swab negative vaginal discharge is the new bane of my existence.

Compassion fatigue

While I'm reading notes and consult letters, I have compassion fatigue. When I am driving to the office, I have compassion fatigue, while I'm processing labs I have compassion fatigue and especially when I'm doing lawyers letters and forms for patients, I have compassion fatigue. But, when I step in that door and actually have the patient encounter? I don't have compassion fatigue. It melts away. But, unfortunately that feeling doesn't last all day. When I get home I'm exhausted and want to go to bed at 6:00. I force myself to exercise and do the things I should do, but the days I really love are my 1/2 days. Makes me think I should just work 5 half days per week :)

In other news, Ben and I went to see Sky Fall last night and given that I'm not a big Bond lover, I actually quite enjoyed it. If you haven't see it, and you want to see it, stop reading now. Spoiler alert...

I was really a bit freaked out by the guy who'd had half of his skeletal structure of his face eaten away by hydrogen cyanide. Imagine being in a torture chamber and finally giving in and poisoning yourself only to find it didn't work and you were maimed and disfigured forever? I can kinda see why he wanted revenge. The whole movie also brought up a lot of "deep thoughts" for me about who exactly is the villain? I mean, the British secret service has sacrificed many people (?hundreds) for the "good of the empire" - granted, if they were spies they probably agreed to die for the good of the empire, but can anyone actually consent to that in advance? to being sold out by their country and tortured/killed? And, for what? I'm not sure. It was interesting all in all.

I went to a conference on Friday/Saturday of this week, which is probably why I feel fatigued because it necessitated me working full days mon-thurs to have Friday off and today (Sunday) is the only day to recuperate and we were out late last night seeing the movie. I went out for a long bike ride today but unfortunately, it was torture rather than pleasure.

THE SHEEPDOG’S PRAYER

The Knights of Olde were Men of Honor
Who used their Might For Right!
Today they’re known as Sheepdogs
Those who carry on the fight.

I am a tired old Sheepdog,
The guardian of my flock.
I keep the predators at bay
And stand watch around the clock.

Please stop the Sheep from pulling my teeth. 
I’ll need them for the fight,
When the hungry Wolves come calling
Some dark and deadly night.

I pray I never need my gun
But someday if I do,
May my cause be just!
My draw be quick!
And my aim be ever true!

Heaven holds a special place
For those who do the deed,
Defenders of the innocent
In their hour of need.

May the Sheep someday be grateful. 
There’s a debt they cannot pay,
To the Sheepdogs who lay it on the line
Each and every day.

I am proud to be a Sheepdog.
I’ve done my very best.
I’ll stand my watch until my Maker
Calls me home to rest.

But when I meet Saint Peter,
There’s just one request I’ll make:
“Please let me spend Eternity
Standing guard at Heaven’s Gate.”

A patient who needs to see a respirologist has refused to go back to the respirologist because he waited 45 minutes at the hospital for his PFTs then left without actually having said PFTs. In my head I was thinking "45 minutes aint that bad". He kept telling me about all the people who were going in before him blah blah blah. I was surprised at how little sympathy I felt. Sometimes things don't go according to plan. Sometimes you just gotta wait. Then this guy tells me that he's found ways to deal with his anger and he thinks he can go off his medication... hmmm I don't think so.

The thing about having all 10 minute appointments is that when someone comes in and says they're going to kill themselves - suddenly I'm 20 minutes behind before I even talk to them. Plus, when the nurse is in the room talking to the patient and weighing them etc. at 9 o'clock, I actually don't even get into the room until 9:10. Bam, I'm behind schedule. I've given up on being on time. I'm trying to keep my lateness to less than 20 minutes now. That is pathetic.

So, I know I've been a bad poster. Very bad.

I came home from California and got sick on the plane and then spent a week with the flu while trying to get ready to start my new locum.

Started my new locum to come in to the surprise that the physician I'm covering for sees a patient very 10 minutes... including physicals and well baby visits. To me, that's unacceptable. I see a patient every 15 minutes, physicals for 20 and well babies for 20 in my own office. I have asked them to change this for me and they said "sure"! but as of yet I'm maybe getting 50/50 compliance on that. I feel run off my feet, strung out, and like a bad doctor. I'm also in a bit of a slump and my exercise level has tanked along with my mood and body image. My gym sent out emails that it's going to close so now I need to find the time to look at new gyms. I'm having palpitations. again. This only happens when I'm stressed out.

pictures and trip report to follow

I got sick on the plane home. I think I got first month of school sickness once removed. When I don't feel like death warmed over I'll post about the trip to California and how things went with my MIL.

California here I come!

I'm off to California tomorrow with my husband and mother in law for a hiking trip for her 60th birthday. Hopefully just because it's her birthday trip won't mean that she wants to dictate everything that we do because there is a bit of shopping I'd like to do and of course I need to hang off the outside of the trollly in San Fran and sing this song. I know it's about St. Louis but it's the only trolly song I know!

MIL

I'm not sure why my mother in law visiting stresses me out so much, but here I am, a ball of stress. I'm wondering, will she notice that crack between the cooker and the counter that no broom can fit into and is full of crumbs? Probably. Will she say something? I hope not. Her room has been lovingly prepared and we are taking her to California for her 60th birthday. Our kitchen island is half put together and the kitchen's a bit of a state with boxes full of kitchen island parts but hopefully she won't mind. Our back and front yards have no grass because the drought killed them so now they are covered in compost and fledgling grass seed and look a bit like the mosh pit of an outdoor festival. Nothing seems to be "done". Hopefully she'll be satisfied with a room to sleep in and food in her tummy. That reminds me, I need to buy food. And wine for myself. How come I feel so chaotic!!!

I'm back

Well, that was certainly an adventure. My first ER shifts alone went ok. Nobody died. Nobody was seriously injured by what I did or didn't do (as far as I know). I put on a cast that the patient later disrespected by removing himself with soaking and scissors, I did more slit lamp exams than ever before, I shipped someone out who had a stroke. All new experiences, all personal growth.

I didn't ride my bike enough and so the provincial championships tomorrow are going to be very interesting. I'm glad to be home though!

Rural Medicine

Man, Rural medicine is hard. Being on your own in the emerg in a rural center with xray and lab but nothing else is hard. Thankfully the place where I am has been very supportive and there is a lot of backup and I came with a fantastic friend, but I'm still worn out and I still have 9 hours of this ER shift left, another 24 hour ER shift left to go and another 1.5 days of clinic. On my call days I'm in a constant state of hypervigilence. My bowels have never worked so well. As a good friend said to me the other day - Sheer terror, the original pro-kinetic.

olympic fever!

I'm obsessed with the olympics. I'm glad that my 3 day work week period coincided with the olympics because I can't get enough! The women's time trial is happening right now and the Canadian Clara Hughes went through the first time check in 3rd place and I'm almost peeing my pants in excitement... I will probably cry if she gets a medal. I'm not sure what it is about the Olympics that makes it appeal so much more to me than watching rowing or judo or weight lifting in a normal event. I would love to go to the olympics one day. I think that would be amazing to just soak up the atmosphere!

I hate physicals

I hate physicals. I always find there is way too much health teaching to do that if the person has even one thing THEY want to talk about, I'm in there for 35 minutes and my schedule is behind. Maybe I'm too much of a talker or want to tell people too much but even to hit the salient points and get in the important stuff... it takes a long time! I help people calculate their calcium, figure out if they should be on ASA, find out if they've had their FOBT, BMD, mammogram, pap test, cholesterol, blood sugar, wear sunscreen, wear a seatbelt, are looking forward to target coming to Canada... lots of stuff! Then, someone busts out that they have chestpain and it really falls off the rails! I feel like efficiency comes from cutting out some of the things that I think are important and I don't want to do that. puts me between a rock and a hard place.

In other news, I'm working in a locum right now that's only 6 weeks long and because of that, lots of the patients are waiting for their own doctor to come back.. and I only see about 9 patients per day. How relaxing!

Our garden

Our garden is absolutely taking over our yard... and trying to make a break for the neighbour's yard. I wish I knew more about cutting things back without compromising their fruiting or even to enhance fruiting. My tomatoes are looking a bit wild. Also, we don't eat enough lettuce to support 5 lettuces... note to self. The neighbours are getting a lot of free produce though!

Wow. how often do you get the opportunity to deliver two sisters' babies about 5 minutes apart across the hall from each other?!? crazy night!

For some reason today I felt the need to research the role that Mennonites played in the holocaust. For some reason, I assumed that they would have been victims. This article tells a very different story.

I'm feeling really burned out this week. I almost lost my mind today when all my patients showed up late and then asked me to see them and their spouse and their kids all in a 10 minute appointment. I'm sure the nurses were tired of hearing my bitching. Good thing there is no race next weekend because it's been 5 weekends in a row of racing now and I'm pooped mentally and physically. Not that I don't have to do 3 hour rides over the weekend for training...

I had to tell someone today that they had a brain tumour and someone yesterday that they probably had breast cancer. What's going to be the third thing?

No good very bad day

Yesterday I was participating in an 8 hour mountain bike race. I was aiming to do 11 laps (improving on my 10 laps from last race last September). After lap 1 my back started to hurt. By lap 6 it was so excruciating that I had to get off my bike twice during the lap to stretch. I had to stop. I felt really bad about stopping. In biking a lot of people talk about suffering through pain and keeping pushing through as being the ultimate in a good racer and touch rider. I can push through lots of types of pain, but these back spasms were just crippling. I have another race next weekend and need to be back at my best and shake this off. I've had two disappointing races in a row over the last two weeks. How do you refocus from failure?

Happy birthday to my wonderful beautiful husband!

Doctors are truly the worst patients. I got to work today and was feeling a bit dizzy... checked my BP in curiosity and it was 74/56. oops! Guess I'm a bit dry!

I had to take two days off this week because of having gastro. Hopefully I'll be able to go back tomorrow. Sometimes I wish I had an office job where me leaving for a few days isn't as difficult. I feel guilty leaving them in the lurch, but I couldn't get off the toilet long enough to even drive to work today.

Just in Time

Just when I never thought I'd have a really good belly laugh again, one of my first year medical students tried to take someone's oral temperature with an ear thermometer... I couldn't help but guffaw.

Residents beware, your first year in practice is exhausting. I barely feel like I have time to catch my breath and I have a half day off per week.

I just found out that another kid I went to high school with is dead of cancer. Osteosarcoma. I haven't seen him since high school and recently found his blog where he talks about being an anesthesia resident and going through treatment for his cancer. I think he turned out to be a much better person than I thought he was in high school. Maybe he was always a better person than I gave him credit for.

The worst moment of any mountain bike race is when you see a huddle of people at the side of the road and someone you know calls out to you to stop because they know you're a doctor. Thankfully, this time it was my husband who ran out to me, so at least I knew that he was ok. Also, fortunately, my team mate was awake and alert despite going over the bars in a big crash and smashing his head into concrete. His helmet certainly saved his white matter. As people whizzed by, another teammate stopped who was a nurse and another guy stopped who is a ski patrol medic. Ben went and got our friend who is a paramedic who was at the start area. We had a great team. The volunteer fire fighter couldn't figure out how to use the oxygen tank... in retrospect, it's funny that the ski patroller had to show him how to fill the non-rebreather.

In the end, all were fine, but I only got to ride the first 1.1 km of a 60km race. But, it probably saved my ass, because I was riding despite being sick and now I feel awful. It drove home how important it is to review basic first aid if you're a doctor - no matter if you're a pathologist or a gynecologist, people trust you to know what you're doing.

I'm currently in a bit of a rut so please don't take my lack of posting to heart. I'm 3 months into a 6 month locum and feeling a bit of the 3 month itch. I'm already looking forward to my next placement... in July. Don't ask me why - the people at the practice are wonderful and the patients are like patients anywhere, but I just feel the need to move on. Maybe it's because in residency I was never anywhere for more than 3 months at a time. That must be it. I also came back from my vacation never wanting to work again. Could someone finance my vagabond biking lifestyle please? Over 400 kms ridden in 1 week with some ridiculous number of feet of elevation and I was in heaven. Work was a bit of a come-down. At least Ben and I hung up some pictures in our house today and got the basement cleaned up... I mean we've only lived here for 3 months!

I have one more week to remember how to ride a bike outside before going away to South Carolina with my hubby and teammates for an adventurous and exhausting week of bike riding in the rolling hills and mountains of north and south Carolina. Let's hope I survive. I see a lot of naps in my future. I think this is one of those vacations that I need a vacation to recover from!

In other news, tonight is the worst night of the year - we lose an hour of sleep. Too bad I have an activity planned for tomorrow and can't sleep in :(

mistakes

People don't talk about making mistakes in our offices. So, we go home and they fester in our bellies. We try to reach out to a colleague only to have them tell us not to take on too much responsibility lest the patient interpret that as guilt and sue us. There is a good TedX presentation on this from Dr. Brian Goldman. I still haven't found someone to tell about my mistakes that understands. Maybe I should email Brian.

http://www.ted.com/talks/brian_goldman_doctors_make_mistakes_can_we_talk_about_that.html

bought some pants today at the gap outlet. When I showed my husband he actually said the words "hallelujah no more MC hammer pants". I guess I didn't realize how baggy my work trousers were getting.

teaching

In two weeks I start teaching medical students clinical skills. I went to a meeting last week about the curriculum etc. I realized that this school does not have a clinical skills manual like we did when I was in med school and the expectations of the modules is not set out for the students. I find this very odd. The modules are based on clinical problems rather than body systems - i.e. heart failure, dehydration, kidney stone. I find this odd as many clinical problems have examination overlap. Relating the examination to a clinical problem is great, but one has to have the basics down. Pairing the renal and bladder examination (part of the abdominal exam) with the peripheral vascular exam and the "fluid status examination" of the JVP - which should be part of the cardiac exam, seems very odd to me. Hopefully I'll have my head wrapped around how to do this logically in the next week or so.

snap out of it

This week I became too cynical and the patients are starting to notice. For some reason, I walked in to appointments thinking that people were always going to ask me for something I didn't want to give them. Or that there was going to be a confrontation. Or that I wasn't going to know what to do. It made me a worse doctor. I need to consciously get back to giving people the benefit of the doubt. I think a lot of it revolves around the patient population. Lots of people with narcotic problems, lots of people who've been given narcotics by the doctor who I'm filling in for that I wouldn't have necessarily given narcotics to, lots of chronic pain that I feel helpless to treat. I think narcotics are one of the things I feel most uncomfortable about and thus I end up leaving people unsatisfied. I give people other things for pain, of course, but often what they're looking for and what I'm giving are different. Unfortunately, this makes it very difficult to have a trusting and pleasant relationship. I need to check my head next week.

I had one of those cold sweat mornings where you wake up worried about a patient and wondering if they're ok. On the intellectual side, I'm 90% sure of my diagnosis and that I did the right thing, on the emotional side, I am worried. Sometimes being a doctor sucks.

I know I should say that my first day was great and that it was so much fun and I loved it, but it was completely and utterly exhausting, mind numbing and scary. I only had to see 15 patients because they're going easy on me for the first little while, and at times I was twiddling my thumbs, but at times I had real head scratchers. And, at times, I was just at a loss. Apparently I'm bad at chronic msk pain. I already knew I was bad at that, but I feel like I'm failing at it. I guess there's some reading to do.

tomorrow I become an attending physician. eek. Wish me luck.

Ok, I found curtains that I like but Ben doesn't like them. How long will I leave them up pinned to the door frame before he groooows to like them?

In other news, I love these:

Both sets of curtains have been rejected. Back to the drawing board. Just as a note - those are website pictures, our walls are actually a taupe/mushroom colour!

Who knew that buying a house didn't end with buying a house... it involves toothbrush holders and toilet brushes and laundry hampers and blinds and curtains and mini garbage bins for the loo and kitchen islands and dining tables and .... lots of stuff. Stuff that involves going to 20 different shops because you can't find the right one!!!!! Our apartment seemed full. Our house seems empty and somewhat pathetic :)

Right now I'm trying to decide on curtains that both Ben and I will like. He's not available to go to the shop so I keep bringing them home and hanging them up for him to veto... we're on curtains number 4 and 5, let's keep our fingers crossed! What I have realized is that I'm going to have to sew blackout material on the back of these fashion curtains because they're much more sheer then they look in the shop! Even the ones that are lined! (oh, and while I"m on that, why line a dark brown curtain in white fabric, it totally discolours the curtain when the light shines through it, making it look purple). I think they'll look better at night. Now hanging:


opinions?!?

Happy New Year everyone! As usual, I didn't actually see the new year come in as I was in bed at 10 o'clock. However, I did drink to the Scottish new year (7pm EST) and we had our new year's Haggis, Neeps and Tatties.

I have one more week off before starting REAL work. I'm scared and unsure of how things will go. I hope well. There are a few key study points for this week to get me ready... most namely the new Ontario immunization schedule, which came out while I was doing my fellowship and is a bit of a pain to remember the ins and outs of. Need to read up on rotateq. Also need to complete getting my OB privileges at the hospital. Today, though, is new year's day and a day of rest! May the new year bring you happiness, health, and reduced work hours :)