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.

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 worst...my old doctor cared, he prescribed me valium and dilaudid...he was a good doctor...you'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?

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.

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.

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.