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.

dear back

Dear Back,
Please stop hurting. This 30 minutes of biking then back pain thing is getting old and it's only been a week.

NSAIDS - I love you. kisses.

future plans

It's very hard to plan your future when your spouse keeps applying for jobs in different cities. Maybe I'm destined to locum. I hope I can find a family/OB locum if I need to locum because it would be a shame to lose my skills.

The OB quotient of my fellowship hasn't picked up at all over the last few weeks. My only 2 deliveries were actually with the OB on call because I stayed in the hospital on Friday instead of going to the office. The family medicine part has been good, but I feel a bit like been there done that and having someone still supervise me although I'm fully licensed is a bit annoying. We have a few people due over the next couple of weeks so hopefully things will pick up!

Some people have anxiety when they're over worked, but honestly I'm made anxious by under-working. I've tried to use my time wisely but often end up sleeping too much and learning too little. I'm planning a few conferences over the next month to try and up the learning factor.

over training or under stretching

I am suffering from either biceps femoris tendonitis or IT band syndrome. I have odd bruising and pain at my fibular head and aching on the lateral knee precipitated it seems by road riding more than mtbing but lately all riding brings it on. I realized today with my foam roller that my IT band is very tender along its length but my hammies are also tight. Looks like I need to do some major stretching and foam rollering. Good thing I have a supply of topical NSAIDs and ice packs.

Jack Layton

Dear Jack,
I was so sad to hear of your passing today. You were a fighter both personally and politically and have inspired a whole new generation to embrace the socialist agenda. Your accomplishments are many, most notably turning the Canadian conservative political scene on its head during the last election. I sincerely hope that you death does not derail the plans you have for Canada, as I think your vision is of a better country for us all.

I hope you did not suffer and that you went gently into the night. I offer my condolences to your family and hope that they had time to tell you how much they loved you. Canada is far worse off without you.

anxiety

I was a very socially awkward child and if there's something that makes you have, it's social anxiety has an adult. Not so much being anxious about social situations in general, but being anxious about people liking you. It makes you work probably harder than you should to make and maintain friendships and it makes you worry that people don't like you. It makes you lie awake in bed at night analyzing social situations from the day before and wondering if you did/said something wrong. I wonder if this ever goes away.

breast feeding

Today I convinced a woman to give breast feeding another try when she didn't get adequate support in hospital. I am so glad I took that breast feeding elective!

podium!

Well, I guess all that extra mountain biking paid off because I came third in my race this weekend! First ever podium since being in the beginner category!

zzzzzzzzzzzz

My new preceptor just told me to view my next two month rotation as a summer vacation... not exactly what I'm looking for. This is my "family medicine OB" experience. Unfortunately, he only has 4 people due this month. He does 10 deliveries per month on average but it seems this month is slow. We'll see how this goes. I guess I have lots of time to read and mountain bike!

The Grand Tour

The Tour De France is over and FINALLY Cadel Evans has won. I have bet on him many times in the past and this year I've finally been rewarded. This year is supposedly the cleanest year in tour history. Read about it here. I almost cried watching him standing on the podium listening to the Australian national anthem. I think it was a good thing that he didn't win yellow until the last day as that jersey seemed to weight him down in the past rather than give him wings. I'm so happy for him.

Yesterday I did a tag-team 8 hour mountain bike race in temperatures over 30 degrees and humidity over 40%. Many people were pulled from the race with heat stroke. After 5 laps each, my partner and I had to bow out - her with stomach issues and me with leg cramps. It was still a fun day of riding my bike!