2009

2009 is going to be a big year for me. I will graduate and become an M.D. I will start residency.

I will get married to my best friend. Twice.

Happy hogmanay everyone. See you on the flip side.

Happy boxing day everybody from my house filled with a barfing baby and a coughing toddler to yours :)

This is what I've been doing instead of blogging. Socializing. Too much socializing (I've got a headache this morning, damn you giant take sushi wine). I'm pictured here with my good friend Debbie at our annual med school class party hosted by the wonderful and talented C.Nik.

I'm on my pre-christmas week of ER now and it's been good. Especially because I have today and had yesterday off. I got an awesome xmas present for Ben today but shhhh, it's a suprise. I'm really ready for a little bit of holiday R and R. There's going to be a huge snowstorm today and another on Sunday and I really hope I"m able to get home after my emerg shift on Saturday!

Ben has always said to me that I get too easily frustrated with not being able to do things on a mountain bike that have taken him years to master. I think some of my frustration in anesthesia stems from the same thing. I am used to things coming easily to me, especially things you do with your hands. I have been told that I one-hand-tie better than most first year surgery residents, I got my first LP on the first try, I can make a mean friendship bracelet, I suture neatly and efficiently... I cannot intubate. But that's OK. I can still work on it and have a bit of faith that eventually I'll get it. Like how I eventually learned to get out of my clipless pedals before falling over. I hope this experience is less painful.

I have fallen in love with Ingrid Michaelson.

I've been a bad poster. I just started anesthesiology last week and it's been rough. Last week I hated it. This week is starting off better. I'm with someone different each day and everyone has their own way of doing things and I'm tired of people telling me how awful and wrong my technique is when someone just told me to do it that way the day before. I'm rubbish at intubating because the mannequin is nothing like the real thing and nobody explained anything to me - they just expected me to do it. I'm afraid of hurting people. One day last week I actually went into the women's bathroom, sat on the toilet and cried. No crying today though... I confessed this morning that I was having a rotten time with the whole intubation thing and the anesthetist was really nice about it and really helped me when I asked for it. I guess I just have to learn to ask for the help that I need. I'm in pain clinic tomorrow in the morning and the OR in the afternoon, so hopefully that will be ok.

Ben and I met our wedding officiant this weekend. He was really nice. I found out last weekend that he married my friend and her husband and they really liked him, so that was good. And, he speaks welsh, so he's going to give a welsh blessing at the wedding just for my Poppy (the only one who will understand it).

Anyway, I'd better go read my pain book and go to bed. I just bought a christmas album called "The Hotel Cafe Presents Winter Songs" and it's really good!

I ate too much sushi.

This weekend

Hello all,
Today has been a good day. Last night I attended the section of teachers dinner at the Family Medicine Forum - it was at Hart House at U of T. My fiend Michelle and her husband were there and it was really nice to see them. Also met some other scholarship winners from Ottawa and Winnipeg. Then today at 8:30 a.m. (yawn) Ben and I were in the Sheraton ballroom waiting for my name to be announced to receive my scholarship. It was really nice. Ruth Wilson (the president of the college, stepping down this year, and a mentor of mine) gave me my award along with the man from Scotia Bank who was wearing a nice purple/blue outfit :) It was super. Ruth gave me a hug and the bank guy was fantastic - he was like 'way to go!' Then Ben and I went around and talked to people from all of the residency programs. Asked a few questions, schmoozed a bit, etc. I missed the lunch because Ben and I had horrific headaches, but I'm really looking forward to being able to go to more of the forum next year in Calgary. Unfortunately, because of my exam, I wasn't able to go to the week-day talks which looked SO interesting.

So, M and 2S asked about post-grad training in Canada. This is how it works from undergrad to post-grad.

1. Get an undergrad degree or at least 3 years of one
2. 4 years of medical school
3. Residency: Family medicine is 2 years, most other programs are 4 or 5 years, for example, obstetrics and gynecology (5 years), general internal medicine (4 years; specialty matches occur after 3rd year of IM residency), urology (5 years), general surgery (5 years), Pediatrics (4 years), etc. etc.
4. Fellowships - say you want to be a colorectal surgeon - you would go and do a fellowship after your general internal medicine specialty which vary in length - usually 2 years or more. Family medicine residents can do a variety of third year programs including anesthesia, emergency medicine and other things. These end after 1 year.
5. Start practicing :)

So, my residency application is done. Well, everything is assigned anyway. Maybe I'll change something before Sunday but as far as I'm concerned right now, everything is as good as it's going to get. I know that family medicine isn't really competitive, but I still worry that I won't be able to go where I want to go and that programs won't want me, etc. I think everyone feels this way no matter whether they're applying to dermatology or psych. Anyway, there's nothing I can really do now except wait. I'm going to re-check all my program requirements to make sure I submitted the right documents, but I think things are correct.

I had a nice talk with my sister this evening and talked about Christmas, fashion advice, kids, and other stuff. It's nice to have such a nice sister who I can talk to. Finally, she stopped trying to put me in the garbage can :)

I'm excited for Christmas! Only 3 more week of work - 2 weeks of Anesthesia and one of ER before I go home for the holidays! I'm kind of sad that I'm working on December 20th but I'll still make it home for our family xmas party on the 21st. I have a lot of ER evening shifts (4pm to midnight) which kind of sucks because I'm not sure when I'll get a chance to talk to Ben. We'll have to work something out like when I used to call him in the morning when I was here and he was in Scotland. Ah, back in the day.

Ok. I'd better get to doing something useful.

I realized a little while ago that I hadn't seen anything on "short white coats and stethoscopes" for a while and now have realized that it's gone private and I wasn't invited :( Google reader makes me a bad commenter.

Ok. I'm less anxious now, I'm only missing one letter and it's from the guy who said he was submitting them online and the deadline isn't until Friday. I need to finalize my personal letters but I'm also studying for this darn psych exam. Ugh. neuroleptics, I hate you.

It's really adding to my stress that two of my reference letters for CaRMS haven't arrived yet. I have enough letters to complete all of my applications but I would have like to have a bit more room to wiggle. One of the people who wrote a letter for me doesn't know me very well and I'd like to substitute another. One of the referees told me he's submitting his online - for which the deadline isn't until Nov 28, but the other person didn't even reply to my email telling him that I left a package in his mailbox. I don't even know if he got it! Dammit.

I just got back from my third dental appointment - cleaning and scaling. They froze me for it because I'm a giant wuss and I hate dental work. Now I can't feel the left side of my nose, mouth or tongue. It's an odd feeling. Why does it feel like my face is swollen 3 times its normal size? It's like I've been in a bar brawl. In good news, it didn't hurt except for my middle tooth on the bottom which wasn't covered by the block. All in all a very positive experience. Take that dentist phobia!

Today I:
Got two fillings
Got my hair cut
Whittled my CaRMS letter for U of T down under 500 words
Read some psych

Sounds like a full day, but you'll notice it doesn't involve any actual clinical work. This is because my attending was away, yet again, today. The hour he was in the hospital coincided with my filling. I could never do psych - all this relaxing is making me very edgy!

My hairdresser and I had a conversation about a perm today. The jury's still out on that one.

Instructions:

1. Grab the nearest book.
2. Open it to page 56.
3. Find the fifth sentence.
4. Post the text of the sentence in your journal along with these instructions. Don’t dig for your favorite book, the cool book, or the intellectual one: pick the closest.

Dragonfly in Amber by Diana Gabaldon:
"All right."

Seriously, that's the sentence. So I'm going to pick one that better represents the book: And I voyaged into him, as he into me, so that when the last small storms of love began to shake me, he cried out, and we rode the waves together as one flesh, and saw ourselves in each other's eyes.


Gotta love a bit of trashy reading every once in a while!

Personal Letters, again

So, here's my dilemma, when a program says you have a maximum of 1500 words to tell them about yourself and answer some questions - is it bad to only have 1000 words? I'm very opposed to filler fluff type stuff and want to be to the point but also don't want to look like I don't care. I'm torn!

I should really be studying right now.

I'm getting my hair cut tomorrow!

Enough randomness.

home again?

Well, if this can be called home, I'm back in it. This week is going to be hectic. Dentist again on Thursday, call Wednesday, haircut Tuesday (ok, that's not very strenuous, but still). Hoping to get to the gym tomorrow and then study study study for the psych exam. Another NBME - good thing there aren't any math questions in psych- no crazy american units!

Ben and I went to Newmarket today to check it out for residency. It's a very nice little town with a quaint main street and a VERY nice hospital. Well, it looked nice from the outside anyway! Ben is getting more into the idea of going there, especially because there is lots of snow lying about when it's all wet and rainy in Toronto!

We are in the process of finding a wedding officiant. I found one I like but he is doing a wedding at 4:00 that day. We're not getting married until 6 but it's on the opposite side of the city. I guess it really depends how long those people's ceremony is. Ours will be a quick 1/2 hour or less (we don't want to lose the light for our photos). I'm thinking it might involve some modification of a celtic handfasting. We'll see, maybe it's a bit too Braveheart :)

What a nice weekend. It's raining outside and our plans for tonight look like they might not come through, but despite that, Ben and I have had a really nice weekend so far. Last night we made fish pie and watched 3 episodes of the Vicar of Dibley. Today we went to give blood. Turns out they don't take British blood so Ben sat and drank tea while I gave blood, but it's the thought that counts! I think we're going to try and find some Christmas gifts for people today. Maybe we will end up at the Santa Claus parade, but it doesn't look like it. Not sure what we're going to do tonight but it's nice to have a long weekend - feels like we actually live together again!

Day off

Today I have the day off. I am going to study psych if it kills me. I did a good few hours with the USMLE Case Review book and I'm going to commune with it again today. I guess it's good that Ben only gets 2 TV channels because it means I don't have that as a distraction. Today is one of those days that I wish I had a road bike to go out and ride. Instead I'm going to go to the gym whether I want to or not :) We had chinese food las night and I'm sure it's now residing in the fat on my ass. I saw this really fun british TV show last night called cook yourself thin and they made some really nice food. Some of the recipes are online but I'd like to find out if they have a cookbook.

I guess I'm doing enough procrastinating!

Ben and I are going to drive around Newmarket tomorrow to see if we like it and would want to live there. Next We need to go to Kitchener-Waterloo because Ben's never been there. Adventures!

I found out today that I need 5 fillings and possibly a root canal. This is why I dont' go to the dentist.

eeeeeeeeeeek

I just submitted my residency application form. Eeek. Now to finish the personal letters. Why do I want to be a family doctor again?

They went with songs to the battle, they were young.

Straight of limb, true of eyes, steady and aglow.

They were staunch to the end against odds uncounted,

They fell with their faces to the foe.

They shall grow not old, as we that are left grow old:

Age shall not weary them, nor the years condemn.

At the going down of the sun and in the morning,

We will remember them.

Headache

I just got home from running some errands and have the most annoying tension headache.

I had to re-submit my CV to CaRMS because of some date discrepancies between my CV and my Dean's letter. I hope everything is sorted out now and matches up. The submission is after the "milestone" but as the milestone is not a deadline (they keep telling us this in emails) I guess it's alright. And, if not, I have my other CV there anyways.

Maybe going to the gym will help my head. I hope so.

Well, the formal is over and I never got called. It was odd, I called in at 5 and gave the resident my pager number. She asked me if I wanted to be called or not and I was like "Whatever you prefer" and then she said that if I didn't want to come she wouldn't bother calling me but then I said "I want to learn so call me". She made it seem like there were consultations already in the emerg. It's 6 hours later and I wasn't called. I wonder if she interpreted my trepidation or unsureness as disinterest... I hope not. I hope to have at least a few busy call evenings so I have some idea of what to do when I'm on call in my R1 year. Maybe Sunday will be busier.

I feel very anxious today. I don't know why. I'm on call tonight (home psych call) and going to the med school formal until I get called. Of course I won't be drinking or anything else. I'm not sure why I feel so uneasy.

Today I went to body pump for the first time in a long time. A half hour ago I tried to pick up my phone and talk on it - my arm started shaking so badly that I couldn't hold it up. I guess that's the definition of a good workout?

Starting working on personal letters today. It's surprisingly easier than I thought to tell people why I love family medicine. I guess that's the sign that it's a good fit!

Just an excerpt: I want to be a family doctor because I want to treat both individuals and communities, I am a passionate patient advocate, and I am dedicated to life-long learning in all aspects of medicine. I believe that preventative medicine is the best way to ensure the future health of Canadians in the most socially and economically responsible way and I want to deliver the highest quality of care possible.

Now I'm looking for a way to increase the personality factor in my letter. I'm not one for anecdotes so I'm going to have to find another way to inject a little bit of me into the text.

Moving on

This is the time in my class of 2009's medical school career when everyone is looking forward. 'Where are you applying for residency' is the first question in most conversations with classmates. 'How is CaRMS treating you' is another popular one. This weekend Ben and I sat down and talked about my current biggest stressor: where to apply. Originally I was really stoked about going to a small program in a small city, somewhere like Kelowna or Newmarket or Peterborough or Sydney or Charlotte town. I craved the independence I have experienced doing rotations in hospitals without many residents. Talking to Ben, we have to address a few issues:
1. Jobs - Ben needs to be somewhere where he can find a civil engineering job and hopefully have a bit of choice
2. Mountains - Ben really craves being near mountains and having a sporty 25 year old carefree lifestyle
3. Togetherness - many rural programs involve travelling to different sites for large chunks of time. Kelowna, for example, involves 7.5 months away split between two different sites. This really doesn't work for us as a couple. I don't want to be separated for 7.5 months of the year.
4. Vacation and wedding - it is important to me that I get enough time off around the wedding to make it both to our Toronto and Scotland weddings - this means at least 2 weeks.
5. Not in Hamilton - Ben is sick of Hamilton and feels that it is poisoning his health (his words, not mine!)

So, I think we have a short list. It includes: Greater Vancouver, Edmonton, Calgary, Greater Toronto and Ottawa. I have come to the conclusion that within each of these programs I can find hospitals to work at and family medicine experiences that meet my needs and prepare me for the semi-rural practice I hope to eventually have. Plus, there are always electives and requirements for rural training in each of the programs. Each of these places has a strong engineering industry. They don't all have mountains but the ones that don't are close to my family and that is a bonus for me.

If anyone has any additional suggestions, feel free to comment.

I really don't feel like going to work today. It's dreary and cold and I haven't showered yet. Daylight savings time doesn't really work very well when there's no daylight to save.

Today was a good day at the psych hospital. We started off with my supervisor telling us about how he once was interviewed for the national enquirer and Maxim magazine about water intoxication and polydypsia and how it was medically dangerous. He said that after the article came out with a guy with huge muscles injecting water into his arm in the photo accompanying the piece, he decided to never do that again. He then said that during that time he told his medical student as a joke that Julia Roberts called him because she wanted help with her water drinking addiction... and the student didn't know who Julia Roberts was!!! We spent a good while laughing about how he could go on Oprah or write a column for the newspaper.

I interviewed my first patient of my psych rotation yesterday and then another today - I am working on a locked ward and the people are quite sick so sometimes it's hard to interview them because they're quite delusional. I think I did an alright job of re-directing though. My resident is really nice and supportive, which has been great. Plus, I got an hour and a half for lunch today, which isn't too shabby.

I've been to the gym 3 times this week which is a vast improvement over the last six weeks of going approximately zero times. I'm gonna be buff I tell you!

My CaRMS application is so random. My research includes:

1. Signal processing in EMG - is correlation-based averaging best?
2. Finite element analysis of the human sclera - a pilot study
3. Biomechanical properties of the porcine anterior lens capsule
4. At your cervix: what teens need to know about the pelvic exam
5. The ___ hospital sexuality survey: What role do mental health professionals see sexuality having in psychiatric well being

I guess I can say I explored lots of options... ophthalmology, radiology, public health, psychiatry... it makes you look back and what you've done and say "why don't I remember any of that"!

Dreary days

Oh my have I ever had a hard time getting out of bed these last few days. Daylight savings time please come and rescue me. Plus, it's been raining non-stop which doesn't help.

I really want a sunrise alarm clock which slowly starts turning on a light in your bedroom 15 minutes before you get up.



I think it would be such a better way to get up because when I was on ortho surgery and I had to get up at 5 I was able to do it because it was light outside. Unfortunately, they're expensive! Maybe I'll ask for one for christmas.

Today I started psychiatry... and by started I mean that I did 2 hours of psych and then having teaching this afternoon after which I do not need to return to the ward. Basically, it's pretty easy so far which is good because I have a lot of CaRMS and psych reading to do! The patients here are extreme examples of different psych diagnoses and even the two patients I did see this morning have been pretty intense. My resident is really really nice and that's good. I think I'm going to have to try out my mental status exam tomorrow! Better read up on that! appearance, affect, mood, speech, um... can't remember any of the rest of them! Oops!

Anyway, had a good weekend but again it was too short. Bought a new grown up coat that I hope will last the remainder of my life because it was expensive.

Finally going back to the gym today! It's been too long...

NBME is DONE!

Now I have to start concentrating on CaRMS. I have done all of my documents and reference letter things but now I actually have to start filling in the application! This is going to be tedious. Plus, I have to write my personal letters... which is hard. I have an example from my friend Andy and his is really good and mine are so far blank. Maybe I'll get inspired this weekend!

I admitted a really nice patient last week with a really nice family. As I'm on subspecialty, I don't actually take care of the patients I admit while on call but I always try to drop in on them and see how they're doing. So, that's what I'm on my way to do now after I pick up my car from its 700 dollar break job.

I also have to book my hotel room for family medicine forum. So much to do, so little time.

rash gone. exam tomorrow. freaking out.

I HATE THIS RASH!

I have a fine papular non-red, non-itchy rash all over my face and neck. Anyone have any ideas? I'm systemically well, haven't changed detergent or makeup or cream... face isn't bothered just bumpy.

fear

Ok... I confess... I am very afraid of the dentist. I have had lots of negative, painful dentist/orthodontist experiences and it makes me a little bit mouth-shy. I finally called a dentist in the city where my medical school is to get an appointment. This is a big step for me. I was flossing my teeth tonight and a bit of filling disintegrated into my mouth... that is worrisome. So, I shoved a mirror into my mouth to take a look and I think I'm missing a bit of filling form a molar. So, now I'm in the process of getting a new dentist. I hope they're gentle.

I have no idea how to get time off from school to actually GO to the dentist so I guess I'll cross that bridge when I come to it. I don't even know how long it takes to get a dental appointment. I guess sending the first email is the first step though... eek. I wish they gave ativan at the dentist.

Ok, I just finished my presentation for rounds tomorrow on neonatal lupus. It's a crapper but I just can't look at it for ONE MORE SECOND. So i'm going to have dinner now. And maybe a glass of wine.

Ben just left. We had a fantastic weekend. We went for a really nice hike in a conservation area near my house (university house), make spanakopita in enormous quantities, read books, snuggled, made curtains, went shopping and washed cars (well, Ben washed our cars while I studied). I hate it when weekends like this end. It's a small glimpse into what our life will hopefully someday be like and then it's taken away again by stupid school.

I have the internal medicine NBME exam a week friday and I have to do a presentation for rheumatology rounds tomorrow which I was told about on Thursday and haven't started. If anyone has any really great review articles on neonatal lupus, let me know.

Now I am 27.

happy birthday to me.

I live in a tree.

I smell like a monkey...

but I don't drink my own pee.

The age old question: is reading the book as good as reading the book and taking notes? Because, when your'e short on time, reading is a lot faster. But taking notes helps keep the eyes open.

Great weekends

Great weekends make for sad Sundays. Had a great pseudo Thanksgiving today (my Dad's away next week so we did it early) with family and pie and cake. Mmmm. Went to a really funny comedy show last night with Ben which was a really fun date. We haven't gone out just the two of us for a while so it was really good to actually go and do something instead of staying in and watching TV and complaining about how we never go anywhere. Ben called me tonight with some financial woes related to having spent a lot of money getting rid of his old car (much more than we both thought it would cost) and spending a moderate amount of money setting up house and getting the internet and things. Good thing I have some money set aside so all will be ok. Thankfully my parents are very financially supportive of us both (thanks Mom and Dad) and we can help each other out of semi-crises like these.

I also went and got my veil and tiara on Saturday (did i put in here that I got my wedding dress 2 weekends ago?). I'm glad to have these things organized but on the other hand, sad that the experience of shopping for them is over. I really want the wedding to come quicker, but I'm sure in a year's time it will have seemed to go quickly.

Anyway, I"d better go read some rheumatology to prepare for tomorrow's new block!

Studying for my medicine NBME is going very slowly. Much too slowly. I'm just so busy with CaRMS stuff and being on nephrology which is quite a busy service that I get bogged down. I really need to get some work done this weekend but I find it very hard when Ben's around because I don't get to see him during the week.

My family is celebrating thanksgiving and my mom's birthday this weekend. Happy birthday mimsy!

I guess I must be feeling a bit better because for the last 2 days I've been averaging 5 hours of studying per day. Pretty good for me, I usually get bored after about 3 or 4. I haven't, however, had much time to myself to do other things because of this excessive studying and I feel like this is going to have to be kept up for the next 5 weeks in order to pass the internal medicine NBME. It's a tuff lot of material to get through and I'm not really sure it's sinking in. I'm working on nephro right now because it's actually what I'm doing at the moment. When I get into cardio and stuff that I'm not doing, I wonder if I'll be able to remember any of it.

I downloaded Sara Bareilles' album "little voice" tonight and it's really good. I highly recommend it.

I'm currently reading 3 different books for bedtime reading. I'm finding it hard to finish any one book so I kind of alternate. The new one (The Memory Keeper's Daughter by Kim Edwards) is my current favorite and I have a feeling I'm going to finish it before the other two, which I started before it.

Anyway, I guess this study break should be over.

If someone could invent a cure for the common cold I would be their new best friend. I am so tired and worn out and I hardly have done anything in the past 3 days. I'm trying to study tonight and I have felt like I'm in a haze all day. I took some cough medicine last night and it did help me sleep, but gave me a foggy head so I think I'm going to take 1/2 the dose tonight. Nephro is killing me. The patients are just too complex for my liking. Thankfully one of my hardest ones is getting discharged tomorrow. I got busted today for not knowing when one of my patients got a colonoscopy - I had just acquired him yesterday and hadn't had a chance to review the chart fully. I tried to fake it during rounds but failed miserably. I feel like my brain has turned off! I didn't even put together that another one of my patients had had a parathyroidectomy and yet her PTH was still high. Duh. They missed a parathyroid gland. Ugh. If I don't start using my brain I'm going to be a pretty horrible doctor.

I am a bad blogger. I just finished ortho and now I'm starting medicine subspecialties - nephro x 2 weeks and then rheumatology x 3 weeks. I can already say that nephro is scary. Basically the fellow said we had to read nephro every night to get anything other than a "marginal pass". That coupled with the fact that i"m taking the internal medicine NBME - which means I have to read all of internal medicine in the span of 5 weeks, means I'm going to shit my pants every night. I also have to finish my CV for CaRMS so I can send it to my referees. I also forgot to ask one person to be my referee so need to now hunt him down to do so. I heard that asking people by email was bad... so I guess I have to find him in person, which is difficult. Ugh. I wish I was still on ortho. The nights were long and the mornings early, but at least I was kind of smart at it.

Argh. Today I got my CaRMS token (canadian residency matching service). Basically this is the computer system for the residency match. I haven't done anything and all these people were talking today about how they were making envelopes out to their reference letter people and making spread sheets and shit. i can hardly stay awake past 7 o'clock when I get home from stupid ortho. I am post-call tomorrow so maybe I'll get something done... maybe.

You know you're on surgery when you think getting up at 6:00 is sleeping in... Today i got to sleep in until 6:15... what luxury. Except that I still woke up at 5:30 thinking that I was late after having a horrendous dream about all the stones falling out of my engagement ring. Anyway. I got to see my new nephew last weekend and he's absolutely gorgeous so I thought I needed to share a few photos. None of me and him up yet but my dad took one so, soon.

My sister had a baby today!!!!!!!!
I'm so stoked. I'm an auntie x 2!
Hello Joel Fletcher. I will spoil you beyond belief!

Dear surgery god,
Please let there be no more emergency surgeries. I am so tired I just can't take it and I'm on call again Sunday and I need to help Ben move into his new apartment today.

Amen

Surgerizing

So,
I'm on surgery. I actually quite like it. But the call is funny. It's home call and if we're not called after 12 then we don't get to go home post-call. But when I"m on call I sleep really badly. Last night I was at the hospital doing some neat stuff until about 9:30 and then wasn't called after that. It doesn't sound bad, but by 2:30 today I was dying of sleepiness. Good thing the last surgery was a lap chole and I was the camerawoman because it kept me awake. I got props for my camera skills too, sweet!

I'm starting to get a hang of rounding in surgery too... I did my 15 patients in an hour and 45 minutes today and one of them had psychosocial issues which I spent a good while chatting with her about. That's not the surgeon's strong suit and he leaves it all up to the nurses, who are really busy, so it was nice to be able to really make a difference.

Anyway, I'm going to go pass out on the couch now and try not to burn my pizza.

surgery

So, today I started my surgery rotation at a hospital that is in the community and affiliated with my medical school. It started off with not beingn told anything of what we were supposed to do with ourselves and has ended with me waiting here for an hour now for a page to be returned after the resident told me he forgot to see a consult this morning and asked me to contact the doctor on call today to see if I should go see them because she's on my team... I mean, if you forgot to see a patient, wouldn't you call the attending to hand them over? I'm not on call, although I think I'm supposed to see consults for my team, but I'm not sure. I'm just not sure how long to wait before paging again. I guess I'll wait another hour?

update: the resident called shortly after I had written this to see how I was doing. He then proceeded to come in and talk to the attending himself because I couldn't get a hold of her and she didn't answer her second page either - perhaps something up with the paging system. Anyways, all is well that ends well, although I kind of would have liked to get to see the patient!

Jennifer Hawke today shared her "I love you" experience - the first time it was said in her new relationship. I thought it would be fun to share my 'first I love you' experience with Ben. I think it would be neat if those with long-term partners (ahem, milk and 2 sugars and my sister) shared their story as well.

Ben and I went to visit his mother about a month into our relationship. Walking up the garden path I was very nervous. Apparently Ben's mom had been telling him for years that he should have married his highschool girlfriend when he had the chance because she was so perfect. I met Ben's Dad's mother coming up the path (she lives next door) and she gave me a wonderful welcome. Ben's mum wasn't home, but when she did get home she gave me a great welcome too. That night Ben and I were lying in bed and I said "good night" and he whispered "I love you". Unfortunately, when we first got together I couldn't really understand his accent when he whispered so I had no idea what he said, so I asked him to repeat himself. He said it again. This time I thought I heard it but wasn't sure. so. I MADE HIM SPELL IT. hahaha. what kind of weirdo am I? Then I said that I loved him too. I just didn't want him to have said "let's have some tea tomorrow morning" and then I say "I love you too". Anyway, now we're getting married so I guess it all worked out ok in the end.

PO'd

I really hate it when you work really really hard on something and have it reviewed by people and then someone comes along and rips it apart. It makes me very very anxious. My level of anxiety is very high right now. My heart is racing and ugh. I want to kill someone. Deep breaths.

I got a new computer! It's a red little racy thing named cherry. I know, I should have named it Hal or something else nerdish but what can I say. I just learned that there may be a hope in hell of me getting all my music back from my ipod back onto my computer too! I'm trying the trick right now and I'll tell you if it works.

In other news, there's really not a whole lot of news! I've been vacationing in Scotland and now I'm back and started an elective in a family doc's office this week. The doc is really fun, although it's a bit less independent than I'm used to. I guess this is what you get for setting up electives with people who aren't used to having clerks. It's only 2 weeks, so I can do anything for two weeks, especially with such a nice person!

Scotland was great. I bagged a Monro, went to high tea, went to see sheep dog trials, went and did the Elie chain walk and many other things I can't quite remember now! It was a full week!

Me on top of Schehallion!

Computer go boom

Today, my computer died. It blue screened and then wouldn't boot and failed to find the operating system. I think my hard drive bit the dust. Now it's in the little computer shop down the way being looked at for chances of resurrection. Hopefully they will be able to save my music and a few school folders. There isn't much on there that I really need - most of my important things are backed up, but my music isn't. Stupid computers.

I had some photos of me in the dress up a second ago but I've taken them down because I want people seeing me in the dress for the first time to be a surprise. The dress is roughly this style:

Trip to Scotland

Scotland was great. Amazingly great. Relaxing, full of outdoors activities, and featuring one great wedding dress trying on! I think I found my style of dress. Hopefully I can find one in Canada that I like. Otherwise, I guess we'll be ordering one from the UK and altering it here. We'll see what happens!

Now I'm on vacay for a week and then starting an elective in family med.

Exam bad

Oh my god that exam was horrific. I just walking home realized that I answered two questions wrong, not to mention everything else I screwed up and don't know it yet. Everyone was talking about answers after the exam and it was killing me. I would prefer silence.

I don't know how i'm going to stop thinking about this all day and night and on the plane tomorrow. Ugh.

I think they should stop naming disease after people. I have too many names going through my head. And, if you get one disease, you shouldn't get TWO: i.e. McCune-Albright and Albright's osteodystrophy, or Fanconi's anemia and Fanconi syndrome. pick ONE.

I swear that studying for this pediatric NBME is going to kill me. Seriously.

I have done the pre-test book and now I'm going over it to try and figure out the things I didn't know. Which is at least 40 percent of the material! Rashes, vitamins, syndromes, immune deficiencies. It's killing me. My brain hurts. Somebody (preferably a pediatrician) want to write it for me?

In good news, I leave for Scotland for a week on Saturday. I'm so excited to see Ben again! 3 weeks is too long to be away from my love.

I will supply photos of the new hair as soon as I can. I'm on call and then studying for our final block exam, and I don't have a camera, so it will probably have to wait until Friday!

I cut all my hair off! I feel so liberated!

I LOVE this song. Seriously. I strutted down the street to it today. I hope that someone will use it for a dance for "So you think you can dance" because I think it would be fab!

In other news, it's exam time yet again. I'm on peds and we have to write the pediatrics NBME exam on Friday. I am on call tomorrow and Tuesday night on NICU - which has been pretty hit and miss for me, but because of the 24h of life well-baby checks, I usually don't have a lot of time in the evenings to study. Thankfully, this means that I get Wednesday afternoon off and Monday afternoon off to sleep/study and I can study all day tomorrow when i'm on call. I've finished going over the review notes for peds and now I'm going over the pretest book, which I've heard is very accurate as to what is on the NBME. It looks right now as though it's going to be a lot about lead poisoning, vitamin deficiencies and toxicities and skin rashes. I'm going to have to brush up on a few things!!! I got 60.7 percent on the general pediatrics portion - mostly because I don't know diddly about vitamins or about weird immunodeficiencies of childhood. Not really emphasized in the Toronto notes. I have a bit of work to do!

Because studying is boring, and I'm getting sick of it, I have spent the last 15 minutes looking for potential haircuts. Yes, that's right, my exam is 2 days away and I'm fixated on haircuts. There must be something wrong with this picture! Anyway, I'm thinking about short hair. I'm thinking about keeping my hair long so I don't have to grow it out for the wedding, but that's a year away! I don't know what to do. These are some of the short styles I've been pondering:I just don't know if I'm ready to take the plunge.

I spent my whole holiday day inside studying :( my roommates spent it going to the beach and drinking their faces off. They are also medical students and also writing an exam next Friday (although I have the additional fun of an oral exam this Friday) - why aren't they studying their faces off? I feel that this is most unfair. The advantage, however, is that they are making me dinner tonight (house taco night). Ben is in Scotland and I am here and I'm lonely. I feel like he's not missing me as much as I am him, but I guess if I hadn't seen my family in a year I might be the same way?

Yay holiday tomorrow!

Happy Canada Day!

So many babies born last night! What happened 9 months ago? Every room in the inn was full last night and a few babies were born in assessment rooms instead of birthing rooms. Everybody did just fine. We were called for a prem, a few meconiums and a few sections. Everyone cried on the perineum or after being ripped from the nice warm womb :)

It was a pretty satisfying and exhausting night and I was on with my favorite resident!

Visual diagnoses

I like a good visual diagnosis. I've had a couple in the minor emergency clinic over the last few days:

1) Fifth disease (parvovirus) - macular to lacy rash starting on the face (slapped cheek rash) and the moving to the trunk and extremities, especially extensor surfaces.


2) Coxsackie virus (hand foot and mouth disease):
Child presented with high fever (40 degrees celcius) and no other symptoms. Resp virus going around at daycare. Throat looked like this:
but my patient had more vesicles present all over both tonsils and the uvula. Coxsackie virus is classic for this. Can also cause blistering lesions around the lips, inside the gums, inside the cheeks. In the classic cases there is a blistering rash on the hands and feet, but not always present.

3) Add in a good subconjunctival hemorrhage today with a small abraison on the conjunctiva showing up with fluorescein dye and it was a pretty good day.

I'm on call tomorrow for the NICU - not looking forward to it. It's hard when you haven't done any time in NICU and you have to go and round on all of the patients! Argh!

I'm in a funk. Liana made me come out and say it, solidarity in numbers. I've been having a lot of trouble making my brain work lately and today in clinic I felt like a giant retard. I couldn't think of blood tests I wanted to order, I couldn't find the words to express myself, I didn't know any of the answers for the questions I was answered. In short, I was a failure.

Let's hope tomorrow is better.

Ok,
I have a new thing I don't like about medicine: dictating!
I wish I could just sit down and type notes on patients and give them to a secretary to mail away instead of having to dictate them. I hate dictating. I forget what I said, I miss things, and you can't really practically go through and listen to a whole dictation for completeness. I have dictated about12 cases since starting ambulatory peds on Monday and I have no idea how I'm doing. 9 of them were today. I managed to do them all in about an hour, which I'm pretty proud of because I'm usually a very slow dictator. Unlike Hitler. (ok... bad pun)

I also hate coming home from a long day just to start studying. Argh. And, our oral exam that was supposed to be on July 8th has now been moved to July 4th, which means I have one less weekend to study for it, and, I'm on call this weekend. Argh!

PICU

So,
I just finished a 3 week stint in the Pediatric ICU. It was one of the most emotionally taxing and stressful 3 weeks of my life. I had my first pediatric patient die, my first patient funeral, my first death summary. I've had adult patients die before, but it just wasn't the same. At all. I'm moving on to ambulatory peds and I'm excited about it.

I'm on call tonight and hoping for good call karma. Last call I had on peds ward was a steady all-night affair. Apparently Mondays tend to be bad because everyone has been resisting coming in over the weekend. Hopefully that applies to the day moreso than the evening. I'm glad I've chosen a specialty that doesn't involve a lot of call and can be scaled back to no call when I'm old and grey.

In other news, Ben is leaving me for 3 weeks to go home and visit his family. I'm joining him for a week 3 weeks from now and I"m pretty excited about it. We have a packed itinerary already that involves climbing a monroe, going to sheep dog trials, high tea, and many other things I forget.

I think we're caught up now!

Why is life so hard sometimes?

So, the things I need in a family medicine residency program are as follows:
1) be able to live with Ben
2) community and rural experience
3) time spent in centers that do not have specialty residents
4) time off to go to my own wedding
5) mountain biking
6) snowboarding

Things Ben needs in a residency program:
1) being able to live with me
2) being able to get a job as a foreign-trained engineer
3) mountain biking
4) snowboarding

Now we have to decide where we want to go.... We talked tonight about taking these two years and using them as an opportunity to take an adventure and go somewhere interesting before settling down for life and families and stuff. Even if we're not sure about babies and stuff yet. I came to realize that I'm ok with that. If he wants to go somewhere fun for 2 years, I'm fine with that. It's two years, I have lived in a foreign country for a year and I'm sure I could do more if I'm with Ben. Now we just have to decide where... before CaRMS

The ring!

Wedding and pediatrics

So, we booked our wedding venue today! We went with the smaller venue that Ben and I really liked. It was funny, we found out that one of the weekends we were considering was booked and we both got sad... I guess that was our litmus test. So, we will be getting married on September 12th, 2009. My bridesmaids/men will be my sister, brother and cousin and Ben will have his two sisters and his best man. He hasn't asked him yet, so I'm not going to mention it here just in case I let the cat out of the bag. Anyhoo, I'm excited to get this part of the planning done and upwards and onwards to trying on wedding dresses!

Pediatrics so far has been good. I was on call for the NICU last night and did a few well-baby exams and other than that there wasn't much to do. Didn't get called for any deliveries and had bad dreams all night about my pager malfunctioning... Haven't heard that I missed anything so I guess it was working. PICU is interesting. We have one patient who is critically ill and one patient who lives in the hospital full time and has for the past 3 years since his birth. The critically ill patient has been a huge learning experience about brain injury. This review supplement to pediatric critical care has really helped me understand what is going on.

The case is taking a big emotional toll on me. I feel very attached to this patient and the patient's family who are just the nicest people. I'm crossing my fingers and toes for this kid.

Wedding plans

Ben and I went to look at wedding venues yesterday. We found somewhere we like, but it has a 70 person limit. This means that our guest list is going to be limited to people we really want to be there. Which introduces a conundrum: how to invite someone without a date. There are people I would like to invite to our wedding who do not have a steady partner, thus, I would want to invite them without a date so they will be there, without a stranger. How do I do that?

How many people will I see die alone in my career. Some by choice, some because they have isolated themselves before they got sick from friends and family, and some because those they call to come to their side don't come.

Mrs. Potts was a lady who was given a diagnosis of cancer along with the promise of curative chemotherapy. Her husband was dead and she only had one friend who she really talked to in this world. Her family was estranged from her and she didn't have any children. When she came into the ICU she had recently been given one chemo treatment - the treatment was killing her. She had no idea it was that bad, and she only had 5 days to come to terms with it before she died. With only strangers with her.

Dear Medstudentitis:

I am writing to congratulate you on receiving the CFPC Medical Student Scholarship. Your application was very impressive as were the letters of reference. You should know that you were highly regarded by the committee and referees who felt you have tremendous potential to contribute not only as a family physician but as a leader for that discipline. I wish you all the best in your continuing studies.

Dean of important medicinal things

Yay!!!! I got the scholarship! I'm soooo stoked! I'm going to use some of the money to go to Amy's wedding!

Another Monday, another drug company sponsored dinner... last month the talk was about smoking cessation, this time about hypertension. The person talked for WAY too long and I kind of tuned out, but the food was good. After my two glasses of wine I felt bombed, maybe I should stick to one next time. I also consumed a lot of water, which was good. I like drug company dinners, mostly because I come out of it forgetting what they talked about and remembering whether the food was good. I was, however, more motivated to talk about smoking cessation with my patients over the last few weeks. I did not push the product that was being talked about though.

I have been tagged for a 7 songs you like meme by Milk and Two Sugars and Xavier, so, here we go:
1. Waiting on the World To Change - John Mayer
2. New Shoes - Paolo Nutini
3. Little Plastic Castle - Ani Difranco
4. Diagnosis - The Weakerthans
5. Anchorless - Propagandhi
6. Ruby Soho - Rancid
7. Fall Down With You - Paperboys

I've been listening to a lot of my old punk albums while riding my bike lately, hence the propagandhi and rancid on the list. "Fall Down with You" is Ben and my song, will be the first to dance to at our wedding. Paolo Nutini is from Glasgow (Paisley to be exact) and that song is one of my favorite dancing in the living room songs, as is Waiting for the World to Change.

How did I get to this age and still have zits? I have BOTH zits and wrinkles! This is so cruel!

Today is Ben's birthday - Happy Birthday Lover! Unfortunately, I am not in the same city as him to celebrate it :( We did have a nice weekend at the cottage with my family. Ben was somewhat grumpy, but I didn't catch his grumpiness until Monday, so I tried to keep the spirits up on the weekend! The weather worked against us, what a bum weekend for a holiday!

I'm on another week of resp... not as bad as I thought... maybe.

Bike racing - O-cup #2

This weekend was the second O-cup race of the year. I almost beat the girl who came second last week. She passed me at the end stretch and beat me by 7 seconds. 7 seconds! I managed to overtake her on the course and then maintain my lead, but then I fell into the bushes and took a while to extract myself and she caught up to me in the last km. I managed to stay in front but she had more legs left in the end than I did. I came 4th and she came 3rd. The same girl won as last week... she's too good for the beginner category! Young and spry she is, old and tired I am! There was a new girl who wasn't there last week who came second. I'm going to miss the next race because it's pretty far away and Ben and I aren't inclined to travel that far. So, in 3 weeks is the next one and I'm gonna be ready for this lady! The course this week was really technical and I surprised myself by being able to ride almost the ENTIRE THING on my first lap. I only got off once and that was to go over this uphill group of 4 logs and I just didn't think I could do the step up. I want to go back now and ride that step-up!

I felt like crap today. I started my week on the respirology consult service and I've been overwhelmed with acronyms that I don't know the meaning of. My homework tonight is to read about the "pneumoconioses" - I hope that's the same as interstitial lung disease because there's nothing about pneumoconioses in my text book!

Anyhoo, I saw someone with Churg-Strauss vasculitis today, which is neat.

Two of my patients from last week died over the weekend. Heartbreakingly sad. I'm kind of glad I wasn't there to witness it, at least this way I can kind of kid myself into thinking it never happened.

I looked SO COOL today. Like, seriously. I went out for my bike ride in my knee warmers, MEC dark grey/blue baggies, castelli jersey, grey nike bubble knit zip up, pink bandana and snot green helmet. I felt like a million bucks... Then I face planted into a tree and got pine sap in my eyebrows. I'm not any worse for wear now though. No facial scratches (thank god, gotta protect the money maker), just a scratch on the shin which is a whole load of nothing. Today I met people on the trails for the first time since I've been biking in this particular park which has some really nice singletrack in it. I'm in active "training" for my race this weekend (this means trying to ride 3 times this week and pushing it a bit harder). I hope I manage not to come last... it felt nice to not come last last time!

We're not going to camp this time. It's mothers day this weekend so we're going to have dinner with my fabby fabulous mimsy on Saturday night and then drive up to the race on Sunday morning. Of course, because I need to know what I'm getting into, we're also pre-riding on Saturday. Please join with me in a prayer that it will not rain on Sunday morning.

Elden over at Fat Cyclist is having a hard time... His wife Susan is dying. Please join with me in sending positive thoughts their way.

idiot

Why am I such a fucking idiot? I feel so stupid every day that I'm in internal medicine. Ugh. I sit there and i'm asked questions and I just am SO BLANK. I used to be smart, what happened? Maybe I should go into obs/gyn, it's the only thing I've actually felt intelligent at.

lost motivation

Last week when the weather was nice I went biking every day. I couldn't wait to go outside and get my bike on. Today and yesterday the weather has been cold and yesterday it was wet. Now I have lost my motivation to ride. I have many excuses, including that I only have shorts, no tights. Though, I haven't gone to the gym to work out inside either... I'm a bum.

Burned popcorn and mountain bike races

Why oh why can't I make microwave popcorn at my apartment without it burning? It just burned within 60 seconds! And, all the popcorn wasn't finished!

In other news, this weekend I did my very first mountain bike race. It was the 1st Ontario Cup cross country race of the year and it was really good. I came third, finished the 15 km in 1:12:05, which would have been reduced if I hadn't been slowed down at the end of the course by this girl who hated descending, but hey, she motivated me to push hard on some of the uphills. I'm glad I didn't do the "try an o-cup" class, which Ben did. It was badly planned with a start time along with the older male class which i can't remember the name of, but suffice it to say it was a bunch of guys who looked like George Hincapie with shaved legs who were pretty serious racers. This lead to some difficult race dynamics for the slower racers and to a result where nearly half of the contestants in the "try an o-cup" didn't finish the race due to minimum lap times (which weren't enforced... but they asked people to pull themselves out of the race voluntarily so many people did). Anyhoo, Ben didn't have much fun and will be doing the beginner cat with me next time.

UBC has screwed me for electives. So, now I'm scrambling to find a CCFP (family doc) to take me for 2 weeks in the summer. I know one person and we've emailed back and forth, but I haven't heard from her for a week and I need to have something set up soon. I never know how long to wait for someone to get back to me.

I just started my core internal medicine today. I'm in the ICU in Peterborough. It's interesting so far and kind of scary. I'm really not cut out for internal - which makes it really super intimidating. I've heard that the exam is really brutal for this block. It's one of the American NBME subject exams. I think a few people have failed it already this year. Apparently everything is in american units and you have to convert them during the test. I've heard that there's a pretest book that you can buy, which I will be going out and purchasing before the exam. Studying starts tonight.

I have found some really cool singletrack to ride in the area of my apartment here. I'm planning on racing next weekend so it's imperative that I get in some riding this week. I also have to go back to the town where my university house is and pick up my racing stuff - bummer because it's 200 km away. Good thing there's no call in this rotation!

Waiting for the world to change

Well, I'm waiting for Ben to get home from a late day of work. We were supposed to go for dinner this evening at our favorite pub, but I think that's destined to be usurped by an installation at Ben's work. Anyhoo, maybe I'll talk a bit about Kash.

My trip to Kashechewan was interesting. When I got there we drove through the reserve and all of the burned down houses and dilapidated buildings were pointed out to me. There has been a rash of fires this year in Kash and considering that the average number of people is over 10 per 3 bedroom house (I can't remember the actual number, I think it's around 15), the loss of any housing is felt hard by the community. There are houses that people are living in with boarded up windows and tarps instead of doors. There are children who have been burned by water from stoves where there were just so many people in the house everyone else thought that someone was watching the kids. There are people who are now working at the diamond mine that has started up the coast, but they are on for 2 week shifts and are away from home, leaving their kids with relatives or teenagers to fend for themselves. The cost of employment is leaving one's family.

I got to go to a coroner's case in a neighboring reserve. Riding in the back of a NAPS (police) Ford F150 along the ice road was quite an adventure... the back seat is a wooden box that is quite hard on the bum! It was a sad case of a person who was physically and mentally ill in the community and the community supports just weren't there to keep them afloat - they fell through the cracks of the system.

The kids in Kash were very cute. The first language taught to children there is Cree, which is really neat to see. Otitis media seemed to be the illness of the week, really bad OM with perforations and draining puss. We also did some drug and alcohol and grief counseling while we were there. It really became apparent to me that the drug and alcohol problems are very intertwined with the lack of community supports for the grief and depression that are rampant in the community. There has been a lot of loss and a lot of frustration with the inaction of the government. Although there have been many people killed in fires, there is no fire engine. There are many teen suicides that affect close families profoundly. People don't really talk to each other about these tragedies in the community unless they are drunk - which leads to a perpetuating cycle of depression and drinking. A new tradition of talking needs to be established.

Really, solutions for this community need to come from within. Many of them, I think, start with empowering the members of the band to make changes, be home owners, and be proud of who they are an their ideas.

Hectic

These past two weeks things have been quite hectic. I came home from Moose to start an elective at McMaster - 1 week of general obs/gyne and 2 weeks of maternal fetal medicine. The week of general obs/gyne was fantastic. I recommend anyone who is doing medical electives in Ontario to request a general obs/gyne elective in Brantford through McMaster. I just started MFM yesterday. The good thing is that I'm working with two really cool docs and I'm the only student in their clinic. The bad thing is that there are many many medical students on the ward and in L and D. I wanted to do some call while I'm here, but feel like I'm stepping on the new clerks' toes if I do (they just started on Monday doing their core obs/gyne rotation). The clerk who's on call on Thursday when my preceptor is on call really wants obs/gyne and I don't want to steal any deliveries from her. Maybe I should just stick to clinics.

Anyhoo. I'll write more about my trip to Kash later. Ben and I are going for a walk outside in the wonderful sunshine. Oh, and, the stones are coming in for me to choose my center stone for my engagement ring! I almost have it!

The proposal

It was very exciting because it was SUCH A SURPRISE!!!

I drove back from Kingston Airport to Toronto after my 3 weeks in Moose Factory. As per my previous post, I was really missing home and really excited to see Ben! When I got home he came out and met me at the car in the front of my parent's house. He gave me a huge hug and then suddenly he got down on one knee with a Tiffany box in his hand and asked me to marry him! It was surreal and wonderful. I haven't slept in 2 days I'm so excited. He gave me a small ring so we can go shopping for the real thing. We spent a day looking and found something I like - now we just have to find it somewhere else cheaper! I think I've located a potential winner, so we'll go on the weekend to see it. We've decided on a pink sapphire mixed with some tiny little sparkley diamonds. We'll probably get married in the summer of 2009 after I graduate. Everyone from my class will be getting married then! We'll probably have two things - one here and one in Scotland. I can't wait to be married!

I AM ENGAGED!

Ready to go home

I've been really down for the past 2 days. I think it's because I'm ready to go home. I miss Ben, I missed being there for Easter with my family, I'm tired of this little green house of blankness. The really odd thing for me is that I have a very ominous feeling, like I'm just waiting for something to go wrong. I'm not sure where it has come from. I can't seem to shake it. Tomorrow I go to Kashechewan. I've been guaranteed that it's going to be an eye opening experience.

Remind me next time I go to dinner with Eastern Europeans not to drink as much as they do

Today my dentist roomie Sylvie and I took a trip to Moosonee for some groceries and supplies....One of the guys who works at the hospital was nice enough to pick us up in his truck and give him a ride back! It was chilly out there...

Dog Treats

I gave in and bought some dog treats today for my two favorite pals: Atim and Brown Doggy.

This is the teepee (also spelled tipi...) that's in my neighbour's garder that my roommate Sylvie is OBSESSED with going into.

Atim

This is the dog that adopted me today for a walk. I call him Atim, which means dog in cree.

The walk was BEAUTIFUL. It was +1 today and nice and sunny. The general surgeon told me about this path he walks regularly.

These colourful strips of fabric are tied to trees around a house down the road from me. Apparently the man who lives there does sweat lodges. I wonder if these having some spiritual significance.

Happy St. Patty's

I'll be going to bed now.... post call... up all night. Another night of bleeding - seems to be the story of my life!

Christianity

It is really surprising how much Christianity (especially the born-again variety) plays a role in this society. There are several churches on Moose Factory Island and in Moosonee. Next weekend is Easter and I'm wondering what it's going to be like here. I wonder if the lasting effect of christianity has something to do with the lack of traditional pursuits here.

When I came here, I naively thought there would be a lot more traditional activities happening like drumming, dancing, crafts, hunting, etc. This probably has a lot to do with my preconceived ideas of aboriginal society. There is some hunting, but a lot of it is done with a different attitude than traditionally ( not hunting for food but hunting for pleasure leads to a lot of people killing more than they need and leaving carcasses in the dump or the bush). The only people doing crafts are the elders, who are in their 70s and 80s and won't be around forever. There is at least one person I know of who does traditional sweat lodges in the community.

Last night a bunch of medical people were at someone's house and this topic came up. Apparently they have noticed the same things about the community. Next on my 'to do' list is to find an elder who will sell me some traditional goods like moccasins and mittens. I hope I can find them to have some keepsakes of my time here.

New Project

So, I'm starting to cook up a new project. Something really useful for the people here and the docs. I'm not going to say what it is until I get the go ahead from the surgeon I"m working with. Let's just say I'm pretty excited!

Aurora Borealis

Oh man, the Northern Lights yesterday were just amaaaaazing. After a chance encounter with some new friends over pie at the eco-lodge, we headed out onto the frozen river to look at the stars. When we got there, all we saw was a halo of green extending over the sky. Slowly it changed into a spiral and then some more vertical shapes.

We're having a potluck at our house tonight for some of the students/residents/dentists who are living around us. Hopefully we'll make some new friends!

Getting used to feeling like an idiot

There are lots of diseases here that are much more common in the native population than in the general population of Canada. For example, Alport's syndrome and IgA nephropathy. These are things I:
a) hardly remember learning about (Alport's we learned in ENT not in nephro)
and
b) have never seen

Consequently, I don't think of them in my differential when I should, and look like an idiot when I am asked about them in clinic.

The experience of being here is really good. I'm doing a bit of everything. I did some surgical assist yesterday. We had a few gastro-type cases and then there was an emergency section. Mom and baby were both fine, but it was a bit hairy for a while.

I have two roomies here. A crazy french girl from Montreal and a guy from Richmond Hill. They're both dentists and it's great to live with people here. Much less lonely than it could be otherwise. Today I had the day off so I'm chilling and doing some laundry. I'm supposed to be off tomorrow too but I asked the general surgeon if I could come to his clinic - I'm just too bored staying home! Then on Friday I'm doing home visits, which should be eye opening.

Overall, I'm having a great time but also miss Ben at home. I'm not sure I could live up here forever on my own, but I would sure love to work somewhere with a similar scope of practice!

Walk

Went walking around with my roomie today. We were originally going up to the Northern (the grocery/everything store) but realised when we got there that it was closed on Sundays!

We then went to this shop that has no sign so I'm not quite sure what it's called. Got some batteries for my camera so now I'll be able to take some snaps and show them when I get back!

THere are SO MANY stray dogs here. Big ones, small ones, huskies, collies, labs, makes me want to take one home... until they start wrestling with each other and making a ruckus! Apparently they have a cull every year of stray dogs because if they're left to their own devices, they'll form packs and attack village children. So, no collar, get culled. Even so, there are lots of dogs with collars wandering the streets!

I'm looking forward to my first full day in family clinic tomorrow!

Last night

Last night was awesome from a medical point of view. My preceptor did call my supervising doc for the night to tell them I'd be late so that we could attend the Weeneebeg Aboriginal film and video festival. It was really good - the films gave me a great perspective of native life. There was a film called Mino Bimaadiziwin (Touching the sky) that chronicled an all-native school's attempt to get kids to sign up to a challenge whereby they wouldn't use drugs or alcohol for a whole semester. Of 75 or so kinds who signed up for the challenge, 18 made it to the end without drinking. Better success rates than most drug/alcohol rehab programs. Fantastic film. Then there was one called "Miss Navajo" - it's about a Navajo "beauty pagent" that's so much more. It was both tranditional skills sections, which involve things like the slaughter of a sheep, and modern talents. If you can get a copy of this doc, it's super.

In my night on call I saw some neat stuff. DKA, pediatric intubation, PPROM, some toxicology in action. The stuff you learn algorithms for in med school! The DKA case was especially interesting because it's a balance act between insulin, D50W, potassium, fluids, and bicarb. Biochemistry at its best!

Tonight I think I'm just going to chill at home. Maybe make some chili and watch movies with my new dentistry student roomie!

tomorrow morning i leave for an elective in Moose Factory. I'm both excited and apprehensive. i don't know what it will be like being a vegetarian in Moose. I have no idea what the experience will be like. I could only take 25 lbs of luggage, so no laptop. I'm not sure how i'll be able to connect with the internerd. I hope my cell phone works. I hope my calling card works. I'm stressing a little bit and haven't had much sleep lately. So, i guess i'm going to bed!

perhaps I should have gone to Wendy's and had their new fish sandwich instead. Regardless, today was a better day. Had a surprise cancer diagnosis, but other than that most people were pretty straight forward. Worked with a great doc who has offered to write me a reference letter for CaRMS. So, one for the good guys.

Death

Saw patient die tonight in ER. Cried in car after shift. Had McDonalds Fillet O'Fish to make myself feel better. Didn't work.

scholarship

Each year the Canadian College of Family Physicians gives one third-year medical student from each Canadian medical school a $10,000 scholarship. The winner is chosen based on a desire to pursue a career in family medicine, a demonstrated involvement in extracurricular activities involving family medicine, electives in family med, research in family med, and family medicine related awards. Two reference letters are also required.

The application involves writing a one-page essay about why one deserves the scholarship. I hate writing things like this. I want to win it, and I think I deserve it, but I think it's hard to seem humble and like a nice person and write all these great things about myself. I also hate actually writing out "I deserve this scholarship because..." so I'm trying to figure out a better way to say that.

I've tried to write this a couple of times so hopefully I'll be able to strike a good balance soon. It's frustrating me!

In a rut

I'm stuck in a rut. I actually put on my gym clothes and left the house and ended up not going to the gym... how did that happen?

I worked until 2 am tonight and I'm back at work at noon tomorrow ... feels like not enough sleep!

I got to see a cool resuscitation today and an anaphylaxis. I got a really nice compliment from a family and felt like I'm finally becoming a competent person in the emerg.

Well. I'm off to bed. Wish I could say more but my brain is fried!

tired

This shift is going to be the death of me. I'm so tired.

Weekend off

Yay! I have the WHOLE weekend off! Friday, Saturday and Sunday! Ben and I are going to the cottage - cross your fingers that the heat and the water both work when we get there.

Next week brings night shifts. 11pm to 8 am x 2. I hope the person I'm working with is nice - although so far everyone has been so I have no reason to believe that anyone at this place is mean!

Yesterday morning I had my first irate patient. He's been in and out of this ER many many times with abdo pain NYD and has a hate on for all of the doctors. He stormed out before we were finished testing him to head to another hospital for the same thing. I'm generally very sympathetic to people who are distressed/angry because they don't know what's happening with them but this dude was SO RUDE. I just couldn't find any common ground with him to try and explain what we thought was going on. He just wouldn't listen and kept yelling at me. Yeesh.

I also have made some really satisfying snap diagnoses over the past couple of days - herpes zoster and roseola infanatum. Easy things to recognize that are really satisfying to tell people about because it explains mystery symptoms and can be quite reassuring. I've also had a couple of mystery patients who couldn't communicate and we had to work them up for everything. This is satisfying if you can find the source of their troubles and really frustrating if you can't.

Anyhoo, I'm really starting to get into the groove of how this ER works. 2 weeks left.

Horse slaughter

I just read a big thing on Willie Nelson's website about stopping horse slaughter. My question is: why is it worse to kill a horse than to kill a cow? They're both treated poorly on the way to slaughter by many slaughterhouses. They're slaughtered in similar fashions. They're both used for meat. In theory, you could ride both, although I've never seen someone ride a cow. Cows are just as lovable and cute as horses. I just don't understand the horse/cow double standard.

guilty

I spend a lot of my life feeling incredibly guilty. If I overlook something and someone feels like I've been neglectful or rude, I feel incredibly guilty. If I make an honest mistake, I beat myself up over it for days. I can't let things go. I guess maybe it's because I really care what other people think of me. I don't know. Anyway, I have to learn how to let things go.

Emerg

So,
I just started my emergency elective in one of the many emergency rooms in the city of Toronto. I am doing an emerg elective because I think I might be interested in mixing some emergency work in with my family practice in future, it's a great way to get to see a really big variety of cases, and I think it will prepare me for future clerkship blocks. I have realized, however, that the hours in emerg suck. I don't know how anyone balances having a family and having emergency medicine as a career. The majority of the shifts are evening/night shifts (2 days shifts vs. 4 evening/night), so if all things are split fairly, most people spend the majority of their time working evenings and getting home late. This isn't great for people whose partners have day jobs. For example, the last 3 shifts I've worked have started at between 2 and 5 and gone until between 10pm and 2 am. I then sleep until 10am and then go the gym and get ready for my next shift. Doing this for the rest of my life seems somewhat less than ideal!

Anyway, the people are nice and the patients have been good for the most part. I like the work but the shifts seem long. This is not the career for me, but it still remains a viable option for a one shift a week type of arrangement along side my family practice.

I got honors in both coursework and clinical skills last semester! Yay!

oral exam

So, finally something goes well. I got 89% on my oral exam (still no results of the MCQ yet). And, I almost delivered a baby. Sadly, the anterior shoulder was very tight and I needed some help with it. Then I did the rest of the delivery and it was great. I always almost cry when they come out - an involuntary reaction!

Exam

Ugh. Stupid stupid exam. So baaaaaad.

Exam

The block exam for Obs and gyne has really sneeked (snuck?). It's on Monday and I started studying 2 days ago. Ack! I'm on call Friday and Sunday from 8 to 5 (get off early because of the exam). Hopefully call will be quiet so I can sleep!

Welcome to your life

I had quite a weekend. I was on 24-hour call on Thursday and Saturday (my co-student was on Friday and Sunday). Ben came up on Friday night and stayed until Sunday evening after dinner. It was hectic. Thursday night I slept through the night but Saturday was a different story. I slept for 2 hours from 1 until 3 and spent the rest of the time assessing people who weren't actually in active labour but came to L and D because they were excited about having babies and then didn't want to go home. The weather was bad so we ended up with a full house of primips at 1-2 cm. Three deliveries during the day, none at night, and my first 8 cervix checks. There were a couple of very posterior cervixes (cervices? cervi?) that I had trouble reaching and learned some good techniques from the nurses. The nurses I was on with were really great this weekend about encouraging me to do exams because I've been pretty timid about doing them on women without epidurals. This is bad news for someone who plans on doing obstetrics, so I conquered that fear with a little help from my nurse friends. I think sometimes it takes someone else in the room with confidence to give me the boost I need to try something I've never done before. From now on I'll be doing all of my own vag exams on women presenting to the floor as long as it's ok with the assessing nurse/doc on call.

Ben and I had a really good time the time we did spend together. Ben spent Saturday with our friend Amanda when I was on call. Today we went shopping for a new snowboard jacket for Ben and we got him a nice one. I managed not to spend any money, yay! I've found that since i've been away from home i've been spending a lot of money on things I had at my house but forgot to bring here. I think the personal costs of doing rotations away from my school-town are way higher than I anticipated. Hopefully I can be more prepared for the next rotation when I'll be here for 6 weeks.

I just got into a post-call fight with rogers wireless on the phone. Basically, every time I access my voicemail from outside my home calling area they are charging me 30 cents. Because I'm on regional rotations, this is costing me a lot of money (around 12 dollars last month alone). So, I called and requested that my voicemail number be added to my myfive. They wouldn't let me do that either (big surprise) so I asked if there was any other way to adjust my plan to not get charged for this. He didn't have any suggestions, so I asked to be transferred to his supervisor. Then, I asked the supervisor what i could do. He told me not to call my voicemail from my mobile. Good one buddy, unfortunately I use my cell as my home phone and would still be charged to call my own phonenumber from out of town to access my voicemail. So, then I got a little bit angry and swore (I'm a bad person, I have a really bad cold and I wasn't in the mood to have this guy be unproductive) so then I told him to remove my voicemail from my account. He then told me that I'd save 6 dollars. So I told him that no, it would be more like 20 dollars because I keep getting charged to call my voicemail. He then told me that I was seeing it all wrong and that he was right. So I told him they had shitty customer service and hung up. He then left a message on my answering machine telling me that I was unprofessional and that I needed to learn how to be more professional on the phone.

Anyway, I'm sure I could have handled it better but I was really really pissed off. My heart is still beating like crazy. I hate my plan. I hate cellular service in Canada (I cant' seem to find a company that isn't a huge ripoff).

I feel like I'm either call or post-call every day. i was on yesterday/last night and I'm on 8am saturday to 8 am sunday. Ben is coming for the weekend and I'll hardly get to see him :(....
At least I'll have a bedmate tonight.

I have a wickid stuffy nose and runny nose. ugh.

obstetrics

At the end of last week I switched over to my obstetrics rotation. I'm out in the community at a smaller regional hospital than the tertiary care center associated with my school. Boy, it's a bit of a culture shock. When we were at our home hospital we were told where we were to be every day and we had a resident we sent our time with. Here there are no residents, and there is no schedule. I'm on 1 in 3 24-hour call (sometimes 1 in 2 because there is a family medicine resident who is sharing call but doesn't "do" weekend call) and then I have a post-call day and then I have this day of nothing which I'm supposed to fill by myself with clinics or OR or other things. It's totally been left up to us to fill it with no guidance. It sucks. I feel like we're getting a bum rap from everyone else who gets to just show up to what they are assigned and don't have to worry about getting turned away. It's really frustrating. Tomorrow is my day when I have to arrange things myself. So far I have a colpo clinic arrange for tomorrow.

I have more to say about the experience but I'm going to save it for a day when I'm not post-call. It makes me a bit grumpy.

My first complete week

Ok, it's hard to document everything that happened this week but I'll try to give you the highlights.

I had my first embarassing surgical experience. Something that most people have at least once in the OR. I vagaled. I didn't pass out totally, just got really dizzy and had to excuse myself and sit down on the floor before I lost it. In my defense, the OR was really really hot and the surgeon had asked them to turn the heat down twice before I lost it. When the nurse (not the scrubbed one) helped me off with my mask she noticed that my whole cap was soaked in sweat - it was really hot. Also, I have been in surgery for longer and with grosser surgeries and never vagaled before so I feel like this was an anomaly. Anyway, it happened, everyone was very empathetic and it hasn't happened again and hopefully won't. I learned some good tips for cooling down in surgery though - one of the best is to take off your shoes and stand for a second on the cold floor (easy if you're wearing surgical clogs) and then put them back on. It really helps.

I have learned at least 4 different techniques for inserting a speculum. It's hard to keep straight who does what and who tells you never to do what - if someone's showed you their way once, they expect you to repeat it the next time you're in their clinic. Part of being a clerk is not getting told twice. I think I've picked my favorite so far and i've picked up some good tricks along the way such as, if you see a bit of the cervix in the field and want to bring the rest of it into view, rotate the handle of the speculum towards it and the bottom bill will sweep the cervix into view, then right the speculum before screwing down the hold screw. Very helpful!

Clinics rarely run on time. No matter how fast the doc is, there are always additions and emergent patients to be seen. Go with the flow, bring an energy bar and some water - you're going to need it.

On a similar note, the hospital is VERY DRY. I don't think I peed for the first 2 days of clerkship because I was so dehydrated. Bring water. Take it with you everywhere. Leave it in the fridge in the OR staff room so you have it on breaks. Water is your friend.

This week I discharged my first 4 surgical patients. All of whom I really liked. All of them very different and there for different reasons, some will continue on to need further treatment for cancer and some are cured of their symptoms/diseases by surgery. I realized that I really like continuity of care, I want to know what happens to these people and I want to be a part of it - just one more sign that I was made for family medicine.

Ben and I discussed moving back to Scotland eventually and staying there for a while. So, now I'm trying to figure out what the steps are to getting a license to practice as a GP in Scotland. I know that there is a lot of turmoil in the British system right now and that makes me nervous. Hopefully I can figure out a way to follow my dreams there too.