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!

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!