I am in my pajamas, on my couch in Toronto. Despite this, I am counting today as the first day of my ER fellowship. I have been watching videos of rapid diagnostic ultrasound all morning, preparing for our crash course next week. I have been letting the first flickers of excitement sneak past my wall of apprehensions.
Now that Family Medicine is over, (passed, attained, whatever) I do feel some regret about moving on. There were patients that cried when I told them I was leaving. Colleagues who I will miss. A lifestyle of 9-5, Monday to Friday that I got comfortable with. ER will be more challenging, with no room for error, terrible hours and less flexibility. I know this, but I am still getting excited.
I am hoping that the ER fellowship will give me lots to write about; the people who choose to work ER tend to have strong personalities, and the patients are generally bat-shit crazy. I will also be teaching residents and medical students, which has great potential for hilarity. (First win: I will be supervising my grade 9 ex-boyfriend, the most misogynistic man on the planet. I will be his boss during August. I will carry the memory of his realization face through the rest of my life.) I will also be working weird hours, alone a lot of the time, and attempting to study huge amounts of material in a small amount of time. There is a strong possibility that my husband will leave me.
All this is just to say; I will be blogging more in the future. I look forward to it.
Finally, whenever I am leaving a city, ending a program or just making a life change, I always seem to get nostalgic for the past. If you have any desire to sit down and hash out the when, why and how of the past, now's the time to do it. I've got lots of room on the couch.
Friday, June 28, 2013
Thursday, June 6, 2013
Kokomo...
Late at night, lying in a single bed and listening to frogs chirping outside your window, you might start to relax. You can feel your sunburn radiating into the cool cotton sheets. Aching muscles remind you that you chased a pack, or flock, or rumble?... of goslings around the lake in the canoe. You stretch out, settling into a deep and untroubled sleep. Big picture happiness.
Medicine is a permanent hierarchy. Regardless of how far you've come, you will always be looking up to someone, looking down on someone else.
Friends of mine have mocked my choices; Australia, family medicine, the non-academic path. These same friends come to me now with sunken eyes and pale complexions. They need to know that their sacrifice is worth it, so they try to convince me they're having more fun than me. They talk about the work they're doing; seeing interesting cases, learning interesting medicine.
Their girlfriends ask me, "How can I get him to do what you're doing? I never see him". The answer is easy, but very hard for those who need the hierarchy to maintain their sense of self.
In family medicine, the work is not glamorous. You see the same patients. You say the same things over and over again.
- It's a virus, you don't need antibiotics.
- It's gonorrhea, you need antibiotics.
- You have got to start eating right and exercising.
- You have got to lose some weight.
Your patients will tell you you're stupid. They will counter your every suggestion with WebMD printouts. They will book an appointment to have you fill out their tax exemption forms, then shout at you when their application is denied. They will threaten to sue you whenever they're unhappy, and ignore you when you do things right. You have to be able to let go of your ego and try to see the big picture.
My big picture involves working reasonable hours for reasonable money. I need to feel that I've made a positive difference in at least one person's life every day. I need time to exercise, to cook (a political action now, according to Michael Pollan) and to wrap myself around my giant man. I need time to read for pleasure. I need time for Pender.
Family Medicine gives you big picture happiness. Emergency medicine will be icing (or gravy) on top. I used to feel defensive when I talked to my Internal Medicine colleagues. Now I look at them with sympathy and say, "When you're ready to let go, come find me".
Medicine is a permanent hierarchy. Regardless of how far you've come, you will always be looking up to someone, looking down on someone else.
Friends of mine have mocked my choices; Australia, family medicine, the non-academic path. These same friends come to me now with sunken eyes and pale complexions. They need to know that their sacrifice is worth it, so they try to convince me they're having more fun than me. They talk about the work they're doing; seeing interesting cases, learning interesting medicine.
Their girlfriends ask me, "How can I get him to do what you're doing? I never see him". The answer is easy, but very hard for those who need the hierarchy to maintain their sense of self.
In family medicine, the work is not glamorous. You see the same patients. You say the same things over and over again.
- It's a virus, you don't need antibiotics.
- It's gonorrhea, you need antibiotics.
- You have got to start eating right and exercising.
- You have got to lose some weight.
Your patients will tell you you're stupid. They will counter your every suggestion with WebMD printouts. They will book an appointment to have you fill out their tax exemption forms, then shout at you when their application is denied. They will threaten to sue you whenever they're unhappy, and ignore you when you do things right. You have to be able to let go of your ego and try to see the big picture.
My big picture involves working reasonable hours for reasonable money. I need to feel that I've made a positive difference in at least one person's life every day. I need time to exercise, to cook (a political action now, according to Michael Pollan) and to wrap myself around my giant man. I need time to read for pleasure. I need time for Pender.
Family Medicine gives you big picture happiness. Emergency medicine will be icing (or gravy) on top. I used to feel defensive when I talked to my Internal Medicine colleagues. Now I look at them with sympathy and say, "When you're ready to let go, come find me".
Sunday, March 17, 2013
Palliation
I have been having panic attacks.
There are a few all-consuming things going on in life right now; licensing/certification exams, life-long commitments, fellowships, new homes & cities. In short, it is totally reasonable that I have been waking up at 3am with the taste of fear in my mouth. My couch and I have developed a meaningful relationship; watching the sun come up together can do that.
However, I am lucky to be working on a Palliative Care unit this month. I am looking after people in the last days of their lives and this is giving me some much-needed perspective.
First, let me say that, yes - the cliches are true. In Palliative Care, you get way more out of it than the patients do. There is the scientific aspect; learning to manage pain, dyspnea, agitation & end-of-life delerium. There is the compassionate aspect; you provide counselling and reassurance to people at a vulnerable time in their lives. There is the immediate reward of working shorter hours with fewer patients and less paperwork. Plus, every day is cake day on the PCU.
The darker side is the sense of relief I feel. At the end of the day, I can walk out the doors of the hospital and go home. I am not dying. I am young and strong and I have made choices that have lead me to a really happy time in my life.
So, frankly, I benefit a lot more than the patients.
I'm still glad I'm going to do ER training, but I could definitely see including palliative care into my practice. After all, the cake is delicious & moist and makes you glad to be alive.
There are a few all-consuming things going on in life right now; licensing/certification exams, life-long commitments, fellowships, new homes & cities. In short, it is totally reasonable that I have been waking up at 3am with the taste of fear in my mouth. My couch and I have developed a meaningful relationship; watching the sun come up together can do that.
However, I am lucky to be working on a Palliative Care unit this month. I am looking after people in the last days of their lives and this is giving me some much-needed perspective.
First, let me say that, yes - the cliches are true. In Palliative Care, you get way more out of it than the patients do. There is the scientific aspect; learning to manage pain, dyspnea, agitation & end-of-life delerium. There is the compassionate aspect; you provide counselling and reassurance to people at a vulnerable time in their lives. There is the immediate reward of working shorter hours with fewer patients and less paperwork. Plus, every day is cake day on the PCU.
The darker side is the sense of relief I feel. At the end of the day, I can walk out the doors of the hospital and go home. I am not dying. I am young and strong and I have made choices that have lead me to a really happy time in my life.
So, frankly, I benefit a lot more than the patients.
I'm still glad I'm going to do ER training, but I could definitely see including palliative care into my practice. After all, the cake is delicious & moist and makes you glad to be alive.
Tuesday, January 15, 2013
Calling
I knew I was going to be a doctor from childhood.
I had the cheesy moments of "yes" - being 14 at summer camp and cleaning up another camper's shredded foot while my counsellor dry-heaved behind me. The prickle of excitement when learning the layers of anatomy. The internal laser-focus and external calm when faced with a crisis.
There was a lot of opposition from the universe. I was rejected from Canadian medical schools coast to coast, told to reapply "once I had my Masters", told to consider nursing, midwifery, to go back to Starbucks.
I moved to Australia and struggled through physical homesickness, depression and a boyfriend who told me "Doctors are the worst people - they're just scientists who want to make money..."
I still wanted to do it. Rather, I didn't want to do it, but felt compelled.
Medical school was a constant flood of deferred gratification and unnatural behaviours. I kept saying I wanted to quit, but I knew I had to finish.
I graduated from medical school in 2009. At graduation, I walked across the stage after hearing my name impressively mispronounced. I spotted my family in the audience, waving, and I grinned like an idiot. I had finally done what I needed to do.
I write this as I am about to hurl myself into another year of delayed happiness and self-selected turmoil. I am moving to Kingston to finish the training required of ER physicians. It's already affecting my relationship and my life choices for the worse. I am, once again, choosing my job over family, friends, love and happy life. I feel that I have to.
When I start a shift in ER, everything else goes away. I don't remember the fight with my partner, my Mum in hospital or my empty stomach. For better or worse, my focus is total. I can only think about the job in front of me. At the end of the shift, it all floods back and I become human again, but during the shift, I am the job. A vessel in scrubs.
If I had a choice, I think I would stop this July, be a family doctor and go about the quiet business of a comfortable life. But I can't. I'm so close, but I'm not where I need to be yet, so I keep going.
Maybe my ex was right; my Doctor life choices make me the worst kind of person, putting the job before all else. I can't stop though, so I might as well keep going.
Just keep swimming.
I had the cheesy moments of "yes" - being 14 at summer camp and cleaning up another camper's shredded foot while my counsellor dry-heaved behind me. The prickle of excitement when learning the layers of anatomy. The internal laser-focus and external calm when faced with a crisis.
There was a lot of opposition from the universe. I was rejected from Canadian medical schools coast to coast, told to reapply "once I had my Masters", told to consider nursing, midwifery, to go back to Starbucks.
I moved to Australia and struggled through physical homesickness, depression and a boyfriend who told me "Doctors are the worst people - they're just scientists who want to make money..."
I still wanted to do it. Rather, I didn't want to do it, but felt compelled.
Medical school was a constant flood of deferred gratification and unnatural behaviours. I kept saying I wanted to quit, but I knew I had to finish.
I graduated from medical school in 2009. At graduation, I walked across the stage after hearing my name impressively mispronounced. I spotted my family in the audience, waving, and I grinned like an idiot. I had finally done what I needed to do.
I write this as I am about to hurl myself into another year of delayed happiness and self-selected turmoil. I am moving to Kingston to finish the training required of ER physicians. It's already affecting my relationship and my life choices for the worse. I am, once again, choosing my job over family, friends, love and happy life. I feel that I have to.
When I start a shift in ER, everything else goes away. I don't remember the fight with my partner, my Mum in hospital or my empty stomach. For better or worse, my focus is total. I can only think about the job in front of me. At the end of the shift, it all floods back and I become human again, but during the shift, I am the job. A vessel in scrubs.
If I had a choice, I think I would stop this July, be a family doctor and go about the quiet business of a comfortable life. But I can't. I'm so close, but I'm not where I need to be yet, so I keep going.
Maybe my ex was right; my Doctor life choices make me the worst kind of person, putting the job before all else. I can't stop though, so I might as well keep going.
Just keep swimming.
Monday, December 10, 2012
interaction
Let me slide needles into your flesh. Let me put my hands on your skin. Let me press into your aches and pains and ask you if it hurts. Let me slice into you with knives and scissors.
Tell me about your pain. Let me ask you about your secrets, your addictions, the last time you bled or shat or felt this way. Tell me about your family. Answer honestly.
I see about 20 patients during a 10 hour night shift in ER. I usually meet them with a resigned expression; I'm tired, the last patient was a dick, something smells bad, and I could really use a coffee. And then I violate them. I ask them questions I wouldn't ask my partner. I touch them in places I wouldn't touch my own child.
Most of the time, I try to be pleasant and positive; patients are less likely to make your night hell if you communicate well and explain what you're doing. But sometimes, at 3am, you dissociate from yourself and think, "Jesus. I just met you, and this is crazy. But here's my ID, now let me stab you..."
Carly Rae Jepsen may be on the radio during this moment.
Night shifts are done for 2012. The next challenges are working ER during New Years, then going to work with the Orthopods in fracture clinic. And what to do with oneself during a Monday off in cold, rainy Toronto.
Tell me about your pain. Let me ask you about your secrets, your addictions, the last time you bled or shat or felt this way. Tell me about your family. Answer honestly.
I see about 20 patients during a 10 hour night shift in ER. I usually meet them with a resigned expression; I'm tired, the last patient was a dick, something smells bad, and I could really use a coffee. And then I violate them. I ask them questions I wouldn't ask my partner. I touch them in places I wouldn't touch my own child.
Most of the time, I try to be pleasant and positive; patients are less likely to make your night hell if you communicate well and explain what you're doing. But sometimes, at 3am, you dissociate from yourself and think, "Jesus. I just met you, and this is crazy. But here's my ID, now let me stab you..."
Carly Rae Jepsen may be on the radio during this moment.
Night shifts are done for 2012. The next challenges are working ER during New Years, then going to work with the Orthopods in fracture clinic. And what to do with oneself during a Monday off in cold, rainy Toronto.
Friday, November 23, 2012
Regrets...
I have been trying to calculate out the cost of being a doctor in Canada.
In Australia, it was fairly straightforward; the cost of medical school, plus living expenses, for 4.5 years. You apply for jobs, get interviewed, and get hired by a hospital. You get paid a salary for your work at the hospital. It is less than a full "Staff" salary, because they assume you will be taking time for learning and education, but you make a living wage for the hours you work.
In Canada, you have to pay to apply for jobs. It costs about 200 bucks to THINK about applying, then, for every school you send a letter to, they charge you another 50-80 dollars. If you get interviews, add transportation costs and accommodation to the bill.
Once interviews are done, you rank the universities from one to ten, or six, or x. Then you wait.
On a specific day, you log in to your account and see what school has picked you. You only get one offer. If you are offered the position, you are legally required to take it. Boom. Five years of your life are set in stone, all through luck of the draw. I did this, and got sent to U of T for my family med program. Yes, it was my first choice, but I don't know that I'd make it twice.
So, back to my interviews. I now know that I want further training in Emergency Medicine so I saddled up for the CaRM's rodeo once again; application fee, individual university application fees, rental car, flights, hotels in Kingston, Ottawa & St Johns. I figure, all in, I'll have spent about $2000 by the time this process is up.
People keep telling me the cost is an investment in my future. And sure, if I get the job, it will all have been worth it. But the ER match is not guaranteed. They interview 40 candidates for 4 places in Ottawa. The odds aren't much better anywhere else.
An investment is where you put your money into a holding pattern, hoping that it will increase in value over time. 1/10 odds sound more like gambling.
Frankly, there are a lot of other things I could do with $2000. Things that don't require me to explain my best qualities to a panel of bored and cranky interviewers.
O Australia. How I miss you.
In Australia, it was fairly straightforward; the cost of medical school, plus living expenses, for 4.5 years. You apply for jobs, get interviewed, and get hired by a hospital. You get paid a salary for your work at the hospital. It is less than a full "Staff" salary, because they assume you will be taking time for learning and education, but you make a living wage for the hours you work.
In Canada, you have to pay to apply for jobs. It costs about 200 bucks to THINK about applying, then, for every school you send a letter to, they charge you another 50-80 dollars. If you get interviews, add transportation costs and accommodation to the bill.
Once interviews are done, you rank the universities from one to ten, or six, or x. Then you wait.
On a specific day, you log in to your account and see what school has picked you. You only get one offer. If you are offered the position, you are legally required to take it. Boom. Five years of your life are set in stone, all through luck of the draw. I did this, and got sent to U of T for my family med program. Yes, it was my first choice, but I don't know that I'd make it twice.
So, back to my interviews. I now know that I want further training in Emergency Medicine so I saddled up for the CaRM's rodeo once again; application fee, individual university application fees, rental car, flights, hotels in Kingston, Ottawa & St Johns. I figure, all in, I'll have spent about $2000 by the time this process is up.
People keep telling me the cost is an investment in my future. And sure, if I get the job, it will all have been worth it. But the ER match is not guaranteed. They interview 40 candidates for 4 places in Ottawa. The odds aren't much better anywhere else.
An investment is where you put your money into a holding pattern, hoping that it will increase in value over time. 1/10 odds sound more like gambling.
Frankly, there are a lot of other things I could do with $2000. Things that don't require me to explain my best qualities to a panel of bored and cranky interviewers.
O Australia. How I miss you.
Tuesday, October 2, 2012
boredom
The nights are dark and still and cold now. In the morning, frost clings to the grass. I leave a trail of footprints on the nature strip and track dew into the clinic. Nature provides a symphony of sensory delights in gorgeous Kincardine.
I am so bored.
The surgeon has moved out of the Locum House, taking away the element of chaos. Say what you will about ego & man... every house needs a force of nature who comes home and says "We're going to play volleyball now".
I am getting lots of sleep. Exercising for at least an hour a day. Cooking balanced and elaborate meals. Painting my toenails. Finishing my assignments early. Preparing for my exams in May.
I keep volunteering to work more in ER, but my boss feels I should work in clinic with him. Clinic is a good learning experience. Clinic is orderly and structured. Clinic is deadly boring...
When you apply for your Rural Rotation, you can choose to do 2 months back to back or seperate them out. They suggest that you double up, "to get the true rural live-work experience". I have been here for 5.3 weeks. I have such bad cabin fever that I considered getting drunk tonight as a means to kill time.
I am living the true rural experience.
I am so bored.
The surgeon has moved out of the Locum House, taking away the element of chaos. Say what you will about ego & man... every house needs a force of nature who comes home and says "We're going to play volleyball now".
I am getting lots of sleep. Exercising for at least an hour a day. Cooking balanced and elaborate meals. Painting my toenails. Finishing my assignments early. Preparing for my exams in May.
I keep volunteering to work more in ER, but my boss feels I should work in clinic with him. Clinic is a good learning experience. Clinic is orderly and structured. Clinic is deadly boring...
When you apply for your Rural Rotation, you can choose to do 2 months back to back or seperate them out. They suggest that you double up, "to get the true rural live-work experience". I have been here for 5.3 weeks. I have such bad cabin fever that I considered getting drunk tonight as a means to kill time.
I am living the true rural experience.
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