note to self

stop reading ratemds.com

I'm back!

Back from Italy, ate too many carbs, drank too much wine, had an amazing time. Feeling a bit jetlagged :) zzzz. Went in to the office today on my usual day off to work through all the messages. Found out that the person's license I took away before I left (she screamed at me for 5 minutes over the phone) came in and had a MOCA score of 1/30... for those non-medical types, that's really not good. I was dreading seeing this patient and am really glad she was seen when I was away by our superstar N.P.

 One of our partners quit today so we'll be looking for fresh blood. Can't say I didn't see it coming.

All of my OB patients who acted up the week before I left started behaving themselves as soon as I was out of the country! score!

All in all, this 2 weeks off was a success. I'm still looking forward to going to the St. Paul's family med conference in Vancouver next month - another week off!

dreading the backlash

This week I took an extra day off in order to spend a long weekend biking in Allegheny park in NY/PA. I took ONE DAY and came home to 40 messages in my EMR inbox and a backlog of crap to deal with. My stress level shot up to 13/10. Maybe even 20/10. I felt like I never left. I hope my 2 week vacation doesn't end up this way.

vacation rocks but getting ready for vacation sucks

I hate getting ready for vacation because it means:
1) doing more call in preparation for vacation so you can get the time off
2) making extensive handover notes on all OB patients just in case they crash and burn while I'm away
3) stressing about packing
4) worrying about crashing in a ball of fire and dying on the flight over
5) worrying that I'm going to forget something when packing

If your stomach has become noisier in the last 2 months and you are worried, fear not, I will do nothing about it when you come to see me. Staying home would probably be a better thing to do.

my body is rebelling

Over the past week my GI system has started seriously rebelling - painful gas one day, GERD, diarrhea. Each on their very own day and not at all related to what I have eaten (I think). I don't feel particularly stressed but I have started forgetting things and putting the milk in the cupboard, so maybe I'm just ignoring my stress better...

I do not have to work for 4 whole days. Amazeballs!

the slooooow crack

Our manager we hired has officially turned down the job after an informal acceptance. I almost cried. I have never really been speechless before... I was speechless. I went to bat for this woman and basically convinced quite a few of my colleagues to go for her and she let me down. I probably feel more gutted than I should, but I was really looking forward to finishing up with my "extra duties". I'm sick of this.

Thankfully, I haven't been sued yet.

I brought a proposal today to our physicians at our board of directors. The proposed plan would have simplified patient's lives and improved patient care and leveraged our already available services from allied health professionals. Why was it rejected? Money. Even though the numbers show that the majority of physicians would not lose any money. Normally I wouldn't take something like this so personally but today I was totally pissed off. Well, live and learn, try to do something good and you get shot down. Maybe I should just stop trying.

Manager Hired!

We finally hired a new manager. Hopefully this one will stick. She seems to have all of the great relevant skills and is very nice. Now to vomit all the things I have learned out of my brain and into hers! I am very excited to get these extra tasks off my plate.

I have been waking up in the middle of the night a lot lately, anxieties, fears, almost like going back to my first month in practice when I worried about everything and anything. I feel like I'm back in that headspace, like someone is suddenly going to figure out that I'm an imposter and I'm not worthy. Someone is going to find me out and sue me and my life will never be the same. I don't know if anyone else feels this way, but I do.

In other news, we are building a deck. Ben and I aren't very good at cooperating on things like this but thankfully there haven't been too many disagreements - just a few bickering sessions! The deck beams and joists are almost done, we're just waiting for some cement to dry and then we can start putting on the deck boards! I'm stoked to hang out and have a drink on the deck when we're done.

change... again

Our office seems to be in a constant state of flux. Managers retiring, new manager starting, managers sucking, managers leaving, interviewing new managers etc. etc. etc. In the absence of a manager the MDs have had to pick up the slack and act as an office manager. I must often have a look of panic on my face because my colleagues have told me I need some time off. I dream about full sharps boxes and paper shredding boxes and needing to discipline employees. I just was not trained for this and never wanted to do anything like this. Management is just not something I get any pleasure from. I also don't like change. Too much going on all at once.

Plus, I have a patient who came in to get copies of his xrays of an injury to "take to a lawyer" and now I wake up in a cold sweat afraid that I'm getting sued. I'm just waiting to be served papers. Ugh. I know I didn't do anything wrong, but that doesn't mean you don't get sued in this business...

Wendy Davis

I hope that you all, like me, are standing in support of Wendy Davis. She is standing for 12 hours in the Texas State Senate to filibuster the anti-abortion bill. You can watch her live here:
http://www.youtube.com/watch?feature=player_embedded&v=2Q8Hr0O20LY

good karma

I must have done something right because the day after my wonderful natural childbirth experience, I had another great delivery! Someone's smiling on me.

fibromyalgia

How many times in a day can you argue with patients about not increasing narcotics for a syndrome that narcotics are not indicated for and haven't actually helped this patient very much given that their pain scores haven't changed with the last increase? I think pain management in general but specifically fibromyalgia management is one of the most frustrating parts of my day. I feel like neither of us leave satisfied from that encounter ever.

Ouch and Yay

Not every birth is beautiful. Most are, but some are hair raising and anxiety provoking and it takes a while to see the beauty. Then, there are some births that are just amazing right from the start. Today I saw one of those. Natural, 2 cm to fully dilated in 45 minutes, 3 pushes, healthy baby. Extraordinarily, it was a 39 year old mother who had been told that she had a very high chance of her baby having Down's Syndrome or another genetic anomaly and who had spent the last 2 weeks coming into my office telling me that she had a bad feeling about this pregnancy and that the baby wanted to come out. It all turned out wonderfully in the end. Phew.

Now on to the ouch. After my race I discovered that the little finger and half of the ring finger of my right hand are numb. It's called a handlebar palsy and is quite common for cyclists. Unfortunately, it hasn't improved much over the past week and it's very uncomfortable to do thinks like wash my hair because something about the texture of hair on my numb fingers is very painful. I really hope this gets better soon because I feel I can't ride my bike until it has resolved to avoid further injury. It's a bummer. I really don't enjoy running this much!

The Real Test

This weekend I went to Lake Placid/Wilmington NY and participated in the Wilmington 100 mountain bike race. It was the most amazing race experience I've ever had. It wasn't because of the race itself, it was because of the people. I think I almost cried 3 or 4 times due to the inspirational speeches that were made at the pre-race meeting. I had the amazing privilege to ride and chat with Rebecca Rusch ( my new girl crush - she's kicking ass and taking names in her 40s setting endurance records and she is SO genuine and nice it's unbelievable) at the pre-ride.

The founder of Leadville, Kennith Chlouber and his wife were there and he gave a similar speech with her to this: http://www.youtube.com/watch?v=I9N_YT-kIaI . I remembered it during the entire race and it pushed me to go further than I thought I could, faster than I thought I could, and push through the killer leg cramps that were so bad I could hardly get back on my bike after pushing it up a loose climb, but I did. I was better than I thought was. I did more than I thought I could. The high of finishing 1 minute under my 6 hour and 30 minute goal was great. I only hope to get faster next year (and maybe train a bit more for endurance - I think 2 endurance rides probably weren't enough). 

The other inspiring thing was the number of amputees there were who raced hard and fast. It was awesome and amazing.

110 km and 7,641 feet of climbing. I wasn't first. I wasn't last but I did it. 

is it working?

Who knows if this physio stuff is working. 4 weeks until my 100km off road/on road race and 4 hour ride today. verdict was: my back hurt. Is it any better? Probably not. Am I going to do 4h of singletrack on race day? no. I think there's probably 2 km of singletrack in the whole race. I need to start just road biking on my mtb.

Most annoying

I tried not to tell the physiotherapist that I was a doctor because often that colours your interactions with other healthcare professionals and not always in a positive way. Unfortunately, I had to put my occupation on the survey. This lead to the very annoying question of "what do you think is going on"? if I knew what was wrong, I would have fixed it myself! Of course, when I told him, he agreed. Hrm.

Doctors are the worst patients

Why is it that I can't seem to take my own advice? I've been suffering through horrible back pain every time I ride my bike for about a year now. I remember that last year's 8 hour race turned into a 4 hour because my back hurt so much. Fast forward, this year's 8 hour is in a week, today's 3 hour ride had to be cut short at 2 hours because of... wait for it... cripple back pain! I really should have gone to a physiotherapist (which is what I would have told my patients) a year ago. Why didn't I go? I'm cheap. I have no coverage and physio is expensive. Yes, I can afford it but would prefer if the pain just went away on its own, but it hasn't, so tomorrow I'm calling for a physiotherapy assessment. A year of pain is enough I think! Hopefully I can get one organized pretty quickly and have it during my day off so I don't have to take any time away from work and cause patient and receptionist anger.

misnomer - Ben asked me today what a pariah is. I said a predatory fish :) I think that's a piranha.

I got drunk tonight instead of exercising. I'm a bad person.

What broke me?

I was actually doing really well in independent practice and what has broken me and continues to break down my self confidence little by little is hospital patient care. My family medicine group does "hospital rounds" where basically one of the 7 of us looks after the practice's hospitalized patients each week. I hate it. I have been on hospital rounds for the last 3 weeks. 2 weeks of "mentored" time and this week on my own. I find it so stressful I really want to quit my job to not have to go back. Seriously. The worst thing is getting the 7-8am phonecall that someone has been admitted to your service. Now you have to go in and try to see all the patients PLUS do an admission in the 3-4 hours you have before having to go back to the office to see afternoon patients. Today my admission was a shit show. Not what was handed over, way more complex, a story that didn't add up, way outside my scope. I spent all day struggling with this patient and finally asked for an internal medicine consult from the run of his feet internist because it all just didn't add up. HOpefully he sees him this evening in the midst of his 100 other things he had to do. I am not an internist. I wasn't trained to be one. My internal medicine rotations were mostly spent trying to discharge patient who were admitted for failure to cope. I'm not sure how much I actually learned. I hate this.

Not waving but drowning.

I may look like I'm waiving very enthusiastically at you all while I'm swimming in the sea of independent practice but I'm actually drowning and trying as hard as I can to keep my head above the water. I am burned out, tired, have compassion fatigue, feel lost, feel like I am/should still be a resident, feel overwhelmed, feel like I'm the first person and the last person to ever feel like this. I am neglecting my family, my friends, my exercise, my race training, my sanity. I'm regretting becoming a doctor. Working at anything else seems so much more appealing right now.

Excuse my tantrum. I'm going to bed now.

Nobody heard him, the dead man,
But still he lay moaning:
I was much further out than you thought
And not waving but drowning.

Poor chap, he always loved larking
And now he's dead
It must have been too cold for him his heart gave way,
They said.

Oh, no no no, it was too cold always
(Still the dead one lay moaning)
I was much too far out all my life
And not waving but drowning. 

Stevie Smith

Everyone is Pregnant

Lots of people I went to med school with or residency or know professionally from my year are pregnant. Lots. And, I am very happy for them. But, it makes me wonder - will I ever feel that biological drive to have a child? to be honest, I really like my life how it is. I like that I don't have to go drop kids off at daycare and that I can go for a long bike ride on a weekend with Ben without worrying about babysitters. I like that my house is neat and tidy some of the time and that we have no toys other than Ben's Lego. I hold a lot of babies and they're cute and all but I never get sad that I get to given them back. But, I worry that our life won't feel complete or full. I worry that we'll regret it down the road, especially when we're old and lonely. I'm not sure that just the two of us is enough to make a whole life, I mean, aren't we eventually going to get bored of each other?

I'm confused.

Medical Bullying

During this 3 weeks of OB call and 9 deliveries, I had to call for 2 OB consults. Both times the same person was on call. Both times this individual belittled me, bullied me and once even tried to refuse to see my consult. Why? Because he didn't want to get up in the night to see a patient. No interest in what's best for the patient or her baby, but pure self interest. Both times he told me my care of the patient was unacceptable. Both times he stormed in and hardly assessed the patient before saying she needed to go to section. One time he was right and one time he was wrong and she went on to deliver vaginally. I will never work at this hospital in obstetrics again. Never. I feel so horrible about both situations that I just can't face ever having to work with this individual again. The nurses and midwives tell me that he does this to everyone. I think that is totally unacceptable. He also didn't round on my patient post-section at all and had the nurses call me to come in and write her a prescription for her discharge medications even though I was at home and he was in the hospital. What an ass.

On Call all the time...

I am entering my second week of 24/7 call for my colleague who is away's large OB practice. There are 9 patients due while he is away for 3 weeks. I average 3-4 per month, so 9 is a lot! I have a few things to say about being on call all the time - even if you don't have to go in, it affects your sleep, your exercise, your relationships, your life. It makes you preoccupied all the time and question every walk, where you go/if you go out for dinner, every sip of wine. I don't know how he does it. The guy I'm covering for has a very different situation from mine and due to home circumstances doesn't go out much. He is always available. He does almost all of the c-sections assists at this hospital and he only works 4 afternoons in clinic a week. Contrast this with my life - training for cycling season, like to go out with my hubby, working 5 days a week in clinic. I'm not sure 9 deliveries will ever be for me unless I have more flexibility like he does. This famly day I had a delivery that took way longer than it should have with a baby that kept flip flopping from transverse to vertex after her water broke and a bleeding 24 weeker barely viable with a placenta previa on one u/s and a placenta 2.5cm from the os on another u/s. I have a full day of office today. I'm exhausted. I can expect at least 2-3 more deliveries this week. Hopefully I don't have to do any inductions for post-dates.

pros and cons of family medicine

I think that if I write this post right now as a reader asked me to, it might come out sounding bitter because I've worked too much this week for seemingly no pay (being a locum, I only get paid for hours seeing patients and the physician who the patients are rostered to gets paid directly from the government... ). Excuse me while I go take a nap. Except that I'm on call for OB so might get called in.

life as a locum...

Sometimes during life as a locum very awkward things happen. For example, you walk into an exam room and there is a patient there for a pap test who you went to university with... You're not sure if she remembers you. You have to then examine her intimately. AWKWARD. So you say "oh hi" at the beginning and then go about the physical choosing not to mention who you are because she of course knows your name (I'm Doctor ***) but does she recognize you? Sometimes it's better to meet patients with their pants on so these moments can be avoided. But then the whole changing interval ruins your schedule's flow. This is the life of a locum...

cleaner day 1

I'm impressed by how much cleaning I did for the cleaner... Before they got here I tidied within an inch of my life to prevent them thinking we're slobs. I didn't clean anything but wanted them to have a clear path to clean. For a first time, it wasn't bad. A few things they missed that will drive me crazy and I'll be sure to mention (leaving our garage light on for one and not sweeping under our bathroom scale or cleaning the scale, not cleaning the inside of the microwave) but the woman was nice and I'm happy to support her two woman business. Next clean, two weeks. The only thing I found odd was giving a key to my house to a total stranger...

yay!

Today Ben finally gave up and told me we could get a cleaning lady. I will have to decide on weekly vs. q2weeks. We're pretty messy but I'm not sure we need weekly. I'm looking forward to not having to clean the bathroom.

I don't want every post on this blog to be about my angst of being a new doctor but it's what I'm going through. All the time. I re-live cases in my head as if they were OSCE stations and realize that in the moment I screwed up, I didn't think of this or that, and that sometimes you don't get second chances. Sometimes you do, and most of the time things work out ok anyway, but someday these things are going to come and bite me in the ass. Some day I will accidentally do harm. It makes me sad/angry/depressed/anxious.

my biological clock just ticked... for 30 seconds

Tonight we went out with friends who have just had a new baby. I think that as I held her my biological clock may have started ticking for about 30 seconds. Then she started to fuss and cry and it stopped. Thanks goodness!

On my Christmas Vacation I....

carried the Yule Log down off the hill

saw a Pheasant close-up for the first time

watched Ben stick his hands under the skin of a turkey... it was gross

went to visit the smallest distillery in Scotland - Edradour

Played on the beach in Balmeadie

went for a big walk in Pitlochery

and had lots of fun!