My first family practice patient to die passed away yesterday. She has been in palliative care for quite some time and I really met her at the end of her life. I wish I could have cured her. I wish I could have made dying even easier, I wish I could have predicted the day she would die so her family could have had more peace. I wish I had the perfect words to say to the husband she leaves behind.
I'm debating going to a weekly race series in town here. I would be going alone because husband isn't here during the week and I basically wouldn't know anybody. But, it would be an opportunity to meet people and mountain bike during the week instead of only rode riding. Bad news - I wouldn't get any more work done than I am now (um.. zero).
The first race is tomorrow. What to do!?!
I'm starting ENT on Thursday. Something I admit I know very little about. Anyone got a good ENT resource for primary care?
The bike computer is found! It was in a box of granola bars we'd taken to the last race. Hoorah!
This weekend was the first o-cup race in Mansfield Ontario. It also marked my first sport category mountain bike race, which would have been much better if a girl hadn't fallen on me right at the start causing me a penalty of about 30 seconds to a minute as she couldn't get up. Anyway, I did ok (6 of 9) for my first one and learned some valuable lessons - I should eat before I start. I should try to drink something at some point on the course (point to be determined for next race). I should hold back a little on the first lap for the second. I should shoot the guy who adjusted my gears after replacing my drive train last week because I dropped my chain several times.
In other news, I spent a lot of the weekend worrying about a patient of mine who has just gone into hospital. She had bad back pain and he has cancer and then later she started having abdo pain and throwing up and I convinced her to go to the ER. When she came to our office with back pain I checked her for compression fractures and there were none and his symptoms seemed mechanical, but our usual pain meds weren't helping. I was lying in bed last night thinking, maybe she has kidney stones. I hope they do a CT on her. I'm not sure why I didn't think stones in the first place - I can't remember the exact character of the pain off the top of my head but she had been seen by two of my colleagues the week earlier and diagnosed with mechanical back pain and the pain started around the time that she was doing some heavy lifting to take care of a sick child. I wonder about diagnosis momentum. This is one of the biggest errors I've noticed in my practice so far. I need to go back to first principles when someone comes to me and they're not getting better. A valuable lesson.
I spent the weekend feeling so good and now I feel so bad. The husband is away in Mexico on a work thing and he's going to be there all week. No phone calls because of the expense and his work won't cover it. Just emails. No snuggles. I miss him.
I lost my bike computer and it sucks. I got all ready to go out on a bike ride today and then couldn't find it and realized how messy our house is. I'm not sure I could find anything in here. So... took off the bike clothes and started cleaning. Still haven't found the computer.
I really need some vacation. I feel really burned out. I have a week off in May and then 2 weeks in June. I'm ready for them now.
Big day tomorrow. Big race - Paris to Ancaster. I did it last year and suffered really badly. This year I'm gonna kick it's ass.
Yesterday I attended a memorial service for everyone who has died in our palliative care and cancer care units over the past year.
One of the staff physicians gave a speech and talked about how patients ask her how she goes to work every day and deals with death and dying over and over. She said something that resonates greatly with me - the greatest burden we carry is yesterday. Very apt for a time in my life when I have many regrets on a daily basis and fears about performing badly and disappointing my patients.
We all carry a bit of the sorrows of the past with us and the memorial service is an opportunity for us also to cleanse our souls clean and move on. It reminds us that people's lives go on after their loved one dies and they leave our doors and ours will too.
One missed diagnosis and BAM, one of my good friends and colleagues is partially blind in one eye.
4 weeks of intermittent one sided headaches that aren't relieved by the usual migraine medication. History of cluster headaches but never with this odd "Vaseline vision" in one eye.
Saw them in the cafeteria - mid fixed and dilated pupil. Took them to emerg to be seen. Expedited their entry but couldn't stay with them because I had clinic. Found out later they'd discharged with meds and a diagnosis of cluster headache.
The doc didn't look at the eye - dismissed it.
2 days later a 6 am. phonecall - "I think I've got acute angle closure glaucoma" - a sleepy drive to emerg. Thank god for a smart medical professional self-diagnosing on google.
We are all relieved when we miss and it makes no difference - but how do we deal with the one we missed that resulted in a bad outcome? I am as guilty as they are - I saw the pupil in the cafeteria and I tested the reactivity and misdiagnosed it myself - all those ophtho lectures in med school didn't sink in. I will never miss a case of this. I will never miss a case of the thing I missed a month ago - but what about all those other things I've never seen?
I'm struggling with the responsibility that comes with my profession.
I was angry because I got my schedule for June (emerg) and I had been scheduled for several shifts during my vacation... which was booked several months ago. Along with the schedule came a note asking if I could change my vacation to suit the emerg department. The Husband and I have spent quite a bit of money on plane tickets, rental car, bike boxes, etc. for this trip and some of those things are non-refundable. The good thing is that my program director is supporting me in still taking the portion of my planned vacation that I'm spending away (I took 2 weeks but I'm only away for a week of it). The bad thing is that without the emerg shifts during that week, I might not have enough shifts to complete my rotation. Fortunately, my program director is going to help me navigate this tricky situation.
So, more to come on this at a later date.
Ah... this "false spring" that we're having is amazing! 2 days in a row of outdoor riding and saying a (if only temporary) goodbye to the rollers and staring at the wall. I even bumped up my average a little from yesterday to today. Plus! I found a type of bike food that I like!
I tried the cliff shot blocks and hated them (too salty and they hurt my teeth and they were too big for my mouth) and then I hit the holy grail - Gu Chomps! Cranberry apple flavour - very good. I'm still holding out to try the jelly belly sport beans (they were out when I went and bought my variety of things to try) and Luna chews. I'm definitely not into the gels and tablets. yucky texture.
I'm on ortho/rheumatology now and I really have very little to say about it. It's fine but I'm not sure I"ll miss it when I'm done. The people are super nice so that's a bonus.
Watching Elvis Stojko today on TV makes me laugh. If he was competing in today's system he would have never won because he can only jump and can't skate in between. He doesn't understand that pushing the envelope can include more difficult footwork and spins and doing your jumps in the second half because it's mentally more tiring and you risk falling on non-jump elements. One jump doesn't make a sport. It's just like any other sport - a perfect 960 can beat a scrappy 1140 that loses you all your speed.
Overall Plushenko's jumps weren't great, he wasn't in a good position in the air, his toes basically came through his skates to save a few. He stood around and posed on the ice in the last minute of the program and didn't do any jumps at the end of the program. His choreography sucked and he hardly moved on the ice at all during his footwork. The quad alone doesn't win the olympics.
There are some things you just can't look up. There are some scenarios that just aren't in "up to date" or your pediatrics textbook.
I had a friend call me today about a case and she was afraid to talk to the consultant in the hospital because they are slightly disgruntled that we are taking care of our own newborns. Hmmm... what to do? Especially if our direct family practice supervisor is away for the day. Conflict doesn't bode well for patient care.
I have olympic fever. Or, more accurately, olympic tears, joy and bliss. I have already cried on the highway, honked my horn like a maniac on the highway and stayed up WAAAAY too late watching olympics on tv.
My childhood friend Mercedes is competing in half-pipe today and I have my fingers crossed 10 or 12 times. GO CANADA!!!
Will someone please let me know if they fix google reader so you can read password protected sites?
One of the physios at the arthritis program today me yesterday that it took her two years to really be confident about her examination and findings. Good thing because I am not confident in my joint count AT ALL at this stage. Oh well. The rheumatologist will check all my findings but I just find this skill elusive.
Today I have to go sit in a lecture theater and hear all about practice management. Good thing I'm already sleepy. Should be easy to snooze through it.
