I'm feeling marginally better, although I now just can't stop coughing and coughing and coughing. But, unfortunately, today the husband started coughing. Uh oh. No good for plane journey on Wednesday. Cross your fingers for me that he's a quick healer.

so sick

I've never been this sick in my life. I was on call last Thursday and got what I thought was a migraine. Early Friday a.m. I was woken up to do 2 deliveries and 1 had a pph, that got rid of the tail end of the headache that lingered on. I went back to bed and woke up for rounds at 6:30 - bam. worst headache I've ever had + body aches. That progressed to body aches + headache + cough and 6 days later bam! now I have diarrhea. If the big guy upstairs thought this was a way to re-fill my empathy bank, I'm not laughing.

Going out to do a very challenging mountain bike trail with a group of people who are WAY better than you are on a day when you're getting your period = bad idea. 2 hours in, I was feeling great, I had accomplished more than I could ever imagine, then I went over the bars twice in about 5 minutes. 4 of those minutes were spent lying on the ground trying not to cry (as tears involuntarily streamed down my face) after crash #1. Thankfully, crash #2 wasn't half as bad. Now I'm having trouble bending my left leg because I'm pretty sure I have a big hematoma in my rectus femoris sheath. Oh well. Tomorrow will reveal the severity of the bruising. Thankful I didn't do anything worse.

It really bothers me when people say it's their "right" to have a child. I believe that it is a privilege to have a child, not a right that I should guarantee every woman who lives in my country. I know that not being able to have children is heart breaking and difficult for many people, but just because something is sad, doesn't mean it's your right not to experience it. There is no right to happiness.

Now, that doesn't mean that I don't support fertility treatments or funding of fertility treatments through the public system. I think that is a separate issue. Would providing single embryo transfer reduce health care costs for multiple premature babies enough to cover IVF? That's where the question lies for me.

The Canadian study Too early, too small released by the Canadian Institute for Health Information concludes that the average lifetime cost for each and every multiple birth baby is $616,800, mostly due to premature birth. 56% of twins and 98% of triplets are born premature.

With Quebec's new publicly funded IVF single-embryo-transfer system, I guess we'll see how things pan out over the next few years.

This week two astounding things happened:
1) a person actually came to me and ASKED to quit smoking
2) a person in my practice came to me having LOST a large amount of weight.

Day after day after day I feel like I harp on people about the importance of weight loss, exercise, a healthy diet and smoking cessation. I try different techniques for different people. I place them on the spectrum of change and use different techniques to try and move them from one stage to another. Most of the time, I know it's going in one ear and out the other. They've heard it before, they'll hear it again. How nice to have two individuals in one week seemingly follow or want to follow my advice. hurrah.

Today is SOO prep day. For anyone who doesn't know - SOO stands for structured office orals and they are an integral part of the Canadian College of Family Physicians exam. We have some medical students visiting our family practice unit this month so we're using them as standardized patients to practice our SOO skills. I'm not sure how this is going to go! SOOs are complex and you really need to figure out a pattern of how to approach them because the patient always has a primary problem and then a secondary problem you need to tease out of them during the interview. This second problem can be totally unrelated or be related to the presenting problem (when it's unrelated it can be difficult to pry it out of them and at times I've resorted to "is there anything else you would like to talk about today"). I worry about running out of time at the stations. We'll see how things go today!

Why is November such a hard month? Daylight savings should have made my mood better, but coming home now with it being darker and darker I'm finding it difficult to get my shit together. I've been managing to follow my turboing and biking regime to try and stay sane, but I just can't find the motivation to read and learn. The journals and piling up and I feel like I'm getting dumber. I'd better snap out of this soon because I need to start studying for the CCFP. Guidelines Guidelines Guidelines!

In Flanders fields the poppies blow
Between the crosses, row on row,
That mark our place; and in the sky
The larks, still bravely singing, fly
Scarce heard amid the guns below.

We are the Dead. Short days ago
We lived, felt dawn, saw sunset glow,
Loved and were loved, and now we lie,
In Flanders fields.

Take up our quarrel with the foe:
To you from failing hands we throw
The torch; be yours to hold it high.
If ye break faith with us who die
We shall not sleep, though poppies grow
In Flanders fields.

let's all insult family doctors

I'm working with a specialist right now who is VERY good at what he does, but constantly insults family doctors. Most of his stories revolve around how a family doctor sent him a ridiculous consult or screwed up or gave the wrong med or was manning the ER when someone died. Does he not realize that I'm a family medicine resident? Or does he not care? Or does he not see how insulting his stories are.

I had a very nice day with my Mom today. Is it the sign of a youngest child that I still go home to hang out with my parents when my husband is away?

Today I had a non-alcoholic beer. I think this is a sign of progress in my recovery from the LMCC-II. Now I have until December 16th to try and forget about it before results come out.

That was the worst exam I've ever done. Seriously. There are 2 stations I absolutely bombed.

I'm SO OVER EXAMS. Damn you LMCC II.

When I see children dying and I read about children dying and the PAIN that their parents go through, I can't help but ask - how can people do it? Is it insanity that people want to bring a life into this world when there's a chance that life will be cut too short and cause them immeasurable pain? Or is it the promise that most people make it to adulthood alive that drives the need to reproduce? Or the opportunity to bring a new and wondrous life into the world?

I struggle with the fact that right now I have no desire to have a baby. I'm too worried. I am content to bring them into the world and hand them off to those more prepared.

And then she was 29.

Kitty

So,
Kitty is still alive but now unable to walk, use the litter box without help, or manipulate his position very well. He often looks like me in an undergrad lecture, nodding off to sleep with his head on his chest only to jerk awake realizing that he can't sleep and hold his head up at the same time. The prednisone is at least increasing his appetite, although he's just skin and bones. Poor thing's owners can't get home soon enough - they'll need to put him down soon and I just can't bring myself to do it without them seeing him. Friday seems like such a long time away.

What kind of karma do I have? I am cat sitting one of my attending's cats while he is on vacation for 3 weeks and 1 week in one of the cats contracts a deadly neurological disease... I guess I should have helped that old lady across the street last week.

When I said I had an interest in palliative care, this isn't what I had in mind.

R3

I'm struggling with whether to pursue R3 training in obstetrics and women's health. On one hand, it would be great to match to a program in the same city where Ben is living/working so we could be together and I could get to know the city/hospitals etc. On the other hand, I could probably just go get a job there post-graduation. My hesitancy with the "just get a job" route is that I don't feel prepared - but does anyone? I still have >6 months of residency left and I don't feel prepared to even make the decision but applications are due Oct 15 so I'd better get my ass in gear if I want to apply. Plus, applying would mean revealing to my program director and colleagues that I'm not planning on staying in the city I'm training in (which I would love to do if Ben could only get a job) - which will make a lot of people unhappy. But seriously, Ben and I cannot live apart for any longer!

To dance or not to dance? I am going away for 2 months during this year's dance season and I think I'll have to pay for those classes whether I take them or not. Is it worth the money for the months I can take class to just suck up the 60 bucks, or should I not start off the season at all since I'll miss a significant portion? What to do!

In other news, I came second in my weekly mountain bike series!! I had so much fun and met so many awesome people. I'm totally motivated to do it again next year along with my goal of doing a solo 8-hour race and maybe a 24 hour race. I need something to motivate me to keep up the winter training!

The contrast between my studying and my urgent care clinic tonight is very obvious. The text talks about all these classic clusters of symptoms. My patients come in with weird shit that I have no idea what it is. It's unfortunate that studying doesn't teach clinical judgment.

LMCC Study day 2

lipid guideline
diabetes guideline
reading about januvia and Victoza
ovarian cancer
asthma guidelines (to be continued)

LMCC II study day 1

A study of randomness:
1) cardiovascular events TOP guideline
2) Cognitive impairment TOPS guideline
3) Urinary tract infection in nursing homes TOPS guideline
4) progesterone for luteal phase support - Cochrane review + other resources
5) Gout
6) Polycythemia vera
7) Canadian guidelines on Sexually Transmitted Infections (to be continued tomorrow)

I should really start doing something systematic, but these were clinical questions from my day/past week I needed to look up anyway. The Alberta TOP guidelines are really useful! They can be found at: http://www.topalbertadoctors.org/informed_practice/about_informed_practice.html

It never ends to amaze me how much people appreciate a simple gesture like a phone call from their GP when something tragic happens in their life. I have had two pregnant patients who got devastating news within the last month - each took it differently, each was heartbroken in their own way. All I could offer was words and a shoulder to cry on - it was almost as if they had expected less.

random crying

I missed my exit on the highway today because I started crying because there were bagpipes on the radio and they reminded me of my wedding day. I'm not sure how I feel about that.

The joys of trying things you're not good at

I never participated in a lot of sports in high school. I was a figure skater and a bit of a dancer, but never found the pleasure from competition and sport that some of my peers did. I think it was because I just wasn't very good at it. I was really good at school and got a lot of pleasure from reaping the rewards of being smart and it motivated me to try harder - which I can thank for getting into med school and getting my commonwealth scholarship to do my Master's degree. In sports I was so behind everyone else I felt like there wasn't a small gap to close that I could strive for, I felt like I needed binoculars to see the rest of the field.

Fast forward to now. I have started doing some mountain bike races and I still need binoculars to see the rest of the field most of the time, but you know, it has started to feel good just to get out there and participate. I know that sound corny, but participation and trying something new and exhilarating has become more important than proving I'm the best or not trying because I can't be the best. I'm married to the man of my dreams, I have the job of my dreams (or I'm on my way anyway) and this added new challenge seems more like the icing on the cake than something I need to hang my self-esteem on. It feels pretty good to have fun just going out and trying, no matter the consequences.

It's nice to be a PGY-2 going back and doing things you've already done for a second time - makes you feel like you actually know something about something! Sometimes. Other times it's extremely challenging because you are viewed by most attendings to be able to do everything yourself and asking PGY-1 type questions is frowned upon. Freedom always comes with a price!

I had my first palliative patient this week who actually expired during the consultation. While I was trying to clean his face with warm towels so the stains of death didn't disturb his family, I noticed that I no longer have overwhelming feelings of sadness when people die. I'm not sure that's a good thing. This month on palliative I have yet to cry and considering I treated someone the other day who's younger than I am and who is dying of metastatic cancer - I'm starting to wonder what's wrong with me. Is my skin growing in too thick after many years of being tender-hearted? Has my disillusionment with residency extended to not emotionally engaging with my patients? Or is it a compensation for one of my colleagues that cries over every patient. Who knows.

Back to OB next! I've delivered 2 of my own babies so far and have another due this week so I'm pretty stoked!

Dear Squirrel

Dear Squirrel,
I know you have baby/adolescent squirrels that are running around with you chucking chestnuts out of the tree on me, my car, my path, but WHY DID YOU HAVE TO EAT MY PEA PLANTS??? That's where I draw the line!!!!!

I hate when a delivery goes well, but not perfect, and I come home and obsess about it. Is this going to be the story of my career?

whole wheat kraft dinner sucks.

So, my current rotation is total balls! Not because the actual rotation is bad, but because the scheduling is a nightmare. I took 2 weeks of vacation during this 6 week rotation (which we are entitled to) and that caused a scheduling problem that was sorted out... or so I thought. Over 4 weeks I need to do 9 shifts and I show up for my shift tonight and find out the person who was supposed to teach me traded the shift to a person who doesn't teach. So, I had the ward clerk bring up the schedule for the week and not only was this shift traded but 2 other shifts have been traded... which leaves me 3 shifts short for the rotation... out of 9. Two thirds of my shifts are gone. I'm not sure what I'm going to do.

Does anyone know any physicians who were trained in Canada or the US and moved to the UK recently to practice?

I know it's a silly thing to say, but I'm nervous about my holiday. Husband and I are going to Italy and we're landing in Rome and driving 6 hours south to see/stay with my father in law and his partner. I've been getting maps and directions and phrase books and trying to figure out where we're going and how best to do it. It doesn't help that the directions I got from my father in law say that he lives on an "unknown road" and the last few directions on the google map have no street names. I know that people went on vacation and made it without GPS units and fancy gadgets for decades and I'm sure it will all be fine, but I'm a worry wart and this apprehension is make me hard to live with. I think my husband wants to kill me.

First year almost over

So, first year of residency is almost over. Someone the other day asked me what I was going to do in July... he thought I was done my two years already. That made me wonder - what am I going to do next July? Things are up in the air with the husband's job and whether he will be able to move to the town where I'm doing my residency. Right now we live about 1.5 hours apart and only see each other on weekends. It's a good thing, because my one bedroom apartment is waaay too small for both of us. We are constantly tripping over each other on weekends and now that we have 5 bikes between us, storage is becoming increasingly difficult. So, if he's making the move here, I think I'll have to make the move into a bigger place... I think a 2 bedroom is ideal for us. A bedroom and a bike room! We also still need to be on a ground floor because taking the bikes up and down stairs is very inconvenient!

Anyway, I know that I want to do OB as a part of my family practice and I know that I want to be in an office with a more experienced doc or a group of more experienced docs to bounce things off of. I have lots of patients in my resident practice who will want to follow me and some I would rather didn't!

I signed up for the LMCCII the other day - SO EXPENSIVE. I never knew it would cost me 1850 dollars. Good thing I got in on time because the late fees are ridiculous as well. If anyone has any tips - I have no idea what to expect.

I'm on holiday. I hate holiday when there's no actual holiday. I'm at home. With a cold.

I was planning on training a lot this week. This cold is really slowing me down. I tried to compete in a race this weekend and had to pull out because I felt like ass. This racing thing isn't going as planned right now. I'm hoping to see some improvement over the next couple of weeks after this pesky cold is gone. It's funny - it feels like everyone else is getting faster and I'm getting slower. How frustrating!

I'd better start reading my big stack of journals so I feel productive. And stop eating chips. Yikes.

What a shit ride!

It was raining, I had the wrong tires on and it was muddy muddy muddy. I slip slided my way around 3 laps of misery. I HATE biking in the rain. I HATE biking in the mud. I HATE when my husband tells me how I should enjoy my back wheel skidding out because it's FUN and why else would I mountain bike. I was just looking for some G-D Sympathy! OK?!?!

And they're back

The palpitations are back. I think it's a mixture of stress, exercising and caffeine consumption. I'm going to go tea free for a while. I always know this is related to stress because not only do I get PVCs but I also get horrible GERD at the same time, making me think I'm having chest pains. The summer ramp up in my training schedule probably doesn't help.

I had an awesome mountain bike ride yesterday with a bunch of guys and girls from our club. The rain fell but we weren't deterred... well, atleast the 5 of us that kept going weren't deterred. We did about 25 km of mountain biking in 2 and 1/2 hours with lots of stops to keep the group together. All in all I think my skills are improving with only one fall on a slippery wooden bridge. I did that Wednesday night race series ride last week and will be heading out there again this week and I'm stoked! There are only 4 of us in the sport women cat but there's one girl who does the o-cup cross country series as well so I think she's really going to motivate me to be more competitive.

And she died...

My first family practice patient to die passed away yesterday. She has been in palliative care for quite some time and I really met her at the end of her life. I wish I could have cured her. I wish I could have made dying even easier, I wish I could have predicted the day she would die so her family could have had more peace. I wish I had the perfect words to say to the husband she leaves behind.

New Things

I'm debating going to a weekly race series in town here. I would be going alone because husband isn't here during the week and I basically wouldn't know anybody. But, it would be an opportunity to meet people and mountain bike during the week instead of only rode riding. Bad news - I wouldn't get any more work done than I am now (um.. zero).

The first race is tomorrow. What to do!?!

ENT

I'm starting ENT on Thursday. Something I admit I know very little about. Anyone got a good ENT resource for primary care?

Ocup 1

The bike computer is found! It was in a box of granola bars we'd taken to the last race. Hoorah!


This weekend was the first o-cup race in Mansfield Ontario. It also marked my first sport category mountain bike race, which would have been much better if a girl hadn't fallen on me right at the start causing me a penalty of about 30 seconds to a minute as she couldn't get up. Anyway, I did ok (6 of 9) for my first one and learned some valuable lessons - I should eat before I start. I should try to drink something at some point on the course (point to be determined for next race). I should hold back a little on the first lap for the second. I should shoot the guy who adjusted my gears after replacing my drive train last week because I dropped my chain several times.

In other news, I spent a lot of the weekend worrying about a patient of mine who has just gone into hospital. She had bad back pain and he has cancer and then later she started having abdo pain and throwing up and I convinced her to go to the ER. When she came to our office with back pain I checked her for compression fractures and there were none and his symptoms seemed mechanical, but our usual pain meds weren't helping. I was lying in bed last night thinking, maybe she has kidney stones. I hope they do a CT on her. I'm not sure why I didn't think stones in the first place - I can't remember the exact character of the pain off the top of my head but she had been seen by two of my colleagues the week earlier and diagnosed with mechanical back pain and the pain started around the time that she was doing some heavy lifting to take care of a sick child. I wonder about diagnosis momentum. This is one of the biggest errors I've noticed in my practice so far. I need to go back to first principles when someone comes to me and they're not getting better. A valuable lesson.

I spent the weekend feeling so good and now I feel so bad. The husband is away in Mexico on a work thing and he's going to be there all week. No phone calls because of the expense and his work won't cover it. Just emails. No snuggles. I miss him.

I lost my bike computer and it sucks. I got all ready to go out on a bike ride today and then couldn't find it and realized how messy our house is. I'm not sure I could find anything in here. So... took off the bike clothes and started cleaning. Still haven't found the computer.

I really need some vacation. I feel really burned out. I have a week off in May and then 2 weeks in June. I'm ready for them now.

Medstudentitis Triumphs over Paris to Ancaster knocking 1 hour and 30 minutes off her time from last year!

big day

Big day tomorrow. Big race - Paris to Ancaster. I did it last year and suffered really badly. This year I'm gonna kick it's ass.

Yesterday I attended a memorial service for everyone who has died in our palliative care and cancer care units over the past year.

One of the staff physicians gave a speech and talked about how patients ask her how she goes to work every day and deals with death and dying over and over. She said something that resonates greatly with me - the greatest burden we carry is yesterday. Very apt for a time in my life when I have many regrets on a daily basis and fears about performing badly and disappointing my patients.

We all carry a bit of the sorrows of the past with us and the memorial service is an opportunity for us also to cleanse our souls clean and move on. It reminds us that people's lives go on after their loved one dies and they leave our doors and ours will too.

One missed diagnosis and BAM, one of my good friends and colleagues is partially blind in one eye.

4 weeks of intermittent one sided headaches that aren't relieved by the usual migraine medication. History of cluster headaches but never with this odd "Vaseline vision" in one eye.

Saw them in the cafeteria - mid fixed and dilated pupil. Took them to emerg to be seen. Expedited their entry but couldn't stay with them because I had clinic. Found out later they'd discharged with meds and a diagnosis of cluster headache.

The doc didn't look at the eye - dismissed it.

2 days later a 6 am. phonecall - "I think I've got acute angle closure glaucoma" - a sleepy drive to emerg. Thank god for a smart medical professional self-diagnosing on google.

We are all relieved when we miss and it makes no difference - but how do we deal with the one we missed that resulted in a bad outcome? I am as guilty as they are - I saw the pupil in the cafeteria and I tested the reactivity and misdiagnosed it myself - all those ophtho lectures in med school didn't sink in. I will never miss a case of this. I will never miss a case of the thing I missed a month ago - but what about all those other things I've never seen?

I'm struggling with the responsibility that comes with my profession.

Today was a horrible day. I made a mistake. I made a big mistake. The mistake was caught right before it was too late. I apologized and they accepted. I still feel like crap.

Easter is a dangerous time. I can fit a lot of mini eggs in my mouth at once.

I was angry because I got my schedule for June (emerg) and I had been scheduled for several shifts during my vacation... which was booked several months ago. Along with the schedule came a note asking if I could change my vacation to suit the emerg department. The Husband and I have spent quite a bit of money on plane tickets, rental car, bike boxes, etc. for this trip and some of those things are non-refundable. The good thing is that my program director is supporting me in still taking the portion of my planned vacation that I'm spending away (I took 2 weeks but I'm only away for a week of it). The bad thing is that without the emerg shifts during that week, I might not have enough shifts to complete my rotation. Fortunately, my program director is going to help me navigate this tricky situation.

So, more to come on this at a later date.

I shouldn't blog when I'm angry
I shouldn't blog when I'm angry
I shouldn't blog when I'm angry

back outside

Ah... this "false spring" that we're having is amazing! 2 days in a row of outdoor riding and saying a (if only temporary) goodbye to the rollers and staring at the wall. I even bumped up my average a little from yesterday to today. Plus! I found a type of bike food that I like!

I tried the cliff shot blocks and hated them (too salty and they hurt my teeth and they were too big for my mouth) and then I hit the holy grail - Gu Chomps! Cranberry apple flavour - very good. I'm still holding out to try the jelly belly sport beans (they were out when I went and bought my variety of things to try) and Luna chews. I'm definitely not into the gels and tablets. yucky texture.

I'm on ortho/rheumatology now and I really have very little to say about it. It's fine but I'm not sure I"ll miss it when I'm done. The people are super nice so that's a bonus.

YAY!!! CANADA BEATS THE USA!!!!

Figure skating controversy

Watching Elvis Stojko today on TV makes me laugh. If he was competing in today's system he would have never won because he can only jump and can't skate in between. He doesn't understand that pushing the envelope can include more difficult footwork and spins and doing your jumps in the second half because it's mentally more tiring and you risk falling on non-jump elements. One jump doesn't make a sport. It's just like any other sport - a perfect 960 can beat a scrappy 1140 that loses you all your speed.

Overall Plushenko's jumps weren't great, he wasn't in a good position in the air, his toes basically came through his skates to save a few. He stood around and posed on the ice in the last minute of the program and didn't do any jumps at the end of the program. His choreography sucked and he hardly moved on the ice at all during his footwork. The quad alone doesn't win the olympics.

There are some things you just can't look up. There are some scenarios that just aren't in "up to date" or your pediatrics textbook.

I had a friend call me today about a case and she was afraid to talk to the consultant in the hospital because they are slightly disgruntled that we are taking care of our own newborns. Hmmm... what to do? Especially if our direct family practice supervisor is away for the day. Conflict doesn't bode well for patient care.

I have olympic fever. Or, more accurately, olympic tears, joy and bliss. I have already cried on the highway, honked my horn like a maniac on the highway and stayed up WAAAAY too late watching olympics on tv.

My childhood friend Mercedes is competing in half-pipe today and I have my fingers crossed 10 or 12 times. GO CANADA!!!

Fix

Will someone please let me know if they fix google reader so you can read password protected sites?

phew

One of the physios at the arthritis program today me yesterday that it took her two years to really be confident about her examination and findings. Good thing because I am not confident in my joint count AT ALL at this stage. Oh well. The rheumatologist will check all my findings but I just find this skill elusive.

Today I have to go sit in a lecture theater and hear all about practice management. Good thing I'm already sleepy. Should be easy to snooze through it.

The battle to keep motivated

Sometimes keeping motivated is a real battle. I can just sit here and be fine with the dishes piling up and the laundry not being done and not reading journals or reading around my cases. Sometimes that feels just fine - until I wake up in a mess with no clean clothes and no dishes. Or even worse, my husband comes to visit on the weekend and feels like he's been made to be my maid and clean up after me and we argue. I need to get back on the wagon. I need to train more. I need to pull my socks up and get out of this hole.

It's funny that when you've bottled up or pushed down a lot of emotions they come out in weird and wonderful ways. For me I think all of the emotions of palliative care hit me yesterday while driving to work and hearing that Andy Barrie is stepping down from his broadcasting booth on CBC. As most listeners know, Andy has parkinsons disease and is finding the early mornings harder and harder on his day to day living. My brother hates Andy Barrie (mostly because he has a long standing habit of throat clearing even from his pre-parkinsons days) but I love him. I find him funny and relaxed and pretty amazing to keep working at 5 a.m. despite his disease. Cheers to you Andy Barrie.

I forgot how good Guns n' Roses are... damn. Best 12 bucks I ever spent on itunes.

This week is my last week in palliative care. My only home palliative care patient sadly went to hospice today and has taken a real turn for the worse. Hopefully she'll still be there when I visit the residential hospice on Thursday. I'm not sure that I'm ever going to be a "palliative care physician" but I certainly learned more about looking after my own patients in the community until end of life.

Next up is MSK - a mixture of fracture clinic, hand clinic, arthritis program, rheumatology and OR time in ortho. I'm not really looking forward to 2 months of that! Here's wishing I didn't just request all my remaining vacation in June!

I can't say it with strong enough words to convey how I feel - I am surprised, outraged and very saddened by the news that the little medic has been diagnosed with testicular cancer. What a bomb dropped into the middle of his and Miss Bliss's lives. He is getting married shortly after I have, he started his first job at a similar time. I feel like we're in the same stage of life and yet he is facing this gigantic beast. I am so thankful for my health.

paged when not on call

Getting paged when you're not on call sucks. It makes you worry about your patients when you aren't supposed to be the one managing them and it makes you conflicted about whether to manage the problem or not because you're already on the phone. Especially when it's your patient and the on-call doctor doesn't really know them.

So... I dealt with the problem and then shut off my pager. Lesson learned, shut off the pager when you leave work!

I'm not sure how people do this palliative care thing all day every day. I can't give any more of myself or there will be nothing left. I haven't cried yet. I think it's coming.