Monday, October 3, 2016

Taking Care

One of my colleagues, Rebecca, came by last week and I think she could tell that things were a bit rocky. She took a look at my schedule and pointed out that I was working 17 days in a row without a day off. And that needed to change.

She was not wrong!

So she urged me to talk to our physician scheduler and ask for some clinic time off and to see if I could get rid of some of my ER shifts. I didn't know I could do that! She texted me on Monday and asked if I had talked to the scheduler yet. I hadn't had a chance. Then I get a sticky note on my desk from the scheduler saying to come talk to her when I have a chance.

Did Rebecca tell you to talk to me?

Sideline glance, non-committal mumble.

Riiiiiight. Okay.

So we did some tweaking and now I have a few afternoons off, and I took the last 3 days of October off. I still have 15 days in a row of surgical call but, that's the way the cookie crumbles when there is only one other GP-Surgeon in town for the time being.

I started using this app called Headspace. It's a mindfulness app. I know, it's an oxymoron to put those words together, really. But I have found it very useful and have been trying to do 10 minutes of guided meditation (or mindfulness or whatever you want to call it) daily. It's not an airy, breathy woman chanting about crystals. It's a dude talking about observing your thoughts in a very straightforward and concrete way.

Hopefully between the little pockets of protected time off, the commitment to spending some time clearing my head, writing, and scurrying around the forest with the pooch, things will start to look up and become more manageable. No one tells you how to take care of yourself. No one else cares if you disintegrate into tiny drooling shell of a person who watches Price Is Right reruns all day. So I'll start with these baby steps.

Tuesday, September 27, 2016

Reality Bites

Well, the shiny gloss of being an attending certainly didn't last long.

I have a new reference point for the expression "being thrown in the deep end of the pool" now. These days I feel like all I'm doing is inhaling water and pathetically thrashing around. 

I can remember rolling my eyes so many times in the past when being dragged through a long-winded seemingly redundant orientation at a new job. I would kiss the feet of someone who would orient me now.

No name tag, no hospital badge to get into the hospital. What are the codes to get into the change room, the back door of the clinic, to photocopy something? What forms do I need to fill out to book a surgery and then where do I put them? Who does the bookings? Do I need to book an anesthetist?

Where are the prescription pads? Where do I send my invoices, my day sheets, my O.R slips? What is my dictation code, do we have an ultrasound tech in the hospital, is there a pharmacy open on Sunday and when do I get paid? What times are the hospitalists on call until, do you routinely collect cord blood, what is an order set, where are the order sets? How do I empanel a patient, send a task, get an old chart?

Just a small sample of the myriad of questions I am trying to sort out while trying to actually care for patients. The cleaning staff are wiping around me an my desk every night. I make so many notes to self during the day; read up on post-kidney transplant surveillance, monitoring polymyositis, review guidelines for Barrett's esophagitis recall, post neonatal resus stabilization...remind myself how to interpret blood gases, put on casts, do fundoscopy, thrombolytics, a lumbar puncture.

But then I get home, nauseated and sweaty. Just so happy to get out of my microbe infested hospital or clinic clothing. I eat and think, "I should read up on those things now, I should work out, I should empty the dishwasher" but instead I find myself crawling into bed. Not caring that my feet probably have dried amniotic fluid on them.

And then a new day comes.

Or it doesn't. Instead the phone rings at 3am and I am driving back to the hospital for another delivery. This time the mom is fine but the baby is not fine. And I spend the next few hours talking to family members who have gone silent with fear and waking up neonatologists who are sleeping hundreds of kilometers away.

Then the night morphs into day and I am the hospitalist for the medical ward and my conversations shift to managing INR results and incontinence and wound vac dressings. A palliative patient, who I haven't met until that day has family there and they want to speak to the doctor about what is happening. My morning becomes afternoon and my lunch becomes the family meeting where I try my hardest to remember all the insightful and beautiful things that Atul Gawande talks about in Being Mortal and I try to remember to do more listening than talking.

So I leave the family meeting and fly into the clinic where on arrival my MOA throws up her hands at all the paperwork I am sending her and tells me it's not working. I duck into the first patient who wants a narcotic refill and disability form filled out and when I press him for details on the background of these requests he tells me...

you doctors are the worst...I was told how terrible the doctors are in this town, they don't care about anyone at all, even if you're dying...the old doctor cared, he prescribed me valium and dilaudid...he was a good're a terrible doctor

And I can't help but feel the exhaustion from the night before crash over me. I can't stop the rising flush in my neck and my quickening pulse.

Where are the disability forms?

Sunday, September 18, 2016

False Summit

I finished my first stretch of call as an attending. Ten days of surgery coverage, two days of obs coverage mixed in there with a few ER shifts, consult clinic days, assisting, and scoping. Lots of "firsts" over the past 10 days.

I did my first middle of the night cesarean as an attending. No one there to tell me to cut higher or wider. No one there saying "it's safe to divide the omentum there" or showing me "the bladder is right there". It was just me standing there with sweat soaking through my bra and my socks.

The call came in around 3am, waking me and my husband up. I threw my pile of getting called back to the hospital clothes on. Duncan sleepily asked me what I was going in for.

Possible section. 

Good luck hon. 

Driving to the hospital I tried to breathe but it wasn't easy. I tried to remember the words of encouragement my attendings had given me over the last few years. Of course the only voices that easily came through were the words of doubt, the criticisms I've received. The houses along the way were quiet and dark as I rolled past, a contrast to my thoughts.

Later, when I got home. I was too wired to sleep. It was around five am. The edges of night were falling away and the morning bird songs had begun. I wasn't ready for bed but I went to our bedroom. I knew that Duncan would have had fragmented sleep after I left. I creaked open the door and he turned over.

How did it go?

It went well. It wasn't easy. I was terrified.  

I couldn't get back to sleep, I kept drifting in and out, wondering what time it was, hoping you'd be home soon.

I'm going to watch TV for a bit, I can't sleep yet. 

Thanks for coming in to tell me everything went OK, congrats. 

The big sleepy and warm hug was perfect. I went to the livingroom and put on Jim Gaffigan's newest stand up.

I thought that things would get easier when I finished residency. I thought that residency was really stressful because you were always having to do things the way other people wanted. You are always having to bend your preferences, practices, and schedule to the whim of your attendings. I had many days last year when I thought that being a resident would break me. I thought the stress and sleep deprivation was reaching the edges of sanity.

Like most things in life if I could go back I would do things much differently, and I'd chill the fuck out a bit too. The transition to becoming an attending has felt like taking off a 60lb backpack at the end of a hike, only to be handed a 100lb one while being told you have another 50 miles to walk. If only I'd known what was coming next.

Sunday, August 28, 2016

Is this thing on...?

I wasn't sure if I still had a blog. I tried to log on from Switzerland and it wasn't working so I was a little concerned.

I finished residency (or rather, all my residencies) at the end of June.

This whole blog, which was meant to document my journey from nurse to doctor has technically come to an end. I am now a fully fledged GP-Surgeon. Want me to explain what that means? Do you have half an hour and half a bottle of wine?

It was a horrific year. Not like a horrific year compared to 70% of the world's population, I know. But, with respect to medical training, residency, life: horrific. I crawled and cried my way to the finish line. Then I worked basically 19 days straight and went on vay cay at the end of July. Sort of a holiday / honeymoon / end of residency party.

It was amazing.

It was an eating melted cheese in Switzerland, hiking in the Alps, drinking Champagne more nights than not sort of endeavor. I got to be a tourist, waking up to the mountains in France one day and then to freshly made scones and clotted cream at one of the finest hotels in London, the next. I had a 37th birthday that was OFF THE HOOK.

Now I am visiting family in BC and soon heading back to officially start my job as an attending-rural-medicine-GP-surgeon-ninja next week.

I am terrified and in debt. And I have so many stories, so many moments from the last year that roll around in my head. I don't even know how to start taking them off the shelf. I don't know if anyone even reads this blog anymore, but I promise, I promise to start writing again now that the dust is settling and a new story is starting.

The morning of my last call shift as a resident.

Thursday, January 7, 2016

Sweaty Scapulas

I am finally half-way through my last year of residency. It has been the hardest year of training, without question. It is difficult to finish one residency feeling somewhat competent and able (Family Medicine) and begin a new residency where every day you just feel like a completely inept moron (Enhanced Surgical Skills). Stack on to that the sleep deprivation, increased debt, crippling self doubt, and sore muscles. It all makes me ask "why am I doing this to myself" on a daily basis.

I was finishing a cesarean section last July and I said to my attending afterward, "I've never actually felt sweat dripping off my scapula before". She just smiled and said, "welcome to surgery". And she was right.

I've seen and done things this year that I haven't even begun to process. I'd love to write about these experiences but I am constantly mindful of confidentiality, not that I have the time anyway. I miss writing. I miss looking back on my perspective on events, being reminded of things I'd completely forgotten about.

A good friend of mine recently published a very...very...brave piece about her life in Iqaluit many years ago. It is so beautiful and raw and brilliantly written. It made me wish I could be a writer and tell the stories we face, and the people we become as a result of being trained in the medical machine.

Maybe that will be my New Years resolution. Just to start writing again. Even if it is only for me.

Thursday, July 23, 2015


That feeling.

When your feet are finally at the level of your heart. Your blood is returned without having to fight gravity. You feel the throb deep in your heels, the heaviness in your bones. There is a thin film of sweat covering your body but you don't care. All you care about is the fact that you are no longer standing, reaching, bending, pulling, straining, and concentrating. This moment, bliss. You're not breathing in your own carbon dioxide or trying to see through your fogged eye protection.

You are finally horizontal. The scenes from the day intrusively play themselves out behind your eyelids but you don't care because you are still, silent, and free.

For a few hours.

Tuesday, July 21, 2015

Dr. Albinoblackbear, CCFP.

Hello Ye Dedicated Readers of My Blog.

I keep thinking about shutting the blog down but then I realized, I can't do it before I finish residency! There are so many unfinished, undocumented, unknown endings in health care, I hate to add this blog to the list of "remember that guy...what ever happened to him?" narratives.

Well nothing has really happened yet. It's all still happening.

I wrote the CCFP / LMCC 2 at the end of April and early May. I finished off my residency in a lovely little community where I had the opportunity to do some ER, some obs, some endoscopy, some surgery. They were a fantastic group of docs who offered me work there when I was done and I was so wishing I could say yes.

Seeing my cohort getting their offices together, planning European vacations, talking about paying down debt, I can't help but ask myself, "what was I thinking signing up for another year of residency?!?!"

To make matters worse, Duncan got a job in BC and is moving back there uhhhh tomorrow.  The job opportunity for him came a few months after I had accepted the PGY3 year training spot. So here I sit, watching him pack up and get ready to move back to my favorite place on earth, and I wonder, "what in the deluded hell was I thinking signing up for another year of residency?!?!"

So yeah. I have another year of training and two more years return of service here before I'll be able to join my husband-to-be-who-will-be-my-husband-by-then in BC. Until then, it'll be a looooooooooooong distance thing, I guess. Good old medicine. It isn't a train you can really get off if the destination starts to look less inviting.

I get a lot of emails from people who come across the blog. They ask me if they should apply for medicine or how to go about doing so. I think no one wants to really hear the real story. I feel like people want a Facebook version of events: big emotional moments where you save the day and feel validated, you steal an hour of two of sleep in call rooms with freshly laundered sheets then drive home in the morning, exhausted yet buoyed by the knowledge you made a difference. Really, it is just a lot of sacrifices and a lot of (mostly scut) work.

I started medical school when I was 30. I am not going to be done my training/return of service until I am 39. That is not an insignificant amount of time to hand-over in exchange for a new career. Putting on hold the place I want to live, a hold on having a family, a hold on traveling adventures, spending time with the people I value.

Many nurses have asked me "was it worth it?" to which I usually reply "ask me in 10 years". I really can't tell yet. I'm still too in it. Now I'm in horrific debt and have a lot more stress than when I was an RN. There were things I loved about nursing and things I hated about it, the same goes for residency. It's not better (yet) that is for sure. 

Monday, March 9, 2015

My Current Theme

My current theme appears to be death. Not that I am thinking so much about my own eventual demise, more about the process and ritual around death and dying. I seem to be stumbling across a lot of articles, books, and podcasts theses days about mortality and I've been so fascinated and appalled and intrigued by it all. Thought I would share a few, in case any of you are interested.

CBC has a great radio show called, Ideas, which recently ran a 3 part series called, "Death Becomes Us". Wow. Spent three evenings walking in the hilly, drizzly Irish mist listening to those. Very captivating and eye-opening. Who knew the origins of embalming? Who knew about death midwives? Who knew people buy concrete blocks to go around coffins? Woodland burial sites? I certainly was ignorant on all of these fronts. I found the whole series quite good, but I think episode 3 was my favorite. Of course the whole thing led to a panicked call to Duncan regarding changes to my death and dying wishes! I think he's become enured to these sorts of phone calls, no longer worried something is actual wrong with me, just that I've read something or watched a TED talk which has caused these addendums.

I also recently finished, "Being Mortal" by Atul Gawande. He's just such a legendary author, I instantly read everything of his that I can track down. Some of the discussions and concepts highlighted in Being Mortal have already changed my fledgling practice. If you want to hear him speak on these matters he also did the Reith Lectures on BBC recently.

And, a smattering of op-eds, old articles and new, and the shifting landscape in Canadian medicine as we face the potential changes to physician assisted suicide. Death is all around us in health care. It's easy to focus on the potassium levels, the next chemo drug, the ventilator settings. The real effort for me is pulling back and looking at all of these aspects of dying in a bigger sense, and including myself in the picture.

Tuesday, February 10, 2015

When Will I Be Good?

I really need to just start writing again, it's starting to make me crazy. I know I've said this on the blog before (maybe I need to go back and start reading old posts again) but the best advice/word of warning I received on this journey was "make sure you like the person you become at the end of your training".

Well, I haven't become a maniacal, self-important, egotistical, jerk. Yet. But I have let so many parts of who I am, fall away. I've definitely stopped being a somewhat multidimensional human. I hardly read (for enjoyment) anymore, I don't play music, I don't train physically like I used to. I've basically stopped doing yoga, writing, traveling. I know this is just a residency-routine-rut but it's frightening sometimes to see hobbies and loves that I once had just gradually fade into the distance, and not even (really) notice. I still am excited about medicine, about learning, about getting better, safer, wiser. But I keep coming back to somehow wanting to make sure I do indeed like the person I am becoming. Right now, it's iffy.

There are good things happening too. Very exciting times, even.

Duncan and I got engaged just a couple of weeks ago!

I got the surgical/obsetrics training spot for next year!

I am temporarily back in Ireland for some surgical training with M.C. It's fantastic being back here.
The thing is, because I am now moving towards my surgery and obstetrics training, I feel like I am back at the drawing board. I feel clumsy and hopeless again as a learner. My knots, my draping, my grasping. The simplest things you see surgeons do, then suddenly you're doing it and dammitiwatchedthisa1000timeswhycantidothis basically runs on repeat in your head. It makes me wonder when I will be good? Will I ever be good? Then I try to remember that I am on a much different path and that I will have to forge some of it myself, instead of constantly worrying about my exact endpoint.

So I will close on this perfect Rumi poem. For now. Evidently "Shams" was Rumi's living mentor. Thus, this poem struck very close to home when I read it this week, as my legs are, indeed, feeling heavy. 
Unfold your own myth

Who gets up early to discover the moment light begins?
Who finds us here circling, bewildered, like atoms?
Who, like Jacob blind with grief and age,
smells the shirt of his lost son
and can see again?
Who lets a bucket down and brings up
a flowing prophet? Or like Moses goes for fire
and finds what burns inside the sunrise?

Jesus slips into a house to escape enemies,
and opens the door to the other world.
Solomon cuts open a fish, and there's a gold ring.
Omar storms in to kill the prophet
and leaves with blessings.

But don't be satisfied with stories, how things
have gone with others. Unfold
your own myth, so everyone will understand
the passage, We have opened you.

Start walking toward Shams. Your legs will get heavy
and tired. Then comes a moment of feeling
the wings you've grown, lifting.
View from a hill, on my Sunday walk.

Sunday, November 16, 2014


I felt a lot of genuine support and was buoyed by the reader comments after my last post. Been thinking a lot about the different things people said. I received some emails that also echoed the comments in the "thank you for being real" vein.

I think I'm feeling a little overwhelmed by the "is that really your life?" emotion when I flick to FB and see an endless stream of perfectly manicured children, lawns, engagement photos, work achievements, and exercise updates.  I look down at the jeans I've been wearing to and from work for the last three days, the stacks of review books I should be pouring over to study, and the pile of t.v dinners I've gone through over the past week for sustenance and I think, "Where am I going wrong here??"

And I don't want to use FB or my blog as a permanent venting space but I think there is a distressing lack of REALNESS in the world these days. We're not supposed to admit that we're scared, or unfulfilled or unhappy. And we are certainly not allowed to admit to failure, mistakes, bad decisions, or regrets.

There are a lot of people out there who I wouldn't want to disclose my shortcomings to, or my sadness to. But many of my blog readers are on a similar path and probably think they are alone. And to those people I want to say, "No, you are not alone.".

I had a beautiful, challenging week. I was up early and in bed late. I was able to sneak in a couple of bike rides on my wind trainer, and eat a couple of meals before 10 pm. But mostly, I was at the hospital with a full bladder and an empty stomach. I picked up a devastating diagnosis on a fit and rugged man, and held up a fresh, slippery, crying baby while grandad took photos on his SLR. I missed my boyfriend and my own bed. I bought a lottery ticket once again hoping magic would erase my student debt, freeing me to chose if medicine was still what I wanted to do instead of had to do now.

But there is no choice now but to carry on. As Winston Churchill famously said, "If you're going through hell, keep going."