Horizontal

That feeling.

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.

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.

For a few hours.

Dr. Albinoblackbear, CCFP.

Hello Ye Dedicated Readers of My Blog.

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.

Well nothing has really happened yet. It's all still happening.

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.

Seeing my cohort getting their offices together, planning European vacations, talking about paying down debt, I can't help but ask myself, "what was I thinking signing up for another year of residency?!?!"

To make matters worse, Duncan got a job in BC and is moving back there uhhhh tomorrow.  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, "what in the deluded hell was I thinking signing up for another year of residency?!?!"

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.

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 made a difference. Really, it is just a lot of sacrifices and a lot of (mostly scut) work.

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.

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 in it. 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 better (yet) that is for sure. 

My Current Theme

My current theme appears to be death. Not that I am thinking so much about my own 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.

CBC has a great radio show called, Ideas, 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 episode 3 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 actual wrong with me, just that I've read something or watched a TED talk which has caused these addendums.

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 Being Mortal have already changed my fledgling practice. If you want to hear him speak on these matters he also did the Reith Lectures on BBC recently.

And, a smattering of op-eds, old articles and new, 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.

When Will I Be Good?

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".

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.

There are good things happening too. Very exciting times, even.

Duncan and I got engaged just a couple of weeks ago!

I got the surgical/obsetrics training spot for next year!

I am temporarily back in Ireland for some surgical training with M.C. It's fantastic being back here.
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.

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. 

 

Unfold your own myth

Who gets up early to discover the moment light begins?

Who finds us here circling, bewildered, like atoms?

Who, like Jacob blind with grief and age,

smells the shirt of his lost son

and can see again?

Who lets a bucket down and brings up

a flowing prophet? Or like Moses goes for fire

and finds what burns inside the sunrise?

Jesus slips into a house to escape enemies,

and opens the door to the other world.

Solomon cuts open a fish, and there's a gold ring.

Omar storms in to kill the prophet

and leaves with blessings.

But don't be satisfied with stories, how things

have gone with others. Unfold

your own myth, so everyone will understand

the passage, We have opened you.

Start walking toward Shams. Your legs will get heavy

and tired. Then comes a moment of feeling

the wings you've grown, lifting.

 

View from a hill, on my Sunday walk.

 

Reality

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.

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??"

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.

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.".

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 chose if medicine was still what I wanted to do instead of had to do now.

But there is no choice now but to carry on. As Winston Churchill famously said, "If you're going through hell, keep going."

Nothing Profound

I realize that the longer I postpone another update on the blog, the more pressure I feel to make it something noteworthy or profound. And so another week or two goes by and I have many little moments where I think, "I should write this down" or "I should post this little anecdote" but then it seems too small to creep back onto the web with.

So I resolved that this week I would just start with a basic hello. An update to say I haven't abandoned ship completely.

It's been a busy few months, as I am sure you all can relate to. Been going though the usual questions regarding life choices, career choices, and where I see myself in 3, 5, 10 years time. Having been on the delayed gratification, long-term goal track, it sometimes feels hard to get off it and just look at today.

I have written and erased so many posts in the last few months. Finding it harder to know who reads this blog and for what reasons. I don't want to violate my patients' privacy but I also don't want to violate my own.

In brief, I will say that I was offered a residency spot last spring in obstetrics. It was a really challenging decision making process to go through. For many reasons I did not take the seat and chose instead to apply for the additional year in enhanced surgical skills training. Which I have done, and found out today that my interview is in a couple of weeks. Which is exciting and daunting.

The GP-Surgeon route is all about faith; faith in rural medicine, future practice, and future policy makers. Faith is something that I have very little of these days. Thus, a nearly ongoing, "what am I doing, where am I going, what type of practice will I have, will I regret this decision" thought spiral of despair. I've worked so hard, so hard to get to this place and yet I am constantly berating myself for not having worked hard enough.

I know a big part of this is burnout, stress related to my family medicine boards, stress related to having to live away from home for 8 months of this year, and having to apply for provisional licences in other provinces/countries. But just because I can identify the aetiology of my distractibility it doesn't make it any easier to bear. I watched the ZdoggMD TED talk a week or so ago and it seemed to tip me over the edge on the major life dissatisfaction precipice. Now all I can think of is one of my mentors telling me a long time ago, "don't lose yourself in medicine, make sure you like the person you become at the end of it.". Well, so much for heeding that advice.

But there are enough REAL issues going on the world. No one needs to come to my blog to read a whiny rant. Real issues like ISIS, and the youth justice system, and violence towards women, soldiers getting killed on Canadian soil, ebola running rampant in West Africa, and I could go on. Hello, reality check.

Well, I will endeavour to keep writing, keep plodding, keep smiling. But for now, laundry, and then a 3 hour drive to work.

Listen

Today in clinic a Dene Elder says to me while I am listening to his heart, "If it sounds a little different, it's 'cuz it has a Native beat".

I have never laughed so hard with a stethoscope in my ears.

One of those patients that I felt an instant connection with. I stared at those deep laugh lines etched in his tan skin while he told me about his cardiology appointment. He pulled out a palm sized moleskin notebook and recited ejection fractions and names of specialists and amiodarone adjustments (which he doesn't care for, after all the reading up he's done on it). He told me that when he had his heart attack he remembered being wheeled in through the hospital doors and that when they closed behind him, many other areas of his life closed behind him too. He woke up eight days later in a cardiac intensive care unit.

He golfs, he lifts weights, he walks everyday. His intensivist told him he was a "ticking time bomb" but he pointed out to me that he was still here. I told him I was glad of that.

I wanted to cancel the rest of my afternoon and just listen. Such a vivid cast of characters in this unfolding narrative which is my life.

Last Day

Today is my last day as an R1, which officially marks the halfway point in my rural family medicine residency training. I find it amusing that I have to have my orders and prescriptions reviewed and see patients in a parallel consulting style today, but once the weekend is over, I don't. It is a magical weekend I suppose wherein all the wisdom of my R1 training will culminate and crystallize to make me safe on Monday morning in a way that was different from today. Ha!

I laugh because this is almost as ridiculous as the fact that a year from now I could go to sleep on Sunday night as a resident and wake up Monday morning as an attending (well if it weren't for the extra training I'm planning in surgery).

These days seem, like all other milestones, eerily anticlimactic. It is exciting though in some ways to feel that sense of independence slowly developing, to find myself feeling slightly more confident with certain things that were so scary and daunting a year ago (my first order as a doctor was for a chest x-ray and I remember being completely freaked out when I wrote it! How pathetic is that?!)

Maybe today to mark the occasion ALL my patients will get chest x-rays! (I'm kidding, of course.)

Onward and upward, amigos!

I See You

My first year of residency is winding down and I've been in my last rotation, internal medicine. 

I've been taking care of a patient who has given me a glimpse into how horrifically a human can hurt another, humiliate another, destroy another. I've had forms to fill out, phone calls to make, family members to meet with. All of this has provided enough busy work to keep my mind from drifting into actually processing the things I see in front of me. It has kept me from considering, for more than a fleeting moment, what my patient might possibly be going through...what the family might be going through. I feel borderline selfish even, getting upset over it, shaking my head over it, because it seems indulgent...like I am making it about me and not my patient. We're all drained, we all want to look away.

I come home, I want to talk about it yet I don't want to say a word.

The manager of the ICU sat beside me yesterday at the nursing station and said, "you are obviously passionate about your job, you obviously chose the right profession". I took it as one of the highest compliments I've received, but as she said it I nearly burst into tears. I thought about how much I hate this job sometimes and the things it shows us, about ourselves and about others. I feel weak when my work upsets me, and I feel jaded when it doesn't.

As I drove home today I felt angry about this job, I thought about what an awful line of work it can be. I watched the bobcat driver roll up and down our front yard, the heat beating down on the metal roof. Back and forth, spreading the dirt out.

My dad used to do work like that, he worked construction and road crews. As I got older I felt sorry for him, that this was his job. I continued to watch the methodical work out my front window and couldn't tell if what I felt was pity or envy.

Not Today

I do not miss my dad on Father’s Day. I miss him on all the other days. The funny days having a new puppy, the tough days struggling through nursing school, the exciting days moving to Ireland, the stressful days interviewing to come back to Canada. The boring days of car shopping, the celebratory days of graduating, the busy days of working, yes, I missed him all those days. I do not miss my dad on Father’s Day.