Heal Thyself...

As soon as I realized I was up the duff*, I booked an appointment with my family doctor.

I had met this man once before. He was older ("I'll probably retire next year"), focused on telling me about his days in residency, and happy that I would see him "as needed".

Cut to January 2014.

I arrive, grey and shivering with nausea. I fill out my paperwork, pee in a cup and wait in the consultation room.
The door opens.
A cheerful, pudgy teen sweeps in the room.

"OMG, sorry I'm sooo late. I'm Dr D and I'm a first year family med resident and I'll be looking after you today!"
"um..."
"So, like, you're pregnant, right? How far along?"
"um..."
"Oh, it's like your first visit! So we don't know for sure. So, like, I'm going to give you some forms to fill out and...Oh! It says here you're a resident!"
 "Yep. Family med. Doing fellowship in ER."
"Whoah! So cool! So, like, maybe you can help me - do I need to order the Rhesus titres today? Or can I leave that for the next visit?"
...
...
...
"Nope. Shut it down."

Consciously, I know I'm being unfair. She's finished medical school, she's a doctor, she can't be 19 and everyone has to learn somewhere.

However.

I was losing weight, unable to work and unable to handle a giggling, baby-talking little sprite who kept congratulating me on a pregnancy that was destroying me.

I've got a new family doctor. An old dude who used to deliver babies, has seen it all, and who knows what blood tests to order in each trimester.

This brings me to my next moral quandary; will I let a resident deliver my baby?
The short answer is no.

The long answer is; I have delivered about 40 babies, under varying circumstances, with varying outcomes. I would not want me or one of my colleagues to deliver my baby.

I want to give birth with someone who has caught 600 babies. Someone who will not think my birth process is, like, so amazing. Someone who will treat it as a run-of-the-mill, un-magical, totally routine experience. That way, if anything unusual happens, they can react to it.

I know, it's not fair to those learners out there, desperate to get their fingers in my cervix. It's hypocritical, considering how many chances I've been given over the years.

But I'm comfortable with it. If I wanted someone to revel in the magic of birth with me, I'd pop the sprog out on Pender.

*Aussie slang is the best. More to come.

Goldfish: 1 Sam: 0

Today is the first day of my medical leave. I am officially too unwell to work.

Little Pickle (the spawn) is feeding me a cocktail of progesterone, estrogen and beta-HCG that somehow conspires to leave me nauseated, lightheaded and dizzy.

I think if I was still in family medicine, I could keep working. The regular, gentle hours, the slower pace and the flexibility of the days would all contribute to a puke-friendly environment.

This is in contrast to, say, ER. Where last night my patient revealed the thick yellow pus coursing from his foreskin, and I had to leave so I could throw up in the bin. His wife chastised me for making him feel bad.

Last weekend I was interviewing a psych patient who was being belligerent. He was yelling at me and the cops and kept saying, "Doc, doc! I just need you to tell me I can have a smoke!" I was trying to reason with him when I felt the dizziness rise. I had to get on the floor with my head between my knees so I didn't pass out. The cops were not happy with me.

Why do I tell these stories of weakness and failure?

Why not mention the awesome catch I made yesterday, when I discovered a hidden skull fracture under a deep laceration? Or tell the hilarious tale of the young woman who hadn't pooped in 11 days? (She's ok. We have stuff for that.)

Because I am riddled with guilt and confusion. I haven't been off work since 2005. I feel as though I have no purpose if I'm not working, or studying, or practicing something to make me a better doctor. So I write down the stories where my body couldn't keep up with demands of work to remind me: I can't do it right now.

Muy depressingo.

I suppose the blog will take a turn from now on. I can't bring myself to commit to the vicious, backstabbing world of mommy-blogs, but maybe I can continue to study and do fun facts and tips. Like managing an aortic dissection! Fun for the whole family!

TTC

You know you're working in a small town when the trauma team is activated for "a Bancroft".

In summer, a Bancroft is an ATV collision. In winter, it's a snowmobile crash. I was trauma team captain on Saturday, and we had a Bancroft of epic proportions. Chest tubes were placed, blood drained from lungs (600mL looks pretty impressive on the floor of the ER), eyeballs pushed back into place. All in all, an exciting and successful night. Nobody died.

That night I also worked an evening shift. (Trauma team sometimes doesn't get called in, so they try to maximize our working hours in a 24hour period.) During this shift, I chatted with the ambos as they brought in patients. You get to know them pretty well during our ride-arounds, and they start to recognize you. "Sam! We've got a Sydenham special for you right here!".

The police are also becoming familiar. This is both wonderful (Sam, I'm just gonna stay in the room cos this guy has already attacked two officers and we heard you're pregnant) and terrible. When I see Officer X, I know there's a troubled psych patient coming in. He has the kindest demeanour and most experience, so they call him out when someone is really frothing.

I don't know what it will be like to come back to a big city hospital. At St Mike's, we had regulars, but no sense of community. Too much turnover between police, paramedics, residents and patients prevents you from building relationships. Yes, you'll see more pathology and more exciting cases, but you may never get the high five from the officer when you convince your patient to take his meds. You won't get the heads up from the ambo that the patient has bedbugs, so you should be wearing a gown. You won't get a page that simply says, "Bancroft ETA 15mins".

I'm gonna miss this place.

Feminism

This Friday, my 99 year old patient was trying to tell me his symptoms and started retching. Instead of my usual response - holding a bowl, rubbing his back, reassuring him - I had to run out of the room and throw up in the nearby eye-wash station.

So, I'm pregnant.

I always envisioned myself as a super-active, unflappable prego. Someone who could get up, drink a kale smoothie, exercise, then work brilliantly all day before coming home to nurture my partner and get a good night's sleep.

Instead, I've been Linda Blair. I have literally, LITERALLY, vomited every day of 2014. I have good days, where I throw up for a few minutes, then settle. I have bad days, where I am crippled by nausea and have to lie still for up to 8 hours.

I've been going to work as much as I can. Luckily, my work is incredibly supportive, but there are only so many times you can run away from a patient holding your mouth and mumbling, "Sorry!"

All my ideas about life, womanhood and feminism have been derailed by a creature the size of a goldfish. I can't work, I need a man to look after me (or someone with a strong stomach and endless patience) and I am delicate and weak, in thrall to my hormones. It has been crushing.

In 2 weeks I start ICU in Peterborough, which promises 14 hour days, 1 in 2 call  and relentless activity. I'm terrified, but the alternative is a leave of absence; conceding that the baby is stronger than me. That my female body makes me unfit to work. I might as well just put my head in the oven now.

I'll keep working. My patients will keep hearing me retch behind curtains. The nurses will keep petting my back while I heave and telling me to take time off. But I'll keep working.

Damn the Man.

Crunch

I am looking after a 19 year old right now. Saturday night he was drinking with buddies and they got all fired up. "Somebody punch me in the face!" he said. "Do it!!" So they did.

He has a broken jaw now.

I met him in the early hours of Sunday morning. He was still pretty intoxicated, his mouth was dripping with blood and he smelled like vomit and Axe body spray. My heart melted.

I gently explained his upcoming operation and gave him drugs so he wouldn't get a hangover. I spoke to his parents on the phone, asking them to give him the benefit of the doubt and be kind to him. I patted his foot as he talked to them.

This kid is getting nothing but scorn from my fellow residents. He asked his friend to hit him and now he's taking up space in our grid-locked hospital, costing the system two thousand dollars a day. He's going to need surgery to correct the jaw, plus about 6 weeks of rehab, tube feeding, ongoing clinic visits and expensive painkillers.

But...I remember being 19. I remember the stupid shit we'd get up to. Throwing shopping carts around, packing 12 people into someone's Mom's volvo and speeding through the night, getting drunk on $4 vodka and vomiting on people's front lawns. The only difference between me and this kid is luck. I did so many stupid things (including drunk fight clubs) and it was only luck that stopped me from ending up in hospital (...ahem. More than I did).

Docs and nurses who are mean to these drunk kids, who refuse them painkillers and fluids, who lecture them when they're injured, surprise me. I suppose there are people who got through med school and university without getting into any trouble. I just didn't met them on my way through.

I like to think that my years of stupid, reckless behaviour give me an edge of compassion. Bring me your drunks, your bottle-lacerations, your huddled pukers. For I am Sam, Patron Saint of Drunk Teenagers. And I'll take care of you...

threshold

Maybe I am getting lazier.
Maybe I am getting weaker.
Maybe I am getting softer.

But:
I am not getting out of bed at 5:30 am to stand around a bed with a bunch of other residents, saying "Um, yeah, I think the wound looks better, but we'll come back at noon with the boss and check..."

Admittedly, I have never been great with early morning. Surgical rotations have always seemed hellish to me, but I could see the point of seeing surgical patients at 6 in the morning. If you have a huge belly wound, and were in pain all night, and we're going to be operating all day, we should see you before we go to theatre.

Plastic surgery, however, is not about big belly wounds.

Rounds on Tuesday were excruciating. We saw 6 patients. It took over an hour (avg # of gen surg patients seen in ward round = 17, in about 30 mins). Because there are only residents in the morning, seeing these patients is useless. We make no decisions, write no orders. We literally wake up these groggy patients to look at their wounds, then say, "We'll be back at noon with the consultant!"

I don't know if it's cos I only have 5 months left.
Maybe I'm drunk with the power of being a senior resident.
All I know is that I haven't been to rounds since Tuesday.
I may not go again this week.
And if they try to make me?
They can't. There is literally nothing they can do to make me.

Ok. I am drunk with power. Never had this realization before. May never go to work again.

PS: Last week I started work at 6am every day - it was ER shifts, so it was a pleasure to get up and go do useful, valuable work. Plastics can burn in hell.

babies for everyone!

I've been threatened with my first lawsuit!!

"J" is a young transgender woman who presented to the emergency department with abdominal pain. She said to me, "My mother wanted a boy, so she fed me hormones as a child. That is why I have an Adam's apple, some facial hair, and sound like a boy."

Ok.
"So, what hormones are you taking, J?"
"NO HORMONES! I'M REALLY A GIRL!"

Ok.
 "Well, tell me about this abdominal pain..."
"Fine. So, I'm pregnant and I want an ultrasound to check on the baby. See, I have this pregnancy test here."
(J is showing me a positive "Clearblue" home pregnancy test. The result has been drawn in with magic marker.)

Ok.
"When was your last period?"
Silence.
"I mean, how pregnant do you think you are?"
"Oh! I'm 17 weeks pregnant!"
I look at her slim build, flat stomach and overall male physique.

Ok.
 "Well, J, I'll just get you to pee in a cup for us here, we'll confirm that you're pregnant, and if that's positive, I'll grab the ultrasound machine!"

At this point J becomes visible angry. She yells.

She tells me I'm a bitch. That I should trust her home pregnancy test and that she refuses to do one in hospital. She tells me that she has a lawyer in Vancouver who will take away my license. She tells me she has a doctor in Toronto who has done a previous ultrasound that shows she's having twins. There is a lot of anger, threats and verbal abuse.

I re-iterate, "You give us a urine sample, if it's positive, I'll do your ultrasound!"

More abuse.

J eventually needs to be escorted from the premises by 4 security guards. She is a big girl. (Such broad shoulders!) As she leaves, she pauses at the physicians desk.

"I hope you don't like your job!! Cos you'll never be a doctor again when I'm done with you!"

I think about this on my way home. Lets say, worst case scenario, that my license was taken away, and that I could never practice medicine again. I have almost NO idea of what I would do for a living.

Seriously. I can't go back to Starbucks. I don't have any real computer or tech skills. I don't have the patience for customer service (when I deal with the public now, I'M always right. Ish.).

I am good at asking people personal questions within minutes of meeting them. And touching them intimately right after that.

I guess I could be a journalist?
Or a prostitute?
I'll keep thinking.