Oh Our Lives

The main comment going back and forth between my friend Gen and I these days is, "Our LIVES!" to basically summarize all the insanity going on. Finishing medical school and leaving Ireland continues to unravel in quirky and unexpected ways.

We are both trying to cope with all the aspects of tying up our lives here while suffering from brain asystole, attempting to cram more information into our grey matter which is already packed to the rafters with random facts.

Gen is trying to sell her car and found a potential buyer who is a physician at a hospital 90 mins from town. I offered to go with her to show it so we could study in the car. That way she wouldn't feel like the precious hours before exams start were wasted.

We pulled up to the ambulance bay and waited for the guy to come out. Finally he appeared as we talked our way through rheumatology questions. He wanted to take the car for a test drive so I hopped in the back seat, she sat up front. He took the wheel, told us he didn't have a drivers license, and proceeded to start pulling donuts. Then he began screeching around the ambulance bay, speeding up towards the cement dividers and slamming on the breaks. I hollered at him to stop the car and let me out--he apologized and then began whipping a second donut near the parked ambulance. I told him, "STOP THE CAR AND LET ME OUT!!! So he did.

He then proceeded to take Gen on a terrifying ride through nearby streets, not using the windshield wipers despite the rain, and accelerating towards the waiting cars at the traffic circles. Gen was convinced that she was saying goodbye to life over a 1000 Euro car.

Incidentally, I also posted my car online and so far have received random late-night texts from weird Irishmen and an offer from an "off shore worker" who wanted to pay by PayPal without coming to see the car.

Hmmm. Yeah. No.

So we retreated to the safe enclave of my kitchen where I then received emails of required documents and YET ANOTHER POLICE RECORD CHECK for my residency program. Both for Ireland and Canada. Really?? I am in medical school here. I wish I had the time to have enough fun to get arrested in Ireland. Today my mom asked me if I was going to quit medical school. I told her yeah, it was just one criminal record check too many.

Tomorrow exams start. Six hours of written papers. The books are now closed. Mostly because studying has taken a giddy and ridiculous turn.

Gen, tell me about the life cycle of malaria...

Well, it replicates in the mosquitoes liver...uhh....

Dude, I don't think mosquitoes have livers...

**Cue peals of laughter**

[You had to be there.]

Ok, next question...Pearl, an 89 year old nursing student suddenly develops intractable diarrhea....er...no...nursing HOME resident...

Wait...woah...GO PEARL! 89 year old nursing student!

**Cue peals of laughter**

[You also had to be there].

Oh. 

Our. 

Lives. 

 

Where are the balloons?!

Yesterday was the last day of my surgery rotation, which also happened to be the last day I had to show up to the hospital as a lowly medical student. Of course it ended with me racing in for a 0730h ward round which didn't happen, giving me time to kill before surgical Grand Rounds. Afterwards our professor of surgery gave us a little pre-finals pep talk which included the well worn phrases:

-don't worry, these are the easiest exams you write in medical school
-know the basics
-you'll be fine
-try not to get too stressed
-know all the medical emergencies
-soon it will be over and you'll wonder what all the fuss was about

It was an uncharacteristically nice and reassuring discussion with him, though it did nothing for my chronic teeth grinding and constant gut-ache. After a few questions about exam specifics from the others I asked him if he was going to miss us. He said (sarcastically) yes, and I will especially miss your esoteric and obscure contributions to tutorial from the corner of the room.

WIN!

(If I leave a legacy of esoteric obscurity behind then I feel I have succeeded as a student in surgery. In much the same way I felt I succeeded in internal medicine when I received an email from one of consultants telling me about a banjo competition this week. Reassuring to know that my true personality somehow shone through my crusted, exhausted exterior.)

We were dismissed after that and a cluster of us emerged into the morning sunlight, blinking and saying goodbyes and good-luck to one another. It was surreal. I was FINISHED my medical school rotations! Where was the fanfare? Where was the receiving line of dancing nurses and interns patting me on the back, handing me pizza, and popping Champagne corks?

I remembered a conversation I had this summer while I was on my pediatric emergency elective. One of the docs was telling me about his last night as a resident, at the end of his 5 year program. He was walking down the dim corridors, leaving after a night shift, "This was MY hospital, I kept these wards humming through the night for five years. I spent my LIFE in these halls...and when I walked through the automatic doors at the end of that shift I didn't get a handshake or a thank you or a good luck. It was just over and I was standing in the parking lot, in the rain, and it wasn't MY hospital anymore". 

I got it when he told me this story but hadn't thought about it until I left the hospital yesterday. I had a very similar feeling as I drove out of the unbelievable chaos pit they call a parking lot. I cranked up the Mumford and Sons with a fitting song, and left a little mental trail of confetti, streamers, and balloons behind me...

Worth It

Things are picking up speed here in the final push to the finish. Suddenly a hundred things are pulling for my attention and I'm remembering the nit-pickiness involved in extricating oneself from one country and moving to another. Annoying things like transferring electrical bills to a different name, showing people the apartment, answering questions about my car to prospective buyers, pawning possessions, cancelling bank accounts and returning internet modems.  Time feels warped in that it seems like an eternity until I am back in Canada, yet there's not enough time to complete all the extracting tasks, study for finals, feed / clothe / wash myself, put petrol in the car from time to time, sleep, and possibly exercise when a window of time and weather presents itself.

Yesterday I was studying with some friends when I realized that we had spent the last 20 minutes discussing which brand of under-eye concealer hides dark circles the best (this may seem like normal conversation to some women but these particular ladies are *not* the make-up discussing types).  This was shortly after we screened each other for depression upon discovering that 'generalized anxiety disorder', 'panic disorder' and 'depression' criteria were starting to hit a little too close to home. We stopped studying psychiatry at that point and moved quickly to cardiology where we all felt slightly safer territory existed.

I woke up a few days ago with a burst blood vessel in my left eye which has definitely hitched up the haggard appearance a couple of notches. I am told that REM sleep can cause blood vessels to burst. Fantastic. This on the heels of 3 straight days of waking up not to an alarm but to the sound of my own teeth, grinding. On the upside I suppose that my face is getting exercise while I am sleeping so...win?

But it's not all cereal for dinner and fitful sleeps.

Today I received a card in the mail from one of my maternity patients. She had been one of those women who labored in such a way that I was in complete awe. I am pretty sure that if (and that is a big IF) I ever have a child I will be the craziest, drug-seeking, wild-eyed, foul-mouthed, sweaty, crying mess. She was this calm, focused, sweet, gracious lady throughout her (analgesic-free!) labor until complications resulted in an emergency c-section. For the duration of our long night together she used hypno-birthing and relaxation techniques to stay calm and work through the contractions. It was an amazing thing to see.

In her card she included the hypno-birthing CD along with a photo of her and her now 5 month old daughter, on holiday in Paris. It was a lovely gesture and a beautiful sentiment. My favorite line from the card being, "I will always have the most amazing memories of my labour...remembering yourself so close in my heart when I think of the wonderful team we had together on that night".

During a week (month? year?) when I have often asked myself if all of this is worth it, I receive this card. What a privileged and beautiful place to occupy in a strangers heart: the place that holds the memory of their child's birth.

Knowing something like that makes up for every single stressful hour. It makes up for being the person who breaks bad news, or the person who has to scavenge for food in the day ward after being in the hospital for 20 hours without a meal break. It really does.

It makes all of this worth it.

Shifting

When I moved to Ireland I made a conscious decision to try and see it as my home for these four years. I did not want to be counting down the days until each trip back to Canada. It wasn't an easy transition and for the first year I was homesick a lot of the time.

Tobie got me through most of those rough patches. We used to go on Canadian fantasy dates where we would describe scenes to each other of where we'd like to go on a Friday night. Keep in mind that at the time we were both living in dorms with no vehicle, plastic furniture, and a varying caliber roommates (from 'good' to 'reality show awful').

Then last year I moved to Kerry and was living in country bliss, working in a fantastic hospital, surrounded by hilarious staff, beautiful beaches, and boggy mountains. Oh, and I finally became capable of understanding the Kerry accent (have a listen below).

Once I moved back to the city to start 4th year in July, things picked up to break-neck speed and I must admit that much of the last 8 months has been an absolute blur. Wasn't I just writing the MCCEE a few weeks ago? Wasn't I catching babies and listening to manic patients tell me about their new business deals just yesterday?

Now I have less than a month left in Ireland, a job in Canada, and a man who wants to get a dog with me. Now I am anxious to get home. The two weeks in surgery and the week of exams ahead seem like a cruel gauntlet to run through, especially because I feel more like crawling through. It is so hard to stay motivated to study, and to keep smiling and nodding enthusiastically during another clinic where I only get to watch other people doctoring.

Roll. On. Residency.

So I am starting to shift now between Ireland and Canada. It's strange, and very nostalgia inducing. When a bottle of fish sauce runs out I don't replace it because I doubt I'll get through another bottle in 6 weeks. My pantry is starting to look very bachelor-esque and barren. I've started using all my hotel shampoo's and soaps because I loathe the thought of buying more that I won't finish (why don't hotels also provide tiny laundry soaps?!) Friends are randomly given clothing, books, music when they come over as part of a pre-purge offloading. I look at all my belongings with a more discerning eye...hmm will I bring my yoga mat home or leave it with 'Enable Ireland'?

I'll tell you one thing, the silicone oven mitts and wine aerator are coming home with me!!!  Oh Ireland, it's been fun but I gotta make a move.

Intimate Insight

I know that these images and this story are making the rounds on social media these days, so my apologies if you're feeling inundated. I felt that these images were too profound and raw and beautiful to pass over.

It is one of the most heart wrenching photo essays I've had the privilege of seeing. I think it shows so poignantly the suffering, strength, love, hope, fear, and anger that features in the struggle with such a devastating diagnosis. To me, these photos express very clearly the questions that we struggle to form when we ask about cancer, and I believe they show the answers to those questions. A few of Angelo Merendino's photos from the website are shown below. In my opinion he is a brilliant photographer, and she a powerful subject.

http://mywifesfightwithbreastcancer.com/

Insert Foot

I was in outpatient clinic recently when I called a patient in from the hall. He was awkwardly positioned in a wheelchair, looked to be in about his mid 50's, with thick brown hair neatly combed back, smartly dressed in a tie and sweater. An elderly woman wearing thick support stockings, polyester skirt and heavy woolen shawls pushed the man into my office.

I introduced myself and said hello to the man, then said to the elderly woman, "and you must be his mother?"

Now I can hear you all cringing and possibly yelling, "NOOOOooooooooooo" at the computer screen. Well as Mike Birbiglia would say,

I know....I am in the future too!!!!

See the thing is, I learned long ago never to assign relationship speculations during interactions with patients! In the emergency department I've often been surprised to discover that the young woman wearing the leather dress, knitting beside the stretcher of an elderly man isn't his daughter / girlfriend / caregiver / niece but is in fact his surrogate mother / Wiccan priestess / life coach / financial advisor.

So I don't know what was wrong with me when I said that, but the elderly woman quickly jumped in to correct me with,

I am NOT his mother, I am his WIFE. I know taking care of him has worn me down but COME ON!

Oh dear. So I apologized and attempted to carry on with the consultation. I was actually surprised that I didn't lose my composure completely. Suppose being berated for years as a basketball referee and then a triage nurse has helped me stay calm when the waters of communication get choppy.

But rather than let it go she kept bringing it up.

At one point she asked me about my "American accent" and I said, "Yeah, actually I am Canadian" to which she replied, "I know, I just said that to annoy you considering what you said to me earlier".  I was mortified. It was awful. Lesson, re-learned.

This is what medical school has done to me! All of my healthcare street smarts have been replaced with useless lists of things like the rare causes of secondary hyperparathyroidism! Thankfully I will be back in the real world soon.



 

6 Minutes

So in case you didn't know, it is World Kidney Day today! I was at our local shopping mall with a gang of retired nurses, fellow medical students, renal nurses, and the renal pharmacist, giving out information and checking blood pressures and blood sugars.

We were MAD busy all day with a steady queue of feisty Irish grannies (mostly) and the odd Irishman who had been dragged there by his wife. It was actually a really fun day but the highlight for me was when a woman standing there with a pram said as I went by, "Hey! I know you!" I looked at her and scanned my mental files for her face. "Er....." She said, "you were there in the maternity hospital when I had my son! Remember me?"

I felt terrible because I couldn't place her (and I am usually great with faces). She said, "Remember? Six minutes??" Then I remembered. YES! I had even written about her on the blog! She was the one that had gone shooting by in the wheelchair panting while the midwife yelled at her not to push yet.

Of course I remembered her. I told her if I'd seen a side profile with her hair blowing behind her I would have recognized her right away. We had a nice visit and I had a chance to see her gorgeous blue eyed chubby boy, grinning away at us. So delightful.

I love my job!

Have you hugged your kidneys yet today?

WOW!

I am totally blown away by how many people commented on my match post!

I have been soaking in the sweet sunshine of many lovely, kind, thoughtful, generous comments from so many readers (many of whom I didn't know existed!) I actually didn't want to make another post because I wanted that one to stay front and centre for a few more days.

Honestly, people. Thank you so much for taking the time to comment and send on such wonderful encouragement. I am truly humbled by this.

Note to self: have mega life accomplishment more often!

I MATCHED!!!

Into what specialty do you match the girl who loves everything?

RURAL FAMILY MEDICINE!!!

I felt that this post needed to be written today. So despite the fact that I am running on 1.5 hrs of sleep and am still trying to grasp the outcome of yesterday's events, I wanted to update the blogosphere. 

The last few weeks seemed to drag on with painful anticipation. I spent many sleepless nights trying to sort out how to rank, and trying to decide what I truly wanted to be. After I submitted my list to CaRMS I started really doubting my list order. I mean, really started doubting. I had what can only be described as pseudo-panic attacks where I would go around and around in my head all the possible outcomes of the match. What would make me happy now? In 5 years? In 10 years? What was going to be able to give me the life that I wanted outside of work? What could provide me with the chance to write, maybe do some more work for CBC, travel, have flexibility, allow me to keep my athletic pursuits up, and also just enjoy big and small adventures with Duncan (I know, I know...I am introducing this character late in the game but he deserves his own post later). I've been wrestling with my first love (emergency medicine) and my new love (obstetrics) and trying to decide which of the two I wanted to do. Then I would be in clinic and see a few kids and think, "But...peds! I LOVE PEDS TOO!" or I'd meet the most fly 87 y.o lady who'd reinforce my hope for aging awesomely and I would mourn the loss of elderly patients. Also? It turns out I really enjoy continuity of care in my life. It just brings a whole other layer to job satisfaction for me.

I know, could the writing on the wall have been any more obvious?! I love getting off the beaten track, away from throbbing mega-hospitals and being somewhere that I know the radiographer's names as well as the name of the woman who serves the casseroles in the cafeteria. I don't want to live somewhere that people look at your handbag, not your face when they see you in the street. I don't want to take a subway to work or require reservations every time I go out. I am a country girl who loves country medicine. I don't know why it took me so long to come back to that, and accept it! 

So when I saw that I matched in rural family medicine, I thought..."Of course!!!" But I've forgiven myself for not knowing this a long time ago. I allowed myself to contemplate other areas of medical specialization to the furthest degree. When I said that I was going to just experience medical school and see what I liked, without preconceived ideas, I DID that. And this is where I ended up. It feels very full circle-ish to me. Now I get to do everything! Peds, obs, emerg, women's health, sports medicine, chronic disease management, surgical assist, palliative, hospitalist and down home family medicine. 

Some weird and wonderful things that have crossed my mind in the last day. 

I matched in the first program that I interviewed at. I adored the program, the people, the location. But I was guarded and wondered if part of my swoon was attributable to the fact that I was fresh and excited about interviews. I mean, initially I was so delighted with the place that I thought about not going to any other interviews. But then realised that would be a ridiculously bad idea for someone like me (a lowly IMG). I kept going back and comparing each subsequent program with that first one. Wondering.

When I was driving into the town (where I ended up matching) I came to a bridge and had a very strong sense that I would end up crossing this bridge a thousand times. I loved the look of it, I think partly because it reminded me of a bridge near my house where I grew up in Alberta. It was one of the few photos that I took during those two weeks of interviews, but it is my favorite. Looking at it, I can remember exactly that sense of predicted familiarity and how my heart had already started to feel tied to the place. It was strangely powerful and most unexpected.

Then last week, I had a dream that I matched to my program. In my dream I was shrieking and celebrating and telling myself that this was the perfect thing, and that I was so happy with the way things worked out. Of course when I woke up I felt the stress and worry creep back in as consciousness returned. The dream had been so vivid. That was where I wanted to go. What if I matched somewhere else?

I recently started on a new rotation with a congenial, fiercely intelligent, slightly quirky, banjo-playing dermatologist. When we met he asked what specialties I had interviewed for while I was in Canada. I told him, but I didn't say where in Canada any of these programs were. I told him about my previous life as a nurse in Nunavut and the NWT. A little while later he was introducing me to a patient and said, "This is ABB, she is going to be a family doctor in northern Saskatchewan". Now, again I will say that I hadn't told him where I was interviewing, and I have yet to find many Irish people who can even pronounce "Saskatchewan" let alone use it in a sentence. I mean, most Irish people know Ontario because their cousins always live in Toronto, and they've all been to Niagara Falls. Funny because it is true. So the comment from Dr. R threw me a little, but I didn't say anything to him about it, I just made a mental note. Innnterrrrresting. 

And now I am here. A little like a dog spinning around before he lies down. I still haven't fully grasped that the uncertainty, that has been hanging over me since I started on this journey over 5 years ago, has lifted.

I have a job as a doctor in Canada.

Let me just say that again on the off-chance that it sinks in.

I have a job as a doctor in Canada.

And it is a bloody good thing (as I am ~$250 000 in debt!) And an exciting thing. I am beyond grateful and excited to start on July 1st. I feel like I've been in the starting blocks for years. As a nurse I hoped some day I would become a doctor, and then as a medical student I had to deal with being slightly taken away from direct patient care. Mostly watching others do the nursing and doctoring. I've been striving, waiting, chomping at the bit for this responsibility.

This past week especially I've had a most distractible mind. My normal regime of night-before ironed work clothes, packed lunches and leisurely breakfasts has disintegrated to eating dry cereal and turning my underwear inside out instead of finding time for laundry...

But tonight I eased myself back into life. I cooked a delicious pot of veggie chilli, did loads of laundry, and sat down to write this post. The lack of sleep last night is catching up with me but I am happy.

It seems I've gradually started living my way into the answers. I cannot believe that I can actually say,

"I am going to be a rural GP!"

At the risk of extending this stream-of-ramblingness any more I just want to also say that over the years this blog has given me a great outlet and a wonderful connection to people all over the world. Even when I've felt like a tiny medical student, hidden away in a dark study room for weeks at a time, I felt connected to the people that read and commented, or took the time to write. I have made great friends and kept in touch with old ones through Asystole and I feel like it has given me many gifts on this wild ride.

And so writing this post for those of you that have been following along, gives me so much pleasure! Thank you all for the words of encouragement, advice, offer of cars, couches, lifts from the airport...for mailing forgotten bathing suits, buying me giant soup pots, sending mugs, meeting me at airports, buying me lunch and even the odd train ticket.

Expect the unexpected. Or maybe what was right in front of you the whole time.

Well That Wasn't Easy

So I finally submitted my rank order list. Those of you who have gone through this whole process please skip the following couple paragraphs. Actually, just skip to the bottom of the post.

After interviewing for residency jobs the candidate has to rank the programs in order of preference. The programs do the same, they rank the candidates in order of preference. These lists are kept confidential so neither the candidates nor the programs ever find out who ranked what / where (theoretically). These lists go into an algorithm which "matches" the program the candidate wanted the most with the program that ranked him/her the highest. The algorithm favors the candidate. What that means is...(by the way, I am explaining this for the 117th time in the last 3 weeks so from now on I will be referring people to this post rather than reciting my little speech)...I will be matched to a program I really want over a program that really wants me. 

An example. I interviewed for several programs. Let's say every program I interviewed for had three IMG positions (this was not usually the case, most places only had one IMG position but this is my fairy tale blogland).

-If the program that I ranked first ranked me in their top three then I match there.

-If the program that I ranked first didn't rank me in their top three then the list goes to my number two choice.

-If my number two choice ranked me in their top three then I will match there.

And it goes down the list like that until I match (hopefully).

-Now, conversely, if I am ranked number four at my top choice, but their top three match somewhere else, then I get bumped up the list and would be their new first choice, thus I will match there. And so on.

So the programs have already submitted their rank order lists which is why I feel like I can be slightly more open about the process now. Well, a tiny little smidgen more open.

I spent the last 3 weeks in a career choice mulling daydream. I emailed former colleagues, texted friends, called my boyfriend, mother, and siblings to ponder out loud. I dropped in on past professors, lunched with career idols, and lay awake at night trying to figure out how I wanted to rank the programs. See the thing is, I interviewed in 3 different specialties...all of which I truly enjoy and all of which I see myself being happy in, ultimately.

These are examples of my considerations for some of the different programs (in no particular order...heh):

1. LOVED the residents, they sold the program very very well. The faculty were very upbeat and relaxed. They had really put a lot of effort into the call schedule and maximizing learning. Great access to outdoor adventures, training tailored to someone who wants to work in rural setting. Research project support as well as required classes on medical education that count towards a masters. Downsides were that the city is sketchy, the winters are brutal, and it is pretty far from the Rockies.

2. LOVED the program, very similar to one above. Brand new hospital, great call schedule, opportunity to engage with the community in interesting ways, very flexible and supportive of residents cultivating their interests within the program. Far from international airport, smaller population, lower volumes, loads of hands on training though as no competing fellows and fewer co-residents.

3. LOVED the institution and what it represents. State of the art training labs, simulators, anatomy sessions. My favorite location by far, bigger but not too big. A program that would definitely support any type of practice I might want to pursue down the road. Close to great recreation, international airport, major city.

4. LOVED the program director. Again, a lot of flexibility, support for master's training. BIG centers, huge volumes, massive exposure to EVERY POSSIBLE THING YOU COULD EVER WANT TO SEE. Big city, big rent prices, big drive to anywhere green and pretty. Very, very far from the Rockies.

And so it goes. Every place I interviewed had similar pros and cons. I tried to sit down and mathematically create an answer to my dilemma. I made categories like "recreation options" and "location" and "academic advantages" and I gave each place a rank for each category. But when I looked at it in the end, I was favorably ranking the programs I really hoped would come out on top, not necessarily objectively tallying the sums.

In the end, I ranked all of the programs I interviewed for. I suppose that my top four choices are all places that will make me jump up and down if I see them on my computer screen on March 5th (match day). My remaining choices will all be perfectly acceptable starting points that will get me where I need to go (and I suspect may be hidden gems).

I do believe that in 5 and 10 years I will look back at this time in my life (the rapidly approaching fork in the road) and laugh at where I thought I was going...and where I actually ended up.