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.

bad

I've been a bad bad blogger. I swear I'll update tomorrow when Ben's gone back home. Right now I'm capitalizing on my snuggle time.

busy busy bee

So,
Although last week started of slow, the pace took off from there. On Thursday I met my resident as we rounded on our patients in the morning and then headed to surgery. We operated from 8 - 3:30 and then rounded again and I had teaching from 4 to 5. Friday morning I rounded on my own patient and then rounded with the group on the rest before teaching at 7:30. After that I went and did a high risk obs clinic for the morning with one of the MFM docs. In the afternoon we rounded again and I got to try my hand at writing orders with the off-service resident who is on gyne at the moment. He was super nice and taught me lots of useful things so I'm stoked about that. Tomorrow is surgery again, Tuesday cancer clinic so I'd better read up on all of my gyne onc notes before tomorrow. I went in this evening and read up on my surgical patients for tomorrow and checked up on "my" patient who might be discharged soon. I felt like a real doctor - tired and in the hospital on weekends. Welcome to the rest of my life. Hopefully soon I'll be quicker at doing my tasks so I have a chance to review surgical patients on Friday afternoon for Monday morning. Let's hope!

Anyway, things are going well I think and I'm learning lots. Drugs still baffle me - too many drugs in too many doses, I can never keep them straight! Hopefully my medicine rotations will do a lot to sort that out for me.

I really need to submit the forms for my electives - must remember to do that tomorrow night!

Now I need to go shower and blowdry my hair so I don't have to do it tomorrow morning!

First day

So, the first day was a big let-down. We arrived at the hospital only to discover that everyone is still on vacation and holiday schedules are in effect until Monday. This means that for my whole service (obs/gyne) there is one resident. There are a few clinics and ORs but not many. I'm on gyne onc service and we only have 2 patients. We showed up to our morning "orientation" and the person doing the orientation didn't have our schedules for the day so after the 2 hour introduction (which wasn't anything we hadn't already learned in clerk camp) we were at a loose end of what to do. By the end of the morning we did get our schedules and I discovered that I wasn't scheduled for anything that afternoon. So, I went to the gyne onc ward and basically read the charts of my patients for an hour and then read some stuff and then went to afternoon teaching without seeing a single doctor the whole time. All of the patients were more or less happy and being looked after by the nurses so I was at a loose end. As a first day, it was very anti-climactic. Tomorrow I'm starting the day in surgery - hopefully it's a bit more exciting and I actually get to try my hand at writing orders or something!

Happy new year everyone. Today is my first day of clerkship. This body hasn't seen 6 am for quite some time and I have a feeling it's going to see 5:30 and other such times much more often than it would like. It's like highschool - I've got my locker code and my lunch packed and I'm afraid of being beat up by the older kids. I hoped I would never have to go through that again.

Wish me luck, I'll keep you posted.