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!

I feel burned out. I need vacation. I have lost some of my mojo and get up every morning after 8 hours of sleep feeling more tired than when I went to bed.

Today is the anniversary of the Montreal Massacre. Let us never forget these women and that they were killed simply for being female.

Geneviève Bergeron, aged 21;
Hélène Colgan, 23;
Nathalie Croteau, 23;
Barbara Daigneault, 22;
Anne-Marie Edward, 21;
Maud Haviernick, 29;
Barbara Maria Klucznik, 31;
Maryse Leclair, 23;
Annie St.-Arneault, 23;
Michèle Richard, 21;
Maryse Laganière, 25;
Anne-Marie Lemay, 22;
Sonia Pelletier, 28; and
Annie Turcotte, aged 21.

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!

AHHHHHHHHHHHHHHHHHHHHHHHHHHHH. could these forms be any longer?!

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.

I've been studying and practicing for years and I'm sooo ready to have a house and decorate it! I've used apartments to experiment with colours and figure out what I like and now I know... just to find a house to put my stamp on! (Let's hope it's got room for 8 bikes)

Epworth Sleepiness Scale

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!

real job

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!

promise of things to come

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.

new rotation

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.

wishing and hoping...

If I ever win the lottery I'm buying all my clothes from Orla Kiely

I would buy these (all of them):

accomplishment

I am turning 30 in a couple of weeks. Yesterday I did an 8-hour solo mountain bike race to prove to myself that I was young and fit. Yesterday someone died at that mountain bike race. My friend did CPR and was wishing I rode by. Unfortunately, I was someone else out on the course and couldn't help her. He did not survive. Life went on as usual. Nobody stopped (except a couple of the guys who helped with the CPR efforts), the race went on, no announcement was made until the awards ceremony. There was no moment of silence, no cancellation of the race. It felt pretty wrong to be honest. Because I was in the midst of a grueling solo effort, quite honestly it didn't compute at the time. My husband was supporting me at the race and wasn't racing himself and he had a really hard time coming to terms with everything just going on as usual without any acknowledgment that a man's life had just ended in his 50s out on the trail. Nobody knows for sure what happened. They told us all that he had an MI, but it's impossible to know. He died out there in the woods, while we all pursued small plaques.


Stop all the clocks, cut off the telephone,
Prevent the dog from barking with a juicy bone,
Silence the pianos and with muffled drum
Bring out the coffin, let the mourners come.

Let aeroplanes circle moaning overhead
Scribbling on the sky the message He Is Dead,
Put crepe bows round the white necks of the public doves,
Let the traffic policemen wear black cotton gloves.

jobs

I'm starting to look for jobs. The problem is that I'm not sure what I want in a job. I have a couple of requirements:
1) must have OB
2) must not have ER
3) opportunity to do palliative care, preferably inpatient

I would also like:
1) in house peds and OB support
2) other family docs doing OB to share call

is that reasonable?

The weight of the pad

Sometimes your prescription pad feels very very heavy. You don't realize until you're not a resident anymore how many people will casually ask you for scrips who aren't your patients. Nurses at the hospital, family members, neighbors, people ask on behalf of other people. Often it feels like it's something trivial and there's no harm but there's always a voice in the back of my mind telling me that I don't have a chart on this person and I don't have any documentation of what they told me and that I could get in big trouble... Of course I take these things on a case by case basis - is it an emergency? Is it a day or location when they have no access to care otherwise? Do I trust this person to take my advice?

An example - I got a text from a friend while I was at the cottage and she had an infected cat bite. I couldn't see the bite so I sent her to the ER for assessment but she was really pissed that I wouldn't just call in an Rx for antibiotics.

Sometimes people take advantage of you because you're new and young and want to make a good impression i.e. nurses at the hospital. It's a hard line to walk and the pen sometimes feels very heavy.