It's been just over a year since we got our lovely pupp Nessa. She can be a right pain in the ass but has also brought smiles, laughter and variety to our lives. I'm glad every day that we rescued her and wish that our home was big enough to rescue all the poor dogs we see on facebook. Maybe next year Nessa will get a sibling!
One thing I don't talk about here is my competitive cycling. I have been racing cross country for 5 years or so now and I'm making the transition from XC short course to XC marathon racing. This seems to be a great thing for women to do as they get a bit older and the slow twitch fibers seem to be taking over the fast twitch like a slow marching army. My inspiration is Rebecca Rusch. She is an athlete to be worshiped in my opinion and was a late comer to the mountain biking world. That, however, did not stop her from excelling, winning the Leadville trail 100 several times, the 24h mtb world championships, and setting the solo record for the Kokopelli Trail.
After last year's mtb season I burned out. I stopped riding for a couple of months and did other things - running, hiking, curling, etc. This year I'm trying to qualify for the Leadville Trail 100 at the Wilmington 100. This is 100 km of mountain biking to qualify for 100 miles of mountain biking at 10,200 ft of altitude with climbing as high as 3000 feet. I'm scared about my ability to cope with elevation after my recent experience in Canmore when I did not cope with the altitude well. This has re-aligned my thinking on how long I need to be there prior the race to acclimate!
I'm getting my mojo back slowly. I started training again and now I'm slowly gaining momentum. I hope I get enough momentum by June to significantly improve on my Wilmington 100 time. I need to shave off about 30 minutes over 100km. I have 3 months to do it! Let's hope I can pull it together with my call schedules, office politics and dog responsibilities!
One day I went to the humane society just to have a look...
Most days I hope at least once during that day for:
1) the weekend to come faster
2) my patients not to show up
3) to be abducted by aliens away from my workplace
The other day my colleague and I were standing at the back door getting ready to leave on a Thursday and she commented that the next day was Friday and it's almost the weekend. I felt wistful and commented that I wish we didn't wish our lives away waiting for the next weekend to come around. I'm tired of wishing my life away. Does that mean I should change practices, careers, locations? I don't know. Maybe I just need to change my attitude.
And sometimes your day is great because you assisted in the OR all day and had absolutely no responsibility for the outcome. 1 retractor, 2 rectractor, 3 rectractor 4... I might quit my day job and just hang around the OR.
Sometimes the best thing that happens in your day is that your scary psychotic patient doesn't show up.
Why is it that different medical specialties AND doctors within the same medical specialty love to badmouth each other? He is a bad doctor because he didn't do this, she's a bad doctor because she didn't do that, surgery hates medicine, medicine hates surgery, everyone hates family medicine, psychiatrists are crazy. I have been guilty of this myself. But, you know what? We all do our best. We all have 24 hours in a day and spend at least 10 of them working, usually more. We worry about our patients when we go to bed at night, we try to do our best by them because we are responsible for them. Orthopedic surgeons ask you for help because they are busy worrying about the broken hip in the ER that they have to get to the OR and feel unsure about that insulin order, family medicine asks for your help with the Guillaine Barre syndrome because they feel uncomfortable sitting on them until a hospital with a neurologist deems the patient bad enough to take them, the internist, they didn't know the patient's fracture needed reducing when the ER doc had casted it. We all work together, we all need each other, let's pull together and stop bad mouthing each other.
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!
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.
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
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...
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.
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.
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...
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
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.
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.
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!
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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...
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...
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.
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!
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.
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.
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!
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!!!
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!
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.
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 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 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!
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...
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?
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 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.
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 :(
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
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.
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 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.
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 :)
So, some photos of our house...
The outside, we're the right half of the semi.
The open concept kitchen/living room/dining room
we're going to put an island with an eating bar area in to add counter space and fill in the tiled area.
The view from the kitchen.
The master bedroom with view into ensuite and hallway
Giant Bathtub!
A friend kindly gave us a gift certificate to a home store so we can buy a few things to make it feel like we've decorated. We only have our couch and bed that we're determined to keep, everything else can go, so we're looking for decorating ideas!!!
So, buying a house will tell you all sorts of things about your husband that you never knew. For example, that he dislikes light coloured countertops and doesn't like a stone backsplash. Also, that he likes carpet in bedrooms and hates top loading washing machines. That he loves Dyson hoovers and hates California shutters (which I love). That we will have lots of compromises ahead!
Tomorrow is my final day as a resident. ever. The big wide world is looming in the distance and I'm pretty scared. All month I've been thinking that I feel ready to be done, but this past day I've been worried. What if I forgot how to do family medicine in the last 6 months of being an OB/Gyn fellow? I'm going to miss the life of always having an attending around that I can call.
In other news of becoming a grown-up, Ben and I bought a house. So, I officially have no money and won't get any money until the ministry of health pays me sometime in Feb. So, I need to be smart with what remains of my savings. Thank goodness Ben has a steady paying job!
Today is the anniversary of the Montreal Massacre. Let us never forget these women and that they were killed simply for being female.
I survived my first sick baby. Survived but did not excel. It definitely revealed a few things to me that family medicine residency didn't prepare me for - putting lines in babies, reading newborn xrays, intubating babies, taking blood from babies. I praise the neonatal team for their mad skills and being so open to teach and having a skills day in the spring that they encouraged me to attend. I'll be there with bells on.
One of the most obvious things to me about almost not being a resident anymore is that the learning isn't going to stop and the learning curve is going to be very steep depending on where I end up. Biggest lesson learned: ask for help, don't be afraid to call the consultant back several times, stabilize stabilize stabilize and ship.
Finally finished all the paperwork. Just remembered I'm not immune to mumps... I guess I need a booster. I've already been boosted - maybe I just have cell-mediated immunity. How many times will I have to get this immunization?
In other news... there is no other news. These forms have dominated my life for the past few days. I've been procrastinating and now they're finally done! done! done!
Went to look at rental houses today near the new job starting in January. In a total turnaround, we ended up leaving thinking we're going to buy a house and if things don't work out, turn it into a rental property. Hmmm.. how life changes quickly! Did a quick mortgage calculation this evening and we figured out that we would be approved for a ridiculous sum - a sum we could never afford without giving the majority of our monthly income to our home (i.e. no eating). I had a fun fantasy 15 minutes looking at houses that cost that much and then came back down to earth to look at some practical options. Looks like we might be home owners soon! Scary thought!
Wading through paperwork for my new job. Keep picking it up and then putting it down after writing one or two things... really need to finish it tomorrow to get it in. I wish life didn't come with so much paperwork.
There isn't often time when I don't get along with people on the team, but I had an incident with a nurse the other day that really didn't go well. At least it wasn't only me she was horrific to. The other resident I was with was in agreement that she should be in another line of work. In good news, I felt confident in a neonatal resus situation today for the first time ever... and then the baby didn't need anything, figures!
Went climbing today for the first time in over a year. Man, my hands are sore and my forearms are burning. I think I'm going to have to go more often - there were some moves I've definitely done before and have lost. I guess it's like medicine - if you don't use it, you lose it.
I finally got my billing number! Yay! Now I just have to figure out what I need to do for electronic transfer and I'll officially be able to work!
In the finishing months of my fellowship I'm starting to get a bit bored with asking for other people's approval to do things I know how to do. I guess this is a good way to end a fellowship - feeling ready to be in the big bad world as opposed to being scared out of my mind. I'm sure I'll still have a few nail biting moments, but I feel pretty confident that I'm going to be able to deal.
In other news, I'm helping one of my mentors write a book full of his obstetrical knowledge that he's going to use to give to his patients as a teaching tool. Dr M's version of "what to expect when you're expecting". His hope is that he will write this edition and then I will write the next one. I may, however, need to remove his controversial chapter on midwives!
In other news, I've been trying to get to the gym because otherwise I"ll be a depressed mess, but lately I've been getting home from the gym at 10 and have been unable to sleep so get into a cycle of being tired in the a.m. then working late and then going to the gym and then being tired again... argh.
Today I thought about my first (but not the last) patient to die. I was on my peds rotation of clerkship and was on peds ICU... a very small service. One patient. I spent every hour of every day watching the ICP monitor on that patient, hoping that they would make it. I came in one morning after a night off call and the I asked the nurse how the patient is. The nurse said "they're a donor" and I lost it. I think I cried all day. I felt so close to that family and so bad for their loss... I went to the funeral and felt so bad that they appreciated me being there so much. I will never forget that patient.
After reading Table for One I decided to score myself on the Epworth Sleepiness Scale I scored 10 - seek advice from a sleep specialist without delay... The thing is - I've always been proud of my ability to sleep at a moment's notice. I often fall asleep in a boring meeting but never in an interesting one - I just find it to be a filtering mechanism. I've never fallen asleep with a patient but have fallen asleep waiting for a patient to arrive... I like to think of it as an economical use of my time!
I just took my first real job. Now I'm peeing my pants. It's only for 6 months, 4 days a week. With obstetrics - about 3 to 4 deliveries per month. We'll see how it goes!
So, with the prospect of a long term locum on the horizon, of course Ben and I go crazy looking for houses again. We are so desperate to have a real house with real places to put all our stuff that every time we think we're going to move somewhere we go crazy moving into MLS houses in our minds. We have only ever looked at 1 house and I have to say, it looked a lot better in the pictures on-line.
Week 2 of my rotation is going a bit better than week 1 because there aren't 3 learners trying to work with 1 consultant this week. Two seems to work much better when there are two consult rooms and one consultant. I'm trying to push myself this rotation to do more teaching of the medical student. I just hope I don't teach her anything wrong! The consultant I'm working with doesn't really ask a lot of questions so I find myself "pimping" the medical student. Not in a mean way, but I'm used to being taught using the Socratic method and I found it quite effective... I'm trying to embody Socrates.
Just started a new rotation in a small town just outside of the bigish city where I now life. Things I have learned so far:
1) crystal meth is much more prevalent in small town Ontario than I thought
2) I need to re-certify my NRP (neonatal resuscitation). If you don't use it, you definitely lose it. Most of the places where I've trained there are NICU nurses that come to resus. situations and do all the work. Hence, I have lost all skills. These are skills I really think I need to have given that I will probably work somewhere where if they have peds, peds will be on home call. Need to learn how to depend on self.
3) I love delivering babies. I did 2 deliveries this week that were uncomplicated, which my last 10 or so haven't been, this was a real blessing and reminded me how much I love birth and being part of someone's birth experience.
4) Getting a good real job might be harder than I thought. The first place I went and met with didn't seem like a great fit and they already have someone starting and someone filling their locum. I have another interview on Thursday which seems promising. I felt out the HR person in the town where I'm now placed and they have no more waiting list so aren't looking for any doctors at this time. It seems like some places are desperate and others are over-supplied. I think it often has to do with whether the city/town has a residency program and is supportive of new grads - those positions seem like they're in high demand. Plus, if you're a resident coming from there, you're a known quantity and are more likely to be hired. I guess we'll see how things go on Thursday
5) after 2 days of being 30, it doesn't seem so bad. We'll see how being a grown up goes.
I can't think of many people who have changed the world we live in so drastically as Steve Jobs did. Whether you love his products or hate them, he started in a garage selling the first personal computers and revolutionized the way we live. I raise my glass to you Steve, you were taken from the world too soon.
