Ok,
I have a new thing I don't like about medicine: dictating!
I wish I could just sit down and type notes on patients and give them to a secretary to mail away instead of having to dictate them. I hate dictating. I forget what I said, I miss things, and you can't really practically go through and listen to a whole dictation for completeness. I have dictated about12 cases since starting ambulatory peds on Monday and I have no idea how I'm doing. 9 of them were today. I managed to do them all in about an hour, which I'm pretty proud of because I'm usually a very slow dictator. Unlike Hitler. (ok... bad pun)

I also hate coming home from a long day just to start studying. Argh. And, our oral exam that was supposed to be on July 8th has now been moved to July 4th, which means I have one less weekend to study for it, and, I'm on call this weekend. Argh!

PICU

So,
I just finished a 3 week stint in the Pediatric ICU. It was one of the most emotionally taxing and stressful 3 weeks of my life. I had my first pediatric patient die, my first patient funeral, my first death summary. I've had adult patients die before, but it just wasn't the same. At all. I'm moving on to ambulatory peds and I'm excited about it.

I'm on call tonight and hoping for good call karma. Last call I had on peds ward was a steady all-night affair. Apparently Mondays tend to be bad because everyone has been resisting coming in over the weekend. Hopefully that applies to the day moreso than the evening. I'm glad I've chosen a specialty that doesn't involve a lot of call and can be scaled back to no call when I'm old and grey.

In other news, Ben is leaving me for 3 weeks to go home and visit his family. I'm joining him for a week 3 weeks from now and I"m pretty excited about it. We have a packed itinerary already that involves climbing a monroe, going to sheep dog trials, high tea, and many other things I forget.

I think we're caught up now!

Why is life so hard sometimes?

So, the things I need in a family medicine residency program are as follows:
1) be able to live with Ben
2) community and rural experience
3) time spent in centers that do not have specialty residents
4) time off to go to my own wedding
5) mountain biking
6) snowboarding

Things Ben needs in a residency program:
1) being able to live with me
2) being able to get a job as a foreign-trained engineer
3) mountain biking
4) snowboarding

Now we have to decide where we want to go.... We talked tonight about taking these two years and using them as an opportunity to take an adventure and go somewhere interesting before settling down for life and families and stuff. Even if we're not sure about babies and stuff yet. I came to realize that I'm ok with that. If he wants to go somewhere fun for 2 years, I'm fine with that. It's two years, I have lived in a foreign country for a year and I'm sure I could do more if I'm with Ben. Now we just have to decide where... before CaRMS

The ring!

Wedding and pediatrics

So, we booked our wedding venue today! We went with the smaller venue that Ben and I really liked. It was funny, we found out that one of the weekends we were considering was booked and we both got sad... I guess that was our litmus test. So, we will be getting married on September 12th, 2009. My bridesmaids/men will be my sister, brother and cousin and Ben will have his two sisters and his best man. He hasn't asked him yet, so I'm not going to mention it here just in case I let the cat out of the bag. Anyhoo, I'm excited to get this part of the planning done and upwards and onwards to trying on wedding dresses!

Pediatrics so far has been good. I was on call for the NICU last night and did a few well-baby exams and other than that there wasn't much to do. Didn't get called for any deliveries and had bad dreams all night about my pager malfunctioning... Haven't heard that I missed anything so I guess it was working. PICU is interesting. We have one patient who is critically ill and one patient who lives in the hospital full time and has for the past 3 years since his birth. The critically ill patient has been a huge learning experience about brain injury. This review supplement to pediatric critical care has really helped me understand what is going on.

The case is taking a big emotional toll on me. I feel very attached to this patient and the patient's family who are just the nicest people. I'm crossing my fingers and toes for this kid.

Wedding plans

Ben and I went to look at wedding venues yesterday. We found somewhere we like, but it has a 70 person limit. This means that our guest list is going to be limited to people we really want to be there. Which introduces a conundrum: how to invite someone without a date. There are people I would like to invite to our wedding who do not have a steady partner, thus, I would want to invite them without a date so they will be there, without a stranger. How do I do that?

How many people will I see die alone in my career. Some by choice, some because they have isolated themselves before they got sick from friends and family, and some because those they call to come to their side don't come.

Mrs. Potts was a lady who was given a diagnosis of cancer along with the promise of curative chemotherapy. Her husband was dead and she only had one friend who she really talked to in this world. Her family was estranged from her and she didn't have any children. When she came into the ICU she had recently been given one chemo treatment - the treatment was killing her. She had no idea it was that bad, and she only had 5 days to come to terms with it before she died. With only strangers with her.

Dear Medstudentitis:

I am writing to congratulate you on receiving the CFPC Medical Student Scholarship. Your application was very impressive as were the letters of reference. You should know that you were highly regarded by the committee and referees who felt you have tremendous potential to contribute not only as a family physician but as a leader for that discipline. I wish you all the best in your continuing studies.

Dean of important medicinal things

Yay!!!! I got the scholarship! I'm soooo stoked! I'm going to use some of the money to go to Amy's wedding!

Another Monday, another drug company sponsored dinner... last month the talk was about smoking cessation, this time about hypertension. The person talked for WAY too long and I kind of tuned out, but the food was good. After my two glasses of wine I felt bombed, maybe I should stick to one next time. I also consumed a lot of water, which was good. I like drug company dinners, mostly because I come out of it forgetting what they talked about and remembering whether the food was good. I was, however, more motivated to talk about smoking cessation with my patients over the last few weeks. I did not push the product that was being talked about though.

I have been tagged for a 7 songs you like meme by Milk and Two Sugars and Xavier, so, here we go:
1. Waiting on the World To Change - John Mayer
2. New Shoes - Paolo Nutini
3. Little Plastic Castle - Ani Difranco
4. Diagnosis - The Weakerthans
5. Anchorless - Propagandhi
6. Ruby Soho - Rancid
7. Fall Down With You - Paperboys

I've been listening to a lot of my old punk albums while riding my bike lately, hence the propagandhi and rancid on the list. "Fall Down with You" is Ben and my song, will be the first to dance to at our wedding. Paolo Nutini is from Glasgow (Paisley to be exact) and that song is one of my favorite dancing in the living room songs, as is Waiting for the World to Change.

How did I get to this age and still have zits? I have BOTH zits and wrinkles! This is so cruel!

Today is Ben's birthday - Happy Birthday Lover! Unfortunately, I am not in the same city as him to celebrate it :( We did have a nice weekend at the cottage with my family. Ben was somewhat grumpy, but I didn't catch his grumpiness until Monday, so I tried to keep the spirits up on the weekend! The weather worked against us, what a bum weekend for a holiday!

I'm on another week of resp... not as bad as I thought... maybe.

Bike racing - O-cup #2

This weekend was the second O-cup race of the year. I almost beat the girl who came second last week. She passed me at the end stretch and beat me by 7 seconds. 7 seconds! I managed to overtake her on the course and then maintain my lead, but then I fell into the bushes and took a while to extract myself and she caught up to me in the last km. I managed to stay in front but she had more legs left in the end than I did. I came 4th and she came 3rd. The same girl won as last week... she's too good for the beginner category! Young and spry she is, old and tired I am! There was a new girl who wasn't there last week who came second. I'm going to miss the next race because it's pretty far away and Ben and I aren't inclined to travel that far. So, in 3 weeks is the next one and I'm gonna be ready for this lady! The course this week was really technical and I surprised myself by being able to ride almost the ENTIRE THING on my first lap. I only got off once and that was to go over this uphill group of 4 logs and I just didn't think I could do the step up. I want to go back now and ride that step-up!

I felt like crap today. I started my week on the respirology consult service and I've been overwhelmed with acronyms that I don't know the meaning of. My homework tonight is to read about the "pneumoconioses" - I hope that's the same as interstitial lung disease because there's nothing about pneumoconioses in my text book!

Anyhoo, I saw someone with Churg-Strauss vasculitis today, which is neat.

Two of my patients from last week died over the weekend. Heartbreakingly sad. I'm kind of glad I wasn't there to witness it, at least this way I can kind of kid myself into thinking it never happened.

I looked SO COOL today. Like, seriously. I went out for my bike ride in my knee warmers, MEC dark grey/blue baggies, castelli jersey, grey nike bubble knit zip up, pink bandana and snot green helmet. I felt like a million bucks... Then I face planted into a tree and got pine sap in my eyebrows. I'm not any worse for wear now though. No facial scratches (thank god, gotta protect the money maker), just a scratch on the shin which is a whole load of nothing. Today I met people on the trails for the first time since I've been biking in this particular park which has some really nice singletrack in it. I'm in active "training" for my race this weekend (this means trying to ride 3 times this week and pushing it a bit harder). I hope I manage not to come last... it felt nice to not come last last time!

We're not going to camp this time. It's mothers day this weekend so we're going to have dinner with my fabby fabulous mimsy on Saturday night and then drive up to the race on Sunday morning. Of course, because I need to know what I'm getting into, we're also pre-riding on Saturday. Please join with me in a prayer that it will not rain on Sunday morning.

Elden over at Fat Cyclist is having a hard time... His wife Susan is dying. Please join with me in sending positive thoughts their way.

idiot

Why am I such a fucking idiot? I feel so stupid every day that I'm in internal medicine. Ugh. I sit there and i'm asked questions and I just am SO BLANK. I used to be smart, what happened? Maybe I should go into obs/gyn, it's the only thing I've actually felt intelligent at.

lost motivation

Last week when the weather was nice I went biking every day. I couldn't wait to go outside and get my bike on. Today and yesterday the weather has been cold and yesterday it was wet. Now I have lost my motivation to ride. I have many excuses, including that I only have shorts, no tights. Though, I haven't gone to the gym to work out inside either... I'm a bum.

Burned popcorn and mountain bike races

Why oh why can't I make microwave popcorn at my apartment without it burning? It just burned within 60 seconds! And, all the popcorn wasn't finished!

In other news, this weekend I did my very first mountain bike race. It was the 1st Ontario Cup cross country race of the year and it was really good. I came third, finished the 15 km in 1:12:05, which would have been reduced if I hadn't been slowed down at the end of the course by this girl who hated descending, but hey, she motivated me to push hard on some of the uphills. I'm glad I didn't do the "try an o-cup" class, which Ben did. It was badly planned with a start time along with the older male class which i can't remember the name of, but suffice it to say it was a bunch of guys who looked like George Hincapie with shaved legs who were pretty serious racers. This lead to some difficult race dynamics for the slower racers and to a result where nearly half of the contestants in the "try an o-cup" didn't finish the race due to minimum lap times (which weren't enforced... but they asked people to pull themselves out of the race voluntarily so many people did). Anyhoo, Ben didn't have much fun and will be doing the beginner cat with me next time.

UBC has screwed me for electives. So, now I'm scrambling to find a CCFP (family doc) to take me for 2 weeks in the summer. I know one person and we've emailed back and forth, but I haven't heard from her for a week and I need to have something set up soon. I never know how long to wait for someone to get back to me.

I just started my core internal medicine today. I'm in the ICU in Peterborough. It's interesting so far and kind of scary. I'm really not cut out for internal - which makes it really super intimidating. I've heard that the exam is really brutal for this block. It's one of the American NBME subject exams. I think a few people have failed it already this year. Apparently everything is in american units and you have to convert them during the test. I've heard that there's a pretest book that you can buy, which I will be going out and purchasing before the exam. Studying starts tonight.

I have found some really cool singletrack to ride in the area of my apartment here. I'm planning on racing next weekend so it's imperative that I get in some riding this week. I also have to go back to the town where my university house is and pick up my racing stuff - bummer because it's 200 km away. Good thing there's no call in this rotation!

Waiting for the world to change

Well, I'm waiting for Ben to get home from a late day of work. We were supposed to go for dinner this evening at our favorite pub, but I think that's destined to be usurped by an installation at Ben's work. Anyhoo, maybe I'll talk a bit about Kash.

My trip to Kashechewan was interesting. When I got there we drove through the reserve and all of the burned down houses and dilapidated buildings were pointed out to me. There has been a rash of fires this year in Kash and considering that the average number of people is over 10 per 3 bedroom house (I can't remember the actual number, I think it's around 15), the loss of any housing is felt hard by the community. There are houses that people are living in with boarded up windows and tarps instead of doors. There are children who have been burned by water from stoves where there were just so many people in the house everyone else thought that someone was watching the kids. There are people who are now working at the diamond mine that has started up the coast, but they are on for 2 week shifts and are away from home, leaving their kids with relatives or teenagers to fend for themselves. The cost of employment is leaving one's family.

I got to go to a coroner's case in a neighboring reserve. Riding in the back of a NAPS (police) Ford F150 along the ice road was quite an adventure... the back seat is a wooden box that is quite hard on the bum! It was a sad case of a person who was physically and mentally ill in the community and the community supports just weren't there to keep them afloat - they fell through the cracks of the system.

The kids in Kash were very cute. The first language taught to children there is Cree, which is really neat to see. Otitis media seemed to be the illness of the week, really bad OM with perforations and draining puss. We also did some drug and alcohol and grief counseling while we were there. It really became apparent to me that the drug and alcohol problems are very intertwined with the lack of community supports for the grief and depression that are rampant in the community. There has been a lot of loss and a lot of frustration with the inaction of the government. Although there have been many people killed in fires, there is no fire engine. There are many teen suicides that affect close families profoundly. People don't really talk to each other about these tragedies in the community unless they are drunk - which leads to a perpetuating cycle of depression and drinking. A new tradition of talking needs to be established.

Really, solutions for this community need to come from within. Many of them, I think, start with empowering the members of the band to make changes, be home owners, and be proud of who they are an their ideas.

Hectic

These past two weeks things have been quite hectic. I came home from Moose to start an elective at McMaster - 1 week of general obs/gyne and 2 weeks of maternal fetal medicine. The week of general obs/gyne was fantastic. I recommend anyone who is doing medical electives in Ontario to request a general obs/gyne elective in Brantford through McMaster. I just started MFM yesterday. The good thing is that I'm working with two really cool docs and I'm the only student in their clinic. The bad thing is that there are many many medical students on the ward and in L and D. I wanted to do some call while I'm here, but feel like I'm stepping on the new clerks' toes if I do (they just started on Monday doing their core obs/gyne rotation). The clerk who's on call on Thursday when my preceptor is on call really wants obs/gyne and I don't want to steal any deliveries from her. Maybe I should just stick to clinics.

Anyhoo. I'll write more about my trip to Kash later. Ben and I are going for a walk outside in the wonderful sunshine. Oh, and, the stones are coming in for me to choose my center stone for my engagement ring! I almost have it!