post-dates.<br />
<br />
I ask her what is up.<br />
<br />
She tells me her garden isn't done.<br />
<br />
Then she asks me if she can come 30 mins later than the scheduled time so she'll be able to milk her cows.<br />
<br />
Later in the same clinic I had another woman who had come in for a possible abscess. She informs me that her mother in law gave her some ointment they use on the animals when they get infections. She was using it all weekend.<br />
<br />
Evidently it worked. <br />
<br />
I love my prenatal patients on the prairies. </div>
Albinoblackbearhttp://www.blogger.com/profile/15222730484450544498noreply@blogger.com36tag:blogger.com,1999:blog-3138625163039637769.post-86596286362443897002017-03-26T01:09:00.000-06:002017-03-26T01:09:07.482-06:00Rural Doc Realities <div dir="ltr" style="text-align: left;" trbidi="on">
Even though alcohol is legal and I don't have an unhealthy relationship with it, I always feel a little awkward about stocking up on wine and beer in my local liquor store. I have this irrational fear that I will see a patient and they will think it's inappropriate that their doctor drinks Chelada's or American reds. I hated buying booze as a resident because I always looked so haggard and forlorn I was convinced people would assume it was the alcohol that made me that way and not the fact that I'd been up for 44 hrs on a surgical "bender". <br />
<br />
As an attending I hardly drink as I'm on call 1:2 (or 1:3 at best). Alcohol has become a treat because it also means my phone can be off and I can shower without having a "get to the hospital in 5 minutes" outfit laid out on the bathroom floor.<br />
<br />
So I go to the (one and only) liquor store the other day in the hopes of maintaining a low profile. I do my sweep while trying to eye out the selection. It's pretty disappointing, as I expected it would be. But, in a way I'm glad it's no <a href="http://thewinecellar.ab.ca/" target="_blank">Wine Cellar* </a>because it would be too hard to stick to my new $100/month budget if I had their glorious products to choose from. When Barefoot and Yellowtail are rounding out the options it makes splurging on a Rodney Strong or a Layer Cake seem indulgent.<br />
<br />
I'm perusing the boxed wines and wondering how rapidly I would descend into alcoholism if I started drinking Copper Moon by the box when I hear "DR. BLACKBEAR!! DR. BLACKBEAR! How ARE YOU??" My eyes have still not quite adjusted from the sunlight outside so I look around, trying to locate the voice while half-hiding behind the Pilsner stand. People are milling about and looking in my direction. A staff member is waving wildly at me and smiling. I think I recognize her from the clinic...? The ED...? I don't think I've delivered her baby recently...did I ?<br />
<br />
<i>Hi.</i><br />
<br />
Hiiiiiiiii!!!! ARE YOU ON CALL TODAY?<br />
<br />
<i>Yes</i>.<i> </i>(I can't lie, dammit. I was on call. What if she ended up going into the hospital that night with an appendicitis and they called me in to see her? Then it would seem even sketchier that I'd lied about it. I wasn't planning to drink the booze THAT night, I just knew I wouldn't have time to get there any other day this week. Besides, I am on call all week anyway!)<br />
<br />
OH MAN YOU WORK SOOOO MUCH! THEY REALLY WORK YOU GUYS TO THE BONE!<br />
<br />
<i>Yes</i>. (Now people are staring at me, they are judging me not only for my choices in alcohol but the fact that I am a doctor and buying it during the day, when I'm on call!!)<br />
<br />
ARE YOU TAKING PATIENTS YET?<br />
<br />
<i>No...erm...I am doing so much call and covering the surgical program right now so I am not really in the clinic that much and I ......</i> (I'm mumbling, trailing off, and deciding if I should just pull the pin on this whole endeavor and leave without buying anything. But I feel like I am committed and really, my husband would come and buy just one bottle of Malbec then try and convince me I liked it in the past).<br />
<br />
WELL I DON'T HAVE A FAMILY DOCTOR!!!<br />
<i> </i><br />
I think I then sputtered something about continuity of care and resources and some apologies while going to the farthest till away and hoping things would peter out from there.<br />
<br />
A lady with tight permed curls and a wrist brace starts ringing in my order. She keeps her eyes locked in mine as I fumble with my wallet and hit the automatic start on my key ring.<br />
<br />
What is your name? Says wrist brace without looking away.<br />
<br />
<i>Albino. </i><br />
<br />
No, what is your DOCTOR name?<br />
<br />
The other people behind me in line lean in slightly.<br />
<br />
<i>Dr. Blackbear </i>(WHY WHY WHYYYYYYY)<br />
<br />
Hmpf. Well I don't have a family doctor EITHER. <br />
<br />
<i>So, so sorry to hear that I think there are a few doctors at the clinic taking patients....byyyyyeeee thank youuuuuuuuuu.........!</i><br />
<br />
I grab my bag and head for the door. My initial greeter yells, BYE DR. BLACKBEAR SEE YOU LATER HOPE YOU GET A BREAK SOON!!!<br />
<i> </i><br />
You and me both, honey, you and me both.<br />
<br />
--<br />
<br />
*I was not paid to put that endorsement there. The Wine Cellar and 124st St Liquor Store were my two favorite places to go when I lived in Edmonton and was discovering the world of wine. The staff were super knowledgeable, the selections were varied and interesting, and I never felt intimidated about asking questions. I loved pretending I knew anything about wine and pretending I could afford the good stuff. And look how far I've come in the past 15 years, now I know even less about it all and can still only afford the cheap stuff!<br />
<br />
<br />
<br />
<i> </i><br />
<br />
<br />
<br />
<br /></div>
Albinoblackbearhttp://www.blogger.com/profile/15222730484450544498noreply@blogger.com4tag:blogger.com,1999:blog-3138625163039637769.post-10102600200935547652017-03-19T18:04:00.000-06:002017-03-19T18:04:22.218-06:00Education Debt IS Bad Debt<div dir="ltr" style="text-align: left;" trbidi="on">
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<div class="MsoNormal">
<span lang="EN-CA" style="mso-ansi-language: EN-CA;">I was
recently given some bad advice. </span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-CA" style="mso-ansi-language: EN-CA;">I am
deeply, profoundly, eye-wateringly in debt thanks to four years of
international medical student tuition and a penchant for expensive wines,
perfumes, and restaurants. </span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-CA" style="mso-ansi-language: EN-CA;">I come by
it honestly. It stemmed, initially, from being a medical student and spending a
thousand euros a week on tuition, <i style="mso-bidi-font-style: normal;">for
four years</i>. Why would I buy a 10 euro bottle of wine instead of a 20 euro
bottle of wine? That ten euro difference was not even a drop in the volume of
<i style="mso-bidi-font-style: normal;">money I was hemorrhaging at the time. </i></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-CA" style="mso-ansi-language: EN-CA;">Then it
morphed into an easy justification. I had no life as a resident. I worked,
slept a little, ate when I could, peed when I could and <i style="mso-bidi-font-style: normal;">I was going to have</i> that cashmere sweater from Club Monaco dammit
because I had nothing else in my life at the time….<i style="mso-bidi-font-style: normal;">nothing</i>! </span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-CA" style="mso-ansi-language: EN-CA;">I could say
that I had made so many many sacrifices; my income, my freedom, my country, my
relationships, my RRSP’s, my whimsy. Didn’t I <i style="mso-bidi-font-style: normal;">deserve</i> that stay at the Fairmont? That 7 course meal at Quattro?
That bottle of Veuve demi sec? HECK YES I DID. </span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-CA" style="mso-ansi-language: EN-CA;">So, now I
am finished residency. I am actually an attending physician, making more a month
than most people do all year. Yet I am broke. Why? Well. That begins with one’s
definition of “broke”. Because, I used to think that rich was how much money
you earned, not how much money you had in the bank. </span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-CA" style="mso-ansi-language: EN-CA;">I have over
$300 000 in debts; student loan, line of credit, and Bank of Mom debts. This
means that I have <i style="mso-bidi-font-style: normal;">no money in the bank</i>.
I am broke. And every 2 weeks when I get my pay check I <i style="mso-bidi-font-style: normal;">continue</i> to be broke. </span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-CA" style="mso-ansi-language: EN-CA;">I was
recently told by a <i style="mso-bidi-font-style: normal;">financial advisor</i>
that I didn’t need to worry so much about my $190 000 line of credit debt
because the interest rate was at prime. I told him that I was about to go on <span style="mso-spacerun: yes;"></span>this mission to just pay that debt down as
fast as my little surgical fingers could spin that money out. </span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-CA" style="mso-ansi-language: EN-CA;">Meh. He
said. </span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-CA" style="mso-ansi-language: EN-CA;">That is low
interest debt. Put money into savings, buy RRSP’s, save up for your next house downpayment.
Pay that debt down at a rate that works for you. (No, he is not given kickbacks
by any financial institution that I am affiliated with). And I was lulled into
believing this. I can afford the <i style="mso-bidi-font-style: normal;">payments</i>
therefore I can afford the <i style="mso-bidi-font-style: normal;">debt. </i></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<i style="mso-bidi-font-style: normal;"><span lang="EN-CA" style="mso-ansi-language: EN-CA;">Oh FUCK NO. </span></i></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-CA" style="mso-ansi-language: EN-CA;">Ok, let me
put this into recent context. </span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-CA" style="mso-ansi-language: EN-CA;">I’ve been
doing a lot of reading and thinking and learning about the concept of
minimalism, money management, debt repayment, financial freedom, need, greed and when I'll be able to step away from mandatory employment. </span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-CA" style="mso-ansi-language: EN-CA;">As part of this quest I watched this <a href="https://minimalismfilm.com/" target="_blank">interesting documentary about minimalism</a>, started listening to their podcast* as well as the Dave Ramsay and Planet Money podcasts. I read "<a href="https://www.amazon.ca/Your-Money-Life-Transforming-Relationship/dp/0143115766" target="_blank">Your Money or Your Life</a>" updated by Vicki Robin, as well as "Total Money Makeover" by <a href="http://www.daveramsey.com/" target="_blank">Ramsey,</a> and am currently reading "<a href="http://ca.wiley.com/WileyCDA/WileyTitle/productCd-1118027612.html" target="_blank">Beyond Wealth: the roadmap to a rich life</a>" by Alexander Green. I listened to a mind-blowing <a href="http://tim.blog/2017/02/13/mr-money-mustache/" target="_blank">interview</a>** with Mr Money Moustache and have since spent hours and hours reading <a href="http://www.mrmoneymustache.com/" target="_blank">his blog</a> and putting his advice into action. </span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-CA" style="mso-ansi-language: EN-CA;">I downloaded a free budgeting app called "Everydollar". I also downloaded a frighteningly sobering app called "Debts Break" which shows you how much money you are paying on the principle, how much interest you are paying each month, and how much total interest you'll pay by the time the debt is paid off. </span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-CA" style="mso-ansi-language: EN-CA;">After this flurry of reading, listening, watching and information absorbing I felt as though I had been awoken from a long, dreamy, line of credit induced financial stupor. It's embarrassing to admit how little I understood about these basic concepts of personal finance and the greater concept of money. There are so many gems I've collected in the resources listed above that I would do no justice to any of it if I tried to summarize or recap. But I will say this, if you are in debt (even a little bit) I urge you to check out some of the links above and start your own journey into mindful spending, debt control, and financial independence. </span></div>
<div class="MsoNormal">
<span lang="EN-CA" style="mso-ansi-language: EN-CA;"><br /></span></div>
<div class="MsoNormal">
<span lang="EN-CA" style="mso-ansi-language: EN-CA;">AND GET RID OF YOUR DEBT BEFORE YOU DO ANYTHING ELSE. </span></div>
<div class="MsoNormal">
<span lang="EN-CA" style="mso-ansi-language: EN-CA;"><br /></span></div>
<div class="MsoNormal">
<span lang="EN-CA" style="mso-ansi-language: EN-CA;">I shudder to think of how much money I've already wasted in ridiculous interest payments (not to mention all the brainless cash I've thrown out for acquiring things I didn't need). </span></div>
<div class="MsoNormal">
<span lang="EN-CA" style="mso-ansi-language: EN-CA;"><br /></span></div>
<div class="MsoNormal">
<span lang="EN-CA" style="mso-ansi-language: EN-CA;">We've gone into basically a spending freeze here in the Blackbear household. My husband even took a job nearly 3 hrs away in order to beef up the "hammer the debt" campaign. We are getting out. It's not going to be easy and it's not going to be quick but man I am so glad that I only wasted 6 months as an attending before I started this new way of thinking. </span></div>
<div class="MsoNormal">
<span lang="EN-CA" style="mso-ansi-language: EN-CA;"><br /></span></div>
<div class="MsoNormal">
<span lang="EN-CA" style="mso-ansi-language: EN-CA;">The main change to spending has come, not from just stopping the spending of money (which is like just deciding to crash diet - a temporary deprivation which will eventually rebound and probably over correct in a bad way) but of changing the way I look at how I spend my money and my relationship to money. </span></div>
<div class="MsoNormal">
<span lang="EN-CA" style="mso-ansi-language: EN-CA;"><br /></span></div>
<div class="MsoNormal">
<span lang="EN-CA" style="mso-ansi-language: EN-CA;">I do the Mr. Money Moustache and minimalist approach before I buy anything. </span></div>
<div class="MsoNormal">
<span lang="EN-CA" style="mso-ansi-language: EN-CA;"><br /></span></div>
<div class="MsoNormal">
<span lang="EN-CA" style="mso-ansi-language: EN-CA;">1) is this purchase adding a positive or taking away a negative in my life?</span></div>
<div class="MsoNormal">
<span lang="EN-CA" style="mso-ansi-language: EN-CA;"><br /></span></div>
<div class="MsoNormal">
<span lang="EN-CA" style="mso-ansi-language: EN-CA;">If it is the former then it is not allowed. It is easy to think that adding a nice sweater will make me happier (for about 30 sec) but it is really the false belief that it is adding a positive. If the purchase is taking away a negative, i.e. I have no winter coat so I will buy a good quality winter coat that I will treat well and cherish and wear for years, then I can buy it. </span></div>
<div class="MsoNormal">
<span lang="EN-CA" style="mso-ansi-language: EN-CA;"><br /></span></div>
<div class="MsoNormal">
<span lang="EN-CA" style="mso-ansi-language: EN-CA;">2) Is this purchase worth my freedom?</span></div>
<div class="MsoNormal">
<span lang="EN-CA" style="mso-ansi-language: EN-CA;"><br /></span></div>
<div class="MsoNormal">
<span lang="EN-CA" style="mso-ansi-language: EN-CA;">Okay, I know what you are thinking. That is a bit over the top. But it isn't. Currently I am a slave to my debt. I will HAVE to work for years and years just to pay off my debt, not just to live, travel, eat, drive...So every dollar I spend is a dollar I am not paying onto my debt, which means I continue to protract my debt repayment servitude. Prolonging my required employment. </span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-CA" style="mso-ansi-language: EN-CA;">3) Is there room for this item in my life? </span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-CA" style="mso-ansi-language: EN-CA;">I hate having stuff I don't need or use in my life. I did a giant Mari Kondo purge last year which was so liberating. Now everything I bring into my life has to have a purpose, a physical space. </span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-CA" style="mso-ansi-language: EN-CA;">4) Is this worth my life energy?</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-CA" style="mso-ansi-language: EN-CA;">This sounds really flaky, I know. But, you have to listen to "Your Money or Your Life" to get the full gist of this one. It boils down to this; money is what we are given in exchange for working. Work is the concrete expression of our life energy, which is then converted into money. So, essentially when you spend money, you spend your life energy. It's an interesting way to look at money in a more abstract way and to see that our life energy is finite (like our years of existence on the planet) so how do you want to spend that finite resource. </span></div>
<div class="MsoNormal">
<span lang="EN-CA" style="mso-ansi-language: EN-CA;"><br /></span></div>
<div class="MsoNormal">
<span lang="EN-CA" style="mso-ansi-language: EN-CA;">I know this is a bit of a long post and I am sure that I have lost many readers at this point for a variety of reasons, which I totally accept. I wouldn't have been ready to hear any of this before I was GOOD AND READY and it was seeing the totals at the bottom of the screen on my debt app which really propelled me into action. I also accept that I am probably the stupidest person on the planet when it comes to finances so I am hesitant to even elucidate how I am dealing with my money situation now, though I think I am on a right-ish track. </span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-CA" style="mso-ansi-language: EN-CA;">I felt the need to write this post though because we are given so little information about any of this as physicians (and just humans in general) that if some of this sparks and interest (or outrage) in any of the readers of this blog then I am beyond delighted. </span></div>
<div class="MsoNormal">
<span lang="EN-CA" style="mso-ansi-language: EN-CA;"><br /></span></div>
<div class="MsoNormal">
<span lang="EN-CA" style="mso-ansi-language: EN-CA;">I'll keep you posted on my progress and how the process is going. </span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-CA" style="mso-ansi-language: EN-CA;"><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://4.bp.blogspot.com/-Peop7HMu7XI/WM8aK9KeWgI/AAAAAAAADOw/Uev12ZCaKdA0ZYzK9Y05DKfI70EjSBwzwCLcB/s1600/Screen%2BShot%2B2017-03-19%2Bat%2B5.22.35%2BPM.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="200" src="https://4.bp.blogspot.com/-Peop7HMu7XI/WM8aK9KeWgI/AAAAAAAADOw/Uev12ZCaKdA0ZYzK9Y05DKfI70EjSBwzwCLcB/s400/Screen%2BShot%2B2017-03-19%2Bat%2B5.22.35%2BPM.png" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">The devil is in the details.</td></tr>
</tbody></table>
</span></div>
<div class="MsoNormal">
<span lang="EN-CA" style="mso-ansi-language: EN-CA;"><br /></span></div>
<div class="MsoNormal">
<span lang="EN-CA" style="mso-ansi-language: EN-CA;"><br /></span></div>
<div class="MsoNormal">
<span lang="EN-CA" style="mso-ansi-language: EN-CA;">* I love these guys and their blog and podcast are very high yield when you are on a crash course to minimalism and mindfulness. Unfortunately, in a recent podcast one of them mentioned their chiropractor and the other mentioned his adrenal fatigue. Thus I called into question every ounce of wisdom I had taken from them. I have since reminded myself about the concept of throwing out the baby with the bathwater and have come back to allowing that though I will never never never agree with their non-evidence based pseudoscience quackery promotion, I can accept that in other areas they have valuable information and ideas that are worth considering. </span></div>
<div class="MsoNormal">
<span lang="EN-CA" style="mso-ansi-language: EN-CA;"><br /></span></div>
<div class="MsoNormal">
<span lang="EN-CA" style="mso-ansi-language: EN-CA;">**Tim Ferris. What can I say. I have a love hate with this guy and what he puts out there. I love his work because it has introduced me to fascinating people who have done extraordinary things with their lives. I hate him because he is annoying and markets himself an expert on everything from matcha tea to exercise to boxing to studying to saturated fats to writing. I just can't. Yet I do, and I hate myself for it. </span></div>
<div class="MsoNormal">
<span lang="EN-CA" style="mso-ansi-language: EN-CA;"> </span></div>
<div class="MsoNormal">
<span lang="EN-CA" style="mso-ansi-language: EN-CA;"><br /></span></div>
<div class="MsoNormal">
<span lang="EN-CA" style="mso-ansi-language: EN-CA;"><br /></span></div>
<div class="MsoNormal">
<br /></div>
</div>
Albinoblackbearhttp://www.blogger.com/profile/15222730484450544498noreply@blogger.com5tag:blogger.com,1999:blog-3138625163039637769.post-51127490095951369252017-01-25T20:24:00.000-06:002017-01-25T20:24:00.890-06:00It's Geting Dark in Here<div dir="ltr" style="text-align: left;" trbidi="on">
So for Christmas Duncan bought be some great books. Maybe true love is someone who knows what books to buy you.<br />
<br />
I am currently reading <i>The Antidote</i>: <i>Happiness for people who can't stand positive thinking</i> by Oliver Burkeman and <i>Awake at the Bedside </i>by Koshin Paley Ellison. They are both SO intriguing and thought provoking. I am trying to be monogamous, but it's not working. These books have many overlapping themes and central ideas despite being about very different subjects. I love how they randomly came into my life at the same time. <br />
<br />
I never really had any proper training in palliative medicine, which I feel was a major gap in my medical education. Yes, I did 18 weeks of general practice, 15 weeks of internal medicine, 15 weeks of surgery, etc etc. but zero weeks in palliative care during medical school and zero weeks in residency. Weird because, uh...we ALL die. We might dodge the nephrotic syndrome, the massive stroke, the carcinoid metastasis, the glioblastoma, the neck fracture, but we all...die. So why is this universal outcome so ignored and unexplored in medical training? It's absurd really.<br />
<br />
I'm left trying to sort out how to manage the physical manifestations of this fact while learning how to listen, problem solve, know when it is not time to problem solve but just listen, juggle oncology telehealth appointments with finding out how to get a ramp made so my patient can get into his house with a wheelchair. It's a clash of the ultimate in existentialism, spirituality, and bowel care. The logistics of continence and difficult discussions and denial and heartbreak weave in and out of daily interactions, most of which I feel woefully inept at.<br />
<br />
So I make mistakes. Say things I shouldn't. Extend myself in ways I won't again and retreat in times I should have been present. But I am trying to learn, LISTEN, read, think, reflect, improve.<br />
<br />
I've learned that the Ellison book is not for bedtime reading. Unless you want to go attempt sleep with questions like "who do you want with you when you die?" or "what are the fundamentals of a good death and how would you like your death to unfold?" rolling around in your head.<br />
<br />
I started this post before going on post-Christmas holidays. I brought so many books with me in the hopes of enlightenment and insight. I read about 2 paragraphs over the 2 weeks. So I am still here, at the same place. But now the pressing paperwork, charting, forms, follow-ups, tasks, notes and labs are pouring in and as usual I find myself mostly living in the "urgent unimportant" world.<br />
<br />
So I will leave this for now. A poem that hit the nail on the head for me at a time when I needed it. <br />
<br />
<u>The Last Time</u><br />
<i>Marie Howe</i> <br />
<br />
The last time we had dinner together in a restaurant<br />
with white tablecloths, he leaned forward<br />
<br />
and took my two hands in his hands and said,<br />
I'm going to die soon. I want you to know that.<br />
<br />
And I said, I think you do know.<br />
And he said. What surprises me is that you don't.<br />
<br />
And I said, I do. And he said, What?<br />
And I said, Know that you're going to die.<br />
<br />
And he said, No, I mean know that you are.<br />
<br /></div>
Albinoblackbearhttp://www.blogger.com/profile/15222730484450544498noreply@blogger.com6tag:blogger.com,1999:blog-3138625163039637769.post-14157779093321947902016-12-24T13:15:00.002-06:002016-12-24T13:15:48.816-06:00Meh.<div dir="ltr" style="text-align: left;" trbidi="on">
Just can't get excited about Christmas this year. All the family is scattered to Hawaii, Australia, and Vancouver Island. I'm on call for the next 10 days here on the frozen prairies.<br />
<br />
Shift from hell yesterday. It was like the 12 Days of Christmas Emergencies....12 colds and coughs, 11 migraines ringing....5 abdominal painnnnnnnns, 4 chest pains, 3 hurty ankles, 2 broken legs and a post arrest resuscitationnnnnnnnnnnnnnn.<br />
<br />
We have a tree, yes. I didn't go too crazy on presents this year, mostly donated money to UNICEF, CBM, The White Helmets and World Vision. I don't know how much those donations actually help or get to the people in need, but I have to tell myself at least a fraction of a donation is better than no donation at all.<br />
<br />
Last year Audree (other ESS resident) and I had a big Christmas Eve dinner for all the orphan docs also stuck working over the holidays. It was a blast. Any dinner party that involves two-stepping in the kitchen with one of your attending's kids while others are attempting the final lift from Dirty Dancing in the living room, is a success in my opinion.<br />
<br />
I just can't get excited about being here, stressed about being on call, and having no friends or family around for any celebrations. And because I'm on call I can't even drink at this little pity party I'm having for myself !!!<br />
<br />
<br />
Merry Christmas to all y'all, enjoy a heavily spiked eggnog on my behalf. xx <br />
<br />
<br /></div>
Albinoblackbearhttp://www.blogger.com/profile/15222730484450544498noreply@blogger.com4tag:blogger.com,1999:blog-3138625163039637769.post-53734576365881507492016-12-22T00:07:00.000-06:002016-12-22T00:07:33.866-06:00Popcorn<div dir="ltr" style="text-align: left;" trbidi="on">
I've been thinking a lot about my own mortality lately, which weirdly manifests itself in an anxiety around popcorn. <br />
<br />
I think this is because of the fact that I've had two palliative patients pass away recently and because I've been reading some books on stoicism and mindfulness. <br />
<br />
I was falling asleep a few nights ago when I woke up my already drifting husband,<br />
<br />
<i>hon...we only have ONE life....ONE. THIS IS IT!!!</i><br />
<br />
He acknowledged this to be true and in his pragmatic way pointed out that it didn't matter because we wouldn't know anything when it ended anyway.<br />
<i> </i><br />
So, I go to work and try to be my best self and give my best self to my patients. And it's hard and stressful and some days I want to cry with them when they are crying, and some days I do. I mean I don't sob away and use their sleeve to blow my nose, but I let myself have that emotion. And then I get home and man, all I want is popcorn. Yes. Truffle salt and cayenne and nutritional yeast, please, you haven't lived until you've tried my popcorn. But it feels gluttonous and my husband is sliding the <i>Obesity Code</i> my direction with monotonous regularity, encouraging me to read it. He keeps telling me about ketogenesis and podcasts and really, I just want popcorn. <br />
<br />
HMPF.<br />
<br />
Because, <i>we only have one life. I should enjoy this popcorn now dammit. I could be dead tomorrow. </i><br />
<br />
But then I get up, and get dressed, and my jeans are tight. And I am OFF popcorn dammit. I go to work and see human suffering, and I see this crap shoot of a hand that we are dealt and I have to wonder.<br />
<i> </i><br />
<i>What if it were me that had the molar pregnancy 4 months ago which has now metastasized to my lungs. All of my worries and all these neurosis really boil down to sweet fuck all. </i><br />
<br />
Having your own mortality pointed out to you at work on a nearly daily basis can really put things into perspective or completely out of perspective, depending on how you look at it.<br />
<i> </i><br />
<i>I didn't have any tonight. For the record. </i><br />
<br />
<i> </i></div>
Albinoblackbearhttp://www.blogger.com/profile/15222730484450544498noreply@blogger.com7tag:blogger.com,1999:blog-3138625163039637769.post-8628714204510987662016-12-14T17:41:00.000-06:002016-12-14T17:41:02.336-06:00What the hell happened in June?<div dir="ltr" style="text-align: left;" trbidi="on">
So this is a weird thing.<br />
<br />
I have kind of had the blog in semi-hibernation since starting residency. I wasn't really checking in, or looking at stats at all (for readers and viewers, etc).<br />
<br />
But, something weird happened in June. I had this crazy spike in visits in June 2016. And I have no idea why. I can't go back now to see where the source was or if there was some link or story featured.<br />
<br />
Just this: <br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://3.bp.blogspot.com/-nqRcCdmriSU/WFHXiIwzjFI/AAAAAAAADL4/-GosLSfINJEtfNwy8Nak-tFqyMfNaRkyQCLcB/s1600/Screen%2BShot%2B2016-12-14%2Bat%2B5.33.42%2BPM.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="151" src="https://3.bp.blogspot.com/-nqRcCdmriSU/WFHXiIwzjFI/AAAAAAAADL4/-GosLSfINJEtfNwy8Nak-tFqyMfNaRkyQCLcB/s320/Screen%2BShot%2B2016-12-14%2Bat%2B5.33.42%2BPM.png" width="320" /></a></div>
<br />
Just wondering if anyone out there has any ideas on where this sudden surge of traffic came from? Was Dr. Grumpy's blog featured on The Daily Show or something? Did I get a shout out on CBC radio 2 ?<br />
<br />
Just curious. </div>
Albinoblackbearhttp://www.blogger.com/profile/15222730484450544498noreply@blogger.com6tag:blogger.com,1999:blog-3138625163039637769.post-47904599948899900532016-12-13T21:38:00.001-06:002016-12-13T21:38:21.724-06:00Letter To This American Life<div dir="ltr" style="text-align: left;" trbidi="on">
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<br />
<span style="font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">Sometimes you need to just take the
time. </span><br />
<br />
<span style="font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">I have very little time for reading, even
less it seems, for writing. But a recent episode of <a href="https://www.thisamericanlife.org/radio-archives/episode/603/once-more-with-feeling" target="_blank">This American Life</a> was so important to
me I forced myself to sit down and write a letter. My mom always reminds me
that we fill our days with urgent, unimportant things instead of important,
non-urgent things. If you haven't heard the podcast episode, "Once More,
With Feeling" especially act two. </span><br />
<span style="font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;">I received a reply today which gave me almost
as many gifts as the episode itself. I'll post it later. </span><br />
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I am a huge fan and have been a dedicated listener for
years. I treasure many episodes and hold some very close to my heart, but this
is the first time I have been so profoundly moved by an episode that I feel the
need to write the show. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I don't know how to illustrate my gratitude in a way that
gives justice to the insight given to me by this episode. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I have two retired infantry soldiers for brothers. One has
done over 10 tours of duty, initially as a mine disarmer and then as a post-blast
forensics specialist. He has served with NATO, the UN and the Canadian military
in Afghanistan, Bosnia, Cyprus, Yugoslavia, Rwanda, and many places he could
never tell us about. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I listened to Once More With Feeling this week while driving
to one of the communities in northern Saskatchewan that I work in. It's a long
and lonely drive. Several hundred kilometers with no cell reception and it's
-35 Celsius right now. I drive with a satellite phone in case of a breakdown.
It's dark too, so the podcast keeps me awake and keeps me company. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
When it got to Act 2 I was listening with intrigue as I know
my brother struggles with PTSD and integrating with normal society now that
he's retired. I know that when he got his first holiday in Greece after a few
months in Afghanistan he just sat on the beach and didn't speak at all for
several days. I know my sister in law has found him sobbing in their closet. I
know he vomited once while crossing the lawn of a friend's house in Ottawa
because a flashback made him think he was walking, without care or attention,
across a minefield. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I drink scotch with him when I visit and he tells me some
stories, which my sister in law knows verbatim. And some mornings she'll say,
"I never heard that one from last night before". I know he told a
story once at a work Christmas party about shooting an Afghan soldier in battle
which left everyone speechless and uncomfortable. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
As Michael Pitre spoke, it was like I was finally able to
see and understand a tiny fraction more of my brother's struggles and his
coping strategies in civilian life. Some of what Mr. Pitre said seemed so
obvious once he described it, I wondered why I hadn't understood, or picked up
on those patterns in my brother before. So there I was, driving and crying and
finally understanding things about someone who is so close to me but so hard to
get close to on many levels. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
My brother is getting counselling now, and his wife tells me
he's getting better and better, slowly. But I still feel so much fear and
sadness when I hear stories of Vet's who commit suicide or harm others once
they are home.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
It was such a powerful and important piece for those of us
living with friends and family struggling with re-integration. It wasn't
exploitative, or indulgent, or sensationalized. It was a beautiful, succinct
snapshot. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I am deeply grateful for this episode, and for all the hard
work that the staff at TAL put into their work every day. You may never realize
how far reaching, truly valuable and life changing the work you do can be for
listeners. I hope this shines a little light on that reality for you. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Thank you again. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Sincerely... </div>
</div>
Albinoblackbearhttp://www.blogger.com/profile/15222730484450544498noreply@blogger.com4tag:blogger.com,1999:blog-3138625163039637769.post-417349856365229072016-11-26T09:49:00.002-06:002016-11-26T09:49:52.651-06:00If several trees fall in the forest...<div dir="ltr" style="text-align: left;" trbidi="on">
We had a huge snow storm in October. <br />
<br />
<a href="https://1.bp.blogspot.com/-8ecYImfspAc/WDctodJs24I/AAAAAAAADKs/RC2LY7M6-Q0kKtrfkaAC4t7jYpx1tZDqwCLcB/s1600/FullSizeRender.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="320" src="https://1.bp.blogspot.com/-8ecYImfspAc/WDctodJs24I/AAAAAAAADKs/RC2LY7M6-Q0kKtrfkaAC4t7jYpx1tZDqwCLcB/s320/FullSizeRender.jpg" width="240" /></a>On the first day heavy wet snow came down in giant flakes. It fell fast and the trees which hadn't yet lost their leaves were weighed down by the sticky clumps. We had a day of respite where the trees stood, just a bit hunched over. The orange and red leaves still clinging to the branches. It looked like frosted sugar icing over all the fall colors.<br />
<br />
Snow with that degree of commitment doesn't usually come down so early in the season. Usually we have at least a few weeks of bare branches, frozen grasses and grey skies before snow fall.<br />
<br />
But, on the third day it really came down. Again the same heavy giant flakes fell for hours and hours and hours without letting up. It fell all day and continued into the night. The trees became more and more burdened.<br />
<br />
<a href="https://3.bp.blogspot.com/-g8m9H28KOkc/WDctnva1cAI/AAAAAAAADKo/ONToJXhfZ7QHjrJca3D77dcwfrQN3nZ2gCLcB/s1600/FullSizeRender_1.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="320" src="https://3.bp.blogspot.com/-g8m9H28KOkc/WDctnva1cAI/AAAAAAAADKo/ONToJXhfZ7QHjrJca3D77dcwfrQN3nZ2gCLcB/s320/FullSizeRender_1.jpg" width="240" /></a>During the night the snapping and cracking of bark could be heard throughout the town. Many of us were awoken by the sounds of huge trees giving into the winter weight. The power went out. So many trees had fallen onto power lines that over 10 000 residents of the province woke up to a cold house and a back yard of destruction. Including us.<br />
<br />
This weekend we volunteered to work on clearing the cross country ski trails. It was my day off and for once I wasn't on call so I dragged my arse out of bed and then dragged my hubs and pups along.<br />
<br />
It was such a fantastic day.<br />
<br />
It was the perfect temperature. The dogs were in heaven. It<br />
was exhilarating just to spend a physical day outside, breathing in the scent of pine needles and spruce gum, mixed with the exhaust of the chainsaw.<br />
<br />
Brings me ring me right back to skidooing as a kid, being pulled on toboggans, screaming with laughter and forgetting how cold my cheeks felt. Then heading home, warming up, and having the best sleep a kid could ever imagine. <br />
<br />
Here are a couple before/after shots of our work (with Monty photobombing, of course). We finished up the 3km and the 5km loop, for now. Nothing like a day in the woods, working until you're muscles ache, to let you forget about all the work that needs to be done everywhere else in your life. <br />
<br />
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Albinoblackbearhttp://www.blogger.com/profile/15222730484450544498noreply@blogger.com0tag:blogger.com,1999:blog-3138625163039637769.post-12619043645561411072016-11-15T22:01:00.000-06:002016-11-15T22:01:26.020-06:00Roads<div dir="ltr" style="text-align: left;" trbidi="on">
One of my patients died today, and I feel so selfishly devastated.<br />
<br />
B was strong, sinewy, and very alive when I met him in November of 2014.<br />
<br />
I was a resident working in the ER and we had had a long and very messy code blue. A man found down in the cold, on the side of a quiet gravel road. It looked like he had been walking home alone and had collapsed. His knees were skinned through his faded jeans and it looked like he had vomited blood on himself, the bright red ice crystals clung to his faded grey hoodie. He was dead, frozen stiff. But, as the brutal saying goes, 'you're not dead until you're warm and dead'.<br />
<br />
So we committed ourselves to warming this man every way possible, in the hopes that we might bring him back to life. Warm forced air under warm blankets, warm ringers into his shin bones, warm saline through a long needle into his abdominal cavity. We worked on him for a few hours, and eventually the patient was pronounced warm and dead.<br />
<br />
My hands felt heavy as I picked up the first chart in the full rack, a glance showing all the non-emergent patients who had arrived while we were busy in the trauma bay. You can't help but think, <i>do any of you really need to be here? That LAST guy needed to be here, HE was an emergency</i>. I just wanted to sit down. I wanted to try and mentally file what had happened. But, there was a chart in my hand and already I was opening the door to the next room.<br />
<br />
"Headaches" <br />
<br />
<i>Oh brother</i>.<br />
<br />
<i>Headaches, toothaches, back aches. Drug seekers. T3 refills.</i> I tried to shake the bias that starts creeping in the moment the presenting complaint is read.<br />
<br />
B was sitting on the stretcher. He looked like someone who could still run a fast mile, chop more wood than a teenager or two-step until the sun started to streak across the horizon. He looked embarrassed to be there, his wife looked determined. His was an easy smile, hers was a worried face.<br />
<br />
Headaches. Getting worse. Never had them before. Worse when he lifted something heavy at work. Feeling...cloudy. Walked around the house for ages trying to find his gloves, only to realize he was wearing them.<br />
<br />
I tried to find something, anything on physical exam to bolster the story I was going to have to sell the radiologist in the city in order to get this guy a CT scan. Maybe some papilledema? Was I imagining that? Maybe something off with his gaze convergence? I couldn't hang my hat on anything but a hunch.<br />
<br />
My attending was trying to clean up the waiting room full of people while I made calls to ER departments and radiology departments. He was going. He was gone.<br />
<br />
I never talked to B again. I saw his CT that afternoon which showed a massive brain tumor, cerebral edema and a midline shift.<br />
<br />
I ended up leaving that rotation and losing track of him. I couldn't remember which attending I'd been working with that day. I updated my phone and lost my notes, one of which was his health card number so I couldn't look up his imaging. I thought about him and his wife often and wondered what had happened and how things had gone for him.<br />
<br />
And then I found out.<br />
<br />
I came into work last week for hospitalist rounds and as I'm settling in to start my morning the nurse tells me, oh you had one admission during the night, a guy with a brain tumor who is here for IV steroids.<br />
<br />
I knew it was him. I turned to the stack of charts and saw his name. <i>I know him</i>!<br />
<br />
I headed down to his room and open the door. I was still in my scrubs and OR cap from an early morning case. His wife was sitting by the bed. I introduced myself and she greeted me politely. <br />
<br />
<i>"We've actually met before...you might not remember me..."</i><br />
<br />
She slightly cocked her head before her eyes widened a bit and she replied,<br />
<br />
"Two years to...the...day. We met you <i>two years ago today."</i><br />
<br />
I felt the hairs on my arms rise.<br />
<i> </i><br />
We exchanged stories of how we'd each lost track but hoped we'd somehow meet again. We let our eyes rim with tears at various points in the telling of the journey. B was settled in the bed and though he didn't open his eyes or say any words, his big hand squeezed mine when I grasped his. He still looked well. It was so incongruous. He didn't look faded into the bed, or sallow, or weak. He looked like he was having a quick kip before heading out to hockey practice.<br />
<br />
I visited them daily and got to meet his kids, and hear about his grandchildren. Over the weekend he went to the city for further treatment. A hail Mary, so to speak. I kept in touch with his wife while they were out of town, just to check in. Things weren't looking good.<br />
<br />
This morning, I woke up just after 5am. I couldn't sleep. I came into the lounge to try and get some reading done for an upcoming course. Shortly after 6am I received a text.<br />
<br />
B had passed.<br />
<br />
She thanked me for my part in their journey with a beautifully written note. It didn't seem right to cry, but it didn't seem right not too. As I got ready for work I tried to listen to some distracting music. Tears fell into my sink, onto my bathroom counter.<br />
<br />
Caring for patients and their families has unexpected side roads. These paths are not on of the map of our training, and no one tells you how to navigate them. No one can guide you or tell you when the road will suddenly become bumpy, or if it will lead you to the most amazing panoramic you can imagine.<br />
<br />
Tonight it seems those roads are often one in the same. <br />
<br />
<br />
<br />
<br /></div>
Albinoblackbearhttp://www.blogger.com/profile/15222730484450544498noreply@blogger.com5tag:blogger.com,1999:blog-3138625163039637769.post-20088910667780224652016-11-13T12:27:00.000-06:002016-11-13T12:27:02.959-06:00Heroes<div dir="ltr" style="text-align: left;" trbidi="on">
A few years ago I had the (crazy, surreal, amazing) fortunate experience of spending some time with Abraham Verghese.<br />
<br />
You know how people say you shouldn't meet your hero because they will inevitably disappoint?<br />
<br />
That is not always true, turns out. He is actually precisely what I thought he would be; articulate, measured, polite, engaging, interesting, <i>and</i> a good cook. We talked a lot about books, and writing, and medicine. He even said he read my blog (!!!) which was flattering and intimidating at the same time. But he said one thing which still rings in my head, something to the effect of "I couldn't write a blog, it would take me so long to feel like something was ready to post. I'd want to edit it and rework it and I just know it would take me so long to feel like it was good enough to publish, ready to be put out there".<br />
<br />
Shit. <br />
<br />
Well, I hadn't thought of blog postings that way before. I mean, sure, I hope that there are no glaring spelling mistakes or complete violations of the rules of grammar, but I had always just written something and then posted it. I also know he is a world renowned, famous author so he can't just throw a random GIF up there with "Happy Saturday" and expect his readers to appreciate it, but still.<br />
<br />
So I currently lie awake at night thinking of things I want to write about on the blog. And then I wonder if I should write a draft then send it to my mom (retired English teacher and editor) then rework it, marinate in it for a while, rewrite, send back to mom, then post. The rumination makes me tired and by the end of this thought cycle I am asleep. Which I suppose is a good thing, since I am usually an insomniac. But it paralyses me from writing at all. <br />
<br />
October whizzed by in a September-like fashion. I pulled a 21 day straight stint which had some ups and a few big downs. So much for "taking time for myself" etc. Why is it that when you start as an attending you're cursed? I've said, "Well I never saw THIS as a resident" more often in the past couple of months than I'd ever admit. The other new attending and I often pass each other at the hospital with mummified expressions that betray our lack of sleep muttering "curse of the new attending" between us. We tried to have wine together one night to commiserate but didn't even finish the bottle before our yawning took over the conversation completely. <br />
<br />
Most of the time, I am just terrified. I woke up one night with a start, my heart was racing and I felt this rush of panic, "shit, I'm on call" check my phone, no missed calls, there was nothing to panic about. My breathing was fast and I couldn't seem to get myself to calm down. I thought, "Am I having a panic attack? WTF? This is awful!" My stomach was in an unrelenting knot for days and I had the worst flare up of eczema I've experienced in my life. I was actually considering blood work because I was scratching my legs so forcefully in my sleep that I developed these multicolored blooming bruises everywhere, giving the appearance of scabies AND a clotting disorder. Apthous ulcers made eating and drinking so painful I was trying to chew/slurp on one side of my mouth. Coupled with the near compulsive hand scratching (oh, the joys of dyshidrotic eczema) I am quite sure I looked like a spectacle to my new colleagues most days.<br />
<br />
I texted one of my surgical attendings from last year. "Did you have resting tachycardia the year you were a new attending?" Her reply, "the first two years".<br />
<br />
Great. Well, I have certainly reached the promised land of being an attending.<br />
<br />
A nurse recently asked me (after I had scoped all day, scurried home to eat and then returned for my 12hr ER night shift), "Are you glad you went back and did medicine? I am thinking of doing that".<br />
<br />
Cue deep intake of breath.<br />
<br />
I remember vividly all the negative input I received from people when I told them I was thinking of going back to school to become a physician. I remember it so clearly because it occurred with monotonous regularity. I don't want to be one of those people to someone else. <br />
<br />
"Oh you don't want to have a life?" "I wanted to do medicine but I chose a life and a family instead" "Why would you ever want to ruin your life and get that much in debt?" "Getting in is basically impossible" "Have you written the MCAT? You'll never get a high enough mark to get in". Etc. Etc. Etc. Those are just a handful of my favorites.<br />
<br />
But looking back now, these comments weren't completely off base. I take a look at what I've gone through in the last 8 years on this tumultuous journey. I see where I am and what my life is now. I am not sure that I am glad about becoming a physician. When asked about my decision to go back and study medicine, I genuinely answer, "Ask me in 10 years" because I feel that by then I can more accurately assess the pros and cons. Right now the "cons" list is pretty heavy.<br />
<br />
I wanted to be a doctor because my Grandad was a doctor, and he was my hero. But now that I am older and can take a wider lens to my perception of him I realize he was also a farmer, a voracious reader, a world traveller, a philosopher.<br />
<br />
Abraham Verghese, Atul Gawande, Jerome Groopman, Walt Lillehei, and Kevin Patterson, Brian Goldman are a few more of my heroes, not because they are doctors but because they inspire me by what they've done in addition to (or despite) being doctors.<br />
<br />
<br />
I can't ask most of my heroes how they came to find the time and energy and inspiration to do the things they've accomplished in their lives. I'm still in survival mode right now but things will hopefully settle in the next few months and I can re-calibrate and re-introduce myself to the things I enjoyed doing. If medicine remains the only thing in my now-one-dimensional life I know I'll burn out fast. I'll find those things that inspire me again and start putting my energies into those things as well. And keep the betaderm handy. <br />
<br />
</div>
Albinoblackbearhttp://www.blogger.com/profile/15222730484450544498noreply@blogger.com8tag:blogger.com,1999:blog-3138625163039637769.post-4691326203628586522016-10-03T21:34:00.001-06:002016-10-03T21:34:30.279-06:00Taking Care<div dir="ltr" style="text-align: left;" trbidi="on">
One of my colleagues, Rebecca, came by last week and I think she could tell that things were a bit rocky. She took a look at my schedule and pointed out that I was working 17 days in a row without a day off. And that needed to change.<br />
<br />
She was not wrong!<br />
<br />
So she urged me to talk to our physician scheduler and ask for some clinic time off and to see if I could get rid of some of my ER shifts. I didn't know I could do that! She texted me on Monday and asked if I had talked to the scheduler yet. I hadn't had a chance. Then I get a sticky note on my desk from the scheduler saying to come talk to her when I have a chance.<br />
<br />
Did Rebecca tell you to talk to me?<br />
<br />
Sideline glance, non-committal mumble.<br />
<br />
Riiiiiight. Okay.<br />
<br />
So we did some tweaking and now I have a few afternoons off, and I took the last 3 days of October off. I still have 15 days in a row of surgical call but, that's the way the cookie crumbles when there is only one other GP-Surgeon in town for the time being.<br />
<br />
I started using this app called Headspace. It's a mindfulness app. I know, it's an oxymoron to put those words together, really. But I have found it very useful and have been <i>trying</i> to do 10 minutes of guided meditation (or mindfulness or whatever you want to call it) daily. It's not an airy, breathy woman chanting about crystals. It's a dude talking about observing your thoughts in a very straightforward and concrete way.<br />
<br />
Hopefully between the little pockets of protected time off, the commitment to spending some time clearing my head, writing, and scurrying around the forest with the pooch, things will start to look up and become more manageable. No one tells you how to take care of yourself. No one else cares if you disintegrate into tiny drooling shell of a person who watches Price Is Right reruns all day. So I'll start with these baby steps. </div>
Albinoblackbearhttp://www.blogger.com/profile/15222730484450544498noreply@blogger.com5tag:blogger.com,1999:blog-3138625163039637769.post-2248747997238809272016-09-27T20:20:00.000-06:002016-09-27T20:20:10.234-06:00Reality Bites<div dir="ltr" style="text-align: left;" trbidi="on">
Well, the shiny gloss of being an attending certainly didn't last long.<br />
<br />
I have a new reference point for the expression "being thrown in the deep end of the pool" now. These days I feel like all I'm doing is inhaling water and pathetically thrashing around. <br />
<br />
I can remember rolling my eyes so many times in the past when being dragged through a long-winded seemingly redundant orientation at a new job. I would kiss the feet of someone who would orient me now.<br />
<br />
No name tag, no hospital badge to get into the hospital. What are the codes to get into the change room, the back door of the clinic, to photocopy something? What forms do I need to fill out to book a surgery and then where do I put them? Who does the bookings? Do I need to book an anesthetist?<br />
<br />
Where are the prescription pads? Where do I send my invoices, my day sheets, my O.R slips? What is my dictation code, do we have an ultrasound tech in the hospital, is there a pharmacy open on Sunday and when do I get paid? What times are the hospitalists on call until, do you routinely collect cord blood, what is an order set, <i>where</i> are the order sets? How do I empanel a patient, send a task, get an old chart?<br />
<br />
Just a small sample of the myriad of questions I am trying to sort out while trying to actually care for patients. The cleaning staff are wiping around me an my desk every night. I make so many notes to self during the day; read up on post-kidney transplant surveillance, monitoring polymyositis, review guidelines for Barrett's esophagitis recall, post neonatal resus stabilization...remind myself how to interpret blood gases, put on casts, do fundoscopy, thrombolytics, a lumbar puncture.<br />
<br />
But then I get home, nauseated and sweaty. Just so happy to get out of my microbe infested hospital or clinic clothing. I eat and think, "I should read up on those things now, I should work out, I should empty the dishwasher" but instead I find myself crawling into bed. Not caring that my feet probably have dried amniotic fluid on them.<br />
<br />
And then a new day comes.<br />
<br />
Or it doesn't. Instead the phone rings at 3am and I am driving back to the hospital for another delivery. This time the mom is fine but the baby is not fine. And I spend the next few hours talking to family members who have gone silent with fear and waking up neonatologists who are sleeping hundreds of kilometers away.<br />
<br />
Then the night morphs into day and I am the hospitalist for the medical ward and my conversations shift to managing INR results and incontinence and wound vac dressings. A palliative patient, who I haven't met until that day has family there and they want to speak to <i>the doctor</i> about what is happening. My morning becomes afternoon and my lunch becomes the family meeting where I try my hardest to remember all the insightful and beautiful things that Atul Gawande talks about in <i>Being Mortal</i> and I try to remember to do more listening than talking.<br />
<br />
So I leave the family meeting and fly into the clinic where on arrival my MOA throws up her hands at all the paperwork I am sending her and tells me it's not working. I duck into the first patient who wants a narcotic refill and disability form filled out and when I press him for details on the background of these requests he tells me...<br />
<br />
<i>you doctors are the worst...I was told how terrible the doctors are in this town, they don't care about anyone at all, even if you're dying...the worst...my old doctor cared, he prescribed me valium and dilaudid...he was a good doctor...you're a terrible doctor</i><br />
<br />
And I can't help but feel the exhaustion from the night before crash over me. I can't stop the rising flush in my neck and my quickening pulse.<br />
<br />
Where are the disability forms? <br />
<br />
<br /></div>
Albinoblackbearhttp://www.blogger.com/profile/15222730484450544498noreply@blogger.com10tag:blogger.com,1999:blog-3138625163039637769.post-89356275818664984192016-09-18T14:52:00.002-06:002016-09-18T14:52:44.595-06:00False Summit<div dir="ltr" style="text-align: left;" trbidi="on">
I finished my first stretch of call as an attending. Ten days of surgery coverage, two days of obs coverage mixed in there with a few ER shifts, consult clinic days, assisting, and scoping. Lots of "firsts" over the past 10 days. <br />
<br />
I did my first middle of the night cesarean as an attending. No one there to tell me to cut higher or wider. No one there saying "it's safe to divide the omentum there" or showing me "the bladder is right there". It was just me standing there with sweat soaking through my bra and my socks.<br />
<br />
The call came in around 3am, waking me and my husband up. I threw my pile of getting called back to the hospital clothes on. Duncan sleepily asked me what I was going in for.<br />
<br />
<i>Possible section. </i><br />
<br />
<i>Good luck hon. </i><br />
<br />
Driving to the hospital I tried to breathe but it wasn't easy. I tried to remember the words of encouragement my attendings had given me over the last few years. Of course the only voices that easily came through were the words of doubt, the criticisms I've received. The houses along the way were quiet and dark as I rolled past, a contrast to my thoughts.<br />
<br />
Later, when I got home. I was too wired to sleep. It was around five am. The edges of night were falling away and the morning bird songs had begun. I wasn't ready for bed but I went to our bedroom. I knew that Duncan would have had fragmented sleep after I left. I creaked open the door and he turned over.<br />
<br />
<i>How did it go? </i><br />
<br />
<i>It went well. It wasn't easy. I was terrified. </i><br />
<br />
<i>I couldn't get back to sleep, I kept drifting in and out, wondering what time it was, hoping you'd be home soon.</i><br />
<br />
<i>I'm going to watch TV for a bit, I can't sleep yet. </i><br />
<br />
<i>Thanks for coming in to tell me everything went OK, congrats. </i><br />
<br />
The big sleepy and warm hug was perfect. I went to the livingroom and put on Jim Gaffigan's newest stand up.<br />
<br />
I thought that things would get easier when I finished residency. I thought that residency was really stressful because you were always having to do things the way other people wanted. You are always having to bend your preferences, practices, and schedule to the whim of your attendings. I had many days last year when I thought that being a resident would break me. I thought the stress and sleep deprivation was reaching the edges of sanity.<br />
<i> </i><br />
Like most things in life if I could go back I would do things much differently, and I'd chill the fuck out a bit too. The transition to becoming an attending has felt like taking off a 60lb backpack at the end of a hike, only to be handed a 100lb one while being told you have another 50 miles to walk. If only I'd known what was coming next.<br />
<br />
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Albinoblackbearhttp://www.blogger.com/profile/15222730484450544498noreply@blogger.com1tag:blogger.com,1999:blog-3138625163039637769.post-248511574242986272016-08-28T23:02:00.000-06:002016-08-29T12:43:18.525-06:00Is this thing on...?<div dir="ltr" style="text-align: left;" trbidi="on">
I wasn't sure if I still had a blog. I tried to log on from Switzerland and it wasn't working so I was a little concerned.<br />
<br />
I finished residency (or rather, all my residencies) at the end of June.<br />
<br />
This whole blog, which was meant to document my journey from nurse to doctor has technically come to an end. I am now a fully fledged GP-Surgeon. Want me to explain what that means? Do you have half an hour and half a bottle of wine?<br />
<br />
It was a horrific year. Not like a horrific year compared to 70% of the world's population, I know. But, with respect to medical training, residency, life: horrific. I crawled and cried my way to the finish line. Then I worked basically 19 days straight and went on vay cay at the end of July. Sort of a holiday / honeymoon / end of residency party.<br />
<br />
It was amazing.<br />
<br />
It was an <i>eating melted cheese in Switzerland, hiking in the Alps, drinking Champagne more nights than not</i> sort of endeavor. I got to be a tourist, waking up to the mountains in France one day and then to freshly made scones and clotted cream at one of the finest hotels in London, the next. I had a 37th birthday that was OFF THE HOOK.<br />
<br />
Now I am visiting family in BC and soon heading back to officially start my job as an attending-rural-medicine-GP-surgeon-ninja next week.<br />
<br />
I am terrified and in debt. And I have so many stories, so many moments from the last year that roll around in my head. I don't even know how to start taking them off the shelf. I don't know if anyone even reads this blog anymore, but I promise, I promise to start writing again now that the dust is settling and a new story is starting.<br />
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://3.bp.blogspot.com/-XddzCKEjIhE/V8PAxmTTONI/AAAAAAAADIg/PWeId5I5jKkRJlud4_DqHGqPRnMDGYWfgCLcB/s1600/IMG_5044.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://3.bp.blogspot.com/-XddzCKEjIhE/V8PAxmTTONI/AAAAAAAADIg/PWeId5I5jKkRJlud4_DqHGqPRnMDGYWfgCLcB/s320/IMG_5044.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">The morning of my last call shift as a resident. </td></tr>
</tbody></table>
</div>
Albinoblackbearhttp://www.blogger.com/profile/15222730484450544498noreply@blogger.com16tag:blogger.com,1999:blog-3138625163039637769.post-1445202842563009332016-01-07T13:53:00.002-06:002016-01-07T13:53:32.297-06:00Sweaty Scapulas<div dir="ltr" style="text-align: left;" trbidi="on">
I am finally half-way through my last year of residency. It has been the hardest year of training, without question. It is difficult to finish one residency feeling somewhat competent and able (Family Medicine) and begin a new residency where every day you just feel like a completely inept moron (Enhanced Surgical Skills). Stack on to that the sleep deprivation, increased debt, crippling self doubt, and sore muscles. It all makes me ask "<i>why am I doing this to myself" </i>on a daily basis.<br />
<br />
I was finishing a cesarean section last July and I said to my attending afterward, "I've never actually felt sweat dripping off my scapula before". She just smiled and said, "welcome to surgery". And she was right.<br />
<br />
I've seen and done things this year that I haven't even begun to process. I'd love to write about these experiences but I am constantly mindful of confidentiality, not that I have the time anyway. I miss writing. I miss looking back on my perspective on events, being reminded of things I'd completely forgotten about.<br />
<br />
A good friend of mine recently published a very<i>...very</i>...<a href="http://eighteenbridges.com/story/breathing-holes-iqaluit-sexual-assault-memoir-lisa-gregoire/" target="_blank">brave piece</a> about her life in Iqaluit many years ago. It is so beautiful and raw and brilliantly written. It made me wish I could be a writer and tell the stories we face, and the people we become as a result of being trained in the medical machine.<br />
<br />
Maybe that will be my New Years resolution. Just to start writing again. Even if it is only for me.<br />
<br /></div>
Albinoblackbearhttp://www.blogger.com/profile/15222730484450544498noreply@blogger.com11tag:blogger.com,1999:blog-3138625163039637769.post-5813369889401056692015-07-23T22:43:00.003-06:002015-07-23T22:43:51.956-06:00Horizontal<div dir="ltr" style="text-align: left;" trbidi="on">
That feeling.<br />
<br />
When your feet are finally at the level of your heart. Your blood is returned without having to fight gravity. You feel the throb deep in your heels, the heaviness in your bones. There is a thin film of sweat covering your body but you don't care. All you care about is the fact that you are no longer standing, reaching, bending, pulling, straining, and concentrating. This moment, this...is bliss. You're not breathing in your own carbon dioxide or trying to see through your fogged eye protection.<br />
<br />
You are finally horizontal. The scenes from the day intrusively play themselves out behind your eyelids but you don't care because you are still, silent, and free. <br />
<br />
For a few hours. </div>
Albinoblackbearhttp://www.blogger.com/profile/15222730484450544498noreply@blogger.com4tag:blogger.com,1999:blog-3138625163039637769.post-19034065314449295462015-07-21T17:08:00.000-06:002015-07-21T17:08:15.489-06:00Dr. Albinoblackbear, CCFP. <div dir="ltr" style="text-align: left;" trbidi="on">
Hello Ye Dedicated Readers of My Blog.<br />
<br />
I keep thinking about shutting the blog down but then I realized, I can't do it before I finish residency! There are so many unfinished, undocumented, unknown endings in health care, I hate to add this blog to the list of "remember that guy...what ever happened to him?" narratives. <br />
<br />
Well nothing has really <i>happened </i>yet. It's all still happening.<br />
<br />
I wrote the CCFP / LMCC 2 at the end of April and early May. I finished off my residency in a lovely little community where I had the opportunity to do some ER, some obs, some endoscopy, some surgery. They were a fantastic group of docs who offered me work there when I was done and I was so wishing I could say yes.<br />
<br />
Seeing my cohort getting their offices together, planning European vacations, talking about paying down debt, I can't help but ask myself, "<i>what was I thinking signing up for another year of residency?!?!"</i><br />
<br />
To make matters worse, Duncan got a job in BC and is moving back there uhhhh tomorrow. <i> </i>The job opportunity for him came a few months after I had accepted the PGY3 year training spot. So here I sit, watching him pack up and get ready to move back to my favorite place on earth, and I wonder, <i>"what in the deluded hell was I thinking signing up for another year of residency?!?!"</i><br />
<br />
So yeah. I have another year of training and two more years return of service here before I'll be able to join my husband-to-be-who-will-be-my-husband-by-then in BC. Until then, it'll be a looooooooooooong distance thing, I guess. Good old medicine. It isn't a train you can really get off if the destination starts to look less inviting.<br />
<br />
I get a lot of emails from people who come across the blog. They ask me if they should apply for medicine or how to go about doing so. I think no one wants to really hear the real story. I feel like people want a Facebook version of events: big emotional moments where you save the day and feel validated, you steal an hour of two of sleep in call rooms with freshly laundered sheets then drive home in the morning, exhausted yet buoyed by the knowledge you <i>made a difference</i>. Really, it is just a lot of sacrifices and a lot of (mostly scut) work.<br />
<br />
I started medical school when I was 30. I am not going to be done my training/return of service until I am 39. That is not an insignificant amount of time to hand-over in exchange for a new career. Putting on hold the place I want to live, a hold on having a family, a hold on traveling adventures, spending time with the people I value.<br />
<br />
Many nurses have asked me "was it worth it?" to which I usually reply "ask me in 10 years". I really can't tell yet. I'm still too <i>in it. </i>Now I'm in horrific debt and have a lot more stress than when I was an RN. There were things I loved about nursing and things I hated about it, the same goes for residency. It's not <i>better</i> (yet) that is for sure. </div>
Albinoblackbearhttp://www.blogger.com/profile/15222730484450544498noreply@blogger.com6tag:blogger.com,1999:blog-3138625163039637769.post-8359512238804980302015-03-09T15:39:00.000-06:002015-03-09T15:39:44.302-06:00My Current Theme<div dir="ltr" style="text-align: left;" trbidi="on">
My current theme appears to be death. Not that I am thinking so much about <i>my own</i>
eventual demise, more about the process and ritual around death and
dying. I seem to be stumbling across a lot of articles, books, and
podcasts theses days about mortality and I've been so fascinated and
appalled and intrigued by it all. Thought I would share a few, in case
any of you are interested.<br />
<br />
CBC has a great radio show called, <i>Ideas</i>,
which recently ran a 3 part series called, "Death Becomes Us". Wow.
Spent three evenings walking in the hilly, drizzly Irish mist listening
to those. Very captivating and eye-opening. Who knew the origins of
embalming? Who knew about death midwives? Who knew people buy concrete
blocks to go around coffins? Woodland burial sites? I certainly was
ignorant on all of these fronts. I found the whole series quite good,
but I think <a href="http://www.cbc.ca/radio/ideas/death-becomes-us-part-3-1.2944858" target="_blank">episode 3</a>
was my favorite. Of course the whole thing led to a panicked call to
Duncan regarding changes to my death and dying wishes! I think he's
become enured to these sorts of phone calls, no longer worried something
is <i>actual wrong</i> with me, just that I've read something or watched a TED talk which has caused these addendums. <br />
<br />
I
also recently finished, "Being Mortal" by Atul Gawande. He's just such a
legendary author, I instantly read everything of his that I can track
down. Some of the discussions and concepts highlighted in <i>Being Mortal</i> have already changed my fledgling practice. If you want to hear him speak on these matters he also did the <a href="http://www.bbc.co.uk/programmes/articles/6F2X8TpsxrJpnsq82hggHW/dr-atul-gawande-2014-reith-lectures" target="_blank">Reith Lectures</a> on BBC recently. <br />
<br />
And, a smattering of <a href="http://opinionator.blogs.nytimes.com/2015/02/07/when-doing-everything-is-way-too-much/?smid=fb-nytimes&smtyp=cur&bicmp=AD&bicmlukp=WT.mc_id&bicmst=1409232722000&bicmet=1419773522000&_r=1" target="_blank">op-eds</a>, <a href="http://www.newyorker.com/magazine/2010/08/02/letting-go-2" target="_blank">old</a> articles and <a href="http://www.cbc.ca/radio/whitecoat/blog/mds-urged-to-write-the-rules-on-assisted-death-1.2987355" target="_blank">new</a>, and the shifting landscape in Canadian medicine as we face the potential changes to physician assisted suicide.
Death is all around us in health care. It's easy to focus on the
potassium levels, the next chemo drug, the ventilator settings. The real
effort for me is pulling back and looking at all of these aspects of
dying in a bigger sense, and including myself in the picture. </div>
Albinoblackbearhttp://www.blogger.com/profile/15222730484450544498noreply@blogger.com3tag:blogger.com,1999:blog-3138625163039637769.post-26098875254249059832015-02-10T17:31:00.000-06:002015-02-10T17:31:04.689-06:00When Will I Be Good?<div dir="ltr" style="text-align: left;" trbidi="on">
I really need to just start writing again, it's starting to make me crazy. I know I've said this on the blog before (maybe I need to go back and start reading old posts again) but the best advice/word of warning I received on this journey was "make sure you like the person you become at the end of your training".<br />
<br />
Well, I haven't become a maniacal, self-important, egotistical, jerk. Yet. But I have let so many parts of who I am, fall away. I've definitely stopped being a somewhat multidimensional human. I hardly read (for enjoyment) anymore, I don't play music, I don't train physically like I used to. I've basically stopped doing yoga, writing, traveling. I know this is just a residency-routine-rut but it's frightening sometimes to see hobbies and loves that I once had just gradually fade into the distance, and not even (really) notice. I still am excited about medicine, about learning, about getting better, safer, wiser. But I keep coming back to somehow wanting to make sure I do indeed like the person I am becoming. Right now, it's iffy. <br />
<br />
There are good things happening too. Very exciting times, even.<br />
<br />
Duncan and I got engaged just a couple of weeks ago! <br />
<br />
I got the surgical/obsetrics training spot for next year!<br />
<br />
I am temporarily back in Ireland for some surgical training with M.C. It's fantastic being back here.<br />
The thing is, because I am now moving towards my surgery and obstetrics training, I feel like I am back at the drawing board. I feel clumsy and hopeless again as a learner. My knots, my draping, my grasping. The simplest things you see surgeons do, then suddenly you're doing it and dammitiwatchedthisa1000timeswhycantidothis basically runs on repeat in your head. It makes me wonder when I will be good? Will I ever be good? Then I try to remember that I am on a much different path and that I will have to forge some of it myself, instead of constantly worrying about my exact endpoint. <br />
<br />
So I will close on this perfect Rumi poem. For now. Evidently "Shams" was Rumi's living mentor. Thus, this poem struck very close to home when I read it this week, as my legs are, indeed, feeling heavy. <br />
<div dir="ltr">
<i> </i></div>
<div dir="ltr">
<div style="text-align: center;">
<i>Unfold your own myth</i></div>
<div style="text-align: center;">
<br /></div>
<div style="text-align: center;">
Who gets up early to discover the moment light begins?</div>
<div style="text-align: center;">
Who finds us here circling, bewildered, like atoms?</div>
<div style="text-align: center;">
Who, like Jacob blind with grief and age,</div>
<div style="text-align: center;">
smells the shirt of his lost son</div>
<div style="text-align: center;">
and can see again?</div>
<div style="text-align: center;">
Who lets a bucket down and brings up</div>
<div style="text-align: center;">
a flowing prophet? Or like Moses goes for fire</div>
<div style="text-align: center;">
and finds what burns inside the sunrise?</div>
<div style="text-align: center;">
<br /></div>
<div style="text-align: center;">
Jesus slips into a house to escape enemies,</div>
<div style="text-align: center;">
and opens the door to the other world.</div>
<div style="text-align: center;">
Solomon cuts open a fish, and there's a gold ring.</div>
<div style="text-align: center;">
Omar storms in to kill the prophet</div>
<div style="text-align: center;">
and leaves with blessings.</div>
<div style="text-align: center;">
<br /></div>
<div style="text-align: center;">
But don't be satisfied with stories, how things</div>
<div style="text-align: center;">
have gone with others. Unfold</div>
<div style="text-align: center;">
your own myth, so everyone will understand</div>
<div style="text-align: center;">
the passage, <i>We have opened you.</i></div>
<div style="text-align: center;">
<i><br /></i></div>
<div style="text-align: center;">
Start walking toward Shams. Your legs will get heavy</div>
<div style="text-align: center;">
and tired. Then comes a moment of feeling</div>
<div style="text-align: center;">
the wings you've grown, lifting.</div>
<div>
</div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://3.bp.blogspot.com/-Hxd3GlSJdWQ/VNqT9wRMmNI/AAAAAAAAC1U/uqjUws4bCKc/s1600/Heaven%2BKerry.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="http://3.bp.blogspot.com/-Hxd3GlSJdWQ/VNqT9wRMmNI/AAAAAAAAC1U/uqjUws4bCKc/s1600/Heaven%2BKerry.jpg" height="275" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">View from a hill, on my Sunday walk.</td></tr>
</tbody></table>
<div>
</div>
</div>
</div>
Albinoblackbearhttp://www.blogger.com/profile/15222730484450544498noreply@blogger.com8tag:blogger.com,1999:blog-3138625163039637769.post-9944658703364192512014-11-16T22:39:00.000-06:002014-11-16T22:39:03.477-06:00Reality<div dir="ltr" style="text-align: left;" trbidi="on">
I felt a lot of genuine support and was buoyed by the reader comments after my last post. Been thinking a lot about the different things people said. I received some emails that also echoed the comments in the "thank you for being real" vein.<br />
<br />
I think I'm feeling a little overwhelmed by the "is that really your life?" emotion when I flick to FB and see an endless stream of perfectly manicured children, lawns, engagement photos, work achievements, and exercise updates. I look down at the jeans I've been wearing to and from work for the last three days, the stacks of review books I should be pouring over to study, and the pile of t.v dinners I've gone through over the past week for sustenance and I think, "Where am I going wrong here??"<br />
<br />
And I don't want to use FB or my blog as a permanent venting space but I think there is a distressing lack of REALNESS in the world these days. We're not supposed to admit that we're scared, or unfulfilled or unhappy. And we are certainly not allowed to admit to failure, mistakes, bad decisions, or regrets.<br />
<br />
There are a lot of people out there who I wouldn't want to disclose my shortcomings to, or my sadness to. But many of my blog readers are on a similar path and probably think they are alone. And to those people I want to say, "No, you are not alone.".<br />
<br />
I had a beautiful, challenging week. I was up early and in bed late. I was able to sneak in a couple of bike rides on my wind trainer, and eat a couple of meals before 10 pm. But mostly, I was at the hospital with a full bladder and an empty stomach. I picked up a devastating diagnosis on a fit and rugged man, and held up a fresh, slippery, crying baby while grandad took photos on his SLR. I missed my boyfriend and my own bed. I bought a lottery ticket once again hoping magic would erase my student debt, freeing me to <i>chose</i> if medicine was still what I <i>wanted</i> to do instead of <i>had</i> to do now.<br />
<br />
But there is no choice now but to carry on. As Winston Churchill famously said, "If you're going through hell, keep going."<br />
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Albinoblackbearhttp://www.blogger.com/profile/15222730484450544498noreply@blogger.com9